GMC and Lazaro: the toothless watchdog bites again

RICHARD WEBSTER

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14 May 2005

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Eleven years ago Dawn Reed and Christopher Lillie were cleared in court of molesting children at the Newcastle nursery where they worked. But the accusations continued - in newspapers and in a report commissioned by Newcastle city council - and they had to disappear, afraid for their lives. Throughout their nine-year ordeal, which was ended by their libel victory in the High Court in July 2002, the case against them had been based on the medical findings of the paediatrician Dr Camille de San Lazaro. In his libel judgment Mr Justice Eady subjected Dr Lazaro to devastating criticism, saying that 'where physical findings were negative or equivocal, Dr San Lazaro was prepared to make up the deficiencies by throwing objectivity and scientific rigour to the winds in a highly emotional misrepresentation of the facts'. Yesterday a disciplinary hearing in front of the General Medical Council came to a different conclusion. Here author Richard Webster, who, with the journalist Bob Woffinden, tracked down Reed and Lillie five years ago and helped them to bring their successful libel action, gives his reaction to the GMC findings.
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YESTERDAY THE General Medical Council, having heard evidence that Dr Camille de San Lazaro had, by her own admission, 'exaggerated and overstated'

findings of sexual abuse, and having ruled that some of her work was 'inappropriate', 'irresponsible' and 'unprofessional', came to the conclusion that all this was perfectly acceptable and that the paediatrician should be free to carry on destroying the lives of innocent people by making more false diagnoses. Not only was she not struck off, she was not even found guilty of serious professional misconduct. No restrictions whatsoever were placed on her work.

As Dr Lazaro held out her hand to take her punishment at the end of the case, and as the GMC watchdog gently closed its toothless gums on it, she might have been forgiven for concluding that what she was receiving was not a reprimand but a kiss of approval. One of the most bizarre features of the case, which was not registered in the Press Association report of the proceedings, was that the GMC had actually concluded that the evidence before them reached the threshold which would permit them to make a finding of serious professional misconduct. But they then decided that Camille Lazaro's pleas of mitigation - that she was overworked and overstressed at the time - meant that she should be given a reprieve.

The GMC seems not to have understood that if a paediatrician recklessly misdiagnoses child after unmolested child as being a victim of sexual abuse, until there are literally dozens of spurious victims and an even larger number of anxious parents who have been pitched headlong into a moral panic, then the paediatrician in question very likely will feel she is suffering from stress and

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overwork. Far from accepting this as evidence of mitigating circumstances, the GMC should have recognised it as further evidence of Lazaro's unfitness to practice. (The fact that the GMC should have accepted without question a plea on Dr Lazaro's behalf from Dr Christopher Hobbs, the Leeds paediatrician who was one of the principal sources of the medical misunderstandings which led to another unfounded sexual abuse scare - the Cleveland scandal - merely confirms how far removed from reality the panel must have been.)

The real problem with the disciplinary hearing was that the GMC evidently had no understanding at all of the dynamics of the Shieldfield case and failed utterly to grasp what the real issues actually were. The central problem was not that Lazaro had repeatedly made errors in her notes and records, as the GMC rightly found. The central problem was that she had repeatedly made grave errors in her diagnoses. Nor was this simply a question of medical misinterpretation. As I urged in a piece posted on this site more than two years ago:

[T]his 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 ... 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.

This is the question on which the GMC would have focused if they had understood the real issues which were at stake. As I noted in January 2003, some of the reasons why Dr Lazaro's reports need to be treated with more than merely clinical scepticism emerged during the course of the libel trial in which the former nursery nurses Chris Lillie and Dawn Reed pursued their action against Newcastle City Council:

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 transection 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.

When I wrote these words in January 2003 I was pointing out what should be self-evident. If a paediatrician herself says that evidence she submitted in support of compensation claims was 'overstated and exaggerated' then that paediatrician is admitting that her own reports are sometimes untruthful or dishonest. What I did not say at the time, and what never emerged in evidence at the libel trial, was that there is at least one other significant piece of evidence which points to Lazaro's untruthfulness.

During the year or so which Bob Woffinden and I spent investigating the Shieldfield case, one of our earliest sources, who was familiar with Dr Lazaro's working methods, described her as ‘a legend in her own imagination’ with ‘a penchant for playing God’. We also spoke on a number of occasions to Brian Roycroft, who had been Newcastle's director of social services in 1993 when Dawn Reed and Chris Lillie were first accused. At the time, this humane and highly-regarded social worker had, like practically everyone else in his department, accepted that the case against the two nursery workers was well-founded. However, from the very outset of our contact with him, he shared our misgivings about Dr Lazaro. On one particular occasion, as we were driving with him to look at the Shieldfield nursery itself, he made it quite clear why. He recounted to us an incident which had taken place some years previously. He had, he told us, received an invitation to a particular event at a nearby university. When he arrived early he discovered that, by pure coincidence, Dr Lazaro was in the middle of giving a lecture on child sexual abuse. Having nothing else to do he quietly took a place at the back of the lecture theatre and listened to what she had to say. The case she was describing, he said, was one that he was familiar with. But what he was not familiar with was the evidence she was presenting. The details which she gave to her audience were, he said, different from and more serious than the evidence which had actually emerged in the case. There was no doubt in his mind, he said, that her lecture was untruthful. Indeed Roycroft was adamant that the account she had given of the case to her university audience had been fundamentally dishonest.

In relating this anecdote I am not endorsing it. I was not present at the lecture in question so I cannot vouch for the accuracy of Roycroft's account. However, it must be said that his account is entirely plausible. If Lazaro has herself admitted that a report she made to the CICB about sexual abuse was 'overstated and exaggerated', then her reported conduct at the lecture theatre would be in keeping with such untruthfulness.

Roycroft himself was reluctant to give his evidence formally since, as he said, it would have been his word against hers. Questions might also have been

raised about why he did not pursue his concerns about Lazaro's veracity at the time. As our investigation continued, however, Roycroft took more and more interest in it. He eventually met Dawn Reed in Newcastle and, by the time of the libel trial, he had become one of Dawn Reed and Chris Lillie's staunchest supporters. During the early spring of 2002 he came down to London specially to attend the trial and had lunch with his two former members of staff. He deliberately chose to come at the time when Dr Lazaro herself was giving evidence. Tragically, only weeks later, on May 24, he died of a heart attack. In the Guardian's obituary he was described by Terry Philpot as 'one of the most charismatic and influential social services directors of the last 30 years'. The Guardian's headline referred, rightly, to his 'passion for justice'. One of the many tragic aspects of his sudden death was that he did not live to see justice done to Dawn Reed and Chris Lillie (although his wife and daughter were present in the High Court when the judgment was eventually handed down at the end of July).

Although the High Court saw to it that justice was done, and although Mr Justice Eady said that 'where physical findings were negative or equivocal, Dr San Lazaro was prepared to make up the deficiencies by throwing objectivity and scientific rigour to the winds in a highly emotional misrepresentation of the facts', the GMC appears to have reached a different conclusion. They have failed in the first place to recognise that the problem at the heart of the Lazaro case is one of multiple misdiagnosis. They have failed in the second place to recognise that Dr Lazaro's honesty and scrupulousness - or lack of it - appears to have played crucial role in her misdiagnoses.

When I rang Dawn Reed this morning to ask her what she made of the hearing's outcome, her response was measured. 'I'd like to say that I can't believe that it's happened,' she said. 'But I can believe that it's happened because I didn't have much faith in the GMC from the word go.'

'I can only hope,' she said, 'that enough people will have read about what has happened in this case so that they realise the dangers themselves. And then if a mother is asked to let her child be examined by Dr Lazaro she will refuse because otherwise you never know what might happen and lives can be destroyed by this.'

The dangers in question are things with which Dawn, who spent 9 years living under the shadow of false allegations of sexual abuse and claims that she belonged to a non-existent paedophile ring, is all too familiar.

Saturday 14 May 2005

For an excellent piece on the GMC judgment by Phil Doherty of the Newcastle Sunday Sun, click here.