Every year between 130 and 160 children and youth die in the District—by murder, by suicide, by infection, by falls, by a fire that broke out from a candle being used to heat a house, by neglect. We didn’t know them in life—how they were born premature, how they had a beef with a kid in the neighborhood that escalated, how they fell through the cracks on the city’s watch.
For each one, someone kept a record of their death. A doctor recorded the respiratory disorder on a chart. A cop started a murder investigation. A social worker kept a file.
The District government puts it all together: compiling statistics, taking medical histories, interviewing mothers, studying social-worker files. And each year the Child Fatality Review Committee issues a public report—the one from 2007 is the most recent available—on its obit work. Much of it is statistics.
The committee tabulates and catalogs the deaths by age, gender, race, ward, cause, and so on. The demographics rarely shock; most of the dead are African-American males from the poorest wards, and many died under the monitoring of a social worker. Of the youth who died from homicides in 2006, 56 percent had been known to the Child and Family Services Agency (CFSA).
Hundreds of dead kids get analyzed in the report. Only a handful become case studies written by the committee for the public record. There are no names. Their identities have been obscured. The neighborhoods where they lived and died are omitted. We do get to know the details of their final days. The stories are essentially and essential autopsies of how a city can fail its most vulnerable wards.
Committee authors start with the circumstances of death. They then chronicle the chain of social workers, probation officers, mental-health counselors, and others who were charged with their care. Many of the narratives end with a jolt: Somebody was paid to protect these kids, sometimes from their parents, sometimes from themselves.
Juvenile Justice Histories
- 29 of the 154 fatalities were known to the juvenile justice system.
- 100 percent were African-American.
- 97 percent were males.
- 80 percent had had multiple arrests. 62 percent had active cases at the time of their deaths.
- 12 youth were under law enforcement supervision or in a District facility.
- In six of the active cases, the youth were AWOL from the system.
- 79 percent had known histories of drug use or involvement.
- 2 had received high school diplomas; 11 had dropped out; 13 were in school. 13 were also known to CFSA.
Case Study No. 1: Natural Death of a Young Child
“One winter evening, a 6-year-old female child, FT, was brought to a local pediatric hospital in critical condition by ambulance and accompanied by a relative. Medical records indicated that there were no signs of trauma or injury; her brain was swollen, but there was no bleeding present. On the day after hospitalization, FT coded and had to be resuscitated. A brain study was performed which indicated that there was no brain activity….
The grandmother reported that FT had eight teeth pulled at a local university several weeks prior, but she appeared fine. She reported no history of falls, fights, accidents or known illnesses. She stated that FT played outside and was very active, playing with the other grandchildren who were at her home.
The maternal grandmother further reported that at approximately 7:00 pm on the day prior to FT’s hospitalization, she woke up complaining that her stomach and legs were hurting. She offered her something to eat, but she refused; she gave her some ginger ale to soothe her stomach and a half dropper of children’s liquid Tylenol.
The child also complained of her ear hurting so she placed toilet tissue in [her] ear in the absence of cotton ball[s]. The grandmother indicated that FT’s head felt warm so she assumed she had the flu. Her symptoms continued and she was given another dose of Tylenol with ginger ale. The next day, FT did not get out of bed.
She slept and sporadically watched television. She ate a little soup and drank a little ginger ale. She was given more Tylenol and she went back to sleep. FT became weaker and began complaining of pain in her legs and was unable to walk unassisted. The grandmother rubbed her legs with an ointment to soothe the pain. On the day of her hospitalization, FT began talking incoherently and laughing and crying inappropriately. It was at this point, that the grandmother realized she could no longer treat the child and sought medical attention.
Based on a review of the child’s dental records, she was taken to a clinic in early January, escorted by her school teacher, who had acquired consent from her mother for a special dental program that provides dental services to needy children. During this one visit, FT had eight teeth extracted, which were described as ‘rotten.’
Prophylactic antibiotics were not given [to FT] prior to the procedure. Additionally, antibiotics were not given following the procedure and were not prescribed as part of the discharge instructions. In addition to the extractions, FT received several fillings and was given Fluoride treatment.
The discharge instructions which were provided to the teacher included: stay home for 24 hours; use Chloroseptic mouth wash as needed; use Advil 200 mg for fever and or pain, and see physician in 72 hours. Based on a review of school records, FT returned to the school with [her] teacher. The school nurse noted as part of Progress Notes the following: ‘Gauze packing applied to tooth extraction sites with noted decrease in amount of bleeding.’ The nurse’s notes also documented that the mother picked FT up from school and that she ‘gave her instructions to follow to relieve further bleeding from her gums and to contact the doctor immediately if the bleeding continued or increased.’
The mother did not speak to the dentist or clinic staff and it was unclear during the case review meeting whether she fully understood the importance of follow-up with the pediatric physician or the significance of symptoms of fever and lethargy that ensued over a two-week period.
Cause/manner of death: Acute Bacterial Meningitis/Natural”
Case Study No. 2: Abuse Death
“At approximately 8:37 am a 911 call was made for a report of an unconscious child. Upon arrival of the emergency response team, the victim was immediately noticed lying face down with his hands tied behind his back. The caller reported that the child was discovered face down in a tub full of water with his hands and feet bound.
The victim was pulled from the tub and CPR was attempted although medics advised that there were no signs of life. The body was wet and clammy; with rigor mortis noted in the lower legs; and the lower [jaw] was rigid. The body was noted to have abrasions on the left side of the face and to the left side of the back. There were also old scars noted on the left and right lower leg.
Death was apparent and the victim was pronounced dead on the scene. During the investigation, a relative admitted to killing the child and based on the evidence was arrested and charged with the murder.”
Case Study No. 3: Accidental Infant Death
“At 2:30 a.m., the Office of Unified Communications Center received a 911 call concerning a fire at a residence where the mother, an infant and other family members resided. The Fire Department responded to the scene and fire fighters entered the apartment and discovered the infant lying in the crib in the rear bedroom. The infant was transported to the nearest hospital where she was noted to have no signs of life and severely charred.
She was pronounced dead at 2:50 a.m.
The mother reported that she and the father of the infant had gone out for the evening leaving the infant and other children in the care of an adult relative. Prior to leaving the mother reported that she checked on the infant who was sleeping in her crib; and she lit a candle which was in a candle holder that was attached to the wall in the child’s room.
According to the mother she was using candles because the electricity had been turned off in the apartment two weeks prior to the fatal incident due to lack of payment. During the review it was revealed that the mother had applied and been approved for energy assistance however the electric company was unaware of the approval.
The cause of the fire was the candle which ignited combustible items in the room causing extensive damage to the walls and ceilings where the child was sleeping.”