Inquiry into death of boy from induced illness recommends tightening of child protection rules
http://www.100md.com
《英国医生杂志》
Wide-ranging improvements to child protection procedures are necessary if children deliberately harmed by a parent are not to slip through the net, an inquiry into the death of a 7 year old boy from induced illness concluded last week.
The review of the case of Michael Dickinson seems to be the first detailed investigation in Britain of a death through Munchausen syndrome by proxy, now officially labelled fabricated or induced illness. Given the controversy surrounding the diagnosis, whose very existence is disputed by some media commentators, the report received surprisingly little media coverage.
The case review was done by members of the Cumbria interagency child protection committee, chaired by Robert Postlethwaite, a consultant paediatric nephrologist from Royal Manchester Children's Hospital and coeditor of a book on abuse through Munchausen syndrome by proxy.
The review found failures in communication between the various agencies responsible for child protection, with the result that no one saw the full picture.
Michelle Dickinson is serving a 16 year sentence for child cruelty
Credit: PHIL NOBLE/PA
Michael Dickinson died in October 2000 of complications caused by pneumonia after several months in hospital on a life support system. His mother, Michelle Dickinson, from Seascale, Cumbria, tricked doctors into prescribing him antiepilepsy drugs, which she administered in large doses over a four year period.
He was eventually unable to go to school and had food and drugs administered through a nasogastric tube. When he was admitted to hospital as an emergency patient, it became apparent that the tube had doubled back on itself so medicines and food were passing into the wind-pipe and lungs rather than the stomach.
Michelle Dickinson, aged 33, is currently serving a 16 year sentence for child cruelty.
The report identifies numerous occasions on which doctors, social workers, and other professionals failed to communicate and properly tackle concerns about Michael.
It makes 34 recommendations, including:
Improving guidance on when child protection meetings may be held in the absence of parents, putting more emphasis on the child's rights
Training "eminent" professionals to be more prepared to listen to the concerns of junior staff and training juniors to be more assertive in voicing concerns to those in authority.
Training professionals to listen more carefully to children
Monitoring repeat prescriptions and repeat attenders at general practices
Introducing intensive "two on one" nursing for patients with suspected fabricated and induced illness in hospital and allowing "covert surveillance"
Training professionals to voice concerns explicitly and on record, avoiding "ambiguous circumlocution."
Dr Rob Walker, medical director for West Cumbria primary care trust, said: "The computer systems to highlight frequent attenders are in place. But this needs to be handled sensitively and carefully, as we do not want to stop parents seeking help and advice when their child is genuinely ill."(Clare Dyer, legal corresp)
The review of the case of Michael Dickinson seems to be the first detailed investigation in Britain of a death through Munchausen syndrome by proxy, now officially labelled fabricated or induced illness. Given the controversy surrounding the diagnosis, whose very existence is disputed by some media commentators, the report received surprisingly little media coverage.
The case review was done by members of the Cumbria interagency child protection committee, chaired by Robert Postlethwaite, a consultant paediatric nephrologist from Royal Manchester Children's Hospital and coeditor of a book on abuse through Munchausen syndrome by proxy.
The review found failures in communication between the various agencies responsible for child protection, with the result that no one saw the full picture.
Michelle Dickinson is serving a 16 year sentence for child cruelty
Credit: PHIL NOBLE/PA
Michael Dickinson died in October 2000 of complications caused by pneumonia after several months in hospital on a life support system. His mother, Michelle Dickinson, from Seascale, Cumbria, tricked doctors into prescribing him antiepilepsy drugs, which she administered in large doses over a four year period.
He was eventually unable to go to school and had food and drugs administered through a nasogastric tube. When he was admitted to hospital as an emergency patient, it became apparent that the tube had doubled back on itself so medicines and food were passing into the wind-pipe and lungs rather than the stomach.
Michelle Dickinson, aged 33, is currently serving a 16 year sentence for child cruelty.
The report identifies numerous occasions on which doctors, social workers, and other professionals failed to communicate and properly tackle concerns about Michael.
It makes 34 recommendations, including:
Improving guidance on when child protection meetings may be held in the absence of parents, putting more emphasis on the child's rights
Training "eminent" professionals to be more prepared to listen to the concerns of junior staff and training juniors to be more assertive in voicing concerns to those in authority.
Training professionals to listen more carefully to children
Monitoring repeat prescriptions and repeat attenders at general practices
Introducing intensive "two on one" nursing for patients with suspected fabricated and induced illness in hospital and allowing "covert surveillance"
Training professionals to voice concerns explicitly and on record, avoiding "ambiguous circumlocution."
Dr Rob Walker, medical director for West Cumbria primary care trust, said: "The computer systems to highlight frequent attenders are in place. But this needs to be handled sensitively and carefully, as we do not want to stop parents seeking help and advice when their child is genuinely ill."(Clare Dyer, legal corresp)