Welcome to PACA - Professionals Against Child Abuse

Children are the most vulnerable members of society. Sometimes the very people who are expected to protect them place them at risk. It is then that professionals who work with children have a duty to protect them. PACA believes that vulnerable children need dedicated paediatricians, nurses, social workers, teachers and the law to protect them. PACA was formed in response to high profile cases against paediatricians at the General Medical Council at which it became clear that the present regulatory systems did not protect children and were open to abuse by those who sought to discredit professionals who stood up publicly for children's rights. PACA advocates for children's rights by campaigning for regulatory organisations to be trained in child protection, for the interests of the child to be paramount, and for professionals who stand up for children to receive fair treatment.

PACA letter published in the Lancet on the outcome of the Southall appeal

The outcome of the Southall appeal was astonishing. Read PACA’s letter published in the Lancet.

Lancet PACA letter (PDF)

Dr David Southall appeal result, another disaster for children.

Following the erasure of Dr David Southall from the GMC medical register.

PACA is saddened to learn that David Southall’s appeal in the High Court
today was unsuccessful in overturning the decision of the GMC’s Fitness to
Practise Committee to erase him from the medical register in December 2007.

The GMC have held three Fitness to Practise Hearings against David Southall:
in 2004, 2006-7 and in 2008. Only in the 2007 Hearing did the outcome lead
to a permanent restriction on David Southall’s ability to practise medicine.
PACA believes the GMC have acted inappropriately and have been improperly
influenced by a skilful and hostile media campaign by parents involved in
alleged child protection cases and their advocates. PACA is now concerned
that today’s result will have further serious and negative effects on the
willingness with which doctors will engage in child protection.

Internationally acclaimed and eminent paediatricians involved in child
protection have sustained repeated harassment in recent years, including
from the GMC. PACA considers that the GMC preliminary assessment procedures
have been ignorant of the nature of child protection procedures in the
Family Courts and that this case should never have been brought against
David Southall; that he has always given honestly held opinions, based on
extensive experience in complex child protection cases and solely with the
purpose of protecting children has never been questioned.

The disciplinary actions of the GMC, today supported by the High Court, will
be a further deterrent to paediatricians and other health professionals from
engagement in child protection work. Last year, the Royal College of
Paediatrics and Child Health voted overwhelmingly to express their grave
concerns about the GMC’s actions in the cases of both Professor Meadow and
David Southall. PACA considers today’s action will be a disservice to
children. The GMC should act only to encourage doctors to report child
protection concerns and engage in child protection work, by making them feel
safe from disciplinary actions, unless the doctor has been shown to have
acted incompetently or with malice.

We will provide full comment when we have read the full judgement.

[Update - the full judgement can be read here: Final_Southall_22_05_09.pdf (236 kb)]

PACA Press Release - Letter in the British Medical Journal - “The GMC’s Procedures and their enactment, in reference to Professor Southall’s hearing.”

Once again PACA is concerned to find information about the actions of the GMC in the case of a highly respected paediatrician involved in child protection work that shows a failure to follow natural justice and due process in their disciplinary procedures.

Dr Leonard Williams, who is a member of PACA, was asked to give evidence at a review fitness to practice hearing about Professor Southall at the GMC in 2008. His pre-hearing instructions were that he should accept the findings of the 2004 panel, and debate whether the sanctions imposed upon Professor Southall should be lifted. As such there was no need to read Professor Southall’s original report. In his written evidence, he accepted and reiterated the criticisms of the 2004 panel but argued that it was right, with the passage of time, to lift those sanction. However while giving oral evidence; he was questioned about the merits of the 2004 hearing.

Shortly after giving his evidence, Dr Williams was sent information which convinced him that some of the statements that he had made about the actions of Professor Southall in the Clark case had been incorrect. As required by the GMC’s own advice to expert witnesses, he was required to make this clear in writing to the panel/judge and he attempted to do this by writing to Professor Southall’s defence team, instructing that his letter be shown to the panel. An objection was raised to the entry of this letter and the legal assessor who works for the GMC advised that the panel should not see Dr Williams’ letter.

We find this decision almost unbelievable and once again reveals injustice meted out to Professor Southall. The result was that the GMC Panel criticised some of Professor Southall’s actions based on incorrect expert data. The media picked up the criticisms and ran with those rather than the main findings, which were that Professor Southall had been correct in contacting the child protection team following his viewing of a television programme that to him raised concerns about the safety of a child and a possible miscarriage of justice resulting in a mother being imprisoned. The GMC Panel also determined that the concerns he had raised about a nosebleed in a 6 week old baby 10 days before that baby was, according to the Criminal Court, suffocated, were not only appropriate but also supplemented by new research that had been published since his hearing before the GMC in 2004. The adverse reports in the media were also compounded by an article in the British Medical Journal which made strong reference to the criticisms. (NEWS: Southall is allowed to return to child protection work. Dyer BMJ 2008; 337: a1811)

One important consequence of this relates to Professor Southall’s imminent appeal in the High Court against the actions of the GMC in 2006-2007. The incorrect criticisms of some of Professor Southall’s report, produced for a pre-trial liaison meeting for the Family Court, may have impaired his Appeal if it wasn’t for the integrity of Dr Williams, who has made public the failure of the GMC to address his incorrect expert evidence.

Download this Press Release

Download the Letter

Read the Letter online on the BMJ website

PACA Press Release - Vexatious Complaints, the GMC agree with PACA

Press Release - 10/02/2009

The GMC Fitness to Practise Committee has now acknowledged shortcomings, pointed out by PACA, in GMC procedures relating to complaints involving child protection. Following a Freedom of Information request, PACA has now discovered that the GMC plans to change its procedures.

The GMC acknowledged that they currently have no power to deal with serial or patently vexatious complainants, and that this may create unfairness for individual doctors who are either the specific target of a vexatious complainant or the random target of a serial complainant. Such circumstances are well recognised in Child Protection work, where some perpetrators of child abuse try and avoid responsibility for their actions by criticising the professionals involved.
The GMC has commented ‘the current rules do not provide us with the flexibility to deal as effectively as we would like with serial complaints or complaints that are clearly vexatious. Although such complaints are relatively uncommon, they can be very resource intensive and are unfair to doctors.’ At a meeting of the Fitness to Practice Committee in November 2008, GMC members agreed to pursue a change to their rules to allow them to reject serial or patently vexatious complaints.

A PACA spokesperson said ‘We are extremely pleased that the GMC has responded constructively to our reasoned arguments about the particular circumstances of complaints in Child Protection. Whilst we are in general highly supportive of the work of the GMC in maintaining professional standards to promote patient safety, we feel that the needs of children for protection were previously being overlooked. ‘

Doctors involved in this work may find themselves caught between the interests of parents and children, and may find themselves the subject of complaint by aggrieved parents who have been implicated in child abuse. As we see from the tragedy of cases like Victoria Climbie and others since, if children are to be properly protected, then professionals must be able to voice and act on reasonably held concerns without fear of being accused of malpractice. This GMC decision is a major step forward and we applaud them for it. ‘
Further information and comment is available from PACA via

http://www.paca.org.uk

Downloadable version of the press release (PDF)

Vexatious Complaints, the GMC agree with PACA - Article

PACA has been drawing attention for a long time to the GMC’s lack of a vexatious complaints policy. Vexatious complaints have been a serious problem for Health Professionals trying to safeguard children. For this reason as well as sending, out this press release, three PACA members have written a paper for publication in the Archives of Diseases of Childhood on A Way To Restore British Paediatricians’ Engagement With Child Protection Arch. Dis. Child. 2009 : adc.2008.154997v1

Here is the link:
http://adc.bmj.com/cgi/rapidpdf/adc.2008.154997v1

The after-effects of Baby P - External Article by Heather Payne

This is not the first reasoned comment published by OnMedica about safeguarding children. This one concerns the baby P case. We need to see clearly amidst all the tabloid encouraged anger.

Read the article online here
Download PDF here

PACA Comment: Laming terms of reference

We think the Laming terms of ref. give PACA adequate scope to contribute to his review. We still do not have an address for his review but note that the ministers letter says he will provide all necessary resources. We have sent our submission to the DCSF expecting them to forward it…

Terms of ref. of Laming Baby P review 17.11.08.pdf

haringey statement update12.11.08.pages.pdf

Documents on the reassessment of abuse process

The ongoing deaths of young children as a result of abuse should signal the fact that the current system of investigation and care still has shortcomings. Perhaps the processes of classifying abuse and the investigation of abuse need reflection. These two papers might help with a reassessment of the process.

Paper on types of abuse.pdf

Police lead child protection BMJ 2003.pdf

Doctors sentenced over boy’s death

External Article by Jonathan Gornall

[Article first published in The National]

Doctors.jpgLawyers confer during the murder trial of a five-year-old French boy. Dennis Charlet
It was a tragically familiar story: a child tortured and battered to death by the adults who should have been caring for him.

What was different about the death of Marc, a five-year-old French boy whose short life ended in a blizzard of punches in Jan 2006, was that the doctors who failed to spot the serial abuse were held to account alongside the stepfather who delivered the blows.

Last week, a court in the French town of Douai sentenced eight people for their part in the death. David da Costa, 38, who punched Marc in the head until he suffered a cerebral hemorrhage, was jailed for life. Isabelle Gosselin, 35, the child’s mother, received 30 years; three other relatives and a childminder were given suspended sentences.
The postmortem revealed Marc had suffered a series of assaults and injuries, including cigarette burns, broken ribs and a fractured pelvis, but two doctors who saw the boy before his death accepted his mother’s explanation that he was self-harming. Christian Tirloy and Michel Vellemans were found guilty of failing to help a person in danger, fined and given three-year suspended prison sentences.
“These sentences are a warning to French society, professionals who work with children, the medical community and politicians to stop keeping silent and to understand the duty of reporting child abuse to the authorities,” said Catherine Bonnet, a French child psychiatrist who in the ’90s became the target of a group campaigning on behalf of accused parents.

In 1998, she was accused of making false allegations of child abuse against parents and banned from practising for three years.

“The pendulum has swung too far and professionals have been condemned for detecting, reporting and preventing child abuse.”

In 2002, Ms Bonnet’s case was taken up by the UN special rapporteur on child exploitation, who urged the French Medical Board to “review its procedures in order to support rather than condemn doctors who report their suspicions of child abuse”.
The French case has resonated among medical professionals in the UK, where for the past decade campaigners have been waging a media war against doctors who work in child protection. Paediatricians are also fighting a running battle with their regulatory body to defend their right to report suspected cases of abuse without fear of disciplinary action.

Dr John Bridson, the chairman of Professionals Against Child Abuse (Paca), founded in the UK last year to defend paediatricians, said the French trial was “symbolic of the lose-lose situation in which child-protection professionals find themselves, both in France, the UK and other countries”.
The case that led to the birth of Paca was that of Dr David Southall, a paediatrician and one of the UK’s most widely known child-protection experts, who has faced a record number of investigations by his regulatory body, the General Medical Council (GMC).

In 2004, he was found guilty of serious professional misconduct and banned from child-protection work after raising concerns about the safety of the surviving child of a woman who had been jailed for the murder of two of her three babies. Dr Southall’s suspicions were raised when, in a television interview, the woman’s husband described a nosebleed his 11-week-old son had suffered while alone with him just 10 days before his death.
Dr Southall, who had conducted research that indicated a relationship between nosebleeds in children of that age and suffocation attempts, contacted the police and the father complained to the GMC. In September, in a successful application to have the ban lifted, all five of the experts who gave evidence agreed Dr Southall had been right to report his concerns and that his research had subsequently been vindicated by other work.
Dr Southall’s long battle is not over yet. Last December, in a case that has caused further outrage among paediatricians, he was struck off the medical register on the say-so of a mother who claimed he had accused her of murder during a formal child-protection interview, conducted 10 years earlier.

The panel chose to believe the mother, despite evidence to the contrary from a senior social worker. Dr Southall is appealing.
In an open letter in the British Medical Journal to the president of the GMC, one doctor said the decision had left paediatricians “in an impossible position… The message your body has sent out is loud and clear: challenge parents at your peril, you will have no conceivable defence.”

But woe betide them if they do not challenge parents. Politicians and the media in the UK this week have been baying for professional blood following a court case on Wednesday in which two men were found guilty of “causing or allowing” the death of a 17-month-old boy. The child’s mother pleaded guilty.
“Baby P”, who was found dead in his bloody cot, had been on the child-protection register and was seen almost 60 times by various professionals. His mother had repeatedly deceived doctors and social workers, at one pointing smearing chocolate on the child to hide his bruises. A doctor who saw Baby P two days before his death failed to notice his broken spine.

Dr Southall, speaking from the Gambia, where he is on assignment for the British medical charity Childhealth Advocacy International, said: “This is at the heart of it; despite all the evidence to the contrary that has been gathered over the years, no one – including the media, politicians and the general public – is prepared to believe child abuse happens as frequently as it does, until it is too late.”

External Article by Beatrix Campbell

Beatrix Campbell is a writer of great wisdom and talent. She has written perceptively about child protection “scandals” for many years, certainly since the problems that arose some years ago in the north east of England. Her comments in this article triggered by the tragedy of Baby P are very relevant and could be used to guide those in positions of influence.

Read Article here