## I L L I N O I S 

## O F F I C I A L 

## R E P O R T S Appellate Court

In re Juan M. , 2012 IL App (1st) 113096

Appellate Court Caption In re J UAN M. and KI HARA M., Minors, Respondents-Appe llees (The People of t h e S t ate of I llinois
, Petitioner-Appellee
, v. J uan Carlos M., Respondent-Appe llant).

District & N o. First District, F irst Division Docke t Nos. 1-11-3096, 1-11- 3192 cons.

Filed April 23, 2012

Held ( Note : T

his syl lab us

con st it ute s n o par t of the opi nio n of the cour t but has bee n pre

par ed by the Rep o rt er of D e c i s i o n s f

o r t h e

c o n v e n i e n c e o

f t h e

rea der

. ) On appeal from the place ment of responde nts’ children under t h e g uardianship of the D e p a

r tm e n t o f Ch ildr en and Family Service s pursuant to a dispositi onal hearing that resulted in a finding that responde nts wer e unable to car e for their children who had been adjudicate d abused and
neg lected, the appellate court, as to responde nt mother, g rante d the public defe nder’ s Finley motion to withdraw and aff irmed on that basis, and as to responde nt fathe r, t h e court aff irmed the trial court’s adjudicary and dispositi onal order s on the basis that the court’s finding s wer e not ag ainst the manife st weig ht of the evide nce.

Dec ision Under Review Appea l from the Circuit Court of Cook County
, Nos. 11-JA-183, 11-JA184; the Hon. Griff

in Max well, J r., Judge, pr esiding

.

J udg ment Affirmed.Counsel on

Appea l Eliz abeth B utler, of Northbrook, for a ppellant.

Robert F. Har

ris, Public Guar dian, of Chicag o (Ka ss A. P lain and Christopher Will iams, of counse l), g uardian ad litem

.

Panel J USTI CE ROCHFORD delivere d t h e judgme nt of the court, with opinion. Presiding J ustice Hoffman and J ustice Karnezis conc u rr ed in the judgme nt and opinion.

OP INION

¶ 1 On September 3 0
, 2 0 1 1
, t h e t ri al co u rt found nine-month old J uan M. to be: (1) phy sically abused; (2) abused due to a substantial risk of phy sical injury ; and (3) neg lected due to an injurious environment, pursuant to the J uvenile Court Act of 1987 (her einaf ter, the Act) (705 IL CS 405/2-3(2)( i), (2)( ii), (1)( b) (West 2010)). The court also found J uan’s older sister, 28-month-old Kihara M., to be neg lected due to an in j u ri o u s environment. After making these adjudicatory finding s, the trial court held a dispositi onal hearing an d fo u nd both pare nts (her einaf

ter, M r. an d Mrs. M.) unable to car e for J uan and Kihara

. J uan and Kihara wer e made war ds of the court and place d under I llinois Depa rtment of Children and Fa m i l y Service s (her einaf ter, DCFS) g uardianship. Both pare nts timely appealed the tri al court’s adjudicatory and dispositi onal order s. T h is court consolidated both appeals on November 17, 2011 (No. 1-11-3096 (Mr. M.) and No. 1-11-3192 (Mrs. M.)). On Dec ember 29, 2011, Mrs. M.’s attorney , t he public defe nder of Cook County
, filed a motion to withdraw as counsel on appeal pursuant to Pennsylv ania v. Finley
, 481 U.S. 551 (1987). We took the Finley motion with the case

. On Mr. M.’s appeal, we aff irm the trial court’s adjud i catory and dispositi onal order s on the basis that the trial court’s finding s wer e not ag ainst the manifest weig ht of the evidenc e. On Mrs. M.’s appeal, we g rant the Finley motion and af firm on that basis. ¶ 2 Mr. and Mrs. M. are marrie d and are the biologic al parents of Juan, born on Dec ember 13, 2010, and Kihara
, born on May 11, 2009. J uan and Kihara came to the attention of DCFS

on Marc h 11, 2011, when Mr. and Mrs. M. took J uan to the emer g ency room at Westlake Communi ty Hospital (her einaf ter, Westlake) afte r J uan had trouble fee ding and then became unresponsive. Upon transfe r to L oy ola University Medica l Ce nter (her einaf ter, L oy ola), he

was diag nosed with two skull fra cture s and had bruising on his fac e. When Mr. and Mrs. M. could not explain his injuries, a h o t line call was place d to DCFS, and a child-abuse and
neg lect investig ation ensued. ¶ 3 On Marc h 24, 2011, t h e S t at e fi l ed m o t ions for temporar y custody and petitions for

-2-adjudication of war dship for both J uan and Kihara

. The State’s adjudication petition alleg ed

that on Marc h 11, 2011, J uan was diag nosed with a skull fra cture and had two bruises on his fac e. Mr. and Mrs. M. had no explanation for the injuries. Be cause of J uan’s ag e and lack of mobilit y , and the se riousness of his injuries, medical personne l w ere conce rned “that ther e is no explanation as t o h o w h e was injured.” The adjudication petitions for both J uan and Kihara alleg ed abuse due to substantial risk of phy sical injury
, and neg lect due to an injurious environment. On Marc h 24, 2011, the t rial court place d both children i n DC FS t empora ry custody

. ¶ 4 On May 4, 2011, the State moved to amend the adjudication petitions and reque sted the following sentenc e be a dded: “Me dical per sonnel state that [J uan’s] injuries areconsistent with injuries suffe red by non-ac cidental means.” The State reque sted a count of phy sical abuse f or Juan. The trial court allowed the amendment to the petitions. ¶ 5 Doctor Maria Conchita Tuason was called as a witnes s at t h e ad j u d icatory

hearing. Doctor Tuason was the primary car e phy sician for J uan from his birth to DCFS involvement. J uan was born premature at 35 wee ks. At birth he weig hed 5.6 pou n d s an d s uffered from respiratory

distress and hy

perbilirubinemia (

jaundice) , which re solved soon afte r his birth. He was rele ased from the hospital on Dec ember 24, 2010. On Dec ember 28, 2010, Mrs. M. broug ht J uan to D octor Tuason’s office for a follow-up examination. Doc tor Tuason noted J uan was doing w ell. On J anuary 6, 2011, Mrs. M. ag ain broug ht J uan to Doctor Tuason’s office for a phy sical examination. Doc tor Tuason had no conce rns about J uan’s well-be ing at that time. ¶ 6 On J anuary 13, 2010, Mrs. M. broug ht J uan to Doctor Tuason beca use he h ad a co l d

. Doctor Tuason noted J u an had some nasal cong estion with mucus, “but nothing more signific ant t han t h at

. ” J uan weighe d 7 pounds, 10 ounces on that visit. On M arc h 7, 2011, Mrs. M. broug ht J uan to Doctor Tuason for his schedule d vacc ines. At that vis i t , J u an weig hed 13 pounds. Doctor Tuason noted he had “som e m ar k on the bitemporal are a. It [was] blackish in color.” Doctor Tuason also testified J uan had a brac elet on his arm and was

conce rned that it presented a choking hazard. ¶ 7 During all of J uan’ s v i s i t s wi th Doctor Tuason, Kihara was prese nt. Doctor Tua son described Kihara as a “re g ular one-and -a -h alf-y ear -old child, very interested in a lot of things.” Doctor Tuason told Mrs. M. to closely supervise Kihara when she was around J uan beca use Kihara was very active and “pulling a lot of things from any wher e.” Doctor Tuason had no other

conce rns about Juan. ¶ 8 The assistant State’s Att orney show ed Do ctor Tuason the bracele t that J uan wore, and Doctor Tuason ag ree d it was “roug hly three to four inches in circ umfere nce with *** small beads around that circ umfere nce.” There was another larg er bead attache d to the brac elet. On

cr o s s -e x amination by the assis tant public g uardian, Doctor Tuason testified s he saw J u an , prior to his head injuries, on Dec ember 28, 2010, J anuary 6 an d 1 3
, 2 011, and Marc h 7, 2011. Doctor Tua son never saw Juan’s head injurie s when he was at L oy ola. ¶ 9 The trial court asked Doctor Tuason about h er t es t i m o n y t h at s h e n oticed a blac k discoloration on J uan’s temple on Marc h 7, 2011. She assessed that mark and testified there was not any

surrounding swelling , so she did not think the mark was dueto trauma.

-3-¶ 10 Moises Cruz, the DCFS worke r who investigated the ab u s e al l egations, testified his

investigation be g an on Marc h 11, 2011, when DCFS rec eived a hotline r eport that Mr. and Mrs. M. had broug ht J uan to the hospital with a “bump on the he ad, old bruises on the le ft side of the fac e.” Mr. Cruz went to Mr. and Mrs. M.’s home on Marc h 11, 2011, and first spoke with Mr. M. alone. Mr. M. told Mr. Cruz that at about 12:30 a.m. on Marc h 11, 2011, he lifted J uan from a swing -chair to g ive him some milk, and h e n o t i ce d that milk was coming out of J uan’s nose. Mr. M. passed J uan to the mother, and at that point J uan became unresponsive. The y

took him to t he hospital. ¶ 11 Mr. Cruz also spoke alone with Mrs. M., who said she would never harm J uan and that she had no explanation for his injuries. Neither pare nt g ave any expla n ation for J uan’s injuries. ¶ 12 After M r. C ru z s poke with the pare nts separ ately
, he spoke with them toge ther, a long with the children’ s g randpa rents, who also lived in the home. Mr. Cruz explained the nature of J uan’s injuries, the abuse alleg ations, and that Kihara would not be able to remain in the home. Kihara wa s p l ac ed in DCFS protec tive custody that day
, and J uan was put in protec tive custody

when hewas re lease d from the hospital on Mar ch 22, 2011. ¶ 13 Doctor Mary J ones testified she is a g ener al pediatric ian and child-abuse specia list at L oy ola and had worke d there for the last seven months. The t rial court admitted Doctor J ones’ s curriculum vitae

. Doctor J ones g radua ted from the University of I llinois Medica l School in 1997 and did her residenc y in g ener al pediatric s at Advocate Christ Hospital from 1997 to 2000. She is licensed to prac tice medicine in I llinois and board certified in pediatric s. Doctor J ones is an assistant profe ssor of pediatric s at L oy ola and is the ph y s i ci an repr esentative of the c hild advocac y team at L oy ola, wher e she is re sponsible for all childabuse and neg lect consultations. She is a fellow at the Americ an Aca demy of Pediatrics, and

a member of the child-abuse and neg lect section there

. Fr om October 2009 to February 2011, Doctor J ones worke d for Aunt Martha’ s Youth Service s and Hea lthcare
, coordinati n g medical car e for DCFS-involved chil d ren, and evaluating children for abuse and neg lect. Fr om 2007 to 2009, she worke d as a pediatric ian at Children’s Hospital in Wis consin. Fr om 2004 to 2007, s h e wo rk ed for Advocate Christ Medica l Center in Oak L awn, supervising residents and coordinating c arefor medic ally complex children. ¶ 14 Do ct o r J o n es t es tified that in her curr ent position as a child-abuse specia list and codirec tor of the ch i l d advoca cy team at L oy ola, her job is to evaluate children who are suspected victims of abuse and neg lect. Over the course of her car eer , she has consulted on thousands of pediatric case s and on over 1 0 0 case s involving suspected abuse or neg lect. Doctor J o nes has testified 5 to 10 times in court and previously has been qualified as an expert in pediatrics and child-abusepediatric s. ¶ 15 On voir dire by Mr. M., Doctor J o n es co u l d n o t quantify the number of case s she had consulted on involving onl y n egl ect or involving skull fra cture s, but a month befor e, she consulted on a ca se involving a skull frac ture and suspected child abuse. Doctor J ones di d
not know if she has ever been qualified as an expert on “child abuse pediatric s invo l v i n g skull fra cture s.” On inquiry from the court, she testified she would be elig ible in 2013 to take the boar d exams for ce rtification in the subspec ialty of child-a

buse pediatrics.

-4-¶ 16 Over Mr. M.’s objection, the trial court admitted Doctor J ones as an expert in pediatrics

and child-a

buse pediatrics. ¶ 17 Doctor J ones testified t h at o n M ar ch 1 1
, 2011, she was called for a consult from the pediatric s team when J uan prese nted with injuries that wer e “conc erning for non-ac cidental trauma.” She examined three- month-old J uan and noted he had a swollen scalp on the l eft side and a two-ce ntimeter bruise on his lef t chee k. The trial court a dmitted photogra phs of J uan’s fac e, taken by Doctor J o n es , wh en she examined him. Doctor J ones testified the photogr aphs showed a bruise on J uan’s chee k, underne ath his left ey e, but did not show the swelling on his scalp, due to his dark hair. J uan’s soft-tissue swelling on his scalp was cause d by trauma. ¶ 18 Doctor J ones revie wed J uan’s CT scan from Westlake, taken befor e he was transfer red
to L oy ola, which showed J uan had a left-pa rietal skull fra cture and an occipital fra cture with a small depre ssion. The parie tal bone cove rs the top and the uppe r half of the skull. ¶ 19 Doctor J ones testified that skull fra cture s are alway s cause d by trauma, and two types of forc e can cause a fra cture

. One type is static forc e, which is compre ssion th at can happen

over a period of time, such as when an infant’s skull is compre ssed in the birth canal during birth. The second type of forc e i s d y n am i c, wher e, ty pically
, the head is stationary and something hits the head, or the head is moving and hits a stationary object. There was no way to tell whether Juan’s skull frac tures we re c aused by static or dynamic for ce. ¶ 20 Doctor J ones testified J uan’s skull fra cture s would have require d a considera ble amount of forc e, beca

use an infant’s skull is thinner than an adult skull, and the bones are separ ated by sutures, which allow an infant’s skull to g row. Skull fra cture s in adults require less forc e. A “sig nificant amount of pressure ” is require d to fra ctu re an i n fa nt’s skull. J uan was not ambulatory

at the time of his fra cture s and was not capa ble of inflicting the skull fra cture s on himself beca

use he did not havethe deve lopmental capa bility

. ¶ 21 Doctor J ones described the occipital fra cture she found on J uan. The occipital bone is the bone in the bac k of the skull. Doctor Jones noted a slig ht depre ssion in the frac ture, whic h is usually cause d by the skull being hit with “something that has a smaller surfa ce are a than something like a floor or a table. For example, it could be a corne r of a table, could be a shoe, something with a smaller surfa ce are a.” The occipital skull fra cture would have been cause d only by trauma, and the occipital bone had the same malleable char acteristic as the parie tal bone in terms of the signific ant forc e neede d to cause the fra cture

. Doctor J ones was not able to date the f

rac tures. ¶ 22 Doctor J ones spoke with Mr. M. on the phone on Marc h 11, 2011, with the assistance of

an interpre ter. Mr. M. told Doctor J ones that around midnight on Marc h 10, 2011, he noticed milk coming from J uan’s nose and he seeme d to be choking

. Mr. M. turned J uan over on his stomach and patted his back. When he turned J uan back over, Mr. M. noticed he was listl ess and wa s not crying. Mr . and Mrs. M then took Juan to the emerg ency room. ¶ 23 Doctor J ones asked Mr. M. ab o u t J uan’s status earlier in the day
, and he told her that around 3 p.m. or 4 p.m. that afte rnoon, J uan was not “ac ting like himself.” J uan was crying and fussy
, seeme d to be in pai n , and looked “blue and purple.” J uan fell aslee p in the afte rnoon, and Mr. M. did not seek medical attention for him at that tim e. Do ct o r J ones

-5-attempted to g ather more history from Mr. M. reg arding how J uan seeme d afte r 4 p.m., but

the phone c onnection wa s lost and could not be re established. ¶ 24 Doctor J ones spoke with Mrs. M. in person on Marc h 21, 2011. She descr ibed the events of Marc h 11, 2011, the same way Mr. M. did. Howeve r, Mrs. M. told Doctor J ones that when she enter ed the room wher e Mr. M. and J uan wer e, she felt J uan’s head and asked if Mr. M. had hit J uan, and Mr. M

. said no. Mrs. M. said she wa s J uan’s primary car eg iver. Mrs. M. broug ht in a brac elet that she put on J uan’s arm, which had beads on it with a small, hollow, wooden ball on the end. Mrs. M. believed J uan could have hit himself with the brac elet while

wea ring it, which she thought might have cause d the bruise, but Doctor J ones did not believe J uan had the m otor skills to self-inflict that kind of i njury

. Mrs. M. also s ai d she had been kissing J uan on the chee k in the car on the way to the emer g ency room on Marc h 11, 2011, and wonder ed if that could have been the cause of the fac ial bruise, but Doctor J ones did not believe that was possible. ¶ 25 Docto r J o n es opined, to a rea sonable deg ree of medical certainty
, that J uan’s injuries

wer e cause d by n o n acc idental trauma. Doctor J ones based her opinion on the medical evidenc e and thelack of

any explanation for J uan’s injuries. ¶ 26 On cross-e x amination by the assistant public g uardian, Doctor J ones testified she could
not determine whether the two differ ent skull fra cture s wer e cause d by the same or separ ate traumas, because she could not determine the age of t h e fr ac t u res and beca use she did not have a history of how they

occur red. ¶ 27 Doctor J ones revie wed a skeletal survey of J uan and saw nothing indicating he was more susceptible to fra cture s due to his premature birth. J uan’s injuries we re c aused by inflicted
trauma. ¶ 28 On cross-e x amination by Mr. M., Doctor J ones testified J uan had not had previous visits
to the hospital for suspected abuse, and the bone survey done on him ruled out other trauma to the body

. There wer e no other b ru i s es o n J uan. J uan also appea red to be of appropriate weig ht. ¶ 29 Doctor J ones testified there is n o reliable way to date an infant’s skull fra cture and no reliable way to acc urate ly deter mine the amount of forc e neede d to cause a skull fra cture in

a three -month-old infant. A skull fra cture , b y i t s el f, in an infant, is not nece ssarily child abuse, and it is possible that a fractur e can be acc idental, but Doct or J ones di d not rec eive
t h at h i s tory from the pare nts. A three -month-old infant may appea r “mainly fussy ” afte r

rec eiving a skull fra cture , and it is not abnorma l for an infant that ag e to act fussy from time to time. ¶ 30 I n terms of J uan’s bruising, Doctor J ones testified a bruise develops afte r sufficie nt f orce to disrupt the blood vessels and the blood leaks from the vessel into the tissue. A bruise may not become appar ent for hours or day s afte r the injury
, depending on the depth of the vessels that wer e disrupted. The re is no method to date thebruise. ¶ 31 During her investigation, Doc tor J ones telephoned J uan’s pediatric ian, Doctor Tuason. She told Doctor J ones, “at one point,” J uan had a bruise on his ri gh t chee k, which Doctor Tuason attributed to Kihara

. Doctor J ones did not rule out Kihara could have cause d the bruise under J uan’s left ey e bec ause she did not g et any history of any cause for the bruise.

-6-¶ 32 Doctor J ones testified that one fac tor contributing to her opinion that J uan’s injuries were

nonacc idental was the lack of history g iven by the pare nts. Do ct or J ones determined the
pare nts were not cre dible when they wer e unable to provide an explanation of J uan’s injuries. ¶ 33 On cr o s s -e x am i n ation by Mrs. M., Doctor J ones testified she could not d et er m i n e whether J uan’s fra cture s wer e cause d by dy namic or static forc e. Howeve r, it was not possible J uan’s fra cture s wer e cause d when he went throug h the birth canal, beca use his softt i ssue swelling over his left-pa rietal skull fra cture indicated an acute injury
, not one that

occur red 2 1⁄2 months ag o. Doctor J ones testified J uan’s bruise under his left ey e was two centimeter s in diameter, and the brac elet Mrs. M. showed her measure d two centimeter s at the end. ¶ 34 On redire ct examination by t h e S t at e, Doctor J ones testified there was no soft-tissue swelling over J uan’s occipital fra cture

. Doctor J ones ag ree d that the pare nts’ inability to g ive

a cause for J uan’s fra cture s was incre dible beca use “this is a three -month-old child who one would rea sonably expect to be car ed for in suc h a way as to not be place d in circ umstances that could cause skeletal fra cture s,” as well as fac ial b ru i s i n g

. On re- cross-e x amination, Doctor J ones testif

i ed it was uncommon for the pare nts not to know the cause of a skull fra cture in their three -month-old infant. Doctor J ones testified, upon inquiry from the court, that the typical mechanism for an infant-skull fra cture was when the pare nt droppe d the infant or the infant rolled off a table onto a hard floor. Whil e she could not state specific ally how much forc e wo u l d be neede d to cause a skull fra cture in a three -month-old infant, it would have to be a “conside rable amount of fo rc e, ” due to the m alleability of t he skul l. A child will not g et a skull fra cture from being “tappe d on the skull.” An i n fa nt J uan’s ag e could not g ener ate the f

orceto cause such an injury to himself. ¶ 35 The trial court admitted People’s exhibi t 4, J uan’s cer tified and deleg ated birth rec ords from St. Mary and St. Eli z ab eth Medica l Center. The trial court also admitted People’s

ex h i b it 5, certified and deleg ated medical rec ords relating to J uan from his regu l ar pediatric ian, Doctor Tuason. The trial court admitted People’s exhibi t 6, J uan’s certified and deleg ated L oy ola re cords. ¶ 36 The State publish ed fr o m P eo p le’s exhibi t 6. The State’s publication ref err ed to the
assessment portion of J uan’s medical rec ords, which states he prese nted with multipl e skull fra cture s and multipl e bruises on his fac e. There was a bruise on the tip of his nose and under his left cheek. The report states J uan’s injuries wer e nonacc idental beca use there was no history of trauma or bone disease, and “an inconsistent a ccounting of the time sur rounding the i njury being detec ted by the careg ivers and the presence of facial bruising on an infant

w it h o ut the developmental capa city to self-inflict, are consistent with non-ac cidental injury .” The State also published from the neurosur g ery consult a section stating J uan repor tedly became “unusually fussy at approx 12:30 a.m.” and “He ad CT there showed larg e, minimally displaced left parie tal bone fx with trac e of underlying SDH as well as evidenc e of older skull frac tures. Pare nts denied any rec ent trauma

or fa lls.” ¶ 37 The trial co u rt ad mitted People’s exhibi t 7, which wer e J uan’s certified and dele g ated

m ed i cal rec ords from Westlake. J uan was taken to Westlake prior to being transport ed t o L oy ola, and the Westlake rec ords indicate J uan prese nted there with multipl e skull fra cture s

-7-and suspec ted abuse

.

¶ 38 At the close of the hear ing, the trial court found J uan was phy sically abused, abused due to a substantial risk of phy sical injury
, and neg lected due to an injurious environment. The trial court found J uan’s neg lect was inflicted by both pare nts, but did not make a finding that the abuse was inflic t ed b y both pare nts or either pare nt. The court found Kihara negle cted due to an injurious environme nt. Kihara ’s neg lect wa s inflicted by both pare nts. ¶ 39 The trial court immediately beg an t h e d i s p o s i t ional hearing. Anna Maria Aldana, the Catholic Charities case worke r assig ned to the case , testified both c hildren had been place d in a n o n relative bilingual foster home. Ms. Aldana testified Kihara was two y ear s old and

was rece iving weekly speec h thera p y , as well as thera

py for her m otor skills. She was due
to start wee kly play thera

py the following wee k at Catholic Charities. J uan was nine months old, and Ms. Aldana did not know whether he had been evaluat ed for developmenta l problems. C atholic C harities had rec eived reports from a doctor whi ch s t at ed J uan had no ong oing me dical conc erns r elating to his previous head injuries. The f oster home wa s safe and appr opriate, and the foster pare nts had no other c hildren and spokeSpanish. ¶ 40 Both pare nts had been assessed for service s, and both neede d pare nting cla s ses, par enting

coac hing, and individual thera py

. They had beg un pare nting classes and coac hing at Catholic Charities. The coac h who conducte d the classes was very please d with both pare nts’
cooper ation. They had not missed any classes and wer e implementing what they had learned. I ndividual thera

py had not y et beg un, beca use the ag ency only had two Spanish-speaking counselors. ¶ 41 T h e p ar ents had supervised visits toge ther twice a wee k, and they interac ted with t h e children appropriately

. Ms. Aldana rec ommended the children bemade wa rds of the c ourt and plac ed into DCFS g uardianship, due to the ong oing se rvice needs of the par ents. ¶ 42 The trial court admitted the May 23, 2011, DCFS integ rate d assessment for the family

. The assessment reports Mr. M. expressed love and conce rn for the children, was confused about DCFS involvement, and was sad the children wer e taken out of his custody

. He denied that he, his wife, or pare nts cause d J u an ’s i n j u ries, and he was willing to participate in service s and cooper ate with D CFS to r eg ain custody of the children. The assessment noted Mr. M. exhibi ted some par enting streng ths, but he display ed a weakne ss by not being able or willing to e nsure Juan’s safe ty

. ¶ 43 The assessment reports Mrs. M.
, al s o , was confuse d and sad about t he family ’s DCFS involvement. She wonder ed if J uan’s injuries wer e cau s ed by the hospital or the DCFS investigator, which was “conc erning as blaming others helps reinforce her denial of g uilt.” She was willing to participate in service s to achievereunific ation. ¶ 44 The assessment reports J uan was developing ag e appr o p ri at el y

. Ki h ar a h ad s o m e d e v e lo p me n tal and behavior al conce rns with her communication skills, fine motor skills, and problem solving. She w as not eating we ll, was ag g ressive, and had a hig h activity level. ¶ 45 When the parties made their closing arg uments, the St at e an d t h e p u b l i c gu ardian
reque sted the children be made war ds of the court, that the parents be found una ble to car e for them, and DCFS g uardianship administrat o r, D. J ea n Orteg a Piron, be appointed the children’ s g uardian. Mr. M.’s attorney stated: “I concur with the State and the g uardian.” The

-8-trial court e ntere d a dispositional order with the f indings re quested by

the par ties. ¶ 46 Both pare nts timely appeal ed t h e co u rt ’s ad j udicatory and dispositi onal order s. We consolidated the a

ppeals.

¶ 47 I . Mr. M.’s Appe al (No. 1- 11-3096) ¶ 48 Mr. M. arg ues the trial court err ed in finding J uan was phy sically abused, abused due to

a substantial risk of phy sical injury
, and neg lected due to an injurious environment, pursuant to the Act. 705 IL CS 405/2-3(2)( i), (2)( ii), (1)( b) (West 2010). Mr. M. also arg ues the court

err ed in finding Kihara was neg lected due to an injurious environment, pursuant to the Act. 705 IL CS 405/ 2-3(1) (b) ( West 2010). ¶ 49 I n a proce eding for the adjudication of abused or neg lected minors, the State must prove the allegations in the petit ion by a preponderance of the evidence. In re F.S.
, 347 I ll. App. 3d 55, 62 (2004); In re Marcus H.
, 297 I ll. App. 3d 1089, 1095 (1998). “ ‘Preponde ranc e of the evidenc e is that amount of evidenc e that leads a trier of fac t to find that the fac t at issue is more proba

ble than not.’ ” In re F.S.
, 347 I ll. App. 3d at 62 (quoting In re K.G. , 288 I ll. App. 3d 728, 735 (1997))

. The c ourt’s primary conce rn is the best intere sts of the children i n volved. In re Marcus H.
, 297 I ll. App. 3d at 1095. “ ‘The trial court h as t h e b es t opportunity to observe the demeanor and conduct of the parties and witnesses and, there fore
, is in the best position to determine the cre dibilit y and weig ht of the witnesses’ testimony .’ ” In re F.S.
, 347 I ll. App. 3d at 63 (quoting In re E.S.
, 324 I ll. App. 3d 661, 667 (2001))

. Cases adjudicating abuse and neg lect are sui generis and must be decide d on their own fac ts. In re B.H
., 389 I ll. App. 3d 316, 319 (2009). We will not disturb the trial court’s finding s that the children have been abused or neg lected, unless those finding s are ag ainst the manifest weig ht of the evidenc e, meaning “ ‘the opposite conclusion i s clea rly evident or *** the determination is unrea sonable, a rbitrary , and not base d on the evidenc e.’ ” In re D.W

. , 386 I ll. App. 3d 124, 134-35 (2008) (quoting In re Tiff any M.
, 353 I ll. App. 3d 883, 890 (2004))

.

¶ 50 A. The Trial Court’s Finding That Juan W as Phy sically Abused ¶ 51 The trial court’s finding
, that J uan was phy sically abused, was made pursuant to section 2-3(2) (i) of the Act, which states: “(2) Those who are abused include any minor under 18 y ear s of ag e whose pare nt or immediate family member, or any person re s ponsible for the minor’s welfa re, or any person who is in the same family or household as the minor, or any individual residing in the same home a s the minor, or a pa ramour of the minor’s parent: (i) inflicts
, ca u s es t o be inflicted, or allows to be inflicted upon such minor phy sical injury
, by other than acc idental means, which cause s death, disfigur ement, impairment of phy sical or emotional health, or loss or imp ai rm ent of any bodily function[.] ” 705 IL CS 405/ 2-3(2) (i) (West 2010). ¶ 52 “Section 2-3(2) (i) require s only that the phy sical injury occur by ‘other than ac cidental’
means; it does not require specific in t en t t o h ar m o r punish the child.” In re F.S.
, 347 I ll. App. 3d at 63.

-9-¶ 53 I n the prese nt case , the trial court found Doctor J ones’s testimony to be “unre butted” and

“per suasive to establish that [J uan] was intentionally and not acc identally abused, phy sically abused such that it cause d a skull fra cture and other injuries.” Mr. M. first arg ues the trial
court err ed in qualifying D octor Jones as an expert in pediatric s and child-abuse pediatric s who could rende r an opinion as to the cause of J uan’ s i n j u ri es

. “Expert testimony is admissible if the proff

ere d expert is qualified as an expert by knowledg e, skill, experienc e, trai n i n g , or education, and the testimony will assist the trier of fac t in understanding the evidenc e.” Ree d v. Jack

son Park Hospital Foundation
, 325 Ill. App. 3d 835, 842 (2001). “Whether a

witness is suf

ficiently qualified to te stify as an e x pert is a matter committed to the sound discretion of the trial court, whose determination on the issue may be reve rsed only if it constitutes a clear abuse of that discretion.” In re Be atriz S. , 267 I ll. App. 3d 496, 499 (1994). ¶ 54 The trial court committed no clea r abuse of discretion by qualifying Doctor J ones as an expert in pediatric s and child-abuse pediatric s. As disc u s s ed above, Doctor J ones is a g raduate of the University of I llinois Medica l School, is board certified in pediatric s, and is

an assistant profe ssor of pediatric s at L oy ola. She is the phy sician repr esentative of the child advoca cy team at L oy ola, wh ere she is responsible for all child-abuse and neg lect consultations there

. She is also a fellow at the Americ an Ac ademy of Pediatrics and a member of the child-abuse and neg lect section there

. Fr om October 2009 to Fe bruary 2011, she worke d for Aunt Martha’ s Youth Service s and Hea lt h ca re , wher e she coordinated medical car e for children involved in DCFS and she evaluated children for abuse and neg lect. Over the course of her car eer , she has consulted on thousands of pediatric case s and on over 1 0 0 ca s es involving suspected abuse or neg lect. A month prior to her testimony
, Doctor J ones evaluated a suspected child-abuse case which, simila r to h e re, involved a skull fra cture

. Ba sed on Doctor J ones’s education, knowledg e, skill, experience and training
, the trial court committed no clea

r abuse of discretion in qualifying her as an expert in pediatric s and childabuse p ediatric s to assist the trier of fac t in understanding whether J uan’s injuries wer e

cause d by neg lect and/or

abuse. ¶ 55 Mr. M. next arg ues that the court er red in relying on Doctor J ones’s testimony
, as her opinion that J uan’s injuries wer e nonacc idental was speculative and, there fore
, insufficient to support a finding of phy sical abuse

. ¶ 56 Mr. M.’s arg ument is without merit. At the adjudicatory hearing, Doctor J ones testified that skull fra cture s, such as those suffere d b y t h ree -month-old J uan, are alway s cause d by
trauma. Due to the malleability of an infant’s skull, a “sig nificant amount of pressure ” would have been neede d to cause J uan’s fra cture s. Doctor J ones noted J uan was not ambulatory at the time of his fra cture s and bruising and he did not have the developmenta l capa bility to inflict the fra cture s or bruise on himself. Doctor J ones reje cte d the arg ument that J uan’s injuries occur

red w hen he hit himself with the bra cele t he was wearing because, as Doc tor J ones ag ain noted, J uan did not have the motor skills to self-inflict those i njuries. Doctor J ones testified that althoug h skull fra cture s in infants can be cause d by acc ident, and are not

nece ssarily uncommon, the pare nts s h o u l d h ave been able to provide a history of how the fra cture s occur

red. Mr. and Mrs. M. wer e unable to provide such a history

. Further, althoug h Doctor J ones was unabl e to definitively determine the ag e of the fra cture s, the evidenc e

-10-indicated the two f rac tures occ urre d at diffe rent times, making it more improbable that the
pare nts would be unable to e x plain the injuries. Specifically
, Doctor J ones noted there was soft-tissue swelling over the left-pa rietal skull fra cture indicating it was an “ac ute injury
, not

an injury that could have happene d two-and- a-half-months ago ” d u ri ng his birth; Doctor J ones observe d no such swelling over the occipital fra cture

. Moreove r, the L oy ola surg eon who consulted on J uan’s case stated in the neurosur g ery consult section of the medical

rec ords, that there was a “lef t parie tal b o n e fx * * * as well as evidenc e of older skull fra cture s.” Doctor J ones testified that based o n t h e medical evidenc e and the lack of an explanation for J uan’s multipl e skull fra cture s an d b ru i s ing, her opinion to a rea sonable deg ree of medical ce rt ai n t y was that the injuries were cause d by “nonac cidental trauma.” Doctor J ones’s testimony was not speculative but, rathe r, was based on the medical evidenc e and on her own expertise in pediatric s and child abuse. Doctor J ones’s testimony supported the trial court’s finding that the State met its burden of proving by a preponde ranc e of the evidenc e that Juan was phy sically abused; a ccor dingly , the court’s finding was not against the manife st weig ht of the evide nce. ¶ 57 Mr. M. arg ues the trial c ourt err ed in disreg arding Doctor Tuason’s t estimony that Mr. and Mrs. M. provided adequate car e for J uan prior to his injuries. Mr. M. arg ues the car e and attention a child rec eives prior to an injury is a fac tor to be considere d in determining whether the injury was acc idental or not. Review of t h e rec ord indicates the court did not disreg ard Doctor Tuason’s testimony re garding Mr. and Mrs. M.’s car e of J uan prior to Marc h 11, 2011. Rather, the court mere ly noted, at the close of the adjudicator y hearing, that Doctor Tuason had offe red no opinion relative to the cause of J uan’s injuries, and the court

corr ectly found that Doc tor J ones’s testimony reg arding causa

tion was unrebutted. ¶ 58 Mr. M

. arg ues t he trial court erre d in relying on Doct o r J ones’s testim ony beca use she fai l ed t o adequa

tely investigate whether Kihara could have cause d J uan’s fra cture s. We disag ree

. During the course of her investigation, Doct o r J ones spoke with both pare nts as well as wi th J uan’s pediatric ian, Doctor Tuason, none of whom identified Kihara as a possible c ause of Juan’s multi ple fra cture s. Mr. M. points to Doctor Tuason’s testimony at the adjudicatory hearing that she told Mrs. M. not to l eave Kihara alone with Juan beca use Kihara was “very active” and liked to “g rab whatev er s h e fi nds interesting .” Howeve r, Doctor Tuason never testified that Kihara could have been responsible for fra cturing J uan’s skull. ¶ 59 I n sum, Doctor J o n es gav e u nrebutted expert testimony that J uan’s injuries wer e the result of nonacc idental trauma. A trial court “ ‘cannot disreg ard exp er t m edica l testimony that is not countervailed by other competent medical testim ony or m edic al ev i d ence.’ ” In

r e F

. S

. , 3 47 Ill. App. 3d at 64 (quoting In re Ashley K.
, 212 I ll. App. 3d 849, 890 (1991)). Ba sed on Doctor J ones’s testimony
, the trial court’s finding that the State met its burden of proving J uan wa s phy sically abused w as not ag ainst the manifest we ight of the evidenc e. ¶ 60 We further note, the trial court’s inability to determine which pare nt, if any , perpe trated
t h e p h y s i ca l abuse, does not compel a differ ent result. We have held “the focus of an adjudicatory hearing is not on whether the responde nt abused the minor but rathe r on whether th e minor was abused.” In re J.C.
, 2011 IL App (1st) 111374, ¶ 20. As discussed, Doctor J ones’s testimony supported the trial court’s finding that J uan was phy sically abused. As the

-11-court’s f inding wa s not ag ainst the manifest we ight of the evidenc e, we aff

irm.

¶ 61 B. TheTrial Court’s F inding That J uan Was Abused Dueto a Substantial Risk of Phy sical Injury ¶ 62 The trial court’s finding that J uan was abused due to a substantial risk of phy sical injury was madepursuant to sec tion 2-3(2)(ii) of the Act, whic h states: “(2) Those who are abused include any minor under 18 y ear s of ag e whose pare nt or immediate family member, or any person responsible for the minor ’s welfare, or any person who is in the same family or household as the minor, or any individual residing in the same home a s the minor, or a pa ramour of the minor’s parent:

*** (ii) cre ates a substantial risk of phy sical injury to such minor by other than

acc idental means w hich would be likely to cause death, disfig ureme nt, impairment of emo t i o n al h ealth, or loss or impairment of any bodily function[.] ” 705 IL CS 405/2-3(2)( ii) (West 2010). ¶ 63 The same evidenc e that s u p p o rt s t h e phy sical-a buse finding also supports the court’s finding that the S tate proved, by a preponderance of the evidenc e, J uan was abused due to a substantial risk of phy sical injury . As the court’s finding pursuant to section 2-3(2) (ii) of the Act wa s not ag ainst the manifest we ight of the evidenc e, we aff

irm.

¶ 64 C. The Trial Court’s F inding That J uan and Kihara Were Ne g lected D ue to an Injurious Environment ¶ 65 T h e t ri al court’s finding that J uan and Kihara were neg lected due to an i n j u ri o u s environment was made pursuant to section 2-3(1) (b) of the Act, which provides a neg lected minor includes “any minor under 18 y ear s of age whose environment is injurious to his or her welfa re.” 705 IL CS 405/2-3(1)( b) (West 2 0 1 0 ). “N eglec t is define d as the failure to exercise the car e that circ umstances justly deman d an d encompa sses both willful and unintentional disreg ard of pare ntal duty .” In r e D. W

. , 386 Ill. App. 3d at 135. The term “neg lect” has a fluid meaning that varie s with the facts and circumstance s of each case. In

re R.R.
, 409 I ll. App. 3d 1041, 1045 (2011). “An inju ri o u s environment is an amorphous

conce pt that cannot be define d with particula rity but has been interpre ted to include the brea ch of a pare nt’s duty to ensure a safe and nurturing shelter for his or her children.” In re D.W

. , 386 Ill. App. 3d at 135. ¶ 66 The same evidenc e that supports the phy sical-a buse finding and the finding of abuse due
to a substantial risk of phy sical inju ry supports the finding that the State proved, by a preponde ranc e of the evidenc e, that J uan was neg lected due to an injurious environment. We have held: “[p] roof of neg lect of one minor is admissible evidenc e on the issue of neg lect of
any other minor for whom the pare nt is responsible.” In r e R

. R

. , 409 I ll. App. 3d at 1045. Thus, the evidenc e supporting the neg lect finding for J uan also supports the neg lect finding for his sister Kihara
, who l ived i n the s ame house as J uan and fo r wh o m M r. and Mrs. M.

wer e responsible. As the court’s finding pursuant t o s ec t ion 2-3(1) (b) was not ag ainst the

-12-manifest we ight of the evidenc e, weaff

irm.

¶ 67 D. The D ispositi onal Order ¶ 68 The trial court held a dispositi onal hearing and found both pare nts unable to car e for Juan and Kihara

. The court made J uan and Kihara war ds of the court an d p l ac ed them under DCFS g uardianship. “P u rsuant to section 2-27(1) of the Act, a trial court may commit a minor to war dship upon a determination that the pare nt is unable, for some rea son other than financ ial circ umstances alone, to car e for, protec t, train or discipline the minor and that the health, safe ty , and best interests of the minor will be jeopar dized if the minor remains in the custody of the pare nt.” In re Gabriel E.
, 372 I ll. App. 3d 817, 828 (2007) (citing 705 IL CS 405/2-27(1) (West 2004)). “The trial court’s determinati o n reg arding this will be reverse d only if the fac tual finding s at the dispositi onal hearing are ag ainst the manifest weig ht of the evidenc e or if the court abused its discretion by selec ting an inappropriate dispositi onal order .” In re Gabrie l E. , 372 I ll. App. 3d at 828. ¶ 69 Mr. M.’s only arg ument is we s h o u l d re v er s e the dispositi onal order beca use the trial
court err ed at the adjudication hearing in finding J uan and Kihara wer e abused and neg lected. As discussed above, we aff irm the court’s finding s at the adjudication hearing; acc ording ly
, Mr. M.’s arg ument, that the dispositi onal order s h o u l d be reve rsed based on err ors in the underlying a djudicatory

order , is without merit. I n the abse nce of any other a rg uments, we aff irm the dispositi onal orde r. ¶ 70 We further note we would aff irm even if Mr. M. had otherwise arg ued the finding s at the dispositi onal hearing wer e ag ainst the manifest weig ht of the evidenc e. As discussed above, Ms. Aldana, the Catholic C h arities case worke r assig ned to the case , testified at the dispositi onal hearing that both pare nts had been assessed for service s and neede d pare nting classes, pare nting coac hing, and individual thera py

. Although the coac h who conducte d the
pare nting c lasses wa s pleased w ith their cooper ation, individual therapy had not y et beg un beca use t he age ncy only

had two Spanish-spea

king c ounselors. Ms. Aldana rec ommended the children be made war ds of the court and place d in DCFS g uardianship due to the ong oing service needs of the pare nts. The trial court also admitted a DCFS-integ rate d assessment of the family which noted that whi l e M r. M

. h ad ex hibited some pare nting streng ths, he also display ed a weakne ss by not being able or willing to ensure J uan’s safety

. The assessment also noted Mr. M.’s tende n cy t o b l ame J uan’s injuries on the hospital or the DCFS investigator. During closing argum en t s , M r. M. concur red with the State’s and the public
g uardian’s reque st that the children be made war ds of the court, the pare nts be found unable
to car e for them, and the children be place d under DCFS g uardianship. Acc ording ly
, Mr. M. has waived re view ther eof. In re W illiam H. , 407 I ll. App. 3d 858, 869-70 (2011). ¶ 71 Even in the absenc e of waiver
, all this evidenc e shows t h at wh i le both pare nts have shown a willingness to cooper ate with DCFS, they were not able to car e for J uan and Kihara
at the tim e of the dispositi onal hearing. Acc ording ly
, the fac tual finding s underlying the court’s dispositi onal order are not ag ainst the manifest weig ht of the evidenc e, and the court did not abuse its discretion by selec ting an “inappr opriate” dispositi onal order

. In re Gabriel E. , 372 I ll. App. 3d at 828. We affirm.

-13-¶ 72 I I . Mrs. M.’s Appeal (No. 1-11- 3192)

¶ 73 The public defe nder of Cook County
, who was appointed to repr esent Mrs. M. on appeal, has filed a motion in this court for leave to withdraw as counsel based on his conclusion that there are no meritorious i s s u es to be raised. Although the motion cited Pennsylv ania v. Finley
, 481 U.S. 551 (1987), counsel has filed a brief ref er ri n g t o matters that might,
arg uably
, support an appeal, comply ing with the stricter standard for withdrawal established in Anders v. Calif

ornia
, 386 U.S. 738 (1967). Copi es of the m otio n an d b ri ef wer e sent to Mrs. M. and she was advised she could submit any points in support of this appeal. She has not responded. ¶ 74 We have car efully examined the rec ord and the afor esaid brief and have found no issues of arg uable merit to be asserte d on appeal. Acc ording ly
, we gr ant t he mot ion of t he publi c defe nder of Cook County for leave to wi thdraw as counsel and aff irm the j udg ment of t he circ uit court. ¶ 75 For

the fore g oing reasons, weaff irm the circ uit court.

¶ 76 Affirmed.

-14-