By KEVIN CROWE
Scripps Howard News Service

Even though Washington state is widely acknowledged as a pioneer in the investigation of sudden infant death, medical authorities there, like the rest of the nation, are struggling to get it right.

State lawmakers as early as 1963 wrote special rules increasing the number of autopsies performed when infants and young children died mysteriously. The state hosted a landmark international conference on Sudden Infant Death Syndrome in 1969, long before most Americans had heard the term.

Yet state officials have ordered a flurry of new procedures in recent years. Like most states, whether an infant death is diagnosed as SIDS, accidental asphyxiation or "unknown causes" varies widely from county to county in Washington.

Deborah Robinson: Deborah Robinson of Kirkland, Wash., an infant-death specialist with the SIDS Foundation of Washington, in a lab at the University of Washington, one of the nation's top centers for research on the causes of sudden unexplained infant death.Although they admit it is a gradual process, state authorities are working to standardize and improve the way first-responders start the investigation at the scene of an infant death, how they interview grief-stricken families and how pathologists complete the medical examination in the weeks and months that follow.

Poor infant-death-scene investigations can tie the hands of prosecutors trying to build a case against irresponsible or malicious caregivers, or prolong an already traumatic experience for parents or sitters who have done nothing wrong.

The first of the recent reforms came in 2001, when the state started reimbursing counties 100 percent for autopsies of children under the age of 3 years who die unexpectedly, but only if authorities do a scene investigation using approved protocols and have a forensic pathologist do the autopsy.

The extra money did prompt better investigations in some counties, officials said, but some scene and medical investigations continue to be sub-par.

"We know that not all of the investigations are being done at the same level of expertise," said Deborah Robinson, an infant-death specialist who works for the SIDS Foundation of Washington and is frequently called on to consult with child-death-review teams around the state. "And some of the autopsies have not been to standard, either."

Statistics show that years after the law changed, how an infant's death is classified can still depend on the county in which the child died, or the pathologist who led the medical investigation.

For example, from 2000 to 2003, Sudden Infant Death Syndrome accounted for 92 percent of the unexpected infant deaths in Kitsap County, a rate 40 percent higher than the national average, according to data reported to the federal Centers for Disease Control and Prevention.

In Thurston County, only 50 percent of unexpected deaths came from SIDS, a number slightly below the national average of 52 percent. Kitsap and Thurston have comparable populations and experience a similar number of sudden or unexpected infant deaths annually.

Last year, Washington also added new training protocols for first-responders who handle sudden or unexpected infant deaths. Patti Toth, a project manager for the state's Criminal Justice Training Commission, does much of the instruction on how to document the scene of an infant death.

"In that first hour or two (of investigation), they may miss something you can never re-create," she said.

Toth speaks from experience. While a deputy prosecutor in Snohomish County in 1986, her office felt the sting of a poor scene investigation.

An infant starved to death, an autopsy later showed, and signs of neglect were evident, even in the baby's crib.

The parents had been giving their child watered-down formula, Toth said.

Even though starvation was ruled the cause of death, the prosecution of the parents for neglect was hardly open-and-shut. The baby's bottles weren't collected as evidence, and when investigators returned days later to interview the parents and investigate the scene, the house had been cleaned.

"The cops were saying, 'Oh, jeez, we saw a bottle in the crib but we didn't take it,'" Toth said. "We had a huge uphill battle to try and make that case."

According to prosecutors, they may only have one shot at the witnesses, too.

One of the most difficult parts of investigating an infant death is interviewing the parents, other family members and the caregivers, said Lisa Johnson, who supervises the special assault unit of the King County prosecutor's office and is an advocate for statewide law-enforcement training on how to handle the scene of an infant death.

It's important to treat the area where the infant is found like a crime scene when it comes to gathering evidence, Toth said. "But you don't want to treat the people there like criminals."

Johnson said in King County, the investigations have gotten better. She's seen more guilty pleas from people charged in connection with infant deaths in recent years.

While encouraged by the progress, both Toth and Johnson said systemic changes are slow to take effect, and that there are no quick answers to some of the problems inherent in investigating infant deaths.

"I wouldn't expect a huge impact from the training (of first-responders) very soon," she said.