Neonatal Drug-Exposure and Refusal of Medically Necessary Testing Support EPS Probable Cause; Treatment-Plan Challenges, IAC Claims, and Guardianship Alternatives Must Be Properly Preserved

1. Introduction

Matter: In the Matter of R.T.C. and R.J.C., Youths in Need of Care (2025 MT 301N).
Court: Supreme Court of Montana (memorandum opinion; noncitable and nonprecedential under the Court’s Internal Operating Rules).
Parties: Mother and Father (appellants) vs. Montana Department of Public Health and Human Services, Child and Family Services Division (the Department) (appellee).
Orders appealed: Termination of both parents’ rights to two children under § 41-3-609(1)(f), MCA.

The case arose from two separate births (March 2023 and August 2024) involving allegations of prenatal drug exposure, neonatal respiratory distress, withdrawal symptoms requiring NICU care, and parental refusal/obstruction of medical testing and care. The central appellate disputes focused on (1) whether probable cause supported emergency removal at the show-cause/EPS stage, (2) whether Father’s treatment plan was appropriate, (3) whether Father received ineffective assistance of counsel and/or was denied due process in self-representation, and (4) whether the District Court should have considered guardianship as an alternative to termination.

2. Summary of the Opinion

The Supreme Court of Montana affirmed the District Court’s termination orders as to both children. The Court held that the record supported probable cause for emergency protection and removal, that the parents failed to complete treatment plans, that Father did not establish ineffective assistance of counsel (including prejudice), that allowing Father to proceed pro se was not error on this record, and that the guardianship argument was unpreserved because it was not raised in the District Court.

3. Analysis

3.1. Precedents Cited

In re A.B., 2020 MT 64 and In re D.F., 2007 MT 147: The Court relied on these authorities for the appellate framework—termination decisions are reviewed for abuse of discretion, with underlying factual findings reviewed for clear error. This posture is crucial in termination cases because it limits reversal to situations where the trial court’s decision lacks evidentiary support or rests on a mistaken view of the law.
In re A.M.G., 2022 MT 175: Cited for the principle that the evidence is viewed “in the light most favorable to the prevailing party.” This reinforced the Court’s willingness to uphold the District Court’s determinations where the record contained substantial evidence of risk and noncompliance.
State v. Ward, 2020 MT 36: Provided the review standard for ineffective assistance claims—mixed questions reviewed de novo. The Court used this standard alongside dependency/termination-specific authority on prejudice.
In re A.D.B., 2013 MT 167: This was the opinion’s centerpiece for ineffective assistance doctrine in termination proceedings. The Court quoted In re A.D.B. for two propositions: (1) due process under Article II, Section 17 includes a right to effective assistance of counsel in termination cases, and (2) ineffective assistance claims “cannot succeed” without a showing of prejudice. The Court applied that prejudice requirement to reject Father’s IAC allegations.
In re T.E., 2002 MT 195 and In re D.H., 2001 MT 200: These cases controlled the issue-preservation ruling. The Court reiterated that issues raised for the first time on appeal will not be considered. Applying In re D.H. (where parents likewise argued a less restrictive alternative only on appeal), the Court declined to address Father’s guardianship-as-an-alternative argument.

3.2. Legal Reasoning

A. Probable cause for emergency protection/removal

Both parents challenged the Department’s initial and subsequent emergency actions, arguing the Department lacked probable cause to believe the children were in “immediate or apparent danger” such that removal was necessary. The Court upheld probable cause findings based on a combination of facts that, in its view, established risk to newborn health and safety:

For R.T.C.: the Court emphasized Mother’s drug exposure evidence (including a positive pregnancy-period test), the newborn’s respiratory complications and withdrawal-type symptoms necessitating NICU care, and the parents’ resistance to medically relevant testing. Even assuming arguendo that some hospital-collected maternal testing should be excluded, the Court concluded the remaining evidence still supported probable cause.
For R.J.C.: the Court highlighted that the District Court found probable cause “even without the drug test evidence” because Mother and Father refused consent for medical testing while the newborn exhibited respiratory issues, thereby endangering the child by obstructing appropriate diagnosis and treatment. The Court also relied on the parents’ history—termination proceedings for the older sibling, ordered substance evaluations, Father’s admission of drug use, and the parents’ failure to comply with testing and treatment recommendations.

A key throughline is that the Court treated refusal of medically necessary testing/care during acute neonatal distress as independently probative of endangerment at the EPS stage—especially when paired with indicia of prenatal drug exposure and a pattern of noncompliance.

B. Termination under § 41-3-609(1)(f), MCA and treatment-plan noncompliance

The Court characterized termination under § 41-3-609(1)(f), MCA as “controlled by settled law,” and then focused on the evidentiary record that both parents failed to complete “nearly every treatment plan task.” The opinion lists noncompliance markers: inconsistent visits, refusal of drug testing, failure to implement parenting skills, failure to obtain mental health evaluations, and failure to maintain contact with the Department.

The Court also rejected post-hoc attacks on the plans’ appropriateness:

Mother: claimed the plan was inappropriate for not addressing domestic violence. The Court reasoned domestic violence concerns arose more than a year after plan approval and that Mother had not shown meaningful improvement; adding tasks could reasonably be viewed as futile.
Father: argued drug testing was inappropriate because nothing suggested he had a drug problem. The Court pointed to risk created by drug use in the home (newborn with drugs in system; cohabitation with Mother) and noted that Father had previously participated in plan approval and later admitted drug use during evaluation. The District Court had also revisited the plan on Father’s request and again found it appropriate.

C. Ineffective assistance of counsel (Father)

Applying State v. Ward, 2020 MT 36 (standard of review) and In re A.D.B., 2013 MT 167 (right to effective counsel plus prejudice requirement), the Court rejected Father’s IAC claims. Two points drove the holding:

No viable missed objection: Father’s treatment plan had already been litigated and reconsidered; counsel lacked a sound basis to re-raise the same objection yet again.
No demonstrated prejudice from counsel’s conduct at the termination hearing: Father did not appear; counsel advised he could not ethically advance arguments without Father present. The Court concluded Father failed to identify evidence or a defensible opposition counsel could have presented in his absence. The opinion’s footnote further undermines Father’s proposed “medical negligence” theory by emphasizing that even if meconium ingestion could have been prevented, it would not eliminate prenatal drug exposure or the parents’ conduct in resisting testing and care.

D. Self-representation and due process (Father)

Father argued the District Court erred by permitting him to proceed pro se because his waiver of counsel was not knowingly, voluntarily, and intelligently made. The Court rejected this, relying on the record of two representation hearings and the trial court’s repeated warnings (including that self-representation was ill-advised and a “fool’s errand”), as well as counsel’s on-record explanation that Father was ill-equipped and did not understand evidentiary requirements. Although the Court “generally caution[s] against permitting parents to engage in self-representation,” it held the District Court did not err on these facts because Father adamantly insisted on representing himself after being warned.

E. Guardianship as a less restrictive alternative

The Court refused to consider Father’s guardianship argument because it was not raised below, invoking In re T.E., 2002 MT 195 and In re D.H., 2001 MT 200. The practical lesson is procedural: arguments about less restrictive alternatives must be timely presented to the trial court to be reviewable on appeal.

3.3. Impact

Although the decision is expressly designated nonprecedential, it illustrates how the Montana Supreme Court applies established termination and EPS principles to a fact pattern involving neonatal distress and suspected prenatal drug exposure. Likely practical effects include:

EPS probable cause: resistance to medically necessary testing during a newborn medical crisis may be treated as an independent basis supporting probable cause, especially when paired with other risk indicators.
Treatment plan litigation strategy: objections to plan tasks should be raised at the plan hearing; stipulations and later reconsiderations make subsequent attacks difficult.
IAC framing in termination cases: allegations must identify what counsel should have done and how it would have changed the outcome (prejudice), not merely assert dissatisfaction or absence from hearings.
Issue preservation: if a parent seeks a less restrictive alternative (e.g., guardianship), it must be proposed and developed in the district court record.

4. Complex Concepts Simplified

Youth in Need of Care (YINC): a legal status finding that a child has been abused, neglected, or is otherwise in need of the court’s protection and state intervention.
Emergency Protective Services (EPS) / show cause stage: early proceedings where the court decides whether there is sufficient basis to keep a child in protective custody. The focus is on immediate safety and risk.
Probable cause (in this context): not proof beyond a reasonable doubt; it is a practical, common-sense standard asking whether there is a fair probability the child is abused/neglected and needs emergency protection.
Treatment plan: a court-ordered set of tasks (e.g., evaluations, testing, services) designed to address the conditions that led to state intervention and to facilitate reunification if safely possible.
Termination under § 41-3-609(1)(f), MCA: a statutory route to termination commonly tied to adjudication, an appropriate court-approved treatment plan, and failure to successfully complete the plan within the relevant timeframes/standards.
Abuse of discretion vs. clear error: “abuse of discretion” reviews the trial court’s ultimate decision for reasonableness; “clear error” reviews factual findings to see if they are unsupported or mistaken.
Ineffective assistance of counsel (IAC) and prejudice: even if counsel performed deficiently, the parent must show the deficiency likely affected the outcome.
Issue preservation: appellate courts generally review only issues raised in the trial court, ensuring fairness and a developed factual record.

5. Conclusion

Matter of R.T.C. and R.J.C. affirms termination orders by applying settled Montana law to a record of neonatal medical distress, suspected prenatal drug exposure, and sustained parental noncompliance with treatment plans. The opinion underscores three practical principles: (1) probable cause for emergency protection may be supported by a parent’s obstruction of medically necessary care during a newborn crisis; (2) treatment plan appropriateness challenges are weakest after stipulation and repeated judicial review, particularly where risk drivers remain unaddressed; and (3) appellate relief is constrained by prejudice requirements for IAC claims and by strict issue-preservation rules, including for proposed guardianship alternatives.