in the Interest of A.J.H., Child v. Department of Family and Protective Services

Court of Appeals of Texas·Decided January 15, 2019·No. 01-18-00245-CV·Published

Opinion

Opinion issued January 15, 2019

In The

Court of Appeals

For The

First District of Texas

endanger the physical or emotional well-being of the child, or that she knowingly engaged in conduct, or knowingly placed the child with persons who engaged in conduct, that endangered the child’s physical or emotional well-being,1 (2) that she failed to comply with the provisions of a court order that specifically established the actions necessary to obtain the return of the child,2 and (3) that termination of her parental rights is in the best interest of the child.3 She also argues in a fourth issue (4) that the trial court abused its discretion by appointing the Department of Family and Protective Services [“DFPS”] as the child’s sole managing conservator instead of herself.4 BACKGROUND

The child, A.J.H., was born in 2015. Mother was not married and no father was listed on his birth certificate. During the course of this proceeding, DNA testing confirmed the identity of A.J.H.’s father, and the father’s parental rights were also terminated in a separate trial. The father is not a part of this appeal, though his appeal is also pending in this Court.

1 TEX. FAM. CODE ANN. § 161.001(b)(1)(D), (E)

2 TEX. FAM. CODE ANN. § 161.001(b)(1)(O)

3 TEX. FAM. CODE ANN. § 161.001(b)(2)

4 TEX. FAM. CODE ANN. § 153.131(a)

The July 2016 Hospitalization On July 7, 2016, when A.J.H. was a year-and-a-half old, Mother took him to Texas Children’s Hospital Urgent Care. According to medical records, A.J.H. presented with vomiting, abdominal pain, and spots on his abdomen. Mother told the medical professional that A.J.H.’s symptoms started on Sunday, July 3rd, after eating a hamburger at McDonald’s and continued through the next day. When the vomiting stopped, Mother noticed marks on his abdomen that looked like bruising, his stomach was distended, he seemed uncomfortable, and he was unable to lie on his stomach. A.J.H. also had pharyngitis and was strep-positive. The medical records note a bruise on A.J.H.’s left ear, three “nonblanching spots that appears to look like bruising” on his abdomen, and two “nonblanching spots that appears to look like bruising” on his lower back. The Urgent Care report concluded that the medical professional was “sending [A.J.H.] downstairs for further evaluation of possible abuse due to multiple bruising found on abdomen, lower back and upper left ear.”

A.J.H. was transferred to Emergency Care with notes that the treatments recommended by his primary care physician were: “Medication for strep. R/O physical abuse work up.” The Emergency Center notes report that, with regard to the bruising, “Mother reports that he had fallen asleep on her coat which has wood buttons and that she thinks he was sleeping on a button . . . . Mother reports that pt

has always seemed to bruise easily but it has been worse this week.” Again, bruises on A.J.H.’s ear, abdomen, and back were noted, as well as hepatomegaly, or liver swelling. The records include the following plan of care:

17 month old with vomiting, abdominal pain, low grade fever and easy bruising, has +strep test, hepatomegaly on exam, concern for coagulopathy, hepatitis, liver failure, possible abdominal injury, malignancy, less likely to be TIP or HSP. Check cbc, liver panel, amylase, lipase, easy bruising panel. Consider US or xray as indicated by lab results.

An ultrasound was done of A.J.H.’s abdomen, and the medical records conclude:

US abdomen: Hepatomegaly. Possible focal area of fibrosis in the right hepatic lobe. No discrete hepatic mass. Small volume ascites.

Gallbladder sludge. Nonspecific urinary bladder debris.

Spoke to GI, can discharge from GI perspective. Liver enzymes elevated but liver function normal. Follow up in GI clinic as an outpatient. Abdominal and ear bruise not visible anymore. Will treat for strep throat. No concern for abuse at this time.

Discharge instructions dated July 8, 2016 provide: “Amoxicillin per script, follow up in GI clinic. Return to EC if not drinking.” The discharge documentation portion of the records provides in part:

Patient Teaching: Discharge instructions complete WITH medication prescription review[.]

Discharge Teaching: Patient/Caregiver Verbalizes Understanding;

Provided copy of AVS [after-visit summary]; follow-up appointment scheduled[.] Referral to GI[.]

The January 2017 Hospitalization In January 2017, Mother left A.J.H. with her live-in boyfriend, Chester Mosely, while she went to work. Mother usually left A.J.H. with her mother, but it was cold outside, and she did not want to have to take A.J.H. on the bus to her mother’s home. While Mother was at work, Mosely called and reported that A.J.H. had minor burns. Mother said that she would look at it when she got home from work. While Mother was on her way home from work, Mosely called again and reported that A.J.H.’s skin was peeling off his buttocks. Mother called an ambulance, and A.J.H was taken to Texas Children’s Hospital.

The Texas Children’s medical records stated that “when asked privately [Mother] denies having concerns about abuse[.]” The hospital noted burns to A.J.H.’s lower back, buttocks, perianal area, and scrotum, and that some blisters were intact, but not on his buttocks. The hospital also noted “[h]yperpigmentation concerning for bruising on torso, check [sic], behind L ear, and R inner thigh.” The hospital concluding that there was a “partial thickness burn on buttock, partial thickness burn on right forearm below elbow, elevated liver and pancreas test could reflect injury to abdomen.” Texas Children’s then ordered A.J.H. transferred to the burn unit at Memorial Hermann Hospital.

The Memorial Hermann Hospital records show that, upon admission, in addition to the burn injuries, A.J.H. had vomited the day before, “after eating apple

juice.” He also had a scab on his left ear, an abrasion of his right ear, and a scab on the scalp behind the right ear. An examination of the abdomen showed “no masses,” but that A.J.H. “cries with palpation but is overall discomfort during examination.” He also had “[h]yperpigmented, brown macules to [the] right abdomen.” In its assessment, the medical personnel noted that “the burn appears to be an immersion injury and [is] not consistent with the history provided of boyfriend bathing the child.” There was no history of trauma to explain the marks on his cheek and abdomen, and that “[i]injury to these areas are uncommon with normal child’s play and are concerning for inflicted trauma.” A.J.H. also had “very high liver and pancreatic enzymes” and “vomiting and a decreased appetite[.]” After reviewing A.J.H.’s history and physical exam, among other things, a physician concluded:

This pattern of burn along with the provided history is very concerning for non accidental trauma and we are concerned that the child’s elevated liver enzymes and lipase may be the result of abdominal trauma and recommend an abdominal CT for further evaluation. CPS is involved and the child cannot be discharged prior to CPS disposition.

Accordingly, a CT scan was performed and the following information was entered into A.J.H.’s medical records.

[A.J.H] received an abdominal CT today which showed a Grade 2 liver laceration and abnormalities of his pancreas concerning for subacute or chronic pancreatitis. Given his abdominal bruises and petechiae, [A.J.H.’s] liver laceration is consistent with blunt force trauma to his abdomen. His liver enzymes (AST/ALT) have trended down rapidly from 1197/1907 to 89/107 within 3 days which likely implies recent abdominal trauma. It is unclear at this time whether his pancreatic abnormalities are due to recent or past trauma.

We reviewed medical records from the child’s ER visit to TCH on 7/7/16 after obtaining a medical release of information from mother.

[A.J.H] presented to TCH ER with his mother for vomiting and bruising to his stomach. Bruises were noted on his abdomen, back, and left ear.

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in the Interest of A.J.H., Child v. Department of Family and Protective Services, (Tex. Ct. App. 2019).

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