Connecticut Supreme Court Mandates Continued Chemotherapy for 17-Year-Old Against Her Wishes

IS IT THE STATE’S DECISION OR THE FAMILY’S?

by Sharon Rondeau

(Jan. 8, 2015) — A 17-year-old girl diagnosed with Hodgkin’s Lymphoma last fall will continue to receive chemotherapy treatments for the condition against her will and that of her mother, according to a unanimous decision issued directly after a hearing on Thursday by the Connecticut Supreme Court.

The case was appealed by the teen, known in court documents as “Cassandra C.,” and her mother, Jackie Fortin, after hearings in Superior Court resulted in an order that DCF take custody and order treatment with chemotherapy despite her objections.

After her diagnosis, physicians at Connecticut Children’s Medical Center (CCMC) in Hartford summoned the Connecticut Department of Children and Families (DCF) because of what they termed “neglect” on the part of her mother.

According to NPR, Ms. Fortin has raised Cassandra alone “for Cassandra’s entire life” and home-schooled her.

Cassandra’s mother claims that court-ordered treatments violate her daughter’s “human, constitutional rights” and the dictates of common law.  According to The Hartford Courant, Fortin had been pursuing other methods of treatment when DCF became involved in the case, although her attorney reportedly did not mention that in court.

Fortin also stated on camera that her daughter fears that she may not be able to have children and will suffer other side effects from the chemotherapy.  “She does not want poisons in her body,” Fortin said.

In some ways, the case resembles that of another Connecticut teen, Justina Pelletier, whose custody was taken away from her parents when a medical team at Boston Children’s Hospital disagreed with Justina’s diagnosis from Tufts Medical Center.  BCH doctors said they believed Justina was the victim of “medical child abuse” for undergoing treatment for mitochondrial disease at Tufts and contacted Massachusetts DCF, which kept Justina locked away in BCH’s psychiatric wing with armed guards present when her family visited her on the once-weekly visited allowed by the child welfare agency.

Justina may have been held by BCH for medical research, as Massachusetts state law provides that wards of the state can undergo medical experimentation upon the judgment of the doctors caring for them.  A study in somatoform disorder, with which BCH  doctors diagnosed Justina very quickly after first seeing her, had reportedly received funding shortly before.

As a result of Justina’s ordeal, several members of the U.S. Congress introduced a bill that would prevent federal funds from going to states which conduct medical research on wards of the state.

Justina was reunited by court order with her family in June.  However, in late September, she was hospitalized with severe stomach pain at Yale-New Haven Hospital, which ultimately could not meet her needs.  Justina was transferred to The Children’s Hospital of Philadelphia in early December but reportedly was able to spend Christmas at home.

Justina’s father stated that her ongoing medical problems are a result of her lack of treatment for mitochondrial disease, which one of her older sisters also has, while she was in Massachusetts DCF’s custody.

Cassandra’s room at CCMC is now guarded, and her mother, Jackie Fortin, has been denied phone calls with her.  One report stated that Fortin is able to visit with a DCF-appointed monitor in the room.

Fox 31 in Denver appears to have more details on the case than many national news outlets, reporting that “After an investigation, DCF requested temporary custody of Cassandra. She was removed from her mother’s home and placed with a relative” and “Cassandra was allowed to return to her mother’s home, under the supervision of DCF and on the condition that she agree to complete the recommended treatment. She underwent two days of chemo beginning November 17 but then ran away for a week, according to court documents, and after returning home said she wanted to discontinue the treatment.”

Cassandra is reportedly undergoing daily treatment for her condition, which the Mayo Clinic reports can resolve to a “full recovery.”

According to Medicine.net, patients who have had Hodgkin’s Lymphoma may be at risk of developing leukemia as they age.  The medical website also states of Hodgkin’s:

Before starting treatment, you might want a second opinion about your diagnosis and treatment options. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some insurance companies actually require a second opinion.

If you get a second opinion, the second doctor may agree with your first doctor’s diagnosis and treatment recommendation. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you’ve looked at all of your options.

It may take some time and effort to gather your medical records and see another doctor. In most cases, it’s not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some people with Hodgkin lymphoma need treatment right away.

Connecticut Attorney General George Jepsen, who was re-elected in November, said that Fortin failed to take Cassandra to “at least four doctor’s appointments last summer and fall,” which caused doctors to “notify child-welfare agents.”

Cassandra’s attorney, assistant public defender Joshua Michtom, said that the state of Connecticut, in which an underage female can obtain an abortion without parental consent, should consider adopting the “mature minor doctrine” in Cassandra’s case because of the possibility that “a smart and knowledgeable 17-year-old (can) make the same choice, for better or worse, than she would be able to make without state interference nine months from now, when she turns 18.”

Fortin’s attorney, Michael Taylor, also supported the “mature minor doctrine” in regard to Cassandra’s ability to make informed decisions about her health.

The teenager will turn 18 on September 30.  Her current course of treatment is expected to last 4-6 months.

Last year, Connecticut DCF acknowledged that six children known to the agency had died from “maltreatment” between January and May.  In an editorial column written on May 16, 2014, former Republican state legislator Kevin Rennie wrote that the deaths of two Connecticut infants with DCF cases resulted from DCF’s failure to protect them.  “Meaningful reform that saves lives is not going to happen from within DCF’s leadership. Others must share what they know. Children’s lives are at stake,” Rennie said.

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