Deaths often unreviewed

Outrage erupts every time a child dies by abuse – and the loss of Summer Phelps has been no different.

Since the death of the Spokane 4-year-old last month, cries have come from all quarters: letters to the editor, radio talk shows, even a YouTube post that simply screamed “Murder!”

Community members have demanded to know how such a thing could happen: How did a little girl wind up beaten and tortured in the heart of Spokane? Who was watching out for her? Why did Summer die?

But those seeking quick answers about Summer – and others – likely won’t get them, at least not from the agencies charged with examining and recording child deaths in the Inland Northwest.

Underfunded and overwhelmed, the child death review systems in Washington and Idaho lag behind the rest of the nation, according to officials inside and outside the process.

In Washington, budget cuts, inconsistent reporting and the lack of statewide coordination have eroded what once was a robust program for monitoring about 750 child deaths each year.

“It was a very good system and we could have confidence in what we were looking at,” said Mary Meinig, director of the Office of the Family and Children’s Ombudsman, which conducts its own reviews. “Now we just don’t have that confidence.”

In Idaho, where about 200 children die each year, the review program was dissolved in 2003, making it the only state in the nation that doesn’t attempt to examine what kills its children.

“It just kind of, no pun intended, died a sorry death,” said Vicki DeGeus-Morris, the Canyon County coroner who sat on the panel for five years. “We had a lot of barriers put in front of us.”

That alarms national advocates like Deanne Tilton Durfee, project manager for the Inter-Agency Council on Child Abuse and Neglect – ICAN – the California agency that pioneered child death reviews three decades ago.

The confidential, multi-agency death reviews are often the only way to recognize past causes of child danger and child abuse – and to prevent them in the future, Durfee said.

“With a review, it doesn’t just evaporate into the ether, where people feel bad, then forget about it and move on,” Durfee said. “Unless you maintain that focus and ensure that whatever is preventable generates some action, all you’re doing is making people feel bad.”

But in Washington and Idaho, the lack of statewide death review systems means that focus is blurred, at best. Only 20 of Washington’s 33 counties consistently report circumstances of child deaths to the state Department of Health, after state budget cuts in 2003 eliminated funding for the program, said Beth Siemon, a health services consultant for the DOH maternal child health division.

“We would love to have data from all the counties, but we can’t compel it because we don’t fund it,” she said.

The Children’s Administration program of the state Department of Social and Health Services receives ongoing funding for reviews, but even those are limited, according to a 2005 report from the ombudsman’s office.

Reviews have been conducted in Washington since 1998, but not every child’s death is examined. In fact, fatality reviews are required only for unexpected deaths in which a child had contact with DSHS in the previous year, or when the death occurred in a state-licensed or -contracted program.

Of the 746 child fatalities in Washington in 2004, for example, 136 were reported to the Children’s Administration, according to the most recent report to the state Legislature. Of those, 83 met the requirements for a Child Fatality Review.

Deaths of youngsters under 18 who had no previous contact with child welfare aren’t examined; neither are deaths of children whose cases may be closed or who had no recent referrals.

“We’re missing kids,” said Meinig, of the ombudsman’s office.

Far fewer children receive an Executive Child Fatality Review, an intensive examination convened only at the discretion of the DSHS assistant secretary. In 2005, for instance, only one was performed.

Even with that limited scope, the Child Fatality Review program is about 18 months behind in its analysis of cases presented in the past two years, department records showed.

Legal delays, difficulties gathering documents and finding the people and time to conduct the complicated reviews hinder the process, said Sharon Gilbert, deputy director of field operations for the Children’s Administration.

The same goes for Spokane’s regional Child Death Review Committee, which reviews about 20 local cases a year, coordinator Cathy Fritz said.

“We had one case from 2005 left,” Fritz said in February. “We’re now starting on 2006.”

The delay means it’s taking longer to recognize and remedy dangers that threaten children’s lives. In Spokane, previous child death reviews sparked a 2004 public awareness campaign that focused on Shaken Baby Syndrome, resulting in a drop in deaths from five in two years to none, said Julie Graham, spokeswoman for the Spokane Regional Health District.

In Idaho, the focus on child deaths began in 1997 when the Child Mortality Review Team was formed. The agency produced reviews and reports for four years, ending with 2000, said Shirley Alexander, program manager for the state Department of Health and Welfare. Of the 197 child deaths reported that year, 81 were reviewed by the team.

But the multi-agency panel of pediatricians, coroners, cops and social workers ran into roadblocks. The reviews took too much time. A federal grant that provided $37,000 a year ran out. And some county officials were reluctant to provide necessary death records and other information.

They cited restraints imposed by the 2003 federal Health Insurance Portability and Accountability Act, without understanding that HIPAA specifically exempts child death reviews from privacy rules.

“We had some problems getting coroners’ reports, autopsies, hospital records,” said Alexander, who chaired the review team. “I don’t think we realized what kind of a problem it would be.”

Alexander is working to revive the program, possibly through legislation that could be introduced in the 2008 session.

Sooner would be better, said Dr. Michael Durfee, an advocate who helped his wife found California’s ICAN. He noted that at least 10 infants were killed by homicide in Idaho between 1999 and 2004, according to figures from the National Center for Injury Prevention and Control.

“That’s pretty damn high for a state with a population of only 1 million,” said Durfee.

He planned to contact Gov. Butch Otter’s office to emphasize the urgency of reinstating Idaho’s review process – and making national coverage complete.But Alexander said Idaho advocates recognize the value of restoring the child death review process.

“We know where we’re at; we don’t need anyone to encourage us,” she said.

Not having the program in place for several years is worrisome, Alexander acknowledged. “I think we’ve lost the understanding of whether anything has changed. We’ve lost the ability to understand trends,” she said.

While Idaho is waiting for the state Legislature to help restore its program, Washington officials are looking to a national solution. Department of Health staff members expect this spring to join a multi-state database sponsored by the National Center for Child Death Review in Michigan, said Siemon, a department consultant.

A federal grant would provide funding for participation in the database, which would collect and track information about Washington’s child deaths, Siemon said. That could help ensure a more complete accounting on which to base Child Fatality Reviews, she said.

Still, the state needs to work toward the goal of reviewing all unexpected child deaths, local and national advocates said.

“In the end, it is a system for agencies to do what they should do anyway,” said Michael Durfee of ICAN.

Summer Phelps’ death, allegedly at the hands of her father and stepmother, Jonathan and Adriana Lytle, is a tragedy. But like many high-profile cases, it could become a catalyst for change in the region and across the state, Durfee said.

“You get the streetlights in front of the school after a kid gets hit by a car,” he said.

“When a kid dies, the whole world kind of tips over and stops. And then even people who don’t like each other are willing to do something.”