H. Gratin Smith, MD

1. UPDATE FROM THE SC CHILD
FATALITY ADVISORY COMMITTEE
H. Gratin Smith, MD
September 11, 2013

2. Why Does Child Death Review
Matter?
 Helps to identify trends on a statewide scale
 Allows for comparison to other states
 Helps to make sure deaths are accurately
classified to make meaningful analysis possible
 Allows for more informed suggestions for
change
 The CDC has determined that the
multidisciplinary approach now in place is the
most effective way to help decrease child deaths

3. An Overview
 What is the SC Child Fatality Advisory
Committee?
 What does the committee do?
 What are the recent trends and findings
noted by the committee, and what are their
recommendations?

4. Formation of the SC CFAC
 In 1993 legislation mandated (but did not provide
for funding of) the formation of the State Child
Fatality Advisory Committee to identify patterns
in child fatalities.
 An annual report is produced. This information is
to be used by communities, individuals and
agencies to decrease the number of preventable
child deaths in our state.
 The report can be viewed at SC DHEC’s website.

5. Deaths Reviewed by the SC
CFAC
 The death of any child (<18) that is
unexpected, suspicious, unexplained or
occurs when the child is NOT under the direct
care of a physician. This includes, but is not
limited to SIDS cases.
 Traffic/highway deaths are not reviewed by
the SC CFAC (unless they occur on private
property). They are reviewed by the DMV.

6. Makeup of the SC CFAC
 Members are appointed by the governor after
recommendation from the specific state
agencies or the committee.

7. Members of the SC CFAC as
specified in the legislation
forming the committee
 DHEC
 DDSN
 SCDE
 SLED
 SCAAP-Pediatrician
 A forensic pathologist
 SC Criminal Justice
Academy
 DSS
 DYS
 SC Commission on
Alcohol and Drug Abuse
 SC Coroner
 Solicitor
 SCDMH
 2 Child Advocates

8. SC CFAC Meetings
 Full day every other month
 Guest presenters
 Reports from members
 Review @ 40 cases per meeting during
executive session (closed to public). (@ 200-
250 cases are reviewed every year)

9. The Process of Child Death
Review
 A child death occurs
 Coroner is notified
 Coroner notifies SLED within 48 hours
 Case is assigned to an agent
 Agent gets details, medical records, DSS
notes, LE notes
 Case report is “completed” by the agent
 Case goes to CFAC

10. What Does the CFAC Actually
Do?
 Case reports are sent to members before the
meeting
 Agencies involved report on their
involvement with the case
 Medical aspects of the case are reviewed
 The committee tries to determine how the
death may have been prevented by looking at
SYSTEMS ISSUES

11. What Does the CFAC NOT DO?
 The committee’s function is not to
investigate or solve crimes
 The goal is not to criticize, but to offer
suggestions for improvement by analyzing
system failures.

12. Recent Findings of the SC CFAC
Reviews
 The cases are categorized based on the year
that they occurred.
 The most recent annual review that has been
completed is 2009. There were 189 deaths in
2009 that were reviewed.
 The statistics in this presentation are from
cases that met the definition for review by
the SCFAC (not the total number of child
deaths in the state)

13. SC Statistics
 Population about 4.5 million
 Population < 18 y.o. (23%) about 1,035,000
 White citizens 66.2%
 Black citizens 27.9%
 17% of citizens below the poverty level
 Per cent of 8th graders to graduate- 75%
 @ 25% of babies born to single mothers

14. 2009 SC Child Fatalities by
Race
81
84
13
5
2
4
White
Black
Hispanic
Biracial
Asian
Unknown

15. 2009 SC Child Fatalities by
Gender
58%
42% male
female

16. Manner of Death Categories
 For every death there is an assigned cause of
death (very many) and one of 5 “manners of
death”
 Natural
 Accidental/Unintentional Injury
 Homicide
 Suicide
 Undetermined

17. 2009 Manner of Child Death by
Category
0%
5%
10%
15%
20%
25%
30%
35%
40%
Accident Natural Homicide Undet Pending Suicide

18. Accidental Child Deaths in SC
1993-2009
0
20
40
60
80
100
120

19. 2009 SC Accidental Child
Deaths
26
19
13
5
3 2 1
Asphyxia
Drowning
Fire
Shooting
Overdose
Vehicular
Poisoning

20. 2009 SC Accidental Child Deaths
by Age
0
5
10
15
20
25
30
<1 y.o. 1-4 y.o. 5-9 y.o. 10-14 y.o. 15-17 y.o.

21. 2009 SC Accidental Child Deaths
by Gender
0
5
10
15
20
25
30
35
40
45
50
male female

22. 2009 SC Child Drowning Deaths
by Age
0
1
2
3
4
5
6
7
8
9
1-4 y.o. 5-9 y.o. 10-14 y.o. 15-17 y.o.

23. 2009 SC Child Drowning Deaths
by Gender
0
2
4
6
8
10
12
14
Male Female

24. 2009 SC Child Fire Deaths
by Race
75
1
Black
Other
White

25. 2009 SC Child Fire Deaths
by Home Structure Type
Mobile
Stick Built

26. 2009 SC Child Fire Deaths by
Age
0
1
2
3
4
5
6
7
8
<1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-17

27. In 2009, Five SC Children Died
of Accidental Gunshot Wounds
0
0.5
1
1.5
2
2.5
5-9 y.o. 10-14 y.o. 15-17 y.o.

28. In 2009, Two SC Children Died
in ATV (4 Wheeler) Accidents

29. SIDS/SUDI/SUID Cases in SC
1993-2009
0
10
20
30
40
50
60
70
80

30. 1993-2009 Child Homicide Deaths
in SC
0
5
10
15
20
25
30
35
40
45

31. 2009 SC Child Homicide Deaths
by Age
0
2
4
6
8
10
12
14
<1 y.o. 1-4 y.o. 5-9 y.o. 10-14 y.o. 15-17

32. Perpetrators of Fatal Child
Abuse and Neglect in SC 2009
4
4
3
2
1
1
1
1
17 cases
Mom's BF
Father
Stranger
Uncle
Mother
Stepmom
Sibling
Other

33. 2009 SC Fatal Child Abuse and
Neglect by Category
4
2
8
1
1
AbusHdTr
Asphyxia
Beating
HeadTr
Malnutrit

34. Some SC Counties With High
Numbers of Child Fatalities 2009
(#), rate (#/100,000)
 Sptnbrg (26) 35
 Richland (21) 24
 Anderson (5) 11.3
 Beaufort (7) 21.5
 York (7) 12.3
 Charleston (16) 22.2
 Berkley (6) 13.7
 Darlington (6) 37
 Greenville (14) 13
 Horry (7) 13
 Lexington (22) 35

35. 2009 SC Child Suicides, # 8
 Males #4
 Females #4
 10-14 y.o. #2
 15-17 y.o. #6
 Shooting #2
 Hanging #6

36. Trends Noted by the SC CFAC
 There are an alarming number of child deaths
involving 4-wheelers
 Child deaths in fires are much more common
in mobile homes
 In fire death cases, the absence of functioning
smoke alarms is often noted in the reports
 Most sleep related deaths involve some
practice recognized as an unsafe sleeping
situation