News At 7 p.m. EDT
Sunday, April 30, 1995
   
   OAKLAND, Calif. (AP) -- The foster mother was worried. The
14-month-old girl placed in her care was perfectly toilet-trained,
practically unheard of at that age, and didn't crow and babble like
other babies.
 
   So she started to ask questions and eventually learned the child
wasn't 14 months old -- she was 2 1/2. And she wasn't just slow to
talk -- she was hearing-impaired.
 
   The case, encountered by workers at the Center for the Vulnerable
Child at Children's Hospital in Oakland, symbolizes much of what's
wrong with foster children's health care, child advocates say.
 
   These children start out sick, coming from a background of
neglect or worse, their medical records are spotty or missing, and
they are a population powerless to speak out.
 
   "Overall, the status of health care for kids in these placements
is ... abysmal," said William Grimm, a lawyer at the National Center
for Youth Law in San Francisco.
 
   "These kids do have a high incidence of emotional developmental
problems, they have a high incidence of asthma, they have a high
incidence of dental problems," he said. "All too often, the system
doesn't do much to improve that."
 
   A study of more than 200 children evaluated at the Oakland center
over a three-year period found 80 percent had medical or emotional
problems that often were overlooked by social workers and foster
parents. The study, published in the April issue of the Archives of
Pediatrics & Adolescent Medicine, also found asthma rates three
times the national average; stress is considered a likely trigger.
 
   A General Accounting Office study of California, New York and
Pennsylvania found that, in 1991, 58 percent of children in foster
care under the age of 3 had serious health problems, including AIDS,
fetal alcohol syndrome and low birthweight complications. The
numbers represented a 33 percent increase over 1986.
 
   The gaps in health delivery can be appalling. 
 
   Children are immunized over and over again because their records
keep getting lost. Babies may be handed over, screaming, in the
middle of the night to new foster parents who have no idea if the
infant is seriously ill or simply scared.
 
   Many of the children are coming from shocking privation. 
 
   San Francisco public health nurse Rebecca Carabez has seen
children used to getting their meals out of garbage cans. She has
looked into the mouths of 4-year-olds and found "just these little
black nubs," where milky white teeth should be.
 
   She recalls talking to the new foster parents of a 12-year-old
getting his first regular dental care.
 
   "We're going to have a hard time today," the parents told her,
"because he's going to have 10 teeth pulled."
 
   And diagnosing the problem is only half the battle. Physicians
   are understandably reluctant to take on foster children who tend
   to have big problems, missing records and the built-in hassle of
   wresting payment out of the government. Even when everything
   works right -- the medical history is re-created, a provider is
   found -- it may all be for nothing as the child is whisked off to
   a new placement and the process begins all over again.
 
   "There are a lot of very good people that do some good things for
these kids locally, but overall ... the state and counties are
oftentimes lacking as the best of parents," said Frank Sanchez,
chief of the state Department of Social Services' foster care
branch.
 
   Cases in point: 
 
   --In Southern California, 3-year-old Tanya's front teeth were
knocked out in a stickball accident. Tanya, not her real name,
needed a space maintainer to allow her permanent teeth to grow in
and prevent speech impairment. But it took months and the
intervention of attorneys from The Alliance For Children's Rights in
Los Angeles to get treatment.
 
  --In Utah, 12-year-old Kenny's teeth stuck out so far he could not
close his mouth. Food dribbled out when he tried to chew. But he did
not get treatment until a lawsuit was filed by the Center for Youth
Law on behalf of Kenny and several other foster children.
 
   There have been little victories. Carabez, who works with the
Child Health and Disability Prevention Program, was able to arrange
regular dental care for foster children and organized a conference
on the issue of foster child health care. But she admits things are
far from fixed.
 
   "This is an overwhelmed system," she said. "It's really a crisis
of what's happening with children."
--- DB 1.58/004358
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