Wright County should retain custody of a 5-year-old boy in order to continue medically recommended chemotherapy treatments that his parents have resisted, a judge ruled this week.

Judge Elizabeth Strand issued an order Thursday that maintained the temporary custody arrangement for Keaton Peck, based on medical testimony that the boy's cancer could return without continued treatments.

The parents "do not want him to die. And they do not want to watch him endure the side-effects of chemotherapy treatment," Strand wrote. "However ... the best way to ensure that they will always have their boy, is to order Keaton to complete the recommended chemotherapy protocol."

Parents Troy Verm and McKena Peck traveled north from Texas to spend Christmas with relatives and have been in Minnesota ever since — first because their son needed emergency treatment at Children's Hospital in Minneapolis, and then because of the court battle over his extended care.

Chemotherapy drove Keaton's form of leukemia to undetectable levels, but his parents opposed two additional years of treatments that Children's doctors recommended to prevent the cancer from returning. Studies have found that a return of T-cell acute lymphoblastic leukemia can be untreatable and fatal.

Strand in her order said she was persuaded by testimony from the Children's oncologist treating Keaton, indicating a 93% chance of survival through continued chemotherapy but a "very bleak" prognosis if the cancer returns.

"It is hard to conceive of a stronger case for medical necessity than this one," the judge wrote.

Keaton's mother said the risk of relapse is small compared with the certainty of side effects, including a bacterial infection that left her son severely ill and hospitalized a month ago. She expressed spiritual and philosophical objections to chemotherapy, a drug regimen that targets and kills fast-growing, cancerous cells.

The family is deciding whether to appeal.

Keaton had become bubbly and playful with his brothers during his latest break between chemo rounds, but he resumed treatments Thursday and will be angry, nauseated and depressed again, his mother said Friday.

"He asked me today, 'Why am I throwing up again?' " Peck said. " 'Why am I sick again? I thought I wasn't sick anymore.' "

Strand's decision followed three days of testimony in May that featured divergent medical opinions. An East Coast expert in medical marijuana and a St. Paul naturopathic doctor testified on behalf of the parents, though the judge in her order noted that neither recommended alternative therapies to the exclusion of chemotherapy.

The standoff is rare but not unprecedented; Minnesota reported 31 cases in 2021 in which allegations of medical neglect were the primary reason for temporarily removing children from parental custody.

A 2009 case drew national attention when a mother fled with her teenage son, Daniel Hauser of Sleepy Eye, Minn., to avoid court-ordered chemotherapy and pursue alternative remedies in Mexico.

Some people have urged Peck to run, but she said she wouldn't do that and, among other things, risk losing parental custody of her two other boys. The youngest was born during the family's stay in Minnesota. The family has been living in Otsego with Keaton's grandmother, who was granted temporary custody of Keaton.

Keaton's father moved to Oklahoma to resume work in the oil industry this spring, and the parents are hoping to relocate there. Medical and legal expenses are piling up, and fundraising on social media hasn't generated much money.

Guardian ad litem Melinda Dom, who represented Keaton in the court case, testified that the boy should relocate with his family. She supported alternative remedies to enhance Keaton's treatment but recommended a court-ordered "safety plan" to make sure that chemotherapy continues if the family moves.

Peck said pediatric cancer research has been underfunded and is needed to discover better treatments and examine the use of cannabis, which she said has helped Keaton deal with chemo side effects.

Keaton was speaking at a young age and has always been inquisitive. Peck said she worries about the effect chemo will have on his development, even though he seems to bounce back between chemo rounds.

"It gives me hope," she said, "but then again we're only six months into this. We have 2½ years left."

A disposition hearing later this month will clarify next steps in the case and any conditions under which the family could move to another state.