WHEN A CHILD DIES; PANEL LOOKS FOR ANSWERS IN CHILDREN'S DEATHS

"Death never looked so bleak as when painted on the face of a child." -- Unknown

When a child dies suddenly and without explanation, the only solace may lie in finding the answers.

How did it happen? Why did it happen? Could it have been prevented? What can we do to make sure it doesn't happen again?

Finding answers to these and other questions is the task of the Cape Girardeau County Child Fatality Review Panel, says Morley Swingle, panel chairman and the county's prosecuting attorney.

"We don't point fingers," Swingle said. "We want to inform the public and find ways to educate people."

During 1995, a total of 1,232 children younger than 18 years of age died in Missouri, according to the state program's 1996 annual report. Of those, 80 were homicides. The majority of deaths, 679, had a clear, nonsuspicious cause and were not referred for further review after an initial meeting.

Cape Girardeau County saw 16 child deaths in 1995, four of which were reviewed by the Child Fatality Review Panel.

Fellow panel member and Cape Girardeau County Coroner John Carpenter said the group's mission is to find information that can educate people about to better ways of keeping their children safe.

"The panel is not there to persecute or find guilt, it's to stop children from dying," Carpenter said. "Does a family need more fuel to keep their children warm? Do they need more food to feed them? We're about keeping kids alive."

In 1991, Missouri was the first state to create panels required to review any suspicious or unexplained sudden death of a child under the age of 18, Swingle said.

They were created after a study by the Department of Social Services and Health and the University of Missouri found that a significant number of child deaths were not being accurately reported.

The study revealed that the causes of death were also not being adequately investigated or identified. As a result of that study, a task force was appointed in August 1990 to further study child fatalities.

The task force made recommendations that became the basis for House Bill 185, which established a statewide, county-based system of child fatality review panels. This bill was passed in May 1991 and signed into law by then-Gov. John Ashcroft in 1991.

That same year, a local panel was formed in Cape Girardeau County. The 21-member panel consists of representatives from a wide range of professions. In addition to the prosecuting attorney and the coroner, doctors, nurses, investigators, health department officials, juvenile officials, Division of Family Services personnel, police officers and a paramedic all participate.

"That way we have many sources to tap when we're reviewing the death of a child," Swingle said. "From those who investigated the death to those who performed the autopsy."

The group meets if there is no immediate individual cause of a child's death, Swingle said. For example, if a child is run over by a car in front of his or her house, the panel would automatically meet to discuss the circumstances, Swingle said.

"Was the operator of the vehicle drunk? Where were the parents? If a child dies in a crib, was it natural or not? We attempt to answer these questions," Swingle said.

One member, Det. Judy Gentry of the Cape Girardeau Police Department, said the group looks at all the facts and tries to determine how the death occurred. They look at photographs, reports, the autopsy and witness statements to try and piece the puzzle together.

"It's just like we do in all cases," she said. "Except these are a little tougher because they involve a dead child. It's very traumatic for everyone."

The panel does not meet when it is obvious that the child died of natural causes, he said. For example, if a child is born without lungs and died, the panel would not have to meet, he said.

Some criteria for a meeting of the Child Fatality Review panel also include possible inadequate supervision, possible suicide, possible inflicted injury, any firearm injury, death due to confinement, suffocation or strangulation and death due to any fire injury.

The panel always has the discretion to review any child death.

Child fatalities (Ages 0-17)

Total Missouri Child Deaths 1232

Child deaths involving illness, injury or an event 1116

Cause of death clear (not suspicious) 679

Deaths with an indication for review 437

Deaths reviewed by panel 432

Causes of child death involving illness, injury or an event

Injury: Homicide 80

Injury: Unintenttional 236

Injury: Suicide 30

Natural: Sids 78

Natural: Other 670

Unknown 22

Child abuse/neglect fatalities of children under the age of 18

1991 40

1992 49

1993 48

1994 58

1995 42

Source: Missouri Child Fatality Review Program Annual Report 1995