2011年爱心包裹扶贫捐赠最新累计统计

JudicialInterventionForMorbidlyObeseChildren AnInterestingCase InterestingCasePresentationSaintFrancisHospitalDept ofPediatricsJayE Sicklick Esq LisaKechejianMEDICAL LEGALPARTNERSHIPPROJECTOctober26 2007 PresentationGoals Introducethe obesitydilemma Provideacaseexampleofchildhoodobesity inthechildprotectioncontextOverlaythelegalbackgroundQuery whendoyourequest stateintervention Invitediscussionre whatistheappropriateinterventionprotocol TheProblem TheThresholdQuestion Whendoesobesitybecomeachildprotectionissuefortheclinician OR HowoutofcontroldothingshavetogetbeforeyoucallDCFwhendealingwithamorbidlyobesechild CaseStudy BrittanyT Age8 morbidlyobese237lbsBMI 50Co morbidities gallstone excessivefatinliver sleepapnea acanthosisnigricans signsofdepressionFatherconfinedtowheelchair mother 430lbs inApril 06 CaseStudy cont Brittany PCPindicatessignificantnon compliancewithdietaryinstructions Threats madeonseveraloccasionstocallchildwelfareofficials Parentsseem incapable ofcontrollingBrittany sweight butreallyloveherBrittanywillbeemotionallydevastatedifremovedfromhome CaseStudy cont Whatistheappropriatedecision Whodecideswhenenoughisenough DoyouthinkthatremovalandcommitmentisappropriateIsterminationofparentalrightsajustifiedaction Source Conn Gen Stat 17a 101a LegalContext MandatedReportingRequirementsReasonableCausetoSuspect AbuseNeglectChildw non accidentalphysicalinjuryoroneatvariancew historygivenChildAtImminentRiskofHarm Source Conn Gen Stat 46b 120 LegalBackground Abuse Inflictedw physicalinjuriesotherthanbyaccidentalmeans Injuriesatvariancew historygivenConditionresultofMaltreatmentsuchasmalnutrition sexualmolestation exploitation deprivationofnecessities emotionalmaltreatmentorcruelpunishment Source Conn Gen Stat 46b 120 LegalBackground cont Neglect AbandonmentDenialofpropercareandattention physically emotionallyormorallyLivingunderconditions circumstances associationsinjurioustothewellbeingofthechild Hasbeenabused APublicHealthCrisis Source NCHS2004NHANESData APublicHealthCrisis APublicHealthCrisis 1999 2002DataonObesity CDC Non Hispanicblack 21 Mexican Americanadolescents 12 19 23 morelikelytobeoverweightthanWhites 14 Another15 children 6 19 considered at risk ofbecomingoverweight BMIbetween85th 95thpercentile Since1994overweightyouthsincreasingtohigherlevels OtherCases ChristinaC California 13y o Weighed680lbs whendiedofCHFMomconsentedtodroppingoutofschoolFounddeadinlivingroomMomfoundguiltyofmisdemeanorchildabuse OtherCases L T Iowa 10y o girl290pounds yeastinfectiongrowingfromskinfoldsinabdomenSemi compliantmomDrovetoappts WouldnotsendtoresidentialChronicdepressionAdjudicatedasa CINA Placedinstatecareforresidentialt ment fostercare Source IowaCode 232 2 6 f 1991 OtherCases CINAStatute IOWA Childinneedofassistance meansanunmarriedchildwhoisinneedofmedicaltreatmenttocureoralleviateseriousmentalillnessordisorder oremotionaldamageasevidencedbysevereanxiety depression withdrawaloruntowardaggressivebehaviortowardselforothersandwhoseparent guardian orcustodianisunwillingorunabletoprovidesuchtreatment OtherCases Indiana CoreyA 5y o boy138lbs Otherhealthconditionsincludingrespiratorydistress r qoxygen sleepapneaConcurrentconditionsinhouse garbage roaches rats rottingfoodStateintervenedduetoneglectWhileinfostercarelost50lbs OtherCases CoreyA Courtruling commitment Interventionappropriateb cM D srecommendationsignored diet toohardtofollow ParentsresentfulandcomplainedaboutbeinginstructedhowtofeedCoreyParentsdirectlyviolateddietbygivingfast foodmealwhilehospitalized OtherCases AnamarieM NewMexico 3y o 120lbs 3 6 tallReferralmadetoChildWelfareagcy Agcyorderedspecialdiet exerciseM D recommendedliquiddiet parentsnon complaintParentsmaintainedcondition medically causedStateCWagcyintervened OtherCases Anamarie cont Outcome returnedtomomthreemonthsafterperiodofcommitmentControversialdecision OtherCases Pennsylvania D K 16y o boy451lbs 5 3 MomobesePCPorderedinpatientstayduetoEnlargedliver hypertension respiratorydifficulty insulinresistance sleepapnea kneepainMomdidnotvisitinhospitalReferralandcourtintervention adjudgeddependent OtherCases D K Courtrationale Childwelfareagency wouldnotbejustifiedbyinterveningsimplybecauseachildwasoverweight ordidnotsimplyengageinahealthyandfitlifestyle Rather theobesitymustbeofaseverenaturereachingthelifethreateningormorbidstate whichhasalsomanifesteditselfinphysicalproblems suchasthosepresenthere ormentalproblems OtherCases Texas G C 4y o boy97lbs PCPrequestbloodsamplefordiagnostictests parentsrefused ParentschangedPCPtwiceChildhospitalizedin1996 difficultybreathing mildlyenlargedheart CHF Childremovedandplacedinfostercare OtherCases G C cont Outcome continuednon compliance TPRRefusaltoworkwithcourtordered homemaker asrolemodelfinalstraw ConnecticutPrecedent InreKennethE 2006WL2773444 Conn Super 2006 15y o boy346lbs Parents failedtorecognizeproblem but unintentional Courtdeniedremovalw parentspromisetocomplybutorderedprotectivesupervisionHappyending childlost56lbs inonesummer CaseStudy cont BrittanyT MandatedprogramstoaddressobesityAttendanceatgymclasses3days weekGeneralnon complianceAbsentfromschool48outof68schooldaysStateDSS NY requestedcourtordertoremoveandseekcommitmentduetomedicalconcerns CourtGrantedorderplacingcustodyw DSS Source 15Misc 3d606 Fam Ct NY2007 OurCaseStudy History OK135S070 APublicHealthCrisis EndResults Whatisthestandardforachildwelfarereferralforanobesechild Whendoyoumakethereferral Doesthepotentialbenefitoutweighremovingachildfromherhome References Murta