Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
What skills are needed?
- Heather Lohr (24 June 2004)
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Systems failure
- Penny Mellor (25 June 2004)
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Brick Walls
- Lisa C Blakemore-Brown (25 June 2004)
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A legal question?
- John D Stone (28 June 2004)
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Expert deception
- Mark Struthers (28 June 2004)
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Re: What skills are needed?
- Debbie A. Grater (28 June 2004)
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Bizarro World
- L. Travis Haws (28 June 2004)
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Child abuse: a touching dilemma
- Dr.Naseem A. Qureshi MD, IMAPA, LMIPS (29 June 2004)
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Re: Bizarro World
- Lisa C Blakemore-Brown (29 June 2004)
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ALL 500 CASES IN DOUBT IF 453 CASES HAD NO SECOND OPINION
- Clifford G. Miller (6 September 2004)
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Heather Lohr, parent Huntingdon PA 16652 USA
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"Children's minister Margaret Hodge has asked chief medical officer Professor Liam Donaldson to look at the skills needed to give evidence in the family courts" (taken from caption accompanying the story) An interesting point is that if it has become necessary to review the skills needed to provide testimony ... who is reviewing whether the ones making the accusations in the first place have the right skills? A large percentage of alleged abuses against children are proven unfounded. Let's put the horse back in front of the cart. I certainly am anxious to hear what those skills would be. I would hope that qualifications would include a thorough, demonstrated understanding of disease process, injury mechanisms and biomechanics. And a huge look at conflicting interests wouldn't hurt. Perhaps a thorough review of the literature relied upon would also be in order. Competing interests: personal experience |
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Penny Mellor, Advocate Home WV9 5HX
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Contrary to what has been said about my personal beliefs, whilst exposing individual paediatrician's shortcomings, I believe the whole area of child protection has needed an overhaul for many years. Out history relating to child protection reads like a horror story. The mainstay of that history seems to me to be that when a theory about child abuse is postulated, particularly if the person advancing it is of some standing, it seems to pray on peoples fears that if nobody does something children will die, it ignites a set of events that go off in a totally irrational manner. I call this the Chicken Licken Syndrome, nobody ever goes back to the source and checks to see if it has any scientific validity, it becomes a "we've got to save the children fervour". Equally when the genuine warning signs are there, bruises, scars, broken bones etc, nobody wants to confront it, it's all quite bizarre and probably has alot to do with the British attitude towards children and our inherent ability as a nation to "mind our own business". This was very well demonstrated when Jamie Bulger was taken, despite the fact that he had been dragged bleeding through the streets of Liverpool, nobody stopped and did anything, they didn't ring the police, they didn't confront the boys that had him, yet they appeared in court and gave evidence about what they had seen, stating that they knew something was wrong but didn't "want to get involved". There just does not seem to be any middle ground when it comes to protecting children. On the one hand we, as a nation have had more scandals involving false allegations of various forms of child abuse than any other country in the world (Cleveland, Orkneys, Shielfield, Nottingham, Clark etc) all of which started with a diagnostic theory or a belief set from either the medical or social work professions. The other sinister side of this are cases like Victoria Climbie, the failures regarding Ian Huntley and the shooting of Toni-Anne Byfield. On both sides the human and resource cost of righting the wrongs have been phenomenal, money that, had we got a better more effective evidence based system with properly trained and experienced child protection personnel, who don't have a particular axe to grind, or a theory to prove then this would not have happened. It seems to me that we just never learn anything from past mistakes, all we do as a nation is paper over the cracks. If police officers and social workers spent a year on a paediatric unit as part of their training, they could learn about differential diagnosis, they could perhaps pick up on abuse that had been overlooked by a doctor and importantly, when it comes to the next step in order to protect a child either at case conference or criminally, their decision making process would be based on their training and understanding of medical issues, rather than the solitary "expert" leading the way. Currently neither the police or social services have the knowledge or training to challenge a medical professional. Ultimately this would mean that instead of the individual expert, you would have a collective body with the appropriate skill sets to give evidence, two heads are always better than one and there are less likely to be mistakes either way. The system for protecting children will never be perfect, no matter what, there will be child abuse whether that be a parent losing their child because of a false allegation, or a child slipping through the net and being abused by either a parent/carer/friend of the family or a stranger. However with all the reviews currently being undertaken perhaps out the ashes that child protection now lies, the Phoenix will emerge and we can have the best system in the world, a system that doesn't allow for theory, but medicine based evidence. If this government truly cared about it's children then there would be a blank check to ensure that we had the best paediatric pathology, the best radiology, the most highly trained child protection workers and support for the many doctors, nurses, police officers and social workers who work in this terribly difficult field. Ultimately it is the system that has failed children parents and professionals alike. A public inquiry would be the starting point for a new era for all concerned. Competing interests: Campaigner against false allegations of MSbP |
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Lisa C Blakemore-Brown, Psychologist Based in UK
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"Mrs Hodge last week announced the results of the first stage of the care cases review, covering children who have been the subject of care proceedings since 23 February this year. Of 5175 cases involving 9195 children, in only 385 cases did the finding of significant harm depend on expert evidence." Why was expert evidence involved in only 385 cases out of 5175 cases involving 9195 children when the Review was triggered after Sir Roy Meadow's evidence in the Clark, Patel and Cannings' cases was highlighted as dubious? One must assume that the 5175 cases were therefore associated with Roy Meadow MSBP type accusations - as pointed out on this Board, they would not all have been Roy Meadow cases - and that was the criteria for choosing them out of the much larger group of children taken in to care of the same period. This much larger group will obviously include the many seriously neglected and abused children whose abuse was unrelated to medical diagnoses. Therefore - how did the social workers in the other 4790 Roy Meadow type cases form the view that they were looking at child abuse of the Roy Meadow theory type? Through their training and Government Guidance with these very same Experts leading the way. Furthermore, as these very same teams of people have been called upon to `review` their own decisions, surely even an eight year old of normal intelligence would be able to guess what the likely outcome would be? Take the following scenario: a teacher tells a group of eight year olds that another eight year old (one who seemed very clever and was quite controlling and whose work they had been copying) had made some deeply worrying and very serious mistakes which the Headteacher had picked up on and so had the Government. If a lot of these mistakes were found he could lose his job and maybe the school would have to be shut down, so he was mighty angry. If it was found that other children had made the same type of mistakes, they would be in very, very serious trouble indeed, as they would show up the school, the Government etc. So the teacher then asks the children to go away and mark their own homework. What do you think they would do? So now we have compounded system abuse by the spin doctors by the very methods chosen to reassure the public about abuse of the system. Conveniently, the medical `Experts` are suddenly reported to be no- where in sight in the vast majority of cases which were picked up precisely because of concern about highly influential Expert theorising in these cases. Since that time, these concerns should have increased, not decreased, given the outcome of the GMC Hearing against the other main proponent of MSBP theorising - Professor David Southall. It is quite astonishing that decisions about how the Review should be handled were not kept back until the decisions had been made on Professor Southall's professional competence in the Clark case before the GMC, given that they were examining precisely the same area of work based on precisely the same theorists using precisely the same thinking and affecting over 9000 British children??? The GMC found that Professor Southall made a `quantum leap` of judgment in a case in which his thinking was not hampered by having any medical information about the child, and rigidly stuck to his erroneous view formed out of this tapestry of omitted evidence and application of parent blame theory, devised and sustained by himself and others including Roy Meadow. A serious miscarriage of justice was narrowly averted by other Experts being heard instead of Professor Southall, but this did not reduce the terrible trauma to the tragic family targeted by both of these MSBP proponents. Yet this did not deter the Minister for Children from publicly declaring her confidence in this Review of MSBP type theorising just days after the GMC declared its lack of confidence in the theorising and subsequent decision making of one of its chief proponents? That rigid thinking, omission of crucial evidence and leaps of logic were leading to false allegations and punitive draconian outcomes was the basis of my fundamental concern expressed in detail to the Department of Health from 1997. In my Letter published in The Psychologist in 1997 (1) I said that I could find no robust statistical and scientific basis for MSBP and asked for an Inquiry given the potential very serious miscarriages of justice if children were removed and in some cases women imprisoned if the allegations were false. I wrote `something seems to be going very wrong`. Many other professionals wrote to me and agreed at the time. Since then they have been silenced. These Meadow type parent blaming Experts have been very much involved in training of social workers, health workers, Judges and politicians. So even if a way has cynically now been found to air brush them out of individual cases - surely a device to ensure they do not meet the narrow criteria of Expert disagreement as set down by Justice Judge in the Cannings' Judgment? - their influence is tightly interwoven into the methods and practices of all those involved the cases of this type. The rigid belief system and easy dismissal or omission of crucial differential diagnoses of the Child Protection teams is breath-taking, but only echoes those of their trainers. I have first hand experience of being an Expert in a case involving Professor David Southall. It led to my diplomatic written concerns to the Dept of Health and others and to my first letter to The Psychologist. I should feel vindicated on hearing the Chair of the GMC echo my own thoughts last week, but on reading this, I do not, as the truth has still to be told. I have first hand experience of trying to explain to social workers and other influenced `Experts` in this and many other cases, about the dangers of rigid thinking and about the importance of looking at other evidence which explains the apparent `abuse` which they have either ignored, omitted or misinterpreted, for a variety of reasons. But you can't talk to brick walls. 1. Blakemore-Brown LC (1997) Letters to the Editor The Psychologist. September. Competing interests: Expert Witness in ASD and ADHD tapestry cases -in Education, Family and Forensic cases |
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John D Stone, none London N22
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What is the legal position of medical expert witnesses who know about problems like Barlow's Disease and adverse reactions to vaccine, but systematically exclude such considerations from their testimony in cases of alleged SBS, MSbP etc.? Competing interests: None declared |
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Mark Struthers, GP Bedfordshire, UK
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Clare Dyer reports on the disagreements between experts in child protection cases. I would like to make two points arising from this news article. 1. In the care review ordered by Margaret Hodge, the children’s minister, there were 385 cases (out of 5175) in which the finding of significant harm depended on expert medical evidence. In my opinion, all these cases and every one of the experts involved should be investigated, and not just the 47 in which there was dispute between doctors. It is certainly possible that the experts in the other 338 cases may have abused their professional position, given irresponsible, inappropriate, misleading advice - and then gone unchallenged in the courts. It is certainly conceivable that these expert witnesses had an inadequate understanding of injury mechanisms or those medical conditions that can mimic abuse. They may also have harboured similar rigid belief systems and ideologies. There is a shortage of paediatricians and child pathologists willing to undertake court work. The peremptory dismissal of Colin Paterson by the GMC provides a salutary lesson on the penalty for dissent. The balance of power in child protection lies firmly with the prosecution. The chief medical officer for England may care to look at this as well as the competencies required to give expert evidence in the family courts. 2. The review has been conducted by local councils despite a glaring conflict of interest. The shadow children’s minister, Tim Loughton, has recognised this conflict and said: "I remain concerned that all the reviews have been conducted entirely under the auspices of the local authorities who were key players in the original decisions ... This will not inspire confidence that justice has been done for every potential case of a child removed from parents unreasonably on questionable evidence." [1] Reference: [1] The Guardian 18 June 2004. John Carvel. Experts in child abuse cases face inquiry. Competing interests: None declared |
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Debbie A. Grater, parent Pottstown,Pa 19464 USA
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I must agree here with Heather Lohr. I am certainly anxious to hear what these skills would be and to know who is making sure the ones making these accusations do have the right skills. Competing interests: Personal Experience |
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L. Travis Haws, Dentist Lakewood CO 80228
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Editor: Lisa Blakemore-Brown points out some serious problems with the way the "system" is going about looking into thousands of potential abhorrent miscarriages of justice: 1) who is actually undertaking these reviews? 2) in light of the Southall review, these so called findings seem premature. It's like asking the experts that initiated and promoted flawed and misleading "studies" to review their own work that they have used to dismantle many innocent families and initiate numerous false imprisonments. Like asking the Chiefs of Enron to analyze all the information they ignored, mis-quoted, mis-read, or shredded, that was pointing to bankruptcy. Then to ask them to re-evaluate such information, they supposedly didn't recognize was erroneous, to see if they are indeed bankrupt. Indeed, akin to asking the potentially corrupted to uncorruptly analyze the mess??? What a HUGE CONFLICT OF INTEREST. Do you think that, at least subconsciously, or more like with outright intent, these reviewers might want to save face??? Especially with such large stakes (reputation, character, public repercussions...). Heather Lohr most appropriately discusses another huge problem which is reinforced rather well by Mark Struthers. The issue is not that "experts" "only disagreed in 47 of the 5000 cases", but rather the qualifications of the experts. If all of the "experts" have similar rigid belief systems and do not correctly understand injury mechanisms and "mimics" of abuse, the apparent, unaffected by conflicts of interest (a huge ?), salutary conclusions of the review are small comfort. This is so far from sensible, that I feel like I'm in Seinfeld's bizarro world. For those not familiar with Jerry Seinfeld, everything is backwards in the bizarro world. Does anyone know which way is up? Please help me, I feel rather discombobulated! Can anyone here prescribe me some zyprexa...please? I feel rather disoriented. Wait, did I already say that? Who's tracking me? Competing interests: Know the falsely accused and the utter devastation heaped upon them with dogmatic hands |
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Dr.Naseem A. Qureshi MD, IMAPA, LMIPS, Locum Psychiatrist Postcode:64399, Prince Sultan Bin Abdulaziz City for Humanitarian Services, Riyadh, Saudi Arabia.
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Sir: The issue of child abuse is complex and highly touching. The defenseless children are abused-sexually, emotionally and physically by their parents or surrogate carers. The early identification of child abuse is crucial in order to prevent further injury to the child who often needs separation from the perpetrators. Child protection agencies, though recently accused of abusing abused children, must look after the interests of abuse children in a humanely manner. The child abuse in terms of death of the child is most puzzling and coupled with major conundrums such as role of the expert witness mostly paediatricians, parental/carer involvement, responsibility of protection agencies for other siblings and the most crucial role of judiciary. The child death shrouded in child abuse and accusation of carers as murderers of the child raises strong media reactions and hence the whole issue is politicised within minutes. When the expert witness is questioned by media, parents and patients advocacy groups as has happened recently in the UK, the problem is further complicated. Furthermore, when there is no medical consensus and rather medical conflicting views prevail about the cause of death of the child, it makes things worse and disgusting. The medical personnel, parents, carers, child protection team, and judicial authorities have not to shirk their individual responsibilties whenever they encounter a case of either simple child abuse or complex one involving the death of the child. Finally, indeed there are recurrent, continuing problems of child abuse globally (about 2.5 million in the USA alone), so there have to be certainly justified solutions. It is wise to know that both escape and defensive clinical practice are tantamout to malpractice. Reference: Clare Dyer. Review finds child experts disagreed in 47 cases out of 5000. BMJ 2004; 328: 1517-b Competing interests: None declared |
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Lisa C Blakemore-Brown, Psychologist UK based
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L. Travis Haws has finally arrived in Bizarro world, or the land of Kafka - but he can take some comfort from the fact that at least he knows it. Well - maybe. You get here on a yellow brick road. The characters you will encounter live in a topsy turvy world, have the hearts of Tin Men, the brains of Scarecrows and the courage of that Wizard of Oz lion. First sign post which gets you thinking points to False Allegations - as you obviously seek to avoid that, you go in the other direction, only to find that it also points to False Allegations. After many attempts to go the right way, you realise it is impossible. You get annoyed at this and go to a lot of trouble to track down the signmaker. He tells you he just takes orders. You say `But surely you must have rules and regulations in your profession?' 'Yes' he says - ' but the ones who give the orders are the ones making the rules and regulations.' Right then. Now the problem is becoming clearer. You write articles and letters to newspapers. In one, I recall saying that this was Malice in Wonderland, topsy turvy, and the Department of Health should be renamed the Sick Department, but it didn't get printed, as by then the lunatics well and truly ran the entire asylum. As your head spins and you know there is no Way Out, you will have to decide whether you'd rather join this mad world, or risk being called paranoid by trying to expose its madness and its influence. Cripes - just seen the Red Queen - which metaphor am I in anyway? Heavens to Betsy, even that's muxed ip! Competing interests: Specialist and Expert Witness in ASD and ADHD disorders |
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Clifford G. Miller, Lawyer & graduate physicist Beckenham, Kent, BR3 3LA
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Dear Sir, ALL 500 CASES IN DOUBT IF 453 CASES HAD NO SECOND OPINION Could Clare Dyer please report on how many cases had only one opinion. Competing interests: Close relative with life threatening food allergy. |
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