Is there any mention of child drug ingestion or overdose?

The ME report (WA_24_2833.pdf) lists the cause of death as "Acute fentanyl, carfentanil, and methamphetamine intoxication." The fatality report (mk-cfr-final-redacted.pdf) states that "M.K. had methamphetamine and fentanyl in [their] system at the time of [their] death" and that "law enforcement found heroin and fentanyl on the counter in the kitchen as well as drug paraphernalia within reach of M.K." This clearly establishes that the child ingested/was exposed to lethal substances.

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

The fatality report states that prior intakes included "concerns for lack of supervision." At the time of death, "law enforcement found heroin and fentanyl on the counter in the kitchen as well as drug paraphernalia within reach of M.K. and [the] five-year-old sibling." Additionally, on June 22, 2023, "the parents were smoking fentanyl in the room with their children present." These constitute clear evidence of inappropriate supervision.

Is there any mention of malnutrition, starvation, or dehydration?

The fatality report states that in April 2022, a relative reported that "the parents are not adequately feeding the child" (referring to M.K.'s sibling). While this is an allegation of inadequate feeding rather than a confirmed diagnosis of malnutrition, starvation, or dehydration, it constitutes a mention of a feeding concern related to the family.

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

The fatality report states that in October 2022, "an intake screened in for a FAR assessment. This intake alleged parental substance use and identified that the mother was pregnant." M.K. was born in January 2023. The caseworker subsequently "arranged for transportation for both parents to their withdrawal management programs," implying the mother was actively using substances during the pregnancy with M.K. While no explicit diagnosis of prenatal substance exposure (such as NAS) is mentioned, the context strongly implies the unborn child was exposed to substances in utero.

Was a biological father involved in the death?

The fatality report states that "Both M.K.'s mother and father were found to be negligent as to both M.K. and [the sibling]. The parents received founded findings of negligence from DCYF." The child died from drug intoxication while in the care of both parents, and drugs were found within reach of the child. The biological father was involved in the death through negligence.

Was a biological mother involved in the death?

The fatality report states that "Both M.K.'s mother and father were found to be negligent as to both M.K. and [the sibling]. The parents received founded findings of negligence from DCYF." The child died from drug intoxication while in the care of both parents, and drugs were found within reach of the child. The biological mother was involved in the death through negligence.

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

The fatality report explicitly states: "Prior to M.K.'s death, DCYF received eight intakes regarding [the] family. Of the eight intakes, five screened in for CPS investigations and the three others did not screen in. The allegations in the screened in intakes included concerns for lack of supervision and parental substance use." This establishes an extensive history of child protection reports prior to the death.

Is domestic violence by the parent/caregiver referenced?

The fatality report states: "The caller, a relative, reported domestic violence (DV) occurred a year earlier when the father threw the mother into something (unknown what she hit)." Additional discussion of DV assessment appears throughout the Committee Discussion section, including that "DCYF has a policy requiring that domestic violence is assessed at different times throughout a case."

Is the mental health of the parent/caregiver referenced?

The fatality report states regarding the June 2023 intake that "mother was diagnosed with an [redacted]" and "the father was diagnosed with [redacted]." It further notes that "Both parents were receiving mental health care through the same provider as their substance use treatment." While the specific diagnoses are redacted, mental health diagnoses and treatment for both parents are explicitly referenced.

Is substance use by the parent/caregiver referenced?

Parental substance use is a central theme throughout the fatality report. The report states: "both tested positive for methamphetamine, morphine, codeine, and heroin." The June 2023 intake states "the parents were smoking fentanyl in the room with their children present." The parents "continued to have positive tests for substances including, but not always limited to fentanyl" and "openly admitted to the FVS caseworker that they continued using substances." At the time of death, "law enforcement found heroin and fentanyl on the counter in the kitchen."

The fatality report describes several significant systemic issues. First, the Committee discussed the impact of HB 1227 (Keeping Families Together Act) and SB 6109, noting confusion around the term "great weight" when courts determine whether children remain with parents, stating this "may contribute to continued frustration for DCYF staff who believe an active safety threat exists and children are not able to safely remain in the physical care of their parent/guardian." Second, despite the parents "openly admitted to the FVS caseworker that they continued using substances" and having positive tests for fentanyl, DCYF did not file a dependency petition because the parents were willing to engage in voluntary services and the caseworker "did not have any information other than the parental substance use to identify immediately physical danger to the children's safety." Third, the Committee discussed how parental likeability bias may have contributed to less scrutiny, noting "multiple caseworkers in the last two years identified that the mother specifically was engaging and likeable and the Committee was concerned that this may have contributed to less curiosity or less work to confirm information she provided." Fourth, FVS caseloads of 20 families per caseworker were deemed unmanageable. Fifth, the ME report identifies carfentanil as a contributing substance in the cause of death, which is not mentioned in the DCYF fatality report.