21 December 2003

That there is a crisis in British paediatrics is beyond doubt. Following a series of high-profile court cases during which expert paediatric testimony has been discredited, public confidence in the profession has slipped to an all-time low.

Peter Bossley What is not so clear is the identity of the heroes and villains in this deeply troubling and upsetting business. Who are the bad guys? 'Easy', say the critics, many of whom are parents who have suffered the loss of a child, 'it's the all-powerful consultant paediatricians like the controversial Professor Sir Roy Meadow and North Staffordshire's own Professor David Southall.'

'Rubbish', claim the professors, 'the real villains of the piece are parents who kill and those well-meaning but misguided media supporters who end up protecting child killers.'

And what of the heroes? Are the good guys those brave parents who fight to clear their name or is it the eminent, brilliant medical men and women who devote their own lives to saving the lives of children - people, in other words, like Professors Meadow and Southall?

Only one thing is clear, however, and that is the identity of this story's victims: children - innocent, trusting children. Among them are new-born babies spirited away by social services departments. Then there are the other child victims, those for whom intervention came too late and whose short, tragic lives ended beneath a blanket or pillow held against their tiny, trusting faces by a parent.

For at the heart of this terrible, heart-wrenching tragedy is one indisputable fact: some parents do kill their children.

It is difficult to come to terms with this dreadful truth but health professionals have long accepted that some people are capable of betraying the most important relationship of all: that of a mother and her child.

The shocking fact that this most basic of bonds can, and does, break down is the cause of much of today's controversy. That anyone - least of all a mother - could harm so defenceless a being as a new-born baby is an effrontery to humanity, a reversal of everything we believe to be civilised. Such behaviour provokes extreme - and in many cases emotional - responses.

In prison, the child killer is regarded with almost mythical hatred. The presence of such an inmate engenders moral outrage (and often extreme violence) among the rest of the prison population.

In hospitals, child victims tend to rouse a deep-rooted protective instinct among health professionals.

For all the adverse publicity heaped upon Professor Sir Roy Meadow's controversial views on Munchausen Syndrome By Proxy (MSBP), the fact remains, he is not a villain.

(MSBP is the theory, first proposed by Prof Meadow in 1977, that depressed mothers harm their babies in an attempt to gain attention. It was, and remains, a deeply controversial view).

Prof Meadow is a passionate, driven defender of children whose expert opinion and research has saved many, many children from a miserable life of abuse.

And yet it is this very real desire to save babies which may be causing irreparable damage to innocent children and their parents.

For, in his desire to protect society's most vulnerable victims, Prof Meadow (and supporters like Prof Southall) can all-too easily adopt an evangelical zeal. Whenever a paediatrician as eminent as Prof Meadow offers expert opinion in the closed, secretive world of the Family Division, the court tends to take notice. In such proceedings, the stakes are high indeed. Get the decision right and a baby's life will have been saved. Get it wrong and the parents (and child) will become victims of a cruel and unending agony.

Take the case of Karen and Mark Haynes of Birmingham. Their first baby, Robert, died aged four months. Thirteen months later a daughter, Sarah, was born. The Haynes held her 20 minutes and then social workers removed her. Forever.

The cause of the Haynes's heartbreak was an emergency protection order granted to Birmingham Social Services after the department had commissioned two paediatricians to review young Robert's case notes.

One of them, Prof Sir Roy Meadow, said he believed that Robert's death was the result of smothering.

Four months later the case was heard in a Family Division court where Prof Meadow repeated his opinion that Robert was smothered due to MSBP. Other experts disagreed, but the court believed Prof Meadow.

Sarah was put up for adoption and the Haynes went home to grieve - again. No police investigation, no criminal case and no jury trial. Just one eminent and expert opinion from a man who has dedicated his life to the protection of children.

The Haynes case was heard in open court. This is unusual because Family Division proceedings are normally held in camera. It has allowed the Haynes to protest their innocence - long and loud. Other parents in a similar situation have been the subject of gagging orders meaning that, as well as losing a child, they are unable even to plead innocence.

Franz Kafka would have understood. And Kafka would also identify the real villain in all of this - the state. Not the doctors on whose words hang lives. Not the parents - both innocent and guilty, for even the latter are victims of psychological illness.

No, the real villain is a state which has failed to protect parents from those protecting their children. MSBP syndrome remains a controversial illness - many experts doubt it even exists. Yet all agree that some parents do kill babies.

The problem is that Family Division verdicts destroy. Such decisions - in secret, behind locked doors, without a jury and requiring only proof "on the balance of probabilities" rather than "beyond reasonable doubt" - destroy families, break hearts and, agonisingly slowly, over years of sadness and impotent rage, sometimes destroy innocent parents.

Of course, vulnerable children need protecting. But there's something wrong with a system that removes babies from mothers within minutes of birth yet which allows the gross wrongs visited upon the Sally Clark and Angela Canning to fester for year after year.

The CPS has ordered a review of every past case that relied on Prof Meadows' expert testimony. That is a start, but it is not the end. We need to review the whole paediatric system. No longer should the word of one paediatrician - no matter how well-meaning - be sufficient to cast a family into the darkness of forced separation from a child.

Too many questions remain unanswered when it comes 'cot death'. We must not allow unproven, controversial theories to rush into this void. In the event of a suspicious death, there must be closer co-operation between the various parties - police, social services coroner, paediatrician and paediatric pathologist. Inviting a variety of opinion and expert advice will help protect parents and children from the dangers of zealotry

Finally, decisions to remove children from their parent should - and must - be subject to the standards of criminal law. Until the state gets its act together and starts to protect parents and children by policing the experts, it will remain the real villain of this piece.

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