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Doctors accuse regulatory body of increasing risk of child abuse 5th January 2006

· Experts afraid to speak out after two were struck off
· GMC 'pays more attention to parents than children'

Children are being left at risk of abuse because doctors are afraid to speak out following the pillorying of paediatricians in the media and by the General Medical Council, senior doctors warn today.

In a strongly worded article for a leading medical journal, a former president of the Royal College of Paediatrics and Child Health criticises the GMC, the doctors' regulatory body, for the disciplinary action it took against the child protection experts Roy Meadow and David Southall.

Many in the profession no longer have confidence in the GMC, says Sir David Hall, implicitly accusing it of paying more attention to parents who complain than to the welfare of the child. "Changes in the way complaints are managed are urgently needed," he writes in the Journal of the Royal Society of Medicine.

Professor Meadow was struck off the medical register by the GMC for wrongly asserting that the chances of a second cot death happening in a family were one in 73 million. His expert evidence was given during the trial of Sally Clark, who was convicted of killing her second child but later freed on appeal.

Professor Southall was suspended from child protection work for contacting police to accuse Mrs Clark's husband of killing two of their babies after watching him on a television programme. Both paediatricians have been the target of vociferous campaigns by groups defending parents accused of abusing their children. But Sir David writes that a paediatrician fundamentally owes a duty of care to the child, not the parent. Guidance from the judiciary and the Children's Act make it clear that the child's interests must be paramount.

"With regret, it must be recorded on behalf of many UK doctors that they currently have no confidence in the competence of the regulatory authorities to apply this guidance when making judgements about the expertise or professional behaviour of those working in child protection," he says. "Nor do they believe that the authorities are able to withstand public, political and media pressures in high-profile cases."

The evidence base in child protection cases is still weak, he says. Insufficient research has been done on forensic questions, such as the ageing or pattern of bruises or the significance of human bite marks. "It is a bitter irony that among the doctors who have been called before the General Medical Council are several who have contributed so much to our knowledge of child abuse."

An editorial in the journal says the profession is becoming frightened of speaking up for abused children. After the GMC verdicts against "the leading lights of child protection", writes editor Kamran Abbasi, "paediatricians began to wonder who would protect them if they raised concerns about child safety or gave evidence in court.

"These were also worrying omens for children who are at risk of injury or abuse but on whose behalf the medical profession finds it increasingly difficult to speak up. How did we come to this? What forces have cowed a profession that prides itself on improving the health and consequently the lives of the most vulnerable members of our society?"

The way forward, says Sir David, is through changes in the regulatory system, a stronger evidence base in child abuse cases, and better training and continuing education for paediatricians.

"Our hope is that protecting children will once again be seen as a core part of paediatric practice and that health professionals can continue clinical work and research with skill, compassion and humility, recognising the difficulties, but aware of their duty to protect children from cruelty, abuse and neglect.

"Our aim is that they will no longer need to be preoccupied with the risk of having their career abruptly interrupted or terminated by inappropriate management of complaints about their work."

Backstory

Roy Meadow, who retired in 1998, was an eminent paediatrician who frequently gave expert evidence on child abuse in court. In 1999, he testified at the trial of Sally Clark for the killing of her first two babies. She was freed on appeal because of undisclosed evidence from the baby's postmortem examination, but the judges said his statistical error - saying the chances of a second cot death in such a family were 73m to one - would also have made the conviction unsafe. Other convictions that relied on expert medical evidence have been reviewed, and Angela Cannings and Donna Anthony, both convicted partly on Meadow's evidence, have been freed. Professor Southall was brought before the GMC and banned from child protection work for three years for intervening in care proceedings over the Clarks' surviving child.

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