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Tuesday, 14 November, 2000, 22:38 GMT
Brittle Truths: Transcript
This is the full transcript of Frontline Scotland's Brittle Truths programme broadcast on 14 November.
Reporter Ewan McIllwraith: Imagine your baby is ill. You don't know what's wrong. In desperation you go to Casualty, only to be told by doctors that your baby has multiple fractures.
Your world collapses. You came to hospital the concerned parents - you leave scored by society accused of child abuse.
Nicky: Well we couldn't...... it was just frightening, it was as if...... we describe now like....... the whole world had changed, it was like a great big jolt that we weren't part of.
You don't think that somebody can come into your home, into your life, demand to know every part of your life, ask you the most intimate questions, and ultimately walk away with your child, just take your child screaming from your arms, literally.
Reporter: But this Dundee doctor believes some parents have been wrongly accused of child abuse. He thinks the fractures are due to a rare bone disease that ninety-nine per cent of medical experts say simply doesn't exist, and that the children are being returned to abusing parents.
Dr Wilkinson: I've worked in two paediatric hospitals in Scotland. I worked at Yorkhill for six years. I've been here for two years.
And I have not come across a colleague who believes in temporary brittle bone disease. Not a single paediatrician, not a single pathologist, not a single radiologist supports Dr Paterson's view.
Ryamond Lawrie: Somebody must be wrong, we've got to find out who, it's as simple as that.
Reporter: A few weeks ago a sheriff here at Hamilton Sheriff Court made a decision which sent shockwaves throughout the medical world.
He decided to return baby twins to parents accused of child abuse. Parents who'd maintained their innocent, but social workers, based on medical opinion of multiple fractures insisted that the twins be taken into care.
And so a whole debate was rekindled that's seen social worker put against family, and doctor against doctor.
The case concerned a family who'd shown up at hospital with one of their twins in pain. Doctors became suspicious of the multiple fractures that showed up on their X-ray.
The Sheriff heard expert testimony that the twins were the victims of child abuse. He also heard Dr Paterson's controversial analysis that the children were suffering from a condition he calls "temporary brittle bone disease".
In his summing up the Sheriff said that Dr Paterson was involved in 103 cases of which 78 had been returned to their parents and continued to do well. He went on to say that: ".... these figures weigh heavily with me.....", ".... including the boys won't to come to harm if returned to the care and control of their parents".
He also said: "It appears to me if those who criticise Dr Paterson to take these figures into account they might have cause to reconsider their position."
The medical establishment has effectively destroyed Dr Paterson's reputation in cases like this, especially south of the Border, to such an extent that if this case had been heard in England then Dr Paterson wouldn't have been called as an expert witness, and the children could still be in care.
Dr Paterson is an expert in bone biochemistry. He has written text books on the subject, and lectures throughout the world. But he's not an expert in child abuse, and he was accused during the Lanarkshire case of putting the twins in danger by arguing for their return to the parents.
Dr Paterson: Yes, I'm aware of that. I think that was wrong, and I was not alone in this, the general practitioner who saw the children at the time when supposedly some of the fractures occurred was also quite clear that there'd been no evidence of injury.
And another colleague from the United States gave evidence in addition, which was quite similar to mine. So it wasn't just me.
Reporter: Dr Graham Wilkinson is a radiologist at the Royal Sick Children's Hospital in Edinburgh. He's not allowed to comment on the Lanarkshire case, but feels, like most doctors, that Dr Paterson's evidence concerning temporary brittle bone disease is dangerous.
Dr Graham Wilkinson: If the water is muddied and a significant seed of doubt is sewn, and it is perfectly possible that children will be returned to be abused. It's well recognised that siblings of abused children can go home and be murdered, and that if the first signs of non-accidental injury are missed that a child can go home and be murdered.
So it is perfectly possible that children will die because the criminal... the child protection cases have sufficient as a result of Dr Paterson's work.
Reporter: There is an undisputed condition - Permanent Brittle Bone Disease - osteogenita imperfecta - or OI, and it's rare. It affects around six thousand people in the United Kingdom. Its effects are devastating. Most end up in a wheelchair, and some die.
In its early stages some forms are hard to spot. But Dr Paterson thinks there's another condition - temporary OI - a short-lived form of an already rare disease.
When did you first become aware that there was a possible condition as temporary brittle bone disease?
Dr Paterson: In about 1985 I came across, I was asked to investigate in fact two children, one in England and one in the United States, and with very similar X-rays. Both had very large numbers of fractures. They could have been ordinary Brittle Bone Disease, but the difficulty was that in both cases the fracturing appeared to stop at the age of about three months, and did not recur.
Reporter: Why can't a simple test be devised?
Dr Paterson: We still don't know the cause of the condition. That's the major difficulty. But the fact that we haven't got a single test, and we haven't got an identifiable cause doesn't mean to say that the condition doesn't exist.
Reporter: But even here at the Brittle Bone Society in Dundee they're not officially convinced of Dr Paterson's theory.
Raymond Lawrie: Society's position on temporary OI is really that the clinical research has not been done in depth for long enough to know about the condition.
But, yes, I mean diagnosis of temporary OI is a very, very contentious issue, and there is no definitive diagnosis for OI itself after thirty, forty years research. Diagnosing temporary OI infinitely more difficult even than that.
Reporter: Fifteen years ago Dave Marshland's wife Lynn gave birth to twin girls - Nina and Lucy.
Dave Marsden: There was no record, or we thought there was no record of twins, there was no record of twins in my family, and then we found that there was in some distant relations of Lynn's going way, way back, because they do say it's a hereditary thing, don't they, twins?
Em, so I were very pleased, just like a ready built family all at once. We then, probably about six weeks of them coming back from hospital, eh..... Nina just died, and we found her dead in her cot.
I went to hospital with her in the ambulance, my wife stayed here in the home with the other child. And when I came home, when I came back from the hospital the police were here, they had been notified by the hospital, which apparently is a normal thing in the event of the death of a child.
Anyhow at the end of it we were requested, or advised I should say, we should take the remaining child into hospital because they were twins, there may be something hereditary in them, and the other one.... there was a possibility the other one may die.
Reporter: And in a striking parallel to the case in Lanarkshire Dave soon found that he and his wife were at the centre of a major police and social work investigation, facing charges of abuse.
Dave: Probably after about a week, a week and a half they started making innuendoes that they'd found a broken rib on Lucy. And then the account went from one to sort of nine within the space of two or three days.
Reporter: Did you know what was on the agenda at that point?
Dave: No, no, my wife and I didn't understand what was happening in the sense of where they were coming from.
Obviously now we know, but we didn't at that time, we'd no idea. We just knew that we'd lost a daughter, we wanted to make sure that the remaining daughter was all right.
We knew in our minds we hadn't done anything to the children. We didn't even think of it. But later on we were accused of it.
Reporter: Lucy, only weeks old, was taken into care. But Dave wasn't prepared to give up without a fight. A chance encounter led him to Dr Paterson. Armed with his diagnosis of temporary brittle bone disease he went to court and won.
Dave: They'd taken the child off us, they were wrong. They'd no reason to take that child off us. So we wanted her back, it's as simple as that. And the only way we could get her back was to go through legal channels.
Reporter: Legal channels that you had to pay for?
Reporter: Legal Aid wasn't an option?
Reporter: What about somebody who maybe didn't have nine and a half thousand pounds disposal income available to them, what do you think would have been the result?
Dave: They would have lost the child. No doubt about that. They'd have lost the child.
Reporter: And Dave is under no illusions of the important part that Dr Paterson played in the return of his daughter.
Dave: I think I'm very lucky to have been able to find somebody to help my wife and I fight and get her back.
Reporter: But most children who suffer fractures like these would be diagnosed as victims of child abuse and taken into care. The problem - one X-ray of a three-month old baby but two very different interpretations. For Dr Paterson it's a case of temporary brittle bone disease. To the radiologist a clear case of child abuse.
Dr Wilkinson: A generally recognised pattern of child abuse is that a child is picked up by the chest, squeezed very tightly by the ribs and shaken backwards and forwards very vigorously using full force for only perhaps a few seconds.
During those seconds the rib cage is compressed from front to back so that the ribs can crack and you get multiple rib fractures that often occur in single line.
The limbs flail about during this motion, the limbs flail about and this puts a twisting and pulling force on the ends of the bones, and caused the characteristic fractures that we see in non-accidental injury, and it caused injury to the brain, and it's this pattern of three things, the limb injuries, the chest injuries and the intracranial injuries that is very specific for non-accidental injury.
Dr Paterson: Many radiologists would take one look at this film and say "this is child abuse".
What they should say is "here are huge numbers of fractures, what is the evidence for child abuse, what is the evidence for Brittle Bone Disease?", and try and devaluate it.
Dr Wilksinson: This X-ray would immediately say to me non-accidental injury. There are certain features that would be very difficult to explain by any other means.
The fractures down the left side of the chest run right down from the third rib to the tenth rib. And some of these ribs have been fractured through areas of ribs that are already healing from previous fractures
Dr Paterson: What we do know is that in a normal child of this sort of age fractures don't occur easily. The ribs, for example, are very flexible and it takes a lot of force to cause even one rib fracture. So a child with twenty rib fractures really represents horrendous injury or no injury at all.
Dr Wilkinson: There are multiple fractures on both sides of the chest, and here on the right side of the chest again we have four fractures all in a line, and this occurs when the chest is squeezed from back to front during an episode of shaking.
Reporter: What kind of force would you need to actually produce these fractures. It's been suggested by Dr Paterson that it's almost equivalent of a car crash to produce that kind of injury.
Dr Wilkinson: Well that's true, this is equivalent to a car crash. It requires immense force to fracture ribs in this way.
Reporter: But we've discovered that estimates of the force taken to break healthy bones in babies, which could be crucial evidence in a child abuse case, are just that - estimates.
Dr Robert Sunderland: First of all, to my knowledge, there hasn't been any research done on this. And quite clearly at one level there never will, because it's never going to ethical to take a hundred babies and twist their bones and see what happens.
That's a silly thing to say. But there are ways forward, and in Birmingham University we are just beginning to do that, because we've discovered this lack of evidence. You can take bone as tissue and treat it as if it were metal, or another material, and determine what its material properties are.
Reporter: Does that not imply that many people are working in the dark, that very little research has been done on the force required to break a bone?
Dr Robert Sunderland: I would reply to you there that if a child is presented to me who has got multiple fractures in different sides of different ages, and nobody knows nothing.
Or you've got a belligerent patent, or the police are coming and saying we've got a very strong history of family violence here, and one's got black eyes, other children with bruises.
For me then to turn round and say "well actually there hasn't been any research, can you come back and five years". The doctors' rule here is treating the ill child, and part of the doctors' job here is actually recognising where the pattern doesn't fit, where it doesn't add up.
Reporter: And once the finger is pointed a whole machinery swings into action. Social workers, police, and lawyers, leaving the parents feeling powerless.
Maggie Eaton knows what it's like to be falsely accused of abusing a child with Brittle Bone Disease. She now counsels families with suspected temporary OI who face similar charges. And she's worked with over one hundred families who simply can't explain what's happening to their child. She's convinced they aren't guilty.
Maggie Eaton: You can usually tell. If you've got any common-sense at all you can usually tell by talking to families for many, many, many hours. Getting to know them and then you can tell whether they are genuine, or whether they are not.
It's instinct a lot of it, which would not stand up in court. But, you know, I've been through it. I've been there. I know how I felt, so I know how they feel. But if a family has hurt their child they will slip up sooner or later. If they haven't, they won't.
The main problem is that a lot of these experts don't see the children, they don't see the parents, they don't talk to the parents.
They've had no contact with the families at all - none whatsoever. How can you judge a family of non-accidental injury, tear their lives to shreds, have their children removed from their homes without having seen them. I fail to see how that can be just.
Reporter: Dr Paterson, however, does listen to parents, refusing to make his diagnosis purely on X-ray evidence. But his critics believe this is unscientific.
Is it not a case where you've just simple been taken in by very persuasive parents who are abusers?
Dr Paterson: I've been very concerned about that possibility. I don't think that's happened, and the ultimate proof that this has not been the case is what happens when the children are returned home.
I do take a personal history from the parents as best I can. And I do do my own assessment of whether they're telling me the truth.
And I also interview all those who also saw the child at the time in question when supposedly the fractures happened in order to get a rounded picture of the events leading up to the discovery of the fractures.
I do my best to get the whole story, and only say that it's bone disease of one sort of another when there's really good evidence to present.
Reporter: Because there could be an argument you're gullible, go up to Dundee, there's a soft touch, he'll get you off.
Dr Paterson: I don't think that's likely, frankly, for the reasons I've already given you. I'm as concerned as anybody not to be a soft touch. I have more to lose than, say, the radiologists who say it's child abuse.
Reporter: The debate still rages as to the existence or otherwise of temporary brittle bone disease.
But we've uncovered evidence that the medical profession can still get it wrong even with undisputed conditions such as permanent Brittle Bone Disease - a condition that affects thousands - and one accepted by medical experts for generations.
Nicky's story is every parent's nightmare. Unknown to her, Andrew had Brittle Bone Disease. A hospital X-ray showed multiple fractures - breaks which she couldn't explain. According to experts a classic of child abuse.
What does it do to you when somebody's accusing you of abusing your child?
Nicky: I can remember the day really clearly. It was like, I can only describe it as been shot. I felt as if somebody had just taken the wind out of me. Actually, a slid to the floor at one point. When I did think I was going to lose consciousness..... I didn't..... it was just to be told that they're going to phone the police if you try to take your son out of the hospital.
From being just an ordinary happy family, to you know.... being accused of the most awful crime you can imagine. It was just so shattering, so frightening.
I'd like to bomb the whole place. It just brings back memories, very bad memories about what was done to my son, and all the suffering that's been caused. In a place like this where you're supposed to be.... you're supposed to come here for help, and you'd like to trust these people. Everything was turned around on us, and they were turned in to our enemies.
He'd been saying every week for the whole of his life, because he was small, low birth weight, he was...... monitored regularly, and he was weighted with nothing on every single week, and there was never a mark on him.
Reporter: Despite this obvious lack of bruising social workers stuck to their conclusion of abuse.
Nicky: About two days after we were accused we were in hospital five days, we couldn't leave, so I left Andrew with my partner, I went to the library. It took me two days, I read every book about childhood illnesses, specifically about fractures, and I discovered, I think, three conditions where fractures occur spontaneously, and this was obviously the one - the osteogenisis imperfecta - because there was twelve indicators to look for, and Andrew had ten.
Dr Paterson: I was asked to examine the child, in fact by the general practitioner, and he and his parents were brought up here, or came up here to see me. And, I examined him, I took some additional X-rays, and I was convinced this was not temporary brittle bone disease, this was ordinary classical osteogenita imperfecta.
Reporter: You were convinced that it was not child abuse at that stage?
Dr Paterson When I first saw the child.....
Reporter: That it was Brittle Bone Disease.
Dr Paterson: Yes, this was classical osteogenita imperfecta.
Reporter: Which there is no argument in the medical profession, it does exist?
Dr Paterson: It certainly exists.
Reporter: Nicky thought her problems were over. Dr Paterson had confirmed that Andrew suffers from Brittle Bone Disease an established medical condition.
Nicky: We had taken that evidence, the report to our solicitor and he just looked at the name and said.... I mean, he actually laughed and said: "There's no way we can use this man, nobody will touch him in court, his name is mud." We couldn't believe it, we said: "Why?", he said: "Well he's been discredited."
And he said there'd been a couple of cases where he'd been kind of laughed out of court by other radiologists, and he said no judge is going to take him seriously, it's not worth the paper it's written on, the report.
Reporter: Nicky's problem was that Dr Paterson's reputation in England was tarnished as a result of an adverse court decision in 1995 where a High Court judge found against him. In his summing up Mr Justice Wall felt that he'd ceased to act as an expert witness.
And here at the Law Department of Sheffield University one lecturer has made a study of that case of child abuse, and the effect it's had on Dr Paterson's career as an expert witness.
Dr Catherine Wiiliams: In the case where Mr Justice Wall was actually criticising Dr Paterson he was actually saying that Dr Paterson had actually strayed away from his independent expert role. He actually felt that he had actually adopted the role of an advocate.
Reporter: What did you feel about that summing up by the judge in that particular case?
Dr Paterson: I was very concerned about it. It was a difficult case. The number of fractures was very large, the child was reliably observed by people, including a medical grandparent, to have had no evidence of injury. I was confident of the diagnosis I made.
Reporter: And that judge's decision has cost Dr Paterson dear. He's never been called in a civil action in England again, despite his obvious expertise in bone disease.
Dr Paterson: I've certainly had a lot of cases south of the Border since then, but only in the criminal courts. And I've had no civil cases since then. It has been particularly difficult, and I think some children have suffered as a result of this, and some families have been damaged.
Reporter: Andrew's fractures continued once he was taken into care, and one year after Dr Paterson's rejected diagnosis he was confirmed as having Brittle Bone Disease.
Nicky: If Dr Paterson had been called none of this would have happened to us. As a result of this I lost my home, my partner lost his job, me and my partner split up, we lost our son. So much damages has been done, and still to this day we can see the effects of the damage that have been done. All of this could have been avoided.
If you know that you haven't abused your child and nobody else has, then you've got to fight for your child. I would also say never, ever admit to something that you haven't done. You will be pressured sometimes by legal people, sometimes by doctors.
Everyone I've spoken to say the same thing, that the social workers and the doctors say "Oh, I know how frustrating children can be sometimes, I feel like throwing mind out of the window, I feel like putting a pillow over my child's head," you always get things like that said to you. Don't.... you know, don't ever admit to something that you haven't done in the mistaken belief that this will help you get your child back, because it won't.
Reporter: Dr Paterson was proved right in this case of permanent OI. But that doesn't make his evidence correct in the more controversial area of temporary brittle bone disease.
The decision by the Hamilton sheriff to accept Dr Paterson's findings have created confusion. South of the Border he's a tarnished witness. In Scotland children were returned to accused parents on his evidence.
Dr Williams: At the moment it is a sheriff's decision and, of course, Scotland, which has a separate legal system than England, so in that sense whatever is decided in the Scottish courts obviously doesn't bind in English courts.
But if you talk hierarchical terms a High Court judge is obviously higher than a sheriff, so in that sense one would say that the English decisions at the moment have more force than the Scottish decision.
Reporter: In an attempt to resolve the dilemma facing the courts and to put an end to the suffering of parents wrongly accused of abuse the Brittle Bone Society are calling for a public inquiry.
Raymond Lawrie: It needs to be sorted out. Like I say, we have records going back twenty-five plus years for families.
The mistakes and presumptions of the medical profession, social workers, and the lawyers are still the same as they were twenty-five years ago. Medical knowledge research has moved ahead. We know a lot more about the condition.
But that hasn't percolated through to these people, and there are still the same problems, the same assumptions, that there must be a victim, there must be a guilty party.
Reporter: If Dr Paterson is right then the disease simply fades away after few months.
Lucy was diagnosed with temporary brittle bone disease thirteen years ago.
Dave: There's absolutely nothing wrong with Lucy. We thought that maybe when she was growing up we'd have to be careful, you know, that the knocks and bangs that children get..... but no, she's fallen off her bike, and grazed her knees like all kids do, and there's been nothing, absolutely nothing.
You know..... I mean she's a very strong, healthy girl. Which again goes to show how wrong they were.
Reporter: According to Dr Paterson in all the cases where children have been returned to the parents on his evidence none have come to further harm.
So either Dr Paterson is right and temporary brittle bone disease exists; or abusing parents have simply learned their lesson.
If you're wrong then the kids are going back to being abused. That is a frightening thing they have to live with.
Dr Paterson: I find that very frightening too, and it gives me the greater incentive to be extremely careful as a I prepare my reports and that I give my evidence.
Reporter: Is there any doubt in your mind at all?
Dr Paterson: There's no doubt in my mind that the condition exists, and I think there's nothing special about me, but I have seen so many cases.
But any doctor who'd seen these cases would have come to a similar conclusion.
Reporter: Have you got it wrong?
Dr Paterson: Not to my knowledge to date.
Reporter: The Lanarkshire case is due for appeal. That decision could decide the fate not only of Dr Paterson's reputation, but that of parents accused of child abuse. Meanwhile Dr Paterson remains a lonely voice in the medical wilderness.
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