David Southall

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Professor David Southall OBE is a British paediatrician who is an expert in international maternal and child hospital healthcare and in child protection including the diagnosis of the controversial Fabricated or Induced Illness (FII, also known as "Munchausen syndrome by proxy"),[1] and who has performed significant research into sudden infant death syndrome.[2]

Early career[edit]

Prior to becoming a paediatrician, Southall spent four years in general adult medicine, one year in obstetrics and two years as a general practitioner.[3]

International humanitarian work[edit]

In 1993, during the Bosnian War, Professor Southall was invited by the Overseas Development Administration of the British Government (now DFID) to visit Sarajevo to identify and evacuate children in need of urgent medical treatment which could not be provided locally because of armed conflict.[3] After this mission he was asked by UNICEF to become a consultant and lead a programme from 1993-1995 to help children in Mostar and in camps for internally displaced families in other areas of Bosnia.[4] Prompted by his experiences in Bosnia of what he described as "trauma inflicted on children and their families, not only by warring factions, but also by the indolence of the international community", Professor Southall established Child Advocacy International (CAI) on his return to the UK, to advocate for international child health issues.[3] Since 2009, and in order to reflect the close involvement of CAI with the emergency care of pregnant women and adolescent girls, the charity was re- named Maternal and Childhealth Advocacy International (MCAI ). Link label

Some of the main advocacy undertaken involved campaigns against the arms trade,[5] healthcare in refugee camps [6] and the development of the Maternal and Child Friendly Healthcare Initiatives (see below) One particular success with advocacy involved the New Jalozai Afghan refugee camp where the Pakistan Government were encouraged by CAI to move the 70,000 refugees living in appalling circumstances into a more suitable camp. The United Nations High Commission for Refugees (UNHCR) wrote a letter to Professor Southall thanking CAI for this achievement.[7]

From 1999 to 2004 Professor Southall was Chairman of a working party developing the Child Friendly Healthcare Initiative (CFHI).[8] In addition to CAI, UNICEF UK, The Royal College of Paediatrics and Child Health and the Royal College of Nursing were parties to this work.

Since 2002,and following on to CAI’s work in Afghanistan and Pakistan, and in collaboration with a British Medical Education charity a program called “Strengthening Emergency Healthcare” involving Emergency Maternal, Neonatal and Child Healthcare (EMNCH) was established. The program was originally started in the Afghan refugee camps in Pakistan and has subsequently been developed in Pakistan with assistance from the local offices of the World Health Organization (WHO) and UNICEF.[9] In 2006, it was successfully introduced into The Gambia following a recommendation from WHO Geneva.[10] In November 2012 a similar programme was started in Liberia with financial support from THET and UKAID.[11]

Additional programs of CAI and subsequently of MCAI involved apprenticeship based training in hospital care of pregnant women, newborn infants and children in Kosovo, Sri Lanka, Afghanistan, Uganda, The Gambia and Liberia.[11] Throughout the last 20 years of this work, Professor Southall has been the Honorary Medical Director of CAI/MCAI and the lead in all of the above work.

Respiratory research and child protection work[edit]

Between 1979 and 1983 a large prospective investigation funded by the British Heart Foundation and the Medical Research Council was led by Professor Southall into the potential role of short episodes of absent breathing and heart rate and rhythm disorders in newborn infants. The study [12] showed no evidence that these episodes in infants were related to subsequent SIDS leading to a major reversal of the role of apnoea monitors in SIDS prevention.[13]

For his research work into SIDS, Professor Southall was given The Mary Gray and William W Cobey Award from the Sudden Infant Death Syndrome Institute in 1994, University of Maryland and in January 1995 the Annenberg Center Apnea of Infancy Award.

In 1993, Professor Southall reported in the British Medical Journal a study investigating the performance of invasive procedures in the intensive care of infants and children.[14] This study revealed inadequate pain control and sedation for a high proportion of painful procedures and led to a national review of this problem. As a consequence he was appointed chair of a working party of the British Paediatric Association to develop guidelines on the management of pain control in children in hospital in the UK.

Between 1986 and 1994, Professor Southall led a program of diagnostic and treatment based clinical work at the Royal Brompton Hospital in London, and the North Staffordshire Royal Infirmary in Stoke-on-Trent involving patients with unexplained life threatening events from a wide area of the UK. This work, involving the police and social services departments, helped protect children from life-threatening episodes of Fabricated or Induced Illness (FII) mostly involving suspected intentional suffocation of infants and young children by one of their parents, usually the mother.[15] Techniques included the controversial covert video surveillance (CVS) in hospital of infant and child patients by police or specially trained nursing staff to observe the interactions of their parents with the children. Surveillance revealed abuse in 33 of 39 suspected cases, with documentation of intentional suffocation observed in 30 patients. Poisonings (with disinfectant or anticonvulsant), a deliberate fracture, and other emotional and physical abuse were also identified under surveillance. Bleeding from the nose and/or mouth was reported in 11 of the 38 patients who had had episodes of near death and were undergoing CVS but in none of 46 controls. Four patients who had been subjected to recurrent suffocation before CVS suffered permanent neurologic deficits and/or required anticonvulsant therapy for epileptic seizures resulting from hypoxic cerebral injury. The 39 patients undergoing CVS had 41 siblings, 12 of whom had previously died suddenly and unexpectedly. Eleven of the deaths had been classified as sudden infant death syndrome (SIDS) but after CVS, four parents admitted to suffocating eight of these siblings. Other signs of serious abuse were documented in the medical, social, and police records of an additional 15 of the siblings. The project concluded in its report in the medical journal Pediatrics that “Induced illness is a severe form of abuse that may cause death or permanent neurologic impairment. It may be accompanied by other severe forms of abuse, may result in behavioural disorders, and may be accompanied by immeasurable suffering. Detection of this abuse requires careful history-taking; thorough examination of the health, social, and police records; and close and focused collaboration between hospital and community child health professionals, child psychiatrists, social workers, and police officers. Covert video surveillance (CVS) may help investigate suspicions and ensure that children are protected from additional abuse. When parents have failed to acknowledge that they have deceived health professionals, partnership with them in seeking to protect their children may be neither safe nor effective”.

The project attracted controversy for its methods and raised ethical implications.[16] Critics argued that the desire of the implementers of CVS to observe the carers harming the children exposed the children to further abuse, that the betrayal of doctor-patient trust necessarily involved in the surveillance could cause harm to the subjects, and that "a diagnosis should lead to treatment, not punishment".[17] However, Professor Southall and his team argued that the surveillance saved the lives of many of the children involved, and Professor Southall himself said that "By doing covert video surveillance we are betraying the trust of parents... but if a parent has been abusing his or her child in this way then the trust between child and parent has already gone."[18]

The concerns of a campaigning group of parents accused of abuse, a small proportion of parents involved in the ventilator study described below and their advocates, including a woman who was imprisoned subsequently for conspiracy to abduct a child,[19] led to an investigation of Professor Southall’s child protection work, in particular covert video surveillance, by his employer the North Staffordshire Hospital. The campaigning group called themselves MAMA (Mothers Against Munchausen syndrome by proxy Allegations).[20] The investigation by his employing hospital cleared Professor Southall.[21]

In the early 1990s, Southall led a study which pioneered continuous negative extrathoracic pressure therapy, a treatment for breathing difficulties in young children involving the application of negative pressure to the patients' chests.[22] The study was controversial, with some parents of the children involved suggesting that the treatment was linked to subsequent death or brain injury.[22] The research was the subject of investigations by the hospital involved and inquiries from police. An independent follow-up study concluded in 2006 that there was "no evidence of disadvantage, in terms of long-term disability or psychological outcomes" from the use of the technique.[22]

General Medical Council sanctions[edit]

In 2004, Southall was found guilty of serious professional misconduct by the General Medical Council (GMC), after alleging to police that the husband of Sally Clark was responsible for murdering the couple's children.[23] Southall made the claim to child protection officers of the Staffordshire police after watching a television documentary about the case.[1] The GMC banned Southall from child protection work for three years; the Council for Healthcare Regulatory Excellence challenged the decision as insufficient and argued that he should be erased from the GMC register, but a High Court of Justice decision in 2005 held that the sanction was not unduly lenient.[24]

In February 2007, Attorney-General Lord Goldsmith announced that a review would be held into a number of criminal cases in which Southall gave evidence for the prosecution, following allegations that Southall kept up to 4,450 personal case files on child patients which were kept separate from the official hospital records.[25]

On 4 December 2007, Southall was struck off the medical register after being found guilty of professional misconduct by the General Medical Council.[26] Southall appealed this decision in the High Court, but the appeal was dismissed.[27] In his judgement, Mr Justice Blake stated that Southall "had speculated on non-medical matters in an offensive manner entirely inconsistent with the status of an independent expert."

On 1 June 2009 Dr Southall was the subject of an episode of the BBC's current affairs program Panorama, title 'A Very Dangerous Doctor'.[28] The interest group 'Professionals Against Child Abuse' commented in the medical journal The Lancet that the "GMC should never have brought this case" (against Southall) [29] and has criticized disciplinary proceedings brought against doctors.[30]

On 4 May 2010 Dr Southall is back on the medical register after winning an appeal over a long-running dispute with the General Medical Council. The Appeal Court's decision means he is able to practise medicine again.[31][32]

In February 2012 the GMC dropped its last remaining case against him. Southall regards this as a "victory over an orchestrated and dangerous campaign which has waged war over 16 years against my work in trying to protect children from life threatening abuse". He plans to sue the GMC for breaching his right to a fair trial within a reasonable time.[33]


  1. ^ a b "Murder theory doctor resumes job". BBC. 2004-06-16. Retrieved 2007-11-27. 
  2. ^ "Profile: Professor David Southall". BBC. 2005-04-14. Retrieved 2007-11-27. 
  3. ^ a b c Abbasi, Kamran (1998-03-28). "The children's advocate". British Medical Journal 316 (7136): 960. doi:10.1136/bmj.316.7136.955m. PMID 9550952. 
  4. ^ Southall, DP; Ellis, J; McMaster, P; McMaster, H; Willock, A; Plunkett, M (1996-01-27). "Medical evacuation from Mostar" (PDF). Lancet 347: 244–245. Retrieved 2015-03-28. 
  5. ^ Southall, DP; O'Hare, B (2002-12-21). "Emptyarms: the effects of the arms trade on mothers and children" (PDF). BMJ 325: 1467-1461. Retrieved 2015-03-31. 
  6. ^ Bile, KM; Hafeez, A; Kazi, GN; Southall, D (2011-12). "Protecting the right to health of internally displaced mothers and children: the imperative of an inter-cluster coordination for translating nest practices into effective participatory action." (PDF). East Mediterr Health J 17 (12): 981–989.  Check date values in: |date= (help)
  7. ^ Utkan, Hasim. "letter of appreciation" (PDF). mcai.org.uk. Retrieved 2015-03-31. 
  8. ^ Southall, D; Burr, S; Smith, R; Radford, A; Williams, A; Nicolson, SA (2000-11-21). "Child Friendly Healthcare Initiative" (PDF). Pediatrics 106 (5): 1054–1064. 
  9. ^ Bin Nisar, Yasir; Hafeez, Assad; Zafar, Shamsa; Southall, David P (2011-02-21). "Impact of essential surgical skills with an emphasis on emergency maternal, neonatal and child health training on the practice of doctors: A cluster randomised controlled trial in Pakistan." (PDF). Resuscitation 82: 1047–1052. Retrieved 2015-03-31. 
  10. ^ Cole-Cessay, Ramou; Cherian, Meena; Sonko, Alieu; Shivute, Nestor; Cham, Mamady; Davis, Mike; Fatty, Famara; Wieteska, Sue; Baro, Momodou; Watson, Diane; Phillips, Barbara; Southall, David (2010-08-18). "Strengthening the Emergency Healthcare system for mothers and children in The Gambia: a pilot programme description and interim evaluation". Reproductive Health 7 (21). 
  11. ^ a b "Liberia: improving maternal and neonatal mortality". mcai.org.uk. Retrieved 2015-03-31. 
  12. ^ Southall, DP; Richards, JM; de Swiet, M; et, al (2 April 1983). "Identification of infants destined to die unexpectedly during infancy: evaluation of predictive importance of prolonged apnoea and disorders of cardiac rhythm or conduction." (PDF). British Medical Journal (286): 1092–1096. Retrieved 2015-05-08. 
  13. ^ National Institutes of Health. "Infantile Apnea and Home Monitoring". NIH Consensus Development Program. Retrieved 2015-05-08. 
  14. ^ Southall, DP; Cronin, BC; Hartmann, H; Harrison-Sewll, C; Samuels, MP (5 June 1993). ". Invasive procedures in children receiving intensive care." (PDF). British Medical Journal 306: 1512–1513. Retrieved 2015-05-08. 
  15. ^ Southall, DP; Plunkett, MCB; Banks, W; Falkov, AF; Samuels, MP (Nov 1997). "Covert Video Recordings of life-threatening Child Abuse: lessons for Child protection". Paediatrics 100 (5): 735–760. Retrieved 14 May 2015. 
  16. ^ Shabde, N; Craft, AW (1999). "Covert video surveillance: an important investigative tool or a breach of trust?". Archives of Disease in Childhood 81: 291–294. Retrieved 14 May 2015. 
  17. ^ Brahams, D. "Video surveillance and Child abuse". Lancet 342: 944–947. doi:10.1016/0140-6736(93)91999-3. 
  18. ^ Southall, DP; Samuels, MP (1995). "Some ethical issues surrounding covert video surveillance - a response" (PDF). Journal of Medical Ethics 21: 104–105. Retrieved 14 May 2015. 
  19. ^ White, C; Freeth, R (2002). "Woman at centre of Southall case faces prison sentence". BMJ 324: 693. Retrieved 14 May 2015. 
  20. ^ Laurence, J. "Munchausen activists threaten child specialists". The Independent. The Independent. Retrieved 14 May 2015. 
  21. ^ Boseley, Sarah. "Paediatrician in surveillance row cleared and re-instated". The Guardian. Guardian. Retrieved 14 May 2015. 
  22. ^ a b c "Baby breathing aid study cleared". BBC. 2006-03-31. Retrieved 2007-11-27. 
  23. ^ Carter, Helen (2006-11-13). "Paediatrician faces new misconduct allegations". Guardian Unlimited (London). Retrieved 2007-11-27. 
  24. ^ "Southall avoids being struck off". BBC. 2005-04-14. Retrieved 2007-11-27. 
  25. ^ "David Southall struck off by GMC". BBC. 2007-12-04. Retrieved 4 December 2007. 
  26. ^ "High Court judgment on David Southall" (PDF). High Court. 2009-08-31. Retrieved 31 August 2009. 
  27. ^ 'A Very Dangerous Doctor' BBC Panorama, accessed 1 June 2009
  28. ^ http://paca.org.uk/2009/06/04/paca-letter-published-in-the-lancet-on-the-outcome-of-the-southall-appeal/
  29. ^ http://paca.org.uk/
  30. ^ Boseley, Sarah (2010-05-04). "Controversial paediatrician David Southall wins appeal". London: Guardian News. 
  31. ^ "Paediatrician David Southall back on medical register". BBC. 2010-05-04. 
  32. ^ Dyer, C. (7 February 2012). "Southall plans to sue GMC for delays and an unfair trial". BMJ 344 (feb07 1): e954–e954. doi:10.1136/bmj.e954. Retrieved 10 February 2012. 


  • Leila Schneps and Coralie Colmez, Math on trial. How numbers get used and abused in the courtroom, Basic Books, 2013. ISBN 978-0-465-03292-1. (First chapter: "Math error number 1: multiplying non-independent probabilities. The case of Sally Clark: motherhood under attack").