Introduction

Following investigations of several such cases, these shortfalls have been identified in the Department of Community Services (DoCS) processes in respect of MSBP cases. 

Individual failings:

• Failure of DoCS officials to inform parents of the notification and accusation/confirmation of medically substantiated case of child abuse.

• Statutory requests for information sent to such places as the child's school, without ensuring that the modes of communication are secure. This has the potential to stigmatise the child and the family within the school and the wider community, and eventually alienate the parent (s) from the school in the future.

• Failure to inform the child's general practitioners and the child's current treatment team of the notification and to seek their involvement in information gathering and the ongoing protection of the child. 

• Failure to adhere to basic child protection policies, procedures and guidelines (e.g. to see the child., to formulate a comprehensive case plan., to allow parents to attend child protection planning meetings see http://Case studies). 

• Allow uncorroborated third party statements and hearsay to stand as evidence of abuse, without using even the most basic of investigation methods.

• Accept the reliability of a notification of MSBP from a major metropolitan children's hospital when: a) there has been a 10 month delay in notifying the child to DoCS following the alleged 'confirmation' of abuse., b) when one of the notifiers is not a member of the child's treatment team., c) when the treatment team has referred the child to the hospital's child protection unit and has held two child protection planning meetings without  informing the child's parents, DoCS, the child's general practitioners or any of the then current treatment team of the allegation /confirmation of abuse and d) when the hospital referred the child at the request of the parents to the new children's hospital without informing any of the new treatment team or the hospital's child protection unit of the allegation/ confirmation of MSBP

• Accepted as plausible and credible the ability of the DoCS medical reviewer to be able to 'confirm' the accusation of MSBP without: a) seeing and talking to the parents or the child, b) without a psychiatric evaluation of the mother., c) without a developmental assessment of the child., d) without a psycho-social assessment of the family,  e) without accessing the child's clinical and child protection file, and f) without questioning anyone about the failure of the child's treatment team to adhere to any of the most basic of child protection policies, procedures or guidelines and g) when he wasn't asked to do so. 

• Naively assumed that the medical reviewer is 'independent' and will act objectively. 

• Allow the medical reviewer to compromise his/her objectivity and independence by allowing the reviewer to: 1) openly communicate with the doctors involved in the notification, prior to finalising the review report., and 2) to attend the second DoCS facilitated child protection planning meeting. 

• Accept as valid and reliable the notifier's pejorative dismissal of the child's general practitioner as 'being sympathetic to the mother' without testing the reliability and validity of this statement with the general practitioner.

• The confirmation of MSBP is seen as evidence of the mother intentionally harming the child. It is impossible for the mother to prove that she does not have MSBP and often the interpretation of her behaviour is highly subjective and is open to interpretation, reinterpretation and misinterpretation.

• Naively rely on the doctors' subjective assessment of the mother’s intent even when there is no evidence – ref. Cleveland Inquiry.

• Naively rely on the honesty, integrity and reliability of the doctors involved in the accusation/confirmation and notification of abuse with no independent assessment of their claims.

• Naively assume that all of the doctors involved in the accusation/ confirmation and notification of abuse: a) share the same opinion., b) arrive at their beliefs independently of each other., c) have all been involved in the child's care., d) have the child's best interests at heart., f) have not been pressured to adopt an collective opinion., g) would inform DoCS if they changed their mind and arrived at an alternative opinion and i) are not motivated by secondary and personal gain.

• Naively accept, without question, the 'conventional and convenient wisdom' that people who engage in this type of abuse are resistant to treatment and that they need not listen to them or engage them in anyway. In this way the voice of the assumed 'abuser' remains unheard or is mediated through the doctors or DoCS officials.

• Naively accept, without question, the ability of a paediatrician who is acting as a medical reviewer to be able to comment on the appropriateness of a child's gastroenterology care when the reviewer is not a gastroenterologist and  does not consult with a gastroenterology specialist.

• Fail to question why a medical reviewer has 'confirmed' the allegation of MSBP, and accept as reliable his report, when the reviewer was only asked to comment on the appropriateness of the gastroenterology care and did not access the child's clinical files. 

• Naively accept, without question, a convenient type of abuse that automatically discredits, isolates, and brings into question everything that the mother (in MSBP cases) or father (in Shaken Baby cases) says in their defence, and positions  the accused parent as 'the cause' of the child's illness and medical mismanagement.

• Failure to recognise the relative powerless position of parents to defend themselves against  allegations of medically substantiated cases of child abuse and the actions of DoCS officials. 

• fail to consider the possible exploitation of the relative powerless position of parents by doctors and DoCS officials by a) assuming that the doctors are 'the experts' and failing to take seriously the concerns of the parents., b) cancelling access visits with little notice and then not rescheduling visits.

• Failure to inform parents of their rights.

• actively intimidate, deceive, harass, threaten, blackmail or/and coerce mothers/parents into confessing ‘their guilt’ on the promise of the retention or return of their child.

• Inability of some DOCS officers to recognise the ‘Blind spot' of notifications of child abuse-the ability of some doctors to abuse children and to make vexatious and malicious notifications for personal and secondary gain.

• Assume that a mother’s denial of Msbp and the families support of her, is indicative of Msbp or naive without giving the mother and her family the benefit of the doubt and investigating her allegations properly.

• Failure to provide support, assistance and opportunities for counselling to children and their families once an accusation of abuse has been substantiated or unsubstantiated.

• Embellishment, fabrication or the omission of relevant information as  evidence before the children's care courts or criminal courts  in order to secure the conviction of parents, and care orders for children.

• Presumption of the 'guilt' of the mother or the father at the commencement of the investigation, or before the the children's care or criminal courts.

• Ignore, disregard or suppress contradictory evidence that conflicts with information supplied by the doctors and which is supportive of the parent. 

• Fail to keep proper case file notes.

• Demonstrate an ignorance of the indicators of Msbp or/and Shaken Baby syndrome. 

• Failing to act on the recommendation of more junior staff to refer individual cases to the child protection council.

Systemic failings:

• There is an assumption of the mother’s guilt at the highest levels in DoCS. 

• Some senior DoCS officials are allowed to flagrantly and consistently breach departmental procedures, policies and the rules of evidence with impunity.

• DoCS officials are too eager to make a child a ward of the state without regard to alternative kinship care arrangements or the potential for the supervision of the child within the existing  family structure.

• Failure to ensure that foster families adhere to stated court conditions  to only take the child to certain doctors. 

• Increasing reluctance of DoCS to adhere to the principles of 'Natural Justice' and allow parental access to the child's clinical, child protection and DoCS file.

• Failure to establish a paediatric medical investigation unit that can independently test and evaluate medical and allied health practitioner evidence, prior to proceeding to the children's care court.

• Allow people who are not versed in health and may not be tertiary educated to investigate medically substantiated cases of child abuse.

• Fail to adopt a standardised code for Msbp and Shaken Baby cases. Therefore it is impossible to know how many cases there are, which centres have an unusually high number of cases, and to identify doctors routinely involved in such cases http://database.htm . Based on anecdotal evidence only, Msbp seems to a be a peculiar affliction of mothers who live in Brisbane, Lismore, Coffs Harbour, Sydney, Melbourne and Adelaide.

• Allowing DoCS officers who do not have the expertise or motivation to interpret them properly, to access Health Insurance Commission (HIC) (Medicare) records.

• Allow a quantitative, rather than a qualitative analysis of the HIC data. 

• While F.R.A.M.E. understands the need for mandatory notification, approximately ¾ of those notifications are unsubstantiated. The psychological and economic cost to the State and to these families is not able to be quantified.

• Failed to take legal action against doctors who they know have intentionally and consistently provided false, misleading, inaccurate, and incomplete information to DoCS in respect of child at risk notifications and during child protection planning meetings in contravention of the Children (Care and Protection) 1987 Act. F.R.A.M.E are of the opinion that families should have a right to legal redress when this occurs.

• Fail to test the assumption that DoCS have made that they cannot prosecute doctors who knowingly provide false, misleading, inaccurate, and incomplete information to DoCS during the child protection planning meetings, as opposed to the actual notification.

•  DoCS has not investigated the geographical discrepancy in the number of Msbp cases.