David Southall

Professor David Southall OBE is a British paediatrician who is an expert in international maternal and child hospital healthcare and in child protection including the diagnosis of the controversial Fabricated or Induced Illness (FII, also known as "Munchausen syndrome by proxy"),^[1] and who has performed significant research into sudden infant death syndrome.^[2]

Early career

Prior to becoming a paediatrician, Southall spent four years in general adult medicine, one year in obstetrics and two years as a general practitioner.^[3]

International humanitarian work

In 1993, during the Bosnian War, Professor Southall was invited by the Overseas Development Administration of the British Government (now DFID) to visit Sarajevo to identify and evacuate children in need of urgent medical treatment which could not be provided locally because of armed conflict. ^[3] After this mission he was asked by UNICEF to become a consultant and lead a programme from 1993-1995 to help children in Mostar and in camps for internally displaced families in other areas of Bosnia.^[4] Prompted by his experiences in Bosnia of what he described as "trauma inflicted on children and their families, not only by warring factions, but also by the indolence of the international community", Professor Southall established Child Advocacy International (CAI) on his return to the UK, to advocate for international child health issues.^[3] Since 2009, and in order to reflect the close involvement of CAI with the emergency care of pregnant women and adolescent girls, the charity was re- named Maternal and Childhealth Advocacy International (MCAI ). Link label

Some of the main advocacy undertaken involved campaigns against the arms trade, ^[5] healthcare in refugee camps ^[6] and the development of the Maternal and Child Friendly Healthcare Initiatives (see below) One particular success with advocacy involved the New Jalozai Afghan refugee camp where the Pakistan Government were encouraged by CAI to move the 70,000 refugees living in appalling circumstances into a more suitable camp. The United Nations High Commission for Refugees (UNHCR) wrote a letter to Professor Southall thanking CAI for this achievement.^[7]

From 1999 to 2004 Professor Southall was Chairman of a working party developing the Child Friendly Healthcare Initiative (CFHI).^[8] In addition to CAI, UNICEF UK, The Royal College of Paediatrics and Child Health and the Royal College of Nursing were parties to this work.

Since 2002,and following on to CAI’s work in Afghanistan and Pakistan, and in collaboration with a British Medical Education charity a program called “Strengthening Emergency Healthcare” involving Emergency Maternal, Neonatal and Child Healthcare (EMNCH) was established. The program was originally started in the Afghan refugee camps in Pakistan and has subsequently been developed in Pakistan with assistance from the local offices of the World Health Organization (WHO) and UNICEF.^[9] In 2006, it was successfully introduced into The Gambia following a recommendation from WHO Geneva.^[10] In November 2012 a similar programme was started in Liberia with financial support from THET and UKAID. ^[11]

Additional programs of CAI and subsequently of MCAI involved apprenticeship based training in hospital care of pregnant women, newborn infants and children in Kosovo, Sri Lanka, Afghanistan, Uganda, The Gambia and Liberia.^[12] Throughout the last 20 years of this work, Professor Southall has been the Honorary Medical Director of CAI/MCAI and the lead in all of the above work.

Research work

Between 1986 and 1994, Southall led a pilot research project into FII involving video surveillance of young hospital patients in an effort to observe their carers (such as parents or guardians) harming them.^[2] The project, which was conducted at the Royal Brompton Hospital in London, and the North Staffordshire Royal Infirmary in Stoke-on-Trent, observed carers using methods such as suffocation and poisoning to harm the children.^[2] As a result of the project, thirty-three parents or stepparents who had harmed their children were prosecuted, and twenty-three were diagnosed with FII.^[2]

The project attracted controversy for its methods and for the ethical implications of the research. Critics argued that the desire of the researchers to observe the carers harming the children exposed the children to further abuse, that the betrayal of doctor-patient trust necessarily involved in the surveillance could cause harm to the subjects, and that "a diagnosis should lead to treatment, not punishment".^[13] However, the researchers argued that the surveillance saved the lives of many of the children involved, and Southall himself said that "By doing covert video surveillance we are betraying the trust of parents... but if a parent has been abusing his or her child in this way then the trust between child and parent has already gone."^[13]

In the early 1990s, Southall led a study which pioneered continuous negative extrathoracic pressure therapy, a treatment for breathing difficulties in young children involving the application of negative pressure to the patients' chests.^[14] The study was controversial, with some parents of the children involved suggesting that the treatment was linked to subsequent death or brain injury.^[14] The research was the subject of investigations by the hospital involved and inquiries from police. An independent follow-up study concluded in 2006 that there was "no evidence of disadvantage, in terms of long-term disability or psychological outcomes" from the use of the technique.^[14]

General Medical Council sanctions

In 2004, Southall was found guilty of serious professional misconduct by the General Medical Council (GMC), after alleging to police that the husband of Sally Clark was responsible for murdering the couple's children.^[15] Southall made the claim to child protection officers of the Staffordshire police after watching a television documentary about the case.^[1] The GMC banned Southall from child protection work for three years; the Council for Healthcare Regulatory Excellence challenged the decision as insufficient and argued that he should be erased from the GMC register, but a High Court of Justice decision in 2005 held that the sanction was not unduly lenient.^[16]

In February 2007, Attorney-General Lord Goldsmith announced that a review would be held into a number of criminal cases in which Southall gave evidence for the prosecution, following allegations that Southall kept up to 4,450 personal case files on child patients which were kept separate from the official hospital records.^[17]

On 4 December 2007, Southall was struck off the medical register after being found guilty of professional misconduct by the General Medical Council.^[18] Southall appealed this decision in the High Court, but the appeal was dismissed.^[19] In his judgement, Mr Justice Blake stated that Southall "had speculated on non-medical matters in an offensive manner entirely inconsistent with the status of an independent expert."

On 1 June 2009 Dr Southall was the subject of an episode of the BBC's current affairs program Panorama, title 'A Very Dangerous Doctor'.^[20] The interest group 'Professionals Against Child Abuse' commented in the medical journal The Lancet that the "GMC should never have brought this case" (against Southall) ^[21] and has criticized disciplinary proceedings brought against doctors.^[22]

On 4 May 2010 Dr Southall is back on the medical register after winning an appeal over a long-running dispute with the General Medical Council. The Appeal Court's decision means he is able to practise medicine again.^{[23] [24]}

In February 2012 the GMC dropped its last remaining case against him. Southall regards this as a "victory over an orchestrated and dangerous campaign which has waged war over 16 years against my work in trying to protect children from life threatening abuse". He plans to sue the GMC for breaching his right to a fair trial within a reasonable time.^[25]

References

Bibliography

• Leila Schneps and Coralie Colmez, Math on trial. How numbers get used and abused in the courtroom, Basic Books, 2013. ISBN 978-0-465-03292-1. (First chapter: "Math error number 1: multiplying non-independent probabilities. The case of Sally Clark: motherhood under attack").