Court Opinion

ID: 9872680
Source: CourtListenerOpinion
Date Created: 2023-09-26 21:11:49.037845+00
Date Added: 2024-06-11T07:46:29.146045
License: Public Domain

OPINION OF THE COURT
Tom, J.P.
In this child protective proceeding, appellant Melissa O. (the mother) appeals from the finding of the Family Court that she neglected her three-month-old baby girl. After being discovered at 3 a.m. walking in the middle of a road in Texas, suffering from delusions and talking to herself while her infant daughter was left in the front seat of a vehicle stopped somewhere on the road, the mother was hospitalized in a Texas psychiatric ward. Thereafter, the mother, due to her abnormal, aggressive and threatening behavior, was examined by two psychiatrists in New York who determined she was delusional and assessed her as suffering from psychosis. Although she was prescribed medication for her condition, the mother never acknowledged her serious mental health condition and refused to take the medication. In addition, the mother’s unfounded fear that her *34infant daughter had been raped led her to repeatedly “check” the child’s physical condition and then make an unnecessary trip to the hospital.
Because a preponderance of the evidence in the record supports the finding that the mother’s untreated mental condition exposed the child to a substantial risk of harm (Family Ct Act § 1046 [b] [i]; see Matter of Isaiah M. [Antoya M.], 96 AD3d 516, 517 [1st Dept 2012]), we affirm.
I. Facts
On May 16, 2013, the Administration for Children’s Services (ACS) filed a neglect petition against the mother alleging, inter alia, that while the mother was hospitalized from May 4 to May 9, 2013 at Green Oaks Hospital in Texas, she was diagnosed with severe mood disorder with psychosis and postpartum depression, refused to take her prescribed medication (Risperdal), and was referred for further mental health services. The petition alleged that the mother suffered from a mental illness that impaired her ability to care for the child, and had placed the child at imminent risk of harm.
Before a hearing could be held, by order dated May 16, 2013, Family Court temporarily placed the child with the maternal aunt but permitted the mother to reside in the same home provided she not be left alone with the child.
At the fact-finding hearing, the court received in evidence an Office of Children and Family Services intake report, dated May 13, 2013, called in by Julie Burkes, a child protective worker at the Department of Family and Protective Services in Plano, Texas. The report stated that on May 3, 2013, the mother was found walking in the middle of a Texas road, talking to herself. The mother stated that she had killed her husband, that she and her daughter were “the devil,” and that she also was Jesus’s wife. At the time of those statements and observations, the child was found in the front seat of the mother’s car. The mother was “extremely delusional and hyper religious,” and was taken to a “mental health facility,” where she remained until May 9, 2013, but was “non-compliant” and “refused medications.”
During the mother’s hospitalization in Texas, her cousin, who lived in the area, was called to take the child. Upon her release, her sister from New York picked her up and subsequently the mother and child returned to New York.
The court also received in evidence medical records from New York City’s St. Barnabas Hospital (SBH) pertaining to the *35mother’s treatment there on May 11 and 12, 2013. According to those records, around noon on May 11, 2013, one day after returning from Texas, the mother walked into the SBH emergency room with the child, and the mother’s sister, asking that the child “be check[ed].” The mother presented with “erratic behavior.” Specifically, she was “screaming” and told triage personnel that she had been raped while in a psychiatric hospital in Texas. Medical personnel were unable to obtain her vital signs due to her “aggressive” behavior.
At around 12:50 p.m., the mother told medical personnel in the adult emergency department that a “[F]ree [M]ason kill [ed] ” and “raped” “my baby,” and thus the child needed to be medically examined. The mother also stated that she herself was raped by a “Free Mason” and she wanted to be tested for sexually transmitted diseases. She “was acting irrationally, screaming, and [she] wantfed] to walk out” of the hospital with the child. She also exhibited “threatening behavior” and was assessed as suffering from “[p]sychosis” and constituting a “threat to staff and other patients,” such that she had to be “physically restrained” and sedated with Haldol and Versed by injection. A psychiatric evaluation was ordered for the mother, and the child was taken to the pediatric unit.
At around 1:35 p.m., an emergency department physician, Jean Dorce, spoke to the mother’s sister, who stated, inter alia, that the mother had been stopped by police in Dallas, Texas and brought to a hospital, where she was diagnosed with an “unknown” psychiatric condition and released with a prescription for medication. The mother’s sister also stated that the mother had returned to New York from Dallas on the night of May 10, 2013.
During a psychiatric consult conducted at SBH by Dr. Jean Robert Jacques on the night of May 11, 2013, the mother was unable to provide “a relevant history,” except to say that police officers in Texas had brought her to a psychiatric hospital, where she remained for one week, that she “was medicated” there but had “refuse[d] meds,” and that while she had been hospitalized, her cousin “raped” the child. Dr. Jacques found the mother to be “paranoid, suspicious and guarded.” Her thought content was marked by “paranoid ideation.” She had “poor” judgment, “limited” insight, and “fair” cognition. Dr. Jacques diagnosed the mother with “psychosis NOS [not otherwise specified]” and directed that she be held in the emergency department for further evaluation and administered *36Risperdal. However, the mother once again refused that medication and it was not administered.
The following morning, the mother was evaluated by Dr. Sa-lim A1 Salem, to whom she reported, inter alia, that she was separated from her husband a month ago due to “domestic violence” and that her husband was “a member of [the] [F]ree [M]ason cult,” whose other members were “backing him,” which explained why she had been denied gas at a Texas gas station. As for the events that led to her hospitalization in Dallas, she reported that she had driven with the child from Louisiana to the home of a cousin, whom she believed was “doing witchcraft” that “affected [the child].” She left her cousin’s home to find a motel, but police officers “followed” her and removed the child from her care, delivered the child to her cousin, and brought her to a psychiatric hospital. When she was discharged from the hospital, she picked up the child and, along with her sister, flew from Dallas to New York City.
The mother brought the child to SBH for a medical examination because she believed the child had been raped by her cousin. The rape claim was based on having observed a “cotton bud” lubricated with “[V]aseline” “go high up in [the child’s] rectum” when she was dealing with the child’s constipation.
Dr. A1 Salem diagnosed the mother with “[d]elusional [disorder” and concluded that she currently was having a “delusion of persecutory type.” After he spoke to the mother’s sister and learned that she was willing to have the mother live with her, he directed that the mother receive Ability, with the “first dose NOW” and a 30-day supply to be provided to her at discharge, along with a referral for follow-up care at Fordham Tremont Mental Health Center (Fordham Tremont).
The SBH emergency department discharge note listed the mother’s discharge diagnosis as delusional disorder, “[a]ctive,” and indicated that medications were “given as ordered” with instruction to follow up with Fordham Tremont “in 3-7 days.”
The medical records also include entries dated June 11, 2013, when the mother came to the emergency department requesting to be reevaluated because she believed that she might not need medication anymore, and noted that she wanted to breast feed her child and that the medication was too costly. A “psych consult” was ordered, but the mother “left against medical advice” before one could be completed. However, the mother was given a refill of her medication “as a courtesy” and written instructions to follow up with Fordham Tremont. The followup was noted to be “urgent.”
*37At the hearing, ACS caseworker Vanessa Wallace, who had been assigned to this matter, testified that, regarding her hospitalization in Texas, the mother told her that police officers had stopped her on a “highway” because they were Free Masons, who were “trying to take [the child].” The mother showed Ms. Wallace her discharge papers, dated May 8, 2013, from the Texas hospital (Green Oaks), and the papers indicated that the mother had “refused” medication. The mother told Ms. Wallace that Green Oaks had prescribed her Risperdal, but she did not take it because she was not “crazy.”
The mother also reported to Ms. Wallace that after she put a Q-tip in the child’s rectum, she concluded that her cousin had raped the child, noting that before the child had stayed with the cousin, a Q-tip would not go “all the way in.” The mother did not tell Ms. Wallace that the child had been bleeding. The mother also asserted that she had been restrained at SBH when she did not want medical personnel to examine the child. Although she had been prescribed Abilify, she did not inform her doctor of her complaints about Ability’s side effects, and the mother told Ms. Wallace that she was not going to take Abilify. The mother also told Ms. Wallace that she had been directed to follow up with Fordham TVemont within three to seven days, but that the mother admitted she had still not done so by the seventh day.
The mother testified at the hearing that her daughter was born on February 14, 2013 and that the mother was her primary caretaker. She breast-fed her, changed her diapers and bathed her. The mother claimed that while she cared for the child, the child was always healthy and that she took the child to the pediatrician for regular checkups.
After separating from her husband in March 2013, she and the child lived together at a friend’s house in Louisiana, but later they had to leave the state because they had “nowhere to stay.” When she decided it was more economical to fly to New York from Dallas, Texas, rather than from Louisiana, she called her cousin, Francis Monio, who lived in Dallas, and asked him to “keep [her] for two days.” However, when she arrived there, she learned that Monio wanted to separate her from the child because he had received a phone call from someone stating that the mother “was sick” and could not go to New York with the child. The mother then “decided not to stay” with Monio and went to find a motel.
According to the mother, at 3:00 a.m. on May 3, 2013, after she had driven 300 miles towards Dallas, she parked her car *38on the side of the road to rest. While she was standing by her car on the side of the road to retrieve her cell phone from the backseat, police officers approached her, handcuffed her, and removed her to a psychiatric facility. She did not understand why the police officers had done this, and while in the hospital, she was not given a chance to talk, other than to say that she was “not sick.” The mother was aware that Green Oaks medical personnel had diagnosed her with severe mood disorder with psychosis and prescribed her Risperdal, but she disagreed with the diagnosis and did not know why they prescribed her Risperdal, remarking, “I am not insane.” Although she insisted she took some of her prescribed medication while in the hospital, she admitted she stopped taking it because “it made her sick.”
After her release from Green Oaks on May 9, 2013, she and her sister picked up the child from Monio’s home and then went to a motel, where she realized that the child was not feeling well. Between the time she left Monio’s home on May 9, 2013, and when she brought the child to SBH on May 11, 2013, the child had been crying and without appetite, and she had a fever, a diaper rash, and a bloody discharge that the mother observed every time she changed the child’s diaper. As the child was “really bleeding” “out of her behind,” and was crying from pain, the mother’s “first thought” was that Monio had sexually abused the child. The mother noted that she was sensitive to sexual abuse because she had been sexually abused as a child.
When she returned to New York, she took the child to SBH where she removed the child’s diaper to show a nurse the bleeding and “the nurse saw what [she] was talking about.” The nurse then spoke to the mother’s sister — to whom the mother had previously shown the blood — after which the nurse called five or six security workers, who restrained the mother to a bed and took the child away. The mother did not know why the nurse had wanted her sister “to take over” or why hospital staff did not allow her to be present for the child’s examination.
The mother told the SBH psychiatrist that she was not mentally ill, but merely that she had a “marital issue.” She also complained to him that “nobody wants to listen to [her].” When she left SBH, she was given a prescription for Abilify. However, she did not comply with her medication regimen because the medication had made her feel sick. The physician *39who prescribed her Abilify had told her that she “just [had] stress,” which the mother wanted to treat with “family support,” not medication. The mother also claimed that the medication cost too much money out-of-pocket, which she did not have, and that she only had Medicaid coverage in Louisiana. She never contacted Medicaid officials about obtaining medical coverage in New York State.
The mother also denied telling Ms. Wallace that she had put something in the child’s rectum or any of her concerns about the Free Masons. A day after her discharge from SBH, the mother reported the child’s bleeding to New York City police officers, but they had “refused to [take] a report.”
In an oral fact-finding decision, later reflected in its written order, the court found that ACS had established the allegations in the petition by a fair preponderance of the credible evidence. The court credited the testimony of Ms. Wallace, finding it to be consistent with the medical records, and did not credit the mother’s testimony, which it found “incredible.” The court concluded that the mother “suffers from a mental illness, which impairs her ability to care for [the child], and that her conduct in.failing to take prescribed medication and follow up with outpatient mental health services constitutes neglect.”
II. Discussion
The overwhelming evidence in the record — much of which is entirely ignored by the dissent — showed that the mother was suffering from mental illness, that she lacked insight into her illness and need for treatment, and that her mental condition interfered with her judgment and parenting abilities, thus placing her infant daughter, who was totally dependent on the mother, at imminent risk of physical, mental, or emotional impairment (see Matter of Isaiah M. [Antoya M.], 96 AD3d 516, 517 [1st Dept 2012]; Matter of Naomi S. [Hadar S], 87 AD3d 936 [1st Dept 2011], Iv denied 18 NY3d 804 [2012]).
More specifically, the record evidence established that the mother had multiple delusional episodes, the most serious of which involved her being found on a Texas road in the middle of the night, uttering bizarre statements while her infant daughter was left in the front seat of her vehicle. That particular episode led to a one-week hospitalization in Texas where the mother was noncompliant and refused to take medication for her condition.
Back in New York, the mother continued to exhibit extremely concerning behavior. Her unfounded belief that her baby *40daughter had been raped led her to bring the child to the hospital where the mother behaved irrationally, and was aggressive and threatening. This behavior led to the mother being restrained, sedated and hospitalized. While hospitalized, the mother continued to make strange and unfounded claims regarding her child being raped, which had caused her to repeatedly check her daughter’s rectum. She was diagnosed with “psychosis NOS” and as having “[d]elusional disorder,” yet continued to refuse necessary medication.
In an unscheduled visit a month after being released from the hospital in New York, the mother sought approval to cease all medications, despite the directions she had been given, and then left against medical advice when a psychological evaluation was requested.
The mother repeated her various bizarre and unfounded beliefs to the ACS caseworker, including her baseless fears about her daughter’s rectum. She also admitted to the caseworker that, despite being prescribed Ability for her condition, she would not take that medication, and denied that she had a mental health condition.
Finally, the mother’s own testimony demonstrated her denial of her mental health condition and poor insight about her condition. Her testimony also corroborated that she repeatedly failed to comply with her medication regimen.
In sum, rather than minimize and separate each individual piece of evidence as insufficient for a neglect finding, as the dissent does, we find that the totality of the evidence in the record clearly established that the child is a neglected child (Family Ct Act § 1012 [f] [i] [B]).
A neglected child is one whose “physical, mental or emotional condition has been impaired or is in imminent danger of becoming impaired as a result of the failure of his parent ... to exercise a minimum degree of care” (Family Ct Act § 1012 [f| [i]). It is well settled that “[a] respondent’s mental condition may form the basis of a finding of neglect if it is shown by a preponderance of the evidence that his or her condition resulted in imminent danger to the child [ ]” (Matter of Noah Jeremiah J. [Kimberly J.], 81 AD3d 37, 42 [1st Dept 2010] [alterations in original]; Family Ct Act § 1046 [b] [i]).
In this case, the mother presented a risk of harm to her child through her unfounded fears that her daughter had been raped, since these fears resulted in the mother on different occasions *41“testing” the child to see if she was raped, by checking her diaper and by sticking a Q-tip inside her, and making an unnecessary trip to the hospital (see Matter of Kiemiyah M. [Cassiah M.], 137 AD3d 1279, 1280 [2d Dept 2016] [four-month-old child was in “imminent risk of harm” if left with mother, who called the police numerous times to report people outside the shelter threatening her and the child, which the evidence at the hearing established were delusions]).
Further, the mother displayed a “lack of insight” into her illness by refusing to agree that she had any mental health condition, despite her diagnoses, and by repeatedly refusing to comply with her medication regimen (see Matter of Naomi S., 87 AD3d at 937 [“child’s physical, mental or emotional condition was in imminent danger of becoming impaired as a result of the mother’s long-standing history of mental illness and resistance to treatment”]; see also Matter of Jacob L. [Chasitiy P], 121 AD3d 502, 502 [1st Dept 2014] [“record demonstrated (mother’s) lack of insight into her illness and repeated relapses due to her noncompliance with treatment and prescribed medication”]).
Significantly, lack of evidence as to actual injury to the child is inconsequential. “A showing that [the child was] impaired by [the mother’s] failure to exercise a minimum degree of care is not required for an adjudication of neglect; it is sufficient that [the child was] ‘in imminent danger of becoming impaired’ ” (Matter of Annalize P. [Angie D.], 78 AD3d 413, 414 [1st Dept 2010]; see also Nicholson v Scoppetta, 3 NY3d 357, 369 [2004] [“ ‘Imminent danger’ reflects the Legislature’s judgment that a finding of neglect may be appropriate even when a child has not actually been harmed”]). Indeed, the imminent danger standard exists specifically to protect children who have not yet been harmed and to prevent impairment (see Matter of Nassau County Dept. of Social Servs. v Denise J., 87 NY2d 73, 79 [1995]).
With regard to mental illness, we have previously found that a parent suffering from untreated paranoid delusions presents an imminent risk of harm to children who are placed in her care (see Matter of Michael P. [Orthensia H.J, 137 AD3d 499 [1st Dept 2016]; see also Matter of Immanuel C.-S. [Debra C.], 104 AD3d 615 [1st Dept 2013]). The fact that these cases also included evidence of actual harm to the children does not somehow indicate that a risk of imminent harm is not sufficient to sustain a neglect finding, as the dissent suggests. Nor does our *42holding constitute a “drastic change in the law,” as the dissent suggests. It would be irrational for the court, with knowledge of a risk of imminent harm to the child, not to act until actual harm is inflicted. This would be an absurd result. The child’s safety and welfare should be the paramount concern and all necessary actions should be taken to prevent any harm to the child.
The neglect finding was not based only on the mother’s mental illness. Rather, it was based on her mental condition in conjunction with her failure to comply with her medication regimen and follow-up treatment, and the fact that her mental illness impaired her ability to care for her infant daughter, and caused her to keep unnecessarily checking her daughter for evidence of rape. In other words, “the finding of neglect was appropriate here since [the mother] displayed a lack of insight into the effect of her illness on her ability to care for the child” (Matter of Lakiyah M. [Shacora M.], 136 AD3d 424, 425 [1st Dept 2016]). The dissent concedes that we have previously found neglect as a result of a parent’s mental illness where the parent “lacked insight into the effect of the untreated mental illness,” even where there is no finding of actual harm to the child. Thus, the dissent’s reliance on Matter of Nialani T. (Elizabeth B.) (125 AD3d 672, 674 [2d Dept 2015]), where there was no “causal connection between the mother’s mental illness and actual or potential harm to the subject child,” is inapposite.
Nor is there any validity to the dissent’s position that “[t]here is no evidence whatsoever in the record” to support the Family Court’s findings that the mother failed to engage in mental health services as recommended by physicians at SBH, and that the mother, “as a consequence of her mental illness, failed to exercise a minimum degree of care for the child, resulting in harm or imminent risk of harm to the child.”
Regarding the failure to seek follow-up treatment, the ACS caseworker specifically testified that the mother told her that she failed to follow up with Fordham Tremont within seven days as directed. The dissent states that this testimony is contradicted by the May 12, 2013 medical records, which “establish that the seventh day after the mother’s release from St. Barnabas had not yet occurred when the caseworker interviewed the mother.” However, the June 11, 2013 medical records in evidence demonstrate that nearly one month after she was initially directed to follow up with Fordham Tremont the mother was again directed to follow up there, and that the *43need to do so was urgent. The Family Court thus could make a fair inference from these records that the mother had not followed up as directed.
As for exposing the child to the risk of harm, the mother’s unfounded allegations that her daughter was raped caused her to repeatedly check her child’s rectum, including inserting a Q-tip inside her, and caused her to take the child to the hospital, subjecting her to an unnecessary examination. The fact that the mother was loving and nurturing at other times, as stressed by the dissent, is of no moment. The mother may have much maternal love for her child but her mental illness and refusal to get treatment posed an imminent risk of harm to the child. The child was also placed in imminent risk of harm when left alone in a car on the road at 3 a.m. while the mother was walking in the middle of the road, delusional and talking to herself.
The dissent disputes that the mother’s claim that her daughter was raped was unfounded. However, there were no medical records or any other evidence submitted to substantiate that claim. Contrary to the dissent’s suggestion, we are not placing the burden of proof on the mother to prove her daughter was raped. Rather, we find the evidence and facts of this case made her statement not believable. The mother’s denial at the hearing of the statements she made to the caseworker and the staff at SBH regarding how her use of a Q-tip made her believe her daughter was raped calls the whole rape allegation into question. The mother’s at times demented and delusional statements on this point, including that she was Jesus’s wife, and that her three-month-old baby was the devil, and was killed and raped by a Free Mason and by her cousin, combined with the absurdity of the Q-tip test and proof of her mental illness, permit for a reasonable inference that her bare claim, without more, that her baby was raped was unfounded. Moreover, Family Court did not credit the mother’s testimony and the court’s credibility determinations are entitled to deference on appeal, and should not be disturbed (see Matter of Irene O., 38 NY2d 776, 777, 778 [1975]).
Similarly, contrary to the dissent’s contention, the evidence showed that the mother repeatedly checked her daughter for evidence of rape. According to the caseworker, the mother checked the child’s rectum with a Q-tip and had reported that on previous occasions the Q-tip “would not go all the way in,” thus indicating she inserted the Q-tip more than once; the *44medical records from SBH note the mother made a similar statement. The mother also testified that after her discharge from SBH she checked her daughter again and reported it to police officers.
The dissent’s attack on the court’s findings that the mother did not take medication similarly lacks a foundation. The dissent also points to the facts that the mother was “calm,” “cooperative,” and was “psychiatrically cleared” following her delusional episode and sedation at SBH. Once again, the dissent downplays the abnormal, aggressive, and threatening behavior exhibited by the mother and the incoherent statements made to the police officers and hospital staff, which resulted in her hospitalization in psychiatric wards in Texas and at SBH.
Initially, the fact that the mother presented as calm and cooperative at one point in time does not in any manner rule out mental illness. In any event, the record evidence clearly supports the finding that the mother had a mental illness. Notably, we have repeatedly held that “[e]xpert testimony or a definitive psychiatric diagnosis is not required to show a parent suffers from a mental illness because ‘the consequences of the proceedings are temporary rather than permanent’ ” (Matter of Jayvien E. [Marisol T.], 70 AD3d 430, 436 [1st Dept 2010]; see also Matter of Devin M. [Margaret W.], 119 AD3d 435 [1st Dept 2014]; Matter of Liarah H. [Dora S.], 111 AD3d 514 [1st Dept 2013]).
No medical expert was needed to determine that the child had been placed at risk by the mother’s delusional thinking and her actions based on such delusional thoughts. A mentally healthy “new parent” would not conclude her three-month-old child was raped because a Q-tip she placed into the child’s rectum went all the way in and then subject the child to an unnecessary trip to the hospital for examination.
The dissent, to reach her conclusion, minimizes the mother’s non-compliance with her medication regimen. Far from simply failing to take medication “for one day” as the dissent describes it, the record, including the mother’s own testimony, demonstrates that the mother repeatedly failed and refused to comply with her medication regimen. Commencing with her hospitalization in Texas, the mother refused prescribed medications. Her poor insight and noncompliance continued when she was hospitalized at SBH and refused Risperdal. The mother also told the ACS caseworker and testified that she did not and *45would not take Ability, despite having been prescribed it at SBH, and offered various insufficient excuses, including its cost and its side effects. The mother also demonstrated extremely poor insight into her condition, testifying that she could treat it with “family support” rather than medication.
Contrary to the dissent’s position, the evidence regarding the mother’s delusional episode and hospitalization in Texas was properly considered as part of the evidence supporting the neglect finding, and there is no basis for this Court not to rely on it.
Furthermore, contrary to the dissent’s contention, Family Court properly conformed the pleadings to the proof, and the mother was afforded due process because she was able to contest the evidence and cross-examine the witnesses at the hearing.
In sum, the record demonstrates that the mother had a serious mental illness but showed poor insight into her illness, and placed her child at imminent risk of harm by failing to comply with follow-up treatment and her medication regimen. There is ample evidence in the record to show that the mother suffers from a mental health condition that needs to be monitored and treated with medications so that she may appropriately care for herself and her daughter, and have a chance to be reunited with her daughter, should that be the ultimate disposition in this matter.
Accordingly, the order of fact-finding, Family Court, Bronx County (Joan L. Piccirillo, J.), entered on or about January 23, 2015, which, after a hearing, determined that respondent mother neglected the subject child, should be affirmed, without costs.