Previous News Items from 2005

Therapy for Toddlers - BBC R4 PM Programme, 29 November 2005

The GMC’s Policy on Mitigation – Inadmissible in a Court of Law? - as yet unpublished

The House of Obsessive Compulsives - Channel 4, 1 & 8 August 2005

Serious Case of Injustice Based on Recovered Memories - Appeal Upheld - 15 July 2005

False Memories are doing real damage - The Sunday Telegraph, 3 July 2005

GMC - A Crisis of Public Confidence - 13 June 2005

Shieldfield - Justice at last? - 16 May 2005

The Church finds a false god in therapy - The Sunday Telegraph, 30 January 2005

Therapy for Toddlers

At a recent conference in London details of new research revealed that about ten percent of two to five year olds have psychiatric disorders such as depression and anxiety and disruptive behaviour, which should be treated as early as possible.

On 29th November 2005 BBC Radio 4’s PM programme interviewed Dr Adrian Angold, an associate professor of psychiatry based at Duke University in the United States of America, who described his research which involved the screening of a thousand children. In view of the huge burden to communities and the extent of human suffering caused by psychiatric disorders he suggested the importance of identifying affected children from as early as pre-school years.

The interviewer, Eddy Mair, suggested with good reason that people might be concerned at the idea of treating two year olds who might eventually grow out of their emotional problems.  Dr Angold stressed that in the short term children can suffer with serious disorders with which they need some help.  He said, “I think that’s an argument for good services with appropriate treatment and careful diagnosis, not an argument for doing nothing”.

We have asked Dr Hamish Cameron, Consultant Child and Adolescent Psychiatrist to respond:

This Radio 4 piece addresses an important child mental health theme.  The 10% incidence of emotional/behavioural problems in 2 – 5 year olds is well accepted.  Of course, the figure is an average across the country as a whole, for in some areas the incidence will be less, in others much greater.

General principle

Risk of harm from treatment may outweigh the likely benefit from therapeutic intervention.

Therapy for problematic 2 to 5 years old children, on a one-to-one basis, calls for exceptional training and treatment expertise in the therapist, and open-mindedness about the several possible causes of the child’s problems is essential.

Positives about helping 2 – 5 year olds

1. It’s often less a child problem than a child/parent communication difficulty.  Informed child mental health support benefits the parent, and thus may improve the child/parent relationship at home.
2. Politically, and professionally, early preventative work for under 5s, within the family setting, is receiving understanding attention nowadays (eg Surestart programmes). This is to be welcomed.
3. A child’s tender age is not, of itself, a bar to family therapy.  Mother-and-baby units for post-natally distressed mothers are invaluable in encouraging mother/child bonding through baby-inclusive treatment approaches.

Negatives

1. ‘Do no harm’ – is the underlying precept for all treatment.  Therapy with a toddler alone risks evoking false stories, which the child (and parent) may come to believe are true.
2. Professionals are slow to label 2 – 5 year olds with a psychiatric diagnosis, for often a family difficulty underlies the child’s symptoms.  (Two useful questions in family work are:- ‘Who is showing the symptoms?’  (often the child) and ‘Who has the problem?’ (often the parent/carer)).
3. The risk of ill-effects from giving a child a psychiatric diagnosis needs to be recognised:-
   • Self labelling can cause long-lasting impairment of self-esteem.
   • A parent may ‘project’ their own emotional dysfunctions onto their child, whom they then blame for behaving badly.
   • A psychiatric diagnosis can result in the anxious carer, in therapy, seizing on post-hoc fabricated explanations (such as sexual abuse) to try to explain various behaviours.
   • Naïve therapy may engender a folie-à-trois (mother-therapist-child) false belief, which may become unshakeable, even in the face of corrective factual evidence.

Therapist experience and training

The emotional sensitivity, suggestibility, and vulnerability of a young child’s mind is well known.  Only well-trained, competent specialists should venture into therapeutic work with children.  Some therapies, such as cognitive behaviour therapy, psychoanalysis, family therapy, and Winnicottian ‘squiggle’ therapy, are effective when used by expert professionals.  But there is a real risk of ‘therapy abuse’ (eg implanting thoughts, ideas and false memories in the mind of the child) when incompletely understood treatments are applied by the inexperienced.  Insufficient training can limit breadth of vision diagnostically, and lead to wrong conclusions about a child’s difficulties.

Messages to be drawn from this Radio 4 piece

1. Skilled early intervention work with 2 – 5 year old children, both pre-school, at nursery school, and starting primary school, is a responsible venture when carried out by competent professionals, with a clear focus.  The need for early intervention at this young age is evident nowadays, for a sizeable sub-group of young children reach the age of five with limited social skills and impaired language, compared with the average for their age.  And, in consequence, unless they receive early help as pre-schoolers, their future attainment at school and as adults may be doomed to be always at a low level.
2. What has to be guarded against is officious therapeutic intervention with children who show only minor deviations from the ‘perfect norm’.  With such children the real risk of causing harm by the therapy evoking ‘false memories’ must constantly be borne in mind.

*

Dr Adrian Angold states that we should try to help young children to better futures. 

Nowadays, ‘therapy zealots’ with pre-conviction explanations in mind are less likely to be released on innocent populations of 2 – 5 year old children than in previous years.  However, cases of therapy-induced false beliefs in children still occur.  Therapy with young children is skilled professional work and should only be carried out by those who understand the ever present pitfall that false beliefs can easily be evoked in the young child’s mind.

Dr H C Cameron
Consultant Child Psychiatrist

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The GMC’s Policy on Mitigation – Inadmissible in a Court of Law?

The Dr Spender hearing raises new doubts

The GMC disciplinary hearing against Dr Quentin Wynn Spender, then a senior lecturer and Consultant in Child and Adolescent Psychiatry in an NHS Trust, was heard between 16 May 2005 and 12 October, following which a statement was issued giving the Fitness to Practise panel’s decision.  The hearing, held in camera, concerned two separate cases: one a child, Miss A, who was diagnosed in 1996 as having been “subjected to sexual abuse by some or all the members of her family”; the other concerned allegations of physical and sexual bullying at a Sussex school, in 1988/9 of boy X by boy Y who, Dr Spender maintained, “had himself been sexually abused”.

Of the charges laid against the doctor, 20 were ‘admitted and found proved’, 12 were ‘found proved’ and four were found ‘not proved’. The GMC found in each case that Dr Spender had acted inappropriately, irresponsibly and unprofessionally. The accusation that his conduct in the case of child A was “not in the best interests of your patient” was found not proved but in the case of boys X and Y he was found to have been guilty of serious professional misconduct.

In relation to the evidence concerning the two schoolboys, X and Y, two salient points stand out: a) Dr Spender said “that the probability that the boy Y had himself been sexually abused was 75%”, that the probability that he was the “perpetrator of abuse on boy X at least 95%” and “that the probability of boy Y having been abused in some way was at least 90%”; and b) Boy Y was not a patient of Dr Spender and he had not seen him. The advisability of attributing mathematical probabilities to conditions diagnosed by psychoanalysis is questionable (particularly when a diagnosis is made without seeing the child concerned) and brings to mind the computational errors of Dr Meadow where probabilities became, in the minds of judge, jury, the press and the public at large, mathematical certainties.

In the case of Miss A, little information is given on the suffering of the family following the allegations. However, charge 7 referred to Dr Spender having written to the girl’s general practitioner (copied to a senior social worker), “Miss A’s parents and I had a major disagreement about the development of A’s current problems. I believe that this is at least in part due to sexual abuse by some or all family members”. This charge against Dr Spender was admitted and found proved. Evidently the parents were in a state of considerable distress.

One question in particular needs to be asked about the GMC’s policy on mitigation, as demonstrated in this and other cases, notably that of Dr Lazaro. Does the passage of time lessen the seriousness with which a court (a role which the FTP panel assumes) views a doctor’s professional misconduct? A doctor’s good conduct since then, and character references, yes, but it is doubtful that the following statement, allowing mitigation because of the time-lag between the ‘event’ and the hearing, would be acceptable in a court of law, and certainly not in cases of historical abuse:

“The Panel might have gone on to consider a more serious sanction but in reaching its decision paid particular regard to the length of the delay in bringing this case to a hearing, which has taken place eight and a half and six and a half years after the events” (how much was this the fault of the GMC?).

There are many references to the doctor failing to seek corroborative evidence, failing to have ‘any sufficient regard to other sources of information’, making assertions based on ‘insufficient information’, and the need for ‘strong statements’ to be supported by ‘strong evidence’ that may have wider implications. If these observations are seen against the background to the Panel’s other comments on the doctor failing to foresee ‘the possible adverse consequences of the inappropriate wording’ and failing to have ‘due consideration for the families concerned’, it could be argued as acceptance by the GMC of a consultant’s duty of care to third parties and, hence, a justification for legal redress being given to parents such as the Fairlies.

The BFMS queried the leniency of the sanction being limited to a ‘reprimand’ with the Council for Healthcare Regulatory Excellence, the body which can exercise its discretion to refer a decision of the GMC to the High Court under Section 29 of the NHS Reform and Health Care Professions Act 2002.

Although they have noted with interest our concerns they have decided not to refer the decision to the High Court in view of the ‘high hurdle’ that will be faced to prove the decision is unduly lenient. However, they have indicated that they have wide ranging powers contained in Sections 25 and 26 to enable them to improve the quality of healthcare regulation and to promote good practice. They meet with officials from the GMC regularly to discuss issues of concern and will raise the case at their next meeting.

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House of Obsessive Compulsives

BFMS members who watched ‘House of Obsessive Compulsives’ on Channel 4 television on 1 and 8 August may have shared the view of Peter White, the BBC’s disability correspondent writing in ‘Community Care’ (April 25): ‘I found myself with so many unanswered questions. For instance, problems that had been going on with these people for decades seem suddenly to make enormous progress. Were we really expected to believe that Gerard, who had been chaining himself to the bed so that he would not sleep walk and inadvertently write confessions, would make so much progress and appear almost a different person to his wife within five days? I am not doubting that these things happen, merely saying that the programme did not say how they happened.’

While some enlightenment may come from listening to the interview with programme adviser, Clinical Psychologist Professor Paul Salkovskis on BBC Radio 4’s Midweek’ (27 July), his comments seemed to raise more questions than they answered. Such enigmatic observations as, ‘(the victims’) realisation that the families were not causing the problem’ and, ‘the therapy they had in the first place was useless,’ left the listener thinking that behind the story that unfolded on Channel 4 lay a much more important saga of personal suffering affecting the wider family. Not only that but were there lessons to be learned about the efficacy of the therapies that patients had been receiving for many years?

Nevertheless, readers may find the following verbatim extract from Professor Salkovskis’s Radio 4 interview of interest. (Most of the interview was concerned with a description of Obsessive Compulsive Disorder, the problems experienced by sufferers and their carers, and the ethics of it being seen as ‘entertainment’).

Presenter (Gill Pyrah): Cognitive Behavioural Therapy seems to work so rapidly, people who might have been under psychotherapists for fifteen years can go through cognitive behavioural therapy and in days of weeks find they no longer have the problem they had.

Professor Salkovskis: Well that’s because the psychotherapy they had in the first place was useless. CBT is highly effective very quickly and these people, the programme people, approached us and said they wanted to do it in four weeks and we said we need a week and we compromised on two weeks in the end, but most of the work had been done by the end of the first week. And we had to consolidate, we had to make sure it held. We also had to deal with the horrible thing which is when the partners who had lived with these people for 20 years have had their lives stolen as well. We had to help them come to terms with what it meant.

Presenter: How do you help them, the person who sees their role in life as being a carer, as being the person who inspects every piece of laundry to check that there’s no tiny piece of glitter, who wraps every piece of laundry, keeps their wife more or less cocooned in a bubble to be told well, thanks, your role is over and now your wife can go out and do her own thing and doesn’t mind the glitter thrown over her. Then what?

Professor Salkovskis: I seem to make a specialty of disagreeing. That wasn’t that person’s role. The partner didn’t have that role. These were partners who were hoping for change and who were just holding on by their fingernails and who did not want to do this and they abandoned those roles amazingly quickly. What happened of course was that they had to find a new role and they had to sort of, find a new way of…….. ……

Presenter: You can help them in this as well. You can teach them to (indistinct)….

Prof: No, no, they help themselves. We also help them make sense of it, we also help them come to terms with the huge anger with all the messing around they have had with all the useless therapy that they have had previously. The biggest thing, if something steals that much from you, and you get it back in a few days, is the coming to terms with the grief if you like for 20 years of wasted time. But also, they (indistinct) …………that the families weren’t causing the problem……….It was like a piece of elastic bounced back into shape and off they go.

ends

***

Serious Case of Injustice Based on Recovered Memories - Appeal Upheld

The case of R v X (Childhood Amnesia) was heard by the Court of Appeal on 1 July resulting in the appellant's conviction being found unsafe, the conviction quashed and a retrial ordered; this five years after the accused was jailed for 12 years by a Crown Court. Although reportage is circumscribed by legal restrictions and the defendant expressed reluctance to have the case widely publicised, it is unfortunate that it has not been recognised as an injustice of equal magnitude to those resulting from other aspects of the 'expert witness' issue - notably those involving Professor Sir Roy Meadow. It is doubly unfortunate and worrying - as this case clearly shows - that courts, legal representatives and juries are still largely ignorant of the dangers of accepting evidence of childhood abuse 'remembered' during therapy.

In view of the restrictions referred to above, we have, therefore, confined reference to the case to the report carried on the website of the ICLR (Incorporated Council of Law Reporting). It is evident from its title and the reference 'the victim of the offences claimed to have memories going back to before she was three years old' that the case is very relevant to the work of the BFMS whose Director, Madeline Greenhalgh, attended the hearing.

The case is due to be re-tried in the autumn.

R v X (Childhood Amnesia)

CA: Smith L J, Hughes and Wakerley J J: 1 July 2005

Expert evidence as to a phenomenon known as 'childhood amnesia' was admissible as likely to be outside the knowledge and experience of a judge or jury.

The Court of Appeal, Criminal Division, so held in allowing an appeal by X, on a reference by the Criminal Cases Review Commission against his conviction of four counts of rape and two counts of indecent assault.

SMITH LJ, giving the judgment of the court, said that the victim of the offences claimed to have memories going back to before she was three years old. In her witness statement, made at the age of 19, she had given very detailed narrative accounts, in relation to the offences of rape, of three specific incidents of sexual intercourse. At the hearing of the appeal the defence were given leave to call fresh evidence, de bene esse, from a professor of cognitive psychology who had worked for about 25 years on memory formation and autobiographical memory. The professor gave evidence that the memories of a child were qualitatively different from the memories of later events. The period of 'childhood amnesia' usually extended up to the age of seven and he had never come across a person who had been able to provide a detailed account of something that had happened to them at the age of four or five. His explanation was that during the first five years of life the frontal lobes of the brain were in a state of rapid change and development. He said that a detailed narrative account of an event during those years of childhood should be treated with caution, especially if it contained a number of details which were extraneous points. The court came to the conclusion that the evidence was true expert evidence suitable for admission at a trial and it would only be in the most unusual circumstances, such as the present, that such evidence would be relevant. The appeal would be allowed, the conviction quashed and a retrial ordered.

Reported by Clare Barsby, barrister, Incorporated Council of Law Reporting

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False Memories are doing real damage - The Sunday Telegraph, 3 July 2005

Alex Tsander, a stage hypnotist, criticises Uri Geller's belief in recovered memories in the same week that an article appears on Martha Beck's supposed recovered memories of childhood abuse (Letters & Magazine, June 26). The author of the latter, Simon Worrall, quotes American False Memory Syndrome Foundation's view that the theory has never been proven.

It is important that readers are aware that this is not just an American phenomenon. Had Mr Worrall contacted the British False Memory Society he would have found that here too there are thousands of parents whose lives have been destroyed by their children's psychotherapy.

Despite being discredited by the report to the Royal College of Psychiatry of a team of psychiatrists led by the late Professor Brandon, recovered memory theory is still practised by therapists, counsellors and even a few psychologists.

William Burgoyne (Author, Counselling or Quackery?), London E16

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GMC - A Crisis of Public Confidence - Did They Fail to Follow the Advice of Their Own Legal Advisor?

If the thirteen day hearing into the Shieldfield case did not cause the GMC to worry about the public reputation of paediatricians, then the media coverage should, particularly the full-page report in the Daily Telegraph of 31 May, 2005 by Cassandra Jardine. There can be few parents among the paper's 900,000 plus readers who, having read the report, did not silently pray that their children would never have to come into contact with a paediatrician. And there can be few nursery nurses in the country, and others who regularly work with children, who did not feel, but for an accident of place and time, they, not Dawn Reed and Chris Lilly, might have been the innocent victims of Dr Sam Lazaro, the paediatrician and 'expert witness' at the hub of the Shieldfield allegations.

For those who are already familiar with the background to the Shieldfield scandal, the article offers some interesting insights into the working of the GMC's Fitness to Practise Panel (the committee of doctors and lay members who hear complaints against members of the medical profession).

The Telegraph report says that Reed was not allowed to instruct her own solicitor. 'When you complain to the GMC they choose a solicitor for you. If you don't accept their choice, you have to pay privately. Is that independent?', said Reed. Apart from appearing to prejudice the complainant's right to ensure that his or her case is properly represented, possibly by a member of the legal profession who is already familiar with the background (and may have previously acted for the complainant), it is clearly 'one law for the rich and one for the poor.' Ms Sullivan, Counsel for the Panel (and representing the interests of Reed and Lillie), was merciless in exposing the numerous inconsistencies in Dr Lazaro's record keeping, but failed to translate these effectively into evidence that she was guilty of serious professional misconduct. In particular, the widespread and deep distress that Dr Lazaro's errors had caused was not exploited. The GMC might say that this was outside the remit of the hearing - which was to look at the doctor's professional competence - and in any case statements from Reed and Lillie had been read out. If so, why was the defence counsel allowed to ask the doctor, 'to what extent did this affect you emotionally?' (day 5, p 35 of the GMC FPP transcript) and to develop this line further in his plea of mitigation on her behalf. Would a similar plea, on behalf of the two nursery nurses, in support of the case against Dr Lazaro, have been allowed to go unchallenged? As the Telegraph article states, 'And they let her off after a colleague, Dr Christopher Hobbs, pleaded that she was overworked and under stress. Such a decision is troubling for those facing charges of sexual and other kinds of child abuse. Unreliable evidence from social workers and doctors often lies behind allegations that turn out to be false. Medical experts often give opinions in court without ever having seen the child or carer, using inaccurate hospital records that have a shattering effect on the lives of the accused. Yet it appears they cannot be held accountable if they can plead tiredness and overwork - even if they are being paid large fees for their expert opinions.'

The Legal Advisor's advice was as follows, 'Mitigation arising from the circumstances in which the practitioner found himself or herself may be relevant to the level of culpability: once serious professional misconduct is proved, personal
mitigation will be relevant to possible penalty. In our judgment, these are distinct issues, to be determined separately, on the basis of evidence relevant to them.' (Day 11, page 2 of GMC FPP transcript). There remains a very big question mark over whether this advice was followed. The doubtful defence that she was the victim of an 'epidemic' should only have been accepted as mitigation if it was proved that she had no part in its creation. Evidence that Dr Lazaro was tired and overworked should only have been considered after a decision had been reached on whether she was guilty of serious professional misconduct and should not have been party to that decision.

Jardine reports that within 48 hours of her interview with Dawn Reed, three further cases came to her attention - one involving Dr Lazaro whose belief that a father had sexually abused his daughter was later rejected by a clinical child psychologist. The father is quoted as saying, 'Had Dr Lazaro's practices been revealed earlier on, things might have gone differently. Had she been struck off by the GMC, I hoped to reopen the case in the civil courts. Now, I can't.'

Anyone who has studied the case and has read the transcript can only be left with a feeling that the Panel operates outside the laws of natural justice - the accused was able to personally give testimony; the victims could not be heard and had to rely on representation through a third party. Another newspaper, the Evening Chronicle, Newcastle, offered a solution, 'the matter would surely have been better dealt with had an independent body considered the evidence rather than a council of her peers. For example, we already have an independent police complaints authority. As things stand, the GMC has hardly covered itself in glory; recent cases like that of Dr Harold Shipman and Professor Roy Meadows are proof that the system isn't working and this latest hearing has done little to inspire future public confidence'.

This view was echoed by the Newcastle Sunday Sun (15 May) which quoted human rights lawyer Vera Baird, MP for Redcar and Cleveland, 'there needs to be a truly independent body scrutinising doctors because the public has no faith in the GMC. She (Dr Lazaro) has been let off by her peers despite the comments of the judge. This shows the GMC have not been impartial in this case. The problem with the GMC is that you have doctors deciding what happens to other doctors. This means they are likely to sympathise with the doctor's point of view over that of the public because they are contemporaries of theirs. We already have an independent police complaints authority and there is soon to be an independent solicitors' body, so there is absolutely no reason why we cannot have the same for medicine. The GMC has already been slammed by senior judge Janet Smith following her inquiry into doctor Harold Shipman's murder rampage. Dame Janet recommended that the government strip it of its right to judge medical misconduct. The council failed to act on suspicions over Shipman, Britain's most prolific serial killer'.

In the Telegraph article Dawn Reed says, 'Given the devastation Dr Lazaro caused, Chris and I had hoped that the GMC would at least impose some restrictions on her work. Since they haven't, any parent who comes into contact with her should know her record.'

The case has been referred to the Council for Healthcare and Regulatory Excellence which, on 26 May, wrote to Madeline Greenhalgh, Director of the BFMS, 'I can confirm that we will be considering the GMC's FTP panel's decision of 13 May 2005 in the case of Dr Camille de Sam Lazaro under our standard procedures under Section 29 of the National Health Service Reform and Health Care Professions Act 2002. I can confirm that we will take into account the information which you have sent to me. Any appeal by CHRE to the High Court in this case would have to be lodged by 9 June 2005'.

The CHRE has since confirmed that it has decided to refer the decision of the GMC's Fitness to Practise Panel in respect of Dr de San Lazaro to the High Court.

***

Shieldfield - Justice at last?

A response to the GMC Hearing of the Case against Dr Sam Lazaro

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

1) did the FTP Panel give due weight to the consequences for the accused and the children of Dr Lazaro's initial faulty assessment?

2) 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?

3) In reaching their decision, did the Panel make too much allowance for her plea that her failings were due to pressures of work?

4) 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?

5) 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?

6) 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!

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The Church finds a false god in therapy - Sunday Telegraph, 30 January 2005
by James Le Fanu

There are apparently now more counsellors in Britain than there are members of the Armed Forces. Some observers, such as Prof Frank Furedi, of Kent University, take a dim view of this, claiming that this army of therapists is seeking to redefine normal experiences and emotions as being stressful or damaging.

No doubt he has a point. But it could be argued that the rising number of therapists is an appropriate response to the previously unfilled needs of the many with depression, anxiety and other psychological afflictions that used to be met, often inexpertly, by the family doctor. Certainly, therapists are the bulwark of our practice, and their sympathy and robust good sense are indispensable.

The problem arises with those therapists who maintain that most psychological disturbance can be explained by some hidden trauma in the past, which must be brought to the surface and "worked through". The concept is a potent one but, no matter how many times it is shown to be harmful nonsense, it keeps returning in another guise.

The dreadful Mr Freud started it with his notions of repressed infantile sexuality. Then, starting in the 1980s, came the epidemic of "recovered memories", where, every year in Britain and America, hundreds of troubled women
(mostly) remembered, while in therapy, having been seduced, traumatised or raped, usually by their father but sometimes by brothers, uncles or other male friends of the family. This not only had a catastrophic effect on those accused, but the "victims" caught in this web of lies and deceit became ever more psychologically disturbed.

Thankfully, and not before time, in 1998 Sydney Brandon , professor of psychiatry at Leicester University, destroyed the credibility of the concept of recovered memories in a devastating report commissioned by the Royal College of Psychiatrists.

Now it has reappeared again, this time under the auspices of, amazingly, the Church of England. In a policy document published last year, Protecting All God's Children , the Church, whether from naivety or stupidity, has endorsed the bible of the recovered memory fanatics, The Courage to Heal , as an "important and useful book". Its insights include the claim that "if you think you were abused, and your life shows the symptoms, then you were". It also encourages so-called survivors of recovered memory syndrome to engage in "pleasurable fantasies of murder and castration against those who have hurt them so terribly" (I kid you not).

There is also a strong Church of England involvement in the Trauma and Abuse Group (TAG), whose chairman, Mike Fisher, is executive director of the Christian Counselling Service. TAG promotes the theory that people develop multiple personalities in response to "repeated and overwhelming childhood trauma, especially sexual and physical abuse" - a theory which has been discredited by, among others, Prof Howard Merskey of the University of Western Ontario (The Persistence of Folly: A Critical Examination of Dissociative Identity Disorder, The Canadian Journal of Psychiatry, September 2004). The group's forthcoming conference, to be held in Derby in April, features a contribution from a therapist who has apparently worked for six years with survivors of satanic rituals who, she claims, are forced "to persecute other children and animals during ceremonies". Meanwhile, Mike Fisher urges the necessity to "keep a balance between demonstrating the unconditional love of Christ and professional good practice".

No doubt the Archbishop of Canterbury, Rowan Williams, will be seeking more details from the British False Memory Society (BFMS), which has just published an excellent booklet, Counselling or Quackery? ( pounds 6.75 plus p&p), providing an insider's view of the consequences of these harmful theories.

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