Helpless & Hooked

LEHIGHTON, Pennsylvania – Brayden Cummings turned 6 weeks old the morning his mother suffocated him.

High on methamphetamine, Xanax and the methadone prescribed to help her kick a heroin habit, 20-year-old Tory Schlier told police that she was “fuzzy” about what happened to her baby boy.

Police weren’t. In an affidavit, the officer who went to Schlier’s house on October 17, 2014, said the mother had fallen asleep on Brayden, “causing him to asphyxiate.”

Like more than 130,000 other children born in the United States in the last decade, Brayden entered the world hooked on drugs – a dependency inherited from a mother battling addiction. 

A 12-year-old federal law calls on states to take steps to safeguard babies like Brayden after they leave the hospital. That effort is failing across the nation, a Reuters investigation has found, endangering a generation of children born into America’s growing addiction to heroin and opioids.

In his first three weeks of life, Brayden suffered through a form of newborn drug dependency called Neonatal Abstinence Syndrome. He trembled and wailed inconsolably, clenching his muscles and sometimes gasping for breath as he went through withdrawal.

When Brayden improved, Lehigh Valley Hospital released him to Schlier and the boy’s father, a 48-year-old with a criminal record. But doctors neglected to take a critical step: They failed to alert child protection workers to the baby or his drug-addicted mother. Three weeks later, Brayden was dead.

“I’d say he didn’t have a chance in life,” said David Cummings, Brayden’s grandfather. “He was doomed, that kid, he really was.”

Reuters identified 110 cases since 2010 that are similar to Brayden’s: babies and toddlers whose mothers used opioids during pregnancy and who later died preventable deaths.

Being born drug-dependent didn’t kill these children. Each recovered enough to be discharged from the hospital. What sealed their fates was being sent home to families ill-equipped to care for them.

Like Brayden, more than 40 of the children suffocated. Thirteen died after swallowing toxic doses of methadone, heroin, oxycodone or other opioids. In one case, a baby in Oklahoma died after her mother, high on methamphetamine and opioids, put the 10-day-old girl in a washing machine with a load of dirty laundry. (See Part 2)

The cases illustrate fatal flaws in the attempts to address what President Barack Obama has called America’s “epidemic” of opioid addiction, a crisis fed by the ready availability of prescription painkillers and cheap heroin.

In 2003, when Congress passed the Keeping Children and Families Safe Act, about 5,000 drug-dependent babies were born in the United States. That number has grown dramatically in the years since. Using hospital discharge records, Reuters tallied more than 27,000 diagnosed cases of drug-dependent newborns in 2013, the latest year for which data are available. On average, one baby was born dependent on opioids every 19 minutes.

The federal law calls on states to protect each of these babies, regardless of whether the drugs their mothers took were illicit or prescribed. Health care providers aren’t simply expected to treat the infants in the hospital. They are supposed to alert child protection authorities so that social workers can ensure the newborn’s safety after the hospital sends the child home.

But most states are ignoring the federal provisions, leaving thousands of newborns at risk every year. Reuters found that at least 36 states have laws or policies that don’t require doctors to report each case. No more than nine states and the District of Columbia appear to conform with the federal law. And statutes or policies in the other five states are murky and confusing, even for doctors and child protection workers.

In three-quarters of the 110 fatalities that Reuters identified, the mother was implicated in her child’s death; in others, her boyfriend, husband or another relative was.

In 75 of the cases, child protection workers were notified but didn’t take protective measures specified in the federal law.

In Brayden’s case and a dozen more, hospitals didn’t report a drug-dependent baby’s condition to social services and the child died after being sent home.

“Those kids could and should be alive today and thriving,” said former U.S. Representative Jim Greenwood, a Republican from Pennsylvania who authored the provisions in the 2003 federal law. “I would’ve hoped that the whole system – starting at the federal and state levels, the obstetricians and pediatricians – would’ve gotten it straight by now. That they haven’t is a national disgrace.”

One reason babies go unprotected: Many states don’t require hospitals to report drug-dependent newborns if the mother was taking methadone, painkillers or other narcotics prescribed by a doctor.

That exemption stems from a well-meaning effort to avoid stigmatizing mothers who are being treated for addiction or other medical problems. Taking methadone under a doctor’s care is generally safer for a baby and its mother than if a mother tries to stop taking opioids altogether, neonatologists said.

But those good intentions ignore a difficult truth: A mother who abuses methadone or other legal opioids can be just as dangerous to her newborn as a parent high on heroin. In at least 39 of the cases in which children died, Reuters found, the mother was taking methadone or another drug that had been prescribed.

In each of the 27,000 cases of Neonatal Abstinence Syndrome diagnosed in 2013, hospital workers were aware of the baby’s condition. Patient discharge records show they treated the child for the syndrome.

Doctors who specialize in these cases say the condition, while sometimes agonizing for the newborn, is treatable and needn’t result in long-term harm to the child. But a diagnosis made in the first days of the baby’s life should serve as a warning, they say. It often indicates that a mother is struggling with addiction, raising questions about a family’s ability to care for the infant.

“This is precisely the time when a woman is ripe for relapse,” said Lauren Jansson, director of pediatrics at the Center for Addiction and Pregnancy at Johns Hopkins University in Baltimore. “She’s feeling terrible, tired, depressed, anxious and guilty.”

Data kept by state governments suggest that thousands of these babies and their mothers are never referred to child protection services.

Reuters made that determination by comparing the number of newborns diagnosed by hospitals as drug-dependent with the number of cases referred to state child welfare authorities. Only seven states specifically tracked referrals of newborns in drug withdrawal. In those states, the total number of cases logged by child protection services was less than half the number of children diagnosed.

“These are just deaths waiting to happen,” said Greenwood, who spent three years as a child protection worker before serving six terms in Congress.

Because so many drug-dependent newborns go unreported, no one knows exactly how many children are injured or killed while in the care of parents struggling with addiction.

Reuters filed more than 200 Freedom of Information Act requests with federal, state, county and city agencies, and reviewed about 5,800 child fatality reports from across the United States to identify such cases. Reporters also scrutinized tens of thousands of pages of reports by police, hospitals, medics, coroners and lawyers.

By examining fatality reports and other public records, the news agency was able to identify 110 examples of children who died across 23 states.

The toll is almost certainly higher. Most states made available only partial information on the circumstances of infant deaths. Some of the largest states, including New York, declined to disclose any reports about child fatalities.

Even so, researchers said the Reuters investigation represents the most comprehensive examination of the perils facing drug-dependent newborns after they are sent home.

“If we start looking at it like you’re doing, we’re going to find more of these babies,” said Theresa Covington, director of the National Fetal, Infant and Child Death Review Center, a government-funded non-profit group. She called the Reuters findings “groundbreaking and heartbreaking.”

“THAT BABY IS IN SERIOUS DANGER”

During the so-called crack-baby epidemic of the 1980s, public concern focused on whether children exposed to cocaine in utero would face long-term developmental problems. Less examined was whether babies born with narcotics in their bodies were in danger after they were treated and released from the hospital.

A longstanding law, the Child Abuse Prevention and Treatment Act, was amended in 2003 to address that issue. The amendment orders states to set up systems to ensure that each case in which a baby is born drug-dependent is reported to child protection authorities. Social services are then to develop a “plan of safe care” for the child.

The law also makes clear that those referrals are not evidence of abuse.

The House majority leader then – Tom DeLay, a Republican from Texas – spoke in Congress about the importance of the amendment. “When child protection workers aren’t told that a baby was born addicted to drugs,” he said, “that baby is in serious danger.” The new legislation “sends a clear message to the states: Drug-addicted newborns must be protected.”

Although the amendment passed with almost no opposition, its impact has been limited. At the time, the National Conference of State Legislatures said that many states would need to pass new laws to meet the federal provisions. Few have.

Congress offers federal funding for states that comply with the law. But the amount of money tied to the provisions is tiny. This year, it ranged from $83,673 for the District of Columbia, which does comply, to $2.8 million for California, which doesn’t.

Despite the widespread lack of compliance, Reuters found that no state has ever lost federal funding for failing to meet the law’s provisions.

Today, most states require health officials to report only babies who were exposed to illicit narcotics. That means child protection services may never learn of babies suffering withdrawal from opioids that were legally prescribed to pregnant mothers. Some state policies are so muddled that even child welfare officials are confused about the reporting requirements.

Laura Velez, deputy commissioner of New York state’s Office of Children and Family Services, initially told Reuters that doctors there must report all cases of drug-dependent newborns, regardless of whether the mother was taking “legal or illegal drugs.” But after checking with a lawyer in her office, Velez offered a different interpretation: Doctors aren’t obligated to report cases in which the mother is using prescribed drugs and “following the course of treatment appropriately.”

At the other extreme, states such as Alabama and Tennessee have taken a punitive approach to expectant mothers battling addiction, enacting laws that make opioid abuse during pregnancy a crime in certain circumstances. Those provisions run counter to the spirit of the federal law, which explicitly states that identifying a drug-dependent newborn shouldn’t be construed as requiring prosecution. Some well-intentioned doctors say the punitive measures give hospitals a strong incentive to keep quiet about certain kinds of cases. (See accompanying article)

“A lot of officials – nurses, social workers – say, ‘We don’t report when the mother is trying to get better,’” said Ila Baugham, a retired pediatrician in North Carolina who reviews cases of unexpected child fatalities. “I always come back and say, ‘Well, it’s not about the mother. What about the baby?’”

How they died

ANTHONY ALLAN DONVITO
Scranton, Pennsylvania
Age: 7 weeks

Early on Jan. 22, 2015, a toddler heard her newborn brother Anthony gasping for air. According to a police report: The girl tried to wake her mother, who lay beside the infant in the bed. But both parents were fast asleep after taking prescription painkillers and anti-anxiety medication. When the mother awoke, the infant was face down and blue. A pathologist deemed the cause of death “sudden unexplained,” adding that asphyxiation “cannot be excluded.” Although the mother had been suspected of drug abuse and young Anthony spent the first days of his life suffering through drug withdrawal in a hospital, a child protection service assessment concluded “there were no services needed.” The parents, Amanda Salvatori and Anthony John Donvito, have pleaded not guilty to felony child endangerment.

• Reuters identified 47 other children since 2010 who were born exposed to drugs, sent home to drug-using parents, and died preventable deaths in unsafe sleeping conditions.

How they died

MARNEE KAY DOWNEY
Tallapoosa, Georgia
Age: 8 months

Melanie Ann Prichard’s reputation as a mother was well documented long before she poisoned her child. A state death report shows that when Marnee was born in February 2012, Prichard and Marnee’s father, Robert Derek Downey, had already had two children removed from their custody for neglect and physical abuse. Although Prichard had a history of methamphetamine abuse, social service workers did not have an open file on the family when the baby died on Oct. 10, 2012. The state report said Marnee was malnourished and dehydrated, and she died after ingesting Fentanyl, a narcotic more powerful than morphine. Prichard pleaded guilty to involuntary manslaughter and was sentenced to at least 10 years in prison. Downey was found guilty of felony child cruelty and was sentenced to at least 12 years in prison.

• Reuters identified 12 other children since 2010 who were born exposed to drugs, sent home to drug-using parents and died from toxic doses of methadone, heroin, oxycodone or other opiates.

How they died

BELLA JANE BLACKISTON
Denton, Maryland
Age: 2 years

In 2012, Bella Blackiston drowned in her family’s pool after her opiate-using mother lost track of her. A neighbor found the toddler naked, face down and under water. After Bella drowned, police reports show, officers found mother Kelly Blackiston glassy-eyed, slurring her speech and stumbling as she walked. They also found prescriptions for 19 different drugs, including a potpourri of painkillers. Blackiston was indicted for second-degree murder in her daughter’s death. She committed suicide in 2012.

• Reuters identified seven other children since 2010 who were born exposed to drugs, were sent home to drug-using parents and died preventable deaths by drowning.

How they died

DUSTIN NGUYEN
Columbus, Ohio
Age: 10 weeks

Authorities allege that Dustin was killed by his mother’s boyfriend. The boyfriend, who has pleaded not guilty, blames child protection services for not intervening, his lawyer said in an interview. “Here’s this baby born addicted, and they send it home with an addicted mother,” said Jo Kaiser, lawyer for the boyfriend, Brandon Adkins. “Doesn’t make a whole lot of sense – the father was available and he was not addicted.” A county spokeswoman said child protection workers were never notified by the hospital about Dustin or his mother, who was taking methadone to stay off heroin. “If medical personnel decide the mother is taking the substance as prescribed, they may not necessarily make a referral to the children’s services,” spokeswoman Deborrha Armstrong said. “The law says they only have to report if they think there is possible abuse or neglect.”

• Reuters identified 10 other children since 2010 who were born exposed to drugs, sent home to drug-using parents and died preventable deaths from physical abuse. Eight of the cases resulted in criminal charges.

The White House has done little to address the problem, some doctors say. In an October speech, President Obama said he “started studying this issue – what’s called opioids,” when he entered office in 2009. “And I was stunned by the statistics.”

His administration convened a conference on opioid-dependent babies in 2012; three years later, White House “action items” included updating agency websites. Last month, Congress passed a bill directing the administration to move faster and devise a national strategy within a year. A White House spokesman said the new law “builds on ongoing efforts.”

Loretta Finnegan, the doctor who developed a widely used medical scale to assess Neonatal Abstinence Syndrome, said she is “discouraged and frustrated” by the administration’s response. Statistics showing the spike in cases have been available since at least 2012, she said.

“It’s 2015. When are they going to start doing something?” Finnegan asked. “We know these babies are very difficult to care for. If you do not create the proper conditions for mother and child, when they go home it’s a setup for the mothers or others in the home to commit abuse.”

Infants with Neonatal Abstinence Syndrome are sometimes born into excruciating misery. As they go through withdrawal, some shake, struggle to eat and often sputter and choke during feedings. They suffer fits of sneezing and severe diarrhea. Many begin crying at the smallest stimulus, including a mother’s smile. They can cry with such force that their bodies shudder.

“It’s a panicked, high-pitched wail, almost desperate, a sound you don’t forget,” said Kimberly Nelson, nurse manager of the neonatal intensive care unit at the Children’s National Medical Center in Washington, D.C.

The symptoms are often worst during the first five weeks of life but can last three to six months, challenging even the most patient parents. The newborns rarely achieve deep sleep. As they endure withdrawal, they crave the darkness and calm of the womb, conditions almost impossible to replicate at home. In West Virginia, cases have become so frequent that one hospital created a unit where babies are weaned off the drugs in dimly lit rooms, sheltered from bright light and commotion.

“It’s relentless. There’s no break,” said Rhonda Edmunds, a neonatal nurse in Huntington, West Virginia. “You can just imagine a sleep-deprived parent, who can’t cope with her own issues, let alone their baby, and how that can lead to abuse or neglect.”

“YOU’RE ON THAT BABY”

In the 110 deaths Reuters identified, expectant mothers typically had been using heroin, synthetic painkillers that include such drugs as Percocet and OxyContin, or methadone, an opioid often prescribed as an alternative to heroin or the other medications.

Like Brayden Cummings, the Pennsylvania baby who died at 6 weeks of age, many of the children suffocated after hospitals released them to mothers unable to care for a baby.

“A lot of officials – nurses, social workers – say, ‘We don’t report when the mother is trying to get better.’ I always come back and say, ‘Well, it’s not about the mother. What about the baby?’”

In December 2012, a Kentucky hospital sent a newborn and a prescription for Percocet home with a 28-year-old mother who was being treated for opioid addiction. Child protection authorities weren’t notified about Angelica Richardson McKenney’s newborn, Lynndaya. Under Kentucky law, the case didn’t have to be reported because McKenney’s opioid-replacement drug, Subutex, had been prescribed.

Five days later, on Dec. 10, Lynndaya was dead. A 36-page state report details the final hours of the newborn’s life.

The night before Lynndaya died, McKenney later told police, she took three different medications: the opioid Percocet, the anti-anxiety medication Xanax, and Subutex. Lynndaya’s grandmother noticed that McKenney’s “knees were buckling under her when she stood.” McKenney recalled that she later fed the infant but “didn’t know what she did with Lynndaya after that.”

The next morning, Lynndaya’s grandmother tried to wake McKenney, who lay at the foot of the bed. Twice, the grandmother asked where the baby was. Then she saw a corner of Lynndaya’s blanket beneath McKenney. “Oh my God,” the grandmother told a still-high McKenney, “you’re on that baby.”

According to the death report, the state of Kentucky ruled that McKenney’s “neglect” had caused her baby’s death. Local prosecutor Douglas Miller said there wasn’t enough evidence of “reckless” or “wanton” conduct, as required by state law, to charge her.

Harrison Memorial Hospital and the doctor who delivered Lynndaya knew of McKenney’s drug problems. The state report said that Lynndaya “tested positive for narcotics” when she was born. McKenney “has been testing positive throughout her pregnancy for opiates, benzodiazepines, and marijuana, none of which she had a prescription for,” the report said.

But no report about McKenney’s drug use was made to child protection authorities when Lynndaya was born, state records show. Hospital spokeswoman Mollie Smith declined to talk about the case, citing medical privacy.

Derek Clarke, the doctor listed on the hospital discharge document, delivered Lynndaya by Cesarean section. He later sent McKenney home with the prescription for Percocet, one of the drugs she took the night before she smothered her baby. The discharge also notes that McKenney “has been taking Subutex throughout her whole pregnancy.”

Contacted by Reuters, Clarke defended his decision to send McKenney home with Percocet. “Just because they’re a drug addict doesn’t mean we’re not going to give them something for their pain,” he said.

The day before Lynndaya died, pharmacy records show, Clarke also prescribed Xanax, which McKenney took with the Percocet and Subutex. Studies have shown that combining Subutex and Xanax can be particularly dangerous. Clarke did not respond to questions about the Xanax prescription.

McKenney said Clarke should have known better than to give her the prescriptions. “I’m an addict. It was my fault, of course, and also it was his fault for offering me the medicine.”

McKenney said she has been off drugs for about two years now. She said she wishes social services had been more involved when Lynndaya was born.

“I think if I had been under the microscope, so to speak, I think things would have been a lot different with somebody coming in and looking at me,” she said. “That probably would’ve changed everything.”

A FATAL MIXTURE

Other children died of drug poisoning – not from the narcotics in their bodies at birth but from doses administered after they left the hospital.

In Utah, a 17-month-old girl named Jaslynn Raquel Mansfield died last year of acute methadone toxicity. Her mother, Courtney Nicole Howell, was on prescription methadone during and after her pregnancy.

“There’s no doubt this baby was at risk, and the mother had already been on drugs. I don’t know what transpired at the hospital.”

Howell told authorities that she twice used a syringe to mix the narcotic with Children’s Tylenol. Her reasoning: Jaslynn “wouldn’t eat or sleep and she wasn’t her normal baby any more,” according to a 42-page police report marked “confidential.” “Courtney admitted that she didn’t know what to do to get Jaslynn help,” the report said.

In August, Howell was sentenced to up to 30 years in prison after pleading guilty to manslaughter and exposing a child to drugs.

“The way she chose to care for the child was reckless,” Judge David Hamilton said at sentencing. “She brought the child into the world saddled with her addictions and her actions, and then she compounded that.”

In a phone interview from the Timpanogos Women’s Correctional Facility near Salt Lake City, Howell said her newborn went through drug withdrawal at the hospital for 16 days. But the Salt Lake Regional Medical Center never reported the case to child protection services.

Utah is among the states that don’t require reporting cases of newborns exposed to drugs prescribed to their mothers. Louise Swensen, director of risk management for the hospital, said a baby in withdrawal wouldn’t be reported to child protection unless the mother was abusing drugs or doctors had other safety concerns.

Charri Brummer, deputy director of the state Division of Child and Family Services, said the state “would prefer” to be notified of all drug-exposed babies. In this case, she said, the state received no drug-related reports on Howell before Jaslynn’s death.

In many ways, Howell represented the kind of vulnerable parent the federal law was meant to help. Not only was her newborn going through withdrawal, but Howell also was homeless. Jaslynn’s father had died three months earlier from a heroin overdose. “I feel I was lucky my daughter had to stay (in the hospital) that long because I had no place to take her,” she said.

After she and Jaslynn were released, Howell said, they went to live with her late boyfriend’s father and then to a women’s shelter. She said the hospital gave her about four micro-doses of morphine to finish weaning Jaslynn off opioids. Howell herself continued to use methadone and other drugs, she said.

Today, she said, she wishes she had been reported to child protection services when Jaslynn was born. “I would have welcomed the help,” Howell said, “and it would have changed my life.”

UNMONITORED

In the case of Brayden Cummings, the 6-week-old who was accidentally suffocated by his mother in Pennsylvania, child welfare authorities learned of the boy only after it was too late.

In September, Brayden’s mother, Tory Schlier, pleaded guilty to involuntary manslaughter and was sentenced to at least 15 months in prison. At sentencing, she told a judge that she had been happy when she got pregnant but “very scared to bring a helpless human being into the world knowing that child would be my responsibility.”

Schlier’s drug problems were no secret. When Tory was a teenager, her parents had sought the county’s help for her “incorrigible behavior and drug use,” a state report said. On probation for theft and pregnant with Brayden, Schlier was jailed in May 2014 after testing positive for heroin, documents show. A judge released her on July 31 – about a month before Brayden was born – on the condition that she take methadone, the opioid-replacement drug.

The lawyer representing Schlier in Brayden’s death said that the baby’s life could have been saved had the hospital alerted social services. But when Schlier and Brayden were sent home, attorney Jennifer Rapa said, “no watch was in effect and no services were offered.”

Not even the county officials who reviewed Brayden’s death can explain why.

The review team was led by child protection workers at Carbon County Children and Youth Services, the local welfare agency. In a report early this year that has not previously been made public, the team wondered how Schlier “could have been seen by so many different professionals before and after the baby’s birth and yet no one considered calling Children and Youth to file a report.”

Even though Schlier was on methadone during her pregnancy, social services were not alerted, the review team wrote. Then, after Brayden was born drug-dependent, he “was prescribed methadone following birth yet no one had called Children and Youth.”

Brayden was seen “by his pediatrician, who was also aware of the baby being on methadone, but yet no one had called Children and Youth,” the review team wrote.

The pediatrician, Narayana Gajula, said he was surprised to learn from Reuters that the hospital never reported the case. At the time, Pennsylvania required doctors, including Gajula, to report all cases in which a child was born drug-dependent, as the federal law spells out.

“There’s no doubt this baby was at risk, and the mother had already been on drugs,” Gajula said. He said that his office generally calls child protective services when babies seem at risk of neglect or abuse. He assumed hospital administrators automatically reported the case to social workers, he said. “I don’t know what transpired at the hospital.”

Citing patient privacy, Brian Downs, a spokesman for the Lehigh Valley Health Network, said neither the hospital nor its staff doctors will comment on the case or the county’s report.

Gajula said he saw Brayden twice in the week before the baby’s death, and “it seemed to be going fine.”

It wasn’t, Schlier wrote in a letter to Reuters from prison. She said she wished that the hospital “had someone check in at our home daily to see how things were going,” for her and for Brayden. “I was an addict, and it was well known to everyone, but no one seemed to care!”

It isn’t clear who finally did alert child welfare officials to Brayden. The state’s report redacted that information. But the report does note that the phone call didn’t come until early this year – 80 days after the baby had died.

In June, state lawmakers voted to change the policy for reporting babies born dependent on drugs: They loosened it. Today, if a drug-dependent baby is born to a mother using prescribed drugs – such as the methadone Schlier had been taking – doctors no longer need to alert social services.

Pennsylvania’s safety net for the babies of the opioid epidemic is now weaker than it was when Brayden Cummings died.

BROOKSVILLE, Florida – Jennifer Lacey Frazier recently completed drug treatment and parenting classes. The help came too late to save her daughter, Jacey.

In December 2011, Frazier gave birth to Jacey at a hospital in Charlotte, North Carolina. The baby inherited her mother’s blue eyes – and Frazier’s dependency on drugs.

Jacey spent two weeks suffering through withdrawal, a result of the methadone Frazier took during pregnancy to control an addiction to prescription painkillers.

Federal law calls on states to require hospitals to report newborns hooked on drugs to child protection services. Records show the North Carolina hospital did precisely that. It alerted child welfare authorities just across the border in nearby York County, South Carolina, where Frazier had been living with her mother.

But the 2003 law has a second, distinct provision – one that many states have failed to embrace, putting thousands of newborns in jeopardy each year, a Reuters investigation has found.

That provision calls on state child protection authorities to immediately assess all cases of drug-dependent newborns. Social workers are then supposed to develop “a plan of safe care” for every infant who is either “affected by illegal substance abuse” or experiencing symptoms of drug withdrawal.

York County took no such action, documents and interviews show. Instead, a hospital social worker wrote in Frazier’s medical records that the county child protection agency “will not be following up with infant.”

The reason: South Carolina has a state law that conflicts with the federal provisions. It says that child protection authorities don’t have to investigate cases of drug-dependent newborns if their mothers were using drugs prescribed by a doctor. Frazier had a prescription for methadone.

Six months later, after Frazier moved to Florida with her daughter and Jacey’s father, the girl was dead – the victim of a lethal dose of methadone Frazier mistakenly gave her.

“I wish social services had been at my home investigating, talking to me, checking on Jacey,” Frazier wrote to Reuters last month in a letter from prison. “I didn’t just slip through the cracks in the system; I fell through the canyon into hell.”

Reuters identified 110 cases since 2010 in which children died preventable deaths after being sent home from the hospital to families ill-equipped to keep them safe. In each of those cases, Reuters found evidence of a mother’s use of opioid drugs during her pregnancy.

In some instances, hospitals failed to alert authorities to infants born dependent on drugs, despite a federal law that was intended to ensure each such case be reported to child welfare workers. (See Part 1)

Social service agencies are falling short, too. Of the 110 deaths Reuters uncovered, 74 other cases appear similar to Jacey’s: Child protection authorities were alerted by the hospital to a drug-dependent newborn, but social workers either chose not to pursue the case or failed to adequately respond.

In many of the fatal cases identified by Reuters, child protection workers conducted cursory investigations, or none at all. Sometimes, authorities created safety plans, but parents simply ignored them. In other instances, such as Jacey’s case, social workers followed less stringent state policies, which don’t require intervention if mothers are using drugs that are prescribed, typically to treat addictions.

What went wrong

RYDER SALMEN
Citrus Heights, California
Age: 7 months

Although Ryder spent his first weeks of life in drug withdrawal, the hospital did not notify child protection workers before releasing him to his mother, a state spokeswoman said. What followed is documented in a redacted copy of the Sacramento County child protective services file and a prosecutor’s statement: In his third month, relatives found Ryder lethargic and somnolent in his bassinet, his mother in a daze nearby. In the emergency room, the boy tested positive for methadone. A social worker swiftly composed a safety assessment for Ryder and his mother, but a supervisor took three months to approve it, records show. The day that plan was approved, the supervisor approved a second assessment, declaring the baby at low risk. Seven weeks later, Ryder died of a drug overdose. His mother, Sarah Stephens, is serving a 12-year sentence for voluntary manslaughter.  

• Reuters identified 25 other children since 2010 born exposed to drugs and who died preventable deaths after child protection services either responded slowly to their predicaments or never were notified.

What went wrong

TYLER LEE DRUMMOND
St. Cloud, Florida
Age: 22 months.

As detailed in a state death review: Tyler was born to a mother who was taking methadone. He spent his first six weeks suffering through drug withdrawal at the hospital. His mother did not visit him often, but late one night, staffers found Tyler choking in his hospital room, his parents asleep beside him, the death review says. His mother seemed confused about her surroundings. “This does cause some concerns as to their ability to adequately care for the child upon discharge,” a child protection worker wrote. Nonetheless, Tyler was sent home with his parents, without any child welfare services. In May 2010, he drowned in a backyard pool after leaving the house through a back door while his mother chatted with her father and a family friend, the death review concluded. The state ruled that his death was the result of inadequate supervision; no charges were filed.

• Reuters identified 74 other children since 2010 born exposed to drugs and who died preventable deaths after child protection services did not meet federal guidelines for a prompt, thorough investigation and a safety plan.

What went wrong

NICCOLO VARNER
Collingdale, Pennsylvania
Age: 11 months

Niccolo Varner spent two months in the hospital suffering withdrawal from his mother’s heroin addiction. The Delaware County Children and Youth agency was notified when the mother, Christina Rivero, had come to the hospital complaining of stomach pain without realizing she was pregnant. The agency later wrote a barebones safety plan to send Niccolo home: The child’s father was not to let Rivero be alone with the baby. “The family began to stabilize,” according to a summary report. The case was closed in May 2012. Two months later, Niccolo died from heroin intoxication. The agency hadn’t realized Rivero was using again. Her public defender, Joseph D’Alonzo, said oversight had “faded away.” Rivero pleaded guilty to involuntary manslaughter and was sentenced to three to six years in prison. Trish Cofiell, county spokeswoman, said caseworkers are being trained in better ways to keep an eye on drug-using parents.

• Reuters identified 32 other children since 2010 born exposed to drugs who died preventable deaths after they were sent to homes in which their caretakers had already come to the attention of child protection services.

“The fact that the mother is in treatment is a good thing,” said former U.S. Representative Jim Greenwood, a Republican from Pennsylvania who championed the 2003 federal law. “But that doesn’t prove that she has a place to live that’s safe. It doesn’t prove that she knows how to parent. It doesn’t prove that there isn’t a violent, other drug user in the home. It doesn’t say anything about the baby’s situation. And this is all about protecting the baby.”

The cases exemplify the wide disparities in oversight afforded to drug-exposed children across America, levels of vigilance that vary dramatically among the 50 states and even within the states themselves.

“In some areas, we had babies positive for marijuana removed from home, and in other places, kids tested positive for methamphetamine and they weren’t removed,” said Lisa Smith, director of the Oklahoma Commission on Children and Youth. “Depends on what part of the state you’re in.”

“A PICKUP LOAD OF DEAD BABIES”

Reuters found dozens of situations in which infants were released from hospitals into unsafe homes where family members used heroin, methadone or prescription painkillers, according to records from social workers, coroners and police.

Some of the newborns died at the hands of drug-abusing parents, even though hospitals had alerted child protection agencies.

One of the most disturbing deaths took place in Oklahoma. On Nov. 4, 2010, Maggie May Trammel died when she was just 10 days old. Mother Lyndsey Fiddler, high on a variety of drugs including opioids, accidentally put her baby in a washing machine with a load of laundry. Then Fiddler passed out.

Maggie May was found dead “after the wash cycle was completed,” a state review of her death shows.

Fiddler is now serving a 15-year sentence for manslaughter and child neglect.

“If only we could have gotten the baby somewhere safe when it was first born,” said Kevin Ickleberry, the police detective who arrested Fiddler.

Before Maggie May died, the Washington County office of the state Department of Human Services had received five reports about Fiddler. Each alleged neglect or abuse related to drug use. One of those reports came the day Maggie May was born.

But child welfare workers concluded Maggie May and two older siblings were safe and that Fiddler “was willing to work on parenting services,” a state report said.

“The fact that the mother is in treatment is a good thing. But that doesn’t prove that she has a place to live that’s safe. It doesn’t prove that she knows how to parent.… It doesn’t say anything about the baby’s situation. And this is all about protecting the baby.”

The case sparked outrage and efforts by the Oklahoma to improve its child protection system.

The Oklahoma Commission on Children and Youth, an independent oversight agency, began reviewing why the state’s social service system was failing.

The commission examined 10 cases in which babies had been reported to child welfare authorities for exposure to drugs in families with a history of neglect or abuse. Only five of the cases had been investigated. Two were quickly dismissed by a child-abuse hotline worker as not appropriate for protection services. In three of the cases, parenting classes were recommended.

Eight of the 10 babies later died of neglect or abuse “on average within 6.5 months of their birth,” the commission concluded. Contributing factors, the panel said, were lack of treatment for mothers and inconsistent reporting by hospitals.

At one meeting, the commission’s chairman at the time, Bart Bouse, asked the state social services chief: “Does it take a pickup load of dead babies before we decide to act?”

In 2012, the state legislature passed a law requiring authorities to investigate any case in which a “drug-endangered” child is reported to the Department of Human Services.

A second panel of experts reported in 2013 that too many newborns and drug-using mothers were sent home together without safety monitoring. “Sometimes there was a tendency to ignore drug abuse in the home because the ‘medications were prescribed,’” the report said.

Today, Oklahoma has a protocol based on the 2003 federal law.

“We’ve made great strides,” said commission director Smith, but “there’s still a lot of work to be done.”

“10 TIMES STRONGER THAN ANY PILL”

Some of the cases Reuters examined show the challenges social workers face even as they try to do right by the child. Although each of the 110 deaths that the news agency identified was preventable, even some of the mothers who killed their children say social workers were vigilant.

“I’m not sure that anyone could have helped prevent my son Liam’s tragic death,” his mother, Amanda McKenzie, wrote last month in a letter she sent Reuters from prison. Her son drowned when McKenzie fell asleep with him in the bathtub.

When Liam McKenzie was born in March 2013, the hospital alerted social workers in Newport, Kentucky, about his mother’s extensive drug use. But neither Liam nor McKenzie tested positive for drugs, state records show, and the case was quickly closed.

About four months later, social service workers logged another report – from whom is unclear – alleging that baby Liam was in danger because his mother was using heroin.

Social service workers went to McKenzie’s house four times in a week before they found her at home on Aug. 2, 2013. In a report, they wrote that the home was “clean and free of clutter” and that mother and child had “formed a positive bond with one another.” But they told McKenzie that, because of the allegations, they were putting in place a “safety plan” that included random drug screenings. Later that day, McKenzie submitted to a drug test; it came back clean.

In the next two weeks, child protection records show, social workers attempted to reach McKenzie and couldn’t. They left voicemails and told her she needed to be drug tested again. There is no record that McKenzie responded. Social workers twice visited her house but got no answer.

Eight days after their last attempt to visit, baby Liam drowned when McKenzie fell asleep in the bathtub with him.

In an interview with Reuters, McKenzie said she had been taking prescription methadone, an opioid used to treat addiction, at the time of Liam’s death. She said she started using it because she had recently relapsed and wanted to stop snorting heroin and abusing painkillers. But the methadone, she said, was more powerful than she expected.

“It’s 10 times stronger than any pill I ever took,” McKenzie said.

Today, McKenzie is serving a five-year prison sentence after pleading guilty to reckless homicide.

WANTED HELP

Jennifer Frazier, now 32, told authorities she confused the antibiotics she was giving to newborn daughter Jacey with the methadone Frazier was taking to kick an addiction to painkillers. A pre-sentence report found that Frazier was “extremely remorseful” and that the mix-up in medications was “not intentional.”

Even so, Frazier was sentenced to 15 years in prison in 2013 after pleading guilty to aggravated manslaughter of a child.

In a prison interview, Frazier admitted that, at the time, she was glad that she didn’t have to deal with child protection authorities. “That would be one more thing on my plate,” she said.

Since entering prison, she has taken parenting classes and has gone through drug treatment. If she had been forced to take those classes earlier – and if the state had threatened to take Jacey away – it might have saved her daughter’s life, she said.

Authorities never intervened, and more than 1,400 pages of hospital records reviewed by Reuters show why: Under South Carolina state law, authorities were not obligated to investigate further because Frazier was on prescribed medication, not illicit drugs.

Although the difference in the type of drugs Frazier was taking proved central in how social services handled the referral, the federal law makes no such distinction between illicit and prescribed drugs. It requires safety plans for all newborns with symptoms of drug withdrawal. These plans can include home nursing, substance-abuse counseling, housing and employment help, and a threat to remove the child if the parents don’t follow the guidelines.

Medical records show that Frazier provided a sanitized version of her drug history to the hospital. She claimed that she became addicted to pain pills after a car accident more than a year before Jacey was born. She told nurses that, six weeks before giving birth to Jacey, she switched to the prescribed methadone on her doctor’s advice because it was safer for the baby.

Records from the methadone clinic, however, show Frazier had been battling addiction much longer than she let on.

According to those records, Frazier, then 28 years old, had used cocaine since she was 14, crystal methamphetamine from ages 16 to 19, cocaine and crack from age 24, and the powerful painkiller Percocet since a back injury in the car accident. That accident had taken place and the addiction had started at least six years earlier – not one, as she had told the hospital. She admitted to that clinic she had been a frequent customer at “pill mills.”

There is no indication in hospital records that doctors, nurses or state social workers ever looked closely at Frazier’s background of drug use before letting her take Jacey home.

In one notation, hospital social worker Catherine Hall wrote that the county’s child protection service wouldn’t stand in the way of Jacey’s discharge from the hospital if the newborn were healthy enough in a few days. York County’s Department of Social Services, Hall wrote, “can follow up with infant and mother at their home if needed.”

Social services declined to open an investigation because of Frazier’s valid methadone prescription, hospital documents show. Frazier and Jacey later moved to Florida.

Reached by Reuters, Hall declined to comment. The county’s social worker, Becky Mann, referred questions to the South Carolina Department of Social Services. Department spokeswoman Karen Wingo said that unless there were other signs of abuse or neglect, the state would not typically accept a case if the baby’s drug exposure was from “medical treatment for the mother.”

“THERE WAS A NEED”

Several times during her hospital stay, the records show, Frazier herself raised the issue of “dealing with infant withdrawal.” For almost two weeks, Jacey had been given smaller and smaller doses of morphine to help ease her shaking, clenching, wailing and other symptoms of opioid withdrawal.

Hospital records included this notation: “Home Health RN visits will begin after discharge.” They didn’t, Frazier said.

On New Year’s Eve 2011, the hospital determined that Jacey – now 25 days old – was well enough to leave. The discharge note also said Frazier was going to be referred to a service program called BabyNet. That never happened, Frazier said.

“They sent her home, and that was basically it,” she said.

Citing patient privacy, a spokesman for Carolinas HealthCare System, where Frazier gave birth, and a spokesman for BabyNet declined to comment.

Frazier takes responsibility for Jacey’s death – “I messed up,” she said. Only later, she said, did she realize just how much help she needed.

“If I was that social worker, I’d be knocking the door down, because I see what can happen,” Frazier said. “They need to find us, and they need to help.”

A hospital doesn’t test for drugs; days later, a newborn is dead

By Duff Wilson

DEVILS LAKE, North Dakota – Two days after giving birth in the summer of 2014, Reanne Pederson left a hospital with her baby boy Avery and a prescription for 20 hydrocodone pills to treat pain.

A day later, Pederson was prescribed another 15 pills. That night, she crushed and snorted a hydrocodone, boosting its narcotic effect. High, she breastfed Avery and then fell asleep on top of him, suffocating the newborn.

Efforts to revive him failed, and he was pronounced dead on June 14, 2014 – five days after he was born.

“I’ll regret it forever,” she said in an interview here, in her hometown of Devils Lake.

Now 32, Pederson pleaded guilty to negligent homicide in the death. She said she spent 100 days in jail and another 180 days in two drug treatment centers. She admits to snorting hydrocodone late in her pregnancy and smoking methamphetamine the day before Avery was born.

But the police detective who investigated the baby’s death also faults those who treated Pederson at the place where Avery was born, Essentia Hospital in Fargo, North Dakota.

Hospital records reviewed by Reuters indicate that the hospital appears to have made little effort to scrutinize mother or child. Although a labor and delivery nurse caught Pederson in a lie about having a doctor’s approval for one drug, no one at the hospital checked a state prescription database. It would have revealed Pederson’s extensive use of addictive drugs during her pregnancy, records show.

Medical records also described Avery as “jittery,” a possible symptom of a condition called Neonatal Abstinence Syndrome. But the hospital never tested the newborn or his mother for drugs, the records show. Neither test was required.

Almost a decade ago, a survey done by the U.S. Department of Health and Human Services highlighted how rarely hospitals test children for drug exposure. “Nearly all states test infants for other health conditions like human immunodeficiency virus (HIV) and phenylketonuria (PKU), which, in reality, impact far fewer children than prenatal exposure to alcohol and illicit drugs,” according to a report about the survey.

The survey was done in 2005-2006, when the U.S. painkiller epidemic hadn’t reached nearly the proportions it has today. In 2013, the number of newborns diagnosed with Neonatal Abstinence Syndrome had grown dramatically from what it was a decade before, swelling to 27,000, a review of federal data show.

Unless they test for drugs, hospitals may never realize a newborn is dependent on opioids. That’s because most infants delivered vaginally are discharged with their mothers just 48 hours after they are born, while some babies won’t begin exhibiting withdrawal symptoms until later – 48 to 72 hours after birth.

Clouded judgment

Derek Cruff, the police detective who investigated Avery’s death, said the hospital had more than enough evidence to test the child and mother for drugs. Not only had the baby been born premature, he said, but Pederson also had tried to persuade a nurse to give her drugs that a doctor had not authorized. Both are signs that a mother may be struggling with addiction.

“Why their protocol wasn’t followed, ask them,” Cruff said of the hospital.

Citing privacy laws, the hospital won’t comment on Avery Pederson except to say that it did follow its procedures. A spokeswoman for the hospital told Reuters that the doctors who treated Pederson also would not comment.

LuWanna Lawrence, spokeswoman for the North Dakota Department of Human Services, said the state could have provided services for the mother if it had been notified about the case. It also would have assessed the situation without accusing Pederson of neglect or abuse, Lawrence said.

“I WAS IN DENIAL”

Pederson said her addiction to opioids began with a doctor’s prescription for painkillers. The pills were meant to help treat jaw pain, but she said she began to crush and snort them. When Pederson got pregnant, she vowed to stop once she could hear the baby’s heartbeat at the doctor’s office.

“I was in denial,” she said. Doctors continued to prescribe the drugs, according to Pederson and her medical records.

James Volk, chief medical officer for Sanford Health in Fargo, another hospital Pederson visited, said she came to the emergency room three times in a 17-day period when she was more than seven months pregnant. Each time, she complained of dental pain and was given 10 to 15 hydrocodone pills.

“It was not an unusual presentation or an unusual treatment,” Volk said. If Pederson had come in a fourth time, however, Volk said she would have been put on a “care plan” that would have prompted doctors to more critically assess her situation before providing the drugs.

After Avery was born, records show, a doctor at Essentia noticed the baby was “jittery.” So did Pederson’s friend Robbie Lee, who visited the hospital. He later told police that he “could visibly see the baby shaking.”

Although Avery was given morphine to combat “pain” and “agitation,” a hospital pediatrician diagnosed Avery’s discomfort as related to his mother’s pack-a-day smoking habit and her use of Prozac, records show.

A notation in the file dismissed without explanation the need for a drug test or an assessment for withdrawal.

Days later, Avery was dead.

In North Carolina, a botched review of a baby’s death

By Duff Wilson

WILKESBORO, North Carolina – Procedures for protecting drug-exposed babies are haphazard in North Carolina. In the case of Caleb Joe Tipton, who died at 4 months of age, authorities failed to check even basic facts about the baby’s life and death.

A 2009 report by a child fatality review panel partially blamed a local hospital for not having sounded the alarm on the boy’s mother when Caleb was born.

“There was no report or notification to the Wilkes County Department of Social Services when the newborn tested positive at birth for marijuana and opiates by the Wilkes Regional Medical Center,” the report said. Authorities pledged to work with the medical center to correct the problem, it added.

But when Reuters recently asked Wilkes Regional Medical Center about that report, hospital vice president Tammy Love said Caleb wasn’t even born there. The hospital had never been asked about the baby’s birth until Reuters called, she said.

In fact, Reuters determined that Caleb was born at a different hospital in an adjoining county, an account confirmed by the child’s birth certificate.

Kevin Kelley, North Carolina’s chief of child welfare, ordered state and county officials to review and correct the report. He could not explain the mistake, or why the state promised to work with the hospital but failed to follow through. “We’ve never had this problem before,” he said.

North Carolina hasn’t adopted federal standards that all cases of drug-dependent newborns should be reported to child protection authorities. In some situations, hospitals alert social services. In others, they do not.

Hospital data analyzed by Reuters show the number of newborns in North Carolina diagnosed with drug withdrawal has nearly doubled from 404 in 2009 – the year the report was written – to 796 in 2012. Despite the increase, the state’s Division of Social Services acknowledged that it cannot say how many of those cases have been reported. That’s because the child protection service lumps such cases in a broad category of reports involving drugs and children, including teenagers.

James Jones, a doctor and an expert on newborn drug withdrawal at Levine Children’s Hospital in Charlotte, said only about half of the drug-dependent babies diagnosed there are reported to the state.

“It just depends on how the mom is doing with her addiction and how appropriate she is with her baby,” he said.

In the Caleb Tipton case, Caleb’s mother, Hollie Harrald, had been abusing painkillers for years, she said in an interview with Reuters. Harrald said she moved to a women’s shelter and stopped taking drugs a few months before Caleb was born. She said social service agencies in two counties had been monitoring her before closing their cases. The fatality report faults social workers for an “insufficient level of contact with the family.”

Caleb suffocated when he became tangled in a plastic trash bag on the floor of the trailer home where his parents lived. The baby’s father, Eric Ray Tipton, admitted to police that he used cocaine that night. According to the authorities, the parents had crushed Xanax, an anti-anxiety medication, and fed it to Caleb. Harrald told Reuters she couldn’t remember whether that was true. Tipton could not be located for comment.

Harrald and Tipton were both convicted of involuntary manslaughter. State records show each served at least a year in prison.

CHARLESTON, West Virginia – This story has a chance of ending happily. But it begins last fall in a mangy downtown apartment as Katy Yeager, seven months pregnant, stares at a syringe and the crumpled foil that holds $40 worth of heroin.

Yeager, 24, had been clean since leaving jail eight months earlier. Initially, she was elated to be pregnant. But then the baby’s father, a former coal miner she’d met in rehab, was sent back to prison. She faced raising the baby alone.

Her final trimester was filled with insomnia, nausea and anxiety. She hated the job required by her probation – eight hours a day on her feet as a waitress at a Shoney’s restaurant. And she was desperate for money to buy a crib and diapers.

“I just wanted to escape from myself,” Yeager recalled, “basically the loneliness, the anger and uncertainty of everything.”

Getting high is easy in Charleston, a city at the center of Appalachia’s epidemic of opioid addiction. On that fall day last year, two months before her baby was due, Yeager poured powdered heroin into a spoon, added water and held a lighter beneath it until the drug liquefied. She filled the syringe and found a vein on the palm of her hand. In seconds, all her worries vanished.

After about a week, Yeager decided to stop using. But this “slip up,” as she describes it, presented a dilemma: Two friends who quit cold turkey had gone into premature labor. With heroin still in their bodies, the state seized their babies. Fearing this, she obtained a legal prescription for Subutex, a drug used to treat opiate addiction.

In mid-December 2014, Yeager went into premature labor anyway. Her baby, Kennedy Jade Yeager, faced a harrowing first few months. Born hooked on the drugs her mother had been taking, Kennedy began an agonized withdrawal.

Federal law requires states to have plans to identify and protect babies like Kennedy, not just during their hospital stays but after they are sent home with their mothers. Most states fail to comply, Reuters found, leaving at risk thousands of children born drug-dependent each year. (See Part 1)

West Virginia is an exception. Along with the District of Columbia, it’s one of no more than nine states that insist doctors report every case to child protection workers – not necessarily to remove babies, officials say, but to keep them safe while helping their mothers.

A memo issued early last year by the state’s Department of Health and Human Services explains why each case must be monitored. It refers to a “rash” of child fatalities involving babies whose mothers had been using drugs that were legally prescribed to them. The memo tells social service and child welfare workers that “it is often impossible to know” whether a mother is “actively involved in a treatment program or if the parent is abusing the prescribed drugs … and unable to properly care for a newborn.”

That’s why the state says it wants to assess all cases in which a child tests positive for drugs.

“All newborns are extremely vulnerable,” the memo says, “as 100% of their livelihood is dependent upon their caregivers.”  

It’s that reality that inspired a charity in nearby Huntington to create a program designed to do more than simply wean newborns off drugs. Health care and social workers also train mothers fighting their own addictions to care for the difficult babies. Experts say only a handful of similar programs exist nationwide.

At the hospital, Yeager was among the first to be offered entry into West Virginia’s pilot program, which began in October 2014. To enroll, she had to sign Kennedy over to state custody. If both baby and mother successfully completed the program, the social worker promised, Yeager would get Kennedy back.

“A CRISIS RIGHT HERE”

Nationally, nearly 7 out of every 1,000 babies born in 2013 were diagnosed with Neonatal Abstinence Syndrome, a consequence of drug dependence among newborns, according to a Reuters analysis of federal data.

In West Virginia, the rate is about five times higher – 37 of every 1,000 babies. At Cabell Huntington Hospital, where Kennedy was born, 108 of every 1,000 babies born in 2013 were diagnosed with Neonatal Abstinence Syndrome. Last year, the rate at Cabell Huntington increased to 139 out of 1,000.

The pace hasn’t slowed this year, nurses said. In one 24-hour period last month, six babies were born in drug withdrawal. On average, the hospital handles eight births a day, which includes both healthy and sick infants.

“Even in your darkest, deepest imagination, you can’t imagine their agony,” said neonatal nurse Sara Murray. “You think you might know what one of these tremoring and screaming babies sounds and looks like, but it’s nothing like a colicky baby. We have some who scream as if their limbs are being ripped off.”

The problem first became acute at Cabell Huntington in 2011, doctors said. By then, newborns withdrawing from drugs occupied two-thirds of the neonatal intensive care unit, which has 36 beds. That left little room for newborns with life-threatening conditions unrelated to a mother’s drug use.

“We are the large regional hospital in a three-hour radius, and we were turning down sick and needy babies from other hospitals,” said Sean Loudin, the neonatologist who treated Kennedy.

In 2012, the hospital created a second neonatal unit just for babies going through withdrawal. Those 16 spots soon filled, too.

The kernel of a solution came when two veteran neonatal nurses, Murray and Rhonda Edmunds, explained to a hospital volunteer that the babies would heal faster if they lived off-site, somewhere far from buzzing machines and bright lights, and where mothers could learn parenting skills. The volunteer, local activist Mary Calhoun Brown, got to work.

“Lots of friends at church go on overseas missions, and no disrespect to them, but we have a crisis right here at home,” Brown said. Her first call was to Evan Jenkins, then a state senator and now a U.S. Congressman.

The nurses developed a medical plan. Jenkins devised ways to navigate state, Medicaid and insurance bureaucracies. Brown founded a charity to manage the facility and raised startup funds from coal industry foundations. A podiatrist’s widow donated her husband’s vacant office building.

Lily’s Place opened last fall with a mission to treat newborns and mothers in a nonjudgmental fashion. Soon, babies began arriving.

DIFFICULT TIMES, HARD CHOICES

Yeager knew the dangers opiates pose. At least five high school friends had overdosed and died. Two women she knew had been jailed shortly after giving birth, one for accidentally smothering and killing her child while in a drugged stupor.

Yeager also understood how difficult motherhood can be. Seven years earlier, while in high school, she’d given birth to a girl. Yeager said she did not get high during that pregnancy, but when her child was a toddler, she began abusing prescription painkillers. Yeager became homeless and transferred guardianship of the child to the father’s parents.

She didn’t want to lose another baby. 

She was already on probation for a crime: Stoned on Xanax and methamphetamine in March 2012, Yeager had helped two men rob an elderly man of $200. Police caught the three hapless addicts hours later.

Yeager pleaded guilty and was sentenced to two years’ probation in spring 2013. Within months she tested positive for morphine and marijuana, skipped probation meetings and fled to Ohio. She was arrested in late 2013 and jailed until early 2014, when she began rehab and went to live in the apartment for female addicts in Charleston.

During recovery sessions nearby, she met Donnie Gooding, a former coal miner who had just served a short jail term for manufacturing meth. He was nine years older and cocksure. She loved his tattoos – he had the word LUNATIC stenciled across his neck – and the passion with which he pursued her. Soon, she became pregnant. For a while the couple dreamed of a sober future with a healthy baby.

But by late summer 2014, Gooding violated probation and was sent back to prison. That’s when Yeager relapsed and then started on Subutex.

A short while later, during her eighth month of pregnancy, Yeager decided to visit her grandparents in Barboursville, about an hour away. Their house happened to be a few miles from Cabell Huntington Hospital and Lily’s Place.

FOUR POUNDS, SIX OUNCES

Yeager went into labor during the visit, and her grandfather rushed her to Cabell Huntington. Kennedy was born there on Dec. 19, 2014, four weeks premature.

She weighed just 4 pounds, 6 ounces. On a chart, a nurse rated Kennedy generally healthy but noted that she seemed hyperactive and jittery, the first hints of withdrawal.

“Even in your darkest, deepest imagination, you can’t imagine their agony. You think you might know what one of these tremoring and screaming babies sounds and looks like, but it’s nothing like a colicky baby. We have some who scream as if their limbs are being ripped off.”

About half of the babies born to mothers who take opiates during pregnancy begin life the way Kennedy did. While she was in the womb, Kennedy’s brain had been stimulated by drugs for months. But at birth, when the umbilical cord was cut, the opiate supply suddenly stopped, creating a chemical imbalance and abnormal behavior.

Babies like Kennedy arrive in the world irritable and hyperactive, making them far more difficult to keep calm than typical newborns. The tiniest noises can trigger inconsolable wailing. They are frightened easily, often by their own movements, even extending a leg. They can suffer involuntarily spasms and fits of yawning and sneezing.

Feeding can be a struggle. Unable to focus, the babies often choke or cough after a few sips of formula or breast milk. The sensation can panic them. Kennedy, typical of newborns in withdrawal, suffered from explosive diarrhea. Painful rashes followed.

Two days after birth, Kennedy was transferred to Cabell Huntington’s special neonatal unit for babies in withdrawal. Yeager was discharged.

“It didn’t really hit me until I got home and she wasn’t with me,” Yeager recalled. “Then I had all the guilt and regret. I’m a terrible mother. Why would I do this?”

Kennedy began a withdrawal protocol – decreasing micro-doses of methadone, a heroin-replacement drug – that lasted five weeks. When Yeager visited the hospital, she found it hard to keep Kennedy calm, in part because the infant shared a room with two other wailing, drug-dependent babies.

A few days later, Yeager was approached by Angela Davis, a Lily’s Place social worker. Davis invited her to put the baby in the new facility. “She explained that it was just like a hospital but Kennedy would get her own room,” Yeager recalled.

The offer included requirements for mother as well: Yeager would have to visit Kennedy six times a week, help the nurses care for her baby, take parenting classes, meet regularly with the social worker, and attend her own addiction recovery sessions. Most important, she needed to learn her newborn’s “stress cues” and how to address them. Yeager promised to do everything.

“DO NOT ABUSE YOUR BABY”  

Kennedy’s condition was charted with a widely used medical scale to tally the frequency, length and severity of symptoms – high-pitched cries, tremors, sweating, poor sleep. A score of 8 or higher means a baby’s condition is considered severe.

After two weeks at the hospital, Kennedy was transferred to Lily’s Place. On her first day there, her average score was 7. Within days, her score climbed to 10. At times it hit 17. Kennedy continued to sweat and cry excessively. Every few days, she shook with tremors.

Kennedy’s average score did not drop below 8 until her third week at Lily’s Place. Although doctors took the baby off methadone, they warned Yeager that Kennedy’s withdrawal would continue for months.

On Kennedy’s final day at Lily’s Place – she was 5 weeks old – Yeager was shown a video prepared by Loudin, the neonatologist.

“You are not taking home a completely normal newborn infant,” the doctor said in the video. “You have to recognize your baby is going to have bad days. At these times it is vital for you to keep yourself calm and not do anything that can harm the baby. Please, if you find yourself frustrated, the safest thing you can do is put your baby in a car seat, put it on the floor and walk away for a few minutes and collect yourself. Do not shake your baby. Do not abuse your baby.”

A FRESH START

For Yeager, her grandparents’ home in Barboursville, a village near Huntington, had long been a refuge. She spent years growing up there and was welcomed back in her early 20s, even after she repeatedly stole from them and a boyfriend once assaulted her grandfather.

The grandparents agreed to drive Yeager to recovery meetings and pediatrician appointments. But they insisted that Yeager would have to care for Kennedy 99 percent of the time.

During the first few weeks at their home, Kennedy’s tremors continued. Often, she was cranky. Yeager said she did her best to calm Kennedy, applying tips from Lily’s Place, such as swaddling the baby snugly and darkening the room.

“It was stressful … I’d be lying if I said I didn’t think about getting high,” she said. “But then I realized how far I had come and where I wanted to go, and that if I did that, Kennedy could be sent to a foster home, and anything could happen to her there.”

Yeager’s own recovery appeared to accelerate late this summer, after Gooding was released from prison. They married, and she began taking college courses online. Gooding got a steady construction job and helped Yeager pay off fines so she could get a learner’s permit to drive.

Recently, the couple rented a tiny apartment near Yeager’s grandparents. She takes a prescription drug to help her resist her heroin cravings. Both say they are off illegal drugs. In September, Yeager took Gooding’s last name. In October, their baby did, too.

Since Lily’s Place opened late last year, 66 babies have been weaned off drugs there. The fates of their mothers vary. Social worker Davis estimated that 80 percent were doing well on the day their baby was discharged; they were either off drugs completely or in recovery as part of a doctor-ordered prescription protocol. Two have overdosed and died.

But all 66 babies are alive.

This fall, Kennedy hit milestones for normal infants of her age: By 8 months, she could sit up, crawl and hold things in her hands. Her weight climbed to 19 pounds. She started pulling herself upright while balancing on the side of a couch or chair, a precursor to her first steps. And she began to smile in elevators and restaurants, no longer frightened by noise and bright light.

Infant deaths prompt changes at methadone clinic

By Duff Wilson

“I told them, ‘Listen, how could you not want to be on the side of saving babies’ lives?’ We want to prevent future deaths. We’re not trying to catch your clients using additional drugs so we can prosecute.’”

BRADENTON, Florida – Connie Shingledecker, a major with the Manatee County Sheriff’s Office here, was investigating the deaths of children in Florida when she noticed a disturbing pattern.

During a six-month period in 2012, four babies had died in the care of mothers with histories of drug abuse. In each case, their babies had been born dependent on drugs. And in each case, the new mothers were trying to kick their opioid addictions by taking methadone, dispensed by a clinic in a local strip mall.

At the time, only about 50 new mothers were visiting the methadone clinic. Shingledecker, a member of a statewide panel that reviews deaths related to child abuse, knew that four infants dying in such a short period represented an extraordinarily high rate.  

Shingledecker called the director of the local methadone clinic. It is run by Operation PAR, a non-profit agency serving recovering addicts in five counties.

Although the clinic drug-tested mothers to ensure they hadn’t relapsed, Shingledecker learned that the facility wasn’t telling authorities about any illegal drug use those tests showed, even though she said state law required that those results be reported.

“We were assuming they were going to call us, but we were wrong,” Shingledecker said.

Nancy Hamilton, chief executive officer of Operation PAR, said she agreed to meet with Shingledecker, but with some trepidation.

Methadone clinics have typically been regarded as safe havens for people trying to control their addictions. And doctors say they are sometimes reluctant to refer drug-dependent mothers and newborns to authorities. They don’t want to report women who seem to be doing their best to overcome addictions to heroin or painkillers.

“It’s a little tough to report the moms when they’re following doctors’ orders,” said Matthew Grossman, a doctor at Yale-New Haven Children’s Hospital.

The Florida cases Shingledecker spotted were somewhat different. Although the women were part of a methadone program, their drug tests also showed they were using illicit drugs.

Shingledecker insisted that Operation PAR follow the state law on mandatory reporting. It requires everybody – particularly health professionals and social workers – to call child protection services if they have reason to suspect a child may be neglected or abused. Parental drug abuse may be considered a form of neglect.

“I told them, ‘Listen, how could you not want to be on the side of saving babies’ lives?’” Shingledecker said. “‘We want to prevent future deaths. We’re not trying to catch your clients using additional drugs so we can prosecute.’”

Operation PAR’s Hamilton said she agreed. “We came up with something good,” Hamilton said. The plan, she said, was “to focus on at-risk pregnant women.”

That meant women who tested positive for illicit substances in their third trimester of pregnancy or who had open cases with child protection services. The at-risk women would be drug-tested two extra times per week. Positive results would be reported to the sheriff immediately.

Since 2013, all 48 new mothers who fit the criteria and use the Operation PAR facility have agreed to the conditions. All 48 of their babies are alive.

Reporter Duff Wilson reviewed more than 50,000 pages of documents and interviewed more than 300 people to assess the impact of opioids on newborns. The documents included about 5,800 child fatality reports and tens of thousands of additional pages of medical records and other documents obtained through more than 200 public records requests. To obtain those documents, Reuters began filing Freedom of Information Act requests in 2014 with federal, state, county and city agencies.

Reporters Wilson and John Shiffman interviewed mothers in seven states – including three mothers who are currently in prison – as well as doctors, nurses, social workers, drug counselors, prosecutors, defense lawyers, academics, child protection workers, lawmakers and relatives of people struggling with addiction.

To track the dramatic increase in babies born drug-dependent, Reuters analyzed hospital patient discharge data kept by the federal Agency for Healthcare Research and Quality. The news agency surveyed each state and the District of Columbia to assess policies and performance on two key parts of federal law – mandatory reporting of drug-withdrawing newborns and the disclosure of child fatality review reports.

To determine whether a child’s death may have been related to the mother’s drug use, Reuters looked at cases since 2010 in which a newborn was diagnosed as dependent on drugs or the mother was found to be using opioids during pregnancy. Then reporters examined whether the deaths of those children, each of whom had been released from the hospital, could have been prevented.

The 110 examples that Reuters found fit the definition of “preventable death” used by most states. It is contained in a glossary of terms to help officials identify and report such cases to the National Fetal, Infant and Child Death Review Center, a government-funded non-profit group. According to the definition, “A child’s death is considered to be preventable if an individual or the community could reasonably have done something that would have changed the circumstances that led to the child’s death.”

Tracing the circumstances of a child’s death back to the conditions at birth is often difficult, said Theresa Covington, a presidential appointee and director of the national center. The 110 cases that Reuters identified, Covington said, likely represent the “tip of the iceberg.”