A Local Authority v A Mother & Ors

In care proceedings, the local authority bears the burden of proving the alleged facts on the balance of probabilities. The court must not base findings on suspicion or concern alone. Where the medical cause of an episode remains uncertain, the court must recognise that uncertainty and avoid treating present medical opinion as infallible. The court may nevertheless make findings on the totality of the evidence, including witness reliability, contemporaneous records and the child’s subsequent condition. A genuine medical condition does not prevent the court from finding that inappropriate parental management caused significant harm where the evidence establishes that conclusion.

A local authority sought care orders for two children. The older child had asthma and a lengthy history of reported desaturations and apparent life-threatening events, accompanied by extensive and increasingly intensive medical treatment. After removal from the parents, her asthma became controlled with ordinary medication and the reported episodes largely ceased.

The parents accepted that the older child had suffered significant harm and did not challenge the threshold case concerning the younger child. The central factual issues were the cause of the reported episodes and the reason for the older child’s previously uncontrolled asthma.

1. Burden and standard of proof. The local authority had to prove its case. The applicable standard was the balance of probabilities. Findings could not be based on suspicion or concern, and facts not proved could not be used as the foundation for future decisions.
2. Medical uncertainty. The court applied the guidance in Re U and Re B (Serious Injury: Standard of Proof) [2004] EWCA Civ 567, [2004] 2 FLR 263. An unexplained medical episode remained equivocal, and current medical certainty could later be revised. That caution was particularly relevant to the alleged nocturnal desaturations and apparent life-threatening events.
3. Findings on the episodes. The judge found that the most probable explanation was asthma exacerbations which became uncontrolled through the parents’ management, with the mother’s increasingly hysterical response communicating fear to the child. The evidence did not establish that the child had suffered a true apparent life-threatening event or respiratory arrest involving unconsciousness. The absence of comparable episodes in hospital, at school or in other carers’ care was significant, but was not treated as conclusive in isolation.
4. Medication and harm. The court accepted the unanimous medical evidence that the child was not receiving Seretide effectively and found that she was probably receiving considerably less Prednisolone than prescribed. The parents’ accounts were rejected as unreliable. Their failure to administer basic medication caused significant physical and emotional harm, with possible longer-term psychological harm.
5. The threshold was therefore crossed in relation to both children. The judgment proceeded to welfare assessment, including the risk that the older child might resume the role of a sick child if returned to her parents and the need for a significant and dependable change in their approach.