Home visit details scant
Did Albany County report omit specifics about baby’s killing?
In January 2017, Albany County child welfare workers received a tip: A 1-year-old boy, Luka Patrick, was being forced to stand in the corner of his mother’s Albany apartment as a punishment, while his mother and her boyfriend aggressively screamed at him.
The apartment was also allegedly infested with cockroaches.
Over the next week, Albany County Child Protective Services workers made at least two visits to Luka’s home. During one, Luka’s mother acknowledged that she was forcing her son to stand in the corner while she screamed. During another, a CPS worker noticed a small cut under Luka’s eye that was explained away by the mother. Three days later, Luka was beaten to death by his mother’s boyfriend, David Bridges.
When a death occurs within New York’s child welfare system, a state law requires a report comprehensively examining the circumstances, including whether Child Protective Services workers followed protocols in examining allegations of neglect and abuse.
The local entity that could have taken up that task, the Albany County Child Fatality
Review Team, delayed doing it and a more cursory review was conducted by the state Office of Children and Family Services, a state agency that oversees county-based CPS offices across New York.
Yet the details of the three home visits in thecase were left out of the state’s review, which also contains little information about the lead-up to Luka’s death, and no analysis of whether CPS workers followed protocols. Some of those details have been publicly revealed only because CPS workers’ notes were part of a court exhibit filed at Bridges’ criminal trial.
When the county’s decision to delay conducting a comprehensive report was made in 2017, the coordinator of the county’s Child Fatality Review Team — Christine Zappone-lenaghan — was also assigned to a second position that arguably posed a conflict of interest.
Zappone-lenaghan supervised county social services workers, and has served as director of the county’s Child Advocacy Center, oversaw the staff conducting child abuse investigations. Those CPS workers, if not for Zappone-lenaghan’s decision, would have been scrutinized by the fatality review team that ZapponeLenaghan also led.
The county also confirmed that in 2017, Zappone-lenaghan was the coordinator who would have decided whether to delay a fatality review team meeting.
Zappone-lenaghan, a decades-long employee who has since left Albany County government, could not be reached for comment.
The situation highlights the arguably conflicting arrangement that exists in certain counties across New York, including Albany: The person responsible for coordinating child fatality reviews works for the county-based child welfare agency that is the subject of the review.
As the Times Union reported in October, county governments exert influence over the stateissued reports on child deaths. OCFS over the past decade has suppressed 725 of the reports on child deaths from being released to the public, often on the advice of county governments. While the stated rationale is that suppression is in the “best interest” of the dead child’s surviving siblings, counties also may have vested interests in keeping reports hidden, including avoiding public scrutiny or liability.
Upon request from the Times Union, the review of Luka’s death was publicly released by OCFS.
But the review of the actions of CPS workers was superficial — a significant concern when a local department of social services and OCFS collaborate on compiling a fatality report, a former OCFS official told the Times Union.
As in Luka’s case, the reviews — which must by law be finalized within six months of a child’s death — at times are simply conducted by staff at OCFS, with county governments then getting the chance to argue for amendments before final release. In certain regions and counties, however, there are also locally based Child Fatality Review Teams certified to compile the reports by OCFS, including the fatality review team in Albany County.
The county-based review teams are legally required to consist of a broad range of specialties that might have been involved in the child’s case preceding the death. The Albany County Child Fatality Review Team, for instance, has over 50 members, including from the county’s social services agency and representatives from the health department, district attorney’s office and various police agencies.
In that structure, the information-sharing between various entities often results in reports being much more comprehensive, the former OCFS official told the Times Union. And crucially, more people in the loop from various agencies decreases the likelihood that important but politically sensitive information will be left out, the person said.
When OCFS writes a report and the local CPS agency gets the chance to argue for amendments, which occurred in Luka’s case, the risk is greater that key facts being will be omitted, the former OCFS official said.
While OCFS is a state agency, and CPS offices are run by county governments, they have certain incentives to be cooperative with one another, the former official added. Those might include easing information sharing
between the levels of government, and jointly trying to avoid criticism for alleged lack of oversight in certain cases.
On July 31, 2017, OCFS issued a report within the required six months following Luka’s death. Much of the 13-page report details a post-death investigation by Albany County CPS.
Only half a page concerns CPS worker interactions with Luka and his family preceding the homicide.
In the report, OCFS issued a brief, 19-word “review” of CPS workers’ actions that contained little content or critique.
It states that Albany County CPS workers “made three home visits between 1/27/17 and 2/6/ 17” when Luka died. “Home was small but met minimal standards.” There was no additional information about the visits or the witnesses who were interviewed ahead of the death. There is a brief comment by Albany County CPS asserting that the witness interviews were “thorough.”
When more comprehensive child death reviews are conducted, the reports can look much different. Each complaint of abuse or neglect investigated by CPS workers is followed by a recounting of investigative steps taken and a detailed OCFS review of whether protocols were followed.
Moira Manning, commissioner of the Albany County Department for Children, Youth and Families Commissioner, said in a prepared statement that the report was written by OCFS alone.
“OCFS puts together its Child Fatality Report from information in the Connections electronic system and then submits the final report to the local district,” Manning said. “We
don’t have anything to do with writing this report.”
After OCFS finished a draft of the report, it was required to submit a copy to Albany County for “review and comment” so the county had the “opportunity to correct factual errors or to supply
missing information.”
Manning did not answer questions about whether Albany County had sought amendments to the OCFS report.
OCFS told the Times Union that the fatality review report was “standard format.” But the
agency refused comment on why details concerning the lead-up to Luka’s death had been omitted from the review.
The visits to Luka’s home were prompted by a complaint called in to the CPS central hotline stat
ing that his mother, Rebecca Patrick, and Bridges were making the 1-yearold stand in a corner “facing a wall for 30 minutes while they acted aggressively and screamed.”
“This report was under investigation” the OCFS report stated. “There was some credible evidence gathered through home visits and interviews to substantiate the allegations.”
The report also briefly gave the reason why the county’s Child Fatality Review Team did not meet before the report’s issuance: “It was decided,” the report stated, that the review team would be “meeting retrospectively due to the pending criminal investigation” into Luka’s mother and her boyfriend.
Manning, the county commissioner overseeing CPS workers, said that if there is a pending law enforcement action or criminal proceeding, a case would be discussed by the district attorney’s office and the Child Fatality Review Team. They would then determine if a fatality review team meeting would “compromise the integrity of the case or if it could be conducted without law enforcement involvement.”
A spokeswoman for Albany County District Attorney David Soares — whose office handled the prosecution of Bridges — said their office never advised anyone at the county level to delay its review.
At no time did prosecutors “instruct, ask or advise members” county officials to refrain from “doing anything in their investigations,” said Cecilia Walsh, a spokesman for the district attorney and member of the county’s Child Fatality Review Team.
Within two days of Luka’s death, county CPS officials interviewed both Bridges and Luka’s mother, subsequently reporting the interview results to Zappone-lenaghan.
According to the CPS workers’ notes, the mother stated in the interview that Bridges moved into the home on Dec. 14, 2016. Roughly two weeks later, Luka “started having bruises” allegedly at the hands of Bridges. The mother subsequently would keep the child home in order to hide the bruises. Patrick, the mother, also alleged she was abused by her boyfriend.
Patrick pleaded guilty to misdemeanor child endangerment and testified against Bridges.
State Supreme Court Justice Roger Mcdonough told Bridges, before sentencing him to 25 years in prison, that the “smiling, healthy, unbruised, unmarked” infant suffered injuries and began to look “worse and worse and worse,” corresponding to when the child’s mother had allowed Bridges to move in.
The CPS caseworkers’ notes detail their key interactions with the family as the abuse escalated to first-degree manslaughter — details that were never included in the OCFS review.
Ten days before Luka’s death, during the first CPS home visit in response to the complaint, Patrick did not deny putting Luka in a corner and screaming at him. But she stated that she did not do so for more than two minutes — not a half hour which had been alleged in the anonymous complaint that triggered the visit.
Patrick also told the CPS caseworkers that she did not use “corporal punishment.”
Bridges was at the residence during that first visit but the case notes don’t indicate that he was interviewed. The CPS notes incorrectly stated that Bridges did not live in the residence.
A week later, a different CPS caseworker conducted a home visit and noticed that Luka had a “small scratch” underneath his eye.
The mother responded, according to the case notes, that Luka had thrown a tantrum, thrown himself on the floor and hit his face on a toy.
The investigation was not closed at that time, but no further action was apparently taken by CPS officials before Luka was beaten to death by Bridges three days later.
On Feb. 13 that year, — a week after Luka’s death — an Albany CPS caseworker entered an “additional” note concerning the initial Jan. 27 visit. His postdeath addition stated that the child was observed during that first visit wearing only a diaper and was “free of visible marks and bruises.” By the time the additional note was entered, evidence was mounting that the abuse had been going on for weeks before Luka’s death.
If a fuller OCFS review were conducted, it’s not clear that CPS workers would have been found to have mishandled the case, even if details about the home visits were left out.
In the past, OCFS reviews have criticized CPS workers for not making a greater effort to interview a mother’s partner who was allegedly abusive, and who like Bridges, went on to kill a child.
Manning, commissioner of the county’s Department for Children, Youth and Families, disputed that it was a conflict of interest for the county’s Child Fatality Review Team to be led by an official overseeing county
CPS workers.
She said that OCFS is really the body tasked with overseeing a child fatality review. So the idea that the Child Fatality Review Team and CPS need to be “entirely independent for the sake of oversight is a misconception.”
“Ultimately, OCFS, not the Albany County CFRT, issues a child fatality report,” Manning said.
Indeed, even if a report is complied by a local fatality review team,
OCFS can edit the report before public release. That process can also result in key information being omitted, according to the former OCFS official.
There are currently 19 Ocfs-certified regional and county Child Fatality Review Teams around the state, and the “coordinator” in some cases comes from whichever nonprofit in the region leads the local Child Advocacy Center.
But in several smaller upstate counties, including Albany, the local fatality review teams are led by an official from the county government.
OCFS provides funding to the entity that coordinates the local Child Fatality Review Team. For example, after issuing a 2018 request for proposal, OCFS signed a five-year, $348,000 contract with Albany County.
Following Bridges’ conviction in May 2018, it’s unclear if a “retrospective” review was conducted by the county’s Child Fatality Review Team, as had been originally promised once the criminal case ended.
OCFS officials told the
Times Union that there was “no updated fatality report” and that any investigative records “outside of the fatality report would be confidential.” Albany County also said that privacy laws prohibit further comment.
If a further review was conducted, the results will likely not be made public.
In the past, OCFS reviews have criticized CPS workers for not making a greater effort to interview a mother’s partner who was allegedly abusive, and who like Bridges, went on to kill a child.