Tainted evidence: Dr Hodes and RAD

One of the most contentious—and persistent—bits of evidence that true believers in the Hampstead hoax like to haul out is that ‘the doctor found evidence of anal scarring’ in the children. This is often accompanied with a ‘so there!’ attitude, as though this information ought to end the argument then and there.

We’ve addressed this issue several times in the past, including in these two posts:

• Why the anal scarring argument doesn’t hold up
• The medical report: Q&A

Yesterday, as so often happens around here, one of our commenters offered us yet another fascinating online resource, this time regarding Dr Deborah Hodes, whose evidence was considered by Mrs Justice Pauffley in the fact-finding hearing. In her judgement, she came as close as a judge can come to sharply criticising Dr Hodes’ work:

129. The only persisting physical sign post peer review was reflex anal dilatation [RAD] in P which, so Dr Hodes, maintains is “consistent with her allegation of the blunt penetrating force to her anus i.e. sexual abuse.” In evidence she referred to her colleagues agreeing it was “abnormal and striking.” It is a sign which is “rarely seen.” In her written report she also said, “There is evidence in the literature that the absence of physical signs neither supports not (sic) refutes an allegation of anal penetration. In this case it was alleged that lubrication was used which adds to the probability of abuse.”

Conclusions in relation to Dr Hodes’ evidence

132. Overall, I feel impelled to observe that the level of Dr Hodes’ involvement in this case was unusual. I remind myself of the several cautionary considerations when a court is considering the contributions made by experts as comprised within Re U; Re B [2004] EWCA Civ 567 – i) The cause of an injury or an episode that cannot be explained scientifically remains equivocal. … iv) The court must always be on guard against the over-dogmatic expert, the expert whose reputation or amour propre is at stake, or the expert who has developed a scientific prejudice.

133. I was dismayed to find, twenty seven years after the Report of the Inquiry into Child Abuse in Cleveland 1987 that Dr Hodes adopted so definite a view as to the likelihood of sexual abuse to which she then adhered notwithstanding several noteworthy contraindications. One of the cardinal messages from Cleveland was as to the importance of multi agency collaboration so as to understand amongst many other things the context in which suspicions arose.

134. In her very last report, Dr Hodes said that “the current evidence is that prolonged reflex anal dilatation (the finding in P) is associated with anal abuse;” and cited the Royal College of Paediatrics 2008 Review. The Review also reflects, I would observe, that there continues to be a debate about the significance of RAD. It is a sign seen in up to a third of children with a history of anal abuse although it can also be seen in small numbers of children selected for non abuse (the evidence base is very limited and unclear on this).

135. I was troubled too that the children were subjected to intimate examinations to search for further signs twice in five days. I regret that Dr Hodes was not asked exactly what she hoped to gain by the second examination positioning the children differently. The 2008 Review suggests, arising out of Myrhe’s 2001 study, that there are differences in the muscle tone in the two positions.

136. I consider it unusual, to say the least, that Ms Draper was invited to discuss her version of the history at a lengthy separate interview with the paediatrician and her SHO at a time when the social work team as well as the police were undertaking inquiries.

137. I was perturbed that Dr Hodes was prepared to conclude and then confirm the presence of fissures when subsequent peer review resulted in them being described as a normal variant. Similarly, I found it curious that even although the physical signs had reduced in number to a single finding of RAD in P, nonetheless Dr Hodes adhered to her view saying that lubrication was used which “added to the probability of abuse.”

138. When confronted, in cross examination, with the evidence about Ms Draper’s treatment of the children with enemas, Dr Hodes did not pause before saying, “No, it does not affect my conclusions. It’s another possible cause of trauma.”

Leaving aside the fact that Dr Hodes only identified RAD in one of RD’s children (when both had allegedly been abused), the statement that it is a sign which is “rarely seen” is patently false. In fact, RAD can occur in up to 49% of non-abused children.

Another case, another example

In the fascinating document ‘Misconceiving the evidence: competence and context in child abuse trials’, written for Chris Saltrese Sols, Margaret Jervis points out that this is not the first time Dr Hodes has fallen into this trap.

Referring to a case which was tried in 2010, in which a two-year-old child’s evidence was originally in question, Ms Jervis writes:

It would appear from the judgment that there was insufficient confidence in the child’s evidence, whatever stage it was at, until April 4th when she was examined by a paediatrician, Dr Deborah Hodes. Dr Hodes examined her bottom and found no indications of past injury.

She did make a finding of ‘anal dilatation’- the opening of the anal canal on parting the buttocks that became the centre of controversy in Cleveland in 1987.

Dr Hodes gave evidence that that such evidence ‘could be supportive’ of an allegation of anal penetration but that it occurred in 11 per cent of non-abused children. This is misleading. Studies do in fact show that the ‘sign’ can appear in up to 49 per cent of non-abused children, that it may be caused by the pressure placed on the buttocks and that it has no diagnostic value in detecting sexual abuse.

During her examination, Dr Hodes also asked the child whether anyone had hurt her bottom and she replied that [the accused person] did.

So what Dr Hodes had was, in effect, not a finding supporting an allegation, but an allegation supporting in inconsequential finding in response to a leading question.

Indeed insofar as Dr Hodes has previously written a letter in a medical journal supporting Dr Camille de Sam Lazaro’s ‘therapeutic approach’ to the sexual abuse medical examination there may be caveats as to her objectivity.

Dr Lazaro was the medical architect of the Shieldfield fiasco. She would routinely examine children for physical symptoms of sexual abuse and elevate minor inconsequential findings into a diagnosis, suggesting to the child that she had been ‘hurt’ by someone even where no prior allegation had been made.

It laid the basis for the mushrooming of countless false allegations and a fixation that two nursery workers had been responsible for a catalogue of bizarre alleged abuse.

And there is more. Through Dr Hodes examination with the colposcope and anal probing, [the child] had gained recent experience of what the alleged abuse might be like – including her lying down.

Clearly, Dr Hodes has strong beliefs about the prevalance and nature of child sexual abuse, and these beliefs affect her clinical judgement. She seems to be locked into applying old, discredited theories such as ‘RAD is indicative of anal abuse’, when in fact it’s nothing of the kind.

We don’t need to be as diplomatic as Mrs Justice Pauffley was in her dismissal of Dr Hodes’ conclusions: we are left wondering why on earth this physician is permitted to continue examining children who are alleged victims of sexual abuse. We shudder to think of the number of innocent people whom her ‘evidence’ might have indicted.

And in the Hoaxtead case, Dr Hodes’ inability to remain neutral has poisoned the well: her evidence, discredited though it is, seems plausible and very real to those who wish to promote the hoax and spread images of RD’s children across the internet.