The Investigation of the Death of Maxim Kuzmin (Shatto)

Yulia Massino has called my attention to a report on the autopsy of Maxim Kuzmin (Shatto), the Russian-adopted three-year-old who died in Texas last January (http://www.oaoa.com/news/crime_justice/law_enforcement/article_53ef4076-9663-11e2-9e1b-0019bb30f31a.html). The autopsy report was released following a request under the Freedom of Information Act.

The report does not answer a great many significant questions, but it does clarify some points that have been made, denied, and then made again. It includes the fact that although Maxim showed a few bruises and scratches when first seen by a pediatrician in the U.S., at the time of his death from internal bleeding he had many bruises at different stages of healing. It also explains that the pediatrician had indeed prescribed an antipsychotic drug after concluding that Maxim was schizophrenic, and that Mr. and Mrs. Shatto, the adoptive parents, had stopped administering the drug three days before the child’s death, because it appeared to them that the medication made it difficult for Maxim to swallow.

The report also notes that Maxim had “breath-holding” incidents and had fallen off a chair after choking on a bite of cooked carrot. When Mrs. Shatto came out of the house and saw Maxim lying on the ground, she believed that he had “held his breath” and lost consciousness. According to the report, she grabbed and shook him while calling out his name. When this had no result, she grabbed him by the neck with both hands and shook hard until bubbles of blood came out of his mouth.

On the day of Maxim’s death, according to the report, he woke at a normal time in the morning but resisted Mrs. Shatto’s efforts to take him to the bathroom. According to her, he “had a fit” and went back to bed, where he remained until she woke him and his napping brother in mid-afternoon.

There is much to talk about here. An important unanswered question about this tragic story has to do with the diagnosis of schizophrenia and the treatment prescribed. Again, the report does not tell everything, and there may be a reasonable answer to this question--  but, are we to take it that the pediatrician made a diagnosis of schizophrenia (very rare in young children) on the basis of the parents’ comments alone? I certainly agree that parents know their children better than anyone else, but in the case of two months’ acquaintance with a child accustomed to a different language, even those who know him best may not know very much. A home visitor or other observer could have contributed much of importance to the diagnosis, for example whether any disturbing child behavior was related to adult actions or other events. Did the adoption agency (still unidentified as far as I know) not provide home visiting as part of post-adoption support? Did the physician not seek more objective evidence than the parents could provide?

Given the surprising diagnosis of schizophrenia, surely there must have been some uncertainty about both diagnosis and treatment. Were there any efforts at professional parent education and social support before medication was prescribed? When there is an unlikely diagnosis like schizophrenia, and when medication specifically approved for children does not exist, why was this treatment given without any attempts at less dangerous approaches? Or, were there other approaches taken, and these have not been included in the report because the right questions were not asked?

Side effects of antipsychotics (and of course we do not seem to know exactly which one was used here) include constipation, difficulty in urinating, and drowsiness. Maxim was reported as resisting toileting and being drowsy on the day of his death. He had been withdrawn, apparently abruptly, from the drug three days before. Did he have persisting effects from the drug? Or was the abrupt withdrawal in some way implicated in his death? Were the Shattos in touch with the prescribing doctor about side effects--  and did they discontinue the medication on their own decision, or did they have guidance in how to do this gradually?

A few weeks ago I commented on this blog that permission for adoption from abroad should be based in part on availability of a range of services that may be needed. The Shatto case exemplifies the problems I was talking about. As far as one can see from the report, their pediatrician not only prescribed in a possibly questionable way, but may have failed in his responsibility for parent education about the use of powerful drugs.

The adoption agency also appears to have failed in both post-adoption services like home visiting and in pre-adoption education. So far, it does not appear that the Shattos learned any Russian or any other means of communicating (like signing) with children who were likely to be language-delayed because of their care history. Mrs. Shatto appears to have misunderstood Maxim’s episodes of “breath-holding” which is an involuntary response to being startled or alarmed, sometimes seen in young children. (Falling off his chair when choking may have been an episode of this.) When she thought he was “holding his breath”, she shook him and shouted, responses which are neither necessary nor beneficial when a child has temporarily lost consciousness in this way. Why she subsequently seized him by the neck with both hands and shook him is incomprehensible except as the panic reaction of a person without the first-aid training that she should have received from the adoption agency.

Perhaps there was some sort of sexual abuse in Russia, as suggested, but if there was, it is hardly relevant except as a way of distracting from the central issues. Sexual abuse, repugnant though it is, does not cause schizophrenia or make young children injure themselves. My question about what happened in Russia is this: who decided that an older couple should take two young children, a year apart in age, and at developmental stages that require even more skill and attentiveness than are needed by infants? This is not the first time I’ve heard of this arrangement being encouraged, or even pressed, by Russian institutions, and permitted by U.S. adoption agencies who ought to know the difficulty being created for the naïve adoptive family.

Murder mysteries sometimes feature a situation in which each of many people contributes to a death, making it difficult to know who is to blame. Maxim’s death is similar, it would seem. A dozen people, perhaps, each made some contribution to the outcome. There is no point thinking of any of them as “a murderer”. But if Russians want to understand what happened, and if we in the U.S. want to keep adopted children safe, we need to know the whole truth and to answer all the questions I’ve posed here.