## Facts

- D.K., age 16, was approximately 5'3" and 451 pounds, with depression, social isolation, and significant school absenteeism and poor performance.
- Medical providers determined D.K.’s morbid obesity created a life-threatening condition requiring hospitalization and intensive intervention.
- D.K. suffered serious obesity-related complications, including hypertension, respiratory problems requiring nighttime oxygen, sleep apnea, insulin resistance, enlarged liver, knee pain, and depressive disorder.
- D.K. had been overweight since infancy and gained over 100 pounds in the year before referral; he had not been taken to a dietician despite longstanding severe obesity.
- D.K.’s father was deceased; his mother was the sole caregiver and was herself severely obese and largely homebound, limiting her ability to participate in appointments and supervise treatment.
- After hospital referral, the mother signed a voluntary entrustment agreement placing D.K. in the custody of Children and Youth Services (CYS), which placed him in foster care.
- In foster care, D.K. followed a physician-supervised diet and exercise plan and lost about 50 pounds in roughly three months.
- D.K. and his mother sought reunification, but expert testimony questioned whether the mother could provide the structure and supervision needed to prevent relapse and address medical and educational needs.

## Issues

1. Whether D.K. qualified as a “dependent child” under the Juvenile Act because he was without proper parental care or control necessary for his physical, mental, or emotional health, despite residing with a parent.
2. If dependency was established, whether continued CYS custody and foster placement was warranted rather than immediate return to the mother, given the medical risks associated with relapse.

## Decision

- The court adjudicated D.K. a dependent child.
- The court found, by clear and convincing evidence, that D.K. was without proper parental care or control necessary for his health and welfare and that such care was not immediately available from his mother.
- The court continued D.K.’s placement in CYS custody in foster care, subject to court oversight and review.

## Legal Principles

- A child may be adjudicated dependent if the child is without proper parental care or control, subsistence, or education necessary for the child’s physical, mental, or emotional health, even when the child resides with a parent.
- Dependency must be proven by clear and convincing evidence of present lack of proper parental care or control and the unavailability of adequate care in the immediate future.
- Severe medical neglect can constitute lack of proper parental care or control when a parent fails to secure necessary treatment for a serious, chronic, and life-threatening condition.
- In determining disposition, the court may prioritize the child’s safety and welfare over immediate reunification where credible evidence indicates a substantial risk of medical harm if returned to an environment unable to support required treatment and lifestyle changes.

## Conclusion

The court treated extreme, life-threatening obesity coupled with parental inability to secure and maintain necessary medical and behavioral intervention as a basis for dependency, and it maintained foster placement under CYS supervision to protect D.K.’s health while preserving ongoing judicial review of reunification prospects.


In re D.K., 58 Pa. D. & C. 4th 353 (Ct. Com. Pl. Northumberland Cnty. 2002)