Avril (A.R.), a 1-year-old girl, died on May 8, 2023, after being brought to the emergency department by her mother on May 7, 2023. The child was not breathing and was found unresponsive in an Everett, Washington hotel room where her mother had been smoking fentanyl. The child received epinephrine, naloxone, and 44 minutes of CPR before being intubated, but she died the following day. The mother reported that the child could have accessed fentanyl and other substances while the mother was sleeping. DCYF had extensive involvement with the family starting from the child's birth in 2022, when the mother tested positive for methamphetamine and self-reported heroin and fentanyl use throughout pregnancy. The child was born premature at 32 weeks. Multiple CPS intakes and investigations followed, with the mother repeatedly relapsing into fentanyl use. Despite the grandmother's efforts to alert CPS and the child's mother being a known active fentanyl user, the most recent CPS case was closed approximately two months before the child's death.
Contexts/Conditions
Is there any mention of child drug ingestion or overdose?
The fatality report states the mother "reported her [child] could have accessed those substances while the mother was sleeping" and that A.R. "was given epinephrine and naloxone." The KING 5 article states: "Avril was staying with her 37-year-old mother on May 7 in an Everett hotel room, where 'fentanyl was being smoked' when the child became unresponsive. Detectives believe fentanyl exposure likely led to her death." The NewsNation article refers to the death as "a suspected fentanyl 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 fatality report states the mother "reported her [child] could have accessed those substances while the mother was sleeping," indicating the child was inadequately supervised. Additionally, in August 2022, the mother "was alleged to have left the facility overnight and left A.R. in the care of a person identified as an inappropriate caregiver."
Is there any mention of inflicted injury? (e.g. slapped, punched, kicked, choked)
Is there any mention of malnutrition, starvation, or dehydration?
Is there any mention of medical neglect?
The fatality report states that "the mother did not obtain prenatal care" and the Committee discussed that "verification of statements made by A.R.'s mother would have been helpful, such as statements that A.R. was up to date with pediatric appointments and that the pediatrician did not have concerns." The lack of prenatal care and unverified claims about pediatric care suggest medical neglect, though the term is not used explicitly.
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.R. was born at 32-weeks gestation and the mother did not obtain prenatal care. At A.R.'s birth, the results of the mother's drug test indicated she had methamphetamines in her system. The mother self-reported using heroin and fentanyl." It further states: "She reported using fentanyl throughout her pregnancy." The Committee also discussed the Plan of Safe Care in the context of "prenatal exposure and identified symptoms of substance-affected infants."
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 fatality report states: "Some Committee members discussed their appreciation of documentation related to identifying an unsafe sleep environment and taking actions to rectify it immediately." This confirms an unsafe sleep environment was identified during the case.
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 states: "A.R.'s mother reported she uses fentanyl and other substances. The mother further reported her [child] could have accessed those substances while the mother was sleeping." The KING 5 article states the child was "staying with her 37-year-old mother on May 7 in an Everett hotel room, where 'fentanyl was being smoked' when the child became unresponsive." The mother brought the child to the hospital, and the child's death is directly attributed to the mother's drug use in the child's presence.
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)
Is there any mention of prematurity or low birthweight?
The fatality report states: "A.R. was born at 32-weeks gestation," which is clearly premature (full term is 37-40 weeks).
Is there a history of child protection reports prior to death (for this child or siblings)?
The fatality report states: "Prior to the intake on May 7, 2023, there were six previous intakes regarding allegations of abuse or neglect. Of those six intakes, five met the legal threshold to screen-in for either a CPS investigation or Family Assessment Response (FAR)." This also includes intakes from before A.R. was born regarding the mother's older children: "Between 2011 and 2022, there were three intakes received regarding A.R.'s mother."
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?
The fatality report states: "the mother was a victim of violence in previous relationships." It further discusses: "The lethality associated with [redacted] is much higher and warranted follow up" and "The history of violence in this case was significant, and follow-up regarding supportive mental health or survivor supports may have been helpful to the mother."
Is there any mention that the death occurred in a temporary shelter or while homeless?
The KING 5 article states: "Avril was staying with her 37-year-old mother on May 7 in an Everett hotel room." The fatality report notes the mother told the caseworker "she was staying at an [redacted] hotel" and "a friend's father was paying for her hotel room."
Is an intellectual disability of the parent/caregiver referenced?
Is the mental health of the parent/caregiver referenced?
The fatality report discusses that "follow-up regarding supportive mental health or survivor supports may have been helpful to the mother" in the context of her history as a domestic violence victim. While no specific mental health diagnosis is identified, the Committee referenced the parent's mental health needs in connection with her DV history and recommended follow-up services.
Is a history of arrests or criminal charges for the parent/caregiver referenced?
Is substance use by the parent/caregiver referenced?
Substance use by the mother is extensively documented throughout all three sources. The fatality report states the mother "self-reported using heroin and fentanyl," had methamphetamines in her system at birth, "reported using fentanyl throughout her pregnancy," admitted to "relapsing" multiple times, and her oral swab indicated recent fentanyl use. The KING 5 article describes the grandmother calling CPS "after she said she observed Avril's mother smoking fentanyl around her grandchild."
Notable Details
Several significant systemic and policy issues are described across the documents. The KING 5 article extensively discusses the "Keeping Families Together Act," a new Washington state law that raised the standard for removing a child from a parent, requiring caseworkers to prove "imminent physical harm" rather than the previous "serious threat of substantial harm," and which "prevents the state from removing children because of certain conditions in the home – including substance use – unless there is a specific connection to imminent physical danger." CPS closed its investigation in March 2023—approximately two months before the child's death—while acknowledging the mother's ongoing fentanyl addiction. The KING 5 article also reports statewide data showing that "since January 2022, fentanyl-related incidents nearly killed at least 38 youth who had prior contact with the state's child welfare system" and "at least 18 Washington kids died from fentanyl-related incidents." The fatality review committee identified that supervisor span of control was too large, reducing the effectiveness of clinical supervision; that a Plan of Safe Care was not created despite prenatal substance exposure because the caseworker believed a formal diagnosis of being substance-affected was required; and that the case was closed with items identified by supervisors left incomplete.
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