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Why Do Children Die? Declo mother Krissy Darrington and her daughters, Ellie, 8, Layne, 3, and Remi, 3 months, reminisce Aug. 4 over scrapbooks of 16-month-old Jaci, who drowned while at a babysitter’s home in 2011. JOY PRUITT, FOR THE TIMES-NEWS
New Idaho Team Searches for Links LAURIE WELCH lwelch@magicvalley.com
BURLEY • The death of any child warrants a closer look to search for ways to keep Idaho’s children safer. And there are many, the new Idaho Child Fatality Review Team concluded this spring. The state needs campaigns to educate parents about the infant health risks of smoking in the home, and about safe storage of guns and medication. Child care facilities should have policies for safe sleeping position. Baby sitters should call 911 — not a friend or relative — as the first response in an emergency. And parents should supervise young ATV riders, even when the law doesn’t require it. Those are among a long list of recommendations from the review team, established by the Governor’s Task Force on Children at Risk in 2013 under executive order from Gov. C.L. “Butch” Otter. For its April report, the team screened all 168 deaths of Idaho children younger than 18 in 2012 and pulled 78 of the cases for full review. The team requested medical, law
10 Leading Causes of Child Deaths Leading causes of death to Idaho children during 2003-2012 (10-year aggregate). Deaths due to the 10 leading causes do not account for 100 percent of deaths. For infants younger than 1
See more of the Times-News’ best work at Magicvalley. com/bigstory.
DREW NASH, TIMES-NEWS
Brooklyn, 18 months old, is dipped into the water by her mother, Carrie Wiltsie, during a ‘Water Babies’ class Aug. 13 at Twin Falls’ Y/City Pool. A new state report emphasizes the importance of water safety education for Idaho children.
enforcement and coroner reports and records from other agencies to look for
common links or circumstances. Until Otter’s order, Idaho was the only state in the nation without a child fatality review team. ••• Sixteen-month-old Jaci Darrington of Declo was a determined, busy toddler with brown eyes and curly brown hair when she slipped away from baby sitters on April 22, 2011, and drowned in the Snake River. Left unattended for a few minutes, Jaci either opened the outside door or found it cracked open, turned backward to navigate down stairs and silently walked into the swift, turbid river. Please see CHILDREN, A6
Sudden/ unexplained infant death 181
Short gestation/low birth weight 180
Congenital malformations 341
Complications of placenta, cord, membranes - 65 Accidents - 55 Neonatal hemorrhage - 39 Diseases of circulatory system - 31 Intrauterine hypoxia and birth asphyxia - 25 Respiratory distress of newborn - 24
For ages 1-17
Suicide 111 Accidents 458
lwelch@magicvalley.com
BURLEY • Public heath agencies, law enforcement, coroners, child care workers and parents all need to change their ways to help prevent child deaths, the
Idaho Child Fatality Review Team recommends. Team members will take their April report back to the agencies they represent, said Kirt Naylor, chairman of the Governor’s Task Force on Children at Risk. Some agencies already are
If You Do One Thing: The Shadows Band performs from 2-5 p.m. for a community dance at the Twin Falls Senior Center, 530 Shoshone St. W. $5 per person.
discussing how to incorporate the team’s recommendations into existing programs. Other components will wait for the governor’s office to allocate funding. G ov. C . L . “ B u tc h ” Otter’s office received the
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Homicide - 39
recommendations last month and is still reviewing them, spokesman Jon Hanian said; it’s too early to say what funding may be allocated. A sampling of the team’s recommendations:
Diseases of heart - 27 Influenza and pneumonia - 18 Tie: Chronic respiratory diseases - 10 Tie: Cerebrovascular diseases - 10 Septicemia - 9 Source: Idaho Child Fatality Review Team
Please see PREVENTION, A5
Bridge D7 Crossword D5
Malignant neoplasms - 89
Congenital malformations - 57
What Can Prevent Child Deaths? 4 Recommendations LAURIE WELCH
Maternal complications of pregnancy - 84
Dear Abby D6 Jumble D6
Sudoku D3 Obituaries B4
Opinion
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Sunday, August 23, 2015 • A5
How the Child Fatality Review Team Operates LAURIE WELCH lwelch@magicvalley.com
B URLEY • The Governor’s Task Force on Children at Risk assembled the Idaho Child Fatality Review Team in 2013, and the team’s April report on 2012 deaths was its second. The team’s members were chosen by task force members to incorporate a variety of expertise and perspective, said Jon Hanian, spokesman for the governor’s office. Task force Chairman Kirt Naylor said the force earmarked $50,000 annually from the federal Children’s Justice Act and the Child Abuse Prevention and Treatment Act to fund the review team, whose members are unpaid
volunteers. Years ago, Naylor said, Idaho had a child mortality review team, but it was disbanded due to fear of the new medical privacy laws. Prior to the new team’s 2013 formation, Idaho was the only state without such a team. The team’s goal is to understand all the factors that led to a death — to help prevent others. “Our purpose is not to secondguess law enforcement or medical professionals in any single case but to see whether there are any trends by certain entities or professionals,” Naylor said. The team used information already gathered by law enforcement, medical personnel, coroners and state agencies to review the deaths of Idaho children.
Child Fatality Review Team’s Full Report Find the team’s full report online: http://bit.ly/1HYB26r and click on “Child Deaths in Idaho, A Report of Findings by the Idaho Child Death Review Team, April 2015.” In 2012, there were 168 deaths of children from birth to 18 years. A subcommittee met prior to each full team meeting to screen deaths by cause and identify possibly preventable deaths for further review. Criteria for full review
included death due to external cause, unexplained death or death due to a cause with identified risk factors. The subcommittee identified what records were needed from death and birth certificates, autopsies, law enforcement and coroner reports, Idaho Transportation Department crash and injury reports, National Transportation Safety Board reports, medical records, EMS records and child protection records. The team did not have subpoena power and could not always obtain confidential records. The team completed a full review of 78 of the deaths and met five times between May 2014 and January to conduct case reviews. Naylor said most
members remained on the team for the second year, although some were replaced. Appointed members for the latest report: Jerrilea Archer, retired from Ada County Sheriff’s Department; Alfred Barrus, former Cassia County prosecutor; Dr. Glen Groben, Ada County coroner and forensic pathologist; Margaret Henbest, executive director of Nurse Leaders of Idaho, pediatric nurse; Dr. Paul McPherson, St. Luke’s Children’s Hospital pediatrician; Kathryn Rose, Bonner County coroner; Erwin Sonnenberg, Ada County coroner; Miren Unsworth of Idaho Department of Health and Welfare, Child and Family Services; and Tahna Cooper-Barton of Court Appointed Special Advocates.
DREW NASH, TIMES-NEWS
Parents work with their children during an Aug. 13 ‘Water Babies’ class at Twin Falls’ Y/City Pool. Idaho needs more education on drowning prevention, a new state team concluded.
Prevention
Child and Teen Suicide Deaths Idaho’s suicide rate for ages younger than 18 increased significantly between 2003 and 2012 and is consistently higher than national rates.
Continued from A1
Suicide death rate per 100,000
Death Certificate Coding
Idaho
U.S.
5
Coroners should seek additional training on coding the cause and manner of death on death certificates, the team said. The historical use of SIDS (sudden infant death syndrome) as a cause of death contributes to confusion in categorizing unexplained infant deaths, the team contends. A death should be coded as SUID (sudden unexpected infant death) only when all external causes are ruled out. Coroners should work with law enforcement agencies to complete a thorough investigation in these deaths. The team recommends that coroners and the Idaho Bureau of Vital Records and Health Statistics eliminate the use of SIDS as a cause of death. Vicki Armbruster, president of the Idaho Association of County Coroners, said she intends to ask coroners who served on the fatality review team to provide training during one of the association’s upcoming conferences. The association offers training during its two conferences a year. “We would like to have all of the coroners here every time, but that’s not possible for some of them,” Armbruster said. Some of Idaho’s county
2012: 19 deaths
4 3
2003: 8 deaths
“We may also be able to talk to the health districts about child care providers being trained in safe sleeping practices,” he said. State licensing for child care providers requires pediatric rescue breathing, infant and child CPR and first aid training, Shanahan said. Other recommendations would require the governor’s office to allocate money.
Lessons for Parents
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Source: Bureau of Vital Records and Health Statistics, Idaho Department of Health and Welfare; via Idaho Child Fatality Review Team
coroners and deputy coroners are part-time, and it is difficult to take time off from other employment to attend training, said Erwin Sonnenberg, a retired Ada County coroner who served on the review team. In smaller counties, coroners may not have as much experience or case load to keep their skills tuned up. “That problem is not unique to Idaho,” Sonnenberg said.
Safe Sleep Education Public health agencies should p ro m o te sa fe s l e e p p ra c tices to parents and medical
professionals, and should do public education campaigns on CPR certification for parents and child supervisors, drowning prevention and the risk to infants of smoking parents, the fatality review team recommends. Tom Shanahan, spokesman for the Idaho Department of Health and Welfare, said the public health division held meetings on how some of the recommendations can be incorporated into existing programs. The agency can speak with parents about safe sleep practices through the Nurse Home Visiting Program and relay the dangers of smoking through the Tobacco Prevention program.
Health care providers should educate patients on the known risk factors of infant stomach sleeping, sleeping on soft surfaces and loose bedding, bed sharing and co-sleeping, the team said. Hospitals that deliver babies are mandated by state law to provide training on proper sleep technique for infants, smoking cessation and the dangers of secondhand smoke, said Nancy Handy, manager of The Birth Center at Cassia Regional Medical Center. The training is offered in multiple languages through a translation program. Some parents disregard the training, Handy said, because a previous child did not have negative effects from an improper sleep position or co-sleeping with a parent. “It worked for them that time, so they continue to do it.” Handy said Cassia Regional has only full-term babies, who are at lower risk for SUID than preterm infants.
“If there are other ways to get this information out to the public like through the WIC (Women, Infants and Children) program, I think it would be fabulous,” Handy said.
ATV Safety Certification The team recommends that ATV riders take a safety certification course and wear helmets, eye protection and other protective gear. Children should ride only during daylight, and nobody should ride while drinking alcohol or using drugs. Children riders should never be allowed to have a passenger. Cassia County Sheriff’s Office offers an ATV certification course, Undersheriff George Warrell said. “But there is not a lot of participation in it.” The sheriff’s department holds patrol campaigns in the South Hills a few times a year, but the county has so many recreational areas it is impossible to patrol them all, Warrell said. Education on safe ATV use has to be geared toward parents because it comes down to parental supervision, he said. “When we see a child get hurt on an ATV it is usually related to lack of supervision or the parents are letting a child ride a machine that is too big,” Warrell said. “Parents need to be the parents. They are the supervisors, and sometimes it just doesn’t happen.”
Motor Vehicle Accident Deaths
Child and Teen Accident Deaths
Motor vehicle fatalities for ages younger than 18 declined sharply in 2008 and have continued to decrease. Contributing factors include economic recession and higher gas prices – both resulting in fewer cars on roads – as well as funding for safe driving programs.
Idaho’s rate of unintentional injury deaths for ages younger than 18 is consistently higher than U.S. rates. Unintentional injuries are those not planned or inflicted by another person; nationally, the leading causes are motor vehicle collisions, fires, drowning, falls and poisoning.
Accident death rate per 100,000
Accident death rate per 100,000
12
Idaho
U.S.
18
2003: 39 deaths
16
Idaho
U.S.
2003: 56 deaths
10 14 12
8
2012: 37 deaths
10 6 2012: 16 deaths
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8 6 4
2 2 2004
2006
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Source: Bureau of Vital Records and Health Statistics, Idaho Department of Health and Welfare; via Idaho Child Fatality Review Team
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Source: Bureau of Vital Records and Health Statistics, Idaho Department of Health and Welfare; via Idaho Child Fatality Review Team
A6 • Sunday, August 23, 2015
Children Continued from A1
Her mother, Krissy Darrington, said she’d left Jaci and her older sister, Ellie, with young sitters to coach an out-of-town softball game. She never imagined tragedy would claim her precious child. Four and a half years later, Darrington said, it still feels like it happened yesterday. Earlier in the day, the sitters took Jaci for a ride on a four-wheeler by the water. Later, back inside the home, the sitters were distracted while they prepared for a camping trip. One went to the garage and left Jaci in a room with Ellie and other children who were watching television. Jaci was not there when she returned, but she thought another sitter had taken the toddler to change her diaper. Jaci, however, took the opportunity to go back to the river. “She really loved the water,” Darrington said. “That’s where she wanted to be.” Friends, family, community members and rescue teams swarmed over the area looking for her. They found her tiny footprints at the river’s edge. Her body later was discovered caught in the root of a tree — the same tree where Krissy had posed for maternity pictures on a happier day. “You can’t turn your back on a child for a minute because they will get away from you even if you think someone is watching them — as a parent you have to make sure. As a parent it’s your responsibility, it’s not anyone else’s responsibility,” Darrington said. “Assuming is your worst enemy. Don’t ever assume someone else has them.” ••• The loss of any child tugs at the heart of pediatrician Paul McPherson, a member of the Idaho Child Fatality Review Team. “The first thing that jumped out at me when I moved here in 2011 was that Idaho was functioning without a child fatality review board,” said McPherson, who practices at St. Luke’s Children’s Hospital in Boise. Idaho had a review team that produced four reports from 1997 to 2000, but it was disbanded mainly due to fear of violations of the federal Health Insurance Portability and Accountability Act, which tightened restrictions on how private health information could be shared, said Kirt Naylor, chairman of the Governor’s Task Force on Children at Risk. The task force lobbied for legislation to establish a child death review team, but the bill failed. So the governor’s office issued the 2012 executive order. “We did not know what preventable causes of death were killing Idaho’s children,” McPherson said. “In order to get a good handle on what’s happening now, you have to get a handle on what’s happened in the past. Now we can look at those numbers with a greater degree of certainty.” In-depth analysis of the cases revealed areas where law enforcement, coroners, medical personnel, public health districts, child caregivers and parents can make improvements to reduce the risk of an accident claiming a child’s life. “It’s not easy being on the team. A lot of these cases are bad and brutal,” said member Al Barrus, former Cassia County prosecutor. One area of concern: death certificate coding by coroners, law enforcement and state agencies. Although some ground has been gained, there continue to be instances of incomplete investigations and misclassifications of
JOY PRUITT, FOR THE TIMES-NEWS
Ellie, 8, and Layne, 3, look at the Darrington family’s scrapbooks of 16-month-old Jaci, who drowned in the Snake River in 2011.
DREW NASH, TIMES-NEWS
TOP: Sven Stewart, 2, smiles during his ‘Water Babies’ class Aug. 13 at Twin Falls’ Y/City Pool. A new state report emphasizes the importance of water safety education for Idaho children. RIGHT: Adeline Smith, 1, pushes off from the edge with the help of her mother, Kelly Smith. infant deaths, the team reported. In Idaho, McPherson said, coroners do not have to be medically trained, and there is a lack of uniform policy on autopsies. Barrus said coroners are among elected officials who “really shouldn’t be elected.” “Coroners undergo more formal training now and they really need to, because often they are left to make decisions that would be tough for professionally trained people to make,” Barrus said. The team also discovered shortfalls in child care facility procedures for safe infant sleep, and there were infant deaths classifieds as SUID, sudden unexpected infant death, which were really cases of infant smothering, McPherson said. Cassia County Coroner Craig Rinehart said infant deaths cross socioeconomic lines and often don’t have clear-cut explanations. “Some of these cases are so
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disturbing,” Barrus said. “In some of these infant deaths the child is being taken care of by good parents, but sometimes they are living in just awful circumstances. They are coded as SIDS but that is clearly not what the facts say. In some cases they were sleeping with a parent or they fell off a mattress and suffocated against a wall.” The team said a child death should be coded as SUID only if other causes are ruled out. “That is one of the really big things that came out of this,” Barrus said. ••• Suicide among Idaho children needs serious attention, too, McPherson said. Suicide is the second-rated cause of death in the state for children older than 1. The rate increased significantly between 2003 and 2012, and in Idaho it is consistently higher than national rates.
Accidents are the leading cause of death in ages 1-19, according to Idaho Department of Health and Welfare’s 2013 vital statistics report on mortality. Suicide ties with pneumonia as the fourth cause of death in ages 5-9; suicide ties for second place with influenza and pneumonia in ages 10-14; and it is the second leading cause of death for ages 15-19. Congenital malformations; short gestation and low birth weight; and SUID are the top three for children younger than 1. “Our hope and purpose in this is to find some common causes or threads so we are able to prevent some of these deaths,” Barrus said. “Looking at these cases like this allows us to break it down,
and it gives us a better picture of what happened.” Barrus said the key recommendations will be forwarded to state agencies, coroners and law enforcement around the state so they can develop programs and education campaigns. “You have to define and identify a problem correctly in order to correct it,” McPherson said. “I think education of the different entities and organizations will be very important. Most of them do great work, but there are areas that we need to tweak.” For the Darringtons, the state’s attention on child fatalities came too late. But better awareness could prevent another family from enduring the pain of losing a child.
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