Part Five: After Goudge: Will There Be Lasting Change? Not Necessarily; Dr. David Southall; The British Experience:

"PAEDIATRICIANS FULFIL AN ABSOLUTELY VITAL ROLE IN CHILD PROTECTION, BUT A MINORITY OF THEM HAVE BEEN MAKING FALSE ALLEGATIONS AGAINST INNOCENT MOTHERS FOR MANY YEARS.

"IT IS ABOUT TIME THE MEDICAL ESTABLISHMENT STOPPED DEFENDING THESE PEOPLE."

LAWYER JOHN BATT:

I am very grateful to several readers who drew my attention to Dr. David Southall, an internationally renowned British pediatrician, who, like Dr. Charles Smith, managed to remain in practice for years in spite of efforts to have him booted out of the medical profession.

These readers broached the subject of Dr. Southall in the context of several recent postings in which I explored whether there would be real consequences for Dr. Smith after Commissioner Stephen Goudge files his report;

I am very grateful to Jason Day of the General Medical Council Press Office for providing me with the disciplinary body's recent decision finding Dr. Southall guilty of serious professional misconduct and erasing his name from the medical register;

In addition to providing our readers with this decision - a fascinating document which prompted several comparisons with Dr. Smith in my mind - I am providing a Wikipedia biographical excerpt on Dr. Southall, and the BBC's Internet account of his erasure.

(It should be noted that Dr. Smith received a mere "caution" form the Ontario College of Physicians and Surgeons for his sub-standard work on three cases in which his sub-standard work led to disastrous consequences for those involved. "Cautions" are not even recorded on the College's official Register);

The Wikipedia account answers the question "who is Dr. David Southall?" as follows:

"Professor David Southall is a UK paediatrician who is regarded by some as a leading expert in Fabricated or Induced Illness (FII, also known as "Munchausen Syndrome by Proxy"), and who has performed significant research into sudden infant death syndrome<" the Wikipedia account begins.

"Southall was struck off the medical register on 4 December 2007, after being found guilty of serious professional misconduct by the General Medical Council," it continues.

"In his early career, Southall spent four years in general adult medicine, one year in obstetrics and two years as a general practitioner.

Between 1986 and 1994, Southall led a pilot research project into FII involving video surveillance of young hospital patients in an effort to observe their carers (such as parents or guardians) harming them.

The project, which was conducted at the Royal Brompton Hospital in London, and the North Staffordshire Royal Infirmary in Stoke-on-Trent, observed carers using methods such as suffocation and poisoning to harm the children.

As a result of the project, thirty-three parents or step-parents who had harmed their children were prosecuted, and twenty-three were diagnosed with FII.

The project attracted controversy for its methods and for the ethical implications of the research.

Critics argued that the desire of the researchers to observe the carers harming the children exposed the children to further abuse, that the betrayal of doctor-patient trust necessarily involved in the surveillance could cause harm to the subjects, and that "a diagnosis should lead to treatment, not punishment".

However, the researchers argued that the surveillance saved the lives of many of the children involved, and Southall himself said that "[b]y doing covert video surveillance we are betraying the trust of parents... [b]ut if a parent has been abusing his or her child in this way then the trust between child and parent has already gone."

In the early 1990s, Southall led a study which pioneered continuous negative extrathoracic pressure therapy, a treatment for breathing difficulties in young children involving the application of pressure to the patients' chests.]

The study was controversial, with some parents of the children involved suggesting that the treatment was linked to subsequent death or brain injury.

The research was the subject of investigations by the hospital involved and inquiries from police.

An independent follow-up study concluded in 2006 that there was "no evidence of disadvantage, in terms of long-term disability or psychological outcomes" from the use of the technique.

In 1993, during the Bosnian War, Southall traveled to Sarajevo as a participant in a medical evacuation programme for sick children from the area.

Prompted by his experiences there of what he described as "trauma inflicted on children and their families, not only by warring factions, but also by the indolence of the international community", Southall established Child Advocacy International on his return, to advocate for international child health issues.

In 2004, Southall was found guilty of serious professional misconduct by the General Medical Council (GMC), after alleging to police that the husband of Sally Clark was responsible for murdering the couple's children.

Southall made the claim to child protection officers of the Staffordshire police after watching a television documentary about the case.

The GMC banned Southall from child protection work for three years; the Council for Healthcare Regulatory Excellence challenged the decision as insufficient and argued that he should be deregistered, but a High Court of Justice decision in 2005 held that the sanction was not unduly lenient.

In February 2007, Attorney-General Lord Goldsmith announced that a review would be held into a number of criminal cases in which Southall gave evidence for the prosecution, following allegations that Southall kept up to 4,450 personal case files on children patients which were kept separate from the official hospital records."

The BBC Internet news report, published on Dec. 4, 2007, under the heading "David Southall struck off by GMC," demonstrates the powerful support that Dr. Southall drew from some of his colleagues in the medical profession, in spite of the disturbing nature of the proven allegations;

"Controversial paediatrician Dr David Southall has been found guilty of serious professional misconduct and struck off the medical register," the report began;

"The General Medical Council decided last week that he had abused his position by accusing a mother of drugging and murdering her son," it continued:

The GMC said Dr Southall had a "deep-seated attitudinal problem".

The GMC found that Dr Southall's actions added to the distress of the mother - Mandy Morris, from Shropshire - whose 10-year-old son Lee hanged himself in 1996.

Dr Southall made the claim in an interview with Mrs Morris about the safety of her surviving son.

He had been instructed by Shropshire County Council to provide an independent expert report to the court.

Special files

The GMC also ruled that, in some cases, Dr Southall acted inappropriately in keeping original medical documents on children in his care in his own special case files separately from their official medical records.

Lawyers acting for the Attorney General are now examing thousands of these files amid concerns that they were not revealed during criminal proceedings.

In 2004 Dr Southall was suspended from child protection work over his role in the case of Sally Clark, wrongly jailed over the death of her two sons.

Dr Southall accused Mrs Clark's husband Steve of murdering the two boys on the basis of a television interview.

Dr Jacqueline Mitton, chair of the GMC disciplinary panel, told Dr Southall: "Your multiple failings over an extended period caused the panel great concern.

"Furthermore, the panel is influenced by the fact that although the events in the current case predate those in the Clark case there are now two instances were without justification you have accused a parent of murdering their child.

"In all the circumstances the panel has concluded that you have deep seated attitudinal problems and that your misconduct is so serious that it is fundamentally incompatible with your continuing to be a registered medical practitioner."

In a statement issued after the hearing, Dr Southall admitted he had taken "difficult and sometimes unpopular decisions" in his career.

But he added: "The welfare of the children has always been paramount in my mind."

Supporters

Dr Paul Davis, a consultant paediatrician in Cardiff, said Dr Southall had been a great pioneer in helping identify mothers who hurt their babies, and, as a result, had become the target of a hate campaign.

He said: "It is a great shame for David Southall personally, and a huge deterrent for paediatricians in Britian to get involved in this kind of work."

The Royal College of Paediatrics and Child Health expressed sadness and disappointment at the ruling.

President Dr Patricia Hamilton said "David Southall has made a major contribution to child health both nationally and internationally and has been a strong advocate for children during a distinguished career."

And Dr Evan Harris, MP called the ruling "disproportionate" and a "serious miscarriage of justice".

But John Batt, lawyer to the Clarks, said: "This has got to be the right decision.

"Paediatricians fulfil an absolutely vital role in child protection, but a minority of them have been making false allegations against innocent mothers for many years.

"It is about time the medical establishment stopped defending these people."

Dr Southall worked as a consultant paediatrician at London's Royal Brompton Hospital from 1982 before moving to the same post at the North Staffordshire Hospital in Stoke-on-Trent in 1992.

The Staffordshire trust said it would now review Dr Southall's position. Trusts are not allowed to employ doctors without the appropriate professional registration.

In a statement it said Dr Southall's competence as a general paediatrician had not given cause for concern.

He has (Filed an appeal aginst the GMC decision."

Here, at last, is the General Medical Council's Fitness to Practise Panel's decision;

"Dr. Southall; The Panel has considered this case in accordance with the General Medical Council Preliminary Proceedings Committee and Professional Conduct Committee (Procedure) Rules 1988.

The Panel has heard that from 1982 you were a senior lecturer and subsequently a consultant paediatrician based at the Royal Brompton Hospital, London.

From 1992 you were professor of paediatrics at the University of Keele and also a consultant paediatrician at the North Staffordshire Hospital, Stoke on Trent.

In January 1998 you were contacted by local authority social workers who had concerns about the welfare of Child M2.

You were told that there were similarities between current events in Child M2’s life (including apparent suicide threats) and events in the life of his elder brother, Child M1, who in June 1996, when aged 10, had died by hanging.

You gave the social workers certain advice.

On 29 January 1998 the court made an emergency protection order.

As a consequence Child M2 was removed from his parents’ care.

On 2 February 1998 you wrote what you described as a preliminary report, following which on 3 February 1998 the local authority applied for an Interim Care Order.

On 17 March 1998 you were instructed by the local authority to prepare a report for the care proceedings.

Your report was to cover both Child M2 and his family.

For the purpose of preparing your report you interviewed Mrs M on 27 April 1998.

The Panel has found proved that during the course of this interview you accused Mrs M of drugging Child M1 and then murdering him by hanging.

This was done in an accusatorial and intimidating manner.

The possibility of M1 being the victim of murder had not been raised until you became involved.

At the inquest the coroner had recorded in his verdict that he had considered suicide and accident but in the event he returned an open verdict.

It is apparent that no evidence was presented at the inquest to suggest that murder was a possibility.

Despite the verdict, you formed the belief that the circumstances of M1’s death needed to be investigated by you.

The Panel is extremely concerned by these facts.

You are a registered medical practitioner and in that capacity you were instructed by Shropshire County Council to write an expert report for the court in care proceedings based on the papers that had been provided to you.

The letter of instruction made it clear that it was important that the parties had confidence in your independent status.

Your action in accusing Mrs M of murdering Child M1 was inappropriate, added to her distress as a bereaved person and was, in the circumstances, an abuse of your professional position.

By acting in an accusatorial and intimidating manner you failed to treat Mrs M politely and considerately and did not respect her dignity.

This behaviour was also inappropriate and caused distress to Mrs M.

In some situations doctors have responsibilities not only to patients but also to third parties.

Although Mrs M was not your patient you interviewed her in your capacity as a registered medical practitioner and you had a clear obligation to
treat her as you should treat a patient, that is politely and considerately and respecting her dignity.

The manner in which you conducted the interview, questioned and directly accused Mrs M was incompatible with your position as a doctor.

The Panel regards your behaviour towards Mrs M as a very serious instance of misconduct.

In March 1989 Dr Dinwiddie, a consultant paediatrician at Great Ormond Street Hospital, referred Child H to you for investigation and advice.

In September 1989 and again in March 1990 Child H was admitted to the Royal Brompton Hospital where his breathing was monitored.

In March 1990 you proposed to the parents a home monitoring and care regime.

However, on about 22 March 1990 Child H’s parents informed you that they no longer wanted you to be involved in the management of Child H’s care.

On 22 March 1990 you wrote to Dr Dinwiddie to the effect that the parents were not acting in Child H’s best long term interests, that they liked the idea of him having a rare illness, that you were suspicious of their motives and that you viewed the long term prognosis with great concern.

You copied and sent this letter to an unnamed Consultant Paediatrician at the Royal Gwent Hospital even though no one there was currently involved in Child H’s care or had been involved in the past.

The letter contained sensitive and confidential information.

Your action was inappropriate and in breach of the confidentiality owed by you to Child H and his parent’s.

In the General Medical Council’s Guidance, Professional Conduct and Discipline: Fitness to Practise (March 1989), which was in force at that time, paragraphs 79-82 cover the subject of professional confidence.

It is a doctor’s duty, subject to the exceptions listed in Paragraph 81, to strictly observe the rule of professional secrecy by refraining from disclosing voluntarily to any third party information about a patient which he has learnt directly or indirectly in his professional capacity.

None of the exceptions applied in this case because the letter was sent to an unidentified recipient.

In relation to Child D and Child H, you created, or caused to be created, an “S/C” File for each child wherein certain original medical hospital records relating to the children were then placed by you or on your behalf.

These medical records are not elsewhere in the children’s hospital medical records. The placing of the original medical records in “S/C” Files damaged the integrity of the children’s hospital medical records and caused the items concerned to be inaccessible to others involved in the medical care of the children at that time or in the future.

You have a responsibility and duty as a doctor to ensure that medical records are readily available to colleagues as and when required.

Failure to do so can result in serious consequences.

Your action in this respect was not in the best interests of either Child D or Child H.

It was inappropriate and an abuse of your professional position.

You treated Child H at the Royal Brompton Hospital, and there created an “S/C” file for the child.

The “S/C” file contained original Royal Brompton Hospital medical records relating to Child H.

When you moved to the North Staffordshire Hospital in 1992 you took, or caused to be taken from the Royal Brompton Hospital, the “S/C” File relating to Child H.

Your action was not in the best interests of Child H.

It was inappropriate and an abuse of your professional position.

The damage to the integrity to the child’s hospital medical records was compounded by transferring them to a hospital at which the child was not being and had not been treated.

The Panel takes a serious view of your conduct in relation to the “S/C” files over a considerable period of time.

In 2004 the Professional Conduct Committee (PCC) found you guilty of serious professional misconduct in relation to the ‘Clark case’ and placed a condition on your registration for a period of three years.

The events in that case took place in 2000 and also concerned child protection issues.

The Council for the Regulation of Health Care Professionals appealed the decision of the PCC.

In his judgment given on 14 April 2005 Mr Justice Collins held that that the PCC’s decision to impose conditions was not unduly lenient but that the condition imposed was not sufficient to prevent any involvement by you in child protection work.

Moreover, the PCC should have directed that a resumed hearing take place towards the end of the three year term.

He substituted more tightly drawn conditions for that originally ordered.

A Fitness to Practise Panel reviewed the case on 23 July 2007 and determined that you had complied with the conditions.

It directed that the period of conditional registration should be extended for a further period of twelve months.

The events that gave rise to the Clark case occurred after the matters before this Panel.

These events and the consequent finding of serious professional misconduct have been disregarded by this Panel when considering the question of serious professional misconduct before it.

In February 2007 the Attorney General set in hand a review of cases in which you had acted as a prosecution witness.

This was with particular reference to the S/C Files.

The report is yet to be published.

The Panel has also heard that the South Wales police are investigating the treatment of Mrs H’s son.

The Panel has concluded that any police investigation and the Attorney General’s review are not relevant to its consideration of the question of serious professional misconduct, nor indeed to any sanction.

It has been accepted on your behalf that, in the light of the findings of fact there is evidence before the Panel from which it could conclude that you are guilty of serious professional misconduct.

The Panel has found that your conduct has fallen well below the standard expected of a registered medical practitioner in a number of respects.

It therefore finds you guilty of serious professional misconduct.

The Panel next considered what action, if any, to take in relation to your registration.

The Panel has borne in mind throughout its deliberations that any sanction imposed must be proportionate and appropriate, and that the purpose of sanctions is not to be punitive, but to protect patients and the public interest.

The public interest includes not only the protection of patients, but also the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour.

The public interest can also include a doctor’s return to safe practice.

The Panel has balanced the public interest against your own interests.

It has taken into account the Indicative Sanctions Guidance published by the General Medical Council.

The Panel is aware that the question of what, if any, sanction to impose is a matter for the Panel, exercising its own independent judgment.

The Panel has given consideration to the submissions made by both Counsel.

Mr Tyson, on behalf of the Complainants has submitted that the only appropriate sanction in this case is that of erasure.

Mr Coonan, on your behalf, has submitted that an order placing tight restrictions on your registration would be sufficient.

The Panel is in no doubt that it is necessary to take action against your registration and that the sanction imposed must mark strong disapproval of your behaviour.

Given the serious nature of your misconduct the Panel has determined that to conclude this case without making any direction in respect of your registration or to issue a reprimand would not be sufficient.

The Panel next considered whether it would be sufficient to impose conditions on your registration.

The Panel is aware that you are a paediatrician of international renown and that you have contributed significantly to the field of paediatrics and child protection.

The Panel recognises that your misconduct has arisen as a result of the child protection work that you were undertaking at that time and that your actions, although clearly misguided, may have been motivated by a concern to protect children.

There is no evidence before the Panel to demonstrate that your actions have caused direct harm to patients or their families other than in cases involving child protection.

Since your reinstatement in 2001, following suspension by your Trust, you have not worked in child protection.

You have complied with the conditions to which your registration has been subject.

The Panel has been provided with testimonials indicating that you are held in high regard by your professional colleagues.

The testimonials highlight your clinical skills and commitment to the welfare of children.

They also indicate that you have undertaken important ground-breaking research, which has influenced how the medical care of babies and children has been managed both in the United Kingdom and internationally.

The Panel has heard oral evidence from Dr Parke, a consultant paediatrician at the University Hospital of North Staffordshire and from Dr Bridson, a recently retired consultant paediatrician and Chairman of the Trustees of Child Health Advocacy International, a charity founded by you.

Dr Parke has given evidence about your outstanding clinical ability and your compliance with the conditions currently on your registration.

He also informed the Panel that numerous letters of support and thanks from your patients have been received.

Both witnesses confirmed that they were aware of the findings of fact made by this Panel.

Nevertheless they remain confident in your clinical abilities.

The Panel has also considered carefully the evidence given by Dr Chipping, Medical Director at the time, to the Professional Conduct Committee in August 2004 and her testimonial dated 16 November 2006.

She holds in high regard your clinical skills and the contribution you have been making to the paediatric team at North Staffordshire Hospital.

The Panel has noted the determination of the Professional Conduct Committee in August 2004, the judgment of Mr Justice Collins in April 2005 and the determination of the Fitness to Practise Panel at the review in July 2007.

The panel has been mindful of Lord Bingham’s well known observation in the case of Bolton v The Law Society, adopted in the case of Dr Gupta, as noted in the Indicative Sanctions Guidance:-

“A profession’s most valuable asset is its collective reputation and the confidence which that inspires………The reputation of the profession is more important than the fortunes of an individual member……… Membership of a profession brings many benefits, but that is part of the price.”

The Panel also had in mind Lord Hoffman’s judgment in Bijl v General Medical Council [2002] Lloyds Med Rep 60, in which he said:-

“The Committee was rightly concerned with public confidence in the profession and its procedures for dealing with doctors who lapse from professional standards. But this should not be carried to the extent if feeling it necessary to sacrifice the career of an otherwise competent and useful doctor who presents no danger to the public in order to satisfy a demand for blame and punishment……..”

Having considered all the evidence that is before it, the Panel accepts that were your registration to be restricted by tightly drawn conditions, patients would be unlikely to be at risk.

However, in considering the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour the Panel has concluded that the imposition of conditions would not reflect the gravity of your misconduct.

Your multiple failings over an extended period caused the Panel great concern.

Furthermore, the Panel is influenced by the fact that, although the events in
the current case predate those in the Clark case, there are now two instances where without justification you have accused a parent of murdering their child.

The Panel has therefore determined that to impose conditions on your registration, no matter how tightly drawn, would not be sufficient to protect the public interest.

The Panel next considered whether a period of suspension would be appropriate.

It has carefully balanced the public interest against your own interests.

It has taken into account the aggravating features of this case and the mitigation that has been advanced by you.

The Panel is particularly concerned by your lack of insight into the multiplicity of your failings over a long period.

The Panel is aware that an apparent lack of remorse should not result in a higher sanction but it has noted that notwithstanding the findings of fact you have not either directly or through your counsel offered an apology to any of the Complainants for your actions nor has there has been any acknowledgement by you as to your failings.

In all the circumstances the Panel has concluded that you have deep seated attitudinal problems and that your misconduct is so serious that it is fundamentally incompatible with your continuing to be a registered medical practitioner.

The Panel therefore directs that your name be erased from the Medical Register.

The Panel is satisfied that this is necessary in the public interest for the maintenance of confidence in the profession and in the interests of declaring and upholding proper standards of professional conduct and behaviour.

The effect of the foregoing direction is that, unless you exercise your right of appeal, your name will be erased from the register 28 days from the date on which notice of this direction is deemed to have been served upon you.

Having reached a decision that your registration should be erased, the Panel is minded to consider, in accordance with Section 38 of the Medical Act 1983 as amended, whether to direct that your registration be suspended forthwith.
The Panel will invite submissions from both Counsel on this matter.

Quite predictably, Dr. Southall has filed an appeal;

Harold Levy...hlevy15@gmail.com;