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DN editorial: Bureaucratic morass killed a 10-year-old boy

THERE IS a long list of adults who failed Ethan Okula, the 10-year-old foster child who died earlier this year because of an obstructed bowel, misdiagnosed as a stomachache.

THERE IS a long list of adults who failed Ethan Okula, the 10-year-old foster child who died earlier this year because of an obstructed bowel, misdiagnosed as a stomachache.

At the top has to be the boy's father, who regularly beat Ethan and his brother and promised to beat them again if he had the chance. That's when Ethan entered the city's foster-care system.

Also on the list is one of his early foster mothers who threw him out on the street when she grew tired of caring for the boy, who had a number of health issues stemming from his premature birth.

On the face of it, Ethan entered the foster-care system at a good time. The 2006 death of Danieal Kelly, who was starved to death by her mother, resulted in creation of a panel to look into how the Department of Human Services handled its job.

The panel recommended - and Mayor Nutter agreed to - a number of steps that, in effect, took DHS out of the business of managing foster-care cases and put it into the hands of non-profit agencies based in the community. The panel also recommended that caseloads be capped at 10 per caseworker.

The recommendations were put into effect, but money was short, and the change coincided with a surge in the number of foster-care placements.

As Inquirer columnist Mike Newall first reported, Ethan's fateful day came on Feb. 10 when he fell ill while attending classes at Julia De Burgos Elementary School. His stomach hurt so much, he could not stand up straight. A classroom aide sent him to the school nurse, who did not detect anything out of the ordinary, though Ethan vomited several times and defecated in his own clothing while in the nurse's office.

A report later said that, had the nurse more carefully inspected the boy, she would have discovered scars on his stomach, evidence of earlier surgery, and a signal that more than an upset stomach could be involved. In this case, an obstructed bowel.

Why the boy wasn't shipped off to the hospital from school is not clear. And why a friend of his foster mother, who picked Ethan up, did not drive him to an emergency room is another mystery. By the time his foster mother came home from work, Ethan was lying on the couch, clearly in distress. An ambulance was called, but it was too late. He died in the hospital that evening.

The usual bureaucratic post-mortems are underway. The school nurse has been suspended by the school district with intent to dismiss. The foster mother has had her certificate pulled. Last week, investigators found that the agency that was overseeing Ethan's case falsified its reports to indicate that caseworkers had a meeting with Ethan and his foster mother in December. Four caseworkers have been fired.

Clearly, we need more caseworkers - and DHS has said it will hire up to 100. We also need to follow the 10-case-per worker cap.Better training for foster parents, when it comes to medical and behavioral issues, would also help.

But while these piecemeal fixes might prevent another story like Ethan's in the short term, obviously more is needed. We have to acknowledge that if even one piece of the larger interconnected system designed to help the city's most vulnerable children is broken, the whole system fails. It's really time to rethink the system.

The price of failure is a child's life. Why do we seem willing to keep paying that price?