In the Matter of the Welfare of the Child of: H. R. and B. R. (deceased), Parents.

This opinion is nonprecedential except as provided by
Minn. R. Civ. App. P. 136.01, subd. 1(c).

STATE OF MINNESOTA
IN COURT OF APPEALS
A21-0611

In the Matter of the Welfare of the Child of:
H. R. and B. R. (deceased), Parents.

Filed October 18, 2021
Affirmed
Bjorkman, Judge

St. Louis County District Court
File No. 69DU-JV-17-590

Matthew Miller, Duluth, Minnesota (for appellant-mother)

Mark S. Rubin, St. Louis County Attorney, Sara Jankofsky, Assistant County Attorney,
Duluth, Minnesota (for respondent St. Louis County Public Health and Human Services
Department)

Rebecca Shaw, Duluth, Minnesota (for child)

Tyler Modderman-Anderson, Duluth, Minnesota (guardian ad litem)

Considered and decided by Smith, Tracy M. , Presiding Judge; Bjorkman, Judge;
and Hooten, Judge.
NONPRECEDENTIAL OPINION
BJORKMAN, Judge
Appellant-mother challenges the termination of her parental rights, arguing that the
district court (1) clearly erred in its findings of fact regarding respondent-county’s efforts
to reunite the family and (2) abused its discretion by determining that termination is in the
child’s best interests. We affirm.
2
FACTS
Appellant H.R. (mother) has four children. Respondent St. Louis County Pu blic
Health and Human Services Department (the county) has been involved with and provided
services to the family since 2006. Mother is hearing impaired and has a borderline IQ of
77. The recurring issues are unsanitary conditions in the home and neglect of her children’s
medical needs.
The child who is the subject of this case was born in 2009 and is the youngest of
mother’s children. The child has significant medical needs. He was diagnosed with a rare
genetic disorder that causes elongated fingers and toes, joint laxity, intellectual disability ,
and skeletal anomalies, which required surgery to correct fused bones in his head. And he
has been diagnosed with asthma, post-traumatic stress disorder , and attention
deficit/hyperactivity disorder . The child takes 11 medications daily. He needs regular
medical monitoring and care from a geneticist, a pediatric orthopedist, a pediatric
physiatrist, an ophthalmologist, a cardiologist, a pediatric neurolo gist, a urologist, and an
endocrinologist. Of greatest concern i s the child’s bicuspid aortic valve . It will likely
require replacement, and routine monitoring is essential to prevent it from rupturing.
In 2011, the county petitioned to have the children adjudicated as needing protection
or services (CHIPS). All four children were placed in temporary foster care. Mother and
B.R. (father) complied with programming aimed at reuniting the family. The two youngest
children remained in foster care longer due, in part, to th eir special needs . Ultimately,
mother and father regained custody of all four children . The CHIPS case was closed in
November 2013.
3
In March 2014, the county began receiving reports of unsanitary conditions in the
home. In November, the county became aware of possible physical abuse by father against
the child. After an investigation, the county determined that the family needed ongoing
child-protection services. Mother and father were less engaged with these efforts than they
had been in the past . But the social workers did not have significant concerns about the
children’s safety based on what they observed in the home. In December 2015, father was
struck and killed by a car. Shortly thereafter, the county closed the child-protection case.
But it continued to provide supportive services.
In May 2016, the county received reports from healthcare providers that the child
was missing medical appointments. The providers expressed concern that mother was not
able to meet the child’s necessary healthcare needs. A social worker met with mother to
discuss the issue and develop ed a plan to help her schedule and get the child to
appointments. Three months later, the social worker learned that the child continued to
miss appointments. She again met with mother to develop a plan to address the medical
situation and condition of the home. Mother signed the plan. But she did not respond to
the social worker ’s multiple attempts to sc hedule homemaker services . When mother
failed to schedule and bring the child to appointments, the county initiated another CHIPS
proceeding.
In July 2017, the coun ty petitioned to terminate mother’s parental rights (TPR) as
to the two youngest children. The district court placed them in foster care and allowed the
two oldest children to remain with mother under the county’s supervision.
4
While the TPR case was pending, t he county continued to provide services to the
family. The social workers created a series of out -of-home placement plans (case plans)
in conjunction with mother and directed her to services designed to help her meet the
child’s special needs and to reunify the family. In May 2018, the county asked to withdraw
the TPR petition, replacing it with a petition for temporary custody. The county retained
custody of the two youngest children.1
In July 2020, the county again petitioned to terminate mother’s parental rights to the
child. The case proceeded to trial in March 2021, during which the district court heard
testimony from 13 witnesses and received 16 exhibits. At the time of trial, the child had
been in out -of-home placement for approximately 1,320 days.2 The assigned social
workers testified that they tried to engage mother in programming and offered alternative
ways for her to meet the case -plan goals. But mother was reluctant to engage with the
support staff and resources offered to her. Mother testified that the social workers did not
explain the case plans to her, failed to accommodate her hearing and intellectual
disabilities, and did not offer her appropriate services.
The district court determined that clear and convincing evidence supported
termination under three statutory bases: (1) refusing or neglecting to comply with the duties
imposed by the parent-child relationship, (2) failure of r easonable efforts to correct the
conditions leading to the child ’s out-of-home placement, and (3) the child’s status as

1 In December 2019, mother consented to transfer custody of the child’s older brother to
his foster parents.

2 This is in addition to the more than 900 days the child was in foster care before July 2017.
5
neglected and in foster care. Minn. Stat. § 260C.301, subd. 1(b)(2), (5), (8) (2020) . The
district court made detailed credibility findings, crediting the testimony of the social
workers, physicians, nurse, guardian ad litem (GAL), and foster mother, and finding it was
“unable” to credit much of mother’s testimony. The district court also determined that
termination is in the child’s best interests. Mother appeals.
DECISION
Parental rights may only be terminated for grave and weighty reasons. In re Custody
of N.A.K., 649 N.W.2d 166, 175 (Minn. 2002). We will affirm a district court’s decision
to terminate “when at least one statutory ground for termination is supported by clear and
convincing evidence and termination is in the best interests of the child, provided that the
county has made reasonable efforts to reunite the family.” In re Welfare of Child. of S.E.P.,
744 N.W.2d 381, 385 (Minn. 2008) (citation s omitted). We defer to a district court’s
credibility determinations. In re Welfare of L.A.F. , 554 N.W.2d 393, 396 (Minn. 1996 ).
And we will not disturb a district court’s determination that clear and convincing evidence
supports a statutory termination ground, absent an abuse of discretion. In re Welfare of
Child. of J.R.B., 805 N.W.2d 895, 899, 901 (Minn. App. 2011), rev. denied (Minn. Jan. 6,
2012).
The district court concluded that clear and convincing evidence supports three
statutory bases for termination. As to these bases, mother’s sole challenge is to the findings
of fact that underly the court’s determination that the county made reasonable efforts to
reunite her with the child. We review a district court’s findings of fact for clear error. In
re Child. of T.R., 750 N.W.2d 656, 660 (Minn. 2008). A finding of fact is clearly erroneous
6
if it is “manifestly contra ry to the weight of the evidence or not reasonably supported by
the evidence as a whole.” Id. at 660-61 (quotation omitted). Noting that “[t]he clear-error
standard of review is familiar because it applies across so many contexts[,]” our supreme
court recently stated:
In applying the clear-error standard, [appellate courts] view the
evidence in a light favorable to the findings. [Appellate courts]
will not conclude that a factfinder clearly erred unless, on the
entire evidence, we are left with a definite and firm conviction
that a mistake has been committed.

In re Commitment of Kenney, 963 N.W.2d 214, 221 (Minn. 2021) (quotations and citations
omitted).
I. The district court did not clearly err in its findings of fact regarding the
county’s efforts to reunite the family.

Unless relieved of its obligation by the district court, a county seeking to terminate
a person’s parental rights must make reasonable efforts to reunite the child and parent.
Minn. Stat. § 260.012(a) (2020). Reasonable efforts must “go beyond mere matters of form
so as to include real, genuine assistance.” In re Welfare of Child. of S.W., 727 N.W.2d 144,
150 (Minn. App. 2007) (quotation omitted), rev. denied (Minn. Mar. 28, 2007). They must
be “(1) relevant to the safety and protection of the child; (2) adequate to meet the needs of
the child and family; (3) culturally appropriate; (4) available and accessible; (5) consistent
and timely; and (6) realistic under the circumstances.” Minn. Stat. § 260.012(h) (2020).
A county must describe these efforts in an out-of-home placement plan filed within
30 days after a child is placed in foster care. Minn. Stat. § 260C.212, subd. 1 (a) (2020).
The plan must be prepared “jointly with the [child’s] parent,” state why the child was
7
placed in foster care, explain the changes and services needed to allow the child to safely
return home, and “when reunification is the plan.” Minn. Stat. § 260C.212, subd. 1(b),
(c)(2) (2020). The plan must be signed by the parent, submitted to the district court for
approval, and “e xplained to all persons involved in its implementation.” Minn. Stat. §
260C.212, subd. 1(b)(1)-(3), (c) (2020); see also In re Welfare of A.R.B., 906 N.W.2d 894,
897 (Minn. App. 2018).
Mother argues that the district court clearly erred by finding that (1) the case plans
were created with her input, (2) the county sufficiently explained the case plans to her, and
(3) the provided services accommodated her hearing and intellectual disabilities. We are
not persuaded for two reasons.
First, the record supports the challenged findings of fact. The four social workers3
who worked with mother from 2016 through the time of trial all testified that mother helped
develop the case plans. Mother’s second social worker stated that she and mother created
the first case plan . The plan required mother to , among other things, keep the home
reasonably clean and ensure that the needs of all family members were met. It also required
her to complete a psychological evaluation and follow recom mendations, and to engage
with services, including parenting-education and homemaker/home-management services.
The social worker arranged for the psychological assessment and referred mother to service
providers, including a number that offered parenting education. Mother continued to resist

3 The four social work ers included the initial social worker who conducted the family
assessment prior to the 2016 CHIPS proceeding , and three social workers who were
assigned sequentially between 2017 and 2021. A fifth social worker has been the child’s
developmental disabilities case manager since 2014.
8
that programming, even after the social worker directed her to a more individualized
program.
The second social worker likewise referred mother to several different programs.
She testified that she provided information about the programs to mother in small chunks,
as recommended by the psychologist who assessed mother, and repeated the information
on multiple occasions. The social worker stated that she “often call [ed] when something
happened so tha t [she] could talk to [mother] and then email [mother] after she didn’t
answer the phone.”
The third social worker testified that mother told him that s he had “ had enough
parenting services” and did not need parenting education. He also testified that h e met
with mother every few months , discussed the case plans in person and provided mother
written copies, and offered to make referrals for the recommended services. At mother’s
request, he generally communicated with her by text or email unless a more urgent issue
required a call. Because mother told him she has trouble hearing, he made a point of
checking to make sure she heard and understood him.
The fourth social worker began working with mother before the COVID -19
pandemic and continued through the time of trial. She gave mother written copies of the
relevant case plans, in person before the pandemic and later by mail. She reviewed the
case plans with mother, and regularly offered to help mother access services, including
virtual programming. She was aware of mother’s disabilities. She often communicated
with mother by text and email. When speaking directly to mother, the social worker made
9
sure mother could read her lips, and she raised her voice. And s he followed mot her’s
request to address problems one-by-one instead of all at once.
Second, mother’s arguments essentially invite us to reweigh the evidence —
something we cannot do. See L.A.F., 554 N.W.2d at 396 (“Considerable deference is due
to the district court’s decision because a district court is in a superior position to assess the
credibility of witnesses.”). Mother contends that the district court should have credited her
testimony over that of the social workers because she did not sign every case plan, some
of the case plans did not list her as involved in its creation, and none of the case plans note
her disabilities. And she points to her own testimony that the social workers never told her
what she needed to do to be reunited with the child and insulted her in various ways. These
arguments are unavailing.
The district court made careful and thorough findings based on the testimony and
other evidence. In particular, the district cour t did not credit mother’s testimony that the
social workers did not communicate effectively with her , said she was “stupid,” and told
her she was “supposed to walk to the Twin Cities” for the child’s medical appointments.
Rather, the court found , “It simply makes no sense that [mother] could hear numerous
insulting and outlandish statements f rom social workers but not hear anything that social
workers told her related to reunification and [the child’s] significant medical constellation.”
Likewise, the court did not credit (and characterized as “astonishing”) mother’s testimony
that the former GAL told her she was “too stupid” to understand the child’s medical needs
and that “the boys were better off without her, and would never come home.”
10
In short, the evidence reasonably supports the district court’s finding—including its
express credibility determinations —that mother had a hand in creating the case plans,
understood what they required, and received services that accommodated her disabilities.
On this record, we discern no clear error in the findings that led the district court to
conclude that the county made reasonable efforts to reunify mother with the child.
II. The district court did not abuse its discretion by determining that termination
is in the best interests of the child.

The child’s best interests are the “paramount consideration” in all termination cases.
Minn. Stat. § 260C.301, subd. 7 (2020). Accordingly, t he rules of juvenile protection
require that
before ordering termination of parental rights, the court shall
make a specific finding that termination is in the best interests
of the child and shall analyze:
1. the child’s interests in preserving the parent -child
relationship;
2. the parent’s interests in preserving the parent -child
relationship; and
3. any competing interests of the child.

Minn. R. Juv. Prot. P. 58. 04(c)(2)(ii); see In re Welfare of Child . of M.A.H., 839 N.W.2d
730, 744 (Minn. App. 2013) ( describing the best -interests analysis in a TPR case as
weighing three discrete interests : the child’s interest in maintaining the relationship, the
parents’ interest in maintaining the relationship, and any competing interest of the child ).
“Competing interests include such things a s a stable environment, health considerations
and the child’s preferences.” In re Welfare of Child. of K.S.F., 823 N.W.2d 656, 668 (Minn.
App. 2012) (quotation omitted). We review a district court’ s best-interests determination
11
for abuse of discretion . In re Welfare of Child . of K.L.W., 924 N.W.2d 649, 656 (Minn.
App. 2019), rev. denied (Minn. Mar. 8, 2019).
It is undisputed that the district court made the requisite best -interests findings.
Mother argues that the district court abused its discretion by determining that the evidence
weighs in favor of termination because the GAL did not investigate before recommending
termination, and because the evidence is insufficient to support the best-interests findings.
We address each argument in turn.
A. Guardian ad Litem
Mother first asserts that the district court abused its discretion because the GAL did
not fulfill his obligation under the Minnesota Rules of General Practice to
conduct an independent investigation to determine the facts
relevant to the situation of the child or incompetent adult and
the child’s parent, legal custodian, or other household or family
member, which must include, unless spec ifically excluded by
the court: . . .
(ii) meeting with and observing the child in the home
setting and considering the child’s or incompetent adult’s
wishes, as appropriate; and
(iii) interviewing parents, caregivers, and others
relevant to the case.

Minn. R. Gen. Prac. 905.01(a)(ii -iii) (rule 905.01). Mother contends that the GAL never
met or spoke to her during the year leading up to the trial, never observed her visits with
the child , and that his trial testimony reflects his failure to conduct an independent
investigation.4 The record defeats these arguments.

4 Mother cites no legal authority to support her argument that a district court abuses its
discretion by terminating parental rights in cases where the GAL did not meet the
requirements of rule 905.01. We have found no such authority. Cf. State Dep’t of Labor
12
The district court found that the GAL reached out to mother several times, but “was
unsuccessful in connecting” with her . The GAL’s testimony supports th is finding. H e
testified that he tried to call mother on June 6, 18, and September 24 of 2020, but her
voicemail was not set up. He tried again on March 4, 2021 , in preparation for trial, and
followed up with a text to which mother responded on March 9 , the day before the trial
began. At that time, the GAL consulted his supervisor who agreed it was not ap propriate
to call mother back as the trial was beginning. In addition to his efforts to interview mother,
the district court found, and the record supports, that the testifying GAL consulted with the
former GAL, met with the child, and attended quarterly meetings with the social worker,
foster-care licenser, and foster mother during which they discussed the visits between
mother and the child and mother’s progress. And the record shows mother and the child
had only one in-person visit while the GAL was assigned to the case, and their virtual visits
were “often incredibly short,” so as to offer the GAL only minimal insight into their
relationship.
The district court specifically addressed mother’s rule 905.01 argument, noting that
interviewing mother and personally observing her with the child was p referable, but that
this was difficult for the GAL to perform under the circumstances, and their absence did
not mean the GAL’s testimony and recommendations should be disregarded. Moreover,
while the district court credited the GAL’s termination recommendation, it expressly stated

& Indus. v. Wintz Parcel Drivers, Inc. , 558 N.W.2d 480, 480 (Minn. 1997) (declining to
reach inadequately briefed issues); see also In re Welfare of Child of P.T. , 657 N.W.2d
577, 586 n.1 (Minn. App. 2003) (applying Wintz in a termination -of-parental-rights
appeal).
13
that it was not “solely relying upon testimony from the [GAL] .” The district court also
found that the county “presented clear and convincing evidence related to the best interests
analysis from every single witness including the mother, [the child’s pediatrician], [ the
coordinated care nurse], [mother’s psychological evaluation administrator], [the child’s
foster mother], and every social worker who testified. ” The record does not p ersuade us
that the district court abused its discretion by considering the GAL’s testimony.
B. Sufficiency of the Evidence
Mother next argues that the evidence is insufficient to support the district court’s
determination that termination serves the child’s best interests. She specifically asserts the
finding that “without the interventions that have been provided , [ the child ’s] medical
condition would be dire” lacks evidentiary support. We disagree.
The child’s genetic condition is rare, requiring continued monitoring as the child
grows to address potential complications. Both the child’s pediatrician and his
coordinated-care nurse testified that the child needs to take numerous medications every
day, must attend regular appointments with numerous specialists , and needs a caregiver
who is able to track his progress . Without these interventions, the child would not make
optimal progress and he could have serious cardiovascular issues.
Although the child’s faili ng bicuspid aortic valve is the most pressing medical
concern, his pediatrician testified that regular monitoring by other medical specialists is
also important. An orthopedist assesses the child’s bones and joints because his genetic
anomalies put the child at risk for “more pain and dysfunction.” A physiatrist oversees his
speech and physical therapy and makes sure he has appropriate orthotics supporting his
14
joints. An ophthalmologist follow s the child’s vision because he is at risk of developing
severe nearsightedness.
Mother points to the pediatrician’s testimony that the child no longer needs growth
hormones—one of the major concerns at the time the child was placed in foster care —as
evidence that the child’s current medical status is not “dire.” But the district court credited
the above medical testimony and the foster mother ’s explanation that the child continues
to have physical and mental -health issues that require regular monitoring and treatment.
And the district court’s finding that no services or programs would enable mother to meet
the child’s medical needs is amply supported by testimony from the social workers and
medical providers about mother’s consistent inability or refusal to use the resources the
county provided or otherwise ensure that the child’s significant medical needs are met.
Ultimately, the district court explained how it balanced the interests of mother and
the child, finding that
mother has not been able to meet the child’s medical or mental
health needs and has demonstrated her complete unwillingness
to engage in the numerous available services that would
increase her capacity to meet [the child’s] needs, any interests
in preserving the relationship would be nominal at best and
would come at significant risk to [the child’s] life.

The district court then found that “the child will be able to be adopted by an individual who
can meet his significant needs, with whom the child already has a significant relationship,
and who is committed to maintaining the child’s relationship with his biological siblings.”
The district court acknowledged mother’s love for the child, but noted that the child had
been in out-of-home placement for more than hal f of his life and continued reunification
15
services were not consistent with permanency plans for the child, particularly because
mother had not “made any meaningful progress on her reunification plan.”
The record shows mother loves the child and expresses her desire to appropriately
care for him. But our careful review of the record persuades us that the district court did
not abuse its discretion by determining that termination is in the child’s best interests.
Affirmed.