Last month a medical expert who gave evidence over more than two decades in dozens of child abuse cases was struck off by the General Medical Council for misleading courts. Yet the children's minister, Margaret Hodge, has no plans to ask local councils to reopen his cases. The expert is not Sir Roy Meadow, the paediatrician who testified that Sally Clark, Angela Cannings and Trupti Patel, all eventually cleared, had murdered their babies; his case has yet to come up before the GMC.
Reams of newsprint have been devoted to Meadow, his flawed evidence in the Sally Clark case, and to Munchausen syndrome by proxy (MSBP), the condition he first named, under which mothers fake or induce illnesses in their children to gain attention for themselves. The other expert, Dr Colin Paterson, attracted only a few paragraphs on the day he was struck off. Yet child protection professionals believe his pet theory may have led to more miscarriages of justice than Meadow's evidence ever did.
Meadow is an eminent paediatrician now discredited as an expert witness because he was too ready to "think dirty", too reluctant to entertain doubts, and strayed outside his area of expertise - crucially, in Sally Clark's original trial, into the realm of statistics. But few child protection specialists doubt that MSBP, now rebranded as a "factitious illness", actually exists. Mothers visiting their children in hospital have been covertly recorded on videotape interfering with their children's breathing and some mothers have eventually admitted making up or bringing on symptoms in their healthy children.
For years Paterson, a retired chemical pathologist from Dundee, peddled a theory around courts in England, Scotland and eventually America which few specialists believe has any basis in reality. Dozens of children with fractures apparently caused by their parents were actually suffering from "temporary brittle bone disease" (TBBD), he argued, a condition whereby babies are prone to fractures in their first few months but grow out of it by a year or so. He also readily attributed fractures to osteogenesis imperfecta, a genuine but rare disorder in which brittle bones are permanent, or to copper deficiency.
Paterson himself has estimated that between 60 and 70 children have been returned to their parents as a result of his evidence. Ministers acted swiftly following the appeal court's judgment in the Cannings case, decreeing that all convictions of parents for killing their children in the past 10 years be re-examined, all pending prosecutions reviewed, and all cases where children were taken into care on disputed evidence trawled through.
For innocent parents to have a child taken from them, or to be prosecuted and convicted of killing a child who actually died from natural causes, is a barely imaginable horror. But what about the children wrongly sent back to parents who harmed them? According to the GMC's charge sheet, Paterson asserted that no child whose parents he had supported later suffered non-accidental injuries. But at least one child, Myles Phipps, died after being returned to his parents following Paterson's diagnosis of brittle bone disease; and at the inquest "there was considerable evidence that his fractures were non-accidental", said the GMC.
Yet there have been no official moves to reopen the cases in which Paterson gave evidence, or to try to find out whether any of the children allowed to return home are now in danger. On March 10, within days of the GMC striking Paterson off the medical register, David Spicer, chairman of the British Association for the Study and Prevention of Child Abuse and Neglect, wrote to Hodge asking whether she would now require local councils to re-examine his cases. The answer, received last week, boiled down to "no", and raises doubts whether she has power to do so.
Spicer, a barrister, is assistant head of legal services for Nottinghamshire county council and has sat on inquiries into the deaths of more than 70 children. As far back as 1990, Paterson was attracting judicial criticism. High court judge Mr Justice Cazalet gave guidance for future cases in a public judgment after Paterson advanced his theory in the case of a baby girl from Nottinghamshire with fractures to five ribs and all four limbs, and extensive brain damage.
But Paterson went on to give evidence for parents throughout the 1990s. In 1994, in another public high court judgment, involving a 10-week-old boy with multiple fractures and brain damage, Mr Justice Wall accused him of being an advocate for his theory rather than a dispassionate expert witness. The judges noted that he ignored findings such as brain damage which appeared to indicate non-accidental injuries. They made their judgments public for fear that the county courts and magistrates courts, which hear many abuse cases, might be unwittingly misled. Despite the mounting criticism, in 2000 a Scottish sheriff ruled that twins should be returned to their parents on the basis of Paterson's evidence.
In 2001, a third high court judge, Mr Justice Singer, branded his evidence "woeful" and directed that he should not appear as an expert in any further cases in England and Wales without the permission of a high court judge. That case involved a baby girl, "X", admitted to hospital at the age of 20 weeks with multiple fractures. Paterson, said the judge, "has in my view provided a misleading opinion, failed to be objective, omitted factors which do not support his opinion, and lacked proper research in his approach to the case". The president of the high court's family division, Dame Elizabeth Butler-Sloss, reported Paterson to the GMC.
Despite a GMC letter of guidance, he went on giving courts the benefit of his opinion. In February 2002 he travelled to Arizona to testify on behalf of Martin and Alma Talmadge, who won a retrial on appeal after they were convicted of harming their daughter Amber, who had 14 broken bones by the age of 11 weeks. The couple were jailed for 35 years for child abuse.
On the basis of the X and Talmadge cases, the GMC last month found Paterson guilty of serious professional misconduct. The chairwoman of the professional conduct committee, Eileen Shaw, said the committee had no doubt of his sincerity, but he had failed to apply his own diagnostic criteria consistently and had ignored factors, such as bruising, that were inconsistent with his published views on the disease.
"You appear to have acted as an advocate for temporary brittle bone disease and ignored the significant clinical evidence which was at variance with your published view on the clinical signs of [TBBD]. You risked misleading the court and undermining the confidence which the judiciary is entitled to place in expert medical witnesses," he was told.
Paterson is appealing, and his lawyers said in a statement after the GMC ruling: "He has never knowingly misled any tribunal or court in setting out his views and has always had regard for the views of others. He has been committed to seeking to act in the best interests of the children at all times."
But in a further letter to Hodge this week, Spicer points out that the judges' criticism of Paterson went beyond any doubts about expert witnesses expressed by the appeal court in the Angela Cannings case. He notes that the cases in which Paterson's evidence may have been influential typically involved babies who had suffered serious fractures of limbs, skulls and ribs. "One can only speculate about what else perpetrators of abuse may have inflicted on these children, other than fractures."
Spicer argues in his letter: "The innocent explanations for serious injuries advanced by Paterson are now at the very least suspect and probably have no foundation. Local authorities that have allowed or been required to allow children who were seriously injured to remain in households as a result of Paterson's influence must now have reasonable cause to believe that those children are suffering or likely to suffer significant harm, and so are under a duty to make inquiries under section 47 of the Children Act 1989 to decide whether they should take any action to safeguard and promote their welfare."
He maintains that Hodge has power to issue guidance to local authorities to reconsider those cases in accordance with their duties under section 47. "If I am wrong in this, then the position must be that a minister, even though aware that children who have been seriously abused remain in households in which the injuries have occurred in reliance on a false assessment of risk, can take no action to inform local authorities and ensure that they reconsider those cases.
"By contrast, the minister can require cases to be reconsidered if children have been removed and are in safe environments. If this is the case, then it must be the case that the children bill should be amended urgently to address this disturbing position at the earliest opportunity."
