Too few medical experts

The state Department of Social Services is not moving quickly enough to recover from its own mistakes, even gut-wrenching ones that result in the death or injury of a child.

On Tuesday, the parents of Rebecca Riley, a DSS client, were arraigned on first-degree murder charges for allegedly killing their 4 -year-old daughter with a drug overdose. State social workers had been in contact with the family dating to 2002, and twice this fall. Like many dysfunctional families, this one was marbled with charges of child neglect and abuse, suspected drug abuse, and restraining orders. Yet there was no awareness within DSS that the Riley children were at higher risk of death or serious injury at the hands of their parents than any of the other roughly 40,000 children served each year by the agency.

DSS should have seen this coming. It had been put on notice in a March 2006 report by a panel investigating the case of Haleigh Poutre , an 11-year-old girl who was allegedly beaten by her adoptive mother and stepfather until she fell into a coma . DSS didn't intervene adequately in the case, despite a dozen complaints. The agency was trumped by outside doctors who were convinced that Haleigh's injuries were self-inflicted. In the Riley case, DSS again deferred to doctors.

A social worker with a queasy feeling that a case is being mismanaged by doctors doesn't have much clout. That's why DSS desperately needs immediate access to its own medical experts with the heft to challenge other physicians. The Poutre report made that abundantly clear. But nearly a year later, and with $1 million in hand from the Legislature, DSS Commissioner Harry Spence has not accomplished the goal. Some of the blame rests with the DSS bureaucracy. But it is no secret that many physicians are reluctant to team up with the child protection agency. Either they lack the courage to contradict other doctors or fear the kinds of controversial cases that keep DSS officials awake at night.

DSS, however, has no good excuse for its slow pace in developing diagnostic tools to help case workers determine which complaints present the greatest potential for harm to a child. Risk management is advancing around the country , and needs to accelerate here.

JudyAnn Bigby, the state secretary of Health and Human Services, said yesterday she will appoint a physician to consult for DSS. In the long term, however, the agency will need teams of medical experts on retainer throughout the state to prevent future tragedies. DSS is also desperate for in-house nurses. Their number has been whittled down from 40 positions to just 1.5 in the past 20 years, says Spence.

No one can predict the next move of every unstable family in the DSS portfolio. But the agency should move decisively, so that it does not pose a risk to itself and others.