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LEHIGHTON, Pennsylvania – Brayden Cummings angry 6 weeks old the morning his mother suffocated him.
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High on methamphetamine, Xanax and the methadone assigned to advice her bang a heroin habit, 20-year-old Tory Schlier told badge that she was “fuzzy” about what happened to her babyish boy.
Police weren’t. In an affidavit, the administrator who went to Schlier’s abode on October 17, 2014, said the mother had collapsed comatose on Brayden, “causing him to asphyxiate.”
Like added than 130,000 other accouchement built-in in the United States in the aftermost decade, Brayden entered the apple absorbed on drugs – a annex affiliated from a mother aggressive addiction.
A 12-year-old federal law calls on states to booty accomplish to safeguard babies like Brayden afterwards they leave the hospital. That accomplishment is declining beyond the nation, a Reuters analysis has found, endangering a bearing of accouchement built-in into America’s growing addiction to heroin and opioids.
In his aboriginal three weeks of life, Brayden suffered through a anatomy of bairn biologic annex alleged Neonatal Abstinence Syndrome. He trembled and wailed inconsolably, clenching his anatomy and sometimes asthmatic for animation as he went through withdrawal.
When Brayden improved, Lehigh Valley Hospital arise him to Schlier and the boy’s father, a 48-year-old with a bent record. But doctors abandoned to booty a analytical step: They bootless to active adolescent aegis workers to the babyish or his drug-addicted mother. Three weeks later, Brayden was dead.
“I’d say he didn’t accept a adventitious in life,” said David Cummings, Brayden’s grandfather. “He was doomed, that kid, he absolutely was.”
Reuters articular 110 cases aback 2010 that are agnate to Brayden’s: babies and toddlers whose mothers acclimated opioids during abundance and who afterwards died preventable deaths.
Being built-in drug-dependent didn’t annihilate these children. Anniversary recovered abundant to be absolved from the hospital. What closed their fates was actuality beatific home to families ill-equipped to affliction for them.
Like Brayden, added than 40 of the accouchement suffocated. Thirteen died afterwards burning baneful doses of methadone, heroin, oxycodone or added opioids. In one case, a babyish in Oklahoma died afterwards her mother, aerial on methamphetamine and opioids, put the 10-day-old babe in a abrasion apparatus with a bulk of bedraggled laundry. (See Part 2)
The cases allegorize baleful flaws in the attempts to abode what President Barack Obama has alleged America’s “epidemic” of opioid addiction, a crisis fed by the accessible availability of decree painkillers and bargain heroin.
In 2003, aback Congress anesthetized the Keeping Accouchement and Families Safe Act, about 5,000 drug-dependent babies were built-in in the United States. That cardinal has developed badly in the years since. Application hospital acquittal records, Reuters tallied added than 27,000 diagnosed cases of drug-dependent newborns in 2013, the latest year for which abstracts are available. On average, one babyish was built-in abased on opioids every 19 minutes.
The federal law calls on states to assure anniversary of these babies, behindhand of whether the drugs their mothers took were adulterous or prescribed. Bloom affliction providers aren’t artlessly accepted to amusement the breed in the hospital. They are declared to active adolescent aegis authorities so that amusing workers can ensure the newborn’s assurance afterwards the hospital sends the adolescent home.
But best states are blank the federal provisions, abrogation bags of newborns at accident every year. Reuters activate that at atomic 36 states accept laws or behavior that don’t crave doctors to abode anniversary case. No added than nine states and the District of Columbia arise to accommodate with the federal law. And statutes or behavior in the added bristles states are black and confusing, alike for doctors and adolescent aegis workers.
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In three-quarters of the 110 fatalities that Reuters identified, the mother was active in her child’s death; in others, her boyfriend, bedmate or addition about was.
In 75 of the cases, adolescent aegis workers were notified but didn’t booty careful measures defined in the federal law.
In Brayden’s case and a dozen more, hospitals didn’t abode a drug-dependent baby’s action to amusing casework and the adolescent died afterwards actuality beatific home.
“Those kids could and should be animate today and thriving,” said above U.S. Representative Jim Greenwood, a Republican from Pennsylvania who authored the accoutrement in the 2003 federal law. “I would’ve hoped that the accomplished arrangement – starting at the federal and accompaniment levels, the obstetricians and pediatricians – would’ve gotten it beeline by now. That they haven’t is a civic disgrace.”
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One acumen babies go unprotected: Abounding states don’t crave hospitals to abode drug-dependent newborns if the mother was demography methadone, painkillers or added narcotics assigned by a doctor.
That absolution stems from a well-meaning accomplishment to abstain stigmatizing mothers who are actuality advised for addiction or added medical problems. Demography methadone below a doctor’s affliction is about safer for a babyish and its mother than if a mother tries to stop demography opioids altogether, neonatologists said.
But those acceptable intentions avoid a difficult truth: A mother who abuses methadone or added acknowledged opioids can be aloof as alarming to her bairn as a ancestor aerial on heroin. In at atomic 39 of the cases in which accouchement died, Reuters found, the mother was demography methadone or addition biologic that had been prescribed.
In anniversary of the 27,000 cases of Neonatal Abstinence Affection diagnosed in 2013, hospital workers were acquainted of the baby’s condition. Accommodating acquittal annal appearance they advised the adolescent for the syndrome.
Doctors who specialize in these cases say the condition, while sometimes disturbing for the newborn, is treatable and needn’t aftereffect in abiding corruption to the child. But a analysis fabricated in the aboriginal canicule of the baby’s activity should serve as a warning, they say. It about indicates that a mother is disturbing with addiction, adopting questions about a family’s adeptness to affliction for the infant.
“This is absolutely the time aback a woman is accomplished for relapse,” said Lauren Jansson, administrator of pediatrics at the Center for Addiction and Abundance at Johns Hopkins University in Baltimore. “She’s activity terrible, tired, depressed, afraid and guilty.”
Data kept by accompaniment governments advance that bags of these babies and their mothers are never referred to adolescent aegis services.
Reuters fabricated that assurance by comparing the cardinal of newborns diagnosed by hospitals as drug-dependent with the cardinal of cases referred to accompaniment adolescent abundance authorities. Abandoned seven states accurately tracked referrals of newborns in biologic withdrawal. In those states, the absolute cardinal of cases logged by adolescent aegis casework was below than bisected the cardinal of accouchement diagnosed.
“These are aloof deaths cat-and-mouse to happen,” said Greenwood, who spent three years as a adolescent aegis artisan afore confined six agreement in Congress.
Because so abounding drug-dependent newborns go unreported, no one knows absolutely how abounding accouchement are afflicted or asleep while in the affliction of parents disturbing with addiction.
Reuters filed added than 200 Freedom of Advice Act requests with federal, state, canton and burghal agencies, and advised about 5,800 adolescent accident letters from beyond the United States to analyze such cases. Reporters additionally scrutinized tens of bags of pages of letters by police, hospitals, medics, coroners and lawyers.
By analytical accident letters and added accessible records, the account bureau was able to analyze 110 examples of accouchement who died beyond 23 states.
The assessment is about absolutely higher. Best states fabricated accessible abandoned fractional advice on the affairs of babyish deaths. Some of the bigger states, including New York, below to acknowledge any letters about adolescent fatalities.
Even so, advisers said the Reuters analysis represents the best absolute assay of the perils adverse drug-dependent newborns afterwards they are beatific home.
“If we alpha attractive at it like you’re doing, we’re activity to acquisition added of these babies,” said Theresa Covington, administrator of the Civic Fetal, Babyish and Adolescent Afterlife Analysis Center, a government-funded non-profit group. She alleged the Reuters allegation “groundbreaking and heartbreaking.”
“THAT BABY IS IN SERIOUS DANGER”
During the alleged crack-baby catching of the 1980s, accessible affair focused on whether accouchement apparent to cocaine in utero would face abiding adorning problems. Below advised was whether babies built-in with narcotics in their bodies were in crisis afterwards they were advised and arise from the hospital.
A longstanding law, the Adolescent Corruption Prevention and Analysis Act, was adapted in 2003 to abode that issue. The alteration orders states to set up systems to ensure that anniversary case in which a babyish is built-in drug-dependent is appear to adolescent aegis authorities. Amusing casework are again to advance a “plan of safe care” for the child.
The law additionally makes ablaze that those referrals are not affirmation of abuse.
The Abode majority baton again – Tom DeLay, a Republican from Texas – batten in Congress about the accent of the amendment. “When adolescent aegis workers aren’t told that a babyish was built-in absorbed to drugs,” he said, “that babyish is in austere danger.” The new legislation “sends a ablaze bulletin to the states: Drug-addicted newborns allegation be protected.”
Although the alteration anesthetized with about no opposition, its appulse has been limited. At the time, the Civic Appointment of Accompaniment Legislatures said that abounding states would allegation to canyon new laws to accommodated the federal provisions. Few have.
Congress offers federal allotment for states that accede with the law. But the bulk of money angry to the accoutrement is tiny. This year, it ranged from $83,673 for the District of Columbia, which does comply, to $2.8 actor for California, which doesn’t.
Despite the boundless abridgement of compliance, Reuters activate that no accompaniment has anytime absent federal allotment for declining to accommodated the law’s provisions.
Today, best states crave bloom admiral to abode abandoned babies who were apparent to adulterous narcotics. That bureau adolescent aegis casework may never apprentice of babies adversity abandonment from opioids that were accurately assigned to abundant mothers. Some accompaniment behavior are so abashed that alike adolescent abundance admiral are abashed about the advertisement requirements.
Laura Velez, agent abettor of New York state’s Appointment of Accouchement and Family Services, initially told Reuters that doctors there allegation abode all cases of drug-dependent newborns, behindhand of whether the mother was demography “legal or actionable drugs.” But afterwards blockage with a advocate in her office, Velez offered a altered interpretation: Doctors aren’t answerable to abode cases in which the mother is application assigned drugs and “following the advance of analysis appropriately.”
At the added extreme, states such as Alabama and Tennessee accept taken a castigating access to active mothers aggressive addiction, assuming laws that accomplish opioid corruption during abundance a abomination in assertive circumstances. Those accoutrement run adverse to the spirit of the federal law, which absolutely states that anecdotic a drug-dependent bairn shouldn’t be construed as astute prosecution. Some well-intentioned doctors say the castigating measures accord hospitals a able allurement to accumulate quiet about assertive kinds of cases. (See accompanying article)
“A lot of admiral – nurses, amusing workers – say, ‘We don’t abode aback the mother is aggravating to get better,’” said Ila Baugham, a retired pediatrician in North Carolina who reviews cases of abrupt adolescent fatalities. “I consistently appear aback and say, ‘Well, it’s not about the mother. What about the baby?’”
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The White Abode has done little to abode the problem, some doctors say. In an October speech, President Obama said he “started belief this affair – what’s alleged opioids,” aback he entered appointment in 2009. “And I was abashed by the statistics.”
His administering convened a appointment on opioid-dependent babies in 2012; three years later, White House “action items” included updating bureau websites. Aftermost month, Congress anesthetized a bill administering the administering to move faster and devise a civic action aural a year. A White Abode agent said the new law “builds on advancing efforts.”
Loretta Finnegan, the doctor who developed a broadly acclimated medical calibration to appraise Neonatal Abstinence Syndrome, said she is “discouraged and frustrated” by the administration’s response. Statistics assuming the fasten in cases accept been accessible aback at atomic 2012, she said.
“It’s 2015. Aback are they activity to alpha accomplishing something?” Finnegan asked. “We apperceive these babies are actual difficult to affliction for. If you do not actualize the able altitude for mother and child, aback they go home it’s a bureaucracy for the mothers or others in the home to accomplish abuse.”
Infants with Neonatal Abstinence Affection are sometimes built-in into astute misery. As they go through withdrawal, some shake, attempt to eat and about sputter and asphyxiate during feedings. They ache fits of sneezing and astringent diarrhea. Abounding activate arrant at the aboriginal stimulus, including a mother’s smile. They can cry with such force that their bodies shudder.
“It’s a panicked, astute wail, about desperate, a complete you don’t forget,” said Kimberly Nelson, assistant administrator of the neonatal accelerated affliction assemblage at the Children’s Civic Medical Center in Washington, D.C.
The affection are about affliction during the aboriginal bristles weeks of activity but can aftermost three to six months, arduous alike the best accommodating parents. The newborns rarely accomplish abysmal sleep. As they abide withdrawal, they crave the black and calm of the womb, altitude about absurd to carbon at home. In West Virginia, cases accept become so common that one hospital created a assemblage area babies are weaned off the drugs in dimly lit rooms, cloistral from ablaze ablaze and commotion.
“It’s relentless. There’s no break,” said Rhonda Edmunds, a neonatal assistant in Huntington, West Virginia. “You can aloof brainstorm a sleep-deprived parent, who can’t cope with her own issues, let abandoned their baby, and how that can advance to corruption or neglect.”
“YOU’RE ON THAT BABY”
In the 110 deaths Reuters identified, active mothers about had been application heroin, constructed painkillers that accommodate such drugs as Percocet and OxyContin, or methadone, an opioid about assigned as an another to heroin or the added medications.
Like Brayden Cummings, the Pennsylvania babyish who died at 6 weeks of age, abounding of the accouchement suffocated afterwards hospitals arise them to mothers clumsy to affliction for a baby.
“A lot of admiral – nurses, amusing workers – say, ‘We don’t abode aback the mother is aggravating to get better.’ I consistently appear aback and say, ‘Well, it’s not about the mother. What about the baby?’”
In December 2012, a Kentucky hospital beatific a bairn and a decree for Percocet home with a 28-year-old mother who was actuality advised for opioid addiction. Adolescent aegis authorities weren’t notified about Angelica Richardson McKenney’s newborn, Lynndaya. Below Kentucky law, the case didn’t accept to be appear because McKenney’s opioid-replacement drug, Subutex, had been prescribed.
Five canicule later, on Dec. 10, Lynndaya was dead. A 36-page accompaniment abode capacity the final hours of the newborn’s life.
The night afore Lynndaya died, McKenney afterwards told police, she took three altered medications: the opioid Percocet, the anti-anxiety medication Xanax, and Subutex. Lynndaya’s grandmother noticed that McKenney’s “knees were accedence below her aback she stood.” McKenney recalled that she afterwards fed the babyish but “didn’t apperceive what she did with Lynndaya afterwards that.”
The abutting morning, Lynndaya’s grandmother approved to deathwatch McKenney, who lay at the bottom of the bed. Twice, the grandmother asked area the babyish was. Again she saw a bend of Lynndaya’s absolute below McKenney. “Oh my God,” the grandmother told a still-high McKenney, “you’re on that baby.”
According to the afterlife report, the accompaniment of Kentucky disqualified that McKenney’s “neglect” had acquired her baby’s death. Bounded prosecutor Douglas Miller said there wasn’t abundant affirmation of “reckless” or “wanton” conduct, as appropriate by accompaniment law, to allegation her.
Harrison Memorial Hospital and the doctor who delivered Lynndaya knew of McKenney’s biologic problems. The accompaniment abode said that Lynndaya “tested absolute for narcotics” aback she was born. McKenney “has been testing absolute throughout her abundance for opiates, benzodiazepines, and marijuana, none of which she had a decree for,” the abode said.
But no abode about McKenney’s biologic use was fabricated to adolescent aegis authorities aback Lynndaya was born, accompaniment annal show. Hospital backer Mollie Smith below to allocution about the case, citation medical privacy.
Derek Clarke, the doctor listed on the hospital acquittal document, delivered Lynndaya by Cesarean section. He afterwards beatific McKenney home with the decree for Percocet, one of the drugs she took the night afore she smothered her baby. The acquittal additionally addendum that McKenney “has been demography Subutex throughout her accomplished pregnancy.”
Contacted by Reuters, Clarke dedicated his accommodation to accelerate McKenney home with Percocet. “Just because they’re a biologic aficionado doesn’t beggarly we’re not activity to accord them article for their pain,” he said.
The day afore Lynndaya died, pharmacy annal show, Clarke additionally assigned Xanax, which McKenney took with the Percocet and Subutex. Studies accept apparent that accumulation Subutex and Xanax can be decidedly dangerous. Clarke did not acknowledge to questions about the Xanax prescription.
McKenney said Clarke should accept accepted bigger than to accord her the prescriptions. “I’m an addict. It was my fault, of course, and additionally it was his accountability for alms me the medicine.”
McKenney said she has been off drugs for about two years now. She said she wishes amusing casework had been added complex aback Lynndaya was born.
“I anticipate if I had been below the microscope, so to speak, I anticipate things would accept been a lot altered with somebody advancing in and attractive at me,” she said. “That apparently would’ve afflicted everything.”
A FATAL MIXTURE
Other accouchement died of biologic contagion – not from the narcotics in their bodies at bearing but from doses administered afterwards they larboard the hospital.
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In Utah, a 17-month-old babe alleged Jaslynn Raquel Mansfield died aftermost year of astute methadone toxicity. Her mother, Courtney Nicole Howell, was on decree methadone during and afterwards her pregnancy.
“There’s no agnosticism this babyish was at risk, and the mother had already been on drugs. I don’t apperceive what transpired at the hospital.”
Howell told authorities that she active acclimated a syringe to mix the analgesic with Children’s Tylenol. Her reasoning: Jaslynn “wouldn’t eat or beddy-bye and she wasn’t her accustomed babyish any more,” according to a 42-page badge abode apparent “confidential.” “Courtney accepted that she didn’t apperceive what to do to get Jaslynn help,” the abode said.
In August, Howell was bedevilled to up to 30 years in bastille afterwards argumentation accusable to assassination and advertisement a adolescent to drugs.
“The way she chose to affliction for the adolescent was reckless,” Adjudicator David Hamilton said at sentencing. “She brought the adolescent into the apple saddled with her addictions and her actions, and again she circuitous that.”
In a buzz account from the Timpanogos Women’s Correctional Facility abreast Salt Lake City, Howell said her bairn went through biologic abandonment at the hospital for 16 days. But the Salt Lake Regional Medical Center never appear the case to adolescent aegis services.
Utah is amid the states that don’t crave advertisement cases of newborns apparent to drugs assigned to their mothers. Louise Swensen, administrator of accident administration for the hospital, said a babyish in abandonment wouldn’t be appear to adolescent aegis unless the mother was abusing drugs or doctors had added assurance concerns.
Charri Brummer, agent administrator of the accompaniment Division of Adolescent and Family Services, said the accompaniment “would prefer” to be notified of all drug-exposed babies. In this case, she said, the accompaniment accustomed no drug-related letters on Howell afore Jaslynn’s death.
In abounding ways, Howell represented the affectionate of accessible ancestor the federal law was meant to help. Not abandoned was her bairn activity through withdrawal, but Howell additionally was homeless. Jaslynn’s ancestor had died three months beforehand from a heroin overdose. “I feel I was advantageous my babe had to break (in the hospital) that connected because I had no abode to booty her,” she said.
After she and Jaslynn were released, Howell said, they went to alive with her backward boyfriend’s ancestor and again to a women’s shelter. She said the hospital gave her about four micro-doses of morphine to accomplishment weaning Jaslynn off opioids. Howell herself connected to use methadone and added drugs, she said.
Today, she said, she wishes she had been appear to adolescent aegis casework aback Jaslynn was born. “I would accept accustomed the help,” Howell said, “and it would accept afflicted my life.”
UNMONITORED
In the case of Brayden Cummings, the 6-week-old who was accidentally suffocated by his mother in Pennsylvania, adolescent abundance authorities abstruse of the boy abandoned afterwards it was too late.
In September, Brayden’s mother, Tory Schlier, pleaded accusable to automatic assassination and was bedevilled to at atomic 15 months in prison. At sentencing, she told a adjudicator that she had been blessed aback she got abundant but “very afraid to accompany a abandoned animal actuality into the apple alive that adolescent would be my responsibility.”
Schlier’s biologic problems were no secret. Aback Tory was a teenager, her parents had approved the county’s advice for her “incorrigible behavior and biologic use,” a accompaniment abode said. On acquittal for annexation and abundant with Brayden, Schlier was confined in May 2014 afterwards testing absolute for heroin, abstracts show. A adjudicator arise her on July 31 – about a ages afore Brayden was built-in – on the action that she booty methadone, the opioid-replacement drug.
The advocate apery Schlier in Brayden’s afterlife said that the baby’s activity could accept been adored had the hospital alerted amusing services. But aback Schlier and Brayden were beatific home, advocate Jennifer Rapa said, “no watch was in aftereffect and no casework were offered.”
Not alike the canton admiral who advised Brayden’s afterlife can explain why.
The analysis aggregation was led by adolescent aegis workers at Carbon Canton Accouchement and Youth Services, the bounded abundance agency. In a abode aboriginal this year that has not ahead been fabricated public, the aggregation wondered how Schlier “could accept been apparent by so abounding altered professionals afore and afterwards the baby’s bearing and yet no one advised calling Accouchement and Youth to book a report.”
Even admitting Schlier was on methadone during her pregnancy, amusing casework were not alerted, the analysis aggregation wrote. Then, afterwards Brayden was built-in drug-dependent, he “was assigned methadone afterward bearing yet no one had alleged Accouchement and Youth.”
Brayden was apparent “by his pediatrician, who was additionally acquainted of the babyish actuality on methadone, but yet no one had alleged Accouchement and Youth,” the analysis aggregation wrote.
The pediatrician, Narayana Gajula, said he was afraid to apprentice from Reuters that the hospital never appear the case. At the time, Pennsylvania appropriate doctors, including Gajula, to abode all cases in which a adolescent was built-in drug-dependent, as the federal law spells out.
“There’s no agnosticism this babyish was at risk, and the mother had already been on drugs,” Gajula said. He said that his appointment about calls adolescent careful casework aback babies assume at accident of carelessness or abuse. He affected hospital administrators automatically appear the case to amusing workers, he said. “I don’t apperceive what transpired at the hospital.”
Citing accommodating privacy, Brian Downs, a agent for the Lehigh Valley Bloom Network, said neither the hospital nor its agents doctors will animadversion on the case or the county’s report.
Gajula said he saw Brayden active in the anniversary afore the baby’s death, and “it seemed to be activity fine.”
It wasn’t, Schlier wrote in a letter to Reuters from prison. She said she admired that the hospital “had addition analysis in at our home circadian to see how things were going,” for her and for Brayden. “I was an addict, and it was able-bodied accepted to everyone, but no one seemed to care!”
It isn’t ablaze who assuredly did active adolescent abundance admiral to Brayden. The state’s abode redacted that information. But the abode does agenda that the buzz alarm didn’t appear until aboriginal this year – 80 days afterwards the babyish had died.
In June, accompaniment assembly voted to change the action for advertisement babies built-in abased on drugs: They alone it. Today, if a drug-dependent babyish is built-in to a mother application assigned drugs – such as the methadone Schlier had been demography – doctors no best allegation to active amusing services.
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