Hadley’s Story

Hadley was born in May 2007.  She was born perfectly healthy. Around the age of 5 months, I (mom) saw that one side of Hadley’s ribs were bulging out. I showed my husband, and he thought she just had more muscle strength on that side from learning to sit.  Hadley’s head also tilted to one side, and we were told she had torticollis.  We were not overly concerned with this diagnosis, since our other daughter also had this.  At Hadley’s 6 month appt., my husband thought we should show the doctor Hadley’s back to make sure everything was normal. The doctor looked at it and agreed that Hadley’s ribs were bulging out on one side and she referred us to the local Children’s Hospital.

At 6 ½ months we got Hadley into the Children’s Hospital to see a pediatric orthopedic surgeon. They took an X-ray and that day Hadley was diagnosed with idiopathic infantile scoliosis with a 30 degree curve. The doctor explained to us that most children’s spine’s will straighten up on their own, but there is a percentage of children who have progressive scoliosis. He said he wanted to wait 3 months to see what Hadley’s back was going to do.  Not knowing anything about scoliosis, my husband and I agreed to this.

3 months passed and we went back to get more X-rays of Hadley’s back. They looked horrible! Hadley (now age 9 months) had a 55 degree curve. That day she was fitted to get a Kalibus brace. We thought that this brace would correct Hadley’s back within a year or so and scoliosis would be out of our lives forever. At 10 months, Hadley finally got her brace. She had to wear it 24 hrs a day. The only reason we got to take it off was for bath time. Once Hadley got her brace, I decided to do some research on it. I was desperate to find any information on this brace.  Unfortunately, I could not find any published research that could prove that bracing could correct scoliosis in an infant.   But after praying and searching, I came across the, “Infantile Scoliosis Outreach Program” (ISOP) website. I searched the site high and low for kids using braces, but I could not find any.  I saw however, that many of the children on this site were in casts. Even though Hadley was in a brace, I decided to join the “CAST Support Group” because I was desperate for any information or anybody to talk to who knew what we were dealing with. Once I started talking to people on the site, I stumbled across other parents that had personal experience with Early Treatment with EDF (elongation, derotation, flexion) casting, bracing, and other treatment modalities.

People on the “CAST Support Group” welcomed me nicely and showed interest in my situation. I was starting to hear that a lot of their situations sounded similar to ours. They informed me of a new procedure called Early Treatment EDF Casting, which was to try and correct a child’s spine, not just hold it. I was never told that Hadleys brace would not correct her spine. I started to get scared and talked to my husband about what I was hearing.   He called Hadley’s orthopedic nurse to clarify the purpose of the brace. Turns out, everything I was hearing on the CAST Support Group was right. A brace was not going to correct Hadley’s back, it was only an attempt to hold it until she is old enough to have surgery!  We were told by the nurse that hopefully that wouldn’t be until maybe age 12 or 13; whenever she hits puberty. We were shocked and devastated! This is the last thing we would want for our child. Ineffective bracing until premature surgery!  People on the support group informed me of the nearest Early Treatment Center of Excellence, which is the Shriners Hospital for Children in Chicago. So, I immediately called them to try to get Hadley an appt. I was told we had to fill out an application and that it takes approximately 3 weeks to get accepted. Thankfully for God’s guidance and  the Cast Support Group, I was able to get advice on how to navigate through the frustrating medical system and we were able to get Hadley an appointment for the following week.

At 11 Months old, we took Hadley to the Shriners in Chicago for a 2nd opinion.  This is when we found out Hadley’s back had progressed to 74 degrees while wearing the brace! My research indicated that internal organs could be compromised at approximately 75 degrees, depending on the child…. It was God’s control  that led us to the right place before Hadley had permanent damage. The surgeon strongly recommended getting Hadley casted the next day. We agreed to it. We spent the night in the hotel in fear, yet still had hope for Hadley’s back.

The next day, we arrived at the hospital at 6 a.m. to get Hadley casted. We were very scared to have our little baby anesthetized, but knew this is what was best for her. 45 minutes after Hadley was in the operating room, the surgeon came out to inform us that Hadley did very well and was waking up in the recovery room. With the correct casting frame and a solid understanding on the principles of the Early Treatment Process, he was able to get her spine down to a 17 degree curve in her first EDF cast, which was remarkable. We are even more hopeful because Hadley is so flexible.  It took a little while to adjust to the cast, but Hadley did very well. I thought not being able to bathe her and let her play in the sand and water would be pure torture, but it wasn’t. She didn’t seem to mind at all. The cast became a part of her life and she is passing all milestones on time.

We were informed that any child with a curve over 50 degrees will more than likely end up needing surgery in the long run, but we are very hopeful.  In the back of my head I have always thought, if we had just found a surgeon trained in this gentle, corrective method from the beginning, the chances of Hadley being corrected completely and permanently from the cast would have been so much greater. However, the first doctor that saw my daughter practiced the “wait and see” approach to treatment and in that time her spine progressed 50 degrees! I am just so thankful to have found ISOP when we did, before her spine got any worse.

After 4 weeks of Hadley being in her cast, we went back to Chicago for a follow up appointment. Her X-ray showed that Hadley s spine was at 27 degrees (in cast). It had relaxed a bit, but that’s normal. Then after 2 ½ months of being in that cast, we went back to get it removed and had her 2nd cast reapplied. The surgeon came out to inform us of the correction achieved from the first properly applied EDF cast. He was very pleased with the correction. In Hadley’s first cast, her spine went from 74 degrees to 47 degrees (out of cast). She had 27 degrees of correction. This was phenomenal. The team at the Shriners Hospital for Children in Chicago had done wonders for our baby girl, what more could we ask for!

Hadley stayed in her 2nd cast for about 2 months and then got it changed. From her 2nd cast, she had 8 degrees of correction. We were going in the right direction. Her back was now at 39 degrees.  In Hadley’s 3rd cast, she was down to 0-5 degrees(in cast) and the correction from her 3rd cast was 6 degrees. Hadley’s back is now at an miraculous 33 degrees(out of cast).
So far, with God’s help, we are beating the statistics that say anything over 50 degrees can not be corrected from a cast. We pray that Hadley’s spine will continue to get lower in degrees and eventually grow straight from the continual guidance of the EDF serial casting. We hope to avoid surgery, but if it is needed, we are so thankful for Early Treatment with EDF casting, which has the ability to buy my toddler invaluable growing time for her chest cavity until she is older for a more definitive spinal surgery.

Hadley is now in her 4th cast with a 12 degree curve(in cast). She will get her 5th in January. While in the cast, Hadley has learned to do everything any normal child could do, but maybe a little bit differently. Hadley developed a hop when she crawled in order to get places. This helped her when she crawled because she could not bend her legs at the normal crawl position. Hadley has recently learned to walk in her cast as well. It took her a little bit longer to master her balance, but she has accomplished this and is walking every where now.

We are so thankful for Dr. Mehta and ISOP with their Early Treatment Awareness Campaign.  It is Dr. Mehta, ISOP, the parents on the CAST Support Group, and the pediatric orthopedic surgeons who are practicing this gentle cure that are helping to make this treatment more widely available in the U.S. and around the world.  Without this casting, our toddler would have already had premature spinal fusion/hardware.  We are grateful that Hadley may get to avoid repeated and invasive spinal surgeries on her growing spine.  Thank you, Dr. Mehta and ISOP for sharing this life saving treatment with parents and the medical community. And Thank you, God for staying at our side and being in control of this situation. Without you,  Hadley would not be able to beat the statistics saying anything above 50 degrees needs surgery and would not have been corrected 41 degrees in only 6 months!

Ryan’s Story

After 5 years of trying to have a baby, God blessed us with twin boys.  My pregnancy was full of uneasy feelings and lots of “what ifs”.  There were many complications along with 3 months of bed rest.  After the danger point passed, the doctors sent me home.  One week after being home I went into labor.

Ryan and his fraternal twin brother, Matthew, were born in April 2005.  They were born 4 weeks early, both were healthy.  Our boys came home 2 days later.

The boys were about 2-3 weeks old when my mother noticed Ryan’s ribs felt funny.  My mother-in-law had made comments about it as well.  Not knowing anything about Infantile Scoliosis, I thought this was due to them still being small babies.  As Ryan grew, we noticed he always leaned his head to one side.  We now know he had torticollis.  It was never treated and he slowly outgrew it.

While bathing the boys, around 7 months old, I noticed Ryan’s back protruded on one side. I still knew nothing, but wondered often if something was wrong.  At his 9-month check-up, we pointed it out to his pediatrician.  She immediately told us she felt he may have Infantile Scoliosis.  We had heard of teenage girls having scoliosis, but had no idea babies could have scoliosis.  It was a weird feeling not knowing.  She referred us to Texas Scottish Rite Hospital for Children in Dallas, Texas.  Shortly after the pediatrician’s referral, Ryan was diagnosed with Progressive Infantile Scoliosis.  X-rays showed a 29 degree right thoracic curve.  They recommended a CT Scan and MRI to rule out any congenital abnormalities.  They also wanted us to see a geneticist.  We were told they would watch him closely and wanted to see him back in 3 months.  At that time, his doctor also talked in-length about Early Treatment with casting.  We were stunned and confused, but knew we wanted to avoid surgery if at all possible.  If Ryan’s curve continued to progress, casting sounded like the best treatment for him.

In 3 months time, Ryan’s curve had progressed from 29 to 34 degrees.  We then knew casting was what Ryan needed, and it would be in our very near future.  Ryan still, however, needed the MRI.  He and his brother were constantly sick so we had to continuously put this procedure off. Ryan was finally well enough for the MRI and thank God it came back normal.  We saw the geneticist and she felt his scoliosis was mainly “positional” while in untero.  The geneticist did not think there was an underlying syndrome diagnosis.
The procedures were all done and all came back normal, so the date was set for Ryan’s first cast.  He was 15 months old (still a baby), had just started walking and I was SCARED to death.  A cast?!  A hard cast?  No baths, no playing in water.  He is going to stink!  How will he sleep?! He will not be able to do all the things his twin brother will do! My mind was going crazy with all these bad thoughts of a cast.  I needed to talk to someone else who had been through the same thing.
Days before his first cast was applied, I found ISOP on the internet.  How had I missed it all those times I was searching for answers and information?  I was still so scared and had no idea what I might learn, but ISOP had a support group.  I wasted no more time.  I immediately joined the group.

Fast forward to November 2008…………Ryan is now in a brace ONLY at night!!!!!  He was in a series of 6 casts over 14 months.  And wore his brace 23 hours a day for 10 months.  Today his curve is down to 8 degrees and he looks GREAT!!!

Casting was nothing like I thought it would be.  Within a week Ryan was walking again just fine.  His baths?  Well, we came up with other fun bath ideas.  Playing in the water was just a special treat for the boys when his cast was removed the day before the new one was  applied.……..they didn’t miss a thing.  Stinking….we just didn’t have that problem.  And he slept……like a baby, within a week of his first cast.

Ryan adjusted so well to the cast and didn’t miss a beat.  He did everything his twin brother did and more!  Looking back, I only wish I would have known about Early Treatment sooner.  Ryan would have been in casts very early on.  Casting is a gentle method for treating Infantile Scoliosis.  And, for most babies, if treated early and properly, has the ability to train their young spines to grow straight, gently and permanently and surgery is not needed.

We are so informed about Infantile Scoliosis because of ISOP and the CAST support group.  I have learned more here, and through the support group than what any doctor could have told me.  The support group is a God send.  I don’t know how I would have made it through without communicating with other Moms and Dads going through the same thing.

If you are just discovering your baby/child has Infantile Scoliosis, join the group.  It has a wealth of information for you and allows interaction with other parents who are experiencing the same situations.  I cannot thank ISOP and Dr. Mehta enough for all they have done to educate us about Ryan’s condition.

Ryan will go in a few weeks for a check-up and we are in hopes he will be finished with the brace.

Early Treatment with EDF (elongation, derogation, flexion) casting works.

If you have any questions about Ryan’s treatment feel free to email me.   Ryanswalk@yahoo.com

To view a blog dedicated to Ryan and others with infantile scoliosis go Here.

Sincerely,
Brant, Tasha, Ryan and Matthew

Bridget’s Story

Our daughter Bridget was born on the 22.2.01. She is the fourth child in our family and her two brothers and one sister were over the moon at having a new addition to the family.

Bridget spent her first year drowning in the attention of her siblings. She sat on her own at about 8 months and it was at this time that I noticed she seemed to sit more on her left buttock. Looking back at photos she also had her head turned to the right in most photos though I did not pick that up at the time. When she was viewed from the back while sitting, it looked as though her spine curved towards the left side.

At 10 months I took her to our GP and then to a paediatrician. The paediatrician said the curve was an optical illusion and not worth xraying. I left the consultation relieved but continued to watch her spine as she was sitting or in the bath. At 16 months Bridget was still not walking. She had developed a bottom shuffling technique which involved leaning to the left and using her left hand behind her and her right hand at the front to propel herself quite quickly around the floor.

I returned to the paediatrician when Bridget was about 18 months. She was still bottom shuffling and when sitting had creases visible on one side of her waist. I pointed this out to the paediatrician but she said she could have built up muscles on one side of her body from bottom shuffling. She felt the curve was an illusion created by her posture and advised me not to be concerned about it.

Bridget finally walked at 22 months. As she progressed from the first toddling steps to competent walking and running her gait remained uneven. She seemed to weight bare more on the left leg and her right shoulder was lower than her left. When standing and in swimming togs we could clearly see a curve in her spine.

I returned to our GP when Bridget was almost three. I showed him the curve in her spine and he agreed with me that it was unusual. He referred me to another paediatrician. This paediatrician felt there was nothing to worry about as he believed her apparent curve was postural and told me we could xray if I liked but he wouldn’t foresee any need for intervention.

The xray revealed a 38 degree thoracolumbar curve. We were referred to a spinal surgeon who arranged for her to have an MRI as he felt sure there must be some neurological problem which was contributing to her scoliosis. This doctor explained that while she was under anaesthetic she would be cast for a TLSO brace.

The MRI and a subsequent consultation with a paediatric neurologist could find no neuromuscular involvement and with no vertebral abnormalities present, Bridget’s curve appeared to be Infantile Idiopathic.

Six weeks later we returned to the Spinal Surgeon to learn about Bridget’s brace. He told us that the brace would not correct the curve nor stop its progression and he estimated by the time Bridget was 10 years old the curve would be so large and the resultant deformity so disfiguring that he would be operating to fuse her spine though she would be far from skeletally mature. He said without the brace the curve would progress much more quickly and he estimated he would be fusing her spine at 7. He explained that as the spine could not grow at the fused area this would result in her having a short trunk and long arms and legs like a “daddy long legs spider.”

Our family was horrified by this prognosis. We sought the opinion of another spinal surgeon in Brisbane as well as consulting with two others in Sydney and Melbourne. Each emphasised how rare Infantile Idiopathic Scoliosis is and mentioned that it was more prevalent in the UK.

I understood that the treatment Bridget was receiving was the standard treatment in Australia but was keen to research how Infantile Idiopathic Scoliosis was treated in other countries. I started with the UK. The Scoliosis Association of the UK website www.sauk.org.uk explained how Infantile Scoliosis could be corrected if treated early enough with a series of plaster casts. I gleaned this information from the SAUK site as it was in 2004. I notice that it has since changed and no longer mentions infantile scoliosis as a separate and curable condition using serial plaster casts.

To apply these casts the child is anaesthetised and suspended on a paediatric traction table. The spine is gently manipulated and placed in a corrected position. The plaster cast is then applied to hold the spine in that position. A widely trimmed mushroom shaped window is left trimmed around the tummy/chest to allow for expansion (chest expamsion window). Another hole is left selectively at the back over the concaved flattened side of the ribs so that the child’s own breathing and laughing encourage symmetrical growth. This alters the direction of the spine and allows it to grow in a straightened position. The cast is changed every three months and the process repeated until the curve has been corrected.

It was emphasized that it is the growth of the spine while it is held in the corrected position that ensures that it stays straight and never needs fusion. For this reason the best and quickest results have been obtained in children under two years as it is at this age that the most rapid rate of growth occurs. All this information I learned from reading the SAUK website as it was at that time and from speaking to Dr Mehta on the phone.

Dr Min Mehta has been successfully using her Early Treatment casting technique in the UK for over 30 years.

I sent Bridget’s xrays to Dr Min Mehta. After viewing Bridget’s xrays and photographs Dr Min Mehta said she believed 18 months of serial plaster casts changed every three months would cure Bridget’s scoliosis but only if treatment was started straight away. She recommended we see a specialist at the Royal National Orthopaedic Hospital in Stanmore, England since she had recently retired from NHS practice.

It was about this time that I read Ella’s Story on the Scoliosis Associan of Australia (SAA) website. I contacted them immediately to see if there was any possibility that serial plaster casting was being used to treat Infantile Scoliosis in Australia. Ella was born in the UK and had since returned to Australia. Ella was casted between 6 months and 14 months by Dr Mehta just before Miss Mehta retired. She is now 13 yrs old and has remained straight. At 6 months Ella had a 60 degree curve. .

In October 2004 we saw the pediatric spine specialist at the RNOH, Stanmore. He applied the first of Bridget’s plaster casts under general anaesthetic. We were delighted to see that in her cast her curve improved from 38 degrees to 21degrees.

Bridget wore her first cast for almost three months. She was a very active and happy child who loved jumping on the trampoline and riding her bike. Wearing a plaster cast did not restrict these activities. On January 9th 2005 we returned to England to have her plaster removed and her second cast applied. At this time I met with Dr Mehta and showed her Bridget’s cast that was applied by the specialist at the hospital from which she recently retired. Miss Mehta was disappointed to see that the specialist was not using the correct mushroom shaped windows to prevent barrel shaped ribs.

At this point, I had made contact with Heather Hyatt, ISOP and the CAST group. I applied to have Bridget included in the first ever ETTP (Early Treatment Trial Project) organized by ISOP at Shriners Salt Lake City. Dr Mehta travelled to SLC to train staff and demonstrate her method of Early Treatment w/ modified EDF casting using a group of patients who were lucky enough to be the first to be treated with this method in the USA. We were very fortunate to have Bridget accepted into this group in May 2005.

Bridget had 14 months of casts from aged 3 yrs 7 months to 4 yrs 9 months. During that time her curve went from 38 degrees to 8 degrees in cast but her curve would go back to 25 degrees out of cast. The casts totally got rid of her rotation and rib hump. At this time she was diagnosed with a connective tissue disorder,

At this point with the Doctors and physios talking together we decided to change to a brace and combine aggressive bracing with an exercise (core strength) program and posture training.

For the last 8 years we have travelled to Salt Lake City every 6 months to have custom fitted braces and shoe orthotics made for Bridget. (who also has a leg length difference) She currently has a providence brace for night time and a modified Boston brace based on the Mehta style Cast with same mushroom shaped window at the front.
Bridget is now almost 12 and a half. She is 155cm tall and enjoys swimming, playing netball and the same active life as any 12 year old. She still has a double curve which has increased over the years (52 thoracic and 42 lumbar) but we are hoping to avoid surgery (fingers crossed) depending how much growing she has left and what her curves do. At the moment, thanks to the hard work of Drs and physios over the years she has no pain, minimal deformity and a wonderful quality of life.

I would dearly have loved the opportunity to cast under 2 when we had the best chance of achieving a permanent cure like Ella in England and the 100s of kids now cured in the USA thanks to Dr Mehta’s treatment.

Thanks

Bert Lehane

 

Introduction to Guardianship for an adult in Colorado.

Guardianship is a court appointment which gives a person or an organization responsibility and authority for making decisions on behalf of an adult who is unable to manage his/her own affairs and make his/her own decisions. Guardianship for adults in Colorado is authorized by Colorado Revised Statutes, Title 15, Article 14, Part 3. The person for whom a guardian is appointed is called a “ward.” Guardianship is a serious responsibility and one that should be approached with the same seriousness and attention which you apply to your own life. Besides being a “legal representative” for your ward, you will also be an advocate and watchdog. You may also be a surrogate family member, teacher and a friend. While guardianship provides important protection and assistance, it is also very restrictive. It can remove all of a person’s legal rights to manage his/her own life and must be imposed only as a last resort.

If you are considering becoming a guardian for someone you must first consider if limited guardianship would be sufficient. Colorado law presumes that only limited guardianship is necessary and you must prove to the court otherwise if an unlimited guardianship is requested. Limited guardianship may include authority to make only medical decisions, only residential decisions, or only financial decisions. Or it may include a combination of one or two areas. In all other matters, the guardian has no authority. An unlimited guardianship can be reduced to a limited guardianship, or the reverse can be done, through a petition to the court which made the initial guardianship appointment.

Duties of a Guardian

As a guardian you are expected to understand and carry out the responsibilities outlined in the specific guardianship orders of your appointment. When in doubt about your authority to decide about a specific matter, you may always seek prior approval from the court. While individual guardianship orders may contain specific instructions, there are general duties and responsibilities which every guardian is expected to fulfill.

Colorado law gives guardians authority to make decisions regarding the ward’s support, care, education, health, and welfare.It further states:

“A guardian shall exercise authority only as necessitated by the ward’s limitations and, to the extent possible, shall encourage the ward to participate in decisions, act on the ward’s own behalf, and develop or regain the capacity to manage the ward’s personal affairs. A guardian, in making decisions, shall consider the expressed desires and personal values of the ward to the extent known to the guardian. A guardian, at all times, shall act in the ward’s best interest and exercise reasonable care, diligence, and prudence.” (C.R.S. 15-14-314(1))

In addition, a guardian shall:

  • Become or remain personally acquainted with the ward and maintain sufficient contact to know of the ward’s capacities, limitations, needs, opportunities, and physical and mental health. (C.R.S. 15-14-314(2)(a))
  • Take reasonable care of the ward’s personal effects and bring protective proceedings if necessary to protect the property of the ward. (C.R.S. 15-14-314(2)(b))
  • Spend the ward’s money that is in the guardian’s control, for the ward’s current needs for support, care, education, health, and welfare. (C.R.S. 15-14-314(2)(c))
  • Save any of the ward’s excess money for the ward’s future needs. If a conservator is appointed for the ward, the guardian must pay the excess money to the conservator, at least quarterly, to be saved for the ward’s future needs. (C.R.S. 15-14-314(2)(d))If your ward has substantial assets (more than the amount required for his/her daily living needs), it is necessary that a conservator be appointed. A conservator is a person or organization appointed by the court to manage the financial affairs of another. The process for appointment of a conservator is similar to that for a guardian. If your ward is also your relative, it may be possible for you to serve as both the guardian and conservator.

Immediately notify the court if the ward’s condition has changed to the degree that guardianship may no longer be necessary.

  • Inform the court of any change in the ward’s residence.
  • Immediately notify the court of the ward’s death.

Powers of a Guardian

Unless limited by the court order, guardians have the following powers:

  • Consent to medical or other care, treatment, or service for the ward. (C.R.S. 15-14-315(1)(d))Advance Directives are arrangements and desires which your ward may have expressed in writing while competent. The Living Will is an example of such an advance directive regarding withholding or withdrawing medical life support systems and/or nourishment. You are obligated to respect your ward’s wishes and directions contained in the Living Will.Another Advance Directive is a Medical Durable Power of Attorney with which your ward would have designated an agent who is to be responsible for making such decisions on his/her behalf. The agent specified to make decisions on your ward’s behalf in the Medical Durable Power of Attorney, has precedence for making health-care decisions over a guardian unless the Medical Durable Power of Attorney is revoked by the court. A guardian may not revoke the ward’s Medical Durable Power of Attorney. (C.R.S. 15-14-316(3))
  • Apply for and receive money payable to the ward, guardian or custodian for the support of the ward from any government or private source. (C.R.S. 15-14-315(1)(a))
  • If not in conflict with other court orders, the guardian may take custody of the ward and decide where the ward is to live. Guardians must obtain permission from the court to move the ward outside of the State of Colorado. (C.R.S. 15-14-315(1)(b))
  • If there is no conservator, the guardian may take necessary actions to force an obligated party to support the ward or to pay money for the benefit of the ward. (C.R.S. 15-14-315(1)(c))
  • Depending upon circumstances, a guardian may allow a ward to make certain decisions affecting the ward’s well-being. (C.R.S. 15-14-315(1)(e))
  • With specific authority or direction from the court, a guardian may consent to the adoption or marriage of the ward. (C.R.S. 15-14-315(2))
  • A guardian may petition the court for authority to apply for a divorce or legal separation on behalf of the ward if it is in the best interest of the ward based on evidence of abandonment, abuse, exploitation, or other compelling circumstances, and the ward either is incapable of consenting or has consented . (C.R.S. 15-14-315.5)

Rights, Immunities, and Limitations

With approval by the court, guardians are entitled to reasonable compensation for services as a guardian and to reimbursement for room and board provided by the guardian or one affiliated with the guardian. If there is a conservator, other than the guardian or one affiliated with the guardian, reasonable compensation and reimbursement to the guardian may be paid by the conservator without order of the court.

Guardians are not required to provide for their ward, or pay for their ward’s expenses, out of the guardian’s own funds. However, you must very carefully read all documents before signing. If you sign something personally accepting financial liability, you may be held personally liable. Neither are guardians liable to third parties for acts of the ward solely by reason of the guardianship. Further, a guardian who exercises reasonable care in selecting parties to provide medical or other care, treatment, or service for the ward, is not liable for injury to the ward resulting from the negligent or wrongful conduct of the providers.

Guardians may not consent to involuntary commitment, or care and treatment of a ward for mental illness, developmental disabilities, or for alcoholism or substance abuse. In all of these instances, a guardian must proceed under the appropriate statute.

Reports to the Court

Within 60 days of appointment, or as otherwise directed by the court, guardians must submit a written report to the court including:

  • the condition of the ward,
  • the guardian’s personal care plan for the ward, and
  • account for money and other assets in the guardian’s possession or control.

Thereafter, guardians are required to submit annual reports which cover:

  • the current mental, physical, and social condition of the ward;
  • the ward’s living arrangements;
  • medical, educational and vocational services provided and the adequacy of the ward’s care;
  • a summary of the guardian’s visits with the ward and actions on behalf of the ward, including the ward’s participation in decision-making;
  • whether the current care plan is in the ward’s best interest;
  • plans for future care; and
  • recommendation as to continued need for guardianship and changes.

In addition, the court may appoint a visitor to review a report, interview the ward or guardian, and make any other investigation the court directs.

General Responsibilities

As a guardian you must know and care about all aspects of the well-being of your ward. If he or she does not live with you, you must visit and spend time with him/her as often as possible. It is your responsibility to make arrangements for, keep informed about, and maintain documentation of your ward’s current situation regarding finances, living arrangements and care givers, health and medical care, education and training, personal needs, preferences and desires, employment, recreation and leisure time.

It is very important to get acquainted with the people who are significant in your ward’s life, for example, family, doctors, nurses, recreation directors, case workers, employers, therapists, teachers, friends, and neighbors.

You are expected to plan for your ward’s future. Anticipate and be prepared for emergencies. Be aware of options in living arrangements or daily living activities in case changes might be necessary. Make sure that insurance or appropriate health care benefits are in place. Assure that funeral and burial or cremation arrangements are in place.

It is important for you to be familiar with laws, rules and regulations that may impact the life of your ward. For example, laws and regulations regarding nursing homes or other residential facilities; laws against discrimination and safety requirements if your ward is employable; education laws if he/she is under age 21; any government benefits and entitlements that he/she might be eligible to receive. You will also need to know how to advocate for your ward in these matters. There are community resources available to provide help, information and assistance.

Making Decisions on Behalf of Someone Else

Even though, as a guardian you will have responsibility for protecting and caring for your ward, it is important to carefully distinguish between providing adequate protection and imposing excessive restrictions. As has already been stated, Colorado law requires guardians to include their wards in making decisions. A ward’s ability to participate will depend to a large extent upon the magnitude of the decision. For example, what to wear to a particular event is a much easier decision than whether or not to have surgery. The kind of information and how it is presented will also have a bearing upon the ward’s ability to participate in a decision. Information should be tailored to the understanding of the individual; the language must be simple, repetition may be necessary, and visual aids may be helpful. Following the attempt to inform, special efforts should be made to determine whether the person has in fact understood the information, perhaps through quizzing or other feedback. You may also enlist the help of others to explain a matter to your ward, possibly in a different setting and at a different time of day.

As a guardian you must weigh all decisions critically and objectively. The following guidelines may be helpful. First, allow your ward to make the decision alone with support and assistance only as needed. If that is not possible, include your ward in a decision-making process whereby all relevant information is discussed and your ward is an active participant. Finally, if a decision must be made by you alone, you must be sensitive to the expressed preferences of your ward, if known, and to the greatest extent possible, make decisions based upon the same set of values he/she would use if making his/her own decisions. In the case of a ward who has never been able to make his/her own preferences known, you have no choice but to make the decision that you believe is best for your ward.

When making decisions for your ward, you must apply informed consent principles in the same manner applied when making decisions about your own life. For example, before giving consent you should have answers to the following questions:

  • What are the alternatives?
  • What are the risks?
  • What are the benefits?
  • What are the consequences?
  • What discomforts might occur?
  • Can I change my mind later?

Termination or Modification of a Guardianship

A guardianship terminates upon death of the ward, or if the ward no longer meets the standard for establishing the guardianship. (Incapacity by clear and convincing evidence.) A ward, guardian or any interested person may petition for removal of a guardian on the grounds that removal would be in the best interest of the ward or for other good cause. Before terminating a guardianship, the court will follow the same procedures to safeguard the rights of the ward as apply to a petition for guardianship. The court may remove a guardian or permit a guardian to resign. A petition for removal or permission to resign may include a request for appointment of a successor guardian. (C.R.S. 15-14-112 and 318)

The court may modify the type of appointment or powers originally granted to the guardian if the extent of protection or assistance is currently excessive or insufficient or the ward’s capacity to provide for support, care, education, health, and welfare has so changed. (C.R.S. 15-14-318(2))

A temporary substitute guardian may be appointed for up to six months when a guardian is not performing effectively and the ward’s welfare requires. (C.R.S. 15-14-313) Except as otherwise ordered by the court, a temporary substitute guardian has the same powers as the original guardian.

Delegation of Power by a Guardian

By the use of a power of attorney, a guardian may delegate to another person, for a period not exceeding 12 months, any power regarding care, custody, or property of a ward, except the power to consent to marriage or adoption. This provision is useful if a guardian must be out of the geographical area for an extended period or during a medical leave. (C.R.S. 15-14-105)

Transfer to another country or state

The court making the appointment of a guardian may transfer the guardianship to a court in another county or another state if the court is satisfied that a transfer will serve the best interest of the ward. (C.R.S. 15-14-107(1))

For more information please call 303-228-5382, or send an email.

Advance Directives

Living Will- Declaration Concerning Medical or Surgical Treatment

  1. Can only be set up while a person is competent to understand the consequences of the decisions.
  2. In order for a Living Will to become operative, four conditions must exist:
    1. The individual (the declarant who has signed the Declaration) must be terminally ill due to an incurable or irreversible condition.
    2. The individual must be unable to decide whether to accept or reject medical or surgical treatment.
    3. The individual must be unable to make that decision because of unconsciousness or incompetence.
    4. The individual, or one acting for the individual, must submit the Declaration to the physician for entry into the individual’s medical record.
  3. When these required conditions exist, the attending and one additional physician must:
    1. Certify the individual’s terminal condition in writing on the hospital record.
    2. Immediately attempt to notify the individual’s spouse, any adult child, parent or agent under a Medical Durable Power of Attorney (in that order) of the certification.
  4. After the physicians’ certification is made, a period of 48 consecutive hours is granted by law for a challenge to the validity of the Declaration.
    1. A parent, adult child, spouse or MDPOA agent may challenge the Declaration in the district court in the county in which the patient is located.
    2. A legal representative is appointed for the patient and notice is given to certain adult relatives.
    3. The court determines the validity of the Declaration.
  5. A physician, or a hospital or person acting at the physician’s direction, is free of criminal or civil liability for acting in accordance with a valid Declaration.
  6. In certain situations, the law allows the physician to take actions not specifically provided in the Declaration:
    1. If the declarant is pregnant and if life-sustaining measures would enable the fetus to develop and survive, the Declaration is not enforceable.
    2. If pain results from the discontinuance of artificial nourishment, the physician may order that nourishment be provided to alleviate the pain.
  7. A Declaration does not have to be notarized, but must be witnessed by two witnesses. Said witness shall not be:
    1. The attending physician or any other physician; or
    2. An employee of the attending physician or health care facility in which the declarant is a patient; or
    3. A person who has a claim against any portion of the estate of the declarant at his death at the time the declaration is signed; or
    4. A person who knows or believes that he is entitled to any portion of the estate of the declarant upon his death either as a beneficiary of a will in existence at the time the declaration is signed or as an heir at law.
  8. If the declarant is a patient or resident of a health care facility, the witnesses shall not be patients of that facility.
  9. In the event that the declarant is physically unable to sign the Declaration, it may be signed by some other person in the declarant’s presence and at his direction. Such other persons shall not be any of those listed in Paragraph 7 above.
  10. A Declaration may be revoked by the declarant orally, in writing or by burning, tearing, canceling, obliterating or destroying such declaration.
  11. Forms are available from hospitals, medical societies, the Guardianship Alliance and most stationery supply stores.
  12. It is wise to have both a Medical Durable Power of Attorney and a Living Will. The Medical Durable Power of Attorney gives someone (an agent) authority to make decisions; the Living Will sets forth one’s desires regarding life sustaining treatment and gives direction to the agent under the Medical Durable Power of Attorney.

Durable Powers of Attorney

  1. With a Power of Attorney, a person (the Principal) appoints another person or organization (the Agent or Attorney-in-fact) to act on his/her behalf in all matters as designated in the document. A person (the Principal) must have capacity to understand the consequences of the document.
  2. In Colorado, there are two Durable Powers of Attorney:
    1. Medical Durable Power of Attorney includes medical and personal decision-making authority which may be limited or broad.
    2. General or Financial Durable Power of Attorney includes decisions about money and property and can include other matters, except medical decisions.
  3. “Durable” means the agency continues if the principal becomes incapacitated. To be durable the document must contain wording such as “this power of attorney shall not be affected by the subsequent incapacity or disability of the principal.
  4. A principal may revoke any power of attorney at any time even if he/she is considered to be incapacitated by a doctor, caregiver or family. To make changes in a document, he/she must write a new one.
  5. An agent may not override the principal’s wishes even though the principal may be assessed as incapacitated.“Nothing in this section or in a medical durable power of attorney shall be construed to abrogate or limit any rights of the principal, including the right to revoke an agent’s authority or the right to consent to or refuse any proposed medical treatment, and no agent may consent to or refuse medical treatment for a principal over the principal’s objection.” C.R.S. 15-14-506.(4)(a)
  6. An agent has the same authority for medical treatment as a guardian. If another person is appointed as the guardian for the principal, the agent has priority for making medical treatment decisions unless the Power of Attorney is revoked by the court.
  7. An agent is obligated to follow the principal’s instructions when making decisions. Unless the DPOA states otherwise, the agent has the same authority to make decisions which the principal would make if able to do so.
  8. The appointment of a spouse as an agent dissolves on divorce.
  9. It is a good idea to designate a successor agent in the event an agent is unwilling, unable, or ineligible to act when a decision is necessary. A successor agent has the same authority as the primary agent.
  10. Powers of Attorney can be set up through an attorney knowledgeable about estate planning and health care issues or set up with preprinted forms which are available from hospitals, nursing homes, or the Guardianship Alliance.
  11. Colorado law does not require a DPOA to be witnessed, however, it is recommended that there be two witnesses or have the document notarized.

For more information please call 303-228-5382, or send an email.

Colorado CPR Directive

  1. CPR – cardiopulmonary resuscitation are measures to restore cardiac function or support breathing in case of cardiac or respiratory arrest or malfunction. Includes:
    1. chest compression
    2. electric shock to the chest
    3. placing tubes in the airway to assist breathing.
  2. May be executed by any person over age 18 who has decisional capacity to provide informed consent or any person authorized by law to make medical treatment decisions on behalf of an adult who lacks decisional capacity.
  3. There is a duty to comply with CPR Directives by:
    1. emergency medical service personnel
    2. health care providers and facilities
  4. No one is subject to civil or criminal liability for complying with a person’s CPR Directive.
  5. A person’s consent to CPR is presumed without a CPR Directive.
  6. In an inpatient setting, the Directive is implemented as a physician’s order concerning resuscitation as directed by the person in the Directive.
  7. May be revoked at any time by the person making the Directive or the person who is the subject of the Directive.
  8. Form can only be obtained through a licensed health care facility or a physician.
  9. Physician must inform person or surrogate of consequences and sign the Directive form.
  10. Person can obtain a specific identifying bracelet or necklace.
  11. Bracelet and necklace and more information available from the Colorado Medical Society.

For more information please call 303-228-5382, or send an email.

Proxy Decision-makers for Medical Treatment

The “Proxy Decision-makers for Medical Treatment Act” is intended to be used to make medical decisions on behalf of someone when no advance directive has been made, when there is no current guardian and when only medical treatment decisions are required. It is applicable for all adults regardless of the nature of a disability or illness and prevents the need to obtain guardianship in many cases. The procedure is authorized by Colorado statute. (C.R.S. 15-18.5-101 et.seq.)

The Proxy Decision-makers process is not an advance directive and must not be established upon admission to a long-term care facility or hospital.. It may be followed for a decisionally impaired adult if all of the following conditions exist:

  1. Decisions are needed for medical treatment.”Medical treatment means the provision, withholding, or withdrawal of any health care, medical procedure, including artificially provided nourishment and hydration, surgery, cardiopulmonary resuscitation, or service to maintain, diagnose, treat, or provide for a patient’s physical or mental health or personal care.” (C.R.S. 15-14-505-(7))
  2. A physician has determined that the patient lacks decisional capacity to provide informed consent to or refusal of medical treatment.Decisional capacity means the ability to provide informed consent to or refusal of medical treatment. To give informed consent the patient must be given all relevant information pertinent to the decision and be able to:
    • Recognize that a decision is needed.
    • Process the information, i.e. discuss it, remember it, evaluate the various factors, understand the consequences.Be cautious – making poor, stupid or unpopular decisions does not necessarily mean the patient lacks decisional capacity.
  3. The patient has not made any Advance Directives such as a Living Will and/or Medical Durable Power of Attorney.
  4. The patient does not have a guardian.
  5. The patient has an interested person or persons, i.e., a spouse, parents, adult children, sibling or grandchildren or a close friend, involved in his/her life.
  6. An interested person is available and able to serve as a proxy decision-maker.

The following is a step-by-step description of the Proxy Decisionmakers procedure.

NOTE: NO specific forms, attorneys, notary, or court are required. Some agencies use forms for their own records. A proxy decision-maker does not have to sign anything.

  1. The attending physician or a court determines that an adult patient lacks decisional capacity to provide informed consent to or refusal of medical treatment.
  2. Such findings along with specifics regarding the cause, nature, and projected duration of the patient’s lack of decisional capacity is recorded in the patient’s medical record.
  3. The attending physician, or the physician’s designee, makes reasonable efforts to notify the patient of the patient’s lack of decisional capacity.
  4. The attending physician, or designee, makes reasonable efforts to locate as many interested persons as practicable and may rely on those individuals to notify other family members or interested persons.
  5. Upon locating an interested person, the physician or designee, informs such person of the patient’s lack of decisional capacity and that a proxy decision-maker should be selected.
  6. The identified interested persons are responsible for making reasonable efforts to reach a consensus as to whom among them should be the proxy decision-maker.It should be a person who has a close relationship with the patient and who is most likely to be currently informed of the patient’s wishes regarding medical treatment decisions. (15-18.5-103(4)(a)
  7. If any interested person disagrees with the selection or the decision of the proxy decision-maker, or if the interested persons cannot decide among them who the proxy decision-maker should be, then any of the interested persons may seek guardianship.
  8. The attending physician or another health care provider makes reasonable efforts to advise the patient of the identity of the proxy decision-maker, and of the patient’s right to object. (C.R.S. 15-18.5-103 (5))The definitions and provisions in C.R.S. 15-14-505 to 15-14-509 (the Medical Durable Power of Attorney) are applicable to the Proxy provisions. For example, just as a DPOA agent cannot override the principal’s wishes, neither can a proxy decision-maker make decisions against the wishes of the patient, regardless of the patient’s decisional capacity.

Additional information:

  1. Artificial nourishment and hydration may be withheld or withdrawn from a patient upon a decision by a proxyONLY after the attending physician and a second independent physician trained in neurology or neurosurgery certify in the patient’s medical record that the provision or continuation of artificial nourishment and hydration is merely prolonging the act of dying and is unlikely to result in the restoration of the patient to independent neurological functioning.
  2. A proxy decision-maker may request assistance with a decision to withhold or withdraw medical treatment from a health care facility’s medical ethics committee or for an outside referral if there is no facility ethics committee.
  3. If any interested person, the guardian or the attending physician believes the patient has regained decisional capacity, the physician must reexamine the patient and determine whether or not the patient has regained such decisional capacity and enter the decision in the patient’s medical record, and notify the patient, the proxy decision-maker, and the person who initiated the redetermination.
  4. Any attending physician, health care provider, or health care facility that makes reasonable attempts to locate and communicate with a proxy decision-maker is not subject to civil or criminal liability or regulatory sanction.

For more information please call 303-228-5382, or send an email.

Procedure for Appointment of a Guardian for an Adult

The following process is generally followed for appointment of a guardian of an incapacitated adult. It may vary with particular cases and by court. (From Colorado Revised Statutes, Title 15, Article 14, Part 3)

  1. The law defines an incapacitated person as “an individual other than a minor, who is unable to effectively receive or evaluate information or both or make or communicate decisions to such an extent that the individual lacks the ability to satisfy essential requirements for physical health, safety, or self-care, even with appropriate and reasonably available technological assistance.” (C.R.S. 15-14-102(5))
  2. A Petition for Appointment of a Guardian for an Incapacitated Person is filed with the District Court in the county in which the allegedly incapacitated person lives. In Denver, it is filed with the Probate Court. A petition can be initiated by any interested person.
  3. There is a $164 filing fee which is payable when the petition is filed. In most counties, the Visitor’s Fee is around $25/hour. In Denver, there is a flat fee of $75.00 for the Court Visitor. If appropriate, the court may waive the fees based on the respondent’s and petitioner’s inabilities to pay as described in an Affidavit of Support of Petition to Proceed In Forma Pauperis.
  4. Medical information must be attached to the petition to support the need for guardianship. This can be a letter or report resulting from a professional evaluation by a physician, psychologist, or other individual qualified to evaluate the respondent’s alleged impairment. If not submitted with the petition, the court may order such an evaluation and shall do so if demanded by the respondent. The evaluation report must contain: (C.R.S. 15-14-306)
    1. A description of the nature, type, and extent of the respondent’s specific cognitive and functional limitations, if any;
    2. An evaluation of the respondent’s mental and physical condition and, if appropriate, educational potential, adaptive behavior, and social skills;
    3. A prognosis for improvement and a recommendation as to the appropriate treatment or habilitation plan; and
    4. The date of any assessment or examination upon which the report is based.
  5. In addition to general information about the respondent and the need for guardianship, the petition must specify the type of guardianship requested. The law presumes that a limited guardianship is necessary in order to preserve the rights of the respondent to manage as many of his/her own affairs as possible while still providing necessary protection and oversight. Limited guardianship may include authority to make only medical decisions, only placement decisions, or only financial decisions. Or it may include a combination of one or two areas. In all other matters, the guardian has no authority. The petition must specify the powers to be granted to the limited guardian. If an unlimited guardianship is necessary, the petition must state the reason why limited guardianship is inappropriate. (C.R.S. 15-14-304(2)(h))
  6. The petition must include a general statement of the respondent’s property with an estimate of its value, any insurance or pension, and the source and amount of any other anticipated income or receipts. (C.R.S. 15-14-304(2)(i))
  7. Priorities For Appointment as Guardian (C.R.S. 15-14-310)
    1. current court-appointed guardian;
    2. respondent’s nominee;
    3. agent under health care power of attorney;
    4. agent under general power of attorney;
    5. spouse or spouse’s nominee in will or other writing;
    6. adult child;
    7. parent or parent’s nominee; or
    8. adult with whom respondent resided for 6 out of 12 months preceding.
  8. Prohibitions Against Appointment as Guardian
    1. Long-term care providers are prohibited from serving as guardian for a person for whom they provide care unless related by blood or marriage. (C.R.S. 15-14-310(4))
    2. Professionals may not serve the same person as both:
      1. guardian and conservator
      2. guardian and direct service providers; or
      3. conservator and direct service provider. (C.R.S. 15-14-310(5)(a))
    3. A guardian or conservator may not employ the same person to act as both care manager and direct service provider for a ward. (C.R.S. 15-14-310(5)(b))
    4. Prohibition against dual roles may be overturned by the court for good cause.
  9. Following the filing of the Petition, the court appoints a Visitor who serves as an investigator for the court. (C.R.S. 15-14-305)
    1. Must interview the respondent to:
      1. explain the substance of the petition,
      2. the nature, purpose, and effect of the proceeding,
      3. the general powers and duties of a guardian, and
      4. the following rights of the respondent:
        1. to have notice of and be present in person at any court proceeding;
        2. to see or hear all evidence bearing on respondent’s condition;
        3. to be represented by counsel of choice or court-appointed counsel;
        4. to present evidence;
        5. to cross-examine witnesses, including any court-appointed visitor, evaluator or physician;
        6. to contest the petition;
        7. to object to the appointment of the proposed guardian or his/her powers or duties;
        8. to object to the creation of the proposed guardianship, or its scope or duration;
        9. to have a guardian ad litem appointed to represent the respondent’s best interests if the court determines that need for such representation exists.
      5. inform the respondent that all costs and expenses of the proceeding, including attorney fees, will be paid from the respondent’s estate, unless otherwise directed by the court.
    2. Interview the petitioner and the proposed guardian (if different).
    3. Visit the present and proposed dwellings of the respondent.
    4. Obtain information from any physician or other person who is known to have treated, advised or assessed the respondent’s relevant physical or mental condition.
    5. Make any other investigation the court directs.
    6. Must promptly file a report in writing with the court which must include:
      1. a recommendation as to whether an attorney and/or a guardian ad litem should be appointed;
      2. a summary of daily functions the respondent can manage without assistance, those he/she could manage with the assistance of supportive services or benefits, including use of appropriate technological assistance, and those he/she cannot manage;
      3. recommendations regarding the appropriateness of guardianship;
      4. whether less restrictive means of intervention are available;
      5. the type of guardianship and, if limited, the powers to be granted to the limited guardian;
      6. a statement of the qualifications of the guardian and a statement as to whether the respondent approves or disapproves of the proposed guardian, the powers and duties proposed and the scope of the guardianship;
      7. a statement of whether the proposed dwelling meets the respondent’s individual needs;
      8. a recommendation of whether a professional evaluation or further evaluation is necessary;
      9. and any other maters the court directs.
  10. A Hearing is scheduled on the matter of the petition for guardianship.
  11. Notice of the Hearing to the Respondent (C.R.S. 15-14-309(1))
    1. Must state that the respondent must be physically present for the hearing, unless excused by the court; include the respondent’s rights at the hearing; describe the nature, purpose and consequences of an appointment.
    2. A copy of the Notice of Hearing to Respondent must be personally served on the respondent, with a copy of the petition attached, at least 10 days prior to the hearing. Personal service may be done by any disinterested person. It is not necessary to hire a Process Server.
  12. Notice of Hearing to Parties Listed on the Petition (C.R.S. 15-14-309(2))
    1. Includes:
      1. spouse or, if no spouse, an adult with whom respondent has resided for at least 6 out of the 12 months preceding the filing of the petition;
      2. adult children and parents;
      3. if none, at least one of the adults nearest in kinship to the respondent who can be found with reasonable efforts;
      4. each person responsible for care or custody of the respondent;
      5. treating physician;
      6. each legal representative of the respondent;
      7. each person nominated as guardian by the respondent.
    2. A copy of the Notice of Hearing to Interested Persons must be served on the above along with a copy of the petition, at least 10 days prior to the hearing.
  13. Hearing Presence, Rights and Findings (C.R.S. 15-14-308)
    1. The respondent must attend the Hearing unless excused by the court for good cause. The Petitioner must make reasonable efforts to secure the respondent’s attendance.
    2. The court may hold the Hearing in a manner that reasonably accommodates the respondent, for example by telephone or in the respondent’s place of residence.
    3. The hearing is open unless it is closed by request of the respondent or any other showing of good cause. It cannot be closed over the objections of the respondent.
    4. The petitioner and proposed guardian (if different) and the respondent must attend the Hearing.
    5. Any person may request permission to participate in the proceeding.
    6. A guardian can be appointed only if the court finds by clear and convincing evidence that the respondent is an incapacitated person whose needs can not be met by less restrict means, including the use of appropriate and reasonably available technological assistance. (C.R.S. 15-14-311(1))
    7. The court must limit the guardian’s powers so as to encourage maximum self-reliance and independence of the ward. (C.R.S. 15-14-311(2))
  14. Notice of Appointment (C.R.S. 15-14-311(3))Within 30 days of the appointment of the guardian, a copy of the Notice of Appointment of Guardian and/or Conservator and Notice of Right to Request Termination or Modification, with a copy of the Order, must be given to the ward (respondent) and persons listed in the petition.
  15. Reports to Court (C.R.S. 15-14-317)
    1. Within 60 days after appointment, the guardian must file a report with the court on the condition of the ward, the guardian’s personal care plan for the ward, and account for money and other assets in the guardian’s possession or control.
    2. Guardians must file an annual report with the court on a form provided by the court.
  16. Notice of post-appointment hearings must be given to the ward and any others required by the court. (C.R.S. 15-14-309(3))
  17. Emergency Guardianship (C.R.S. 15-14-312)
    1. The court may appoint an emergency guardian when substantial harm to the respondent’s health, safety or welfare is likely to occur without intervention.
    2. Emergency guardianship is limited to 60 days.
    3. Appointment of an attorney for the respondent is mandatory and continues throughout the emergency guardianship.
    4. Appointment of an emergency guardian is not a determination of incapacity.
  18. A Temporary Substitute Guardian may be appointed for up to 6 months when a guardian is not performing effectively and the ward’s welfare requires. (C.R.S. 15-14-313)
  19. A Successor or Co-Guardian may be named by a guardian and appointed by the court upon filing of an Acceptance of Appointment either at any time after the appointment or within 30 days after a vacancy occurs. (C.R.S. 15-14-112(3))

For more information please call 303-228-5382, or send an email.

Why was PIS not noticed at our Well Baby checks and appointments?

Unfortunately, at this time, scoliosis checks are not part of the suggested guidelines for Well Baby Checks. While pediatricians and family physicians provide a general look at your baby’s overall health, it may fall on your shoulders to monitor this. One of the best tools that you have is your camera. When you suspect that your child’s spinal growth is not normal, take pictures of your baby’s back on a weekly basis to monitor and compare through time.

Your parental intuition will make sure that your baby has the best options for his or her health. Follow your gut!

ISOP Screening Guide

Back to Frequently Asked Questions for Parents

The doctor recommended surgery to insert metal rods beside my baby’s spine. Does this mean that my baby is not a candidate for treatment with Mehta’s Growth Guidance Casting?

Not necessarily.

MGGC is a gentle, conservative, and perhaps most importantly, non-invasive treatment option to
address the three dimensional curves of progressive infantile scoliosis. There are no side effects when MGGC protocols are applied by a surgeon who has received proper, specialized
training.

In contrast, the complication rates for surgery and implantation of distraction hardware involve numerous risks and complications, including:

  • Rod breakage inside the body
  • Premature spinal fusion
  • Risk of infection
  • Potential for chest wall rigidity

Also, a study of 38 patients treated with dual growing rods demonstrates that the gains from lengthening decreases with each subsequent lengthening and over time. Cobb angle improves after the initial instrumentation but does not change significantly with repeated lengthenings. Spine May, 2011

ISOP advocates that conservative treatment with MGGC is a first line of defense, and that in most cases, surgery is a last resort.
Back to Frequently Asked Questions for Parents

What is Mehta casting?

Mehta’s Growth Guidance Casting (MGGC) is a validated, non-surgical, potentially
curative treatment for progressive infantile scoliosis (PIS). PIS in infancy is considered the only potentially life threatening condition in the world of pediatric orthopedics because the curve(s) will keep pace at the rate of the child’s growth, which is fast the first two years of life.

Scoliosis is a three-dimensional issue which can be addressed gently in all dimensions with this specialized EDF (Elongation, Derotation, Flexion) treatment.  Early Treatment with MGGC involves application of specialized plaster casts on a specially-designed frame. The number of casts needed will be determined as the curve is measured over time by your child’s physician.

Dr. Mehta utilized “over the shoulder” casts for all curve types and all RVAD measurements because they address all curves. Click here to read more about this from the ISOP Physican’s Advisory Board.

The modified “under arm” casts were developed by American surgeons and were never included in Mehta Casting protocols. Under arm casts only have the ability to address curves below T-8.  It is worth repeating that over the shoulder casts address all curve types at all locations.

Mehta casts must be applied by a trained pediatric orthopedic surgeon. The child is under anesthetized and placed on a pediatric size EDF casting frame. For more information about the frames required, please visit www.noeledfcastframe.com.
Back to Frequently Asked Questions for Parents

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