Across Area, Dozens of Suspicious Deaths
First of two articles by Nancy Lewis, Washington Post Staff Writer
From the Washington Post, September 20, 1998


Even today, six years later, D.C. police Sgt. Bruce Feirson recalls every detail of the case of Chaulette Willis. The call that hot August afternoon came for an address in Southeast Washington that he knew well -- a crack house and heroin shooting gallery. When he and paramedics arrived, they found not an adult drug victim but a tiny 4-month-old girl.

She was dirty and reeked of an awful odor, police and medical records show. The skin beneath her unchanged diaper was raw, ulcerated, rotting. The stench in the basement apartment was almost overwhelming. Doctors found two pounds of feces in the diaper of the 10-pound baby.

Chaulette was dead on arrival at the hospital; in fact, she may have been dead for 12 hours. The D.C. medical examiner blamed sudden infant death syndrome -- usually used in an unexplained death in an otherwise healthy infant. No criminal investigation. Case closed.

"We find babies dead in horrible conditions here in [the 7th Police District] all the time," Feirson said, "and they're always coming back 'undetermined' . . . and nothing ever happens."

Chaulette's is one of 263 young children's deaths in the Washington area in recent years attributed to SIDS or "undetermined" causes. Scores more have been blamed on falls from sofas and beds and down stairs, accidental drownings and unexplained convulsions.

But dozens of these children likely were killed, either directly at the hand of another person or as the inevitable result of abuse or neglect, The Washington Post has found.

To try to gauge the true toll of this violence, The Post compiled death statistics, asked an expert to analyze them and interviewed police officers, prosecutors, doctors, child abuse experts and social workers from across the country and throughout the metropolitan area. All said they are certain numerous suspicious child deaths in the Washington region have gone undetected or been ignored.

The questions raised in the course of this reporting already have led the newly appointed D.C. chief medical examiner, Jonathan L. Arden, to reopen medical investigations into the causes of death for five children, including Chaulette, to determine whether they were homicides.

"There is a lot more child abuse than people think there is, and child abusers are not stereotypical but cross all economic and ethnic lines," said Craig Futterman, associate director of pediatric intensive care at Inova Hospital for Children in Fairfax County, one of the area's two main pediatric trauma centers. Throughout the region, children's deaths have been misexamined, mislabeled or misdiagnosed, according to interviews and a detailed review of child death statistics.

Doctors and medical examiners missed signs of injury, and the Washington area lacks the type of broad-based specialty teams that operate elsewhere in the country to immediately investigate children's deaths. Police investigations were poorly handled. Family members shielded accused relatives. And the bureaucracies assigned to flag cases of suspected abuse -- from hospitals to schools to social service agencies -- failed to respond.

Even in those area cases in which an adult was held accountable, punishment at times was minimal. In 1996 alone, a Silver Spring father punched and shook his 7-month-old and left him in a coma, a D.C. mother withheld medical care from her cancer-ridden son, and a Carroll County mother stuffed a rag into her 4-month-old daughter's mouth to quiet her. All three children eventually died. All three parents got suspended jail sentences or probation.

From scaldings to starvations to suffocations, there have been some child killings that generated public uproar, but most others passed without notice.

"All taken together, we are missing a substantial number of homicides," said Deputy Attorney General Eric H. Holder Jr., a former judge and former U.S. attorney for the District of Columbia.

The Hidden Death Toll
No single local or regional agency gathers statistics on child deaths in the Washington area. To learn how many children may have died from abuse and neglect here, The Post created a database of causes of death for the 2,379 area children younger than 5 who died from 1993 through 1995, the most recent year when complete information was available.

Of the 790 on average who died annually from all causes, only a few were officially recorded by police as homicides: 14 in 1993, five in 1994 and 10 in 1995.

Bernard Ewigman, a family practice physician and researcher in epidemiology at the University of Missouri-Columbia, analyzed the death data at The Post's request. Ewigman and his research team have devised a mathematical formula for estimating how many childhood deaths attributed to "external causes" -- which include anything that is not a disease or a condition the child had at birth -- are in fact attributable to abuse or neglect. The method evolved from a landmark study the team published in 1993 in which it did intensive case-by-case studies of every child death in Missouri attributed to external causes during a six-year period and determined whether the original finding was correct.

In examining the statistics for the Washington area, Ewigman said a conservative estimate is that a child a week in the region -- 50 each year -- died from abuse or neglect, far more than in official police counts or court cases.

"True accidents are rare," Ewigman said. "Fatal maltreatment is quite common -- a phenomenon that is difficult to comprehend, much less accept, for most people."

Ewigman's method makes no attempt to unmask childhood deaths that had been attributed to natural causes but were, in fact, intentional killings. Neither Ewigman's team, nor anyone else, has tried to ferret out those cases from all the childhood deaths in a given area over a long period of time.

"Of course there are deaths signed out as SIDS or natural causes that are actually caused by child abuse, and there are even more that are caused by neglect, from starvation, failure to seek medical attention, failure to provide a safe environment," said Carole Jenny, director of the Child Protection Team at Hasbro Children's Hospital of Brown University in Providence, R.I. Jenny has worked as a consultant to review autopsy results and medical reports in several child death cases in this area.

Several other national and local experts, including Arden, the District's new medical examiner, reviewed The Post's database or the portions related to their expertise. All said they, too, believe an estimate of 50 abuse and neglect deaths in the region, although four to five times more than the official homicide numbers for several years, is conservative.

Futterman, who serves on the committee that reviews the circumstances of all child deaths in Fairfax County, estimates that 20 percent of all child deaths in the county -- or 15 to 20 deaths a year in recent years -- result from neglect or abuse. Those cases, Futterman said, can range from a fatal beating to fatal injuries that stem from a child's not being in a safety restraint at the time of a car accident.

Nationally, medical professionals have conducted at least three detailed studies of children's deaths from external causes over the last two decades. Each, using data from such differing locales as Chicago, New York City and Missouri, has found that deaths from maltreatment have been underreported by at least 50 percent.

Doing a better job overall of identifying the true cause of child deaths, Futterman said, would require that "kids have to matter in ways that right now they really don't."

It would also demand a willingness to suspect the possibility of killings that are almost too horrible to consider.

"The idea that parents or people close to a child could possibly injure or kill a child is just so abhorrent" that the possibility is often ignored, said Robert M. Reece, a Boston pediatrician and editor of the primary medical textbook on the diagnosis and treatment of abused or neglected children. "We are in collective denial."

Clusters of Deaths
The death data for the District and 17 surrounding jurisdictions point toclusters of deaths that demand more explanation.

In 1994 in the District, the percentage of young children's deaths attributed to an "undetermined" cause was 12.4 percent of all deaths -- five times the 2.4 percent nationally for the same category.

The D.C. police department is the de facto clearinghouse for all suspicious child death information in the District, including those children who die at Children's Hospital, regardless of where their injuries occurred. Likewise, the D.C. medical examiner's office performs the autopsies for all those children.

A special review of child deaths by the D.C. police homicide unit in late 1996 uncovered 92 cases in 1995 and 1996 -- half were children younger than 1 -- for which the medical examiner's office forwarded no final cause of death. In more than one-third of the deaths, 34, the preliminary findings stated that the cause of death was "undetermined."

Arden said that for the District to have more infants dying from unknown causes, which he described as a "wastebasket category," than from SIDS "begs for an explanation" and "raises the question of undetected smotherings."

Arden initiated a review of the 34 cases. In 14, records were missing or incomplete. Of the rest, 16 died from natural causes, one was correctly listed as undetermined, and three are now under active review as possible homicides, Arden said. He declined to identify those children.

Chaulette Willis was not on that list of 34, nor was Ebony Brown, whose case Arden reviewed at The Post's request and has now reopened to determine whether the original stated cause of death is correct.

Like Chaulette, Ebony was born prematurely and drug-addicted, medical records show, weighing but 3 pounds, 13 ounces. She didn't leave the hospital until she was 7 weeks old and soon was hospitalized again for a severe diaper rash and a viral infection. But by Sept. 15, 1994, when she was 2 months old and sent home from the hospital again, she was up to 6 pounds, 9 ounces.

Eight weeks later, Ebony was dead.

Her mother told police that she found Ebony unconscious about 8:45 a.m. that Saturday in November. A doctor at Children's Hospital pronounced her dead 45 minutes later. An autopsy found numerous healed and healing fractures, including four fractured ribs and a broken bone in her arm. She also had multiple scrapes on her tiny body and severe diaper rash. She weighed just seven pounds. In two months, she had gained less than a half pound.

The D.C. medical examiner's office ruled at that time that the cause of Ebony's death was undetermined. No criminal investigation.

Chaulette's parents and Ebony's mother could not be located for comment on their daughters' deaths.

Several medical specialists who reviewed The Post data, saw questionable patterns in other death categories.

In Prince George's County in 1994, 11 percent of all deaths of children younger than 5 were attributed to "other newborn respiratory diseases," another red-flag category, those national experts said. Only 2.4 percent of child deaths nationwide fell in that category. The county also accounted for most of the deaths attributed to that cause for all of Maryland in 1994 and 1995.

Without delving into its old cases individually, the Prince George's County Health Department said it could not comment on those newborns' deaths. The Maryland medical examiner's office declined to comment, referring questions to the county.

To get a picture of SIDS deaths, a category that has come under increased suspicion in recent years, The Post broadened its database to include causes of death for the 4,598 children younger than 5 from the District, Maryland and Virginia who died from 1992 through 1995.

In 35 rural Virginia counties and cities over a period of four years, there were 53 cases of SIDS deaths for children from age 28 days through 5 months, including some counties where every death of infants for that multi-year period was listed as a SIDS case and other counties where SIDS was the only cause listed for that age group in several of the years. Most of those counties are in rural areas, clustered in the Appalachian Mountains, the area between Petersburg and the North Carolina line, and along the Eastern Shore and the Chesapeake Bay.

Since 1993, Virginia law has required an autopsy be performed before a death can be attributed to SIDS, and that requirement, said Virginia's chief medical examiner, Marcella Fierro, leaves her confident of the SIDS findings in the clusters. "There are no child abuse deaths in those areas," Fierro said.

In addition to an autopsy -- which likely would not distinguish a SIDS death from a smothering -- the American Academy of Pediatrics recommends an extensive battery of testing and a detailed investigation, including visiting the scene at which a child was found, before making a SIDS determination. A site visit could reveal discrepancies in accounts of the incident or other evidence that would point to a different cause of death.

Both the National Center for Health Statistics and the World Health Organization have agreed that no death should be ruled as SIDS without the death investigation the pediatrics group laid out. Virginia, Fierro said, is "largely relying" on testing recommended by the Armed Forces Institute of Pathology, which does not require a site visit.

One cluster of deaths currently recorded as accidental involves children suffocated by adults who may have been drunk or using drugs and in their sleep roll over on a child. Such deaths occur throughout the area, with two such fatal incidents in the District alone within a three-week period this summer.

Ryan A. Rainey, an assistant U.S. attorney in the District who for a decade has specialized in child homicide cases here and elsewhere, said prosecutors are looking for a test case to try to show that suffocations amount to a criminal act when they result from an adult's use of illegal drugs or from alcohol abuse.

"What's the difference between suffocating a baby while on drugs or intoxicated and getting behind the wheel of a car while on drugs or intoxicated and killing someone?" Rainey asked.

Confronting the Unthinkable
If the medics and police who respond to the call for help don't ask the right questions, if the doctors who treat the child don't realize the injuries couldn't fit the explanations offered, if the medical examiner assigned the case doesn't know what clues to look for, if relatives never share their disquiet, a doubt may never be raised about a child's death.

Even when the unthinkable becomes undeniable, a child's killer may never face any consequences.

Two years ago, a 4-month-old District girl was found dead in bed, and her death preliminarily was attributed to SIDS. When toxicology tests were completed months later, the true cause of death was found to be alcohol poisoning. A District police detective was then sent back to the home, but she said there were too many people sharing it for her to determine who might have fed alcohol to the child. No one has been charged in the case.

A year ago, 14-month-old Devon McCallister, an otherwise healthy boy, an autopsy shows, was found unconscious by his father in his babysitter's apartment on 12th Street in Southeast Washington just after midnight. He was pronounced dead at D.C. General Hospital. An autopsy showed he died of morphine poisoning.

Throughout the day, according to police, Devon had been in the care only of the family and the sitter. No one has been charged in his case.

The autopsy of 8-month-old Alonzo Rajah, who died in 1996 in the District, revealed that he had died of a fractured skull and indicated that a AA battery found lodged in his throat may have been inserted after death. Alonzo's death was ruled a homicide, but his killer has not been found.

It was a second child's killing that raised questions anew about a District child's death that had been ruled an accident.

When Monica Wheeler's battered body was found in the bathroom of the apartment of her mother's boyfriend in September 1997, D.C. paramedics immediately suspected that the 4-year-old had been beaten to death. An autopsy confirmed that, and her death was ruled a homicide. The boyfriend, Michael Lorenzo Tubman, 33, was charged.

Her killing came almost exactly three years after her brother, Andre Wheeler, 2, was found drowned with bruises on his head and neck -- also while in the care of Tubman, who at the time gave various accounts of what had happened. The police homicide investigation of Andre's death ended when the medical examiner ruled it accidental. But after his sister's killing, it was reclassified -- as a homicide.

Tubman denies killing Andre. When he pleaded guilty to manslaughter in Monica's death, he asked for leniency, blaming Monica's death on his "flipping" out on drugs. Without comment, D.C. Superior Court Judge Mary Ellen Abrecht sent him to prison for the maximum term allowable: 10 to 30 years on the manslaughter charge and 40 months to 10 years on the child abuse count, to run consecutively.

Prosecutors have decided not to pursue a homicide trial in Andre's death because the medical examiner's conflicting rulings undermine the case.

Doctors, police and prosecutors struggle with the emotional toll child death cases exact.

Assistant U.S. Attorney June M. Jeffries, who handles many of the child death cases that reach court in the District, said her work can be "a rather surreal world" in which she may attend a child's autopsy, then be obliged to carry on with routine appointments.

"I feel that you should be screaming, 'This baby is dead.' And instead, we have to go to lunch."

To Bill Hammond, who conducts training sessions nationally for the U.S. Justice Department in how to investigate children's deaths, there is a sad, disturbing truth about child killings.

Too often, he said, there never is a suspicion raised, and a child's passing is forever recorded as the unfortunate consequence of disease or accident.

"The younger the child, the easier it is to murder a child, and get away with it," Hammond said.

Tomorrow: Why child killings go undetected

ABOUT THIS REPORT
As part of its reporting for this series, The Washington Post undertook a broad analysis of child deaths in the Washington area.

The analysis was conducted based on information from death certificates of 4,598 District, Maryland and Virginia children younger than 5 who died from 1992 through 1995. The information is collected by each jurisdiction and forwarded by law to the National Center for Health Statistics. It does not contain names of individuals but does group deaths by a person's age, home county or city, and cause.

Maryland declined to provide The Post with all of its data. Both Virginia and the District released data, although in the case of the District, the raw information is recoded by the center before being used in national studies. The Post acquired the Maryland statistics using public information posted on the National Center for Health Statistics site on the Internet. As a result of this process, the most up-to-date, comparable data that could be obtained for all three jurisdictions was from 1995.

The data was submitted to Bernard Ewigman, who with his wife, Coleen Kivlahan, and Garland Land, have studied child deaths that are attributed to accidents. Their six-year study, conducted in Missouri, has become the hallmark of child death investigations. In it, the researchers compared information extracted from death certificates, autopsies and medical records with reports kept by child protective services, courts, police and schools, and discovered abuse cases that had gone undetected.

From that study, Ewigman and national epidemiologists developed formulas that can be applied to raw data to unmask abuse deaths amid the deaths that officially are attributed to accidents such as falls or drownings. They applied these formulas to the death data for the Washington area provided by The Post.

In addition, The Post interviewed other specialists -- including Michael Durfee of the Los Angeles Department of Health -- about the patterns of child deaths in the Washington area. Interviews also were done with numerous doctors, forensic specialists, police officers, social service workers and others involved in child death investigations.

Invisible Victims: Child Deaths in Washington

Hundreds of children younger than 5 die in the Washington metropolitan area each year. Some die in accidents, some from disease, and some are killed. Many of these deaths are misdiagnosed or mislabeled, according to specialists, with only a few classified as homicides. A look at child deaths in the region:

Jurisdictional breakdown of deaths for children younger than 5:

Maryland 1993 1994 1995

Anne Arundel 46 52 57

Calvert 2 3 9

Charles 22 9 17

Howard 15 19 18

Montgomery 111 101 102

Prince George's 210 190 182

St. Mary's 19 8 22

Virginia

Alexandria 29 18 13

Arlington 29 8 22

Fairfax 93 86 80

Fairfax City 3 0 3

Falls Church 1 0 0

Fauquier 6 9 5

Loudoun 15 18 9

Manassas 5 6 2

Manassas Park 3 0 4

Prince William 36 32 31

D.C. 219 210 170

Undetermined Deaths
The District uses "undetermined" as a cause of death much more often than Los Angeles or national averages.

Below are statistics showing undetermined baby deaths nationally, for the District and for Los Angeles, which has a comprehensive child fatality review team.

Undetermined deaths

'93

D.C. 9.6%

National 2.7%

L.A. .48%

'94

D.C. 12.4%

National 2.4%

L.A. 1.9%

'95

D.C. 6.5%

National 3.0%

L.A. 2.7%

Looking for a Cause of Death
Properly investigating a child's death is time-consuming and expensive. Medical professionals cite several "wastebasket categories" for causes of death that are used when a cause cannot be firmly established, including "other respiratory diseases," "unknown causes" or SIDS.

Below is a breakdown of the child deaths from 1993 through 1995 that fell into these three categories and their percentage of the total deaths for children younger than 5.

Maryland SIDS Undetermined Respiratory* Percentage of total deaths

Anne Arundel 16 3 2 13.5%

Calvert 1 0 0 8

Charles 5 2 1 17

Howard 5 0 0 10

Montgomery 17 5 13 11

Prince George's 41 18 48 18

St. Mary's 6 0 2 16

Virginia
Alexandria 2 0 0 3%

Arlington 4 0 1 8.5

Fairfax 23 1 6 12

Fairfax City 1 0 0 17

Falls Church 0 0 0 0

Fauquier 1 0 0 5

Loudoun 3 0 0 7

Manassas 2 1 0 23

Manassas Park 1 0 0 14

Prince William 10 0 2 12

D.C. 32 58 32 20

*Other newborn respiratory diseases

SOURCE: Virginia, D.C. death certificates, National Center for Health Statistics (for Maryland data).

Copyright 1998 The Washington Post Company


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