Court Opinion

ID: 9371166
Source: CourtListenerOpinion
Date Created: 2023-02-15 17:09:05.918442+00
Date Added: 2024-06-11T17:16:25.770463
License: Public Domain

J-A06041-23

NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37

    IN THE INTEREST OF: J.H, A MINOR                :   IN THE SUPERIOR COURT OF
                                                    :        PENNSYLVANIA
                                                    :
    APPEAL OF: H.J., MOTHER                         :
                                                    :
                                                    :
                                                    :
                                                    :
                                                    :   No. 960 WDA 2022

                 Appeal from the Order Entered August 4, 2022
    In the Court of Common Pleas of Westmoreland County Criminal Division
                          at No(s): CP-65-DP-45-2022

BEFORE: OLSON, J., NICHOLS, J., and PELLEGRINI, J.*

MEMORANDUM BY PELLEGRINI, J.:                            FILED: FEBRUARY 15, 2023

        H.J. (Mother) appeals from the August 4, 2022 order of the Court of

Common Pleas of Westmoreland County (trial court) designating her as a

perpetrator of child abuse against J.H. (Child) pursuant to the Child Protective

Services Law (CPSL).1 We affirm.2

                                               I.

        We glean the following facts from the certified record.                The

Westmoreland County Children’s Bureau (WCCB) took emergency protective

____________________________________________

*   Retired Senior Judge assigned to the Superior Court.

1   23 Pa.C.S. §§ 6301 et seq.

2 J.H. (Father) has also appealed the child abuse determination entered
against him at the same proceeding. We address his appeal at 961 WDA 2022.
J-A06041-23

custody of Child on April 1, 2022, after he had been hospitalized for severe

malnourishment. It subsequently filed for dependency and sought a finding

of abuse against Mother and Father.3             Mother and Father stipulated to

dependency but opposed the finding of abuse.

       At the dependency hearing, WCCB sought to introduce court records

from Clackamas County, Oregon, establishing that Mother had entered a guilty

plea to child neglect in 2012.           It also produced records from Oregon’s

Department of Human Services (DHS) establishing that findings of abuse had

previously been entered against Mother in four cases. Mother objected to the

admission of these records on Rule of Evidence 404(b) and relevancy grounds.

The trial court admitted the criminal records and admitted the DHS records

for the limited purpose of establishing that prior findings of abuse had been

entered, but did not admit the narrative portions of the records.          Upon

Mother’s request, the trial court also took judicial notice of the emergency

declarations issued by the governor in response to the covid-19 pandemic.

       WCCB called Dr. Adelaide Eichman (Dr. Eichman) from the Division of

Child Advocacy at Children’s Hospital of Pittsburgh to testify regarding their

treatment of Child. Child was admitted to the hospital on March 24, 2022,

and was diagnosed with severe failure to thrive.         He was 12 months old,

____________________________________________

3WCCB filed dependency petitions for four of Mother and Father’s children.
Only the finding of abuse as to Child is at issue in this appeal.

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weighed 15.1 pounds and had developmental delays. A large flat spot on the

back of his head caused abnormal development in his face.        His hair was

thinning and matted on the back of his head and he had developed lanugo, a

very fine hair, on his back. He was unable to sit up on his own and his weight

was below the third percentile for children his age. A skeletal survey revealed

he had osteopenia or thinning of his bones, and brain imaging showed he had

lost brain volume.    These conditions result from chronic malnutrition or

starvation.

      Dr. Eichman testified that the cause of Child’s medical problems was

chronic underfeeding for a period of months, and she could not say whether

the loss of brain volume would be reversible.     She opined that Child had

suffered from neglect and said that once he was fed regularly he began gaining

weight. When he was discharged from the hospital after four days, he weighed

16.7 pounds and by mid-April he weighed 19 pounds.

      Upon speaking to Mother, Dr. Eichman learned that she fed Child

powdered milk instead of powdered formula, which is not recommended for

children under one year old. Mother said she fed Child two to four ounces of

milk every two to four hours, except overnight, which was not consistent with

Child’s severe malnourishment. Mother told Dr. Eichman that she had not

been able to obtain medical insurance for Child after moving to Pennsylvania.

Dr. Eichman testified that she did not believe insurance was necessary to

schedule an early intervention evaluation for a child and insurance would not

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have been required for Child to be seen in the emergency room. The hospital

additionally has employees who could have helped Mother and Father enroll

Child in medical insurance if necessary.

      Jarrett Dorazio (Dorazio), a physician assistant who evaluated Child

prior to his hospitalization, testified that his office does not require insurance

to see a patient, and that they direct patients without insurance to state

resources where they can obtain it. Dorazio first saw Child on March 10, 2022,

for a well visit that Mother and Father were required to schedule due to WCCB

involvement with one of their other children. Dorazio was concerned about

Child’s muscle tone, neurologic and gross and fine motor development. Child

could not sit up or push up from his stomach on his own, while most children

at his age could walk. He was not using words and would stare at the wall

without reacting to noises or Dorazio’s voice. His arms and hands remained

in a clenched position and would return to that stance if Dorazio attempted to

move them. At the first visit, Child weighed 14.6 pounds. Dorazio diagnosed

Child with failure to thrive, low muscle tone and neglect, and recommended

that Mother have him evaluated by the Children’s Institute and then return for

a follow-up visit. He recommended applying for Women, Infants and Children

(WIC) benefits, and Mother said that she was unable to get WIC and that

formula was expensive. Dorazio testified that he did not make a ChildLine

report after Child’s first visit because he believed Child had not been seen by

a doctor in approximately ten months and he wanted to give Mother and

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Father a chance to make a good faith effort at complying with his

recommendations.

      Dorazio saw Child for a follow-up visit on March 24, 2022, and he had

gained approximately half-a-pound.      Due to the low weight gain, Dorazio

recommended that Mother admit Child into the hospital. Child gained weight

more rapidly after his hospitalization and at a well-visit on April 15, 2022, he

weighed 19.10 pounds. At his most recent visit in May 2022, Child was able

to sit up with some assistance, was making babbling noises and was

interacting with his surroundings and reaching for his toes and ears.

      Rachel Menhorn (Menhorn), a school nurse who worked with one of

Mother and Father’s other children, testified that she provided them with

written information regarding the Children’s Health Insurance Program (CHIP)

and the online application process on two occasions.       She also spoke with

Mother directly about CHIP multiple times. Mother did not ask for any help

with the application but told Menhorn in January 2022 that the state was

giving her the “runaround.” N.T., 5/25/22, at 119.

      Colleen Flynn (Flynn) of the Children’s Institute testified that she opened

a case with the family in the Star Babies program, which provides an intensive

in-home family services specialist. She began working directly with the family

in mid-March and first saw Child shortly before his hospitalization. She said

he was emaciated and that his appearance was shocking. Mother told Flynn

that Child had recently been to the doctor but did not consider Dorazio’s

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recommendations urgent. She said she did not have time to make phone calls

for Child’s care. She had scheduled an appointment with a gastroenterologist

but had not followed up with a nutritionist or feeding specialist. Flynn said

that Child had a blank stare, lanugo on his back, and his hands and fingers

were curled and stiff. He did not smile or make eye contact and would cry

when he was touched.

      After Child was discharged from the hospital, Flynn began visiting the

family to weigh Child every day, with the understanding that if he lost weight,

WCCB would intervene. The weigh-ins took place as planned for several days

but Mother missed the appointment on April 1, 2022.         She texted Flynn

throughout the day to push the visit back and said that she was running an

errand in Pittsburgh. Flynn was not able to complete the visit and WCCB took

custody of the children that day. Flynn opined that Mother did not understand

the urgency of Child’s condition. Flynn spoke with Father once on the phone

prior to Child’s hospitalization, and he wanted to know why the doctor wanted

to send Child to the hospital.

      Amanda Karas (Karas), a caseworker for WCCB, opened a case with the

family in January 2022 following a referral related to one of Father’s other

children. At that time, Mother and Father were living with their four children

and another adult couple with two children.      Mother requested parenting

services and services for children with special needs because she was

concerned about the development of Child and his sister.        Karas did not

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perform a home visit with the family until after Child was released from the

hospital at the end of March, but prior to that she was in contact with the Star

Babies staff about the family.

       Karas learned that the last time Child had seen a doctor was in July 2021

when the family still lived in Oregon. Mother and Father reported that they

had taken Child to a local emergency room for a cough in July 2021, but the

hospital’s records did not confirm any visit had taken place.        Mother and

Father also told Karas that they had not taken Child to the doctor because

they did not have health insurance. When WCCB became involved with the

family, Mother was the primary caregiver.           They had previously left the

children with one of the other adults in the household while Mother and Father

worked, but Mother quit her job in October because they were concerned that

the other adult was not providing appropriate care.4 Father continued to work

full-time.

       After Child’s release from the hospital, Mother and Father attended an

evaluation to qualify for WIC.          They told Karas that they had previously

received WIC benefits, but WIC staff reported that they had no involvement

with the family outside of the first evaluation. Mother and Father told Karas

that WIC had required regular weight checks that were too strenuous so they

____________________________________________

4This adult continued to live with the family and help with caretaking into
2022. She was eventually reported for abuse of one of the other children via
ChildLine and faced criminal charges. She then moved out of the home.

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discontinued the program. WIC staff confirmed that recipients usually have a

monthly evaluation that includes a weigh-in.

      Mother and Father were able to successfully obtain health insurance

shortly before Karas began working with the family at the end of March.

Mother reported to Karas that she had difficulty applying for insurance through

the state and providing all the necessary documentation. Mother submitted

exhibits at the hearing showing that she applied for health insurance through

the Pennsylvania DHS in July and August 2021, but the applications were

rejected because she did not provide required records. Mother told Karas that

she attempted to send the documents and speak to DHS on the phone but

was not able to obtain insurance.

      Joe Bowles (Bowles), one of the individuals who lived with Mother and

Father, testified on their behalf. He said Mother quit her job in October 2021

to stay home, though she earned money baking cookies at home and

delivering them to customers. He said that Child had difficulty with formula

and was spitting it up a lot, but Mother switched formulas and that helped the

issue. He said Mother and Father applied for health insurance and called DHS

multiple times about why their applications were rejected. He further testified

that Mother called providers about obtaining health insurance for the children

but it was very expensive. He said Mother did take Child to the hospital at

one point for his cough.

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       Following the hearing, the trial court adjudicated Child dependent and

entered an order determining Mother perpetrated abuse pursuant to the CPSL.

Mother timely appealed and she and the trial court have complied with Pa.

R.A.P. 1925.

                                               II.

       Mother raises three issues on appeal: whether the trial court abused its

discretion in finding that WCCB presented clear and convincing evidence that

she had abused Child; whether the trial court abused its discretion in admitting

evidence of her criminal conviction and the findings of abuse entered against

her in Oregon; and whether the trial court abused its discretion by failing to

consider the shutdowns related to the covid-19 pandemic as an exception to

the finding of abuse under the CPSL.5

                                               A.

       Mother first argues that the evidence at the dependency hearing did not

establish that she acted intentionally, knowingly or recklessly to perpetrate

abuse against Child. She argues that she attempted to get medical care for

____________________________________________

5

       The standard of review in dependency cases requires an appellate
       court to accept the findings of fact and credibility determinations
       of the trial court if they are supported by the record, but does not
       require the appellate court to accept the lower court’s inferences
       or conclusions of law. Accordingly, we review for an abuse of
       discretion.

Interest of K.D., 237 A.3d 566, 568 (Pa. Super. 2020) (citation omitted).

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Child by first seeking health insurance and contends that none of the witnesses

testified that she engaged in abuse, but rather that the source of Child’s

medical issues was neglect. She points out that Dorazio did not think it was

necessary to file a ChildLine report the first time he treated Child, and that

the hospital released him back into her care after his treatment.

       A determination that a person perpetrated abuse against a child must

be supported by clear and convincing evidence. Interest of T.G., 208 A.3d

487, 490 (Pa. Super. 2019). The definition of child abuse under the CPSL

includes intentionally, knowingly or recklessly causing “serious physical

neglect of a child.” 23 Pa.C.S. § 6303(b.1)(7).6 It defines serious physical

neglect as follows:

       Any of the following when committed by a perpetrator that
       endangers a child’s life or health, threatens a child’s well-being,
       causes bodily injury or impairs a child’s health, development or
       functioning:

                                           ***

               (2) The failure to provide a child with adequate essentials of
       life, including food, shelter or medical care.

23 Pa.C.S. § 6303(a). The statute further defines “recklessly” with reference

to the Crimes Code’s definition of the term:

____________________________________________

6 The trial court’s order does not specifically identify the subsection of the
definition of child abuse that it found WCCB had established by clear and
convincing evidence. However, it did state that “neglect” by Mother and
Father “caused severe malnutrition” of Child. Order, 8/4/22 at 3.

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      A person acts recklessly with respect to a material element of an
      offense when he consciously disregards a substantial and
      unjustifiable risk that the material element exists or will result
      from his conduct. The risk must be of such a nature and degree
      that, considering the nature and intent of the actor’s conduct and
      the circumstances known to him, its disregard involves a gross
      deviation from the standard of conduct that a reasonable person
      would observe in the actor’s situation.

Id. (citing 18 Pa.C.S. § 302). Severe neglect resulting in failure to thrive can

be the basis for a finding of abuse under subsection 6303(b.1)(7). Interest

of T.G., supra, at 494-95 (finding clear and convincing evidence of severe

physical neglect when mother missed medical appointments for child and did

not comply with treatment recommendations, resulting in failure to thrive).

      The record overwhelmingly supports the trial court’s determination that

Child suffered serious physical neglect by Mother’s actions or inactions. The

professionals who evaluated Child or visited with the family in their home

uniformly described Child as emaciated, low-energy, with low muscle tone and

as being significantly developmentally delayed compared to the average 12-

month-old child.   At 15.1 pounds, Child’s weight was well below the third

percentile for children of his age, and he was unable to support his head while

being held by Mother or sit up on his own. He had a flat spot on the back of

his head that resulted in disfiguration to his facial features.    He had not

reached average benchmarks, such as walking or crawling, and did not make

eye contact or typical verbalizations for a child his age. His condition was

immediately apparent to the naked eye of the individuals who evaluated him.

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      Moreover, further testing revealed that he had lost brain volume and

experienced osteopenia and lanugo.      All of these conditions are caused by

malnutrition, and Dr. Eichman was unable to say whether the loss of brain

volume would ultimately be reversible. After enumerating the many medical

and developmental issues Child was exhibiting, Dr. Eichman testified that he

had been diagnosed with failure to thrive and had been chronically underfed

for a period of months.    Once he received adequate nutrition, he had no

trouble gaining weight.    She concluded that “essentially from a medical

standpoint, the baby just needed to be fed.” N.T., 5/25/22, at 39. She further

stated, “I do want to underscore that neglect is not a benign process. It is

not any better or worse than physical abuse, for instance.” Id. at 56.

      This evidence amply supports the trial court’s conclusion that Mother,

as Child’s caregiver, “consciously disregard[ed] a substantial and unjustifiable

risk” to his health and well-being by failing to feed him adequately for an

extended period of time. 18 Pa.C.S. § 302; 23 Pa.C.S. § 6303(a). The neglect

was immediately apparent to medical and WCCB professionals upon seeing

Child. While he was released to Mother and Father’s care after his first well-

visit and his hospitalization, this was only after they received counseling on

the next steps for his care and agreed to work with the Star Babies project

and comply with daily weigh-ins to monitor his progress. Less than a week

after his release from the hospital, Mother missed one of the required weigh-

ins, resulting in his removal. Finally, the medical professionals who testified

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at the hearing confirmed that Child would have received care regardless of

whether he had medical insurance. Her first issue merits no relief.

                                               B.

       Next, Mother argues that the trial court abused its discretion in

admitting evidence of her criminal conviction for neglect and the founded

reports of abuse against her in Oregon.7 She argues that the records were

from events too remote in time to be relevant, that their admission violated

Rule of Evidence 404, and that they contained double hearsay.

       Under Rule 404(b), evidence of specific crimes or acts is admissible only

for limited purposes:

       (b) Other Crimes, Wrongs, or Acts.

              (1) Prohibited Uses. Evidence of any other crime, wrong, or
       act is not admissible to prove a person’s character in order to show
       that on a particular occasion the person acted in accordance with
       the character.

             (2) Permitted Uses. This evidence may be admissible for
       another purpose, such as proving motive, opportunity, intent,
       preparation, plan, knowledge, identity, absence of mistake, or
       lack of accident.

____________________________________________

7 We review the trial court’s decision to admit this evidence for an abuse of
discretion. In re A.J.R.-H., 188 A.3d 1157, 1166 (Pa. 2018). “An abuse of
discretion is not merely an error of judgment, but is rather the overriding or
misapplication of the law, or the exercise of judgment that is manifestly
unreasonable, or the result of bias, prejudice, ill-will or partiality, as shown by
the evidence of record.” Commonwealth v. Tyson, 119 A.3d 353, 357-58
(Pa. Super. 2015) (citation omitted).

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Pa.R.E. 404. In its opinion, the trial court concluded that the fact of the prior

criminal conviction and abuse findings was “relevant to show the absence of

mistake and a lack of accident as to [Mother and Father’s] treatment of

[Child], as well as their knowledge of the implications of an allegation of

abuse.” Trial Court Opinion, 10/25/22, at 4. It explained that “[t]he fact that

the Appellants have been through this process before was relevant to

demonstrating that their lack of adherence to the recommendations of Dr.

Eichman, [] Dorazio, and [] Flynn was, indeed, abusive to [Child].” Id.

      We discern no abuse of discretion.      Mother’s criminal conviction and

findings of abuse in Oregon demonstrate that she had previously been

involved in child abuse investigations and should have appreciated the

seriousness of the concerns raised by WCCB and Child’s medical providers.

Despite detailed counseling by Dorazio regarding Child’s development delays

and nutritional needs, she continued to feed him so inadequately that he

gained only half-a-pound in the two weeks between appointments. Once he

was hospitalized and fed adequately, he gained approximately 1.5 pounds in

four days.     Moreover, her caseworkers from WCCB and Star Babies

emphasized to her that daily weigh-ins were necessary to monitor Child’s

progress, and that he would be removed from her care if she was unable to

meet that requirement. Mother nonetheless chose to miss weigh-ins less than

a week after Child was returned to her care, resulting in his removal from her

home. The evidence of the prior findings of abuse supported the conclusion

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that Mother understood the importance of complying with these directives.

The trial court did not abuse its discretion in holding that the fact of the prior

conviction and findings of abuse, without reference to the narrative portions

of the documents, supported her knowledge, lack of accident and absence of

mistake failing to care for Child.

       Additionally, the record belies Mother’s argument that the records were

inadmissible because they contained double hearsay. At the hearing and in

its subsequent order, the trial court specifically held that the narrative portions

of the reports would not be admitted. Compare In re A.J.R.-H., 188 A.3d

1157, 1169-70 (Pa. 2018) (finding that error in admitting double hearsay

narratives in agency reports was not harmless when the trial court relied on

the information therein when terminating parental rights). Rather, it admitted

only the fact of the criminal conviction and past founded reports to establish

knowledge and a course of conduct. Because the alleged double hearsay was

not admitted as evidence, no relief is due.8

____________________________________________

8 Additionally, the admittance of these records was harmless in the context of
the entire record. An error is not harmless and the appellant is entitled to a
new hearing if, “in light of the record as a whole, an erroneous evidentiary
ruling could potentially have affected the decision.” A.J.R.-H., supra, at 1170
(addressing harmless error in the context of a termination of parental rights
proceeding). The evidence that Mother perpetrated abuse against Child by
failing to provide him with adequate nutrition for months was overwhelming,
and the trial court noted in its opinion that the records from Oregon played a
de minimus role in its decision. See Trial Court Opinion, 10/25/22, at 4.

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                                      C.

      Finally, Mother argues that the trial court erred by failing to consider

environmental factors, namely, lack of health insurance and the covid-19

shutdowns, as rendering Child’s condition outside of her control.          She

highlights that Pennsylvania was under a disaster declaration in July 2021 that

precluded her from visiting DHS offices to obtain health insurance for Child.

She maintains that she attempted to communicate with the department online

and by phone but was still unsuccessful.

      The CPSL mandates that certain environmental factors outside of a

parent’s control cannot support a finding of abuse:

      No child shall be deemed to be physically or mentally abused
      based on injuries that result solely from environmental factors,
      such as inadequate housing, furnishings, income, clothing and
      medical care, that are beyond the control of the parent. . . .

23 Pa.C.S. § 6304(a).

      The record is devoid of any evidence that the covid-19 pandemic

prevented Mother from obtaining medical care for Child or from feeding him

appropriately. While Mother requested that the trial court take judicial notice

of the governor’s covid-19 disaster declarations, she presented no evidence

that the shutdowns affected her ability to obtain health insurance or medical

care for Child.   To the contrary, the documentation she submitted into

evidence revealed that she began the online process of applying for health

insurance and other benefits through the state in July 2021. She promptly

received notice that her application had been received and that she needed to

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submit additional documentation either in person, online or by mail or fax.

She was also required to complete an in-person interview.

      Mother was then notified less than a week later that she qualified for

expedited Supplemental Nutrition Assistance Program (SNAP) benefits

amounting to $1,393 through the end of August 2021, but still needed to

provide additional documentation.       She did not complete her required

interview by July 30, 2021, and was notified that she would need to do so by

August 13, 2021. She then received a second notification that she needed to

provide employment and income verification documents to qualify for cash

assistance, medical assistance and SNAP.       When she did not provide the

requested documents, DHS notified her that her request was denied and that

she could appeal that decision.

      Mother started the process anew in September 2021 and was again

notified that she needed to provide additional documentation to qualify for

medical assistance and SNAP. She was also notified that her SNAP benefits,

which she was apparently still receiving, would increase from $929 to $992

monthly in October. She provided no further documentation related to her

second application for benefits, but the record is undisputed that Child did not

have health insurance until March 2022.

      These documents do not support Mother’s argument that she was

prevented from obtaining adequate health coverage for Child due to

government shutdowns, as she received prompt responses to both of her

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applications and was able to submit necessary documentation by mail or

online. She was able to complete the required interview by phone but there

is no record of her doing so for either application. She finally made the first

wellness appointment with Dorazio in March 2022 only after WCCB had

become involved with the family and required her to have check-ups for all of

the children.   Dorazio testified that his office was not closed to the public

between July 2021 and March 2022, that he was able to see patients who did

not have insurance, and that the office employed individuals who would help

patients with insurance inquiries.   Finally, Dr. Eichman testified that Child

would have been treated in any hospital emergency room even without

insurance, and his condition was so severe as to merit emergency treatment.

Based on this evidence, we cannot conclude that the disaster declarations

related to the covid-10 pandemic constituted an environmental factor

preventing Mother from obtaining medical care for Child. No relief is due.

      Order affirmed.

Judgment Entered.

Joseph D. Seletyn, Esq.
Prothonotary

Date: 2/15/2023

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