New positions boost DSS medical expertise

Social workers at the Department of Social Services will soon have the equivalent of 12 additional full-time physicians, child psychiatrists, and other medical personnel to advise them on complex cases, new hires that follow two high-profile child abuse cases that exposed the agency's shortage of medical expertise, state officials said yesterday.

The new medical input will come from a combination of new positions within DSS and the Department of Mental Health, two agencies that have pledged to work more closely in the future on high-risk cases. This means that the two agencies will have the equivalent of 16 full-time medical staff positions, up from four.

"The combination of medical services that we'll be providing, and DMH support, will be an important contribution to increasing the safety of children with medical and psychiatric conditions," said DSS Commissioner Harry Spence following a public hearing at the State House.

The special hearing, held by the House Child Abuse and Neglect Committee, came three weeks after a Hull couple was arrested on murder charges for giving a fatal overdose of a psychotropic drug to their 4-year-old daughter, Rebecca Riley. Because of complaints that the parents abused and neglected their children, DSS staff was involved in monitoring the family when the girl died in December.

The psychiatrist who diagnosed Rebecca with bipolar disorder when she was 2 and prescribed her three psychotropic drugs has come under investigation by the state's medical licensing board.

Speaking last night on WGBH's "Greater Boston," Governor Deval Patrick said he considered asking for Spence's resignation after the Riley case, but decided it would not be fair. "This is a distinguished profession. And I think it is right and wise to take the time to make a judgment on the facts and not in the heat of the moment."

DSS has also come under scrutiny because of the case involving Haleigh Poutre, 13, a child-abuse victim who lapsed into a coma in fall 2005. Within weeks, DSS asked a judge to stop life-support systems, saying it received medical opinions that her condition was hopeless. But last winter, Haleigh began breathing on her own and responding to commands. She is now in stable condition in a pediatric rehabilitation hospital.

These cases prompted state officials to call for in increase in medical support for DSS. Two weeks ago, Health and Human Services Secretary JudyAnn Bigby appointed Dr. Gordon Harper, a child psychiatrist with the Department of Mental Health, to serve as an interim adviser to DSS.

State officials cautioned lawmakers yesterday that additional medical staff alone will not ensure children's safety. DMH Commissioner Elizabeth Childs said understanding how to best treat families with complicated medical, psychological, and social problems -- especially those with young children -- takes extraordinary collaboration among specialists.

"There is a dearth of research on what is best practice," she said.

Many psychiatrists have said the emotional problems of 4-year-old Rebecca must have stemmed from many contributing factors. She came from a family with a history of domestic violence, child sexual abuse, and homelessness , police and state officials said. The girl's two older siblings, as well as the mother, were also on psychotropic drugs , they said.

To supplement the medical staff it already has, DSS will use $1 million to hire a part-time chief medical officer, a medical social worker, six nurses, and three nurse liaisons. DMH is also boosting its staff of child psychiatrists in its area offices, assigning the equivalent of one additional full-time and one part-time psychiatrist to work exclusively with DSS case workers and be available on short notice to advise them.

Yesterday's hearing included testimony from several prominent child psychiatrists, who urged lawmakers to fund and support efforts to improve children's health services, especially for those involved with DSS. Dr. David DeMaso, psychiatrist-in-chief at Children's Hospital, said child psychiatrists need to be supported in their efforts to get at the root of a child's troubles. The solutions are often complex, he said, and he urged greater collaboration among specialists.

Patricia Wen can be reached at wen@globe.com.