A Local Authority v Mother & Ors

In fact-finding proceedings, the local authority bears the burden of proving each allegation on the balance of probabilities. The court must assess the evidence in the round and may conclude that the evidence is insufficient, rather than choosing between competing explanations. Findings must rest on evidence, not suspicion or speculation.

Expert evidence remains a matter for evaluation by the court. A separate pharmacological expert is not essential where the existing expert evidence adequately addresses causation. In an alleged fabricated or induced illness case, labels must not replace precise factual findings. The court may find responsibility and knowledge on the totality of the evidence even where it cannot attribute every episode with precision.

The local authority brought care proceedings concerning two children. The principal allegation was that the mother and father had administered excessive doses of Chloral Hydrate to Lucy, a seriously disabled child, during a prolonged hospital admission, causing episodes of unresponsiveness. Further allegations concerned the father's conduct towards Lucy and his possession of child sexual abuse material.

The court considered extensive medical, nursing, toxicological and factual evidence. The parents disputed the allegations and relied, among other matters, on Lucy's underlying conditions, polypharmacy, possible medication interactions, weaknesses in the hospital's oversight and the absence of a pharmacological expert. The central issues were causation, the parents' involvement and knowledge, and whether the evidence justified findings against either or both parents.

1. Applicable approach. The local authority bore the burden of proof throughout and had to establish the allegations on the balance of probabilities. The court was not required to choose between the local authority's case and an alternative explanation. It could conclude that the evidence left the allegation unproved. Evidence had to be assessed in the context of the totality of the evidence, with appropriate caution concerning lies, memory and expert opinion.
2. Medical evidence and causation. The court accepted that the episodes were not characteristic of epilepsy. It rejected the suggestion that there was a material evidential lacuna because no pharmacologist had been instructed. Dr Morrell was an experienced single joint expert, the issue fell within his expertise, three episodes had been examined in detail, and no pattern linked the episodes to the prescribed medication combination. The possibility of re-sedation was unsupported speculation.
3. Factual findings. The timing of the episodes, their occurrence when a parent was present, their absence during one-to-one nursing and after the parents' removal, the parents' possession and stockpiling of Chloral, the bottle found in the father's bag, relevant messages and the parents' lies cumulatively established that the father administered excessive Chloral. The mother knew on occasions that this was happening and, when present, either administered it herself or knew of the father's conduct.
4. The court found that the mother did not intend to harm Lucy but believed that additional Chloral was beneficial and that she was better placed than hospital staff to judge Lucy's needs. It was impossible to define more closely the responsibility and knowledge relating to each individual episode. The allegations concerning Ramipril were withdrawn and were not determined.