A.A. was a child born in 2021 with short bowel syndrome, a medically complex condition requiring a central line for nutritional feedings and frequent dressing changes. On July 14, 2022, a medical professional reported to DCYF that A.A.'s mother was not following the care plan, and A.A. had been hospitalized four times for central line infections. A CPS investigation was opened and a caseworker monitored the family, but the mother repeatedly missed or was late to medical appointments and was inconsistent with A.A.'s care. On August 15, 2022, DCYF was notified that A.A. had died of cardiac arrest. Initially, no autopsy was planned and the death was attributed to medical causes. However, on September 13, 2022, DCYF learned that an autopsy had been completed revealing 11 fractures of varying ages and a lacerated spleen, injuries consistent with non-accidental trauma. A.A.'s sibling was subsequently placed in out-of-home care, and a law enforcement investigation was ongoing at the time of the report.
Contexts/Conditions
Is there any mention of child drug ingestion or overdose?
Is there any mention of a drowning incident (either intentional or accidental)?
Is there any mention of a firearm incident?
Is there any mention of inappropriate supervision (e.g., child wandered off and drowned)?
Is there any mention of inflicted injury? (e.g. slapped, punched, kicked, choked)
The fatality report states that the medical examiner found "A.A. had 11 fractures of varying ages and a lacerated spleen" and that the reporting party "stated that these injuries were likely due to non-accidental trauma." The presence of 11 fractures of varying ages and a lacerated spleen constitutes clear evidence of inflicted injury.
Is there any mention of malnutrition, starvation, or dehydration?
Is there any mention of medical neglect?
The fatality report explicitly describes medical neglect. On July 14, 2022, "a medical professional contacted DCYF to report concerns that A.A.'s mother was not following A.A.'s care plan to meet medically complex needs." A.A. required a central line for nutritional feedings and dressings that needed to be changed every seven days to prevent infection. The mother repeatedly missed or was late to medical appointments. The committee discussed "allegations of medical neglect" and suggested DCYF employ nurses to "assess medical needs for cases involving complex medical diagnosis or allegations of medical neglect."
Is there any mention of a motor vehicle crash or incident?
Is there any mention of a murder-suicide incident?
Is there any mention of outdoor elements (including hot car deaths)?
Is there any mention of prenatal substance exposure (including fetal alcohol syndrome or neonatal abstinence syndrome)?
Is there any mention of sexual abuse?
Is there any specific mention of shaken baby or abusive head trauma?
Is there any mention of prolonged abuse or torture (including restraints, captivity)?
Is there any mention of an unsafe sleeping environment?
Individuals Involved
Was an adoptive parent or guardian involved in the death?
Was a biological father involved in the death?
Was a biological mother involved in the death?
The fatality report indicates A.A.'s biological mother was the primary caregiver and the subject of medical neglect allegations: "A.A.'s mother was not following A.A.'s care plan to meet medically complex needs." A.A. died while in the mother's care. The autopsy revealed non-accidental trauma (11 fractures, lacerated spleen), but the perpetrator of the physical injuries was not identified and "There is an on-going law enforcement investigation at the time of this report." A.A.'s sibling was "placed in out-of-home care due to the unexplained injuries of A.A.," suggesting the home environment (under the mother's care) was deemed unsafe. The mother's role in the death is not confirmed but is a reasonable inference given she was the primary caregiver and the subject of the investigation.
Was a day care worker, babysitter, or nanny involved in the death?
Was a female paramour or friend involved in the death (e.g., girlfriend, stepmother)?
Was a foster parent involved in the death?
Was a male paramour or friend involved in the death (e.g., boyfriend, stepfather)?
Was another adult relative involved in the death? (e.g., grandfather, aunt)
Was a sibling involved in the death?
Child Characteristics
Was the child adopted?
Was the child homeschooled (including "cyberschooling") or taken out of school?
Was the child in foster care at the time of the incident?
Was the child living with relatives at the time of the incident (but not parents)?
Is there any mention of a neurological developmental child disability? (e.g., autism, intellectual disability, nonverbal)
Is there any mention of a physical child disability? (e.g., feeding tube)
The fatality report states A.A. "had medically complex needs due to a diagnosis of short bowel syndrome and required a central line for nutritional feedings." A central line is a medical device providing intravenous nutrition, functionally analogous to the feeding tube example given in the question. The child's medical condition constituted a physical disability requiring ongoing medical intervention.
Is there any mention of prematurity or low birthweight?
Is there a history of child protection reports prior to death (for this child or siblings)?
The fatality report states that on July 14, 2022, "a medical professional contacted DCYF to report concerns that A.A.'s mother was not following A.A.'s care plan." A CPS investigation was assigned and was open at the time of A.A.'s death on August 15, 2022: "At the time of A.A.'s death, the family had an open Child Protective Services (CPS) case." This constitutes a history of child protection reports prior to the child's death.
Does the child have a history of foster care (but not in care at time of incident)?
Is there a history of a sibling death (separate incident from this death)?
Parent/Caregiver Factors
Was an adult charged or arrested for the child's death?
Is domestic violence by the parent/caregiver referenced?
Is there any mention that the death occurred in a temporary shelter or while homeless?
Is an intellectual disability of the parent/caregiver referenced?
Is the mental health of the parent/caregiver referenced?
Is a history of arrests or criminal charges for the parent/caregiver referenced?
Is substance use by the parent/caregiver referenced?
Notable Details
The fatality report describes significant systemic and workforce issues that affected the handling of A.A.'s case. The CPS caseworker "was employed less than six months prior to receiving this case assignment," there was a supervisory change mid-case, and the new supervisor "had recently transitioned to supervision of this unit approximately two weeks before A.A.'s death and said they were carrying 15 cases." The Committee noted "high vacancy rates, and a workforce of many new field staff and supervisors." Critically, "the agency requested medical records, but neither the caseworker or supervisor read the records," and the initial supervisor's guidance was to "mediate the relationship between the mother and [the hospital]" rather than focus on assessing child safety. After A.A.'s death, the field office initially "screened out" the case because "no autopsy would be conducted and DCYF believed A.A. died due to medical condition." It was only a month later, on September 13, 2022, that DCYF was notified of the autopsy results revealing non-accidental trauma. The Committee's primary recommendation was the creation of a "Health Lead" position to provide consultation on medically complex cases.
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