The decision to determine maltreatment, (or not), was dependent on context included within a specific medical record regarding a doctor appointment day prior to child's death.   

It was learned that it took multiple contacts and a lot of persistence to receive the medical record needed. Investigations writes request via County Letterhead, including the statute which allows them access to medical records during an open CP investigation. The amount of time spent trying to access the records is somewhat how operations typically go between the hospital and child protection investigations, but this particular case it created significant concern due to the amount of time spent waiting on getting the information needed. The ME report typically takes 2-3 months to receive for child death cases and this occurred for this investigation.

The medical records department follows a strict procedure of releasing only exact date and clinic location where care received for an individual.  The information requested is included on County Letterhead, with the Statute allowing investigations access to the child's records. A release of information is not needed, but if specific date or location is not known where child received medical care, the information will not be included just by providing a child's name. It is not possible to request all records without including dates, so if there was a discrepancy in exact date, or an exact location where care was received, this becomes problematic. Ultimately, the decision to find maltreatment was delayed due to amount of time it took to obtain access to the specific medical record that was needed to inform preponderance of evidence to use in determining maltreatment.
Timeline: 
9/6/2017 -Consult occurred with upper management about next steps for the investigation and if preponderance of evidence met or not met. Need medical records to understand context of parents' awareness and education of risk to their infant.
9/7/2017- Requested medical records
9/12/2017 -Follow up call to medical records department. Request for records is being processed. Medical records department cannot fax medical records due to protected health information. They can mail them when ready. 
9/12/2017 – Collateral hospital social worker contact informs about a different clinic and resident provider who saw the subject child. Social worker could not release the record, but shared verbally the context of what education and directives were given to the caregivers by the doctor.  
10/2/2017 -Follow up call to medical records department. Medical records included 600+ pages of medical records information and were mailed on 9/21/2017. 
10/6/2017 – Receipt of 600+ pages of medical records information; Consultation with supervisor regarding medical documentation not including needed medical note from doctor appointment. New request sent back to medical records department at local hospital. 
10/13/2017 – Worker walk to local hospital and hand delivered a written request for medical note for subject child's doctor appointment that took place at the specific location on the specific date. The records personnel reported they do not provide documentation in hand, but was able to print off the medical notes and provided to the worker. Department was waiting on the medical notes from doctor appointment to determine whether to make maltreatment finding or not. It was dependent on what was included in the context of the medical appointment note.