Professionals Against Child Abuse

Children are the most vulnerable members of society. Sometimes the very people who are expected to protect them place them at risk. It is then that professionals who work with children have a duty to protect them. PACA believes that vulnerable children need dedicated paediatricians, nurses, social workers, teachers and the law to protect them. PACA was formed in response to high profile cases against paediatricians at the General Medical Council at which it became clear that the present regulatory systems did not protect children and were open to abuse by those who sought to discredit professionals who stood up publicly for children's rights. PACA advocates for children's rights by campaigning for regulatory organisations to be trained in child protection, for the interests of the child to be paramount, and for professionals who stand up for children to receive fair treatment.

Press Release: Friday 4th July 2008

Following the Determination by the GMC Fitness to Practise Panel in the cases of Dr Spencer, Dr Southall and Dr Samuels that there is No Case to Answer

This decision must put to an end the longstanding allegations[i] that have been repeatedly quoted in the press regarding the CNEP trial[ii]. This whole process has led to cruel and unnecessary anxiety for those families who may have thought that their children had been given harmful treatment.

After hearing detailed evidence from the complainants, from 22 GMC witnesses and from three experts, the GMC panel concluded that there was no case to answer and abandoned its case. No evidence was presented to the Panel to show that any baby had been damaged by CNEP or by poor quality care. One independent GMC expert described the conduct of the CNEP trial as outstanding and another expressed regret that the longstanding media campaign has deprived children of a very promising treatment.

PACA considers that this case is a disturbing demonstration of how the GMC ignores the findings of previous investigations. The issues in this case had already been investigated by the doctors’ employing Trust[iii], the NHS Regional Office and Staffordshire Police. Professor Rod Griffiths concluded in 2006 that “CNEP did no more damage than any other treatment that might have been used to try and help these [sick, preterm] infants.”[iv] Others had previously stated that “the conduct of the CNEP trial was exemplary”[v]. Yet this is the third time the GMC have considered this complaint over 11 years and in doing so the GMC Panel acknowledged that delays in the GMC process had breached the human rights of the doctors under investigation as set out in Article 6 of the European Convention on Human Rights.

PACA is concerned that GMC reform has led to the pendulum swinging so far in the direction of protecting patients that the doctors’ rights are being abused and that this may deter those doctors who must act on behalf of the vulnerable child. The RCPCH passed a motion at its AGM in March 2008 expressing “grave concerns over current GMC procedures for dealing with cases related to child protection”. Whilst this Hearing was about a research study in newborn infants and not ostensibly about child protection, it is part of a pattern targeting doctors who have been involved in child protection. Two of these doctors had pioneered the use of covert surveillance to detect life-threatening child abuse. One of these, David Southall, is currently appealing his erasure from the medical register arising out of his child protection work. The GMC does not recognise vexatious complaints. These complainants are putting vulnerable children at risk by trying to discredit certain types of child abuse, particularly FII, and by recruiting the GMC to discredit those who make that diagnosis.

The GMC must reform its procedures to ensure justice for both patients and doctors and, in particular, to support those doctors whose duty is to protect vulnerable children.

Click here to download the transcript of the hearing - PDF file, 5.8MB

Footnotes

[i] Allegations of forgery, fraud and killing babies have been repeatedly made against medical staff over the last 11 years, led by the complainants in the Fitness to Practise Hearing concluded today.
[ii] The CNEP trial was a research study undertaken to examine whether the use of Continuous Negative Extrathoracic Pressure (CNEP) could help reduce the incidence of chronic lung disease of prematurity. It was carried out in two newborn intensive care units at Queen Charlotte’s Hospital, London and the North Staffordshire Hospital, Stoke-on-Trent between 1989 and 1993.
[iii] The North Staffordshire Hospital suspended two out of the three doctors from 1999 to 2001 for 20 and 27 months, whilst undertaking inquiries into their work in research and child protection.
[iv] Quote from Griffiths R. CNEP and research governance. Lancet 2006;367:1037-38.
[v] Quote from Hey E, Chalmers I. Investigating allegations of research misconduct: the vital need for due process. BMJ 2000:321:1-8

PACA has Early Day Motion in the House of Commons put forward by Daniel Kawczynski

“General Medical Council Complaints System - 10-06-2008

That this House believes that the General Medical Council’s (GMC) complaints mechanism fails to comply with standards of fairness and due process required by Article 6 of the European Convention on Human Rights; observes that the GMC’s role in investigating, prosecuting and sentencing falls below the standard required of an independent and impartial tribunal; notes that in practice the GMC represents the interest of parents in cases where doctors suspect abuse; further notes that children themselves have no independent representation to present a doctor’s concerns; further believes that no published guidelines appear to guide prosecution decisions and that, as prosecutor, the GMC amends and adds charges in an ad hoc fashion; considers that doctors are uncertain of the allegations they face, compromising their ability to mount a cogent defence; further considers that the GMC calls expert witnesses with clear conflicts of interest in the proceedings who are unrepresentative of mainstream practice or opinion, and that the GMC adopts a populist, punitive, deterrent and disproportionate approach to sentencing; further considers that the GMC’s apparently arbitrary admission and exclusion of evidence extends to ignoring the findings of previous investigations into a case conducted by an accused doctor’s employer; further believes that the GMC values the public perception and integrity of the profession above individual rights; and further observes that, contrary to basic principles of justice, the GMC appears to assume the guilt of doctors before it, and refuses to acquit when a conviction is impossible, instead finding ‘no realistic prospect of prosecution’.”

For the full article, please visit: http://edmi.parliament.uk/EDMi/EDMList.aspx

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Article cited with kind permission of onmedica.com

A recent OnMedica poll of 589 doctors has found that 74% disagree with the General Medical Council’s decision to remove paediatrician David Southall from the medical register.

Dr Southall was struck off the register in December 2007 after being found guilty by the GMC of serious professional misconduct. The GMC decided Prof Southall’s conduct in a case where he accused a mother of drugging and murdering her son was an abuse of position and fundamentally incompatible with his continuing as a registered medical practitioner.

At the time of the ruling, the Royal College of Paediatrics and Child Health spoke out against the GMC’s decision, and paid tribute to the major contribution to child health made by Dr Southall during a distinguished career.

Kamran Abbasi, CEO of OnMedica, said: “The GMC was criticised for its decision at the time of the ruling. This poll proves that a large majority of doctors agree that Dr Southall should not have been struck off. It is important that doctors are not deterred from undertaking child protection work.”

Dr David Southall was erased from the medical register in December 2007 by the GMC. As it turns out this action was against the GMC’s own rules about erasure and he has subsequently been restored to the register pending appeal. In response to this volte face PACA issued the following press release outlining the issues facing the GMC in their case against Southall.

PACA has had major concerns about the General Medical Council’s Fitness to Practice procedures in high profile cases of paediatricians who have led the way in child protection work. PACA considers the GMC’s actions have reduced the willingness with which paediatricians will report suspicions of child abuse and engage in child protection work, including acting as expert witnesses. PACA has attempted to engage with the GMC, but Professor Catto, President of the GMC, and Finlay Scott, CEO, have responded that PACA is “painting a misleading picture, thus adding to the very problem they say they wish to resolve”.
 
However, last week, PACA’s concerns were overwhelmingly supported by a motion at the Annual General Meeting of the Royal College of Paediatrics and Child Health. The motion listed the areas of concern (see below) and called for the GMC to review the Fitness to Practice procedures as a matter of urgency. They recommended involvement of the RCPCH, the Department of Health, Department for Children, Schools and Families, Social Services Inspectorate and National Children’s Bureau. Unlike the GMC, these bodies better understand the relevant legislation and practice.

PACA is now further disturbed by the announcement today that the GMC failed to comply with its own regulations when they applied an immediate sanction against Professor Southall, resulting in his inability to work as a doctor. The GMC’s sanction led to Professor Southall’s immediate suspension from clinical and charity work, including his honorary medical directorship of the aid agency Childhealth Advocacy International (CAI).  This sanction was applied in the absence of evidence that his clinical or CAI work had caused any harm and had in fact brought enormous benefits to patients.  As a direct result of this sanction, Professor Southall had resigned from his consultant post at the University Hospital of North Staffordshire. Furthermore, the actions of the GMC against him have seriously impaired CAI’s ability to raise funds for its humanitarian aid work.

At least the GMC’s have conceded that they had made an error, resulting in cancellation of the suspension. However, it compounds their existing inability to regulate judiciously in cases involving leading child protection professionals. Given the GMC’s inability to recognise their error in erasing Professor Sir Roy Meadow from the medical register, described by a high court judge as approaching the irrational, and apologise to him, we have little expectation that the GMC will move forward with an urgent review of its procedures, as voted for at the RCPCH AGM. It is now time that the GMC reviewed the sanctions and erasure that they applied to Professor Southall’s cases in 2004 and 2007 respectively. In the view of PACA, they were both incorrect judgements.

Currently the GMC will receive complaints from anyone (having no vexatious complaints policy) - it then investigates and prosecutes these complaints, sits in judgement on its own investigation and finally decides what penalty should be applied. This is hardly a fair or balanced process and certainly not one that fulfils a doctor’s right to a fair hearing under Article 6 of the European Convention. Our experience of the GMC responses to its errors lead us only to conclude that it is incompetent and disingenuous in the way it attempts to defend the indefensible.

——

Motion for RCPCH AGM – York University, April 2008

The College has grave concerns about the actions of the GMC relating to proceedings involving child protection work directly or indirectly. These actions include:

1. The GMC erased from the register one paediatrician acting as an expert witness in a case where two children had died and where the mother was tried for murder. The erasure was quashed by the High Court, but the GMC have not acknowledged that the erasure decision was wrong and have not satisfactorily explained why they consider it is not related to the child protection field. As a consequence, paediatricians have been deterred from acting as expert witnesses in cases involving child injury or death, many of which would be classified as possible child protection cases.

2. The GMC sanctioned a paediatrician for reporting concerns to the statutory authorities for child protection and, describing the doctors’ behaviour as “precipitate” and criticising his evidence-based opinion given in good faith, found him guilty of serious professional misconduct and suspended him from further child protection work. This contravenes the stated professional and public duty to report child protection concerns and the latest guidance issued by the GMC itself. As a consequence, paediatricians now feel less certain of the correct way to proceed and may therefore be less likely to report child protection concerns.

3. The GMC erased from the register a paediatrician who was exploring with a parent the mechanism of death of their child at the request of social services in the context of care proceedings. The parent alleged that the paediatrician had accused her of murder, despite evidence to the contrary from the senior social worker present who along with the paediatrician took notes throughout the interview. As a consequence, many paediatricians are now more reluctant to participate in child death reviews or indeed explore with parents possible mechanisms for sudden death.

4. The GMC have repeatedly relied on an expert witness known to have opposing views to the doctor being investigated and who had advised contrary to that doctor in the first of the above cases. This raises serious questions about the impartiality of this expert, particularly as the GMC did not use any other expert evidence. As a consequence, paediatricians feel that GMC hearings in the field of child protection have not had the benefit of truly impartial advice representing current mainstream professional practice.

5. The GMC have undertaken a number of investigations on paediatricians who have already been the subject of investigations by other bodies and have been exonerated. The GMC have not inquired about such investigations, or have failed to take account of these previous investigations. We consider that this represents double jeopardy and demonstrates an unfair and incomplete process. As a consequence, paediatricians have become less willing to be involved in child protection work, knowing it may result in multiple complaints and investigations.

6. GMC registered doctors working in other specialities, who were convicted of various crimes, including assaults on children and viewing child pornography (offences which would render them unemployable as paediatricians) have been reinstated to the register. As a consequence, paediatricians feel treated more harshly than other specialities by the GMC.

7. The GMC does not automatically inform the doctor when it decides not to proceed with a complaint. College members know that complaints in child protection are rising and are under extreme and often public stress when they receive such a complaint. As a consequence, paediatricians are poorly informed by the GMC of progress in their own personal case.

8. The GMC is unwilling to state whether it has received multiple complaints from the same person(s) acting as part of a campaign against factitious and induced illness, quoting data protection legislation. Paediatricians have been asking the GMC to develop a policy for dealing with vexatious complaints and serial complainants. As a consequence, paediatricians feel the GMC is not taking their concerns on board.

For the above reasons, the College continues to have grave concerns over current GMC procedures for dealing with cases related to child protection. We call upon the GMC to review these procedures as a matter of urgency and involve in the review this College and other bodies such as the Department of Health, Department for Children, Schools and Families, Social Services Inspectorate and National Children’s Bureau, who have an understanding of the relevant legislation and practice, in order to support continued quality work by paediatricians in this field to the ultimate benefit of children and their families.

It is becoming clear that children remain at risk if they do not have the protection and advocacy of professionals. There has been an increase in violent crime against children according to figures from the NHS as published in the Observer, April 20 2008 by Jo Revill, Whitehall editor.

Observer article: http://www.guardian.co.uk/society/2008/apr/13/childprotection.health

There are many reasons for this, but it is the view of PACA that one major contributory factor is the increasing reluctance of doctors and other professionals to risk bringing concerns about child abuse to light for fear of condemnation and censure. The Guardian has published an article about this “climate of fear” (April 13 2008 by Gaby Hinsliff, political editor) which has arisen consequent to the GMC actions against Southall, Meadow and San Lazaro. The consequence of this “climate of fear” may be that in another 5 years we will see a further tragic rise in assaults on children.

Guardian article: http://www.guardian.co.uk/society/2008/apr/20/children.nhs

The GMC feel that this is not their responsibility and continue to repeat the same reassurances about numbers of paediatricians brought to fitness to practice hearings. PACA feels that the GMC figures do not reflect the true impact of the high profile cases; nor do their statements reflect the RCPCH work on this subject, as evidenced by the numerous unfilled child protection consultant posts.

The Guardian article, whilst being very helpful in highlighting many of the concerns that PACA seeks to publicise, has been challenged by David Southall. Southall’s concerns relate to details of Finlay Scott’s statement and some assumptions made in the text of the article. He has written a letter to the Guardian explaining this which was not published but reads as follows:

In Harm’s Way - Article published in The Financial Times, April 7 2008
Writer: Margaret McCartney

Child protection is not a medical speciality for the faint-hearted. The people doing this work, typically paediatricians who have undergone focused training, can be subjected to abusive language, threatening telephone calls and worse. The tragedy is that child-protection work should be necessary at all, though of course it is, and doctors, nurses and social workers must all be aware of it.

Read the full article: In harm’s way?

Bearing Good Witness: The Reluctant Experts, by Catherine Williams, Reader in Law, Sheffield University
[Republished with publisher’s permission]

“In October 2006 the government launched a consultation document, Bearing Good Witness: Proposals for reforming the delivery of medical expert evidence in family law cases. The consultation closed in February 2007 and a summary of responses was published in July 2007. Prior to that, in a parliamentary statement on 17 June 2004, the Minister for Children, Young People and Families indicated that she had arranged for the Chief Medical Officer (CMO) to carry out an inquiry into how best to ensure the availability and quality of medical expert resources in court proceedings because there was an ‘acute problem … in finding experts of high standing to give medical evidence in proceedings’. She did not explain why this situation had arisen nor did she address the more acute problem. The unavailability of expert witnesses in proceedings is a symptom of the widespread reluctance of paediatricians, in particular, but also other professional staff, to be involved in child protection work in any respect. That reluctance was and is having a serious detrimental effect on the current arrangements for the protection of vulnerable children generally and will ensure that the narrower area of interest, that of experts being appointed for a specific purpose, will become even more difficult for want of the availability of sufficiently experienced professionals. The executive summary of Bearing Good Witness sets out the factors that, in the opinion of the CMO, deter doctors from being expert witnesses:

• few training programmes;

• court processes intimidating and stressful;

• court processes slow, bureaucratic and time consuming; and

• fear of referral to the General Medical Council (GMC) by vexatious parties.”[…]

To read the full article, please download it here

PACA letter to Safeguarding Children Boards, written 16th February 2008

“We are writing to you about the crisis in child protection following the decision in December by a GMC Fitness to Practise panel to erase Professor David Southall from the medical register. We are appealing to you as we believe that the effect of this case will be to deter paediatricians from acting in child protection matters. This can only place the most vulnerable children at even greater risk […]”
To read the full letter, please download it here

Letter 1: Open letter to the General Medical Council
In Views & reviews, BMJ 2007;335:1265 (15 December), doi:10.1136/bmj.39427.640069.DE

Dear Professor Catto,

I am writing to you as a designated doctor for child protection. As part of my responsibilities I am required to offer advice and guidance to doctors within my area about child protection matters. Unfortunately, in the light of the recent verdict against Professor David Southall, I feel I cannot fulfil that role responsibly; to do so would put both my and their registration at peril. We urgently need guidance.

I have struggled through the available transcripts of the 33 day hearing which culminated in this judgment. The judgment found that David Southall had inappropriately accused a mother of murdering her 10 year old child. Much of the case hinges on a complaint made by a Mrs “M.” As you are doubtless aware, there have been many such complaints made over the years against Dr Southall, almost all of which are linked to an energetic and committed, but deeply misguided campaign largely run by Penny Mellor. It is perhaps worth noting the commentary on her activities given by Mr Justice Whitburn, in sentencing her to two years imprisonment for her part in the abduction of a child: “Impervious to debate, convinced that you are right, you have traduced, complained about and harried dedicated professional people working in this difficult area. … What is unforgivable is the way in which you manipulated for your own, as I find, purposes, the genuine distress of the [XXXX] family.” The complainant in this case claimed minimal involvement with Mrs Mellor, though Mrs Mellor had contacted her.

It is also unsurprising that the complaints—along with Mrs Mellor’s obsessional interest—started around Professor Southall’s groundbreaking work using the technique of covert video surveillance. Using this technique, Professor Southall demonstrated beyond any possible doubt a very uncomfortable truth: that apparently normal, “loving” parents could and did inflict the most horrific and life threatening abuse on their helpless infants when they thought they were not being observed. To many, including many doctors and sadly even paediatricians, the emotional impact of this truth has been so great that they have retreated into a variety of forms of denial. It is, however, significant that, to my knowledge, not a single one of Professor Southall’s detractors has yet given any cogent explanation of how he or she would have dealt differently with these extremely difficult cases and still protected the lives of the children involved. Notably, one such detractor, Professor David,1 was the only expert witness called by the GMC in both this hearing and in the previous hearing, in which the GMC reviewed David Southall’s involvement in the Sally Clark case. He can hardly be claimed to be suitable as the only expert used at the hearing in the circumstances.

So incensed were Mrs Mellor and her associates, however, that over the years their campaign has grown to encompass almost every aspect of David Southall’s professional career. No stone has been left unturned, and his career has been examined in a detail that few doctors’ practices have ever been before. As a result of complaints generated by Mrs Mellor and her group, he has been subjected to at least 20 inquiries into his conduct and practice, including one into this very complaint, by a panel far better qualified and more competent than your own on child protection issues. North Staffordshire NHS Trust issued a public statement saying that there was no case to answer on any of the complaints. Your organisation is the only one to have found any serious deficiencies in his practice or conduct.

Which brings me back to your hearing. Fundamentally, Mrs M’s complaint relates to events in a closed room in a hospital in Stoke-on-Trent in 1998. There were three people in this room: Mrs M, Professor Southall, and Francine Salem, a senior social worker. Ms Salem made handwritten notes at the time which were clearly quite comprehensive, and which Mrs M accepted at the hearing as an accurate account of the meeting. These notes, and her sworn evidence given over three days at your hearing, clearly show Professor Southall acting entirely appropriately and professionally. Mrs M, however, claimed an almost diametrically opposing scenario, despite accepting that Ms Salem’s notes were accurate.

This leaves me, and the doctors I must advise, in an impossible position. If faced with a situation of possible child abuse, we could ignore it, contrary to all morality, good practice, government, and even your own guidance. This would obviously be wrong, but the evidence suggests that we are unlikely seriously to be sanctioned by your body for such dereliction of duty. Or we could, following good practice guidelines, raise our concerns with the child’s parents. Last week’s ruling, however, shows that even having the best of witnesses will not protect us against increasingly probable complaints. The message your body has sent out is loud and clear: challenge parents at your peril, you will have no conceivable defence.

But sadly it does not end with such dramatic undermining of good practice. From April next year, the government expects us to take part in a review of all children’s deaths. Reviewing the death of a child was what Professor Southall was doing here. It is clear that this important piece of government policy cannot operate while the GMC regulates any part of it. If uncorrected, the inevitable consequence of the incompetence of your Fitness to Practice Panel is that regulation of all “Safeguarding Children” matters must be withdrawn from you.

by R Wheatley, consultant community paediatrician, designated doctor for child protection. Child Development and Family Support Centre, Blackpool

Competing interests: RW worked alongside David Southall’s department in Stoke-on-Trent for about one month, as a registrar in paediatrics, and has been involved is research projects run by him.

References
-David TJ. Spying on mothers. Lancet 1994;344:133.[ISI][Medline
-BMJ 2008;336:231 (2 February), doi:10.1136/bmj.39471.702141.3A

Letter 2: Open letter to the General Medical Council
In Letters, BMJ 2008;336:232 (2 February), doi:10.1136/bmj.39472.786690.BE

How many doctors are referred for child protection work?

Catto’s analysis (previous letter) in response to Wheatley’s open letter needs comment.1 He must accept that the GMC’s decision about Meadow was incorrect. The High Court overturned the GMC’s decision, stating that the GMC’s judgment “approached the irrational.” The Court of Appeal confirmed the High Court’s action.2 Perhaps Catto would like to state that it was the GMC that erred.

Some readers may not realise that the eight paediatricians that Catto says were referred to the fitness to practise procedures were only a fraction of those actually referred to the GMC. The fitness to practise procedure is not the start of the GMC process but is a hurdle along the route. It would be useful if Catto told us exactly how many senior paediatricians had been referred to the GMC because of their work in child protection. A survey by the Royal College of Paediatrics and Child Health in 2004 reports that 86 complaints about 76 doctors were referred to the GMC, albeit over a longer time period.3
Paediatricians were shocked when Meadow was struck off. The actions against Southall have greatly increased that alarm because Southall seemed to be doing exactly what he should according to the government guidelines and indeed the GMC’s own advice. Paediatricians need the support and understanding of the GMC, but the GMC must understand the difficulties and complexities of child protection and must not be a tool for understandably aggrieved parents. Its judgment must be based on the principle that the needs of the child are paramount. The GMC must be competent to understand the paediatrician’s action from the point of view of the child.

by Leonard H P Williams, consultant paediatrician
Bassetlaw District General Hospital, Worksop S81 0BD

Competing interests: None declared.
References
• Wheatley R. Open letter to the General Medical Council. BMJ 2007;335:1265. (15 December.)[Free Full Text]
• Meadow v GMC [2006] EWCA Civ 1390
• Royal College of Paediatrics and Child Health. Child protection complaint survey. London: RCPCH, 2004.

Letter 3: Open letter to the General Medical Council

GMC statement does not reflect actions

Catto says that nothing could be further from the truth than the perception that the General Medical Council (GMC) is somehow determined unfairly to persecute paediatricians involved in child protection work (second letter). However, although the GMC made a similar response to the Guardian in April after our article in Pediatrics,1 2 a recent GMC panel in David Southall’s case produced a perverse and erroneous determination.3 We do not consider therefore that the GMC’s statement is yet reflected in its actions.

The GMC’s actions have included:

A failure to acknowledge that it was wrong in stating that 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 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 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 Southall had accused her of murder was to be believed to a criminal standard of proof over the combined testimonies of 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 by Southall’s employing trust six years earlier had found no basis for this allegation (first letter)4.
Using fitness to practise 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 in 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.

Both Meadow and Southall are internationally acclaimed experts in fabricated and induced illness who have been targeted to discredit the recognition of this form of serious child abuse. We have seen these two doctors vilified in the media while the GMC undertakes prolonged investigations to support the orchestrated complaints against them. Even some members 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 (PACA) 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’s actions are causing for doctors in their child protection work. Our professional duty is to ensure the effective protection of children. Although we welcome 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.

by John Bridson, chair
Professionals Against Child Abuse, Childhealth Advocacy International, Nottingham NG1 5BB

On behalf of Professionals Against Child Abuse (PACA) (www.paca.org.uk)
Competing interests: None declared.
References
• Williams C. United Kingdom General Medical Council fails child protection. Pediatrics 2007;119:800-2.[Abstract/Free Full Text]
• Boseley S. Guardian 2007 2 Apr. www.guardian.co.uk/society/2007/apr/02/childrensservices.uknews
• Wheatley R. Open letter to the General Medical Council. BMJ 2007;335:1265. (15 December.)[Free Full Text]
• Hall DMB. How to investigate complaints. bmj.com 2007. www.bmj.com/cgi/eletters/335/7632/1265#187703.

Article republished with permission from onmedica.com

Author: Dr Heather Payne, consultant paediatrician

Child Protection work is demanding, sensitive and often difficult, and generates much anxiety for all concerned – children, parents, and all professionals including Paediatricians.

If, like me, you deal with child protection matters on a daily basis, you probably, like me, spend a fair bit of time reflecting on how the process works, and whether it does what it says on the tin. It’s not protecting children to remove them from non-abusive parents. Neither is it protecting them to leave them with abusive ones. There are many things we know we don’t know, like the EXACT significance of fingertip bruising, or of a simple skull fracture attributed to a fall.

The truth is that some of these injuries will be accidental, but some will be NAI, and it can be extremely difficult to get it right in every case. Err in one direction, and a baby goes home to further risk of abuse and may come back dead. Err in the other direction, and enormous distress is caused by unnecessary hospitalisation of the child or removal to foster care.

Until recently, I had confidence that the Child Protection process, (based on many years of ‘Working Together’ [1] with Social Services, Police and other colleagues highly skilled in this field) would protect both me and the children it was put in place to serve. The deal, reinforced by the Laming Report [2], is this: when you see a child who MAY have suffered NAI, but you are not sure, then use the Child Protection procedures to involve other eyes and ears, share information and come to a collective decision about the risk to the child. I felt that there was safety in numbers (decisions taken with professional colleagues), and that this appropriate use of the ‘medical model’ would mean I could express concerns and get answers to tough questions like ‘Is it safe for this bruised child to be in this household tonight or should we remove to a safer place?’

But my illusion of safe practice has been shattered by two recent GMC decisions [3] about professional practice relating to the Paediatrician Dr David Southall. In direct opposition to the Laming recommendations, the GMC have adjudged that David Southall was wrong to share his concerns about a high profile child abuse case when he did not have the full information. But this is precisely what we are obliged to do under all Child Protection procedures, which use words to the effect that ‘if you have concerns that a child MAY be suffering abuse you MUST refer’. This reflects the reality, often called the ‘jigsaw of child protection’ that no individual has all the pieces, but requires the help of others to get the full picture.

When there is concern about abuse, it is vital to assess the risk to the child of remaining at home. This is especially the case when a child has died and there is therefore a risk to any other children of the household. High stakes and high pressure assessments are the name of this game. However hard I try to maintain professional calm, and however carefully I choose my words, it’s not unusual for stressed parents to construe my precise but neutral questions about how the child came by their injury as ‘an accusation that they have battered their child’. I had always thought that the presence of a social work colleague would protect me from this becoming a substantiated complaint, but the GMC have now discounted the stories of David Southall and a senior Social Worker who took contemporaneous notes, and believed a parent’s accusation that David Southall accused her of murder. He has been struck off and the protection I thought I had which allowed me to do this difficult work as well and conscientiously as I can, without the worry of losing my job, is no longer there.

Nobody wants to get it wrong in Child Protection. Children’s lives and happiness are at stake in the short term. But in the longer term, the average Paediatrician is already walking away [4] from work in areas where they feel they are a sitting duck for those who would ‘shoot the messenger’. Courts delays in child care cases due to the lack of Paediatricians willing to provide Expert Witness reports are already directly affecting the lives of children and their families.

The rock of Child Protection work and the hard place of these GMC decisions [5] has led to this situation. The rock will not go away, so the hard place needs to examine itself and see whether its decisions are justified and really serve children, or whether the GMC has fallen into the first trap of child protection that we warn trainees about – always listen to what the child is telling you rather than just the parent.

References

1 HM Government 2006 Working Together to Safeguard Children http://www.everychildmatters.gov.uk/resources-and-practice/IG00060

2 Lord Laming 2003 The Victoria Climbie Inquiry http://www.victoria-climbie-inquiry.org.uk/finreport/finreport.htm

3 Chadwick DL, Krous HF, Runyan DK. Meadow, Southall, and the General Medical Council of the United Kingdom. Pediatrics 2006;117:2247-2251

4 Haines L, Turton J. Complaints in Child Protection. Arch.Dis.Child. 2008;93:4-6.

5 Williams, C. United Kingdom General Medical Council Fails Child Protection. Pediatrics 2007;119:800-802