In re P. M.

318 A.3d 1085

226 Conn.App. 378

IN RE P. M.^*

(AC 47076)

Appellate Court of Connecticut.

Argued April 8, 2024

Officially Released June 18, 2024^**

David B. Rozwaski, assigned counsel, for the appellant (respondent father).

Albert J. Oneto IV, assistant attorney general, with whom, on the brief, were William Tong, attorney general, and Nisa Khan, assistant attorney general, for the appellee (petitioner).

Catherine L. Williams, assigned counsel, for the minor child.

Alvord, Cradle and Suarez, Js.

CRADLE, J.

₃₇₉The respondent father, I. M. (respondent), appeals from the judgment of the trial court adjudicating his minor child, P. M. (P), neglected.¹ On appeal, the respondent claims that the court erred in adjudicating P neglected because the evidence relied upon by the court is not sufficient to support its determination that P was denied proper care and attention and was permitted to live under conditions and circumstances injurious to his well-being. We affirm the judgment of the trial court.

The following facts, as found by the trial court, and procedural history are relevant to our resolution of this appeal. P was born healthy and without complications in August, 2022, to T. T. (mother) and the respondent (collectively, parents). P’s parents believe in an alkaline, plant-based diet for their family, so they created a homemade infant formula when their first child, C. M. (C), was born in May, 2021. Neha Kaushik, a naturopathic doctor, first met the family and became C’s primary care provider when C was approximately six months old. Kaushik had no information about C’s growth ₃₈₀before that time but subsequently worked with the respondent to help him alter the homemade infant formula to ensure that C received necessary nutrients.

About six days after P was born, his parents took him to see Kaushik for his first well-baby visit. At his initial visit in August, 2022, Kaushik spoke to P’s parents about their homemade infant formula, and they provided her with a list of ingredients in the formula. Kaushik reviewed the list and made a recommendation to add certain nutrients to the formula. Although P is the youngest patient Kaushik had treated in her career and she did not have experience or specialized training in treating infants, Kaushik indicated that she had no concerns that the homemade infant formula would provide P with the nutrients that he, as an infant, needed in order to develop.

Kaushik followed up with P’s parents about the need to bring him in for monthly infant wellness checkups, but they failed to do so. Kaushik did not see P again until December, 2022, when he was ill and present for a virtual appointment during which she diagnosed him with respiratory syncytial virus (RSV) and provided his parents with some naturopathic treatments.

Kaushik next saw P virtually on January 27, 2023. At that visit, P’s parents told Kaushik that he had been having breathing difficulties starting on January 25, 2023, and that he was not eating. His parents also indicated that they had provided him with ginger and cucumber water along with other naturopathic treatments. Kaushik gave the parents treatment advice and further explained that they would need to bring him to an urgent care facility if his breathing did not improve in the following two to three hours. When she called P’s parents a few hours later, his condition had not improved, and they had not taken him to urgent care. Kaushik told them that she would call the authorities ₃₈₁if they did not take him. Later that evening, P’s parents brought him to St. Vincent’s Medical Center (St. Vincent’s). By the time P arrived at St. Vincent’s, he was critically ill, and St. Vincent’s transferred him to Yale New Haven Children’s Hospital (Yale), where the Yale medical team admitted him and diagnosed him with croup, COVID-19, anemia, and severe metabolic acidosis. The Yale medical team also noted that, despite being five and one-half months old, he presented, in weight, length, and head circumference, as a two month old.

The Yale medical team worked diligently and urgently to stabilize him. On January 28, 2023, the Yale medical team intubated P to treat acute hypoxemia. The Yale medical team later told P’s parents that a blood transfusion would be medically necessary to save his life. At first, P’s parents would not consent. Even after P’s mother consented, the respondent, who was disruptive and aggressive at the hospital, refused to consent. The Yale medical team notified P’s parents that they were initiating legal action to obtain a court order to allow the blood transfusion, and the respondent eventually consented to the blood transfusion without a court order being issued. Following the blood transfusion, P started to stabilize.

On January 29, 2023, the petitioner, the Commissioner of Children and Families, invoked a ninety-six hour hold on P and C due to concerns regarding the children’s nutritional status.² On January 30, 2023, additional members of the Yale medical team became involved with P as it related to his growth and nutrition. Sharon Bertrand, a registered, board-certified dietician ₃₈₂with a specialty certification in pediatric critical care nutrition, diagnosed P as severely malnourished based on his " ‘z-scores,’ "³ which were considerably below the standard and placed him barely at the first percentile for growth. In addition, P’s lab results revealed that he was deficient in vitamin A, carnitine, and seven essential amino acids.

Bertrand met with the respondent to discuss the ingredients in the homemade infant formula. Although the respondent had given the Yale medical team a list of the formula’s ingredients, the list did not provide the measurement of each ingredient or the sources that produced the ingredients. It was also unclear to the Yale medical team how the respondent was making the formula, so there was no way of knowing if the homemade infant formula was contaminated. It was later determined that the homemade infant formula was nutritionally deficient. Bertrand, who found that P’s homemade infant formula lacked amino acids, fatty acids, and vitamins, attempted to speak to the respondent about her concerns, but he refused to engage in conversation, talked over her, and was combative. The Yale medical team made the decision to stop using the homemade infant formula and switched to Neocate, a commercially made, vegan, non-soy formula.⁴

On February 2, 2023, the petitioner filed the present neglect petition, alleging that P was neglected in that he ₃₈₃had been denied proper care and attention, physically, educationally, emotionally or morally, or that he had been permitted to live under conditions, circumstances or associations injurious to his well-being.⁵ On the same day, the court, Maronich, J., granted the petitioner’s motion for an ex parte order of temporary custody (OTC), vesting temporary custody of P in the petitioner, and vacated the ninety-six hour hold. On February 22, 2023, the court, Hon. William Holden, judge trial referee, sustained the OTC until further order of the court.

On February 10, 2023, the Yale medical team extubated P, but he remained in critical condition, in part, due to his malnutrition. He was steadily gaining weight on the Neocate and his iron and vitamin numbers were stabilizing. On February 27, 2023, the Yale medical team discharged P from the hospital, and the petitioner placed him in the care of his paternal grandmother.

During the neglect trial, which took place on September 21, 25 and 27, 2023, the court, McLaughlin, J., admitted into evidence, inter alia, Yale medical records dated January 28 and February 27, 2023, the affidavits of Chelsea Lepus, an attending physician at the Department of Pediatric Gastroenterology, Hepatology and Nutrition at Yale, and Lisa Pavlovic, the attending pediatrician with the child abuse program at Yale, and a chart made by Kaushik comparing the nutritional content of infant formulas, including the homemade infant formula and Neocate. The petitioner offered the testimony of, among others, Bertrand, Lepus, and Pavlovic. P’s mother offered the testimony of Kaushik, and the ₃₈₄respondent offered the testimony of P’s paternal grandmother. The court issued a memorandum of decision, dated September 29, 2023, in which it held that "[t]he overwhelming credible evidence established by more than a fair preponderance that, as of the filing of the neglect petition on February 2, 2023, [P] was neglected in that he was denied proper care and attention physically and medically and in that he was permitted to live under conditions or circumstances injurious to his well-being."

In so holding, the court credited the testimony of Bertrand, Lepus, and Pavlovic. Specifically, the court credited their testimony that, based on the severity of P’s condition when he was admitted to Yale, he had been malnourished for at least three months prior to his hospitalization. Moreover, the court found Kaushik’s testimony unpersuasive and unreliable as to the adequacy of P’s growth and found equally unreliable her comparison of the respondent’s homemade infant formula with Neocate. The court further found that P was critically ill when he arrived at Yale, had been malnourished well before his admission, and was failing to thrive. The court then concluded that the petitioner had established by more than a fair preponderance of the evidence that P was malnourished because he was not receiving necessary nutrients from the homemade infant formula supplied by his parents.

The court also found that P’s parents failed to comply with Kaushik’s recommendation of monthly visits as a part of a wellbaby care plan. It found that P’s parents "simply did not follow up. No doctor saw [P] during the early months of his life. It was not until [P] was sick with RSV that [his] parents reached out to … Kaushik. Thereafter, [P’s] parents did not seek out medical care for [him] until he was so critically ill that he stayed in the...