Privacy vs. Protection : Child Abuse: Dilemma of Prevention

There was a time not that long ago when few people would have listened to Michael Hall’s outburst at Broadlawns Medical Center here.

Hall, after all, was a patient in Broadlawns’ psychiatric ward, involuntarily committed, and he seemed obsessed. Here was a short, loud man of 31 years, with long brown hair reaching to his shoulders, telling everyone that his wife, Joan, had yanked their infant son by the arms.

Investigators and doctors in the following days found no evidence of abuse or physical harm to the child. Michael Lee Hall appeared to be healthy and happy. A judge concluded that the arm-yanking never happened.

All the same, Polk County authorities with an emergency court order removed the 2-month-old boy from the Halls’ home last July. On Nov. 2, a juvenile court judged the baby to be a child in need of assistance and placed him in a foster home.

Took Precautionary Action

Authorities acted not because they believed the baby had been abused, but because they feared he would be harmed in the future.

The Hall case reflects the changing times in the contentious, uncertain world of child protection. Most child abuse stories, such as the much-publicized death of 6-year-old Elizabeth Steinberg in New York, are sadly familiar and horrific, full of people and systems that failed to protect a battered child. The Halls’ situation is far less familiar to the public, but no longer uncommon. This is the story of a county that chose to take the risk of acting too soon rather than risk being too late.

The Polk County authorities relied on more than gut instinct. They turned to the techniques of statistical risk-factor analysis, apparently for the first time in such a setting. By matching his parents’ characters and backgrounds with the findings of scholarly studies, they decided that Michael Lee Hall faced a precise 40% chance of being abused within the next five years.

‘The Prediction Game’

“Once the government gets into the business of protecting, there is no alternative but to get involved in the prediction game, whether you like it or not,” said Randall Wilson, the Iowa Civil Liberties Union attorney who represented Michael Lee Hall.

Such an impulse to protect children, however, comes with a price.

Bruises and broken bones can be seen, after all, but potential risk must be divined. Mothers and fathers come with all sorts of stripes, many not so attractive. When should authorities intervene, and how to decide? What is the threshold of risk? Is it to be judged by gut instinct or statistics or cultural sensibilities? Are the alternative foster homes any better than the natural parents’?

Public officials are finding that they must choose, in an uncertain arena, what type of mistake they would rather make. Trade-offs accompany any decision.

Public officials have always balanced the obligation to protect children against the right of families to be left alone. The balancing act shifts regularly with public opinion and the law. Parental rights groups such as Victims of Child Abuse Laws in recent years have gained considerable clout. Just now, though, pressures of another sort are leading government agencies to ever-greater intrusion into the private affairs of families.

“There are two extremely important laws here, child protection versus family privacy,” said William Ketch, an Iowa Department of Human Services district administrator. “The public doesn’t want authorities busting in on families, but the public also doesn’t want kids hurt. The pendulum swings on this. It depends on how the public feels. . . . I think this Hall case was a turning point.”

If it was a turning point, the Hall case may be leading policy makers up a complicated path. An even broader issue lurks, unspoken but implicit, beyond the immediate decision to take Michael Lee Hall from his mother and father.

Past Antisocial Acts

The Halls are not a terribly winning couple. Joan Hall served time in prison for voluntary manslaughter after she was charged with delivering a blow that killed a daughter in 1982. Doctors and caseworkers say that both Halls have antisocial personality disorders regarded as untreatable and unlikely to change.

If government agencies are going to remove children on the basis of potential for abuse, will they seize newborns from all parents who are innately, chronically at high risk?

“We haven’t gotten there,” said Larry Eisenhauer, the Polk County juvenile court judge who ordered the Halls’ son removed from his home. “We work under the assumption everything can be remedied. But I know it’s coming.”

A Polk County sheriff’s deputy brought Mike Hall to the Broadlawns psychiatric ward early in the evening of July 5. After consuming almost a case of beer, Hall had fought with his wife, waved a knife, cut his own chest and then hurled the blade into the floor. Joan Hall and a neighbor had signed the emergency commitment papers.

While he was being lead away, Hall told his wife: “If I can’t have the baby, you’re not going to have him.”

When Toni Brown, an in-patient social worker with the Broadlawns psychiatric unit, met Hall the next morning, she found him obsessed with the topic of his wife’s care of their son.

He said Joan had yanked the baby’s arms. He did not feel either he or Joan could care for their son. The infant, he said, should be placed in a foster home.

Just a handful of years ago, the Halls’ unfortunate lives would have remained a matter for them to endure in private. This is no longer so.

New Protection Laws

By the middle of this decade, Iowa and many other states were seeing unprecedented numbers of abuse cases and a huge increase in demand for treatment services. The Iowa government responded with all sorts of programs--child protective investigative units, focus committees, task forces.

Public support for this type of intervention has grown in the aftermath of several horrifying, much-publicized reports of battered children’s deaths.

State legislatures have been drafting laws that encourage social workers to intervene before harm is inflicted, whenever they perceive a risk. Agencies that don’t intervene quickly enough are finding themselves on the receiving end of million-dollar lawsuits.

“If this same case came up five years ago,” said human services administrator Ketch, “the baby might have been removed, but if so, it would have been the work of one lonely social worker fighting a bunch of lawyers.”

It being 1988, the Halls instead encountered a multidisciplinary government team that was remarkable for its speed and depth.

At 9:02 p.m. on July 5, an on-call social worker logged Broadlawns Medical Center’s referral of Mike Hall’s child abuse report. By 10:30 the next morning, child protective investigator Phyliss Franklin had the case. By 10:45 a.m., she had checked the state’s central registry for any record of past allegations against Joan Hall. By 11 a.m., she was at the Halls’ front door.

No one was home. Franklin left a card, asking the Halls to contact her.

At 9:30 the next morning, Franklin found Joan Hall in her apartment with the baby. Here was a plain-looking woman of 28, a stocky 5 ft. 6 inches and 135 pounds, with round eyeglasses and a muted demeanor. She spoke quietly, with little expression. Methodically, she told Franklin her story.

Both she and Mike had come from small Midwest towns and broken homes. He finished the seventh grade; she completed high school. Mike Hall spent some months in a mental institution as a teen-ager. Neither had held a job for longer than six months. She had worked as a cook and waitress; he washed cars and dishes.

First Child Removed

In 1979, 18 and unmarried, Joan gave birth to a daughter, Christina. There were “pressures and problems,” she said. A string of abuse reports soon accumulated. Authorities finally placed Chrissy in a foster home when she was 7 months old. Two years later, though, the state returned Chrissy to her mother.

Joan by then was married and had a second daughter, Jessica. Her husband, she said, drank, abused her and resented Chrissy. Joan said she also boozed and did drugs in those days. She was speeding on uppers the night Chrissy died.

Chrissy had thrown up and wet her pants, Joan explained. So she had gotten angry, lost control and pushed Chrissy against a wall. Chrissy had fallen. She was just lying on the floor, her body moving funny. Joan had called her name but she hadn’t answered.

Joan pleaded guilty to voluntary manslaughter. A juvenile court judge terminated her right to keep Jessica.

In prison, she took classes for parents and visited a counselor weekly. After 3 1/2 years, the corrections department paroled Joan in January of 1987, releasing her to a Des Moines drug and alcohol treatment facility called IAUP.

Drug-Treatment Romance

That’s where she met Mike Hall. He arrived at IAUP the same month, also through a court order. He had a wife and child somewhere in his past, Joan said, but he had been living for several years in his parents’ basement, unemployed, selling blood to a plasma center twice a week for money to buy alcohol and drugs. While in a drunken state in mid-January, he had tried to hang himself in the basement with an electrical cord.

Joan and Mike got married in April and left the program, against their counselors’ wishes.

Hall had an explosive temper along with his taste for alcohol and drugs. He and Joan separated four times in their first months together. He sometimes bruised her and once bit her.

They were separated in early August, when Joan learned she was pregnant. She called Hall and talked about the idea of an abortion. They weighed alternatives. Hall moved back into the apartment.

“We had wanted to have a baby but not quite that soon,” Joan Hall said, “but we were happy about it.”

Michael Lee Hall was born May 18, 1988. Two weeks later, the proud parents appeared on the doorstep of their alma mater, the IAUP center, to show the counselors their new baby.

Continued Domestic Spats

Hall has continued to fight with her, Joan said. That’s why she committed him to Broadlawns. But he has never physically harmed the baby.

Phyliss Franklin looked about her when Joan finished her story. She was a hard-nosed veteran in what is regarded as a burn-out position. Her experience had seasoned her attitudes. She saw what she considered to be an extremely clean apartment, adequately furnished. The baby, Michael Lee, was clean and appeared very healthy. The interaction between mother and child appeared most appropriate. Joan Hall was tender and comforting to the baby when he fussed.

All the same, Franklin felt concern. In the following days, she made a number of calls.

She phoned the Halls’ pediatrician. The doctor said the baby always seemed clean and healthy, the mother’s behavior appropriate and caring. Recent X-rays showed the boy had no hidden fractures.

Franklin interviewed the Halls’ neighbors. They considered Joan a loving and attentive mother. They regularly saw the baby nestled in her arms, appearing healthy and happy. They sometimes left their own children with Joan.

The neighbors, however, could not be as encouraging about Mike Hall. He would rant and rave at Joan while she cradled their baby in her arms. He would just “go off,” the neighbors said, staring into space and losing control.

Neighbors Intervened

Sometimes Joan would retreat to a neighbor’s apartment with the baby in her arms. Sometimes neighbors would come out and intervene. Sometimes neighbors would take the baby to their apartments. The police showed up often.

Franklin could take some comfort in noting that Mike Hall, at least, was no longer in the home. That, however, soon changed.

Three days after he was committed to Broadlawns, Hall faced a hospital hearing. Dr. Karl Northwall diagnosed alcohol abuse, marijuana abuse and an antisocial personality disorder--but no psychotic disorder.

Hall presented a danger to others when drunk, but so did many others. Hall got drunk a lot, but so did many others. Northwall figured he couldn’t lock them all up. On July 8, Broadlawns released Hall.

Eight days after the Broadlawns commitment, the Halls were back together. Hall was saying he had made up the arm-yanking story.

When Franklin made an unannounced visit one day, Hall was less than pleased with her involvement in their lives. His body and hands started shaking. His eyes appeared to Franklin to change color and focus. He yelled, full of rage.

He would do the talking, he said. He would tell them what he would allow and not allow. He had no problem with someone coming to check on his baby, as long as it didn’t get to be too much. He did not want anyone telling him what he had to do or how to live in his own home. If it got to be too much, he would take his wife and child and leave the state and they would never find him.

Franklin, retreating in alarm, had much to consider.

The Halls’ lives were a sorry mess, but in this they were far from alone. If government agencies removed babies from every house where the parents fought and abused alcohol and drugs, they would need millions of foster homes.

On the other hand, all the ingredients in the death of Joan’s daughter Chrissy seemed to be in place again: an abusive and addicted husband, violent fighting between the parents, alcohol and drugs, money problems, isolation from family or community support, an infant going through the stages of soiling his pants and spitting up.

Which kind of gamble should the state take?

Traumatic Experience

The civil rights of parents, a sense of fairness and the drive to keep families together create pressure of one sort. Removing a child is a traumatic experience for all concerned, especially for infants in critical stages of bonding. Finding a better alternative is highly problematic, given an acute national shortage of adequate foster homes.

Parental rights groups do not hesitate to speak out. They complain that cultural biases often guide state agencies, leading them to move most frequently against the poor, the uneducated and the unconventional.

“This woman (Joan Hall) has paid her debt to society,” said Kelvin Robinson, Iowa coordinator for Victims of Child Abuse Laws. “It is a civil rights issue.”

The arguments offered by mothers deprived of their children also can be affecting.

“It’s pretty discriminating to act before even giving a human being a chance,” Joan Hall said. “We never abused our baby. He is our child. He needs to grow up in our family. I feel like I’m on trial again for what happened to Chrissy in 1982. I’ve served time for that. The sentence didn’t say I couldn’t have other children. . . . Nobody said I could never have kids again.”

The prospect of a child being harmed, on the other hand, exerts a different type of pressure. Caseworkers and judicial officers have seen enough brain-dead children and cocaine-addicted infants to shake even the most deeply felt liberal political tenets. The benefit of the doubt, they end up thinking, should go to the child.

Mistakes and Heroism

“You lie awake at night and say, ‘Oh, I hope I did the right thing,’ human services bureau chief John Fairweather said. “If we take a kid out because of imminent danger, we’re accused of busting up a family. If we leave a kid home, everybody thinks we don’t care. . . . The truth is, not a day goes by we don’t make terrible mistakes and also commit heroic acts.”

To complicate matters further, another, more particular pressure emerged in the Hall case. During her investigation, Franklin learned that a million-dollar lawsuit was pending against the Iowa Department of Human Services, filed years ago by Chrissy’s paternal grandparents. The suit charged the state agency with negligence in Chrissy’s death, with failing to protect the child from Joan.

The lawsuit, as it happened, was due to come to trial within weeks. What’s more, the Des Moines Register newspaper, because of the lawsuit, was planning to publish a three-part anatomy of Chrissy’s death.

Public agencies are starting to see a scattering of such lawsuits, and they dread the prospect of more. These suits argue that the agencies have a legal duty to intervene in dangerous situations. Failing to intervene, they contend, violates the child’s constitutional rights. Lower courts have been divided on the question. The U. S. Supreme Court this session will consider one such case, DeShaney vs. Winnebago County (Iowa).

System Moves Swiftly

Whatever the mix of reasons, the Polk County system in mid-July began to move decisively against the Halls. The human services supervisors were briefed, meetings held, prosecutors and juvenile court officials consulted.

On July 26, a special Polk County multidisciplinary team of experts unanimously recommended immediate removal of the baby. At 3:30 p.m., the agency obtained a court order.

At 5 p.m., as Joan sat in a living room rocking chair feeding Michael Lee, the Halls heard a knock. Mike Hall opened the door to four people--two uniformed police officers, another in plain clothes and a woman, Candace Bennett, from the juvenile court. The man in plain clothes handed Mike the documents.

“We have an order for the removal of your son,” he said.

Joan started crying. She clutched hard at her baby. Candy Bennett reached down to take the infant.

At noon two days later, the Hall case came before yet another Polk County advisory body, a group of doctors called the pediatric consultation team. Their task normally is to judge whether a child has been abused, and in what manner. The Hall case was the first in which they were asked to consider the risk to a child who had not yet been harmed.

“We needed some way to show the risk,” said Dr. Rizwan Shah. “We needed a scientific way to make the judgment.”

The doctors found what they needed in a recent edition of the journal “Child Abuse and Neglect.” A team of physicians had studied 45 abusive parents in a large urban medical center’s child abuse program. The study matched them against 22 variable factors bearing on repeated abuse.

The Halls’ profiles were full of those factors. The risk of child abuse occurring in a family such as theirs ranged between 16% and 66%, the report said.

The Polk County pediatric consultants fixed the Halls’ number at 40%.

“In the old days,” said Wilson, the Iowa Civil Liberties Union attorney, “they might take away a child on instinct. Now we must prove it, have due process, base it on something, even if it is our myth. Statistics and risk calculations are what we use. I don’t think they are a myth, unless science is a myth. It’s what we rely on.”

Judge Eisenhauer presided over three hearings--one in August on whether to continue the emergency removal, a second in October to determine if Michael Lee Hall was a child in need of assistance, a third on Dec. 8 to decide where to place the baby.

The hearings unfolded in a small room on the fourth floor of the Polk County courthouse. Four lawyers ringed the conference table, representing the county attorney, the baby, Mike Hall and Joan Hall. Rob Garver and Tom McCann, the Halls’ attorneys, were both court-appointed.

The hearings demonstrated just how deeply government agencies now involve themselves in families’ private lives.

The Halls told the court they had spent the past weekend painting the baby’s bedroom. They had bought a dog. They had jobs now. They liked their jobs. They were renovating an upstairs apartment for the landlord in exchange for a free month’s rent.

What about baby expenses? Hall was asked. After all, their annual income was just $6,700, with both working part time at a minimum-wage job sorting mail for a private firm.

On the witness stand, Hall dutifully produced the family budget, scribbled on a wrinkled piece of paper. He stared at his budget.

“I can just stop drinking pop. I spend $30, $40 a week on pop. I don’t need that.”

Joan Hall took the stand. She, too, studied the budget. She spotted an item from the previous week’s expenses.

“We can get by without ordering that Domino’s pizza,” she said. “One pizza costs the same as a pack of 60 diapers. We don’t need pizza.”

The Halls’ lawyers, meanwhile, labored mightily to unravel the meaning of the risk factors that had been attached to their clients. They grilled the doctors.

“No, I cannot pick out who will abuse and who will not,” allowed Dr. Fred Aldrich of the pediatric consultation team. “I can say you have a high or higher likelihood of abusing. I cannot say this person will re-abuse. If I could, I would not be here. I would be saying sooths.”

Garver and McCann were beside themselves. Risk factor analysis seemed quite an ephemeral tool to use against their clients. How did they get those figures? Above all, how could the figures be reduced so the Halls could get their baby back?

Defense Arguments

The Halls had modified their behavior since their baby was removed, their lawyers pointed out. They were living in a new, clean apartment with a room for the baby. They were attending Alcoholics Anonymous meetings and hadn’t had a drink in three months. They weren’t fighting.

Would that change the risk factor?

“No. . . . I can’t change my opinion,” Aldrich said. “That’s still the way I would see it.”

How could they reduce the risk? The lawyers pawed through their notes, as if looking for answers.

“But that 40% risk factor,” Garver sputtered. “It’s based on elements in the Halls’ past, elements that are not true today. . . .”

“Do you have a question?” the judge interrupted.

“I’m working on it,” Garver said.

He paced around the table, then sat down, staring at his notes.

“No further questions.”

Garver’s difficulty was understandable. He was, after all, fighting an invisible opponent. No one in the courtroom wanted to say what the hearing truly involved.

At the core of the Hall case sat an unspoken notion: Shouldn’t some people, a good number of people, just not be parents?

A Hard Question

A fair share of child protection officials, weighed down by what they see daily, flirt with this uncomfortable question privately, but most hesitate to face it publicly.

“That’s a hard question. . . . I don’t know there is an answer to that,” Dr. Shah of the pediatric consulting team said.

Instead, authorities talk of “due process” and of handling matters “case by case.” On the witness stand, the doctors said the Halls’ risk factor could be reduced but not eliminated by “long-term, multipart therapy.”

Such comments, however, are disingenuous. Authorities regard the Halls as high-risk simply because of who they are, and they are not considered likely to alter their basic natures.

Joan Hall carries a 10-year history of refusing and remaining impervious to all manner of counseling. She rejected three assistance programs and canceled half a dozen appointments with social workers in the weeks before Chrissy died. She has done much the same in recent months.

“Persons with (her) type of personality disorder are difficult to treat,” a psychiatrist wrote about Joan in 1984. “As a practical matter, significant alteration of this personality disorder . . . is unlikely to occur.”

Improvement Seen Unlikely

Concurring, Dr. Northwall said that Mike Hall’s antisocial personality disorder “is not ordinarily regarded as something to try to treat psychiatrically.”

Human services investigator Franklin wrote in her report’s conclusion: “It should be noted that this child, Michael Lee Hall, is at risk by the mere fact of his existence. Joan Hall places any child at risk by merely bringing them into the world.”

In truth, Polk County officials most likely would have taken Joan Hall’s baby at his birth if they had known she was pregnant, and they said as much privately. There was considerable muttering behind the scenes about the probation officer’s failure to inform the agency of Joan’s condition.

Judge Eisenhauer summoned the lawyers to his chambers midway through the October proceeding. Unless you’ve got something to show me, he said, don’t drag this out.

Eisenhauer, a judge limited to handling only juvenile cases for the last four years, had removed an unabused child from home only once before. He ordered a newborn removed at birth from a woman who had sexually abused her older child.

You’re saying my client can’t have kids, that mother’s lawyer had argued. Eisenhauer couldn’t refute that. It was true.

“The longer I’ve been doing this, the easier it is to do,” the judge said in chambers just before he made his ruling. “I came from a viewpoint of looking out for everyone’s rights, but the nature and severity of the abuses I’ve seen make it easier to rule on behalf of the child. . . . If the parent has injured children in the past, I’m not bothered much with the thought of removing them as soon as they spit them out.”

On Nov. 2, Eisenhauer found Michael Lee Hall to be a child in need of assistance. On Dec. 8, he ruled the baby should remain in foster care while the Halls once more underwent extensive counseling. If the counseling efforts again fail, the court could later terminate their parental rights.

That, at least for now, would seem to be the end of the Hall affair.

It may not be, however.

The Halls are thinking about having another baby.

Mike Hall says he wants one. Joan is not sure. She has had difficult deliveries, and worries that authorities will just take away a new baby.

The authorities say that if conditions remained the same, they would do just that. They would go back to square one and start the whole process over again.

“No, they won’t,” Mike Hall says, “because they won’t know where we are.”

Given all their problems, the Halls were asked one recent afternoon, why do they want children?

Mike Hall answered without hesitation.

“Because we’re not complete,” he said.

QUICK ACTION MAY 18, 1988--Michael Lee Hall is born. JULY 5--The father, Mike Hall, who is facing an emergency psychiatric commitment, tells a social worker that the infant had been abused by his wife. JULY 6--County authorities take the case and check the parents’ backgrounds. JULY 7--Investigators go to the Hall home. JULY 26--County recommends the child be removed from the home and gets a court order. JULY 28--County medical team determines that the Halls have a 40% risk of being abusers. AUGUST--Court orders continued foster care. NOV. 2--Court finds Michael Lee Hall a “child in need of assistance.” DEC. 8--Court rules that the baby will remain in foster care.