Court Opinion

ID: 9897466
Source: CourtListenerOpinion
Date Created: 2023-11-14 19:14:23.575134+00
Date Added: 2024-06-11T09:14:28.592115
License: Public Domain

939 Nev., Advance   opinion 39
                       IN THE SUPREME COURT OF THE STATE OF NEVADA

                BROOKE WESTLAKE KELLEY,                                  No. 84685
                Appellant,
                vs.                                                      HLED
                SCOTT G. KELLEY,
                Respondent.

                            Appeal from a district court order in post-divorce decree custody
                litigation awarding a parent sole legal custody for the limited purpose of
                vaccinating a minor child against COVID-19.        Second Judicial District
                Court, Family Division, Washoe County; Frances Doherty, Sr. Judge.
                            Affirmed.

                Attorney Marilyn D. York, Inc., and Marilyn D. York and Chloe L.
                McClintick, Reno,
                for Appellant.

                Scott G. Kelley, Sparks,
                Pro Se.

                BEFORE THE SUPREME COURT, EN BANC.'

                                                OPINION

                By the Court, STIGLICH, C.J.:
                           The best-interest-of-the-child standard is ubiquitous in child
                custody rnatters, and the Legislature and this court often guide such

                      'The Honorable Ron Parraguirre, Justice, voluntarily recused himself
                and thus did not participate in the decision of this matter.
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                    analysis by providing factors for district courts to weigh in making best-
                    interest determinations. We now hold that when parents with court-
                    ordered joint legal custody of a minor child disagree on medical decisions
                    concerning that child, the district court breaks the tie by determining which
                    course of action is in the child's best interest. Because district courts lack
                    guidance on how to apply the best-interest-of-the-child standard in this
                    context, we adopt nonexhaustive factors for district courts to consider in
                    making such determinations: (1) the seriousness of the harm the child is
                    suffering or the substantial likelihood that the child will suffer serious
                    harrn; (2) the evaluation or recommendation by a medical professional;
                    (3) the risks involved in medically treating the child; and (4) if the child is
                    of a sufficient age and capacity to form an intelligent preference, the
                    expressed preference of the child.
                                Here, divorced parents with joint legal custody disagreed on
                    whether their 11-year-old child should be vaccinated against COVID-19.
                    The district court found that vaccination was in the child's best interest
                    based on the child's pediatrician's recommendation and government and
                    professional groups' guidelines and research results. Although the district
                    court did not have the benefit of express factors to weigh, we conclude the
                    district court did not abuse its discretion in finding vaccination in the child's
                    best interest because consideration of the other factors would not change
                    the result in this case. Accordingly, we affirm.
                                    FACTS AND PROCEDURAL HISTORY
                                When appellant Brooke Westlake Kelley and respondent Scott
                    G. Kelley divorced, they stipulated to joint legal custody of their two minor
                    children, G.W.-K. and A.W.-K. Specifically, Brooke and Scott agreed to
                    "confer on all matters regarding the medical care of the children, including

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                    medical, dental, orthodontic, [er] surgical [decisions]." However, the parties
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                disagreed on whether to have the children vaccinated against COVID-19.
                Scott wanted to vaccinate the children in preparation for international
                trips, but Brooke disagreed, citing the vaccine's novelty and unknown long-
                term effects. Scott then moved the district court for an order compelling
                Brooke to allow the children to be vaccinated, arguing that vaccination was
                in the children's best interests. Brooke opposed the motion but did not
                object to the best-interest-of-the-child standard.
                            At the time of the dist.rict court's evidentiary hearing on the
                matter, G.W.-K. was 11 years old (almost 12), and A.W.-K. *as 3 years old.
                The parties submitted a recommendation from the children's pediatrician
                indicating that G.W.-K. should be vaccinated, but not A.W.-K., who was too
                young to be eligible for the vaccines available at the time. Additionally,
                Scott and Brooke testified. Scott testified that he believed it was in the
                children's best interests to be vaccinated based on the pediatrician's
                recommendation and the risk of illness he saw the COVID-19 pandemic
                pose. Brooke testified that she did not want the children vaccinated for
                several reasons: (1) the children were young and healthy, (2) the COVM-19
                vaccine was new and there were no studies on its effectiveness, (3) she got
                the vaccine but nonetheless still got sick with COVID-19, (4) she worried
                the vaccine could affect the fertility of her children, and (5) the vaccine may
                impact G.W.-K.'s behavior in a negative way. She also testified that she
                believed that the COVID-19 pandemic was no longer a medical emergency,
                given that, by the time this issue arose, mask and vaccine mandates had
                been lifted. In closing, Brooke's counsel for the first time raised the prospect
                of a "medically necessary" standard. She argued that "fflypically,
                Court uses medically necessary as the terminology when we are talking
                about recommendations." She continued that "[w]hat. we are not seeing is

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                this doctor say is that the COVID vaccine for these children or particularly,
                [vaccination for G.W.-K.) is medically necessary."
                             The court took judicial notice of the Centers for Disease Control
                and Prevention (CDC) and American Academy of Pediatrics (AAP)
                guidelines and research from those organizations regarding the safety of
                the COVID-19 vaccine, accepted the pediatrician's recommendations, and
                orally ruled that it was in G.W.-K.'s best interest for the vaccination to go
                forward. 2   After the oral ruling, Brooke's counsel inquired for• a point of

                clarification as to . whether "medically necessary" was the applicable
                standard. The court answered that the best interest of the child controlled..
                A written order followed, awarding Scott "sole legal custody to act singularly
                to obtain the COVID vaccine" for G.W.-K. Brooke appeals, arguing that the
                diStrict court erred in failing to apply a "inedically necessary" standard and
                alternatively that the court did not properly analyze G.W.-K.'s best interest.
                                               DISCUSSION
                The best-interest-of-the-child standard applies
                             Brooke argues that the district court :infringed her fundamental
                right to the care, custody, and control over her child by applying the be
                interest-of-the-child standard.   Rather than the best-interest standard,

                Bro.oke contends that the district court should have applied -a medically
                necessary standard derived from NRS 695G.055.

                      2 0n appeal, Brooke briefly argues that the district court should not
                have taken judicial notice of the CDC and AAP guidelines. She did not
                object below, so this argument is waived. See Old Aztec Mine, Inc. v..Brown,
                97, Nev. 49, 52, 623 P.2d. 981..983 (1981.) CA..point not urged•in the trial
                court, unless it goes to the jurisdiction of that court, is deemed to have been
                waived and will not be considered on appeal."). We note that courts in other
                jurisdictions have taken judicial notice of CDC and AAP guidelines
                regarding vaccinations. See, e.g., Brown v. Smith, 235 Cal. Rptr. 3d 218,
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                223 (Ct. App. 2018).
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                            Although Brooke failed to preserve a challenge to applying the
                best-interest-of-the-child standard by neglecting to raise it until after the
                district court's oral ruling, we exercise our discretion to con.sider and clarify
                this.constitutional issue. See Barrett v. Baird, 111 Nev. 1496, 1500, 908
                P.2d 689, 693 (1995) (electing to consider a constitutional issue for the first
                time on appeal notwithstanding the failure to object below), overruled on
                other grounds by Lioce v. Cohen, 124 Nev. 1, 17, 174 P.3d 970, 980 (2008).
                Whether the district court applied the.correct legal standard and whether
                such standard infringes on a fundamental right are questions of law We
                review de novo. Lawrence v. Clark County. 127 Nev. 390, 393, 254 P.3d 606,
                608 (Dill) (constitutional interpretation); Staccato v. Valley Hosp., 123
                Nev. 526, 530, 170 P.3d 503, 505-06 (2007) (correct legal standard).
                            Parents have a fundamental right to manage the "care, custody,
                and control of their children." Troxel v. Granville, 530 U.S. 57, 65 (2000).
                When divorced parents have joint legal custody, they are both responsible
                for making decisions regarding the children's health, education, and
                religious upbringing. Rivero v. Rivero, 125 Nev. 410, 420, 216 P.3d 21.3, 221
                (2009), overruled on other grounds by Romano v. Rornano, 138 Nev. 1, 4, 501
                P.3d 980, 983 (2022). Generally, when parents agree on how to raise th.eir
                children, courts may not interfere. Arcella v. Arcella, 1.33 Nev. 868, 870,
                407 P.3d 341, 344 (2017). But when parents with court-ordered joint legal
                custody disagree on a parenting decision, "the.n the parties may appear
                before the court Cm an. equal footing to have the court decide what is in the
                best interest of the child." Rivero, 125 Nev. at 421, 21.6 P.3d at 221-22
                (internal quotation marks omitted). And in a custody dispute, the district
                court may enter "an order for the custody, care, education, maintenance and •

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                support of the minor child as appears in his or her best interest." NRS
                125C.0045(1)(a).
                            We hold that a parent's constitutional interest in the care,
                custody, and control of their child is not infringed when the district court
                settles a dispute between parents with joint legal custody under the best-
                interest-of-the-child standard. It is presumed that parents make health-
                related decisions for their children with the children's best interests in
                mind. See NRS 125C.002(1) (stating presumption that joint legal custody
                is in a child's best interest); Rivero, 125 Nev. at 420, 216 P.3d at 221
                (recognizing that legal custody involves making healthcare decisions for a
                child and that joint custody requires that parents act in the child's best
                interest).   When the parents, who have equal constitutional rights
                concerning the care of their children, disagree on what is in the children's
                best interests, the court decides. Rivero, 125 Nev. at 421, 216 P.3d at 221-
                22. 'Basing a decision on what is "medically necessary" alone goes beyond
                breaking a tie, then, and could infringe a parent's rights to control by
                requiring a higher showing—that something is or is not "medically
                necessary." See Mack v. Ashlock, 11.2 Nev. 1062, 1065-66, 921 P.2d 1258,
                1260-61 (1996) (stating that the court's sole consideration in custody
                disputes is the child's best interest and rejecting a standard other than best
                interest by a preponderance of the evidence).
                             Our decision in Arcella is analogous. There, divorced parents
                with joint legal custody disagreed on whether to send their child to a
                religiOus private school or a local public school. 133 Nev. at 369, 407 P.3d
                at 344. The mother objected to her child receiving a religious education. Id.
                In light of the mother's objection, the district court ordered the child to
                attend the public school. Id. This court held that "a district court does not
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                        violate the First or Fourteenth Amendments by ordering a child to attend a
                        school over a parent's religious objection." Id. at 871, 407 P.3d at 345. To
                        the contrary, a district court must order a child to attend a religious school
                        over a parent's objection if attending the religious school is in the child.'s
                        best interest. Id. Although Areella addressed the First Amendment rather
                        than substantive due process (from which.the fundamental i.nterest in the
                        care; custody, and control of a child arises),. if a courtcan override a parent's
                        religious objection if attending a religious school is in the 'child's best
                        interest, similarly, •a district court May override a parent's objection to
                        vaccination if vaccination iS in the child's best interest.
                                       Other jurisdictions siniilarly hold that wh.ere parents with joint
                        legal custody disagree on an issue related to the.. child's upbringing, the
                        court's resolution based on the best interest of the child does not contravene
                        the complaining parent's fundamental rights regarding the care, custody,
                        and . 'control of the child. For example, the Arizona Court. of Appeals .in
                        Jordan 1 Rea observed that although each parent has a con.stitutional right
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                        to control the upbringing of their child, where the parents seek to exercise
                        those rights in a conflicting manner, "there is no usurPation. by the court of
                        either parent's constitutional rights" when "the court is called upon to
                        res'Ave that conflict." 212 P.3d 919, 927 (Ariz. Ct. App". •2009) (a.pPlying a
                        best-interest standard when parents are unable to• agree on choice of
                        [ichool). The Alabama Colirt of Appeals likewise recognized that ."a court
                        may apply the best-i.nterests standard in a custody dispute between •such
                        parents [sharing joint legal. custody] without implicating the Fourteenth
                        Amendment due-process rights of eithe-f parent," Morgan u. Morgan, 964
                        So. 2d 24, 31' (Ala. Civ. App. 2007), and the New Hampshire Supreme Court
                        applied this logic in rejecting an argument t.hat strict scrutiny applies when

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                a district court adjudicates a child's best interest even though it involves a
                parent's fundamental right to make decisions about the child's upbringing,
                In re Kurowski, 20 A.3d 306, 317 (N.H. .2011). Relevantly, various courts
                across the country have applied the best-interest-of-the-child standard
                where parents with joint legal custody disagree over vaccinating a. minor
                child.3 Accordingly, we conclude that the district court did not err in
                considering the vaccination issue under the best-interest-of-the-child
                standard.
                            Insofar as Brooke relies on NRS 695G.055, a provision in the
                chapter on managed care, that statute defines 'medically necessary" for
                insurance purposes. See, e.g.; NRS 422.27179(1)(a)(2) & (3)(a) (mandating
                Medicaid coverage when "medically necessary" and referring to NRS
                695G.055 for the meaning of that term); NRS 687B.740 (prohibiting an
                insurance provider from enticing healthcare providers to deliver services
                less than what is "medically necessary").        In the .insurance context,

                      3 See, e.g., A.R. v. J.A., No. CK14-01551, 2022 WL 11121330, at *3
                (Del. Fam. Ct. Sept. 14, 2022) (holding that the mother's position to
                vaccinate her child against COVID-19 aligned with the best interest of the
                child); Nieber v. Nieber, No. A20-0616, 2021 WL 1.525184, at *2 (Minn. Ct.
                App. Apr. 19, 2021) (confirming that the best-interest standard applies
                where parents with joint custody disagree on vaccination); J.F. v. D.F. 160
                N.Y.S.3d 551, 556-57 (N.Y. Sup. Ct. 2021) (finding vaccination t.o be :in a
                child's best interest); L.L.B. u. T.R.B., 283 A.3d 859, 864 (Pa. Super. Ct.
                2022) (holding the district court properly applied the best-interest stan.dard
                in resolving an impasse between parents with joint custody who disagreed
                on COVID-19 vaccination); In re A.J.E., 372 S.W.3d 696, 699 (Tex. App.
                2012) (holding that resolving a. dispute between parents wit.h joint custody
                regarding immunizations under the best-interest-of-the-child standard does
                not infringe a fundamental right because the government is not overriding
                the will of parents who agree on a medical decision or . a sole parent's
                decision).
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                     medically necessary means "health care services or products that a prudent
                     physician would provide to a patient to prevent, diagnose or treat an illness,
                     injury or disease." NRS 695G.055. Brooke has not shown that this standard
                     applies in family law contexts. Further, we see no justifiable reason to shift
                     the inquiry away from the best interest of the child in favor of the prudent
                     physician. As discussed below, we hold that a medical professional's
                     recommendation is a factor in deterrnining the best interest of the child, but
                     it is not the sole or necessarily conclusive factor.
                     Factors to consider in determining the best interest of the child
                                 Alternatively, Brooke argues that the district court abused its
                     discretion in applying the best-interest-of-the-child standard. She points
                     out that the district court did not analyze the best-interest factors laid out
                     in NRS 125C.0035(4). She also contends that the district. court erred in
                     simply accepting the pediatrician's recommendation as in G.W.-K.'s best
                     interest.
                                 When a district court applies the best-interest-of-the-child
                     standard, this court reviews its determination for an abuse of discretion.
                     Mack v. Ashlock, 112 Nev. 1062, 1065, 921 P.2d 1258, 1261 (1996); Waiktce
                     u. Wallace, 112 Nev. 1015, 1019, 922 P.2d 541, 543 (1996).               NRS
                     125C.0035(4) provides factors that a court must consider in determining a
                     child's best interest in an action to decide physical custody. Monahan v.
                     Hogan., 138 Nev. 58, 62, 507 P.3d 588, 592 (Ct. App. 2022). It does nOt
                     necessarily control other types of best-interest-of-the-child analyses. Id. at
                     62-63, 507 P.3d at 592 (recognizing that additional factors may be Salient
                     in determining whether relocation serves a child's best interest). This court
                     has provided best-interest guidance in different instances. For example,
                     this court adopted factOrs tailored to education for the district court to

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                     consider in determining what school a child should attend, without
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                        reference to the NRS 125C.0035(4) factors. Arcella, 133 1..q.ev. at 872-73, 407
                        P.3d at 346-47. And the court has adopted a different list of considerations
                        in a dispute regarding naming a child. Petit v. Adrianzen, 133 Nev. 91., 94-
                        95, 392 P.3d 630, 633 (2017).
                                    Here, the district court did not make any decisions regarding
                        joint physical custody, and thus the court did not need to weigh the NRS
                        1.25C.0035(4) factors. Indeed, the NRS 125C.0035(4) factors appear largely
                        irrelevant in deciding Whether vaccination is in a child'S- best interest. See,
                        e.g., NRS• 125C.0035(4)(d) ("the level -of conflict betWeen the •parentS") '&
                        (4)(j) ("Mny history of parental abuse or neglect of the Child"): In light of
                        the foregoing, the district court was not bound to apply the NRS
                        125C.0035(4) factors in determining whether Vaccination agaihsi COVID-
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                        19 -Was in G.W.-K.'s best interest.
                                    Given that the NRS 125C.0035(4) factors do not apply, we
                       • acknowledge that district courts lack guidance on how to applk the best-
                        interest-of-the-child standard in the context of a dispute 'between Parents
                        with joint legal custody regarding inedical decisions cOncerning • a minor
                        child.. .Although not exactly on point, we find. instructive the factors
                        enumerated in in re Eric B., 235 Cal. Rptr. 22 (Ct.-App.1987), and we adopt
                        them as -nonexhaustive factors for district courts to weigh in making hest-
                       interest-of-the-child determinations in this •conte.xt.      'In Eric       the

                        California Court of Appeal considered whether a juvenile court abused its
                       discretion by ordering that a minor child retain "dependent child" stattis •for
                       purposes of obtaining cancer treatment over his: parents' objections. 236
                       Cal. Rptr. at 23-24: In reviewing Whether medical treatment wOuld serve
                       the child's best interest, the -Court of Appeal rioted several factors. for
                       consideration: (1) "the seriousnešs of the harm the child is suffering'or the

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                substantial likelihood that he will suffer serious harm," (2) "the evaluation
                for the treatment by the medical profession," (3) "the risks involved in
                medically treating the child," and (4) the "expressed preferences of the
                child." Id. at 27 (internal quotation marks omitted). Because these factors
                are useful in evaluating the best-interest-of-the-child standard in the
                context of a dispute between parents with joint legal custody concerning the
                medical treatment of a minor child, we adopt them with two modifications.
                In order to facilitate individualized determinations, we direct. courts to
                consider the evaluation or recommendation by a medical professional—
                rather than the evaluation by the medical profession in general. And we
                clarify that a district court need only consider the child's express
                preferences if the district court finds that the child is of a sufficient age and
                capacity to form an intelligent preference. We stress that district courts
                have discretion as to how much weight to give each factor and that these
                factors are nonexhaustive, meaning district courts should consider any
                information that is relevant under the circumstances. Cf. Arcella, 133 Nev.
                at 873, 407 P.3d at 346-47 (emphasizing that the factors are "illustratiVe
                rather than exhaustive").
                             Here,   the    district   court   "accepted"   the   pediatrician's
                recommendation to vaccinate G.W.-K. against COVID-19 as in his best
                interest. ln terms of the framework we now adopt, the court determined
                that   the   recommendation-by-a-medical-professional          factor   favored
                vaccination. The district court also took judicial notice of the CDC and AAP
                guidelines and the research from those organizations regarding the safety
                of the vaccines and thus considered both the risks involved in the medical
                treatment and the likelihood that G.W.-K. would suffer serious harm.
                While Brooke specUlated that the COM-19 vaccine could negatively affect
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                G.W.-K.'s behavior and fertility, this contention was not supported by any
                evidence at the hearing, and Brooke has not otherwise shown a risk of
                serious harm. And the district court found that international travel, which
                vaccination would facilitate, was in G.W.-K.'s best interest. Although the
                district court did not have the benefit of express factors to weigh, the court
                considered similar matters in reaching its decision, and substantial
                evidence supports its findings. See Rico v. Rodriguez, 121 Nev. 695, 702,
                120 P.3d 812, 817 (2005) (revieWing a child's best-interest determination for
                support by substantial evidence in a custody matter). The district court did
                not specifically address G.W.-K.'s wishes or his capacity to reach an
                informed decision, and we accordingly do not consider that factor to weigh
                in either direction.4 Other than expressing her personal preference against
                vaccination, Brooke did not provide evidence that vaccination against
                COVID-19 was not in G.W.-K.'S best interest. Brooke's preference not to
                vaccinate G.W.-K. in and of itself does not. outweigh Scott's Preference to
                vaccinate G.W.-K., and vice versa, Scott's preference in and of itself does not
                outweigh Brooke's preference. Given that the district court's best-interest
                finding accords with the factors we adopt here, we affirm. See Saavedra-
                Sandoval v. Wal-Mart Stores, Inc., 126 Nev. 592, 599, 245 P.3d 11.98, 1202
                (2010) (holding that we will affirm the district court if it reaches the correct
                result, even if for the wrong reason).
                                            CONCLUSION
                            When parents with court-ordered joint legal custody of a minor
                child disagree on medical decisions regarding that child, the district court

                      We observe that Scott's testimony that G.W.-K. wanted to be
                      4
                vaccinated was stricken as hearsay.
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                breaks the tie by determining which course of action is in the best interest
                of the child. In determining which. medical decision is in the child's best
                interest, the district court should consider (1) the seriousness of the harm
                the child is suffering or the substantial likelihood that the child will suffer
                serious harm; (2) the evaluation or recommendation by, a medical
                professional; (3) the risks involved in medically treating the child; and (4) i.f
                the child is of a sufficient age and capacity to form an intelligent preference,
                •the expressed preference of the child.            We einphasize that a. medical

                professional's . recommendati.on is not necessarily conclusive- in every

                dispute, as each caSe turns on its particular cirCumstances. .Becanse the
                district court's finding of best interest aligns with the factors we now adopt,
                we affirm its order.                                               •

                                                                                       C.J.
                                                        Stiglich

                We cóncur.':

                Cadish                                         Pickering

                                         `gs,   J   .
                Herndon                                        Lee

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