A city nurse kept tabs on Bryanna Harris for most of her short life, but during that time the nurse had little or no communication with the agency that protects vulnerable children, Baltimore's health commissioner disclosed yesterday.

The nurse tried to keep contact with the family even after Bryanna's second birthday, at which time such visits are typically ended, according to Health Commissioner Dr. Joshua M. Sharfstein. But on eight occasions in the spring of 2007, the nurse could not find anyone at the Harris house. About the same time, Vernice Harris, the toddler's mother, told a Baltimore Department of Social Services caseworker that she needed help with Bryanna.

Social Services did not act, and Bryanna died June 5 from methadone poisoning. Harris, 30, has been charged with murder.

What stands out, Sharfstein said in an interview with The Sun, is that the nurse seemed to be working in "complete isolation" to make sure the toddler and her drug-addicted and mentally ill mother had the help they needed.

"There should have been much better communication between the nurse and Social Services caseworkers the whole time," Sharfstein said. "The nurse could have been an ally who worked with caseworkers, but that doesn't appear to have happened. Our nurse could not recall a specific conversation with the Department of Social Services."

Sharfstein said the tragedy prompted him to work out new means of communicating and collaborating with the Department of Social Services. He is encouraging other organizations that work with at-risk families to take similar steps, and he has sent letters notifying such groups that DSS will be contacting them about how to improve their working relationships.

The nurse, who voiced concerns at Bryanna's birth, found during home visits that she was "doing well," Sharfstein said. The nurse became concerned when Bryanna's great-grandmother left the home in early 2007 but did not "identify any life-threatening risk" to the toddler.

Molly McGrath, chief operating officer for the Department of Social Services, said effective communications between that agency and others who have regular contact with troubled families is key to protecting children from harm.

"In order for [Social Services] to keep kids safe, we have to have more eyes and feet on the ground earlier in children's lives so we can take action before something catastrophic happens -- long before someone has made a hot line call to report a case of abuse," McGrath said.

As a result of discussions between Sharfstein and McGrath, her agency has agreed to assign two staff members to work as liaisons with members of the Health Department's Maternal and Infant Nursing Program. Also, an official with Social Services will attend monthly meetings with members of the city nursing program team to review cases.

And prior to a birth, a nurse who has concerns about the future safety of an infant will be able to alert Social Services so the agency can investigate after being notified of the birth, Sharfstein said.

"We had someone who was doing everything they could to help this family but who was working in isolation," he said. "That requires a response ... to fix the system, so that is why we jumped in there with the Department of Social Services."

Nurses in the city Maternal and Infant Nursing Program, who care for at-risk pregnant women, have not been in the habit of contacting the Department of Social Services, said Sharfstein, in part because they have been let down by the agency in the past. He said nurses complained to him that caseworkers don't call them back or share information about families. Also, some nurses believe that caseworker involvement could make it harder for them to get in to see a family.

"There's no tradition of communication between the two agencies," Sharfstein said. "We're operating in two different worlds."

Bryanna's death has led to policy changes at the Maryland Department of Human Resources, which oversees child welfare programs and the city Department of Social Services. The head of the state agency, Brenda Donald, is backing legislation to step up abuse reporting and prevention. Also, five Social Services staff members have been disciplined or fired as a result of the toddler's death.

Sharfstein has declined to identify the nurse who had contact with the Harris family, but he said the nurse is "devastated" by Bryanna's death. The nurse visited the Harris family 30 times before and after Bryanna's birth, often bringing diapers and formula, Sharfstein said. The nurse also contacted a hospital social worker when Bryanna was born and voiced concerns about the infant's care.

Sharfstein said that the nurse's concerns, which he did not specify, "likely led" to a referral to Social Services. However, the nurse could not recall any specific conversation or communication with a caseworker from the agency.

McGrath said she agrees with Sharfstein's assessment of past lack of communication. She said she and other Social Services staff members plan to meet with Health Department staff and outside groups that work with troubled families.

"They need to know that they can call us and get help if they are concerned about something," McGrath said.

She said that communications between her agency and others, such as city police and schools, have not always been adequate. She said she intends to change that because it requires a network of resources to deal with issues of child abuse and neglect.

Said McGrath: "We are going to stand shoulder to shoulder with [Sharfstein] to make sure we close every gap we can between his program and ours."

lynn.anderson@baltsun.com

greg.garland@baltsun.com