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In Re E.E., Jr., et al., Persons Coming Under the Juvenile Court v. K.E. et al

February 22, 2011


(Super. Ct. Nos. JD229558, JD229821)

The opinion of the court was delivered by: Hull ,j.

In re E.E. CA3


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 This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

E.E., Sr., (father) and K.E. (mother) appeal from the juvenile court's jurisdictional and dispositional orders removing minors E.E., Jr., and M.B. from the parents' custody and denying reunification services to father. (Welf. & Inst. Code, § 395 [unless otherwise specified, statutory references that follow are to the Welfare and Institutions Code].) Both parents contend there is insufficient evidence to support the jurisdictional findings and dispositional orders; father also attacks the order denying reunification services to him. We affirm the trial court's orders.


The First Section 300 Petition (E.E., Jr.)

On April 14, 2009, the Sacramento County Department of Health and Human Services (Department) filed a petition under section 300, subdivision (b), as to E.E., Jr., a six-month-old male, alleging that in February, March, and April 2009, mother disregarded medical recommendations for the minor, causing him to be hospitalized for failure to thrive.

The detention report added:

On February 26, 2009, mother was advised to give the minor formula, add rice cereal to his bottle, and start him on Zantac; mother stopped adding rice cereal and never started Zantac because she had read of possible side effects. The doctor, concerned about the minor's failure to gain weight, reiterated his advice.

On March 3, 2009, mother asked about switching the minor's formula to Nutramigen. The doctor advised that mother give thickened feedings and Karo syrup a chance.

On March 6, 2009, the minor was reweighed; he had gained no weight. Mother said she was diluting the formula. The doctor stressed it should be concentrated and advised mother that diluting it put the minor at risk of hyponatremia and seizures.

On March 10, 2009, mother demanded a switch to Nutramigen. Again, it was explained to her that she had not given the thickened treatment a chance.

On or around March 27, 2009, gastroenterologist Dr. Michael Durant concluded the minor probably had cow's milk protein entropy [sic; enteropathy] (i.e., milk intolerance) with secondary vomiting, constipation, and failure to thrive. As long as mother followed Dr. Durant's advice not to give the minor cow's milk, he did better, but then she resumed giving it to him and his symptoms returned. Dr. Durant thought mother did not accept the milk intolerance diagnosis; he suspected she lacked understanding and might have mental health problems.

On April 3, 2009, mother was advised to feed the minor three ounces every three hours and continue him on Nutramigen. However, mother refused to wake him up every three hours for feeding.

On April 6 or 7, 2009, the minor was admitted to Kaiser Roseville Hospital for failure to thrive and dehydration. His weight on admission was 4.741 kilograms (approximately 10 pounds). On April 10, 2009, when discharged, he weighed 4.895 kilograms.

Though the minor was medically ready for discharge, hospital staff had grave concerns about mother. They thought she gave misleading information and was "doctor shopping"; she was also suspected of Munchausen syndrome by proxy.

On discharge, the Department placed the minor in protective custody. Three days later, his weight had increased to 5.024 kilograms. He did not spit up after feedings or have diarrhea.

On April 10, 2009, interviewed by a social worker, mother denied all allegations against her. She had never refused treatment for the minor; however, she had not awakened him every three hours for feeding because it would not be "fair" to him.

On April 12, 2009, interviewed by another social worker, mother said the minor had weighed around 10 pounds since February, but the hospital did not seem concerned about it. She knew he was sick and had digestive complications, but thought it might be an undiagnosed heart condition. She would not wake him up to feed him because "[h]e knows when he wants to eat."

Mother alternated between saying she understood the allegations and saying she did not. She did not seem to grasp the severity of the minor's medical condition. Her moods and expressions shifted constantly. She asked: "Do you think the foster parents are taking him outside? Do you think they are walking in the home with their shoes on?" But she denied mental health problems and did not want a psychological evaluation.

Mother reported that father (E.E., Sr.) resided in Arizona. His last reported address, however, was at a Sacramento jail. He had felony convictions for robbery and assault.

The minor had two siblings or half siblings: M.B., a five-year-old female who lived with mother, and E.B., a seven-year-old male who lived with his father, J.B., in Solano County.

At the initial hearing on the section 300 petition on April 15, 2009, the juvenile court found that E.E., Sr., was the minor's presumed father.

At the detention hearing on April 17, 2009, the juvenile court learned that father was incarcerated through the State of California but housed in Arizona. The court ordered the minor detained, with supervised visitation and reunification services for mother.

The First Jurisdiction/Disposition Report

The jurisdiction/disposition report, dated June 9, 2009, recommended continued out-of-home placement for the minor, with reunification services and a psychological evaluation for mother, but no services for father, a convicted violent felon. (§ 361.5, subd. (b)(12).) The report stated:

On April 20, 2009, mother said father was transported to a correctional facility in Arizona before the minor was born; though father had never seen the minor, he held the minor out as his child. Interviewed by telephone, father said that after his upcoming release in December 2009 he planned to move in with mother and the minor.

Mother denied substance abuse and stated she had no current mental health diagnosis.

Mother did not know why dependency proceedings had arisen. She had done everything she could to get the minor the care he needed, following all medical advice and calling constantly to check on his progress. She had filed a complaint against Kaiser Medical Facility on April 6, 2009, because she believed the doctors were not providing appropriate care.

When prescribed formulas did not improve the minor's condition or worsened it, she added or subtracted ingredients according to her own judgment. She always told the doctors everything she was doing.

She requested Nutramigen after a dietician suggested it. On March 27, 2009, Dr. Durant told her to give the minor half Nutramigen and half regular formula. He did not tell her the minor had a milk allergy. A purported copy of the minor's medical records from the Kaiser Permanente Web site said the minor had "no known allergies." However, his actual records, which she saw only after he was taken into protective custody, included a notation of "possible cow's milk allergy."

On April 3, 2009, after the minor had been ill for two months even though mother brought him to the doctor's office every four or five days, he began vomiting again. Frustrated by the hospital staff's continually changing instructions, on her mother-in-law's advice she began giving the minor boiled cow's milk. The message she left about this went unanswered. On April 6, after she had fed him this way for three days in a row and he kept getting worse, she requested that he be hospitalized. Only then did she learn that he had been assessed as failing to thrive. She requested a second opinion because the minor had been sick for two months and she had received constantly changing information about the cause.

Mother said that not until April 3, 2009, had she been advised to wake the minor every three hours to feed him and had done so then (although with boiled cow's milk).

Asked whether, as stated in the detention report, she gave the minor two ounces of formula at a time instead of five to six (which he seemed to want), mother said she did not limit his intake to two ounces, but he usually would not drink more. Even so, he still vomited while in the hospital.

Mother admitted that she had asked that the minor be tested for other conditions, including SIDS and pyloric stenosis. She did not refuse to listen to the medical staff; they simply had not explained what caused the minor's condition.

Mother wanted the minor returned to her as soon as possible. She also wanted a full review of the minor's medical records.

Dr. Villalobos, the minor's original pediatrician, reported that by following medical directives only for a few days at a time, then changing the minor's treatment on her own, mother had complicated the case. She regularly did the opposite of what the doctors asked her to do. Her reporting of the minor's history also constantly changed, which made it hard to figure out what was going on. In short, according to Dr. Villalobos, "[s]he never allowed me to do my job."

The symptoms mother reported were observed by no one else, and her accounts were confusing. She claimed the minor vomited and had diarrhea, yet Dr. Villalobos never saw diarrhea or vomiting, only spitting up. She claimed the minor was "fussy," but he appeared very calm to Dr. Villalobos. She reported levels of formula consumption and urination which, if accurate, would have meant the minor was dehydrated, but he was not.

Dr. Villalobos suspected mother had mental health problems. She would present herself compliantly, then act otherwise. She gave inconsistent information about where she lived. She had different ...

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