in the Interest of M.H., S.H., and G.H., Children , 2010 Tex. App. LEXIS 3380 ( 2010 )


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  •                                  IN THE
    TENTH COURT OF APPEALS
    No. 10-08-00308-CV
    IN THE INTEREST OF M.H., S.H., AND G.H., CHILDREN
    From the County Court at Law
    Ellis County, Texas
    Trial Court No. 73,951 CCL
    OPINION
    The mother and the maternal grandparents of the children the subject of this suit
    bring this appeal from a decree terminating the mother’s parental rights, designating
    the father of S.H. as her managing conservator, and designating the Department of
    Family and Protective Services as the managing conservator of the other two children.
    The grandparents contend that the court erred by: (1) failing to exclude the testimony of
    the Department’s expert witnesses for failure to properly designate the experts and
    disclose their mental impressions and opinions before trial in response to a request for
    disclosure; and (2) denying their motion for new trial because there is no evidence to
    support the jury’s refusal to find that the grandparents’ appointment as joint managing
    conservators is in the best interest of the children and these adverse findings are against
    the great weight and preponderance of the evidence (three issues).1                         The mother
    contends that: (1) the evidence is factually insufficient to support the jury’s finding that
    termination of the parent-child relationship is in the best interest of the children; and (2)
    the court abused its discretion by denying her no-evidence motion for summary
    judgment. In a third issue, the mother adopts by reference the grandparents’ issues. See
    TEX. R. APP. P. 9.7. We will affirm the judgment.
    Background
    The children were born in two other states. S.H.’s father is Appellee “Jack”2 who
    still resides in the state of S.H.’s birth.             The other children’s father voluntarily
    relinquished his parental rights. The mother is Appellant “Sandra,” and her parents are
    Appellants “Bradley” and “Paula.” Bradley and Paula moved to Texas in 2003. Sandra
    moved with the children to Texas in 2004.
    The Department became involved in 2006 amid concerns that the children were
    at risk because Sandra suffered from what was thought to be Munchausen Syndrome
    by Proxy. In March 2007, the children were removed from the home. S.H. and G.H.
    1
    The grandparents contend in their second issue that there is no evidence to support the
    challenged findings. They contend in their third issue that there is not factually sufficient evidence to
    support the findings. And they contend in their fourth issue that the challenged findings are against the
    great weight and preponderance of the evidence. Because they had the burden of proof at trial on this
    issue, they must establish that the challenged findings are against the great weight and preponderance of
    the evidence to prevail on a factual insufficiency claim. Dow Chem. Co. v. Francis, 
    46 S.W.3d 237
    , 242 (Tex.
    2001); Hunter v. Ford Motor Co., 
    305 S.W.3d 202
    , 206 (Tex. App.—Waco 2009, no pet.).
    2
    To protect the identity of the children, we shall refer to the parents and grandparents by
    pseudonyms. See TEX. FAM. CODE ANN. § 109.002(d) (Vernon 2008); TEX. R. APP. P. 9.8(b)(1).
    In the Interest of M.H.                                                                              Page 2
    were placed in foster care, and M.H. was placed with Bradley and Paula.                                After
    extensive discovery and the usual services afforded to families by the Department, the
    case proceeded to a jury trial in June 2008. Following several weeks of testimony, the
    jury returned its verdict.
    Disclosure of Expert Opinions3
    Bradley and Paula contend in their first issue (and Sandra contends as part of her
    third issue) that the court erred by failing to exclude the testimony of eight of the
    Department’s4 expert witnesses for failure to properly designate the experts and
    disclose their mental impressions and opinions before trial in response to a request for
    disclosure. There are three components to this appellate complaint: (1) whether the
    experts are retained or non-retained; (2) whether the Department disclosed the mental
    impressions and opinions of the experts; and (3) if not, whether Appellants were
    unfairly surprised or prejudiced by the failure to disclose this information.
    Bradley and Paula served the Department with a request for disclosure under
    Rule of Civil Procedure 194. See TEX. R. CIV. P. 194. Sandra filed a “written trial
    3
    Generally, when a party presents multiple issues, an appellate court should first address the
    issue(s) that would afford the party the greatest relief (like a no-evidence issue which could lead to
    rendition of judgment by the appellate court). Bradleys’ Elec., Inc. v. Cigna Lloyds Ins. Co., 
    995 S.W.2d 675
    ,
    677 (Tex. 1999) (per curiam); see Builders Transp., Inc. v. Grice-Smith, 
    167 S.W.3d 1
    , 6 n.2 (Tex. App.—Waco
    2005, pet. denied); In re K.W., 
    138 S.W.3d 420
    , 428 (Tex. App.—Fort Worth 2004, pet. denied). Here,
    however, because of the intertwined nature of the issues relating to termination of the parent-child
    relationship and post-termination conservatorship, we first address the issues relevant to termination and
    then those relevant to conservatorship.
    4
    Although this complaint actually refers to experts of the Department “and the Children,” we
    refer to these experts collectively as the Department’s experts because no information in the record
    indicates that a distinction should be noted for purposes of our analysis.
    In the Interest of M.H.                                                                                Page 3
    objection” to the admission of expert testimony on the ground that the Department
    failed to disclose the mental impressions or opinions of its experts. 
    Id. 194.2(f)(3). The
    court conducted a hearing on Sandra’s written objection before opening
    statements. Bradley and Paula joined in Sandra’s objection.5 After hearing argument of
    counsel, the court advised the parties that it would defer a ruling until the following
    day. The next day the court signed and entered an order overruling the objection and
    finding that permitting the experts to testify would not cause unfair surprise or
    prejudice “as the discovery responses themselves (documents, medical records, reports,
    etc.), and the available testimony of many of the individual non-retained experts”
    provided adequate notice “of the non-retained experts’ impressions.” In response to
    this ruling, the objection was re-urged, and the court granted a running objection with
    respect to each expert.
    Preservation
    Jack argues that Appellants failed to preserve this issue for appellate review
    because their “broad general objection” was not sufficiently specific. We disagree. The
    basis of the objection was that the discovery responses with respect to the experts failed
    to adequately disclose “the general substance of [each] expert’s mental impressions and
    opinions and a brief summary of the basis for them.” See TEX. R. CIV. P. 194.2(f)(3). The
    court’s written order essentially overruled this objection for two reasons: (1) the
    Department’s discovery responses provided the requisite information regarding the
    5
    See Owens-Corning Fiberglas Corp. v. Malone, 
    916 S.W.2d 551
    , 556 (Tex. App.—Houston [1st Dist.]
    1996), aff’d, 
    972 S.W.2d 35
    (Tex. 1998) (in trials involving multiple defendants, each defendant must make
    his own objections to preserve error, but defendants may agree with court’s approval that the objection of
    one defendant may be considered as having been made on behalf of all defendants).
    In the Interest of M.H.                                                                            Page 4
    experts’ mental impressions and opinions even if the specific response to the request for
    disclosure did not; and (2) Appellants would not be unfairly surprised or prejudiced by
    permitting the experts to testify.
    Appellants presented a specific objection.      The trial court’s written order
    demonstrates that the court (1) understood the basis for the objection and (2) clearly
    overruled the objection. In addition, the trial court granted a running objection as to the
    testimony of each expert witness for the reasons specified in the written objection.
    Thus, we hold that Appellants adequately preserved this issue. See Volkswagen of Am.,
    Inc. v. Ramirez, 
    159 S.W.3d 897
    , 907 (Tex. 2004).
    Waiver
    Jack contends that Appellants waived their complaint because they did not
    request a continuance. He cites Wal-Mart Stores Texas, LP v. Crosby, 
    295 S.W.3d 346
    (Tex.
    App.—Dallas 2009, pet. denied), to support this contention. However, we find that case
    distinguishable for several reasons.
    The Dallas Court’s discussion regarding Wal-Mart’s failure to request a
    continuance was an alternate ground for disposing of Wal-Mart’s multi-faceted
    appellate complaint. See 
    id. at 355.
    The court’s primary holding was that Wal-Mart
    could not complain on appeal regarding the admission of those portions of the
    complained-of evidence (medical records and testimony) to which it did not object. 
    Id. Specifically concerning
    the issue of surprise, the appellate court observed that the trial
    court did not make any express rulings on this issue. Then the appellate court recited a
    litany of reasons the trial court could have concluded that Wal-Mart was not unfairly
    In the Interest of M.H.                                                              Page 5
    surprised by the plaintiff’s late supplementation of discovery. 
    Id. Finally, in
    response
    to Wal-Mart’s complaint that it “had no opportunity to evaluate [the expert’s] opinions
    and, if necessary, to obtain an expert to counter those opinions,” the appellate court
    observed that, after the trial court ruled on Wal-Mart’s objections and indicated that
    some of the expert’s testimony would be admitted, “Wal-Mart did not re-urge a
    continuance motion or otherwise raise with the trial court the need for a countering
    expert witness.”
    We decline to apply Wal-Mart to the facts of this case.         As explained, the
    continuance discussion was an alternate ground for overruling Wal-Mart’s multi-
    faceted complaint.        In addition, the parties in Wal-Mart did not have to concern
    themselves with the statutory dismissal deadline established by section 263.401 of the
    Family Code. See TEX. FAM. CODE ANN. § 263.401 (Vernon 2008). Accordingly, we hold
    that Appellants did not waive their complaint by failing to request a continuance after
    the court overruled their objection.
    Retained Expert
    Rule 194.2(f)(3) requires, on proper request, a party to disclose for any testifying
    expert “the general substance of the expert’s mental impressions and opinions and a
    brief summary of the basis for them, or if the expert is not retained by, employed by, or
    otherwise subject to the control of the responding party, documents reflecting such
    information.” TEX. R. CIV. P. 194.2(f)(3).     The rule draws distinctions between the
    disclosure requirements for retained experts and those for non-retained experts. See In
    In the Interest of M.H.                                                               Page 6
    re Reaud, 
    286 S.W.3d 574
    , 579 n.3 (Tex. App.—Beaumont 2009, orig. proceeding) (per
    curiam).
    Appellants challenge the admission of the testimony of eight experts but contend
    that only one, Dr. Matthew Cox, was a retained expert. The trial court implicitly found
    that Cox was a non-retained expert because the court referred to all of the Department’s
    experts in its written ruling on Appellants’ objection as “non-retained experts.”
    Our research has not disclosed a rule, statute or case explicitly defining who a
    “retained expert” is. But the Rules of Civil Procedure appear to view the term rather
    broadly because the rules treat similarly any expert “retained by, employed by, or
    otherwise subject to the control of [a party].” See TEX. R. CIV. P. 194.2(f), 195.3, 195.6.
    Dr. Cox testified that he is an employee of the State of Texas, serving as an
    assistant professor and pediatrician at the University of Texas Southwestern Medical
    School and Children’s Medical Center in Dallas.           He explained that the State has
    provided funding to create “centers of consultation for Child Protective Services” at the
    four medical schools operated by the University of Texas to furnish experts to CPS for
    “evaluating kids when there’s concerns of abuse or neglect.” On cross-examination, he
    explained that part of his duties through this program are “to provide medical expertise
    and court appearances as needed for [the Department].”                “I’m not getting any
    individual pay [for testifying]. This is part of my salary at Children’s reviewing these
    records and coming to court, part of my job that’s partially funded by the state.”
    Though Cox may not be a “retained expert” in the traditional sense, we conclude
    from his testimony that he is a retained expert for purposes of the discovery rules
    In the Interest of M.H.                                                                  Page 7
    because he is “employed by [and] otherwise subject to the control of” the State on
    behalf of the Department. See 
    id. 194.2(f). The
    trial court abused its discretion to the
    extent it held otherwise.
    Disclosure of Mental Impressions and Opinions
    Because Cox was a retained expert, Rule 194.2(f)(3) required the Department to
    disclose “the general substance of [Cox]’s mental impressions and opinions and a brief
    summary of the basis for them.” 
    Id. 194.2(f)(3). For
    the non-retained experts, the Rule
    required the Department to disclose “the general substance of [their] mental
    impressions and opinions and [documents reflecting] a brief summary of the basis for
    them.” Id.; Barr v. AAA Tex., LLC, 
    167 S.W.3d 32
    , 36-37 (Tex. App.—Waco 2005, no pet.).
    In an attempt to satisfy these requirements,6 the Department in its amended
    response to the request for disclosure stated that these experts:
    may have knowledge of relevant facts concerning the subject matter of the
    above-referenced litigation, and/or any matter relating to the healthcare
    services provided to the Children, Respondent [Sandra], and/or
    Intervenors.    Some are healthcare doctors, providers, therapists,
    developmental psychologists or clinical psychologists, who have provided
    healthcare services to the Children and/or to the Respondents and/or
    Intervenors, or they have testified concerning matters relating to the
    Children, [Sandra], and/or the Intervenors.
    This statement does not in any manner identify or disclose: (1) “the general
    substance of the expert’s mental impressions and opinions”; (2) “a brief summary of the
    basis for them” (with regard to Cox); or (3) documents reflecting such a summary with
    regard to the non-retained experts. See Llanes v. Davila, 
    133 S.W.3d 635
    , 638-39 (Tex.
    6
    The Department’s Amended Responses to Intervenor’s Request for Disclosure is 18 pages long
    and tracks the relevant language of Rule 194.2. The quoted portion appears on page 15 of the amended
    response directly after a reference to and quotation of subdivision (f)(3) of the rule.
    In the Interest of M.H.                                                                      Page 8
    App.—Corpus Christi 2003, pet. denied). Thus, these experts should not have been
    permitted to testify unless, as the trial court found, permitting them to testify did not
    cause unfair surprise or prejudice.
    Unfair Surprise or Prejudice
    The Department had the “burden of establishing . . . the lack of unfair surprise or
    unfair prejudice.”        TEX. R. CIV. P. 193.6(b).    The trial court had the discretion to
    determine whether the Department satisfied its burden, but the court’s finding must be
    supported by the record. Tex. Mun. League Intergov’tal Risk Pool v. Burns, 
    209 S.W.3d 806
    , 817 (Tex. App.—Fort Worth 2006, no pet.) (citing Alvarado v. Farah Mfg. Co., 
    830 S.W.2d 911
    , 914 (Tex. 1992); TEX. R. CIV. P. 193.6(b)).
    The Department characterizes this issue as a failure to supplement previous
    disclosures, but the issue presented by Appellants is whether the Department wholly
    failed to disclose the required information.7 Thus, we do not address the Department’s
    contention that supplementation was unnecessary because the experts’ trial testimony
    reflected only a refinement of an already disclosed subject. See Exxon Corp. v. W. Tex.
    Gathering Co., 
    868 S.W.2d 299
    , 304 (Tex. 1993); Pilgrim’s Pride Corp. v. Smoak, 
    134 S.W.3d 880
    , 902 (Tex. App.—Texarkana 2004, pet. denied). Nevertheless, the issue of whether
    Appellants were on notice regarding the mental impressions and opinions of the
    experts is relevant to whether they suffered unfair surprise or prejudice. See Hoefker v.
    7
    It is noteworthy that the Department does not cite to any previous discovery response in the
    record which would have given Appellants the information they contend was never disclosed.
    In the Interest of M.H.                                                                      Page 9
    Elgohary, 
    248 S.W.3d 326
    , 331 (Tex. App.—Houston [1st Dist.] 2007, no pet.); 
    Burns, 209 S.W.3d at 817-18
    .
    Dr. Matthew Cox
    Appellants contend they were unfairly surprised or prejudiced because Dr. Cox’s
    opinions changed between the 14-day adversary hearing conducted in April 2007 and
    the trial held in June 2008. At the 14-day hearing, the Department initially asked Cox to
    differentiate Falsification Syndrome and Factitious Disorder. Sandra objected that Cox
    was not qualified as an expert in mental health. The court noted that Cox was qualified
    without objection to testify as a pediatric forensic specialist. The court asked Cox
    whether, as a pediatric forensic specialist, he had the training and experience and
    whether it was part of his “regular protocol” to make such a differentiation. Cox
    answered:
    As a child abuse expert, the spectrum of disorder of Munchausen
    Syndrome by proxy is the diagnosis in the child of pediatric condition
    falsification and a parental diagnosis of a mental illness, Factitious
    Disorder by proxy, so those two have interplays.
    My role is the diagnosis of the falsification of the children’s
    symptom, but they work together.
    The court overruled Sandra’s objection after Cox testified that it was part of his “regular
    course of conduct or protocol to distinguish the two.”
    Cox testified in the 14-day hearing that he had reviewed S.H.’s and G.H.’s
    medical records8 and had found numerous examples where Sandra had misreported or
    8
    A transcription of Dr. Cox’s testimony from the 14-day hearing was filed 2 weeks before trial and
    made available to the other parties for copying. Cox testified at trial that he did not have M.H.’s medical
    records at the time of the 14-day hearing,
    In the Interest of M.H.                                                                            Page 10
    falsified their medical history or their symptoms. He opined at this hearing that both
    children had suffered “abuse by pediatric condition falsification.”
    At trial, Cox provided similar testimony regarding Sandra’s misreporting and/or
    falsification of S.H.’s and G.H.’s medical history or symptoms.        Over objection, he
    defined Munchausen Syndrome by proxy, but he never opined that Sandra suffered
    from this condition. He concluded that S.H. and G.H. both were abused because of
    “pediatric condition falsification.” With respect to M.H., he testified that “there was a
    history” which led to (“in retrospect”) unnecessary diagnostic tests.         He did not
    unequivocally testify that M.H. was abused by pediatric condition falsification.
    At trial, Dr. Cox testified, consistently with his testimony at the 14-day hearing,
    that S.H. and G.H. suffered abuse by “pediatric condition falsification.” He expressed
    similar concerns at trial with regard to M.H. but did not opine that she suffered abuse in
    this manner. He reviewed additional records (including all of M.H.’s available records)
    between the 14-day hearing and trial, but his expert opinion remained consistent.
    Accordingly, we cannot say that the court abused its discretion by concluding that
    Appellants were not unfairly surprised or prejudiced by the Department’s failure to
    disclose his mental impressions or opinions. See 
    Hoefker, 248 S.W.3d at 331
    ; 
    Burns, 209 S.W.3d at 817-18
    .
    Dr. Muhammad Qamar
    The Department did not list Dr. Qamar as a testifying expert in its response to
    the request for disclosure, but it did include him in an attached list of expert witnesses
    which included more than 250 other healthcare providers. Qamar did not testify at the
    In the Interest of M.H.                                                             Page 11
    14-day hearing. Qamar was asked to evaluate Sandra in August 2007 by physicians at
    John Peter Smith Hospital for suspicion of factitious disorder. Based on his evaluation,
    Qamar concluded that she has factitious disorder. On cross-examination, he opined
    more forcefully that she “100 percent meets the criteria.” Qamar testified that Sandra’s
    prognosis with regard to this condition is good so long as she has family support,
    personal motivation, and appropriate counseling services.
    Assuming without deciding Appellants were unfairly surprised or prejudiced by
    the admission of Qamar’s testimony, his opinion was admitted elsewhere without
    objection when his written consultation report was admitted in evidence. Therefore,
    any error in the admission of his testimony was rendered harmless by the admission of
    the same evidence in written form without objection. See Benavides v. Cushman, Inc., 
    189 S.W.3d 875
    , 885 (Tex. App.—Houston [1st Dist.] 2006, no pet.); Combs v. Gent, 
    181 S.W.3d 378
    , 385 (Tex. App.—Dallas 2005, no pet.).
    Dr. Christian Sanchez
    Dr. Sanchez testified concerning Sandra’s return to the Ennis Regional Medical
    Center in April 2008, several weeks after having surgery there to remove a staple from
    her knee. During her stay, nurses discovered that she had broken the lock on the PCA
    pump, which administered morphine for pain relief, and manipulated her dosage.
    Sanchez confronted Sandra about what he perceived to be a “definitely psychological, if
    not physical, addiction to pain medicine.”
    In reviewing her history regarding the staple lodged in her knee, Sanchez
    testified that Sandra’s version of how the injury occurred was not entirely consistent
    In the Interest of M.H.                                                          Page 12
    with her injury. He explained this is a matter of concern when patients exaggerate
    symptoms or “inflict things upon themselves” to get medical attention or certain drugs.
    Based on his observations, he diagnosed her as suffering from Munchausen’s.
    Assuming without deciding Appellants were unfairly surprised or prejudiced by
    the admission of Sanchez’s testimony, his opinion was admitted elsewhere without
    objection when his handwritten notes were admitted in evidence as part of Sandra’s
    medical records from Ennis Regional Medical Center.         Therefore, any error in the
    admission of his testimony was rendered harmless by the admission of the same
    evidence in written form without objection. 
    Id. Other Physicians
    Appellants also complain about the Department’s failure to disclose the mental
    impressions or opinions of Doctors Karen Schultz, Lorie Belitere-Blessing, Amy Haller,
    and Kimberly Sweet. However, Appellants present no argument or authority specific to
    the testimony of these doctors.    We will not make their argument for them.         See
    Robertson v. Sw. Bell Yellow Pages, Inc., 
    190 S.W.3d 899
    , 903 (Tex. App.—Dallas 2006, no
    pet.); Beard v. Beard, 
    49 S.W.3d 40
    , 67 (Tex. App.—Waco 2001, pet. denied).
    Dr. Mitchell Dunn
    Dr. Dunn’s opinion did change between the time of the 14-day hearing and trial.
    He testified as a psychiatric expert on Sandra’s behalf at the 14-day hearing and
    diagnosed her with a depressive personality disorder. In his opinion at that time, she
    was able to perform normal life functions and provide appropriate care for her children.
    Although it was discussed at the 14-day hearing, Dunn determined that Sandra did not
    In the Interest of M.H.                                                          Page 13
    have factitious disorder. The only medical record available to him at that time referred
    to an incident in which treating physicians felt she had “purposefully extended a
    laceration on her head.” He thought this incident “had more to do with a battle with
    the doctors, kind of an impulsive response” rather than an attempt to mislead them
    about her condition.
    Dunn reviewed additional medical records provided by the Department about a
    week before trial. These records reflected subsequent incidents in which Sandra: (1)
    had some eyedrops which caused dilation of the pupils when she came to the hospital
    in August 2007 complaining of a dilated left pupil; and (2) had been giving herself
    heparin, a blood thinner, at the time of a different hospitalization in December 2007.
    Dunn opined at trial that, based on this additional information, “factitious disorder is
    more likely.”
    Relying on Norfolk Southern Railway v. Bailey, 
    92 S.W.3d 577
    (Tex. App.—Austin
    2002, no pet.), the Department contends that Appellants were not unfairly surprised or
    prejudiced by the Department’s failure to disclose Dunn’s diagnosis of factitious
    disorder because this represents only a refinement of his previous diagnosis, a
    perfection of his report, and an expansion of an already-disclosed subject. We disagree.
    In Norfolk Southern, the expert’s diagnosis changed from asbestosis with no impairment
    to asbestosis with mild impairment. 
    Id. at 580.
    Here, Dunn’s opinion changed from an
    affirmative determination that Sandra did not have factitious disorder to the exact
    opposite determination, namely, that she likely does have factitious disorder. The
    Department’s suggestion that this change of opinion is only a refinement of Dunn’s
    In the Interest of M.H.                                                          Page 14
    prior opinion that Sandra suffers from several personality disorders is unpersuasive.
    Dunn explained that the disorders he had previously diagnosed are conditions which
    can be managed by medication and therapy. However, he is aware of no successful
    treatment regimen for factitious disorder.
    The court abused its discretion by ruling that Appellants would not be unfairly
    surprised or prejudiced by the admission of Dunn’s testimony. This error requires
    reversal if we conclude that it probably caused the rendition of an improper judgment.
    TEX. R. APP. P. 44.1(a)(1); Lopez v. La Madeleine of Tex., Inc., 
    200 S.W.3d 854
    , 863 (Tex.
    App.—Dallas 2006, no pet.); see Gee v. Liberty Mut. Fire Ins. Co., 
    765 S.W.2d 394
    , 396 (Tex.
    1989).
    Dunn was Sandra’s own expert, so she was undoubtedly surprised when he was
    called by the Department at trial and testified against her. However, his testimony was
    only cumulative of other expert witnesses whose testimony has not been challenged (or
    not adequately challenged) on appeal. See State v. Dawmar Partners, Ltd., 
    267 S.W.3d 875
    , 881 (Tex. 2008) (per curiam). Drs. Qamar and Sanchez both testified that Sandra
    has factitious disorder or Munchausen by proxy syndrome. Iowa psychiatrist Truce
    Ordona testified that he diagnosed her as having Munchausen by proxy syndrome after
    treating her in 2003. Moreover, the Department could have waited until after Sandra
    called Dunn to testify on her behalf, presented her medical records to him, and then
    cross-examined him during which he would presumably reach the same conclusion he
    reached during his direct examination as the Department’s witness. See Hunter v. Ford
    Motor Co., 
    305 S.W.3d 202
    , 208 (Tex. App.—Waco 2009, no pet.) (“An expert’s testimony
    In the Interest of M.H.                                                              Page 15
    may be contradicted by the testimony of other witnesses or by cross-examination of the
    expert witness.”).
    Accordingly, we hold that the erroneous admission of Dunn’s expert opinion
    testimony probably did not cause the rendition of an improper judgment. See Dawmar
    
    Partners, 267 S.W.3d at 881
    ; 
    Gee, 765 S.W.2d at 396-97
    . We overrule Bradley’s and
    Paula’s first issue and that portion of Sandra’s third issue which incorporates their first
    issue.
    Best Interest of the Children-Termination
    Sandra contends in her first issue that the evidence is factually insufficient to
    support the jury’s finding that termination of the parent-child relationship is in the best
    interest of the children.
    In conducting a factual sufficiency review, “a court of appeals must give due
    consideration to evidence that the factfinder could reasonably have found to be clear
    and convincing.” In re J.F.C., 
    96 S.W.3d 256
    , 266 (Tex. 2002); In re T.N.F., 
    205 S.W.3d 625
    ,
    630 (Tex. App.—Waco 2006, pet. denied).
    The primary factors to consider when evaluating whether termination is in the
    best interest of a child are the familiar Holley factors, which include:
    (1) the desires of the child; (2) the emotional and physical needs of the
    child now and in the future; (3) the emotional and physical danger to the
    child now and in the future; (4) the parental abilities of the individuals
    seeking custody; (5) the programs available to assist these individuals to
    promote the best interest of the child; (6) the plans for the child by these
    individuals or by the agency seeking custody; (7) the stability of the home
    or proposed placement; (8) the acts or omissions of the parent which may
    indicate that the existing parent-child relationship is not a proper one; and
    (9) any excuse for the acts or omissions of the parent.
    In the Interest of M.H.                                                                  Page 16
    Holley v. Adams, 
    544 S.W.2d 367
    , 372 (Tex. 1976); 
    T.N.F., 205 S.W.3d at 632
    .
    Desires of the Children: Sandra refers to the testimony of the children’s guardian
    ad litem that the children love Sandra “very much,” enjoyed their visits with her, and
    showed affection toward her during the visits. This evidence is at best marginally
    relevant. See In re S.N., 
    272 S.W.3d 45
    , 51-52 (Tex. App.—Waco 2008, no pet.) (“it is
    doubtful that such evidence is indicative of the [child]’s conscious, volitional desire to
    maintain a parent-child relationship or to permanently sever that relationship”). The
    record contains scant evidence that any of the children possess sufficient maturity to
    express an opinion regarding a parental preference.9 
    Id. Children’s Emotional
    and Physical Needs: The children have the usual emotional
    and physical needs. According to a sibling assessment prepared by a social worker,
    they need individual therapy and non-sibling peer groups to help them each establish
    their unique identities. Sandra herself testified that she is not currently able to provide
    for the children’s needs.10
    Emotional and Physical Danger to Children: The primary evidence relevant to this
    factor are the children’s medical histories which are replete with instances in which they
    have suffered emotionally and physically because of Sandra’s false reports of non-
    existent medical conditions. The experts are divided on whether Sandra’s condition can
    9
    At the time of trial, the children were 9, 7, and 5 years old.
    10
    For several of the best-interest factors, Sandra refers to evidence that Bradley and Paula are
    currently able to provide for the children’s needs, but in deciding whether the evidence supports the
    verdict that termination of Sandra’s parental rights is in the best interest of the children, our focus must
    necessarily be on Sandra and not other potential caregivers. See Holley v. Adams, 
    544 S.W.2d 367
    , 372 (Tex.
    1976) (best-interest inquiry focuses on “the individuals seeking custody”).
    In the Interest of M.H.                                                                             Page 17
    be treated. Bradley and Paula both testified that Sandra’s visits with the children
    should be supervised. This evidence supports a finding that Sandra poses a present or
    future risk of danger to the children.
    Parental Abilities: Sandra herself testified that she is not currently able to provide
    for their needs. The experts are divided on whether Sandra’s condition can be treated.
    This evidence supports a finding that Sandra currently lacks the requisite parental
    abilities.
    Available Programs: A caseworker testified that Sandra has been attending
    counseling sessions three times per week, which exceeds what the Department
    requested. In her own testimony, Sandra did not highlight any particular programs she
    is participating in to improve her situation. Thus, there is conflicting evidence relevant
    to this factor.
    Plans for the Children: Sandra’s only plan for the children at the time of trial was
    for them to remain with her parents. Her parents testified that they would not allow
    her to be around the children. She acknowledged her diagnoses and testified of her
    desire to become well enough for her children to return. She could not give a specific
    time to accomplish this other than to say “[w]hatever time frame it takes.” Thus, the
    evidence relevant to this factor supports the best-interest finding.
    Stability of the Home: Sandra cannot provide the children a stable home at this
    time. The evidence relevant to this factor supports the best-interest finding.
    Sandra’s Acts and Omissions (and Excuses): The children’s medical histories are
    replete with instances in which they have suffered emotionally and physically because
    In the Interest of M.H.                                                                Page 18
    of Sandra’s false reports of non-existent medical conditions. The experts are divided on
    whether Sandra’s condition can be treated.             The evidence relevant to this factor
    supports the best-interest finding.
    Summary: Considering all the evidence in a neutral light, we hold that the
    evidence is such that the jurors “could reasonably form a firm belief or conviction” that
    termination of Sandra’s parental rights was in the best interest of the children. See
    
    J.F.C., 96 S.W.3d at 266
    ; 
    T.N.F., 205 S.W.3d at 630
    . Thus, the evidence is factually
    sufficient on this element. We overrule Sandra’s first issue.
    Best Interest of S.H.-Conservatorship
    Bradley and Paula contend in their second issue that the court erred by denying
    their motion for new trial because there is no evidence to support the jury’s refusal to
    find that their appointment as joint managing conservators is in the best interest of the
    children. They contend in their third and fourth issues that the challenged findings are
    against the great weight and preponderance of the evidence. Sandra incorporates these
    issues as part of her third issue.11 We focus first on the evidence relevant to S.H.
    Section 153.131 of the Family Code provides a rebuttable presumption that the
    appointment of a parent as a child’s managing conservator is in her best interest unless
    the appointment “would significantly impair the child’s physical health or emotional
    development.” See TEX. FAM. CODE ANN. § 153.131 (Vernon 2008); In re J.A.J., 
    243 S.W.3d 611
    , 615 (Tex. 2007). To successfully overcome this presumption:
    11
    We assume without deciding that Sandra has standing to do so even though her parental rights
    have been terminated.
    In the Interest of M.H.                                                                    Page 19
    the non-parent must prove by a preponderance of credible evidence that
    appointing the parent as a managing conservator would result in serious
    physical or emotional harm to the child. Evidence must be presented to
    support the logical inference that some specific, identifiable behavior or
    conduct of the parent will probably cause that harm. This link between
    the parent’s conduct and harm to the child may not be based on evidence
    that merely raises a surmise or speculation of possible harm. When a non-
    parent and a parent are both seeking managing conservatorship, “close
    calls” go to the parent.
    Taylor v. Taylor, 
    254 S.W.3d 527
    , 536 (Tex. App.—Houston [1st Dist.] 2008, no pet.)
    (citations omitted).
    We assume without deciding that Bradley and Paula presented evidence
    sufficient to rebut the parental presumption favoring Jack. Rather, we focus on whether
    the evidence conclusively establishes that it would be in S.H.’s best interest for them to
    be appointed as her managing conservators or whether the jury’s adverse finding on
    this issue is against the great weight and preponderance of the evidence.12 See TEX.
    FAM. CODE ANN. § 153.002 (Vernon 2008) (“The best interest of the child shall always be
    the primary consideration of the court in determining [conservatorship] issues”); see also
    
    Hunter, 305 S.W.3d at 205-06
    . We again apply the Holley factors. See 
    Holley, 544 S.W.2d at 372
    ; 
    T.N.F., 205 S.W.3d at 632
    .
    In considering the no-evidence issue, we view all of the evidence in the light
    most favorable to Jack, “crediting favorable evidence if reasonable jurors could, and
    disregarding contrary evidence unless reasonable jurors could not.” City of Keller v.
    Wilson, 
    168 S.W.3d 802
    , 807 (Tex. 2005); 
    Hunter, 305 S.W.3d at 205-06
    . Because the
    12
    Bradley and Paula do not challenge the jury’s refusal to find that Jack’s appointment “would
    significantly impair [S.H.’s] physical health or emotional development.” See TEX. FAM. CODE ANN. §
    153.131 (Vernon 2008); In re J.A.J., 
    243 S.W.3d 611
    , 615 (Tex. 2007).
    In the Interest of M.H.                                                                      Page 20
    burden of proof at trial was a preponderance of the evidence on the conservatorship
    issues, we do not apply the heightened standard of review required for findings in
    parental-rights termination cases in which the burden of proof at trial is clear-and-
    convincing evidence. See 
    J.A.J., 243 S.W.3d at 616
    .
    For Bradley’s and Paula’s contention that the adverse finding is against the great
    weight and preponderance of the evidence, we weigh all the evidence and may set
    aside the adverse finding only if it is so against the great weight and preponderance of
    the evidence that it is clearly wrong and unjust. Dow Chem. Co. v. Francis, 
    46 S.W.3d 237
    , 242 (Tex. 2001); 
    Hunter, 305 S.W.3d at 206
    .
    Desires of the Child: The record contains no evidence that S.H. possesses sufficient
    maturity to express an opinion regarding a conservatorship preference.
    Child’s Emotional and Physical Needs: S.H. has the usual emotional and physical
    needs. She needs individual therapy and a non-sibling peer group to help her establish
    her unique identity. Jack testified that such services are available in his home state and
    that he has a supportive family and lives in a good neighborhood where her needs can
    be met.
    A social worker testified that, while S.H. was in Bradley’s and Paula’s care
    during the pendency of the case, her needs were being met appropriately.
    Emotional and Physical Danger to Child: S.H. suffered emotionally and physically
    on numerous occasions because of Sandra’s false reports of non-existent medical
    conditions. The parties agree that S.H. must be protected from Sandra. Jack testified
    In the Interest of M.H.                                                              Page 21
    that, if Sandra were at some point permitted to visit S.H., he would make sure that “the
    proper safety rules [were] in place and followed.”
    There is conflicting evidence in the record regarding whether Bradley and Paula
    are willing and able to protect S.H. from Sandra. The Department’s witnesses are
    generally not convinced of their willingness to do so. These witnesses are concerned
    because of past history and in particular because of the failure of Paula, a registered
    nurse, to acknowledge Sandra’s condition despite a 10-year history of similar incidents
    involving Sandra or her children. However, Bradley and Paula presented evidence that
    Dr. Ordona initially assured them that Sandra did not suffer from Munchausen’s
    although he stated in his deposition that he later did diagnose her with this condition.
    The social worker reported that Bradley and Paula want to follow the recommendations
    of the various professionals with regard to Sandra and the girls and “have chosen to
    accept to put their Grandchildren’s needs above the needs of their daughter.”
    Parental Abilities: Jack testified about counseling services he has received to better
    understand S.H.’s needs and to gain the tools needed to develop a close relationship
    with her. He described what he learned in a 4-hour parent education program and how
    it would affect him if given custody of S.H.
    The evidence indicates that Bradley and Paula are also capable of providing
    appropriate parenting for S.H.
    Available Programs: Jack testified about various programs and services that are
    available in his home state to meet S.H.’s needs.         Similar services are available to
    Bradley and Paula and have been employed during the pendency of the suit.
    In the Interest of M.H.                                                                Page 22
    Plans for the Child: Jack told the jury about his plans for S.H.: how he would
    change his work schedule to maximize his time with her, how extended family would
    be available to help as needed, how he will allow her to maintain a relationship with
    her mother, grandparents and sisters as possible, and how he wants to provide her “a
    life of happiness” by showing her love and giving her the attention that she has been
    deprived in the past.
    Paula testified that Bradley and she are “ready to raise the children for the rest of
    their lives but ready to allow [Sandra] to have some involvement in their lives” with
    appropriate “safety features.”
    Stability of the Home: Jack currently lives with his parents in an appropriate home
    and has no plans to move in the near future.            Bradley and Paula also have an
    appropriate and stable home environment, although their continuing relationship with
    Sandra at least poses a potential threat to the stability of the home.
    Acts and Omissions (and Excuses): Jack failed to pay child support when S.H. first
    moved away, but Sandra would not allow the court in that state to provide him her
    address so he could make proper arrangements. After being served, Jack came to Texas
    for the 14-day hearing.       Before being permitted access to S.H., he submitted to
    numerous tests, interviews, and screening procedures. He has made ten or eleven trips
    to Texas to see S.H. He testified that he has called to talk with S.H. almost every week.
    He sought appropriate counseling and parent education services in his home state.
    Paula testified that the regularity of Jack’s phone calls was “erratic,” perhaps
    twice a month. Bradley and she have been the primary caregivers for S.H. during the
    In the Interest of M.H.                                                               Page 23
    pendency of the case. However, we have already reviewed the evidence regarding their
    unwillingness to accept Sandra’s diagnosis and the consequences flowing from that.
    The jury could have inferred from the evidence that they did not come to accept the
    diagnosis until the eve of trial and could have questioned the sincerity of their
    acceptance.
    Sibling Relationships:13 Bradley and Paula cite Autry v. Autry, 
    350 S.W.2d 233
    , 236
    (Tex. Civ. App.—El Paso 1961, writ dism’d), Dalton v. Doherty, 
    670 S.W.2d 422
    , 424 (Tex.
    App.—Fort Worth 1984, no writ), and similar cases for the proposition that it is not in
    the best interest of siblings to be separated absent “clear and compelling reasons.” See
    also TEX. FAM. CODE ANN. § 162.302(e) (Vernon 2008) (“It is the intent of the legislature
    that the department in providing adoption services, when it is in the children’s best
    interest, keep siblings together and whenever possible place siblings in the same
    adoptive home.”).
    However, there is no statutorily prescribed “clear and compelling” standard to
    be met before siblings may be separated. See In re D.R.L.M., 
    84 S.W.3d 281
    , 303-04 (Tex.
    App.—Fort Worth 2002, pet. denied).
    More importantly, the preference that siblings be kept together when possible
    applies only in cases involving children of the same marriage (or non-married parents)
    and not half-siblings. In re K.L.R., 
    162 S.W.3d 291
    , 306 (Tex. App.—Tyler 2005, no pet.);
    13
    The Holley factors are a non-exclusive list of considerations for the best-interest determination
    and other factors may also be considered. See In re C.H., 
    89 S.W.3d 17
    , 27 (Tex. 2002); In re T.N.F., 
    205 S.W.3d 625
    , 632-33 (Tex. App.—Waco 2006, pet. denied).
    In the Interest of M.H.                                                                          Page 24
    
    D.R.L.M., 84 S.W.3d at 303
    . Even the cases cited by Bradley and Paula recognize this
    limitation. See 
    Autry, 350 S.W.2d at 236
    ; 
    Dalton, 670 S.W.2d at 424
    .
    Nevertheless, it is undisputed that S.H.’s emotional well-being will be adversely
    affected by her separation from her half-sisters. Therefore, the impact of separating the
    girls is an appropriate consideration in evaluating what is in S.H.’s best interest. See
    
    K.L.R., 162 S.W.3d at 306
    . And the evidence relevant to this factor indicates that it
    would be in S.H.’s best interest for Bradley and Paula to be appointed as her managing
    conservators (so long as they were also appointed as managing conservators of her half-
    sisters).
    Summary: Viewing the evidence in the light most favorable to Jack, we cannot say
    that the evidence conclusively establishes that it would be in S.H.’s best interest for
    Bradley and Paula to be appointed as her managing conservators. Thus, we reject
    Bradley’s and Paula’s no-evidence challenge with regard to this issue.
    Viewing the evidence in a neutral light, there is evidence on many of the relevant
    factors which would have supported a verdict in favor of Jack or in favor of Bradley and
    Paula on this issue. “When a non-parent and a parent are both seeking managing
    conservatorship, ‘close calls’ go to the parent.” 
    Taylor, 254 S.W.3d at 536
    . Thus, we
    reject Bradley’s and Paula’s contention that the jury’s finding on this issue is against the
    great weight and preponderance of the evidence.
    Best Interest of M.H. and G.H.-Conservatorship
    Bradley and Paula also contend in their second issue that the court erred by
    denying their motion for new trial because there is no evidence to support the jury’s
    In the Interest of M.H.                                                              Page 25
    refusal to find that their appointment as joint managing conservators is in the best
    interest of M.H. and G.H.      They contend in their third and fourth issues that the
    challenged findings are against the great weight and preponderance of the evidence.
    Sandra incorporates these issues as part of her third issue.
    The evidence relevant to Bradley and Paula regarding the Holley factors and
    keeping the girls together in a single family does not vary appreciably from what has
    already been stated, so we will not repeat it.
    For their no-evidence claim, the issue on appeal is whether the evidence
    conclusively establishes that it would be in M.H.’s and G.H.’s best interests for Bradley
    and Paula to be appointed as their managing conservators. See 
    Hunter, 305 S.W.3d at 205
    .
    The Department’s primary argument was (and is) that Bradley and Paula are not
    willing to protect the children from Sandra. There is ample evidence in the record to
    support the Department’s position. After viewing all the evidence in the light most
    favorable to the verdict, we cannot say that the evidence conclusively establishes that it
    would be in M.H.’s and G.H.’s best interests for Bradley and Paula to be appointed as
    their managing conservators.
    Nor do we agree that the challenged findings are against the great weight and
    preponderance of the evidence.       
    Id. at 206.
      The jury heard conflicting evidence
    regarding what is in the best interest of the children and determined that the
    appointment of Bradley and Paula as managing conservators would not be in their best
    interest. We must defer to the jury on its resolution of these issues. See Harris v. Tex.
    In the Interest of M.H.                                                            Page 26
    Dep’t of Family & Protective Servs., 
    228 S.W.3d 819
    , 829-30 (Tex. App.—Austin 2007, no
    pet.); 
    Hunter, 305 S.W.3d at 206
    .
    For these reasons, we overrule Bradley’s and Paula’s second, third and fourth
    issues and that part of Sandra’s third issue which incorporates these issues by reference.
    Denial of Summary Judgment
    Sandra contends in her second issue that the court erred by denying her no-
    evidence summary-judgment motion.         “Where a motion for summary judgment is
    denied by the trial court and the case is tried on its merits, the order denying the
    summary judgment cannot be reviewed on appeal.” Moore v. Jet Stream Invs., Ltd., 
    261 S.W.3d 412
    , 427 (Tex. App.—Texarkana 2008, pet. denied) (citing Ackermann v.
    Vordenbaum, 
    403 S.W.2d 362
    , 365 (Tex. 1966)).
    We overrule Sandra’s second issue and affirm the judgment.
    FELIPE REYNA
    Justice
    Before Chief Justice Gray,
    Justice Reyna, and
    Justice Davis
    (Chief Justice Gray concurring with note)*
    Affirmed
    Opinion delivered and filed May 5, 2010
    [CV06]
    *       (Chief Justice Gray concurs in the judgment of the Court to the extent it affirms
    the trial court’s judgment. He joins no part of the Opinion including its designation as
    such rather than as a memorandum opinion. A separate opinion will not issue, due in
    part to the already lengthy time this appeal has been pending.)
    In the Interest of M.H.                                                            Page 27