Two instances of apparent "diabetes neglect" have been in the news recently.

negligence signThis certainly is a topic I wish we never had to write about. It's both depressing and infuriating! But there's a need to highlight this issue because it could touch any family that's touched by diabetes.

Yes, anyone.

The two cases recently in the news are from Wisconsin and Indiana. Together, they highlight the blurry lines that our entire Diabetes Community faces when confronted with these potentially deadly situations. And they've spurred a discussion across the country about whether parental care for diabetic child (or lack of it) can cross a line into neglect.

We are so quick to judge in today's society, and it's very easy to simply say "you know it when you see it." But it's getting less clean cut as more of these cases make the news and courtrooms, and we see that it's often unclear what's really line-crossing or simply some third party's own interpretation of neglect.

Honestly, it's the fact that these accusations could be lodged against any D-Parent that really bothers me.

Death by Diabetes in Wisconsin

First, the big news: On July 3, the Wisconsin Supreme Court ruled against two parents who on Easter Sunday in March 2008 chose to pray for their 11-year old daughter, Madeline Kara Neumann, rather than take her to the doctor to treat her type 1 diabetes. Although Dale and Leilani Neumann didn't belong to any organized church at the time, they identified themselves as Pentecostals and believed there are spiritual root causes to sickness. Although all of their kids were born in a hospital and vaccinated, Dale believed he'd once been cured of back pain through prayer and the couple decided not to seek treatment by doctors anymore, instead believing that "putting the doctor before God" would heal.

Well, that Madeline Kara Neumannbelief boiled over when their daughter died from untreated type 1 and DKA (diabetic ketoacidosis). Court records show that Madeline had been sick for weeks before she died, with gradually worsening D-symptoms including exhaustion, dehydration and weight loss. The day before she died, Madeline slept all day, and early that evening her legs were "skinny and blue," and that's when her mother emailed for friends and family to pray.

At the trial, her parents testified that they didn't sense any danger in her condition and thought prayer could heal her, and some of the court records show testimony saying they believed that healing was happening on Sunday morning just hours before their daughter died. It was only after Madeline stopped breathing that the mother's sister-in-law, living in California, called 911 after hearing about her neice's condition. The paramedics on the scene did a blood sugar check, but the court records show it was too high for the meter to register an actual number.

The Neumanns were convicted of reckless homicide in two separate jury trials in 2009, but their sentences were put on hold while the parents appealed. They argued that a state law provision, Wis. Stat. 948.03(6), protects prayer healers and that their due process rights were violated because they didn't know criminal liability was possible if the faith healing failed to save their child.

In the court's ruling, 6 of 7 of the state's justices determined the law was narrowly written and didn't protect parents in all cases of child abuse. If there's a "substantial risk of death," then the parents could be prosecuted. Basically, the court majority ruled that the Neumanns had a duty to seek medical care because they should have recognized the danger posed by the DKA symptoms.

Only one justice disagreed, interestingly bringing up a point that many in the D-Community know well: diabetes and DKA symptoms can vary, and both the general public and even the medical profession is known to miss or misdiagnose these potentially-deadly signals.

The lone dissenter,  Justice David T. Prosser, wrote a 23-page opinion (starting on page 73) that plainly says this case isn't as clear-cut as it sounds. He pointed out that the larger issue is how this parental "duty" will be interpreted in future cases, whether it's a parent confronted with possible DKA symptoms or some other non-diabetes illness. Prosser was the minority view, but he makes a valid Leilani Neumann, Dale Neumannpoint: Where does the line stand, especially in a world where DKA can mirror so many other illnesses and a diabetes diagnosis is sadly missed by many medical professionals?

The D-Community both online and offline lit up over this case, outraged over how parents could allow this to happen in today's world, when the effects of DKA and untreated type 1 are well-known.

The law may dictate here that the Neumanns relied too much on faith-healing, but what about other parents who have no idea what diabetes symptoms look like and just miss the diagnosis and don't call a doctor? Could a similar suit be filed against them? Or those who let blood sugars or A1C rise above the ADA-recommended guidelines, risking possible future complications? Could they be tried as criminals as well?

The fact is that these symptoms aren't always caught even by licensed medical professionals... so where do we draw the line when it's not just about seeking medical care when an issue is apparent, but about imposing a standard that any parent know the risks of undiagnosed diabetes, DKA, or even poor D-management?

It's not such a simple matter as we might have thought for the D-Community to ponder.

An Indiana D-Mom's Case

Case-in-point, from the Midwest:

A county prosecutor in northern Indiana filed felony child neglect charges in late June against a Fort Wayne woman accused of withholding insulin from her 9-year-old son, who then slipped into a coma.

I could only find one news story online about this, although D-Dad Tom Karlya write about it too. Unconvinced by the newspaper story, I obtained a copy of the prosecutor's charging documents and was pretty shocked to see how flimsy the case appears to be against 27-year-old Mary Gene Markley.

Apparently, officers determined she was lying about checking her son's blood sugar three times a day because they checked the Accu-Chek Aviva meter she had and it hadn't been used since April 16. There's nothing mentioned about other meters she may have used. Another adult that she's been staying with since mid-April also told investigators that Markley didn't have any insulin, that she'd never witnessed Markley giving the boy insulin or checking his BGs, and that she hadn't seen any "insulin items" in the trash. The boy had been ill and was vomiting leading up to his being taken to the hospital, where the police were called.

That's it. Based on those points, the mother has been charged and accused of "withholding" insulin.

Now, this could very well be what it claims to be -- a case of D-Parenting neglect. But it could also be any number of things short of that, just pieces of a puzzle that show a different picture. One where an uniformed parent was struggling with a lack of resources and knowledge, and maybe also frantic and bewildered by her son's symptoms. Meanwhile, someone believed D-Neglect was happening, but in reality no one has shown any hard evidence that the mother intentionally crossed that line.

And that should worry all of us.

Bigger Concern for Any D-Parent

Looking at this, I have to also keep in mind the other court cases I've combed through, like the Tennessee case I mentioned in May where school officials seem to have called child protective services and reported "neglect" because D-Parents allowed their kids to go to school with blood sugars in the 200s (with the "officials" having no understanding that this may have been post-meal or pre-exercise), and blaming parents because their CWDs sometimes eat candy bars or have low blood sugar reactions.

There are numerous frivolous cases like this out there, being filed against D-Parents who haven't done anything wrong except in the eyes of ignorant bystanders. But these parents are being accused, some are going to court, and some have even been ruled against by judges.

That's pretty scary stuff, don't you think?Crossing The Line Right Wrong

Back in April, low-carb guru Dr. Richard Bernstein mentioned in a webcast that he'd recently been contacted by a law firm specializing in medical malpractice, saying that some endos in parts of the country are telling D-Parents that their kids could taken away if they don't try harder to "normalize" blood sugars and get A1Cs down closer to ADA standards.


It seems unlikely that social services would actually take kids away after investigating these charges, but with all of the legal hype and "duties" being imposed on parents these days, who knows?

And who draws the line on "neglect" anyway? Is it ADA guidelines that say we should be "in range," or some other standard imposed by a panel of legal and medical professionals? Where do we, as a society, draw the line between protection and unreasonable behavior...?

It all just makes me think we're on our way to being neglectful in how we judge and treat D-Parents.

Agree? Disagree? Or feel like punching someone just now? Can't say that I blame you.

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