On appeal from Superior Court of New Jersey, Chancery Division, Family Part, Passaic County, Docket No. FG-16-93-08.
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
Submitted December 15, 2009
Before Judges Carchman and Parrillo.
In this parental termination case, defendant S.R., the biological mother, appeals from a judgment of guardianship terminating her parental rights to her three-year-old daughter, A.R. She contends that the New Jersey Division of Youth and Family Services (DYFS) failed to establish that termination of her parental rights was in the best interests of A.R. We disagree and affirm for the following reasons.
A.R., a medically fragile child, was born on October 26, 2006, to then nineteen-year-old, S.R., who has limited cognitive abilities,*fn1 and is dependent on her own mother, A.R.'s maternal grandmother, G.V. A.R. was born with DiGeorge Syndrome, a congenital disease with serious symptoms, including trouble swallowing, which requires placement of a "G-tube" in A.R.'s stomach, heart problems that initially required A.R. to take Lasix and Digoxin, hypoplasia of the optic nerve causing ongoing visual problems, hearing difficulties in A.R.'s right ear, and immune system deficiencies. A.R. also suffers from asthma.
Because of her fragile medical condition, A.R. remained in the hospital for about five months after her birth. On December 21, 2006, less than two months after A.R.'s birth, S.R. commenced training with hospital staff to learn the specialized care methods necessary to properly treat A.R.'s medical issues. The training, however, went "terribly," due to S.R.'s limited cognitive abilities, which prevented her from being able to grasp and retain much of the information imparted to her, coupled with G.V.'s volatile temperament and constant interference with her daughter's attempts at training. For instance, it was reported that S.R. and G.V. often missed appointments and only stayed for an hour when they chose to attend. Hospital staff also requested S.R. attend several overnight sessions with A.R. so that she could better understand the child's sleep and feeding patterns; however, S.R. refused to attend some of these sessions.
Of particular concern was S.R.'s inability to administer A.R.'s medication. Digoxin is a very powerful medication that if "given incorrectly . . . can kill the baby within half an hour." S.R. was unable to check the baby's pulse or administer a proper dosage of the medication to A.R. Especially disconcerting, S.R. was supposedly unable to tell the assisting nurse whether the number twenty-three was smaller than the number forty-seven and, furthermore, to distinguish between 0.5 ml and 1.0 ml when administering A.R's medication. According to a DYFS social worker, S.R. could not "grasp simple, yet critical procedures for the care of . . . [A.R.]," such as putting clothing on the child.
Compounding the matter was G.V.'s emotional nature. She consistently obstructed S.R. from completing her training and exhibited extremely volatile behavior. On one occasion, G.V., while yelling, threw a diaper and baby clothes in the direction of a nurse at the hospital. On another occasion, when a DYFS social worker visited S.R. at G.V.'s home on February 13, 2007, G.V. became upset and started cursing in Spanish, refusing to leave S.R. alone with the social worker, and paced the room while yelling. G.V. eventually positioned herself close to the social worker's face and said she needed no help.
Two days after this incident, on February 15, 2007, G.V. arrived at the hospital "screaming and yelling," claiming that DYFS had kidnapped her daughter.*fn2 G.V. was eventually banned from visiting A.R. at the hospital, and later prohibited from visiting A.R. at the foster mother's home, where the infant was placed when she was five months old. In yet another incident, G.V. went to a DYFS office and accused the agency of taking S.R. and A.R.; threatened to sue both DYFS and the hospital; and claimed that A.R.'s medical problems were minimal, insisting: "[my] granddaughter [is] perfectly fine and the Division is crazy." Moreover, according to S.R., her mother is physically and verbally abusive to her, and is also rough when handling A.R. Additionally, G.V. refused to complete a court-ordered psychological evaluation.
Two days after the last hospital incident, on February 16, 2007, DYFS filed a verified complaint for custody, care, and supervision of A.R. That same day, DYFS was awarded custody of A.R. and S.R. was ordered to undergo a psychological examination and to follow DYFS recommendations. In her March 30, 2007 evaluation report, Dr. Margaret Doherty Delong concluded that:
[S.R.] demonstrated significant problems in cognitive functioning and self-sufficiency that would interfere with her ability to parent. . . .
Regarding parenting, [S.R.] appears to be lacking in skills. However, this was difficulty [sic] to assess due to her cognitive problems. She did not appear to have a clear idea about discipline practices or what her child needs from her.
[S.R.] does not appear capable of meeting her daughter's complex medical needs. . . .
. . . Despite her acknowledgment of her limitations, [S.R.] also has narcissistic personality traits that interfere with her ability to acknowledge the negative impact of her limitations on her daughter.
[S.R.] demonstrated a disturbance in thinking. This is likely related to her low cognitive functioning. She does not appear to fully understand what is happening in her current situation. . . . She also has demonstrated paranoid and delusional thinking on the MCMI-III. . . . Regarding delusional thinking, she indicated that for years, many people have been spying into her private life, and that people are trying to make her think that she is crazy.
[S.R.] lacks social support. . . . She does not have the support of family, and her relationship with her mother is troublesome. . . .
[S.R.] does not appear to be an appropriate caregiver for her daughter, despite her desire to do so. . . . Her prognosis for improving sufficiently within the foreseeable future to be able to provide minimally adequate parenting is guarded at best. . . .
Pursuant to an April 16, 2007 court order, S.R. was also evaluated twice by Dr. James F. Battaglia. From the neuro-developmental examination administered on June 5, 2007, Dr. Battaglia concluded:
Although there was some variability, most of [S.R.'s] intellectual skills are far below expectations and within the Mentally Deficient range. . . .
. . . For example, she cannot be expected to retain information she has learned and her reasoning skills are like that of a young child. She is easily confused and cannot anticipate the consequences of her actions. She is best when she is involved in rote tasks or tasks that have been over learned. . . . It is within reasonable psychological certainty that I conclude [S.R] is a young woman with significantly compromised intellectual functioning who cannot meet the demands of caring for her daughter alone. She needs significant assistance.
As a result of this initial evaluation, Dr. Battaglia opined that S.R. "wasn't able to care for her child in the way that would keep the child safe because of her intellectual limitations." He further explained that there likely were no services that the State could provide to help S.R. overcome her intellectual limitations to the degree needed to raise a medically fragile child.
Following his October 21, 2008 psychological examination of S.R., Dr. Battaglia once again concluded that S.R. "would not be able to safely parent [A.R.]" and live independently:
[S.R.] is incapable of caring for her daughter. (She may even be incapable of taking care of herself.) Further, she does not have a healthy support system in her family to help guide her or co-parent with her. The domestic violence with her most recent paramour suggests she is unable to keep herself out of harm's way. It is not likely she will be any better at protecting her developmentally compromised daughter. Therefore, sadly, it is with reasonable psychological certainty that I conclude that [S.R.] is unable to provide [A.R.] with a minimal level of care to protect her from harm.
Thereafter, Dr. Battaglia also performed a bonding evaluation, wherein he found, to a reasonable psychological certainty, that "little bonding has developed between" S.R. and A.R. In contrast, as between A.R. and her foster mother, Dr. Battaglia found a "solid" and "healthy" bond, and that ...