How Could You? Hall of Shame-Ethan Okula case-Child Death and Lawsuit UPDATED

This will be an archive of heinous actions by those involved in child welfare, foster care and adoption. We forewarn you that these are deeply disturbing stories that may involve sex abuse, murder, kidnapping and other horrendous actions.

From Philadelphia, Pennsylvania, foster child Ethan Okula, 10, ” died from bowel obstruction, a likely complication of his medical conditions” on February 10, 2016.

“Ethan Okula’s stomach hurt so badly his legs buckled beneath him.

He was moaning when a teaching assistant at Julia De Burgos Elementary in North Philly took him to the school nurse on Feb. 10. The nurse placed him in a wheelchair because he was too weak to sit up in a chair and kept falling to the floor.

Ethan vomited and fell asleep. He defecated in his pants.

He was 10 years old and he was dying, and no one seemed to realize it.

Ethan had been failed by adults his whole life. Now, when he needed help the most, he was about to be failed by the child-welfare system charged with caring for him.

In fact, Ethan’s story is one of wholesale, systemic failure. And it’s far from the exception in our city’s embattled Department of Human Services.

The city’s report on his death, compiled by a team of health professionals, social workers, and prosecutors, is just the most recent one to land on my desk. I’m so tired of reading them.

On Thursday, Mayor Kenney announced Cynthia Figueroa, a former deputy DHS commissioner and the president of Congreso de Latinos Unidos, as the agency’s new commissioner.

Figueroa, who replaces acting Commissioner Jessica Shapiro, now faces the task of reforming the agency that had its license downgraded in May, when state auditors cited the swamped agency with dozens of violations of child-welfare laws, including falsified visit reports and sloppy casework.

I don’t know if the state auditors read Ethan’s file. I hope it’s one of the first things Figueroa does. It will help her realize just how much work she has to do to protect the city’s vulnerable children.

Ethan was one of the most vulnerable.

Ethan was intellectually impaired. Born at one pound, he had hearing and vision issues. He had medical problems, including a serious bowel condition.

He landed in foster care when he was 7. His father beat him and his brother – “I was going to give the kid another shiner,” his dad said at one point, according to the report – and withheld a breathing machine Ethan needed daily.

Last summer, a previous foster family locked Ethan out of their home, leaving him in the summer heat with his belongings – his glasses, inhaler, and hearing aids – before a social worker could come and take him away, the report said.

That’s when Ethan was placed in a foster home through the Northeast Treatment Center, one of 30 city agencies that provide foster-care services for DHS. There are about 180 children from DHS in foster care in Northeast Treatment, said Regan Kelly, the company’s president.

At 9:35, on the morning of Ethan’s death, the school nurse called his foster mother, but she said she could not come to pick him up. She had taken him to a hearing doctor the day before and could not leave work.

The nurse waited with Ethan as he writhed in his wheelchair until about noon, the report said, when she had to leave to teach a CPR class. He was left in the care of a teaching assistant and a school police officer.

The nurse, who was not named in the report, “clearly missed how sick he was,” investigators concluded, and noted that an official complaint could be made against her nursing license.[But WAS it made?]

The assistant and the school officer waited with Ethan until 1 p.m., when Ethan’s foster mother sent a friend to pick him up.

They should have called 911, the report said. They didn’t. They told investigators they had recommended that Ethan be taken to the hospital.

But the friend, a woman who spent time in the foster mother’s home, seemed more concerned that the boy might dirty her Mercedes than she was about helping him.

Seeing Ethan in the wheelchair, the woman cursed and told Ethan to “stop making scenes,” the report said. Learning Ethan had defecated in his pants, she at first refused to let him in her car.

“He’s not getting in my Mercedes-Benz,” the report quoted the woman as saying.

She relented only when the school gave her trash bags to cover her seats, the report said. When Ethan was unable to sit up in the car, she yelled at him to “get up” and “pulled him up by his shirt.”

The woman told the school staff she wasn’t taking him to the hospital. “He pulls this at home all the time,” she said, according to the report. He was going home to his room, she said.

School staffers who witnessed the exchange were required to notify DHS of the woman’s verbal and physical abuse of Ethan, the report found. They did not.

School District spokesman Fernando Gallard told me the district conducted an extensive investigation of the circumstances that led up to Ethan’s death. The nurse was suspended with intent to dismiss, and two other employees were disciplined for their inaction.

The investigation continues, he said: “We need to figure out what went wrong and how we can improve for our students.”

When Ethan was taken home from school that day, he lay on a couch until 7 p.m., when his foster mother finally called an ambulance. By then, he was unresponsive, and likely had been for about an hour.

He was dead upon arrival at Hahnemann University Hospital, but doctors still tried to save him.

A medical examiner ruled that Ethan died from bowel obstruction, a likely complication of his medical conditions.

The report said: “The physician noted that the absence of any family arriving to the hospital during or after the emergency was concerning to him.”

On the night of Ethan’s death, his foster mom lied to a DHS case manager, saying she had picked him up at school. A Northeast Treatment supervisor initially told investigators the mother was one of their “stronger foster parents,” the report said. [Yeah, right!]

But the review panel found differently. And it said Northeast Treatment’s oversight of the foster home was “severely lacking.”

Ethan should not have even been in the care of his foster mother. Her training was not up-to-date and the certificate licensing her home for foster care had lapsed.

The foster mother had a criminal history – including arrests for forgery and theft – that the report said was not documented in her file. The offenses, dating from 1979 to 1982, would not prohibit her from being a foster parent, the report found, but knowing about them could have helped Northeast Treatment assess her suitability as a caregiver. (The agency told me it knew about the foster mother’s criminal past and it did not disqualify her.)

The foster mother was “not well educated” about Ethan’s medical needs, the report found. “His routine medical care was not being met,” it said.

Records of Ethan’s care were incomplete, with some details of his treatment added only after his death.

On Thursday, Northeast Treatment vice president Deszeree Thomas said a “thorough external review” of the case led the agency to fire four employees involved in Ethan’s care – a program director, a case manager supervisor, a foster parent supervisor, and a case manager.

“We are deeply saddened by the tragic death of this child,” she said in an email. “We continue to be very transparent about the issues his death illuminated for us.”

All of the agency’s foster parents are being retrained for recertification, she said.

Ethan’s foster mother has been decertified as a foster parent and DHS has taken steps to ensure that no other children are placed in her care. And her name has been placed on a national registry to alert other states of her foster-care history.[Why hasn’t she been prosecuted????]

The woman has retained a lawyer, the report said, and she and the friend who picked Ethan up at school are no longer cooperating with DHS and city officials investigating the death.

A woman who answered the door of the foster mother’s home Thursday said that the foster mother was at work and that she would pass on my request to talk.

The woman, who said she was not the one who picked Ethan up at school that day, said the boy was a “sweetie pie.” She did not say anything more.

The report found still more failures in Ethan’s case by Turning Points for Children, one of the 10 community umbrella agencies DHS contracts with to handle the bulk of its child protection and foster-care services.

The agency failed to schedule follow-up medical appointments for Ethan even as his primary physician urged them to do so, the report said.

His care suffered in the confusion as DHS turned over many of its services to private contractors, the report said. His critical medical information wasn’t even completely entered into the agency’s database.

City officials said they were saddened by Ethan’s death and the disturbing details laid out in the report. They said they would seize on the report as a guide for improvement.

“It is heartbreaking when any child dies, but this case is particularly troubling,” said Eva Gladstein, the city’s deputy manager for children and families.

Ethan Okula was 10 years old when he died a wholly preventable death. If one person had spoken up, taken action, gotten him to the hospital, Ethan would be alive today.

Instead he was buried in a cemetery without a tombstone.

Ethan’s death was a failure of individuals that became a failure of a system when one by one they did nothing, or did the wrong thing.

He was failed by the adults in his life, by the system charged with his care. Now, it’s up to the system to make sure it doesn’t fail him in death. It’s up to the new commissioner, and those who work for her, to realize how much work they have to do to save the next Ethan.

A 10-year-old’s wholly preventable death [Philly.com 7/18/16 by Mike Newall]

“A second report on the death of a 10-year-old foster child has found that a caseworker falsified documents after the boy’s death and Philadelphia school officials failed to follow district protocol that could have helped him.

The report on the death of Ethan Okula was released Tuesday by the Act 33 team charged with investigating child fatalities for the Department of Human Services. It’s the first time a child’s death has prompted a follow-up report since the review team was formed in 2009. The second report was triggered by a separate state review of Ethan’s death, which raised additional questions.

Ethan, a student at Julia De Burgos Elementary School in Fairhill, died Feb. 10 of a bowel obstruction after complaining to the school nurse of a stomachache.

The report found that after Ethan’s death, a foster-care worker with Northeast Treatment Services faked a document describing a December meeting with caseworkers that should have taken place but never occurred.

The meeting would have outlined goals for Ethan’s care and served as a check-in on the boy’s well-being.

The fraud was discovered when follow-up interviews were conducted with people alleged to have been at the meeting who said no such meeting occurred.

“It is absolutely, 100 percent, completely unacceptable to falsify documentation,” said Jessica Shapiro, chief of staff to the new commissioner, Cynthia Figueroa, who started this week. “I’m of the philosophy, I’d rather someone tell me they didn’t do the work, or didn’t document the visit, then make up the visit, and I think in this particular case they got nervous.”

The review team wrote that “in light of rising caseloads, there is an increased risk in the potential that staff will falsify documents.”

That concern is paramount considering home visits and planning meetings ensure a children’s safety, said Sam Gulino, chief medical examiner and chair of the Act 33 Team.

Since January, 11 child-welfare workers have been fired and two have resigned for forging case documents, including four people involved in Ethan’s case, the department said.

The department does accountability checks to make sure visits recorded actually occurred. The computer system does not allow for backdating reports, but problems persist and caseloads have swelled to 13 families per worker as more children have entered into DHS care in recent years.

In response, DHS has released funding to the private providers to hire 100 more caseworkers.

The report released Tuesday also added new details to the narrative of Ethan’s last day.

While under the nurse’s supervision, Ethan’s legs gave way and he fell while in the bathroom. His stomach hurt so badly he couldn’t sit up and he was placed in a wheelchair, according to the report.

The Act 33 Team found the school nurse, who has since been suspended from the district, did not follow protocol.

The nurse said she checked the boy’s stomach and everything appeared normal.

A pathology report showed Ethan had abdominal surgery as a baby, causing serious scar tissue, the Act 33 Team found.

The pathology review said the scar tissue caused the bowel obstruction leading to Ethan’s death.

“If the nurse had checked Ethan’s abdomen, she should have noticed the scarring from his prior surgery,” the report says. “Instead, the nurse noted no abnormalities.”

The nurse also failed to fill out and send home with Ethan a form explaining his condition and instructions for his care.

After vomiting throughout the day and defecating on himself, Ethan was picked up by a friend of his foster mother.

A school officer had previously told the Act 33 team that the woman verbally and physically abused Ethan as she pushed him into her car, but no one reported anything to police.

According to the report, the District Attorney’s Office declined to pursue criminal charges against School District staff for failing to report Ethan’s condition or the alleged abuse to authorities.

Cameron Kline, a spokesman for the District Attorney’s Office, said the investigation into Ethan’s death was ongoing but declined to comment further.

Ethan was found unresponsive around 7 p.m. that day and was pronounced dead when he arrived at the hospital.”

Report: Child-care worker falsified record in Ethan Okula’s death [Philly.com 9/10/16 by Julia Terruso]

REFORM Puzzle Piece

Update: “There are a lot of tragic stories about foster care children who slip through the cracks.

But 10-year-old Ethan Okula isn’t one of them. He was surrounded by his supposed caretakers on the day he died, none of whom got him the medical attention that could have saved his life.

“Everybody failed Ethan. Everybody,” said attorney Nadeem Bezar, who is representing Ethan’s family. “I don’t think I’ve ever seen failure at every level like this.”

In February 2016, Ethan fell ill at his North Philly elementary school in the morning. He was brought to his foster home that afternoon. By evening, he had stopped breathing. The cause of death was later determined to be an intestinal blockage.

Bezar, an attorney at Kline & Specter who specializes in child abuse and welfare cases, is in the early stages of a negligence action against Northeast Treatment Centers (NET), the agency that placed Ethan, who had a gastric condition, with a foster mother who “did not seem fully knowledgeable about Ethan’s service needs,” according to a state Department of Human Services report on his death.

“The day of his death, they thought, ‘Oh, he just ate too much,’” Bezar recounted. “But he had an underlying condition that required medical attention.”

NET declined to comment on the case due to pending litigation. “Our hearts remain heavy over the tragic death of Ethan Okula,” a spokeswoman said.

Bezar claims NET placed Ethan with a foster mother not properly trained in addressing his medical needs. He is also investigating possible misconduct by school district employees who released Ethan to the foster mother’s friend before he died.

“Nobody at the school called 911,” Bezar said, “and the school, I believe, knew that this friend of the foster mother was not going to take Ethan to a hospital.”

On the last day of his life, Ethan began complaining of severe stomach pain to his teacher. He couldn’t walk, and he vomited and defecated on himself, according to the state report.

A nurse asked his foster mother of the past seven months to pick him up at 9:38 a.m. The foster mother sent a friend, who arrived around 1 p.m. and brought Ethan home, despite a school police officer advising that Ethan needed medical care. Left on a couch, he stopped breathing, and was found to be dead on arrival at a hospital after his foster mother finally did call 911.

Bezar is representing Ethan’s grandparents, who were denied custody of Ethan because the grandmother uses a wheelchair and the grandfather works at night. (His brother, also in foster care, would be the beneficiary of his estate).

Ethan was removed from the home of his biological parents around the age of 1, as both had drug problems, and his father was physically abusive, according to Bezar. His mother is “devastated by everything that happened,” he said.

Before medical issues led to his death, Ethan reportedly suffered years of abuse, including being beaten by his father and at one point locked outside by previous foster parents. Nonetheless, the child was known to have a joyful personality.

“He was outgoing. He liked to dance, be goofy, he was fond of music, he had a bit of an infectious smile. … Even on his last day, someone saw him dancing,” Bezar said. “I’m sorry I didn’t get to meet him.”

But with his history of medical issues, and guardians who allegedly were unaware of them, the odds were stacked against Ethan.

“He was a sweet boy who had been through a lot,” Bezar said. “His foster care mother has claimed she didn’t know about his medical background. With all of that, how is an estranged little boy supposed to survive?””

Lawyer targets foster care agency over 10-year-old’s death

[Metro 5/18/17 by Sam Newhouse]
Update 2: “Two women who allegedly didn’t seek medical attention for a 10-year-old boy after he was sent home from school with severe pain until he had stopped breathing are now facing criminal charges.

Denise Alston, 55, and her wife Carol Fletcher, 53, were charged on Feb. 1 with involuntary manslaughter, conspiracy and endangering the welfare of children related to the death of Ethan Okula.

Ethan died on Feb. 10, 2016 in their home after being sent home from Julia De Burgos Elementary in North Philly with severe stomach pain. Ethan had a gastric condition, and his death was caused by intestinal blockage.

According to the Pennsylvania Department of Human Services’ Act 33 investigation into Ethan’s death,  after he fell ill at school, vomiting and defecating, the school called his foster mother, Alston, around 9:38 a.m. telling them he needed to be picked up.

Alston reportedly told the school she was busy at work, and instead that her wife, Fletcher, would pick Ethan up. Fletcher arrived between noon and 1 p.m., the state’s Act 33 team, which investigates the death of all children in state custody, reported.

“The perpetrator asserted that the child’s current behavior and claim of stomach and abdominal pain was an habitual occurrence which did not warrant medical attention and that the child would be taken home and sent to his room,” the state’s report said. “The alleged perpetrator used profanity when stating that she did not want the child, who had reportedly had a bowel accident, to be in her car. School personnel provided her with a trash bag to put on the seat of her car.”

Once brought home, Ethan was reportedly left on a couch, where around 7 p.m. Alston and Fletcher noticed he was not breathing and called 911. Ethan “was revived briefly at the hospital, but was later pronounced dead,” the state report said. Another foster child at their home was later removed.

Fletcher’s defense lawyer, Troy Crichton, called the prosecution a “witch hunt” and said the women are being “scapegoated” for the fact that child welfare agencies never told the women Ethan had a stomach condition

“The government is on a witch hunt to pin this on somebody, when it’s the government that failed Ethan, not Ms. Fletcher,” Crichton said. “The foster mom, Denise Alton, didn’t even know this kid had any condition, because DHS failed to tell her, and then falsified reports to cover it up.”

State investigators found that, in addition to the foster parents reportedly not fully understanding Ethan’s gastric condition that caused his death, that the school nurse, who was later fired, should have noted abdominal scarring and called 911.

Four DHS social workers involved in Ethan’s case reportedly lost their jobs, out of 13 let go in 2016 due to alleged connections to document falsification, the Inquirer reported. One Northeast Treatment Services (NET) employee also reportedly falsified paperwork claiming they met with his caseworkers.

Attorney Nadeem Bezar has filed a lawsuit against NET, claiming they and DHS placed Ethan with a foster mother without properly making her aware of his medical issues.

“I can tell you we firmly believe that the agencies are responsible for Ethan’s death,” Bezar said. “In terms of how this led to Ethan’s demise, we’ll let the DA’s office make the determination.”

Before being placed in the foster home where he died, Ethan reportedly suffered years of abuse with other foster families, including at one point being locked outside a home with all his possessions by a previous set of foster parents.

He was removed from the home of his biological parents around the age of 1 due to both having drug problems, and his father being abusive.

Bezar is representing Ethan’s grandparents, who were denied custody of Ethan because the grandmother uses a wheelchair and the grandfather works at night. His brother, also in foster care, would be the beneficiary of any lawsuit.

Alston and Fletcher’s preliminary hearing on involuntary manslaughter charges is scheduled for April 4.”

Couple who left 10-year-old foster kid dying on couch charged

[Metro 3/12/18 by Sam Newhouse]

Update 3: “Two child placement agencies have agreed to pay a combined $5 million to settle a wrongful death lawsuit over the death of a 10-year-old boy whose caregivers failed to get him medical attention for an intestinal blockage.

The settlement was reached between defendants NorthEast Treatment Centers and NET Treatment Centers and the estate of Ethan Okula, who died in February 2016, a death that his lawyer claims was “entirely preventable.”

According to the plaintiffs’ court papers, Okula complained of severe stomach pain and began vomiting shortly after arriving at school. The school nurse called his foster mother to pick him up at 9:30 in the morning. The foster mother who had been housing Okula for six months, Denise Alston, sent her friend to the school at 1 p.m. The friend took Okula home, where he laid on the couch.

By the time Alston found Okula unresponsive and called 911 at 6 p.m. that evening, the child had died of a bowel obstruction, according to a Department of Human Services fatality report.

Criminal charges were subsequently filed against Alston and her wife, Carol Fletcher. The couple is currently out on bail. Their attorney, Edward Meehan, did not return a call seeking comment.

“It hurts my heart to think about how Ethan spent his last few hours in pain before he died alone,” said Okula’s lawyer, Nadeem Bezar of Kline & Specter. “I pray that the tragedy of Ethan’s death continues to inspire those who work in child welfare to continue to protect this vulnerable population.”

In court papers, Bezar argued that the child placement agencies were on notice about Okula’s pre-existng health conditions and special needs stemming from his premature birth and should have more carefully chosen his foster home.

“But for the acts and/or admissions of defendants NorthEast Treatment Centers and/or NET Treatment Services, Ethan Okula would not have died at 10 years old after defendants placed Ethan, a special needs child, in the foster home of an untrained, unlicensed individual, in reckless disregard for Ethan’s safety and well-being,” the plaintiffs’ court papers said.

The defendants’ lawyer, Francis Deasey of Deasey, Mahoney & Valentini, did not return a call seeking comment.

In the defendants’ objections to the Okula estate’s lawsuit, the treatment centers argued that there was no link between their placement of Okula in the Alston home and his subsequent death.

The agencies argued that the plaintiffs failed to show how there was any liability on NorthEast or NET’s part.

“The symptoms exhibited by the decedent on the date of his death, starting at his school, i.e. vomiting, defecating, weakness requiring a wheelchair, were observed by school personnel,” court papers said. “There is no allegation that the foster parent’s friend or the foster parent were aware of these symptoms.”

“However,” the defendants continued, “even if they were, that still does not sufficiently causally link their actions to the allegations” against the agencies.

Okula came from a broken home, Bezar said: “Ethan was horribly physically abused by his father, had a struggling mother … then he goes into foster care. He’s initially placed in a series of foster homes where they’re not equipped to handle him.”

Bezar said Okula’s negligent treatment began in 2015, when doctor’s appointments were missed and no follow-up visits were sought. He also said that the agencies failed to regularly check up on the child.

“There’s some effort made, but it’s inadequate,” Bezar said.”

Foster Care Agencies Settle Lawsuit Over Child’s Death for $5M

[The Legal Intelligencer 5/4/18 by PJ D’Annunzio]