Sandra R./sergio C. v. dcs/m.R./f.M./j.M.Sandra R./sergio C. v. dcs/m.R./f.M./j.M.
JUSTICE LOPEZ, opinion of the Court:
¶1 We consider the inquiry a juvenile court must make when terminating parental rights under
I.
¶2 Sandra R. (“Mother“) and her five-year-old daughter M.R. began living with Sergio C. (“Father“) in 2013. Mother subsequently gave birth to Father‘s children, F.M., in 2015 and J.M., in 2017. On April 24, 2017, then six-week-old J.M. slept most of the day and began vomiting that evening. Later that night, her condition worsened. J.M.‘s arms began to shake, she turned pale, started moaning, could not fully open her eyes, and her arms became stiff. Mother and Father took J.M. to an urgent-care center where, upon examination, the doctor told them to immediately take J.M. to
¶3 Dr. Melissa Jones, a PCH pediatrician with a specialty in child abuse pediatrics, evaluated J.M post-surgery. After reviewing the family‘s medical history and J.M.‘s birth records, Dr. Jones determined J.M.‘s injuries resulted from abusive head trauma. Mother and Father provided no alternative explanation for the cause of J.M.‘s injuries. PCH reported the injuries and, as a result, the Arizona Department of Child Safety (“DCS“) took custody and filed dependency petitions as to all three children. In July 2017, DCS moved to terminate Mother‘s rights to J.M., F.M., and M.R., and Father‘s rights to J.M. and F.M., for parental abuse or failure to protect from abuse. See
¶4 Over seven months, DCS offered Mother and Father services, including hair-follicle testing to rule out drug abuse, psychological evaluations, individual counseling, and a parent-aide during visits with the children. Mother and Father participated in services but continued to minimize J.M.‘s injuries and provided no further explanation for how the injuries occurred.
¶5 The juvenile court held a four-day termination hearing in December 2017 and April 2018. Dr. Jones testified for DCS, stating she believed that J.M.‘s injuries resulted from nonaccidental trauma and that J.M.‘s lack of external injuries did not rule out abuse. According to Dr. Jones, the retinal hemorrhaging was indicative of “massive trauma” caused by acceleration and deceleration with “significant force.” Dr. Ruth Bristol, the pediatric neurosurgeon who performed the emergency surgery, testified that J.M.‘s injuries were most likely caused by recent trauma and that J.M. would require long-term, full-time care for the foreseeable future.
¶6 Mother and Father‘s expert, pediatric neurologist Dr. Joseph Scheller, disagreed with DCS‘s experts. He testified that a scalp injury caused J.M.‘s retinal hemorrhages at birth resulting in a subdural hematoma that began spontaneously re-bleeding some weeks later. He conceded that this occurrence would be “an unusual complication” and that no other non-traumatic medical condition could have caused J.M.‘s injuries.
¶7 Dr. Jones and Dr. Bristol rejected Dr. Scheller‘s conclusion. Dr. Jones testified that such an occurrence under J.M.‘s circumstances would be “very, very rare” and that “children [who] have spontaneous re-bleeding [also] have some other complicating factor with their brain.” Dr. Bristol testified that the blood clot was only one or two days old and had not been present since birth. She further testified that in her experience as a pediatric neurosurgeon, she had “not seen a spontaneous re-bleed to that degree.” Dr. Jones stated that the only time PCH sees J.M.‘s pattern of retinal hemorrhages is from abusive head trauma, severe motor vehicle collisions, or children who have fallen out of two- or three-story windows onto concrete.
¶8 On April 23, 2018, the juvenile court terminated Mother‘s rights to J.M., F.M., and M.R., and Father‘s rights to J.M. and F.M. The court found that J.M.‘s injuries were the result of nonaccidental trauma and that Mother or Father, or both, intentionally abused J.M. or knew or reasonably should have known that the other parent abused her “as she was in their sole care when she suffered life-threatening injuries.” Applying the “constitutional nexus” standard established by Linda V. v. Arizona Department of Economic Security, 211 Ariz. 76 (App. 2005), the juvenile court found a significant nexus existed between J.M.‘s abuse and the risk of abuse to J.M.‘s siblings. The court found that despite J.M.‘s extensive injuries, Mother and Father continued to deny that abusive conduct occurred, presented a “united front,” and remained committed to each other and their relationship, even marrying. Because neither parent had shown a willingness to leave the other to protect the children from the other parent, the court concluded that both parents demonstrated their lack of protective capacities for all the children.
¶9 Mother and Father appealed, arguing that the court did not find a sufficient “constitutional nexus” between J.M.‘s abuse and risk of
¶10 In reaching its decision, the court concluded that our opinion in Alma S. v. Department of Child Safety, 245 Ariz. 146 (2018), requires courts to analyze the “constitutional nexus” standard under the totality of the circumstances in determining whether termination is in the best interests of the child rather than during the initial parental unfitness inquiry. Sandra R., 246 Ariz. at 186–87 ¶ 22. The court then determined that reasonable evidence supported the juvenile court‘s best-interests analysis, noting the evidence of J.M.‘s abuse and the juvenile court‘s finding of a significant nexus between J.M.‘s abuse and the risk of abuse to J.M.‘s siblings. Id. at 187 ¶¶ 23–24.
¶11 We granted review to clarify the appropriate inquiry under
II.
¶12 Section 8-533 lists the statutory bases to terminate a parent‘s right to the care, custody, and control of a child. “We have interpreted § 8-533(B) as entailing a two-step inquiry.” Alma S., 245 Ariz. at 149 ¶ 8. The juvenile court must first find that a statutory ground for termination exists by clear and convincing evidence. Id. Next, the court must determine by a preponderance of the evidence that severance is in the child‘s best interests. Id. at 149–50 ¶ 8. In Alma S., we reiterated that the substantive grounds for
¶13 A parent may be deemed unfit under
¶14 Linda V. was the first case to hold that in order to support a parental termination on this basis, there must be a “constitutional nexus” between the neglect or abuse committed on “a child” and the risk that such neglect or abuse will occur to the child at issue in the proceeding. Id. at 80 ¶ 17 n.3. Although the court established the “constitutional nexus” requirement, it did not analyze how it was met in that case. Rather, the court concluded—in a footnote—that “the constitutional requirement of showing a nexus . . . was established.” Id.
¶15 Since Linda V., several court of appeals decisions have adopted and expanded the “constitutional nexus” standard. See Tina T. v. Dep‘t of Child Safety, 236 Ariz. 295, 299–300 ¶ 18 (App. 2014) (finding sufficient constitutional nexus between mother‘s willful abuse of her two children and risk of abuse to a child born after previous severance); Mario G. v. Ariz. Dep‘t of Econ. Sec., 227 Ariz. 282, 285–86 ¶ 16 (App. 2011) (extending constitutional nexus to children not yet born when previous abuse occurred); but see Seth M. v. Arienne M., 245 Ariz. 245, 248 ¶ 11 (App. 2018) (noting that Linda V. “does not identify any legal source for such a requirement and it is not present in the statute itself,” but declining to address the validity of the “constitutional nexus” requirement). Although Linda V. did not state when the court should consider the nexus requirement during the two-step inquiry, until this case, the cases adopting the standard considered it during the initial statutory unfitness inquiry.
III.
¶16 We consider here whether a juvenile court, when determining whether to terminate parental rights under
¶17 As an initial matter, we note that the “constitutional nexus” terminology, which is not in the statute, has engendered confusion in the courts. See, e.g., Seth M., 245 Ariz. at 248 ¶ 11. Thus, to allay confusion, we disavow use of the “constitutional nexus” phraseology. Instead, we clarify the due process requirement embodied in the “constitutional nexus” concept: to terminate parental rights to children who exhibit no evidence of neglect or abuse, under
¶18 Here, the juvenile court, following previous court of appeals decisions, analyzed the risk of harm to the non-abused children based on Mother and Father‘s alleged abuse of J.M. during the initial statutory unfitness inquiry. After finding Mother and Father unfit as to J.M. under
¶19 The court of appeals, however, reasoned that Alma S. “makes clear that, at the statutory-[unfitness] grounds stage, the juvenile court should only determine whether the party seeking termination has met its
¶20 Although the court of appeals correctly affirmed the juvenile court‘s severance of parental rights as to F.M. and M.R., infra ¶¶ 28–32, it misconstrued this Court‘s holding in Alma S. and misinterpreted
¶21 First, the court of appeals erred by relying on Alma S. for the proposition that a juvenile court should consider the risk of harm to a non-abused child during the best-interests inquiry. Alma S. does not address this issue. Instead, it simply reiterates that the “substantive grounds for termination listed in § 8-533(B)” are equated with parental unfitness. See Alma S., 245 Ariz. at 150 ¶ 9. We granted review in Alma S. to “clarify the appropriate inquiry for a best-interests analysis under § 8-533(B)” and, in our analysis of this discrete issue, we observed that “once the court finds ‘that a parent is unfit [under § 8-533(B)], the focus shifts to the interests of the child as distinct from those of the parent.‘” Id. at 149 ¶ 7, 150 ¶ 12 (quoting Kent K. v. Bobby M., 210 Ariz. 279, 285 ¶ 31 (2005)). Thus, Alma S. does not support, much less require, relegation of the necessary finding that the child at issue is at risk for abuse or neglect to the best-interests inquiry.
¶22 Second, the court improperly held that determining the risk for abuse or neglect of a non-abused child is “outside the scope” of
IV.
¶23 We next consider the application of
¶24 Any extrapolation of unfitness must pass constitutional muster under Santosky. In other words, as with any parental rights termination, Santosky requires a finding of parental unfitness as to a child by at least clear and convincing evidence. 455 U.S. at 769–70 (“[D]etermination of the precise burden equal to or greater than that standard is a matter of state law properly left to state legislatures and state courts.“). Inherent in this requirement is a demonstrable connection between the ground for termination and the harm or risk of harm to a child. Id. at 767 (“The State‘s interest in finding the child an alternative permanent home arises only when it is clear that the natural parent cannot or will not provide a normal family home for the child.” (citation omitted) (internal quotation marks omitted)). Thus, a juvenile court may terminate a parent‘s rights to non-abused children under
¶25 Here, although the parties dispute whether the legislature intended
¶26 The State argues that parents’ due process rights may be preserved by applying the clear and convincing standard to the risk of harm finding in the best-interests inquiry. Although this approach would satisfy Santosky‘s due process requirements, it is procedurally inconsistent with our two-step inquiry under
¶27 In sum, a juvenile court‘s extrapolation of parental unfitness will not pass constitutional muster under Santosky unless the risk of harm to non-abused children is proven by clear and convincing evidence. Consequently, a juvenile court is encouraged to make express findings
V.
¶28 Mother and Father argue that the juvenile court‘s termination order is constitutionally infirm because the record does not establish J.M.‘s abuse presents a risk of harm to her siblings sufficient to justify termination of parental rights to F.M. and M.R. “[W]e accept the juvenile court‘s findings of fact if reasonable evidence and inferences support them, and will affirm a severance order unless it is clearly erroneous.” Demetrius L. v. Joshlynn F., 239 Ariz. 1, 3 ¶ 9 (2016).
¶29 The juvenile court‘s findings were sufficient to support termination of Mother and Father‘s parental rights as to F.M. and M.R. The juvenile court found that the only plausible explanation for J.M.‘s injuries was abuse because Mother and Father were her only caregivers, they denied that J.M. was dropped or any other accidental trauma occurred, and J.M.‘s injuries were consistent with abuse. The court found that Mother and Father were not forthcoming about the cause of J.M.‘s injuries and that, just as their denials about J.M.‘s abuse were not credible, Mother and Father‘s “testimony that they would not harm their other children lacked credibility.” The court reasoned that each parent either abused J.M., knew that J.M. had been abused, or reasonably should have known that the other parent abused J.M. due to the “timing, extent, mechanics, and presentation of her injuries.”
¶30 The court further noted that Mother and Father remained committed to one another to the exclusion of the children, and thus the court had “grave concerns about the parents’ protective capabilities in the future” as to all their children. The court concluded that the extent and degree of J.M.‘s injuries, along with Mother and Father‘s unwillingness to protect the children from future abuse, established a severe risk of abuse to
¶31 Although the juvenile court did not make explicit factual findings concerning the risk of abuse to F.M. and M.R., the court sufficiently imputed the risk of harm to the other children based on J.M.‘s serious injuries and Mother and Father‘s lack of credibility in their assurances that they would insulate their other children from abuse. On this record, the juvenile court was not required to make detailed express findings concerning the risk of abuse to F.M. and M.R. because such risk was manifest in light of the nature of J.M.‘s injuries and the other children‘s vulnerability due to age.
¶32 As for the best-interests analysis, reasonable evidence supported the court‘s finding that the severance of parental rights will benefit the children because they require a home environment free of a heightened risk of abuse. Further, F.M. and M.R. are currently in adoptable home placements.
VI.
¶33 We affirm the juvenile court‘s severance order and vacate the court of appeals’ opinion in part. We do not disturb the court of appeals’ opinion as to J.M.
¶34 I agree with the Court‘s reasoning and conclusion. I write separately only to reiterate the concerns I raised in Alma S. v. Department of Child Services that some of the statutes and rules governing the termination of parental rights, and this Court‘s decisions interpreting and applying them, do not provide sufficient protection of the parents’ rights under the United States Constitution. 245 Ariz. 146, 152–56 ¶¶ 24–39 (2018).