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Girl with damage to brain is sent to rehab center

Haleigh Poutre, the brain-damaged girl at the center of a passionate end-of-life debate, was transferred yesterday from a pediatric intensive-care unit to a Brighton rehabilitation center, two days after the state's top child-protection official saw her pick up a Curious George stuffed animal and a yellow duck on command.

''It's her incredible will to live," said Harry Spence, commissioner of the state Department of Social Services, which has had custody of the 11-year-old girl since she was brought, badly beaten, to a hospital last September and lapsed into a coma.

Spence, who has been criticized for seeking to remove her life support as soon as eight days after her hospitalization, said he visited Haleigh for the first time ''out of some sense of responsibility."

He said he wanted to see the girl whose fate he will help determine. ''I needed to put myself in the place of a parent," he said.

During his 30-minute visit Tuesday evening at Baystate Medical Center in Springfield, Spence said he noticed her eyes tracking his movements some of the time. He said that, except for her arms, her body did not move.

In a telephone interview yesterday, Spence emphasized that he is not a physician and that he cannot evaluate the significance of these signs.

Many neurologists say that patients with extensive brain injuries often, despite significant recovery, end up with severe disabilities. Still, Spence said his first instinct, after seeing Haleigh, was to say, ''We've got to start this child in rehab."

Spence's comments offered the most vivid account of the condition of Haleigh, whose story has drawn national attention to end-of-life issues, as well as to the agency's failure to protect her against abuse at home. Haleigh's adoptive mother and stepfather were charged with her near-fatal beating in September.

Spence again defended the agency's decision to move quickly to remove Haleigh's life support.

Doctors had said she was in a vegetative state, and ''virtually brain dead." On Oct. 5, a juvenile court judge approved the request, but the stepfather appealed to the Supreme Judicial Court to keep her alive. Many in his hometown of Westfield saw that as a way for him to avoid further charges.

The week before the SJC ruled on Jan. 17 that life support could be removed, DSS ordered a new round of tests on Haleigh after her biological mother visited and described the girl as being responsive. Based on the new tests, doctors told DSS officials that there was ''not a chance" of recovery, Spence said.

But a day after the high court's ruling, doctors told DSS that they had noticed significant improvements in Haleigh, saying, in effect, ''Oops, we're seeing something," Spence said. Haleigh was off the ventilator and had begun to show increasing responsiveness.

On Tuesday, Spence said, he went to Haleigh's room at Baystate and noticed a quiet brown-haired girl lying in bed. In front of her, he said, there were three objects: a yellow duck, a Curious George stuffed animal, and a yellow block. He said a DSS social worker accompanied him, and she said, ''Haleigh, this is Harry."

''Give him the yellow duck," the social worker said, according to Spence's recollection.

Haleigh picked up the yellow duck, he said.

''Where's Curious George?" the social worker asked Haleigh.

Haleigh then picked up the stuffed animal, Spence said.

''It's an astounding case," he said.

Haleigh did not appear to be grimacing or making sounds suggesting she was in pain, he said.

Spence said he remains hopeful that she will continue to move and that she will express herself more. He reiterated that his agency has suspended any efforts to remove life support.

He said that he has asked several pediatric neurologists to further evaluate Haleigh at her new home, Franciscan Hospital for Children in Brighton.

Some neurologists say Haleigh's actions suggest she may have moved into a ''minimally conscious state," in which patients are aware of their surroundings and can respond to commands.

That condition could sometimes strengthen arguments to withdraw life support, because such patients can feel pain, some medical ethicists said. Patients in a vegetative state, on the other hand, are oblivious to the agony that is part of their life.

''Suffering requires consciousness," said Dr. Robert L. Fine, a medical ethicist at Baylor University Medical Center in Dallas.

Children are more likely than adults to significantly recover from severe brain injuries, and some neurologists say they would want to wait at least a year before concluding that a child had stagnated in that state with no hope for a better life.

''I wouldn't give up before a year," said Dr. Douglas Katz, medical director of the traumatic brain injury program at Braintree Rehabilitation Hospital.

Katz said many patients in a minimally conscious state can track movements with their eyes and even pick up objects. But only when they begin to pick up objects and use them appropriately are they believed to have gained a higher level of consciousness.

At best, however, these patients generally stay ''extremely disabled," Katz said.

In another development yesterday in Haleigh's case, Allison Avrett, her biological mother, said she has asked a Boston lawyer, Wendy Murphy, to represent her in dealings with DSS.

Murphy and Avrett declined to say what actions they hope to pursue, though they acknowledged that they were introduced by leaders of the Yellow Ribbon Kids Club, a group in Whitman that advocates for foster children. That group called last week for Spence to resign over his handling of Haleigh's case, among others.

Murphy said she will hold a press conference soon to announce Avrett's legal plans and added that she would not preclude legal action.

Avrett gave up legal custody when Haleigh was 7, after DSS accused Avrett of neglecting her daughter and accused Avrett's boyfriend of sexually abusing the girl. Avrett, who now has two other children, has denied the charges.

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

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