Non-compliance/medical neglect in a child with an open case with protective services

[Esme12, ASN, BSN, RN]

MODERATOR NOTE....several posts have been edited/deleted

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This post is about this child in need and the parents who are challenged to care for this child and what resources are next to help the OP/child. NOT about sterilization.

Please stick to topic or points will be assigned.

[KelRN215, BSN, RN]

Update: After many attempts to reach the child's mother and her social worker with the state telling her that she had to allow me to see her child, I was able to see him this past Tuesday. She did have all of his meds (the clinic's social worker followed up with her last Friday after I did to remind her again that she needed to get them) and all of them were filled on Friday at the pharmacy by her apartment and the pharmacy confirmed they were picked up on Friday. So there is NO doubt in my mind that she was not giving his meds at all last week and didn't have them at the child's father's house last Friday when she blocked me from visiting. She gave his G-tube meds at least for a few days but he is also supposed to be on Flovent 2 puffs BID and she's given him a grand total of 11 puffs since she filled the prescription, which the pharmacy informed me was in May. I don't think she knew that I could see on the dose counter that 109 out of 120 doses remained and she tried to tell me that she filled this one last week with all the others, but I knew that wasn't true. I did speak with her Social Worker from CPS, her outreach worker with the agency she gets her services through and the child's doctor this week. At this point, everyone is concerned but I am just worried that no action is going to be taken until something really bad happens to the child. A social worker I know personally who works in a different city but also deals with many challenging cases told me that, in her experience, the state often doesn't take children like this as quickly as they might another child because they simply don't have anywhere to put them.

[LadyFree28, BSN, LPN, RN]

A social worker I know personally who works in a different city but also deals with many challenging cases told me that' date=' in her experience, the state often doesn't take children like this as quickly as they might another child because they simply don't have anywhere to put them.[/quote']

^This is true in the area I work. There are no group homes for medically fragile children, and the closest one is 50-100 miles away. It is only used if they determine that the mother has NO possible way to adhere to support, whether their judgment is severely altered and they are not keeping appoints with anyone: doctors, caseworker, life skills therapists, etc. They don't have that many beds either.

The system is so burdened and also the families that they place kids with have been closely scrutinized because they find those that they placed with are NOT fit either. They did a study on how many generations that were in the system were likely to a use their kids, and they found a very close correlation on the linger the kids were in the system, the likelihood of anise and neglect, and they found a huge percentage of kids were physically and/or sexually abused.

It is truly a bad cycle, unfortunately, but I think you are doing your absolute best in advocating for this child. Keep the faith and continue to advocate for this family. I did this for a good portion of my Peds career, and while its tough, I enjoyed the nursing work, and advocating for the children and the family, with positive results, no matter how small.

Thanks for the update-sending positive vibes in helping you with this case.

[LadyFree28, BSN, LPN, RN]

*linger=longer; anise=abuse...wacky autocorrect!

[~PedsRN~, BSN, RN]

This has been an interesting thread for me.... I work with so many medically neglected children, and at this point in my (somewhat new) nursing career, I have a very low opinion of both CPS and DSS. I actually don't know what it takes at this point to have a child removed from the home, because from what I can tell you can starve, refuse treatment, refuse medications, not buy clothes, and dump your kid off at the hospital for weeks at a time without every showing your face, and still you get to show up in time to sign the discharge papers and take the kids back.

Back in my younger years, I was on track to be a social worker. I am glad I didn't pursue that career.... I would have been arrested by now.

[KelRN215, BSN, RN]

Ugh, so this situation has kind of exploded again. I was away last week and a colleague saw him for me- she reported back that the objective data (96 doses of Flovent on the dial 8 days after I found 109 when he's supposed to be getting 4 per day) doesn't match with mom's story that she is giving it regularly. I updated the team yesterday and then while I'm en route to another house, get a phone call from Mom yelling at me asking me why I told the Social Worker that she wasn't giving the child his medications. I attempted to explain that I simply relayed what the nurse who saw the child last week told me and then she got angry and hung up. Today I get an email from someone at the MD's office saying that she called them to say that I was lying about her not giving the medication and that she wants a new nurse. The MD did contact me and say "I think you've done a great job with this family" and I have a feeling that this situation will change again after the Social Worker sees her tomorrow. I don't really care that she's told the Social Worker that I'm lying, everyone knows that she is lying and you can't really get more objective data than "there's 3/4 of a prescription left that was filled in May" to prove what the truth is...

It just really sucks when you do your job and try to do a job of it/are fulfilling your legal obligations and things like this are said about you...

[~PedsRN~, BSN, RN]

:(

[Esme12, ASN, BSN, RN]

((HUGS)) sometime the right thing isn't the easy thing......trust me. I have done the right thing a couple of times andI walked a rough path....but I knew I had to do the right thing.

[rnsusan]

It is so sad to see a case like this. I have seen a few examples myself where DHR needed to take custody but didn't. I suspect that the reason the state has not taken custody is that they are worried that they have no place for the child. I couple of kids finally were taken by the state and placed in a nursing home. Every once in a while there are wonderful foster parents that will take the super complicated kids and love them as if they were there own, but those couples are hard to come by.

[A&Ox6, MSN, RN]

On the first part....you are 100% correct and I am surprised that social services doesn't remove the child (as sad as it is) to a place where he can be cared for. I feel bad for these women, but this is why (as controversial as it is) that state mandated birth control, sterilization, something should be used, because you run the risk of these women giving birth to a child that they cannot take care of or inheriting a genetic disorder that leaves the state to take care of them.

This is called eugenics, and I don't see how this is any different or better than "experiments" of infamous Nazi Dr Mengele or any other weeding that was used to form a "pure" race.

I am appalled that you actually feel this way!

[KelRN215, BSN, RN]

I need to resurrect this topic. Several months later and all of this is STILL an issue. The child started medical daycare in the fall. The hope was that we'd be able to bow out once he was established in the program. I went on vacation, came home and it took me weeks to track down the mother. When I finally did, she told me how great everything he was and how the child was enjoying going to school every day. And THEN, I hear from his doctor who says that, in fact, he's been missing school at least once/week and missed the appointment he had with her only one day after his mother told me she was going to it. She basically begged me to keep him on service if only just to see him once/month to check on his meds. I knew that plan was going to fail- first day I finally reach her to get out there she's got NO meds for him at home because she claims she sent them all to school. Clearly I couldn't just say "ok, see you in a month" to someone who's outright admitting to not giving her child his meds for several days. She told me several lies that day all of which I knew immediately were lies and confirmed with the pharmacy soon after I left. (The most notable of which was that she didn't have his seizure medication because the pharmacy was compounding it- he takes a medication that comes in liquid suspension/doesn't need to be compounded.) The next week I go back and the lies are even more apparent- now she's got bottles of meds that were filled months ago that still have more than half the bottle remaining, yet she expects me to believe that she's giving her kid his meds. Last week there's even more meds that she conveniently "found" around the house... again, all with labels from months ago that were for 30 day supplies. Sorry, if you found a 1/3 full bottle of medication from July and if the pharmacy tells me you haven't picked up a new inhaler since September but the one you have is more than 3/4 full, you haven't been giving the meds .

Today, I'm just MAD. She asked me to go out there WAY later than I normally work, which I did because conversations I had with other providers today led me to believe it was important that he be seen. And I get there and she's not home. She just left the kid with her parents knowing that they would let me in and let me see him but that I would have no way to assess her compliance with his meds without seeing them... and of course they are conveniently only in HER apartment. Several hours after it was due, no one had given the kid his afternoon bolus feed and, despite the fact that his overnight feeds were due to go up in about half hour, Mom was nowhere to be found, not coming home anytime soon and no one had any intention of feeding the kid until the Mom arrived home... whenever that would be. Now I'm completely convinced that she told me to come at a time when she had no intentions of being home so that I would have no way to see the meds and that she's not giving them. I will be calling CPS with an update first thing in the morning.

(He's also had two recent non-detectable AED levels as well as one non-trough level that was barely detectable.)

[ixchel]

Such big hugs to you, love. I hope this gets better, quickly.