Medway Council v Mother & Ors

In care proceedings involving disputed medical causation, the local authority bears the burden of proving the alleged harm on the balance of probabilities. The court must assess the whole evidential picture, including expert evidence, and must not treat the absence of an identified alternative cause as proof of abusive injury. Unknown medical aetiology is a relevant factor in deciding whether the alleged cause has been established. Where the evidence remains equivocal, the allegation is not proved. An application to withdraw care proceedings concerning a child’s upbringing engages the child’s welfare and the statutory principle that delay is likely to prejudice welfare.

Medway Council issued care proceedings after an infant was admitted to hospital with chronic subdural haematomas and retinal haemorrhages. The central issues were the causation and timing of those injuries, including the possible significance of birth-related bleeding, benign enlargement of the subarachnoid spaces, anaemia and other medical explanations.

During the hearing, the local authority concluded that it could not prove that either parent had shaken the child or that the injuries were caused by a non-accidental event. It applied for permission to withdraw the proceedings under rule 29.4(4) of the Family Proceedings Rules 2010.

1. The local authority was granted permission to withdraw the care proceedings. The court had to determine whether withdrawal would promote or conflict with the child’s welfare and whether there was a solid advantage to the child in continuing the proceedings.

2. The burden of proof rested on the local authority, and the standard was the balance of probabilities. The court’s findings had to be based on evidence and properly drawn inferences, rather than speculation or suspicion. If the evidence remained equivocal, the local authority failed to establish the allegation.

3. The medical evidence had to be assessed on a wide canvas. The court had to consider each item in the context of the whole evidence. The roles of the court and experts remained distinct: experts provided opinion evidence, but the judge weighed that evidence with the other evidence and made the final decision.

4. The court had to resist the temptation to infer non-accidental injury merely because no other understood mechanism had been identified. Whether the cause was unknown was a factor relevant to deciding whether the alleged causation had been proved. An unknown aetiology did not alter the burden or standard of proof.

5. The uncertainties were substantial. It was unknown whether benign enlargement of the subarachnoid spaces pre-dated the subdural collections; the early ultrasound could not exclude acute subdural bleeding; the possibility of birth-related bleeding developing into chronic collections could not be resolved; the retinal haemorrhages had unusual features; and the effect of anaemia was unclear.

6. Considering the medical evidence together with the parents’ consistent accounts, cooperation and conduct, the court was left with several possibilities but no consistent evidential thread establishing, more likely than not, that the injuries were caused by shaking by either parent. The local authority was therefore correct to seek withdrawal. The parties had agreed a rehabilitation plan for the child’s return to her parents’ care.