Introduction

This memorandum decision from the Supreme Court of Appeals of West Virginia affirms the termination of parental rights of Petitioner Father D.E. and Petitioner Mother K.B. to their nineteen-month-old child, N.E. The case arises from allegations of neglect, with a particular focus on medical neglect of a medically complex infant and the parents’ failure to engage meaningfully in the child’s medical care and visitation during post-adjudicatory improvement periods.

The central legal questions were whether the circuit court erred by (1) denying the parents’ motions to extend their court-ordered improvement periods and (2) terminating parental rights. The Supreme Court held that the circuit court acted within its discretion in denying an extension because the parents showed only “moderate compliance,” not “substantial compliance,” and that termination was proper given the absence of a reasonable likelihood of improvement in the near future and the child’s best interests.

Although issued as a memorandum decision, the opinion reinforces a critical practical rule in West Virginia abuse and neglect proceedings: in cases involving medically fragile children, “substantial compliance” under West Virginia Code § 49-4-610(6) requires meaningful engagement with and implementation of medical care and parenting skills, not mere attendance or box-checking. Moderate compliance—especially where caregivers fail to internalize and apply training to meet a child’s specific medical needs—does not require extension of improvement periods and can support termination.

Summary of the Opinion

• Facts and adjudication: DHS alleged homelessness, drug abuse, and severe medical neglect of an eleven-month-old with multiple diagnoses (plagiocephaly, curved spine, torticollis, right hemidiaphragm paralysis; “dented” ribs from prolonged positioning). Parents admitted housing and drug issues (mother) but denied medical neglect. The circuit court adjudicated both parents as neglecting, including on medical neglect.
• Improvement periods and reviews: The court granted six-month post-adjudicatory improvement periods with requirements including drug screening, parenting/adult life skills, visitation, suitable housing, and meaningful participation in the child’s medical appointments. Over successive reviews, DHS reported “moderate compliance,” noting minimal hospital visitation during a life-threatening hospitalization, missed medical appointments, and failures during visits to provide appropriate care.
• Dispositional hearing: Despite participation in services, evidence showed the parents failed to implement skills, continued behaviors harmful to a child with respiratory vulnerabilities (smoking; leaving cannabis devices within reach; leaving the toddler alone to smoke), and the father engaged in verbal/emotional abuse during visits. The service provider reported minimal or no bond. The circuit court denied extension, found no reasonable likelihood of substantial correction, and terminated parental rights; permanency plan: adoption.
• Supreme Court holding: Affirmed. Under § 49-4-610(6), extension requires substantial compliance; “moderate compliance” is insufficient, particularly where parents fail to meaningfully participate in medical appointments and visits. Termination was supported by statutory criteria under § 49-4-604(d)(3) and (c)(6), especially given the parents’ refusal to acknowledge medical neglect and inability to implement care for a medically fragile child.

Analysis

Precedents Cited and Their Influence

• In re Cecil T., 228 W. Va. 89, 717 S.E.2d 873 (2011): Cited for the standard of review—clear error for factual findings and de novo for conclusions of law (Syl. Pt. 1). This frames the appellate posture: the circuit court’s on-the-ground determinations (e.g., credibility, compliance level, bond) receive deference.
• In re Jonathan Michael D., 194 W. Va. 20, 459 S.E.2d 131 (1995): Emphasizes that a parent can comply with “specific aspects of the case plan” while failing to improve their overall parenting approach. The Court relied on this to reject the argument that attendance at services, drug screens, and evaluations equated to remediating neglect, underscoring substance over form.
• In re Timber M., 231 W. Va. 44, 743 S.E.2d 352 (2013): Establishes that failure to acknowledge the problem renders it untreatable. The court applied this principle to the parents’ continued denial of medical neglect and their minimization of the child’s specific needs, supporting the finding that improvement in the near future was unlikely.
• Statutes:
  • W. Va. Code § 49-4-610(6): Courts may extend improvement periods upon findings of substantial compliance. The permissive “may” confers discretion; the parents’ “moderate compliance” fell short.
  • W. Va. Code § 49-4-604(d)(3): “No reasonable likelihood” includes failing to respond to or follow through with reasonable family case plans or other rehabilitative efforts, including medical. The parents’ failure to attend appointments, implement training, and acknowledge medical neglect met this definition.
  • W. Va. Code § 49-4-604(c)(6): Authorizes termination upon findings of “no reasonable likelihood” and best interests. Both were satisfied.

Legal Reasoning

The Court’s reasoning proceeded in two major steps: the discretionary denial of an extension to the improvement period and the propriety of termination.

1. Extension of improvement period:
   • Statutory threshold: § 49-4-610(6) requires substantial compliance; it does not mandate extension upon partial or moderate compliance. The parents’ compliance was found “moderate,” principally because they failed to meet two critical case-plan conditions—meaningful participation in the child’s medical appointments and meaningful participation in visitation.
   • Evidence of noncompliance going to the heart of neglect:
     • Minimal hospital visitation during a near-fatal admission, despite DHS offering unlimited access and transportation.
     • Seven missed medical appointments; inability to identify the child’s diagnoses, medications, or special care needs.
     • Failure to implement parenting instruction during visits (e.g., not addressing illness symptoms, unsafe exposure to smoke, leaving cannabis devices within reach, leaving child unattended).
   • Given this record, the circuit court’s “moderate compliance” finding was supported, and its decision to deny an extension was within its discretion.
2. Termination of parental rights:
   • The parents’ participation in services did not translate into improved parenting sufficient to meet the child’s needs (Jonathan Michael D.). In particular, their inability to implement skills for a medically complex child was decisive.
   • Continued denial of medical neglect and minimization of the child’s health needs rendered the problem “untreatable” (Timber M.), supporting the finding of no reasonable likelihood of correction in the near future (§ 49-4-604[d][3]).
   • Additional best-interest evidence included the father’s verbal/emotional abuse during visits, minimal/no bond, and ongoing decisions inconsistent with the child’s respiratory vulnerabilities (continued smoking and exposure).
   • Accordingly, termination was authorized under § 49-4-604(c)(6) and aligned with the child’s best interests and permanency needs (adoption in current placement).

Impact and Practical Significance

While the Court did not announce a new rule of law (as reflected in its use of a memorandum decision), In re N.E. clarifies and reinforces several practice-critical principles likely to influence how abuse and neglect cases—especially those involving medically fragile children—are litigated and managed:

• Substantial compliance is substantive, not formalistic: Attendance at services, negative screens, and paperwork completion will not suffice without demonstrated ability to implement skills in real time to meet the child’s specific needs.
• “Meaningful participation” has teeth in medically complex cases: Courts will scrutinize whether parents engage with and learn from medical appointments—understanding diagnoses, therapies, medications, and day-to-day care requirements—and whether they apply that knowledge during visits.
• Denial and minimization can be dispositive: Persistent refusal to acknowledge medical neglect or to appreciate the gravity of a child’s diagnoses can establish that problems are not amenable to correction in the near term, supporting termination.
• Cannabis use is context-sensitive: Although DHS indicated that cannabis positives would not be disqualifying if not interfering with parenting, use that creates respiratory risk or safety hazards (e.g., smoke exposure, accessible paraphernalia) can evidence ongoing neglect and failure to implement instruction.
• Visitation quality matters as much as quantity: Verbal/emotional abuse, inability to soothe or provide routine care, and failure to respond to illness symptoms during visits undercut claims of progress and bonding and support reductions in visitation and ultimate termination.
• Case planning implications: Agencies and counsel should ensure case plans for medically fragile children include:
  • Clear attendance expectations for all medical appointments, with transportation supports;
  • Hands-on training in medication administration and symptom response;
  • Documentation of parents’ ability to articulate diagnoses and care plans;
  • Visit coaching focused on real-time implementation of medical and developmental care.
• Appellate posture: The decision underscores deference to circuit courts on compliance findings and credibility assessments in complex neglect cases.

Complex Concepts Simplified

• Improvement Period: A court-ordered period during which parents receive services and supports to correct conditions of abuse or neglect. Progress is measured not only by participation but by improvement in parenting capacity.
• Substantial vs. Moderate Compliance: “Substantial” means meaningful adherence to the plan’s core requirements in a way that remedially addresses neglect; “moderate” suggests partial compliance or box-checking without real change. Only substantial compliance may justify extending the improvement period, and even then extension is discretionary.
• Meaningful Participation: Not mere attendance. It requires understanding and applying what is taught—e.g., learning diagnoses, administering medication, recognizing symptoms, and adjusting care accordingly.
• No Reasonable Likelihood of Substantial Correction: A statutory finding that, despite services, the parent is not correcting the conditions of neglect in the near future. It can be based on failure to follow through with rehabilitative efforts or persistent denial of the problem.
• Best Interests of the Child: The overriding standard guiding dispositional decisions; for medically fragile children, stability, safety, adequate medical care, and attentive, informed day-to-day caretaking are paramount.
• Memorandum Decision: An appellate disposition used when no new point of law is announced. It applies existing law to the facts and typically lacks syllabus points, but it still provides persuasive guidance on how the Court applies established standards.

Case Details and Procedural Timeline

• Parties: Petitioner Father D.E.; Petitioner Mother K.B.; West Virginia Department of Human Services (DHS); child N.E.; Guardian ad litem: Juston H. Moore.
• Allegations (August 2023): Homelessness; impairing drug use; severe medical neglect of an 11-month-old with significant diagnoses attributed by physicians to prolonged positional neglect; missed appointments and therapies.
• Adjudication (September 2023): Mother admitted unsuitable housing and drug impairment; father admitted unsuitable housing; both denied medical neglect. Court adjudicated both as neglecting, including on medical neglect.
• Improvement Period (November 2023): Six months; terms included drug screens, parenting and adult life skills, attendance at medical appointments, visitation, housing, and parental evaluations.
• First Review (January 2024): “Moderate compliance”; minimal hospital visitation during life-threatening hospitalization.
• Second Review (March 2024): “Moderate compliance”; seven missed medical appointments; early termination of visits when the child was unwell without providing care.
• Dispositional Hearing (May 2024): Evidence of failure to implement parenting skills; unsafe smoke exposure and accessible cannabis; father’s verbal abuse; minimal/no bond; parents could not articulate diagnoses or special care needs. Requests for extension denied; parental rights terminated; plan of adoption.
• Appeal: Parents argued for extension due to participation in services and general compliance. Supreme Court affirmed denial of extension and termination (September 10, 2025).

Practice Pointers

• For parents’ counsel: Encourage clients to do more than attend—prepare them to discuss the child’s diagnoses, medications (names, dosing, indications), therapies, and day-to-day care, and to demonstrate these during visits. Address denial head-on; acknowledgment is often a precondition to meaningful change.
• For DHS and service providers: Build documentation that distinguishes attendance from implementation. Record parents’ ability to articulate diagnoses, steps taken during child illness, medication administration competence, and smoke-free compliance for respiratory conditions.
• On substance use (including medical cannabis): Emphasize safe storage, no smoke exposure (especially with respiratory diagnoses), and no impairment during visits. Document olfactory smoke exposure and access to devices.
• Visitation coaching: Target soothing skills, responsive caregiving for illness, and safe routines (mealtime, bathtime) and document improvements or lack thereof.
• Extension motions: Be prepared to show “substantial compliance” with the plan’s core objectives, not just peripheral tasks; link competencies to the specific risks that led to adjudication.

Conclusion

In re N.E. underscores that in West Virginia abuse and neglect proceedings, especially those involving medically fragile children, meaningful engagement with the child’s medical care and demonstrable implementation of parenting instruction lie at the heart of “substantial compliance.” The Court affirmed that:

• Moderate compliance—marked by missed medical appointments, failure to visit meaningfully during crisis, and inability to implement learned skills—does not entitle parents to extensions of improvement periods.
• Partial participation in services cannot substitute for genuine remediation of the conditions of neglect (Jonathan Michael D.).
• Persistent denial of medical neglect renders the issues effectively untreatable, supporting a finding of no reasonable likelihood of correction in the near future (Timber M.).
• Termination is appropriate under § 49-4-604 where the parent fails to follow through with a reasonable case plan and where the child’s best interests demand stable and informed care.

Although styled as a memorandum decision, the opinion offers powerful guidance: courts will privilege the child’s safety and medical stability over checklist compliance, and “substantial compliance” will be measured by a parent’s real-world ability to meet the child’s specific needs. For practitioners, it is a roadmap for designing, documenting, and litigating case plans in medically complex neglect cases.