## Facts

- Nikolas E. was a four-year-old child who was HIV-positive and lived with his mother, who had sole responsibility for his medical care.
- Nikolas’s parents were divorced and both were HIV-positive; Nikolas’s HIV-positive sister died at age four from AIDS-related complications.
- A pediatric infectious-disease specialist recommended highly active antiretroviral therapy (HAART) for Nikolas, described in the record as aggressive and experimental for children at the time.
- Based on her own illness and her experience with her daughter’s painful decline while undergoing drug therapy, the mother distrusted HAART and declined to authorize it at that time.
- A second specialist testified HAART was experimental for children, with unpleasant side effects and unknown long-term effects, and could not quantify benefits or state whether it would extend Nikolas’s life.
- The mother did not reject medical care generally and indicated she would comply with a court order requiring treatment.
- The Maine Department of Human Services filed a child protection petition seeking custody limited to authorizing HIV treatment; the District Court denied the petition.
- The guardian ad litem appealed from the denial.

## Issues

1. Whether a guardian ad litem appointed in a child protection proceeding has standing to appeal a judgment denying a child protection petition.
2. Whether the mother’s refusal (or delay) in consenting to HAART placed Nikolas in circumstances of abuse or neglect, or a substantial risk of abuse or neglect, justifying state custody to approve treatment.

## Decision

- The Law Court held the guardian ad litem had standing to appeal because appointed representation continues on appeal unless otherwise ordered.
- The Law Court affirmed the denial of the child protection petition.
- The court concluded the evidence did not compel a finding that Nikolas was abused or neglected, or at substantial risk, due to the mother’s decision to delay HAART.

## Legal Principles

- In Maine child protection proceedings, a guardian ad litem appointed to represent a child’s interests may continue representation on appeal and may seek appellate review of an adverse judgment unless the court orders otherwise.
- Appellate review of child protection factfinding is for clear error; an appellate court will not reweigh evidence and will disturb the judgment only if the evidence compels a contrary result.
- A parent’s informed and reasoned decision to delay or refuse a proposed medical treatment that is experimental and carries uncertain benefits and unknown long-term risks, without more, does not necessarily constitute abuse or neglect or a substantial risk of abuse or neglect warranting state intervention to override parental medical decision-making.

## Conclusion

The court permitted the guardian ad litem to appeal but affirmed the denial of state custody, holding that the mother’s reasoned delay in consenting to experimental pediatric HIV therapy did not meet the statutory threshold for abuse, neglect, or substantial risk requiring state intervention.


In re Nikolas E., 720 A.2d 562 (Me. 1998)