Devon County Council v EB & Ors (Minors)

Factual and Procedural Background

On 5th July 2011, a female infant (referred to as E) was taken by air ambulance to The Hospital in The City after collapsing at home. She was discharged the following day but was readmitted a few days later when investigations revealed subdural haemorrhages and bone fractures. Her twin brother (referred to as J) was also admitted and found to have similar injuries including subdural haemorrhages and rib fractures. The medical staff suspected non-accidental injury and notified social workers and the police. The Local Authority initiated care proceedings.

Over the next 19 months, the twins and their parents resided at the home of the maternal grandparents. On 22nd February 2013, the court dismissed the Local Authority’s application for care orders concerning the twins and their younger brother, T. This judgment sets out the reasons for that decision.

The parents have complex medical histories, with the mother diagnosed with Ehlers-Danlos Syndrome (EDS) type 3 and the father suffering from joint hypermobility and other health issues. The twins were conceived via IVF and were born prematurely by Caesarean section on 21st February 2011.

Following birth, the twins were regularly monitored by a health visitor and medical professionals due to feeding difficulties and other health concerns, particularly with E. Both children eventually exhibited multiple injuries, including fractures and intracranial bleeding, leading to investigations and care proceedings.

The Local Authority also commenced proceedings concerning the younger brother, T, after he sustained skull fractures and subdural haemorrhage following a witnessed low-level fall. Interim care orders were not granted at that time, and the case was managed alongside the twins’ proceedings.

Extensive expert evidence was gathered, including genetic, radiological, neurological, and paediatric opinions, to explore the cause of the injuries and the possibility of non-accidental injury versus medical explanations related to familial connective tissue disorders.

Legal Issues Presented

1. Whether the significant harm suffered by the twins, in the form of bone fractures and intracranial bleeding, was attributable to care that was less than what a reasonable parent would provide, i.e., whether the injuries were inflicted non-accidentally by one or both parents.
2. If the injuries were non-accidental, the identification of the perpetrator responsible for inflicting those injuries.

Arguments of the Parties

Local Authority's Arguments

• The injuries sustained by the twins were non-accidental and likely caused by one or other parent in moments of loss of control rather than deliberate cruelty.
• Stress factors in the early months of the twins’ lives, including new parenthood, health difficulties of both parents, and feeding issues, contributed to the risk of injury.
• Extensive medical testing ruled out common and uncommon diseases or disorders that could explain the injuries.
• The fractures and subdural haemorrhages are strongly indicative of non-accidental injury, given their nature and timing.
• The subdural haemorrhages and fractures should be considered together, reinforcing the conclusion of non-accidental injury.
• The timing of some rib fractures in J suggested possible injury inflicted while in the father’s sole care, although the father’s prompt medical response was noted.

Parents' Arguments

• Both parents are loving and devoted carers who have provided appropriate care and nurturing.
• The twins’ medical conditions, including EDS type 3 and joint hypermobility, along with familial history, may predispose them to fragility, including fractures and bleeding.
• The injuries could be explained by medical conditions, birth-related subdural haemorrhages, or accidental causes, including hospital-related injuries.
• The younger brother’s skull fracture from a low-level fall supports the possibility of familial susceptibility to fractures.
• Some injuries may have occurred after the children were under supervision, including possible hospital-related injuries.
• The absence of bruising or discomfort despite multiple fractures is unusual and suggests an alternative explanation to abuse.
• The Local Authority’s theory of shaking on 5th July does not fit with the evidence of the family’s improved circumstances and the children’s condition at that time.
• Frequent professional contact with the children failed to detect any signs of injury over a prolonged period.
• The possibility of unknown causes or medical explanations should be seriously considered given the complexity of the case.

Table of Precedents Cited

Court's Reasoning and Analysis

The court undertook a detailed and multidisciplinary analysis of the medical, genetic, and contextual evidence. It acknowledged that both children sustained significant injuries, including multiple fractures and intracranial bleeding, which prima facie suggested non-accidental injury. However, the court considered the extensive expert evidence indicating the presence of familial connective tissue disorders (EDS type 3 in the mother and joint hypermobility in the father), which could predispose the children to fragility and bleeding.

The court noted the unusual absence of external signs such as bruising or pain despite multiple fractures, which was highly significant and suggested the possibility of injury from forces insufficient to cause external marks. It also took into account the possibility that some subdural haemorrhages could date back to birth, consistent with recent research showing birth-related subdural bleeding is more common than previously understood.

The court carefully evaluated the credibility and reliability of the parents, finding them honest and devoted carers, and rejected the Local Authority’s assertion that the father’s evidence was unimpressive. The court also considered the parents’ explanations for the injuries, including the possibility that some injuries occurred in hospital or were related to medical procedures.

While accepting that the injuries were serious and unexplained by accidental causes, the court found that the Local Authority had not proven on the balance of probabilities that the injuries were inflicted non-accidentally by the parents. The possibility of unknown or complex medical causes, familial susceptibility, and the lack of direct evidence of abuse led the court to conclude that the threshold for care orders was not crossed.

The court emphasized the importance of a thorough forensic investigation, the involvement of multiple expert disciplines, and judicial continuity in managing complex cases. It also highlighted the significant contribution of specialist family lawyers in ensuring justice.

Holding and Implications

The court’s final decision was to DISMISS the Local Authority’s application for care orders in respect of the twins and their younger brother.

This decision means that the children will remain in the care of their parents and maternal grandparents under existing arrangements. The court found that the Local Authority had not met the burden of proving non-accidental injury caused by the parents on the balance of probabilities, and therefore the statutory threshold for care orders under section 31(2) of the Children Act 1989 was not satisfied.

No new legal precedent was established by this decision; rather, it underscores the necessity of comprehensive expert evidence and careful judicial consideration in cases involving complex medical and familial factors in suspected child abuse proceedings.