UPMC Children's Hospital of Pittsburgh (Tribune-Review)
Story by DEB ERDLEY
Dec. 17, 2023
Dr. Bill Jenkins thought he had seen most of what life could throw at people during his years as an emergency room physician and medical director of Greensburg-based Mutual Aid, one of the state’s largest ambulance services.
In the past three decades, he has tended to patients with drug overdoses, heart attacks and strokes, along with those bloodied and battered in vehicle crashes and savagely beaten in bar brawls and domestic violence incidents.
But then came the day he had to administer Narcan to a baby to save her life.
Jenkins, who has worked in the emergency room of Independence Westmoreland Hospital in Greensburg since 1991, said he was nearing the end of his shift late one summer day 3½ years ago when the call came in about a baby not breathing.
By the time the 6-month-old girl reached the hospital, first responders had started an intravenous line and were using a mechanical device to force air into and out of her tiny body.
The child’s mother told doctors she had no idea what was wrong.
“The mother painted the story that the child was just laying on the bed and she just turned around and the baby was not breathing,” Jenkins said. “It turns out that one of the staff members recognized the mother to be someone she knew to be on suboxone (an opioid replacement drug given as a treatment to those battling addiction).
“We gave the child Narcan, and within 20 minutes she was up and crying. She just was fine when we handed her off for the ride to Children’s (Hospital). Apparently she got into a suboxone film.”
Suboxone film is a treatment placed under the tongue or against the inner lining of the cheek to treat opioid addiction.
For Jenkins, it was his first step into a new world where children — some only a few days old — now routinely are victims of an illicit drug crisis that has reached epidemic proportions.
“In 1999, (child) deaths from fentanyl were so low I could not report them,” said Julie Gaither, a Yale University epidemiologist who led a study scrutinizing national mortality figures from the U.S. Centers for Disease Control and Prevention.
A TribLive analysis of 845 deaths and near-deaths in children under 18 across the state from 2018 to 2022 showed most of the drug overdoses occurred in the most populous counties — Allegheny, Dauphin and Philadelphia — but rural areas have not escaped.
Dr. Stephen Sandelich, who has worked in pediatric emergency medicine in Tacoma, Wash.; Philadelphia; and Charleston, S.C., is now at Penn State Health Children’s Hospital, a 146-bed pediatric hospital in central Pennsylvania.
“To be totally honest, there have been so many of them, I can’t remember the first time (I had to administer Narcan to a child),” he said. “But we had one here a couple of weeks ago. It was a little 2-year-old. The call came in that a kid was down at home, wasn’t breathing. They got in here, and we gave Narcan, and the kid popped right up.
“Family swore they had no idea how the kid got it. Thankfully the kid did great. They were clean and the family looked like reasonable human beings. It’s not like the stereotypical junkie missing teeth. These were reasonable middle-class people.”
Cases such as these are reported to child welfare officials for further investigation, but experts say these problems are increasing at such a rapid rate that officials are having difficulty keeping pace.
“I have seen ingestion from mother’s milk before. We see instances where there is fentanyl in the house, but families have no idea how it gets in there. One of the problems with fentanyl is it’s so potent that even a small amount in a small child can cause serious problems,” Sandelich said. “We now assume that any opiate now has some fentanyl in it. … And I have seen a lot more marijuana in young children. The gummies look like candy.”
Dr. Christopher Gaw, an emergency room physician at Nationwide Children’s Hospital in Columbus, Ohio, and assistant professor of pediatrics at Ohio State University, was part of a team that published a study reviewing fatal pediatric poisonings between 2005 and 2018. The researchers found that the rate of opioid overdoses doubled in that span.
Physicians are taking a growing interest in the impact of drug overdoses among small children, Gaw said.
“Some of these children are coming in very sick. Some of these children, if they haven’t been breathing for a while, may have irreversible damage,” he said.
For front-line workers, the memories of seeing children dying as a result of their parents’ drug use are hard to erase.
Mike Chitwood Sr., 79, worked for five decades in law enforcement, including nine years as a Philadelphia homicide detective, until retiring as police superintendent in Upper Darby in eastern Pennsylvania. He oversaw the 2018 investigation into the death of 10-month-old Angelina Milano from a fentanyl overdose in her Delaware County home.
Shortly after 1 a.m. on the day of Angelina’s death, the baby’s father came running out of the house with Angelina in his arms, screaming to police that she had stopped breathing, police reports indicate.
He told police the child slid under the water during a bath, according to reports. Despite attempts by police to revive the child using CPR, she later died at a hospital.
The child’s mother admitted at the hospital that Angelina had put a blue piece of paper in her mouth, reports indicate. Heroin often is sold in blue paper bags and sometimes laced with fentanyl to boost the seller’s profits.
A toxicology report confirmed the presence of fentanyl in the Angelina’s system, Chitwood said.
Both of Angelina’s parents were charged with involuntary manslaughter and are serving prison sentences, court records show.
“It’s a great tragedy. You didn’t used to see it at all,” Chitwood said. “The victim was a 10-month-old baby girl. She was healthy. She was learning to walk. … And now she’ll never get to grow up.”
Deb Erdley is a Tribune-Review staff writer. You can contact Deb at derdley@triblive.com or via Twitter @deberdley_trib.