Kiva O. v. State, Dept. of Health & Social Services, Office of Children's Services
408 P.3d 1181
Alaska2018Background
- Alec, an Indian child in OCS custody, diagnosed with PTSD and major depressive disorder; psychiatrist Dr. Brown recommended starting Lexapro (5 mg → 10 mg) and, if needed later, adding a mood stabilizer (Risperdal).
- Mother Kiva objected to medicating Alec, citing safety concerns (black-box warning for under-12s) and sought to retain decisionmaking over medical treatment.
- OCS petitioned superior court for authority to consent to psychiatric medication over Kiva’s objection; tribe and guardian ad litem supported OCS.
- Superior court held evidentiary hearings, found Dr. Brown’s plan narrowly tailored and in Alec’s best interests, and authorized Lexapro and future use of a mood stabilizer as needed.
- Mother appealed arguing the court failed to apply the Myers constitutional standard for overriding parental medical decisions and that the conditional authorization for Risperdal was premature.
- Supreme Court affirmed authorization for Lexapro, reversed the open-ended authorization for Risperdal, and remanded for further proceedings (requiring review of future authorization and at least 90-day judicial review cadence).
Issues
| Issue | Plaintiff's Argument (Kiva) | Defendant's Argument (OCS) | Held |
|---|---|---|---|
| Whether Myers standard applies when OCS seeks to medicate a child over parental objection | Myers applies; parental right to consent/refuse medical treatment is fundamental and requires strict scrutiny before overridden | OCS: parental rights are residual and OCS statutory duties can override based on child’s best interests (K.T.E. standard) | Myers standard applies; parental right is fundamental and substantially burdened, so court must apply Myers balancing |
| Whether administering Lexapro met Myers (compelling interest, best interests, least restrictive means) | Court failed to adequately weigh risks/alternatives; mother urged non-medical alternatives | OCS: evidence (Dr. Brown) showed diagnoses, prior non-medication efforts, benefits/risks, and necessity to avoid inpatient care | Affirmed: superior court’s findings satisfied Myers by clear and convincing evidence; Lexapro authorized |
| Whether conditional/blanket authorization for Risperdal was permissible | Authorization premature; court needed a later hearing when need was concrete and to weigh serious side effects | OCS: trial testimony gave adequate criteria and made future use contingent on clinician judgment; second hearing unnecessary | Reversed as to Risperdal: open-ended future authorization was premature; court should await factual need and hold a new hearing before authorizing such medication |
| Whether court must first find parent lacks capacity or that refusal is unreasonable | Mother argued capacity/unreasonableness finding required before overriding parental consent | OCS argued Myers balancing suffices without pre-finding of incompetence | Held: No separate preliminary finding required; Myers test (compelling interest, best interests, least intrusive means) adequately protects parental rights |
| Timing/oversight of judicial authorization | Mother sought time limits and regular review | OCS argued existing order sufficient | Held: Court should set periodic judicial review at least every 90 days for orders authorizing medication over parental objection |
Key Cases Cited
- Myers v. Alaska Psychiatric Inst., 138 P.3d 238 (Alaska 2006) (establishes that refusal of psychotropic drugs is a fundamental right and sets test: compelling interest, best interests by clear and convincing evidence, and no less intrusive means)
- Huffman v. State, 204 P.3d 339 (Alaska 2009) (extends fundamental-right analysis to parents’ medical decisions for children and requires consideration of less intrusive alternatives)
- Bigley v. Alaska Psychiatric Inst., 208 P.3d 168 (Alaska 2009) (clarifies feasibility and effectiveness inquiry for least restrictive alternative under Myers)
- K.T.E. v. State, 689 P.2d 472 (Alaska 1984) (discusses statutory reservation of parental rights such as visitation; court explains best-interests limits on statutory rights)