Denial of Critical Care

 "Denial of critical care" is defined as the failure on the part of a person responsible for the care of a child to provide for the adequate food, shelter, clothing or other care necessary for the child's health and welfare when financially able to do so or when offered financial or other reasonable means to do so.

 A parent or guardian legitimately practicing religious beliefs who does not provide specified medical treatment for a child for that reason alone shall not be considered abusing the child. However, this does not preclude a court from ordering that medical service be provided to the child where the child's health requires it.

 Denial of critical care includes the following eight sub-categories:

  • Failure to provide adequate food and nutrition to such an extent that there is danger of the child suffering injury or death.
  • Failure to provide adequate shelter to such an extent that there is danger of the child suffering injury or death.
  • Failure to provide adequate clothing to such an extent that there is danger of the child suffering injury or death.
  • Failure to provide adequate health care to such an extent that there is danger of the child suffering serious injury or death.
  • Failure to provide the mental health care necessary to adequately treat an observable and substantial impairment in the child's ability to function.
  • Gross failure to meet the emotional needs of the child necessary for normal development evidenced by the presence of an observable and substantial impairment in the child's ability to function within the normal range of performance and behavior.
  • Failure to provide proper supervision of a child which a reasonable and prudent person would exercise under similar facts and circumstances, to such an extent that the child was directly harmed or placed at risk of harm.
Note: This definition includes cruel and undue confinement of a child and the dangerous operation of a motor vehicle when the person responsible for the care of the child is driving recklessly or driving while intoxicated with the child in the vehicle.
 
The Department of Human Services receives many inquiries each year regarding when a child can be left home alone safely. Iowa law does not define an age that is appropriate for a child to be left alone. Each situation is unique. Examples of questions to help determine whether there are safety concerns for the child include:
  •    Does the child have any physical disabilities?
  •    Could the child get out of the house in an emergency?
  •    Does the child have a phone and know how to use it?
  •    Does the child know how to reach the caretaker?
  •    How long will the child be left home alone?
  •    Is the child afraid to be left home alone?
  •    Does the child know how to respond to an emergency such as fire or injury?

Failure to respond to the infant's life-threatening conditions by failing to provide treatment which in the treating physician's judgment will be most likely to be effective in ameliorating or correcting all conditions. This subcategory or the denial of critical care abuse type is also known as withholding of medically indicated treatment. The type of treatments included are appropriate nutrition, hydration and medication. The term does not include the failure to provide treatment other than appropriate nutrition, hydration and medication to an infant when in the treating physician's medical judgment, any of the following circumstances apply:

  • The infant is chronically and irreversibly comatose.
  • The provision of treatment would merely prolong dying, not be effective in ameliorating or correcting all of the infant's life-threatening conditions, or otherwise be futile in terms of the survival of the infant.  
  • The provision of the treatment would be virtually futile in terms of the survival of the infant and the treatment itself under the circumstances would be inhumane.