Child-death 'experts' face greater scrutiny

Sweeping changes to the investigation of sudden infant deaths were called for yesterday to protect children and prevent parents from being wrongly accused of murder.

Sweeping changes to the investigation of sudden infant deaths were called for yesterday to protect children and prevent parents from being wrongly accused of murder.

An 18-month inquiry by the Royal College of Pathologists and the Royal College of Paediatrics said every cot death should be fully investigated and greater scrutiny introduced of expert witnesses in court cases.

The report comes in the wake of the cases of Sally Clark, Trupti Patel and Angela Cannings, who were wrongly accused of killing their babies. MrsClark and Mrs Cannings were acquitted on appeal in 2003 after being jailed and Mrs Patel was cleared at her trial. The cases led to the biggest review in legal history of child abuse cases and convulsed the medical and legal establishments.

Alan Williams, the Home Office pathologist who gave evidence in the Sally Clark trial, was strongly criticised by the Court of Appeal for failing to pass on test results showing one of her two sons, both of whom died in cot deaths, may have been killed by an infection.

Professor Sir Roy Meadow, who gave evidence in the Clark and Cannings cases, was also criticised and is to appear before the General Medical Council in the new year. Colin Paterson, a pathologist who defended parents against charges in child abuse cases for more than two decades by claiming the babies may have suffered from "temporary brittle bone disease", which few specialists recognised, was struck off the medical register by the GMC.

Yesterday's report, from a working party of the two royal colleges, contains trenchant criticisms of the role of expert witnesses in cot death cases.

Without naming them it says: "Those regularly involved in child abuse can find it hard to be dispassionate and indeed sometimes become hawkish."

It says witnesses have sometimes relied on "medical belief" rather than scientific evidence and that the adversarial nature of the legal system has pushed them into being over-confident of their conclusions.

"It is also important that the courtroom is not ... used by doctors to fly their personal kites or push a theory from the far end of the medical spectrum."

The report says judges should order a pre-trial hearing to establish areas of agreement and disagreement between expert witnesses so a judgement can be made of whether the case should proceed to court. Any expert giving evidence should have recent clinical experience, peer-reviewed research and should not go outside their area of expertise, it says.

Inquests should be held into all cot deaths where the cause of death is not obvious and post-mortem examinations carried out by paediatric pathologists according to a national protocol, the report says.

Baroness Helena Kennedy, QC, who chaired the working party, said: "What parents want is a proper investigation for their own peace of mind into why their baby died."

In practice, investigations were often haphazard, insensitive and stigmatised families who were left under a cloud of suspicion. Baroness Kennedy said the working party had uncovered a great deal of unhappiness among parents who had been investigated. It was essential to avoid "the language of suspicion" with families who were facing a terrible tragedy and needed support.

It was also essential to protect children from abuse and balance had to be struck. By ensuring every cot death was investigated according to a standard national protocol, the stigma could be avoided, she said.

Professor James Underwood, president of the Royal College of Pathologists, said the investigation of cot death was "one of the most opinion-led and least evidence-based" areas of medicine. There was an urgent need for reform but there were only around 40 paediatric pathologists in the country with the necessary expertise to carry out post-mortem examinations.

The report called for Margaret Hodge, children's minister, to take a lead in implement- ing the national protocol for investigating cot deaths. A spokeswoman for the Department for Education said: "We welcome the report. It will inform the future handling of these tragic events and the steps necessary to prevent potential miscarriages of justice, while protecting the interests and safety of children."

Joyce Epstein, director of the Foundation for the Study of Infant Deaths, and a member of the working group, welcomed the recommendations.

"The investigation of sudden infant death in this country lacks thoroughness and consistency, and vital evidence is being lost. It is time for this protocol to be made mandatory."

THE RECOMMENDATIONS

• All sudden deaths in infancy to be fully investigated according to a standard national protocol.
• Inquests to be held in every case unless there is an immediately recognisable natural cause.
• Decisions to prosecute should only be made after reference to a multiprofessional review.
• Post-mortem examinations to be carried out by specialist paediatric pathologists.
• Expert witnesses to have recent clinical experience, peer-reviewed research and should not go outside their area of expertise.
• Pre-trial meetings of experts should establish areas of disagreement and set them out in writing for the court.
• Better training for all staff involved in investigating deaths.