Task force: Team help needed for drug-exposed infants

When he died in September, 8-month-old Aiden Hundley's little body was broken. In his eight months of life, he suffered a broken leg, collarbone, wrist and arm, and several broken ribs. His skull was fractured; he had hemorrhages in both eyes. His blood was infected with E. coli that had infiltrated his brain.

Aiden was born dependent on drugs his mother was using and spent 26 days recovering at Beebe Healthcare; on day 27, the Division of Family Services permitted Beebe to release Aiden to his parents, according to court records. Aiden and his parents then disappeared, records state, although they were later arrested at a home in Harbeson.

His parents – Doyle J. Hundley Jr., 37, and Casey R. Layton, 38, both of Harbeson – now face first-degree murder by abuse charges. They are both in custody in default of $106,000 cash bond.

Just weeks after their arrest, state officials have changed a protocol for releasing high-risk medical discharge infants to help prevent future tragedies.

“I see a need for immediate response because of the deaths we've seen,” said Jen Donahue, child abuse investigator coordinator for the Department of Services for Children, Youth and their Families, during a Jan. 15 meeting of the Child Protection Accountability Joint Committee on Substance-Exposed Infants/Medically Fragile Children.

Without specifically identifying Aiden, a Division of Family Services spokesman previously said three infant deaths in Sussex County since May 2015 were related to heroin. A fourth child died of suicide in September. The spokesman also said Division of Family Services was involved with all four children before they died.

Bridget Buckaloo, executive director of Beebe Healthcare Women's Health Services, said it has been up to individual hospitals to decide whether to initiate the Hospital High Risk Medical Discharge Protocol – a process developed by the Division of Family Services to protect children once they leave the hospital and return home.

“If the hospital requests it, DFS can't refuse it,” she said.

When a hospital requests the protocol, a collaborative team of child service and healthcare providers, and the child's parents or family members develop a safe plan for a child after discharge from the hospital.

Citing confidentiality under HIPAA, a law designed to keep health information private, Beebe officials declined to discuss whether the protocol was invoked in Aiden's case.

The wording of the original protocol, however, was unclear and difficult to understand, Buckaloo said.

On Jan. 15, the joint committee of more than 20 health and hospital representatives across the state clarified when hospitals should invoke the protocol regarding substance-exposed infants.

The committee unanimously agreed to add six triggers, any of which could initiate the Hospital High Risk Medical Discharge Protocol:

• Significant noncompliance with care of the infant; not visiting or participating in care

• Use of a drug not used in a treatment program

• Evidence of current illicit drug use that impairs caregiving ability

• Infant length of stay is greater than 30 days as an indication of severity

• Use of more than one drug by the mother

• Medically unstable/complex medical care in addition to concern of ability of caregiver.

Linda Shannon, program manager for the Division of Family Services, said adding the six triggers should help more infants after they are released from the hospital.

“We can do this immediately. It's quicker than legislation,” she said.

Shannon said the original protocol was intended to protect children from birth to age 18 from abuse; hospitals could have invoked the protocol for a drug-exposed infant, she said.

She said the new language does not require hospitals use the protocol, but judging by the overwhelming support by committee members to add drug-related triggers, she expects all hospitals will use it. Committee members wanted drug-related exposure in infants and use by the mother highlighted in the protocol, she said.

“By having those specific factors in the protocol, the hospitals will request a discharge meeting,” Shannon said.

Legislation to coordinate service

The joint committee is also drafting legislation to mandate coordination between state child services, healthcare professionals and a child's parents or family when a child is born exposed to drugs. In other words, a safety net to protect the child at home.

“This legislation just ties in the resources out there,” Donahue said. “It defines and puts together safe care.”

A plan of safe care is required by the federal Child Abuse Prevention and Treatment Act and is similar to the meeting of healthcare professionals and family members when the Hospital High Risk Medical Discharge Protocol has been invoked. However, Donahue said, the federal law is vague about who creates the plan and enforces it. State legislation is needed to clarify who is responsible for creating a safe plan and how it will work, she said.

The proposed legislation met resistance from upstate officials who fear mothers would interpret the legislation as punitive, even though Donahue and others stressed there is nothing punitive in the draft legislation.

“Do we think this will really help?” asked Dr. David Paul, chair of Christiana Care Health System's Department of Pediatrics. “Fears are driving women out of care.”

Paul questioned referring women to a safe plan meeting when their children have been exposed to drugs such as methadone or suboxone, used to treat drug addiction, or legal prescriptions used to treat other medical issues. For example, he said, exposure could include medication a woman is taking for a bad back or lung issues.

“It becomes a gray line who we report,” Paul said. “I know the intention is not to be punitive … but now you're talking about women in treatment, and there's no incentive to get clean.”

Paul suggested taking more time to collect data before creating legislation to create a safety plan for substance-exposed infants.

Others disagreed.

“In the meantime there are a certain number of children who have been abused by parents who aren't engaged,” said Dr. Allan DeJong, a pediatrician with A.I. DuPont Hospital. “We need an approach for mothers who do not engage.”

A safety net is needed before a child is sent home to protect the child and make sure an at-risk child does not disappear.

“This is exactly what happened with a case in Sussex,” Donahue said. “The family fled.”

The legislation could prevent a child from falling through the cracks, she said.

"... I'm not being dramatic about this,” Donahue said. “There are too many babies going through severe withdrawal and going home to unsafe homes and dying.”