Bianca (B.M.), a two-year-old girl, died on April 21, 2022, from septic shock caused by bacterial pneumonia, with protein-calorie malnutrition as a major contributing factor. At the time of death she weighed just 17 pounds — less than she had weighed at 9 months old — and was severely malnourished and dehydrated with no body mass. She presented at Kittitas Valley Healthcare with numerous unexplained injuries including bruising on her forehead, chin, and jaw, a second-degree burn on her hand, a severe open wound on her buttocks consistent with prolonged exposure to soiled diapers, and marks consistent with bed sores from being left in one position. Her mother, Rachel McCombs, reported the child became sick on April 17, 2022, but did not seek medical care until April 21 when the child was in critical condition. The child died during transport to Seattle Children's Hospital. B.M. had extensive prior DCYF involvement including 26 intakes, a dependency, foster care placement, and multiple CPS investigations. Her mother was subsequently charged with second-degree manslaughter.
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)?
The news article affidavit states the sibling "said it was common for them to be left to care for the younger children when McCombs left the house." On the night in question, "McCombs left the house around dusk" and left again around 9 p.m., leaving the younger sibling in charge of B.M. The fatality report also notes that allegations regarding B.M.'s siblings included "lack of supervision."
Is there any mention of inflicted injury? (e.g. slapped, punched, kicked, choked)
The news article states the autopsy found "the etiology of the blunt force injuries was unexplained" and "the medical examiner did not believe the stated cause of the injuries to the victim's ear was a reasonable cause." The fatality report notes "several unexplained marks on the child, including bruising, possible burns, a cut on bridge of nose, marks on back... bruising on lower chin and jaw, and a bruise on the right side of head." The child also had a "second-degree burn on her hand from an unknown source." The presence of unexplained blunt force injuries whose stated explanations were rejected by the medical examiner strongly implies inflicted injury.
Is there any mention of malnutrition, starvation, or dehydration?
Malnutrition, starvation, and dehydration are extensively documented. The fatality report states: "it appeared B.M. was severely malnourished and dehydrated" and "B.M. had long term and ongoing medical, nutritional, and developmental deficiencies." The news article states: "the victim weighed 17 pounds, which was later found to be less than the victim weighed at 9 months" and the autopsy showed "protein-calorie malnutrition, an indication that the child was not getting enough food." Dr. Lubin's final report identified "protein-calorie malnutrition being a major contributing factor" to death.
Is there any mention of medical neglect?
The fatality report states: "B.M.'s mother did not reach out to B.M.'s doctor or seek medical care or assistance until the day B.M. died" and "the child missed several requested weight checks at local doctor's office despite reminder letters and phone calls made by the medical provider to the mother." The child's last doctor visit was December 16, 2021, four months before death. The news article further states: "Doctor Frick stated that he believed that (the victim) would have survived had she been medically treated at least a day earlier."
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)?
The fatality report states: "a local hospital placed a hold on newborn B.M. because of the mother's substance use." Additionally, "Maternal use, domestic violence in the home, unaddressed child dental and medical needs, and maternal mental health concerns were some of the allegations cited as the basis for the dependency petition." The hospital hold on a newborn due to maternal substance use directly indicates prenatal substance exposure.
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?
The news article affidavit states the mother reported "they would either sleep together in the same bed or that the child would sleep in a pack and play." Additionally, the mother told DCYF that "B.M. fell asleep in the high chair" (fatality report), and the sibling's account in the affidavit confirms the child was left in the highchair while the mother was out. A child sleeping in a highchair is an unsafe sleeping arrangement, and the mother co-slept with the 2-year-old in the same bed. While these arrangements are not traditional unsafe sleep scenarios for an older toddler, the highchair sleeping is notably unsafe.
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 child was in the biological mother's care at the time of death. The mother, Rachel Nicole McCombs, was charged with second-degree manslaughter. The fatality report documents that the child was living with the mother, and the mother delayed seeking medical care while the child was severely ill. The news article states McCombs "is facing charges of Second-Degree Manslaughter."
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)
The fatality report documents B.M. had "long term and ongoing medical, nutritional, and developmental deficiencies." B.M. received a Birth-to-Three assessment for developmental progress, had a "neurological Magnetic Resonance Imaging (MRI)," and was noted to have "rapid correction with neurodevelopmental progress." A follow-up MRI was recommended. The combination of Birth-to-Three services, neurological MRI, and references to neurodevelopmental progress implies the child had neurodevelopmental concerns.
Is there any mention of a physical child disability? (e.g., feeding tube)
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: "From September 2012 to March 2022, DCYF received 26 intakes about B.M. and/or siblings in common with mother. Of the 26 intakes, 10 screened out. Eight intakes directly referenced B.M." Additionally, there were multiple CPS investigations and interventions throughout 2020-2022.
Does the child have a history of foster care (but not in care at time of incident)?
The fatality report states: "On Nov. 4, 2019, the court placed B.M. and siblings in a foster care or relative placement." B.M. was in out-of-home care during the dependency from November 2019 through June 2021. On Sept. 24, 2020, B.M. was returned to the mother's care in a trial return home. The dependency was dismissed on June 24, 2021. At the time of death in April 2022, B.M. was living with the mother and was not in foster care.
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?
The news article from the Daily Record states: "Rachel Nicole McCombs pleaded not guilty during her arraignment on the charge [of second-degree manslaughter] in Kittitas County Superior Court on Sept. 12." The KIMA article confirms: "the mom of Bianca, Rachel McCombs, is facing charges of Second-Degree Manslaughter."
Is domestic violence by the parent/caregiver referenced?
The fatality report documents multiple domestic violence incidents. "On Aug. 11, 2021, B.M.'s father was arrested following a domestic violence incident. B.M.'s father and partner were in an altercation and law enforcement determined B.M.'s father was the aggressor." Also, "On Jan. 28, 2022, two reports alleged B.M.'s older brothers witnessed domestic violence between B.M.'s mother and her paramour." Domestic violence was also cited in the dependency petition allegations.
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?
The fatality report states that "maternal mental health concerns" were among the allegations cited as the basis for the dependency petition.
Is a history of arrests or criminal charges for the parent/caregiver referenced?
The fatality report states: "On Aug. 11, 2021, B.M.'s father was arrested following a domestic violence incident. B.M.'s father and partner were in an altercation and law enforcement determined B.M.'s father was the aggressor." This arrest occurred in August 2021, well before B.M.'s death in April 2022, and is a separate event from the fatal incident.
Is substance use by the parent/caregiver referenced?
The fatality report states: "a local hospital placed a hold on newborn B.M. because of the mother's substance use." Additionally, maternal substance use was listed as one of the allegations cited as the basis for the dependency petition.
Notable Details
Several significant systemic and policy issues are described. The fatality report documents that in March 2022, approximately five weeks before B.M.'s death, an intake about B.M.'s 8-year-old brother being lethargic and unable to awake at school was screened out with no contact made with the family: "the CPS supervisor screened out the intake and closed the investigation after reportedly staffing with the Area Administrator. No contact was made with the family." The Committee explicitly "disagreed with the CPS supervisor and the Area Administrator's decision to screen out the intake" and noted "this incident may have been an example of DCYF's possible bias as to the mother's parental capabilities." Additionally, the mother deliberately removed B.M. from child care to avoid DCYF reports — "she had not been sending B.M. to child care for fear of ongoing reports being made to DCYF" — which the Committee identified as the removal of a critical protective factor. The Committee also identified inter-office confusion about decision-making authority due to program manager involvement, multiple caseworker turnover (three different CPS workers from August 2021 to the incident), and a new supervisor who could have benefited from internal case consultation.
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