The state attorney general’s office now says three children died of abuse in Hawaii’s Child Welfare Services system in the past decade — not one, as legislators were told last week — and some child advocates were stunned Monday to learn that deaths in state custody are not reported in Hawaii’s Child Death Review.

Former state Rep. Alex Santiago, who helped create the Child Death Review Program in 1997, expressed disappointment that the program’s report does not contain specific information on children who died while in state custody. The attorney general’s office said that 29 children have died while under state protective care since 2000, mostly from medical conditions.

The Legislature created the Child Death Review Program to identify trends and reduce the number of children who die each year, said Santiago, who helped create the program as chairman of the House Health Committee.

"It does surprise me that we don’t have more detailed information about what’s going on," said Santiago, a former Child Welfare Services caseworker. "I’m a little disappointed to hear this. I have to accept some responsibility. If we weren’t more clear about what we wanted, maybe that needs to be revisited so we can do a good job. Protecting children is the bottom line. How can you do that if you don’t get good data?"

The death report and the Child Death Review Program were created to give legislators information to help guide public policy. The reports were intended to be released annually but have not been updated since 2006.

In response to the unexplained death of 9-month-old Jayvid Waa-Ili on Aug. 26 while in state custody, Department of Human Services officials originally said that 30 children — including Waa-Ili of Hauula — died while in state custody since 2000. But one of the cases was later discovered to have been miscoded as a fatality.

The Honolulu Medical Examiner’s Office has yet to determine a cause of death for Waa-Ili, pending the outcome of toxicology tests.

DHS Director Patricia McManaman told lawmakers Thursday that one child died of abuse while in state custody, but offered no details. She emphasized the need to protect the privacy of families in the state system.

The information later released by the attorney general’s office showed that two other children died of abuse suffered prior to entering state custody.

Officials with the state Health Department who oversee the Child Death Review Program did not respond to repeated requests for comment Monday.

The information on the 29 child deaths released by the attorney general’s office provides no dates, names or identifying information, including which island the children died on. Nor does it say when the children came to the attention of child welfare officials. But it does provide general information on the cases:

» "Infant admitted to hospital unresponsive with multiple fractures. Cause of death unknown following autopsy. Physical abuse and neglect by unknown perpetrator was confirmed."

» "Child died in the hospital as a result of injuries by unknown perpetrators. (Child was taken into foster care as a result of the injury.)"

» "Parents brought child to hospital with bleeding to the brain and in both eyes. Child Protective Services took custody of child on day of admittance to hospital. Physical abuse by parents was confirmed."

Child Protective Service is one of the programs under state Child Welfare Services, which also covers foster care and adoption.

Four of the 29 deaths involved drug-exposed infants. One died in an auto accident, one committed suicide and one was struck by a vehicle in another state.

Twelve children died in state custody suffering from serious or multiple medical problems, such as leukemia, heart conditions, cerebral palsy, head trauma and brain tumors.

"I certainly remember going to the meetings to set up the Death Review panels, and I thought all deaths of minor children were going to be reviewed and I assumed that would mean those with Child Welfare Services," said Annabel Murray, who used to represent foster children and now practices family law with a focus on child custody evaluations and mediation through the Children’s Law Center. "My recollection is that all deaths, including (those related to) Child Welfare, would be reviewed."

While Murray said she’s disappointed that the Child Death Review Report does not include information about children in state custody, she also worries that so many medically fragile children are dying while under the responsibility of the state Department of Human Services.

"If we actually have kids with enlarged hearts, does it show that we need foster homes that are capable of taking care of medically fragile children?" Murray asked. "I’m surprised that so many medically fragile children died. I want to know why a kid with leukemia is in foster care."

State Sen. Suzanne Chun Oakland, chairwoman of the Senate Human Services Committee, who helped create Hawaii’s Child Death Review Program, used to get information on children who died in state custody during informal, monthly "CPS Roundtable" discussions.

"If they understood a child was killed by an abusive caretaker, they shouldn’t wait for a year’s report for something to happen," Chun Oakland said. "But in more recent times we didn’t get that good data. It was a lot more difficult to get any kind of data."

The lack of detailed information on child fatalities became less of a priority as the number of children entering state custody fell during the past several years, Chun Oakland said.

"We started to reduce the number of CPS Roundtable meetings to the point we don’t have them anymore," she said. "Now that things are getting bad again, in terms of resources, we just know that we have to restore a number of the services that actually prevent child abuse and neglect."