## Facts

- Rosa Ariel Anaya was born at home in Douglas County, Nebraska, without a physician present, and the birth was reported to the Nebraska Department of Health and Human Services (DHHS) several days later.
- DHHS determined that the newborn metabolic screening required by Neb. Rev. Stat. § 71-519 had not been performed.
- DHHS notified Josue and Mary Anaya of the statutory requirement and described the screening as a minor heel-stick blood draw.
- The Anayas refused to permit the screening based on sincerely held religious beliefs opposing removal of blood.
- Douglas County filed an action to compel compliance with § 71-519.
- The Anayas sought dismissal and a judicial exemption, arguing (1) the statute violated their rights under the First and Fourteenth Amendments and (2) compliance was impossible and the case moot because DHHS regulations contemplated testing within a short time after birth registration for unattended births.
- The district court rejected the constitutional challenge and ordered the Anayas to submit their child to screening; the Anayas appealed.

## Issues

1. Whether Neb. Rev. Stat. § 71-519, requiring newborn metabolic screening, violates parents’ First Amendment free exercise rights and Fourteenth Amendment parental liberty interests when the parents object on sincere religious grounds.
2. Whether the action was moot, or compliance impossible, because the regulatory testing period had allegedly expired.

## Decision

- The Nebraska Supreme Court affirmed the order compelling the Anayas to submit their child to newborn metabolic screening.
- The court held § 71-519 constitutional as applied, concluding the State’s interest in protecting children from serious and preventable harm justified the mandated, minimally invasive test despite religious objection.
- The court rejected mootness/impossibility and reached the merits, concluding the statutory duty and requested relief were not defeated by the parents’ delay past the referenced regulatory timeframe.

## Legal Principles

- Statutes are presumed constitutional; constitutional challenges are reviewed as questions of law, and doubts are resolved in favor of constitutionality.
- Parental rights and religious exercise, while protected, are not absolute and may be limited when the State shows a compelling interest in protecting a child’s health and life.
- A minimally intrusive medical procedure designed for early detection of serious, treatable conditions may be mandated for newborns over parental religious objection when reasonably tailored to the State’s child-welfare interest.
- A claimed lapse of a regulatory testing window does not automatically moot enforcement of a continuing statutory health requirement, particularly where delay is attributable to noncompliance.

## Conclusion

Nebraska may compel a one-time newborn metabolic screening via heel-stick blood draw under § 71-519 notwithstanding parents’ sincere religious objections, and parents cannot avoid enforcement by delaying until an asserted regulatory testing period has passed.


Douglas County v. Anaya, 694 N.W.2d 601 (Neb. 2005)