Government

Idaho emergency doctor sued for overriding parent's decision

A jury will decide if the physician exaggerated the risks of the parent's refusal of treatment in order to get the state involved.

By — Posted April 9, 2007

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A recent Idaho federal court ruling shows doctors should tread carefully when considering whether to get the state involved to ensure that a child gets critical treatment despite the parent's objections.

The court found, in a Feb. 26 ruling, that the state gave too broad of consent for the treatment of 5-week-old-Taige L. Mueller. Judge B. Lynn Winmill sent part of the case back to trial court to determine, among other questions, whether the doctor involved exaggerated the risks of the infant's condition to get the state to intervene so he could treat the child over her parent's refusal. No hearing date has been set.

In 2002, Corissa D. Mueller brought her daughter to the emergency department at Saint Luke's Regional Medical Center, Boise, with a 101.3 F temperature, court records state. Emergency physician Richard K. MacDonald, MD, saw the child. Consistent with the hospital's standard of care, he recommended antibiotics and a spinal tap to test for meningitis or other serious bacterial infections, for which the baby showed symptoms, court documents state.

Dr. MacDonald also explained to the mother the risks, including death, of leaving meningitis untreated. He also said the infant's condition could worsen quickly. Mueller, however, refused to authorize the spinal tap. She concluded from her own research that the procedure's risks outweighed the chances that her daughter had meningitis, records show.

Dr. MacDonald called a hospital social worker, who called state Child Protective Services. After he reiterated the risks to the police, the officers took custody of the child, and Dr. MacDonald performed the spinal tap.

The test was negative for meningitis. The Muellers sued Dr. MacDonald, along with the social workers, the police and the hospital, for depriving them of their constitutional right to make a medical decision for their child. They also allege that Dr. MacDonald knowingly magnified the risks of meningitis to the police so he could treat the child.

The court sided with the Muellers on the question of whether the state overstepped its bounds.

"A difficult choice -- a choice that poses risks either way -- should never trigger intervention by the state. With no obvious safe alternative, the state ... loses all claim to make decisions for the child. It is now the grim duty of the parents to make the call," Winmill wrote.

Under Idaho's Child Protective Act, a local judge may authorize emergency care for a child over the parents' objections if a physician informs the judge that, in his or her professional opinion, the child's life is in imminent danger without treatment, the court noted. The police also are permitted to act when an emergency requires an immediate response before a judge can be contacted.

But if the state wants to compel treatment for a child, it must be able to show more than just a difference of opinion between the doctor and the parents. It must show that no reasonable parent would decline the care, the court said.

Dr. MacDonald denies any wrongdoing. "He met the standard of care in every respect, and everything he did was in the child's best interest," said his attorney, Richard E. Hall.

Attorneys for the state and Saint Luke's Regional Medical Center did not return calls for comment.

The Muellers' attorney, Michael E. Rosman, said the girl was not facing immediate injury or death, and Dr. MacDonald did not completely disclose to the Muellers or to the officers the risks involved.

Dr. MacDonald, the hospital and the police had plenty of time to contact a judge to get a court order before overriding the Muellers' decision, added Rosman, general counsel of the Center for Individual Rights, a nonprofit law firm.

Tread carefully

Legal and medical experts say the decision to ask the state to override parents' refusal can put doctors in a precarious situation.

If a doctor fails to get the state involved in an emergency when the parents refuse treatment and the child ends up seriously injured, the physician risks a medical liability lawsuit, said Arthur R. Derse, MD, chair of the American College of Emergency Physicians' Ethics Committee.

If doctors feel parents are not acting in the best interest of their child, it's wise to ask the state to intervene, he said. But physicians should be careful because many treatment decisions are not clear-cut.

"There may be other subtle questions as to whether you had the time to [first] seek a court order," said Dr. Derse, who also is an attorney. Doctors should consider getting an order either on their own or through child protective services. But even then, a court order does not immunize doctors from any ensuing medical liability action, he warned.

If immediate care is necessary, however, Dr. Derse said doctors can start treatment right away and in a parallel process, seek the state's help.

Melissa J. Mitchell, a health lawyer who specializes in children's services, said the most important thing doctors can do is clearly explain the risks of refusing care, compared with the risks of undergoing treatment, to the parents, as well as a social worker or referring physician. She also recommends having both parents involved in the discussion.

Doctors need to know their state laws, which can vary, regarding when the state can intervene, said Mitchell, an associate with Ohio-based Vorys, Sater, Seymour and Pease LLP. Because states do not have unlimited authority and generally can only order treatment to stabilize a patient, doctors need to "be crystal clear about what [they] are authorized to do."

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ADDITIONAL INFORMATION

Case at a glance

Eric Mueller and Corissa D. Mueller v. April K. Auker et al.

Venue: U.S. District Court for the District Court of Idaho
At issue: Whether an emergency physician and the state deprived parents of their constitutional right to make a medical decision for their child. The judge ruled that the state overstepped its bounds but sent other parts of the case, including whether the doctor exaggerated the danger of the child's condition, back to trial court.
Potential impact: Doctors fear that if the trial court sides with the parents, physicians could face a "Catch-22." On one hand, they could be sued by parents for asking the state to intervene to get a child emergency medical care. On the other, they could face a medical liability action if they fail to ask the state to override the parent's refusal. The parents worry that doctors will not completely disclose all the medical risks involved in treatment if they have carte blanche to override parent's medical decisions.

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