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  Specter of Suspicious Deaths Haunts Area

   
About This Series

D.C. Chief Medical Examiner Jonathan L. Arden has reopened investigations into five deaths.
(By Lucian Perkins – The Washington Post)

Findings
Throughout the region, children's deaths have been misexamined, mislabeled or misdiagnosed.

Part One
The Post created a database of causes of death for the 2,379 children younger than 5 who died from 1993 through 1995.
Sidebar: While most adults wish to spare children from talking about death, they are eager to discuss it, a specialist says.

Part Two
Why child killings go undetected.
First of two articles

By Nancy Lewis
Washington Post Staff Writer
Sunday, September 20, 1998; Page A1

Even today, six years later, D.C. police Sgt. Bruce Feirson recalls every detail of the case of Chaulette Willis. The call that hot August afternoon came for an address in Southeast Washington that he knew well – a crack house and heroin shooting gallery. When he and paramedics arrived, they found not an adult drug victim but a tiny 4-month-old girl.

She was dirty and reeked of an awful odor, police and medical records show. The skin beneath her unchanged diaper was raw, ulcerated, rotting. The stench in the basement apartment was almost overwhelming. Doctors found two pounds of feces in the diaper of the 10-pound baby.

Chaulette was dead on arrival at the hospital; in fact, she may have been dead for 12 hours. The D.C. medical examiner blamed sudden infant death syndrome – usually used in an unexplained death in an otherwise healthy infant. No criminal investigation. Case closed.

"We find babies dead in horrible conditions here in [the 7th Police District] all the time," Feirson said, "and they're always coming back 'undetermined' ... and nothing ever happens."

Chaulette's is one of 263 young children's deaths in the Washington area in recent years attributed to SIDS or "undetermined" causes. Scores more have been blamed on falls from sofas and beds and down stairs, accidental drownings and unexplained convulsions.

But dozens of these children likely were killed, either directly at the hand of another person or as the inevitable result of abuse or neglect, The Washington Post has found.

To try to gauge the true toll of this violence, The Post compiled death statistics, asked an expert to analyze them and interviewed police officers, prosecutors, doctors, child abuse experts and social workers from across the country and throughout the metropolitan area. All said they are certain numerous suspicious child deaths in the Washington region have gone undetected or been ignored.

The questions raised in the course of this reporting already have led the newly appointed D.C. chief medical examiner, Jonathan L. Arden, to reopen medical investigations into the causes of death for five children, including Chaulette, to determine whether they were homicides.

"There is a lot more child abuse than people think there is, and child abusers are not stereotypical but cross all economic and ethnic lines," said Craig Futterman, associate director of pediatric intensive care at Inova Hospital for Children in Fairfax County, one of the area's two main pediatric trauma centers. Throughout the region, children's deaths have been misexamined, mislabeled or misdiagnosed, according to interviews and a detailed review of child death statistics.

Doctors and medical examiners missed signs of injury, and the Washington area lacks the type of broad-based specialty teams that operate elsewhere in the country to immediately investigate children's deaths. Police investigations were poorly handled. Family members shielded accused relatives. And the bureaucracies assigned to flag cases of suspected abuse – from hospitals to schools to social service agencies – failed to respond.

Even in those area cases in which an adult was held accountable, punishment at times was minimal. In 1996 alone, a Silver Spring father punched and shook his 7-month-old and left him in a coma, a D.C. mother withheld medical care from her cancer-ridden son, and a Carroll County mother stuffed a rag into her 4-month-old daughter's mouth to quiet her. All three children eventually died. All three parents got suspended jail sentences or probation.

From scaldings to starvations to suffocations, there have been some child killings that generated public uproar, but most others passed without notice.

"All taken together, we are missing a substantial number of homicides," said Deputy Attorney General Eric H. Holder Jr., a former judge and former U.S. attorney for the District of Columbia.

Photo shows D.C. Medical Examiner Jonathan L. Arden.
Arden says the number of deaths "begs for an explanation."
(By Lucian Perkins – The Washington Post)
   
The Hidden Death Toll


No single local or regional agency gathers statistics on child deaths in the Washington area. To learn how many children may have died from abuse and neglect here, The Post created a database of causes of death for the 2,379 area children younger than 5 who died from 1993 through 1995, the most recent year when complete information was available.

Of the 790 on average who died annually from all causes, only a few were officially recorded by police as homicides: 14 in 1993, five in 1994 and 10 in 1995.

Bernard Ewigman, a family practice physician and researcher in epidemiology at the University of Missouri-Columbia, analyzed the death data at The Post's request. Ewigman and his research team have devised a mathematical formula for estimating how many childhood deaths attributed to "external causes" – which include anything that is not a disease or a condition the child had at birth – are in fact attributable to abuse or neglect. The method evolved from a landmark study the team published in 1993 in which it did intensive case-by-case studies of every child death in Missouri attributed to external causes during a six-year period and determined whether the original finding was correct.

Chart

In examining the statistics for the Washington area, Ewigman said a conservative estimate is that a child a week in the region – 50 each year – died from abuse or neglect, far more than in official police counts or court cases.

"True accidents are rare," Ewigman said. "Fatal maltreatment is quite common – a phenomenon that is difficult to comprehend, much less accept, for most people."

Ewigman's method makes no attempt to unmask childhood deaths that had been attributed to natural causes but were, in fact, intentional killings. Neither Ewigman's team, nor anyone else, has tried to ferret out those cases from all the childhood deaths in a given area over a long period of time.

"Of course there are deaths signed out as SIDS or natural causes that are actually caused by child abuse, and there are even more that are caused by neglect, from starvation, failure to seek medical attention, failure to provide a safe environment," said Carole Jenny, director of the Child Protection Team at Hasbro Children's Hospital of Brown University in Providence, R.I. Jenny has worked as a consultant to review autopsy results and medical reports in several child death cases in this area.

Several other national and local experts, including Arden, the District's new medical examiner, reviewed The Post's database or the portions related to their expertise. All said they, too, believe an estimate of 50 abuse and neglect deaths in the region, although four to five times more than the official homicide numbers for several years, is conservative.

Chart

Futterman, who serves on the committee that reviews the circumstances of all child deaths in Fairfax County, estimates that 20 percent of all child deaths in the county – or 15 to 20 deaths a year in recent years – result from neglect or abuse. Those cases, Futterman said, can range from a fatal beating to fatal injuries that stem from a child's not being in a safety restraint at the time of a car accident.

Nationally, medical professionals have conducted at least three detailed studies of children's deaths from external causes over the last two decades. Each, using data from such differing locales as Chicago, New York City and Missouri, has found that deaths from maltreatment have been underreported by at least 50 percent.

Doing a better job overall of identifying the true cause of child deaths, Futterman said, would require that "kids have to matter in ways that right now they really don't."

It would also demand a willingness to suspect the possibility of killings that are almost too horrible to consider.

"The idea that parents or people close to a child could possibly injure or kill a child is just so abhorrent" that the possibility is often ignored, said Robert M. Reece, a Boston pediatrician and editor of the primary medical textbook on the diagnosis and treatment of abused or neglected children. "We are in collective denial."


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