Judge questions use of colposcopy photos in child abuse cases
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《英国医生杂志》
The practice of relying on photographs taken by colposcopy for expert or second opinions in cases of sex abuse of children risks causing "grave miscarriages of justice," a High Court judge has warned.
Mr Justice Holman delivered the cautionary message in a judgment the week before Christmas. The case was heard in private in the family division, and the family cannot be identified. But the judge gave permission for the judgment to be reported to alert doctors and lawyers to the "potential danger."
He called on the Royal College of Paediatrics and Child Health and the Association of Police Surgeons to reconsider guidance issued in 2002 that suggests the use of still or video colposcopy images to spare child victims of alleged sexual abuse further intimate examinations.
The case concerns a girl from the north of England who was aged 2?years when her mother抯 sister told social services that the girl had said, "Daddy hurts my bum," when her aunt was changing her nappy.
Her mother later explained: "She always said when Mummy and Daddy changed her nappies it hurt her bottom. She had vulvitis from nine months."
Doctors who examined the girl thought her hymen had been torn at some point by penetration, probably by a finger. Photographs taken at the initial examination were sent to two experts, who concurred.
The girl抯 mother and stepfather were forced to live apart for nearly 18 months, with the stepfather having only limited supervised access to her and her younger sister, who was his own child.
Eventually, when the case was heading for the appeal court and further reports were required, the two experts decided they needed to examine the girl physically. In a report described by the judge as "remarkable" the experts found that the girl抯 hymen was intact, and there was no evidence she had ever been abused.
They said they had been misled by the photos, and they added that the pictures they took themselves when they examined the girl did not correspond with what they had seen with their own eyes.
Between December 2000 and June 2003, said the judge, "all the expanding medical evidence" was that the girl had definitely been sexually abused, with penetration.
Reliance on the photographs had "narrowly avoided causing a grave miscarriage of justice and wrongly breaking up a family, perhaps for ever."
The judge said he was not criticising any individual doctor, but he added: "The story is a very serious one. The consequences for this family have been grave and might have been even more grave."
He said extra examinations were "preferable to a potential grave miscarriage of justice and irreparable harm" to children and parents.
Allan Levy QC, an expert on child law, described the case as "a cautionary tale of the highest degree."
Harvey Marcovitch, a former NHS consultant paediatrician, said: "I think it is an area absolutely fraught with error. There are enormous variations in girls?genitalia, and I think it抯 very easy to go wrong."
Professor Alan Craft, president of the Royal College of Paediatrics and Child Health, said: "The whole idea of being photographed is to try to prevent trauma to the child. We review the joint guidelines periodically. As part of our review we will be looking at how you get the evidence."(BMJ Clare Dyer, legal cor)
Mr Justice Holman delivered the cautionary message in a judgment the week before Christmas. The case was heard in private in the family division, and the family cannot be identified. But the judge gave permission for the judgment to be reported to alert doctors and lawyers to the "potential danger."
He called on the Royal College of Paediatrics and Child Health and the Association of Police Surgeons to reconsider guidance issued in 2002 that suggests the use of still or video colposcopy images to spare child victims of alleged sexual abuse further intimate examinations.
The case concerns a girl from the north of England who was aged 2?years when her mother抯 sister told social services that the girl had said, "Daddy hurts my bum," when her aunt was changing her nappy.
Her mother later explained: "She always said when Mummy and Daddy changed her nappies it hurt her bottom. She had vulvitis from nine months."
Doctors who examined the girl thought her hymen had been torn at some point by penetration, probably by a finger. Photographs taken at the initial examination were sent to two experts, who concurred.
The girl抯 mother and stepfather were forced to live apart for nearly 18 months, with the stepfather having only limited supervised access to her and her younger sister, who was his own child.
Eventually, when the case was heading for the appeal court and further reports were required, the two experts decided they needed to examine the girl physically. In a report described by the judge as "remarkable" the experts found that the girl抯 hymen was intact, and there was no evidence she had ever been abused.
They said they had been misled by the photos, and they added that the pictures they took themselves when they examined the girl did not correspond with what they had seen with their own eyes.
Between December 2000 and June 2003, said the judge, "all the expanding medical evidence" was that the girl had definitely been sexually abused, with penetration.
Reliance on the photographs had "narrowly avoided causing a grave miscarriage of justice and wrongly breaking up a family, perhaps for ever."
The judge said he was not criticising any individual doctor, but he added: "The story is a very serious one. The consequences for this family have been grave and might have been even more grave."
He said extra examinations were "preferable to a potential grave miscarriage of justice and irreparable harm" to children and parents.
Allan Levy QC, an expert on child law, described the case as "a cautionary tale of the highest degree."
Harvey Marcovitch, a former NHS consultant paediatrician, said: "I think it is an area absolutely fraught with error. There are enormous variations in girls?genitalia, and I think it抯 very easy to go wrong."
Professor Alan Craft, president of the Royal College of Paediatrics and Child Health, said: "The whole idea of being photographed is to try to prevent trauma to the child. We review the joint guidelines periodically. As part of our review we will be looking at how you get the evidence."(BMJ Clare Dyer, legal cor)