Bartholomew's Notes

From the Evening Standard, a couple of days ago:

A leading London doctor who says that women should be free to choose what to do with their bodies has been spared prosecution over allegations that he authorised unlawful genital surgery on a mother of two.

Professor David Veale was placed under a three-year Met investigation after another senior doctor complained to police that his involvement in a clitoris removal operation on the 33-year-old woman appeared to breach the law on female genital mutilation.

A file on the case was sent to the Crown Prosecution Service….

…Mr Veale told the Evening Standard that he had been caught up in a “highly political” campaign to secure a first conviction for female genital mutilation and that there was a “completely clear” difference between FGM and cosmetic surgery… On the criminal investigation against him, he said it had “dragged on” despite having no chance of success.

Female genital mutilation has been illegal in the UK since 1985. It is also illegal to take a child out of the country for the purpose of FGM or to assist with the procedure on a British national outside the UK. However, as noted by the Guardian in 2014, girls continue to be sent abroad, and families pool resources to bring “cutters” into Britain. Yet so far, there has not been a single successful prosecution – and there was consternation a few days ago when the official social media account of West Midlands Police indicated that pursuing prosecutions of parents was “unlikely to benefit child”.

Veale is the co-author of “Cosmetic Clitoridectomy in a 33-Year-Old Woman“, a short case history that was published in the Archives of Sexual Behavior in 2011. The authors showed that they were well aware of the law regarding FGM, but they argued that this particular case came under “mental health exceptions for cosmetic surgery resulting from perceived abnormality”:

She had a longstanding aversion to her genitalia associated with an extreme desire for a cosmetic procedure. Such a request, in the absence of any cultural beliefs, would suggest to most clinicians that a patient was very disturbed. However, on a structured diagnostic interview for DSM-IV, she had no evidence of any psychiatric disorder or personality disorder and I could not elicit any further information that might make a cosmetic procedure unwise or require further investigation.

Veale had to “distance himself from his astonishment at, and aversion to, the request”, and he “gave an opinion on the basis of his mental assessment and clinical experience in body image disorders and cosmetic procedures.”

The paper provoked critical responses in the same journal, to which Veale responded in subsequent follow-up pieces (here and here). One of those critics, Susan Bewley, raised the possibility that an unlawful procedure had been undertaken, and referred the matter to police.

It seems very odd that this should have taken three years to resolve. Police perhaps needed to check that the published details were a true reflection of the facts of the case, and then to ask for a legal opinion – but it is difficult to see why that should have taken so long. Was the delay down to the police, or the CPS?

This tardiness is worth noting as a general observation: it is often assumed that a lengthy police investigation must mean that the police are uncovering lots of evidence; that a referral to the CPS must mean that this evidence is strong; and that the longer it takes the CPS to come to final decision the more reason we have to doubt the suspect’s innocence. In 2016 I noted the case of a high-profile harassment allegation, in which the complainant specifically referred to the amount of time taken by the CPS to drop the matter as a vindication of her failed complaint; and in the case of Veale, Bewley has referred to the length of time taken as a reason why the CPS ought to have proceeded to prosecution.

Of course, this is wrong-headed. There may be delays in gathering evidence for reasons outside the police’s control (e.g. temporary unavailability of a witness); there may indeed be a large quantity of evidence to go through, but that turns out to be weak or invalid (for example, the extensive false testimony of “Nick”, the Operation Midland complainant); and some investigations and deliberations may be queued behind other, more urgent matters. However, we should not discount the possibility that the police and/or CPS may sometimes allow things to drag out unnecessarily due to incompetence (or even malice), or because of a wish to postpone or avoid criticism (the latter may include the police referring a matter to the CPS even though an allegation has no merit).

In this instance, it seems that the authorities wanted to be seen to be doing something about FGM, but their efforts were misdirected – and not for the first time. In 2015, Dhanuson Dharmasena was prosecuted for having cut and re-stitched scar tissue on a incised woman who was giving birth. Medically informed commentary ahead of the trial made it clear beyond any reasonable doubt that the doctor had acted for medical reasons, yet the case went to trial anyway – and he was duly cleared after 30 minutes of jury deliberation. David Richmond, the president of the Royal College of Obstetricians and Gynacagologists, wrote after the case that

Every single professional I have encountered in the last 12 months was astonished at the prosecution of this young doctor but assumed, wrongly it transpires, that the CPS must have strong evidence. Dr Dharmasena was a junior doctor providing emergency obstetric care to save the baby of a young mother in labour who had suffered FGM as a young girl. He was doing, to the best of his ability, what obstetricians do every hour of every day.

This demonstrates how assumptions about the CPS can lead to wider reputational damage.

Meanwhile, genuine cases have gone unpunished by the law: in 2012, a doctor named Ali Mao-Aweys advised a Sunday Times reporter posing as an aunt wanting her nieces to be “circumcised” to contact a dentist in Birmingham named Omar Addow; both men were arrested, but later released without charge and although they were both struck off by their respective regulatory bodies no wider investigation into their activities seems to have followed.

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