In the soup

This is a set of care proceedings dealt with by His Honour Judge Wood in Newcastle – so not binding or exciting case law, but sad and interesting and with some unusual quirks.  So far as I am aware, it is the first set of care proceedings in which a tin of tomato soup plays a key role.

[The very unfortunately named Lancashire County Council v A (Burned Child) 2015 mentions soup tangentially, but it does not specify tomato…   http://www.bailii.org/ew/cases/EWHC/Fam/2015/1156.html

Oh, and of course the Hampstead Hoax case Re P and Q 2015 involves a finding that the mother and her partner made Hemp Soup and fed it to the children       http://www.bailii.org/ew/cases/EWFC/HCJ/2015/26.html   

Turns out soup crops up more than you’d think. Spaghetti hoops, however, have never turned up in a published family judgment on bailii, just in one horrendously complex case about tanks used to store polymers – a case apparently worth £40 million…

Baked beans feature in no published  family law judgments at all.  Lots of other weird stuff, including the wonderfully named

Baron Uno Carl Samuel Akerhielm and another v Rolf De Mare and others (Eastern Africa) [1959] UKPC 11 

Quite hard to imagine the Baron, or Rolf De Mare eating baked beans 

My dear old friend Shepherd’s Pie just comes up in a criminal case, where the plan was to add death’s head mushrooms to the Shepherd’s Pie to poison someone.     http://www.bailii.org/ew/cases/Misc/2011/13.html

I have digressed into foodstuffs versus the law. Sorry! ]

Re S 2016

http://www.bailii.org/ew/cases/EWFC/OJ/2016/B7.html

The case involved two very ill children, and parents who were from India, and who in the midst of care proceedings went back to India and who were saying that they would only return to collect the children and take them to India. Thus not participating any further in the care proceedings. That is a shame, because certainly from the judgment it seems that mother was potentially a perfectly suitable carer for the children and the issues were really around father. Additionally that father’s issues were potentially of a mental health nature and thus potentially treatable.  If the parents had engaged with the process, the outcome could easily have been very different.

This being an international case, efforts were made to contact the Indian authorities. With the exception of what used to be called the Slavic countries, this response is pretty typical of what we tend to get when contacting foreign authorities.

I should mention at the outset that as these children are Indian nationals it is only right and proper that the Indian authorities should have been notified of this action being taken by the local authority in respect of Indian subjects. They were duly notified via their Embassy in November 2015 with full details as to the nature of the action being taken, as well as the contact details of all relevant family members, receipt of which was apparently acknowledged, with an indication that the Embassy would contact F, but nothing has been heard since.

The two children were, as I have said, very unwell.

9. The background is significant. Each of these children suffers from profound disability and severe cognitive impairment. In B’s case, her current diagnosis is epilepsy, encephalopathy, global developmental delay, microcephaly, cortical visual impairment. She is fed by gastrostomy. She suffers from prolonged seizures as well as sound sensitivity. She has scoliosis of her spine and subluxation of her hip. By reason of her disability she receives extensive support from a community paediatrician, a consultant paediatric neurologist, consultant orthopaedic surgeon, an epilepsy nurse, dietician, speech and language therapist, occupational therapist and physiotherapist and sensory support team with regard to her health, mobility and postural needs.
10. So far as C is concerned, his current diagnosis is dystonia, perinatal hypoxic lactatemia, encephalopathy, epilepsy and global developmental delay. He had previously had a nasogastric tube to aid feeding until May 2014 when it was replaced by a gastrostomy. He is currently in receipt of support from the community paediatrician, orthopaedic surgeon, epilepsy nurse, dietician, speech and language therapist, occupational therapist, physiotherapist and sensory support team.
11. It goes without saying that each of these children is totally dependent on carers to meet all of their holistic needs, to ensure that they receive the medication and the delivery of their health plans as well as being closely monitored to ensure that their health and presentation, safety and wellbeing is at all times met. Neither has any verbal communication. B will apparently cry with distress, but it is said to be hard to find the cause at any time other than by elimination. C responds to sounds and sensory stimulation only.
12. The local authority says that F in particular does not recognise the needs of his children and their increase. He has, from time to time, as part of a pattern, accused health and educational staff of harming both of the children, as well as ignoring advice from a range of professionals.
13. There is, as I say, a significant history, but the onset of the precipitating event, if I can put it that way, was that on 13^th March 2015, C was admitted to the University Hospital of North Durham with life threatening dystonia, that is to say a movement disorder that causes muscle spasms and contractions. This particular episode required a high level of nursing on admission and frequent monitoring, as persistent back arching had put him at risk of airways compression. This was described by medical staff as a serious life threatening medical condition, resulting from a gradual increase in muscle tone and, on admission, his father reported that he could no longer manage this at home, the spasms having become more frequent.
14. The medical records record, and one of the treating paediatrician’s comments based on that record, that such severe dystonia would have developed over time and suggest that health support should have been sought at an earlier date to prevent this life threatening episode.
15. B was admitted to the same hospital on 19^th May 2015 due to increased seizures and she required monitoring and medication review and due to her complex needs and swallowing difficulties she has been fed by a gastrostomy which enables her to receive liquid feeds throughout the day in accordance with a dietician devised regime.

Given B’s difficulties with feeding and seizures, it was of vital importance that any medical advice regarding feeding be followed. There was an incident where it appeared not to have been, and the investigation as to the cause cannot have been too onerous or complex.

The local authority say this has been extensively discussed with B’s father and, on 9^th June last year, whilst she remained an in-patient and F had been alone with her in her room, carers arrived to find B vomiting over her clothes and bedding, a liquid that was orange in colour and smelt of tomato soup. A tin of tomato soup was noticed in the waste bin in the room. F, who had briefly left the room, returned and was asked if he had fed B foods either orally or via the gastrostomy site and he denied it, but it is said that later in the evening he admitted that he had given B tomato soup with mashed potato. Medical advice suggested that this placed her at significant risk of aspiration and choking and could have been a life threatening situation for her. It constituted, in any event, having ignored the dietary advice, giving oral feeds that had not been agreed by medical staff, and thereby placed her at risk of significant harm. F at different times, it is said, has disagreed with the feeding and medication regime for the children and has indicated in terms that he would not follow such a regime once the children returned to his care.

The father’s behaviour become more challenging and peculiar after this. He started to assert that the medication given to the children was making them ill, that hospital staff had inserted electronic chips into their heads, that there was silver metal being placed in their brains and that the hospital were using the children as human guinea pigs to test the effects of bacteria upon them.  It was this behaviour, in combination with the fact that the children had very significant health needs which would have to be met, on discharge by their parents, that led to the degree of concerns that the Local Authority held.

24. In addition to the evidence of the then social worker, Claire Brown, the local authority relied on the reports of two paediatricians who have cared for the children in Durham, Dr Haves and Dr Balu. These are frank and, in the case of Dr Haves in particular, really quite hard hitting reports, in which neither pull their punches. Dr Haves expressed belief that both of these children would suffer significant harm if they were returned to the care of their parents they being in hospital continuously from the time of their admission up until November, as I will come to. She was very concerned at what to her was M’s extended and unexplained absence. She considered F to have a significant undiagnosed mental health disorder, which was deteriorating and impacting on his ability to work with professionals, he declining to undergo mental health assessment. Dr Haves considered his belief about the causation of the children’s disability, which is thought, from a medical point of view, to be genetic in origin, to be paranoid or delusional in nature, but more worryingly, that belief acted as a barrier to the administration of proper care and she gave a long list of examples of that, some of which I have already touched upon.
25. She felt his allegations against medical professionals were incompatible with any evidence, or indeed reasonable expectation. Nor, in her experience, could his views be explained by a cultural variant, or an adjustment reaction to the children’s disability, she having had some significant experience of working in communities where many people from the Indian sub-continent live. She gave examples of F’s paranoid beliefs that extended to his emails being hacked, his receiving telephone guidance from professionals in London and neighbours reporting on him, and she said it was impossible to engage with him in a rational way, which in turn made the provision of medical care in the community almost impossible.
26. There were other specific concerns. First, his inability or unwillingness to recognise and manage seizures of which there was a long history. This had profound implications for ensuring the correct medication. His inability or unwillingness to comply with medical advice, withdrawing, reducing or increasing doses of medication, particularly anti-convulsants, such that, at times, the children were inadequately protected, or so dosed up that they presented as sedated. F also made claims of medical expertise, repeated, I see, in his closing submissions. His claims of academic qualifications include biology, microbiology, immunology, pharmacology, none of which were ever substantiated, but used by him to engage with professionals in what they considered an inappropriate way. He had acquired medical equipment with no qualifications to use it, such as a blood pressure machine, as well as taking steps such as dressing in an NHS uniform or a white coat, thereby implying that he had qualifications that he did not have. He had, on occasion, administered high flow oxygen to B, without any medical intervention or advice. He fed her orally, as I have mentioned, and administered a privately acquired nebuliser. Dr Haves also had worries about his emotional attachment and basic care, noting on occasion a lack of reaction to distress, a lack of stimulation, at one point offering to donate the children to medical science if a genetic condition was ever established, as well as leaving the children unaccompanied for significant periods. Finally, was her concern about his reluctance to accept support. She concluded her report by saying this: “B and C have profound and complex neuro disability. They are highly dependent on others for all aspects of their care and remain highly vulnerable to complications. As such, the level of parenting capacity required to meet their needs is extremely high and it is expected that any parent in that situation would require the help and support of a wide range of professionals, to give expert advice and opinion. Professionals working with families caring for such disabled children are generally highly skilled and experienced at working with families with a variety of different beliefs and levels of understanding and work hard to develop positive relationships with the families, regardless of any differences in opinion. However, in order to work in an effective way with families, professionals need to be able to expect a level of honesty and openness and to be satisfied that parents and carers have a reasonable understanding of key health issues. Where parental understanding or belief systems appear to be acting as a barrier to providing adequate care to highly vulnerable children, professionals must raise their concerns. Professionals working with F have had long standing concerns about his mental health and well being and how his strongly held beliefs are impacting on the care of his children and his ability to work with professionals. There has been real professional anxiety about the possibility of actual harm occurring, as a result of his beliefs and behaviour and about the potential future risk to the children, owing to any possible undiagnosed, untreated and unmonitored mental health condition. There is now additional witness evidence of incidents of a very serious nature, in which the children have been placed at high risk due to F’s behaviour. I strongly recommend that he should not be allowed any further unsupervised access to his children and that he undergoes an expert psychiatric assessment.”

The Judge made the following findings in relation to father

“iv) F holds strong and dogmatic views on the treatment of his children. Some of these views are paranoid and delusional. His insistence on the validity of these views impinges on the ability of the treating team to treat the children effectively. F is unable to exercise consistently rational judgments in relation to what care and treatments are in the children’s best interests, thus placing them at the risk of significant harm. The following are examples.

(i). C had a microchip deliberately implanted in his head, which is the cause of his fits.

(ii). B has been deliberately inoculated with harmful substances.

(iii). B’s fits at school are caused by allergens and bacteria.

(iv). The dose of Keppra may be poisoning B.

(v). An obsessive belief that Lamotrigine is the cause of B’s fits.

(vi). Both children have been implanted with bacterial pathogens and silver fragments in their brain.

(vii). A refusal to submit to psychiatric assessment by professionals from the National Health Service who were ‘the opponent’ and were ‘a criminal organisation’, who fabricate information.

(viii). M has gone to India to have children since it is safer. The NHS have made the children how they are.

(ix). The other paranoid beliefs, some of which I have mentioned, including the view that his emails are being hacked.”

The father claimed, though was not able to evidence this claim, that he had a Masters degree in Zoology.

However, given one of the later findings made was :-

“viii) F made unsubstantiated claims of expertise in science, microbiology, biology, immunology and pharmacology. He seeks to take on a medical role in relation to the children, over and above that which it is reasonable for a parent to claim in such circumstances. The following are specific examples:

(i). F required various medical equipment – a blood monitoring machine – which he had no expertise to utilise.

(ii). F dresses in a white coat and has been seen examining the children with a stethoscope in hospital.

(iii). F brought intravenous bags to administer fluids without seeking advice.

(iv). The use of an Abigail pump incompatible with the current feeding regime.

(v). Administering high flow oxygen without medical advice.

(vi). Administering privately acquired nebuliser.

(vii). Administering a significant quantity of potato and tomato soup, either orally, or via a nasogastric tube, without seeking prior advice.

(viii). F’s expressed intention to return to a natural feeding regime, should the children return to his care, which is contrary to professional advice, which will place the children at risk of harm.”

One can see why hospital staff were concerned. An unsubstantiated Masters in Zoology doesn’t really equip one to be walking round in a white coat in a hospital wearing a stethascope and examining children. I’d be pretty concerned if he’d been walking round a petting zoo examining rabbits.

Given that the parents had withdrawn from the process by going back to India (it seemed very likely that this had been because mother was pregnant and wanted to have the baby overseas and not return to the UK) the Judge had very little choice but to make the Care Orders sought.

71. The court has therefore been presented with two options: a return to the parents or other family in India, or the making of a care order with a plan of long term foster care. The return to India was far from fanciful as an outcome. It is perfectly possible that, despite the findings the court has now made, that these children could go to India, could there receive suitable care and be cared for either by extended family or some institution, nevertheless maintaining the link with the birth family. The local authority says that the findings in fact do not permit a return to the parents and unless and until there is acceptance of those findings and an understanding as to how they can work with professionals in the future, that is simply not a possible outcome. Although the parents say they can access a lot of support, both from family and from professionals, there is no indication that they do not seek to care for the children themselves. Indeed, they seem to be saying that they intend to care for them. Whatever it is, in any event, it is all wholly unassessed and that is not because the local authority has not tried to assess it, but because of the parents’ conduct throughout this litigation.
72. The local authority is supported by the guardian in its entirety over the inability of a plan to place the children with the parents. Counsel for the parents frankly accept that they cannot presently advance the parents as carers, given their responses to the litigation.
73. The only other contention is long term foster care. There is, literally, no other alternative. The local authority has identified a permanent foster parent who, with the support of 24 hour professional care, can care for the children at their present home, which was for a time at any rate the home of the family, and which is adapted and fully equipped to meet the children’s needs. Their needs will be met in accordance with the care plan, if approved, that is to say medical needs, a multi-agency care team, schooling, personal education plan, as well as universal services.
74. The children’s guardian raised an issue as to whether Children and Families Across Borders should nevertheless embark upon assessment in India, as the present social worker appeared to be suggesting in her final statement, but withdrew after the discussion we had about it. Because, unless and until there is a plan, or at least a proposal of a plan, that could meet the children’s needs, it would, I am satisfied, be an academic exercise, despite, as I say the suggestion that it should be proceeded upon, in any event.
75. From the court’s point of view, nothing would give greater pleasure than to be able to reunite this family, scattered across two continents. However, the findings that the court has made, are serious and, absent them being addressed by the parents, or them preparing a care regime where safety would be ensured by others who have made themselves available and been assessed, it seems to the court that it would be completely unrealistic and disproportionate to embark upon an assessment in what would be a vacuum. If the parents seek to oppose the order actively, they can of course apply to discharge any care order made, explain their responses to the findings and offer properly supported proposals, which are capable of investigation and assessment. It seems to the court that, at the present time, they are in denial and they have not, despite on the face of it putting forward long lists of names, advanced proposals which are capable of being exposed to such a process.
76. By reference to the welfare checklist, the wishes and feelings of these children would be very difficult to ascertain. I accept they have a relationship with their father, in particular, which is of value to them. Set against that, they are well and building good relationships and thriving within their limitations. Their needs and characteristics are central to this case: they are complete, profound and life long, as well as life limiting. Any change in circumstances for them would be very hard to manage but, if all other factors were in place, no doubt could be managed. The risk of harm is, in the court’s judgment, profound. The findings go directly to the welfare question and there is simply no understanding as to why F, in particular, but M to an extent, have behaved as they have. It turns directly on their capability, which is impossible to assess, because neither has engaged meaningfully in the final analysis, so it is really very difficult to measure.
77. Looking at the range of powers available to the court, they are in truth extremely limited.
78. This is a desperately sad case, where, whatever their motives, the two children with whom I am concerned, have been effectively abandoned. I am satisfied that on an application of the welfare checklist and by reference to the Article 8 rights of parents and children, the only order that presently meets their needs, is a care order. So I approve the care plan for long term foster care. I note that the local authority will seek to facilitate regular contact, should the parents come. Should they choose not to, they will endeavour to facilitate Skype contact. Whilst it is of course for the local authority to promote contact for children who are in their care, it is also incumbent upon the parents to make themselves available and demonstrate a commitment so that any contact that takes place can be meaningful.
79. I wish both children and their carers well. I very much hope that the parents, faced with the enormity of what they have done, can and will reflect and, in time, at any rate, engage in a way that might yet give these children a chance of life within their family.

[Later edit – very sad postscript is that the health of one of the children deteriorated still further and the Hospital sought a declaration from the High Court that treatment cease   http://www.bailii.org/ew/cases/EWHC/Fam/2016/535.html    The parents represented themselves in those proceedings, and stood by their views that the children had been made unwell by the hospital and that they should be sent to India forthwith]