In re Interest of M.E.

• Decision Date: 14 September 2022
• Docket Number: 113 WDA 2022, No. 114 WDA 2022, No. 133 WDA 2022, No. 134 WDA 2022
• Citation: 283 A.3d 820
• Parties: In the INTEREST OF: M.E., a Minor Appeal of: J.E.E., Father In the Interest of: M.E., a Minor Appeal of: J.E.E., Father In the Interest of: M.E., a Minor Appeal of: K.E., Mother In the Interest of: M.E., a Minor Appeal of: K.E., Mother
• Court: Pennsylvania Superior Court

283 A.3d 820

In the INTEREST OF: M.E., a Minor

Appeal of: J.E.E., Father

In the Interest of: M.E., a Minor

Appeal of: J.E.E., Father

In the Interest of: M.E., a Minor

Appeal of: K.E., Mother

In the Interest of: M.E., a Minor

Appeal of: K.E., Mother

No. 113 WDA 2022

No. 114 WDA 2022

No. 133 WDA 2022

No. 134 WDA 2022

Superior Court of Pennsylvania.

Submitted June 21, 2022

Filed September 14, 2022

Julie E. Beroes, Pittsburgh, for appellant.

Erin M. Krotosznski, Pittsburgh, for appellee.

Ilene L. Durbin, Pittsburgh, for Allegheny County CYF, participating party.

Maegan S. Filo, New Kensington, for K.E., participating party.

BEFORE: BOWES, J., KUNSELMAN, J., and SULLIVAN, J.

OPINION BY BOWES, J.:

J.E. ("Father") and K.E. ("Mother") appeal from the orders entered on January 18, 2022, which involuntarily terminated their parental rights to M.M.E. and M.R.E., their minor daughters born in July 2016 and August 2019, respectively.¹ After review, we affirm.

This case, and the involvement of Allegheny County Children, Youth and Families ("CYF") with this family, stems from severe injuries inflicted upon M.R.E. when she was approximately one month old. M.R.E.’s pediatrician was the first person to discover the injuries. The orphans’ court recounted the facts in the certified record regarding the pediatrician's discovery as follows:

[Around 2:30 p.m.] on Wednesday, September 11, 2019, [M]other called the pediatrician's office to obtain an appointment for [M.R.E.] later that same day. Mother indicated she requested the appointment because [M.R.E.] was not consuming a lot of food, and when she did eat, [M.R.E.] would vomit.

When [F]ather returned home from work that day, the parents and both children went to the pediatrician's office for the appointment. The pediatrician, Dr. Brittany Raburn, had a note on the schedule that [M.R.E.’s] appointment was because [M.R.E.] was "not eating well, no fever, refusing to eat at times, wet diaper one hour ago." Upon arrival in the examination room, Dr. Raburn's staff conducted a pulse ox reading on the baby, which came back at 94 percent. Dr. Raburn entered the examination room and observed that the baby was in clear distress, with a pulse ox reading of 84 percent. Dr. Raburn told [Father and Mother] she was going to call an ambulance and estimated she made this decision within a minute of being in the room and observing the child. While the nurses in the pediatrician's office called for the ambulance, Dr. Raburn had oxygen brought to [M.R.E.] Other than the crying and distress, Dr. Raburn noticed that there was bruising on [M.R.E.’s] face that was "quite significant," specifically, "bluish bruising on both cheeks" and "other scattered bruising on her body as well." Dr. Raburn attempted to get an explanation from [Father and Mother] but the main concern they identified was that "she wasn't feeding appropriate, that she wasn't taking her bottles as she normally did in the last two days. That was their biggest complaint." Upon her further questioning, [Father and Mother] acknowledged that they noticed the infant had some difficulty breathing earlier that day.

Orphans’ Court Opinion, 3/3/22, at 2-4 (citations omitted).

Following her transport by ambulance to Children's Hospital of Pittsburgh, M.R.E. was admitted to the pediatric intensive care unit ("PICU") in critical condition. Dr. Jennifer Clarke, who is employed by Children's Hospital of Pittsburgh in the Child Advocacy Center ("CAC") department, examined M.R.E. as part of a consult on M.R.E.’s medical situation. The orphans’ court provided the following summary of Dr. Clarke's assessment of M.R.E.’s injuries:

M.R.E. had nineteen total rib fractures, and as a result of that trauma, there was fluid and blood in her chest that required a chest tube for drainage, and she required continued oxygen support through a nasal cannula. These rib fractures, Dr. Clarke stated, is most commonly caused in infants by "squeezing."

The CT scan showed "parietal skull fractures, as well as blood in her brain, subdural and subarachnoid hemorrhages," which was confirmed by MRI. Dr. Clarke explained that these injuries would have resulted from a violent shaking of the child and an impact to the back of the child's head.

MRI of [M.R.E.’s] cervical spine showed edema in her soft tissue indicative of a neck sprain. In addition to the fluid in her chest, the chest CT also showed "extensive soft tissue swelling of her back," which was concerning for additional impact trauma, such as a "slam down on her back."

The abdominal CT depicted a linear, one to two centimeter laceration of her liver. Dr. Clarke stated this would have been due to a blunt force trauma and could have been a result of "a stomp on her, that would be compressive forces, and potentially explain some of her injuries."

The skeletal survey which, in addition to the nineteen rib fractures, showed a transverse radius fracture in her left arm, and multiple corner fractures in her legs. Dr. Clark stated that the forearm fracture is normally seen with direct impact trauma "or a very strong yank or grab to that forearm." Dr. Clarke also explained that the corner fractures in her legs, located around her knees and her ankles, usually occur with yanking or jerking of the extremity, which could also happen if extremities were flailing during a violent shake.

Finally, Dr. Clarke found that there was a nearly healed upper frenulum injury. Dr. Clarke stated that the frenulum injury occurs in toddlers who run and fall but that a four[-]week[-]old infant could not cause this injury. Dr. Clarke stated that the infant could not have caused the bruising on her face and body. As a result of all these injuries, the baby was in the [PICU] for five days, and but for the healing frenulum injuries, the doctor estimated that the acute injuries were inflicted in the preceding 72 hours.

Id . at 4-6 (citations omitted; paragraph breaks added).

Dr. Clarke also offered an assessment of the bruising on M.R.E.’s face. As the orphans’ court explained:

Dr. Clarke reviewed the photos from [a] professional photo shoot that occurred on [Monday,] September 9, 2019, between 9:00 and 10:00 a.m.,^{[2 ]} and concluded that [M.R.E.] had already been abused by that point, as there was visible facial bruising on her right cheek, right jaw, and left forehead in those pictures, which correlated to the pictures taken in the hospital on September 11[,] and 12, 2019. Dr. Clark further reported that the "facial bruises resulted from impact trauma — either forceful impact or grabbing — that would not occur from normal, routine care of a neonate, from self-inflicted trauma or from a short household fall (the latter two being histories provided by her caregivers)^{[3 ]}."

Id . at 7 (citing CYF Exhibit 9).

After conducting her consult, Dr. Clarke opined that M.R.E.’s injuries were indicative of abuse. She summarized her finding in her report as follows:

[M.R.E.] has extensive injuries that resulted from severe, inflicted violent trauma. These injuries are diagnostic of physical child abuse. Not only did she experience substantial pain at the time her injuries occurred, she continues to be in substantial pain and requires external respiratory support. [M.R.E.] is in serious condition, is admitted to the [PICU], and this qualifies as a Near Fatality from Injuries due to Child Abuse under Pennsylvania Law.^{[4 ]} Given the history of prior bruising and an injured upper frenulum, [M.R.E.] has been abused on more than one occasion. She did not cause her bruising and frenulum injury. A fall from any household bed does not result in the extensive, massive injuries present in [M.R.E.] In addition, there is no medical condition that exists that would predispose these traumatic injuries in [M.R.E.]. She will die if she is returned to the environment in which she was abused. [M.R.E.] became symptomatic immediately after she was injured. Any reasonable adult would have recognized how severely ill [M.R.E.] was and sought medical attention.

CYF Exhibit 9.

A ChildLine report of child abuse pursuant to the Child Protective Services Law ("CPSL") alerted CYF and the police to the situation. Detective Michael Heinl from the Shaler Township Police Department, where Father and Mother resided, and Josie Pickens, a CYF intake caseworker, interviewed Father and Mother on the same night M.R.E. was admitted to Children's Hospital.

Initially, neither parent offered any explanation for how M.R.E. was injured. Both parents insisted M.R.E. seemed fine, other than her growing resistance to feeding on Tuesday and Wednesday that caused Mother to call the pediatrician and both parents to accompany her to the appointment. Both parents agreed that they were the only individuals who provided care for M.R.E. in the seventy-two hours prior to M.R.E.’s hospital admission. Both parents had opportunities to be alone with M.R.E., but generally, each participated in child caring duties such as bottle feedings and diaper changes.

Detective Heinl interviewed Father again on Thursday, September 12, 2019. This time, Father stated that while Mother was at an appointment on Monday afternoon, he went to the bathroom and left M.R.E. laying on top of the bed in his bedroom. When he returned, three-year-old M.M.E. was standing over M.R.E., who was now lying face up on the hardwood floor. According to Father, M.R.E. seemed fine so he did not tell Mother about this incident until right before he told Detective Heinl.

After consulting with Dr. Clarke, Detective Heinl told Father and Mother that Dr. Clarke did not believe a three-year-old child's pulling an infant off a bed onto the floor was consistent with M.R.E.’s injuries. Detective Heinl informed Father and Mother he was leaving to consult with the District Attorney's office about filing criminal charges against them. Detective Heinl returned quickly upon a call from Ms. Pickens, who informed him Father wanted to make an additional disclosure after speaking privately with Mother.

Detective...