in the Interest of J.A.M., Jr., a Child

Court of Appeals of Texas·Decided May 9, 2012·No. 04-11-00165-CV·Published

Opinion

MEMORANDUM OPINION

No. 04-11-00165-CV

IN THE INTEREST OF J.A.M., JR., a Child

From the 38th Judicial District Court, Uvalde County, Texas Trial Court No. 2010-03-27,480-CV The Honorable Cathy O. Morris, Judge Presiding

Opinion by: Phylis J. Speedlin, Justice

Sitting: Sandee Bryan Marion, Justice Phylis J. Speedlin, Justice Rebecca Simmons, Justice

Delivered and Filed: May 9, 2012 AFFIRMED Desiree 1 appeals the termination of her parental rights to her child, J.A.M., Jr. Having now reviewed the entire record, we conclude that Desiree has failed to establish that any of her appellate issues warrant reversal. We, therefore, affirm the trial court’s judgment terminating Desiree’s parental rights.

FACTUAL AND PROCEDURAL BACKGROUND J.A.M., Jr. was born on December 21, 2009 to 19-year old parents Desiree and Joel, a young married couple. On the morning of March 2, 2010, when the child was ten weeks old, Desiree and Joel took J.A.M, Jr. to the emergency room at Uvalde Memorial Hospital, stating

that the child had been crying a lot for about a day and a half; they also told the doctor that 1 In accordance with TEX. R. APP. P. 9.8(b), we refer to the parents of the minor child by their first names only.

J.A.M., Jr.’s left leg was swollen and he had not been moving it. Desiree and Joel did not know why the child’s leg was swollen. The emergency room physician, Dr. David Blackburn, did not see any bruises on J.A.M., Jr. Dr. Blackburn examined J.A.M., Jr.’s left leg and found it swollen and tender. X-rays revealed that J.A.M., Jr. had two distal, or “corner,” fractures in his left leg— one near his ankle (distal tibia fracture) and one near his knee (distal femur fracture). Dr. Blackburn stated that such fractures in an infant under six months of age are not common, and are “very suspicious” for non-accidental trauma, such as violent or fast grabbing of the child involving twisting or jerking, or hyper-flexion of the joint. Dr. Blackburn also stated that such distal fractures could occur in a child with bone disease. Dr. Blackburn stated the fractures appeared to be new because there was soft tissue swelling and no new bone formation. After consulting with J.A.M., Jr.’s doctor, Dr. Kevin Uptergrove, Dr. Blackburn transferred J.A.M., Jr. to Santa Rosa Children’s Hospital in San Antonio for a complete work-up, including more x- rays, blood work, a complete skeletal study, and a head CT scan. Dr. Blackburn felt that J.A.M., Jr. needed further evaluation to rule out any type of bone disease, although his bones appeared healthy on the x-ray he viewed.

At Santa Rosa Children’s Hospital, J.A.M., Jr. was examined by Dr. James Lukefahr, a pediatrician and medical director of San Rosa’s child abuse center. A skeletal survey performed on J.A.M., Jr. on the evening of March 2 showed two healing rib fractures and eight to ten healing corner fractures on the child’s wrists, knees, and ankles. J.A.M., Jr.’s blood tests did not reveal any abnormalities. The Department of Family and Protective Services (the “Department”) was called in to investigate and, on March 3, 2010, the Department filed an emergency petition to remove J.A.M., Jr. from his parents’ care; the Department was appointed temporary managing conservator of J.A.M., Jr. that day due to the aggravating circumstances. After an investigation

of the suspected physical abuse, the Department initiated termination proceedings against both parents.

On the first day of trial, Joel decided to voluntarily relinquish his parental rights to J.A.M., Jr. pursuant to a Rule 11 agreement in which the Department agreed to expedite consideration of placement of J.A.M., Jr. with his paternal grandmother. Desiree proceeded to a jury trial. At trial, the Department presented the testimony of two medical experts: Dr. Blackburn, the Uvalde Hospital ER physician, and Dr. Lukefahr, the treating pediatrician and child abuse expert at Santa Rosa. In addition, the Department’s investigator and J.A.M., Jr.’s case worker testified about the Department’s investigation, and J.A.M., Jr.’s foster mother testified that he was a normal healthy infant and had suffered no further fractures since his placement with her in October 2010. Finally, a Uvalde deputy sheriff testified that he conducted a criminal investigation that led to the indictment of Desiree and Joel for injury to a child. There was no eyewitness testimony, or other direct evidence, that either parent had ever physically abused J.A.M., Jr. The evidence of physical abuse came from J.A.M., Jr.’s medical records and the expert medical opinions.

Dr. Lukefahr was the main witness for the Department. He testified that the initial skeletal survey taken on March 2 showed that J.A.M., Jr. had two healing rib fractures (lateral and posterior), which would be caused by squeezing of the chest, and eight to ten healing corner, or distal, fractures of his wrists, knees, and ankles, which would be caused by “forceful twisting and jerking” of the arms and legs. Dr. Lukefahr stated that child abuse of small infants typically results in these types of fractures. He testified that the skeletal survey and blood tests he ran ruled out any type of bone disease as the cause of J.A.M., Jr.’s fractures. Specifically, Dr. Lukefahr stated that his tests ruled out osteopenia, which is related to a calcium or mineral

deficiency, metabolic bone disease or rickets, which results from a vitamin D deficiency, osteogenesis imperfecta or brittle bone disease, which has a different appearance and manifests in different locations than JA.M., Jr.’s fractures, and other rare genetic conditions. Dr. Lukefahr testified that, based on the x-rays, J.A.M., Jr. has “really healthy bones,” and stated his opinion that there was no other possible explanation for J.A.M., Jr.’s physical injuries other than child abuse, and the fractures on J.A.M., Jr. could not be the result of a nurse’s handling during immunizations or measurement. Dr. Lukefahr explained the appearance of some additional fractures on a follow-up skeletal survey taken on March 18, by stating that a fracture on such a small infant does not show up immediately on an x-ray because the ends of an infant’s bones are really still cartilage; “it’s not until some healing starts taking place that the body starts depositing calcium on the area that it becomes visible on the x-ray.” Dr. Lukefahr stated he was “very confident” the new fractures did not occur after March 2, but were simply not far enough along in the healing process to show up on the March 2 x-rays.

Desiree consistently denied that either she or Joel had hurt J.A.M., Jr., but could not explain how he had suffered the multiple fractures. Desiree testified about her pregnancy and J.A.M., Jr.’s vacuum-assisted delivery and temperature of 104 degrees at birth. Desiree detailed the many times she had taken J.A.M., Jr. to the family doctor or to the emergency room, and expressed her belief that something was wrong with him. During the 10 weeks after his birth, Desiree took J.A.M., Jr. to the family doctor, Dr. Uptergrove, on: (1) December 24, 2009 for jaundice; (2) December 28, 2009 because Desiree felt he was “breathing way too hard;” (3) January 18, 2010 for his one-month check-up and immunizations; (4) January 22, 2010 because Desiree had seen purple marks on the inside of J.A.M., Jr.’s hands and between his toes; Dr. Uptergrove ordered blood tests which were normal; and (5) on February 25, 2010 for his two-

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