Court Opinion

ID: 9412791
Source: CourtListenerOpinion
Date Created: 2023-08-01 17:06:10.587007+00
Date Added: 2024-06-11T16:41:28.108415
License: Public Domain

Filed 8/1/23 In re Z.W. CA4/1
                 NOT TO BE PUBLISHED IN OFFICIAL REPORTS
California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for
publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication
or ordered published for purposes of rule 8.1115.

                COURT OF APPEAL, FOURTH APPELLATE DISTRICT

                                                 DIVISION ONE

                                         STATE OF CALIFORNIA

 In re Z.W., a Person Coming Under                               D081748
 the Juvenile Court Law.

 SAN DIEGO COUNTY HEALTH                                         (Super. Ct. No. J521163)
 AND HUMAN SERVICES
 AGENCY,

           Petitioner and Respondent,

           v.

 N.B.,

           Defendant and Appellant.

         APPEAL from an order of the Superior Court of San Diego County,
Michael P. Pulos, Judge. Affirmed.
         William D. Caldwell, under appointment by the Court of Appeal, for
Defendant and Appellant.
         Claudia G. Silva, County Counsel, Lisa M. Maldonado, Chief Deputy
County Counsel and Emily Harlan, Deputy County Counsel, for Plaintiff and
Respondent.
      N.B. (Mother) appeals the juvenile court’s jurisdictional and

dispositional findings and orders in a Welfare and Institutions Code1 section
300 dependency proceeding for her son, Z.W. Mother argues substantial
evidence does not support the juvenile court’s jurisdictional findings under
section 300, subdivision (b). She also argues that there was no substantial
evidence supporting the juvenile court’s orders removing Z.W. from her
custody under section 361, subdivision (c). We disagree and conclude that
substantial evidence supports the court’s jurisdictional and dispositional
findings and orders.
              FACTUAL AND PROCEDURAL BACKGROUND
      A.    Background Information

      Z.W. is Mother’s first child with her husband, T.W. (Father).2 At the
time of trial, they were expecting their second child together.
      Mother’s child welfare referral history includes a report from 2018 that
she was manic and paranoid after using THC regularly, including at least
once “laced with crack.” Around that time, she had multiple psychiatric
hospitalizations and refused to accept or treat her diagnosis of bipolar
disorder. The referral was determined to be “inconclusive as [the social
worker] was unable to locate the family.”
      B.    Z.W.’s Birth
      Mother gave birth to Z.W. in Hawaii in November 2021. She had
received inconsistent prenatal care due to chronic back pain. Mother was
diagnosed with a “mild substance use disorder in pregnancy.” She stopped

1     All further statutory references are to the Welfare and Institutions
Code, unless otherwise indicated.

2     Father is not a party to this appeal.
                                       2
using narcotics three weeks before Z.W. was born because she did not want
him to suffer “withdrawal problems.” She used marijuana two days before
his birth. Although Z.W. tested negative for drug exposure, the hospital
advised that he needed to stay in the hospital for three to five days to be
monitored for withdrawal symptoms. Mother also was advised to avoid
marijuana and narcotics while breastfeeding.
      A few weeks after Z.W. was discharged from the hospital, Mother was
placed on a psychiatric hold and Z.W. was removed from his parents’ care.
According to Mother, she was experiencing postpartum depression, and she
reported to Hawaii’s child welfare services that T.W. was not a good father,
had an alcohol problem, and was too forceful with Z.W.’s feedings. After
Mother was discharged, Z.W. was returned to his parents’ custody.
      C.    Z.W.’s Medical Procedures
      In February 2022, Mother brought Z.W. to a children’s hospital in San
Diego for noisy breathing. Mother told the San Diego hospital staff that the
hospital in Hawaii had “implanted a foreign body” into Z.W. She further
stated that the doctors “took [Z.W.] away for studies [and] now he has noisy
breathing.” Z.W. received a foreign body x-rays series, which was normal.

The hospital staff advised Mother he could have laryngomalacia,3 and he was
discharged home.
      The next day, Mother took Z.W. to a different hospital for noisy
breathing and a possible foreign body. Mother stated to the staff, “I know
[Z.W.’s] rectum has been [tasered] and something has been inserted at some
point.” Hospital staff ordered a chest x-ray, which showed normal results.

3     Laryngomalacia is an abnormality of the larynx (voice box) that causes
the airway to collapse inward as air goes to the lungs. The condition
generally is noticeable at birth or shortly afterwards, and then slowly
improves until it fully resolves when the child gets older.
                                        3
Mother became upset, stating that no one was examining Z.W. and everyone
was trying to make her feel crazy. Hospital staff contacted law enforcement.
Father reported to hospital staff that Mother had a history of bipolar
depression with mania, and she was not on medication.
      The next day, parents brought Z.W. to a third hospital. Mother again
insisted a doctor in Hawaii had inserted something into Z.W. She further
claimed that the doctor in Hawaii was making Z.W. get shocked when she
answers her phone or puts him down to rest. Z.W. was examined and no
concern was found.
      The family returned to Hawaii and, in April 2022, Mother took Z.W. to
a medical center for concerns about breathing and a retained foreign body.
The doctor diagnosed Z.W. with laryngomalacia and advised Mother that
Z.W.’s condition would slowly improve until it fully resolves when he is older.
      Also, in April 2022, Mother took Z.W. to a hospital emergency
department due to concerns for his noisy breathing and a retained foreign
body. The medical staff took a foreign body x-ray of Z.W., and the results
were normal. They explained the diagnosis and symptoms of laryngomalacia,
documented their concern for Mother’s delusional behavior and possible
factitious disorder, and made a report to Hawaii’s child welfare services.
Child welfare services refused to open a new investigation because it had
already determined Father was safe following a previous report raising
similar concerns. The medical staff discussed with parents the plan for a
follow up appointment at the ear, nose, and throat clinic.
      In November 2022, the parents took Z.W. to the emergency room at a
children’s hospital in San Diego because he had been nauseous and vomiting
for five days. Mother was concerned that the doctor in Hawaii had put
something in Z.W.’s airway and a radiopaque plastic straw in his rectum.

                                       4
She also complained that Z.W. has a “valve” in his bottom that “tazes” him,
causes him pain, and allows him to have timed stools. The medical staff
documented that Mother was “exhibiting concerns consistent with psychiatric
illness.” The medical staff examined Z.W. and found no objects. They
discharged him and referred him to the ear, nose, and throat department.
      In December 2022, Mother took Z.T. to the ear, nose, and throat
department. Medical staff gave Z.W. a flexible laryngoscopy, which revealed
moderate laryngomalacia and no foreign body. Due to concerns for difficulty
swallowing, the medical staff admitted Z.W. to the hospital for further
evaluation and a possible “triple scope” procedure.
      A pediatrician specializing in child abuse evaluated Z.W. for possible
medical child abuse. She explained: “If parents continue to request medical
evaluations and/or treatments that are not warranted this would be
consistent with medical child abuse.” She concluded that “[t]here is clear
evidence that [M]other’s persistent delusions have resulted in unnecessary
medical testing.” She was concerned that Z.W. may face neglect due to
Mother’s “incapacitation due to her untreated medical conditions.” The
doctor also noted that Mother’s “drug seeking behavior” was concerning. She
also had “significant concerns for [F]ather’s ability to be protective.”
      The doctor opined: “Caregivers with untreated psychotic symptoms
related to foreign bodies inside their children pose an extreme risk to those
children as they may attempt to remove these perceived foreign objects on
their own. Attempted removal of perceived internal objects can result in
severe and/or potentially fatal harm.” “If [Z.W.] were to be returned to the
environment in which [Mother] has ongoing psychotic symptoms, in which
there is domestic violence, and in which there is concern for substance

                                        5
abuse/misuse, it would place him at extreme risk of ongoing and potentially
escalating forms of maltreatment to include the possibility of death.”
      D.    Agency Investigation
      San Diego County Health and Human Services Agency (Agency)
received a report on its child welfare hotline from a caller who expressed
concern about Mother’s mental health and Father’s inability to protect Z.W.
Father told the social worker that he understands the concern for Mother’s
mental health, although he continued to be present when Mother asked for
additional examinations of Z.W. despite proof there is no foreign body present
in Z.W.
      While at the hospital with Z.W., Mother reported having chronic back
pain, postpartum depression, and postpartum anxiety. She wanted
medication. The hospital staff observed Mother kicking Father in the
hospital room.
      Mother refused to speak with a social worker at the hospital and would
not allow the social worker to have access to Z.W. Mother told hospital
personnel she would not feed Z.W. while he was recovering from a medical
procedure, insisting she wait until the doctor checked on him.
      While at the hospital, Father explained to the social worker that he
understood Z.W.’s condition was unrelated to Mother’s concern about a
foreign object in Z.W.’s body, but he allowed Mother to bring Z.W. to the
hospital to “ease her mind.” He also reported that he wanted Z.W. but he did
not want Mother. “I don’t feel he will be safe with her; those procedures are
bad. I don’t want her to be around him.”
      In December 2022, law enforcement placed Mother on a 72-hour
psychiatric hold for threatening to cut Father’s throat while he slept. The

                                       6
social worker could not visit Mother during the hospitalization due to the
hospital’s visitation policy.
        When the hospital released Mother, Mother was taking medication. A
week later, Mother told the social worker, “Everything that is for bipolar
people makes you sedated; you cannot be a mother taking bipolar meds.”
Mother believed that she only needed pain medication because her bipolar
symptoms were triggered by her back pain.
        Mother told the social worker she used marijuana and medication for
muscle spasms when she could not sleep, and pain medication during the
day. She later denied using any pain medication because she was pregnant.
Mother insisted that Z.W. has medical conditions, but “[t]he problem is that
no doctors can find it.”
        E.    Detention Report

        Z.W.’s grandmother reported that Mother was hospitalized four times
for bipolar and behavior issues and needed help to treat her bipolar disorder.
When Mother was released from the hospital, she would stay on her bipolar
medication for two weeks at most. Still Z.W.’s grandmother did not have any
concern about Mother hurting her children or being physically abusive to
them.
        Mother disclosed a history of domestic violence in her relationship with
Father, including an incident in which she brandished a knife at him because
he was becoming aggressive. Mother also reported Father drank alcohol to

the point of physically injuring himself.4 After his arrest, Mother “did not

4      In December 2022, Father sought and received a temporary restraining
order against Mother to protect Z.W. A few days later, he was arrested for
child endangerment. We do not detail these facts because they are not
relevant to resolving Mother’s appeal. Father has not appealed the court’s
order.
                                        7
trust him” because he was an “abusive raging alcoholic” who drank whenever
he had money. Mother reported she did not need mental health treatment.
      The Agency was concerned that if Z.W. were returned to Mother’s care,
“he is at substantial risk of suffering physical and emotional harm due to
[Mother’s] untreated mental health.” Mother’s “continued delusions that
[Z.W.] has a foreign object in him raises great concern for [her] ability to care
for [Z.W.]” Despite Father “reporting concern for [Mother’s] mental health,
he continued to accompany her with [Z.W.] to the hospital to have
procedures.” He also “has significant alcohol abuse” that he is just beginning
to address. The Agency determined voluntary services would not be
appropriate because “the parents have not demonstrated insight or
acknowledgement into the concerns.”
      F.    Dependency Petition and Detention Hearing
      In December 2022, the Agency filed a petition alleging Z.W. was a child
described by section 300, subdivision (b)(1) because he had suffered, or there
was a substantial risk he would suffer, serious physical harm or illness from
the inability of his parents to provide regular care for him due to the parent’s
mental illness or substance abuse. It detailed Mother’s mental illness and
also alleged that Father became distracted while intoxicated and had a
history of alcohol abuse rendering him unable to provide regular care.
      At the December 2022 detention hearing, Mother and Father informed
the court that they were living together despite the issuance of the temporary
restraining order against Mother. The Agency asked to detain Z.W. in a
licensed foster home because the maternal relatives were no longer interested
in placement.
      The court made a prima facie finding on the petition and determined
there was a substantial danger to Z.W.’s physical health, and there were no

                                        8
reasonable means to protect him without removing him from the parents’
custody. It found that reasonable efforts had been made to prevent or
eliminate the need for removal, and there were no reasonable services that
would prevent the need for further detention. The court ordered Z.W.
detained in a licensed foster home or children’s shelter and authorized the
Agency to detain him with an approved relative or a nonrelative extended
family member with the concurrence of minor’s counsel. The court also
ordered liberal, supervised, separate visits for each parent consistent with
any other court orders, including the temporary restraining order.
      The court ordered Mother to participate in a psychological evaluation to
assist the Agency in connecting her to appropriate treatment and services
and “for planning going forward.” The court noted that the psychological
evaluation would be used for dispositional purposes only and not for
jurisdiction. The court also ordered Father to meet with a substance abuse
specialist. The Agency was ordered to provide voluntary services to the
parents, including timely referrals for the psychological evaluation and the
substance abuse specialist. Father signed the consent for examination and
treatment paperwork for Z.W. to have access to healthcare while he was
detained, after Mother had refused to sign.
      G.    The Agency’s Jurisdiction/Disposition Report and Initial Hearing
      In January 2023, the Agency reported that Father got a job with night
shift hours, which helped him remain sober because “nobody drinks in the
morning.” He was meeting with the substance abuse specialist and getting
into a substance abuse program, but he did not consider himself an alcoholic.
He also believed Mother was getting better now that she stopped smoking
marijuana because it had made her “paranoid.” He did not think she wanted

                                       9
Z.W. to undergo any more procedures. Both reported their belief that he was
“fine now” and would outgrow his “throat problems.”
      The restraining order was dropped at the parents’ request. Mother
reported she and Father were trying not to involve other people, including
her relatives, in her case because her family thinks she is “crazy.” Cutting off
those relationships helped her cope. They were staying in a motel because
they were kicked out of their housing.
      In a January 2023 interview with the social worker, Mother denied
having any mental health conditions. She believed she had been
misdiagnosed with bipolar disorder and that her problems were pain related.
She was participating in weekly virtual therapy to learn new coping
mechanisms for stress. She also participated in the court-ordered
psychological evaluation.
      At the initial jurisdiction and disposition hearing in January 2023, the
parents set the matter for trial on the truth of the allegations, placement, and
the case plan.
      H.    Mother’s Psychological Evaluation
      Mother’s psychological evaluation showed that she was “formally
diagnosed” with bipolar disorder during hospitalization. It indicated she
“maintained fixed beliefs that both she and her son have received improper
medical treatments and/or misdiagnoses.”
      Mother had smoked marijuana every other night for 10 years until she
stopped after her December 2022 psychiatric hospitalization. Both her
psychological evaluator and medication evaluator recommended that she be
monitored closely for substance abuse due to her history of chronic pain and
her potential for addiction.

                                      10
      Her psychological evaluator noted Mother suffered from severe
depression and anxiety; schizoaffective disorder, bipolar type; cannabis
dependence in early full remission; chronic pain disorder; and obsessive-
compulsive personality disorder. Her psychological evaluator recommended
extensive collaboration of a multidisciplinary team specializing in pain,
prenatal treatment, and psychiatry for Mother, and with Z.W.’s pediatrician
to ensure adequate care and to prevent Z.W.’s exposure to unnecessary
medical procedures. Mother also needed to develop a support network of
people with whom she could communicate openly about her mental health
and her safety plan.
      Overall, Mother “appeared limited in her insight regarding mental
health concerns,” and she maintained her fixed belief that her “mental health
symptoms are all attributed to pain and will dissipate once adequate
prescription pain medication is obtained.” Nevertheless, Mother “genuinely
appear[ed] to desire support in order to reunify with [Z.W.]” Her
psychological evaluator opined that she would likely require “ongoing
psychotherapeutic treatment” for the rest of her life, but she could make
“measurable progress” in six to 12 months “if she remained highly engaged
and motivated.”
      I.    The Agency’s Addendum Reports
      According to the Agency’s February 2023 reports, due to Father’s
arrest, the criminal court issued a criminal protective order prohibiting him
from contacting Z.W. except for court-ordered visitation. The parents
obtained housing by late January 2023. They played with Z.W., fed him, and
were affectionate with and attentive to him during their supervised visits.
      Mother informed the social worker that the reports were incorrect and
that she did not believe aliens or the government implanted something in her

                                      11
son. Rather, she wanted answers and did not know what happened to Z.W.
when he was out of her sight at the hospital. Mother stated she did not think
they implanted anything, but she was concerned something could have been
left in his throat during a procedure, and she wanted to have it checked out.
She took Z.W. to the ear, nose, and throat department because the hospital
failed to give her answers. She did not believe the medical appointments
were unnecessary.
        Mother agreed to participate in a medication evaluation and reported
she had never refused medication but did not want to take any medication
while she was pregnant. Mother believed she did not need any medicines
except to address her pain. Mother declined medication for her mental
health, and reported she only wanted medication to manage her pain,
including Xanax, muscle relaxers, and controlled narcotics.
        The clinician opined Mother had poor insight and judgment as to her
mental health and advised the social worker that Mother might seek street
drugs if she could not get what she wanted from medical providers. The
clinician also advised that people with severe bipolar disorder and extreme
mania often suffer from blackouts, lack insight, and do not know what to do
next.
        J.   Contested Jurisdiction and Disposition Hearing
        At the contested jurisdiction and disposition hearing in February 2023,
Mother testified she believed that her child welfare services case remained
active because she was still extremely concerned about Z.W.’s breathing, and
she sought answers.
        Mother testified she was alarmed by the internal fetal monitor placed
on Z.W. during delivery. She also testified that hospital staff took Z.W. from

                                       12
the hospital room three times, but she did not notice the breathing issue until
their last day there.
      When they got home from the hospital, the noisy breathing continued
and sounded like a tube or plastic, which is why she asked for x-rays. She
explained, “I don’t know if it’s something that [the hospital] did that created
this floppy laryngeal malaysia [sic], tracheal malaysia [sic] diagnosis because,
again, when he was first born, I do not remember hearing it. . . .” Also Z.W.
was easy to feed because he did not burp, spit up, or have hiccups, and that
made Mother wonder if they did something to make this baby so easy to
nurse and feed.
      Mother testified she went to the hospital in Hawaii in January 2022 to
get away from drunk people on New Year’s Day. She added that she also
thought a hospital would have a solution for her back pain.
      She explained that every time she complained about pain, she got a
mental illness diagnosis instead of someone realizing that she had rods and
screws in her spine. She testified that her bipolar diagnosis was incorrect,
and she should have been properly diagnosed as suffering from scoliosis pain.
      Mother acknowledged the children’s hospital staff informed her that
Z.W. had laryngomalacia. The next day, at a different hospital, she expected
to hear, “ ‘There[’s] something wrong with your child. Here is the treatment
plan. This is what we would do.’ ” However, Mother’s mental state was
evaluated because she was “so worried and concerned and seeking answers.”
Although she wanted an explanation, she was not provided one, so she did
her own research into Z.W.’s diagnosis.
      Mother denied saying Z.W. had a valve in his bottom that tased him
and caused him pain. She wanted to know if the other hospital had done
something to Z.W. because of his noisy breathing, his vomiting spell, and the

                                       13
fact that they had just moved back to San Diego. She noted that “the timing
was very strange.” She also denied telling anyone that aliens implanted a
foreign object in his body and denied telling the hospital social worker she
would not feed Z.W. until the doctor checked on him. Mother also testified
she did not currently believe there was a foreign object in Z.W. because she
“had him checked out by so many places and people.” When asked why she
had such a hard time accepting that there was no foreign object, Mother
replied, “Because the breathing still is noisy.” She testified she would not try
to remove a foreign object from Z.W. herself.
       Mother also denied kicking Father at the hospital in December 2022.
She pushed him out of the way with her foot and “kicked him to tell him to
leave the room.” Mother testified she did not need Father’s help to care for
Z.W.
       When asked how she would handle a stressful situation given her pain
issues if Z.W. was returned to her care, Mother replied she would not want
any injuries to happen to him, so she would be “overcautious and over
endearing.” She was participating in weekly virtual therapy sessions where
she discussed issues she was having and her pain.
       During her medication evaluation, Mother wrote that she preferred
pain medications because bipolar medications had negative side effects and
did not mitigate her pain. According to her, the evaluator warned her that
the pursuit of pain management drugs would raise red flags and require a
pain management doctor and a primary care doctor. If no one would
prescribe her pain medication, Mother’s plan for managing her pain was to
focus on not rushing to pick Z.W. up now that he was older and walking.
Mother testified the pain was worth it to hold him and she “will be in pain for

                                       14
[him].” She had wanted to get her pain under control, but “now I realize I
have to live with pain. It’s part of my life. And that’s okay.”
      K.    Findings and Orders
      The juvenile court found the allegations in the petition were true by a
preponderance of the evidence. Z.W. is a child described within section 300,
subdivision (b)(1). It declared Z.W. to be a dependent under the care, custody
and control of the Agency and found by clear and convincing evidence his
removal from parent’s custody to be appropriate under section 361,
subdivision (c)(1).
      The court found there are “very clearly mental health challenges that
lead her to observe medical issues, even in common experiences like a baby
fussing and flipping during a diaper change, and draw from that implausible
explanations.” The court was concerned about Mother’s fixation on medical
malpractice, which it found continued to persist. It also found mother’s
repeated denial of medical explanations for Z.W. concerning: “Without those
acknowledged and under control, there is going to be a substantial risk of
detriment to [Z.W.], given the totality of the circumstances.”
      The court separately found that Father failed to challenge Mother and
stop her and explained: “What we have before us is extremely dangerous
conduct that was driven by a substance abuse issue that we are dealing
with. . . . ¶ But we are just in the beginning of that long journey.”
      The court found the case plan to be “narrowly tailored” and
“appropriate” and ordered reunification services and liberal supervised
visitation for both parents.

                                       15
                                  DISCUSSION
      Mother contends that there was no substantial evidence supporting the
juvenile court’s jurisdictional findings and removal orders. We disagree.
      A.     Standard of Review
      Section 300, subdivision (b)(1) authorizes dependency jurisdiction if a
child “has suffered, or there is a substantial risk that the child will suffer,
serious physical harm or illness, as a result of the failure or inability of the
child’s parent . . . to adequately supervise or protect the child, . . . by the
inability of the parent . . . to provide regular care for the child due to the
parent’s . . . mental illness, developmental disability, or substance abuse.”
(§ 300, subd. (b)(1).)
      Proof by a preponderance of the evidence is all that is required to
sustain a true jurisdictional finding. (§ 355, subd. (a).) In reviewing such
findings, “ ‘we look to see if substantial evidence, contradicted or
uncontradicted, supports them. [Citation.] In making this determination, we
draw all reasonable inferences from the evidence to support the findings and
orders of the dependency court; we review the record in the light most
favorable to the court’s determinations; and we note that issues of fact and
credibility are the province of the trial court.’ ” (In re R.T. (2017) 3 Cal.5th
622, 633.) The appellant has the burden to show there is insufficient
evidence to support the juvenile court’s order. (In re Lana S. (2012) 207
Cal.App.4th 94, 103 (Lana S.); In re N.M. (2011) 197 Cal.App.4th 159, 168.)
      After a juvenile court exercises jurisdiction over a child pursuant to
section 300, it must determine the appropriate disposition for that child.
(§§ 360, subd. (d), 361, 362; In re N.M., supra, 197 Cal.App.4th at p. 169.)
Because section 361, subdivision (c) requires proof by clear and convincing
evidence, we determine “whether the record as a whole contains substantial

                                         16
evidence from which a reasonable fact finder could have found it highly
probable that the fact was true.” (Conservatorship of O.B. (2020) 9 Cal.5th
989, 1011; see also In re V.L., at pp. 154–155 [standard of review described in
Conservatorship of O.B. applies to removal findings under § 361, subd. (c)].)
      B.    Justiciability
      As an initial matter, we reject the Agency’s argument that Mother’s
appeal is not justiciable because she does not challenge the jurisdictional
allegations involving Father’s conduct and substance abuse. Indeed, Mother
challenges the findings relating to Father when she cites In re L.C. (2019) 38
Cal.App.5th 646 for the proposition that a jurisdictional order sustaining a
petition can be reversed where the record only shows that the parent used a
drug but did not abuse the drug. Based on In re L.C., Mother argues that the
jurisdictional findings relating to Father concerning “his abusing alcohol . . .
arguably” do not support assuming jurisdiction. Moreover, to the extent
Mother “does not challenge all jurisdictional findings,” we exercise discretion
to evaluate the merits of her appeal. (See In re D.P. (2023) 14 Cal. 5th 266,
283, 286 [even if an appeal is moot because a parent failed to demonstrate “a
specific legal or practical consequence that will be averted upon reversal, . . .
the court has discretion to decide the merits”].)
      C.    Jurisdictional Findings
      Mother incorrectly argues “there is no evidence that her mental illness
and/or persistent beliefs harmed her son or placed him at substantial risk of
harm.” In fact, a pediatrician specializing in medical child abuse opined that
“[t]here is clear evidence that [M]other’s persistent delusions have resulted in
unnecessary medical testing.” Her delusions resulted in Z.W. being
unnecessarily subjected to at least two foreign body x-ray series, a chest x-

                                       17
ray, at least five emergency room visits, multiple endoscopies and a
laryngoscopy.
      Mother continues to suffer delusions. During a supervised visit in
January 2023, Mother announced that Z.W. needed to see a pediatrician for
his breathing. She stated, “It sounds like plastic is lodged in his throat.” She
added, “I don’t get what that throat problem is.” At trial, she remained
concerned about Z.W.’s noisy breathing despite repeated assurances he would
grow out of it. She testified she had an open case with child welfare services
“[b]ecause [she] had extreme concern for [her] son’s breathing, and [she] was
still seeking answers.” She was also still seeking a medical treatment plan
and was frustrated that she was no longer in control of Z.W.’s medical
appointments.
      Mother points out that Z.W. “does suffer from a concerning respiratory
condition” and that “foreign objects have been left inside patients.” Even
accepting Mother’s views, substantial evidence supports the court’s finding
here. (In re N.M., supra, 197 Cal.App.4th at p. 168.)
      Mother argues her mental illness no longer posed any risk to the child
because she was “in individual therapy[,] she was evaluated by a
psychologist[,] and she agreed to have her medications evaluated.” She
strenuously denied that she suffered from any mental illness during her trial
testimony, attributing all her behaviors to her chronic pain. She also stated
that she had no plans to take medication because she was pregnant again,
and she did not believe she needed medication for anything other than pain.
      Mother’s refusal to acknowledge her mental illness is further evidence
that a substantial risk of harm to Z.W. existed at the time of the
jurisdictional and dispositional hearing. (See In re Gabriel K. (2012) 203
Cal.App.4th 188, 197 [“[o]ne cannot correct a problem one fails to

                                      18
acknowledge”]; In re Esmeralda B. (1992) 11 Cal.App.4th 1036, 1044 [“denial
is a factor often relevant to determining whether persons are likely to modify
their behavior in the future without court supervision”].)
      Because substantial evidence supports the juvenile court’s finding that
Mother’s mental illness rendered her incapable of providing adequate care for
Z.W., we need not address whether substantial evidence supports the court’s
other jurisdictional findings. (D.M. v. Superior Court (2009) 173 Cal.App.4th
1117, 1127 [“[T]he juvenile court’s jurisdiction may rest on a single ground”].)
Nonetheless, there is substantial evidence that Z.W. suffered actual harm
and was at continued risk of future harm due to the parents’ dangerous
conduct. One of Z.W.’s doctors, for example, opined that Mother had already
exposed Z.W. to “psychological maltreatment” by engaging in “domestic
violence” with Father at the hospital.
      We conclude that Z.W. has experienced sufficient harm for purposes of
section 300, subdivision (b)(1), and that the juvenile court did not err in
assuming jurisdiction over Z.W. The juvenile court need not wait until Z.W.
is seriously abused or injured to assume jurisdiction and take steps necessary
to protect him. (In re R.V. (2012) 208 Cal.App.4th 837, 843; In re Heather A.
(1996) 52 Cal.App.4th 183, 194–195.)
      D.    Dispositional Findings
      Mother’s arguments regarding the juvenile court’s dispositional
findings are similar to the arguments she raises regarding the jurisdictional
findings.
      The evidence documents risk that is not merely speculative, as Mother
asserts. As discussed above, Mother’s persistent delusions have caused Z.W.
to undergo numerous unnecessary medical procedures. According to Father,
Z.W. is not “safe” around Mother because of these procedures; Mother even

                                         19
acknowledges they caused Z.W. to be “tortured.” The court “may consider
past events in deciding whether a child presently needs the court’s
protection.” (In re N.M., supra, 197 Cal.App.4th at p. 165.) The child abuse
pediatrician opined that children are at “extreme risk” of danger if a
caregiver has “untreated psychotic symptoms related to foreign bodies inside
their children.” Father similarly feared Mother would “do something to
[Z.W.]” due to her persistent beliefs.
      Mother also continues to deny any mental health issues despite her
diagnosis of bipolar disorder, mania, and mild substance use disorder. She is
not on medication and may suffer from “manic blackouts” where she does not
recall manic episodes. Multiple clinicians are concerned about substance
abuse due to her history of chronic pain and her potential for addiction. She
stopped using narcotics a few weeks before Z.W. was born. The child abuse
pediatrician opined that returning Z.W. to an environment with “ongoing
psychotic symptoms,” “domestic violence,” and “substance abuse/misuse”
would place him at “extreme risk of ongoing and potentially escalating forms
of maltreatment to include the possibility of death.”
      Due to her persistent delusions and unaddressed mental health issues,
the juvenile court could reasonably conclude it was highly probable that Z.W.
would still be at risk of harm. (See In re Savannah M. (2005) 131
Cal.App.4th 1387, 1394.)
      Mother also argues that the juvenile court should have considered a
“family maintenance safety-plan” as a “reasonable means of protecting Z.W.
without removing [him] from his parents’ care.” That is not a reasonable
plan because Father had an active criminal protective order preventing
placement of Z.W. with him, Father had just begun treatment for alcohol
abuse, Mother had distanced herself her maternal family support system,

                                         20
and there was substantial evidence Mother could not care for Z.W. alone.
Thus, the court’s finding that no reasonable means existed to protect Z.W.
other than removal was supported by clear and convincing evidence.
                                   DISPOSITION
      The juvenile court’s jurisdictional and dispositional orders are affirmed.

                                                         HUFFMAN, Acting P. J.

WE CONCUR:

IRION, J.

KELETY, J.

                                      21