D.F.v. State (In re State ex rel. K.J.)

1

2024 UT App 47

State of Utah, in the interest of K.J., M.J., and K.J., persons under eighteen years of age.

D.F. and K.J., Appellants, v. State of Utah, Appellee.

No. 20230102-CA, 20230103-CA

Court of Appeals of Utah

April 4, 2024

First District Juvenile Court, Logan Department The Honorable Bryan P. Galloway No. 1218130

Alexandra Mareschal, Kirstin Norman, and Jason B. Richards Attorneys for Appellant D.F.

Emily Adams, Attorney for Appellant K.J.

Sean D. Reyes, Carol L.C. Verdoia, and John M. Peterson, Attorneys for Appellee

Martha Pierce, Guardian ad Litem

Judge Ryan M. Harris authored this Opinion, in which Judges Gregory K. Orme and John D. Luthy concurred.

HARRIS, JUDGE

¶1 In separate appeals that we consider together in this opinion, K.J. (Father) and D.F. (Mother) (collectively Parents) challenge the juvenile court's orders removing their three children (Children) from their home and, later adjudicating the Children abused and neglected. Parents' main challenge concerns the court's adjudication that they abused and neglected the Children. Parents also assert that, in one respect, they received ineffective assistance of counsel. For the reasons discussed, we find Parents' arguments on these two topics unpersuasive.

¶2 But Parents also assert that, during the shelter hearing held at the beginning of the case, the juvenile court did not undertake a proper and complete analysis of the factors the governing statute required the court to consider. In this respect, Parents' arguments have merit, and we remand the case so that the juvenile court can conduct the proper statutory analysis.

BACKGROUND

¶3 Parents are the legal and biological parents of three "medically complex" children: Kevin, Mia, and Kaleb.^[1] The family moved to Utah in 2022, after having lived in Nevada and Arizona; at that time, Kevin was five years old, Mia was four, and Kaleb was not quite two. Parents believed that the Children suffered from a long list of various medical maladies; when the family arrived in Utah all three Children-despite having largely different medical diagnoses-had surgically placed gastric feeding tubes (G-tubes), were developmentally delayed, and used wheelchairs for mobility.

¶4 In July 2022, Kevin was rushed to a local hospital by ambulance after Mother reported that he had suffered a seizure. Mia was hospitalized at the same time due to concerns about weight and dehydration. Kevin and Mia were transferred to Primary Children's Medical Center (PCMC) in Salt Lake City; Kevin was treated with IV fluids to address "severe hypernatremia" due to dehydration. Kevin and Mia ended up staying at PCMC for nearly two weeks, and Kevin was even admitted to the pediatric intensive care unit. While Kevin and Mia were at PCMC, medical professionals there became concerned that they were being medically neglected. In particular, hospital personnel observed that Kevin and Mia were "severely underweight," despite the presence of G-tubes, and "were considered a failure to thrive."

¶5 After Kevin and Mia were discharged from PCMC, all three Children were referred to a pediatric nurse practitioner (Nurse Practitioner) for follow-up primary care. When the Children arrived at her medical clinic, Nurse Practitioner discovered that the Children-partly due to only recently having arrived in Utah-were not yet set up for medical insurance. But after examining the Children, Nurse Practitioner agreed to treat them anyway, despite their lack of insurance, because in her view "it was medically necessary to see them regardless of the insurance difficulties." As she saw it, "these kids needed medical care whether [she] got paid" or not, because they were facing "significant medical issues" that she considered potentially "life and death" matters. The Children arrived at her clinic in wheelchairs and were developmentally delayed and nonverbal. None were toilet trained. Over the course of her treatment- which lasted several weeks-Nurse Practitioner also observed that the Children had not been "gaining [weight] as they [had been] in the hospital," which made her wonder whether the Children might at some point need "to be rehospitalized."

¶6 A few weeks later, a pediatrician (Pediatrician) was assigned to the Children. When he first saw the Children, he observed that they were all "nonverbal," and while Kevin had some ability to walk on his own, Mia and Kaleb were "nonambulatory." During the course of his treatment of the Children, he worked with them to improve their motor skills and their ability to walk, and he monitored their weight, which he indicated was the thing he was "following most closely." Soon after Pediatrician took over primary care of the Children, Kaleb came in for his "two-year well[ness] visit." During that visit, Mother indicated that Kaleb had spina bifida, which is "a neural defect at the base of the spine" that can often be fixed with surgery. Mother insisted that Kaleb had already had the surgery to correct the spina bifida, and she even pointed to Kaleb's back where she indicated there was a scar from the surgery. But Pediatrician saw no scar.

¶7 At some point after Kevin and Mia were released from PCMC, a physician at Nurse Practitioner's clinic contacted the Utah Division of Child and Family Services (DCFS) to notify them about potential issues with the Children. Thereafter, DCFS assigned caseworkers to investigate the matter, and those caseworkers made some ten visits to Parents' home, prior to removal, to check on the Children and to assess the situation. These visits occurred at different times of day, yet in every visit except for one, the Children were all confined in "Pack 'n Play" playpens. Parents stated that the Children needed to be in the playpens so that their G-tubes could function properly, but caseworkers observed that Parents had-but were not using- portable devices that would have maintained a "continuous feed" from the feeding tubes without restricting the Children's movement. On one visit, one of the caseworkers asked Mother to show her the Children's medications, and in response Mother brought out a large "two feet by three feet" sized tote bag "full of prescription bottles and different ointments." During this time, Kevin-who was five years old and eligible to begin kindergarten-was not enrolled in school and therefore was not receiving any of the services a school could potentially provide to a medically complex child.

¶8 In addition to receiving primary care from Nurse Practitioner and Pediatrician, the Children were also referred to and treated by the Pediatric Complex Care Clinic at PCMC. They missed their first scheduled appointment with the clinic, which caused the lead physician there (Physician) a great deal of concern, because she knew that "it was critical that [PCMC] follow up with" the Children. Physician notified DCFS of the missed appointment, which was eventually rescheduled for about three weeks later.

¶9 At that rescheduled visit, Mother reported to Physician that the Children were all suffering from "dysphagia," which is the "inability to swallow food properly." Physician observed that Kevin and Mia had "continued to lose weight" since their discharge from the hospital. This was troubling, because the Children all had G-tubes, which exist primarily to make sure the Children are receiving enough nutrition; as one member of the PCMC team testified, "a child with a G-tube whose caregiver is fully responsible for that nutrition intake should not be experiencing failure to thrive in the absence of a disease or pathology that could cause failure to thrive."

¶10 PCMC doctors investigated whether there could be any medical reason for the Children's continued malnutrition and failure to gain weight, and eventually concluded that "none of the [C]hildren [had] a pathology consistent with a disease process that could cause failure to thrive." Indeed, the PCMC team eventually determined that the Children's "malnourishment and poor growth [were] directly related to insufficient caloric intake," despite their G-tubes, and that the Children's "failure to thrive was not due to their medical conditions but due to [Parents'] neglect . . . in feeding them appropriately."

¶11 In addition, after her examination of the Children, Physician was concerned "that the [medical] history being provided by" Parents was "not consistent with what" she was "seeing on physical exam." Given these concerns, the PCMC team then set out to review the Children's various medical diagnoses, as reported by Parents, with the goal of verifying or eliminating each of them. As reported by Parents, the Children suffered from the following medical maladies, among others:

• Kevin had suffered a stroke either in utero or shortly after birth, and had Ehlers-Danlos syndrome, Erb's palsy, a seizure disorder, hearing loss, premature birth, sleep apnea, and an "allerg[y] to the sun."

• Mia had DiGeorge syndrome, blindness, hearing loss, premature birth, cerebral palsy, and prediabetes.

• Kaleb had spina bifida, gastroparesis, premature birth, clubfoot affecting both feet, urinary retention issues that required catheterization, and hydrocephalus.

In an effort to confirm these diagnoses, the PCMC team requested obtained, and reviewed over 7,000 pages of medical records regarding the Children, including records from Nevada and Arizona. After completing their review, and after examining the Children both before and after removal, the PCMC team was able to confirm some of the diagnoses. For instance, Kaleb does suffer from clubfoot in both feet, and Mia does have a genetic disorder similar to DiGeorge syndrome. But with regard to most of the diagnoses, the PCMC team concluded that Parents' assertions were simply...