This spring, when a friend sent Juli Shamash a Scripps News article about a pair of infant twins who survived a 2024 fentanyl poisoning in southern California, she says she started crying tears of joy.

I was like, Oh my gosh! I was so happy, she said.

In 2018, the California mom had lost her own son, Tyler Shamash, 19, to a fentanyl overdose.

In the years following his death, Shamash relentlessly and successfully pushed for a new state law in Tylers name that requires most California hospitals to include fentanyl testing in urine drug screenings to help determine what may be causing a patients symptoms.

A test like that, she said, might have prevented her sons overdose.

Tylers Law took effect in 2023.

Last year, the twins received hospital fentanyl tests, their parents say saved their lives.

It kind of makes me feel like (Tylers) death was not in vain. Like, something positive came out of his death, Shamash told Scripps News.

Who was Tyler Shamash?

Tyler Shamash was an adventurous teen who had a love for computers, an interest in Bitcoin, and a knack for building and fixing things.

He was like a little professor. He was on the spectrum (with) mild Asperger (syndrome), so if there was something he was interested in, he would know everything about it, Shamash said.

He was articulate, loving, polite and funny, but he also suffered from bad anxiety, Shamash said, and when he was 14, he started smoking marijuana.

He said, Mom, when were high, I fit in. No one notices Im different, Shamash recalled.

Eventually, he sought out stronger drugs, and then we noticed he had a problem, Shamash said.

Tyler attended a wilderness program, boarding school, therapy, and he was in and out of various sober living facilities to help kick the drug habit. However, he eventually started using heroin and overdosed.

At the time, no one knew the drugs also contained fentanyl, Shamash said.

We got a phone call at 3 oclock in the morning saying, Hes ok, but hes on his way to the hospital, she said. I should have had it on my radar because he was using drugs, but I just never thought that he would overdose because he is so smart. He knew every drug and what was in every drug.

Tyler was released from the hospital without being tested for fentanyl, according to Shamash, and the next day, she said he died from fentanyl poisoning.

Tylers Law

After Tylers Law passed in California, Shamash continued to push for federal legislation in his name.

Twice in recent years, members of Congress have introduced a bipartisan bill in Tylers name that would require the United States Department of Health and Human Services to study how frequently hospitals test for fentanyl and use the results...to issue guidance to hospitals on implementing fentanyl testing in emergency rooms.

So far, the bill, supported by bipartisan members in the Senate and the House, seems to be stalled.

However, several states have proposed or enacted similar laws since Californias law went into effect.

Two mothers connect

After Shamash read the Scripps News article in which the mother of the twins, Lauren Hinton, credited Tylers Law for saving her two boys and the rest of her family, Shamash said she reached out to Hinton on social media.

I just said, I was so happy to see that this law in honor of my son was able to save her boys, Shamash said.

In the spring, Hinton told Scripps News she believed the fact that her children were tested for fentanyl in the hospital helped trigger a chain of events that also allowed her and her partner to seek support for their addiction.

All I know is they caught it in enough time because (the twin I took to the hospital) could have overdosed and died, she said. It saved his life. It saved my life. It saved everybodys life involved. Everybody.

Knowing the family is working on recovery and that the twin boys survived, that was like the icing on the cake, said Shamash.

Over the course of more than two years, Scripps News has been reporting on fentanyl poisonings among babies, toddlers, and young children.

Here are some of the faces of children who died in recent years:

Serenity Hernandez, Avondale, Arizona

Date of death: 9/16/2023

She was a really happy baby and she was always smiling and laughing. I loved to be around her and I also enjoyed seeing her after a long day at school. It made my day to see her smile and laugh. Serenitys older sisters, ages 11 and 8.

Mitchell Robinson, East Baton Rouge, Louisiana

Date of death: 6/26/2022

I miss him. I miss my grandbaby. I miss him coming in my room at night, jumping on my bed like it was a trampoline or just walking in there and giving me a hug, and he would kiss me, and he would say I love you...we only had a short time with him, and thats real hard. Stephanie Murray-Robinson, grandmother.

Madison Stodulski, Rolla, Missouri

Date of death: 12/21/2019

She was a spitfire. She loved to dance. She loved Shrek. Just so smart. Very smart. She loved candy - M&Ms. Chicken nuggets were her favorite. She loved being outside, loved going to the park. Just an all-around 22-month-old angel. She was amazing. Christina Forester, grandmother

Lucca Lien, Wichita, Kansas

Date of death: 7/3/2022

He loved to play and love on his big sister Oakleigh, who he absolutely adored. Walking quickly turned into running and exploring everything that he could reach. He was a content, quiet baby that loved to be tickled. We will always cherish his smile and laughs. Lucca Liens obituary

Leightyn Lee

Date of death: 1/16/2022

He was such a loving, fun (child) that loved to play with his big brother. Full of life, such a cuddle bug with his family. Diane Blankenship, grandmother

Jaxon Vogt, Ludlow, Kentucky

Date of death: 3/18/2021

Jaxon was a true bundle of joy and one of the happiest boys you would ever meet. You would never find him without his heart melting smile on his face. Jaxon was a joy to everyone he met. Even though he was only 2 years old, he was wise beyond his years. He oved to play with his older brothers, loved all dog dogs and being outdoors. Jaxon Vogts obituary

Jream Smith, Dearborn Hts., Michigan

Date of death: 9/16/2022

You were loved beyond measure, and we will always remember your sweet smile. Your little footprints have left an imprint on our hearts that will never fade. #JusticeforJream Jamie Smith, mother

Hailey Goding, Old Town, Maine

Date of death: 6/5/2021

She was just full of life, full of it. Shed make you laugh all the time. Always doing silly things...Shed want to just climb up on the bed and snuggle, and wed read a book or something like that. She was a love bug. She was. She loved everybody. Ursula Picciano, grandmother

Ezikeal Aguilar, Pueblo, Colorado

Date of death: 9/23/2024

Ezikeal was the sweetest little boy, he filled our hearts with joy! Ezikeal gave so much love as we all played, laughed and cherished every moment we had with him! He will be a part of our hearts for eternity! Jose Naranjo, grandfather

Damien Coats, Apache Junction, Arizona

Date of death: 1/25/2023

I'm pretty sure Damien, who was three years old would just like to be home with his mom (and) his dad, and he would like to play...He would be five years old this year. That means kindergarten. Im sure he would love to be at the playground playing and stuff. Lt. Thomas Parker, Apache Junction Police Department

Charlie Sumner

Date of death: 12/16/2022

"Shes so Beautiful, so pure. Constantly cares about everyone, all of her family and friends...She was patient. So beyond patient, and she continued to show her generosity to everyone. Im forever in awe of how wise she was, beyond her years...We love you Charlie. Josie Benner, neighbor

Brighton Hendron

Brighton was and still is a light. She loved traveling and going to the park and dressing fancy like her mom. Her favorite spot was the beach and her favorite color is pink. She had the brightest beautiful eyes. Cheyenne Helm, mother

Bair Johnson, Palm Beach, Florida

Date of death: 8/22/2019

Bair offered to the world his beautiful smile, adorable laugh and contagious love to everyone he met. In his short life, he touched so many. He was full of wonder and joy. Our precious miracle, sweet boy, and light of our lives leaves us all smiling through our tears. We are comforted by the fact that nothing can separate love. Because of this, we will always be connected. Bair Johnsons obituary

Breckin Danter

Date of Death: 9/3/2024

Breckin was so full of life and laughter. Everything was funny to him. He was definitely all boy and loved Paw Patrol, dinosaurs, and monster trucks. But most of all he loved his mom and sisters. He was a light in the world and without him its a little dimmer. He was the best boy I couldve ever asked for and my soul longs for the day I meet him again." Brittany Mahaney, mother

Aviyana Montoya, Brighton, Colorado

Date of death: 1/2/2022

Avie loved the simple things in life she would play with something so simple and small over anything big. Avie loved to be the center of attention no matter where we went. Every person who walked through the door she carried a special relationship with each and everyone of them. One thing for sure she had a way to forget all your worries and man she had a smile that would light up a room and laughter that would never be forgotten." Aviyana Montoyas obituary

Avery Santiago, Wilmington, Delaware

Date of death: 8/18/2018

Luna Sellers, Port Orange, Florida

Date of death: 1/28/2021

Kathilina Pinkerman, Palm Beach, FL

Date of death: 6/28/2020

When Emery Patterson was suffering from a fentanyl poisoning due to his mothers drug use in Scottsdale, Arizona, in 2022, his mother, Gabrielle Marshall, Googled whether she might be imprisoned if she called for help.

She texted her friend to request Narcan, an opioid reversal medication, but ultimately waited too long to seek professional medical help, and the little boy, who was just one year old, died.

In 2023, an eight-month-old baby, Serenity Hernandez, died of a fentanyl poisoning in Avondale, Arizona, after she was found unresponsive and turning purple in bed.

Even though she was airlifted to a hospital, doctors could not save her.

And in 2024, the Phoenix mother of one-year-old Jody Jackson delayed seeking medical care after she realized the child may have ingested fentanyl.

The baby did not survive.

In each of these cases and many other Arizona child deaths and near deaths, the children's families had had previous contact with the Arizona Department of Child Services, the state agency charged with child protection.

Any time a child that is known to us dies is horrendous, said Kathryn Ptak, director of the Arizona Department of Child Safety. Its horrendous for the agency. Its horrendous for the workers.

Ptak, a long-time AZDCS employee, was confirmed as the agencys director in May 2025 after being appointed in January.

Nobody comes into this work, making no money and putting themselves in danger, and spending time away from their families, to have a kid on their caseload die, right? Its terrible, she said.

In Jacksons case, the department previously investigated the childs mother, Natalie Tate, after receiving a 2022 report that Tate had abused drugs during her pregnancy, resulting in the child being born substance exposed.

According to an AZDCS review of the death, the investigation assessed (the child) and a sibling as safe with their mother with a safety plan in place. The family was referred for services but did not engage in services.

The case was closed about eight months before Jackson died.

Fentanyl Cases

Ptak said Arizona has seen an uptick in drug exposure cases in the past year, including several involving fentanyl.

The drug is being taken much more seriously when it comes to considering whether or not to remove a child from the home, she said.

It is so much more deadly than some of the other drugs," Ptak insisted.

According to child fatality reports publicly released by AZDCS and other records and information gathered by Scripps News, at least 42 Arizona children have died or nearly died of a fentanyl poisoning since 2020.

There may be other cases about which Scripps News is unaware.

The vast majority of children who die of fentanyl poisoning and who die of any type of abuse in our country are known to social workers, so our system is failing, said Darcy Olsen, the founder and CEO of the Center for the Rights of Abused Children.

Every single one of these children's lives needs to be respected and honored, and the way to do that is to force the agencies to open up these cases so that the public can see exactly what went wrong, so that it doesn't happen again, she said.

While some agencies keep many details of state and local child fatality reviews private, the state of Arizona makes public its summaries of fatality reviews and the agencys history with families that have experienced a death or near-death of a child.

If there is a simultaneous criminal case involved, however, sometimes the details of the incident may not be revealed immediately.

In some cases, it may take months or years.

We try to be as open and transparent on (the cases) as possible, said Ptak.

Child safety agencies also have varying statutory powers when handling child protection as well.

In Arizona, for example, AZDCS is a secondary prevention agency, Ptak said. The agency can only intervene in a childs welfare after it has received a call about abuse or neglect, she said.

We are waiting until a childs already been abused or neglected before were statutorily allowed to intervene, so, a lot of times when were seeing these cases for the first time is after something bad has already happened, Ptak said.

When to Remove a Child

In Arizona, making the decision to remove a child from a home is based on many factors.

Ptak said the agency uses a safety decision-making guide.

The agency asks, Is the child safe, or is the child unsafe? And if the childs unsafe, are there ways to keep the child safely in the home with other protections around?

A case may be closed if a caregiver successfully participates in support services and has a clean drug test, Ptak said. However, we all know relapse is part of recovery. And so, we might then see six months later or a year later that the parent has returned to using substances, and then we get another call. We don't have a crystal ball. We don't know what's going to happen in these cases.

The decision about a childs safety may also be made based upon whether a reliable relative is available to assist in oversight or management of the childs care, she said.

We have a lot of cases where we interact with families and we close (the case), and everybody goes about their lives and are just fine, Ptak said.

Child Advocates Weigh In

Most of these children who die are known to authorities. What also happens is theyre just sending them home, Olsen said.

Olsen said her pro bono law clinic recently handled an Arizona case in which an infant was placed back in a home where a teenager had recently died of a fentanyl overdose. Without specific names and records, Scripps News could not verify details of the incident.

This is happening every single day, not just in Arizona, but all across the country, she said.

She acknowledged that sometimes children in abuse and neglect cases are wrongly taken from their homes, but the reality is, she said, that children are dying even though theyre on the radar of these agencies. And we need to put a stop to it. We need to hold the agencies accountable, and we need to save these childrens lives.

The reality is that if youre an addict and you cant take care of yourself, you cant take care of a child, Olsen said.

Sometimes removal is better than keeping the child at home, said Marie Cohen, a Washington, D.C.-based child advocate who has spent years reviewing abuse and neglect cases in various parts of the country.

She also writes a blog called Child Welfare Monitor.

Im all for not removing the child if you can protect the child at home, she said.

However, I think we have to adjust our thinking a bit more where sometimes removal is better than the alternative, which would be keeping the child at home, she said.

It doesnt make sense to give a family chance after chance after chance.

Ptak said sometimes her agency is hindered by the court system when making decisions about whether a child should be removed from their home.

Sometimes, the kids are returned home over the agencys objection, Ptak said. There are a lot of parties involved in these cases. Parents have attorneys, children have attorneys, and everybody kind of sees it a little bit differently.

Prevention Programs for Older Youth

In Arizona, fentanyl poisonings are also prevalent among older youth, many of whom live in group homes, Ptak said.

The agency has been working to address that demographic in recent months with treatment programs and other safety measures.

We came up with a policy where all caregivers have to have Narcan in their possession. So, if you are a foster caregiver, if youre a group home, you have to have a dose of Narcan available to you in case a child in your care is exposed or overdoses, she said.

Child welfare agents who investigate cases involving child neglect and abuse, however, are not required to carry Narcan or distribute it to the families they are investigating, Ptak said.

Depending on the severity of the allegations and depending on what happened, sometimes we can do interventions, like we have a lockbox program where we talk to parents about, You gotta lock up your drugs... here's Narcan ... the things they need to make sure that the child is staying safe.

In March of 2025, a 911 dispatcher in Spokane Valley, Washington answered a panicked call.

My nephew is blue, a woman reported, crying. His mom said he might have gotten fentanyl from her purse!

Another voice joined the call as the woman sobbed. I Narcanned him twice, referring to the drug Narcan which reverses the effects of an opioid overdose. The women said the victim was not awake, and his breathing was rattling.

And how old is he? the dispatcher asked. Hell be a year old, answered the childs aunt.

The local sheriffs office said the child recovered, and his mother was arrested.

The 911 recording is one of many the Scripps News team has gathered and reviewed, along with police body-camera recordings and law enforcement interview videos, in an effort to understand how children too young to choose to use drugs end up ingesting them anyway, and how they can be saved.

The reporting process

In 2022, Scripps News began tracking cases of fentanyl poisonings among babies, toddlers, and young children. We wanted to show how the powerful opioid is affecting young children.

The team spent months gathering as many cases as we could, building our own database from scratch from local news stories, state child fatality and near-fatality reports, and medical examiner records. Then, we decided to find out as much information as we could about each case gathering police reports, court records, and child welfare records.

We revisited the cases over time, tracking whether anyone was arrested for exposing the child to fentanyl, whether anyone was convicted, and re-requesting records that were previously withheld after cases closed or were adjudicated. In some cases, we filed appeals to receive records that were withheld due to the perception of secrecy in cases involving children. Some records are still being withheld. Along the way, weve continued to add newly-reported cases to our dataset.

Now, more than two years later, our team has compiled more than 460 cases of reported child opioid poisoning incidents from nearly every state in the U.S. from 2018 to 2025 a total that is almost certainly an undercount. That tally includes more than 260 deaths. Trends found across the data set include:

Some exposures were reported while children were at daycare or in the care of babysitters, but most of the cases reviewed by Scripps News occurred when children were in their own homes or in the care of their own parents or relatives.

It is probably the biggest crisis weve seen in child welfare in the past 20 years, said Darcy Olsen, founder of the Center for the Rights of Abused Children.

How children are exposed 

Body-worn camera video from the Village of Liberty, New York, shows the chaotic moments in 2023 when police responded to the lobby of a hotel to find an unconscious child clad in a onesie as her panicked parents looked on.

An officer performed CPR for several minutes before a medical team arrived, but the little girl, Akasha Luvert, did not survive.

The babys mother told police she found her daughter lying on the floor, lifeless, next to a piece of foil that the parents used to smoke drugs. Police believed Akashas father was supposed to be supervising her, but he fell asleep.

Police across the country investigating child fentanyl poisonings often report finding pieces of foil, straws, baggies, and other tools used to consume drugs left within reach of children. Police have reported finding foils that appeared to have been bitten, and pieces of plastic baggies have been found in the mouths of children being resuscitated.

In Florida, police found video evidence showing how 1-year-old James Valiquette was exposed before his death in 2022. A court document describes a father, recorded on surveillance video in his living room, falling asleep, which allowed the victim to roam around the living room unsupervised. About 20 minutes later, police describe the child picking up what appears to be a scrap of tin foil from the floor, and placing it in his mouth.

Police said the video showed the childs mother entering the room, discovering something in his mouth and removing it, before putting the boy to bed. She found him dead the next morning. (The childs father pleaded guilty to manslaughter last year. The mother has pleaded not guilty and is awaiting trial.)

In other cases, medical providers said they found pills or pieces of pills in a childs mouth.

When you look at these situations where kids are in [a] home where illicit fentanyl is being used, we know that is a very dangerous situation, said Dr. Natalie Laub, a San Diego child abuse physician. We also know when caregivers, people responsible for the children, are under the influence, they cannot provide a safe and nurturing environment for that child.

Lauren Hinton, a southern California mother, told Scripps News she doesnt know exactly how her five-month-old twins ingested the drugs she and the childs father had been using in 2024. A police report said both children tested positive for the drug at a local hospital.

It wouldnt surprise me if it was residue or maybe a binky laid down on something, or me making a bottle, Hinton said. I was at a point of just unmanageability and carelessness. It was just super out of control at that point.

Both children survived, and their parents spent several months in jail. This past spring, Hinton and her partner, Alexander Santiago, told Scripps News they were in recovery and had regained custody of their twins. They said the incident set their family on a new course.

One of us probably wouldve ended up dying, Santiago said. It saved our lives, honestly.

Symptoms of poisoning

When a mother in Florida noticed her childs breathing was unusual in March of 2022, she pulled out her phone and hit record.

This cant possibly be a normal sleeping sound, she wrote while sending the video to family members, according to a court document. Police said the mother called 911 hours later, but help did not arrive in time to save her baby.

Unusual breathing sounds, snoring, gasping, gurgling, and gagging are symptoms frequently described by witnesses in records linked to child fentanyl poisonings reviewed by Scripps News.

People have coined it the 'death rattle,' said Dr. Roneet Lev, a former Chief Medical Officer at the White House Office of National Drug Control Policy, who highlighted the Scripps News reporting on her podcast. That often happens before they stop breathing and that's the time to intervene.

Witnesses also describe children turning blue or purple due to lack of oxygen, seeming lethargic, acting drowsy, and dozing off.

If a kid is found not breathing, pinpoint pupils, blue, unconscious the number one, two, and three most likely things that it is, is a drug overdose, Dr. Laub said. That kid should get Narcan immediately in the field. You should treat them as if they're an adult who's overdosed on fentanyl.

Scripps News interviewed a child who was old enough to remember how it felt when she inadvertently ingested fentanyl when she said she swallowed a pill she found in her kindergarten classroom.

I wanted to go to sleep so bad, Addison Mott said. I was dizzy. When I would walk, I would start wobbling.

Call 911 and give Narcan

When police arrived at a home in Wisconsins Columbia County in November 2023, a father quickly insisted he knew the source of his 1-year-olds distress.

He needs Narcan! He needs Narcan! the father told an officer and an emergency responder on video. He got into a pill! The officer quickly administered a dose of the overdose-reversing medication, and the child survived.

Scripps News reviewed numerous cases in which caregivers quickly disclosed children may have ingested drugs, but also reviewed cases in which caregivers either said they did not know or withheld that information, potentially delaying a childs treatment.

One report in Arizona from 2022 said a child did not receive Narcan from paramedics because the parents denied drug use, until a hospital screening revealed fentanyl in the childs system. The child received Narcan after the test results came in and survived.

The best thing is just [to] be truthful with the medical staff, and give them the ability to use their resources to properly treat [the child], said Lt. Thomas Parker, a police lieutenant at the Apache Junction, Arizona police department whose office oversaw the investigation of a childs 2023 death. The likelihood of survival is much greater.

In several cases, caregivers were accused of waiting for hours to seek medical treatment for children, attempting instead to reverse the childs symptoms with Narcan on their own.

In June, a couple in Illinois were indicted on charges of first-degree murder after prosecutors said they ordered Narcan from Uber for their toddler before seeking professional help. By the time they called 911, police said, the child could not be saved.

Many reports said children needed multiple doses of the medication in the hospital, often a constant drip, and other medical interventions to recover from their overdose symptoms. Thats why health officials emphasize that professional medical care is needed in the event of a poisoning incident.

Search for solutions 

Child protection agencies across the country have been searching for solutions for years to protect children at risk of fentanyl ingestion.

I remember telling my husband, We've had like three or four in one week of these kids that were exposed to fentanyl and either died or nearly died, and feeling like this is something that we're gonna have to start talking about, said Kathryn Ptak, the director of the Department of Child Safety in Arizona.

Some child welfare agencies have implemented interventions like distributing lockboxes, fentanyl test strips, and Narcan to families with histories of substance use. In Colorado, child welfare officials said caseworkers in some counties instruct families how to use Narcan and more children are surviving these incidents.

Some states have launched public awareness campaigns about keeping drugs out of the reach of children and messaging that it is safe to administer Narcan to children. Communities like Pennsylvanias Allegheny County have used opioid settlement funds to expand access to treatment for substance use disorders.

Some deaths have prompted reckonings in child protective agencies, as grieving families and child safety advocates have argued the government is not doing enough to remove children from homes where they are exposed to substance use.

In Louisiana, the death of 3-year-old Mitchell Robinson after repeated poisonings in his mothers care prompted legislation to study the needs of child welfare in this state. In New York, the death of Akasha Luvert in a Liberty hotel room where her family had been placed for housing by social workers led to a grand jury investigation and spurred efforts to improve the countys protective services.

I would say the system at large failed this child, Libertys police chief, Steven DAgata, told Scripps News. The protection of children [should be] first and foremost in all of our minds when we're dealing with families that are struggling with substance use. The government must take an active role in taking steps to ensure that the children are safe.

Drug overdose deaths overall declined by close to 27% nationwide in 2024, according to the CDC, and experts told Scripps News its important to maintain that momentum to protect children.

This is the time to keep the pressure on, keep pushing on the right interventions to reduce overdose, said Dr. Joshua Black, a Denver-based researcher who studied the increase in non-fatal pediatric fentanyl exposures. Reducing access, finding treatments, having reversal agents like naloxone available, will keep the trend downward.

We know how to solve this problem, Dr. Rahul Gupta, the former White House drug czar under President Biden, told Scripps News. Its critical we embrace the policies without regard to politics, those that work, like making sure that life-saving medications are available [and] people have access to treatment and recovery services.

Lieutenant Thomas Parkers eyes filled with tears when he pictured where Damien Coats might be today.

He would be 5 years old this year. That means kindergarten, Parker said. Im sure he would love to be at the playground playing.

Damien was 3 years old when he died in January 2023 in an Arizona hospital due to complications of fentanyl intoxication, according to the medical examiner. A police report indicates the child ingested an illicit version of the powerful opioid, and Parker says he believes the boys death was a crime.

Parker oversees the Apache Junction Police Department detectives who conducted the criminal investigation of Damiens death. Police closed that investigation more than a year after the child died without arresting anyone.

RELATED STORY | States push for life-saving fentanyl testing laws amid rising opioid concerns

A state child safety investigation of Damiens death determined the boys mother and grandmother were neglectful in their care for the child. According to the state report, his mother allowed the child to reside in a home with active fentanyl users, and his maternal grandmother failed to seek immediate medical attention for him.

Prosecutors in Maricopa County declined to bring criminal charges in the case. A spokesperson for Rachel Mitchell, the county attorney, said her office declined the case due to no reasonable likelihood of conviction a decision Parker called heartbreaking for all those involved.

Even the prosecutors, they dont want to turn down cases. But there are laws and procedures in the system to make sure we are having the proper methods of justice, he said.

In Apache Junction and across the country, prosecutors and police say it can be challenging to prove in court how a child ingested the drug and who was responsible.

Where is her justice? Scripps News finds dozens of cases nationwide still unsolved

A two-year Scripps News investigation examining nearly 450 fatal and near-fatal fentanyl poisonings in young children across the country identified at least 43 deaths in more than a dozen states in which no one has been prosecuted more than a year after the child died.

RELATED STORY | Twin babies and parents saved following hospital fentanyl test

These numbers are likely not comprehensive, as Scripps News has worked to compile a data set of incidents using a variety of sources, including news articles, law enforcement press releases, court records, government child fatality reports, and medical examiner data. The availability of public information like child fatality reviews and medical examiner information varies by state.

The uncharged cases analyzed by Scripps News date back as far as 2019, and there were a variety of reasons why the cases have not yet resulted in prosecutions:

Prosecutors in Jacksonville, Florida, said the investigation of 1-year-old Mac Johnstons 2019 death is ongoing, more than six years later. The childs father, Lee Bradley Johnston, recently pleaded guilty in connection with another persons fatal 2023 overdose.

In Aurora, Colorado, police are asking anyone with information, no matter how insignificant it may seem, to come forward with details about the 2021 death of 1-year-old Bryce Wilhite Jr.

The long waits for criminal charges have provoked strong community reactions. In Palm Beach County, Florida, someone sent an anonymous email to investigators asking why a toddlers death in 2020 had not been solved.

Why isnt justice being served for her? Where is her justice? the person wrote. The sheriffs office later made the case inactive without seeking charges, concluding probable cause does not exist, at this time, to support criminal charges.

In Lorain, Ohio, the mother of 2-year-old Marcellino Flores told the Scripps News Group TV station in Cleveland last year she was offering a cash reward for information leading to justice in her sons 2023 death. The Lorain Police Department told Scripps News the criminal investigation is ongoing and police are hoping someone will come forward to help them solve the case.

Insufficient evidence to prove these cases beyond a reasonable doubt

Prosecutors in Wayne County, Michigan, declined to prosecute a pair of cases that have made headlines in Detroit: the 2022 death of Jream Smith and the 2023 death of Prenteis KeLeo Goode.

A prosecutors office spokesperson said there was insufficient evidence to prove these cases beyond a reasonable doubt, and in general, these types of incidents can present investigative challenges.

When there are multiple people residing in the home it is often not possible to determine who gave or exposed the child to the drugs, spokesperson Maria Miller said. There can be roommates, parents, or friends [who] had close contact with the child prior to his or her death [who] all may have had ongoing or recent drug issues.

Other cases around the country hit snags because a potential suspect subsequently died of an overdose. In some cases, investigations seemed to be delayed because the childs death did not initially seem to be suspicious, and toxicology tests from autopsies can take weeks or months to complete.

These cases are tough

Eight of the unsolved child deaths reviewed by Scripps News happened in Maricopa County, Arizona one of the most populated counties in the country.

In four of those cases, including the death of Damien Coats, prosecutors declined to file charges citing no reasonable likelihood of conviction.

Prosecutors also declined charges in a near-fatal overdose that had been presented twice by Phoenix Police.

The county attorneys office said an additional two cases involving deaths in 2022 are under review, meaning a charging decision has not yet been made.

The county attorneys office declined to be interviewed by Scripps News to discuss the challenges in prosecuting these types of cases. However, a spokesperson wrote in emails that there are multiple factors involved when considering whether to take allegations to court.

These cases are tough, and often need layer upon layer of evidence to have a reasonable likelihood of conviction. Those layers can take time, a lot of time, said Karla Navarrete-Contreras, a spokesperson for the Maricopa County Attorneys Office. Fentanyl has been and continues to be a priority for County Attorney Mitchell since taking office in 2022.

The office has successfully prosecuted several cases in recent years involving children who died from exposure to fentanyl. A Scottsdale mother, Gabrielle Marshall, is serving an 11 year sentence for her childs 2022 death, and a Phoenix mother, Natalie Tate, was sentenced to serve 12 years in prison for leaving pills where her 18-month-old could reach them.

Some of the unsolved cases reviewed by Scripps News have not been presented to prosecutors for consideration of charges.

The Maricopa County Sheriffs Office, for example, said its investigators had not yet completed their report related to the death of a 23-month-old girl named Emoni Bridges in September of 2020. (Some public records spell the childs first name as Emani.)

Phoenix Police said one of the cases it investigated was closed due to the manner of death being undetermined by county medical examiners. If additional information or evidence becomes available, the case can be re-opened for charging considerations, police said.

Phoenix Police said in a statement:

The Phoenix Police Department takes every case involving the death of a child extremely seriously, especially those related to fentanyl exposure. Our detectives conduct thorough and detailed investigations working closely with crime scene specialists, the medical examiner's office and prosecutors to make sure all available evidence is collected.

The decision to prosecute rests with the Maricopa County Attorney's Office, which evaluates each case. We understand and respect the role of the MCAO. The Phoenix Police Department remains committed to investigating these tragic cases to the fullest extent and ensuring justice is pursued whenever possible.

In Apache Junction, police said they are hopeful someone will come forward with details about the death of Damien Coats that will allow them to reopen their case.

Please call our police department and share that information. Lets give Damien the justice that he deserves, Parker said.

Four lives may have been saved the day Lauren Hinton rushed her 5-month-old son to Childrens Hospital of Orange County in January 2024.

Hinton, 31, said she noticed her infant periodically seemed to be gagging on his saliva in previous weeks. One medical professional had passed it off as acid reflux, but Hinton noticed it was getting worse.

On the day she hurried to that southern California emergency department, the issue had become so severe she worried her baby might die.

I just remember being super frantic, like, Im getting him to the hospital! she said. It just got extremely concerning when we would feed him a bottle, and he wouldnt (spit up), she said. Maybe an hour later, it would be a ton of saliva coming up to where hed be choking.

A drug test at the hospital confirmed the baby had fentanyl in his system.

In a police report, one officer who saw the baby at the hospital said the child, did not appear like a healthy infant. Instead, his movements were slow, as if he were weak.

He could have overdosed and died, said Hinton.

(This test) saved his life. It saved his life. It saved my life. It saved everybodys life involved. Everybody, she said, explaining that she also believed the test saved the childrens father and their sons twin.

A history with fentanyl

Hinton now works as a Substance Use Disorder Registered Counselor according to the California Association of DUI Treatment Programs, but in early 2024, she was deep in the throes of fentanyl addiction.

She and her partner, Alexander Santiago who says he now relies on addiction support programs to stay sober told Scripps News they had struggled with drugs for many years and relapsed in the months after the birth of their twin sons.

I was at a point of just unmanageability and carelessness. It was just super out of control at that point, said Hinton.

The power of addiction, its crazy, said Santiago, 35, Like nothing else matters.

Despite being intoxicated beyond belief, Hinton said she knew something was gravely wrong with her child.

That was just the (maternal) instinct, she said.

So, she took her baby to the hospital.

Tylers Law

Most hospitals in California are required by law to include a urine drug screening for fentanyl if a person is treated at the hospital and the hospital conducts a urine drug screening to assist in diagnosing the patients condition.

The legislation, which took effect in 2023, was named after Tyler Shamash, a young man who died of a fentanyl overdose in 2018 after a hospital drug test during a previous non-fatal overdose did not specifically screen for fentanyl and did not reveal that the deadly substance was in his system.

The test on the second twin

(That test) saved our lives, honestly, said Santiago. I dont think (fentanyl) probably would have ever been detected if they didnt test for that.

The positive hospital test on Santiago's and Hinton's baby triggered authorities to check on the infants twin brother who was at home, in Garden Grove, with Santiago.

Garden Grove Officer Ryan Richmond and Detective Sindy Orozco said they prepared for the worst as they drove to the familys home.

I was prepared that if we showed up and the baby was not fine to be able to hopefully perform life-saving measures and get that baby out of the house, said Richmond, who said he planned to use Narcan or naloxone the opioid reversing antidote if the baby was unresponsive.

To have a kid thats testing positive for (fentanyl) is really scary, and we just want to make sure that we do everything we can to protect those children, said Orozco.

When they arrived, they found an alert baby, being cradled by his father.

I didnt see any objective symptoms or anything like that, said Richmond. I did feel like theres a chance that he might have something in his system...He was acting a little lethargic. Nothing obviously that raised any hairs on the back of my neck.

Orozco said she did not see obvious signs of fentanyl poisoning. Thats the thing. You sometimes cant tell that these babies or children are affected by it unless they get tested.

The officers convinced Santiago to hand over the baby, which he did willingly, so he could have a free hand to sign some police paperwork. Then, they took Santiago into custody on child abuse and endangerment charges.

Hinton was arrested on the same charges.

Everything was just such a numb feeling, like a shock, said Santiago.

First responders transported the baby to the hospital where he also tested positive for fentanyl.

The twins were placed in foster care while Hinton and Santiago went to jail and participated in rehabilitative support programs.

I thank that detective for charging me and ...that day, coming into the house. Like, I thank them for doing that because if they didnt do that that day something tragic would have happened, Santiago said. And because of that, it lit a fire under me to want to never witness or experience that again.

The parents pleaded guilty last year to the charges against them and spent several months in jail.

It was necessary for me to do the time that I did, said Hinton. The only concern I had when I was finally coherent was like, hopefully Ill get the chance to be a mother to my kids.

Hinton, who said she has other children who have been removed from her care in the past, said this close call changed the trajectory of her life.

Had none of that happened, I wouldnt be where I am right now, she told Scripps News. She said she wants other people who struggle with substance abuse to know there is hope for recovery.

The road was long. The things I had to accomplish were not easy, she said. What was different this time was the hope factor, was wanting to be a different person than I was the day before, and everything just fell in line after that, but I had to ask for help first.

This is life or death, she said. You gotta be your own voice of reason. Your own advocate to your recovery, and the best thing out of the entire situation was eventually someone heard me.... There is help out there. There is no reason why you have to go out there and do this alone, and that if you dont do something soon, its going to be fatal.

Other states

A Scripps News analysis of state legislatures found at least 14 states have considered bills related to fentanyl testing at hospitals with at least six states including Virginia, Louisiana, Connecticut, Pennsylvania, Maryland, and California enacting legislation.

Thats horrifying to think that there are small children in our communities ingesting fentanyl, said Del. Irene Shin, a Democrat, and the sponsor of Virginias legislation called Malcolms Law.

Virginia Gov. Glenn Youngkin signed the bill into law this past March.

You cant treat something you dont know is there, and weve seen so many instances of that not just for small children and toddlers but even for adults, Shin said.

Malcolms Law was named in honor of Malcolm Kent, a teen who died of a fentanyl overdose in 2023 after being sent home from an emergency room with instructions to drink water and rest despite never being tested for fentanyl.

The legislation was actually a pretty common-sense step, and it garnered bipartisan support, said Shin. She called the legislation a first step toward figuring out how we can better combat whats happening in our communities.

Shin said her research showed the cost could ultimately be less than a dollar per test depending on the total number of tests that are ordered and administered.

In Louisiana, a legislative measure to test minors for fentanyl took effect in 2024.

Sen. Stewart Cathey Jr., a Republican, said he was inspired to propose the bill when he learned his friend had lost an adult friend to a fentanyl overdose.

I think fentanyl is an issue nationwide, but we have certainly seen quite a few particularly young children who have overdosed unintentionally from fentanyl, he said. Anything that we can do to protect those children is a step in the right direction, and hopefully, legislation like this helps make children safer.

In 2022, 2-year-old Mitchell Robinson, died in Baton Rouge following a series of trips to the hospital for overdose symptoms.

According to a state review of his death, toxicology screens used by the hospital did not test for synthetic opioids leading to initial negative results. Later, more tests confirmed fentanyl in his system.

Catheys law requires hospitals to document positive fentanyl tests among children and to report the results to the state department of health.

Since the law took effect in August 2024, data obtained by Scripps News shows at least 22 children who were two or younger had the drug in their system when they were tested for fentanyl at the hospital.

A bill enacted in Maryland affects hospital patients of any age. Data shows more than 33,000 people tested positive for fentanyl at hospitals in the state since the law took effect in October 2023. The number accounts for approximately 10.5 percent of people who were tested.

Connecticuts law, passed in 2024, is designed to improve opioid monitoring in the state. It requires hospitals to complete toxicology testing on consenting patients who survive overdoses and to screen for numerous substances including opioids like fentanyl. The results are reported to the state for better understanding [of] the types of substances causing nonfatal overdoses.

Several other states have proposed laws, but many of those bills have not advanced.

Michigan state Rep. Stephanie A. Young, a Democrat, said she plans to reintroduce a testing-related bill this session after first proposing a bill in 2023.

This isnt partisan legislation, Young said. This is human legislation. This is legislation that will impact the health and wellbeing of some of the most vulnerable in our communities.

For Rep. Marcia Morey, a Democrat who proposed a bill in the state of North Carolina in 2023, the push for a law like this is not yet over, but it may have to be in a future session.

I would like to carry it forward, she told Scripps News. This is about the health and safety of people of families and its such an easy, low-cost thing to do. Its one way to tackle the problem.

Other states that have considered legislation in the past or are currently considering proposals include Arizona, Florida, Illinois, Massachusetts, New Jersey and New York.

On Wednesday, Floridas state legislature passed Gages Law, a bill named after Gage Austin Taylor, a 29-year-old who died of a fentanyl overdose in 2022. The bill is headed to the Governors desk.

In March, a bipartisan group of Congressmembers reintroduced a federal bill proposal named after Shamash, that would encourage the U.S. Department of Health and Human Services to provide hospitals with fentanyl testing guidance.

Industry Groups React

The American Hospital Association told Scripps News it defers to medical specialty societies and their recommendations including the Centers for Disease Control and Prevention and the American College of Emergency Physicians.

A spokesperson told Scripps News that AHA supports evidence-based guidelines for treatment of patients.

As far as a federal law mandating any such testing, any considerations on whether wed support something like that in the future would be driven by clinical evidence, said Colleen Kincaid, vice president of media relations and strategy for AHA, told Scripps News in 2023.

Kincaid said the AHAs position then still stands today.

Its important to appreciate that testing every child with any symptom related to overdose (such as lethargy) without any other indicator of exposure to fentanyl for an overdose could consume and divert critical health care resources, Kincaid said.

According to Steven Arnoff, a spokesperson for ACEP, the group supports federal legislation that would help prevent fentanyl overdoses by having (the U.S. Department of Health and Human Services) study how frequently hospitals test for fentanyl ...and then issue guidance to hospitals on implementing fentanyl testing in the (Emergency Department).

"Emergency physicians are on the frontlines of the opioid and substance use disorder crisis, and every day we witness the impact of overdose on our patients and their families," said Alison J. Haddock, president ACEP. Illicit fentanyl has exacerbated the overdose crisis, and it is vital to ensure that emergency physicians are equipped with the necessary tools and resources to best treat and educate our patients as we help them on their path to recovery.

The American Academy of Emergency Medicine is monitoring the situation, according to Jonathan Jones, the immediate past president of AAEM.

We strongly support physicians being able to order the tests they want to order. We oppose any restrictions hospitals or systems may place on those physicians, Jones said. "However, we also oppose mandating testing for any condition. Given many small rural hospitals dire financial situations, we are hesitant to endorse any unfunded mandates for these hospitals.

Four lives may have been saved the day Lauren Hinton rushed her 5-month-old son to Childrens Hospital of Orange County in January 2024.

Hinton, 31, said she noticed her infant periodically seemed to be gagging on his saliva in previous weeks. One medical professional had passed it off as acid reflux, but Hinton noticed it was getting worse.

On the day she hurried to that southern California emergency department, the issue had become so severe she worried her baby might die.

I just remember being super frantic, like, Im getting him to the hospital! she said. It just got extremely concerning when we would feed him a bottle, and he wouldnt (spit up), she said. Maybe an hour later, it would be a ton of saliva coming up to where hed be choking.

A drug test at the hospital confirmed the baby had fentanyl in his system.

In a police report, one officer who saw the baby at the hospital said the child, did not appear like a healthy infant. Instead, his movements were slow, as if he were weak.

He could have overdosed and died, said Hinton.

(This test) saved his life. It saved his life. It saved my life. It saved everybodys life involved. Everybody, she said, explaining that she also believed the test saved the childrens father and their sons twin.

A history with fentanyl

Hinton now works as a Substance Use Disorder Registered Counselor according to the California Association of DUI Treatment Programs, but in early 2024, she was deep in the throes of fentanyl addiction.

She and her partner, Alexander Santiago who says he now relies on addiction support programs to stay sober told Scripps News they had struggled with drugs for many years and relapsed in the months after the birth of their twin sons.

I was at a point of just unmanageability and carelessness. It was just super out of control at that point, said Hinton.

The power of addiction, its crazy, said Santiago, 35, Like nothing else matters.

Despite being intoxicated beyond belief, Hinton said she knew something was gravely wrong with her child.

That was just the (maternal) instinct, she said.

So, she took her baby to the hospital.

Tylers Law

Most hospitals in California are required by law to include a urine drug screening for fentanyl if a person is treated at the hospital and the hospital conducts a urine drug screening to assist in diagnosing the patients condition.

The legislation, which took effect in 2023, was named after Tyler Shamash, a young man who died of a fentanyl overdose in 2018 after a hospital drug test during a previous non-fatal overdose did not specifically screen for fentanyl and did not reveal that the deadly substance was in his system.

The test on the second twin

(That test) saved our lives, honestly, said Santiago. I dont think (fentanyl) probably would have ever been detected if they didnt test for that.

The positive hospital test on Santiago's and Hinton's baby triggered authorities to check on the infants twin brother who was at home, in Garden Grove, with Santiago.

Garden Grove Officer Ryan Richmond and Detective Sindy Orozco said they prepared for the worst as they drove to the familys home.

I was prepared that if we showed up and the baby was not fine to be able to hopefully perform life-saving measures and get that baby out of the house, said Richmond, who said he planned to use Narcan or naloxone the opioid reversing antidote if the baby was unresponsive.

To have a kid thats testing positive for (fentanyl) is really scary, and we just want to make sure that we do everything we can to protect those children, said Orozco.

When they arrived, they found an alert baby, being cradled by his father.

I didnt see any objective symptoms or anything like that, said Richmond. I did feel like theres a chance that he might have something in his system...He was acting a little lethargic. Nothing obviously that raised any hairs on the back of my neck.

Orozco said she did not see obvious signs of fentanyl poisoning. Thats the thing. You sometimes cant tell that these babies or children are affected by it unless they get tested.

The officers convinced Santiago to hand over the baby, which he did willingly, so he could have a free hand to sign some police paperwork. Then, they took Santiago into custody on child abuse and endangerment charges.

Hinton was arrested on the same charges.

Everything was just such a numb feeling, like a shock, said Santiago.

First responders transported the baby to the hospital where he also tested positive for fentanyl.

The twins were placed in foster care while Hinton and Santiago went to jail and participated in rehabilitative support programs.

I thank that detective for charging me and ...that day, coming into the house. Like, I thank them for doing that because if they didnt do that that day something tragic would have happened, Santiago said. And because of that, it lit a fire under me to want to never witness or experience that again.

The parents pleaded guilty last year to the charges against them and spent several months in jail.

It was necessary for me to do the time that I did, said Hinton. The only concern I had when I was finally coherent was like, hopefully Ill get the chance to be a mother to my kids.

Hinton, who said she has other children who have been removed from her care in the past, said this close call changed the trajectory of her life.

Had none of that happened, I wouldnt be where I am right now, she told Scripps News. She said she wants other people who struggle with substance abuse to know there is hope for recovery.

The road was long. The things I had to accomplish were not easy, she said. What was different this time was the hope factor, was wanting to be a different person than I was the day before, and everything just fell in line after that, but I had to ask for help first.

This is life or death, she said. You gotta be your own voice of reason. Your own advocate to your recovery, and the best thing out of the entire situation was eventually someone heard me.... There is help out there. There is no reason why you have to go out there and do this alone, and that if you dont do something soon, its going to be fatal.

Other states

A Scripps News analysis of state legislatures found at least 14 states have considered bills related to fentanyl testing at hospitals with at least six states including Virginia, Louisiana, Connecticut, Pennsylvania, Maryland, and California enacting legislation.

Thats horrifying to think that there are small children in our communities ingesting fentanyl, said Del. Irene Shin, a Democrat, and the sponsor of Virginias legislation called Malcolms Law.

Virginia Gov. Glenn Youngkin signed the bill into law this past March.

You cant treat something you dont know is there, and weve seen so many instances of that not just for small children and toddlers but even for adults, Shin said.

Malcolms Law was named in honor of Malcolm Kent, a teen who died of a fentanyl overdose in 2023 after being sent home from an emergency room with instructions to drink water and rest despite never being tested for fentanyl.

The legislation was actually a pretty common-sense step, and it garnered bipartisan support, said Shin. She called the legislation a first step toward figuring out how we can better combat whats happening in our communities.

Shin said her research showed the cost could ultimately be less than a dollar per test depending on the total number of tests that are ordered and administered.

In Louisiana, a legislative measure to test minors for fentanyl took effect in 2024.

Sen. Stewart Cathey Jr., a Republican, said he was inspired to propose the bill when he learned his friend had lost an adult friend to a fentanyl overdose.

I think fentanyl is an issue nationwide, but we have certainly seen quite a few particularly young children who have overdosed unintentionally from fentanyl, he said. Anything that we can do to protect those children is a step in the right direction, and hopefully, legislation like this helps make children safer.

In 2022, 2-year-old Mitchell Robinson, died in Baton Rouge following a series of trips to the hospital for overdose symptoms.

According to a state review of his death, toxicology screens used by the hospital did not test for synthetic opioids leading to initial negative results. Later, more tests confirmed fentanyl in his system.

Catheys law requires hospitals to document positive fentanyl tests among children and to report the results to the state department of health.

Since the law took effect in August 2024, data obtained by Scripps News shows at least 22 children who were two or younger had the drug in their system when they were tested for fentanyl at the hospital.

A bill enacted in Maryland affects hospital patients of any age. Data shows more than 33,000 people tested positive for fentanyl at hospitals in the state since the law took effect in October 2023. The number accounts for approximately 10.5 percent of people who were tested.

Connecticuts law, passed in 2024, is designed to improve opioid monitoring in the state. It requires hospitals to complete toxicology testing on consenting patients who survive overdoses and to screen for numerous substances including opioids like fentanyl. The results are reported to the state for better understanding [of] the types of substances causing nonfatal overdoses.

Several other states have proposed laws, but many of those bills have not advanced.

Michigan state Rep. Stephanie A. Young, a Democrat, said she plans to reintroduce a testing-related bill this session after first proposing a bill in 2023.

This isnt partisan legislation, Young said. This is human legislation. This is legislation that will impact the health and wellbeing of some of the most vulnerable in our communities.

For Rep. Marcia Morey, a Democrat who proposed a bill in the state of North Carolina in 2023, the push for a law like this is not yet over, but it may have to be in a future session.

I would like to carry it forward, she told Scripps News. This is about the health and safety of people of families and its such an easy, low-cost thing to do. Its one way to tackle the problem.

Other states that have considered legislation in the past or are currently considering proposals include Arizona, Florida, Illinois, Massachusetts, New Jersey and New York.

On Wednesday, Floridas state legislature passed Gages Law, a bill named after Gage Austin Taylor, a 29-year-old who died of a fentanyl overdose in 2022. The bill is headed to the Governors desk.

In March, a bipartisan group of Congressmembers reintroduced a federal bill proposal named after Shamash, that would encourage the U.S. Department of Health and Human Services to provide hospitals with fentanyl testing guidance.

Industry Groups React

The American Hospital Association told Scripps News it defers to medical specialty societies and their recommendations including the Centers for Disease Control and Prevention and the American College of Emergency Physicians.

A spokesperson told Scripps News that AHA supports evidence-based guidelines for treatment of patients.

As far as a federal law mandating any such testing, any considerations on whether wed support something like that in the future would be driven by clinical evidence, said Colleen Kincaid, vice president of media relations and strategy for AHA, told Scripps News in 2023.

Kincaid said the AHAs position then still stands today.

Its important to appreciate that testing every child with any symptom related to overdose (such as lethargy) without any other indicator of exposure to fentanyl for an overdose could consume and divert critical health care resources, Kincaid said.

According to Steven Arnoff, a spokesperson for ACEP, the group supports federal legislation that would help prevent fentanyl overdoses by having (the U.S. Department of Health and Human Services) study how frequently hospitals test for fentanyl ...and then issue guidance to hospitals on implementing fentanyl testing in the (Emergency Department).

"Emergency physicians are on the frontlines of the opioid and substance use disorder crisis, and every day we witness the impact of overdose on our patients and their families," said Alison J. Haddock, president ACEP. Illicit fentanyl has exacerbated the overdose crisis, and it is vital to ensure that emergency physicians are equipped with the necessary tools and resources to best treat and educate our patients as we help them on their path to recovery.

The American Academy of Emergency Medicine is monitoring the situation, according to Jonathan Jones, the immediate past president of AAEM.

We strongly support physicians being able to order the tests they want to order. We oppose any restrictions hospitals or systems may place on those physicians, Jones said. "However, we also oppose mandating testing for any condition. Given many small rural hospitals dire financial situations, we are hesitant to endorse any unfunded mandates for these hospitals.

When Aviyana Montoya died in 2022, the toddler had ingested so much fentanyl a prosecutor said it was 10 times the amount that would kill an adult.

She was cold to the touch when adults found her unresponsive in her bedroom, and when paramedics arrived, they said signs of rigor mortis had already taken effect.

The little girl, who was approaching her second birthday, had been living in a home that had been used for a drug-dealing operation, according to prosecutors who handled the criminal case against her parents.

A death investigation conducted by the states Child Fatality Review Team indicated, the parents... had been selling fentanyl to pay for their cocaine.

Aviyana's case is one of two Colorado child fentanyl deaths Scripps News highlighted in December 2024 after receiving access to recently released death investigation reports and other public records.

Scripps News wanted to know: were there warning signs before their deaths, and were those red flags handled properly?

Communication failures

After reviewing the records in Aviyanas case and in the case of another toddler who died of fentanyl poisoning in Aurora in 2021, Scripps News discovered that communication failures between law enforcement and child welfare workers preceded each childs death.

Several months prior to their deaths, both children had a parent who had a drug-related run-in with the police in which the child was present.

In both cases, law enforcement officers failed to alert child welfare workers about the incidents, against their agencies policies.

Governor Polis is disheartened by these stories and committed to ensuring that law enforcement properly notifies and coordinates with state agencies to ensure the safety of all Colorado children, said Shelby Wieman, a spokesperson for Colorado Gov. Jared Polis, in response to Scripps News investigation.

What happened in each case

More than a year before Aviyanas death, a Colorado State Patrol trooper pulled over Aviyanas father while she was riding in his car.

The officer arrested him for drug and child abuse charges but did not notify child welfare workers about the incident

in violation of the agencys policy, according to Sgt. Patrick Rice, a spokesperson for the agency.

Our policy is that the responding trooper contact a CSP victim's advocate to work with human services and the family, or contact human services directly, said Rice.

In the Aurora case, first responders revived a mother with the opioid reversal antidote, naloxone, after she passed out behind the wheel of her vehicle with her child in the car.

No one alerted child welfare workers about the incident, according to Joe Moylan, a spokesperson for the Aurora Police Department, and about nine months later, the child died of fentanyl poisoning.

The officer was disciplined and suspended for 20 hours without pay, Moylan said.

What lawmakers are saying

Especially having seen your story, I think its critical that we take a look and see what is missing in the breakdown in that communication, said Rep. Chad Clifford, a Democrat who sits on Colorados legislative judiciary committee.

In Colorado, mandatory reporters, including peace officers, physicians, school employees, and many others, are required to report suspected child abuse or neglect to either a county child welfare agency, to the child abuse hotline, or a local law enforcement agency.

However, police officers are not mandated, under state law, to report child abuse claims directly to child welfare workers, according to the Colorado Office of the Attorney General.

Statute requires peace officers to report suspected child abuse, but that can be to a law enforcement agency or child protective services, said Lawrence Pacheco, a spokesperson for Colorados Office of the Attorney General.

There is not a specific requirement that cases are reported to child protective services, although many agencies have individual policies in place to require this type of reporting, he said.

I think we definitely need to address this some way with legislation, Rep. Clifford said.

I would assert that there are police departments around the state and sheriffs departments that do have good communications and relationships with child protective services," he said. "I think we should probably take a look at what has been working in areas - if it is - and get some feedback ... and then codify something, so that its more universal.

State Sen. John Carson, a Republican who sits on the states judiciary and health and human services committees, said he believes communication should be enhanced.

What you reported on...indicates we do need to have more communication out there at all levels of society, he said. We need more education to parents. We need more education to law enforcement. We need education here at the Capitol with state legislators. And weve got to figure out how to get a handle on this and prevent more deaths.

Carson said he is a proponent of increasing penalties for possessing fentanyl, and if he believes it is warranted, he would consider a new law.

If theres legislation or work we need to do to improve that communication, I would want to take a look at that, he said. Im interested in looking at anything that might help. But a lot of times you find theres a lot of legislation already out there a lot of regulations already out there they're just not being followed...we ought to first take a look at that and make sure that the agencies are following the guidelines and the rules and that its a top priority.

A spokesperson for Polis said the issue is important.

Governor Polis is open to ideas that keep our kids safe and prevent this type of communication breakdown from occurring again, ensuring that Colorados Division of Child Welfare has the information it needs to protect Colorado kids. Governor Polis is committed to making Colorado one of the top ten safest states, and that includes protecting our communities and kids from the scourge of fentanyl, said Wieman.

An ongoing problem

Communication issues like these have been a problem for many years, according to state records reviewed by Scripps News.

The Child Fatality Prevention System which is administered by the Colorado Department of Public Health and Environment reported a need to address issues with information sharing between agencies, as far back as 2016.

Scripps News also repeatedly found similar recommendations for improved communication in annual reports prepared by the states Child Fatality Review Team, which operates under the Colorado Department of Human Services.

I think thats going to be something thats going to be in progress for a while, April Jenkins, a manager for CDHS's child protection and prevention unit, told Scripps News in December last year.

In response to questions about how communication issues would be addressed by CDHS, a spokesperson told Scripps News that it was planning a workgroup that would focus on designing standard protocols for enhancing working relationships and communication between human services, social services, and law enforcement agencies statewide.

A CDHS spokesperson told Scripps News that a preliminary planning group met last week and planned to reach out to counties and law enforcement agencies to participate in the workgroup.

Louisiana state investigation identifies similar breakdown

Scripps News also found similar communication breakdowns in other states.

In Louisiana, for example, police conducted a drug raid at Mitchell Robinsons home, weeks before the two-year-old died of fentanyl poisoning in 2022. According to a state investigation, child welfare workers had no record of being contacted by law enforcement.

A police officers body-worn camera captured the scene in New York after authorities received a 911 call reporting an 11-month-old baby was unresponsive.

Hes gasping, the childs mother explained to first responders as she cradled him in her arms in a Lake Grove home in January 2024.

As the baby struggled to breathe in an ambulance, first responders noticed the pupils of his eyes appeared to be small and pinpoint a sign the baby may have ingested an opioid.

I think we ought to do some Narcan just in case, a first responder said.

The crew administered a dose of the opioid reversal drug, and soon noticed the childs pupils were back to normal. After several tense minutes, the baby began to cry loudly. He survived after receiving more doses of Narcan in the hospital, where he was diagnosed with acute fentanyl poisoning.

Prosecutors said police found a straw containing fentanyl residue in the home. His father was convicted for the near-fatal overdose of his child and is awaiting sentencing later this month. Prosecutors said a dealer who sold the father drugs has also been sentenced to prison.

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This video is one of hundreds of police recordings and 911 calls following a young childs fentanyl poisoning reviewed by Scripps News Investigates over the past two years.

The Scripps News review found caregivers often described similar symptoms, including children who were:

In these cases, young children were often reported to have inadvertently ingested fentanyl used by parents or caregivers by putting pills or items used to consume drugs like straws and foils in their mouths.

In many cases reviewed by Scripps News, first responders who recognized overdose symptoms in children quickly were able to save their lives.

Study finds sharp increase in non-fatal child fentanyl exposures

The Scripps review comes as researchers found nonfatal fentanyl exposures among children have spiked dramatically in recent years.

A study of poison control centers across the country, released earlier this month, found such exposures among children aged 0-12 grew from 37 cases in 2015 to 379 in 2023 an increase of more than 900%.

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Joshua Black, a researcher at Rocky Mountain Poison and Drug Safety in Denver, helped conduct the study. He said non-fatal cases are also increasing in severity.

We think that a consequence of that is that parents need to be much more aware and cognizant of the signs and symptoms that would indicate an overdose is occurring, Black told Scripps News. Those would be ... individuals becoming more pale, becoming unresponsive, in the worst cases, falling unconscious, [and] seizing.

Caregivers describe weird breathing 

Across more than 110 hours of police video, interview recordings, and 911 audio, the Scripps News investigative team heard witnesses from around the country describing the symptoms that drove them to seek help for poisoned children.

Often, they described distinctive and unusual breathing.

In Florida, a couple told police the noises their baby made during a near-fatal overdose sounded like the child was having a bad dream at first.

Like nightmares, the mother said.

Its like a croak. I dont know how to imitate it, the father told officers.

In a separate case in Arizona, a woman described her nephews symptoms in a similar way.

I realized he was breathing, like, really weird ... like in a snoring way, but heavy, she said outside the hospital where the toddler received lifesaving treatment. He was gasping for air.

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In Ohio, a father described his childs heavy breathing as weird noises like Ive never heard of.

Police said first responders initially believed the child was suffering from croup a sickness that can cause coughing and heavy breathing. As a result, they did not immediately administer the opioid reversal antidote, naloxone. The child survived after being treated in a hospital.

Separate research finds children without symptoms testing positive for fentanyl

A research project conducted by the child protection team at University of California Rady Childrens Hospital-San Diego found children who live in homes where fentanyl is being used or distributed are being exposed to the drug more often than previously known.

Its very scary for us because what we know is the line between life and death is probably very very small, said Dr. Natalie Laub, a researcher and child abuse pediatrician at Rady Childrens Hospital-San Diego. We dont know how much fentanyl it takes for a child to stop breathing.

Laub said the hospital added screening for fentanyl to its standard drug testing panel in 2020 and began to notice many children had fentanyl in their systems even when they displayed no symptoms.

We began to see a dramatic rise in fentanyl-positive urine drug screens after that, notably in children who werent showing symptoms, she told Scripps News. When our team of researchers (including myself) looked at the data we were very alarmed.

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According to Laub, her research team tested 102 children from homes where fentanyl was used or distributed and found more than 80% of the children had fentanyl in their systems even those who showed no outward symptoms of fentanyl exposure.

We believe this is only a small fraction of the children out there living in homes where there is illicit fentanyl use," she said. "Most children fly under the radar or arent tested because people dont think its important to test well-appearing children when they are found in homes where fentanyl is being used."

Way more children than we know are absolutely on the brink of death, said Laub.

For more than two years, Scripps News has been independently tracking the fentanyl deaths and poisonings of babies and young children to shine light on trends that might save lives.

Investigative reporter Lori Jane Gliha and investigative producer Brittany Freeman have read through thousands of pages of police documents, child fatality reports, autopsies, and court records.

The Scripps News investigative team obtained more than 80 hours of police body camera footage, interrogation videos, and 911 calls to shine a light on common health trends and repeated mistakes that have led to hundreds of child cases in recent years.

Theyve shared their reporting with health leaders, child protection agencies, members of Congress, and local legislators throughout the country and continue to pursue this project as they uncover more details that could potentially prevent more deaths.

Here are some key things theyve discovered:

In the coming months, Scripps News will continue its dedicated original reporting by continuing to expose new data, updated research, and other factors that have led to child fentanyl poisonings across the country.

Blurry surveillance video recorded inside Aviyana Montoyas home on New Years Day in 2022 captured the last hours the 22-month-old girl was alive.

Like any teething toddler, she bounded around the master bedroom, climbing on furniture and the bed. She ran up to familiar adults, touching and embracing them, and she can be seen putting things in her mouth

Several hours later, she was dead.

According to Brian Mason, the district attorney in Adams County, Colorado, where the little girl lived, Aviyana had 10 times the amount of fentanyl in her system needed to kill an intolerant adult user.

Video cameras inside the home also recorded adults preparing drugs and smoking them, according to the district attorneys office that prosecuted the case.

According to Masons office, the little girls father, Alonzo Montoya, was running a drug-dealing operation out of his home. A child fatality review team also reported the parents were known to use crack rock, and had been selling fentanyl to pay for their cocaine.

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In 2024, Montoya was convicted of child abuse resulting in death and a series of other drug-related charges. A jury also found the girls mother, Nicole Casias, guilty of child abuse resulting in death and fentanyl possession with the intent to distribute.

A state review of the fatality made public in October revealed a communication gap in the child welfare system aimed at protecting children like Aviyana. Police knew about her fathers drug problem long before her death, but no one alerted the Department of Human Services or child welfare workers that he had previously exposed her to potentially lethal drugs.

Communication is critical, said April Jenkins, the child protection and prevention unit manager for Colorados Division of Child Welfare. Law enforcement are critical partners for us and also critical in the safety of children.

Jenkins said she could not speak about details of any specific case. Colorado state child fatality reviews do not include the names of the children involved.

An ongoing Scripps News review of child deaths and fentanyl poisonings across the country found other similar communication breakdowns between law enforcement and child welfare agencies.

In Aviyana's case, an officer from the Colorado State Patrol pulled over her father in July 2020, and police found narcotics and drug paraphernalia in the car. Montoya faced numerous charges in connection with the traffic stop including impaired driving and child abuse. He was eventually acquitted of the child abuse charge.

In the video of the traffic stop obtained by Scripps News, he told the patrol officer he was a drug user and that he was scared for his wife and child. Court records show he was charged with impaired driving and child abuse.

However, according to the Colorado State Patrol, It appears there was no request for a victims advocate or notification (to child welfare workers) which is inconsistent with our policy, said Sgt. Patrick Rice, a spokesperson for the agency.

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Our policy is that the responding trooper contact a CSP victims advocate to work with human services and the family, or contact human services directly, he added. Rice said the agency has since conducted audits and training to ensure communication gaps like this do not continue.

Our most recent audit through August 31 shows that we have 0% failures to notify the Department of Human Services in child abuse cases year-to-date in 2024, he said.

Jenkins said there is no mechanism within the state court system that would automatically alert her agency that someone has been charged with child abuse.

I think that would be helpful, she said. Jenkins added she feels law enforcement generally does a really great job reviewing cases that may have slipped through the cracks and sending them to her agency when they involve child abuse.

Scripps News found other cases in which police and child welfare workers failed to communicate about a childs drug exposure in the weeks or months ahead of the childs fentanyl-related death.

In Aurora, Colorado, police encountered a woman who had passed out behind the wheel of her vehicle while her baby was in the car in September 2020. Medical crews revived the woman with the opioid-reversal drug, Narcan, and provided her with extra doses of Narcan to take home.

However, no one made a report of concern to the Department of Human Services.

In June 2021, the womans 3-year-old died from fentanyl poisoning, according to a state review of the death.

According to Joe Moylan, a spokesperson for the Aurora Police Department, an internal affairs review of the incident conducted after the childs death found the officer violated three agency policies including Responsibility for Preliminary Investigation, Unsatisfactory Performance and Mandatory Reporting to Social Services.

Moylan said the officer was suspended without pay for 20 hours.

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In Colorado, the states Child Fatality Review Team has made repeated recommendations in recent years for creating a task force that would develop protocol for creating a strong working relationship/communication among (child welfare and law enforcement) agencies.

According to the states 2024 Child Maltreatment Fatality Review report, many of these recommendations some dating back several years are still in progress.

I think thats going to always probably be in progress because youre also going to have new people coming onto the job. Youre going to have new people training, learning how to communicate with child welfare, learning our role, learning how we work together, said Jenkins. I think thats going to be something that will be in progress for a while because I think thats an area where we always can improve. It may not ever be perfect, but I think thats something that were always working on.

Similar cases have also occurred outside of Colorado.

In Baton Rouge, Louisiana, 2-year-old Mitchell Robinson died of fentanyl poisoning in June 2022 after two previous poisonings.

The month before he died, narcotics agents found fentanyl in the kitchen, attic, and in the barbeque grill at the boys home, and they arrested the boys mother and father, charging them with numerous drug-related offenses including illegal use of a controlled dangerous substance in the presence of a minor.

However, according to a state review of the boys death, child welfare workers had no record of being contacted by law enforcement following the drug arrests of the childs parents.