Doctor reports mom who won’t let son take drug

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From: Debs

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Doctor reports mom who won't let son take drug

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By Bob LaMendola

Health Writer

July 21, 2002

A physician lodged a child-abuse complaint against a Coral Springs mother who

refused to let her 11-year-old son take a medication that might save the boy

from going blind.

Dr. Barry Waters said he and the family's eye specialists recommended that the

boy take a commonly prescribed drug, methotrexate, for an arthritis-related eye

condition that is eroding the child's sight.

But the mother, Margie Lacre, researched the drug and several other treatments

and as recently as last week decided they posed too much risk of side effects,

including lung and liver damage, said Waters, an arthritis specialist. Over the

past year, she has not let her son take the drugs, leaving him on medicines that

let the eye get worse, he said.

The doctors contend that the mother is overreacting because the risks of side

effects are tiny and the son could lose his sight within months without

treatment, Waters said.

" The kid is becoming more and more blind, and now it's getting to the desperate

stage, " Waters said. " She is making a big mistake. All of this refusing and

procrastinating is like sticking a stick in his eye and blinding him yourself. "

Waters' staff called in the " medical neglect " complaint on Wednesday in hopes

that the state Department of Children and Families would try to persuade or

force the mother to agree to the treatment.

The son has a different last name than his mother, and Waters would not name him

because of patient confidentiality.

Lacre could not be reached for comment with calls and phone messages left at her

home. A woman who answered the phone said Lacre would not be available for

questions.

The doctor's complaint is being investigated by child protection officers at the

Broward Sheriff's Office, which investigates abuse complaints for the DCF. They

and a DCF spokeswoman said they could not comment on the case.

Officials who handle medical neglect cases said it's not unusual for parents to

refuse a treatment suggested for their children. When complaints are filed, the

key question is whether the refusal is reasonable or would needlessly endanger

the child's health, which often is a fine line.

" Medical neglect is a really touchy area to navigate, " said Dennis Nicewander, a

Broward County assistant state attorney who prosecutes child-abuse cases. " Whose

standard do you use to decide what is the right medical treatment? When do you

go beyond being a bad parent and become a criminal? There are no easy answers. "

In this case, investigators will rely on the opinions of doctors and health care

workers on a team that reviews the medical aspects of child-abuse complaints,

said Capt. Atkinson, head of the Sheriff's Office child protection unit.

If the health experts side with the boy's doctors, the state could ask a judge

to order the treatment, Atkinson said.

" I could see where people might have different views than their doctors " about

the right medical treatment, Atkinson said. " Ultimately, it's the safety of the

child that has to be decided. "

The drug in question, methotrexate, often is prescribed for children and adults

to relieve the inflammation and pain of arthritis. The drug suppresses the

body's immune system, which in arthritis is mistakenly attacking the body's own

connective tissue, such as joints and tendons.

In the boy's case, Waters said the arthritis is attacking collagen in his eyes,

harming eyesight and preventing the eye from moving normally.

The family's eye doctors at Bascom-Palmer Eye Institute in Miami had suggested

methotrexate more than a year ago, Waters said, but Lacre declined. He said the

boy instead was treated with steroid eyedrops that helped but led to glaucoma

and cataracts that are now complicating the situation. The boy's eye doctor in

Miami could not be reached for comment.

Bascom-Palmer sent the boy to an eye specialist in Alabama and to Waters a few

weeks ago. Both favored methotrexate.

The drug can cause nausea, hair loss, liver damage, lung damage and decreased

fertility when it is used as a once-a-day chemotherapy to fight cancer, but it

is safe when used as a once-a-week treatment for arthritis, the National

Institute of Arthritis and Musculoskeletal and Skin Diseases said in a report

for consumers last year.

" Because only small doses of methotrexate are needed to relieve arthritis

symptoms, potentially dangerous side effects rarely occur, " the report said.

" We just need to start doing something for the kid, " Waters said. " Let's not

wait another day, because he's about to go blind. "

Bob LaMendola can be reached at blamendola@... or 954-356-4526.

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