Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Unduly alarmist?
- Jay Ilangaratne (22 July 2005)
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A disaster on many levels
- Carmelo Aquilina (22 July 2005)
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Sir Alan's failure to restore trust
- John Stone (23 July 2005)
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"In good faith"
- William G. Pickering (23 July 2005)
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Right or wrong
- Giusto Giusti (24 July 2005)
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Re: A disaster on many levels
- Stevie M Gamble (24 July 2005)
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Re: A disaster on many levels
- Jay Ilangaratne (25 July 2005)
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GMC Quasi "Criminal" Court of Law
- Brian Morgan (25 July 2005)
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Blamestorming
- Barrington Johnson (26 July 2005)
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Jay Ilangaratne, Founder www.medical-journals.com
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No doubt Prof Meadow and his advisers are aware of the legal remedies available if they are dissatisfied with the GMC's decision[1].Though Prof Craft is entitled to take sceptical view of the GMC's decsion, some of his reported remarks[1]deserve a response, among other things, in the interest of fairness. Prof Craft says[1]: "The one thing it will do is frighten any sensible doctor away from doing expert witness work,".I think, sensible doctors will not be frightened, given it is unlikely that a "sensible doctor" would express extreme opinions of the scale (1 in 73 million chance) that Prof Meadow had made. Nor is it likely that a "sensible doctor" would act beyond "the limits of his expertise" as found against Prof Meadow[1]. Further, Prof Craft is reported as saying[1],"There will be a huge knock-on effect on expert witnesses, both in child protection, which is bad for children, and right across the whole field of medicine, which is bad for the public." At best, that is a prediction from Prof Craft. Surely, there is no independent evidence to that effect, as yet. The suggestion that Meadow-decision would have an adverse effect on experts "right across the whole field of medicine"[1] is most unlikely to be accurate, given there are plenty of experts who are quite capable fo making-up their own minds without being unduly influenced by the exceptional saga involving Prof Meadow.Some may not be even remotely concerned about the Meadow-decision.In any event,the 'expert industry',though poorly regulated, is very much a mushrooming one with enough willing takers at the right price. References [1]Clare Dyer. Professor Roy Meadow struck off BMJ 2005; 331: 177. Competing interests: None declared |
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Carmelo Aquilina, Consultant Psychiatrist Queen's Resource Centre, Croydon
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The decision to strike off Professor Meadows by the GMC is a disaster on many levels. At a personal level it is a disaster for Professor Meadows whose distinguished and corageous career should have been considered in deciding the sanctions applicable to a single statement in Court which was not by itself responsible for the subsequent Court verdict. It is a disaster for anyone working in the field of child abuse where supremely difficult decisions become more difficult if honest mistakes are to be so severely punished. It also discourages people from joining this field in the same way as the media hysteria after the Alder Hey case discouraged people from becoming paediatric pathologists. It is a also disaster for children because the multitude of ignorant media reports which have oreceded this decision rubbishing the very concept of Munchausen's by proxy. Finally it is a disaster for the General Medical Council which has offered Professor Meadows as a sacrifice to "public confidence", and now stands discredited as a body which should be able to resist media hype and political concerns. Competing interests: None declared |
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John Stone, none London N22
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Sir Alan Craft's remarks are extraordinary [1]. Why should any expert fear to give evidence if that evidence is properly researched and well- founded? Is he saying that the evidence given by experts is commonly of the sort of quality for which Sir Roy Meadow has been struck off? The current leader of the profession should be lamenting his predecessor's lack of rigour, and the disrepute into which he has brought the profession. What on earth are the public supposed to think? [1] Clare Dyer, 'Professor Roy Meadow struck off': Alan Craft, president of the Royal College of Paediatrics and Child Health, a position once held by Professor Meadow, described the GMC's decision to strike him off as "astonishing." Professor Craft added: "The one thing it will do is frighten any sensible doctor away from doing expert witness work, and the more eminent you are and the more important you are in terms of providing expert evidence the less likely you will be to provide it in future. "There will be a huge knock-on effect on expert witnesses, both in child protection, which is bad for children, and right across the whole field of medicine, which is bad for the public." http://bmj.bmjjournals.com/cgi/content/full/331/7510/177 Competing interests: None declared |
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William G. Pickering, Doctor 7 Moor Place, Gosforth, Newcastle upon Tyne NE3 4AL
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"In good faith" The president of the royal college of paediatricians and child health A.Craft was "surprised and disappointed" at R.Meadow's fate. The media asked him why. [1,2]. "Because", said Craft, as though informed by a species of medical logic, "he gave his evidence in good faith". The royal college's bulging scrapbook of newspaper cuttings of paediatric debacles will surely include, for instance, the Cleveland and Bristol Affairs. Their leading actors and actresses would, like Craft, perhaps proclaim that they too had been acting "in good faith". It is a common justification and defence for elementary mistakes and aberrant actions both inside medicine and out, as school teachers and judges will well know. In neither situation is it an apology of course. No term better illustrates how impossible it is for some in the medical profession to admit error (and therefore address their never-ending endemic problems). Its use nicely defines the stark limitations of self-regulation. Note that it is subtly and deliberately different from doing something 'for the best', which term is, as here, even more obviously contradicted by awful outcome. William G. Pickering. wgpi@hotmail.com References: 1. Radio 4 News. 6pm. 15th July 2005 2. Channel 4 News. 7pm. Friday. 15t Competing interests: None declared |
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Giusto Giusti, Professor of Legal Medicina Rome 00133
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Right or wrong A case like the one that interested professor Meadows should never happen. I have no precise information on his conduct, and, in any case, I cannot enter a discussion on a decision of GMC. Therefore, my opinion cannot concern the case, but only general aspects of the responsibility of expert witnesses. Usually, before taking a disciplinary decision against a doctor, a medical council will wait until a judiciary and definitive decision is taken by a Court in a trial against the doctor. This seems to be a very reasonable position, because in a penal trial the accused can defend himself in the best way. I think that it is also questionable that a medical council can evaluate (and punish) technical viewpoints expressed before a Court. The problem of the professional responsibility of the expert witness is a very hard one, as it contains both the normal responsibility of the witness (of telling the truth), and the duty of giving an honest interpretation of facts. In penal cases, the “battle of experts” is a common event, and no expert is struck off the professional association for giving an opinion different from the one definitely accepted. Unless he do not tell the truth. I did not find in the medical legal literature a complete review of the responsibility of the medical expert, both from the disciplinary and the judicial viewpoint, but a short monograph on this topic is being prepared by professor Francesco Introna of Padua University. Competing interests: None declared |
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Stevie M Gamble, retired HMIT EC2Y 8BL
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Carmelo Aquilina, Consultant Psychiatrist, claims in his Rapid Response of 22 July that Meadow was struck off because of : ‘a single statement in Court’. His claim has no basis in fact. The GMC’s decision notes that it relates to: ‘expert evidence given in [Meadow’s] police statement to the Cheshire Constabulary in June 1998. This evidence was used again at the committal proceedings at Chester Magistrates Court in May 1999, followed by the Crown Court trial of Sally Clark in October 1999 for the murder of her two children.’ (1) Furthermore, those statements changed over time; the original police statement included Meadow’s one in a million claim, and by the time the case finally went to trial he had expanded that to one in seventy three million. (1) No reasonable person would describe a series of changing statements over a period of sixteen months as a ‘single statement in court’. I am sure that Carmelo Aquilina has no intention to deliberately mislead, and that his erroneous claim springs from his simple failure to actually read the GMC’s decision, but nevertheless his statement is grossly misleading. And the general public is unlikely to repose much in the way of confidence in a profession whose practioners seem oblivious to the entire concept of acquainting themselves with the evidence before forming an opinion. Stevie Gamble (1) http://www.gmcpressoffice.org.uk/apps/news/latest/detail.php?key=180 Competing interests: None declared |
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Jay Ilangaratne, Founder medical-journals.com
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Carmelo Aquilina says,"Professor Meadows whose distinguished and corageous career should have been considered in deciding the sanctions applicable..". In fact, the GMC had expressly considered such factors before applying the ultimate sanction of earsure. In the GMC's press release it is said[1]: "It paid considerable attention to the many medical colleagues who spoke or wrote on your behalf. It accepted that you have made great contributions over many years in your specialist field. However, it also considered the need to recognise the public interest and the need to maintain public confidence in those who give evidence to the courts as well as the crucial need for judges and families throughout the country to be confident that those medical practitioners who give evidence before the courts have complied with the accepted duties of an expert. This you failed to do." Further, in disciplinary hearings before the GMC, three interests fall to be weighed in deciding what sanction to impose[2]: "(a) public confidence in the medical profession; (b) the public interest in retaining the services of a doctor with considerable abilities and commitments; and (c) the interests of the doctor in not having his career cut short". It appears Prof Meadow had failed to impress the GMC on each of the above,thus the recommendation of erasure. References [1]http://www.gmcpressoffice.org.uk/apps/news/latest/detail.php?key=180 (accessed 25 July 2005) [2]Wentzel v GMC[2004]EWHC 381 (Admin);para.22. [http://www.bailii.org/cgi- bin/markup.cgi?doc=/ew/cases/EWHC/Admin/2004/381.html&query=Psychiatrist+GMC&method=all] Competing interests: None declared |
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Brian Morgan, Freelance Journalistg Cardiff CF11 6LF
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I will defer to my media contacts at the General Medical Council (GMC), but as I understand it, GMC hearings operate to exactly the same standards as a criminal court, allegations must be proved "beyond reasonable doubt". I have given evidence at a GMC hearing, and believe me witnesses are given a hard time - the professional future of the doctor is at stake - just as the freedom of an accused is in the criminal court. I've been there too, it's in the public record, and the case against me was thrown out. The case against Meadow wasn't. What might be helpful is if Professor Giusti would relate experience in this general medico-legal domain in his own country. Another (medical) academic assured me many years ago that the concept of Munchausen's by Proxy does not exist in Italy, it was some time ago and this is pure recollection. But children are taken to doctors with exaggerations of symptoms in order to make sure they are seen and if it's necessary, treated. Here, social workers might be called in. Of course times may have changed in Italy - what is the situation now? Competing interests: None declared |
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Barrington Johnson, consultant (medical) Oxford
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My understanding of this is that the GMC has struck Meadow off because his statistics were inaccurate, and that the statistics were biased by his belief that more than one infant death is highly likely to be non-natural. I attended an expert witness training workshop where a (very) senior barrister explained to the naive medics that the law is not about justice, it is about who has the best story. And the best story wins. The role of the expert witness seems to have been misunderstood by many of the participants, not least the defendants, one of whom commented that "he decided this without even meeting the family". The assumption was that the expert was there to judge (i.e. be right all the time) rather than to give an opinion (a view of the events informed by education and experience). As an expert witness, you are paid for your opinion, which may be right or wrong. As each side in a trial may have its own experts, it is unlikely that they will all be right. There are a lot of very shonky expert witnesses (guns for hire), even though the expert is supposed to be providing an opinion for the court, rather than for one side or the other. The validation for the expert's opinion comes from education and experience, together with their peer-reviewed contributions to the subject in question. If an expert witness produces a flawed opinion, it is up to the court to challenge and discredit that opinion. It seems that the reason doctors resent this action from the GMC is that it is felt that Medicine (in the form of Meadow) is being blamed for the Law's failings. This is compounded by the view that the GMC is complicit in this. Rather than bow down, it would be pleasant to see the leaders of the Royal Colleges take some action. A good start would be recommending that their members do not take part in such legal proceedings until the role of the expert is sorted out. I also resent having my medical defence subscription wasted by this pointless action. I think a GBP 10,000 premium for expert witnesses would do the trick nicely. It is time for our leaders to make themselves known. Competing interests: None declared |
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