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 In December 2011, Frazier gave birth to Jacey at a hospital in
Charlotte, North Carolina. The baby inherited her mother’s blue eyes
– and Frazier’s dependency on drugs.
Jacey spent two weeks suffering through withdrawal, a result of the
methadone Frazier took during pregnancy to control an addiction to
prescription painkillers.
Federal law calls on states to require hospitals to report newborns
hooked on drugs to child protection services. Records show the North
Carolina hospital did precisely that. It alerted child welfare
authorities just across the border in nearby York County, South
Carolina, where Frazier had been living with her mother.
But the 2003 law has a second, distinct provision – one that many
states have failed to embrace, putting thousands of newborns in
jeopardy each year, a Reuters investigation has found.
That provision calls on state child protection authorities to
immediately assess all cases of drug-dependent newborns. Social
workers are then supposed to develop “a plan of safe care” for every
infant who is either “affected by illegal substance abuse” or
experiencing symptoms of drug withdrawal.
 York County took no such action, documents and interviews show.
Instead, a hospital social worker wrote in Frazier’s medical records
that the county child protection agency “will not be following up
with infant.”
The reason: South Carolina has a state law that conflicts with the
federal provisions. It says that child protection authorities don’t
have to investigate cases of drug-dependent newborns if their
mothers were using drugs prescribed by a doctor. Frazier had a
prescription for methadone.
Six months later, after Frazier moved to Florida with her daughter
and Jacey’s father, the girl was dead – the victim of a lethal dose
of methadone Frazier mistakenly gave her.
DISPARITIES IN OVERSIGHT
“I wish social services had been at my home investigating, talking
to me, checking on Jacey,” Frazier wrote to Reuters last month in a
letter from prison. “I didn’t just slip through the cracks in the
system; I fell through the canyon into hell.”
Reuters identified 110 cases since 2010 in which children died
preventable deaths after being sent home from the hospital to
families ill-equipped to keep them safe. In each of those cases,
Reuters found evidence of a mother’s use of opioid drugs during her
pregnancy.
In some instances, hospitals failed to alert authorities to infants
born dependent on drugs, despite a federal law that was intended to
ensure each such case be reported to child welfare workers.
Social service agencies are falling short, too. Of the 110 deaths
Reuters uncovered, 74 other cases appear similar to Jacey’s: Child
protection authorities were alerted by the hospital to a
drug-dependent newborn, but social workers either chose not to
pursue the case or failed to adequately respond.
In many of the fatal cases identified by Reuters, child protection
workers conducted cursory investigations, or none at all. Sometimes,
authorities created safety plans, but parents simply ignored them.
In other instances, such as Jacey’s case, social workers followed
less stringent state policies, which don’t require intervention if
mothers are using drugs that are prescribed, typically to treat
addictions.
“The fact that the mother is in treatment is a good thing,” said
former U.S. Representative Jim Greenwood, a Republican from
Pennsylvania who championed the 2003 federal law. “But that doesn’t
prove that she has a place to live that’s safe. It doesn’t prove
that she knows how to parent. It doesn’t prove that there isn’t a
violent, other drug user in the home. It doesn’t say anything about
the baby’s situation. And this is all about protecting the baby.”
The cases exemplify the wide disparities in oversight afforded to
drug-exposed children across America, levels of vigilance that vary
dramatically among the 50 states and even within the states
themselves.
“In some areas, we had babies positive for marijuana removed from
home, and in other places, kids tested positive for methamphetamine
and they weren’t removed,” said Lisa Smith, director of the Oklahoma
Commission on Children and Youth. “Depends on what part of the state
you’re in.”
OUTRAGE IN OKLAHOMA
Reuters found dozens of situations in which infants were released
from hospitals into unsafe homes where family members used heroin,
methadone or prescription painkillers, according to records from
social workers, coroners and police.
Some of the newborns died at the hands of drug-abusing parents, even
though hospitals had alerted child protection agencies.
One of the most disturbing deaths took place in Oklahoma. On Nov. 4,
2010, Maggie May Trammel died when she was just 10 days old. Mother
Lyndsey Fiddler, high on a variety of drugs including opioids,
accidentally put her baby in a washing machine with a load of
laundry. Then Fiddler passed out.
Maggie May was found dead “after the wash cycle was completed,” a
state review of her death shows.
Fiddler is now serving a 15-year sentence for manslaughter and child
neglect.
“If only we could have gotten the baby somewhere safe when it was
first born,” said Kevin Ickleberry, the police detective who
arrested Fiddler.
Before Maggie May died, the Washington County office of the state
Department of Human Services had received five reports about
Fiddler. Each alleged neglect or abuse related to drug use. One of
those reports came the day Maggie May was born.
But child welfare workers concluded Maggie May and two older
siblings were safe and that Fiddler “was willing to work on
parenting services,” a state report said.
The case sparked outrage and efforts by the Oklahoma to improve its
child protection system.
The Oklahoma Commission on Children and Youth, an independent
oversight agency, began reviewing why the state’s social service
system was failing.
The commission examined 10 cases in which babies had been reported
to child welfare authorities for exposure to drugs in families with
a history of neglect or abuse. Only five of the cases had been
investigated. Two were quickly dismissed by a child-abuse hotline
worker as not appropriate for protection services. In three of the
cases, parenting classes were recommended.
Eight of the 10 babies later died of neglect or abuse “on average
within 6.5 months of their birth,” the commission concluded.
Contributing factors, the panel said, were lack of treatment for
mothers and inconsistent reporting by hospitals.
At one meeting, the commission’s chairman at the time, Bart Bouse,
asked the state social services chief: “Does it take a pickup load
of dead babies before we decide to act?”
In 2012, the state legislature passed a law requiring authorities to
investigate any case in which a “drug-endangered” child is reported
to the Department of Human Services.
A second panel of experts reported in 2013 that too many newborns
and drug-using mothers were sent home together without safety
monitoring. “Sometimes there was a tendency to ignore drug abuse in
the home because the ‘medications were prescribed,’” the report
said.
Today, Oklahoma has a protocol based on the 2003 federal law.
 “We’ve made great strides,” said commission director Smith, but
“there’s still a lot of work to be done.” “10 TIMES STRONGER THAN
ANY PILL”
Some of the cases Reuters examined show the challenges social
workers face even as they try to do right by the child. Although
each of the 110 deaths that the news agency identified was
preventable, even some of the mothers who killed their children say
social workers were vigilant.
[to top of second column] |
“I’m not sure that anyone could have helped prevent my son Liam’s
tragic death,” his mother, Amanda McKenzie, wrote last month in a
letter she sent Reuters from prison. Her son drowned when McKenzie
fell asleep with him in the bathtub.
When Liam McKenzie was born in March 2013, the hospital alerted
social workers in Newport, Kentucky, about his mother’s extensive
drug use. But neither Liam nor McKenzie tested positive for drugs,
state records show, and the case was quickly closed.
About four months later, social service workers logged another
report – from whom is unclear – alleging that baby Liam was in
danger because his mother was using heroin.
Social service workers went to McKenzie’s house four times in a week
before they found her at home on Aug. 2, 2013. In a report, they
wrote that the home was “clean and free of clutter” and that mother
and child had “formed a positive bond with one another.” But they
told McKenzie that, because of the allegations, they were putting in
place a “safety plan” that included random drug screenings. Later
that day, McKenzie submitted to a drug test; it came back clean.
In the next two weeks, child protection records show, social workers
attempted to reach McKenzie and couldn’t. They left voicemails and
told her she needed to be drug tested again. There is no record that
McKenzie responded. Social workers twice visited her house but got
no answer.
Eight days after their last attempt to visit, baby Liam drowned when
McKenzie fell asleep in the bathtub with him.
In an interview with Reuters, McKenzie said she had been taking
prescription methadone, an opioid used to treat addiction, at the
time of Liam’s death. She said she started using it because she had
recently relapsed and wanted to stop snorting heroin and abusing
painkillers. But the methadone, she said, was more powerful than she
expected.
“It’s 10 times stronger than any pill I ever took,” McKenzie said.
Today, McKenzie is serving a five-year prison sentence after
pleading guilty to reckless homicide.
WANTED HELP
Jennifer Frazier, now 32, told authorities she confused the
antibiotics she was giving to newborn daughter Jacey with the
methadone Frazier was taking to kick an addiction to painkillers. A
pre-sentence report found that Frazier was “extremely remorseful”
and that the mix-up in medications was “not intentional.”
Even so, Frazier was sentenced to 15 years in prison in 2013 after
pleading guilty to aggravated manslaughter of a child.
In a prison interview, Frazier admitted that, at the time, she was
glad that she didn’t have to deal with child protection authorities.
“That would be one more thing on my plate,” she said.
Since entering prison, she has taken parenting classes and has gone
through drug treatment. If she had been forced to take those classes
earlier – and if the state had threatened to take Jacey away – it
might have saved her daughter’s life, she said.
Authorities never intervened, and more than 1,400 pages of hospital
records reviewed by Reuters show why: Under South Carolina state
law, authorities were not obligated to investigate further because
Frazier was on prescribed medication, not illicit drugs.
Although the difference in the type of drugs Frazier was taking
proved central in how social services handled the referral, the
federal law makes no such distinction between illicit and prescribed
drugs. It requires safety plans for all newborns with symptoms of
drug withdrawal. These plans can include home nursing,
substance-abuse counseling, housing and employment help, and a
threat to remove the child if the parents don’t follow the
guidelines.
Medical records show that Frazier provided a sanitized version of
her drug history to the hospital. She claimed that she became
addicted to pain pills after a car accident more than a year before
Jacey was born. She told nurses that, six weeks before giving birth
to Jacey, she switched to the prescribed methadone on her doctor’s
advice because it was safer for the baby.
Records from the methadone clinic, however, show Frazier had been
battling addiction much longer than she let on.
According to those records, Frazier, then 28 years old, had used
cocaine since she was 14, crystal methamphetamine from ages 16 to
19, cocaine and crack from age 24, and the powerful painkiller
Percocet since a back injury in the car accident. That accident had
taken place and the addiction had started at least six years earlier
– not one, as she had told the hospital. She admitted to that clinic
she had been a frequent customer at “pill mills.”
There is no indication in hospital records that doctors, nurses or
state social workers ever looked closely at Frazier’s background of
drug use before letting her take Jacey home.
In one notation, hospital social worker Catherine Hall wrote that
the county’s child protection service wouldn’t stand in the way of
Jacey’s discharge from the hospital if the newborn were healthy
enough in a few days. York County’s Department of Social Services,
Hall wrote, “can follow up with infant and mother at their home if
needed.”
Social services declined to open an investigation because of
Frazier’s valid methadone prescription, hospital documents show.
Frazier and Jacey later moved to Florida.
Reached by Reuters, Hall declined to comment. The county’s social
worker, Becky Mann, referred questions to the South Carolina
Department of Social Services. Department spokeswoman Karen Wingo
said that unless there were other signs of abuse or neglect, the
state would not typically accept a case if the baby’s drug exposure
was from “medical treatment for the mother.”
“THERE WAS A NEED”
Several times during her hospital stay, the records show, Frazier
herself raised the issue of “dealing with infant withdrawal.” For
almost two weeks, Jacey had been given smaller and smaller doses of
morphine to help ease her shaking, clenching, wailing and other
symptoms of opioid withdrawal.
Hospital records included this notation: “Home Health RN visits will
begin after discharge.” They didn’t, Frazier said.
On New Year’s Eve 2011, the hospital determined that Jacey – now 25
days old – was well enough to leave. The discharge note also said
Frazier was going to be referred to a service program called
BabyNet. That never happened, Frazier said.
"They sent her home, and that was basically it,” she said.
Citing patient privacy, a spokesman for Carolinas HealthCare System,
where Frazier gave birth, and a spokesman for BabyNet declined to
comment.
Frazier takes responsibility for Jacey’s death – “I messed up,” she
said. Only later, she said, did she realize just how much help she
needed.
“If I was that social worker, I’d be knocking the door down, because
I see what can happen,” Frazier said. “They need to find us, and
they need to help.”
(Part two in a series: "Helpless & Hooked: the most vulnerable
victims of America's opioid epidemic")
(Edited by Blake Morrison. Additional reporting by John Shiffman.)
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