Wednesday, September 13, 2023

Münchausen by proxy infanticide

I’ve mentioned David Southall three times previously (see firstsecond and third posts). He was a professor of paediatrics and a child protection specialist with a worldwide reputation. He spent 14 years under investigation (including being struck off and reinstated) by the General Medical Council.

As a specialist at the Royal Brompton in babies’ breathing problems, he set up a system with the cooperation of police and social services of covert video suveillance, which showed that some parents were suffocating their children. He became a leading expert on Münchausen syndrome by proxy, first named by Sir Roy Meadow in 1977. Meadow too was struck off by the GMC, but appeal to the Court of Appeal was found in his favour by a majority. What got him into trouble was his so-called law that “one sudden infant death is a tragedy, two is suspicious and three is murder, until proved otherwise“. This was because Sally Clark’s conviction for the murder of her two baby sons, primarily on the basis of Meadow’s law, was overturned by the Court of Appeal (see BBC news report).. 

People do kill defenceless infants. This even includes health care staff, such as Beverley Allitt (see Wikipedia entry) and Lucy Letby. I doubt the Lucy Letby statutory inquiry, which will include looking at the Trust’s response to the consultants who expressed their suspicions of infanticide (see SOS statement), will take us forward much in the understanding of Munchausen by proxy infanticide, about which the consultants will have had some knowledge. However, the inquiry should improve working relationships between managers and consultants in the NHS. The primary problem is that, because of increased accountability over recent years, managers have usurped clinical responsibility. Instead they need to be held to account for creating the right environment in which clinicians can exert that clinical responsibility. Clinicians shouldn’t necessarily be accused of bullying, or some other disciplinary offence, because they express dissent (see eg. my BMJ letter). Managers must not misuse their disciplinary power (see previous post). If they hadn’t in the Letby case, her serial killing might have been detected earlier.

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