Ill. Pediatrician Pushes for Program to Identify Child Abuse

Jan. 02--When Jahki Carpenter arrived at the University of Chicago's Comer Children's Hospital in respiratory distress, doctors at first were puzzled about what was making the nearly 1-month-old infant so ill, prosecutors said.

Soon, though, members of the hospital's child protective service team spotted something peculiar while examining an X-ray of the infant's chest. Dr. Jill Glick, the medical director, led her team to diagnose a puncture wound deep in the boy's throat -- similar in length to an adult finger. Prosecutors said doctors realized Jahki had been intentionally harmed.

"You don't see that naturally," Glick said of the tear's location. "Someone held the baby's face and jammed their finger down his throat."

The Chicago boy died Nov. 11 from a bacterial infection related to the injury. Though he could not be saved, the team's round-the-clock efforts to glean family history, mobilize investigators and preserve medical evidence revealed that the baby did not die from an accident or undetermined cause. Prosecutors have charged the father, Arthur Carpenter, 22, with first-degree murder.

Glick has long argued for the expansion of child abuse pediatric teams in the child welfare system, building on the handful of teams like the one at Comer. She recently lobbied a state Senate panel for the creation of medically based multidisciplinary teams that would work with the Illinois Department of Children and Family Services to help reduce fatalities or, in cases like Jahki's, provide evidence of where deadly abuse may have occurred.

In several death cases reviewed by the Tribune in the past two years, many of the children had suffered an earlier injury, but DCFS did not take protective custody because of uncertain medical opinion about how the bruise, broken bone or head trauma had occurred.

Glick, known for her tie-dyed lab coat and impassioned, quick-paced comments, has tackled thousands of similarly tough cases in her medical career. One of only 11 board-certified child abuse pediatricians in Illinois and 264 across the country, she is regarded as a national leader in the emerging field of pediatric forensics.

More than a decade ago, Glick helped launch a program at a few Chicago hospitals in which every child under age 3 with a head wound, bone fracture or other traumatic injury is evaluated by a specially trained child abuse pediatrician who reports his or her findings to authorities.

The program was intended to be a pilot for all of the state but, more than a decade later, still exists only at a handful of hospitals and is without a systemic funding source. Under an expanded concept Glick envisions, medical professionals in hospitals would work on a team with specifically assigned police officers and DCFS investigators who are better trained in assessing physical abuse.

"The process we have now is fragmented and often incomplete, leading to delayed decisions or, in many cases, no decision," she said. "The reality is, we don't come together for every kid. We don't have a relationship. We don't have accountability to each other. That's a big problem."

In Jahki's case, for example, once abuse was suspected it was difficult for medical personnel to trade information with the DCFS investigator who tried in earnest to keep up while also juggling cases involving an additional two dozen children. Also, Glick said the baby's death would have been ruled "undetermined" by the medical examiner's office had it not been for her team's investigation because the injury had healed by the time the boy died.

Making her idea reality requires legislation. Besides identifying a funding source, lawmakers would have to require larger hospitals that treat serious trauma injuries to have a child abuse pediatric team. Smaller clinics also could be used so that children with a suspicious bruise or less serious injury could be evaluated without having to sit in a bustling hospital emergency room.

Glick also is pushing for the creation of a medical unit within DCFS headed by a certified child abuse pediatrician to improve evaluations in ongoing investigations, as well as review and strengthen the agency's policies, research and relationships with the medical community, including coroner and medical examiner offices.

In her first month as acting DCFS director, Denise Gonzales said she has met with Glick to discuss a possible pilot program. And Sen. Julie Morrison, a Deerfield Democrat who chairs the legislative panel before which Glick appeared, said they also will meet soon to figure out how the program could work.

A similar concept has been used in Florida for decades. Dr. Randell Alexander, the statewide medical director, said there are 24 teams across Florida. He said the program costs $17 million a year and is administered through the state's public health department, which awards contracts to the university, hospital and social service agencies that oversee teams in specific regions.

"The reason other states aren't doing it is because it costs money," Alexander said. "Convincing the legislature to spend money on child abuse exams doesn't work as well for some reason as convincing them to spend money on old people with heart problems."

Alexander said Illinois, however, isn't alone in eyeing the idea. Officials in Maryland, Mississippi, Texas and West Virginia are holding similar discussions, he said. Alexander estimated that a statewide program in Illinois would likely cost $13 million annually.

The field of child abuse pediatrics is a relatively new specialty. The American Board of Pediatrics began offering the certification about 2007.

But officials there said interest in child abuse certification continues to grow, and Glick argues that further public awareness and education in Illinois' medical field will help attract more doctors to the specialty.

"We know that with child abuse it is all about putting puzzles together of disparate information from many sources," she said. "Right now there is no central place where we all convene to have a discussion and review the case at the time of the injury. The only comprehensive review now is after a bad outcome, after the child dies, and that's too late."

cmgutowski@tribune.com

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