A legal fight over custody and medical treatment of a 4-month-old boy who has tested positive for HIV kicked off in a southern Minnesota courtroom Monday with the boy’s grandmother saying that she would take him off the drugs used to treat his infection if she could legally do so.

Cheryl Nagel, grandmother of Rico Martinez Nagel, said her family’s decision to take her daughter Lindsey off HIV-fighting drugs 20 years ago after she was adopted as an infant from Romania, likely saved her life.

And she said after Monday’s court hearing that she fears her grandson might suffer as her daughter once did if Mower County officials win custody of the boy and the right to supervise his medical treatments.

“My goal is to have a healthy, thriving grandson,” Cheryl Nagel testified in a courtroom filled with several dozen relatives and friends. “We’re complying now because I’d like to keep my grandson here. It makes [my daughter] very happy to have him home, and she wants to raise him herself.”

Nagel’s perspective could be key in the two-day hearing before Mower County District Judge Fred Wellmann, who must decide whether the county should take custody of the boy and supervise his medical treatments or continue to trust those treatments to the care of his parents, Lindsey Nagel and John Martinez.

Monday’s hearing was dominated by Aaron Jones, an assistant county attorney arguing that the county should retain custody of the boy, who tested positive for HIV after his birth Dec. 19 and was put on treatments within two weeks of delivery, but only after his parents initially refused to consent to testing or treatment.

County officials who testified pointed to statements, Facebook postings and YouTube videos by Cheryl Nagel and her husband, Steve Nagel, about how their daughter’s health deteriorated when she was given powerful anti-retroviral drugs shortly after her adoption.

“I do have concerns,” said Lindsay Brekke, a Mower County Health and Human Services supervisor.

When Jones asked her why, Brekke cited “various statements” by Lindsey Nagel and John Martinez about administering medication and the grandparents’ video and online postings questioning the need for the treatments.

The Nagels have said that nearly two years of treatments years ago left their daughter, now 22, so sick and weak that they stopped them for fear she might die. They have also said she has been healthy since and believe that the county’s action to seek custody of their grandson stems from the grandparents’ belief that the drugs will do more harm than good.

“Right now, we’re following the plan,” Cheryl Nagel said after the hearing. “But we’re legally going to try to get him off the medications if we can. Because we know they’ll kill him eventually.”

An emotional few weeks

Rico’s custody and care became an issue in mid-January, when his parents missed an appointment with Mayo Clinic physicians regarding his nutritional needs.

Within days, child protection officials, claiming the baby was being medically neglected by his family, obtained a court order and removed him from the family’s home in Brownsdale, Minn., southwest of Rochester.

Rico was hospitalized under county supervision over the next seven weeks, with IV tubes used to feed him and deliver anti-retroviral drugs. He was returned to the custody of his parents March 8 pending the outcome of this week’s hearing.

Annette Ekoue, a county social worker, testified that the couple have not missed a daily treatment, and in fact have been so diligent about delivering medication that at one point, she suggested scaling back on the number of times the county checks in. Nagel and Martinez declined, she said, saying that they didn’t want to take the chance that officials might think they missed a treatment or were not being careful.

Earlier Monday, Jones called on Dr. W. Charles Huskins, a Mayo Clinic expert in pediatric infectious disease who was on call when Rico was born, to outline concerns the clinic staff had at the time of the birth.

Huskins testified that Lindsey Nagel failed to provide written documentation in her initial medical history that she was infected. He said she also apparently refused recommendations that she undergo treatment while pregnant that could reduce the risk of transmission of the HIV infection to the fetus to “less than 2 percent.”

He said that after he learned of her history in the hours after the baby’s delivery, the parents were asked to consent to HIV testing for both the mother and baby, but refused. They later relented after doctors contacted social services for a court order to intervene, he said.

Within days, doctors, with the approval of Rico’s parents, began administering some of the same, but less potent, anti-retroviral treatments Rico’s mother had received to reduce the risk of AIDS.

But when the Nagels, who had agreed to continue administering the treatments when Rico was discharged from the hospital Jan. 10, missed a nutritional appointment Jan. 16, instead driving toward Seattle to get a second opinion, the county moved to take custody. The parents later turned around in North Dakota and returned home after learning the doctor was not a pediatrician.

Doctor: ‘I’m very hopeful’

Monday’s most emotional moment came when Jones played an audio recording of a tearful mother and angry family handing the boy over to child protection officials.

Steve Nagel walked his sobbing daughter from the courtroom as friends and relatives grabbed tissues to dab wet eyes.

When asked by Jones what Rico’s prognosis is if he continues the treatments, Huskins said, “He will grow and thrive and develop.”

Without them, he said, “there is a very significant risk he could progress to AIDS, and given that, a very significant risk of death.”

When asked by Jones if Rico needs to continue with the treatments, Huskins said, “Yes.”

When asked if he had concerns that those treatments would continue without a court order, Huskins said, “We’ve had conversations with the parents, and I think it’s fair to say I’ve seen an evolution in the nature of our conversations that I’d regard as positive . … I’m very hopeful, but still as yet uncertain.”

Attorneys representing the Nagel family are expected to argue their case Tuesday.