The family of a boy who died of multiple skull fractures had been reported 25 times to the Department of Children and Family Services and the mother had a known history of methamphetamine use. In other families, children died within months or even one day after a social worker's last visit.
The records, which included previously confidential family services and police reports, medical charts and other documents, were obtained by The Times through a California Public Records Act request and provide the first comprehensive snapshot of child fatalities countywide.
A new state law that took effect last year loosened the confidentiality requirements that had kept most such information from public view.
All told, the records show, 32 children in the county died in 2008 from abuse and neglect, including physical assault, drowning and malnourishment. Eighteen of the children were in families that had never been in contact with the family services agency.
But the other 14 families should have been well-known to child welfare officials, based on previous referrals and investigations. For whatever reasons, many of the earlier allegations were not substantiated.
In 10 of those cases, the agency has launched investigations that will probably result in discipline against social workers, agency officials said.
"These are shocking cases," said county Supervisor Gloria Molina, who contends that disciplinary and training procedures need to be dramatically improved in the department. "The biggest problem is that no lessons are learned."
Agency officials say they lack adequate resources to handle daunting caseloads.
The heavily redacted files paint a horrific picture of the circumstances in which the children died. Among the cases:
* A 1-year-old girl who was left alone with her mother last March, despite a court order requiring monitored visits. The girl had fallen down the stairs and hit her head, her mother told authorities, explaining that she gave the girl an ice pack, put her to bed and went back to doing the laundry.
Only three hours later, when the child's grandmother returned, did the family realize that she was unconscious. Doctors found the scenario described by the mother as "highly unlikely," concluding the girl had died of blunt force trauma "consistent with being thrown or slammed against a hard surface."
Child welfare records show the mother had history of neglect.
* Another 1-year-old girl who died May 8 after a babysitter allegedly punished her for jumping on the bed. The sitter allegedly knocked the girl's feet out from under her and slammed her head against a dresser, according to police.
Family Services had received 11 complaints to the child abuse hotline related to the baby's family. One call occurred four months before the child's death, when her 18-year-old mother was arrested for petty theft.
Police at the time discovered extensive "unexplained injuries" on the infant, including "dirty and pink eyes" and rashes on her buttocks that were "almost bleeding."
Still, social workers determined that the allegation of general neglect was "inconclusive." The child remained with her mother after a social worker overruled a computer-generated recommendation that stronger action be taken.
* An 18-month-old boy who was found breathing but unconscious last May. His mother's boyfriend told them that the child had choked on a penny. When patting the boy's back didn't dislodge it, the man told medics and a sheriff's deputy, he tried to perform the Heimlich maneuver on him.
At the hospital, however, tests revealed that the boy had suffered hemorrhaging on the right side of his brain, an injury that was "indicative of shaken baby syndrome," records show. He was declared brain-dead two days later. Caseworkers had previously substantiated allegations of emotional abuse and "caretaker absence."