Dr Woods damned by her own zeal
The Medical Council's report seems an incomplete appraisal of Dr Moira Woods's place in Irish history, says Stephen Dodd
VIDEOTAPES, in the opinion of the Medical Council's inquiry, add damning detail to the case against Dr Moira Woods. The doctor, questioning a young child over allegations that she had been sexually abused, used anatomically correct dolls. Her technique was simple. The dolls were shown to the girl while questions were asked.
"Take his hand and point," Dr Woods said to the child. "Show me him touching you in places that upset you. You remember you showed me before."
There was more; questions that the Council claims were leading. "Was his tongue inside his mouth," Dr Woods is alleged to have asked the girl, "or any other place?"
Last week, the Medical Council censured pioneering doctor Moira Woods for professional misconduct. The complaints arose from several investigations of child sexual abuse made in the 1980s, at a time when Dr Woods ran Ireland's first sexual assault unit in Dublin's Rotunda Hospital.
The Council's ruling came after an inquiry that began five years ago and ran to 43 days of hearing Forty-nine witnesses were heard, and it is likely the investigation will cost £750,000.
There are reports of a case where Dr Woods allegedly failed to check opinions of other medics; where she accused fathers of abuse with insufficient evidence; where she failed to seek expert advice on a key issue before making far-reaching allegations of abuse. On her decisions, children were kept apart from their parents.
The case is inevitably chilling, as much for its implication as its recorded facts. It deals with nightmares: the terror of sexual abuse, but also the ultimate horror of any parent, losing custody of a child over allegations of abuse.
There are allegations of over-hasty conclusions, unfair interviews and incomplete reports. In all, Dr Woods was effectively accused of 55 counts of misconduct. The tally is not as broad as it might seem, however, for the inquiry dealt with 11 children from a number of families. In each case Dr Woods was examined on five different areas of possible misconduct. These included failure to apply adequate clinical judgement, making accusations based on insufficient evidence, a failure of competence, not acting in the best interests of the children and acting in a manner derogatory to the medical profession.
The final tally of proven counts is not summarised in the Fitness to Practise Committee's findings, but examination shows the allegations against Dr Woods were found proven in 13 of the 55 allegations. In the case of one of the 11 children, the Committee ruled against Dr Woods in all five areas of possible misconduct. It was also found that she had accused a relative of sexual abuse in cases involving five of the 11 children, "when you knew or ought to have known that there was insufficient foundation to or basis for such advice". In no case was the Committee's decision unanimous.
While Dr Woods has not been accused of actually making false abuse accusations, the evidence amassed against her in the Committee's findings is considerable.
The allegations arise from a period in the 1980s when Dr Woods was "effectively in sole control" of SATU, the Sexual Assault Treatment Unit opened at the Rotunda. The unit was originally intended to treat suspected adult victims of sexual assault, but before long it was tackling a flood of child cases.
The figures for three of the years of SATU's existence, from 1985 to 1987, show not only the rapid increase in referred cases, but also the remarkable validation rate claimed by the Unit.
In the first six months of 1985, 51 children under the age of 16 were seen at the Unit. "In all 51 cases SATU was able to identify the relationship of the assailant to the victim and indeed in all 51 cases could identify the place of assault," the Committee found. It noted that because these were early figures they might be lopsided, but concluded: "It is still noteworthy ... that during this period SATU arrived at an apparent 100 per cent validation rate. It will be noted that this process involved not just validation but identification of the relationship of the assailant to the victim."
Subsequent years brought a massive increase in cases referred to SATU, and though the validation rate dropped, the Committee believed it remained "very high". In 1987, for example, 600 children were examined and 511 offenders were identified.
The Committee found: "It is the view of the majority of the committee that such figures, even if they did not purport to be entirely scientific or conclusive, should have placed Dr Woods and the other persons involved in SATU on notice of the risks of excessive certainty and an excessive rate ofvalidation."
Excessive certainty. There is underlying resonance in the phrase, the qualification of an absolute, that seems to underpin much of the conflict over Dr Woods and her accusers. In essence, the case against her suggests not that she was malicious or wilful, but that she was too sure. In the 1980s, in a climate where the true scale of sexual abuse in the family stood as a recent and horrific revelation, was Dr Woods certain where she should have doubted, too tied to a well-intentioned mindset to see its potential pitfalls?
There is detail in the Committee's findings that suggests Dr Woods made rash and potentially damaging judgements. Her methods are detailed and held as suspect. In effect, the Committee indicates, she did not take proper heed of the power of her position, a role where her word on cases was considered as final by others within the health care system.
"It is important ... to recognise that not only might there be the potential for criminal proceedings," the Committee concluded, "but also there existed a very substantial risk that application for a fit person order might be made by the District Court which might have the consequences of the removal of children from the custody and care of their parents for an indefinite or unspecified period."
Individual cases outlined in the Committee findings make disturbing reading. One such case involving Miss A was first brought to SATU after a worker in a residential day care centre began to notice abnormal behaviour exhibited by a mentally handicapped five-year-old girl. The care worker "stated that there was evidence of sexualised behaviour," the Committee heard. "This included putting lollipop sticks ... and other objects including knives up her vagina. [The worker] also stated that there was evidence of her 'masturbating at night'."
Such behaviour was, of course, hugely inappropriate for a five-year-old, and the care worker's fears were passed on to the relevant health board. The worker also contacted Dr Woods, "without the involvement of the parents", and an interview was conducted in late 1986. "It appears that anatomically correct dolls were used and a physical examination was carried out," the Committee says. "Dr Woods's report was issued thereafter. Although it does not positively identify [the girl's father] as the perpetrator, it points strongly towards him."
In a subsequent report, Dr Woods again repeated the suggestion. "It was apparent from an examination of Miss A that she had been sexually abused," the doctor wrote. "It was difficult to think of any other person who could have been in contact with her other than her father."
After the first report, a Health Board official contacted Dr Woods and told her Miss A had "several autistic features". The Committee reported: "He asked whether there could be any doubt under those circumstances about the origin of her behaviour in inserting objects into her vagina, that is, having discovered it, she might have developed a fixation."
Dr Woods said she believed her assessment stood. The case went to the District Court, where Dr Woods "stated that all the indicators pointed to the father as being the perpetrator as he was the only person who could have been in regular contact with the child". The child was kept in care until 1989, when she was returned to herparents.
In its findings, a majority of the Committee found Moira Woods had acted without considering the possibility that the girl's actions were due to mental handicap rather than abuse. The doctor had not taken into account the possibility of any perpetrator other than the father. There was certainly opportunity for a range of abusers, as the girl had spent a period of time in residential care. "In the view of the majority of the Committee the failure of Dr Woods to obtain expert advice on autism was a substantial falling below the standards that are to be expected of a medical practitioner," the Committee found. In short, the Committee said, Dr Woods' conclusions and accusations were "inappropriate and too bold". In reports, she had failed to mention the possible connection between autism and the girl's behaviour.
In a separate case, the Committee heard evidence about Miss B, whose parents were involved in a legal separation at the time of the abuse investigation. The girl's father had assaulted her mother when she pregnant with a second child. The mother brought an assault case against her husband, who was placed on probation. After the assault but before the court hearing, Miss B's mother brought her daughter, then aged three, to a hospital to be examined for signs of sexual abuse. Nothing was found.
The couple separated, amid conflicting stories of domestic violence. After one weekend when the husband had access to Miss B, the girl's mother again brought her to hospital, saying she suspected abuse. The mother said the girl had suffered a vaginal discharge.
She was examined by a specialist, several weeks after the date of the alleged abuse, and again nothing was found. Such discharge, the doctor noted, was not rare in young girls. Dissatisfied, the mother took the recommendation of her GP and contacted Dr Woods.
The Committee noted: "The entire incident took place in the context of matrimonial proceedings where, clearly, it would be prudent for a medical practitioner to proceed carefully." Dr Woods, the Committee found, had not been careful enough. She interviewed the girl at her home and found "that Miss B had been sexually assaulted and that it was believed to have been done by her father," the Committee said.
There was a clear conflict between the diagnoses of Dr Woods and other medics who had been involved in the case, one of whom had concluded: "On the balance of probabilities, it is not possible to confirm that Miss B has been sexually abused."
Dr Woods, the Committee said, made no attempt to contact the other medics. She gave evidence in court it was her opinion Miss B had been sexually abused by her father.
Distressing detail punctuates the Committee's findings. The use of anatomically correct dolls is again mentioned in the case of Miss A, where one medical witness questioned Dr Woods' interpretations of the child's response. Dr Woods had written in a report: "Daddy lies on his back. Miss A lies on top. Daddy's penis is in contact with the vulva/vaginal area of Miss A." The Committee found that the medical witness disagreed with this interpretation of the dolls. Instead, the girl was "simply engaged in a game with Dr Woods that has no meaning or reality."
Supporters of Dr Woods have found themselves facing almost overwhelming arguments in the wake of the tide of evidence contained in the Fitness to Practise Committee's report. The detail is, of course, highly damaging, yet there are important elements missing in most media coverage of the story, elements that appear to be the key to a wider understanding of Dr Woods's position. The Committee elected, in most cases, to detail in its findings only the allegations that were found proven against Dr Woods. There is only record of other cases in which she was exonerated of misconduct where the cases also form evidence for proven allegations.
In one series of cases involving five children, the council found no allegation proven against Dr Woods, yet no detail of these cases is given in its findings.
"The Committee considered that Dr Woods was entitled to be exonerated from a finding of professional misconduct in these cases," the findings state. "Again, it is unnecessary to recite the factual background and detail."
Such detail may well have been unnecessary for those who were there, and it is important to note that the Medical Council has not released the document. To those who have seen it, however, it represents a half-story, representative merely of the most damning facets of the Dr Woods case.
The Committee findings do record something of the background leading to the abuse allegations, and these go some way towards placing the cases in chronological perspective. SATU was opened in 1985, the result of discussions between the Rotunda's then Master Dr George Henry and the Department of Health. Initially it was not designed for child victims of alleged sexual abuse, but the need for such a unit quickly became obvious. It would be several years before specialist child units were set up in Temple Street and Crumlin hospitals.
The Rotunda unit, under Dr Woods's guidance, was for several years the sole avenue of help for child victims and concerned parents. The workload became huge.
"As a matter of fairness to Dr Woods," the Fitness to Practise Committee found, "it must be recognised that she was a pioneer in the area in which she became involved ... It is accepted that Dr Woods operated under substantial pressure and in circumstances where the resources available to her were meagre. It is accepted that at the relevant times she was endeavouring to act in what she considered was an appropriate manner. Unfortunately, this was not always so."
In the early and mid 1980s, abuse was a far more neglected area of medical practice than it is today. Around the country, as liberal attitudes began to expose darker truths that had been hidden behind the notion of an inviolate, traditional family unit, medics scrambled to catch up. Friends of Dr Woods say it is vital to place the report within this context, to see her work for what it was: pioneering; overloaded; a constant struggle with both society's ignorance and an overwhelming need.
At issue was nothing less than a perception of children's safety. Ireland had yet to discover the sexual abuses of the industrial schools, but doctors were already being deluged with stories of a more commonplace blight, abuse within the home. It was a difficult call for a medic to make. If abuse was suspected, should the child be removed from the family?
Hindsight now offers different perspectives, but at the time doctors were forced to weigh the dangers of possible mistakes against the potential consequences of inaction. There was sometimes little firm proof but to do nothing might result in psychological damage, physical injury or worse.
"You have to ask the question, not what is the practice now, but what was the practice in 1985," one social worker said.
SURROUNDING the case, too, is the wider issue of Moira Woods's role within Irish liberal history. In the 1970s and 1980s, Moira Woods was a familiar and controversial figure. She stood at the forefront of change, allying herself to campaigns against the war in Vietnam, against Bloody Sunday, against the destruction of Dublin by developers. Most pertinently, she stood for a new kind of sexual freedom.
Dr Woods was already vastly experienced in women's health by the time she arrived to work with SATU at the Rotunda. She had worked at the Well Woman Centre and the Rape Crisis Centre, hearing regular tales of brutality from within Irish families. Her involvement continued at the Rotunda, where she helped draw up the official Department of Health guidelines on sexual abuse.
There were other issues that brought Moira Woods into the public eye, and earned her the disapproval of the conservative lobby. She campaigned for contraceptive rights, and worked on the campaign against the abortion amendment. Today, there are those who still see Moira Woods' current travails in the light of past crusades, and talk darkly of enemies the 67-year-old doctor has made through the years. One fellow activist pointed out that the issues on which Dr Woods campaigned throughout the 1970s and 1980s resulted in 22 changes of legislation involving women.
The Medical Council's censure, though serious, is viewed by many in the profession as a relatively mild rebuke for misconduct. It may still be appealed, but unless it is, the Fitness to Practise report will remain the concluding document of a uniquely spirited career. Damning its evidence remains, but if Ireland is to take it as final judgement on Moira Woods's career, it seems an incomplete appraisal.
Undoubtedly, serious damage was done, and the Committee's findings hint at a surfeit of zeal the accusation of excessive certainty. The facts, or at least, the part we know of them, appear to support these findings, yet without zeal, without Dr Woods's sometimes reckless energies, Irish medicine would today be very different.
Times change, and in place of zeal, abuse workers now seem to face the dangers of apathy. In 1998, a survey by Dr Helen Buckley found GPs attend only 20 per cent of case conferences on child sex abuse. They were unwilling to be involved, she found, with the gardaí or with social workers. She was told they considered the meetings a waste of their time. It is a far cry from the excessive certainties of Moira Woods, but in its turn, it appears an equally scandalous situation. Fifteen years on from SATU's pioneering overload, is this now accepted professional conduct, or is such apathy simply too widespread to earn the medical profession's dedicated attention?