Advocates: Bucks, Pennsylvania reports missed day care violations in Bristol Township toddler death

Posted April 1, 2018

After a 19-month-old girl died last year in the care of a Bucks County babysitter who strapped her in a car seat for a nap, local child abuse professionals dug into what went wrong and how similar tragedies could be prevented.

Their recommendation -- better car seat education for parents.

Alivia Sawicki died while being cared for 

Pennsylvania’s Department of Human Services, which had a representative at the local review, agreed with the findings in its subsequent report. The Bucks County District Attorney’s Office, also present at the review, found no laws were broken.

But months later, after the state and local reports were released, outside child advocates found both reviews overlooked apparent violations of state standards for child care providers including whether the babysitter was state licensed.

The report states the babysitter was watching nine children the day Alivia Sawicki died, but it says nothing about whether that contributed to her death. The report’s recommendations focused solely on car seat safety.

The review report stands in stark contrast to two other near-death reviews last year involving Bucks County infants also harmed while in the care of a babysitter who was not a family member. One of those incidents occurred three days before Alivia died and the second about a month later, according to the county and state reviews obtained by this news organization.

Both of those local and state reviews made recommendations that focused on child care issues.

Pennsylvania law makes county child welfare agencies responsible for convening a review team when a child death or near death is substantiated as abuse or neglect or the agency hasn’t made an abuse determination within 30 days after the incident.

The county review team should include at least six individuals with expertise in the prevention and treatment of child abuse. Early childhood development professional is among the individuals suggested, but not required. The state review team consists of child welfare department representatives.

The county Act 33 team reviews:

• The circumstances of the fatality or near-fatality.
• The delivery of services provided (if any) by the county agency (or contractor) to the child, his/her family and the alleged perpetrator.
• Relevant court records and documents.
• The county agency’s “compliance with statutes and regulations and with relevant policies and procedures.

The county team issues a report that does the following:

• Identifies deficiencies and strengths related to compliance with statutes and regulations and service delivery to children and families.
• Recommends changes at the state and local levels related to reducing the likelihood of future incidents.
• Recommends changes at the state and local levels on monitoring and inspection of county agencies and collaboration of community agencies and service providers to prevent child abuse.

The state DHS review and report addresses:

• The circumstances of the child’s fatality or near fatality and the nature and extent of the review.
• Statutory and regulatory compliance by the county agency and any other county where the child resided within the 16 months preceding the incident, and its findings.
• Recommendations for reducing the likelihood of future incidents.

The apparent disconnect between the circumstances surrounding how Alivia died and the findings of two state-mandated investigations into her death raises questions about how the reviews were done. Under a 10-year-old law called Act 33 of 2008, local and state child welfare and abuse experts are required to conduct separate, in-depth reviews when a Pennsylvania child dies, or nearly dies, under suspicious circumstances.

The purpose of the local and state reviews is to provide a window into the normally confidential world of child abuse and neglect probes, identify strengths and weaknesses in systems that serve children and families, and highlight emerging trends that might endanger children, according to the law.

But child advocates contend that Alivia’s case magnifies what happens when the state-mandated reviews focus narrowly on the role child service systems played in an incident, while overlooking details identifying broader issues that impact communities, such as the potential dangers of unlicensed child care providers.

“This one child’s death is showing how complicated and convoluted the whole Act 33 process has become,” said Cathleen Palm, founder and executive director of the Center for Children’s Justice in Berks County. “Often the main topic is what did child welfare do or not do, instead of what are the root causes of what happened or contributed to the death.”

•

Alivia suffocated to death on June 16, 2017, after she was not properly strapped into a car seat for a nap and left in a second floor bedroom unchecked for an hour, according to authorities and the death review.

The review reports stated that when she was found by a 14-year-old relative of the babysitter who went to wake her, it appeared the chest buckle on the car seat pressed into her neck when the toddler tried to get out of the seat.

The babysitter, Jaimee Lee Gorman, 36, of Bristol Township, was watching nine children the day Alivia died, the reports said, adding that Gorman sometimes watched up to 13 children a day.

Pennsylvania requires state licensing for child care providers who watch four or more children at a time who are not their own children, grandchildren, foster children or stepchildren. Licensed child care providers also must follow quality and safety standards including requirements that children be supervised at all times. It also forbids the use of ties or straps to restrain a child’s movement. Forbids volunteers under age 16 from assisting child care providers. Operating an unlicensed facility is illegal.

It was not until eight months after Alivia’s death, when this news organization started an investigation after obtaining copies of the death reviews, that the district attorney’s office reopened its criminal investigation into Gorman, who was charged March 9 with operating an unlicensed facility, a third-degree felony when a death occurs.

Bucks County Children and Youth Director Lynne Kallus-Rainey said in an email that the number of children in Gorman’s care was discussed at the July 12, 2017 death review meeting. The county report redacted the names of panel participants, but noted attendees included police, the county coroner’s office, county and state child welfare representatives, the county’s mental health department and drug and alcohol commission, and the Network Of Victim Assistance.

A Bucks County social worker assigned to the case, who also participated in the review, said she had “numerous” conversations with authorities after Alivia’s death about the number of children in the Gorman home, Kallus-Rainey added. A state DHS representative participated in the review. Bucks County Children and Youth officials also notified the state licensing bureau about the number of children in Gorman’s care after it received a report about Alivia’s death, Kallus-Rainey added.

But no details about those child care discussions made it into the six-page report. The local and state reviews mentioned only that Gorman was no longer watching any children, had moved out of the Bristol Township home after the death, and Gorman was not related to Alivia or her 3-year-old brother, who was also left in her care.

DHS spokesman Colin Day confirmed a licensing investigator went to the Gorman house twice after Alivia’s death, but no one was home. The case was closed after “authorities” said children in Gorman’s care the day of the death were all family members, which would exempt her from licensing requirements and regulations, Day said in an email response to questions.

But according to the probable cause affidavit in Gorman’s criminal case, she told Bristol Township police that she did not have a state license to provide child care services and that more than four of the children she was watching the day of Alivia’s death were not related to her.

It is unclear whether Bristol Township police, who have not responded to requests for comment about its investigation, participated in the county death review. The report redacted the name of the participating police department.

Kallus-Rainey declined comment on whether the relationship between Gorman and the children she was watching was made clear to the review team, stating she could not comment on items not included in the written report.

•

Under the Act 33 law, county review teams must have six members with knowledge in the prevention and treatment of child abuse. It encourages, but does not require, including individuals with early childhood education and child care knowledge and experience.

Alivia Sawicki

The second-level state review is done by representatives of the Bureau of Children and Family Services, the Bureau of Policy Programs and Operations, and the Deputy DHS Secretary’s office, according to the law.

None of the 19 Bucks County panelists who participated in Alivia’s death review had any identified child care experience, according to the report. Bucks County had a licensed day care operator as a regular review team member until the person moved out of the county, Kallus-Rainey said. She did not recall when the person left, but said it was before Alivia’s death. 

Local child advocates believe that had a child care professional been part of the review, the final report would have flagged the state violations and connected the alleged unlicensed nature of the home in the recommendations.

“In this particular situation, someone with that type of background and experience may have delved into some of the aspects of the case that were not as fleshed out as much because they have a greater knowledge and background of the law,” said Haven Evans, a training director with the Pennsylvania Family Support Alliance.

The number of children Gorman was watching highlights the need for better oversight and training for family day care home operators and a statewide media campaign educating parents what to look for in out-of-home child care -- not better car seat education for parents, said Frank Cervone, executive director of the Support Center for Child Advocates in Philadelphia.

“This review would have been more meaningful with a child development professional at the table to help the group think about how much time and attention each child might demand,” Cervone added. “As well the rules and regulations on child care are themselves technical, suggesting need for a child care expert in case of such as this.”

Palm added that even if a local review misses something involving regulations or child services, the state review should connect the dots, since it oversees child welfare, services and programs and has that deeper knowledge base.

“The review doesn’t mesh with circumstances of the death,” Palm said. “If the state was really seriously looking at the report, they shouldn’t have missed the violations.”

Conjoined ‘miracle babies’ successfully separated

Posted March 25, 2018

Desiree Hall is no different than most parents. The Northampton mother could talk for hours about each of her six children.

Desiree Hall, her twins Vinny and Joey, and Hall's brother

Her 10-year-old loves puns and has his own YouTube channel, and her 8-year-old helps care for her brothers and sister. Her 7-year-old buys presents for his siblings with his own money. The family’s 4-year-old, who Hall thought would be her last, talks about being a mommy, too, someday.

Then there are her youngest — identical twins, Vincent and Joseph, born Jan. 5.

These two have a special bond, literally. They spent the first six weeks of their lives connected to each other.

“They’re my miracle babies,” Hall said.

The Fiore brothers were born conjoined, an anomaly that occurs one in every 50,000 to 60,000 births, according to the Children’s Hospital of Philadelphia. Other studies suggest conjoined twins occur in 1 in 100,000 births.

Even more rare are conjoined twins who survive and can be successfully separated. The Fiore brothers are only the 25th pair of conjoined twins since 1957 successfully separated at CHOP, which claims it has separated more conjoined twins than any other hospital in the western world.

Most conjoined twins share at least one vital organ or system and conjoined girls are more common, according to the Mayo Clinic, which is what makes the Fiore boys even more unique among this most unique type of twins.

Doctors initially worried that scans showed the boys shared a liver, which would make separation riskier.

But when they underwent surgery on Feb. 20, the medical team found the boys’ livers were overlapping, making it appear they were one, said Dr. Holly Hedrick, the surgeon who performed the surgery at CHOP.

Did you know?

Since 1995, 40 pairs of conjoined twins from around the world have undergone prenatal evaluation at Children’s Hospital of Philadelphia’s Center for Fetal Diagnosis and Treatment. Before the center opened, CHOP doctors began care for conjoined twins after they were born at another hospital.

“They had the very, very, very best situation,” Hedrick added.

Making the very best out of any situation is something that comes naturally to Hall, 33, a single mom. She struggles with health issues while raising her children, as well as taking care of her elderly grandparents who took in Hall when she was 12. First her unique pregnancy, then her health issues combined with her terminally ill grandfather have made her unable to work, she said.

“I’ve just been trying to pray and take it day by day. Financial issues are definitely a stress but I’m so grateful because I know my boys are a miracle and I’m blessed to have them. So I’m trying to not sweat the money end of things,” she said.

Amazing lady

Hall had no plans to expand her family last year. When she developed symptoms that she attributed to a flare up of lupus, an autoimmune disease she was diagnosed with at age 25, she went to the doctor. The news she was pregnant left her stunned. Until a few weeks later, when Hall learned she was having twins who were due in early March.

Twenty-two weeks into her pregnancy, the doctor told her it appeared the twins were conjoined.

Hall was dumbfounded but resolute to carry the babies as long as she could.

“God doesn’t give you more than you can handle,” she said.

The twins are the first children for her boyfriend, who declined to be interviewed, but Hall said he is looking forward to watching them grow up.

Truth be told, Hall wasn’t expecting a good outcome with the pregnancy. She studied nursing in college. She knew conjoined twins have a high rate of miscarriages, still births, and low survival rates even after they are born. She joined a social media group for parents of conjoined twins where the stories often had heartbreaking endings.

“I was too scared to be excited,” Hall said.

While Hall prayed for the best outcome, she prepared for the worst, she said. She didn’t buy anything for the twins. She didn’t want a baby shower.

As it turned out, she didn’t need one.

Employees at Holland Elementary School, where three of Hall’s children attend, stepped in, Principal Joseph McClay said. Employees held a drive to collect baby essentials like diapers, clothes, toys and a pack-n-play for the twins and items for Halls older children, McClay said.

The staff took up a collection so Hall’s kids could attend the after-school daycare program, allowing Desiree to spend more time with the twins at CHOP after they were born.

Recently, the school organized a dress-down day where staffers donated money to wear casual clothes to work. They collected nearly $2,300 in contributions from employees, their family and neighbors. The money was used to buy car seats, a stroller, crib, changing table and high chairs.

“Desiree is an amazing lady. She cares for her grandparents and has always kept such a positive outlook despite the ups and downs that were in front of her,” McClay said. “Her children are wonderful kids. We looked forward to the day when Vinny and Joey come to Holland as kindergartners and we get to be reminded each day that they’re miracle children.”

So blessed

Three of Hall's other children with twins Vinny and Joey 

The Fiore boys — who weighed a combined 8 pounds — were delivered by C-section after Desiree went into labor about two weeks before doctors had scheduled the surgery, she said. Initially, the premature babies required breathing and feeding tubes, but they were weaned as they grew bigger and stronger.

The boys were joined at the abdominal wall. Roughly 75 percent of conjoined twins are connected at the chest wall or upper abdomen so the babies face each other, according to CHOP. They shared a diaphragm and xiphoid process (the cartilage at the end of the breastbone), which could be divided. Each Fiore twin had separate GI tracks and other abdominal organs, Hedrick said.

Surgery to separate conjoined twins can range from relatively easy to complex depending on the point of attachment and the internal parts that are shared, Hedrick said. Often, surgery results in the death of one or both twins, particularly if they are joined at the head or share a vital organ, she added.

Typically, conjoined twins who are candidates for separation can’t undergo the surgery for months because their bodies need to get stronger (conjoined twins are typically born premature), and doctors need to monitor their bodies and prepare and plan the surgery. Conjoined twins are often implanted with tissue expanders to grow the necessary soft tissue to cover and close at the separation points, Hedrick said.

The Fiore twins had to wait only a little more than a month after their birth before they could be separated because they didn’t share any major organs and didn’t require extensive skin grafts, Hedrick said.

The surgery took about three hours, Hedrick said. Each boy had his own color-coded medical team: blue for Vincent and green for Joseph.

“This is straightforward and we’re always grateful when things are straightforward,” the doctor said.

The boys were discharged from CHOP on March 8. Doctors will continue to monitor the brothers, who now each weigh a little over 6 pounds, to make sure they hit their developmental milestones.

Doctors also will watch for medical issues. Vincent has a slight heart defect. The brothers could develop hernias where implanted mesh was used to complete their once-shared abdomen walls. But otherwise Hedrick doesn’t predict any lasting consequences — other than faux belly buttons and 4-inch chest scars.

The brothers often can be found hugging each other, mimicking how they came into the world, Hall said. She added that they get cranky when they are too physically far apart, but calm down when they are moved close together.

“They do miss each other,” she said.

The twins’ brothers and sisters love taking turns holding them and feeding them. They even fight over who gets to read them books.

“I’m so blessed. My kids are so good,” she said.

Big sister Gabrielle, 8, loves to help feed her brothers. On a recent snow day, instead of sleeping in, she got up to help Desiree give the boys their morning bottle. Gabrielle thought it was cool that her brothers were connected, because they hugged a lot, she said.

Big brother Carl, 10, was surprised he was getting two little brothers, but he said he is happy.

“It’s pretty fun to have them around,” he said. “If I’m feeling sad, they’re very cute and they’ll probably cheer me up.”

And while Hall loves kids, six is more than enough, she said.

“Oh, we are done,” she said. “I’m so done.”

Local child advocates will watch Pennsylvania Supreme Court case involving prenatal drug use

April 11, 2018

Pennsylvania child advocates are closely watching an upcoming state Supreme Court case that will decide whether a woman’s use of narcotics while pregnant is considered child abuse, in a state where at least five babies a day are born dependent on prescription and illegal drugs, according to new state data.

“I can see there is a concern, but I will tell you this, from my perspective, this would be absolutely disastrous,” said Angela Liddle, CEO and president of the Pennsylvania Family Support Alliance in Harrisburg. “I cannot see anyone who works in the child welfare area saying that this is a good thing, and in the long run that it will better protect the child.”

The state’s highest court last week agreed to hear a case involving a Clinton County mother, identified in court records as “A.R.,” who gave birth in January 2017 to a child — identified in court records as “L.B.” — who subsequently was diagnosed with neonatal abstinence syndrome, a collection of symptoms frequently associated with opiate and opioid withdrawal that include fever, seizures and tremors, vomiting, inconsolably crying, feeding and sleep difficulty.

The mother later tested positive for marijuana, benzodiazepines and suboxone, the latter a drug commonly prescribed pregnant women with opiate use disorders, but she did not have a prescription for the drugs, which made the use illegal, according to court records in the case.

The hospital reported the newborn to local child welfare authorities, as required under a 2003 federal law that requires child protection workers assess the family home environment and create a plan of safe care for newborns who show signs of narcotics withdrawal. County child welfare filed for emergency protective custody of the infant and in its petition the agency alleged the newborn was a “victim of child abuse,” noting the newborn had been hospitalized for 19 days for treatment.

Commonwealth court agreed to put the child in state custody, but decided that the mother’s actions were not considered child abuse under the civil Child Protective Services Law since the law does not apply to a fetus.

In December, though, the state Superior Court reversed the lower court, stating while a fetus does not meet the definition of a “child” under the state law, after the infant was born — diagnosed and treated for NAS — the abuse definition was met. The appeals court decision cleared the way for a child abuse finding to be filed against “A.R.,” which could restrict her ability to interact with children in the future.

Local child advocates condemned the idea of including prenatal drug use in the definition of child abuse. They cited the near universal recognition among medical and public health organizations that substance abuse is a chronic medical condition and abruptly stopping opioid or opiate use during pregnancy places a mother and fetus is potentially life-threatening to both.

“If substance abuse during pregnancy is defined as child abuse, women may be less likely to seek treatment during pregnancy or to discuss their drug use with health care providers,” said Daniel Miringoff, Chief Community Program Officer at the Family Service Association of Bucks County, one of Pennsylvania’s Center of Excellence for opiate use disorder care. “This could lead to negative consequences for both mother and baby. We want pregnant women to open up about addiction, and that is best done when we recognize and treat addiction as the illness it is.”

Advocates added that the case touches on constitutional issues that could have broad implications for pregnant and child-bearing age women and it could open a door to other prenatal actions being considered as child abuse including smoking, eating raw fish, staying with an abusive partner and traveling to countries with health advisories such as during the 2015-16 Zika outbreak.

In Pennsylvania, parental substance abuse does not meet the definition of child abuse, meaning a parent cannot be found to have committed abuse or neglect against a child based only on drug use.

Fourteen other states and the District of Columbia include prenatal narcotics exposure in their state definitions of child abuse or neglect, as of 2015, the most recent year statistics were available through the Child Welfare Information Gateway, a federal information service.

Cathleen Palm, the founder and executive director of the Center for Children’s Justice in Berks County, noted that Congress has consistently reinforced that its 2003 mandate that local child welfare authorities develop a plan of safe care for infants with prenatal drug exposure is not a punitive measure, but a protective one.

Palm was among the advocates who wondered if the high court found prenatal narcotics exposure meets the state’s child abuse definition, how it would impact women properly taking prescribed opiate replacement drugs, known as Medication Assisted Treatment. MAT is a commonly prescribed therapy for pregnant heroin abusers as part of drug treatment, but it carries the same risk of developing NAS in newborn as taking illegal opiates.

“That seems to become a pretty slippery slope,” Palm added.