In re M.S.

2023 UT App 74
THE UTAH C OURT OF APPEALS
S TATE OF U TAH , IN THE INTEREST OF M.S.,
A PERSON UNDER EIGHTEEN YEARS OF AGE.
R.S. AND J.S.,
Appellants,
v.
S TATE OF U TAH ,
Appellee.
Opinion
No. 20210657-CA
Filed July 6, 2023
Fourth District Juvenile Court, Spanish Fork Department
The Honorable F. Richards Smith
No. 1186449
Emily Adams, Sara Pfrommer, Freyja Johnson, and
Hannah Leavitt-Howell, Attorneys for Appellants
Sean D. Reyes, Carol L.C. Verdoia, and
John M. Peterson, Attorneys for Appellee
Martha Pierce, Guardian ad Litem
JUDGE GREGORY K. O RME authored this Opinion, in which
JUDGES DAVID N. M ORTENSEN and R YAN D. TENNEY concurred.
ORME, Judge:
¶1 	R.S. (Mother) and J.S. (Father) (collectively, Parents) appeal
the juvenile court’s award of temporary custody of their infant
son, M.S. (Child), to the Department of Child and Family Services
(DCFS) following a shelter hearing and the court’s later finding
that Child was neglected. We hold that Parents’ first argument is
moot but conclude that their second argument satisfies the
collateral consequences exception to mootness. And because the

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juvenile court did not make the necessary findings of fact and
conduct 	the 	required 	analysis 	of 	whether 	Parents’ 	medical
decisions for Child were “reasonable and informed,” we reverse
the court’s neglect adjudication.
BACKGROUND1
¶2 	Child was born on March 6, 2020, weighing 9.63 pounds.
During 	her 	pregnancy, 	Mother 	had 	gestational 	diabetes—a
condition which has been linked to increased birth weights.
Therefore, while not off the charts, Child’s somewhat larger birth
weight was likely caused by Mother’s gestational diabetes. Child
was also born with elevated bilirubin levels and was prescribed
photo light therapy for jaundice, which Parents administered for
the next ten days. Hospital staff informed Mother that Child
needed 	to 	be 	seen 	by 	a 	pediatrician 	three 	days 	following
discharge from the hospital. Mother complied with the instruction
and made an appointment to see a pediatrician (First Pediatrician)
at a nearby clinic on March 9.
¶3 	By the time of the appointment, Child had lost 12.5% of his
birth weight, weighing in at 8.42 pounds. First Pediatrician found
Child “to be in good health” overall, but he was concerned about
Child’s 	elevated 	bilirubin 	levels 	and 	weight 	loss. 	Although
weight loss is typically expected immediately after birth for
infants whose mothers had gestational diabetes, First Pediatrician
noted Child’s weight “to be more down than we usually would
expect at that time.” First Pediatrician recommended a follow-up
appointment “in the next day or two” to check on Child’s bilirubin
levels and weight. No such follow-up appointment took place.
1. “We recite the facts in the light most favorable to the juvenile
court findings.” In re J.M., 2020 UT App 52, n.1, 463 P.3d 66
(quotation simplified).

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¶4 	First Pediatrician saw Child again about two-and-a-half
weeks later, on March 26. Father took Child to this appointment
because Mother did not appreciate First Pediatrician’s “bedside
manner” and she did not feel that he had been “very willing to
listen to [her] concerns.” At this appointment, Child weighed in
at 7.96 pounds, which according to First Pediatrician was a total
weight loss of approximately 18% of Child’s original birth weight.
First Pediatrician told Father that because Child had lost even
more weight, he was concerned that Child was not getting
sufficient 	nutrients 	from 	Mother’s 	breast 	milk—which 	was
Child’s sole source of nourishment. First Pediatrician became
even more concerned when he learned that Child had not had a
bowel movement in three days. First Pediatrician explained that
while exclusively breast-fed babies can sometimes “go a few
days” without producing stool, this information combined with
the 	weight 	loss 	caused 	him 	to 	further 	worry 	that 	Child’s
nutritional needs were not being met.
¶5 	First Pediatrician recommended that Mother pump so that
they could quantify the amount of milk she was producing and
that Child be given formula every few hours and be weighed each
day so it could be determined whether “there was appropriate
weight gain with a known specified amount of volume he was
taking in.” Father expressed doubt whether this was something
Mother would “go for” because they preferred to exclusively
breast-feed 	Child, 	but 	he 	said 	he 	would 	discuss 	the
recommendations with her. First Pediatrician wrote down his
recommendations on a note for Father to give to Mother and said
for her to contact him if she had any questions. He also tried to
contact Mother both during and after the appointment but was
unsuccessful.
¶6 	First Pediatrician also emphasized the importance of a
follow-up appointment the next day to check Child’s electrolyte
levels and weight, which instruction he also included in his
written note to Mother. At this point, First Pediatrician was

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“[v]ery concerned” about Child’s health and safety and noted in
Child’s file, “If labs are not obtained and no visits happen, I will
report to DCFS.”
¶7 	Neither 	parent 	brought 	Child 	in 	for 	the 	labs 	and
weight-check the following day. When First Pediatrician learned
this, he called Mother to express his concerns. Mother stated that
she was not aware of the missed appointment, that she was out of
town, and that she would not be able to come in with Child that
day. Mother informed First Pediatrician that she was feeding
Child more often, but she was not giving him formula. She
repeatedly thanked First Pediatrician for his recommendations
and told him she would “take them under consideration.” At the
end of the conversation, they both agreed that Mother should find
another pediatrician for Child. Mother subsequently scheduled
an appointment with another pediatrician for April 2 but did not
relay this information to First Pediatrician. She also increased the
frequency of Child’s breast-feedings to every two hours, and she
immediately filled and began administering a medication for
diaper rash First Pediatrician had prescribed during the March 26
appointment.
¶8 	Following 	the 	phone 	conversation, 	First 	Pediatrician
contacted DCFS and reported Parents’ apparent medical neglect
and physical neglect of Child and Child’s failure to thrive. First
Pediatrician later testified that even if he had known that Child
had an appointment with another pediatrician set for April 2, his
concerns would not have been eased. He explained that he had
ordered labs on Child’s electrolyte levels because his “biggest
concern” was that if Child became dehydrated, he would develop
“elevated sodium levels in the blood . . . that could potentially
cause a lot of health problems” such as lethargy, seizures, and
neurological damage. First Pediatrician stated that “the problem
with the elevated sodium is more of an urgent or emergent
problem that could have been developing, and so it couldn’t have
waited” until the April 2 appointment.

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¶9 	On March 30, a DCFS caseworker (Caseworker) followed
up with First Pediatrician, who expressed his concern that Child
was at risk of dehydration, which could lead to further health
complications. Following the conversation, Caseworker had a
difficult time locating and communicating with Parents. When
Caseworker called one of the phone numbers provided to her, a
man 	Caseworker 	believed 	to 	be 	Father 	answered. 	He 	was
skeptical that Caseworker worked for DCFS, and the conversation
proved unfruitful. After visiting multiple addresses on file for the
family 	to 	no 	avail, 	Caseworker 	contacted 	law 	enforcement
officers, who were able to locate Mother, Father, and Child in a
motel by “pinging” their cellphone.
¶10 	Caseworker arrived at the motel around 1:00 a.m. on April
1. 	Law 	enforcement 	was 	already 	at 	the 	motel 	and 	officers
informed Caseworker that paramedics had already examined
Child 	and 	had 	determined 	that 	Child 	was 	alert, 	breathing
normally, had a strong heartbeat, and exhibited no obvious signs
of dehydration. Because the examination revealed no concerns,
the paramedics did not consider Child in need of further medical
attention and returned him to Mother. The paramedics had left by
the time Caseworker arrived, so she did not have an opportunity
to speak with them.
¶11 	The officers warned Caseworker that Father was very
upset about her being there and that Father even instructed an
officer 	to 	stand 	between 	him 	and 	Caseworker. 	During 	the
hour-long conversation that ensued, Father refused to allow
Caseworker to see Child and instead insisted that Child was
“fine.” At one point, Father told Caseworker that he would allow
her to see Child if she returned at 8:00 a.m. Caseworker was
reluctant to do so because she was aware of a prior case in which
Father had fled across state lines with two of his other children,
and she worried that Child “would be gone” by 8:00 a.m. if she
left. She also found it odd that she had located the family at a
motel that was approximately 20 miles from their home.

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¶12 	Caseworker then requested a warrant for removal of Child.
A judge approved the warrant, and Child was taken into DCFS
custody in the wee hours of the morning. Caseworker then took
Child to an emergency room. There, Child appeared to have
gained a little weight, weighing in at 8.05 pounds, although
Caseworker suggested the slight weight gain could have also been
attributed to a wet diaper. According to the pediatrician (Second
Pediatrician) who examined Child later that afternoon when he
was brought in by the foster parents with whom Child had been
placed, Child “was within the 11th percentile for weight, but his
weight to length ratio was in the 3rd percentile,” which was
troubling, especially given Child’s higher birth weight. Second
Pediatrician stated that although Child was “generally well
appearing,” 	he 	nonetheless 	“did 	appear 	dehydrated” 	and
underweight. Child’s lab results revealed “abnormalities that
were consistent with dehydration and possibly poor feeding,”
including abnormal bilirubin levels and elevated liver enzymes
(transaminases). 	Child’s 	initial 	lab 	results 	also 	“show[ed]
evidence of hemolysis,” which is when the body destroys red
blood cells quicker than it can produce them, so the hospital had
the labs redone. The second round of labs revealed “normal
potassium, but the transaminases still remained mildly elevated.”
The lab report also included the following note: “I spoke with
[the] 	pediatric hospitalist, 	and 	confirmed 	that these 	current
findings are not worrisome in this current setting, and they
recommended that the patient follow-up with [a] pediatrician in
about a week for recheck.”
¶13 	Second Pediatrician noted that Child needed to be closely
monitored for kernicterus, which he explained “is when bilirubin
levels get to a high enough point in the blood that they deposit
into the brain, and can cause some brain damage, to use layman’s
terms.” Second Pediatrician instructed Child’s foster parents to
feed Child formula every “three to four hours” and to return in a
couple of days.

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¶14 	At the follow-up appointment two days later, on April 3,
Child had gained approximately 13 ounces,2 weighing in at 8.88
pounds. At a second follow-up appointment three days later, on
April 6, Child weighed 9.44 pounds, meaning he had gained
approximately 9 more ounces. A week later, on April 13, Child
weighed 10.08 pounds. Child continued to show weight gain in
other subsequent exams. Based on this, Second Pediatrician
testified that it was his “clinical impression” that Child had not
been 	“receiving 	appropriate 	nutrition, 	and 	upon 	receiving
appropriate nutrition [Child] returned to an expected weight.” He
further explained that “inadequate nutrition can have devastating
effects on someone so young” because “dehydration can lead to
renal failure, and poor growth can affect development in all areas,
physical and mental development.”
¶15 	On April 1, the State petitioned for legal custody and
guardianship of Child, alleging, in relevant part, neglect by
Parents “in that [Child] lacks proper parental care by reason of the
fault 	or 	habits 	of 	the 	parents.” 	See 	Utah 	Code 	Ann.
§ 80-1-102(58)(a)(ii) 	(LexisNexis 	Supp. 	2022).3 	The 	petition
alleged, among other things, the following:
• 	Child “had lost 18% body weight since birth and was at
significant risk for seizures and brain damage,” but Parents
2. Second Pediatrician testified that Child had gained around 6
ounces by the April 3 appointment, but medical records show that
Child’s weight increased from 3.65 kg to 4.03 kg in the two-day
interval, for a total weight gain of 0.38 kg, which is 13.40 ounces.
3. 	At 	the 	time, 	the 	relevant 	provision 	appeared 	in 	section
78A-6-105 of the Utah Code. The provision has since, without any
substantial change, been moved to section 80-1-102. Compare Utah
Code Ann. § 78A-6-105(36)(a)(ii) (LexisNexis Supp. 2018), with id.
§ 80-1-102(58)(a)(ii) (Supp. 2022). We cite the current version of
the annotated code for convenience.

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refused to follow medical advice and supplement Mother’s
breast milk with formula.
• 	Parents had provided First Pediatrician’s office with an
incorrect 	address, 	but 	with 	assistance 	from 	law
enforcement, DCFS eventually located them and Child in a
motel approximately 20 miles from their home.
• 	Paramedics examined Child and determined that he “was
not in distress,” but because the paramedics left prior to
Caseworker’s arrival at the motel, DCFS “was not able to
get additional information regarding the failure to thrive
medical concerns, particularly a weight measurement.”
• 	Father refused to allow Caseworker to see Child, and he
was “hostile” toward her, even going so far as instructing
a police officer to stand between them “so that [he] did not
harm” her.
• 	Father had several aliases and had “a history of parental
kidnapping.”4
• 	At the emergency room, it was noted that Child had gained
a little weight but also that he had a significant diaper rash.
¶16 	The juvenile court held a shelter hearing on April 3, which
at Parents’ request was then continued until April 8. Following
4. Specifically, the petition alleged that he took his then two- and
four-year-old 	children 	out 	of 	state 	during 	his 	weekend
parent-time and disappeared for eight months. Father and the
children were finally located in Pennsylvania where they were
observed outside in the winter cold, without coats. The petition
further alleged that Father first refused to give responding police
officers his name and eventually gave an alias. Once his true
identity was discovered, Father was arrested, and the children
were returned to their mother in Utah.

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the continued hearing, the court “found that, based upon the
medical records relating to [Child], removal was appropriate.”
Specifically, the court found that “[t]he medical records indicate
that [Child] was underweight,” that Child’s “lab values continued
to show that transaminases still remained mildly elevated, and
that the bilirubin is also mildly elevated.” The court was also
“concerned about the medical evidence of malnutrition presented
by the State.”
¶17 	A few weeks later, on April 30, Parents filed an Emergency
Motion to Return Custody and Dismiss Petition, in which they
argued, among other things, that it was common for infants born
from mothers with gestational diabetes to lose more than 10% of
their birth weight in their first week. They also emphasized the
benefits of breast-feeding and asserted that Child had repeatedly
been examined following removal and had been found to be
healthy. They also submitted a letter from their latest pediatrician
(Third Pediatrician), who had originally been scheduled to see
Child on April 2. Although Third Pediatrician had not examined
Child, he reviewed Child’s medical records and concluded that
“while the concerns of [First Pediatrician] were valid, he failed to
convey this concern properly to the parents and their wishes were
not taken into consideration” and that the April 1 lab results did
not reveal “signs of nutritional deficiency or compromise.”
¶18 	Some three weeks later, Parents filed an Order to Show
Cause and Motion for Order seeking sanctions against DCFS for
violating their right to seek a second medical opinion prior to
removal. At a subsequent hearing, the State explained that it
never opposed a second medical opinion but that Parents had
never properly requested one under the Utah Rules of Juvenile
Procedure or the Utah Rules of Civil Procedure. Parents withdrew
their motion for sanctions and Order to Show Cause and moved
for Third Pediatrician to examine Child. At a subsequent hearing,
Mother reported that Third Pediatrician had examined Child and
concluded “there are no safety concerns in this case.” And in

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September 2020, the juvenile court placed Child in a trial home
placement with Parents.
¶19 	Following a multi-day trial in January 2021, the juvenile
court found the State had proved the allegations in its petition by
clear and convincing evidence and adjudicated Child neglected
on the ground that Child lacked “proper parental care by reason
of the fault or habits of” Parents. The court did not find that
Parents abused Child. The court found First Pediatrician’s and
Second Pediatrician’s testimonies to be persuasive and stated
“that the cursory physical examination by paramedics could not
have identified” the “very real and very serious” medical issues
that were later identified at the hospital.
¶20 	The court next determined that Child’s removal from
Parents’ home following the shelter hearing “was appropriate and
necessary and in [Child’s] best interest.” But the court also found
that the circumstances giving rise to Child’s removal, i.e., Child’s
failure to thrive, were “largely resolved” and that Child’s trial
home placement with Parents that had begun some six months
earlier had “not revealed any child safety concerns.” Accordingly,
the court terminated its jurisdiction in the case and returned
custody of Child to Parents.
¶21 	Parents appeal. Obviously, they do not appeal the decision
that Child be returned to them. But they challenge prior rulings of
the court.
ISSUES AND STANDARDS OF REVIEW
¶22 	Parents raise two issues on appeal. First, they argue that
“the juvenile court erred as a matter of law by awarding custody
of Child to the State at the shelter hearing without giving [them]
a reasonable time to obtain a second medical opinion.” But
because this issue is moot, as explained in Part I.A. below, we lack
judicial 	power 	to 	address it. 	See Transportation 	All. 	Bank v.

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International Confections Co., 2017 UT 55, ¶ 14, 423 P.3d 1171 (“The
mootness doctrine is not a simple matter of judicial convenience
or an ascetic act of discretion. It is a constitutional principle
limiting our exercise of judicial power under article VIII of the
Utah Constitution.”) (quotation simplified); Utah Transit Auth. v.
Local 382 of Amalgamated Transit Union, 2012 UT 75, ¶ 12, 289 P.3d
582 (“[B]ecause it is moot, we lack the power to address the
underlying merits or issue what would amount to an advisory
opinion.”).
¶23 	Second, 	Parents 	argue 	that 	the 	“court 	improperly
adjudicated Child as neglected.” Specifically, they assert that
(a) the court “did not consider the full statutory definition of
neglect,” (b) the court’s findings “did not support its ultimate
decision 	that 	Child 	was 	neglected,” 	and 	(c) 	“the 	neglect
adjudication was against the clear weight of the evidence.” “We
apply 	differing 	standards 	of 	review 	to 	findings 	of 	fact,
conclusions of law, and determinations of mixed questions of law
and fact.” In re E.R., 2021 UT 36, ¶ 14, 496 P.3d 58. “We afford the
[juvenile court] no deference on questions of law, reviewing
issues de novo, and the most deference on questions of fact,
reviewing only for clear error.” In re A.B., 2022 UT 39, ¶ 23, 523
P.3d 168. The level of deference afforded to mixed questions of
law and fact, however, depends on whether they are more
“law-like” or “fact-like,” with the former being subject to de novo
review while the latter are subject to deferential review. See In re
E.R., 2021 UT 36, ¶ 18. A juvenile court’s neglect adjudication falls
within the former category because, “[o]nce the facts have been
established, the juvenile court is limited to determining whether
the statutory criteria for neglect have been met,” which “is
primarily a law-like endeavor.” In re A.B., 2022 UT 39, ¶ 28.
Accordingly, we review the court’s ultimate adjudication of
neglect for correctness.

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ANALYSIS
I. Mootness
¶24 	Before 	we 	proceed 	to 	address the 	merits of 	Parents’
arguments, we must first address the contention of the guardian
ad litem (the GAL) that this appeal is moot. See Ramos v.
Cobblestone Centre, 2020 UT 55, ¶ 22, 472 P.3d 910 (stating that
“mootness is a threshold determination” that appellate courts
must make before reaching the merits of an appeal). “The defining
feature of a moot controversy is the lack of capacity for the court
to order a remedy that will have a meaningful impact on the
practical positions of the parties.” Utah Transit Auth. v. Local 382 of
Amalgamated Transit Union, 2012 UT 75, ¶ 24, 289 P.3d 582. “When
a case is moot in this sense, the parties’ interest in its resolution is
purely academic.” Id. See Transportation All. Bank v. International
Confections Co., 2017 UT 55, ¶ 15, 423 P.3d 1171 (“A case may be
mooted on appeal if the relief requested is rendered impossible or
of no legal effect.”) (quotation simplified).
¶25 	The GAL argues that both issues Parents raise on appeal
are moot. We agree that Parents’ argument related to Child’s
removal following the shelter hearing is moot and does not satisfy
a mootness exception, and we therefore do not reach the merits of
that argument. But because we conclude Parents’ arguments
related 	to 	the 	juvenile 	court’s 	adjudication 	that 	Child 	was
neglected 	satisfies 	the 	collateral 	consequences 	exception 	to
mootness, we address the merits of those arguments in Part II.
A. 	Child’s Removal
¶26 	The GAL argues that Parents’ challenge to Child’s removal
from their care following the shelter hearing is moot because
“they now enjoy full custody of Child.” Although Parents concede
that “appellate review would not affect the rights of the parties
because the shelter hearing ruling was an interim ruling that is no

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longer operative,” thereby rendering the issue technically moot,
they 	nonetheless 	assert 	that 	“the 	issue 	qualifies 	under 	the
exception to the mootness doctrine.”
¶27 	Under the mootness exception, “we will decide a moot
issue when a litigant can demonstrate that the issue will (1) affect
the public interest, (2) be likely to recur, and (3) because of the
brief time that any one litigant is affected, be likely to evade
review.” Widdison v. State, 2021 UT 12, ¶ 14, 489 P.3d 158
(quotation simplified). Even assuming, without deciding, that the
first and third elements are met, Parents have not carried their
burden of persuasion on the second element. Accordingly, this
issue does not satisfy the mootness exception.
¶28 	Under the second element, “[a] party must convince us that
the issue will arise again.” Id. ¶ 17. “Under settled case law, a mere
physical or theoretical possibility of recurrence is insufficient” to
satisfy this element. Id. (quotation simplified). Rather, “there must
be a reasonable expectation or a demonstrated probability that the
same controversy will recur.” Utah Transit Auth., 2012 UT 75, ¶ 36
(quotation simplified).
¶29 	Parents’ 	argument 	on 	this 	element 	is 	limited 	to 	the
assertion that at shelter hearings, “whenever the basis for removal
is an allegation of medical neglect, the issue will again arise as to
whether 	the 	juvenile 	court 	can 	remove 	the 	child 	without
permitting the parents reasonable time to seek a second medical
opinion.” But Parents’ argument is more intricate than the mere
question of whether they were entitled to seek a second medical
opinion prior to Child’s removal from their care. Indeed, Utah law
is clear that parents facing removal of their child for medical
neglect are generally entitled to a reasonable time to obtain such
an opinion. See Utah Code Ann. § 80-3-304(1) (LexisNexis Supp.
2022) (“In cases of alleged medical neglect where [DCFS] seeks
protective custody, temporary custody, or custody of the child
based on the report or testimony of a physician, a parent or

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guardian shall have a reasonable amount of time, as determined
by the juvenile court, to obtain a second medical opinion from
another physician of the parent’s or guardian’s choosing who has
expertise in the applicable field.”). See also id. § 80-3-304(3) (“If the
second 	medical 	opinion 	results 	in 	a 	different 	diagnosis 	or
treatment recommendation 	from that of the 	opinion 	of the
physician [DCFS] used, the juvenile court shall give deference to
the second medical opinion as long as that opinion is reasonable
and informed and is consistent with treatment that is regularly
prescribed by medical experts in the applicable field.”). What
Parents’ argument on this issue boils down to, however, is
whether, under the facts of this case, Child was facing “an
imminent risk of death or a deteriorating condition of [his]
health,” see id. § 80-3-304(2),5 or “an immediate threat of death or
serious and irreparable harm,” see id. § 80-3-304(4),6 thereby
depriving Parents of what would otherwise be their statutory
5. The subsection, in its entirety, states,
Unless there is an imminent risk of death or a
deteriorating condition of the child’s health, the
child shall remain in the custody of the parent or
guardian while the parent or guardian obtains a
second medical opinion.
Utah Code Ann. § 80-3-304(2) (LexisNexis Supp. 2022).
6. The subsection, in its entirety, states,
Subsections 	(1) 	through 	(3) 	do 	not 	apply 	to
emergency treatment or care when the child faces an
immediate threat of death or serious and irreparable
harm and when there is insufficient time to safely
allow the parent or guardian to provide alternative
necessary care and treatment of the parent’s or
guardian’s choosing.
Id. § 80-3-304(4).

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right to seek a second medical opinion prior to Child’s removal,
see id. § 80-3-304(1)–(2).
¶30 	Because Parents’ argument on the “likely to recur” element
of the mootness exception does not directly address the intricacies
of the issue they raise on appeal, they have not carried their
burden of persuasion on this element. See Allen v. Friel, 2008 UT
56, ¶ 9, 194 P.3d 903. Accordingly, this issue is not exempted from
the mootness doctrine, and we lack judicial power to address it
further.
B. 	Neglect Adjudication
¶31 	The GAL next asserts that because the juvenile court
terminated its jurisdiction and returned Child to Parents’ custody,
Child no longer has the status of “neglected” and Parents’
challenge to the juvenile court’s neglect adjudication is therefore
moot. Parents and the State oppose this suggestion of mootness.
Specifically, although the State agrees that “this appeal may be
technically moot because the child has been returned to the
Parents and court jurisdiction terminated,” it concedes that the
issue satisfies the collateral consequences exception to mootness.
This argument is likewise adopted by Parents in their reply brief.7
7. But unlike the State, Parents do not concede that the current
appeal is technically moot. Rather, they argue that the appeal is
not moot because the juvenile court’s neglect adjudication affects
their parental rights. They support their assertion by adopting the
State’s collateral consequences argument. That is, Parents do not
assert that our resolution of this issue in their favor would have
any current or practicable effect on their parental rights. Instead,
they base their argument on a potential future event, asserting
that their rights are affected because, as discussed in greater detail
later in this opinion, “a neglect adjudication remains a statutory
(continued…)

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¶32 	“Generally, once mootness has been demonstrated, the
party 	seeking 	to 	survive 	dismissal 	bears 	the 	burden 	of
demonstrating that collateral legal consequences will flow from
the challenged issue.” In re J.S., 2017 UT App 5, ¶ 11, 391 P.3d 358
(quotation simplified). Our approach to applying the collateral
consequences 	exception 	differs 	depending 	on 	whether 	the
collateral consequences are presumed or not. “When collateral
legal consequences are presumed, the case isn’t moot unless it can
be shown that no adverse collateral consequences will result.”
State v. Legg, 2018 UT 12, ¶ 14, 417 P.3d 592 (quotation simplified).
Conversely, 	“[w]hen 	collateral 	legal 	consequences 	aren’t
presumed, a case is moot unless the party opposing mootness can
establish actual collateral legal consequences.” Id. We conclude
that 	Parents’ 	argument 	satisfies 	the 	former 	of 	these 	two
approaches.
¶33 	While “we presume collateral legal consequences follow
criminal convictions,” id. ¶ 17, the presumption may arise in other
contexts when the collateral consequences are “sufficient to
mandate the same undeniable conclusion as criminal convictions,
i.e., the existence of a collateral legal consequence is virtually
basis for terminating Parents’ rights going forward.” See In re J.M.,
2020 UT App 52, ¶¶ 28–30, 463 P.3d 66 (“Once neglect has
occurred, a juvenile court is entirely justified in making a finding
that a parent ‘has neglected’ a child, even if that parent has
improved herself since.”). But we are unpersuaded that even if
Parents’ argument proves meritorious, any remedy we could
order would “have a meaningful impact on the practical positions
of the parties.” Utah Transit Auth. v. Local 382 of Amalgamated
Transit Union, 2012 UT 75, ¶ 24, 289 P.3d 582. See State v. Legg, 2018
UT 12, ¶ 26, 417 P.3d 592 (“The question of mootness doesn’t turn
on which collateral legal consequences the defendant will suffer,
but on whether the requested judicial relief can affect the rights of
the litigants.”) (quotation simplified).

In re M.S.
20210657-CA 	17 	2023 UT App 74
inescapable,”8 id. ¶ 18. See id. (“We will only presume collateral
legal consequences when the challenged action carries extensive
collateral consequences imposed by law.”); id. ¶ 24 (“Presumed
collateral legal consequences aren’t inherently limited to the
realm of criminal convictions.”). This presumption “does not
come lightly.” Id. ¶ 18. Indeed, the presumption in the criminal
conviction 	context 	exists 	only 	because 	“the 	law 	mandates
numerous legal consequences follow a criminal conviction to such
an 	extent that the existence 	of 	at least one 	collateral 	legal
consequence 	for 	an 	individual 	defendant 	is 	effectively
inevitable.”9 Id. ¶ 17. Thus, in the non-conviction context, the
presumption likewise requires a demonstration of “numerous
consequences 	imposed 	by 	law 	that 	would 	command 	the
conclusion that some collateral legal consequence is inevitable for
every” similarly situated party. Id. ¶ 32. Such consequences must
be “statutorily mandated and cannot be avoided by conforming
with the law.” Id. ¶ 31. See id. ¶¶ 29–30.
¶34 	Parents and the State both argue that the juvenile court’s
“finding 	of 	neglect 	remains 	significant 	and 	important
notwithstanding 	the 	fact 	that 	the 	juvenile 	court 	has 	now
8. An example of a non-criminal context in which the collateral
consequences presumption applies is that of civil commitments
because “patients of mental hospitals face similar deprivations of
liberty as criminals.” State v. Legg, 2018 UT 12, ¶ 29 n.4, 417 P.3d
592 (quotation simplified). See In re Giles, 657 P.2d 285, 286–87
(Utah 1982).
9. Our Supreme Court has “recognized several collateral legal
consequences that may result from a criminal conviction, such as
the use of the conviction to impeach the petitioner’s character or
as a factor in determining a sentence in a future trial, as well as
the petitioner’s inability to vote, engage in certain businesses, or
serve on a jury.” State v. Legg, 2018 UT 12, ¶ 22, 417 P.3d 592
(quotation simplified).

In re M.S.
20210657-CA 	18 	2023 UT App 74
terminated jurisdiction over this family.” Specifically, they assert
that “a finding of neglect does provide a statutory basis for
termination 	of 	parental 	rights 	were 	Parents 	to 	again 	find
themselves before the juvenile court.” See Utah Code Ann.
§ 80-4-301(1)(b) (LexisNexis Supp. 2022) (listing “that the parent
has neglected or abused the child” as a legal ground for which a
parent’s rights may be terminated); In re J.M., 2020 UT App 52,
¶¶ 28–30 & n.3, 463 P.3d 66 (stating that a prior adjudication of
abuse or neglect, regardless of whether the “parent has improved
herself 	since,” 	satisfies 	the 	statutory 	ground 	for 	parental
termination, leaving the juvenile court to decide only whether
termination 	is 	in 	the 	best 	interest 	of 	the 	child). 	The 	State
additionally asserts that the neglect adjudication “precludes
Parents from challenging their substantiated finding of neglect on
the 	DCFS 	Management 	Information 	System 	child 	abuse
database,” see Utah Code Ann. § 80-2-707(7)(a) (LexisNexis Supp.
2022) (“[A]n alleged perpetrator may not make a request . . . to
challenge a supported finding if a court of competent jurisdiction
entered 	a 	finding, 	in 	a 	proceeding 	in 	which 	the 	alleged
perpetrator 	was 	a 	party, 	that 	the 	alleged 	perpetrator 	is
substantially responsible for the abuse, neglect, or dependency
that is the subject of the supported finding.”), which will have
“implications for any future investigations of child abuse/neglect
regarding the Parents, as well as affect[] things such as the
Parents’ ability to serve as foster parents in the future.” We agree
and 	conclude 	that 	this 	satisfies 	the 	presumed 	collateral
consequences approach.
¶35 	In State v. Legg, 2018 UT 12, 417 P.3d 592, our Supreme
Court 	held 	that 	revocation 	of 	probation 	did 	not 	warrant
presumed collateral consequences (or amount to actual collateral
consequences, for that matter). See id. ¶¶ 25, 32, 38. The appellant
in that case argued that probation revocation could be used as a
“prior history in future contact with the legal system,” could be
used “as an aggravating factor in the sentencing recommendation
matrix,” could be a basis for the State to refuse “plea offers or

In re M.S.
20210657-CA 	19 	2023 UT App 74
offers of probation,” and would render him ineligible “for a
reduction of the degree of his or her first offense under Utah Code
section 76-3-402.” Id. ¶ 28 (quotation simplified). The Court
rejected these arguments, holding that the first three arguments
simply amounted to the allegation that “certain non-statutory
consequences may occur,” and that “these types of discretionary
decisions are not governed by the mere presence or absence of a
recorded violation of probation.” Id. ¶ 29 (quotation simplified).
Additionally, the Court stated that “the first three potential
collateral legal consequences are contingent upon [the appellant]
again violating state law,” and that he is “able—and indeed
required by law—to prevent such a possibility from occurring.”
Id. 	¶ 	30 	(quotation 	simplified). 	And 	concerning 	the 	fourth
argument regarding “the potential of a 402 reduction,” the Court
stated that because it was discretionary, the reduction was “at
most, 	highly 	speculative 	and 	nothing 	more 	than 	a 	mere
possibility.” Id. ¶ 31.
¶36 	Our Supreme Court also distinguished its prior opinion in
In re Giles, 657 P.2d 285 (Utah 1982), in which it “concluded that
an appeal of a civil commitment was not moot because there were
‘collateral consequences that may be imposed upon appellant that
might arise were he to face future confrontations with the legal
system,’” Legg, 2018 UT 12, ¶ 29 n.4 (quoting In re Giles, 657 P.2d
at 287) (quotation otherwise simplified). The Court stated that
individuals 	subject 	to 	civil 	commitments 	“face 	similar
deprivations of liberty as criminals” and that “unlike the use of
previous 	commitment 	in 	future 	commitment 	hearings, 	a
defendant is able to completely avoid the use of a probation
revocation in a future sentencing decision by not committing a
future 	violation 	of 	law.”10 	Id. 	(quotation 	simplified).
10. Our Supreme Court also noted that, at the time, “being labeled
‘mentally 	incompetent’ 	carried 	collateral 	legal 	consequences
comparable to criminal convictions,” such as restrictions on
(continued…)

In re M.S.
20210657-CA 	20 	2023 UT App 74
Adjudications of neglect by a juvenile court are on much the same
footing.
¶37 	As an initial matter, “[a] parent’s right to raise his or her
child is one of the most precious rights any person enjoys, and is
among the fundamental rights clearly protected by our federal
and state constitutions.” In re B.T.B., 2018 UT App 157, ¶ 9, 436
P.3d 206, aff’d, 2020 UT 60, 472 P.3d 827. See Utah Code Ann.
§ 80-4-104(1) (LexisNexis Supp. 2022) (“Under both the United
States Constitution and the constitution of this state, a parent
possesses a fundamental liberty interest in the care, custody, and
management of the parent’s child. For this reason, the termination
of family ties by the state may only be done for compelling
reasons.”). Accordingly, although taking a different form than
that in the criminal-conviction context, parents nonetheless face
“deprivations of liberty” as a result of neglect adjudications,
which 	include 	collateral 	consequences 	in 	possible 	“future
confrontations with the legal system.” See Legg, 2018 UT 12, ¶ 29
n.4 (quotation simplified).
¶38 	Unlike the arguments made by the appellant in Legg, the
consequences that Parents would be subject to as a result of the
neglect 	adjudication 	are 	imposed 	by 	law 	and 	are 	not
discretionary. Under Utah law, the prior adjudication of neglect
is a sufficient ground for termination of parental rights. See Utah
Code Ann. § 80-4-301(1)(b); In re J.M., 2020 UT App 52, ¶¶ 28–30.
Although it would satisfy only one of the two elements required
for termination of parental rights,11 see Utah Code Ann. § 80-4-301,
voting rights and the ability to serve on a jury, obtain a driver
license, or obtain a firearm license. See Legg, 2018 UT 12, ¶ 29 n.4.
11. Parental rights may be terminated only if the following two
elements are met: (1) “a trial court must find that one or more of
the statutory grounds for termination are present” and (2) “a trial
(continued…)

In re M.S.
20210657-CA 	21 	2023 UT App 74
that first element plays a critical role in the protection of parental
rights, see In re B.T.B., 2018 UT App 157, ¶ 14 (“Termination of
parental rights solely on the basis of the child’s best interest and
without any finding of parental unfitness, abandonment, or
substantial neglect, violates the parent’s constitutional liberty
rights.”) (quotation simplified). Additionally, a finding of neglect
carries various consequences because the adjudication remains on
the DCFS Management Information System child abuse database.
See Utah Code Ann. § 80-2-707(7)(a). As the State explains, this
will at the very least preclude Parents from acting as foster
parents 	and 	will 	affect 	any 	possible 	future 	investigations
conducted by DCFS.
¶39 	Finally, unlike in Legg where the appellant’s arguments
were contingent on the appellant again violating the law, see 2018
UT 12, ¶ 30, such is not the case here. Under the parental rights
termination test, based on the prior adjudication of neglect, a
parent’s rights could conceivably be terminated without the
parent 	subsequently 	satisfying 	a 	statutory 	ground 	for
termination, so long as termination is in the child’s best interest.
See In re J.M., 2020 UT App 52, ¶¶ 28–30 & n.3.
¶40 	For these reasons, we hold that Parents’ challenge to the
juvenile 	court’s 	neglect 	adjudication 	satisfies 	the 	collateral
consequences exception to the mootness doctrine. We accordingly
proceed to address the merits of their argument, even though the
issue is technically moot.
II. Merits of the Neglect Adjudication
¶41 	In challenging the juvenile court’s adjudication of Child as
neglected, Parents argue that the court committed a threshold
court must find that termination of the parent’s rights is in the best
interests of the child.” In re B.T.B., 2018 UT App 157, ¶ 13, 436 P.3d
206 (quotation simplified), aff’d, 2020 UT 60, 472 P.3d 827.

In re M.S.
20210657-CA 	22 	2023 UT App 74
legal error when it “failed to conduct the requisite legal analysis
into 	whether 	Parents’ 	conduct 	involved 	a 	reasonable 	and
informed health care decision.” We agree with Parents in this
regard.
¶42 	The juvenile court adjudicated Child neglected on the
ground that Child lacked “proper parental care by reason of the
fault or habits of” Parents. See Utah Code Ann. § 80-1-102(58)(a)(ii)
(LexisNexis Supp. 2022). But the Utah Code specifically exempts
from its definition of neglect “a health care decision made for a
child by the child’s parent or guardian, unless the state or other
party to a proceeding shows, by clear and convincing evidence,
that the health care decision is not reasonable and informed.” Id.
§ 80-1-102(58)(b)(ii).12
¶43 	In 	determining 	whether 	a 	parent 	acted 	reasonably
regarding a child’s healthcare, “the pivotal question is what action
by the parent was proper under the circumstances.” In re N.K.C.,
1999 UT App 345, ¶ 15, 995 P.2d 1.13 This standard “is flexible and
12. The Utah Code further exempts from its definition of neglect
a parent’s exercise of his or her right to seek a second medical
opinion when DCFS seeks to remove the child from the parent’s
custody on allegations of medical neglect. See Utah Code Ann.
§ 80-1-102(58)(b)(iii) 	(LexisNexis 	Supp. 	2022). 	See 	also 	id.
§ 80-3-304 (stating that, with certain limitations, parents have a
right to seek a second medical opinion in cases of alleged medical
neglect). Parents also argue that the juvenile court erred in failing
to consider this provision as part of its adjudication ruling.
Because we reverse on the ground that the court did not consider
whether 	Parents’ 	medical 	decisions 	were 	“reasonable 	and
informed,” we do not reach this question.
13. In re N.K.C., 1999 UT App 345, 995 P.2d 1, addressed the
reasonable parent standard under the medical neglect statute then
(continued…)

In re M.S.
20210657-CA 	23 	2023 UT App 74
depends on the actual circumstances involved,” id. ¶ 17, “includes
a full range of conduct on the part of parents and guardians,” and
“does not require extraordinary caution or exceptional skill,” id.
¶ 19 (quotation simplified). See id. ¶ 18 (“[P]erfection is not
required[.]”). Rather, “similar to a reasonableness standard in
torts,” “reasonable care is what an ordinary, prudent parent uses
in effect, which required this court to determine whether a parent
provided a child with “proper or necessary” medical care. See
id. ¶ 8. The statute has since been rephrased and renumbered,
without any substantive change that is relevant to the current
appeal. Compare Utah Code Ann. § 80-1-102(58)(a)(iii) (LexisNexis
Supp. 2022) (defining “neglect” as “failure or refusal of a parent,
guardian, or custodian to provide proper or necessary subsistence
or medical care, or any other care necessary for the child’s health,
safety, morals, or well-being”), with id. § 78-3a-103(1)(r)(i)(C)
(Supp. 1999) (defining “neglected child” as “a minor . . . whose
parent, guardian, or custodian fails or refuses to provide proper
or necessary subsistence, education, or medical care, including
surgery or psychiatric services when required, or any other care
necessary for health, safety, morals, or well-being”). Although the
juvenile court in the case before us did not adjudicate Child
neglected under the medical neglect statute, it nevertheless was
barred from finding neglect if the underlying conduct constituted
a 	“reasonable 	and 	informed” 	healthcare 	decision. 	See 	id.
§ 80-1-102(58)(b)(ii) (Supp. 2022) (“‘Neglect’ does not include . . .
a health care decision made for a child by the child’s parent or
guardian, unless the state or other party to a proceeding shows,
by clear and convincing evidence, that the health care decision is
not reasonable and informed[.]”). Additionally, we see no reason
why 	the 	reasonable 	parent 	standard 	that 	is 	applied 	to 	a
determination 	of 	whether 	a 	parent 	provided 	“proper 	or
necessary” medical care under the medical neglect statute should
differ from the standard applied in determining whether a parent
made a “reasonable” healthcare decision under the statute at issue
in this case.

In re M.S.
20210657-CA 	24 	2023 UT App 74
in 	similar 	situations.” 	Id. 	¶ 	19 	(quotation 	simplified).
Additionally, although this “standard may accommodate the
cautious and the hesitant, . . . it cannot accommodate inaction in
the face of an obvious cause for immediate concern.” Id. ¶ 21. See
id. ¶ 16 (“[W]aiting even an hour when a child is suffering from
an obvious and serious injury is ordinarily not reasonable and
could support a determination of medical neglect.”).
¶44 	In addition to being reasonable, the parent’s health care
decisions must be “informed.” Utah Code Ann. § 80-1-102(58)(b)
(ii). “Informed” is defined as “having information” or “based on
possession 	of 	information.” 	Informed, 	Merriam-Webster
Dictionary, https://www.merriam-webster.com /dictionary/infor
med [https://perma.cc/S8NV-S8X7]. See Informed, Dictionary.com,
https://www.dictionary.com/browse/informed [https://perma.cc/
TN64-KHLB] 	(defining 	“informed” 	as 	“having 	or 	[being]
prepared 	with 	information 	or 	knowledge; 	apprised”). 	Thus,
parents must take the time to apprise themselves of the necessary
information to allow them to make a considered health care
decision for their child. Indeed, in cases of alleged medical
neglect, absent “an immediate threat of death or serious and
irreparable harm” to the child, if a parent obtains a second
medical opinion that “results in a different diagnosis or treatment
recommendation from that of the opinion of the physician [that
DCFS] used,” that opinion is entitled to deference “as long as that
opinion 	is 	reasonable 	and 	informed 	and 	is 	consistent 	with
treatment that is regularly prescribed by medical experts in the
applicable field.” Utah Code Ann. § 80-3-304(3)–(4) (LexisNexis
Supp. 2022).
¶45 	Here, at the adjudication hearing, the State argued that
Parents’ actions “were not reasonable and informed under the
circumstance” 	because 	they 	failed 	to 	appear 	for 	follow-up
appointments to check Child’s weight and conduct additional lab
tests. Parents countered, asserting that they “have a strong
conviction against formula” and that based on the American

In re M.S.
20210657-CA 	25 	2023 UT App 74
Academy of Pediatrics’ recommendation, 	they believed that
exclusively breast-feeding “is the healthiest way to provide for
your child.” Indeed, the materials First Pediatrician gave Parents
following the March 26, 2020 appointment state, “Breast milk is
the best food for your baby.” Parents further asserted that they
did follow medical advice by “treating the bilirubin levels with
the light therapy,” treating Child’s diaper rash by administering
prescribed 	medication, 	and 	treating 	Child’s 	weight 	loss 	by
increasing 	the 	frequency 	of 	feedings 	and 	by 	making 	an
appointment to see Third Pediatrician on April 2. Parents pointed
to the fact that increased feedings (albeit with formula) were what
Second 	Pediatrician 	instructed 	Child’s 	foster 	parents 	to 	do
following his examination of Child. Accordingly, they asserted
that although they “disagreed with” First Pediatrician concerning
the 	use 	of 	formula, 	they 	“did 	not 	disregard” 	his 	medical
recommendation to increase the frequency of Child’s feedings.
¶46 	In finding Child was neglected by Parents, the juvenile
court did not discuss whether the State had proven, by clear and
convincing evidence, that Parents’ medical decisions for Child
were not “reasonable and informed.” Instead, the court found that
the State had proven the following facts by clear and convincing
evidence:
• 	By March 30, 2020, Child “had lost 18% body weight since
birth and was at significant risk for seizures and brain
damage.”
• 	Paramedics who examined Child at the motel concluded
that Child “was not in distress,” but this “cursory physical
examination . . . could not have identified” the “very real
and very serious” medical issues that were later identified
at the hospital.
• 	First Pediatrician “was very concerned about dehydration
of” Child.

In re M.S.
20210657-CA 	26 	2023 UT App 74
• 	Parents “were advised by [First Pediatrician] of the very
serious medical danger to [Child] and advised [Parents] to
supplement the baby’s intake with formula.”
• 	Parents “refused to follow the medical advice and bring the
baby in for weight checks, lab draws, and treatment
recommendations regarding [Mother’s] breastmilk supply,
or follow the other medical advice given to” them.
• 	When taken to the emergency room by DCFS, Child’s
“weight had increased from the last time he was seen by”
First Pediatrician.
The court also made findings regarding the difficulty Caseworker
experienced in locating Child, Father’s aggressive and belligerent
attitude toward Caseworker, Father’s use of aliases and “history
of parental interference,” and Father’s “very strong, passionate
feelings about Government interference or involvement in the
lives of private citizens.”14
¶47 	But despite the GAL’s assertions to the contrary, these
facts, without more, are insufficient to establish that Parents’
medical decisions for Child were unreasonable, i.e., that Parents
did not “exhibit appropriate concern for the infant’s needs given
the observable evidence,” In re N.K.C., 1999 UT App 345, ¶ 20
(quotation 	simplified), 	and 	whether 	their 	decisions 	were
informed. Specifically, the court’s findings do not go to the
14. The GAL makes much of Father’s contentious behavior, his
history of parental interference, and the difficulty Caseworker
experienced in locating Parents and Child. There is no question
that these behaviors were not constructive and were not helpful
to Parents’ cause. But these findings of fact do not go to the
reasonableness of Parents’ medical decisions and are therefore
largely irrelevant to the determination of whether their medical
decisions were reasonable and informed.

In re M.S.
20210657-CA 	27 	2023 UT App 74
reasonableness of Parents’ decision to increase feeding frequency
without supplementing with formula in response to Child’s
more-than-expected weight loss, whether Parents’ decision to
forgo 	feeding 	Child 	formula 	under 	the 	circumstances 	was
informed, or the reasonableness of Parents’ decision to wait until
April 2 to have Child re-examined following the March 26
appointment with First Pediatrician in lieu of the follow-up
appointment scheduled for the following day.
¶48 	More importantly, even if the juvenile court did make the
relevant findings, it did not undertake the necessary analysis of
whether Parents’ medical decisions were reasonable, which is an
ultimate determination that is left to the juvenile court—not an
appellate 	court. 	Reasonableness 	determinations 	involve 	the
application of law to facts, some of which, depending on the
context, are entitled to deferential review and others of which are
subject to de novo review. See Sawyer v. Department of Workforce
Services, 2015 UT 33, ¶ 20, 345 P.3d 1253 (“[S]ome determinations
of reasonableness should be reviewed de novo and others should
not.”). 	The 	reasonable 	parent 	standard 	is 	“similar 	to 	a
reasonableness standard in torts,” In re N.K.C., 1999 UT App 345,
¶ 19, which “is determined by the fact-finder and subject only to
deferential review,” Sawyer, 2015 UT 33, ¶ 21. This is because “the
particular facts and circumstances of the [parent’s] conduct are
likely to be so complex and varying that no rule adequately
addressing the relevance of all these facts can be spelled out.” In
re adoption of Baby B., 2012 UT 35, ¶ 43, 308 P.3d 382 (quotation
simplified). Additionally, a juvenile court’s determination under
the reasonable parent standard “would often be affected by [the
court’s] observation of a competing witness’s appearance and
demeanor on matters that cannot be adequately reflected in the
record 	available 	to 	the 	appellate 	courts.” 	Id. 	(quotation
simplified). Accordingly, absent the court’s analysis of whether
Parents’ 	medical 	decisions 	satisfied 	the 	reasonable 	parent
standard, the juvenile court’s adjudication of neglect in this case
is unsustainable, and this court cannot undertake the analysis in

In re M.S.
20210657-CA 	28 	2023 UT App 74
the juvenile court’s stead even if it had made the requisite factual
findings.
¶49 	The State argues that Parents’ conduct was objectively
unreasonable and the fact that Child did not suffer permanent
harm is not determinative. We certainly agree with the latter
portion of this argument, that is, “[a] parent should not benefit
from the happenstance that her child’s condition did not worsen”
as a result of her unreasonable medical decision. In re N.K.C., 1999
UT App 345, ¶ 14. But for a healthcare decision to be objectively
unreasonable, as was the case in In re N.K.C.,15 the court needed to
find 	that 	Child’s condition 	presented 	“an obvious 	cause 	for
immediate concern.” Id. ¶ 21 (emphasis added). Although the
juvenile court did find that Child’s examination at the hospital
revealed “very real and very serious” medical issues, the court did
15. In In re N.K.C., 1999 UT App 345, 995 P.2d 1, the father
“vigorously shook” his one-month-old child. Id. ¶ 2. The child’s
mother, who had been absent during the abuse, later “observed
that the child was limp and lethargic” and that his “pupils were
fixed.” Id. Instead of seeking immediate medical attention, the
mother put the child to bed. Id. Later that night, after the child’s
condition had not improved, the mother contacted the child’s
pediatrician, who directed her to immediately take the child to the
emergency room. Id. ¶ 3. The mother arrived with the child at the
emergency room almost five hours after she initially discovered
the child’s serious condition. Id. The juvenile court determined
that the mother “neglected the child by failing to obtain timely
medical care.” Id. ¶ 6 (quotation simplified). We affirmed, stating
that under the reasonable-parent standard, the mother’s conduct,
in light of the severe symptoms the child was exhibiting, was
“well outside that which can reasonably be expected of a parent
in that situation,” and therefore “the mother’s failure to summon
immediate medical attention amounted to a failure to exercise the
minimum degree of care expected of a reasonably prudent
parent.” Id. ¶ 21.

In re M.S.
20210657-CA 	29 	2023 UT App 74
not make a finding regarding whether they were issues that
should have been obvious to Parents. To the contrary, the court
acknowledged that the examination completed by responding
paramedics earlier that night at the motel revealed that Child
“was not in distress.” See id. ¶ 20 (stating that a parent is not
expected “to make a diagnosis, only to exhibit appropriate
concern for the infant’s needs given the observable evidence”)
(emphasis 	added) 	(quotation 	otherwise 	simplified). 	Thus,
Parents’ conduct at the time could not have been objectively
unreasonable.
¶50 	In sum, because the underlying conduct that should have
been the focus of the juvenile court’s neglect adjudication was
Parents’ medical decisions regarding Child, the court could not
find neglect unless the State had met its burden of proving that
those decisions were not “reasonable and informed.” See Utah
Code Ann. § 80-1-102(58)(b)(ii) (LexisNexis Supp. 2022). Because
the 	court 	did 	not 	conduct 	the 	requisite 	analysis, 	its ruling
contained legal errors, and we therefore reverse.
CONCLUSION
¶51 	Because Parents’ argument regarding Child’s removal
from their care following the shelter hearing is moot and not
subject to a recognized exception to the mootness doctrine, we
lack judicial power to address it. But we have power to address
Parents’ challenge to the juvenile court’s neglect adjudication
because that argument, while technically moot, satisfies the
collateral consequences exception to mootness. And because the
juvenile court did not make findings or conduct an analysis
related to whether Parents’ medical decisions for Child were
“reasonable and informed,” the court’s ruling contained critical
legal 	errors, 	and 	we 	therefore 	reverse 	the 	court’s 	neglect
adjudication.