In Re Zaliyah S. ( 2020 )


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  •                                                                                          06/26/2020
    IN THE COURT OF APPEALS OF TENNESSEE
    AT NASHVILLE
    Assigned on Briefs April 2, 2020
    IN RE ZALIYAH S. ET AL.
    Appeal from the Circuit Court for Davidson County
    No. 17D1413              Philip E. Smith, Judge
    ___________________________________
    No. M2019-01241-COA-R3-JV
    ___________________________________
    This is a dependency and neglect case focusing on twin siblings (collectively, “the
    Twins”), who are the minor children of Tamika S. (“Mother”). The Twins were taken
    into protective custody by the Tennessee Department of Children’s Services (“DCS”)
    upon an investigation prompted by a referral that Mother had given birth to the Twins
    after she had previously lost custody of one of her other children due to nutritional and
    medical neglect. Following Mother’s refusal to comply with DCS’s request to perform a
    health check on the Twins, DCS filed a petition for custody and emergency removal. The
    Juvenile Court for Davidson County (“juvenile court”) conducted a hearing and
    adjudicated the Twins dependent and neglected upon its finding that Mother had
    committed severe child abuse. The juvenile court awarded DCS legal and physical
    custody of the Twins. Mother appealed to the Circuit Court for Davidson County (“trial
    court”), which, following a de novo trial, issued a final order determining that Mother had
    perpetrated severe child abuse upon the Twins while they were in her care.
    Consequently, the trial court adjudicated the Twins dependent and neglected. The trial
    court ordered that it would be in the Twins’ best interest to remain in DCS custody.
    Mother has appealed. Discerning no reversible error, we affirm.
    Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Circuit Court
    Affirmed; Case Remanded
    THOMAS R. FRIERSON, II, J., delivered the opinion of the court, in which RICHARD H.
    DINKINS and KENNY W. ARMSTRONG, JJ., joined.
    Dustin Faeder, Nashville, Tennessee, for the appellant, Tamika S.
    Herbert H. Slatery, III, Attorney General and Reporter, and Amber L. Seymour, Assistant
    Attorney General, for the appellee, Tennessee Department of Children’s Services.
    OPINION
    I. Factual and Procedural Background
    The Twins were born prematurely in December 2016. It is undisputed that Mother
    had previously given birth to four children, two of whom were deceased within weeks of
    their birth due to undetermined causes, and one of whom had been adjudicated dependent
    and neglected and removed from Mother’s custody because of nutritional neglect.
    Mother voluntarily relinquished custody of the fourth child to the maternal grandmother,
    Earlene S. (“Grandmother”). Relevant to this appeal, DCS obtained temporary custody
    of the Twins on January 5, 2017, pursuant to an emergency protective order entered by
    the juvenile court, after DCS investigator, Elizabeth Butler, was turned away by Mother
    when she attempted to conduct a welfare check on the Twins at Mother’s residence. In
    the emergency order, the juvenile court set a preliminary hearing for the matter on the
    following day, January 6, 2017, and ordered an attachment pro corpus requiring Mother
    to deliver the Twins to DCS pending further court order.
    According to the juvenile court’s preliminary hearing order, when Mother
    appeared at the January 6, 2017 hearing without the Twins, the juvenile court magistrate
    ordered Mother to disclose the Twins’ whereabouts. While Mother remained in the
    courtroom and without her cooperation, court officers located the Twins and brought
    them to the hearing, where Ms. Butler determined that the Twins required immediate
    medical care. The Twins were subsequently admitted to Vanderbilt Children’s Hospital
    (“the Hospital”) for medical treatment. Meanwhile, during the hearing, Mother testified
    that she had been exclusively breastfeeding the Twins and claimed that she had
    previously sought care for the Twins at Eve’s: A New Beginning, a Nashville, Tennessee
    facility (“Eve’s”) that offers prenatal and primary care for infants. Notwithstanding,
    Mother refused to sign a release to allow DCS access to any records from Eve’s.
    Medical records later admitted as exhibits indicated that the Twins were
    hospitalized from January 6, 2017, through January 11, 2017. The Twins were diagnosed
    by Danielle Knox, a pediatric nurse practitioner at the Hospital, as victims of nutritional
    and medical neglect, suffering from malnourishment and failure to thrive. During the
    dependency and neglect hearing at issue, Ms. Knox testified that although the Twins were
    nearly a month old at that time, one sibling had only gained 100 grams while the other
    had gained no weight since birth. Ms. Knox determined that due to their poor health, the
    Twins’ risk of death was increased. Ms. Knox also related that while at the Hospital, the
    Twins gained weight and became more aware and alert. The Twins were subsequently
    discharged from the Hospital into the care of Grandmother.
    On January 9, 2017, the juvenile court appointed legal counsel for Mother and a
    guardian ad litem for the Twins. On January 13, 2017, the juvenile court awarded
    -2-
    supervised visitation with the Twins to Mother and required Mother to, inter alia,
    undergo a psychological assessment. Although Mother filed a motion on February 13,
    2017, wherein she sought the juvenile court’s permission to breastfeed the Twins, the
    juvenile court denied Mother’s request in a subsequent order. Furthermore, pending
    adjudication of the Twins’ custody, the trial court denied a motion in which DCS sought
    leave of court to vaccinate the Twins. The juvenile court subsequently scheduled the
    matter for an adjudicatory hearing on April 26, 2017.
    At the April 26, 2017 hearing, all parties were present and represented by counsel.
    The juvenile court considered testimony from several witnesses but reserved its ruling
    until closing arguments set for May 5, 2017. In the respective order, the juvenile court
    magistrate determined that the Twins were dependent and neglected as to Mother upon a
    finding that they were severely abused. The court directed that the Twins remain in DCS
    custody. On June 14, 2017, Mother filed a notice of appeal with a notation stating, “Final
    written order still pending, DCS is to prepare it.” On November 28, 2017, Mother filed a
    “Motion for a Written Instruction On Medical Treatment Notice,” wherein she requested
    that the juvenile court issue an order instructing Grandmother and DCS to provide notice
    to Mother at any time when the Twins were to receive medical care. The motion was
    subsequently withdrawn.
    On May 15, 2018, the juvenile court entered an “Order of Adjudication and
    Disposition,” inter alia, confirming the magistrate’s May 2017 ruling and sustaining
    DCS’s petition “in its entirety.” The juvenile court also delineated its factual history with
    Mother, specifically stating that respecting Mother’s six children, two children were
    deceased, with one of the deaths resulting from circumstances related to inappropriate co-
    sleeping with Mother; one child had been removed from Mother’s custody pursuant to an
    agreed petition to change custody; and another child had been adjudicated dependent and
    neglected and abused by Mother. The juvenile court further determined that Mother had
    repeatedly refused to follow recommended medical advice with respect to the Twins.
    Moreover, it concluded that Mother’s conduct constituted “knowing neglect,” resulting in
    the Twins’ “substantial risk of suffering serious bodily injury or death” thereby
    constituting “severe abuse.”
    As a result of its findings, the juvenile court adjudicated the Twins “dependent and
    neglected, abused and severely abused” “based upon their severe nutritional and medical
    neglect and the risks presented . . . .” Consequently, the juvenile court ordered legal and
    physical custody of the Twins in the favor of DCS, which would maintain the authority to
    consent to any necessary medical care. The juvenile court further awarded Mother
    supervised visitation with the Twins. Mother filed a second notice of appeal on May 24,
    2018, appealing both the adjudication and disposition of the juvenile court’s ruling.
    Meanwhile, in November 2018, following a separate action adjudicated by jury
    trial in the Davidson County Criminal Court (“criminal court”), Mother was convicted on
    -3-
    two counts of child neglect of a child under eight years old, a Class E felony, concerning
    the Twins. See Tenn. Code Ann. § 39-15-401(b) (2018). The criminal court sentenced
    Mother to serve two years’ imprisonment but suspended her sentence to twenty days
    served upon entering an order of judicial diversion. The criminal court further ordered
    that Mother would serve a two-year term of supervised probation.
    On appeal from the juvenile court in the case at bar, the trial court conducted a
    trial spanning three non-consecutive days from March 19 to March 26, 2019.1 Upon the
    conclusion of trial, the trial court ordered the parties to submit proposed findings of fact
    and conclusions of law in lieu of closing arguments. On June 11, 2019, the trial court
    entered a “Memorandum Opinion and Order of Adjudication and Disposition” (“final
    order”), wherein it concluded, inter alia, that the Twins were dependent and neglected
    upon a finding of severe child abuse perpetrated by Mother pursuant to Tennessee Code
    Annotated §§ 37-1-102(b)(1) (2014); 37-1-102(b)(13)(B), (F)-(G) (West 2017); and 37-1-
    102(b)(27) (2014).2 The trial court also noted that Mother had been found guilty by the
    criminal court of two counts of child neglect concerning a child under eight years of age.
    The trial court found that DCS had exercised reasonable efforts to prevent the removal of
    the Twins from Mother’s custody. Furthermore, the trial court determined that placement
    of the Twins with Mother would subject them to a high risk of serious harm or bodily
    injury and that it was in the best interest of the Twins to remain in DCS custody.
    Mother timely appealed to this Court.
    II. Issue Presented
    Mother presents a single issue on appeal, which we have restated slightly as
    follows:
    Whether the trial court erred by determining that Mother severely abused
    the Twins by knowingly failing to provide proper nutrition and medical
    care.
    III. Standard of Review
    Concerning the standard of review in dependency and neglect cases involving
    severe child abuse, this Court has previously elucidated:
    1
    The trial also consisted of a separate and companion dependency and neglect case involving one of
    Mother’s other children. That adjudication is not at issue in this appeal.
    2
    Effective July 1, 2018, the General Assembly amended this section, recodifying Tennessee Code
    Annotated § 37-1-102(b)(22) to Tennessee Code Annotated § 37-1-102(b)(27). See 2018 Pub. Acts Ch.
    1052 (H.B. 2271). For purposes of our review on appeal, we will cite to the version in effect at the time
    the petition was filed in January 2017.
    -4-
    A child who is suffering from abuse is a dependent and neglected
    child. See Tenn. Code Ann. § 37-1-102(12)(G). A determination that a
    child is dependent and neglected must be supported by clear and
    convincing evidence. See Tenn. Code Ann. § 37-1-129(a)(1) & (c). Severe
    child abuse in a dependency and neglect proceeding must also be
    established by clear and convincing evidence. In re S.J., 
    387 S.W.3d 576
    ,
    591 (Tenn. Ct. App. 2012).
    The “clear and convincing evidence standard” is more exacting than
    the “preponderance of the evidence” standard, although it does not demand
    the certainty required by the “beyond a reasonable doubt” standard. In re
    C.W.W., 
    37 S.W.3d 467
    , 474 (Tenn. Ct. App. 2000). The clear and
    convincing evidence standard defies precise definition. Majors v. Smith,
    
    776 S.W.2d 538
    , 540 (Tenn. Ct. App. 1989). Evidence satisfying this high
    standard produces a firm belief or conviction regarding the truth of facts
    sought to be established. In re 
    C.W.W., 37 S.W.3d at 474
    . Clear and
    convincing evidence eliminates any serious or substantial doubt concerning
    the correctness of the conclusions to be drawn from the evidence. Hodges
    v. S.C. Toof & Co., 
    833 S.W.2d 896
    , 901 n.3 (Tenn. 1992).
    Our review of the trial court’s determinations on questions of fact is
    de novo with a presumption of correctness, unless the evidence
    preponderates otherwise. Tenn. R. App. P. 13(d). Whether a child has
    been proven dependent and neglected by clear and convincing evidence is a
    question of law which we review de novo without a presumption of
    correctness. In re H.L.F., 
    297 S.W.3d 223
    , 233 (Tenn. Ct. App. 2009). To
    the extent the trial court’s determinations rest upon an assessment of the
    credibility of witnesses, the determinations will not be overturned absent
    clear and convincing evidence to the contrary. Wells v. Tennessee Bd. of
    Regents, 
    9 S.W.3d 779
    , 783 (Tenn. 1999).
    In re M.D., No. M2015-01023-COA-R3-JV, 
    2016 WL 5723954
    , at *3-4 (Tenn. Ct. App.
    Sept. 30, 2016) (quoting In re Kaitlynne D., No. M2013-00546-COA-R3-JV, 
    2014 WL 2168515
    , at *1-2 (Tenn. Ct. App. May 21, 2014)).
    IV. Severe Child Abuse
    On appeal from the juvenile court, the trial court determined that the Twins were
    dependent and neglected children upon finding that Mother had perpetrated severe child
    -5-
    abuse upon the Twins.3 The statutory definition of severe child abuse applicable to
    dependency and neglect proceedings is found in Tennessee Code Annotated § 37-1-
    102(b)(22) (West 2017), which provides in relevant part:
    (22) “Severe child abuse” means:
    (A)(i) The knowing exposure of a child to or the knowing failure to
    protect a child from abuse or neglect that is likely to cause
    serious bodily injury or death and the knowing use of force on a
    child that is likely to cause serious bodily injury or death;
    (Emphasis added.)
    On appeal, Mother concedes that the Twins were dependent and neglected as a
    result of her failure to properly feed them and provide medical care. Mother contends,
    however, that the trial court erred by finding clear and convincing evidence that her
    neglect of the Twins was “knowing” as required by Tennessee Code Annotated § 37-1-
    102(b)(22)(A)(i) for a determination of severe child abuse. Mother’s argument here is
    two-fold. First, Mother posits that the trial court improperly applied the doctrine of
    collateral estoppel relative to Mother’s criminal convictions to establish the “knowing”
    requirement contained in Tennessee Code Annotated § 37-1-102(b)(22)(A)(i). Second,
    Mother contends that the evidence in the record is insufficient to establish that she
    knowingly exposed the Twins to the risk of severe bodily injury or death. We will
    address each of Mother’s arguments in turn.
    Concerning collateral estoppel, Mother acknowledges that in an independent
    criminal prosecution she was convicted by the criminal court under Tennessee Code
    Annotated § 39-15-401(b), which provides:
    3
    The trial court adjudicated the Twins dependent and neglected, pursuant to Tennessee Code Annotated §
    37-1-102(b)(13)(B), (F), and (G), which define a dependent and neglected child as one:
    (B)     Whose parent, guardian or person with whom the child lives, by reason of
    cruelty, mental incapacity, immorality or depravity is unfit to properly care for
    such child;
    ***
    (F)     Who is in such condition of want or suffering or is under such improper
    guardianship or control as to injure or endanger the morals or health of such child
    or others;
    (G)     Who is suffering from abuse or neglect[.]
    -6-
    (b)    Any person who knowingly abuses or neglects a child under
    eighteen (18) years of age, so as to adversely affect the child’s health
    and welfare, commits a Class A misdemeanor; provided, that, if the
    abused or neglected child is eight (8) years of age or less, the penalty
    is a Class E felony.
    Notwithstanding her conviction under subsection 401(b), Mother contends that the trial
    court erred by applying the definition of “knowingly” provided in a separate subsection
    of Tennessee Code Annotated § 39-15-401, specifically subsection (c), to determine that
    her perpetration of severe child abuse, pursuant to the definition provided in Tennessee
    Code Annotated § 37-1-102(b)(22)(A)(i), was “knowing” in the instant action.
    Tennessee Code Annotated § 39-15-401(c) (2018), the criminal child
    endangerment statute, provides in pertinent part:
    (c)(1) A parent or custodian of a child eight (8) years of age or less
    commits child endangerment who knowingly exposes such child to
    or knowingly fails to protect such child from abuse or neglect
    resulting in physical injury or imminent danger to the child.
    (2)    For purposes of this subsection (c):
    (B)    “Knowingly” means the person knew, or should have known
    upon a reasonable inquiry, that abuse to or neglect of the
    child would occur which would result in physical injury to the
    child. The risk must be of such a nature and degree that the
    failure to perceive it constitutes a gross deviation from the
    standard of care that an ordinary parent or legal custodian of a
    child eight (8) years of age or less would exercise under all
    the circumstances as viewed from the defendant’s
    standpoint[.]
    (Emphasis added.)
    Mother asserts that because subsection 401(c)’s definition of “knowingly” is
    preceded by the phrase, “[f]or purposes of this subsection (c),” that definition of
    “knowingly” does not apply to subsection 401(b), the statute under which she was
    convicted. Mother contends that as a consequence, the trial court erred by applying the
    doctrine of collateral estoppel to prevent her from defending against the mens rea
    -7-
    requirement of “knowing” under the severe child abuse definition provided in Tennessee
    Code Annotated § 37-1-102(b)(22)(A)(i).4
    Relative to this issue, the trial court stated the following in its final order:
    This Court cannot ignore that a jury found [Mother] guilty of two (2)
    counts of child neglect on a child under eight (8) years old. Both of these
    convictions were felony convictions.
    Tenn. Code Ann. § 39-15-401(c) defines child neglect on a child
    under eight (8) years of age. The statute states the following:
    (c)(1) A parent or custodian of a child eight (8) years of age
    or less commits child endangerment who knowingly exposes
    such child to or knowingly fails to protect such child from
    abuse or neglect resulting in physical injury or imminent
    danger to the child.
    (2) For purposes of this subsection (c):
    (A) “Imminent danger” means the existence of any condition
    or practice that could reasonably be expected to cause death
    or serious bodily injury;
    (B) “Knowingly” means the person knew, or should have
    known upon a reasonable inquiry, that abuse to or neglect of
    the child would occur which would result in physical injury to
    the child. The risk must be of such a nature and degree that
    the failure to perceive it constitutes a gross deviation from the
    standard of care that an ordinary parent or legal custodian of a
    child eight (8) years of age or less would exercise under all
    the circumstances as viewed from the defendant’s standpoint;
    4
    We note that Mother does not argue that the doctrine of collateral estoppel could not have been applied
    by the trial court; rather, Mother argues that the trial court referenced an inapplicable definition of
    “knowingly” located in Tennessee Code Annotated 39-15-401(c), a subsection under which she was not
    convicted, regarding subsection 401(b), and in turn applied the same definition to collaterally estop her
    from contesting a determination of severe child abuse pursuant to Tennessee Code Annotated § 37-1-
    102(b)(22). Stated differently, Mother argues that the definition in subsection 401(c) does not apply to
    subsection 401(b). Ergo, Mother does not dispute that a criminal conviction may be used to prevent a
    litigant from subsequently relitigating severe child abuse in an ensuing civil action provided there is some
    comparison of the criminal conviction with the definition of severe child abuse located in Tennessee Code
    Annotated § 37-1-102(b)(22). See In re C.S., No. E2019-01657-COA-R3-PT, 
    2020 WL 2066247
    , at *4
    (Tenn. Ct. App. Apr. 29, 2020) (“Courts have also relied on criminal convictions to establish the ground
    of severe abuse.”).
    -8-
    and
    (C) “Parent or custodian” means the biological or adoptive
    parent or any person who has legal custody of the child.
    The definition of “knowingly” in Tenn. Code Ann. § 39-15-
    401(c)(2)(B) sets forth a meaning remarkably similar to the meaning of
    “knowing” set forth by the Court of Appeals. In Re R.C.P., [No. M2003-
    01143-COA-R3-PT, 
    2004 WL 1567122
    (Tenn. Ct. App. July 13, 2004)].
    The Court is also mindful that the jury was required to adhere to the stricter
    standard of proof “beyond a reasonable doubt.” “Knowingly” is an
    essential element of the offenses [Mother] was convicted of.
    ***
    There is no serious or substantial doubt in this Court’s mind that the
    abuse committed by [Mother] was “knowing” within the meaning of the
    case law. . . . [Mother] “knowingly” failed to protect [the Twins] from the
    abuse or neglect that almost caused their deaths.
    In the instant action, the trial court relied in part on the definition of “knowingly”
    found in the child endangerment statute, Tennessee Code Annotated § 39-15-401(c), in
    support of its determination of the existence of severe child abuse under Tennessee Code
    Annotated § 37-1-102(b)(22)(A)(i). However, Mother was not convicted under
    Tennessee Code Annotated § 39-15-401(c); rather, she was convicted under subsection
    (b), which does not statutorily define “knowingly.” Moreover, the Tennessee Court of
    Criminal Appeals has previously explained that the “knowing” mens rea requirement is
    exclusive to offenses involving child endangerment under Tennessee Code Annotated §
    39-15-401(c). See State v. Love, No. M2015-00183-CCA-R3-CD, 
    2016 WL 4697583
    , at
    *11 (Tenn. Crim. App. Sept. 7, 2016) (rejecting the State’s argument that the “knowing”
    requirement, as defined in Tennessee Code Annotated § 39-15-401(c), applies to child
    abuse or neglect as codified in § 39-15-401(b)). Thus, the trial court erred to the extent
    that it relied on the definition of “knowingly” found in Tennessee Code Annotated § 39-
    15-401(c), a statute under which Mother was not convicted, to establish that the
    “knowing” requirement found in the severe child abuse statute, Tennessee Code
    Annotated § 37-1-102(b)(22)(A)(i), had been satisfied.5 However, as more fully
    5
    To clarify, what rendered the trial court’s application of collateral estoppel erroneous was its improper
    use of an inapplicable statute, Tennessee Code Annotated § 39-15-401(c), to prevent Mother from
    specifically defending against the severe child abuse statute codified at Tennessee Code Annotated § 37-
    1-102(b)(22). Thus, our determination does not disrupt the well established principle that criminal
    convictions may serve to establish the ground of severe child abuse under Tennessee Code Annotated §
    37-1-102(b)(22), thereby collaterally estopping a litigant from relitigating the same issue(s) previously
    litigated in his or her prior criminal conviction. See, e.g., In re C.S., 
    2020 WL 2066247
    , at *4; In re
    -9-
    discussed below, because the trial court found sufficient proof of severe child abuse
    based upon the totality of the evidence presented at trial, we determine this error to be
    harmless.
    Mother also contends that the evidence in the record is insufficient to establish that
    she knowingly exposed the Twins to the risk of severe bodily injury or death. In support
    of her argument, Mother in part relies on her own testimony and her having taken the
    Twins to Eve’s for medical attention two weeks prior to the Twins’ removal from her
    custody. Specifically, when confronted with photographs of the Twins’ poor physical
    condition at trial, Mother testified concerning one of the twins, “I don’t remember my
    child looking like this before you guys picked him up at all.” Regarding the other twin,
    Mother related, “I do not remember my child looking like that before they came, no.”
    Mother further testified that the Twins’ poor condition was the result of her
    unsuccessful attempts to breastfeed, stating, “I was feeding my babies, but, apparently,
    they wasn’t getting enough milk from my breasts, but I was feeding my babies.” Mother
    explained that she was feeding the Twins every two to three hours during the day and
    every three to four hours at night. In her brief on appeal, Mother makes several
    additional references to her testimony, as well as to the testimony of Grandmother and a
    DCS family service worker, which Mother claims establish that she did not comprehend
    the seriousness of the risk to the Twins’ health and well-being. Thus, Mother posits that
    by not understanding the severity of the risk, she did not possess sufficient knowledge to
    have committed severe child abuse. Upon careful review, we find Mother’s argument in
    this regard to be unavailing.
    As this Court has previously explained with regard to establishing the “knowing”
    requirement in the severe child abuse statute, Tennessee Code Annotated § 37-1-
    102(b)(22):
    the “knowing” element can and often must be gleaned from circumstantial
    evidence, including but not limited to, medical expert testimony on the
    Imerald W., No. W2019-00490-COA-R3-PT, 
    2020 WL 504991
    , at *7 (Tenn. Ct. App. Jan. 31, 2020); In
    re Demarkus T., No. M2016-01839-COA-R3-PT, 
    2017 WL 3311313
    , at *4 (Tenn. Ct. App. Aug. 3,
    2017); In re Jakaeha A.L., No. E2012-02272-COA-R3-PT, 
    2013 WL 3148246
    , at *6-7 (Tenn. Ct. App.
    June 18, 2013). However, as this Court has previously stated, “a criminal conviction, standing alone, is
    not determinative. There must be some comparison of the criminal conviction with the definition of
    severe child abuse in Tennessee Code Annotated section 37-1-102.” In re C.S., 
    2020 WL 2066247
    , at *4.
    Thus, the trial court may have applied the definition of “knowingly” located in Tennessee Code
    Annotated § 39-15-401(b), the statute under which Mother was convicted, to collaterally estop her from
    relitigating severe child abuse in the instant action, provided the trial court also demonstrated “how the
    evidence support[ed] the ground of severe abuse.” See in re C.J.B., No. M2016-01585-COA-R3-PT,
    
    2017 WL 2805193
    , at *5 (Tenn. Ct. App. June 28, 2017) (determining that a father’s guilty plea to felony
    child neglect did “not, in and of itself, qualify as severe child abuse” because the trial court must also
    “demonstrate how the evidence support[ed] the ground of severe child abuse.”).
    - 10 -
    likelihood that the injury occurred in the manner described by the parent or
    caregiver. Moreover, “knowing” conduct by a parent or caregiver is not
    limited to conduct intended to cause injury:
    The term “knowing” as used in Section 37-1-102(b)(2[2]) is
    not defined by statute . . . . In the context of the dependency
    and neglect statutes, the term has been described as follows:
    We consider a person’s conduct to be
    “knowing,” and a person to act or fail to act
    “knowingly,” when he or she has actual
    knowledge of the relevant facts and
    circumstances or when he or she is either in
    deliberate ignorance of or in reckless disregard
    of the information that has been presented to
    him or her.
    In re Caleb J.B.W., No. E2009-01996-COA-R3-PT, 
    2010 WL 2787848
    , at *5, 2010 Tenn. App. LEXIS 447 (Tenn. Ct. App.
    July 14, 2010) (citing In re R.C.P., 2004 Tenn. App. LEXIS
    449, 
    2004 WL 1567122
    , at *7); see also In re H.L.F., 
    297 S.W.3d 223
    , 236 (Tenn. Ct. App. 2009).
    In re S.J., 
    387 S.W.3d 576
    , 592 (Tenn. Ct. App. 2012). It is also well-established that
    “[t]he Trial Court is the arbiter of witness credibility of those who testify live before it.”
    See In re M.D., 
    2016 WL 5723954
    , at *5; 
    Wells, 9 S.W.3d at 783
    . As our Supreme Court
    has previously instructed, “When credibility and weight to be given testimony are
    involved, considerable deference must be afforded to the trial court when the trial judge
    had the opportunity to observe the witnesses’ demeanor and to hear in-court testimony.”
    Hughes v. Metro. Gov’t of Nashville and Davidson Cty., 
    340 S.W.3d 352
    , 360 (Tenn.
    2011) (quoting Randolph v. Randolph, 
    937 S.W.2d 815
    , 819 (Tenn. 1996)).
    As to Mother’s argument that her testimony demonstrates that she did not have
    knowledge of the severe child abuse, we first address the trial court’s credibility
    determinations. The trial court made specific credibility determinations relative to
    several of the witnesses who testified in its presence, including Mother, whom the trial
    court found not to be credible. In its final order, the trial court made the following
    findings regarding Mother’s testimony:
    The next witness to testify was [Mother]. The Court will note that
    during [Mother’s] testimony, she admitted that she perjured herself on at
    least four (4) occasions in the various Juvenile Court proceedings.
    [Mother’s] testimony was often self-serving. Her responses were often not
    - 11 -
    to the questions asked. [Mother] appeared to be very defensive. [Mother]
    also appeared to blame everyone else for her problems. On the one hand,
    [Mother] appears to admit that the twins were medically and nutritionally
    neglected and that it was her fault, yet later in her testimony assumes no
    responsibility for the health of any of these children. [Mother] would
    attempt to answer a question and later in her testimony attempt to spin her
    response to fit the question asked. This Court views the oath that a witness
    or a party takes as part of the very foundation of our judicial system. When
    a party or witness, after taking the oath, fails to tell the truth, the testimony
    given is an affront to our system of justice. The Court believes that
    [Mother] perjured herself repeatedly in this proceeding based on her many
    inconsistencies during her testimony. Further, the Court knows that
    [Mother] perjured herself in earlier Juvenile Court proceedings by her own
    admissions. [Mother] is not worthy of belief and the Court will give no
    weight to her testimony in this matter.
    In a subsequent section of its final order, the trial court further stated:
    [Mother] did appear in Juvenile Court with an individual by the
    name of [Z.S.M.]. The twins [were] not with [Mother]. In [Mother’s] first
    act of deception, she falsely testifie[d] [in the juvenile court] that [Z.S.M.]
    is the father of the twins. In another act of deception, [Mother] falsely
    testifie[d] that she was a surrogate for the twins. She stated the twins were
    not hers. In yet another act of deception, [Mother] falsely testified that the
    twins were residing with [Z.S.M.]. [Mother] asked the Court to determine
    that [Z.S.M.] was the father while knowing she would be perpetrating a
    continuing fraud on the Court. Further, after being directed by the Court to
    disclose the whereabouts of the twins, only [Z.S.M.] testified where the
    twins could be located. [Mother] stood silent in what this Court finds as a
    continuation of this false and elaborate cover-up of known abuse.
    ***
    The attempted cover up by [Mother] validates the Court’s belief that she
    knew her abuse or neglect would be discovered if she testified truthfully.
    Mother specifically argues that her testimony demonstrated that she did know that the
    Twins were at risk of serious bodily injury or death. However, Mother acknowledged
    that she falsely testified in the juvenile court preliminary hearing and admitted falsely
    testifying about her pregnancy with the Twins in a former custody proceeding concerning
    another child. Particularly in light of the deference we afford to the trial court’s
    credibility determination, see 
    Hughes, 340 S.W.3d at 360
    , we conclude that the evidence
    in the record supports the trial court’s determination in this regard.
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    Mother also relies in part on Ms. Butler’s testimony that she had to change the
    Twins’ diapers when they were brought into DCS custody. Mother asserts that the fact
    that the Twins’ diapers needed changing demonstrated that the Twins were receiving the
    necessary nutrition they needed. We disagree.
    As the trial court determined, the testimony of Ms. Knox, a pediatric nurse
    practitioner at the Hospital and a qualified expert, refutes any argument that the Twins
    were receiving the nutrition they required while in Mother’s care. Ms. Knox explained
    that upon the Twins’ arrival at the Hospital, their official diagnosis was malnutrition and
    failure to thrive as a result of inadequate calories. She opined that the Twins were both
    victims of nutritional neglect and medical neglect and that both were dehydrated upon
    admission to the Hospital.
    As the trial court indicated in its final order, “Ms. Knox’s testimony reflected an
    extensive description of the physical condition of [the Twins] . . . . Ms. Knox described
    from photographs the condition of [the Twins] . . . . These photographs were made
    Exhibit 3 to her deposition.” Significantly, Ms. Knox testified that the Twins’ risk of
    death was “nine fold” and that there was a likelihood that the Twins would have died but
    for DCS’s intervention. The trial court concluded that her testimony was “impressive,”
    and “well prepared,” and that “[h]er explanation of the nutritional and medical neglect
    that she diagnosed substantially assisted” the trial court. As a result, the court also gave
    “great weight” to her testimony. Affording considerable deference to the trial court’s
    credibility determinations, see
    id., we conclude
    that the evidence preponderated in favor
    of the trial court’s findings, thereby establishing by clear and convincing evidence that
    the Twins were the victims of severe child abuse in that they were malnourished when
    they were removed from Mother’s custody.
    Upon determining that the Twins were dependent and neglected as to Mother, the
    trial court in its final order further determined that it was in the Twins’ best interest to
    remain in DCS custody. In support of its determination, the trial court, during its three-
    day trial, considered extensive testimony and numerous exhibits, all of which were
    clearly detailed in the trial court’s final order. The trial court also concluded that
    placement with Mother would subject the Twins to a high risk of serious harm or bodily
    injury.
    In addition to Ms. Butler’s testimony, the trial court considered testimony from
    Grandmother, who stated that when she first observed the Twins following their removal
    from Mother’s custody, it was “very difficult” to look at them and that the Twins
    appeared lifeless. Grandmother related that by the time of trial, the Twins were healthy.
    According to Grandmother, the Twins no longer manifested any problems eating and
    were well nourished. Grandmother added that Mother had refused to have any of her
    children vaccinated, including the Twins, despite their apparent need for vaccinations.
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    The trial court also afforded “great weight” to Grandmother’s testimony.
    Our review of the evidence in the record on appeal substantiates a determination
    that the proof supports the trial court’s findings. When the Twins were brought to the
    juvenile court via court order, they were clearly in poor medical condition. Mother
    conceded as much and agreed that the Twins needed medical attention. Despite her
    admitted belief that the Twins required medical care, Mother refused to disclose the
    Twins’ location during the juvenile court preliminary hearing. After the Twins were
    located, Ms. Butler testified that the moment she saw the Twins, she was extremely
    concerned, as demonstrated by the fact that the Twins were immediately taken to the
    Hospital for medical treatment.
    Prior to the Twins’ removal from her custody, Mother purportedly transported the
    Twins to Eve’s for medical treatment, a fact that, if true, indicates that she likely knew
    the Twins were in poor health. Mother acknowledged that she was criminally convicted
    by a jury of two counts of felony child neglect pursuant to Tennessee Code Annotated §
    39-15-401(b). Moreover, Mother admitted that the Twins were abused and neglected by
    her failure to properly feed them and by her failure to provide them with medical care.
    The circumstantial evidence clearly established that Mother’s neglect of the Twins was
    with her knowledge of the danger to their lives and health.
    Upon our thorough review of the record, we conclude that the evidence
    preponderates in favor of the trial court’s findings by clear and convincing evidence that
    the Twins were dependent and neglected due to severe child abuse perpetrated by
    Mother.
    V. Conclusion
    For the foregoing reasons, we affirm the judgment of the trial court. We
    determine that the trial court’s application of the incorrect statute for purposes of
    collateral estoppel was harmless error because the trial court otherwise made exhaustive
    findings of fact that clearly and convincingly demonstrated that the Twins were
    dependent and neglected as a result of severe child abuse perpetrated by Mother. This
    case is remanded to the trial court for enforcement of the judgment and collection of costs
    assessed below. Costs on appeal are assessed to the appellant, Tamika S.
    _________________________________
    THOMAS R. FRIERSON, II, JUDGE
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