A.A. v. L.A.

• Court: New Jersey Superior Court Appellate Division
• Decided: June 18, 2025
• Docket: A-1963-24
• Status: Unpublished

Opinion

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court ." Although it is posted on the internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.

SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION DOCKET NO. A-1963-24

A.A.,1

Plaintiff-Respondent,

v.

L.A.,

Defendant-Appellant. ________________________

Argued June 3, 2025 – Decided June 18, 2025

Before Judges Gilson and Augostini.

On appeal from the Superior Court of New Jersey, Chancery Division, Family Part, Bergen County, Docket No. FM-02-1770-22.

William Strazza (Law Office of William Strazza, LLC) argued the cause for appellant.

John E. Clancy argued the cause for the respondent (Townsend, Tomaio & Newmark, LLC, attorneys; John E. Clancy, on the brief).

1 We use initials for the parties and children to protect the confidentiality of these proceedings. R. 1:38-3(d)(13). PER CURIAM

This post-divorce-judgment appeal arises from the parties' disagreement

about whether their children should receive the Tdap and Meningococcal

vaccines. Defendant L.A. appeals from a Family Part order, following a

multiple-day bench trial, granting plaintiff A.A. limited medical decision-

making authority to consent to the administration of these two vaccines. We

affirm the order because substantial credible evidence in the record to supports

the trial court's decision.

I.

We summarize the facts from the record only to the extent necessary to

address the issues raised on appeal. The parties were married on May 15, 2010.

During their marriage, they had two children: A.V.A., born in 2011, and M.A.,

born in 2013. After twelve years of marriage, the parties were divorced on June

9, 2022 by way of a Dual Final Judgment of Divorce. Their judgment of divorce

incorporated their Marital Settlement Agreement (MSA) and a Custody and

Parenting Time Plan.

The parties agreed to share joint legal and physical custody of the children.

They negotiated a "true 50/50 joint residential arrangement" with neither parent

being designated as the parent of primary residence. The parties also agreed to

A-1963-24 2 consult with each other regarding major decisions, including health decisions

for the children. In the event a disagreement arose, the parties agreed to attend

mediation. Their MSA did not address vaccinations for the children.

After their divorce, for the most part, the parties co-parented their children

cooperatively and acted in their best interests. On the issue of vaccinating their

children, during their marriage, the children "received the majority of" their

standard recommended vaccinations, to which defendant consented. However,

following the divorce, defendant's position changed regarding the most recent

standard vaccines—Tdap and Meningococcal.

In May 2023, as A.V.A. was finishing fifth grade and scheduled to enter

sixth grade in the fall, the parties were notified by the children's school of the

required vaccinations for entry into sixth grade. In July 2023, the parties

attended a medical appointment with the children's pediatrician, Dr. Darren

Saks, during which they discussed the issue of these vaccines. Defendant

objected to A.V.A. being given these vaccines. When the parties were unable

to resolve this disagreement over whether these vaccines should be administered

to their children, they sought court intervention.

On July 31, 2023, plaintiff filed a motion, seeking permission to

administer the Tdap and Meningococcal vaccines to the children, to be granted

A-1963-24 3 sole medical decision-making authority, and for an award of counsel fees.

Plaintiff also filed an order to show cause with interim restraints, seeking

permission to take A.V.A. for the required vaccines before school began. On

August 28, 2023, the court denied the order to show cause and converted it to a

motion returnable on September 15, 2023. In a separate order, the court

appointed Evelyn F. Nissirios, Esq. as guardian ad litem (GAL) to represent the

best interests of the children and render a recommendation concerning the

vaccination issue. On September 29, 2023, the court ordered a plenary hearing

to resolve the parties' dispute regarding this issue.

Around the time plaintiff filed his motion, defendant had begun the

process for obtaining a school medical exemption for A.V.A. Defendant

contacted Dr. Lisa Bryhn of Affordable Health Inc. and requested a letter in

support of a medical exemption for A.V.A. However, the medical exemption

was initially denied.

Defendant sent in a second request, which was also denied. Defendant

then retained Dr. Stephen M. Smith to assist with securing the exemption for

A.V.A. so he could continue attending school. The Bergen County Department

of Health (BCDOH) agreed to a temporary extension of the vaccine requirement

until October 31, 2023, to permit defendant to provide additional

A-1963-24 4 documentation. On October 11, 2023, Dr. Bryhn submitted a second exemption

letter. Two days later, on October 13, 2023, A.V.A. was granted a medical

exemption for school.

The plenary hearing began on January 5, 2024, and proceeded over

multiple days over the course of several months, with the testimony concluding

on August 2, 2024. Plaintiff testified initially and called the GAL and the

children's pediatrician, Dr. Saks, as witnesses. Defendant testified and called

her privately retained expert, Dr. Stephen Smith.

As the hearing neared conclusion, the parties realized that they would be

confronted shortly with the same issue for their younger child, M.A., who was

due to enter sixth grade in September 2024. On August 20, 2024, defendant

filed an emergent application seeking leave to apply for a medical exemption

for M.A.

On September 16, 2024, the court authorized defendant, over plaintiff's

objection, to pursue a medical exemption from the required vaccines for M.A.

The court made clear that the exemption decision before the BCDOH and the

school were "distinct" from the decision before the court. The court concluded

it had the authority based on the need for continuity of the child's education

under these emergent circumstances to grant defendant this limited authority.

A-1963-24 5 Moreover, the emotional well-being of the children factored into this decision,

because the court did not want to create a sibling discrepancy where one child

would be attending school and the other would not. Finally, the court stated that

it was not making any finding that the child did not need the vaccines.

Following the close of the hearing, on February 26, 2025, the court issued

an order, with an accompanying 154-page written opinion, granting plaintiff's

application in part and permitting him "limited medical decision-making

authority as it relates to the administration of the subject vaccinations . . . ." The

court further "require[d] the parties to utilize a co-parenting professional to help

them navigate their ongoing differing perspectives as it relate[d] to the medical

care of their children."

The court made detailed credibility findings, beginning with the GAL,

who the court found "extremely credible." The GAL conducted a thorough

investigation, culminating in her December 1, 2023 report and supplemented by

her July report. The GAL considered the concerns of both parties in rendering

her recommendations. The GAL consulted with Dr. Michael Russo, a pediatric

infectious disease specialist at the Children's Hospital of Philadelphia (CHOP) ,

and requested the Doctor to review the children's records, consider the concerns

raised by the parties, and render an independent, third-party expert opinion as to

A-1963-24 6 whether the vaccines should be administered. According to the GAL, Dr. Russo

recommended that both children receive the vaccinations and particularly noted

that he "wholeheartedly recommends that [M.A.] get[] vaccinated."

The GAL made five specific recommendations and on the ultimate

question concluded that "the parties abide by the recommendations of the

children's treating pediatrician, [Dr.] Darren Saks . . . with regard to the

administration of all future vaccines." The court found the recommendations of

the GAL reasonable and consistent with the children's best interests, "including

having the parents continue to share joint legal custody and [] have the parties

abide by the recommendations of their [medical] provider."

In terms of the credibility of the parties, the court found defendant

partially credible and less credible than plaintiff. The court noted that

defendant's testimony was contradictory to her own beliefs and that of her

expert, Dr. Smith. Defendant's contradictory testimony led the court to question

the reasonableness of her testimony. The court explained that during her

testimony, defendant "exclaimed that either child 'could die!' if compelled to

receive the vaccine, which [had] not been articulated in any testimony . . . not

even in [defendant's expert] Dr. Smith's testimony."

A-1963-24 7 The court also found defendant's testimony regarding the concerns she

expressed with the children's gene deficiency, the MTHFR gene, their stomach

issues, "plus the lack of absorption of nutrients and heavy metals toxicity[,]" and

the effect of "putting vaccines" into their bodies, not supported by the medical

professionals, which led the court to find her position not reasonable. The court

also did not find defendant's position connecting M.A.'s hearing loss with the

measles-mumps-rubella (German measles) vaccines to be reasonable.

The court noted concern with defendant's expert, Dr. Bryhn, who

submitted letters in support of the children's school medical exemption. Those

concerns included Dr. Bryhn not having met nor examined either child and that

her report contained only generalities. The court concluded that defendant's

"credibility is impugned by her reliance on Dr. Bryhn's correspondence . . . ."

For instance, as the trial court noted, the evidence demonstrated that A.V.A.

"had not suffered any known allergic reaction to prior vaccinations ."

Nonetheless, Dr. Bryhn's made a generalized statement that "due to his various

'medical conditions,' he '[was] at greater risk of an allergic reaction to any

vaccines.'" The court found that statement lacked any support in the record.

With respect to the parties' expert witnesses, the court found Dr. Saks

credible and that his testimony focused on the interests of his patients. However,

A-1963-24 8 the court found Dr. Smith's testimony "lack[ing in] knowledge about these

children" and therefore, "his opinion not largely credible . . . ." The court also

acknowledged correspondence referred to by the parties and the GAL from Dr.

Michael Russo and Dr. Lisa Bryhn.

The court applied the best-interests-of-the-child test in determining

whether the children's best interest would be served by modifying "the parties'

legal custodial arrangement to award [plaintiff] limited medical authority for the

purpose of making vaccination decisions for the children." The court analyzed

the factors under N.J.S.A. 9:2-4, giving "great weight" to factor seven, the needs

of the children, and factor nine, the quality and continuity of the children's

education. The court recognized that defendant "would like the [c]ourt to rely

upon the fact that [A.V.A.] has been granted a medical exemption by the

[BCDOH], this [c]ourt [did] not find that fact to be dispositive." The court also

noted that "this fact [was] not evidential, nor being considered by [the] [c]ourt

in rendering [its] opinion."

In granting plaintiff limited medical decision-making authority for these

vaccines only, the court noted that "[t]his modification to the [parties'] joint legal

custody arrangement applies only to the authority to determine if the children

should receive the [Tdap] and Meningococcal vaccines." The court clearly held

A-1963-24 9 that "[t]his modification does not change any other custody provisions" in the

parties' agreement.

During his testimony, Dr. Smith testified that he was relying on lab reports

for M.A. from 2017. According to Dr. Smith, the results showed markers for

immunodeficiency, which may be relevant to whether M.A. should be

vaccinated. Thus, as it relates to M.A., the court "strongly urged" the parties to

speak with the pediatrician and follow-up with any bloodwork the pediatrician

"may be able to utilize to determine if [M.A.] has an autoimmune disorder that

would require further analysis by an immunologist."

Immediately following the issuance of the court's decision, plaintiff

scheduled the children to be vaccinated. On February 26, 2025, defendant filed

a motion for a stay with the family court. Although the court denied the motion,

it delayed implementation of the order for seven days, allowing defendant to file

an emergent application. On March 17, 2025, we granted a stay and accelerated

the appeal.

On appeal, defendant contends the family court's best interests analysis

was erroneous and warrants reversal. More specifically, defendant alleges two

errors by the trial court: (1) not giving adequate deference to the BCDOH's

medical exemption; and (2) erring in its credibility assessments of defendant and

A-1963-24 10 defendant's expert, Dr. Smith. Having reviewed the record and governing law,

we are satisfied the family court's findings are supported by substantial and

credible evidence and are consistent with the governing law.

II.

Our "review of a trial court's fact-finding function is limited." Cesare v.

Cesare, 154 N.J. 394, 411 (1998). The court's factual findings following a

plenary hearing are entitled to deference provided those findings are "supported

by adequate, substantial, credible evidence." Id. at 411-12 (citing Rova Farms

Resort, Inc. v. Invs. Ins. Co., 65 N.J. 474, 484 (1974)). Deference for the trial

court's factual and credibility findings is particularly important "[b]ecause a trial

court 'hears the case, sees and observes the witnesses, [and] hears them testify

. . . .'" Id. at 412 (second alteration in original) (quoting Pascale v. Pascale, 113

N.J. 20, 33 (1988)) (internal quotation marks omitted). Therefore, "it has a

better perspective than a reviewing court in evaluating the veracity of

witnesses." Ibid. (quoting Pascale, 113 N.J. at 33). Accordingly, we will not

disturb the trial court's fact findings unless we are "convinced that they are so

manifestly unsupported by or inconsistent with the competent, relevant, and

reasonably credible evidence as to offend the interests of justice." Ibid. (quoting

Rova Farms, 65 N.J. at 484).

A-1963-24 11 As to questions of law and a trial court's legal conclusions, we owe no

deference. N.J. Div. of Youth & Fam. Servs. v. V.T., 423 N.J. Super. 320, 330

(App. Div. 2011). "A trial court's interpretation of the law and the legal

consequences that flow from established facts are not entitled to any special

deference." Manalapan Realty, L.P. v. Twp. Comm. of Manalapan, 140 N.J.

366, 378 (1995).

"A custody arrangement adopted by the trial court, whether based on the

parties' agreement or imposed by the court, is subject to modification based on

a showing of changed circumstances, with the court determining custody in

accordance with the best interests standard of N.J.S.A. 9:2-4." Bisbing v.

Bisbing, 230 N.J. 309, 322 (2017). When faced with the responsibility of

resolving a dispute between parents concerning their children, the polestar of

the court's decision is always the best interests of the children. D.A. v. R.C.,

438 N.J. Super. 431, 450 (2014). "This overarching consideration" represents

the "paramount judicial responsibility [which is] to consider and safeguard 'the

safety, happiness, physical, mental and moral welfare of the child.'" Ibid.

(quoting Fantony v. Fantony, 21 N.J. 525, 536 (1956)).

On appeal, defendant contends that the family court erred in failing "to

even acknowledge" the BCDOH's decision to grant both A.V.A. and M.A.

A-1963-24 12 medical exemptions as a component of its credibility analysis and not accord

this decision due deference. This argument fails for the following reasons.

Defendant asserts the court erred in not deferring to the BCDOH's

"expertise" and argues that the BCDOH reviewed the same letters and reports

the family court had reviewed. However, defendant concedes that the BCDOH

did not have "any submissions" from either the children's pediatrician, Dr. Saks,

or Dr. Russo, whose expertise the trial court relied upon. Further, defendant

elected not to call as witnesses during the plenary hearing any representative

from the BCDOH. Nor did defendant call Dr. Bryhn, who defendant retained to

pursue the exemption and who had submitted letters to the BCDOH in support

of the medical exemptions.

Moreover, there was no evidence to suggest that due process was afforded

to plaintiff prior to the issuance of A.V.A.'s medical exemption. With respect

to the exemption for M.A., the court permitted defendant, over plaintiff's

objection, to pursue a medical exemption for M.A. As the GAL testified, the

parties and the court understood that the exemption was pursued "to allow for

[the] plenary hearing [and] . . . court determination" to be completed and for the

children to remain in their school without disruption until that decision by the

family court could be made.

A-1963-24 13 The BCDOH recognized that the family court was the appropriate forum

in which to address the parents' conflicting positions and "make a determination

as to the best interest of the child." Contrary to defendant's assertion, the trial

court did acknowledge the medical exemptions and noted that defendant "would

like the [c]ourt to rely upon the fact that [A.V.A.] has been granted a medical

exemption . . . ." Nonetheless, the court did not find that fact dispositive nor

evidential, and thus, did not consider it in its decision. We conclude the trial

court did not err by not considering or deferring to the BCDOH's decision.

Defendant next contends the family court's credibility assessment of both

defendant and defendant's expert, Dr. Smith, was contrary to the credible

evidence and warrants reversal. First, with respect to Dr. Smith, defendant

argues that the family court's credibility assessment was inconsistent because on

one hand, the court "urged" the parties to follow Dr. Smith's advice, yet on the

other hand, did not credit his opinion on the ultimate issue.

A factfinder is free to "give [the expert's testimony] whatever weight [it]

deem[s] [] appropriate," and "accept or reject all or part of an expert's

opinion(s)." Model Jury Charges (Civil), 1.13, "Expert Testimony" (approved

Apr. 1995); State v. Spann, 236 N.J. Super. 13, 21 (App. Div. 1989). A trial

court "need not adopt the opinion of [any] expert in its entirety." Brown v.

A-1963-24 14 Brown, 348 N.J. Super. 466, 478 (App. Div. 2002) (citing Carey v. Lovett, 132

N.J. 44, 64 (1993)).

Even though the court was free to accept Dr. Smith's opinion in part, the

court did not order the parties to follow Dr. Smith's advice. Instead, the court,

consistent with its decision, "strongly urged" the parents to consult with the

pediatrician regarding any bloodwork necessary to determine if M.A. has an

autoimmune disorder requiring further analysis.

Likewise, in assessing defendant's credibility, the court was free to

"believe everything a witness said or only part of it or none of it." Model Jury

Charges (Civil), at 1.12, "Credibility" (approved Nov. 1998). The court's

credibility findings as to defendant were detailed and well-grounded in the

record. We discern no abuse of the court's discretion in those findings and defer

to them.

In conclusion, we note that because these divorced parents could not agree

on this medical issue affecting their children, the family court appropriately stepped

in to resolve the disagreement. Horswell v. Horswell, 297 N.J. Super. 94, 104 (App.

Div. 1997). In a comprehensive written decision, the family court summarized the

evidence, made detailed credibility findings, and applied the best interests of the

child factors as set forth in N.J.S.A. 9:2-4(c). The court then issued a narrow

A-1963-24 15 modification of legal custody aimed at resolving this limited dispute while

maintaining the parents' right to joint legal custody and effectuating a decision in the

children's best interests. See Sacharow v. Sacharow, 177 N.J. 62, 80 (2003) (holding

that divorced parents who invoke the jurisdiction of the family court assent to the

possibility of a curtailment of their rights).

We discern no abuse of discretion in the court's fact-finding conclusions,

which are well supported by the sufficient, credible evidence in the record. We are

also satisfied the court applied the appropriate legal standard and did not owe

deference to the BCDOH's medical exemption decision.

Affirmed.

A-1963-24 16