North Carolina's Response to Child Fatalities

What happens when a child dies in North Carolina? As someone working in the child welfare system, you may know that the department of social services (DSS) in the county where the child lived is required to find out immediately whether there are other children in the home. If there are, DSS has 24 hours to initiate a child protective services (CPS) investigation into what happened and whether these remaining children are safe.

Yet DSS is only one of the agencies involved when a child dies in North Carolina. After a child fatality there are many investigations that try to determine why a child died, who as involved, and what can be done to prevent this kind of tragedy from happening in the future.

Perhaps the clearest and most comprehensive description of the different disciplines and agencies that respond to child fatalities in North Carolina can be found in Not Invisible, . One of the recurrent themes of the contributors to this unique guidebook, edited by Dr. Marcia Herman-Giddens (North Carolina Child Advocacy Institute, 2001), is the importance of collaboration in our efforts to respond to and prevent child deaths.

To collaborate effectively, you must first have a clear idea of the aims and concerns of those with whom you are supposed collaborate. Therefore, we present you the following brief descriptions of key professionals and organizations that respond to and prevent child fatalities in this state. These descriptions are adapted, with permission, from Not Invisible, .

Medical Professionals

Emergency Medical Services (EMS) and Medical Professionals. EMS personnel and emergency room doctors and nurses are often the first professionals to come in contact with a child who has died. North Carolina reporting laws for suspected abuse and neglect apply to every person. If a child is found dead or near-dead in suspicious circumstances (e.g., the child’s injuries do not correspond to the accident parents describe), these professionals are required to make a report to child protective services and law enforcement.

County Medical Examiners (ME). Appointed by the Office of the Chief Medical Examiner (OCME), county MEs are physicians who serve three-year terms. Most counties have more than one ME; a few counties have coroners who also act as county MEs.

Child deaths that are suspicious for violence or trauma must be investigated and certified by the county ME. Sudden and unexplained deaths in neonates, infants, and children also fall under ME jurisdiction. The only child deaths not reported to the ME system are those in which the child had a well-documented medical condition and died of that condition while under the care of a physician.

The ME must take charge of the body and conduct an inquiry to determine cause and manner of death. In investigating the death, the ME must consult with emergency medical services, local law enforcement, and any other relevant parties before finalizing the conclusions. (In most cases where the child has siblings in the home, this would include DSS.) MEs must either visit the scene of death or gather the equivalent information from trained individuals who have knowledge of the scene and circumstances of the death or discovery of the body. If circumstances warrant, the ME will ask the regional pathologist to conduct an autopsy. The ME must file a report about the fatality with OCME within 15 days, although determining cause and manner of death may take longer.

Regional Pathologists. Each county has one or more designated pathology centers. When a child death occurs, the regional pathologist works with law enforcement and the ME to stay properly informed of the case. If necessary, the pathologist conducts an autopsy to determine, if possible, the cause of death.

Office of the Chief Medical Examiner (OCME). This organization oversees North Carolina’s medical examiner system. All reports of medical investigation, copies of the death certificate, results of the toxicological analyses, and, when performed, reports of autopsies are received at the OCME. If all documents present are in agreement and deemed appropriate, the case is initialled and becomes official public record. If there are inconsistencies or additional evaluations are needed to complete the case, further evaluation is initiated at the OCME in collaboration with the ME and/or regional pathologist. Even after a case has been finalized, it may be reopened upon receipt of pertinent new information.

Law Enforcement

The death of a child should always be reported to law enforcement. This includes accidents, apparent natural deaths caused by illness, suicides, unexplained deaths, and all obvious homicides.

The police or sheriff’s department involved is then responsible for conducting a thorough, detailed, systematic investigation. Without evidence to the contrary, the “worst case scenario” (homicide) is assumed until it can be eliminated. This investigation will usually involve death/crime scene investigations, examination and collection of physical evidence, and interviews with witnesses and possible suspects. Investigators are also responsible, if necessary, for notifying parents, family members, and others of the death of the child.

Consultation with DSS and other agencies (e.g., medical examiner) is a key component of law enforcement’s response to child fatalities. Specifically, police investigators may ask CPS to provide records or reports regarding the family or child in question, and for assistance in conducting initial or follow-up interviews with witnesses. If child abuse is a suspicion, confidentiality should not be an issue between agencies conducting a joint investigation. CPS expertise is often critical in helping law enforcement determine what constitutes child maltreatment. Ultimately, however, it is up to the police to determine whether a crime has been committed and who is responsible.

District Attorneys (Prosecutors)

Prosecutors take up where law enforcement and the other investigators leave off. Responsible for criminal filing decisions, plea negotiations, and sentencing recommendations, prosecutors have significant power to charge people with crimes. To improve their success in prosecuting child fatality cases, some prosecutors participate in a multidisciplinary response to child fatalities that involves the prosecutor, the medical examiner and other medical professionals, law enforcement, and CPS.

Child Fatality Prevention System

The purposes of the North Carolina Child Fatality Prevention System (see NCGS § 7B-1406-1413) include: developing a community approach to the prevention of child abuse and neglect, understanding and reporting the causes of child deaths, identifying gaps in services to children and families, and making and carrying out recommendations for changes to laws, rules, and policies to prevent future child deaths, especially those from abuse and neglect. The components of this system are outlined below. Also, see “NC Prevention System Response to a Child Death”, which describes how different system components interact after the death of child known to DSS.

North Carolina Child Fatality Task Force. The Task Force is the public policy arm created to prevent deaths of children in North Carolina. It meets several times a year, and makes an annual report and recommendations to the General Assembly regarding multidisciplinary child death reviews, confidentiality laws, and rules, laws, and policies promoting the prevention of child deaths.

North Carolina Child Fatality Prevention Team. This team is a multidisciplinary group that reviews all medical examiner deaths of children under the age of 18 to prevent future deaths by identifying gaps in systems, policies, and laws that may have contributed to child deaths. It meets monthly, and also makes recommendations to the Task Force for improvements and remedies.

Community Child Protection Teams (CCPT). Every county has a CCPT that meets at least quarterly. These groups are comprised of representatives from the community and public and private agencies that provide services to children and their families. Each CCPT promotes a community-wide approach to the problem of child abuse and neglect. They review active CPS cases and child fatalities when the deceased child or the child’s family had received child welfare services within twelve months prior to the child’s death and the death was suspected to have been caused by abuse or neglect.

CCPTs review fatalities to determine whether child abuse, neglect, or dependency were factors in the death. Based on their review, the CCPT recommends actions the community should take to fill in gaps in community services or resources that may prevent other child fatalities. This information is presented in the CCPT’s annual report to the board of county commissioners. As illustrated below, during some maltreatment fatality reviews CCPTs sometimes interact with the NCDSS Child Fatality Review Team and the State Team.

Local Child Fatality Prevention Teams (CFPT). Every county has a CFPT which meets at least quarterly. Local CFPTs review all child fatalities that do not meet criteria for review by the local CCPT. (Note: in many counties CFPTs are combined with CCPTs). The purpose of the CFPT review is to promote an understanding of the causes of each child’s death, to identify deficiencies in the delivery of services to children and families, and to recommend and implement changes that will prevent future child deaths. CFPTs usually review fatalities from the previous year; once a year they make recommendations for preventing future deaths to their county commissioners.

N.C. Division of Social Services State Child Fatality Review Team. Local departments of social services, with the assistance of the state DSS, must review any child fatality where there was suspicion of abuse or neglect involved in the death and where the child had a record with child protective services within the past twelve months. Reviews take between one and two days. For more about the NCDSS child fatality review team, please refer to "Interview with the N.C. Child Fatality Review Team".