Jose Carter was at work when he received an urgent call: His son was in an Arizona hospital being treated for an overdose.
"What do you mean he overdosed on fentanyl?" Carter recalls wondering. "He's a baby."
Carter's son was just 16 months old when emergency room workers saved his life after he apparently ate a pill during a visitation with his mother, Carter's ex, at her home. The incident came about a year after child welfare workers had investigated a complaint the mother overdosed around her children, but they "did not find evidence to support the allegations."
Asked to describe the system designed to protect his son and other children across Arizona, Carter put it plainly: "I think it failed. I think it failed a lot."
An exclusive Scripps News nationwide review of more than 260 fentanyl overdose cases of babies, toddlers and young children found approximately half the cases involved families who had been previously reported to police or had contact with child welfare workers for drug use or neglect issues.
A review of court documents, child welfare paperwork and police records in 45 states and the District of Columbia revealed many cases involving repeated reports to social workers about a child's welfare.
Despite these efforts, children and babies — including some who were just a few months old — still overdosed or died in at least 80 of the incidents between 2018 and 2023 that Scripps News reviewed.
"I feel like the people that we vote in, (that) we hire as a community to protect our kids and us, dropped the ball," said Christina Forester, the grandmother of Madison Stodulski, a 22-month-old who died of fentanyl poisoning in 2019 in Rolla, Missouri. "I've never been so broken. I'll never be the same," she said.
The death of a toddler at home
Forester said Madison was a delicate, smiley, brown-eyed toddler who loved dancing to the theme music of "Shrek" movies. In late 2019, she was learning how to say "I love you" while mastering the art of blowing kisses to her grandmother during FaceTime calls.
But a few days before Christmas that year, all of that would stop.
Madison nestled on the couch next to her mother, Sassy, a struggling substance user, and they both fell asleep. Madison never woke up.
"There's not a day (that) goes by that I don't close my eyes and still see her dead in my arms and see me having to give my daughter CPR and her not coming back," said Sassy Stodulski, 31, who is serving a 10-year prison sentence for her daughter's death.
"She never got to have friends. Having to think about all that is the worst pain in the world," Sassy said. "I don't get to see my child grow up because I was selfish, and I just hope that other people don't make the same mistakes I did."
Early warning signs in many cases
The tragedy of Madison Stodulski's death is like many others around the country in that child protective workers and police had information about her parents' drug use in the weeks and months leading up to her death but could not prevent it.
"I'm pissed. I'm real mad. I'm hurt," said Forester, who is also Sassy Stodulski's mother.
Forester said she was kept in the dark about her daughter's substance use, but she says she believes child protective workers had enough information to intervene in a more significant way.
"(Madison) was my world, and they let that go," Forester said.
Missed opportunities
Scripps News obtained records showing Madison Stodulski and her parents had been on the radar of authorities for more than a month before Madison died.
Someone called the child abuse hotline to express concern about Madison's safety approximately six weeks before she died, but a caseworker had trouble reaching the family, so she wrote them a letter asking to connect with them.
"I am writing to inform you that you have been named as an alleged perpetrator in a hotline (sic) regarding child abuse and neglect that was received on November 5, 2019," the caseworker for Phelps County Children's Division wrote in a letter dated Nov. 15.
On Dec. 5, 2019, a couple weeks before Madison's death, records reviewed by Scripps News show police officers conducted a search warrant on the family's home after watching Madison's father, Reginald Stodulski, sell heroin to an undercover informant the previous day.
Reginald had also been linked to the Oct. 1, 2019, overdose death of another man, according to Brendon Fox, the prosecuting attorney for Phelps County, Missouri.
Police called the child abuse hotline when they believed they found drugs in Madison's shoes and in a candy dish during the search of the home, though tests on the substance later turned up negative, according to Fox.
That triggered a child welfare caseworker to visit Madison's home and test Madison and her parents for drugs. The caseworker also developed a safety plan that would place Madison with a relative while they waited for the test results.
According to a police report, Madison's test results were positive for opiates when they came back a week later, but both her parents tested negative.
Sassy Stodulski admitted to Scripps News that she would frequently cheat scheduled drug tests because she didn't want her mother to find out she was addicted to heroin. "I was so scared of disappointing her," Sassy said.
"I was on drugs, and I passed my drug test," she said, explaining that she cheated the scheduled saliva test by placing Listerine strips in her cheeks. An unscheduled blood test, she said, would have revealed the drugs in her system.
Days later, Sassy and Reginald took Madison back to their own home, against their caseworker's plan, where Madison died hours later.
Both parents are now serving prison time for the death.
Filing a lawsuit
Forester filed a wrongful death lawsuit against the caseworker claiming the caseworker failed to complete important paperwork that might have triggered additional protections for Madison before she died.
In court filings, the defendant argued she was entitled to official immunity that protects public officials from liability and that there was no link between the paperwork and Madison's cause of death.
The case was dismissed, and Missouri's Supreme Court upheld that ruling last week.
"If I could save grandparents from having to go into a crematorium and kiss their grandbaby goodbye, and that being their last vision of that baby, it's worth it," Forester said.
Child welfare improvements
"Any time a child dies, there's clearly an indication of a failure in the system. Whether that system failure is a result of parental inadequacy, whether that's a coordination challenge or whether or not there were circumstances that may have been missed, the reality is we all have an effort of responsibility to mitigate the loss of life," said Adam Crumbliss, the deputy director of Missouri's Department of Social Services, which oversees the state's children's division.
Scripps News examined reports of eight child overdoses in Missouri since 2019, including seven deaths. In one case, methadone is linked to the child's death, but it's unclear if fentanyl was also involved.
"When you have circumstances that that happens, we have to really go in and do a deep dive, specific to that case, to determine what the circumstances were, what led to the actual death, and ensure that we try to take steps that that would not happen again in the future," Crumbliss said.
Scripps News asked the state for months to share its investigative findings from the Stodulski case, but the state has not produced any records. Crumbliss would not speak to Scripps News about specifics of any case, citing confidentiality laws.
He said the state is working to hire, retain and better compensate caseworkers. The department is also looking at ways to develop additional strategies, he said, that will help prevent deaths like Madison's.
"We can't be in a position that we're waiting to address issues in a family situation at the worst point. We need that to happen earlier in the intervention process," he said. "We're making a lot of leveraged efforts right now to begin to develop a much stronger prevention system that identifies benchmarks and indicators to tell us we have problems in specific families and in communities and (to) develop that network for prevention care, (allowing us) to go in before we see the safety risks that come to children."
Crumbliss suggested the department might increase engagement with local community providers to learn where resources might be better placed.
Nine reports to child welfare agency before Wisconsin baby died
Beyond Missouri, Scripps News found dozens of child fentanyl deaths involving families who had prior interactions with child welfare and police agencies.
In Madison, Wisconsin, for example, child welfare workers received at least nine prior reports expressing concern about Zariah Hawkins' family before Zariah died a few days shy of her first birthday.
All the reports were either "screened-out" or "unsubstantiated" prior to her death.
According to a criminal complaint in the case, in one of the reports, someone contacted child protective services shortly after Zariah was born to say the newborn's "umbilical drug screen tested positive for THC, methadone, and hydromorphone."
Months later, someone reported that the mother was using "pills and heroin" and had "fallen asleep while at the park with (Zariah) in her stroller." In the weeks before Zariah's death, another complaint alleged the mother may have been using drugs and "engaging in sex while (Zariah was) present," according to a police record.
Zariah's parents, Kelsey Kindschy and Derrick Hawkins, are each facing a felony child neglect charge. Counsel for each person entered not guilty pleas on their behalf. A trial is set for October.
"We are saddened by all the tragic incidents of child maltreatment that touch our child welfare system and are committed to strengthening families so that child maltreatment does not occur," said Gina Paige, a spokesperson for the Wisconsin Department of Children and Families. Paige described the child welfare system as "state-managed and county-run" except for the Division of Milwaukee Child Protective Services.
"The child welfare system is complex as no two child welfare cases are the same; family dynamics and stressors vary," said Paige. "Additionally, those stressors can be impacted by changes in the community, such as the prevalence of substances use disorder and mental health issues, the economy, lack of resources and housing...because of this, we are constantly assessing our system to see how we can better meet the needs of families across the state."
Near-death in Arizona after mother overdosed
Nearly two years after Chandler, Arizona, medical workers revived Jose Carter's son, he's now a vibrant and energetic child. But the father said he knows their story could have ended differently.
Scripps News obtained police body worn camera footage from the day the child overdosed in the care of his mother. She told child protective workers that she had overdosed on fentanyl the previous year, and she believed her child might have picked up a pill off the floor at her home. The boy required multiple doses of Narcan to be revived, according to his father, who lived in a separate home.
According to records obtained by Scripps News, the state's Department of Child Safety investigated a report of the mother overdosing with the boy and his sibling in the home but said the allegations were "unsubstantiated" and provided no support services to the mother or family.
"We can only remove a child if there is sufficient evidence that a child is unsafe with their parent or caregiver," said Darren DaRonco, a spokesperson for the Arizona Department of Child Safety.
"In this case the children were with a babysitter in the home when the incident occurred. In addition, the children's father obtained a court order for custody of the children. Since the children were safe with another parent, we had no grounds to remove them," he said.
Solutions for saving lives
"Narcan is a drug that is safe for anyone. Even an infant can receive Narcan, and it can reverse the effects," said Julie Gaither, an epidemiologist and assistant professor of pediatrics at the Yale School of Medicine, who conducted the research.
Gaither's research, published in JAMA Pediatrics in May, revealed a nearly 4,000% increase in all pediatric deaths from fentanyl between 2013 and 2021. Gaither said her research also revealed that at least 43.8% percent of child fentanyl poisoning deaths occur at home.
"That's really where we need to be focusing is making sure that parents are taking the precautions that they need to," she said.
"I think the most important thing for people to know is that like anything that can harm a child, you have to keep it away from the kid somehow, and so whether that's with a locked medicine cabinet (or) with a lockbox, just taking these commonsense precautions," Gaither said.
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