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}}</ref> It is not clear that Cole, who recently had heart surgery, was stable and healthy. <ref>{{REFjournal |last=Nast |first= |init=VG |author-link= |last2=Markham |first2= |init2=LW |author2-link= |last3= |first3= |init3= |author3-link= |last4= |first4= |init4= |author4-link= |last5= |first5= |init5= |author5-link= |last6= |first6= |init6= |author6-link= |last7= |first7= |init7= |author7-link= |last8= |first8= |init8= |author8-link= |last9= |first9= |init9= |author9-link= |etal=yes |title=Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association |trans-title= |language= |journal=Circ Cardiovasc Qual Outcomes |location= |date=2023-01 |season= |volume=16 |issue=1 |article= |page=e000113 |pages= |url=https://www.ahajournals.org/doi/pdf/10.1161/HCQ.0000000000000113 |archived= |quote= |pubmedID=36519439 |pubmedCID= |DOI=10.1161/HCQ.0000000000000113 |doi= |format=PDF |accessdate=2025-05-01}}</ref> It also is not clear that the legal required [[informed consent]] was received by the parents, Tim and Gabrielle Groth, who apparently granted [[surrogate consent]] for a non-therapeutic surgical [[amputation]] and [[genital mutilation]] in violation of [[Medical_ethics#Medical_ethics_and_circumcision| standards of medical ethics]].<ref>{{REFweb