In re B.C. C.P. ( 2021 )


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    DISTRICT OF COLUMBIA COURT OF APPEALS
    No. 19-FS-984
    IN RE B.C.;
    C.P., APPELLANT.
    Appeal from the Superior Court
    of the District of Columbia
    (NEG-9-19)
    (Hon. Janet Albert, Magistrate Judge)
    (Hon. Darlene Soltys, Associate Judge)
    (Argued June 16, 2021                                      Decided August 19, 2021)
    Allison K. Bauer was on the brief for appellant.
    Karl A. Racine, Attorney General for the District of Columbia, Loren L.
    AliKhan, Solicitor General, Caroline S. Van Zile, Principal Deputy Solicitor
    General, Stacy L. Anderson, Senior Assistant Attorney General, and David Stark,
    Assistant Attorney General, were on the brief for appellee.
    Before THOMPSON and EASTERLY, Associate Judges, and OKUN, Associate
    Judge, Superior Court of the District of Columbia. *
    EASTERLY, Associate Judge: A determination that a parent is unable to
    discharge their responsibilities to care for their child due to mental incapacity under
    *
    Sitting by designation pursuant to 
    D.C. Code § 11-707
    (a) (2012 Repl.).
    2
    
    D.C. Code § 16-2301
    (9)(A)(iii) (2012 Repl. & 2021 Supp.) is momentous. It can
    have an adverse impact on the parent, both legally and reputationally. For this
    reason, even if a parent opts not to challenge other grounds of neglect under 
    D.C. Code § 16-2301
    (9)(A), a parent will often still be able to demonstrate that they have
    standing to seek review of a mental incapacity determination. Further, a mental
    incapacity neglect determination must be supported by sufficient evidence, which
    may well necessitate a presentation of expert testimony. This case illustrates these
    principles.
    I. Facts and Procedural History
    In 2018, the District’s Child and Family Services Agency opened an
    investigation into then eight-year-old B.C.’s care by his mother, C.P.          CFSA
    subsequently filed neglect charges pursuant to 
    D.C. Code § 16-2301
    (9)(A)(ii)
    (defining a neglected child to include one “who is without proper parental care or
    control, subsistence, education as required by law, or other care or control necessary
    for his or her physical, mental, or emotional health, and the deprivation is not due to
    the lack of financial means of his or her parent”), and 
    D.C. Code § 16-2301
    (9)(A)(iii)
    (defining a neglected child to include one “whose parent . . . is unable to discharge
    3
    his or her responsibilities to and for the child because of incarceration,
    hospitalization, or other physical or mental incapacity”).
    A. The Government’s Theories of Neglect and the Evidence at Trial
    At the 2019 neglect trial before a magistrate judge, the government argued
    that B.C. was a neglected child under 
    D.C. Code § 16-2301
    (9)(A)(ii) because “his
    basic educational needs [were] not being met.” The government presented evidence
    that B.C. had been enrolled and removed from three different schools in the fall of
    2018, that he had attended school at most a handful of days during that timeframe,
    that C.P. had eventually sought authorization/permission to homeschool him but had
    not received the waiver she needed as a non-high school graduate, and that B.C.’s
    current academic performance was far below grade level.
    Separately, the government argued that B.C. was a neglected child under 
    D.C. Code § 16-2301
    (9)(A)(iii) because C.P.’s mental incapacity rendered her unable to
    discharge her parental responsibilities. The government’s theory was that C.P. had
    previously exhibited paranoid behavior and delusional thinking, she had sought
    unnecessary medical treatment for herself, and she was now doing the same for B.C.
    To this last point, the government submitted medical records for B.C., documenting
    C.P.’s numerous efforts to get B.C. care, often in relation to swelling on the right
    4
    side of his face. These records showed, however, that medical professionals had
    observed the swelling, diagnosed an abscessed tooth, and recommended soft tissue
    excision as treatment.
    The government did not present any recent psychiatric records or expert
    testimony to substantiate its allegation that C.P.’s mental incapacity led her to seek
    unnecessary treatment for B.C. Instead, the government presented a variety of
    medical records from (1) Jordan House, a psychiatric facility where C.P. received
    treatment for three days in 2011 for depression and suicidal ideation before checking
    herself out against therapeutic advice; (2) Core Health and Wellness Center, a
    “primary care, alternative medicine and holistic wellness services” facility, 2
    documenting numerous appointments for a range of reported ailments in 2012–16
    which indicated that she may have had ongoing mental health issues, 3 but only a
    handful of appointments in 2017 and 2018 for ailments which were verified and
    treated; and (3) United Medical Center, spanning 2011–19, documenting
    2
    About      us,   Core     Health      and    Wellness             Center,
    https://www.corehealthdc.com/about-us; https://perma.cc/KZZ3-VHVJ               (last
    visited August 10, 2021).
    3
    A 2014 note stated that C.P. had requested a heart transplant. A 2016 note
    stated that she had claimed to have untreated cancer. And a 2016 note stated that
    she “sees psychiatry but has remarked to the other providers [at Core Health and
    Wellness Center] that she does not take her psychiatric medicines.”
    5
    appointments in 2017–19 for verified and treated ailments and minor injuries (e.g.,
    a recurring sore throat, a urinary tract infection, and a bruised finger).
    The government also presented testimony regarding C.P.’s mental health from
    three CFSA employees who had interacted with C.P. 4 Narendra Date, the social
    worker assigned to B.C.’s case in 2018, testified that he met with C.P. in person five
    times over the course of that year and that C.P. was generally resistant to his effort
    to investigate her case and would not let him talk to B.C. alone. Mr. Date stated that
    “there was an indication that [C.P.] had unaddressed mental health needs.” When
    asked to elaborate on the behavior that led him to believe C.P. had unaddressed
    mental health needs, he stated that she “mistrust[ed] the people around here” and
    had “ideations about herself being seriously ill . . . [and] about the child being
    seriously ill without any documentations to back it up.”
    4
    Other government witnesses testified that they had contact with C.P., but
    they provided no information related to C.P.’s mental health or capacity: (1)
    Stephanie Thomas, the homeschool coordinator for the Office of the State
    Superintendent of Education, testified about her communications with C.P. in the
    fall of 2018 regarding approval of homeschooling for B.C., and (2) Nikki Barnes,
    B.C.’s teacher, testified that she had had a phone call and an email exchange with
    C.P., but she was not asked to detail those conversations.
    6
    Edward Rodrigues, the social worker assigned to B.C.’s case in January 2019
    after B.C. was removed from C.P.’s care, testified that he had talked on the phone
    and texted with C.P. weekly but met with her only once to supervise a visit with B.C.
    He noted that her texts could sometimes “go[] onto a tangent” and that she had called
    the police on him twice. 5 He expressed concern about her “lack of awareness of her
    mental health needs” but also stated that “I don’t know if it’s — we have an
    understanding of where she is at mentally right now.” When asked to explain why
    he thought she had current mental health needs, he testified that it was “[j]ust the
    long text messages that are . . . kind of incoherent; the ongoing lack of trust with
    anyone, particularly me,” and “[t]he idea that she still sees . . . a medical problem,
    or dental problems despite the advice of the doctor.” But he also testified that their
    relationship had improved over time, that she had become “more open” to working
    with the agency, and that she was working with a peer mentor. When asked to
    connect his concerns about C.P.’s mental health to her parenting, he testified that “I
    can’t say because I’ve only witnessed one visit.”
    Lastly, Shanay Tymus, a registered nurse employed by CFSA, testified about
    accompanying Mr. Date on a home visit to C.P.’s house in April 2018. At that visit,
    5
    He provided no detail about these incidents.
    7
    she and Mr. Date tried to get more information about B.C.’s health history, but C.P.
    refused to provide them any documents or sign a release form. Ms. Tymus testified
    that C.P. was “frustrated, really defensive, kind of like paranoid, but she wasn’t
    confrontational or anything.”
    C.P. testified on her own behalf. Regarding B.C.’s education, she explained
    that, with authorization and instructions from OSSE, she had homeschooled him in
    2017 (when B.C. would have been in first grade) because “he improves with working
    one-on-one.” She testified that she used “many” curriculums from the D.C. Library,
    but she was not asked to identify any one of them by name. She testified that, for
    reading, she used flash cards to teach B.C. sight words; for math, she worked with
    him on addition and subtraction (she noted that he struggled with double digit
    numbers); for science, she had him draw pictures of “plants, and things like that.”
    Over the summer of 2018, she enrolled him in Beers Elementary School, but she
    explained that he never attended because it was 30 minutes away and she wanted to
    enroll him at a school closer to home. She then enrolled B.C. at Martin Luther King,
    Jr. Elementary School, but when he got a spot at Ingenuity Prep, she decided to enroll
    him there because she wanted him to “go to a prep school [instead of a] public
    school.” She took him out of Ingenuity Prep after a few weeks because of bullying
    concerns, but she explained that she got in contact with OSSE to get permission to
    8
    homeschool B.C. again. She acknowledged that her “pattern” of enrolling and
    removing B.C. from various schools did not reflect “the best choices.” She testified
    that she was learning from her mistakes. She vaguely testified that in the fall of 2018
    she taught B.C. in “all” subjects, and she documented her instruction, albeit
    incompletely, in the required portfolio. She acknowledged that B.C. was behind
    academically and that his Individualized Education Plan from kindergarten had
    expired, but she testified that she had been trying to update it with Ingenuity Prep.
    Regarding her mental health, C.P. admitted that she had received treatment in
    2011–12 for postpartum depression but stated that she had no current diagnoses.
    Regarding B.C.’s medical care, she testified that his facial swelling was documented
    and diagnosed as the reaction to an impacted molar, and she pushed back against the
    notion that “[she] was just paranoid.” She explained that B.C. was scheduled to have
    a surgical procedure to address his impacted molar in January, but he was removed
    from her care before the procedure could be performed.
    B. The Neglect Determinations by the Magistrate Judge and the
    Associate Judge
    After the government gave its initial closing argument, the magistrate judge
    indicated for the first time that she was contemplating whether B.C. was neglected
    9
    not only based on the government’s theories that (1) C.P. had failed to ensure B.C.
    was getting adequate educational support, and (2) C.P.’s mental incapacity had
    caused her to seek out unnecessary medical care for B.C., but also based on a theory
    that the government had not argued, namely, (3) C.P.’s alleged mental incapacity
    had affected her decisionmaking regarding B.C.’s education. 6
    Alluding to the need to prove that a parent’s mental incapacity has a nexus to
    a child’s neglect, the magistrate judge asked the government during its rebuttal,
    “what’s the nexus for both the school and the medical?” The government responded
    only “as it relates to the medical” by explaining that “there’s a nexus between her
    mental health, her paranoia and her fixation that something is wrong with B.[C.]”
    The magistrate judge subsequently asked again, “what do you say the nexus is on
    the mental health on the decision making around schooling?” Obliged to address
    the court’s question, the government focused on the fact that B.C. was not getting
    the educational support he needed but proffered no link to C.P.’s mental health.
    Indeed, highlighting C.P.’s movement of B.C. from school to school, the counsel for
    the government acknowledged that he was “not sure of” “[t]he reason” for her
    6
    The magistrate judge appeared to have adopted this theory from the guardian
    ad litem, who argued in opening and closing that C.P.’s mental incapacity adversely
    impacted her decisionmaking regarding B.C.’s medical care and his education.
    10
    actions. Even so, the government ended the discussion by conclusorily arguing that
    B.C. was “unable to get what he needs educationally in [C.P.’s] care because [of]
    the mental health and the medical issue.”
    In a written order, the magistrate judge determined that the government had
    carried its burden to prove educational neglect, 
    D.C. Code § 16-2301
    (9)(A)(ii), but
    not neglect by reason of mental incapacity under 
    D.C. Code § 16-2301
    (9)(A)(iii)
    insofar as that neglect related to C.P.’s efforts to seek out unnecessary medical care
    for B.C. As to the latter theory of neglect, the magistrate judge found that “the
    mother has some level of paranoia but the record does not establish that the paranoia
    rises to the level of being the cause of the number o[f] appointments/providers
    consulted” regarding the swelling on the side of B.C.’s face. The magistrate judge
    highlighted the lack of “live testimony” regarding B.C.’s medical care, specifically
    the failure of the government to “call the providers as witnesses or to present the
    entirety of [B.C.’s] medical records to a medical expert . . . and have that expert
    testify.” While acknowledging that the number of appointments made by C.P. to
    address this issue seemed “excessive,” the magistrate judge observed that “the
    medical records are replete with conclusions drawn by the medical/dental
    professional about the mother’s understanding, motivation, actions, etc. that cannot
    be properly cross[-]examined” and it was “essential under the circumstances to have
    11
    at least one expert to be able to opine on the mother’s actions being tantamount to
    medical neglect.”
    Nevertheless, the magistrate judge concluded that B.C. was neglected under
    
    D.C. Code § 16-2301
    (9)(A)(iii) based on the third theory of neglect that she had
    raised, namely the theory that B.C. was neglected because of C.P.’s mental
    incapacity as reflected in her poor educational decisionmaking. Reviewing the
    evidence of C.P.’s mental incapacity, the magistrate judge no longer expressed any
    concern about the absence of expert testimony. Appearing to rely on the medical
    records as well as the testimony of lay witnesses, the magistrate judge found that
    C.P. “has a diagnosis of post-partum depression and struggles with other mental
    health issues related to anxiety, paranoia, and an inability to trust others.” The
    magistrate judge also found that C.P.’s mental health issues had a nexus to her
    educational decisions for B.C. The magistrate judge connected C.P.’s “lack of trust
    in others and inability to have [B.C.] outside her sight” both to the fact that, “when
    he attended school, [he] would regularly arrive late or was picked up early,” and to
    C.P.’s decision to homeschool B.C. The magistrate judge also noted that C.P.
    “admitted to making poor decisions as it relates to” B.C.’s education. Finally, the
    court noted C.P.’s “lack of insight” regarding B.C.’s “multiple school placements”
    12
    and whether and how to homeschool him in light of his needs and her lack of a high
    school diploma.
    C.P. sought review by an associate judge and raised sufficiency challenges to
    both of the magistrate judge’s neglect determinations.        The associate judge
    determined that the educational neglect determination under 
    D.C. Code § 16
    -
    2301(9)(A)(ii) was amply supported by B.C.’s extended school absences and C.P.’s
    inadequate homeschooling. The associate judge likewise determined that the mental
    incapacity neglect determination under 
    D.C. Code § 16-2301
    (9)(A)(iii) was
    supported by sufficient evidence. The associate judge rejected C.P.’s argument that
    expert testimony addressing her mental health should have been presented, citing
    decisions of this court for the proposition that mental incapacity under the neglect
    statute “need not be a diagnosable mental illness” and need not be established by
    expert testimony. The associate judge concluded that recognizing and understanding
    C.P.’s “obsession with imaginary medical conditions which [B.C.] and she do not
    have, paranoia, anxiety, and a severe lack of trust” were “within the realm of
    common knowledge.” The associate judge further concluded that there was
    sufficient evidence that C.P.’s mental incapacity led to B.C.’s deficient education.
    The associate judge attributed B.C.’s absence from school to his numerous medical
    appointments; opined that C.P.’s “demonstrated paranoia” and “lack-of-trust in
    13
    leaving [B.C.] in the care of third parties . . . were the reasons that [C.P.] opted to
    home-school [B.C.]”; and determined that C.P.’s “mental incapacity (which
    precluded her from recognizing her own inadequacies as a home schooling teacher)
    interfered with her ability to adequately provide homeschooling instruction to
    [B.C.]” This appeal followed.
    II. Analysis
    A. Standing
    Before we consider the merits of C.P.’s sufficiency challenge, we must
    address the government’s challenge to her standing to pursue this appeal. See D.C.
    Appleseed Ctr. for Law & Justice, Inc. v. District of Columbia Dep’t of Ins., Sec., &
    Banking, 
    54 A.3d 1188
    , 1199 (D.C. 2012) (“Standing is a threshold jurisdictional
    question which must be addressed prior to and independent of the merits of a party’s
    claims.” (internal quotation marks omitted)). In her brief to this court, C.P. does not
    challenge the educational neglect determination pursuant to 
    D.C. Code § 16
    -
    2301(9)(A)(ii); she only challenges the mental incapacity neglect determination
    pursuant to 
    D.C. Code § 16-2301
    (9)(A)(iii). Because B.C. will still be adjudicated
    neglected regardless of the outcome of this appeal, the government argues that C.P.
    lacks standing to be heard by this court regarding any errors in the associate judge’s
    14
    order affirming the magistrate judge’s findings of fact and conclusions of law that
    she neglected B.C. We cannot agree.
    Generally, to establish standing, a litigant must have “a personal stake in the
    outcome of the controversy.” Equal Rights Ctr. v. Props. Int’l, 
    110 A.3d 599
    , 603
    (D.C. 2015) (internal quotation marks omitted). The litigant must claim “an actual
    or imminent, concrete and particularized, invasion of a legally protected interest”
    that can be “‘fairly trace[d]’ to [the opposing party’s] challenged actions” and that
    can “be redressed by a favorable decision.” 
    Id.
     (ellipsis omitted) (quoting Lujan v.
    Defenders of Wildlife, 
    504 U.S. 555
    , 560–61 (1992)); see also UMC Dev., LLC v.
    District of Columbia, 
    120 A.3d 37
    , 42 (D.C. 2015) (explaining that this court,
    although created under Article I, “generally adhere[s] to the case and controversy
    requirement of Article III” of the Constitution). We have no trouble concluding that
    C.P. has the requisite personal stake in the outcome of this appeal.
    Beyond the injury of having a child removed from their care, a parent whose
    child has been deemed neglected is adversely impacted by the neglect determination
    itself, which “constitutes a permanent, and significant, stigma.” In re E.R., 
    649 A.2d 10
    , 12 (D.C. 1994) (internal quotation marks omitted). The impact on a parent’s
    reputational interest alone gives them standing to challenge a determination of
    15
    neglect. Cf. 
    id. at 13
     (holding that the mother’s appeal of a neglect determination
    was not moot even though her child had left the country and did not intend to return);
    In re G.H., 
    797 A.2d 679
    , 683 (D.C. 2002) (in a neglect appeal, holding that the
    mother’s boyfriend had “a reputational interest sufficient to provide him with
    standing to challenge” the determination that he had physically abused a child, even
    though he was “in no position to complain of the disposition of the children in the
    absence of an appeal by the mother”).
    The government argues that it is “purely speculative” for C.P. to argue that
    she will suffer reputational harm from the neglect determination under § 16-
    2301(9)(A)(iii) that is separate and distinct from the harm of a neglect determination
    under § 16-2301(9)(A)(ii). But the determination that a parent is so mentally
    incapacitated—i.e., that they have some sort of mental health condition or cognitive
    impairment, see infra II.B.1. (discussing the definition of this term)—that the
    incapacity has caused the child to be neglected impinges on a parent’s reputation in
    a way that is distinct from a determination that a parent has failed to meet the
    government’s educational standards for their child. See Bruce J. Winick, The Side
    Effects of Incompetency Labeling and the Implications for Mental Health Law, 1
    PSYCHOL. PUB. POL’Y & L. 6, 8 (1995) (explaining that the adverse effects of a
    mental incompetence label applied by courts and administrative bodies include not
    16
    only legal consequences but also “serious social disadvantages, adversely affecting
    the way others regard and treat” those who are so labeled); Justin L. Joffe, Student
    Note, Don’t Call Me Crazy: A Survey of America’s Mental Health System, 91 CHI.-
    KENT L. REV. 1145, 1166–68 (2016) (explaining that “the stigma surrounding mental
    illness stubbornly persists,” notwithstanding advances in understanding of the
    causes and treatments of mental illness). The distinct impact of a mental incapacity
    neglect determination is sufficient to give C.P. standing to challenge this
    determination on appeal. Cf. In re A.B., 
    999 A.2d 36
    , 44 n.25 (D.C. 2010) (rejecting
    the argument that, because it was affirming neglect as to one child, “any additional
    injury to [the mother’s] reputation flowing from the neglect findings with respect to
    her other children is too negligible to support her standing to contest them”).
    In re Z.C., 
    813 A.2d 199
     (D.C. 2002), cited by the government, is factually
    inapposite and does not support a different conclusion. In that case, the mother, who
    had repeatedly and severely beaten her son, was convicted of assaulting him with a
    dangerous weapon and sentenced to a term of imprisonment. She was then deemed
    to have neglected him on multiple grounds, including that she was unable to
    discharge her responsibilities as a parent “because of incarceration.” 
    Id.
     at 200 n.3
    (quoting 
    D.C. Code § 16-2301
    (9)(C) (2001)). The mother sought review of only
    that incarceration neglect determination, and this court determined that she lacked
    17
    standing to appeal. 
    Id. at 202
    . Distinguishing cases like In re E.R. and In re G.H.,
    where we had concluded the appellants had standing based on the adverse impact a
    neglect determination had on their reputational interests, we concluded in In re Z.C.
    that “[t]he mother’s [ADW] conviction . . . is a permanent stigma that would survive
    any relief that she could obtain through this appeal.” 813 A.2d at 203. Unlike in In
    re Z.C., in this case there is no other independent adjudication of the basis for the
    challenged neglect (C.P.’s alleged mental incapacity) that would negate the
    possibility of additional, appreciable reputational harm and preclude any meaningful
    relief if that neglect determination were reversed.
    In any event, the harm from the mental incapacity neglect determination that
    C.P. seeks to challenge is not just reputational and not at all speculative. Once a
    child has been deemed neglected and removed from the parent’s custody, the court
    must regularly conduct permanency planning hearings to determine inter alia
    “whether, and if so when, the child will be returned to the parent(s).” In re Ta.L.,
    
    149 A.3d 1060
    , 1077 (D.C. 2016) (en banc) (citing 
    D.C. Code § 16-2323
    (c)(2) (2012
    Repl.). A “primary focus” of a permanency planning hearing is “on the parents’
    efforts to ameliorate the conditions that led to the neglect and the District’s efforts
    to assist them in achieving those goals.” 
    Id. at 1078
     (emphasis added). Accordingly,
    a particular determination of neglect, such as a mental incapacity neglect
    18
    determination under § 16-2301(9)(A)(iii), is likely to have a direct impact on the
    parent’s ability to regain custody of their children. Cf. In re A.B., 
    999 A.2d at
    44
    n.25 (concluding that the mother’s challenge to neglect determinations was not moot
    even though the children had been returned to her because the neglect determinations
    “might indirectly affect [her] status in potential future proceedings” (internal
    quotation marks omitted)).
    The government dismisses these collateral legal consequences, however. It
    asserts that “there is no reason to think that permanency planning for B.C. will be
    adversely impacted by” the § 16-2301(9)(A)(iii) neglect determination “because the
    Superior Court Family Division does not need an adjudication [thereunder] in order
    to remediate neglect under [§ 16-2301(9)(A)(ii)] where the court believes the neglect
    under (ii) is predicated on concerns of a parent’s mental health.” To the extent the
    government is arguing that trial courts may act on “belief” instead of substantiated
    facts, we disagree. Absent a determination that a parent’s mental incapacity led to
    their child’s neglect, the government would have to present some evidence at a
    permanency planning hearing that mental health or incapacity was impeding
    reunification in order to convince the court to order remedial measures. See In re
    Z.W., 
    214 A.3d 1023
    , 1036–37 (D.C. 2019) (trial court’s permanency goal decisions
    “must be based upon and drawn from a firm factual foundation” (internal quotation
    19
    marks omitted)). In contrast, if a mental incapacity neglect determination pursuant
    to § 16-2301(9)(A)(iii) has been made, the court would necessarily incorporate an
    assessment of the parent’s mental health or incapacity into its permanency planning
    calculus. See § 16-2323(b)(4). Accordingly, the existence of the mental incapacity
    determination is a cognizable harm to C.P.
    The government separately argues that even if C.P. can show the requisite
    injury for standing, there is another reason to conclude that C.P. cannot pursue this
    appeal, namely that “this [c]ourt reviews judgments and not merely findings.” As
    support for this proposition, the government once again relies on this court’s
    decision in In re Z.C. We acknowledge that, after concluding that the mother in that
    case did not have standing to pursue an appeal, this court went on to observe in its
    final paragraph that the appeal was “subject to dismissal for a slightly different, but
    related, reason.” In re Z.C., 813 A.2d at 203. We explained that “the case [was]
    reminiscent of Thoubboron v. Ford Motor Co., 
    624 A.2d 1210
     (D.C. 1993),” where
    we had observed that “this court reviews judgments, not opinions” and declined the
    appellant’s request to “strike . . . dictum” from a trial court’s order. In re Z.C., 813
    A.2d at 203 (brackets and internal quotation marks omitted). We then said in In re
    Z.C. that “this case does not differ in principle from the issue addressed in the
    Thoubboron footnote.” 813 A.2d at 203 (emphasis added).
    20
    For multiple reasons, we disagree that In re Z.C. categorically bars appellate
    review of fewer than all neglect determinations made in a case. First, if this court in
    In re Z.C. had meant to impose such a categorical bar, the preceding standing
    analysis that serves as the foundation for the court’s primary holding would have
    been entirely unnecessary. See 813 A.2d at 203 (discussing the lack of reputational
    harm and concluding that “[a]ccordingly, the mother lacks standing to prosecute her
    appeal”); see also In re M.L., 
    28 A.3d 520
    , 531 n.22 (D.C. 2011) (relying on In re
    Z.C. for the principle that an appellant who cannot secure “any remedial benefit from
    a decision by this court” lacks standing to bring an appeal (internal quotation marks
    omitted)).   Second and relatedly, any such categorical bar would have been
    irreconcilable with the binding precedent cited in In re Z.C., authorizing neglect
    appeals to be litigated even though they would not alter the bottom-line adjudication
    of neglect. See In re G.H., 
    797 A.2d at 683, 686
     (allowing mother’s boyfriend to
    pursue his appeal, even though it could not affect the neglect adjudication, and
    ultimately concluding that the evidence was insufficient to support the finding that
    the boyfriend had placed two of the children in danger, but leaving the disposition
    order undisturbed).    Third, it is simply incorrect that this court only reviews
    “judgments.” We regularly review component rulings within judgments, and when
    we conclude that any errors were harmless, we do not simply dismiss these appeals.
    Fourth and finally, it would make little sense to force appellants to frivolously
    21
    challenge every neglect determination just to be able to claim standing to challenge
    one that can cause real injury under a traditional standing analysis. In the absence
    of any subsequent decision relying on this language in the manner the government
    advocates, we thus interpret In re Z.C. narrowly as a decision where our discussion
    of appealability was driven by our assessment that the mother—who was not
    challenging the determination either that she was in prison or that she was unable to
    personally care for her children as a result—was, like the litigant in Thoubboron,
    seeking review of inconsequential facts. See In re Z.C., 813 A.2d at 200 n.4.
    For all of these reasons, we hold that C.P. has standing to challenge on appeal
    the determination of neglect pursuant to D.C. § 16-2301(9)(A)(iii).
    B. Sufficiency of the Evidence
    “In a child neglect proceeding, the [government] has the burden of proving by
    a preponderance of the evidence that a child is neglected . . . .” In re E.H., 
    718 A.2d 162
    , 168 (D.C. 1998). On appeal, “[w]e will reverse a finding of neglect only if it
    is plainly wrong or without evidence to support it, and only after viewing the
    evidence in the light most favorable to the court’s ruling.” In re Ta.C., 
    237 A.3d 114
    , 120 (D.C. 2020) (internal quotation marks omitted). “But consistent with that
    deference, we must ensure that a finding of neglect embodies a correct understanding
    22
    of the relevant statutory terms. The proper construction of the neglect statute is a
    legal question, as to which our review is not deferential, but de novo.” 
    Id.
     (brackets,
    footnote, and internal quotation marks omitted). In addition, as we explained in In
    re S.L.G., 
    110 A.3d 1275
     (D.C. 2015), although our review is of “the order of the
    associate judge, who reviewed the magistrate judge’s order in this case for errors of
    law, abuse of discretion, or clear lack of evidentiary support,” we may still “look to
    the findings and conclusions of the fact finder on which that ruling is based.” 
    Id. at 1285
     (internal quotation marks omitted).
    In order to make out a case of neglect under 
    D.C. Code § 16-2301
    (9)(A)(iii),
    the government must prove both that a parent has a mental incapacity and that the
    mental incapacity has caused their “inability to provide proper parental care,” i.e.,
    that there is a nexus between the mental incapacity and their lack of care for the
    child. In re P.B., 
    54 A.3d 660
    , 667 (D.C. 2012) (quoting In re N.P., 
    882 A.2d 241
    ,
    251 (D.C. 2005)). Here, C.P. argues that the government failed to carry its burden
    for either element. We examine each in turn.
    23
    1.     Mental incapacity
    While acknowledging that “she has a history of mental health issues and
    hospitalization in 2010 through 2012” after B.C.’s birth, C.P. argues that the
    evidence was insufficient for the Superior Court to find that she suffered from a
    mental incapacity at the time of the alleged neglect in 2018–19, particularly in the
    absence of any expert testimony. In essence, she argues that the mental health
    records from six to eight years earlier presented by the government had little bearing
    on her mental state in 2018–19 and that the “observations made by Mr. Date, Ms.
    Tymus, and Mr. Rodrigues,” none of whom are licensed mental health professionals,
    were too limited to support a determination that she was mentally incapacitated at
    the time of the alleged neglect.
    Before we assess the sufficiency of the evidence of mental incapacity
    presented at the neglect trial in this case, we must address two predicate subjects,
    namely, the meaning of “mental incapacity” and the manner in which it may be
    proved. The term “mental incapacity” is not defined in the neglect statute, and the
    closest this court has come to discerning the definition of the term is to reject efforts
    to interpret it too narrowly. See, e.g. In re N.P., 
    882 A.2d at 251
     (concluding that
    the government’s expert testimony diagnosing the mother with battered woman
    24
    syndrome, “severe dependency,” and low-level intellectual functioning was
    sufficient evidence of “mental incapacity”); In re P.B., 
    54 A.3d at
    664–65, 667
    (concluding that the government’s evidence of the mother’s mental incapacity was
    sufficient where (1) the government’s expert testified that the mother suffered from
    some sort of mood disorder, (2) the mother’s expert agreed that testimony about the
    mother’s behavior, if credited, indicated she “might be suffering from some kind of
    psychotic condition,” and (3) “numerous witnesses . . . described [the mother’s]
    paranoid beliefs, delusional thinking, and seclusion” (internal quotation marks
    omitted)). Thus, we have yet to discern a comprehensive definition for this statutory
    term.
    “We start, as we must, with the language of the statute.” Tippett v. Daly, 
    10 A.3d 1123
    , 1126 (D.C. 2010) (internal quotation marks omitted). In examining this
    language, “it is axiomatic that the words . . . should be construed according to their
    ordinary sense and with the meaning commonly attributed to them.” 
    Id.
     (internal
    quotation marks omitted); see also 
    id. at 1127
     (endorsing “look[ing] to dictionary
    definitions to determine the ordinary meaning”). The ordinary meaning of “mental”
    is “of or relating to the mind,” Mental, Merriam-Webster’s Collegiate Dictionary
    (11th ed. 2003); and the ordinary meaning of “incapacity” is the “quality or state of
    being incapable,” Incapacity, Merriam-Webster’s Collegiate Dictionary, with
    25
    “incapable” meaning “lacking capacity, ability, or qualification for the purpose or
    end in view,” Incapable, Merriam-Webster’s Collegiate Dictionary. Reading these
    words together makes readily apparent that “mental incapacity” encompasses, but is
    not limited to, debilitating mental illness.    See In re N.P., 
    882 A.2d at 251
    (incorporating an assessment of mother’s cognitive ability). The cause of mental
    incapacity encompasses a range of psychiatric, psychological, or physiological
    conditions that may adversely impact a parent’s thought processes. But those
    conditions must be related to mental functioning, and they must be “incapacitating,”
    i.e., they must pose a serious impediment to the parent’s ability to navigate their
    daily life. This conclusion is compelled not just because of the statutory language,
    but also because of the underlying constitutional considerations which limit the
    government’s power to intrude into the parent-child relationship. 7 The exercise of
    poor judgment or irrational decisionmaking cannot be enough. Parents are human
    after all; they can and do make mistakes.
    7
    See In re Ta.L., 149 A.3d at 1072 (acknowledging “the fundamental right of
    parents to raise their children”); see also id. at 1121–27 (Beckwith & Easterly, JJ.,
    concurring in part and dissenting in part) (same).
    26
    Relatedly, because mental incapacity often is “related to some science,
    profession, or occupation [so] as to be beyond the ken of the average layperson,” 8 it
    may well need to be substantiated with expert testimony, as the neglect statute and
    our cases reflect. Like other provisions of the D.C. Code, 9 the neglect statute
    anticipates the need for expert input and authorizes the court “on its own motion or
    the motion of any party, for good cause shown,” to “order the mental . . .
    examination of the parent, guardian, or custodian of the child whose ability to care
    for the child is at issue.” 10 
    D.C. Code § 16-2315
    (e)(1) (2012 Repl.). Likewise, our
    8
    In re B.L., 
    824 A.2d 954
    , 956 (D.C. 2003) (internal quotation marks
    omitted); cf. In re Wyler, 
    46 A.3d 396
    , 401 (D.C. 2012) (recognizing that mental
    illness is an “unusually complex and technical area” and explaining that proffered
    expert testimony must be properly vetted).
    Mental health professionals in the District are required to be professionally
    licensed (e.g., license to practice medicine, license to practice psychology, license
    to serve as a social worker). See 
    D.C. Code § 7-1201.01
    (11) (2018 Repl.). More
    specifically, for a social worker to opine on a diagnosis and treatment of
    psychosocial problems, the social worker has to have “at least 3,000 hours of post-
    master’s or postdoctoral experience participating in the diagnosis and treatment of
    individuals . . . with psychosocial problems.” 
    D.C. Code § 3-1208.04
    (a) (2021
    Repl.).
    9
    See, e.g., 
    D.C. Code § 21-2204
    (a) (2012 Repl.) (providing that before health
    care decisions for a person with mental illness may be made by a third party, the
    individual’s mental incapacity must be certified “by 2 professionals who are licensed
    to practice in the District and qualified to make a determination of mental
    incapacity”).
    10
    The magistrate judge twice directed C.P. to get a mental health assessment.
    The government represents in its brief that C.P. did not “timely present herself” for
    evaluation. But there is no information in the record about C.P.’s compliance with
    these orders. In any event, C.P.’s compliance was not essential to the presentation
    27
    cases reflect regular reliance on the testimony of one or more experts to support a
    determination of mental capacity. 11 See, e.g., In re E.H., 
    718 A.2d at
    166–68 (five
    medical experts testified); In re P.B., 
    54 A.3d at
    664–65 (two medical experts
    testified); In re K.M., 
    75 A.3d 224
    , 233–35 (D.C. 2013) (two medical experts
    testified, but evidence of nexus to neglect deemed insufficient).
    Turning to the evidence in this case, we consider the foundation for the
    associate judge’s conclusion that the government had carried its burden to prove
    C.P.’s “mental incapacity, specifically obsession with imaginary medical conditions
    which [B.C.] and she do not have, paranoia, anxiety, and a severe lack of trust.” 12
    of expert testimony, which could have been based on C.P.’s medical records. Cf. In
    re Amey, 
    40 A.3d 902
    , 914–15 (D.C. 2012) (holding trial court did not err by
    allowing psychiatrist testifying as an expert witness to refer to hospital records and
    other hearsay statements in explaining the basis of his opinions, in part because
    hospital records “are unquestionably of the type[] [of statement] customarily relied
    on by psychiatrists” ).
    11
    The government highlights our determination in In re B.L. that alcoholism,
    the subject of the mental incapacity, was “a matter of common knowledge” which
    did not need to be substantiated with expert testimony. 
    824 A.2d at 956
     (internal
    quotation marks omitted)). For the reasons discussed above, we disagree with the
    government that In re B.L. supports an expansive proposition that expert testimony
    is generally unnecessary to prove a parent’s mental incapacity under 
    D.C. Code § 16-2301
    (9)(A)(iii); the case simply held that expert testimony was not required in
    light of the facts of that case.
    12
    Unlike the magistrate judge, the associate judge does not appear to have
    relied on C.P.’s historical “diagnosis of post-partum depression.” We agree that this
    diagnosis did not assist the government in carrying its burden of proof. We see no
    28
    To support her determination of C.P.’s mental incapacity, the associate judge
    relied on nine years of C.P.’s medical records that the government put into evidence.
    The associate judge noted that these records documented C.P.’s “several mental
    health hospitalizations, including an involuntary commitment” and her receipt of
    “Haldol, a psychotropic medication, on multiple occasions” and reflected her
    “history of paranoia, depression, and anxiety.” The associate judge also relied on
    “[r]ecords from [C.P.’s] primary care physician, Core Health and Wellness,
    indicat[ing] that [C.P.] would frequently request unnecessary medical procedures
    [and] exaggerate her symptoms.”
    While this court has held that “[i]n evaluating the child’s condition, the trial
    court’s inquiry must go beyond simply examining the most recent episode [of
    neglect] or a single snapshot [in time], and instead must consider the entire mosaic in
    making its determination,” In re P.B., 
    54 A.3d at 666
     (brackets, citation, and internal
    quotation marks omitted), particularly when assessing a parent’s mental incapacity,
    connection on this record between C.P.’s diagnosis of postpartum depression after
    B.C.’s birth and her mental state years later, particularly in the absence of any expert
    testimony explaining what postpartum depression is, how long it can last, and
    whether and how it relates to other mental health issues. Although we held in In re
    B.L. that expert testimony is not necessarily required to support a finding of mental
    incapacity under the statute if the source of the incapacity is “a matter of common
    knowledge,” 
    824 A.2d at 956
    , as our questions reveal, we cannot so categorize
    postpartum depression.
    29
    the trial court must also take care not to rely too heavily on dated and potentially
    stale information. Here, we cannot agree that C.P.’s medical records carry much
    weight in establishing C.P.’s mental incapacity at the time of the alleged neglect.
    C.P.’s actual mental health records were, like her postpartum depression diagnosis,
    see supra note 12, many years old, from 2010–12. See In re L.H., 
    925 A.2d 579
    ,
    582–83 (D.C. 2007) (concluding that there was no foundation for the “perceived . . .
    link” between mother’s hospitalization and mental health treatment in 1998 and the
    state of her mental health at the time of the alleged neglect in 2004–05). Although
    C.P.’s overall medical records spanned a time period up to the time of the alleged
    neglect, the records that reflected a potential mental health problem—those
    documenting her efforts to obtain medical care for perhaps questionable
    complaints—were not contemporaneous with the alleged neglect.           Rather, the
    medical records from 2018–19 reflected that she had properly sought and received
    treatment for verified ailments. Particularly in the absence of expert testimony
    explaining what could be gleaned from these records about C.P.’s current mental
    health, the associate judge’s inference from these records that C.P. was currently
    mentally incapacitated “rests, in our view, on too much speculation.” 
    Id.
     at 582–83
    (“[T]he judge heard no psychiatric or other medical testimony relating the mother’s
    past medical condition to her conduct in 2004 and her present capacity to parent.”).
    30
    As additional and more current evidence of C.P.’s mental incapacity, the
    associate judge also relied on the medical records reflecting C.P.’s multiple efforts
    to obtain medical care primarily for B.C.’s facial swelling. But the magistrate judge
    had deemed these same records insufficient to support a determination that C.P.’s
    mental incapacity caused her to seek out unnecessary medical treatment for B.C. We
    agree with the magistrate judge that, on their own, these records did not support a
    determination that visiting medical professionals was “a symptom of [C.P.’s]
    paranoia,” as opposed to “a well-reasoned decision” and “proper diligence” on
    C.P.’s part, especially when the evidence established that B.C. in fact had visible
    facial swelling. And we further agree that it was “essential . . . to have at least one
    expert to be able to opine on the mother’s actions being tantamount to medical
    neglect.” Accordingly, while “mindful . . . of a trial judge’s prerogative to draw
    reasonable inferences from the record,” In re L.H., 
    925 A.2d at 582
    , we cannot
    endorse the associate judge’s reliance on the same medical records to support a
    determination that C.P. was mentally incapacitated in the context of her educational
    decisionmaking for B.C. 13 Here too, expert testimony was needed to evaluate the
    medical records and explain their relevance to C.P.’s current mental health.
    13
    The associate judge’s reliance on these records after the magistrate judge
    declined to rely on them might be attributable to the associate judge’s
    misunderstanding that C.P. had imagined B.C.’s facial swelling.
    31
    This leaves the testimony from three lay witnesses—two CFSA social
    workers assigned to C.P.’s case, Mr. Date and Mr. Rodrigues, and one CFSA
    registered nurse, Ms. Tymus—who testified for the government about their
    observations of C.P. The associate judge, like the magistrate judge before her, relied
    on this testimony to support her determination that C.P. was mentally incapacitated.
    Examining this testimony, we conclude that, at most, it constituted some evidence
    on which an expert diagnosis could have been based or corroborated. But these
    witnesses were not themselves qualified to make such a diagnosis, see supra note 8,
    and their ultimately equivocal testimony did not provide a foundation for the
    associate judge to determine that C.P.’s mental state could be assessed based on
    common knowledge.
    All three witnesses testified about C.P.’s resistance to working with them, and
    Mr. Date and Mr. Rodrigues both cited C.P.’s distrust of them as a basis of their
    belief that C.P. might have mental health issues. Although these CFSA employees
    considered C.P.’s hostility abnormal, some amount of distrust and resentment is not
    surprising under the circumstances where parents know that CFSA is responsible for
    the removal of their child from their custody. Furthermore, Mr. Rodrigues, who had
    had the most recent contact with C.P., testified that the situation had improved in the
    four months he had been working on B.C.’s case. Mr. Date and Mr. Rodrigues also
    32
    grounded their mental health concerns in C.P.’s efforts to seek medical treatment for
    B.C. But as discussed above, this was the allegation the magistrate judge determined
    could not be supported in the absence of expert testimony. Ultimately, none of these
    witnesses testified with any certainty that C.P. actually had a mental illness. Mr.
    Date, who worked on B.C.’s case for the longest time and had the most in-person
    interactions with C.P., testified only that “there was an indication that she had
    unaddressed mental health needs.” (emphasis added). Mr. Rodrigues testified only
    that he was “concern[ed]” about C.P.’s “lack of awareness of her mental health
    needs” but also acknowledged that he was unsure that the agency had “an
    understanding of where she is at mentally right now.”
    This layperson testimony, like the mental health and medical records
    presented by the government, was not sufficient to prove C.P.’s mental incapacity at
    the time of the alleged neglect. Instead, this evidence in its totality indicates that the
    situation was complicated and ambiguous, particularly in the absence of expert
    testimony. The associate judge’s own assessment that C.P. was “obsess[ed] with
    imaginary medical conditions” and suffered from “paranoia, anxiety, and a severe
    lack of trust” was thus not adequately founded, and her conclusion that the
    government had carried its burden to establish mental incapacity to support a
    determination of neglect pursuant to § 16-2301(9)(A)(iii) was in error.
    33
    2.     Nexus to Educational Neglect
    As noted above, in addition to proving a parent’s mental incapacity at the time
    of the alleged neglect, the government must demonstrate a causal relationship
    between a parent’s mental incapacity and their inability provide parental care. See
    In re E.H., 
    718 A.2d at 169
    . “Without any evidence of such a nexus, the adjudication
    of neglect under [subsection (9)(A)(iii)] cannot be sustained.” In re Am. V., 
    833 A.2d 493
    , 499 (D.C. 2003) (insufficient evidence of nexus between mother’s
    incapacity and inadequate care for her child); see also In re K.M., 
    75 A.3d at
    231–
    33; In re N.P., 
    882 A.2d at 251
    . Assuming for the sake of argument that C.P. was
    mentally incapacitated at the time of the alleged neglect, there is simply no proof in
    this record that her mental health had any bearing on B.C.’s educational neglect.
    None of the government’s witnesses provided any such nexus testimony because this
    was not the theory of neglect that the government pursued at trial. See supra I.A.
    The government’s theory was that C.P.’s mental incapacity had led her to seek
    unnecessary medical care for B.C. It was only after the magistrate judge twice
    prompted the government to argue this alternate rationale that C.P.’s mental
    incapacity led to B.C.’s educational neglect that the government pivoted to this
    theory of neglect under § 16-2301(9)(A)(iii).
    34
    To the extent any relevant evidence was presented, it did not support a nexus
    between any mental incapacity and B.C.’s educational neglect; instead it indicated
    that C.P. was attentive to and concerned about B.C.’s education, even as she failed
    to make good choices for him. Although she enrolled B.C. at three different schools
    in a short span of time, C.P. offered not patently unreasonable explanations for her
    actions—she withdrew B.C. from the first school because the commute was too long,
    from the second because a spot opened up at the third that she thought would be
    better for him, and from the third because she had some concern about bullying and
    because in her estimation he worked better in “one-on-one sessions.” And she
    contacted OSSE thereafter to get permission to homeschool B.C., as she had done
    the year prior, and followed the agency’s instructions. None of this evidence
    indicates that any mental incapacity had a causal connection to B.C.’s educational
    neglect, and the government never argued otherwise. Instead, the government
    conceded in rebuttal that it was “not sure of” “[t]he reason” for C.P.’s educational
    decisions for B.C.
    The associate judge’s conclusion that B.C.’s “numerous excused and
    unexcused absences” from school were “presumably at least in part due to some of”
    his appointments to address his “imaginary facial swelling” is problematic for
    multiple reasons. First, B.C.’s facial swelling was not “imaginary.” Second, as the
    35
    magistrate judge found, the allegation that C.P. had sought unnecessary treatment
    for B.C. was unsubstantiated. And third, the associate judge provided no basis, and
    we discern none, for her determination that B.C. missed school to go to the doctor. 14
    Likewise, the associate judge’s finding that C.P. opted to homeschool B.C.
    because she did not want to leave him in the care of third parties had no foundation.
    No witness ever attributed that rationale for homeschooling to C.P., and she never
    testified to that effect. Nor can we conclude there was a reasonable basis for the
    court to draw this inference either from Mr. Date’s testimony that C.P. was unwilling
    to let B.C. be alone with him—a perceived adversary in the neglect process—or from
    his testimony about C.P.’s actions at a January court hearing when B.C. was
    removed from C.P.’s custody. The government presented no evidence at the neglect
    trial that C.P. would not leave B.C. in the care of third parties, “even in the hallway
    of the courthouse,” as the associate judge found. Mr. Date simply testified that C.P.
    had failed to make arrangements for someone to watch B.C., that the hearing was
    delayed “until some professional could watch him,” and that C.P. had to leave the
    14
    Although the magistrate judge found that C.P. often dropped B.C. off late
    or picked him up early at school because of her “lack of trust in others and inability
    to have [B.C.] outside her sight,” we see no evidence in the record supporting this
    finding either.
    36
    courtroom several times because B.C. was being disruptive. Mr. Date was unable
    to say whether C.P. was willing to leave B.C. with someone else on that day.
    Lastly, the associate judge’s conclusion that C.P.’s mental incapacity
    “precluded her from recognizing her own inadequacies as a home schooling teacher”
    is also unsubstantiated. Other than the fact that C.P. sought to homeschool B.C.,
    there is no evidence about what C.P. thought at the time of her own abilities as a
    homeschooling teacher. Without more, her decision to homeschool him in 2018
    cannot be attributed to mental incapacity, especially when OSSE had authorized her
    to homeschool him in 2017. Moreover, C.P. subsequently acknowledged at the
    neglect trial that she could see now that she had not made the best choices for B.C.
    vis-a-vis his education. 15
    15
    Citing to C.P.’s “admissions” that “she had made bad decisions” about
    B.C’s schooling and her inability to describe with precision the content of her
    homeschooling instruction, the government argues that there is sufficient evidence
    of nexus between C.P.’s mental incapacity and her educational neglect of B.C. But
    as explained above, mental incapacity is more than bad judgment, and the
    government’s nexus argument on appeal appears premised on a theory of cognitive
    impairment as mental incapacity, which the government never argued or proved at
    the neglect trial.
    37
    For all these reasons, we conclude that there was insufficient evidence to
    support the associate judge’s affirmance of the magistrate judge’s determination of
    mental incapacity neglect pursuant to D.C. Code 16-2301(9)(A)(iii).
    III. Conclusion
    Based on the above analysis, we reverse and remand for further proceedings
    consistent with this opinion.
    So ordered.