Sunday 21 December 2003

Nursery crimes

Amid growing disquiet about the fate of women diagnosed with Munchausen Sydnrome by Proxy, LAUREN QUAINTANCE reports on an Auckland woman who has had six children taken off her.

When they came for the last of Sarah Mitchell's children, her North Shore home was dark and hushed, the routines of family life suspended for another day.

It was 2am on a Wednesday morning in August 2000 and Mitchell and her three-year-old daughter Kimberley were asleep on the couch, undisturbed by the low hum of the TV.

Her husband, Victor, was sleeping in the couple's bedroom and their youngest and most fragile child, 14-month-old John, was lying in his cot.

The knock on the door was more like an insistent pounding with a closed fist. When Mitchell opened the door she was confronted by at least seven people - some uniformed police officers. She was pushed back inside the house by a policeman and held against a wall. Victor Mitchell came out of their bedroom, half-dressed, and shouted "what the hell is going on?" The officers began searching the house.

A social worker the couple recognised said "Where's the baby? Get the baby!" Suzanne Mitchell was apoplectic. She was "swearing and cursing" at everyone. "You're all sick," she spat at them.

Eventually the social worker said that John and Kimberley were being taken to Starship Hospital for tests. Victor Mitchell said he would dress so that he could go with the children. A social worker, gesturing toward his wife, said, "Fine, but if she goes anywhere near the hospital she'll be arrested". John, who rarely cried, stared blankly as he was lifted from his cot, but Kimberley was sobbing.

"We told her that she would be getting a ride in a police car and that it would be fun and that if she was really lucky they might put the lights on," said Sarah Mitchell.

When the house emptied, she retreated to the lounge and collapsed on the floor. It was the last night they had together as a family.

Five years earlier, almost 20,000km away in the prosaic working class town of Gosport on England's south coast, Mitchell's first four children were taken from her. She couldn't face saying goodbye so, at the appointed time, she went for a walk while a friend babysat. When she returned the friend said simply: "They're all gone."

Ironically, it was Mitchell herself who first contacted the Gosport social services department asking for help with her children. At the age of 20, she gave birth to twin girls, Jenna and Emma, who were 13 weeks premature and spent 21/2 months cocooned in incubators.

It was soon obvious that they suffered from serious developmental problems. They were still wearing nappies at the age of five and they were extremely violent, often trying to bash and strangle each other without warning.

In 1990 Mitchell gave birth to Oliver, a "perfectly healthy boy" and two years later had Lucy, a "sickly baby" who suffered from apnea attacks that meant she had difficulty breathing and would often have to be rushed to hospital. Social workers assigned to Mitchell soon made it clear they suspected that she was deliberately harming her children and faking illnesses to draw attention to herself.

Although British paediatrician Roy Meadow invented the term Munchausen Syndrome by Proxy (MSBP) in 1977, the idea gained real currency in child protection circles in the '90s. Named after the 18th-century German soldier who was renowned for exaggerated accounts of his travels, a small coterie of younger doctors in Britain, including paediatrician David Southall, adopted the theory - also known as Meadow's law - and diagnosed hundreds of cases across Britain.

It was Southall who, without seeing Mitchell with her children, concluded she suffered from MSBP and became the expert witness in her case.

But the validity of Meadow's law has come under intense scrutiny following three high-profile cases involving British women cleared of charges of murdering their babies.

Sally Clark, 39, was freed after spending three years in jail for the murder of her two children. Trupti Patel, 35, was acquitted of smothering her three babies. A third woman, Angela Cannings, 40 - jailed for killing her two sons - was released by the Court of Appeal this month.

In all three cases Meadow was the main prosecution witness and, as a result, the British government has asked prosecutors to identify cases in which Meadow, 70, has given evidence and inform the defence in case they want to appeal. Meadow faces being struck off.

Although Southall has not been as high-profile, largely because he has often given evidence in closed Family Court hearings rather than criminal trials, he also faces charges of serious misconduct. The General Medical Council in London has decided that Southall has a case to answer in three cases - including those of Sally Clark and Sarah Mitchell.

When Southall examined Mitchell's children's medical files he identified four suspicious incidents that he claimed were proof she suffered from MSBP.

The first incident occurred almost 10 years earlier. Mitchell took one of the then 21/2-year-old twins, Jenna, to hospital because she had vomited in her cot and Mitchell believed she may have swallowed Brufen tablets prescribed for her headaches. Seven years later she took Lucy, 18 months, and Oliver, four, to hospital within months of each other because she believed they had taken drugs that were not prescribed for them.

There was no evidence that Lucy had drugs in her system but Oliver's blood tests proved he had taken carbamazipine - Lucy's anti-epilepsy drug - but he recovered with no ill effects. During his hospital stay Oliver woke up one night and, without prompting, told a nurse that he had taken his sister's pills to "make himself feel better".

None of these incidents was considered suspicious at the time. Hospital staff did not alert social workers or the police. But once Mitchell was "diagnosed" with MSBP, the drug-taking incidents were no longer viewed as examples of a young single mother struggling to cope with four demanding children, two of whom suffered from behavioural problems, but as evidence of her own illness.

Southall also claimed that Mitchell pretended Lucy suffered epilectic fits and Oliver had asthma - when they were both healthy - and that she

cruelly tried to have Oliver circumcised because of an infection when the procedure was unnecessary. Medical notes that were "missing" during her British court case, but later turned up, show that Lucy had fits in front of ambulance staff. Oliver suffered from asthma and was given a circumcision in foster care.

Psychologist Lisa Blakemore-Brown, an expert witness in Mitchell's British case, was so unconvinced by the allegations that she has spent the past eight years campaigning about the case. Before Blakemore-Brown even had the opportunity to examine the children, social workers attempted to convince her that Mitchell was a monster.

"I was very concerned about what was going on," she told the Sunday Star-Times. "It seemed contrived for our purposes - there was nothing professional about it. (Social workers) wanted to manipulate our thinking before we'd even seen them."

Blakemore-Brown said Mitchell's twin girls were extremely hyperactive and displayed symptoms of autism and Attention Deficit Disorder (ADHD) - problems she says are commonly linked with premature babies.

In those circumstances it was more plausible that Mitchell was struggling to cope and had not deliberately fed the children drugs or falsely claimed they swallowed them. Another two experts agreed with Blakemore's ADHD diagnosis, but Southall - neither a psychologist nor an expert in ADHD - rejected this out of hand.

This is one of the criticisms of Southall's work. He is a general paediatrician and does not always have the expertise to decide whether the children he is asked to assess suffer from their alleged medical problems.

Dr Paul Johnson is a specialist in breathing problems at John Radcliffe Hospital in Oxford and has testified in MSBP cases in which Southall was the key expert witness. He says he believes Southall has misdiagnosed dozens of mothers. "He believes fervently and almost passionately in this, to the extent that he's not willing to look at other evidence. I think he's absolutely wrong."

Shortly after she lost her British case in mid-1996, Sarah Mitchell married a New Zealander.

By then Oliver and Lucy were in the process of being adopted and Emma and Jenna were in permanent care. Sarah decided to move with Victor, initially to Australia and later to New Zealand.

"When I met Victor I'd tried everything. Leaving my children was very hard. It didn't mean I didn't love them, but moving to New Zealand was a fresh start."

It wasn't exactly a fresh start, of course, since British authorities contacted New Zealand's Child, Youth and Family (CYF) when they learned that Mitchell was pregnant again. Although British doctors may have been at the vanguard of the MSBP movement, by the late '90s New Zealand paediatricians were diagnosing MSBP at more than three times the rate of their British counterparts.

A 1999 survey showed doctors found 18 cases of MSBP in New Zealand that year although, inexplicably, only 61% were referred to social workers or police.

Mitchell had Kimberley - a healthy baby - in February 1997. Fourteen months later she had John, who was six weeks premature. John was born with a brain abnormality doctors suggested may be due to an infection Mitchell had during her pregnancy, and has been slow to develop motor and language skills.

Although doctors have disagreed about the significance of the brain abnormality on John's development, they agree it is highly unlikely that the sedative Mitchell was later accused of giving John caused his problems.

In July 2000, when John was 15 months old, he was admitted to Starship Hospital with bronchitis. During routine tests, the hospital laboratory LabPlus recorded that an adult hypno-sedative zopiclone was detected in John's urine.

The result did not apparently alarm hospital staff - until three weeks later when paediatrician Dr Ralph Pinnock spotted the result while reviewing John's file, which also stated: "Maternal Munchausen by Proxy".

By then John had been discharged, but Pinnock asked laboratory staff to check the result that night. When it was "confirmed" he immediately notified CYF. Sarah's children were removed from her care at 2am the next morning.

When the case was eventually heard in the Family Court in Takapuna three months later, Judge Laurence Ryan heard evidence from New Zealand psychologists and psychiatrists about MSBP - including one who quoted Professor Roy Meadow's diagnostic criteria - but he was unable and found it unnecessary to decide whether Mitchell suffered from MSBP.

In his written decision the judge said he gave little weight to the British judgement because he did not have access to the evidence presented to the court, meaning he could not assess Mitchell's claim that the case was unfair.

Instead he made it clear that the case hung on whether Mitchell's children were at risk and, crucially, whether she gave John zopiclone as CYF alleged. Because the standard of proof required in Family Court is much lower than that required in a criminal court, the judge only had to be satisfied "on the balance of probabilities" she fed him the sedative.

Although Mitchell had been prescribed 10 tablets of zopiclone by her GP a month earlier, she was able to produce nine-and-a-half of those in court. She insists that she took the other half tablet herself and did not take any more because it made her feel groggy.

Her husband, Victor, claims that he fed his wife the half tablet and he has never retracted this story, despite the fact the couple have since divorced.

No investigation was ever carried out to look for evidence to support the suggestion that Mitchell may have had access to more zopiclone, either by ordering the drug off the internet or using false prescriptions.

Lawyers for the Mitchells argued that the testing done by LabPlus fell well short of forensic standards required in a criminal case. In particular, scientist Dr Jim Sprott argued that the test LabPlus used to identify the zopiclone, known as thin layer chromatography (TLC), was merely a screening test used to identify which drugs were likely to be in a patient's system when, for example, a quick result was needed in the case of an overdose.

Sprott also claimed the results of this low-level test were misinterpreted because only one "spot" showed up on the chromatographic plate when two would normally be present if there was zopiclone in a sample. LabPlus said this was because the drug had a different effect on a 15-month old baby, but the Italian expert quoted by crown lawyers to support this has since said publicly that his work was misconstrued.

The Sunday Star-Times has obtained a draft affidavit from former Auckland University chemistry lecturer Mike Fitzpatrick, prepared for a possible appeal of Mitchell's case but never submitted to court in its entirety. The affidavit says that LabPlus breached international standards by relying on TLC, a screening test, and had not backed up its findings with a more sophisticated confirmatory test.

Fitzpatrick, now an environmental chemist who has taught chromatographic techniques to university students since 1985, told the Star-Times he was staggered that LabPLus relied on TLC alone.

"That wouldn't be good enough to test for dope in the horse racing industry. It wouldn't last three seconds in court, and that mother has had her children taken off her on the basis of it."

LabPlus did a second test, gas chromatography mass spectro-metry (GC-MS), on John's urine. But it did not test for zopiclone because, according to the laboratory, GC-MS cannot pick up zopiclone in urine.

In his decision Judge Ryan quotes the lab's senior scientific specialist Ron Couch as saying this is as a "well-accepted scientific mystery". Fitzpatrick strongly disputes this. He says GC-MS can pick up zopiclone in urine and the negative result either meant that the test was done incorrectly or zopiclone was not present.

The government-owned laboratory ESR - the laboratory that would have done the testing in a criminal case - says that there is no question that GC-MS can be used to test for zopiclone in a urine sample. ESR's toxicology expert Stuart Dixon says that GC-MS is the most appopriate test and the laboratory would be very reluctant to rely on TLC results.

Couch offered to do a more sophisticated test known as high performance liquid chromatography (HPLC), but Pinnock declined because results would not have been available for up to three weeks.

As part of his research into the case, Fitzpatrick took zopiclone and a drug John had been prescribed for an ear infection called co-trimoxazole and tested his own urine. He found that the two drugs were indistinguishable in a TLC test.

Because Fitzpatrick was not involved during the Family Court case - and only part of his work was submitted to a hearing in the high court and was then said inadmissible because it was new evidence that the judge ruled it should have been presented at the original hearing - no judge has had the benefit of seeing his full results.

Lawyers familiar with the case describe the Fitzpatrick affidavit as a "smoking gun" which would have cut straight through the crown's evidence. Because this is a Family court case with strict rules about reporting, it is difficult for almost anyone including lawyers and expert witnesses to speak out. But, privately, many say that the Mitchell case is a miscarriage of justice.

Observers say it was quite clear that Judge Ryan did not think Mitchell was an entirely credible witness. In his judgement he said that he believed she had a "dysfunctional personality" that was probably due to abuse she suffered as a child. He said she had acted in an "exaggerated and bizarre way" by laying no fewer than 38 complaints against professionals involved in her case and had displayed "obsessional behaviour" in her campaign against David Southall.

Anti-MSBP campaigners claim that it is near impossible for women who are falsely accused to clear their names. Not only are they required to explain complex and baffling medical problems, but everything they do is interpreted as a sign of their illness, they are often dismissed as obsessive and any

explanations they give are seen as lies.

But even some of Mitchell's supporters admit that she probably has a personality disorder - something that has probably been compounded by the stress of losing her children. But that does not necessarily mean she suffers from MSBP.

For Mitchell, it all means very little now. She has had her hopes lifted - and dashed - before, and she refuses to hope any more. Her face is thinner and more angular than it was a few years ago. Her dark hair is cropped short, and on the two occasions we meet in cafes in Auckland she favours dark, anonymous suits.

Mostly she seems like a lonely, defeated figure. The fight has been knocked out of her and it's as if she is gasping for breath. Occasionally something sets her off and and she talks urgently, obsessively, about the minutiae of the evidence before stopping suddenly. It is difficult to get her to talk about her feelings and she does not cry.

Mitchell, 39, says that she has almost no friends any more and never wants another relationship with a man because she finds it impossible to trust anyone. As for more children she wouldn't contemplate bringing a seventh child into the world who could be snatched away.

She has not seen John and Kimberley for almost two years. They are being cared for by family members. She is entitled to supervised access at a community centre, but she does not believe it is helpful for the children. "I'm not going to see them in that prison," she says. Besides, she is not sure what she would say now that Kimberley is old enough to ask why she hurt them and she refuses to lie.

"You can't actually describe how you're feeling because it's like you're numb. If you let yourself feel it would cut you in half. It's not so much how it hurts me because I'm an adult. Nobody, not once, has ever considered what it does to these children. Kimberley just thinks that I don't want her and that I don't love her. Lucy asks if I'm better now and if I love her. I don't even have any pictures on the wall any more because I can't stand it when people say are those your children?' I say yes, but they're not my children any more'."

Perhaps strangely her greatest hope is that she would be charged with a criminal offence - like attempted murder - in relation to the allegation that she drugged John. That way her case could be heard in an open court and the Family Court evidence would be laid bare. The idea of being sent to prison doesn't frighten her in the least. "Do they think I'd feel any worse in a prison cell? I'd rather be in prison because at least you do your time."

* Sarah and Victor Mitchell's names and those of their children have been changed for legal reasons.

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