Doctor 'broke guidelines in sex abuse cases': Parents say their children have been wrongly diagnosed by a consultant accused of an over-zealous approach. Rosie Waterhouse reports

SEVEN formal complaints against a doctor who specialises in child sexual abuse cases are to be investigated, following allegations from families that she breached national procedures for diagnosing sexual abuse.

Dr Heather Richardson, a consultant paediatrician, is facing allegations from six parents that she wrongly diagnosed sexual abuse cases, causing unnecessary trauma and stigma to the parents and children.

A seventh family complains that she correctly suspected sexual abuse of their seven year-old daughter but failed to tell the parents, police or the social services department for seven months.

During this period they suspect that the child was subjected to further abuse by the perpetrator, a teenaged neighbour, and her parents are seeking compensation for alleged negligence.

The alleged failure to notify other agencies about this case occurred in 1991 when Dr Richardson's working relationship with Kent social services and Kent police had broken down over complaints about her allegedly 'over-zealous' approach to child abuse.

The families are represented by Sarah Harman, a solicitor in Canterbury, who said she has heard from dozens of families who say their children have been wrongly diagnosed by Dr Richardson. The complaints will be heard by assessors appointed by South East Thames regional health authority, which employs Dr Richardson as a specialist in community and child care on secondment to Canterbury and Thanet district health authority. The assessors will examine whether her handling of the cases was appropriate. If they decide it was not, the health authority could institute disciplinary proceedings.

Several of the complaints alleged: 'Dr Richardson's determined view (is) that sexual abuse is widespread in the general population and must be exposed whatever the social and emotional cost. In making so many families subject to sexual abuse investigations, Dr Richardson set her level of suspicion far too high and again this is in breach of long established principles of good practice.'

Other complaints allege: 'Because of Dr Richardson's unequivocal view that sexual abuse had occurred, our clients found themselves caught up in multi-disciplinary inquiries into, not whether abuse had taken place, but into when the abuse occurred and who the perpetrator was. Dr Richardson left no room for doubt in her view, which again is contrary to principles of good practice.'

Last year, Dr Richardson was boycotted by Kent social services after the local authority and Kent police complained about her behaviour at case conferences, attitude to colleagues, the standard of her medical reports and her diagnostic methods.

The regional health authority set up an inquiry into alleged professional misconduct and professional incompetence. In December she was cleared when the inquiry found no reason to take disciplinary action and commended some aspects of her work. But the inquiry report concluded that in Canterbury and Thanet there had been 'a breakdown in the working relationships necessary to child protection'.

The report said an additional consultant paediatrician should be appointed. The boycott was lifted in April and new working practices for handling suspected child abuse cases have been agreed.

Peter Gilroy, an assistant director of Kent social services and chairman of Kent's child protection committee, said concerns had been expressed that the number of children, suspected as at risk of sexual abuse, being referred to the committee from Canterbury and Thanet health authority was high, compared with the neighbouring South East Kent health authority.

In 1990, Canterbury and Thanet referred 49 new sexual abuse cases to Kent, while South East Kent referred 15. In 1989, Canterbury and Thanet referred 78 sexual abuse cases while South East Kent referred 26. The percentages of children on the Kent child protection register judged to be at risk of sexual abuse were 16 per cent in 1988, 21 per cent in 1989, 19 per cent in 1990, 16 per cent in 1991 and 11 per cent in the year to March 1992. The national average is 14 per cent.

The new complaints allege a series of breaches of good practice and official guidelines. They include: setting the level of suspicion too high; repeated examinations and repeated taking of photographs; failure to obtain informed consent for repeated examinations and photographs; claiming as 'second opinions' supporting diagnoses made by junior colleagues and those trained by her; the making of bizarre diagnoses on the basis of findings not widely accepted as consistent with, or diagnostic of, sexual abuse; making definite, uncompromising diagnoses on the basis of inadequate supportive findings; failing to keep parents adequately informed regarding diagnosis and treatment; refusal to co-operate with a parent's wish for a second opinion by failing to pass on case notes and photographs; failure to give sufficient weight to alternative reasons than sexual abuse for physical symptoms.

In an interview with the Independent, held at the British Medical Association headquarters in London, Dr Richardson said she was not allowed to discuss individual cases. But she rejected the complaints in general terms.

Dr Richardson said: 'It is not the function of the paediatrician alone to come to a diagnosis of sexual abuse.

'In appropriate cases, where there are abnormal physical signs which may be transient, good medical practice demands proper documentation, which may include the taking of photographs.

'It is my practice to limit the number of medical examinations to those that are essential for the safe management of the child patient. No opinion is reached on the basis of physical signs alone.'

She added: 'All complaints in the health authority should be investigated fully and fairly under the existing procedures to ensure fairness to all parties.'

(Photograph omitted)