Death Watch

The number of Arizona children who died last year in unexpected and tragic ways rose sharply, according to a new report from the state department of health. Many significant areas, from suicide to drowning, also showed troubling increases.

The report, compiled annually by a team of volunteer doctors, psychologists and cops for the state Department of Health Services, reviewed every death of an Arizona resident under 18 in 2005. The researchers then did their best to determine whether the cause was accidental, medical, or criminal — and quantify whether the death could have been prevented.

As it turns out, the bad news is really bad. There was nearly a 10 percent leap in child fatalities in 2005. Even allowing for population growth, that's alarmingly high. "Preventable" deaths were higher than ever, notching a 25 percent increase from 2004.

The researchers also concluded that 50 children died because of maltreatment. That's the highest number of maltreatment deaths Arizona has ever recorded.

But what makes the deaths particularly tragic is that Child Protective Services had prior contact with almost half of the kids who died because of abuse or neglect, according to the report. And 14 of the 50 kids actually had open cases at the time of their deaths.

That, too, is a state record — albeit one you're never going to see touted in a press release.

Perhaps for that reason, the report has been ignored by just about every media outlet in the state. (The Arizona Republic gave the report so little coverage that its story failed even to mention CPS — much less note that the total number of deaths had increased. But to the paper's credit, other news outlets ignored the report entirely.)

Still, it's gotten the attention of some state legislators. And it's bringing CPS scrutiny its leaders would probably just as soon avoid.

Without context, numbers like the ones in the Department of Health Services report can be deceiving. For example, children drowning: Since 2003, there's been a 25 percent increase.

But researchers like Dr. Michael Durfee, the psychiatrist who serves as the chief consultant for the National Center on Child Fatality Review, a Los Angeles-based nonprofit, cautions observers not to take yearly "trends" too far. Any 12-month window, after all, is an artificial construct.

"If I kill two of my kids in December, it isn't necessarily a trend if the number of deaths drops in January," Durfee notes.

Drowning deaths are a good example. Yes, the report shows a striking increase from 2003 to 2005. But a little more information puts the number in perspective. Turns out that the 2003 number represented a significant drop from the years prior — and the 2005 deaths aren't actually out of whack with the general trend. Sure, way too many kids drown for a state without a Great Lake or an ocean. (Pools should be fairly easy to fence; miles and miles of coastline are much less so.) But it's not like 2005 represents a new crisis so much as a longstanding problem.

There's also a question of definition: The fatality rate for Arizona kids is, overall, higher than the national average, according to statistics from the U.S. Department of Health and Human Services. But when it comes to subcategories — how many kids were murdered? how many died from abuse? — it can be a judgment call. Fatality review teams often have different standards from state to state, Durfee says, and what Arizona calls a murder might well be an accident in Nevada, or vice versa.

Still, some numbers in the 2005 report can't be ignored.

There were no cases of kids dying because of a fire (either from smoke inhalation or burns) in either 2003 or 2004. Last year, there were 20 such deaths.

In 2004, six children died because of exposure. Last year, that number rose to 19 — most of them dying during attempts to cross the border during extreme heat.

And Dr. Mary Rimsza, the pediatrician who chairs Arizona's team and also serves as medical director at ASU's Center for Health Information and Research, says she's noticed a troubling rise in suicides.

"We used to get an occasional suicide in the 10-to-14-year-old range, but last year, we had 13," she says. "And it's even occurring now in the 5-to-9-year-old range." (The report shows one suicide in that age group last year.)

But it will likely be the Child Protective Services-related deaths that draw the Arizona Legislature's attention.

In 2003, at Governor Janet Napolitano's urging, the Legislature approved a mammoth funding increase for CPS, and funding has only continued to grow. Last year, the state earmarked $163 million for the Department of Children, Family, and Youth Services, almost double its allocation prior to Napolitano's election.

And though more kids than ever are in foster care, deaths from child abuse and neglect have continued to rise. The 2005 statistic isn't an anomaly, it's part of a steady uptick that began in 2002. (See "Suffer the Children," October 26, 2006.) More than two times the number of kids have died from abuse on Napolitano's watch than in a similar period under Governor Jane Hull.

Part of that, as Durfee cautions, is that the terms have changed. Rimsza, the task force chair, says that her team clarified its definition of "maltreatment" deaths in 2002 to include more cases, and numbers jumped accordingly. But it's also clear that since then, abuse-related deaths have continued to rise.

Even more troubling for the agency, more kids are being killed while their CPS files are still open.

State Senator John Huppenthal, a Chandler Republican, says that the funding increases were supposed to prevent just that. So was putting more kids in foster care.

"Their solution was, 'Pull out more kids, and the kids will be safer,'" he says. "But we've found there's no correlation between removal rates and safety. None at all. You would hope that, on some level, they would realize that this has failed."

Huppenthal points to one sobering statistic in the report: Nine of the kids who died in 2005 were in foster care at the time of their deaths.

Three were ruled dead from natural causes. But two were accidents, one was a suicide, and two more were murders. (The ninth death is officially "undetermined.")

After reading the report, Huppenthal requested CPS's report on the deaths. He was told there wasn't one.

Indeed, CPS seems more intent on explaining away the numbers than figuring out what's gone wrong. CPS spokeswoman Liz Barker Alvarez downplayed the numerical trends, telling New Times in an e-mail that it's "incorrect and unfair to make a correlation between budget increases to the agency and overall child deaths from maltreatment" because the issues are too complex.

Alvarez was also quick to explain that just because the report noted "CPS involvement" doesn't mean Arizona CPS was involved — it might have been a similar unit from another state, she wrote, or even the protective services workers with jurisdiction over tribal communities. (Alvarez then failed to respond to repeated follow-up requests asking just how many cases weren't connected to her agency.)

The sad thing is that letting out more information might actually help CPS fend off more legislative scrutiny. Last week, Senator Huppenthal met with CPS officials to try to get more answers on the foster care deaths. He feels better after hearing the agency's case-by-case summary. "It's not anything as troubling as I'd thought," he says, noting that some of the deaths were clearly not preventable: Some of the kids had congenital health problems, which is part of the reason they ended up in foster care in the first place. Two other deaths were due to Sudden Infant Death Syndrome.

But information can be hard to come by. Durfee, medical director for the national registry, overall praises the work of Arizona's team. "Mary Rimsza is doing great work," he says. But he's critical of the report's willingness to stop at numbers when it comes to the kids who died from abuse.

The report contains no detail about their deaths other than showing where they fit into broad age ranges. And that's wrong, Durfee argues.

"You should know their age, their race, their gender, and how they died," he says. "If I understood this at a human level — if you can make these children real to me — then I understand that my neighbor's kids are my responsibility. That's what they need to be doing."

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Sarah Fenske
Contact: Sarah Fenske