Saturday, October 14, 2006

Preventable

I practically begged the court referee to take the baby out of the home. Please, I said over the phone, this kid has been abused. The referee disagreed and sent the baby with the parents.

The baby had been admitted at about 6 weeks of age with a couple of rib fractures. It seems he might have had some other fracture but it was a long time ago and I don't remember for sure. Child abuse was number one, two, and three on our list of possible causes. I was a second year resident at the time and dutifully filed a report with Protective Services. The parents weren't too happy with me. I asked the P.S. folks if they wanted me to come to court to testify, but they said no, that wouldn't be necessary.

Later that day I heard the news that the court ordered the child released to his parents, which prompted my phone call to the referee who made the decision. I have to give him credit, at last he took my phone call - but he didn't change his mind.

I think that a big part of the reason this baby went home instead of to foster care was because it was a white, suburban, intact family. There were other kids in the home, I think, with no signs of abuse. If this had been a black baby with a single mom on Medicaid, I can't help but think that things would have been different.

If only they had been. About six weeks later this baby was found dead at home. The medical examiner ruled it a SIDS case, even though one of our hospital pathologists said the baby had a cut frenulum - the thing that holds your tongue to the floor of the mouth - that he said can indicate smothering. Like most pediatricians, I've seen a fair amount of child neglect and abuse, but this stands out as probably the most preventable death I've seen.

A couple of days ago Flea wrote about a family he reported to his state's protective services, and he criticized them for removing the children from the home. Maybe he's right in that case, but I don't know. We are all influenced by our past experiences; I think I'll always be one who's in favor of erring on the side of removing the kids if it's questionable.

7 Comments:

Blogger Flea said...

ND, perhaps you missed the point of my post. The fundamental problem with the Mass. DSS is not that they abscond with children, although that is a problem.

The problem is that they suck.

Our posts tell two sides of the same story

Flea

6:54 AM  
Blogger Kelly said...

I am definately NOT in favor of the Almighty "System" taking children out of the home because someone calls foul. I've heard of these stories: the parents are guilty until proven innocent.

As a parent, that scares me to death. All it takes is one disgruntled neighbor to make up a story and my kids are gone?

That's the type of thing that would happen. And unfortunately, things are not ALWAYS preventable in a society where we'd like to keep our civil liberties in tact.

6:41 PM  
Blogger neonataldoc said...

Flea, I agree that our posts tell two sides of the same story. I just think that our opinions of how quickly to remove children from parents is influenced by past experience. Also, I realize that not all our protective services workers are great - but they do have a very difficult task.

8:27 PM  
Blogger stockingup99 said...

What I took from Flea's Post was that the DSS took the kids, and didn't offer any help to the mom. They should help mom get her act together.

Look what happened to a kid in foster care:

http://yummiesprite.livejournal.com/160285.html

Which is worse, a messy home or ...

11:15 AM  
Anonymous Dianne said...

This is going to be a very messy comment, because in effect I agree with everyone and disagree with everyone...

It's a very difficult problem. Taking a child from its parents is a huge decision and ought not to be made lightly. On the other hand, clearly, some children are in danger from parents who neglect them, abuse them, leave them with untrustworthy people, or simply don't have the foggiest idea of how to take care of a child. (Particularly, as in flea's example, a sick child.) Conversely, a foster family may also abuse, neglect, etc the child. And, at best, the removal is going to be traumatic for both child(ren) and parent(s). But sometimes it's got to be done for the safety of the child--and, maybe, the sanity of the parents. If you'll excuse the analogy, it's a little like giving chemotherapy: Unpleasant, dangerous and not something to be undertaken lightly but sometimes life saving. The question is how to know when it must be done and when it is unnecessary and potentially harmful.

I don't know the answer to that question. I doubt anyone does. There are obvious cases--a baby with bruises in the shape of a human hand and internal injuries or a 10 year old pregnant by her father. But what about a child with a history of a lot of injuries, none of them particularly suspicious in themselves? Is he/she a clumsy child or an abused one? Is poverty ever a reason to remove a child? What if the parents flat out can't afford to feed them? In that case a little financial aid might solve the problem. What if they are addicted to something and spending their money on drugs instead of food but appear to genuinely want to quit and raise their children? Try drug rehab, which is notoriously unreliable? Take the children and hope the trauma of separation and the risks of foster care are outweighed by the advantages of a (hopefully) safer home and better nutrition and care?

If we're ever going to have a system that doesn't constantly make disasterous mistakes we're going to have to go about it more systematically than we have been. Social workers need to be considered true professionals and paid like professionals. Decisions need to be made based on evidence: which programs work, when is removing the child necessary, which interventions make removing the child unnecessary? And we need to stop treating upper middle class abusers differently from poor abusers. It doesn't matter how clean the house is, if the baby is being beaten hard enough to break ribs, it is in trouble.

12:04 PM  
Blogger Michele said...

Wow. Rib fractures are almost pathoneumonic with NAT, assuming the baby wasn't a preemie or had some wierd metabolic dz. I can't believe the parents weren't charged. If they were something other than white-middle class I am sure things would be different. I testified in a case where the dad was charged with murder after his baby died (came in unconscious and had old rib fxs). I encountered him in the ER and had only a very brief conversation with him. The trial was very eye opening into what things are really like. It wasn't like Law and Order. It hardly captured anyones interest; the mom and a couple of clerks were the only ones in the court room (other than court and trial personel). It is a sad deal all around. Even though the dad was convicted, I feel that nobody really won here. I certainly am in favor of keeping kids with their parents when at all possible, but there are times when a situation is cut and dry. How much force does it take to fracture a newborns ribs? Think about how these people are handling their kids...

10:55 AM  
Blogger neonataldoc said...

Diane, great point about using evidence based programs. Michele, you're right, there are no winners in these cases.

7:13 PM  

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