KB, DOHS and CR & KR 2008 VChC 5

A single mother of infant twins aged about 4 months observed lesions on the faces of the twins and she took the children to a doctor.  The lesions did not heal while the children were in the care of the mother for a period over 6 months.  The children were admitted to hospital on three occasions.  A protection order was obtained as there was no medical explanation for the failure of the wounds to heal, and there was concern that the mother may have contributed to inflicting the lesions, which she denied.

On discharge the children were placed in out-of-home care for a period of 16 months.   The boys remained in foster care for 16 months and had supervised visits by the mother for 4 days per week.  The mother applied to have the children returned to her care.  The department applied for a long term placement.

The boys were discharged into the care of a hospital-at-home service and the staff of this service reported that the mother was not as cooperative with them or as proactive in caring for the wounds as they expected.

A question was raised of whether the mother had intentionally contributed to the lesions, and whether she had a condition of Munchausen’s by proxy, a condition whose symptoms are persistent presentation of a child for medical care, where the parent is preoccupied with a child’s health condition (health preoccupation) that is motivated by a desire to seek help for the parent rather than for the child.   Munchausen’s by Proxy was defined as a syndrome in which a parent persistently fabricates or induces illness in a child with the intent of remaining in contact with hospitals and physicians.  The parent poses as being a good parent by ‘saving’ the child from medical catastrophe, and the child serves as an object of manipulation.

The judge found that the mother did not excessively take the children to health services, but instead missed some appointments.  The judge found that the mother’s behaviour deviated from that commonly reported for the Munchausen’s syndrome, as the mother did not consistently remain in contact with doctors but she missed some appointments.  The judge found that the sores healed more quickly in hospital than when the boys were in the care of the mother.  However the judge did not find that the mother had caused or aggravated the sores.  The judge did not find that the mother had intentionally harmed the children, and did not find a likelihood of future harm (assess unacceptable risk).

The judge found there was inconsistent evidence about the rate of healing of the sores while the boys were in hospital and in the mother’s care.  Foster carers reported that the sores continued to flare up for 9 months after discharge from hospital, but were not as serious.

The judge ordered that the children be reunited with the mother in an reunification plan that was based on staged reunification (graduated approach).

The proposal for permanent care was not granted.