Poor process causes more injustice than poor professional practice

Two years ago the chief medical officer, Sir Liam Donaldson, in the course of a letter to every doctor in England and Wales, said that he doubted whether the public realised the extent to which “when things go wrong, the true cause lies in weakness within the system rather than the culpable actions of an individual.”1

One area where the British public sense that things have gone badly wrong is in the field of suspected child abuse. The quashing of Sally Clark's conviction for the murder of two of her children in January,^w1 and the collapse of the Crown Prosecution case against Trupti Patel in June,^w2 have shaken public confidence. In each case the issue at stake was whether it could be shown—beyond reasonable doubt—that a death originally certified as due to natural causes had, in retrospect, been caused by a parent. In each case suspicion only arose after a second child died. The Attorney General has now set up a review of these and other related cases,^w3 and the actions of individuals are under scrutiny. A landmark ruling in the Court of Appeal in the last week has also brought much needed clarity to the issue of whether children have a right to legal redress if decisions about their care are taken negligently.2

Sir Roy Meadow, a senior paediatrician with a life-time's experience of investigating cases of suspected abuse, was an expert witness in both the murder trials. A comment about the likelihood of unexplained sudden death claiming two young children in a single family formed part of his testimony in the first case. It went unchallenged at the …