Child-neglect deaths fall — as Florida redefines child neglect

When the number of child deaths by abuse and neglect fell dramatically, it looked like Floridians were improving their parenting skills and DCF was doing a better job. But there is another explanation.

05/26/2012 5:00 AM

05/26/2012 4:08 PM

In 2009, 197 Florida children died as a result of abuse or neglect.

The following year, the number fell to 136 — a remarkable drop of 30 percent.

Among kids whose family had a prior history of intervention by child-welfare workers, the improvement was even more dramatic: The death toll fell 40 percent.

Did Florida, a state with a long-troubled child-protection system, dramatically improve its efforts on behalf of at-risk children?

Hardly.

In fact, the Department of Children & Families unilaterally changed the way it tallied child deaths involving neglect.

The new policy, approved in the summer of 2010, significantly narrowed the parameters for what is considered abuse and neglect. The steep decline followed immediately — the first significant reduction in a decade.

However, the new calculation didn’t sit well with several members of the Statewide Child Abuse Death Review Committee. Headed by the state Department of Health, its job is to study child deaths each year in an effort to prevent them in the future. To those critics, the supposed reduction was simply a matter of manipulating data.

A Jacksonville doctor who heads a local death review team blasted the new guidelines in a detailed, six-page 2010 memo, calling them “fatally flawed.”

“These [child-death] investigations are not intended to stigmatize families, but to identify families who may need services to prevent future tragedies involving other children,” wrote Bruce McIntosh, a pediatrician who heads the Department of Health’s Child Protection Team in Jacksonville and serves on a local death-review committee. “They are also essential for identifying epidemiologic risk factors that can be used for education and the prevention of other unintended deaths in the future.”

DCF Secretary David Wilkins, in an interview with The Miami Herald Friday, defended the changes, declaring “We have nothing to hide.”

He said the agency is seeking to be more transparent with state death reviewers this year, partly as a result of ongoing discussions he has had with other members of Gov. Rick Scott’s Children’s Cabinet.

Cabinet members, for instance, have recommended changing state law so that only one state agency evaluates child deaths each year, and stipulating that that group has the authority to investigate every fatality — regardless of whether DCF verifies the death as being the result of parental maltreatment.

Regardless, Wilkins said, he expects DCF to provide statewide death reviewers with records involving all child deaths this year, as members of the team have recommended for several years.“We will make sure that they are looking at a complete set” of death cases, Wilkins said.

So what is a child death involving abuse or neglect?

Two of the most common ways children die in Florida are by drowning in a swimming pool or smothering when they are sleeping in bed with a parent and the parent rolls over. Prior to 2010, those deaths were routinely categorized as abuse or neglect. In many cases, the deaths involved parents who were impaired by alcohol or drugs.

The June 2010 rewrite of DCF procedures dramatically narrowed the definition, essentially saying “a willful act by the caregiver” was required in these instances to constitute neglect.

By way of further explanation, DCF’s top death review coordinator, Keith Perlman, wrote in September 2010 that a child’s drowning should only be considered the result of neglect if the caregiver understood the child was “at risk and, with intent, allowed the child to be placed at risk.”

Perlman also suggested that a child smothered to death by his or her parents in bed has not necessarily died of neglect if the parents’ behavior met a “socially acceptable threshold” — in other words, if other parents place their children in an adult bed at night.

McIntosh, the Jacksonville doctor, took particular issue with Perlman’s claim that investigators must find “intent” to leave a child at risk when a child drowns or is suffocated.

“This proposal,” he wrote, “assumes that a caretaker could credibly claim not to know that it was dangerous to leave a child unsupervised around a body of water.”

Death investigators, McIntosh added, should not consider whether it is “socially acceptable” to place infants in bed with their parents, adding that just because many parents engage in a risky practice “does not make it safe or right.”

“There was a time when parents did not have to buckle their children into car seats, during which time thousands died annually in car accidents,” McIntosh wrote. “Those deaths are now prevented. We are tasked with identifying avoidable death hazards that need to be corrected, not simply accepting the way they are.”

McIntosh added: “Under-reporting and under-verification [of deaths] compromise the validity of the statistics related to child abuse and neglect, make it more difficult to ascertain true progress in combating these problems and, most importantly, defeat efforts to identify causes of preventable death that could be addressed through education, product redesign and legislative regulatory action.”

In a draft of the statewide committee’s annual report, death team members noted that DCF had eliminated more than half of the drowning deaths from 2010 — verifying neglect in 42 of the 91 drownings that were reported to the state. As a result, they stated, the other 48 were never studied and their absence from the sample made it appear as if neglectful drownings had declined dramatically.

In the report language, they used the word “only” in referring to the 42 verified drownings.

That one world — “only” — raised hackles at DCF. Christie Ferris, a member of the committee from DCF, fired off an email on Dec. 30 that said: “The over-use of the word ONLY...implies DCF is under-verifying the reports and/or is not being transparent.”

Another line in the draft report also angered DCF. The agency threatened to vote against release of the report if the full committee refused to delete the line — one that said the dramatic decline in abuse and neglect deaths was owing to DCF “modify[ing] their criteria for verification of certain neglect deaths.”

Ferris, in her email, insisted “no criteria was changed or modified and therefore this is a false statement.” She said the sentence “must be deleted to gain a YES vote from DCF.”

In the end, the sentence was removed as DCF demanded.

Manatee County Sheriff’s Major Connie Shingledecker, who chaired the committee last year, said she supported the concept of achieving consistency throughout the state in the investigation of child deaths: Some regions, she said, considered most drownings a result of neglect, while others required other circumstances, such as the caregiver’s use of drugs or alcohol, as a factor in their poor supervision.

Perlman’s memo, she added, seemed to go too far in excusing poor — and fatal — decisions by parents, unless the parents intended to harm their children.

Both Shingledecker and other team members strongly suspected the reduction in deaths resulted from DCF’s decision to change its criteria. But the denials from Ferris and others prompted her to agree to remove the objectionable language.

“I couldn’t prove it,” Shingledecker told The Herald. “We were told they had not made any changes.”

Going forward, Shingledecker hopes the group will be able to study every case in which a child dies, because such inquiries are the best way to prevent tragedies, she said.

“You never know about the lives you’ve saved,” Shingledecker said. “You only know about the ones you don’t.”

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