Opinion
2d Juv. No. B202188
4-15-2008
In re J. P. et al., Persons Coming Under the Juvenile Court Law. VENTURA COUNTY HUMAN SERVICES AGENCY, Plaintiff and Respondent, v. HEATHER S., Defendant and Appellant.
Aida Aslanian, under appointment by the Court of Appeal, for Defendant and Appellant. Noel A. Klebaum, County Counsel, Joseph J. Randazzo, Assistant County Counsel, for Plaintiff and Respondent.
NOT TO BE PUBLISHED
Heather S. (mother) appeals from orders of the juvenile court at the jurisdictional and dispositional hearing in which her sons became dependents of the court. She seeks reversal of the placement orders, challenges the sufficiency of the evidence to support certain findings, and argues that the court abused its discretion by delegating its authority to the Ventura County Human Services Agency (HSA). We affirm.
FACTUAL AND PROCEDURAL BACKGROUND
In 2007, mother and father lived with their sons J.P. and G.P., who were born in April 2004 and October 2006, respectively. Mother favored alternative health practices over conventional medical treatment. Neither son had received any immunizations.
In late March 2007, three-year-old J.P. had a seizure; he became stiff and his eyes rolled back. The seizure lasted approximately one minute; he then slept. On the same day he went to Los Robles Hospital emergency room where he was observed and discharged with a recommendation for follow-up with his own doctor. He had several similar short seizures in April, slept after each episode, and was taken to the emergency room for many or all of the seizures.
Mother took J.P. to Dr. Mark Corazza in Santa Barbara on April 11, 2007. After J.P. had several short seizures in his office, Corazzas staff escorted J.P. to the pediatric intensive care unit of Santa Barbara Cottage Hospital. Following tests, doctors diagnosed J.P. with idiopathic partial epilepsy. Dr. Curtis Pickert had an "extended and difficult conversation" with mother regarding the need for medication to treat a "child with seizures." Mother indicated that the seizures should "resolve naturally and compared [them] to things such as the common cold and childbirth." Pickert expressed concern that untreated seizures could have a significant adverse effect on J.P.s life and development. Attributing J.P.s seizures to both "a dose of Vistaril [he had] received ... during a dental procedure" and a "growth spurt," mother was reluctant to have him "receive any medication to control the seizures." She felt that his "body needed to be cleansed of the Vistaril" without any medical intervention.
In light of the potential danger to J.P. without medication, Cottage Hospital doctors recommended a child protective services consultation for his family. A HSA emergency response worker met with parents. Parents signed a safety plan that provided father would be in charge of J.P.s medication, mother would not give her children medication or treatments that were not approved by the doctor, and that both parents would seek medical attention if J.P.s condition persisted. Because father seemed to understand the seriousness of J.P.s condition, doctors provided him with a prescription for Trileptal for J.P., discharge directions, etc.
During the weekend of May 12, 2007, J.P. had seizures on two consecutive days. On the second day, May 13, father took J.P. to Los Robles Hospital despite mothers contrary wishes. Because J.P.s condition was so serious, Los Robles sent him to Ventura County Medical Center (VCMC). Mother advised VCMC staff that she had been giving J.P. and G.P. mineral salt, vitamins and "sleepy" tea to help them. Mother interfered with routine procedures, argued with doctors, and would not allow nurses to care for J.P. For example, when doctors tried to control J.P.s seizures with medication, mother refused to allow them to check medication levels in his blood. She also threatened to take J.P. from the hospital against their advice. Father advised VCMC staff that he had been trying to seek medical attention for two days, but that mother had not allowed him to do so. The attending doctor feared that J.P. could suffer permanent neurological damage or die if he were not treated immediately.
In J.P.s hospital room, mother and father cursed at each other which upset J.P. Father cussed at staff and his mood escalated; he was hitting his head because he was financially overwhelmed. He said that he was "snapping" and needed help. Father went to Hillmont Behavioral Health, where he informed staff that he was "[f]rustrated and angry over disagreement of care for [a] child [with] seizures." Hillmont staff recommended that he enter an in-patient facility for psychiatric evaluation. Father obtained an anti-anxiety medication prescription and left.
J.P. was having several 45-second seizures daily at VCMC. Mother continued to interfere with medical treatments and remained convinced that J.P. had toxic levels of metal, including aluminum in his system. Despite doctors warnings that J.P. could suffer permanent damage or death without treatment, mother continued to refuse treatment. She stated that "seizing may be a means of his [bodys] mechanism to rid his brain of these [lethal] toxic metals." In a note, she informed VCMC that she "object[ed] to and refuse[d] any and all tests or treatment on ... or to ... J.P., until the test results indicative of toxic metal poisoning have been acknowledged and addressed appropriately and satisfactorily ...." Her note referred to a hair analysis that was collected on April 13, and completed on April 23, 2007, by a laboratory, which she apparently sought through the office of Dr. James Kwako.
On May 16, 2007, HSA removed J.P. and G.P. from parents and placed G.P. in a confidential foster home; J.P. remained in VCMC. HSA also obtained a court order authorizing VCMC to treat J.P. until a May 21, detention hearing.
A social worker asked mother to control herself during visits with J.P. at VCMC. When mother said that the hospital would kill J.P., the social worker requested that mother not contact the hospital or her sons until the detention hearing. Mother later tried to enter J.P.s hospital room. The social worker called the police. A police officer came to the hospital and parked his squad car next to mother. Mother stated that she did not believe that he was real or was a real police officer. Mother took a large sign to the front of the hospital to protest that VCMC was killing her son. The social worker tried to discuss J.P.s condition with her, but mother displayed scattered thought patterns and did not seem to comprehend the seriousness of J.P.s condition.
When asked about her sons very low weight, mother explained that her "maiden" name and the fathers last name both ended with "ini," which "means small," and that they were just small people by nature. Mother breast fed both J.P. and G.P. A nurse suggested that mother nurse her infant, G.P., for at least 30 minutes, before nursing J.P., because J.P. was old enough to receive basic nutrition through solid foods. Parents explained that J.P. was persistent about wanting to nurse if he saw G.P. nursing; the nurse recommended that mother feed G.P. in another room to avoid this conflict.
On May 24, 2007, J.P. and G.P. were placed with their maternal aunt and uncle. They were later placed with their maternal grandmother. While in placement, both boys gained weight and J.P. received his medication and had no seizures.
HSA filed a petition alleging that mother and father each exhibited signs and symptoms of a mental illness that interfered with their ability to provide care and support for J.P. It also filed a petition regarding G.P., alleging that their failure to care and support J.P. placed G.P. at risk.
In juvenile court, mother repeatedly declined court-appointed counsel and represented herself before and during the contested jurisdiction and disposition hearing. The court granted fathers motion to amend one allegation to state that he was exhibiting signs and symptoms of mental instability rather than mental illness. The court sustained the petitions, ordered that J.P. and G.P. remain dependents and made other findings and orders that mother challenges on appeal.
DISCUSSION
Mother contends that there is not sufficient evidence to support the sustained petition. On review, we determine whether there is any substantial evidence, contradicted or uncontradicted, that supports the judgment. All conflicts in the evidence are resolved in favor of the trial courts decision. (In re Katrina C. (1988) 201 Cal.App.3d 540, 547.) "`The ultimate test is whether it is reasonable for a trier of fact to make the ruling in question in light of the whole record." (In re Savannah M. (2005) 131 Cal.App.4th 1387, 1394.) Mother claims that there is not sufficient evidence to support the finding and underlying allegation which read as follows: "[Mother] failed to provide adequate medical care and refused to follow through with the recommended medical treatment of [J.P.s] seizure condition. [J.P.] suffered seizures for two days without medical intervention. If left untreated, the seizures could cause disability and death." Mother argues that the finding is too broad and that the evidence supports only a narrower finding that "the basis of jurisdiction was due to [her] activity or lack thereof having to do with the May 13-16 incident of [J.P.s] hospitalization which exposed [him] to risk of harm." She argues that the broad finding made her conduct appear worse than it was and thus interfered with the courts returning her children. We disagree.
In April 2007, after Cottage Hospital doctors informed mother that untreated seizures could have a significant adverse effect on J.P.s life and development, she insisted that the seizures were his bodys mechanism to purge toxins from his system. The doctors fear that mother would not provide necessary medical care to J.P. resulted in the development of a safety plan before J.P.s discharge from the hospital. In that plan, mother agreed that father would be responsible for J.P.s medication, that she would not give her children medication or treatments that were not approved by the doctor, and that she and father would seek medical attention if J.P.s condition persisted.
In May, after J.P. was admitted to VCMC, father reported that "mother [gave their] children herbs and holistic remedies, against doctors orders." The evidence of that conduct defeats mothers claim that the finding should be limited to the period between May 13 and May 16. Mother avoided taking J.P. to the hospital when his seizures began on May 12. Ultimately, father took J.P. for medical treatment against mothers wishes on May 13, after J.P.s seizures continued for more than 24 hours. Further, the evidence concerning the parents consistent administration of J.P.s medication is mixed. Although both parents testified that J.P. received his prescribed medication regularly, father previously had informed a social worker that mother would not let him give medicine to J.P. He also testified that the first time he gave medication to J.P., mother did not want him to do so. Following his May "meltdown," father disclosed that he was "[f]rustrated and angry over disagreement [regarding the] care for [a] child [with] seizures."
Substantial evidence supports the finding concerning mothers failure to provide adequate medical care and her refusal to follow through with recommended medical treatment. The finding is not overly broad.
Mother also contends that there is not sufficient evidence to support the finding and underlying allegation that she was exhibiting signs and symptoms of mental illness that interfered with her ability to provide adequate care for J.P. We disagree.
In April, when Cottage Hospital doctors tried to explain the critical need to treat J.P.s epilepsy with medicine, mother compared his seizures to the common cold. Multiple doctors at different facilities informed mother that there were serious risks if J.P.s seizures were not medically treated (including at least one doctor who said that the risks included death or brain damage). Nevertheless, mother continued to insist that the seizures were the way that J.P.s body was purging toxic substances. At VCMC, when a social worker tried to discuss the serious nature of J.P.s condition with her, mother displayed scattered thought patterns and did not seem to comprehend the seriousness of J.P.s condition. Despite J.P.s precarious condition, mother threatened to remove him from the hospital against medical advice. When asked to control herself inside the hospital, she said that VCMC would kill her son. Outside VCMC, she protested with a sign saying that VCMC was killing her son. VCMC staff noted that mother "presented very depressed and agitated," and there were "[c]oncerns with regard to [her] experiencing a major depressive episode due to post [partum], or an underlying depressive/psychotic [condition] exacerbated by post [partum]." Substantial evidence supports the finding that mother was exhibiting signs and symptoms of mental illness that interfered with her ability to provide adequately for J.P.
We also reject mothers contentions that the juvenile court abused its discretion by delegating the authority to HSA to determine (1) whether to modify the terms of mothers visitation with the children, and (2) whether mother required a psychological evaluation. The court ordered that "Visitation between the child(ren) and the mother shall be consistent with the well-being of the child(ren) and shall be supervised." It added that HSA "has discretion to liberalize visitation between the mother and the children to be monitored or unsupervised, depending on her progress with the case plan."
Visitation between the parent and child must be "as frequent as possible, consistent with the well-being of the child." (Welf. & Inst. Code, § 362.1, subd. (a)(1)(A).) While it is unlawful for a court to delegate total discretion about whether visitation occurs, it may delegate the management of visitation details to the social services agency. (In re Moriah T. (1994) 23 Cal.App.4th 1367, 1374; see also In re Christopher H. (1996) 50 Cal.App.4th 1001, 1009 [upholding an order for "reasonable supervised visits" for father with child, where agency had discretion to allow unsupervised visits].) Here, the court did not delegate to HSA the authority to determine whether any visits would occur. Rather, it ordered that visits must occur and merely delegated to HSA the management of details of the visits, primarily by granting it leeway to allow mother more frequent visits and unsupervised visits.
Mother further argues that the court abused its discretion by authorizing HSA to determine whether she required an Evidence Code section 730 psychological evaluation. During the July 17, 2007, disposition hearing, there was a discussion concerning orders for the parents psychological evaluations. Most of that discussion focused on the father. At the close of the hearing, the court stated it was ordering that "the Agency has discretion to require a psychological evaluation for both parents," then added, "For [mother], ... I believe it would be helpful to understand what services, additional services might be helpful for [mother]. [¶] For [father], ... that is less demonstrated, but the Agency has discretion ...." It added that "mother should comply with some counseling requirements," and that "perhaps thats whats a psychological assessment would require, but Id like to see it start sooner rather than later." The court then stated that mothers case plan "includes a requirement she begin counseling and not wait for the recommendation of a psychological evaluation."
The minute order for the July 17, 2007, hearing states, "Agency is granted discretion to require psychological evaluation for both parents." That minute order was mailed to mother and father on July 19. The court ordered the agency to prepare new findings and orders by July 24. HAS prepared an order stating that "mother ... shall participate in a psychological assessment as arranged by [HSA] and shall follow all recommendations of that assessment." The court signed that order on August 9. The order reflects the intention that the court expressed during the hearing. The courts equivocal comments about the need for a psychological assessment applied to father rather than mother. The courts August 9 order did not improperly delegate to HSA any authority concerning mothers psychological assessment.
Finally, mother claims that the court erred in signing the final findings and orders on August 9, 2007, because they differed from the courts verbal orders on July 17, 2007; the court signed them without providing her the opportunity to review and comment upon them; and they were ambiguous and left her confused regarding the requirements of her case plan. The differences between the verbal findings and orders of the court on July 17 and its August 9 order were minimal. We have already explained that its written order concerning mothers psychological evaluation reflects the intention expressed by the court on July 17. The proposed visitation orders provided that both parents would have supervised visitation and granted HSA discretion to liberalize visitation to include monitored or unsupervised visits; the provisions concerning mothers visitation rights were the same in both versions of the order.
The orders of the juvenile court are affirmed.
We Concur:
GILBERT, P.J.
ERREN, J.