Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Enquiries not finished
- Brian Morgan (23 October 2001)
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Self regulation does not work
- Penny Mellor (23 October 2001)
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Re - Leading UK Paediatrician reinstated
- Carl Henshall, Deborah Henshall (23 October 2001)
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Covert video surveillance is wrong
- Brid Hehir (23 October 2001)
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It is certainly no suprise
- Tanja Negovanovic (25 October 2001)
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Paediatricians working in Child Protection, Relieved by the outcome of Inquiryinto Professor David S
- Michael Ryan (25 October 2001)
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Re: Self regulation does not work
- Jenny L Robertson (13 July 2003)
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Multi-functional medics
- Charles Pragnell (30 October 2003)
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MSBP doctors under official investigation
- Michael Nott (18 November 2003)
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Brian Morgan, Freelance Journalist Cardiff
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My fellow journalist Caroline White is to be praised for her article, which within the constraints of space presents an albeit short but balanced account of the controversy. Had she been able to wait a day or two she might have told you that North Staffs NHS Trust has conceded that enquiries were by no means finished before the reinstatement was announced (prematurely to my mind), that no consent forms have been examined forensically, (and I have heard from always reliable sources that they have not even been independently scrutinised), that one Health Minister agreed in the House of Commons on Tuesday to answer a local MP's questions about the conduct of the trust's inquiries and in the House of Lords on Wednesday the other Health Minister has restated the right of parents to be heard, to seek a second medical opinion about their child's condition, and to have that second opinion considered when accused of child abuse. That frankly is at the heart of false allegations of Munchausen's by Proxy, where parents wanting to have their accusing paediatrician's diagnosis reviewed is taken by all as confirmation of the diagnosis. As the freelance who was exclusively 'leaked' the news of reinstatement (I prefer to say that I was told by a whistleblower) I might remind readers that it was I who was also told exclusively by a whistleblower in 1999 that two consultants had been suspended by North Staffordshire Trust. Whistleblowers know who to call and here's my number (02920 222656), but sad to say there are all too few where this scandal is concerned. In my opinion the plan to hold a press conference on Tuesday was a cynical ploy to undermine Earl Howe's debate on the Wednesday, with only selected 'tame' journalists invited. Breaking the news early meant a press conference with critical questioning - out of the question. Readers should ask this question: Why have so many parents maintained their protests for so long? It's not because they are funded by paedophiles and child abusers as so egregiously suggested by the professionals - and not because they _are_ paedophiles or child abusers either. The parents are the ones who know whether they signed consent forms, who know how to spell their own and their children's names and when they named them, and who know whether or not they performed the acts they were accused of. Doctors who are thinking rationally might expect parents whose children emerged damaged or worse from a medical experiment not to remain silent if they believe with good reason that malpractice has taken place - and they ought not to expect parents to remain silent who believe their children have been wrongly removed and put up for adoption or to have suffered ill health through genuine illnesses being ignored. Even innocent wrongly convicted criminals are permitted to deny their guilt and campaign for justice and no less is expected of them. The Lords have asked for a Select Comittee hearing into false allegations of child abuse. Parents of CNEP babies and victims of false positive MSBP diagnoses want a public inquiry. The General Medical Council is expected to begin hearings in January: I have my sources, trust me. It's not over yet - the fat lady has not yet sung. |
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Penny Mellor, Child Advocate Home
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The issue of consent is not what has prompted my decision to seek to judicially review North Staffs NHS Trust’s decision to reinstate David Southall, that is a complaint against the trust itself. I am taking legal advice on these grounds: 1) That North Staffs failed to properly investigate complaints in not interviewing nor seeking further evidence from some of the complainants. 2) That they have stated that we are not allowed to see their report as this was an investigation that was undertaken within the auspices of normal NHS complaints procedures and is confidential on those grounds, this is totally untrue, this was an investigation that was originally done on those terms of reference, however was swiftly moved to another level right back in May 1999 and remained a multi-agency investigation until the announcement on October 12th of Southall’s reinstatement. 3) That complainants who had been accused of MSbP by David Southall and cleared by various agencies including world renowned EXPERTS in their children’s particular disorders, would now appear to be labeled all over again flying in the face of any sort of justice. I have it on advice that this could be tantamount to criminal libel. 4) That in one of the cases no such “review” of consent forms for CNEP could have been undertaken as North Staffs themselves have admitted destroying all the original notes from that child including the consent form, again an issue that has never been investigated. 5) That reinstatement prior to any outcome of the GMC investigations could have prejudiced the right of the complainants to a fair hearing at the GMC and in fact is in breach of their human rights. Sadly this has all taken far too long yet again at astronomical cost to the tax payer taking much needed NHS funding away from areas where it is desperately needed, the whole “investigation” would appear to either have been a deliberate whitewash or incompetent. The press release from North Staffs Trust itself was misleading and in fact almost defamatory to certain parents, implying that the complaints were CVS cases when none of them were and leaving the reader to believe that the mothers that can prove they were falsely accused are in fact still child abusers. If our calls for a public inquiry had been heeded from the outset then this very embarrassing situation for the NHS would not still be rumbling on. “Openness and Honesty ” no “Cover-up and Deviousness” is the appropriate phrase. How sad for the parents, how sad for the children, how sad that our trust in the system could be so betrayed after the Bristol and Alderhey scandals. What is it about paediatrics? On a final point, the GMC waited for this report before they proceeded with their investigations into David Southall and then state that "the reistatement of David Southall will not influence any decision they make" (yeh right)if that's the case then why have we had to wait first for Griffiths to report, then for North Staffs to report and FINALLY the GMC, with all respect, for 10% of what this has cost and the time it has taken I could have employed other professionls to do a better job. |
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Carl Henshall, Parents/Carers/Campaigners Home, Deborah Henshall
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North Staffs. Hospital Trust will shortly be extremely embarrassed by this foolish attempt at cover-up, aided and abetted by the Royal College of Paediatrics. They talk about lessons being learnt but only in the context of "How these complex matters should be handled" Surely the best way to handle these so called complexities is to ensure they do not occur in the first place. Unfortunately, because the NHS is not at all open and transparent or accountable, we have not been privy to the Trust's report looking at the design and content of the CNEP (Continuous Negative Extrathoracic Pressure) trials so we are unable to surmise how the working panel reached the extraordinary conclusion that it was of a high standard. It is said that the randomised controlled trial is the gold standard method of evaluating and comparing differences in two treatments and yet this trial could not have shown anything of the sort. The results speak for themselves. That is if you blindly trust what you read in the Pediatrics (1) paper and do not look further into the cited references. If you do take the trouble to look deeper you will find yourselves totally confused as many of the "pilot " studies (which are cited as showing the safety and efficacy of CNEP ) refer to work carried out on many of the same children in the follow-up study and indeed two years into the four year study. This is fact and we should know because our child, born in 1992, was a participant. Again this was without our knowledge or understanding that this monitoring (Near Infrared Spectroscopy) was a separate study. Confused??? What is FACT in this scenario is that the so- called expert panel have not asked to meet with any parents with concerns. We believe we qualify simply for being there at the time and having studied ALL literature made available to us either by the North Staffs. Hospital Trust or searching countless university libraries, medical institutes etc. Including, of course, most importantly our children's medical records and data collection sheets. We have no reason to believe that these panels have had the same privilege as no-one has asked for our consent to view those confidential medical records. We fail to see how they could accurately determine the standard of the research without this access. On the other hand you refer to the Department of Health considering "Fresh Information" last August. We confess, we have not been informed (again!) or allowed to see whatever it may be; despite the fact it must concern our children. It seems that nobody cares about our human rights or our opinion least of all the Royal College Of Paediatrics and Child Health, Department of Health or North Staffs. Hospital Trust. (1) Pediatrics Vol 98 No6 December 1996 1154-1160 Competing Interest:- Parents of two child treated with CNEP. |
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Brid Hehir, User Involvement Co-ordinator Camden & Islington Community NHS Trust
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Though the investigation into the work of Dr David Southall found no evidence to suggest the inappropriate use of covert video surveillance, I hope that his reinstatement does not now legitimise its use by health professionals. As a Nurse I am amazed at how little debate there has been in the nursing press about this practice, which was sanctioned by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) last year and which I find utterly abhorrent. Yes, as nurses we are now being allowed to use CVS ‘as an action of last resort’ to spy on parents who are suspected of abusing their children (1). Consent will not be sought because the element of surprise is deemed necessary. This is apparently justified in the interest of saving children’s lives. Doctors too will soon have permission to do likewise. Why has this practice, which ‘by its very nature is not a normal part of nursing, midwifery and health visiting practice which is based on transparency, openness, consent and truth telling in the professional relationship’ been sanctioned?(1). CVS came to public attention in the UK following the publication of research by David Southall and colleagues, undertaken in the period 1986- 1994 (2). They had investigated suspicions of induced illness in 39 children aged two to 44 months, by adult carers. The work was carried out at two hospitals - in North Staffordshire, Stoke on Trent and another, with police support, at the Royal Brompton in London. The results were reported to reveal abuse in 33 out of 39 suspected cases, with intentional suffocation observed in 30 patients. Other forms of abuse reported included poisoning, a deliberate fracture as well as emotional abuse. Not surprisingly, parents were horrified when the use of CVS came to light in the UK. Some children were taken into care as a consequence and some carers diagnosed with Munchausen Syndrome by Proxy (MSBP). Conflicting opinions as to the accuracy of applying the ill-defined label ‘cot death’ to unexplained deaths in infancy, for which there is no other explanation, is part of the history leading to the use of CVS. The last Sudden Unexpected Deaths in Infancy report suggested that six per cent of child deaths in the UK had maltreatment as the main cause (3). The publicity given to this small number of deaths has helped to generate suspicion around sudden infant deaths in general and their carers in particular. This is despite the fact that the vast majority are inexplicable and the overall number is falling (from 1390 in 1988 to 372 in 1999). This has been compounded by the mistaken belief that child abuse is at an all time high and that every child is at risk because most adults cannot be trusted with children. The National Society for the Prevention of Cruelty to Children’s (NSPCC) ongoing high profile ‘Full STOP’ campaign has fuelled the fallacy of widespread child abuse (4). It has popularised the notion that thousands of children suffer unspeakable cruelty every year because people close their eyes to it. I believe this campaign has helped inform and influence the perceived need for and the acceptance of CVS in order to spy on parents in hospitals. If this isn’t evidence enough, nurses who remain unconvinced are further persuaded of the need for CVS because vulnerable children, if not protected from abuse by their carers, could be killed or suffer serious incapacitating illness. The private life of families has as a consequence become open to public scrutiny and is justified in the interest of protecting vulnerable children. In such cases we are told, we owe our duty of care exclusively to the child and must act in the child’s best interest. Adults have no rights in such situations and do not need to be told about or consent to CVS. Practitioners are therefore allowed to lie and deceive those close to the child by witholding information regarding the use of CVS. This removal of adult rights in favour of the child’s was first sanctioned by the widely acclaimed 1989 Children Act. It decreed that the interest of the child is paramount. Adult rights were as a consequence sanctioned by law as secondary to those of a child. If those arguments are not sufficiently persuasive the duty of the citizen to prevent or aid the detection of serious crime (child mistreatment or death in this instance) has to be considered. CVS can help here. Because it is conducted in the public interest, it is supposedly justifiable. The actual or potential benefit to the patient can be explicitly stated. Responsible nurses surely cannot have a problem with these justifications, can we? Well, yes we can. Just because the UKCC can ethically, morally and professionally sanction CVS ‘as an action of last resort’ doesn’t make it right. I certainly don’t agree with it. Neither does the Royal Brompton any longer. As their spokeswoman said ‘There are two ways of looking at it. Either you think of it as a necessary safeguard or an infringement of people’s rights. We don’t use it’(5). A central question remains however. Are parents, mothers in particular, responsible for the unexplained deaths of some children? We know that infanticide has occurred for centuries. What should health professionals do about it, if suspicious? Whatever the answer I am convinced that if parents realise that hospitals use CVS to spy on them, some, possibly the most needy, are likely to avoid attending with a ‘sick’ child, for fear of being ‘caught’ or having their actions misinterpreted. In the interest of children and their carers, this practice should not be introduced, and nurses or any other health professional should not collude with the UKCC or any professional organisation against patients, no matter how seductively they justify CVS. References 1. Ethics Panel (22.08.00) Covert surveillance: ethical implications for practitioners. United Kingdom Central Council for Nursing, Midwifery and Health Visiting. 2. Southall DP Plunkett MC et al (November 1997) Covert video recordings of life-threatening child abuse: lessons for child protection. Paediatrics 100 (5): 735-60. 3. Sudden Unexpected Deaths in Infancy: The CESDI SUDI Studies 1993- 96. The Stationary Office. 4. NSPCC leaflet. You and the NSPCC - Together we can stop cruelty to children. March 1999. 5. Bloomfield R. Nurses to use covert cameras on patients. Time Out Magazine 4-11 October 2000 No 1572. |
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Tanja Negovanovic, social woker australia
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It certainly doesnt shock me that a physician was not held accountable for his actions. What appears shocking is that the very people (the accused parents) for whom this enquiry appears to have been launched were never consulted by those investigating. What would it mean to a system if its medical practitioners were held accountable for their actions? Indeed if they were accountable to their patients. What ever happened to "above all do no harm" |
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Michael Ryan, Senior Consulting Paediatrician The child Protection unit The Children's hospital at Westmead,Sydney Australia
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Munchausen By Proxy Syndrome has a high mortality and morbidity.A paediatrician confronted with such a case has a responsibility to ensure that the child is discharged into a safe environment. David Southall carried out this responsibility to his patients by using covert video surveillance of children suspected of being the victims of munchausen by proxy syndrome. His actions were not malicious nor were they vexatious. He was simply carrying out his responsibity as a paediatrician to notify children who were being abused or who were at risk at risk of abuse. This extreme form of child abuse is hard for the lay person to comprehend. The perpetrators are convincing in their denial that they have not harmed their child. The media support for the perpetrators has lead to a reluctance for paediatricians to make this diagnosis for fear of being investigated in the manner that David Southall was subjected to. As a result , I am sure that children around the world are suffering from this form of abuse.Hopefully as a result of this inquiry, the fear of being accused of making false allegations will result in a pick up in the numbers of children who are victims of this extreme form of child abuse. Dr. Michael Ryan
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Jenny L Robertson, Journalist London SW15 5DP
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NHS complaints procedures are notorious for failing to get anywhere near the truth, with cover-ups, denials, 'missing' notes being commonplace - and in the process squandering hundreds and thousands of pounds of tax payers money. NHS managers and their teams seem to have a policy of aggressively defending each and every complaint, however justified it might be - and who picks up the bill for all this obstruction? Yes, the beleagured British tax payer who niavely thought his or her taxes were going towards improving patient care, not defending incompetence. Aggrieved patients who resort to the medico-legal route to try to gain some kind of justice often find the way to the truth is similarly blocked by unscrupulous lawyers and medical expert witnesses who gobble up (again tax payers) money, writing inaccurate and misleading reports which attempt to defend the indefensible. Of the billions of pounds of NHS money spent on complaints procedures and litigation, I am sure that a pitifully small amount ends up in the hands of genuine victims of medical negligence/incompetence. NHS trust managers and their complaints teams, the lawyers, the medical expert witnesses and medical insurance/protection are the main beneficiaries. As well as being the most appalling abuse of public money, this also means that we have virtually no accountability within the NHS. And that is bad for all of us. Competing interests: None declared |
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Charles Pragnell, Expert Defence Witness-Child protection and Child/Family Advocate Melbourne, Victoria
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Dr Michael Ryan claims that there is a high mortality and morbidity rate from MSBP yet there is no scientifically-based evidence to support such an assertion. In fact the entire basis for claims of MSBP is no more than conjecture, fanciful speculation, and supposition going back as far as the original proposition by Sir Roy Meadow in 1977. (Hinterlands of Child Abuse). What is apparent on examination of alleged MSBP cases are that no tests have been carried out into whether sick and dying children are suffering from genetic disorders, pre-birth injuries, surgical injuries, toxic poisoning, adverse reactions to prescribed medications, vaccine damage, severe allergic reactions etc. In every case of alleged MSBP, questions should be asked as to whether such investigations have been carried out prior to the allegation being made, or whether the allegation of MSBP is being made following only a rudimentary examination of the child. Pressure on the paediatrician from the parent for a diagnosis and treatment for their sick child seems to be a pre-cursor to MSBP allegations and it is notable how many times threats by parents to sue or report the physician for negligence or incompetence, precedes an allegation of MSBP. Such important information never seems to appear in what has been euphemistically described as `research’ into MSBP and the literature concerning MSBP epidemiology. If a physician has concerns that a child may be being abused, then it is the physician’s duty to report those concerns to the proper authorities i.e. the police and child protection authorities. Undertaking their own detective work by using CVS is not part of the physician’s role or responsibility. It is for the duly appointed agencies to decide whether, and how to conduct their inquiries into the allegations and to consider whether CVS may have a part to play in such inquiries. The events in Cleveland in 1987 occurred largely because the police and child protection workers were unable or unwilling to carry out their own inquiries and assessments and to form a view with full information available, rather than have to rely solely on a medical diagnosis. The ethics and legality of using CVS in alleged child abuse cases are highly debatable and using a single camera in CVS gives an extremely limited perspective of events and actions and can grossly distort perceptions and interpretations of those events. This is blatantly obvious in the television reporting of sports events such as football, soccer, and rugby. A minimum of three cameras would be absolutely essential where there are concerns of child abuse, in order to produce any kind of reasonable representation of what occurred and thereby give a reasonable perspective and credence to interpretations of those events. In conducting their own investigations and making an allegation of MSBP, a physician is usurping the role of the police and child protection investigators, and in asserting that a mother has a personality disorder is usurping the role of a psychiatrist and in naming an alleged perpetrator of child abuse, is bypassing the due process of investigation and inquiry into a criminal offence. Are paediatricians so extensively trained and have so little medical work, that they can engage in such a wide variety of activities?. Competing interests: None declared |
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Michael Nott, freelance journalist Sydney Australia
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In regards to munchausen by proxy syndrome as debated in these columns, it should be noted that the originator of the syndrome, Sir Roy Meadow, and one of the major proponents of his theories, Dr David Southall, are both currently under investigation by the British General Medical Council as ‘problem doctors’. The GMC has declined to detail to me the matters that they are investigating with both doctors. With these investigations occurring, one wonders how doctors can diagnosis MSBP in alleged child abuse cases in ‘good faith’ and how doctors can continue to use Sir Roy Meadow as one of their principal references in court affidavits when alleging MSBP. Here in New South Wales, Australia, the government’s child protection agency, the Department of Community Services, has confirmed it is ‘precluded’ by law from using allegations of munchausen by proxy syndrome as the basis for removal of a child. Yet it has been using MSBP allegations for many years as the central allegation in child protection proceedings. A DoCS written statement suggests it is in breach of its own legislation by stating that the, ‘Children and Young Persons (Care and Protection) Act 1998 (Section 71, Subsection 2), precludes DoCS from taking any medical condition of a parent or carer into account when making a child protection decision’. It would seem that agencies such as DoCS and some doctors from child protection units at major public hospitals are showing scant regard for legal requirements. The legitimacy of the munchausen by proxy syndrome theory is now undergoing intense scrutiny worldwide for its lack of scientific integrity, highly questionable support literature in medical journals, and its continuing use by a minority of members of the medical profession. This has resulted in gross injustices to children, mothers, and their families, not only in the U.K, but in Australasia and North America. It is also causing immense harm to the status of the medical profession and public trust in physicians, as relatives and friends of affected families are alarmed and angered by the needless and unwarranted removal of children and in some cases, the imprisonment of innocent mothers. Michael Nott Competing interests: None declared |
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