Opinion
E052247 Super.Ct.No. RIJ117903
08-17-2011
In re J.B. et al., Persons Coming Under the Juvenile Court Law. RIVERSIDE COUNTY DEPARTMENT OF PUBLIC SOCIAL SERVICES, Plaintiff and Respondent, v. J.M., Defendant and Appellant.
Rich Pfeiffer, under appointment by the Court of Appeal, for Defendant and Appellant. Pamela J. Walls, County Counsel, and Julie Koons Jarvi, Deputy County Counsel, for Plaintiff and Respondent.
NOT TO BE PUBLISHED IN OFFICIAL REPORTS
California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.
OPINION
APPEAL from the Superior Court of Riverside County. Gary Vincent, Temporary Judge. (Pursuant to Cal. Const., art. VI, § 21.) Affirmed.
Rich Pfeiffer, under appointment by the Court of Appeal, for Defendant and Appellant.
Pamela J. Walls, County Counsel, and Julie Koons Jarvi, Deputy County Counsel, for Plaintiff and Respondent.
In this dependency proceeding, the juvenile court asserted jurisdiction over three children of J.M. (the mother) based on "medical child abuse." In 2006, the youngest child had undergone an operation (Nissen fundoplication) to reconfigure her esophagus and stomach. In 2007, she had had a second operation to install a gastric feeding tube (G-tube), which delivered food directly into her digestive system. Finally, in 2008, she had had a third operation to implant a tube (central line) to deliver nutrients directly into a vein (total parenteral nutrition, or TPN). This meant that, for 16 hours a day, the child was hooked up to a pump. She had to be home-schooled, she had no friends, and she was at constant risk of infection and liver damage. When the G-tube and the central line were removed — over the mother's opposition — the child flourished. In the opinion of several doctors, the mother had caused the child to have unnecessary medical treatment. There was also evidence (though less clear and less striking) that the mother had caused her other children to have unnecessary medical treatment as well.
The mother appeals, contending:
1. There was insufficient evidence to support the juvenile court's jurisdictional findings.
2. The juvenile court erred by ruling that the expert witnesses that the mother called at trial were unqualified.
3. The juvenile court erred by denying the mother's pretrial request for expert witnesses at public expense.
We find no prejudicial error. Hence, we will affirm.
I
FACTUAL AND PROCEDURAL BACKGROUND
The mother has four children, two (daughter V.L. and son J.B.) from previous relationships, and two (daughters Al.R. and Ar.R.) by her current husband (the father).
Between 2003 and 2008, the Department of Public Social Services (the Department) received 21 reports that the children were being abused or neglected. From these, and from the Department's contemporaneous investigations, it appeared that three of the four children had long-term health problems. The oldest child, V., had schizoaffective disorder and depression and had repeatedly threatened to kill herself. The second oldest child, J., had "gastric problems," an anxiety disorder, and depression. The youngest child, Ar., had cerebral palsy and digestive problems.
Beginning in 2007, anonymous reporting parties began to voice concern that the mother was exaggerating or fabricating the children's symptoms. One physician who reviewed J.'s medical records "strongly suspect[ed]" that the mother had "factitious disorder by [p]roxy." A second physician, however, who apparently reviewed all the children's medical records, concluded that their symptoms were not fabricated and that their diagnoses were appropriate.
In 2007, Ar. was implanted with the G-tube. In 2008, she was implanted with the central line. In February 2009, she was admitted to Loma Linda Hospital for further treatment of her digestive problems. An anonymous reporter at Loma Linda contacted the Department and alleged that the mother was "a possible Munchhausen [sic] by Proxy candidate . . . ."
A doctor at Loma Linda referred Ar. to UCLA Medical Center, to determine whether the mother was "manipulat[ing]" her symptoms. As a result, in March 2009, Ar. was admitted to UCLA. An anonymous reporter at UCLA contacted the Department and alleged that the mother appeared to be fabricating Ar.'s illness. When the Department investigated, other UCLA personnel — including Ar.'s treating physician, Dr. Jorge Vargas — agreed. Meanwhile, UCLA removed Ar.'s TPN tube and G-tube. The mother was upset at this; she said, "[A]s soon as [Ar.] is released from UCLA, I am going to have her seen at San Diego Children's Hospital."
Accordingly, the Department detained all four children and filed a dependency petition concerning them. In December 2009, V. turned 18, and the dependency as to her was dismissed. Thus, she is not a party to this appeal.
In April 2010, after an extended jurisdictional hearing, the juvenile court found true the following allegations of the operative petition:
1. As to Ar. only, serious physical abuse (Welf. & Inst. Code, § 300, subd. (a)) and failure to protect (id., § 300, subd. (b)), in that: "While in the care of the [mother], . . . Ar[.] has suffered serious physical abuse, including but not limited to unnecessary medical evaluations and treatments at the instigation of the [mother], placing Ar[.] at risk of suffering additional serious physical harm or death."
2. As to J. and Ar. only, serious emotional damage (Welf. & Inst. Code, § 300, subd. (c)), in that: "Ar[.] and J[.] have been emotionally abused by the mother, by leading the children to amplify symptoms and believe they have serious medical and mental health conditions that render them disabled and labeled handicapped, requiring excessive medication, procedures, and special education placement[.]"
3. As to J. and Al. only, abuse of a sibling (Welf. & Inst. Code, § 300, subd. (j)), in that: "Ar[.] has been physically abused . . . and there is a substantial risk these children are at similar risk."
4. As to all three children, failure to protect (Welf. & Inst. Code, § 300, subd. (b)), in that:
a. "The mother displays behaviors consistent with medical child abuse, the mother repeatedly takes the children to different physicians for the same perceived illness, . . . reporting and amplifying signs and symptoms of illness or physical distress that are neither real, present, nor supported by medical test[s]."
b. "The mother . . . ha[s] caused the children emotional distress, by leading the children [to] believe they have serious medical conditions that affect their daily routines, placing the children at serious risk of harm."
c. "The mother has unresolved and untreated mental health issues that affect her ability to parent."
In September 2010, at the conclusion of the dispositional hearing, the juvenile court adopted the following stipulated disposition: The children were formally removed from the mother's custody; she was allowed visitation with them, but she was ordered not to reside with them. J. was placed with the father, and his biological father was allowed visitation with him. Al. and Ar. were also placed with the father; with respect to them, the dependency was ordered terminated, conditional on the filing of family law orders.
In November 2010, family law orders were duly entered, and the dependency as to Al. and Ar. was terminated.
II
EVIDENCE REGARDING JURISDICTION
A. Preface.
The evidence admitted at the jurisdictional hearing consisted of six specified social worker's reports and the social workers' case notes, along with the oral testimony of various witnesses. We limit our review to this evidence.
The trial court also admitted a number of exhibits. Aside from exhibits that were already attached to social worker's reports, however, the parties have not asked to have these exhibits included in the clerk's transcript or transmitted to us. Accordingly, we cannot consider them. (See Cal. Rules of Court, rules 8.122(b)(3)(B), 8.224, 8.407(f).)
Welfare and Institutions Code section 355, subdivision (c)(1) provides that, subject to certain exceptions, "[i]f any party to the jurisdictional hearing raises a timely objection to the admission of specific hearsay evidence contained in a social study, the specific hearsay evidence shall not be sufficient by itself to support a jurisdictional finding or any ultimate fact upon which a jurisdictional finding is based . . . ." The mother's counsel objected to the reports en masse, based on hearsay. However, he never objected to any specific hearsay evidence in the reports. Thus, we are entitled to consider hearsay as well as nonhearsay evidence in the reports.
B. Ar.'s Medical History.
Ar., the youngest child, was born in 1998. By February 2009, when she was 10 1/2, she had been seen at Loma Linda 104 times. The Department did not attempt to show that any of the visits prior to 2006 were unnecessary. As background, however, during this period, she was seen frequently (including five hospital admissions) for breathing difficulties and for reflux.
These included shortness of breath, pneumonia, multiple upper respiratory infections, congestion, cough, bronchitis, a "[r]espiratory [a]bnormality," "[c]yanosis," "[a]sphyxia," and "[a]pne[a]."
In 2004, Dr. Sidney Wu at Loma Linda diagnosed Ar. as having cerebral palsy, based partly on a physical exam, but also partly on her history; according to a parent (presumably the mother), she had balance problems and was "falling all the time." An MRI, however, was normal.
In March 2006, Ar. was admitted to the hospital for reportedly coughing up food, choking, and abdominal pain. The mother stated that Ar. had gastroesophageal reflux disease (GERD) and had experienced multiple episodes of aspiration pneumonia.
During this stay, Ar. was "a 'happy, energetic' child with no complaints when interacting with clinical staff, but a change in demeanor and increase in complaints [were] noted when mother [was] present." She had "[n]o significant clinical problems . . . ." Except for one pH probe, her test results were normal. Hospital staff found no evidence to support her supposed history of aspiration pneumonia.
During this March 2006 stay, the mother reported that Ar. had frequent urinary tract infections because her cerebral palsy "prevent[ed] adequate hygiene." As a result, neurologists at Loma Linda evaluated Ar. for cerebral palsy again, but this time they found no sign of it.
In December 2006, Ar. was admitted to the hospital, where she underwent an operation for GERD. This was a Nissen fundoplication — i.e., the upper stomach was wrapped around the lower esophagus, like a collar, and sewn into place, to reinforce the esophageal sphincter. (See <http://www.mayoclinic.com/health/gerd/DS00967/ DSECTION=treatments-and-drugs>, as of Aug. 8, 2011; http://www.mayoclinic.com /health/medical/IM03999>, as of Aug. 9, 2011.)
In June 2007, Ar. had an appendectomy. It is more or less undisputed that the appendectomy was medically necessary. As a result of it, however, according to the mother, Ar.'s digestion was ruined: "[S]he 'wouldn't eat since that hospitalization.'"
Initially, Dr. Mark Massi, a witness for the Department, felt that the mother "over-exaggerated the appendix issue . . . ." He relied on the surgeon's report, which said (or which he understood to say) that the appendix was not ruptured. The surgeon testified, however, that the appendix was ruptured. Moreover, the pathologist's report confirmed that it was ruptured. Thus, Dr. Massi eventually conceded that the ruptured appendix was not fabricated.
In July 2007, the mother took Ar. to Loma Linda, reporting abdominal pain. Ar.'s abdomen was "severely distended," though no reason for this was found. Hospital staff began to suspect that "interactions between mother and child may be exacerbating [the] child's symptoms." Again, Ar. complained of pain more when the mother was present; when the mother was gone, Ar. was cheerful, ate better, and did not complain of any pain. When a nurse encouraged Ar. to get out of bed, the mother objected. The mother was "combative and belligerent with hospital staff, nurses and doctors." She gave the "impression" that she wanted Ar. to get a G-tube. Based in part on Ar.'s history, but also based on a swallowing study, which showed "mild esophageal dysmotility" and a gastric emptying study, which showed some "minimal delay," the G-tube was implanted.
The mother reported, however, that Ar. could not tolerate feeding via the G-tube. In November 2007, Dr. Inderpal Randhawa examined Ar. for disability or Medi-Cal. He found that her weight was at the fifth percentile. In his opinion, given that she had the G-tube in place, this indicated failure to thrive.
In February 2008, Ar. was admitted to Loma Linda due to reported weight loss, abdominal pain, and distension. During her stay, she was seen to eat without pain. However, her fecal fat was "slightly elevated"; this would be a sign of poor absorption. Thus, the central line was implanted, and Ar. was started on TPN. This meant that, for 16 hours a day, she was hooked up to a pump that delivered nutrients intravenously. As a result, she had to be home-schooled. She was at risk of infection and liver damage.
Ar. was provided with a registered nurse (RN) for eight hours a day and a licensed vocational nurse (LVN) for another eight hours a day. Nancy Pearson was Ar.'s RN from July 2008 through March 2009. According to Pearson, Ar. was "real thin" and "couldn't eat that much by mouth." Sometimes Ar.'s stomach appeared distended. Ar. did gain weight while on TPN.
Pearson did not see any signs of abuse. She did not feel that the mother was exaggerating or fabricating Ar.'s medical condition. She stated, "The mother can be a drama queen sometimes, making things seem bigger than life, but that was no real concern. . . . I could see where she could get somebody's back up. I don't think she would actually do anything to hurt her children."
Beatrice Azorjy was Ar.'s LVN from July 2008 through March 2009. Azorjy, too, did not see any signs of abuse. She stated, "[Ar.] was not gaining weight, and then when they started TPN . . . started gaining weight. [The mother] is a very good mother. She cares so much."
In June 2008, Loma Linda sent Ar. to Dr. Marvin Ament at UCLA for a second opinion. He gave her an electrogastrography test; the results were normal. Based on his recommendation, Loma Linda discontinued TPN and let Ar. eat normally. The mother complained, however, that Ar. was losing weight. The doctors at Loma Linda therefore reinstituted TPN. However, they refused to treat Ar. any further. They referred her to UCLA.
The mother later claimed that she was told that they were "significantly abnormal."
In February 2009, the mother took Ar. to the UCLA emergency room because her abdomen was distended. She and Ar. were sent home with directions to schedule an appointment with a gastroenterologist.
As a result, on March 4, 2009, Dr. Jorge Vargas, a pediatric gastroenterologist at UCLA, examined Ar. Her main complaint was "episodes of short-lived abdominal pain which had a vague localization . . . and were not accompanied by any other major problems . . . ." The mother gave him a copy of Ar.'s X-rays from Loma Linda, explaining that they showed "major abnormalities of Ar[.]'s stomach . . . ." When he reviewed them, however, they were perfectly normal. Her other records from Loma Linda showed that all of her test results were normal, except for one gastric emptying test. In Dr. Vargas's opinion, that one test, which showed "border-line" delayed gastric emptying, had not been done properly.
Dr. Vargas was concerned about the discrepancy between Ar.'s reported symptoms and her test results. He recommended admitting Ar. to the hospital for observation while limiting the mother's access to her.
Accordingly, on March 25, 2009, Ar. was admitted to UCLA. When Dr. Vargas told the mother that the plan was to observe Ar. in her absence, she objected. She wanted "more invasive tests." She "refuse[d] to leave Ar[.]'s bedside." When he said that he was going to take Ar. off TPN, she kept angrily interrupting him.
After Ar. had been in the hospital a day or so, the mother did leave, though she continued to visit and to phone.
After the first night, the mother told a nurse that Ar. had been unable to sleep, due to pain. Ar., however, told the nurse that she had slept well and was not in pain. She ate normally; her stomach was not distended. Occasionally, she complained of "mild" and "poorly defined" abdominal pain. In Dr. Vargas's opinion, however, she had simply become hypersensitive to the normal workings of her digestive system.
At Dr. Vargas's direction, UCLA removed Ar.'s G-tube and central line. The mother was "very upset" about this. She phoned the social worker, crying and saying she needed help "immediately." She said, "UCLA is trying to convince Ar[.] that she is normal and this is not fair because they don't know for sure that she will not start having problems again." She also claimed that "she knows more about her daughter than any doctor or nurse and they don't like her because she is smart."
After Ar. was discharged from UCLA, she continued to eat normally; a follow-up examination showed that she was in good health. Dr. Vargas concluded that the mother had caused Ar. to have unnecessary medical treatment. He stated, "[T]here is a definite perception problem on the part of the mother, who seems to thrive in the presence of possible disease or dysfunction and seems to amplify the nature and acuity of any minor complaints, but also evidence that she has reported the presence of symptoms and signs that are not real or present . . . ."
In April 2009, a social worker interviewed the children. Ar. was happy to be in regular school and to have friends. She stated, "I think I needed the tube. Every time I ate my stomach got big. Now it's good. I'm fine eating regular food. . . . I think I'm healthy."
J. insisted, "Ar[.]'s tube was necessary. She was belching all the time. Her stomach would get large." Al. reported, "Sometimes Ar[.]'s stomach got bloated and big and then it would go back." She denied that the mother had told Ar. to be sick. "She just wants to be sure we are getting the correct care. She loves us very much."
The foster mother said that Ar. was "eating like a horse." She added that "[t]he children are constantly raising issues concerning their health and requesting to go to the doctor. . . . 'It's too much. For every little scratch they want to go to the doctor o[r] the hospital.'"
In May 2009, Dr. Jong E. Song saw Ar. for a fever. She also reported stomach pain, but he found no physical reason for the stomach pain.
Later in May, the mother asserted, "[Ar.] is losing weight, and I can see her bones. She's anemic." Hence, Dr. Song examined Ar. again. Her weight was normal, and her bones were not unduly visible. A blood test, however, showed a "very mild iron deficiency," so he prescribed an iron supplement.
In June 2009, the mother told the social worker, "I want to know why you have not followed up on all the other health concerns that I have for Ar[.]" The social worker explained that Dr. Vargas had determined that Ar. was healthy. The mother responded, "I know more than any specialist, like Dr. Vargas, about her health and what she needs."
Meanwhile, back in January 2009, Loma Linda had asked Dr. Mark Massi, a pediatrician in its Child Protection Center, to evaluate Ar. for possible "medical abuse." He examined her personally. He interviewed the mother. He also reviewed all of Ar.'s medical records from Loma Linda, which consumed a substantial period of time. Finally, in June 2009, Dr. Massi rendered his report. He concluded that Ar. had "undergone unnecessary medical evaluations and treatments at the instigation of her parents, which is medical child abuse." In his opinion, none of the test results from Loma Linda showed any significant gastrointestinal problem.
In November 2009, the mother told Ar., "You look so tired. . . . Do you really think you should be playing in this soccer league?" She added, "[T]ell your PE teacher that you can't run because you are sick and can't do what the others can do." Ar. then told the foster mother that she was too anemic to participate in physical education.
The mother asked to have Ar. seen by a different doctor. She also asked to have Ar. retested for anemia. Through her attorney, she accused the Department of "minimizing" the children's health conditions.
As a result, in December 2009, Dr. Vargas did a follow-up examination of Ar. He found that she was "[v]ery healthy" and not anemic. Her appetite and growth were "excellent." She continued to have stomach pain "perhaps once a month."
C. Al.'s Medical History.
Al. was born in 1997. She was generally regarded as the only healthy child in the family. According to the mother, however, Al. did have a history of asthma and meningitis. When Al. was interviewed in April 2009, she said that she got "meningitis headaches." While living with her mother, she got them once or twice a week. "My mom gives me medication every 30 minutes until the headache is gone." During her first three weeks in foster care, however, she had had only one headache. "My foster mom just told me to sit down for a few minutes, and it went away."
D. J.'s Medical History.
J. was born in 1996. In 1997, according to the mother, he started having "severe asthma." Also, according to the mother, he had had gastrointestinal problems "for years." J.'s father reported that at one point, the mother had wanted J. to have an operation for reflux. "[T]he doctors told [her] it was not necessary but she kept arguing with them and demanding the surgery." The surgery did not occur, because he refused consent.
J.'s major diagnoses, however, were mental, including depression and anxiety. He had been hospitalized five times due to threats to kill himself. According to the mother, he had hallucinations.
As of February 2007, J. was on 14 prescriptions. At this point, a doctor reviewed his medical records and found "little objective data" to support either J.'s diagnoses or his medication regime. At the insistence of the Department, J. was "weaned off of several medications . . . ."
In 2008, J. was placed in special education. He attended Somerset, a private school for "children with emotional needs." His middle school counselor said, "[The mother] forced the evaluation and the labeling of him as special ed." She was "vicious and irrational about his physical and psychological issues." She "was reporting that J[.] was urinating on himself and that was a sign of his mental illness. That occurred only one time when he had to go the bathroom very badly, and he didn't make it in time. That was all." A Somerset representative reported, "His mother told us he was bipolar and schizophrenic." "We never observed any of that behavior whatsoever. Not once." She did not think he belonged at the school.
According to J.'s former therapist, "[T]he mother was very difficult. She constantly exaggerated the things that were going on with him. His original diagnosis was depressive disorder. Through the years she created bigger and broader things that were wrong with him." "She wanted to increase his medications. Before we intervened he was on 12 different medications at one time." "The facts had nothing to do with what mom made it sound like." "For example, [the mother] started to say J[.] was urinating in his pants all the time at school. I [w]ould call the school. They would say no. . . . I said at the time, she will definitely get him out of a normal public school. She did."
J.'s father told the social worker, " . . . I never believed there was anything wrong with J[.] He's just a normal active kid. A little too active sometime[s], but not someone who is depressed and needs medication. He did not need to go to a psychiatric hospital. How many times did that happen? Five? It's ridiculous. Now he believes he's sick himself, but to tell you the truth, I've always thought it was all her."
Dr. Richard Lee, a psychiatrist, treated J. from March 2008 through March 2009. He diagnosed J. as having anxiety and depression. He relied on what the mother told him about J.'s history, although J. did appear depressed "during some of the visits." He did not recall J. being suicidal.
When a social worker interviewed the children, J. said, "I don't know why you are really here. My mom can fulfill our medical needs. She's been doing it all our lives. What kind of mother would hurt her children?" He added, "I don't want to leave my mom. I need her, in case I get sick." A psychological evaluation in April 2009 indicated that J. was depressed but not suicidal.
By July 2009, J. was on the lowest dosage of a single medication (10 mg. of Prozac). His psychiatrist believed that he did not actually need any medication.
In August 2009, the mother claimed that J. had told her that his chest hurt when he ran while playing soccer. She asserted that he "had a life[-]threatening, chronic condition that required daily medication and regular visits with a specialist." After talking to the mother, J. began to complain about chest pain during soccer practice.
In November 2009, the mother phoned the Department, claiming that during a visit, J. had threatened to kill himself. The Department contacted him at school, where he was "outside playing football with other students and was not displaying signs or threatening suicide." It was determined that he was not in any danger.
In December 2009, after a hearing, the mother contacted J. in the hallway (in violation of the court's visitation orders). She told him, "You will commit suicide if you go to live with your father."
Later in December 2009, the mother called police. She told them that J. was "suffering" and that his father had refused to take him to a hospital. She also contacted the social worker and said that J. was suicidal, not eating, and deeply depressed.
The social worker contacted J.'s father, who denied that J. was depressed or suicidal. He also denied that the mother had asked him to take J. to the hospital or that he had refused to do so. Due to the mother's phone calls, however, J. asked his father to take him to the hospital. Once there, he asked that his medication be increased. The hospital denied his request.
E. V.'s Medical History.
V., the oldest child, was born in 1991. As of 2004, she had been diagnosed with depression and placed on medication. Later that year, she was "5150'd" (i.e., involuntarily committed pursuant to Welf. & Inst. Code, § 5150) because she was threatening to kill herself. In 2008 and 2009, she was 5150'd again. Like J., V. had been placed in special education and attended Somerset.
V. had been diagnosed as bipolar. According to the mother, V. also had schizoaffective disorder. V. admitted hearing voices that told her to do things, including "to kill people with a knife." She also claimed to have an eating disorder.
As of February 2009, V. was taking four medications (Thorazine, Lexapro, Topamax, and lithium). Due to these medications, she was "very lethargic, had tremors, and her speech was slurred." J.'s father commented, "[S]he's so just drugged up, I hardly recognize her anymore."
By July 2009, under the care of a psychiatrist from the Department of Mental Health, V. had stopped taking Topamax; she was taking lower dosages of the other three medications. When first placed in foster care, she wanted her medication increased; she was fearful about missing a dose. Later, however, she wanted it reduced, so she could be alert. According to the foster mother, "V[.] is doing great. This is a miracle." The social worker agreed, stating, "[W]e are more rapidly than anyone could have hoped beginning to see V[.]'s lovely unmedicated personality."
Nevertheless, in October 2009, V. was 5150'd again because she had been threatening persons in her foster home. In November 2009, she was 5150'd yet again because she claimed to have taken an overdose of Vicodin.
F. The Mother's Psychological Status.
In February 2007, the mother said she had bipolar disorder, though she claimed it did not affect her parenting. In July 2007, however, she denied having "any mental health problems/history." In January 2009, she said she had a history of posttraumatic stress disorder and anxiety, but she was not taking any medication. In April 2009, she told a social worker that her only diagnosis was anxiety.
In October 2009, the mother's therapist (who was a licensed marriage and family therapist) diagnosed her as having both hypochondria by proxy and paranoid personality disorder. The therapist reported that the mother was "preoccupied with ideas or fears of [her children] having a serious illness; [a]ppropriate medical investigation and reassurance do not relieve her fears and ideas . . . ." She was not delusional, but she did misinterpret normal bodily functions as signs of disease.
The therapist concluded that the mother "appears to have poor or limited ability to accurately perceive the needs of her children when it comes to their mental and physical health. [Her] distrust of others . . . leads to an aggressive protective pattern or seeking medical assistance and treatments that may not have always been needed and [that were] possibly detrimental to her children. Without treatment, reunification will be unlikely and unsuccessful."
In November 2009, Dr. Senia Vitale, a psychologist, did a psychological evaluation of the mother. She gave the mother a personality test; however, "the validity scales [we]re so elevated that [it was] useless . . . ."
In Dr. Vitale's opinion, the mother had "generalized anxiety disorder" and posttraumatic stress disorder. This meant that she had "[e]xcessive worry, excessive concern . . . about a lot of things, not just her children . . . ." Dr. Vitale found no evidence of hypochondria, whether by proxy or otherwise. She also found no evidence of paranoid personality disorder. However, she admitted that the mother was "over[-]protecti[ve] and mistrusting of others" and that she felt "victimized."
G. The Testimony of the Children.
Ar. testified that she loved her mother and liked living with her. She testified that her stomach had sometimes hurt. Her mother never told her to say it hurt when it did not. Her mother never took her to the doctor when she did not feel sick.
J. testified that he liked living with his mother. He was upset about not living with his family. He felt bad "[a]ll the time."
J. also testified that his mother did not make any false statements to his doctors. She never tried to make him think he was sick when he was not sick. He denied that she ever told him that, if he went to live with his father, he could commit suicide.
Finally, Al., too, testified that she loved her mother and wanted to live with her. She never felt that her mother was hurting either Ar. or J.
III
THE SUFFICIENCY OF THE EVIDENCE
TO SUPPORT THE JURISDICTIONAL FINDINGS
The mother contends that there was insufficient evidence to support the juvenile court's jurisdictional findings.
"'In juvenile cases, as in other areas of the law, the power of an appellate court asked to assess the sufficiency of the evidence begins and ends with a determination as to whether or not there is any substantial evidence, whether or not contradicted, which will support the conclusion of the trier of fact. All conflicts must be resolved in favor of the respondent and all legitimate inferences indulged in to uphold the verdict, if possible. Where there is more than one inference which can reasonably be deduced from the facts, the appellate court is without power to substitute its deductions for those of the trier of fact.' [Citation.]" (In re Carlos T. (2009) 174 Cal.App.4th 795, 804-805.)
There was certainly ample evidence that the mother had caused Ar. to undergo unnecessary medical treatment, and hence also that a sibling of J. and Al. had been abused. First and foremost, there was compelling evidence that Ar. did not need either a G-tube or a central line — much less both. These were implanted based largely on the mother's complaints, following Ar.'s appendectomy, that Ar. could not eat without suffering abdominal pain and distension. Observation of Ar. while she was hospitalized failed to substantiate these complaints. Although Ar. did complain of pain when the mother was present, she ate cheerfully and with no apparent pain when the mother was away. Her test results were normal, or, at worst, marginally abnormal. Dr. Ament examined Ar. after the G-tube and central line were implanted, but he found no need for them. Likewise, Dr. Vargas not only examined Ar., but also observed her in a controlled environment, in the absence of the mother. He, too, concluded that Ar. did not need the G-tube or the central line. Most important, when these contrivances were removed, Ar. ate with gusto, maintained her weight, and was "[v]ery healthy."
The mother argues that any blame for unnecessary medical procedures belongs to the children's doctors, not to her. But there is more than enough blame to go around. The mother pushed for the procedures that she wanted. No fewer than five professionals who had dealt with her each described her as "relentless." As one stated, "If [people] were not willing to [k]ow tow to her demands, then she would go all the way up the chain of command until she got what she wanted."
Moreover, the mother repeatedly claimed that the children had symptoms that could not be objectively verified. She would say that Ar.'s stomach hurt when she ate, even though in the hospital, Ar. would eat without pain. She claimed that Ar.'s stomach X-rays were abnormal when they were actually normal. After J. experienced a single incident of accidental juvenile incontinence, she claimed that he was urinating on himself regularly, and moreover that this was a sign of a mental illness. She asserted falsely that J. was threatening to kill himself.
The mother also rejected any indications that her children were healthy. During a 2007 hospital stay, when the nursing staff encouraged Ar. to get out of bed, the mother objected. In 2009, when Dr. Vargas told the mother that Ar. did not need TPN, instead of being overjoyed, she was angry. She phoned the social worker, crying and begging for help. She claimed it was not "fair" to tell Ar. that she was "normal."
As the trial testimony showed, doctors depend on a parent's reports of a child patient's symptoms and history. "The medical field succeeds in correctly diagnosing and treating illnesses largely because of a relationship built on trust. Doctors rely on patients and their guardians to explain symptoms, and from that information, doctors determine the proper course of action. When a young child is the patient, parents and guardians become responsible for adequately informing the doctor of the child's ailments. . . . 'Having no cause to doubt their patients, physicians are motivated by a sincere desire to relieve the patient's suffering. Add to this benign intent the fear of malpractice litigation in an increasingly scrutinized profession and the result is a treatment approach that leaves no stone unturned.'" (Miller, Detecting the Undetectable: An Examination of the Intersection Between Sudden Infant Death Syndrome and Munchausen by Proxy Syndrome (2006) 5 Conn. Pub. Int. L.J. 287, 294-295, fn. omitted (Detecting the Undetectable).)
Consistent with this reasoning, several of Ar.'s physicians testified that their treatment of Ar. was necessary and appropriate. The juvenile court, however, was not required to accept their understandable but self-serving opinions.
Dr. Donald Moores was the surgeon who had performed the Nissen and also installed the G-tube. He testified that he performed the Nissen based on a pH probe that was "positive for reflux" and an endoscopy that "demonstrated irritation of the esophagus." He added, however, that "[t]he diagnosis of reflux was established by a pediatric gastroenterologist, not myself." He conceded that he would also have relied on any history that he got from the mother.
Dr. Moores also installed the G-tube, based on a swallowing study, which showed "a little bit of delay in clearance from the esophagus." Again, as the surgeon, he relied on Ar.'s "primary care team" (who inferably relied, at least in part, on the mother). He further conceded that he had not documented any observations or impressions of his own. For example, he had no idea whether Ar. was under- or overweight.
Dr. Wu diagnosed Ar. as having cerebral palsy. He admitted, however, that he also relied in part on the mother's claim that Ar. had symptoms of cerebral palsy, including balance problems. There was no other evidence that Ar. ever had any balance problems. In any event, even assuming that the mother was initially entitled to rely on Dr. Wu's diagnosis, two years later, neurologists at Loma Linda tested Ar. for cerebral palsy and found no evidence of it. Nevertheless, the mother continued to tell doctors new to Ar.'s case that Ar. had cerebral palsy. Thus, again, she continued to reject evidence that Ar. was healthy.
Dr. Randhawa diagnosed Ar. with failure to thrive, even with the G-tube in place; his diagnosis supported the subsequent installation of the central line. However, he saw Ar. only once, in the course of doing "exams for disability and Medi-[C]al . . . ." His diagnosis was based, in part, "upon her history, which I took from the mother . . . ." The major fact he relied on in making his diagnosis was that Ar.'s weight was at the fifth percentile. It must be remembered that the mother had considerable control over how much Ar. ate. While Ar. was in the hospital, around the same time, the mother and Ar. were heard "battling" over whether Ar. should eat. When Ar. reported "some discomfort prior to a meal," the mother told her not to eat, though she proceeded to "eat with no problem." Other evidence shows that, around the same time, Ar. was actually gaining weight. In sum, then, the opinions of these three physicians did not conclusively establish that Ar.'s treatment was necessary.
The mother also cites the opinions of the nurses (Pearson and Azorjy) who cared for Ar. in 2008-2009. They saw no signs of abuse; they believed that Ar. was genuinely in need of their care. At that point, however, Ar. already had both the G-tube and the central line. A pump was forcing nutrients into her veins for 16 hours a day; she was at risk of a life-threatening infection if the central line became contaminated. Of course she was in need of nursing care. The nurses had no way of knowing, however, and did not claim to know, whether she needed the G-tube and the central line in the first place.
There was evidence that the mother also caused J. to undergo unnecessary medical treatment. It is essentially undisputed that he suffered from depression. The mother, however, kept asserting that he was schizophrenic, even though professionals at his schools saw no sign of this. At one point, he was taking 14 medications; after he was in foster care, this was reduced to the lowest dose of Prozac. She manipulated him into claiming that his chest hurt and that he needed more medication. She even tried to plant the idea that, if he went to live with his father, he would commit suicide.
The mother argues that the Department failed to prove that she suffered from Munchausen syndrome by proxy (MSP). MSP is generally understood to be a psychological condition that causes a parent (usually a mother) to exaggerate, fake, or induce symptoms of illness in a child in order to get attention. MSP is a "sexy" disorder, in the sense that it has garnered coverage in the popular press, as well as in popular fiction. The current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), however, does not recognize it as a distinct psychological disorder; it would fall under "factitious disorder not otherwise specified." (Detecting the Undetectable, supra, 5 Conn. Pub. Int. L.J. at p. 296.) It has been argued that classifying the underlying behavior as a psychological disorder is unhelpful, because it focuses on "the motivation of the perpetrator," rather than "the victimization of the child." (Goldman & Yorker, Mommie Dearest? Prosecuting Cases of Munchausen Syndrome by Proxy (1999) 13 Crim. Just. 26, 27.) "This is analogous to having to prove that a perpetrator suffers from pedophilia in order to prove that a child has been sexually abused — an unnecessary hurdle for child protection." (Ibid.)
In this case, the operative petition did not allege that the mother had MSP (or factitious disorder). There was some evidence that her motive was financial, rather than emotional; the family's main source of income consisted of state and federal medical and disability benefits. If the mother was, in fact, causing Ar. or any of her children to be subjected to unnecessary medical treatment, it did not matter why she was doing it; even assuming that she was acting out of over-protective concern for their welfare, they were still endangered.
The original petition did allege that the mother "displays behaviors consistent with Munchausen by Proxy Syndrome . . . ." No such allegation, however, was included in the first or second amended petition.
The mother's point may be that there was insufficient evidence to support the juvenile court's specific finding that she had "mental health issues that affect her ability to parent." But not so. In addition to all of the evidence just discussed, her own therapist diagnosed her as having both hypochondria by proxy and paranoid personality disorder. The therapist concluded that "[w]ithout treatment, reunification will be unlikely and unsuccessful." While Dr. Vitale disagreed with this diagnosis, she agreed that the mother had "[e]xcessive worry, excessive concern," and that she was "over[-]protecti[ve]." The juvenile court was entitled to accept the therapist's opinion.
In sum, then, there was sufficient evidence to support the allegations of serious physical abuse as to Ar. (Welf. & Inst. Code, § 300, subd. (a)) and abuse of a sibling as to J. and Al. (id., subd. (j)). If there is substantial evidence to support any of the jurisdictional findings, we need not decide whether there is substantial evidence to support the others (at least when there has been no claim or showing of prejudice). (In re Athena P. (2002) 103 Cal.App.4th 617, 630 [Fourth Dist., Div. Two].) Without going into detail, however, the foregoing evidence was also sufficient to support the allegations of serious emotional damage as to J. and Ar. (Welf. & Inst. Code, § 300, subd. (c)) and of failure to protect (id., subd. (b)).
IV
THE QUALIFICATIONS OF THE MOTHER'S EXPERT WITNESSES
The mother contends that the juvenile court erred by ruling that each of the three expert witnesses that she called at trial was unqualified.
A. Additional Factual and Procedural Background.
1. Dr. Wu.
The mother attempted to present expert testimony from three witnesses. The first was Dr. Sidney Wu. Dr. Wu was board certified in internal medicine and pediatrics. As a resident, he had been trained in how to diagnose cerebral palsy in a child. He had received additional training in the diagnosis of cerebral palsy while working at a California Children's Services clinic. When asked how many children he had examined for cerebral palsy, he answered, "In the hundreds."
Counsel for the Department, for the father, and for the minors objected that Dr. Wu was not qualified as an expert on cerebral palsy. The juvenile court sustained the objection, although its ruling was somewhat ambiguous:
"THE COURT: I don't qualify him as an expert. He can testify he's a medical doctor with lots of experience. [¶] . . . [¶]
[COUNSEL FOR THE MOTHER]: I respectfully disagree. I will ask his impressions of the child. I object to that.
"THE COURT: You've made your record. I'm interested to hear his testimony. He's qualified in terms of experience."
Dr. Wu was allowed to testify that he diagnosed Ar. as having cerebral palsy. He explained that she had "hyper tonicity/spasticity" (i.e., increased muscle tone) in the lower extremities, and that she displayed Babinski's sign (i.e., her big toe went up, rather than down, when the sole of her foot was stroked). He admitted, however, that he also relied on the fact that, according to the mother, Ar. had a history of cerebral palsy symptoms.
2. Dr. Francomano.
The mother's second expert was Dr. Clair Francomano. Dr. Francomano had been a doctor for 30 years. She was board certified in internal medicine and medical genetics. Since 1984, she had been an associate professor of medicine and pediatrics at Johns Hopkins. She saw pediatric patients in her genetics practice, although not in her internal medicine practice.
Children's gastrointestinal disorders, Dr. Francomano testified, "[c]ome[] up very often in my practice." She treated "several hundred" children a year with gastrointestinal problems, including about 50 children a year who had motility problems.
Counsel for the Department, for the father, and for the minors objected that Dr. Francomano was not qualified as an expert, other than in genetics.
The juvenile court sustained the objection. It ruled: "You are not just an average doctor but exceptional[,] especially in genetics[,] you are an expert. Your background and history are overwhelming and impressive. It's the difference between a dentist and a cardiologist. If the focus of the hearing was on genetics, there would be no problem. [¶] You haven't said anything here that any other doctor couldn't say that had the chance to review everything and had general experience . . . . I'm not going to qualify her as an expert."
Dr. Francomano was allowed to testify that, contrary to Dr. Massi's testimony, Ar.'s medical records included test results and other objective evidence supporting many of her complaints, including aspiration pneumonia, difficulty swallowing, reflux, choking after eating, appendicitis, abdominal tenderness, abdominal pain, weight loss, and nausea. Dr. Francomano also testified that some motility disorders are transient — a patient may have symptoms on one day, but not on the next.
3. Dr. Vitale.
Finally, the mother called Dr. Senia Vitale. Before she testified, her report was admitted by stipulation.
Dr. Vitale had been a licensed psychologist for over 13 years; "99.9 percent" of her practice involved evaluating patients' mental health. She "had experience diagnosing people with a variety of disorders," including paranoid personality disorder. She had dealt with "about 10 to 15" patients with that disorder.
Counsel for the Department, the father, and the minors objected that, although Dr. Vitale was qualified as a psychologist, she was not qualified as an expert on diagnosing "paranoid personality disorder or hypochondriasis by proxy or any other specific disorder[; there] doesn't appear to be specific information stating she would be an expert in any one of those disorders."
The juvenile court observed, "She's probably the most qualified psychologist that I've seen in my courtroom in 20 years." It concluded, however, "I just don't have . . . any showing she's more uniquely qualified than anyone else who is qualified." "She can diagnose patients regarding psychological conditions, but that doesn't make her an expert as a gestalt which encompasses all manner of psychosis conditions and so on."
Dr. Vitale nevertheless was allowed to testify that she diagnosed the mother as suffering from generalized anxiety disorder and posttraumatic stress disorder. She saw no evidence that the mother had either paranoid personality disorder or hypochondria by proxy.
B. Discussion.
"'A person is qualified to testify as an expert if he has special knowledge, skill, experience, training, or education sufficient to qualify him as an expert on the subject to which his testimony relates. Against the objection of a party, such special knowledge, skill, experience, training, or education must be shown before the witness may testify as an expert.' [Citation.] '"The competency of an expert is relative to the topic and fields of knowledge about which the person is asked to make a statement."' [Citation.] We review the trial court's ruling on the admissibility of expert testimony for abuse of discretion. [Citation.]" (People v. Watson (2008) 43 Cal.4th 652, 692.)
"If the expert has disclosed sufficient knowledge of the subject to entitle his or her opinion to go to the jury, the court abuses its discretion by excluding his or her testimony. [Citation.]" (Avivi v. Centro Medico Urgente Medical Center (2008) 159 Cal.App.4th 463, 467-468.) "'Where a witness has disclosed sufficient knowledge, the question of the degree of knowledge goes more to the weight of the evidence than its admissibility.' [Citations.]" (EHP Glendale, LLC v. County of Los Angeles (2011) 193 Cal.App.4th 262, 276.)
In Mann v. Cracchiolo (1985) 38 Cal.3d 18, a malpractice action, one Dr. Fox, a neurosurgeon, testified that the defendants had misread the decedent's X-rays and should have taken more X-rays. He disputed the opinions of the defendants' expert radiologist. (Id. at pp. 27, 34-35.) The trial court ruled that Dr. Fox was not qualified. (Id. at pp. 26, 31.)
The Supreme Court held that this was an abuse of discretion. (Mann v. Cracchiolo, supra, 38 Cal.3d at pp. 31-39.) It explained: "'Some early cases were unbending in requiring expertise as to the precise injury involved in the litigation, as, e.g., not permitting an autopsy surgeon to testify on urology [citation]. Other authorities, however, have permitted variations, as, e.g., a pathologist was qualified to testify as to causes of aseptic necrosis [citation]; an expert in otolaryngology to testify regarding plastic surgery [citation]; a homeopathic physician and surgeon to testify on the degree of care required of a physician educated in the allopathic school of medicine [citation]; a pathologist and professor of pathology to testify on the subject of gynecology [citation].'" (Id. at pp. 37-38.)
"Dr. Fox is a diplomate in surgery and neurosurgery, and it would be unreasonable to assume that he does not regularly read X-rays and radiologists' reports and is unfamiliar with the standard of care exercised by radiologists in reading X-rays and preparing reports." (Mann v. Cracchiolo, supra, 38 Cal.3d at p. 38.) "[A] neurosurgeon is obviously aware not only of the practice of his speciality but also the symptomology which leads other specialists to treat patients coming within his speciality and to refer patients to neurosurgeons." (Id. at pp. 38-39.) The court concluded, "As a diplomate of surgery and neurosurgery, Dr. Fox is qualified to testify as to the standard of care in reading X-rays, in submitting X-ray reports, and in diagnosing, and the court abused its discretion in concluding that there was no proper foundation." (Id. at p. 39.)
1. Dr. Wu.
The juvenile court clearly erred by ruling that Dr. Wu was not an expert with respect to cerebral palsy. Arguably, just being a board-certified internist and pediatrician constituted sufficient qualifications for this purpose. Under Mann, he did not have to be a neurologist or other specialist. In addition, however, he had specific training in the diagnosis of cerebral palsy, both during his residency and in practice, and he had examined "hundreds" of children for cerebral palsy.
The mere fact that the juvenile court erred, however, does not require reversal. "The erroneous exclusion of admissible evidence requires reversal only if the reviewing court is of the opinion, after examining the entire record, that it is probable that a result more favorable to appellants would have been reached absent the error. [Citation.]" (Lunghi v. Clark Equipment Co. (1984) 153 Cal.App.3d 485, 489; see Cal. Const., art. VI, § 13; Code Civ. Proc., § 475; Evid. Code, § 354.)
Despite the juvenile court's ruling, Dr. Wu managed to give his opinion anyway. Basically, he testified that, in his opinion, Ar. did have cerebral palsy. Moreover, he explained the basis for this opinion. He added that, if other doctors determined later that she did not have cerebral palsy, he would be "surprised." His testimony was relevant to show that the mother had some basis for claiming that Ar. had cerebral palsy. Counsel for the mother never made an offer of proof as to any additional testimony that Dr. Wu could have given; accordingly, any error in excluding any such testimony is not reversible. (Evid. Code, § 354, subd. (a).)
Indeed, in this appeal, the mother cites Dr. Wu's testimony to support her argument that there was insufficient evidence to support jurisdiction.
2. Dr. Francomano.
The juvenile court also erred by ruling that Dr. Francomano was not an expert on pediatrics or gastroenterology. She was an associate professor of pediatrics at Johns Hopkins; in addition, she treated pediatric patients, albeit in the course of her genetics practice, rather than her internal medicine practice. This was sufficient to qualify her as a pediatric expert. She also testified that children's gastrointestinal problems came up "very often" in her practice; every year, she treated "several hundred" children with gastrointestinal problems, including about 50 with motility problems. This was sufficient to qualify her specifically as an expert on pediatric gastrointestinal mobility disorders. Any lingering doubts regarding the depth or extent of her experience went to the weight, not the admissibility, of her opinion.
As with Dr. Wu, however, the mother has not shown that the juvenile court's ruling with respect to Dr. Francomano was prejudicial. Dr. Francomano was allowed to give a number of expert opinions. In particular, she disagreed extensively with Dr. Massi; she testified that there were, in fact, some objective test results supporting some of Ar.'s subjective complaints. The mother argues that she was at a disadvantage, because the Department's expert witnesses, such as Dr. Massi, were allowed to present their opinions, and her experts were not allowed to rebut them. However, that is exactly what Dr. Francomano did. The mother's counsel never made an offer of proof; thus, we have no way of knowing what additional testimony — if any — Dr. Francomano could have given. Accordingly, any error in excluding such additional testimony is not reversible.
3. Dr. Vitale.
Finally, the juvenile court also erred by ruling that Dr. Vitale was not qualified as an expert on any specific disorder. Its error is encapsulated in its statement, "I just don't have . . . any showing she's more uniquely qualified than anyone else who is qualified." Dr. Vitale was a trained, licensed, experienced practicing psychologist who screened people for assorted psychological disorders on a regular basis. This meant that she was sufficiently qualified. She did not have to be "uniquely qualified."
Once again, however, the mother has not shown that the error was prejudicial. Dr. Vitale was allowed to state her opinion that the mother did not have either hypochondria by proxy or paranoid personality disorder. Her entire report was admitted into evidence by stipulation. Thus, she did what she evidently was called to do — to rebut the opinion of the mother's therapist that the mother did have these disorders.
Because the mother's counsel did not make any offer of proof, we have no way of knowing what additional testimony Dr. Vitale could have given. Hence, this error, too, is not reversible.
V
THE REFUSAL TO APPOINT EXPERT WITNESSES FOR THE MOTHER
The mother contends that the juvenile court erred by denying her application for the appointment of two expert witnesses at public expense.
A. Additional Factual and Procedural Background.
In July 2009, the mother filed ex parte applications for the appointment of two expert witnesses at public expense: Dr. Clair Francomano, as a medical expert, and Dr. Michael Kania, as a psychological expert.
The juvenile court denied the applications. It ruled that, even assuming the mother was indigent, she was not entitled to funding for experts: "This is not a criminal proceeding. And liberty is not at stake in terms of the mother. . . . I have no fundamental problem with Mother having her own experts. But I do have a problem paying for it because this is not a criminal proceeding."
B. Analysis.
An indigent parent has a constitutional right to appointed counsel when, under the circumstances of the particular case, fundamental fairness requires such an appointment. (Katheryn S. v. Superior Court (2000) 82 Cal.App.4th 958, 971; In re Emilye A. (1992) 9 Cal.App.4th 1695, 1707-1711 [Fourth Dist., Div. Two].) Moreover, an indigent parent whose child has been removed has a statutory right to appointed counsel. (Welf. & Inst. Code, § 317, subd. (b).)
We may assume, without deciding, that in this case, the mother had both a constitutional and a statutory right to appointed counsel. We may further assume, although again without deciding, that if she had a right to appointed counsel, then she also had a right to appointed experts. (See Ake v. Oklahoma (1985) 470 U.S. 68, 76-85 [105 S.Ct. 1087, 84 L.Ed.2d 53]; Corenevsky v. Superior Court (1984) 36 Cal.3d 307, 319.)
Even if so, the claimed error clearly was not prejudicial under any standard. The mother sought the appointment of two particular witnesses. First, she wanted Dr. Francomano appointed as a medical expert. Even though the juvenile court denied this request, however, the mother ultimately was able to call Dr. Francomano to testify at trial. Evidently either Dr. Francomano agreed to work pro bono, or the mother was able to scrape together enough money from some other source to hire her.
Second, the mother wanted Dr. Kania to testify as a psychological expert. At trial, she did not call Dr. Kania, but she did call a different psychological expert, Dr. Vitale. It does not appear that Dr. Vitale was significantly less qualified. To the contrary, in the opinion of the juvenile court — which was also the trier of fact — Dr. Vitale was "probably the most qualified psychologist that I've seen in my courtroom in 20 years." When she left the stand, the juvenile court urged her to do more court-ordered psychological evaluations, adding, "I like the qualifications, and I like the way you've conducted yourself. We're always looking for good psychologists."
Admittedly, as we discussed in part IV, ante, the juvenile court did rule that Dr. Vitale was not qualified as an expert on diagnosing either hypochondria by proxy or paranoid personality disorder. According to his curriculum vitae, however, Dr. Kania had no particular qualifications with respect to these particular disorders, either. Moreover, Dr. Vitale ultimately was allowed to testify that, in her opinion, the mother did not have either of these disorders. Thus, the failure to appoint experts was harmless.
VI
DISPOSITION
The order appealed from is affirmed.
NOT TO BE PUBLISHED IN OFFICIAL REPORTS
RICHLI J. We concur: RAMIREZ P.J. HOLLENHORST J.