Thread: Pediatric Court Orders

It is just after 11 PM on a Saturday and the phone rings. You are contacted by the anxious parents of a child who has been transferred to the Neonatal Intensive Care Unit of the regional medical center. They inform you that the Department of Social Service in seeking an emergency court order to transfuse. The trial will be held in three hours. On a practical level, how can you help this family? Can stipulations be made in the order that would encourage bloodless management? What has worked in some instances?

Read more...

at least there is a trial! I've seen where the court order is faxed from the judges office back to the hospital and then the parents are informed. I would get legal representation ASAP although 3 hrs. is indeed a challenge. Is the judge aware of any alternatives? another NICU that is better equipped to handle this case and is willing to accept the patient?

If it is Saturday evening you would be waking a judge up at home, the court order would be issued and the transfusion given before court Monday morning. To help the family, anemia needs to be prevented before it happens, but there are times when there is no way around a blood transfusion for NICU babies. Each state has different laws dealing with this issue. Example: Michigan laws states that a parent refusing blood for a religious reason is not view as child abuse, so we do not need to get protective services involved when obtaining a court orders. Parents do have a right to go before the judge, but no judge is going to allow a [B]newborn [B][to die. As a pediatric blood avoidance service we are involved with the mother before delievery and continue care until the baby is D/C. Babies in the NICU are usually very ill with many problems so each hour after birth is critical that a bloodless program is involved with the babies care.

Rob, thanks for your thoughts. That intro was hypothetical and meant to capture attention, but perhaps you would agree that when children get sick, it is usually on a weekend or late at night!

In the typical situation, the judge knows nothing about bloodless management of sick neonates, and takes verbatim the advice of the neonatologist(s) that request the order. The parents will not be able to produce comparable experts, but certainly can get constraints put on the order.

Transfer is certainly an option. The first time I went to court over a neonate, this was about 20 years ago in Manhattan, the judge decided against the family. A few hours later a transfer was arranged!

Since then, managed care constraints & legal (EMTALA) considerations make transfers a little tougher. Besides, there are only a handful of pediatric bloodless programs in the US. (Probably we should start a list on the site somewhere.) A micro-premie on high vent settings might not handle a long flight too well.

But if the baby was in Michigan, where Cecilia works, it would certainly be prudent to get that infant to DeVos Childrens Hospital. They hosted the 4th national conference on pediatric bloodless care last year ([media]http://www.devoschildrens.org/ContentStore/BAS_SaveDate2007.pdf[/media] )

I have been with HLC from the beginning 20+ yrs. ago. This info is extremely helpful.

Agape

Richard Avis

Well done! Thank you so much for this posting! I work for a bloodless surgery program in the NW; we currently have a Pediatric Policy in place and are working to implement the program at our regional children's hospital. I am enclosing a few links regarding a 14 year old boy that died of leukemia last November 2007. The child's legal guardians were his aunt and uncle. The parents had been out of the picture for some time. The matter was brought before a judge who sided with the patient and did not force the transfusion. The links are posted below.


http://www.king5.com/localnews/north/stories/NW_112907WAB_transfusion_boy_dies_SW.4e4b0d2f.html
Young Jehovah's Witness who refused blood transfusion dies


http://www.king5.com/localnews/north/stories/NW_112807WAB_leukemia_jehovahs_transfusion_TP.4a60 000d.html
Boy who refused blood transfusion dies

Sorry to hear about Dennis. 20 days from diagnosis to death!
-Do you recall his hgb and plts counts at admission & before death?
-Was induction chemo modified in any way, given anticipated nadirs?

Yes, very unfortunate indeed. This took place in a town further north. I do not know what his lab values were at the time; nor the treatment plan. Being a JW myself, I was very impressed that Dennis had the knowledge and conviction to take a stand and maintain it under such pressure.

Since you asked for examples of court decisions from different countries.

I read about a court case in the High Court of Dublin in Ireland in 2008 where the doctors took a pregnant Witness woman and her husband to court because their twins were severely anemic. They wanted to use blood when they were born.

The woman said that she understood the seriousness of the situation and was not trying to harm her children, but she could not consent to blood due to her religious beliefs. She only asked that the doctors try alternatives options first and only use blood as a last resort. The justice said that the doctors should try to work with the parents and ordered that blood may be used if medically necessary when no other alternatives or methods were available.


http://news.bbc.co.uk/2/hi/uk_news/n...nd/7365724.stm

I read another story that discussed more of what the judge said but I'm not sure where.

It was not a case conserning blood transfusions but in 1979 the New York Court of Appeals ruled:

“The most significant factor in determining whether a child is being deprived of adequate medical care . . . is whether the parents have provided an acceptable course of medical treatment for their child in light of all the surrounding circumstances and have provided reasonable alternatives. This inquiry cannot be posed in terms of whether the parent has made a ‘right’ or a ‘wrong’ decision, for the present state of the practice of medicine, despite its vast advances, very seldom permits such definitive conclusions. Nor can a court assume the role of a surrogate parent.”—In re Hofbauer.

This was along time ago around 1974.

The Pennsylvania Supreme Court ruled that the wishes of a polio-crippled 17-year-old boy should be considered in support of his mother’s refusal to allow an operation using blood transfusions. American Medical News reported that “at the hearing, the boy answered all questions without hesitation and seemed to understand both the benefits that he might receive from the surgery and the possible consequences of not having it.” The court found that, under the law, he was not a neglected child and dismissed the petition to appoint a guardian who would allow transfusions.

good references, thank you