Inside a cramped hearing room at Broward County’s child welfare court, nearly a dozen lawyers argued over the fate of Baby Ricardo on Friday.
There were lawyers for the infant’s mother, his father, the hospital where he is being treated, state child welfare administrators, his court-appointed guardian — and for him. But Ricardo will never know the sad courtroom drama his personal tragedy has engendered. Ricardo is going to die without speaking a single word.
The only remaining question is when.
Born seven months ago with catastrophic brain damage, Ricardo suffers from a textbook-full of medical conditions. He relies on a ventilator to breathe and a stomach tube for nourishment. He endures seizures and heart attacks that lead to painful resuscitations. Even the oxygen that sustains him is causing his tissue to break down.
“There is no hope for recovery,” a court pleading lamented.
Doctors at Plantation General Hospital have urged Ricardo’s parents to sign “Do Not Resuscitate” orders and to transfer the infant into hospice care, where he would die without further suffering. The hospital has asked Broward Circuit Judge Kenneth Gillespie to order Ricardo into hospice care. The boy’s father — doctors say he visits the boy nearly every day — has signed the DNR order.
But Ricardo’s mother — who didn’t obtain prenatal medical care, the state has alleged — has so far refused to sign. The Miami Herald is not fully identifying the infant to protect his privacy.
Kenneth Goodman, who heads the University of Miami medical school’s bioethics program, said “unfortunately, we see dying children with bleak prognoses far too often. What we don’t see often are parents who are divided in this unhappy way.”
After a two-hour hearing Friday, Gillespie ordered that a medical guardian — a doctor — be appointed to speak with Ricardo’s treating doctors and make recommendations at the next hearing, scheduled for Feb. 19. Paulina Forrest, a lawyer for the child’s mother, objected to the appointment of such a guardian, as the mother feared the doctor might have the authority to discontinue treatment. Gillespie did not grant the guardian, who has not yet been named, that power.
Gillespie, who presides over cases in Broward’s child protection court, ultimately will decide whether doctors will be given permission to discontinue heroic efforts to sustain Ricardo’s life. The boy’s mother argued, through her lawyer, that Plantation General lacks the legal authority to press the case. But Gillespie, who is the second judge to be asked the fraught question, said it would be wrong to further delay consideration while the infant continues to suffer.
“His condition is irreversible; he is not getting better; and he is in pain,” Gillespie said. “In other words, he is terminal.”
“This child, indeed, is suffering,” the judge said. “What are we to do?”
Ricardo was born in August 2014. He was premature, and had been badly deprived of oxygen, leading to severe brain damage. A court record says the infant has a seizure disorder, is dependent on a ventilator to breathe, cannot eat on his own, and has suffered cardiac arrests. Ricardo, the hospital wrote in the pleading, is “unresponsive and in a vegetative state.”
The “medical interventions” necessary to keep Ricardo alive “are causing more harm than help,” the infant’s doctor is quoted as saying in the hospital’s pleading.
“The current medical treatment is only prolonging the dying process and causing undue pain and suffering,” the hospital alleged. “The humane and compassionate resolution of his suffering is a hospice referral.”
Ricardo’s father, the pleading said, “is extremely distraught over the baby’s ongoing suffering.” The pleading added: “Understandably, the father is extremely frustrated with the court system.”
With the boy’s father’s blessing, Plantation General filed a court petition Jan. 30 asking a probate judge to appoint a professional guardian with the power to consent to Ricardo being transferred to hospice care. But just before the probate hearing was to occur, Broward Circuit Judge Charles M. Greene relinquished his jurisdiction over the case, and transferred it to Gillespie, who already had authority over the family in child welfare court.
The Department of Children & Families has not challenged the fitness of Ricardo’s father. But the boy’s mother technically does not have custody over him because the state alleges she is unfit. The hospital said she has visited the boy twice since his hospitalization Jan. 8. Still, the infant’s mother retains parental rights to him, and has the ability to consent to treatment — or to withdraw it.
Forrest said that as both a lawyer and a mom she believes it is right to keep fighting for him. “As a mother, and someone who is pretty religious, when someone tells me a child can experience pain, I don’t think that child is brain dead,” Forrest told Gillespie. “To me, that sounds like life.”
“No parent wants to see their child in pain,” Forrest said. “But they retain hope that the child is still there.”
The father’s lawyer, Jeffrey Levy, said the dad “has been at the hospital virtually every day, has seen the condition of this child, and is very involved in the case.” Levy said the boy’s father was told “there is no ability for this child to recover or have any meaningful kind of life.” The father would like Plantation General to “proceed the way it feels is appropriate.”
Stuck in the middle with “an ethical dilemma” is Plantation General, said the hospital’s lawyer, Carol J. Healy Glasgow. As it now stands, doctors must perform chest compressions and “push” medications into the baby’s bloodstream every time he “codes,” Glasgow said. “And watch him suffer.”
“The dad is saying please, for the love of God, let this child die peacefully. And the mom is saying she can’t decide.”
“If the mother would sign the same DNR as the dad,” Glasgow said, “all of this would go away.”
A court-appointed lawyer for Ricardo, Walter Honaman, did not address the hospital’s request specifically at the hearing, except to say that prolonging the dispute is not in the baby’s best interests. Ricardo, he said, “has a right to have a decision made quickly.”
“There are not just two parents,” Honaman said, “but also Ricardo.”