CLEARWATER — Pinellas Sheriff Bob Gualtieri said his agency is conducting an internal review after the death of a 5-year-old girl in foster care.
While initial reports indicate a medical event prompted her death, the investigation revealed that sheriff's employees broke a state rule after they removed the girl from her home earlier this month.
The rule they broke requires that children taken into foster care receive a medical screening within three days. The screening never occurred, though it's not clear if it would have detected the medical issue that led to the girl's death.
Elizabeth Holder was taken from her parents' care on Jan. 11 after a neighbor spotted her wandering unattended at the Gulf to Bay Mobile Home Park near Clearwater. Pinellas deputies said Elizabeth's mother, who was arrested that day, and father were high on prescription pills at the time.
Elizabeth and her sister, who will turn 2 next month, were placed into foster care. Eight days later, on Saturday, the children were at a babysitter's in Dunedin when Elizabeth began clutching her head.
"She began to scream, 'It hurts! It hurts! It hurts!' " Gualtieri said at a news conference Thursday.
A few moments later, Elizabeth went limp. She was taken to the hospital, but pronounced dead a short time later. The Pinellas-Pasco Medical Examiner's Office has conducted an autopsy but has not determined a cause of death.
Gualtieri said there is no indication the girl suffered physical trauma to her body and it appears at this point a medical event prompted her death. She didn't display signs of sickness while in foster care, he said.
But in reviewing the case, the sheriff said, authorities did find a mistake.
State law says children removed from their home must get a health screening within 72 hours. But neither she nor her younger sister saw a doctor after the Sheriff's Office, which handles child protection investigations in Pinellas County, took them from their parents.
"There was an omission on our part, where we should have acted but didn't," Gualtieri said. "I accept responsibility. We own it. This falls squarely on me. This falls squarely on us."
A family support worker at the agency tried to get the children a health screening, he said, but made the doctor's appointments for Jan. 22 and Jan. 24.
"Have we missed this deadline before? I won't know until the review is complete," Gualtieri said, adding the internal review will cover a year back.
Gualtieri said it is unclear at this point whether the health screening could have caught something or prevented Elizabeth's death.
"I don't know the answer to that, and I may never know the answer to that," he said. "I can only hope that failure did not contribute to her death."
Still, it appears the breakdown began almost immediately.
The clock on the 72-hour rule starts as soon as the children are removed, Gualtieri said. So the girls, who were removed on a Friday, should have been seen by a health professional by Monday.
The family support worker didn't even start making calls to get the children to a doctor until Monday.
The worker, Gualtieri said, called the health department and got a recording, then called a St. Petersburg pediatric office that had seen the girl previously. That doctor agreed to see the children several days later.
Denette Holder, Elizabeth's grandmother, initially didn't believe the blond, blue-eyed child had died.
"My head can't wrap around it," Holder, 53, said Thursday. "It doesn't make sense. That beautiful, beautiful girl."
Officials at the Medical Examiner's Office said toxicology results are expected in 60 to 90 days, which is typical in death investigations.
But the girl's grandmother told the Tampa Bay Times she believes Elizabeth may have suffered a brain aneurysm. She said a doctor at Mease Countryside Hospital, where Elizabeth was pronounced dead, told her it was the likely cause.
"Maybe it was her time," she said. "Maybe God wanted her back."
Gualtieri said there were indications Elizabeth had developmental issues. At 5 years old, she was not potty trained. The sheriff did not know if she was in school.
"Elizabeth had a tough life," he said.
When sheriff's deputies removed Elizabeth from her parent's Clearwater mobile home, Holder didn't take the girl because her boyfriend, whom she lived with, didn't allow it.
"I had nowhere else," she said.
Holder has since moved into a friend's home in Clearwater. She said she is now the primary caretaker of Elizabeth's 2-year-old sister, Kala.
Stephanie Judah, 35, the girls' mother, faces a child neglect charge from the Jan. 11 incident. She could not be reached for comment.
Their father, Corey Holder, is staying with his mother. He declined to speak with the newspaper Thursday.
Wherever she goes, Denette Holder carries photos of Elizabeth: as an infant, at Cirque du Soleil in Tampa, in her back yard sniffing big, pink flowers.
"I'll never accept this," she said. "I'm her grandma. I'm supposed to be the protector."
Elizabeth loved Cookie Monster, Busch Gardens and bubble baths, Denette Holder said. She rode through her mobile home park on a miniature pink motorcycle.
The family is planning a small funeral.
Times researcher Caryn Baird contributed to this report. Kameel Stanley can be reached at email@example.com or (727) 893-8643.