SD51 - A Study of the Child Death Review and Advisory Committee


Executive Summary:
Senate Joint Resolution 174 (SJR 174) and House Bill 627 (HB 627) are, for the purposes of this study, considered together because both describe the development of child death review teams. (Appendix 1, 2) SJR 174 requested the Secretary of Health and Human Resources and the Secretary of Public Safety to study the feasibility of establishing an Infant and Child Death Review Advisory Committee. HB 627 amended § 32.1-283 of the Medical Examiner Code mandating the creation of the Child Fatality Review Advisory Committee. The Secretary of Health and Human Resources was named as Chair (Appendix 3, § 32.1-283.1). HB 627, in addition, also amended § 63.1-209 of the Social Services Code to provide for the release of records to multidisciplinary teams, development of formal cooperative agreements records to multidisciplinary teams, development of formal cooperative agreements between local social services and local law enforcement, and the adoption of protocols for criminal investigation. The Department of Health was designated as the lead agency for the study. SJR 174 stated that direct costs of the study were not to exceed $3,600. Study findings and recommendations were to be submitted to the Governor and the 1995 Session of the General Assembly.

Both documents, with slight variations in language, direct that a team/task force be selected to study and develop procedures to ensure that child deaths occurring in Virginia are reviewed in a systematic way. Task force members were charged with developing protocols (SJR 174) or making recommendations (HB 627) for teams. Task force members were mandated to:

1. Develop protocols for the establishment and operation of a child death review teams. HB 627 (§ 32.1-283.1) specified that a protocol be developed for the establishment and operation of child death review teams. SJR 174 requested that a protocol be developed for the establishment and operation of local or regional child death review teams.

2. Recommend procedures (SJR 174) and develop protocols/procedures (HB 127) to improve identification of child deaths to be reviewed.

3. Recommend procedures for the identification, data collection and record keeping of the causes of infant and child deaths.

4. Develop procedures for coordination among the agencies and professionals involved.

5. Recommend prevention and education programs.

6. Recommend training to improve the investigation of infant and child deaths.

Recommendations:

• The Task Force recommended that, in accordance with the mandate § 32.1-283.1, and in consideration of the budget, that for the present, a single statewide review team be established and that the committee adopt bylaws for its operation. It was the consensus of the Task Force that a review of fatalities be retrospective with the focus of the review being to gain information on how and why children die. The presumption by the Task Force was that some funding would be granted to set up and support team activities.

• Whereas some other state teams survey only for suspicious, abuse and neglect deaths, the Task Force members concluded the review should be broader and that childhood accidental injury and suicidal injury are modes of death worthy of study, educational efforts and prevention programs.

• The Task Force recommended that the team, upon request of the Chair, be provided access to information and records regarding the child whose death is being reviewed and information and records regarding the child's family. Such records should include but not be limited to information and records maintained by any state or local governmental agency and records from medical, dental and mental health providers.

• A code section is needed to acquire records and for requiring records maintained by any state or local governmental agency be retained until such time that the child death review is completed but not longer than twelve months.

• The Task Force recommended that local and regional teams remain voluntary and a coordinator position be established to serve as a central advisor and resource.

• The Task Force Core Study Group recommended the position of statewide coordinator be established to assist the mandated Child Death Review and Advisory Committee, to serve, when local teams are developed, as a coordinator and resource; to assist the multiple agencies involved in state, regional and local death review teams; to assist in developing protocols and educational curricula and to devise and disseminate statewide prevention and education programs. The establishment of a coordinator position would be dependent upon whether any new legislation mandates the formation of local and regional teams as well as a single statewide team.

• The Task Force Core Study Group recommended the Child Fatality Review and Advisory Committee be chaired by the Chief Medical Examiner. The Task Force further recommended that the Chief Medical Examiner collect the names of provisional appointees from the named agencies and groups and submit the names to the Secretary of Health and Human Resources for approval and/or amendment within 30 days. This would facilitate appointment of members.

• Focus groups desired to meet further to refine individual group protocols before promulgation and before they can be incorporated into the standard operating procedures of emergency rooms, police departments and rescue squads.

• The Task Force recommended that a study subcommittee be formed to review curricula in place and on-going programs and to evaluate them for statewide dissemination into the curricula of Emergency Medical Services, Child Protective Services, Medical Examiners, Firefighters, Police and points of possible intervention and prevention.

• The Task Force Core Study Group recommended a study subcommittee work with an epidemiology and computer consultant to develop a statewide computer child death database to be established and supported within the Office of the Chief Medical Examiner. At present the databases of Vital Records, Emergency Medical Services, and Child Protective Services cannot be electronically linked nor can selected items be identified and transmitted to the child death database.

• The Task Force recommended funding be provided for a computer consultant/programmer to develop a computer database and to develop computer linkages for surveilling agencies. After establishment, an agency management analyst will be needed to provide reports and manage the database.

• The Task Force recommended that team members serve terms of several years to develop expertise in review cases.

• The Task Force recommended that the first formal statewide review be scheduled in 1996 of 1995 cases. An informal review to test systems and protocols was recommended for 1995 to review 1994 cases.

• The Task Force recommended the team meet quarterly to review cases together with interim study of individual cases as received by mail from the coordinator.

• The Task Force recommended a representative from vital records, an educator, a local department of health, a circuit court judge, and a representative of the Attorney General be added to the team.

• The Task Force recommended educational endeavors be delayed until after the first death review takes place, reasoning the review should identify the most obvious training deficiencies to be remedied by the educational effort.

• The Task Force recommended that the designing of preventive programs delayed until after the review of death cases identifies risk events for child death that are amenable to prevention strategies.

• Child death review team meetings should be closed to the public when the team is reviewing individual child fatality cases. All other team meetings should be open to the public.

• The Task Force recommended that information and records acquired by the team be considered confidential and not subject to subpoena, discovery or introduction as evidence. Records available from other sources should not be immune from subpoena solely because they were presented to or reviewed by a team. Attendees of a team meeting should not be subject to questioning in any civil or criminal proceeding regarding information or conclusions presented at a team meeting. Team members and other attendees should sign a statement of confidentiality.