How Could You? Hall of Shame-Las Vegas, Nevada foster daughter-Child Death 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 Nevada, “The June death of her 7-month-old foster daughter prompted Sheila Smith to ask a legislative committee to evaluate Clark County Department of Family Services’ medical policies and procedures on Friday.
The Clark County foster mother did take her ailing foster daughter to the hospital, but doctors needed to run a test to treat her condition, which required consent from the biological mother, she said. Family Services couldn’t locate the biological mother and told Smith it would take two weeks to get a court order allowing the baby to undergo the needed medical procedures .
After seven days, medical staff conducted the necessary procedures because the infant’s health had deteriorated, Smith said. The foster mother believes that the baby’s life might have been saved if she’d been treated sooner.
“I would like to request that this committee evaluate the Department of Family Services’ medical policies that are not aligned with their procedures,” she told members of the Legislative Committee on Child Welfare and Juvenile Justice.
The baby had surgery within 24 hours of the test. But on the 17th day after being hospitalized, she died, Smith said. She wouldn’t disclose what kind of test was performed due to confidentiality.
Chairman and Assemblyman Jason Frierson, D-Las Vegas, said it’s too late for the committee to tackle the issue since Friday was its last meeting of the year.
“In an ideal world, I would have liked to have a hearing on it to hear both sides,” he said. “…Hopefully, we’ll be able to vet it at some point.”
Frierson said he wants to hear from the Department of Family Services. If there are issues to be addressed, they don’t have to wait for a legislative fix, he said.
It can be taken care of “in the absence of legislation,” he said.
A fatality report posted on the state’s Division of Child and Family Services showed that a 7-month-old girl in Clark County died on June 6 while “en route to receive a life-saving procedure in a hospital out of state.”
Family Services is not able to comment on case-specific information because of confidentiality issues, according to Kristi Jourdan, Family Services spokeswoman. However, she said in any “emergent, life-threatening situation, medical professionals have the ability to perform diagnostic testing or treatment.”
“This applies to anyone, including children in the child welfare system,” she said. “As an example, medical professionals routinely treat accident victims without waiting for appropriate consent if that treatment is deemed life-saving.”
Family Services passed decision-making responsibility to the medical staff, Smith said.
If testing or treatment is not deemed emergent or life-saving and IV sedation is necessary, Family Services requires parental consent or a court order, according to Jourdan.
“We do this because parents, whose rights are intact, are legally entitled to make decisions about the care of their children,” Jourdan said. “We first try to contact parents for their permission and it’s important to note that if we are unable to get parental consent, we take the request to court.”
Family Services’ medical case management policy and procedures don’t specify time limits on acquiring either parental consent or a court order because there are many variables involved, such as the availability of the parent and the gathering of medical records from providers and the department, Jourdan said.
In the case of a court order, the Clark County district attorney’s office has to present information for the judge’s approval, according to the department’s policy.
“As a system, we work diligently to ensure a child’s health and well-being needs are met,” Jourdan said.
Family Services did not respond to the question of why the department’s medical case management policy and procedures from 2009 don’t list a date for enactment. The policy is labeled “TBA” under its effective date and the documents indicate “not in effect.””
Foster daughter’s death spurs appeal to lawmakers[Las Vegas Review-Journal 7/18/14 by Yesenia Amaro]
REFORM Puzzle Piece
Update:“In the wake of the June death of a 7-month-old foster girl in deteriorating health, the Clark County Department of Family Services’ medical consent practices are being reviewed.
The agency is required to get parental consent for medical procedures involving general anesthesia or other sedation needed by children in custody.
If the biological parents can’t be found, the agency can request a court order for treatment instead, said Brigid Duffy, chief deputy district attorney for the juvenile division of the Clark County prosecutor’s office.
It’s important for the public to understand the “big picture of where we are in trying to get help for kids who need help,” Duffy said. “I don’t want to say that parents’ rights are an obstacle, but it creates something we have to consider before we can get an end result.”
The issue of medical consent garnered attention in July after the 7-month-old’s grieving foster mother implored state lawmakers to review Clark County’s procedures.
Sheila Smith said the baby’s life might have been saved by earlier treatment.
In a life-or-death situation, hospitals do have the ability to perform medical procedures on children without parental consent, Duffy said.
If Family Services goes through court, Duffy’s agency can file a motion that would be heard within 21 days, she said. In emergencies, her office can file a separate motion for a hearing within 24 working hours.
A children’s advocacy organization also is working with county officials to make it easier for children in foster care to get necessary medical treatment.
“At what level we are going to be seeking legislation or policy practice change will depend on the research that we get,” Denise Tanata Ashby, executive director for the Children’s Advocacy Alliance, said on Thursday.
Ashby’s organization recently launched the Stakeholder Opinion Survey to find ways to improve Nevada’s child welfare system.
“When we get responses that we feel are policy issues, we take it to the department and have a discussion with them,” she said.
The 7-month-old’s death was such a case.
OBTAINING ADVANCE CONSENT
The Children’s Advocacy Alliance is looking at how other agencies handle parental consent for medical treatment. One option is getting broad parental consent at the beginning of a Family Services case.
Another option is expanding the decision-making scope of foster parents and of the agency.
Jeanne Marsh, director for the Washoe County Children’s Services Division, said her agency has parents sign medical releases when their children are removed from the home. The medical release is also addressed during the 72-hour emergency child protective hearings.
“The judge states the order out loud so that parents are aware, and then the parents get a copy of the orders,” she said.
But it’s the department’s practice to include parents in any medical situation when possible, Marsh said.
In the case of the 7-month-old girl who died in Clark County, the foster mother took the ailing baby to the hospital, but doctors needed to run a test to treat her, which required consent from the biological mother.
Family Services couldn’t locate the biological mother and told Smith it would take two weeks to get a court order for the needed procedures, the foster mother said in July.
Hospital staff conducted the procedure after seven days because the infant was in serious decline, Smith said. The baby later died.
Janice Wolf, directing attorney for the Children’s Attorneys Project at Legal Aid of Southern Nevada, said she didn’t know the specifics of the 7-month-old’s death, but noted there was another option — filing an “emergency setting slip” to get cases in front of the court quickly.
“While it’s nice to do motions, I don’t understand why a slip wasn’t used,” she said.
Wolf believes current medical consent practices in Clark County do work. But part of making them work in cases like that of the 7-month-old girl is effectively communicating the urgency of the situation.
“It sounds like someone didn’t realize how urgent it was,” Wolf said.
LIABILITY VERSUS NEED
The medical consent practices in Clark County have been in place since the early 2000s. At the time, a couple of parents became upset because the Nevada Division of Child and Family Services sought medical treatment for foster children when parents thought they should have been consulted, Duffy explained.
Since the current medical consent policy was put in place, “there’s been some really tough days,” she said.
In a few circumstances, a parent was responsible for their child’s medical problems through abuse or neglect. While the parent faced criminal charges, the hospital wanted a decision on do not resuscitate orders, Duffy said.
“If we make that decision, that could be the (difference) between attempted murder and murder,” Duffy said.
Duffy met with the grieving foster parents of the 7-month-old girl but couldn’t talk about case specifics because the district attorney’s office represents Family Services. The agency is not commenting on details of the girl’s death.
Family Services also would not comment on what’s being done to improve current medical consent practices. Officials referred the Review-Journal to a July statement released when the baby’s death was first reported. The statement reiterated the department’s current policy.
There also are liability issues officials have to consider.
“If we make those gigantic leaps into saying this more-than-routine medical procedure is needed and something happens, and we, being the department, consent to it without a court (order), then the liability falls on the department and not onto the court,” she said.
There might also be some hesitation on the part of hospitals to proceed without parental or court consent because of liability issues, Ashby said.
“There’s got to be a balance between protecting both the agency and the medical providers, but also making sure the kids are getting the medical care they need when they need it,” she said.
Dr. Jay Fisher, head of University Medical Center’s pediatric emergency department, said he speaks to the hospital’s lawyers about their practices frequently and there’s a great latitude in the law to do what’s right for patients.
“It would be highly unusual to look at a team of professionals and say that they were neglectful or guilty of some type of incorrect activity” for providing a life-saving measure to a child, he said.
Under state statute, the director or other authorized representative for a child welfare agency should organize one or more multidisciplinary teams to review the death of a child in several circumstances, including if the child dies while in custody of the agency.
“The statute does not require an additional team to be convened,” Kristi Jourdan, Family Services spokeswoman, said last month when asked if a team was formed to review the death of the 7-month-old girl. “The current Clark County Child Death Review Team process, which reviews every child death in our community, already meets the statutory requirements, according to the district attorney’s office.”
Tara Phebus with the Clark County Child Death Review Team said she couldn’t talk about specific cases, but the team meets monthly to review all child deaths.
Duffy would like to see the court move away from the current medical consent practices because of their complexity.
“I recognize that parents have rights and they are fundamental rights, regardless of how these kids landed in the system, but at some point, I would like to see the courts say the department has this ability and trusts the department to make these decisions,” she said. “But that’s not going to be a popular stance because parents have rights.”
It would be ideal if parents stayed in constant communication with Family Services, but that’s not the case, Duffy said.
“The district attorney’s office will find a way to help the department attain the ability to have more control over those decisions,” she said. “We’ll keep working with the courts to figure out a better process.””
Medical consent at issue for ailing foster children [Las Vegas Review-Journal 9/6/14 by Yesenia Amaro]
Recent Comments