Extra level of review sought in child death cases

Boston Statehouse

Massachusetts State House

BOSTON (SHNS) – Pointing to high-profile legal cases that resulted in dropped or reduced charges, lawmakers and parents on Monday renewed their push for legislation that would impose new oversight requirements on the chief medical examiner in cases involving the death of a young child.

Supporters pressed for passage of legislation (H 2261/S 1439) that would make any autopsy findings involving children younger than two years old, plus all subsequent revisions to the autopsy report, subject to personal review and approval by the chief medical examiner.

Sen. Cindy Friedman, one of the bill’s authors, told the Joint Committee on Public Health that involving the state’s top investigator for suspicious or unexplained deaths in those reports would create more certainty and ensure accountability in emotionally fraught cases.

“This is a small ask for a very important issue, and I think it will especially help those that find themselves in this terrible situation as parents,” Friedman, an Arlington Democrat, said.

The legislation, a refile of a proposal that died in committee during the 2019-2020 lawmaking session, comes after the state’s Office of the Chief Medical Examiner last year implemented its own policy requiring additional review of cases involving the deaths of children aged 2 or younger.

Forensic pathology involving children that young is rare in Massachusetts, typically representing fewer than 5 percent of cases handled by the medical examiner’s office, according to Friedman.

Those autopsies are among the most sensitive that a medical examiner can tackle, but Friedman said under existing law, an associate medical examiner with “very limited experience in pediatric cases” can determine and then revise a cause of death without any review from the chief examiner.

On several occasions in recent decades, prosecutors have reduced or dropped murder charges in cases of young children who died after an associate medical examiner amended a report and changed a ruling from homicide to an undetermined cause of death.

Sameer Sabir told the committee on Monday about the death of his daughter, Rehma, shortly after her first birthday.

In January 2013, Sabir’s mother found Rehma having seizures after she had been in the sole care of Aisling Brady McCarthy, her nanny. Rehma was taken to Boston Children’s Hospital, where she died several days later of injuries.

Katherine Lindstrom, an associate medical examiner, in April 2013 deemed Rehma’s death a homicide, and McCarthy was charged with murder.

As the Boston Globe reported, Lindstrom later revised her opinion to an “undetermined” cause of death after multiple pre-trial conversations with medical experts on the case’s defense team who believed that there could have been other explanations for Rehma’s death.

Following Lindstrom’s retraction, prosecutors dropped charges against McCarthy, who was released after spending two years in prison and returned to her native Ireland.

“Sadly, this was not the first nor the last time this has happened,” Sabir told lawmakers on Monday, later adding, “We live in the premiere hub of medical and scientific expertise in the country, and we can do better.”

Sabir said “many other” medical examiners offices in the United States have similar policies requiring the chief’s review on pediatric cases. He told the committee that it would help protect both parents and caretakers.

“This is simply about arriving at the right answer and about accountability given the indescribable toll this takes on loved ones, and, importantly, making sure that people who hurt people are prosecuted but also ensuring that people aren’t falsely accused of hurting children,” he said.

The Public Health Committee favorably reported a previous version of the bill in December 2019 and sent it to the Health Care Financing Committee, but it never emerged from that panel amid pandemic upheaval and the mid-session departure of House chair Rep. Jennifer Benson.

Sen. Jo Comerford, the Public Health Committee’s chair in both sessions, said Monday that the medical examiner reporting bill had “quite a lot of momentum” last session that she hopes will now be reignited.

Rep. Marjorie Decker, a Cambridge Democrat who filed the bill alongside Friedman and Republican Rep. Sheila Harrington of Groton, said Monday that she and Harrington met with Chief Medical Examiner Dr. Mindy Hull about a year and a half ago, before COVID-19 hit, and that Hull “made it very clear she didn’t think this should be part of her responsibility.”

“The number of cases involving children under the age of 2 are very small,” Decker said. “Absolutely, the chief medical examiner’s office has the bandwidth to do this, and the fact that the highest-paid public servant in the state of Massachusetts did not want the responsibility to do this means that, because the administration won’t move forward with this, we are moving forward with this as a bill.”

The Executive Office of Public Safety and Security, which houses the Office of the Chief Medical Examiner, said in response Monday that it implemented a new policy in 2020 aimed at addressing concerns about cases involving the deaths of children 2 years old and younger.

Under the revised policy, any medical examiner who conducts an autopsy in a case with a child that young must present their findings to a group of peers including either the chief or deputy chief for feedback before signing the death certificate. The chief is not explicitly required to grant approval on every finding.

Examiners would need to go through a similar process when they propose amending a death certificate.

“Dr. Hull and her team at OCME understand that behind every case is a grieving family anxious to learn the cause and manner of their loved one’s death,” EOPSS spokesman Jake Wark said in a statement to the News Service. “To strengthen review processes for infant death cases, last year OCME implemented a new policy which requires the medical examiner assigned to a death of a child 2 or younger to present the case and findings for additional peer review, including by either the Chief or Deputy Chief Medical Examiner, before signing a death certificate. The Administration will carefully review any legislation that reaches the governor’s desk.”

Decker said during Monday’s hearing that she believes lawmakers must act because Gov. Charlie Baker will not pursue the proposed reforms administratively.

“It’s clear that Governor Baker actually could just do this. We don’t necessarily need legislation to do this, but because they’re not doing it, we do need legislation,” Decker, who co-chairs the Public Health Committee, said.

Baker’s office did not respond to a News Service request for comment.

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