Paediatricians did not have duty of care to patient's mother

A mother who alleged that Professor David Southall and another paediatrician caused her to develop a psychiatric illness by wrongly diagnosing her child as a possible victim of Munchausen syndrome by proxy is taking her case to the Court of Appeal after it was thrown out by a judge at Chester county court.

Judge Hale ruled that Professor Southall and Dr Karen Whiting, a community paediatrician, owed no duty of care to Janet Davies, mother of Michael, and therefore no claim for negligence could proceed against the former East Berkshire Health Authority, Dr Whiting's employer.

Michael, then aged nearly 6 years, was referred to Professor Southall, of North Staffordshire Hospital, in 1994 by his GP, who described him as “the most allergic patient I have ever known.”

Professor Southall was asked to assess his suitability for a breathing monitor, so that he could sleep in his own bedroom. Michael was admitted to North Staffordshire Hospital, Stoke-on-Trent, where he and his mother were observed by Professor Southall, who wrote in his notes: “Agreed that mother is exaggerating symptoms. Example of fabricated illness. Need social service strategy meeting.”

No action was taken until Dr Whiting took over as community paediatrician in Berkshire in December 1996. A meeting was convened in March 1997, at which those present included Dr Whiting, Professor Southall, a social worker, and Professor Stephan Strobel of Great Ormond Street Hospital for Children in London.

Professor Strobel wrote after the meeting: “It was felt that false reporting of the severity of Michael's symptoms, equivalent to Munchausen by proxy, remains a distinct possibility and needs to be ruled out or confirmed.”

In April Professor Southall wrote to the child protection coordinator of Berkshire county council suggesting that Michael was at significant risk of suffering harm, and in June the boy's name was put on the at-risk register.

Professor Southall said at the case conference that, although he had no doubt that Michael was allergic, he was concerned that his mother had exaggerated his problem and had sometimes fabricated information about it.

Michael was subsequently assessed by Professor John Warner of Southampton General Hospital, an expert on paediatric allergy, who confirmed that he had severe allergic problems. He was removed from the at-risk register in September 1997, and the suggestion of Munchausen started to fall away, eventually to disappear,” said Judge Hale.

“Once a suspicion arises about someone who was the mother of a patient, there was a clear duty to investigate in the interests of Michael, even if initiating the process might damage the mother,” said the judge. “In fact [the doctors] could be negligent in certain circumstances to the child if they did not do so.”

He concluded: “In my judgment public policy considerations militate strongly against the existence of any duty of care towards the claimant on the facts of this case. My ruling therefore is that no duty of care exists towards Mrs Davies and that is fatal to this action.”

Professor David Southall who thought his patient's mother had exaggerated symptoms of his illness