A four-month dispute over the custody and care of a southern Minnesota boy born last December with the HIV infection ended in a split decision Monday, with the infant’s parents winning physical custody while county officials will continue to supervise his medical treatment.

In a 20-page court ruling, Mower County District Judge Fred Wellmann said that statements made by the parents and grandparents of Rico Martinez Nagel opposing the baby’s daily antiretroviral medical treatments gave him “little choice” but to rule in favor of continued county medical supervision “to protect the child.”

“Their words and actions establish clear and convincing evidence to this Court that they will not provide necessary medical care” without county supervision, he wrote.

The ruling follows a court hearing last month in which the baby’s parents, Lindsey Nagel and John Martinez, fought to win custody and control over the boy’s medical treatments after losing custody in January after a missed appointment with Mayo Clinic physicians.

The family has expressed doubts about the treatments because of Lindsey Nagel’s experience with powerful antiretroviral drugs after she was diagnosed with HIV shortly after she was adopted as an infant from Romania.

Her parents, Steve and Cheryl Nagel, have said that the treatments, administered 20 years ago, almost killed Lindsey, leaving her sick, underweight and screaming with leg pain. They took her off the drugs after 22 months.

The fight over Rico’s treatment began within hours of his Dec. 19 birth and escalated in mid-January, when county officials moved to take custody after his parents missed the appointment at Mayo. Within days, child protection officials, claiming the baby was being medically neglected, obtained a court order and removed him from the family’s home in Brownsdale, Minn., southwest of Rochester.

After being hospitalized for seven weeks with IV tubes to feed him and deliver antiretroviral drugs, Rico was returned to the custody of his parents, but with the stipulation that county officials continue to monitor the daily feedings and medical treatment pending a court hearing and Wellmann’s final decision.

At a two-day hearing in April, county officials argued that the family couldn’t be trusted based on the missed appointment and other concerns, including Lindsey Nagel’s refusal to undergo prenatal treatments that could lower the risk of transmitting HIV to her fetus and her initial refusal to have her son tested after his birth.

But Lindsey Nagel testified that she was never told of prenatal treatments while pregnant, adding that she ultimately consented to have her son tested for HIV hours after giving birth because she was told she would be charged with child endangerment and could lose custody if she didn’t.

In his ruling Monday, Wellmann expressed concerns about the grandparents’ influence on the young parents — Lindsey Nagel is 22, John Martinez is 21. He noted that Cheryl Nagel testified in court that the family’s intent was “legally to stop medications” if it could. Rico and his parents live with Steve and Cheryl Nagel.

Wellmann also noted that Rico’s health has steadily improved with the treatments, which are administered by his parents under county supervision. His anemia is under control, his head size has increased and his viral load has been reduced, all of which are indications that “the virus is being suppressed,” he wrote.

“No evidence has been submitted to the court that the treatment regimen ... has not been successful,” he said.

Cheryl Nagel said Monday that her family wasn’t surprised by the decision and may appeal it.

Mower County Attorney Kristen Nelsen declined to discuss the case, saying “the order speaks for itself.”