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 MassKids is urging the Governor to create oversight and accountability at the Medical Examiner’s Office so that decisions about the causes of suspicious Infant deaths, currently being made unilaterally by individual M.E.s, can be appropriately reviewed, and any changes in the official cause of death can be properly evaluated. This call is in response to three cases involving infants whose deaths were initially ruled homicides and caused by Abusive Head Trauma and were later independently changed to cause of death “undetermined.” See MassKids Press Release and the Boston Globe’s reporting on these cases.

 

PRESS RELEASE

Governor Baker Urged to Improve Oversight at the Medical Examiner’s Office to Better Address Child Deaths


August 26, 2016, BOSTON, MA – Child advocates today are publicly urging Governor Baker to appoint an independent panel of forensic experts to review current practices at the State’s Medical Examiner’s Office, and recommend how oversight and accountability can be improved as it relates to determining the official causes of suspicious child deaths. The call by MassKids, a statewide child advocacy organization, is in response to three cases of infants whose deaths were investigated by the Boston Globe and reported on earlier this week. Abusive Head Trauma or Shaken Baby Syndrome was ruled by the Medical Examiner’s Office to be the cause of injuries that led to the deaths. During an 18- month period, however, those initial determinations of homicide, were later revised to “undetermined.” These judgements have now been called into question because the three Medical Examiners who made those decisions in each of their respective cases, appear to have been heavily influenced by defense lawyers committed to debunking Abusive Head Trauma as a credible syndrome in order to defend their clients charged with the homicides. The impartiality of at least two of the M.E.s has also been raised because each of them has or is now benefitting financially by testifying in court in favor of the defense in such cases.

Jetta Bernier who directs MassKids, describes why the lack of oversight and accountability for these decisions is unacceptable. “When agencies that are a part of our state’s child protection system including DCF, medical providers, police, and district attorneys, are involved in child death cases, multiple players in each of those systems participate in the investigation and decision making about circumstances surrounding those deaths. In Boston hospitals, for example, when a seriously injured child is seen, a multidisciplinary group of experts including pediatricians, radiologists, ophthalmologists, and other specialist share their combined knowledge to make a differential diagnosis about the cause of those injuries. While no system is fail safe, this team approach provides the best possible chance that the diagnosis will be accurate. How is it then that in the Medical Examiner’s Office, also a critical member of the child protection system, a single M.E, without consultation with and formal review by the Chief Medical Examiner or other forensic experts, can make a unilateral decision on the cause of death of a child, and even change their mind later, without ever having to account to anyone? This is untenable.”

The Secretary of Public Safety, Daniel Bennett, indicated earlier this week that he has no concerns about individual Medical Examiners having total authority and autonomy to determine or revise causes of death without ever having to consult with or defend their decisions with the Chief Medical Examiner.

“It has been well known that for decades the Medical Examiners’ Office has been underfunded and understaffed,” noted Bernier. “As a result, its policies and practices have only garnered it a “partial accreditation” with the National Association of Medical Examiners. Other states have policies that require the Chief Medical Examiner or a second M.E. to review and sign off on decisions involving any homicide, the death of a child under age 2, and any case in which the cause of death is ruled “undetermined. Massachusetts is clearly out-of-step with these best practices.”

MassKids believes an independent panel of forensic pathologists could recommend to the Governor how to build checks and balances into the system and finally bring the M.E.’s Office into full accreditation. According to Bernier, “We applaud the Governor for his commitment to improving our state’s child protection system and for the strides that are being made at DCF. But the M.E.’s Office is also a critical part of child protection and his commitment should extend to that agency, as well. If decisions about the causes of child deaths are made unilaterally and without any oversight and review, errors will be made. As a result, justice for those children will be lost, those who commit crimes against them will not be held accountable, and our ability to prevent other children from similar deaths will be undermined.”

What Story do the Numbers Tell?

Select which items belong together and which one is different:

  • Massachusetts ranks third in the nation on overall child well-being.
  • Massachusetts children lead the nation in educational achievement.
  • Massachusetts has the lowest teen birth rate for 15-19 year olds in the country.
  • Massachusetts has the highest percentage of children covered by health insurance.
  • Massachusetts has the lowest overall child death rate in the country.
  • Massachusetts has the highest rate of child abuse and neglect in the U.S.

 

...

 

Ready for the answer?

 

The first five items reported by the Annie E. Casey Foundation’s Kids Count project are based on robust, defensible data. The last item reported in the federal Child Maltreatment 2014 Report should not be presented as a stand-alone fact.

A recent Boston Globe Editorial “Scrutiny could save children’s lives,” provides the seemingly incontrovertible statement that Massachusetts has “the highest rate of abused and neglected children in the nation…” In support of transparency around child abuse cases, which is what the editorial was arguing for, it would have benefited readers to be informed that comparing states on child maltreatment rates is an “apples and oranges” exercise, and not all purported “facts” are what they seem.

States operate their child protection systems on one of five levels of evidence. The strictest, “clear and convincing,” requires that an individual making a report of child abuse, must convince the state that their concern is “substantially more likely than not to be true.” Eight-five percent of states require less strict levels of evidence, i.e. “credible” “probable cause” or “preponderance.” Only six, including Massachusetts, accept reports at the lowest level of evidence. In these states, a concerned citizen or mandated reporter need only have “reasonable” cause to believe that a child is suffering from abuse or neglect. This clearly impacts the number of reports received and investigated by child protection agencies, the data that states then report to the federal government, and the facts that the media then promote and the public come to believe.
For example, Kansas which requires the strictest “clear and convincing” evidence, reports only 2.8 of 1,000 children are victims of child maltreatment in their state, whereas, Massachusetts with the lowest level of “reasonable” evidence reports 22.9 of 1,000 children are victims. The high bar Kansas sets is also reflected in the percentage of confirmed physical abuse cases reported there, which is twice as high as in Massachusetts - 21.2 % of cases versus 10.8 %. Sexual abuse cases there constitute 29% of all cases, yet only 2.3% in Massachusetts.

Failure to identify the types of maltreatment being substantiated continues to fuel the public’s false belief that most maltreated children are suffering from serious, life-threatening physical abuse. In fact, 94% of all confirmed cases in Massachusetts involve child neglect which because of its chronic negative impact on a child’s physical and emotional health, is also serious. However, this high rate is more likely a product of family economic challenges and Massachusetts’ persistent and unacceptable 15% child poverty rate, rather than the result of parental incompetence or cruelty.

Massachusetts citizens and professionals report more cases of child maltreatment because its “reasonable cause” policy encourages them to. Also, several high profile cases have sensitized the public to the need to report any suspected child maltreatment. This is not uncommon. Note that in post-Sandusky Pennsylvania, the percentage of sexual abuse reports now comprises over 60% of all reported child maltreatment.

No state in the country can point to a child protection system without flaws and challenges. The mandate to address the needs of children living in dysfunctional families involved in violence, substance abuse, and poverty is the toughest burden of any state agency. Advocating for better child protection policies at the Department of Children and Families, and more support for efforts to prevent child abuse from ever occurring must be our priorities.

We should recognize, however, that more reports lead to more identified victims and that’s a good thing for kids. Rather than using unexplained data which promotes the notion that our state, its citizens, and its child protection system are callous to children and incompetent to protect them, let’s consider it a badge of honor that our Commonwealth casts a wide net to early identify and respond to children suffering from abuse and neglect.

Jetta Bernier, Executive Director
MassKids
14 Beacon Street
Boston, MA
617-742-8555
This email address is being protected from spambots. You need JavaScript enabled to view it.

April 13, 2016

Making Sense of Baby Bella’s Senseless Death

Let’s admit it.  State agencies tasked with given the noble mission of protecting children from abuse and neglect are essentially running band-aid dispensaries. The brave workers who staff these beleaguered agencies enter a human battlefield every day charged with the assignment of trying to mend the broken lives of mothers, fathers, and other various adults living in households struggling to be safe havens for children.  Sometimes band-aids can help close wounds from the damaged childhoods many of these adults have faced and healing allows them to become better caregivers than they ever had.  In too many cases, however, band-aids can’t heal the deep injuries caused by what are now referred to as “ACEs” or adverse childhood experiences. As a result, their children often become the next victims in line to suffer physical, sexual, or emotional abuse or neglect.  Often the brilliant spirits of these children are dimmed; sometimes they are extinguished, despite our best intentions and fallible human efforts.

Many in Massachusetts continue to mourn the death of 2-year old Baby Bella and are confounded as to how such a bright and hopeful child could have met such a sad end. The terrible truth is there is great sense in this seemingly senseless tragedy.

Over a decade ago, CDC and Kaiser Permanente conducted the seminal Adverse Childhood Experiences (ACE) Study, the largest study of its kind ever done to examine the health and social effects of adverse childhood experiences over the lifespan.  It involved 17,000 participants from Kaiser’s pool of HMO members who were asked to identify which of ten ACEs they had experienced growing up. These included: abuse (physical, sexual or emotional), neglect (physical or emotional), and living in a household experiencing divorce or separation, alcohol/substance abuse, mental illness, violence, suicidal behavior and/or imprisonment of a household member.

Researchers documented that the more ACEs a person had experienced, the more likely they would  engage in high risk health behaviors, including smoking, overeating, abusing alcohol or drugs, having 50 or more sexual partners, etc.  For example, an ACE score of 6 increased by 4,600 percent one’s chances of becoming an IV drug user.  Individuals with an ACE score of ten faced an astoundingly high likelihood that they would find themselves living on the street, serving a life sentence in prison, or dead by their own hand.

Researchers then were able to link the high-risky behaviors of these individuals to the most common causes of disease and death in our country, including heart disease, cancer and diabetes, to name a few.  With an ACE score of 4 or more, the likelihood of chronic pulmonary lung disease increased 390%; hepatitis, 240%; depression 460%; suicide, 1,220%.

Clearly, billions of dollars are spent each year as child welfare, health/mental health, law enforcement and court systems struggle to deal with the aftermath of child maltreatment.  If we want to prevent abuse and neglect and ensure each child’s right to the safe and healthy childhood they deserve, every person - whether governor or grandmother, neighbor or legislator, mother or mayor - must make a commitment to support vulnerable parents, and reduce children’s exposure to adverse childhood experiences.  We must interrupt the trajectory that leads traumatized children to become traumatized adults who then traumatize their children.

Doing this will first require a shift in our personal and collective thinking. We cannot continue to marginalize those who engage in high risk health behaviors as being “bad people” who just lack morals and the will power to get their lives together.  As the ACE study demonstrated, many are simply trying to survive emotionally by numbing the pain and trying to erase the memories of their traumatic, dysfunctional childhoods.  Unfortunately, these survival strategies for coping work but only temporarily before they begin to create their own web of problems, such as injected drug use, alcoholism, morbid obesity, chronic depression, etc.  As a result, too many find themselves living the kind of life they swore they would never replay for their own children.

 I don’t know the reasons Baby Bella’s aunt publicly described Bella’s mother Rachelle as “a very, very angry woman” or why the mother turned to drugs, prostitution, and a string of men with their own demons.  I don’t know what drove Michael McCarthy, Baby Bella’s alleged murderer, to punch the life out of her tiny body.  But the ACE study helps me imagine why. 

How many adverse experiences rocked Michael McCarthy’s world when he was an innocent child with all the promising possibilities of life before him?  What traumas did Rachelle suffer through when she was the bright, hopeful child that was later reflected in Bella’s beautiful face?  The confirmed links between traumatic childhood experiences and later adult dysfunction and disease, does not dictate that those who hurt children should not be held accountable.  But it may help us understand why a mother who described Bella as “my love, my soul, my life” was unable to keep the most precious person in her life safe from the abuser who killed her.    

                                                                                                                                          Jetta Bernier, Executive Director
                                                                                                                MassKids ~ Prevent Child Abuse Massachusetts

 

Governor Patrick Signs Statute of Limitations Law

Survivors Moving Forward to File Civil Actions

June 26, 2014, BOSTON, MA – Today Governor Deval Patrick officially signed into law a bill that will finally provide civil relief for victims of child sexual abuse who were previously time-barred under the old law from filing charges against their alleged abusers.  After several months of behind-the-scenes negotiations among legislators, legal experts, child advocates and the MA Catholic Archdioceses, the bill passed unanimously in both the House and Senate late last week. The bill, which included an emergency provision, immediately went into effect this afternoon upon the Governor’s signing.  Given the favorable support by the legislature last week, however, many survivors already began to explore their new legal options.

Read more ...

How do the new and old SOL laws compare?

NEW LAW: Statute of Limitations for child sexual abuse - age 53
For abuse occurring from this date on, a victim can bring suit against their abuser and the supervisor or employer of the abuser, any time before their 53rd birthday.

For abuse that occurred prior to passage of the new law, a victim who was barred under the old law can now bring suit against their abuser, any time before their 53rd birthday. They are still restricted from bringing suit against the supervisor or employer of the abuser.

OLD LAW: Statute of Limitations for child sexual abuse - age 18
A victim of child sexual abuse upon reaching the age of 18 could file suit against their abuser and supervisor or employer of the abuser.

* * *

NEW LAW: Discovery Rule - 7 years
A victim of child sexual abuse now has 7 years after they reach their 18th birthday, or 7 years from the time they discover or reasonably should have discovered the harm caused by the abuse, to file a complaint.

There is NO age limit to the 7 year discovery rule, e.g. a victim abused at age 15 who does not discover the harm done until they are significantly older may still file a complaint if it is filed within 7 years after they discover the harm done or before their 53rd birthday, whichever is LATER.

The 7 Year Discovery Rule is also retroactive for supervisors and employers, e.g. a victim of child sexual abuse who is 40 years old and discovers at that time the harm done by the abuse would have until age 47 to file a complaint against the abuser's supervisor or employer. The victim would have until age 53 to sue their abuser as the time limit is the later of the two ages that is, age 53 or 47 years – 7 years from discovery.)

OLD LAW: Discovery Rule - 3 years
A victim of child sexual abuse had 3 years after their 18th birthday, or 3 years from the time they discovered or should have discovered the harm caused by the abuse, to file a complaint. There was no retroactive provision for this Discovery Rule.

* * *

NEW LAW: MA Tort Claims for child sexual abuse claims only
A written notice of intent to file a complaint against an abuser, supervisor or employer is no longer required.

OLD LAW: MA Tort Claims- 2 year notice & 3 Year SOL
There was a required 2-year written notice of intent to file a complaint for suits brought against towns, cities, governments, municipalities and a 3-year SOL.