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In re Audrey B.

Court of Appeals of Illinois, First District, Fourth Division

April 30, 2015

In re AUDREY B., a Minor
v.
Michael C., Respondent-Appellant. The People of the State of Illinois, Petitioner-Appellee,

Page 893

Appeal from the Circuit Court of Cook County. No. 13 JA 701. Honorable Nicholas Geanopoulos, Judge Presiding.

For Appellant: Abishi C. Cunningham, Jr., Public Defender of Cook County, Chicago, Trenis Jackson, Of Counsel.

For Minor-Appellee: Robert F. Harris, Kass A. Plain, Lynn Pavalon, Office of the Cook County Public Guardian, Chicago.

For Appellee: Anita alvarez, State's Attorney of Cook County, Chicago; Alan J. Spellberg, Nancy Kisicki, Nicole Lucero, Of Counsel.

JUSTICE HOWSE delivered the judgment of the court, with opinion. Justices Ellis and Cobbs concurred in the judgment and opinion.

OPINION

Page 894

HOWSE, JUSTICE.

[¶1] On August 1, 2014, the State filed a petition for adjudication of wardship of Audrey B., born November 25, 2011, and a motion for temporary custody. The same day, the circuit court of Cook County entered an order granting temporary custody of Audrey to the Illinois Department of Children and Family Services (DCFS) guardianship administrator, and an order appointing the Cook County public guardian as attorney of record and guardian ad litem for Audrey On August 19, 2014, following a hearing, the court entered an adjudication order finding that Audrey was abused and neglected as defined in section 2-3 of the Juvenile Court Act of 1987 (Act) (705 ILCS 405/2-3 (West 2012)). The court set the matter for a dispositional hearing.

[¶2] On September 3, 2014, following the dispositional hearing, the trial court found respondent, Michael C., was unable and unwilling to care for, protect, train, or discipline the minor and adjudged Audrey a ward of the court. The court placed Audrey in the custody and guardianship of the DCFS guardianship administrator with the right to place the child and set the matter for a permanency planning hearing on March 4, 2015. On September 19, 2014, Michael C. filed a notice of appeal from the court's September 3, 2014 judgment. For the following reasons, we affirm.

[¶3] BACKGROUND

[¶4] Michael is Audrey's father and primary caretaker. Her mother, also named Audrey B., is not a party to this appeal. On June 12, 2013, DCFS received a hotline report regarding Audrey alleging bone fractures, medical neglect, and cuts, welts, and bruises. The same day, Carolyn Hudgins-Teil, a DCFS child protection investigator,

Page 895

responded to Roseland Hospital (Roseland). Hudgins-Teil spoke to Michael at Roseland. On the evening of June 12, 2013, Michael told Hudgins-Teil that on June 11, 2013, he had taken Audrey to a park and that Audrey had fallen three times while trying to walk and run. Michael told Hudgins-Teil that the first fall resulted in a bruise on her nose, the second time Audrey put her hands out to try to catch herself but she fell, and the third time she fell on her side and rolled over. Michael did not state to Hudgins-Teil that Audrey cried after any of the falls. Michael told Hudgins-Teil that he was with Audrey and, other than a bruise to her nose, he did not notice anything wrong with Audrey until 11 p.m. that night when he tried to get Audrey to lay down and she would not lay her arms out.

[¶5] Michael reported that he lived with his parents. Hudgins-Teil and Michael agreed he would go with his sister and girlfriend to take Audrey to University of Chicago Medicine Comer Children's Hospital (Comer) the next day for a second opinion as to what happened to Audrey. Hudgins-Teil had no further involvement in the case.

[¶6] On June 14, 2013, DCFS assigned Lisa Maltbia to Audrey's case. That day, Maltbia spoke to Dr. Ramaiah from Comer and met with Michael and his parents at his parents' home. Michael told Maltbia that on June 11, 2013, he had taken Audrey to the park and she fell and scraped her nose. Michael told Maltbia that as they were approaching a set of stairs to leave the park, Audrey fell and braced herself. Then, as they approached their residence, he and Audrey were playing and she fell, braced herself, and flipped over into the grass. Michael told Maltbia that when Audrey fell the third time, Michael picked her up by both hands. Michael told Maltbia that when they returned home he gave Audrey to his sister and he left the residence. Michael told Maltbia that he did not have any contact with his family between the time he left the residence and 7 a.m. the next morning. Michael's sister had called him at 6 a.m. but he missed her call. Michael's mother called him at approximately 7 a.m. and told him that Audrey needed to go to the hospital. Michael told Maltbia that Audrey fell frequently but other than a fall about two weeks earlier, when she fell on her stomach running from the family dog, he did not give specific dates or provide details.

[¶7] On July 13, 2013, Maltbia spoke to Michael again. Michael told Maltbia that he was Audrey's primary caretaker and that he was the person who always bathed, clothed, and fed her. By this time, Maltbia had learned that Audrey had a fracture to her collarbone that predated their first interview. When Maltbia asked Michael about the collarbone injury Michael said he had no knowledge of that injury and he did not observe anything in Audrey's demeanor that indicated she had any type of injury or pain.

[¶8] The trial court qualified Dr. Veena Ramaiah as an expert in pediatric medicine, pediatric emergency medicine, and child abuse pediatrics. Dr. Ramaiah is an attending physician in the pediatric emergency room and is an attending physician on the child protective services team (CPS). Dr. Ramaiah consulted as a member of CPS when Audrey went to the emergency room at Comer. Dr. Ramaiah was not able to speak to Michael that day because he was not present. Pursuant to their protocol, the team at Comer requested a skeletal survey to look for additional injuries. The skeletal survey and other imaging surveys of Audrey revealed four bone fractures in Audrey's arms. Audrey had fractures on two forearm bones (the

Page 896

radius and ulna) in both her left and right arm.

[¶9] Dr. Ramaiah testified that the arm fractures were less than 7 to 10 days old. She testified these fractures were unusual in that they were bilateral fractures__ meaning fractures on both arms. Dr. Ramaiah testified that usually when children fall they fall on one arm. She also testified that a ground-level fall on an outstretched hand can cause the type of fracture Audrey had in a child her age, but that it is unusual to have fractures in both arms. A radius-ulna fracture is common in children Audrey's age but a bilateral radius-ulna fracture occurs very rarely. Dr. Ramaiah testified that she has seen a bilateral injury in the context of an automobile accident. Dr. Ramaiah described Audrey's injuries as mirror-image, which she testified meant the injuries were fairly symmetric and looked almost the same on both arms. Audrey's fractures occurred at approximately the same distance from her wrist in both arms. Dr. Ramaiah testified that bilateral fractures are often asymmetric. Dr. Ramaiah testified she had only seen mirror image bilateral fractures in the context of a " much more significant impact." Dr. Ramaiah testified that in her experience in the emergency room, pediatric emergency room, and on the CPS she has never seen bilateral mirror-image radius and ulna fractures caused by just a ground-level fall. She testified that most of the mechanisms of bilateral fractures are high velocity. She did not come across case reports of bilateral forearm fractures in children resulting from ground-level falls.

[¶10] Dr. Ramaiah testified that if someone were to inflict injuries of the type Audrey had in her arms it would require a direct impact across both arms at the same level or taking the bones and bending them back the wrong way. Dr. Ramaiah opined to a reasonable degree of medical certainty that simply lifting the child by the wrists in a reasonable manner would not cause these types of injuries. An adult could generate enough force while bending the child's arms back to account for Audrey's injuries. (Although it was not Dr. Ramaiah's opinion to a reasonable degree of medical certainty that was what occurred in this case.) She testified that bilateral fractures could occur from a fall, although she had never seen a case where that happened. Audrey would experience pain if someone was to pick her up by her arms or hands if her arms were broken. She would be able to do something with her hands but she would not be able to pull herself up or grab things while playing if her arms were broken.

[¶11] Audrey's skeletal survey also revealed a healing clavicle fracture on her left side. The two pieces of bone were completely separated. Dr. Ramaiah testified that clavicle injuries are common in children and can occur from a fall. She testified Audrey's clavicle injury was at least 7 to 10 days old at the time of the skeletal survey because callous had begun to form. She consulted with an orthopedist who estimated that Audrey's injury was two to six weeks old. Dr. Ramaiah learned that, about a week or two earlier, Audrey had been playing with the family dog and fell.

[¶12] Dr. Ramaiah testified that with a collarbone injury movement of the shoulder and lifting of the arm would create pain. ...


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