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Munchausen Syndrome

And the real losers are............

Faith in child protection system must be restored

28 May 2004



Recent court cases into unexplained infant deaths have led to widespread confusion and have made many paediatricians reluctant to take part in child protection cases, warn experts in this week's BMJ.

They call for an urgent review of procedures to restore faith in the child protection systems.

The term Munchausen syndrome by proxy received publicity when in 1977 Meadow reported a case with deliberate fabrication of symptoms. Many manifestations of the syndrome are now recognised.

Yet recent events have raised questions about the diagnosis of the syndrome and have prompted some soul searching about the ways professionals respond to the unexpected death of an infant.

A non-adversarial approach needs to be introduced to deal with sudden infant deaths, say the authors. The emphasis must be first on assessing and minimising the risk to any other children cared for by the parents and secondly on management of the parents' needs. Professionals who offer expert evidence must also not promote ideas that are unsupported by research.

"We must restore the faith of the public and the professions in the child protection systems that are vital for a civilised society," say the authors. "Munchausen syndrome by proxy has captured the public imagination, but there is still much that we do not know about other aspects of child abuse.

"We urgently need to review procedures and to fund more research into the causes, mechanisms, and diagnosis of child abuse. And we call on journalists, lawyers, and the judiciary to ensure that they are well informed about the mass of evidence and data gathered over the past 40 years in child protection."

Contacts:

David Hall, Professor of Community Paediatrics, Institute of General Practice, Northern General Hospital, Sheffield, UK
Email: [email protected]

Alan Craft, Professor of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK

(Munchausen syndrome by proxy and sudden infant death)
http://bmj.com/cgi/content/full/328/7451/1309
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http://www.medicalnewstoday.com/index.php?newsid=8814

Full text and PDF of the BMJ article are available via that link.

Emps
 
Not specifically relevant to MSbP but a very clear indication of the approach to science that has occasionally been used in these cases:

Paediatrician faces GMC hearing

A senior paediatrician has been accused of acting irresponsibly by diagnosing child abuse on the basis of a television documentary.

Professor David Southall could be struck off if he is found guilty of professional misconduct.

Professor Southall claimed the husband of cleared solicitor Sally Clark murdered their two babies.

He contacted police after seeing a Steve Clark interview conducted while his wife was in prison for the deaths.

Mrs Clark, who was living in Wilmslow, Cheshire at the time of her conviction, was later released after the Court of Appeal quashed her conviction in January 2003.

The Channel 4 Dispatches documentary, broadcast in April 2000, featured an interview with Mr Clark, in which he described a nosebleed suffered by their first baby Christopher in a London hotel just 10 days before he died in December 1996.

Professor Southall saw the programme and told police it was his view that it was Mr Clark, rather than his wife, who had killed Christopher and his brother Harry.

Investigation

This case is about Professor Southall's dogmatic belief in his own expertise
Richard Tyson
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Mr Clark was interviewed by social workers, and the courts appointed another paediatrician to review Professor Southall's claims.

The second paediatrician did not agree with Professor Southall and the matter went no further.

Mr Clark then lodged a complaint against the professor with the GMC in London.

Richard Tyson, opening the case on behalf of the GMC and Mr Clark, said: "This case is about Professor Southall's dogmatic belief in his own expertise which he brought to bear on a case in which he had no professional involvement but in which he intervened in a high-handed fashion largely on the basis of watching a programme on TV."

Mr Tyson said the facts of the case were both "astonishing and extremely serious".

Professor Southall, based at North Staffordshire Hospital in Stoke, is one of Britain's leading experts on Munchausen's Syndrome By Proxy, a condition which apparently drives parents to harm their own children in order to win attention.

He admits contacting Cheshire police after watching the programme, and forming the view that Steve Clark had deliberately suffocated his son.

However, he denies that his behaviour was irresponsible or an abuse of his professional position and he denies serious professional misconduct.

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/3782957.stm

Published: 2004/06/07 09:26:39 GMT

© BBC MMIV
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Paediatricians shy away from dealing with abuse as backlash from parents grows

Sandra Laville
Monday June 7, 2004
The Guardian

When his wife gave birth to their first child, one of the country's leading paediatricians expected to receive cards, flowers and congratulations. What he never imagined was the announcement of his baby's arrival on an internet site supporting parents who claim they have been falsely accused of child abuse.
"It feels intimidating. In common with any paediatrician who has an experience of this sort of attack it makes you feel frightened. Some of the cases I have been asked to comment on in court involve families who have killed their children. It's deliberate intimidation and it works."

The consultant, like many who claim they have been the victims of threats and harassment by some of the groups campaigning for parents, did not want to be named for fear of being further targeted.

As a result much of the evidence of intimidation against paediatricians is anecdotal, few if any allegations have reached the ears of police officers and none has been heard in open court.

Many cite this type of harassment and intimidation for the crisis in the profession. More importantly they believe the climate of vilification is putting children at risk as paediatricians shy away from diagnosing abuse for fear of a public barracking, harassment and ultimately an appearance before the General Medical Council.

Life sentence

For their part, campaigners believe many doctors are exaggerating claims of harassment. What some paediatricians are going through is nothing compared with the life sentence of having a child taken away on the evidence of an expert in a secret family court hearing, they say.

The crisis in trust between those representing parents and the professionals has reached a critical point following the court of appeal ruling in the Angela Cannings case. It follows a letter to the Guardian from a group of paediatricians saying the balance had swung too far in favour of those exploiting differences of opinion between doctors to claim there was overdiagnosis of abuse and neglect.

To the observer it is hard to know where the truth lies in a frenzied atmosphere of claim and counter claim.

On one hand, parents have been released from prison after grave miscarriages of justice, judges have criticised expert evidence from paediatricians which helped put them there and campaigners say there are many more unfortunate families behind each of these cases.

On the other, paediatricians warn that the level of child abuse being detected is a tip of the iceberg, that by its very nature it is shrouded in secrecy and that someone has to be an advocate for the young victims who have no campaign groups to give them a voice. Anthony Douglas, director of Suffolk social services department and chairman of the British Association for Adoption and Fostering Agencies (BAAF) said paediatricians were now experiencing the scrutiny social workers had been under for years. He said it was quite right that professionals were held to account by parents or pressure groups, even though at times particularly vigorous campaigning could make people feel exposed.

Geoff Debelle, consultant paediatrician from Birmingham Children's Hospital, said the attacks on individuals could be vitriolic. "You hear colleagues saying all the time they are not interested in child protection work anymore. Cases aren't being detected because consciously or subconsciously you tend to put the barrier up a bit."

Chris Hobbs, consultant paediatrician at St James's Hospital, Leeds, points to falling numbers on the child protection register - from 35,000 in 1995 to 26,600 last year - and the shortage of "named" doctors who oversee child protection in NHS trusts, as evidence of a sustained campaign against paediatricians.

"People always assumed they were a little bit protected as an expert. There was not going to be comeback, now there is."

Penny Mellor, a mother of eight who runs the Portia Campaign, is one of the most vocal campaigners for parents who say they have been wrongly accused. She denies harassing anyone and says she has asked for several meetings with the Royal College of Paediatrics and Child Health, but all have been refused. Talk of harassment and intimidation was obscuring the real issue, Ms Mellor said, but she admitted she contributed to a website, Mothers Against Munchausens, which many paediatricians see as a vehicle for attacking them.

"What we have been saying for years is that children are being removed by the family courts on the basis of unscientific evaluation of evidence and experts going out of their expertise. Some paediatricians have a polarised view, their first port of call is abuse. This is zealotry."

Such are the entrenched positions of the professionals and the campaigners as the most high profile professional misconduct hearing yet against a paediatrician begins in Manchester. Professor David Southall is not the only leading child expert to face a GMC trial. Professor Sir Roy Meadow and Camille de San Lozaro, one of the country's few forensic paediatricians, will face similar hearings this year.

"Three of the key people in this country, all eminent and expert in their work, have all been either suspended and/or are being investigated by the GMC," said Dr Martin Samuels, consultant paediatrician at North Staffordshire Hospital. In a personal statement before his GMC hearing today, Prof Southall said there was "an urgent need to expose the way in which a small group of people is trying to undermine public confidence in the way professionals investigate cases of possible child abuse".

All the paediatricians facing the GMC this year have been a focal point for campaign groups. Ms Mellor, who represents 150 parents, is open about focusing on certain practitioners, many of whom have promoted the theory of Munchausen's syndrome by proxy, but she denies she is out to get all paediatricians.

The hopes of parents and campaigners such as Ms Mellor that the court of appeal ruling in the Cannings' case would lead to thousands of child care cases being reviewed were dashed recently by Dame Elizabeth Butler Sloss, president of the family division, when she threw out the first two appeals after the judgment. Although the Cannings case was a "useful warning ... practitioners should be slow to assume that past cases which had been carefully tried on a wide range of evidence would be readily reopened," she said.

Embattled


For embattled paediatricians that ruling changed the atmosphere somewhat, according to Paul Davis, consultant paediatrician at Cardiff and Vale NHS trust, but it had done nothing to restore public confidence in individuals or in the legal system within the world of paediatrics.

"The damage to a large extent has been done," he said. Dr Davis has first hand experience of the tactics of some campaigners and is being investigated by the GMC as a result of complaints by Ms Mellor and parents. "It begins very slowly, you become aware that you are being mentioned on the internet and that people are saying very unpleasant things about you which are largely untrue," he said.

The widespread dissemination of these claims eventually impacted on his professional reputation. "You hear through the grapevine that certain patients don't wish to be referred to you because they think you are going to take their children. It bears no resemblance to your role at all but the public are now very suspicious of paediatricians," he said.

Like most of his colleagues Dr Davis believes the massive publicity which the Southall hearing will attract will do little to restore faith, either of parents in the professionals or of paediatricians in a legal system which they believe should protect them from intimidation and harassment. "This has now gone so deep within the profession that it will take 30 years to get things back on some sort of even keel."
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http://www.guardian.co.uk/uk_news/story/0,3604,1232762,00.html
 
A sick child or a sick mind?

Some parents believe Munchausen's by proxy barely exists, while doctors say it is hugely under-diagnosed. Jeremy Laurance examines the conflicting claims

07 June 2004


In 1977 a paediatrician called Roy Meadow was called to see a six-year-old girl. Her name was Kay, and she had been referred to Seacroft Hospital in Leeds with foul-smelling, bloody urine.

Something about the girl's symptoms didn't add up and, after investigations, Meadow found out why. It turned out that Kay's mother had been mixing her own urine, contaminated with menstrual blood, with her daughter's, and over a period of years had involved the medical profession in a cat-and-mouse game to see if they could diagnose Kay's condition. Each time they completed one series of investigations, Kay would mysteriously develop a new symptom that required further inquiry.

By the time she arrived at Seacroft Hospital, Kay had already been admitted to hospital 12 times, had had seven major X-ray investigations, six examinations under anaesthetic and been treated with eight antibiotics, vaginal pessaries and creams. Sixteen consultants were involved in her care and her urine was cultured in laboratories 150 times before the doctors realised it was her mother who was ill.

Kay's mother became the first patient in the world to be identified with Munchausen's by proxy. The syndrome - and the recognition that parents can harm their children under cover of appearing to care for them - has since entered the national consciousness.

Today, Professor Sir Roy Meadow is a household name, known not so much for this discovery, as for his work as an expert witness in a number of controversial cot-death cases. To some, he is a hate figure, seen to be responsible for a string of wrongful convictions of innocent parents.

There are few crimes to equal abusing a child, but one of them is to accuse a parent falsely of committing such a crime. This is the dilemma faced by paediatricians working in child protection. How can they steer a course between wrongly diagnosing abuse and missing it altogether, when the consequences of either error are equally devastating?

Their role will be highlighted today when the General Medical Council opens its case against Professor David Southall, a consultant paediatrician at the North Staffordshire Royal Infirmary in Stoke-on-Trent. Professor Southall is an expert in child protection, who has been targeted for a decade by campaigners seeking to expose false allegations of abuse. He is accused by the GMC of intervening in the case of Sally Clark - the solicitor convicted of killing her babies in 1999, and who was cleared by the Court of Appeal last year. The GMC maintains that Professor Southall made allegations against Clark's husband, Stephen, purely on the basis of information he gleaned from a television programme.

Depending on the outcome of that case, he will also face eight further charges before the GMC in relation to his use of the controversial diagnosis of Munchausen's syndrome by proxy, to be heard at a later date.

But the big fish, due to appear before the GMC later this year, is Professor Meadow. It was his evidence that helped secure convictions in a series of high-profile cases, including those of Clark and Angela Cannings, who was also later freed. The collapse of the cases and criticisms of Sir Roy's evidence by the Court of Appeal led the Attorney General to order a review of 258 child-protection cases, the biggest in legal history. That outcome has been hailed as a victory by campaigners, and has provoked a bout of soul-searching among paediatricians. It has led many to conclude that the diagnosis of Munchausen's by proxy, the condition whereby parents induce symptoms in their children in order to gain medical attention for them, is now discredited and that doctors have been seeing child abuse where none in fact exists.

The paediatricians have, however, been heartened by the first stage of the review ordered by the attorney general. Of about 100 cases examined so far, where mothers had been convicted of murdering their children, only five were considered potential candidates for referring back to the Court of Appeal. Although even one wrongful conviction is unacceptable, the fact that 95 per cent of the convictions have been found to be safe does suggest that the notion that mothers sometimes harm their children is not one invented by evil doctors.

One victim of the harm that mothers can do is Julie Gregory. She describes in her book Sickened, published earlier this year, how, as a young girl growing up in north America, an outing with her mother usually meant an appointment with a specialist for another needless and unpleasant test. For her, the problem was not doctors seeing child abuse where it did not exist, but the opposite. They refused to listen to her pleas that there was nothing wrong with her, and she has suggested that the investigations being carried out amounted to assault.

Her life became one, long round of visits to doctors and hospitals, culminating in a week of invasive heart tests when she was 13, as her mother used her as a vehicle to gain the professional attention she craved. "They [the doctors] tried everything they could to find out what was wrong with me. My mum told them I had a mysterious heart condition and described all sorts of symptoms. But the truth is that my so-called illness was all in her head. She robbed me of my childhood."

Julie was lucky. She survived, left home at 17 and now, at the age 34, has told the tale of her bizarre upbringing, based on the 200 pages of her medical records that she has managed to collect. When she confronted the surgeon who conducted the heart catheterisation test on her, and told him she had been a victim of Munchausen's by proxy, he broke down in tears. "It was an important moment for me," Julie writes. "It was very emotional, but I felt vindicated."

Julie grew up in the 1970s, before Munchausen's by proxy was recognised. It was some years before it fully entered the public consciousness when it helped to secure the conviction of Beverly Allitt, the nurse-turned-serial killer, jailed for killing four children and harming nine others in 1993.

But, by the late 1990s, there was concern that the condition was being diagnosed too widely. In some cases in which mothers suffocated their children, they did not seem to be doing it to attract medical attention, but in order to exert control over their babies. These mothers were often disturbed and were frequently unaware of what they were doing, and were driven instead by a sense that their new baby was taking over and that they must get control of their life back.

Aside from these were the cases in which mothers fed their children salt or medicines to induce symptoms in them that would then lead to a round of medical investigations - the classic Munchausen's by proxy case.

In a report published in 2002, the Royal College of Paediatrics said that the term Munchausen's by proxy should be abandoned because it made unwarranted assumptions about the parent's mental state and motivation. Fabricated or Induced Illness (FII) is now the preferred term, because it makes no assumption about why the mother is doing it, but shifts the focus onto the child.

So how common is it? This is the most contentious question. Campaigners such as the Mothers Against Munchausen by proxy Allegations (MAMA) group, a militant collective of aggrieved parents and their supporters, say it is over-diagnosed. Professor Southall told The Independent in April that it was "grossly under-diagnosed and under-reported".

Writing in the British Medical Journal two weeks ago, Professor Alan Craft, president of the Royal College of Paediatrics and head of child health at the Royal Victoria Infirmary, Newcastle, and Professor David Hall, of the Northern General Hospital, Sheffield, cited a UK-wide survey on Munchausen's syndrome by proxy in 1992-94 that identified 128 cases in two years. That, they acknowledged, made it rare. But, they added, in support of Professor Southall's view: "A growing number of case reports suggest that many manifestations of Munchausen's syndrome by proxy are under-identified because of lack of professional expertise and public awareness."

Of those 128 cases, 32 involved suffocation. The most recent estimate, the authors say, is that one in 10 otherwise unexplained cot deaths may be caused by deliberate suffocation, amounting to about one a fortnight.

These are the cases that have sparked the recent controversy and lie at the centre of the court cases involving Clark and Cannings. Where two or three cot deaths occur in the same family there are only two possibilities, Professors Craft and Hall say - homicide or inherited conditions such as heart defects or metabolic disorders. Although these conditions probably account for a "small fraction" of cases, their existence and the possibility that other conditions may yet be discovered adds a dimension of uncertainty to any death, they say.

Any certainty in cases of child abuse is hard to come by and that makes them inappropriate for the criminal courts. Far better, as Professors Craft and Hall suggest, that they be dealt with in the civil courts, where experts can review the evidence in a non-adversarial meeting focused first of all on minimising risk to all the children in the family, and second of all on meeting the parents' needs, too.

As the professors themselves put it: "Although the reasons why parents kill their children are poorly understood, perhaps many deserve sympathy and treatment rather than imprisonment."
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http://news.independent.co.uk/uk/health_medical/story.jsp?story=528917
 
An amazing story - about the leghts MSbP parents can go to and about the imprtance of forgiveness (and I'm not sure I could forgive someone for inflicting 40 operations on me - it does make one wonder when the doctors might have suspected something was a bit wrong there).

Posted on Sat, Jun. 12, 2004


Teen wants contact with mom convicted of abusing her

Associated Press


FORT LAUDERDALE, Fla. - Two judges have agreed to let a teen have contact with her jailed mother, who was convicted of intentionally making her so ill that she was hospitalized hundreds of times and underwent numerous unnecessary operations.

Jennifer Bush, 17 and living in foster care in Illinois, wrote a letter to her mother, Kathy Bush, and told officials at the state Department of Children & Families that she wanted her mother to be allowed to write to her, according to court documents and testimony.

Kathy Bush, formerly of Coral Springs, is two years into her five year prison sentence on child abuse charges.

Prosecutors said she had Munchausen syndrome by proxy, a psychological disorder in which parents cause illnesses in a child to draw attention to themselves.

Jennifer was hospitalized 200 times and underwent about 40 operations before the state began investigating in 1996.

Bush has denied that she ever did anything to hurt her daughter.

Before the criminal investigation began, Jennifer's illnesses and mounting medical bills garnered national attention when the girl and her mother went to the White House in 1994 to help lobby for health insurance improvements.

Because Bush has been banned from having any contact with Jennifer since 1999, two Broward Circuit judges had to agree to the correspondence.

Friday's final "order finally recognizes that Jennifer Bush and Kathy Bush seek to have a normal mother-daughter relationship," said Robert Buschel, attorney for Kathy Bush.

The decision is a reversal from Jennifer Bush's feelings two years ago.

In a two-page letter read on her behalf in court at her mother's sentencing, Jennifer blamed her mother for harming her and for never admitting guilt. She also wrote she did not want to reunite with either of her parents.

A therapist will read any letters Bush writes to her daughter before they are delivered, said Broward prosecutor Dennis Nicewander.

Bush is scheduled for release in February 2006 when she will have served more than 3 1/2 years of her sentence.
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http://www.miami.com/mld/miamiherald/news/state/8909009.htm?1c
 
I sorry, I've got to this thread a bit late...

I notice that the 2 personal examples we have here describe 'greying out' or passing out when feeling emotional. I know I'm just being Devils Advocat here, but there's a sleeping disorder that makes people fall asleep when feeling stressed or emotional. I think there still may be thread on here somewhere, I do remember seeing a programme on TV about it. Some poor little girl who kept falling over everytime she got excited.
 
What you are referring to is an Elipleptic like condition known as Narcolepsy.

LD
 
The 'greying out' could also be some kind of dissociative thing also.
 
Clark doctor 'made quantum leap'

A doctor who accused a father of murdering his two sons after watching a TV documentary made a "quantum leap", a medical tribunal has heard.

Professor David Southall made the claims about Steve Clark, whose wife Sally was jailed for and then cleared of murdering their baby sons.

But Professor Dennis McDevitt, chairing a General Medical Council hearing, said there was no evidence for his theories.

The GMC is considering whether he should be struck off.


Sally Clark was convicted in 1999 of murdering her two sons Christopher and Harry.

But that conviction was quashed when new medical evidence showing the babies died of natural causes was accepted at a second appeal hearing in January, 2003.

You have had to concoct stories in your own mind to make Mr Clark pivotal
Prof Dennis McDevitt
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The GMC case centres around conclusions Prof Southall drew after seeing an interview with Mr Clark on Channel 4's Dispatches programme broadcast in April 2000.

In his interview, Mr Clark described how the couple's first baby Christopher had suffered a nosebleed just 10 days before he died in December 1996.

ProfessorSouthall told the GMC that he still believed that Mr Clark may have killed the children, and said he stood by his decision to contact the police regarding his theory.

He said his actions had been informed by his experience as a paediatrician.

But Professor McDevitt questioned research carried out by Professor Southall in 1997 into the relationship between children suffering nosebleeds and suffocation attempts.

'Sick joke'

He suggested the research was based on a very small study "without an adequate control".

Nobody disputed that Professor Southall should have told the authorities of his concerns that Mr Clark could be the killer, but "everything beyond that seems to be a quantum leap", he added.

"You have had to concoct stories in your own mind to make Mr Clark pivotal to everything after without, as far as I can understand, any evidence to support these theories at all."

In his closing speech, Richard Tyson, for the GMC, said: "Professor Southall has not really changed his views at all even with the benefit of hindsight nor has he apologised or expressed any regret over his high handed actions.

"It appears that he remains convinced he was right in just about everything he said in the course of this saga."

But Professor Southall told the hearing he was concerned that he had given the chairman of the committee the impression that the conclusions of his research applied to any baby.

He said: "It was only relevant to the babies in the project."

Kieran Coonan, for Professor Southall, said the paediatrician had been acting in an "anonymous state".

"He was simply acting as a concerned informant at that stage."

He said he was "perfectly entitled" to go to the police on that basis.

"Whether or not you lacked primary data at this stage, the greater your concern, the stronger your belief is held, the greater the duty to do something about it."

Mr Clark, who lodged a complaint against the professor, told the GMC hearing last week that he had thought the allegations against him were a "sick joke".

Professor Southall, based at North Staffordshire Hospital in Stoke, is one of Britain's leading experts on Munchausen's Syndrome By Proxy, a condition which apparently drives parents to harm their own children in order to win attention.

The case was adjourned until Tuesday.

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/3805719.stm

Published: 2004/06/14 13:43:38 GMT

© BBC MMIV
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and the verdict:

GMC rules against paediatrician

The doctor who accused Sally Clark's husband of murdering their two sons abused his professional position, the General Medical Council has ruled.

Professor David Southall accused Steve Clark of the murders on the basis of a TV documentary. Mrs Clark was jailed and later cleared of killing the boys.

A GMC panel ruled that Professor Southall's actions were "inappropriate", "irresponsible" and "misleading".

It will decide in August whether he should be struck off.

Sally Clark was convicted in 1999 of murdering her two sons Christopher and Harry.

But that conviction was quashed when new medical evidence showing the babies died of natural causes was accepted at a second appeal hearing in January 2003.

TV documentary

The GMC hearing centred around conclusions Professor Southall drew after seeing an interview with Mr Clark on Channel 4's Dispatches programme broadcast in April 2000.

In his interview, Mr Clark described how the couple's first baby Christopher had suffered a nosebleed just 10 days before he died in December 1996.

Professor Southall told police he believed Mr Clark had killed the children after watching the interview.

He later outlined his concerns in a report. It was submitted to the family court, which was considering who should take care of the Clark's third child.

Professor Southall drew up his report even though he had no access to case papers, medical records or post mortem results.
He did not interview Steve or Sally Clark before submitting the report.

The GMC panel's criticisms centred around Professor Southall's decision to write a report on the family.

The paediatrician had defended his actions during the seven-day hearing and denied serious professional misconduct. He also said that he still believed Mr Clark may have killed his two sons.

Mr Clark, who lodged the complaint against the professor, told the GMC hearing last week that he had thought the allegations against him were a "sick joke".

The chairman of the GMC panel had criticised Professor Southall at the hearing on Tuesday.

Professor Dennis McDevitt said Professor Southall should have told the authorities of his concerns that Mr Clark could have killed his sons.

But he said "everything beyond that seems to be a quantum leap".

Mike Mackay, the Clark family solicitor, said Steve would be happy with the GMC ruling.

"He will be very pleased that at last this part of the proceedings has been concluded after four years," he told the BBC.

Professor Southall, based at North Staffordshire Hospital in Stoke, is one of Britain's leading experts on Munchausen's Syndrome By Proxy, a condition which apparently drives parents to harm their own children in order to win attention.


Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/3808515.stm

Published: 2004/06/15 16:13:05 GMT

© BBC MMIV
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I've just finished reading Sickened by Julie Gregory. Her mother suffered from Munchaussen by Proxy (although it just sounds like good old fashioned child abuse to me). Julie Gregory was subjected to heart cauterisation (!). The doctors and nursing staff she saw did not recognise she was suffering from starvation, and thought her eating habits were due to allergies, and her heart beat racing as she stood due to some heart problem they had yet to trace.

Quite an horrific story.
 
I very nearly bought that book about three weeks ago but wasn't sure if i'd be able to read it without getting angry or having nightmares about it. Might give it a go....
 
I read it pretty quickly. I'm sorry to say that, towards the end, I skimmed it rather. She was getting a bit (dare I say) boring. And if I read one more comment about her 'coltish legs' I was about ready to scream. The therapy bits were the worst. When she's lying in some hammock thing (I wasn't paying much attention at that point) visualising a child and screaming stuff. I have a low attention span for that kind of thing, unless it's from the other side of it. I have a distrust of therapy, well the visualisation stuff. Smacks too much of recovered memories.

Well, that makes me sound like an unsympathetic cow! :D
 
"and i feel i need to thank the people on here for being a stepping stone, from telling nobody, to talking to you all on here, to making the first step to a new understanding of my condition"

Hey Nik, I want to thank you, for now I feel I can talk about my problem. This will probably be good for me to share because as of now the only person who knows about it is my boyfriend and I have told him that I stopped(I thought I had, but I was wrong. Not intentionally lying). Anyway, I don't want to get into the details, but I think it is some kind of self destructive behaviour -sorry its a little off topic. Anyway, its nothing that could kill me, but it leaves marks on me that take a while to disappear. I don't know why I do it. I don't want to because I don't want to put marks on myself, but it feels good and it is fun and when I am really upset it makes me feel a little better. I am trying to stop and have actually made significant improvement, but I thought it would be good to talk about it with someone other than my boyfriend, so, thanks for reading.
 
I used to do that Rainy, if I read your description correctly. It's much more common than you might think. There's probably quite a few of us on here who've done it, or are still doing it.
To state the obvious here, but you need to deal with the emotion that causes it. PM me if you like.
 
Yeah, the annoying thing is that I don't know what emotion it is that actually causes it. It is often worse when I am upset, but it does happen when I am feeling just fine sometimes. Anyway, I think I'm doing ok, but thanks!:)
 
I must agree with beak that it's probably more common than you think because I have done this and a year or so ago did regularly.
 
hey rainy, nobody is going to judge you here, so if you do want to talk at length about your problem then come and do it here. believe me just sitting down and typing the words that you feel helps no end ( i know ).
And you never know you may just get more help than you would expect.
whatever happens dont let life grind you down.

take care nik x
 
Health workers ignored boy poisoned by mother

(Filed: 13/07/2004)


Health workers have been criticised by a report into the death of a seven-year-old boy who was poisoned by his mother.


Michelle Dickinson, 32, of Seascale, Cumbria, had the mental condition Munchausen's Syndrome By Proxy, now called Fabricated or Induced Illness, in which sufferers harm others to gain attention.

She tricked doctors into prescribing her son, Michael, anti-epilepsy drugs over a four-year period. He died in October 2000 after being reduced to a physical wreck who had to be fed through a tube.

Dickinson had her conviction for attempted murder quashed last month but is still serving a 16-year sentence for child cruelty.

A Serious Case Review into Michael's death by Cumbria's Child Protection Committee found that health workers had failed on numerous occasions to raise concerns about Michael's health.

Doctors, social workers and other professionals failed to communicate properly or address concerns repeatedly raised by Michael's paternal grandmother.

Dr Bob Postlethwaite, chair of the review group, said that despite the failures, Dickinson's abuse of Michael would still probably have happened.

"Only one person was cruel to Michael - his mother," he said. "His form of abuse is complex and challenges professional norms.

"Agency responses could have been different, but even then the abuse to Michael probably would have still occurred."
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http://www.telegraph.co.uk/news/mai...ml&sSheet=/portal/2004/07/13/ixportaltop.html
 
I saw a movie a few days ago about a mother who had this. Her son was hospitalized and they did not know what was wrong with him. It was then discovered that the mother was putting saliva and feces into his iv. (shudder)
 
Woman accused in 1982 baby death

A woman has appeared in court charged with the murder of a baby in Edinburgh nearly 22 years ago.

Jennifer Liehne, 40, is accused of both the attempted murder and murder by suffocation of seven-month-old Jacqueline Smith on 20 December, 1982.

The case may take a year to come to trial and the defence may involve Munchausen's Syndrome by Proxy.

This is a medical condition in which sufferers cause or fabricate illnesses in their children.

Ms Liehne, of Clermiston Place, in Edinburgh, is charged with murdering Jacqueline Smith at an address in the city's Hyvot Avenue by assaulting her by obstructing her upper airways by means unknown, by restricting her breathing and by suffocating her.

She is also alleged to have attempted to murder her between 14 October and the day of her death in 1982 at houses in Edinburgh.

If it raises this syndrome, to which much publicity has been given recently, as to its validity, it is a very complicated matter indeed
Lord Johnston
Click to expand...

She is further charged with assaulting another girl over a period between 1986 and 1996.
It is alleged she caused her to suffer from illness and rendered her subject to unnecessary medical intervention.

Having been prescribed an anti-depressant she administered it to her and pretended to doctors and medical staff that the child suffered illness from natural causes and suffered from fits and convulsions, had stopped breathing and had bleeding, it is alleged.

The charge states that doctors and medical staff were caused to examine the child and admit her to hospital and she was "falsely diagnosed with epilepsy and subjected to repeated unnecessary hospitalisation, to unnecessary invasive examinations, to the prescription and administration of various medications".

Alternative wording

The charge involving the second child was also brought in an alternative form against Liehne alleging culpable and reckless conduct by her.

At a preliminary hearing it was suggested Munchausen's Syndrome by Proxy (MSbP), where sufferers induce or fabricate illnesses in their children, may form part of Ms Liehne's defence.

Lord Johnston said if the case raised the attention-seeking syndrome then it would be very complicated.

He said: "If it raises this syndrome, to which much publicity has been given recently, as to its validity, it is a very complicated matter indeed."

The case was brought to the court on Friday for a hearing to check on the state of preparation for going to trial.

'Medical interpretations'

Defence counsel William Taylor QC said among the witnesses expected to be called at trial were "a number of very senior medical people".

He said: "The trial will essentially be a competition between different medical interpretations.

"There is no prospect this case will be ready for trial, in the opinion of those instructing me and indeed counsel instructed for the trial, for a period of a year from now."

Advocate depute Alan Mackay said he was advised by those preparing the case that it was "not an unreasonable estimate".

The Crown agreed to desert the indictment meantime, in a way that allows it to raise charges at a later date.


Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/uk_news/scotland/3920739.stm

Published: 2004/07/23 13:54:00 GMT

© BBC MMIV
Click to expand...
 
Sat 24 Jul 2004

Woman in the dock accused of baby death

DAVE FINLAY


A WOMAN has appeared in court charged with murdering a baby in an Edinburgh flat nearly 22 years ago.

Jennifer Liehne, 40, was alleged to have suffocated the seven-month-old child at a house in the Capital on December 20 in 1982.

She was also accused of attempting to murder the baby, Jacqueline Smith, and assaulting another child who was allegedly subjected to "repeated unnecessary hospitalisation".

A judge at the High Court in Edinburgh heard that it was an exceptionally complicated case that may take a year before it is ready to go to trial.

The Crown agreed to desert the indictment meantime, in a way that allows them to raise charges at a later date.

Defence counsel William Taylor QC told Lord Johnston at a preliminary hearing: "It might well be the words Munchausen’s by proxy will appear in my Lord’s mind, if that condition, in the present state of medical knowledge, exists at all."

The judge said: "If it raises this syndrome, to which much publicity has been given recently as to its validity, it is a very complicated matter indeed."

The case was brought to court for a hearing to check on the state of preparation for going to trial, which was scheduled for next month. It was originally called on Thursday but was continued until yesterday.

Mr Taylor said that among the witnesses expected to be called at a trial were "a number of very senior medical people". He said the defence would require the services of experts from around the UK in different disciplines to examine expert conclusions.

"The trial will essentially be a competition between different medical interpretations, " he said. "There is no prospect this case will be ready for trial, in the opinion of those instructing me and indeed counsel instructed for the trial for a period of a year from now."

Advocate depute Alan Mackay said he was advised by those preparing the case that that was "not an unreasonable estimate".

He said that in the circumstances he would move to desert the case for the time being.

Liehne, of Clermiston Place, Edinburgh, was charged with murdering Jacqueline Smith five days before Christmas in 1982 at an address in Hyvot Avenue, Edinburgh, by obstructing her upper airways, by restricting her breathing and by suffocating her.

She was also alleged to have attempted to murder her between October 14 and December 20 in 1982 at houses in Edinburgh.

She was further charged with assaulting another girl over a period between 1986 and 1996.

It was alleged that she caused her to suffer from illness and rendered her subject to unnecessary medical intervention.

It was alleged that having been prescribed an anti-depressant she administered it to her and pretended to doctors and medical staff that the child suffered illness from natural causes and suffered from fits and convulsions, and had stopped breathing.

The charge stated that doctors and medical staff were caused to admit the child to hospital where she was "falsely diagnosed with epilepsy and subjected to repeated unnecessary hospitalisation, to unnecessary invasive examination and to the administration of various medications".
Click to expand...

http://news.scotsman.com/edinburgh.cfm?id=848112004
 
Doesn't sound like Munchausen by Proxy; just good old fashioned child abuse. :(
 
Murder claim doctor guilty of misconduct

Friday August 6, 2004

A consultant paediatrician was today barred from any child protection work for three years after being found guilty of serious professional misconduct for accusing a father of murdering his two baby sons on the basis of a television documentary.
The General Medical Council (GMC) decided to limit the medical work Professor David Southall, an expert on Munchhausen's syndrome by proxy with more than 30 years' experience, can do following a two-day disciplinary hearing in Manchester. But the GMC stopped short of actually striking him off as some reports had suggested it would.

The GMC tribunal chairman, Denis McDevitt, told Prof Southall that he must not engage in any aspect of child protection work either in or outside the NHS for three years.

Prof Southal, 56, accused Stephen Clark, 42, of deliberately suffocating his infant sons after watching a Channel 4 Dispatches programme in April 2000 in which he talked about his wife Sally's 1999 conviction for the murders of the two boys. Mrs Clark's murder convictions were quashed on appeal last year.

Mr McDevitt, chairman of the GMC professional conduct committee, told Prof Southall: "Taking into account the facts found proved against you including inappropriate and irresponsible behaviour and an abuse of your professional position, the committee consider your conduct amounts to a serious departure from the standards expected from a registered medical practitioner."

Mr McDevitt the paediatrician failed to take reasonable steps to verify his allegations when he produced a report on the Clark family in August 2000. Prof Southall claimed it was "beyond reasonable doubt" that Mr Clark had suffocated his first son, Christopher, in a hotel room.

"Your failure to adhere to these principles resulted in substantial stress to Mr Clark and his family at a time when they were most vulnerable and could have resulted in a child being taken back into care unnecessarily, and Mr Clark prosecuted as a result of your false allegation.

"The committee are concerned that at no time during these proceedings have you seen fit to withdraw these allegations or to offer any apology. In the circumstances, the committee have concluded that in your own and the public interest it must take action regarding your registration."

Mr Clark said he hoped that the GMC's verdict would stop Prof Southall and other doctors from making "reckless allegations of child abuse against innocent parents".

He said: "I hope that the committee's finding of serious professional misconduct against Professor Southall, and the imposition of conditions preventing him from working in the child protection field for three years, will send a strong message to him - and to any other, like-minded doctors - that irresponsible and reckless allegations of child abuse against innocent parents are simply not acceptable and will no longer be tolerated.

"I am also, of course, relieved that at last my complaints have been upheld and I have been fully exonerated from any blame."

In June, the GMC decided Prof Southall acted in a way that was "inappropriate", "irresponsible" and "misleading" when he produced the report on the Clark family based on a theory about the case that he presented as fact underpinned by his own research.

But the council then decided that it was not an abuse of his professional position to contact child protection officers, voice his concerns to police or make the allegations at a time when he was suspended from his job at the North Staffordshire hospital NHS trust.

Prof Southall previously admitted to the GMC that at the time he produced his report he had not interviewed either Steve or Sally Clark. The paediatrician said he had declined another doctor's request to place a caveat in his report to child protection staff explaining that it was based upon limited information.

The doctor has always denied serious professional misconduct. He will face the GMC's professional conduct committee again in January on seven other sets of complaints.

Prof Southall has previously attracted controversy for using hidden cameras to film parents suspected of abusing their children.
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Guardian Unlimited
 
I am currently reading an article in the new (9 & 16 August) New Yorker magazine. It's not on-line anywhere, as far as I can tell, but might be worth hunting down in the library or newsstand if one has a particular interest in the subject. Here's the preview from the magazine's website: http://www.newyorker.com


"In recent years," Margaret Talbot writes, in "The Bad Mother," "Munchausen syndrome by proxy"—M.S.B.P., a bizarre psychological disorder in which mothers sicken their children, or subject them to unnecessary medical interventions, like surgery—"has seeped into popular culture, with a rapidity and a fervency that recall the fascination with child sexual abuse in the nineteen-eighties....Just as," Talbot continues, "in the nineteen-eigthies, satanic ritual abuse represented the worst fears of what could happen in day care, so M.S.B.P. has come to represent the danger posed by mothers who are excessively involved with their children." Talbot reports on the history of Munchausen syndrome by proxy, and focusses on its most recent trend: false allegations. Talbot examines in detail the case of a Canadian woman named Nicola de Sousa, whom officials began investigating in 2002 as a possible M.S.B.P. perpetrator. De Sousa had been seeking surgery for her daughter Katerina, who was born with serious spine and liver defects. Talbot writes, "Over the years, psychologists have steadily loosened the narrow definition of an arcane syndrome—a phenomenon known as 'definitional creep.' In an effort to prevent Munchausen abuse by drawing up a standard portrait of the perpetrator, they fashioned a profile that was broad enough to cast suspicion on many mothers whose children were genuinely ill." De Sousa certainly seemed to fall into this category. Shortly after their daughter was born, she and her husband were told that she might die. They ended up seeking an experimental treatment in Boston, which the doctor who administered it said saved Katerina's life. Talbot writes, "The de Sousas, for their part, began to think of the American medical system as more responsive than the Canadian system. Some of the de Sousas' Canadian doctors, however, thought they were seeking care in the States unnecessarily and habitually—almost addictively." The de Sousas later sought a neurosurgical operation, also in the States, to correct Chiari syndrome, a brain abnormality that their Canadian doctor did not believe Katerina exhibited. Two prominent surgeons, one in Brooklyn and the other in Chicago, both concluded that she did suffer from the syndrome, and in fact the child's symptoms cleared up soon after she underwent the recommended surgery. It seemed to be Mrs. de Sousa's personality as much as her therapeutic quest that prompted health-care workers' suspicions of Munchausen by proxy. Her daughter's pediatrician wrote that the mother seemed "driven" and "anxious." Similar subjective remarks appear in other medical files. Talbot points out that "it is no accident that the rise of the Munchausen by proxy diagnosis has run parallel with the rise of aggressive behavior in medical patients....These patients, caught up in their conceptions of themselves as 'empowered advocates,' can come into conflict with doctors and caseworkers." The Canadian M.S.B.P. inquiry went on for more than a year, and the de Sousas racked up fifteen thousand dollars in legal fees; they finally received a curt letter telling them that "the Children's Aid Society of Ottawa will be closing its file....I trust the above is satisfactory." "Though the accusations against Nicola have been shelved," Talbot writes, "she is still shaken, and bewildered. She said, 'I asked them, "How could you say we put our daughter under the knife for surgeries that are unnecessary? How could you be threatening to take our child away?" We went to the ends of the earth to help her. I just hope they'd do the same if it were their child.'"
 
lopaka: Well spotted.

Another MSbP case - very much like the first one in this thread:

Mother Faces Probation For Making Her Son Sick


Reported by: 9News
Web produced by: Neil Relyea
Photographed by: 9News
8/17/04 6:18:17 PM

A Tri-state mother will likely face five years probation for the intentionally making her son sick.

Barbara Craft's four-year old son was being treated at Cincinnati's Childrens Hospital Medical Center (CHMC), but doctors say the boy was not sick until Craft put human waste into his medicine line.

Her son nearly died from a cardiac arrest.

Craft has pled guilty to a reduced charge of attempted child endangering.

Craft's attorney says his client suffers a rare condition known as "Munchausen Syndrome by Proxy," where parents fake illness in a child or report false symptoms to gain attention or sympathy for themselves.

Craft, who no longer has custody of her son, is expected to be sentenced to probation next month.
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http://www.wcpo.com/news/2004/local/08/17/craft.html
 
I have a question. All the descriptions of this seem to say that the mother does this to the child. Does the father ever do it?
 
RainyOcean: That is one of the important issues - it is being portrayed (by the anti-MSbP camp) as being a kind of assault on motherhood but I'd suspect it has more to do with opportunity and/or the fact that men may just abuse their children in different ways.
 
PROF SOUTHALL ACCEPTS MISCONDUCT VERDICT


DAVE BLACKHURST

11:35 - 02 September 2004

North Staffordshire paediatrician David Southall will not fight a verdict of serious professional misconduct handed to him last month by the General Medical Council. Days before the deadline passes for an appeal to be lodged against the GMC finding, it emerged that Professor Southall is not to contest the judgment by the disciplinary body.

The 56-year-old specialist at the University Hospital of North Staffordshire will also accept the ban on all child protection work for three years.

The GMC's professional conduct committee allowed Prof Southall to continue as a doctor despite being asked to strike him off by those representing lawyer Steve Clark, whose complaint brought the case.

The 28 days allowed to lodge an appeal expire on Monday, but today a source close to Prof Southall said: "He is not to make an appeal against the ruling."

Prof Southall, who will be back before the GMC in January to face another seven professional misconduct charges, would not comment.

He is currently treating sick children in his clinics and conducting ward rounds.

But, as part of the conditions imposed on him, he must pass the case on to the duty child protection doctor if he suspects a patient has a non-accidental injury.

Mr Clark complained to the GMC after Prof Southall told police the father had killed his two babies on the strength of watching a television documentary. The doctor said he feared for the safety of his third child who was still with Mr Clark.

Social services held a case conference for which Prof Southall wrote a report despite not seeing any medical or other records about the deaths. It decided Mr Clark was a fit father.

Mr Clark's wife, Sally, had been jailed for the two murders but was later freed on appeal. During the hearing, the doctor repeated his allegations that Mr Clark was the real killer and after the verdict was delivered, he refused invitations to apologise to the father.

Instead, he said that while relieved with the ruling, he hoped it would not deter other paediatricians from speaking out when they suspected child abuse.

Mr Clark's barrister told the GMC panel that Prof Southall was a danger to the public, but the members also heard more than 80 testimonials from international experts about his cutting edge, dedicated and compassionate work with children.

One said it would be a catastrophe for the profession if he was struck off.

Even the hospital's medical director, Dr Pat Chipping, pleaded with the panel for his job - although she admitted being astonished and disappointed he had got involved in the Clark case without telling her first.

The GMC concluded that his actions had been irresponsible and had abused his professional position although he had an otherwise unblemished record.

The cases scheduled for January involve claims that he misdiagnosed child abuse in families. Some centre on his diagnosis of the disputed condition, Munchausen Syndrome by Proxy, which is said to drive parents to harm their children to draw attention to themselves.
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http://www.thesentinel.co.uk/displayNode.jsp?command=newPage&nodeId=158314&contentPK=10877889
 
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