Showing posts with label GMC. Show all posts
Showing posts with label GMC. Show all posts

Sunday, December 23, 2007

Southall Rant

Your humble Devil has the greatest respect for the Dr Rant team—even though he often agrees with them—as their no nonsense, sweary approach is one that, as readers will know, I favour and enjoy. However, there are times when they just go too far and some of this post on the striking off of David Southall just irritated me beyond belief.

First, some background from Unity (to whom I will be referring frequently in this post).
So far as getting himself in the public eye is concerned, Southall’s main claim to notoriety prior to his recent striking off arose out his actions in the Sally Clark case, a case which resulted in the professional downfall of another noted paediatrician, Sir Roy Meadow, whose erroneous use of inaccurate statistical data on sudden infant death syndrome resulted in the late Mrs Clark being wrongly convicted of murdering two of her own infant children, a conviction that was later overturned on appeal, but only after Clark spent four years in prison.

Southall’s attempted ‘intervention’ in this case, for which he was quite rightly sanctioned by the GMC after being found guilty of serious professional misconduct in 2004 and barred from carrying out child protection work for three years, was to lodge a complaint with Staffordshire police alleging that Clark’s husband had, in fact, murdered the children on the strength of having watch a television documentary about the case.

That said, the case that led directly to Southall being struck off was not that of the Clarks but one that occurred nine years ago in which Southall, while acting as an expert witness for a family court, was asked to assess the safety/vulnerability of a child in a household where the child’s older sibling had been found hanging from a curtain rail two years previously. The child who died was just 10 years old.

What happened next is both contentious and contested. According the complainant, the mother of both children, during the course of an assessment interview Southall accused her of drugging and murdering her son - although not stated in any of the coverage of the case, one would assume that the coroner’s verdict on the child’s cause of death was most likely to have been suicide or, at the outside, misadventure as no charges appear to have even been brought against the mother. Southall, in his defence, asserts that he only raised the idea that the older sibling may have been murdered as ‘a possibility’, an account supported by the social worker who attended the interview and who served as Southall’s ‘independent’ professional witness.

So, let us move onto Dr Rant's egregious post.
The most obvious result of this is a further set back for child protection in the UK, and a weakening of the string suspending the sword of Damocles above the heads of the dwindling number of doctors working in this field.

No, the most obvious result of this decision is that a deeply arrogant and unpleasant little fuck—who, amongst other things, was responsible for a mother being wrongfully imprisoned for four years and who then tried to accuse the father of abuse after hearing one line in a documentary—has been removed from the medical profession rather than being allowed to continue to lie and throw around false accusations left, right and centre.

If the medical profession had any honour, they would celebrate this decision as a proof that patients can trust the medical profession because they have their house in order.

But Unity addresses the nub of this issue, whilst fisking an Independent article by Jeremy Laurence, with neat precision (apologies for the long quote, but the whole thing is essential).
Those who recall the aftermath of the GMC’s decision to strike off Sir Roy Meadow will find this line of argument all too familiar - if the GMC insists on striking off paediatricians in cases such as this then paediatricians will take their ball home and stop taking on child protection issues for fear of risking their professional reputations, in not their careers.

In short, don’t try and hold us to account or we won’t do the work.

It’s an argument, that one can say, but it's one that needs to backed up with evidence if its to stand up to scrutiny, i.e. it hinges on the question of whether in the cases of Meadow and Southall, these individuals have been unduly and unjustly punished for actions that while erroneous - and seriously so - were undertaken in good faith and with the best of motives.

That’s the nub of the issue. Has the GMC disciplined two otherwise diligent professionals for making what amounts to genuine but honest mistakes in what is, admitting, a very difficult field of clinical practice? If yes, then other paediatricians in the field have something to fear as the GMC is (arguably) setting unfeasibly high standards for clinical practice in this field giving doctors the options of perfection or nothing. If no, then the argument fails to stand up.

So let’s take a good close look at Laurance’s arguments:
His [Southall’s] account was backed by the social worker, who gave evidence to the GMC over two days based on handwritten notes made at the time. But the GMC chose to believe the evidence of the mother, dismissing the social worker’s account.

This has, unsurprisingly, alarmed other paediatricians working in child protection, who feel a key part of their defence against false accusations - the presence of an independent professional witness - has been demolished by the decision. Thirty-nine of them wrote a joint letter to the press setting out their anxieties about what many describe as a “perverse” decision.

On the face it, this seems a reasonable point. Southall had a witness to corroborate his account of the interview, the parent didn’t, so you’d expect the GMC to take the corroborated account over the uncorroborated account… or would you?

In the context of a child protection interview you could certainly take the view that a social worker is a professional witness - let’s not get on a downer about social work - but in what exact sense is this professional witness also ‘independent’?

The social worker may be considered independent in one sense. They may not be assign to this particular case, but otherwise the scenario here appears to one of a mother being interviewed by two individuals who have a clear professional interest in child protection, a two on one situation in which it appears that the least ‘qualified’ person in the room, the mother, has neither representation nor a witness to the interview who does not have at least some measure of interest in proceedings.

Surely, the correct response here is not to complain that the GMC has undermined the role of the ‘independent’ professional witness but rather to question whether the system under which these interviews could not be improved in such a way that it does not rely solely on the verbal testimony of an observer who may conceivably develop a bias towards one of the two main parties in the course of their observation, if such a bias is not present from the outset. In criminal proceedings, where a suspect is interviewed by the police, it has been standard practice for many years that all such interview are recorded, initially on audio tape but more recently using video technology. The camera doesn’t lie nor does it provide a biased account of events, at least not without some form of outside intervention which can be forensically identified if there is a suspicion that a recording has been tampered with.

As such, the only sensible and reasonable response to doubts over the status of ‘professional’ witness is the introduction of contemporaneous recording of interviews, recording which can then be used as evidence both in court and in proceeding such as those undertaken by the GMC in regards to the conduct of David Southall.

And with that, one of the key planks of Laurance’s ‘taking our ball home’ arguments falls flat on its face.

Quite. And with Laurence's argument, so goes Dr Rant's argument. So let's move onto our sweary medico's next paragraph, shall we?
It also happens to a controversial, but hugely necessary and important field that is effectively still in it's infancy.

Pun intended?
Without Southall and Meadow, it has lost the opportunity to learn from mistakes that have been made.

I'm sorry, but I think that the removal of these two cunts actually does allow doctors to learn from mistakes. If you make the mistake of throwing around unfounded and unjustified allegations then you will lose your livelihood—and fucking well count yourselves lucky that you don't find yourself in a criminal court, sunshine.
Let's face it. Southall may have been wrong on occasion, and also rash. However, the only people who would deny that he was wrong all of the time are the disturbingly numerous lunatics who refuse to accept that child abuse ever occurs.

Oh, that's a fucking cracker, that is: if you think that this man never did anything good, then you are an Abuse-Denier! Burn the Abuse-Denier! For fuck's sake.

Still, what good did Southall do? Over to Unity again...
However, the GMC’s diagnosis of an attitudinal problem goes to the heart of the case. Every profession needs its pioneers, those who are prepared to test the boundaries and advance medicine. In the field of child protection, Professor Southall was that man, doing groundbreaking work in the 1980s and 1990s in developing the technique of covert video surveillance that secured the conviction of dozens of abusive parents.

That he did, but not without sailing very close to the wind in regards to professional ethics and the legality of his actions in conducting this research. The use of covert surveillance is not generally considered to be ethical and the surveillance was carried out in a manner and set of circumstances in which the police would not have been permitted to carry out this kind of surveillance as they almost certainly would not have been able to obtain a warrant to cover the kind of ‘fishing expedition’ that Southall conducted in the name of research. That Southall’s project did not result in either disciplinary or legal action seems, on the face of it, to be the result of the ends - a series of prosecutions against parents - being accepted as having justified the means and had his project no delivered those results its questionable as to whether Southall might not have found himself in serious difficulties much earlier in his career.

Indeed. And the argument that the ends always justify the means is a very dangerous one: if you argue that, then you must also support the torture of suspects in order to extract information, and a myriad of other very dodgy practices. But I digress; the main point being made here was that Southall was dodgy from the start or was, at the very least, had a deeply cavalier attitude to the law of the land.

So, to protest this decision—whilst attempting to imply that anyone who regards Southall and Meadow as unpleasant little shits who have ruined at least one life is an Abuse-Denier—is fucking stupid and disgusting attitude, but it is only what one expects from the notoriously clannish and cliquey medical profession.

My general answer is to say, "fuck you, medico shitsticks." My more specific answer is that I don't give two cunts if, some years ago, Southall had invented a cure for cancer—it is his serious and deeply unprofessional breaches of medical etiquette and, possibly, the law that is relevant here.

But it is the law that Dr Rant is exercised about.
What disturbs Dr Rant and other doctors is the manner in which the GMC dealt with the case. Have a listen to David Southall being interviewed by John Humphreys this morning (click here). It would appear that he was removed from the medical register by a panel of 5 people. In the Western world, a trial by a jury of one's peers seems to have been adopted as 'quite a good idea'. However, the GMC haven't quite managed to 'get with program it' would seem, and due to political pressure, now think that 'protecting the public' is less Jurisprudence and more Jeremy Kyle.

A 'jury of ones peers' means you are judged by your equals i.e. people who are able to understand the issues and frame the case through their own experience and expertise. What did David Southall get?

David Southall: Professor of Paediatrics with year of experience. A leader in the new discipline of forensic paediatrics.

The Panel: Chaired by 'Dr' Jacqueline Mitton, an astonomer and author of books for children. An orthopaedic surgeon and 3 'lay people'.

In summary, a stargazer, an orthopod and three 'disgusted of Tunbridge Wells'.

So in response to unfounded innuendo that that the GMC was 'matey' and that 'doctors looked after their own', it was NuLaboured to become the opposite extreme - a media driven witch hunting club for self appointed busy bodies.

The whole of this is disingenuous in the extreme. First, Southall was in front of the General Medical Council, not in a criminal trial (as some think that he should have been). He might lose his livelihood but not his freedom.

Second, once again, Dr Rant demonstrates all of the perceived arrogance of the medical profession when he seems to think that there should be different rules for doctors than for the rest of us. Very few people actually appear before a jury of their peers.

If, for example, I were to appear in a criminal court, would I be allowed to weed out any jurors with an IQ lower than 137? For I could claim that anyone with a lower IQ than I was not one of my peers, could I not?

Could I not also claim that anyone without my life experience was not one of my peers and thus dismiss any juror under the age of 30, who had not had a job, who had not run their own business and who had not had a private education?

The answer to all of these scenarios is that, no, I could not do so. So why in the name of hell should it be any different for doctors? Is it because doctors are oh-so-very-special, that they are, in fact, the peer of everyone else? No, it's not. Fuck them.

In the words of Rant,
"I don't think that requires any further exploration really does it?"

Quite.
How does this serve either the interest of justice or the protection of the public? It certainly doesn't serve the interests of vulnerable children.

Won't somebody think of the chiiiiiiildreeeeeeeeeeen? Oh, think of the chiiiiildreeeeeen!

Yeah, as Unity points out once more, we remember what your profession has done to children and their families, Rant.
Sadly, in the field of child protection, we’ve seen the ‘no smoke without fire’ argument deployed too often before with devastating effect on innocent families. Remember Cleveland, where the use of an unverified and unscientific method of ‘diagnosing’ sexual abuse in children by a single paediatrician, Marietta Higgs, resulting in a stream of innocent families having their children taken forcibly into care? Or what about the all too Salem-like qualities of the ‘Satanic abuse’ scares in Rochdale and the Orkneys?

Hundreds of ruined lives, Rant; that's what your profession has done. Yes, it has done some good, but many people are prosecuted for accidents daily: why the fuck do you medicos think that you should be any different? Fuck you and your arrogance.

Rarely has the stock of doctors and scientists been so low: the constant glare of truth shone upon their high-handedness and dodgy statistics—drinking limits, salt,obesity, diet—over the last months have frightened them. As it should: for too long these bastards have believed themselves above the law.

But I do agree with Dr Rant on one point: the GMC is an outdated and politicised union and doctors should not be tried by the GMC. No, it is time that we started prosecuting them with the full force of the criminal system and see if we can't teach them that they are not above the law.

P.S. Go and read the whole of Unity's article.

Sunday, May 20, 2007

The General Medical Council

The GMC is the regulator of the medical profession in the UK. It licenses doctors to practice, has the power to revoke or place restrictions on that license when a doctor's fitness to practice is called into question. The purpose of the GMC is to protect, promote and maintain the health and safety of the community by ensuring proper standards in the practice of medicine. The main guidance that the GMC provides for doctors is called Good Medical Practice, which outlines the standards that are expected of doctors. This all sounds well and good, however the reality of the GMC is entirely different.

Judge Charles Harris raged: "It is like a totalitarian regime: anybody who criticises it is said to be mentally ill - what used to happen in Russia."

This comment related to the case of an NHS whistle blower who the GMC tried to smear as mentally ill and incompetent, before investigating the very serious concerns raised. It sums up the utter contempt that the GMC has for fairness. Ironically 'Clinical Governance', the NHS' version of corporate governance, has 'openness' as one of its key elements. One of the chief architects of Clinical Governance, the Chief Medical Officer Sir Liam Donaldson, seems intent on ignoring his own chatter; as medical politicians and managers are never held to account for their dangerous actions by the GMC.

The GMC uses the most bizarre and dishonest argument to justify this stance. They claim that their guidance is only 'directed towards practising doctors involved in medical management.' This is despite the GMC printing a document about good medical practice in management. This effectively means that once a doctor has stopped practising medicine, they can behave as dangerously and dishonestly as they like without the GMC lifting a finger.

This stance grants our non-practising medical dictators the freedom to make decisions that may result in the wanton slaughter of patients, while their practising colleagues on the ground can be held to account for the most minor of indiscretions. Whistle blowers in the NHS are written off as loony or incompetent, while the dangerous practice that they tried to uncover is quietly brushed under the GMC's expensive carpet.

The GMC is also happy to put any old doctor on their UK medical register, even if they cannot speak and write english to an appropriate level. The GMC thinks it should be left to the employer to determine this. I am hardly filled with confidence that the GMC is protecting patients given that they accept any old EU medical degree as proof of medical competence, even if the degree comes from the most dodgy of medical schools in the most dubious of countries.

The GMC is endangering patients by collaborating with our political masters in Whitehall. The GMC is used by the government to help enforce a brutal NHS culture of fear and intimidation that prevents doctors from speaking out against the government's dangerous reform agenda. The pretence at 'openness' is a sham that covers up a vicious dictatorship that stifles progress by encouraging the exact opposite. It's a shame because genuine progress can only come with a culture that fosters an open and accountable democratic structure, not this top down Stalinist approach. Recent government reforms via Sir Liam's white paper promise to do little to improve this dismal situation, as it appears that the new system will be subject to yet more corrupt political control.

It's ironic that if Stalin were a medic then the GMC would not be able to strike him off the medical register, however they would be able to dish out brutal punishment to a petrified doctor who was simply following Stalin's orders. This is the world of the brave new NHS.



UPDATE: due to various requests, emails, comments, etc. around and about this post, I have hidden comments and am allowing no more. This is the first time in my two and a half years of vituperative blogging that I have ever had to do this.

I've removed my more vituperative comments about the medical profession in general as I don't hold any brief against them; however, I do not want this argument to continue here. Please take it elsewhere.

Thank you Dr De'ath for writing this piece (on which I believe him to be substantially correct), and to those few who joined the debate rationally.

DK