In the Matter of Matthew V. A Child under Eighteen Years of Age Alleged to be Abused by Lynette G., Respondent.
Sputz, Esq. Special Assistant Corporation Counsel
Administration for Children's Services Family Court Legal
Caroline Irvin, Esq. Andrew Friedman, Esq. Friedman Sanchez
Counsel for Lynette G. Maria Roumiantseva, Esq. Legal Aid
Society, Juvenile Rights Practice Attorney for the Child
S. Pitchal, J.
petition dated April 20, 2017, ACS alleges that the
respondent, Lynette G., abused her 13-year-old son, Matthew
V. The gravamen of the petition is that Matthew is diagnosed
with Ewing sarcoma, the only indicated treatment for which is
chemotherapy, and that Ms. G. is unreasonably refusing to
consent, putting the child's life at risk.
the filing of the petition, ACS sought a court order giving
it medical decision-making authority for Matthew. ACS did not
seek a remand of the child or the transfer of any other
parental or custodial duties, recognizing that as he goes
through chemotherapy, the child would be best off remaining
in his mother's care. The matter was transferred to the
undersigned for the purpose of a hearing on the issue.
to commencing the hearing, the Court confirmed, on the
record, that if the Court were to grant the ACS application,
Ms. G. would obey the order and bring the child to
chemotherapy appointments despite her objection to them,
obviating the need to expand the scope of the hearing to
consider a full remand. Also prior to commencing the hearing,
the Court ascertained that the child also opposed
chemotherapy, and thus the attorney for the child would be
opposing the ACS application. Nevertheless, the attorney for
the child noted the importance for the child to receive
independent counseling from a licensed mental health
professional familiar with pediatric cancer issues, so that,
in the event the Court granted the ACS application, Matthew
could be emotionally prepared to accept the result. Ms. G.
indicated that she would consent to such counseling.
Court also inquired regarding Matthew's father, and was
informed that Mr. V. resides in Florida and is in touch with
Matthew and Ms. G. He is also said to oppose the chemotherapy
hearing commenced on April 21, 2017, and continued on April
25, with closing arguments delivered on April 27. The record
at the hearing consisted of the credible testimony of ACS
child protection supervisor Ms. Tonza Smart and Dr. Alice Lee
(qualified by stipulation as an expert in pediatric
oncology), and the testimony of Ms. G., which the Court found
credible in some respects and not credible in others, as
detailed below; Petitioner's Exhibits 1 (Memorial Sloan
Kettering Cancer Center records) and 2 (ORT dated March 30,
3017); and Respondent's Exhibit A (MRI report dated April
17, 2017), B (hematopathology report dated March 3, 2017), C
(pediatrician letter dated April 24, 2017), and D (CT scan
report dated April 21, 2017).  Based on the record, the
Court makes the following findings of fact:
1. The child Matthew V. was born on xxxx, 2003, and is
2. Matthew and his mother first noticed a pea-sized mass on
the left side of his neck in approximately 2014. They thought
it was a benign cyst. Over the years, it grew in size, and by
December 2016, Matthew was complaining of discomfort when he
turned his head to the left.
3. Ms. V. brought Matthew to the emergency department at
Morgan Stanley Children's Hospital of New York/New
York-Presbyterian ("CHONY"). CHONY staff told the
family that, based on imaging, the mass was not a cyst, and
surgery was recommended.
4. Dr. Duron performed surgery and excised the mass on
January 7, 2017. Pathology examination showed the margins to
5. However, Dr. Alice Lee, the pediatric oncologist at CHONY
also informed Ms. V. that Matthew has Ewing sarcoma. This was
based on the genetic testing done on the mass that Dr. Duron
removed, which revealed an EWS-ERG fusion. Moreover, a chest
CT scan revealed three tiny nodules on his lungs, which were
too small to biopsy.
6. Ewing sarcoma is a type of tumor found in soft tissue or
bones, which most typically strikes adolescents and young
adults. Systemic chemotherapy is the standard treatment for
this kind of cancer. When Ewing sarcoma metastasizes, it most
commonly spreads to the lungs, other bones, and bone marrow,
but it can travel anywhere in the body. CHONY conducted a PET
scan to assess the presence of disease elsewhere in his body,
and the results were negative. CHONY also conducted a bone
marrow biopsy to determine if he had cancer in his bones, and
the result was negative.
7. Nevertheless, because of the definitive diagnosis of Ewing
sarcoma, Dr. Lee recommended initiation of systemic
chemotherapy. She believed the nodules in Matthew's lungs
were evidence that the cancer had spread there. Ms. G. was
reluctant and wanted a second opinion.
8. Ms. G. arranged for a second opinion at Memorial-Sloane
Kettering Cancer Center ("MSKCC"). MSKCC was
provided various tissue slides from CHONY to conduct their
own examination and testing. As early as March 3, 2017, a
hematopathologist at MSKCC, Dr. Wenbin Xiao, examined slides
of a bone biopsy conducted by CHONY on January 26, 2017 and
found no evidence of metastatic disease.
9. Another MSKCC pathologist, Dr. Cristina Antonescu,
reviewed the biopsy slides of the mass that had been removed
by CHONY. From her initial histology review, she did not
think the cells were completely consistent with Ewing
sarcoma. Her first method of genetic testing led her to think
that Matthew may have a myoepithelial carcinoma instead, so
she performed a different type of genetic testing to be
10. The indicated treatment for myoepithelial carcinoma is
quite different than the systemic chemotherapy indicated for
Ewing sarcoma. For a myoepithelial cancer, MSKCC would
recommend more surgery at the cancer site, to remove a
greater area of tissue, as well as possible post-surgical
11. When Ms. G. brought Matthew for an in-person consultation
at MSKCC on March 22, 2017, the pediatric oncologist, Dr.
Paul Meyers, informed them of Dr. Antonescu's findings,
her plan to perform additional genetic testing on the tumor
sample, and the different treatment recommendations depending
on the results of that testing. The family also met on March
24, 2017, with Dr. Todd Heaton, the pediatric surgeon, who
explained the excision he would ...