J-A07035-19

NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37

IN THE INTEREST OF: L.V., A MINOR

APPEAL OF: J.H., MOTHER

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 IN THE SUPERIOR COURT OF

 PENNSYLVANIA

 No. 1390 EDA 2018

Appeal from the Dispositional Order April 16, 2018

in the Court of Common Pleas of Philadelphia County Family Court at 

No(s): CP-51-DP-0002253-2016

IN THE INTEREST OF: L.V-H., A 

MINOR

APPEAL OF: J.H., MOTHER

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 IN THE SUPERIOR COURT OF

 PENNSYLVANIA

 No. 1392 EDA 2018

Appeal from the Dispositional Order April 16, 2018

in the Court of Common Pleas of Philadelphia County Family Court at 

No(s): CP-51-DP-0002269-2016

BEFORE: LAZARUS, J., OLSON, J., and STEVENS, P.J.E.*

MEMORANDUM BY STEVENS, P.J.E.: FILED APRIL 09, 2019

Appellant, J.H. (“Mother”), files these consolidated appeals from the 

orders entered April 16, 2018 in the Philadelphia County Court of Common 

Pleas, adjudicating dependent her son, L.V., born in August 2016, and 

daughter, L.V.-H., born in January 2015 (collectively, the “Children”), as well 

____________________________________________

* Former Justice specially assigned to the Superior Court.
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as finding L.V. was abused, that aggravated circumstances exist, and that no 

efforts need to be made toward reunification. Mother also challenges the trial 

court’s partial denial of Mother’s motion for permission to take L.V. for medical 

examination (April 5, 2017), its denial of Mother’s motion for reconsideration

of that order (May 17, 2017), and its denial of Mother’s motion for recusal

(December 15, 2017).

1 After careful review, we affirm.

The trial court summarized the relevant factual history as follows:

FINDINGS OF FACT

On October 11, 2016, the Department of Human Services 

(“DHS”) received a Child Protective Services (“CPS”) report 

alleging that two (2) month old [c]hild[,] L.V. was admitted to the 

Children’s Hospital of Philadelphia (“CHOP”) on October 10, 2016 

with multiple fractures. In total[,] twenty[-]six (26) fractures 

were eventually discovered. . . . Medical staff at CHOP determined 

that [] L.V.’s injuries were highly indicative of child abuse. These 

fractures were also in various stages of healing. CHOP admitted 

[] L.V. to the Trauma Unit where [] L.V. remained for several days. 

Mother and Father were unable to explain the causes of [] L.V.’s

fractures. Mother and Father denied that the [c]hild had been 

dropped or fallen or left in the care of someone other than Mother 

or Father.

***

On October 13, 2016[,] [DHS] obtained an Order of Protective

Custody for [] L.V. and [] L.V.H.[2]. . . On October 21, 2016, DHS 

filed the underlying Petition for Dependency and sought a finding 

of aggravated circumstances and child abuse against Mother and 

Father[.]

Trial Court Opinion (“T.C.O.”), 10/5/18, at 4-5. 

____________________________________________

1 The Children’s father, J.A. (“Father”) did not appeal any of these matters.

2 The Children initially were placed in kinship care with Maternal Cousin, but 

were subsequently placed with Maternal Aunt on December 21, 2016. Notes 

of Testimony (“N.T.”), 8/23/17, at 220-21; Continuance Order, 12/21/16. 
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On December 5, 2016, the CPS report stated that Mother and Father 

had been indicated as perpetrators of abuse based on medical evidence. N.T., 

8/23/17, at 207-208. DHS investigative worker Ashley Wingate testified that 

the report was indicated based on “CHOP’s findings that the injuries were 

extensive and indicative of inflicted injury. The parents couldn’t offer any 

explanation for the injuries or how they occurred. Also, no one else was 

caretaker who could have caused the multiple injuries, including new and 

healing fractures.” Id. at 219-20.

The trial court conducted adjudicatory hearings on August 23, 2017, 

September 11, 2017, December 15, 2017, March 27, 2018, and April 16, 

2018. The Children were represented by Beth Kahn, Esquire, and Jalaine 

Stokes, Esquire, of the Defenders’ Association Child Advocate Unit. Mother 

and Father were present and represented by counsel throughout.

Mother and Father testified on their own behalf as to the events that led 

to L.V.’s hospitalization on October 10, 2016. Mother noticed L.V.’s shoulder

swelling on Thursday, October 6, 2016. Mother called the pediatrician on 

Friday, October 7, 2016 and was advised there were no doctors available to 

see L.V. While the doctor’s office directed Mother to take L.V. to the 

emergency room, Mother decided to wait until L.V.’s scheduled pediatric 

appointment on Monday, October 10, 2016. 

Mother testified that she felt the swelling in L.V.’s shoulder was not a 

serious injury as L.V. was not crying. That weekend, Mother felt L.V. was doing 

fine and sleeping well, but observed that he had reduced his level of feeding.
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On Monday, before taking L.V. to his appointment, Mother noticed swelling in 

L.V.’s leg, but asserted that she never saw any bruises. At this visit, L.V.’s 

pediatrician directed Mother to take L.V. to the emergency room, where CHOP 

personnel discovered that L.V. had twenty-six fractures.3

Mother claimed she had no reason to believe Father harmed L.V.; she 

indicated she always was with the baby as she was on maternity leave and 

L.V. was left alone with Father “maybe three, five times.” N.T., 3/27/18, at 

153. After the Children were removed from her home, Mother admitted that 

she and Father could not “handle ... the fact that our kids were taken away,” 

and shared that Parents’ marriage experienced a lot of conflict. Id. at 159. 

Mother conceded that she filed for a Protection from Abuse (PFA) order against 

Father, claiming he threatened to slice her throat. Id. at 159. However, 

Mother testified that she had no reason to believe Father injured L.V.

Father gave similar testimony describing the days before L.V.’s injuries 

were discovered in the CHOP emergency room. Father admitted seeing L.V.’s 

shoulder was swollen on Thursday, October 6, 2016, but corroborated 

Mother’s testimony that the pediatrician was not available until the following 

Monday morning. Father claimed that he did not see that L.V.’s leg was 

swollen as the baby always had clothes on; Father shared that both Mother 

____________________________________________

3 Notably, Mother indicated she had taken L.V. to the emergency room at St. 

Christopher’s Hospital two weeks earlier on September 16, 2016, at the 

direction of the pediatrician, due to discoloration in L.V.’s nails, his vomiting

of formula and breast milk, and a “lump” on his back. However, emergency 

room personnel sent Mother home without a diagnosis. Id. at 146-47. 
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and Father cared for him. Father indicated that “at no time whatsoever” would 

Mother have caused L.V.’s injuries. N.T., 3/27/18, at 180. When asked about 

Mother’s claim that he threatened to slice her throat, Father asserted that he 

did not use those words. Id. at 181.

The parties offered competing medical expert testimony to attempt to 

explain the cause of L.V.’s injuries. DHS first presented the testimony of Dr. 

Cindy Christian, a CHOP pediatrician on the Suspected Child Abuse and 

Neglect (“SCAN”) team or child protection team, whom the trial court qualified 

as an expert in pediatrics and pediatric child abuse. Dr. Christian reported 

L.V. presented at the CHOP emergency room in a lot of pain and was not 

moving his left leg. L.V. was admitted to the Trauma Service as he exhibited 

twenty-six fractures and had to be treated gently. N.T., 8/23/17, at 66. L.V.

had both new and healing fractures of his ribs, metatarsal (foot), tibia (shin 

bone), femur (thigh bone), humerus (arm), and acromion (shoulder blade). 

Id. at 49-50, 54-59, 66. Dr. Christian stated,

Many of the fractures that we saw were fractures that are 

more specific or not seen very frequently in children who have 

accidental fractures; more commonly seen in children who have 

inflicted fractures.

And I think what was remarkable about [L.V.] was how 

many fractures he had when he came into the hospital.

Id. at 64. She noted that shoulder blade and rib fractures are uncommon in 

accidental trauma. She noted L.V. had some metaphyseal fractures located 

at “the end or the growing portion of the bone,” which were uncommon. Id.
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at 55, 65. Moreover, Dr. Christian reiterated that she never saw the amount 

of fractures exhibited instantly as a result of accidental trauma. Id. at 66. 

Due to the high number of fractures, Dr. Christian found it necessary to 

rule out any underlying disease processes and obtained a consult for metabolic 

bone disease. Id. at 70-71. After further testing, Dr. Christian was able to 

rule out osteogenesis imperfecta (brittle bone disease), vitamin D deficiency, 

and rickets disease.4 Id. at 71-75; see also DHS Exhibit 6. When asked to 

evaluate the opinion of Mother’s expert, Dr. Michael Holick, who believes L.V. 

has a metabolic bone disease called Ehlers-Danlos syndrome, Dr. Christian 

asserted that Ehlers-Danlos syndrome is “not a disease that’s known to cause 

multiple fractures in infants, and not a disease that’s associated with fractures 

in infants.” N.T., 8/23/17, at 85.

____________________________________________

4 With respect to rickets, Dr. Christian explained that, 

Rickets is a metabolic disorder of growing bones where, 

because -- most commonly -- there are multiple causes of rickets, 

but the most common is vitamin D deficiency.

You need good vitamin D to mineralize your growing bones. 

And if you don’t have enough vitamin D, then you can’t lay down 

the normal calcium and phosphorus at the ends of your growing 

bones.

N.T., 8/23/17, at 76-77. In addition, Dr. Christian reported that L.V.’s vitamin 

D level was “insufficient, but sufficient for bone health.” A level is deemed 

“deficient” if below 20; L.V.’s level was 23. Id. at 74. A course of vitamin D 

supplementation was recommended and instituted. See DHS Exhibit 4.
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Moreover, after Dr. Christian observed abnormal healing of L.V.’s bones

on a second skeletal survey, she obtained a third survey, which revealed no 

new fractures and normal healing of existing fractures.5 She explained,

At the time of [L.V.’s] follow-up skeletal survey, which was two or 

three weeks after he was hospitalized, when we reviewed the xrays and he had some unusual kind of findings on -- as his bones 

were healing, in addition to doing genetic testing, I thought that 

it might be useful to get yet a third set of skeletal survey because 

-- which I don’t normally do.

We always would get a skeletal survey when babies are 

initially hospitalized. We often get a follow-up a few weeks after 

hospitalization.

But I thought – I knew that [L.V.] was in a different home 

environment and that, if I waited a few more weeks and got yet a 

third skeletal survey and I saw additional new fractures that I 

hadn’t been seeing on the first two skeletal surveys, it would 

indicate to me that there was something inherently wrong with his 

bones that maybe we were missing with our osteogenesis 

imperfecta studies.

I don’t know what that was, but I felt like it was -- it would 

tell me that there were -- that there was more testing that we 

should think about or -- or do.

And, so, I asked for [L.V.] to have a third skeletal survey. 

And, again, Your Honor, I don’t normally do this. And he did have 

the third skeletal survey, and there were no new fractures.

So -- and all of the other fractures that he already had were 

healing very nicely. And, so, at that time, I didn’t think that 

additional testing for genetic diseases was indicated at that time 

because, as soon as he came into the hospital, he had no further 

fractures.

And in the first two months of life, he had multiple, multiple 

fractures. So, if he had a genetic disease that was so terrible that 

it broke multiple bones in the first two months of life, it didn’t 

seem consistent with then it suddenly -- there were no more 

fractures after that. 

____________________________________________

5 Three skeletal surveys were obtained on October 11, 2016, October 28, 

2016, and on November 17, 2016. N.T., 8/23/17, at 81; DHS Exhibit 5.
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Id. at 79-80. She found that the fact that L.V.’s “third skeletal survey [] didn’t 

show ongoing fragility of his bones suggested that he didn’t have a genetic 

disease that caused all of the fractures that we saw in the first -- at two 

months of age.” Id. at 98. As such, Dr. Christian testified to a reasonable 

degree of medical certainty that L.V.’s injuries were “highly concerning for 

inflicted or non-accidental trauma.” Id. at 100. 

DHS also offered the testimony of Dr. Maria Katherine Henry, a fellow 

physician on the child protection team at CHOP, who was qualified without 

objection as an expert in pediatrics and child abuse. Dr. Henry concurred that 

L.V.’s injuries were “highly concerning for inflicted trauma.” N.T., 8/23/17, at 

194. When asked for the basis for this determination, Dr. Henry stated,

So, we based that on the absence of a history of trauma 

provided. In addition, we did a medical evaluation, looking at 

nutritional bone disease, and did not find significant diseases in 

his vitamin D level.

We, in addition, consulted our colleagues in metabolism, 

who sent different testing for osteogenesis imperfecta, and that 

was negative, as well.

So, it was the absence of a history of any type of accidental 

trauma that could explain these findings, and then, in addition, an 

absence of a medical cause that was identified to explain his 

injuries.

Id. When asked if L.V.’s injuries caused concern, Dr. Henry explained,

So -- yes. We look at the constellation of injuries, and that’s 

concerning. And, so, as a whole, his injuries were concerning, but 

there were some injuries in isolation that would be concerning for 

inflicted trauma.

And those include the rib fractures, the fractured scapula, 

as well his foot fractures. So, he did have injuries in isolation, but 

it was also the constellation of injuries that was concerning.

Id. at 194-95.
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Moreover, DHS presented the testimony of Ashley Wingate, DHS 

investigative worker, and Patrice Stewart-Lane, CUA case manager, Catholic 

Community Services. Ms. Stewart-Lane testified that she was troubled that 

there was no explanation for L.V.’s fractures, and that the family needed 

services due to issues of domestic abuse. N.T., 8/23/17, at 233. She 

expressed that the Children should remain in the kinship home. Id.

Mother presented the testimony of Dr. Michael Holick, a practicing 

endocrinologist who specializes in the area of metabolic bone disease with

research focused on vitamin D deficiency. Although Mother offered Dr. Holick 

as an expert in endocrinology and pediatric endocrinology, the trial court only 

qualified Dr. Holick as an expert in the treatment of vitamin D deficiency.

6

Dr. Holick testified that L.V. had a “high likelihood” of having EhlersDanlos hypermobility type 3 syndrome, a disorder of the collagen matrix 

related to osteogenesis imperfecta and marfan syndrome. N.T., 8/23/17, at 

284. He further noted that, due to vitamin D insufficiency, L.V. was at 

increased risk for bone fragility. Id. at 285-86. Dr. Holick opined that this 

combination “markedly increases the fragility of [the collagen matrix], 

increasing risk for fracture with normal handling.” Id. at 303-304. 

____________________________________________

6 Dr. Holick’s report, dated March 15, 2017, was admitted as Mother’s Exhibit 

6. N.T., 8/23/17, at 310-11. He testified on voir dire that “endocrinology is 

the study of hormones, and vitamin D is a hormone. . . .And also, ... many of 

the hormones are related to metabolic bone disease. . . .And, so, typically, 

patients with metabolic bone disease will see an endocrinologist.” Id. at 263.
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Although Dr. Holick admitted that he did not examine L.V., he noted 

symptoms of Ehlers-Danlos syndrome from L.V.’s medical records, such as 

gastroparesis, mast cell hypersensitivity, and blue sclera (whites of the eyes).

7

 

Id. at 277. Dr. Holick indicated that Mother was vitamin D deficient and, as 

Mother breastfed L.V., “he was likely vitamin D deficient at the time of his 

birth, and at least during the first month, when he was being breastfed, since 

there is essentially no vitamin D in breast milk.” Id. at 285.

Moreover, Dr. Holick felt L.V. was likely to have Ehlers-Danlos syndrome 

based on the fact that he diagnosed Mother with Ehlers-Danlos syndrome with 

marfanoid features after clinical examination. Id. at 269, 274-75, 287.8 

Given that Ehlers-Danlos syndrome is a genetic disorder that is autosomal 

dominant, Dr. Holick believed L.V. had a fifty percent chance of acquiring it 

from Mother. Id. at 268, 275, 284. As to his diagnosis that L.V. has EhlersDanlos syndrome, Dr. Holick stated, “I can’t say that it explains 26 fractures, 

____________________________________________

7 Dr. Holick testified that some pediatricians have not fully understood or 

appreciated the variety of symptoms associated with Ehlers-Danlos syndrome 

in infants, such as difficulty having full meals, gastroparesis, muddled-looking 

skin, which is a sign for mast cell hypersensitivity. Dr. Holick claimed that it 

is “well-documented in the literature by many publications that Ehlers-Danlos 

syndrome is associated with fragility fractures of the skeleton.” Id. at 273.

8 Dr. Holick indicated that Ehlers-Danlos syndrome, while a genetic syndrome, 

is diagnosed clinically with a nine-point Beighton score analysis that examines

the flexibility of various joints. A score of five out of nine would be diagnostic 

for Ehlers-Danlos syndrome; Dr. Holick found Mother had a Beighton score of 

seven out of nine. Id. at 269-71, 278-79. 

However, Dr. Holick acknowledged that, as a Beighton score cannot be 

assessed on infants, a diagnosis of Ehlers-Danlos syndrome cannot be made 

with “a high degree of medical certainty” in infants. Id. at 299-300, 307-308. 
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but what I can say is that it can certainly explain many of the fractures, 

because it’s associated with bone fragility in children and adults.” Id. at 288.

Mother also presented the testimony of Dr. Julie Mack, a physician 

certified in both radiology and pediatric radiology. Despite noting that Dr. 

Mack had not focused in pediatric radiology for an extended period of time, 

the trial court qualified Dr. Mack as an expert in pediatric radiology.

9

 

Dr. Mack testified to an abnormality with L.V.’s case upon review of 

radiologic imaging. N.T., 3/27/18, at 42. She observed that, “the imaging 

was so unusual. This was not a case of standard fracture with typical healing 

of fractures. . . . There’s something odd about these bones. . . . A lot of my 

report is recommendation for more information, because I considered the 

findings unusual.” Id. Thus, Dr. Mack expressed the need for further 

consideration and investigation as to underlying metabolic and/or genetic 

disease process. Id. at 42, 47, 69, 82.

I think ... my conclusion in this case is that there are many 

things in this case that do not -- should not be brushed aside as 

irrelevant or unimportant, because they are standing out like big 

white light bulbs, saying this is -- something’s unusual here and 

this child deserves a consideration that these things actually 

contributed to weak bones in this case. . . . 

____________________________________________

9 Dr. Mack’s report, dated March 15, 2017, was admitted as Mother’s Exhibit 

4. N.T., 3/27/18, at 81. Dr. Mack admitted that she has focused on breast 

imaging since 2006, except for when on-call until 2011 and conducting private 

consulting work. In qualifying Dr. Mack as an expert in pediatric radiology, 

the trial court stated, “All right. I’m going to find the doctor’s an expert in 

pediatric radiology, with this caveat, that her – and I’m going to give her 

testimony the weight it deserves. However, keeping in mind that she has 

really not practiced in this field since 2006. . . .” Id. at 38. 
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Id. at 94. Dr. Mack further opined in her report,

[w]hile unexplained fractures raise the suspicion of possible 

abuse, the radiologic findings seen in [L.V.] also raise a significant 

concern that the best explanation for these unexplained fractures 

and bone abnormalities is a bone fragility disorder that remains 

undiagnosed. A work up by a clinician or geneticist with expertise 

in bone fragility syndromes, preferably with an emphasis on 

structural proteins, to ascertain whether additional imaging 

and/or testing, such as whole exome sequencing, is warranted is 

recommended. . . .

Mother’s Exhibit 4, at 18. However, while noting that features on the imaging

supported a diagnosis of rickets or a collagen disorder, Dr. Mack clarified that 

Ehlers-Danlos syndrome requires a clinical diagnosis, not a radiographic one. 

As such, Dr. Mack could not say whether L.V.’s injuries were due to an 

underlying genetic disorder and could not rule out that L.V.’s injuries were 

caused by abuse. N.T., 3/27/18, at 94-95, 102. 

The Child Advocate presented, by way of rebuttal to the testimony of

Mother’s experts, respectively, the testimony of Dr. Sabah Servaes, a pediatric 

radiologist at CHOP, who was also qualified as an expert in pediatric radiology. 

Dr. Servaes questioned Dr. Mack’s conclusions:

Q. Okay. Can you tell the [c]ourt whether you -- what your --

whether you’re in agreement with what Dr. Mack has testified here 

today?

A. Largely, no. Much of her commentary, some of her statements 

are accurate and true, but her overall summary, I disagree with.

Q. Okay. Can you explain that in any further detail though?

A. Yes. So she has suggested that there may be some underlying 

metabolic bone disease. That seems to be her primary concern. 

And with metabolic bone disease, that’s a systemic disorder, that 

we see it in multiple bones, that we don’t just see it in a single 

bone or a single area of the body. And it is true that, for example, 

rickets, one of the named disorders that she listed, you might see 
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it earlier in part of the skeleton than another -- than in other parts. 

However, it will be symmetric. You’ll see it on both sides. . . .

N.T., 3/27/18, at 115-16.

In her professional opinion, Dr. Servaes testified that she did not believe 

that L.V. has any kind of metabolic bone disorder. Id. at 124. She provided 

that “the findings that we see in his case are very asymmetric. There is no 

underlying systemic disorder that I can see on the images and it is typical 

when there is metabolic bone disease that severe enough to result in fractures 

that you can see the abnormality in the bones.” Id. 

Rather, Dr. Servaes opined that L.V. was the victim of non-accidental 

trauma. Id. at 128-29. When asked to explain, she responded, “There are 

multiple fractures -- there are multiple fractures in different stages of healing. 

They’re in characteristic locations, being at the ribs and at the ends of long 

bones like the femur, the tibia, the humerus. And there isn’t any apparent 

underlying disorder that I can see.” Id. at 129.

The Child Advocate also presented Dr. Paige Kaplan, a physician 

formerly associated with CHOP, who was qualified as an expert in pediatric 

genetics. Dr. Kaplan testified that she was present at the September 1, 2017 

examination of L.V. (who was then one year old). Dr. Kaplan stated,

I observed that there were no features of Ehlers-Danlos syndrome 

in [L.V.] He did not have any joint hypermobility. He walked very

well, independently, with a very steady gait for a child of one year 

and three weeks.

The whites of his eyes, the sclera, were only slightly gray, 

which is common in this age group. . . .

***

He did not have stretchy skin. He did not have any bruises. And, 

in the history, his aunt reported no features that were suggestive 
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of Ehlers-Danlos syndrome, such as frequent falls, bruising, 

constipation, changes in color of his skin.

Additionally, he’d been reported to have dark brown 

discoloration and pitting of his nails from birth, and I had seen 

photographs of those. And, by the time he was evaluated at a 

year and three weeks, this had cleared up.

N.T. 4/16/18, at 12-13. She continued,

In my observation of his exam that day, and in view of the 

fact that he’d had extensive testing using the most modern 

molecular methods for osteogenesis imperfecta -- brittle bone 

disease -- and his chemical value, there was no evidence for him 

having Ehlers-Danlos syndrome or osteogenesis imperfecta and it 

was not warranted to do any other testing. 

Id. at 14.

As such, Dr. Kaplan disagreed with Dr. Holick’s conclusion that L.V. had 

Ehlers-Danlos syndrome. Id. at 14-15. Aside from a lack of evidence, she 

explained that it is “not compatible with Ehlers-Danlos syndrome to have 

fractures in a one or two or three month old baby. This is not part of the 

Ehlers-Danlos syndrome.” Id. at 15-16. She also disagreed with Dr. Holick’s 

conclusion that a vitamin D deficiency made L.V. susceptible to fracture, 

noting, “a recent article by another consortium of vitamin D experts from 

around the world concluded that low vitamin D was not the reason for people 

having multiple fractures, per se.” Id. at 16-17. Further, while vitamin D 

deficiency can result in rickets, which can be linked with fractures, Dr. Kaplan 

indicated that this usually occurs with weight-bearing fractures, which would 

not occur in a two-month old baby. Id. at 17.

Moreover, Dr. Kaplan reiterated that genetic testing was conducted and 

revealed that L.V. did not have osteogenesis imperfecta. Id. at 18, 20. As 
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such, when asked if there was evidence of an underlying genetic disorder for 

L.V.’s injuries, Dr. Kaplan responded, “There was no evidence for [L.V.] having 

a condition that would lead to multiple fractures[,] such as osteogenesis 

imperfecta[,] in this two to three month-old baby.” Id. at 20-21.

At the conclusion of the hearing on April 16, 2018, the lower court 

adjudicated the Children dependent, and found aggravated circumstances 

existed such that reasonable efforts were not required by CYS to reunify Child 

with Mother or Father. The court stated,

Based on the testimony of Dr. Christian, Dr. Henry, Dr. 

[Servaes] and Dr. Kaplan, today, I’m making the following 

findings: That there are no symptoms in this child of genetic 

disorder, there are no Ehlers-Danlos syndrome [sic], there’s no 

brittle bone disease, and there’s no evidence of [R]ickets in this 

child.

What there is evidence of is child abuse -- 26 fractures. And 

the testimony of the experts, the pediatric experts and the genetic 

experts, the child abuse experts -- none of which was presented 

by the parents’ attorney.

Dr. Holick was qualified as a vitamin D expert. I had trouble 

with his testimony. It did not appear to be credible to me.

I did find the testimony of the doctors[] presented by the 

City and by the child advocate[] to be credible, along with the CUA 

case manager, Ms. ... Stewart-Lane, and also the DHS 

investigator, Ms. Wingate. I found the divergent testimony of the 

parents, pointing fingers at each other, to be incredible.[10]

And therefore, I am adjudicating the child dependent based 

on present inability. I’m making a finding of child abuse under 

Title 23, and also making a finding of aggravated circumstances 

as to both parents under Title 42, Section 6202(2).

____________________________________________

10 Mother and Father’s testimony does not suggest that they were “pointing

fingers at each other.” Mother claimed she had no reason to believe L.V. was 

harmed by Father. N.T., 3/27/18, at 154, 160. Further, Father testified he 

did not believe it was possible that Mother harmed L.V. Id. at 180.
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I am ordering no reasonable efforts to reunite this child, 

based upon the severity of the injuries to this child, and based 

upon all of the testimony, the totality of which -- I’ve reached the 

inescapable conclusion that this child has been abused and that 

the parents were the ones who had custody of this child while the 

abuse occurred.

N.T., 4/16/18, at 76-77. Upon clarification, the court indicated that it was 

also adjudicating L.V.-H. dependent, and making a finding of aggravated 

circumstances and that no reasonable efforts for reunification were necessary. 

Id. at 77-78. However, the trial court allowed Mother and Father to have 

continued visitation. These findings were memorialized by orders entered 

April 16, 2018. The court entered separate orders of adjudication and 

disposition and aggravated circumstances orders for each child.

On May 11, 2018, Mother filed a timely notice of appeal, along with 

concise statement of errors complained of on appeal pursuant to Pa.R.A.P. 

1925(a)(2)(i) and (b). On May 23, 2018, this Court consolidated Mother’s 

appeals pursuant to Pa.R.A.P. 513. 

On appeal, Mother raises the following issues for our review:

1. Did the trial court err when it denied Mother the opportunity to

take her son, L.V., outside of Philadelphia to be examined by a

Massachusetts [e]ndocrinologist (Dr. Michael Holick) and Ohio

pediatric geneticist (Dr. Marvin Miller)?

2. Did the trial court err when it failed to credit Dr. Holick’s

testimony because he had not examined L.V., failed to credit Dr. 

Holick because he was not a child abuse doctor, failed to qualify 

Dr. Holick as an expert in endocrinology and pediatric

endocrinology, and criticized Mother for failing to procure a

geneticist?

3. Did the trial court err when it failed to recuse itself for having a

bias in favor of child abuse and CHOP doctors?
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4. Did the trial court err when it ordered that DHS make no efforts

to reunify the children with their Mother?

5. Did the trial court err by extreme delay in scheduling the

dependency hearing?

6. Did the trial court err when it ordered that DHS make no efforts

to reunify the children with their Mother?

7. Did the trial court err when it linked reunification with one or

both of the parents’ confessing to abusing L.V.?

Mother’s Brief at 2-3.

[11]

Our standard of review for dependency cases is as follows:

[T]he standard of review in dependency cases requires an 

appellate court to accept the findings of fact and credibility 

determinations of the trial court if they are supported by the 

record, but does not require the appellate court to accept the 

lower court’s inferences or conclusions of law. Accordingly, we 

review for an abuse of discretion.

In re R.J.T., 608 Pa. 9, 26-27, 9 A.3d 1179, 1190 (2010) (citations omitted). 

The trial court is free to believe all, part, or none of the evidence presented 

and is likewise free to make all credibility determinations and resolve conflicts 

in the evidence.” In re M.G. & J.G., 855 A.2d 68, 73-74 (Pa.Super. 2004) 

(citation omitted).

____________________________________________

11 Upon review of Mother’s Rule 1925(b) statement and the argument section 

of her brief, it appears that Mother made an error and repeated her sixth issue 

in her statement of questions presented. From her Rule 1925(b) statement 

and argument, we recognize that her fourth issue is, “The trial court erred 

when it found the children dependent, when it found [L.V.] had been abused 

and erred in finding aggravated circumstances.” Concise Statement of Matters 

Complained of on Appeal, 5/11/18. As we are able to discern the issue, as 

were the trial court and other parties, we do not penalize Mother.
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However, prior to reaching the merits of Mother’s arguments, we must 

first address we have jurisdiction over the appeal. “This [C]ourt may examine 

appealability sua sponte because it affects our jurisdiction over the matter.” 

In re K.K., 957 A.2d 298, 303 (Pa.Super. 2008) (citation omitted).

First, we observe Mother filed only one notice of appeal on May 11, 2018 

from the separate orders as to each child entered on the separate dockets. 

Our Supreme Court has held that “where a single order resolves issues arising 

on more than one docket, separate notices of appeal must be filed for each 

case.” Commonwealth v. Walker, ___Pa.___, 185 A.3d 969, 971 (2018). 

However, the Court in Walker declined to apply the rule to the case 

before it, because to do so would run “contrary to decades of case law from 

[the Pennsylvania Supreme Court] and the intermediate appellate courts that, 

while disapproving of the practice of failing to file multiple appeals, 

seldom quashed appeals as a result.” Id. Thus, the Supreme Court instructed 

that in all future cases, a failure to file a notice of appeal for each lower court 

docket will result in quashal of the appeal. As Mother’s notice of appeal was 

filed prior to the Walker ruling, Walker is not controlling in this case. Thus, 

we decline to quash Mother’s appeal on this basis.

Next, we must determine whether we have jurisdiction as to review the 

trial court’s previous orders denying Mother’s request to take L.V. out-of-state

for medical examination, and its denial of Mother’s motion for recusal. The 

trial court did not address the merits of these claims, which it deemed untimely 

as Mother did not file appeals within thirty days of the entry of these orders. 
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See Pa.R.A.P. 903 (providing that a notice of appeal “shall be filed within 30 

days after the entry of the order from which the appeal is taken”).

However, it is well-settled that, “[a]n appeal lies only from a final order, 

unless permitted by rule or statute.” Stewart v. Foxworth, 65 A.3d 468, 

471 (Pa.Super. 2013). Generally, a final order is one that disposes of all 

claims and all parties. See Pa.R.A.P. 341(b). See also In re H.S.W.C.-B & 

S.E.C.-B., 575 Pa. 473, 478, 836 A.2d 908, 911 (2003) (finding, with regard 

to dependency matters, “[a]n order granting or denying a status change, as 

well as an order terminating or preserving parental rights, shall be deemed 

final when entered”) (citation omitted).

Upon review, we conclude that the April 5, 2017 and May 17, 2017 

orders as to permission to take L.V. for additional medical examination, and 

the December 15, 2017 order as to recusal were not final, appealable orders. 

As these orders did not dispose of a goal change and/or termination petition, 

the within appeal challenging those matters is timely. 

Moreover, DHS and the Child Advocate argue that the majority of 

Mother’s claims should be deemed waived as they are undeveloped without 

pertinent citation to legal authority. See In re W.H., 25 A.3d 330, 339 n.3 

(Pa.Super. 2011), appeal denied, 611 Pa. 643, 24 A.3d 364 (2011) (quoting 

In re A.C., 991 A.2d 884, 897 (Pa.Super. 2010)) (“[W]here an appellate brief 

fails to provide any discussion of a claim with citation to relevant authority or 

fails to develop the issue in any other meaningful fashion capable of review, 

that claim is waived”); see also In re M.Z.T.M.W., 163 A.3d 462, 465-66 
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(Pa.Super. 2017). Although Mother’s brief is deficient in some instances, 

Mother provides some citation to legal authority and does not prevent 

meaningful review. Thus, we decline to find waiver. 

Turning to the merits of Mother’s appeal, Mother first claims that the 

trial court erred when it denied her the opportunity to take L.V. for 

examination by Dr. Holick (an endocrinologist in Massachusetts) and Dr. Miller 

(a pediatric geneticist in Ohio). Mother’s Brief at 10. Mother argues, 

[t]he right to obtain expert witness evidence in a medically 

complex case is mandated by the due process clause of the United 

States Constitution. The Pennsylvania Supreme Court has 

recognized a parent’s right to have relevant expert witness 

testimony admitted at a dependency hearing, reversing the trial 

court’s decision to exclude such evidence. [In re C.M.T.], 861 

A.2d 348, (Pa. 2004). The trial court’s refusal to allow Mother to 

take (or send) L.V. outside of Philadelphia to obtain second 

opinions to counter the opinions of the four CHOP doctors called 

by DHS and the CA [Child Advocate], effectively denied Mother 

the ability to adequately defend the medically diagnosed 

allegations of child abuse in the dependency petition.

Id. at 10-11. While Mother acknowledges the lower court permitted further 

examination of L.V. in Philadelphia, she claims this restriction is unfair as 

neither of her desired experts is licensed in Pennsylvania, Pennsylvania does 

not allow telemedicine, and Pennsylvania’s temporary license requirements 

are burdensome. Id. at 13-14.

Section 6339 of the Juvenile Act provides in pertinent part:

(b) Physical and mental examinations and treatment.--

During the pendency of any proceeding the court may order the 

child to be examined at a suitable place by a physician or 

psychologist and may also order medical or surgical treatment of 

a child who is suffering from a serious physical condition or illness 
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which in the opinion of a licensed physician requires prompt 

treatment, even if the parent, guardian, or other custodian has 

not been given notice of a hearing, is not available, or without 

good cause informs the court of his refusal to consent to the 

treatment.

42 Pa.C.S.A. § 6339(b).

In this case, the trial court granted Mother’s motion to seek additional 

medical examination from the physicians of her choice, but required that such 

examinations be conducted in Philadelphia. The trial court provided:

THE COURT: So, I’m granting your motion as to allowing 

an examination of the child. I need the names of which doctors 

you wish the child to be examined by. This examination will take 

place in Philadelphia. Your expert doctors are to make 

arrangements with the appropriate hospital or doctor to conduct 

these examinations. 

[] how old is the child now, seven months old?

[Counsel for DHS]: Eight months, Your Honor.

THE COURT: Eight months old. I’m not having an eightmonth-old dragged throughout the country. I mean[,] if your 

expert was in China[,] I wouldn’t grant the motion either. 

***

I’m just changing the venue of where these exams will take 

place. The most logical place is where the child is in placement in 

Philadelphia. This [c]ourt has jurisdiction. And the injuries 

allegedly occurred in Philadelphia. The expert doctors at CHOP 

are in Philadelphia. I’m not denying your motion[,] I’m just 

granting your motion and telling you that you are to make 

arrangements for the doctors to examine the child. You put in 

your motion[,] I think I read[,] this examination would only take 

an hour or two. Have the doctor fly down on his clinical day for 

an hour or two from Boston. It’s a one hour flight. He’ll be back 

in two hours or three hours after he examines the child, and he 

can write up his report. 

N.T., 4/5/17, at 23-24.
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In denying Mother’s motion for reconsideration, the court explained:

THE COURT: I’m not precluding you from having this 

doctor examine this child. My ruling was the child’s not going to 

be moved out of state to accommodate your client’s interest. It’s 

not in the best interest of a child who is severely injured to be 

moved and examined by a doctor who I don’t even know is 

qualified to examine the child.

N.T., 5/17/17, at 12.

The trial court appropriately exercised its discretion in determining that 

the only suitable place for L.V. to be examined was Philadelphia, as it would 

not be in L.V.’s best interests to move him long distances due to his recent

recovery from twenty-six fractures and the possibility that L.V.’s bones were 

fragile due to a metabolic and/or genetic condition. 

Mother baldly asserts that it was too burdensome for her experts to 

obtain temporary licensing to examine L.V. in Pennsylvania. However, it 

appears that she did not fully investigate this course of action as her own 

expert, Dr. Holick, was unaware such licensing was available. Moreover, 

Pennsylvania regulatory law allows for the temporary licensure of an 

appropriately licensed physician who is licensed in “another state, territory, or 

possession of the United States” for numerous circumstances, including the 

physician’s “participation in a medical or surgical procedure necessary for the 

well-being of a specified patient.” 49 Pa.Code § 17.6(a)(2). The Board of 

Medicine also has the discretion to issue a temporary license to a physician

for a purpose as deemed appropriate on a case by case basis. 49 Pa.Code § 

17.6(i). As such, this claim is meritless.
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Second, Mother asserts that the trial court should have qualified Dr. 

Holick as an expert in endocrinology and given Dr. Holick’s testimony more 

weight. To the extent Mother opposes the court’s failure to qualify Dr. Holick 

as an endocrinologist or pediatric endocrinologist, we find that Mother failed 

to preserve such a challenge as she did not specifically include this issue in 

her Rule 1925(b) statement. See Krebs v. United Refining Co. of 

Pennsylvania, 893 A.2d 776, 797 (Pa.Super. 2006) (stating that a failure to 

preserve issues by raising them both in the concise statement of errors 

complained of on appeal and statement of questions involved portion of the 

brief on appeal results in a waiver of those issues); see also In re 

M.Z.T.M.W., 163 A.3d at 466 (same). As such, this portion of Mother’s 

second issue raised would be waived. 

Nevertheless, regardless of waiver, we find the entire issue to be without 

merit. As to expert witnesses and qualification, this Court has stated,

“Whether a witness has been properly qualified to give 

expert witness testimony is vested in the discretion of the trial 

court.” Kovalev v. Sowell, 839 A.2d 359, 362–363 (Pa.Super. 

2003) (citation omitted). “It is well settled in Pennsylvania that 

the standard for qualification of an expert witness is a liberal one. 

When determining whether a witness is qualified as an expert the 

court is to examine whether the witness has any reasonable 

pretension to specialized knowledge on the subject under 

investigation.” Id. (citations omitted).

The determination of whether a witness is a qualified expert 

involves two inquiries: When a witness is offered as an expert, 

the first question the trial court should ask is whether the subject 

on which the witness will express an opinion is so distinctly related 

to some science, profession, business or occupation as to be 

beyond the ken of the average layman.... If the subject is of this 
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sort, the next question the court should ask is whether the witness 

has sufficient skill, knowledge, or experience in that field or calling 

as to make it appear that his opinion or inference will probably aid 

the trier in his search for truth. Sowell, 839 A.2d at 363 (citations 

and quotation marks omitted).

Seels v. Tenet Health Sys. Hahnemann, LLC, 167 A.3d 190, 200–201 

(Pa.Super. 2017); see also Pa.R.E. 702. Further, “the weight to be given to 

such testimony is for the trier of fact to determine.” Miller v. Brass Rail 

Tavern, Inc., 541 Pa. 474, 480-81, 664 A.2d 525, 528 (1995). 

Upon review, the record supports the trial court’s qualification of Dr. 

Holick as an expert in vitamin D deficiency and treatment. Dr. Holick testified 

that, while he practiced in the field of endocrinology, which is the study of 

hormones, he focused his research on vitamin D deficiency. N.T., 8/23/17, at 

240, 263. He confirmed that he is neither a pediatrician nor child abuse expert 

nor geneticist. Id. at 261-62, 265.

Moreover, the trial court “had trouble” finding Dr. Holick’s testimony to 

be credible as Dr. Holick admitted he diagnosed L.V. with Ehlers-Danlos 

syndrome without ever physically examining L.V. Rather, Dr. Holick inferred

that L.V. had this condition by reviewing L.V.’s medical records and examining 

Mother. Id. at 266. The trial court chose to give more weight to DHS’s experts 

who argued that L.V.’s numerous fractures were indicative of child abuse as 

there was no signs that L.V. suffered from metabolic bone disease. 

As noted above, we are required to defer to a trial court’s credibility 

findings if they are supported by the evidence. In re R.J.T., supra. The trial 

court was free to resolve conflicts in the competing medical expert testimony 
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and find DHS’s experts to be more credible than Mother’s experts. See In re 

M.G. & J.G., supra. As the trial court’s findings are supported by the record, 

the trial court was within its discretion to give Dr. Holick’s testimony the 

weight and credibility it deemed appropriate. 

Third, Mother asserts that the trial court should have recused itself due 

to its fixed belief that child abuse had occurred and in showing bias for CHOP 

doctors over physicians who were not from Philadelphia. Moreover, Mother 

asserts that the trial court exhibited hostility towards her expert, Dr. Holick. 

Mother asserts, “[t]he trial court made a series of comments on the record 

that would lead a reasonable person to question the trial court’s ability to be 

fair and impartial when hearing child abuse and CHOP doctor testimony.” 

Mother’s Brief at 29. 

The denial of a motion to recuse is preserved as an assignment of error 

that can be raised on appeal following the conclusion of the case. Reilly by 

Reilly v. Southeastern Pennsylvania Transp. Authority, 507 Pa. 204, 

222, 489 A.2d 1291, 1300 (1985), overruled on other grounds as recognized 

by Gallagher v. Harleysville Mut., 617 A.2d 790, 794 (Pa.Super. 1992). 

We review a trial court’s decision to deny a motion to recuse for an abuse of 

discretion. Vargo v. Schwartz, 940 A.2d 459, 471 (Pa.Super. 2007). 

Indeed, our review of a trial court’s denial of a motion to recuse is 

exceptionally deferential. Id. (“[W]e extend extreme deference to a trial 

court’s decision not to recuse”). “We recognize that our trial judges are 

‘honorable, fair and competent,’ and although we employ an abuse of 
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discretion standard, we do so recognizing that the judge himself is best 

qualified to gauge his ability to preside impartially.” Commonwealth v. 

Harris, 979 A.2d 387, 391-92 (Pa.Super. 2009) (citation omitted). A trial 

judge should grant the motion to recuse only if a doubt exists as to his or her 

ability to preside impartially or if impartiality can be reasonably questioned. 

In re Bridgeport Fire Litigation, 5 A.3d 1250, 1254 (Pa.Super. 2010). 

In order to prevail on a motion for recusal, the party seeking recusal is

required “to produce evidence establishing bias, prejudice or unfairness which 

raises a substantial doubt as to the jurist’s ability to preside impartially.” In 

re S.H., 879 A.2d 802, 808 (Pa.Super. 2005) (citation omitted). Critically, 

Code of Judicial Conduct Rule 2.2 (Impartiality and Fairness) provides that 

“[a] judge shall uphold and apply the law, and shall perform all duties of 

judicial office fairly and impartially.”

In the case sub judice, we discern no abuse of discretion. Although the 

court expressed confidence in the qualifications and opinions of the CHOP 

physicians offered by DHS and questioned Dr. Holick’s credibility, the trial 

court’s statements do not evidence bias. Rather, the trial judge’s reluctance 

to credit Dr. Holick’s opinion was based on his skepticism of Dr. Holick’s 

diagnosis of L.V. with a metabolic bone disease given that (1) Dr. Holick had 

not examined the child and (2) doctors that had examined L.V. found no 

indication of metabolic bone disease. 

Although the trial court at several points did make seemingly 

inappropriate criticisms of Dr. Holick’s credentials, past achievements, and 
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publications, “we are nevertheless mindful of the fact that judges, too, are 

subject to human emotion.” Commonwealth v. Abu-Jamal, 553 Pa. 485, 

507–508, 720 A.2d 79, 89–90 (1998) (finding trial court’s hostile and 

intemperate remarks did not evidence a settled bias). We recognize that the 

trial court was dealing with a difficult and emotionally-charged matter where 

a two-month-old child suffered twenty-six fractures without explanation. 

Moreover, while Mother highlights statements of the trial court that she 

finds objectionable, Mother ignores the trial court’s statements in support of 

her position and completely contrary to any assertion of bias. Notably, the 

court stated,

[Mother and Father] are raising very legitimate claims . . . 

that these injuries may have in fact occurred as a result of genetic 

predisposition that the child suffers from. And I don’t think your 

contradictions – I don’t know if you’re going to present any 

evidence that [M]other doesn’t have this condition or not. If she 

has the condition and the child is fifty percent predisposed as 

counsel argues of having this condition, it weighs heavily with 

regard to any ruling this [c]ourt has on child abuse.

N.T., 4/5/17, at 26. As such, we cannot find the trial judge abused his 

discretion in ruling that he would be able to preside over the case fairly and 

impartially.

In Mother’s fourth and sixth issues, she claims the trial court erred in its 

findings relevant to dependency, abuse, and aggravated circumstances, which

suspended the need for DHS to make efforts toward reunification. We address 

these claims together, as Mother intermingles these issues in her discussion. 

Mother also claims DHS failed to establish her lack of parental capacity:
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Mother maintains that she never saw Father abuse L.V., and 

never noticed any bruising or indications of abuse after L.V. was 

alone with Father. However, during the pendency of this 

dependency proceeding, Mother sought and obtained a Protection 

[f]rom Abuse Order against Father for threats the father made 

against her. . . . As a result, Mother and Father are no longer 

together. Mother is not blindly protecting Father. Mother’s 

actions to protect herself from Father after he made a verbal 

threat, coupled with the fact that the medical professionals that 

treated L.V. had no suspicion that L.V. was abused, are evidence 

that Mother has protective capacity and was not ignoring L.V.’s 

needs. The burden of proof that Mother lacked parenting or 

protective capacity remains on Petitioner DHS[,] and DHS failed 

to present any evidence whatsoever that Mother was unable to 

care for her children. Without such evidence on the record, the 

trial court erred when it found the children to be dependent and 

when it ordered that no efforts be made to reunify the children 

with the Mother.

Id. at 41-42 (footnote omitted).

Our standard of review is as follows:

[T]o adjudicate a child dependent, a trial court must 

determine, by clear and convincing evidence, that the child:

is without proper parental care or control, 

subsistence, education as required by law, or other 

care or control necessary for his physical, mental, or 

emotional health, or morals. A determination that 

there is a lack of proper parental care or control may 

be based upon evidence of conduct by the parent, 

guardian or other custodian that places the health, 

safety or welfare of the child at risk.

42 Pa.C.S.A. § 6302(1). “Clear and convincing” evidence has 

been defined as testimony that is “so clear, direct, weighty, and 

convincing as to enable the trier of facts to come to a clear 

conviction, without hesitancy, of the truth of the precise facts in

issue.” In re C.R.S., 696 A.2d 840, 843 (Pa.Super. 1997) 

(citation omitted).

In accordance with the overarching purpose of the Juvenile 

Act “[t]o preserve the unity of the family wherever possible,” see 
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42 Pa.C.S.A. § 6301(b)(1), “a child will only be declared 

dependent when he is presently without proper parental care and 

when such care is not immediately available.” In re R.T., [ ] 592 

A.2d 55, 57 (Pa.Super. 1991) (citation omitted). This Court has 

defined “proper parental care” as “that care which (1) is geared 

to the particularized needs of the child and (2) at a minimum, is 

likely to prevent serious injury to the child.” In re C.R.S., supra 

at 845 (citation omitted).

In re A.B., 63 A.3d 345, 349 (Pa.Super. 2013).

Although dependency proceedings are governed by the Juvenile Act (42 

Pa.C.S.A. §§ 6301-75), the Child Protective Services Law (CPSL) “controls 

determinations regarding findings of child abuse, which the juvenile courts 

must find by clear and convincing evidence.” In Interest of N.M., 186 A.3d 

998, 1011 (Pa.Super. 2018) (citing In the Interest of J.R.W., 631 A.2d 1019 

(Pa.Super. 1993)). Section 6303 of the CPSL defines child abuse as including,

“intentionally, knowingly or recklessly” “[c]ausing bodily injury to a child 

through any recent act or failure to act” or “[c]ausing serious physical neglect 

of a child.” 23 Pa.C.S.A. § 6303(b.1)(1),(7) (effective June 12, 2018).12 

Bodily injury is defined as “[i]mpairment of physical condition or substantial 

pain.” 23 Pa.C.S.A. § 6303(a). Serious physical neglect is defined as follows:

Any of the following when committed by a perpetrator that 

endangers a child’s life or health, threatens a child’s well-being, 

causes bodily injury or impairs a child’s health, development or 

functioning: 

(1) A repeated, prolonged or egregious failure to supervise a 

child in a manner that is appropriate considering the child’s 

developmental age and abilities. 

____________________________________________

12 The definition of child abuse remained the same as the prior version of the 

CPSL, effective October 28, 2016 to February 20, 2018. 
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(2) The failure to provide a child with adequate essentials of life, 

including food, shelter or medical care. 

23 Pa.C.S.A. § 6303(a). 

Moreover, Section 6381 of the CPSL provides, in part: 

(d) Prima facie evidence of abuse.--Evidence that a child has 

suffered child abuse of such a nature as would ordinarily not be 

sustained or exist except by reason of the acts or omissions of the 

parent or other person responsible for the welfare of the child shall 

be prima facie evidence of child abuse by the parent or other 

person responsible for the welfare of the child.

23 Pa.C.S.A. § 6381.

Upon careful review of the record, we discern no abuse of discretion with 

the trial court’s determination to adjudicate the Children dependent. The 

record substantiates the trial court’s findings that Mother and Father’s conduct 

placed the health, safety or welfare of the Children at risk, and thus, its 

conclusion that the Children were dependent without parental care and 

control. The record further corroborates the finding of child abuse as the trial 

court found DHS’s medical experts credible in testifying that L.V. suffered 

numerous fractures that were most likely caused by inflicted or non-accidental 

trauma. Thus, we will not disturb these findings.

As to aggravated circumstances, the Juvenile Act provides as follows:

(c.1) Aggravated circumstances.--If the county agency 

or the child’s attorney alleges the existence of aggravated 

circumstances and the court determines that the child is 

dependent, the court shall also determine if aggravated 

circumstances exist. If the court finds from clear and 

convincing evidence that aggravated circumstances exist, 

the court shall determine whether or not reasonable efforts 

to prevent or eliminate the need for removing the child from 
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the home or to preserve and reunify the family shall be 

made or continue to be made and schedule a hearing as 

required in section 6351(e)(3) (relating to disposition of 

dependent child).

42 Pa.C.S.A. § 6341(c.1). The term “[a]ggravated circumstances” is defined 

in part, as circumstances in which “[t]he child or another child of the parent 

has been the victim of physical abuse resulting in serious bodily injury, sexual 

violence or aggravated physical neglect by a parent.” 42 Pa.C.S.A. § 6302. 

In turn, “serious bodily injury” is defined as “[b]odily injury which creates a 

substantial risk of death or which causes serious, permanent disfigurement or 

protracted loss or impairment of the function of any bodily member or organ.” 

Id. Further, “aggravated physical neglect” is defined as “[a]ny omission in 

the care of a child which results in a life-threatening condition or seriously 

impairs the child’s functioning.” Id. 

As revealed, DHS’s medical expert opined that two-month-old L.V.

suffered twenty-six fractures, causing pain and swelling, as a result of nonaccidental trauma or abuse. Thus, the record supports the trial court’s finding 

of aggravated circumstances based upon physical abuse to L.V. and its 

determination requiring no efforts toward reunification. See 42 Pa.C.S.A. § 

6302.

With respect to Mother’s claim that that trial court failed to show she 

exhibited a lack of parental care towards the Children, this Court has 

recognized that a trial court “need not find the existence of aggravated 

circumstances as to a particular party; rather, it merely must determine 

whether they are present in the case. This is ... because the focus is not on 
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the rights of the [p]arents; instead, the children’s safety, permanence, and 

well-being take precedence.” In re R.P., 957 A.2d 1205, 1219 (Pa.Super. 

2008) (citation omitted).

Accordingly, after a thorough review of the record, including the notes 

of testimony, the exhibits presented, the trial court opinion, and the parties’ 

briefs, we discern no abuse of discretion in the trial court’s decision to 

adjudicate the Children dependent and finding abuse, aggravated 

circumstances, and that no reasonable efforts at reunification are required. 

Mother next claims error due to the trial court’s delay in scheduling the 

dependency hearing. Mother’s Brief at 36. She asserts that the trial court 

took over one year from the time she had obtained her expert reports and 

was prepared to proceed to complete the dependency hearing. 

Mother, however, waived this issue by failing to raise it in the court 

below as the matter proceeded and was scheduled. See Pa.R.A.P. 302(a) 

(providing for waiver of issues not first raised in lower court).

In order to preserve an issue for appellate review, a party 

must make a timely and specific objection at the appropriate stage 

of the proceedings before the trial court. Failure to timely object

to a basic and fundamental error will result in waiver of that issue. 

On appeal the Superior Court will not consider a claim which was 

not called to the trial court's attention at a time when any error 

committed could have been corrected. In this jurisdiction ... one 

must object to errors, improprieties or irregularities at the earliest 

possible stage of the adjudicatory process to afford the jurist 

hearing the case the first occasion to remedy the wrong and 

possibly avoid an unnecessary appeal to complain of the matter.
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In re S.C.B., 990 A.2d 762, 767 (Pa.Super. 2010) (citations omitted). As a 

result, we need not review this claim further.

Lastly, Mother argues that the trial court erred in suggesting that no 

reunification efforts would be made unless Mother or Father confessed to 

causing L.V.’s injuries. Mother relies on In re N.M., in which this Court found 

that a trial court abused its discretion in repeatedly refusing to consider 

approved kinship care for a child with her grandmother based on an 

unsupported speculation that the parents would visit the child without agency 

supervision. This Court also found the trial court improperly expressed a fixed 

presumptive idea that the child was abused and put barriers up for 

reunification when her parents were fully compliant with their service plan 

objectives. In addition, this Court admonished the lower court for telling the 

parents that they would lose their child unless one of them confessed to 

causing their child’s injuries. In re N.M., 186 A.3d at 1014 n.30. Based on 

all of these observations, this Court found that the lower court had “done 

everything in her power to alienate [the] parents from their child.” Id.

Upon our review of the record, we find this case distinguishable. The 

trial court held numerous hearings, heard extensive testimony, and reviewed 

hundreds of pages of documents before concluding that Mother and Father 

were responsible for L.V.’s injuries. After finding aggravated circumstances 

existed and directing that no reasonable efforts need to be made towards 

reunification, the trial court indicated the following:
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THE COURT: Somebody did this, okay? And I don’t know

which parent is responsible, but collectively, you’re both 

responsible. 

There could come a time in the future in this case where one 

of the parties comes forward and tells us what the real truth is, 

and find out who was the perpetrator, or if they were both 

perpetrators. 

I’ll keep an open mind as to that. However, the facts of 

this case dictate that this is a clear case of child abuse, and the 

City has met its burden by clear and convincing evidence. . . .

N.T., 4/16/18, at 78 (emphasis added). With an open mind towards 

reunification, the trial court ordered that Parents could continue visiting the 

Children. As a result, we reject Mother’s claim that the trial court attempted 

to extort a confession from Parents as to L.V.’s injuries.

For the foregoing reasons, we affirm the orders of the trial court 

adjudicating the Children dependent, finding abuse as to both Mother and 

Father, and finding aggravated circumstances and that no efforts need be 

made toward reunification.

Orders affirmed.

Judgment Entered.

Joseph D. Seletyn, Esq.

Prothonotary

Date: 4/9/19