In the Interest of R.G.

885 S.W.2d 757, 1994 Mo. App. LEXIS 1609, 1994 WL 565199
CourtMissouri Court of Appeals
DecidedOctober 18, 1994
Docket64263
StatusPublished
Cited by16 cases

This text of 885 S.W.2d 757 (In the Interest of R.G.) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In the Interest of R.G., 885 S.W.2d 757, 1994 Mo. App. LEXIS 1609, 1994 WL 565199 (Mo. Ct. App. 1994).

Opinion

CARL R. GAERTNER, Judge.

K.K. (Mother) appeals from an order entered by the Juvenile Division of the Circuit Court of St. Louis County finding that it had jurisdiction over R.G., Mother’s natural daughter, due to medical neglect, and placing R.G. in the legal and physical custody of her natural father, L.G. (Father).

We state the facts in the light most favorable to the juvenile court’s order. R.G. was born on October 1, 1989, at Jewish Hospital in St. Louis. The next day, R.G. suffered a seizure and was transferred to St. Louis Children’s Hospital. During the course of R.G.’s stay at Children’s Hospital, Mother and Father refused to permit the performance of various diagnostic tests and therapeutic interventions, disregarded hospital rules, and argued with physicians and nurses.

On October 10, 1989, Mother and Father transferred R.G. to St. John’s Mercy Medical Center. R.G. was diagnosed as suffering from hyperinsulinemic hypoglycemia, 1 a condition that can lead to fainting, seizures, apnea, brain damage or death 2 if not properly treated by a pediatric endocrinologist. Hy-perinsulinism is caused by a tumor in the pancreas or by the enlargement of insulin-producing cells in the pancreas.

On October 14, 1989, Dr. Patricia Wolff, a pediatric endocrinologist practicing at St. John’s, began treating R.G. She explained to R.G.’s parents the importance of determining the cause of R.G.’s hyperinsulinism. If the cause was a tumor, Dr. Wolff explained, it could be surgically removed. The most accurate way to determine the cause of hy-perinsulinism is to thread a catheter into the pancreas and extract various blood samples. Less accurate testing methods include taking a CT scan, an MRI or an ultrasound of the pancreas. Dr. Wolff and the parents agreed to have an ultrasound taken of R.G.’s pancreas. The test did not show a tumor; however, it failed to give a clear picture of her entire pancreas. Mother and Father refused to have a CT scan taken of R.G.’s pancreas.

Dr. Wolff explained to Mother and Father that the most common methods of treatment available to stabilize and control R.G.’s hy-perinsulinemic hypoglycemia include: (1) frequently feeding the child, usually every three to four hours; (2)' administering diazoxide medication; or (3) performing a pancreatec-tomy in which 95% of the pancreas is surgically removed. Mother and Father chose the frequent feeding method. Dr. Wolff instructed the parents to feed R.G. every three and a half hours, regularly monitor her blood sugar level and report the readings to Dr. Wolff. She also pointed out that this method was too difficult to sustain and would only be a short-term option to see if R.G. would recover spontaneously. If this method failed, Dr. Wolff told Mother and Father, they would then try diazoxide treatment.

On October 18, 1989, St. John’s “reluctantly discharged” R.G. to her parents. Dr. Wolff soon noted that Mother and Father were failing to maintain an appropriate feeding schedule and that R.G. continued to have dangerously low blood sugar readings. In late October and early November 1989, Dr. Wolff repeatedly recommended that R.G. be placed on diazoxide; Mother and Father refused. On November 20, 1989, Dr. Wolff recommended that R.G. be rehospitalized to evaluate her insulin and blood sugar levels to prove whether medication was necessary to control her condition; Mother and Father refused. They also informed Dr. Wolff they were soon going to put R.G. in day care. Dr. *760 Wolff testified that their failure to rehospitalize R.G. was- medical neglect.

Thereafter, Dr. Wolff repeatedly attempted to contact the parents to no avail. In a letter dated December 4, 1989, which she sent to Mother and Father, Dr. Wolff withdrew from treating R.G. In the letter, she outlined R.G.’s condition and detailed the risks of the child’s condition, the available medical treatments and the parents’ failure to cooperate and seek necessary medical care. She also explained that it was dangerous to ignore R.G.’s condition. Dr. Wolff testified that the parents “basically didn’t think [R.G.] had any problem_ I perceived it as a tremendous amount of denial.”

From November 20, 1989, until early February 1990, Mother and Father continued to follow the frequent feeding method; however, R.G. was not under the care of a pediatric endocrinologist, and Mother and Father did not regularly monitor her blood sugar level. Dr. Maurice Lonsway, R.G.’s pediatrician, regularly saw R.G. during this time period, but Mother and Father did not inform him that R.G.’s hypoglycemia was caused by hy-perinsulinism. Dr. Lonsway had no expertise or experience in treating such a condition. During this time period, R.G. also exhibited unusual eye movements. Mother and Father took her to a neurologist for evaluations. They told the neurologist R.G. suffered from hypoglycemia but never mentioned her hyperinsulinism.

On February 13, 1990, R.G. showed signs of profound hypoglycemia. Mother and Father took her to the emergency room at St. John’s Mercy Medical Center. R.G.’s blood sugar level was tested and initially was so low it was “not detectable.” That night, R.G. was transferred to Cardinal Glennon Children’s Hospital where she remained hospitalized until March 15, 1990, under the care of Dr. Thomas Aceto, a pediatric endocrinologist.

From February 13 to February 26, 1990, R.G.’s condition was potentially life-threatening. During this time, Mother and Father refused to give permission to Dr. Aceto to perform diagnostic tests to determine the cause of R.G.’s hyperinsulinism. Furthermore, Mother and Father refused to. give Dr. Aceto permission to place a central line to R.G.’s vena cava to facilitate the injection of glucose into her body. Dr. Aceto explained the procedure was critical to controlling R.G.’s blood sugar level because he was unable to do so by injecting glucose in R.G.’s smaller peripheral veins and R.G. was not sucking and thus could not take glucose orally. Dr. Aceto also felt the procedure was necessary to prevent or quickly treat any recurrence of hypoglycemia. Mother resisted most of Dr. Aceto’s suggestions regarding treatment, would not listen to his explanations and was hostile to him and the hospital staff at Cardinal Glennon.

Mother and Father contacted Dr. Wolff and begged her to treat R.G. again. Dr. Wolff testified that she refused the parents’ request because “they really had a tremendous amount of denial about [R.G.’s] problem and, also, a tremendous suspicion and lack of trust in physicians, I mean, much more so than other people do, I mean, just not able to trust any physician anywhere.”

On February 23, 1990, the Juvenile Division of the Circuit Court of the City of St. Louis issued an order placing R.G. in the protective custody of the Division of Family 1 Services (DFS). On February 26, 1990, the Juvenile Officer of St. Louis filed a petition alleging that R.G. was without proper care, custody and support due to Mother and Father’s refusal to permit the performance of diagnostic tests and to provide recognized medical treatment for R.G. On the same day, the court issued an order permitting the placement of a central line to R.G.’s vena cava. On March 2, 1990, the court transferred the neglect proceeding to the Juvenile Division of the Circuit Court of St. Louis County. On April 12, 1990, the case was dismissed without prejudice.

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Bluebook (online)
885 S.W.2d 757, 1994 Mo. App. LEXIS 1609, 1994 WL 565199, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-the-interest-of-rg-moctapp-1994.