Powys County Council v AB & Ors

In a fact-finding case involving suspected fabricated or induced illness, the court must distinguish genuine illness from exaggerated, fabricated or misreported symptoms. A genuine medical diagnosis does not prevent harmful medicalisation or the imposition of a sick role. Findings of repeated exaggeration, inaccurate reporting and unnecessary medical intervention may establish a risk of significant harm without requiring the court to diagnose the parent or attach the label of fabricated or induced illness. The court should determine the disputed matters necessary and proportionate to resolve the welfare issues, rather than every evidential disagreement. Evidence from treating clinicians must be assessed with care, particularly where treatment depends on the accuracy of a parent’s account.

Powys County Council applied for public law orders under section 31 of the Children Act 1989 concerning three children. The central allegations concerned the mother’s presentation of her youngest child, EB, who had a genuine diagnosis of epilepsy. The local authority alleged exaggeration or fabrication of seizures and other symptoms, unnecessary medicalisation, placing EB in a sick role, and related conduct affecting the children’s welfare.

The High Court conducted a fact-finding hearing and considered whether the allegations were proved on the balance of probabilities, whether they established the statutory threshold, and whether it was necessary to characterise the mother’s conduct as fabricated or induced illness.

1. Scope of fact-finding. The court was required to determine the matters necessary and proportionate to resolve the welfare issues. It was neither proportionate nor purposive to determine every disputed detail in the extensive evidence.
2. Genuine illness did not exclude harmful conduct. EB had properly diagnosed epilepsy. Nevertheless, the court found that the mother materially exaggerated seizure activity, including reporting five or six daily drop seizures and frequent generalised tonic-clonic seizures. The court also found inaccurate or exaggerated reporting concerning swallowing difficulties, apnoea and a possible need for nasogastric or PEG feeding.
3. Reliance on parental accounts. Treatment decisions, including prescribing anti-epilepsy medication and considering a ketogenic diet, depended substantially on the accuracy of the history supplied by the parent. Misreporting could therefore expose the child to unnecessary medication, investigation or treatment.
4. Medicalisation and the sick role. The court found that EB had been placed in the sick role. The helmet, differential treatment and repeated presentation of EB as more unwell than she was had caused emotional harm and created a risk of significant harm. The court accepted that medicalisation may cause a child to believe that they are ill, or more seriously ill than they are.
5. FII label and threshold. The findings fitted within the relevant professional guidance concerning fabricated or induced illness. However, determining the mother’s motivation and applying the diagnostic label of FII were not necessary. What mattered was the proved conduct and its effect and risk to the children. The findings established the statutory threshold in relation to EB and the older children’s exposure to the same harmful characterisation.
6. The matter was listed for consequential directions following the findings.