Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Suspecting or perpetrating abuse
- C Johnson (8 August 2003)
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Expert truth
- Mark Struthers (12 August 2003)
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Systematic Clinical Accountability
- Dr William Graham Pickering (12 August 2003)
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Re: Systematic Clinical Accountability
- Jenny L Robertson (13 August 2003)
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To every onlooker
- Omotakin Omolokun, none (15 August 2003)
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Expert Witness on Child Abuse
- Peter MR von Kaehne (24 August 2003)
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"Blaming the System" - An epitaph to dead children
- Charles Pragnell (12 January 2004)
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C Johnson, Parent LA9
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The best interests of the child must indeed come first. A significant problem is the fact that when a paediatrician reports a suspicion of abuse the resulting process is currently itself abusive. Social services involvement is heavy-handed and often bullying. Children suffer psychological and emotional damage when removed from their parents, and a few suffer physically as well. Proper medical investigation of symptoms ceases and if a child's condition has not been correctly diagnosed he is denied the treatment he needs. Families are terribly disrupted, sometimes permanently destroyed, and siblings can suffer a similar fate. The evidence of harm to these children is clear, and even if abuse is later disproved parents find it impossible to get the allegation removed from records, resulting in further suspicions and abusive practises if there is ever need to seek medical attention for the child again. To put it simply, reporting a suspicion of abuse is in effect an accusation because the ensuing process proceeds on the blind assumption that maltreatment has taken place. If the suspicion is ill-founded the paeditatrican then finds himself or herself in the position of having perpetrated abuse. It should be no surprise, therefore, that complaints and litigation are likely to follow. From the family's point of view it is wholly justified, and given their suffering many would argue that it should be treated as a criminal offence. For this reason it is vital that no paeditrican make an accusation unless every possible test and investigation has been carried out to eliminate other possibilities. This does not happen, as just a few recent cases reported in the media prove - e.g. one of a child with a brain tumor and another with allergies; how difficult would tests for these conditions have been? In the former case the parents even asked for tests which were denied. The public is asking what the motives of the accusing doctors could have possibly been in such situations. Indeed if parents ask for more tests, or request a second opinion, this in itself can be enough to trigger a report of abuse. If paediatricians are not to fear advocating for a child they must eliminate those from their ranks who make allegations without good reason. This can only be done if the GMC takes action against such doctors instead of protecting them and dismissing complaints made against them. The profession must also take positive steps to rectify false allegations and records when they come to light, and impress upon other authorities, especially police and social services, the significant harm done to children when heavy-handed action is taken before reports of suspicions are proved or disproved. There is a long way to go and judging by the defensive responses of a few it appears that change will be difficult to achieve. But in the best interests of children, it must. Competing interests: None declared |
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Mark Struthers, General Practitioner HMP Bedford
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This editorial by Edmund Hey is muddled and unconvincing. It is disingenuous to suggest that the stream of disasters in the criminal courts were due to weaknesses in the system rather than due to the culpable actions of individuals. About this, Dr Hey is almost certainly wrong. In the context in which he spoke, Sir Liam Donaldson, the chief medical officer is certainly right. In the hospital setting it is systemic weakness that is usually the reason for things going wrong, mostly amongst young and inexperienced doctors. However Deborah Orr in 'The Independent' said that: "Anyone who has ever been in a courtroom will recognise that under our adversarial system, the establishment of the truth comes a poor second to the serious business of winning cases or losing them." [1] Professor Sir Roy Meadow "is a senior paediatrician with a life-times experience of investigating cases of suspected abuse." He also has long experience in the criminal and family courts as an expert witness for the prosecution. Sir Roy knows the system well, is persuasive before a jury and is popular with the prosecution because he wins cases. His expertise has ensured that a series of mothers with convictions for the murder of their infants are now serving long sentences in British jails. Sally Clark and Trupti Patel are the only two that have so far managed to prove their innocence. Under the current merciful British system a convicted murderer will not be released on parole until they admit their crime, a crime in these cases they will probably not have committed. In defending Sir Roy, Dr Hey makes much of the misbehaviour of the defence medical expert. The fact that a defence expert can be economical with the truth and play the system too, underlines the importance of the individual expert witness to the decisions judges and juries make. But then "which is worse, missing one (a smothered baby) or finding someone guilty who is in fact innocent [2]. The fact that we have had to choose between helping a troubled mother and a long and pointless prison sentence is certainly due to a failure in the system that should be rectified. Dr Hey didn't mention that. Dr Hey wonders why Sir Roy's testimony in the trial of Sally Clark on the likelihood of two infant deaths in a single family went unchallenged. I would suggest that the answer will not be found by deflecting the blame for this judicial disaster from the eminent, titled and powerful individual in the spotlight. There may be a dearth of high quality forensic input into the investigation of sudden infant deaths. This doesn't get away from the fact that it is impossible for a pathologist to tell - beyond reasonable doubt - that an infant has been smothered by its mother. Surely every doctor instinctively knows that - including Sir Roy Meadow. He inferred as much in his infamous and ill-judged personal paper [3]. At the end of 2001, Sir Donald Irvine, president of the GMC in his final speech before retirement, hit out at arrogant doctors. He may have had in mind that very small minority of paediatricians who cannot admit that they might on occasion be wrong and will not acknowledge and apologise for the damage their errors have caused. It is they who have damaged child protection, shaken public confidence and broken public trust in the medical profession. What are paediatricians going to do about it? [1] Deborah Orr 'The Independent' 8 August. Bullying witnesses is no way to find the truth [2] Quote by Dr Harvey Marcovitch. 'The Independent' 13 June: 'Doctors warn cot death verdict could alter legal climate' http://news.independent.co.uk/uk/health/story.jsp?story=414972 [3] Professor Sir Roy Meadow in his 'personal paper' 'A case of murder and the BMJ' http://bmj.com/cgi/content/full/324/7328/41 Competing interests: my mother was a member of the Griffiths inquiry into the research activities of Professor David Southall et al. The report was unfairly trashed by Dr Hey and Sir Iain Chalmers |
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Dr William Graham Pickering, Medical Practitioner 7 Moor Place, Gosforth, Newcastle upon Tyne NE3 4AL
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"Doctors", writes Dr Hey (BMJ 2003; 327: 299-300), "being human, will sometimes give flawed advice." In this at least he is correct. As a paediatrician he will well remember the Cleveland affair when there was so much medically flawed advice given to so many people that it required a Judge to intervene (1). Lessons (2), alas, were not learned then, as Hey's comments some fifteen years later testify. However, there is no mention in his discursive article of the continuing absence of doctors' clinical accountability. This omission is characteristic of a certain medico-political line, extant for decades, and which has lead to one serial clinical disaster after another, as well as to unknown numbers of single medical errors. "There needs to be a robust system in our courts to see that doctors' flawed advice does not result in a miscarriage of justice," exhorts Hey in his peroration. But what about a "robust system" within the health services? One that identifies single errors and so nips serial disasters in the bud — and would, thereby, ensure emptier Courts. Earnestly echoing the Chief Medical Officer, Hey agrees "We need to look less critically at the people caught in the spotlight, and more at the systems failure involved." However, driving a car through a red light is not a system failure, any more than driving through a clinical red light in the consulting room is not due to a named doctor. Hey though, (like the CMO, GMC and colleges) will not talk of doctors being brought to account for rudimentary medical errors. Self-regulation, albeit variously re-named under a frenzy of new medico-political schemes hastily (and expensively) concocted in the wake of repeated bad press, continues to be the medical 'system.' And so, day after day, along with much good medicine, error after error continue, just as they always have done. Most pass even without professional remark let alone action or penalty. It requires relatives, press or police to bring a proportion of them to light. And then the Courts. The profession, its regulators and its modern 'initiatives' are always several laps behind. Impartial, informed, separately paid doctors, examining patient complaints, with the medical records to hand, would be a good place to start exacting clinical accountability. Standards throughout the medical sphere would improve overnight, and patients would be spared both more errors and the possibility of the awful ordeal of Court. Refs: 1. Butler-Schloss (Lord) (1988) Report of the Committee of Inquiry into Child Sexual Abuse in Cleveland 1987. Presented to the Secretary of State for Social Services by the Right Honourable Lord Butler-Schloss DBE, Cm 412, London: HMSO. 2. Pickering W. G Glasnost and the medical inspectorate. J of RC of Gen Pract. Nov. 1988 517-518. Competing interests: None declared |
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Jenny L Robertson, Journalist London SW15 5DP
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Hear, hear! A system of clinical accountability is long overdue. Self -regulation does not and will never work and leads to an unacceptably high number of errors. It also leads to a lack of incentive for making much- needed reforms and improvements to health care. From the patient' point of view, the problem is further compounded by the current adversarial medico- legal system which fails to gain justice or compensation for many genuine victims of medical negligence. In effect, this means that patients' have very little protection against medical mistakes and their often devastating consequences. The main beneficiaries of the current medico- legal system in the UK are the lawyers, the expert witnesses and the increasingly busy NHS Trust clinical complaints teams. And all funded at enormous expense by the UK tax payer! Competing interests: None declared |
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Omotakin Omolokun, Senior House Officer St Peter's Hospital,Chertsey.KT16 0PZ, none
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Dear Editor, That Edmund Hey has written at all to these goings on,is worth commending.But articles like this would have been valued a lot more had it been written at the peak of the trials and not when the court had given their verdict. I am very surprised that no Paediatrician was willing to stick their neck out and say publicly that situations like this do arise,especially in consanguineous marriages.All through the investigation and trial,it was very glaring even to the common man that the crown prosecution was not going to get anywhere. I believe the trial of Trupti Patel was a mere waste of time and a gross deprivation of slots for good TV Viewing. I believe it's about time Paediatricians speak out and prevent the judiciary and pathologist from dabbling and fiddling with our expertise and betraying the public trust. Competing interests: None declared |
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Peter MR von Kaehne, General Practitioner Fernbank Medical Centre, Glasgow, G22 6BD
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While making a very valid point re the problems of growing intimidation of doctors reporting child abuse and possible solutions, Dr Hey does his cause great disservice by mixing it with an underhand attack on an unnamed colleague who does not share his opinion with regard to the cause of some fractures. Whether 'Temporary Brittle Bone Disease' exists or not is hardly a matter of concern in regard to the vulnerable position any doctor will find him/herself in after reporting his/her fears or suspicions of child abuse. Further, one of the two references given regarding said colleague (Milroy CM. Medical experts and the criminal courts. BMJ 2003;326:294-5) appears to have little or no connection to that particular matter. It appears to me that Dr Hey attempts to carry out a personal feud on the back of a very serious concern. The concern, I am sure, is shared by many, the feud though only by a few. Competing interests: None declared |
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Charles Pragnell, Expert Defence Witness - Child Protection and Child/Family Advocate U.K./Australasia
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To suggest that, “when things go wrong, the true cause lies in weakness within the system rather than the culpable actions of an individual”, is plain nonsense. I’m sure it will bring no comfort to the parents of Victoria Climbie’ and the other children who have died over the last thirty years while under the care and supervision of child protection workers. Virtually every major Inquiry into those deaths and the Cleveland Inquiry, the Orkney Inquiry and other Inquiries where children and families have been wrongly and falsely accused, has concluded in “Blaming the System”. Thereafter the “System’ has repeatedly stated, “We have learned important lessons” and “We have made the necessary changes”. Yet very clearly lessons have not been learned and the changes made have had little, if any, effect on practices. This is despite the child protection “System” being given increased powers and resources following every Inquiry but which have served only to make such “Systems” more monolithic, oppressive, and punitive, and increasingly erratic in their performance. “Blaming the System” gives absolution to every negligent, incompetent, and malicious member of such “System”, in the knowledge that they will not be answerable or accountable for anything they may say or do to others. “Pursuing structural change as a means of solving organisational problems is as vain as the search for the philosopher’s stone…… if you change attitudes, structures will look after themselves, and if you can’t, then no structure will do the job for you.” Anon. Attitudes in the child protection “System” will only change when individuals are held immediately accountable and answerable in law and by their professions for their errors, negligence, and incompetence. Until that day, the epitaph of “The System was to Blame” will continue to be engraved on the tombs of dead children, and families falsely accused of child abuse will continue to be destroyed by unwarranted and unnecessary intrusions into their lives and their children will continue to suffer severe and long-lasting emotional harm. Competing interests: A concern to obtain the root and branch reform of the child protection 'System' |
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