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The case of a mother who took her 9-month-old child on the lam, frantically searching for alternative therapies as state and medical authorities demanded kidney surgery for the boy, unfolded before the public last week like a high-drama television show. But at bottom, it pitted the rights of a mother and father against the power of the state.
While rare, such disputes typically involve parents who decline treatment for their children based on religious beliefs. Tina Carlsen has now refocused those questions. The issue is not opposing treatment but whether a parent may look beyond traditional medicine for help.
In the middle sits her ailing child, and legal experts say precedent holds that a judge's decision on the boy's best interests will determine whether he and others in like situations remain with their parents or become wards of the state.
Initially, the storyline seemed clear: Carlsen ignored a court order and secreted her baby out of Children's Hospital and Regional Medical Center last week, even though child-welfare officials, concerned about medical neglect, had won custody of the boy. His mother, a 34-year-old homemaker, now faces up to a year in prison if convicted on second-degree kidnapping charges.
But the picture soon became murkier. Legal rulings hold that only in a medical emergency may the state override parents' health care wishes -- and physicians acknowledge that Riley was in no immediate danger of dying.
A growing chorus of family supporters sees the case as a frightening example of government authority overstepping its bounds, essentially forcing Carlsen to take drastic action by badgering her into compliance and preventing her from finding other treatment options for Riley.
After police arrested her on a road in Yelm early last Saturday, they brought the boy back to Children's for surgery and put Carlsen in jail. As of Wednesday, she had no idea whether he had undergone an operation, family members said.
"This mother's rights have been annihilated," said Kelly Meinig, president of Citizens for Safe Birth, a non-profit organization that works to improve consumer access to information in medical matters. "Here, we've got doctors saying, 'You must do this.' And apparently, you must or you'll be put in jail and your child taken. What's so scary is this could happen to any of us. All this family wanted was the ability to make an informed decision."
But experienced physicians say exactly the opposite.
"OK, it isn't an urgent situation, but what do you do -- wait until the child goes into a coma?" said Abe Bergman, a pediatrician at Harborview Medical Center who often treats youths in the child-welfare system.
Though prosecutors sought $500,000 bail in their arrest warrant, Carlsen's attorney, Jim Lobsenz, plans to ask a judge to release her this morning while she awaits trial. He called Carlsen "a caring and loving mother" and said he hoped a court order preventing her from seeing Riley would be lifted "as soon as possible."
Dan Donohoe, a spokesman for the King County prosecutor, agreed that Carlsen should be free without bail as long as she complies with conditions set by the judge or recommended by Child Protective Services.
In the past, such cases have forced the religiously orthodox to fight medical professionals. Bergman recalled several instances of Jehovah's Witnesses refusing blood transfusions and forcing doctors to summon judges to hospitals for emergency medical rulings.
Almost always, he added, the medical establishment wins.
"Parents may be free to become martyrs themselves. But it does not follow that they are free in identical circumstances to make martyrs of their children," says the prevailing U.S. Supreme Court decision.
It was written in response to religiously based arguments against treatment, but the increasing popularity of alternative therapies may soon force courts to consider new issues in that arena. Last week, an Oregon woman hid her 4-year-old daughter from authorities for several days because the child was ill with pneumonia and her mother did not believe in using Western medicine to treat it. The woman, Jennifer Sullivan, 30, turned herself in to police last Friday.
Yet even in situations where conventional wisdom holds that the rules are ironclad -- such as preschool shots for kids -- there are loopholes.
"Everyone believes compulsory vaccinations are indeed compulsory, but in Washington, there's a personal, or philosophical, exemption," said Steve Calandrillo, a professor at the University of Washington School of Law who writes about debated areas of medicine. "You cannot compel a parent to vaccinate their child, even though a doctor could claim that's medical negligence."
In Riley's case, a family physician did exactly that, said the child's grandmother, Teena Thill. Twice, a nephrologist asked child-welfare authorities to investigate the family for failure to obey her medical orders, and twice, Thill said, caseworkers saw no reason to take action.
"The second social worker actually gave Tina a high-five and said, 'You're doing a wonderful job with that baby, keep up the good work,' " she said.
Carlsen had been using alternative therapies -- baths, herbs and a low-stress environment -- to heal her son, with some success, Thill added. But disputes over his care had been ongoing, almost from birth. They erupted earlier this month when his physician insisted that the baby begin a course of prescription medication to pave the way for kidney dialysis.
"The doctor told Tina, 'You do what I tell you to do, or I will have the police at the door, taking that baby from you,' " Thill said. "They all said this was the only treatment."
Officials at the Department of Social and Health Services have been circumspect about details in the Carlsen case, citing privacy laws. Attempts to reach a spokeswoman late Wednesday afternoon were unsuccessful.
By law, however, parents are entitled to get a second opinion before state officials take over. Thill maintains that her daughter-in-law never had that chance.
"Basically the state isn't supposed to take custody of the child unless there's imminent harm," said Lisa Kelly, who teaches family law at the UW. "That's what's interesting here, whether there was indeed imminent harm to this child."
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