Beaten with a belt and DVD case. Deprived of food and water. Strapped to a bed. Force-fed Benadryl. For nearly two months, four-year-old Marchella Brett-Pierce survived under these conditions, and her struggle mainly went unnoticed.
But when Marchella died last September — weighing just 18 pounds, with blunt impact injuries and suffering from acute drug poisoning and dehydration — the invisibility that characterized her life gave way to a highly visible death.
It brought to the fore the question of whether systemic failures in the Administration for Children's Services — to whose attention the Brett-Pierce family had come 10 months earlier — still existed. The case hearkened back to 2006, when another child, seven-year-old Nixzmary Brown, was beaten to death by her step-father. At the time, the city reformed its policies to protect children served by ACS.
But five years later Marchella's case has exposed a new set of issues. Namely, how a child who suffered from a variety of ailments since her birth — something experts refer to as medical fragility — had never been identified as such and never became the focus of ACS' investigation.
The Brooklyn District Attorney has launched a criminal investigation into two former ACS workers, who handled Marchella's case, and will also convene a special investigative grand jury in May to begin hearing evidence of alleged systemic failures at the agency.
Brett-Pierce Family Under Watch
In November 2009, ACS became involved with the Brett-Pierce family after Marchella’s mother, Carlotta, tested positive for drugs at the birth of her third child, a son. ACS launched an investigation and decided to make a referral to the Child Development Support Corporation, a preventive program for families with substance abuse histories. It had the task of ensuring the mother received drug treatment and that her three children remained safe and adequately cared for.
At that time, Marchella was at Pathways Nursing and Rehabilitation Center in Niskayuna, New York (then called Northwoods at Hilltop). She spent more than half of her short life in hospitals and nursing homes — from her four-months premature birth in April 2006 to spring 2007. A year later, in May 2008, Marchella returned to hospital and was discharged in February 2010.
Both ACS in its initial investigation, conducted after Carlotta had a positive toxicology test, and CDSC in its subsequent work with the Brett-Pierce family focused on the mother’s substance abuse and failed to identify Marchella as a medically fragile child, according to the report released by the Children’s Services Planning Group, which was formed by ACS and the Public Advocate’s Office to look into issues raised by Marchella's death. If Marchella had been identified as medically fragile, it is likely she would have been referred to an agency that works with children with complex medical conditions.
Medically Fragile Children
Medically fragile children make up a tiny part of population, several thousand in New York, according to an estimate by the Coalition for Medically Fragile Children. Their condition doesn't have a single definition. Melinda Dutton, counsel to the Coalition, who was also a member of the Planning Group, said medically fragile children often require durable medical equipment, such as a feeding or tracheal tube, wheelchair or ventilators. They may rely on multiple medications, and receive intensive therapies to maintain normal life function or even survive.
While it is unclear how many medically fragile children are under ACS' watch, the agency currently has 225 preventive slots for them, which are used at over 90 percent capacity, according to the agency’s spokesman, Michael Fagan.
Hospitals and nursing homes in New York State are required to follow guidelines when discharging medically fragile children. When, for example, a child is released with a tracheal tube, like Marchella had, experts said the family would typically get training on how to take care for the trache – how to clean it; make sure it doesn't become obstructive; look for warning signs of infection; recognize malfunctions; learn how to use a rescue bag if there is a problem with electricity.
"Typically, families are eager to get that kind of training," Dutton said. "Bringing a child home with a trache is a scary thing."
Pathways, the nursing home from which Marchella was discharged in February 2010 with a tracheal tube, has a poor track record and is designated a "special focus facility" by Centers for Medicare and Medicaid Services, which puts it under a higher level of monitoring.
It remains unclear, though, what kind of care Marchella got there, or whether they knew of the open child welfare investigation for the Brett-Pierce family and raised concerns with ACS about the mother's ability to take care of Marchella before discharging her. Pathways' staff declined to comment, citing privacy rules, as did ACS.
Marchella's Condition Worsens
Only a few weeks after Marchella left the facility, though, a red flag was raised. The mother brought Marchella to a hospital in New York, because the trache was not working correctly. She refused to stay in the hospital long enough to get training on how to take care of the tube, and the hospital alerted the child abuse hotline, according to the Planning Group's report.
ACS Emergency Services sent an investigator into the Brett-Pierce home the same night. The investigator reported that "while children seemed to be doing fine, the mother should be evaluated on her ability to take care for a special needs child," according to the same report. A new investigation, however, never happened, and the agency's actions in the light of this new information were characterized as "inadequate" in the report.
Marchella appeared to rapidly decline in her mother's care during following months. Last month Brooklyn District Attorney, Charles Hynes, said she weighed 30 pounds when she left Pathways and only 18 pounds when she died in September.
"Had anyone bothered to enter that bedroom [in the Brett-Pierce apartment],” he said, “it would have been very very clear that child needed to be rescued. But she wasn't."
Plenty of Blame to Go Around
Hynes indicted Carlotta Brett-Pierce on top count of murder and her mother, Loretta Brett, in whose room Marchella was bound to a bed between May and September, of manslaughter. Additionally, for the first time in the city's history, child welfare workers have been charged with criminally negligent homicide: Damon Adams, the former ACS caseworker assigned to the Brett-Pierce family and his former supervisor, Chereece Bell.
While no charges were brought against CDSC, the Planning Group's report describes the preventive agency’s involvement in the Brett-Pierce case as "woefully inadequate" for failing to alert ACS that Brett-Pierce had left her drug treatment program and tested positive for marijuana.
In February 2010, one of CDSC's supervisors noted she was concerned about the kids, especially the one with significant medical needs, but there was no follow up. Marcia Rowe-Riddick, CDSC’s executive director, declined to comment for this article.
"If the contracted provider did their job, Marchella would still be with us," said Tim Ross, managing partner of Action Research, consulting firm that focuses on child welfare, who was also a member of the Planning Group. "If the ACS paid additional attention, Marchella would still be with us."
The Planning Group made a series of recommendations in wake of Marchella's case, most of which focused on medically fragile children. It included developing a program for tracking medically fragile children who are in foster care or receive preventive services; improving safety assessments to include consideration of whether medically fragile children are in a home; developing assessment tools to determine the ability of parents to take care of medically fragile children.
Jackie Sherman, general counsel at the Office of Public Advocate Bill de Blasio, said they are also in the process of drafting legislation that aims to ensure medically fragile children in the child welfare system are identified and that they receive needed medical services.
"As a result of the review process we know that is not occurring right now," she said.
While Sherman and other interviewed members of the Planning Group said they felt satisfied with results of the report, most of the work that needs to be done to ensure a case of a medically fragile child, like Marchella, does not again fall through the cracks of ACS' system lies ahead.
"We are at a point where there has been a recognition that there's a problem," Dutton said. "I don't think we are yet at a point where we feel any level of confidence that that problem has been solved."
Cindy Rodriguez contributed reporting.