SECTION FOUR PROTOCOLS FOR INVESTIGATING CHILD FATALITIES The Following Protocol was Developed in cooperation with Lt. Jim Collins, San Diego Police Department; Lt. Bill Walsh, Dallas Police Department; The State of Minnesota Department of Health; Pam Booth, Deputy District Attorney, Los Angeles County; and Dr. Michael Durfee, National Center on Child Fatality Review. For more information on child death investigations, please refer to SECTION III of this Curriculum. D eath investigation is an ancient practice. Law enforcement adds the benefits of modern forensics. The death of a child, particularly a young child, calls for specialized ways of dealing with unique issues. The following protocol is based on one such document. It will be updated in the future with other work, including a document being developed through the US Department of Justice. Law Enforcement Response Law Enforcement holds the responsibility for the death investigation, whether at the scene or at the hospital. Emergency medical professionals may not always be first to the scene, which means that law enforcement may be required to provide first aid or life support in their absence. Law Enforcement may have many things to consider, but ultimately, they have the primary responsibility for the investigation. Evaluate the victim and secure the scene Consider the need for treatment and transportation. Evaluate and provide emergency care for the victim, if needed. Identify other children who may be in the home or on the property Secure and preserve the scene Record the location, condition and position of the body and surroundings Identify adults and other children who may have been witnesses. Evaluate the Scene and record
Observe and record the surroundings. Case Management: One officer may accompany the victim to hospital and the second officer should remain at Scene. Pronouncement The first scene responders may be required to make some difficult decisions at the scene: Is the child dead or beyond recovery? Is this a crime scene? Should the body be removed to be taken for emergency care or remain at the scene for investigation? Training and understanding of the issues is critical. All professionals involved must consider the following questions. Law Enforcement or Emergency Medical Services may pronounce death at the scene. Follow your department s protocol for managing and preserving death scenes. Suggested protocols are listed below. The two issues are preserving life and collecting and preserving evidence and witnesses if it is determined that there is a possible crime. Obvious signs of death, beyond lack of respiration and motion, include loss of color. With time, the body will be cold and rigid. If in doubt, have Paramedics evaluate the body and use hospital contacts by phone Note evidence of trauma or foul play. If noted, follow homicide procedures. Many deaths are natural. Some children may be terminally ill and cared for at home. It is important to support the family. SIDS is a natural death, however that diagnosis cannot be determined until the autopsy. Public Health nursing may be of assistance with possible SIDS deaths. Some deaths may be difficult to categorize before and sometimes even after autopsy. SIDS is a natural death. Intentional suffocation is a homicide. It may not be possible to distinguish between them. Investigators must consider the spectrum of possibilities. PHNs may be of assistance in serving families with possible SIDS. The fact of Law Enforcement involvement does not necessarily make the death a crime. Public Health involvement does not necessarily make a death natural. Notifications Other professionals will need to be notified of a death. Questions about possible criminal acts and/or poor parenting must be resolved enough so that involved professionals can make decisions to ensure the safety of other children. An ongoing relationship combining formal protocols and informal communications is necessary. Fire/EMT (Notified by 9-1-1 or uniformed officer) Detectives (Notified by a uniformed officer) Coroner/Investigator, Child Protective Services, Public Health Nursing (By local protocol) Detectives are responsible for the immediate response to all sudden, unexplained or traumatic deaths or near deaths of children. The detective or investigator responsible for the initial investigation continues the questions: Is this a natural death, an accident, evidence of neglect, or a crime? Are the adult caretakers victims of a child s death or are they the suspects? These may be difficult questions. The expertise of other professions may be needed. Child death team 2
review may help involved professionals understand how to answer these questions and future questions on the child s death or near death. Concern about the investigation must be mixed with concern for living children and for the family that must now manage this death. This requires clear thought, and steady predictable pursuit of factual evidence. The Scene The death scene investigation is critical. Opinions of medical professionals at a hospital do not replace gathering physical evidence and interviews at the site of death. The family may not want to leave the child s body for detectives, or caretakers may want to stay away from the scene completely. The death may, in fact, be natural as with Sudden Infant Death Syndrome (SIDS). If the death scene is not investigated, reasons for that omission should be recorded and explained, (e.g., the hospital explains that this is a known child with a terminal illness). Investigation is a basic law enforcement activity. Unique complications may come with young victims and possible family violence in the home. An understanding of child development and parenting can be critical. What is reasonable childcare? What was this child capable of doing? What injuries might be acceptable? Fire EMT, emergency medical professionals, coroner and child protective services personnel can add observations and understanding. Following are some important steps in the investigation of the scene: Observe and examine the scene. Document the entire house or location and the scene of the incident through written or recorded reports and through photographs or drawings Describe and photograph the general geographical setting of the home or other location where the body was found, and compare the dwelling with others in the neighborhood. Describe and photograph the general condition, including temperature and cleanliness, of the residence or area where the body was found. Determine if there is evidence for a history of tobacco, alcohol or other drug use by the parents or caretakers and describe drug paraphernalia observed in the home. Determine where the body was found, the condition of the room where the body was found. State if there is blood, vomit, urine or feces on or near the body. State if there is evidence for alteration, addition of deletion of anything at the scene. Describe the condition and position of the body as you first observed it. Record the temperature, if the body seems abnormally hot or cold. Record the extent of rigidity and lividity. Describe and retain the clothing worn by the child, including clothing removed before you examined him/her. State if there is evidence for alteration, addition or deletion of anything on the body. Take measurements of environmental conditions, such as: The height of the fall Water depth (drownings) Water temperature (scaldings and burns) 3
Be sure that reports are thorough and factual, remembering that if it s not in the report it didn t happen. Some Coroner s Offices have investigators who may assist with the death scene. The Coroner may also be necessary to transport the body to preserve potential evidence. Interviews The categories of death noted below may be unclear in the first minutes, hours and days after the death. The cause of death may begin as suspicious or natural and shift as evidence is collected an understood. Apparent SIDS may actually be homicide and apparent homicide may be encephalitis. Team review may result in helping agency representatives and other involved parties understand more about the death and may assist in building relationships to assist in future cases. Considered Homicide or Suspicious Death. ~~Seriously considered suspects should be taken to the station for interviewing, considering the issues of custody, Miranda Rights, and style of interrogation. Also consider video taping the interview Considered SIDS or Natural ~~The interview may in the home or the hospital without needing to address legal issues, such as custody and Miranda Rights. Also consider audio taping the interviews. Get the story Be sure to obtain historical and statistical Information, including history of the events leading to death, previous health of the child, and previous child deaths in the family, if any Let them tell you what happened in their own words Continually clarify and confirm what the interviewee is saying Ask the witness to demonstrate the location and position of the body and cause of injuries (what happened) Ask questions and/or confront the witness if elements of the history are not logical or conflict with other accounts Witnesses A very young child who seldom leaves the home may actually have a large social network. A death investigation includes understanding that network and finding useful witnesses. Very young children may not qualify as witnesses for court, but may be able to provide information on incidents surrounding the death and the quality of life in that home. Previous medical records may be hard to find, but parents and caretakers may be willing to help locate records by signing a consent for release of medical information. Schools and preschools may have some knowledge of the child s life and be able to support the family including the surviving siblings. Child death cases can be unique. The cause and manner of death may be difficult to define and may never be clearly understood. Very young children are particularly vulnerable and fragile so there may be little or no physical evidence of assault. Experts on death investigation may lack training or experience with the unique issues of young bodies and family violence. Since 4
involved professionals may be divided between human services and criminal justice, working together allows both to serve sanctions and service. Nomenclature may also be a challenge. The coroner and law enforcement have similar definitions for the words homicide and intent. Social services adds the terms child abuse/neglect that overlap with homicide but also include cases with little or no intent to harm. Civil and criminal attorneys have additional nomenclature. For instance, criminal acts may be felonies of misdemeanors. Criminal court, dependency and family law may all be involved, and death investigation may be critical to all of them. A good understanding of these differences is central to a thorough and successful investigation. Possible witnesses may be: Siblings Other Children Extended Family Neighbors Caregivers Pediatrician The Autopsy A complete postmortem examination is an essential part of any infant death investigation, and may be omitted only under extreme extenuating circumstances. If a postmortem examination is not performed because of parental religious objections, and the death is suspected to be due to SIDS, total body x-rays must be obtained and interpreted by a Board certified radiologist before the body is released, and vitreous, urine and blood must be saved. The postmortem exam, including autopsy, is structurally similar to the medical examination of a live person. Consideration must be made for history, physical examination, and laboratory evidence. Law Enforcement may be asked to attend the autopsy and assist the Medical Examiner (ME) with a history of the death. Measurements, water temperature, and other information from the scene will assist the ME in interpreting the findings. The actual autopsy is generally performed with a standardized protocol. Laboratory evidence may include 1) microbiology to explain possible infections and expert consultation on tissues like sections of the brain or eyes, 2) toxicology to rule out exposure to hazardous substances, and 3) x-rays to detect fractures that may not be visible in the physical examination or autopsy. A pediatrician may be useful to detect a medical illness. A pediatrician with forensic expertise may also assist with an understanding of potential criminal evidence. The investigator should understand the local protocols for child autopsy and ask questions as to why procedures are or are not followed. The questions from a non-medical professional about an autopsy are as legitimate as those asked by an individual or parent who may be trying to understand decisions of a health care professional treating a living child. There may be legitimate reasons to skip forensic medical procedures. For example, with motor vehicles and severely damaged body, the medical examiner may rest his conclusions primarily upon the external examination of the body. Forensic pathologists may reasonably disagree on the potential value of individual procedures. 5
Final issues of the investigation may involve the District Attorney. The Prosecutor must ultimately decide if the investigation meets the standards for presentation to a criminal court. The Prosecutor may also provide direction for the investigator to resolve potential questions. Independent of what the Prosecutor may decide for the criminal justice system, the investigation provides material for a civil court action and/or social services intervention by Child Protective Services. Additional expertise may come from Health Systems with Pediatrician trained in forensic issues of child abuse and neglect. ~~~~~ Challenges with Suspicious Child Death Investigation The death of a child, particularly a young child, may bring unique complications and considerations to the investigation. The body and health of a young child is different from an adult s. The social position of a child with a potential caretaker as suspect is different from the social position of an adult. Many professionals involved in death investigation do not have adequate training and understanding of unique issues with young children. Suspicious child death also may also precipitate an emotional response to professionals that may potentially cloud their judgement. Consider the following: There are usually no witnesses or accomplices. A common exception is a caretaker who has failed to protect the child or who interferes with the investigation, possibly to protect the perpetrator Usually there is no weapon involved except the perpetrator s hands, feet or ability to shake a small child There is usually little physical evidence except for bite marks and pattern injuries if belts or other instruments are used to strike a child. Fingerprints, trace evidence and DNA are not of value if the perpetrator is reasonably in the presence of the child It is difficult to prove the intent. Even professionals sometimes find it hard to believe that anyone, least of all someone close to the child, would hurt that child. CHILD HOMICIDE VS. ADULT HOMICIDE The child may have no visible external injuries. With soft suffocation, the child may have no internal injuries and the death may appear natural The victim may have been moved from location by the suspect or paramedics The cause and manner of death may not be known until autopsy. Even after autopsy, cause and manner may both be designated as undetermined. The case depends heavily on medical evidence and may depend heavily on technical evidence that may be confusing with conflicting reports by experts. The case may depend on circumstantial evidence, which creates a challenge to proving beyond a reasonable doubt that only the defendant could have committed the fatal abuse 6
RED FLAGS EXPLANATIONS Certain explanations have proven false in the past but all require investigation. Some examples are: The child fell (from a low height of less than four feet) The toddler fell down (from standing) The child fell down stairs Child hurt themselves or were hurt by a young sibling The child was unexpectedly found dead with the history or age inconsistent with SIDS RED FLAGS - ACTIONS An understanding of child abuse/neglect will help to understand fatal injuries. One potentially useful concept is to consider how the case if the child had not died but had similar injuries. Caretaker delayed reporting the incident Caretaker did not transport to nearest facility The child was choking so caretaker shook/hit child on the back A Coordinated Effort Involving others may add understanding and clarity to difficult cases and build relationships for future investigation. Agencies/professions may include: Health professionals Fire EMT schools and preschools Mental health Civil attorneys, Child advocates Law enforcement Coroner/medical examiner Child protective services Prosecutor Child death review team The investigation of a child death may tell the story from the view of that child. The factual pursuit of truth may be the only focus on the child. The larger community can learn from that truth. Families that have no culpability may appreciate the concern for their child. Suspects may present their own problems in a compelling manner. The deceased are not present to generate empathy. We speak for the victim. ~~~~~~ 7
Other Special Issues to Consider Much of this work may be shared. Child protective services, coroner investigators and other may have a role but the responsibility for investigation of potential crime remains with law enforcement. Shared investigation may increase competence and effectiveness. The need for referral of the family and professionals for support after the death. Child death can have a unique impact on others. A multi-agency match of records that may provide critical material on a case and will also provide lessons for connecting agencies. Significant multi-county and multi-state records may be lost if no one pursues them. Forensic experts with adult deaths who need additional training or resources to manage the unique issues of a child death. This includes understanding child development and parenting. The role of coroners investigators and others with investigation and the need to understand and agree on roles before an investigation The ability to understand early verbal and nonverbal communications. The need to evaluate other children in the home including formal medical examination The need to support families and their social network for issues of grief and mourning Media relations that may help public education or may compromise an investigation The measure of success found in civil and criminal courts that need the results of the investigation. The measure of success that can come from families that may appreciate a professional concern for their child. The potential value of a multi-agency team review as part of investigation. The potential value of previous health records and the value of matching record systems for criminal justice, health and social services 8