Doctor failed to be objective over 'shaken baby death' court cases, panel rules


A doctor failed to be objective and unbiased in a number of alleged "shaken baby death" court cases, a disciplinary panel has ruled.

The conduct of Dr Waney Squier at civil and criminal proceedings was found to be irresponsible, deliberately misleading, dishonest and likely to bring the reputation of the medical profession into disrepute.

On Friday, a Medical Practitioners Tribunal Service panel made the finding of facts in relation to six cases in which the consultant neuropathologist provided evidence, including the deaths of four babies and a 19-month-old child.

Dr Squier, 67, who works at the John Radcliffe Hospital in Oxford, gave expert evidence that the injuries involved were either not consistent with non-accidental injury, or were more likely to have been caused by some other means.

Her minority view on shaken baby syndrome is in contrast to the opinions of the majority of experts in the field who argue the so-called triad - swelling of the brain, bleeding between the skull and brain, and bleeding in the retina - is a strong indicator of trauma.

The panel heard Dr Squier disagreed with those opinions unless there was other evidence of external or internal injury.

In earlier evidence, she explained to the panel she had previously gone along with accepted thought on the syndrome until about 2000 when she became aware of a study by Dr Jennian Geddes of babies thought to have died from non-accidental head injuries.

She told the panel the study found no evidence of mechanical disruption of nerve fibres in the brain, which questioned whether trauma had taken place at all.

Dr Squier, represented by Sir Robert Francis QC, denied misconduct but the panel, sitting in Manchester, ruled against her on the vast majority of allegations she faced.

In its ruling, the panel stated: "The tribunal notes that your opinion on the mechanisms of AHT (abusive head trauma) changed after the publication of Dr Geddes's hypotheses. It found that in your written and oral evidence you were dogmatic, inflexible and unreceptive to any other view."

It added: "The furthest you were prepared to accept any criticism was to state either that you had made a typing error or that you could have been clearer in what you had said in your reports or evidence."

The panel also noted that Dr Squier had, in its consideration, made "an outrageous and untruthful assertion" that she had gone to an operating theatre "and asked the surgeon to try and damage the arachnoid (a protective membrane that covers the brain and spinal cord); it is extremely difficult".

Opening the case last October for the General Medical Council (GMC), Tom Kark QC said Dr Squier's conduct was affected by her "preconceived and blinkered approach".

He said: "In a number of cases in which she provided a report and gave evidence, the GMC suggests that Dr Squier went well outside her sphere of expertise and gave evidence and opinions in relation to areas of medicine and physiology in which she was not an expert.

''On occasions she misquoted or mis-stated the facts upon which her expert opinion was said to be founded in order to fit in with her preconceived ideas. On occasions she purported to rely upon medical and other research which, upon close examination, does not in fact support what she was saying. She failed in her overriding duty to the court to remain objective and to assist the court."

The hearing was adjourned until next Monday ahead of submissions to be made by counsel on whether Dr Squier's fitness to practise is impaired because of her misconduct.

Dr Squier also denied misconduct in relation to an expert witness report she was said to have submitted in April 2014 to a Court of Appeal civil case involving a child.

It is said she failed to disclose to those instructing her, or the court, that there were outstanding disciplinary proceedings against her.

The panel ruled the above failure was misleading and irresponsible but was not deliberately misleading or dishonest.

In her overall ruling, panel chairwoman Michele Codd pointed out the tribunal was not empanelled to determine either the relevance of the triad to AHT or who was right in the cases before it.

But, last year, Mr Kark had submitted to the panel that it would have to answer whether her opinions had a "significant effect" upon the various proceedings between 2008 and 2010.

He said among those misled would have been the families and other parties to litigation - the judges, the lawyers and the other experts.

In most of the cases, Dr Squier - who had not actively worked in paediatrics for more than 40 years, the panel noted - was the sole expert instructed on one side of the litigation.

The panel was told she had given evidence in between 150 and 200 cases since the mid-1990s involving either medical negligence or cause of deaths in early months and years of life.

In evidence, Dr Squier explained she was mostly instructed by the police in her early years as an expert witness, but the pattern changed from 2002 when she received more requests from defence solicitors.

Sir Robert, representing Dr Squier, had submitted that a number of witnesses called to Manchester by the GMC were, or could be, biased themselves because they held the majority view on shaken baby syndrome but the panel ruled their evidence was "credible".

Following Friday's ruling, human rights lawyer Clive Stafford Smith said: "Shaken baby syndrome is not a medical diagnosis to be treated but, almost uniquely, it's a doctor's opinion that a crime has been committed.

"I have represented a number of people who have been sentenced to death based on this 'theory', although increasingly the evidence suggests that it is unscientific nonsense.

"Justice demands that a doctor who honestly holds views supported by scientific evidence be permitted to give testimony that challenges the hypotheses of others. After all, Galileo Galilei was forbidden from saying that the Earth revolved around the Sun 400 years ago. Unfortunately it took until 1982 before Pope John Paul II conceded the Catholic Church had been wrong.

"Setting aside the devastating personal impact on Dr Squier, I am most troubled by the effect of this process on the delivery of justice in this country and around the world. Hundreds if not thousands of parents or carers have been condemned, or lost custody of their children, when the medical profession has diagnosed a crime. Today, unqualified though they may be, the panel announced that the GMC will brook no scientific dissent."

The panel was told by Mr Kark that a BBC Panorama programme on so-called shaken baby syndrome was due to be broadcast next Monday.

He said he understood that Dr Squier would feature in the edition.

Mr Kark repeated his advice to the panel at the start of the hearing to ignore any media coverage surrounding the case.

Panel chairwoman Mrs Codd said members would not watch the programme.