In the Interest of M.R.R.

M.R.R. was a four-year-old child whose parents were divorced. M.R.R. was diagnosed with a seizure disorder. She visited numerous specialists, who recommended special diets and medication. While M.R.R. had success with the diets, she reacted poorly to medication. The Iowa Department of Human Services became involved after a conflict at a medical facility between M.R.R.’s parents (defendants), who had joint custody, regarding her treatment. The state (plaintiff) filed a child-in-need-of-assistance petition. A court order was entered requiring the parents to abide by the recommendations of M.R.R.’s neurologist at the Mayo Clinic (the clinic), where doctors suggested placing the child on a ketogenic diet. At a follow-up appointment, doctors recommended that the diet be supplemented with medication. The mother canceled several appointments after that before the state compelled her to take M.R.R. back to the clinic, where it was determined that the diet had reduced M.R.R.’s seizures but that medication would be ordered if they were not under control by the next appointment. The parents sought a second opinion at the mother’s request. The doctor who provided the second opinion concluded that treatment beyond the diets was necessary. At M.R.R.’s next clinic appointment, it was recommended that she begin a low-dose medication. The mother asked if they could try a more restrictive ketogenic diet instead. The mother indicated that she would not allow M.R.R. to take medication unless ordered by the court, while the father was willing to provide it. Eventually, the parents began providing it. At the next court hearing, the father testified that the mother was against medication, while the mother testified that she wanted to further explore the ketogenic diet first. The social worker assigned to the case testified that without medication, M.R.R. would exhibit academic and behavior problems and suffer from brain damage. The court determined that M.R.R. needed medication that the mother was resistant to providing and deemed M.R.R. a child in need of assistance. The order compelled the parents to comply with the clinic’s recommendations, including any medications prescribed.