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 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

Presentation on the role of the GMC to the Birmingham medico legal society

Peter Gooderham is a PACA member and a former GP. He is currently an academic lawyer with an interest in clinical negligence, professional regulation, and the role of expert witnesses. He recently gave this presentation on the role of the GMC to the Birmingham medico legal society.

Download PDF here (3.6MB)

Letter to the BMJ in response to article by Clare Dyer

The determination of the GMC panel, following the recent hearing looking at the condition imposed on Dr Southalls’ license to practice, was not fully explained in a sympathetic article in the BMJ written by Clare Dyer. This rapid response now published as a letter sought to make things clearer.

Here is the letter, published 13 October 2008, doi:10.1136/bmj.a2069, and reprinted here with permission.

Letter Title: Southall verdict
Subject: Clarification
PACA members wish to make it clear that the apology Professor Southall made at his recent hearing was not about the child protection importance of the episode of nose bleeding and difficulty in breathing described by Mr Clark in his own words on a television programme—an incident that had occurred in his 10 week old infant just 10 days before his sudden death.1 Southall apologised about the language in his report, which was an agenda item for a meeting of professionals involved in the family court case, including Southall, Professor David, who was acting as the instructed expert, and the child’s solicitor.

The phrasing he used was regarded as injudicious by one of five child protection experts at the recent General Medical Council fitness to practise hearing, and as a result he apologised (only to Mrs Clark) because it damaged the message he was giving and because it was originally used by the GMC in 2004 to find him guilty of serious professional misconduct, thereby causing damage to child protection in this country.

Panel members indicated that they understood only too well the importance of the nose bleeding incident (see transcripts on www.paca.org.uk). The latest GMC panel was thus very clear and supportive regarding Southall’s evidence on the incident of nose bleeding and difficulty breathing; they accepted his opinion as a result of what they heard from the five experts. The panel also dismissed the issue of Southall’s failure to interview the parents, given that he was acting as an informant to the proceedings and not as an instructed expert.

John Bridson, coordinator,
Professionals Against Child Abuse (PACA)

References
Dyer C. Southall is allowed to return to child protection work. BMJ 2008;337:a1811. (24 September.)

The transcripts of the GMC hearing considering the renewal of the Sanction.

Many of the misunderstandings of the 2004 panel were cleared up by the five new expert witnesses called by Dr Southalls team. Undue weight has been given in the media to Dr Southall’s humility in this hearing, the fact that his opinion about the need to inform the police has not been altered, more it has been reinforced by the passage of time and the arrival of supporting evidence, hasn’t been given the same prominence.

Dr Southall is now able to practice without restriction pending the appeal against the panel’s findings at the Mrs M hearing.

Download the transcripts of days 1 to 6 here (PDF) and days 8 and 9 here (PDF).