In the Int. of: T.G., Appeal of: Phila Dept.(DHS)

208 A.3d 487
Superior Court of Pennsylvania·Decided April 22, 2019·No. 1195 EDA 2018·Published·Cited by 30 cases

Opinion

OPINION BY BOWES, J.:

The Philadelphia Department of Human Services ("DHS") appeals from the March 12, 2018 juvenile court order of adjudication that denied its request to find F.A. ("Mother") a perpetrator of child abuse against her daughter, T.G. We reverse in part and remand.

During November 2009, T.G. was born four and one-half months premature with myriad health conditions, including necrotizing enterocolitis, chronic lung problems, heart arrhythmia, ventricular tachycardia, vision delays, retinopathy, cerebral palsy, and microcephaly. Since 2010, she has been treated by a team of twenty-one medical professionals at St. Christopher's Hospital for Children ("St. Christopher's") in Philadelphia. T.G. has global developmental delay, and she is unable to speak or walk. In addition, T.G. suffers from a swallow dysfunction that has required the utilization of a specialized feeding tube. The child cannot chew or swallow effectively and food and liquid gets misdirected to her trachea.

DHS's involvement with the family began on January 10, 2018, after it received a December 28, 2017 child protective services ("CPS") report alleging that then-eight-year-old T.G. had missed several medical appointments and was diagnosed with failure to thrive due to chronic malnutrition. The agency asserted that Mother missed approximately eighteen appointments with T.G.'s medical specialists at St. Christopher's during that year. In addition, DHS asserted that Mother neglected to provide T.G. early intervention services ("EIS") or register her in school. The two-week delay between the CPS report and the initial meeting with Mother was based upon the agency's inability to contact Mother despite making several attempts to confront her at the family's residence, leaving correspondence for her, and talking *489 to other family members. When the agency finally located Mother and scheduled an in-person meeting with her and T.G., the conference was twice rescheduled before it occurred on January 10, 2018. Following that meeting, Mother rejected DHS's subsequent attempts to meet with her in the home. Instead, she advised the agency, "No, it's okay, I'll see you in court." N.T., 3/12/18, at 74.

Following DHS's investigation, the CPS report was indicated for serious physical neglect based upon Mother's failure to provide medical care. 1 In addition to malnutrition, the investigative assessment highlighted that, due to T.G.'s failure to attend physical therapy and orthopedic appointments, the child's limbs had contracted, i.e. , the joints had stiffened into an unnatural position. The St. Christopher's staff opined that T.G.'s ankles might have to be broken in order to correct her orthopedic condition.

On February 27, 2018, DHS filed a dependency petition and asserted that Mother's physical neglect of T.G. was tantamount to child abuse. During the ensuing hearing, DHS presented the testimony of Renee Turchi, MD, the Medical Director of the Center for Children and Youth and Special Healthcare Needs at St. Christopher's, and Melanie Davis, the DHS investigator. Mother testified on her own behalf.

As it relates to the issues raised in this appeal, Dr. Turchi testified that, between 2013 and March 12, 2018, T.G. attended only twenty-five of ninety-two medical appointments. She also indicated that T.G. was drastically underweight. Indeed, as of the date of the evidentiary hearing, eight-year-old T.G. weighed 15.6 kilograms (approximately thirty-four pounds). That weight corresponds to the average three-year-old child, and it is four standard deviations below the zero percentile for T.G.'s age group. Dr. Turchi explained that T.G.'s chronic malnutrition was abnormal notwithstanding T.G.'s extensive medical diagnoses, and peculiar in light of the fact that T.G. received a specialized formula delivered to her home without any expense to Mother. She opined that T.G.'s failure to thrive was caused by Mother's failure to feed her daughter the prescribed amount. N.T., 3/12/18, at 25. In fact, noting that the specialized formula provided "one and [one-]half times the calories per ounce" than the typical mixture, she concluded, "there's no reason why [T.G.], given the proper calories, would not be gaining weight." Id. at 60-61. Dr. Turchi confirmed that Mother indicated that she was not feeding her daughter the recommended amount of formula. Id. at 62-63.

In addition, Dr. Turchi noted that T.G. had several cavities and missed all five dental appointments scheduled since 2014. Id. at 26-27. Likewise, she missed seventy-four of 126 physical therapy sessions scheduled since 2010. Id. at 29. The incomplete physical therapy contributed to the contractures in T.G.'s legs, hips, and upper arms. Id. at 30. Dr. Turchi highlighted that Mother declined EIS, which would have permitted T.G. to receive services at home rather than at St. Christopher's. Id. at 31-32, 45-46.

During her direct testimony, Mother countered that she did, in fact, provide T.G. the recommended amount of formula, but she never received the fortified formula that Dr. Turchi prescribed. She also testified that her inattentiveness to the *490 calendar of appointments was the result of her struggle with the death of her husband and a recent cancer diagnosis. As it relates to the contractures, Mother stated that T.G.'s orthopedic surgeon recently ordered specialized braces for the child's legs.

After hearing the evidence and the parties' countervailing arguments, the juvenile court adjudicated T.G. dependent based on Mother's neglect of T.G.'s medical needs, but declined to find Mother a perpetrator of child abuse. From the bench, the court stated, "it's quite clear that there's a failure to thrive here due to [M]other's medical neglect[.]" Id. at 101. Nevertheless, the court concluded, "I am not finding child abuse. I don't see enough evidence to support that." Id. Thereafter, the juvenile court entered an order of adjudication and disposition that memorialized its finding that T.G. was a dependent child, and formally denied DHS's request for a finding of child abuse as to Mother.

DHS appealed and complied with Pa.R.A.P. 1925(a)(2)(i) by filing a concise statement of errors complained of on appeal wherein it asserted two substantive issues. DHS combined its issues for our review as follows: "Whether the trial court erred as a matter of law and abused its discretion when it declined to find child abuse against [Mother] where there was uncontroverted evidence of serious physical neglect, and where the trial court found that there was 'failure to thrive ... due to [Mother's] medical neglect' "? DHS brief at 6. The guardian ad litem submitted a letter to this Court, wherein it joined the brief filed by DHS.

Our standard of review is as follows:

Free access — add to your briefcase to read the full text and ask questions with AI

In the Int. of: T.G., Appeal of: Phila Dept.(DHS), 208 A.3d 487 (Pa. Ct. App. 2019).

208 A.3d 487 (In the Int. of: T.G., Appeal of: Phila Dept.(DHS)) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

In the Int. of: R.R., Appeal of: BCC&Y
Superior Court of Pennsylvania, 2026
In the Int. of: M.S., Appeal of: J.T.
Superior Court of Pennsylvania, 2024
In the Int. of: J.F., Appeal of: J.F.
2024 Pa. Super. 12 (Superior Court of Pennsylvania, 2024)
In the Int. of: S.A.S., Appeal of: DHS
2023 Pa. Super. 235 (Superior Court of Pennsylvania, 2023)
In the Int. of: B.G., a Minor
Superior Court of Pennsylvania, 2023
In the Int. of: V.D., a Minor
Superior Court of Pennsylvania, 2023
In the Int. of: X.F., a Minor
Superior Court of Pennsylvania, 2023
In the Interest of: J.H., Appeal of: H.J.
Superior Court of Pennsylvania, 2023
In the Int. of: J.M., Appeal of: D.M.
Superior Court of Pennsylvania, 2022
In the Int. of: K.L., Appeal of: N.L.
Superior Court of Pennsylvania, 2022
In the Int. of: W.C. a Minor, Appeal of: S.C.
Superior Court of Pennsylvania, 2021
In the Int. of: C.C. a Minor, Appeal of: C.C.
Superior Court of Pennsylvania, 2021
In the Int. of: T.H., Appeal of: T.H.
Superior Court of Pennsylvania, 2021
In the Int. of: X.P., Appeal of: K.J.P.
2021 Pa. Super. 55 (Superior Court of Pennsylvania, 2021)
In the Int. of: J.F., Appeal of: E.R.F.
Superior Court of Pennsylvania, 2021
In the Int. of: A.B, Appeal of: C.B.
Superior Court of Pennsylvania, 2020
In the Int. of: A.B., Appeal of: S.S.
Superior Court of Pennsylvania, 2020
Com. v. Morris-Carr, S.
Superior Court of Pennsylvania, 2020
In the Int. of: S.C., Appeal of: M.C.
2020 Pa. Super. 53 (Superior Court of Pennsylvania, 2020)
In the Int. of: J.H., Appeal of: P.H.
Superior Court of Pennsylvania, 2020