When systems fail

From the New York Times comes a truly horrifying story of a child’s death following a series of unremitting failures.

She died in September by the ugliest means, weighing an unthinkable 18 pounds, half what a 4-year-old ought to. She withered in poverty in a home in Brooklyn where the authorities said she had been drugged and often bound to a toddler bed by her mother, having realized a bare thimble’s worth of living.

Every single named individual and institution in this child’s life failed her in the most abysmal, profound way possible.  Reading this harrowing and heartbreaking article, not one solitary person advocated for her in a meaningful way.  It started, of course, with her utterly unfit parents and eventually involved incompetent and dishonest agency workers, charged with ensuring her safety.

Marchella’s mother, Carlotta Brett-Pierce, 31, is charged with murder, and her grandmother, Loretta Brett, 56, with manslaughter. Both are in jail awaiting trial. Damon Adams, 37, a Children’s Services caseworker, and his supervisor, Chereece Bell, 34, are charged with criminally negligent homicide; it is thought to be the first time that city child welfare workers have been incriminated in a death. Prosecutors said that Mr. Adams had not made required visits to the family and lied about it, and that Ms. Bell had failed to supervise him. Both have left the agency.

There’s not much that I have to say about this poor little girl’s parents and grandmother. Railing against them neither illuminates nor solves anything. I do, however, wonder about Mr. Adams and Ms. Bell.

The agency assigned the family to one of its own caseworkers, Mr. Adams, who had joined it in 2006. He was a graduate of Tufts University, where he studied psychology and childhood development and was a star athlete. For the next three months, both he and the Child Development Support Corporation were supposed to be looking out for Marchella.

In 2005, the city had put the support corporation on a watch list for poor performance, and the next year the city gave it a “needs improvement” rating. In March 2008, an audit by the city comptroller found it made insufficient visits to families and did not test parents in substance abuse treatment.

[snip]

By July 1, Mr. Adams was the only caseworker for Marchella’s family. Colleagues said that he was diligent and that caseworkers juggled impossible workloads. They said they were forced to assign their own priorities and decide which households to visit and which to skip. “You ask yourself, if I don’t do a visit, will this child die?” said Kelly Mares, a city caseworker supportive of Mr. Adams and his supervisor, Ms. Bell. “That’s horrible. But that’s what we have to do. The truth is any child can die if you don’t make a visit.”

The arrests have made things worse, she said. “I don’t know how to do this job,” she said. “We’re terrified.”

Children’s Services, in its own investigation, said it was “questionable” that Mr. Adams had ever seen the family. After the child’s death, the agency said, Mr. Adams documented visits he supposedly had made, and Ms. Bell documented meetings she said she had had with Mr. Adams. Ms. Bell had been with the agency 12 years, a married mother of two young children who was working on a double graduate degree.

Her lawyer said Ms. Bell had wanted Mr. Adams transferred because his work was substandard. Mr. Adams, his lawyer said, knew of no transfer plans.

I don’t doubt that Mr. Adams had a horrible workload.  Anyone who has worked with impoverished people for very long and has had contact with their various agencies and support services knows that the people who work there are overworked and overextended.  This has been true in my experience from inner-city New York to rural New England.  I am deeply skeptical, however, that these workers have no recourse but to lie.  In this case, whatever the pressures on Mr. Adams, his laxity may have cost a little girl her life.

My colleagues have heard me refer glibly to my “I’m Not a Wizard” file.  It’s my way of acknowledging and trying to accept that I am largely impotent to change most of my patients’ lives.  For the span of their time with me, I can guarantee them an attentive doctor who cares about them, and that’s about it.  I can follow up on lab tests and call consulting physicians and make myself as accessible for contact as possible, which goes as far as it can.  The overwhelming majority of my patients need nothing more.  But for those in failing schools (luckily not such a problem where I work now), I can’t make them any better.  I cannot make indifferent parents more invested in their kids.  I cannot improve their homes or their neighborhoods or their friends.  My inner conservative accepts the limits of well-intentioned intervention.  I am not a wizard.

However, my much louder outer liberal wonders what might have been for Marchella Pierce if she had had workers assigned to her with enough time and resources to truly help her.  For cases like hers, and for the countless other children in less dire but still harrowing circumstances whose own lives I have actually seen, who will look out for them if we don’t collectively decide it’s worth our investment to do so?  If the social programs that are already cash-strapped come under the knife for more cuts in the name of deficit reduction, putting even more work on the workers whose jobs remain, who will look out for the most vulnerable?  I can call every agency in the government listings for my at-risk patients, but nothing will get better if there isn’t someone at the end of the line to pick up.  Is the relative pittance social programs receive now worth less than the bloated defense budget or the sacrosanct status of current taxation levels?

Who knows if a better funded Children’s Services would have had enough good workers to have rescued Marchella from her short, hellish life.  Enough people came into contact with her from her birth until her death that a substantial part of the blame must be ascribed to indifference on the part of many, and all the agency money in the world won’t change how much any given individual cares.  Her death is certainly a crime, and perhaps Mr. Adams and Ms. Bell truly were criminally negligent.  But surely it bears asking if those who are tasked with looking out for those with the very least are given enough to do their jobs well.

Update:  In some ways, I find myself asking some of the same questions that Mr. Kain asks in his recent post at the main page.  How can we balance the freedom of parents to raise their own kids, even badly, with our need to protect children from the truly horrible?  How do we both acknowledge the limits of our ability to help in many circumstances and the need to provide those we charge with helping with enough to do what they can?