Is it ‘child neglect’ if you don't buckle your kids up? Doctors, government don't agree

The National Highway Traffic Safety Administration is among the agencies that publishes guidelines and tips for child restraint in cars.
The National Highway Traffic Safety Administration is among the agencies that publishes guidelines and tips for child restraint in cars.

Florida child welfare administrators are deeply at odds with doctors’ groups about one of the most basic aspects of their job: the definition of child neglect.

Pediatricians and emergency room doctors have been critical of a Department of Children & Families policy that allows the agency to routinely decline to investigate child deaths and injuries that result from car wrecks in which youngsters are unrestrained. At least two professional associations went on record last month opposing the policy.

“There is abundant evidence to support that use of seat belts and child restraints in traveling vehicles have significant impact on decreasing fatalities and injuries,” the head of the American Academy of Pediatrics’ Florida chapter wrote in a Feb. 5 letter to DCF Secretary Mike Carroll. “The failure to take such measures meets the definition of neglect when leading to injuries [or] death.”

U.S. Centers for Disease Control and Prevention (CDC) statistics show that more than 700,000 children are referred to child protective agencies as a result of abuse or neglect in the U.S. each year.

Car wrecks are the leading cause of injury deaths among children and young adults aged five to 24, and the second-leading cause of death among youngsters aged one through four, according to the U.S. Centers for Disease Control and Prevention. In 2015, the most recent year for which statistics are available, 149 Florida children died in car crashes. That was up from 121 the year before, according to the Florida Department of Highway Safety and Motor Vehicles. Of those 149, 14 were in Miami-Dade, making it the most deadly in the state.

Randell C. Alexander, a professor of pediatrics at the University of Florida College of Medicine in Jacksonville, said he spoke with Carroll by phone earlier this month about pediatricians’ concerns and is hopeful the talk could spark a new look at DCF’s policy. In the past, “we tried several contacts, and it didn’t get anywhere,” Alexander said. Some months ago, Alexander scheduled a meeting with Carroll to discuss the rule; Carroll failed to show up, Alexander said.

Carroll’s position has been that administrators are free to routinely “screen out” neglect calls involving unrestrained children because the policy is reflected in an agency rule, Alexander said. But, he said, DCF can change its rules at any time. “They just tell us ‘it’s the rule’,” said Alexander, who is chairman of the Florida Chapter of the American Academy of Pediatrics’ Committee on Child Abuse and Injury Prevention.

Jessica K. Sims, a DCF spokeswoman, said the agency accepts for investigation every report that “meets statutory criteria, whether related to child vehicle restraints or not.”

“The department is absolutely committed to protecting every child who may be the subject of caregiver abuse or neglect, no matter how it occurs, and has met with and is actively working with [doctors’ groups] to review this portion of the administrative rule to make any clarifications needed,” Sims said.

“Currently, even though improper restraint in and of itself does not automatically constitute caregiver abuse or neglect, pursuant to rule, seventy percent of reports that mention improper child restraints are screened in for investigation,” Sims said.

Children’s advocates and pediatricians have been lobbying DCF for about a year to count and study the deaths of children who were unrestrained in a car crash. The efforts have intensified in recent months.

Madeline Joseph, a pediatric emergency room doctor in Jacksonville who heads the American Academy of Pediatrics’ Florida chapter, said in her letter that she spoke with Carroll briefly about her organization’s concerns at a Children’s Week Award Dinner.

“As you are aware, the definition of child abuse and neglect includes any recent act or failure to act on the part of a caretaker which results in death, physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminant risk of serious harm,” wrote Joseph, who is chief of the the division of pediatric emergency medicine at the UF College of Medicine–Jacksonville.

Given the overwhelming evidence that seat belts and child restraints save lives, Joseph wrote, “the failure to take such measures meets the definition of neglect when [it leads to ] injuries or death.”

There is no state law governing whether the abuse hotline should investigate child deaths or injuries resulting from a lack of restraints. Florida administrative rules say such deaths or injuries don’t quality as neglect unless a parent was impaired by drugs or alcohol at the time of the wreck. DCF writes the rules.

“We believe that all such situations should be reported to and accepted by the DCF Child Abuse Hot Line — without having to substantiate that the driver of the vehicle was impaired,” Joseph wrote.

DCF has a long history of manipulating data to improve its image. Such efforts make it more difficult to document, study and prevent abuse and neglect.

A 2014 Miami Herald investigation into the deaths of hundreds of Florida children, Innocents Lost, documented a years-long pattern of DCF dramatically under-reporting abuse and neglect deaths to the Florida Legislature, and manipulating the definition of neglect to exclude scores of child deaths from its tally.

Doctors have complained for years, for example, that DCF often will not count as a “neglect death” those incidents in which children drown or are smothered in bed by parents who defy public health warnings not to co-sleep with newborns and infants. DCF has argued that such cases are “tragedies” but not misconduct because parents did not “intend” for their children to die. DCF policy often is to count only those deaths in which a parent was too impaired to act responsibly.

Drownings and smotherings that result from co-sleeping are among the most common causes of child death.

Under state law, doctors, teachers and some other groups are required to report suspected child abuse to the state’s abuse hotline. They’re called “mandatory reporters.”

“The hotline takes every report of suspected abuse or neglect and carefully evaluates the information provided to determine if it meets statutory criteria to be screened in for an investigation,” Sims said. “Under no circumstance does the department request or suggest that anyone should not call the hotline if they believe abuse or neglect may have occurred.”

Some doctors are frustrated that they can be prosecuted for failing to report suspicions of abuse or neglect while DCF often ignores their complaints. Dr. Ronald Renuart, a doctor of osteopathy at Baptist Primary Care in Jacksonville, wrote in a letter to Carroll that it made no sense for DCF to require doctors to report unrestrained child deaths and injuries to the hotline when many of the calls are discarded.

Renuart also noted that, while DCF doesn’t consider it neglectful to drive with an unrestrained child, police and sheriff’s offices typically charge such drivers with a crime. “The failure to properly restrain a child while travelling in a vehicle is considered a form of child abuse, punishable under Florida law,” he wrote.

“There appears to be no rational explanation for not at least accepting the calls and documenting the information provided,” Renuart, who is president of the Florida Osteopathic Medical Association, wrote in a Feb. 5 letter to Carroll. “The opportunities for documentation, intervention and prevention (individually and population-wide) are therefore lost.”

An incident last month stands as a stark reminder of the consequences of leaving small children unrestrained in cars. On Feb. 12, 24-year-old Katrina Bennett was driving her Chevrolet Tahoe on Arlington Road in Jacksonville when her 1-year-old son, Kingston Love, toppled out of the SUV and was run over by a Chevrolet Silverado pickup truck. Kingston survived being run over, but was gravely injured. The tragedy was widely reported in Jacksonville.

Sims confirmed that DCF had “an open investigation into this incident” but declined to discuss it further.