Summer Phelps case prompts state review

Officials for the state program that sent a nurse to Summer Phelps’ home the day she died will meet with Spokane health-care providers next week to review the case.

At issue will be whether changes need to be made in the First Steps program, which sent staff to monitor an 8-month-old baby boy, but not his 4-year-old half-sister, whose bruised and battered body alarmed hospital emergency room workers.

Police said Summer was killed March 10 by her father, Jonathan Lytle, 28, and her stepmother, Adriana Lytle, 32, who remain jailed on charges of homicidal abuse.

“When anything like this happens with any provider, we sit down with the provider to see whether we have some lessons to be learned from this,” said Dr. Nancy Anderson, who oversees the program that provides prenatal and postpartum care to poor women and children.

As it stands now, the nurse who visited the Monroe Street apartment of Jonathan and Adriana Lytle that Saturday would have been there to see the couple’s infant son, Jonny, and would have had no professional reason to inquire about the boy’s older sister, Anderson said.

Although staff members are required by state law to report child abuse, the program directs their attention to providing services to the mother and the infant child, she said.

“We don’t tell them your job is to do a comprehensive family assessment,” said Anderson. “It would not be a requirement for them to ask about other children.”

Court documents indicate that Jonathan Lytle told police he took Summer on a car ride to avoid the visit from the First Steps nurse, who was provided through a contract with Family Home Care and Hospice Corp. of Spokane.

The agency is one of five local First Steps providers who offer maternity support services and infant case management to about 1,800 Spokane County women and children who use Medicaid.

It’s not clear how many times Family Home Care staff members had visited with the Lytle family, or how familiar the staff member was with Summer.

Anderson and the agency’s owner, Michael Nowling, declined to release specific records about the visits, citing an ongoing criminal investigation and privacy concerns.

However, records from another First Steps provider, the Spokane Regional Health District, indicated that Adriana Lytle turned away a public health nurse from that agency in July 2006, after four months of visits.

“Refused service,” reads the staff notation in a visit log obtained by The Spokesman-Review through a public records request.

Julie Graham, a spokeswoman for the health district, said staff members couldn’t comment on the reasons for the refusal.

First Steps is a voluntary program, and it would not have been unusual for clients to terminate services with one provider and then begin with another, Anderson said.

She refused to say when the agency would meet with First Steps providers, including Family Home Care. Graham said a health district calendar indicated that a meeting with Anderson is set for Monday.

The session is not punitive, she noted.

“I don’t have any reason to think at this point that a disciplining action has been planned,” she said.

Instead, participants will talk about general procedures for First Steps providers.

“Should we be doing something else? Should we be doing something differently? Those are the questions we’ll ask ourselves,” said Anderson, who added:

“I don’t know that there’s anything (Family Home Care) could have done differently.”