Shieldfield - Justice at last?
This item was first published on the F.A.C.T. website on the 20th May 2005
Introduction
No BFMS member can be unaware of the scandal of the two falsely accused Newcastle nursery nurses, Chris Lillie and Dawn Reed, whose fight for justice seemed to be at and end with the appearance before the GMC of Dr Camille De Sam Lazaro, the consultant paediatrician on whose 'expert evidence' the allegations against them were based and from which grew an unstoppable bandwagon of victimisation involving social services, children's charities, parents, psychologists, therapists and the press.
The harrowing story from the time that allegations against the two were first made in 1993, through their pre-trial acquittal in July 1994, to their being awarded the maximum damages possible in the 2002 libel trial is told in detail in the October 2002 and July 2003 BFMS newsletters. Briefly, for nine years two trained nurses were vilified and their young lives ruined for crimes which did not happen. Despite being found not guilty by the judge, Mr Justice Holland, who at the pre-trial hearing in 1994 concluded that the case should not even be put before a jury, the pair continued to be harassed. There was a near riot in the court room, with cries of 'Hang them' from the parents. As Margaret Jervis reported in part 2 of her article (July 2003 Newsletter), 'Enraged groups of parents surged forward, grabbing hold of Chris and Dawn. After the trial concluded, the parents and their supporters marched to the city hall with banners proclaiming "WE BELIEVE THE KIDS" and with compensation solicitor Claire Routledge at the helm; the parents demanded a public enquiry'. Further vilification came from the media, the council and children's charities.
Newcastle City Council commissioned a team of four other 'experts': Dr Richard Barker, a professor of social work at Northumbrian University; Jacqui Saradjian, a clinical psychologist in Leeds; Judith Jones, a child abuse consultant; and Roy Wardell, a former social services director. Their report further fuelled the media's uncritical portrayal of abused children let down by the courts. The Sun appealed to its readers, 'Help us find these fiends - Do you know where perverts Lillie and Reed are now?' - and they, understandably, were forced into hiding.
The action of their saviours is reminiscent of the saying 'all that is necessary for evil to triumph is for good people to do nothing'. Fortunately writers Bob Woffinden and Richard Webster were those 'good people' who decided not 'to do nothing'. They found the two in hiding, Dawn contemplating suicide, persuaded them to pursue a libel action against Newcastle City Council and the four members of the review team, and found them legal representation, on a conditional fee basis. The case began on 11 January 2002 and ran for six months, becoming the most expensive libel case ever fought in the British courts on a no-win, no-fee basis.
It is worth repeating the comments of psychologist Maggie Bruck of John Hopkins University, testifying for the plaintiffs, who described the video interviews as 'among the worst I have encountered, extremely young and bewildered children were brought in and interrogated by interviewers who used the full array of suggestive techniques to elicit allegations of abuse. When the children denied they had been abused, they were bombarded with more suggestions; they were scolded, threatened and bribed. When some children whimpered, moaned or begged the interviewers to end the questioning, the interviewers continued.' This and other evidence leads one to wonder who were the real abusers? On 30th July 2002, the pair were each awarded £200,000 damages. What was the cost to Newcastle City Council taxpayers? Nearly £4 million.
The Case before the Fitness to Practise Panel
At the General Medical Council's Fitness to Practise (FTP) hearing which began in Manchester on 25 April 2005, Dr Lazaro admitted to all but one of the sixteen charges. Charges 1 to 13 related to the professional standing of Dr Lazaro and to the events leading up to the hearing. Charges 14 and 15 (admitted), stated:
14. In the course of your evidence you further agreed that
a) there were deficiencies and/or inaccuracies in your recording in the Child Protection Medical Records
b) there were inconsistencies as between your medical records and your medical reports
c) there were inconsistencies as between your medical reports and police witness statements
d) there were on occasions confusing uses of terminology
15.
a) you accepted that the Generic Report referred to in head of charge 5 above (NOTE: this referred to the 'generic' report provided to the Criminal Injuries Compensation Board) was written to support the claims of parents for criminal injuries compensation on the basis that their children had been sexually abused by Christopher Lillie and/or Dawn Reed
b) you accepted responsibility for the content of the report
c) you indicated that you wrote it without reference to records and notes.
d) you indicated that there were inaccuracies within it
e) you accepted that in one instance your claim that an identical bacterium was isolated in boys was inaccurate and did not have forensic probative value
f) you expressed regret that you have included in the report 'any event which potentially could have arisen from this crisis'
g) you accepted that the report was, i) overstated ii) exaggerated, iii) emotive.
The Sixteenth charge, the only one contested by Dr Lazaro, read as follows:
'Your admitted conduct as described in heads of charge 14 and/or 15 above was
a) inappropriate
b) irresponsible
c) unprofessional
And that in relation to the facts alleged you have been guilty of serious professional misconduct'.
In a later document the Panel gave a detailed account of its views on charge 16 and concluded, 'Having reached these findings on the facts the Panel then considered whether the facts admitted and those found proved would be sufficient to support a finding of serious professional misconduct. The Panel concluded that they would not be insufficient.'
Dr Lazaro's successful defence of charge 16 rested on the following statement by the FTP Panel: In considering whether you have been guilty of serious professional misconduct the Panel has been advised that it should bear in mind the Court of Appeal case of Campbell v General Medical Council (2005) EWCA Civ 250. In that case a distinction was drawn between contextual mitigation, ie the circumstances in which the doctor found himself at the time of the incidents in question, and personal mitigation, ie the testimonials and other character evidence. In particular the Panel's attention has been drawn to the words of Lord Justice Judge in that judgement: "…..the error under consideration may need to be examined in the context of a dedicated practitioner working in isolation and under huge pressure of, say, an epidemic. Such circumstances may be relevant to the question of whether he should be found guilty of serious professional misconduct. In short, the same facts may on occasion impact on both the question of whether the practitioner's conduct amounted to serious professional misconduct, and on the appropriate consequential sanction."
As a result of the above considerations and having heard personal testimonies, the Panel made the following statement:
'At this point in its deliberations, the Panel was especially aware of the advice given by the Legal Assessor that they had to be sure of a finding of serious professional misconduct. Therefore the Panel has found that your conduct, although falling short of that expected of a registered medical practitioner, did not reach the threshold of serious professional misconduct. Accordingly, the Panel has found you not guilty of serious professional misconduct. That concludes the case.'
Questions That Need to be Answered
- did the FTP Panel give due weight to the consequences for the accused and the children of Dr Lazaro's initial faulty assessment?
- why did she fail to question the validity of her original findings in the light of later developments, particularly the criticisms made by Mr Justice Holland and Mr Justice Eady of her interview and record keeping procedures?
- In reaching their decision, did the Panel make too much allowance for her plea that her failings were due to pressures of work?
- in seeking to apply the Court of Appeal case of Campbell v General Medical Council (2005) as a precedent by which to judge the case, did the Panel wrongly accept the plea of 'contextual mitigation? The application of the word, 'epidemic' to the situation faced by Dr Lazaro needs to be challenged. Was the situation that Dr Lazaro found herself in a set of circumstances which she helped create rather than an 'epidemic' the creation of which was beyond her control?
- why did the Panel offer no recommendations for a) the retraining and/or peer group supervision of Dr Lazaro? b) procedural changes in order to minimise the risk of a repeat of the Shieldfield tragedy?
- one of the most astonishing statements in the Panel's concluding comments was offered in defence of Dr Lazaro by colleague Professor Hobbs, Consultant Paediatrician at the St James's University Hospital, Leeds and accepted by the Panel as part of the evidence for not finding her guilty of serious professional misconduct. It read:
"Her caseload was excessive. I have no doubt that she would have been at risk of confusing children in her mind, that she would have had insufficient time to have performed routine quality checks on her reports and may very easily have made the kind of errors which she has acknowledged. Errors of (this kind) in my experience occur not uncommonly in this work."
Given that Dr Lazaro, like her colleague Professor Hobbs, must have been aware that, "Errors of this kind occur not uncommonly in this work", why was she so uncompromising in her beliefs? Surely this statement should be seen as evidence against, not for, Dr Lazaro.
The appearance before the GMC's Fitness to Practise panel by Dr Lazaro should have signalled the end of this tragic story. But, inevitably, now that she has been found not guilty of serious professional misconduct the consequences will live on: for the two nurses whose lives and careers have been irreversibly damaged and for the children who were subjected to questionable investigative procedures. The Panel's failure to address the above questions, in particular the conciliatory approach to Dr Lazaro's professional shortcomings will only have given justification for those paediatricians, social workers, psychiatrists, child protection charities, the police, parents and media to continue to believe that she was right.
Watch out for Shieldfield Mark II!
We are grateful to the BFMS for making this statement available