Court dismisses application against parents after challenge to medical view in care proceedings

The case involved a young girl, “CA”, who appeared at hospital with six marks when three weeks old. A number of treating clinicians formed the view that the marks were bruises. In the absence of parental explanation for such ‘bruises’, it was deemed to be a possible non-accidental injury. The parents disputed the marks on CA were in fact bruises, and the case was listed for a fact finding hearing. Both parents were in the pool of perpetrators.

Prior to the fact finding hearing, CA remained with her parents under a regime of wider familial supervision. It is noteworthy that for almost the first full year of CA’s life, she and her parents had stringent supervision requirements. The court-appointed paediatrician, Dr Rylance, took a more nuanced view as to the marks in his oral evidence, and on balance could not opine the marks were in fact bruises. Dr Rylance set out in his oral evidence that the marks were similar in appearance to cutis marmorata, and the speed of their resolution was in keeping with a diagnosis of cutis marmorata.

At the conclusion of the fact finding hearing, the Court found that Local Authority was unable to discharge the burden of proof required to satisfy the Court that the marks were in fact bruises. Considering the wider evidential canvass, including text message communication, there was insufficient evidence for the Court to make any findings against the parents, and the application was dismissed.

This case illustrates the importance of challenging initial clinical medical views surrounding bruising in non-mobile babies, and is an important reminder of the necessity for court-appointed practitioners to have a specific specialism in bruising. Dr Rylance formed the view that there may be a number of medical practitioners that are unaware of such a condition. It is vital for practitioners to consider some key themes when encountering cases of bruising in particular:

1. Medical evidence that marks are in fact bruises will depend on the accuracy of the treating clinicians’ reports. In this case, there were no photographs of the marks provided during the fact finding hearing, save for those produced by the parents. It would be good practice for medical or police photography be taken, with a resolution of sufficient strength to allow the photographs to be of greater evidential value to anyone considering them later.
2. There is no evidence the treating clinicians considered cutis marmorata. This should be considered at an early stage in proceedings where there is bruising in a non-mobile baby.
3. The blanching test may be insufficient to exclude cutis marmorata (because it may not appear to blanch) there is a risk of misdiagnosis by the clinicians.
4. The absence of marks a few days post-birth is less consistent with cutis marmorata, but does not exclude it.
5. Experts appointed in court proceedings should be specifically asked if bruises could be linked to a diagnosis for cutis marmorata.