LINCOLN — Parents who withdrew their child from cancer treatment were rightly deemed unfit to retain custody of the child, the Nebraska Supreme Court ruled Friday.
The case involved a 4-year-old child, identified as “Prince R.” in the court’s ruling, who had contracted a very rare form of cancer in his right forearm that has spread to his lymph nodes.
Physicians at Children’s Hospital in Omaha had informed the parents that the child had a 60% chance of “relapse-free, long-term survival” from alveolar rhabdomyosarcoma with the recommended course of treatment: 66 weeks of chemotherapy, as well as radiation treatments and possible surgery.
Dr. Melissa Acquazzino, a cancer specialist at Children’s, told the parents that Prince would likely die within six months if he didn’t get the treatments.
She also testified that in cases with a poor prognosis, parents are given the option of palliative “comfort care,” to make a patient comfortable until he dies, but that option was not discussed, given Prince’s more positive outlook.
While the parents expressed initial concerns about chemotherapy, those treatments began in July 2019.
Prince’s initial treatment went well, according to Acquazzino. His tumor visibly shrank and his side effects were minimal. The hospital’s social worker also arranged for money to help the parents, who were unmarried, repair their car so they could make the weekly chemo appointments.
But two months after treatments began, Prince began experiencing side effects such as nausea, vomiting and fatigue, court records indicated, and his parents began skipping some of his appointments. The father, according to the social worker, said doctors were giving Prince too much medicine, too quickly.
That led to a meeting with the parents in which it was emphasized that skipping appointments could lead to the cancer “building resistance” to the treatments, and that side effects would not decline even if drug doses were reduced.
The father, though, insisted that the the cancer would not kill his son, but the treatments would. He and his wife voiced interest in getting a second opinion, but then later in the meeting, agreed to bring Prince to his first radiation treatment the next day. But after that treatment, the child was not brought to any chemo or radiation appointments.
Hospital officials contacted the state Child Protective Services agency, which investigates cases of child abuse and neglect. A state investigator, according to court records, experienced difficulty in locating Prince, who had been living with his mother at a Lincoln homeless shelter.
The father, according to the investigator, said the mother was in Arizona seeking a second opinion. The father also disagreed with the investigator’s opinion that Prince was in danger of dying if his treatments were not resumed.
After about two weeks, Lincoln police initiated an emergency “ping” on the mother’s cellphone, which indicated that she was in Murfreesboro, Tennessee, not Arizona. The police officer testified that the mother later told him that “if I even get another doctor, it’s not going to be in Nebraska.”
Eventually, Prince was located, and his treatments were resumed under the temporary custody of the Nebraska Department of Health and Human Services.
During a four-day trial in Lancaster County Juvenile Court, there was no evidence presented that the parents had sought a second medical opinion, nor that Prince had received any treatments from Oct. 2 to 26, 2019. Neither parent raised a religious or cultural objection to the treatments.
The court ruled that the child lacked proper parental care by reason of the “fault or habits” of both parents.
The Supreme Court, in upholding the lower court’s decision, cited previous rulings that “proper parental care” included providing for the “health, morals, and well-being” of a child, and not placing them “in situations dangerous to life or limb ...”
The court’s unanimous opinion, written by Judge Jonathan Papik, also said the state proved that the cancer treatments were essential for Prince’s survival, and that withholding them risked future harm.
Lancaster County Attorney Pat Condon said Prince remains a state ward and has been “safely” placed in a foster home. He said further court hearings are planned to develop a rehabilitative plan for him and “correct the issues that led to Prince needing to come into care.”