SITTING AT LIVERPOOL
B e f o r e :
____________________
Cheshire East Borough Council |
Applicant |
|
- and - |
||
NA -and- LN -and- PN -and- DA -and- HA |
First Respondent Second Respondent Third Respondent First Intervener Second Intervener |
____________________
Ms Fiona Holloran (instructed by Otten Penna) for the First Respondent
Ms Sara Lewis (instructed by Platt Halpern) for the Second Respondent
Ms Ruth Scarisbrick (of Bell, Lamb & Joynson solicitors) for the Third Respondent
Ms Leonie Caplan for the First Intervener
The Second Intervener appeared in person
Hearing dates: 5, 6, 7, 8, 9, 12, 13, 14, 15 and 20 December 2016
____________________
Crown Copyright ©
Mr Justice MacDonald:
INTRODUCTION
THE BACKGROUND AND THE LAY EVIDENCE
The Parents
i) On 29 September 2006 the police were called after it was alleged that the mother had assaulted her sister, HA. The mother was recorded to be intoxicated with alcohol. The maternal family were recorded as being "at the end of their tether" and wished for the mother to leave the family home.ii) On 27 August 2006 the mother called the Police and alleged she had been attacked with a baseball bat by her brother. The officer recorded the following in respect of this allegation: "I have spoken to NA who was clearly intoxicated and admitted that she had been drinking. NA explained that she is currently suffering from mental issues and needs medication. Therefore even the slightest argument upsets her. NA also explained that no assault took place either with fists or a bat by her brother and she used this excuse to get police response quicker." In her oral evidence to this court the mother confirmed that she had fabricated the allegation against her brother.
iii) On 1 October 2006 HA called the police to report that the mother had come home drunk and stated that the mother calls the police and tells lies. The record states that "Speaking to all parties concerned it is obvious that NA fabricates these allegations in an effort to persuade police to arrest various members of her family in a 'tit-for-tat' way." In her oral evidence the mother the mother conceded that she had lied in order to make the Police attend. In their oral evidence both DA and HA conceded that the mother was capable of telling lies.
iv) On 3 October 2006 a mental health referral was made in respect of the mother after she presented at the Emergency Department. She was diagnosed with a manic-depressive episode and was seen by a psychiatrist.
v) On 11 October 2006 the mother called the Police whilst drunk following an argument with DA. The mother stated she rang 999 because she needed someone to talk to.
vi) On 21 January 2010 the Police were called to an incident between the mother and her then boyfriend. The boyfriend alleged that the mother had begun punching herself and saying that she would tell the Police that he did it. The boyfriend filmed the mother punching herself. When the Police arrived the mother claimed that her boyfriend had assaulted her. When however, she was shown the film she admitted she had punched herself. The mother had drunk a bottle of wine and two cans of lager. In oral evidence the mother conceded that on this occasion she had been trying to manipulate the legal process by telling lies to the Police and that she had made a false allegation in attempt to get her partner into trouble.
vii) On 7 October 2011 the Police were called by the mother during an argument with her ex-boyfriend. The Police recorded that during the altercation the ex-boyfriend had been stabbed in the foot and the mother had had one of her lower teeth knocked out by a kick to the face. There was blood and alcohol on the kitchen floor. Both were arrested. In her oral evidence the mother admitted that she stabbed her boyfriend but did not accept she had perpetrated violence by doing so, stating that "I thought I was completely in my rights to do that".
viii) On 5 November 2012 the Police were called by MA's father alleging that the mother had contacted him by text threatening "reprisals" and that she had turned up at his place of work. When the Police attended MA's father alleged that the mother had stated she had had enough of MA and asked the father of MA to take him, saying she had even had thoughts of killing him. It is not clear that the Police spoke to the mother about these allegations.
ix) On 10 November 2012, the Police were called due to allegations by the father of MA that the mother was being aggressive on an occasion when she was due to have contact with MA supervised by DA and HA. The mother was alleged to be aggressive to all parties.
"I spoke to [the father's previous partner] at length outside the flat. She did not confirm any assaults but did state that she had been the aggressor by throwing cups around and smashing them which was in front of the children. She did this as she is fed up with LN acting like everything is OK even though this is not the case. LN had removed her from the flat as she was upsetting the children and he worried for their safety. [She] was worked up but did calm down and went to her mum's house with the children".
21 February to 6 May 2016
6 May to 16 May 2016
"When my husband came to pick me up from work tonight he was covered in blood, as my son LN had punched him in the face through the car window numerous times! LN had rowed and been fighting with NA in her house and social and Police had asked him to leave, so he'd got himself to a very angry state and took it out on my husband when he asked him to get away off our drive".
16 May to 23 May 2016
"[The social worker] had assessed that LN was fit to look after PN and gave LN parental responsibility. I did express my concerns to [the social worker] regarding his winding technique and that he can't even look after himself but at this time NA wanted me just to agree with them to get them off her and LN's back so I did not say much. NA did not want [the social worker] to know about the beatings she receives of LN".
As I have already noted, during her oral evidence, HA conceded that she had also not told the social worker about the mother being intoxicated whilst caring for PN on 4 March 2016. When that incident and the foregoing passage from her statement was put to her, HA replied "I did not give the full story because NA wouldn't let me".
24 May to 27 May 2016
27 May to 11 July 2016
"PN is not to be left alone with NA until a risk assessment has been completed.
HA and DA to reside in respective home addresses.
"HA and DA must phone police immediately if NA wants to take PN out on her own."
PN's Diagnosis
"Unexplained bi-lateral subdural haematomas. The overall appearance is likely to represent acute bleeds into pre-existing sub-durals, rather than a single event causing acute bleeds with CSF mixing. The appearance is concerning for non-accidental head injury with no history of head trauma provided and the known background of domestic violence/ safeguarding issue."
A further CT scan was undertaken at 20:34 hours on 11 July 2016. In relation to that scan, Dr T recorded that "there is an increase amount of hyperdense acute blood in the right subdural indicating further acute bleed since the last CT."
"PN has multi location subdural haemorrhage with some associated sub-arachnoid bleeding. In the absence of an identified bleeding or metabolic disorder this is highly concerning for an inflicted traumatic injury. In addition, there is a possible right temporal lobe contusional injury which again be in keeping with a traumatic aetiology, although follow up imaging would be necessary for confirmation of this and better assessment of any brain injuries. The imaging, both CT and MRI, cannot determine if there has been more than one episode of bleeding. There is evidence of neo-membrane formation implying that it is likely that the subdural haemorrhages have been present for more than two weeks. In the presence of established haemorrhage repeat bleeding can occur with little or no recognised trauma, hence the presence of some minor amounts of bleeding on the CT scans do not assist in dating the primary traumatic insult. This would need to be determined clinically in this case if possible. Repeat imaging in three months is advised to include MR of the brain.
Explanation: The brain scans show subdural haemorrhage in multiple locations on both sides of the brain. The blood is causing compression of the brain. There is also sub-arachnoid blood. This is bleeding between the lining of the brain and the brain itself. There may be an injury to the right side of the brain itself (contusional injury in the right temporal lobe). This is not certain. There is membrane formation seen within the subdural haemorrhage. Membrane formation occurs within subdural haemorrhage after approximately 2 weeks suggesting that the subdural haemorrhage is at least 2 weeks old."
Relevant Subsequent Events
THE MEDICAL EVIDENCE
Dr Mittal
Dr Keenan
Dr Newman
Dr Stoodley
i) A large loculated (meaning membrane formation has occurred) subdural fluid collection over the right hemisphere of PN's brain. This subdural collection is seen to be causing considerable mass effect with sulcal effacement, effacement of the right lateral ventricle and the basal cisterns, with midline shift to the left.ii) A low attenuation subdural collection over the frontal and lateral aspects of the left frontal region of PN's brain. The left hemisphere that appears atrophic with enlarged lateral ventricles and sulcal spaces.
iii) Scattered, high attenuation (brighter) components seen superiorly in the right front region of PN's brain with a smaller, lower attenuation component inferior to the right frontal convexity of PN's brain.
iv) A few small foci of subarachnoid haemorrhage (bleeding between the lining of the brain and the brain itself) over the superior aspects of the cerebral hemispheres.
v) Areas of haemorrhagic diffuse axonal injury in the lateral right temporal lobe and in the posterior left temporal and parietal lobes.
vi) A generalised reduction in white matter volume in both hemispheres of PN's brain, worse on the left.
vii) A degree of sutural widening consistent with a degree of raised intracranial pressure and / or volume
Mr Richards
"Well it's not the re-bleed that Dr Stoodley is hanging the idea that there is another more recent episode of trauma on. There's the possible contusion, the bruising or the diffuse external[1] injury that one of the scans shows and what Dr Stoodley interprets as sub-arachnoid blood. It is not the fact that there's fresh blood in the subdural space, which is known to occur with minor handling, it's the other elements would require more forceful injury to cause. However, it wasn't of sufficient force to cause a major change in the baby's condition because what drove the child to hospital and treatment was the fact that her head was enlarging."
THE LAW
i) The burden of proving the facts pleaded rests with the local authority. In cases of alleged inflicted injury, it is for the local authority to establish on the balance of probabilities that the injuries in question were inflicted. There is no requirement on the parents or interveners to show that the injuries have an innocent explanation.ii) The standard to which the local authority must satisfy the court is the simple balance of probabilities. The inherent probability or improbability of an event remains a matter to be taken into account when weighing the probabilities and deciding whether, on balance, the event occurred (Re B [2008] UKHL 35 at [15]). Within this context, there is no room for a finding by the court that something might have happened. The court may decide that it did or that it did not (Re B [2008] UKHL 35 at [2]).
iii) Findings of fact must be based on evidence not on speculation. The decision on whether the facts in issue have been proved to the requisite standard must be based on all of the available evidence and should have regard to the wide context of social, emotional, ethical and moral factors (A County Council v A Mother, A Father and X, Y and Z [2005] EWHC 31 (Fam)).
iv) In determining whether the local authority has discharged the burden upon it the court looks at what has been described as 'the broad canvass' of the evidence before it. The role of the court is to consider the evidence in its totality and to make findings on the balance of probabilities accordingly. Within this context, the court must consider each piece of evidence in the context of all of the other evidence (Re T [2004] 2 FLR 838 at [33]).
v) In this context, and self-evidently, I am not limited to considering the expert evidence before me. Rather, I must take account of a wide range of matters that includes the expert evidence but also includes, for example, my assessment of the credibility of the witnesses and inferences that can be properly drawn from the evidence. Accordingly, the opinions of the medical experts need to be considered in the context of all of the other evidence. When considering the medical evidence, the court must bear in mind, to the extent appropriate in the given case, the possibility of the unknown cause (R v Henderson and Butler and Others [2010] EWCA Crim 126 and Re R (Care Proceedings: Causation) [2011] EWHC 1715 Fam).
vi) In respect of the medical evidence, it is vital to avoid blurring the important distinction between treating clinicians and experts (Re H-L (A Child) [2013] EWCA Civ 655). Where it is proposed to seek an overview opinion from one of the doctors who has treated a child, then that proposal must be expressly raised with the other parties and with the court. If permission is given to instruct one of the treating clinicians as an expert, then that instruction and all that flows from it must be conducted in accordance with the rules, the Protocol and established practice in exactly the same manner as it would be for an 'expert' who is brought into the case and who has not treated the child (Oxfordshire CC v DP, RS and BS [2008] 2 FLR 1708).
vii) The evidence of the parents and carers is of utmost importance and it is essential that the court forms a clear assessment of their credibility and reliability. The court is likely to place considerable reliability and weight on the evidence and impression it forms of them. In this regard, it is important to bear in mind the observation of Peter Jackson J in Lancashire County Council v M and F [2014] EWHC 3 (Fam) that:
"To these matters I would only add that in cases where repeated accounts are given of events surrounding injury and death, the court must think carefully about the significance or otherwise of any reported discrepancies. They may arise for a number of reasons. One possibility is of course that they are lies designed to hide culpability. Another is that they are lies told for other reasons. Further possibilities include faulty recollection or confusion at times of stress or when the importance of accuracy is not fully appreciated, or there may be inaccuracy or mistake in the record keeping or recollection of the person hearing or relaying the account. The possible effects of delay and repeated questioning upon memory should also be considered, as should the effect on one person of hearing accounts given by others. As memory fades, a desire to iron out wrinkles may not be unnatural – a process that might inelegantly be described as "story-creep" may occur without any necessary inference of bad faith."viii) As to the issue of lies, the court must always bear in mind that a witnesses may tell lies in the course of an investigation and the hearing. The court must be careful to bear in mind that a witness may lie for many reasons, such as shame, misplaced loyalty, panic, fear and distress. The fact that a witness has lied about some matters does not mean that he or she has lied above everything (R v Lucas [1982] QB 720). Within this context, it is important to note that, in line with the principles outlined in the R v Lucas, in seeking to determine whether a person is a perpetrator, or should be included within the pool of possible perpetrators, it is essential that the court weighs any lies told by that person against any evidence that points away from them having been responsible (H v City and Council of Swansea and Others [2011] EWCA Civ 195).
ix) It is also important when considering its decision as to the findings sought that the Court take into account of the presence or absence of any risk factors and any protective factors which are apparent on the evidence. In Re BR [2015] EWFC 41 Peter Jackson J sets out a useful summary of those factors drawn from information from the NSPCC, the Common Assessment Framework and the Patient UK Guidance for Health Professionals.
x) It is in the public interest that those who cause injury to children be identified (Re K (Non-accidental Injuries: Perpetrator: New Evidence) [2005] 1 FLR 285). The court should accordingly endeavour to identify on the simple balance of probabilities the person or persons responsible for inflicting the injuries in question where it is possible to do so.
xi) The Court should not, however, 'strain' the evidence before it in order to identify on the simple balance of probabilities the individual or individuals who inflicted the injuries. If it is clear that it is not possible on the evidence before the court for the court to conclude on the balance of probabilities who the perpetrator of the injuries is and the court remains genuinely uncertain, then the court should reach that conclusion (Re D (Care Proceedings: Preliminary Hearing) [2009] 2 FLR 668).
xii) Where the court cannot identify a perpetrator or perpetrators on the simple balance of probabilities, it is still important to identify the pool of possible perpetrators by asking whether the evidence establishes that there is a 'likelihood or real possibility' that a given person perpetrated the injuries in question (North Yorkshire CC v SA [2003] 2 FLR 849). In such circumstances, the court must scrutinise the evidence carefully and consider whether anyone, and if so who, should be included in the pool of possible perpetrators of the injuries sustained by the child (Re S (A Child) [2014] 1 FLR 739).
DISCUSSION
i) PN has sustained the following injuries:a) A large loculated subdural haematoma over the right hemisphere of the brain causing considerable mass effect with sulcal effacement, effacement of the right lateral ventricle and the basal cisterns, with midline shift to the left.b) A subdural haematoma over the frontal and lateral aspects of the left frontal region of the brain.c) Subarachnoid haemorrhages over the superior aspects of the cerebral hemispheres.d) Haemorrhagic diffuse axonal injury in the lateral right temporal lobe and in the posterior left temporal and parietal lobese) Generalised reduction in white matter volume in both hemispheres of PN's brain, worse on the left.f) A single pre-retinal haemorrhage in both eyes.ii) The left and right chronic subdural haematomas and the pre-retinal haemorrhages resulted from a shaking type injury or a shaking type injury with impact.
iii) The acute sub-arachnoid bleeding and haemorrhagic diffuse axonal injury resulted from a shaking type injury or a shaking type injury with impact.
iv) The level of force applied to cause the injuries to PN was a level of force that exceeded normal handling and would have been obviously inappropriate to an independent observer sufficient to cause intra-cranial bleeding and diffuse axonal injury but not sufficient to result in hypoxic ischaemic injury and a major change in PN's neurological condition.
v) The left and right chronic subdural haematomas were sustained by PN on one or more occasions during the period between early April and late May 2016. The pre-retinal haemorrhages were sustained by PN during the period between early April and late May 2016
vi) The acute sub-arachnoid bleeding and haemorrhagic diffuse axonal injury were sustained at a point over the weekend of 1 to 4 July 2016.
vii) During April and May 2016 the mother cared for PN alone on a number of occasions whilst she was intoxicated and in circumstances where she was suffering from mental health difficulties, under stress from a toxic and destructive relationship with the father, struggling to bond with PN and struggling to parent PN.
viii) HA and/or DA allowed the mother to have contact with PN without close supervision on at least one occasion over the course of the weekend of 1 to 4 July 2016 at a time when the mother's alcohol use and mental health difficulties persisted, she continued to be under stress from her relationship with the father and she continued to struggle to bond with, and parent PN.
ix) The injuries sustained by PN were on each occasion caused by the mother during momentary losses of control at a time when she abusing alcohol, was suffering from mental health difficulties, was under significant stress and struggling form a bond with, and parent PN.
x) At the time the injuries were inflicted the mother would have, or reasonably should have, known that her actions which resulted in the injuries risked injury to PN.
xi) By reason of the fact that the injuries were sufficient to cause intra-cranial bleeding and diffuse axonal injury but not sufficient to result in hypoxic ischaemic injury and a major change in PN's neurological condition there was no major or specific change to PN's neurological presentation following her injuries.
xii) Following the identification of PN's increasing head circumference the mother failed to make an appointment with the paediatrician following a referral on 23 June 2016 despite a request that she do so, thereby delaying the examination and treatment of PN.
xiii) The mother has told lies in an effort to implicate the father with respect to the injuries sustained by PN and to deflect her own culpability for those injuries. In particular, the mother has lied about the events of 27 May 2016.
xiv) Both parents caused significant emotional harm to PN, and exposed her to a risk of significant physical harm, on repeated occasions over an extended period of time by reason of their toxic and volatile relationship, which relationship was characterised by incidents of domestic abuse on both sides fuelled by alcohol without any regard to her emotional or physical wellbeing of PN. Both parents failed to prioritise PN's emotional needs and failed to ensure a safe home environment.
My reasons for making these findings of fact on the totality of the evidence before the court are as follows.
"Let me tell you, you know, I went to court with MA and I won and I'll fucking win again, let me tell you, I don't fuck about, I go all in and I'm fucking going to go all in, yes, you don't stand a chance."
i) Both DA and HA accepted that they considered it was open to them to leave the mother alone with PN provided they were somewhere in the house. DA said "I would have let NA stay on her own with PN. I had no worries about leaving NA alone with PN. It did not happen because she did not stay but Carol never said I could not leave them alone in a room. Carol never said I had to be in the same room as her". HA said "Carol did insinuate that NA could come round and be with PN. She did not say how it had to be." Within this context, I again note that the Written Agreement of 27 May 2016 was both vague and confusing when it came to exactly what the arrangements for the supervision of the mother were.ii) I am also satisfied that the pervading maternal family narrative at this time was that it was the father who was the incompetent, neglectful and violent parent, that family narrative having been reinforced by the mother's untrue account of the events on 27 May 2016 and her one sided account of the parent's relationship. Within this context, I am satisfied that neither DA nor HA believed that it was necessary to be with the mother and PN at all times.
iii) Accepting that they are both in a difficult position given family loyalties, I am satisfied that both DA and HA are extremely loyal to the mother and have in the past demonstrated themselves willing to disguise concerns regarding the mother's parenting of PN. DA sought to disguise the fact that the mother on occasion cared for PN whilst intoxicated and attempted to mislead the Police regarding the involvement of social services. HA conceded that she had failed to give the social worker a full account of the parents' relationship because the mother did not want her to.
iv) Within this context, there is evidence before the court that is inconsistent with the assertion by DA and HA that they did not have a great deal of contact with the mother between 27 May 2016 and 11 July 2016. The unchallenged evidence of the health visitor is that on 22 June 2016 the mother said she was being given her medication by DA which she was taking regularly. There is no indication that DA sought to dispute this. This is consistent with the mother's statement during her Police interview that she would go to DA's three to four times per week and would also go to HA's regularly.
v) In circumstances where both want to, and have been assessed with respect to caring for PN, DA and HA have a powerful motive to deny permitting the mother unsupervised contact with PN, although I bear in mind that both said they maintained that denial in the full knowledge of its potential adverse impact on their ability to care for PN in the future should the court reject that denial.
vi) On the balance of probabilities, PN suffered an abusive head injury over the weekend of 1 to 4 July 2016 during which period DA, HA and the mother were at times present. On the evidence before the court I am satisfied that it is unlikely that DA or HA inflicted such an injury on PN or would have allowed such an injury to occur had they been present at the time.
vii) HA sought initially to deny that the mother had spent time at her house over the weekend of 1 to 4 July 2016 in the face of the mother's evidence to the contrary. HA's later evidence that the mother would not have come into contact with, or have been left alone with PN on the afternoon she spent at HA's property over the weekend of 1 to 4 July 2016 because she spent the time in the shower and doing her hair strained the bounds of credibility. I am satisfied that HA sought to minimise the significance of the time spent by the mother at her home over the weekend of 1 to 4 July 2016.
CONCLUSION
i) PN has sustained the following injuries:a) A large loculated subdural haematoma over the right hemisphere of the brain causing considerable mass effect with sulcal effacement, effacement of the right lateral ventricle and the basal cisterns, with midline shift to the left.
b) A subdural haematoma over the frontal and lateral aspects of the left frontal region of the brain.
c) Subarachnoid haemorrhages over the superior aspects of the cerebral hemispheres.
d) Haemorrhagic diffuse axonal injury in the lateral right temporal lobe and in the posterior left temporal and parietal lobes
e) Generalised reduction in white matter volume in both hemispheres of PN's brain, worse on the left.
f) A single pre-retinal haemorrhage in both eyes.
ii) The left and right chronic subdural haematomas and the pre-retinal haemorrhages resulted from a shaking type injury or a shaking type injury with impact.
iii) The acute sub-arachnoid bleeding and haemorrhagic diffuse axonal injury resulted from a shaking type injury or a shaking type injury with impact.
iv) The level of force applied to cause the injuries to PN was a level of force that exceeded normal handling and would have been obviously inappropriate to an independent observer sufficient to cause intra-cranial bleeding and diffuse axonal injury but not sufficient to result in hypoxic ischaemic injury and a major change in PN's neurological condition.
v) The left and right chronic subdural haematomas were sustained by PN on one or more occasions during the period between early April and late May 2016. The pre-retinal haemorrhages were sustained by PN during the period between early April and late May 2016
vi) The acute sub-arachnoid bleeding and haemorrhagic diffuse axonal injury were sustained at a point over the weekend of 1 to 4 July 2016.
vii) During April and May 2016 the mother cared for PN alone on a number of occasions whilst she was intoxicated and in circumstances where she was suffering from mental health difficulties, under stress from a toxic and destructive relationship with the father, struggling to bond with PN and struggling to parent PN.
viii) HA and/or DA allowed the mother to have contact with PN without close supervision on at least one occasion over the course of the weekend of 1 to 4 July 2016 at a time when the mother's alcohol use and mental health difficulties persisted, she continued to be under stress from her relationship with the father and she continued to struggle to bond with, and parent PN.
ix) The injuries sustained by PN were on each occasion caused by the mother during momentary losses of control at a time when she abusing alcohol, was suffering from mental health difficulties, was under significant stress and struggling form a bond with, and parent PN.
x) At the time the injuries were inflicted the mother would have, or reasonably should have, known that her actions which resulted in the injuries risked injury to PN.
xi) By reason of the fact that the injuries were sufficient to cause intra-cranial bleeding and diffuse axonal injury but not sufficient to result in hypoxic ischaemic injury and a major change in PN's neurological condition there was no major or specific change to PN's neurological presentation following her injuries.
xii) Following the identification of PN's increasing head circumference the mother failed to make an appointment with the paediatrician following a referral on 23 June 2016 despite a request that she do so, thereby delaying the examination and treatment of PN.
xiii) The mother has told lies in an effort to implicate the father with respect to the injuries sustained by PN and to deflect her own culpability for those injuries. In particular, the mother has lied about the events of 27 May 2016.
xiv) Both parents caused significant emotional harm to PN, and exposed her to a risk of significant physical harm, on repeated occasions over an extended period of time by reason of their toxic and volatile relationship, which relationship characterised by incidents of domestic abuse on both sides fuelled by alcohol without any regard to her emotional or physical wellbeing of PN. Both parents failed to prioritise PN's emotional needs and failed to ensure a safe home environment.
Note 1 It would appear that this is a typographical error and that “external” should in fact read “axonal”. [Back]