The Times
By Andrew Norfolk November 21,
2002
Doctor in abuse case
allegations suspended A LEADING consultant paediatrician
has been suspended from clinical practice and is to be investigated
by the General Medical Council over her role in a child abuse
scandal. Camille San Lazaro has had to leave her posts at
Newcastle University and the city’s Royal Victoria Infirmary pending
an inquiry into her involvement in false allegations of abuse at a
local nursery school.
'P4p have learnt that
another Expert Witness Mrs Camille San Lazaro OBE will be in front of the
GMC
[General Medical Council]
at Manchester on April 26th 2005'
Her suspension comes after a High Court hearing
this year at which two former nursery workers, Christopher Lillie
and Dawn Reed, were each awarded £200,000 in libel damages after
they were wrongly branded as paedophiles in a report commissioned by
Newcastle City Council that drew heavily on Dr San Lazaro’s
opinions.
She examined 53 children at the council-run
Shieldfield Nursery and concluded that several showed signs of
sexual or other abuse. During the High Court case, however, she
admitted that there were inaccuracies in her report and that she had
given exaggerated accounts to the Criminal Injuries Compensation
Board after acting as an “advocate” to help parents with claims. Dr
San Lazaro, a paediatrician for more than 30 years, was appointed
OBE in 1999 for services in the care of sexually abused
children.
Abuse cases doc face probe
IC
Newcastle Jan 26 2004 By Rob
Kennedy, The Evening Chronicle
Dozens of child abuse
cases could be re-opened because of the evidence of a controversial
expert. Calls were today made for a review after a North East man
had his conviction for raping a boy overturned because of the
evidence of Dr Camille San Lazaro.
Dr Lazaro was criticised
in 2002 for her role in the investigation into false claims of abuse
at a Newcastle nursery by Dawn Reed and Christopher
Lillie.
Now her evidence has been blamed for Kevin Brown's
conviction. He has served his seven-year sentence for raping the
five-year-old boy.
Today it was claimed dozens of other
convictions could be overturned after the Appeal Court referred back
to the 2002 libel proceedings in which Dr Lazaro's evidence was
branded "completely discredited".
Dr Lazaro, a senior
lecturer and consultant paediatrician at Newcastle Royal Victoria
Infirmary and Newcastle University, is facing a probe by the General
Medical Council in March.
Tom Watkins, of justice campaigners
the Portia Campaign, said: "Every case she has been involved in
should be looked at again. There must be a review here. I think
cases where an expert's opinion has got someone convicted need to be
reviewed. It's unsafe unless something else proves they are guilty.
Without corroborating evidence of another kind that makes it certain
that they committed the offence, it is extremely
dangerous."
Brown, 38, of Medwyn Close, Bournmoor,
Chester-le-Street, had already served the sentence after his
conviction in 1996. Dr Lazaro's evidence had been central to the
prosecution. Lord Justice Kennedy told the court that in the 2002
libel trial, the doctor had been "completely discredited" in
relation to her handling of a number of allegations of sexual abuse
prior to February, 1995. The judge ruled the conviction of Brown was
unsafe in the light of fresh medical evidence. Brown had denied
raping the boy.
Brown's first appeal was dismissed in 1997
but his case was referred back to the Appeal Court by the Criminal
Cases Review Commission which investigates claims of miscarriages of
justice. The CCRC obtained three medical reports, including one from
a doctor at the forefront of the 1987 Cleveland Child Sex Abuse
Inquiry, that suggested injuries to the boy may not have been caused
by a sexual act. Ruling the conviction unsafe, Lord Justice Kennedy
said medical evidence at the trial had been oversimplified to the
detriment of the defence. He added that a large part of the
prosecution case at trial had been reliant on evidence from Dr San
Lazaro.
Lord Justice Kennedy concluded of the boy's injuries:
"It now has to be recognised that what was found is capable of a
number of explanations. If the jury had the advantage of hearing the
additional medical evidence that we have heard, it seems to us that
they would have been bound to have had serious doubts about the
extent to which they could rely on the medical evidence to assist
them to reach a conclusion.
Were it not for the fact that the
trial took place seven and-a-half years ago and Mr Brown has served
his sentence we would have ordered a re-trial because the
prosecution can still present a strong prima facie case. But,
because that sentence has already been served, we order that the
appeal be allowed and the conviction quashed."
Today the
Crown Prosecution Service and the Criminal Cases Review Commission
said it would be up to other individuals convicted of similar
offences to seek an appeal based on the evidence of Dr
Lazaro.
Boris Worrall, of the CCRC, said: "The commission has
not yet studied the judgment in detail, and although it is obviously
open to interpretation, the circumstances of every case would have
to be looked at individually. "
A CPS spokeswoman said:
"There are no mechanisms to check which witnesses have given
evidence and it would be down to the defence to come forward. After
the High Court criticised this doctor we looked at all live cases to
see if there was any impact but there wasn't."
A spokeswoman
for Newcastle Hospitals NHS Trust, which employs Dr Lazaro, said:
"Arising out of the criticisms directed at Dr Lazaro, primarily in
relation to the Newcastle libel case judgement, the clinical
practice of Dr Lazaro has been extensively reviewed by four
experienced assessors from the Royal College of Paediatrics and
Child Health.
They recommended Dr Lazaro should return to
work although not in the field of child abuse and pending the
outcome of a General Medical Council hearing. The trust and the
University of Newcastle accepted the recommendation."
A
Durham Police spokesman said: "A thorough investigation was carried
out into what was a particularly nasty offence. The facts were
presented to a jury who convicted the defendant. "While noting the
action of the Court of Appeal we feel there is nothing further we
can add except to say we have no plans to look into the
case."
The Chronicle reported in 2002 how two top sex abuse
experts' reputations were in tatters after they were damned by a
libel trial judge.Dr Lazaro was blasted by a judge who
awarded nurses Christopher Lillie and Dawn Reed £200,000 in libel
damages.
The pair were accused in a Newcastle City Council
report of systematic sex abuse of dozens of children at a Newcastle
nursery. But Mr Justice Eady declared them innocent of all charges
and condemned the report as a legal `shambles.'
Dr Richard
Barker, head of the review team which wrote the report Abuse in
Early Years, was slammed for being unprofessional. The judge said
his four-strong inquiry team had fallen under the spell of Dr
Lazaro.
Dr Lazaro had examined more than 50 children who had
alleged abuse at the hands of the two nurses. She decided some of
them showed signs of sexual or other abuse and her findings were
used in the report which wrongly found Mr Lillie and Ms Reed guilty
of abuse.
During cross examination
during the libel trial, she admitted that her reports to the CCRB,
which had helped parents recover compensation from public funds, had
been `exaggerated and overstated in the past.'
After
discrepancies were found in the medical notes of one of the children
she examined, Dr Lazaro said: "All of this is a substantial
professional lapse, I would have said." Evening
Chronicle comment The Home Secretary will decide on whether
Brown's case is suitable for compensation.
Shieldfield doctor faces GMC
hearing
THE FACT THAT THE General Medical Council
is due to hold its initial review of the complaint against Dr
Camille san Lazaro soon (on the 28 and 29 January) may seem, to
those who have followed the case closely, to mark the beginning of
the end of Dr Lazaro's career as a forensic paediatrician. This may
indeed turn out to be the case. However, recent developments in the
Republic of Ireland suggest that it would be wrong to assume that
professional bodies always act as robustly as the evidence suggests
that they should.
In the
case involving Dr Moira Woods, who for many years led the sexual
assault treatment unit at the Rotunda Hospital in Dublin, the Irish
Medical Council last year examined numerous complaints that Dr Woods
had wrongly diagnosed sexual abuse. In a number of these cases
children had been removed from their parents as a result. Although
the Medical Council upheld many of these complaints and found Dr
Woods guilty of professional misconduct, one of the supposed
'sanctions' it
imposed on her was that she
should in future
engage in child protection work only as part of an expert
multi-disciplinary team. In a
fierce
article written at the time, Irish Times
columnist John Waters argued that this should have been happening
anyway and that 'It is utterly incomprehensible to the layperson
that investigations into allegations as serious as child sex abuse
can be carried out by a single individual whose word becomes holy
writ.'
Earlier this month, after the Medical Council
had issued another report criticising the running of the hospital in
question, Irish Medical News reported that
Dr Woods was fighting back and had issued a
statement:
. . . I fully reject the
committee's report and I stand by my judgments in the cases
considered in the inquiry. This is not a matter of pride or
defiance. No doctor is infallible. Mistakes and oversights are a
daily risk for all doctors, and I am no exception. But as regards
these cases, which have been under intensive review during this
inquiry, I remain adamant that I had no option but to act as I did,
on the evidence presented to me, and on my interviews with the
children concerned. Regrettably, much of the media comment on the
report reflected what I think is a fundamental misunderstanding of
what is involved in investigating alleged child sexual abuse. Those
charged with this responsibility are rarely able to establish proof
of abuse to a standard required for criminal prosecution. This is
especially true if the children are very young, which is often the
case. Investigation of sexual abuse is about child protection. It is
beyond doubt, given all the documented cases of sexual abuse we now
know about, that the medical profession in all its disciplines was
found wanting in this area in the past.
I am aware that some
50 doctors have protested to the council at the manner in which the
cases brought against me were handled and the consequences of the
unchecked inaccurate publicity. I am very grateful to them, and to
the many doctors, social workers and others who have contacted me
privately to express their support and solidarity.
The case relating to Dr
Lazaro is by no means an exact parallel with that of Dr Woods. But
we need not doubt that, given the issues which are at stake, she too
will have professional supporters. However, those who believe that
Dr Lazaro should be treated leniently when she faces the GMC would
do well to recall why it is she has been summoned to appear before
them in the first place.
At the Shieldfield libel trial last year it
emerged that Dr Lazaro had played the central role in an
investigation as a result of which two completely innocent nursery
nurses had found themselves imprisoned on remand as suspected
paedophiles. At their criminal trial in 1994 Dawn Reed and Chris
Lillie were found not guilty. However, largely because of the
medical evidence which had been supplied by Dr Lazaro, Newcastle
City Council remained convinced of their guilt. They set up an
independent inquiry. After the four child abuse experts who sat on
the inquiry had taken evidence once again from Dr Lazaro, and from
parents whose children she had examined, they found Reed and Lillie
guilty over the heads of the Court.
Branded by the local and national media as
wicked perverts who had systematically subjected the very young
children in their care to horrific sexual abuse, Dawn Reed and Chris
Lillie were forced into hiding in different parts of the country.
The only way they had of clearing their names
was to take a libel action against Newcastle City Council and the
four members of the Review Team. The case began in the High Court in
London almost exactly a year ago on 9 January 2002. During the
six-month trial the Court learned that on numerous occasions mothers
had taken their children to be examined by Dr Lazaro principally in
order to find reassurance. In many instances, however, they came
away believing that their children had been abused. On a number of
occasions Dr Lazaro had based her view that abuse had taken place
not on any medical signs she had observed or claimed to observe but
on her own interpretations of the child's reported
behaviour.
On other occasions she said that she had found
physical evidence of sexual abuse. However, because she did not
arrange with any of her colleagues to conduct joint examinations of
the children, and because she did not use the photographic equipment
available to her to record the evidence she reported, there has
never been any objective confirmation of Dr Lazaro's
observations.
In many ordinary medical situations, of course,
diagnoses frequently depend on the unverified observations of a
particular doctor. However, this was not an ordinary situation. It
was a criminal investigation of the gravest possible kind involving
the most serious allegations which had ever been made in relation to
any nursery in the UK. In such circumstances every precaution was
clearly necessary in order to ensure the integrity and accuracy of
the evidence which was reported. Yet still there were no joint
examinations and no photographic records of the reported physical
signs.
Everything therefore depended on the one hand on
the clinical competence of Dr Lazaro, and on the other hand (and
perhaps even more importantly) on her own integrity and on the
accuracy, reliability and truthfulness of her medical
reports.
During the libel trial some highly significant
evidence was put forward which called Dr Lazaro's clinical
competence into question. But, even more disturbingly, evidence
emerged which suggested that her records and reported findings could
not be relied on as truthful or accurate descriptions of what she
had in fact observed.
In a report which she had submitted to the
Criminal Injuries Compensation Authority she had made claims about
horrific abuse allegedly suffered by a number of children. Yet these
claims were, according to her own earlier findings, untrue. The
crucial fact here is not that Dr Lazaro herself admitted under
cross-examination that her report was 'overstated and exaggerated'.
The crucial fact is that her own records established beyond doubt
that she made claims in her report which were flatly contradicted by
her own earlier reported findings.
This was by no means the most grave example of
Dr Lazaro's conduct which emerged in the trial. As Bob Woffinden and
I noted in
the article we wrote in the Guardian to
mark the conclusion of the libel trial:
The case of
four-year-old Tracy, who had made the allegation of rape only after
three video interviews, was the most disturbing of all. Dr Lazaro
examined the child on 8 October and said she had found a partial
tear in the hymen; however, normal variants are sometimes
misinterpreted as partial tears. On 22 October, after Tracy had been
cajoled into making the rape allegation, the police paid an urgent
visit to Dr Lazaro. Without having seen the child in the meantime,
she now produced a statement claiming that she had found a complete
transaction of the hymen. This finding was indeed consistent with
the allegation freshly made by the child. But it was not consistent
with the paediatrician’s own medical records,
The evidence which emerged in
the trial, in other words, clearly showed that the medical findings
originally made in relation to Tracy had subsequently been changed
by Dr Lazaro without there being any new medical examination of the
child to warrant this. There are only two possible explanations of
this. The first explanation is that Dr Lazaro acted with gross and
inexcusable recklessness in circumstances whose gravity demanded
that she show the greatest possible caution and the most meticulous
attention to detail. The other explanation is that Dr Lazaro
deliberately ratcheted up her findings in a possibly
well-intentioned, but thoroughly dishonest attempt to oblige the
police by affording medical 'corroboration' for an allegation which
would eventually be found to be without any substance at
all.
It might be tempting for the
GMC to opt for the first of these two explanations. However, when it
is placed alongside the clear evidence afforded by the false report
which Dr Lazaro submitted to the CICA (and other examples of false
or misleading information which was given out by Dr Lazaro), the
incident involving the 're-diagnosis' of Tracy is extremely
disturbing.
Whichever view is ultimately taken of Dr
Lazaro’s conduct in regard to Tracy there can be no doubt at all
that, either through dishonesty or recklessness, she made a decisive
contribution to the terrible injustice which was inflicted on Dawn
Reed and Chris Lillie and to bringing about the nine-year ordeal
which they subsequently suffered.
The General Medical
Council, in seeking to deal with Dr Lazaro both fairly and firmly,
faces a difficult and sensitive task. In the past it has frequently
been accused of 'looking after its own'. It is right and proper that
it should look after its own in any case where false or exaggerated
allegations have been made against a medical practitioner. But in
this case the evidence which was available to the Court even before
Dr Lazaro's disastrous appearance in the witness box, suggests that
the only false and exaggerated claims which are in question were
those made by the medical practitioner herself.
Above all it should be clear,
and the GMC should itself recognise this at the outset of its
inquiry, that this is not a case which turns on whether medical
signs whose objective presence has never been in doubt have been
correctly interpreted. That would be a matter for specialists and
one on which writers, journalists or members of the public who are
not medically trained would have no authority to pronounce.
This, however, is an inquiry
which concerns, or should concern, the credibility and reliability
of the reports which Dr Lazaro made of medical signs which she
said she observed but which may not in fact have been present
at all.
When, some four years ago, Bob Woffinden and I
compiled our 70,000 word case analysis which eventually led to the
bringing of the libel trial, we reached our own assessment of the
medical evidence only after we had discussed it in detail with five
experienced paediatricians or police surgeons. However, one of the
main effects of these discussions was to confirm the view that
the most important issue in the case was the reliability of Dr
Lazaro’s original reports and not the manner in which other medical
practitioners might now construe the evidence they purported to
record. It was this view which we set out at the time:
The only reasonable conclusion
it is possible to reach is that Dr Lazaro’s findings, unsupported as
they are by photographic evidence, or by the opinion of fellow
clinicians, should properly be treated as subjective opinions,
rather than as clinical facts. There is no objective evidence that
any of the children in the Shieldfield case had been sexually
abused.
There is only Dr Lazaro’s
stated belief that she had discovered such evidence [in some
children] at the time of her examinations. For all the reasons given
above her reports should never have been relied on in the way that
they were either by social services or by the police.This
view was subsequently vindicated in the libel trial itself. It
should be noted that it is not a medical conclusion; it is a
conclusion about the reliability and proneness to error of an
individual human being.
This is the issue on which the GMC
will shortly have to deliberate. Ultimately the question they have
to address is one which no amount of medical knowledge can help them
to resolve. It is nothing other than the question of whether Dr
Lazaro's reports of what she said she saw can be relied on as
accurate and truthful.
In assessing this question the GMC panel should
above all remember two things. They should remember that doctors are
human beings and that human beings - even though they may be
qualified doctors - are not always reliable and do not always tell
the truth.
If they attempt to resolve the issue in any
other way, or to present it as though it turned on questions of
medical interpretation, they will themselves be guilty of seriously
misrepresenting the evidence which has been placed before them. Were
they to do that they would destroy at a stroke the confidence which
the GMC now has reposed in it by members of the public.
It is to be hoped that, for the good both of
that public, and of the medical profession itself, the GMC will face
the issue which now confronts it squarely and without flinching. If
it does not, it will itself succeed in bringing into grave disrepute
the very profession it was set up to protect.
Note, added 11 February: The complaint against
Dr Lazaro has now passed through the initial hearing stage and will
be heard in full at a future date.
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