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In re A.W.

Superior Court of Pennsylvania

May 4, 2018


          Appeal from the Order Entered December 14, 2016 In the Court of Common Pleas of Philadelphia County Family Court at No(s): CP-51-DP-0001428-2016, CP-51-DP-0001513-2016, CP-51-DP-0001514-2016, CP-51-DP-0001515-2016, FID# 51-FN-001537-2016

          BEFORE: BOWES, J., OLSON, J., and NICHOLS, J.


          BOWES, J.

         A.W., Sr. ("Father") and T.A. ("Mother") (collectively, "Parents") appeal from the order entered on December 14, 2016, wherein the juvenile court directed the Philadelphia Department of Human Services ("DHS") to fully vaccinate and immunize Parents' four minor sons: S.W., A.W., Jr., J.W., and M.W. We affirm.

         The juvenile court summarized the relevant factual history of this case as follows.

On July 9, 2016[, ] DHS received a Child Protective Services (CPS) report alleging that A.W.[, Jr., born August 2010, ] was hospitalized at the Children's Hospital of Philadelphia (CHOP) and was diagnosed with a rare form of epilepsy named, "Refractory Epilepsy." The family was visiting an unidentified person in Lehigh County when A.W.[, Jr.] had a seizure and was transported to a hospital in Lehigh County and [then] transferred to CHOP. Mother refused medical treatment for A.W.[, Jr.] because she believed the anti-seizure medication prescribed to A.W.[, Jr.] was increasing his seizures. Mother attempted to remove A.W.[, Jr.] from CHOP. CHOP staff would not allow Mother to remove A.W.[, Jr.] as it would have endangered A.W.[, Jr.]'s life not to receive the prescribed medication. The report stated A.W.[, Jr.] resided in the state of Delaware. The report stated the family had an open case in Lehigh County Children and Youth Services (CYS).
On July 10, 2016, D[H]S received a supplemental report alleging that A.W.[, Jr.] was having increased seizure activity. CYS previously had physical custody of A.W.[, Jr.] and returned physical custody to Mother on July 5, 2016[, ] to make medical decisions for A.W.[, Jr.]. Mother continued to refuse treatment on the evening of July 9, 2016[, ] as A.W.[, Jr.] suffered increased seizures. The report further stated that if Mother continued to refuse medical care for A.W.[, Jr.], he would suffer either neurological damages or sudden death. The report stated between the evening of July 9, 2016[, ] and the morning of July 10, 2016, A.W.[, Jr.] experienced at least 42 seizures. As a result of the 42 seizures, A.W.[, Jr.]'s medical status had deteriorated. A.W.[, Jr.] was moved to the Pediatric Intensive Care Unit (PIC) and was intubated.

Juvenile Court Opinion, 11/1/17, at 1-2.

         On July 10, 2016, DHS obtained an Order of Protective Custody ("OPC") for A.W., Jr. Approximately one week later, DHS filed a dependency petition, and a hearing was held on July 19, 2016. At the hearing, the court discovered that A.W., Jr., had three other siblings who were in need of medical treatment. Specifically, it was noted that A.W., Jr.'s, siblings had extensive dental issues. At the conclusion of the hearing, the juvenile court adjudicated A.W., Jr., dependent pursuant to 42 Pa.C.S. § 6302(1) and ordered that DHS investigate the condition of A.W., Jr.'s, siblings.

         DHS immediately obtained protective custody of S.W., J.W., and M.W., who were born October 2007, December 2010, and January 2013 respectively.[1] DHS filed a dependency petition on July 29, 2016, and following a hearing, the juvenile court adjudicated S.W., J.W., and M.W. dependent.

         On December 14, 2016, the juvenile court held a permanency review hearing, wherein it ordered S.W., A.W., Jr., J.W., and M.W. to be fully vaccinated and immunized to ensure their day-to-day medical needs. Parents objected to the vaccinations, noting that they preferred their children to be treated through natural modalities, such as marijuana. That same day, the juvenile court held a hearing on the matter to allow Parents to state their opposition to the vaccinations on the record. At the hearing, DHS presented the testimony of Peaches Mulba, the caseworker assigned to the family, and Laura Simon, M.D., A.W., Jr.'s, attending physician and an expert in pediatrics. Parents did not present any testimony; however, counsel summarized their opposition on the record: "[My] clients believe that the interference with the immune system is unnatural and it's not well understood and not tested for long term safety. And that's a moral and philosophical reason not to have an immunization." N.T., 12/14/16, at 10.

         Ms. Mulba testified regarding her conversations with Mother about vaccinating the children, and specifically, A.W., Jr. She stated, "Mom said that she wasn't going to get - they wasn't going to get vaccination to [A.W., Jr.] because that is one of the reasons that keeps him in the hospital and this [way] they can be with him." N.T., 12/14/16, at 18. On cross-examination, Ms. Mulba elaborated, "Mom said that the vaccination wasn't good for the children. It's just not good for the immune system[, and] because of that they wasn't prone to sign for vaccinations for any of [the children]." Id. at 19.

         Dr. Simon testified to her opinion that immunizations are generally accepted as safe and effective, with minimal risk. N.T., 12/14/16, at 34. Likewise, Dr. Simon noted that she recommends immunizations to all of her patients. Id. Dr. Simon expressed concern that there are a large number of vaccine-preventable diseases that can cause chronic illness, disability or death. Id. As it relates to A.W., Jr., Dr. Simon explained that because of A.W., Jr.'s increased risk of disability due to his seizures, she recommended that A.W., Jr., be fully immunized. Id. at 38, 41. Dr. Simon testified that as A.W., Jr., approaches school-age, his risk of contracting a vaccine-preventable disease increases as he attends daycare or school. Id. at 41.

         Moreover, Dr. Simon also recommended that S.W., J.W., and M.W. be fully vaccinated. Like with A.W., Jr., Dr. Simon explained that the other children, if left unvaccinated, would be at a higher risk of contracting vaccine-preventable diseases and could suffer from more severe reactions or illnesses if they were to contract a disease. Id. at 42. Further, Dr. Simon cautioned the court that if any of A.W., Jr.'s, siblings were to ...

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