[ OUR OPINION ]

Boy’s death exposes
flaw in child protection

THE ISSUE Police are investigating the April death of a 2-year-old Waipahu boy that the medical examiner has declared a homicide.

REUBYNE'S Bill was enacted by the Legislature five years ago to increase protection of children from abuse such as that inflicted upon 4-year-old Reubyne Buentipo Jr., beaten into a vegetative state a year earlier by his mother. Further legislation is needed in response to the April 24 death of 2-year-old Jose Flores, of Waipahu, from head injuries. In addition to a Jose Bill, a thorough review of the state's system of investigating cases of possible child abuse is long overdue.

Among other provisions, the 1998 law allows doctors to share medical information if a child's situation is being monitored by Child Protective Services, the child-abuse investigative arm of the state Department of Human Services. But it does not allow CPS social workers to share information about children with the doctors, preventing them from considering the nature of injuries in the context of the child's past.

A few weeks before Jose's death, physicians had treated a fracture in his left leg, the type that occurs when a leg is wrenched or twisted from a fall or from child abuse. The doctors diagnosed it as having resulted from a fall. If they had known that Jose had been the subject of two previous investigations of possible child abuse, the toddler's life might have been saved by intervention. The city medical examiner has ruled Jose's death a homicide.

"You need to consider the story and the child's history (of any abuse)," says Dr. Cynthia Tinsley, a child-abuse expert who worked 12 years in the pediatric intensive care unit of Kapiolani Medical Center for Women & Children. "If the injuries or history don't match the story, that's a big red flag to report it. ... But what if that history is confidential? You're missing an important piece of information."

Lillian Koller, the new director of the Department of Human Services, agrees that the confidentiality law creates "a huge problem" in doctors' ability to identify injuries caused by child abuse. "The doc can give us information and ask advice whether a mandatory report (of abuse) should be made (to CPS)," Koller told the Star-Bulletin's Sally Apgar. "But really, as the laws now stand, we can't give information that would help the doctors make an informed decision."

No criminal charges have been filed in connection with Jose's death. The strained relations between the boy's parents, who are separated, and among baby-sitters, family members and friends have complicated the police investigation into the death and previous child-abuse inquiries.

Koller acknowledges that a re-evaluation is needed of "the proc-esses and systems involved in child protection," encompassing not only CPS, but schools, police, medical providers and the courts. State Auditor Marion Higa made that same assessment and recommendation more than four years ago.