The Munchausen Syndrome by Proxy witch hunt

Meadow is facing professional misconduct charges (June 2005) being brought by the British General Medical Council, concerning alleged misleading and contradictory evidence. The Royal Statistical Society publicly condemned (October 23, 2001) his statistical methodology, relating to his evidence in the Sally Clark case. A supporter, Professor David Southall, has also been found guilty of serious professional misconduct regarding a child abuse case. The UK Government has ordered official reviews of both criminal and civil cases involving Meadow's MSBP and cot death theories. The Opposition has called for a public inquiry.

In the US, Howard Fishman, a former education director at the Harvard Medical School's psychiatry department, commented, “The child abuse industry has devoted itself to the removal of children from their homes based on spectral evidence, phantom disorders and fanciful modes of purported abuse that should be assigned to the trash bin of junk science”.

Evidence involving the label or profile of MSBP has been rejected by Australian courts. For example, the Queensland Court of Appeal (R v LM [2004] QCA 192), ruled it prejudicial and inadmissible. The South Australian Supreme Court (S4118, 1993) ruled that, although a pediatrician, Professor David Southall's MSBP testimony could only be regarded as a lay person's opinion.

Meadow's cot death theory - that one child death in the same family is a tragedy, two suspicious and three murder - has been rejected by the UK Court of Appeal (R v Angela Cannings [2004] EWCA Crim. 01) and in Tennessee, US, (2003, no. 99-D-2836). Judicial comments in the UK Clark case (R v Sally Clark [2003] 200203824 Y3) were that Meadow's medical and statistical evidence on cot deaths in the case was "wrong" and "grossly overstated".

The Queensland Court of Appeal (R v LM [2004] QCA 192), in a unanimous judgment, stated MSBP (or factitious disorder by proxy) was not a recognised psychiatric disorder or mental illness in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM IV). The court went on to say that MSBP had no agreed sets of symptoms or signs that allowed it to be classified into a recognised psychiatric diagnostic system, it was not a recognised medical condition, disorder or syndrome, and the court excluded evidence from a psychiatrist as "extremely prejudicial". Justice Holmes noted that the MSBP argument was inherently circular and did nothing to prove criminal conduct.

The Australian Capital Territory's Director of Public Prosecutions, Richard Refshauge, said the QCA decision on MSBP made “clear that if a woman is to be prosecuted for harming her children, it is not enough to put a label on it; facts are required to justify the case”.

"By labelling the woman in this way with MSBP or factitious illness by proxy you are saying the woman is guilty, as the label creates the guilt … People are not convicted for having a syndrome or a particular behaviour; they are convicted for the illegal acts that they do."

The QCA decision resulted from a case in a criminal court, where guilt must be established beyond reasonable doubt, but Munchausen Syndrome by Proxy is frequently used in care proceedings in the children's court where a decision rests on the degree of probability and does not necessarily abide by the rules of evidence.

According to Pragnell, this is the heart of the problem. He said that in care proceedings, hearsay evidence was admissible, while such evidence would be inadmissible in criminal matters. Therefore, in care cases, the cards were heavily stacked against mothers when added to any balance-of-probability decision. He suggested care courts should be inquisitorial, aimed at establishing what has happened and what the outcome should be.

As Hayward-Brown pointed out, parents had limited finances and were often denied government legal aid and support as opposed to the authorities, which appeared to have unlimited funds.

The NSW child protection agency, Department of Community Services (DOCS), has confirmed it is "precluded" by law from using allegations of MSBP as the basis for the removal of a child. Yet, the writer believes it has used MSBP allegations for many years as the central allegation in child protection proceedings. Written statements to this writer from DOCS (September 10, 2003 and September 24, 2003) suggest that DOCS was in breach of its own legislation when it stated the “Children and Young Persons (Care and Protection) Act 1998 (Section 71, Subsection 2) precludes DOCS from taking any medical condition of a parent or carer into account when making a child protection decision”. The Director-General of DOCS, Dr Neil Shepherd, declined to be interviewed for this article.

Pragnell claims some medical authorities show scant regard for legal requirements. "This is causing immense harm to the status of the medical profession and public trust in physicians, as relatives and friends of affected families are alarmed and angered by the needless and unwarranted removal of children and, in some cases, the imprisonment of innocent mothers," he said.