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Drug addiction and infant death: Who's to blame?

med mal baby in crib.jpgBirth injuries are slowly declining, according to a report issued by the Agency for Healthcare Research and Quality (AHRC). According to the agency, overall birth injuries in the U.S. declined from 2.64 to 1.91 per 1,000 live births between 2004 and 2012.

While this is good news for babies and their parents, there are areas where things have gotten worse. In particular, injuries and deaths related to social conditions, rather than medical errors, have been more difficult to reduce. In fact, some types of neonatal injuries have increased.

For example, more babies have died because they were born to drug-addicted mothers, and not because the infants themselves were born drug-addicted. Rather, these babies were released to families ill-equipped to care for them, according to a Reuters story.

According to the story, 110 children in the United States have died after being sent home from the hospital to mothers and caregivers who were addicted to drugs. The deaths resulted primarily from suffocation or ingesting lethal doses of opioids. However, some were particularly frightening: One baby in Oklahoma died when she was put into a washing machine along with the dirty laundry.

A federal law enacted in 2003, the Keeping Children and Families Safe Act, was intended to protect the more than 5,000 babies born to drug-dependent mothers. Since 2003, the number of drug-dependent babies born in the United States has grown to 27,000 as of 2013, according to the Reuters story. The law requires health care workers in hospitals to alert child protection services so that social workers can monitor a child's well-being. However, the law is not being followed in most places for a variety of reasons.

Local child protection agencies have suffered significant cuts in recent years, making it difficult to check up on every child. Only nine states and the District of Columbia have their own laws that conform to the federal law. Five other states have laws that are confusing and difficult to enforce. The other 36 states have laws that do not require doctors and other health care workers to report drug-addicted babies.

Most of the 110 deaths reported were caused by mothers, although a quarter of those deaths implicated the father, a boyfriend or another man. In three-quarters of the cases, medical providers had reported the baby's condition to child protection authorities, but the child protection staff had not taken any action. In other instances, hospitals did not notify a child protection agency.

One reason some state laws do not require health care providers to report drug-addicted infants is to avoid stigmatizing mothers who are undergoing methadone treatment for drug addiction or are taking prescription drugs. However, while prescribed doses of methadone or opioids could be safe for babies, abusing either is almost certainly going to cause harm.

The 110 infant deaths identified by Reuters are probably only the tip of the iceberg, as several large states do not report child deaths that occur after a baby is discharged. There are almost certainly more.

Who is to blame? Is it the health care system, child protection agencies or state laws? It is a complicated issue that incorporates a variety of conflicting laws, overburdened social services agencies, the desire to not stigmatize struggling mothers and the demonizing of drug addicts. In some instances, the baby's well-being becomes lost in the tangled web of conflicting interests.

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