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.