Why an expert witness is in the dock

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LITTLE more than a year ago, Professor Sir Roy Meadow wore the crown of the children’s champion.

As a paediatrician he was credited with discovering Munchausen’s syndrome by proxy, a particularly insidious form of child abuse. When he stated that one sudden infant death was a tragedy, two suspicious and three murder, until proven otherwise, his aphorism was dubbed Meadow’s Law.

By appearing as an expert witness at the trials of mothers convicted of murdering their babies, he had helped jail some of the most repulsive criminals our society has produced.

Or so we thought.

Over the past 12 months, Sir Roy has seen his professional reputation all but destroyed.

In January last year, Sally Clark walked free from jail when the Appeal Court overturned her convictions in 1999 for murdering her baby sons, Christopher and Harry.

In June, Trupti Patel was acquitted of killing her three youngest babies, Amar, Jamie and Mia.

And last month, the Appeal Court threw out Angela Cannings’s conviction for the murder of her little boys, after 19 months in jail.

Sir Roy acted as an expert witness for the prosecution at all three trials.

Following Mrs Cannings’ release, three Appeal Court judges ruled that a mother should not be convicted in cot death cases on expert medical opinion alone.

Now it is Sir Roy who is in the dock of public and professional opinion: the existence of Munchausen’s syndrome by proxy is being questioned; Sir Roy is to be investigated by the General Medical Council, the doctors’ governing body, and Lord Goldsmith, the Attorney General, is to examine dozens, if not hundreds, of criminal convictions to see if more mothers have been wrongly convicted of killing their children. Sir Roy has been vilified in the press, with one tabloid describing him as "the child-snatcher-in-chief".

Sir Roy’s glittering medical career is shattered. But to some who have known him most of his life, there is a sad inevitability to the situation he is in now.

"In retrospect, the signs were there - in who Roy was - that he would go too far," said Gillian Paterson, Sir Roy’s former wife, and the mother of his two adult children.

"He found it everywhere. He was over the top. He saw mothers with Munchausen’s syndrome by proxy wherever he looked.

"I wish that somebody could have said to him: ‘Roy, they’re not everywhere. They do exist, but they’re rare’. I wish somebody could have stopped him."

As the post mortem examination of the professor’s career begins, questions abound. How many innocent mothers have been jailed because of the evidence he, and doctors who followed his theories, gave at trials which should never have taken place? How many children were wrongly removed from their parents at behind-closed-doors family law hearings, because sheriffs and judges unquestioningly gave credence to his beliefs? How did a man now so vilified rise to become a criminal prosecutor’s expert witness of choice, a position which gave him unparalleled power to shatter so many lives?

And what is the character of this 70-year-old retired doctor, whose name will forever be associated with one of the most serious miscarriages of justice the UK has ever known?

According to his former wife, Sir Roy is a misogynist - a claim which will be seized upon by those who have accused him of conducting a witch hunt against innocent mothers. "I don’t think he likes women," said Ms Paterson, a journalist and writer. "He’s not gay. I don’t think he’s gay. But, although I can’t go into details, I’m sure he has a serious problem with women," she said.

Samuel Roy Meadow was born in June 1933, the son of a chartered accountant from Wigan, Lancashire. His mother was a housewife, but according to those who know Sir Roy, her ambition for her son, and his elder sister, Pauline, was fierce.

"Roy’s parents weren’t wealthy," family sources have said, "but they were incredibly driven for their children to succeed. Doris, especially, was fantastically proud of Roy. But her affection was - I would say - conditional upon him doing well. Roy knew the score. He had to do well. Doris was very judging. Her children were her trophies in this rather dreary, small town."

After studying at Wigan Grammar School and Bromsgrove School, he won a place to study medicine at Worcester College, Oxford, graduating in 1957. While working as a GP in Banbury, Oxfordshire he became interested in child healthcare, and by 1980 he had risen to become the head of paediatrics at St James Hospital, in Leeds - one of the most prestigious posts in his field.

In 1961, Sir Roy had married Gillian MacLennan, the daughter of the British ambassador to Ireland, a match which must have rocketed him up the social ladder. Their children, Julian and Anna, were born in 1963 and 1965 respectively. Now, his former wife says that although popular with colleagues, Sir Roy had no close friends.

She also recalls how he would visit the Anna Freud Centre - Anna was the psychologist daughter of Sigmund Freud - for what she described as a "Bloomsbury-set" chats about child health.

In a bizarre coincidence, sources claim that Sir Roy starred in an amateur production of Arthur Miller’s play The Crucible, playing the role of the discredited Judge Danforth who is at the heart of the witch-hunt that is the backbone of the play. "Roy confided in me that he found it an uncomfortable part because he identified with this judge more than he was happy with," a source recalled. "I always remember Roy playing that part. He was made for it. He was brilliant."

It was in 1977 that Sir Roy wrote the paper that was to change his life: "Munchausen’s Syndrome by Proxy (MSbP): the Hinterlands of Child Abuse."

In the study, Sir Roy described the cases of two sick children whose symptoms had left doctors puzzled.

It transpired that in the first case, a mother had added some of her own blood to her child’s urine sample. In the second, the mother had allegedly poisoned her toddler with excessive salt doses.

Sir Roy wrote that both mothers were suffering from Munchausen’s syndrome by proxy. The new illness took its name from Munchausen’s syndrome - the term coined in 1951 by Dr Richard Asher (the father of the actress Jane Asher), in reference to Baron von Munchausen, the 18th-century German mercenary famed for his fabulous lies.

Munchausen’s syndrome sufferers fake symptoms of illness and will travel from hospital to hospital to secure surgical and medical procedures for illnesses they do not have, simply to get attention.

Munchausen’s syndrome by proxy is a more sinister variant of Munchausen’s syndrome, in which parents - almost always the mother - replicate or even cause symptoms of illness in their children, simply to draw attention to themselves.

His findings were published in the Lancet medical journal, and attracted worldwide attention.

Ms Paterson recalls: "He took a lot of flak at the time. Nobody wanted to believe mothers did that sort of thing. Later [in 1993], he was vindicated with the Beverley Allitt trial (The nurse who murdered four children in her care and harmed a number of others). That’s when they stuck him on a pedestal, made him the number one expert witness in the land, and proceeded to believe everything he said."

But it was in 1989 that Sir Roy coined the now infamous Meadow’s Law, when he wrote in The ABC of Child Abuse: "One sudden infant death is a tragedy, two is suspicious and three is murder until proved otherwise."

It was this phrase, which captured the imagination of public and press when Sir Roy was called as an expert witness for the prosecution at the trial of Mrs Clark.

Mrs Clark was found guilty and jailed, but her conviction was overturned last year, after her husband, Steve, unearthed new evidence that the baby had a life-threatening infection at the time of death. It was Mrs Clark’s case that was to turn the tide against Sir Roy. After more than 20 years as an expert witness, Sir Roy now stands accused of failing to provide a scientific basis for his claims.

Jean Golding, the professor of epidemiology at Bristol University, was originally asked to be a prosecution witness at the trial of Mrs Cannings. But her reading of the pre-trial evidence swung her to the defence.

In court she savaged Sir Roy’s methodology, saying that 81 cases on which he based his outlook did not stand up to scrutiny, because he had no control group. (In fact, Sir Roy has admitted shredding the raw data on which he based his beliefs.)

Prof Golding told a Radio 4 File on Four programme in July 2002 that Sir Roy’s statement "lacked scientific rigour" adding: "I called it stamp collecting ... you pick out the cases that you want to present and then you present them."

The Royal Statistical Society also wrote to the Lord Chancellor stating there was no statistical basis for Sir Roy’s court claim that there was only a one in 73 million chance of Mrs Clark losing two babies in sudden and unexplained circumstances.

Shortly afterwards Mrs Patel was acquitted of murdering her babies - and now Mrs Cannings has seen her conviction overturned.

Presented with a situation of three mothers found innocent, the government has been forced to react, hence Lord Goldsmith’s review. Thousands of other cases dealt with by local authorities are expected to be reviewed as well.

So how did Sir Roy maintain so much credibility for so long in our supposedly rigorous courts of law?

Dr Lucy Blakemore-Brown, a psychologist from Brunel University who has studied Sir Roy’s work for some time, says juries and judges quite simply trusted a man whom society had rewarded by making him a doctor, professor and knight of the realm. Dr Blakemore-Brown also believes that Sir Roy’s turn of phrase has played a crucial part in his credibility in court.

She says: "One, two, three, ABC ... 73 million to one....these are phrases a jury can understand amid the foreign language of the court - but why did the judges not realise Sir Roy had no science to back his claims?"

Whatever the questions hanging over Sir Roy now, he has undoubtedly enjoyed widespread respect among his peers. A number of colleagues have jumped to his defence in recent weeks.

Harvey Marcovitch was a paediatrician for more than three decades and is a member of the Royal College of Paediatrics and Health Care and a member of the General Medical Council of the UK.

He suggests that a simple case of supply and demand may have helped Sir Roy become a pre-eminent expert witness: there is a limited number of paediatricians; those practising are unlikely to be able to clear two or three weeks of their diary to give evidence at a trial; of those, many will not be experienced or expert; many are reluctant to risk the public scrutiny of a case in which they have no need to get involved.

Dr Marcovitch explains: "You are left with few expert witnesses. Then, if one performs well in court, the lawyers will employ him for their next trial. The word gets round that this guy is good, and he is called again and again. So he become known as the foremost expert witness in his field - it’s sort of a self-fulfilling prophecy."

Dr Marcovitch is in no doubt that Munchausen’s syndrome by proxy exists. He points to a recent study of UK paediatricians carried out by the British Paediatrics Surveillance Unit which found that doctors were discovering between one and two cases of the syndrome annually per million head of population. He adds: "I do not think you will find a paediatrician who does not believe MSbP exists. But it is rare, and over the years the term was used to describe a wider and wider range of things. For example, Beverley Allitt did not have MSbP as suggested at the time - she was a killer."

It was because of concerns about the increasingly blurred definition of Munchausen’s syndrome by proxy that the Royal College officially dropped the term in 2002. It now uses the terms "fabricated" and "induced illnesses".

Sir Roy was not answering the telephone at his home near Leeds, yesterday, where he lives with his second wife, Marianne.

Whatever the GMC and Attorney General’s investigations discover, it will be painful for all involved.

In the past, Sir Roy was applauded for thinking the unthinkable, and he has no doubt rescued some infants from abuse. But far from being a children’s champion, he may have simply championed his own cause - at the expense of truth.

Pivotal evidence now deemed ‘manifestly wrong’ and ‘grossly misleading’

Over the past five years Prof Meadow’s evidence was pivotal in the trials of three women:

• 22 November, 1999: Angela Cannings was arrested and questioned about the death of her four-month-old son.

• 26 November, 1999: Sally Clark is sentenced to life imprisonment for killing her two baby sons in 1996 and 1998. Prof Meadow gave evidence to the effect that any more than three cot deaths in one family could be construed as involving murder.

• 16 April, 2002: Angela Cannings is jailed for life at Winchester Crown Court after being found guilty by a jury of smothering her two sons.

• 29 January, 2003: Sally Clark’s conviction is quashed as the appeal judges condemned Prof Meadow’s claim that the chances of having two cot deaths in one family was 73 million to one as "manifestly wrong" and "grossly misleading", and express concern that key evidence was not put before a jury.

• 12 June, 2003: Trupti Patel is acquitted of killing her three babies. During the case, evidence is given by Prof Meadow, and a small group of protesters attempt to distribute leaflets questioning his credibility.

• 10 December, 2003: Angela Cannings is freed after the Court of Appeal overturned the verdict on the ground that the convictions - which were based on Prof Meadow’s research - were "unsafe".