June Fatality Review Agenda 6l6f12 General meeting issues: Policy 20.50 needs to be removed. Attendees: Lisa Lund, Carla Aaron. Debbie Miller. Susan Mitchell. Alan Hall. and Frankie Cowan Declined: Irma Buchanan and David Shoemaker due to there being no custodial cases to be reviewed. Not in attendance but invited: Eunice Leckey, Lawanda Christmon. Patti Slade. Deb Gattlin. Mandy Lewis. and Marjahna Hart were unable to attend due to schedule conflicts. Next Meeting: July 11. 2012, 10am-12pm. Cordell I-lull Building, Room 7B. This meeting is being held the second week of July due to the holiday on 714/2012. Subsequent Meeting Dates: 811/12, and 9f15l12. All efforts will be made to continue to schedule these meetings on the first Wednesday of the month from 10am to llpm. Locations are to be announced as well as any changes to the regular meeting date and time. Carried over from previous month 1. team requested this case be brought back in order to review prior severe abuse case. Both children entered foster care on as a result of this investigation and both children remain in custody. Case recording entered for contact held on Entered By: reads as follows: CM made a face with and on this date. The children were playing while CM and talked about this case. CM explained that the department is still asking for severe abuse adjudication, scheduled for expressed her concern of getting the children back due to unusual behaviors and the no Contact between and since she was born. also explained to CM that was not getting a house now and has stated she is petitioning the court for custody. The children are doing very well with X. CM will continue to see the children twice a month or as needed. tn) CM made a face with and vines on this date. The children were playing while and talked about this case. CM explained that the department is still asking for severe abuse adjudication. scheduled for XXth. expressed her concern of getting the children back due to unusual behaviors and the no contact between and since she was born. also explained to CM that was not getting a house now. The children are doing very well with CM will continue to see the children twice a month or as needed. During hospitalization: Dr. said extra axial hemorrhage right apteral temporal bone fi'acture. Dr. said bleeding coming from fracture as infants' brains will sometimes expand. Also said CT scan showed fracture and hematoma. Dr. subdural hematomas on both sides of brain and later reported healing rib fractures as well said rib fractures difficult to see initially also couldn't do all rays because child was on the ventilator. At discharge, had feeding tube because her "brain and stomach were not communicating with each other, which is a sign of brain damage." Allegation ofSevere Physical Abuse indicated against in County CPIT. XIILX has exercised his right to not speak with Law Enforcement about these allegations. would not give a detailed statement to CPS but did verbally deny any wrongdoing. states was alone with the child when it became "Sick" and no one else had access to the child several days prior to the injuries. Medical notes state that without a historical event then non-accidental trauma is suspected. did admit that he was alone with the child when she became ill. Both and have been indicated for Severe Physical Abuse against was (according to alone with the child when she became ill and no one else had access to the child during the time frame possible for the injuries to occur. has refused to speak with Law Enforcement about these allegations. knew that had a no contact order initiated against him with his other child due to abuse allegations against this other child. does not believe injured the child. CPS CM was informed by Foster Care that fired her court appointed attorney as she was advised to separate fiorn due to these allegations. Both and are indicated on Lack of Supervision allegations in regards to both children. suffered life threatening injuries (according to medical personnel) and neither have an explanation for these injuries and these injuries occurred while in and care. Case recordings also reflected that the mother of father's other child has order of protection against him, however this was not confirmed. as the case on was unfounded. History on this family: One prior assessment for medical maltreatment of sibling, on case was listed as severe on last month's summary and the case is not severe. This investigation was classified as no services needed. was another case presented last month and the team wanted to be sure that there was no relation between and this sibling, confirmed there is no relationship. TEAM DECISION: There are no further actions to be completed on point. There is no need for this case this case at this to be presented to the team again. 2. Team agreed we would seek information fiom regional staff as well as review the initial lack of supervision case and circumstances Mother charged in criminal court with custodial child- As mother tested positive for amphetamines and hair follicle test, both allegations indicated and Child continues to remain in custody. her visits have been suspended until interference and drug exposed methamphetarnines when given a child placed in foster home on Mother is in an in-patient treatment program and he completes the program successfully. Near-Fatality Incident: Allegation of LOS by to her year old son is indicated. The child was not being properly supervised, as he had access to his mother's prescription medication and ingested two and a half Suboxine tablets. began to show signs of respiratory distress and was airlifted to the Children's Hospital PICU. has been charged with aggravated child abuse, and those charges are pending in court. admitted that she should have put the bottle of medication elsewhere and that she didn't see the baby get the medication until he came towards her with the bottle. purchased a lockbox for meds, rearranged the room. and is working on parenting with the services of at this time. Initial LOS case and circumstances Case previous to this near fatality was and case was unfounded for 1.03 and DEC. The circumstances of this case were that the mother had a needle mark inside her left elbow. She stated that this was due to her having blood drawn. However, the allegations were that different people had been cooking methamphetamine in the home and that mother had shot up methamphetamine with a needle. DCS took the case to court requesting that blood drug tests and/or hair follicle tests be administered to all household members, the court refused this request and the case was unfounded. TEAM DECISION: Determine ifthe regional staffconferenced regarding this case. RESULTS: Yes. regional staffconferenced this case and the case was taken to County Juvenile Court and the court placed the child in state custody on and child remains in state custody. As mother was still participating in in-patient substance abuse treatment at (foniniunity Services but there are 2 updates included below. La.- Information relevant to updates about mother's substance abuse treatment: Case recording entered on CM called community Services on this date and spoke with to check to see how was doing there. stated that showed up an hour late yesterday at AM, but ended up leaving last night at PM. stated that she was told that said that she could not do the program because she would not be able to see her family and that she needed to call her mom and wanted the number for her probation officer. stated that when they searched bags last night that they found a needlefsyringe in her bag and when asked where It came from; stated that her boyfriend's friend put it in her shoe. stated that the nurse disposed of the needlefsyringe and that they did a urine screen on when she arrived, but that it would not come back for a couple of days. but that CM could call back to get the results. stated that told the staff last night that she had not used anything in 2 months. stated that they did send her to her counselor last night and did speak with her, but that mother ended up coming to pick up and took her home. stated that in order for to come back, she had to get back on the waiting list. but was not guaranteed a spot. Case recording added on CM made a telephone call on this date to the Center to request a flow sheet for CM received a call from the agency was told that showed up for an intake appointment on but that the intake did not get very far because stated that her attorney told her not to answer any questions. had two other appointments scheduled for and but she was a no show and her case was just closed today. New Cases: Circumstances: The child was found in the bed with the father, and sister, The father's girlfriend, came in the room at approximately am this morning and saw that the child was under the father's leg. called 911 and the father attempted CPR. This investigation was classified as allegation indicated, perpetrator indicated because the father had .06 BAC on the morning the child died. CPIT staffed case and determined that due to the child's age, the child should have struggled for breath and the father should have responded. As of June X, the family was unwilling to supervise visitation between and her father because he had started drinking again. At the time of death, the father was verbalizing suicidal ideations and he was jailed until he sobered up and was not a danger to himself. He has not been charged criminally for the incident and there are no plans to charge him. There were three trash bags of empty beer cans at the home and another seven beer cans on living room table. He was not charged in the death of Referrals were made for to attend grief counseling, there is no record if the referral has been followed with actual services. Both and have the same birth mother, History: -ASMT -- Drug Exposed Child -Services Recommended - Referred to drug endangered program at due to mother failing 2 drug screens for marijuana. It was noted that there was no evidence the mother's drug use impaired her ability to parent or even that she had used drugs in the presence of the children. Case classified as services recommended and accepted. TEAM DECISION: The team would like this case returned next month to consider information obtained about current situation and whereabouts. Additionally. the team would like to know from the District Attorney's office why charges were not filed against the father since the team determined that the child was old enough to have struggled for breath and that the father should have responded. Additionally, the team would like to know what assessment was made during the involvement regarding the father's use of alcohol or drugs. Also, what services were offered and provided to mother from the case and what was the outcome of those services. It was also asked if father was not criminally charged. did DCS approach juvenile court to seek limiting contact between father and children. RESULTS: spoke with the Team Leader. about this case and review. He explained that and were in the custody of their mother but were visiting the father's home when this incident happened. continues to reside with her mother. Team Leader reported that the father was not charged with any crime because it was lelt that the incident was an accident. This information was obtained when the case was staffed with Child Protective investigative Team. on which the District Attorney participates. 1% Alleged victim was and alleged perpetrators were: and parents. Allegations were neglect death and enviromnental neglect. Child was believed to be climbing on a dresser in her bedroom attempting to change the TV channels when the dresser tipped down causing the TV to fall on the child. Incident was believed to be the cause of the child's death. At time of the incident, father tested positive for marijuana and opioids but had prescription for opioids. Investigation was unfounded for environmental neglect as well as neglect death. A re-enactment was done by law enforcement that exhibited how easily the dresser and television were turned over. Autopsy results indicate cause of death to be blunt force injury to head, including severe skull fractures, including a basilar hinge fracture: associated epidural hemorrhage; moderate to severe cerebral endema; multiple skin depressions and contusions of the head; lacerations of the right ear; blood within the right external auditory canal and the bilateral nostrils; scalp and subgaleal tissue hemorrhage; multiple contusions of the torso and extremities and hemoaspiration, and very early decompositional changes. The manner of death is accident. Classification for this investigation was unfounded with no evidence to support the allegation and per CPIT recommendation. Environmental Neglect - No Services Needed. Police officers had been to the home two times. a few weeks apart and stated the home was nasty with dirty dishes and food all over the house and multiple adults in the home. On when case manager went to the home, it was neat, clean. well organized and the child's room was tidy and decorated in Dora the Explorer; there was adequate food in the home, and the parents were very attentive to the child. Case closed as no services needed. Intake Environmental Neglect - No Services Needed. Drug exposed Child/Infant - Services recommended and accepted. Referral for was made for the family and worker was assigned as sibling serious medical issues, child is diagnosed with Crohn's Disease (born 3 months premature with history of heart surgery) home health is in the home with this child. AV: and APs: and parents. Allegations of drug exposed infant, drug exposed child and environmental neglect. Environmental neglect allegations were classified as unfounded. In regards to the drug exposure, and have remained clean since CM didn't observe any visible safety hazards in the home although it was very cluttered. seems to be doing better since being released from CM asked is referring the family to and and home health remains in the home to assist with X. CM will close as services recommended and accepted. Reporter states: and newborn sibling are the children of and was transferred to Medical Center shortly after birth due to being bom at 27 weeks (weighing 2.7 pounds). The placenta was separating and this caused to go into early labor. This could have been caused by drug use. It is unknown if Meconiuni has been collected at this time. was positive for marijuana and opiates yesterday by urine drug screen. did have appropriate prenatal care. She states she took Lortab for pain, but she does not have a prescription. stated her OB physician (Dr. said marijuana would not harm the fetus. She has been using marijuana regularly for about 3-5 years. states that she smoked marijuana during her first pregnancy with Although was born prematurely and appropriate preparations had not yet been made for him to come home. states that family members are buying supplies for them. DCS has been involved with the family before on two different occasions. will be discharged today. discharge is unknown at this time. He will be kept in the hospital for "quite a while". has a history of depression, anxiety and bipolar disorder, but was not taking her medication due to her pregnancy. She stated she will be going back to Health to resume medications. Cue questions were asked and no further information was available. Classification: and have remained clean since CM didn't observe any visible safety hazards in the home although it was very cluttered. seems to be doing better since being released from CM asked is referring the family to and and DKX home health remains in the home to assist with CM will close as services recommended and accepted. Note: This child, is listed as a case member in one of 6 cases involving and however. the relationship between these two families cannot be determined trom all information in TFACTS on both families. Therefore, the information regarding the family has been deleted from this fatality summary. TEAM DECISIONS: is looking to use this case to explore why multiple involvements with one family need to be prioritized and the region needs a protocol for these cases. The team also discussed having follow-up contact with in home medical providers, such as to discuss increased awareness of potential safety hazards in homes in which they work. Team also wants to contact the regional staff and determine if there is a legitimate reason is listed in the cases and ifnot, a help desk ticket needs to be submitted to have her removed from that case. Team is interested in why mother's substance abuse issues were not addressed. is to look at cases and detennine if there has been different workers each investigation or if the same worker has been assigned. RESULTS: The child, being included in the case was an accident and has been deleted from that case in TFACTS. The case was worked by and supervised by The case was worked by and supervised by The case was worked by and also supervised by 3. EMS brought infant, to the County General Hospital. The child arrived at the ER at a.m. The child was dead on arrival as the EMS staff attempted CPR on the infant with no success. mother, said that she found the child not breathing and called child's father. came over to the home and attempted to get a pulse. He couldn't get a pulse. called EMS. stated that prior to the child's death: she laid down and was gone for about 15 minutes. She stated when she returned he was unresponsive. Per autopsy: Cause of death listed as Complications of Herpes Simplex infection. including viral hepatitis with subrnassive necrosis of liver; viral adrenalitis with rnultifocal necrosis; associated conditions of pulmonary edema, splenomegal y, dusky appearance of intestines. and no pneumonitis identified. Other autopsy findings: 16 day old neonate; small thin subgaleal hemorrhage. superior/posterior aspect of the skull. thin filmy subdural hemorrhage, posterior/inferior aspect of brain. Marmot of Death - Natural. Investigation for neglect death. closed allegation unfounded, perpetrator unfounded Following the conclusion ofthis investigation. which was unfounded another child has been born to and was admitted to This child has been released and details regarding this involverrtent are included below. -- Lack Of Supervision (open case). Alleged victim - Alleged Perpetrator - (mother). -Sexual Abuse/Exploitation - Drug Exposed Child Alleged victim - Alleged Perpetrator -- SEEIDEC allegation unfounded, perpetrator unfounded. Alleged Perpetrator - SEEIDEC. allegation unfounded, perpetrator unfounded. - Lack Of Supervision. Alleged victims - Alleged Perpetrator - X. No Services Needed. - Lack Of Supervision/Sexual Abuse/Exploitation. Alleged Victim -- Alleged Perpetrator Alleged perpetrator - indicated, perpetrator indicated. Physical Neglect of all children by and AVs All allegations were classified as unfounded due to a lack of evidence. Allegations of physical neglect of all of the children against both parents. All allegations are classified as unfounded. There are no case recordings in the record as the case was prior to TN Kids. EOCX Sexual Abuse of by Unknown AP. AUPU due to no evidence to support allegationsand All allegations are unfounded but there are no reasons for the classification provided in the systemclassified as Unable to be completed. denied that she just ate Ramen Noodles. reported she likes pizza. spaghetti. and hamburgers and lot of stuff. reported they have pet mice and their cage is on the floor in the kitchen. Case is being closed as unable to complete due to this worker not being able to interview the alleged perpetrator or complete a home visitand Unable to be completed. This worker was not able to locate This worker tried home visits and telephone calls to locate This worker had three possible places where she was locatedclosing this case and will classify as Unable to Complete. CM has been unable to take contact with the alleged victim's caregivers. Numerous good faith attempts have been made with no success. CM has observed the outside of the home. The home is an older trailer. The trailer has no obvious safety hazards outside but was in obvious need of some repair. CM visited the children at their schools and there were no disclosures of abuse and or neglect. CM contacted Officer (referent) of the County Sher-riffs Dept. Officer has visit the home on two occasions. Officer stated that although the trailer was dirty. there were no obvious safety concerns and there was adequate food in the home. Appropriate notices have been left at the home. including letters and card. There have been no additional referrals made on these children. Case will be closed UABC at this timeand Regarding CM is closing this case and will classify as Unable to Complete. Results of investigation included: CM has been unable to take contact with the alleged victirn's caregivers. Numerous good faith attempts have been made with no success. CM has observed the outside of the home. The home is an older trailer. The trailer has no obvious safety hazards outside but was in obvious need of some repair. CM visited the children at their schools and there were no disclosures of abuse and or neglect. CM contacted Officer (referent) of the County Sheriffs Dept. Oflicer has visit the home on two occasions. Officer stated that although the trailer was dirty. there were no obvious safety concerns and there was adequate food in the home. Appropriate notices have been left at the home, including letters' and card. There have been no additional referrals made on these children. Case will be closed UABC at this time. SEE of by (AIPI) and LOS by In regards to the sexual abuse: disclosed during a forensic interview that she had sex with a 20 year old named and she described them kissing on the couch and then going to his bedroom and taking their clothes off. and him putting his "dick" in her "cooch". or middle hole. denied her mother knowing she was over at house. because she and her brother were supposed to be over at someone else's house staying the night. who has some mental limitations and, according to his mother, has the mind of a 14 year old, was interviewed and he admitted to having sex with a 12 year old girl named He described them kissing on the couch, going to his bedroom, pulling off their clothes. and he "fucked her". He described putting his "dick" in her "pussy". CPIT members agreed there is enough evidence to support the allegation of Sexual Abuse/Exploitation. Therefore, per policy. the allegation of Sexual AbusefE.xploitation is being classified as Allegations Indicated and Perpetrator Indicated. Regarding the lack of supervision: Case is classified as allegations unfounded. perpetrator unfounded due to a lack of evidence to substantiate allegations. LOS and by No Services Needed due to a lack of evidence to substantiate allegations. SEE of by father and SEE and DEC by Allegations unfounded, perpetrator unfounded due to a lack of evidence to substantiate allegations. 10 LOS of by Services recommended and accepted- services provided to and are receiving services through the Incident involving death- related to Herpes Simplex Virus and HPV. died due to medical complications. (baby boy) born on allegations of ENN which are classified as services recommended and accepted. was bom at Medical Center in X. TN to unmarried parents. birth mother (age XX) and X, birth father (age XX). He was transferred to Medical Center for respiratory distress and placed on antibiotics related to his potential to develop an infection that his mother had at the time ofhis birth. for Herpes Simplex Virus and Human Papillomavirus He is reported to reside with his parents at the home of the rnatemal uncle and aunt. has on record, a sibling that shares his birth mother, who died due to and HSV and HPV infection the parents' home being renovated. the family is living with matemal aunt and uncle, and The home was very nice and appropriate for baby and family. Parenting classes and grief counseling were recommended. The father is working full time; the mother was in GED classes up until she went into labor with The family is supported by the maternal uncle and aunt as the uncle works at CPSA went into NICU at about pm and viewed baby He 15 stated to be lbs. oz. and in length. He was in NICU. but not hooked up to any support systems and was sleeping quietly during visit. He was reportedly free from trauma as he was delivered Caesar-ian section. The nurses reported that he is not positive for any current infections and is eating and sleeping well. The nurse said the parents were both at the hospital as they had just finished feeding him. CPSA asked to be taken to where the parents were waiting. Case currently remains open and services (Tennessee X) are working with the family. is also involved in the home. TEAM DECISIONS: Team would like and from to review the medical history of and determine why child was released from hospital so soon following birth. Also interested if medical records reflect mother disclosing herpes and HPV. There was also discussion regarding herpes simplex, type I versus type 11, genital herpes. to request medical records and copy of case file from region so that this information can be provided to the medical staff for consult. Case is to be brought back to team next month. is also to notify law enforcement as the situation is still considered statutory rape per law. RESULTS: Herpes type 1, herpes simplex is oral herpes, not genital herpes; but can still include genital sores. has contacted staff and a summary of the progress made on this case in regard to the parents and the new baby, is being prepared and will be provided to the team. It was learned that the mother and father have no married. which means there is no longer a situation which constitutes statutory rape, so a referral will not be made to law enforcement. ll Work is still being done to obtain the medical records for as this all happened in another region. An update on the status ofthose records and the subsequent reviews will he provided in The County Department of Children's Services received a Priority 1 fatality referral on The on at approximately a house fire broke out on TN X, in the home of and The fire inspector's preliminary conclusion is that this was a "grease or flash fire". The medical examiner's preliminary conclusion is that victim, passed away from smoke inhalation due to the amount of soot found in her esophagus and lungs. The mother, is unconscious and is being treated at Hospital. The father, is being treated at Hospital for burns and injuries received from breaking a window in his search for CPS Investigation open from The referral alleged Drug Exposed Child regarding X, mos., with the alleged perpetrator being her mother. was given a drug screen and tested positive for cocaine. A safety plan was put in place, which stated: will participate in an Alcohol and Drug Assessment and follow all recommendations, will be safety placed with and will pass random drug screens. The safety placement was lifted on CM had received updates from concerning the number of classes had attended, which was 14 low intensity outpatient program sessions and she has attended 16 Twelve Step meetings. CM put a safety plan in place. The plan stated: will not use any illegal drugs. will have random drug screens. will continue to attend A outpatient treatment and ANNA meetings. The allegation was classified as AUPU. While the CPS case was still open. the family had been spending the majority of their time in with the father parents. Mother was required to have supervised contact only. but that was lified and she was allowed to resume unsupervised contact with As the case is closed currently. there is no updated information available in regard to grief counseling for sister. CPS Investigation open from The alleged perpetrator was identified as Ms. mother. Mother was witnessed shaking and threatening client while shopping in Wal-Mart by several witnesses. When interviewed by law enforcement, denied shaking client, but admitted that she had made the statement, could just kill you". Mother reported that she did not mean this statement literally. was charged with Child Abuse and Neglect. Mother pleaded guilty to the charges in court on in exchange for a deal placing mother on probation for one year and requiring mother to continue with DCS services. The allegations were changed to non-severe physical abuse per CPIT and recommendation. The allegation was classified as AIPI due to the mother pleading guilty to the criminal charges associated with this referral. There is no available infonnation regarding this mother through the 'Tennessee Felony Offender Information Lookup. Case recordings reflect that she served one year of probation and then the record would be expunged. TEAM DECISIONS: is to discuss this case with regional management of region to establish protocol for multiple involvements with same family. The team would like input from as to how the fire started as well as ifwe went to court to limit mom's contact with Team would also like to see the autopsy. Following the input trom the team would like to review that information. RESULTS: had Contact with and it was later determined by Fire Marshall that the fire was accidental and was NOT started as a result of the mother cooking in the kitchen during the middle ofthe night. TL, stated we did not go to court to limit mother's contact with as a result ofthis fatality. The only time mother's Contact with was limited was in the case, and that was taken to court. Paternal Grandmother contacted 911 at a.m. today when she found her month old grandchild unresponsive. Child was found with blood coming from the nose and month. There are several children in the home including this child and siblings as well as two cousins. Adults in the home include the mother, father, father's sister, grandmother, and grandfather. The father admitted to having the child sleep in his bed the night prior to the child's death. One child described the adult family members (except the grandparents) taking brown stuff out of a cigar and replacing it with green stuff as well as that the father, mother and aunt smoke in the bathroom. Child also disclosed that there were pills seen in the house. The mother and aunt admitted during the investigation that they falsified drug screens by using another person's urine. The mother also admitted to taking "a pill" when she learned the infant had died. The father admitted to smoking a joint the afternoon prior to the death of the infant. Following the death investigation, services were being provided to the family by who were providing assessments, counseling to address needs identified by the assessments, and grief counseling. These services are provided in the family home. The father stated he did not wish to have any more children, but the mother is pregnant. The family has had a insect infestation, including scabies, in the home and has had to move back into the home with extended family members. which resulted in the home being overcrowded again. As of X, the family has been approved for housing. has also been working with the parents to address environmental concerns and health issues. The children are current on medical appointments and immunizations. There is a plan for the family to move into their own housing, which should help address the space issues. Both parents completed their assessments and the mother has been referred to outpatient counseling and father had no recommendations. 13 Medical reports from autopsy include that the child died from a blood clot in stomach and he apparently choked on blood in his throat. Family members received grief counseling through the employee assistance program of the grandfather's employer. Both father and mother had outstanding warrants for arrest related to prior charges. The record is not clear on what these charges were. In home services have been provided to the family through Care as mother was pregnant again. Case was transferred for on--going services. The ongoing case has and continues to remain open. In addition to Foothills Care for intensive family support services, the family home was treated for bug infestation through purchased services. Per autopsy: Final anatomic diagnosis acute pulmonary hemorrhage. blood clot cast in tracheobronchial tree, aspiration of blood with large blood clot in stomach, blood clot in esophagus; visceral pallor; pulmonary edema. severe; cerebral edema, hypoxia. severe and unbilical hernia. The main cause of death is acute idiopathic pulmonary hemorrhage. The manner of death is natural. Drug Exposed Child; AVs: and AP: Father, Classified as no services needed. is the father of and and he is not involved with the children. Drug Exposed Child: Ali's: and and and AP: and father and mother. Case classified as Allegations lndicated and Perpetrator Indicated against both and On the following closing surnmary was entered: This case came to the attention of the Department on with allegations of and NGD. It was alleged that the child was found in the bed unresponsive by the patemal grandmother. There was blood found on his face and coming out his nose when the police responded. He was found in the father's bed but the father was not present. Upon firrther investigation it was learned the child died of natural causes. He was reported to have pulmonary hemorrhage. The father tested positive for THC and Benzo upon drug screen. The mother was bus with the aunt, It was found during the investigation that the child was not seen by a PCP for any reason. Please see case summary in dictation for the entire closing summary. AV: AP: mother: Allegations unfounded, perpetrator unfounded. This case is being closed as Allegations Unfounded and Perpetrator Unfounded for the allegation of drug exposed infant. The baby's urine screen was negative, but meconium came back positive for cannabis. but there is no history that the mother had positive drug screens during the pregnancy, and admitted that she did smoke before she found out she was pregnant at three months but not after that, evident by the negative urine screen which would have detected any current use. TEAM DECISION: to check on to determine why case is clusstlieti and is classified as indicated when appear to be same allegations. same victims. and same perpetrators. I4 RESULTS: entered rcclassitications into and classified the cases as administratively closed and provided the information that the findings from the investigation could be located under NEAR FATALITIES I. On March EMS was dispatched to the home for a child in respiratory distress. EMS found child in mother's arm awake but having a disconjugate gaze about him. Mother reported she had found the child on the co uch between a dog and a couch cushion. Mother reported child was blue and limp and was not breathing. Mother performed mouth to mouth on child and took him to her mother who continued rescue breathing. Child was transported to County General Hospital where upon arrival he was found to be completely normal except for having left otitis media which he had been diagnosed with about 4 days prior. Child was kept overnight for observation and was discharged the next day. The family placed the dog in another home. 2. Following this investigation, on X, the child's sibling, tun-redacted version notes "cousin" not sibling) 1 died. The parents had placed the baby in bed with them. Both parents are large and it is suspected that one of the parents rolled onto the child and suffocated him. Autopsy was unable to determine cause of death and listed manner of death as undetermined and cause of death also as undetermined. A (PI) investigation was received today at approximately a.m. informing of the child's death. It was reported the week old infant passed away on of undetermined cause. It was reported there are at least 4 other children living in the home. It was also reported to be several adults living in the home. There was no known information provided concerning the environmental situation within the home. The reporter also did not know the whereabouts of parents. The allegations of neglect death were unfounded against the mother and father, and Other children in the home included: age X. sibling to age X, cousin to age X. cousin to and months, cousin to Also in the home is age XX, family friend. Interviews are being done now to determine what safet measures need to be put in place for all 4 children names. The home consists of multiple adults is the primary owner of the home and her adult daughter, age XX resides in the home. along with and parents of and resides in the home when is not on the road driving a truck. and are children. is a friend of the family. She has been residing in the home for approximately a month. I {One} prior referral concerning and with and her boyfriend, being the named perpetrators for drug exposed children, on both boys. 15 Allegations were indicated on both perpetrators. Children were temporarily placed in the care of her mother at that time. Children have since been returned to mother. A follow-up contact will be made with XX Regional staff to determine current Status of services as well as how mother obtained custody back of the children and if the case manager tieels living arrangements for this family is currently meeting the needs of the adults and the children in this home as well as additional information on TEAM DECISIONS: is to contact the about the possible conditions of the dogs that the father is reportedly breeding. to work with regional staff to determine if grief counseling has been offered to the siblings and cousins in order to assist them in dealing with death. The follow-up mentioned in the above paragraph is also to be done with region to determine if the children's needs can and are being met in the home with so many people residing in the home. Concerns include sleeping arrangements since a child has died in the home due to co-sleeping. Also, is to make contact with region to determine if still remains in this home with the family and determine why her parents are not caring for her. RESULTS: Contact was made with X. Team Leader for assessment. At the time this case was closed. there were no longer any dogs living at the home. either inside or outside. Therefore. a referral to the has not been made since it has been over a year since the family had dogs. was removed from the home when the case was presented to court. Another adult family member obtained custody of and she was released fi'om custody of DC S. A11 additional requested information is not available as there is not currently an open case through which contact is maintained with the family to check on the status of services being provided. 3.fl This case was in part due to the criminal charges filed against for admitting to shaking her Step sister 's baby; was life flighted to and in the NICU for several weeks. The trauma to him was extensive and medical records have been received and placed into the hard file. Dr's did not give any chance at survival for the first few weeks in the hospital. His prognosis was that he would remain in a vegetative state. on maximum life support, and permanently blinded due to the extensive tratnna he endured at the hands of Shortly after a Catholic Priest visited him in the room, baptized him and anointed him that he came out of the coma, the ventilator was removed, as well as the feeding tube. Within 3 days, was well enough to go home from the hospital. Medical personnel have stated he is a living miracle. Currently is still undergoing extensive medical appointments, and it is still unknown if his vision will be restored. He has physical therapy several times a week and on seizure medication. is set for criminal trial in February for Aggravated Child Abuse. No information is available on the Tennessee Felony Offender Information L0Ol(up. Her attorney is Her child was alleged to have a black by several family members who did not 'report the bruise to DCS. XX was placed with Paternal Aunt, due to the fact his father, had no stable housing or employment. was court ordered to have visitation with her son at the She has not appeared for the visitation as scheduled and has allegedly been out with friends attending parties and not concerned with visitation. This case was unfounded by CPIT due to no evidence of the bruising. This case is ready to close. is currently in Children's Hospital due to severe neurological consistent with "shaken baby caused by (maternal step aunt). was criminally charged with child abuse. was also indicated for lack of supervision. Initially, the allegations of physical abuse were against mother, these allegations were unfounded as the injuries were a result of It was also determined that has Von Willibald blood disorder, which causes him to be a "fiee bleeder."' (age child of X, was placed with a relative, due to the criminal charges against in the case. Court was held on and remained in the custody Mother's visits are supervised. Prior Involvement: Alleged Victim: Alleged Perpetrators: Mother and Child's Boyfriend. and [Father of Allegations: Lack of Supervision (Mother) and Sexual abuse (Father) Lack of Supervision: Allegations Indicated, Perpetrator lndicated- Mother was indicated although she had been deceased for three years Sexual Abuse: Allegations Unfounded Perpetrator Unfounded Indicated Drug Exposed lnfant-- with as indicated perpetrator as admitted to judge that he was selling drugs in order to provide for He tested negative For all drugs. TEAM DECISIONS: to clear up dates as II is documented that father. admitted to the court that he was selling drugs to provide for the child in but child was not yet bom until RESULTS: There was an error the date court was held and II actually was on that Mr. made this statement. not in 4. 1 Mother, allowed her children and to dangle their feet out the van doors while the van was in motion. Child fell out of the van and was run over 17 by the back wheel of the van. The medical records indicate that has a pulmonary contusion in the right lung with a small right side "pneumothorax," meaning a small portion of her lungs collapsed. This investigation was unfounded for lack of supervision. told the worker that she is for County. stated that she is attending college perusing a degree in early child hood education. Father left the hospital with the two other children while the mother stayed at the hospital with X. Hospital staff and on-call worker expressed to the family how they need to ensure the safety of the children. A written safety plan is being completed with the family that they will ensure the children are in child restraint seatfappropriate restraints while riding in a vehicle. No history. TEAM DECISION: to follow-up with about changing the classification of this case. to have is to be asked to complete a due process review of this case to determine ifnotification to County Schools is needed. Investigation number tor this case is and case is classified as unfounded but mother admitted to allowing the children to ride in van with door open. RESULTS: completed the due process review and did not feel that the classification should be changed- Reasons provided for the decision were: All. This message is to inform that a form at tile review was conducted on the investigation involving and this reviewer agrees with the investigator. determination that the allegation of lack of supervision was unfounded. Things considered: The alleged perpetrator did NOT "tail to provide adequate supervision" to her child nor did she place her in a situation beyond her child's maturity (this is despite being in when the incident occurred). This incident seems exemplary ot poor judgment on pan of the alleged perpetrator to not acknowledge the level of RISK involved in allowing the children to engage in such activity. probably did not realize how she changed the surroundings when she decided to attempt a "jump" and the alleged perpetrator probably did not suspect that would change the playing field by standing versus sitting. The decision of the mom to only allow this kind of ride while she is slowly going up her driveway after getting the mail was probably this farnilyrs form of "piair" but it also serves purpose to give consideration to mom's attempt to air on the side oi caution - driving slow and only up the family's driveway versus on a road or street?. She indicated that this was the first time that she had allowed this - that's leave this reviewer with some doubt What was likely a first was standing during the ride versus sitting and dangling her feet. The category that might have been suitable was the previously used "Substantial Risk of Physical Injury" simply due to the obvious - the risk involved with riding 18 with the door of the van open and allowing the kids to situate themselves at the door while in motion. Overall Risk Factor: While the alleged perpetrator made a poor decision in judgment and assessment of safety relative to the act that she engaged in with her children. this does not seem. to this reviewer an indication that children would be at risk as the alleged perpetrator serve In her prolessional capacity. It seems that the alleged perpetrator assessed the driveway and the minimal speed to he a controlled environment - She was Wrong not to consider what could happen it one of her children stood up or if she simply rode over a choir situated in the gravel -- so this incident will likely serve as one of the greatest lessons that she learns during the course of parenting. Contact was also made with Team Leader for this case and she stated that there were no charges filed against the mother because although it was considered to be poor judgment. it was felt that this was an accident and the mother had no intent to harm the children. Also, the incident happened on the family's private property. Additional ly. once the accident happened, mother reacted appropriately. to send policy 14.20 as well as email from to this was not done because and resolved the policy issues. "It was also recommended that when CPS is unable to determine court disposition of criminal charges that assistance can be offered through Internal Affairs to seek this information. is going to work to establish a protocol for CPS to request and receive this information.