N (Children: Fact Finding - Perplexing Presentation/Fabricated or Induced Illness), Re
[2024] EWFC 326
Redcar & Cleveland Borough Council v AB & Ors
7 July 2023
[2023] EWFC 139 (B)
Family Court
A mom was accused of making her kids seem sicker than they were to get more medical attention. The judge agreed she often exaggerated, causing extra tests and treatments that weren't needed, but didn't find enough evidence to prove she deliberately harmed them.
Key Facts
- •C, born prematurely in 2017, had multiple complex congenital health issues requiring extensive medical intervention.
- •C's mother reported a high frequency of seizures, vomiting, and diarrhea, often not corroborated by medical professionals.
- •Concerns arose regarding potential fabrication or induced illness (FII), particularly after an incident involving contaminated gastric aspirate.
- •A referral was made by Dr. W, a gastroenterologist, expressing concerns about fabricated illness.
- •The Local Authority (LA) initiated proceedings, leading to a 10-day fact-finding hearing.
- •Experts, including a paediatric gastroenterologist and psychiatrist, were consulted.
- •The second child, D, born in 2022, also had numerous medical appointments, raising similar concerns.
- •The mother admitted to anxiety and difficulties expressing herself clearly, potentially leading to exaggeration.
Legal Principles
Burden of proof lies on the Local Authority to prove allegations on the balance of probabilities.
Various case laws cited in the judgment, including Re B (Children) [2008] UKHL 35
Findings must be based on evidence, not speculation or suspicion.
Re A (Fact Finding: Disputed findings) [2011] 1 FLR 1817
Expert opinions must be considered in context with all other evidence.
A County Council v KD & L [2005] EWHC 144 Fam
Court must assess parental credibility and reliability, considering the context of their anxiety and potential difficulties expressing themselves.
Re W and another (Non-accidental injury) [2003] FCR 346, Re M (Children) [2013] EWCA Civ 1147
A finding that a witness lied about one matter does not mean they lied about everything.
R v Lucas [1981] QB 720
Threshold criteria in s31 Children Act 1989 are objective and not concerned with intent or blame.
Re B (A Child) Threshold Criteria) [2013] UKSC 33, Re S (Split Hearing) [2014] EWCA Civ 25
Outcomes
The court found that the mother had a general tendency to exaggerate to both family and professionals.
Based on multiple instances where the mother's reports of C's symptoms were not fully corroborated by medical professionals or other caregivers, and her admission of exaggeration in speech.
Several specific allegations of symptom exaggeration and misrepresentation concerning C were upheld.
Evidence showed inconsistencies between the mother's reports and medical observations, particularly regarding seizures, behavioral difficulties, autism claims, breathlessness, and vomiting.
Allegations of tampering with C's gastrojejunal tube (GJT) were not proven.
The expert witness (Dr. Salvestrini) found accidental dislodgement unlikely, but the absence of contemporaneous concerns from medical professionals and the potential for other factors (infection, improper inflation) left the court unconvinced.
The allegation of contaminating the gastric aspirate was not proven.
The evidence was confusing and contradictory, with no forensic tests to confirm the presence of fecal matter. The court found the evidence insufficient to meet the standard of proof.
The court found the mother's actions compromised medical professionals' ability to make rational decisions, leading to unnecessary investigations and treatments for C.
Direct consequence of the findings on exaggeration and misrepresentation; impacting the assessment and treatment plan for C.
The court found that D was likely to suffer significant harm due to a repeated pattern of exaggerated medical needs reporting by the mother.
The excessive number of medical appointments for D, along with the incident concerning exaggerated skin inflammation, suggested a continuation of the mother's pattern of behavior.