Opinion ID: 2259324
Heading Depth: 1
Heading Rank: 2

Heading: Circumstances of jeopardy

Text: [¶ 11] The guardian argues that the State made a showing sufficient to establish that, by withholding medical treatment, the mother subjected Nikolas to serious abuse or neglect. In attempting to intervene, the State invoked the Child and Family Services and Child Protection Act, which contains the following statement of purpose: Recognizing that the right to family integrity is limited by the right of children to be protected from abuse and neglect and recognizing also that uncertainty and instability are possible in extended foster home or institutional living, it is the intent of the Legislature that this chapter: 1. Authorization. Authorize the department to protect and assist abused and neglected children, children in circumstances which present a substantial risk of abuse and neglect, and their families. 2. Removal from parental custody. Provide that children will be taken from the custody of their parents only where failure to do so would jeopardize their health and welfare; 22 M.R.S.A. § 4003 (1992), amended by P.L. 1997, ch. 715, § B-4 (effective June 30, 1998). [¶ 12] The State's petition was brought as a child protection petition. [3] The court held a hearing on the petition pursuant to 22 M.R.S.A. § 4035(1) (1992), amended by P.L.1997, ch. 715, § A-7 (effective June 30, 1998). The statute requires the court, after hearing the evidence, to make a finding, by a preponderance of the evidence, whether the child is in circumstances of jeopardy to his health or welfare. 22 M.R.S.A. § 4035(2) (1992). Jeopardy to health or welfare or jeopardy is defined as serious abuse or neglect, as evidenced by ... [d]eprivation of adequate food, clothing, shelter, supervision or care, including health care when that deprivation causes a threat of serious harm. 22 M.R.S.A. § 4002(6)(B) (1992) (emphasis added). Serious harm is defined in part as serious injury. 22 M.R.S.A. § 4002(10) (1992). The State has the burden to prove by a preponderance of the evidence that a child is in circumstances of jeopardy. [¶ 13] In the present case, the court described the State's burden and its ruling as follows: The initial issue presented in this case is whether the decision of [the mother] to delay drug therapy for her son is rational and reasoned. The court feels that it is. The next issue is whether that decision, despite being the product of a reasoned approach, still places Nikolas's health or welfare in jeopardy by bringing about or threatening serious harm or depriving him of health care when that deprivation causes a threat of serious harm. A threat as intended in this context is an indication of imminent danger, harm, evil, etc.... It is the obligation of the petitioning Department in this matter to prove by a preponderance of the evidence that [the mother's] deprivation of reasonable and effective health care for her son by now refusing to enter him into HIV/AIDS aggressive drug therapy constitutes an imminent threat of serious harm. The Department has proven that according to the current conventional medical wisdom in the relatively new and rapidly evolving art of treating children with certain elevated levels of HIV in the blood, that Nikolas would benefit from such treatment. However, it has not sufficiently prove [sic] what that benefit will likely be and that no significant injury or harm may ultimately befall the child if that therapy is now commenced. . . . [W]ith the relative uncertainty of the efficacy of the proposed treatment, it can only reasonably be left up to the parent to make an informed choice in this regard. (emphasis added). [¶ 14] The State did not file an appeal in this matter and concedes that the evidence that it presented at the hearing would support a ruling either way on the issue of jeopardy. In its brief as appellee, however, it questions whether the court may have interjected erroneously the issue whether the mother's decision to delay drug therapy is rational and reasoned. The guardian argues on appeal that the court erred in applying the legal standard in three other respects: First, in framing the issue of whether the acts of the mother threatened serious harm, the court erroneously added the concept of imminence; second, by adding a requirement that the State prove that no significant injury or harm would befall Nikolas if the treatment plan were implemented; and, third, by failing to address the best interests of Nikolas, focusing instead on the mother's interest, vis-a-vis the State. [¶ 15] The State's argument with reference to the finding that the mother's decision is rational and reasoned establishes no legal error. Although we have stated that the statute is designed to protect children from circumstances that threaten serious harm, and the defined interest of the state is not confined to those circumstances that are the fault of the parent, In re Shawn H., 667 A.2d 1377, 1379 (Me.1995), the court's remarks were appropriate within the context of the evidence. Dr. Milliken opined that the mother was incapable of managing her son's medical care. Perhaps because of her own illness and the unsuccessful treatment of her daughter, she undoubtedly exercised an unusual degree of independence and skepticism in medical decision-making. Dr. McIntosh, on the other hand, observed no irrationality on the part of the mother. In resolving this factual disagreement, the court did not elevate the finding to a statutory requirement. It made a subsidiary factual finding to permit a fair evaluation of the conflicting evidence. In any event, the court proceeded to qualify the question of rationality by stating the next issue is whether that decision, despite being the product of a reasoned approach, still places Nikolas's health or welfare in jeopardy. Thus, the determination that the mother's decision was rational and reasoned assisted the court in evaluating the evidence and resulted in no misapplication of the law. [¶ 16] Both the guardian and the State argue that the court erroneously required that the threat of harm to Nikolas be imminent. Threat is not defined in the statute. The court defined threat as requiring an indication of imminent danger. The State argues that the requirement of imminence connotes an immediate risk of serious harm that is the basis for requesting a preliminary protection order pursuant to 22 M.R.S.A. § 4034(2) (1992), prior to a hearing on the final protection petition. Accordingly, to require immediate harm in both the preliminary petition and the final petition would fail to recognize the separate and distinct purposes of each request. Further, in In re Jeffrey E., 557 A.2d 954 (Me.1989), we explained that [i]n order for a court to take into account the special medical needs of a child, a present medical emergency need not exist, nor does such a medical emergency have to be imminent or even certain to recur. Id. at 956. It follows then that, if the medical emergency need not be imminent, any harm relating thereto need not be imminent, and, in fact, the Child Protection Act contains no requirement that the harm be imminent. [¶ 17] In the present case, however, the court was called upon to decide whether it should override the mother's decision to wait and see if Nikolas's health began to deteriorate significantly before accepting treatment. The court's failure to find that the mother subjected her son to an imminent threat of serious harm must be considered in connection with the court's conclusions regarding the efficacy of the proposed drug therapy. In effect, the court was unpersuaded by the evidence that the mother was subjecting her son to a serious risk of harm merely by delaying the decision to accept a course of treatment of uncertain efficacy. [¶ 18] Similarly, with respect to the guardian's argument that the court added a requirement that the State prove that no significant harm would ultimately befall Nikolas from the treatment, we find that the court did not treat this conclusion as a required element of proof pursuant to the statute. It appropriately considered the effectiveness and safety of the treatment as one of the subsidiary factual issues in its determination of jeopardy. [¶ 19] Although the court did not explicitly articulate and discuss all of the competing interests  the interests of the parent, the interests of the state, and the best interests of the child  and did not expressly balance the benefits and risks of treatment against the benefits and risks of delaying treatment, the court's findings implicitly reflect that the appropriate factors were weighed. The court found, for example, that although the State produced opinion evidence that Nikolas would benefit from treatment, the State did not produce evidence to persuade the court that there was a quantifiable benefit. The court also was unable to determine the likely effects of the treatment on the child. The court accepted as accurate that the drugs used in the therapy are very potent and cause often unpleasant side effects. The court also found that the State was unable to produce evidence of the likely long-term side effects because the treatment is essentially new and experimental. The court also found that removal of Nikolas from his home would have a severe and detrimental effect on his well-being. Implicit in the court's conclusion that the mother's decision does not constitute serious parental neglect is the express finding that the court is unpersuaded of the overall efficacy of the proposed treatment despite the recommendations of the physicians. Thus, the court did not apply an improper legal standard in reaching its decision. [¶ 20] The guardian argues that the evidence compels the conclusion that the medical treatment is beneficial and that the mother's refusal constitutes jeopardy. She argues that the court's finding that the mother's refusal is rational and reasoned is contrary to the weight of the evidence and that the court plainly erred in assessing the evidence concerning the treatment of AIDS. [¶ 21] We review the court's factual findings for clear error. Because the court based its decision on a determination that the State failed to establish sufficient facts to support its petition and because the State bears the burden of proof, [s]uch a determination may be reversed on appeal only if the evidence in support of the [petition] was of such a nature that the factfinder was compelled to believe it and to draw therefrom the requested inference to the exclusion of any other. Luce Co. v. Hoefler, 464 A.2d 213, 215 (Me.1983). In this case, although there was evidence that would support the guardian's argument that Nikolas was in circumstances of jeopardy, the evidence does not compel such a finding to the exclusion of any other. The credibility and weight of the evidence is within the province of the factfinder. [¶ 22] Viewing Dr. McIntosh's testimony as the strongest evidence offered in favor of the State's position, it falls short of compelling a finding of serious child abuse or neglect. Even though there is significant evidence from Dr. McIntosh that he believes, based on the clinical trials, his expertise in this field, and his examination of Nikolas, that Nikolas would benefit from this treatment, there is also competent evidence from Dr. McIntosh that the theories on AIDS are still evolving, that this treatment has not been given for a long period of time, that the information on effects and prognosis are being studied on the children receiving treatment and therefore the longterm effects cannot be identified and that, although he believes a cure along the same lines as the present therapies is not likely, a person could lessen the chances of getting a good response to subsequent medications because of a resistance that could be built up from the therapy in question. The State concedes that Dr. McIntosh's testimony alone is sufficient to support either factual conclusion. We agree. Thus, the court was not clearly erroneous in remaining unpersuaded that jeopardy had been established. [¶ 23] We emphasize that the decision required the trial court to weigh the interests of the State, the child, and the parents, and to balance the benefits and risks of treatment against the benefits and risks of declining treatment. If the child's health should change, if the treatment efficacy should be demonstrated to be better than it is now known to be, or if better treatment options should become available, that balance could shift in favor of treatment. Neither the parents nor the State should assume that the trial court's decision, affirmed by our opinion today, is necessarily the final word on treatment for Nikolas. The entry is: Judgment affirmed.