MINNESOTA News

A group of motorcycle enthusiasts from Hastings is donating $25,000 to help fund the state's Amber Alert program.Bureau of Criminal Apprehension Superintendent Tim O'Malley will accept a check from the group on Sunday. He says Amber Alert runs entirely on donated funds, and the program is critical in getting the word out about a missing child.The motorcycle group has raised $100,000 for Amber Alert since 2003.The BCA says each Amber Alert costs between $6,000 and $12,000. Donations also help defray the cost of law enforcement training and education about the program.Since its inception, 22 Amber Alerts have been issued in Minnesota. The BCA says so far, every alert has ended with the child's safe recovery.

U.S. Sen. Amy Klobuchar is announcing
legislation that would give local law enforcement a new tool to help find missing children.
The "Access to Information about Missing
Children Act" would give local police access to Internal Revenue Service
records that they currently can't get.
The U.S. Justice Department says that each
year, more than 200,000 missing children cases are the result of family
abductions. Klobuchar says family abductors often take on false
identities, yet still file tax returns and claim the children as dependents.
Under current law, the IRS can't share any information with police.
The bipartisan legislation would require that police get a federal court order before they can get IRS data.
Klobuchar will announce the legislation Sunday.
She'll be joined by child safety advocate Patty Wetterling and Hopkins police Chief Mike Reynolds.

by Madeleine Baran, Minnesota Public Radio
September 23, 2011


St. Paul, Minn. —
As Colleen Lindstrom drove through
Minneapolis to pick up her baby daughter from daycare in July 2005, she
noticed a police car ahead of her. It stayed there the whole trip,
forming an ominous motorcade that ended in front of the daycare
building. A fire truck was parked outside.



Inside was three-month-old Brady, a
giggly, alert little girl, and the first daughter of Colleen and Matt
Lindstrom. Colleen rushed to the front door. The manager greeted her.
Colleen looked down and saw her baby's empty car seat on the ground.
Brady, the manager said, was dead.



Her daughter was taking a nap when
she stopped breathing, everyone said. Colleen assumed it was a classic
case of Sudden Infant Death Syndrome and that nothing could've prevented
it. But a few weeks later, the family learned what really happened.
Brady had accidentally suffocated because daycare workers placed her to
sleep on her stomach. "A mistake was made that cost us our child,"
Lindstrom said.



Fourteen months earlier in
Alexandria Minn., the infant daughter of Michael Hansen and Amanda
Schulke died in a basement bedroom where she had been sleeping on a
futon with her father and three-year-old sister. Her father said he woke
up to find four-month-old Avryonna cold and unresponsive.



The police were suspicious. Hansen
was charged with second-degree murder, convicted, and sentenced to 14
1/2 years in prison. He maintained that he did not kill his daughter,
and in July a judge overturned the conviction. Last week, the Douglas
County prosecutor dropped all charges.



Brady and Avryonna died less than
150 miles from each other, but their deaths received two very different
investigations.



Brady's death was investigated by
the Hennepin County Medical Examiner's Office, and a forensic
pathologist from there performed the autopsy. Its investigators visited
the daycare and used a doll to re-enact how Brady died.



Avryonna's death didn't prompt a
visit from any medical examiner's office. There was no doll
re-enactment. The medical examiner relied on law enforcement officials
to investigate the scene. They looked for evidence of a homicide, but
paid little attention to the baby's sleeping arrangements. Avryonna's
body was autopsied twice - by the Douglas County medical examiner, who
is not a forensic pathologist, and by Ramsey County medical examiner
Michael McGee, whose office is more than 100 miles away.



McGee, a forensic pathologist, wrote
the final autopsy report. He found that Avryonna died of blunt force
head trauma and ruled the death a homicide. However, five doctors,
including two medical examiners, who reviewed the case last year said
it's more likely the baby accidentally suffocated in her sleep.






Brady Lindstrom




INCONSISTENT LAWS



While the contrasting approaches are clear, they are similar in one potent way.



The investigation of Brady's death
followed state and national guidelines for investigating sudden,
unexpected infant deaths. The investigation of Avryonna's death did not.
Neither, however, was required to adhere to any particular set of
guidelines.



That's because there are no state or
federal laws that require Minnesota medical examiners or coroners to
follow even the most basic guidelines for investigating infant deaths.
And what guidelines exist are routinely ignored by counties. Moreover,
supervision of medical examiners and coroners is lacking in Minnesota
along with any reliable process to track infant deaths.



The inconsistencies, say state and
national experts in child death investigations, have resulted in a
patchwork system where crimes go undiscovered, innocent parents are
charged with homicide, rare genetic diseases go undetected, and public
health officials do not have accurate data to prevent accidental deaths.



"We are not only missing cases,
sometimes we're over calling them, and we're putting people in prison
for things that they didn't do," said Michael Laposata, the chief
pathologist for Vanderbilt University Medical Center in Tennessee, who
has helped identify rare blood disorders in children who appeared to
have suffered head trauma and other child abuse.



Laposata and others say the lack of
oversight makes it difficult to know how many infant deaths are
improperly investigated. "My gut feeling is probably dozens," he said,
although he added that his desk is covered with files from parents in
prison and he has not been able to review all of them.



Medical examiners and coroners are
licensed physicians, and, as with all doctors, any concerns about their
work can be reported to the Minnesota Board of Medical Practice. But
medical examiners are quick to point out that they're not like other
doctors.



Dr. Thomas Uncini, the medical
examiner for St. Louis and Koochiching counties, said doctors who treat
living patients run the risk of a malpractice suit if they fail to
diagnose an illness or make a mistake during surgery. But medical
examiners are different. They diagnose the dead, and Uncini said it's
rare for families to get a second opinion or challenge their findings.
He said he's never heard of anyone filing a complaint with the Board of
Medical Practice.



For the most part, Uncini and other
medical examiners said, they are accountable only to themselves and the
courts.






Colleen Lindstrom




"If you look like a fool in court,
hopefully you think to yourself, 'Geez, maybe we should be doing
something different,'" Uncini said.



Minimal oversight is provided by the
state's Child Mortality Review Panel, a group of doctors, child abuse
experts, and others that review a select number of infant deaths each
year. The panel looks for cases that could have a broader impact on
public health, child abuse prevention, and death investigations. It can
request that officials take another look at a case they believe was
mishandled.



They rely on counties to report
infant deaths for review, but not all counties comply with the
requirement. Avryonna's death was never reported. The panel first
learned of the death when contacted by MPR News.



"I don't know what happened here,"
said panel member Erin Sullivan Sutton, who also serves as the assistant
commissioner for children and family services at the Department of
Human Services.



Panel members said state guidelines
on infant death investigations are rarely followed in any consistent
way. The panel's reports from 2003, 2004, and 2006 raise concern about
insufficient death scene investigations, inconsistent use of state
guidelines, and inconsistent death classifications by medical examiners
and coroners. The panel repeatedly recommended that the state update the
guidelines, which were created in 1990. They were not revised until
2002.



In 2000, the panel recommended that
the state's Bureau of Criminal Apprehension post the guidelines on its
website so local law enforcement officials could find them. Eleven years
later, they're still not posted.



DIFFERNT COUNTY, DIFFERENT INVESTIGATION



Across the state's 87 counties,
infant deaths are investigated a variety of ways. Many counties have a
coroner or medical examiner who may follow some guidelines and not
others.

Big Stone County coroner Robert Ross is a good example. He said he's
never heard of any guidelines. "I guess I go by my own experience," he
said. "I've been at this for 35 years."
Some counties, including Hennepin, Dakota, Ramsey, Washington, Anoka and
St. Louis, always send an investigator from the medical examiner's
office to the death scene. Doll re-enactments are common in those
counties.



But in at least 14 counties across
the state, local law enforcement conduct most death scene
investigations. They include rural Beltrami County and 13 counties
overseen by McGee, the Ramsey County medical examiner. McGee said that
he does not send investigators from the medical examiner's office to
death scenes outside of Ramsey and Washington counties.



In Sherburne County, one of the
counties that contracts with McGee, the sheriff's office takes
photographs of the scene, but Capt. Scott Fildes said they rarely
conduct doll re-enactments.
"It certainly is something that we can use and would consider using," he
said, "but I wouldn't say it's common, not for us, maybe for a
department that has a lot more child deaths that they're investigating."






Photos




McGee said he offers training for
local law enforcement on how to investigate suspicious child deaths, but
it's not mandatory. "I can't sit here and tell you that every
investigator from every county that we've gone to or that we work with
has gone to it," he said. "I'm going to imagine the majority of them
have."



Some county medical examiners and
coroners said it's not possible to travel to all death scenes. In rural
Beltrami County, one of the largest counties in the state -about 18
times the size of Ramsey County - law enforcement officials handle all
death scene investigations. The county has just one coroner and an
assistant. More complicated cases are sent to Dakota or Ramsey County
for autopsy.



"We don't have the resources that
the urban counties do, and we know that, and we try to act accordingly,"
said Lori Thompson, Beltrami County's coroner assistant.



CHALLENGING CASES



Medical examiners in Minnesota say
child deaths are often the most challenging cases to investigate. Adults
are supposed to die, they said. Children are not.



"When you have a two-year-old die,
there's a distinct possibility that that child's been murdered," said
Uncini, the medical examiner for St. Louis and Koochiching counties. "So
you have to approach those deaths differently."



Adults who die often leave behind
helpful clues, Uncini said, and they're usually found in the same place
where they died.



In contrast, babies who die often
leave behind questions, not clues. They may have suffered from an
undiagnosed illness or been abused. Even the death site can be difficult
to pinpoint because babies who die are almost always picked up and
moved, usually by distraught caregivers.



"We're kind of the opposite of your
pediatrician," said McGee, the Ramsey County medical examiner. "You take
one of your kids to the doctor, and the pediatrician says, 'What's
wrong?' and you give him the whole story, and so he ... has an idea of
what is wrong with your child before he ever lays hands on him. We're
just the opposite. You have to kind of go backwards."



Few infant deaths also make it
difficult for medical examiners and coroners to gain experience and keep
up their skills, particularly in smaller or less densely populated
counties.






Colleen Lindstrom and Ollie




In 2009, 324 infants died in
Minnesota, according to data from the Minnesota Department of Health.
Statewide, only five babies died from "assault." Forty-three babies were
found to have died from Sudden Infant Death Syndrome, and 11 babies
died because of accidental suffocation. That year, one-third of the
state's counties had zero infant deaths, and one-fourth had just one
infant death.



MANY RECOMMENDATIONS, FEW RULES



In Minnesota, when a baby dies in a
hospital of a disease or complications from labor, a doctor notes the
cause and manner of death on the baby's death certificate. In those
cases, an autopsy or investigation is rarely needed.



However, when a baby dies
unexpectedly, state law requires that the death be reported to the
county medical examiner or coroner for evaluation. The medical examiner
or coroner determines whether to perform an autopsy or conduct any
additional investigation.



There is no shortage of voluntary
guidelines for how to conduct a proper infant death investigation.



The Minnesota Department of Health
has a 78-page guide that includes sample forms that prompt paramedics,
police, and medical examiners to fill out sections about the baby's
eating habits, sleeping position, and history. It asks about the
condition of the caregiver. There's even a drawing of a baby that
paramedics can use to mark areas where the baby appeared injured.



The state guidelines recommend a
thorough investigation and autopsy for all children under age two who
die unexpectedly. It advises that every investigation should include a
scene re-enactment with the person who found the baby, photographs of
the scene and the re-enactment, medical records, and information from
social services and law enforcement agencies that may have had contact
with the family before the death.



The state guidelines are meant to
create standard practices. The problem is that no one requires anyone to
use them, said Mary Jo Chippendale, who supervises the woman and infant
health unit at the Minnesota Department of Health.



"It's very rare that we see folks
using a consistent kind of way to investigate these infant deaths,"
Chippendale said.



Instead, she said, "folks develop
their own set of ways of doing it, or they pick and choose which of the
things they want to look at."
Chippendale said the lack of standards has made it difficult to compile
statistics, like the number of infant deaths caused by drowning or the
number of deaths due to unsafe sleeping arrangements.



"If everybody's doing things
differently, you're getting lots of data, but you can't really look at
it and get a handle on what it is that it's telling you," she said.



Federal guidelines, developed by the
Centers for Disease Control and Prevention, include a "top 25" list of
critical information for investigations of sudden, unexplained infant
deaths. The list includes unsafe sleeping conditions, recent
hospitalizations, prior sibling deaths, objection to autopsy, recent
fall or injury, suspicious circumstances, and other items.



But Carrie Shapiro-Mendoza, who
heads the CDC's work on SIDS, said there's no way to track how many
counties use the guidelines or how infant deaths are investigated.



"We know there seems to be a good
proportion of medical examiners and coroners offices across the country
that say they do have protocols for investigating infant deaths, but
what those protocols consist of, it's not clear," she said.



The National Association of Medical
Examiners also has its own guidelines on what it calls the "bare
minimum" to consider an infant death investigation "complete." The
recommendations, issued in a 2005 report, are less detailed, but they
are also voluntary.



They include a scene investigation
by a medical examiner, coroner, or someone working on their behalf, the
review of medical records, and the interview of witnesses.



LIMITED REVIEW



The state's Child Mortality Review
Panel has repeatedly urged counties to comply with state law and report
deaths.



In a September 2010 report, panel
member Erin Sullivan Sutton wrote, "It has been determined that some
local agencies that had child deaths or near fatalities, requiring a
child protection assessment or criminal investigation, did not follow
state statute. No case should be overlooked."



For the past decade, the panel has
been critical of how the state handles infant death investigations. It
often makes the same recommendations in each report, but has had little
success convincing anyone to follow them.



A panel report published in 2003
noted, "Unfortunately, the state does not have an accurate picture of
the causes of children's deaths. Nor does the state have an accurate
count of children who die from abuse and neglect."



In 2004, the panel included the exact same statement. Later reports echo those concerns.



Several reports found that the
state's guidelines on infant death investigations are rarely followed.
"Some law enforcement officers are not aware that infant death
investigation guidelines exist," a 2001 report found. "Comprehensive
training on the Infant Death Investigation Guidelines has not been
presented for several years."



The state's Department of Health is
currently revising the guidelines, and Chippendale, of MDH, said it will
ask the Bureau of Criminal Apprehension to post them on its website
once they're updated. The 11-year delay in posting the guidelines was
due, in part, to concerns that the information could be used by parents
to cover up a crime, Sutton said.



PROSPECTS FOR REFORM



The inconsistent treatment of infant
deaths should prompt Minnesota to regulate infant death investigations,
said Dr. Lindsey Thomas, who serves as the medical examiner for eight
counties.



"It's ridiculous that no one's in charge of any of this," she said.



Thomas wants the state's medical
examiners and coroners to agree on a set of guidelines to follow, but
she said it's unlikely that the group would be able to reach consensus
on what guidelines, if any, should become law.



In part, she said, that's because of
the tension between medical examiners and coroners, both in Minnesota
and nationwide. Prominent groups, including the National Academy of
Sciences, have criticized coroners, who typically are not required to
have as much experience as medical examiners. In Minnesota, state law
requires that coroners be physicians with active licenses, while medical
examiners must be forensic pathologists.



Thomas said she hopes that medical
examiners and coroners can set aside their differences to come to an
agreement about child death investigations.



"That political issue shouldn't affect how a death investigation is done," she said.

http://minnesota.publicradio.org/display/web/2011/09/22/infant-death-investigations/