Friday, September 11th, 2020
It is not commonly known that Factitious or Induced illness (FII), formerly known as Munchausen Syndrome by Proxy, is a form of child abuse. The term ‘Munchausen Syndrome by Proxy’ has now been labelled as inaccurate and inappropriate, removing the focus from the child and placing it on the diagnosis of the perpetrator. This aligns with the overriding objective of care proceedings, which has and always will be, the safety and welfare of the child.
FII occurs when a carer deliberately causes a child to display symptoms of a particular illness or general unwellness to gain medical attention. There are three main forms; fabrication, falsification or inducement. This could be of medical records, results or symptoms and can lead to unneeded procedures and treatments being provided to the child as the doctors to whom the child has been presented make efforts to understand and treat them. In very serious cases, the child may have been poisoned or the perpetrator may have tampered with medical equipment or medication prescribed to the child in good faith and based on the false history given by the carer.
If a child is deemed to be suffering or at risk of harm, a referral to social services will be made. In FII cases the referral will often be made by a GP, health visitor or hospital when over a period of time they have suspicion that a child is being presented for medical attention but the observations of the child do not match with the symptoms that the carer states the child has.
A referral to social services can be made purely on the basis of suspicion under s.47 CA 1989, but social services will need to be satisfied that the child is suffering or at risk of suffering significant harm before it can commence legal proceedings to seek the removal of the child from its family. At Hanne & Co, we would recommend that the parents should obtain legal advice at this stage where the local authority may convene family meetings and assessments before court proceedings are commenced.
Expert medical evidence plays a central part in identifying this form of abuse. However as set out in A County Council v A Mother, A Father and X, Y and Z, the welfare of the child cannot rest upon solely one expert but from the collective opinions of medical, educational and social workers. It is usual for a medical chronology to be collated with a timeline of all doctor and hospital visits. This is a necessary but lengthy exercise which helps to rule out any underlying rare or hereditary disease or illness within the family which may be a genuine as opposed to factitious cause for the child’s illness. Whilst the outcome of FII might not be fatal, a medical chronology can identify that the child has suffered from an ongoing pattern of life-threatening events (R v Canning).
Difficulties arise where there are historic concerns of FII and a new child is about to be born into the family. The local authority may choose to carry out a ‘pre-birth assessment’ to assess the level of risk not just of the mother, but all members of the family.
Concerns of FII is a particularly sensitive issue when the carer in question may not understand that their actions are causing harm to the child. Steps should be taken to ascertain whether that person has the requisite capacity to acknowledge that their actions do not meet the best interests of the child. Any mental health issues of the carer are insufficient on their own to proving FII.
In care proceedings with an element of FII, the court will likely need to hold a fact finding hearing to determine whether allegations that the child has been subjected to a form of factitious or induced illness are borne out on the evidence. The sole focus of the court is the welfare of the child. The burden is upon the local authority to prove the allegations with the standard of proof for harm being ‘on the balance of probabilities’.
At Hanne & Co, our team of highly skilled child care solicitors and Law Society Children Panel accredited solicitors represent clients in care proceedings concerning allegations of FII.
We recommend that anyone accused of such allegations contact us as soon as possible when it becomes apparent that such accusations are being made. Our child care legal team can be contacted on 020 7228 0017. The accused may also require assistance from our criminal department who are able to attend the police station at short notice. The criminal team can be contacted 24 hours per day on 07710 454125.
Katharine Whittingham is a Trainee Solicitor in Hanne & Co’s Child Care Law Team