After being called by a concerned hospital worker, the Baltimore Department of Social Services should have dispatched a caseworker to investigate a 17-year-old girl who had a history of child abuse and had just delivered twins, city and state officials said yesterday.
But the inquiry from Johns Hopkins Hospital prompted no immediate response from the state agency. That enabled the girl, a runaway from foster care, to take her babies home to an abandoned basement without electricity or toilets, where the infants died a month later, their skulls and ribs cracked.
"In an ideal world, we'd go out there and make sure she had what she needs to take care of her children," said Sue Fitzsimmons, spokeswoman for the department. "If she's a runaway foster child, we'd want her to have a safe place to live and a safe place to put her baby."
The young mother, Sierra Swann, was known to hospital officials as a drug abuser who lacked a support network and had had a previous child taken away because of neglect, records show.
After being told by the state agency that there were no "active" allegations of child abuse pending against Swann, the hospital released the twin girls with their mother.
Swann and the infants' father, Nathaniel Broadway, 24, were charged with first-degree murder last week in the deaths of the babies, Emunnea and Emonney Broadway.
The department has no plans to investigate or punish the worker who took the call from Hopkins, in part because it has no record of who it was, Fitzsimmons said.
The department's performance in the case prompted a testy exchange yesterday between Mayor Martin O'Malley and Gov. Robert L. Ehrlich Jr., who have been engaged in a legal battle for months over who should lead the Baltimore Department of Social Services. The agency is part of the state government, but its director is supposed to be appointed jointly by the mayor and governor, and to serve in the mayor's Cabinet.
O'Malley sued the governor Nov. 24 over Ehrlich's choice as interim director, Floyd Blair. O'Malley said Blair should be removed because he lacks required management experience and the approval of the mayor.
"We owe it to the most vulnerable families and children to do a search by people with backgrounds in social work to find the best candidate we can to lead the Department of Social Services," O'Malley said yesterday. "And I indicated to [state Secretary of Human Resources Christopher J. McCabe] that if we compromised the best leadership of this agency, that neither of us could look ourselves in the mirror if a tragedy happened and children slip through the cracks."
Communication between Blair and the O'Malley administration has broken down so completely that Blair and McCabe, his boss, did not respond to the city health commissioner's report to them in January on child abuse.
Dr. Peter L. Beilenson, the city health commissioner, said recommendations in the report could help prevent children's deaths. They include a call to "design measures to protect future children" of a parent convicted of abuse and to station caseworkers in hospitals 24 hours a day.
Ehrlich said he has asked McCabe to prepare a full report on the twins' case.
"I wish there was less finger-pointing when a child dies," Ehrlich said. "Children are dead. It's not the time for politics. The focus needs to be on what happened in this case."
McCabe said yesterday that he is considering Beilenson's report and contended that Blair has gotten off to a good start planning improvements in his first eight months.
The changes include expanding night and weekend coverage of Child Protective Services by asking more workers to adjust their schedules. Blair has hired 35 more foster care workers and is moving a protective-services intake center next to the juvenile courts.
"We are trying to do everything we can to improve our system," said McCabe. "This case demonstrates to me how interactive all the parts of the system are, and if there is a breakdown in communication by any of the parties, a child could be severely harmed."
McCabe declined to say where he thinks communications might have broken down in the Swann case, but he implied that the young runaway's friends and neighbors could have helped the state intervene if they had reported that she was living in a basement with no electricity or plumbing.
"If we had this information that this young woman was living in this basement, we could have taken all sorts of actions," McCabe said.
Beilenson said yesterday that if the child protective system had been functioning optimally, the hospital's call should have triggered a visit from a state social worker, who might have learned before Swann left Hopkins that she was a runaway foster child living in a basement unfit for babies.
With that information, the state could have monitored the children closely or asked the courts to put them in foster care, Beilenson said. The twins' elder sister had been removed from Swann because of abuse.