## Facts

- M.R.R. was a four-year-old child whose divorced parents had joint custody.
- M.R.R. was diagnosed with a seizure disorder and was seen by multiple medical providers.
- Treating specialists recommended dietary treatment (including a ketogenic diet) and medication; M.R.R. improved on diets but had a poor reaction to medication at one point.
- The Iowa Department of Human Services (DHS) became involved after a dispute between the parents at a medical facility about M.R.R.’s care.
- The State filed a child-in-need-of-assistance (CINA) petition.
- The juvenile court entered an order requiring the parents to follow the recommendations of M.R.R.’s neurologist at the Mayo Clinic.
- Mayo Clinic physicians initially recommended continuing a ketogenic diet; at a later follow-up, they recommended supplementing the diet with medication.
- After medication was recommended, the mother canceled several appointments; the State later compelled her to take M.R.R. back to Mayo Clinic.
- At that visit, Mayo Clinic reported the diet had reduced seizures but indicated medication would be ordered if seizures were not controlled by the next appointment.
- At the mother’s request, the parents obtained a second opinion; that doctor concluded treatment beyond diet alone was necessary.
- At the next Mayo Clinic appointment, physicians recommended starting a low-dose medication.
- The mother asked whether a more restrictive ketogenic diet could be tried instead and stated she would not allow medication unless the court ordered it; the father was willing to provide the medication.
- The parents eventually began administering the medication.
- At a later juvenile-court hearing, the father testified the mother opposed medication; the mother testified she wanted to try dietary measures first.
- A social worker testified that without medication M.R.R. would have academic and behavioral problems and could suffer brain damage.
- The juvenile court found M.R.R. needed medication and that the mother’s resistance placed M.R.R. at risk; it adjudicated M.R.R. a CINA and ordered both parents to comply with Mayo Clinic recommendations, including prescribed medications.

## Issues

1. Whether the evidence supported adjudicating M.R.R. a child in need of assistance based on the parents’ conflict and the mother’s resistance to medically recommended seizure medication despite evidence of risk of serious harm.
2. Whether, following a CINA adjudication, the juvenile court could order the parents with joint custody to comply with the Mayo Clinic neurologist’s treatment recommendations, including prescribed medication.

## Decision

- The Iowa Supreme Court affirmed the juvenile court’s CINA adjudication.
- The court affirmed the dispositional order requiring the parents to comply with the Mayo Clinic neurologist’s recommendations, including any prescribed seizure medication.

## Legal Principles

- The State may intervene through CINA proceedings when a child faces a serious risk to health due to a parent’s failure or refusal to provide medically necessary care.
- In evaluating medical necessity and risk, courts may credit testimony and recommendations from treating specialists and consistent second-opinion evidence.
- Ongoing parental conflict and a pattern of delaying or obstructing recommended treatment can support a finding that the child is not receiving necessary care without court involvement.
- After a CINA adjudication, the juvenile court may issue orders designed to protect the child’s health and ensure the child receives needed medical treatment, including directing parents to follow a specialist’s recommendations.

## Conclusion

In the Interest of M.R.R. upheld a CINA adjudication where evidence showed that parental conflict and the mother’s resistance to recommended seizure medication created a serious risk of harm, and it affirmed the juvenile court’s authority to require the parents to comply with the Mayo Clinic neurologist’s treatment plan, including prescribed medication.


In the Interest of M.R.R., 807 N.W.2d 158 (2011)