Opinion ID: 2265769
Heading Depth: 4
Heading Rank: 1

Heading: Nutritional supplements may be considered a health care expense.

Text: According to the child support order, Matthew and Carol Jean must each pay half of the child's reasonable health care expenses not covered by insurance. [12] The child support order states health care expenses includ[e] medical, dental, vision and mental health counseling expenses. Further, the child support order cites to Civil Rule 90.3, which defines health care expenses almost identically. [13] Because health care expenses is not a technical term, we interpret it according to the rules of grammar and according to [its] common and approved usage. [14] We have endorsed a broad, inclusive view of what constitutes health-related expenses for purposes of child support. [15] Because the child support order and Rule 90.3 both clarify health care expenses using an enumerated listmedical, dental, vision, and mental health counselingthere is a preliminary question of whether that list is exclusive. It is not. We interpret enumerated lists beginning with including or includes to be non-exclusive, as if the word were followed by the phrase `but not limited to.' [16] Our case law has extended the same logic to include and included. [17] Thus, because the child support order's list begins with including and 90.3's list begins with include, [18] these lists are illustrative, not exclusive. Accordingly, we address whether nutritional supplements are a health care expense, and do not attempt to determine whether supplements are medical, dental, vision, or mental health counseling expenses. As noted above, we have interpreted health care expenses broadly in the child support context. [19] In Cedergreen v. Cedergreen, [20] before Rule 90.3 addressed health care expenses, [21] we upheld a superior court's broad, inclusive interpretation of the contract term medical and dental expenses. [22] We ultimately concluded that counseling, travel expenses, contact lenses, and braces were all medical and dental expenses. [23] However, we have never addressed the precise question of whether nutritional supplements qualify as health care expenses for the purposes of child support. To the extent cases from other jurisdictions are relevant, they suggest that supplements may be a health care expense if they are subject to professional oversight or if they produce demonstrated health benefits. Addressing a workers' compensation claim, a Florida appellate court concluded that nutritional supplements were a reimbursable medical expense when they were taken on the advice of a doctor and noticeably beneficial, despite the health care plan's exclusion of vitamins. [24] In a bankruptcy case from Vermont, the federal court granted an allowance for vitamins where the debtor testified they had been a sound, prophylactic measure for maintaining the Debtor's health. [25] A Mississippi court calculating the custodial parent's expenses in order to determine child support made a line item calculation for medical, dental, drugs, and vitamins. [26] And in a divorce decree a Connecticut court took notice of a wife's preference for vitamins and supplements rather than prescribed medication when awarding child support and alimonyalthough the degree to which the preference influenced the award is not stated. [27] Similarly, this case involves supplements purchased directly from the clinics treating the autistic child and the charges appear on invoices from the clinics. Some of the invoices for supplements also include charges for appointments. The invoices show the child as a patient. Those invoices from Natural Health Center list a naturopathic doctor, Adam Grove. The invoices, although not listing a doctor, include charges for appointments in addition to supplements. Carol Jean's affidavit states that the charges on the invoices were medically necessary . . . as a result of [the child's] [a]utism. Accordingly, the present case contains many of the factors relied on by other courts to conclude that the cost of supplements is a health care expense. Consistent with our broad interpretation of health expenses for child support, [28] and other courts' inclusion of nutritional supplements in health care expenses, it was not erroneous for the superior court to consider nutritional supplements to be a health care expense, particularly when the supplements are recommended by, and purchased from, a health care practice. Matthew's argument that paying for supplements is part of the custodial parent's responsibility for nutrition, and so should be paid for from regular child support payments, is unpersuasive. There is no indication that these supplements are needed because the child is not being fed properly. Rather, the evidence shows that the supplements were used to treat a medical problem. The bills in question show the expenses were incurred at clinics and include items such as evening primrose oil, zinc citrate, and methyl B12. In other words, the charges do not appear to be for routine, daily multi-vitamins, as one might purchase at the grocery store to supplement nutrition. Matthew's other points about diet and nutrition are similarly unpersuasive. First, he defines supplement as something that completes or makes an addition. He is correct that nutritional supplements generally enhance nutrition, but that does not show that they are part of a normal diet that Carol Jean should be providing. Second, even if regular child support is meant to cover everyday nutrition and dietary needs, Matthew does not show that regular support is also meant to cover special diets, or that special diets are not medical expenses. Third, he seems to mistake the diet his child eats with the nutritional supplements his child takes. He points out that a medical study found no difference in autistic children who avoided gluten and casein, and those who did not. That evidence might be relevant were the mother billing the father for grocery items such as gluten-free bread, but here there has been no dispute over such food expenses nor any claims that the child's special diet necessitates supplements. [29] Indeed, Matthew states that there is no evidence that the nutritional supplements (vitamins) [are needed] because of this diet.