Not guilty verdict in FGM case - what do we think?

Was listening this morning on BBC R4 of harrowing account from a woman when she was young, initially told how she was having a party as part of her becoming a woman, gifts, dress etc then as things progressed to a room with a bowl of ice water be being pinned by women while one cut her. She is still haunted today by the womans face.

I still wonder how you can fight this, is it just hoped that education will work, though I struggle to see this stopping girls being spirited away on 'holidays'. (same for forced marriage)

Dino, yes I do consider a person who carries out the incorrect procedure, and illegal procedure, to be unprofessional.

When I was a teacher people were lining up to tell us we were unprofessional for not keeping track of every single piece of every child's unlabelled clothing, or for raising our voices slightly now and again.

Certain human mistakes under pressure are understandable. But it is still unprofessional for an obs and gynae doctor not to know the guidance on something so fundamental to his job. Whether that lack of professionalism was down to him or down to a hospital with poor induction and training, remains to be seen. It's not worth prosecuting him for, at all, but it is worth doing something about.

I feel really sorry for the doctor and how this miscarriage of justice has ruined him.

Alison Saunders was just under pressure to bring a case. And a lot of the leading Obs profs in this country told her they didn't agree. But the case was still pushed on, to the CPS anyway.

It does make a mockery of our justice system. And I don't think it's done FGM much good either.

Seriously? Little girls living in the UK are undergoing FGM now at the estimated rate of 500 per year and rising and this, seriously, THIS is the best they can dig up for a first prosecution? Way to go, CPS. That poor man.

Jesus wept. What a fucking joke. This is the best example of fiddling while Rome burns I think I have ever seen.

Agree, chunderella. Sometimes it is necessary for things to be done and should be possible but made clear to all involved. I think too often no thought is given to the most vulnerable people and there is a lack of honesty.

That seems to be one of the problems. I don't think anyone sensible would say these aren't enormously difficult problems which throw up many issues that need specialised knowledge. No one sensible wants trial by social media or mob rule. There is huge pressure on large organisations like the police, nhs and cps and I am glad I am not bloody running one of them. But at the moment I think they don't do themselves any favours.

"They shared no cultural background at all and there is no culture of FGM in Sri Lanka."

This is not accurate. Sri Lanka is 10% Muslim and they do have FGM as such.

"It is apparent that a form of genital incision is practiced on infant girls four to five weeks after birth on the rationale of circumcision. The practice involves making a tiny incision on some part of the female genital area and is performed by a traditional midwife or female elder to draw blood. Though the women confirmed that their daughters were subject to this ritual, none of those interviewed had participated in the ritual itself nor witnessed the procedure. They said that they felt obliged to follow the custom, even though it distressed them to even talk about the ritual. One mother cried when she spoke about it carried out on her infant daughter. "

It is not comparable to the FGM in Somalia, however - it wouldn't cause childbirth complications.

I've never known "strict protocols" in any hospital I've worked in either, Kundry!

The Guardian though does say that the hospital did report it to the police:

"In the aftermath of the incident, a hospital inquiry examined what had taken place, labelling the event a “serious untoward incident”. The inquiry recommended more training for the doctor and a period of reflection. Five months after the incident, he was made a senior registrar.

Meanwhile, the hospital had referred what had taken place in the delivery room to the Metropolitan police as a matter of course because of its concerns."

www.theguardian.com/society/2015/feb/04/first-female-genital-mutilation-prosecution-dhanuson-dharmasena-fgm

It isn't clear how or particularly why in this case it was reported to the police though.

The timing of the announcement of the prosecution and Saunders' appearance at the select committee are very interesting...

Ah, thanks Kundry.

The hospital did not report the case to the police. They conducted an inquiry which said that the doctor and some other staff needed retraining and some time to reflect.

Clearly this wasn't enough for someone with an axe to grind who leaked it to the police.

The police then sat on it for 2 years after a rubbish initial inquiry - they didn't look at the notes or interview the woman with an interpreter.

Until suddenly the CPS was under intense pressure to have a prosecution and they remembered this one gathering dust in a cupboard - and hey, presto! A prosecution.

Strict protocols? Ha ha ha.

Also, I don't think it's fair to say the hospital hung him out to dry. I assume there are strict protocols when an injury in the course of medical treatment needs to be reported to police and I imagine the hospital expected the report to be filed, maybe a couple of questions, then the case put away.

It is a real shame that this was the first case. Certainly the media impression I was left with when he was first charged was that he had done this at the instruction of the husband and wasn't it awful etc. Which seems to be far from true.

shaska, "I did read that he had denied a couple of motions to dismiss, or something - does anyone know why?"

One of the Guardian articles says:

"During the trial process the judge rejected two attempts by the defence to dismiss the prosecution on the grounds that, under the Female Genital Mutilation Act 2003, a doctor is exempt from prosecution if a surgical procedure was carried out on a woman in labour or after childbirth and was medically necessary."

www.theguardian.com/society/2015/feb/05/cps-chief-alison-saunders-fgm-case-doctor-acquitted-30-minutees

The woman had said that she had had FGM performed but she had surgery to allow her to get pregnant. It appears that in the time between that & labour, the scar had healed up again. She was not examined prior to labour despite her caregivers knowing this and was not referred her to the relevant consultant or antenatal clinic to allow for repeat surgery/planning.

www.bbc.co.uk/news/uk-england-31138218

cailindana, you have called Dr Dharmasena "unprofessional" twice.

I'd be interested to know what you, with your training in obs and gynae, would have done in those busy few minutes of helping one mother deliver her distressed baby and then bleed from a wound before having to dash off to perform/assist with an emergency section on another mother with a distressed baby.

He made the best decision he could at the time.

He agrees that he could have done better but the patient, surely one of the best judges here, was not harmed and does not believe herself to have been harmed.

Why was the Dr prosecuted? From what I can gather he was repairing an existing FGM after the patient had given birth. Albeit he may not have carried out the procedure completely correctly, but he obviously did not set out to mutilate the patient. He flagged the issue to a colleague, so he wasn't trying to cover it up. This incidence is a training issue, not a criminal one IMO.
I agree the French law /system seems better. Action needs to be taken in communities in which FGM is prevalent when potential victims are young girls / babies (e.g. random inspections of potential victims). Anything else is too late.

I heard the DPP on the radio this morning talking about this case and found her unconvincing. Having read the article posted above, the whole thing seems even less satisfactory.

The CPS invariably seems to take a defensive stance about the rightness of its decisions and processes, which is worrying, particularly given that Rotherham council has just been criticised for refusing to consider they could be at fault over anything, ever. The CPS seems to take the same stance whenever they are asked about any of their decisions.

For example, recently there was a case where the DPP carried out a review into their decision making when a woman they were prosecuting killed herself. Surprise surprise, it was found the CPS was blameless. Various victim groups complained.

The CPS has been criticised by its own inspectors for how it deals with complaints and set up something they call an independent assessor, but if a complaint is made to the independent assessor the CPS writes the terms of reference, which hardly seems independent to me. In some cases people can complain under the victim's code but the criteria for that are narrow and not always relevant. The Attorney General's office is supposed to be responsible for the CPS but any complaints to them get forwarded to the CPS to draft the answer, and most of the AG's lawyers are seconded from the CPS anyway. The CPS is not covered by the Parliamentary Ombudsman either, so there is no check or balance there.

Sorry if this is at a bit of a tangent to the case under discussion but I think it is quite dangerous to have an organisation today that basically is allowed to regulate itself.

I agree with the poster who said it is interesting the DPP was to attend a select committee meeting shortly after the decision to prosecute was made. Maybe that is cynical, but the CPS is pretty keen on doing PR in the media to make itself look good. I was a victim and was treated terribly by them, despite there being an eventual conviction, and I have noticed for years and years that how they present themselves in the media bears no relation to how they behave as an organisation when no one is looking. I think they need to concentrate a bit less on defending themselves or trying to make themselves look good and a bit more about their competence, decision making, being answerable, how to behave when something goes wrong, and how to improve from now on with the currently disgraceful situation regarding the lack of FGM prosecutions.

I lived in Nigeria for a couple of years. FGM was common in my area (don't know what type but pretty extreme). It was sometimes discussed b/w the ex-pat midwifery/medical community (never amongst Nigerian women in my hearing - very taboo subject). Certainly I was left with the impression that there was no choice after childbirth but to restitch the incision. Maybe that was due to the basic facilities available but I must admit I can't envisage a straightforward alternative. When the labias etc are gone how/what do you reconstruct with? I imagine a series of surgeries would be required and for full consent from the woman (the important bit) you'd need a more detailed discussion about possible outcomes etc than is possible in the immediate aftermath of birth.

This was clearly a desperate attempt to bring a prosecution, any prosecution. The real disgrace is that no-one has been prosecuted for undertaking an initial FGM, not a post partum stiching.

The law here is clearly not fit for purpose, since it seems to rely on girls giving evidence against their families. The French law seems better. As I understand it, if one has custody of a child and that child is (on inspection; and there are inspections) found to have suffered FGM then the person with custody is automatically guilty of an offence. The French are less squeamish about idenitifying girls at risk and overtly monitoring them

I'm not sure Breaking. I mean, I suppose if someone learns that a person is carrying out FGM they can report them but I'd imagine that's well covered up.

The only time I've ever had a vaginal exam is when in labour. I've had smears but it was up to me to attend them, if I was trying to hide FGM I wouldn't go.

Many women who've undergone FGM live in extremely misogynistic cultures where their movements are very restricted. A lot may not understand English very well and so may not know how to report. They may also be told by the people around them that they will be in trouble if the FGM is found.

I was just wondering how apart from girls/coming forward is there no other way that you are going to catch perpetrators?

My general experience is that HCPs have appallingly poor knowledge of even the basics of female reproductive health so it doesn't surprise that the extra knowledge about FGM isn't being passed on.

"I would have thought that, in an inner London hospital, FGM should be pretty high up on the list of subjects that any member of staff in oby/gyn should be fully briefed and educated in?"

I'm not sure, and would be interested to know. My completely un-educated guess would be that they should definitely be well briefed, but I'd be surprised if the briefing was put into practise enough to have the all doctors be experienced enough to make 100% correct judgement calls in high pressure situations. If that makes sense.

Oh yeah I don't think he should have been prosecuted at all, he was clearly targeted. But the only positive outcome is that it will make doctors vigilant and hopefully dramatically increase detection and awareness of FGM.

Horrible thought though - will some women be forced to labour at home for fear FGM will be discovered? If a woman has FGM the chances of a risky delivery are very high.