Dr. Squier “struck off” by GMC
As part of the campaign initiated by D I Welsh, a complaint was made to the General Medical Council (GMC) about the role of Dr. Squier as an expert witness in court cases involving Shaken Baby Syndrome (SBS). The GMC conducted a hearing in which the evidence presented by Dr. Squier in these cases was subject to detailed examination. Here is a summary of the findings (1):
“The tribunal has determined that you have shown a blatant disregard for the fundamental tenets of the medical profession. You have breached the requirements of Good Medical Practice not only in terms of your honesty and probity, but also in your failure to respect the skills and contributions of your colleagues and recognising the limits of your knowledge and competence in giving evidence. Your attitude towards your colleagues was shocking, openly displaying your disdain for their expertise and opinions. You repeatedly gave evidence both in your reports and in court that fell outside your own field of expertise and competence. You deliberately and dishonestly misinterpreted, misstated and misquoted research literature to support your own opinions. The tribunal considers all these breaches to be very serious. You have caused harm to the reputation of the profession and the tribunal cannot be satisfied that there would be no repetition of your misconduct.”
“The tribunal has determined that your conduct is fundamentally incompatible with continued registration as a medical practitioner. As such it has determined that your name be erased from the medical register. The tribunal considers that erasure is the only appropriate sanction which will maintain public confidence in the profession.”
Flawed and unfair judgment
Michael Birnbaum QC, who is a distinguished barrister and was one of the defence witnesses at the Tribunal wrote a highly critical review of the proceedings and the judgment (2). This is the executive summary of that report:
“In my 43 years of practice at the Bar I have rarely read a judgment of an English Court or Tribunal so deeply flawed and unfair as this.
The Tribunal had to consider charges that Dr Squier had misled courts by expressing views on matters beyond her expertise as a neuropathologist and by “cherry-picking” literature and evidence in order to support those views. It found her guilty on all but a small minority of the charges. It made numerous findings that she had been dishonest. It had heard over 50 days of very detailed evidence and submissions on both sides of a very complex case. Yet its “Determination on Facts” is little more than a detailed recital of the main points of the prosecution case against Dr Squier, punctuated by only very occasional references to her own evidence, the arguments of her counsel and the huge array of character witnesses who supported her.
The Tribunal appeared to be strongly biased against Dr Squier, not only because it omitted most of the defence case, but because of its outrageous treatment of the five expert witnesses who gave evidence on her behalf. It dismissed their evidence in a few sentences as outdated in one case and, in the other four, as lacking impartiality and / or credibility. Thereafter it completely ignored their opinions save in a few cases where it thought that they supported the prosecution argument. So the Tribunal itself “picked cherries” by the kilo.
Even worse the four defence experts who were criticised do not know why the Tribunal dismissed their evidence in support of Dr Squier. Therefore they cannot effectively defend themselves against the Tribunal’s trashing of their evidence and their reputations, because they do not know what they need to refute in order to do so.
The Tribunal’s reasoning was largely formulaic and frequently illogical. I say this for two reasons. First, although there were over 150 charges relating to six cases, the Tribunal did not relate its findings to the specific circumstances of each case. Instead it used a very limited repertoire of stock arguments to find that she had acted irresponsibly and then to escalate that finding to one of dishonesty. The most startling example is the Tribunal’s view that for a doctor to give evidence outside his or her field of expertise was dishonest. This of course meant that, once the Tribunal found that Dr Squier had gone beyond her expertise (which it defined very narrowly), she had no defence to the charge that she had been dishonest in so doing. The prosecution had never put the case in this way. The Tribunal blundered into treating an offence of dishonesty as if it was one of “strict liability” not requiring any culpable intention. Moreover it apparently ignored decisions of the Court of Appeal Criminal Division admitting her evidence on such matters as low level falls and lucid intervals, about which – according to the Tribunal – she could not honestly testify at all.
Secondly the Tribunal repeatedly confused mere error, misunderstanding or disagreement with dishonesty. This led to a series of illogical howlers, such as deciding on the one hand that Dr Squier had “misinterpreted” an article and on the other that she had “understood” it and confusing doing something deliberately with doing it deliberately to mislead. The Tribunal did not even consider what motive she could have had to be dishonest.
And even though the Tribunal disclaimed any intention to make judgments about the reliability of the NAHI hypothesis, it appeared to take sides on that scientific controversy, because it viewed the expression of doubts about NAHI by a defence expert as evidence of his bias.
Given this bizarre combination of the apparently one-sided and the obviously inept, I cannot make up my mind whether the Tribunal was actually biased in the sense of being actively prejudiced against Dr Squier or whether it was just not up to its task and was ultimately defeated by the complexity of the case. Whatever view one takes of its impartiality, the Tribunal’s presentation of the evidence is so inadequate and its conclusions so poorly reasoned that its determination lacks all credibility.”
The decision on Dr. Squier was based primarily on the judgment that she provided evidence that was outside her field of expertise and competence.
What is the definition of expertise and its boundaries?
Dr. Michael Powers QC commented specifically on this issue as follows:
“The tribunal produced no clarity as to the expertise required. No criteria for the necessary expertise were set out. No one reading its decision could possibly determine the borderline, stepping beyond which is punished by the ultimate sanction. Although the tribunal did not know where the borderline was itself, it expected the expert to know it and to know that by going beyond it was necessarily dishonest. Strict liability requires strict criteria and there were none” (3).
Essentially what he is saying is that the judgements on expertise were entirely arbitrary.
Powers also referred to a testimonial written by Professor Norman Guthkelch, who first described the SBS in 1971, which said:
“I am surprised and puzzled by the allegation that Dr. Squier transgressed the boundaries of her area of expertise, if transgression of these boundaries is a punishable offence then these should be clearly defined. The boundaries are a matter of individual opinion and they will change with the continuing advance of relevant knowledge. Yesterday’s abstruse deduction is tomorrow’s obvious consequence. These boundaries are artificial and subjective. The field of knowledge of an expert, whether in art or science, is not bounded by a rigid fence. Personal experience has taught me that an active doctor who takes a scholarly approach to his or her specialty finds that sphere of knowledge changes literally from day to day. This applies to Dr Squier too.”
Powers went on to discuss the implications of this decision. An expert may genuinely believe he/she is acting within their expertise and has been accepted as such by the court but nevertheless can still be struck off for straying beyond what a lay disciplinary tribunal regards as the boundaries of the individual’s expertise. This is then used as the justification for the person to be castigated as dishonest and no longer allowed to practice.
With specific reference to SBS, it is essential to have inputs from a number of different disciplines and unless these can be related to each other it is impossible to provide the insight which the court requires in order to make a balanced judgement.
It follows from this that the effect of the decision will be to deter other medical practitioners from acting as expert witnesses in trials that involve SBS. Even if a person is accepted by a court as a satisfactory expert witness, they still run the risk that a disciplinary tribunal will get involved resulting in the individual being disgraced and struck off. As Powers puts it:
“Where a medical practitioner has a genuinely held and honest belief that the subject matter on which he/she is requested to give an opinion is within his/her expertise, how can such a person found to be dishonest and deserving of being erased from the medical register?”
Conclusion…a kangaroo court?
It is very difficult to see this as an objective evaluation of the charges levelled against Dr. Squier. The exercise has all the hallmarks of a kangaroo court.