IPCA
Posted by News Editor
Tuesday, July 10, 2007
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
This item first published by F.A.C.T. on 8th May 2005
Following the recent General Election the following changes have been made to All Party Group on Abuse Allegation.
The eight M.Ps. from the All Party Group in the previous parliament who are no longer in the House of Commons are
Defeated
Sye Doughty, Liberal Democrat, Guildford
Huw Edwards, Labour, Monmouth
Tony McWalter, Labour, Hemel Hempstead
Philip Sawford, Labour, Kettering
Retired
Nigel Jones, Liberal Democrat, Cheltenham
Alice Mahon, Labour, Halifax
Kevin McNamara, Labour, Hull North
Martyn Smyth, Ulster Unionist, Belfast South
A member of the previous All Party Group, John MacDougall, Labour, formerly MP for Fife Central is now MP for Glenrothes, a newly named seat created due to the extensive boundary changes resulting from the reduction of Scottish constituencies by fourteen.
We hope to keep you informed of any additions when they are announced.
This item first published on F.A.C.T website 12th May 2005
Chief Constable Terry Grange
ACPO Lead Chief Constable - Child Protection
Dyfed-Powys Police Headquarters
PO Box 99
Llangunnor
Carmarthen
SA31 2PF
12-05-05
Police Investigation of Child Abuse
Dear Terry Grange,
You will be aware of our campaign on behalf of falsely accused carers and teachers who have been the focus of extensive police operations throughout the country in relation to historical allegations of abuse.
For many years, serious concerns have been expressed that the so-called trawling method of investigation used in these abuse investigations, has led to the largest number of miscarriages of justice in recent legal history.
Senior judges, lawyers, academics and politicians have lent their voice in support of campaigners who continue to protest that gross injustices have taken place as a result of historical investigations.
To date, our campaign has relied largely upon the testimony of former staff members and family and friends of the accused to defend our claims of their innocence. We believe that the publication of Richard Webster’s book, The Secret of Bryn Estyn-The making of a modern witch hunt , has strengthened our cause immeasurably; this nine year research project is the most extensive study of the relevant subject which has ever been conducted. Its findings are both devastating and conclusive.
Given your special responsibility for abuse investigations within the Association of Police Officers, we respectfully urge you to consider the contents of this book.
It would be most informative and constructive if you were able to relay to us your response to the book in due course.
Thanking you for your kind attention,
Gail Saunders (On behalf of F.A.C.T)
We will keep you informed of Mr Grange's response. As yet (17 July 2005) no reply has been forthcoming.
Item first published on F.A.C.T website on 13th May 2005
This press release was issued by F.A.C.T on the 13th May 2005 in response to the GMC decision not to find Dr San Lazaro guilty of serious professional misconduct following her admissions that she made exaggerated and inaccurate statements in the Shieldfield nursery nurse case.
RELEASE
The decision of the General Medical Council's 'Fitness to Practice Committee' not to regard Dr San Lazaro's admitted conduct in exaggerating and distorting the facts, and misdiagnosis in child abuse investigations not only calls into question her conduct but also that of the General Medical Council itself. There is an urgent need for GMC to restore the public's confidence in medical practitioners involvement in child protection cases. What this judgment does is send out a message that it is alright for paediatricians to mislead Courts and exaggerate the truth. Doesn’t the GMC realise that public confidence in doctors handling of child protection cases needs restoring.
Dr Lazaro is a senior consultant paediatrician who the general public expects to maintain the highest professional standards at all times. She was not a junior doctor whose mistakes might be understandable and more easily forgiven. It is of no defence that she was overworked. As a result of her mistakes two people were wrongly accused of child abuse, with devastating consequences, and children unnecessarily subjected to intrusive medical examinations. The public were misled.
Despite the fact that a high court judge (Mr Justice Eady) has called her obsessive and over emotional and the GMC acknowledge that some of her statements were untrue, misleading or otherwise improper she is being allowed to continue in practice and continue to teach other medical students. Despite her mistakes she has hardly been admonished. This does nothing to restore the public's confidence in paediatricians or in the medical profession to regulate itself. There is no room in child protection investigative work for any one who cannot meet the exacting standards which the general public and the Courts expect. The General Medical Council seriously need to review their decision in this case.
F.A.C.T.
F.A.C.T. is grateful for all its members and supporters who mounted a lobby of the GMC on the opening day of Dr Lazaro's hearing.
This item first appeared on the F.A.C.T. website on the 16th May 2005
Judgement handed down by Fitness to Practise Panel (Conduct)
Session dated 25 April – 13 May 2005
St James’s Buildings, 79 Oxford Street, Manchester M1 6FQ
Dr Camille De Sam Lazaro
Dr Lazaro: At the material times you were practising as a Consultant Paediatrician at the Lindisfarne Centre, The Royal Victoria Infirmary, Newcastle-upon-Tyne, where you specialised in the area of child abuse.
You have admitted that in 1993 and 1994 you examined 53 children from Shieldfield Nursery, Newcastle-upon-Tyne, following allegations of sexual abuse at the nursery. Your records in relation to the children included Child Protection medical records, medical reports, statements for use in criminal proceedings, and reports to the Criminal Injuries Compensation Board (CICB). On repeated occasions you provided to the CICB a “generic” report entitled “Report into Multiple Abuse Shieldfield Nursery, Newcastle-Upon-Tyne”, dated November 1994.
Criminal charges were brought against two workers in the nursery, namely Christopher Lillie and Dawn Reed, in relation to six of the children allegedly abused. On 14 July 1994 both were acquitted on all charges on the direction of the Honourable Mr Justice Holland following the exclusion of video evidence and the Crown Prosecution Service’s decision to offer no evidence. Newcastle City Council subsequently appointed a team to review the abuse allegations, the report of which was published on 12 November 1998.
Christopher Lillie and Dawn Reed thereafter brought libel proceedings against Newcastle City Council and that Review Team. In a judgment delivered on 30 July 2002 the Honourable Mr Justice Eady found that the claimants were entitled to judgment against the Council and members of the Review Team. You gave evidence on oath in the libel proceedings during which you acknowledged that, as most of the children allegedly abused were pre-verbal or poorly verbal, the medical assessments of them were of a potentially critical nature. In the course of your evidence you further agreed that
- there were deficiencies and/or inaccuracies in your recording in the Child Protection Medical Records;
- there were inconsistencies as between your medical records and your medical reports;
- there were inconsistencies as between your medical reports and police witness statements; and
there were on occasions confusing uses of terminology.
In relation to the eight children cited during this hearing, your actions have been found to be inappropriate in relation to seven, irresponsible in relation to six, and unprofessional in relation to five.
You accepted that the Generic Report referred to above 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. You accepted responsibility for the content of that report and indicated that you wrote it without reference to records and notes, and that there were inaccuracies within it. You further accepted that, in one instance, your claim that an identical bacterium was isolated in boys was inaccurate and did not have forensic probative value. You expressed regret that you had included in the report “any event which potentially could have arisen from this crisis”. You have accepted that the report was overstated, exaggerated and emotive. In relation to this report your admitted conduct has been found to be inappropriate, irresponsible and unprofessional.
The Panel has been provided with three sets of specific guidance on child sexual abuse available to you in 1993 and 1994, namely:
- the report of the Royal College of Physicians “Physical signs of sexual abuse in children”, dated 1991, (the RCP report);
- the Report of the Inquiry into Child Abuse in Cleveland 1987 (the Cleveland Inquiry report); and
- the Department of Health document “Working Together under the Children Act 1989”, dated 1991, (Working Together).
You have confirmed that you were aware of each of the above documents. The Panel has noted Mr Coonan’s comment that Working Together states at paragraph 1.14 “This document is not intended to be a practice guide for any particular agency or worker”. However, the Panel also notes that this paragraph goes on to say that “it provides a brief account of some of the legal and ethical considerations which underpin work in child protection”. The Panel is therefore of the view that the principles outlined in the document are applicable to your practice.
It is clear from all of the guidance, and indeed you have admitted in evidence, that accurate, precise and comprehensive record keeping is of paramount importance in cases of alleged child sexual abuse. In particular, the RCP report states at page 5, paragraph 2.3, that doctors undertaking examinations “… will need to keep meticulous records”, particularly as the doctor should be aware that they may need to “… present reports, and give evidence in courts”. Indeed, the Cleveland Inquiry report states in paragraph 6(d)(iii) “The doctor concerned should recognise the importance of taking a full medical history and making a thorough examination … of completing full and accurate medical records [and that] those records should be made at the time of the examination”. Working Together states that “Well kept records are essential to good child protection practice”. It further states at paragraph 5.14.9 that “Recording of … interviews should be accurate and should differentiate between fact, hearsay and opinion”.
The Panel has seen several instances throughout your records where you have failed to record exactly what the child had said to you during examinations, and where potential confusion might arise as a result. The RCP report states at paragraph 10 “The single most important feature is a statement by the child” and at paragraph 2.1 “… it is good practice to record verbatim what both the child and the interviewer say”.
A further feature in several of the documents presented to the Panel is that you failed to be consistent in the terminology used to describe the physical findings you saw, and that your descriptions of physical findings in subsequent documents were different from those in the medical records. The RCP report states that “It is very important, as was stressed in the Report of the Inquiry into Child Abuse in Cleveland 1987, that a consistent vocabulary is used to describe the appearances of the ano-genital region in order that doctors and others may understand each others’ descriptions”. The Panel considered that it is particularly important in police statements that the same wording is used to describe physical findings as was used in the medical records because of the weight which may be placed on factual medical evidence in judicial proceedings.
The General Medical Counsel’s document Professional Conduct and Discipline: Fitness to Practise (January 1993), which was applicable at the time, states at paragraph 36 that “The public are entitled to expect that a registered medical practitioner will afford and maintain a good standard of medical care. This includes a conscientious assessment of the history, symptoms and signs of the patient’s conditions [and] sufficiently thorough professional attention, examination and, where necessary, diagnostic investigation”. At paragraph 45 it is stated that “Doctors are … expected to exercise care in issuing certificates and similar documents, and should not certify statements which they have not taken appropriate steps to verify. Any doctor who in a professional capacity signs any certificate or similar document containing statements which are untrue, misleading or otherwise improper may be liable to disciplinary proceedings.”
The Panel considers that you did not adhere to the principles of good practice outlined in the documents above in your production of medical records, medical reports and police statements with regard to seven children.
With regard to the generic CICB report, the Panel considers that the purpose of such a report is to inform the CICB’s decision making process when considering claims for compensation. This compensation is awarded from the public purse and therefore, as the author of such a report, you had a responsibility to ensure that the contents were accurate, precise and capable of being proved, so that any expenditure of public money would be fully accountable. The Panel notes your defence that a similar report had been provided in relation to the Bolam Street crisis, and, as it was not criticised, you adopted the same style and format with the Shieldfield Nursery report. The Panel does not accept this defence, as the report which you provided in relation to Bolam Street had been written following the conviction of the care worker involved and therefore the facts were no longer in dispute.
You have stated that you saw your role in providing the report as acting as an advocate for the children involved. Whilst the Panel agrees that this was entirely appropriate, this did not absolve you from your responsibility to ensure that the information you provided was accurate. In such a professional report there was a need for measured language, and your failure to use such language may have undermined the content. Further, this had the potential to affect the claimants adversely.
During the period in question, you were practising as a Consultant Paediatrician specialising in forensic paediatrics. Throughout its consideration of your case, the Panel has been careful to judge you against the standards expected of Consultant Paediatrician undertaking this work. You have told the Panel that you were looked upon as the person with most expertise in this specialty in the Region, and you accepted tertiary referrals from across the north of England. Indeed you had been a senior lecturer in Paediatric Forensic Medicine for four years, had been responsible for training paediatric colleagues, organised conferences on child abuse both nationally and internationally and were an acknowledged author in the field. The Panel accepts that in the early 1990s this was still an emerging field of practice. However, clear guidance was available and the Panel considers that you had a responsibility, not only in relation to your own individual practice, but also as a supervisor of more junior colleagues and an expert in the field, to set an example by complying with the standards set out in the guidance.
The Legal Assessor has advised the Panel that its duty is to act in the public interest, ie to ensure public safety, to ensure public confidence in the profession, to uphold the standards in the profession and to maintain the reputation of the profession. In deciding whether to take action in relation to your registration, the Panel has considered the issue of proportionality. With regard to this latter point, the Panel notes that it has found your record keeping to be unprofessional in relation to only five sets of records. Three of the sets of records presented to the Panel were found not to be unprofessional and the Panel has received no evidence that any other documents which you produced during that period, before, or since, were less than satisfactory.
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 the 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 testimonials and other character evidence. In particular, the Panel’s attention has been drawn to the words of Lord Justice Judge in that judgment:
“… 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 whether he should be found guilty of serious professional misconduct. In short, the same facts may on occasion impact both on the question of whether the practitioner’s conduct amounted to serious professional misconduct, and on the appropriate consequential sanction.”
The Panel has received considerable evidence of the difficulties you were experiencing at the time of the Shieldfield crisis. It has heard that you were a sole practitioner with insufficient resources struggling to cope with an excessive caseload. The Panel has noted the testimonial provided by Professor Hobbs, Consultant Paediatrician at the St James’s University Hospital, Leeds, which states
“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.”
The Panel has heard a great deal of praise of your pioneering work in establishing the service at the Lindisfarne Centre, but it appears that this had been done with little nursing or administrative support. The Panel is also concerned that, despite the support you derived from other colleagues in the field nationally, you were at risk of being professionally isolated as the sole permanent Consultant responsible for the service. Whilst the Panel cannot condone the errors identified in your practice, it has viewed these in the context of the situation in which you found yourself at the time.
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 this case.
ACPO Lobby - Thankyou
Posted by News Editor
Sunday, July 17, 2005
ACPO Lobby
Item first published on the F.A.C.T. website on the 20th May 2005.
We would like to thank all those who supported the F.A.C.T. lobby of the ACPO (Association of Chief Police Officers) conference at the NEC on the 19th May. Despite drizzly weather there was good turnout with representatives from across the UK. Thankyou.
This item was first published on the F.A.C.T website on the 24th May 2005
In November 2004 the South Australia Government opened a Commission of Inquiry into allegations of sexual abuse of children who were in State care and allegations of criminal misconduct that resulted in the death of a child in State care. The Honourable Edward P. Mullighan Q.C. was appointed to examine and report on whether there was a failure on the part of government agencies, employees or other relevant persons, to investigate or appropriately deal with allegations concerning sexual offences against children. The Inquiry will also determine and report on whether appropriate and adequate records were maintained. The Honourable Edward P. Mullighan Q.C has now published an interim report of his progress so far. His findings will be depressingly familiar to State care workers in the UK and beyond.