Baltimore's top health official proposed yesterday that the state reformits troubled child protective system by stationing abuse caseworkers inhospitals 24 hours a day and acting more quickly to remove minors fromdangerous homes.
Dr. Peter L. Beilenson, the city's health commissioner, said the reforms tothe state-run Baltimore Department of Social Services could help preventdeaths such as that of 2-month- old David Carr, whose fatal beating wasdetailed in The Sun on Sunday.
"As illustrated in recent local media reports, far too many children arebeing abused while on the watch of the Department of Social Services,"Beilenson wrote in a report released yesterday. "Too frequently, our city'schildren suffer in the wake of DSS's poor decision making."
Neither the department's interim director, Floyd Blair, or his boss, stateHuman Resources Secretary Christopher J. McCabe, returned calls yesterdayseeking comment on the report.
Henry Fawell, a spokesman for Gov. Robert L. Ehrlich Jr., said the governor"would welcome the suggestions and they will certainly be reviewed at thedepartmental level, by the Department of Human Resources."
An investigation by The Sun, which drew on criminal court records andinterviews with child abuse experts, revealed that David Carr's death on Feb.12 in a West Baltimore rowhouse was in part the result of an overburdenedDepartment of Social Services and juvenile courts that often fail to protectabused children in the city.
Norris P. West, a spokesman for the Department of Human Resources, sent thenewspaper an e-mail Sunday stating that the article "grossly misrepresentedthe role and responsibilities of the Baltimore DSS caseworkers in this verydisturbing and tragic case. We are very saddened by the loss of innocent lifeand disappointed that the Sun erroneously caricatured caseworkers who pridethemselves on saving vulnerable children."
West refused to elaborate and did not return calls for comment onBeilenson's report.
Chief among Beilenson's recommendations for reform is for the state toassign child abuse caseworkers seven days a week, 24 hours a day, at Johns Hopkins Hospital and the University of Maryland Medical Center so that abusedchildren don't have to wait for hours for them to appear after being called byhospital staffers.
The report also urges the state's juvenile court system to shift itsdefinition of the child's "best interest" away from reuniting families atalmost any cost toward protecting minors from abusive parents.
Susan Leviton, director of the Children's Law Center at the University of Maryland School of Law, said she was disturbed that the state refused toanswer any questions about David Carr's death or respond to the suggestionsfor improvements to the agency.
"This drives me crazy with this agency, because any time you find anyproblem, they say, `We can't talk about it; we have to protect the children'sconfidentiality,'" Leviton said. "When a child dies, and they won't talk aboutit, who are they really protecting? The agency."
Beilenson is chairman of the city Child Fatality Review Committee, whichscrutinizes the deaths of about 120 children a year by nonmedical causes, suchas vehicle crashes, accidents and abuse.
As part of that review, Beilenson said that he was disturbed by a trend ofa large number of children who appeared to be dying of abuse after theyentered the state's Child Protective Services system.
"In looking at the child abuse deaths, the vast majority of the cases wereknown to DSS," he said in an interview yesterday. "The children were beingtaken out of abusive families by the DSS, and then returned to the families,or placed in situations that were clearly dangerous."
In November, Beilenson created a special task force called the ChildWelfare Reform Committee, for which he recruited eight experts, includingLeviton and Dr. Allen Walker of Johns Hopkins Hospital. The panel's report wasreleased yesterday.
The Sun's recent investigation into the failings of the DSS and juvenilecourts to prevent the death of David Carr underscored the urgent need forreform, Beilenson said.
"These deaths you have been writing about are only the tip of the iceberg,"said Beilenson, referring also to the deaths of 5-year-old Travon Morris inFebruary and 15-year-old Ciara Jobes in December 2002.
David Carr's mother, Keisha Carr, was on probation for breaking the armsand legs of her older child, James, at age 2 months and was supposedly underthe watch of the state's Child Protective Services system, when her secondson, David, was killed, his skull, ribs and arm broken.
About three months before David's death, a health counselor called the DSSto warn that Keisha Carr had dropped out of a court-mandated psychiatrictreatment program and might harm her children again. But the call did notinspire the agency to put her babies in foster care, according to courtdocuments and interviews.
Among the recommendations in Beilenson's report:
The state should increase staffing and training for the Child ProtectiveServices emergency call center so that people calling to report emergenciesdon't have to put on hold for more than 30 minutes, as they sometimes aretoday.
The state should study the mental health history of foster parents andguardians before approving the placement of children in homes.
The state should form committees of caseworkers to analyze their mostdifficult cases so that employees of Child Protective Services don't have tomake life-and-death decisions on their own. These committees could be assistedby a computerized system similar to the CitiStat software that the city usesto study trends in crime, lead poisoning and other areas.
Mayor Martin O'Malley said yesterday that he would have instituted severalof these reforms had Ehrlich's administration not usurped his right to jointlyselect a director for the city Department of Social Services.
Instead, Ehrlich picked Blair, a former Bush administration official whomO'Malley asserts has almost no management experience, for the post inSeptember. The mayor sued Ehrlich in November in an attempt to block Blair'sappointment; the lawsuit is pending.
"You can't improve a department unless you have a combination of leadershipand resources, and the will to bring about reform," O'Malley said. "I do thinkthere is much greater public understanding of the problem now. ... Butleadership is still a missing ingredient."