Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Reluctant doctors
- CA Johnson (6 February 2004)
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Courage of your conviction ?
- Davina Hollisey-Mclean (6 February 2004)
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Re: Courage of your conviction ?
- Penny Mellor (6 February 2004)
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Paediatricians should not exceed their role and responsibilities
- Charles Pragnell (7 February 2004)
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The art of sophistry
- Mark Struthers (7 February 2004)
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Reluctance in Child Protection
- Ashok Beckaya (7 February 2004)
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Paediatricians reluctant to take on child protection work
- William Pimm (10 February 2004)
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reluctance to work in child protection
- munera I khan (13 February 2004)
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Re: reluctance to work in child protection
- Michael D Innis (14 February 2004)
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Re: reluctance to work in child protection
- Umesh Prabhu (14 February 2004)
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Re: reluctance to work in child protection
- CA Johnson (16 February 2004)
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Re: reluctance to work in child protection
- David Stevens (16 February 2004)
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Re: Re: reluctance to work in child protection
- Michael D Innis (17 February 2004)
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The ‘Infamous Five’ and saying sorry
- Mark Struthers (17 February 2004)
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Re: reluctance to work in child protection
- CA Johnson (17 February 2004)
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Re: Re: reluctance to work in child protection
- CA Johnson (20 February 2004)
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Re: Re: reluctance to work in child protection
- s m latta (20 February 2004)
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Re: Re: Re: reluctance to work in child protection
- Brian Morgan (21 February 2004)
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Recent Debate on the Role of Paediatrics in Child Protection
- Dr Lynne Wrennall (26 February 2004)
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Re: Recent Debate on the Role of Paediatrics in Child Protection
- Clive Davies (26 February 2004)
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Spinning a poor future for the children
- Lisa C Blakemore-Brown (26 February 2004)
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Re: Recent Debate on the Role of Paediatrics in Child Protection
- William Pimm (27 February 2004)
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Doctors or lawyers and judges?
- Brian Morgan (27 February 2004)
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An urgent need for a Public Inquiry
- Charles Pragnell (28 February 2004)
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Re: An urgent need for a Public Inquiry
- Davina Hollisey-Mclean (1 March 2004)
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Re: Re: An urgent need for a Public Inquiry
- Davina Hollisey-Mclean (2 March 2004)
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Re: An urgent need for a Public Inquiry
- CA Johnson (2 March 2004)
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The welfare of the child is paramount
- David A C Elliman (2 March 2004)
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Re: Re: An urgent need for a Public Inquiry
- s m latta (2 March 2004)
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Re: The welfare of the child is paramount
- Lisa C Blakemore-Brown (2 March 2004)
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Re: The welfare of the child is paramount
- Michael D Innis (2 March 2004)
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Re: Re: The welfare of the child is paramount
- James Noone (3 March 2004)
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Re: The welfare of the child is paramount
- CA Johnson (3 March 2004)
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The Welfare of the child is paramount
- Charles Pragnell (4 March 2004)
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We need to talk about this.
- Dr Lynne Wrennall (6 March 2004)
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Re: The Welfare of the child is paramount
- V J Smith (6 March 2004)
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Iatrogenic Abuse of the child
- Lisa C Blakemore-Brown (6 March 2004)
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Getting it all wrong
- Mark Struthers (20 March 2004)
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CA Johnson, Parent LA9
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The shame of this current situation is that it could have been avoided. Members of the public and key professionals have tried to draw the paediatric authority's attention to the problem of false accusations for many years. (1) If we've now got to the point of meltdown, who is to blame? Not the falsely accused parents, that's for certain. Nor the children. Nor those who protested to no avail. The medical establishment should have listened long ago; but perhaps it is not surprising that it didn't - after all, senior paediatricians such as Professor Meadow constituted that medical establishment. If the RCPCH is serious about restoring confidence, for both the public and the profession, there is a clear course of action: an immediate, full, open public inquiry; and the immediate right of all parents so inclined to have their cases reviewed in open court, with access to their own experts' testimony. It is in the profession's interests to press for this urgently, surely? Or the public will start to question its reluctance on that too. 1. BMJ Rapid Responses for Marcovitch: Cruel Brittania - despite 1997 Published concerns by a British Professional Psychologist - Lisa C Blakemore-Brown http://bmj.bmjjournals.com/cgi/eletters/324/7330/167/a#42898 Competing interests: None declared |
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Davina Hollisey-Mclean, Housewife and mother SA4 3DT
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What a pathetic lament! God forbid that a patient should challenge a doctor of any speciality. I would hope that the days of everyone treating doctors has Gods and never asking questions have gone. For the patient that is a good thing but for some doctors it is seen as an insult to their God like status, how dare us mere mortals question them or challenge them in any way. After all it is only OUR body, OUR children or OUR family that they are making decisions about. Yes Professors Meadows and Southall are to appear before the GMC. Yes, Dr Southall did, it is claimed catch mothers on video abusing their children (some experts who have seen the tapes question this claim) if the videos do show something though surely it doesn’t prove the existence of MSBP, what it does show is a parent abusing their child something that we all know is a tragic reality. Call a spade a spade, a cigarette burn is what it is, attempted smothering is what it is, physical abuse is what it is, mental cruelty is what it is. If child protection professionals had stuck to reality instead of going off into the realms of fantasy and “ The Emperors New Suit” the world would be a much safer place for the children and families of today, and maybe the research into cot death SIDS would be more advanced. There are vast sums of money to be made by doctors who are involved in child abuse, for their court reports and court appearances! So do the doctors of today not have the courage of their conviction? Which is the most important.? The safety of children or that a doctors decisions or allegations should not being challenged. From this report it would appear to be the latter. Something that I don’t want to believe! Competing interests: Courage of my conviction! |
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Penny Mellor, Advocate Home WV9 5HX
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Bang bang bang that is the sound of my head bouncing off a wall. May I remind Professor Craft that in 1994 BPSU conducted an inquiry into MSbP after concerns were raised to the then BPA, nothing was done. Yet another review was conducted in 1999 by both the RCPCH and the DOH and what happened?? NOTHING oh except to change the name of MSbP to FII a la Windscale/Sellafield. Not once were parents invited to present evidence, not once was a parent's offer to meet either the RCPCH or the DOH taken up and we are expected to go along with ANOTHER review. I don't think so. What we will have is fast track appeals in open court with doctors who specialise in the sub speciality relating to the child's disorder, as the RCPCH FII paper guidelines state, the ones NOBODY took any notice of and then we are having a public inquiry, to put this to bed once and for all, so that never ever again are children left as vulnerable as they are right now. As to being too scared to protect children?????? Oh please, what's more important? Let's get another thing straight, the WHOLE of the NHS is short handed not just paediatrics, it's just not fair to blame parents who have actually taken more stick protesting their innocence than any paediatrician for what is essentially a) a common crisis within the NHS and b) a problem that could have been resolved a decade ago For God sake paediatricians be accountable for what you have done and the part you have played, all we ever did was highlight the problem, the paediatric world created it. Competing interests: Convicted for my courage?! Anti MSbP campaigner |
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Charles Pragnell, Expert Defence Witness - Child Protection and Child/Family Advocate U.K./Australasia
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Is it an endemic syndrome among some paediatricians to use information and statistics to mislead rather than to enlighten?. Professor Alan Craft states that 30% of posts of `designated doctor’ are unfilled. That tells us nothing. If 50% of those posts were unfilled a year previously, then this is a vast improvement and contradicts Craft’s assertions about the reluctance of paediatricians to fill these posts because of the current crisis in paediatrics and child protection. In the absence of comparative figures from other years, I shall reasonably assume therefore that the position has greatly improved. Craft also claims that concealed video cameras provided graphic evidence of the existence of MSBP. Such video evidence showed nothing of the sort – arguably it showed a mother harming her child, and nothing more – has Craft not studied the RCPCH definition of MSBP?. Where was she `fabricating’ the child’s illness on the video?. Where was she inducing the child’s illness on the video?. Where was the evidence on the video that she was `seeking attention for herself’ from a paediatrician?. It is just this kind of misleading statistics and information which has brought paediatric evidence in child protection cases into disrepute. Instead of blaming others for its troubles, the paediatric profession should be examining how to put its own house in order. In regard to the covert video recordings, Craft would have been better engaged examining the legal, moral, and ethical issues raised by such covert video recording. Inflicting harm on a child is a criminal offence and the proper authorities to investigate such alleged offences are the police. So why were the police not doing the video-recording or at least participating in such recording?. If for example, this mother had been known to have, or was suspected of having, harmed her child on a previous occasion, would the setting up of this video-recording scenario be viewed by a Court as entrapment?. Where were the child protection workers whose role and responsibilities it is to investigate whether, or not, a child has been harmed?. Further legal matters arise from the data protection issues. Video recordings come within the meaning of data under the Data Protection Act and would be included in the hospital's Data Protection Registration. The Act requires that the collection of data must be done fairly and lawfully – how could these covert video recording be seen as being fair and lawful?. Presumably, Craft has seen the video recordings. Was this with the data subject's knowledge and permission?. Is the public disclosure of data obtained in this way included in the hospital’s data protection registration or was this a breach of privacy and confidentiality?. In a New Zealand television documentary, one of the mothers who was the subject of the covert video recording claims she was filmed while dressing and undressing. Is there not a morality issue here?. There are clearly matters regarding these covert video recordings which would warrant a very close examination of the hospital’s data protection registration by the Data Protection Registrar. It seems that this demise in paediatrics has been brought about by a small number of paediatricians who have grossly exceeded their expected roles and responsibilities in child protection procedures, by seeking to act as crime investigators, social workers, expert statisticians, and psychiatrists. Does this not raise ethical issues?. I would suggest that any paediatrician who confines their involvement in child protection matters to their own very specific and invaluable role and responsibilities and within their expected expertise, will have no problems whatsoever and I would further suggest that the vast majority of paediatricians are doing so (i.e. the 70%), and are not experiencing any problems of the kind which Craft is highlighting. So there is a final question as to whether Craft is, as he claims, speaking for the entire paediatric profession or is merely seeking to defend a very small minority from the consequences of their highly questionable and discredited actions in child protection matters. Competing interests: Concerned to reform a grossly dysfunctional Child Protection System in the Best Interests of Children |
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Mark Struthers, GP HMP Bedford
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Professor Allan Craft, current president of the Royal College of Paediatrics and Child Health, thinks that paediatricians are demoralised and misunderstood because a former president of the college has been arraigned before the conduct committee of the GMC. I wonder what he thinks general practitioners should feel about the activities of the late, lamented Harold Shipman? [1] Professor Craft is a sophist. It is nonsense to suggest that fear of complaint from parents is the reason for the dearth of doctors on child protection teams. Child protection is difficult and time consuming. Paediatricians and GPs will also be reluctant to serve on these teams if they are driven to think the worst of parents and whipped up to ‘thinking dirty’ at the sudden death of an infant at the time of one of the “worst events to happen to a family”. [2] The hysteria surrounding MSbP has sensitised these doctors to the worst of fears: missing a serial baby killer, the trial, and the lengthy custodial sentence that society has decided such crimes must attract. Professor Sir Roy Meadow is a master of the art of sophistry. [3] It is time that paediatricians were inclined to understand these inclinations and with it the immense damage that has been done to child protection. Now is the time to isolate Professor Meadow and his acolytes, and bring back some balance and humanity to the work of protecting children. [1] Obituary. Harold Shipman. Jackson and Smith BMJ 2004;328:231 (24 January) http://bmj.bmjjournals.com/cgi/content/full/328/7433/231 [2] Fleming P et al Investigating sudden unexpected deaths in infancy and childhood and caring for bereaved families: an integrated multiagency approach. BMJ 2004; 328: 331-334 [3] Meadow R. A case of murder and the BMJ. BMJ 2002;324:41-43 ( 5 January ) http://bmj.bmjjournals.com/cgi/content/full/324/7328/41 Competing interests: None declared |
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Ashok Beckaya, Staff Paediatrician Epsom&StHelier University Hospitals Trust KT18 7EG
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I have yet to meet a paediatrician who is genunely keen to do child protection work. Not surprisingly, the Royal College of Paediatrics and Child Health is experiencing enormous difficulties filling the relevant posts. Infact, most paediatricians in training today do not wish to do community paediatrics in the future. It is certainly essential to have a named paediatrician for child protection in every hospital but, ironically, in my experience even the named paediatricians for child protection in some cases are somewhat reluctant to show passion in this field. The general reluctance in this field must be due to a number of reasons, not least due to lack of proper training. The RCPCH should look into this with an open mind. Also, why should only the paediatricians have the responsibility for child protection work? There is no reason why other medical specialties like general practice, Orthopaedics and others should not take equal responsibility. Competing interests: None declared |
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William Pimm, Student Falmouth TR11 2UJ
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After reading the rapid responses it is not hard to see why paediatricians do not wish to take on child protection work. Caring for desperately ill babies on ventilators, looking after children with cancer and leukaemia, paediatric intensive care are all much easier options which do not run the same risk of being pilloried in public and dammed if you do and dammed if you don't. The surprise is that any paediatrician can be found who has the courage to carry on with this vital work. I predict more responses to this letter which if read by paediatricians will further discourage them from child protection work. William Pimm Competing interests: None declared |
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munera I khan, consultant Paediatrician luton LU4 0DZ
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I have done child protection since being a consultant. I feel it is a necessary task, I do not enjoy it but I am honest with myself and my patients. Occasionally I have got it wrong but mostly children have been protected. I do not prosecute or accuse people, I only highlight the concerns that we have, both the team and myself. I am both shocked and saddened by the vitriol in some of the responses. Should we not protect children because some cases have gone badly wrong? Should I look at the next batterred child and deny help and acknowledgement because I am scared to say. Is what happened to Victoria Klimbie acceptable in this day and age. As paediatricians this is our job, just as diagnosing cancer is our job, dont tell me you havent thought 'malignancy' and found something benign. do you stop thinking malignancy. Thanks to all the paediatricians out there who go on doing their job and doing them well. We are not Gods we never thought we were, if people cannot accept that its just too bad. So a big salute to all the paediatricians out there. Well done. Competing interests: None declared |
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Michael D Innis, Director Medisets International Home 4575
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Editor, “Is what happened to Victoria Klimbie acceptable in this day and age”, asks Munera I khan. Of course it isn’t. Is what happened to Sally Clark, Angela Canning and Trupti Patel acceptable in this day and age? Of course it isn’t. The public are with Paediatricians in the prevention of abuse of children – it is the abuse of carers by paediatric misdiagnoses to which objections are raised. Unless Paediatricians take more care in eliminating “natural causes” before accusing a carer of murder or manslaughter there are going to be protests. Some horrific examples of Paediatric misdiagnoses have been brought to my notice including one in which doctors advised foster care only to have a recurrence of the same problem while in that care with a fatal outcome. The mother was called to the dying child, she “held him and sang him into heaven.” Michael Innis Competing interests: Advised some accused |
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Umesh Prabhu, Consultant Paediatrician Fairfield Hospital Bury BL9 7TA
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Well-done Dr. Khan I totally agree with you. I am a consultant paediatrician and also named doctor for 'Child protection' and I do enjoy it. It is challenging like any other part of my job. Diagnosing child abuse is like any other clinical case. One has to take a detailed history, look at the clinical signs and then come to a diagnosis. Nearly 90% of the cases, I can be sure and say that either it is an abuse or not an abuse or in 10% of cases where I can't be sure I do write the same thing and then I discuss with rest of the members of our 'Child protection team' and we make a joint decision. Of course over last 10 years, once I got it wrong and did apologise the parents but explained why I got it wrong. They were not happy and did send me a solicitor’s letter but after looking at my report they withdrew the legal case. These are all part of my life as a paediatrician. It is important to make sure that children are protected but one should be careful when one accuses parents causing deliberate harm to their children. Most parents do love their kids and want what is best for them. One must have a good reason and strong evidence that the child has been harmed before one gives such an opinion. It is the dogma, which is wrong in medicine. Competing interests: None declared |
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CA Johnson, Parent LA9
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Umesh Prabhu writes, "Diagnosing child abuse is like any other clinical case." No. It is not. The failure to grasp this is fundamental to the problem we now see. Firstly we have the tension between a paediatrician's role as physician (which is unquestioned) and an additional role he takes upon himself as an agent of the state, to which I draw attention to Munera I Khan's remarks: "I do not prosecute or accuse people, I only highlight the concerns that we have..." This is ducking the responsibility. As soon as a paediatrician 'highlights concerns', that is in effect an accusation as far as other agents of the state are concerned. Children and families are dealt with on that basis, which may constitute abuse even to the point of death. Secondly, when a paediatrician "diagnoses" abuse, he is making a judgement regarding a suspected abuser, usually a parent. He is not pointing the finger at a mere virus, but at a fellow human being. While he may justly regard himself as qualified to identify a virus, what qualifies him to judge another's character or intent in a professional capacity? I am not saying that this is a simple issue. I am saying that Umesh Prabhu fails to see a very real difficulty which can only exacerbate the problem of false accusations. It easily leads to a "diagnosis" of abuse becoming a catch-all explanation when the physician is at a loss. Munera I Khan writes, "As paediatricians this is our job, just as diagnosing cancer is our job, dont tell me you havent thought 'malignancy' and found something benign. do you stop thinking malignancy." But a parent is not a tumor, either malignant or benign! The issue can NOT be approached in a like fashion, yet we now appear to have paediatric melt-down precisely because for so long it has. An unnecessary or pre-emptive strike against a family is in itself a damaging form of abuse. At best it is a psychological and emotional abuse of the child, siblings and parents, and possibly the denial of medical treatment for a genuine condition; at worst it is fatal. Some rapid responses here appear indignant or surprised at the harsh words directed at the profession. My answer to that is this: I can not falsely accuse another person of child abuse and expect less than a lengthy jail term for it. You can; because you're paid. Isn't that more than enough? If the anguish and anger of those falsely accused is too harsh for you, perhaps it is better that fewer paediatricians are prepared to do child protection work after all. Then we may be left with a dedicated core who care more for the children than for their own sensibilities and careers. Competing interests: None declared |
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David Stevens, Consultant Paediatrician Gloucestershire Royal Hospital
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Over the last 4 years, five people have contributed 455 rapid responses to the BMJ, nearly all the letters have been critical of the role of paediatricians in child protection; the language often vitriolic, abusive, and speaking of a thirst for revenge. There is of course no evidence that these responses are in any way co-ordinated. None of these people have any experience in the front-line of child protection, have been called in to a paediatric ward at the weekend or at night to see a child with unexplained injuries, knowing that a wrong decision could result in the death of a child or the destruction of a family through an incorrect diagnosis. Only if you have never been in that situation will you believe that doctors can and should always get it right. If you spoke to paediatricians, you would find that nearly all of us have missed cases when children have been abused or injured rather than raised false concerns when parents have been innocent. I am not aware of a single letter to the BMJ that has spoken for these children. One thing may reassure you. Paediatricians do not accuse parents, never sentence them, but only raise concerns. This week we have heard for the first time, after 455 letters on one side of the argument, letters from 2 paediatricians, working at the front -line of child protection. I ask the readers of the BMJ to compare the description of paediatricians by the 'famous five' and the voice of these two paediatricians. David Stevens Competing interests: I am a paediatrician. I have given evidence in court on a few occasions during the 26 years I spent as an on-call consultant paediatrician but always refused a fee. If you are thinking of coming round to slash my tyres, please choose the ones that need to be replaced. |
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Michael D Innis, Director Medisets International Home 4575
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Editor “None of these people have any experience in the front-line of child protection, have been called in to a paediatric ward at the weekend or at night to see a child with unexplained injuries…..” says David Stevens, Consultant Paediatrician. He sees “unexplained injuries” while those not in the “front-line of child protection” might see a child with “unexplained signs and symptoms” and approach the problems of the child from an entirely different perspective. Unless “those in the front-line of child protection” are prepared to cease using the word “injury” when they see a bruise or a subdural haematoma and approach the problem from a non-pejorative point of view they will continue to make mistakes and be responsible for the incarceration of innocent persons. Finally it is not a “thirst for revenge” that motivates the “five people (who) have contributed 455 rapid responses to the BMJ” it is a plea for rationality. Michael Innis Competing interests: As previously declared |
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Mark Struthers, GP HMP Bedford
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It was a joy to be reminded of those wonderful children’s stories about the ‘Famous Five’. In my youth, I was a great fan of Enid Blyton and had always wanted to join Julian, Dick, George, Anne and Timmy the dog in their exciting and dangerous adventures together. In middle age and after more than twenty years in the frontline of medicine, perhaps it is not too late to indulge in a little fantasy that I might be one of the ‘Famous Five’. I applaud Dr Stevens’ diligent research and wonder if other workers in the frontline of child protection can replicate these intriguing figures. That the ‘Famous Five’ could have amassed the remarkable tally of 455 vitriolic and abusive responses to the BMJ amid multiple frivolous complaints to the GMC [1] – and in just four years, is truly astounding. How can it be that so many have been so misunderstood by the vexatious misunderstanding of so few. Childish capers indeed! To move on from these childish things: in the Longford Lecture on Monday this week, the emeritus Archbishop of Cape Town drew on his experience in South Africa to raise his concerns about ‘retributive justice’ and how it ignored victims’ needs and was ‘cold and impersonal’. He is quoted as saying: [1] “How wonderful if paediatricians* could bring themselves to admit they are only fallible human creatures and not God and thus by definition can make mistakes. Unfortunately, they seem to think that such an admission is a sign of weakness. Weak and insecure people hardly ever say ‘sorry’. It is large-hearted and courageous people who are not diminished by saying: ‘I made a mistake’.” Archbishop Desmond Tutu ridiculed the “dangerously flawed” intelligence that was used to justify retributive actions and which has made the world a great deal less safe. He goes on: “There are many who resent the powerful who can throw their weight about so callously and with so much impunity. The ‘Infamous Five’ paediatricians** would recover considerable credibility and respect if they were to say: ‘Yes, we made a mistake’”. The Archbishop headed South Africa’s Truth and Reconciliation Commission, which introduced the concept of ‘restorative justice’ - by which offenders and victims are brought together and the vicious cycle of violence and destruction is ended peacefully. [3]. Saying sorry could help restore some confidence in the world of child protection. It could also make us all feel a great deal safer. Substitutions made in error (for which I apologise) * politicians ** President Bush and Prime Minister Blair [1] Harvey Marcovitch. GMC must recognise and deal with vexatious complaints fast BMJ 2002; 324: 167a [2] The Independent. 16 February 2004 Front page ‘Apologise for your ‘immoral’ war…. [3] Personal rapid response. 21 January 2004 Atoning Sin http://bmj.bmjjournals.com/cgi/eletters/328/7430/9#47655 Competing interests: None declared |
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CA Johnson, LA9 Parent
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David Stevens' input on the difficulty of front-line child protection is most relevant. I don't believe any letters to the BMJ have claimed it is easy, or "that doctors can and should always get it right". Nor do I see any threats of revenge against life or property. Given his views I'm sure he will join me in condemning those paediatricians who have written reports and testified in court to child abuse having failed to refer to relevant specialists; or having seen a child presenting with tricky symptoms for just a few minutes; or in some cases not at all. I urge all paediatricians to protest these practises, and to call for a public enquiry in their own interests as much as anyone else's. It would also be nice if there were an end to charactising any who criticise such practises as merely ignorant or anti-paediatrician in general. Competing interests: None declared |
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CA Johnson, Parent LA9
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Four days ago I emailed David Stevens asking him to supply references for his comments re. rapid responses, in particular quotes for the "abusive" or vengeful responses he alleges. So far I've received no reply. Neither has he identified his "famous five". There are, of course, hundreds of parents in Britain who wish that they could write openly to the BMJ, protest their innocence to local and national media, and put their names and faces to their heart-breaking stories of stolen children. They can not speak out for themselves, nor dare the media report their tragedies openly, because of family court secrecy. Should they try, jail awaits. Were it not for this, the BMJ's webserver might be creaking under the weight of their anguish by now. Of course it is not down to paediatricians that such gagging exists. It is, however, down to the medical leadership that professionals and others who spoke up for those gagged have been ignored during these years. Competing interests: None declared |
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s m latta, director po16
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Dr Stevens, it would seem judges all paediatricains on his standards. This is not the case, in any work place you have those that are good at thier jobs and those who are not. He also misses the point that many, many paediatricians do not have the same good grace to give evidence free of charge, many earn what for most of us would be a small fortune. One thing that may suprise you Dr Stevens is that Paediatricians do accuse parents. I know it as i have heard it with my own ears. It is not a case that anyone thinks that anyone can get it right all of the time. That is part of being a human, mistakes can and do happen. It is when the system as a whole fails, and thats the police, medical and social services all unable to see past a pointed finger. All of these public sectors are also vastly under funded. So Dr Stevens is right, it is not just the medical proffession who accuse. It is true however that many many trials are based purley on medical evidence. I can only be one sided to a degree i have seen my daughter die in my arms, my family ripped apart and a member of my family accused of murder. I have read prosecution openers that read like cheap novels, social services be less than open with the truth. I have seen a world that i had no idea existed. Most paediatricians do a fantastic job, and they should be admired for what they do. Lets just make sure that the science is there in the first place. Was sadly lacking in MSBC and i also belive SBS. But what do i know i'm not medical! Competing interests: None declared |
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Brian Morgan, Freelance Journalist Cardiff CF11 6LF
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On February 18th 2004 I sent the following email to Dr David Stevens. I await a response. Dear Dr Stevens I hope you will not mind me enquiring, but as I am possibly one of the five contributors you refer to in your response (my contributions would be needed I think to make up the total number you have quoted) I was wondering if you would let me know which one you are of the six David Stevens the GMC press office tell me are listed on the medical register? I can assure you I have not expressed myself even remotely in the manner you suggest, and there is no co-ordination I am aware of in submitting responses relating to child-protection, only a common interest. If you wouldn't mind relaying details of your registration I would be grateful. If you were not the contributor then do please accept my apologies. Regards Brian Morgan NUJ number is 080549. Competing interests: I believe I may be one of the "famous five". |
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Dr Lynne Wrennall, Fellow University of Liverpool
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As I understand it, the main terms of the recent debate on the role of Paediatrics in Child Protection may be distilled in the following manner: Argument one states that the current critique is bringing Child Protection into disrepute and should be halted. The media supported parental criticisms are not valid and are unhelpful. Doctors and other professionals are becoming increasingly unwilling to work in Child Protection and this will result in children being under protected against abuse and neglect by parents and carers. The guidelines on Fabricated and Induced Illness are helpful in the work that paediatricians, together with other professionals, undertake in protecting children. The professionals involved in protecting children must be allowed to do their work without being pilloried. Decisions about children are made after serious consideration by multi-disciplinary teams on the information available at the time. The Child protection system is working well, although too many children currently die in the UK. Argument two states that a major overhaul of the Child Protection discourse is required. Over-zealousness in false allegations is at the cost of under-resourcing of the preventative and therapeutic strategies which would significantly enhance the lives of children. Resources wasted on false allegations and social policing should be re-allocated into preventative and therapeutic strategies and into addressing genuine cases of abuse. Current philosophies of practice have caused relations between families and Child Protection to deteriorate to the point that the discourse may be described as being in a state of crisis. Adverse health and social impacts are resulting from current policy and practice, some of which are fatal for children. Within a democracy, the issues must be resolved through extensive open public debate. Both arguments relate to the lives and deaths of children. Where do we go from here? 1.Professor Alan Craft, President, Royal College of Paediatrics and Child Health and Dr Lynne Wrennall, Fellow of the University of Liverpool, in debate on Women’s Hour, BBC Radio, Thursday, 5.2.2004. Competing interests: It is a matter of public record that I support argument two. |
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Clive Davies, GP London W1G 9SX
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I dispute that most people's attitudes are as polarised as Dr Wrennall suggests. I agree with the first and last sentences of "argument two", but only with the main body of "argument one". Remember though that the major child protection decisions are made neither by individuals nor even by multi-disciplinary teams, but by courts. We need to hear more from the lawyers and lawmakers. Competing interests: None declared |
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Lisa C Blakemore-Brown, Psychologist UK
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'Within a democracy, the issues must be resolved through extensive open public debate.' Lynne Wrennall writes. Surely this cannot be argued against??? Let us start the open debate on the use of dogmatic theorising, flawed thinking and lack of logic within the context of child protection following the Cannings Judgment. The subject of the debate is thus worked out - now for the hard task - how to make a spinning and morphing and ne'er do wrong system face up to major flaws and accept its responsibilities for the protection of children. At the very least it must want to provide good role models for our growing adolescent children and to show them that they cannot escape wrongdoing by denying, twisting and morphing. The way things are going no teenager will ever accept he is wrong - and will point to our system as justification. Competing interests: None declared |
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William Pimm, Student Falmouth TR11 2UJ
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Dr Wrennall sees the problem as over-zealous paediatricians making false accusations of child abuse and asks for a public discourse. It may be that this is the problem, but could it also be that paediatricians are failing to diagnose cases of child abuse? A public discourse is taking place, with or without the blessing of the Royal College of Paediatrics and Child Health. The media, an infinitely more powerful force than the RCPCH, or a 'Scott or a Hutton', have found paediatricians guilty of both over and underdiagnosis of child abuse. The emphasis has been on over diagnosis, perhaps due to the ability of parents and those who have feel they are the victims of injustice to make their case whereas children who have been tortured, injured and abused have no voice. There must be many paediatricians who wish they could opt out of those awkward daily decisions where they are likely to be dammed if they do and dammed if they don't and had opted for the safety of a career in a department of public health policy research Competing interests: None declared |
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Brian Morgan, Freelance Journalist Cardiff CF11 6LF
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Of course the question must be addressed as to why judges and lawyers preferred the 'dogmatic' opinions of very senior and highly respected doctors over others who were, throughout more than a decade of this controversy, protesting about flawed evidence and testimony. The place for that is not in the columns of the BMJ, but in the law journals and at a public inquiry. The questions for members of the medical professions remains this: why did such doctors presenting such dogma as reliable, scientifically based opinion come to be supported by so many colleagues? And especially within paediatrics - we are after all talking about people at the top of their professional ladder. Paediatricians especially, but members of other medical professions too continue to defend those who purveyed this dogma on grounds that this was only a recent aberration. But surely of practioners display faulty thinking then the whole of what has been a very influential opus should be re-assessed long with the work of others who relied upon it? I would like to know how the entity Munchausen's Syndrome by Proxy, also known as Meadow's Syndrome, came to be included in the Department of Health's guidance Working Together for the first time in 1990 (leading to an increase in allegations. Competing interests: Currently working for and being paid under contract to report for television on these matters. |
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Charles Pragnell, Expert Defence Witness - Child Protection and Child/Family Advocate U.K./Australasia
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After over forty years of being engaged in child protection work, initially as a protective worker then latterly as an advocate for falsely and wrongfully accused children and families, I very strongly support the second of Dr, Wrennall’s propositions. Nothing less than a Public Inquiry is needed to uncover and expose the problems and issues in what is a deeply flawed, erratic, and dysfunctional Child Protection Service in the U.K. Other correspondents in this debate have correctly stated that some cases of child abuse may not be being identified and recognised and this is certainly so, considering the numbers of children who have died over the last thirty years whilst under the surveillance or supervision of child protective workers, the latest being Victoria Climbie’. Conversely however, each year over 85% of child abuse reports are found to have `No Substantive Basis’ i.e. they are false accusations made for mistaken, mischievous, malicious, or monetary reasons. So every year over 150,000 children and their families have to endure the intrusive invasions into their lives by child protection investigators, leaving them severely traumatised and with serious and long-lasting harm to their emotional, and social well-being. In the absence of a document stating there was no foundation to the accusations, such children and their families are stigmatised and often isolated from their extended families, neighbours, and their communities and falsely accused parents are discriminated against in child care related work. Then of course there have been the major child protection scandals in Cleveland, the Orkney Islands, Nottingham, Rochdale, Shieldfield Newcastle, where children and their families have been subjected to unnecessary and unwarranted intrusions into their lives on the basis of unproven and poorly researched medical and social work theories of child abuse. And now there is the recent scandal involving many thousands of children wrongfully removed into state care and adoption and innocent parents being imprisoned on the basis of medical theories which were “manifestly wrong and grossly misleading.” The self-defensive cliché’ of “damned if you do, and damned if you don’t” has no relevance whatsoever, when children are dying or being significantly harmed as a result of gross incompetence, negligence, malpractices, and mismanagement within the child protection system. Despite the catalogue of false accusations every year, the child abuse industry continue to try to convince the public and politicians that there is a vast amount of child abuse which is undetected and that child abuse is increasing. Not So!. And they are callously using the tragic case of Victoria Climbie’, one of their own enormous calamities, to support their arguments. Whilst increasing numbers of children and their families have been drawn into the child protection net, government statistics show that in the five year period between April 1997 and March 2002, the number of children’s’ names added to Child Protection Registers fell dramatically in all categories. Physical abuse fell by 57%, sexual abuse by 17%, and emotional abuse by just over 2%. It is highly significant that three of the major child protection scandals involving false accusations of child abuse in the last two decades, Cleveland, Shieldfield Newcastle, and now regarding SIDS/MSBP allegations, have involved unproven paediatric theories and opinions. Yet the paediatric profession have still failed to develop a rigorous system of verifying and validating such theories before they are introduced into practice. Instead, they have given their unqualified and uncritical endorsement to Fabricated or Induced Illness in Children (more commonly known as Munchausen Syndrome By Proxy and a multitude of other ill-defined variants), which was based solely on anecdotal information in two cases and a number of conjectures, speculations and suppositions and involved no research methodologies and protocols (yet interestingly this latter criticism is now being levelled at Dr. Andrew Wakefield’s research into MMR/Autism). The RCPCH did not conduct any independent and scientifically-based research into FII/MSBP nor took into account the very considerable concerns regarding its validity in detecting child abuse, but simply re- gurgitated the utterings of the MSBP believers. A similar endorsement of this unproven theory was also given in governmental guidance, as stated by Brian Morgan, which made the government and the RCPCH complicit in the wrongful removal of those children from their families and to be continuingly complicit whilst those documents remain in force. Last year less than 1 child in 1,000 children were considered to be `At Risk’ of child abuse on the basis of a social work assessment and only a very small percentage of those were proven to courts to have been abused, yet over 150,000 children and their families were caused significant harm by a system which has been given the legal duty and responsibilities to protect them. The Clark/Cannings/Patel cases are but the tip of a very large iceberg of false accusations of child abuse and it was long overdue that this scandalous situation was brought to public attention. The earlier case of P,C, & S in the European Court of Human Rights in 2001 exposed the draconian and punitive intrusions which child protective workers are making into the lives of children and their families. A Public Inquiry into the Child Protection system must be ordered immediately if the present government are to have any credibility for their `Family Friendly’ policies and to have any commitment to the rights of children to be protected from harm, especially from the government’s own institutions. Such a Public Inquiry should have the remit of examining the entire child protections system including, but not exclusively, the support for children and families in need, the system of reporting and investigating child abuse, the respective roles and responsibilities of the various agencies involved in the child protection system, the involvement of the media to ensure public knowledge of the working of the child protection system, the inspectorial role and responsibilities of government departments, and the role and functions of Courts and legal system. The most important witnesses to such an Inquiry would have to be the children and families who have suffered from `System Abuse’ over at least the last two decades. Some of their tragedies and sufferings are now being revealed in the media but there are many thousands more, who continue to suffer in silence because of the secrecies of Family Courts and the suppression of their sufferings by `Gagging Orders’ sought by child protection agencies to save themselves from embarrassment and exposure. Competing interests: Concern for the harm caused to children and families by the Child Protection System |
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Davina Hollisey-Mclean, Housewife and mother, fighting for justice SA4 3DT
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Dear Sir / Madam How about the doctors who make these claims and make vast sums of money on the back of it? They could be said to have the theoretical condition of Msbp/FII. They are the ones who “Pursue a rare and life threatening illness on the children’s behalf, that does not exist and it is in fact thier behaviour that is detrimental to the child’s well-being” It is about time that the NSPCC, Social workers, police and others started looking at the child abuse that these “Professionals” have inflicted on the children. Some of the doctors have insisted on these children being subjected to various tests and investigations in order to prove their MSBP/FII allegations and on occasions have used them in research projects ignoring the protests, screams and suffering of the children. The NSPCC and others for years have IGNORED parents who have gone to them about the abuse being inflicted on the children, by the “Professionals” they have been known to say "But my dear a doctor would never do anything like that ". There will come a time in my opinion when they will have to” eat their words". They too must be held accountable in any public enquiry; they have to account for why they have ignored the pleas of parents and others for over a decade at least. They too have failed the children because of their belief in doctors. Why is it that when over many years child abusers have been found amongst the Police, Social services, various religious bodies, etc that the NSPCC and others have failed to see that just has there was at least one Shipman in the Medical profession that on the balance of probability there has to be child abusers somewhere in the medical profession too. That profession too is made up of mere mortals although it would appear that some like to be seen has God. Even when a doctor is a proven paedophile, this “ little demeanour ” is put down to “Pressure of work. I call on all those who maybe unwittingly have allowed this “child abuse” scandal to continue for many years to WAKE UP, look at the facts, the evidence that parents and others can supply and identify the wood from the trees. Stop being victims of “ The Emperors New Clothes Syndrome “ and use your own brains and common sense, I assume that you have both. In our attempt to fight for truth and justice we have had to rely on the GMC, over the years we have come to realise what a inept orgainisation they are! I don't think I need to say anymore in light of the leaked " salmon letter" in connection with the Shipman inquiry. Competing interests: Parent calling for public Inquiry |
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Davina Hollisey-Mclean, Housewife and mother, fighting for justice SA4 3DT
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Tonight (March 1st) is the 12th anniversary of our son being allowed to sleep at home for the first time in eight months following a false allegation of MSBP. I wonder if any of those who protest on the basis of “ You are damned if you do and damned if you don’t “ would like to come and swap places with my husband and I when we try to explain to our sons why they were victims of what can only be described has a terrorist assault on our family by so called Child protection professionals. My children were old enough to scream for themselves that this was a case of the “Emperors New Clothes ” but no one would listen. The claim was that their parents had influenced them. More importantly would someone like to come to explain to them, why after all these years so many of you out there who claim to be so interested in protecting children have allowed this system abuse to continue? For you ignorance is bliss, unfortunately for my children and many others, who have been and will become victims of your claimed ignorance and failure to act, life is not so blissful the horror and terror that a wrongful allegation of MSBP brings is only too real! Competing interests: Mother still fighting for justice |
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CA Johnson, Parent LA9
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A few days ago a Swiss air traffic controller was stabbed to death at his home. Swiss police have arrested a man who lost his family in the air accident in which the controller was involved. Nothing is proven yet but there is obvious speculation. Nearly two years ago I wrote to the Home Office and to my MP to express my concerns regarding the cases of Sally Clark and Angela Cannings. Both bereaved mothers were in prison. I predicted a national scandal if something were not done quickly about the flawed testimony of doctors. Nothing was done. The CPS did their best to destroy bereaved mother Trupti Patel just last year, yet again hiring a willing Roy Meadow as their weapon of choice. Now a national scandal is upon us. Those who make accurate predictions are blessed neither with the gift of clairvoyance nor infallibility. They just review the past, pay attention and give a damn. I'm going to make another one. People are prepared to protest, to fight legal battles, and to take direct action over such things as new motorways, mobile phone masts and threatened village post offices. They'll do at least as much for their children. And unlike village post offices, the children are not going to disappear. They are going to grow up (soon) into adults who know everything. Those that have managed to cling onto their natural parents against the odds will have learned that doctors, social workers and police can be dangerous. They will not forget the doctors who betrayed them. They will not forget living in terror of abduction by social services. They will not forget being afraid to fall over in the playground in case a bruise is questioned. They will not forget the stigma of false allegations, nor their parents trying to comfort them when none of their classmates came to their birthday party. Some will even remember why their parents' marriage collapsed under the stress. And those children that were taken by force from loving parents and adopted will find out everything. The emotional baggage sometimes carried by adopted people will be magnified a thousand-fold for these. It will be traumatic for them, traumatic for their adoptive parents, and it will be complicated yet further when they have children of their own and the issue of Stolen Children is compounded with that of Stolen Grandchildren too. Some falsely accused parents have committed suicide because they could not face life without their beloved children. Many families are just living on hope. That hope is that justice will be done with a full, independent public inquiry at which they can give evidence, that their cases will all be independently reviewed, that meaningful contact will be re-established with their children, and that recently adopted children will be returned. It is in the long-term interests of all front-line professionals involved in such cases to press for this too, because injustices left to fester are dangerous. Wronged people may one day seek out those they see as persecutors, and the professionals at the sharp end may have to carry that can. Some grown-up children will turn up with heavy lawsuits, but what if some turn up with heavy crowbars or lighter-fuel instead? Independent inquiries and reviews may not be palatable to those whose failings they expose, but there are worse things that can happen. Justice done quickly now will save much agony later, and not just for the families concerned. Competing interests: None declared |
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David A C Elliman, Consultant Community Paediatrician Islington PCT & Great Ormond Street Hospital for Children, WC1N 3JH
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The diagnosis and management of child abuse is, in many respects, like that of any medical condition. It is rarely based on one feature, but more likely a combination of the story presented, examination of the child and, possibly, some special investigations. Taking these into account, a diagnosis is made on a balance of probabilities and management that is more likely to be beneficial is instituted. Where child abuse differs is that the history, or account of the condition, is often given by a parent who is not being truthful. It also differs in that the final diagnosis and decisions about management are made by a group of disciplines - doctors, social workers, police and others. In all of this the welfare of the child has to be the major consideration. It is inevitable that mistakes will be made. Some children's abuse may be overlooked or underestimated and as a result they are permanently harmed, or even killed, by a parent. On the other hand, some parents may be accused, wrongly, of harming their children. What is the alternative? Never to take action unless there is absolute certainty? Of course not. We don't operate in this way in any other field of life, so why should we here, especially as it may mean that children die because of our inaction? May I take the opportunity to set the record straight on some other points. The suggestion that FII does not exist is plain daft. There may be some debate about how common it is and exactly what form it takes, but exist it does. A mother smothering her baby and then saying the baby had a funny turn, is FII (Fabricatedand Induced Illness). A criminal court in England requires that the evidence shows, beyond any reasonable doubt, that a crime has been committed otherwise a verdict of ‘not guilty’ is returned. In reality, in many cases, this means ‘not proven’ (a verdict allowed in Scottish law) which is more accurate. If measures were taken to protect a child, based purely on this standard of proof, the scales would be heavily weighted against children. It is fallacious to say that because a case of child abuse was not proven in a criminal court, it did not occur. Child abuse is a difficult field for everyone involved. No-one relishes the thought of a child being taken away from their parents, much less a paediatrician, however in some instances it is necessary for the child’s welfare. Children will not be best served by the current hysteria, epitomised in some of these rapid responses. Competing interests: None declared |
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s m latta, director po16
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Did lord chief justice Judge not call for an end to the trials of parents when conflicting medical experts could not agree? Oh well at least it is not only just us parents who are banging our heads on the wall by not being heard, it is the judicial system too! The review that was called for is being carried out by social services. This is total madness and i for one am disgusted that all those that have been harmed by this system are agian being let down. Having said that we are used to it and it was too much to ask that things would improve. Trials are still going ahead within the closed doors of the family courts and also the criminal courts. The experts who stood next to Meadows and supported him with the neuro findings and radiology are still standing in courts saying the same as they did they are just one short these days. When will this stop? Not soon enough. In family proceedings these experts would all be branded with putting children at risk of emotional abuse and failing to protect the best interests of the child. But they are not, these comments are kept for the parents who watch their childrens lives being ruined by the system they can not be heard in or protect their children from. It is truely heartbreaking, it is a shock to see that humanity is in such sort supply. Competing interests: None declared |
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Lisa C Blakemore-Brown, Psychologist UK
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David Elliman says: 'The suggestion that FII does not exist is plain daft. There may be some debate about how common it is and exactly what form it takes, but exist it does.' Could I ask Dr Elliman - do you think that iatrogenic abuse exists? Competing interests: None declared |
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Michael D Innis, Director Medisets International Home 4575
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Editor, “Where child abuse differs is that the history, or account of the condition, is often given by a parent who is not being truthful” says David Elliman. This is the typical attitude of the “think dirty” advocates of the Munchausen Syndrome and the sooner the Courts realize it the sooner will misdiagnoses and wrongful convictions be abolished. Michael Innis Competing interests: As previously declared |
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James Noone, Retired Lecturer London EC1
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I am sure that we can all agree with Michael Innis that if parents were always believed there would not be any false accusations of factitious illness; in fact one could go further and say that the diagnosis of all forms of child abuse by parents would disappear completely and we would be back to the world that existed when Dr Innis qualified in medicine. A better, 'cleaner' world for us to think about, but perhaps not always so for children. Competing interests: None declared |
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CA Johnson, Parent LA9
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The welfare of the child is paramount, writes David A C Elliman. He also states: "What is the alternative? Never to take action unless there is absolute certainty? Of course not." So put yorself in the position, sir, of a parent who does know with absolute certainty that their child is ill. A mother, perhaps, who is certain that she did not try try to smother her baby. A mother who knows that her baby stops breathing suddenly, without warning, and that his life hangs in the balance. She seeks medical help, and is accused instead. She knows with that afore-mentioned certainty that the professionals are risking her child's life. She knows that her baby is to be abducted, dumped on onwitting foster carers who are not familiar with her baby and not told that her baby is ill. She knows that the professionals' actions may well kill her child. It has happened. Yet such a mother may take no action to protect her child from such harm. Were she to fail to protect her child from an abusive partner, she would be prosecuted; but protect her child from abusive professionals - she will be prosecuted for that! As things stand, the child's welfare does not come first. Only the professionals' right to do what they like. So is action the answer, as David A C Elliman suggests? How about parents taking direct action against professionals, in the certain knowledge that they are defending their children from danger and abuse? And as he points out, we shouldn't even wait for certainty before we take action, eh? Or maybe he will protest that such action would be criminally irresponsible? The professionals may be traumatised, or injured, or even killed! Hmm, perhaps it would be wrong after all. And does it ring any bells? Competing interests: None declared |
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Charles Pragnell, Expert Defence Witness - Child Protection U.K./Australasia
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The welfare of the child is paramount, argues David Elliman, and who would disagree with what is now such a well-worn cliché, except to add that those interests lie within the context of the child’s immediate and extended natural family and not in opposition to them, as is so often the case. Elliman also claims that child abuse diagnosis and management is “rarely based on one feature”, yet this is precisely what occurs in MSBP/FII cases, (despite the post-Cleveland advice that child protection proceedings should not be based solely on a medical opinion) – social workers failing to carry out a thorough investigation and assessment of the child and family and relying entirely on the MSBP/FII allegation or event where such assessments have been carried out, the opinion of the paediatrician has been an over-riding and dominating influence. Such opinions have often been given by telephone, fax, or letter without the paediatrician ever meeting the child or the family and with secret Family Courts acting merely as a `rubber-stamp’ of the paediatrician’s `opinion’. That is a major reason why a review of such cases has had to be ordered by the government. It is interesting that Elliman accuses parents of being untruthful when parents accuse paediatricians and social workers of the same behaviour, often adding that evidence has been fabricated, distorted, and embellished to build a case against them. Of course once a parent is labeled as `untruthful’ any complaint they may make against the paediatrician for incompetence, negligence, or malpractice can then be neatly and conveniently disregarded by the General Medical Council as “vexatious”. Elliman then claims to be able to `set the record straight’ regarding the existence of MSBP/FII but is unable to point to any scientifically- based evidence to support his contention or how the original conjectures and speculations about its existence were independently replicated. Nor can he point to a single case where a thorough and exhaustive investigation has been carried out as to whether a child may be suffering from a genetic disorder, birth injury, reaction to a prescribed medication e.g. Cisapride, toxic poisoning, severe allergic reaction or a variety of other possible causes, before the MSBP/FII label has been attached. MSBP/FII has just become a `label of convenience’ to silence an anxious, concerned, and caring parent who challenges and disputes a medical opinion. In short and to put the record straight, MSBP/FII lacks any form of scientific integrity and validity whatsoever and is simply a belief system, with a far greater affinity to UFO-spotting than evidence-based medicine or child protection practice. It is an insult to the earlier injuries and injustices suffered by many hundreds of distressed parents, for Elliman to describe their demands for the return of their state-stolen children as hysteria. They have a just cause and want a just outcome and redress from the gross injustices which have been visited upon them by an idiosyncratic and dysfunctional child protection system. Competing interests: Concern to reform the Child Protection system |
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Dr Lynne Wrennall, Fellow University of Liverpool, Liverpool, L69 3BX
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Dr Davies asks about lawyers and courts. Interesting questions. We | |||