DSS to seek outside expertise in Haleigh case
No plans to take girl off life support
State Department of Social Services Commissioner Harry Spence said yesterday that he plans to solicit outside expertise to help his agency sort out the complex medical and ethical issues around the fate of Haleigh Poutre.
''We would like to draw in additional medical input," he said in an interview following an afternoon press conference at which he said that the agency no longer plans to take the brain-damaged 11-year-old off life support.
Citing an order from Juvenile Court Judge James G. Collins, Spence said he was barred from discussing developments in Haleigh's condition. On Wednesday, DSS officials said that Haleigh had improved significantly since last week, when the Westfield girl was taken off a ventilator and began to show increasing responsiveness.
Haleigh, whose adoptive mother and stepfather are accused of beating her severely last year, has been in the pediatric intensive care unit at Baystate Medical Center in Springfield for more than four months in what doctors had deemed a ''persistent vegetative state."
Several neurologists say that many brain-injured patients recover some consciousness, but often not for several months or more, causing families frequently to delay for months before making the heart-rending decision of whether to continue life support and come to grips with their own definition of what constitutes a life worth saving.
Spence said that, ''acting on the best medical advice at the time," he personally approved the DSS's decision last fall to seek a juvenile court's permission to remove Haleigh's breathing and feeding tubes. Court records show that the DSS filed its motion sometime before Sept. 30, within three weeks of when the child was hospitalized.
During the press conference, Spence said he would later give reporters the exact date when DSS went to court, but later said through his spokeswoman that he was barred by his legal staff from doing so. The DSS request to remove life support was approved by Collins on Oct. 5. The girl's stepfather appealed that ruling to the Supreme Judicial Court, which on Tuesday upheld Collins's ruling.
Governor Mitt Romney weighed in on the controversy yesterday, issuing a statement that said: ''My concern is with this young girl and her current status. In light of reported improvements in her medical condition, it should be clear to everyone that no action should be taken to end this girl's life."
Spence admitted yesterday that the agency missed repeated signs over a three-year period that Haleigh was being abused in her adoptive home. He said social workers and therapists, who spent many hours evaluating the family, mistakenly believed that Haleigh was a ''deeply disturbed girl" who injured herself and that her adoptive mother, Holli Strickland, was ''a supportive mother" struggling with a problem child.
He said that last summer the DSS was on the brink of placing Haleigh in a residential treatment facility, after concluding that Strickland could not keep Haleigh from hurting herself by putting her feet in hot water, throwing herself against walls, or hitting herself.
But on Sept. 11, DSS officials were told that Haleigh had been rushed to a Westfield hospital with massive brain injuries and many bruises in different stages of healing. Spence said his staff was horrified to realize they had misread the entire situation.
Still, Spence said, he was proud of his agency's hard work on the case. ''I believe the department has nothing to be ashamed of," he said.
He also maintained that the agency's failure to detect the long-running abuse, as well as its discovery of Haleigh's recent physical improvements, should not erode the department's credibility or disqualify it from having custody of Haleigh.
Several neurologists who specialize in brain injuries said yesterday that it is hard to know if there was enough conclusive medical evidence about Haleigh's condition to warrant the DSS's decision to seek to withdraw life support within three weeks of her hospitalization.
''Three weeks is early with what we know can happen with recovery," said Dr. Nancy Childs, executive medical director of Texas NeuroRehab Center in Austin, Texas, who has been working with brain-injured patients for more than 20 years.
Childs said statistics show that 52 percent of brain-injured adult patients recover consciousness a month after their trauma and that 16 percent recover after three months. She also said that, in general, brain-injured children, with their growing and elastic brains, ''have a better outcome" than brain-injured adults.
Still, most families eventually agonize over how much progress is enough to keep life support going, said Dr. Michael Grodin, director of biomedical ethics at Boston University. Is it enough that the patient is breathing on his or her own and showing normal sleep-wake cycles, even if there is no prospect of being able to talk or feed themselves? Or does the patient need to substantially return to normal?
When families struggle with such decisions, Grodin said, ''people are more cautious in children."
If Haleigh suffered severe strokes on both sides of her brain, as indicated in medical testimony in court records, she may have the potential for only a limited recovery of consciousness at best, said Dr. Douglas Katz, medical director of the traumatic brain injury program at Braintree Rehabilitation Hospital, who is not involved in Haleigh's care.
Adding to the difficulty in assessing Haleigh's case is the fact that two doctors at Baystate Medical Center differed on how to withdraw life support, according to the Supreme Judicial Court ruling. Haleigh's treating physician recommended that the ventilator and feeding tube be withdrawn. But the head of the pediatric intensive care unit recommended that only her ventilator be removed, though he added that ''the removal of life support in this case would not be contrary to prevailing medical ethics."
Also yesterday, Peter Cornetta, a 53-year-old North Grafton man, said he and his wife have contacted the DSS in the past month seeking to adopt Haleigh. He said that he has worked as a foster parent for the DSS and that six years ago they adopted a daughter.
''This is all about getting her some dignity and compassion," he said.
Haleigh currently has no legal parents. After her biological mother, Allison Avrett, was deemed unfit to care for Haleigh and Avrett's former boyfriend was accused of sexually abusing Haleigh, the girl went to live with Avrett's sister, Holli Strickland, who later adopted Haleigh.
On Sept. 20, Strickland and her husband, Jason, were arrested on assault charges in Haleigh's alleged beating. Two days later, Holli Strickland was found dead, alongside her grandmother, in what police believe was a murder-suicide.
Jason Strickland petitioned the Supreme Judicial Court to keep her alive and asked to be designated a ''de facto" parent. Judges rejected as ''unthinkable" the notion of giving such a voice to someone who is charged with beating her and who could face murder charges if she dies.
Still, Jack Egan, one of Strickland's lawyers, said this week, ''Say whatever you want to say about Jason Strickland, he slowed the process" and prevented the Oct. 5 court order removing life support from being executed.
At a passionately argued hearing in early December before the SJC, Egan accused DSS of rushing to end her life because of hospital costs, a charge DSS lawyers flatly denied. A spokeswoman for Baystate Medical Center said it costs about $4,000 a day to keep a patient in pediatric intensive care.
Patricia Wen can be reached at wen@globe.com. 