In the Interest of B.S., Minor Child

IN THE COURT OF APPEALS OF IOWA

No. 25-1410
Filed December 17, 2025

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

B.B., Mother,
Appellant.
________________________________________________________________

Appeal from the Iowa District Court for Dallas County, Erica Crisp, Judge.

A mother appeals the termination of her parental rights to her child.

AFFIRMED.

Karen A. Taylor of Taylor Law Offices, P.C., Des Moines, for appellant

mother.

Brenna Bird, Attorney General, Natalie Hedberg, Assistant Attorney

General, for appellee State.

Paul White, Des Moines, attorney and guardian ad litem for minor child.

Considered without oral argument by Greer, P.J., and Ahlers and Badding,

JJ.
2

GREER, Presiding Judge.

A mother appeals the juvenile court order terminating her parental rights to

her child. The mother alleges: (1) the State failed to prove the grounds for

termination, (2) termination is not in the child’s best interests, and (3) exceptions

apply to prevent termination. After a de novo review of the record, we affirm.

I. Background Facts and Proceedings.

The mother gave birth to B.S. in January 2022. B.S.’s biological father is

unknown.1

Due to the mother’s preexisting opioid-use issues, the mother used

prescribed methadone throughout her pregnancy and at the time she gave birth to

B.S. After the child was born, she experienced withdrawal symptoms and had to

be weaned off methadone. B.S. also had a stroke at birth, which a doctor attributed

to the drug in her system. Even now, the child has lingering, but improving, eye

issues due to the stroke.

The child first came to the attention of the Iowa Department of Health and

Human Services (HHS)2 in April 2022, when she was approximately three months

old. At that time, police found the mother and her paramour passed out in their

vehicle after a single-vehicle accident. The mother and her paramour had

overdosed on fentanyl.

1 The mother’s paramour was originally thought to be the child’s father until he was

excluded by a paternity test. The juvenile court terminated the parental rights of
all putative fathers on October 30, 2024. No putative fathers appealed that
determination.
2 At the time, the department was still known as the Iowa Department of Human

Services. We use its current name to avoid confusion.
3

When police found the couple, the mother was slumped over while holding

the child. When the mother was removed from the vehicle, officers found a baggie

near the child with a substance that later tested positive for fentanyl. Given the

situation in which she was found, the child was at risk both of suffocation and

fentanyl exposure. Both the mother and her paramour were charged criminally

after this incident.

The State filed a petition to adjudicate B.S. as a child in need of assistance

(CINA) and temporarily remove the child from the mother’s care. At first, HHS

placed the child with the maternal grandfather for approximately one week, until

the grandfather tested positive for methamphetamine. After that, the child was

removed from his care and placed with the paramour’s parents (the “fictive

grandparents”).3

After the child was removed from the mother’s care, the mother underwent

substance-use and mental-health evaluations. She began participating in

intensive outpatient therapy and medication assisted treatment. The mother

completed a SafeCare program through Children and Families of Iowa. As the

mother progressed through her treatment, her visits with B.S. progressed from

supervised, to semi-supervised, to unsupervised. The mother was subject to

random drug screenings, which were negative.

3 “‘Fictive kin’ means an adult person who is not a relative of a child but who has

an emotionally positive significant relationship with the child or the child’s family.”
Iowa Code § 232.2(22) (2025).
4

Given the mother’s progress, on March 1, 2023, the juvenile court held a

permanency hearing, after which it ordered the child to be returned to the mother’s

care under HHS supervision. The court set a review hearing for June.

A little over a month later, however, HHS suspected the mother was under

the influence of a drug while acting as the sole caregiver for B.S. after it was

reported that the mother was disoriented, struggling to keep her eyes open, and

rambling while taking care of the child. The mother later tested positive for THC.

The child was again removed from the mother’s custody and placed with the fictive

grandparents.

At this time, the mother actively participated in services; she was able to

stay sober. Based on the mother’s demonstrated sobriety, in September, HHS

recommended that the child again be returned to the mother’s care under its

supervision. Soon after, the court approved the change in placement.

Unfortunately, concerns again arose about the mother’s substance use

approximately one month later. A safety plan was put in place so that the child

could remain in the mother’s care. One of the requirements of the safety plan was

that the mother was not to watch the child without supervision from her paramour.

A few days later, however, an HHS social worker saw the mother and maternal

grandfather in public without the paramour present. Given the maternal

grandfather’s substance-use issues, he was not a suitable supervisor of the mother

and B.S.

On November 3, the child was removed from the mother’s care a third time

after a service provider observed the mother, while the sole caretaker for the child,

stumbling and slurring her words. After this incident, the mother again tested
5

positive for THC. The mother later claimed that this behavior was due to a then-

undiagnosed thyroid issue, rather than a substance-use or mental-health issue.

The HHS social worker concluded that the mother was misusing her prescriptions

and had not been forthcoming to her healthcare providers about her methadone

use. The social worker was concerned that the mother’s lack of honesty regarding

her prescriptions led to the mother taking medications that interacted negatively.

The child was again placed with the fictive grandparents, and the mother went

back to supervised visits.

On April 8, 2024, the State filed its first petition to terminate the mother’s

parental rights. However, in the meantime, the mother continued attending

substance-use counseling. On July 8, the mother was successfully discharged

from substance-use counseling after completing the program.

On September 18, the juvenile court held a termination hearing. After the

hearing, the court determined that the State failed to meet its burden to show that

the mother had a severe substance-related disorder because the mother’s

counselor testified that the mother had maintained sobriety—with the exception of

positive THC tests—for over two years and she did not believe the mother had a

severe substance use related disorder at that time. According to the counselor,

the mother’s substance-use disorder was in remission.

The district court concluded:

Although the State has submitted evidence that the mother has a
substance abuse issue, there is a lack of evidence that her use has
been continued and repeated throughout this case. The mother has
tested positive on several drug tests, but these were spread out over
time (three in the last two and a half years) and there is insufficient
evidence that these are not isolated incidents. Furthermore, these
tests were positive for THC only. [HHS] also essentially stopped
6

testing the mother after the third removal. Finally, the mother has
been randomly tested through her probation and it has not been
reported by her probation officer that she has tested positive for any
controlled substance.

However, the court did express concerns about the reliability of the mother’s

counselor’s testimony:

The Court has significant concerns about the credibility of the
mother’s substance abuse counselor. She is clearly not a “neutral”
witness, insofar as she very clearly feels it is her role to advocate for
the mother. Nevertheless, much of what she testified to is not
contradicted by other credible evidence in the record. She testified
that at this point the mother does not have a diagnosable substance
abuse disorder and considers the mother in remission. The Court
finds that the State has not met its burden as to this ground.

Despite concluding the State had failed to meet its burden, the juvenile court

noted, “It is deeply unsettling to the Court to order reunification at this point in time,

and it [is] not without severe reservation that the Court comes to this conclusion.

However, given the statutory framework, the Court concludes it is the correct

choice, though not an easy one.”

The child was gradually placed back in the mother’s care as the mother

continued to demonstrate sobriety. The child was fully returned to the mother’s

care in January 2025. On March 31, the HHS social worker met with the mother

and discussed the possibility of closing the case. A review hearing was set for

April 9.

On April 3, however, the mother reached out to a friend of a friend to ask if

he had fentanyl. The person stated he did, and the mother went to meet him. The

man gave the mother a baggie of what looked like crushed-up, different-colored

pills. The mother took the substance in a parking lot then drove home to the

paramour and B.S. The next morning, the paramour, unaware that the mother had
7

ingested anything, found the mother unresponsive in the living room. He

administered Narcan, which was ineffective, and called 911. He did chest

compressions on the mother until the paramedics arrived. Unfortunately, the child

was present during this incident.

Paramedics arrived and took the mother to the hospital, where she

remained for several days, including spending time on a ventilator. Drug testing

at the hospital revealed the mother tested positive for amphetamines, opiates,

benzodiazepines, and methadone.4 The mother was not aware she had taken any

substance other than fentanyl. The mother later reported that she ingested the

powder because she was feeling depressed and did not have a good support

system. After this overdose, the child was removed from the mother’s care and

placed with the fictive grandparents for a fourth time.

After the mother’s release from the hospital, she reengaged with substance-

use treatment. She underwent a new substance-use evaluation and was

diagnosed with opioid use disorder, severe. The evaluation also recommended

individual and group therapy, mental-health therapy, and medication assisted

treatment.

On April 9, the State filed another petition to terminate the mother’s parental

rights under Iowa Code section 232.116(1)(l). In the meantime, the mother

continued participating in substance-use counseling and mental-health therapy.

Although the mother was initially resistant to mental-health therapy, after the April

4 The mother was taking a prescription at the time that could have resulted in a

positive test result for amphetamines. HHS reported, however, that the mother
had never tested positive for amphetamines in prior drug screens despite taking
this medication.
8

overdose, she acknowledged that she had mental-health issues she needed to

address. The mother also continued attending weekly visits with B.S.

The juvenile court held a hearing on the termination petition on June 17.

The court took judicial notice of the underlying CINA proceedings and the first

termination proceedings. The juvenile court heard testimony from the fictive

grandmother, the mother’s aunt, the mother’s paramour, the HHS social worker,

the mother’s substance-use counselor, and the mother. HHS and the child’s

guardian ad litem (GAL) recommended termination of the mother’s parental rights.

On April 12, 2025, the juvenile court terminated the mother’s parental rights

under Iowa Code section 232.116(1)(l). The mother timely appealed.

II. Standard of Review.

Our review is de novo. In re W.M., 957 N.W.2d 305, 312 (Iowa 2021).

“While we are not bound by the juvenile court’s factual findings, we accord them

weight, especially in assessing witness credibility.” In re J.H., 952 N.W.2d 157,

166 (Iowa 2020). “We will uphold an order terminating parental rights if there is

clear and convincing evidence of grounds for termination under Iowa Code

section 232.116.” In re D.W., 791 N.W.2d 703, 706 (Iowa 2010). “Evidence is

clear and convincing when there are no serious or substantial doubts as to the

correctness or conclusions of law drawn from the evidence.” Id. (cleaned up).

III. Analysis.

“We generally apply a three-step analysis to review termination of parental

rights.” In re L.B., 970 N.W.2d 311, 313 (Iowa 2022). First, we determine whether

the statutory ground for termination has been established. Id. If so, we next

determine whether termination is in the child’s best interests. Id. Finally, even if
9

we conclude termination is in the child’s best interests, we will nevertheless

consider whether any permissive exception to termination applies. Id.

The mother alleges the district court erred at every step in the analysis. We

will address each step in turn.

A. Statutory Grounds for Termination. The juvenile court terminated the

mother’s parental rights under Iowa Code section 232.116(1)(l), which provides

that the court may terminate parental rights when:

(1) The child has been adjudicated a child in need of
assistance pursuant to section 232.96 and custody has been
transferred from the child’s parents for placement pursuant to
section 232.102.
(2) The parent has a severe substance use disorder as
described by either of the following:
(a) The severe substance use disorder meets the
definition for that term as defined in the most current edition
of the diagnostic and statistical manual prepared by the
American psychiatric association, and the parent presents a
danger to self or others as evidenced by prior acts.
(b) The disorder is evidenced by continued and
repeated use through the case, the parent’s refusal to obtain
a substance use disorder evaluation or treatment after given
the opportunity to do so, and the parent presents a danger to
self or others as evidenced by prior acts.
(3) There is clear and convincing evidence that the parent’s
prognosis indicates that the child will not be able to be returned to
the custody of the parent within a reasonable period of time
considering the child’s age and need for a permanent home.

Iowa Code § 232.116(1)(l).

On appeal, the mother does not dispute that the State proved the first

element of section 232.116(1)(l). Instead, the mother disputes (1) that she has a

severe substance-use disorder as defined by the statute and (2) that the child

could not be returned to her custody within a reasonable period of time. The

mother argues that the evidence produced at the termination hearing showed that,
10

since the latest overdose, she had been making significant progress, reengaged

in services, including mental-health treatment, and recognized the changes that

needed to be made. According to the mother, “There was no evidence presented

that the [overdose] was not just an isolated incident.” For that reason, according

to the mother, there is no reason why the child could not be returned to her care

at the time of the termination hearing or within a reasonable period of time.

We conclude there is clear and convincing evidence that each of the

requirements of section 232.116(1)(l) has been met. First, regarding whether the

mother has a severe substance-use disorder, the mother’s most recent substance

use evaluation resulted in a diagnosis of F11.20, opioid use disorder, severe. The

mother received this diagnosis after she nearly died of an overdose after ingesting

an unknown pill powder she got from a friend of a friend. The mother’s diagnoses,

along with her drug use, provides clear and convincing evidence that the State

proved the mother has a “severe substance use disorder.” See In re L.H., 949

N.W.2d 268, 271 (Iowa Ct. App. 2020) (concluding there was clear and convincing

evidence of a severe substance-use disorder when “the mother was diagnosed

with F15.20 amphetamine type substance disorder, severe and F10.10, alcohol

use disorder, mild”); see also In re L.B., No. 21-0937, 2021 WL 3896359, at *3

(Iowa Ct. App. Sept 1, 2021) (concluding that there was clear and convincing

evidence of a severe substance-use disorder when the mother was diagnosed with

F11.20 opioid use disorder, severe, “coupled with her history of illegal drug

usage”).

Next, there is clear and convincing evidence that the mother is a danger to

herself as well as to B.S. if left alone in the mother’s care. Two of the four removals
11

in this case occurred after the mother was incapacitated by fentanyl while caring

for or in the presence of the child. The other two removals occurred after the

mother was suspected of being under the influence of drugs while caring for the

child. The mother’s most recent relapse was nearly fatal, and she was fully

incapacitated while B.S. was in her care and vicinity. Fortunately, the mother’s

paramour found her, administered Narcan, called 911, and was there to protect

the child. The mother spent days in the hospital, including some time on a

ventilator. The mother’s prior acts show that she is a danger to herself, and thereby

a danger to the child, who would be wholly reliant on the mother for care.

Finally, there is clear and convincing evidence that the child could not be

returned to the mother’s care at the time of termination or within a reasonable time

thereafter. At the termination hearing, when the mother was asked whether the

child could be returned to her care, she replied, “Yes. If I continue in treatment.”

As the juvenile court aptly noted:

The child has been removed from her mother’s care four times; she
demonstrates sobriety when the child is not in her care, and within
no more than three months of the child’s return, the mother has
consistently relapsed. The child is at a young age that the repeated
removals are traumatizing to her.

The mother has been unable to maintain her sobriety long term. While she can

remain sober when the child is not in her care, the mother has consistently

relapsed within three months of the child’s placement with her. J.H., 952 N.W.2d

at 171 (“[R]ather than speculate about what the future holds for” a parent, “it is

more accurate to look in the rear-view mirror and make a decision for [the child]

based on what has already happened.” (citation omitted)). We conclude the State
12

proved that B.S. could not be returned to her mother at the time of the termination

hearing or within a reasonable time thereafter.

Based on the foregoing, the State has shown the statutory grounds for

termination under Iowa Code section 232.116(1)(l) by clear and convincing

evidence. We next consider whether termination was in the child’s best interests.

B. Best Interests. The mother argues that termination is not in B.S.’s best

interests. We disagree.

“Even after we have determined that statutory grounds for termination exist,

we must still determine whether termination is in the [child’s] best interests.” In re

A.M., 843 N.W.2d 100, 112 (Iowa 2014) (citation omitted). “We ‘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.’” Id. (quoting Iowa Code § 232.116(2)). “[W]e

look to the child’s long-range as well as immediate interests, consider what the

future holds for the child if returned to the parents, and weigh the child’s safety and

need for a permanent home.” In re L.T., 924 N.W.2d 521, 529 (Iowa 2019)

(cleaned up). “It is well-settled law that we cannot deprive a child of permanency

after the State has proved a ground for termination under section 232.116(1) by

hoping someday a parent will learn to be a parent and be able to provide a stable

home for the child.” In re A.B., 815 N.W.2d 764, 777 (Iowa 2012) (citation omitted).

We conclude that termination of the mother’s parental rights is in the child’s

best interests. By all accounts, the mother is a good parent when she is sober.

And we do not doubt that the mother loves the child. However, she has

consistently demonstrated that she is incapable of maintaining sobriety so she can
13

safely parent B.S. on her own. See W.M., 957 N.W.2d at 314 (“This is exactly the

sort of case where we must not deprive a child of permanency on the hope Mom

will get better. Mom clearly loves her children. Yet, we cannot deprive these

children of a stable home on the hope that Mom will someday be able to succeed

in her efforts to remain sober.”); see also D.W., 791 N.W.2d at 707 (“We do not

gamble with the children’s future by asking them to continuously wait for a stable

biological parent, particularly at such tender ages.” (internal quotation marks

omitted)). B.S. has spent most of her young life in the care of her fictive

grandparents. The fictive grandparents have provided a safe and stable home for

the child, who has done well in their care. Both HHS and the GAL agreed that

termination was in the child’s best interests. Considering the child’s age, the

amount of time she has spent out of the mother’s care, the child’s need for

permanency and safety, and the mother’s inability to maintain sobriety, termination

is in B.S.’s best interests.

C. Permissive Exception to Termination. Finally, the mother argues

permissive exceptions to termination apply based on (1) the child’s placement with

a relative and (2) the strength of the parent-child bond. We decline to apply these

permissive exceptions to termination in this case.

“Once we have established that the termination of parental rights is in the

child[’s] best interests, the last step of our analysis is to determine whether any

exceptions in section 232.116(3) apply to preclude the termination.” In re M.W.,

876 N.W.2d 212, 225 (Iowa 2016). These exceptions “are permissive, not

mandatory.” A.M., 843 N.W.2d at 113. “[T]he parent resisting termination bears

the burden to establish an exception.” In re A.S., 906 N.W.2d 467, 476 (Iowa
14

2018). “We may use our discretion, based on the unique circumstances of each

case and the best interests of the child, whether to apply the factors in this section

to save the parent-child relationship.” M.W., 876 N.W.2d at 225 (cleaned up). In

any event, “[t]he child’s best interests always remain the first consideration.” In re

C.K., 558 N.W.2d 170, 174 (Iowa 1997).

Iowa Code section 232.116(3) provides, in relevant part,

The court need not terminate the relationship between the parent and
child if the court finds any of the following:
a. A relative has legal custody of the child.
....
c. There is clear and convincing evidence that the termination
would be detrimental to the child at the time due to the closeness of
the parent-child relationship.
....
Iowa Code § 232.116(3)(a), (c).

1. Relative placement. The mother first argues that termination is not in

B.S.’s best interests because she is in the care of a relative. We determine this

permissive exception is not applicable.

In this case, the child is not in the legal custody of relatives; HHS has legal

custody. And, in this context, a “relative” is defined as “an individual related to a

child within the fourth degree of consanguinity or affinity, by marriage, or through

adoption.” Iowa Code § 232.2(56). While the paramour was originally thought to

be the child’s father, paternity testing excluded him. The child is placed with the

paramour’s parents, the fictive grandparents. But here, they are not the mother’s

or the child’s biological relatives and custody is with HHS. For these reasons, this

permissive exception to termination does not apply.

To the extent the mother is seeking a guardianship, even if the child were

in a relative placement, we conclude that a guardianship is not preferable to
15

termination in this case. See In re B.T., 849 N.W.2d 29, 32 (Iowa Ct. App. 2017)

(“[G]uardianship is not a legally preferable alternative to termination.”); see also

A.S., 906 N.W.2d at 478 (discussing factors relevant to guardianship

determinations). With a guardianship in place, the fictive grandparents would then

be in the position to monitor the mother’s sobriety to protect the child from exposure

and we find termination best protects the child and achieves the stability the child

needs.

2. Closeness of parent-child bond. Next, the mother argues that

termination is not in B.S.’s best interests due to the closeness of the parent- child

bond. We disagree.

“We begin by noting that ‘love is not enough to trigger this exception.’” In

re L.B., No. 21-0937, 2021 WL 3896359, at *4 (Iowa Ct. App. Sept. 1, 2021)

(citation omitted). “The relevant consideration when assessing this exception is

not the parent's love for the child, but whether the child will be disadvantaged by

termination.” Id.; see also D.W., 791 N.W.2d at 709 (same).

At the time of the termination hearing, the child was three and one-half years

old. She had spent nearly three-fourths of her life living with her fictive

grandparents. The longest, continuous amount of time the child had spent with

her mother in her lifetime was three months, after which she was removed due to

her mother’s drug use.

At the termination trial, the fictive grandmother testified that each removal

had been more difficult for the child as she has grown older. The fictive

grandmother described the child’s behaviors, noting some anger issues and

confusion when the child transitioned back to their care after a removal from her
16

mother. After the most recent removal, B.S. told her fictive grandmother that her

mom did not wake up because she took the wrong medicine and was in the

hospital, showing she is becoming aware of the mother’s substance-use issues.

B.S. is doing well in her fictive grandparents’ care and has formed a bond

with them. And the fictive grandparents would like to adopt B.S. and have become

licensed to do so. Termination will allow the child to achieve the permanency she

deserves. See W.M., 957 N.W.2d at 315 (“We do not discount that there is a bond

between Mom and both boys. But Mom has failed to provide the clear and

convincing evidence necessary to show that, on balance, that bond makes

termination more detrimental than not.”).

The mother has not shown by clear and convincing evidence that

termination would be detrimental to the child. For that reason, we decline to apply

this permissive exception to termination.

IV. Conclusion.

Based on our de novo review of the juvenile court record, we conclude the

State proved by clear and convincing evidence the grounds for termination under

Iowa Code section 232.116(1)(l), termination is in the child’s best interests, and

that the mother did not meet her burden to prove a permissive exception applies

to prevent termination. We therefore affirm the decision of the juvenile court

terminating the mother’s parental rights to B.S.

AFFIRMED.