In THE INTEREST OF M. B., CHILDREN (MOTHER) ( 2022 )

FIFTH DIVISION
RICKMAN, C. J.,
MCFADDEN, P. J., and SENIOR APPELLATE JUDGE PHIPPS
NOTICE: Motions for reconsideration must be
physically received in our clerk’s office within ten
days of the date of decision to be deemed timely filed.
https://www.gaappeals.us/rules
February 11, 2022
In the Court of Appeals of Georgia
A21A1348. IN THE INTEREST OF M. B. et al., children.
PHIPPS, Senior Appellate Judge.
The mother of eleven-year-old M. B. and her nine-year-old brother, P. B.,
appeals from a juvenile court order modifying the disposition of M. B. and P. B., who
had previously been determined to be dependent. The mother contends that the
Whitfield County Juvenile Court (“Whitfield Court”) erred by finding that the
evidence was sufficient to support the placement of custody of the children with the
Whitfield County Department of Family and Children Services (“Whitfield DFCS”).
For the reasons that follow, we affirm.
M. B. and P. B. were found to be dependent by the Chatham County Juvenile
Court (“Chatham Court”) in 2017. The Chatham Court found that the mother suffered
from a mental health condition that impairs her ability to provide proper parental care,
that she received social security benefits as a result of a depression diagnosis, and that
she acknowledged she needs a higher level of mental health care than she was
receiving through her then-current counseling. The Chatham Court also noted that the
Chatham County Department of Family and Children Services (“Chatham DFCS”)
had conducted a parental fitness assessment of the mother and recommended a
psychological evaluation, including personality testing for the condition of factitious
disorder imposed on another. Although the Chatham Court found the children to be
dependent, the court ordered custody and control of the children to remain with the
mother subject to conditions placed upon her by the court. One such condition was
that the mother undergo a psychological evaluation and comply with any
recommendations arising out of the evaluation.
After the mother relocated to Whitfield County, the Whitfield DFCS filed a
dependency complaint in February 2020 alleging that M. B. had not been to school
in approximately six weeks and that the mother had reported to school and medical
providers that M. B. had been injured while the family was running from a tornado.1
The complaint also alleged that P. B. had been hospitalized over ten times for
1
At the preliminary protective hearing, a supervisor with the Whitfield DFCS
testified that there had been no tornado in the area on the date the mother claimed M.
B. was injured.
2
suicidal/homicidal thoughts or actions, was at that time hospitalized in Savannah, and
had not been receiving any mental health treatment or medication prior to his
hospitalization. The Whitfield Court removed the children from the custody of the
mother and placed the children in the custody of the Whitfield DFCS. Following a
preliminary protective hearing, the Whitfield DFCS filed a petition alleging
dependency in March 2020. The Whitfield DFCS also filed a motion requesting the
court to order the mother to undergo a psychological evaluation. After a hearing, the
Whitfield Court granted the Whitfield DFCS’s motion.
On September 25, 2020, the Whitfield Court held a hearing to determine
whether to modify the Chatham Court’s disposition order.2 During the hearing, with
the agreement of the parties, the Whitfield Court dismissed the dependency petition
filed in that court (because the children had already been determined to be dependent
by the Chatham Court) but moved forward with the hearing on the issue of whether
the disposition of custody should be changed.
At the September 25 hearing, an expert in the field of forensic psychology
testified that she evaluated the mother and that her evaluation included reviewing
2
In March 2020, the Chatham Court dependency proceedings were transferred
to the Whitfield Court.
3
documents provided to her by the Whitfield DFCS and examining the mother, who
provided additional documents. According to the expert, she performed various tests
with the mother, including a basic personality assessment inventory, a child abuse
potential inventory, a parenting stress inventory for both M. B. and P. B., and a
psychopathic personality inventory. The expert also completed a mental status exam
and an extensive interview of the mother.
The expert concluded that the mother has the condition known as factitious
disorder imposed on another (“FDIA”), which was previously known as Munchausen
syndrome by proxy. The expert’s written evaluation described the disorder as follows:
In this mental illness, a person acts as if an individual he or she is caring
for has a physical or mental illness when the person is not really sick.
The adult perpetrator who has the diagnosis (FDIA) directly produces
or lies about illness in another person under his or her care, usually a
child under 6 years of age. . . . People with FDIA have an inner need for
the other person (often his or her child) to be seen as ill or injured. It is
not usually done to achieve a concrete benefit, such as financial gain,
although that may occur in some cases. People with FDIA are even
willing to have the child or patient undergo painful or risky tests and
operations in order to get the sympathy and special attention given to
people who are truly ill and their families. Factitious disorders are
considered mental illnesses because they are associated with severe
emotional difficulties.
4
At the hearing, the expert described, in detail, the basis for her conclusion that the
mother has factitious disorder imposed on another. She explained that there was a
consistent pattern of the mother finding problems with P. B. from a young age. For
example, by the time he was three years old, the mother had P. B. put on an attention
deficit hyperactivity disorder (“ADHD”) medicine, even though it is not usually
administered to children until about the age of six. According to the expert, every
time the mother had problems that she could not handle, the mother put P. B. in a
mental hospital. The expert testified that the records show that each time P. B. was
assessed by a child psychologist, reading specialist, or other educational evaluator,
the evaluator described him as a “sweet child” who responded to adult attention and
calmed down easily if he became upset. The expert noted that P. B. was not accepted
to one particular program because his behavior was “too good.” Furthermore, the
expert testified that although P. B. was hospitalized over fifteen times during the five-
year period he was in the mother’s care, P. B. has not been hospitalized at all since
he has been in foster care.
According to the expert, although the mother told her that P. B. “did not have
a good cognitive level,” a cognitive development assessor described P. B. as
“demonstrating the cognitive and early academic skills expected of a child of his
5
age,” and one of his teachers said P. B. “demonstrates the same level of cognitive
skills as peers, if not a little more advanced.”
Similarly, although the mother claimed that P. B. had severe hearing loss and
needed to wear bilateral hearing aids, the expert testified that in both 2016 and after
P. B. entered foster care, testing showed normal hearing in one ear and mild hearing
loss in the other. According to the expert, a report indicated that when P. B. told his
mother that he did not have hearing loss, she told him that he did. The expert
characterized this a sign of factitious disorder imposed on another.
The expert noted that P. B.’s school records indicate that he was “always”
hungry at school. According to the expert, the school was concerned because the
mother said P. B. was on a special diet, and she would send lunches to school with
him in a locked lunch box, explaining that she did not want him eating his food
before lunchtime. The expert testified that teachers took the locks off the lunch box
and let P. B. have the food. In fact, school personnel started feeding him more and
different food, which made the mother very angry. The mother claimed, on the other
hand, that P. B.’s school requested that she lock his lunch box so he could not sneak
food on the bus; she explained that she was a food blogger and because he saw her
taking pictures of his lunch every day, he really looked forward to what he had to eat
6
and he started eating his lunch before lunchtime and not having any food after that.
Notably, when P. B. first arrived in foster care, he hoarded food; his foster parents
would find hundreds of food wrappers under his bed and in his laundry.
Consequently, P. B.’s foster family worked hard to teach him that he was going to get
as much food as he wanted, and P. B.’s food hoarding has subsided in the time that
he has been in foster care.
The expert also testified that the mother said P. B. had major allergies,
including an allergy to peanuts. In fact, at one point, when he got near peanuts, the
mother injected him with epinephrine, using an auto-injector, and then took him to
the hospital, but the hospital found no indication of an anaphylactic response.
According to the expert, after P. B. came into foster care, allergy tests showed that he
has only mild allergies.
Regarding M. B., the expert testified that when M. B. was an infant, she was
diagnosed with an unusual disorder that caused her to “spit up” and “go rigid.” The
disorder was diagnosed the first time the mother took M. B. to an emergency room,
but the mother brought M. B. back to the emergency room with similar symptoms
many times. According to the expert, although the mother reported that M. B.’s
7
symptoms were getting worse, hospital personnel detected no worsening of
symptoms.
The expert determined that the family has five of the seven basic criteria for a
diagnosis of factitious disorder imposed on another in the mother: (1) a history of
hospitalizations of the children; (2) worsening of the children’s symptoms as reported
by the parent but not witnessed during hospital stays; (3) a mismatch between the
children’s reported conditions and symptoms and the results of testing; (4) one or
more unusual illnesses or deaths of children in the family; and (5) an improvement
of the children’s conditions in the hospital, with symptoms reoccuring when they
return home. The expert found that the other two criteria for a diagnosis of factitious
disorder imposed on another are not present – blood in lab samples not matching the
blood of the children, and signs of chemicals in the children’s blood, stool, or urine.
The expert explained that treating factitious disorder imposed on another is
difficult because those with the disorder often deny there is a problem, and successful
treatment is dependent on catching the person in the act or the person telling the truth.
The expert testified that the mother’s disorder had harmed the children by subjecting
them to unnecessary medical procedures, hospitalizations, hunger, potential
malnutrition, and psychological abuse. According to the expert, the psychological
8
harm caused to children by factitious disorder imposed on another is intense and “not
easily gotten over.”
The children’s foster parent also testified at the hearing. According to the foster
parent, “it was rough” when M. B. and P. B. first came to live with his family, but
they are now “doing pretty well.”
At the hearing, the mother testified she did not know the medical details related
to P. B.’s hearing issues because she was in prison when he was born and he was then
cared for by his father and his grandmother. According to the mother, P. B. failed his
newborn hearing test, and his diagnoses varied between hearing loss in one ear and
hearing loss in both ears.
The mother testified that, when she got out of prison, P. B. was two-and-a-half
years old and was “delayed language-wise,” “had sensory issues,” and was “kind of
hyper.” She claimed that P. B. was put on ADHD medication when he was three-and-
a-half years old based on a doctor’s recommendation. The mother testified that P. B.
was first hospitalized after he tried to stab M. B. with a pair of scissors in 2016.
According to the mother, he was hospitalized many times after that for running in
traffic or jumping out of a car.
9
Based on the evidence presented at the hearing, the Whitfield Court found that
the mother has factitious disorder imposed on another3 and that the disorder has
adversely affected both children, especially P. B. The Whitfield Court concluded that
the findings from the mother’s psychological evaluation constituted changed
circumstances that required a modification of the disposition order. Consequently, the
Whitfield Court modified the disposition order to vest temporary custody of the
children in the Whitfield DFCS, with supervised visitation by the mother. This appeal
followed.
We review a juvenile court’s modification of disposition for abuse of
discretion. See In the Interest of J. N. F., 306 Ga. App. 313, 315 (701 SE2d 925)
(2010). “There can be no abuse of discretion if there was any evidence to support the
ruling of the juvenile court.” Id.In her sole enumeration of error, the mother contends that the Whitfield Court
erred by finding the evidence sufficient to support the placement of custody of the
children with the Whitfield DFCS. Specifically, the mother contends that (1) her
testimony refuted the testimony of the expert, (2) she “loves her children and has
3
Although the Whitfield Court’s order used the term “Factitious Disorder,” in
context, it is clear that the court was referring to factitious disorder imposed on
another.
10
taken good care of them,” and (3) she showed “substantial credibility both as a person
and a mother by the detailed and knowledgeable testimony that she provided.” She
argues that the Chatham Court did not find the mother a threat to the children and
allowed them to live with her and that the Whitfield Court “abused [its] discretion in
failing to allow the children to live with their mom” and making a custody decision
that was “not in accordance with [the decision of the Chatham Court].”
The Whitfield Court had the authority to modify the earlier disposition order
based on changed circumstances if doing so would be in the best interest of M. B. and
P. B. See OCGA § 15-11-32 (b) (an order of the juvenile court may be “changed,
modified, or vacated on the ground that changed circumstances so require in the best
interests of a child[.]”); In the Interest of H. G. D., 342 Ga. App. 651, 653 (1) (803
SE2d 788) (2017) (juvenile court had authority to modify custody of dependent
children where it determined that the safest placement of the children would be in
DFCS custody). On appeal, this Court does not determine witness credibility but
instead defers to the factual findings made by the juvenile court. In the Interest of R.
D., 346 Ga. App. 257, 259 (1) (816 SE2d 132) (2018). Despite the mother’s
argument, the Whitfield Court’s finding that the mother has factitious disorder
imposed on another and that the disorder has adversely affected both children is
11
supported by the record. Furthermore, although the Chatham DFCS had
recommended that the mother be evaluated for factitious disorder imposed on
another, the mother had never been diagnosed with the disorder until she was
evaluated by the expert who testified at the Whitfield Court hearing on modification
of disposition. Thus, the evidence in the record regarding the mother’s diagnosis and
her behavior consistent with that diagnosis supports the Whitfield Court’s conclusion
that changed circumstances require a modification of the disposition order.
Judgment affirmed. Rickman, C. J., and McFadden, P. J., concur.
12