PURPOSE: This rule establishes a standardized method for identifying and collecting data for child deaths determined to be suspicious of child abuse, neglect, or both. The child fatality review process will assist state and local agencies in identifying systemic issues and policy deficiencies which must be addressed to prevent similar deaths from occurring in the future.

1. (1) The prosecuting attorney or circuit attorney shall convene a local child fatality review panel in each of the state’s one hundred fourteen (114) counties and St. Louis City to review suspicious child deaths.
2. (2) The Department of Social Services (DSS) shall convene a state child fatality review panel appointed by the director of DSS to identify systemic problems and prepare an annual report on ways to prevent further child deaths.
3. (3) The local child fatality review panel will review all deaths of children less than fifteen

4. (15) years of age at the time of their death where one (1) or more of the following factors are present:

   1. (A) Possible inflicted injury;
   2. (B) Any firearm injury;
   3. (C) Injury not witnessed by the person in charge of child at time of the injury event;
   4. (D) Possible inadequate supervision;
   5. (E) Sudden unexplained death of a child under age one (1);
   6. (F) Natural cause of death possibly due to malnutrition or to delay in seeking medical care;
   7. (G) Death due to confinement;
   8. (H) Bathtub/bucket drowning;
   9. (I) Suffocation/strangulation;
   10. (J) Any poisoning;
   11. (K) Severe unexplained injury;
   12. (L) Prior Division of Family Services

5. (DFS) substantiation on the victim or other children in the residence for similar circumstances;

   1. (M) Open DFS protective service case on victim;
   2. (N) Victim in DFS custody;
   3. (O) Pedestrian driveway injury;
   4. (P) Unexplained death or death in an undetermined manner;
   5. (Q) Suspected sexual assault; or
   6. (R) Any other suspicious findings.

6. (4) The local child fatality review panel at least shall review the following information on all suspicious deaths:

   1. (A) Findings from interviews, history or death scene investigation;
   2. (B) Physical evidence at the scene of injury, death, or both;
   3. (C) Findings from physical and medical examinations;
   4. (D) Findings from autopsy, radiological examination and laboratory evaluation;
   5. (E) Reports of investigation/evaluation; and
   6. (F) Relevant past history/agency involvement.

7. (5) The director of DSS shall appoint regional coordinators to serve as resources to local child fatality review panels. The regional coordinators will provide the following services:

   1. (A) Consultation and technical assistance;
   2. (B) Training; and
   3. (C) Review forms and provide recommendations on procedures developed by local panels.

8. (6) Initially, all members will be appointed by the prosecuting attorney. Subsequent appointments will be made by the chairperson. All members who represent a governmental agency defined as mandatory in this section will serve as long as they hold the position which made them eligible for appointment to the local child fatality review panel. All other members shall serve a term which is defined in the procedures developed by the local panel. The local procedures also shall define the selection and removal processes for noncore members. The chairperson shall be elected by the review panel. The chairperson and all other members may be reappointed for consecutive terms. The local child fatality review panel shall include, but not be limited to, the following core members:

   1. (A) The prosecuting or circuit attorney;
   2. (B) Medical examiner/coroner;
   3. (C) A law enforcement officer;
   4. (D) A representative of the DFS;
   5. (E) A provider of public health services; and
   6. (F) A representative of the juvenile court.

9. (7) If the county of residence, injury or death are different, the child fatality review panel in the county where the injury occurred shall review the death.

   1. (A) The activated review panel may communicate with the chairperson of the child fatality review panel in the county of residence and death, if different, to request necessary information.
   2. (B) The review panel in the county of death, residence, or both, may choose to review the death.
   3. (C) The Coroner/Medical Examiner report form must be completed on all children ages birth through fourteen (0-14) who die in Missouri, regardless of state of residence.
   4. (D) Children injured out of state, who die in Missouri, may be reviewed at the sole discretion of the county panel, regardless of state of residence.
10. (8) The panel members will hold all information obtained in the course of a review in the strictest confidence and will not discuss or disclose any information regarding any case, except as permitted by applicable statutes.
11. (9) DFS will not reimburse or compensate a county child fatality review panel for expenses associated with review panel business. Expenses may be reimbursed consistent with state travel rules and limitations for required participation of DFS panel members in training. DFS will be responsible for payment of expenses, subject to state travel rules and limitations, and compensation for its employees who are members of a review panel.

12. (10) The following process will be followed by the county child fatality review panels:

    1. (A) Any police officer, sheriff, law enforcement officer or official, physician, coroner/medical examiner, funeral director, hospital personnel or any person having knowledge that a person less than fifteen (15) years of age has died, shall notify the coroner or medical examiner immediately in the county of injury.

       1. 1. If the coroner or medical examiner in

the county of death or residence is notified of a death, s/he shall notify the coroner or medical/examiner immediately in the county of injury, if different.

1. 2. If the coroner or medical examiner in

the county of injury determines that the death of the person under age fifteen (15) does not exhibit any suspicious circumstances as described in section (3), the panel chairperson will be responsible for cosigning Form 1 and shall forward the form within forty-eight (48) hours through the regional coordinator to the Department of Health. If the chairperson disagrees with the coroner or medical examiner regarding the nature of the death and desires a review, the review panel can be activated.

1. 3. The coroner or medical examiner in

the county of injury shall notify a certified child death pathologist to determine the need for an autopsy. If there is disagreement, the certified child death pathologist shall make the determination, unless the child fatality review panel, within twelve (12) hours, decides against the certified child death pathologist;

1. (B) The coroner or medical examiner in the county of injury shall notify the chairperson of the child fatality review panel immediately if the death is suspicious;
2. (C) Upon notification, the chairperson will activate the review panel within twenty-four

1. (24) hours to review the death.

   1. 1. Each member of the panel shall share

information and records available to that panel member.

1. 2. Each review panel shall operate the

review based on procedures developed by the panel and based on guidelines and protocols developed by the DSS;

1. (D) The review panel shall determine, at a minimum—

   1. 1. The place where the injury/illness

causing a death occurred;

1. 2. The manner and circumstances of the

death;

1. 3. Actions taken by the agencies/persons

involved with the child and his/her family;

1. 4. The identification of any siblings or

other children in the home of the deceased 13 CSR 40-31

child and whether they require protection; and

1. 5. The identification of local systemic

issues or policies which enhance or detract from efforts to assist in the investigation, treatment or prevention of fatalities; and

1. (E) The chairperson of the local child fatality review panel will complete Form 2 and forward it through the regional coordinator to the Department of Health, for linkage with death certificates. This form must be sent within forty-five (45) days of the date of death.

1. (11) The state child fatality review panel shall be composed of a minimum of seven (7) members. All members will be appointed by the director of the DSS.

   1. (A) Members mandated by this rule to be members of this panel may serve as long as they hold the position which made them eligible for appointment.
   2. (B) The DSS shall establish procedures which define the terms for all members, reasons for the removal of members from the panel and how members will be appointed in the future.
   3. (C) The chairperson and all members may be reappointed for consecutive terms.

2. (12) The director of DSS shall appoint the following persons to serve on the state fatality review panel:

   1. (A) A prosecuting attorney or circuit attorney;
   2. (B) A coroner or medical examiner;
   3. (C) A law enforcement officer or official;
   4. (D) A representative from DFS;
   5. (E) A provider of public health care services;
   6. (F) A representative from the Department of Health; and
   7. (G) A representative of the juvenile court.

3. (13) Other members of the state child fatality review panel may include persons from the following agencies/groups:

   1. (A) Division of Youth Services;
   2. (B) Attorney General;
   3. (C) Missouri Juvenile Justice Association;
   4. (D) A physician experienced in examining and treating abused/neglected children;
   5. (E) Department of Mental Health;
   6. (F) Department of Public Safety;
   7. (G) Department of Elementary and Secondary Education;
   8. (H) Department of Corrections; and
   9. (I) Any other professionals or citizens with special interest in child abuse and neglect.
4. (14) The state child fatality review panel will meet a minimum of once every six (6) months. DFS may reimburse the members who are not division employees for reasonable expenses, consistent with state travel death and whether death was attributable to rules and limitations for expenses associated child abuse/neglect; with review panel business held outside their county of residence, but will not provide for any other compensation. DFS will be responaddressed through changes in policy, procesible for the reimbursement of expenses, subdures or statute. ject to state travel rules and limitations, and compensation for its employees on the panel.

5. (15) The state child fatality review panel shall review and discuss all relevant materials submitted by the local panels and the state implementation team. The purpose of the review will be to—

   1. (A) Review the findings of the county child fatality review panels to determine the frequency and cause of child fatalities throughout the state;
   2. (B) Identify the appropriateness and comprehensiveness of current statutes, policies and procedures relevant to the management of fatal abuse/neglect cases;
   3. (C) Review data collected by the Department of Health to determine the accuracy of identification of fatally abused and neglected children;
   4. (D) Review reports on the status of the operations of the county child fatality review panels; and
   5. (E) Recommend prevention strategies after reviewing statewide trends and actions suggested by local panels.
6. (16) The panel members will hold all information obtained in the course of a review in the strictest confidence and will not discuss or disclose any information regarding any case, except as permitted by applicable statutes.

7. (17) DSS and the state child fatality review panel annually shall evaluate the following factors related to the work of the local child fatality review panels:

   1. (A) Number of reviews;
   2. (B) Geographic area of reviews;
   3. (C) Results of reviews; and
   4. (D) Necessary amendments to the rules.

8. (18) The state child fatality review panel shall submit an annual report to the director of DSS, the governor, the speaker of the house of representatives, the president pro tempore of the senate, and the children’s services commission. At a minimum, the report shall address the following issues:

   1. (A) The number of child fatality cases reviewed by county panels;
   2. (B) Nonidentifying characteristics for perpetrators;
   3. (C) Nonidentifying characteristics for deceased children;
9. (D) The number of fatalities by cause(s) of
10. (E) Effectiveness of local panels; and
11. (F) Systemic issues which need to be

AUTHORITY: section 207.020, RSMo (1986). Original rule filed June 15, 1989, effective Jan. 1, 1990. Emergency rescission and emergency rule filed Dec. 20, 1991, effective Jan. 1, 1992, expired April 29, 1992. Emergency rescission and emergency rule filed April 16, 1992, effective April 26, 1992, expired Aug. 23, 1992. Rescinded and readopted: Filed Jan. 3, 1992, effective Aug. 6, 1992.