GENERAL MEDICAL COUNCIL
PROFESSIONAL CONDUCT COMMITTEE
On:
Friday, 11 June 2004
Held at:
St James’ Buildings
79 Oxford Street
Manchester M1 6FQ
Case of:
DAVID SOUTHALL MB BS 1971 Lond
(Day Five)
Committee Members:
Prof D McDevitt (Chairman)
Ms F Bremner
Mr S Gurjar
Ms C Langridge
Rev J Philpott
Mr D Mason (Legal Assessor)
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MR K COONAN QC, of Counsel, instructed by Messrs Hempsons, appeared on behalf of the Doctor, who was present.
MR R TYSON, of Counsel, instructed by Messrs Field Fisher Waterhouse, appeared on behalf of the Council and Mr Stephen Clark.
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(Transcript of the shorthand notes of TranscribeUK
Tel No: 0208 614 5799)
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INDEX
Page
SOUTHALL, David Patrick, Recalled
Examined by MR COONAN (Cont’d) 1 Cross-examined by MR TYSON 25
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THE CHAIRMAN: Good morning, Mr Coonan.
PROFESSOR DAVID PATRICK SOUTHALL, recalled
Examined by MR COONAN (Cont’d.)
Q Professor Southall, can we turn to page 18, please, of C1. There are a number of passages in the memorandum prepared by Detective Inspector Gardner that I would like your assistance with. If you go just over halfway down you will see the reference to Professor Sir Roy Meadow and Professor Mike Green. Just take that as a starting point and then drop down about four or five lines. Do you see where the memorandum says:
“He stated his concerns initially were two fold”.
Do you see that?
A Yes.
Q “He thought that Stephen Clark came over as insincere and an attention seeker and more importantly he was alone with Christopher during the nose bleeding incident whilst at the Strand Palace Hotel”.
I just want to be clear about this. Did you express a view about your assessment of Stephen Clark on the television film to Mr Gardner?
A Yes, I did.
Q Does that capture your assessment based on the film at the time?
A I cannot completely remember, but I am pretty sure that I did raise that kind of concern, but it was never a major issue.
Q Then you go on to the second element:
“More importantly he was alone with Christopher during the nose bleeding incident whilst at the Strand Palace Hotel. Dr Southall appears adamant that had Christopher suffered a nose bleed, then unless there was a rare medical reason such as leukaemia then it was a deliberate act to suffocate and the bleeding would have been at the point of the abusive act.”
This, of course, is Mr Gardner’s memorandum. Can you help the Committee, please. Does that actually capture what you were saying to Mr Gardner at that time?
A Yes, but I am not sure the order is quite right, because I would only be adamant after making sure from talking to him that the alibi of Mr Clark at the restaurant had already been looked at and excluded, the possibility that he had not been there for the whole period had been excluded, and it was only when that had been told to me by Detective Inspector Gardener that I realised that what I was theorising was now becoming a major issue.
Q Then he goes on:
“In other words it would not have been resultant from earlier abuse. However Doctor Southall is not aware of the full facts and did state that he would need to know exactly how Christopher had suffered, difficulty in breathing, amount of blood, necessity to resuscitate, visual observations and what records were made”.
Just help us about that. Were you raising those as issues of which you were at that stage ignorant?
A Not ignorant, no. What I wanted to have was far more information if I could on the circumstances surrounding in the living child what had actually happened in that room. This was not information that really made a major impact on my concern but it was information that I wanted to have because for completeness you need to know, if you can, all there is to know.
Q If I can put it this way, were the answer to those questions you were raising there a pre condition to the view that you had expressed?
A No, not a pre condition, because the major issues that I was looking for the answers to were coming out in the discussions I had with Professor Green, Professor Meadow and with Detective Inspector Gardner.
Q It goes on:
“The investigation into this incident by the police was inconclusive having to rely on friends of the Clarks to support the nose bleed without positive corroboration from medical, or hotel staff”
and I think you have already dealt with that particular point in your evidence yesterday.
A Yes.
Q Then there is a reference to you providing the inspector with your CV. Did you do that?
A I did.
Q And a copy of the published paper we have seen in C4, page 318, is that correct?
A Yes, it is.
Q Over the page at 19 we see in the third and fourth lines Mr Gardner pointing out that Sally Clark was alone in the family bedroom on both occasions when the baby showed signs of distress. We see what follows. I am not going to take you through that laboriously, but can I just put this to you as a question in the round? On the factual basis that Sally Clark was alone in the family bedroom on both occasions, did that to you at that stage undermine the proposition that you were putting to Mr Gardner?
A No, but, firstly, let us examine both deaths because they are two different circumstances. With the first death, Christopher’s death, everything had pointed to the mother being alone with the baby, but when I asked the key question of Detective Inspector Gardner as to whether the alibi had been checked, whether he had talked to people in that restaurant, he denied it and I asked him why and he said because at the time of that death it was put down to natural causes. With regard to the second death, I yesterday explained that it is frequently the case from my experience with intentional suffocation that when there is more than one person around that generally speaking the person who undertakes the smothering sets the scene so that somebody else finds the baby and that is characteristic of what is done. So the point he was making that she was alone in the family bedroom on the second death when the baby was found, not when the baby necessarily started to become ill, was not an issue that damaged what I was saying.
Q Let us leave the contents of the memorandum and go on to in effect the employment aspect to this event. First of all, in what capacity were you discussing this matter with Detective Inspector Green?
A A highly informed expert on this issue, but as an individual citizen who felt that there was a major risk to a baby and that the knowledge I had was fairly unique, if not unique, and that it should be provided to people who could possibly act and do something about my concern.
Q You told the Committee yesterday that you had not told Dr Chipping in advance of contacting the police officer, Mr Gibson.
A Yes.
Q Did you contact Dr Chipping before you and Mr Gardner met?
A No, I did not.
Q How long was the time between Mr Gardner contacting you and both of you meeting on 2 June, can you remember?
A I cannot remember, I am sorry.
Q But at any rate, was there any particular reason why you did not inform Dr Chipping in advance of the meeting with Mr Gardner?
A No particular reason. It was similar to the reasoning behind my discussions with Detective Constable Gibson, but I recognised as soon as I had finished talking to Detective Inspector Gardner that I had consolidated my view that there were two possibilities then. One was that nothing would happen, although I felt that was very unlikely, because section 47 of the Children Act demands that something happens in that circumstance, and in fact Detective Inspector Gardner I think totally appropriately asked me whether I would be willing to have my views taken forward in the child protection arena. I have to say, this is difficult, because of my position, but it was obvious that I had given the information, but really for social services, the lead agency, to protect the child, they would need to talk to me. I knew that would have to happen. Therefore, having got to that position with Detective Inspector Gardner I felt that it was absolutely right that I was willing to take it further and pass on my concerns, you know, should that be thought to be appropriate.
Q To other agencies?
A Yes.
Q Did you in respect of that make contact with Dr Chipping at the Trust?
A Yes. The same day. I am almost certain, I cannot be absolutely certain, but I am almost certain it was the same afternoon, because I knew that once I had given that permission I was no longer an anonymous informer, I was somebody who was actually going to be identified, albeit completely in camera (this was confidential to the parties) but it meant that it was entering the child protection field and, therefore, because of my agreement with the Trust earlier, in my view, this was the right time to inform Dr Chipping.
Q So just before we look at any further documents, up to the moment when you were discussing it with Mr Gardner, did you consider the subject matter or your actions to be child protection work?
A That is complicated to answer. I did not as such, because I was not at that stage in a child protection forum. This was the police. This was an anonymous potentially concern being raised and also until I had Mr Gardner tell me that Mr Clark effectively did not have an alibi, up until that absolute moment in time, all of my concerns might have evaporated. I am not saying they would, but they might have.
Q Let us move forward then. The fact that Mr Gardner told you or you indicated to him that you were willing for the matter to go forward, marked a water shed in your perceptions of the general position.
A Yes.
Q If you turn to page 21 Dr Chipping’s letter dated 12 June refers on the first line to a recent telephone discussion between the two of you and in the body of the letter she refers to three issues that were discussed in that telephone call. The first two bullet points I am not concerned with. The second one is to be noted. But the third one is that you had referred to your actions regarding what she describes as the child protection case involving Sally Clark. Did you mention that matter in that telephone call?
A Yes, I did. We discussed this a lot and I said that I really to would like to have those papers. We are not talking about here clearly all of the papers on the cases which Professor David described in detail yesterday. We are talking only about the living baby, this baby, and the nosebleed incident, and I felt that I should be given those papers and they agreed actually and my understanding was that it was going to happen.
Q Over the page at item two, the planning at that stage appeared to be that following that, the access to those notes or materials, you be asked to file a report?
A Yes.
Q At this stage, on the 25th, had your view changed since the meeting with
Mr Gardner in any way?
A Only that I found both of the social workers here very open and a helpful, really. They wanted -- they did not want to hold back information, they wanted to share information, which is absolutely the spirit of child protection, and they consolidated, as far as I was concerned, that there was not a medical cause and you might say, “They are not doctors”, but social workers, especially senior social workers, really do know about the bleeding and blood clotting abnormalities. It is bread and butter work for them because it is so common an issue. They know that you must exclude medical causes for bleeding and bruising and so on. So they know what they are talking about. If they say to me: “No, there is no medical cause for the bleeding”, then that is very helpful and confirmatory of what I had already gleaned from the various previous sources we talked about.
Q Three days later there is a bigger meeting on the 28th in Wilmslow. If you turn to page 29, we have been told the personnel who were present, and I would like to ask you a number of questions about the content of this document. Did you tell those present about that you had discussed the matter with Professor Green and Professor Sir Roy Meadow?
A I do not think so.
Q For the same reason that you indicated to the Committee you had not spoken about the (Inaudible)?
A Yes.
Q Can you turn to page 30. Can you just pick it up on the third line:
“Professor Southall had many concerns about Mr Clark's involvement. Professor Southall indicated that what he heard on the television programme suggested that the nosebleed did in fact taken place and this is corroborated by a friend”?
A Sorry. I do not know where you are.
Q Top of page 30.
A Sorry, okay, I have got it now.
Q
“Professor Southall had many concerns about Mr Clark's involvement. Professor Southall indicated that what he had heard on the television programme suggested that the nosebleed did in fact take place and this is corroborated by a friend.”
What was that a reference to?
A That was the friend, Liz Cox, who, on the video, stated that she had been told about this and this was really crucial because this was before either baby had died, before there was any legal proceedings or anything and this to me, unless she was lying, this was confirmatory that it occurred.
Q It goes on:
“Given his work Professor Southall is aware that bleeding from the nose or mouth or both is a feature of a proportion of cases of suffocation. It is not a feature that arises naturally.”
Again, does this accurately reflect your opinion in broad terms?
A Yes.
Q Not asking for the exact words.
A No. In broad terms, except, again, I have to say it does not include the description of the ALTE, the Apparent Life Threatening Event, but I think it is the combination, but in broad terms.
Q Just jump a line or two and pick it up at the next sentence:
“Professor Southall indicated that his knowledge of bleeding from the nose and mouth in such a way is that that it appears contemporaneously with an assault as when the baby has been suffocated.”
That is the second point you made previously?
A Yes.
Q
“Therefore if one took that event alone Professor Southall's view is that you are looking at the scenario, assuming the truth of the corroboration of the friend, that this baby was suffocated by his father whilst mother and friend were out shopping. He was not aware of any other cause of bleeding such as this unless a child suffers from a serious disorder such as leukaemia or a blood clotting disorder.”
As a ,proposition does that capture what you were, in effect, putting to them?
A Yes.
Q
“He understood there was quite a lot of bleeding and he would put that as intentional suffocation. Professor Southall expressed the view that he would have assumed that this had been covered at the trial.”
What did you mean by that?
A I assumed that the police investigating this had done so very thoroughly because it is in complete contradiction to the fact that Sally Clark was in prison but I knew from Professor Green that the delay issue had allowed, if you like, the police to back off it and not take it as absolutely contradictory to what hat happened with Sally. Now, that is a lot of words and that is really what I am trying to suggest that this memorandum says. I do not know if I have made it clear?
Q If you just jump down four lines where the memorandum says:
“Professor Southall said that he felt that an investigation needed to be done.”
What investigation did you think needed to be done?
A Yes. I felt that, notwithstanding the considerable time that had elapsed, the police should, in my opinion, have looked much harder into the issue of when Sally was supposed to have been alone on the first baby’s death by talking to the people who had been with Mr Clark at the party by interviewing Mr Clark again about this, not me interviewing him, and it has been suggested that I did not speak to either the mother and the father in this case and that that was negligent. I do not agree because it is not appropriate for somebody who is untrained like me to talk to, say, Mr Clark about such
a serious issue, it needs to be to done properly. That is what I was getting at.
Q Just look at the next part of the text:
“He was aware from the television programme that at the time of the first death father was apparently not on the scene but was in relation to the second death. Explaining…”
that is you explaining,
“…that his understanding was that both parents were present but the father was downstairs at some point...”
Pausing there, that is a reference, clearly, to the second death?
A Yes.
Q
“…and it was whilst he was away that mother noticed there was something wrong with the child. Professor Southall highlighted the fact that in his experience the process of the baby dying can take a long time and it is not immediate. You can see a gasping in breathing for five or more minutes after suffocation. He indicated that he wanted to bring the attention to the police the fact that the child could well have already been dead before the father went downstairs.”
Does that also capture the analysis that you were putting to this group?
A Yes, it captures is quite well, actually. It is a difficult concept, but it is quite well captured and it is based on the number of experiences, not just in the child protection field, it is also based on my experience of paediatric intensive care and seeing babies die of medical causes.
Q Look at the next line:
“Professor Southall indicated that he accepted that he did not know enough about all the facts that had been dealt with at the trial or any of the medical evidence but that he was seriously concerned and that if father had suffocated Christopher at the hotel it was unlikely that he wasn’t responsible for the two deaths”?
A Yes.
Q Can I have your observations, please, about the memorandum which observes, firstly, your comment that you did not know enough about the facts and, secondly, that you did not know any of the medical evidence?
A Yes, I tried to bring this up a few minutes ago, whilst the facts with regard to the post mortems on the two babies, the medical facts, are important, very important, they had obviously been covered by the experts in the trial. I had a second-hand account of that from both the video and from Professor Green and Professor Meadow. But the central issue over which I was concerned involved Christopher when he was alive. So the facts that I wanted to know more about, if I could, were to do with the nosebleed rather than to do with the all the pathology, post mortem work that had been done on the two babies or on the clinical thing that had been done on the living baby, Child A, because they were not the crucially relevant to my concern.
Q I take you over the page, in the third paragraph there is a reference to the frenulum:
“Professor Southall clarified whether there had been any bleeding at death and it was confirmed there was certainly no reference to any in any of the information that all parties had. The frenulum was torn and Professor Southall said he would expect something bleeding then.
Again, does that reflect the discussion about the frenulum between the parties at that stage?
A Yes, this is where, if you like, the fact that there was a damage to the frenulum was consolidated to me, but I had already heard it from Professor Green, but it was consolidated.
Q It goes on, on the same subject:
“The meeting discussed some of the issues around the torn frenulum and the fact that in Professor Southall's view it is very unlikely for it to be torn in resuscitation and a hand over baby’s was a possible cause of the torn frenulum.”
Was a reflection of your clinical experience that you referred the Committee to earlier?
A Yes, in intensive care with intubation of babies you do not -- I just do not know of any evidence that intubation of babies by a doctor is going to cause that sort of damage because of the position of the frenulum.
Q In the next paragraph beginning John Linney, can I take you, first of all in passing, I note that on the fifth line:
“Professor Southall also highlighted the fact that he felt given the nosebleed had occurred he found it strange that Stephen Clark had not called 999.”
We dealt with that yesterday. I just draw your attention to the last three lines:
“Professor Southall indicated that there was some other research into bleeding which has not yet been published and it was American research that may be helpful to this case.”
Has that paper now been published?
A Yes, it has.
Q The name of the paper?
A Well, the first author is Trueman.
Q Is that referred to, I just pause. And if we look at the first bullet point, we can perhaps derive a time for this call where she says, “You advised me” – that is in the ‘phone call – “that on Tuesday 6th June you would be in Edinburgh”. So one can make an inference sensibly, is that right?
A It fits very well.
Q Before the ‘phone call before the 6th June?
A And likely because Tuesday was the 6th and Monday the 5th, you can work it back to Friday but, you know, the weekend coming that fits well with my memory that it was the same day immediately that I contacted Dr Chipping because I knew that once I left Mr Gardner that action might be very well taken.
Q If we just look at the bottom of this document, there is a reference which reflects her understanding that you had provided a statement to the police. Did you at any stage provide a written statement to the police?
A No.
Q The next line, where she records that you stated to her in the telephone call that you had made this, and I put this in inverted commas for the purposes of my question, statement “in the public interest”. Dr Southall, when you went to the police what was, in a word or two, the motivation for it?
A The main overriding motivation was the fact that there was a third child in the family living with a person who I was very concerned might harm him.
Q Did you tell Dr Chipping that you had, as it were, discussed the matter in the public interest?
A I don’t remember that phrase because it is not something … that’s not the point. The real point was that the child was at risk. The second point was that the mother of that child was in prison and, regardless of the terrible effects on her of that, it meant that the third child did not have a mother to look after him. So there is an important issue from a paediatrician’s point of view over that as well, but the main overriding concern was the risk to the baby.
Q I want you to have a look please at the Notice of Inquiry, I think you may find it on top of the box. I am just going to ask you specifically to look at head 6, a, b and c. I want to ask your own view, you are entitled to express a view about this. In the light of what you have explained to the Committee, of first of all your reasoning and secondly your motivation, what is your view, do you think you acted precipitously?
A No.
Q Do you think you were acting irresponsibly when you went to the police?
A No.
Q And do you think that what you did was an abuse of your professional position?
A No. On the contrary, if I had not done what I did I think that would have been a hidden abuse of my professional responsibility.
Q Can you put that to one side? Can I ask you just to move on in the chronology to page 20. Mr Blomeley writes to Mrs Holland at Cheshire County Council a letter dated the 6th June. Did you hand out your address in that form to either Mr Blomeley of the Crown Prosecution Service or to anybody else?
A Not in specific terms. I suspect it came from the video surveillance papers, so I would have given that to him. I did give it to Detective Inspector Gardner, but I certainly do not recall handing him or writing down my professional address.
Q And I do not invite the Committee to turn it up now, but it is page 318 in the left hand column. On page 24 Cheshire County Council having received the letter from Mr Blomeley write to you at that address which mirrors the address in Mr Blomeley’s letter, all right?
A Yes.
Q Did you know that the County Council were going to write to you at the hospital?
A No.
Q And we have heard from Dr Chipping that your mail was looked at and Dr Chipping contacted you about that and did you then reply to Cheshire at page 25?
A Yes.
Q The contact by Cheshire to you having been made, were you content to share your concerns with them?
A Yes, I was.
Q Again, I do not want to labour the point, it may be obvious by now, but in a word or two why?
A Well because the lead agency for child protection and social services, and at long last I felt that something was actually happening. I mean I have to say that I was concerned about how long all this was taking because I raised my concerns on the 28th April and the person, or the persons, or the agency that really needed to know my concerns was social services, so I was pleased when I found out about this letter, although again there is a big delay here. It is written on the 26th June and I do not know exactly when I got it, but my letter is on the 23rd July and so all along it seemed that although I was expressing serious concerns about the baby, delays were occurring in something happening to look at the question of protection, just to look at it.
Q I am not going to ask you to go through the body of the document, the Committee are well aware of that document. I just draw your attention to the bottom left hand corner where the letter is copied apparently to Dr Chipping and what was the purpose of that?
A Well to make sure that she was informed of my actions with regard to helping social services, because this was child protection work, this was truly child protection work.
Q At this stage?
A Yes. So she needed to know everything about it.
Q Can we move on to the first of the two meetings which took place two days later on the 25th, preliminary meeting and the first part of page 26 is background commentary by the author of the memorandum and I do not need to ask you to comment on that. Can I take you to the bottom of the page under the heading of “Subjects discussed”:
“Nosebleeds: Professor Southall explained his point of view on nose-bleeds in infancy. He argued, on the basis of his research and clinical experience in this field over many years, that a bilateral nose-bleed in an infant in the absence of an identifiable disease or accident, was virtually always the consequence of life-threatening child abuse, usually an attempted smothering”.
Pausing there, does that accurately capture what you were saying to this small meeting?
A No, not completely, because it is not just a bilateral nose-bleed it is a bilateral nose-bleed accompanying difficulty breathing, either choking and frightening to the observer, it was an apparent life threatening event.
Q But with that gloss, does that essentially capture it?
A That was otherwise correct, yes.
Q And then you go on:
“Furthermore, while it might be theoretically possible for there to be delay between the smothering and the actual nose-bleed, he had never known this to happen”.
And did that represent the truth and the reflection of your experience at that time?
A Yes.
Q “In all the cases of which he had experience (either research or clinical) the bleeding had happened immediately, that is to say at the time of the assault”.
Can I just ask you about this, under “Stephen’s role”:
“It was understood by all three of us that Professor Southall’s knowledge of this case was derived almost exclusively from the Despatches programme”.
Just pausing there. Did you tell the other two present, that is to say Jan Ash, Guy Mitchell, that you had spoken to Professor Green and Professor Sir Roy Meadow?
A I can not absolutely remember, but I do not think so and there is a reason for that.
Q Which is?
A I was worried that they might have got into trouble for telling me about this. I did not understand for certain the rules of engagement that they had with the case and may be I should have done, but I did not, and I was worried that my discussions with them, albeit incredibly helpful from my point of view, whether it was right and so I do not think I did say anything. It would have probably been in the memo if I had.
Q Towards the bottom of the memorandum under the heading of “Conclusions reached” it appears to be their commentary on what they had heard. At the bottom of the page it is proposed that on the 1st August one or other of the two of them should ask the court to direct that there be disclosed to Professor Southall such of the papers (civil and criminal) as relate specifically to the question of the alleged nose-bleed in the Strand Palace Hotel. Did you know that they were going to move forward on that point in that way? Is that referred to on page 11 of the scheduling of the literature that you handed in yesterday, table 2?
MR TYSON: D2 is this?
MR COONAN: Yes, D2. We see that on page 11:
“Truman: Child Maltreatment 2002”.
Is that right?
A Yes.
Q I just return to the memorandum.
“Guy Mitchell asked Professor David whether he agreed with any other possible causes for bleeding from the nose and mouth other than suffocation. Professor David confirmed that Professor Southall had covered those sorts of cases ie because of a medical condition of which there was no evidence that Christopher had. Professor Southall confirmed that if there was such a condition he would expect bleeding from other sites from that suggested”.
That observation there is covering what sorts of conditions?
A I cannot remember exactly all the discussion around that, but I knew already from Professor Green that in addition to the more common and clinically relevant issues of clotting disorders there had also been this idiopathic pulmonary haemosiderosis question raised in the criminal trial by Professor David. I knew that from discussions with Professor Green. So this statement here by Professor David and the discussion that we had further consolidated to me the fact that there was no medical cause for the bleeding.
Q Can we just go over the page. We have to make allowances obviously for the structure of the memo, but if you look at the end of the memorandum on page 32, the penultimate paragraph:
“There was some discussion about whether Christopher himself could have caused the bleeding to himself by accident injury and Professor Southall indicated that it was very unlikely in a child of this age. Patrick Wheeler asked whether IPH had been considered. Professor Southall felt that he needed more evidence and would need to see the post mortem findings.”
In so far as Patrick Wheeler was raising the question of IPH, can you help the Committee about your response to that issue as it appears to be standing at that moment?
A Yes. I cannot recall all the discussion and how he has phrased it, but I indicated a minute ago that Professor David’s view was there was no medical cause, Professor Green had indicated to me there was no pathological evidence of IPH, I know about IPH because when I was a consultant paediatrician at the Royal Brompton Hospital I was responsible for specialist respiratory paediatrics and that was a condition very rare that was something that we have knowledge and experience of and it did not fit in any way with a baby of this age. So basically I am not sure why I would need more evidence or why I would need to see the post mortem findings. I had already been told that it was not there.
Q If I can just ask you on the same subject, did you consult any literature on the question of IPH at any stage?
A I think I did actually because I knew that there had been some discussions about pulmonary haemorrhage in babies in America. There had been a cluster of cases. Earlier when the IPH issue had come up I had looked it all up just to see what this was about and it was rather unusual material but to my mind it did not have any bearing on this case, in my mind, to my view.
Q The last matter I want to ask for your assistance on is on page 32 at the top. Let me pick it up at the bottom of page 31:
“Patrick Wheeler indicated that he couldn’t at this stage give him access” (that is you) “to any papers and clearly we would need court approval for that but it may be possible for us to give access to certain papers once we have cleared the matter with the court. Professor Southall indicated that he is prepared to give his view once he had full facts and he could do that immediately. He clarified that he would be happy with the information about the nose bleed”.
What is the status of your view; in other words, that your view would be given once you had the full facts?
A In child protection proceedings (and this was the strategy discussion so this is, you know, formal) it is very unusual for anybody with an expert view to not be given the relevant papers. It is, you know, really completely inappropriate for those to be withheld and for an expert view to be ascertained. So it was a matter of fact that I assumed without question that they were going to give me that material and I was expecting to receive it and I would act fast because I was already concerned about the time, as I told you a minute ago, how long it had all taken. So that is to do with the immediate view, immediate action.
Q The second part of this meeting is self evident. You were not present. I do not ask you anything myself about that. We move on, please, to page 35. On 15 August, just over two weeks since the meeting, did you receive a letter from Patrick Wheeler, the solicitor on behalf of the child?
A Yes, I did.
Q With an invitation to meet Professor David.
A Yes.
Q The proposal, as we can see in the document, was that you outline in writing the points of concern that you had and then after that there would be a meeting chaired by him between yourself and Professor David. When you heard about that did you think that was a good idea?
A Yes, I did, because the most important issue in child protection is that it is a multi agency approach, not just doctors, not just social workers, not just the police, and I thought this was a good idea to have a meeting at which the child’s solicitor was chairing it so that he is representing, you know, social services, the guardian, the child, and then we have an expert, medical expert, Professor David, and then we have me with my concerns and I thought this was an appropriate way forward.
Q Your report, as we know, if you just turn on to page 42, is dated 30th August. Did you have any contact with the Trust before sending that report off? If you look at page 48.
A Yes.
Q This is from Sally Campbell to you in a letter dated 14 September and in the first paragraph she is referring to a telephone conversation between the two of you on 4 September.
A Yes. That is the day before I sent the report off.
Q You say the day before you sent the report. If you turn back to the report we see in the bottom left hand corner the date, 5 September, when the report is faxed. Was that fax from you?
A Yes, that is the fax number in Leek, the office.
Q At the top of the page you see a time and the name of a company. Can you help us about that?
A Yes. I shared an office with this company.
Q In Leek?
A In Leek called Assesstec Ltd.
Q So that document came from you.
A Yes. I have to be completely honest here, I am just not 100% sure obviously because this only says where it came from, but it is my recollection that this was the date I sent this to the solicitor and presumably that is the case because it has come back in this way and I just do not want to mislead anybody on that point. But I am pretty sure that that was the day after I spoke to Sally Campbell.
Q Thank you. Professor Southall, we need to look at the report starting at page 42. It is the fact that you had not received any court papers.
A No, they did not come.
Q What was your reaction to the fact that you were not being provided with them?
A I was surprised because it had been agreed, I thought, that they were going to apply to the court for them and they did not obviously, so I was left to produce the report without them.
Q When did you first know that they had not applied to the court to get access to the notes?
A I cannot remember.
Q When you realised that you were not going to be given the documents, did you consider how you were going to produce a report in the absence of that information?
A Yes.
Q Can you just talk generally for the moment. On what basis were you going to do it?
A As far as I was concerned, the truth, the facts behind my opinion, were already corroborated by various eminent people who knew what they were talking about and were involved in the case. I just wanted to have the court transcripts, for instance, of Mr Clark’s evidence so that I knew more. I wanted information about this bleeding incident to just help me personally as a person, but in terms of an opinion I had it and I had the corroboration that I felt I needed to have. I was very concerned ….. I have to say at this moment I was in a situation where for years I have been involved in child protection, serious child protection work, and I had seen case after case where delays in action, communication problems, had led to disastrous situations for children, and I felt if I make a big fuss about this and say, you know, “I am not going to produce this opinion”, even though my opinion was very firm, I would delay everything even further, the child all this time was still in the care of the father and I felt, right, I have just got to produce my opinion, so I did it.
Q Did you feel that any opinion you were going to express, even on the basis of the information that you already had, corroborated or otherwise, was damaged or necessarily limited or inhibited by absence, for example, of lab reports, X rays, witness statements and the like that you have heard Professor David describe?
A No. It was not going to be weakened, otherwise I would not have written what I wrote and I would not have written the E mail subsequently. I thought long and hard about this issue. It would not have weakened my near certainty to certainty, if you like, about what I was reporting as a concern about this child.
Q When you sat down and compiled this document were you purporting to carry out the sort of paediatric overview that Professor David had been involved in and which apparently produced over 300 pages?
A No. I was concentrating on one very important issue, the bleeding and the apparent life threatening event in the hotel, and its relevance to the subsequent two deaths of those babies and that was the issue, not all the other issues, as I have already talked about – post mortem findings, the conflict over those. They were just going to get in the way of the simple message that I was trying to put across and in this kind of work there is a danger in flooding people with unnecessary information. What you need is the core information with regard to the issue that you are trying to highlight.
Q The face of the document on page 42 does not bear the description “Preliminary medical report”, it just simply says “Medical report”. What was its status in fact?
A I think in retrospect I would prefer to have put down there “Points of concern”, because that is what I was asked to write. But equally earlier there had been a question of me producing the report, that was written in the first memo, I think, the word “report”. It is somewhat lazy in my point(sic). I should have put a bit more precisely “Points of concern” and I agree with Professor David that the word “preliminary” would have been a very good word to have added. So I am not disagreeing with him at all over that issue.
Q There are four or five specific matters I would like your assistance on. Can we turn to page 43? There are a series of bullet points and the Committee may just find it helpful to number them, because of the way in which Mr Tyson produced them the other day and I am going to refer to them as second, third and fifth bullet point. But if we can just set the scene, on the previous page you have summarised some of the material which appeared from the television programme, is that right?
A Yes.
Q You even set out a number of quotations from the dialogue. Then over the page you set out a number of facts coupled with observations and it is the second bullet point that I draw attention to:
“The first death was initially attributed to a lower respiratory tract infection”.
What was the source of that information?
A All of this was from the programme, because that is what it says.
Q I need to do it step by step.
A Fine, okay, yes.
Q It may be a little pedestrian, but it is important.
A No, that is fine.
Q Where did you get that from?
A From the programme.
Q Did you get any confirmation of that from anybody else?
A Yes.
Q From?
A Professor Green later.
Q Then you say:
“Later there were reported to be a torn frenulum and some possible bruises on his legs at the time of death”.
It is suggested that that is factually wrong, because there was reported to be a torn frenulum at autopsy. But leaving that aside for the minute, where did you get the information from that there was reported to be a torn frenulum?
A Initially from the video.
Q Was it supported or corroborated in any way by anybody?
A Dr Cowan was commenting.
Q Yes, but any other third party?
A Later, you mean?
Q Third party to you.
A Yes, later by Professor Green.
Q Thank you.
A. By the way, I should have mentioned that Detective Inspector Gardner also corroborated the lower respiratory tract infection. Remember that is why he said that natural cause had been identified for the first death and that is why they had not initially investigated Mr. Clark’s alibi.
Q And the reference to some possible bruises on his legs at the time of death, what was the source of that information?
A The video first and later Professor Green.
Q Before leaving number 2, there is also a comment, “There was also recorded to be fresh and old blood in Christopher’s lungs”. Where did you get that from?
A The video.
Q Anywhere else?
A From Professor Green.
Q And then the next comment in bullet 2:
“Dr Cowan attributed the torn frenulum to the resuscitation”.
Where did you get that from?
A The video.
Q Bullet point 3:
“The second death was initially reported to be a consequence of the shaken baby syndrome”.
That is Harry’s death. Where did you get that from?
A The video.
Q And it goes on:
“With evidence of a rib fracture, possible injuries to the brain, spinal cord and eyes”.
And again taken as a whole that sentence, where did that come from?
A The video.
Q Anywhere else?
A Yes, again all these issues were discussed with Professor Green by myself.
Q And then the text goes on:
“Later there was dispute about some of thee findings”.
How did you know that there was a dispute about some of these findings?
A That is the video.
Q From anywhere else?
A Again from Professor Green.
Q “However it was reported that there were two petechial haemorrhages above Harry’s eyelids after death”. Where did you know that from?
A The video.
Q Anybody else?
A Yes, I definitely remember Professor Meadow telling me that that was the case and we discussed it.
Q Can I take you to number 5:
“I noted that Harry was on a breathing monitor at home”.
How did you know that?
A The video.
Q It is suggested in this particular context that you could not know whether it was working, general performance and so on and so forth; were you purporting to make any comment about its performance of its operation there?
A No, I was reporting what the video told me, that is what all this is about, this is a layout of the video.
Q Can we go please to 44 under the heading of “Other Issues”. There is reference to the two petechial haemorrhages and this is particularly singled out by Professor David and he commented that you did not have any detail because you did not have any access to the post mortem report. What do you say about that?
A He is right, I did not, but I had talked to Professor Meadow about the petechial haemorrhages.
Q And then in the second point under “Other Issues”, number 2, there is reference to the frenulum once again and Professor David told the Committee that in this connection you had no actual access to the post mortem report or to the photograph and thirdly, that you were taking issue with Dr Cowan’s opinion that we know she expressed on the video. What do you say about those criticisms?
A I think his points about I did not have access to the post mortem report or the photograph and I had not spoken personally with Dr Cowan and Dr Cowan was there, but I had spoken to Professor Green about the injury to the frenulum, it was discussed, at the strategy meeting and I do have experience, a lot of experience, of intubating babies.
Q They may be criticisms of fact, I think really the thrust of the criticism, if I may say so, is the fact that therefore whatever you were writing about them is therefore in some way limited and/or damaged; what do you say about that?
A It is always good to have everything about every item, but in terms of the scheme of things, in terms of the main issue that I was concerned about, which was the bleeding and the apparent life threatening events, all this was was information that added some component to it. Even if there had not been a torn frenulum I would have still had the same concerns about the baby and concerns about the bleedings and the apparent life threatening events.
Q And the last matter that had attention specifically drawn to it was again on page 44 at item number 4 which deals with the question of blood; do you see that at number 5?
A Yes.
Q “The fresh blood in Christopher’s lungs after death would be typical of intentional suffocation. The old blood in his lungs could have been associated with a previous episode of intentional suffocation”. That is what you wrote and what is said about that is that you did not have a post mortem report or witness statement and he said in his evidence and I ask you to deal with this specifically, “You could not have known about these matters”. Do you know about them?
A Yes, I did.
Q And, for the avoidance of doubt, from whom?
A Initially from the video. I think Professor Berry commented in the video about the old blood. Then I spoke at length with Professor Green. Now Professor Green and I had both, I Knew he had a major interest in intentional suffocation and bleeding into the lungs and so I talked to him about this and this is my opinion on that, it is a comment, it is under the “comments” section. The old blood could have been associated with a previous episode of intentional suffocation, that is my opinion correct, and the fresh blood would be typical of intentional suffocation is also correct, based on literature review and discussions with Professor Green.
Q There are two fundamental matters I would like your help with. Wherever a statement of fact is made in this document, did you know of those facts?
A Yes.
Q And when you recorded them as facts, did you believe them to be true?
A Yes.
Q When you record a statement of opinion by you, were those statements of opinion honestly held?
A Yes.
Q If you look at page 45, right at the last line:
“I declare the contents of this report are true and that they may be used in a court of law”.
By the same token was that assertion of declaration true?
A Yes.
Q And did you anticipate at least the possibility that this document might find its way before Mr Justice Connell?
A Yes I did.
Q Before we leave this document, if we could deal with a couple of matters arising out of the conclusion. A number of matters in the first major paragraph under the “conclusion” heading, I think probably summarises what you have said in the body of the document, but I take you to the short sentence immediately below that, where it says:
“I feel that every event subsequent to that in the hotel should be re-examined with this new evidence in mind”.
Who were you addressing that opinion to, namely that the event should be re-examined?
A I was addressing it to the family court, but hoping that they might request the police to re-investigate some issues, taking into account what I was trying to say.
Q If I can just take you to that next but one line:
“I suggest that all of the remaining film work undertaken for the Despatches programme but not shown, be examined”.
Why did you suggest that?
A Because I thought that there might be some information there which would be helpful to the family court in deciding about the risk to the baby.
Q In compiling this report to Professor David, did you go through the mental process or the mental diagnostic process that Professor David talked about in his evidence yesterday?
A Yes, I did.
Q Did you consider the question of spontaneous bleeding caused by a foreign body or viral infection?
A Well, yes, both of them.
Q I want you to deal with how you dealt with it. Did you consider them?
A Yes.
Q Did you reject them?
A Yes.
Q Did you consider ---
A Well hang on, sorry, I do not want to mislead you. I did not consider foreign body in the nose and because babies do not have foreign bodies in their nose unless somebody has put them there, not at this age, and viral infection, I never in my whole career seen or heard of a baby with a virus infection bleeding from the nose during that infection, less somebody had pushed a tube into the nose for treatment purposes.
Q So as an issue that can be put on one side?
A Yes, I think I was wrong when I said that I considered them and rejected them. I would not have considered them, because they are not relevant. I made a mistake when I said that.
Q Did you consider whether the bleeding as recounted may have been caused by an underlying blood clotting disorder?
A Yes, I did.
Q And did you reject that?
A Yes.
Q Did you consider whether the bleeding might have been caused by IPH, in other words that the mechanisms was mimicking a nose-bleed?
A Yes, I did.
Q Did you consider that?
A Yes, I did.
Q And did you reject it?
A Yes, I did.
Q I will ask you what was left?
A Because of the combination with apparent life threatening event, intentional suffocation was left.
Q By one or other parent?
A Yes.
Q And did you apply your mind to the two choices, Sally or Stephen?
A I did.
Q And we can see you came down on the side of Stephen?
A Because he was there when the nose-bleed occurred and because they are contemporaneous.
Q It is the case that within the document, or at the end of it, you do not specifically say that you have not been given access to the documents, either the totality of them or even the narrow tranche that you were led to believe, you told the Committee, that you might get?
A Yes.
Q Now why did you not mention that?
A Because it was known by all of us that that was the case, because it was known that I had not been given access to the documents by everybody who was going to receive the document. However, saying that, I do accept that it would have been better to put it in, if only to prevent this for instance and, you know, I regret that, because it would have been a good thing to have done it, but it was not essential to my concern.
Q If you had thought about putting it in and put it in would it have changed your opinion in any way?
A No, not at all, I have already been through that.
Q Following the disclosure of the report you had a meeting with Professor David on the 8th September and for my present purpose it is not necessary to dwell on the content of that meeting, save this: did you repeat the thrust of your argument to Professor David?
A Yes.
Q And did you refer to your paper?
A Yes, I did.
Q Did you refer to any other matters?
A Yes, I referred to the body of world literature and I referred to my category two work, but not in the specific detail I have got here.
Q Not in the detail that the Committee have in the schedule?
A No.
Q You received on the 10th September, if we go to page 46, an e-mail from Professor David and let us just look again, please, at the second paragraph:
“I appreciate that for all the reasons that you set out” – he is presumably referring to the report – “you have great concern about the possibility that Mr Clark rather than Mrs Clark killed the children. My question is simple, do you accept that it is possible that there is either medical data, or circumstantial data, or both, that could in fact largely or even completely exclude the possibility that Mr Clark killed either of his children?”
And that question is linked to his invitation to appending a caveat. When you received this
e-mail how did you respond within yourself to that invitation?
A It was the question that bothered me, it was the question that was so relevant and important, which is exactly as it is written and I thought a long time before replying. Since my report had gone in, the only new contact I had had was with Professor David and again there was consolidation of what I was thinking and in particular Professor David, I believe and I remember, completely agreed with me that nose-bleeds and apparent life threatening events are coincidental without the delay, you know, he backed me up, and I was already at the point of my report certain in my own mind that Mr. Clark had been responsible and when writing that first report I was mindful if you are going to make such a statement, such a serious allegation really, the evidence needs to be strong and I considered that from my enquiries, albeit without what I would have liked, that my enquiries were strong enough for me to express that opinion in the way I did and so the answer to Professor David I thought about and then produced, as you know.
Q I am sorry you dropped your voice.
A Then I produced it, as you know, in my response.
Q In your e-mail?
A Yes, in my response.
Q If we can just turn to page 47, can you tell the Committee, does this e-mail of yours in effect represent accurately what yourself felt at the time and what your analysis was at the time?
A It does, yes.
Q Is it exaggerated in any way?
A No.
Q Just let us look at it. On the second line:
“I should say and should put into my report that I had undertaken a number of discussions with people involved with the case after seeing the video, namely Mr Gardner, the guardian and the social worker.”
Just pausing there a minute. Did you at any stage ever tell Professor David you had spoken to Professor Green and Professor Sir Roy Meadow?
A No.
Q It goes on:
“I had asked questions relating to other, possibly extremely unlikely mechanisms for the bleeding and scenarios which would allow rejection
of my opinion. I received negative answers to these questions.”
Is that the truth?
A Yes.
Q You go on to rehearse them:
“Thus there can, in my opinion, and beyond reasonable doubt be no explanation for the Apparent Life Threatening Event suffered by the first baby.”
Professor Southall, when you use that expression what were you seeking to convey?
A The strength of my opinion.
Q How strong was it?
A Beyond reasonable doubt in my mind.
Q And you use that expression again in the fourth line from the bottom. There is
a sentence on the fourth line I want your help with:
“I am not used to giving opinions without all of the evidence being made available and I feel vulnerable over my report.”
Let us pause for a minute. You had declined the invitation to put a formal assertion at the bottom of the report?
A Yes.
Q But you are here saying, on the other hand I have not had all the documents, and
I feel vulnerable over my report. Can you help the Committee about an apparent tension there between those two positions?
A Yes, this is very difficult to put across and I will just try, but basically the issues that were being addressed in my opinion are incredibly complicated and based on a lot of experience and I also know that, quite rightly, it should be tested, my opinion should be tested. Properly tested. I knew that if it was properly tested one of the questions would be: well, where is the source data for some of these issues? The source data was extremely experienced forensic pathologist, the police, and a very experienced child protection paediatrician. But having the paper work would have been the -- would have been ideal, but it would not have changed the strength of my opinion and as I had not been given it I could have said: “Right - no opinion. I'm not going to give it”, but then
I have already mentioned to you the massive delay that there had been in this case. I was also, I have to say, very concerned that the original plan, which was for me to meet with the solicitor for the child and Professor David had been overturned. That plan was absolutely within the spirit of child protection; sharing of information and so as that had not happened I was feeling vulnerable and I suppose I was trying to capture some of those feelings in this sentence. But the strength of my view was not in question, it was my vulnerability that was in question.
Q You closed the e-mail by saying:
“Based on what I saw into that video and my discussions with the police officers, social worker and the guardian I remain of the view that other explanations cannot hold. The evidence of the family friend…”,
again, just for clarification, who is that?
A Liz Cox.
Q Yes.
“…is particularly important.”
Professor Southall, when you expressed these views in the e-mail were those opinions honestly held?
A They were, yes.
Q Can you take the notice of inquiry, again, please. The blue document. I take you to Head 8, and I ask you these questions in the context of there having been a considerable amount of time which has elapsed since the actions which you took in the year 2000. It is nearly four years since these events. In the light of what you have described to the Committee you did and in relation to why you did it, do you think that what you did was inappropriate?
A No.
Q Do you think it was irresponsible?
A No.
Q In your opinion was that report misleading?
A In only one sense and that was that I had not revealed my discussions with Professor Green and Professor Meadow.
Q That apart, was there any other aspect of that report which was, on reflection, misleading in your opinion?
A No.
Q Of course, there is then the catch-all of an allegation that you abused your professional position in relation to the report and, secondly, in relation to the e-mail of yours declining to add a caveat. Do you say or accept that you abused your professional position?
A No, no.
MR COONAN: Professor Southall, that is all I am going to ask you.
THE CHAIRMAN: I think probably this would be an appropriate moment to have a break before Mr Tyson begins his questions.
MR TYSON: I wonder if I can have a slightly longer break than usual? If we start again at 12?
THE CHAIRMAN: Yes. We will take a break now, we will resume at 12 o'clock and, Professor Southall, I need to remind you that you are under oath and you should not discuss your evidence.
Cross-examined by MR TYSON
Q Professor Southall, in view of what you were telling the Committee both last night and particularly today, is it still your view that Stephen Clark killed both the Clark children?
A Yes.
Q And, thus, it is he who should be still serving a life imprisonment?
A I would not -- I am not able to make that comment. I am -- my concerns were over the baby, the safety of the baby and the access of the baby to the mother. I am not interested in the criminal side of this. It is not my place to be.
Q Save your concern expressed both to the police and the social services was that
a miscarriage of justice had taken place?
A Well, I do not know that phrase is my phrase, but I felt that the information I had on the bleeding nose incident indicated that Mr Clark had done it and, therefore, that the two subsequent deaths had been done by Mr Clark as well. That is where I stand on that.
Q And you still stand today?
A I do, yes.
Q That is having still not seen any of the medical material relating to the case?
A The medical material relating to the two dead babies and the third living baby
I have not seen, but I indicated earlier that my opinion on this related to the living baby and that event, for which, as far as I am aware, there was not any, in the living baby,
x-rays, medical reports that I could have had access to. The type of data I wanted access to was information surrounding the cause of the nosebleed and breathing problem.
Q But it was crucial information, was it not, because it was from your analysis of the nosebleed that all else follows?
A Not crucial to the strength of my opinion, but valuable and I felt it needed to be
re-examined in the light of the new, what I considered to be new slant on the case that
I was bringing.
Q We will come to that in a moment. I wanted to get your current position. Can
I make some observations about your research and see whether you can agree with me or not, to see where we are apart on that. I say that, as my learned friend did, the research aspect is not the highlight of the Heads of Charge against you. Do you accept that in Christopher there was no record of apnoea?
A I do accept that.
Q And there was no record, or you knew nothing of whether or not there was
a colour change in him?
A No report that I saw.
Q No report that he lost consciousness?
A That is correct.
Q No report that there was a change in tone, colour tone?
A No.
Q And no report of unresponsiveness?
A No.
Q You accept that?
A I accept that. I accept all of that, yes.
Q Do you accept that it follows from that that the label ALTE would not be put on Christopher in a number of the definitions of an ALTE?
A By certain, yes, I agree with that.
Q Yes. Including the confidentiality inquiry, the SENSI paper which is the biggest in sudden infant death?
A In sudden infant death, but on not on Apparent Life Threatening Event it is not, it is big issue on sudden death but in terms of Apparent Life Threatening Events that is one of the factors.
Q But they interviewed, I think, over 300 (Inaudible) in depth, it is very big?
A It very big, yes.
Q So it would not fit in with the SENSI definition, nor the Birchfield and Rawlings definition of ALTE?
A I accept that, yes.
Q Or the Rahalegh(?), if that is how you pronounce it, definition?
A From memory, to be absolutely certain I would check it, but if you are telling me that, it sounds like that.
Q I can take you to the references.
A If you wish, but as I recall that is correct.
Q Similarly in does not fit in with the Beale definition?
A Again, I cannot recall all of them but sounds like that is right.
Q So we would have not fallen out yet on matters. I will try another one, do you accept that Christopher and the event relating to Christopher in the hotel, that would not have qualified him to have been part of your panel of 39 previous suffocations that you in your study put through CVS?
A In what respect?
Q That his event was not, as it were, as strong or dramatic or whatever?
A You are raising the issue of cardiopulmonary resuscitation.
Q I am not necessarily raising that. If we look at your sample. If we could see C4 at page 319 and we see under “Method” at 319 that:
“39 patients underwent CVS. 36 after an ALTE. The number of ALTE reported by parents before CVS ranged from 20 to more than 50”?
A I am lost. Sorry.
Q Under “Methods”, page 319?
A Yes got that.
Q The first paragraph?
A Okay, yes, sorry, yes.
Q
“The number of ALTE reported by parents before
CVS ranged from 2 to more than 50 (median 7)”?
A Yes, that is correct.
Q So on that basis alone Christopher does not fit into that group, does he?
A No.
Q In addition in 29 of the patients of your CVS team or group, if I can put it that way, 29 of them had had cardiopulmonary resuscitation and Christopher did not fit in that either, did he?
A No.
Q So he did not qualify for your group of 39 because your group of 39 was taken, if
I can put it this way, at the top of the end of the scale?
A I would not use the phrase “would not qualify”, I would use the phrase did not it fit into that those two caveats that you just raised, but he still had an Apparent Life Threatening Event, according to the definition we used, and he had bleeding, according to the definition, and probably of most importance he subsequently died suddenly and unexpectedly and, of crucial importance, suffocation was deemed the mechanism.
Q But you would not know about that at the time, would you? I am talking about the history of ALTE. He had one.
A No, that is correct.
Q Whilst we are looking at this page, can you look at the left hand column and when you are describing your own work when you say “during the past 10 years”, do you see that?
A Yes.
Q It is the third paragraph down of the article.
A Yes, I can, yes.
Q “During the past 10 years, we have developed the use of covert video surveillance and documented the persistent and perverse nature of this life-threatening abuse as it occurs in infants and young children presenting with one particular symptom, namely recurrent apneic or cyanotic episodes, often called apparent life-threatening events”.
A Yes.
Q Christopher was not, was he, displaying recurrent apneic episodes? That is correct, is it not?
A Only one. Not recurrent.
Q Yes and no cyanotic episode.
A Correct, that is the blue, blueness, yes.
Q Do you accept from what Professor David was saying that your group of 39 was highly selective? It came from all these different hospitals, I think 32 different hospitals, and they came to you on the basis that the ALTEs that they had sustained were in some way suspicious. That is right, is it not?
A Yes. We mentioned this yesterday.
“Therefore these figures cannot provide a true epidemiological indication of the frequency of intentional suffocation as a mechanism”.
Q Yes.
A But they are selected.
Q They were selected because there was a high index of suspicion in relation to the ALTEs.
A That half of the group -----
Q Yes, the 39.
A There is a control group.
Q Yes. I have not reached the control group yet.
A Fine. Yes. That group was selected, yes.
Q The suspiciousness of the ALTEs largely was that the ALTEs had involved to a significant extent suffocation.
A No, the reason that they were selected was ----
Q No, but as a fact.
A No, the fact is that they had prior to CVS evidence on their physiological recording suggesting it and then -----
Q Suggesting suffocation?
A Suggesting it and then it was subsequently factually based, yes.
Q But the reason for inclusion of this highly selected group was that their previous ALTEs had involved a suspicion of deliberate suffocation.
A Yes, both in clinical and physiological terms. That is correct.
Q It is right, is it not, that it is well known in the literature that there is an association between suffocation and bleeding?
A Yes.
Q You set out, for instance, in the document D2 that you have given us, for instance, the Beecroft paper which we can see at one of the pages. There are a number of page 8s. It is the one unmarked page that is between page 11 and page 9. Do you see that, the Beecroft paper?
A Yes.
Q So in a sense in your group of 29 -----
A 39, sorry.
Q Group of 29.
A 39, sorry.
Q In your group of 39 they were selected because of the suspicion of suffocation in the past and there is an association between suffocation and bleeding, so in a sense you are expecting to see bleeding, are you not, of some sort from the nose or mouth or both in that group?
A Prior to our work there were only a few such cases, as you can see from my literature review, but based on those few cases one could anticipate possibly that that was an issue or could become an issue when we analysed the whole group.
Q But there was a prior association. We just have to look at the heading of table 2 -----
A Yes, I agree.
Q Where you say:
“Papers describing bleeding from the nose and/or mouth in association with ALTE or sudden deaths in infants …. wherein intentional suffocation has been considered the probable mechanism”.
A I agree, yes.
Q So in your selected group you are anticipating seeing bleeding, are you not?
A Yes.
Q In your control group it was also highly selected, was it not?
A Yes.
Q I think they all required CPR.
A Yes.
Q And they all had either respiratory or epileptic problems.
A Yes.
Q It is right, is it not, that in those circumstances you would not expect to see bleeding from the nose or mouth associated with epilepsy or with respiratory problems?
A It had not been reported.
Q So one of the principal differences between your control group and your group of 39 is that in one group you are anticipating seeing bleeding and in the other group you are not anticipating seeing bleeding because it has not been reported.
A That is correct.
Q So your control group, because it was so different from your group of 39, you are not really comparing like with like, are you?
A It depends how you interpret that, but I am not going to argue. What you said earlier is absolutely correct. It is a retrospective study and I made that clear. So retrospective studies always have that as a caveat. So it is not a prospective study.
Q But there is that difficulty, I suggest, in trying to generalise from your research that in one group you were anticipating bleeding, in the other group you were not anticipating bleeding from the nose or mouth.
A We discussed this with the statisticians involved in our work and they thought that it was appropriate to do that statistical calculation and we are talking high level support on this and Pediatrics is the number one peer reviewed paediatric journal in the world and they do not publish anything unless it is really rigorous. I know what you are saying and I accept it completely ----
Q Right, we will move on.
A But it does not damage the relationship between the cases and the controls in terms of the results.
Q It is also right as a matter of fact in relation to your research, is it not, that you found only three infants who had bled by the nose in their ALTE where subsequently CVS showed suffocation?
A Yes.
Q Three out of your highly selected 39. It is also right as a matter of fact from your research, is it not, that in your video surveillance you did not observe any bleeding on the suffocation there observed ----
A Yes.
Q For all, of course, the proper medical reasons that you intervened before ----
A That is correct, yes.
Q But it is a matter of fact that you did not observe it.
A No, we did not, no.
Q It is also a matter of fact from your research that you relied on all the information relating to the apparent life threatening events from the parents themselves ----
A That is not correct.
Q To a large degree.
A Now you have qualified it. If you look even in our paper there is a report by a nurse who found the baby having one with blood coming out of their nose. I think nose or mouth, I would have to look. But it is correct that most of the reports came from the parents, but some came from other professionals.
Q Yes and you appropriately cautioned your report, as we have seen, at page 327. Perhaps we can just look at that at the end of your table 3, I think it is, at page 327 where you say:
“The number of ALTE reported refers to information received from the parents and must be considered with caution”.
A The important word is the “number” there, “the number of”, not “associated features of”.
Q The information that you were relying on from the parents was from parents who, because of the very nature of how the parents and children were selected, were parents who were considered by you to be abusive parents.
A That is correct.
Q So you were having principally to rely on what abusive parents were telling you about the previous events.
A Yes.
Q You had no formal proof that the previous ALTEs were a result of deliberate suffocation.
A The concept that they might have been natural was considered actually, because ----
Q Perhaps you can just answer my question.
A Yes, but ----
Q The answer is yes, is it not? You had no proof that the previous ALTEs were a result of ----
A The answer to that is yes.
Q This is the last point about your research data in particular. There is no research data, is there, that all nose bleeds in infants not due to coagulation disorders are due to suffocation?
A There is no information that absolutely defines that as a fact, because such information would be almost impossible to obtain.
Q But it is a fact, is it not, there is no research data that says that all nose bleeds in infants who do not have coagulation disorders are due to deliberate suffocation?
A That is why I put the rider into my report “according to our research”, because that is a crucial phrase.
Q Yes, but your research does not support that proposition as a fact, does it? There is no research data that all nose bleeds in infants that are not due to coagulation disorders are due to deliberate suffocation.
A There is, as far as I am aware in the world literature, no information that nose bleeds in infants due to other conditions that are medical in babies of this age other than due to commonly ….. well, not commonly, keeping away from the very, very, very rare.
Q In that context, in the context of what you and I have largely agreed upon, can we just for a moment look at one aspect of your court report which we find in the 40s in this case, starting at page 42 and I would like to pick it up at page 44. It is the first paragraph where it said:
“Christopher suffered an ALTE with bleeding from both nostrils 10 days before he died”.
First of all, you are expressing that as a fact, are you not?
A I am.
Q As a scientific fact.
A A fact. I do not know where the science comes in, but fact.
Q Secondly, you have accepted already that not all definitions for an ALTE would fit in with that description.
A I am accepting that.
Q Then you go on to say that ALTEs which are accompanied by nasal or oral bleeding
“are due to intentional suffocation according to our research”.
There is no equivocation there, is there?
A No.
Q You are stating that as a fact.
A Yes.
Q I have to suggest to you, first of all, as we have discussed, whether there was any research basis for that and you have admitted no and, secondly, that in relation to Christopher your research cannot be used in relation to Christopher in this context, because with your highly selected group you cannot say it follows that if you have an ALTE and if you have a nose bleed it must be due to suffocation.
A According to the research, using the definition of ALTE that was in it, that sentence is correct.
Q But it is a circular argument, can I put to you, because you cannot say, as I said, that if you have an ALTE and you have bleeding from the nose it must be due to deliberate suffocation because you have pre selected your 39 on the basis that they had been suffocated already.
A We did not prove that until we got the CVS but, yes, but the important point about the paper is that it was a case control study and that we had a control group whose ALTE defined in the same way was due to something else, natural causes. So that is the point that I was making here in this report.
Q But the point in relation to Christopher arising from that, do you accept there is a circular argument that if you selected your 39 on the basis that they have suffocated already, you cannot say it follows that if they have an ALTE and bleeding that it must be due to deliberate suffocation? So it is a logical nonsense.
A No, it is not, and I do not think that is the right way of analysing the data that I presented, nor was it the way it was analysed in the paper and it is not a circular argument, it is a controlled argument, and just because a few case reports have revealed that bleeding could occur did not affect that argument.
Q But are you not generalising? Isn’t the serious problem here that you are generalising in relation to Christopher from the highly specific group of 39 to which Christopher is, you have told us, not an obvious candidate?
A No, because that would be a fair comment if I had not put at the end of that sentence the phrase I have repeatedly given you and if you look also at those 39 patients in the paper, many of them had events similar to Christopher. Not all of the events were accompanied by cardio pulmonary resuscitation. To qualify for the study one of them had to be and you saw that the number of events varied from two to a large number. So I still believe that Christopher’s event can be looked at reasonably. I understand what you are saying, but it can be looked at reasonably within the context of this research, this case controlled research.
Q You see when you say, as it were, as a fact ALTEs, which are accompanied by nasal/oral bleeding are due to intentional suffocating, you seem to be qualifying that even in the course of giving your evidence in this case where I noted you said that, “It is likely to be caused”?
A But you missed out the last phrase again when you read the sentence, “According to our research”, and that statement, I believed, to be fair. If I had left off the phrase at the end I think that your argument is absolutely correct.
Q Why is it, therefore, that even in giving evidence today when describing your research and your evidence on those two lines, you use the expressions – and my learned friend will correct me if I am wrong – that instead of using the expression, “They are due to intentional suffocation”, you qualified it by saying, “Highly likely to be due to”, or, “Likely to be due to”, as opposed to, “Are”; you see it is important?
A Yes, you know, I understand that, the difference in words. The research showed, as I said from the statistical analysis, and we can go over this for ever, but one in ten thousand chance of this being by chance alone, so when you are talking about something as being a fact in medical, or medico-legal work, the concept that it is always a hundred per cent is difficult. It is to do with wording. If you are saying to me, “Would you prefer to use the word ‘are highly likely to be due to intentional suffocation’?” I don’t think that would have affected the strength of my opinion, but it is a reasonable point, but I still stick to what I said.
Q You see what I am suggesting to you, Professor, is that as in a number of occasions you make statements without qualification in a dogmatic way and this is just one of them?
A And that is why I have put … If I was to leave off, “According to our research”, and used, “Highly likely”, that would be okay. As I put in, “According to our research” and the word, “are”, I think it is reasonable.
Q Except as we have been through it does not follow from your research, but I will not go round it again. Can I go to a different area entirely and that is about the involvement that you say in this case of Professor Green and Professor Meadow?
A Yes.
Q Firstly can I put this: those are both individuals who are known to you?
A Yes.
Q And are friends?
A Very difficult word. There are different levels of friends. I am friendly with them, but we do not go out together or do things together, you know, but I am friendly with them.
Q And professionally, if I can put it this way, you come from the same viewpoint as to the importance of rooting out child abuse?
A I do not like the phrase, “Rooting out child abuse”, I do not like that phrase.
Q Use your own phrase?
A Helping to protect children from abuse.
Q It has been suggested in some quarters that you and Professor Green and Professor Meadow and others are, as it were, missionaries in this field; would you accept that as being a description that has been used to describe you three?
A I accept that that has been a description used.
Q Can we look at one or two documents for a moment, but before we look at them can we see if we can agree on some basic propositions that in child protection work openness is all, to use, I think, your own expression in-chief, and I see you nodding?
A I am not there yet, I just want to answer you. I think it is a very important part of the proceedings, openness, yes.
Q And in child protection work sharing of material is the key to the multi-disciplinary approach?
A Yes.
Q And for the benefit of the child who is sought to be protected, sharing of material includes sharing of information?
A Yes.
Q Because it is through the openness and the sharing of information that proper protection can be planned for the child?
A Yes.
Q So why was it thus that when you met two key members of the team, namely the principal social worker and the guardian, you did not share with them the information that you had had telephone calls with Professor Meadow and Professor Green?
A Because they were not questioning the factual basis for what I was saying about issues such as, for example, the blood in the lungs, they were not questioning the factual basis.
Q Who was not questioning the factual basis?
A Anybody in that meeting was not saying to me, “But Professor Southall, you do not know the facts, you cannot know this”, because if anybody had said that to me at any time I would have said, “Well, I do, because I have spoken to Professor Green”.
Q Let us just look together, please, at page 27 under, “Stephen’s role”:
“It was understood by all three of us that Professor Southall’s knowledge of the case was derived almost exclusively from the Despatches programme”.
A That is what is written.
Q Yes. Is that wrong what is written?
A Yes.
Q And if it is wrong, why did you not tell those two people the crucial information relating to child protection that you discussed the matter with Messrs Green and Meadow?
A Because nobody questioned what I was saying that I had got from them, so when I, for instance, just sticking with the bleeding, nobody said, “There is something wrong with that”, or, “You have got it wrong, where is the factual basis?” Nobody said that to me, they accepted, without reservation, what I was saying and they were confirming and consolidating it themselves.
Q But you have been relying throughout during the course of your case here before the Committee on the support you say you derive from your telephone discussions with these two gentlemen?
A Yes.
Q I repeat the question, why did you never divulge that involvement, the fact that you were relying on, to the two in this case, the crucial social worker and the children’s guardian?
A The programme itself outlined those … let us stick with the bleeding for a minute, because it is simple to stick to one. That was outlined in the video programme. The social worker and the guardian both knew that, I knew that. I said that that was the case and they agreed, they did not say, “Where is the basis for that?” or “You have got it wrong”. If they had said, “Oh, you have got it wrong, there was no old bleeding, the programme was faulty”, I would have said, “But that is not my understanding, because I have spoken to Professor Green and Professor Meadow”, and I think mostly Professor Green on that point. So nobody, neither of them, questioned my knowledge base on those facts.
Q Because everybody was assuming, because that is all you let everybody know, that your knowledge base was based on the television programme?
A Because, as I said earlier, I was a bit concerned to be careful about my discussions with Professor Green and Professor Meadow, because I did not want to in some way get them into difficulties.
Q Well you have said that and that is exactly … As you know, they gave evidence in the criminal trial?
A Yes, that is right.
Q And as you know a criminal trial is held in public?
A Yes.
Q And there was nothing, was there, that would prevent them telling you what they had said and learnt from the criminal trial?
A Probably that is correct, but ---
Q So why did they need protecting?
A Because there was the appeal and I did not know whether there was information, for example, that they were not supposed to discuss and a good example was the fact that they were not prepared to appear in that television programme because they were, I do not know, worried about talking about it. If you remember, none of the prosecution witnesses appeared in the television programme. But I have admitted already this morning that I was unsure about this and as there was no questioning on my factual basis, I did not at that point feel it was necessary. I had indicated it to the police though, as you know, I had told the Detective Inspector Gardner.
Q I understand that and it is there recorded and I do not dispute that. What I am failing to understand at the moment is why you felt the need to protect your sources, if I can put it that way, when the sources had been given public information about their knowledge, I simply do not understand it?
A It was not a big issue at that point. It became an issue later, but at this point neither of the social workers questioned the facts on that issue, on say the bleeding issue, nobody said to me, “But where did you get that information and is it certain?” because they knew it was a fact already themselves, so there was nothing to dispute and there was no need to bring it into the discussion, that is my view.
Q That is not right, is it, they were dealing with you on the basis that you had watched a television programme, that is what they said they dealt with you on the basis that you watched a television programme?
A And that I had talked to the police, both. And that I talked to the police is a very important point.
Q The matter is compounded, I would suggest, if we look at the strategy meeting, and that we find at page 29 and we see the concerns of Professor Southall on the bottom of page 29?
A Yes.
Q “Professor Southall outlined his involvement in that he knew a little about the case as he had been observing the issues that were arising on the web site devoted to alleged child abuse and he had been watching the debate that unfolded on the web site at the Royal College also”. That is what you told them. Pausing there for a moment, it is right that on no web site would the medical data be reproduced, you would not get the medical reports and the post mortem on the web site?
A No.
Q “He was also aware of a lot of hype about the programme and therefore had watched it. As he watched it, Professor Southall realised that much of it focussed on Mr Clark and in particular in relation to the nose-bleed and Professor Southall had many concerns about Mr Clark’s involvement”. Now here is a serious strategy meeting to decide what to do about your “concerns”, attended by representatives of the police, social services, the guardian and the like and the local authority. And I repeat my question, when you were outlining your sources as you were at the bottom of page 29 and the top of page 30, why did you not indicate that you felt your facts were true and had been verified by the virtuous discussion with one or other of the other professors, why did you not do that?
A For the same reasons I gave earlier, but also – again I gave this earlier, but I will just repeat it – the key issues in this case were not around the findings at post mortem, they were important, but not the key issues. The key/new thing I was bringing to this case was the living baby with the event.
Q Pause for a minute on “new”, we will flag that up and come back.
A Sure. But that was the major focus of the new stuff that I was bringing to the child protection strategy discussion, it was the emphasis on that ---
Q Well let us deal with “new” now. You did not know, did you, whether the information you were providing was new, because you did not know what they already knew?
A I knew that from my earlier discussions with Professor Green that the delay had been the issue, the delay that had been postulated. I knew also that the delay has been postulated, because I spoke to Detective Inspector Gardner about it.
Q You knew it from the television programme?
A And, I am going backwards, you are right. The television programme, but most importantly the discussion with Gardner and Green, the delay was in issue and that was the big issue that I had, if you like, as a new, in my opinion, new information, new emphasis.
Q But it was not new as it turns out, was it, Professor, because it was a matter that had been raised centrally in Professor David’s report?
A But I had not seen Professor David’s report and I had not, up until now, you know, until these proceedings, I have never seen Professor David’s report.
Q But is it fair to assume that you assumed that you were giving new information?
A That is the right point, I assumed that I was giving new information, based on my discussions, the video, Mr Gardner, Professor Green discussions.
Q And your assumption was in fact wrong, it was not new information, do you accept that too?
A The emphasis was new and I think Mr Blomeley confirmed he felt that the emphasis that I was placing on this was new and that I had information from my experience in child protection and in particular intentional suffocation that needed to be listened to.
Q Whether or not Mr Blomeley felt it was new, in fact it was not new, because it had been raised at a report that was available at the criminal trial?
A But there is a natural lack of logic in this, because if indeed the criminal court had accepted that there could not be a delay, then why was Mrs Clark in prison? So, therefore, it was new, or the emphasis on it had not been adequately looked at in life.
Q What I am saying is you were not in a position to know what the arguments for or against delay at the criminal trial, at that time?
A Except for my discussions with Professor Green, which I had had, yes.
Q Are you saying that are you relying on telephone discussions as a source of primary fact?
A Telephone discussions with somebody who was well informed about the concept that there was a delay, yes.
Q But a telephone conversation with one of the participants can be no substitution, can it, for the primary data?
A The primary data is better.
Q Perhaps you can accept my proposition: there can be can be no substitute?
A Yes, it is better.
Q For the primary data?
A It is better. I remain of the view it is better. No substitute is the ideal situation.
Q In this meeting, in this strategy meeting, you made no reference, as you accept, to the meeting that you had had any discussions with these outside experts and to an extent,
I have to suggest, you, thereby, misled them as to your knowledge that you had about the case?
A I think that in retrospect I should have mentioned that. I said that earlier in my examination. But I repeat that nobody present had questioned those particular concepts which were not the main issue I was raising. The main issue was the living child with the bleeding and Apparent Life Threatening Event.
Q You felt it was the main issue, but, as you know, different people come with different views to child protection conferences?
A Yes.
Q What makes child protection conferences work is sharing of information?
A Yes.
Q And you were keeping a few cards behind?
A Not cards, because cards imply something that had never come out before.
If I was holding back information that have never been discussed anywhere before, that concept that you have raised would be correct. What I was doing was failing to, if you like, provide the chapter and verse for what had already been reported on the video and which was already known by the people present, but which all I was doing was not confirming that with them because nobody asked me to confirm it at those meetings. Nobody asked me to confirm that, so I did not.
Q I accept that you were not cross-examined---
A That is---
Q ---about the source simply because that -- what you said was “Why should anybody disbelieve you”, you said in terms that you knew a little bit the case from two sources, one the websites and, two, the television programme?
A But it was not like that in the sense that -- I think that is a very good phrase, I was not
cross-examined and these are not my minutes, so…
Q But you did not volunteer any other source, did you?
A At that point, no, I did not.
Q You are being less than frank in that?
A I have already said that in retrospect I could have done. But if you really wish to understand that issue I think I should perhaps present the fact that the real issue over qualification of facts came in the submission that Professor David made to the court, which I did not see, and the important point I would make is that Professor David did not share what he was going to put into the court with me before he put it in, because if he had said to me: “I don't think these are facts, David, I think that these are suppositions”,
I would have said to him: “I'm sorry, but that's not true, I have spoken to Professor Green.” So my contention is -- the real problem here is that the information that Professor David submitted was not shared with me before he put it into the family court.
Q Let us go back on the chronology, I will come back to that. The next bit of the chronology is your report.
A Yes.
Q It is right as a matter of fact that you did not mention in support of any of your contentions, both as to conclusions and as to fact, the involvement of Messrs Green and Meadows?
A That is correct.
Q You set the out in terms what you observed from the television programme?
A To start with in the paper, yes.
Q Your narrative was from what you had seen from the television programme and then your analysis does not depend upon the involvement of any other source of information, does it?
A Yes, it does.
Q Save the website and your research?
A No, no, no. The analysis relied on a sequence of events, a sequence of checking. Your point is that I did not reveal all the check points, but I did them all. That is to say
I started off with the police, Detective Inspector Gardner, sorry, I started off with Professor Green and Meadow, then Detective Inspector Gardner, then the social workers and I was consolidating all along my view before I wrote it down.
Q We will come back in due course as to what you learnt from the each of the sources. I am leading to the involvement or otherwise of Messrs Green and Meadow.
A Sure.
Q The reader of this report, as you call it, would understand that you had seen a television programme and that you had done some research and you produced your article in paediatrics in support. That is all the reader of the report will know as your sources of information. Is that right?
A Sorry to be -- I just want to get this correct.
Q Take as much time as you like.
A (Pause) Yes, that is correct.
Q You are familiar with the drafting of medico legal reports?
A Yes.
Q You have an enormous experience of writing reports for the court, both for care proceedings and in criminal proceedings?
A Yes.
Q Indeed, you are probably one of the most experienced consultant paediatricians in this area in the land?
A Yes.
Q You are aware as a basis for writing any report that you set out your sources of information?
A Yes.
Q So that the reader can see where you are coming from?
A Yes.
Q So why did to the you not set out in your report the sources of information that you had obtained, so you tell us, from Messrs Green and Meadow?
A Because this was completely different to the usual report that I produced for the court. In that, firstly, it was requested of me that the report to the court was going to be put in not by me but by Professor David. What I was to provide was points of concern in writing to then be considered by a meeting between Professor David, myself and the solicitor for the child and that I had understood at that point I was going to have the papers. So the whole thing is completely different to what I normally do. So this is
a unique situation and that is why it is different.
Q We will come to what you were asked to do, but the result is a court report, is it not? It is headed report -- medical report?
A I do not think it says court report. It says medical report.
Q It is tailed that it may be used in a court of law?
A It may be used in, but that is different to saying this is a court report of the same kind I am used to doing. It is words again but I am going back to what I was asked to do. I was asked to put in writing my concerns and I have already agreed that in retrospect it would have been better if this was labelled points of concern. But this is not like my normal medical report.
Q But in any report that is going to, or may come to a court of law, as you envisaged, you have admitted, you have agreed with me earlier that you have to set out your sources of information?
A In any -- I said that with regard to the reports that I am putting into court. I have just made it clear that I was not put putting this into court. What I was say here was
I would be happy, in effect, for Professor David to place this into the court as part of his report for the court.
Q Exactly. You anticipated, as you told us earlier, and, indeed, I suspect, wanted this report to come to the court?
A I did, yes, as part of a proper report put together by Professor David of the kind
I would do.
Q So, again, I ask the question, and it will be the last time I ask this, as this was a report which you envisaged going to the court, why did you not set out all of your sources of information?
A Because it was different to what I usually do. It was – the court had requested points of concern, it had not asked me to do a proper report. If it had it would have provided me with all the papers and it would have been my report, not Professor David's report.
MR TYSON: That might be a convenient moment, I am moving on to a slightly different area.
THE CHAIRMAN: Yes, we do need a break. We will start at 2 o'clock. I understand that we are agreed that we will finish at four?
MR TYSON: Certainly Mrs Tyson would appreciate that!
THE CHAIRMAN: There are quite a few people that would appreciate it. So, Professor Southall, again, the same comment from me about your evidence.
The Committee adjourned for lunch
THE CHAIRMAN: Mr Tyson?
MR TYSON (To the witness): Professor Southall, I am still on the topic of your disclosure of the involvement of Professors Green and Meadow and we have dealt with it in your report, but I will come back to your report and other matters later. Can I ask you, please, to look at bundle C1 at page 52. It is right, is it not, that on 8 September 2000 you met with Professor David?
A Yes.
Q As per the court order and as per the letter that you got.
A As per the varied court order.
Q As per the court order.
A It was varied though.
Q There is no evidence that the order was varied, Professor Southall.
A That is clear. What I mean by that is that I originally was due to meet with Professor David and the solicitor.
Q Yes.
A That is what I meant, that the change had occurred.
Q Yes. You accept you met him on 8 September.
A Yes, I did.
Q Just pausing here on one matter. Did you take any notes of your meetings with Professor David?
A No.
Q Did you take any notes of your telephone conversations with Professor Green?
A No.
Q Did you take any notes of your telephone conversations with Professor Meadow?
A No.
Q Up until and including the time that you prepared your report did you take any notes at all in respect of your involvement in this matter?
A Yes.
Q Where are those notes?
A I got rid of them years ago. They were in my note book, a little note book I carried around, and I remember after I looked at the video, every time I looked at it, because I was trying to work out what I needed to check, I wrote down the key points, so that when I spoke to, say, Professor Green, I had them in front of me. But I have not kept those notes.
Q Did you take any notes of the conversation that you had when you met the guardian and the senior social worker?
A No.
Q Did you take any notes relating to your involvement at the strategy meeting?
A No.
Q Do you accept that the note that Professor David made of that meeting was virtually contemporaneous?
A He told us, did he not? Yes.
Q Yes. Do you accept from what you have just told us that his recollection as recorded here of what took place in that meeting is more likely to be accurate than your recollection without the benefit of taking any notes of that meeting?
A That is a reasonable point.
Q We can see at paragraph 9 on page 52 that you outline your concerns.
A Yes.
Q As far as the concerns we see on page, 52 is it right that those were your concerns at the time, only one possible cause for the nose bleed which was intentional suffocation; nose bleeds from suffocation happen immediately; Mr Clark must have caused the nose bleed by deliberately suffocating Christopher; in your opinion, Mr Clark did not seem to be genuine and appeared to be acting. Is that faithfully recorded what you told him?
A It is very close, but I would add a few points, because you are asking me to agree the absolute wording now and I cannot. They are not major issues. All I want to say is that when it says:
“Nose bleeds that result from suffocation happen immediately after the suffocation attempt, and are not in any way delayed”
that is absolutely correct. But the one above it:
“There is only one possible cause of Christopher Clark’s nosebleed and that is intentional suffocation”
is correct, but I would have put in: “There is only one possible cause of Christopher Clark’s nose bleed and difficulty breathing and choking”, because I think that is how I would have expressed it, but that is correct otherwise.
Q At 9.4 he records your view that Mr Clark was a liar.
A Ah. I do not think I would use the word “liar” in talking to Professor David about Mr Clark, but I did allude to the untruthful account at the time of his return home. But I do not think I would have used the word “liar”.
Q Again, this is in the context that he made contemporaneous notes ----
A Yes, as I said, it is ----
Q And this is some four years later.
A Yes, it is.
Q He recorded that an additional concern of yours was Mr Clark’s failure to dial 999 and at 9.6 an additional concern was his failure to give Harry to his wife rather than putting the baby in a bouncy chair.
A I do not know for certain, but there is perhaps more to that point than is made there, but I cannot remember exactly. It is too long ago.
Q An additional concern was the finding of the two petechiae on Harry’s eyelid.
A Yes.
Q A pointer which you attributed to deliberate suffocation.
A It is not that strong but it is a supporting feature.
Q Perhaps the word a “pointer” is a fair way of putting it.
A Yes.
Q An additional pointer was the finding of the torn frenulum.
A Yes.
Q You indicated to him that you did not feel that could be explained by attempted resuscitation.
A Yes.
Q Your view, because you felt that Mr Clark was the person who had killed Christopher and Harry, was that the life of Child A must be in danger whilst in Mr Clark’s care.
A Yes.
Q Additionally, at that time you expressed your resentment perhaps about the attitude of the police because they had not taken up and run with your theory.
A My concerns about the police were not quite like that. They were the delay that I alluded to earlier between my raising concerns and something being done and it being reported to a multi agency basis and I was also concerned that they had not investigated the alibi for Mr Clark. Those were my two worries about the police. So I remember discussing those worries with Professor David, but ----
Q But it is also fair, is it not, that point 10 is correct, you were unhappy about the attitude of the police because they had apparently both rejected and failed to act on your views?
A It is one way of putting it, but it does not explain why and I have just done that.
Q It is right there is nothing there in what you told Professor David that indicates that you were also relying for your views on your conversations with Professors Green and/or Meadow?
A Correct.
Q Can we go on to paragraph 12. You see what it is entitled: “Existing involvement of Meadow and other experts”. You were asked by Professor David about Professor Meadow’s involvement and you said at the top of page 55:
“He explained that he was well aware of Professor Meadow’s involvement, which had been discussed extensively, both on an internet web site ….. and on the Royal College of Paediatrics and Child Health internet mailing list”.
Why did you not tell him you were aware of his involvement because you had spoken to him?
A For the same reason that I mentioned earlier, that I was concerned that I did not get Professor Meadow or Professor Green into any difficulties. That was my, perhaps misplaced, concern, but that was what I felt at the time. I accept looking back, for the reasons you gave actually earlier, that may have been misplaced but that was the thinking I had at the time and because at this stage at my meeting with Professor David he appeared to be agreeing with all that I was saying and he was not testing the truth of any of my remarks. He was listening to me and he did not say to me, “Well, how do you know that the bleeding in the lungs occurred?” He did not say that to me. So I did not have to justify, I did not feel, so there was no necessity to reveal that.
Q The only necessity was openness and frankness in child protection proceedings.
A Yes and at our joint meeting if I felt that Professor David was not happy that I had the truth of the situation, then I would have told him about Professor Green and Professor Meadow, but he did not indicate it to me and, as I said earlier, neither did he share his report with me before he submitted it to the family proceedings which, in my mind, is the most important issue, because if I had seen his report before he submitted it, I would have realised that there was a terrible gap between his understanding and mine and that that needed to be corrected. So that is in a nutshell ----
Q You might think that is the most important issue. The public in this case might think there are many other issues that were more important, Professor Southall, but can we go on to paragraph 13. It is right, is it not, that you specifically discussed
Professor Meadow’s paper on the subject of suffocation?
A Yes, that is right, yes.
Q Not to put too fine a point on it, you rubbished it.
A No, I am not going to accept that. I think that is very unfair. I have enormous respect for Professor Meadow and I would never rubbish his work. I think that is wrong.
Q Okay. I probably over emphasised. I will just repeat what you said. You felt that he had no personal experience of suffocation as opposed to you.
A Yes. What I meant by that was that Professor Meadow had very carefully collected and collated from a number of sources his information on intentional suffocation. The difference is that I had spoken to the parents, looked at the medical records for our paper of babies who had been suffocated as shown by our surveillance work. So I had the personal experience of talking to the families. He had more of the case collection data from different sources which was different.
Q Yes. You also felt that he had considerably less expertise than you in the area of suffocation.
A Yes. Professor Meadow is an acute paediatrician with an expertise in renal/kidney problems in children, whereas I was an acute paediatrician with an expertise in apparent life threatening events and intentional suffocation. So that is true.
Q Is Professor David’s last four lines fair or unfair?
“In short, Professor Southall felt that he knew considerably more about suffocation than Professor Meadow and was therefore in a position to make additional observations and come to conclusions over and above any input that could be provided by Meadow”.
A Yes, that is correct.
Q Is that a fair summary?
A That is fair.
Q What many people might find astonishing in the context of discussion about Professor Meadow and his work is that you failed to disclose to Professor David that you had actually spoken to him about these matters.
A The main issue that I got from discussion with Professor Meadow was the issue of the petechial haemorrhages on the eyelid and, as I said, I was worried about disclosing these conversations and -----
Q There came a time, and we will go into the detail in due course, when you got an E mail from Professor David advising you to be a bit more cautious than you had been so far, if I can put it globally that way. Let us just establish, you received that E mail.
A Yes, I received that E mail. It was not ----
Q As a result of that E mail you had a telephone conversation, did you not, with Professor David?
A Yes, I did.
Q Can we turn, please, to page 80 in this bundle in front of us. Just to put it into context, as we know, basically the E mail was asking you or suggesting to you that it might be wise for you to put in a caveat of some sort, if I can just deal with it globally that way.
A I would prefer a different way, but we can obviously disagree, but he put to me a question, I answered that question. That was the important point.
Q Can we just go together through paragraph 66 for the moment.
“Professor Southall discussed his provisional reply with me on the telephone. I reiterated that there was an enormous amount of data in the case which had involved a considerable number of experts, and I tried to hypothesise situations that could invalidate his conclusions, including a full confession from Mrs Clark giving details that could leave no doubt that she had killed both children. Professor Southall pointed out that he had been told by the police, the guardian and the social worker that both children were perfectly healthy, and I pointed out that they were all non-medical and could not have a complete understanding of the complex medical issues”.
Is that a fair summary of the telephone conversation as far as that aspect is concerned?
A That particular sentence, the last one you read, I cannot remember, but it does not read right to me as it stands, but I cannot remember, so I cannot really say yes or no to your question.
Q But would you accept this? You did mention reliance upon the police, the guardian and the social worker.
A I probably did that bit, that bit I probably did, but it is the other bit I am not sure about.
Q And that you did not there place reliance on what you had learned from Professors Green and/or Meadow.
A No, again I would not have said anything about them at any stage with Professor David, either in the phone call or in my meeting.
Q Even when you are being pressed to justify your conclusions.
A Yes. I knew what I knew and I was asked the question, as you saw in the previous page. I thought about that before answering it, both in verbal terms and in the E mail.
Q You see at the bottom of page 79:
“ My question is simple. Do you accept that it is possible that there is either medical data, or circumstantial data, or both, that could in fact largely or even completely exclude the possibility that Mr Clark killed either of his children?”
A Yes, that is the question, that is the question.
Q In your evidence today repeatedly in support of both the factual basis of what you were saying and the conclusions that you made from those factual bases you are and have heavily relied upon the views and information given to you by Professors Green and/or Meadow. That is right, is it not?
A No, not heavily. They consolidated what was in the video, what was said to me by others. The whole picture is a consolidated jigsaw puzzle of information, but, yes, you are right, their information was very important, particularly Professor Green actually.
Q But why did you not tell Professor David that you had very important information, particularly from Professor Green?
A Because at no stage did Professor David say to me, “Look, your information on the bleeding”, say, “in the lung”, as I used earlier, “is not factually correct”. He did not question any of the facts of which I put to him which were the basis of my opinion. Not where I got the facts; facts, he did not question any of them. If he had questioned them more at the time we met, then I would have obviously realised that I had to deal with that and that is what ---
Q You are being directly questioned, are you not, by the paragraph we read at the bottom on page 79, “My question is simple, do you accept that it is possible there is either medical data or circumstantial data, or both, that could in fact largely or even completely exclude the possibility that Mr Clark killed either of the children”, you are being challenged as to the data?
A And I answered, frankly answered the question as I have thought about it, I think I have got hard enough information and therefore I do not want to change the scope of my opinion.
Q On the basis, as you told Professor David, on the basis of what you had been told by the police, the guardian and the social worker?
A That is because, to repeat again why, I did not wish to in any way compromise Professor Green.
Q You were misleading Professor Green, were you not?
A No, because Professor David did not in any way indicate to me that there was a problem with the facts that I presented to him. What he was getting at was that any additional information, new information, that I might not have. It is not the existing information, he never said to me when I said there was old and new bleeding in the lung, he did not say to me, “That is incorrect, where did you get that from?” or words to that effect, it’s new information.
Q That was not his role to give you information and you knew what the position was from the start, he was to ask you about your views, not to give you his, that was the terms of engagement, if I can put it in that way?
A No, no. That letter where he puts out the terms of engagement I have not seen. My understanding was that this was child protection proceedings and I was to meet with him in the presence of the solicitor to put across my concerns. My understanding was that we would share information, when we met we shared information and we had a four hour meeting. It was impossible for that to be completely one way, we shared information and he did not indicate to me any of the reservations, major reservations, that I subsequently saw in his report and that is where I have a problem, because in child care proceedings if he was going to disagree with me so violently I hoped he would have put this to me in advance so that we could sit down and look at the report together before it went in, because as the judge put it, he wanted to know what I thought, my concerns.
Q Exactly, he wanted your thoughts unvarnished and he got them?
A There is no question, I am not denying or want to in any way that Professor David did not put across my report or the e-mail, but what he then did was analyse it in a way which was denigrating the information and he did not tell me he was going to do that and if he had and sat down with me and said, “Look, I do not think you have got hard enough evidence for the bleeding into lungs”, for example, and then I would have said, “Well, actually the reason for that is simple is that I did get additional information and now that I know that that is a problem for you, here is that information”, that is ---
Q Dr Southall, this is pure sophistry, is it not? Let us look at what you were told by Professor David in his e-mail to you, we can pick it up at page 79:
“Dear David: Please could I put a question to you? As I am sure you can imagine, there is a good deal of data about this case, both medical and circumstantial. As you know, I cannot disclose any details of it”.
You knew that?
A That is what he says, yes. That is not what I understood, but that is what he said.
Q “I appreciate that for all the reasons that you set out, you have great concern about the possibility that Mr Clark, rather than Mrs. Clark, killed the children. My question is simple: do you accept that it is possible that there is either medical data, or circumstantial data, or both, that could in fact largely or even completely exclude the possibility that Mr Clark killed either of his children?” So he is making it clear there is a huge amount of information, both medical and otherwise, in this case about which you knew nothing?
A Yes, that is absolutely correct.
Q He is suggesting to you, first of all, do you accept that it is possible in something about which you knew nothing that there was something which would contradict your theory?
A Well I knew already from talking to him that he, for instance, had lots of information about child A, but that information was of no relevance to what I was trying to put across on Christopher before he died.
Q Please answer the question Professor Southall. Do you accept that what he was doing was asking you to accept the possibility that there was material in there that you did not know and he was not able to tell you that could contradict your theory?
A That is what he was saying.
Q And he was giving a reason for that because of your lack of caution, or indeed caveat, in your report and he was giving you the option, saying, “Have I got it wrong?” or, “Did you not put one in because you were in such a hurry to complete the report?”?
A As I explained earlier that the reason I did not put the caveat in was I assumed that ---
Q So there is a direct challenge to you there about what you knew and the quality of what you knew, Professor Southall, and you replied that you relied on the evidence of the television programme and the police, the guardian and the social worker, and I again put it to you that was misleading in relation to what you have told this Committee about the involvement of the other professors?
A I have already accepted that, I made that point when I was giving my main evidence that I understand that point and can see why you are making it but, as I said, if I had realised that Professor David was so concerned I would have involved him on that. We would have shared that data, if he had shared his concerns on the data with me before he submitted it, that would have made all the difference.
Q He is clearly sharing his concerns about the data with you, is he not, he has written you an e-mail about his concerns?
A But I have indicated that the kind of data that I am interested in is not the kind of data that he is putting across as an overall picture.
Q Then we get the e-mail in reply, which is at our page 47 and can we look at the first two sentences together:
“I had thought through the issue of whether there might be other evidence not seen/heard by me which makes it impossible or very unlikely that Mr. Clark killed the two children. I should say and should have put into my report that I had undertaken a number of discussions with people involved in the case after seeing the video, namely Mr Gardner, the guardian and the senior social worker and asked questions relating to other possible but extremely unlikely mechanisms”.
You say:
“I had thought about the case and I should have put in that I spoke about it with other people”.
And you there list the three other people that you should have put in your report. What is the difference between those three people who you did mention and those two people who you did not mention, namely Meadow and Green?
A In strict terms there is not a difference but, and this is not trying to get out of it, because I have already admitted what you are getting at, but the point is that I have undertaken these discussions and asked questions relating to other possible, but extremely unlikely,mechanisms for the bleeding and scenarios which would enable rejection of my opinion. The scenarios, for example, would be that the alibi had been checked, so the important person there would be the police. The issue of what occurred in the post mortem examinations of Christopher when he died, which were stated on the video, confirmed in part on the video by Professor Berry and then confirmed to me by Professor Green, are consolidated information, but the important information relating to my opinion or to something that would change my opinion came mostly from the police and mostly from Mr Gardner, but I accept that I could have written in there Professor Green and Professor Meadow and I did not.
Q You could, but you accept ---
A And I did not.
Q And do you accept you should, in the spirit of openness in child protection work, have mentioned their involvement?
A I am willing to accept that, I have already said that earlier that I am willing to accept that in an ideal, you know, thinking now retrospectively, yes.
Q And the reader of this e-mail, namely Professor David, would have no idea from those two sentences that you had spoken to those two professors, would he?
A No.
Q Can we look now at your conclusion:
“However” – this is after you concluded beyond reasonable doubt that my client was a killer – “however, based on what I saw in that video alone and my discussions with the police office, the social worker and guardian, I remain of the view that other explanations cannot hold”.
Again, that is only a partial account on your evidence to this Committee?
A It is the same, exactly the same I agree.
Q Other explanations cannot hold based on your discussions with three people?
A Yes.
Q Did you in fact speak to Professor Green about this case?
A Yes, I did, on a number of occasions.
Q Did you in fact speak to Professor Meadow?
A Yes, I did, on one occasion.
Q Can we turn to a different area; can we look together please, I hope you have got the heads of charge 4 and 5. You see that, and it is right that you have admitted the whole of the head of charge 4, Professor:
“As a result of such contact” - that is the initial contact with the CPU - “you met Detective Inspector Gardner, the senior investigating officer, and you in effect told him that as a result of watching the programme you considered that Stephen Clark had deliberately suffocated Christopher Clark, Stephen Clark was thus implicated in the deaths of both Christopher and Harry Clark.
C: there was thus concern over Stephen Clark’s access to and the safety of the Clark’s third child”.
A Yes, that is correct, that as a result of watching the programme and discussions as well that went with that, you know, discussions I have just indicated, plus the discussions with Detective Inspector Gardner.
Q And by the time that you had your discussion with Detective Inspector Gardner, is it fair to say that you were certain that your theory was really correct?
A After I had had my … well, you know, the end of my meeting?
Q Yes.
A Yes, that is right.
Q Is there a fatal flaw in your theory, or several fatal flaws in your theory, Professor, one of which is that there is no evidence whatsoever that Mr Clark was there at the death of the child Christopher?
A There is no positive evidence that he was there.
Q And at the trial it was not disputed that he was not there at the death?
A I do not know.
Q Your theory requires two things, does it, as you have explained to the Detective Inspector, your theory requires first of all that contrary to all the evidence he returned home at night and killed the child?
A Yes, that is correct.
Q And, secondly, it requires Sally to be in an alcoholic haze?
A That was a suggested possibility, no more than that. She could have been asleep, but the suggestion I made to the detective was that she maybe was suffering from alcohol.
Q Well we can se it together at page 19, “Sally being oblivious to what has happened because she is in an alcoholic haze”?
A That was a suggested possibility.
Q So you require two things of which there are no evidence, one, Stephen being there at the house and, two, Sally being in an alcoholic haze. As a result of merely watching the television programme were you not aware that what was said in the television programme – I will be careful here, because I am not necessarily putting that forward as the truth of what was said – but the evidence of alcohol was excluded entirely and there was no evidence that Mrs Clark had any alcoholic problems at the time of Christopher?
A I put this to Detective Inspector Gardner as a hypothesis about the alcohol and he did not say to me, “That is not possible”. What he said was, “We did not check whether Mr Clark was there or not, we did not do those checks”, so that is different to positive evidence that he was there, I agree completely there was not, but there was no evidence that he was not there either, that had not been checked, that is all I was saying.
Q What Detective Inspector Gardner did in fact say was, “The above illustrates how a well-meaning but scantily informed person can theorise”?
A Yes, I saw that, yes.
Q It is quite clear from that and indeed subsequent with the CPS that they thought very little of your theory, they did not even bother to investigate it further?
A Well I think they did actually because they went and informed social services, so that is a step in the direction of accepting that there might be something in it, otherwise they would have, and this could have happened, I accept that, they could have just said, “Right, that is the end of it, we do not think there is anything in Dr Southall’s view, therefore we are not taking this matter further”, in which case, of course, nobody would have known about it because if they had not taken it forward, it was then ended from my point of view and theirs.
Q Yes, and as we have seen from the letters, they only informed the local authority out of an abundance of caution, as we can see at page 17?
A Yes, I know, yes.
Q “I do not know whether you wish to take this matter forward, have the consultant’s name and should you wish to take the matte further would need to speak to the police. I can confirm that he has no knowledge of the case other than watching the television”?
A But I think you heard from Mr Blomeley that he actually felt that this was an important issue that needed … and that he was very grateful for me for bringing it up if I remember this right, but maybe I have got it wrong, but I thought he was …
Q But neither the police took the matter any further, nor did the CPS take the matter any further, as a matter of fact, did they?
A In terms of a criminal investigation, no.
Q You were unhappy about both those facts?
A I would have liked them to have investigated it further.
Q You expressed that unhappiness to, amongst others, Professor David?
A Yes.
Q Can I suggest to you that a reason why they took the matter further was because of the fatal flaws that I have just outlined to you, namely that your theory required,
(a), Mr Clark to have been there on the murder, and (b), Sally to be intoxicated, of which there was no evidence of either?
A No, I do not think those are fatal flaws. What would have been a fatal flaw in my argument was if the police had investigated the alibi and confirmed that Mr. Clarke was in the restaurant that evening and could not have been there. That would have been a fatal flaw. The issue of alcoholism was nothing more than a suggestion. She could have been asleep. That was just one suggestion. The fatal flaw would have been exactly that; that they did check the alibi and did find no corroboration that he was there all evening.
Q Do you accept that by the time you had finished talking to Inspector Gardner that you were at that stage medically in no position to give a medical opinion? That is my proposition. I will go further. Do you accept that you had no medical history from either the patient or the parents?
A The medical aspects that I was concerned for was the bleeding, the Apparent Life Threatening Event and I have a lot of experience in those conditions, so medically I had
a view which was based on what the information I had received.
Q I fully understand you had a view. You made no secret of your view. What I am trying to establish is basic medical principles. In order to establish a diagnosis you essentially need three things, do you not. You need a history?
A Yes.
Q You need an examination? For ordinary common or garden medical diagnosis?
A Who was I supposed to examine? The baby was dead. How could I examine the baby?
Q Or you could examine or speak to, in this case, the carers?
A No, I do not think so. I have already indicated that it would not have been appropriate for me in my position to have questioned either Mrs Clark or Mr Clark. That would have been inappropriate.
Q Precisely. Therefore, as you hand not been able to carry out any kind of examination or discussion with either of the carers, that was a flaw in your ability to come up with a diagnosis?
I am just talking basic medics here.
A Oh, I know you are.
Q You need a history and examination and examination of the medical data?
A I do not think that this is like any other clinical scenario where as a doctor I would be examining or dealing with a child's problem. In this instance I have raised the concerns because of my worry about the baby. I was not sitting there like a doctor does in a hospital or out-patient clinic seeing a baby with this problem. Now, if you had said to me -- if Mr and Mrs Clark, or both had called a doctor when that event occurred and I had been asked to look at that baby after that event then I would have gone through those processes that you have just described absolutely. I would have talked to them, got the history. I would have examined the baby and formulated a diagnosis. That is completely right.
Q But you were not in a position, were you, for a variety of reasons, all of which we understand, to examine the baby and to take a history and to look at the other material?
A Nobody would be then, no.
Q You were not in a position medically to come to a position about what had, in fact, occurred in relation to Christopher and the nosebleed because you did not see any of the nosebleed data which you asked for?
A No, I have already explained that I would have liked to have seen that nosebleed data but already there was sufficient data for me to make my opinion known, which I
did---
Q But there was no medical data. You had not one iota of medical data before you, did you?
A But as far as I understand did it this baby was not taken to hospital, was not seen by a doctor, therefore, where is the medical data?
Q You are wrong there.
A Was the baby taken to the doctor?
Q It was taken to the doctor afterwards.
A Because of the bleeding?
Q Because of the bleeding.
A Okay. I was told by Mr Gardner that this baby -- there was no evidence this baby had seen -- that Mr Clark had contacted a doctor. That is what he told me. He told me absolutely there was no evidence. So if you are saying something different then obviously I do not know about that.
MR COONAN: It is the first we have heard about it. My learned friend is putting
a positive proposition that this child was taken to a doctor. It may be that my learned friend has access to material we do not but we have never had heard that suggestion before. It may be, I do not know, that it comes from the main report or from Professor David, but if it does then that is in breach of the order.
MR TYSON: No, it does not come from either of those but it indicates the difficulty that this witness has because he does not know the full facts.
MR COONAN: Sir, I am a little troubled because if my learned friend is suggesting: you did not know one way or the other, that is one thing. But to make a positive suggestion that the child was, in fact, taken to the hospital is, I suggest, a new piece of information that we have never known about before.
MR TYSON: I am not suggesting, as I keep saying, that he was taken to the hospital.
MR COONAN: I think Professor Southall understood that to be the case and so do I.
MR TYSON: I said he was seen by a doctor.
THE CHAIRMAN: The evidence we have heard so far relates to whether at the time a phone call was made, or whether a 999 call was put in. That does not, in my opinion, I do not know what Mr Tyson is going to say, preclude the fact that he was seen after that by
a doctor.
MR COONAN: I accept that. But my learned friend appeared to be putting a positive suggestion that the child was in fact seen by a doctor. It is that latter part that catches me by surprise.
THE CHAIRMAN: It is new information. But it does not mean it is not fact.
MR COONAN: I entirely accept that but it is not been a fact which has been, as it were, proved within the proceedings so far and my learned friend is bringing it into the arena as fact in an attempt, no doubt, to demonstrate that this witness was wrong in his assumption, as I read it at the moment.
MR TYSON: No. I will rephrase it. The information that I have just given came out in the criminal trial so it should be of no surprise and I will indicate to my learned friend either within or without these proceedings precisely what the information is and that child was seen by a doctor. Irrespective of whether that child was seen by a doctor, the importance of this case as far as you Professor Southall....
THE CHAIRMAN: It might be helpful if you gave more information about this and its timing.
MR TYSON: Certainly. My instructions are from my client and the evidence he gave was that, firstly, two paramedics came to the hotel and, secondly, and subsequently when they got home the child was taken to the GP.
MR COONAN: I am not in a position to comment. I hear what my learned friend says.
I will consider how I deal with it, but that is what has been said. I cannot deal with it at the moment.
THE CHAIRMAN: I think what we did hear was there was no external confirmation of the paramedics. But the doctor bit seems to be new information but perhaps not information that would otherwise have come to light to this point.
MR TYSON: (To the witness) You have been hearing the conversation?
A Yes.
Q Does it not precisely indicate to you, demonstrate to you the dangers of the position you found yourself in at the time; namely, that you were making strong -- you were convinced by this time that my client had killed his two children on the basis of incomplete information which you did not know? That is the point. It is a serious one, is it not?
A Yes, it is a very serious point and I have tried throughout to indicate to you where the weight of different pieces of information lies in this business so that, for example, the weight of the fact that there was no evidence that a 999 call and the ambulance was called is very high to me. The weight that there was no evidence that a doctor was called at the time was very high to me. If you are now telling me that some time later, maybe a day, maybe two, I do not know, the baby was taken to the GP then I do not have that information, but it would not weigh much at all with me over my theory, my theory would remain as strong. That is what I am saying.
Q Are you really saying that your theory, of which you are by now convinced, could not be counter-balanced by any information at all?
A No. Of course not. That is why I went through the system that I did to try and check my information, particularly with the police when I met Detective Inspector Gardner because, for instance, if the police had told me: look, we checked Mr Clark's alibi, he was at that party throughout the time he said he was and, therefore, I would have been completely taken of the view that I had got it wrong. But that was not what happened. He did not confirm that and I checked with the major issues that would reject my contention and nobody was able to reject -- to produce one of the things that you are really asking me, which was something serious to override my concern.
Q Let us deal with it this way. Do you accept that you did not take a note of the Gardner conversation?
A Yes, I do.
Q You accept that he took a note of what was said and do you accept that when he gave evidence to this Committee he could not recall you discussing the precise matter that you now allege that you rely on?
A Yes, I do remember that, yes.
Q And that it would have been the kind of thing that he would have put in the note which is contemporaneous?
A Well, I would have hoped so, yes.
Q This is precisely the point, you see; here you are certain that my client has killed his two children and you have not seen one bit of medical information to come to that certainty.
A But I have already explained earlier to you.
Q It is fact, is it not?
A Yes, that the medical information---
Q You are a consultant paediatrician and on, as I understand it, no paediatric documentation or observations, simply on the basis of watching a television conversation and a couple of telephone calls - so television and telephone calls - you accuse my client of being a double murderer. That simply is not acceptable, is it?
A I am sorry, but you heard by my evidence on this, that it is not as simple as that.
I would not have gone to that level unless I had carefully analysed all the information from all the different sources that I had and put it together.
Q But you did not have any medical sources. You did not have any prime material. You did not have post mortems. You did not have any of the medical reports. You did not have any of the statements of any of the witnesses. You had nothing except what you had seen in a television programme and what you had heard from mates on the telephone. That is what it boils down to?
A These are not just any mates. This is a very -- the whole thing was properly done as far as I was concerned. That I went through the sequencing necessary to try and knock down this theory that I had at the beginning and I was acting at all times, not to accuse
Mr Clark, that is not my role, my role was I was concerned for the safety of the baby, I do not want you to go away thinking that my main objective in all this was to excuse
Mr Clark of something. My objective was that I had serious concerns about the safety of a baby. That was my concern. Not Mr Clark.
Q Do you accept it is a serious matter to accuse a man of murder?
A Of course it is. Very, very serious.
Q Do you accept that in order to accuse a man of murder you need to be pretty sure?
A Yes.
Q Do you accept that in order to be pretty sure you have got to look at all of the available information as a doctor?
A Yes, I looked at all the information that was made available to me. I asked for additional information, it was not made available. What else could I do? Either I walk away and say: “Well, I'm sorry, I can't help this baby, I can't do anything about this.
I can't make my opinion clear because nobody will give me the necessary information to do it”, or carry on hoping that I would be placed in a position where the appropriate information was made available to me to do that.
Q What you can do is extremely simple. You can say: “I’m afraid I have only got very limited information. I’m afraid”, you can say, “that I haven't got or seen any of the medical information so all I have got is a theory which you might like to look at.” Not that you have got a certainty. Do you understand that?
A Yes, I understand that, yes.
Q So option one was to not do the report at all. Option two was to do the report but set out the true weight of the report, namely the limitations of it?
A No, I think your point is correct - the true weight of the report. What I did was, the weight of the information that I had was so strong, that was the answer to Professor David's question, was so strong that I felt it was sufficient for me to write it in the report for the family court.
Q Precisely. You took neither of the options, did you? You neither backed off?
A No, I did not back off.
Q You did not write the report setting out any limitations to it?
A No.
Q But you wrote a report without putting any caveat in because you were so convinced you were right.
A I was convinced on the data that I had, because that was the question that Professor David was asking. He was asking whether there was any additional information that I felt could come to light and he gave an example that Sally Clark admitted that she had killed the babies, but I knew she had not, we all knew she had not, so that was no information. That was not information that would have changed my mind because it had not happened. So I had gone through the best I could ----
Q What happens if the information which you did not know about and could not have known about included six witness statements from Mr Clark’s fellow partners at the party ----
A Yes.
Q Which was information you did not know and could not have known.
A If -----
Q Why, for instance, would that information have made no difference to you?
A It would have made all the difference in the world, but it was not available, because I asked Detective Inspector Gardner if he had done that and he told me he had not. Now, if he had said to me, “I have got six witness statements here of the type you have said” ….. He did not say that to me.
Q He might have said he has not got them, but it does not mean that they were not there available on, say, behalf of the defence.
A No, he did not say that to me. He told me this had not been investigated. I am absolutely crystal clear of that. I would not otherwise have been safe in the situation.
Q I just want to come back to this medical aspect. Here you are, a consultant paediatrician, very distinguished, as is without a doubt, and you manage to hold a medical opinion without any medical data. You had made a diagnosis that Christopher suffered an ALTE a few days before death, you made a subsequent diagnosis based on your research that that means that he went on to kill Christopher a few days later and those two diagnoses (namely, that there was an ALTE and that it followed that my client was the murderer) are based on not one jot of medical information, including the post mortem reports of Christopher. This is what is so astonishing, is it not?
A It is not astonishing to me and I have a lot of experience in this field and it is based on my years of experience of investigating this kind of thing medically, but medically in this case the relevant part of the involvement I had would not have produced medical data, because the child was not taken as an emergency to a hospital.
Q I think that is why you are here in fact, Professor Southall. It is not astonishing to you that you can produce a report and make a statement about my client being a double murderer without any medical back up. It is not astonishing to you. It is, I would understand, astonishing to the public at large and it is certainly astonishing to those who are accusing you of serious professional misconduct.
THE CHAIRMAN: Mr Tyson, could I just intervene for a moment? My intention is to run on until four, but I am conscious that that leaves Professor Southall in the witness chair for two hours without a break. If you would like a short break I would be happy to have one at this stage.
MR TYSON: I am not going to complete my cross-examination by 4 o’clock.
THE CHAIRMAN: No, I understand that. Even with that -----
MR TYSON: I am happy to go on forever. I think it is Professor Southall who one should be perhaps thinking of.
THE CHAIRMAN: That is why I am asking him whether he would like us to have a short break now.
A Yes, thank you, Chairman, I would actually, if you do not mind. A short break would be nice.
THE CHAIRMAN: Why don’t we stop then and start, say, at 20 past three and then we will run right through to 4 o’clock and stop then?
(The Committee adjourned for a short time)
THE CHAIRMAN: Mr Tyson?
MR TYSON (To the witness): Professor, can we move on to another area? Can I ask you just to look at head of charge 5 for a moment and can I ask you to look and we will read together heads of charge 5© and 5(d). Do you recall that you admitted that at the time of the meeting with Detective Inspector Gardner you admitted that you were suspended from your duties by your employers, the Trust?
A Yes.
Q You admitted that you knew that it was an agreed term of the Trust’s enquiries that led to such suspension that you would not undertake new outside child protection work without prior permission of the Acting Medical Director?
A Yes.
Q Can we just examine for a moment together the inferences from those two admissions that you made. Can we start, please, by looking at the letter that you got from Mrs Chipping which is at page 7 in the bundle C1. This is a letter of October 1999. It is written to you. She says:
“I write to provide further clarity in relation to your agreement to comply with the Trust’s request in ceasing to work on any of your current child protection cases.
As you are aware, the Trust has made this request on the advice of the inter- agency review panel”.
Pausing there a moment, the outside advocate or group of advocates who had made the complaint about you was being investigated at this time by an inter-agency review panel.
A Yes.
Q Headed by I think it was outside people, was it not?
A Yes.
Q So, as it were, by this stage the concerns of the original agitators had been looked at and were being looked at and examined by inter-agency panels.
A Yes.
Q So it was on the advice of the inter-agency panels, as we can see:
“As you are aware, the Trust has made this request on the advice of the inter-agency review panel. Until the panel are at a stage in their inquiry to advise otherwise, your compliance with this request is required. I will write to you to confirm if this position changes. Until you receive written confirmation from myself, you should not undertake any child protection work”.
A Yes.
Q You on the next page understood what she was saying, because you wrote to the officer at Tameside about one of your ongoing matters. Can we just pick it up in about the third sentence in the first main paragraph:
“I have been advised by the Acting Medical Director of the North Staffordshire Hospital NHS Trust to discontinue all of my child protection work including category 2 protection work, until this inter-agency inquiry has responded”.
A Yes.
Q Can I suggest to you that the requirement to discontinue all of your child protection work means exactly what it says, namely that you should not get involved in any child protection work without the express permission of the Acting Medical Director?
A Yes.
Q So the question arises having written this kind of letter to some of your category 2 people, why on earth did you not seek the written permission of Dr Chipping before you picked up the phone to the Staffordshire Child Support Unit?
A Yes.
Q That is the question.
A Yes.
Q The answer you gave when answering my learned friend was, I think, you thought it might not lead to anything. That is the answer you gave. It is not very satisfactory, is it, professor, to not comply with your obligations merely because you did not know where it was going lead? Would you like to deal with that?
A Yes, thank you. As I indicated yesterday, when I had seen the programme I was concerned for the baby, but at that stage it was very worrying what I was seeing, but I needed advice, so I contacted DC Gibson and told him what my concerns were, because it is possible, of course, he could immediately have answered “very unlikely then” because he was not, as far as I knew, the police officer involved in the case, because he is a child protection person. Then I heard nothing for five weeks, I think, and then Detective Inspector Gardner came.
Q We have not reached the Detective Inspector Gardner stage.
A No, fine.
Q My question to you is why did you not pick up or speak to Dr Chipping before you spoke to the child protection unit.
A Because this was neither category 2 work nor acute child protection work of the kind that I was doing in October when asked to stop. This was something completely different to those two issues. Be that as it may though, I understand why Dr Chipping was cross about this. I can understand her view. But I did not at that time think I was acting as an employee of the Trust. I was acting as an informed individual. That is the reasoning.
Q You agreed with me that “all my child protection work” means what it says, all child protection work.
A Yes. Well, I did not regard this as in the same light as the two issues that she was asking me about. The two issues she was asking me were to give up acute category 1 child protection work and any existing category 2 and not to take on any more of category 2.
Q She does not mention category 1.
A But that is all it can be, category 1.
Q Let us look at the letter, page 7:
“Until you receive written confirmation from myself, you should not undertake any child protection work”.
A And I understood that, as I indicated in the next letter, to equal acute child protection work as done by myself as a paediatrician in the hospital (NHS work) and category 2 work.
Q No.
A What I did not envisage was the situation I found myself in which, of course, could have happened with others.
Q I am sorry, professor, just look at what your understanding was. Your understanding was in the next letter, the letter 8:
“I have been advised by the Acting Medical Director of the North Staffordshire Hospital NHS Trust to discontinue all of my child protection work including category 2 protection work”.
A Yes, and ----
Q You accepted from me that meant what it says. It clearly does mean cease all child protection work.
A To me that phrase meant the child protection work I was doing as a paediatrician in the NHS and the category 2 work. That is what it meant to me. But this situation that came along when I was suspended was a unique event as far as I was concerned and I did not know whether it was going to lead into the child protection arena until I was asked by Detective Inspector Gardner. At that point I informed the Trust because I knew then that this was child protection work. That is my opinion.
Q Yes, but it is nonsense, is it not? You rang up an officer from the child protection unit.
A Yes.
Q And you rang up an officer from the child protection unit because you were concerned in matters of child protection.
A Because I knew the police officers in the child protection unit and because this was a matter that could lead to child protection, so there were two reasons for it, yes.
Q It was not could lead. You were starting the process. As you know, you start the process by ringing up the child protection officer which is what you did. You set the ball rolling.
A Yes. That is what anybody would do in those circumstances.
Q Precisely. You are rather more knowledgeable than other people who ring up child protection units but you must accept from me that you ring up a child protection unit because you are concerned about child protection matters.
A Yes.
Q And, as you told us, you saw this programme and you were stunned and you were very concerned about the safety of Child A.
A Yes.
Q So very concerned about the safety of Child A you then rang up the child protection officer.
A As an individual, not as an employee of the NHS Trust. That is the point.
Q Do you not accept that you were getting involved then in child protection work by you starting the ball rolling?
A There may not have been a ball to roll. For all I knew, there would be an adequate explanation for this which he …. Not him, but through the police connection would be able to deal with.
Q But you did not know how it was going to come out, did you?
A No, but at that -----
Q But you had started the ball rolling in child protection.
A In that respect, yes, and in that respect though until Detective Inspector Gardner got consent from me to take it forward into the child protection arena, as far as I was concerned, there was no compromise to the Trust from what I was doing or compromise to anybody actually, because nobody would know until I gave consent for that to be released. So there was no harm but only positive things that could come from what I was doing. That is my view.
Q I have to suggest to you that you were wrong not to speak to Dr Chipping first, you were wrong in terms of your employment contract not to speak to Dr Chipping first.
A I accept that view of yours and I understand Dr Chipping’s view, but my situation was that I felt that it was not quite like that, but I accept the view and I am not dismissing it, it is just different point of view and I understand it and accept it.
Q You wait some considerable time, I think you felt it to be, but as we know some six weeks before you were contacted by Detective Inspector Gardner?
A Yes.
Q And by this time, I think you told us when answering questions from Mr. Coonan, you were getting more and more concerned because the delay in your view was going on and on there was, as it were, six weeks more opportunity for potential harm to child A?
A Yes.
Q And then you got, as it were, the invitation to meet with Detective Inspector Gardner and then you knew at least someone was coming along to take your views on child protection seriously?
A Yes, or to reject completely my concern, one or the other.
Q At that stage why did you not pick up the ‘phone to Dr Chipping and say, “I have made my concerns known in a matter of child protection, a senior officer is going to now come and interview me about it”, why did you not at that stage, a matter concerning child protection, let the trust know?
A Because Detective Inspector Gardner could have completely satisfied me in that interview that my concerns were groundless.
Q But you would not know this at this time, would you?
A No.
Q. You had this big concern about child A?
A Yes.
Q Based on your theory?
A Yes.
Q And you were hoping that he would deal with your concerns seriously, bearing in mind the position that you held, the reputation you had?
A I was hoping that he would be able to dismiss my concerns for me, because I had been worried for quite a while, the longer it went on the more I assumed there was a good explanation and that therefore, although I was worried, I assumed the police had an answer, so why not wait until they tell me, because if the police had told me, “No it is not possible that Mr Clark could have done this”, then that would have been it and there would have been no further action by me, by them, nobody would know, Mr Clark would not know, because it would not be necessary, child protection would not know because it was not necessary, that was my thinking. Now I am not suggesting that thinking is perfect, but it is ---
Q Well it is clearly imperfect, is it not, because one of your concerns were bound to be taken seriously and your concerns were child protection concerns about which you were going to be interviewed by a very senior police officer?
A Yes.
Q That is true, is it not?
A Yes.
Q And your concerns were not about any old case or any old child, as it were, your concerns were about one of the most high profile cases involving children in the country?
A Yes.
Q And your concerns, or the knowledge of your concerns in your involvement, or seeking to be involved in this case, was bound to be grease to the mill of your detractors?
A It would be if they knew about it, yes. That is why I told the trust as soon as I knew it was possible that they would find out.
Q You recall Dr Chipping’s letter to you when she did in fact find out after the event that you had met and you had contact with two different police officers?
A Yes.
Q Can we just examine that for a moment at page 21. You told her that you had got involved in, as she described it as, and I suggest to you rightly, that you got involved in the child protection case, as we see it described on page 21, involving Sally Clark and you told her in the bottom paragraph that you had called the child protection unit advising them of your concerns, you were suddenly contacted by Macclesfield Police who had taken a statement. You stated that you had made this statement in the public interest as you believed that a miscarriage of justice had been done. Pausing there for a moment, there is no mention there that you did it on behalf of child A is there?
A No and this is incorrect, both that I had a statement taken from me is incorrect and that I had made a statement in the public interest, that is not why I made the statement and I have been saying this from the beginning and I will not change it.
Q Detective Inspector Gardner was writing down what you were saying, was he not, at the time, he was recording what you were saying?
A I thought he made the notes later that day, but I may recall that incorrectly. I do not remember him sitting there writing things down while we were talking if that is what you mean, but it is a long time ago, but certainly this was not a statement that I gave to the police.
Q Well you gave an oral statement to the police, did you not?
A No, we had a discussion. A statement I would regard as something a little more formal. We had a discussion about the case.
Q Let us go over the page to page 22, the second paragraph:
“Since our telephone conversation I have given this matter some considerable thought. Whilst I acknowledge your rights as a private citizen, I remind you of the terms of your suspension as set out in my letter. You have been asked not to become involved in any new child protection work whilst the preliminary enquiry is in process as the allegations made against you in relation to child protection issues are of a very serious nature. By taking this action you have potentially put yourself and the trust in a very difficult position. I am concerned that you did not consider discussing this issue with me before contacting the child protection unit at Staffordshire Police and that you only thought to inform me after the event”.
And you recall, do you not, her evidence to this Committee about that?
A Yes, I do.
Q I think that she said words to the effect that to say that she was disappointed that you had not contacted her was an understatement?
A Yes, I think that is a fair summary.
Q And she went on to say, “In fact I was astonished”?
A She did.
Q And she had every right to be astonished, did she not Professor, because you had breached your agreement with her?
A I have already explained I thought … we had different perspectives on this. I had a perspective that I was not to do any new child protection work, that is clinical work, obviously that had stopped on the suspension, but category two work. I was certainly reporting to her every time I was asked about category two work, throughout the whole enquiry I kept her informed. This case was different in my view and when it reached the child protection point of the case in my opinion, and I accept it is only my opinion, I notified her, because that was the point at which any compromise of the trust or of myself could have occurred from that point on, that is why I did nothing.
Q We are going to go round in circles here, but really contacting the child protection officer is the start of the process, as we discussed before, and involves child protection work?
A I understand your point and I understand hers.
Q Do you recall the three reasons that she gave to the Committee as to why she was so concerned that you had not contacted her first?
A I would like to be reminded.
Q One of them was the investigations were only half way through and in a sense the agitators could cause a lot of stink if they knew about your involvement with the Clark case?
A But I have already explained that they would not have known until that moment, because the police would not have released my information without my permission in this situation, so from that moment they knew from the moment there could be problems with the agitators I informed the trust, so they knew in advance of any potential problems, so that point I think is covered by what I did.
Q She always wanted, I think to use her words, “To save you from yourself”?
A Yes. Now I ---
Q And as she put it, “We wouldn’t be here had you followed her advice and guidance”?
A I think that Dr Chipping was certainly trying to protect me by that point and I respect that and I agree with her. She said, did she not, that she might have been able to handle it for me and I accept that. I did not know that, this is retrospective stuff, I did not know what she would, but when she ---
Q But you never gave her the opportunity, did you ---
A No
Q … because you breached your agreement that you would seek written permission before you got involved in any child protection work?
A I do not think I did, but that is my opinion and that is the different perspective that we both have on that.
Q The third point she put, you may recall, is that there were serious child protection issues being investigated against you?
A Yes.
Q And that she had a duty to ensure that you as an employee, or even as a suspended employee, practised safely?
A Yes, but in fact she also agreed, if I am remembering correctly, that I was not practising because I was suspended, therefore I was doing no NHS child protection work, so that is not a worry. I was not doing category two, because that means fee paying work coming from social services, so the only issue was this one and she did concede that as a private individual outside my employment, what I did, I thought she agreed, that it was reasonable as a private individual outside my employment contract.
Q She said as is quite clear from the letter that you have put, by your actions, you have put the trust in a very difficult position?
A Well that is where I am not sure I agree, because the rust was not in any position until the police released that information to social services and at that point and before that point I informed the trust, so they were not in a difficult position until it became a child protection case in the social services which are the lead agency for child protection.
Q I have to suggest to you, Professor, that in light of the instruction by the trust in relation to any child protection work, for you not to contact her before you got in touch was, of its very nature, precipitate?
A I have told you that I understand the perspective you have as well as Dr Chipping, but my perspective was not of that view. I did what I thought was right in contacting the child protection committee for the sake of raising my concerns over the safety of a baby.
Q And I have to suggest to you that by getting in touch, first with the child protection unit and thereafter Detective Inspector Gardner without speaking to Dr Chipping first, was irresponsible of you?
A I definitely do not accept that.
Q And I have to suggest to you that it was particularly precipitate and irresponsible of you to have gone in the way you did with your convictions merely on the basis of watching a television programme?
A Can I just address that? Basically when it entered the child protection arena I had started on the premise - I must go back to this - that there had been two children whose deaths had been attributed to intentional suffocation by the criminal court on a majority verdict based on an assessment of all the evidence, including the medical evidence. Then there comes the television programme. Now, all throughout you have been implying that a television programme is a meaningless, trivial event and I would question that, really, because if the television programme is well made and contains throughout accurate information, television programmes of that kind can make enormous impacts on conditions in the world. Let alone, in this case, on a child and a family.
Q I readily accept that, Professor, but you were not in a position to know whether this television programme was accurate or inaccurate, do you?
A Not at the time that I saw it except in terms of the words spoken by the key participants, in this case Mr Clark, but then in order to check these issues I went through process, namely talking to Professor Green, Professor Meadow, Detective Inspector Gardner, social services and so on to produce in writing my concerns for the court. I think that process is okay myself.
Q Yes, I understand you think that process is okay, Professor. Let us go back to television programmes. It is right, is it not, that you, and I think you accept this, cannot tell merely by watching a television programme whether the information in it is accurate or inaccurate?
A No, you are absolutely right. Anything stated by the reporter has to be accepted with a reservation. But---
Q It is -- carry on.
A Is that okay? But if the words spoken by the people about which the programme is made are stated in your face on the television in real words, not reported, but stated, they enter a completely different level of fact to the words spoken by the journalist making the programme. It is the latter that I needed to check, but the former were real. He was telling me what had happened.
Q But you accept on the basis of the television programmes that you cannot tell whether they are partial or impartial because you do not know what material they started with and what has ended up on the cutting room floor? You cannot tell, can you, merely by watching a television programme?
A No, one of the points I made in my report, if you remember, was that the remaining information that was made for that programme should be re-examined in the light of what I was saying because of that very point that you are making.
Q Yes. Just so I can completely understand where you are coming from – is it your case that it was an appropriate process for you to rely on confirmation of the medical facts in the Sally Clark case on the basis of a few telephone conversations with a few professors? Is that your case; that it is appropriate?
A The majority of the medical facts had already entered the public domain and were available to me before I watched the programme and were consolidated during it, but there were certain issues that had not been consolidated that I needed to consolidated, ideally by looking, as you say, at the medical records, but initially by talking to the experts who had themselves looked at the records who were more expert than myself, like a pathologist is more expert than I am in looking at a pathology report.
Q What medical facts do you say were available about Christopher and/or Harry Clark before the television programme?
A The central fact, the really central fact that was available was that Mrs Clark was in prison for killing those two children by smothering. Those are medical as well as forensic facts. That is to me the central medical facts and that clearly, Professor David indicated I think it was 20 experts, all the expert medical evidence would have been analysed in that criminal court process and the upshot of it was, the best system we have, that a criminal court had decided on the basis of those medical evidences that she, Mrs Clark, had suffocated those two babies.
Q Right, okay, we have got the facts that she had been convicted. That is not the question I ask you. What medical facts, what primary basic medical fact was there/did you have before the programme rather than the actual fact that there had been a conviction?
A One of the most important medical facts was the historical one that I have just described. Medical facts can be historical as well as they can be examinatory and/or investigatory. In the case of child protection it is quite frequently the historical facts that matter enormously. Still medical but---
Q You have got an historical/medical fact that there had been a conviction?
A For smothering.
Q Is there any other - before you watched the programme - medical fact that you knew from primary material upon which you rely before the Committee?
A No. No other.
Q In the programme there were a number of medical matters put?
A Yes.
Q And you have listed them in your report in so far as you relied on them?
A In so far as they existed. Not that I relied on them. I think there is a difference. They existed. That is all I said. They existed.
Q As a result of watching the programme you could not know, because you had no access to crime data, for instance, that the first death was initially treated as a lower respiratory tract infection?
A That is correct. It was stated by the journalist. If it had been stated by Mr Clark I might have had more, or, no, not Mr Clarke, it probably should be the pathologist, I will not say his name, but if the pathologist in the case had been on the programme and said: “I attributed the first death to a lower respiratory tract infection”, in his own words that would have a been a primary fact. So it was a journalist statement which I needed to check. Which I explained that I did.
Q But you did not check it because you had no ability to check it by looking at any of the primary medical documentation?
A That is correct. I did not.
Q You checked it in a hearsay way, as it were, by ringing a friend?
A Not---
Q Phone a friend?
A No, no, by ringing the main forensic pathology expert called by the Crown. I do not think that is the same thing as a friend. It is not a friend. It was the person who could give me the information that I needed to check the data on the video.
Q A person, incidentally, whose own evidence, principle evidence in this case was subject to very severe difficulties, was it not? Professor Green and the retinal haemorrhages?
A That is not relevant. I do not understand the relevance of that because you are talking about the lower respiratory tract infection diagnosis with which the child was initially labelled. Why would that be so contentious as the issue of something like retinal haemorrhages in the second child? It is not same kind of data.
Q I am merely saying it is as impermissible, I would suggest to you, to in a medical report, so stated, to feel that you have confirmation of a medical fact merely by phoning somebody else?
A I would have liked to have confirmation of that fact by the written papers, but, as you well know, for some reason despite my asking for them and spite the strategy planning meeting agreeing to provide them, they were not provided to me. What am I supposed to do?
MR TYSON: We will deal with that on Monday, but not to do what you in fact did, is the answer. That would be a convenient moment.
THE CHAIRMAN: You are happy for us to close there? That brings us to the end of today’s proceedings. Regrettably you are still under oath and still in process of giving your evidence, therefore we rely on you not to discuss your evidence with anyone else until we meet aging on Monday morning at 9.30.
MR TYSON: Before you rise, sir, can I raise a matter about the future conduct of this hearing. My learned friend and I, in fact, had a discussion about it and the proposition, which I suspect will be jointly put to the Committee to consider, is that when we end part one, whenever that is, Monday or Tuesday, and you make your determination on one, we then draw stumps and deal with part two, if there is a part two on the second occasion. My anticipation is that there will be my continuation and my summing-up. I do not know whether my learned friend is gong to call any witnesses. My anticipation is that you will be retiring on part one either towards the end of Monday or on Tuesday and if this case has to go part heard then the most obvious time for it to go part heard is when you have made your determination on part one and the application I am going to make is whatever time it is that we reach the end of part one and if there is to be a part two, then the we start the whole part two on another date.
MR COONAN: Mr Tyson is absolutely right. We have discussed this. For our part we see there is sense in that, we come to the same conclusion. Otherwise there would be a great sense of trying to cram in quite a lot of one work on a task which was essentially open ended as matters stand at this particular moment. So we agree with that and we would invite you as a Committee to adopt so that we could all of us know, really, where we stand in terms of future dates.
THE CHAIRMAN: I am content, except under the circumstance where we concluded part one and were going on to part two where it became clear that we would have sufficient time. From what you are telling me that seems unlikely.
MR COONAN: We think it is unlikely, yes.
THE CHAIRMAN: The most satisfactory thing is if we could get the whole thing concluded within the time allotted by Tuesday evening, otherwise, assuming we were going to on to part two, that leaves Professor Southall in limbo.
MR COONAN: Obviously the most recent thinking on this Professor Southall has not been privy to because we have not been able to talk to him, as the Committee will appreciate. So what he is hearing may, of course, be news to him. I do not know. But the other aspect is that I have got to, and my solicitor, primarily, has to organise any material that may be relevant to part two if we get there and you will appreciate, I hope, the difficulties that are associated with that in terms of practitioners (Inaudible) and so forth. Knowing that there would not be a definite specific time for a part two, if we got there, would help the logistics side of things from our standpoint.
THE CHAIRMAN: Yes. I perfectly understand what you are saying. My only slight reservation is I understood you were having quite a lot of difficulty in finding dates for part two. So we might finish up with a single day in August, if my understanding of our dates is correct. I do not know whether we consider at this stage that if we are at that point that would be sufficient time to deal with it.
MR COONAN: Sir, it may be a case, if there is only one day, where you may, if we got to it, of course, you may have to sit late.
THE CHAIRMAN: I am not trying top obstructive. Let us assume that on the basis that I do not think we are going to complete part one all that quickly anyway by the time Mr Tyson continues with Professor Southall and the Committee has an opportunity to question him and we come back to your re-examination. I do not know what other witnesses you may have. We may have then have closing speeches and we have to have our determination. That sounds like most of two days’ work anyway.
MR COONAN: It could well be.
THE CHAIRMAN: So in principle I am quite happy to agree with what you are saying.
MR COONAN: Obliged.
The Committee adjourned until 9.30 on Monday, 14 June, 2004