G-P (A Child)

Physical/emotional harm from:

The mother has factitious illness disorder (FID) in relation to herself.

The mother’s FID behaviour has extended to Mary, causing her to have medical appointments, an in-patient food trial, dietary restriction and restrictions on her contact with adults and children, all of which were unnecessary.

The father has colluded with the mother’s behaviour in relation to her FID behaviour towards herself and towards Mary and has failed to protect Mary from harm.

The father has begun to accept the mother’s behaviour and his part in it.

The mother does not yet accept that she suffers from FID.

The head injuries were the result of an impact and a shaking mechanism beyond reasonable handling. It is not possible to say whether these events occurred at the same time or at different times.

Mary would have shown immediate effects from her head injuries. There was no ‘lucid interval’.

The perpetrator of the head injuries was Ms R.

Some of the 42 marks and bruises were inflicted injuries, namely:

The injuries at paragraph 4 were inflicted by Ms R.

There was a bite mark to Mary’s right foot. It was inflicted by a child. That child was J.

To the extent that any of the 42 injuries were not inflicted as set out in the above paragraphs or caused during the course of medical intervention to save Mary’s life, the sheer number of marks and signs of injury indicates inadequate supervision by the parents and Ms R in the days prior to her presentation at hospital.

Mary’s hymen was bruised. This was caused by significant force by a blunt object such as fingers.

The hymenal bruising was caused by Ms R examining Mary’s vaginal area.

feature is that the local authority had at the end of the evidence argued that the court should exonerate Ms R and find the parents responsible for the injuries. The judge disagreed. The main thrust of the submissions now made on behalf of Ms R by Mr Ekaney QC and Ms Price is that in doing so she took insufficient account of the inherent improbability of her conclusion when she had at the same time made such resonant findings against the parents.

[1-18] Introduction and procedural background

[19-35] The law relating to fact-finding

[36-58] Mary’s early medical history and involvement with professionals [59-60] The introduction of Ms R

[241-267] Psychiatric and forensic assessment of the mother and her FID: Professor Turkington, Dr Payne-James

[280-326] Mother’s FID behaviour toward Mary and the father’s part in it: Professor Turkington, Dr Payne-James, Dr B

[401-420] Discussion of the circumstances and credibility of the three adults [421-435] Review of medical evidence of head injury alongside the other evidence and announcement of findings

[436-446] Review of medical evidence of hymenal injury alongside the other evidence and announcement of findings

[447-465] Review of medical evidence of other marks and bruises alongside the other evidence and announcement of findings

The mother asserted she had at one point been paralysed for 6 months and that she has suffered from ulcerative colitis, cauda equina syndrome with left-sided foot drop, fibromyalgia, narcolepsy, cataplexy with catathrenia, night terrors, seizures and allergies. The judge could not say that the mother in fact suffers

In relation to an episode when Mary collapsed in the care of her parents in hospital aged three days with bleeding from her mouth and nose caused by pulmonary haemorrhage, Ms R alleged that this was induced by the mother, but the judge considered the evidence, though suspicious, insufficient for such a finding. Likewise, while it was understandable that Dr B suspected the mother of having deliberately caused Mary’s nappy rash, this was at best speculation. [288, 304]

However, Mary has been subject to the mother’s FID behaviour by the mother perpetuating her own fixed beliefs and preoccupations with allergies, narcolepsy and cataplexy, leading to harmful and unnecessary experiences and restrictions for Mary. The mother’s conduct is entrenched and there is a real likelihood it will be repeated. [325-6]

The father asserted a long-standing history of hypersexuality with use of pornography and sexual chat rooms. He accepted lying to the mother about this and accepted that he had reverted to the use of chat rooms in December 2017. He had not assisted in the process of understanding his use of pornography. The police had attempted to analyse his mobile phone, but it emerged during evidence that Cyfor had been unable to access his phone and that he had remotely interfered with its SIM while it was being held by the police. [345]

The dirty, cluttered and unsafe conditions in the parents’ home were of long standing and posed a risk to Mary’s safety and welfare. The conditions in Ms R’s home were noticeably better. [211, 213]

With the mother’s health issues and the father working, the care arrangements made by the parents for Mary were inconsistent, chaotic and potentially harmful, with her being exposed to a number of different carers who were comparative strangers to her and to the parents. She had been cared for by Ms R on two previous occasions (3 and 9 December). [239-241]

Ms R herself had an interest in hardcore internet pornography with a sexual sadism tendency and had accessed it on the afternoon of 17 December while the children were in her care. On 6 November, some weeks before the first occasion on which she cared for Mary, Ms R had made an internet search for signs of sexual abuse in the hymens of young girls. [417-419, 436]

The judge’s assessment of the general situation of the adults was this:

“400.

Much has been made of the stresses and difficulties in the parents’ lives. The findings I have made in relation to the mother’s conduct, in relation to her own and Mary’s health and the exaggerations and misrepresentations of course mean that I have doubts about her credibility, and there are similar concerns about the father’s evidence. He has joined in many of the accounts given to doctors, social workers and nursery about the health issues and, thus, I have difficulties about his credibility too. There is the added dimension that he used porn, as I have described, and I have precious little information about the sort of porn he was accessing.

401.

However, I also have to weigh in the balance various factors that have become apparent about Ms R during these proceedings and have to consider the inconsistencies and lack of credibility in some of her evidence. She too has had physical health difficulties, as are reflected in her medical records. She has had long-standing and chronic physical health problems.… It is also apparent that she has a long-standing history of depression and anxiety, and that she has had time off work as a result of that.”

The parents’ situation in the days leading up to 17 December was significantly stressful and their daily life was very difficult to manage. However, Ms R’s account of Mary appearing as a neglected, withdrawn child at this time was not accepted in the light of the evidence of the nursery and health visitor of her being lively and engaged. Nor did the judge accept the evidence of previous carers who raised concerns about attachment between Mary and her parents, viewing those concerns as being affected by the unhappy employment history. The carers had a prior arrangement to meet social services later on 18 December, but the judge found that the focus of the meeting was to be the unsatisfactory care arrangements for the mother rather than Mary’s situation. [351, 537, 365]

On 17 December, the father left Mary alone with her mother when he went to work although the mother was not out of bed. This situation lasted for three hours until Ms R arrived to collect Mary. There was confusion about the handover arrangements. These were of the father’s making and he lied to the court about them. [239, 370]

After Mary went to Ms R, a number of text messages passed between Ms R and the mother and between Ms R and her own mother. The judge reviewed these. The messages, which included some photographs, included descriptions of Mary’s activities on both days. These included playing a game of ‘Ring o’ Roses’ with J, playing in a toy car, taking chocolate from an advent calendar, bouncing on the bed, being bathed, cuddling Ms R in bed and (on the morning

Ms R gave evidence of having taken a photograph of Mary’s genital area on 17 December to show its soreness and as being a possible sign of sexual abuse. She later deleted the photograph, but it was forensically recovered. The evidence of Dr Morrell was that the injury to the hymen could not have been seen without parting the labia. The judge rejected Ms R’s evidence as to her motivation, and her account of having told the doctors of her suspicions, but she made no finding about Ms R having a sexual motivation for touching and photographing Mary’s genital area. [441-445]

The medical evidence in relation to the head injuries came from Dr Stoodley

In relation to the head injuries, the judge concluded that the joint evidence of Dr Stoodley, Mr Richards and Dr Morrell was compelling.

“152.

In my judgment there is a large amount of consensus between the experts relating to the head injury. On the totality of their evidence I am satisfied that the head injuries that Mary suffered were inflicted. In my judgment the medical evidence all points to the perpetrator knowing at the time the injuries occurred that significant harm had been caused to the child such that medical attention should be sought as a matter of urgency. In addition, anyone present would have known that the action was inappropriate and had caused the child’s presentation to change, such that medical attention should be sough urgently. I furthermore accept the medical evidence that the child’s presentation would have deteriorated following the injury and find that it did so, as reflected in the medical notes, which chart the child’s condition worsening until she was placed in an induced coma.” [152]

“I am satisfied that there was no lengthy lucid interval in this case.” [425]

“In my judgment it is highly unlikely that Mary would have been able to carry out these actions, in particular the ‘Ring a Ring o’

Roses’ game, if she had already sustained injuries to her brain and

skull. … The major changes that Ms R describes started to occur after lunch and about an hour before she went to get the assistance of [the neighbour] on 18 December.” [427-8]

“I am satisfied on all the evidence that I have heard that the injury to Mary occurred whilst in the care of Ms R, in all probability, on 18 December.” [429]

“Having considered all the evidence, I have reached the conclusion that Ms R inflicted the head injuries on Mary on 18 December. She, thereafter, panicked and realised that Mary’s condition was becoming increasingly serious and then took her for medical attention. Her own personal situation was sufficiently complex in my judgment to support a conclusion that, for some reason, she lost her temper with Mary and caused the injuries.” [432]

“Like the doctors, I am not able to tell whether there were two separate events, that is an impact followed by a separate shake or vice versa, or whether there was one event which incorporated the two mechanisms. Nevertheless, having considered the medical evidence, I [am] satisfied that the two mechanisms were used in a short time span and that neither had occurred prior to Mary’s arrival at Ms R’s home. She has given no account of any accident that could explain the condition that Mary was in when she presented to hospital.” [433]

“Whilst I have found that the mother did exaggerate and mislead professionals about Mary’s health, the infliction of a head injury such as this is of a totally different order from what had gone before, and in my judgment, it is unlikely that either the mother or the father caused this significant injury to their daughter. Furthermore, as I explained that conclusion is supported by the weight of the medical evidence as to the timing of the injuries and I am satisfied that I can exclude the parents from being perpetrators of that head injury.” [435]

In relation to the genital findings, having considered the evidence of Dr Rollison (forensic paediatrician) and treating doctors Dr G and Dr T, the judge concluded:

“172.

I am satisfied on all the evidence I have heard and read that the hymenal injury was not caused by the failed catheterisation. I accept Dr Rollison’s evidence that the injuries were caused by the insertion of something like fingers or a penis.”

In relation to the mark to the foot, having considered the evidence of Professor Craig (forensic odontologist), Dr G and Dr Kouble (forensic odontologist), the judge concluded that it was a child’s bite, probably inflicted within 48 hours of

In relation to the other marks on Mary’s body, having considered the evidence of Dr Morrell, the judge identified the bruising to the head and chin as having been inflicted by Ms R. The bruising to the knees was caused when Ms R parted her legs to examine and photograph her genitals. Ms R’s accounts of the bruising were inconsistent and evolving. Ms R’s mother’s evidence was rejected by the judge as being partial. Injuries such as the abrasion to the arm and the bruise to the forehead would have been evident to a carer if they had been sustained before Mary went into Ms R’s care. [446, 449, 458, 460, 463, 465]

The judge noted that she had come to conclusions not supported or sought by the local authority and said this in conclusion:

“466.

I am, of course, conscious that I have come to conclusions which are not supported, or indeed sought, by the local authority. They have submitted that I can exclude Ms R from the pool of perpetrators. I have considered that stance carefully and I, of course, have considered all the submissions on behalf of Ms R. However, having considered all the evidence in this case, I have reached the conclusion that the positions of the local authority and the intervenor do not give full weight of the totality of the medical evidence, by that, I mean the totality of the neuroscientific evidence taken together with the paediatric evidence. In addition, I find that they have not attached sufficient weight to the fracture to Mary’s skull. Furthermore, in my judgment, they have not fully weighed in the balance the complexity of Ms R’s difficulties and the stresses within her life and the contradictions within her evidence. I have also had well in mind the often-quoted principle that a child is unlikely to face more than one abusive carer in her life, however, that does not mean that such a situation never arises. While I have made adverse findings about Mary’s parents, I have sadly come to the conclusion that Mary was indeed faced with two abusive factors in her life. The two types of abuse are very different from each other and I do not consider, on the facts of this case, that it is so improbable as to not have occurred.”

Failure to analyse the relevance of the mother’s FID to the identity of the perpetrator of the injuries.

Failure to address the relevance of the father’s lies and collusion to the identity of the perpetrator of the injuries.

Insufficient analysis of the risks posed to Mary when left alone in the mother’s care on the morning of 17 December.

Insufficient analysis of the parents’ elaborate deception in relation to the care arrangements for Mary on 17 December

Failure to attach sufficient weight to the cogent ‘social factors’ rendering the findings against Ms R unsafe.

Failure to sufficiently analyse and explain the rationale for departing from the findings sought by the local authority.

Mary has unfortunately suffered a wide range of emotional and physical harm, though the pervasive consequences of the mother’s FID and the father’s connivance were different in kind to the infliction of direct physical harm.

The stresses and pathological processes present in both homes made it possible that the injuries could have been inflicted in either.

The three adults best placed to assist the court all proved to be thoroughly untrustworthy witnesses.

The neuroscientific and paediatric evidence compellingly described the nature of the head injuries and their probable effects. More exact timing depended upon the clinical picture. As to that, Ms R herself gave a consistent account of Mary’s essential normality over a period of more than 24 hours, both in contemporaneous messages and in later statements.

The four bruises/marks, had they been there, would probably have been seen and remarked upon at or around the point of handover, including by Ms R, but they were not.

The presence of the genital injury was troubling, and the evidence of Ms R’s behaviour in searching the internet and photographing the child was significant.

The bite was also a concerning finding, but attribution of responsibility for it could add little or nothing to the overall assessment.