When the Department of Children and Families sought emergency custody last year of a 7-year-old girl whom doctors suspected had been poisoned by her parents, it didn't have to start a new file on the couple.
The department had been aware of Christopher and Julie Conley for at least six years, going back to 2009, when the girl was a toddler suffering from what a prosecutor has called unexplained medical issues.
The department's counsel was able to convince a juvenile court judge at that time that there was reasonable proof that the Conleys had harmed their daughter through medical child abuse, also known as Munchausen by proxy.
The child was removed from their care and according to court filings by Assistant Northwestern District Attorney Linda Pisano, "every single medical condition went away" during that time.
Still, the child was returned to her parents in 2011. Pisano said her medical issues came back sometime later, after DCF ceased to monitor the girl and closed the case.
The indictments grand juries returned against the parents charge them with abusing the girl going back to July 27, 2013.
On April 15, 2015, according to prosecutors, either one or both of her parents poured a caustic substance into her cecostomy tube, a medical tube used to flush her intestines. She became critically ill and lost two-thirds of her bowel and part of her bladder. Christopher Conley confessed to the crime but later recanted.
So why was the girl returned to her parents after DCF had determined she was more likely than not medically abused?
The decision was made by a juvenile court judge who heard arguments from both sides, including from DCF officials who opposed letting the girl go home…
An expert in Munchausen by proxy said that a judge's decision to return a child to their parents who medically abused them flies in the face of what research shows: people who medically abuse their children once will do it again.
"The risk of reabuse in confirmed Munchausen by proxy cases is very high," said Marc Feldman, a clinical professor of psychiatry at the University of Alabama who has studied Munchausen by proxy cases for 25 years…
The girl, now 8, has been living with a foster family since being discharged from the hospital.
In the case of Christopher and Julie Conley of Northampton, there is a fairly strong piece of evidence of medical abuse by at least one of the parents in that their daughter was seriously injured with a caustic substance April 15, 2015.
But her parents for years before that maintained that she has mitochondrial disease, the same disease with which Pelletier was diagnosed. Court records have not clarified whether the Conley's daughter was officially diagnosed with it.
Like Pelletier's case, doctors at Boston Children's Hospital first raised the question of medical abuse, but court documents do not indicate that they filed a report with DCF. The Conleys moved their daughter to Tufts Medical Center, where doctors suspected abuse and filed a report.
Christopher Conley confessed to pouring Liquid-Plumr into his daughter's intestinal tube, although he later recanted. His wife has maintained her innocence, but she was also charged with similar crimes more than five months later.
A Department of Children and Families official said in court that Christopher Conley's time sheets at work have made investigators wonder if he could have been home when he was alleged to have poisoned his daughter, which points to his wife.
But another thing mentioned in court documents about Julie Conley's role in the suspected medical abuse is her level of involvement in her daughter's medical care. She was described as the primary care giver for her daughter, very knowledgeable and interested in her daughter's care, present at all her appointments and the one who makes medical decisions for the child.
The prosecutor in the case said medical staff indicated that both parents "either did not mention previous medical treatment and/or testing done and misrepresented, minimized or exaggerated medical testing or results."
But Feldman said that he was "wary of condemning the mother" based on behavior in a hospital.
Sometimes mothers accused of Munchausen by proxy are pushy or argumentative, Feldman said, which can strain doctors' relationships with them. He said that while a person who disagrees with doctors and insists the child has a different or undiagnosed condition may be more likely to be medically abusing the child, "it's not proof."
And while doctors have said a caustic substance is the only explanation of the Conley girl's injuries last year, there is at least some possibility that the girl had medical problems she was born with. Christopher Conley told police he was attempting to kill his daughter because she was suffering — it's still criminal, but it's not an intention typically seen in Munchausen by proxy cases.
In court Allen has said that the girl's parents believe she has mitochondrial disease, severe hypoglycemia, seizures, and other issues.
A charitable foundation that provides free family photos for children with serious illnesses posted an online album of photos of the Conleys Sept. 25, 2014. It named mitochondrial disease and other illnesses and also said that the girl was born with a duplication of her 22nd chromosome.