Strand, London, WC2A 2LL
B e f o r e :
|- and -
(3) W (a child)
(4) X (a child)
(5) Y (a child)
(6) Z (a child)
Anna McKenna (instructed by WSCC Legal Department) for the Applicant
Rohan Auld (instructed by Anthony Morris Solicitors) for the 1st Respondent
Jacqueline Roach (instructed by Mahany & Co.) for the 2nd Respondent
Richard Tambling (instructed by John Stebbing at Stephen Rimmer LLP) for the 3rd Respondent
Peter Horrocks (instructed by Jane Dahill at NLH Solicitors LLP) for the 4th, 5th and 6th Respondents (their Children's Guardian)
Hearing dates: 19th July 2010
Crown Copyright ©
Mr. Justice Hedley :
"I would not expect [that] to make the slightest difference, in practice, to the way in which applications to withdraw care proceedings under r. 4.5 are approached by the courts … the only practical results, therefore, … is that a court dealing with an application to withdraw proceedings under r. 4.5. is free, when assessing the considerations affecting the welfare of the child so far as they apply to that application, to make specific use of the S. 1(3) checklist if it so wishes, but cannot be criticised if it omits to do so."
It follows from that that Section 1(1) is engaged and Section 1(3) is available for the assistance of the court but its use is not mandatory. The court makes it clear that the consequences of giving permission (i.e. discharging interim care orders) do not determine of themselves the nature of the application. In other words the focus is on permission not on discharge.
The Ambit of the Judgment
"In February 2003, Dr. Churcher-Brown, psychiatrist, found that M came from an emotionally deprived and disturbed family background and that her low opinion of herself was typical of people with such a childhood history. She was the victim of childhood physical and sexual abuse and in adult life became involved with violent men. He described her previous episodes of emotional distress as adjustment disorder - transient and in response to significant life events. Dr. Churcher-Brown did not consider that M was suffering from any formal psychiatric disorder. He described "some pathological personality traits which are a reflection of her traumatic early life". He did not feel that she fulfilled the criteria of any formal personality disorder. "
That is an important perspective not to be lost in the evaluation of this case. Happily no-one has ever suggested that the father is a violent man but one has to conclude that the mother is quite emotionally dependent whilst at the same time having a history of violent and unsustainable relationships with P, Q and R. Sadly these consequences of early life abuse are all too well known to the court.
The Institution of Proceedings
"It is my opinion that these three children have been subject to fabricated illness, and that their mother … has indulged in verbal fabrication resulting in unnecessary treatment and investigation."
She then sets out the facts from the medical records and her own involvement upon which she relies to justify that opinion. She ends her first letter thus -
"It is my opinion that M demonstrates a classic case of fabricated or induced illness. I am of the opinion that she fabricates illness in herself necessitating unnecessary medical intervention, investigation and treatment, not to mention unneccesary utilisation of the emergency services. I am also of the opinion that she demonstrates fabrication of illness in her children particularly in X, but more worryingly that she is beginning to focus on W and potential cardiac problems. Consequently, I fear for the safety and well being of these children, and I advocate that they are removed from the care of M until further investigation can be completed by Social Services."
Clearly any responsible local authority would in those circumstances have to take action. This local authority decided to institute care proceedings and to seek a removal. The question then arose as to when to engage with the family. Dr. Atkinson was quite clear about that. In her second letter she wrote-
"I feel that these children are at continued risk of harm and, consequently, advocate that they are removed from the care of M whilst further investigation is carried out. I am also of the opinion that it would be detrimental and, indeed, dangerous to inform M prior to the event of the intention to remove the children from her care. I say this on the basis that this is a complex case of factitious illness involving a large number of hospital departments and feel that it is a particularly difficult case owing to the fact that not only are the three children who are currently resident with Mother subject to factitious illness allegations, but the mother is also fabricating illness in herself. It is well recorded that, in such complex cases of factitious illness, challenge of the perpetrator can result in verbal fabrications rapidly being converted into induced illnesses in the children. There is always a risk that such inductions could potentially be fatal."
In those circumstances the local authority applied and (on transfer to Brighton County Court) their application came before HHJ Norrie on 4th September in which the local authority sought interim care orders in respect of W, X, Y and Z based on an interim care plan for immediate removal of all children into foster care.
The History of the Proceedings
"3. My duty is to protect the welfare of the children, which is paramount. In these extraordinary circumstances, and based on the evidence of Dr. Atkinson who is known extremely well to this court, in the interests of their welfare and safety, it is important the children are removed without - the father is not the birth father of all the children, but it would seem that he is a father-figure role - the knowledge of the parents. Bearing in mind the human rights of both of the adults in this case, I am satisfied that the case should come back to me on Monday, thereby giving the parents the earliest opportunity to deal with this matter."
On the Monday the case was duly transferred to this court.
"X has had enormous input from health professionals. He has a number of well documented medical problems but this should not negate the importance of considering whether there has been over-medicalisation and impairment of the child's everyday life as a result of unnecessary restrictions and medication."
Dr. Ward then goes on to make these comments -
"Review of the medical records reveals many examples of inconsistency and exaggeration. M was recognised as being a highly anxious parent and at times professionals spoke of her description being dramatic. The GP refers to this and often records her description verbatim…The consequence of escalating concerns about X's health was that he was effectively disabled, using a wheelchair, not going to school and spending a significant amount of his time in the presence of health professionals…There is clear evidence of exaggeration of symptoms in all of X's medical problems. It is more difficult to be certain that symptoms were completely fabricated as it is difficult to know whether he was having fits or not. However the fact that his seizures ceased abruptly when M was no longer X's primary carer suggests that there was fabrication. (Author's emphasis)
Obtaining specialist treatments or equipment for children who do not require them. Requests for an electric wheelchair, a ripple bed and a special school were undoubtedly unjustified and damaging. Professionals were probably influenced in prescribing treatment for gastro-oesophageal reflux and epilepsy by the mother's dramatic and exaggerated description of symptoms (Author's emphasis)"
She concludes by saying that apart from the need to manage his Eczema, "he now presents as a happy, lively boy who enjoys all aspects of school, sport and other activities."
"the dramatic way in which the history was delivered [by mother] is likely to have affected the investigations and may have led to more investigations being checked than usual in simple constipation … in summary, professionals have been concerned at the over dramatisations and focus on illness in Z."
Further than that she does not go.
General comment on the Case
The Welfare Assessment