Babies who die in unexplained circumstances must have a postmortem carried out by a paediatric pathologist, despite an acute shortage of such doctors, a report said yesterday.
The shortage, caused by paediatric pathologists leaving the profession after the outcry over the retention of children's organs by hospitals including Alder Hey in Liverpool, must be addressed, said a working group from two royal colleges.
The group, chaired by Helena Kennedy QC, was set up to improve the investigation of the deaths of babies after the successful appeal of Sally Clark against her conviction for murder and Trupti Patel's acquittal. In both cases, and that subsequently of Angela Canning, expert medical testimony was discredited.
Lady Kennedy said yesterday she hoped the new investigation protocol for doctors, pathologists, police, lawyers, judges, expert witnesses and coroners would be championed by the children's minister, Margaret Hodge, and put in place around the country.
There are only about 40 paediatric pathologists in Britain. James Underwood, the president of the Royal College of Pathologists which commissioned the report with the Royal College of Paediatrics and Child Health, said that number needed to double. About a quarter of paediatric pathology posts are vacant, with new ones not being created due to lack of applicants.
"One of the things that harmed paediatric pathology greatly was the reaction to organ retention," said Prof Underwood. He said the way the matter was handled had demonised the profession, causing some experts to retire early and others to switch to adult work or other branches of medicine.
In the future, coroners should order small tissue samples to be taken from the infant and retained in all cases. In some cases it may be necessary to keep the brain. The report says that "the altruism of parents who have lost babies should not be underestimated" and that if the case is properly explained they "are very willing to do what they can to further medical understanding of these tragic occurrences".
The report envisages a more active role for judges in vetting expert witnesses in baby murder cases.
The recommendations, if implemented, would see a wider range of experts, possibly accredited by the royal colleges, appear in court and end the reliance on a small number of child abuse specialists. Doctors as well as lawyers and judges can become "case-hardened", says the report. "Those regularly involved with child abuse can find it hard to be dispassionate and indeed sometimes become hawkish."
Those who regularly appear in care cases, where the standard of proof is lower and the child's interests paramount, can lose sight of the different situation in the courts, where the case starts from a presumption of innocence, it adds.
Doctors must also make sure their findings are based solely on scientific evidence. "A doctor can be convinced, based on his or her experience, that a defendant is guilty but unless there is compelling evidence supported scientifically, he or she should not express that view in criminal proceedings."
Prosecution and defence lawyers tried to push experts to express more definite opinions than they felt was warranted, said Lady Kennedy. "The court system doesn't like the answer, 'I don't know' to a question, but sometimes that is the only answer and professionals have to be prepared to give it."
