[UPDATE 25 May 2017: Further blog post on this case here : Judge flags complaint on behalf of child against journalist who sneaked into hospital]
We posted a short blog yesterday noting that The (Sunday) Telegraph’s Christopher Booker had reported on a case involving an intelligent but physically unwell boy approaching his 16th birthday, who had been recently taken to a psychiatric unit, against his wishes, under the auspices of The Children Act. We said that the case was both puzzling and concerning. You can read our initial blog post here and Mr Booker’s original column “A gifted child in a psychiatric unit is madness” (scroll down, premium content).
We have now located a judgment (thanks to those who flagged it for us) which appears to relate to the same child, and it sheds a wholly different light on this case. As a result, we are very concerned that the Telegraph‘s piece is seriously misleading. We can’t be 100% sure that the case is one and the same as the one reported by Mr Booker, but we have cross referenced facts and details in the judgment and the article and are confident that either this is the same family or there is a very surprising coincidence of facts between two different families (we’ve set out the common facts below at the foot of this post).
As reported by Booker, the case is inexplicable and worrying. Ignoring the wishes of a “highly gifted” child, and removing him “forcibly” into a psychiatric unit, on the basis of some technicality about his impending 16th birthday. Removing his social connections by restricting access to the internet and devices, and cutting off his contact with his family. All pretty grim and highly unusual.
Sadly, the reality is perhaps more upsetting, but not in the way that Booker describes. That story is told in the judgment of Mr Justice Hayden delivered in mid March this year, in the case of H (A Child), Re (Interim Care Order : fact finding)  EWHC 518 (Fam). Booker’s summary appears to represent steps taken subsequent to the delivery of that judgment, which are not at all inexplicable once you have read the judgment.
The judgment tells us in very clear and distressing terms that H is a young man who for many years has been exposed to the harmful behaviour of his parents, and that behaviour has jeopardised his physical and educational development and wellbeing and has put his life at risk. The judge summarises his findings :
- …I intend that this judgment should be made available to a wide range of medical practitioners presently and historically involved in H’s care. I propose that key staff at the unit should read it. I am determined that it should be placed on H’s medical records. I intend that H’s parents be distanced from any involvement in his medical care, physiotherapy or therapeutic support in order that H may be afforded the opportunity to assert his most basic of rights, his own personal autonomy.
- In order that my intentions can be effective and conscious that this is a lengthy judgment, covering a wide range of issues, my findings require to be set out clearly and accessibly. Thus:
i) The parents have misreported and exaggerated H’s medical symptoms, which has led to his physical and emotional harm;
ii) The consequence of (i) above, particularly the exaggerated gastro-intestinal pain, led to the unnecessary insertion or prolonged use of a Hickman Line which exposed H not merely to risk of short term infection but to the risk of liver failure in the longer term;
iii) M, through her bullying and bombastic behaviour has intimidated medical professionals and others, to the extent that she has confused and undermined their confidence in their own professional judgement. This generated a febrile atmosphere in which there was an elevated risk of clinical error, thus compromising H’s safety;
iv) In April 2016, both parents and on separate occasions, covertly tampered with H’s TPN pump. The effect of this was to cause confusion and alarm on the ward and jeopardise professional objectivity;
v) F has both directly supported and passively acquiesced in M’s distorted perspective of H’s medical needs;
vi) M presented H to the world as dying and inculcated in him a view that he was;
vii) The parents’ actions above led to H’s prolonged stays in hospital and denied him his opportunity for education and socialisation.
Again, in order that the point is not lost in the detail of the judgment the harm caused to H by his parents, protracted over many years, exposed him to significant harm at the most serious end of the spectrum, ultimately risking his life. [our emphasis]
What is perhaps the most striking line in the judgment is the quotation from the treating consultant (an expert in the connective tissue disorder that H suffers from who had “championed the cause” for H and his family :
- Dr Ninis told me, in powerful language, what in her view, the future medical/emotional/educational objectives should be for H:
‘[H] has been taught how to die, he now has to learn how to live’
Although the judge doesn’t use the term FII or factitious disorder (what used to be called Munchausen’s by Proxy), he describes this as case involving allegations of “misreporting, exaggeration or fabrication of the symptoms of illness“.
When one understands that this was a case of factitious or induced illness, and the judge’s remarks about the pressing need for H to be placed in a situation where he can develop the personal autonomy he has so far been denied, the reported move of H to a children’s psychiatric unit makes sense, although it is likely to have been distressing for him and his family. It can be understood as the logical implementation of the judge’s remarks at paragraph 98. It is quite possible that it was realised that the options for H were narrowing and that if H were not admitted before his 16th birthday he would be left with a more limited range of therapeutic options or less appropriate placements designed for adults, which would not meet his needs.
As Mr Booker correctly identifies, the decision to make the move for H will have been taken with his best interests in mind, albeit quite possibly against his clearly and articulately expressed wishes. The judgment tells us that H was separately represented in the proceedings, so those wishes will have been conveyed to and taken into account by the judge (assuming the move was sanctioned by the judge and not made after the conclusion of proceedings). However, the judge found that H’s relationship with his mother was “enmeshed” and he lacked personal autonomy, so those wishes may – unusually but lawfully – not have been granted. (For a discussion of circumstances in which the wishes and feelings of an articulate and intelligent teenager may have to be overridden, see the recent judgment of Mr Justice Macdonald in L v L (Child : Arrangements Following Treatment)  EWHC 1212 (Fam) (19 May 2017), which involved a 14 year old girl suffering with anorexia who wished to return to live with her mother. The judge decided she could not.).
There is, as you might imagine, a lot more detail to the judgment than we have summarised above – the court heard from or read documents prepared by a number of medical and other professionals, and was critical of one expert and some of the care provided to H since his removal into the residential unit (you can read a bit about that here) – but the thrust of the judgment is that this young man has been seriously harmed by his parents and is at risk of that continuing, if something does not change.
It is important to note that the only source of information about what has happened to H since mid March (i.e. the move to a “psychiatric unit” is Mr Booker. In view of the way in which the case has been reported, we do not think it is wise to rely too heavily upon the way in which Mr Booker describes these events or the nature of the placement and its “house rules” (although some restrictions on visitors and access to the outside world are not uncommon for a period in cases of residential psychiatric treatment). So for example, when it is said that the mother has been told she may never see her son again, that may not represent an accepted or accurate picture – it may be merely be the perspective or report of someone Mr Booker has been talking to, or his own interpretation. The Telegraph cannot have it both ways – they assert Booker’s writing is opinion when we complain that it is not accurate, as if that offers some sort of immunity; we think it is therefore legitimate to question the accuracy of material that The Telegraph concede is only “opinion” rather than fact. If it is opinion however, it is opinion couched in the language of fact – and that is the source of the problem.
Mr Booker’s account then appears to be written from the sole perspective of the family, without any acknowledgment that there is any other perspective, let alone any acknowledgment that the court has heard and read vast amounts of evidence (including that of the parents who were represented by highly experienced and specialist leading counsel), before concluding that the parental perspective was completely irrational, wrong and directly harmful to H. For Mr Booker to peddle this “opinion” in the absence of any counterbalance is shockingly irresponsible and misleading. People who read the column may have been very worried by what was going on here, and it may have made the parents of disabled children in particular very anxious. We think it highly unlikely that Mr Booker was unaware of the existence or gist of the judgment, but his failure to give readers any information about the findings made against the parents (even if just to disagree with those findings as wrong) is misleading and completely distorts the reality.
We will complain about this to The Telegraph, and pursue the matter through IPSO if necessary. We consider the article to be a significant breach of the Editors’ Code requirements in respect of accuracy through omission. We do not accept that the inclusion of this material in a piece characterised as “opinion” should excuse the Telegraph or its journalists from the basic requirements of accuracy and avoiding misleading reports. This is a misleading report because it posits H’s situation as inexplicable, unjustified and heavy handed, when it is entirely explicable and justified in the context of the harmful conduct of H’s parents – even if one does not accept the findings or agree with the steps apparently taken as a result, there is no conscionable way of describing this as the “oddest“, “most troubling” case or that what has happened is “madness” without engaging with the very obvious rationale for what has happened since March, even if one still draws the conclusion that it is a wrong thing to have happened.
It is important to note that Mr Justice Hayden has published his judgment on the basis that H may not be identified. We have been sent various information which appears to identify H, but we are unable to publish any information which in our view may risk the identification of this very vulnerable young man. We do not think that cross referencing with Mr Booker’s article runs that risk, because it contains very little factual information at all, and none of significance that is not in the judgment (although it does of course appear to describe a further step in the care planning for H since the judgment was delivered). The important feature of Mr Booker’s article is what it leaves out.
Cross referencing between Booker and Hayden judgment
|Booker (21 May 17)||Hayden J (16 Mar 17), Re H|
|A boy who is almost 16||H is male.
DoB provided, confirms H will be 16 shortly
|Children Act best interests / paramountcy principle relied upon||H is on an interim care order (in March) and had previously been a ward of court. Interim Care Orders are made under The Children Act and the best interests / paramountcy principle applies.|
|Exceptionally bright child, won a place at a school for gifted children (before a period of home education), refers to linguistic ability (Japanese / Hindi).||Judge refers to child’s “vibrancy and curiosity of intellect”, “sophisticated powers of expression” (90)
H won a place at a highly regarded public school. Real academic potential (91).
|Complex physical disabilities||Complex needs including a connective tissue disorder and orthostatic tachycardia – but “virtually every aspect of H’s childhood, education and medical treatment is the subject of different interpretations or impressions between the parties”.|
|Last year education ceased, removed from family and moved to a “respite home” (until last week i.e. mid May) – article suggests somehow required prior to 16th birthday.||In August 2016, H was moved from hospital to a residential unit (under the ICO).
Judgment confirms that a move in mid May 17 would have been a few weeks prior to H’s 16th birthday.
|Does not have any mental difficulties (refers to intellectual capacity)||“He shares parents’ profound and…entirely irrational opposition to psychological support…. H will most certainly require it in the future”. (92).|
|Parents told may never see him again||I intend that H’s parents be distanced from any involvement in his medical care, physiotherapy or therapeutic support in order that H may be afforded the opportunity to assert his most basic of rights, his own personal autonomy. (98)|
Feature Pic : Ink Stained Wretches by Jeff Eaton on Flickr (creative commons – thanks!)