4.3.9  Baby Doe Cases

The Federal Child Abuse Amendments of 1984 (Pub. Law 98-457) introduced certain requirements state agencies must adhere to in the investigation of reports of medical neglect involving handicapped infants in hospitals and health care facilities.  These regulations are better known as "Baby Doe" regulations.

These regulations prohibit the withholding of nourishment and medically beneficial treatment from handicapped infants solely on the basis of their present or anticipated mental or physical impairments.

Medically indicated treatment must be provided except when in the treating physician's reasonable medical judgment any of the following circumstances apply:

• The infant is chronically and irreversibly comatose;
• The provision of such treatment would merely prolong dying, not be effective in improving or correcting all of the infant's life-threatening conditions, or otherwise be futile in terms of the survival of the infant; or
• The provision of such treatment would be virtually futile in terms of the survival of the infant and the treatment itself, under such circumstances, would be inhumane.

The Division has the legal responsibility to develop procedures to investigate suspected medical neglect complaints, coordinate the investigation with the individuals designated by the appropriate health care facilities and determine if the treating physician(s) has made the appropriate decision based on the regulations and definitions within the regulation.

Each county office is responsible for updating, on an annual basis, the name, title and telephone number of the individual(s) designated by the facility.  If an Infant Care Review Committee (ICRC) has been developed by the facility this team shall be utilized.

When staff determines that complaint concerns medical neglect of a handicapped infant in a hospital or health care facility, it will be necessary for staff to contact reporter to assist in determining present status of child and gather further information.  Request the following basic information if not already available:

1. Name and address of infant and parent.
2. Name and address of the hospital where child is being treated.
3. The condition of the infant.
4. The basis of the reporter's belief that medically indicated treatment or appropriate nutrition is being or will be withheld.
5. The names, addresses and telephone numbers of others who might be able to provide further information.

Staff shall inform juvenile officer of complaint and request assistance in investigation.  Staff are expected to notify Director of the Children’s Division through supervisory lines immediately of medical neglect report of a handicapped child.  Staff shall also contact designated personnel at hospital or health care facility;

• Provide form CS-30 - Medical Records Report.
• Gather medical information, as well as any other documenting material, which will allow for an informal decision to be made on medical care necessary to preserve life.

NOTE:  Medical information should include diagnostic and medical records on the condition and treatment of the child as well as any other information which can assist in the determination as to whether appropriate medical care and nutrition are being provided.

• Contact juvenile office and/or juvenile court immediately for assistance if medical facility does not provide all appropriate information.
• Determine if it appears medical and nutritional services are being provided to infant in order to sustain life while information gathered is being reviewed.

Staff shall contact and interview parent(s) of child and inform of the report and request access to necessary medical information.  This information will be provided as soon as possible, through supervisory lines, to the Division Director with all medical information and other documenting material.

NOTE:  The Division Director will review this material in consultation with physicians from the MO HealthNet Division (MHD) or other independent doctors to determine if appropriate medical and nutritional services are being provided.

Staff shall determine, based on all information received, if appropriate medical and nutritional services are being provided or one of the exceptions to provision of these services is met.

In the event of the following circumstances, the CSW or other appropriate CD personnel should inform the parent that a recommendation will be made to the juvenile court to secure a court order for an independent medical examination:

• When the parent(s) of the infant does not consent to review of the infant's treatment;
• When the attending physician and/or parent(s) does not agree with the recommendation of the Infant Care Review Committee and the Division;
• When the Division does not agree with the recommendation of the Infant Care Review Committee;
• When there is no Infant Care Review Committee and the parent(s) does not consent to a consultation and/or individual medical examination.

Staff shall provide written documentation to the following:

• Provide written findings to the juvenile officer.
• Notify and provide written findings to the Division Director.
• Notify appropriate health facility in writing of findings.

NOTE:  These procedures should also be consulted if a report of medical neglect is received involving an infant older than one year of age who has been continuously hospitalized since birth, who was born extremely premature, or who has a long-term disability.