Luke Clements

A ‘sitting duck’ for allegations of fabricated or induced illness (FII)

The Sunday Times in its investigation into wrongful allegations of FII, carried a further harrowing story on 10 August 2025.  It concerns Maeve Boothby O’Neill who died in 2021 (aged 27) “because of severe myalgic encephalomyelitis (ME)”.  As a result of the evidence that emerged at her inquest, the coroner published a Prevention of Future Deaths Report[1] which recorded (among other things) that:

• there were no specialist hospitals or hospices, beds, wards or other health care provision in England for patients such as Maeve with severe ME.
• there was extremely limited training for doctors on how to treat severe ME.

What Maeve’s mother (a former social worker) did not know, however, is that as she was begging ‘for help for her daughter’  … ‘The people she was turning to were holding secret safeguarding meetings’ due to suggestions that she was causing or fabricating Maeve’s illness and that in consequence Maeve should be ‘forcibly removed’.

The full story (by the journalist Emily Dugan) under the headline of ‘As my daughter died of ME the state met in secret to blame me’ can be accessed by clicking here – but only if you have a Times subscription.[2]

The story describes how the more Meave’s mother sought to protect her (for example from unannounced social work visits) the more this was interpreted as ‘coercive control’ and fed the belief that this was a case of FII.  The article cites Dr Nigel Speight, a medical adviser to the ME Association as saying that until there is a diagnosis for ME, patients are ‘a sitting duck’ for allegations of FII because ‘the guidelines on FII will raise suspicions in nearly every case of undiagnosed ME’.

Emily Dugan’s Sunday Times investigation coincided with the publication of an Independent investigation report following the ‘tragic death of Yusuf Nazir in November 2022’.[3]   Yusuf (aged five) died of pneumonia and sepsis at Sheffield children’s hospital.  As the Independent report states:

Our primary finding is that the parental concerns, particularly the mother’s instinct that her child was unwell, were repeatedly not addressed across services.  … . This led to a lack of shared decision-making and there was limited evidence of collaborative discussions with Yusuf’s family around clinical decisions, leading to a sense of exclusion and reduced trust in care plans.  Yusuf had 23 separate healthcare contacts, across four organisations with no single, coordinated record or oversight, contributing to fragmented and disjointed care.  Many of the healthcare professionals acted primarily in triage roles which diminished parental voices.

 

There is a great deal in the report that warrants reading, and some of these extracts are listed separately below.

Yusuf’s mother Soniya Ahmed was not accused of FII, but many of her desperate actions could have been interpreted as alerting signs to possible FII.  At para 4.4.2 of the Royal College of Paediatrics and Child Health guidance ‘Perplexing Presentations (PP) / Fabricated or induced illness by carers: A practical guide for paediatricians’ (2021) it advises that alerting signs include:

• Parents’ insistence on continued investigations instead of focusing on symptom alleviation when reported symptoms and signs not explained by any known medical condition in the child
• Parents’ insistence on continued investigations instead of focusing on symptom alleviation when results of examination and investigations have already not explained the reported symptoms or signs
• Repeated reporting of new symptoms
• Repeated presentations to and attendance at medical settings including Emergency Departments
• Inappropriately seeking multiple medical opinions
• Not able to accept reassurance or recommended management, and insistence on more, clinically unwarranted, investigations, referrals, continuation of, or new treatments (sometimes based on internet searches)

 

The Guardian in its coverage of the Independent report int Yusuf ‘s death, highlighted the similarities between his mother’s concerns being downplayed by the hospital staff and those of Merope Mills when she was told (for example) ‘not to look things up on the internet’ and that her daughter Martha was not going to die and that “I should pull myself together”.

 

Extracts from the Independent investigation report following the ‘tragic death of Yusuf Nazir

• Unheard Parental Voice Across Multiple Healthcare Encounters
• Failure to Acknowledge Parental Concerns Yusuf’s care highlights how the family’s instinctive observations expressed repeatedly to healthcare providers across multiple settings went unheard or were downplayed and considers the consequences of this communication failure. Evidence from research and national standards demonstrates that early caregiver concern (often termed maternal instinct) can be a valid predictor of serious illness, and that healthcare systems overly focused on measurable symptoms may miss subtle signs apparent to family members.
• The child’s mother sought help at every stage, her General Practitioner, an ambulance crew, Emergency Departments, and the paediatric ward, yet her observations were often minimised.
• However, the family’s intuition was that “something isn’t right” and this was not present in the documented history, contributing to a false sense of reassurance as the case progressed.
• When Yusuf’s condition worsened at home, the mother again voiced panic. In a WhatsApp message to a family member, she wrote: “He keeps doing this every 5 mins?’ Page 115 of 139 This raw statement shows her fear that Yusuf was repeatedly having difficulty breathing. Although, as clinicians, we do not have access to her social media as part of our decision making, this reflects that fears were not adequately acknowledged by professionals.
• On arrival at the Emergency Department (TRFT), the pattern continued. The mother’s persistent concerns especially about her son’s breathing and profound lethargy were not fully addressed. Multiple interactions
• the family’s experience was one of being devalued and not taken seriously by professionals 
• There appears to be a “system-wide” tendency to invalidate symptoms that are genuinely concerning to a parent … Regardless of the underlying need for treatment this leads to caregiver feeling, or actually, being labelled as over-anxious.
• This communication dichotomy leads to mistrust, even for conditions which are self-limiting and don’t need further escalation.
• In desperation, the family step into advocacy roles even phoning the paediatric ward directly, begging to bypass the ED   This led to further barriers, … the loss of trust in the hospital
• family remain convinced Yusuf was gravely ill, but again their views were downplayed.
• The family were compelled to advocate repeatedly, only to be reassured without effective communication. It is clear that across all settings – primary care, pre-hospital, emergency, and inpatient – the healthcare system failed to truly hear the family’s voice.
• Evidence for Maternal Instinct and Early Caregiver Concern The mother’s relentless worry was not mere anxiety, substantial evidence indicates that parental intuition can be an early and accurate indicator of serious deterioration. Research has long observed that parents are often the first to notice the subtle signs of a child’s decline.
• In other words, when a parent was deeply concerned that “something is wrong,” they are often correct.
• [This underscores] … that maternal (or caregiver) instinct is a valuable red-flag symptom in its own right. Leading healthcare guidelines formally recognise the importance of caregiver concern. The National Institute for Health and Care Excellence (NICE), in its guidelines for evaluating acutely ill children, advises clinicians to “pay particular attention to concerns expressed by parents, families or carers” about unusual changes in a child’s behaviour or condition.
• This case highlights a misalignment between clinical assessment systems and the nuanced, non-verbal cues of serious illness that caregivers often observe. Modern clinical practice relies heavily on standardised tools – tools are invaluable for flagging obvious physiological changes, but they can fall short when a child’s decline manifests in less quantifiable ways and appear that our processes over-ride parental concerns.
• The system is not designed to capture “something feels very wrong” as an input, and thus a gap opens between family and clinicians. In paediatric practice, it is increasingly recognised that relying solely on quantitative metrics can lead to false reassurance.
• A child might still have “normal” observations while mounting a serious internal struggle, compensating such as maintaining blood pressure until crashing. The misalignment meant that while the family were escalating their concerns, the healthcare team were not escalating care, and a fundamental disconnect between the family’s alarm signal and the system’s trigger threshold.
• Throughout the illness, there was a stark disconnect between the family’s perception of severity and the clinical narrative of Yusuf. The family believe Yusuf was “always severely unwell” from the very beginning of symptoms, whereas clinicians documented a more gradual deterioration, a child who was ill but with a minor self-limiting condition, … .  The caregivers’ continuous alarm was viewed with a degree of scepticism until objective evidence “caught up” (e.g. a collapse in vital signs or lab results confirming organ dysfunction).
• the mother’s reports of important symptoms and her level of worry were either omitted or downplayed in notes from multiple services. All records failed to include the mother’s descriptions of her son’s abnormal breathing patterns … . Nursing and medical notes include the child’s observable clinical data (temperature, heart rate, throat examination findings, etc.) but omit statements like the mother’s concern that “he can’t sleep for a minute… I feel like something is very wrong.” Documentation is an acknowledgement of the caregiver’s voice; excluding it sends a subtle message that those details were not considered important.
• The experience of having concerns dismissed had a profound emotional and psychological impact on the family of Yusuf. From the early stages of the child’s illness, they were worried for Yusuf while feeling unheard by those who were supposed to help. Her WhatsApp messages portray a parent who is exhausted and fearful. “I have zero energy, I am sooo drained out,” she wrote “He can’t sleep for a min even daytime… I feel like I’m gonna drop.” This candid message illustrates the physical exhaustion and anxiety endured as Yusuf remained ill without improvement. She describes holding her son upright all night so he could breathe and sleep, to the point of utter fatigue. Yet, despite her desperation, when she sought help, she often felt dismissed or even judged as overly anxious.
• The family did everything in their power: At each stage the organisation responded according to protocol and would be considered as being correct in their management. Such experiences can leave families with deep emotions: guilt (wondering if they should have done even more or pushed harder), loss of trust in healthcare, and psychological trauma from feeling unheard during a crisis.

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[1] Deborah Archer, assistant coroner for Devon, Plymouth and Torbay. Regulation 28 Report to Prevent Future Deaths: Maeve Boothby O’Neill 8 October 2024 at https://www.judiciary.uk/prevention-of-future-death-reports/maeve-boothby-oneill-prevention-of-future-deaths-report/

[2] At https://www.thetimes.com/uk/healthcare/article/as-my-daughter-died-of-me-the-state-met-in-secret-to-blame-me-tm9g86hmv.  It is possible to subscribe for 3 months for £1 and before the expiry period to unsubscribe.  The paper copy of the article appears under the headline ‘As Maeve lay dying in pain, they were pointing the finger at me’.  Postings concerning two earlier articles by Emily Dugan of the Sunday Times, can be accessed at https://www.lukeclements.co.uk/fabricated-or-induced-illness-fii-further-investigations/  and at https://www.lukeclements.co.uk/sunday-times-fii-investigation/.

[3] P Carter Independent Patient Safety Investigation (IPSI) Report Of Yusuf Mahmud Nazir (31 July 2025) at https://www.therotherhamft.nhs.uk/sites/default/files/2025-07/YN%20IPSI%20%20Report%2020250730.pdf

Posted 19 August 2025