In the Int. of: X.R., Appeal of: C.R.

CourtSuperior Court of Pennsylvania
DecidedJune 12, 2024
Docket2332 EDA 2023
StatusUnpublished

This text of In the Int. of: X.R., Appeal of: C.R. (In the Int. of: X.R., Appeal of: C.R.) is published on Counsel Stack Legal Research, covering Superior Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In the Int. of: X.R., Appeal of: C.R., (Pa. Ct. App. 2024).

Opinion

J-S15014-24 J-S15015-24

NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT O.P. 65.37

IN THE INTEREST OF: X.R., A : IN THE SUPERIOR COURT OF MINOR : PENNSYLVANIA : : APPEAL OF: C.R., FATHER : : : : : No. 2332 EDA 2023

Appeal from the Order Entered August 15, 2023 In the Court of Common Pleas of Philadelphia County Juvenile Division at No(s): CP-51-DP-0000538-2023

IN THE INTEREST OF: X.R., A : IN THE SUPERIOR COURT OF MINOR : PENNSYLVANIA : : APPEAL OF: A.A., MOTHER : : : : : No. 2696 EDA 2023

Appeal from the Order Entered August 15, 2023 In the Court of Common Pleas of Philadelphia County Juvenile Division at No(s): CP-51-DP-0000538-2023

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

MEMORANDUM BY OLSON, J.: FILED JUNE 12, 2024

C.R. (“Father”) and A.A. (“Mother”) (collectively, “Parents”) separately

appeal from the August 15, 2023 order adjudicating their son, X.R. (“Child”),

born in May 2022, dependent, finding that Child was a victim of “child abuse,”

____________________________________________

* Retired Senior Judge assigned to the Superior Court. J-S15014-24 J-S15015-24

and concluding that they were the perpetrators of the abuse.1 23 Pa.C.S.A.

§§ 6303(b.1), 6381(d). After review, we affirm.

On May 15, 2023, then one-year-old Child presented to the Emergency

Room at St. Christopher’s Hospital for Children (“St. Christopher’s”)

unresponsive with head injuries after reportedly falling out of a Pack ‘n Play.

N.T., 8/15/23, at 16; see also id. at 47-48; see also Exhibit DHS-6 (St.

Christopher’s medical records).

Upon examination by the Emergency Department, initial concerns were

of altered mental status,2 as well as seizure activity. N.T., 8/15/23, at 44-45.

Dr. Michelle Dominguez (“Dr. Dominguez”), an attending physician in child

abuse pediatrics and member of the Child Protection Program at St.

Christopher’s, examined Child upon referral from the Emergency Department.

According to Dr. Dominguez, imaging revealed: “significant bleeding into the

subdural space, so the lining around his brain. . . . So that’s bleeding under

the skull, essentially on top of the surface of the brain.” Id. at 45. Child was

intubated and treated with hypertonic saline, which is utilized for brain

swelling, as well as seizure medication. Id. at 47-48, 51.

1 We have sua sponte consolidated Mother’s and Father’s appeals, as the orders appealed and questions involved are essentially the same. See Pa.R.A.P. 513 (consolidation of multiple appeals).

2 Child “was not active the way he should be at that age. He was not interactive. He did[, however,] respond to pain. . . .” N.T., 8/15/23, at 47-48.

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Ultimately, Child was found to have suffered near-fatal injuries. Id. at

57, 64. Dr. Dominguez testified:

[H]e had bilateral subdural hemorrhages, so that’s both sides of the head. What we could see on the initial head CT, the initial head imaging, was bleeding to the front of the left side that extended to the side of the head; blood along the falx, which is membrane that separates [the] two sides of the head. And then, over time we could see additional bleeding, essentially on both sides of the head.

He also had -- on the spine, we could see subdural blood from the -- I believe it was T10 to L5 level, so like mid back to -- to the lower back, which may just be drainage from the subdurals in the brain.

He had retinal hemorrhages . . . to the backs of both eyes, too many to count, essentially covering the entirety of both retinas, so pretty severe retinal hemorrhages.

Id. at 59-60; see also id. at 45, 55-57, 72, 76; see also Exhibit DHS-6 (St.

Christopher’s medical records). Child additionally had “bruising across his

forehead, in two different areas,” and was “seizing on and off for three days,”

also potentially fatal. N.T., 8/15/23, at 48, 64 (“Brain injury itself is fatal at

this level. And ongoing seizure activity can also -- status epilepticus, as it’s

called, when you seize and you can’t stop, that can also be fatal.”).

Given the extent of Child’s injuries, Dr. Dominguez testified that she

would expect Child to have been “immediately symptomatic.” Id. at 60

(“[W]hen we see this level of intercranial injury, I would expect that he would

have been immediately symptomatic. When a child has this level of injury,

they don’t appear to be normal after it happens.”). Moreover, she stated,

“[I]t’s hard to speak definitely to prognosis, but I would say I expect injuries

-3- J-S15014-24 J-S15015-24

like this to have a longstanding effect. . . . I expect . . . [Child] would need

extensive therapies to ensure he regains function.” Id. at 63. She explained:

[F]or instance, when -- when he was in the hospital, he was not able to eat. Even after he was X-rayed, he was irritable, but he wasn’t acting normally. He had . . . decreased muscle tone in his body, increased tension in his arms and legs. He lost function. He was not the same level of function he was when he came in. And when you have this level of damage to the brain, and the retinal hemorrhages in the back of the eyes, you can have issues with sight. Some children don’t see after this kind of injury or have sight impairment. You can see very longstanding developmental delays essentially.

Id. at 63-64.

With respect to Parents’ explanation of Child’s injuries, DHS social work

service manager, Tierra Dunn (“Ms. Dunn”), who investigated the incident,

testified:

[Parents] were home with [Child and his brother, C.R.3], that they had just got finished eating and they had [given them] their bottles. It was reported that [Parents] took the children upstairs to put them in their Pack ‘n Play and crib. Specifically, [Child] was in a Pack ‘n Play and [C.R.] was in his crib, which are both in the same bedroom, and they’re like catercorner [sic] to each other. [P]arents’ bedroom is attached to the children’s room . . . . Father said that he . . . went downstairs to clean up. Mother was in [P]arents’ room. She reported that she heard a thump, so she ran into the boys’ room, and she found [Child] on his back, I believe, and he was crying, screaming, yelling. Mother picked him up. She said she immediately saw swelling going across his forehead, swelling of his head, and then she called for Dad to come back upstairs. I believe he was coming back upstairs because he heard the thump as well. So when he got back upstairs, he also was observing the swelling of his head. Dad then went back downstairs to get some ice for [Child]. And as he was ____________________________________________

3 C.R., almost two years old at the time of the subject hearing, is not a subject

of the instant appeals.

-4- J-S15014-24 J-S15015-24

going downstairs, it was reported by Mother that [Child] was going in and out of consciousness, that his lips were turning blue. And then she had called for Father to come back upstairs. . . . [T]hey called 911. 911 instructed them to complete CPR, so they completed CPR until the medics arrived, and [Child] was taken away to St. Chris[topher’s].

Id. at 17-19.4

Significantly, there is no dispute that Child was in the sole care of

Parents at the time of the incident. Id. at 21. In short, Parents alleged that

Child pulled himself up to a standing position in the Pack ‘n Play and then fell

over and hit his head. See id. at 77-78.

Dr. Dominguez opined that Child’s injuries were not consistent with the

accident mechanism provided by Parents. Id. at 52-53. Specifically, while

acknowledging that Child “could pull to stand,”5 Dr.

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