in the Interest of A.A., a Child

Court of Appeals of Texas·Decided February 8, 2018·No. 02-17-00307-CV·Published

Opinion

COURT OF APPEALS

SECOND DISTRICT OF TEXAS

FORT WORTH

NO. 02-17-00307-CV

IN THE INTEREST OF A.A., A CHILD

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FROM THE 323RD DISTRICT COURT OF TARRANT COUNTY TRIAL COURT NO. 323-103402-16

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MEMORANDUM OPINION1

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Appellant D.V. (Father) and I.A. (Mother) took A.A. to Cook Children’s Hospital when she was about four months old. Doctors discovered that A.A. had bleeding on her brain, healing fractures of both upper and lower legs, and five broken ribs. Child Protective Services (CPS) removed A.A. from her parents,

1 See Tex. R. App. P. 47.4.

and the Texas Department of Family and Protective Services (TDFPS) filed a petition for termination of the parents’ rights to A.A. After a bench trial, the trial court found by clear and convincing evidence that:

 Father “failed to comply with the provisions of a court order that specifically established the actions necessary . . . [for] the return of [A.A.] who ha[d] been in the . . . temporary managing conservatorship of [TDFPS] for not less than nine months as a result of [her] removal from the parent . . . for . . . abuse or neglect”; and

 termination of the parent-child relationship between Father and A.A.

is in her best interest.

See Tex. Fam. Code Ann. § 161.001(b)(1)(O), (2) (West Supp. 2017). The trial court therefore terminated Father’s parent-child relationship with his daughter A.A. In two issues, Father challenges the legal sufficiency of the evidence supporting the best-interest finding and the factual sufficiency of the evidence supporting both findings. We affirm.

I. BACKGROUND FACTS

A. A.A. Was Admitted to Cook Children’s Hospital with Serious Injuries.

Father and Mother took A.A. and her twenty-two-month-old half-sister E.A.

to Cook Children’s Hospital on Monday, June 20, 2016. Testimony conflicted about whether the parents sought treatment only of E.A., who was sick and vomiting, or also of A.A., whose swollen head Father had noticed the previous evening. Regardless, after nurses noticed A.A.’s enlarged head, the hospital admitted A.A., and Dr. Sophia Grant, one of about 350 board-certified child abuse pediatricians in the United States, evaluated her the next morning. Dr.

Grant testified that A.A.:

 “appeared to be in pain or uncomfortable”;

 had the body and weight of a two-week-old but her head was “markedly bigger than the rest of her body”;

 “would have looked like a very tiny baby with a very large head”;

 had brain issues and injuries including:

(1) intracranial pressure, as indicated by an “open and full”

fontanelle;

(2) chronic, large, subdural hematomas;

(3) “a small amount of subarachnoid hemorrhage with a thrombosed [clotted] and torn bridging vein[]”; and

(4) some brain atrophy;

 had five healing rib fractures with calluses on the right side of her body;

 had healing fractures of her left and right femurs; and  had left and right tibia fractures.

Dr. Grant also testified:

 “[I]t would have been very obvious” to an ordinary person that something was wrong with the size of A.A.’s head;

 A.A.’s “large head . . . was a result of her bleeding on her brain which caused the bones to separate”;

 The word “chronic” “means an ongoing process; something that didn’t happen the day before or two days before”;

 A.A.’s femur fractures and right tibia fracture were consistent with classical metaphyseal fractures or lesions, which result “from a sudden jerking or pulling”; “a shearing force on the edge of the bone . . . causes . . . tearing off of the top of the bone”;

 The force that could cause the fractures:

would be a force that any reasonable person would recognize was inappropriate. When it occurred, the baby would scream out in pain.

These injuries can also occur with acceleration, deceleration. If the limbs are flailing like a rag doll, that can cause enough force to cause the metaphyseal lesions to occur[;]

 By acceleration and deceleration, Dr. Grant meant:

the rapid movement forward, rapid movement back, rapid movement forward, rapid movement back, repeated.

And a child of this age cannot keep her head still, so if she were to experience those forces, her head would be going back and forth, but also side to side, because she doesn’t have the neck musculature or the awareness to try and keep her head straight. So . . . those kids suffer the most damage just because of poor neck control and also because the head is much bigger than the rest of the body relatively speaking;

 A callus can form in “maybe five days, but . . . they are very prominent at 10 days.” However, Dr. Grant also testified that it takes at least two weeks “to see callus formation”; and

 A.A.’s rib fractures could only have occurred from someone holding her and putting too much pressure on her ribs.

Dr. Grant denied that  There was evidence of a birth defect in A.A.’s brain;

 Brittle bone disease, which is a genetic disease, could have caused A.A.’s fractures; and

 The fractures could have resulted from a fall.

Dr. Grant believed that A.A.’s multiple healing fractures and hematomas showed that A.A. “was [a] victim of nonaccidental trauma” and had been “victimized at various points on more than one occasion.” Dr. Grant explained

that child abuse pediatricians use terms like “abusive head trauma” and “nonaccidental head injury” for “shaken baby syndrome.”

CPS investigator Haley Koren testified that doctors performed surgery, drilling burr holes into A.A.’s head to alleviate the cranial pressure. A.A. was hospitalized for at least a week.

B. Neither Mother nor Father, A.A.’s Only Caretakers, Claimed Responsibility for Her Injuries.

It was undisputed that Mother was A.A.’s primary caretaker and that Father was A.A.’s only other caretaker. On June 21, 2016, CPS investigator Koren and a police detective interviewed the parents separately. Koren testified that Mother told her:

 Mother noticed A.A.’s head was getting larger the Wednesday before the removal and told Father;

 Mother’s four-year-old son A.E. caused the injuries by picking A.A.

up out of her crib; and

 Mother had seen A.E. “trying to get off the bed with A.A. at one point.”

CPS investigator Koren testified that Father told her:

 He had been alone with A.A. when Mother showered and on similar brief occasions;

 He did not know how A.A. was injured;

 He did not know if Mother could have caused the injuries but “had doubts as to whether or not she actually caused [them]”;

 Mother told him that A.E. had done it, and he believed her;

 He did not notice A.A.’s swollen head until the weekend;

 He called JPS, where A.A. was born, to find out if the swelling was normal and was told that it was normal; and

 He called Cook Children’s to schedule an appointment for A.A. but could not get an appointment until August.

CPS investigator Koren also testified:

 She noticed A.A.’s enlarged head immediately upon first seeing her;

 She did not believe that the parents had failed to notice A.A.’s head getting bigger and bigger;

 A previous investigation for physical abuse of E.A., who suffered a broken humerus, had been closed with the explanation that A.E.

“had been jumping and fell on top of her”;2

 The parents told Koren that they did not get frustrated with A.A. and would rock her;

 Before the removal, A.A. had not been seen by a doctor since her release from the NICU after her premature birth;

 According to the parents, the CPS referral, and Koren’s discussions with medical staff, the parents went to the hospital on June 20, 2016 because E.A. was sick, not because of A.A.’s head;

 The “nurses noticed A.A.’s head and said that they needed to take a look at her”;

 Mother “always seemed to have a flat affect” on each of the two or three occasions Koren interviewed her:

She really didn’t have much emotion with regards to the situation, in regards to . . . [A.A.] being in the hospital and in regards to her being severely injured.

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