In early 2010, 22-month-old Danika Charles of Powell County was admitted to the University of Kentucky Chandler Hospital with hair loss and an ulcer in her mouth, according to a report by state child-protection workers.
While at the hospital, the toddler developed bruises, and she cried when her mother came into the room, the report said. Hospital officials called the state Cabinet for Health and Family Services to see whether they should file a request for services, but the referral was never made, the report said.
On Feb. 19, 2010, Danika was rushed to an unnamed regional hospital, where she was pronounced dead. An autopsy showed she had broken bones, a detached aorta, a liver laceration and multiple bruises, according to a review of her death by the state's social services system.
She bore knuckle marks, and her hair had been pulled with such force that she had a large hematoma on the top of her head, the report said.
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The review of Danika's case was one of 14 involving children who died or nearly died in 2009 and 2010 that cited a need for better communication between medical professionals and child-protection workers, according to an analysis by the Lexington Herald-Leader of 86 such reviews.
The cabinet released the files Monday under order from Franklin Circuit Judge Phillip Shepherd after the Herald-Leader and The (Louisville) Courier-Journal sued to get them. The state identified Danika in its review of her case, but officials redacted the names of many other children and their caregivers before releasing the documents.
The newspapers asked Shepherd on Wednesday to order the state to release unaltered versions of the reports. A hearing is set for Wednesday.
Danika's mother, Jessica Charles of Clay City, was indicted for murder, accused of beating Danika to death. She pleaded not guilty. A trial date has not been set, her attorney, Tucker Richardson, said Thursday.
Richardson said he had not seen the cabinet's review of the case, but he disagreed with many of the findings, including that Danika cried when her mother entered Danika's room at UK. He said the state report was in direct conflict with the child's medical records.
In its review of the death, cabinet officials found that UK did not report its concerns because the family had no history of abuse.
"This has already been addressed with UK, and their policies have changed as a result of this incident," the report said.
UK HealthCare spokeswoman Kristi Lopez said she could not speak directly about Danika's case, citing federal medical privacy laws.
However, Lopez said UK's policy on reporting suspected child abuse was last updated in 2009 as part of a routine review, not as the result of a specific case.
"Our health care providers and employees take their responsibility in the reporting of any suspected abuse very seriously and are strongly committed to the protection of children in the commonwealth," she said in a statement.
UK's policy says every hospital employee has a professional and legal responsibility to report all suspected cases of child abuse and neglect to the cabinet and police. Every child who is treated at the hospital for a physical injury should be examined for signs of abuse and neglect, the policy says.
The cabinet review in Danika's case also said it should "develop a UK liaison as a point of contact for front-line staff across the state in order to improve communications."
The cabinet is working with an organization called Prevent Child Abuse Kentucky to achieve better collaboration between medical professionals and child-protection workers, spokeswoman Jill Midkiff said Thursday.
Prevent Child Abuse Kentucky officials meet with medical personnel to promote communication and understanding. The cabinet incorporates feedback from the organization, which has a state contract, into staff training, she said.
The internal reviews released Monday highlight a number of other communications breakdowns between child-protection workers and medical professionals.
One review found that drug-testing a newborn might have helped in the case of a child who died 20 days after she was born in January 2009.
The mother, who had a history of drug abuse, allegedly rolled over on the sleeping baby, a report said. The mother tested positive for drugs the following day, although the report doesn't make clear whether they were illegal drugs.
"Hospital personnel need to understand the importance of drug testing infants and mothers at the time of birth," the review said.
Another review found that child-protection workers failed to complete a thorough assessment of the chronic medical condition of a diabetic child whose family had been the subject of 13 reports to the cabinet before he was rushed to the hospital unresponsive in November 2009.
Discovering that the child's mother had missed medical appointments with his specialist "would have highlighted" the mother's "lack of engagement in and neglect of her parenting responsibilities," a review said.
There was a similar problem with the cabinet not tracking a parent's attendance at medical appointments in the case of a 4-month-old child who died in February 2010. The baby died after being taken off of oxygen without a physician's permission, a review found.
The baby was premature, and the mother had missed eight doctor's appointments before the child's death, the report said.
In the case of a 16-year-old girl who committed suicide in April 2010, cabinet officials found that better communication "regarding the role" of the cabinet was needed between child-protection workers and The Ridge, a Lexington psychiatric facility where the girl had been treated.
Officials at The Ridge did not return a telephone call seeking comment Thursday.
Some hospitals in Kentucky are making efforts to educate medical staff and parents about child abuse.
Kosair Children's Hospital in Louisville has seen an increase in the number of patients who have been determined to be abused because "we've amplified the education and awareness around child abuse," said Therese Sirles, the hospital's director of child advocacy.
"There are certain patterns of bruising that we recognize as being indicative of abuse that need further evaluation," Sirles said.