[Cite as In re R.G., 2020-Ohio-381.]

COURT OF APPEALS OF OHIO 

EIGHTH APPELLATE DISTRICT 

COUNTY OF CUYAHOGA 

 

 

IN RE R.G. : 

 

A Minor Child : No. 108537 

 

[Appeal by S.A., Mother] : 

 : 

 

JOURNAL ENTRY AND OPINION 

 JUDGMENT: REVERSED AND REMANDED

RELEASED AND JOURNALIZED: February 6, 2020 

 

Civil Appeal from the Cuyahoga County Court of Common Pleas 

Juvenile Division 

Case No. AD-17907988 

 

Appearances: 

Gregory T. Stralka, for appellant. 

Michael C. O’Malley, Cuyahoga County Prosecuting 

Attorney, and Willie Mitchell, Assistant Prosecuting 

Attorney, for appellee CCDCFS. 

PATRICIA ANN BLACKMON, P.J.: 

Appellant, S.A. (referred to herein as “Mother”), appeals from the 

order of the juvenile court that awarded permanent custody of her son, R.G., to the 

Cuyahoga County Department of Children and Family Services (“CCDCFS”). 

Mother assigns the following error for our review: 
The [CCDCFS] failed to present sufficient evidence to establish that 

[Mother] failed to substantially remedy the condition that caused the 

removal of the child. 

Having reviewed the record and the controlling case law, we reverse 

the decision of the trial court and remand for further proceedings. 

R.G. was born prematurely in 2016 and required a lengthy 

hospitalization in the NICU after his birth. On May 18, 2017, prior to R.G.’s 

discharge from the hospital, CCDCFS filed a complaint for emergency temporary 

custody. CCDCFS alleged that R.G. is neglected and dependent because of his 

premature birth, special medical needs, and Mother’s lack of consistency in visiting 

with him. CCDCFS further alleged that R.G.’s father has not established paternity 

and is not in contact with R.G. R.G. was subsequently placed in the pre-adjudicatory 

temporary custody of CCDCFS in June 2017. 

The adjudicatory hearing was held on August 23, 2017. Prior to the 

hearing, CCDCFS amended its complaint to delete the allegation of neglect, and 

Mother admitted the dependency allegations. The court found R.G. to be a 

dependent child and ordered him committed to the temporary custody of CCDCFS. 

Mother’s case plan required her to: (1) participate in a mental health 

assessment and follow recommendations; (2) consistently visit with R.G.; and (3) 

complete the required training for providing care for R.G. The stated goal was 

reunification. 
In April 2018, CCDCFS filed a motion to modify temporary custody 

to permanent custody. In response, Mother asked the court to extend the temporary 

custody order. The trial court held a hearing in April 2019. 

With regard to R.G.’s condition, social worker Cynthia Hurry 

(“Hurry”) testified that R.G. was placed in therapeutic foster care in Ashland, Ohio, 

about an hour away from Mother. Hurry testified that this foster care was selected 

based upon availability of an appropriate placement at the time of R.G.’s discharge 

from the hospital. The placement required foster parents who were trained in CPR, 

use of the Pulse Oximeter Machine, the oxygen machine, feeding tube, and other 

care. They must also take him to a pulmonologist, a gastro specialist, a neurologist, 

and a therapist from the Help Me Grow Program. 

Foster parent Gary Gerwig testified that he and his wife, Celeste, have 

a therapeutic foster care license that permits them to care for medically fragile 

children and take ongoing training. For R.G. specifically, they completed two days 

of training at Rainbow Babies and Children’s Hospital. They learned how to use his 

feeding machine, oxygen machine, Pulse Oximeter Machine, and generally care for 

him at their home. Gerwig also outlined for the court a typical day of their care for 

R.G., including feeding him via the feeding machine, giving him his medicine, and 

clearing his mucous using the pulmonary vest. According to this testimony, the 

concerted effort of both foster parents is required to complete the detailed care 

regimen, especially if R.G. is ill. R.G. is improving, but he is currently at the 

developmental level of a one-year-old. Gerwig also testified that Mother holds R.G. 
but does not participate in care during her visit. However, he acknowledged that no 

feeding or pulmonary treatments were required during the course of her visits. 

Dr. Amy DiMarino (“Dr. DiMarino”), R.G.’s pediatric pulmonologist, 

testified that R.G. has chronic lung disease due to his premature birth. He is 

required to wear a pulmonary vest twice a day for 15 to 20 minutes in order to clear 

mucus from his lungs. R.G. also takes various medications by inhaler and nebulizer 

for coughing, wheezing, and asthma. Dr. DiMarino sees R.G. every two or three 

months to review his symptoms and medication. She stated that without proper 

care at home, R.G. would have to be hospitalized. However, Dr. DiMarino testified 

that R.G. is improving. He now has a normal breathing pattern and has been 

weaned off of some medication. Dr. DiMarino met Mother twice. To Dr. DiMarino, 

Mother did not seem engaged. 

With regard to Mother’s compliance with the case plan requirement 

that she learn to care for R.G., Hurry established that prior to R.G.’s discharge from 

the hospital, Mother undertook some training to care for R.G. but did not learn all 

that is needed to care for him or to manage his medical appointments that are 

scheduled at various locations. Mother has attended only about ten of R.G.’s 60 

appointments, but she did attend a feeding clinic to learn how to feed R.G. In 

another instance, Mother arrived for an appointment involving a medical procedure, 

but she was not permitted in because she had another child with her. 

As to the case plan requirement that Mother visit R.G., Hurry further 

testified that Mother’s home is not appropriate for R.G.’s care. Mother visited R.G. 
at the foster home in June 2017, but she did not visit him again until June 2018. 

After obtaining a court order for Mother’s transportation, Hurry arranged for a 

driver to take Mother to Ashland each Friday. Mother did not attend each week, but 

visited the child throughout June to September 2018, and several times in 2019. 

Mother also informed Hurry that she started a new job and was still a probationary 

employee, so she has difficulty attending visits and medical appointments. 

As to Mother’s compliance with the case plan requirement that she 

undergo a mental health assessment, Hurry testified that in August 2017, Mother 

completed the assessment, but she did not return for additional services until May 

2018. 

Mother testified that she has another child who lives with maternal 

grandmother, but she sees Mother most days. Mother works as a nursing assistant 

and is preparing to take her certification examination. As part of her employment, 

she works with feeding machines and trachea equipment. She acknowledged that 

she has difficulties in visiting with R.G., but she explained that she is a probationary 

employee and does not have a driver’s license. 

R.G.’s guardian ad litem (“GAL”) testified that R.G.’s condition has 

improved due to the care of the foster parents and the doctors. The GAL did not 

believe that Mother would have been able to handle the required 24-hour care that 

R.G. needs, and he opined that permanent custody should be awarded to CCDCFS. 

On April 6, 2019, the trial court awarded permanent custody of R.G. 

to CCDCFS, concluding: 
The Court determines that the seriousness and nature of the child’s 

special needs makes the child’s placement with the child’s parent a 

threat to the child’s safety where the parent(s) have failed to remedy 

the conditions that caused the child to be placed outside the home. 

The Court finds that the child’s continued residence in or return to the 

home of mother, will be contrary to the child’s best interest. 

The Court further finds that reasonable efforts were made to prevent 

the removal of the child from her home, or to return the child to the 

home, and to finalize the permanency plan, to wit: reunification. 

Relevant services provided to the family and the reasons those services 

were not successful: case plan services included mental health 

services/counseling, transportation to and from visits due to out of 

county placement of the child, attendance at medical appointments and 

for medical training necessary for the care of the child, housing, 

supportive services and assistance for the child while in the parent’s 

care. 

That one or more of the factors in division (E) of section 2151.414 of the 

Revised Code exist and the child cannot be placed with one of the 

child’s parents within a reasonable period of time or should not be 

placed with either parent; * * * the child has been in temporary custody 

of a public children services agency or private child placing agency 

under one or more separate orders of disposition for twelve or more 

months of a consecutive twenty-two month period; * * * the Court finds 

by clear and convincing evidence that a grant of permanent custody is 

in the best interests of the child and the child cannot be placed with one 

of the child’s parents within a reasonable time or should not be placed 

with either parent. 

Sufficiency of the Evidence 

In the assigned error, Mother argues that there is insufficient 

evidence to show that she failed to substantially remedy the conditions that caused 

removal of R.G. She also argues that CCDCFS did not use reasonable case planning 

and diligent efforts to assist her in remedying the problems that caused placement 

outside her home. 
As an initial matter, we recognize that ‘[t]he purpose of the 

termination of parental rights statutes is to make a more stable life for the dependent 

children and to facilitate adoption to foster permanency for children.” In re N.B., 

8th Dist. Cuyahoga No. 101390, 2015-Ohio-314, ¶ 67. However, a “parent’s right to 

raise a child is an essential and basic civil right.” Id., quoting In re Hayes, 79 Ohio 

St.3d 46, 48, 679 N.E.2d 680 (1997). The termination of parental rights is “the 

family law equivalent of the death penalty in a criminal case.” In re Hoffman, 97 

Ohio St.3d 92, 2002-Ohio-5368, 776 N.E.2d 485, ¶ 14. It is “an alternative [of] last 

resort.” In re Gill, 8th Dist. Cuyahoga No. 79640, 2002-Ohio-3242, ¶ 21. 

R.C. 2151.414 sets forth a two-part analysis to be applied by a juvenile 

court in adjudicating a motion for permanent custody. R.C. 2151.414(B). Under this 

statute, the juvenile court is authorized to grant permanent custody of a child to the 

agency if, after a hearing, the court determines, by clear and convincing evidence, 

that (1) any of the five factors under R.C. 2151.414(B)(1)(a) to (e) exist; and (2) 

permanent custody is in the best interest of the child under the factors enumerated 

in R.C. 2151.414(D). Clear and convincing evidence is that which will produce in 

the trier of fact “‘a firm belief or conviction as to the facts sought to be established.’” 

In re Adoption of Holcomb, 18 Ohio St.3d 361, 419, 481 N.E.2d 613 (1985), quoting 

Cross v. Ledford, 161 Ohio St. 469, 120 N.E.2d 118 (1954), paragraph three of the 

syllabus. 

Examining the first prong of the permanent custody analysis, the trial 

court found that the child has been in the temporary custody for 12 or more months 
of a consecutive 22-month period and that the child cannot be placed with either 

parent within a reasonable time or should not be placed with them under R.C. 

2151.414(B)(1)(a); R.C. 2151.414(B)(1)(d). Therefore, the trial court must also 

consider the enumerated reunification factors. In re J.J., 8th Dist. Cuyahoga No. 

108564, 2019-Ohio-4984, ¶ 33. These include: 

(1) Following the placement of the child outside the child’s home and 

notwithstanding reasonable case planning and diligent efforts by the 

agency to assist the parents to remedy the problems that initially 

caused the child to be placed outside the home, the parent has failed 

continuously and repeatedly to substantially remedy the conditions 

causing the child to be placed outside the child’s home. In determining 

whether the parents have substantially remedied those conditions, the 

court shall consider parental utilization of medical, psychiatric, 

psychological, and other social and rehabilitative services and material 

resources that were made available to the parents for the purpose of 

changing parental conduct to allow them to resume and maintain 

parental duties. 

* * * 

 (16) Any other factor the court considers relevant. 

In this matter, we do not find that that clear and convincing evidence 

supports the trial court’s findings under the first prong of the analysis. As an initial 

matter, placement of the child outside of the home occurred due to the tragic 

intersection of the peculiarities of the Ohio law and the child’s unfortunate illness. 

That is, the child was not adjudicated to be neglected; he was deemed dependent 

due to his extremely challenging and life-threatening medical situation, a 

circumstance not of Mother’s own creation. Ohio law defines a dependent child as 

any child: 
(C) Whose condition or environment is such as to warrant the State, in 

the interests of the child, in assuming the child’s guardianship; 

(D) To whom both of the following apply: 

(1) The child is residing in a household in which a parent, guardian, or 

custodian or other member of the household committed an act that was 

the basis for an adjudication that a sibling of the child or any other child 

who resides in the household is an abused, neglected, or dependent 

child; 

(2) Because of the circumstances surrounding the abuse, neglect, or 

dependency of the sibling or other child and the other conditions in the 

household of the child, the child is in danger of being abused or 

neglected by that parent, guardian, or custodian or member of the 

household. 

R.C. 2151.04. 

This definition appears to be unique. That is, the majority of states in 

this country tend to define dependency in terms of a parent’s abuse, neglect, illness, 

addiction, or other condition that make the parent unable to discharge their parental 

responsibilities. See, e.g., Cal.Welf. & Inst.Code Section 300; Florida Stat.Ann. 

39.01(15). Generally, dependency must be shown in relation to “evidence of 

conduct” that “places the health, safety or welfare of the child at risk.” See, e.g., 23 

Pa.C.S. 6302. 

Ohio’s less stringent dependency definition places it within the small 

group of states that define dependency beyond the risks of harm from a parent’s 

abuse, neglect, illness, addiction, or other conditions that make the parent unable to 

discharge their parental responsibilities. In this group, dependency can result 

absent parental fault. Accord Maine 22 R.S.A. 4055(1)(B)(2)(b)(i)-(ii) (the parent is 

unwilling or unable to protect the child from jeopardy, and parent has been 
unwilling or unable to take responsibility for the child); Wis. Stat. 48.424(4) (no 

intent to harm or neglect is needed, or parent fails to assume significant 

responsibility for the daily care of the child); N.C. Gen. Stat. 7B-101(9) (the parent is 

unable to provide for the care or supervision and lacks an appropriate alternative 

child care arrangement). 

Ohio dependency determinations for medically fragile children 

present especially difficult questions. Often the medical problems are unexpected, 

at which point the parent is neither emotionally nor medically prepared to address 

these challenges and to understand and comply with case plan requirements. 

Typically, as in this matter, the parent has job obligations and other family needing 

his or her care. Once under county control, the parent has limited time to both learn 

to cope with the situation and become able to provide the requisite medical care and 

support. Time is of the essence to avoid the loss of parental rights, yet extreme 

stressors remain. 

Turning next to the question of whether the CCDCFS used reasonable 

planning and diligent efforts to assist Mother in remedying the problems causing 

placement of the child outside of the home, the record clearly demonstrated that 

Mother had difficulty in traveling to R.G. due to his placement in Ashland. However, 

the court did not inquire as to whether a suitable foster care option ever became 

available closer to Mother’s home. While R.G.’s placement in Ashland may still be 

reasonable given all of the presently available alternatives, there is nothing in the 

record to demonstrate that this is the case. 
With regard to the next question of whether Mother failed 

continuously and repeatedly to substantially remedy the conditions causing the 

child to be placed outside the child’s home, the record plainly demonstrates that 

Mother was making progress in her case plan objectives. Significantly, she obtained 

employment as a nurse’s assistant and worked with feeding tubes and trachea 

equipment in her employment. 

We recognize that R.G. has chronic lung disease related to his 

premature birth. Twice a day, he must wear a special vest in order to clear mucous 

from his lungs. He also requires inhalers and nebulized medications. Additionally, 

he must see a gastrointestinal specialist to address feeding issues, an immunology 

specialist, and an orthopedic specialist. He has a specialized feeder and a Pulse 

Oximeter Machine. We also recognize and acknowledge the high degree of excellent 

care that the Gerwigs are providing to R.G. in his therapeutic foster care. As his 

condition improves and he gets stronger, Mother is also improving her ability to care 

for him. Therefore, we conclude that Mother was simply not given enough of an 

opportunity for reunification. 

In accordance with the forgoing, we find that there is insufficient 

evidence to support the first prong of the required showing for termination of 

parental rights. The assigned error is well-taken. 

The judgment of the trial court is reversed and the matter is 

remanded for further proceedings consistent with this opinion 

It is ordered that appellant recover from appellee costs herein taxed. 
The court finds there were reasonable grounds for this appeal. 

It is ordered that a special mandate issue out of this court directing the 

common pleas court, juvenile division, to carry this judgment into execution. 

A certified copy of this entry shall constitute the mandate pursuant to Rule 27 

of the Rules of Appellate Procedure. 

______________________________________ 

PATRICIA ANN BLACKMON, PRESIDING JUDGE 

RAYMOND C. HEADEN, J., CONCURS; 

KATHLEEN ANN KEOUGH, J., DISSENTS 

WITH ATTACHED OPINION 

KATHLEEN ANN KEOUGH, J., DISSENTING: 

Respectfully, I dissent. The majority concludes there was not clear 

and convincing evidence to support the trial court’s finding that R.G. could not or 

should not be placed with Mother in a reasonable time because CCDCFS did not 

make reasonable efforts toward reunification, and Mother was not given a sufficient 

opportunity to remedy the conditions that led to R.G.’s removal from her home. I 

disagree. 

As the majority points out, Mother had difficulty visiting R.G. due to 

his placement in Ashland. But the record reflects that this placement was necessary 

because R.G. needed to be placed with medically qualified foster parents who were 

able to care for his extensive medical needs. Social worker Hurry testified that in 

June 2018, the agency made arrangements with a cab service to provide door-to-
door transportation for Mother to and from the foster home every Friday afternoon, 

but although Mother visited a few times in June and July, the visits “immediately 

started tapering off.” Hurry testified that since Mother’s last visit in September 

2018, she had visited R.G. only once in January 2019 and once in February 2019. 

Mother acknowledged on cross-examination that even after the agency began 

providing transportation for her to and from the foster home, she missed more than 

half of her scheduled visits with R.G. It is difficult to conclude on this evidence that 

CCDCFS did not make reasonable efforts to assist Mother with reunification. 

Instead, the evidence demonstrates that Mother did not avail herself of the 

opportunities provided to her. 

The majority also concludes that “Mother was making progress in her 

case plan objectives” and “improving her ability to care for [R.G.]” such that the trial 

court’s finding that Mother failed to substantially remedy the conditions that led to 

R.G. being placed outside her home was not supported by clear and convincing 

evidence. Again I disagree. 

The record demonstrates that as of April 3, 2019, the date of the 

permanent custody hearing, Mother was not making any progress with her mental 

health treatment recommendations, one of her case plan objectives. Hurry testified 

that Mother had a mental health evaluation in August 2017, and was referred for 

additional services, but did not return to the mental health agency until May 2018. 

She was again seen there in September 2018, and November 2018, but never 

returned after that for any mental health services. 
With respect to completing the required training regarding the 

various medical devices used by R.G., another case plan objective, Mother testified 

that she learned how to use a feeding tube in her job as a nurse assistant. She 

acknowledged, however, that she had no experience with the vest that R.G. wears 

every day, and admitted that she had not met many of R.G.’s doctors. Indeed, the 

record reflects that although the foster parents took R.G. to at least 60 doctor’s visits 

after June 2017, and Mother was advised by CCDCFS of all the appointments, 

Mother went to only six appointments in 2017, two in 2018, and one in 2019. The 

evidence further reflects that Mother did not ask any questions of the doctors during 

the visits, nor did she ever give Hurry any reasons regarding why she missed the 

medical appointments. In light of this evidence, I fail to see how Mother was making 

any progress on her case plan objectives. 

The majority notes that R.G.’s condition has improved during his 

nearly two-year stay with the foster parents, and concludes that given more time, 

Mother could adequately care for him. But R.G.’s medical condition improved 

precisely because he received the medically prescribed care from his foster parents, 

who went to all his doctor’s appointments and obtained training on all of the medical 

devices used to treat him. 

And Mother’s minimal progress in learning to use a feeding tube is 

not sufficient to demonstrate that given more time, she could adequately care for 

R.G.’s extensive medical needs when he is healthy, much less when he is sick. As 

described by Gerwig, R.G.’s foster father, a typical day with R.G. requires constant 
attention to R.G.’s needs. Gerwig said that R.G. wakes up around 8:00 a.m. and if 

he is healthy, “he has two puffs of Ventolin with a spacer, then ten minutes in the 

vest, then two puffs of the Dulera, and we count to make sure it’s a least ten breaths 

on each side.” Gerwig said that after that is completed, he and his wife mix the 

formula for R.G. and feed him through his feeding tube, which takes approximately 

30 minutes. They then give him two more medications and water through a bolus 

syringe. At 10 a.m., they given him more water. At noon, they feed him again, and 

then put him down for a nap. At around 4:30 p.m., they again treat him with the 

vest, and then feed him and give him more medicine, a process that takes at least an 

hour. Gerwig said that after the evening feeding, they give R.G. more medications 

and then water. At around 7:30 p.m., they get R.G. ready for bed, which includes 

placing him in a hip-abductor brace to correct his hip placement. Gerwig said that 

when R.G. is sick, he and his wife do breathing treatments every two to three hours 

during the day and a few times at night. Gerwig said that it “would be hard to keep 

up with him” if he had to take care of R.G. by himself because even when R.G. is 

healthy, “it’s a full-time job with R.G.” In light of this testimony, it is difficult to 

conclude that Mother’s minimal training and familiarity with R.G.’s extensive 

medical needs would allow her to adequately care for R.G. in a manner that would 

sustain his improved medical condition or foster continued improvement in his 

condition. 

On this record, I would affirm the trial court’s judgment finding that 

CCDCFS made reasonable efforts for reunification, but Mother failed to remedy the 
conditions that led to R.G.’s removal from her home, R.G. could not or should not 

be placed with Mother within a reasonable time, and permanent custody was in 

R.G.’s best interest.