Is there any mention of inappropriate supervision (e.g., child wandered off and drowned)?

The fatality report describes the parents placing the 10-month-old child to sleep on a couch with a pillow under her head and a t-shirt as a blanket, which subsequently covered the child's nose and face. Allegations of "Inadequate Guardianship" were made against both parents. The parents also co-slept with the infant on an adult-sized bed. These arrangements reflect inappropriate supervision of an infant during sleep.

Is there any mention of medical neglect?

The fatality report states: "The SC had a doctor appointment scheduled for 4/10/22, that the SM reported was missed due to transportation issues. Hospital staff noted that if the SC's death was related to an underlying medical condition, it may have been caught at this appointment." The child was last seen by a pediatrician on 1/6/22, nearly four months before her death. Additionally, the child was noted to be "acutely ill during the two weeks before death." While no formal "Lack of Medical Care" allegation was made against the parents for the subject child, these circumstances imply medical neglect concerns. A separate "Lack of Medical Care" allegation was substantiated against the mother of the 2yo cousin in the 09/28/2021 CPS investigation.

Is there any mention of prenatal substance exposure (including fetal alcohol syndrome or neonatal abstinence syndrome)?

The fatality report states: "BCDSS learned that the SC was born with a positive toxicology for marijuana." Additionally, under the "Infants Under One Year Old" section, "Used illicit drugs" is checked for the mother during pregnancy, and "Drug exposed" is checked for the infant's birth status.

Is there any mention of an unsafe sleeping environment?

The fatality report extensively documents an unsafe sleeping environment. The father "moved the subject child to a couch, where he put a pillow under the subject child's head and covered her with a t-shirt, as a blanket." When the parents awoke, "the t-shirt and pillow were covering her nose and face." The report also states: "the parents had recently been evicted from their home and had been staying at the 20yo MU's residence for approximately one week and therefore did not have safe sleep accommodations at the new residence. The SF reported the SC normally slept in a portable crib at their previous residence; however, co-slept with the parents or slept on the couch since moving." Additionally, the SM "observed the SF with his arm over the SC" and "felt the SF was putting too much pressure on the SC" while co-sleeping on an adult-sized bed.

Was a biological father involved in the death?

The father is listed as an "Alleged Perpetrator" for DOA/Fatality, Inadequate Guardianship, and Inadequate Food/Clothing/Shelter. He is the one who placed the child on the couch with a pillow and t-shirt, co-slept with the child on an adult bed, and was noted by the mother to have had his arm over the child with too much pressure. The fatality report identifies him as the 22-year-old father.

Was a biological mother involved in the death?

The mother is listed as an "Alleged Perpetrator" for DOA/Fatality, Inadequate Guardianship, and Inadequate Food/Clothing/Shelter in the fatality investigation. The fatality report identifies her as the 19-year-old mother who was present in the room during the night of the child's death.

Was another adult relative involved in the death? (e.g., grandfather, aunt)

The 20-year-old maternal uncle is listed as an "Alleged Perpetrator" in the fatality investigation for Inadequate Guardianship and Inadequate Food/Clothing/Shelter against the deceased child. His home, where the child was residing at the time of death, had ongoing concerns about unsanitary conditions including animal feces and garbage. While he did not directly cause the death, he is an adult relative alleged to have contributed to the unsafe conditions in which the child died.

Is there a history of child protection reports prior to death (for this child or siblings)?

The fatality report documents CPS investigative history within three years prior to the fatality. The 09/28/2021 SCR report names the "Deceased Child, Female, 3 Months" as an alleged victim with allegations of Inadequate Guardianship and Parents Drug/Alcohol Misuse against the MGM and the mother. Additionally, there are multiple prior reports involving the 2yo cousin and other household children dating to 01/15/2020 and 04/28/2020.

Is domestic violence by the parent/caregiver referenced?

The prior CPS report from 01/15/2020 states: "The mother of the now 2yo cousin and the 20yo MU engaged in verbal and physical altercations in the presence of the now 2yo cousin." Both the 20yo MU and the mother of the 2yo cousin were members of the deceased child's household and alleged perpetrators in the fatality investigation. While this domestic violence is between household caregivers rather than the deceased child's parents, it is referenced in the case history. The SM's pregnancy checklist does not check "Experienced domestic violence."

Is there any mention that the death occurred in a temporary shelter or while homeless?

The fatality report states: "The parents reported that they had recently been evicted from their home and had been staying at the 20yo MU's residence for approximately one week and therefore did not have safe sleep accommodations at the new residence." While not in a formal shelter, the family was displaced from their home due to eviction and temporarily staying with a relative, lacking basic necessities for the child such as a crib.

Is substance use by the parent/caregiver referenced?

The fatality report contains multiple references to substance use by parents/caregivers. The SM used illicit drugs during pregnancy, and "the SC was born with a positive toxicology for marijuana." The 09/28/2021 CPS report alleged "the mother of the SC smoked marijuana in the home while in the presence of the 10yo MU, 2yo cousin, and then 3-month-old SC." The 01/15/2020 report alleged "the mother of the now 2yo cousin and 20yo MU abused marijuana to the point of impairment" and "the mother of the now 2yo cousin abused heroin two months prior." The MGM was also observed to have signs of possible substance misuse. Additionally, the 10yo MU's foster care placement history notes the MGM and MGF's substance misuse.

Several notable details emerge. First, there is a critical discrepancy regarding the 10yo MU's involvement: he reported being asleep during the incident, but "The MGM later reported that the 10yo MU heard the SC crying around 5:00AM and put the SC back to sleep." BCDSS was cited for failing to explore this discrepancy, which could have been significant to the investigation. Second, law enforcement noted abnormal lab values at the time of the child's death: "the subject child had a low PH, a high white blood cell count, and very high blood sugar," suggesting a possible underlying medical condition. Third, the child was marked as "acutely ill during the two weeks before death" and had missed a doctor appointment on 4/10/22 where "Hospital staff noted that if the SC's death was related to an underlying medical condition, it may have been caught at this appointment." Finally, the parents refused a reenactment requested by Broome County, and multiple discrepancies between the parents' accounts (including whether the child was found face-up or face-down) were not fully clarified by investigators.