July 28, 2007 in City

Boy’s doctor missed abuse

Thomas Clouse Staff writer
 
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The family doctor who treated Tyler DeLeon didn’t recognize or report the pattern of abuse that killed him, according to a state investigation released last month.

Child Protective Services investigators concluded that Dr. David Fregeau — in addition to Tyler’s adoptive mother, Carole DeLeon, and the state itself — failed to protect the boy as he starved.

Carole DeLeon, 52, recently was sentenced to six years in prison after entering an Alford plea to criminally mistreating Tyler and another boy in her care, Steven Miller.

Fregeau’s role became public last month with the release of the findings of CPS investigators Brett Helling and Ron Stewart, who relied mostly on the agency’s own files.

“Ms. DeLeon was able to mislead well-respected professionals and physicians in her community about the behaviors of the children in her care,” they wrote. “Tyler and (Steven) had numerous injuries that were seen by their physician, Dr. Fregeau.

“All of the children in Ms. DeLeon’s care saw Dr. Fregeau for pediatric care. Four of them, Tyler, Steven, (redacted) and (redacted) dropped below the 5th percentile for weight gain. Dr. Fregeau did not make referrals to (the) Children’s Administration about this disturbing pattern.”

Fregeau, who supervises pediatricians at Sacred Heart Children’s Hospital, did not respond to repeated requests for an interview.

Dr. Robert Block, the immediate past-chairman of the committee on child abuse and neglect for the American Academy of Pediatrics, called the case tragic when contacted this week.

“If I were the chairman of the (Sacred Heart) selection committee, I would be gravely concerned,” Block said.

Officials at Sacred Heart, the region’s only dedicated children’s hospital, refused to answer questions about what they knew about the CPS investigation prior to hiring Fregeau 18 months ago as director of pediatric services. But spokeswoman Patricia Servine issued the following statement:

“Dr. Fregeau has been in Spokane for over 15 years, practicing as a pediatrician. He and all the physicians who provide care for children at Sacred Heart remain committed to providing the very best care possible. What is important is that the entire community is engaged in the reduction and prevention of child abuse.”

The CPS investigators, whose report was made public long after Fregeau was hired, also say the doctor assured the pathologist who performed Tyler’s autopsy that the boy had not been abused

Carole DeLeon, a former paralegal for the U.S Attorney’s Office in Spokane, had been facing up to life in prison on a homicide by abuse charge in which prosecutors alleged she tortured Tyler by withholding food and water. The boy died in January 2005.

However, Stevens County Prosecutor Tim Rasmussen offered DeLeon a plea agreement for lesser charges, mostly because the autopsy showed only dehydration.

Fregeau, who by state law is required to report suspected child abuse to law enforcement or CPS, “told the medical examiner’s office that he had no concerns about Ms. DeLeon’s care of Tyler, which resulted in the medical examiner’s office releasing Tyler’s body before completing more in-depth tests,” the CPS report states.

Tyler’s body was cremated before the pathologist, Dr. Marco Ross, learned of those concerns, which prevented further tests that “may have provided more insight about the cause and manner of Tyler’s death,” the report states.

The embattled Rasmussen, who faced community outrage for accepting a plea bargain for DeLeon, acknowledged that Fregeau’s care played a role in Tyler’s death. But Rasmussen laid most of the blame on CPS case workers DeLeon.

“I think lots of people did let Ty down, starting with the people in the Department of Social and Health Services,” Rasmussen said. “I will not say this happened because it was Dr. Fregeau’s fault. People as individuals failed him, Carole failed him and the system failed him.”

However, Rasmussen sent a statement to The Spokesman-Review the day after he accepted DeLeon’s plea. In it, he blamed the weakness of his criminal case on “assurances made to the medical examiner that abuse was not a consideration.”

Rasmussen confirmed in an interview that those assurances came from Fregeau.

In their report, Stewart and Helling described a meeting they had with medical examiners Ross and Dr. Sally Aiken to discuss Tyler’s autopsy.

Ross and Aiken “claimed they were not aware of the extent of the concerns about Tyler’s treatment before releasing the child’s body because Dr. Fregeau told them that there were no concerns,” the report states.

Tyler’s body was cremated the next day. “Dr. Ross indicated that they would have performed the autopsy differently had they known about Ms. Deleon’s history,” the CPS records state.

Helling and Stewart’s 2005 investigation was the basis of the fatality review by a panel of politicians, a foster parent, a police chief, doctors and other social service officials who released their conclusions in February 2006. Other than Fregeau, the only medical professional CPS investigators criticized in their report was Dr. Sandra Dexter, Tyler’s psychiatrist, who wrote a letter “encouraging people to ignore” Tyler’s behaviors.

“The committee found that Tyler DeLeon’s case was remarkable because there were so many professionals involved with his physical, emotional and psychological care, and no one realized the extent of the peril he was in at his adoptive home,” the fatality review board found.

Stevens County Sheriff’s detectives Fran Lynn and Jerry Taylor interviewed Fregeau on April 11, 2005. When asked whether, in his medical opinion, Tyler was underweight for a 7-year-old, Fregeau responded: “Tyler had a history of being small � below the 5th percentile and he had been worked up for that with X-rays, blood test(s) and was also seen by an endocrinologist.”

Block, a professor and chair of the Pediatrics Department at the University of Oklahoma-Tulsa, said he recently published an article detailing the need for family doctors to search further for causes when they have patients failing to thrive.

Children may not gain weight for a myriad of reasons, including disease, psychological or even social disorders, he said.

“We have to keep an open mind for different reasons. But the real point that is important with this case was there was no consideration that somebody was harming this child,” he said. “This is a tragic case to make this demonstration.”

Seattle attorney Tim Tesh represents the families of seven children who had lived with DeLeon or were removed from her care by CPS. In addition to a total of $55 million in civil claims filed against the state, Tesh sent Fregeau and three other medical professionals notices earlier this year of his intent to file a lawsuit.

Tesh, who said he expects to file the suit against Fregeau in about two months, referred to the records of one of Tyler’s visits in May 1999, when Fregeau treated the 1-year-old for a spiral fracture of his thigh bone. According to the CPS report, Fregeau also noticed bruises all over Tyler’s body.

Fregeau consulted with two other doctors, Dr. Antoine Tomeh and Dr. Timothy Crum, “and all agreed the injuries did not appear to be the result of abuse,” the CPS report states.

Tesh argued that Tyler’s broken leg was a pivotal point in the boy’s troubled history.

“The spiral fracture to his leg was particularly disturbing because it came at a time where so much of his suffering could have been avoided,” Tesh said. “Our complaint will allege that if a competent medical professional would have stepped in at that point and done a thorough investigation, Ty would have been removed from the home.”

Danita Petek, spokeswoman for Sacred Heart Children’s Hospital, said Fregeau was hired 18 months ago from Rockwood Clinic to oversee a team of pediatric doctors. In addition, Fregeau is a hospitalist, which means he cares for child patients at the hospital, such as those from out of state, when their own doctors can’t, Petek said.

CPS records show that in at least two instances, caseworkers asked Fregeau to check injuries on Tyler to determine if they were abuse. In both cases, Fregeau found no abuse.

Tesh, the civil attorney, said it appeared from his reading of the case files that Fregeau didn’t trust state child welfare officials, who in turn were relying on Fregeau to alert them to problems.

Block, the pediatrics professor, doesn’t agree the blame should fall solely on state case workers. “If the baby was failing to thrive, I don’t think a case worker should be responsible for what is otherwise a medical diagnosis,” he said. “That’s a grave error if you don’t trust CPS. If you don’t trust them, work with them to make them better.”

Dr. Naomi Sugar, who works at Seattle’s Harborview Medical Center, was asked by the CPS investigators to review Fregeau’s records concerning Tyler and the other children. Sugar, who coordinates advanced training for medical professionals who provide consultation on child physical and sexual abuse, said through a spokeswoman that she could not comment for this story because of the potential for future litigation.

Sugar, in her review for CPS, noted that the only time Tyler was removed from the DeLeon home was for two weeks in 2003m, when he gained seven pounds.

“The pediatrician, Dr. Fregeau, the child psychiatrist (Dr. Dexter), and the (Family Preservation Services) therapist had very positive impressions of Ms. DeLeon as a parent,” Sugar wrote. “However, professionals at the school and the neighbor friend � show a picture of a parent who engaged in extremely negative attributions to both Steven and Tyler.”

Investigative records include two letters, one from CPS and another from a nurse at Tyler’s school, asking Fregeau if Tyler or Steven should have any restrictions on fluid or food intake, as Carole DeLeon had requested. Rasmussen, the Stevens County prosecutor, said Fregeau never responded.

“Ms. DeLeon did inform medical providers that she needed to keep the boys from drinking too much, and they apparently concurred with her management, although I did not see a recommendation for such management,” Sugar wrote.

According to the reports, Fregeau apparently didn’t realize the extent of the allegations against Carole DeLeon until March 23, 2005, when he met with Helling and Stewart.

They detailed claims in 1988 from DeLeon’s biological son, John, and foster daughter, Mary Shuhart. Shuhart said that when she was 12, DeLeon often tied her hands and left her in the basement for long periods.

Investigators also told Fregeau how DeLeon lied to obtain her foster parent’s license in 1996 and how Steven Miller had gained 18 pounds in four months after he left DeLeon’s home.

Lastly, investigators described how Tyler clawed his way through the screen window in his bedroom the day before he died to get at snow for something to drink.

“Dr. Fregeau said that he was ‘appalled’ by this information and that he supported removal of the remaining children in the home,” the CPS report states.

However, Fregeau told social worker Kathryn Paull a week later he may have reacted too quickly.

“Dr. Fregeau explained that while he still feels that there are lots of red flags and the children needed to be removed, he does not think that Carole intentionally hurt any children in her care,” the CPS records say. “Dr. Fregeau stated that he has known Carole both professionally and personally for eight years and she has even been calling him at home to discuss the current situation.”

Fregeau informed the caseworker that he told DeLeon it was a “problem” that she had lied about her past allegations of abuse, according to the report. “Dr. Fregeau stated that because he is Carole’s doctor, maybe he doesn’t need to know about her past.”


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