In re Interest of Gavin S. & Jordan S. ( 2015 )


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  •                                     - 401 -
    Decisions of the Nebraska Court of A ppeals
    23 Nebraska A ppellate R eports
    IN RE INTEREST OF GAVIN S. & JORDAN S.
    Cite as 
    23 Neb. Ct. App. 401
    In   re I nterest of
    Gavin S. and Jordan S.,
    children under18 years of age.
    State of Nebraska, appellee and cross-appellee,
    v. Lacy S., appellant, and Daniel S.,
    appellee and cross-appellant.
    ___ N.W.2d ___
    Filed November 24, 2015.   No. A-14-1124.
    1.	 Juvenile Courts: Evidence: Appeal and Error. Juvenile cases are
    reviewed de novo on the record, and an appellate court is required to
    reach a conclusion independent of the juvenile court’s findings. When
    the evidence is in conflict, however, an appellate court may give weight
    to the fact that the lower court observed the witnesses and accepted one
    version of the facts over the other.
    2.	 Parental Rights: Evidence: Appeal and Error. Because factual ques-
    tions concerning a judgment or order terminating parental rights are
    tried by an appellate court de novo on the record, impermissible or
    improper evidence is not considered by an appellate court.
    3.	 Parental Rights. When parental rights are terminated pursuant to Neb.
    Rev. Stat. § 43-292(9) (Cum. Supp. 2014), a prior adjudication order is
    not required.
    4.	 Parental Rights: Evidence: Proof. For a juvenile court to terminate
    parental rights under Neb. Rev. Stat. § 43-292 (Cum. Supp. 2014), it
    must find by clear and convincing evidence that one or more of the
    statutory grounds listed in this section have been satisfied and that ter-
    mination is in the child’s best interests.
    5.	 Evidence: Words and Phrases. Clear and convincing evidence is that
    amount of evidence which produces in the trier of fact a firm belief or
    conviction about the existence of the fact to be proven.
    Appeal from the Separate Juvenile Court of Lancaster
    County: Toni G. Thorson, Judge. Affirmed.
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    IN RE INTEREST OF GAVIN S. & JORDAN S.
    Cite as 
    23 Neb. Ct. App. 401
    Lisa F. Lozano for appellant.
    Joe Kelly, Lancaster County Attorney, Alicia B. Henderson,
    and Joshua L. Christolear, Senior Certified Law Student, for
    appellee State of Nebraska.
    Sanford J. Pollack, of Pollack & Ball, L.L.C., for appellee
    Daniel S.
    Irwin, Inbody, and R iedmann, Judges.
    Irwin, Judge.
    I. INTRODUCTION
    Lacy S. appeals and Daniel S. cross-appeals from an order
    of the separate juvenile court of Lancaster County, which
    order adjudicated Lacy and Daniel’s two minor children to be
    within the meaning of Neb. Rev. Stat. § 43-247(3)(a) (Supp.
    2013) and terminated Lacy’s and Daniel’s parental rights to
    the children. In their appeals, both Lacy and Daniel assert that
    the juvenile court erred in admitting into evidence a report
    authored by a doctor who was unavailable to testify during the
    juvenile court proceedings. In addition, both Lacy and Daniel
    allege that the juvenile court erred in finding sufficient evi-
    dence to warrant the adjudication of their children pursuant to
    § 43-247(3)(a) and to warrant the termination of their parental
    rights. For the reasons set forth below, we affirm the decision
    of the juvenile court.
    II. BACKGROUND
    Lacy and Daniel are the parents of Gavin S., born in August
    2009, and Jordan S., born in June 2011. The events which gave
    rise to the juvenile court proceedings involving this family
    occurred on January 3, 2012.
    In January 2012, Lacy was a stay-at-home mother who
    operated a daycare out of the family’s home in order to
    earn additional income. One of the children who attended
    Lacy’s daycare was 1-year-old Zachary T. On the morning
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    IN RE INTEREST OF GAVIN S. & JORDAN S.
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    of January 3, Zachary’s father dropped him off at Lacy and
    Daniel’s home. When Zachary arrived at the daycare, he was
    awake, alert, happy, and playful.
    Approximately 1 hour after Zachary arrived at the day-
    care, Lacy left to take Gavin and Jordan to a doctor’s
    appointment. Daniel stayed behind to watch Zachary, who
    was in a baby swing in the family’s living room. When Lacy
    returned to the home a couple of hours later, Zachary was
    still in the baby swing. Zachary remained in the swing, not
    moving and not making any noise, until about 3:30 p.m.,
    when Lacy checked on him. At that time, she discovered that
    Zachary was not breathing and felt cold to the touch. Lacy
    called the 911 emergency dispatch service and attempted
    to perform CPR on Zachary. Zachary was later pronounced
    dead at the hospital.
    After Zachary’s death, doctors discovered that he had a
    skull fracture which was a few weeks old and that he had
    significant additional trauma to his brain which the doctors
    believed had occurred much more recently.
    Due to the events of January 3, 2012, the State filed a
    motion for emergency temporary custody of Gavin and Jordan
    on January 5. The juvenile court granted this motion, ordered
    Gavin and Jordan removed from Lacy and Daniel’s home, and
    placed them in the custody of the Department of Health and
    Human Services. The children have remained in the custody of
    the department, in an out-of-home placement, since the entry
    of the court’s order on January 5. The next day, on January 6,
    the State filed a petition alleging that Gavin and Jordan were
    within the meaning of § 43-247(3)(a).
    The petition alleged that the children were within the mean-
    ing of § 43-247(3)(a) due to the faults or habits of Lacy and
    Daniel or due to being in a situation dangerous to life or limb
    or injurious to their health. Specifically, the petition alleged
    that Zachary had “died as a result of extensive, inflicted head
    trauma” while in Lacy’s and Daniel’s care; that neither Lacy
    nor Daniel had provided any explanation for Zachary’s head
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    IN RE INTEREST OF GAVIN S. & JORDAN S.
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    trauma; and that consequently, Gavin and Jordan were at risk
    for harm.
    A few months after the filing of the original petition, on
    March 29, 2012, the State filed an amended petition and a
    motion for the termination of Lacy’s and Daniel’s parental
    rights. In the amended petition, the State again alleged that
    Gavin and Jordan were within the meaning of § 43-247(3)(a)
    due to the faults or habits of Lacy and Daniel or due to being in
    a situation dangerous to life or limb or injurious to their health.
    Specifically, the amended petition alleged:
    On or about January 3, 2012, Zachary . . . , a one-year old
    child who had been in the care of [Daniel] and [Lacy],
    died as a result of cerebral edema which occurred while
    Zachary . . . was in the care of [Daniel] and/or [Lacy].
    Zachary . . . also suffered from cerebral contusion(s),
    subarachnoid hemorrhages and bruises to his shoulders,
    which occurred while he was in the care of [Daniel] and
    [Lacy]. These injuries are most consistent with abusive
    head trauma.
    The petition also alleged that Lacy and Daniel had not pro-
    vided any explanation as to how Zachary’s injuries occurred
    and that Lacy and Daniel had caused Zachary’s death or
    failed to provide appropriate care to Zachary, which failure
    had contributed to or caused his death. The petition alleged
    that as a result of these facts, Gavin and Jordan were at risk
    for harm.
    The motion for the termination of Lacy’s and Daniel’s
    parental rights alleged that termination was warranted pursu-
    ant to Neb. Rev. Stat. § 43-292(9) (Cum. Supp. 2014) because
    Lacy and Daniel subjected Zachary to aggravated circum-
    stances, including, but not limited to, torture and chronic
    abuse. In addition, the State alleged that termination of Lacy’s
    and Daniel’s parental rights was in the children’s best inter-
    ests and that reasonable efforts to reunify the family were
    not required.
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    IN RE INTEREST OF GAVIN S. & JORDAN S.
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    On January 13, 2014, the State filed a second amended
    petition and amended motion for termination of Lacy’s and
    Daniel’s parental rights. This petition and motion constitute the
    operative pleading for the proceedings at issue in this appeal.
    Accordingly, we lay out the allegations contained in this sec-
    ond amended petition and motion to terminate parental rights
    in some detail.
    In the second amended petition, the State again alleged that
    Gavin and Jordan were within the meaning of § 43-247(3)(a)
    due to the faults or habits of Lacy and Daniel or due to being in
    a situation dangerous to life or limb or injurious to their health.
    Specifically, the second amended petition alleged:
    A) On or between November of 2011 and January 3,
    2012, [Daniel] and [Lacy] provided day-care for Zachary
    ....
    B) On or after December 1, 2011, Zachary[’s] skull
    was fractured while in the care of [Daniel] and/or [Lacy].
    C) On or about January 3, 2012, Zachary . . . died as a
    result of cerebral edema and/or trauma to his brain which
    occurred while Zachary . . . was in the care of [Daniel]
    and/or [Lacy], and which was the result of child abuse
    and/or non-accidental or abusive head trauma.
    D) On or about January 3, 2012, while in the care of
    [Daniel] and/or [Lacy], Zachary . . . suffered from acute
    injuries to his brain, acute injuries to his head, and acute
    symmetrical bruising to his shoulders which injuries and
    bruising are most consistent with child abuse and/or non-
    accidental or abusive head trauma.
    E) Neither [Daniel] nor [Lacy] has provided an expla-
    nation as to how the above-described injuries, bruising,
    skull fracture, and/or death occurred to Zachary . . . .
    F) [Daniel] and/or [Lacy] caused Zachary[’s] death;
    and/or [Daniel] and/or [Lacy] failed to provide appropri-
    ate care to Zachary . . . which resulted in his death; and/or
    [Daniel] and/or [Lacy] failed to provide appropriate care
    to Zachary . . . which contributed to his death.
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    G) One or more of the above and/or this situation
    place(s) said juveniles at risk of harm.
    H) All in Lancaster County, Nebraska.
    In the amended motion to terminate Lacy’s and Daniel’s
    parental rights, the State again alleged that termination was
    warranted pursuant to § 43-292(9); however, in addition,
    the State alleged that termination was also warranted pursu-
    ant to § 43-292(7) because Gavin and Jordan had been in an
    out-of-home placement for 15 or more months of the most
    recent 22 months. The State alleged that termination of Lacy’s
    and Daniel’s parental rights was in the children’s best inter-
    ests and that reasonable efforts to reunify the family were
    not required.
    On the same day that the State filed its second amended
    petition and amended motion to terminate parental rights,
    January 13, 2014, the hearing on that pleading began. This
    lengthy hearing continued on numerous dates in January
    through June 2014. We have reviewed the evidence presented
    at this hearing in its entirety, including the 2,500-page bill of
    exceptions and each of the more than 80 exhibits presented by
    the parties. However, we do not set forth the specifics of all of
    the voluminous testimony and exhibits here.
    Nevertheless, because the exact cause of Zachary’s death
    and the precise time his injuries were sustained played a cen-
    tral role in the hearing, and are similarly significant in this
    appeal, we do briefly summarize the expert witness testimony
    presented by all of the parties on this topic.
    The State and the children’s guardian ad litem offered the
    testimony of three separate medical professionals in order to
    prove that Zachary died as a result of injuries he sustained
    while at Lacy and Daniel’s home on January 3, 2012. These
    medical professionals included Dr. Robert Bowen, a patholo-
    gist who performed the autopsy on Zachary; Dr. Daniel Davis,
    a pathologist and medical examiner in the State of Oregon;
    and Dr. Suzanne Haney, a pediatrician specializing in child
    abuse treatment.
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    IN RE INTEREST OF GAVIN S. & JORDAN S.
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    Dr. Bowen testified that during the autopsy of Zachary,
    he observed evidence of both recent and older head trauma.
    Dr. Bowen testified that Zachary had a healing skull fracture
    which was more than 2 weeks old. Zachary also had bruising
    on his brain and bleeding on the surface of the brain which
    were much more recent. Dr. Bowen opined that these injuries
    were less than 24 hours old. In addition, Dr. Bowen observed
    bruising on both of Zachary’s shoulders which he believed to
    be less than 24 hours old. Dr. Bowen testified that it was the
    most recent traumatic brain injuries, and not the skull fracture,
    that were the cause of Zachary’s death.
    After reviewing Zachary’s medical records, police reports,
    and the autopsy report authored by Dr. Bowen, Dr. Davis testi-
    fied that Zachary died from inflicted, blunt force head trauma
    which caused bruising to the brain and bleeding on the surface
    of the brain. He testified that such injuries would cause imme-
    diate and dramatic changes in Zachary, including irregular
    breathing, stiffening of his limbs, and unresponsiveness. Dr.
    Davis testified that given that Zachary was awake, alert, and
    mobile when he arrived at Lacy and Daniel’s home on January
    3, 2012, he had to have been injured by either Lacy or Daniel
    when they were caring for him that morning. Dr. Davis specifi-
    cally testified that Zachary’s preexisting skull fracture did not
    directly contribute to his death on January 3.
    Similarly, Dr. Haney testified that Zachary’s death was
    caused by abusive head trauma which occurred after Zachary
    was dropped off at Lacy and Daniel’s home on January 3,
    2012. She testified that the preexisting skull fracture did not
    cause Zachary’s death. Dr. Haney indicated that in her expe-
    rience in treating skull fractures in children, a child can die
    from a skull fracture and a resulting brain injury, but such
    death would occur immediately or in a few days after the
    injury. A child’s condition would not dramatically worsen in
    the weeks following the injury; nor would a child die sud-
    denly and unexpectedly weeks after incurring such an injury.
    Dr. Haney testified that Zachary’s death was caused by a
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    second injury to Zachary’s brain. This injury was caused by
    a force similar to a fall of approximately 12 feet, such as out
    of a window, or to a car accident. It was not an injury which
    could have occurred with normal caretaking or a fall from a
    piece of household furniture.
    Lacy offered the testimony of one medical professional,
    Dr. Janice Ophoven, a pediatric pathologist. Dr. Ophoven dis-
    agreed with the other three medical professionals who testified.
    She testified that Zachary died as a result of complications
    from the skull fracture he sustained a few weeks prior to his
    death. She testified that Zachary did not sustain any new, sig-
    nificant trauma on January 3, 2012.
    We will set forth other pertinent facts as presented at the
    hearing as necessary in our analysis below.
    After the hearing, the juvenile court entered a detailed,
    21-page order summarizing and analyzing the evidence pre-
    sented by all the parties. In the order, the court indicated
    that it found the medical opinions of Drs. Bowen, Davis, and
    Haney to be credible and, accordingly, that Zachary “died as
    a result of blunt force trauma to his head and that the trauma
    was caused by physical force consistent with a finding of
    intentional injury.” The court specifically stated that it found
    that the medical opinion of Dr. Ophoven was not supported
    by the evidence. The court found that Zachary did not die as
    a result of the skull fracture he sustained weeks before his
    death. Instead, the court found that on January 3, 2012, “[a]fter
    [Zachary] was left in the care of Daniel . . . and Lacy . . . , one
    or both of them inflicted the injury that resulted in his death
    and one or both of them failed to provide prompt medical care
    to Zachary.”
    Ultimately, the court adjudicated Gavin and Jordan as chil-
    dren described in § 43-247(3)(a). The court also terminated
    Lacy’s and Daniel’s parental rights to the children after finding
    the children were within the meaning of § 43-292(7) and (9)
    and that such termination was in their best interests.
    Lacy appeals and Daniel cross-appeals from this order.
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    III. ASSIGNMENTS OF ERROR
    Given that Lacy and Daniel present the same assignments of
    error in their appeals, we combine their assignments of error
    as follows: Lacy and Daniel assert that the juvenile court erred
    in (1) admitting into evidence exhibit 53, a report authored by
    Dr. Roger Brumback, a neuropathologist, when Dr. Brumback
    was unavailable to testify at the termination hearing; (2) find-
    ing sufficient evidence to warrant the adjudication of Gavin
    and Jordan pursuant to § 43-247(3)(a); and (3) finding suf-
    ficient evidence to warrant the termination of their parental
    rights to Gavin and Jordan.
    IV. ANALYSIS
    1. Standard of R eview
    [1] Juvenile cases are reviewed de novo on the record, and
    an appellate court is required to reach a conclusion indepen-
    dent of the juvenile court’s findings. In re Interest of Jagger L.,
    
    270 Neb. 828
    , 
    708 N.W.2d 802
    (2006). When the evidence is
    in conflict, however, an appellate court may give weight to the
    fact that the lower court observed the witnesses and accepted
    one version of the facts over the other. 
    Id. 2. A
    dmissibility of Exhibit 53
    Lacy and Daniel first challenge the juvenile court’s deci-
    sion to admit into evidence exhibit 53, a pathology report
    authored by Dr. Brumback, who was not available to testify
    at the termination hearing. On appeal, they both assert that
    the report was inadmissible because it contained hearsay and
    because they were unable to cross-examine Dr. Brumback
    about his opinions and conclusions. Lacy and Daniel also both
    assert that the juvenile court erred in permitting Dr. Bowen
    to discuss the report during his testimony. For the reasons set
    forth below, we find Lacy’s and Daniel’s assertions concerning
    exhibit 53 to be without merit.
    As we discussed above, Dr. Bowen performed the autopsy
    of Zachary after his death. Part of the autopsy involved
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    studying specific areas of Zachary’s brain. For this portion
    of the autopsy, Dr. Bowen worked in collaboration with Dr.
    Brumback. Together, Drs. Bowen and Brumback determined
    what specific testing needed to be completed on the brain and
    then conducted that testing and analyzed the results. Once the
    testing and analysis were completed, Dr. Brumback authored
    a report containing his observations and conclusions. After
    he authored this report, but before the time of the termination
    hearing in this case, Dr. Brumback died unexpectedly. As a
    result, he was unavailable to testify at the hearing.
    During Dr. Bowen’s testimony, the State questioned him
    about Dr. Brumback’s report. Dr. Bowen indicated that he
    relied on some of the conclusions in the report in rendering
    his opinion about the cause of Zachary’s death. After this tes-
    timony, the State offered into evidence those portions of Dr.
    Brumback’s report that Dr. Bowen relied upon. This exhibit
    was identified as exhibit 53. Lacy and Daniel objected to the
    admission of this exhibit, arguing that the report was not rel-
    evant, that it was not admissible because Dr. Brumback was
    not available to be cross-examined, and that it constituted
    hearsay. The court overruled the objections and admitted into
    evidence exhibit 53. Lacy and Daniel appeal from this eviden-
    tiary ruling.
    In analyzing whether the juvenile court erred in admitting
    into evidence Dr. Brumback’s report, we first note that in its
    lengthy order and recitation of the evidence presented, the
    court did not ever mention Dr. Brumback, his report, or the
    conclusions contained in the report. In fact, the court specifi-
    cally stated that it based its conclusion that Zachary died from
    significant injuries which were inflicted on January 3, 2012,
    “on the medical testimony provided by Dr. Davis and Dr. . . .
    Bowen and Dr. . . . Haney.” Accordingly, it does not appear
    that the juvenile court relied on Dr. Brumback’s report in
    any way.
    [2] However, even if the juvenile court did rely on Dr.
    Brumback’s report and even if that report was erroneously
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    admitted into evidence, a juvenile court’s consideration of
    improper evidence does not, by itself, require reversal of
    a judgment terminating parental rights under the Nebraska
    Juvenile Code. Because factual questions concerning a judg-
    ment or order terminating parental rights are tried by an appel-
    late court de novo on the record, impermissible or improper
    evidence is not considered by an appellate court. See In re
    Interest of J.S., A.C., and C.S., 
    227 Neb. 251
    , 
    417 N.W.2d 147
    (1987).
    In our review of the juvenile court’s decision to terminate
    Lacy’s and Daniel’s parental rights, we assume, without spe-
    cifically deciding, that exhibit 53, Dr. Brumback’s report, was
    improperly admitted into evidence, and as such, we do not con-
    sider that exhibit in determining whether there was sufficient
    evidence to warrant the termination of Lacy’s and Daniel’s
    parental rights. Instead, we rely on the testimonies of the four
    other experts, Drs. Bowen, Davis, Haney, and Ophoven, in
    determining the cause of Zachary’s death.
    3. A djudication
    Lacy and Daniel next challenge the juvenile court’s deci-
    sion to adjudicate their children pursuant to § 43-247(3)(a).
    However, before we address the merits of this assertion, we
    address their arguments concerning the juvenile court’s deci-
    sion to terminate their parental rights, because we find that
    a prior adjudication is not necessary when parental rights are
    terminated pursuant to § 43-292(9). So, if we affirm the court’s
    decision to terminate Lacy’s and Daniel’s parental rights on
    that ground, an analysis of the propriety of the juvenile court’s
    adjudication order would be unnecessary.
    The Nebraska Supreme Court has previously found that the
    grounds contained in § 43-292(1) through (5) do not “require,
    imply, or contemplate juvenile court involvement, including
    adjudication, prior to the filing of the petition for termina-
    tion of parental rights.” In re Interest of Joshua M. et al., 
    256 Neb. 596
    , 609, 
    591 N.W.2d 557
    , 566 (1999). Subsection (9)
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    of § 43-292 was not in effect at the time of the decision in In
    re Interest of Joshua M. et al., and as a result, the Supreme
    Court did not specifically determine whether termination under
    that subsection required a prior adjudication order. See 
    id. However, based
    upon our review of the court’s rationale with
    regard to § 43-292(1) through (5) and our reading of subsec-
    tion (9), we conclude that subsection (9) also does not require,
    imply, or contemplate an adjudication prior to the termination
    of parental rights.
    In In re Interest of Joshua M. et 
    al., 256 Neb. at 609-10
    , 591
    N.W.2d at 566, the Supreme Court explained its rationale for
    finding that § 43-292(1) through (5), unlike subsections (6) and
    (7), do not require a prior adjudication order:
    [S]ubsections (1) through (5) each concern historical
    actions or conditions of the parents such as abandonment,
    neglect, unfitness, and mental deficiency. There is no
    requirement of longitudinal involvement of the juvenile
    court under § 43-292(1) through (5), much less a prior
    adjudication. . . .
    Through the plain language of § 43-292, the Legislature
    has demonstrated its intention that under certain circum-
    stances, prior court action or an adjudication is required
    before parental rights can be terminated. See § 43-292(6)
    and (7). Conversely, in this same statutory section, the
    Legislature has listed other conditions justifying paren-
    tal termination, dependent not upon prior juvenile court
    action but upon the actions or conditions of the parents.
    The Legislature’s obvious inclusion of prior court action
    under certain conditions demonstrates a clear intention
    that such action is necessary only under the enumer-
    ated circumstances.
    When we apply the court’s rationale concerning § 43-292(1)
    through (5) to the language of subsection (9), we conclude
    that there is no indication that the Legislature contemplated
    any prior court action prior to termination under this subsec-
    tion. Section 43-292(9) provides that a court may terminate
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    parental rights when “[t]he parent of the juvenile has sub-
    jected the juvenile or another minor child to aggravated cir-
    cumstances, including, but not limited to, abandonment, tor-
    ture, chronic abuse, or sexual abuse.” This language is focused
    primarily on “the actions or conditions of the parents” and not
    on any prior juvenile court involvement. See In re Interest of
    Joshua M. et 
    al., 256 Neb. at 610
    , 591 N.W.2d at 566. The
    Legislature did not include any mention of prior court action
    under this subsection.
    [3] We conclude that terminating parental rights pursuant
    to § 43-292(9) does not require a prior adjudication order.
    And, because no prior adjudication order is required, we do
    not review at this point in our analysis the juvenile court’s
    decision to adjudicate Gavin and Jordan. Instead, we will first
    analyze whether the court abused its discretion in terminating
    Lacy’s and Daniel’s parental rights pursuant to § 43-292(9). If
    we do not find an abuse of discretion in this regard, we need
    not discuss the court’s adjudication order any further.
    4. Termination of Parental R ights
    On appeal, both Lacy and Daniel assert that the juvenile
    court erred in finding that clear and convincing evidence sup-
    ports the termination of their parental rights to Gavin and
    Jordan. Specifically, Lacy and Daniel assert that there was
    insufficient evidence presented to prove they were responsible
    for Zachary’s death and that without such definitive evidence,
    there is no basis for the termination of their parental rights.
    Upon our de novo review of the record, we affirm the decision
    of the juvenile court to terminate Lacy’s and Daniel’s paren-
    tal rights.
    [4,5] For a juvenile court to terminate parental rights under
    § 43-292, it must find that one or more of the statutory grounds
    listed in this section have been satisfied and that termination
    is in the child’s best interests. See In re Interest of Jagger L.,
    
    270 Neb. 828
    , 
    708 N.W.2d 802
    (2006). The State must prove
    these facts by clear and convincing evidence. 
    Id. Clear and
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    convincing evidence is that amount of evidence which pro-
    duces in the trier of fact a firm belief or conviction about the
    existence of the fact to be proven. 
    Id. (a) Statutory
    Factors
    In this case, the juvenile court found that termination of
    Lacy’s and Daniel’s parental rights was warranted pursuant to
    § 43-292(7) and (9). Because only one statutory ground con-
    tained within § 43-292 must be proven to support the termina-
    tion of parental rights, we focus our discussion on the evidence
    presented with regard to § 43-292(9).
    As we have stated above, § 43-292(9) provides that parental
    rights may be terminated when “[t]he parent of the juvenile
    has subjected the juvenile or another minor child to aggravated
    circumstances, including, but not limited to, abandonment, tor-
    ture, chronic abuse, or sexual abuse.” Upon our de novo review
    of the record, we conclude that there was clear and convincing
    evidence presented at the termination hearing to demonstrate
    that Lacy and Daniel subjected Zachary to “aggravated circum-
    stances” pursuant to subsection (9).
    The evidence presented by the State at the termination
    hearing revealed that 1-year-old Zachary arrived at Lacy and
    Daniel’s home for daycare on January 3, 2012. When he
    arrived, he was alert, playful, and happy. And, although he was
    suffering from an undiagnosed skull fracture, that injury had
    begun to heal and, on that morning, was not affecting Zachary
    in a significant way.
    Approximately 8 hours after Zachary arrived at Lacy and
    Daniel’s home, he was pronounced dead due to recent and
    severe head trauma similar to that incurred in a fall from a
    height of at least 12 feet or in a car accident. Such trauma was
    so significant that anyone would have been able to observe an
    immediate and dramatic change in Zachary. He would have
    had trouble breathing and moving his limbs, and soon after
    sustaining the injury, he would have become completely unre-
    sponsive. Clearly, Zachary did not have such an injury when
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    he arrived at Lacy and Daniel’s home. Lacy and Daniel were
    the only people who provided care for Zachary during and
    after the time he sustained this serious injury. Neither Lacy
    nor Daniel offered any explanation for Zachary’s injury or
    death. Instead, they contend that Zachary fell asleep in a baby
    swing at 10:15 in the morning and that they assumed that
    he continued to sleep for the next 6 hours until Lacy finally
    checked on him and found him unresponsive. While Zachary
    was in the swing for that extended period of time, no one
    checked on his well-being, even though Zachary had never
    before slept that long and even though he had skipped meal-
    time, snacktime, and all diaper changes. Lacy and Daniel’s
    story provides more questions than answers, and it is simply
    not supported by the weight of a majority of the expert medi-
    cal testimony.
    Moreover, there was some evidence which suggested that
    Zachary had previously been seriously injured in Lacy and
    Daniel’s home in the weeks leading up to January 3, 2012.
    Specifically, there was evidence that Zachary sustained his
    skull fracture while at daycare when he fell down some stairs.
    Lacy did not report Zachary’s fall to his parents and, in fact,
    seemingly lied to his parents when they asked how he obtained
    a large bump on the back of his head. As a result of Lacy’s
    failure to report the fall, Zachary’s skull fracture went undiag-
    nosed, despite his parents’ repeated trips to multiple medical
    professionals. After Zachary’s death, Lacy attempted to cover
    up this earlier incident.
    When viewed as a whole, the evidence presented by the
    State is sufficient to clearly and convincingly prove that Lacy
    and Daniel subjected Zachary to “aggravated circumstances”
    pursuant to § 43-292(9). This evidence demonstrates that
    Zachary died as a result of serious injuries he sustained while
    in Lacy’s and Daniel’s care. These injuries could not have
    been sustained by normal toddler activities or by normal care-
    taking. Instead, these injuries were a result of intentional child
    abuse. In addition, the evidence demonstrates that Lacy and
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    Daniel failed to obtain medical care for Zachary both after he
    sustained the fatal injuries and on a previous occasion, after
    he fell and fractured his skull. Instead, they tried to cover
    up Zachary’s injuries and delayed obtaining necessary medi-
    cal intervention.
    On appeal, Lacy and Daniel assert that the State’s evidence
    concerning the cause of Zachary’s fatal injuries and the cause
    of his skull fracture was not sufficient to demonstrate their
    responsibility for Zachary’s death, because there was con-
    flicting evidence presented about both the events of January
    3, 2012, and the cause of Zachary’s death. Specifically, they
    point to the testimony of Lacy’s expert, Dr. Ophoven, who
    opined that Zachary’s death was a result of complications from
    the skull fracture and not from any new injury he suffered on
    January 3, and to evidence that doctors were not able to place
    a specific date on when Zachary sustained that skull fracture.
    Lacy’s and Daniel’s assertions lack merit.
    While we recognize that there was conflicting evidence
    presented at the trial about the cause and timing of Zachary’s
    fatal injuries, we also must recognize that the juvenile court
    heard and observed all of the witnesses and that it specifi-
    cally determined that the State’s and the guardian ad litem’s
    experts, Drs. Bowen, Davis, and Haney, were credible, while
    Lacy’s expert, Dr. Ophoven, was not credible. In addition, the
    court found that the statements of Lacy and Daniel and the
    testimony of Lacy were also not credible. As we stated above,
    in appeals from juvenile court proceedings, when the evidence
    is in conflict, an appellate court may give weight to the fact
    that the lower court observed the witnesses and accepted
    one version of the facts over the other. See In re Interest of
    Jagger L., 
    270 Neb. 828
    , 
    708 N.W.2d 802
    (2006). Given our
    de novo review of all of the evidence presented, and giving
    weight to the juvenile court’s findings about witness cred-
    ibility, we affirm the juvenile court’s conclusion that termi-
    nation of Lacy’s and Daniel’s parental rights was warranted
    pursuant to § 43-292(9). There was clear and convincing
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    evidence presented to demonstrate that Lacy and Daniel sub-
    jected Zachary to “aggravated circumstances.” See 
    id. (b) Best
    Interests
    Section 43-292 requires that parental rights can be ter-
    minated only when the court finds that termination is in the
    child’s best interests. A termination of parental rights is a
    final and complete severance of the child from the parent and
    removes the entire bundle of parental rights. See In re Interest
    of Crystal C., 
    12 Neb. Ct. App. 458
    , 
    676 N.W.2d 378
    (2004).
    Therefore, given such severe and final consequences, paren-
    tal rights should be terminated only “‘[i]n the absence of any
    reasonable alternative and as the last resort . . . .’” See In re
    Interest of Kantril P. & Chenelle P., 
    257 Neb. 450
    , 467, 
    598 N.W.2d 729
    , 741 (1999), quoting In re Interest of J.H., 
    242 Neb. 906
    , 
    497 N.W.2d 346
    (1993).
    In its order, the juvenile court found that because Lacy
    and Daniel “bear the responsibility for the abuse and death of
    Zachary,” it is in the best interests of Gavin and Jordan that
    their parental rights be terminated. Specifically, the court found
    that Lacy and Daniel are “unfit to be entrusted with the care
    of their children because of their abuse and neglect of Zachary
    . . . and their failure to accept responsibility for their actions.”
    The court explained its decision further:
    [Lacy and Daniel] have not accepted responsibility
    for their actions or failures to act to provide medical
    care for Zachary. They have not explained the injuries
    Zachary received. It is unlikely that they will do so
    now because to do so would potentially result in crimi-
    nal charges being brought they have thus far avoided.
    [Lacy and Daniel] have remained silent as to the true
    events involving Zachary despite having their children
    removed. They have remained silent despite having their
    parental rights placed at jeopardy. Given their silence
    to date, with so much at stake, it is unlikely they would
    now come forward with an explanation. Without that
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    explanation and acceptance of responsibility there can
    be no elimination of risk of harm to their children.
    There is no rehabilitative plan that could be developed
    by [the Nebraska Department of Health and Human
    Services] that could correct the adjudicated conditions in
    the Second Amended Petition or that would adequately
    correct the actions of these parents or that would protect
    [Gavin and Jordan].
    [Gavin and Jordan] need permanency and the ability to
    move on with parents that can provide a safe and stable
    home. Lacy . . . and Daniel . . . are unable to provide
    that home. It is in the best interest of the above children
    that the parental rights of Lacy . . . and Daniel . . . be
    ­terminated. . . .
    Lacy and Daniel appeal from the juvenile court’s find-
    ing that termination of their parental rights is in Gavin’s and
    Jordan’s best interests. In support of their argument, they again
    assert that there was not sufficient evidence to demonstrate
    their responsibility for Zachary’s injuries and death. In addi-
    tion, they assert that there was no evidence whatsoever which
    demonstrated that they were anything but loving and involved
    parents to their own children, Gavin and Jordan. Upon our
    de novo review of the record, we affirm the decision of the
    juvenile court that termination of Lacy’s and Daniel’s parental
    rights is in the children’s best interests.
    As we discussed more thoroughly above, there was clear
    and convincing evidence presented at the termination hear-
    ing which revealed that Lacy and Daniel were responsible for
    the injuries Zachary sustained on January 3, 2012, and his
    resulting death. There was also clear and convincing evidence
    presented which demonstrated that Lacy and Daniel failed
    to obtain any medical intervention for Zachary after he suf-
    fered his injuries. Neither Lacy nor Daniel has ever provided
    any reasonable explanation for what happened to Zachary
    on January 3. Given the gravity of Zachary’s fatal injuries
    and given the lack of explanation for those injuries, we must
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    agree with the findings of the juvenile court. There are no
    rehabilitative measures which can be offered to Lacy and
    Daniel which would make reunification of the family possible
    at some point in the future, and returning Gavin and Jordan
    to the care and custody of their parents without any such
    meas­ures would present an unacceptable risk to their safety
    and well-being.
    We recognize that there was no evidence presented about
    Lacy and Daniel acting inappropriately or violently with their
    own children. In fact, the visitation notes from their daily visi-
    tations with the children while this case was pending reflect
    that Lacy and Daniel have a strong bond with the children
    and love them very much. However, because we do not know
    exactly what happened to Zachary on January 3, 2012, the risk
    of harm to Gavin and Jordan in their parents’ home is simply
    too much to overcome. There is no reasonable alternative
    other than to terminate Lacy’s and Daniel’s parental rights to
    Gavin and Jordan.
    V. CONCLUSION
    After reviewing the record de novo, we conclude that the
    juvenile court did not err in finding that clear and convinc-
    ing evidence supports the termination of Lacy’s and Daniel’s
    parental rights to Gavin and Jordan under § 43-292(9) or in
    finding that clear and convincing evidence shows that termina-
    tion of Lacy’s and Daniel’s parental rights is in the children’s
    best interests. For those reasons, we affirm the court’s order
    terminating Lacy’s and Daniel’s parental rights to both Gavin
    and Jordan.
    A ffirmed.