On April 30, 1985, four days after her eleventh hospital admission, the visiting nurse found that the Lees were giving Lia a double dose of Tegretol pills that they had stored in an old phenobarb bottle. And the following day, that Lia's father "refused to give any Tegretol whatsoever." In addition, in the pediatric clinic that day, "the family stated that they had stopped the pheonobarb" on the day of discharge from the hospital.
That day, Lia's pediatrician requested that:
"Because of poor parental compliance regarding the medication, this case obviously would come under the realm of child abuse, specifically child neglect... Unless there could be some form of compliance with the medication regimen and control of the child's seizure disorder, this child is at risk for status epilepticus which could result in irreversible brain damage and also possibly death. It is my opinion that this child should be placed in foster home placement so that compliance with medication could be assured."
On that day, Lia Lee was placed in the custody of the court. At the foster home, despite almost daily clinic visits and attempts to follow the anticonvulsant prescriptions to the letter, Lia was still experiencing daily seizures. After several hospitalizations and a new diagnosis of Lennox-Gastaut Syndrome, a rare form of epilepsy characterized by mental retardation and hard-to-control seizures, her anticonvulsant regimen was changed to Depakene alone. Lia was finally returned home on April 30, 1986.
In September 1986, Lia fell off a swing, hit her head, and went into status epilepticus. She was admitted to MCMC, then transferred to Valley Children's Hospital in Fresno where she was found to be in septic shock. Several hours later, she developed disseminated intravascular coagulation and cerebral edema. EEG showed essentially no brain activity and Lia was taken off all medications and transferred to MCMC for supportive care. At that time her diagnoses were:
- severe hypoxic brain damage
- pseudomonas septicemia
- severe seizure disorder
- status post disseminated intravascular coagulation
- status post septic shock
From your perspective, which of the following statements describes the situation in the case? (You may choose more than one answer.)
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