Posts Tagged ‘Child protection’

Guidance on duty to protect children from abuse

By Mike Broad - 28th June 2011 7:05 pm

Doctors have a duty to protect children from abuse, new guidance from the GMC confirms.

Doctors who suspect children are being abused or neglected must tell parents and the young people themselves as soon as possible about their concerns and what action they will take.

The new guidance, developed by a working group chaired by Lord Justice Thorpe, seeks to set clear standards for all doctors, including those who do not routinely treat children. It says doctors have a duty to protect children even when they are only treating adults.

Every doctor should be able to spot signs that a child could be at risk at an early stage, for example if a parent misuses drugs or alcohol.

The group was set up following concerns by paediatricians and others involved in child protection about the difficulties of working in this area. These include knowing when to share confidential information and the risk of complaints being made by parents about the doctor’s decisions.

Evidence presented to the group from both doctors and parents suggested that open and early communication can help reduce the distress and confusion that parents and children often experience after concerns are raised.

Niall Dickson, chief executive of the GMC, said: “We recognise that taking action to protect children from abuse can be challenging and distressing for everyone involved. This is a complex area of practice, but we believe this new guidance will provide greater clarity about what doctors need to do to protect children, even if they are uncertain about the risks involved. We hope it will also help give doctors confidence to make these extremely difficult decisions.”

A foreword to the guidance reassures doctors that when they act reasonably in response to concerns about abuse or neglect, following the principles in this guidance, they will not be subject to censure by the GMC.

Key issues emerging during the development of the guidance included the importance of working closely and effectively with other professionals involved in child protection and the benefits of good and constructive communication with parents and carers. The guidance covers these and other areas including giving evidence in court, communicating with children and parents and sharing confidential information. 

Dr Amanda Thomas, officer for child protection at the Royal College of Paediatrics and Child Health, said: “Spotting signs of child abuse and neglect is a complex and difficult field. This new guidance is fundamental for all medical staff to protect children and young people from harm.

“We have worked very closely with the GMC on this as the first duty of a paediatrician is to the child or young person. There is no doubt that these standards will help to keep children and young people safe and the consultation is a real chance to improve their medical care.”

Dr Nick Clements, head of medical services of MPS, added: “We have seen doctors concerned and potentially confused about when they should disclose information to other agencies, and how much information they should provide. The new GMC guidance is very helpful in this regard, and also provides further clarification about other important issues, such as where to store case conference records, and what information to provide to families about any investigation process.”

The GMC has also published analysis of the involvement of paediatricians in the GMC’s fitness to practise procedures which shows that paediatricians are no more likely than other doctors to have their cases referred to a public hearing.

Over a five year period, paediatricians received proportionately fewer complaints on average than other specialties including general practice and surgery. The analysis also indicates that complaints about paediatricians are more likely to be investigated, but are also more likely to be closed following an investigation with no further action than complaints about other doctors. This may be because paediatricians can be involved in contentious areas of practice that raise serious concerns, which may not always be borne out on investigation.

Since April 2006, the GMC has held 15 fitness-to-practise hearings involving paediatricians and only two were concerned with paediatricians involved in child protection.

The regulator controversially struck off both professors Southall and Meadow for their roles in fabricated and induced illness cases, before they were re-instated by the high court. Southall’s long-running case with the GMC is ongoing.

The consultation runs to 16 October 2011.

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Prof David Southall back in front of the GMC

By Mike Broad - 3rd May 2011 10:50 am

Professor David Southall is back in front of the GMC this week in a further challenge to his right to work as a paediatrician.

Southall, who came to prominence for his expertise on Fabricated or Induced Illness, was reinstated to the register by the High Court last May, after being struck off by in 2007. The GMC previously found that he had ‘wrongly’ accused a woman of involvement in the death of her son.

However, the GMC was left with outstanding issues over patient confidentiality and the keeping of secret files on patients. The High Court said the GMC should come to a conclusion on these issues.

In December 2007, a fitness to practise panel alleged that Southall, when informed by a child’s parents that they no longer wanted him to be involved in the child’s management, wrote to the referring doctor and copied the letter to another consultant paediatrician not involved in the child’s care without the consent of the child’s parents and that his actions were ‘inappropriate and breached confidentiality’.

It also claimed that he ‘damaged the integrity’ of a child’s medical records making them inaccessible to others involved in the child’s care. His actions were not in the best interests of the children, inappropriate and an abuse of his professional position, the panel alleged.

This week’s hearing - the third since last July - will decide whether the findings warrant a fresh attempt to remove the paediatrician from the register.

At the end of last year, Southall called for an inquiry into the GMC’s treatment of doctors who work in child protection. He cited cases where doctors have only been suspended for downloading child pornography prior to a return to work - whereas high profile child advocates, like him, have been struck off.

Southall’s case follows that of Prof Sir Roy Meadow, who was struck off in 2005 by the GMC for his role in Sally Clarke’s imprisonment, only to be reinstated by the High Court in 2006.

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Child protection - guidance on confidentiality and disclosure

By Dr George Fernie, senior medicolegal adviser, and Gareth Gillespie, casebook editor at the Medical Protection Society - 22nd March 2011 10:47 am

The issue of confidentiality is a complex one for doctors, particularly with regards to disclosing patient information to third parties. When you can and can’t do it, and whose consent you need and in what circumstances, are legal and ethical dilemmas that are among the most common queries received on the MPS advice line. When you also have to consider possible risks to a child, it is an issue that can get even more complex and automatically charged.

The GMC freely acknowledges that: “Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality, patients may be reluctant to seek medical attention or to give doctors the information they need in order to provide good care. But appropriate information sharing is essential to the efficient provision of safe, effective care, both for the individual patient and for the wider community of patients.”

Within the area of child protection, the underpinning principle is that the safety and welfare of the child is paramount, and that it takes priority over other considerations. But your duty to disclose (or not) also rests upon whether the child or young person (aged under 18) sufficiently understands the purpose and consequences of the disclosure i.e. whether or not they are Gillick competent or complies with statute based law in Scotland .

If the child has the capacity to consent to disclosure of their personal information, and refuses consent, you must nevertheless disclose the information if it is necessary to protect the child or someone else from serious harm, or if it is justifiable in the public interest. You should weigh up each situation on a case-by-case basis, giving careful consideration to the child’s reasons for withholding consent; if you do decide to disclose the information, you should explain your decision to the child, if practicable.

Examples of situations where you would be expected to disclose patient records to a third party are, according to GMC guidance: “[If] the information would help in the prevention, detection or prosecution of serious crime, usually crime against the person… [or] a child or young person is involved in behaviour that might put them or others at risk of serious harm, such as serious addiction, self-harm or joy-riding.” Other examples are for the purpose of a criminal investigation, which includes terrorist activity, and a GMC investigation or coroner’s inquest.

Another area of concern that is put forward by the GMC is child protection. As hot a topic as ever at the moment, the issue of child protection is covered in some depth in paragraphs 56 to 63 of the GMC’s 0-18 Years: Guidance for All Doctors (2007).

Even if you are not in a position where you work regularly with children and young people, as a doctor you play a key role in the protection of children - which means you must always be vigilant for early signs of abuse or neglect.

You are in a unique position to deal with any risks posed to children and young people, and may be privy to confidential information that is not made available to teachers and social workers, for example. However, such a position can place you in a difficult ethical dilemma - information delicately confided in you by a child may need to be disclosed if you feel it suggests a risk to the child’s safety; the child and/or parents, on the other hand, may fear contact with the police or social services. While it is preferable that you make them aware of the importance of sharing such information, you must take care not to delay notifying the appropriate authorities if this will increase the risk to the child.

The situation is even more blurred in scenarios where a child or young person lacks the capacity to consent. While those with parental responsibility can consent to disclosures on their child’s behalf - and the consent of only one such person is needed in this case - you may find yourself in a position where you do not feel the person with parental responsibility is making a decision that is in the best interests of the child. If this particular dilemma cannot be resolved by discussion and mutual agreement, then it is strongly advised that you contact your medical defence organisation for further guidance.

A child who is not Gillick competent may confide in you with information that they do not wish to be shared with their parents. If you require the parent (or those with parental responsibility) to make an important decision regarding consent, then the child’s best interests again take precedence; as the GMC says: “You should usually try to persuade the child to involve a parent in such circumstances. If they refuse and you consider it is necessary in the child’s best interests for the information to be shared (for example, to enable a parent to make an important decision, or to provide proper care for the child), you can disclose information to parents or appropriate authorities. You should record your discussions and reasons for sharing the information.”

Ultimately, the primary concern is the safety of children and young people, and you should have no fears over raising a concern that later proves groundless. As long as all disclosures are made through the appropriate channels, and you can show that you had a reasonable foundation for your initial concern, you will be able to demonstrate any decision that you have made was justified.

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Why punish child advocates more than abusers?

By Mike Broad - 24th November 2010 12:09 pm

You might have read my recent moan about the GMC. I know - easy target and all that.

I guess I was trying to make the basic point that after all these years, all the changes to the way it works, all the year-on-year rises in fees, there still appears to be puzzling inconsistencies in its consideration of a doctor’s fitness to practise.

As was pointed out to me after I’d posted the blog, I wasn’t being particularly fair. I was ignoring the culpability of trusts and the courts in the regulatory process, and I wasn’t comparing like-with-like in the cases I’d highlighted. I accept these points.

But then I read the BMJ, on 20 November, and felt vindicated in my suspicions that GMC decision making can be influenced by the media profile of a case.

Paediatrician Prof David Southall is soon to be up in front of a fitness to practise panel once more as part of long running investigations into his work.

In the post-Shipman era, when all the eyes were on the GMC to prove it was an advocate of patient safety, the investigations into the leading experts of fabricated or induced illness provided an opportunity for the regulator to dispel the perception that it looked after its own.

Both Southall and Roy Meadow were struck off the register for their work on child protection before being re-instated by the courts.

Behind all this there was a vociferous, and well-coordinated media campaign by parental activists, and its influences are still being felt today with the presence (all be it briefly) of chief protagonist Penny Mellor on the GMC’s children protection working group.

Whatever you think of Southall, and his actions concerning Sally and David Clark, he made an incredibly valid point this week at a conference; doctors who have accessed child pornography, and thus been complicit in abuse, have been treated more leniently by the GMC than those who have stridently attempted to protect children.

He cited a number of cases of doctors being simply suspended for downloading kiddie porn prior to a return to work.

Southall is calling for an inquiry into the GMC’s treatment of doctors who work in child protection. I’d go further, and suggest we need an inquiry into the consistency of the regulator’s decision making.

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Penny Mellor steps down from GMC group

By Mike Broad - 1st November 2010 4:22 pm

Penny Mellor - the controversial parents’ rights activist - has resigned from the GMC’s child protection working group.

In a letter to the GMC, Mellor explained she had decided to resign because she felt that the response to her membership was detracting from the important work of the group.

There was outrage, particularly among paediatricians, back in July, when the GMC appointed Mellor to their new child protection working group.

The group, chaired by Rt. Hon. Lord Justice Thorpe, deputy chair of the Family Justice Council and Lord Justice of Appeal, is producing new guidance for doctors involved in child protection.

The group has 14 members including seven doctors from a number of specialities and seven lay members - of which Mellor was one.

At the time, campaign group Professionals Against Child Abuse wrote to the BMJ pointing out that Mellor had made false allegations against health professionals about their involvement in child protection cases, even accusing some of sexual abuse and paedophilia.

Mellor also reported professionals to their employers, regulatory bodies, and politicians, and harassed them through the media, in some cases wrecking their professional lives. She played a significant role in the media campaign against the paediatricians who were central to the recognition and diagnosis of fabricated and induced illness (FII, previously known as Munchausen’s syndrome by proxy). It contributed to the GMC’s decisions to order the names of Professor Sir Roy Meadow and Professor David Southall OBE to be erased from the medical register in 2004 and 2007 respectively.

After much damage to child protection work, these decisions were found to be erroneous: Sir Roy was reinstated to the medical register by the High Court and Southall by the Court of Appeal.

Her resignation followed the launch of a legal challenge to the decision to appoint her.

Commenting on Mellor’s decision to stand down from the group, Niall Dickson, chief executive of the GMC, said: “We established this group to develop guidance that will help doctors involved in this complex and challenging area of practice to interpret and apply the standards expected by the GMC.

“We are determined to ensure that parents, children, doctors, and other professionals are able to take part and help shape this important guidance.”

Read a blog on the issue.

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Why give the scourge of paediatricians credibility?

By Bob Bury - 26th July 2010 1:36 pm

Only a week ago I was slagging off the GMC, saying that just when I thought they couldn’t do anything that would make me think even less of them than I already did, they had done just that (in their sentencing of Dr Jerome Ikwueke, one of the doctors in the Baby P case).

Foolishly, I thought that must be it. I didn’t feel it was possible for any organisation composed of supposedly sentient beings to sink lower in my estimation. But I underestimated them. They have trumped even that profoundly stupid decision by appointing Mrs Penny Mellor to their Expert Group on Child Protection.

In case you don’t know this lady, let me quote from an open letter to the president of the GMC from four paediatricians, who are chair and members of the organisation Professionals Against Child Abuse, which appeared in this week’s BMJ. They point out that Mellor:

• made false allegations against numerous paediatricians, other doctors, and nurses about their involvement in child protection cases, even to the extent of accusing doctors of sexual abuse of children, paedophilia and comparing one paediatrician to Josef Mengele.

• reported such professionals to their employers, regulatory bodies, and politicians, and harassed them through the media, in some cases wrecking their professional lives.

• contributed to a misguided and hostile media campaign against internationally acclaimed paediatricians who were central to the recognition and diagnosis of fabricated and induced illness (FII, previously known as Munchausen’s syndrome by proxy), which contributed to the fitness to practise panels’ decisions to order the names of Professor Sir Roy Meadow and Professor David Southall OBE to be erased from the medical register in 2004 and 2007 respectively. After much damage to child protection work, these decisions were found to be erroneous: Sir Roy was reinstated to the medical register by the High Court and Southall by the Court of Appeal.

• created an environment in which doctors are now turning their back on child protection work for fear of being targeted in the above way.

• has been convicted herself of “conspiring to abduct a child,” with Judge Whitburn concluding: “…you have been a self-appointed advocate for those, amongst others, whose children are taken into care on the basis of what was known as Munchausens Syndrome By Proxy, now known as Fictitious Illness Syndrome. Your view was that this was a misdiagnosis, designed to cover up medical negligence. Impervious to debate, convinced you are right, you have traduced, complained about and harried dedicated professional people working in this difficult area.”

I hear on the grapevine that at least one paediatrician has resigned from the Royal College of Paediatrics and Child Health in protest at the continuing presence of members of that college on the Expert Group despite Mellor’s appointment. No-one objects to the inclusion of parent representatives on the group, indeed, it’s essential that they should be there. But there must be some sensible people out there who are not “impervious to debate” and who are capable of arguing rationally on this fraught topic.

Not only would Mellor appear to be supremely unqualified to sit on a group considering child protection issues, but the GMC is currently (wait for it - you won’t believe this) dealing with a fitness to practise case against Prof Southall (yes - again), the man whose career Mellor has made it her business to destroy.

And yet the idiots have appointed her to their advisory group dealing with the very issue in which she has been a major protagonist. I am not, as they say, a lawyer, but it occurs to me that, should the case go against Southall, he would have an excellent prima facie case for arguing that he cannot have had a fair hearing from an institution displaying such bizarre behaviour.

This appointment shows contempt for dedicated paediatricians who continue, despite the continual barrage of ill-informed abuse from la Mellor and her posse of single-issue zealots, to practise in this difficult and essential area. But then contempt for doctors is fast becoming the hallmark of the GMC. Given the inability of the medical profession to speak with a single voice on anything, it is presumably unlikely that we could ever arrange a mass refusal to pay the GMC annual fee. But a man can dream.

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Royal college attacks GMC over child protection

By Mike Broad - 21st April 2010 12:10 pm

The Royal College of Paediatrics and Child Health has criticised the GMC’s approach to cases involving paediatricians and child protection work.

It follows paediatrician Dr David Southall’s successful appeal in a long-running dispute with the GMC. He was struck off in 2007 for accusing a mother - Mrs M - of drugging and murdering her 10-year-old son.

While the Appeal Court ruled that the GMC fitness to practise panel should provide more detailed reasons for its findings, Southall remains struck off the register.

A spokesperson for the RCPCH said: “There is a genuine and widespread sense of puzzlement by paediatricians regarding the fact that the GMC would prefer a parent’s evidence, even when the paediatrician’s account was corroborated by a second professional who was also present.

Southall was instructed as an expert witness in care proceedings involving Mrs M’s younger, surviving son. He was accused of expressing concerns about the son’s safety in an interview with her. Southall said he outlined three possible scenarios but did not accuse her of murder. He argued that if she felt accused that was a misconception. 

A senior social worker was also present during the interview, and took notes, and also denied that an accusation of murder had taken place.

The GMC, however, found that his actions added to her distress following the death of her other son, who hanged himself in 1996.

“As a result, all paediatricians remain concerned and worried about their own clinical practice.” 

Following the Appeal Court judges’ findings that the GMC had failed to give adequate reasons for saying Southall had made unjustified allegations about Mandy Morris, a further hearing will be held to decide on the charges.

The RCPCH said it did not comment on individual cases but felt there was an important principle to note. It pointed to an acknowledgement by Lord Justice Leveson, one of the judges involved, that in raising child protection concerns a paediatrician will be damned if they do and damned if they don’t.

The GMC panel said Southall had a “deep-seated attitudinal problem”.

Southall argued that the GMC had failed to give “any or adequate weight” to inconsistencies in Mrs M’s evidence and that it didn’t understand what child protection work involved.

In giving his ruling, Lord Justice Leveson said: “I would allow this appeal although I must make it clear that this conclusion is not a condemnation of Mrs M or a vindication for Dr Southall and should not be seen as either.”

A GMC spokesperson said: “At this stage we believe that the best way to proceed would be for the original panel to reconvene and provide further reasoning on its decision so that this case can be resolved.”

In a prior case, in 2004, Southall was found guilty of serious professional misconduct and suspended from child protection work for his role in the case of Sally Clark, wrongly jailed over the death of her two sons. He accused her husband of murdering the boys after having watched him interviewed on television.

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