Opinion
NOT TO BE PUBLISHED
San Francisco County Super. Ct. No. JD05-3300
Sepulveda, J.
A newborn child was removed from his mother’s custody and placed in foster care because mental illness impaired the mother’s ability to safely care for and protect her child. (Welf. & Inst. Code, § 300, subd. (b) (all further section references are to this code).) After more than 12 months of efforts at reunifying mother and child, the juvenile court terminated reunification services and scheduled a hearing to establish a permanent plan for the child. (§ 366.26.) The mother petitions this court for a writ of mandate to reverse the juvenile court’s order. The mother claims she was not provided reasonable reunification services. (§ 366.21, subd. (f).) We reject the claim and affirm the order.
I. FACTS
Appellant S. S. (Mother) gave birth to a son, A. I., in August 2005. A. I. is Mother’s only child. At the time of giving birth, Mother was 31 years old, divorced, and in a “questionable mental state.” A. I. was referred to child protective services the day after he was born, upon reports that Mother had denied being pregnant and had maintained her denial even while on the delivery table.
The San Francisco Department of Human Services (Department) detained the infant and reported to court that Mother mistook her pregnancy for an illness, despite receiving positive pregnancy test results from two different hospitals. Mother told a social worker that she did not believe the physicians who disclosed the test results because they appeared to be “insincere.” Mother believed she had a thyroid problem, and that is why her stomach expanded. Mother was in “excruciating pain” for three days prior to her delivery, but thought it would go away in time. Mother looked on the Internet for possible explanations for her symptoms, as she continued to rule out that she was pregnant and having contractions. Mother said she felt the urge to push but thought it was because she needed to have a bowel movement. By the third day of pain, she called 911 because she could no longer move. On the delivery table, Mother denied that she was giving birth. Mother thought there “was an object in her that needed to come out.” Two days after the baby was born, Mother said she was still “shocked that she delivered a baby.”
Mother did not receive any prenatal care because she did not believe she was pregnant. A. I. has recently been diagnosed with multiple medical problems including asthma, “poor growth, global developmental delay, and reactive airway disease.” He requires twice weekly physical therapy and daily medication. A. I. was placed in a “medically fragile infant foster home” within a week of his birth.
On August 26, 2005, the Department filed a dependency petition alleging that the infant was at substantial risk of suffering serious physical harm as a result of Mother’s inability to protect him, and the father’s unwillingness to provide care. (§ 300, subd. (b).) Mother identified A. I.’s father as a man she previously dated. Paternity was confirmed by genetic testing but the father does not want custody and has refused all efforts to unite him with the child. (§ 361.5, subd. (b)(14).) Mother told the Department that she does want to unite with A. I., and the Department facilitated visitation and referred Mother to parenting classes and a psychologist. A psychological evaluation concluded that Mother “may [have] a serious mental illness that includes psychosis.” A psychiatrist recommended medication but Mother refuses to take psychotropic medication.
In December 2005, the court sustained the dependency petition upon finding that “[t]wo independent psychological evaluations confirm that the mother suffers from a psychological condition that caused her to deny that she was pregnant despite confirmation from [two] medical providers, and that now impairs her ability to safely care for and protect the child.” The court ordered reunification services for Mother.
At the six-month review hearing in May 2006, the court continued reunification services upon finding that Mother was making progress. The Department reported that Mother attended therapy sessions and visited her son twice weekly. However, Mother continued to have problems with certain parenting skills like dressing the baby and changing his diaper regularly. The Department also expressed “an urgent concern regarding the mother’s ability to understand that her child has medical difficulties and is considered as medically fragile.” Mother “tried to convince the foster mother not to administer prescribed medication for the child,” and insisted that the child’s illness was due to a lack of contact with Mother. The Department also noted that Mother’s reunification case plan required that she follow any recommended psychological treatment, yet she was “adamant” about not taking medication. The social worker said that Mother “continues to present well, however her peculiar behaviors and affects are concerning.” Mother reportedly “goes back and forth with her intentions for her son,” sometimes saying that she wants her son in a nice place where she can visit him and other times demanding his immediate return.
The 12-month review hearing was held in February 2007. The Department recommended terminating reunification services and setting the matter for a permanency planning hearing. (§ 366.26.) The Department reported that Mother was provided with “intensive” reunification services “to address her mental health issues, anxiety, parenting and bonding skills” but that Mother “continues to exhibit the inability to provide care for her child.”
The therapist who supervised a dozen visits between Mother and A. I. testified that Mother exhibited symptoms of depression and anxiety. The therapist, Patricia Bouchera, said that Mother did not have the energy to leave the house or to cook “for days on end.” By the conclusion of the three-hour supervised visits with A. I., Mother would often say she was exhausted and needed to lie down. Bouchera also said that Mother experienced anxiety attacks, especially when the baby cried and was upset. Mother also reportedly failed to react quickly and decisively when the baby choked on food. A. I. has digestive problems. He once turned red choking on a cracker and Mother did nothing. Bouchera was supervising the visit and grabbed the baby and hit him on the back. According to Bouchera, Mother seemed to sense the severity of the situation when the baby responded by vomiting a lot of food, but Mother continued to “[minimize] the danger to the child” by saying that there was not that much vomit.
A social worker who managed the case for a year testified that A. I. would be at risk of harm if returned to Mother because Mother is unable to accept the child’s fragile medical condition and to provide for his special needs. The social worker and Boucher, the therapist, both testified that Mother is unable to apply a nebulizer mask over the child’s mouth and nose essential to administering prescribed medication for his asthma. The mask must be in place for 15 minutes, and Bouchera testified “it was just too emotional” for Mother because the baby cries and fights application of the mask.
Mother testified that she is not depressed and that her prior depression was linked to the birth. Mother admitted to having panic attacks in the past, but said she no longer has them. As to therapist Bouchera’s account of the choking incident, Mother explained that she did not react because she did not realize the baby was choking and has since attended a safety seminar to gain confidence in recognizing the signs of distress. At the hearing, Mother acknowledged that A. I. has medical conditions, including developmental delays and asthma. Mother said she knows A. I. needs a nebulizer and explained that she has not been able to administer the nebulizer treatment successfully because she did not receive sufficient instruction in its use. Mother admitted that it took her “some while” to get used to the idea of the nebulizer because the treatment made her son scream and cry. Mother testified that she will not take psychotropic medication, and explained that she felt medication was unnecessary because she made a lot of progress without it. Mother also said that supportive people were more help than medication and worried about side effects and drug dependency.
The court noted that Mother “testifies very well” and “appears very well” but remarked that “actions speak louder than words.” While Mother said she understood that A. I. has medical problems and that she was willing to cooperate with medical practitioners, the court observed that reports of her actions did not substantiate her words. “[T]he thing that is of primary concern to the Court are the basic care and basic safety needs that this child would have given that he has such special medical needs, medical needs which I think could be very crucial to his very survival if they were not met in an appropriate fashion.” The court terminated reunification services and set the case for a permanency planning hearing to be held on June 13, 2007. (§ 366.26.) On April 18, 2007, Mother filed in this court a petition for a writ of mandate to reverse the juvenile court order terminating services and setting the section 366.26 hearing.
II. DISCUSSION
“ ‘California has a comprehensive statutory scheme establishing procedures for the juvenile court to follow when and after a child is removed from the home for the child’s welfare. (§ 300 et seq.; [citation].) “The objective of the dependency scheme is to protect abused or neglected children and those at substantial risk thereof and to provide permanent, stable homes if those children cannot be returned home within a prescribed period of time.” ’ ” (Sara M. v. Superior Court (2005) 36 Cal.4th 998, 1008.) A parent is typically entitled to social services aimed at family reunification after a child is removed from parental custody and placed in protective care. (§ 361.5, subd. (a).)
Reunification services are strictly time-limited in recognition of the “ ‘ “need to provide children with stable environments, and the damage to a minor of prolonged temporary placements.” ’ ” (Jessica A. v. Superior Court (2004) 124 Cal.App.4th 636, 644.) For children like A. I. who were under three years of age when removed from parental custody, reunification services are often limited to six months, and may not exceed 18 months. (§ 361.5., subd. (a).) The juvenile court periodically reviews the continuing need for out-of-home placement and the reasonableness of efforts at reunification. (§ 366.) “If, after the specified time period has expired, the efforts to reunify the family have failed, ‘ “the court must terminate reunification efforts and set the matter for a [permanency planning] hearing.” ’ ” (Sara M. v. Superior Court, supra, 36 Cal.4th at pp. 1008-1009.) Before terminating reunification services, the juvenile court must find that reasonable services designed to aid the parent in overcoming the problems that led to the initial removal and continued custody of the child were provided or offered to the parent. (§ 366.21, subd. (f).)
Mother claims the reunification services were not reasonable because the Department failed to adequately facilitate Mother’s attendance at the child’s medical appointments. Mother argues that greater access to the medical appointments would have aided her understanding of A. I.’s medical condition and thus her ability to care for his special needs. In reviewing Mother’s claim that reasonable services were not provided, “our sole task on review is to determine whether the record discloses substantial evidence which supports the juvenile court’s finding that reasonable services were provided or offered.” (Angela S. v. Superior Court (1995) 36 Cal.App.4th 758, 762.) In so doing, we construe all reasonable inferences in favor of the juvenile court’s findings regarding the adequacy of services and the reasonableness of the agency’s efforts. (In re Julie M. (1999) 69 Cal.App.4th 41, 46; In re Misako R. (1991) 2 Cal.App.4th 538, 545.)
The juvenile court expressly found that the Department made “adequate offers and invitations” for Mother to attend A. I.’s medical appointments. That finding is supported by the record. The social worker testified that she twice contacted Mother to arrange Mother’s attendance at medical appointments but Mother was unable to attend because of a conflict with Mother’s college class schedule. According to the social worker, Mother said that she could not attend medical appointments from Monday through Thursday. The Department specially set two doctor appointments so that Mother could attend. Mother also attended at least two physical therapy sessions.
Mother admitted that she told the social worker that she preferred not to miss her college classes to attend medical appointments, but also testified about times when she decided to miss class but was frustrated in trying to attend the child’s medical appointments. Mother said the doctors and foster mother would not respond to her inquiries about appointments, and the social worker was slow to respond and gave confusing directives. The juvenile court acknowledged that “[t]here might have been some miscommunication or misunderstanding” about Mother’s attendance at the medical appointments.
Any miscommunication or misunderstanding does not make the services offered unreasonable. Reunification services “are often imperfect.” (Katie V. v. Superior Court (2005) 130 Cal.App.4th 586, 598.) “ ‘The standard is not whether the services provided were the best that might be provided in an ideal world, but whether the services were reasonable under the circumstances.’ ” (Id. at pp. 598-599.) The Department made good faith efforts to educate Mother about A. I.’s medical condition, including making special arrangements for her to attend several medical appointments. When Mother attended a doctor’s appointment, she was encouraged to ask questions so that she might understand the child’s need for medical attention. Mother had insisted to the social worker that A. I. was not sick and the medical appointments were “too consuming.” But when given the opportunity to learn about the child’s condition, Mother asked the doctor only “one or two questions.”
Mother’s poor comprehension of A. I.’s needs was unlikely to be cured by attending more medical appointments. Mother shows a pattern of psychological resistance to medical practitioners and a denial of medical science. Mother rejected the results of two pregnancy tests because she found the doctors who provided the results “insincere.” She denied her own pregnancy through nine months of development, three days of labor, and childbirth. She denied the paternity of A. I. despite conclusive genetic testing. And now she minimizes the developmental delays experienced by her son.
Mother’s conduct at the medical appointments she attended shows an inability to grasp the nature of A. I.’s needs and to respond appropriately to them. The record shows that A. I. “is not able to crawl correctly and when he attempts will crawl in a circle, due to not being able to move his left side of his body adequately.” It is reportedly visible to all that the left side of his body “is not on track with his right side.” Yet, Mother used the occasion of her attendance at a physical therapy session to tell the therapist that she did not consider it important for the child to receive therapy, and to “question[]” the therapist in such a way that further sessions had to be supervised.
At a doctor’s appointment, Mother repeatedly left A. I. unattended on a high examination table above a concrete floor. When told it was unsafe to leave him, Mother said “something like, oh, it was just a second. And that it was a little thing.” Mother’s testimony at the review hearing shows a continued unawareness of the danger inherent in leaving any baby unattended on an examination table, especially a developmentally delayed baby. Mother dismissed the incident by saying that “[h]e seems to recognize when he’s sitting on a chair or table and he seems okay with that. He’s able to handle it. And apart from that, I didn’t go too far away from him.” Mother admitted she was six feet away, but felt this was not “too far.”
The reunification services were not unreasonable in failing to facilitate greater access to the child’s medical appointments. The Department offered or provided adequate services designed to aid Mother in overcoming the problems that led to A. I.’s removal and out-of-home placement. The services were simply unable to resolve Mother’s deep psychological problems. The juvenile court properly terminated reunification services and scheduled a permanency planning hearing.
III. DISPOSITION
The order is affirmed.
We concur: Ruvolo, P.J., Reardon, J.