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At age 19, Kimberly Price was raising a 2-year-old son and living with her mother at the family’s home in Southeast. The two women did not get along, and one day in December 2000, Price’s mother told her to get out. Price was not aware at the time that she was pregnant.

Price took her toddler, Tony Price, with her to live at D.C. Village in Southwest. Employees at the homeless shelter also did not know Price was expecting, but they were concerned about the way she treated young Tony. One employee described her in records filed in D.C. Superior Court as a “very, very angry” person who handled the child in a rough manner.

According to the same employee, Price often left Tony alone at the shelter while she went outside or to other areas of the building, leaving him vulnerable to the other residents and violating the rules of the shelter.

Cleanliness also was an issue. “At one point, Ms. Price’s roommate or nearest neighbor asked for a reassignment because of Ms. Price’s poor hygiene practices and the odor associated with her,” according to court records. Likewise, Tony’s clothes were filthy, his nose runny and hair uncombed.

After a few weeks, Price left D.C. Village and went to live at the Community of Hope Shelter at Girard Street in Northwest. Employees there, also unaware that Price was pregnant, had similar concerns about her treatment of Tony. One employee described her as “immature and like a little kid.” She did not think Price was capable of maintaining a household.

One of the shelters reported Price to the city’s Child and Family Services Agency for neglecting Tony and because one of the workers said she had seen Price hit Tony in the head with a broom. But Price and her son left the shelter before agency investigators arrived. Child and Family Services assigned a social worker to the family, but the social worker made only one visit, according to the Washington Post.

Five months into her term, Price realized she was pregnant. She moved a few times and then settled into a subsidized apartment in the 4500 block of B Street SE with her boyfriend, Tony Hodge. On Aug. 21, 2001, Price went into labor. She was rushed by ambulance to Providence Hospital and delivered a full-term baby. Shawn Price weighed 6 pounds 11 ounces and measured 19 inches long. He was “feeding well,” a nurse reported in Price’s medical records, and in “satisfactory” condition.

“There was no reason to suspect anything was wrong,” says a hospital spokesperson.

Even when infants present well, the maternity ward at Providence Hospital follows procedures to identify parents who may pose a danger to their children.

Patients in labor who arrive unexpectedly and with no medical history are automatically referred to hospital social workers for a consultation and needs assessment, according to Sharon McMillian, director of maternal and infant health. Based on the social worker’s findings, referrals are provided in a number of areas, including psychiatric counseling, home visitation, or medical care. If a mother refuses treatment, McMillian says, “there is nothing we can do unless we physically see abuse.”

She notes that the hospital has only two days to assess a new mother. In that time, hospital workers watch to see how well the mother bonds with and talks to the baby, and ensure she schedules outpatient follow-up appointments before she is discharged.

Although Price arrived at the hospital by ambulance and in labor, nothing in her medical records filed at the court indicates she was ever referred to a social worker or for home visitation. Hospital spokesperson Curtis McCormick says that that could be because there was a notation in the records that Price had a private physician at the hospital.

Price apparently did have some prenatal care. According to a psychiatric evaluation taken in 2001, she became sick in her sixth month of pregnancy and twice visited an emergency room. But attorney J. Christopher McKee, the public defender assigned to Price’s case, says she never had an established relationship with a doctor who might have been familiar with her background and general living and parenting skills. And the hospital also might have picked up on the fact that Price had little family support; according to McKee, no one visited her or her newborn during their hospital stay.

Like all new mothers, Price received instruction at the hospital in basic infant care, including diapering, feeding, and use of a bulb syringe. According to McMillian, the training is tailored to the needs of exhausted parents: The directions are explicit, and patients are asked to repeat back what they have been taught. McMillian, however, acknowledges that there are no opportunities for patients to practice mixing formula because the hospital bottles come pre-prepared. “All you have to do is put on the nipple,” she says.

McKee says the instructions do not seem targeted toward patients like Price. A standard hospital video shown to new parents, for example, advises them to rely on family or friends to clean the house and offers tips on such topics as picking out a car seat. “The video did not appear to be prepared for the poor, but rather geared toward those who are better off financially and able to afford cars and housekeepers,” says McKee.

Dr. Cheryl Focht, medical director for pediatrics at Mary’s Center for Maternal and Child Care, says, “I see patients come out of [Providence] all the time not having understood what happened to them at the hospital. There’s little focus on breast-feeding and not a lot of education about the baby.”

Hospital staff advised Price several times to visit a pediatrician two to three days after discharge, but there is no indication in the records that anyone confirmed she had scheduled an appointment. Instead, Price left the hospital with Shawn within 36 hours after his birth and “made her way home somehow,” McKee says. “Nobody picked them up.”

Within a week of returning home, Price was working at a Wendy’s restaurant, putting in 35 to 40 hours a week. Hodge, meanwhile, may have had odd jobs, according to court records, but he did not have steady employment.

Although Price and Hodge had an older son, McKee explains, young Tony had been cared for as an infant by a paternal grandmother who died before Shawn was born. Thus, this essentially was the couple’s first experience looking after a newborn. They twice hired an aunt to baby-sit and introduced Shawn to other relatives, but otherwise they handled all of his care themselves.

Although Hodge may have had responsibility for the daytime child care, arrangements for medical treatment were apparently left up to Price. According to McKee, Price made several futile attempts to set up an appointment with Children’s Hospital’s Generations Program, which targets adolescent parents. “Either she wouldn’t know the name of the doctor, or didn’t have the baby’s Social Security number, or didn’t have the proper paperwork,” McKee says. He says he does not know how many times Price tried, but asserts that she “made efforts on getting Shawn to see a doctor.”

Dr. Dana Best was the medical director of Generations at the time and, according to court records, doubts that Price ever tried to make an appointment. The physicians at Generations would always see a newborn, said Best, even if the parent just showed up.

It wasn’t until Shawn was 3 weeks old that he received any professional attention; Price took him to see a nutritionist at the Women, Infants, and Children (WIC) Program clinic at Children’s Hospital. During the visit, Shawn weighed in at 6 pounds and one-quarter ounce—a drop of nearly 11 ounces since birth. It is difficult to know what happened next, because Children’s Hospital does not comment on individual cases. According to court records, the nutritionist charted Shawn in the 10th percentile for weight—low, but still within “normal” range.

But Dr. Cynthia L. Ogden, an epidemiologist with the Centers for Disease Control and Prevention, writes via e-mail that Shawn was actually in the 2nd percentile, which meant he weighed less than 98 percent of all infant boys his age.

Shawn, at 3 weeks old, had not regained his birth weight. “That should have been a huge, huge red flag,” says Focht. “Someone should have made sure this woman got to a doctor.”

A month later, on Oct. 19, Price realized something was terribly wrong. She changed her son’s diaper, wrapped him in a blanket, and ran a block away, to the home of Evelyn Hodge, step-grandmother to the baby’s father.

“I got a baby that won’t wake up,” Price said. The older woman felt one of Shawn’s legs, which had fallen out of the blanket, and knew before Price even placed the 911 call that it was too late.

“That baby’s dead, honey,” Evelyn Hodge remembers saying.

Later that morning, officers with the Metropolitan Police Department arrived at the apartment Price shared with Tony Hodge and their two children.

Inside they found “many” empty Smirnoff Ice bottles, as well as a package of Tops rolling papers in the trash and marijuana in a bedroom, according to court documents. They also found 22 unopened cans of Enfamil baby formula, six boxes of baby cereal, and some partially empty bottles in Shawn’s crib.

A community supervision officer asked Price to explain how, with a three-week supply of formula in the apartment, her nearly 2-month-old son could have starved to death. “To tell the truth I don’t know,” Price told the officer. “My son was dead. I don’t know what happened. He was being fed.”

Price had used a WIC voucher to buy food for Shawn. She’d exchanged the voucher at a grocery store for 31 cans of formula concentrate. When mixed properly, each can supplies a day’s feeding, or a total of 24 ounces.

Apparently, neither parent knew how to mix the formula correctly, even though there were illustrated instructions on each can. Rather than following the required 1-to-1 ratio, Hodge “super-diluted” the formula, according to court records, mixing each can with an excessive amount of water. Hodge further admitted to feeding his son only 12 ounces a day—“woefully inadequate” for an infant, said June Jeffries, an assistant U.S. attorney. Shawn’s cries went ignored, she reported, because Hodge did not want to spoil him.

Though it is impossible to predict with certainty which new parents are most likely to abuse or neglect a child, there are factors that researchers have identified as increasing a child’s risk of maltreatment.

According to a 1995 report by the U.S. Department of Health and Human Services, “[t]he average abusive parent is in his or her mid-20s, lives near or below the poverty level, often has not finished high school, is depressed and unable to cope with stress and has experienced violence first hand.”

During two psychiatric evaluations, conducted in 2001 and 2004, write-ups of which were included in the court files, Price denied ever being maltreated as a child but said both of her parents abused drugs and alcohol. She described her childhood as “boring” and said she did not have any good memories of

growing up—although she also said her father was “fun.”

She completed 10th grade and dropped out the next year, when she gave birth to Tony. She received average grades even though she reads at the kindergarten level and measured at the top of the “extremely low” range in

IQ tests.

Price said in an evaluation that she loves Hodge “like my brother” and wants to marry him, but McKee believes there is another side to the relationship, on the basis of his interviews with acquaintances and family members. “Kim never wanted to talk about it,” he says, “but there is information that he was somewhat physically abusive.” Price and Hodge declined to comment for this article, as did Hodge’s lawyer, Nancy Allen.

Hodge, who is reportedly of normal intelligence, never denied that Shawn was underweight. In court records, he is quoted as saying he just assumed his son would be a “thin person.” Price, meanwhile, may have been oblivious to the fact that her son was wasting away. According to McKee, she left the WIC nutritionist’s office “confused about whether she was feeding Shawn too much or too little.”

After the highly publicized beating death of 3-year-old Brianna Blackmond in January 2000—21 months before Shawn’s death—D.C. Mayor Anthony A. Williams was quoted in a Washington Post article as saying, “We must continue to learn from the death of this child as we work to rebuild the government agencies responsible for the care of our most vulnerable children and their families.”

Some improvements have been made, such as the creation of a family court. But the bureaucracy seems impervious to the kind of change required to reduce a high-risk-infant death rate that the nonprofit Center for the Study of Social Policy calls “alarming.” “Several systemic issues become heartbreakingly clear when you sit in on the [Child Fatality Review] Committee,” the center’s Clare Anderson said in a 2004 address to the D.C. Council. “Issues that are raised again and again but are never addressed.”

City leaders lauded the year Shawn died as a turning point for the District in infant mortality. Williams described the infant-mortality rate that year—10.6 deaths per 1,000 live births—as “the lowest ever in the city’s reported history.”

The rate that year had indeed declined substantially from 1989, when it peaked at 23.1 per 1,000—more than double the national rate of 9.8. What the city did not highlight was the infant-mortality rate in Southeast, where Shawn lived and where the majority of District children live. There, the rate in 2001 was 18.4 deaths per 1,000 live births, an increase from 17.6 deaths the year before.

The city can point to some successes in infant health. But despite improvements in providing access to prenatal care and reducing preterm deliveries, the District continues to rank among the bottom 10 of the nation’s 50 largest cities on four of eight measures for a healthy start in life, according to a 2005 study by the nonprofit D.C. Children’s Trust Fund and the Annie E. Casey Foundation. And since 2001, the number of District children living in poverty has increased by nearly 8 percent, according to the fund.

These problems are a direct cause of infant death. Dr. Michael Durfee, a child psychiatrist and senior adviser to the National Committee on Child Fatality Review, explains, “What

we find is that poverty, violence, substance abuse, social isolation, economic stress—all those factors that can screw up a pregnancy are the same things that make [infant] homicide more frequent.”

Durfee claims that even though most infant deaths are officially due to natural causes, there are cases in which a child’s living conditions may contribute to his death, although not to the extent where the death could be ruled a homicide. “Common sense would tell you it was neglect,” he says.

But in Shawn’s case, proving criminal conduct wasn’t a tough job. Here is an excerpt from the committee’s annual report for 2001 and 2002:

On a fall morning in 2001 a [20-year-old] mother discovered her 7-week-old child cold and unresponsive in his crib. She took him to a family member’s house where she called 911. Medics found the child without a pulse and unresponsive; he was intubated and CPR was initiated while being transported to a hospital. Despite resuscitation efforts, the infant was pronounced dead at 11 a.m. Hospital records indicated that the infant was severely emaciated. Based on interviews with the mother, she indicated that between 7 p.m. and 9 a.m. she fed and changed the infant three times and after his 9 a.m. feeding, she checked on him, kissed his arm, noticing movement, and covered him while he slept in his crib. She checked on him several additional times and found him in the same position. When she attempted to awaken him for his feeding she noticed he was cold and unresponsive. She removed his sock and plucked his foot to arouse him with no change. She changed his diaper and his clothes and went to get assistance.

Shawn’s autopsy sheds further light on his final days.

According to Dr. Eli Newberger of Harvard Medical School, Shawn’s stomach was empty when he arrived by ambulance at Greater Southeast Community, and his body temperature was 81.7 degrees, “showing that he had lain unattended for some time.”

There was an absence of subcutaneous fat, “and the weights of his vital organs were sharply reduced from their normal ranges….Artifacts of neglect were also evident in the dirt and fecal encrustation of the skin.”

Hodge and Price had two more children by the time they pleaded guilty in September 2004 to involuntary manslaughter. These children, along with young Tony, are in foster care, and both parents have been sent to prison, Hodge for 42 months and Price for 50. But neither parent has accepted responsibility for Shawn’s starvation. When asked about his son, Hodge reportedly told a community-supervision officer he “often wonders” what he could have done differently—as if, according to the prosecutor, “there is some mystery as to why this child died.”

Price, meanwhile, is quoted in a psychiatric evaluation as saying that she feels “sad because I lost my son…but I know he’s in a better place.” When asked the cause of Shawn’s death, she replied, “They still haven’t told me.” While in prison, Price gave birth to her fifth child earlier this year, at age 23. This child has also been placed in foster care.

According to one of the psychiatric reports, Price apparently feels unaccepted by the other inmates and would like to “get on with her life.” She said she “loves caring for children” and would like to work at a day-care center. McKee is trying to get her sentence reduced. In an April 20, 2005, motion to the court,

he stated that a reduction is justified given Price’s mental state, her poor parenting

skills, and “the principle of fairness and justice since her role as a mother makes her no more culpable than the father for the death of their child.”

McKee also noted that Shawn showed no evidence of bruises, broken bones, sores, lice, or other signs of physical abuse.

Indeed, Shawn’s injuries were internal. “[Shawn] suffered the pains of hunger and dehydration—and infants do experience pain,” according to Newberger. “The word ‘neglect’ does not nearly sufficiently characterize the atrocity of his starvation.”CP

Art accompanying story in the printed newspaper is not available in this archive: Illustrations by Greg Houston.