## Facts

- Within a month of his birth, Riley M. suffered a severe brain injury after being shaken by his father.
- Following the incident, Riley became a juvenile-court ward and was placed in the custody of the Nebraska Department of Social Services (the department).
- Riley’s mother, D’Etta H., was the parent involved in the underlying juvenile proceeding.
- When Riley was about one year old, Riley’s doctors diagnosed him as being in a persistent vegetative state.
- Riley’s doctors recommended that a do-not-resuscitate (DNR) order be entered for Riley.
- The department and Riley’s guardian ad litem asked the juvenile court to approve entry of a DNR order.
- The evidence supporting the DNR request was undisputed and included medical evidence of Riley’s diagnosis and testimony from pediatric specialist Dr. Mary Kay Bowen that a DNR order would be in Riley’s best interests.
- The juvenile court approved entry of a DNR order for Riley.
- Later, Dr. Bowen observed marked changes in Riley’s condition and changed her medical opinion.
- Dr. Bowen concluded that, although Riley remained severely injured, he was no longer in a persistent vegetative state and that a DNR order was no longer appropriate.
- Based on Dr. Bowen’s revised opinion, the juvenile court withdrew its prior DNR authorization.
- The juvenile court submitted a bill of exceptions to the Nebraska Court of Appeals for review of the juvenile court’s decision.

## Issues

1. Does a Nebraska juvenile court supervising a child in state custody have authority to approve a DNR order and later withdraw that authorization based on updated medical information?
2. In deciding whether a DNR order should remain in place for a ward of the state, is the controlling standard the child’s best interests as shown by competent, current medical evidence?
3. When the treating physician’s opinion changes and the child’s diagnosis materially changes, may the juvenile court modify or revoke a previously authorized DNR order?

## Decision

- The Nebraska Court of Appeals treated the juvenile court as having authority, in its supervisory role over a child in the department’s custody, to address major medical directives such as a DNR order.
- The court applied a best-interests approach that depends on competent and current medical evidence about the child’s condition and prognosis.
- Because the medical basis for the original DNR authorization changed—most notably through the treating specialist’s revised assessment that Riley was no longer in a persistent vegetative state—the appellate court upheld the juvenile court’s withdrawal of the prior DNR authorization.

## Legal Principles

- The juvenile court’s responsibility for a child who is a ward of the state includes oversight of significant medical decisions affecting the child’s care and welfare.
- Decisions authorizing or withdrawing a DNR directive for a child in state custody are evaluated through the child’s best interests, informed by qualified medical testimony and the child’s present condition.
- A DNR authorization is not permanent; it depends on the medical facts supporting it at the time it is entered.
- When later medical evidence materially differs from the evidence supporting the earlier order, the juvenile court may revisit and modify its prior authorization to reflect the child’s current condition.
- Undisputed, updated medical testimony from a treating specialist can support withdrawal of a prior DNR authorization when it no longer matches the child’s condition and medical outlook.

## Conclusion

In *In re Interest of Riley, State of Nebraska v. D’Etta H.*, the Nebraska Court of Appeals reviewed a juvenile court’s handling of a DNR directive for a severely brain-injured child in state custody and upheld the juvenile court’s decision to withdraw its earlier DNR authorization after the treating pediatric specialist reported marked changes in the child’s condition and concluded that a DNR order was no longer medically appropriate or in the child’s best interests.


In re Interest of Riley, State of Nebraska v. D'Etta H., 1997 Neb. App. Lexis 49 (1997)