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San Joaquin County Human Services Agency v. Marcus W.

June 2, 2010


APPEAL from a judgment of the Superior Court of San Joaquin County, Jose L. Alva, Judge. Reversed. (Super.Ct.No. J05078).

The opinion of the court was delivered by: Scotland , P. J.


Marcus W. (the minor) has sickle cell anemia and was 16 years old when he was ordered by the juvenile court to undergo periodic blood transfusions to prevent him from suffering a third stroke and possibly death. The minor, one of Jehovah's Witnesses, opposed the transfusions as contrary to his religious beliefs.

On appeal, the minor argues the order must be reversed because the application did not "set forth the legal basis for its request for a one-year court order compelling [the minor] to undergo blood transfusions." In any event, the minor contends the juvenile court erred in not "recogniz[ing] that mature adolescents may possess the competency and the capacity to make their own medical decisions in exercise of their right of bodily self-determination" (known in some jurisdictions as the "mature minor doctrine") and in depriving the minor of the opportunity to cross-examine a medical witness and to call and examine his own medical witness and his minister.

We conclude the juvenile court lacked jurisdiction to issue the order because the requirements of Welfare and Institutions Code section 369 were not met. (Further section references are to this code unless otherwise specified.) Thus, we need not address the minor's other claims of error.

As we will explain, section 369 provides the juvenile court with jurisdiction to order the performance of necessary medical care for a minor only when (1) the minor has been taken into temporary custody pursuant to section 305, or is a dependent of the court pursuant to section 300, or is named in a petition filed to declare the minor a dependent of the court, (2) a licensed health care professional recommends that the minor needs medical, surgical, dental, or other remedial care, and (3) the minor's parent, guardian, or person standing in loco parentis is unwilling or incapable of authorizing such care.

Here, the minor had not been taken into temporary custody pursuant to section 305, the San Joaquin County Human Services Agency (the Agency) had not filed a section 300 petition to declare the minor a dependent child of the court, and the minor had not already been adjudicated a dependent child of the court. Thus, the juvenile court did not have jurisdiction to order the minor to undergo blood transfusions against his will and over the objection of his parents.


On October 21, 2008, the Agency filed an ex parte application with the juvenile court, seeking permission for the minor's treating physician to "administer blood transfusions to [the minor] without parental consent as medically necessary until OCTOBER 1, 2009," at which time "the treating physician must provide an update concerning [the minor's] need for further transfusions," and in the meantime, "should any bloodless treatment alternatives become available that would meet the minor's needs," the minor's father and the Jehovah's Witness Hospital Liaison Committee would be "promptly notified and the alternatives utilized with the father's consent."

Attached to the application was a letter from the minor's treating physician, Dr. Keith C. Quirolo, asking for a court order to continue blood transfusions treatment. Dr. Quirolo's letter stated the following: The minor "has sickle cell anemia" and has suffered "two strokes and has developed moya moya disease due to the cerebral ischemia that was caused by the strokes." "[C]hronic blood transfusion" is the "only definitive therapy for stroke in sickle cell disease"; however, because the minor and his parents expressed opposition to blood transfusions based on their religious beliefs, Dr. Quirolo attempted "alternative medical therapies," such as hydroxyurea and decidabine. Neither drug increased the minor's level of hemoglobin F enough to prevent strokes. Indeed, the minor suffered a stroke while taking hydroxyurea and had to be returned to blood transfusion treatment. Following three months of decidabine treatment, without sufficient increase in hemoglobin F levels, Dr. Quirolo concluded that returning to blood transfusion treatment was the only definitive means of preventing another stroke and possibly death. Dr. Quirolo stressed: "I am not willing to wait for him to have another event while I, and the family, are waiting for this medication to increase his hemoglobin F."

The minor and his parents filed opposition to the application, requested an evidentiary hearing to determine whether the minor is a "mature minor possessing the competency and the responsibility to make his own medical decisions," and asked the juvenile court to dismiss the application "on the basis that [the minor] is a mature minor with the capacity of giving informed consent."

Counsel for the Agency responded that, while some states have recognized a mature minor doctrine, allowing sufficiently mature minors to make their own medical decisions, such a doctrine "has not been recognized in California." Indeed, argued county counsel, the fact the Legislature has enacted specific statutes allowing certain minors to make their own medical decisions--e.g., emancipated minors (see Fam. Code, § 7050, subd. (e)) and minors seeking medical care related to sexually transmitted diseases, treatment of drug or alcohol abuse, and mental health care (see Fam. Code, § 6926)--indicates "the failure to enact a broad 'mature minor' statute is not an oversight, but rather an intentional limit on the rights of minors to make their own health care decisions." Accordingly, county counsel asserted, "until such time as [the minor] reaches the age of full and legal discretion, the court [should] exercise its interest as parens patriae, to [e]nsure that [he] gets appropriate treatment."

At the hearing on the application, the minor's attorney conceded "California does not have a mature minor doctrine," but disagreed with county counsel's assessment that the specific statutes allowing certain minors to make their own medical decisions in certain situations indicated the Legislature intended to preclude the courts from straying outside the confines of these provisions in recognition of a broader mature minor doctrine. In the alternative, the minor's attorney argued that the juvenile court should hear from the minor, "as [a] due process measure," to allow him to express his feelings concerning the blood transfusions.

Without ruling on whether the mature minor doctrine is viable in California, the juvenile court decided to hold a short hearing to hear from the minor and his parents.*fn1 Both the minor and his father testified that the minor began blood transfusion treatment following his first stroke at the age of four. As the father elaborated, monthly blood transfusions were ordered by the court because the minor's father and mother, as Jehovah's Witnesses, would not consent to the treatment. According to the father, the minor initially opposed the blood transfusions simply to go along with his parents' wishes. However, by the age of seven, when the minor became more active in the ...

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