The full report is available online.
File No: 16-2558
Children:
Penny Watson (DOB: 4-2011 and DOD: 4-2016) Oscar Watson (DOB: 1-2008) Nicole Geiger (DOB: 8-2001) Reed Geiger (DOB: 5-1999)
SUMMARY OF COMPLAINT
In April 2016, Penny Watson was suffocated by her mother Sarah Geiger, one day prior to her 5th birthday. Sarah Geiger’s paramour came home and found Sarah naked on top of Penny and holding her hand over Penny’s nose and mouth while saying “she is going to send Penny to Jesus.” A City A Police Officer arrived at the home and the paramour and Police Officer had to wrestle Sarah off Penny. The Officer attempted CPR but was unable to revive Penny. Prior to the death, Sarah Geiger had been investigated fifteen times, dating back to 2013. In June 2015, an intact family services case was opened and remained open until after the death. There were six child protection investigations during the intact family services case. Sarah Geiger had a history of bi-polar disorder and substance use disorder.
Following Penny Watson’s death, Sarah Geiger was charged with murder. In June 2017, she was found not guilty by reason of insanity and placed in the care of the Illinois Department of Human Services. Sarah Geiger was indicated for #10 Substantial Risk of Physical Injury and #1 Death.
INVESTIGATION
Family Composition
During an August 2015, integrated assessment interview, Sarah Geiger reported that she moved in with Troy Geiger in 1994 when they were both fifteen-years-old. Sarah reported that they later married and had three children together, Valerie Geiger (DOB: 8-1996), Reed Geiger (DOB: 5-1999) and Nicole Geiger (DOB: 8-2001). According to County B court records, Sarah and Troy Geiger divorced in April 2004. A-2 PENNY WATSON Following the divorce Troy Geiger was granted primary custody of their children and Sarah was allowed supervised visitation.
In 2004, after Sarah Geiger’s separation from Troy Geiger, she moved to another state with a marijuana dealer (information reported by Sarah Geiger during her August 2015 Integrated Assessment interview). Sarah reported that she later met Oscar’s father, Zach Watson, also known as Wes Watson. Sarah stated that Zach Watson was abusive. Sarah reported that she used crack cocaine but stopped once she found out she was pregnant with Oscar. Oscar was born in January 2008. When Oscar was six months old, Sarah left Zach Watson and moved to City C. Sarah reported that while living in City C, she started dating Andres Harris. Sarah stated that after she told Andres Harris that she was pregnant, he disclosed that he was married. Penny Watson was born in April 2011 with cystic fibrosis. Sarah stated that Andres only saw Penny three times. Andres Harris died of leukemia in October 2014. Sarah reported that she moved with Oscar (age 5) and Penny (age 2) to City D, Illinois in late 2013 to be closer to Valerie, Reed, and Nicole.
After the death of Penny Watson, Zach Watson reported during an integrated assessment interview in January 2017 that he met Sarah Geiger in 2006 and they dated for a few months and then lived together from 2006 to 2008. Zach Watson stated that he was aware that Sarah Geiger had bi-polar disorder and had lost primary custody of her three older children, Valerie, Reed, and Nicole. Mr. Watson stated that the older children would occasionally visit Sarah Geiger while they were living together. Zach Watson stated that when his relationship ended with Sarah Geiger, he remained a part of her and Oscar’s lives. Zach Watson stated that he also assumed a father role to Penny Watson. Zach Watson stated that after Sarah Geiger and Oscar Watson moved to City C, he would visit them for 2-3 days approximately every three weeks.
History with the Department
Prior to February 2015, ten hotline calls involving the Geiger-Watson children were taken for investigation but unfounded. The calls included concerns about domestic violence, severe environmental neglect, sexual acting out between the children, lack of supervision, substance abuse, severe mental illness, and medical neglect of a medically complex child. Many of the reports came from the school. The hotline narratives became available in SACWIS on August 6, 2017 with the release of a new SACWIS software update. Prior to this date, investigators would have been unable to access the hotline narratives that are currently in SACWIS. [The old State Automated Child Welfare Information System (SACWIS) is also known as the Illinois Child Welfare Information System (ICWIS) - Eric]
Sarah Geiger moved back to Illinois in late 2013. Following her return to Illinois, there were six unfounded child protection investigations in the 16 months between November 2013 and February 2015. The investigations were expunged from SACWIS prior to the death of Penny Watson. The investigations in SACWIS would have been available for 1 year from the dates the investigations were closed. The following are summaries of the hotline calls that resulted in the unfounded investigations:
SCR# 1111 A: On November 13, 2013, the hotline was contacted with allegations that Oscar Watson, age 5, came to school with a black eye. The reporter stated that Oscar said the injury occurred when his mother, Sarah Geiger got mad at him because he drank her soda, so she threw a toy at him, striking him in the eye. The hotline narrative also stated that Oscar and his family had just moved to City A within the past two weeks from another state.
SCR# 2222 A: On May 2, 2014, the hotline was contacted with allegations that Oscar (age 6) told the reporter that he did not come to school the previous day because his mother, Sarah Geiger did not get out of bed all day. The narrative also stated that Oscar said that he fed himself and his 3- year-old sister crackers with cream cheese. The reporter was concerned because Penny has cystic fibrosis and would have needed to take enzyme medication while she eats.
SCR# 3333 A: On January 13, 2015, the hotline was contacted alleging that there is black mold in the bedrooms and the kitchen of Troy Geiger’s home, and the gas has been turned off. The next day, on January 14th, a second reporter contacted the hotline also alleging that there was no heat or water in the home of Troy Geiger. On January 15th, Sarah Geiger also contacted the hotline with concerns of Troy Geiger’s home. Sarah Geiger reported that her children Reed and Nicole have threatened to make false reports against her for obtaining an order of protection against Troy Geiger. Sarah Geiger reported that she lost custody of her children [Valerie, Reed, and Nicole] ten years ago.
SCR# 4444 A: On January 16, 2015, the hotline was contacted alleging that Sarah Geiger smokes marijuana daily with her son Reed. The reporter also stated that Reed told the reporter that when he was 4 or 5 years old his mother beat him until he bled.
SCR# 5555 A: On January 28, 2015, the hotline was contacted alleging that Sarah Geiger told the reporter that she left Oscar and Penny outside of the maternal grandparent’s home and without knowing if the grandparents were home. The reporter stated that Sarah Geiger then drove away and called the suicide hotline. The reporter stated that the suicide hotline spoke to Sarah Geiger again later and Sarah reported that everything was better because she had smoked a bowl. The next day on January 29, 2015, police contacted the hotline regarding the incident that occurred the previous day and the report was taken as information related to SCR# 5555 A.
According to City A Police Department records obtained by OIG investigators, on January 28, 2015, police were dispatched to the home of Sarah Geiger. While at the home, Valerie Geiger (age 18) reported that her mother was out of control and she was scared that she was going to harm her and her siblings, Reed Geiger, Nicole Geiger, Oscar Watson, and Penny Watson. Valerie reported that earlier in the day, Sarah Geiger dropped Oscar and Penny off at their grandparent’s home, leaving them on the grandparent’s front porch with no shoes or coat. Valerie stated that her mother has mental health issues and she is scared that her mother has been smoking crack and could possibly hurt her or the kids. Valerie stated that she wanted to leave the apartment with the kids for the night or wants her mother to leave or go to the hospital for her mental health problems. Sarah Geiger denied the allegations and refused an ambulance. The police officer documented that he told Sarah Geiger that her children do not feel safe being around her while she is acting out of control. The officer observed that Sarah Geiger was overly energetic and could not keep her voice down and continued yelling while not holding a conversation with them. The officer told Sarah Geiger that Valerie was willing to leave so that she could go to bed but wanted to take the kids with her. Sarah Geiger agreed and Valerie took the kids to their grandparent’s house. The officer also noted that while inside the family’s apartment, he observed clothing, food, and toys scattered all around the apartment and it seemed to have not been cleaned in a while. The officer went back to the Geiger residence later that day and saw that Sarah Geiger’s vehicle was gone and Valerie’s vehicle was parked. Valerie told the officer that Sarah Geiger called and said that she admitted herself into the psychiatric facility at Alpha Behavioral Health so Valerie returned to the home with the children. Officer Isaacs contacted the DCFS hotline to report Sarah Geiger for neglect.
While it is unknown what documents the investigator accessed prior to the investigation being unfounded it is important to note that on January 28, 2015, Sarah Geiger was admitted for suicidal thought with a plan to drive her car off an embankment. She was discharged on February 2, 2015. Sarah Geiger reported to medical staff that her kids feared her and believed that she was delusional and overwhelmed. She also reported using marijuana to relax.
SCR# 4444 B: On February 12, 2015, the hotline was contacted alleging that Sarah Geiger got into a verbal argument with her daughter Nicole Geiger while driving Oscar to school. Nicole showed the reporter a video that showed Sarah driving recklessly and stating that she was going to wreck the car. Nicole told the reporter that Sarah hit Oscar on the back of the head with an open hand. The reporter stated that Oscar reported that he had a headache from the hit. The reporter stated that Oscar did not have any marks or bruises.
SCR# 4444 C- First Indicated Investigation
The first indicated investigation of the family was in February 2015. In June 2015, an intact service case was opened. While the intact case was open, there were an additional six child protection investigations of the family. Penny’s death was an L sequence investigation, but the sequencing did not include the ten unfounded investigations prior to February 2015. A summary of the investigations from February 2015 through Penny’s death follows.
On February 18, 2015, the City A Police Department contacted the hotline to report that Sarah Geiger was arrested for domestic battery for battering her 18-year-old daughter Valerie Geiger in the presence of her other children, Penny (age 4) and Nicole (age 13).
City A Police Department Records
Valerie Geiger (age 18) and Nicole Geiger (age 13) told police that when Valerie tried to leave in her car, Sarah Geiger dragged her out of the car. Sarah Geiger denied ever touching Valerie. Police noted that the inside of the apartment was in complete disarray and filthy. Sarah Geiger reported that she is bipolar but takes her medication every day. Sarah Geiger admitted to smoking weed in order to help her relax. Sarah Geiger reported that she has had to do everything for Oscar and Penny since Valerie found out she was pregnant.
Nicole Geiger reported that Sarah Geiger grabbed Valerie Geiger by the arm and dragged her to the front door of the apartment. Valerie tried to get away, but Sarah followed her with a “crazed look” on her face. Valerie reported that she was backing out trying to leave when Sarah jumped on the windshield of the car and then yanked the door open and dragged her out of the car. Valerie reported that Sarah chased her, but she was able to get away and call the police. Valerie stated that Sarah gets violent when she is mad.
Sarah Geiger was arrested for domestic battery and placed on a 48-hour domestic battery hold. She was found guilty on May 14, 2015.
The investigation was assigned to child protection investigator Bella Jenkins. CPI Jenkins was also the investigator on two subsequent investigations involving Sarah Geiger. CPI Jenkins contacted the reporter, Cesar Kline from the City A Police Department, who said that police had been to the home at least every other day for the past two months concerning domestic situations between Sarah and the children. The Officer reported that Diana Geiger (Troy Geiger’s ex-wife) was at the police station with Nicole and Penny, and that Sarah made a childcare plan for Reed (age 15), Nicole (age 13), Oscar (age 7), and Penny (age 4) to stay with Diana Geiger while she was in jail.
The family’s interactions with the City A police included an incident in which Sarah Geiger called accusing Valerie’s boyfriend of breaking doors in her home and breaking her car window; Sarah called to request the police check on Reed at his father’s because Reed had threatened to ‘blow his brains out.’ School personnel had called twice – once Reed’s principal had called because Sarah came to school and was extremely disruptive, screaming and swearing and had to be asked to leave. This incident resulted in Sarah being issued a citation for disorderly conduct. On another occasion, Nicole’s school social worker called after Nicole reported that Sarah was screaming in the morning and hit Reed in the car on the way to school that morning.
During the investigation, Sarah Geiger agreed to be assessed at Beta Hospital. It appears that the assessment was generic and not intended to determine Sarah’s parenting capacities. The findings from Beta Hospital were:
Pt. is a 35 yr. Old Caucasian Female who came in as a walk-in due to the Children’s Division telling her she needed to come in to make sure she is ok. Pt. [patient] And her 18 yr. Old daughter who is Pregnant got into an argument because the daughter said her Mother had her weed pipe. Pt. Said she tried to tell her she did not have it but her daughter did not believe her and took her safe deposit box and her cell phone and would not give it back. Pt. said she wrestled with her then the Daughter called the police and told the police that her mother scratched her. Pt. was put in jail for two days and did not have her medications. Pt. is bi-polar and takes Geodon 40mg. in the morning and 60mg in the evening, Neurontin 100mg, 3x a day, Buspar 75mg 2 times a day, Wellbutrin 75mg two times a day and Trazodone 150mg. Pt said she just was not able to take them while she was in jail. Pt. has a Children’s Division worker and she stated that she wanted her to come in for an Evaluation to makes sure she was ok. Pt. is accompanied by her sister whom she is currently staying with who verifies her story. Pt’s sister says Pt’s oldest 3 children ages 18, 15, and 13 are by her ex-husband and they lived with him for most of their lives and she has a lot of trouble with them and they want to stay with their Father. Pt. says they get into frequent arguments. Pt. says she will now be staying with her sister where there is less stress. Pt. says she was here at Alpha Behavioral Health 3 weeks ago because she was feeling SI [suicidal] because her children were out of control, so she came to check herself in. Pt. says she takes her medications and has no problems with taking her medications she was just not able to get them when she was in jail for two days. Pt. Reports that she is not SI or HI [homicidal], reports that her eating and sleeping are good and that she is going to college and is almost complete in achieving her bachelor’s degree in Business. Pt. says she sees Dr. Lang at Delta MH and that she will begin seeing a therapist in the next couple of months to assist her with feelings and problems she is having particularly with her 18-year-old daughter and 15-year-old son.
The discharge instructions stated, “Dr. Muro has authorized Pt. [patient] to be released to go home accompanied by her sister. Pt. [patient] is encouraged to keep her follow-up appointment with her Psychiatrist at Delta Mental Health Center and to seek out getting a Therapist at Delta Mental Health Center. Pt. [patient] is encouraged to continue taking her medications as prescribed by her Doctor and to feel free to call if she feels that she is in crisis or has any questions.”
On March 30, 2015, a hotline call was taken as Related Information from Oscar Watson’s counselor, Elias Neal from Delta Health Systems. The narrative stated the following:
Reporter states she meets with Oscar Watson, DOB 1-08 at school for counseling. Oscar has an IEP for ADHD and emotional issues. Reporter states today she asked Oscar if things were going better at home and he said 'no, mom still has drugs'. Reporter asked Oscar what kind of drugs and he replied, 'I'm just kidding'. Reporter states this morning Oscar was late for school and said he was late because he had to wake his mom up. Reporter states she told the school SW what Oscar told her; both Reporter and school staff have had concerns for Oscar and are aware that the family has had DCFS intervention.
According to the SACWIS investigation and hardcopy documents, there was no documented attempt to interview Oscar Watson during the investigation nor was there a child welfare check completed following the March 30th hotline call.
The C-sequence Investigation was closed on April 19, 2015 and Sarah Geiger was indicated for #60- substantial risk of physical injury/environment injurious to health and welfare by neglect. The rationale for the indicated finding stated:
…Sarah Geiger was arrested and charged with domestic battery of adult daughter, Valerie Geiger. The child, Nicole was present and witnessed the physical altercation. City A Police Officer, Cesar Kline, reported that the police have been dispatched to this home regularly for domestic situations over the past 2 months.
While they were not retrieved during the investigation, Delta Health Systems records obtained by the Inspector General’s Office showed that Sarah Geiger had been involved with Delta since February 2014 and diagnosed with bi-polar disorder and depression. Delta recommended medication management services A-6 PENNY WATSON and individual therapy, but Sarah never followed through with the recommendation for individual therapy. She attended nine out of twelve monthly medication compliance sessions but was off medication from time to time – including January 9, 2015 through February 18, 2015.
SCR# 6666 A (unfounded) and SCR# 4444 D (indicated)
SCR# 6666
On June 3, 2015, three months after the C sequence investigation closed, an anonymous reporter contacted the hotline and said that the night before, she saw a little girl sitting in the window of Sarah Geiger’s home screaming for help. The reporter stated that she has called the police in the past but all they do is pull up to the home and then leave. The reporter stated that the youngest children in the home are often seen outside wandering around unsupervised late at night.
The investigation (SCR# 6666 A) was assigned to child protection investigator Faith Oakley. On June 4, 2015, CPI Oakley contacted the City A Police Department. Clerical staff at the police station reported that the last documented police call to Sarah Geiger’s residence was on April 22, 2015. The allegation of #74- inadequate supervision for SCR# 6666 A was unfounded on July 6, 2015. The rationale for the finding stated, “Sarah Geiger reports she leaves her daughter Penny Watson age 4 and son Oscar Watson age 7 in the care of her son 15-year-old Reed Geiger and daughter 13-year-old Nicole Geiger. The minors have access to a phone to contact relatives or law enforcement in case of emergency. The minor reported she is left in the care of her older brother if her mother is not home.”
SCR# 4444 D
On June 12, 2015, while SCR# 6666 A was pending, the City A Police Department contacted the hotline to report the following:
…When reporter arrived, he could hear Sarah screaming and heard lots of glass breaking and things being thrown. Sarah told reporter she is at her wit’s end with the kids. She said she is tired and can’t take care of the kids anymore. She started making suicidal comments and she was taken to Beta Hospital in County E. Sarah broke a lot of glass and she was telling the kids she hoped they would step on the glass and hurt themselves. Reporter said Penny has cystic fibrosis. No other diagnosed disabilities known. Sarah had a history of substance abuse but has been clean for quite a while…
Following the incident, Reed and Nicole were taken to the home of their paternal grandmother, Gemma Pettis. Penny and Oscar were taken to the home of the maternal grandparents, Henry and Isabelle Regis.
Sarah had told the police officer that she wanted to go to the Alpha Center and talk with someone before she hurt herself. Officer Terry interviewed Reed Geiger, Nicole Geiger, Oscar Watson, Penny Watson, and Sarah Geiger’s niece, Josie Sawa and documented that the children reported that Sarah Geiger was acting crazy and breaking things. Reed reported that when he woke up that morning, his mother was going crazy and started knocking pictures off the wall upstairs and then went into the kitchen and started breaking glass.
The hardcopy documents to SCR# 6666 A contained records from the City A Police Department that were printed on June 19, 2015. The records did not contain the incident report from the June 12, 2015 incident. The police records included incident reports from January 12, 2015, February 5, 2015, February 15, 2015 and February 18, 2015 that were also obtained during the C-sequence investigation. In addition to those records, an incident report from January 28, 2015 was also included in the requested records.
The next day, a hospital social worker from Beta Medical Center contacted the hotline and reported that Sarah told the reporter that she was overwhelmed and had not been giving Penny her morning cystic fibrosis treatments. Sarah also told the reporter that she had been using her money to buy marijuana and had not bought groceries.
The June 12th and June 13th hotline calls were taken for investigation (SCR# 4444 D) and assigned to CPI Faith Oakley. Nicole reported to CPI Oakley that she “could hear her mother kicking the bathtub making the wall in the kids’ room shake. Nicole reported her mother told her to come downstairs to clean because [she] was planning to take a nap. My mom went into her room to lie down then got up and started breaking things. She threw a salt rock lamp toward me and it almost hit Penny. She left her room, walked down the steps and pulled all of the pictures off the wall breaking them”
Nicole informed the CPI that her mother made comments about leaving the home and driving off a cliff. Nicole stated that her mom was screaming in a deep raspy voice and ‘freaking out.’ Nicole said her mother usually takes her medication but that even when her mother is on her meds she sometimes ‘freaks out.’ Nicole denied her younger siblings are unsupervised when her mother attends school. Nicole reported she feels safe with her mother and feels her siblings are safe when her mother is normal, however, Nicole expressed concern regarding her mother’s anger. She reported when her mother is angry, she threatens [to harm] herself.
This same day, CPI Unsworth contacted Gemma Pettis, the paternal grandmother of Reed and Nicole. Ms. Pettis reported that she has tried to care for Reed and Nicole in the past, but they do not listen, so she does not want to care for them. Ms. Pettis stated that after Sarah went to Beta Hospital, she took Nicole to her father’s home.
On June 15, 2015, CPI Oakley’s supervisor, Leanna Villa, documented the following in a supervisory note:
This supervisor questioned if we could take PC or should that [have] been done on Friday. Is mom just sick of her older kids or having a mental break down? Will other family take the kids? Faith stated no. Faith stated mom appears overwhelmed with her older kids. Supervisor will staff with Maggie Wolfe, AA to see if we can open the case for services.
While at the home, CPI Oakley interviewed Sarah’s’ mother, Isabelle Regis. Ms. Regis reported that Sarah is overwhelmed with Reed and Nicole and reported that they are prescribed psychotropic medication but will not take the medication nor will they attend counseling.
On June 24, 2015 CPI Oakley received an Integrated Mental Health and Substance Abuse Assessment, from Delta Health Systems. The assessment was dated April 23, 2015 and documented Sarah’s presenting problems/current emotional and behavioral functioning as the following:
…Sarah reports she has been diagnosed with bipolar disorder in the past (since the age of 17). Sarah continues to report having thoughts of grandiosity and sleepless nights. She says that “I could go for 2 or 3 days without sleeping.” She further reports racing thoughts, paranoia, loss of appetite, inability to concentrate and focus, and low motivation. Sarah continues to report feelings of helplessness, hopelessness and worthlessness. She reports thoughts of suicide in the past and a recent suicide attempt last year. Sarah could not remember the date. Sarah further reports problems concentrating and focusing, isolation and anhedonia. She reports becoming frustrated easily but feels that she is able to control her impulses…Sarah has been receiving SSI due to mental health diagnosis for approximately 13 years.
When Sarah went to Delta Health Systems on June 19, 2015, she reported that she had not been taking her medications since she was discharged from Beta on June 19, 2015. Sarah attended another appointment at Delta Health Systems on July 17, 2015 and again reported that she was not taking her medication as prescribed because she was confused. Sarah reported that she was not sleeping well and only slept 2 hours the previous night. Sarah also reported that her appetite had increased and that she smokes marijuana daily. This information was not obtained by CPI Oakley.
On June 23, 2015, CPI Oakley received records from Beta Medical Center for Sarah Geiger’s psychiatric hospitalization that occurred June 12, 2015 to June 16, 2015. Sarah Geiger was admitted for suicidal ideation with a plan to overdose on her medications or intentionally wreck her car by not wearing a seat belt and running her car into a pillar or off a bridge. She confirmed that earlier that day she was upset with her children and she began throwing dishes, framed pictures of her children, and a fan. Sarah reported that she feared if she gets angry again and throws things, she could accidentally hurt one of her kids. Sarah also reported that she had not been giving Penny Watson her morning treatments for cystic fibrosis because she was overwhelmed. Sarah admitted that she had not bought groceries in 3 months because she has been buying marijuana. Upon discharge Sarah was given prescriptions for a 30-day supply of Celexa 20mg, Lamictal 25mg, and Geodon 20mg and told to follow-up with Delta Health Systems.
CPI Oakley also obtained historical records from Beta Medical Center. The records detailed Sarah Geiger’s prior hospital admissions on January 28, 2015 for suicidal ideation and June 12, 2015. The records also documented the following psychiatric hospital admissions for Sarah Geiger:
On June 27, 2010 Sarah Geiger was admitted for suicidal ideation but later told hospital staff that she was not suicidal she just said that to get admitted in order to get medication and an updated diagnosis because her SI benefits were denied. While at the hospital Sarah reported feeling jittery, anxious, overwhelmed, having racing thoughts. She feels irritable towards son [Oscar age 2], can’t tolerate sons crying. She worries about finances and feels helpless. She denies drug use in the last 4 years. Sarah reported last use of marijuana was 4 years ago, last use of crack cocaine at the age of 28 and last cigarette was 4 years ago.” Sarah also reported that she has 3 older children that live with her ex-husband and she is behind on child support. Sarah was discharged from Alpha Behavioral Health with a diagnosis of Malingering. Sarah was instructed to restart Zoloft 50mg and Abilify 5mg every evening and follow-up with Psychiatrist and Primary Health Provider.
On September 17, 2010 Sarah Geiger was admitted for two days due to suicidal and homicidal thoughts. Sarah reported that she stopped taking her bi-polar medication 2-weeks ago because she found out she was pregnant and now reports feeling manic. A nursing note stated, “Pt states she’s been HI [homicidal], ‘wants to kill her sons’ father’ Pt states she’s having violent thoughts toward him.” The medical record also stated, “Sarah has a history of prostitution, drug use of cocaine and heroin. She reported her boyfriend was not supportive of her emotionally or financially. She denied taking medications because of the current pregnancy. In the past she was taking Abilify 5mg and Zoloft 50mg to control her bipolar, currently she is only taking prenatal vitamins. Sarah wrote the following on her recreational therapy self-assessment, “overwhelmed, angry at son’s father. Stressed out. No resources, no family or friends.” RN progress note reads, “pt. alert and oriented x3. states she has no depression or anxiety. Says she just needed a break from her son and boyfriend. Felt overwhelmed at home and now that she’s been able to sleep, she feels much better. Denies SI, HI. Pt requesting Vistaril 25mg to aid with sleep.” Sarah Geiger was discharged home and instructed to follow up with outpatient therapist Dr. Naomi Zimmerman at Eta Counseling Center and her current psychiatrist. Her discharge medications included Abilify 5mg nightly and Zoloft 50mg daily.
CPI Oakley contacted the Department of Social Services, Children’s Division in another state. She learned that the other state had previously investigated an allegation of sexual abuse of Penny Watson by her father Zach Watson who lives in another state. The social services worker reported that Penny had two Victim Sensitive Interviews and Penny denied sexual contact therefore the report was unsubstantiated. Ms. Avila reported that Sarah Geiger did not agree with the findings and has continued to call in reports against Zach Watson.
According to the Children’s Division records, on April 9, 2015 Sarah Geiger contacted the Child Abuse and Neglect hotline to report that Penny Watson disclosed to her that Zach Watson (aka Wes Watson) had tickled her butt. Sarah Geiger stated that when she asked Penny what that meant Penny pointed to her vagina and made a flicking motion with her finger. Sarah reported that she and Zach Watson broke up in November 2013 and from November 2013 to February 2015, Oscar and Penny would visit Zach Watson at his home in another state on Sundays. Sarah reported that she once found pictures of children on Zach Watson’s computer and he told her that the pictures were from a previous owner. Sarah reported that after the breakup she found a disk with naked pictures of Penny when she was a baby that she believed Zach had taken. Sarah also stated that she met Zach when she was a prostitute and he was her customer. The report stated that Sarah would not say why she continued to allow Zach access to Penny after she found the pictures. The allegation of Lack of Supervision against Sarah Geiger was added to the investigation. On April 27, 2015, Penny Watson went to Iota Agency for a forensic interview. Penny did not make a disclosure. A second forensic interview was conducted on May 4, 2015. Penny was cooperative with the interview but did not make a disclosure regarding sexual abuse. The sexual abuse allegation against Zach Watson was unsubstantiated on May 29, 2015. The allegation of Lack of Supervision against Sarah Geiger was also unsubstantiated.
CPI Oakley contacted Sarah Geiger by phone. Sarah reported that she saw Oscar “humping” Penny and when she asked Oscar about it and he said it was no big deal. Sarah stated that “Oscar had a smirk on his face and was making kissing noises and aiming them toward her crotch.” Sarah reported that she was not going to let the children be around Zach Watson because she believed something happened. Sarah also reported that Reed and Nicole moved back to her home.
CPI Oakley contacted Reed and Nicole’s father, Troy Geiger. Mr. Geiger reported that he obtained full custody of Reed and Nicole years ago because Sarah “went nuts.” Mr. Geiger reported that previously there was an order for only supervised contact between Sarah and their children, Valerie, Reed, and Nicole. Mr. Geiger stated that during the summer months Reed and Nicole go back and forth between his house and Sarah Geiger’s house, but they do not live with Sarah. Troy Geiger requested that his phone number be put on file so that he could be contacted if anything else occurs.
CPI Oakley contacted Gamma Hospital where Penny receives treatment for cystic fibrosis. The nurse reported that Penny has been a patient since May 2011. She stated that “Sarah Geiger appears a little challenged and sometimes asks a lot of questions regarding medical recommendations for Penny. The nurse informed CPI cystic fibrosis care can be difficult and requires a lot of organization but there have not been any immediate concerns that Sarah is not following the recommendations or treatment.” The nurse reported that Sarah will call the office when she does not understand what is being asked of her.
SCR# 4444 D was closed on August 11, 2015. Sarah Geiger was indicated for #60 substantial risk of physical injury/environment injurious to health and welfare by neglect and the allegation of medical neglect was unfounded.
Children’s Needs
Because of Penny’s cystic fibrosis, she required treatments every morning as well as ensuring that she ingested an enzyme with every meal. When evaluated at City A Elementary School in April 2014, Penny had limited speech and language skills and was not toilet-trained. The other children presented emotional and behavioral challenges. Nicole, while living with her father most of the time, also suffered from depression and lack of medication compliance.
According to Delta Health Systems records obtained by OIG investigators, Nicole (then age 13) received services through Delta from January 2015 – July 2015. Nicole was diagnosed with oppositional defiant disorder and mood disorder not otherwise specified. Nicole reported that she had lived with her father her entire life and would only see her mom about every two weeks. Nicole reported that she hates her mom and does not want to be around her. In addition to Nicole refusing to take her medications, the assessment also stated that Nicole was very argumentative with her mom throughout the assessment and at one point told her mom to shut up. During the assessment, Sarah Geiger reported that Nicole has posted pictures of cuts and told her that she was going to jump off a cliff.
According to the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR, 4th Edition, mood disorder not otherwise specified “includes disorders with mood symptoms that do not meet the criteria for any specific mood disorder and in which it is difficult to choose between depressive disorder not otherwise specified and bipolar disorder not otherwise specified.”
From February 2015 to July 2015, Nicole met monthly with a counselor from Delta Health Systems at City A Junior-Senior High School. Nicole also attended a support group three days per week from January 2015 to March 2015. According to the record, during individual counseling sessions, Nicole would often talk about conflict with Sarah Geiger. In May 2015 Nicole told the counselor that she had to go to court this day due to her mother assaulting her sister, Valerie Geiger. Nicole stated that her mother is probably upset with her for telling the truth at court. Nicole reported that she does not like her relationship with her mother but has started to realize that she cannot change her mother and make her a better mother. Nicole reported that she only goes to her mother’s home to visit her younger siblings. In June 2015, Nicole reported that she never knows what kind of mood her mother will be in and stated that her mother recently spent a week in the hospital because she was throwing things at her younger siblings and talking about suicide. Nicole reported that her mother is verbally abusive, but she gets mad at her father (Troy Geiger) because he has a drug problem and his living space is not suitable to live in.
Oscar had severe Attention Deficit Hyper Disorder (ADHD). and school staff noted his inability to function in school without his medication. According to Delta Health Systems records for Oscar Watson, obtained by OIG investigators, Oscar was also enrolled in the medication program at Delta for ADHD. During a September 2015 visit the nurse practitioner documented that Sarah did not consistently bring Oscar for his appointments. The nurse noted that he was hyperactive and unable to focus. Oscar reported that he had been off his medication but needed it for school. Oscar was prescribed Focalin 5mg, twice daily.
Oscar Watson also met with a counselor from Delta at City A Elementary School almost weekly starting in August 2015. According to the record, during counseling sessions from August 2015 to March 2016 the counselor documented that Oscar was often agitated or hyperactive and had difficulty focusing during the sessions. On October 13, 2015, Oscar reported that his mother struggles with anger and stated that when she takes her pills she doesn’t yell. School staff reported that Oscar could do well at school when he had his medication. According to City A Elementary School records, both Oscar and Penny were absent over 30 days in the 2015-2016 school year.
Reed’s relationship with his mother was strained and frequently confrontational.
Intact Family Services
While both SCR# 6666 A and SCR# 4444 D were pending, an intact family services case was opened on June 24, 2015 and assigned to DCFS intact worker Paige Berrett and supervisor Quinn Carlson. The intact case remained open for 9 ½ months until the death of five-year-old Penny Watson in April 2016. During the 9 ½ months of the intact family services case there were nine additional calls to the hotline, which resulted in six child protection investigations. Eight of the calls to the hotline were from mandated reporters. The following chart provides an overview of child protection’s involvement with the family during the intact family services case and prior to Penny Watson’s death in April 2016.
Paige Barrett began employment with DCFS as a permanency worker in August 2009 and became an intact family services worker in December 2010.
| SCR # | Hotline Calls | Finding |
|---|---|---|
| 4444 E Closed: 12- 7-15 | 10-8-15: The school principal reported that Reed (16) was not at school and when the principal contacted Reed’s mother, she stated that she kicked Reed out of the home, and she did not know where he was. 10-8-15: An anonymous caller reported that Sarah told the reporter she had no food in the home and the children had lost weight. The reporter alleged that Sarah smokes marijuana with her son Reed and the home was unclean. |
#84- Lockout: Unfounded #76-Inadequate Food: Unfounded #15-Substance Misuse: Unfounded |
| 4444 G Closed: 12- 27-15 | 10-29-15: Police Officer reported that he responded to a domestic disturbance when the maternal grandfather grabbed Oscar by the arm, and both fell. The grandfather told the officer that the mother leaves the children with the elderly grandparents for days at a time because she is bipolar and cannot handle the children. | #74-Inadequate Supervision: Indicated |
| 4444 H Closed: 1-11-16 | 10-13-15: Reed’s school counselor reported that Reed told her that his mother poured water on him, hit him in the head with a belt buckle, and punched him in the nose. Reed had a mark on his head and some redness on the nose. Reed told the reporter that his mother was high at the time of the incident. | #11 Cuts, Bruises, Welts, Abrasions by abuse: Unfounded |
| 4444 I Closed: 3-21-16 | 12-22-15: School social worker reported that while delivering Christmas gifts to the Geiger family, she observed Oscar outside without shoes, socks or a coat. Oscar told the reporter that he was afraid to go inside because his mother would smack him again; Oscar told the reporter that his mother hits him with a belt and hanger on the butt often leaving marks. The reporter stated that the house was unclean and smelled like marijuana. The reporter stated that the mother (Sarah) is bipolar and reportedly compliant with medication, but she was displaying extreme mood swings, her eyes were red and appeared to be intoxicated. 1-29-16: Hospital Social Worker reported that Josie’s mother reported that Josie stays with her Aunt, Sarah Geiger, who smokes marijuana with the children and has allowed Josie to driver her car without a permit. |
#74-Inadequate Supervision: Indicated #10-Substantial Risk of Physical Injury: Unfounded #15-Substance Misuse: Unfounded |
| 4444 J Closed: 3-21-16 | 1-28-16: School social worker reported that Penny (age 4) was crying and stated that her mother hit her that morning. Oscar Watson (age 7) confirmed the report and stated that he gets hit with broken hangers and belts, so he hides in the closet or goes outside until things calm down. The reporter also stated that the mother was 55 minutes late picking up Oscar and 90 minutes late picking up Penny. 2-18-16: A police officer reported that Sarah was arrested on an outstanding warrant. Sarah asked a sitter to keep Penny and Oscar overnight while she was in jail however the sitter contacted the school because this was the first time she had cared for the children and was uncomfortable keeping them overnight. The officer reported that the school staff provided contact information for the maternal grandparents and the officer drove Oscar and Penny to the grandparents’ home. |
#74- Inadequate Supervision: Indicated #11- Cuts, bruises, welts and abrasions: Unfounded #10-substantial risk of physical injury: Unfounded |
| 4444 K Closed: 4-14-16 | 2-18-16: The school social worker also reported that Sarah left Oscar and Penny with a new sitter. Oscar has ADHD and is unable to function without his medication, and Penny also requires medication for cystic fibrosis. The social worker reported that Sarah did not give the sitter any information on caring for Penny’s medical condition. The reporter stated that Sarah sent the sitter a text requesting money and asking her to care for Oscar and Penny. The reporter stated that Sarah has a diagnosis of bipolar disorder and does not take her medication. The reporter stated that police said the mother has reported using marijuana around the children and does not see a problem with it. | #74- Inadequate Supervision: Indicated #79-Medical Neglect: Unfounded |
During the entire intact services case, Sarah exhibited a failure to follow through with service recommendations and failure to maintain consistent medication compliance. On June 24, 2015, a transitional visit was conducted by CPI Faith Oakley and DCFS intact worker Paige Barrett at the home of Sarah Geiger. Sarah agreed to intact family services and acknowledged that she could use the help. Sarah reported that her house gets messy because of her depression and the kids have to remind her to clean it. Intact worker Paige Barrett informed Sarah that DCFS would monitor her mental health treatment and ensure she was taking her medication for her bipolar and depressive disorders. The intact worker also recommended protective daycare and parent education. During the transitional visit, Sarah reported that Reed and Nicole were also living in the home.
During an interview with CPI Oakley on June 15, 2015, Sarah reported that she could not have Reed and Nicole living with her “because it was too much.”
In an interview with OIG investigators, intact worker Paige Barrett reported that Sarah wanted Oscar and Penny home with her and was not interested in protective daycare. Intact worker Barrett reported that she would count Sarah’s pills during home visits to monitor Sarah’s medication compliance.
Following the transitional visit, intact worker Barrett conducted both scheduled and unscheduled weekly home visits to Sarah Geiger’s home. According to the integrated assessment dated August 15, 2015, intact worker Barrett’s integrated assessment interview of Sarah Geiger took several visits to complete due to distractions in the home. Sarah admitted to daily marijuana use because it relaxes her. When asked if marijuana use altered her functioning, Sarah reported that she misplaces things. When asked about her history of mental illness, Sarah reported that she has a diagnosis of bipolar disorder and has a history of psychiatric hospitalizations. Sarah reported that she was feeling overwhelmed with raising her children prior to the hospitalization. Intact worker Barrett documented the following under the section of the integrated assessment titled Family Composition and Prognosis:
Prognosis for this family is very guarded. Sarah has difficulty in keeping mental health appointments. She states she takes her medication as prescribed. However, she has had previous domestic violence with her 18-year-old daughter and continues to have ongoing conflictual relationships with Reed and Nicole. Reed is totally disrespectful to Sarah and has control of the household. Sarah is very ineffective in her efforts to calm and redirect Reed. This relationship needs some serious work and Sarah has to learn methods to gain parental control in her home.
According to the Service Plan dated August 12, 2015, intact worker Barrett recommended the following services for Sarah Geiger: family counseling, parenting, substance abuse assessment, and anger management. In addition, Sarah Geiger agreed to follow all recommended mental health treatment to address her bi-polar disorder. In addition the service plan states that Sarah agreed to sign releases of information for herself and her children and agrees to participate in visits with the intact worker. The Service Plan also documented that DCFS agreed to keep in ongoing contact with the counseling, parenting, substance abuse and anger management providers.
According to the financial section of the Service Plan, Penny receives $1173/month in survivor benefits from her father dying and disability from cystic fibrosis and Sarah receives $733 in disability for her mental health and $150 in child support from Oscar’s father [Zach Watson] every three months. In addition, Sarah reportedly donates plasma each month and receives $260/month.
On August 14, 2015, supervisor Quinn Carlson documented that the initial Child and Family Team Meeting was held at the home of Sarah Geiger. Quinn Carlson, Paige Barrett, Sarah Geiger, Reed, Penny, Oscar and Nicole were present. Supervisor Carlson documented the following regarding the meeting:
Nicole is currently living with her father's ex-wife Diana [According to County B Court records, Diana Geiger was appointed guardian of Nicole Geiger on September 14, 2015] and her mother, Robin Day. Reed was more than disruptive throughout the meeting. He curses at his mother and interrupts almost every statement she attempts to make. Reed is beyond angry and it is very unreasonable as Sarah has told him that he can go and live with his father if he so desires. He reported the reason for this anger is that he can't stand his mother bad mouthing his father. Ms. Geiger made every effort not to do this by refusing pretty much to even discuss his father. Reed has some mental health issues reported but we are not sure of his diagnosis. We do know that he refuses to take his medication and when I questioned him about this, he stated he is not going to take any medication because Drs [doctors] only give it to people they think are "crazy" and he is not crazy. There was no reasoning with him on this subject. Ms. Geiger stated she is very glad that she requested services because she has no one she can talk to about anything and it has made a big difference since Ms. Paige [Barrett] has been coming to the home. She is hopeful that our involvement will help her with managing her children. Although the home is totally chaotic, no safety hazards observed. Worker reports that it is much cleaner and more organized than it has been. All of the children appear healthy and cared for properly however there is some concerns in how Reed relates to the rest of the family. Ms. Geiger [was] encouraged to make sure she follows up on her mental health treatment as well as encourage her son to do the same…
In an interview with OIG investigators, supervisor Quinn Carlson reported that when the intact family services case was first opened the main focus of the case was Sarah and Reed’s negative interactions with one another, as Sarah and Reed would scream at each other. Supervisor Carlson reported that while at the home for the initial Child and Family Team Meeting, she thought Sarah’s interaction with Oscar and Penny was more motherly.
On August 20, 2015, intact worker Barrett referred Sarah for homemaker services and on August 24, 2015, intact worker Barrett met with Sarah and the assigned parenting coach, Skyla Enders from Kappa Agency. During the meeting, intact worker Barrett explained that Sarah needed assistance with parenting, budgeting, instruction on how to keep her house clean and organizing mental health appointments.
On September 9, 2015, intact worker Barrett received a return call from Sarah Geiger’s Advanced Nurse Practitioner at Delta Health Services where Sarah receives medication management for her bi-polar disorder. Nurse Frascatti reported that she has recommended that Sarah attend individual therapy to address her bi-polar disorder and cannabis dependent diagnosis however Sarah has not followed through.
According to Delta Health Systems records obtained by OIG investigators, Sarah Geiger was required to attend appointments at Delta monthly to receive medication prescriptions for her bi-polar disorder. However, following the July 17, 2015 appointment at Delta Health Systems in which Sarah reported she had not been taking her medication as prescribed, Sarah missed an appointment on August 14, 2015. Sarah attended an appointment on September 3, 2015 at which time Sarah reported that she smokes marijuana and has been taking her medication. Sarah did not attend the required monthly appointments in October or November 2015. Nurse Frascatti also documented that she discussed Sarah’s last appointment [September 3, 2015] with a DCFS case manager on September 9, 2015.
Intact worker Barrett spoke to Delta Mental Health Services concerning Reed, Oscar and Nicole. They reported:
…Oscar’s diagnosis is ADHD and conduct disorder. He started coming to Delta in April of 2014. He takes Focalin 5mg in am and at lunch. Sarah is very inconsistent in bringing him. He came January, February, April, July, and September. It's almost been two months since his last appt, and he is out of meds. She does recommend family counseling, but he is not currently seeing a counselor. When Sarah brought him for his last appt she dropped him off and left saying that nothing had changed, and he just needs his meds. She is supposed to be a part of the appt to give a good idea of what is going on with the child and his meds and behavior. Nicole’s SASS counselor does not believe that Nicole is getting any medicine. Worker then spoke with Tabitha Gosha who is Reed’s prescriber. Reed started coming to Delta 10/7/14 with anger and depression. He reported depression about his stepmother and father divorcing. His current mental health diagnosis is ADHD, PTSD, cannabis abuse, and Bipolar. Reed is taking Adderall XR 30mg which is a medium dose. He was on a higher dose but was taken down due to the rumors that his father was also taking it. Reed also takes Zyprexa 5mg for his mood/bipolar. She has recommended counseling for him but [he] is not seeing anyone. Reed is overall very rude to everyone when he comes into the office. He is talking back to his mom and threatening not to come back if Tabitha did not give him his Adderall. He was very defensive when asked if he takes it every day. Before his appt on 9/3/15 his last refill was March.
4444 E (Unfounded), G-sequence (Indicated) and H-sequence (Unfounded)
SCR# 4444 E
On October 8, 2015, 3 ½ months after the intact family services case was opened, the principal at City F School contacted the hotline to report that Reed was not at school and when the principal contacted Sarah Geiger regarding the absence, Sarah reported that she kicked Reed out of her home the previous night and did not know where he was.
Also, on October 8th, an anonymous caller reported that Sarah told the reporter there was no food in the home and the family had been living on peanut butter. The reporter also stated that Sarah had been smoking marijuana with her son Reed around her two younger children [Oscar and Penny]. The reporter stated that the home was dirty and alleged that Sarah recently let Oscar’s father, Wes Watson [Zach], spend the night even though there were previous allegations that he had molested Sarah’s daughter, Penny.
The day prior to the hotline calls, on October 7, 2015, the City A Police Department was dispatched to Sarah Geiger’s home because of a domestic disturbance. Reed told the police that his mother was going crazy again and chased him with a hammer. Reed denied kicking the door to the apartment and stated that he was going to live with his father Troy Geiger. Officer Terry documented the following regarding his interview with Sarah Geiger:
…I asked Sarah if she chased her son with a hammer. She stated she did not. She stated she had the hammer to try and fix her door. She kept yelling and screaming and saying her son needed shock therapy. I told her maybe she was the one that needed the shock therapy. She then told me to leave and she did not need the police. Sarah then made a phone call and was telling someone that her and Reed were into it again. She stated he came at her so she chased him across the parking lot with the hammer. When Sarah got off the phone I asked her about chasing Reed with the hammer. She again denied it and stated I was no longer needed there. Reed left and stated he would be staying with his grandparents.
The child protection investigation (SCR# 4444 E) was assigned to child protection investigator Victoria Huisel and supervisor Wendy Irwin.
Following the hotline calls, intact worker Paige Barrett left a phone message for Victoria Huisel. CPI Huisel documented the following regarding the voicemail, “…Paige Barrett stated that she has [the] case and that she believes that alleged perpetrator would let child victim back in. She stated that she went out yesterday and that nobody was home. She stated that child victim attends City F school and that alleged perpetrator [Sarah Geiger] has been participating in parenting. She stated that alleged perpetrator does not follow-up with mental health very well. She stated that child victim [Reed Geiger] is diagnosed bi-polar, cannabis abuse and ADHD.”
Also, on the day of the hotline call, CPI Huisel went to the home of Sarah Geiger. Sarah Geiger’s niece Josie Sawa (age 15) and Reed Geiger (age 15) were at the home alone. While at the home Josie Sawa reported that Ms. Geiger and Reed got into an argument and Reed made false accusations to the police to make Ms. Geiger go to jail. Josie reported that Ms. Geiger makes sure the kids get what they need. Josie stated that they have eaten peanut butter and jelly sandwiches when there was no money to buy anything else but denied living off peanut butter. Josie reported that she lives with her mother, Yasmin Geiger but her mother lets her frequent Sarah Geiger’s home.
Reed reported that he had a fight with his mom because he did not want to clean the house, so he left on his own. Reed reported that when he came back to the house it was locked so he kicked the door in. Reed reported that he gets enough food and denied living off peanut butter. Reed reported that he stays with his mother, Sarah Geiger. Reed reported that Ms. Geiger, Penny and Oscar are at his grandmother’s home.
CPI Huisel interviewed Penny and Oscar at maternal grandmother’s home. Penny and Oscar reported feeling safe and not afraid of anyone who lived in or visits their home. Both reported that there was food in the home and denied being hungry.
CPI Huisel next interviewed Sarah Geiger, who affirmed her earlier statements to police. On October 13, 2015, CPI Huisel talked to intact worker Paige Barrett by phone. CPI Huisel documented that Paige Barrett reported that a parenting coach through Kappa Agency has been working with Ms. Geiger for approximately one month. Intact worker Barrett also informed CPI Huisel that Sarah Geiger could not handle Reed Geiger in the home.
Intact worker Barrett contacted the parenting coach Skyla Enders on October 13, 2015 and documented the following concerns:
…she has concerns about Reed’s out of control behavior…Sarah was trying to fix the door and running after Reed with the hammer in her hand (but not trying to hit him with it). Sarah stated that she cannot handle him and he is out of control. She stated Reed went over to his dads that night and tried to blow up the dad’s car and the dad got to him before he could do it. Skyla stated Sarah was cussing while she was there and Skyla told her to calm down and she didn't need to be cussing. She believes Sarah does need anger management. She has an appointment on Friday at Delta to set up all needed services. Reed has been out of control and taking the keys to the van after Sarah has said no. Josie who lives there has said that Reed has hit her before. Skyla believes Josie does not need to be living there as Sarah has enough on her plate. Sarah has been keeping the house cleaner. The two little kids have been keeping their toys picked up. Sarah is not watching them when they go outside. Oscar was riding his bike near the street. Skyla stated the dog has snapped at Penny and she told Sarah that Penny needs to sit in time out for messing with the dog and the dog needed to get in trouble too for snapping. Sarah stated she will get a calendar when she gets her school money. Skyla is going to start working with her on the parenting programs. Sarah hasn't been taking her advice regarding the grocery shopping and that there is probably too many extra kids in that home who are eating it all.
The next day, on October 14, 2015, intact worker Barrett conducted a home visit. Barrett told Sarah that she should contact the police anytime she feels that Reed is a danger to himself or others. Intact worker Barrett also gave Sarah the contact information to SASS. While at the home, intact worker Barrett questioned why Oscar’s father, Zach Watson, was at the home given that she had accused him of sexually abusing Penny. Sarah reported that Zach Watson spent the day with them and took them grocery shopping and out to eat. Intact worker Barrett told Sarah that she could be putting her children at risk by allowing him around her children. Sarah also reported that she had an appointment on Friday, October 16, 2015, at Delta to initiate family counseling, a substance abuse assessment and anger management classes.
Supervisor Wendy Irwin documented the following regarding a supervision meeting with Victoria Huisel on October 15, 2015:
CPI has seen all of the kids. CPI has seen the house and Mom. CPI has also seen Grandmother. Reed denies his mother locked him out. He also denies smoking pot or smoking pot with his mom. There was plenty of food in the home. Case is open for intact services and CPI has spoken to the caseworker. There is a parenting coach. Both Ms. Geiger and Reed are on probation for domestic violence to one another. CPI needs to make contact with reporter and school counselor. CPI and PSA discussed the decision to unfound report as minor was not locked out, there was adequate food and minor denies smoking pot with his mother…
On October 23, 2015, intact worker Paige Barrett documented that Sarah reported that Reed moved in with his paternal grandmother and stated that she did not want Reed’s behavior to cause her to lose Oscar and Penny. Sarah also reported that Reed took 2 Adderall pills with him but did not take his bipolar medication with him. Sarah told intact worker Barrett that she missed her appointment at Delta Health Systems on October 16, 2015, because she did not have any gas. Intact worker Barrett told Sarah that Reed’s school contacted her and asked if she wanted to sign a consent for the intact worker to be able to talk to the school counselor and Sarah stated no and that she would contact the school herself.
Zoey Jacoby then contacted intact family services worker Paige Barrett. Intact worker Barrett documented the following:
…Zoey, a school social worker at City F School called and stated that she believed that Reed needed counseling and anger management services. The school social worker also stated he has a temper and will say random things like “I don't have my medication?” She stated that he seems unstable and will say that he has court but isn't sure when and is not sure if he will be going to jail. This worker stated Sarah would not sign a release allowing worker to give information to this school. Worker asked if she had tried to phone Sarah and give her this information. Zoey stated no she is afraid of the kickback. Worker asked if Sarah had tried to call the school and Zoey stated no.
Located in the hardcopy documents to the child protection investigation were the requested records of police contact with the family from February 5th, 12th, 15th, and 18, 2015 and June 12, 2015 which is detailed earlier in this report, as well as incident reports for September 2, 2015 and October 20, 2015 (see incident report summaries below):
On September 2, 2015, Officer Cesar Kline was dispatched to Sarah Geiger’s home. When Officer Kline arrived, Reed Geiger and Josie Sawa reported that Sarah Geiger is going nuts because they were sitting in the van and accused them of stealing money out of her purse. Reed and Josie reported that Sarah turned over the BBQ grill. When Officer Kline interviewed Sarah Geiger, Sarah reported that Reed was calling her a bitch and she was tired of it. Sarah also reported that Reed was out of his medication.
On October 20, 2015, Josie Sawa’s mother Yasmin Geiger reported to police that her daughter has been staying with Sarah Geiger and has 7 unexcused absences. Officer Kline went to the home of Sarah Geiger with Yasmin Geiger. When they arrived Josie Sawa walked past the Officer and got in her mother’s car. Officer Kline told Sarah Geiger that if Josie comes to her home when she is supposed to be at school Sarah could be charged with harboring a runaway.
On December 7, 2015, the child protection investigation (SCR# 4444 E) was closed and the allegations of #84-lock out, #76-inadequate food, and #15-substance misuse were unfounded.
SCR# 4444 G
On October 29, 2015, while the E-sequence investigation was pending, an officer from the City G Police Department contacted the hotline to report that police responded to a disturbance involving Oscar Watson and his maternal grandfather Henry Regis. The G-sequence investigation was also assigned to CPI Victoria Huisel. The hotline narrative stated the following:
…Reporter explained that Sarah Geiger drops her children off to her parents [Henry and Isabelle Regis] every week for an unspecified amount of days. Reporter stated that Henry had taken his two grandchildren to church. Oscar (age 7) has a lot of behavior problems and that while at church he was throwing candy and was spinning Penny in a swivel chair and made Penny fall. Henry grabbed Oscar by the arm and they both fell. When Henry got up and he grabbed Oscar again and Oscar fell. No injuries or reports were made. When reporter spoke to Henry [he] explained that Sarah is always dropping the children off and he and his wife are too old to care for the children. Reporter stated that Henry was stooped over and weak. Henry reported that Sarah is bi-polar and cannot handle the children either.
CPI Huisel went to Sarah Geiger’s home to meet the mandate on October 29, 2015 and October 30, 2015 but no one answered the door. CPI Huisel documented that on October 30, 2015, she received a voicemail from Sarah Geiger. Sarah Geiger reported that she had been at the hospital with Penny.
City G Police Department Records
This same day, a City G Police Officer contacted Sarah Geiger by phone to schedule a time to interview her and Oscar at the police station. While on the phone, Sarah stated the following: “…She thinks her father has Dementia. He has anger issues, yells, and throws things. He starts fights with everyone. He has refused to get a psychological evaluation. She confronts him about it, and they argue. He has been like this for many years. He has thrown a table at Penny when she was a baby. He is literally insane. She was abused by him when she was a kid. She wants him to learn a lesson and have him put away. He has terrorized her. He is now banned from seeing her kids. He also is mean to her mother. She is going to call the Elder Abuse Hotline because for years he has yelled at her and pushed her around.” When the Police Officer asked Ms. Geiger why she left her kids with Mr. Regis if he has anger issues, she stated that she had to drop her kids off with her parents over the weekend because she was getting her van fixed. The meeting was scheduled for October 25, 2015 but Sarah did not show up for the meeting and on October 28, 2015, the Police Officer contacted the DCFS hotline to report the incident.
Penny Watson’s Hospital Admission from October 29-November 7, 2015
According to the hardcopy documents to SCR# 4444 E, on November 3, 2015 CPI Huisel faxed a request for Penny Watson’s medical records to Gamma Hospital. CPI Huisel also documented in a SACWIS contact note that on November 10, 2015 she contacted Gamma Hospital and requested medical records for Penny Watson.
On October 29th Penny Watson was hospitalized at Gamma Hospital for a lung infection. She was given a ten-day course of intravenous antibiotics. Penny was discharged on November 7, 2015. While she was hospitalized, several staff commented in the record that she was left alone and that her mother was uninvolved. Staff reached out to Sarah to see whether there was anything they could do to facilitate her visiting her daughter and Sarah said no.
On November 2, 2015, CPI Huisel interviewed Oscar Watson at City A Elementary School and documented the following regarding the interview:
…Oscar reported that his paternal grandfather “yanked his right arm and told him to come on. Oscar stated that Mr. Regis tripped on him and that he tripped on Mr. Regis. He stated that Mr. Regis yelled and that he got scared and found a hiding spot between two video games. Oscar indicated that he felt safe at home. He stated that he’s afraid of Reed because Reed hits him on the butt. He stated that his mom goes out and gets groceries and that Reed sends him to his room and doesn’t let him get out until his mom gets back. He stated that Reed doesn’t live with him anymore- he [Reed] lives with Val (adult sister) and Andy (paramour of adult sister). He stated that he doesn’t want Josie to live with them anymore because Josie smacks him on different body places. Investigator observed that Oscar was clean, appropriately dressed and well-groomed with no visible evidence of abuse or neglect.
Delta Health Systems
According to the hardcopy documents to SCR# 4444 H, on November 5, 2015 Victoria Huisel received a fax from Delta Health Systems. The fax included the CFS 968-90, Questions for Mental Health Professionals which was completed and signed by Brooklyn Frascatti and a patient prescription summary.
According to the completed CFS 968-90 Questions for Mental Health Professionals dated November 5, 2015, Sarah Geiger’s diagnoses includes: Axis I-Bipolar I Disorder, mixed, Panic/Anxiety/Cannabis Abuse; Axis II-Possibly Borderline; Axis III-Hypertension [High Blood Pressure] and Obesity; Axis IV-Moderate [psychosocial and environmental problems]; Axis V- Global Assessment of Functioning score- 40%. The form also documented that “Sarah is non-compliant with her recommended follow-up appointments. Last seen 9/3/2015.” Nurse Frascatti listed Sarah’s diagnosis as “fair to poor” and documented the following regarding her prognosis, “Unable to determine at this time although poor if she continues to be noncompliant.” Nurse Frascatti documented that Sarah is not compliant with treatment because she “does not take medication as directed.” Nurse Frascatti gave the following answers to these questions on the CFS form:
Do the client’s symptoms of mental illness place the child or children at an increased risk of maltreatment or harm? “Sarah’s symptoms may place her children at an increase of maltreatment.”
Are there long-term effects of the client’s mental illness symptoms on the child’s or children’s well-being that need to be considered in developing a treatment plan? “Highly possible.”
If the client’s current treatment plan is changed, will it likely bring about an improvement in the client’s parenting skills? “Yes, if she is compliant with follow up appointments and medication regimen.”
What would need to be, or could be, added to the client’s treatment plan that would improve the client’s parenting skills? “Therapy, skill building, anger management.”
According to the patient prescription summary located in the hardcopy documents to SCR# 4444 H, on September 3, 2015 Sarah Geiger was prescribed Wellbutrin 75mg twice a day (Antidepressant), Lamotrigine 50mg every morning (Mood stabilizer, treat depression and mania, used for mixed states), Geodon 20mg at bedtime (Antipsychotic, used to stabilize mood, maintenance treatment for bipolar disorder, helps with agitation) and Citalopram 20mg one a day (Antidepressant). All medications were prescribed with one refill and given a 30-day supply. In July 2015, Sarah was also prescribed Trazodone 100mg at night and given a 30-day supply with one refill. However, the medication was discontinued with the new prescriptions prescribed September 3, 2015.
In an interview with OIG investigators, intact worker Paige Barrett reported that she could not recall specifically seeing the CFS 968-90 form that OIG investigators found in the intact family services hard copy file.
In an interview with OIG investigators, supervisor Wendy Irwin reported that she had not seen the form prior to the interview with the OIG and stated that had she seen the CFS 968-90 form during the investigation “action” would have been taken.
On November 12, 2015, intact worker Barrett went to the home of Sarah Geiger for an unannounced home visit. Intact worker Barrett documented the following in a SACWIS contact note regarding the home visit:
…Worker knocked several times on the door. Worker heard Oscar and Penny laughing upstairs. The window was open and worker yelled for them to come to the window. Penny stated that her mother was down stairs smoking and please don't take my mommy away. Worker knocked on the back door and then heard Sarah yell something about answering the door. Oscar answered the door. Worker walked in and it smelled very strongly of marijuana smoke. Josie was sitting on the couch and stated Sarah was in the bathroom. Sarah came out and stated that Reed was just here and smoking pot. Worker stated she shouldn't allow him to smoke in the house. Especially because of Penny’s cystic fibrosis (lung condition). Sarah stated that it was her who was smoking pot in the house and that she makes Penny and Oscar stay upstairs. Worker stated she should not be getting high and taking care of her children. Worker was agitated and stated that this case was not seeing any progress. Sarah stated she has been keeping her house cleaner. Worker stated it has been a little bit cleaner. Worker asked if she had made any of her appointments at Delta for family counseling, substance abuse assessment, or anger management. Sarah stated no and asked if worker would call. Worker stated that was a little ridiculous that worker had to make the call since Sarah is fully capable. Worker stated Sarah has Delta’s phone number. Sarah stated that there was an incident last Sunday where Reed was asking to take the car, she told him no, and he wouldn't stop asking about it. He then started calling Oscar names and Sarah grabbed a belt and was telling him to get out of the house. She stated she was going to swat him on the butt with it. But he took it away from her and was trying to hit her with it. Worker stated these incidents were the reason for case opening and she is risking losing her other children. She stated she knows this. She stated she is thinking about calling SASS and having them go to Reed’s school to evaluate him. She stated she was going to call them the day it happened, but he went over to his dads and SASS won’t go there because his dad is not the one that called. Worker recommended that she call and talk to SASS and figure out what the best plan is. Worker asked if she had spoken to the school as worker recommended, she do last week. She stated no she had not called them.
On November 13, 2015, intact supervisor Quinn Carlson documented in an intact SACWIS contact note that due to Sarah’s lack of progress with intact family services if there was not improvement by the end of December, the intact case would be assessed for case closing. Supervisor Carlson noted that Sarah had not engaged in counseling for her family nor had she addressed her children’s mental health issues.
On November 13, 2015 at 10:25am CPI Bianca Little went to the home of Sarah Geiger to interview Penny Watson for CPI Huisel. [CPI Bianca Little first went to City A Elementary school at 10:00am to interview Penny Watson for CPI Huisel but was told by the school secretary that Penny was not at school that day.] CPI Little documented in a SACWIS contact note that when she arrived, she observed Penny come out of the apartment and go to the side of the building. CPI Little noted that Penny was dressed in a sleeveless pink ruffle dress, with no shoes, socks or coat and the current temperature was 55 degrees. When Sarah Geiger answered the door, CPI Little asked Ms. Geiger where Penny was, and Sarah yelled for Penny inside the apartment. CPI Little told Ms. Geiger that Penny was outside sitting on the side of the apartment building playing in the dirt. Ms. Geiger yelled for Penny to “get inside.” Ms. Geiger stated that she would talk to the landlord about getting a latch for the top of the front door. Ms. Geiger reported that Penny and Oscar both had colds this day, so they did not go to school.
While at the home CPI Little attempted to interview Penny. CPI Little documented that Penny stated, “mom does not spank her butt” and “she gets food to eat.” CPI Little documented that Penny “had no visible signs of any old or new injuries.”
Also, on November 13th at 2:15pm, CPI Huisel went to the home of the paternal grandfather Henry Regis. Mr. Regis reported the events that happened at church on October 19, 2015. Mr. Regis also reported the following:
…stated that he grabbed Oscar and he was going to put Oscar next to Isabelle Regis and he fell. He stated that a plain clothed officer gave him a lecture about how he's not supposed to grab a kid by the arm. He denied that Oscar had any marks or bruises. Mr. Regis stated that he was upset by the incident and that Oscar is unruly…Mr. Regis stated that he and his wife continue to care for the children but that they are too old. He pointed out that his wife walks with a cane and a walker…
The allegation of #74-inadequate supervision against Sarah Geiger for the G-sequence investigation involving Oscar Watson and his grandfather Henry Regis was indicated against Sarah Geiger and closed on December 28, 2015. The rationale for the indicated finding stated:
…Parent reported that she knew that the caregiver was inappropriate. The alleged perpetrator stated that the caregiver suffers from dementia and is literally insane. The alleged perpetrator stated that the caregiver abused and terrorized her as a child. Because the alleged perpetrator admitted that she left the minors in the care of the caregiver despite having knowledge of the aforementioned limitations, this investigator is recommending that the allegation of Inadequate Supervision be indicated.
SCR# 4444 H
On the evening of November 13, 2015, while the E and G sequence investigations were pending, Dayton Malone, a counselor from Reed’s school contacted the hotline to report that Reed stated that on Veteran’s Day (November 11th) his mother, Sarah Geiger poured water on him, swung a belt at him and the metal part hit him in the head. Reed also stated that his mother punched him in the nose and was high at the time. The reporter stated that Reed was now at his father’s home.
The H-sequence investigation was also assigned to Victoria Huisel. On November 14th, November 18th, and December 5, 2015 CPI Huisel went to the home of Troy Geiger to meet the mandate and interview Reed Geiger. There was no answer at the door and CPI Huisel left her business card. At a later attempted visit in December CPI Huisel documented that the card she left on November 18 had been removed.
On December 2, 2015, supervisor Wendy Irwin documented that CPI Huisel “will reach out to the Intact worker to see if she can get help with us making contact with the family.” On December 9, 2015, CPI Huisel documented that she met with intact worker Paige Barrett at the DCFS office and intact worker Barrett “agreed to explore ways she could assist.” On December 10, 2015, CPI Huisel documented that intact worker Paige Barrett left a voicemail with the following information, “…Paige Barrett stated that Reed is still living at his father’s house and that his father doesn’t want anything to do with the Department. She stated that Reed’s dad expressed that he doesn’t have to let DCFS in or speak with DCFS.”
In an interview with OIG investigators, intact worker Paige Barrett reported that she has never met or spoken to Troy Geiger but was told by Sarah Geiger that Troy Geiger wanted nothing to do with DCFS.
On December 11, 2015, CPI Huisel interviewed Reed’s school counselor, Dayton Malone, at the High School. Ms. Malone reported that following the incident in which Sarah Geiger hit Reed with a belt and punched him in the nose she observed the side of Reed’s face to be red. Ms. Malone also stated that on December 8, 2015, Reed came to school very tired and stated that he was up most of the night due to his mother getting hit by a car. Reed was too tired to concentrate so the school contacted Sarah Geiger to pick him up from school. Ms. Malone stated that Sarah Geiger appeared under the influence of something and had sunglasses on at the time of the pick-up. Ms. Malone reported that Reed was doing very well in school and was making very good grades.
While at the school, CPI Huisel interviewed Reed Geiger. When questioned about the incident that resulted in the November 13th hotline call Reed stated the following:
…He stated that he was hungry that day, so he made himself a Totina’s Pizza, Reed stated his mother wanted to know if he was going to share the pizza and Reed said you know how small a Totina’s pizza is no he wasn’t going to share it. His mother then grabbed a bottle of water and poured it on Reed’s head. She then told him to get the hell out of her house and if you step foot in the house again, she is going to beat Reed’s ass. He then came back in the house to get his clothes and he said that his mother grabbed a belt and started hitting him with it, Reed stated that his mother hit him in the head and face with the metal part of the belt. He stated that he was trying to defend himself, so he grabbed the belt and broke it in half and was hitting her with it. Reed stated that he had some red marks on his face, CPI observed no injuries to Reed’s face. Reed stated that it did not hurt just made him mad…Reed reported that his mother was high on marijuana at the time this occurred, and he stated that he knew because he had seen her smoking a bowl with his little cousin Josie Sawa who is 15…
On December 22, 2015 at 12:50pm, CPI Huisel went to the home of Sarah Geiger and interviewed Sarah Geiger, Josie Sawa (Sarah Geiger’s niece), and Penny and Oscar Watson. [CPI Huisel documented in a contact note that the parenting coach was present at the home at the time of the interview with Sarah Geiger on December 22, 2015. There is no contact note regarding an interview with the parenting coach.] When asked about the incident between Sarah Geiger and Reed, Sarah Geiger stated that she used a belt to threaten Reed but denied punching Reed or hitting him with the belt. Sarah Geiger stated that Reed took the belt from her by sticking his foot on her sternum and ripping it from her. Sarah Geiger stated that Reed raised his fist like he was going to hit her but then went outside and she went back inside. Sarah Geiger stated that Reed is disrespectful, and she is considering getting a restraining order. Sarah Geiger reported that the argument started because Reed put a whole pack of pizza rolls on a tray and refused to share. Sarah Geiger denied pouring water on Reed or throwing objects at Reed and denied being high or smoking marijuana with her niece, Josie Sawa. During CPI Huisel’s interview with Penny Watson, Penny reported that she did not feel safe at home because her brother Oscar is always hitting her. CPI Huisel documented in a contact note that Oscar Watson reported that “he does not feel safe at home and stated that his mom beats him with hangers and belts.” CPI Huisel documented that no injuries were observed.
Also, while at the home on December 22, 2015, CPI Huisel interviewed Sarah Geiger’s niece, Josie Sawa, whom was also living in the home. CPI Huisel documented the following regarding the interview:
…She stated that on the day of the incident, Reed was making pizza and he always eats all the food and doesn’t leave anything for dinner. She stated that Ms. Geiger got mad and that she and Reed got into a fight. She stated that Reed was calling Oscar gay. She stated that Reed and Ms. Geiger were hitting each other with a belt. She stated that Reed hit Ms. Geiger first but that Ms. Geiger threw water on Reed which started the physical altercation. She stated that Reed and Ms. Geiger were hitting each other as they were going out the door. She stated that the cops showed up after that and Reed walked away from Ms. Geiger. She stated that Reed and Ms. Geiger had marks on them but she didn’t remember where the marks were. She stated that both were equally guilty.
On January 12, 2016, the allegation #11-cuts, bruises, welts abrasions and oral injuries against Sarah Geiger for the H-sequence investigation was unfounded. The rationale for the finding stated:
This case was brought to the attention of the Department because it was reported that alleged perpetrator hit 16-year old child victim with a belt buckle and punched teenager in the nose causing injuries. No injuries were observed by adult sibling who picked up child victim from alleged perpetrator’s home. Reporter and identified witness observed injuries but non-offending parent did not provide access to child victim so that injuries could be assessed by investigator. Investigator did not observe any injuries. Furthermore, alleged perpetrator denied the allegation. Due to lack of sufficient evidence that the child victim had an injury or that the injury was caused by the direct action of the alleged perpetrator, this investigator is recommending that the allegation of cuts bruises welts and abrasions and oral injuries be unfounded.
SCR# 4444 I (Indicated)
On December 22, 2015, while the G and H sequence investigations were pending, and the same day CPI Victoria Huisel conducted a home visit to Sarah Geiger’s residence for the H-sequence investigation, school social worker Cassidy Newman from City A High School contacted the hotline with the following information:
Reporter states that reporter went to the home to deliver gifts today. Reporter states when reporter arrived, Oscar was outside with no shoes or socks and no coat. Reporter states that Oscar said that he was afraid to go inside because his mom will smack him again. Reporter states that Oscar said that his mom hits him all the time and hits him with a belt and hanger on the butt. Oscar said that his mom has left marks many times. Reporter states that Oscar took reporter inside the home. Reporter states that the home smelt [sic] like marijuana. Reporter states that Sarah started screaming at the top of the stairs and Oscar started trembling and acting scared. Reporter states that when Sarah noticed the reporter she stopped the screaming and complained about the kids not behaving. Reporter states that Sarah said that she was having a nervous breakdown. Reporter states that there was a big dog in a little cage and cats jumping all over the place. Reporter states that the living room was a mess and dirty all over. Reporter states that Sarah is Bipolar and is taking her medication. Reporter states that Sarah was going from emotional extreme to another. Reporter states that Sarah appeared to be intoxicated and her eyes were red. Reporter states that Josie [Sarah’s niece] has said that she uses marijuana to treat her anxiety. Reporter states that Josie also appeared to be intoxicated and her eyes were all red. Reporter states that Josie has been staying with Sarah for the last 5 months because her home life is worse than being with Sarah. Reporter states that Sarah is Josie’s aunt by marriage. Reporter states that OPWI (Yasmin Geiger, Josie’s mom) has a warrant for her arrest for truancy. Reporter states that she called the police and City A police officer came to the home. Reporter states that Sarah was having major emotional swings. Reporter states that Sarah was very worried about getting arrested. Reporter states that Oscar has a learning disability and emotional problems.
Included in City A High School records, obtained by OIG investigators, was a, Written Confirmation of Suspected Child Abuse/Neglect Report: Mandated Reporters form completed by school social worker Cassidy Newman and dated December 22, 2015. The form stated the following:
The child [Oscar Watson] said “My mom hits me all the time, with hanger or whatever she can find.” The child was trembling when mom yelled at him. He also started crying and went into fetal position because he was so scared of mom when she was yelling... I talked to Oscar around noon, he was riding a bicycle with no socks or shoes or jacket (short-sleeve shirt) and it was cold outside. I asked Oscar why he didn’t have socks/shoes on and he said they were inside and didn’t want to go inside because he didn’t want to get hit again by his mom. When I first walked into Sarah’s apartment, I smelled marijuana smoke. Sarah was screaming at her children from upstairs. She didn’t know I was there. Josie let me in... I do not work closely with Oscar or Penny. I was there to see Josie who has been staying with Sarah…I called the police to come talk to Sarah because she was screaming at her kids when I got there. There were cats climbing on counters, cat food on the counters by food products. It smelled like animal urine and feces in the apartment. Sarah’s mood swings were very evident (angry, crying, laughing, polite) even though she said she was taking her medication for bipolar disorder Sarah said she didn’t have medication for anxiety because they won’t prescribe it to her because she was addicted to it…
The child protection investigation was assigned to CPI Bianca Little and supervisor Wendy Irwin. On December 23, 2015, the day after the hotline call, CPI Little contacted intact family services worker, Paige Barrett. CPI Little documented that Paige Barrett reported that the family has a homemaker. Intact worker Barrett reported that Sarah works in the morning and Sarah’s ex-husband’s ex-wife, Diana Geiger, watches the children while Sarah Geiger works.
This same day, CPI Little went to the home of Sarah Geiger but no one answered the door. CPI Little left messages for Sarah Geiger, Yasmin Geiger, school social worker/reporter Cassidy Newman, and Valerie Geiger requesting a return call. CPI Little also contacted the maternal grandmother, Isabelle Regis on December 23rd. Ms. Regis reported that her grandchildren are with Diana Geiger but she did not have an address or telephone number for Diana. CPI Little asked Ms. Regis to tell Sarah Geiger to call her.
On December 24, 2015, CPI Little met with CPI Victoria Huisel at the DCFS office to discuss the case. CPI Little documented the following in a contact note:
…Victoria CPI has 3 pending investigations on the alleged perpetrator. Victoria CPI stated the following; The babysitters name and telephone number is Diana Day XXX-XXX-XXXX. She received a call from the alleged perpetrator yesterday. She received the babysitter’s name and telephone number. She admitted she was at the home on the same day this report was called into the hotline. She denies smelling any Marijuana in the home on 12-23-2015. The Parenting Coach was also in the home when she was there on yesterday. There was nothing stated to her or observed which would indicate the alleged victims were being abused or neglected…
There are no documented contacts in SACWIS for 31 days from December 25, 2015 to January 24, 2016.
Intact worker Paige Barrett conducted a home visit on December 17, 2015, five days prior to the December 22nd hotline call. Intact worker Barrett documented that Oscar and Penny were observed to be safe and free of signs of child abuse and neglect.
On January 5, 2016, intact worker Paige Barrett interviewed advanced nurse practitioner Brooklyn Frascatti from Delta Health Systems. Nurse Frascatti reported that Sarah Geiger was assigned a new counselor for the medication management program in September and provided Ms. Barrett with contact information for the new counselor, Nurse Freya Olmsted. Nurse Frascatti reported that Sarah has not been medication compliant and stated that Sarah was last seen at Delta on December 29, 2015, however prior to that visit, she was seen on September 3, 2015 and given a prescription for a 1 month supply of medication. Nurse Frascatti reported that Sarah was inappropriate in their sessions and noted that Sarah is moody and impulsive and has tried to get controlled substances. Nurse Frascatti reported that Sarah’s diagnosis is Bipolar I disorder and most recently depression. Nurse Frascatti stated that individual counseling has been recommended but Sarah has not followed through on the recommendation.
According to Delta Heath Systems records obtained by OIG investigators, in addition to the information above, Nurse Frascatti recorded that she stated that she felt that Sarah’s children should not be exposed to Sarah’s behaviors and lifestyle and the DCFS ‘social worker’ agreed. The notation, however, was entered after Penny Watson’s death. Intact worker Barrett documented that she attempted to visit the family on January 7, 2016 and January 14, 2016 but no one answered the door.
Intact worker Barrett documented that during the January 14th attempt Sarah’s car was at the home and the upstairs window was open. Intact worker Barrett returned to Sarah Geiger’s home on January 22, 2016 and documented the following regarding the home visit:
Worker conducted scheduled visit for purpose of safety check and case progress. Both kids were observed to be safe and free of signs of CA/N. Oscar was playing video games and Penny kept asking Sarah to get her something to eat. Penny’s hair was not combed, and she did not have any pants on. Worker asked if they went to school today. She stated no Penny is on an antibiotic for strep that she got last week. Worker stated she should be okay to go to school if she's been on the antibiotic for more than 24 hours. Sarah stated she and Oscar did not eat much yesterday so she didn't want to send them to school today. Worker stated she spoke to Brooklyn Frascatti at Delta (Sarah’s old counselor). Worker stated Brooklyn looked into the computer and said that Sarah had an appt in September and then not again until December 29th. Which meant Sarah should've been out of meds for two months. Sarah stated she had a stockpile of medicine for when she was in the hospital. She stated she was taking medicine the whole time. She did say she ran out of one of them (i believe Celexa) for two days but called to get some more. She stated she is now out of her stockpile of medicine. But has the medicine she was prescribed on 12/29/15. Sarah stated she has not yet signed up for family counseling, anger management, or substance abuse assessment. Worker stated she thought Sarah’s case may be closing soon. Worker discussed how there has not been a lot of progress in home organization, structure, discipline, or substance abuse, or anger management. Worker stated she has not gotten through much of the parenting program that the parenting coach has to physically help Sarah through the chapters instead of Sarah doing them on her own and then discussing them with coach like most clients. Sarah stated the coach comes on Tuesdays when Sarah is trying to do her homework, so she has the coach read them to her while she is doing her homework. Worker stated Sarah needs more organization and less procrastination. Sarah needs to arrange her priorities. Worker stated she could've arranged the coach to come on another day. Worker also phoned Bianca Little investigator and set up a visit for Bianca to come out on Monday at 3:30 to discuss the most recent investigation. Worker stated Sarah has had several investigations and she is seriously risking losing her children by getting all these investigations. Worker stated if she gets more than one indicated report for the same thing her kids could be taken. Worker advised her to ensure she appropriately supervises her children and not get in any altercations with them. Sarah stated she did not throw anything at Nicole who claimed that. She stated she is doing the best she can considering she has so many kids, goes to school, and was working. She stated her older children have it out for her and kept calling in false DCFS reports on her. Sarah stated when she lived in City C, she didn't have DCFS called on her one time and she had people to help her. She is thinking of moving back there. She is going to keep Reed and Nicole away from her because she does not want any more reports. She stated she is planning on getting another job.
Intact supervisor Quinn Carlson documented in a supervisory contact note in the intact family services record that on January 25, 2016 she contacted child protection investigator Wendy Irwin by phone to discuss the case. Supervisor Carlson documented the following:
Phoned Wendy Irwin, CP supervisor to discuss plans for case closure once they complete the pending investigation. We discussed and agreed that this latest incident does not rise to level of imminent risk of harm and there is not anything to take before the court. Wendy stated that they will look at her most recent mental health stuff before making a decision regarding the final finding. Explained all of the services we had provided over the past months and Sarah’s lack of change although she did for all practical purposes participate in the service. Advised that worker has consistently spoken with Sarah about her marijuana usage, but Sarah does not see any problem with it. Once they receive the required mental health documentation, she will make a decision and let me know.
On January 25, 2016, intact worker Barrett documented that she went to Sarah Geiger’s home to conduct a home visit and meet CPI Bianca Little. Intact worker Barrett documented that when she arrived at the home, she informed Sarah Geiger that the intact family services case would be closing this week due to lack of progress and she would no longer receive parenting services. Intact worker Barrett also noted that the home smelled like marijuana.
In an interview with OIG investigators, intact worker Paige Barrett reported that during visits she would try to interview Oscar and Penny alone away from Sarah Geiger, but the children would not say much as it appeared the children had been coached.
Also, on January 25, 2016, thirty-four days after CPI Bianca Little’s one failed attempt to see the family, CPI Little documented that she returned to Sarah Geiger’s home to interview the family. CPI Little documented the following regarding her interview with Sarah Geiger:
…She denied giving Josie (15 years old) Marijuana. She denied allowing her kids to be outside with no shoes, no socks, or coats. She denied smacking Oscar or Penny. She denied hitting the kids with hangers or belts on the butt. She denied smoking Marijuana. She denies screaming at Oscar causing him to be afraid. She admits she is tired of the school calling in on her. She admits she will just move to City C. She admits she has not complied with Parenting, Family Counseling, Anger Management referred by DCFS. She admits she was unable to attend the services as she was working at that time. She admits she is not working at this time. She admits she is Bi-Polar and takes medications. She allowed this CPI to see her medications and make [note] of them in the file. Citatopram 1 every day and Bupropion 75mg twice daily. She admits she has to [pay] 579.00 per month for her van. She admits getting 733.00 per month SSI. She admits she pays 675.00 per month rent. She denies abusing/neglecting her kids. This CPI stated based upon the information received, and her statements, the allegation against Oscar and Penny would be indicated but the allegation towards Josie would be unfounded. The alleged perpetrator stated no one is taking her kids. This ended the interview at this time. She pays 220.00 car Insurance.
While at the home, CPI Little interviewed Oscar Watson. CPI Little documented that Oscar was playing video games at the time of her interview and would only nod his head to her questioning. CPI Little documented that Oscar, “…nodded his head he was ok when asked. The alleged victim [Oscar] nodded his head he was not afraid of his mother when asked. The alleged victim [Oscar] nodded his head he was not hit with belts and hangers when asked….” CPI Little documented that she did not observe any old or new marks on Oscar. CPI Little attempted to interview Penny Watson while at the home, but Penny was running around playing with the cats in the home and would not answer any questions. CPI Little documented that she did not observe any old or new marks on Penny.
CPI Little also interviewed Sarah’s niece, Josie Sawa while at Sarah Geiger’s home. Josie admitted that she smokes marijuana with her friend but denied that Sarah Geiger allows her to smoke marijuana or gives her marijuana to smoke. Josie reported that she helps with Oscar and Penny and stated that she liked living with Sarah Geiger. CPI Little documented that there was no smell of marijuana while at the home.
On March 21, 2016, the Sequence I investigation was closed. Allegation #74-inadequate supervision and allegation #60-substantial risk of physical injury by neglect were indicated against Sarah Geiger. The rationale for indicating #74 stated that on December 22, 2015, Sarah was unaware that her son Oscar (age 7) was found outside the family’s home alone with no shoes, no socks, and no coat. The rationale for indicating #60 stated, “…Mom was acting erratic when mandated reporter was at the house, mom was yelling and screaming due to being upset. Sarah has a diagnosis of Bipolar and has an open case in which she is supposed to attend Anger management which she has not completed per the caseworker. Caseworker also states Sarah has not been compliant with counseling or parenting. Due to this, the minor is put at risk by Sarah’s mental health issues.”
Allegation #15-substance misuse and allegation #10- substantial risk of physical injury were unfounded against Sarah Geiger for the I-sequence investigation. The rationale for unfounding allegation #15- substance misuse stated that the alleged victim Josie Sawa denied that Sarah Geiger gives her marijuana. The rationale for unfounding allegation #10-substantial risk of physical injury stated, “…The alleged victim denied being hit with belts and hangers. The alleged victim denied being scared of the alleged perpetrator. The alleged victim was observed to have no old or new marks on his person…”
SCR# 4444 J (Indicated)
On January 28, 2016, while the I-sequence investigation was pending, school social worker Eliza Pena from City A Elementary School contacted the hotline with concerns regarding the care of Oscar and Penny. The hotline narrative stated the following:
Reporter states that on 01/28/16, Penny Watson (age 4) was crying and showed reporter a ''mark'' on her right lower arm near the wrist and disclosed that it was from mother Sarah Geiger hitting her and smacking A-26 PENNY WATSON her this morning. Oscar Watson (age 7) confirmed this story and disclosed that the abuse is ongoing and he gets hit with broken hangers and belts. Oscar states that he tries to hide in his closet when he knows he's going to get hurt. Reporter is unaware of current injuries to Oscar. Oscar states he's so tired of the yelling in the home, so he goes outside and sits outside until things get calm. Reporter states there are also supervision issues with Sarah. On 01/28/16, Sarah was 90 minutes late picking Penny up and 55 minutes late picking Oscar up. Sarah is diagnosed with Bipolar disorder. Oscar is diagnosed with ADHD. Penny is diagnosed with Cystic Fibrosis. The family has a history of DCFS involvement. Maternal Grandparents are a support system…
In an interview with OIG investigators, Eliza Pena reported that in January 2016 she was concerned with the lack of response by DCFS, so she began documenting her conversations with Oscar and Penny as well as DCFS staff. Ms. Pena documented the following on January 28, 2016:
Both kids late today and without breakfast. Both reported mom yelling and smacking on Penny. Josie was there too and was yelling. Penny and Oscar both reported mom smacking her on the leg and arm several times. Oscar said this is our family every morning. Oscar reported that the hanger and belt are the worst. Josie hits them with a broken hanger and mom hits them with a belt. He said that he makes a hiding place in his room with his toy boxes – he use[d] to but no[w] he hides in the closet or goes outside until things are calmed down. When I come back in I can hear Penny crying like crazy and screaming for someone to save her from mom or Josie.
On January 28, 2016, CPI Gwen Rivas documented that she was initiating the report for the primary investigator, Bianca Little. CPI Gwen Rivas went to City A Elementary School to interview Penny and Oscar Watson. CPI Rivas documented the following regarding her interview with Penny:
…She [Penny Watson] reported that Josie and her mom smacks her every time and it makes her mad. The minor stated that mom and Josie hits her with a belt or broken hanger. CPI inquired if minor was afraid of anyone in her home and she stated monsters. CPI asked if monsters had a name and she stated "monsters". CPI observed minor to have a small scratch on her hand but no other injuries.
CPI Rivas documented the following regarding her interview of Oscar Watson at City A Elementary School:
…CPI observed minor [Oscar Watson] not to have any visible injuries and minor denied being in any pain. The minor stated he lives with his mom, Josie and sister (Penny). The minor stated that mom hits with a belt and Josie hits him with a broken hanger. The minor stated it's a lot of screaming and yelling in the home. He reported that he goes outside to color or draw until it's calm. The minor denied being afraid of anyone in the home. The minor stated his dad (Wes [Zach] Watson), is his favorite person and he lives in City H, Mo. The minor stated he does not see him a lot.
Following her interviews with Oscar and Penny Watson, CPI Rivas went to the High School to interview Josie Sawa. Josie reported that she is currently living with Sarah Geiger but is tired of watching Oscar and Penny. When asked if she had ever witnessed Sarah hitting Oscar and Penny, Josie stated the following:
…we don’t hit the kids (Penny and Oscar) anymore and minors were only hit with a belt a long time ago…The minor [Josie Sawa] stated that she does scream at minors but it’s better than Sarah dealing with minors because she is bipolar and she is easily overwhelmed. The minor stated that Sarah has a hard time dealing with her children and she wants the minors to be safe, so this is why she stays too.
While at the home, CPI Little attempted to interview Oscar and Penny Watson however both were preoccupied playing with each other. Oscar denied being hit with hangers or belts and Penny was too busy playing to answer questions. CPI Little documented that neither Oscar nor Penny had new or old injuries. A-27 PENNY WATSON CPI Little documented that there were 6 cats in the home and 1 dog and that the home smelled somewhat of animals but there was no marijuana smell. CPI Little observed food in the home during the visit.
On February 1, 2016, intact supervisor Quinn Carlson documented in a supervisory contact note in the intact record that the intact case would remain open until the child protection investigation was completed. This same day, intact worker Paige Barrett conducted a home visit to the home of Sarah Geiger. During the home visit Sarah reported that she kicked Josie out of the home and was trying to be the best parent she could be.
Also, on February 4, 2016, supervisor Wendy Irwin received a return a call from school Social Worker Eliza Pena. Supervisor Irwin documented the following regarding the phone call:
PSA returned a call from Eliza Pena, school social worker. She states Penny and Oscar have not been back to school since last Friday [January 29th] when DCFS came out and interviewed them about the hotline report she made. She has called Sarah who said they were sick. She went out with the resource person and saw the kids but did not feel like they were sick. Today they are not in school and when she called Sarah she told her she was in City I. She is very concerned because she doesn't have them in school, she yells at them, and they come to school upset stating she hits them. She also discussed the issue of mom not having Oscar’s medication for ADHD filled punctually and if he doesn't have his medication he is disruptive. PSA explained that the medication issue should be communicated to the [intact] case in which Eliza responded she doesn't know who the [intact] case worker is as she has only spoke to her one time last year and when she did tell her the concerns she had Eliza felt that she blew her off. PSA gave caseworker Paige Barrett’s name to Eliza and her phone number. PSA also discussed that we do not deal with educational neglect. Eliza states she understands this. PSA then discussed her other concerns about mom yelling and hitting them. PSA explained that we can't do anything about a parent yelling it may not be the best way to parent but it is not abuse/neglect. We then discussed the minors reporting their mother hits them but they do not have any injuries from being hit by mom. PSA explained that based on this, we would not remove the children but discuss this with mom especially since she has a caseworker. PSA explained that CPI Bianca Little and CWS Paige Barrett went out on Monday and talked to mom about this report and that she needs to cooperate with services that her caseworker is offering. Eliza thanked PSA for returning her call and giving her the caseworkers name and number. PSA asked Eliza to let her know if the minors return to school tomorrow or not as Sarah told Eliza she would have them at school tomorrow. Eliza said she would.
Eliza Pena reported to OIG investigators that she had no knowledge that the family was involved in intact family services until she spoke to Wendy Irwin on February 4, 2016.
Eliza Pena documented that on February 5th she left a message for Intact worker Paige Barrett and on February 8 th she received a return call. Eliza Pena documented the following regarding her conversation with the intact worker:
Caseworker called me back and I expressed all the concerns Re: medication, absences, not picking up the children on time, the children being told not to talk about home at school. Both children stating they are scared of mom and don't want to be there. I let her know I am considering writing a letter to the state regarding my concerns.
Intact worker Barrett documented that she explained to Eliza Pena that services had been provided for the family and that “there has to be enough evidence to take the case to court.”
There are no documented attempts to see the family until February 9, 2016, when intact worker Barrett attempted to visit the home of Sarah Geiger, but no one was home.
On February 16, 2016. Intact worker Barrett visited Sarah’s home and explained to Sarah that the intact case would remain open and the intact worker would assess the safety of the children until the child protection investigation was closed. Intact worker Barrett documented that she “observed Oscar and Penny to be safe and free of signs of child abuse and neglect.”
On February 25th Ms. Pena documented that Oscar reported that DCFS told his mom that if they get another call on her, the kids are going to go into foster care, and she would go to jail. Oscar also reported that they are going to move and not give DCFS their new address so DCFS can't find them.
On March 21, 2016, the Sequence J investigation was closed. Allegation #74-inadequate supervision was indicated against Sarah Geiger. The rationale for the indicated finding stated that Sarah Geiger failed to pick up her children Oscar and Penny on time and school personnel were unable to reach her.
Allegation #11-cuts, bruises, welts, abrasions and oral injuries and allegation #10-substantial risk of physical injury were unfounded against Sarah Geiger. The rationale for the unfounded investigation for allegation #11 stated that on February 2, 2016 the investigator and the intact caseworker, “…visited the home and observed no mark on the alleged victim’s [Penny Watson] arm or any old or new injuries. The alleged victim did not disclose any abuse by her mother as she would not talk with the CPI or CWS caseworker as she was preoccupied playing. The alleged perpetrator and Other child [Oscar Watson] in the home denied hitting the alleged victim with belts and broken hangers.” The rationale for the unfounded investigation for allegation #10 stated that Oscar Watson denied being whipped with broken hangers and belts by the alleged perpetrator and no old or new injuries were observed.
SCR# 4444 K (Indicated)
On February 18, 2016, while the I and J Sequence investigations were pending, the Hotline received two calls concerning the Geiger Family from the City A Police Department and City A School. On February 17th, Sarah Geiger had left her children with a new babysitter. While out, Sarah was arrested for an outstanding warrant. She asked the babysitter to keep Oscar and Penny overnight because she was in jail. The babysitter brought the children back to the school and school personnel contacted the police. Penny needed to have enzymes every time she eats, and Sarah had not provided the enzymes to the babysitter. The babysitter was also not given Oscar’s ADHD medication and the school reported that he could not function without it. The maternal grandfather, Henry Regis, agreed to care for the children for the night.
Following the February 18th hotline calls, CPI Bianca Little went to the maternal grandparent’s home. Henry Regis reported that Oscar and Penny went home with their mother earlier that day.
After going to the maternal grandparent’s home, CPI Little went to the home of Sarah Geiger. While at the home, CPI Little documented that she attempted to interview Penny Watson, but Penny would not talk to the investigator. CPI Little also documented that Oscar did not want to be interviewed because he wanted to go outside to ride his bike. CPI Little documented that there were no signs of any old or new injuries on either Oscar or Penny. This was the last documented in person contact that CPI Little had with the family prior to the death of Penny Watson in April 2016.
In an interview with OIG investigators, CPI Bianca Little reported that she was surprised when she heard about the death of Penny Watson due to Sarah’s positive demeanor during the interview on February 18th. CPI Little reported that in past interviews Sarah acted upset that DCFS kept coming to the home and would usually be wearing a robe even though it was the middle of the day “but on this day she [Sarah] seemed happy, she was dressed for the day and the kids were okay.”
Located in the hardcopy documents to the K-sequence investigation were incident reports from the City A Police Department for incidents that occurred on September 5, 2015, October 7, 2015, and October 20, 2015.
Also, on March 21st, CPI Little contacted Oscar’s primary care physician’s office. An office associate reported that Oscar was last seen for a well-child exam on July 16, 2015 and there were no concerns of abuse or neglect reported in the file.
According to the intact family services record, intact worker Barrett conducted a home visit on March 13, 2016 at Sarah Geiger’s home. Intact worker Barrett documented that “…Oscar, Penny and Sarah’s ‘friend’ Hank were at the home.” This was the last documented in person contact that intact worker Barrett had with the family prior to Penny Watson’s death in April 2016.
On March 15, 2016, intact worker Paige Barrett left phone messages for Sarah’s nurse practitioner Freya Olmsted at Delta Health Systems and Oscar’s counselor at Delta Health Systems requesting a return call. Intact worker Barrett documented that on March 28, 2016, she interviewed Oscar’s counselor. The counselor reported that Sarah was supposed to come to the office for some paperwork and case management, but she did not show up. The counselor reported that he has been meeting with Oscar for 20- minute sessions at City A Elementary School. The counselor reported that school staff do not think Oscar is getting his medication due to his behavioral issues. The counselor reported that family counseling has been recommended but Sarah has not followed through.
On March 28, 2016, CPI Little contacted school social worker, Eliza Pena. Ms. Pena reported that on January 28, 2016, Sarah Geiger was late picking Oscar and Penny up for school and school personnel were unable to reach Sarah Geiger. Ms. Pena stated that Penny was taken to the afternoon preschool classroom to wait. Ms. Pena also reported that this has happened previously.
On March 29, 2016, intact worker Paige Barrett documented that she interviewed Sarah’s case manager [Iris Torres] at Delta Health Systems. The case manager reported that Sarah came to Delta to set up individual counseling, but Sarah did not mention family counseling. The case manager reported that Sarah had not been consistent about keeping her appointments. When intact worker asked if Sarah had requested a substance abuse assessment, anger management services and getting her medication prescriptions regularly the case manager reported that the intact worker would have to contact those individual departments to find out that information. Intact worker Barrett documented that she left a message for Freya Olmsted at Delta requesting a return call on March 30, 2016.
According to Delta Heath Systems records obtained by OIG investigators, Sarah Geiger attended a medication management appointment with Advanced Nurse Practitioner Freya Olmsted on March 30, 2016. According to the record, during the appointment Sarah Geiger rated her anxiety as 10 or more out of 10 and depression an 8 out of 10 (10 being the worst). At the appointment, Nurse Olmsted increased the dosage for Wellbutrin (for anxiety and depression) and added Buspar to Sarah’s medication regimen. Also included in the records obtained by OIG investigators was a contact note written by Nurse Olmsted on June 3, 2016 (after the death of Penny Watson) regarding phone contact with intact worker Paige Barrett on March 31, 2016:
. . . I discussed with her what happened with the children at the appointment on 3/30/16. How the young girl [Penny Watson] appeared to be afraid of the mother in response to the mother’s grabbing her and how the mother was obnoxious and abrasive toward the children. Also discussed with the DCFS worker that Sarah was noncompliant with taking her medications and keeping her appointment with this provider.
There is no documented contact note in the intact family services record between Paige Barrett and Nurse Olmsted on March 31, 2016. However according to the service plan approved on April 1, 2016, intact worker Barrett documented the following regarding Sarah’s participation in recommended mental health treatment to address her bipolar diagnosis and rated Sarah’s progress as Unsatisfactory:
Sarah has not been on time for appointments and has missed appointments. She was seen in December, February and March. She has made appts that keep her medicine compliant and has not run out this reporting period. Sarah is still wanting to switch providers and asking for Xanax. Prescribers will not give it to her. Today was her first counseling session with June Selock. She has not initiated family counseling. Diagnosis is Bipolar, Depressed and Cannabis Use. She tested positive for THC [marijuana] on 3/30/16.
Four days after the death of Penny Watson, the Sequence K investigation was closed, and Sarah Geiger was indicated for #74-inadequate supervision. The rationale for the indicated finding stated that the babysitter reported that she had never met Oscar prior to picking him up from school the day that Sarah was arrested and was unprepared to care for Oscar and Penny following Sarah’s arrest.
Allegation #79-medical neglect was unfounded against Sarah Geiger. The rationale for the finding stated that according to the cystic fibrosis clinic at Ksi Hospital, Penny was last seen on February 26, 2016 for a routine check-up and due to Penny’s age, there was no way to determine if Penny had been receiving her treatments.
In an interview with OIG investigators, Area Administrator Wendy Irwin (previously child protection supervisor) stated that prior to the death of Penny Watson, she did not believe that the case would have been accepted for screening with the states Attorney’s Office. Ms. Irwin reported that following the death of Penny Watson, DCFS staff met with area judges regarding accepting these types of cases for rules of supervision when a case did not rise to the level of taking protective custody. In separate interviews, Wendy Irwin, Quinn Carlson and Paige Barrett reported that the judges in the local counties are now accepting the cases for orders of supervision.
Death of Penny Watson
In April 2016, Officer Lucas Terry from the City A Police Department contacted the DCFS hotline to report the death of Penny Watson. The hotline narrative stated the following:
…Officer Terry says that an unknown doctor at Beta Medical Center pronounced Penny Watson dead due to homicide, at 3:21 PM today. Penny was going to turn 5 tomorrow. The mother's roommate (Hank Day, not related and not a boyfriend) said that he came home and saw Sarah in the living room sitting on top of her daughter Penny, with Sarah’s hand over Penny’s nose and mouth, saying that she is going to send Penny to Jesus. Penny wasn't breathing. Oscar (aged 8) was in the living room, watching all of this. The roommate [Hank Day] called 911 at 2:27 PM, within minutes of his arrival. Officer Vincent arrived first and had to fight Sarah in order to have access to Penny. The roommate helped Officer Vincent wrestle with Sarah and the roommate held Sarah to the ground while Officer Vincent carried Penny outside and started CPR. The roommate showed an officer text messages on Sarah’s phone, in which she had written that she was going to take Oscar’s life also. Sarah was suicidal and was trying to kill herself, so she was transported to Lambda Hospital, where she is now. The child's body is at Beta Medical Center…
According to Beta Medical Center records, Penny Watson arrived at the hospital, “unresponsive, no obvious hematoma's or lacerations to head/scalp noted. Pupils fixed and dilated, petechia noted to eyelids and area around eyes.” Upon arrival Penny was given multiple rounds of medication however Penny remained asystole throughout and was pronounced dead at 4:15pm.
Sarah Geiger was taken to Lambda Hospital on the day of Penny Watson’s death accompanied by City A police officers. According to medical records upon admission Sarah displayed bizarre/paranoid behavior and was sexually inappropriate. Shortly after admission Sarah calmed down and was remorseful about her behavior and reported she was no longer suicidal. When staff tried to administer an injection of Haldol and Lorazepam, Sarah had to be placed in a 4-point restraint for the injection. The medical report states that Sarah was cursing, making racial slurs and was sexually inappropriate.
According to the Office of the Medical Examiners autopsy report Penny Watson’s immediate cause of death was asphyxiation by suffocation and neck compression. The death was ruled a homicide.
The child protection investigation of the death was assigned to CPI Keith Walls. CPI Walls documented the following regarding a forensic interview of Oscar Watson at Mu Agency the day of Penny’s death:
He [Oscar Watson] stated he lives with his mom, sister, Penny and Hank. Oscar said if he lied he would burn in Hell Oscar reports- His mom was humping his sister Penny She had her hand over Penny’s mouth (he demonstrated this) He said Penny was on the ground playing with her dolls, his mom "got on her", Penny was laying on her belly and his mom got on her laying the same way. He said his mom was on Penny’s head, indicated her chest was on Penny’s head. He said his mom's hand was on Penny’s mouth and it was tight. Penny didn't make a "peep." and that "she was dead." Hank was not home when Hank got home, he called the police and was crying and talking to Oscar’s mom. Oscar reported humping is having the "s" word. He stated it’s like "when people suck that" and pointed to his genitalia. He reported during the incident his mom was naked and his sister was clothed.
Located in the child protection hard copy file was a letter authored by clinical psychologist Lewis York, Ph.D. and addressed to Assistant Public Defender Morgan Arzani. According to the letter Pursuant to a court order on December 14, 2016, Clinical Psychologist Lewis York, Ph.D. evaluated Sarah Geiger for the purpose of establishing an opinion as to her sanity at the time of the alleged offense on the day of Penny’s death. Dr. York documented the following regarding his assessment of Sarah Geiger:
…Sarah Geiger is a 37-year-old, Caucasian, divorced female who is currently charged with First Degree Murder. It is alleged that Sarah Geiger killed her then four-year-old daughter. When Ms. Geiger was asked with what she had been charged, she cried, “My daughter. Had cystic fibrosis. I had to take care of her myself.” She began sobbing, “My mom would help me, but DCFS said she couldn’t. I trying to do better. My dad’s mad. I working at Nu Company. I trying, I trying. DCFS got involved. I giving up. I called for help for my bills. My water being turned off. I would never have done that to my daughter. I love my daughter. Brave, the Disney cartoon was playing and my daughter was penetrated that that man gave me a one hitter. He didn’t tell me. I told him that not weed. I puked and I passed out. I kinda remember. I put my head under the faucet. I in a trance state. I the stated I screaming Jesus help me. Kids came to me. I saying help me. I told them I had to leave. In my dream stated I told her she was born on April XX and she had no clothes on. I felt we were lost. If I did, I don’t remember.”
…While no specific delusional thinking could currently [at the time of the interview] be elicited in her thinking, she has been delusional in the past. The Child Death Investigative Task Force Investigative Report indicated that when Ms. Geiger was placed in the ambulance on the day of her daughter’s death, she “kept saying that she wanted them to smother her, to cut her heart out and drink her blood. Geiger said something to Nia [ENT] about wanting her to eat her shit. He stated Geiger also kept talking about either an archangel or a dark angel.” The police reports noted that in Ms. Geiger’s [interview] on the day of Penny’s death at 4:06pm she had stated that she suffocated Penny, God told her to do it, and that Penny was the cure for AIDS. When I had seen Ms. Geiger in April 2016, she stated that in the past she had thought she was “special.” She had explained, “I felt God made me different than other people. Like what I do can change the world.” Her thinking itself was neither loose nor tangential as she could logically and coherently respond to questions.
…Her affect was that of an agitated depression. She would often break into tears and wail that no one loved her. She lamented that she will feel worthless and abandoned. She would often lay her head down on the desk and make little eye contact. Ms. Geiger has an extremely low frustration tolerance level and will quickly decompensate when placed under even minimal stress. When she turns this anger inward, she becomes depressed and at times suicidal and self-mutilative. She spoke of how she has attempted suicide three or four times and will often think of “taking too many pills, jump off a bridge.” Another time she spoke of how she had become so upset that she repeatedly beat her head against the wall and had to be hospitalized. When she turns this anger outward, she lashes out in rage. This would be consistent with her numerous threats to hurt others. Her June 12, 2015 hospital records from Beta Medical Center noted, “She has been getting out of control, anger and agitation, out of control. Like I said, broke some dishes.” Her extremely low frustration tolerance level would be consistent with her behavior at the jail and her placements in the Quiet Room. Ms. Geiger had most recently been placed in the Quiet Room in early December 2016. When asked why, she cried, “Last week suicidal thoughts. I have nothing left! I need shock treatment.” In addition, Ms. Geiger has had periods of extreme mood swings where she would bounce from depression to mania. During these periods of mania Ms. Geiger stated that she would go days without sleep and feel as if her thoughts were racing.
Ms. Geiger is a mentally ill substance abuser. She has repeatedly attempted to self-medicate with drugs as a means of dealing with her severe mood swings. When asked about her alcohol consumption, Ms. Geiger exclaimed, “I don’t!” She did admit to a lengthy history of marijuana use. When asked about her marijuana use, she insisted, “Marijuana, but no more. When I had an abortion at 12, I smoked it before. I smoked bongs, joints. Smoked a lot-bongs, one hitters, joints.”
She does have a lengthy history of mental health treatment. She spoke of how in first grade she had been diagnosed with Attention Deficit Hyperactivity Disorder and was placed on Ritalin. She continued that she continued this medication for a year. Ms. Geiger stated that she was first hospitalized at Omega when she was 12. She cried, “I was raped and someone gave me a coat hanger, drugged me, and gave me an abortion. I tried to kill myself. Well I didn’t. I told them at Omega I wouldn’t say who raped me. I went to Omega because I was bleeding. She continued that her next mental health treatment was at 13. She exclaimed, “My dad was abusive to me. When I was little, I said I going to kill him. I had a knife. I chased him and they locked me out. They gave me a 45-day evaluation at IYC City J. I got into trouble. I told them I was going to run away, stab someone, and steal their car. They kept me in 45 days. They put me on a lot of medicine. I can’t remember.” Ms. Geiger stated that after her time at IYC City J she was placed at Omicron, a therapeutic and educational residential facility in City H, MO. She stated that she stayed there “a month or two and went home.” At 16 she stated that she was hospitalized at Alpha Center [Beta Medical Center] in City H, MO. She explained, “I was pregnant with my daughter. Me and my ex-husband [Troy Geiger]. We not married then. I got mad because he was mean so I tried to kill myself. They put me in Alpha. I was there about a week.” Ms. Geiger continued that she has been hospitalized twice at Phi Hospital and “five to six times” at Alpha Center. She stated that she was last hospitalized in the fall of 2015. She continued, “I banged my head against the wall because I couldn’t find my keys. I think I was there a week.”
Ms. Geiger stated that she has been on psychotropic medication her “whole life. She complained that she had previously been on Buspar 7.5mg, Wellbutrin 150 mg twice a day and Geodon 20 mg and this medication “sent me into a manic phase.” While at the jail Ms. Geiger is taking the following psychotropic medication—Haldol 5 mg and Ativan 2 mg twice a day. The diagnosis for Ms. Sarah Geiger based upon my evaluation to date would be the following: Bipolar I Disorder, Most Recent Episode Depressed; Cannabis Use Disorder in a Controlled Environment; Borderline Personality Disorder.
It would be my opinion that Ms. Sarah Geiger was suffering from a mental illness (Bipolar I Disorder, Most Recent Episode Depressed, Cannabis Use Disorder in Controlled Environment, and Borderline Personality Disorder) which substantially impaired her ability to appreciate the criminality of her conduct at the time of the alleged offense. She was acutely psychotic at the time of the alleged offense and was not taking her medication as prescribed. She has a lengthy history of mental health treatment with frequent relapses into psychosis. The police reports indicated that she was acutely psychotic when the ambulance came. She was speaking of how God had told her to kill Penny and how Penny was the cure for AIDS. She acted out on her delusions. Her mental illness was the major factor in her actions. Therefore, it is my opinion that Ms. Sarah Geiger was legally insane at the time of the alleged offense…
According to County A Court records, on the day of Penny Watson’s death, Sarah Geiger was arrested and charged with Murder. On June 29, 2017 Sarah Geiger was found not guilty by reason of insanity and remanded to the Department of Mental Health and Developmental Disabilities, where she remains as of August 2018.
On June 21, 2017, the child protection investigation was closed. Sarah Geiger was indicated for #1-death to Penny Watson; #60-Substantial Risk of Physical Injury to Reed Geiger and #10a- Substantial Risk of Physical Injury/Environment Injurious to Health and Welfare – Incidents of Violence or Intimidation to Oscar Watson.
Current Update of Oscar Watson and Reed Geiger
[According to County B Court records, Diana Geiger (Troy Geiger’s ex-wife) was appointed guardian of Nicole Geiger on September 14, 2015.]
In April 2016, following the death of Penny Watson, DCFS was granted protective custody of Oscar Watson and Reed Geiger. Oscar Watson was placed with his nineteen-year-old sister, Valerie Geiger and her paramour Andy Bilal. Reed’s father, Troy Geiger told DCFS workers that he was unable to care for Reed Geiger due to his substance abuse issues. Reed was then placed with his paternal grandmother, Gemma Pettis, where he remains as of August 2018. Reed’s current permanency goal is substitute care pending independence.
On June 25, 2016, Oscar Watson was moved from the home of Andy Bilal and placed with Gemma Pettis, the paternal grandmother of Valerie, Reed, and Nicole Geiger. The move occurred following a hotline call on June 25, 2016, in which Valerie Geiger reported that Andy Bilal “destroyed everything in their trailer—ripped cabinets off the walls, broke windows, punched their tv, busted out their car windows, and put Val’s shoes in the toilet and peed on them.” Valerie and her infant son also moved in with Gemma Pettis, following the incident, to help with Oscar Watson. Oscar was later placed with Piper Curtis, a former teacher of Oscar Watson, from November 2016 to July 2017. Oscar moved to a traditional licensed foster home in July 2017.
Also following Penny Watson’s death, Oscar’s biological father whom was living in another state at the time of the death began cooperating with DCFS to gain custody of his son Oscar Watson. Zach Watson moved to City A, IL to expedite the return home and on June 4, 2018 Oscar was placed with his biological father, Zach Watson.
ANALYSIS
In 2008, the Legislature required the Inspector General’s Office to develop Error Reduction Plans to remedy patterns of errors or practice that compromise child safety. In 2011, the OIG analyzed hundreds of cases and outcomes as part of an Error Reduction Plan. The analysis determined that when multiple critical risk factors were present in a single case - danger to children was greatly increased. The following critical risk factors were identified:
Few families in our system present with all the above noted risk factors. The Geiger-Watson family did. Despite the numerous investigators and intact family services staff, as well as their respective supervisors with many years of experience, the Department failed this family. This family required a heightened level of attention, and it should have been apparent that there was an urgency to involve the court to compel compliance and monitor progress with services. Sarah Geiger was investigated 15 times prior to the death of Penny Watson. Six of the investigations were initiated in a span of five months while an intact case was pending.
At the time, the Geiger-Watson family was referred for intact family services, child protection staff had knowledge of the following issues regarding Sarah Geiger:
The family was referred to a DCFS high risk intact family services worker, but a clear plan of how to address all the obstacles facing the Geiger-Watson family was never fully developed. A case with such high risk should have had a concurrent plan for providing necessary services, monitoring progress in those services and then how and when it might have been necessary to go to court for additional intervention and oversight if there was a failure to address multiple risk factors.
In fact, when the field determined that Ms. Geiger failed to demonstrate any meaningful change during the intact service case, DCFS intact staff were ready to close out the high-risk case because no progress was being made. This decision was being made without consulting with or alerting DCFS legal staff or the State’s Attorney’s Office. It is important to note, that under the current intact outcome measures, such a decision could be coded as a ‘successful closure.’
Inadequate Mental Health Assessment
While Sarah’s ability to parent was a question throughout her involvement with the Department, neither investigators nor intact family service workers ensured that her ability to parent was assessed. Following Sarah Geiger’s arrest for battering her eighteen-year old daughter, during the C-sequence investigation, the field appeared to place some reliance on Sarah’s walk-in assessment at Beta, which was cursory and unrelated to parenting capacity.
Gathering information is critical to any assessment of child safety when the parent has significant mental health issues. Sarah Geiger was enrolled in a medication management program at Delta Health Systems and both investigators and intact workers had a consent signed by Sarah Geiger releasing the “Diagnosis, Prognosis and Hx [History]” from Delta Health Systems but still failed to gather critical information concerning her lack of medication compliance. Procedures 300.50(c)(6)(d), Obtaining Any Mental Health Records of Parents/Caregivers states’s that:
During initial contact with parents/caregivers who are listed as subjects of the report, the Child Protection Specialist shall ask the parents/caregivers about their overall mental health, current and previous medications to treat mental health issues (type, dosage, prescribing doctor, reason, medication compliance, etc.), prior mental health-related hospitalizations (when, where, reason, length of time, etc.), currently involved mental health professionals (name, contact information, last visit, etc.), compliance with treatment and support systems. The Child Protection Specialist shall refer to the CFS 440-12, Investigation/Intact Parental Mental Health Case Matrix, during the interview as a guide to types of information to be obtained regarding the parents/caregivers’ mental health. All information obtained from the parents/caregivers shall be documented in a contact note. When a parent/caregiver discloses, or information suggests, that he/she or the other parent/caregiver has a known or suspected mental health issue (including treatment and/or hospitalization), the Child Protection Specialist shall ask the affected parent/caregiver to sign a CFS 600-3, Consent for Release of Information authorizing the Child Protection Specialist to obtain his/her mental health records from the identified hospitals, physicians and therapists. If a parent or caregiver refuses to sign a CFS 600-3, the Child Protection Specialist shall request an Administrative Subpoena or send a HIPPA Letter (CFS 600-5, Request for Records) for these records within two business days of the refusal…. Requests for mental health records shall be made within 2 business days after initial contact with the affected family member whether by a signed CFS 600-3 or Administrative Subpoena. Upon receipt, records must be reviewed and assessed for any actions needed to ensure safety. Investigations shall not be approved and closed until all formal requests for mental health records have been made and the requested or subpoenaed records received and reviewed.
Although, consents for release of information were signed by Sarah Geiger, neither complete historical nor current mental health information of Sarah Geiger was sought or obtained in any of the child protection investigations. In addition, Procedures 300.130 (c)(2)(B), Subpoena of Mental Health Records states the following:
At the case hand-off meeting, the Child Protection Specialist shall share all parent/caregiver mental health information and records with the IFS specialist. If mental health records are received by the Child Protection Specialist after the case hand-off meeting, a conference including the Child Protection and IFS Supervisors shall occur immediately to address safety and risk implications noted in subpoenaed records and required protective action, up to and including involvement of juvenile court. The Child Protection Supervisor shall note in a supervisory note if any specific safety decisions were shared with the IFS Supervisor. During the case hand-off meeting, the Child Protection and IFS Supervisors shall use the CFS 440-12 Investigation/Intact Parental Mental Health Case Matrix to determine urgent service planning needs for the family. The supervisors shall document, in the investigation and IFS files, the topics on the Matrix checklist reviewed at the meeting, as well as any other relevant topics not listed in the Matrix
Located in the Investigations section of the intact family services hard copy file were police records from the City A Police Department, as well as two signed consents, one for Beta Medical Center, and another for Delta Health Systems, both signed by Sarah Geiger and the child protection investigator. However, there were no mental health records located in the file nor was use of the Parental Mental Health Matrix documented by child protection or intact family services staff or their supervisors. The matrix would have assisted the investigator in obtaining a full mental health history, which ultimately could have expedited the delivery of services to the family.
Another tool available to intact family services staff that was not utilized was the CFS 968-90, Questions for Mental Health Professionals. Procedures 302.388(h)(2), Assessments to Develop the Family Service Plan, requires intact family services workers to utilize the form prior to completing the Initial Family Service Plan. The form would have assisted in the development of an informed service plan.
Although, Procedures 300 does not require investigators to utilize the CFS 968-90 form, 4-months after the intact case was opened CPI Victoria Huisel faxed the form to Delta Health Systems. CPI Huisel received the completed CFS 968-90 via fax from Sarah Geiger’s nurse practitioner who prescribed Sarah Geiger’s psychotropic medications. The completed questionnaire revealed that Sarah was non-compliant with her medication. The nurse also documented that “Sarah’s symptoms may place her children at an increase of maltreatment.” The form was in the hardcopy documents to the H-sequence investigation, as well as in the intact family services hard copy file. Despite the nurse practitioner’s concerns and three pending child protection investigations, there was no follow-up or action taken by child protection or intact family services workers after receiving the information from Delta.
Ineffective Intact Family Services
From the onset, the intact family services case proceeded without a clear plan to gather information or monitor Sarah Geiger’s medication compliance, a critical component of helping this family. The WatsonGeiger family had significant barriers to achieving stability, on a short or long-term basis. There is no indication that intact services ever developed a cohesive plan of what was needed or expected for Sarah to function as a parent, and what long term supports she would need to have in place.
On a short-term basis, intact workers ignored Sarah’s significant challenges and serviced the case by telling Sarah what services she needed to set up for herself. Sarah needed far more proactive services. Procedures 302.388(g) Responsibilities of the Assigned Intact Family Service Worker states that the Intact Family Services Worker:
…is expected to be the agent of change and is expected to utilize services to address specific problems identified in the Family Service Plan. The Intact Family Services Worker’s responsibilities include effective family engagement; direct crisis intervention and problem resolution; parenting training with individual parents and their children present; Advocacy with other governmental, medical and community systems; risk monitoring/management; and actively managing and coordinating supportive services.
Week after week the intact worker went to the Geiger-Watson home, observed the children, and repeatedly asked Sarah Geiger if she had scheduled her appointments for individual therapy, family therapy, and a substance abuse assessment. Even after the Kappa Agency worker assisted Sarah Geiger in scheduling appointments at Delta, the intact worker failed to be proactive in ensuring Sarah Geiger attended the appointment on the scheduled day. The intact worker was aware that Sarah Geiger often had issues with transportation. Providing this service could have ensured Sarah Geiger’s enrollment in services.
Another example of the failure to be more proactive, occurred when after talking to Oscar’s medication prescriber in October 2015, the intact worker Barrett learned that Oscar had not been seen in almost two months and was out of ADHD medication. There are no documented attempts to ensure that Oscar received his medication. Despite school staff reporting that Oscar needed the medication to focus at school, intact worker Barrett took no action to ensure this was addressed. Intact worker Barrett needed to be more involved in ensuring that Sarah was following up with appointments for herself and her family. Similarly, Penny and Oscar telling mandated reporters that they were afraid was not followed up on by intact workers.
While the intact family services case was opened, there were 6 child protection investigations, as a result of 9 calls to the hotline in a 4 ½ month time period. At the time of the first hotline call, the intact case had been open for three months, and Sarah Geiger had not followed through on any of the service referrals made to address the mental health needs of the family. Despite Sarah Geiger’s non-compliance with services and continued numerous calls to the hotline, intact staff intended on closing the case.
Failure to communicate effectively with Delta Health Systems
It took intact worker Barrett two months of leaving phone messages with Delta staff at the City K location before she received a return call. The Department should work with Delta to establish a system or liaison at Delta that could help expedite information sharing in these difficult cases. Department staff should also discuss what information would be helpful when Child protection staff or intact workers request records.
Minimizing the impact of Marijuana Use
There is a common perception that alcohol and marijuana are benign drugs and the occasional use of marijuana is not problematic. While that may be true in some circumstances, there is growing research that this is not as true for a person with severe mental illness. It has been established that persons with
schizophrenia have an increased risk for an episode of psychosis when using marijuana and a 2007 study found that marijuana use for persons with bipolar disorder or depression was associated with longer periods of affective (mood) episodes and rapid cycling. A 2014 systemic review and meta-analysis concluded “…that cannabis use may worsen the occurrence of manic symptoms in those diagnosed with bipolar disorder, and may also act as a causal risk factor in the incidence of manic symptoms. This underscores the importance of discouraging cannabis use among youth and those with bipolar disorder to help prevent chronic psychiatric morbidity.” In this case it was apparent that Sarah Geiger’s habitual use of marijuana was discounted.
Moore T., Zammit S., Lingford-Hughes A., Barnes T., Jones P.B., Burke M., Lewis G. (2007). Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. Lancet, 370: 319–28.
Strakowlsi S., DelBello, M., Fleck, D, Caleb, A, Anthenelli, R, Keck, P., Arnold, L., Amicone, J. (2007). Effects of Coocurring Cannabis Use Disorders on the Course of Bipolar Disorder After a First Hospitalization for Mania. Archives of General Psychiatry, 64: 57-64.
Gibbs, M., Winsper, C., Marwaha, S., Gilbert, E., Broome, M., & Singh, S. (2015). Cannabis Use and Mania Symptoms: A Systematic Review and Meta-analysis. Journal of Affective Disorders, 171, 39-47.
RECOMMENDATIONS
Mental Illness and Substance Use Disorder
1. Whenever serious mental illness raises questions about parenting capacity a parenting capacity assessment must be completed. This should be addressed through training and development of resources.
2. Child Protection staff should be required to utilize the CFS 968-90, Questions for Mental Health Professionals form when interviewing mental health professionals regarding an alleged perpetrator.
Subsequent Oral Reports
3. If a subsequent oral report (SOR) of abuse and/or neglect is received on an open Intact Family Services case, the Child Protection Investigator and supervisor, as well as, the Intact Family services caseworker and supervisor should discuss and document in SACWIS, the case within 2 days of the SOR, and ensure a method of maintaining ongoing communication is established as required by current procedure, which should include attendance at all Child and Family Team Meetings.
4. With 3 or more investigations involving the same family, a management review should be conducted to determine if there is a need for court intervention (also recommended in OIG Report #17-2911).
Intact Family Services
5. Each intact family services case should have a written concurrent plan to identify factors that are critical to ensuring child safety and minimizing risk, and if there is a change in circumstances when court intervention may be necessary.
6. The Department should consider adding an alternative on the Child Endangerment Risk Assessment (CERAP) to allow a finding of “conditionally safe” – identifying factors where if there is a change in circumstances court intervention may be warranted.
7. To avoid the over reliance on a caregiver’s self-report in intact family service cases, Procedures 302.388(i)(5) Evaluating Family Progress, should be amended to require that intact family service workers contact service providers at a minimum monthly to assess the level of the family member’s engagement with services and the progress of the family on tasks of the Family Service Plan.
Court Involvement
8. Intact family services workers should refer to DCFS Office of Legal Services those intact cases with parenting non-compliance over time, risk to children and when the State’s attorney’s Office has declined to file a petition (see OIG recommendation 09-1028).
9. DCFS Legal must track cases not accepted for filing of a petition in Juvenile Court. The Department should identify a single contact person to work with each State’s Attorney’s office and consider whether to advocate further or file a petition themselves.
10. DCFS regional counsel should meet quarterly with local State’s Attorney’s and other relevant professionals to address any issues regarding the filing of petitions for court involvement.
Delta Health Systems
11. The Area Administrator should meet with Delta Health Systems in City K to develop a system and/or identify a liaison at Delta to expedite information sharing.