The Texas Supreme Court has denied a surrogate mother's bid to block the biological parents of a critically ill infant from transferring him to a Los Angeles hospital, a ruling that may not end the fight, because the surrogate has already asked the U.S. Supreme Court to step in.
The court ruled Thursday that "sustaining the life of the medically fragile child is the paramount concern in this time-sensitive matter," siding with biological parents Nausheen Gilkar and Omar Ahmed over surrogate McKenna West. The decision clears the way for the couple to move their one-month-old son, Rumi, from Children's Hospital in Dallas to a hospital in Los Angeles for additional heart surgeries his doctors say he needs to survive.
The case sits at the intersection of surrogacy law, parental rights, abortion policy, and disability protections, and it has drawn intervention from Texas Attorney General Ken Paxton and the Trump administration's Department of Health and Human Services. At its center is a baby born with a severe heart defect whose surrogate refused to abort him, and whose biological parents have now won custody battles in three states.
Rumi was diagnosed in April, while still in utero, with hypoplastic left heart syndrome, a condition in which the left side of the heart is too underdeveloped to pump blood normally. The defect is severe but treatable. Standard care involves three surgeries after birth, beginning with a procedure called the Norwood.
West, an Alaska nurse who entered the surrogacy agreement through Worldwide Surrogacy Specialists, a Connecticut-based agency, refused the intended parents' request to abort the baby after the diagnosis. She flew to Texas, a state that bans abortion, to seek custody and ensure the child received life-saving treatment after birth.
Gilkar and Ahmed, the Los Angeles couple who are Rumi's biological parents, have acknowledged they once considered having West terminate the pregnancy. But they have maintained throughout the litigation that they are committed to Rumi's health and medical care. Gilkar disclosed that she underwent eight unsuccessful rounds of in vitro fertilization and a hysterectomy before turning to surrogacy.
The Texas Supreme Court's Thursday ruling is the latest in a string of decisions favoring Gilkar and Ahmed. Courts in California, Alaska, and now Texas have all upheld the couple's parental rights and rejected West's bids for custody or decision-making authority over Rumi's medical care.
A Dallas court had earlier ordered that life-saving medical care be provided upon the baby's birth and prevented anyone from withholding treatment or removing the child while the case was being considered. Rumi was born on August 12 in Dallas, the day after that court ruling. He has already undergone one surgery and will likely need others.
At an August 25 hearing in Dallas, the baby's doctor testified that the child's remaining surgeries should be performed at a hospital in Los Angeles and recommended an ICU-to-ICU transfer. Susan Duesler, the guardian ad litem, a court-appointed advocate for the child's interests, agreed, stating the child should receive the care his doctor recommends, which may include the transfer to California.
Delaying the move, the doctor warned, would create "much more complicated treatment" for the baby.
The case drew high-profile involvement well before it reached the state's highest court. Texas Attorney General Ken Paxton joined the legal fight to ensure Rumi received treatment after birth, citing the biological parents' initial refusal to consent to heart surgery. Paxton's office sent a letter to Dallas hospitals outlining its position that the baby deserved life-saving care.
Paxton said in a statement:
"My office utilized every tool at our disposal to protect life, and we will not back down in continuing to support baby Gabriel's well-being. Every child in our state deserves to be cared for and protected, and that's exactly what I'll fight for."
The Trump administration's HHS Office for Civil Rights also weighed in, sending letters to Children's Medical Center of Dallas and UT Southwestern Medical Center. Those letters outlined federal obligations under disability civil rights laws, stating that "federal law prohibits withholding medical treatment based on a person's disability, including based on judgments that the life of someone with a disability has less value or that the individual would impose a burden on others."
The federal and state interventions both pointed in the same direction: the baby was entitled to treatment regardless of his diagnosis, and no party could lawfully deny him care.
West has not exhausted her legal options. She filed an emergency plea with the U.S. Supreme Court seeking an administrative stay to prevent Rumi from being moved out of Texas. Her lawyers argued that "relief was urgently needed" and that "future care for Baby G. is uncertain and unknowable" under the California court order upholding the biological parents' rights.
Gilkar and Ahmed fired back with a heavily redacted response arguing the case has already been decided and falls outside the high court's jurisdiction. They warned that if the Supreme Court intervened and ruled for West, it would interrupt the child's medical care with "chaos."
Lee Budner, the couple's attorney, issued a pointed statement on Friday, as the Texas Tribune reported:
"While McKenna West has been conducting a publicity tour, Rumi's parents have been quietly caring for their child and following the recommendations of Rumi's medical team."
Budner added that West's Supreme Court request "threatens the continuity of Rumi's medical care," arguing that a stay "would not change who Rumi's parents are" but "would only create confusion over medical decision-making authority and jeopardize the providers' ability to rely on the parents' consent to Rumi's treatment."
West's attorney did not respond to a request for comment. The trial court case has been sealed from public view.
The Texas Supreme Court's ruling quoted "uncontroverted medical testimony" from the child's physician that the transfer serves the child's best interest. The court framed its decision narrowly around the baby's medical needs, not the broader surrogacy dispute.
But the case has exposed fault lines in surrogacy law that no single ruling can resolve. The agreement was executed in Alaska, the biological parents live in California, and the baby was born in Texas, three states with different legal frameworks for surrogacy, parental rights, and abortion. West crossed state lines specifically because Texas bans abortion, hoping the state's legal environment would be more favorable to her custody bid.
National Review's Wesley J. Smith used the case to argue that commercial surrogacy "turns women into machines, babies into products," warning that the industry treats both surrogates and children as commodities in arrangements driven by personal desire rather than moral principle. The biological parents, meanwhile, are suing West for at least $100,000.
The parents' lawyers insisted in their Texas Supreme Court brief that the guardian ad litem testified the couple had "followed the recommendations of the doctors to a T" and that the doctors had "unequivocally, no" concerns about the parents' medical decision-making. The parents' legal team also stated that hospice is not part of the child's medical plan, pushing back against an implication, though the source of that claim remains unclear from the sealed record.
Three states, two federal agencies, and now a potential Supreme Court filing, all over one baby whose only certain need is surgery. When adults turn a child's medical care into a multi-state legal marathon, the system has failed someone. The question is whether any court left in the chain will say so plainly.
