Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Professor Southall should appeal and we should support him.
- ted willis (15 December 2007)
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Proof
- B Mucci (19 December 2007)
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Unfair Decision by GMC
- Jerold F. Lucey (22 December 2007)
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How to investigate complaints
- David M B Hall (23 December 2007)
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read the transcripts...
- David Bell (24 December 2007)
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The Transcripts exonorate Southall
- Robert Wheatley (27 December 2007)
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Are we reading the same transcripts ???
- david bell (28 December 2007)
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Further reading
- John M Bridson (30 December 2007)
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Re: Are we reading the same transcripts ???
- Robert Wheatley (31 December 2007)
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Spin doctors
- Penny Mellor (7 January 2008)
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Response to open letter
- Professor Sir Graeme Catto, NW1 3JN (17 January 2008)
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Re: Response to open letter
- Penny Mellor (19 January 2008)
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Re: Response to open letter
- leonard h p Williams (20 January 2008)
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Less Than One Percent
- Brian Morgan (20 January 2008)
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Re: Re: Response to open letter
- William G Pickering (21 January 2008)
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Response to Professor Catto
- John Bridson, on behalf of Professionals Against Child Abuse (www.paca.org.uk) (24 January 2008)
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Re: Response to Professor Catto
- William G Pickering (25 January 2008)
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Re: Re: Response to Professor Catto
- Jonathan R. James (27 January 2008)
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Re: Response to Professor Catto
- Penny Mellor (29 January 2008)
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GMC-is it fit to practise
- james f kirwan (8 February 2008)
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the GMC's analysis of the transcripts is vindicated in the court of appeal
- david bell (26 May 2009)
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Re: the GMC's analysis of the transcripts is vindicated in the court of appeal
- Penny Mellor (27 May 2009)
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A reply for Mr Bell
- Rob Wheatley (29 May 2009)
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A question for Dr Wheatley
- Penny Mellor (29 May 2009)
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The High Court judgement
- david bell (2 June 2009)
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ted willis, gp Brigg North lincs
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What an astounding and disturbing letter. The accounts of the GMC action that i had seen had not mentioned these astonishing facts. The GMC found prof southall guilty on the basis of an one persons unsupported allegation, which was contradicted by an independent witness! This was despite the clear evidence that he was the target of a campaign of persecution. So much for justice. And if this is proof to a criminal standard, the mind boggles as to how the burden of proof can be lessened! The government and the media want to give doctors a kicking, but it isnt necessary for Prof Catto and his ilk to help them by sacrificing honest doctors like Prof Southall just so they can keep their jobs. I dont know the fitness to practice panel can sleep at night having destroyed his career, and in the process destroyed child protection work. After Prof meadows case - in which the GMC was overturned by the courts at great expense- and the MMC disaster, and with zero respect within the profession, Prof Catto should resign and let someone better qualified take over the GMC and 'support doctors and protect patients'. Pigs might fly - so we should all cease to pay for our own so called regulator. Competing interests: 'member' and funder of the GMC |
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B Mucci, Consultant Radiologiat Southern General Hospital, Glasgow G51
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This article is indeed disturbing for the future of child protection. However even more disturbing is the level of proof used to “convict” in this case. If this could occur when beyond reasonable doubt is the mark what hope has anyone if this is changed to balance of probability? The GMC must be forced to maintain, and use the criminal level of required proof. They hand down sentences as draconian as any criminal court. Competing interests: None declared |
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Jerold F. Lucey, Professor and Editor of Pediatrics University of Vermont 05405
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I find the recent GMC decision regarding Dr. David Southall incredible. How could this happen? The public owes a great deal to Dr. Southall. His landmark study demonstrated beyond all doubt that apnea monitoring could not predict Sudden Infant Death. This stopped a bogus industry in the USA and saved millions of dollars. His article, published in Pediatrics, used videotaping of hospitalized children being brutalized by parents, led to the conviction of these parents. This technique is now used in the USA. He should be winning prizes for his accomplishments and honored for his work. He has, instead, been hounded and vilified by a group of parents (MOMA) on the Internet and in court. These efforts have gone on for over a decade. The legal system, in England, has been a total failure. It should have defended him. It has not. It is a disgrace. A guilty parent, when asked if they killed their child, is bound to get angry. To put normal parents on a committee is totally unfair. I would expect them to identify with the mother and feel sorry for her. They don’t realize how convincing an abusive parent can be! The person who deserves sympathy and a fair legal trial is Dr. Southall. Competing interests: None declared |
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David M B Hall, emeritus professor retired
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Editor - In his open letter to the president of the General Medical Council (GMC) about the case of David Southall, Dr Wheatley refers to a previous enquiry conducted by “a panel far better qualified and more competent than your own on child protection issues”. I was responsible for setting up the panel to which he refers. As president of the Royal College of Paediatrics and Child Health I was asked in 2000 to assist David Southall’s employing Trust in their investigation of complaints in respect of his child protection work, by putting forward names of paediatricians who would be willing to review and report on his practice. In a letter to the Trust and subsequently in a journal article (Arch Dis Child 2003;88:557–559 , I set out the principles which I believe should govern such investigations. The investigators must be unbiased and have no rigid a priori opinions on the key issues. Actual or perceived conflicts of interest arising from, for example, previous clinical or research collaboration, or ethnicity issues, should be avoided. To protect the interests of the investigators, the trust and the employee, at least two investigators should be involved, with at least one working in a similar setting to that of the doctor being investigated. They must declare any complaints currently against themselves; and they must be thoroughly briefed about terms of reference, indemnity, and the status and ownership of their report. In this case, after consultation with senior colleagues, I concluded that the task needed not two but three paediatricians in view of the size and complexity of the review and the public interest in the issues. Our unique knowledge of our specialty enabled us to nominate three individuals who brought to their task in total over forty years of experience in child protection work. Of course, Colleges are not disciplinary bodies and our College never saw their report as this was confidential to the Trust; however, I was told that Southall’s employers considered it to be authoritative, balanced and useful and they subsequently reinstated him. Many members of our profession say they have little confidence in the GMC’s Fitness to Practice panels and there is much anxiety about the move to a civil standard of proof. The GMC rules, which are approved by the Privy Council, state that no specialist expertise is required in any of the panel members; instead, the panel relies on “evidence” from “experts”. It follows that the confidence of the profession in the panels’ adjudications depends to a considerable extent on how the GMC’s experts are recruited. Perhaps confidence would to some extent be restored if the GMC were to adopt a more transparent approach, similar to that of our College, when gathering expert evidence and opinion. David Hall, Professor emeritus of community paediatrics, University of Sheffield; hon. professor, University of Cape Town. d.hall@sheffield.ac.uk Competing interests: None declared |
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David Bell, academic nottingham ng7 2rd
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the inference of this letter is that the GMC took the word of the parent, over the contemporaneous notes of a witness (the social worker, Salem), and David Southall. This would be a very serious charge, if it were true. The transcripts of the GMC hearing reveal a different story. David Southall's own notes, and subsequent action points, made absolutely clear that he explored in depth the possibility that the parent had killed her child with the parent. Southall's account agrees in several aspects with the parent's account. If Salem's notes fail to record this, then that must give cause for concern. The cross-examination of Salem was also interesting in the points it raised. If I recall correctly, it was put to her that she knew that the death of the child had been investigated by the police and the coroner, and it was put to her that she knew that re-investigation of the child's death was a matter that was reserved for the police and was ongoing, and that consequently, it would be wrong for her to undertake an investigation into the death of the child. As I understand it, David Southall was tasked with providing a medical opinion on the welfare of a second, live child. He was not tasked with reviewing the death of another child, although he did so. I write in a personal capacity. Competing interests: None declared |
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Robert Wheatley, Consultant Community Paediatrician Blenheim House Child Development and Family Support Centre, 145-147 Newton Drive, BLACKPOOL, FY3 8LZ
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David Bell suggests that reading the transcripts would reveal why the GMC reached the verdict they did in this case. He is sadly very mistaken, as the whole point of my letter was that the transcripts point the opposite way. It was never in dispute that Professor Southall raised with Mrs M the possibility that actions on her part might have lead to her first childs death. What was in dispute was how he did it, and why. As to how, the evidence available suggests very clearly that it was done sensitively and professionally. As to why, perhaps Dr Bell, like the (unqualified) GMC panel, fails to understand that the Social Services Department is a statutory investigating agency in its own right, quite separate from the police. In this case, it is clear, that in keeping with standard good practice, Social Services and the Police were conducting a joint investigation. There was no serious evidence presented to the contrary; nor under the circumstances would I expect there to be. The primary aim of the investigation was the protection of Mrs M’s second child, and so, as is normal practice in such cases, Social Services took the lead in the investigation. The Social Services Department instructed Professor Southall; he very clearly indicated to them ahead of the interview the areas he would be covering during the interview. If, as the lead investigating agency, they felt that there was anything in this which might compromise any other parts of the investigation, they could have objected, or suggested changes. They did not. In no small part, the areas to be covered were important areas which had been missed in the earlier enquiries into the first childs death. As such, it was absolutely appropriate that they be raised, and essential to gathering the best possible evidence base to best protect the second child. My letter was based on my reading of the voluminous transcripts of this case. The charge against the GMC is indeed a very serious one. It stands. Competing interests: Author of the original letter |
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david bell, academic ng7 2rd
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Dr Wheatley wrote: "It was never in dispute that Professor Southall raised with Mrs M the possibility that actions on her part might have lead to her first childs death." This is euphemistic. Professor Southall recorded: “The third possibility was that Mrs (redacted) had killed M1. A discussion ensued about this including the concept that at 10 years old it would be quite difficult to deliberately suffocate or asphyxiate M1 and then pretend to hang him. Probably some form of sedation would be involved.” Salem's documentation records a discussion with Mrs X about the possibility "3. That he was murdered." I can understand why the GMC relies upon this evidence to find beyond reasonable doubt that Southall accused the mother of murder. Dr Wheatley wrote: "In this case, it is clear, that in keeping with standard good practice, Social Services and the Police were conducting a joint investigation. There was no serious evidence presented to the contrary;..." this conflates the investigation of the live child, with that of the previously deceased child. As the transcripts reveal (http://jonathangornall.squarespace.com/southall2007day18/), in respect of the deceased child: "Dr Solomon asked whether the investigation was a joint one with social services under child protection or was it criminal, to which Steve Martin [the police officer] replied that it was a criminal investigation." although Salem disagreed with the implications, it is clear that evidence was presented that the investigation of the death of the first child was a matter for the police. Finally, the death of the deceased child had previously been investigated, as per the GMC- "At the inquest the coroner had recorded in his verdict that he had considered suicide and accident but in the event he returned an open verdict. It is apparent that no evidence was presented at the inquest to suggest that murder was a possibility." Competing interests: None declared |
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John M Bridson, retired Paedoatrician Home , Barnsley S73 8ER
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It is true that the GMC panel believed a parent who was already upset with Professor Southall over his actions in the child protection investigation of her family, rather than believe Professor Southall and a senior independent social worker. However, Mr Bell needs to not only read but understand the transcripts and therein lies the problem. To understand child protection investigations requires experience and special knowledge and this is where the GMC and its panel went wrong. Here are the precise charges made against Professor Southall as put forward by the GMC in their charge sheet: 4. On 17th March 1998 you were instructed by the local authority to prepare an assessment/report for them in the care proceedings. Such report was to cover Child M2 and his family: Admitted and Found proved. 5. a. For the purpose of preparing your assessment/report you interviewed Mrs M on 27th April 1998, Admitted and Found proved. b. During the course of such interview, you accused Mrs M of drugging and then murdering Child M1 by hanging him: 6. Your actions set out in 5b above a. were inappropriate b. added to the distress of a bereaved person c. were an abuse of your professional position The terms of the direct accusation of murder were set out in the evidence of Mrs M at Day 2 page 14D and Day 2 page 18D. On any view it was a graphic allegation. This is what Mrs M stated that Dr Southall is alleged to have said: “I put it to you that you killed your son by injecting him, hanging him up, leaving him there to die and then ringing the ambulance.” Mr Bell then writes: "The transcripts of the GMC hearing reveal a different story. David Southall's own notes, and subsequent action points, made absolutely clear that he explored in depth the possibility that the parent had killed her child with the parent. Southall's account agrees in several aspects with the parent's account. If Salem's notes fail to record this, then that must give cause for concern". It is absolutely correct that Dr Southall explored the possible mechanisms for Child M1's death, but he denies ever making the accusation outlined above. The fact is that in child protection investigations, possible explanations for injuries or deaths in children have to be explored as part of a section 47 inquiry. If Mr Bell had read all of the transcripts he would have been aware that Ms Salem's handwritten and immediately typed notes of the interview with Mrs M also recorded the 3 scenarios put to Mrs M. (Day 17 pages 64-66) which included 1. Accidental/experiment 2. He decided to kill himself. 3. Murder.” so his comment that Ms Salem failed to record this is incorrect. Analysis of the transcripts from day 17 pages 52 to 57 show that social services, who were the lead agency in a section 47 inquiry in to the family, were clear that it was appropriate for Professor Southall to raise issues about the death of M1 with the mother regardless of the involvement or otherwise of the police investigation: in fact he had explained that this would be his intention to the senior social worker before the interview. Day 12 pages 19-24 , Day 17 pages 52 to 57. Competing interests: Coordinator Professionals against Child Abuse (PACA) Chair of Trustees, Childhealth Advocacy International (CAI) |
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Robert Wheatley, Consultant Community Paediatrician Blenheim House Child Development and Family Support Centre,145-147 Newton Drive, BLACKPOOL FY3 8LZ
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Yes, we are reading the same transcripts, even from the same source. Whilst you are on Mr Gornall’s excellent website (www.gornall.info) can I commend “Opposing Evidence”, accessed from the homepage, which gives a clear and concise exposition of the injustice of Professor Southall’s first GMC hearing. Where we differ is that I actually have some understanding of the processes involved, having to work with them on a daily basis. It was never in dispute that Professor Southall raised the possibility of Mrs M having killed her son M1, this was in the context, as noted, of that being one amongst other possibilities. I would not call that “accusing Mrs M of murder”, still less the colourful and legalistic discourse claimed by Mrs M: “I put it to you that you killed your son by injecting him, hanging him up, leaving him there to die and then ringing the ambulance.” The open verdict recorded at M1’s inquest is just that – open, with insufficient evidence presented to record any verdict. In any case, there was significant subsequent evidence which the inquest could not possibly have known; not least of which was the pattern of “history repeating itself” which had so justifiably alarmed Mrs M’s hospital employers. As to the issue of the “on/off” murder inquiry into M1, this is beset by technical errors. First of all, a murder inquiry would in no way remove the need for a joint inquiry taking place – indeed it would reinforce its need where there is a surviving child (such as M2). A false dichotomy has therefore been introduced by the prosecuting counsel. Secondly the charge clearly implicit (though carefully never actually stated) in this line of questioning is that David Southall deliberately acted in a way which obstructed a murder inquiry – a serious charge indeed and one which I would have expected to be addressed in the courts, not the GMC. In this context, a single exchange lifted entirely out of context from the middle of the minutes of a strategy meeting is not “serious evidence”. A statement from the police to this effect would be, and would not be difficult to obtain, but is curiously missing. Other evidence clearly suggests that the police were not actively pursuing a murder inquiry – not least the fact that the parents were successful in overturning an Interim Care Order in respect of M2; I can think of almost no better ground for the maintainence of such an order than the existence of an ongoing active murder inquiry into the death of a sibling, where the mother is the main suspect! However, at the end of the day, the exact state of play of the relationship between the Social Services and Police arms of the inquiry is of little significance. Prof Southall was instructed by a legitimate statutory investigating agency, and checked out his intended course of action with them before he proceeded. It is not his fault if they were in error about the investigating intentions, or requirements of their investigating partners. As to the idea that he should have somehow not addressed M1’s death at all, this is plainly wrong given that it was the similarity between the circumstances surrounding M1’s death and M2’s (then) current situation which had given rise to concern for M2’s safety in the first place! It is clearly apparent that this urgently needed to be addressed; and in the absence of any actual police action on this point, it is entirely reasonable that Prof Southall should address it. Competing interests: Author of the original letter |
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Penny Mellor, Campaigner - legal researcher Home WV9 5HX
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Dr Wheatley you are wrong, I did not get involved because of CVS and furthermore the use of CVS started in 1984 at the Royal Brompton and ended, according to Southall, in 1994 at Stoke, three years before I became involved. Do I like Southall's use of CVS? No and I will give a cogent explaination as to why later in my response. David Southall was also found guilty of storing 4,500 files away from the main body of the original files that were not accessible to anyone else. This includes the removal of some 2,500 medical records from Royal Brompton up to Stoke, of course there is no mention of that in any of the rapid responses is there? Further to that, not only did he not let anyone know about these files, when it was put to him, during the hearing, that he was bound by both civil and criminal procedural rules regarding disclosure, he stated that unless somebody asked for them by name he would not hand them over?? Of course that's behaviour that is acceptable from a doctor isn't it? (day 12) There's all this tosh about the panel not being "qualified" to undertake such a difficult task, has everyone forgotten that there was an expert in child protection who gave evidence and that during the hearing, when questioned about the storage of files relating to child protection this is what Southall himself stated. Day 16 for anyone interested in actually reading the bits that don't suit the theory: Question by Ms Lloyd "lay person" Q Finally, again when you were asked a question yesterday by a fellow Panellist you mentioned the Children Act 1989. A Yes. Q That was a major piece of legislation, and I just wondered whether you were familiar with the Children Act and whether you were familiar with any reference to record keeping requirements in that legislation. A The context in which I mentioned the Children Act was in response to Mr Simanowitz’s question, I think, about the interview process which was in the Family Court arena, that is in the best interests of the child, nothing to do with criminal proceedings or anything else. I think it was for that reason. That was encompassed in great detail by the Children Act, the fact that social services and their agents like me would and could do those kind of interviews as part of child protection procedures, accepting that this is not criminal proceedings, and anything that we elicit may or may not be usable. With regard to record keeping, I would have to look at it. The Children Act document, if I remember, is quite big, and I cannot remember now if there is anything in it. It is an interesting question to look at and I think it is worth looking at, but I have not done so and I do not know the answer. The phrase "if I remember" is telling is it not, indicating that David Southall has NOT kept abreast with procedures relating to child protection himself, because the Children Act 1989 has very specific guidelines regarding how child protection records are to be kept, ones that are updated as the laws in this country evolve and David Southall didn't bother reading them yet has the audacity to state that "others were not qualified to ask him the appropriate questions" SECTION THREE RECORD KEEPING, INFORMATION SHARING AND CONFIDENTIALITY 3.1 Record Keeping: 3.1.2 Records should be clear, accessible and comprehensive. Judgements made, and actions and decisions taken should be carefully recorded. Where decisions have been taken jointly across agencies or endorsed by a manager, this should be made clear.[1] Lord Lamming found that Victoria Climbie and many other such children died as a direct result of lack of communication between the agencies, if important records pertaining to a child are being withheld in a file marked SC and they are not accessible, that means David Southall did not follow child protection procedures as underpinned by the Children Act 1989 - there isn't enough space in the BMJ for me to highlight further departures from the guidance, however a THOROUGH read of the transcripts will elicit that truth. [2] Finally I will move onto CVS (Covert Video Surveillance) Dr Wheatley claims that the parents recruited into CVS were "apparently normal, "loving" parents," they were not, by any stretch of the imagination, normal parents. Table Four in the CVS paper [3] shows that 22 out of the 39 parents/carers placed under CVS had already been diagnosed with a personality disorder prior to being recruited into CVS. 22 had already had significant involvement with social services, including investigations for suspected abuse. Of even more concern is the fact that table 2 shows that three of the "parents" were just 16 years old when the index child was born and as the age range of the babies was on average around 6 months, the oldest being 33 months (table 3), I have to ask where the duty of care lay? Did David Southall place a "child" as the parent, under CVS? If he did, then there is a clear breach of any sort of ethics because which "child" was their priority? Does Dr Wheatley condone this? The means justifies the end? Does Dr Wheatley condone placing mentally ill parents, some of whom may have been children themsleves, under CVS to "see what will happen"? I wonder what those that claim shaking a baby can do feel about the lack of intervention - they knew mother was getting more and more irrate and the baby was in danger, yet they just sat and watched and did nothing until it was too late - do I really need a cogent argument? Does this not speak for itself? The actions of these doctors is deplorable, THEY placed the baby in harms way. Does Dr Wheatley condone the following extract from the CVS paper? Case 24, 3-Month-Old Girl Day 1 Time, 12:44 PM: CVS began. 14:02 PM: the mother slaps the infant's head. 14:03 PM: repeated. 14:09 PM: repeated. 14:53 PM: the mother tears up the nursing record and throws it out of the window. 14:58 PM: the mother swears at the infant, accusing her of being responsible for them having to remain in hospital. There is growing anger, with the mother repeatedly ordering the infant to kiss her. The interaction is as follows: "Give me a kiss you, little sod, give me a kiss."Kiss! Kiss! Kiss! Kiss! "Kiss mummy ... ... mummy." (The mother gives the child a kiss.) "More, more, more." (Stimulates vomiting or spitting.) "Come on, come on. Mummy, mummy, mummy, mummy!" (Bounces roughly.) "I'm sick of it, sick of it, bloody sick of it. All the bloody time, mummy, mummy, mummy. "Stinking mummy, mummy, mummy." (Bounces roughly on knee.) "Give me a kiss, give me a kiss" (Shakes roughly.) (Indecipherable; raising volume, single screamed words.) (Mother then calms slightly, cuddles child briefly.) "Rock a bye, rock, rock a bye." (Holds child up by her arms.) (Indecipherable) "Dance, dance, dance." (Shakes, lifts by arms, sings.) Time, 15:01 PM: the mother roughly patted the child's face 14 times and then presses her hand forcibly against the child's face in an unusual way. She then started to shake the infant like a doll. 15:02 PM: the mother deliberately and forcefully bent back the infant's left arm at the elbow. The force used led to the elbow going well beyond 180 degrees. The infant started screaming. The mother pressed the nurse alarm call button. When the nurse came in, the mother stated that the child had caught her arm in one of the toys attached to the cot as she was trying to lift her. The child was examined by a doctor who was unsure as to whether there was a fracture and indicated this to the mother. Unfortunately, the mother was then left alone for 30 seconds, and again she forcibly bent back the child's left arm at the elbow causing her to scream. (See reference 23 for additional comments on this case.) 15:06 PM: surveillance ends, mother separated from child. I don't believe that any doctor would not be disturbed by the lack of intervention in this and some of the other cases, even more worrying, I have evidence from this case that shows that the concerns were so great prior to this mopther being placed under CVS that she was already being monitored on the ward by nursing staff. [1] http://www.northamptonshire.gov.uk/NR/rdonlyres/BDEBDE21-376F- 454E-ADA7- CE93B5B1E3FE/0/SectionThreeRecordKeepingInformationSharingandConfidentiality.pdf [2] http://www.rcgp.org.uk/pdf/ISS_SUMM03_09.pdf [3] http://pediatrics.aappublications.org/cgi/content/abstract/100/5/735? maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=david+sout hall&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec =relevance&resourcetype=HWCIT Competing interests: I campaign against false allegations of child abuse. |
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Professor Sir Graeme Catto, President General Medical Council, NW1 3JN
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The open letter to me from Dr Wheatley (BMJ 15th December) makes a number of statements about the case of Dr David Southall. Dr Southall has appealed to the High Court and it would be inappropriate for me to comment on the case at this stage. But I am very concerned about Dr Wheatley’s conclusion that paediatricians will not be fairly dealt with by the GMC. This is wrong; and it is not borne out by the facts. It is important that Dr Wheatley - and those in PACA who agree with him - do not allow their unhappiness over this particular decision to create an unjustified perception that there is a problem with the regulatory system for doctors. By overstating the case, critics of the GMC are running the real risk of creating the very problem they say they want to address. They are fuelling a perception that the GMC is somehow bent on unfairly persecuting paediatricians involved in child protection work. Nothing could be further from the truth. GMC fitness to practise panels are conducted according to very strict guidelines which are published on our website. Every panel sits with a legal assessor, an experienced lawyer whose statutory duty is to ensure that the procedures operate fairly. Doctors can also appeal to the High Court; as Dr Southall has done. Paediatricians attract complaints to the GMC like other doctors. Between April 2006 and December 2007, we received 8,400 complaints to our fitness to practise procedures. Our records suggest that eight of those complaints were about paediatricians involved in child protection work. Of those seven were concluded following investigation, without referral to a fitness to practise panel. The eighth doctor entered into voluntary undertakings related to their health. Furthermore, it is extremely rare for a paediatrician to be referred to a fitness to practice panel in connection with their child protection work. Since 2004, fitness to practise panels have considered more than 600 cases. Only two could reasonably be said to have been about paediatricians involved in child protection. We agree it cannot be in the public interest if doctors are inhibited from acting to protect children, or deterred from giving evidence honestly and truthfully, and within their competence. But equally it cannot be in the public interest, or the interests of the medical profession, if the GMC does not act when doctors practise incompetently or inappropriately. Competing interests: None declared |
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Penny Mellor, Campaigner/legal researcher Home WV9 5HX
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Professor Catto gives us some statistics that fly in the face of the statements being made in the press by newly formed groups such as PACA, (professionals against child abuse - http://paca.org.uk/category/press- release/ )about the alleged "witch hunt" against child protection paediatricians. 8,400 complaints to the GMC, only 8 that relate to child protection, that's less than 1%, hardly a concerted campaign. Furthermore just this week ADC published research undertaken having interviewed paediatricians regarding this very problem and this is what they found [1]: "The current difficulties facing paediatricians working in child protection have already been well document.1–3 Studies have shown that as well as causing significant stress and psychological morbidity,4 complaints against UK paediatricians in relation to a child protection issue are becoming increasingly common.5 A survey of members of the Royal College of Paediatrics and Child Health (RCPCH) found that 13.8% of over 4500 respondents had been subject to a total of 786 complaints about child protection and that the number of complaints per year had increased from less than 20 in 1995 to over 100 in 2003.6 Although worrying, the finding that the number of child protection complaints rose fivefold in 4 years needs to be set in context. Over this same period there were still almost twice as many paediatricians with a non-child protection complaint against them, and information from the Medical Defence Union shows that complaints to the General Medical Council increased almost 15-fold between 1990 and 2003, an annual rise of 33%.7" The bottom line here is that a) you run a much higher risk of being referred to the GMC if you DON'T work in child protection and b) that the rise in complaints are statistically compatible with the way in which the public are now unaccepting of bad practise, whether that be in retailing or medicine. What is even more disconcerting about the research was the claim that "Paediatricians clearly feel under pressure from other agencies to make a firm decision about the cause of an injury, whilst being acutely aware that the evidence base behind any particular signs and symptoms may be weak. For instance, the challenges of aging bruises13 and the controversy regarding retinal haemorrhages in "shaken baby" syndrome14 have made professionals more vulnerable to complaints. The ambiguity of signs leads paediatricians to seek further tests, advice or second opinions and complaints can arise when the initial suspicion is not confirmed, with innocent parents clearly aggrieved that non-accidental injury (NAI) was even considered. A difference in opinion between clinicians can also lead to the complaint that the paediatrician lacked the expertise in making a diagnosis of NAI." [2] What agencies? And if a doctor is not sure then that is exactly what they should say! I guess if you shout long enough, often enough and loud enough, then people will fall for the rhetoric. It is the child protection paediatricians themselves that have created this problem, nobody else, they are undermining their own profession, which in turn leaves children at risk. How noble. [1]Archives of Disease in Childhood 2008;93:4-6; doi:10.1136/adc.2006.099838 [2]http://www.inthenews.co.uk/money/news/property/top-10-consumer- complaints-$1187973.htm Competing interests: I am a campaigner against false allegations of child abuse |
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leonard h p Williams, consultant paediatrician Bassetlaw DGH, a81 0bd
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Professor Catto's analysis needs comment. Prof Catto must accept that the GMC's decision about Professor Meadow was incorrect. The High Court overturned the GMC's decision stating that the GMC's judgement 'approached the irrational'. The Court of Appeal confirmed the High Court's action. Prof Meadow is still described as 'disgraced' and 'discredited'.Perhaps Prof Catto would like to state that it was the GMC that erred. Some readers may not realise that the 8 paediatricians that Prof Catto says were referred to the fitness to practice procedures were only a fraction of those actually referred to the GMC. The fitness to practice procedure is not the start of the GMC process but is a hurdle along the route. It would be useful if Prof Catto told us exactly how many senior paediatricians had been referred to the GMC because of their work in child protecton. A survey by the Royal College of Paediatrics and Child Health (1) in 2004 reports that 86 complaints about 76 doctors were referred to the GMC, albeit over a longer time period. Paediatricians were shocked when Prof Meadow was struck off. The actions against Prof Southall have greatly increased that alarm because Prof Southall seemed to be doing exactly what he should according to the goverment guilelines and indeed the GMC's own advice. These two men are the cream of the chld protection professionals and it is no wonder that the rest of us look on with alarm at the actions of the GMC. PACA is not 'creating the very problem it wishes to address' by highlighting this issue. PACA was formed only as a re-action to the actions against Professors Meadow and Southall, not before. Paediaticians need the support and understanding of the GMC but the GMC must understand the difficulties and complexities of child protection. They must not be a tool for understandably aggrieved parents. Their jugdement must be based on the principle that the needs of the child are paramount. They must be competant to understand the paediatrician's action from the point of view of the child. 1. Child protection complaint survey. London:RCPCH, 2004,available from http://www.rcpch.ac.uk/Health-Services/Child Protection/Child Protection Publications Competing interests: None declared |
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Brian Morgan, Freelance Journalist CF11 6LF
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"8,400 complaints to the GMC, only 8 that relate to child protection, that's less than 1%, hardly a concerted campaign." Certainly less than 1%, actually less than 0.1%. It would be interesting to see a breakdown of complaints against different specialities within the medical profession. When is the body that helps train and support paediatricians going to address the issue of false positives (and importantly negatives) in the assessment of whether there has been Non Accidental Injury or other forms of alleged deliberate harm against children by carers? It's been 13 years since a group of falsely accused mothers publicly asked the BPA as it then was to carry out such an investigation (in respect of infant breathing disorders). I and many other journalists were there, I have a recording of the press conference where this happened. If the BPA, led then by Professor Meadow, had offered to help these parents we would I suggest not be where we are now. Competing interests: I report on these issues for television and am paid for this work. |
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William G Pickering, Doctor 7 Moor Place, Gosforth, Newcastle upon Tyne. NE3 4AL.
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Partisanship in medicine, and its outcome. Dr L Williams, in connection with the actions of recently reprimanded paediatricians, writes: The GMC “must not be the tool of understandably aggrieved parents”. Who should then? Who should act for “understandably aggrieved parents”? In his haste to defend his own species, he conspicuously leaves that question unanswered. Should it be MPs (as at Cleveland)? [1]. Should it be the press or the police as in other paediatric horror stories. Either he or other priests in the Royal College of Paediatrics and Child Health should tell “understandably aggrieved parents” who will help them. To imply all child protection problems contain “difficulties and complexities” penetrable only by paediatricians is as terrifying and mystifying a claim to some doctors, as it is to many mother’s and grandmother’s who have been on the receiving end of paediatric edicts (but who were reunited with their children in the end). Who then? Tell those parents and patients Dr Williams. When “understandably aggrieved” by paediatricians (or by any other person in or around the UK health services come to that), to whom should they turn? [2,3]. William G. Pickering. 21.1.08 wgpi@hotmail.com 1. Butler-Schloss (Lord). 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. London: HMSO, 1988. (Cm 412.) 2. Pickering W G. Systematic clinical accountability is required BMJ, Nov 2003; 327: 1109. 3. Pickering W G. Glasnost and the medical inspectorate. J R Coll Gen Pract 1988; 38: 517-8. Competing interests: None declared |
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John Bridson, Paediatrician & Chair of 'Professionals Against Child Abuse' Childhealth Advocacy International, Nottingham, NG1 5BB, on behalf of Professionals Against Child Abuse (www.paca.org.uk)
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We are pleased that Professor Sir Graeme Catto states that “nothing could be further from the truth” regarding the “perception that the GMC is somehow bent on unfairly persecuting paediatricians involved in child protection work”. However, despite the GMC making a similar response last year to the Guardian newspaper (2nd April 2007), following our own article in Pediatrics (1), a recent GMC panel in David Southall’s case produced a perverse and erroneous determination, as outlined in part in the original article by Dr Wheatley and the subsequent responses. We do not consider therefore that the GMC’s statement is yet reflected in their actions. The GMC actions have included: • a failure to acknowledge that they were wrong in stating Professor Meadow’s “conduct was ‘fundamentally incompatible with what is expected by the public from a registered medical practitioner’, given that Mr Justice Collins considered this conclusion “approached the irrational”. • a failure to recognise that Professor Meadow’s professional activity was about child protection – he was called as a witness in the criminal case because of his expertise in sudden infant death and infant suffocation, having been an internationally acclaimed expert in the recognition of Fabricated and Induced Illness. • a determination in 2004 that Professor Southall’s confidential contact with the police over a child’s safety was “precipitate”, reflecting a lack of understanding of the doctor’s and, indeed, the public’s duty to child protection. • a determination in 2007 that the testimony of an aggrieved parent that Professor Southall had accused her of murder was to be believed to a criminal standard of proof over the combined testimonies of Professor Southall and the senior social worker present at the interview, despite information available to the GMC and its panel which questioned the mother’s reliability as a witness. • a failure to recognise that a substantially more robust investigation (2) by Professor Southall’s employing trust 6 years earlier had found no basis for this allegation. • using Fitness to Practice panels where the members, medical experts and legal assessors have little understanding of the Children Act or of the roles of doctors in child protection and are therefore not qualified to judge the actions of doctors working within the child protection system. • undertaking investigations into the conduct of a number of other doctors acting in child protection cases, which have been either inappropriate, unduly prolonged, or a repeat of an investigation already undertaken either by an employing authority or other agency with statutory functions in child protection. • failing to have a policy and process for dealing with vexatious complainants. Professors Meadow and Southall are both internationally acclaimed experts in fabricated and induced illness, who have been targeted in order to discredit the recognition of this form of serious child abuse. We have seen these two doctors vilified in the media while the GMC undertake prolonged investigations to support the orchestrated complaints against them. Even some members in the Houses of Parliament consider Fabricated and Induced Illness a ‘discredited theory’. Yet paediatricians and others in child protection regularly recognise and manage such cases. ‘Professionals against Child Abuse’ was not set up to create a perception that there is a problem with the regulatory system for doctors. It was formed only recently as a response to the problems that the GMC actions are causing for doctors in their child protection work. Our professional duty is to ensure the effective protection of children. Whilst welcoming the GMC’s recent 0 – 18 years Guidance, we do not see representation of the child’s voice in the actions of the GMC against doctors who have acted in good faith on behalf of vulnerable children. References (1) Williams C. United Kingdom General Medical Council fails child protection. Pediatrics 2007;119:800–802 (2) Hall DMB. How to investigate complaints. BMJ Rapid Responses 23rd December 2007. http://www.bmj.com/cgi/eletters/335/7632/1265#187703 (accessed 19th January 2008). 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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Protest too much? The jeremiad of Dr Bridson will have forcibly struck many ‘understandably aggrieved’ parents [1,2,3]. When professionals deem one of their own has been “persecuted”, they call upon fresh paid-up battalions for prompt support and defence. Parents, by contrast, after interrogation and what they felt was “persecution”, can be subjected to professional indifference, and then left to beweep their forlorn state alone. Headed by Dr Bridson, this committee-produced letter has something of the cold politeness that parents might recognise. No outright accusations to the GMC of course, but thoughtful facts, dressed in the most caring and reasonable language. Neither hubris nor self-righteousness is permitted to pucker this carefully arranged article. The writers’ noble solicitude for their own species, and, of course, for children, is evident nearly to excess. “Doctors who have acted ‘in good faith’” was perhaps one slip in Dr Bridson’s letter [4]. “In good faith” can be mitigating: it can obscure the truth too — as magistrates, judges and policemen well know. Its use is certainly not equivalent to, or synonymous with, clinical accountability [5,6]. Are the GMC wondering why they didn’t take a closer look at paediatrics in the 1980s [7]? Their recent actions seem to have stiffened the attention of the slumbering Royal College: might such intervention have prevented countless subsequent paediatric disasters – of all varieties? Only time will tell whether it will alter one jot the future modus operandi of some paediatricians. William G Pickering wgpi@hotmail.com 24.1.08 References: 1. Bridson J. Response to Professor Catto http://bmj.com/cgi/eletters/335/7632/1265#188107, 23 Jan 2008 2. Williams L H P. Re: Response to open letter http://bmj.com/cgi/eletters/335/7632/1265#187892, 20 Jan 2008 3. Pickering W G. Re: Re: Response to open letter http://bmj.com/cgi/eletters/335/7632/1265#187939, 20 Jan 2008 4. Pickering W G. "In good faith" http://bmj.com/cgi/eletters/331/7510/177#112874, 23 Jul 2005 5. Pickering W G. Systematic clinical accountability is required. BMJ, Nov 2003; 327: 1109 ; doi:10.1136/bmj.327.7423.1109 6. Pickering WG. An independent medical inspectorate. In: Gladstone D, ed. Regulating doctors. London: Institute for the Study of Civil Society, 2000: 47-63. (Civitas). 7. Butler-Schloss (Lord). 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. London: HMSO, 1988. (Cm 412.) Competing interests: None declared |
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Jonathan R. James, Consultant Paediatrician Friarage Hospital, Northallerton, DL 6 1JG
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I meet many "understandably aggrieved parents" in the course of my work. The vast majority have either abused or been complicit in the abuse of their children. Sometimes their anger is directed at me for making a diagnosis they don't like. More usually they fall out with the entire multidisciplinary team in which I work. If they go on a crusade to complain about me or other members of the team it can be for a variety of reasons - for example, fear of prosecution, a failure to recognise their behaviour is abusive, personal pride. Unfortunately, it does not very often seem to me that a carer is protesting out of apparent concern for the child. If they "beweep their forlorn state alone" it is by choice. they have access to counselling through social services, their G.P. and the mental health team. What may get in the way of this of course is the discomfort of having to confront what they have done. It is rare for the removal of a child under a care order or the prosecution of a parent to depend enirely, or almost entirely on medical evidence alone. Where errors are made in child protection they tend to be collective and are far more likely to result in a child not being protected than in a parent being wrongly accused of abuse. Even after all the recent controversy I am still more concerned that I will figure in a serious case review after a child has been seriously injured or killed (the worst of all outcomes) than be hauled up in front of the GMC by an aggrieved parent. I will continue to follow GMC and College guidance and treat the child's interests as paramount. I hope for a successful outcome from David Southall's appeal after which the GMC will surely have to deal with the shortcomings it should have addressed in the aftermath of Roy Meadow's appeal. Competing interests: Named Doctor, Child Protection |
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Penny Mellor, Campaigner/legal researcher Home WV9 5HX
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Dr Bridson states the following in his response: • a determination in 2004 that Professor Southall’s confidential contact with the police over a child’s safety was “precipitate”, reflecting a lack of understanding of the doctor’s and, indeed, the public’s duty to child protection. David Southall was NOT found guilty of raising his concerns about a child, he was found guilty of failing to inform his trust, as per the undertaking he had given them not to involve himself in child protection. It was upheld on appeal by Justice Collins.[1] This is the very same Justice Collins that Dr Bridson relies upon in defence of Professor Meadow .... Dr Bridson also states that "• using Fitness to Practice panels where the members, medical experts and legal assessors have little understanding of the Children Act or of the roles of doctors in child protection and are therefore not qualified to judge the actions of doctors working within the child protection system" Does Dr Bridson now agree that if the above statement is his genuinely held belief, that all criminal trials involving complex medical and child protection matters, which are then placed before lay people who have little or no understanding of child protection procedures are miscarriages of justice? Will Dr Bridson concede that an expert witness, who is vastly experienced in child protection, gave evidence to the panel as to correct child protection procedures and that the panel were not coming to any decisions without expert input? David Southall was found guilty of several other very serious offences relating to the SC Files.[2] [1]http://www.bailii.org/ew/cases/EWHC/Admin/2005/579.html [2]http://www.gmc- uk.org/concerns/hearings_and_decisions/ftp/20071204_ftp_panel_southall.asp Competing interests: I am a campaigner against false allegations |
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james f kirwan, consultant ophthalmic surgeon portsmouth po6 3ly
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The issues brought up by Dr Wheatley and others really concern a fundamental problem with the GMC. As an organization is it fit to assess doctors fitness to practice? This case and others, show that in a rush to recover from prior criticism, the GMC appears to be unstable and is quite prepared to destroy the careers of as many doctors as required to exorcise the ghosts of Shipman, Bristol etc for it’s own survival. If a doctor behaved as the GMC does, would he be subject to a fitness to practice investigation? Competing interests: None declared |
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david bell, academic ng7 2rd
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Mr Justice Blake re-heard evidence as to whether the decision of the GMC to find David Southall guilty of serious professional misconduct was correct (http://www.bailii.org/ew/cases/EWHC/Admin/2009/1155.html), examining lines of argument similar to those deployed by Dr Wheatley (paras 41, 50). Justice Blake relied upon the transcript to find that the evidence of Salem (Paras 61, 64) and of Southall (paras 62-64) supported the claims of mrs M, and the GMC panel were fully entitled to reach the conclusions they did. If Dr Wheatley is arguing that "The Transcripts exonorate Southall", he is wrong. Justice Blake also appears to me to have a very different view of Dr Southall's remit and actions, compared to Dr Wheatley; he found that Dr Southall "was speculating on non-medical matters in an offensive manner entirely inconsistent with the status of independent expert." Finally, Dr Wheatley said that I am "sadly very mistaken"; Dr Bridson implied that I did not understand the transcripts. Would it be too much to ask for an apology ? Competing interests: None declared |
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Penny Mellor, Medico/legal researcher campaigner Home Wv9 5HX
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Mr Bell, You will not get an apology. David Southall has thus far been found guilty by two judges and two panels to a criminal standard of proof, yet they still cry injustice. A parent/carer need only be found guilty by one judge in a family court, to a probable standard of proof 51% or be tried by a jury of their peers, who are not experts in child protection either and the same Southall supporters cite these cases as being proven guilty. To quote the late JFK: The great enemy of the truth is very often not the lie -- deliberate, contrived and dishonest, but the myth, persistent, persuasive, and unrealistic. Belief in myths allows the comfort of opinion without the discomfort of thought. John F. Kennedy 35th president of US 1961-1963 (1917 - 1963) Competing interests: Campaigner against false allegations of abuse |
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Rob Wheatley, Consultant Community Paediatrician Blackpool
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Thank you for your communication. I am sorry to say that you remain, in my view, sadly very mistaken. That you have received such authoritative support for your mistakes is nothing short of a national disgrace, which could do untold harm, not only to children, but to all of us. It is deeply ironic that on the very day that Professor Southall lost his appeal, Ed Balls said, in response to another high profile case, “...the paediatrician... should act to put the child first and not be deceived by parents covering things up”. Indeed so. Unfortunately, in the real world, parents do not come to us conveniently labelled as “trustworthy” or “deceitful”. Perhaps they should. In the real world, those of us who have these responsibilities, those of us who actually have to do this work, inevitably have to ask awkward, uncomfortable and difficult questions of parents – many of whom will turn out to have done nothing untoward at all. But fail to ask those questions, take everything at face value, and you end up with another of the 200 or so children who needlessly die each year – like the tragic London toddler now known as Peter. What the transcripts show is that, as the Secretary of State would urge, Southall was trying to establish the truth as best he could. He did this in a manner which the only eyewitness present described as very sensitive and professional. It is also clear, that over the next couple of days, Mrs M was very upset at what had happened, and complained to her GP and her solicitor. This is understandable given the very difficult nature of the issues at hand. She very clearly felt that she had been accused of murder – this was indeed the substance of her complaint. That feeling, on her part, is not however evidence that she had – merely that that was her emotional reaction. The message given and the message heard are not always the same – especially in emotionally charged situations. It remains the case that the only eyewitness reinforces Southall’s case that he did not accuse Mrs M of murder, though he undoubtedly discussed issues around M1s death which included that possibility. This is a vital distinction; if we are to be forbidden from even raising the possibility of abuse with a parent (who will almost always feel accused by such a suggestion) we cannot do our job in protecting children. Which brings me back to my second paragraph. What Mr Justice Blake has done in upholding the GMC’s perverse decision is to create an incredibly dangerous precedent. He has upheld a judgement, supposedly to the criminal standard of proof, “beyond reasonable doubt”, which is directly counter to the evidence of the only independent eyewitness. This effectively means that eyewitnesses are redundant, and we are into voodoo law. In my (broader) profession, this means that the practice of having a chaperone for intimate examinations now offers no protection against false accusations of wrongdoing; whilst in other areas of life the implications are truly frightening. Justice Blake’s judgement will doubtless be welcomed by the very many ill informed armchair critics of David Southall and all his works, and by the campaigners who have been trying to achieve this for years. It is rather grimmer for those of us who actually have the responsibility of trying, as best we can, to help protect children. We’re used to having one hand tied behind our backs; now we have both. Competing interests: Author of original letter |
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Penny Mellor, As stated previously Home WV9 5HX
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Would you agree that part of the reason that Baby Peter died was the failure by the agencies to share information regarding child protection concerns, as has been found to be the case in the inquiries into his death? [1] If so, how do you reconcile that with this finding in David Southall's case with regard to information pertaining to the child not being available to anyone as it was hidden in files marked SC? "68. Further, I have no hesitation in reaching the conclusion that the panel was entitled to conclude that the integrity of medical records was compromised by Dr Southall’s practice of maintaining special cases files. It was apparent that there was insufficient internal sign posting to direct a person from the main medical files to the special files. The fact that the hospital’s records administrator was unaware of the existence of the special cases files, and what any available markings on the main medical files may mean is cogent evidence in this respect. The integrity of the records is vital not merely for future treating physicians but equally for medico-legal and related questions. If the records are incomplete without any signposting of that fact problems are likely to arise of the sort that did arise in the case of child H. Moreover, it was not necessary for the complainants to establish that future treating physicians had actually been misled by the state of the records, it was sufficient that this was a likely consequence of having incomplete records. In my judgment the panel was neither diminishing the criminal standard of proof nor reversing the burden of proof when it commented that it did not accept Dr Southall had made sufficient arrangements to prevent this consequence." [2] You see Dr Wheatley, you can't have your cake and eat it. All five cases at the GMC involved child protection, in four of the five there was an SC file, in two of those cases it was proven to a criminal standard of proof, not once but twice, that vital medical evidence was withheld from everyone. Not so dissimilar to the Baby Peter case is it? What do you think the result of that has been and, as a child protection doctor, why are you condoning such actions? (1)http://www.politics.co.uk/news/children-and-family/more-damning- criticism-of-nhs-over-baby-p-$1295236.htm (2)http://www.bailii.org/cgi- bin/markup.cgi?doc=/ew/cases/EWHC/Admin/2009/1155.html&query=david+and+southall&method=boolean Competing interests: Campaigner against false allegations |
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david bell, academic ng7 2rd
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According to Dr Wheatley, Justice Blake’s judgement is a “national disgrace”, and Blake has upheld the “GMC’s perverse decision ”. It is worth examining the arguments put forward by Dr Wheatley to see if they support these rather startling comments about a High Court judgement. The first argument seems to be that paediatricians are at risk from this judgement in their daily job; however, I can see no foundation for this argument in the judgement. In this case, Dr Southall was instructed to make an expert assessment of child M2, pursuant to the judgement of HHJ Tonkins. In fact, Dr Southall investigated the death of a different child, M1, whose death had already been thoroughly investigated; he did not have access to all the relevant information, he speculated in areas outside his competence as a paediatrician, he knew the police were re-examining their investigation of M1, but still he interviewed Mrs M about the death of M1- a decision that the Judge described as “surprising”. Justice Blake concluded, “the panel was entitled to conclude that the sensible guidance in [his] letter of instruction had been disregarded by Dr Southall. He was speculating on non-medical matters in an offensive manner entirely inconsistent with the status of independent expert.” The second argument is that the judgement runs counter to the evidence of Dr Southall and Ms Salem. This argument simply ignores those parts of the judgement which make plain that the written reports of Dr Southall and Ms Salem underpin the charge against Dr Southall (Paras 61- 65). For example, Dr Southall wrote, “Mrs M categorically denied asphyxiating M1 ...”, and the Judge remarked, “Thirdly, a categorical denial of this scenario is highly consistent with an allegation being put that leads to the denial. ... The categorical denial is also consistent with Ms Salem's typed notes of the interview in which she recorded Mrs M saying she would talk about the belt around M1's neck "if it cleared her name" and "as she felt she wanted to prove her innocence". No-one could have challenged her innocence apart from Dr Southall.” Dr Wheatley has stated that the transcripts exonerate Southall. The GMC and a High Court Judge both found that the transcripts provide evidence, beyond reasonable doubt, that Dr Southall committed serious professional misconduct. Competing interests: None declared |
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