Appellant N.B. asks us to reverse the adjudication of her three young daughters
The first is whether the trial court erred in allowing Dr. Allison Jackson, a pediatrician аnd expert on child abuse, to render the opinion that Ma.F.’s multiple fractures were caused by blunt force trauma rather than a genetic bone disorder known as osteogenesis imperfecta, where Dr. Jackson based her opinion, in part, on the findings of a colleague in a medical specialty (pediatric genetics) outside her own area of expertise. We conclude the court properly admitted Dr. Jackson’s testimony under the general rule that an expert witness is permitted to rely on the opinion of another expert in formulating her own opinion when such reliance is reasonable in the expert’s particular field. Although the rule is not a license for one expert merely to parrot the conclusion of another, that is not what occurred in this case.
The second question is whether there was sufficient evidence for the trial court to conclude that A.B. and N.D. were neglected children. The court so found in consideration of the pattern of physical abuse inflicted on their infant sibling, Ma. F., with whom they resided; A.B.’s report that her mother and Ma.F.’s father had hit her with a ruler and a belt; and the adverse inference the court drew upon finding that Ma.F.’s father testified falsely at trial when he denied having corporally punished the girls. We conclude that the evidence before the court was insufficient to support the adjudications of neglect as to A.B. and N.D., in essence because it did not show that the children had been, or were in imminent danger of being, abused within the meaning of the neglect statute.
I. Background
Ma.F. was three months old when her parents, N.B. and M.F., brought her to Children’s National Medical Center (“Children’s Hospital”) in the middle of the night because she was in discomfort, her feet were swollen, and the skin on her feet was peeling. X-rays of the feet revealed fractures of her left first metatarsal (the “big toe”) and the ends of her tibias near her ankles. The tibia fractures were of the “corner” or “bucket handle” type, where a slivеr of the bone shears off from the main shaft — or, to put it another way, the plane of the fracture is closer to being parallel to the length of the bone than it is to being transverse. A follow-up full skeletal survey, which x-rayed all the bones in Ma.F.’s body from multiple views, disclosed a number of additional fractures in her arms and legs, including corner fractures of her left and right tibias and her left femur near the knee, a corner fracture of her right humerus near the elbow, two fractures of her left radius (one near the wrist and the other near the elbow), and a fracture of her left ulna. The fractures were in various stages of healing, implying they had been sustained at different timеs.
Ma.F. was treated at Children’s Hospital by emergency room staff and by the orthopedic surgeon on call. In light of the
N.B. and M.F. met with a social worker from CFSA’s Child Protection Services Unit the day after Dr. Jackson filed her report. Neither parent was able to account for Ma.F.’s injuries (an inability that continued through the еnsuing proceedings in Superior Court
II. Dr. Jackson’s Testimony Regarding Ma.F.’s Injuries
N.B. frames her challenge to the admission of Dr. Jackson’s opinion testimony regarding the cause of Ma.F.’s injuries as an attack on the doctor’s qualifications. To bе qualified as an expert, a witness must have “sufficient skill, knowledge, or experience” in the relevant area that her opinion testimony will “probably aid” the trier of fact to arrive at the truth.
N.B. contends, however, that Dr. Jackson was unqualified to interpret Ma.F.’s blood test results and exclude the genetic disorder osteogenesis imperfecta (“O.I.”) as the cause of her bone fractures. Only a geneticist, N.B. argues, would have been qualified to render such an expert judgment. Dr. Jackson admittedly was not a specialist in genetics or in the treatment of the congenital bone disorder. N.B. asserts that Dr. Jackson impermissibly parroted the geneticist’s conclusion in rendering her own medical opinion that Ma.F.’s fractures were caused by blunt force trauma and not 0.1.
We disagree. N.B. understates Dr. Jackson’s expertise and overstates the extent to which Dr. Jackson relied on the geneticist’s finding. Dr. Jackson testified without contradiction that she was capable of recognizing osteogenesis imperfecta herself by virtue of her pediatric training and her experience. Indeed, she testified that any pediatrician would have been able to do so. Dr. Jackson had cared for other patients with the disorder and had diagnosed O.I. or offered it as a differential diagnosis in other cases in which the condition later was confirmed. She was familiar with the clinical signs of O.I., which include abnormal bone mineralization and fragility, misshapen bones and abnormal healing of older fracturеs, so-called “wormian” bones in the skull (small plates in between the cranial bones), and a bluish tinge to the whites of the eyes. When Dr. Jackson examined Ma.F. and reviewed her x-rays and laboratory test results at Children’s Hospital, she observed none of those signs. Dr. Jackson agreed that a particularly mild form of O.I. might not manifest such obvious symptoms, but, as she explained in her testimony, the sheer number of fractures Ma.F. had sustained made the theoretical possibility of mild O.I. implausible. The fact that Ma.F.’s fractures healed and no new fractures occurred in the two-month period following her placement in shelter care
We are satisfied that neither Dr. Jackson’s lack of specialization in genetics (or in bone disorders) nor her partial reliance on another expert’s finding was disqualifying. A physician offering expert testimony need not be “a specialist in the particular field of which [s]he speaks,”
As to Dr. Jackson’s partial reliance on a colleague’s expertise, “[mjedical professionals have long been expected to rely on the opinions of other medical professionals in forming their opinions.”
To be sure, “[a] scientist, however well credentialed he may be, is not permitted to be the [mere] mouthpiece of a scientist in a different specialty.”
In this case, there is no evidence suggesting that it was unreasonable for Dr. Jackson to rely on the geneticist’s report of Ma.F.’s blood test result. It was precisely the kind of routine medicаl consultation that physicians normally request and rely on, and there is no reason to think the consultation was performed inappropriately in this instance. All the evidence corroborated the geneticist’s report; there is no evidence Ma.F. actually had 0.1. or any other bone disorder. And, in rendering her opinion, Dr. Jackson did not “parrot”
Accordingly, we affirm the trial court’s judgment that Ma.F. was a neglected child.
III. The Sufficiency of the Evidence that A.B. and N.D. Were Neglected Children
N.B.’s second challenge is to the legal sufficiency of the evidence to support the neglect adjudications of five-year-old A.B. and seven-year-old N.D.
Neither A.B. nor N.D. testified at trial, and the government introduced no direct evidence or expert witness testimony that either girl ever had been abused, injured, or otherwise neglected by (or through the fault of) their parents. The physical examinations performed on the girls at CFSA’s request by Dr. Franceschini, a pediatrician, were, at best, inconclusive. A.B. had no observable injuries or any other physical sign that she had been mistreated. On the older girl, Dr. Frances-chini observed “a one-centimeter, old, healing scar” on her right arm and a more recent two-centimeter “red linear abrasion” on her forehead. N.D. denied ever having been hit by an adult and told the pediatrician that the abrasion on her forehead had happened “on the playground a long time ago” — an explanation Dr. Fran-ceschini deemed plausible. Dr. Frances-chini found no reason to conclude that N.D. had been abused or neglected.
The sole evidence that either girl ever had been maltreated was provided in the
N.B. did not testify at trial. M.F., who did take the witness stand, acknowledged having disciplined A.B. and N.D. when they misbehaved, but claimed he did so only by depriving them of things they wanted, or by sending them to their rooms.
Crediting A.B.’s statements to Dr. Fran-ceschini and Dr. Carter, the court found that N.B. and M.F. had subjected each of the older girls to “excessive corporal punishment” by hitting them with a belt and (in the mother’s case) a ruler. The court found that M.F. had lied on the witness stand when he denied using corporal punishment, and it inferred from his “false exculpatory statements a consciousness of guilt, from which guilt itself could be inferred.”
The court found thаt A.B. and N.D. were neglected children under two statutory criteria: they were “without proper parental care and control,”
In our view, the court’s rationale was flawed. The finding that Ma.F. had endured a pattern of physical abuse for which her parents bore responsibility was suрported by the evidence. By itself, however, that finding was not enough to support findings of neglect with respect to the older girls. “[T]here is no per se rule allowing a child to be adjudicated neglected ... simply because a different child in the same home has been abused.... A finding of imminent danger [of being abused] does not necessarily follow from the fact that a sibling has been abused.”
Of course, the trial court here relied on its additional finding that, by hitting them with a belt and a ruler, the parents had employed excessive corporal punishment in disciplining A.B. and N.D. It is difficult to sustain this finding as to N.D. She did not complain of such mistreatment,
Although it is a close question, we do think the court fairly could find by the requisite preponderance of the evidence that M.F. (if not also the children’s mother) had used excеssive corporal punishment in disciplining A.B.
Nonetheless, to be upheld, “a finding of neglect must embody a correct understanding of the relevant statutory terms.”
The trial court did not find, and the government cites no record evidence showing, that A.B. or N.D. had suffered or was threatened with “mental injury,” defined as “harm to a child’s psychological or intellectual functioning, which may be exhibited by severe anxiety, depression, withdrawal, or outwardly aggressive behavior, or a combination of those behaviors, and which may be demonstrated by a change in behavior, emotional response, or cognition.”
Accordingly, for insufficiency of proof, we reverse the trial court’s judgment that A.B. and N.D. were neglected children.
IV. Conclusion
For the aforesaid reasons, the judgment in No. 06-FS-1012 (the neglect adjudication of Ma.F.) is affirmed. The judgments in Nos. 06-FS-1010 and 06-FS-1011 (the neglect adjudications of A.B. and N.D.) are reversed.
So ordered.
Notes
. Ma.F.’s father, M.F., has not challenged the neglect adjudications on appeal. S.D., the biological father of A.B. and N.D., did not participate in the proceedings below and is not a party to this appeal.
. The radiologist and the geneticist were not called to testify at trial. The orthopedic surgeon, who did testify, described Ma.F.'s injuries but expressed no opinion as to their cause or whether Ma.F. had a bone disorder.
. The trial court made no finding as to who had injured Ma.F., concluding only that her parents had failed to make reasonable efforts to prevent the infliction of abuse upon the child. See D.C.Code § 16-2301(9)(A)(i).
. See D.C.Code §§ 16-2309(a)(3), 16-2310(b) (2009 Supp.).
. See D.C.Code § 16-2312(a)(l) (2009 Supp.).
. N.D. was evaluated by a different psychologist, who was not called to testify at the neglect trial.
. Dyas v. United States,
. See In re Melton,
. This information was provided at trial by the orthopedic surgeon, who had examined Ma.F. both at Children’s Hospital and after she had been placed in foster care.
. According to Dr. Jackson, the pediatric geneticist did meet with Ma.F.’s parents. While it is not clear what information the geneticist obtained from them, there is no suggestion in the record that Ma.F. has a family history of O.I.
. Melton,
. See, e.g., Ferrell v. Rosenbaum,
. Walker v. Soo Line R.R.,
. Melton,
. See id. at 901-904.
. Fed.R.Evid. 703 advisory committee’s note to 1972 Proposed Rules.
. Id. This long has been the rule in this jurisdiction. See, e.g., Jenkins, 113 U.S.App. D.C. at 304-05,
. Dura Auto. Sys. of Ind., Inc. v. CTS Corp.,
. Id. at 613-14. "Such reliance would amount to offering an opinion of another in violation of the hearsay rule." Jenkins,
. Dura Auto.,
. Melton,
. Id. at 903-04. In criminal cases, the Confrontation Clause of the Sixth Amendment may limit a prosecution expert’s reliance at trial on testimonial hearsay, including the out-of-court opinion of a non-testifying expert. See Veney v. United States,
. Melton,
. N.B. herself could have called the geneticist to testify, of course.
. N.B.’s challenge to those adjudications is not moot (as the government contends) merely because all the children already have been returned to her and their cases have been closed, if only because the neglect findings still “might indirectly affect the appellant's status in potential future proceedings” relating to each child. In re E.R.,
. In re L.H.,
. E.g., In re E.H.,
. The trial court admitted A.B.’s out-of-court statements to Dr. Franceschini and Dr. Carter (over objection in the latter case) under the hearsay exception for statements made for purposes of medical diagnosis or treatment. See In re Kya. B.,
. Dr. Carter was not asked about her psychological evaluation of A.B., and her evaluation report (on which she relied to refresh her recollection at trial) was not introduced in evidence. It is, however, in the court file and the record before us. Lest there be any question, we note that thе report described A.B. as an apparently "well functioning child" who presented with no "acute mental health problems.”
. See In re G.H.,
. D.C.Code § 16-2301 (9)(A)(ii).
. D.C.Code § 16-2301(9)(A)(v).
. From the fact that Ma.F.'s numerous fractures evidently were inflicted over an extended period of time rather than in a single "isolated or impulsive incident,” the court inferred that she had been the victim of "a consistent pattern of conduct posing a continuing risk.”
. There was no claim, nor any evidence, that A.B. or N.D. had suffered abuse (as that term is used in the neglect statute, which we discuss below) in the past, nor did the court so find. Rather, the court explained, "[biased on [Ma.F.'s] type and number of fractures, the consistent pattern of [Ma.F.’s] maltreatment, [M.F.'s] false exculpatory statements, and the continued presence of [A.B.] and [N.D.] in the home, concerns of imminent danger are well founded.” And "[t]he unexplained fractures sustained by [Ma.F.] as a result of physical abuse combined with the excessive corporal punishment exerted on [N.D.] and [A.B.], establish the lack of proper parent care and control.” The court cited no other basis for finding a lack of prоper parental care and control.
. In re Kya. B.,
. Id. at 473.
. The record on appeal contains a psychological evaluation of N.D. performed by a Dr. Michael Gilliard. Dr. Gilliard did not testify, his evaluation report was not introduced in evidence at trial, and the trial court did not purport to rely on the report in finding that N.D. was a neglected child. Out of an abundance of caution, however, we have examined the report ourselves. As described in the report, N.D.’s statements to Dr. Gilliard on the subject of parental discipline do not establish that either parent used excessive corporal punishment in disciplining her:
[N.D.] indicated that as an infant, her mоther would pop her on the hand as a form of discipline. She subsequently reported that over time, her mother primarily used punishment and corporal punishment as forms of discipline. [N.D.] denied having ever felt as if she were abused....
According to [N.D.], her father’s primary form of discipline was corporal punishment. She asserted that her father’s corporal punishment was not "hard.” She denied having ever felt as if she were abused by her father.
.The government's burden is to prove neglect by a preponderance of the evidence. In re E.H.,
. D.C.Code § 16-2301 (23)(B)(i) (2009 Supp.); see also In re G.H.,
. See In re S.K.,
. In re Kya. B.,
. In re L.H.,
. See id. at 581-82.
. D.C.Code § 16-2301(23)(A)(i) (2009 Supp.). The statutory definition of the term "abused” also encompasses "sexual abusе or exploitation” and "negligent treatment or maltreatment,” which are themselves defined terms. See D.C.Code § 16 — 230l(23)(A)(ii), 23(A)(iii), (24), (25), (31), (32). These other meanings of the term "abused” are not implicated in this case.
. D.C.Code § 16-2301(30) (2009 Supp.). See, e.g., In re L.H.,
. See In re K.S.,
. D.C.Code § 16-2301(31).
. To the contrary, see footnote 29, supra. Cf. In re K.S.,
. It might be suggested that the parental use of excessive corporal punishment, even if it did not place A.B. and N.D. in imminent danger of “abuse,” by itself meant that the two girls were "without proper parental care or control” (and hence were neglected children within the meaning of D.C.Code § 16-2301 (9)(A)(ii)). That was not the trial court's rationаle, nor is it the District's argument on appeal. We believe the statutory language cannot be stretched so far. Not every improper parenting method constitutes neglect, and ordinarily, we think, instances of excessive physical discipline (not amounting to "abuse”) would not, without more, justify a finding that a child lacked proper care and control. Cf. In re L.H.,
