ROBERT M. MURPHY, Judge.
The district court rendered judgment in this case on the petition of the Department of Children and Family Services ("DCFS"), terminating the parental rights of the mother, A.C., and the father, M.C., to the minor child A.M.C.
A.M.C. was born on March 16, 2014, and is the minor child of A.C. and M.C. On February 18, 2016, DCFS filed a petition to terminate A.C.'s and M.C.'s parental rights, alleging that they had abandoned A.M.C. and that their rights should be terminated under La. Ch.C. art. 1015(4) and/or (5).
Following a hearing on June 23, 2016, the court found that DCFS had established grounds for termination under La. Ch.C. art. 1015(5). Specifically, the court noted that: 1) A.M.C. had been removed from her parents' custody for over one year; 2) there had not been substantial parental compliance, and; 3) there was no reasonable expectation that the parents' condition of a diminished capacity to understand how to properly care for A.M.C.'s special medical needs would improve in the near future. Additionally, the court found that being freed for adoption was in A.M.C.'s best interest considering that the prospective adoptive parent knew how to operate A.M.C.'s medical equipment and administer medication, and the prospective adoptive parent is related to one of A.M.C's parents and "would likely continue to foster a relationship between [A.M.C] and her biological parents." The court rendered judgment on August 26, 2016, terminating the parental rights of both parents. It is from this judgment that A.C. and M.C. appeal.
In their first assignment of error, A.C. and M.C. argue that the trial court erred in finding that they had not substantially complied with the case plan. In their second assignment, it is argued that the trial court committed manifested error and/or abused its discretion in finding that termination of parental rights was in A.M.C.'s best interest. Conversely, DCFS argues that while A.C. and M.C. apparently made some effort toward the case plan goals, their efforts were not sufficient to improve their "situation." Furthermore, DCFS contends that the trial court did not err in finding that the termination of parental rights was in A.M.C.'s best interest.
In its petition to terminate, DCFS asserted that after A.M.C. was taken into the State's custody on September 16, 2014, the court approved a case plan for services to return A.M.C. to her parents, but that neither parent had substantially complied with the case plan. With respect to A.C., the petition alleged the following:
The petition alleged identical grounds as to M.C. and, in addition, alleged that M.C. had "failed to submit to either a mental health assessment or a substance abuse assessment; he had a positive drug screen as recently as October, 2015."
At the termination hearing on June 23, 2016, it was first noted for the record that neither A.C. nor M.C. were present, and that service on both parents had been verified. The court also took judicial notice of the child in need of care proceedings underlying the termination. The first witness, Katrina Price, testified that she was a child welfare specialist for DCFS assigned to A.M.C. and her parents since February 18, 2015. A.M.C. came into care after medical staff at Children's Hospital became concerned that A.M.C.'s parents had limited cognitive ability that prevented them from operating the oxygen machine that A.M.C. used to breathe
Ms. Price further testified that A.M.C's parents were ordered to complete a case plan. Since the implementation of the plan, A.C. made no "parental contributions" or child support payments toward A.M.C., nor did A.C. provide food, clothing, or "other necessities" to A.M.C. A.C. was given "liberal visits" with A.M.C., yet had only seen A.M.C. twice in 2016, as of the date of the hearing, and "four to six times" in the prior year. Ms. Price explained that A.C. saw A.M.C. only when dropping off her other child, L.C., to the same caretaker who watched A.M.C. A.C. did not keep DCFS informed of her whereabouts at all times, and also did not provide current contact information. At the time of the hearing, Ms. Price had just learned that A.C. and M.C. had moved into a trailer, but A.C. could not provide any documentation as to whom the trailer was leased. In a visit to the parent's apartment, Ms. Price could smell marijuana in the home. There were also concerns that A.C.'s mother, who was identified by A.C. as someone who would help care for A.M.C. if returned to her parents, appeared to be intoxicated "most of the time." A.C. did not attend all "FTC" meetings, missed three court hearings, and did not attend medical appointments with A.M.C., even though she was offered transportation. A.C. did attend parenting classes from April of 2015, through November of 2015, but was terminated from that program due to "limited cognitive capacity." A.C. had not learned the skills necessary to address A.M.C.'s special medical needs which, at the time of the hearing, consisted of multiple daily breathing treatments, and regular doctor visits with different specialists. A.C. had never met with A.M.C.'s team of specialists to learn what A.M.C.'s needs are, or how to operate the medical equipment.
With regard to M.C., Ms. Price testified that he was ordered to complete a case plan as well. Similar to A.C., M.C. did not contribute to A.M.C.'s support or provide necessities for her. He visited A.M.C. twice in 2016 and approximately "four to six times" in 2015. M.C. did not keep the department informed of his whereabouts at all times, and also changed his phone number. M.C. did not maintain stable, safe, or appropriate housing during the course of the case. According to Ms. Price, M.C. failed to provide DCFS with a plan for care if A.M.C. were returned to him. Similar to A.C., M.C. did not attend all "FTCs," missed three court hearings, and had not attended A.M.C.'s medical appointments. He did not complete parenting classes and was terminated from the program. M.C. had not learned the skills necessary to address A.M.C.'s special medical needs. He also did not complete a psychiatric assessment. While M.C. did enroll in treatment for substance abuse three times, he consistently dropped out after attending a single session. He did not complete all of the required random drug screens. Ms. Price concluded that M.C. had not made substantial improvement in addressing the problems preventing reunification.
Ms. Price opined that A.M.C.'s life would be at risk if she were returned to her parents, because they would not be able to tell if she was having an asthma attack and did not know how to administer A.M.C.'s medications. A.M.C. came into care on September 1, 2014. She resided with A.C.'s maternal cousin in an adoptive placement. It was Ms. Price's opinion that A.M.C. was doing well, and her caretaker was ensuring that A.M.C. made all of her appointments with her specialists. It was the opinion of DFCS that it was in A.M.C's best interest to be freed for adoption.
On cross-examination, Ms. Price explained that A.C.'s and M.C.'s parenting classes were terminated because of their limited cognitive capacity. M.C. had a total of eight positive drug screens. A.M.C. was two years old at the time of the hearing. Her original diagnosis was that she had "premature lungs" and a hole in her heart. She used an "oxygen tank machine" and a "sleep apnea monitor," and took several prescription medications. Ms. Price stated that A.M.C. had improved since being placed with a caretaker. Based upon the information she had gathered from different professionals, Ms. Price believed that A.C. and M.C. did not have the ability to provide for A.M.C.'s needs.
On additional cross-examination, Ms. Price clarified that there was a difference between the "original oxygen machine" and the nebulizer currently used to treat A.M.C.'s asthma condition. A.M.C.'s parents did not understand how to mix her medications together. The information that M.C. did not visit frequently came from A.M.C.'s caretaker. A.M.C.'s parents were comfortable with A.M.C.'s caretaker, who used to provide transportation for A.C. and M.C. M.C. did complete a mental health assessment, but failed to make an appointment for I.Q. testing with a psychiatrist. A.C. did not have to take a mental health assessment or undergo psychiatric testing because she had previously been diagnosed with "an intellectual disability with a moderate diagnosis." On October 2, 2015, M.C. tested positive for methamphetamines, amphetamines, and marijuana. Ms. Price explained that the typical parenting class lasts nine to twelve sessions, but that A.C. and M.C. attended 30 because they were not grasping the concepts being taught. Both parents knew about the termination hearing that was set, and neither one indicated to Ms. Price that they would not attend. Ms. Price was questioned about changes in the plan that took place over time and asked whether A.C. was in compliance regarding requirements for a mental health assessment, a substance abuse assessment, parenting classes, stable housing, a "care plan," and learning how to care for A.M.C.'s medical needs. Ms. Price stated that A.C. did not provide her with a current address, did not "keep the agency informed of medical, emotional, and physical needs," had not learned to care for her "medically-fragile child" including recognizing signs and symptoms of illness and mixing medications, and could not comprehend the lessons taught in parenting classes. M.C. told Ms. Price's supervisor on one occasion that he would not pass a drug screen that day because he had smoked "weed." Ms. Price testified that A.C. had identified her mother as a possible person to assist in taking care of A.M.C., however, her mother was unable "to administer the oxygen machine" or "tend to [A.M.C.'s] medical needs." Ms. Price indicated that if A.C. had kept her scheduled visits at the DCFS Office, then Ms. Price would have shown her how to use A.M.C.'s medical equipment.
Next, Cynthia Miller was called to testify. She stated that she was A.M.C.'s foster parent, and was also a cousin to A.C. A.M.C. had been in Ms. Miller's care from approximately the time she was three months old until the time she was two years old. At the time of the hearing, A.M.C. had special medical needs and required "close attention" on a daily basis, including breathing treatments and medication. While A.M.C.'s parents had visited her at Ms. Miller's home, they did not "come often." When they did come over, A.C. would "just sit there and watch television," and M.C. would go into the freezer and "get some food to cook." The parents had visited approximately one time in 2016, as of the date of the hearing. Ms. Miller testified that she was committed to adopting A.M.C. "as soon as possible."
On cross examination, Ms. Miller explained how A.M.C.'s nebulizer and oxygen machine were operated. She tried to teach A.M.C.'s parents how to use the nebulizer, but A.C. did not want to do it.
CASA supervisor, Stacy Ashmore, testified that A.M.C.'s parents had not been cooperative with the case plan, or visited A.M.C. CASA's recommendation was that A.M.C. be freed for adoption, and stay in her current placement.
Ivy Matthew testified that she was the CASA volunteer for A.M.C. In the two months prior to the hearing, she observed A.M.C. and her family. Ms. Matthew had not seen A.M.C. with her parents, but did see her in the home of Ms. Miller. Ms. Matthew concluded that A.M.C. appeared to be "well adjusted" and "energetic." Based on her interaction with A.M.C., her recommendation was for A.M.C. "to stay with Ms. Miller."
The trial court's judgment terminating A.C.'s and M.C.'s parental rights was rendered on August 26, 2016. In its reasons for judgment issued on the same date, the trial court wrote, in relevant part:
In State ex rel. J.A, 99-2905 (La.1/12/00), 752 So.2d 806, the Louisiana Supreme Court discussed termination of parental rights proceedings, as follows:
In this case, the State based the petition for termination on La. Ch.C. art. 1015(5) and (6), which provide:
The State only needs to establish one ground under La. Ch.C. art. 1015 upon which to base the termination of parental rights, and must prove those elements by clear and convincing evidence. State ex rel. J.A, 99-2905, p. 9 (La. 1/12/00), 752 So.2d 806, 811; State ex rel J.T.C., 04-1096, p. 12 (La. App. 5th Cir. 2/15/05), 895 So.2d 607, 615, writs denied, 05-0466 (La. 4/8/05), 899 So.2d 11; La. Ch.C. art. 1035(A); La. Ch.C. art. 1037. In addition, the trial judge must also find that the termination is in the best interest of the child. State ex rel. J.A., 99-2905 at 9, 752 So.2d at 811; La. Ch.C. art. 1037. The appellate court reviews a trial court's findings as to whether parental rights should be terminated according to the manifest error standard. State ex rel. K.G., 02-2886, p. 4 (La.3/18/03), 841 So.2d 759, 762.
In the instant case, the record establishes that A.M.C.'s premature birth left her with a host of physical difficulties which required the use of life sustaining medical equipment and the administration of exact doses of medications throughout the day, every day.
As discussed above, evidence was presented at the termination hearing that M.C. and A.C. failed to comply with several objectives of the case plan. Most notably, evidence established M.C. and A.C. were unable to learn how to operate the medical devices and administer the medications that A.M.C. relies upon daily. The record supports an uncontradicted finding that a degree of cognitive impairment or a "diminished capacity" exists in both parents which prevents them from comprehending the necessary information for A.M.C.'s medical care, with no reasonable expectation of significant improvement with respect to that impairment.
More than simply protecting parental rights, our judicial system is required to protect the children's rights to thrive and survive. State in the Interest of S.M., supra. In this case, the record demonstrates that A.M.C.'s physical and medical needs must be, by necessity, the highest priority of her caretakers. The evidence established that M.C. and A.C. demonstrated an unwillingness or inability to provide adequate care for the physical and emotional needs of A.M.C., despite being given multiple opportunities to do so. When given an opportunity to attend A.M.C.'s medical appointments and to ask questions concerning her care, M.C. and A.C. failed to do so. There is no evidence that M.C. and A.C.'s ability to care for A.M.C. has improved since DCFS became involved in this case after her parents left her alone at Children's Hospital's Neonatal Intensive Care Unit. A.M.C. has resided in the same placement, and her foster mother has expressed her desire to continue to care for A.M.C. indefinitely. Of the greatest importance, A.M.C. has received consistent medical treatment at her current placement, which is necessary for her best interest.
Accordingly, for the foregoing reasons, we do not find that the trial court was manifestly erroneous in finding that the best interest of A.M.C. will be served by terminating M.C. and A.C.'s parental rights and certifying A.M.C. for adoption. The judgment of the trial court is affirmed.
While no expert testimony was presented on the issue of cognitive impairment of the parents, we find that the record contains sufficient support to establish a pattern that M.C. and A.C. repeatedly failed to learn the medical information necessary to adequately care for A.M.C.