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In re Elianah T.-T.

Supreme Court of Connecticut

August 15, 2017

IN RE ELIANAH T.-T. ET AL.[*]

          Argued May 4, 2017 [***]

          Benjamin M. Wattenmaker, with whom was Joshua Michtom, for the appellants (respondents).

          Rosemarie T. Weber, assistant attorney general, with whom were Evan O'Roark, assistant attorney general, and, on the brief, George Jepsen, attorney general, and Benjamin Zivyon, assistant attorney general, for the appellee (petitioner).

          Rogers, C. J., and Palmer, Eveleigh, McDonald, Espinosa, Robinson and Vertefeuille, Js. [**]

         Syllabus

         Pursuant tostatute(§ 17a-10 [c]), the Commissioner of Children and Families may authorize, on the advice of a licensed physician, ‘‘medical treatment, including surgery, to insure the continued good health or life'' of a child committed to his or her custody.

         The respondent parents appealed from the decision of the trial court granting the petitioner, the Commissioner of Children and Families, permission to vaccinate their minor children. The children had been removed from the respondents' custody after a social worker employed by the Department of Children and Families discovered the children covered in bruises and in a generally poor state of hygiene. The trial court subsequently rendered judgments adjudicating the children neglected and, with the consent of the parties, committed the children to the temporary custody of the commissioner. At that time, the respondents made a motion seeking to prevent, on the basis of certain religious beliefs, the commissioner from authorizing vaccinations for the children pursuant to § 17a-10 (c) in accordance with the department's usual practice. The trial court denied the respondents' motion and granted the commissioner permission to vaccinate the children, concluding that, because the commissioner had custody of and control over the children, she had the authority and obligation to vaccinate the children pursuant to § 17a-10 (c) notwithstanding the respondents' religious objection. On the respondents' subsequent appeal, held that the trial court improperly granted the commissioner permission to vaccinate the children in light of the respondents' religious objection, this court having concluded that vaccinations do not constitute medical treatment under § 17a-10 (c) and that, therefore, the commissioner is not authorized to vaccinate children committed to her temporary custody without parental consent; although the apparent conflict between the ordinary meaning of the phrase ‘‘medical treatment, '' which contemplates curing an existing condition, and the phrase ‘‘insure the continued good health or life of the child, '' which may reasonably be read to permit preventative care, created ambiguity in § 17a-10 (c) with respect to vaccinations, which are prophylactic in nature, the modification of the phrase ‘‘medical treatment'' by the phrase ‘‘including surgery, '' the existence of related statutes explicitly authorizing preventative measures in other contexts, and an examination of relevant portions of legislative history supported the conclusion that the legislature intended to grant the commissioner only limited authority to provide medical treatment without parental consent in emergency situations.

         Petitions by the Commissioner of Children and Families to adjudicate the respondents' minor children neglected, brought to the Superior Court in the judicial district of New Britain, Juvenile Matters, where the respondents entered pleas of nolo contendere as to the neglect allegations; thereafter, the court, Abery-Wetstone, J., issued an order adjudicating the minor children neglected and transferring temporary custody of the minor children to the Commissioner of Children and Families; subsequently, the court, Abery-Wetstone, J., denied the respondents' motion seeking to prevent the Commissioner of Children and Families from vaccinating the minor children, from which the respondents appealed. Reversed; judgment directed.

          OPINION

          ROBINSON, J.

         The dispositive issue in this appeal is whether General Statutes § 17a-10 (c)[1] authorizes the petitioner, the Commissioner of Children and Families (commissioner), to vaccinate a child placed temporarily in her custody, over the objection of that child's parents. The respondents, Giordan T. and Nicanol T., appeal[2]from the decision of the trial court denying their motion seeking to prevent vaccination of their minor children, Elianah T.-T. and Nathaniel T.-T. On appeal, the respondents claim, inter alia, that § 17a-10 (c) does not authorize the commissioner to vaccinate the children over the respondents' objection because vaccinations do not constitute ‘‘medical treatment'' within the meaning of that statute.[3] We agree with this claim and conclude that vaccinations are not ‘‘medical treatment'' as contemplated by § 17a-10 (c). Accordingly, we reverse the decision of the trial court.

         The record reveals the following undisputed facts and procedural history. The Department of Children and Families (department) first became involved with the respondents' family on April 21, 2016, after the Rocky Hill Police Department was called to investigate a physical altercation between the respondents. The department learned from police that the respondents and the children, who were one and two years old at the time, had been living out of a minivan for several months as they moved from Florida to Connecticut, making stops in North Carolina, Colorado, and New York. The police subsequently arrested both respondents for disorderly conduct. Following the respondents' arrest, a social worker from the department met with the children at the police station and observed that they smelled of urine, were filthy, and were covered with multiple bruises. The department then invoked a ninety-six hour hold over the children pursuant to General Statutes § 17a-101g (e). The respondent mother gave the department permission to have the children medically evaluated.[4]

         Thereafter, on April 25, 2016, the commissioner filed neglect petitions as to both of the children and sought ex parte orders of temporary custody. On April 29, 2016, the trial court sustained the orders of temporary custody and ordered specific steps to facilitate reunification of the children with the respondents pursuant to General Statutes § 46b-129. At a hearing held on August 23, 2016, the respondents entered pleas of nolo contendere as to the neglect allegations and agreed to commit the children temporarily to the care and custody of the commissioner. The trial court entered findings of neglect, rendered judgments on the petitions in accordance with the respondents' pleas, and committed the children to the custody of the commissioner. At that hearing, the parties advised the court that the respondents, on the basis of their sincerely held religious beliefs, objected to vaccination of the children for common childhood diseases in accordance with the department's usual practice. The respondents then made an oral motion seeking to prevent vaccination, to which the commissioner objected.

         On November 17, 2016, the trial court held a one day hearing to determine whether the commissioner had the authority to vaccinate the children in light of the respondents' religious objection. During the hearing, the commissioner presented four witnesses: (1) Iris Thompson, a nurse consultant employed by the department; (2) Stephen Humphrey, a clinical psychologist who had conducted a court ordered evaluation of the respondents; (3) Fredericka Wolman, a pediatrician employed as the department's director of pediatrics; and (4) Jessica Nordlund, a department social worker. Thompson and Humphrey testified that they had communicated with the respondents regarding the immunizations and that the respondents never expressed a religious objection. Wolman testified about the medical importance of immunizations, and Nordlund testified that she had to call numerous physicians before locating one who would treat unvaccinated children. In response, the respondent mother testified about her religious beliefs.

         On January 13, 2017, the trial court issued a memorandum of decision denying the respondents' motion and granting the commissioner permission to vaccinate the children. The trial court stated that it ‘‘need not reach the issue of [the respondent] mother's religious belief, because the children are committed to the [custody of the commissioner].'' The trial court similarly determined that the exemption provided by General Statutes § 10-204a to the state's vaccination requirement for school children, for religious objections to immunization, did not apply in this case because the children were committed to the care and custody of the commissioner. The court concluded that the crucial issue in this case was the fact that the commissioner had custody of and control over the children, which gave the commissioner ‘‘the authority and obligation to vaccinate'' them pursuant to § 17a-10 (c). This appeal followed.[5] See footnote 2 of this opinion.

         On appeal, the respondents claim, inter alia, that § 17a-10 (c) does not authorize the commissioner to vaccinate the children over the respondents' objection because vaccinations are not ‘‘medical treatment'' as contemplated by the statute. The respondents contend that the plain language of § 17a-10 (c) indicates that preventative vaccinations are not ‘‘medical treatment'' because ‘‘treatment'' is defined as the steps taken to cure an injury or disease. Thus, the respondents argue that the commissioner may authorize ‘‘medical treatment'' without parental consent only to address an existing injury, illness, or disease. Because the commissioner did not seek to vaccinate the children to cure an existing illness or disease, but rather as a precautionary measure, the respondents contend that such vaccinations do not fall within the plain language of the statute. Alternatively, the respondents contend that, even if the court deems the phrase ‘‘medical treatment'' ambiguous, the legislative history of § 17a-10 (c) establishes that the legislature intended the statute to give the commissioner only limited authority to provide medical treatment without parental consent in emergency situations.

         In response, the commissioner contends that ‘‘[t]he plain language of § 17a-10 (c), very simply, gives the commissioner the authority to provide medical treatment to children in its care, consistent with the child's best interests.'' In the commissioner's view, § 17a-10 (c) is plain and unambiguous, and the phrase ‘‘medical treatment'' is commonly understood to include the ‘‘mit-igat[ion]'' of an illness or disease. Accordingly, the commissioner contends that vaccinations are ‘‘medical treatment'' because they are amedicine administered by a physician to mitigate against diseases. We, however, agree with the respondents and conclude that vaccinations do not constitute ‘‘medical treatment'' under § 17a-10 (c).

         The issue of whether § 17a-10 (c) authorizes the commissioner to vaccinate children committed to her temporary custody over parental objection presents a question of statutory construction over which we exercise plenary review. Gonzalez v. O & G Industries, Inc., 322 Conn. 291, 302, 140 A.3d 950 (2016). ‘‘When construing a statute, [o]ur fundamental objective is to ascertain and give effect to the apparent intent of the legislature. . . . In other words, we seek to determine, in a reasoned manner, the meaning of the statutory language as applied to the facts of [the] case, including the question of whether the language actually does apply. . . . In seeking to determine that meaning, General Statutes § 1-2z directs us first to consider the text of the statute itself and its relationship to other statutes. If, after examining such text and considering such relationship, the meaning of such text is plain and unambiguous and does not yield absurd or unworkable results, extratextual evidence of the meaning of the statute shall not be considered. . . . When a statute is not plain and unambiguous, we also look for interpretive guidance to the legislative history and circumstances surrounding its enactment, to the legislative policy it was designed to implement, and to its relationship to existing legislation and common law principles governing the same general subject matter . . . .'' (Internal quotation marks omitted.) Id., 302-303. Importantly, ‘‘ambiguity exists only if the statutory language at issue is susceptible to more than one plausible interpretation.'' State v. Orr, 291 Conn. 642, 654, 969 A.2d 750 (2009). In other words, ‘‘statutory language does not become ambiguous merely because the parties contend for different meanings.'' (Internal quotation marks omitted.) Allen v. Commissioner of Revenue Services, 324 Conn. 292, 309, 152 A.3d 488 (2016).

         In accordance with § 1-2z, we begin our analysis with the relevant statutory text. Section 17a-10 (c) provides in relevant part: ‘‘When deemed in the best interests of a child in the custody of the commissioner, the commissioner, the commissioner's designee, a superintendent or assistant superintendent or, when the child is in transit between department facilities, a designee of the commissioner, may authorize, on the advice of a physician licensed to practice in the state, medical treatment, including surgery, to insure the continued good health or life of the child. . . .'' (Emphasis added.)

         As the statute does not define the phrase ‘‘medical treatment, '' in accordance with General Statutes § 1-1 (a), we look to the common understanding expressed in dictionaries in order to afford the term its ordinary meaning. See, e.g., Standard Oil of Connecticut, Inc. v. Administrator, Unemployment Compensation Act, 320 Conn. 611, 645, 134 A.3d 581 (2016). The American Heritage College Dictionary (4th Ed. 2007) defines ‘‘treatment'' as the ‘‘[a]dministration or application of remedies to a patient for a disease or injury . . . .'' (Emphasis added.) Similarly, Black's Law Dictionary (4th Ed. 1968) defines the word ‘‘treatment'' as ‘‘[a] broad term covering all the steps taken to effect a cure of an injury or disease; the word including examination and diagnosis as well as application of remedies.'' (Emphasis added.) These definitions, and particularly their focus on remedies, [6] make clear that the phrase ‘‘medical treatment'' in § 17a-10 (c) contemplates the cure of an existing illness, injury, or disease.

         The commissioner, however, relies on other definitions of ‘‘treatment'' that include the ‘‘mitigation'' of a disease or illness. See The American Heritage Dictionary of the English Language (5th Ed. 2011) (defining ‘‘treatment'' as ‘‘[t]he use of an agent, procedure, or regimen, such as a drug, surgery, or exercise, in an attempt to cure or mitigate a disease, condition, or injury''). The definition of ‘‘mitigate, '' however, is to ‘‘make or become milder, less severe, less rigorous or less painful . . . .'' Webster's New World Dictionary (2d Ed. 1972). Thus, the commissioner's contention that the phrase ‘‘medical treatment'' includes vaccinations because they ‘‘mitigate'' against the possibility of contracting a disease does not comport with the plain meaning of the word ‘‘mitigate'' because the definition of that term contemplates addressing a presently existing condition. Put differently, one cannot mitigate an ailment that may or may not arise in the future.

         Ambiguity arises, however, because the plain meaning of ‘‘medical treatment'' with respect to vaccinations conflicts with the subsequent phrase in § 17a-10 (c), namely, to ‘‘insure the continued good health or life of the child.'' The phrase ‘‘continued good health'' reasonably may be read to suggest that the commissioner may seek preventive ‘‘medical treatment'' for a healthy child in her custody. This contrasts with the plain meaning of ‘‘medical treatment, '' which requires an existing illness to trigger the ...


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