PHILADELPHIA (AP) -- A Philadelphia couple faces murder charges in the starvation death of their disabled 3-year-old girl, a case with harrowing echoes in a city where a series of children have suffered similarly slow, agonizing deaths.
Nathalyz (pronounced NAT'-uh-leez) Rivera, one of a set of twins, weighed just 11 pounds when she died Monday. Although she had severe disabilities, she had not seen a doctor in more than a year and was apparently not on the radar of social services.
Carlos Rivera, 30, and his wife Carmen Ramirez, 27, were charged Tuesday with third-degree murder. They have four other children, who were placed in protective custody. Neither parent immediately had a lawyer listed in court records, and attempts to reach relatives proved unsuccessful.
"The fact you can have a child that literally starved to death in the city of Philadelphia is abysmal," said Dr. Rachel P. Berger, chief of the division of child advocacy at Children's Hospital of Pittsburgh of UPMC, who is not involved in the case.
"The real question is, as a society, how did we fail this child? Who saw this child, outside of the family or even within the family?"
Police did not disclose Nathalyz's specific health issues, although Ramirez told police that her daughter was born blind and had Down syndrome, The Philadelphia Inquirer reported. The family last had contact with the Department of Human Services in 2008, before she was born.
They lived in a rented row home on a neatly kept block of mostly retirees. Police said the home was in deplorable condition, infested with insects and rodents that they suspect caused some of the bruising on the girl's body.
Neighbors told reporters this week that they rarely saw the family, although others said they saw the children -- but not Nathalyz -- playing outside while the mother watched them or Rivera worked on cars. He has prior arrests for assault, endangerment and threatening behavior, although many of the charges were ultimately dropped.
According to police, Rivera found his youngest daughter unresponsive at about midnight Sunday, and called the girl's mother rather than 911. Ramirez came and went from the house, and arrived with a male friend to take Nathalyz to the hospital.
It was nearly 2 a.m. when the girl was pronounced dead, although homicide Capt. James Clark believes she was dead when Rivera found her. Clark called the autopsy photos among the most disturbing he has seen on the job.
More than 1,500 U.S. children die from abuse or neglect each year, most of them under age 4, but the Department of Health and Human Services said Tuesday that it could not break out the number of starvation deaths.
"We had a bunch of child starvation and abuse deaths over my 19 years. Lots, unfortunately," said former Philadelphia District Attorney Lynne Abraham, whose office spent years investigating the 2006 death of Danieal Kelly, who weighed 42 pounds when she died at age 14.
"A lot of the parents are totally ill-equipped to take care of one child, let alone multiple children," Abraham said.
Kelly, who had cerebral palsy and used a wheelchair, died despite the family's enrollment in an intensive program for the city's most needy households.
More recently, 2-month-old twin Quasir Alexander weighed just over 4 pounds when he died at a homeless shelter in 2010, where his mother lived with her six children and received an array of social services.
Ensuing criminal trials revealed fraud in the Kelly case -- social workers and contractors skipped the weekly home visits -- and perhaps inexperience in the Alexander case. A social worker saw Quasir 36 hours before he died, but the baby was swaddled in clothing and the social worker found nothing amiss.
Danieal's mother was convicted of third-degree murder, her father of felony neglect. Quasir's mother was convicted of involuntary manslaughter.
Nathalyz's death may point to a third phenomenon, in which families remain isolated from people who could help. It may be up to a jury to determine if that was intentional.
"When you have parents that are not invested in their children -- sometimes they have mental health disease, sometimes they're so overwhelmed with life, that getting health care is not on their agenda -- and you couple that with a child that's got medical problems, that's when you get into these kinds of situations," said Dr. Cindy Christian, a Children's Hospital of Philadelphia pediatrician who serves as medical director of the city's Department of Human Services.
"But there should never be a child who dies of starvation," she said. "We know how to nourish children, even with the most complex health care needs."
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