BETHEL -- Two years ago, a sickly baby from Bethel was placed in an Anchorage foster home. One day, just as the foster family was preparing for his return to Bethel, the baby was laid face down on a pillow-top mattress. There, according to a wrongful death lawsuit, he suffocated.
This summer, the state paid $500,000 to the family of the child, identified only as J.K. in the lawsuit.
The civil lawsuit and its resolution come just as the state is putting renewed attention on the disturbing -- and preventable -- problem of infant sleep deaths.
In the case of J.K., the Office of Children's Services placed a fragile baby with a foster mother who, according to the events described in the suit, failed to follow well-established public health protocols.
A national "Back to Sleep" campaign began in 1994 to urge parents to put babies to sleep on their backs, to prevent sudden infant death syndrome. Public health officials have been refining that message for years. The state foster care handbook includes that message.
The state wasn't named as a defendant in the suit against foster mother Patricia Abell, but has a responsibility to defend foster parents, according to Cori Mills, an assistant attorney general and spokesperson for the Department of Law.
Efforts to reach Abell were unsuccessful. The attorney general's office, which represented her, passed along a message to her from a reporter. She didn't respond.
A lawyer for the baby's family said the state is responsible when foster parents make mistakes.
A fragile baby
J.K. was born healthy in January 2013. As a newborn, he caught a cold that developed into respiratory distress, the family's attorney, Myron Angstman of Bethel, said. He was hospitalized at the Yukon-Kuskokwim Health Corp., the Native-run hospital in Bethel, then released to his parents, according to the suit filed in 2014 by Angstman.
But the baby's conditioned worsened. He ended up in the Bethel emergency room, then was flown to Alaska Native Medical Center in Anchorage for more advanced care, the suit said. He was intubated and placed on a ventilator, Angstman said. For about three weeks in early 2013, the little boy was hospitalized in Anchorage. Days after he was admitted, his parents were told he was in critical condition, the lawyer said.
Then he improved. On March 11 of that year, he was discharged. He needed close monitoring as an outpatient, the suit said.
The Office of Children's Services took custody of him. The reasons are unexplained in the lawsuit.
Angstman, one of the attorneys for the child's parents, brother and grandmother, said he wasn't at liberty to discuss any troubles in the home. The lawsuit did not concern whether it was necessary for OCS to take custody, he said.
Patricia and Chad Abell were state-licensed foster parents responsible for providing emergency care for the baby, the suit said. They first became approved for foster care in September 2010, according to Travis Erickson, operations manager for the Office of Children's Services.
On April 1, 2013, J.K. was supposed to return to Bethel. Early that morning, Chad fed him a bottle and Patricia burped him. Then the foster mother put J.K. on his stomach, on her bed, the suit said.
"Patricia's mattress had a pillow-top, making this a very soft surface," the document said.
She left the baby alone while she did other things. When she returned to the room, the suit said she found him "still face down on the mattress, but unresponsive."
She put him on the floor and started CPR. At 8:08 a.m., someone called 911. Medics arrived seven minutes later and kept up efforts to save the baby while rushing him to Providence Alaska Medical Center. About 40 minutes after the 911 call, J.K. was declared dead at the Anchorage hospital.
"The medical examiner determined from the scene investigation, autopsy, and a doll reenactment that the cause of death was suffocation and the manner of death was accidental," the suit said.
In Bethel at the Office of Children's Services, the parents were told of their baby's death. They asked to go to Anchorage to see him, but the suit said they were told there wasn't public money for that. Later, the child's body was returned to Bethel.
Duty to provide care
The foster mother "owed a duty of reasonable care" to J.K.'s family, the lawsuit said. Abell either lacked skill or knowledge, or otherwise failed to exercise that care, said the complaint.
In July, the state paid $500,000 on behalf of the foster mother to settle the lawsuit over J.K.'s death, Mills said in an email. Abell didn't admit any liability, nor did the state, which wasn't a defendant, she said. The suit was dismissed earlier this month. The baby's family was represented by Angstman and Anchorage attorney John Cashion.
Public health experts say it is well established that babies should be put to sleep on their backs -- a message officials have been pushing in Alaska for years.
Almost all sleep-related baby deaths are preventable, researchers have found. Sometimes the baby dies while sleeping with an adult. Sometimes the adult is intoxicated, or sleeping heavily because of medication. And sometimes, the sleeping space is just wrong.
The Abells had a crib, which is required for foster parents who take in infants, Erickson of OCS said on Friday. Licensing workers go over the requirements when someone first becomes a foster parent, he said. The foster parent handbook includes some information, including that babies need to be in cribs or bassinets, without soft pillows. It says pediatricians now advise that babies be placed on their backs for sleeping to minimize the risk of sudden infant death syndrome.
Still, the latest public education campaign on safe sleeping for babies was not yet fully in place at the time of J.K.'s death in early 2013.
In addition, foster parent core training then did not specifically cover how to put an infant to sleep, Erickson said.
At some point in 2013, the state Division of Public Health began distributing brochures and posters to hospitals that said babies are safest when they sleep alone, on their backs, in a crib -- the "A-B-C" message. Babies need a firm surface, the materials said.
"When baby is sleeping someplace other than a safety-approved crib, remember to give them lots of room to breathe!" the brochure said.
A troubling spike
In Alaska on average, two babies die a month "in a sleep environment," on their belly or their side, in soft bedding, in a shared sleeping space or in an otherwise risky setting, according to state epidemiologists.
Then in July 2014, seven Alaska babies died in sleep-related circumstances -- a serious spike. That triggered an in-depth investigation of infant sleep-related deaths that occurred from 2012 to 2014 and new attention to the problem.
State child protection and licensing workers for the past year have been handing out brochures on safe sleeping to families and foster homes, Erickson said. Before that, handouts on sleeping were available, but not systematically distributed.
"This information has been out there. We are just trying to elevate it," he said.
This June, the Division of Public Health published a bulletin about the deaths that urged health providers to reinforce a safe sleep message with families.
On Friday, Erickson found out the core foster parent training didn't specifically address safe sleeping and said he directed it be added.
"They haven't been getting it in core, in the past. And they will, starting immediately," he said.
The Abells no longer are Alaska foster parents, he said.
The Bethel family didn't want to talk about the loss of the baby in a place that was supposed to keep him safe.
"They have had their troubles," Angstman said. "There are family issues that are being addressed."
Maybe, he said, the settlement will help them do that.