Parents' sensitivity blamed for failure to detect child abuse

Doctors working in the field of child abuse are being subjected to a barrage of complaints from parents, leading to a fall in the detection of those at risk, experts allege today.

The General Medical Council (GMC) has failed to understand the unique difficulty paediatricians face in balancing the needs of the child and its parents, causing a crisis of confidence in the disciplinary body, they say. The allegations, in an editorial in the British Medical Journal (BMJ), reopen old wounds caused by controversial cases in which high-profile paediatricians have been struck off the medical register.

Child abuse is one of the most fraught areas of medicine: a wrong decision can needlessly rip a family apart or leave a child vulnerable to serious harm.

Complaints against paediatricians over child abuse work rose 500 per cent between 1995 and 2003, with 61 per cent of currently active complaints made after 2003, the authors of the BMJ editorial say. Since 2003, the number of children placed on the at-risk register for emotional abuse and neglect has increased, but those for physical or sexual abuse have declined.

"This suggests paediatricians may be avoiding work related to abuse, for which more detailed physical examinations are needed," say David Foreman, a consultant paediatrician, and Juliet Williams, a barrister. "If so, this is bad for children."

It is the latest broadside in a bitter row that has been simmering for years. Paediatricians claim there is a witch-hunt against them, highlighted by two cases in which colleagues were struck off by the GMC.

Professor Sir Roy Meadow, a former president of the Royal College of Paediatrics, was found guilty of serious professional misconduct and removed from the medical register in 2005 after evidence which he gave in the case of Sally Clark, who was jailed for the murder of two of her babies, was found to be "misleading". He later successfully appealed against the decision and was restored to the register, but not before the Government had ordered a review of hundreds of abuse cases.

Professor David Southall, a consultant paediatrician at North Staffordshire Hospital in Stoke-on-Trent, was struck off the register last December after he was found to have accused a mother of murdering her son during an investigation into the 10-year-old boy's death. Despite the presence of a professional social worker during the interview when the accusation was alleged to have been made, the GMC fitness to practise panel chose to believe the evidence of the mother. Professor Southall has launched an appeal.

Writing in the BMJ, Dr Foreman and Ms Williams say there is a fundamental confusion about doctors' duties in child protection cases which has been exacerbated by the GMC's decisions: "In many, if not all, child protection investigations there will be prima facie evidence that the doctor acted contrary to the usual duty of care expected towards the child's parents, as fluctuating suspicion pushes the paediatrician uncertainly from role to role. Because child protection should be preventive, in many cases no abuse will be detected retrospectively to justify this breach of care."

They call on the GMC to provide more specific guidance for doctors about how to handle child abuse cases and a review of the handling of complaints, as well as better public information.

Concern about the GMC among paediatricians peaked last year after the verdict in the Southall case in December. Many expressed alarm that a key part of their defence against false accusations by parents – the presence of an independent witness – had been undermined.

Thirty-nine of them wrote a joint letter to the press condemning the "perverse decision" and Patricia Hamilton, the president of the Royal College of Paediatrics, warned that the verdict would deter paediatricians and social workers from undertaking child protection work. "We are very concerned ... children and young people will come to harm," she said.

Nine months later, the profession is split, with the Royal College adopting a more emollient line that sets it apart from Professionals Against Child Abuse (PACA), a 100-strong group of paediatricians formed to defend the profession against malicious allegations.

PACA claimed paediatricians were turning away from work in child abuse and pointed to a 28 per cent decline in cases on the child abuse register between 1995 and 2005, but a 245 per cent increase in criminal convictions (from 1998 to 2005) for abuse and neglect, implying that children were being left unprotected.

But the college says reports of a flood of complaints against paediatricians are exaggerated and that there is no evidence of a decline in the numbers involved in child protection.

It says relations with the GMC have improved and there have been only two public hearings before the GMC, out of more than 600 in total since 2004, involving paediatricians working in child protection.

Rosalyn Proops, a child protection officer at the college, said: "I am personally not aware of any evidence that the decline in children registered for physical or sexual abuse is related to doctors' reluctance to identify it." She said the number of children on child abuse registers in the US and Europe was also declining for reasons that were unexplained. "Some say abuse is not being identified, while others say it is actually declining," she added.

But she conceded there were problems with the handling of vexatious complaints and with finding paediatricians prepared to act as expert witnesses, following the Meadow and Southall cases.

A GMC spokeswoman said: "Doctors should always act in the interests of children ... If they are competent and professional, they have nothing to fear from the courts or from families."

Trials of an expert witness

The General Medical Council case that sent shock waves through the child protection community involved a 10-year-old boy who hanged himself from a curtain rail in 1996.

Professor David Southall, an expert witness, was alleged to have accused the mother in an interview of drugging the boy and stringing him up by his belt.

In the case, heard by the GMC last December, he denied making the allegation, saying he had put "scenarios" to the mother but had not directly accused her. His version was backed by an independent social worker who was present at the interview.

But the GMC panel dismissed his account and that of the social worker. Professor Southall was found guilty and struck off. He is appealing.

The verdict led some paediatricians to call for a boycott of the GMC and accused it of "popular punitivism". Professionals Against Child Abuse, a group of paediatricians who back Professor Southall, said the message it sent to anyone thinking of working in child protection was, "Don't bother; you will lose your livelihood".

The GMC denied paediatricians were any more likely to face accusations of misconduct.

David Southall was already suspended from child protection after a previous GMC case in which he accused the husband of Sally Clark of murdering her children. His appeal against the suspension is being heard.

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