Neglected Child Case Study

Day one

Ms K is a newly registered patient and brings her three-year-old daughter Ruth into the surgery for childhood immunisations. She is seen by both the practice nurse and a healthcare assistant. Both are very concerned about the state of the young girl. Her skin is smudged with dirt and her clothes are stained and smelly. The child is also quiet and unresponsive, and something “seems amiss” between her and her mother. Ms K does not comfort the girl when she becomes upset after her jabs and is rough when putting the child’s coat back on. Both members of staff are uncomfortable about what they have witnessed and report their concerns to the practice manager and one of the GPs. The GP decides to write to the local health visitor to see if they have any background information on Ruth.

Day five

An email response from the health visitor confirms that she last saw Ruth seven months ago and that there were no recorded issues. This presents the practice with a dilemma and it is decided to seek advice from local child services who decide there is sufficient cause for the practice to put its concerns in writing.

Day 14

An officer from child services informs the practice manager that they have spoken to Ms K and her former GP and health visitor and that no further action will be taken. Ms K had explained that at Ruth’s nursery the boys and girls spend much of their time outdoors and parents are encouraged to dress their children in clothes that can get dirty. A phone call to the nursery confirmed that there have been no concerns over Ruth’s home life or welfare.

Day 25

Ms K asks to speak with the practice manager in regard to the report made to child services regarding Ruth. She is very upset that the practice did not contact her first to allow an explanation. She has taken legal advice and states the practice did not follow correct procedure in contacting social services without informing her of this action. In the meeting she asks why the practice staff did not raise their concerns at the time. Ms K admits that Ruth had been fractious that day as she did not want to get her jabs and both of them had been a little “on edge” – but she was devastated when contacted by child services to say she had been reported for suspected neglect. She wonders if it might have something to do with her being a single mother. Ms K is also concerned that the matter will now be recorded in her child’s permanent medical records and she wants all reference to it removed. The practice manager asks how Ms K would like to take her complaint forward and it is agreed the practice will further investigate and respond in writing.

THE practice manager meets again with the staff involved and then drafts a letter of response. This is sent to an MDDUS adviser for review. The letter first expresses regret at Ms K’s distress and acknowledges that child services now consider the concerns over Ruth’s welfare are unfounded. She states that on reviewing the circumstances the practice still feels it acted appropriately in referring the matter but in hindsight should have informed Ms K of its actions. The PM also denies the decision had anything to do with Ms K being a single mother.

In response the practice states it will review its procedures and ensure that parents or care givers are routinely informed of any child welfare concerns and the intention to refer the matter to child services (unless doing so would increase the risk of harm to the child). In regard to the request to remove entries in the patient records the PM states that it cannot retrospectively alter medical details unless factually incorrect but that it would be possible for Ms K to review the records to check for inaccuracies in the entry. The PM or mother would also be allowed to annotate the entries.

The PM offers to arrange a further meeting involving other practice staff if this is wished. The letter also states that if Ms K is not satisfied with this response she has the right to take her complaint to the ombudsman and an address is provided.

KEY POINTS

  • Healthcare professionals have a duty to act on any concerns they have about the safety or welfare of a child or young person.
  • You do not need to be certain that the child is at risk of significant harm in order to inform an appropriate authority.
  • Conduct a full investigation before coming to any conclusions over a perceived breach.
  • Inform children and their parents when you have concerns about abuse or neglect and how you will act on these concerns (unless doing so may put the child or anyone else at risk of harm).
  • Patients have the right to check medical records and request that inaccuracies are corrected.

The story of Lisa, whose given name was Elizabeth, has also provoked widespread concern over the problems of identifying and preventing brutality against children. But Tamika, Keiko, Julian and Jose represent the other victims of fatal child abuse, the ones whose stories are often quickly forgotten by all but the protagonists.

In all, about 1,300 children nationwide are reported to have died from abuse or neglect in 1986, according to the National Committee for the Prevention of Child Abuse. In New York State alone, 162 children died last year of abuse and neglect; more than 100 of those deaths were in New York City, about 1 every 4 days. In New Jersey, there were 12 deaths, according to state officials. No figures were available for Connecticut.

Most of these deaths, the authorities say, are the result of negligence rather than intentional brutality by parents or guardians.

While precise figures are unavailable, according to prosecutors, only a handful of abuse cases result in criminal charges for murder or a lesser count, such as manslaughter.

Among them are the cases of Tamika, Keiko, Julian and Jose, and of Lisa Steinberg. They were children from different backgrounds and different places who are linked by violent death. According to the authorities, they reflect a common pattern: most often, experts say, it is a father or stepfather who is the killer.

From a review of court records and interviews with investigators and lawyers, here are four case studies. Keiko: Autopsy Clues

Leslie Aylor left her 5-week-old daughter, Keiko, alone with her husband, Aaron, while she was out shopping. When she returned to her condominium apartment in East Windsor, N.J., on Sept. 30, 1984, Mr. Aylor was asleep.

She peeked at the baby's crib and shrieked because Keiko was not breathing. Resuscitation efforts by a medical team failed. The infant was dead.

There were no apparent bruises on the baby's body and physicians at the Princeton Medical Center attributed the death to Sudden Infant Death Syndrome.

Before the body was removed for burial, however, a pathologist at the hospital, Dr. William Lowery, performed an autopsy to gather possible clues about the mysterious syndrome. To his surprise, Dr. Lowery discovered hemorrhaging in the skull.

A more comprehensive autopsy and forensic tests revealed that Keiko's death had been caused by a trauma, or a blow, to the head. The back of her skull had been fractured.

Detectives from the East Windsor Police Department became suspicious of Mr. Aylor, who was then 19, after he gave them inconsistent statements. At one point, he admitted clapping the infant on both sides of her head with his hands because she would not stop crying, but he later recanted that admission.

Testifying at his trial in March, Mr. Aylor, a slight, bespectacled man, wept as he denied striking Keiko.

Mr. Aylor, who had worked as a truck dispatcher for a pharmaceutical company, was convicted of reckless manslaughter and sentenced to a prison term of up to seven years.

East Windsor police Lieut. Pat L. Delre said investigators believe that Mr. Aylor may have committed the crime because he felt threatened by the birth of his daughter. ''He sensed a loss of feeling from his wife after the baby was born,'' Lieutenant Delre said. Tamika: Insurance Money

The short life and violent death of Tamika Greene unfolded last summer at the trial of her father, James Greene, in State Supreme Court in Manhattan. At the same trial, Mr. Greene, 3l, also was convicted of smothering the infant son of a woman companion.

Tamika's mother, Connie Robinson Greene, testified that she had left Mr. Greene shortly after Tamika was born in 1980. She said her husband had often beat her. Mrs. Greene, who was 19, said she had permitted Tamika to live with Mr. Greene's mother in the Bronx because the grandmother could take better care of Tamika.

In 1983, Mr. Greene proposed marriage to 17-year-old Wanda Pruitt. Miss Pruitt testified that he did not tell her he was married or that he had legally changed the name on the birth certificate of her son from Levalle Pruitt to James William Greene.

Mr. Greene obtained life insurance policies for Tamika and for Miss Pruitt's son in March 1984. He listed himself as the father of both children and the principal beneficiary of the two $10,000 policies.

On April 2, 1984, Miss Pruitt and her son, 10 months, were staying with Mr. Greene in his apartment at 17 West 125th Street in Harlem. Miss Pruitt testified that Mr. Greene had volunteered to give the boy his bottle of milk and put him to sleep in their bedroom.

Mr. Greene, she testified, told her: '' 'Stay out of the room or he'll never get to sleep.' '' About an hour after Mr. Greene left the bedroom, Miss Pruitt found the child dead, a plastic dry-cleaning bag over his face.

Mr. Greene told detectives that the bag had been left nearby on the bed and the boy must have become entangled in it. The death was listed by the police as ''accidental suffocation.''

A month later, Mr. Greene collected the infant's $10,000 life insurance and stopped seeing Miss Pruitt.

In June 1985, about a month before Tamika's fifth birthday, Mr. Greene took her from her grandmother. A 13-year-old girl who had been living with Mr. Greene testified that during the last month of Tamika's life, Mr. Greene had frequently locked Tamika in the bedroom, lashed her with an electrical cord and forced her to keep eating until she threw up.

Tamika's mother said she had visited the apartment a few days before Tamika died and had seen bruises and lacerations on the girl. But, she testified, her husband had prevented her from removing Tamika.

Mrs. Greene was not questioned at the trial about why she had failed to notify the authorities about her daughter's mistreatment.

Esther Bishop, who lived next door to Mr. Greene, said that on the night of July 29, 1985, she had heard Tamika crying and screaming. The woman testified that Mr. Greene could be heard saying, '' 'Take it, take it,' '' and the girl replying, '' 'No daddy, I don't want to.' ''

Mrs. Bishop said she had wanted to call the police but a neighbor dissuaded her saying, '' 'Mind your own business.' ''

Later that evening, Tamika's body was found by the 13-year-old companion of Mr. Greene when she returned to the apartment. Tamika had been in the same bed where Miss Pruitt's son had suffocated 15 months earlier.

An autopsy disclosed that the girl had died of a lethal dose of antihistamine capsules.

A month after Tamika's death, Mr. Greene, who was unemployed, had applied for her $10,000 life insurance. This time he was not paid. Instead, he was indicted for the murders of Tamika and Miss Pruitt's son.

''There is no lower form of human being than the one sitting here,'' a prosecutor, Consuelo Fernandez, said pointing to Mr. Greene during his trial in August.

Convicted of the murders of Tamika and Miss Pruitt's son, and of welfare fraud, Mr. Greene was sentenced to a prison term of 59 years to life. Julian: Emotional Stress?

Julian Shamoon was 4 years old and in a coma when he died. Later, investigators and prosecutors in the office of the Queens District Attorney, John J. Santucci, pieced together this account of the boy's final hours.

Shortly before the murder, Julian's mother, Krystal, had separated from his father, Harry, and was living in Germany, her native country. The father, who was unemployed, was caring for Julian and an older brother, Simone, 6, in their apartment at 139-27 88th Avenue in Jamaica.

Detectives say that Mr. Shamoon told them that on the night of Jan. 6, 1986, he had been playing chess with Simone when Julian repeatedly interrupted the game and refused to obey his father.

Mr. Shamoon admitted, according to police reports, that in trying to to discipline Julian he had ordered the boy to kneel on the floor and had struck him with his hands and with a broom.

A report by the medical examiner's office said the boy had suffered internal bleeding and multiple abrasions of the body and the head.

A defense lawyer, Stephen J. Singer, said Mr. Shamoon had been under emotional stress because his wife, who had been the family's main financial support, had left him and he had to care for his two young sons.

According to Mr. Singer, the 42-year-old Mr. Shamoon, who was born in Iran, ''was a brilliant, gifted guy'' who had suffered a mental breakdown before the death of Julian.

Mr. Shamoon has pleaded not guilty to a murder charge. Mr. Singer said he expected to offer a defense of insanity or extreme emotional disturbance when a trial date is set. Jose: First Offense

The first time Jose DeJesus was brought to the Montefiore Medical Center in the Bronx, physicians were immediately suspicious. It was December 1983 and the 15-month-old boy was unconscious, his body lacerated and covered with huge bruises. There were also contusions around his mouth, indicating that he had been gagged.

His mother, Maria Cadelario Collado, who was 26, denied that the child had been mistreated. He had been listless for weeks and throwing up, she told doctors. His stepfather, Ramon Collado, 26, corroborated her story.

Jose remained at the hospital for a month while the city's Human Resources Administration examined the case for possible child abuse. Jose's mother had been married for several months to Mr. Collado, an unemployed immigrant from the Dominican Republic. The couple had lived with Jose and another son of Mrs. Collado's, Moses, 4, in an apartment at 2146 Vyse Avenue in the South Bronx.

A Family Court judge in January 1984 ordered that while the case was under review, the child be kept with Mrs. Collado's parents in the Bronx while the case was reviewed.

On March 25, 1984 - less than two months after he had been released from Montefiore - Jose was carried into the hosital's emergency room by his mother and stepfather. The boy, 17 months, was pronounced dead. An autopsy disclosed that Jose had died from ruptured intestines.

According to detectives, Mrs. Collado, her parents, and Mr. Collado gave conflicting stories about how the child had been injured. But they eventually acknowledged, detectives testified, that Jose had been living with the Collados and not with his grandparents as directed by a judge.

Mr. Collado said the boy had suffered a fatal injury when he fell from a tricycle in the apartment. Mr. Collado was indicted for murder. No charges of wrongdoing were brought against Mrs. Collado, who said she had not been at home when the boy was injured.

At the trial, the prosecution presented evidence from pathologists who said Jose's injuries were inconsistent with a tumble from a tricycle and that the boy had been struck with a fist or a blunt object.

The jury convicted Mr. Collado in October 1984 of criminally negligent homicide after finding him not guilty of murder or manslaughter. He was sentenced to a prison term of 5 to 15 years.

The prosecutor, Diana Farrell, said she was disappointed by the verdict because it carried a minimum sentence of five years instead of the mininum 15 years Mr. Collado would have had received if he had been convicted of murder.

''On the witness stand he showed no remorse and a very quick temper,'' Ms. Farrell, a Bronx assistant district attorney, said referring to Mr. Collado. ''But after the trial some of the jurors said they convicted him of the lesser charge because it was his first offense and he looked and dressed like a decent man.''

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