in the Interest of A. G. G., A. D. G., I. v. and v. v. Minor Children

CourtCourt of Appeals of Texas
DecidedJanuary 3, 2013
Docket13-11-00299-CV
StatusPublished

This text of in the Interest of A. G. G., A. D. G., I. v. and v. v. Minor Children (in the Interest of A. G. G., A. D. G., I. v. and v. v. Minor Children) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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in the Interest of A. G. G., A. D. G., I. v. and v. v. Minor Children, (Tex. Ct. App. 2013).

Opinion

NUMBER 13-11-00299-CV

COURT OF APPEALS

THIRTEENTH DISTRICT OF TEXAS

CORPUS CHRISTI - EDINBURG

IN THE INTEREST OF A.G.G., A.D.G., I.V, AND V.V., MINOR CHILDREN

On appeal from the County Court at Law No. 5 of Nueces County, Texas.

MEMORANDUM OPINION Before Justices Garza, Benavides, and Perkes Memorandum Opinion by Justice Benavides This appeal involves the termination of A.V.’s (“Mother”) parental rights over

A.G.G., A.D.G., I.V., and V.V.1 By two issues, Mother asserts that (1) the trial court

abused its discretion in finding her appeal frivolous under former family code section

1 To protect the privacy of the parties, we will use aliases throughout this opinion. See TEX. R. APP. P. 9.8. 263.405(d)(3); and (2) insufficient evidence supports the jury’s findings. We affirm.

I. BACKGROUND

The Texas Department of Family and Protective Services (“the Department”)

brought this involuntary parental termination action against Mother following its

investigation of alleged child abuse—specifically, starvation and malnourishment of I.V.

A. The Evidence at Trial

(1) I.V.’s Medical Condition and Testimony from Treating Doctors2

On February 27, 2009, I.V., age 3, arrived at Christus Spohn Hospital’s

emergency room in Corpus Christi unresponsive, not breathing, and with a weak pulse

rate of 30. Attending physician Amalia Tinoco, M.D., aided by the triage staff, worked to

resuscitate I.V. by intubating him and running intravenous fluids into his body. As part

of the resuscitation process, Dr. Tinoco ordered a “finger-stick” reading of I.V.’s blood to

determine his glucose level. The “finger-stick” reading was performed twice on I.V. and

revealed a glucose level of 3 each time. According to Dr. Tinoco, a glucose level of 3 is

incompatible with life and likely to result in death if not immediately restored to normal

levels. A “normal” glucose reading for humans is between 60 and 110. Dr. Tinoco

admitted that a glucose level of 3 was a rare reading in her practice. Dr. Tinoco

described I.V.’s physical appearance that day as “totally emaciated, just like a little

skeleton of skin and bone.” In more descriptive terms, Dr. Tinoco likened I.V.’s

2 Shortly after I.V.’s hospitalization at Christus Spohn, the Department was alerted to I.V.’s condition. On March 2, 2009, the Department filed a petition for protection, conservatorship, and termination of parental rights against Mother regarding I.V. Subsequently, the Department was appointed temporary managing conservator of A.G.G., A.D.G., I.V., and V.V.

2 appearance to that of concentration camp prisoners from World War II. Dr. Tinoco

medically opined that I.V. had been starved.

Once I.V.’s condition was stablized, Dr. Tinoco interviewed Mother. Mother told

Dr. Tinoco that she had last fed I.V. a hamburger earlier that morning. Dr. Tinoco

stated that based on I.V.’s diagnostic condition and physical appearance, she found

Mother’s statements “medically impossible.”

After approximately two hours of emergency care, I.V. was transferred to the

Driscoll Children’s Hospital Child Abuse Resource and Evaluation (CARE) team under

the direct supervision of Nancy Harper, M.D., a double board-certified pediatrician and

child-abuse pediatrician.

Dr. Harper spoke directly to I.V. during her initial consultation, in which he told her

that he had not eaten anything in the last forty-eight hours. I.V. stated that he could

neither walk nor run but wanted to eat a cheeseburger. Dr. Harper also interviewed

Mother about what I.V. had eaten the previous day. Mother stated that she fed I.V.

three meals the day prior, including an afternoon snack. Dr. Harper took several

photographs of I.V. in his hospital bed to document his condition. These photos were

admitted into evidence at trial and depicted a withered child whose ribcage was

prominent and whose skin was sagging from his buttocks. Dr. Harper testified that the

photos were “descriptive of how wasted [I.V.] was and was consistent with severe

malnutrition.” Dr. Harper further indicated that I.V.’s appearance and condition was not

consistent with his having eaten anything in the last forty-eight hours.

Dr. Harper and the Driscoll CARE team retrieved I.V.’s medical records from

previous health care providers and used these records to compile a “growth curve” that

3 spanned I.V.’s life. According to Dr. Harper, as a young baby, I.V. was “quite chubby,”

and weighed in the 95th percentile for his age. Most of his life, I.V.’s documented

weights were in the 95th percentile and showed good growth until just after he turned

age two. At that point, I.V.’s weight gain slowed, and he stopped growing in height.

Dr. Harper testified that these factors are indicative of a child who is failing to thrive, also

called “chronic malnutrition” or “stunting,” which causes the child to stop growing. Due

to his malnutrition, Dr. Harper testified that I.V.’s “metabolic machinery” was at a point

where it was no longer functioning properly.

During I.V.’s near-month-long stay at Driscoll, more than sixty different genetic,

metabolic, and medical tests were performed on him by multiple subspecialists in the

fields of gastroenterology, hematology, nutrition, and physical and occupational therapy

to determine the cause of his starvation. After the battery of tests, Dr. Harper

concluded that chronic malnutrition brought on I.V.’s condition.

According to Dr. Harper, I.V. developed other medical conditions and

complications as a result of his chronic malnutrition. One process, called “catabolism,”

occurred where I.V.’s body was breaking down fat in his body to provide fuel for energy.

Under this condition, once the body runs out of fat-fuel sources, it begins to break down

protein in the muscle and fats from other organs such as the brain and liver. Medical

imaging showed brain atrophy, or shrinkage, in I.V.’s skull caused by starvation.

According to Dr. Harper, I.V.’s body was “consuming his organs,” including his brain, for

energy. Dr. Harper stated that lowered cognitive skills and hyperactivity disorder were

the potential consequences of brain atrophy. The CARE team also worked to avoid

“refeeding syndrome” caused by a sudden surge in insulin from feeding a starved

4 person. This syndrome causes cells to retain electrolytes and deprive the blood from

receiving them. Therefore, the CARE team fed I.V. at a slow pace so that he would

gain weight at a slower rate to avoid further complications. However, I.V.’s bone

marrow had already gone into shock as a result of the refeeding syndrome, which led to

his anemia and required several blood transfusions to treat.

Dr. Harper noted that I.V. progressed positively during his hospitalization, but still

struggled with walking up stairs unassisted. Dr. Harper was later informed in follow-up

visits that I.V. overcame these mobility obstacles with time. From his hospitalization in

late February/early March 20093 to his follow up visit in December 2009, I.V. had gained

“almost 26 pounds” and had grown four inches in height. Dr. Harper described I.V.

during his last visit as “playful” and “active,” and said that he could run, despite having

“slightly small calves.” Overall, Dr. Harper testified that he did “great.”

Dr. Harper opined from a medical perspective that I.V. was tortured. She also

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