CALGARY – Deficiencies, miscommunications and inadequate critical thinking are to blame for the death of a 14-month-old Calgary girl, according to a report revealed Thursday.
Elizabeth Velasquez was allegedly suffocated to death last year despite members of her family filing complaints with social services months before.
Elizabeth was transported to the Alberta Children’s Hospital in medical distress on May 2nd, 2010 after police and paramedics were called to a home in the 900 block of 44th Street S.E.
She died in hospital. An autopsy performed the next day was inconclusive.
Almost a year later, Calgary Police announced they were investigating her death as a homicide after an autopsy report released to investigators in December identified the cause of death as non-accidental asphyxia.
Police say Elizabeth was in the care of her biological mother and her boyfriend at the time of her death.
The girl’s paternal grandparents had lodged a complaint with social services in March of 2010 after the child appeared neglected; they said they began noticing concerning signs in their weekly visits including rashes, becoming fearful of strangers and crying because she was in pain.
Elizabeth had repeatedly appeared at the ACH over a period of 61 days prior to her death for a number of issues including broken legs, arms and an ear infection.
The girl waited two weeks for an assessment with a paediatric child abuse specialist at ACH. It took another two weeks to get results and confirm abuse.
“There wasn’t any one specific breakdown. It was a series of gaps and delays and miscommunications,” says Gayla Rogers, social work expert at the University of Calgary.
During a joint meeting between a child case worker, police and health officials, no one took notes and a paediatric report wasn’t handed out.
Once the abuse was confirmed, police repeatedly urged the case worker to remove the toddler form her mother’s home.
That didn’t happen and 19 days later she was suffocated to death.
“I think timeliness in access to care is something we’re going to examine a little bit deeper,” says Dr. Francois Belanger, Alberta Health Services.
“We have no learned that the way we speak and the way Child and Family Services speaks and Alberta Health Services – there’s maybe difference in how we speak or how we express our concerns. Perhaps we could have been more clear in expressing our concerns,” says Police Chief Rick Hanson.
Children and Youth Services Minister Yvonne Fritz ordered an external investigation into the matter.
On Thursday, Fritz released the results of that report which makes 11 recommendations including strengthening partnerships between police, health professionals, prosecutors and educators, community agencies and Children and Youth Services.
It also recommends the formation of an independent child and family services council which will have a legislated role in quality assurance and accountability through public reporting. The arms-length council will be notified of all deaths and serious injuries of children in the province’s care and will decide which incidents need to be independently reviewed.
The Ministry has allocated $1.5-million to support the council over the next three years.
Experts from the fields of public health, social work, law enforcement, child abuse and Child and Family Services worked on the review.
During the news conference, the minister defended her team of experts, bristling when asked if staff involved are being held accountable and if she will step down.
“I did not ask the panel to lay blame,” said Fritz.
See below for the full report:
Findings of the External Expert Panel Regarding the Death of a Young Child
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