The paediatrician David Southall this week defended his practice of keeping “special case files” separately from patients' medical records, at a General Medical Council hearing in London. Professor Southall is facing the GMC's fitness to practise committee, accused of serious professional misconduct.
He is accused of “keeping what amounted to secret medical records” on four children in his care and of failing to respect the privacy and dignity of their mothers.
Earlier this month a woman named only as Mrs M testified that Professor Southall accused her of murdering her son, who was found hanging in his bedroom (BMJ 2006;333:1036). An inquest into the child's death ended in an open verdict.
As Professor Southall opened his defence, he argued that the “special case files” contained documents relating to child protection orders and investigations and were meant to be kept separate from other medical records.
“It's child protection, it's hospital policy, then and now,” he told the hearing. “With all medical matters, as part of our policy, all correspondence, particularly child protection correspondence, must go in the special case file, not in the main file. It's not the sort of thing that should be in hospital records.”
The mother of a boy named as child H had earlier told the hearing that Professor Southall kept secret files on her son after the parents had requested that he no longer be involved in the child's care. Professor Southall acknowledged sending a letter on the child's condition to another paediatrician not involved in his care without seeking permission from the parents.
Mrs H told the hearing that she believed Professor Southall saw her son as “nothing more than a lab rat” and described the letter as a “breach of confidence.”
Child H was referred to Professor Southall in 1989, when he worked at the Royal Brompton Hospital. A year later the family asked that he no longer be involved in the child's care. But Professor Southall took child H's special case file with him in 1992 when he moved to North Staffordshire Hospital. He told the panel that he had accumulated roughly 1000 special case files at the Royal Brompton, which were later transferred to a “secure place” in Staffordshire.
Mrs H told the panel that she spent several years seeking disclosure of the records. She said that the contents she did unearth were “rather strange and seemed to be some sort of trophy memento.”
“To my surprise there was a poem written by me that had been for my husband and child in 1992. Dr Southall had a copy of that poem in his file.” Asked if she believed she now had seen the whole file, she replied, “I'm sure that I have not. We do not believe we will ever get a complete file.”
Professor Southall said the special case files were essential to child protection work. “We needed a system to find out quickly what was going on with the child.” Asked if he felt the transfer of files from the Royal Brompton posed a risk to patients, he answered, “I couldn't think of one. I still can't.”
He is also accused of keeping secret files on a patient named as child D and two other children. But he was earlier cleared of failing to respect the privacy and dignity of child D's mother, Mrs D, on the basis of insufficient evidence.
Professor Southall has been referred to the fitness to practise committee in another case, along with his colleagues Martin Samuels and Andy Spencer. The new case relates to his research into continuous negative extrathoracic pressure, an experimental system of neonatal ventilation. The complaint was brought by Carl and Deborah Henshall, whose two daughters participated in the research. One, Stacey, died shortly after birth; the other, Sofie, has cerebral palsy. No hearing date or charges have been released.