Second Medical Opinions in Child Protection Cases

Publication: 31/07/2014  
Next review: 20/10/2023  
Standard Operating Procedure
CURRENT 
ID: 3920 
Approved By: Trustwide Child Protection Steering Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2020  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Second Medical Opinions in Child Protection Cases

Background and indications for standard operating procedure/protocol

Definition: A second opinion is where another professional (in this case a doctor) is asked to provide an opinion on a clinical matter. In the context of child protection very often the issue is whether the child has or has not suffered abuse.

A High Court Judge raised the following points in his judgment in a Leeds case which are pertinent to the choice of a second opinion:

  • The doctor should have complete independence from the first examiner
  • The doctor should be someone of equal seniority (not expressing an opinion about someone of greater seniority than themselves)
  • The doctor should not work in the same hospital
  • The doctor should not have been  a pupil of the first doctor
  • The case should not have been discussed with the doctor by the doctor who conducted the first assessment.

Doctors in both LTHT and PCT Care Services should be made aware that ‘second’ opinions for medical child protection issues must be independent and should be sought from a clinician with expertise in the field from outside the Leeds NHS Service. They should also ensure that this is reflected in advice given to referring GPs.

GPs in Leeds should be made aware that any referral for an independent ‘second’ opinion regarding medical child protection should be directed to a paediatrician with expertise in the field outside the Leeds service. They should also be made aware of where such second opinions may be obtained or who to approach (e.g. Designated and Named Doctors) for advice.

Brief summary for when the SOP/protocol should be used and why....

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Procedure method (step by step)

Who requests a second opinion?

  • The doctor themselves may request a second opinion
  • The parents may request a second opinion
  • The court may request a second (“expert”) opinion
  • Others e.g. children’s and young Peoples Social Care may occasionally request a second opinion.

Why ask for a second opinion?
There are various reasons but examples given here are some of the common ones:

  • The doctor is either unsure or looking for support for his opinion in a difficult and contentious area of practice.
  • The parents are looking to challenge the first doctor’s opinion.
  • The court wants to check that the first opinion is sound and to seek the advice of an independent expert who is at a distance from the case.
  • The local authority may disagree with the first opinion and wish to pursue a different path of case management.

How to choose?
The second opinion must have the following qualities:

  1. appropriately qualified and experienced
  2. acceptable to the party making the referral and preferably also to those directly affected by the outcome
  3. seen to be acting independently
  4. be agreeable to undertaking the work

Who chooses the second opinion?
This will depend to some extent who is requesting the opinion. A doctor who wishes to have a second opinion will choose a Doctor who in his opinion is the best one to provide that opinion.

The family will take advice from another professional, usually either their GP or solicitor. It is not appropriate to take advice from the doctor who gave the first opinion.

In many cases GP’s may seek advice from a Named or Designated Doctor or from the Doctor who gave the first opinion. The latter could be criticised as not being independent.

The court is often guided by the guardian ad litem and her solicitor representing the child. A joint instruction agreed by all parties is frequently used as the best way forward.

Recommendations

  1. Paediatricians or other clinicians in the LTHT who are experiencing difficulties with the diagnosis or management of a child protection case or who need support should in the first instance obtain this from a Named or Designated Professional.
  2. If after discussion it is felt that an outside second opinion should be sought then an appropriately qualified and experienced doctor (Consultant) from outside Leeds should be approached. The referral should include a letter outlining the case along with medical notes, photographs, x-rays and reports as appropriate. Opinions obtained in this way must be shared within the multidisciplinary process along with the first examiners report. It is unwise to undertake detailed discussion of the case beforehand with the second opinion.
  3. Continuing responsibility for the case remains with the first paediatrician who will arrange follow up and attend any case conference and court as appropriate.
  4. When a parent requests a second opinion, the examining doctor, if approached, should advise the parent to request this via their GP or solicitor. The first doctor should have no part in choosing the second opinion but make it clear to the parent that any records will be made available to the second opinion who should be informed of the involvement of the first doctor. 
  5. Approaches made by a GP for advice re choice of a second opinion should be made to a designated or named doctor who will be able to advise on who may be able to assist.
  6. GP’s should be notified of this procedure.
  7. LTHT staff should be notified of this procedure
  8. Solicitors are likely to continue to select second opinions as they feel best in the interests of their clients but could approach Designated/ Named professionals for advice through the appropriate mechanism.

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Provenance

Record: 3920
Objective:

To standardise and optimise the process by which a second medical opinion is obtained from another medical doctor in suspected child abuse and neglect cases.

Clinical condition:

Safeguarding Children

Target patient group: Children and Young People
Target professional group(s): Allied Health Professionals
Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

D (no national guidance exists)
Evidence levels:
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)

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Approved By

Trustwide Child Protection Steering Group

Document history

LHP version 1.0

Related information

Compliance with LSCB directive

Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.