Background
Matthew, a four-month-old infant, was brought to Womack Army Medical Center’s emergency room in cardiac arrest on August 25, 2024, after his father attempted CPR when Matthew became unresponsive. Matthew was airlifted to UNC-Chapel Hill Hospital, where he was found to have a subdural hematoma, a skull fracture on the right side, multiple rib fractures at various stages of healing, and a hemorrhagic spot in the right eye. The Cumberland County Department of Social Services received a referral the next day and, in September 2024, filed a juvenile petition alleging Matthew was abused and neglected under N.C. Gen. Stat. §§ 7B-101(1) and 7B-101(15).
At the adjudication hearing in June 2025, DSS presented testimony from two social workers — the original investigating social worker had retired before the hearing — and called both parents as its own witnesses. The social workers had limited firsthand knowledge of Matthew’s medical history. Father testified that he may have struck Matthew’s head on a door frame while carrying him and that he attempted CPR prior to the hospital, though he acknowledged he was unsure how to perform CPR on an infant. Mother acknowledged that vacuum-assisted delivery could not account for the injuries per the hospital’s advice, and that CPR could have caused some of them. DSS admitted nearly 1,500 pages of medical records from Womack and UNC Hospitals under the business-records exception, but did not call any medical provider, expert witness, or physician to testify to the contents, findings, or opinions in those records. DSS also failed to admit the Child Medical Evaluation (CME) report completed by the UNC Beacon Team, because no expert was available to authenticate it beyond the business-records affidavit procedure. At the close of DSS’s evidence, parents’ counsel moved to dismiss for insufficient evidence under N.C. R. Civ. P. 41(b). The trial court granted the motion, finding DSS had not shown by clear and convincing evidence that Matthew’s injuries were the result of intentional wrongdoing or non-accidental means by his parents.
The Court’s Holding
The Court of Appeals affirmed. In a Rule 41(b) dismissal at the close of plaintiff’s evidence in a bench trial, the trial court sits as factfinder and weighs all competent evidence; the appellate court reviews for abuse of discretion. The court found no abuse of discretion here for two distinct reasons.
First, DSS’s own witnesses — the parents it called — provided explanations for Matthew’s injuries (attempted CPR, possible door-frame contact, hospital resuscitation), and those explanations became part of DSS’s case in chief. DSS alleged non-accidental injury but presented testimony that was consistent with accidental causation while presenting no testimony rebutting the parents’ account.
Second, and more broadly, the admission of medical records as business records under Rule 803(6) does not substitute for expert testimony about what those records mean. The trial court correctly recognized that 1,500 pages of medical records — with findings in specialized clinical language — could not themselves establish causation without expert interpretation. As the trial court put it: “I’m not a medical provider, and I’m not a medical expert. So what good does it do to give me a report with all this big language that I may or may not understand.” The Court of Appeals agreed: “only an expert could have interpreted the records to give an opinion as to the proximate cause of the injuries.” Without that expert, the trial court was left solely with the parents’ account. DSS’s strategic decision not to subpoena medical providers or secure an expert — which respondents’ counsel characterized at trial as an attempt to “backdoor in expert witness testimony to avoid having to pay expert witness fees” — left an evidentiary gap that business-records admission alone could not fill.
The court acknowledged prior cases in which abuse adjudications have been upheld where a child sustained unexplained non-accidental injuries, but distinguished them: in each such case, the trial court’s findings or record evidence supported the inference that the parents were responsible. Here, the evidence went the other direction — DSS’s own witnesses supplied the innocent explanations, and no evidence rebutted those explanations as inadequate.
Key Takeaways
- Business records admitted under Rule 803(6) at a juvenile adjudication hearing establish that the records exist and reflect what was recorded, but do not independently prove causation or the source of a child’s injuries; medical records alone are insufficient to establish non-accidental injury without expert interpretation.
- When DSS calls parents as its own witnesses at an adjudication hearing and they provide explanations consistent with accidental injury, those explanations become part of DSS’s case in chief and must be affirmatively rebutted by competent evidence — including expert testimony — to meet the clear-and-convincing standard.
- Rule 41(b) dismissal at the close of DSS’s evidence in a juvenile adjudication is reviewed for abuse of discretion; the trial court as factfinder weighs all competent evidence and may find DSS has not met its burden even where circumstantial evidence raises concern.
- A Child Medical Evaluation (CME) report cannot substitute for live expert testimony on causation when DSS has not secured a medical expert and the self-authentication procedure for business records does not carry the report’s opinions into evidence as substantive proof.
Why It Matters
For DSS attorneys across North Carolina, In re M.D., Jr. is a cautionary decision about trial preparation in child abuse adjudications. The business-records self-authentication procedure under N.C. Gen. Stat. § 8C-1, Rule 803(6) was enacted in part to reduce burdens on the court system — but it does not relieve DSS of the obligation to present expert medical testimony when the core issue is whether a child’s injuries are consistent with non-accidental trauma. Courts cannot be expected to read hundreds of pages of clinical records and independently conclude that injuries — such as rib fractures at multiple stages of healing, skull fractures, and subdural hematomas — are non-accidental without a medical expert to explain that inference. When the adversarial record offers only parental explanations for the injuries (CPR attempt, birth complications), and DSS presents no expert to challenge those explanations, the factfinder cannot reasonably find clear and convincing evidence of abuse.
The decision also illustrates the risks of calling respondent-parents as DSS witnesses at adjudication. When parents testify in DSS’s case in chief and provide plausible alternative explanations for the child’s injuries, those explanations cut against DSS’s burden of proof and become part of the record DSS must overcome — not the parents’ record to overcome. DSS practitioners should carefully assess whether calling parents as adverse witnesses will generate testimony that, without expert rebuttal, undermines rather than supports the petition.