New Jersey Division of Child Protection and Permanency v. Y.N. (072804) , 220 N.J. 165 ( 2014 )

SYLLABUS
(This syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for the
convenience of the reader. It has been neither reviewed nor approved by the Supreme Court. Please note that, in the
interest of brevity, portions of any opinion may not have been summarized.)
New Jersey Division of Child Protection and Permanency v. Y.N. (A-24-13) (072804)
Argued September 9, 2014 -- Decided December 22, 2014
ALBIN, J., writing for a unanimous Court.
The primary issue in this case is whether, under N.J.S.A. 9:6-8.21(c)(4)(b), a finding of abuse or neglect
can be sustained against a woman who, while addicted to drugs, learns she is pregnant and enters a bona fide
methadone treatment program, and whose child suffers methadone withdrawal symptoms at birth.
In or about September 2010, after injuring her hand in a fall, Y.N. (Yvonne) 1 went to a hospital where she
learned for the first time that she was four months pregnant. Yvonne disclosed to hospital personnel that she had
been taking prescription Percocet for injuries caused by a car accident several months earlier. She was informed that
if she suddenly stopped taking the Percocet she might suffer withdrawal symptoms and lose her unborn baby.
Yvonne secured prenatal care at Morristown Memorial Hospital where she was told that she could only stop taking
Percocet through a methadone maintenance treatment program. On January 5, 2011, Yvonne enrolled in a
methadone maintenance program at American Habitare & Counseling, Inc. (Habitare). Yvonne had entered
detoxification programs in 2009 and 2010 for abusing prescription drugs and using cocaine and heroin.
From January 6 through March 15, 2011, Yvonne’s urine screens indicated no drugs in her system other
than methadone. On February 18, 2011, Yvonne gave birth to P.A.C. (Paul), who was diagnosed with neonatal
abstinence syndrome as a result of his withdrawal symptoms from methadone. He was admitted into the neonatal
intensive care unit where he received treatment, which included the administration of morphine, and was released to
Yvonne’s care on April 6, 2011.
In the morning of February 23, 2011, Paul’s father, P.C. (Phil) had a hostile encounter with Yvonne and
hospital personnel and threatened to take Paul from the hospital. Yvonne obtained a domestic violence temporary
restraining order based on the events at the hospital and on Yvonne’s allegations that Phil previously had thrown her
down a set of stairs and choked her. A week afterwards, at Yvonne’s request, the restraining order was dismissed.
Yvonne later confessed that she lied about prior bouts of domestic violence from fear of losing Paul. As a result of
the domestic violence episode in the hospital, the police referred the matter to the Division of Youth and Family
Services, since renamed the Division of Child Protection and Permanency. This was the beginning of the
Division’s involvement with Yvonne and Paul.
On March 15, 2011, Phil called the Division, claiming that he observed Yvonne high on drugs. On March
18, when she went to Habitare, Yvonne was told she would have to submit to a random drug test. According to
Yvonne, she waited fifteen minutes for the test but then had to leave because a cab whose fare she had pre-paid was
outside honking its horn. She testified that she returned the next day to Habitare but was told she already had been
marked down for a refusal. Habitare considered her failure to submit to the urine analysis the equivalent of a
positive test result.
On April 5, 2011, the Division filed a complaint seeking care, custody, and supervision of Paul. N.J.S.A.
30:4C-12. The complaint also alleged that Yvonne abused or neglected Paul based on Yvonne’s prior drug history,
her refusal to take the March 18 drug test, Paul’s methadone withdrawal, and the domestic violence involving
Yvonne and Phil. N.J.S.A. 9:6-8.21. At the conclusion of the abuse and neglect hearing on June 29, 2011, the
family court determined that the Division had proven abuse or neglect by a preponderance of the evidence.
In rendering its decision, the court made the following findings: (1) Yvonne had a long drug history dating
1
Pseudonyms are used for ease of reference.
1
back to 2005; (2) Yvonne became aware that she was pregnant but continued to “expose” her unborn child to drugs
for another four months before her entry into the Habitare program, one month before Paul’s birth; (3) Yvonne
refused to take a random drug test in March 2011 even though she was “reasonably compliant” with the program;
and (4) she has the potential to expose her child to domestic violence.
Yvonne appealed the court’s finding of abuse and neglect. The Appellate Division affirmed the family
court’s abuse and neglect finding solely on the basis that Yvonne caused her child to suffer withdrawal symptoms
from the methadone she took as part of a prescribed, bona fide medical treatment plan. N.J. Div. of Youth & Family
Servs. v. Y.N., 431 N.J. Super. 74, 82 (App. Div. 2013). The panel held Yvonne strictly liable for the harm suffered
by Paul and gave no consideration to whether Yvonne acted unreasonably or failed to provide a minimum level of
care for her newborn.
The Supreme Court granted Yvonne’s petition for certification. N.J. Dep’t of Children & Families v. Y.N.,
216 N.J. 13 (2013). The Court also granted the motions of four parties to participate as amici curiae.
HELD: Absent exceptional circumstances, a finding of abuse or neglect cannot be sustained based solely on a
newborn’s enduring methadone withdrawal following a mother’s timely participation in a bona fide treatment
program prescribed by a licensed healthcare professional to whom she has made full disclosure.
1. New Jersey’s child-welfare laws balance a parent’s right to raise a child against “the State’s parens patriae
responsibility to protect the welfare of children.” N.J. Dep’t. of Children and Families v. A.L., 213 N.J. 1, 17-18
(2013). One of Title Nine’s primary purposes is to protect children “who have had serious injury inflicted upon
them” and to safeguard them “from further injury and possible death.” N.J.S.A. 9:6-8.8(a). A finding of abuse or
neglect against a parent may result in significant and longstanding adverse consequences. Strict adherence to the
statutory standards of N.J.S.A. 9:6-8.21(c)(4) is important because the stakes are high for all parties concerned. (pp.
18-19)
2. The plain language of N.J.S.A. 9:6-8.21(c)(4)(b) requires proof that the child was impaired or in imminent
danger of becoming impaired because the parent (1) failed to exercise a minimum degree of care and (2)
unreasonably inflicted or allowed to be inflicted harm, or created a substantial risk of inflicting harm, on the child.
The statute makes clear that parental fault is an essential element for a finding of abuse or neglect. At the very least,
a minimum degree of care means that a parent’s conduct must be “grossly negligent or reckless.” N.J. Dep’t of
Children and Families, Div. of Youth & Family Servs. v. T.B., 207 N.J. 294, 306 (2011). N.J.S.A. 9:6-8.21(c)(4)(b)
is not a strict liability statute. It does not suggest that a finding of abuse or neglect can be premised solely on a harm
caused to a child without consideration of the reasonableness of the parent’s conduct. Sometimes a parent may
cause injury to a child to protect that child from greater harm. Under those circumstances, the parent may be acting
reasonably. The Division must establish that, at a minimum, a parent acted with gross negligence or recklessness to
succeed in a prosecution under N.J.S.A. 9:6-8.21(c)(4)(b). (pp. 20-25)
3. The Court rejects the Appellate Division’s conclusion that “[w]here there is evidence of actual impairment, it is
immaterial whether the drugs taken were from a legal or illicit source.” Y.N., supra, 431 N.J. Super. at 82. The
Court cannot ignore the other statutory elements of N.J.S.A. 9:6-8.21(c)(4)(b) – whether Yvonne exercised a
“minimum degree of care” or “unreasonably” inflicted harm on her newborn. The reasoning of the Appellate
Division creates a perverse disincentive for a pregnant woman to seek medical help and enter a bona fide
detoxification treatment program that will address her and her baby’s health needs. Nothing in N.J.S.A. 9:6-
8.21(c)(4)(b) suggests that a woman is not exercising the minimum level of care by obtaining timely medical advice
and by timely entering a medically approved detoxification program that will improve the outcome for her newborn.
Absent exceptional circumstances, a finding of abuse or neglect cannot be sustained based solely on a newborn’s
enduring methadone withdrawal following a mother’s timely participation in a bona fide treatment program
prescribed by a licensed healthcare professional to whom she has made full disclosure. (pp. 25-30)
The judgment of the Appellate Division is REVERSED and the matter is REMANDED to the Appellate
Division for further consideration of whether there is any alternative basis on which to sustain the family court’s
finding of abuse or neglect.
2
CHIEF JUSTICE RABNER; JUSTICES LaVECCHIA, PATTERSON, FERNANDEZ-VINA and
SOLOMON join in JUSTICE ALBIN’s opinion; JUDGE CUFF (temporarily assigned) did not participate.
3
SUPREME COURT OF NEW JERSEY
A-24 September Term 2013
072804
NEW JERSEY DIVISION OF CHILD
PROTECTION AND PERMANENCY
Plaintiff-Respondent,
v.
Y.N.,
Defendant-Appellant,
and
P.C.,
Defendant.
____________________________
IN THE MATTER OF P.A.C., a
minor.
Argued September 9, 2014 – Decided December 22, 2014
On certification to the Superior Court,
Appellate Division, whose opinion is
reported at 431 N.J. Super. 74 (2013).
Clara S. Licata, Designated Counsel, argued
the cause for appellant (Joseph E. Krakora,
Public Defender Parental Representation,
attorney; Ms. Licata and T. Gary Mitchell,
Deputy Public Defender, of counsel and on
the briefs).
Erin O’Leary, Deputy Attorney General,
argued the cause for respondent New Jersey
Division of Child Protection and Permanency
(John J. Hoffman, Acting Attorney General,
attorney; Andrea M. Silkowitz, Assistant
Attorney General; Ms. O’Leary and Lisa J.
Rusciano, on the briefs).
1
James A. Louis, Deputy Public Defender,
argued the cause for respondent P.A.C.
(Joseph E. Krakora, Public Defender Law
Guardian, attorney; Mr. Louis, Olivia
Belfatto-Crisp, Assistant Deputy Public
Defender, and Lisa M. Black, Designated
Counsel, on the briefs).
Lawrence S. Lustberg argued the cause for
amici curiae Experts in Maternal and Fetal
Health, Public Health, and Drug Treatment
(Gibbons and National Advocates for Pregnant
Women, attorneys; Mr. Lustberg, Lynn M.
Paltrow, and Farah C. Diaz-Tello, members of
the New York bar, on the briefs).
Sean Marotta argued the cause for amicus
curiae Statewide Parent Advocacy Network,
Inc. (Hogan Lovells US, attorneys).
Ronald K. Chen argued the cause for amici
curiae American Civil Liberties Union of New
Jersey and American Civil Liberties Union
Foundation (Rutgers Constitutional
Litigation Clinic Center for Law & Justice,
Mr. Chen, Edward L. Barocas, Jeanne M.
LoCicero, Alexander R. Shalom, and Alexa
Kolbi-Molinas, a member of the New York bar,
on the brief).
Mary M. McManus-Smith, argued the cause for
amicus curiae Legal Services of New Jersey
(Melville D. Miller, Jr., President,
attorney; Ms. McManus-Smith, Mr. Miller, and
Jeyanthi C. Rajaraman, on the brief).
JUSTICE ALBIN delivered the opinion of the Court.
At a routine doctor’s appointment for a hand injury, Y.N.
(Yvonne)1 learned that she was four months pregnant. During that
1 Pseudonyms are used for ease of reference.
2
four-month period, Yvonne had been taking Percocet for injuries
caused in a car accident and became dependent on that
medication. Hospital personnel advised her that she could not
stop taking Percocet abruptly without endangering her pregnancy
and recommended that she enter a methadone maintenance treatment
program. Yvonne entered such a program four months later, a
month before she gave birth. Her baby, P.A.C. (Paul), suffered
methadone withdrawal symptoms at birth and remained hospitalized
for about seven weeks.
The Division of Youth and Family Services (Division)2 filed
an abuse and neglect complaint against Yvonne based on her long-
term drug use before and during her pregnancy, the harm caused
to Paul from methadone withdrawal, and her failure to address
acts of domestic violence committed against her. After a
hearing, the family court entered a finding of abuse and
neglect.
The Appellate Division affirmed solely on the basis that
Yvonne caused her child to suffer withdrawal symptoms from the
methadone she took as part of a prescribed, bona fide medical
treatment plan. N.J. Div. of Youth & Family Servs. v. Y.N., 431
N.J. Super. 74, 82 (App. Div. 2013). The panel held her
2 Effective June 29, 2012, the New Jersey Division of Youth and
Family Services was renamed the Division of Child Protection and
Permanency. L. 2012, c. 16, § 20.
3
strictly liable for the harm suffered by Paul and gave no
consideration to whether Yvonne acted unreasonably or failed to
provide a minimum level of care for her newborn.
We disagree with the Appellate Division’s reasoning and now
reverse. We hold that, absent exceptional circumstances, a
finding of abuse or neglect cannot be sustained based solely on
a newborn’s enduring methadone withdrawal following a mother’s
timely participation in a bona fide treatment program prescribed
by a licensed healthcare professional to whom she has made full
disclosure. In this case, a finding of abuse or neglect under
N.J.S.A. 9:6-8.21(c)(4)(b) required proof that Yvonne
unreasonably inflicted harm on her newborn and did so, at least,
by acting with gross negligence or recklessness. The Appellate
Division looked only to the child’s withdrawal symptoms at the
time of his birth and not to whether his mother took reasonable
steps to minimize the harm to her child by securing treatment
for her addiction. In short, the Appellate Division did not
consider all of the requisite statutory elements in its
analysis.
We remand to the Appellate Division to determine whether
the finding of abuse or neglect can be sustained on any other
ground articulated by the family court.
4
I.
A.
The issue in this appeal arises from a June 2011 hearing
before the family court at which the Division charged Yvonne
with the abuse or neglect of her newborn child, Paul. At the
hearing, the Division presented two witnesses -- a Division
supervisor and a Division caseworker. The Division also
introduced into evidence various medical, psychological, and
investigative reports. Yvonne testified as well. The following
three paragraphs are based on Yvonne’s testimony.
In or about September 2010, after injuring her hand in a
fall, she went to a hospital where she learned for the first
time that she was four months pregnant. Yvonne disclosed to
hospital personnel that she had been taking prescription
Percocet for injuries caused by a car accident several months
earlier. She was informed that if she suddenly stopped taking
the Percocet she might suffer withdrawal symptoms and lose her
unborn baby. She was told to secure prenatal care immediately.
She received prenatal care at Morristown Memorial Hospital
where she was told that she could only stop taking Percocet
through a methadone maintenance treatment program. For the next
four months, Yvonne had appointments with “regular doctors and
high risk doctors,” received prenatal care, and searched for a
detoxification clinic. On January 5, 2011, Yvonne enrolled in a
5
methadone maintenance program at American Habitare & Counseling,
Inc. (Habitare).
This was not her first experience in a detoxification
program. In 2005, Yvonne struggled with depression after the
loss of her young daughter due to illness. In the aftermath,
she began abusing prescription pills and then turned to cocaine
and heroin. To address her drug abuse, she entered
detoxification programs in 2009 and 2010. The last time she
used cocaine and heroin was about eight months before
discovering she was pregnant.3
Yvonne’s initial drug test at Habitare revealed the
presence of opiates in her system. The test was consistent with
her account of taking Percocet, which is an opioid drug.4
Physicians’ Desk Reference 1096-97 (65th ed. 2011). In
accordance with Habitare’s protocols, Yvonne began taking a
daily dosage of methadone and followed her treatment plan.
From January 6, 2011, through March 15, 2011, Yvonne’s
urine screens indicated no drugs in her system other than
methadone. On February 18, 2011, Yvonne gave birth to Paul at
Morristown Memorial Hospital. Paul was diagnosed with neonatal
3In contrast, at Habitare, Yvonne disclosed that she had
continued to use cocaine and heroin until about the time of
Paul’s conception.
4 Other opioids are morphine and heroin. Taber’s Cyclopedic Med.
Dictionary 1124 (Donald Venes et al. eds., 22d ed. 2013).
6
abstinence syndrome as a result of his withdrawal symptoms from
methadone.5 Those symptoms included tremors, fever, and trouble
sleeping. Paul was admitted into the neonatal intensive care
unit where he received treatment, which included the
administration of morphine. Paul was released to Yvonne’s care
on April 6, 2011.
In the early morning of February 23, 2011, Paul’s father,
P.C. (Phil) had a hostile encounter with Yvonne and hospital
personnel. Yvonne complained to Phil that he was not supporting
the baby’s head properly while holding him. Phil became
confrontational and threatened to take the child from the
hospital. The hospital’s staff asked Phil to leave and, when he
refused, he was removed by the police and hospital security.
Later that same day, Yvonne obtained a domestic violence
temporary restraining order. The order was based not only on
the events at the hospital, but also on Yvonne’s allegations
that Phil previously had thrown her down a set of stairs and
choked her.
A week afterwards, at Yvonne’s request, the restraining
order was dismissed. At the abuse and neglect hearing, Yvonne
5Neonatal abstinence syndrome is defined as “[a]ny of the
adverse consequences in the newborn of exposure to addictive or
dangerous intoxicants during fetal development.” Taber’s
Cyclopedic Med. Dictionary, supra, at 1158.
7
stated that, although she and Phil had their “share of fights,”
she felt pressured to seek a restraining order and lied about
the prior bouts of domestic violence from fear of losing Paul.
As a result of the domestic violence episode in the
hospital, the police referred the matter to the Division of
Youth and Family Services. This was the beginning of the
Division’s involvement with Yvonne and Paul.
On March 15, 2011, Phil called the Division, claiming that
he observed Yvonne high on drugs. Three days later when Yvonne
went to Habitare for her methadone treatment, she was told she
would have to submit to a random drug test. According to
Yvonne, she waited fifteen minutes to give a urine sample, but
then had to leave because a cab whose fare she had pre-paid was
outside honking its horn. She testified that she returned the
next day to Habitare but was told she already had been marked
down for a refusal. Habitare considered her failure to submit
to the urine analysis the equivalent of a positive test result.
On April 5, 2011, the Division filed a complaint, seeking
care, custody, and supervision of Paul. N.J.S.A. 30:4C-12. The
complaint also alleged that Yvonne abused or neglected Paul
based on Yvonne’s prior drug history, her refusal to take the
March 18 drug test, Paul’s methadone withdrawal, and the
domestic violence involving Yvonne and Phil. N.J.S.A. 9:6-8.21.
The day after the filing of the complaint, Yvonne passed a drug
8
test, and the family court released Paul to her custody.6
B.
At the conclusion of the abuse and neglect hearing on June
29, 2011, the family court determined that the Division had
proven abuse or neglect by a preponderance of the evidence. The
court conceded that the Division had not presented “overwhelming
testimony” or “the strongest case in the world.” The court also
commended Yvonne for entering a recognized detoxification
program and acknowledged that she had “made strides.”
Nevertheless, the court maintained that the evidence presented
by the Division was sufficient to prove abuse or neglect. The
court found Yvonne’s “credibility very questionable,”
particularly given her recantation of her domestic violence
claims.
In rendering its decision, the court made the following
findings: (1) Yvonne had a long drug history dating back to
2005; (2) Yvonne became aware that she was pregnant but
continued to “expose” her unborn child to drugs for another four
months before her entry into the Habitare program, one month
before Paul’s birth; (3) Yvonne refused to take a random drug
test in March 2011 even though she was “reasonably compliant”
6 Yvonne tested positive for cocaine on April 18, 2011, but that
test post-dated the complaint and was not part of the Division’s
proofs at the abuse and neglect hearing.
9
with the program; and (4) she has the potential to expose her
child to domestic violence. Last, the court expressed that
“[w]hen a child is born drug exposed to illicit drugs, we
routinely say that’s abuse and neglect.” The court permitted
Yvonne to retain physical custody of Paul, but under the care
and supervision of the Division.
Yvonne appealed the court’s finding of abuse or neglect.
II.
A.
In affirming the family court’s abuse or neglect finding,
the Appellate Division focused solely on the harm suffered by
Paul due to his methadone withdrawal. Y.N., supra, 431 N.J.
Super. at 80-84. The panel rejected Yvonne’s contention that a
“finding of abuse or neglect cannot be based upon her ingestion
of methadone from ‘a legitimate program providing assistance
from withdrawal.’” Id. at 81. The panel noted that “Paul’s
severe withdrawal, which required treatment in the [neonatal
intensive care unit] and numerous doses of morphine over an
extended period of time, is compelling evidence of actual
impairment.” Id. at 82. The panel then determined that
“[w]here there is evidence of actual impairment, it is
immaterial whether the drugs taken were from a legal or illicit
source.” Ibid. In the panel’s view, “[t]he fact that defendant
obtained the methadone from a legal source does not preclude our
10
consideration of the harm it caused to the newborn.” Id. at 81.
The panel maintained that “[a]n inquiry under N.J.S.A. 9:6-8.21
[the abuse and neglect statute] must focus on the harm to the
child, rather than on the intent of the caregiver.” Ibid.
In a footnote, the panel observed that it did “not appear
that anyone from [the hospital] notified the Division that
Yvonne gave birth to a child suffering withdrawal symptoms.”
Id. at 78 n.3. The panel then added: “We take this opportunity
to note that N.J.S.A. 9:6-8.10 requires ‘any person having
reasonable cause to believe that a child has been subjected to
child abuse or acts of child abuse shall report the same
immediately to the Division of Child Protection and Permanency
by telephone or otherwise.’” Ibid.
Last, because “defendant admit[ted] that her use of
methadone caused Paul’s withdrawal symptoms,” the panel found it
unnecessary to “consider her claim that the Division failed to
prove that her prenatal use of Percocet and OxyContin caused
harm to Paul or exposed him to a risk of harm.” Id. at 84.
B.
We granted Yvonne’s petition for certification, N.J. Dep’t
of Children & Families v. Y.N., 216 N.J. 13 (2013), which
presented two questions: (1) whether, under N.J.S.A. 9:6-
8.21(c)(4)(b), a finding of abuse or neglect can be sustained
against a woman who, while addicted to drugs, learns she is
11
pregnant and enters a bona fide methadone treatment program, and
whose child suffers methadone withdrawal symptoms at birth; and
(2) whether a physician is required to make an abuse or neglect
report to the Division pursuant to N.J.S.A. 9:6-8.10, whenever a
child is born with neonatal abstinence syndrome resulting from a
mother’s prenatal medical treatment.
We also granted the motions of four parties to participate
as amici curiae: Legal Services of New Jersey (Legal Services);
Statewide Parent Advocacy Network, Inc.; Experts in Maternal and
Fetal Health, Public Health, and Drug Treatment; and the
American Civil Liberties Union of New Jersey and the American
Civil Liberties Union Foundation (ACLU).
III.
A.
Yvonne argues that the Appellate Division erred in holding
that abuse or neglect can be found under N.J.S.A. 9:6-
8.21(c)(4)(b) based merely on a harm caused to a child without
proof that the parent unreasonably inflicted the harm by
departing from the necessary minimum degree of care. Yvonne
contends that she followed medical advice not to abruptly stop
taking Percocet to avoid a potential miscarriage or harm to her
fetus. She also points out that the Division did not present
any evidence that Paul’s neonatal abstinence syndrome symptoms
“would have been milder, of shorter duration, or avoided
12
entirely if she entered treatment earlier.” She submits that
she did not unreasonably inflict harm on her newborn by securing
methadone treatment for her preexisting Percocet addiction. She
claims that she made an informed medical decision -- entitled to
constitutional protection -- to enter a detoxification program
to minimize the more serious side effects to her unborn child
rather than continue to use Percocet or suddenly terminate its
use.
In response to the Appellate Division’s footnote on
reporting child abuse, Yvonne maintains that healthcare
officials have no mandatory requirement under N.J.S.A. 9:6-8.10
to report the “treatable side effects of [neonatal abstinence
syndrome]” caused by a mother’s participation in a medically
approved methadone program.
B.
Amici, Legal Services; Statewide Parent Advocacy Network;
Experts in Maternal and Fetal Health, Public Health, and Drug
Treatment; and ACLU, all submit that the Appellate Division
erred in finding that a newborn child who experiences neonatal
abstinence syndrome as the result of a mother’s participation in
a medically prescribed methadone treatment program is an abused
or neglected child under N.J.S.A. 9:6-8.21(c)(4)(b). Among the
arguments offered by amici are these: (1) “a parent’s adherence
to a bona fide treatment plan prescribed by a licensed health
13
professional cannot rise to the level” of gross negligence,
recklessness, or willful or wanton conduct, a necessary
predicate for a finding of abuse or neglect under N.J.S.A. 9:6-
8.21(c)(4)(b); (2) Yvonne should not be punished for entering a
methadone treatment program for an addiction that preexisted her
pregnancy when treatment will mitigate the risks to her child;
(3) pregnant women suffering drug addiction should not be
discouraged from entering a methadone maintenance program, which
is the most effective treatment for opioid dependence and which
has treatable effects on a newborn; and (4) a woman has a
constitutional right to self-autonomy in making medically
approved decisions for her health and her child’s health. In
short, amici contend that a woman addicted to drugs who becomes
pregnant and secures medical advice, who discloses all relevant
information to a medical professional, and who complies with a
prescribed detoxification treatment plan has not abused or
neglected her newborn, even if the child suffers methadone
withdrawal symptoms.
C.
The Division urges this Court to affirm the appellate
panel. The Division contends that it is unnecessary to decide
whether Yvonne “failed to exercise a minimum degree of care”
because Paul “suffered actual harm, and that harm was severe
enough to meet the statutory requirements of N.J.S.A. 9:6-
14
8.21(c)(4)(b).” According to the Division, Yvonne’s intentions
are irrelevant and all that matters is whether her conduct
caused harm to her child. The Division maintains that Paul’s
neonatal abstinence syndrome was evidence of harm sufficient for
an abuse or neglect finding, even if Yvonne’s use of methadone
was directed by healthcare professionals. Additionally, the
Division asks this Court to affirm the Appellate Division’s
judgment because the evidence in the record is ample to support
the trial court’s finding of abuse or neglect. The Division
points “to multiple factors that placed [Paul] at substantial
risk of harm,” such as “[Yvonne’s] illegal drug use during
pregnancy,” her four-month delay in securing addiction treatment
after learning of her pregnancy, her “continued substance abuse
after Paul’s birth,” and her lack of honesty in recounting the
domestic violence involving Phil.
The Division submits that the Appellate Division’s footnote
was a necessary reminder to hospital personnel of their
reporting obligation pursuant to N.J.S.A. 9:6-8.10. It insists
that a physician should contact the Division whenever a child is
suffering from “significant” drug withdrawal symptoms. The
Division states that an investigation is the best vehicle for
“determining whether a child requires and deserves the
protections afforded by Title [Nine].”
15
D.
Paul’s Law Guardian urges the Court to uphold the family
court’s determination that Yvonne abused or neglected Paul.
Although the Law Guardian argues that the actual harm suffered
by Paul was sufficient for a finding of abuse or neglect, he
asks that we look to the entirety of the family court’s factual
findings. In particular, the Law Guardian points to the court’s
findings on Yvonne’s prior drug use, her involvement in domestic
violence, and her four-month delay in entering a detoxification
program. He claims that this delay in getting treatment
increased the risk of harm to Paul.
Last, the Law Guardian comments that the Appellate
Division’s footnote on a hospital’s obligation to report child
abuse is “dicta” and irrelevant to the issues in this case, and
therefore should not be reviewed in this appeal.
IV.
A.
The primary issue in this case involves statutory
interpretation: whether a finding of abuse or neglect under
N.J.S.A. 9:6-8.21(c)(4)(b) can be based solely on the harm
caused to Paul by methadone withdrawal -- without regard to
whether Yvonne acted unreasonably or with a minimum degree of
care. In addressing that issue, we must identify the statutory
elements necessary to prove abuse or neglect under N.J.S.A. 9:6-
16
8.21(c)(4)(b).
“In construing the meaning of a statute, our review is de
novo,” and therefore we need not defer to the Appellate
Division’s or trial court’s interpretive conclusions. Murray v.
Plainfield Rescue Squad, 210 N.J. 581, 584 (2012); see also
Manalapan Realty, L.P. v. Twp. Comm., 140 N.J. 366, 378 (1995)
(“A trial court’s interpretation of the law and the legal
consequences that flow from established facts are not entitled
to any special deference.”).
“Our paramount goal in interpreting a statute is to give
effect to the Legislature’s intent.” Wilson ex rel. Manzano v.
City of Jersey City, 209 N.J. 558, 572 (2012). The starting
point of all statutory interpretation must be the language used
in the enactment. Farmers Mut. Fire Ins. Co. of Salem v. N.J.
Prop.-Liab. Ins. Guar. Ass’n, 215 N.J. 522, 536 (2013); see also
N.J.S.A. 1:1-1 (stating that words of statute are customarily
construed according to their “generally accepted meaning”). “If
the statutory language is clear and unambiguous, and reveals the
Legislature’s intent, we need look no further.” Farmers Mut.,
supra, 215 N.J. at 536. Only when faithful adherence to the
words of the statute leads to more than one plausible
interpretation or to an absurd result or to a result at odds
with the objective of the overall legislative scheme do we look
to extrinsic sources, such as legislative history. Ibid.;
17
DiProspero v. Penn, 183 N.J. 477, 492-93 (2005).
With those principles in mind, we turn first to the
purpose, nature, and consequences of abuse and neglect
proceedings and then to the contents of the statute in question.
B.
New Jersey’s child-welfare laws balance a parent’s right to
raise a child against “the State’s parens patriae responsibility
to protect the welfare of children.” N.J. Dep’t. of Children
and Families v. A.L., 213 N.J. 1, 17-18 (2013) (internal
quotation marks omitted). One of Title Nine’s primary purposes
is to protect children “who have had serious injury inflicted
upon them” and to safeguard them “from further injury and
possible death.” N.J.S.A. 9:6-8.8(a). To that end, Title Nine
provides for the civil prosecution of a parent or guardian who
abuses or neglects a child. N.J.S.A. 9:6-8.33.
In this case, the Title Nine proceedings began when the
Division filed a complaint alleging that Yvonne had abused or
neglected her newborn, Paul. See ibid. At the fact-finding
hearing, the Division bore the burden of proving abuse or
neglect by a preponderance of the evidence based on “competent,
material and relevant evidence.” N.J.S.A. 9:6-8.46(b).
A finding of abuse or neglect against a parent may result
in significant and longstanding adverse consequences. A.L.,
supra, 213 N.J. at 25. The parent’s name and information
18
concerning the case are forwarded to a Central Registry and kept
on file by the Department of Children and Families. See
N.J.S.A. 9:6-8.11. That information may be released to certain
entities responsible for “employment-related screening of an
individual . . . seeking employment with an agency or
organization providing services to children,” N.J.S.A. 9:-
8.10a(b)(13), as well as to doctors, courts, and child welfare
agencies. N.J.S.A. 9:6-8.10a(b)(1),(3),(4),(5),(6),(13); see
also N.J.S.A. 9:6-8.10e (mandating that Division conduct check
of child abuse registry for each person seeking registration as
professional guardian); N.J.S.A. 30:5B-25.3 (mandating child
abuse registry check for applicant seeking daycare facility
licensure). A court, moreover, “can enter a dispositional order
that places the child in the custody of a relative or another
suitable person for a substantial period of time.” A.L., supra,
213 N.J. at 25-26 (citing N.J.S.A. 9:6-8.50(d), -8.51(a), -
8.54(a)). Finally, and perhaps most significantly, an abuse or
neglect finding may provide a basis for an action to terminate a
parent’s custodial rights to a child. N.J.S.A. 30:4C-15(a)
(allowing petition to terminate parental rights based on
adjudication of abuse or neglect).
Strict adherence to the statutory standards of N.J.S.A.
9:6-8.21(c)(4) is important because the stakes are high for all
parties concerned.
19
C.
A child may be abused or neglected in different ways in
violation of Title Nine. N.J.S.A. 9:6-8.21(c). Here, the
Division proceeded on a theory that Yvonne abused or neglected
her child by violating a subpart of N.J.S.A. 9:6-8.21(c).
N.J.S.A. 9:6-8.21(c)(4)(b) defines an abused or neglected child
as a child
whose physical, mental, or emotional condition
has been impaired or is in imminent danger of
becoming impaired as the result of the failure
of his parent or guardian, as herein defined,
to exercise a minimum degree of care . . . (b)
in providing the child with proper supervision
or guardianship, by unreasonably inflicting or
allowing to be inflicted harm, or substantial
risk thereof, . . . or by any other acts of a
similarly serious nature requiring the aid of
the court.
[N.J.S.A. 9:6-8.21(c)(4)(b) (emphasis
added).]
The plain language of N.J.S.A. 9:6-8.21(c)(4)(b) requires
proof that the child was impaired or in imminent danger of
becoming impaired because the parent (1) failed to exercise a
minimum degree of care and (2) unreasonably inflicted or allowed
to be inflicted harm, or created a substantial risk of
inflicting harm, on the child. The statute makes clear that
parental fault is an essential element for a finding of abuse or
neglect under N.J.S.A. 9:6-8.21(c)(4)(b). The Division must
establish that a parent failed “to exercise a minimum degree of
20
care” in a prosecution under N.J.S.A. 9:6-8.21(c)(4)(b). N.J.
Dep’t of Children & Families, Div. of Youth & Family Servs. v.
T.B., 207 N.J. 294, 309-10 (2011) (concluding that Division
failed to prove abuse or neglect because parent’s conduct did
not constitute failure to exercise minimum degree of care); N.J.
Div. of Youth & Family Servs. v. S.N.W., 428 N.J. Super. 247,
249 (App. Div. 2012) (reversing adjudication of abuse or neglect
because trial court did not make finding that “defendant failed
to provide a minimum degree of care”).
At the very least, a minimum degree of care means that a
parent’s conduct must be “grossly negligent or reckless.” T.B.,
supra, 207 N.J. at 306. In contrast, a parent’s negligent
conduct is not sufficient to justify a finding of abuse or
neglect under N.J.S.A. 9:6-8.21(c)(4)(b). Id. at 306-07; see
also N.J. Dep’t of Youth & Family Servs. v. J.L., 410 N.J.
Super. 159, 168-69 (App. Div. 2009) (reversing abuse or neglect
finding because mother’s conduct, although “arguably inattentive
or even negligent,” was not grossly negligent or reckless). A
civil prosecution under N.J.S.A. 9:6-8.21(c)(4)(b) also requires
proof that a parent “unreasonably” inflicted harm. However, it
follows that a parent who causes harm to a child by grossly
negligent or reckless conduct has acted unreasonably.
We need not look beyond the words of N.J.S.A. 9:6-
8.21(c)(4)(b). We will not read out of the statute the
21
standard-of-care language that the Legislature pointedly
included as a prerequisite to a finding of abuse or neglect.
See DiProspero, supra, 183 N.J. at 492 (noting that court
“cannot write in an additional qualification which the
Legislature pointedly omitted in drafting its own enactment”
(internal quotation marks omitted)). N.J.S.A. 9:6-8.21(c)(4)(b)
is not a strict liability statute. It does not suggest that a
finding of abuse or neglect can be premised solely on a harm
caused to a child without consideration of the reasonableness of
the parent’s conduct.
Sometimes a parent may cause injury to a child to protect
that child from a greater harm. Under those circumstances, the
parent may be acting reasonably. Simply stated, the statute
requires more than a mere showing of harm to a child. The
Division must establish that, at a minimum, a parent acted with
gross negligence or recklessness to succeed in a prosecution
under N.J.S.A. 9:6-8.21(c)(4)(b).
The Appellate Division relied on In re Guardianship of
K.H.O., 161 N.J. 337 (1999), State v. Tamburro, 68 N.J. 414
(1975), and A.L., supra, 213 N.J. 1, in support of its position
that harm alone is sufficient for an adjudication of abuse or
neglect under N.J.S.A. 9:6-8.21(c)(4)(b). Those cases do not
support the conclusion reached by the Appellate Division.
K.H.O., supra, was a parental-termination case arising
22
under N.J.S.A. 30:4C-15.1(a). 161 N.J. at 345. In that case,
the mother abused heroin during her pregnancy and did not seek
drug treatment until after her child’s birth. Id. at 344. Her
child was born “suffering from heroin withdrawal, cleft palate
syndrome, and respiratory difficulties.” Ibid. We noted that
generally “[d]rug use during pregnancy, in and of itself, does
not constitute a harm to the child.” Id. at 349. We held,
however, that because the baby was born suffering withdrawal
symptoms from heroin addiction, the State met prong one of the
four-part, parental-termination test: “[t]he child’s safety,
health or development has or will continue to be endangered by
the parental relationship,” N.J.S.A. 30:4C-15.1(a). Id. at 349-
50.
K.H.O. is not comparable to the present case. K.H.O. did
not involve Title Nine or an interpretation of similar statutory
language relating to the minimum level of care owed to a child.
It did not involve a mother who sought and entered a drug
treatment program prescribed by medical professionals for her
and her newborn’s care. Significantly, here, at the time of
Paul’s birth, Yvonne was taking methadone -- a prescribed
medication administered pursuant to a bona fide program to treat
her addiction. Unlike the child in K.H.O., Paul was born
suffering withdrawal symptoms from medication lawfully taken by
his mother, as recommended by her doctor.
23
Tamburro, supra, is also inapposite because, there, we
construed N.J.S.A. 39:4-50, the driving under the influence
statute. 68 N.J. at 420-21. In that case, we simply determined
that, based on its language, N.J.S.A. 39:4-50 is a strict
liability statute. Id. at 421. We came to the unremarkable
conclusion that a person is no less guilty of driving under the
influence of methadone than of driving under the influence of
alcohol or any other drug. Ibid. One can lawfully take
methadone or imbibe alcohol. Ibid. However, driving under the
influence of either drugs or alcohol is a violation of N.J.S.A.
39:4-50. Ibid.
Last, the Appellate Division’s reliance on A.L. is
misplaced. In that case, a mother ingested cocaine during the
course of her pregnancy, and her newborn’s first stool tested
positive for “cocaine metabolites.” A.L., supra, 213 N.J. at 9.
The child, however, did not suffer any withdrawal symptoms or
any other identifiable harm. Id. at 11. Nevertheless, the
Division of Youth and Family Services contended that the
presence of cocaine in the child’s system established that the
mother posed a substantial risk of harm to the child and
therefore the child was abused or neglected under N.J.S.A. 9:6-
8.21(c)(4)(b). Id. at 13.
On appeal, the mother in A.L. did not argue that taking
cocaine during pregnancy might not breach the minimum level of
24
care mandated by the statute. Id. at 15-16. Rather, we
addressed the mother’s argument that “N.J.S.A. 9:6-8.21(c)(4)
does not apply to a fetus or a pregnant woman absent harm or
imminent risk of harm to a child after birth.” Id. at 15. We
stated in A.L. that, absent evidence of actual impairment to the
child, “the critical focus is on evidence of imminent danger or
substantial risk of harm.” Id. at 22. We noted that “[p]roof
that a child’s mother frequently used cocaine or other dangerous
substances during pregnancy would be relevant to that issue,”
but added that “not every instance of drug use by a parent
during pregnancy, standing alone, will substantiate a finding of
abuse and neglect in light of the specific language of the
statute.” Id. at 23. In A.L., we found that the presence of
cocaine metabolites in the newborn’s stool, without anything
more, including expert testimony to explain its meaning and
significance, was insufficient to sustain an abuse or neglect
determination. Id. at 29-30.
Importantly, A.L. did not address the scenario of a child
experiencing withdrawal symptoms from medication lawfully
prescribed by a physician to the child’s mother to treat her
addiction.
In short, none of those three cases resolves the issue
before us.
25
V.
The issue here is whether the Appellate Division erred in
determining that Yvonne violated the abuse and neglect statute
solely because her newborn suffered neonatal abstinence syndrome
as a result of her participation in a medically prescribed
methadone maintenance treatment program. In our view, the
Appellate Division went astray by concentrating on harm without
regard to parental fault. We reject the Appellate Division’s
conclusion that “[w]here there is evidence of actual impairment,
it is immaterial whether the drugs taken were from a legal or
illicit source.” Y.N., supra, 431 N.J. Super. at 82. We cannot
ignore the other statutory elements of N.J.S.A. 9:6-
8.21(c)(4)(b) -- whether Yvonne exercised a “minimum degree of
care” or “unreasonably” inflicted harm on her newborn.
Whether a parent exercised a minimum degree of care must
“be analyzed in light of the dangers and risks associated with
the situation.” G.S. v. Dep’t of Human Servs., 157 N.J. 161,
181-82 (1999). A woman who becomes addicted to lawfully
prescribed medication and then learns she is pregnant is
confronted with a choice -- either to seek treatment that will
improve the outcome for her newborn or to continue on the path
of her addiction. The reasoning of the Appellate Division
creates a perverse disincentive for a pregnant woman to seek
medical help and enter a bona fide detoxification treatment
26
program that will address her and her baby’s health needs. In
weighing the relative harms facing the child, the greater
potential harm is if the mother does not secure proper prenatal
care, including treatment for her drug dependency. Nothing in
N.J.S.A. 9:6-8.21(c)(4)(b) suggests that a woman is not
exercising the minimum level of care by obtaining timely medical
advice and by timely entering a medically approved
detoxification program that will improve the outcome for her
newborn.
According to the record in this case, before she knew she
was pregnant, Yvonne was addicted to a prescribed opioid,
Percocet, which she had been taking to deal with a physical
injury. Yvonne followed the advice of a medical professional
and later entered into a methadone maintenance program.
According to the Centers for Disease Control and Prevention,
methadone maintenance treatment is “the most effective treatment
for opiate addiction” and leads to “improved pregnancy
outcomes.” Ctrs. for Disease Control & Prevention, Methadone
Maintenance Treatment, 1 (2002),
http://www.cdc.gov/idu/facts/methadonefin.pdf. The United
States Department of Health and Human Services has reported that
methadone maintenance treatment can save the life of a baby born
to an addicted mother and that a newborn experiencing methadone
withdrawal is far better off than a newborn addicted to heroin.
27
Substance Abuse and Mental Health Servs. Admin., U.S. Dept. of
Health and Human Servs., Methadone Treatment for Pregnant Women
(2014), available at,
http://store.samhsa.gov/shin/content//SMA14-4124/SMA14-4124.pdf.
Commentators warn that finding a mother liable of abuse or
neglect for her newborn’s neonatal abstinence syndrome after the
mother has made an informed medical decision to undergo
methadone maintenance treatment will discourage women from
entering detoxification programs that will likely improve their
children’s health prospects. Martha A. Jessup, et al.,
Extrinsic Barriers to Substance Abuse Treatment Among Pregnant
Drug Dependent Women, 33 J. Drug Issues 285, 291 (2003) (noting
that pregnant woman’s fear of seeking appropriate medical help
for addiction will have adverse consequences on newborn’s
health); see also U.S. Gen. Accounting Office, GAO/HRD-90-138,
Report to the Chairman, Comm. on Finance, U.S. Senate, Drug-
Exposed Infants: A Generation at Risk 9 (1990) (“[T]he
increasing fear of incarceration and losing children to foster
care is discouraging pregnant [addicts] from seeking care.”);
Marilyn L. Poland, et al., Punishing Pregnant Drug Users:
Enhancing the Flight from Care, 31 Drug and Alcohol Dependence
199, 202 (1993) (noting “that substance using pregnant women
[will] ‘go underground’” if they fear incarceration and loss of
children following treatment for their addiction).
28
N.J.S.A. 9:6-8.21(c)(4)(b) does not require a finding of
abuse or neglect when an addicted woman, who learns that she is
pregnant, seeks timely professional treatment for her addiction
that will improve the outcome for her unborn child. We hold
that, absent exceptional circumstances, a finding of abuse or
neglect cannot be sustained based solely on a newborn’s enduring
methadone withdrawal following a mother’s timely participation
in a bona fide treatment program prescribed by a licensed
healthcare professional to whom she has made full disclosure.
We therefore reverse the Appellate Division’s determination
that the withdrawal symptoms experienced by Paul resulting from
Yvonne’s participation in a bona fide methadone maintenance
program was, standing alone, a sufficient basis for a finding of
abuse or neglect.
We have resolved only the issue before us. We do not pass
on whether there is sufficient credible evidence to support an
abuse or neglect finding on some other basis referenced by the
family court, such as the timeliness of Yvonne’s seeking drug
treatment -- that is, whether an unjustified delay might have
adversely affected her newborn’s later withdrawal symptoms. We
also do not address whether Yvonne violated the abuse and
neglect statute because of the manner in which she responded to
the domestic violence allegedly committed against her. We
therefore remand to the Appellate Division to decide whether
29
there is sufficient credible evidence in the record to support
the finding of abuse or neglect on an alternate theory
articulated by the family court.
VI.
Last, the Appellate Division’s footnote on the child abuse
reporting requirement under N.J.S.A. 9:6-8.10 does not resolve
whether a hospital has a legal duty to report when a newborn is
afflicted with neonatal abstinence syndrome resulting from a
mother’s participation in a medically approved methadone
maintenance program.7 That issue was not properly joined in this
case. It was not raised, argued, or briefed in the family court
or Appellate Division. The hospital and its professional
personnel -- whose interests were directly implicated by the
footnote -- were not parties to the abuse and neglect litigation
and therefore had no opportunity to address the scope of their
reporting requirement. No party in this case had a similar
adversity of interest to that of the hospital and its
professional staff. This case does not present an appropriate
vehicle -- either for the Appellate Division or this Court -- to
discuss a hospital’s reporting requirement under N.J.S.A. 9:6-
7 As noted earlier, N.J.S.A. 9:6-8.10 states that “[a]ny person
having reasonable cause to believe that a child has been
subjected to child abuse or acts of child abuse shall report the
same immediately to the Division of Child Protection and
Permanency by telephone or otherwise.”
30
8.10, and therefore the footnote has no effect.
VII.
For the reasons given, we reverse the judgment of the
Appellate Division. We remand to the Appellate Division for
further consideration of whether there is any alternative basis
on which to sustain the family court’s finding of abuse or
neglect. We express no opinion on that subject.
CHIEF JUSTICE RABNER; JUSTICES LaVECCHIA, PATTERSON,
FERNANDEZ-VINA, and SOLOMON join in JUSTICE ALBIN’s opinion.
JUDGE CUFF (temporarily assigned) did not participate.
31
SUPREME COURT OF NEW JERSEY
NO. A-24 SEPTEMBER TERM 2013
ON CERTIFICATION TO Appellate Division, Superior Court
NEW JERSEY DIVISION OF CHILD
PROTECTION AND PERMANENCY,
Plaintiff-Respondent,
v.
Y.N.,
Defendant-Appellant,
and
P.C.,
Defendant.
__________________________________
IN THE MATTER OF P.A.C., a minor.
DECIDED December 22, 2014
Chief Justice Rabner PRESIDING
OPINION BY Justice Albin
CONCURRING/DISSENTING OPINIONS BY
DISSENTING OPINION BY
REVERSE AND
CHECKLIST
REMAND
CHIEF JUSTICE RABNER X
JUSTICE LaVECCHIA X
JUSTICE ALBIN X
JUSTICE PATTERSON X
JUSTICE FERNANDEZ-VINA X
JUSTICE SOLOMON X
JUDGE CUFF (t/a) ----------------------- --------------------
TOTALS 6
1