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G.S. v. Department of Human Services

February 17, 1999

G.S., APPELLANT-RESPONDENT,
v.
DEPARTMENT OF HUMAN SERVICES, DIVISION OF YOUTH AND FAMILY SERVICES, RESPONDENT-APPELLANT.



The opinion of the court was delivered by: Garibaldi, J.

Argued October 26, 1998

On certification to the Superior Court, Appellate Division.

This appeal arises out of a medication overdose administered to a child by a care-giver at a facility for retarded persons. The child was hospitalized after G.S., the caregiver, failed to follow the facility's medication dispensation procedures and administered a dosage seventy-eight times the prescribed amount. Although the child recovered and the incident was, by all accounts, an accident, the Division of Youth and Family Services (DYFS) concluded that G.S. had committed an act of child neglect within the meaning of N.J.S.A. 9:6-8.21. G.S. appealed the investigative finding and the Appellate Division overruled DYFS's determination, concluding that accidental injuries cannot form the basis for a finding of neglect under N.J.S.A. 9:6-8.21. This Court remanded for a determination of whether the finding of neglect was sustainable under N.J.S.A. 9:6-8.21(c)(4)(b). The Appellate Division again concluded that the finding of neglect was improper. DYFS now appeals that decision, urging us to find that accidental injuries can support a finding of neglect under N.J.S.A. 9:6-8.21(c)(4)(b). We agree and reverse.

I.

The material facts are undisputed. G.S. was the Saturday Coordinator for Respite Care at the Association for Retarded Citizens (ARC). As Coordinator, G.S. solely was responsible for administering the medication brought by parents. Although G.S. is not a nurse and it is not clear whether she had prior medication training, she had been dispensing medication at ARC for over one year prior to the incident.

N.D. is an autistic, non-verbal, developmentally disabled minor who suffers from petit mal seizures, a form of epileptic disorder. On June 4, 1994, N.D.'s mother dropped him off at ARC. M.B., an ARC worker who arrived around the same time, offered to take N.D. inside. N.D.'s mother agreed and handed M.B. a bottle containing Clonidine, an anti-hyperactive drug. The mother told M.B. that it was a new medication and that she had "crushed it" already. When M.B. went inside, she immediately brought the vial to G.S. and repeated what the mother had told her.

The ARC's written policy governing medication dispensation required parents to "supply the proper dosage of medication in a properly labeled bottle." Prior to administering the medication, the Coordinator was to "check[ ] the bottle for the correct child's name, correct medication, correct dosage, correct time, and correct method."

When the time came to administer N.D.'s medication, G.S. opened the bottle. Inside she found "crushed pink pieces - not a powder, but none similarly sized." Confused about how much to administer, G.S. asked M.B. to repeat the directions. M.B. replied that the medication "was already crushed for [N.D.]." Still uncertain what that signified, G.S. read the directions on the bottle. The directions said to give one-half a pill, increasing the dosage as needed. Because the bottle did not contain any pills in whole form, G.S. did not know how big one pill was. She did not attempt to obtain clarification from N.D.'s mother or from any other source. G.S. simply assumed that the entire bottle, which contained seventy-eight pieces, was a single dose. G.S. gave N.D. the entire bottle.

N.D. fell asleep shortly after he was given his medicine, a half-hour before his usual nap time. He was in a semi-conscious state when his mother arrived at ARC to pick him up. She rushed him to the hospital upon learning that G.S. had given him the entire bottle of Clonidine.

When N.D. arrived at the hospital, he appeared "lethargic and pale." His heart rate was plummeting, although his vital signs were stable. N.D. was admitted to the Intensive Care Unit with a diagnosis of prescription medication overdose. Doctors determined that he had ingested seventy-eight times the prescribed amount. Although he suffered no permanent harm, he remained in the hospital for forty-eight hours.

The police, ARC, and DYFS's Institutional Abuse Investigation Unit (IAIU) all investigated the incident. The police determined that the incident was an "unfortunate accident" caused by "a lack of communication between [G.S.] and the mother . . ." and closed their investigation. On August 3, 1994, ARC personnel notified G.S. that their investigation revealed that she had failed to follow proper medication procedure in dispensing the drug. *fn1 G.S. resigned after being told that her employment was being terminated.

On November 7, 1994, DYFS notified G.S. that the Division's investigation concluded that her actions in administering the medication on June 4, 1994 constituted neglect within the meaning of N.J.S.A. 9:6-8.11. Pursuant to N.J.S.A. 9:6-8.10(a), the finding of neglect would be forwarded to the Central Registry. *fn2 G.S. appealed DYFS's investigative findings.

On appeal, G.S. argued that her conduct could not be considered neglect under N.J.S.A. 9:6-8.21 because her actions were accidental. Relying on criminal neglect cases, G.S. contended that a guardian must act with a willful or purposeful intent in order for his or her conduct to be characterized as child neglect. State v. Hofford, 169 N.J. Super. 377, 384 (App. Div. 1979); State v. Burden, 126 N.J. Super. 424, 427 (App. Div. 1974). Because G.S. did not intend to administer an overdose or to harm N.D., she had not committed an act of child neglect.

The Appellate Division, in an unpublished opinion, held that G.S.'s conduct could not support a finding of child neglect under N.J.S.A. 9:6-8.21. To support a finding of neglect under that section, the Division reasoned that the injury must be caused by "other than accidental means." Despite the "persuasive evidence [indicating] that G.S. [had] violated the [ARC's] clear mandated policies with respect to the administration of medications," the Division found no evidence that G.S.'s conduct was "other than accidental." The Division reversed DYFS's investigative findings and ordered that the report to the Central Registry be withdrawn.

This Court remanded the case for a determination of whether action was sustainable under N.J.S.A. 9:6-8.21(c)(4). G.S. v. Department of Human Servs., 151 N.J. 67 (1997). The Appellate Division held that DYFS's action was not sustainable under N.J.S.A. 9:6-8.21(c)(4), and reaffirmed its Conclusion that "accidentally caused injuries [should] not be treated as child abuse." We granted certification and now consider whether a finding of neglect is sustainable under N.J.S.A. 9:6-8.21(c)(4) when the injury to the child is accidental. 153 N.J. 215 (1998).

II ...


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