In the Interest of L.S., Minor Child

IN THE COURT OF APPEALS OF IOWA

No. 24-1738
Filed March 5, 2025

IN THE INTEREST OF L.S.,
Minor Child,

A.F., Mother,
Appellant.
________________________________________________________________

Appeal from the Iowa District Court for Linn County, Carrie K. Bryner,

Judge.

The mother appeals the termination of her parental rights. AFFIRMED.

David R. Fiester, Cedar Rapids, for appellant mother.

Brenna Bird, Attorney General, and Mackenzie Moran, Assistant Attorney

General, for appellee State.

Julie F. Trachta of Linn County Advocate, Cedar Rapids, attorney and

guardian ad litem for minor child.

Considered by Greer, P.J., and Langholz and Sandy, JJ.
2

GREER, Presiding Judge.

The juvenile court terminated the mother’s parental rights to L.S., born in

2019, pursuant to Iowa Code section 232.116(1)(f) (2024).1 On appeal, the mother

challenges the juvenile court’s conclusion the statutory ground was proved,

arguing L.S. could have been returned to her custody at the time of the termination

trial or, alternatively, that the Iowa Department of Health and Human Services (the

department) failed to make reasonable efforts at reunifying her with the child. She

also argues that the loss of her rights is not in the child’s best interests because of

the bond the two share.2

I. Background Facts and Proceedings.

The department became involved with this family in March 2023 after it was

alleged the mother was seen on video injecting L.S.’s younger sibling, M.S., with

unprescribed insulin while he was a patient in the hospital. At the time, the mother

and father were no longer in a relationship; the mother was the children’s main

caregiver, though L.S. and the father sometimes spent weekends together.

Based on the allegations against the mother, L.S. was removed from her

care and custody; the child remained in the father’s custody and was placed in his

1 In separate proceedings, the juvenile court also terminated the mother’s parental

rights to L.S.’s sibling, M.S. The juvenile court held separate termination trials and
issued termination orders at different times. The mother appealed the termination
of her rights to each child. We also file a ruling regarding the mother’s rights to
M.S. today. See In re M.S., No. 24-1688, 2025 WL _____, at *_ (Iowa Ct. App.
Mar. 5, 2025).
2 The State never sought to terminate the father’s parental rights; L.S. remained in

the father’s care and custody at the time of the termination trial (with department
supervision).
3

care subject to department supervision.3 The mother consented to L.S.’s

continued removal from her care and for the child to be adjudicated in need of

assistance (CINA).

The department eventually entered a founded child abuse report against

the mother regarding the injection of insulin. Separately, the mother was criminally

charged with two felonies: child endangerment causing serious injury and

administering harmful substances.4 According to the department’s social

investigation report assessment:

The team of doctors and social workers reviewed the
[mother’s] questions. All medical professionals present at this
meeting stated that none of these concerns, presented by [the
mother], would explain the high insulin levels and the corresponding
undetectable C-peptides. They all agreed that the[] only way for
[M.S.] to have the insulin and C-peptide levels that he had, was for
someone to be giving him an outside source of insulin.
They explained that Insulin and C-peptides go hand in hand.
They explained that it [is] like taking a stick and breaking it in half.
One of the halves would be insulin—the other would be C-peptide.
Basically, the levels should almost be at a one to one ratio. [M.S.’s]
levels were way off. The diagnosis that they have given is Fictitious
Hypoglycemia. The team also believes that [M.S.] received multiple
doses of insulin to be affected as he was. They believe that they can
confirm that exogenous insulin was given to [him]. The person that
had access to him at most times was his mother. They also stated
that a nurse found an insulin pen in [M.S.’s] bed on level 10—after
he had been transferred to the PICU [when he experienced the
hypoglycemic reaction]. The nurse stated that when the nurse asked
what it was, [the mother] claimed that it was hers. [M.S.] has two
medications that come in a pen. He has a Gvoke and his HGH that
come in a pen. However, the description of the pen does not match
what the nurse found in [M.S.’s] bed.

3 The father informed the department that he was unable to provide M.S.’s care

because of the child’s special needs. M.S. was removed from both parent’s
custody and care and, eventually, placed with a foster family.
4 As of the termination trial in June 2024, the mother’s criminal charges were still

pending. The mother testified she also challenged the child abuse report, which
was also still pending.
4

When the mother was questioned by an investigative social worker and by local

police officers, she told inconsistent versions of what took place. At various times,

the mother denied giving M.S. any injection, admitted giving him an injection of a

prescribed steroid rather than insulin, claimed she was using water to flush M.S.’s

feeding tube, and stated she was taking M.S.’s rectal temperature.

The mother participated in fully supervised visits with L.S. until they were

temporarily suspended in October after L.S. returned from a visit with a medical

syringe (without a needle) and medical grade lubricant. Visits resumed for a short

window but were held in the community rather than the mother’s home.

Then, in the lead up to the permanency review hearing, the GAL filed a

report raising concerns about the mother’s continued involvement with L.S. In the

GAL’s November 1 statement to the court, she stated:

[L.S.’s] play therapist reports she is very concerned about [L.S.’s]
emotional and mental well-being, and the impact ongoing contact
with [the mother] is having on her. When visits with [the mother and
L.S.] were suspended for three weeks, [L.S.] was noted to be calmer
and more well-adjusted. When visits resumed, she immediately
displayed acting out behaviors. Even with a provider and nurse
present, there continue to be concerns during visits. The children
are giving direct signs of their discomfort during visits and
interactions with [the mother]. It is not in their best interest to
continue to force them to have interactions with [the mother].

In its November 3 permanency review order, the juvenile court temporarily

suspended the mother’s visits with L.S. pending a later contested hearing.

The contested hearing took place on December 11 and 18.5 In its written

ruling, the court suspended the mother’s visits, concluding they were “clearly

harmful to the children.” The court explained:

5 We do not have a transcript of this proceeding.
5

Visits between the mother and the children have remained
fully supervised throughout this case. Visits were suspended in the
fall for approximately three weeks after [L.S.] had brought a medical
syringe and a tube of medical grade lubricant home from her
mother’s house after a visit. Thereafter, visits have been in the
community or the provider office. On November 2, 2023, the Court
again suspended visits pending contested hearing due to concerns
for the children’s physical, mental and emotional health. [The
daycare director] where [L.S.] attends daycare, testified that [L.S.’s]
behaviors changed after visits with her mother resumed. [L.S.] was
exhibiting disruptive behavior, was obstinate, and was not sleeping
during naps. [L.S.] was also having accidents (not making it to the
bathroom) when visits were occurring. It would take her two to three
days to regulate once she had a visit. [The daycare director] noted
that since the visits have been suspended again, her behaviors have
stopped. In fact, the day after visits were suspended, [L.S.] slept
through her nap and was cooperative the whole week. [L.S.] had
also told her in October that she didn’t see her mom all the time
because her mom had hurt her and her brother and it “made her sad.”
[L.S.’s] play therapist, Kim Korte, testified that she has been
seeing [L.S.] weekly since August. She unequivocally recommended
that visits between [L.S.] and her mother stop at this time. She noted
that in sessions, [L.S.] can become quite distressed exhibiting
trauma responses and is either numb or hyper and silly. She has
displayed avoidance, emotional dysregulation, high anxiety and high
stress. [L.S.] has a pattern of “feeding” baby dolls with a bottle that
she says is hot sauce, pee and poo, then says it’s a “secret” and
shuts down. On one occasion, [L.S.] said that her mom hurt her
brother, then shut down and wanted to end the session. Ms. Korte
saw a lot of distress and emotional dysregulation at that time.
Notably, she has noted a change in [L.S.] since visits have been
suspended again. She testified that [L.S.] is now calm and regulated
and has been very happy and bright. Ms. Korte recommends that
[L.S.] be allowed the opportunity to work through her trauma without
visits so that she is not further traumatized until she has processed
the trauma. She believes that the mother needs to be in therapy at
the same time so that she will then be able to provide [L.S.] what she
needs emotionally and physically. Ms. Korte recommended that
once [L.S.] has addressed her trauma, therapy with mom should
occur to ensure that she is ready to meet [L.S.’s] needs, then they
should begin family therapy. It would be detrimental to force [L.S.]
to have visits at the time and would damage her trust in adults. [L.S.]
cannot heal if she doesn’t feel safe.
[The department case manager] testified that at a visit she
attended, mom was very controlling and wouldn’t let [M.S.] be
interactive. She noted [M.S.] had a very flat affect with his mom. It
was very concerning to her that the mother chose to feed [M.S.] a
6

hot dog when it was not on the list of foods that he could have
especially given that his diet was very “liquid-y” at the time with only
pureed foods being given. [The case manager] testified that the
mother also interferes with the child’s physical therapy and
occupational therapy appointments. The mother checks [M.S.’s] “my
Chart” [online medical chart] multiple times a day and thinks that the
doctors are withholding information from her. Further, the mother
has scheduled both children for medical appointments and tests that
have been unnecessary.
[The case manager] also relayed an interaction she had with
[L.S.] in which [L.S.] threw a [Care Bear] against a wall stating,
“mommy [mother’s name] hurts babies.” After visits were suspended
then reinstated, the mother was not allowed to take [L.S.] to the
bathroom alone after [L.S.] stated that her mother wiped her too hard
and she was sore in her private area. [The case manager]
recommended that the mother’s visits remain suspended and also
testified that [M.S.] is blossoming since visits have been suspended.
The mother also testified. The Court found the mother had an
answer for all of the concerns that had been brought forth but did not
find these explanations to be believable. In fact, the Court is very
concerned that the mother has absolutely no insight into the
concerns presented. The actions of the mother in many instances
have put her children in danger, especially [M.S.] who has many
special needs. It appears to the Court that the mother seeks
attention through her medical needs and those of her children,
whether real issues or those brought to medical professionals solely
by mother’s report. She is placing her children in danger through
those actions as well as the behavior described by [the case
manager] and alluded to by [L.S.] in daycare and in therapy sessions.
Most important, the testimony by Ms. Korte and [the daycare director]
was incredibly persuasive in determining that [L.S.] is experiencing
emotional and mental harm from visits with her mother.

Visits remained suspended through the termination trial, which took place on

June 4 and 5, 2024.

At trial, the mother continued to maintain she never injected M.S. with

insulin. And she asserted the case was a mistake and that she had not done

anything that would require the department and juvenile court to be involved with

the family. The mother testified that she completed mental-health and

psychological evaluations, as required by the court, and attended therapy. She
7

was “working on the emotion effect that this case has played.” But, because she

consistently denied harming her children, she was not addressing the department’s

underlying concerns in therapy.

L.S.’s therapist, Kim Korte, also testified at trial. Korte had been providing

therapy for L.S. since August 2023 for a total of thirty-two sessions. Korte

explained the positive changes she witnessed in L.S. since visits with the mother

were suspended, testifying:

So she is more regulated. She is less avoidant and can
tolerate talking about her past, talking about feelings. She can
tolerate talking about mom, talking about her past, without having to
stop the play or stop our conversation, ignoring me. She’ll actually,
on her own, bring up mom or brother [M.S.] so she can be present in
my office. We can talk and we can play. She’s appropriate, she
doesn’t show signs of distress when those things are brought up.

While L.S. had made positive progress, the therapist recommended that visits with

the mother not restart:

[L.S.] continues to have that conflicting message of why would a
mom be mean? And so she’s very stuck there, and that leads me to
believe that she would not feel safe, because she’s still conflicted
and still scared of being hurt or being in a situation where she would
be unsafe, or her brother would be unsafe.

The juvenile court issued its written termination order in October 2024,

granting the petition to terminate the mother’s parental rights to L.S. under Iowa

Code section 232.116(1)(f) (2024). The court ruled:

The main concern throughout this case was the emotional
trauma and abuse [L.S.] endured while in the care of her mother.
[The case manager] testified that she met with [L.S.] monthly, and
each month [L.S.] opened up more to her. At one visit, [L.S.] told her
the “Mommy [mother’s name] hurts babies.” She was playing with
her dollhouse and her [Care Bears] at the time. When she made that
statement, she threw a [Care Bear] that she identified as “Mommy
[mother’s name]” against the wall. At another visit, [L.S.] told her that
Mommy [mother’s name] hurt M.S. As [L.S.] got more comfortable
8

with [the case manager], [L.S.] told her that “[mother’s name]” hurt
her and M.S. It was notable to [the case manager] that [L.S.]
changed from addressing her mother as Mommy [mother’s name] to
[mother’s name]. [The case manager] testified that she believed that
[L.S.] became more open and more comfortable due to finally feeling
safe.
[The case manager] also testified that [L.S.] had told her that
her mother made her stay in a crib. [L.S.] was given an iPad to keep
her busy but was told that she had to stay in the crib. [The case
manager] testified that she was concerned that this occurred at an
age that [L.S.] could remember that it occurred and that she was
traumatized from the incident. She was also very concerned that
[L.S.’s] needs were not being met at that time.
....
Throughout [the mother’s] testimony, she did not
acknowledge any of the fears her daughter had nor that she had
created any trauma to [L.S.] through her actions. In fact, she testified
about what a close relationship they had. [The mother] exhibited a
flat affect at times but also appeared to be acting as the victim many
times. She gave different versions of events and was not credible
due to the many discrepancies and changes in her stories. The
Court does not believe that this mother is a victim, rather her
daughter is the victim of her serious mental health issues that have
caused [L.S.] mental and emotional harm.
....
[L.S.] remains in the care and custody of her father. She is
thriving and is a different child than when the case first opened due
to feeling safe and no longer experiencing any abuse or trauma. She
sees her brother frequently and is bonded with him. That relationship
should continue as it is important to both children.

The mother appeals.

II. Standard of Review.

“In termination-of-parental-rights cases, we review the proceedings de

novo.” In re R.M.-V., 13 N.W.3d 620, 624 (Iowa Ct. App. 2024) (citation omitted).

“We are not bound by the juvenile court’s findings of fact, but we do give them

weight, especially in assessing the credibility of witnesses.” Id. (citation omitted).
9

III. Discussion.

The juvenile court terminated the mother’s parental rights to L.S. under

section 232.116(1)(f), which allows termination when

(1) The child is four years of age or older.
(2) The child has been adjudicated a child in need of
assistance pursuant to section 232.96.
(3) The child has been removed from the physical custody of
the child’s parents for at least twelve of the last eighteen months, or
for the last twelve consecutive months and any trial period at home
has been less than thirty days.
(4) There is clear and convincing evidence that at the present
time the child cannot be returned to the custody of the child’s parents
as provided in section 232.102.

The mother challenges only the fourth element—whether L.S. could be returned

to her custody at the time of the termination trial. See In re A.M., 843 N.W.2d

100, 111 (Iowa 2014) (interpreting “at the present time” to mean at the time of the

termination trial). As part of this challenge, the mother argues the State failed to

make reasonable efforts to return L.S. to her custody and points to the suspension

of her visits with the child. See In re C.B., 611 N.W.2d 489, 493 (Iowa 2000) (“[T]he

State must show reasonable efforts as a part of its ultimate proof the child cannot

be safely returned to the care of a parent.”); In re C.G., No. 23-1234, 2024

WL 260926, at *1 (Iowa Ct. App. Jan. 24, 2024) (recognizing that “[a]t its core, a

parent’s reasonable-efforts challenge functions as a challenge to a component of

the statutory grounds”).

We understand the mother’s “reasonable efforts” argument to be an

assertion that the court wrongly allowed the department to suspend her visits with

L.S. in November 2023, which negatively impacted her ability to reunify with the

child leading up to the termination trial. The mother resisted the department’s
10

request to suspend her visits and participated in a contested hearing on the issue.

In its November permanency order, the juvenile court determined that the

department had made reasonable efforts and listed those efforts provided. As far

as we can tell, the mother never framed the issue as involving “reasonable efforts,”

but we think she did enough to preserve error on the claim.

Still, we cannot reach the merits of the mother’s argument that the juvenile

court was wrong to suspend visits because we do not have a transcript of the

contested hearing. Without it, we cannot review the evidence upon which the

juvenile court made its decision. “If the appellant intends to argue on appeal that

a finding or conclusion is unsupported by the evidence or is contrary to the

evidence, the record on appeal must include a transcript of all evidence relevant

to such finding or conclusion.” Iowa R. App. P. 6.803(1). “It is the appellant’s duty

to provide a record on appeal affirmatively disclosing the alleged error relied upon.”

In re F.W.S., 698 N.W.2d 134, 135 (Iowa 2005). And the failure to provide the

record prevents us from deciding in the mother’s favor on this issue. See id.

at 135–36.

While bypassing the mother’s reasonable-efforts challenge, we consider

whether the State proved L.S. could not be returned to the mother’s custody at the

time of the termination trial. The mother notes that she followed court orders,

obtaining mental-health and psychological evaluations and participating in therapy

as required. She complains that, despite this, the court and the department

decided she was unsafe because she refused to admit to her treatment providers

that she injected L.S.’s sibling with insulin. She suggests this is a violation of her

constitutional right against self-incrimination. See U.S. Const. amend. V. But this
11

argument fails. First, the mother never invoked her Fifth Amendment right; she

has steadfastly maintained she did not inject M.S. with insulin (even while her

explanation of what the video shows varies). And second, even if she invoked her

Fifth Amendment right, that does not free her from the consequences that follow

for failure to take responsibility for her actions. See In re R.B., 832 N.W.2d

375, 378 (Iowa Ct. App. 2013) (“[T]he government need not make the exercise of

the Fifth Amendment privilege cost free.” (quoting McKune v. Lile, 536 U.S. 24, 41

(2002))). While “[t]he State may not penalize [the mother] for noncompliance with

a court order impinging on [her] right against self-incrimination,” “this is as far as

the Fifth Amendment privilege extends.” In re C.H., 652 N.W.2d 144, 150

(Iowa 2002). “A parent’s failure to address his or her role in the abuse may hurt

the parents’ chances of regaining custody and care of their children.” Id. “These

consequences lie outside the protective ambit of the Fifth Amendment.” Id.

(citation omitted). The mother may have been faced with a dilemma regarding

whether to speak honestly with her treatment providers, but that dilemma does not

trigger constitutional protection. See id.

While the mother attended therapy, she did not complete any treatment to

address the underlying issues that led to department’s and juvenile court’s

involvement with the family. And the concerns were not limited to M.S. but related

to safety issues over L.S.’s care. So, L.S. could not safely be returned to the

mother’s custody at the time of the termination trial. See id. at 151 (finding that

because the father “fail[ed] to complete any form of treatment, we cannot conclude

[he] has fixed his problems and is now fit as a parent”); In re H.R.K., 433 N.W.2d

46, 50 (Iowa Ct. App. 1988) (noting “the requirement that the parents acknowledge
12

and recognize the abuse before any meaningful change can occur is essential in

meeting the child’s needs”); In re E.S., No 23-0544, 2023 WL 3335326, at *2 (Iowa

Ct. App. May 10, 2023) (affirming termination of parental rights when children were

removed from father’s custody after a child protective assessment found the father

sexually abused an older half-sibling and the father “completed mental-health and

psychosexual evaluations [but] did not follow through with the recommended

intensive treatment and continued to deny the abuse occurred”).

Next, the mother argues termination of her parental rights is not in L.S.’s

best interests. In making this determination, we use the structured best-interests

framework provided in Iowa Code section 232.116(2). See In re P.L., 778 N.W.2d

33, 37 (Iowa 2010) (requiring the court to “base its best-interest determination on

the legislative requirements contained in section 232.116(2), rather than upon the

court’s own value system”); see also Iowa Code § 232.116(2) (requiring the court

to “give primary consideration to the child’s safety, to the best placement for

furthering the long-term nurturing and growth of the child, and to the physical,

mental, and emotional condition and needs of the child”). “[A] child’s safety and

his or her need for a permanent home [are] the defining elements in a child’s best

interests.” In re H.S., 805 N.W.2d 737, 748 (Iowa 2011) (citation omitted). And

we consider “the child’s long-range as well as immediate interests.” In re J.E., 723

N.W.2d 793, 798 (Iowa 2006) (citation omitted). The mother cannot provide L.S.

with the safe home that she needs and deserves. While the mother participated

in some therapy during the more than fourteen months between when L.S. was

removed from her care and the termination trial, she did not address the issues

that led to department involvement. By the time of the June 2024 termination trial,
13

the mother had not seen L.S. in approximately seven months. And by all

descriptions, L.S. was thriving outside of her mother’s care and presence.

Termination of the mother’s parental rights is in L.S.’s best interests.

Finally, the mother argues we should forego termination because there is

clear and convincing evidence that the loss of her rights would be detrimental to

L.S. due to the closeness of the parent-child relationship. See Iowa Code

§ 232.116(3)(c). The mother recognizes that the bond between her and L.S. had

suffered by the time of the June 2024 termination trial—more than six months after

visits between L.S. and the mother were suspended. But she suggests that

because those visits were wrongly suspended, we should not discount the bond

they shared earlier in L.S.’s life, when the mother was the child’s main caretaker.

As the parent resisting termination, the mother has the burden to show application

of this permissive exception is warranted. See In re A.S., 906 N.W.2d 467, 476

(Iowa 2018). And she has not done so; L.S.’s long-term needs outweigh the

hardships of termination. We decline to apply a permissive exception to save the

parent-child relationship.

We affirm the termination of the mother’s parental rights to L.S.

AFFIRMED.