Medical Record Collation specialises in sorting and organising medical records. In recent years, MRC has worked as a trusted partner for solicitor firms and Local Authorities working on child protection cases. We have provided collation and chronology services for over 50 child protection cases, sorting, paginating and indexing the medical and educational records of individuals involved, providing objective and unbiased chronologies of often distressing and challenging situations.
Among these child protection cases, a significant subset are complex cases involving suspicions of fabricated or induced illness (FII). This post aims to explain what FII is, the signs that may be present and the role of well sorted medical records in assisting in care proceedings.
What is FII
Fabricated or Induced Illness is a form of child abuse in which a caregiver (most often the child’s mother) intentionally creates or exaggerates medical conditions in a child, often leading to unnecessary medical interventions. The American term for the condition is Munchausen by proxy, although this term is not used in the UK. It can consist of any (or all) of:
- Fabrication of a child’s signs and symptoms, including past medical history.
- Fabrication of hospital charts and records, specimen samples, letters and documents.
- The caregiver causing illness in a child by a variety of means.
How common is FII?
In UK statistical reporting FII is classified as physical abuse, so only limited statistics about its overall prevalence are available. A 2013 study in Italy (Ferrara et al., 2013) found that, of 751 children referred to a paediatric unit, 0.53% were identified as being victims of FII. Professor Danya Glaser of University College London’s Psychoanalysis Unit states that “although it is quoted as being rare, clinically it is not uncommon” – and according to Bass et al. 2014, it is widely believed that incidents of FII are under-recognised.
How is it identified?
Healthcare workers as well as friends and family members are most often the people who raise a concern. Signs that FII may be present and include:
| Category | Signs |
| Unexplained and changing symptoms.
|
The symptoms and signs do not correlate with any recognisable disease or with a disease known to be present.
When previous symptoms resolve, new and often seemingly unrelated conditions arise. E.g. where the focus had previously been on diarrhoea and vomiting, when appropriate assessments fail to confirm this, the story changes to one of convulsions. |
| Findings from physical exams and medical investigations do not match with reported symptoms. | Upon physical examination, the clinician cannot find evidence supportive of the reported symptoms and monitoring and investigations (e.g. blood tests) come back negative. |
| Unusually and inadequate reaction to the recommended medication or treatment without a clear reason. | Comprehensive evaluation may reveal variations in drug levels, with periods of heightened concentrations occasionally alternating with lower amounts, suggesting an irregular pattern of medication administration ranging from excessive use to discontinuation. |
| Multiple and repeated medical presentations.
|
Over time, the child is repeatedly and consistently presented with a variety of indications and ailments. Presentation may be made to many different services e.g. A&E, out of hours GP, NHS 111, different GPs as well as outpatient hospital appointments, sometimes without informing clinicians about the other clinicians being consulted. |
| Symptoms only appear to be observabe in the presence of the caregiver and fade when the child and the caregiver are separated.
|
If the person suspected of causing the child’s illness is the only one who claims to see the symptoms, and these symptoms don’t show up when the child is at school or in the hospital, it’s a cause for concern. Especially if these symptoms are serious or happen very often.
In cases where the suspected person is separated from the child the symptoms tend to go away. |
| The child’s normal daily life activities are unreasonably restricted by the caregiver either without telling medical professionals or against medical advice.
|
The child is made to do less than they should in their daily life because of a supposed medical condition and this goes far beyond what’s normal for that condition.
The caregiver limits the child’s activities, often without asking doctors or even when doctors say it’s not needed. For instance, they might make the child miss school, use an oxygen mask, or strictly control their diet for no good reason. |
| Inaccurate or deceptive information presented by the caregiver
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This can sometimes extend to social media about the child. The caregiver may even use social media posts to spread the false idea that the child is on the brink of death, despite no medical professional ever suggesting such a prognosis.
Alternatively, exaggerated reported illnesses or deaths within the family (often with very dramatic stories attached) where there is no evidence to support them or they are shown to be fictitious. |
| History of unexplained illnesses or deaths within the family.
|
In naturally occurring illness, often a history of illnesses or deaths in a child’s parents or siblings can provide valuable clues for diagnosis. However, in cases of FII, those responsible for inducing illness in a child often have their own unexplained health issues and frequent visits to the doctor.
Self-harm and eating disorders are common features among these caregiver, and other children in the family may have experienced FII abuse as well. |
| Inconsistency in how the caregiver handles the severity of the child’s illness. | Often there is a mismatch between how serious a child’s illness is claimed to be and what the caregiver does. For example, they might keep missing important medical checks even though they say the child is very sick, or provide extravagant or unreasonable excuses for non-attendance. |
Recognising these signs is the first step in identifying potential cases of FII. However, a comprehensive evaluation and coordinated response are essential.
Why sorted medical records and chronologies are important in legal proceedings
Well sorted medical records and chronologies, such as those MRC provide, are crucial in cases of Fabricated or Induced Illness (FII).
The report of an expert is necessary to assist the court to resolve the proceedings because disclosure of medical records has been ordered from multiple medical services and is extensive. Each provider provides disclosure separately and, in all cases, the records disclosed are unlikely to be indexed by the provider and often will not be provided in any, easily identifiable, order.
In guidance relating to Re X, Y and Z [2010] All ER (D) 228 (paragraph 141), the judge comments:
“In a case such as this, where GP, hospital and other health records are voluminous, I have no hesitation in saying that the parties and their legal teams, any expert witness instructed and the trial judge would be greatly assisted by having such records collated, paginated and indexed. I am aware that this is quite often done in heavy clinical negligence cases. In terms of the overall management of a case such as this, I am in no doubt that the expense involved would be a proportionate expense and one which could well lead to a reduction in costs in other areas (for example, in the fees of a medical expert).”
How MRC can help
- We make vast quantities of medical records easy to navigate, saving time and effort.
- We help experts identify patterns and inconsistencies more quickly, saving time and cost.
- We provide detailed summaries of all interactions between parties involved and healthcare practitioners.
- We allow all parties to work from a single and complete set of records.
- We enable efficient cross-referencing of information between various entities involved in complex cases.
- We provide essential historical records for assessing a child’s medical history.
MRC specialises in sorting and organising medical records and we have provided our expertise in the handling of many FII cases. If you are a solicitor firm or a Local Authority handling a child protection case, consider utilising the services of MRC. We are committed to providing invaluable assistance in these complex cases, ultimately safeguarding the well-being of the children involved.
