Saturday, October 8, 2011

State agrees to pay $4.6 million to victims in Carnation starvation case

Blog authors note:
How can CPS possibly be this incompetent and grossly negligent that this kind of thing happens, let alone happens frequently across the US? Aren't they supposed to be trained professionals?

Posted by Matt Kreamer

The Department of Social and Health Services has agreed to pay $4.6 million to two children who were abused by their father and stepmother three years ago in their Carnation home.

A girl, who was so emaciated she wore a size 2 shoe and weighed 48 pounds at age 14, had begged a social worker to put her in foster care more than three years before her father and stepmother were arrested in 2008, according to a King County Superior Court lawsuit filed against the state.

The civil suit claimed the girl's "nightmare of abuse and torture" extended to her younger brother, who was forced to participate in the abuse of his sister and was "essentially her jailer."

Because the plaintiffs are minors, the settlement will not be final until approved by the court, according to a DSHS news release.

"We deeply regret that these children had to suffer at the hands of the two adults they trusted to love them and keep them safe," said DSHS Children's Administration Assistant Secretary Denise Revels Robinson.

The case, and the subsequent arrest and guilty pleas of both parents of first and second degree criminal mistreatment in October 2008, received broad media attention at the time.

When law enforcement arrived at the children's home in August of 2008, they did not take the children into protective custody but referred the case to DSHS Child Protective Services, who went to the home the next day and directed the parents to seek immediate medical attention for the girl. She was subsequently transported to Children's Hospital by ambulance, where doctors found her to be suffering from extreme malnutrition and other abuse and neglect, according to the news release.

Child Protective Services received one previous referral on this family in March 2005 -- more than three years earlier -- in which the girl told a public school teacher she was frequently locked in her room and was given little to eat. Child Protective Services, working with local law enforcement, found that the stepmother's locking the child in her room constituted negligent treatment and maltreatment. The stepmother agreed to stop doing so. At the time, when interviewed by Child Protective Services, the girl indicated she was provided adequate food to eat every day, according to the release.


Thursday, October 6, 2011

Jury: NC hospital negligent in child abuse case

By: Associated Press
Published: October 05, 2011

A Cumberland County jury has awarded a boy and his father $25 million, ruling that a hospital was negligent when its employees didn't notice the boy was a victim of child abuse.

But The Fayetteville Observer reported that Cape Fear Valley Health System will pay less than the jury's award to 14-year-old Ajamu Gaines Jr., and his father. The two sides reached a private settlement following the verdict Monday.

Testimony showed Ajamu was brought to the hospital in 2003 with old and new broken bones, and again three months later with a brain injury to the then 6-year-old.

An attorney says the hospital disagrees with the verdict.

Ajamu lives in Charleston, W.Va., with his father, who says the money will ensure lifelong care for his son.


D.C. child welfare agency often acts too quickly to remove children, study says

By Teresa Tomassoni, Published: October 5

The number of children removed from their homes by child abuse investigators in the District has fallen in the past year, but a recent review of some cases concluded that children are still regularly separated from their parents without adequate justification.

The study, conducted by a federally mandated panel of volunteer monitors, examined 27 cases involving 41 children over several years. In many of the instances examined by the panel, children who were placed briefly in foster care should have stayed with their families, the report concluded.

The Citizens Review Panel said the District’s Child and Family Services Agency has not done enough to keep families together and urged the agency to do better.

“CFSA’s child removal decisions must balance the need to protect children from serious abuse or neglect with the need to protect children from the significant emotional trauma that comes from the government separating them from their families,” the report, released last week, stated.

The review, released last week, is the latest examination of the challenges that CFSA, like other child welfare agencies, faces in balancing the inclination to remove children when neglect or abuse is suspected and the imperative to leave them in the home unless they are in imminent danger.

In more than half of the reviews conducted, panel members found that the case record did not justify removal.

In one case cited in the report, a social worker removed a child upon discovering suspicious marks on the child’s body, most likely from being whipped with a cord. The social worker placed him and his three siblings, who did not show signs of abuse, into foster care without obtaining a family court order.

After the removal, the social worker met with the mother to work out a strategy, known as a safety plan, for addressing the problems in the home. Less than a week later, the children were back at home. The report said that if this conversation had taken place before the children were taken, foster care would not have been necessary.

CFSA’s statistics show that even as the number of removals are on pace to be their lowest in years, the percentage of children who are being returned home within four months is at 35 percent, roughly the same rate as last year and a higher rate than in any of the previous three years.

Debra Porchia-Usher, the child welfare agency’s interim director, said how quickly children are removed from their families and how quickly they are returned is an issue the CFSA continues to monitor. “We all agree fewer removals are better,” she said. But she does not agree that the problem is as prevalent as the report suggests.

In an effort to make better decisions about removals, the agency recently launched a pilot program of a strategy known as differential response, which acknowledges that not every abuse or neglect report is an indicator of imminent danger.

Earlier this year, the agency also completed a policy manual on conducting investigations. All social workers, supervisors and program managers have been trained using this new resource, Porchia-Usher said.


Sick Child's Parents Say Hospital & County Falsely Labeled Them as Child Abusers


HARRISBURG, Pa. (CN) - Parents say they lost custody of their children, were identified as child abusers and the father was jailed for more than a year because doctors and state officials falsely attributed their 4-month-old daughter's childhood stroke and congenital rickets to child abuse.

Jamel Billups and Jacqueline Rosario, who are black, sued the Penn State Milton S. Hershey Medical Center, Franklin County and its Office of Children, Youth and Families and a long list of individuals, in Federal Court.

The parents say that when their daughter, L.B., suffered a stroke and showed signs of rickets on Oct. 19, 2009, the Child Safety team at Penn State Hershey Medical Center falsely blamed her condition on child abuse, and the state then seized her and her 2-year-old brother, T.R., and sent them to foster homes.

The parents say L.B.'s abdominal CT scan and skeletal surveys revealed 16 rib fractures, but medical evidence that showed no related internal injuries proved these fractures were the result of "weak bones rather than abusive trauma."

They say that despite medical knowledge that Vitamin D deficiency can lead to rickets and weak bones in African Americans, Penn State's Child Safety Team failed to require that L.B.'s blood be tested for abnormal clotting factors or that the child's or mother's blood be tested for vitamin D deficiency.

They add that "no evidence of any injury to L.B.'s spine or any evidence of disruption of her spinal ligaments" was apparent after her stroke, and a report on an MRI exam stated that "thrombosis was a possible explanation."

The parents say, "It is well established in the medical literature that a thrombophilia workup should be performed looking for potential risk factors for clotting when thrombosis is possibility. No such thrombophilia workup was ordered to be performed in 2009 by L.B.'s treating physician or by any member of defendant Penn State's Child Safety Team."

The parents say the Franklin County Office of Children, Youth and Families "has a policy of relying upon doctors affiliated with the American Academy Pediatrics, whose opinions are tainted by a burden shifting medical presumption that the cause of any intracranial injury in a child under the age of one year is caused by abuse unless the parents provide an accidental explanation, to perform the medical investigation into whether injuries suspected to have been caused by child abuse were, in fact, caused by child abuse."

They claim that agents of the Office of Children, Youth and Families, defendants Tammie Lay and Dawn M. Watson, "failed to conduct their own independent non-presumption tainted investigation" and "relied exclusively upon the conclusion of defendant Penn State's Child Safety Team and defendants [Drs. Mark S.] Dias, [Kathryn R.] Crowell and [Arabinda K.] Choudhary that L.B.'s intracranial hemorrhages were caused by abuse on the afternoon of October 19, 2009 and rib fractures were caused by abuse 4 to 8 weeks prior to her hospitalization without conducting any independent medical review or confirmation of their own."

The complaint continues: "On October 21, 2009, eight days before Jamel was arrested, defendant [Lauren] Sulcove emailed defendant Dias to introduce herself as the prosecutor that would be handling the case against Jamel."

Sulcove, an assistant prosecutor, worked for defendant Franklin County District Attorney Matthew Fogel, according to the complaint, which continues: "On October 28, 2009, with reckless indifference to the truth and the Billups' family civil rights, defendant Crowell issued a report on Penn State letterhead falsely concluding that L.B.'s childhood stroke and 16 rib fractures without internal injuries were caused by abuse. Defendant Crowell's report stated that L.B. 'does not have any evidence of coagulopathy or bleeding disorder' and concluded that 16 anterior rib fractures without any associated internal injuries 'occurred as a previous incident of inflicted trauma' concluding that 'this is a clinical picture of inflicted trauma' of 'some event ... likely a short time before [L.B.] had difficulty breathing'." (Brackets and ellipsis in complaint.)

After the report was issued, Jamel Billups was charged with felony aggravated assault and endangering the welfare of a child.

The parents say: "As soon as Jamel learned of the issuance of the arrest warrant on the day it was issued, October 29, 2009, he immediately and voluntarily reported to the Chambersburg police station and was taken into custody. The court set a $200,000.00 straight bail for Jamel, a bail that the Billups' family could not post. Jamel's remained in jail from October 29, 2009 until December 17, 2010, when a jury acquitted Jamel of all criminal charges."

According to the complaint, "Penn State created a Child Safety Team on September 1, 2009 for the express purpose, inter alia, of investigating whether injuries reported as suspicious for child abuse were, in fact, caused by child abuse. Penn State has a discriminatory policy that lends the full faith and credit of Penn State to employees who testify for the Commonwealth of Pennsylvania in criminal prosecutions, for the Commonwealth's county child protection agencies in dependency proceedings and Childline expunction hearings but denies the same full faith and credit of the Penn State Hershey Medical Center to those employees who testify for the accused parents."

Penn State, according to the complaint, received "a 2.8 million dollar grant from the United States Center for Disease Control (CDC) for educating parents about shaken baby syndrome."

Defendant Dr. Mark Dias, co-director of the Penn State Child Safety Team, is a neurosurgeon, a Fellow of the American Academy of Pediatrics, and "holds himself out as an expert in child abuse who can determine whether an injury was caused by abuse and frequently testifies with the full faith and credit of Penn State for the prosecution in criminal cases," according to the complaint.

"In 2010, defendant Dias wrote a chapter of a book about child abuse entitled 'The Case for Shaking'." It was Defendant Dias' published efforts that enabled Penn State to receive the CDC 2.8 million dollar grant to 'educate' parents about shaken baby syndrome."

While Dias was never L.B.'s treating physician or surgeon, the parents say that Dias "attributed L.B.'s venous childhood stroke to a congenital anomaly (an anatomic impossibility) and with reckless indifference to the truth wrote a report rendering the false conclusion that L.B.'s injuries were caused by abuse on Penn State letterhead, testified at Jamel's criminal trial that defendant Dias was a professor at Penn State and, upon belief, was paid by, and enjoyed the liability insurance, of Penn State when he participated in the investigation of whether L.B.'s injuries were caused by abuse and testified at Jamel's criminal trial." (Parentheses in complaint.)

The parents add that Dr. Crowell, a member of the Penn State Child Safety Team, "qualified as an expert in child abuse for the first time in her life at the dependency hearing for L.B. and T.R on December 18, 2009. Defendant Crowell was qualified as an expert in child abuse for the second time in her life at Jamel's preliminary criminal hearing on December 28, 2009. Dr. Crowell acknowledged under oath at Jamel's criminal trial that she misrepresented medical evidence critical to L.B.'s case when she testified at Jamel's preliminary hearing."

Thirty paragraphs later, the parents say that Dr. Crowell "testified falsely that L.B. had 'an extensive screening' for 'coagulation problems' and 'an extensive screening for bleeding disorders' that were 'normal' and that L.B.'s 'metabolic workup was normal.'"

The parents add that Crowell testified, erroneously, that the child's rib injuries "were on the posterior side," but that "Contrary to Crowell's testimony, no Penn State radiologist ever reported that any of L.B.'s rib findings were posterior."

Rib injuries in true child abuse cases are "typically lateral or posterior," according to the complaint.

The complaint adds: "Posterior rib fractures have been considered by proponents of the shaken baby syndrome hypothesis as pathognomonic, or having a virtual 100 percent predictive diagnostic value, of the diagnosis of abuse in the medical literature. Whether L.B.'s rib fractures were located posterior, in the back near the spinal column, or anterior in the front, as was L.B.'s rib findings, has been considered by proponents of shaken baby syndrome as critical to making conclusion of child abuse."

The parents say that Crowell was also "paid by, and enjoyed the liability insurance, of Penn State" and was never their daughter's treating physician.

Defendant Dr. Arabinda Choudhary, another member of the Penn State Child Safety Team, "was not board certified by the American Board of Radiology nor does he possess any certificates of additional qualifications in pediatric radiology or neuro-radiology," according to the complaint. The parents say that Dr. Choudhary, "with reckless indifference to the truth, changed his initial diagnosis of L.B.'s venous stroke from possible thrombosis to the anatomically impossible diagnosis of a congenital/developmental anomaly."

Choudhary also was "paid by, and enjoyed the liability insurance, of Penn State" and was never their daughter's treating physician, the parents say.

The chairwoman of Penn State's Radiology Department, defendant Dr. Kathleen D. Eggli, "just before the scheduled criminal trial of Jamel ... implemented a new policy in the radiology department in which defendant Eggli selectively imposed restrictions on a Penn State radiologist who was sought out for a second opinion by the Billups family and rendered an opinion different than that of the Penn State Child Safety Team," the complaint states. "The restrictions imposed on this doctor who was willing to testify for the Billups family were not imposed on the Penn State radiologist who testified for the prosecution, defendant Choudhary, or on any other doctor at Penn State who testified for the prosecution. The restrictions included a prohibition on communicating the doctor's faculty appointment as an assistant professor of radiology at Penn State, denial of liability insurance from Penn State and a prohibition on the use of Penn State logo and letterhead, all prohibitions that were not applied to Defendants Dias, Crowell or Choudhary during their investigation and testimony on behalf of the prosecution and county children and youth agency."

The district attorney and assistant district attorney of Franklin County, Matthew Fogel and Lauren Sulcove, are also named as defendants. Sulcove is "sued solely in her role of investigating the false allegations of abuse prior to the arrest of Jamel." According to the complaint, "Pennsylvania law mandated that Defendant Fogel convene an investigative team upon the report of L.B.'s suspected abuse in October of 2009 to avoid duplication of fact-finding efforts with such team consisting of a minimum of a health care provider, county caseworker and law enforcement official. Defendant Sulcove led and/or was a member of the team and either followed the policy of the District Attorney's office to exclusively rely upon doctors affiliated with the American Academy of Pediatrics to make conclusions about whether suspected child abuse was, in fact, child abuse or defendant Sulcove individually failed to ensure that the investigation into allegations of abuse against Jamel was not tainted with the burden shifting medical presumption of doctors affiliated with the American Academy of Pediatrics."

Also sued is William C. Frisby Jr., an employee of the defendant Borough of Chambersburg. "Frisby was the detective assigned to investigate the allegations of abuse against Jamel and is sued solely in his role of investigating the allegations against Jamel. Defendant Frisby either followed the policy of defendant Chambersburg to rely upon doctors affiliated with the American Academy of Pediatrics for child abuse investigations or defendant Frisby individually failed to ensure that the investigation into allegations of abuse against Jamel was not tainted with the burden shifting medical presumption of doctors affiliated with the American Academy of Pediatrics."

The parents say that even after Jamel was acquitted of criminal charges, "FCCYS agents Kari Coccagna and Minnie Tuner threatened to immediately send the police to forcibly remove T.R. and L.B. from Jamel and Jackie if Jamel and Jackie did not agree to a 'voluntary' safety plan. The 'voluntary' safety plan required that Jamel 'agree' that he would not be alone with his children and required Jackie and Jamel to 'agree' to unannounced visits from employees of defendant FCCYS or suffer the immediate removal of their children from their care by the police. At all times relevant to this complaint, defendant Franklin County and defendant FCCYS had a policy of using safety plans as voluntary placement agreements and extending those agreements beyond 30 days in violation of 55 Pa. Code §3130.65. Defendants Franklin County, FCCYS, Coccagna and Tuner extended the voluntary placement agreement beyond 30 days without obtaining a court order in violation of Pennsylvania law and Jamel's and Jackie's right to due process pursuant to Franklin County and FCCYS policy or, in the alternative, defendants Coccagna and Watson violated the due process protection provided in 55 Pa. Code §3130.65 and failed to obtain a court order to extend the 'voluntary' safety plan beyond 30 days on their own."

The parents add: "On June 18, 2011, FCCYS closed its case with the Billups family and terminated the 'voluntary' safety plan."

The parents and their children seek punitive damages for reckless indifference to civil rights, due process violations, negligence, failure to train, extending voluntary placement agreements beyond 30 days, unconstitutionally favoring expert witnesses for the prosecution and disadvantaging expert witnesses for the defendants, and for the 414 days that Jamel was jailed for a crime he did not commit.

They are represented by Mark Freeman of Media, Pa.


Fractured Leg, Fractured Family: A Misdiagnosis Leads to Allegations of Child Abuse

Written by: Ryan Schill on Oct 3, 2011

When Anthony Richards, Jr., was born on an early Sunday morning in June, the only complications involved his family getting the cameras in focus to capture his arrival into the world. He was a healthy baby and his parents, Queenyona Boyd and Anthony Richards, Sr., couldn’t have been happier. Yet, only four days later Anthony was put in foster care after doctors discovered an unexplained broken femur, his distraught parents the suspects of child abuse.

A Protective Father’s Discovery

After the hospital discharged Boyd and her baby boy, Richards took the two straight home later that Sunday. The following day, Boyd slipped out to pick up her prescriptions at a pharmacy only a short drive away. She wasn’t gone long when she received a phone call from her husband. Something was wrong with Anthony.

Although Boyd had a daughter already, Richards was a first-time dad. And like many first-time dads he was protective to a fault and he worried, maybe a little too much. So when he found a lump on Anthony’s leg while changing a diaper, he grew concerned.

“Did you notice his leg has some swelling?” he asked Boyd.

“Is it where he got the hepatitis B vaccine?” she asked. Richards said it was. Boyd wasn’t worried. Swelling around inoculations is normal, she thought. But she came home just in case.

Her husband wasn’t convinced the swelling was from the vaccine so he called his sister, a nurse. She told them to put warm compresses on the leg and massage the swollen area. Baby Anthony never cried while his parents followed the nurse’s advice. He even fell asleep.

Anthony was due for his three-day check-up with the pediatrician on Wednesday, but his parents moved it up to Tuesday as a precaution. The swelling was still present despite their efforts.

At the check-up, the pediatrician gave Anthony a clean bill of health. The only problem he saw was the swelling on the baby’s leg. He referred them to the emergency room at Children’s Health Care of Atlanta’s (CHOA) Egleston hospital in metro Atlanta. (A spokesperson for CHOA declined to comment for this story citing patient privacy concerns.)

In the ER, the doctor looked Anthony over and said that he thought the swelling could be a result of the hepatitis B injection missing the muscle. Swelling like Anthony had is not uncommon if the injection is mistakenly delivered subcutaneously. The doctor ordered X-rays and an ultrasound to be sure. Through it all, Anthony didn’t cry except when they were changing his diaper and Boyd suspected this was because Anthony had been circumcised Sunday.

First, they X-rayed Anthony’s leg. While the images were developing they took Anthony for the ultrasound, but just before they were to begin, the X-ray technician rushed into the room.

“Stop the ultrasound,” she said. “There’s a break.”

That’s when everything changed for Anthony’s parents.

The Science of Misdiagnosis of Child Abuse

In a recent report, the federal Administration on Children, Youth and Families estimated that 702,000 children were victims of maltreatment in 2009. That’s the equivalent of nine abused children for every 1000 in the population. But the report also says that only one in five investigations of abuse are substantiated. The rest, 80 percent, are cases in which the children are “found to be non-victims of maltreatment.”

What is not counted in the study is the number of investigations leading to deprivation (the state taking the child from the parents and placing them in foster care) before the parents are ultimately cleared of abuse. No one knows how many incidences of misdiagnosis occur each year. But one Child Welfare Law Specialist from Atlanta, Diana Rugh Johnson (who would eventually represent Boyd and Anthony) says she has brought six cases of misdiagnosis to trial in the last two years.

“Once a child abuse expert says there has been child abuse, that’s not the end of the investigation,” she said. “It’s the beginning.”

Experts must determine whether an injury is the result of trauma or was accidental or natural. But once a child abuse expert makes a determination of abuse, says Dr. Julie Mack, professor of radiology at Hershey Medical Center in Pennsylvania, it becomes very difficult to change the tenor of the conversation.

“The problem,” Mack wrote in an email, “is with the assumption of trauma — it becomes the default diagnosis, the one that is assumed as most likely. This is a dangerous assumption for the patient (who may have an underlying medical disease) and for the parents (who will appropriately deny trauma if none existent).”

In her cases, Johnson has found the same thing. She relies on out-of-state medical experts because she often cannot find a doctor locally who would publicly disagree with CHOA’s child abuse expert.

“Once [the child abuse expert] says it’s child abuse, everyone else shuts up,” she wrote.

But in infants especially, Mack wrote, “it is not appropriate to assume trauma is the most likely diagnosis, particularly in the absence of outward evidence of trauma.” Although, she adds, no physician she knows believes child abuse is not a reality. “Children are abused by their parents,” she wrote. Because of that, it is important to work hard to find the correct diagnosis.

“Fractures in the absence of history of significant trauma,” she wrote, “are also a characteristic feature of fractures caused by bone diseases such as osteogenesis imperfecta, bone disease of prematurity, and bone disease associated with vitamin deficiencies (rickets).”

Often cited as a contributing factor is rickets, a disorder that causes weak or soft bones. Rickets is often caused by a deficiency of vitamin D and in many cases a vitamin D deficiency in the mother will lead to the same deficiency in their newborn. But vitamin D deficiency may be hard to diagnose.

In a commentary in the journal Pediatrics, Dr. Colin Patterson of the University of Dundee, Scotland, writes that one difficulty in the diagnosis of vitamin D deficiency, “is that the radiologic signs may be absent or unimpressive in cases of children with biochemically severe deficiency, which is particularly true of infants younger than one year.”

The conundrum, Mack says, occurs in an infant with fractures. “If a child presents with multiple fractures, but no clinical history or signs of trauma, ‘hidden’ (abusive) forceful trauma is often assumed,” she said. “The logic used is ‘abuse is present because the parents have failed to explain the fractures.’”

Queenyana Boyd struggled with a vitamin D deficiency throughout her pregnancy with Anthony.

“Are you here to take my child away?”

Boyd and Richards were in shock. How could Anthony’s leg be broken? You must have the wrong family, they told the X-ray tech. They had brought the newborn to the hospital because of complications from a vaccination. But the tech confirmed their details. It was true; Anthony had a broken leg.

When Boyd and her husband returned to their room in the ER, the doctor and a social worker met them. The doctor spoke first.

“I’m sorry,” he said. “I should have asked you if you could have dropped Anthony or if he could have fallen.”

Absolutely not, Boyd and Richards told him. The social worker spoke up wanting to know what happened, so Boyd told them both the story, from the moment her husband discovered the swelling to when they arrived at the ER.

Richards’ eyes were tearing up. “Are you here to take my child away?” he asked the social worker. Boyd refused to believe that. They’d done nothing wrong.

“Well,” the social worker said, “we’re going to have to admit him to the hospital and do further tests.”

No one took their son that day. In fact, Boyd and Richards were allowed to stay in the hospital with Anthony, often alone in their room with the door closed, while Anthony was breastfed.

A caseworker from Georgia’s Child Protective Services (CPS) arrived later that day and began interviewing Anthony’s family. He spoke with Boyd and Richards, Boyd’s 7-year-old daughter Anya, Boyd’s sister and Richards’ mother, who had flown in after the birth. He also interviewed the nurses who had treated Anthony in the hospital. No one had a negative thing to say. The caseworker even told Boyd that her Anya was very happy and showed no signs of abuse. (Repeated calls to CPS were not returned.)

Boyd then asked the caseworker to contact Anthony’s pediatrician. She was told he would get to that later. He then explained to Boyd and Richards they needed to meet with a representative from the hospital’s child protection division. In the meantime, doctors continued to run tests on baby Anthony.

The next morning, the couple arrived for the interview with the child protection division. Once again they told the story of finding the swollen leg and how they had wound up in an interview with protective services. The representative said that she saw no indications of abuse; the break looked like “one of those things that happens.” Boyd agreed. She was also struggling to pinpoint when or how the leg could have broken.

Following the interview, a doctor from the child protection division spent a few minutes examining Anthony. He told the parents that Anthony appeared to be completely healthy, save for the broken leg.

Boyd and Richards were beginning to feel a little relief. They felt that if the hospital or CPS truly suspected abuse they would have contacted the police by now. At this point, it had been more than a day since the break was discovered. Boyd and Richards had been left alone with Anthony on multiple occasions. No one involved in the case had indicated seeing any signs of abuse. But as the day wore on, the couple began to worry. Although it was true no one had said their case looked like abuse, no one had told them they were cleared either. The pair repeatedly called the CPS caseworker asking for information but they never received any.

That evening, the CPS caseworker walked into their hospital room with a security officer. “I’m sorry,” he said, “but I have to take your son into custody.”

With those words Boyd felt the air go out of her. “Why?” she managed to ask. “Why are you taking our son?”

The caseworker explained that the report from the child protection division doctor who had examined Anthony concluded the break was non-accidental and to investigate possible child abuse.

“There’s nothing we can do,” he told her.

Boyd pleaded with the caseworker, asking if her sister could take Anthony rather than placing him in foster care. She was told that was impossible. He had no choice but to put Anthony in foster care. As CPS took her son away, Boyd felt like Anthony was being kidnapped. She had no idea where her son was — CPS wouldn’t tell her — and she had no way of continuing to breastfeed him. Boyd wouldn’t learn where her child was for five more days.

How Big a Problem?

Misdiagnosis of child abuse occurs, especially in infants. It is the word of the parents against the medical opinion of the doctor who examines the child. But is it a growing problem?

“I think it has been a problem since the 1990s or maybe a little earlier -– we just didn’t know it,” Seattle attorney Heather Kirkwood said. “In the past decade, it has begun to spiral, I think . . . one of those pendulums that swings too far and is due for correction. [The same thing] happened in antitrust, too, just not with such disastrous consequences. Here, I suspect that we are looking at hundreds to thousands of destroyed families and falsely imprisoned parents and caretakers.”

Kirkwood has handled a number of high profile cases of misdiagnosed child abuse. Her cases have been written about in The New York Times and The Chicago Tribune. Others were featured on the PBS documentary series, Frontline, as well as on NPR and ProPublica.

According to Kirkwood, many misdiagnoses originate “simply because we don’t know (or in some cases have forgotten) how to diagnose vitamin D deficiency (rickets), vitamin C deficiency (scurvy), etc.”

“Often the key to the diagnosis,” she said, “is that the child has no bruises, no pain and the ‘fractures’ are self-curing — with good nutrition, the bones will develop normally without any other intervention. Not, in short, your typical fracture picture.”

The first step for Kirkwood when investigating is to do a retrospective diagnosis.

“In that stage,” she said, “I work with experts and read the literature to see how the medical findings fit together, both within the disciplines and with the clinical history. Sometimes it takes quite a few tries before we begin to put the entire picture together.”

Over time, in what is an evolving process, she has learned what to look for.

“When I first began to review cases,” she said, “I assumed that one fracture might be accidental but that multiple fractures without a major accident must be abusive.”

As she examined more cases, however, she began to conclude “that in cases in which the baby has no bruises or signs of abuse and otherwise seems well cared for, the opposite is true: the more fractures there are, the more likely it is that we are looking at some type of metabolic bone disease.”

And rickets often leads to fractures. Patterson, in his commentary in Pediatrics, writes, “In a recent retrospective study, fractures were found in seven of 40 children younger than 24 months with overt radiologic evidence of rickets.”

A Mother’s anguish

It was Wednesday evening. Boyd’s son had been placed in foster care earlier in the day. She was distraught and couldn’t understand why CPS wouldn’t let Anthony go with a family member. She called her aunt who had been in the delivery room when Anthony was born.

She was feeling hysterical and needed to talk to someone she trusted who would calm her down. While on the phone, her aunt began flipping through the pictures she’d taken at the delivery. And that’s when — in the middle of the conversation — Boyd’s aunt made a startling discovery that would further alter the course of events.

“I’m going to send you a picture,” her aunt said. “Did you see your son’s leg?”

Boyd’s aunt immediately emailed the camera phone picture to her. Boyd looked at the photograph, taken moments after delivery before the umbilical cord was cut; Anthony’s leg was already swollen in the photo. Boyd searched her own pictures for a higher resolution picture and found another that showed Anthony’s leg was swollen at birth. She discovered a picture on her camera taken at nearly the same moment as her aunt’s picture. It two appeared to show swelling on Anthony’s leg.

If the leg was broken before Boyd had even held her baby — and the swollen leg in the photos would seem to indicate that — CPS had no case. This was all the evidence she needed, Boyd thought. She emailed the photos to CPS the same night and asked that they be shown to the doctor at the child protective division at CHOA hospital. She never heard back.

Outraged at CPS for not communicating with her and impatient for the first hearing Monday (delayed until after the weekend because of a state furlough day on Friday), Boyd enlisted the help of Johnson. When shown the photos from the delivery, Johnson was astonished.

“The leg looked completely messed up,” she said later.

A mandatory “72-hour” hearing was held Monday to determine if further foster care was necessary for Anthony. The judge granted Boyd and Richards’ daily visitation rights with their son. They could spend three hours a day with him, but they weren’t allowed to bring him home yet. The judge scheduled an ad judicatory hearing for nearly three weeks later.

Adjudication is similar to a trial, but the judge makes the final ruling without a jury’s involvement. In this case, the judge would decide if the allegations of child abuse were true. The hearing lasted five hours. The prosecutor argued that Anthony must have been abused, as there was no other explanation for the broken femur. Both the CHOA hospital child protective division doctor and the obstetrician from Anthony’s delivery testified that the kind of break that Anthony had could not have happened at delivery. They were too rare.

Johnson brought in Dr. Julie Mack, a medical expert from Lancaster, Pa., who countered that claim. Mack had research that showed numerous similar cases. In nearly every one, the break wasn’t diagnosed until days later, even if the baby never left the hospital. She also compared the photos from the delivery with Anthony’s X-rays, showing that the swollen area in the picture was where the break was in the X-ray.

The judge ruled for Boyd and Richards. Anthony could finally come home with his parents.

While she is overjoyed to have her son back, the experience has left Boyd scared and upset. She worries every time she has to take Anthony to the pediatrician. She’d done nothing wrong when she took Anthony in with the swollen leg. In fact, she did everything right. But CPS took her child anyway. Boyd felt as if she were guilty until proven innocent. Until CPS said otherwise, she was an abusive parent.

Anthony was later diagnosed with a vitamin D deficiency, likely inherited from his mother. However, he was never tested during the abuse investigation and has not, to date, been diagnosed with rickets.


New Md. Child Neglect Law Could Have Big Impact

By: Matt Bush // October 3, 2011

On October 1, Maryland became the last state in the country to make child neglect a crime -- in this case, a misdemeanor offense punishable by up to five years in prison.

At the Baltimore Child Abuse Center, painted butterflies decorate the walls. They're one of the many ways the center tries to be a bright place, because many of the stories told in here are anything but. Children suspected of being abused come here to be interviewed, as authorities believe it is easier for them to talk in a place like this than a police station.

"A child is able to be a child when they're here," says Adam Rosenberg, BCAC's executive director. "And they can go from being a victim back to being a child."

Each child who comes to the center gets to decorate a butterfly. Rosenberg says that, unfortunately, those butterflies cover all the walls of the four-story building -- as many as 887 just in 2010.

Many of those interviewed at the center were not abused, just neglected, and that's something Rosenberg says they couldn't do much worth before the signing of the new child neglect law. Previously their only recourse was to make a referral to child protective services.

"For years, Maryland has had a neglect statute for vulnerable adults and animals, but not children," says lieutenant governor Anthony Brown, saying that it was a major oversight that they were eager to correct.

The general assembly approved the law earlier this year, after bills seeking the measure were defeated the previous three years. One of many reasons for that was concern the law was too broad.

Brown says disagrees: "We're not intending to prosecute parents or guardians who are unable to sufficiently take care of their children due to an involuntary condition such as poverty or homelessness."

One of the hopes Adam Rosenberg has for the law is that people who see child neglect may feel more inclined to report it.

"We're only as successful as people who report abuse," says Rosenberg. "We're not going to find this on our own. And, this battle against child abuse and neglect is something that folks like me and you in our private lives need to be able to take a stand, and pick up a phone and report that they see something."

Last year, Maryland's child protective services received more than 14,000 reports of suspected child neglect, and confirmed more than 4,000 of them.


Sunday, October 2, 2011

Should negligent child welfare workers spend time behind bars?

Here's an interesting article on the Children and Law Blog

We think that CPS workers should be held accountable when they are negligent or they are incompetent.

How do you think?

State’s child, family welfare reforms collapse

by George Lauby (North Platte Bulletin) - 10/1/2011

First, three top private companies backed out of their deals to provide child and family welfare services in Nebraska.

Second, the Nebraska State Auditor found severe financial problems with the two-year-old “privatized” program.

Third, the man at the top resigned.

That was how a sweeping state welfare reform collapsed in just two years.

Director Todd Reckling announced his resignation one week after a state audit of the program’s finances reported serious problems.

Reckling, 44, said he is resigning for health reasons effective Oct. 14. Already thin, he had been losing weight, coworkers told an Omaha news reporter.

Reckling was in charge of Nebraska’s controversial child welfare privatization, which put the child welfare system in the hands of five privately-owned "lead" agencies.

The system-wide reform was aimed at decreasing the Nebraska Department of Health and Human Services’s hand, while allowing the department to retain oversight.

The idea was capitalism and competition, with government supervision, would drive costs down while ensuring the quality of care stayed high.

It never worked in most of Nebraska.

Early on, trouble appeared. Only one company applied to lead the programs in central and western Nebraska, so there was no competition.

Small-scale group homes for vulnerable children were closed in western and central Nebraska, such as the Alliance Boys Ranch, North Platte’s Boy’s and Girl’s Home and two Salvation Army group homes.

When the North Platte group homes closed, employees told the Bulletin that the program was taking a giant step backward -- eliminating existing programs and moving already alienated children to new and strange places.

Officials, including Reckling, were reassuring. When the Salvation Army homes closed, officials said children would be cared for in an expanded Boys and Girls Home in North Platte, or in Cedars Home near Broken Bow.

But those homes closed too.

Big scale

In contrast to small group homes, the Nebraska division of children and family services is a large unit -- employing more than 1,800 people.

It is the largest of six state health and human services divisions, including not only child welfare and juvenile services, but also adult protective services, economic assistance/welfare programs, the refugee program and child support enforcement activities.

As the privatization got underway, Reckling signed contracts with five large companies in 2009 to oversee those programs. The state program came to be called “Families Matter.”

The program suffered an astonishing drop out rate at the top level. By October 2010, three of the five lead companies had withdrawn, including the agency handling all of central and western Nebraska, the Boys and Girls Home.

Prompted by complaints, Nebraska State Auditors investigated the Families Matter program during the summer, and released their findings Sept. 7.

They found the costs of the program had gone up 27 percent in two years, with millions of dollars improperly accounted. At the same time, the top agencies said they didn’t have enough money to operate.

The audit made headlines all over the state. Democrats pointed blame at Gov. Dave Heineman, who made no comment for several days. But eight days after the audit was released, Reckling announced his resignation and Heineman spoke.

Heineman said the state will continue trying to privatize Nebraska's child welfare system, but must do better.

"I want to help our children and families, but this reform effort has not been easy to implement,” he said in a news conference. “We can and we must do better.”

"I believe in accountability, so I'm not going to make excuses for what has occurred. I expect better results and I expect them soon," he said.

Heineman expressed special disappointment with Boys and Girls Home of Sioux City, Iowa, which failed to pay subcontractors after it dropped out of the program last October.

Boys and Girls Home was in charge of central and western Nebraska, including North Platte.

Heineman said BGH’s failure to pay its bills was "irresponsible and very disappointing."

And he compared the failure to a bad performance on the football field.

"I think we have the right idea, but we've got to execute it better,” Heineman said. “It's like a football team. If you don't execute the play, you don't score a touchdown. Well, we've lost a lot of yards here lately because we're not executing as well as we should have. But I still believe we can make this work."


When the BGH pulled out, local providers scrambled to come up with alternatives. The North Platte School District created an educational program for students in grades 6-12 during the school year, hiring a teacher and an aide and setting up a classroom at the high school.

The county sheriff made plans to transport kids across the state to the nearest place, in Columbus.

In June, Family Skill Building Services re-opened one of the Salvation Army homes that had been closed during the reshuffling and now operates the Nebraska Youth Center, a home for about a dozen boys on the north side of town.

Not in these parts

Sen. Tom Hansen of North Platte said privatization shouldn’t be tried again now in central and western Nebraska, and never have been tried throughout the state in the first place.

“It probably should have been done on a smaller level (in southeastern Nebraska). Out here, we don’t have a lot of providers,” Hansen said. “Out here, Boys and Girls Home was the only bidder for lead agency. Looking back, that was a clue that we had a problem.”


It seems logical that the Boys and Girls Home building on 2300 E. Second might reopen for vulnerable children under better management, but the price of the empty building is too high, Hansen said. The Boys and Girls Home, Inc. inherited the building, and is now asking $1 million for it, even though its taxable value is about $400,000.

Among the financial scandals, as private agencies failed to deliver and collapsed, foster parents were not paid or were underpaid, especially those with children with special needs, Hansen said.

Foster parents dropped out in droves. For example, the number of foster homes in Dawson County dwindled from 45 to 11, according to the Legislature’s Health and Human Services Committee.

“There are lots of upset foster parents,” Hansen said. “These are wards of the state. The state needs to take responsibility.”

State auditors also found that some subcontractors – smaller companies with workers on the front lines – hired workers with no experience or education and paid them around $10 an hour.

However, the subcontractors turned around and billed the state $47 an hour for the work.

Staggering along

How it is all reformed will “depend on what the governor wants to do,” Hansen said, but he and some other senators think the HHS child and family division should be separated from the overall HHS department, so authorities can keep better watch.

Auditors complained of their struggle to get facts and figures from HHS, even though state law explicitly requires state departments to open their books for a public audit.

Hansen has often experienced the same problems -- it is difficult for legislators to study the HHS operation, even a legislator such as Hansen on the health and human services or appropriations committees, which have the duty to oversee the HHS.

Hansen said breaking up the Health and Human Services department would make it more transparent.

“As legislators, we don’t think we’re being very accountable,” he said.

Local critics

Counselors, clients, parents and foster parents have long expressed dissatisfaction with HHS services.

Ongoing dissatisfaction led them to go to lengths to arrange a meeting in early August with Todd Reckling and other state officials.

Lisa Zlomke of North Platte’s Aurora Counseling and Jenny Olson of Liberty House in North Platte attended. The meeting was arranged by Melanie Williams-Smotherman, the owner of Family Advocacy Movement, headquartered in Lincoln.

The meeting lasted three-and-a-half hours, and “we had the ability to share examples of specific cases to illustrate points and to show three short videos during that time, including two regarding the harmful practice of drugging foster care children - which is becoming quite routine,” Williams-Smotherman said afterwards.

At the meeting, Williams-Smotherman said the number of Nebraska children taken from parents and put into the foster care and group home system is too high.

Most of those cases do not involve abuse, she said, but rather alleged neglect, she said.

Richard Wexler of the National Coalition for Child Protection Reform in Alexandria, Va. also says that too many children are taken from too many homes in the state.

According to the organization’s numbers, Nebraska removed 3,373 children from their natural homes last year. That’s nearly 7.5 of every 1,000 children, based on 2009 population numbers.

The national average is 3.4 per 1,000.

The only state that rates higher than Nebraska, according to Wexler, is West Virginia with a rate of 7.7.

Zlomke and Olson also said that HHS officials in the North Platte region do not contract services with private companies such as theirs.

Zlomke and Olson allege that Region II officials keep welfare recipients – particularly those with mental and behavioral disabilities -- in a tight circle of select caregivers who really don’t have any competition, don’t do a good job, but are well paid.