NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
Before Judges Yannotti and Espinosa.
M.A. appeals from a final determination of the Director of the Department of Children and Families (Director) in the Division of Youth and Family Services (Division), finding that she neglected her infant child K.A. by failing to provide him with necessary medical care. We affirm.
Here, the Division informed M.A. that it had substantiated a finding that she had medically neglected K.A. M.A. requested a dispositional review in order to contest this finding. The Division's finding was affirmed. Thereafter, M.A. requested an administrative hearing, and the Division referred the matter to the Office of Administrative Law for a hearing before an Administrative Law Judge (ALJ).
The evidence presented at the hearing indicated that M.A. had given birth to K.A. on June 27, 2005. L.A. is the child's biological father.*fn1 The child had tested positive for presumptive medium-chain acyl-CoA dehydrogenase deficiency (MCAD). An individual with MCAD cannot convert fatty acids into "fuel" for the body. A child with this disorder must be fed approximately every two to four hours so the body has sufficient nutrition. In addition to the recommended frequent feedings, carnitine supplements are often suggested. Carnitine assists the fatty acids to oxidize, and facilitates the production of ketones, which can take the place of sugar or carbohydrates in the body.
An individual with MCAD can become hypoglycemic, which may lead to metabolic decompensation that can cause such effects as Attention Deficit Hyperactivity Disorder (ADHD) and certain developmental delays. In addition, a child with MCAD is at substantial risk during times of illness and physical stress. In certain circumstances, MCAD can lead to death if not properly treated.
On July 1, 2005, St. Peter's University Hospital (St. Peter's) confirmed K.A.'s presumptive diagnosis of MCAD. Dr. Debra-Lynn Day-Salvatore (Dr. Day-Salvatore), Director of the Institute for Genetic Medicine (Institute) at St. Peter's, attempted to schedule an appointment for K.A. on July 7, 2005; however, his parents declined that appointment. Dr. Day-Salvatore first saw K.A. on August 19, 2005.
The doctor counseled the family and explained the risks associated with MCAD and the appropriate treatment for the condition, including a feeding schedule, glucose monitoring and possible carnitine supplementation. K.A.'s parents decided not to have DNA tests performed on the child, although such tests had been recommended to further confirm the MCAD diagnosis. On August 24, 2005, Dr. Day-Salvatore wrote to K.A.'s pediatrician, Dr. Vidya Vakil (Dr. Vakil), and advised her concerning the initial consultation.
In addition, on August 25, 2005, Dr. Day-Salvatore wrote to K.A.'s parents and confirmed the diagnosis of MCAD. She again recommended carnitine supplementation to minimize the risk that K.A. would experience a metabolic crisis. The doctor also recommended that M.A. contact her directly so that a treatment plan for K.A. would be established.
On September 1, 2005, M.A. called Dr. Day-Salvatore, but the doctor was not available at that time. M.A. did not leave her phone number and said that she would call again. M.A. did not call St. Peter's again until June 2006.
The record indicates that M.A. failed to bring K.A. for visits with Dr. Vakil that had been scheduled for August 27, 2005, and September 16, 2005. M.A. brought K.A. for an appointment with Dr. Vakil on November 8, 2005. Dr. Vakil noted in her chart that M.A. would not permit K.A. to receive all of his vaccines at the same time, and M.A. had requested that only two vaccines be administered at a time.
Dr. Vakil also noted that M.A. had not started K.A. on carnitine, as had been recommended. Dr. Vakil suggested that the parents follow up at a metabolic treatment center (MTC), and she gave them the ...