In re Interest of Prince R. , 308 Neb. 415 ( 2021 )


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  • Nebraska Supreme Court Online Library
    www.nebraska.gov/apps-courts-epub/
    04/29/2021 08:09 AM CDT
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    Nebraska Supreme Court Advance Sheets
    308 Nebraska Reports
    IN RE INTEREST OF PRINCE R.
    Cite as 
    308 Neb. 415
    In re Interest of Prince R., a child
    under 18 years of age.
    State of Nebraska, appellee, v. Mohamed K.,
    appellant, and Abak R., appellee
    and cross-appellant.
    ___ N.W.2d ___
    Filed February 12, 2021.   No. S-20-342.
    1. Juvenile Courts: Evidence: Appeal and Error. Juvenile cases are
    reviewed de novo on the record, and an appellate court is required to
    reach a conclusion independent of the juvenile court’s findings; how-
    ever, when the evidence is in conflict, an appellate court may consider
    and give weight to the fact that the trial court observed the witnesses
    and accepted one version of the facts over the other.
    2. Parental Rights. The purpose of the adjudication phase is to protect the
    interests of the child.
    3. Juvenile Courts: Jurisdiction. To obtain jurisdiction over a juvenile at
    the adjudication stage, the court’s only concern is whether the conditions
    in which the juvenile presently finds himself or herself fit within the
    asserted subsection of 
    Neb. Rev. Stat. § 43-247
     (Reissue 2016).
    4. Juvenile Courts: Jurisdiction: Proof. At the adjudication stage, in
    order for a juvenile court to assume jurisdiction of minor children under
    
    Neb. Rev. Stat. § 43-247
    (3)(a) (Reissue 2016), the State must prove the
    allegations of the petition by a preponderance of the evidence.
    Appeal from the Separate Juvenile Court of Lancaster
    County: Linda S. Porter, Judge. Affirmed.
    Robert Wm. Chapin, Jr., of Chapin Law Office, for appellant.
    Patrick F. Condon, Lancaster County Attorney, and Maureen
    E. Lamski for appellee State of Nebraska.
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    308 Nebraska Reports
    IN RE INTEREST OF PRINCE R.
    Cite as 
    308 Neb. 415
    Mona L. Burton, of Anderson, Creager & Wittstruck, P.C.,
    L.L.O., for appellee Abak R.
    Heavican, C.J., Miller-Lerman, Cassel, Stacy, Funke,
    Papik, and Freudenberg, JJ.
    Papik, J.
    The separate juvenile court of Lancaster County adjudicated
    Prince R. as a child who lacked proper parental care by reason
    of the fault or habits of his parents, Mohamed K. and Abak R.
    The juvenile court concluded that the parents failed to ensure
    that Prince received necessary medical care after he was diag-
    nosed with a rare form of cancer. Mohamed appealed and Abak
    cross-appealed this determination, but, for reasons we will
    explain, we affirm.
    BACKGROUND
    Adjudication Petition and
    Preliminary Motions.
    The State commenced this action on October 21, 2019. In
    its adjudication petition, the State alleged that Prince, who was
    born in August 2015, lacked proper parental care by reason
    of the fault or habits of both Mohamed and Abak. The State
    asserted that Prince had been diagnosed with alveolar rhab-
    domyosarcoma of the right forearm with local metastases to
    the axillary lymph nodes; that the condition was curable with
    regular chemotherapy and radiation; that without treatment,
    the condition would be fatal; that Mohamed and Abak, having
    been informed of Prince’s diagnosis and prognosis, intention-
    ally kept him from receiving treatment; and that the actions of
    Mohamed and Abak placed Prince at a risk of harm.
    On the same day the State filed its petition, it filed an
    ex parte motion for immediate custody of Prince. The juve-
    nile court granted the State’s motion. The court later granted
    motions by the State for Prince to remain in the temporary
    legal and physical custody of the Nebraska Department of
    Health and Human Services (DHHS).
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    IN RE INTEREST OF PRINCE R.
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    308 Neb. 415
    Adjudication Hearing.
    The juvenile court held a trial on the State’s adjudication
    petition over the course of 4 days in January and February
    2020. A summary of the evidence presented follows.
    Melissa Acquazzino, a board-certified physician who spe-
    cializes in treating children with cancer at Children’s Hospital
    and Medical Center (Children’s) in Omaha, Nebraska, first
    saw Prince when he came to Children’s in July 2019 with a
    tumor on his right forearm. Following a biopsy, Acquazzino
    and others on a pediatric pathology team diagnosed Prince
    with alveolar rhabdomyosarcoma, a form of cancer. It was later
    determined that the cancer had spread to the lymph nodes of
    Prince’s armpit. Acquazzino testified that there are only about
    350 patients diagnosed with this form of cancer in the United
    States per year.
    Acquazzino informed Mohamed and Abak of Prince’s diag-
    nosis. She also informed Mohamed and Abak that Prince
    would need to receive chemotherapy. Acquazzino recalled
    that Mohamed and Abak were “distraught.” She testified that
    Mohamed expressed anger at the length of time it took to make
    the diagnosis as well as a belief that if Prince had received
    antibiotics earlier, cancer would not have developed.
    After additional testing on the tumor tissue, Prince was
    determined to have what Acquazzino referred to as “inter-
    mediate risk” rhabdomyosarcoma. Acquazzino testified that
    this meant that Prince had about a 60-percent chance of
    relapse-free, long-term survival if the best available treatment
    were provided. According to Acquazzino, the best available
    treatment in Prince’s case would include an initial round of
    chem­otherapy followed by either surgery or radiation and then
    continued chemotherapy for a total treatment duration of about
    66 weeks. She testified that an international consortium of
    children’s hospitals to which Children’s belonged recognized
    this course of treatment as the best available and that any other
    hospital within that consortium would have recommended
    the same treatment. If Prince did not receive this treatment,
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    Acquazzino said that he would die in 6 months to a year.
    Acquazzino testified that when patients have a very poor prog-
    nosis even if the standard treatment is provided, Children’s will
    offer the option of palliative “comfort care,” which is expected
    to end in the patient’s death. Acquazzino testified that was not
    an option explored in this case given Prince’s prognosis.
    On July 23, 2019, Acquazzino and Christina Chesters, a
    social worker at Children’s, met with Mohamed and Abak
    regarding Prince’s prognosis and next steps. Acquazzino testi-
    fied that she outlined the recommended treatment and informed
    Mohamed and Abak that most patients with Prince’s condition
    will respond to the treatment and achieve long-term survival.
    Acquazzino also testified that she told Mohamed and Abak
    that the treatment could involve side effects, which could be
    managed with medication. Mohamed and Abak also received
    various printed materials explaining the treatment and possible
    side effects.
    According to Acquazzino, Mohamed and Abak expressed
    concern at the July 23, 2019, meeting, about the need for
    chemotherapy. Acquazzino perceived Mohamed and Abak as
    resistant to the recommended treatment. After Acquazzino
    told them that this was the best available treatment and that,
    without treatment, Prince would die, Mohamed and Abak
    agreed to proceed. Prince began the recommended treatment
    that night.
    Acquazzino testified that Prince’s treatment went well ini-
    tially. His tumor visibly shrank, his side effects were minimal,
    and he made it to all his appointments. Chesters worked with
    Mohamed to identify and eliminate any barriers to regular
    attendance at treatment. As part of that effort, she made finan-
    cial resources available to pay for car repairs and other bills
    Mohamed and Abak reported having trouble paying.
    After several weeks of treatment, Prince began to experience
    expected side effects such as nausea, vomiting, and fatigue.
    Then, in September 2019, Prince started missing some of
    his scheduled chemotherapy appointments. Chesters testified
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    IN RE INTEREST OF PRINCE R.
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    that she contacted Mohamed after Prince missed one appoint-
    ment and that Mohamed told her he believed the doctors
    were giving Prince too much medicine too quickly. According
    to Chesters, she emphasized to Mohamed that it was very
    important Prince receive the treatments as scheduled and that
    the appointments were not optional. The missed appointments
    were concerning to Acquazzino, because they could lead to the
    cancer building resistance to the treatment regimen.
    The treatment plan called for Prince to begin radiation
    treatments while continuing chemotherapy in early October
    2019. Concerned about the prior missed chemotherapy appoint-
    ments and whether Mohamed and Abak would bring Prince
    to the radiation appointments, Acquazzino asked to meet with
    Mohamed and Abak on October 1, 2019.
    Both Mohamed and Abak attended the October 1, 2019, meet-
    ing with Acquazzino and Chesters. The meeting lasted about
    an hour. Acquazzino recalled that, at the meeting, Mohamed
    and Abak said Prince was being given too much medicine and
    that Mohamed said the cancer would not kill Prince, but the
    chemotherapy would. Mohamed and Abak asked that Prince
    be given less medicine. Acquazzino explained to them that
    reducing the medication would expose Prince to the same side
    effects, but would not be as effective at treating the cancer. She
    also told them that skipping scheduled treatments could lead
    to the cancer building resistance and becoming more difficult
    to treat.
    Acquazzino testified that during the meeting on October 1,
    2019, Mohamed and Abak said that they wanted to get a sec-
    ond opinion. While Acquazzino and Chesters offered to help
    facilitate a second opinion by making a referral or sending
    records to another provider, they also emphasized that the sit­
    uation was time sensitive, so any second opinion would need to
    be obtained quickly. Acquazzino testified that while any delay
    in treatment was not ideal, she would have “tolerated maybe
    a one to two week delay” to get a second opinion because
    the benefits of improving the relationship with Mohamed and
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    IN RE INTEREST OF PRINCE R.
    Cite as 
    308 Neb. 415
    Abak would counter the risk of delaying treatment. According
    to Acquazzino, Mohamed and Abak did not ask for a referral
    and said they had to think and talk about whether they were
    interested in one.
    Acquazzino testified that for much of the meeting on
    October 1, 2019, Mohamed and Abak expressed opposition
    to beginning radiation treatment. By the end of the meeting,
    however, Mohamed and Abak committed to bringing Prince
    to his radiation appointment the next day. After the meeting,
    Acquazzino and Chesters decided to make a Child Protective
    Services referral. Acquazzino felt that a referral was appropri-
    ate because, based on the discussion at the meeting, she was
    concerned that Mohamed and Abak would not ensure that
    Prince continued to receive treatment.
    Prince did attend his radiation appointment on October 2,
    2019. After that, however, neither parent brought Prince to any
    further radiation or chemotherapy appointments.
    On October 2, 2019, Vildana Parmer, a caseworker at
    DHHS, was assigned to investigate the concerns expressed in
    the Child Protective Services referral. Parmer had access to
    several possible addresses in Lincoln, Nebraska, for Mohamed
    and Abak and initially tried to make contact with them at
    those locations. These efforts were unsuccessful, but Parmer
    did reach Mohamed by telephone on October 4. She testified
    that she asked Mohamed where Prince and Abak were and
    that Mohamed told her they were at one of the addresses she
    already visited. After Parmer informed Mohamed that she had
    recently visited that address and no one was there, Mohamed
    told her that Abak and Prince were residing at the People’s
    City Mission (PCM). Parmer then visited PCM and asked an
    employee there to provide her business card to Abak.
    Deanna Borg, an employee of PCM, testified that PCM
    records showed that Abak and Prince began residing at PCM
    on August 1, 2019. Borg testified that in early October, some-
    one from DHHS asked her to provide Abak with the DHHS
    employee’s business card. Borg provided Abak with the
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    IN RE INTEREST OF PRINCE R.
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    card and told her that the DHHS employee said that it was
    important that Abak contact her. After providing the business
    card, Borg did not see Abak and Prince again. Borg testified
    that those people staying at PCM are required to sign a paper
    on their door if they intend to spend that night there. Abak last
    signed the paper on her door on October 1.
    Parmer later found Mohamed outside his residence in
    Lincoln. She testified that she asked Mohamed where Prince
    was and that Mohamed initially said that Abak and Prince went
    to Utah, but later stated they were in Arizona. He said that
    they went there to seek a second opinion for Prince’s medical
    treatment. Parmer testified that she asked Mohamed to have
    Abak call her, but Abak never did. Parmer also testified she
    emphasized to Mohamed that it was important Prince receive
    his medical treatment and that if he did not receive it, he would
    likely die. According to Parmer, Mohamed expressed disagree-
    ment with that statement.
    Patrick Wingfield, an officer with the Lincoln Police
    Department, attempted to locate Abak, beginning on October
    8, 2019. Wingfield found Mohamed outside his residence in
    Lincoln and requested that Mohamed ask Abak to contact
    him. Mohamed told Wingfield that Abak had taken Prince to
    Arizona to get a second opinion for his medical treatment.
    Wingfield testified that Mohamed told him that this was none
    of his concern and that Prince was safe.
    Luis Herrera, an investigator with the Lincoln Police
    Department, began attempting to locate Abak and Prince on
    October 9, 2019. Herrera first attempted to contact Abak via
    text message and by contacting other police departments. On
    October 12, he reached Mohamed by telephone. Mohamed told
    Herrera that Abak and Prince were in Arizona to get a second
    opinion for Prince’s medical treatment. Herrera testified that
    Mohamed told him, based on his research, Prince was being
    given too much medication and that Mohamed said, if he dis-
    agreed with the medication being given, “he would step in and
    correct the doctor.”
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    IN RE INTEREST OF PRINCE R.
    Cite as 
    308 Neb. 415
    After other attempts to locate Abak and Prince were unsuc-
    cessful, Herrera initiated an emergency “ping” on a cell phone
    number belonging to Abak on October 18, 2019. The ping
    indicated that the cell phone was in Murfreesboro, Tennessee.
    Herrera then called Mohamed again. Mohamed indicated he
    had been in contact with Abak. Herrera asked that Mohamed
    facilitate contact between Herrera and Abak. Herrera testified
    that during this conversation, Mohamed complained about the
    treatment Prince was receiving through Children’s and stated
    that Children’s had a “clandestine agenda.”
    A few hours after his conversation with Mohamed, Herrera
    spoke to Abak on the telephone. During the call, Herrera asked
    Abak whether Prince was receiving medical treatment, but
    Abak said she did not want to discuss that. When Herrera asked
    whether Abak and Prince were still in Nebraska, Abak said she
    was not and would not be coming back. She also said that “if I
    even get another doctor, it’s not going to be in Nebraska.”
    Herrera acquired a warrant to obtain an ongoing ping on
    Abak’s cell phone. Those pings indicated that the cell phone
    was at an apartment complex in Murfreesboro. After Herrera
    provided law enforcement in Tennessee with information
    regarding the case, Tennessee law enforcement found Abak at
    the apartment complex on October 26, 2019. Herrera worked
    with child welfare services in Tennessee to ensure that Prince
    was taken to a hospital as soon as he was found.
    No evidence was presented that Prince received any treat-
    ment or was seen by any medical professionals between October
    2 and 26, 2019. No evidence was presented that Mohamed or
    Abak had arranged for another medical professional to provide
    a second opinion. Chesters testified that although she compiled
    Prince’s medical records in response to Mohamed’s request in
    an October 8 email, she also told Mohamed that he would need
    to pick up a disc containing the records and that he failed to
    do so.
    Prince, in the temporary custody of DHHS, resumed
    treatment through Children’s once he returned to Nebraska.
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    IN RE INTEREST OF PRINCE R.
    Cite as 
    308 Neb. 415
    Although Acquazzino could not say with certainty to what
    extent the delay in treatment affected Prince’s prognosis, she
    testified that, in general, delays increase the risk of relapse and
    decrease the overall efficacy of the treatment. Acquazzino also
    testified that because chemotherapy can cause blood counts to
    drop severely, Prince was placed at risk by not having blood
    tests run on a weekly basis. In addition, she testified that
    because Prince was receiving chemotherapy and had a central
    line inserted in his body, Prince was at risk for infection.
    Mohamed testified at trial. He agreed that after beginning
    chemotherapy, Prince’s tumor noticeably shrank. He testified
    that when Prince began experiencing side effects, it was dif-
    ficult to get him to take the oral medications that would help
    manage them. He testified that he asked the doctors if Prince
    could take the medications used to manage side effects in some
    other way. At one point in his testimony, Mohamed said that he
    only wanted a second opinion regarding Prince’s wrist, which
    had limited functionality after the biopsy, and that he never
    wanted a second opinion about the treatment protocol. Later in
    his testimony, however, he testified that he also wanted to get
    a second opinion for Prince’s cancer diagnosis.
    Mohamed testified that he and Abak were not and had never
    been married. He testified that while Prince resided with Abak
    at the time of the events at issue, Prince had lived with him at
    earlier points in his life. Mohamed testified that it was Abak’s
    decision to leave Nebraska. He testified that he did not ask
    Abak to return because he believed she was seeking a sec-
    ond opinion.
    Mohamed disagreed with Chesters’ testimony that he did
    not obtain the medical records, claiming that she emailed the
    records to him. He conceded that he never gave the records to
    another medical provider.
    Mohamed denied ever telling anyone that the treatment
    would kill Prince, but the cancer would not. He also denied ever
    saying that he intentionally did not bring Prince to treatments
    because he believed Prince was receiving too much medicine
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    through chemotherapy. He acknowledged that Acquazzino had
    informed him that it was harmful to Prince to miss scheduled
    treatments, and he testified that he believed that was true. He
    testified that he wanted Prince to receive all of the treatment
    recommended by Children’s.
    Abak did not testify at trial.
    Juvenile Court’s Adjudication Order.
    The juvenile court found that Prince lacked proper parental
    care by reason of the fault or habits of both Mohamed and
    Abak. In reaching this conclusion, the juvenile court empha-
    sized various points. It observed that there was no medical
    evidence presented disputing Acquazzino’s opinions concern-
    ing Prince’s diagnosis or that there was a standard treatment
    provided for patients with such a diagnosis. It also credited
    Acquazzino’s opinion that Prince had a 60-percent chance of
    survival with the standard treatment, but would die without
    it, and that if Prince’s treatment was interrupted or delayed, it
    would increase the risk of relapse and decrease the treatment’s
    efficacy. It noted that neither parent raised a religious or cul-
    tural objection to the treatment Prince was receiving.
    The juvenile court also considered and rejected both parents’
    argument that they withdrew Prince from treatment only to
    obtain a second opinion. It found that the parents’ “more likely
    motivation in removing Prince from the state was to stop his
    treatment altogether for an undetermined period of time.” The
    juvenile court specifically noted that it found unconvincing
    Mohamed’s testimony that he deferred to Abak in removing
    Prince from the state and that he lacked knowledge of Abak’s
    “efforts or lack thereof in seeking a second opinion.”
    Mohamed appealed, and Abak cross-appealed.
    ASSIGNMENTS OF ERROR
    Mohamed assigns that the juvenile court erred by find-
    ing (1) that Prince lacked proper parental care by reason of
    his faults or habits and (2) that his actions placed Prince at a
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    definite risk of harm. On cross-appeal, Abak assigns that the
    juvenile court erred by making the same determinations with
    respect to her.
    STANDARD OF REVIEW
    [1] Juvenile cases are reviewed de novo on the record, and
    an appellate court is required to reach a conclusion independent
    of the juvenile court’s findings; however, when the evidence is
    in conflict, an appellate court may consider and give weight to
    the fact that the trial court observed the witnesses and accepted
    one version of the facts over the other. In re Interest of A.A. et
    al., 
    307 Neb. 817
    , 
    951 N.W.2d 144
     (2020).
    ANALYSIS
    Background Regarding Adjudication
    Proceedings in Juvenile Court.
    [2,3] Before addressing Mohamed’s and Abak’s arguments,
    we briefly review the standards governing the adjudication
    phase of a juvenile court proceeding. The purpose of the adju-
    dication phase is to protect the interests of the child. In re
    Interest of Justine J., 
    286 Neb. 250
    , 
    835 N.W.2d 674
     (2013).
    To obtain jurisdiction over a juvenile at the adjudication stage,
    the court’s only concern is whether the conditions in which
    the juvenile presently finds himself or herself fit within the
    asserted subsection of 
    Neb. Rev. Stat. § 43-247
     (Reissue 2016).
    In re Interest of Justine J., 
    supra.
    Section 43-247(3)(a) sets forth numerous grounds by which
    the juvenile court could take jurisdiction over a juvenile.
    See In re Interest of Jeremy U. et al., 
    304 Neb. 734
    , 
    936 N.W.2d 733
     (2020). The ground relevant to this case is that
    the juvenile “lacks proper parental care by reason of the fault
    or habits of his or her parent, guardian, or custodian.” See
    § 43-247(3)(a). As we have previously explained, “proper
    parental care” includes
    providing a home, support, subsistence, education, and
    other care necessary for the health, morals, and well-
    being of the child. . . . It commands that the child not
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    be placed in situations dangerous to life or limb, and not
    be permitted to engage in activities injurious to his health
    or morals.
    State v. Metteer, 
    203 Neb. 515
    , 520, 
    279 N.W.2d 374
    , 377
    (1979). See, also, In re Interest of Jeremy U. et al., supra.
    In considering whether a juvenile lacks proper parental care,
    our case law has incorporated a risk of harm component. In
    re Interest of Jeremy U. et al., supra. To show that a juvenile
    lacks proper parental care, the State is not required to prove
    that the child has actually suffered physical harm, but the State
    must establish that, without intervention, there is a definite risk
    of future harm. See In re Interest of Kane L. & Carter L., 
    299 Neb. 834
    , 
    910 N.W.2d 789
     (2018).
    We recently explained in In re Interest of Jeremy U. et al.
    that a claim under § 43-247(3)(a) that a juvenile “lacks proper
    parental care by reason of the fault or habits of his or her par-
    ent, guardian, or custodian” should be analyzed through a two-
    step inquiry:
    The first step is to determine if the juvenile is lacking
    proper parental care, whether such care is being provided
    by a parent, a guardian, or a custodian. If a juvenile is
    not lacking that type of care (and . . . there is no defi-
    nite risk of harm), adjudication under this provision of
    § 43-247(3)(a) is improper. If, on the other hand, the
    juvenile is lacking such care, the court should proceed to
    the second step: Does that condition result from the fault
    or habits of the juvenile’s parent, guardian, or custodian?
    If the answer to that question is also yes, then the juvenile
    court should take jurisdiction of the juvenile and proceed
    to a proper disposition.
    
    304 Neb. at 748
    , 936 N.W.2d at 744-45.
    [4] At the adjudication stage, in order for a juvenile court
    to assume jurisdiction of minor children under § 43-247(3)(a),
    the State must prove the allegations of the petition by a pre-
    ponderance of the evidence. In re Interest of Heather R. et al.,
    
    269 Neb. 653
    , 
    694 N.W.2d 659
     (2005). A preponderance of
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    the evidence is the equivalent of the greater weight of the evi-
    dence, which means evidence sufficient to make a claim more
    likely true than not true. See In re Interest of Vladimir G., 
    306 Neb. 127
    , 
    944 N.W.2d 309
     (2020). Both Mohamed and Abak
    argue on appeal and cross-appeal that the State failed to carry
    its burden to show that Prince lacked proper parental care by
    reason of their faults or habits and that, without intervention,
    Prince faced a definite risk of future harm. We turn to their
    arguments now, beginning with Abak’s.
    Abak’s Cross-Appeal.
    Abak contends that Prince did not lack proper parental care
    by reason of her fault or habits and that Prince did not face a
    definite risk of future harm. In support of her argument that
    Prince received adequate parental care, Abak primarily empha-
    sizes evidence of her care for Prince prior to the meeting at
    Children’s on October 1, 2019. She mentions, for example,
    that she noticed the swelling in Prince’s forearm and arranged
    for him to be seen by doctors. She points out that she agreed
    to the treatment plan recommended by Children’s and that
    Prince initially received treatment as recommended. She also
    directs us to a note recorded by Chesters in July 2019 stating
    that she and Mohamed “love Prince very much.” But even if
    this evidence tends to show that Abak was ensuring that Prince
    received adequate medical care for a period of time, it fails
    to address the crux of the State’s case: that in early October,
    Abak took Prince out of Nebraska and, for more than 3 weeks
    until the State was able to locate them, kept Prince from
    receiving the treatment Acquazzino testified was essential to
    his survival.
    The closest Abak comes to providing an explanation for
    her actions after the October 1, 2019, meeting are sugges-
    tions that she was not refusing to allow treatment, but merely
    seeking a second opinion. This claim might have more force
    if there were evidence in the record that Abak had actu-
    ally made arrangements to obtain a second opinion or taken
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    significant, concrete steps toward doing so. But even though
    Acquazzino had recently informed Mohamed and Abak that
    Prince’s condition was serious, that delays in treatment sub-
    jected Prince to risk of lethal harm, and that thus, any second
    opinion must be obtained quickly, there is no evidence that
    even after Prince had already missed approximately 3 weeks
    of scheduled treatment, Abak had so much as begun to iden-
    tify where she might obtain a second opinion. Further, Abak’s
    comment to Herrera that “if I even get another doctor, it’s not
    going to be in Nebraska,” suggests that Abak had no immedi-
    ate intentions of arranging for a second opinion. (Emphasis
    supplied.) Based on this evidence, we agree with the juvenile
    court that it is more likely than not that Abak did not leave
    Nebraska with Prince to obtain a second opinion, but to stop
    his treatment altogether for an indefinite period of time. We
    also agree with the juvenile court that the decision to indefi-
    nitely stop treatment, which Acquazzino testified was essential
    to Prince’s survival, deprived Prince of proper parental care by
    reason of the faults or habits of Abak.
    Abak also argues that the juvenile court erred by find-
    ing that, without intervention, Prince faced a definite risk of
    future harm. Here, Abak argues that because the State could
    not definitively show that Prince was harmed by not receiving
    treatment during the time in which she and Prince were not in
    Nebraska, it did not prove the risk of harm element. Abak’s
    argument, however, is an attempt to transform the risk of harm
    requirement into a requirement that the juvenile suffer actual
    harm before the juvenile court obtains jurisdiction. As we
    have emphasized on many occasions, however, the Nebraska
    Juvenile Code does not require a juvenile court to wait until
    disaster has befallen a minor child before the court may acquire
    jurisdiction. See, e.g., In re Interest of Justine J., 
    286 Neb. 250
    ,
    
    835 N.W.2d 674
     (2013).
    The State introduced evidence showing that Prince was
    placed at risk of harm by a delay in treatment. As we have
    noted, Acquazzino testified that treatment delays increase
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    the risk of relapse and decrease the overall efficacy of the
    treatment and that if the treatment was stopped altogether,
    Prince would die. Her testimony also established that due to
    his treatment and the central line in his body, Prince needed to
    be regularly seen by medical professionals. We find the State
    established that, without intervention, there was a definite risk
    of future harm to Prince as a result of Abak’s actions.
    Under the two-step analysis set forth in In re Interest of
    Jeremy U. et al., 
    304 Neb. 734
    , 
    936 N.W.2d 733
     (2020), the
    State established that Prince lacked proper parental care and
    faced a definite risk of future harm and that this resulted
    from the fault or habits of Abak. We thus find no merit to
    Abak’s cross-appeal.
    Mohamed’s Appeal.
    In his appeal, Mohamed makes many of the arguments
    made by Abak. Like Abak, he contends that he ensured Prince
    received the treatment recommended by Children’s up until
    early October 2019 and that the treatment stopped at that point
    only because a decision was made to obtain a second opinion.
    He also makes the argument that because the State did not
    prove that Prince actually suffered harm because of the treat-
    ment delay, it did not establish the risk of harm element. As we
    have already explained, however, we are unpersuaded by these
    arguments. We have already determined under the first step of
    the two-step In re Interest of Jeremy U. analysis that, after his
    treatment was stopped in early October 2019, Prince lacked
    proper parental care and, as a result, faced a definite risk of
    future harm.
    Mohamed does make one argument, however, that remains
    unaddressed even after our analysis of Abak’s cross-appeal:
    Mohamed attempts to place any blame for a lack of paren-
    tal care exclusively on Abak. Mohamed argues that while he
    agreed that a second opinion should be sought, he believed
    Abak was, in fact, seeking such an opinion when she left
    the state with Prince in October 2019. Although he does not
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    frame the argument in these exact terms, Mohamed appears
    to argue that even if the State proved at step one of the In re
    Interest of Jeremy U. analysis that Prince lacked proper paren-
    tal care and faced a definite risk of future harm because of the
    treatment delay in October 2019, it did not prove at step two
    that this was a result of the fault or habits of Mohamed.
    As noted above, the juvenile court rejected this argument,
    finding that both parents made the decision to withdraw Prince
    from treatment and to remove him from Nebraska—not to
    obtain a second opinion but to stop his treatment altogether for
    an undetermined period of time. We agree that, based on the
    evidence in the record, it is more likely than not that Mohamed
    supported and bears responsibility for the decision to remove
    Prince from treatment indefinitely regardless of whether a sec-
    ond opinion was sought. Several pieces of evidence inform this
    conclusion, which we outline below.
    Initially, we note that the record contains evidence of mul-
    tiple statements by Mohamed that the recommended treatment
    was not only unnecessary to Prince’s survival, but harmful to
    him. Acquazzino, Chesters, Parmer, and Herrera all testified
    that Mohamed made such statements. Although the fact that
    Mohamed made these statements alone would not demonstrate
    that Prince lacked proper parental care by reason of the fault or
    habits of Mohamed, they do suggest that Mohamed disagreed
    with and wanted to discontinue the recommended treatment
    and was not merely an unwitting victim of Abak.
    There are also pieces of evidence that, when considered
    together, undermine Mohamed’s claims that he wanted to
    obtain a second opinion, that he deferred to Abak to arrange
    for such an opinion, and that he believed that such an opin-
    ion was being sought. First, Mohamed offered testimony
    regarding his devotion and attachment to Prince. The juvenile
    court found this testimony credible, observing that Mohamed
    “undoubtedly loves his son.” But while there is no dispute that
    Mohamed cared deeply for Prince, there is evidence suggest-
    ing that he would not have trusted Abak to ensure that Prince
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    received needed medical care. Mohamed and Abak reported to
    Chesters that “they don’t always get along.” In addition, in a
    meeting with Chesters, Mohamed shared that he was concerned
    about Abak’s arrest record and drug and alcohol use and that
    he believed her drug usage might explain why Prince missed
    several speech therapy appointments. During that meeting,
    Mohamed requested that all appointments be made on days on
    which he did not have to work. Given Mohamed’s attachment
    to Prince and his prior concerns regarding Abak’s reliability, it
    is difficult to believe that Mohamed entrusted Abak with the
    task of obtaining a second opinion.
    Mohamed emphasizes that he sent an email to Chesters on
    October 8, 2019, asking that Prince’s medical records be com-
    piled so that a second opinion could be sought. This evidence
    does not persuade us that Mohamed bears no responsibility
    for the lack of proper parental care. Chesters testified that
    while she compiled the records, she also informed Mohamed
    he would need to arrange to come pick up a disc containing
    the records, and he never did so. Mohamed disagreed with this
    testimony, claiming that Chesters emailed the records to him.
    But even assuming the truth of Mohamed’s testimony on this
    point, Mohamed also testified that he never sent the records to
    another medical provider. The assertion that Mohamed believed
    a second opinion was being obtained is difficult to square with
    the fact that he knew the records necessary to obtain such an
    opinion had not been given to another provider.
    We acknowledge that Mohamed testified that he believed
    Abak was arranging for a second opinion and that Abak told
    him she had made an appointment with another provider. The
    juvenile court, however, found Mohamed’s “claimed ignorance
    of [Prince’s and Abak’s] whereabouts, or [Abak’s] efforts or
    lack thereof in seeking a second opinion, unconvincing.” The
    juvenile court had the opportunity to observe Mohamed’s
    testimony firsthand, and given the evidence in the record we
    have discussed, we believe deference to its assessment of
    the credibility of Mohamed’s claims is warranted. See In re
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    Interest of Leyton C. & Landyn C., 
    307 Neb. 529
    , 
    949 N.W.2d 773
     (2020).
    Based on the foregoing, we agree with the juvenile court that
    it is more likely than not that Mohamed supported Abak’s tak-
    ing Prince from the state because he too wanted the treatment
    stopped indefinitely and did not want Prince to be found. We
    thus reject Mohamed’s argument that the State failed to prove
    at step two of the analysis under In re Interest of Jeremy U. et
    al., 
    304 Neb. 734
    , 
    936 N.W.2d 733
     (2020), that Prince lacked
    proper parental care because of Mohamed’s fault or habits.
    CONCLUSION
    We find that the juvenile court did not err by adjudicating
    Prince as a child that lacked proper parental care by reason of
    the fault or habits of both Mohamed and Abak. Accordingly,
    we affirm.
    Affirmed.