Pope County child protection workers violated state law and missed numerous chances to intervene on behalf of 4-year-old Eric Dean before he was murdered by his stepmother in 2013, according to findings from a state child mortality report released Friday.

The mortality panel detailed failures not only by the county but also by the state, for endorsing child protection practices that ultimately failed Eric. The panel recommended that the Minnesota Department of Human Services (DHS) and the Legislature implement significant reforms to the system, including mandating an investigation whenever a child under age 6 is abused.

A child protection task force formed by Gov. Mark Dayton last year already taken up many of those recommendations and reviewed the report on Eric’s case at a meeting Friday.

“I think it’s really important to read this because the governor called us together because of this little boy’s death,” said Kathleen Blatz, a task force member and former chief justice of the Minnesota Supreme Court. “He died too early, and he died tragically, but if we can respond to these failures and improve the system … he will have done more in his little life than perhaps most of us will have accomplished in ours.”

The multiple problems documented by the state’s mortality report are a stark contrast to Pope County’s own review of the case last year, which did not identify any failures in how its child protection workers handled Eric’s case.Nevertheless, the county has changed its child protection practices, said Nicole Names, Pope County human services director. “In a lot of ways Pope County has taken significant steps toward practices that meet the recommendations outlined in the review,” Names said Friday. Among the changes, Names said the county now provides all abuse reports to police, will not close cases when children are at high risk for more abuse, and will consult with police and the county attorney on difficult cases.The state mortality panel — made up of law enforcement officers, health care professionals and DHS administrators — is charged with reviewing child abuse deaths and near-fatalities and making recommendations on how to prevent future cases. The report is the most comprehensive to come from the panel, which itself has come under criticism for operating in virtual secrecy and failing to stem patterns of child abuse deaths.

How system was designed

The panel found that Pope County failed to follow the law several times when workers did not investigate or notify law enforcement when the boy was reported to have visible injuries. The county also should gathered information about potential drug or alcohol abuse by Eric’s parents and determined if Eric was safe in his home, the panel found.

Dr. Mark Hudson, a member of both the mortality panel and Gov. Mark Dayton’s child protection task force, said in reviewing Eric’s case that the state’s preference for a nonconfrontational response to reports of child abuse, not child protection workers, was to blame.

“The system is designed to not have law enforcement involved, to not have a forensic investigation, to not have to gather the facts about whether maltreatment happened,” Hudson said. “And [in Eric’s case] it worked as designed.”

The Star Tribune reported last year that Eric’s caregivers reported suspected maltreatment at least 15 times, including when he had bite marks on his face and bruises all over his body. Pope County child protection workers investigated only one of the reports. The rest were either dismissed or referred to family assessment.

Family assessment was started in Minnesota about 15 years ago as a response to less-serious abuse reports. It has become the predominant method of handling child abuse cases in Minnesota, with only about 9 percent of cases being investigated.

The panel criticized the use of family assessment in Eric’s case, saying that process “does not emphasize a need to determine if an allegation has merit or if an injury was caused by physical abuse.”

Multiple guidelines

The mortality panel made numerous recommendations to Pope County and the DHS on how to improve child protection, including that abuse should be investigated after multiple prior family assessments. The panel also wants the DHS to share mortality findings with all county child protection agencies, as the current practice is to share it only with the agency responsible for protecting the child.

The DHS also should revise its guidelines to make clear which cases should be investigated, the panel recommended. If a case involving physical injury goes to family assessment, the panel said the DHS should emphasize that child protection agencies still need to determine if the child was abused. It also recommended increased funding to counties to increase child protection staffing.

The child protection task force on Friday gave preliminary approval to several recommendations for improvement. But the group failed to reach consensus on when an abuse report should be investigated or assigned to family assessment.

Cases now are assigned to a track after an abuse report is accepted. Critics of family assessment say the cases should be assigned after determining if a child was abused. However, county child protection representatives on the task force said they would fight that proposal if it goes the Legislature.

The task force is expected to vote on its final recommendations to the governor on March 13.