Foster mother not told about child's health problems
Fatality inquiry examined death of 13-month-old Hobbema girl in March 2009
A 13-month-old foster child who died of pneumonia four years ago had a lengthy history of asthma and respiratory problems that were never shared with her foster mother, a fatality inquiry has found.
The little girl was under the care of the Kasohkowew Child Wellness Society (KCWS) when she died in Hobbema in March 2009.
A fatality inquiry into her death was held earlier this year. A report from provincial court Judge Bart Rosborough was released Thursday.
The child, named K in the report, had been admitted to hospital 10 times in the last year of her life.
When K was placed in foster care in December 2008, her foster mother was never informed about her health history, which included a bout of pneumonia.
In the months before she died, K frequently cried and displayed "cold-like symptoms," the report says, but her foster family never took her to the doctor.
Four days before she died, K was heard making a gurgling noise when she breathed. However, her foster mother testified during the inquiry that the child was never taken to the hospital as she didn’t believe that K was sick enough to need a doctor.
On March 28, 2009, K cried for about 5 to 10 minutes after she was put to bed. An hour later, her foster mother found her lying facedown on the pillow, her eyes rolled back in her head.
Paramedics were called but the girl was pronounced dead in hospital.
'Archaic and inefficient' filing system
Provincial court Judge Bart Rosborough made nine recommendations in his report on K’s death.
They include implementing health-care training for foster parents; improving the operations at KCWS; and most importantly, ensuring that medical information is shared with new foster parents within 72 hours of a child’s placement in provincial care.
"Of all the deficiencies in KCWS procedures, this particular deficiency was the most important in placing K at risk," the judge writes.
However, even without knowledge of K’s medical history, the judge says the foster mother should have sought medical attention given how ill the child must have appeared.
"In all likelihood [K} would have experienced coughing, fever and irritability. She likely wouldn’t have been eating well," the judge writes.
"An ordinary reasonable caregiver with average education would have sought medical intervention for a child with symptoms of pneumonia serious enough to have caused her death."
A number of the recommendations focus on improving operations at KCWS, which laboured under substantial staff shortages and huge caseloads.
Evidence revealed that KCWS was operating under what the judge called an "archaic and inefficient" filing system, which meant clerks had to check at least three different files for each case.
The judge recommends that a comprehensive review be put in place to ensure this system is modernized and streamlined.
Testimony pointed to deficiencies in how First Nations child welfare agencies are funded compared to off-reserve agencies. The report recommends the province take action to ensure there is no difference.
Evidence also showed that core funding for KCWS was used to send staff for a seminar outside of Canada and for cultural activities. The judge says spending must be closely monitored.
"While education and ‘cultural activities’ are both important in their own rights, they are secondary to ensuring the health and safety of children in care," the reports states.
Human Services Minister Dave Hancock said that the province is attempting to address the funding gap between on- and off-reserve child welfare agencies.
"Funding is always an issue but you know we continue to work with that and we'll work with the First Nations to and federal government on that piece."