Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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GMC has no clothes
- edmund willis (29 September 2008)
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Re: GMC has no clothes
- richard t steele (30 September 2008)
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Re: Re: GMC has no clothes
- Mark Struthers (1 October 2008)
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Author's response
- Jonathan Gornall (2 October 2008)
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Re: Author's response
- richard t steele (3 October 2008)
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Clarification
- John Bridson, members of PACA (3 October 2008)
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The injudicious apology
- Mark Struthers (4 October 2008)
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re Clarification
- Penny Mellor (4 October 2008)
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The GMC's Procedures and their enactment, in reference to Professor Southall’s hearing.
- Leonard Williams (17 February 2009)
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edmund willis, GP Brigg n lincs bridge street surgery, brigg, north lincs, dn20 8nt
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The GMC has obviously realised the damage they have done to the child protection system, and that is why they have lifted the restrictions on Prof Southall. Andrew Reid from the GMC isnt fooling anyone with his offensive and gratuitous comments about Prof Southall having 'learned' from the GMC proceedings. We have all 'learnt' that the GMC is a spineless poodle which was prepared to make a scapegoat of honest doctors in order to curry favour with the media and the government. Child protection has been damaged for decades, along with professional self regulation, but thats the price the GMC has paid to avoid abolition. But they have completely lost the respect of ordinary doctors. If they want to regain that respect - it would help if they either said sorry - or at least kept silent. Competing interests: None declared |
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richard t steele, retired gp 56 poolfield drive solihull B91 1SH
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Thank Goodness Prof. Southall’s appeal has been successful! May I as a retired GP venture into these muddied waters? I was incensed after reading “Three Doctors and the GMC” (BMJ 12/8/08) and wrote to the Director of the Department for Fitness to Practice at the GMC. I received a very informative and, I would add, kind answer from the Assistant Director. He pointed out that much time was lost because the complainants won an appeal at High Court (should this be allowed to happen?), forcing the GMC to start proceedings again. He emphasised the importance of reading transcripts in full before judging the quality of witnesses, expert or otherwise. As Jonathon Gornall omitted that important cause of delay, it is difficult to know what else has been left out of his report. I think Sir Roy Meadow and up to now, Prof. Southall received harsh treatment. I am unclear why the CNEP research was investigated in the first place (my MP is looking into that) but if anything good is to come out of these tragedies (from whatever perspective), reconciliation with the GMC is necessary. In addition to changes that are planned or already in place, that stem from these very public events, I would offer the following: That representatives from the various bodies within the medical profession (including research), together with the medical defence societies meet with the GMC on a regular basis and publish jointly on issues that lead to complaints. A panel of expert witnesses, selected and agreed by all parties, be drawn up and made available both for the GMC and the law courts. The new recommendations might also add attendance at an expert witness course, including as it does, practical experience in the witness box .Within the Forensic Science Service, this is mandatory. I would commend Theodore Dalrymple’s article in the Spectator (6/9/08) to those who wish to see this matter resolved. It sheds much light. A report from Holland in the 20/9/08 issue of the BMJ tells us that between 100,000 and 170,000 children there are abused annually including 50 deaths. Only 2% of those are reported by doctors. When it comes to gratuitous violence, are country can match anywhere in Europe. There is work to be done. Richard Steele MB Ch B Competing Interests - none Competing interests: None declared |
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Mark Struthers, GP and prison medical officer Bedfordshire
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Dr Richard Steele believes that Professor Sir Roy Meadow and Professor David Southall have been treated harshly by the GMC. Perhaps I may be permitted to take a contrary view. I believe that these two highly influential doctors have been treated with extraordinary leniency, bearing in mind the extent to which they abused their power and influence over others - matters found proven by the GMC. After the GMC's investigation of his complaint against Professor Southall, Sally Clark's husband Stephen said, "It is a sad day when a doctor is dragged before his professional body, is found guilty of serious professional misconduct and has sanctions imposed upon him. As a professional, myself, I take no satisfaction from it. However, as a father, the sole purpose of bringing my complaint, four long years ago, was to try to ensure that no other innocent parent is ever again falsely accused of harming their children." [1] Neither Sir Roy nor David Southall have ever apologised for their errors or for the enormous damage done to the Clark family. I wonder if Dr Steele could try to put himself in Stephen Clark's shoes and then consider whether he really believes that these two very important men of medicine have been unfairly treated. [1] Statement by Stephen Clark, August 2004. http://www.sallyclark.org.uk/Stephen0407.html Competing interests: None declared |
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Jonathan Gornall, Freelance writer London E1
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I really must take exception to Richard's Steele's unwarranted criticism of my article, "Three doctors and a GMC prosecution".[1] Contacting the GMC after reading it, he says he was told that much time was lost in pursuing the GMC case against Southall et al "because the complainants won an appeal at High Court". Some time was, of course, lost to this process, but it hardly accounted for the ten-year lapse between the original complaint being made and the GMC, on the basis of no additional evidence, perversely reversing its previous decisions not to proceed with the case. I would invite Dr Steele to imagine having spent the last 10 years of his career with such a sword hanging over his head. Dr Steele, whose initial outrage was, apparently, easily dispelled by the "kind answer" he received from the GMC, then writes: "As Jonathon [sic] Gornall omitted that important cause of delay, it is difficult to know what else has been left out of his report." Quite apart from the implied slur, it is simply not true to say that my report "omitted that important cause of delay". Indeed, it highlighted the extraordinarily tardy nature of the GMC process. I wrote: "In 2002 and 2004, preliminary proceedings committees of the GMC twice considered and rejected Mr and Mrs Henshall’s complaints. The Henshalls appealed and, in December 2005, the Court of Appeal ordered that their case be 'remitted to a reconstituted PPC for reconsideration.' A committee was duly convened in 2007 to consider their complaint again. This time it chose to refer the case to a full hearing. Nevertheless, it was not the case, as Mr Scott seemed to imply in an article in the Observer published shortly before the hearing began, that the GMC had been left with no choice." I can confirm that a great deal was left out of my report, chiefly as a result of advice from lawyers, but I can assure Dr Steele that none of it was favourable to the GMC. [1] BMJ 2008;337:a907 Competing interests: None declared |
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richard t steele, retired gp 56 poolfield drive solihull B91 1SH
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My apologies, you did mention the delay caused by the Court of Appeal but not in your opening statement. Of course I sympathise with Prof. Southall and his colleagues who lived under a cloud for 11 years. That they were subject two trials, as it were, smacks of double jeopardy. This was one of the reasons for asking my MP to investigate. The main thrust of my letter was to seek reconciliation between the profession and the GMC. There is a common purpose - to reduce the likelihood of complaints - better served if working in unison and perhaps that contact will create mutual understanding. I fully appreciate your final paragraph, I suspect those details will be a long time coming, meanwhile there is stagnation. Competing interests: None declared |
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John Bridson, Coordinator of PACA home S73 8ER, members of PACA
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PACA members wish to make it clear that the apology Dr Southall made at his recent hearing was not about the child protection significance of the episode of nose bleeding and difficulty in breathing described by Mr Clark in his own words on a television programme - an incident that had occurred in his 10 week old infant just 10 days before his sudden death. Dr Southall apologised about the language in his report, which was an agenda item for a meeting of professionals involved in the Family Court case, including Dr Southall, Professor David, who was acting as the instructed expert, and the child's solicitor. The phrasing Dr Southall used was regarded as injudicious by one of 5 child protection experts at the recent GMC fitness to practice hearing and as a result he apologised (only to Mrs Clark) because it damaged the message he was giving and because it was originally used by the GMC in 2004 to find him guilty of serious professional misconduct, thereby causing damage to child protection in this country. As indicated by the recent Fitness to Practice Panel they understood only too well the significance of the nose bleeding incident and stated as follows: “You have made various other expressions of regret but have not resiled from your view that the events in the hotel room could have indicated non accidental injury. The expert witnesses before this Panel have shared that view. Dr Williams stated: “I would have thought very very strongly that this must be looked into very carefully indeed.” The latest GMC panel was thus very clear and supportive regarding Dr Southall’s evidence on the incident of nose bleeding and difficulty breathing; they accepted his opinion as a result of what they heard from the 5 experts. The panel also dismissed the issue of Dr Southall’s failure to interview the parents, given that he was acting as an informant to the proceedings and not as an instructed expert. The transcripts are available on the PACA website www.paca.org.uk. Competing interests: None declared |
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Mark Struthers, General Practitioner Bedfordshire
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In her news article Clare Dyer tells us that Professor Southall “said he owed an apology to the late Mrs Clark for his assumption that if her husband had smothered Christopher he must also have killed Harry.” But Mrs Clark is dead. Dr John Bridson, coordinator of PACA, in his ‘clarification’ [1] indicated that the apology (only to Mrs Clark) was actually given for the following reasons, 1. The injudicious phraseology damaged the child protective message David Southall was trying to make. 2. The GMC used this injudicious turn of phrase to prove ‘serious professional misconduct.’ 3. In highlighting this injudicious wording, the GMC thereby damaged the business of child protection in this country. 4. One out of five child protection experts considered the Professor’s phrasing injudicious. Mrs Clark died in March 2007 at the age of 42, leaving her husband Stephen and their third and only surviving son. Would it not have been judicious to apologise to Stephen Clark who had been accused of murdering his two baby sons and whose complaint against the Professor had ultimately been upheld as ‘serious professional misconduct’ by the GMC? Dr Bridson infers that the Professor’s injudicious use of language has damaged child protection in this country. There are thus many others, young and old, who deserve an apology. Would it not be judicious to apologise to them? [1] John Bridson. 'Clarification'. Rapid response 3 October 2008 Competing interests: None declared |
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Penny Mellor, Campaigner medico/legal researcher unremunerated Home WV9 5HX
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This FTP hearing at the GMC was a review into Dr Southall's fitness to practice in child protection following on from a ruling in the Court of Appeal by Justice Collins. The GMC REVIEW panel do not legally have the jurisdiction to: a) Accept into the hearing "new evidence" with regard to the findings of original hearing in 2004 b) Go behind the findings of SPM from the 2004 hearing The law is very clear - if you want to appeal a legally binding decision ratified by the Court of Appeal, then you do it in the Court of Appeal, not a GMC FTP REVIEW hearing. John Bridson conflicts of interest: Gave evidence on behalf of Dr Southall GMC hearing 2007 Chairman of David Southall's Charity childhlath advocacy international [1] http://bmj.bmjjournals.com/cgi/content/full/330/7497/920-b Competing interests: I actively campaign to prevent David Southall from practising child protection |
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Leonard Williams, Consultant Paediatrician Bassetlaw District General Hospital
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I appeared as an expert at the recent GMC hearing on behalf of Professor Southall at which it was decided to lift the sanctions that had been imposed in 2004. I was glad to be of assistance to the panel. The hearing was not about whether the 2004 panel had been right to impose those sanctions, only about whether those sanctions should now be lifted. I am pleased that the sanctions were lifted but I do, however, have concerns about the procedures of the GMC and about the enactment of these procedures which I would like to describe. I was aware of my duties as an expert both in writing my report and in giving evidence. I had read the GMC’s, “Acting as an Expert Witness ” and was aware of their instruction; “You must give a balanced opinion”.[1] I followed this instruction and had read the GMC’s 2004 determination about Professor Southall. In my written evidence, I followed the instructions given to me by the defence solicitor [Professor Southall's solicitor] that I should accept the determination of the 2004 panel. I did not therefore go behind that determination; I accepted and reiterated the criticisms made about Professor Southall. However, I supported the lifting of the sanctions that had been imposed on him because I believed that he had been right to report his concerns to the authorities. I believed the logic of his concerns was sound but I accepted that aspects of how he presented his concerns were “inappropriately worded.” In extracts of my written testimony, which is copied below, my criticism is quite moderate. However, in oral evidence, I was taken behind the 2004 determination, at times, by the barristers for both sides. At one point, I was shown an important letter written by Mr Wheeler that I had not previously seen and from which I will quote below. Having been taken behind the determination by the barrister, I was entitled to and did further moderate my criticisms. For instance, when asked at the hearing, "How serious a failing was it to omit the caveat stating that he had not read the reports about the child’s nose bleed?”, my exact words when I replied were: "I think, if I might, answer that by saying I wonder what the Judge would have said, if that had actually gone to Court? I think the Judge would have "tut tutted", a little like you - your eyebrows raised - when I made my (previous) comment" but "would probably not have distracted the Court with a discussion of it". When a witness changes his mind. A few days after I had given evidence, but before the hearing had finished, I was sent, unsolicited, information about the case that was new to me. It further changed my views about some of those critical comments that I had made about Professor Southall. The GMC’s report, “Acting as an Expert Witness,” states: “If, at any stage, you change your view on any material matter, you have a duty to ensure that those instructing you, the opposing party and the judge are made aware of this without delay.” I therefore knew I should write to the panel explaining this change of views. I copy the whole of that letter below. Dear Miss O’Rourke [for BMJ readers, Professor Southall’s barrister], I am contacting you because since the hearing about Professor David Southall at which I attended as an expert witness, I have been given further information that modifies some of the opinions that I expressed at the hearing. I am aware that I have a duty to inform the panel about this, as stated in the GMC’s document, Acting as an Expert Witness, section 13. The document states that I can do this by informing you. The new information that I have received is a full copy of the Medical Report written by Professor Southall (for BMJ readers, this Report was not in the public domain and I had not previously seen it) which he sent to Mr Wheeler (for BMJ readers, the solicitor acting for the surviving child) in response to Mr Wheeler’s letter of 15th August 2000. Mr Wheeler’s letter was read out to me at the hearing. It is the conjunction of the two documents that has forced me to modify my opinions. The full significance of Mr Wheeler’s letter had not been clear to me during the hearing (for BMJ readers, this letter had not been in the public domain and I had not seen it before I appeared at the hearing), because I had not been shown it in conjunction with the Medical Report. However, as a result of seeing both documents together it means that firstly I am now aware that Professor Southall’s report could not have been intended to be presented to Court and that the only people that should have read it were Professor David (for BMJ readers, Professor David was the court appointed expert acting for the surviving child and supporting Mr Clark in the care of that child), Mr Wheeler, and anyone else who would have been invited to Mr Wheeler’s meeting. Secondly, I see that Professor Southall has included cautions in his report of which I had not been aware. As these important documents are not in the public domain and I had not previously seen them, I wrote my expert’s report in ignorance of them. My prior knowledge of Professor Southall’s case is largely described in my Family Law article. The information I acquired was gleaned from various sources in the public domain, particularly the determination of the 2004 hearing published on the GMC website. In my report to the current hearing I stated: The report he wrote for court was criticised because it stated with near certainty that Mr Clark was responsible for the death of his babies, and because Professor Southall had not interviewed Mr Clark before submitting the report. The report was also criticised because he did not include a caveat stating that he had not read the medical notes. Further, at the time, Professor Southall was barred by his Trust from undertaking child protection work. Finally, his actions were described as precipitous. These statements were selected from the GMC determination. My interpretation of these statements was reported in two sentences which I then went on to discuss. Of them, I wrote: I would agree that the report was worded too strongly. It appeared to usurp the role of the judge by declaring Mr Clarke’s ‘guilt.’ Having read the two documents I must modify that opinion for the following reasons. 1) My statement above opened, “The report he wrote for court”. That is clearly inaccurate. Mr Wheeler’s letter could not be more clear. Professor Southall’s Report is to enable Professor David to write to the Court. Professor Southall’s report will not be presented to Court. Mr Wheeler’s letter makes plain that Professor Southall is “Ordered to produce his points of concern,” presumably by the Court. Mr Wheeler will “then form an Agenda and attend and Chair a meeting between yourself (Professor Southall) and Professor David.” The minutes of this meeting will be circulated to the other parties. The meeting with you (Professor Southall) will “enable Professor David to provide an Addendum Report for the Court.” His Report could not therefore usurp the role of the judge. It was never intended that a judge would see it. 2) My statement, “I would agree that the report was worded too strongly”, needs to be modified in the light of what I now read in Professor Southall’s Report. There are bulleted paragraphs in his Report that demonstrate his uncertainty. These paragraphs were not known to me and are not in the public domain. They are: • At the time Christopher was found dead, he was alone with his mother. The father was apparently attending a Christmas party. A neighbour described how he heard a commotion and gave the Clarke’s house keys he had to the ambulance men to allow them to gain access to the house. It appeared that the door was locked and that Sally could not find the key. And • When Christopher died, Mr Clarke was called from a party and drove down the motorway to the hospital in Macclesfield (which motorway?). Sally had been alone with the baby at the time he was found dead. The importance of these two paragraphs is that they show that Professor Southall is keenly aware of the weaknesses of his suspicions. He is aware that his suspicions are disproved if Mr Clarke’s absence is verified. Furthermore, Professor Southall provides the simple means to disprove his own logic. Thus these paragraphs demonstrate that the report is provisional, in that it would be inconceivable to present a report to Court that says, in effect, “I am sure of my facts, except that these facts may be disproved by simply following my advice of checking Mr Clarke’s alibi.” The Report discusses other medical causes of bleeding: • There are other causes of bleeding from both nostrils in an infant but they are much rarer than intentional suffocation. Other clinical indicators of a serious illness accompany the vast majority. One cause would be a disorder of the clotting of the blood, such as leukaemia. Idiopathic pulmonary haemosiderosis can produce the coughing up of blood but usually this occurs through the mouth or the mouth and nose together. Infants with this latter condition have progressive respiratory failure and evidence of multiple haemorrhages before dying. Bilateral trickling of fresh blood, described by Mr Clarke would not be in accordance with this diagnosis. It is important to note that a doctor did not ever see Christopher prior to his death, which would be incompatible with this latter diagnosis or any other medical causes of nose bleeding except for intentional suffocation. As such, it is a discussion of the likelihood of suffocation, albeit, coming down strongly in favour of that event. My opinion, that Professor Southall’s report is too strongly worded, is therefore modified by what I now know. The wording is somewhat too strong for a report to the Court, but it is not too strong for a discussion document for a colleague and a solicitor. 3) In my oral evidence I suggested an alternative explanation for Mr Clarke’s description of the events in the hotel room. I suggested that he may have elaborated or exaggerated the events in order to assist his wife’s appeal. That now seems to me to be incompatible with what Professor Southall says in his report: • The statement of Liz Cox backs up the reality of the ALTE and that it could not have been fabricated to help clear Mrs Clarke, since her first baby was still alive. [for BMJ readers, Liz Cox is a friend of the Clarks who appeared in the TV interview with Mr Clark. ALTE means acute life threatening event). I believe this means that Ms Cox states that she knew about the events in the hotel room before the first baby died. As such, I believe the alternative explanation I gave was wrong. In light of modified opinion there is a further clarification that I must make. Mr Tyson opened his questions to me by asking if I had read the transcripts. I answered “Yes, in parts,” or something similar. That answer was incomplete and I may have unintentionally misled the panel, leading them to believe that I had read Professor Southall’s Medical Report. What I had read are extracts of the transcripts that are in the public domain. However, I have never had access to the full transcripts and have therefore not been able to select important parts to read. I had not previously read the Medical Report. Yours sincerely, Leonard Williams. GMC number 1471371 Until recently I thought that the GMC’s barrister had objected to the letter being shown to the panel and that the Legal Assessor to the panel had advised that it was irrelevant, with the consequence that the panel never saw it, despite the efforts of Professor Southall’s barrister. However, in response to inquiries, the GMC alleges that this letter never came to the attention of the GMC’s barrister or the Legal Assessor or the GMC itself while the hearing was still ongoing. When invited to comment on Miss O’Rourke’s claim that it had, the GMC declined, stating that it was not prepared to enter into a discussion about “a concluded case”. In its final determination the panel made the following comments about the manner in which Professor Southall expressed his concerns: “The Panel has accepted your evidence that, whilst you were entitled to express your concerns and report your views, the language you used was “inappropriate”, “injudicious” and “too strong”; that you were wrong to present your report in the format you did; that you were wrong to use phrases such as “almost certain” and “beyond reasonable doubt”; that you should have made clear the information on which your report was based, and should have indicated your lack of access to certain information. The Panel has noted your recognition that use of injudicious language can damage the message a paediatrician is trying to put across, and your concern and regret that this is what happened in this case. You have also told the Panel that you went further than you should have in reporting your concerns. You stated that in similar circumstances you would now raise your concerns and stop at that. You have made various other expressions of regret but have not resiled from your view that the events in the hotel room could have indicated non accidental injury. The expert witnesses before this Panel have shared that view. Dr Williams stated “I would have thought very very strongly that this must be looked into very carefully indeed.” "[2] Comment • The panel accepted that Professor Southall was right to report his concerns to the appropriate authorities and that his action with regards to not interviewing the parents should not now be criticised. I applaud them for going behind the 2004 determination. The conditions on his registration were to expire on 16th December 2008 but the panel decided to revoke them with immediate effect. • The panel criticised the format of Professor Southall’s report and the injudicious use of words. I had quoted and reiterated the criticisms of the 2004 panel in my written evidence. I moderated that criticism in my oral evidence when I was taken behind the determination and again in the letter that I wrote for the panel after I was given the Medical Report. Unfortunately, the news report for the BMJ by Clare Dyer[3] and by most of the major media outlets covering the result of this Fitness to Practice Review emphasised the criticism of Professor Southall’s use of words and his apology rather more than the support he received from the experts and the panel. • The GMC’s instructions are clear and precise. If I change my mind about the evidence that I have given I must inform the judge. When I was given Professor Southall’s actual report, rather than the descriptions given of it in the 2004 determination, I wrote to the panel explaining that I had further moderated my criticisms of Professor Southall’s wording. • However the omission occurred, my letter did not come to the attention of the panel, the “judge.” The whole letter is copied above so that the reader can consider whether and, if so, to what extent what I had to say affects the passage I have extracted from the determination. • If the panel had seen my letter might they also have been less critical of Professor Southall? This would have been a declaration of support to those who practise child protection. References. 1. http://www.gmc- uk.org/guidance/ethical_guidance/expert_witness_guidance.asp 2. http://www.gmc- uk.org/concerns/hearings_and_decisions/ftp/20080921_ftp_panel_southall.asp 3. Clare Dyer News Southall is allowed to return to child protection work BMJ 2008;337:a1811: Competing interests: I am a member of PACA, Professionals against Child Abuse, and I received a fee for appearing as an expert witness in the 2008 Southall hearing. |
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