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____________________________________ * Retired Senior Judge assigned to the Superior Court. NON - PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37 IN THE INTEREST OF: S.N.R., A MINOR APPEAL OF: S.R., MOTHER : : : : : : : : : IN THE SUPERIOR COURT OF

PENNSYLVANIA

No. 2758 EDA 2018 Appeal from the Order Entered August 15, 2018 In the Court of Common Pleas of Philadelphia County Family Court at

No(s): CP - 51 - DP - 0001387 - 2018 BEFORE: LAZARUS, J., KUNSELMAN, J., and STRASSBURGER*, J. MEMORANDUM BY LAZARUS, J.: FILED MAY 1 7 , 2019 S.R. (Mother) appeals from the order, entered in the Court of Common Pleas of Philadelphia County, adjudicating S.N.R. (Child ), born September, 2003, dependent , and finding Chil d the victim of abuse by Mother. 23 Pa.C.S.A. § 6303. After our review, we affirm based on the opinion authored by the Honorable Joseph L. Fernandes. 1 

## On April 2, 2018, the Philadelphia Department of Human Services (DHS) received a Child Protective Ser vices (CPS) report that Mother was suffering

_________________ ____________________ _______ 1 

## We note that the court appointed counsel for Child , as well as a guardian ad litem (GAL). Counsel for Child filed a letter to this Court indicating she would not be filing a brief on behalf of Child. The GAL has filed a brief on appeal on behalf of Child , recommending this Court affirm the trial court’s order adjudicating Child dependent and finding child abuse as to Mother. Brief of Appellee S.N.R., at 16. The Philadelphia Department of Human Services (DHS) also filed a brief as a participant, requesting this Court affirm the trial court’s order. Brief for Participant, at 31.

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from Munchausen s yndrome by p roxy . 2 

## The report stated that Mother had made multiple medical specialist appointments for Child, including 37 calls to Child’s primary care physician, 62 healthcare visits, and six emergency room visits in 2016, and 21 calls and 38 healthcare visits in 2017. DHS filed a dependency petition on June 7, 2018, alleging Child was without proper care or control and that Child was a victim of child abuse as defined at 23 Pa.C.S.A. § 6303. Dependency Petition, 6/7/18, at 1. 3 

## Mother and Se.R. (Father) are recently divorced.

_________________ ____________________ _______ 2 

## Munchausen s yndrome by p roxy , a mental illness, now known as Factitious Disorder Imposed on Another (FDIA) , is considered a form of child abuse by the American Professional Society on the Abuse of Children. https://my.clevelandclinic.org/health/diseases/9834 - factitious - disorder imposed - on - another - fdia ( last visited 4/17/19). “ In this mental illness, a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. The adult perpetrator has the diagnosis (FDIA) and directly produces or lies about illness in another person under his or her car e, usually a child under 6 years of age .” Id. 3 

## The dependency petition alleged, inter alia , that [Child] had developed conversion disorder, which is a mental condition in which a person has blindness, paralysis, or other nervous system symptoms that cannot be explained by medical evaluation. The [CPS] report alleged that [Child] had developed ticks [sic] and automatic movements, and that [Child] began receiving mental health treatment through Children’s Hospital of Philadelphia (CHOP) with a social worker and psychiatrist in 2016 because of her diagnosis; that [Child] had not shown any improvement and the ticks [sic] were still present; and t h at [Child] had been admitted to Cumberland Hospital for Children and Adolescents [Cumberland] in Virginia for inpatient mental health treatment as a result of her lack of improvement . The report alleged that [Child] remained at Cumberland Hospital for

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On June 2 5 , 2018, pursuant to a protective custody order, Child was removed from Mother’s care and placed in DHS ’ custody . Order of Protective Custody, 6/2 5 /18. On July 23, 2018, the court held an adjudicatory /child abuse hearing and heard testimony from Brian Brennan, M.D., a child abuse pediatrics fellow at Children’s Hospital of Philadelphia (CHOP). Both Mother and Father were present at the hearing, and Child participated b y telephone. Doctor Brennan testified with respect to the issue of medical child abuse. The evidence established that for the first two years of Child’s life, medical visits were typical. N.T. Hearing, 7/23/18, at 31. Thereafter , medical v isits increased exponentially, to 46 visit s between the ages of two and five , and, by the age of five, Child had been prescribed twenty different medications. Id. at 28, 29 - 31. C hild’s healthcare team at CHOP noted Mother’s behavior. CHOP cha racterized Mother as “hypervigilant” with Child, who was her only child . In 2014, Child was d iagnose d with amplified musculoskeletal pain syndrome (AMPS), a syndrome that cause s amplified pain response to

_________________ ____________________ _______ 

## Children and Adolescents for five to six months beginning in July 2017; that while hospitalized, Child showed g reat improvement and had lost all ticks [sic] and automatic behaviors; that when [Child] returned home around October 2017, she regressed and reverted to exhibiting automatic behaviors and ticks [sic] ; and that since returning home, [Child] has made claims that she was sexually abused by [Father] and staff at Cumberland Hospital for Children and Adolescents. Dependency Petition, 6/17/18, at 2 - 4.

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relatively innocuous physical contact. Despite the recommended treatment of “minimizing accommodations for the child” and “ normaliz[ing] [Child’s] existence,” the increasingly frequent medical visits continued. In 2016, during the time Mother and Father were going through divorce proceedings, Child w as diagnosed with Conversion Disorder. 4 

## This diagnosis led to inpatient admission to Cumberland Hospital for Children and Adolescents [Cumberland], a behavioral health hospita l . Id . at 37 - 38 . While there, and separated from Mother, Child showed marked improvement ; she was discharged asymptomatic. 5 

## Id. at 40 - 41. In June 2018, approximately eighteen months after her discharge from Cumberland, Child was admitted to CHOP with s ever e paralysis; at this time, Dr. Brennan evaluated Child for medical child abu se. Id. at 87, 90 - 91. D octor Brennan testified: [Child] did so well during her three months at Cumberland to the point she was asymptomatic and able to come home only to turn around within a month and — and decompensate to the point where she was having pa ralysis again and needing to be loaded into the

_________________ ____________________ _______ 4 

## Conversion disorder, also called functional neurological disorder, is a condition in which abnormal movem ents or sensations (spells, weakness, tremors) are not due to injury or disease, but rather a result of a miscommunication of the nervous system and the body . https://my.clevelandclinic.org/health/diseases/17787 - conversion - disorder in - children -- adolescents ( last visited 4/17/19). 5 

## When Child returned from Cumberland, she made allegations of prior sexual abuse when she was five or six, against Father. These allegations were determined to be unfounded. N.T. Hearing, 8/15/18, at 21 - 22.

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car. And — and then her doctors had to come down to the parking lot to see her. Id. at 46. Doctor Brennan noted the reference in Child’s medical records to concerns that Mother was “catastrophizing” and exagg erating Child’s symptoms and that Child was “ over - medicalized. ” Id. at 39 - 40, 87. He also expressed concern that Mother and Child were “enmeshed .” 6 

## Id. at 44 . Doctor Brennan testified that in his opinion, to a reasonable degree of medical certainty, Child suffered from medical child abuse. Id. at 42. He explained: [M]edical child abuse is defined as a child who receives unnecessary and harmful or potentially harmful medical care at the instigation of the caregiver. What used to be known as Munchausen’s syndrome by proxy was kind of redefined relatively recently to exclude the intention of the caregiver. In [Child’s] case, [Child] has been provided multiple, multiple, multip le medical therapies and interventions that are potentially harmful and are unnecessary given what w e — what we currently know. . . . In medical child abuse cases, it’s difficult from that one - time clinical perspective to see things until they reach a poin t where you take a . . . big step back and you look at the constellation of everything that’s going on and the severity of the — the psychopathology that the child is starting to exhibit t hat you really do start to . . . get that feeling that maybe this is something that you need to evaluate further [.] Id. at 42 - 44. At the time of that hearing, Child was at CHOP and suffering from “functional paralysis,” which Dr. Brennan described as an inability to walk with no physical or organic explanation. He stated that Child is able to transfer

_________________ ____________________ _______ 6 

## At the August hearing, both Mother and Child testified that they slept together on the living room sofa, and tha t they had done so for the past few years. N.T. Hearing , 8/15/18, at 55, 95 - 96. In fact, Mother testified that this sleeping arrangement had started when Child was nine years old. Id. at 96.

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herself over to a wheelchair and that her legs move in her sleep. “ And so, she’s able to do things that someone who was legitimately paralyzed from the waist down would be unable to do .” Id. at 91. At CHOP, Child was under going intensive psychotherapy. Id. at 92. At the conclusion of the hearing, the court ordered parental visitation at the discretion of the treatment team and Child , and scheduled a hearing for August 15, 2018. At the August hearing, th e court heard testi mony from Child, Child’s GAL, Mother, Father, DHS , and CUA caseworker/ Catholic Community Services worker. Mother and Father were both represented by counsel. Also appearing were Child’s legal counsel and a Child Advocates Staff Attorney . At the conclusion of the hearing , and following the argument of counsel, the court adjudicated Child dependent pursuant to the Juvenile Act, 4 2 Pa.C.S.A. §§ 6301 - 6365, found clear and convincing evidence of child abuse under section 6303 of the Child Protective S ervices Law (“CPSL”), 23 Pa.C.S.A. §§ 630 1 - 6386, and ordered the CPS report changed from indicated to founded. Mother raises three issues on appeal: 1. Did the trial court err and/or abuse its discretion when it found that the [DHS] had met its burden of finding, by clear and convincing evidence, that Child was dependent? 2. Did the trial court err and/or abuse its discretion when it found that the [DHS] had met is burden of establishing child abuse as to Mother by clear and convincing evidence? 3. Did the trial court err and/or abuse its discretion when it determined the [CPS] report was “founded” and changed the report from a “CY48” into a “CY49?”

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Appellant’s Brief, at vi (slightly reworded for clarity ). Our standard and scope of review from an or der in a dependency case are well settled. We must accept the facts as found by the trial court unless they are not supported by the record. Although bound by the facts, we are not bound by the trial court’s inferences, deductions, and conclusions therefr om; we must exercise our independent judgment in reviewing the court’s determination, as opposed to its findings of fact, and must order whatever right and justice dictate. We review for abuse of discretion. Our scope of review, accordingly, is of the bro adest possible nature. It is this Court’s responsibility to ensure that the record represents a comprehensive inquiry and that the hearing judge has applied the appropriate legal principles to that record. Nevertheless, we accord great weight to the court ’s fact - finding function because the court is in the best position to observe and rule on the credibility of the parties and witnesses. In re C.M.T. , 861 A.2d 348, 351 (Pa. Super. 2004) (citations omitted). Expert medical testimony established that it was Mother's actions — insisting on invasive and unnecessary medical intervention — that resulted in Child’s ailment s and diagnoses. Child was diagnosed with conversion disorder, and intensive behavioral health and psychiatry evaluation and treatment were rec ommended. However, Mother refused to accept that there was not a medical explanation for Child’s symptoms, and continued to interfere in her treatment, requesting more invasive testing and medications , including a lumbar puncture. Nevertheless, under Moth er’s care, Child’s condition continued to deteriorate until she could no longer complete age - appropriate activities of her daily life. Mother continued to insist on unnecessary treatments and accommodations for Child , such as a chair lift and pain

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medicati on. By the time of Child’s August 2017 hospitalization at CHOP, Mother was insisting on anti - seizure medications and cardiac monitoring. 7 

## After our review of the parties’ briefs, the record, and the relevant law, we conclude that the trial court properly foun d Child was dependent and that Mother committed child abuse pursuant to 23 Pa.C.S.A. § 6303(b.1)(2) ( “[f]abricating, feigning, or intentionally exaggerating or inducing a medical symptom or disease which results in a potentially harmful medical evaluat ion or treatment to the child through any recent act.” ). 8

_________________ ____________________ _______ 7 

## The Child Protective Services Law (CPSL), 23 Pa.C.S.A. § 630 1 - 6308, provides, in relevant part: (b.1) Child abuse . -- The term “child abuse” shall mean intentionally, knowingly or recklessly doing any of the following: * * * (1) Causing bodily injury to a child through any recent act or failure to act. (2) Fabrica ting, feigning, or intentionally exaggerating or inducing a medical symptom or disease which results in a potentially harmful medical evaluation or treatment to the child through any recent act. (3) Causing or substantially contributing to serious mental injury to a child through any act or failure to act or a series of such acts or failures to act. 23 Pa.C.S.A. § 6303(b.1)(1) - (3). 8 

## We note also that the trial court found Child’s testimony not credible, found Father’s testimony credible, and made no dete rmination with respect to Mother’s credibility. However, the court concluded that the evidence presented by the caseworkers and medical expert established that Mother

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The trial court has comprehensively and correctly addressed Mother’s claims on appeal . Accordingly, we affirm the trial court’s August 15, 2018 order on the basis of Judge Fernandes’ opinion. 9 

## We direct the parties to attach the trial court opinion in the event of future proceedings. Order affirmed. Judgment Entered. Joseph D. Seletyn, Esq. Prothonotary Date: 5/17/19

_________________ ____________________ _______ 

## posed a “grave threat” and that her visits would be suspended until further hearing and recommendation by Child’s treatment team. 9 

## W note a typographical error on page 10 of the trial court’s opinion; the first word of the second paragraph should read “Mother’s,” not “DHS’s.”Circulated 05/10/2019 02:05 PM



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### B e g gi n , Es qui r e , c o un s e l fo r M o th e r ( " M o th er ' s C o unse l " ) 

### fil ed a tim e l y N o ti c e o f Ap p e al 

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### s ympto m s th at cann o t 

### be e xp l ain e d b y 

### m edi c al ev aluati o n . (N . T . 0 7 /23 /1 8 , p gs . 3 7 - 3 8 ) . P a g e 1 o f 1 4s oc i al w o r k e r an d p s y c h i atri s t in 2 0 1 6 d u e to h er di agn o s i s ; C hi l d ha d n o t sh o wn any imp ro v e m e nt an d th e ti c k s w e re s till p r es e nt ; C hil d h ad be e n adm i tt e d t o C umbe rl an d H o sp i tal fo r C hi l dr e n an d A d o l e s c e nt s ( ' 'C H C A " ) in V i rg ini a fo r inp ati e nt m e ntal h eal th tre atm e nt as a r e s u lt o fh er l ac k o f imp ro v e m e nt ; C hi l d r e m a in e d at C H C A fo r fi v e t o s i x m o nth s , 

### b e ginni n g in Ju ly 

### 2 0 l 7 ; whi l e C hi l d w as h o s p i t al iz e d at C H C A, C hi l d sh o w ed gr e at imp r o v em e nt and J o st al l ti cks an d o th er auto m ati c be hav i o r s ; wh e n C hi l d r e turn e d h o m e t o M o th e r 

### in O c t o b e r 

### 2 0 1 7 , s h e 

### re gre s se d an d r e v e rt ed t o e xh ib i tin g aut o m atic b e hav i o r s an d ti c k s ; aft e r C hi l d r e turn e d h o m e fro m C H C A , sh e c l aim ed that s h e w as s e xu al ly ab us ed b y F ath e r an d s taff at C H C A ; M o th e r re m o v e d C hi l d fro m s c h o o l tw o y ears p ri o r ; C hi l d n o l o n g e r t o o k dan ce l e s so ns ; C hi l d w as enro ll ed in a ho m e s c h o o l p ro gr am ; C hi l d h a d l i ttl e so ci al co ntac t ; M o th e r stat e d that C hi l d ' s be havi o r w as a re s ul t o f F ath e r ' s acti o ns ; M o th e r h a d p re v i o u s ly g o n e t o C hil d ' s P C P ' s o ffi ce an d t o l d an o th e r p hy s i c i an that C h i l d w as havin g t e rrib l e mi grai n e s ; 

### ihar p hy si ci an s e nt C hi l d t o a n euro l o gi s t ; M o th e r re turn e d to th e P C P ' s o ffi c e an d s p o k e t o a di ff erent p hy s i c i an a

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### has been p r es cribe d m edi c ati o n fo r m e ntal h e al th c o n ce rn s ; M o th er an d F ath e r w e re g o in g thro u gh a di v o r ce ; M o th e r a ppeare d t o be anx io u s ; M o th er d e s c rib e d F ath er 

### as an ab u s i v e pe r so n ; M o th e r s tat e d that th e f ami l y h a d been inv o l v e d wi th c hi l dre n and y o uth s e rvi ce s auth o ri ti e s in th e p as t. Thi s rep o rt w as in di c at e d . D H S vi s i t ed C hi l d an d M o th e r o. t th e i r h o m e o n th e s am e day . Wh e n D H S spo ke Wi th C hi l d , C h i l d deni ed th e al l e g ati o ns ; s h e di d n o t be l i e v e that M o the r w as 

### makin g h e r s i c k t o g e t attenti o n an d th at th e s ymp t o m s w e re r e al ; M o th e r was th e o nly pe rs o n wh o und ers tood what s h e 

### was g o in g thro u gh ; s h e n o l o n g e r int erac te d wi th F ath e r afte r b e ann o un ce d that 

### he w as div o rc in g M o th e r o n F a c eb o o k ; p ri o r t o th e div o rce , C hi l d rare ly int e rac t e d wi th F ath er becaus e h e w as e i th er w o rki n g o r r ar e ly at h o m e ; C hi l d w a s s u p po se d to be g in thera

p y s e ss io ns wi th F ath e r but M o the r t o l d h e r th at i f s h e di d n o t g et be tt er, F ath e r wo u l d g e t ful l c us to dy , whi ch caus ed h e r a l o t o f anxi ety ; C h i l d ac c use d F ath er o f sexual ly ab us in g h er wh e n s h e w as abo ut fi v e o r s ix y ears o l d, b ut wa s unab l e t o gi v e D H S f urth e r d etai l as to F ath e r ' s ac ti o ns o th er than that h e c am e int o h e r bedro o m at ni ght. D uri n g th e int e rv i e w , C hi l d be g an makin g cl i c ki n g no i s e s wi th h er m o uth an d P a g e 2 o f 1 4C h il d s t at e d th at sh e co ul d n o t c o ntro l the so und s becaus e sh e h ad c o nv e rs i o n di s o r d e r ; s h e b e g an exh ib i ti n g th e symp t o m s o f th e di s o rd e r 

### a f

e w y ears ag o ; the s ymp t o ms w e re d u e to s tr e s s at sc h o o l an d m an i fe s ted aft e r an i n c i d e nt in sc h oo l whe re a f e ll o w s tud e nt s p ray e d m a c e int o th e 

### air ; s h e had p s eu d o - s ei zur e s ; s h e s o m e t im es h ad o utb ursts o f statin g th e p hrase " w o o - h o o " an d bec am e 

### p aralyz e d ; s taff at th e h o s p i tal to l d h er d oc to rs 

### that she was 

### g ettin g b ett e r b ut th e y l i e d an d that s h e 

### fak ed h e r imp ro v e m e nt s o th at s h e co ul d be 

### disc harg ed from th e h o s p i tal . Wh e n 

### D H S spo k e wi th M o th e r , wh o al s o d e n i e d th e al l e g at io ns o fthe report, M o the r s tat ed that 

### after th e in c i d e nt wh e r e th e s t u d e nt s p r ay e d m a c e · in th e ai r , C hi l d de v el o ped ti c ks an d p s e u do - symp to m s o f p hy s i cal di s o rd e r s an d il ln e s se s ; s h e had tak e n C hi l d t o 

### many sp eci al is ts to h e lp c ar e fo r C hi l d an d th at co u l d n o t b e d o n e wi th o ut a re f erral fro m 

### the PCP d

u e t o insuran ce re s tri cti o ns . O H S l at e r l e arn e d that M oth e r an d C h il d had P ers o nal Cho i ce m edi cal 

### insuran c e . ' M o th e r al s o s tat ed 

### that s h e n e v e r saw F ath e r t o u c h C h il d ina p p ro p ri ate ly ; C hi ld 

### bad n o t to ld he r abo ut th e s exual ab use 

### unti l r ec ently vi a te xt m e s s ag e ; C hi l d n e v er to l d h e r in d etail abo ut what hap pe n e d wi th F ath er , b ut s h e w a s s ur e C hi l d t o l d th e th e r a

p i s t . O H S as s es sed th e 

### h om e and de termi n ed that i t was a p p r o p ri at e ; h o w e v er , 

### D H S l e arn e d th at al th o u gh C hil d 

### has he r o wn 

### bed an d bedroo m , C hi l d an d M o th e r s l ept i n th e li v i n g ro o m in th e i r o wn r e cl in ers . 

### Wh en D H S ask ed C hil d 

### abo ut th e s l e ep in g arr an g e m e nts , C hi l d e xp l ai n e d th at sh e c o ul d n o t s l eep in h er r oo m because sh e w as 

### se xually as saul t e d b y F ath e r i n h e r bedro o m . 

### On M ay I , 2 0 1 8 , D H S s po k e wi th F ath er , wh o 

### deni ed se xually as saul tin g C hi l d , an d h e stat ed th at h e b e l i e v e d th e al l e g ati o ns w e re a p art o f a p l o t fo r custody o f C hi l d b y M o th e r ; h e w as a c c use d o f m any th i n g s s in ce h e ini ti at ed di v orce p roc eed i n gs again gt M o th er tw o y e ars a g o ; h e be li e v e d h e w as a c c u s e d o f th in gs wh e n e v e r h e di d so m e tbmg to furth e r th e sep arati o n fro m M o th e r ; thi s r ece nt al l e g ati o n aro se tw o w e e ks afte r he s i gned the family ho m e o v e r to M o th e r ; h e be l i ev e d that th e al l e g ati o n s s t e mm ed fro m th e fa ct that h e woul d no t r e linquis h his p arental ri ghts to C hi l d n o r wo ul d h e reuni te wi th M o th er ; h e co ul d no t hav e 

### sexually ab us e d C hi l d bec aus e h e w as n e v e r al l o w e d to b e al o n e wi th C hil d ; M o th er w as o v erly pos sessi v e o f C hil d ; h e n e v e r went i nto C hil d ' s be dro o m at ni ght ; h e w o rk ed m ost ni ghts as a fire fi ght er and , ex c ept fo r o n e vi si t , h ad n o t s e e n C hi l d o ut s i d e o f a h o s p i tal in th e l as t two years; he 

### was co ncern e d abo ut C hil d ; C hi l d had o v er 3 0 0 ex am s , l abo rat o ry t es ts , an d o ther speci al ty servi ce s since she w as nin e y e ar s o l d ; h e vi s i t ed C hi l d

4 

### P erso n al C h o i ce insuran ce does n o t require a re f erral to 

### see a special ist. Page 3 o f1 4wh i l e s h e was at C H C A an d s h e w as d o in g w e ll th e re ; C hi l d re gr es sed wh e n s h e return e d to M o th er ' s c are . On M ay 1 1 , 

### 20 1 8 , C hi l d att e n d ed a fo re ns i c int erv i e w at th e P hi lade lp h i a C hil dre n ' s Al li an c e ( " P C A " ) . Wh e n 

### C hi l d arri v ed , s h e t o l d 

### staff 

### that s h e c o ul d n o t s e e 

### anythin g be cau se o f h e r co nv e rs i o n di s o rd er ; h o we v er , C hi l d 

### was o b s e rv e d 

### o n vi d e o us in g he r c e llul ar 

### t e l ep h o n e . C h i l d k ept h e r e y e s cl o se d thro u gh o ut the e ntire inte rvi e w . C hi l d ini ti al ly c o ul d n o t e xp l ain anythi n g in d e t ai l th at h ap pe n e d t o h er , b ut e v e ntu a lly s tated that ab o ut fi v e t o e i ght y e ars ag o F athe r cam e int o h e r b e droo m an d to u c h e d him s e lf ina p pro p ri at e ly bef

o re pen e tratin g h e r . C hi l d s tat e d th at s h e c o ul dn ' t re m e mbe r 

### if this w as a re c urrin g e v ent ; sh e only rec ent l y rem e mb e red ; s h e u s e d t o b e stro n g ly b o n d e d wi th F athe r unti l tw o y ear s p ri o r ; wh e n F athe r 

### s ep arated fro m M o th e r , h e 

### be g an treatin g M o th e r 

### poo rly ; s h e o nly di s c lo sed to M o ther bec aus e M o th e r t o l d h e r 

### th a t 

### i f s h e 

### di d n o t get h e r 

### m e ntal h e al th an d s c h oo l i s s u e s un d e r co ntro l , 

### s he w o ul d be s e nt t o li v e wi th F ath e r ; s h e di d n o t w ant t o li v e wi th F ather . Wh e n th e inte rvi e w end e d, C hi l d o pen ed h er e y e s an d w as s ee n in th e w ai t i n g area u s in g he r ce llul ar t e l ep h o n e an d 

### li st enin g to mus i c . O n M ay 

### 2 5, 20 1 8 , D H S rec e i v ed c o rre s p o n de n c e fr o m Chi l d ' s 

### m ental h eal th tre atm e nt t eam at C H O P . T h e c o rre s po n d e n c e in di c at ed that M o th e r 

### had be en hype rv i gi l ant ab o ut C h i l d ' s h e al th s in ce s h e w as a b ab y , e v e n g o i n g 

### so f ar 

### as s l eep in g o n th e fl o o r o f C hi l d ' s ro o m , n e xt t o h er c rib , whi c h w as unwarr amed becaus e C hi l d was a h eal thy b ab y ; M o th e r ' s hyp e rvi gil an c e caus ed a strain o n b e r m arri a g e an d 

### F ath er di se n g a g ed fro m the f am ily as M o ther an d C hi l d b ec am e m o re an d m o re e nm es h ed an d c o ntinu e d t o m eet eac a o th er ' s e m o ti o nal n e e ds ; C hi l d be g an e xhib i ti n g so m ati c s ymp t o ms aro un d ag e e i ght, after F ath e r m o v ed o ut o f the h o m e fo r an e xt en d e d pe ri o d 

### o f tim e ; C h i l d was e v e nt

ual ly di a gn o se d wi th amp l i fi ed muscul o s ke l e tal p ain s yn dro m e ( " AMP S " ) aft e r mu l tip l e vi s i ts to v ari o us s pec i al i s ts ; C hil d be g an tre atm e nt fo r anxie ty in 2 0 1 4 an d that anxi ety tri g g e r ed C hil d ' s 

### AMP S ; C hi l d 

### an d M o th er atten d ed 

### th era p y s e s s i o ns to g eth e r fo r 

### y ears wi th o ut F ath e r ; C hi l d b e g an 

### e xhib i tin g co nv er s i o n di s o rd er s ympt o ms in 

### 2 0 1 6 ; after 

### F ath er m o v ed 

### o ut o f th e 

### h o m e in 

### 2 0 1 6 , C hi l d be g an 

### suff erin g fro m p seud o- se izures , ful l b o dy p araly s i s , an d th e inab ili ty t o o pe n h er e y e s and/o r m o uth, in ad di ti o n to AMP S ; C hi l d ' s s ymp t o m s b ecame s o d eb ili tatin g that s h e c o u l d n o l o n ger atte nd s c h oo l o r p arti c ip at e i n ag e - a p p ro p ri at e ac ti v i ti e s ; F ath er b e g an parti c ip at in g in th e ra p y whi l e Chi l d w as at C H C A an d i t was r ec o mm en d e d th at th e s es s io n s c o nti nu e o n ce C h i l d was di s c h arg ed fr o m C H C A ; th e fo c u s 

### o f th e 

### th erap y s ess i o ns P a g e 4 o f 1 4betw e e n F ath er an d C hi l d was t o r e e n g ag e F ather in the fami ly uni t 

### an d t o d e c r e as e 

### C h il d ' s c o nv e rs i o n di s o rd er s ymp t o m s 

### b y dilutin g the enm eshm ent betw e e n C hi l d an d M o th e r s o 

### that C hi l d c o u l d de v e l o p a g e 

### ap p ro p ri ate aut o n o my 

### an d ind ep e n d en ce ; aft e r C hi l d ' s s ymp t o ms re gre s s e d a ft e r sh e w as di s charg e d fro m C H C A. M o th er rem o v ed 

### C hi l d fro m p u b li c s c h o o l an d enro ll e d C h i l d 

### in a 

### c yb e r - sc h o o l agai nst th e recomme ndati o n o f C h i l d ' s tr e atm e nt t e am ; C hi l d w a s sti ll att e n din g th e r a

p y 

### se ss i o ns wi th F ather, 

### ho wev er , her 

### symp t oms p r e v ent ed h er fro m 

### atte ndin g s e s s i o n s ; 

### wh e n F ath e r s u g g ested pe ti ti o nin g the 

### Dom esti c Rel ati o ns 

### B ran c h o f F am i ly C o urt 

### to r e vi s i t h i s 

### an d M o the r ' s 

### shared c ust o dy arrang em e nt, the thera p y s es s i o ns re sum e d ; wh e n 

### C hi l d ' s symp to m s di d n o t d e cre as e , 

### th e tr eatm ent team su gg est ed that C hil d 

### re turn t o re s i de nt i al tr eatm e nt ; C hil d m a d e a cc us ati o ns 

### th.at F ath e r s e xually assaul ted her sho rtly the re aft e r an d F ath e r ' s th e r a p y s es s i o n s w i th C hi l d c e as e d ; th e tr eatment team e xpressed co n ce rns that whi l e M o th e r di d n o t 

### stri ctly m e e t th e d e fi ni ti o n o f facti ti o us diso rd er 

### imposed on ano th e r , th e re was s i gnifi c ant illn e s s 

### e xagg e r ati o n and s ymp t o m reinf o rcem e nt 

### occurring ; C hi l d 

### d i d n o t 

### hav e any s o c i al inte racti o ns 

### an d C h i I d and M o th er ' s l i v e s appear ed to re v o lv e 

### aro und C hi l d ' s p hy s i cal s ymp t o m s 

### an d s us pe c t ed ai lm e nts ; 

### M o th e r ma y be 

### p urp o s e ly attempting to 

### keep C hil d fro m F ath e r 

### d u e t o h e r 

### o wn f

ear o f l os s and v e ry s i gnifi cant e nm eshment 

### wi th Child; C hi l d w as cau ght in a d e s tru c ti v e c o nfl i c t b e twe e n F ath e r and M o th er t o th e po int that Chil d ' s well - be in g w as be in g impac ted . On M ay 2 9 . 2 0 1 8 , D H S l earn e d 

### that since 2 0 1 6 , Chl l d had 2 5 x - ray e x am in ati o n s , three m a gn e ti c res o n an c e 

### imagin g (' ' MRI" ) 

### e xaminati ons , 

### and tw o ul traso un d s . 

### Eac h e x am inati o n s h o w e d that C hi l d w as e xpe ri e n c in g p se ud o- s ympt o m s . Chi ld' s th era p i st stat ed th at M o th e r w as i n 

### d e ni al o f C hil d ' s s tr e n gths an d l imi tati o ns and f e l t that Chi l d ' s h eal th 

### w o ul d i mp r o v e o n c e F ath e r w a s n o 

### l o n ge r i nv o lv ed 

### in h er c are ; 

### h o w e v er , F ather 

### had no t been 

### inv o l v ed fo r 

### m o nths an d C hi l d ' s s ymp t o ms h a d o nly in c reased . On 

### M ay 3 1 , 2 0 1 8 , O H S r ece iv ed co rrespoeden ce 

### fro m Chil d ' s P C P . P C P s tated that C hi l d 

### hsd an extre m e numb er o f

o ffi ce an d e m e rg en c y department visi ts ; C hil d 

### was ex amin e d 

### b y a 

### l arg e number o f 

### s ub s p e c i al i s ts ; C hi l d had 

### b een wi th drawn 

### fro m sc hoo l and c eas ed 

### al l ac t i vi ti e s n o rm al fo r a c hi l d h e r a g e ; th ere w e re n o o rg ani c c auses fo r any o f C hi ld ' s s ymp t o ms ; h e r e f err ed C hi l d fo r i npati e nt tr e atm e nt at 

### C H C A 

### after m edi cati o n 

### and o utpati ent tr eatm e nt d i d n o t w o r k an d th at 

### aft e r C hi l d re gre s s ed u

po n re turnin g h o m e , b e questi on ed her abo ut th e re gre s s i o n an d s h e s tated that s h e hat e d h o s p i tals so muc h that sh e 

### d i d ev erything 

### sh e could t o be 

### di s c harg ed , whi c h 

### s u g g e st ed Page 5 o f l 4

### � 

# .. ..

. . 

### � that C h il d 

### was ab l e to 

### co ntro l h er s ymp t oms ; Chi l d 

### repo rt ed th at s h e w as s e xual ly ab us e d b y



### h o s p i t a l s t a ff 

### an d F ath e r ; th e h o s p i tal fo und 

### n o cred ibi li ty in h er 

### stat e m e nt s re g ardi n g al l e g ati o n s o f ab u s e 

### ar th e h o s p ital ; h e 

### w as co nce rn ed that Chi l d ' s cas e s h o w ed s i gn s o f 

### Mun cbau se n syndro m e 

### b y p ro xy an d that 

### C hil d an d M o the r 

### were in co llusi o n 

### aro un d C hi l d ' s s ymp t o m s ; 

### C hil d 

### w as co mp le te ly dy s fun cti o nal an d 

### in 

### need o f c hang e o f be r 

### enviro nm ent, e i th e r in 

### an in s ti tuti o n al 

### o r fo s te r 

### c are p l ac e m e nt 

### PC P 

### in clud ed a l i st 

### o f th e numbe r o f 

### v i s i ts t o 

### bo th 

### th e o ffi ce an d e m e rg e n c y ro o m , t e l ep h o n e call s mad e b y M o th er reg ardin g 

### C hil d ' s h e al th b e tw e en 2 0 0 9 an d 2 0 1 7 , 

### an d a l i s t o f s pec i al i s ts th at C hil d has 

### bee n e xamin e d b y s o 

### f ar . C urre ntly , C hi l d is 

### o v e rw e i ght an d 

### has b een diagnosed with 

### co nv e rs i o n di s o rd e r . C hi l d i s recei vin g tr eatm e nt thro u gh C H O P an d i s o n a 5 04 

### p lan f or spec i al ed

ucati o n ac c o mm odati o ns in 

### sc h oo l d u e t o h e r c o nv e rs i o n di so rd e r di agn o s i s . M o ther i s c urre ntly un e mp l o y e d an d w as 

### p r e v i o us ly emp l o y e d as a 

### m ed i c al p ro fe s s i o nal at 

### C H O P . M o th er has a 

### hi sto ry o f m e ntal h eal th i ss ue s . D H S l earn e d th at 

### M o th er p re vi o us ly recei v ed the rapy thro u gh C o uns e l i n g 

### Or Re f erral A s s i stan ce ( " C O RA " ) in 2 0 1 7 ; h o w ev e r , sh e st o p ped atte nding 

### afte r s ix s es s i o n s . M o th e r has 

### p r ev i o u s ly be e n di a gn o s e d 

### w i th anx i e ty an d dep r e ssi o n . 

### On J une 

### 7 , 20 1 8 , O H S fi l ed a d epe n d e n c y p e ti ti o n fo r C hi l d . 

### On July 2 3 , 2 0 1 8 , an d Au gus t 1 5 , 2 0 1 8 , an ad judi cat o ry , c hil d ab u s e an d pe rman en c y h e ari n g w as h e l d fo r C h i l d . Th e 

### tri al c o urt h eard t estim ony from the 

### D H S inv e s ti g at o r , th e C UA c as e m an a g er, a p hy s i c i an fro m C H O P , M o ther , F ather , an d Chil d . Th e tri al 

### co un ad j udi c at ed C hi l d d ep e n d ent an d fo un d c l e ar an d co nvin c in g evi d en c e that 

### Chil d 

### was a vi c tim o f c h i l d ab u s e un d e r 2 3 P a. C . S . A . § 6 3 0 3 ( b . 1 ) ( 2 ) . The 

### tri al c o urt di s c h arged the tempo rary 

### co mmi tm e nt t o D H S an d ful l y 

### co mmi tt ed C hi ld . T h e tri al co urt o rd e r ed C UA to 

### d o a hom e e v aluati o n an d c l earan c e s o n M o th e r ' s h o m e . The 

### tri al co urt re f

erre d M o th er fo r a pare ntin g capaci ty 

### e v aluati o n ( " P C E " ) , B H S fo r a co ns ul tati o n an d/o r e v alu ati o n . Th e tri al co urt al so o rd e red Mo the r to 

### p r o vi d e v eri fi c atio n o f e mp l o ym e nt an d fo un d M o th e r to 

### b e a grav e thr eat 

### t o 

### the 

### best interests o f C hi l d th e r eb y s us pe n di n g h er v i s i ts an d te l ep h o n e c o ntac t wi th C hi l d . 

### If M o the r w as no t e mp l o y ed, M o th er was 

### t o b e r e fe rred to 

### ARC fo r emp l o ym e nt . F urth erm o re , the 

### tri al co urt 

### fo unded th e C Y 4 8 an d 

### turn e d i t i nt o a C Y 4 9 . O n S ep te m h e r l I , 2 0 1 8 , C o unse l fi l ed tbi s a ppeal o n be hal f

o f M o th e r.

P ag e 6 o f l 4D i s c u s s i o n : O n a p pe al , M o th e r s tat e s th at th e 

### tri al c o urt err ed an d/o r ab us e d i t s d i s c re tio n wh en : 1. It fo un d that D H S , b y c l e ar an d co nv in c in g e vi d e n c e , h ad m e t it s b urd e n t o e s t ab l i s h th at c h il d ab us e e x i s t ed 

### as t o M o th e r . 

### 2 . It
.. fo un d ed " th e 

### C P S rep o rt o f

### Ap ril 2 , 2 0 1 8 , as t o M o th e r . 

### 3 . It fo un d th at 

### O H S , b y 

### cl ear an d c o nvin c in g e v i d e n c e 

### ha d m e t i t s b urd e n t o fin d C h i l d d epe n d e nt . Fo r th e p urp o se o f th i s o p ini o n , M o th er ' s i s su e s wi ll be co n s o li dat e d t o r ead : Di d th e tri al co urt 

### e rr o r ab u s e it s di sc re ti o n 

### wh e n i t fo un d b y cl e ar an d c o nv in c in g e v i de nc e that C hi l d 

### w as a vi c ti m o f c h i l d ab u s e und e r 

### 2 3 P a. C . S .A. 

### § 6 3 0 3 and th e re fo r e 

### m et th e d e fini ti o n o f 

### a d ep e n d e nt c hi l d un d e r th e Juv e nil e A c t ? An i s s ue i s w ai v ed o n a p p eal 

### wh ere i t i s n o t s pec i fi ca lly p r e s e nt e d in th e Ap pe ll ant ' s P a . R. A. P . l 9 2 5 (b ) s tat em e nt . 

### I n re 

### C. P. , 9 0 1 A . 2 d 5 1 6 , 5 2 2 ( P a. S u p e r . 20 0 6 ) ; 

### S

e e I n 

### re J. E. D. . 8 7 9 A. 2 d 2 8 8 , 2 9 3 , fn . 7 (P a . S u pe r . 2 0 0 5 ) . lt s h o ul d be n o t ed that M o th er di d n o t ap peal th e fin din g o f grav e thre at , th e reb y s us p en din g h er vi s i ts an d t e l ep h o n e c o ntac t wi th C h il d . A s s u c h , M o th e r has w ai v e d h e r ri ght to a p peal th e fin ding o f gr av e thre at an d vi s i t s us p e ns i o n . C hil d ab u s e i s d e fin e d at 

### 2 3 P a . C . S . A . 

### § 6 3 0 3 (b . 1 ) ( 2 ) as f a b ri c atin g , f

e i gnin g , o r int e nti o n al ! y e xag g e r atin g o r ind

uc in g 

### a m e di c al s ymp to m 

### o r di se as e , whi c h 

### res ults in a p o t enti al ly h arm ful m edi c al e v alu ati o n o r tre atm e nt to th e c hi l d thr o u gh 

### any r e c e nt act 5 Th e e x i s t e n ce o f chi l d a bu s e must be fo un d b y cl ear an d c o nv i n c in g evi d en c e b ut th e i d e nti ty o f th e a b u s e r n e e d o nly b e e s tab l i s h e d thro ugh p rima fa d e e vi d e n ce . 

### I n re L. Z. , 1 1 1 A. 3 d 1 1 6 4 , 1 1 7 4 ( P a . 2 0 1 5 ) . P rim a f ac i e e vi d e n c e o f a

b us e i s e s t ab li s h e d un d e r 2 3 P a . C . S . A. § 6 3 8 1 ( d) as : Ev i d e n c e that a c hi l d 

### h as s u ff ered c hil d 

### ab us e o f su c h 

### a n ature as w o ul d o rdi n ari ly n o t b e s ustai n e d o r e xi s t e xc ep t b y reaso n o f th e a c ts o r o m i s s io ns o f th e 

### pare nt . . . r e s po n s ib l e fo r th e w e l f

ar e o f th e c hi l d shal l be p rirn a fa d e ev i d en c e o f c hil d ab us e b y 

### th e p are nt .. . r es po ns i b l e fo r th e w e lfare o f 

### th e c h il d . Thi s s tatut o ry se c ti o n a

p p l i e s i fth e ab us e i s o f a nature that w o ul d o rdinari ly n o t be s u stain ed o r e x i st e x c ep t b y re as o n o f th e ac ts o f th e parent an d that th e p ar e nt i s p ro v e d t o h av e h ad re s p o ns ib i l i ty fo r th e w el f are o f th e chi l d at 

### the tim e o f

ab use . 

### I n re L Z. , 1 1 1 A .3 d at 1 1 7 0 .

' Th i s is c o mm o n l y r e f

erre d t o as " Mun ch aus e n S yndr ome b y Pro xy " o r "fa c ti ti o us d is orde r . " Th e Op i n i o n w ill re f er to 

### lh e ac t as m e di cal c hild ab u s e . P ag e 7 o fl 4

### M o th er all e g e s 

### that th e tri al c o urt err ed in fin din g c hi l d ab us e b y 

### cl e ar an d 

### co nvi n c in g evi d en c e . 

### D H S o b tain e d an O P C 

### afte r th e 

### C H O P C hi l d Ab u s e C l ini c d e t e rm in e d 

### th at C h il d 

### w as s uff eri n g 

### fro m m e di cal c hi l d ab us e . (N . T . 0 8 / l S / 1 8 , 

### p g . 2 0 ) . I t 

### was e s tab li s h ed fro m th e t e s tim o ny 

### o f D r . B ri an W i ll i am B r enn an o f C H O P ( "' P hy s i ci an " ) 6 

### that C hi l d s uff ered fro m m e di c al chi l d ab use b ased o n th e exte ns i v e m e di cal hi s t o ry o f Ch il d . (N .T. 0 7 /2 3 /I 8 , p g . 4 2 , 4 9 - 5 0 ) . C hil d w as fir s t e valu ate d 

### b y P hy s i c i an i n Jun e 2 0 1 8 , aft er C hi l d p re s e nt ed at th e se xual a b u s e c l ini c at 

### C H O P b ased o n th e all e gati o ns o fsexual ab us e b y F ather an d tbe s ra ff at C H C A . (N . T . 0 7 /2 3 /1 8 , p g s . 2 4 - 2 5 ) . 7 D H S 

### h as d et e rmin ed 

### that th e s e xual ab use al l e g ati o ns mad e 

### b y C hi l d w e r e unf oun d e d . (N 

### . T . 0 8 / 1 5 / 1 8 . p g . 2 9 ) . A ft e r 

### re v i ew o f C hil d ' s m edi c al 

### r e c o rd s , P hy s i c i an o b se rv e d th at 

### C h i l d had 

### vi s i ted h e r P C P 

### a

ppro ximate ly 1 5 6 tim e s , M o th e r m ad e twi ce as m any p h o n e 

### c al l s t o th e 

### P C P as vi s i ts , an d C hil d vi s i ted 1 5 di ff ere nt s ub spec i al i sts . (N . T . 0 7 /2 3 / 1 8 , p g s . 2 9 - 3 0 , 3 3 - 3 4 ) . Wh e n C hi l d b e g an see ing a 

### th e r ap i st fo r 

### be h avi o r al h e al th aro un d a g e 7 , C hi l d ' s m e di c al 

### uti li zati o n o f m edi cal 

### a p p o intm e nts d ec r eas ed d urin g that ti m e p eri od . (N . T . 07 /2 3 /1 8 , p g s . 3 5 - 3 6 ) . B y C hi l d ' s 

### pre - t e e n y e ars , C hi l d had 

### be en di a gn osed wi th 

### asthma, re flux , S e v er s D i s eas e . ! AMP S 9 , 

### an d co nv e r s i o n d i so rd e r . (N . T . 0 7 /2 3 / 1 8 , p g s . 

### 3 4 , 3 7 , S 1 ) . F o ll o wi ng C hi l d ' s di a gn o s i s o f

### AMP S , C hi l d w as di a gn o s ed wi th co nv e r si o n di s o rd er wh e re C hil d 

### be g an hav i n g p s e u d o - se i zure s 1 0 

### inv o lvi n g l e g m o v e m ents an d arm flai l i n g . C hi l d al s o had 

### s e l ec ti v e 

### muti sm , p araly s i s o fth e l e g s , an d b i z arre hal luc in ati o n s in clu din g peo p l e 

### in th e ro om that 

### we r e n o t p res e nt , peo p l e thr eate nin g to 

### ki ll h e r , and 

### b ub b l e s o n th e s un . (N . T . 0 7 12 3 /1 8 , p g s , 

### 3 8 - 3 9 ) . In 

### r e g ard s t o C hi l d ' s p araly s i s , th ere i s n o m edi c al e xp l anati o n an d i t c an be de sc ribed as a fun c ti o na l paraly s i s . (N . T . 0 7 12 3 / 1 8 , p g . 9 1 ) . C hi l d w a s tr e at ed fo r 

### h e r diagno s i s at the C H C A 

### b e havi o ral h eal th p ro gram in V irgi ni a fo r 

### thr ee m o nth s (N , T . 0 7 /2

j / l 8 , p ga . 4 0 - 4 1 ) . C hil d .... as d fa c hAc g cd fro m C H C A an e r 

### thre e m o nth s Wh e n 

### s he a p p ear ed to 

### hav e co mp l e te ly rec o v e red . (N . T . 0 7 /2 3 / 18 , p g . 4 1 ) . C h il d an d M o th er hav e 

## ' in di cat e d th at C hil d c laims t o hav e f ak ed imp ro v em e nt b y 

### imp ro v in g h er s ymp to m s in 

### o rd er to 

### b e

6 A ll p arti e s b es i des M o th er ' s C o UDSe l stip u!J!ied t o Phys ic i an ' s C V an d e xpe rtis e in p e diatri c s ao d ch il d a b us e pcdi oui �
. (N . T . 0 7 1.2 3 / 1 8 , pg. 1 2 ) . Th e tri al court accep te d P hys i ci an as an expert b y kn o w l ed ge . (N . T . 0 7 123 /1 8 , p g . 23 ; O H S E xh ib i t 1 ). • Phy s i c i an p e rfo rm ed a v er b al and curso ry p hy s i c al ex ami nati o n o f C h i l d, b ut C h il d w a s una b l e to c oop erat e wi th a g e n eral urin ary ex lllll . (N . T . 07 f.? 3 /J 8 , p g. 2 5 ), P hy s i c ian a ls o re vi e w e d C hil d ' s m edi cal re c o rds an d s p o k e wi th both 

### Chi l d an d M o th er re garding 

### C hi ld ' s bi.s to ry . (N . 'f . 0 7 1.2 3 / 1 8 , 

### p gs . 25 - 2 6 , 2 7 · 2 8 ) . • S e v er s D i s e a s e is th e il'l flammati o n o f the gro wth p l ate, c o mm o nly se en in the s ho ul d ers o f li ttl e l ea gu e p i tcii e n . (N . T . 0 7 123 / l S . pgs , 5 1 · 5 2 ) . 9 AM P S i s a s yn drome wher e re lati v e ly inn oc u o us co ntact leads t o an amp li fi ed pain re s po n s e . (N . T . 0 7 12 3 / 1 8 , p gs , 3 4- 3 5 ) . r e P hy s i c i an in d i c ated that Chi ld was h avin g p s eudo- se izures b ecaus e C h il d di d n o t h ave E E G p att ern s th at in di c at ed



### · , : , , an aaual s e i zure , (N. T . 0 7 123 1\ S , p g. 

### 3 8 ) . P ag e 8 o f 1 4

### di sch arg ed from C H C A 

### because Chil d di d no t want 

### t o remai n in inp ati ent car e . (N . T . 0 8/ 1 5 / 1 8 , 

### pgs . 1 6 - 1 7 , 3 2 - 3 3 , S 0- 5 1) : Child c l ai med 

### that her sympt o m s began 

### r eoccurri n g after 

### h e r tteatment at 

### CH C A because she had 

### t o att end family therap y wi th 

### F ather and the stress 

### o f re ruriring t o 

### s c h oo l. (N . T . 0 8 /1 5 / 1 8 , p g. 

### 5 2 ) . Chi l d ' s 

### o nly o rg ani c path o l o gi cal finding 

### was th e Se v ers D isease , whi c h 

### Chil d was treated fo r thro ugh 

### p hy si cal th erap y , b ut Chil d ' s reco rds i n di cate 

### that C hil d 

### was experi enc ing s ymp toms n ot pro po rti o nal t o 

### what is 

### c o mm only seen 

### in S e v ers D i sease . {N . T . 0 7 /23 / 1 8 , p gs . 

### 5 1 - 5 3 ) . Man y 

### o f C hi l d ' s 

### is s ues w ere se lf - reso lving, butChi l d ' s m edi cal reco rds 

### indi cates that 

### p ho n e calls from 

### Mo ther 

### re g ardin g th e descri bed ailments we r e not 

### co ns istent with th e p hy si cal e xam on the fo ll o wing day . (N . T . 0 7 /2 3 / 1 8 , 

### p g . 8 9 ) . P hysi cian n o ted that th e m os t c o ncern i ng issue regarding Chil d was that M o th er and Chi l d a p peared t o be enm eshed and that 

### Child ' s be havi o rs re l ated to 

### the conv ers i o n diso rd er were 

### e nab l ed b y 

### M other . (N . T . 0 7 123 / 1 8 , pgs . 44-4 5 ) . A d di tio nally , Chil d ' s symp t oms appeared 

### to be 

### amp lifi ed by 

### M o th er ' s pres ence , whi ch 

### was m o s t no ti ceab l e d

uring Chi ld ' s stay at 

### CH C A , wh ere C hi l d was disc harg ed 

### as ymp t omati c . (N . T . 0 7 123 / 1 8 , p gs, 4 5-46 ) . P hy si c ian n oted that if 

### C hi l d we r e t o be 

### reunifi ed wi th 

### M oth er, i t 

### w o ul d be l i ke ly that Chil d w o ul d begin 

### having symptoms 

### o f conv e rsi o n di so rd er again. 

### (N . T . 0 7 !23 / 1 8 , p gs. 

### 4 6 -4 7) . A d di ti onally , i f Chi l d wer e to remain 

### in M othe r ' s 

### car e , the re is 

### a ri sk f or Chil d ' s ps y ch opath o l o gy to amplify 

### o v er time and 

### beco me m o re e l abo rat e wi th 

### m ore medi cal 

### int erv e nti o n . (N . T . 0 7 /23 /1 8 , p g . 4 7) . Chi l d ' s m edi cal reco rd in di cat es an e xagg erati o n an d insti gati o n o f

Chil d ' s sympt o ms, all co nsi stent wi th 

### m ed i cal ch i l d ab use . (N . T . 07 /23 / 1 8 , p g. 54 ) . 

## } £_ i Through 

### r evi e w o f Chi l d ' s m edi cal reco rds, co ncerns o f m edi cal ch i l d abuse hav e been 

### raised by 

### other m e di ca1 

### pro f

essi o nal s. (N
. 

### T . 07 $ / 1 8 , p g. 6 9 ) . On 

### m o re than 

### o ne occasi on, 

### M othe r has 

### o v e r exaggera ted Child ' s symp to ms . (N . T . 0 7 /2 3 / 1 8 , p g . 8 7 ) . M o th er was n o t al w ay s c o mp li ant wi th the 

### m edi cal reco mmen dati o ns gi v en to 

### Chil d . (N . T . 0 7 123 / 1 8 , 

### p gs . 3 7 , 8 0-8 1 , 8 3 ) . Mo ther has 

### bee n the primary 

### hi storian thro ugho ut Chi l d ' s medi cal treatm ent 

### in terms 

### o f repo rting symptoms 

### an d illn esses t o 

### m edi cal p ro f

ess i onals . {N . T . 0 7 123 /1 8 , p g. 8 8 ) . Mo th er i s al so th e primary 

### car etak er o f Chil d . (N . T . 0 81 1 5 / 1 8 , pg. 

### 2 2 ; O HS Exhib i t 3 ) . Be fo re C hil d 

### was bo rn, 

### M o ther w o rk ed as an 

### em erg en c y m edi cal techni ci an ( "EMT"} 

### fo r 

### C H O P and 

### i t is co mm on fo r 

### parents in m edi cal c hi l d abuse 

### cas e s t o hav e a m edi cal backgr o und o f so m e sort 

### {N . T . 0 7 123 /1 8 , pg . 44 ) . C hil d has had 

### far mo re med i cal interacti o n than wo ul d be typ i cal 

### o f an oth er c hil d at 

### th e sam e l e ve l o f h eal th. (N . T . 07 n.3 / l 8 , p g . 

### 7 8 ). M o ther 

### was aware that a doct o r wh o w o rk ed wi th 

### Chi ld ' s P CP was c o ncern ed that 

### Chi l d w as " o v er d oct ored. " {N . T . 08/ 1 5 / 1 8 , 

### p g . 8 1 ) . M o th er c laim ed that she 

### ne v er fo rced P age 9 of 1 4 ;' ·C hi l d t o g o t o th e d o c t o r wh e n sh e di d no t w ant t o g o . (N . T . 0 8 / 1 5 / 1 8 , p g . 7 3 ) . C hi l d ' s s ymp to m s and m e d i c al car e al i gn wi th th e o n g o i n g c us t o dy l i ti gati o n b e tw e en M o th e r an d F ath e r (N . T . 0 8 / 1 5 /1 8 , p g . 3 5 ) . M o th e r b l am e s F ath er fo r C hi l d ' s s ymp to m s . (N . T . 0 8 / 1 5 / 1 8 , p g . 8 � 8 7) . 

### P hy s i c i an in di c ated th at C hi l d ' s p ro pe r c o urs e 

### o f tre atm e nt m o vi n g fo rward s h o ul d b e inp ati e nt 

### p s y c hi atri c c are 

### and fo r 

### M o th er , s in ce th e m edi c al c hi l d ab us e 

### inv o lv ed i s 

### co nv ers io n di s o rd e r , th e reco mm en d ati o n 

### i s be havi o ral h e al th th e ra p y . 

### (N . T . 0 7 /2 3 / 1 8 , 

### p g . 4 8 ) . 

### P hy s i c i an al so in di cat ed th at M o th e r d e cl in ed t o atten d p s y c h o th e ra p y 

### wh en r eco mm e n d ed in 

### 2 0 1 4 , al th o ugh Mo th er c laim ed th at s h e di d atte n d th er a p y . (N .T
. 0 8 / 1 5 / 1 8 , p g s . 7 8 - 7 9 ) . Th e tri al c o urt fo un d P hy s ic i an ' s te stim o ny v e ry c o mpe ll in g an d c re dib l e . B as e d o n th e te s tim o ny o n July 2 3 , 2 0 1 8 , an d Au gu st 1 5 , 2 0 1 8 th e tri al c o urt fo un d cl e ar an d 

### c o nvin c in g e vi d en ce that M o ther ' s p ro l o n g e d int e nti o nal exagg er ati o n 

### o f

C hil d ' s s ymp to m s 

### re sulted in m edi cal 

### c hil d ab use un de r 1 3 P a . C . S . A . § 6 3 0 3 { b .l ) . Furtb. e nn o re , th ere was p rima fa ci e e v i d e n c e 

### that M o th er i s th e perpetrat o r o f 

### c hil d a bus e un d e r 2 3 P a . C . S . A . § 6 3 8 \ ( d) s in c e M o th er was th e p ri m ary c ar e gi v e r fo r Chi l d . M o th e r 

### was unab l e to reb ut th e p re s ump ti o n . C o ns eque ntly , th e tri al co urt di d n o t err o r ab us e i ts disc reti o n in fin ding c hil d ab u s e . D H S ' s n e xt i s s u e o n a

p peal as k ed wh e th e r th e tri al co urt err ed in ad j u di cating C hi l d d epe n d e nt 

### b as ed o n c l e ar 

### and co nv in c in g e v i d e n ce . A " D epe n d e nt C hi l d " wi ll 

### be ad j u di cate d d epe nd e nt 

### i f th e tri al c o urt dete rm i n e s , 

### b y cl ear an d c o nvi n c in g e vi d e n ce . that C hil d i s wi th o ut p ro p e r p arental care o r c o ntr o l , s ub si ste nc e , ed u c ati o n. as require d b y l aw , o r o th er car e o r co ntro l n ece s sary fo r C hi l d ' s p hy s i cal , m ental , o r e m o ti o nal h eal th, o r m o ral s . A d e t erminati o n that th e re i s a l ac k o f p ro pe r p ar e ntal c ar e o r c o ntro l m ay b e b ase d u po n e vi d en c e o f c o n d

u ct b y th e p arent , guard i an , o r o th er c u s t o di an . C l e ar an d co nvi nc in g evi d e n c e has b ee n d e fin ed as te stim o ny b y c redib l e wi tn e s s e s wh o 

### cl early re l ate f ac t s that are so c l e ar , dir ect , w e i ghty , 

### and c o nvinc ing as t o enab l e th e tri e r o f fa c t to c o m e t o a 

### c l ear co nvi cti o n wi tho ut h e s i tan c e o f th e truth o f

pre c i s e fa c t s 

### in i ss u e . 

### I n I n t e res t n [ J, M , 1 6 6 A . 3 d 4 0 8 , 4 2 7 (P a . S u pe r . 2 0 1 7 ) (

ci ting 

### I n R e N o l' os i e ls ld , 9 92 A. 2 d 8 9 , 

## t i , : , I 0 7 (P a . 2 0 1 0 )) . Th e p urpo s e o f th e Juv e ni l e A c t i s to p reserv e th e uni ty o fth e f amily wh ene v e r po ss ib l e . 4 2 

### P a . C . S . A. § 

### 6 3 0 1 (b )( l ) . N o n e th e l e s s, a c hi l d will b e ad j u di cat ed d epen d e nt wh e n th e c hil d i s p re s e ntly wi th o ut pro pe r pare nt.al c are an d th e c are is n o t imm e di at e ly av ai l ab l e . I n 

### re R . T. . 5 9 2 A . 2 d 5 5 , 5 7 (P a. S up e r . 

### 1 9 9 \ ) ( c i ting I n R e LaR u e, 3 6 6

A
. 2 d 

### 1 2 7 1 (P a. S u

p er . 1 9 7 6 ) ) . S u

peri o r C o urt h a s d e fi n ed pro p e r p are ntal c are as th e c are whi c h i s g eare d to th e parti c ul ari z ed n e e ds o f P a g e 1 0 o f1 4!
. . . 

### the 

### c h i l d an d. at 

### a minimum , i s l ike ly t o pre v ent seri o us in j ury to 

### th e chi l d. 

### In 

### re 

### C. R. S
. • 6 96 A 2 d 

### 84 0 , & 4 1 (P a . 

### S uper . l 9 97 ) ( ci ting 

### In lni e rest o

f .Justin S. , 

### 5 4 3 A.2 d 1 1 92, 

### 1 2 00 (P a. 

### S uper . l 9 8 8 ) ) . A CY4 8 r ep o rt i s deem ed to be 

### f o un ded 

### if th ere has 

### been any j udi ci al 

### ad judi cati o n 

### based upo n a findin g that a 

### chi l d wh o is a sub j ect o f the 

### repo rt bas been ab us ed. J. 

### G
. v . De p t. o f 

### Pub lic W

e l f are, 

### 79 5 A. 2 d l 0 8 9 , 1 0 92 (P a. 

### Co mmw . Ct . 2 0 02 ) . M o th er al l e g es that th e 

### trial co urt erred in adj u di c atin g chil d depe ndent 

### b y c l ear an d convinc in g 

### evi de n c e . O HS 

### obtained an O PC after the 

### C H O P C lu 1 d Abuse C lini c determi n ed that 

### C hi l d was suff eri n g f rom m edi cal c hil d a

buse . (N . T . 0 8/ 1 5 / 1 8 , pg. 2 0 ) . lt was estab l is hed fro m the testimo ny 

### o f 

### Dr . B ri an W illi am B r e nnan o f C H O P (" P hy si cian ") that 

### C hil d su ff ered fro m m edi cal chil d ab use based o n th e extens i v e 

### medical history o f 

### C hil d. (N . T . 

### 0 7 /2 3 /1 8 , pg . 4 2 , 4 9 - 5 0 ) . Chil d was first e valuat e d b y Physi cian 

### in June 2 0 l 8 , 

### after C hild 

### presented at 

### th e se xual ab use c l ini c at 

### C H O P 

### based o n the 

### al l egati o ns o fse xual abuse b y 

### F ather and 

### 1he staff at 

### CH C A. (N
. 

### T . 0 7/23 / 1 8 , pgs . 24- 

### 2 5) . D H S has 

### d e termined that the 

### sexual abuse all egati o ns 

### made b y Chil d w ere unf o und ed. (N . T . 0 8/ 1 5 /I S , p g . 2 9 ) . A ft e r 

### revie w o f Chi ld ' s 

### medi cal re co rds, 

### P hy si cian o bse rv ed that C hi l d had



### · . .. vis i ted h e r P C P 

### ap pro x imate ly 1 5 6 times, 

### M o th er made 

### twi ce as 

### many pho ne call s t o the 

### PC P as

visi ts, an d C hild 

### visi ted I S diff erent subspec ialists . (N . T . 07 /23 / 1 8 , p gs . 

### 2 9 - 3 0 , 3 3 - 34 ) . When C hi l d 

### beg an 

### seein g a th erap ist f or behavi o ral 

### heal th aro und ag e 7 , Chi l d ' s m edi cal util izati o n o f 

### medical a p po i ntments d ecreased during that time peri od. (N . T . 0 7 123 / 1 8 , pgs. 

### 3 5 - 3 6) . B y 

### C hil d ' s pre- teen 

### y ears , C hil d had been 

### diagnosed with 

### asthma. re flux. S ev ers Disease , AMP S , and co nv e rs i o n disorder , 

### (N . T . 0 7/2 3 / 1 8 , 

### pg s . 3 4 , 3 7 , S 1 ) . 

### F oll o win g Chil d ' s di agnos i s o f 

### AMP S , Chil d 

### was d i a gn o se d wi th co nv ersi o n 

### di sorder where Chil d began h aving pse ud o -se izures inv o lvin g l eg mo v em ent s an d arm fl ailing. C hil d also had se l ecti v e mutism, 

### paraly sis of the l egs, and b izarre halluc i n ati o ns inc luding peo p l e in th e 

## room that were no t present, peo p l e threate nin g to ki ll h er , and 

### b ub b l es on th e sun. 

### (N . T . 07 1.23 / 1 8 , p gs , 

### 3 8- 3 9 } . In 

### re gards to 

### Chil d ' s paralysis, 

### ther e is 

### n o medi ca l e xp l anati o n 

### and i t can be 

### descri bed as a functi o nal 

### paraly sis. {N . T . 0 7 123 /1 8 , pg . 9 1 ) . 

### Chi l d wa s tr eated fo r h er di agno sis at 

### th e C H C A behavi o ral heal th 

### pro gram in V irginia fo r thr ee months (N . T . 0 7 123 / 1 8 , pgs . 404 1 ) . C hi l d was 

### disc harged fro m C H C A after three 

### m o nths when 

### she ap pe are d to hav e co mpl et e l y reco v ered. (N . T . 0 7 /23 / 1 8 , 

### p g . 4 1 ) . Chil d 

### and M oth er hav e 

### indi cate d th at 

### Chi l d c lai ms to 

### hav e fak ed 

### impro v ement by 

### impro ving h e r sympto ms 

### in o rder to be



# . . di scharg ed fro m CH C A because 

### C hil d di d not want to remain in 

### inpati ent care . (N . T . 0 81 1 5 / 1 8 , Page 11 o f 1 4



# - - . . . .;..- � : L
. :I · f
. . ·

: · : , 

### p gs. 1 6 - 1 7 , 3 2 .: n , S0- 5 1 ) . C hil d c l aimed that her sympt o ms began 

### r eocc urrin g 

### after h e r treatme nt

at 

### C H C A because she 

### ha d to att end 

### family th erap y 

### wi th F ather and 

### th e stress 

### o f re turnin g t o sc h oo l. (N . T . 0 8 / 1 5 / 1 8 , pg. 5 2 ) . C hil d ' s o nly organi c path o l ogi cal finding was 

### th e S ev e rs D i sease, whi ch 

### Chi ld was 

### treated fo r thro ugh 

### phy s ic al th e rapy , but Ch il d ' s reco rds i ndi cat e 

### that C hil d 

### was e xperi e n c in g 

### sympto ms n ot 

### propo rti o nal to 

### what is co mm o nly seen 

### in S ev ers D isease . (N . T . 07 /2 3 / 1 8 , 

### pgs , 5 1 - 5 3 ) . 

### Many o f Chi l d ' s 

### issues were 

### se lf - reso lving, b ut Chil d ' s 

### m edi cal reco rds ind i cat e s that 

### pho ne calls 

### fro m M o ther regarding the 

### described ailm ents w e re not cons i ste nt wi th 

### th e p hy s i cal 

### e xam on 

### the fo ll o wing day . (N . T . 0 7 123 /1 8 , p g. 8 9 ) . 

### P hys i c i an n o t ed that the 

### m o st co n ce rn in g i ssue re g arding Chil d 

### was that 

### M o ther and C hi l d 

### appear ed to be 

### enm es hed and that 

### C hil d ' s be h avi o rs re lat ed to the co nv ersi on dis o rder w ere enab l ed b y 

### M o ther . (N . T . 0 7 n.3 / 1 8 , p gs. 44-4 5 ) . A d di ti onal l y , Chil d ' s sympto ms 

### appeared to 

### be amp l ifi ed by 

### M o th er' s p re se nce , whi c h 

### was m o s t n o ti ceab l e during C hi ld ' s stay 

### at C H C A, 

### wh ere C hil d 

### was di scharg ed as ympto mati c . (N . T . 07 /2 3 / 1 8 , pgs . 4 5 46) . Phy sic ian 

### n o ted 

### that if Chil d 

### w ere to be 

### reunified wi th M o ther , i t wo ul d be l i ke ly that 

### Chi l d w o uld begin havin g sympto ms 

### o f co nv ersi on d iso rd e r a gain . (N . T . 07 /23 / 1 8 , 

### pgs . 4 6 -4 7) . A dditi o nal l y , if Chil d were to remain in 

### M o the r ' s care , th e r e i s a risk fo r Chil d ' s psy c ho patho l ogy to amp lify o ver 

### time 

### and beco me 

### m o re e labo rat e with 

### m ore m edi cal interv enti o n . 

### (N . T . 0 7 123 / 1 8, p g. 4 7) . C hild ' s 

### medi cal reco rd indi cates an 

### e xagg erati o n an d insti gati o n o f Child ' s symptoms, al l co ns istent with m edi cal c hil d ab use . (N . T . 0 7 /23 11 8 , p g. 5 4 ) . Thro ugh re v i ew 

### o f

Chil d ' s m edi cal reco rds , c o nc erns 

### o f medi cal 

### chi l d ab use hav e bee n rai sed b y 

### o ther medi cal 

### pro f

essiomls . (N . T . 07 12 3 /l 8 , pg. 

### 6 9 ) . On 

### mo re than one occasi o n. M o th er has o v er · e xagg erat ed 

### Chil d ' s symptoms. 

### (N . T . 07 12 3 /1 8 , 

### pg. 8 7) . M o ther 

### was n o t always co mp l iant wi th th.e in ed i cal reco tmna1 dati O!loS given t o Chil d. (N . T . 0 7 123 / 1 8 , pgs, 3 7 , 8 0- 8 1 , 8 3 ) . M o ther has been the pri mary 

### hi storian thro ugh out 

### Child ' s m edi cal treatm ent in terms 

### o f repo rting 

### sympt o ms and il lnesses to m edi cal pro f ess i onals . 

### (N . T . 0 7

/23 /1 8 , 

### pg. 8 8 ) . 

### M o th er is also th e 

### p rimary care tak e r 

### o f C hil d . (N . T . 0 81 1 5 11 8, pg. 

### 2 2 ; D HS Exhib i t 3 ) . 

### Be fo r e Chi l d 

### w as 

### born. M o the r w o rked as an emerg e n c y m edical 

### tec hni cian (" EMT') 

### fo r C H O P 

### and 

### it i s co mm o n fo r parents 

### in m edi cal c hi l d 

### ab use cases to hav e a m edical 

### backgro und o fsome sort. 

### (N . T . 0 7 123 / 1 8 , p g. 

### 44 ) . C hil d 

### has 

### had 

### far mo re medi cal 

### interacti o n than 

### w oul d be typical 

### o f an o th er c hil d at the 

### same l ev el o f heal th . (N . T . 07 /2 3 / 

### l 8 , p g . 7 8 ) . 

### Mo ther was aware that a d oc t or who 

### work ed 

### wi th C hild ' s PCP 

### was concern ed that Chi l d 

### w as .. o v er doctored. " 

### (N . T . 0 8/ 1 5 / 1 8 , 

### pg . 8 1 ) . 

### M o the r c laim ed that 

### s he n ev er fo rced Chil d t o g o t o the 

### d oc to r wh en she 

### di d no t want to go . 

### (N . T . 0 8/ 1 5 /1 8 , 

### p g . 7 3 ) . 

### C hil d ' s s ymp to ms P age 1 2 o f 1 4, : · -- ·

... !"- . 

### an d m e di c al c ar e al i gn wi th th e o n g o in g c ust o dy l i ti g ati o n be tw e en M o th er an d F ath e r (N . T .

0 8 / 1 5 / 1 8 , p g . 3 5 ) . M o th. er b l am e s F ath e r fo r C hi l d ' s s ymp t o ms . (N . T . 

### 0 8 / 1 5 /1 8 , p g . 8 6 - 8 7 ) . P hy s i c i an in di cated th at 

### C hi l d ' s p ro pe r co urs e o f tre atm ent m o v in g fo rw ard 

### s h o ul d b e inp ati e nt p syc hi atri c c are an d fo r 

### M o th. e r , s in c e th e m edi c al c hi l d ab us e inv o lv ed i s 

### c o nv ers i o n di s o rd er , th e rec o mm e n d ati o n i s be havi o ral h eal th th e r a p y . (N . T . 0 7 /2 3 / 1 8 , p g . 4 8 ) . P hy s i c i an al s o in di cated that 

### M o th er dec l in ed t o att en d p s y c h o th erap y wh e n reco mm e n d e d 

### in 2 0 1 4 , al th o ugh M o th er cl ai m ed 

### th at s h e di d att en d th e ra p y . (N . T . 

### 0 8 / 1 5 /1 8 , 

### p gs , 7 8 - 7 9 ) . D H S in di cat e d th e C P S rep o rt as 

### t o M o th e r b a s ed o n m e di cal evi d e n ce an d th e f act that M o th e r was 

### th e primary 

### c are take r o f Ch il d . (N . T . 

### 0 8 / 1 5 / 1 8 , p g . 2 2 ) . 

### In ad d i ti o n t o C hil d ' s m e di cal hi s t o ry , M o th e r ' s h o m e i s in qu e s ti o n bec au s e alth o u gh C hi l d bas 

### a bedro o m. C hi l d c h o o s e s t o s l eep o n a co u c h in th e li v in g ro o m n e xt to 

### M o th e r an d has 

### d o n e so fo r s e v eral y ears . (N . T . 

### 0 8/ 1 5 / 1 8 , p g . 2 3 ) . M o th e r al so t e s ti fi e d th at sh e be li e v e d p l ace m ent o uts i d e o f th e ho m e i s a

p p ro p ri at e fo r C hil d , i f

C hi l d 

### is p l ace d 

### in 

### a s pe ci al ized tr eatm e nt fa c ili ty . (N . T . 0 8 / 1 5 / 1 8 , p g . 

### 8 8 ) . C o ns e quently , M o th e r i s in agree m e nt w i th th e tri al 

### co urt ' s di s p o s i ti o n d eci s i o n . P lace m e nt o uts i de th e h o m e i s th e l east re s tri cti v e s e ttin g fo r C hi l d t o rece i v e th e s pe ci al ized tre atm ent n eed ed . Th e rec o rd re fl e c ts that th ere w as cl ear an d c o nvin c in g e vi d e n c e 1 0 

### ad

j udi cat e C hi l d d epen d ent as it 

### i s un saf e fo r C hil d t o re turn 

### to M o th e r ' s c are . M o th e r d o es n o c h av e th e p re s e nt ab il i ty 

### t o care 

### fo r C hi l d ' s p hy s i cal , 

### m e ntal , o r e m o ti o n.al h e al th. Th e tri al 

### co urt 

### fo un d th e 

### D H S wi tn e s se s cr edib l e . Th e re fo re , th e tri al co urt di d n o t e rr o r a b use 

### i t s di s c r e ti o n in fi n di n g C h i l d depe nd ent and d e t erminin g 

### th e C P S repo rt fo un d e d . C o n cl u s i o n : 

### Fo r th e af

o r e m enti o n e d re as o n s , th e 

### co urt fo un d that 

### D H S m e t its statut o ry b urd en b y c l ear an d c o nv in ci n g e vi d e nc e re g arding 

### th e fin ding that 

### C hi l d was a vi c tim o fm edi c al c hi l d ab us e purs uant to 

### 2 3 P . C . S .A. 

### § 6 3 0 3 (b . l ) ( 2 ) . D H S al so 

### m et its s tatut o ry b urd e n b y c l e ar an d c o nv in c ing ev i d e n c e that C h il d m e t th e d e fini ti o n o f 

### a d ep e n d e nt c hi l d un d e r th e Juv e ni l e A c t. A c c o rdin g ly , th e o rd e r 

### entered o n 

### Au gust 1 5 , 2 0 1 8 , s h o ul d 

### be affi rm ed .

P a g e 1 3 o f 1 4

### IN THE C O URT O F C O MM O N P L E A S F O R 

## T H E C O UNTY O F P HILAD E LP HIA F AMI L Y C O URT D MS I O N In 

### th e Intere st 

### o f

### S N .R , a Minor
AP P EAL O F : S . R. , M oth er 

### C P - 5 I - D P -000 1 3 8 7 - 20 1 8 F ID : 5 1 - FN -00 1 2 06- 2 0 1 8 2 7 5 8 ED A 

### 2 0 1 8 CE RTIFI C A TE O F SE R VI C E 

### 1 her eb y c e rti fy 

### 1hat this 

### court i s serving 

### a 

### cop y o f this duly 

### ex ecuted Op ini o n upo n all 

### co unsel o n 

### N o vembe r 2 8 , 2 0 1 8 . The 

### nam es and 

### addr esses o f all 

### persons 

### se rv ed are as fo ll o ws: Li ndse y C ordes, Esq . 

### C i ty 

## o f P hilade lphia La w 

### Department 

### I 5 1 5 

### Arc h Street, l � 

### Floo r P h i l ade lphia, P ennsy lv ania 1 9 1 02 L indse y . Cordes@phila. g o v 

### Atto rne y fo r D . H. S . S han e Th o mpso n, Esq . 1 7 06 Race 

### Street. 4 111 Fl o o r 

### P h il ade lp hia, P ennsylvania 1 9 1 0 3 J\no rney fo r 

### F ather B ar ry Kasse l , Esq . S u p p¢rt C em er f

or Chil d Adv o cates 1 6 1 7 J o hn F . Kennedy B l v d. . S ui te 1 2 00 

### P h il adelp hi a. P ennsylvania 1 9 1 03 b k asse l ( ii 1scc al aw . o rg 

### Att orne y fo r 

### Chil d J alain e 

### Sto kes. Esq . 

### De f en d er s Associ ati o n 

### o f

P hil ad e lp hia 1 44 1 Sanso m S treet P hilade lphia, P ennsy lv ania 1 9 1 0 2 

### j sto kes@p hilade f

end er . o rg Guar dian A d L item C arla Bcggin. Esq . 1 8 00 J o hn F . Kennedy B l v d. , S uit e 3 00 

### P hil ad e lp hia, P enns y lvania 1 9 10 3 begginl aw@mac . co m Atto rne y f

or 

### M o th er



### Law Cl erk to 

### the H o n . 

### Jo sep h L F e rnand es F irst Judi c i al Di stri ct 

### o f

P ennsy lv ani a F ami ly D i visi o n 1 50 1 

### Arch S t. , Roo m 1 4 3 1 

### P hilade lp hi a. P a. 1 9 1 02 T : ( 2 1 5) 

### 6 8 6- 2 660 I F : ( 2 1 5 ) 

### 68 6-4 2 2 4 Ari el. bruce@co urts . phila .g o v Page 

### 1 4 o f 1 4