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Half of child deaths left unreviewed in Pa. since 2020 as counties struggle with ‘unfunded mandate’

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Half of child deaths left unreviewed in Pa. since 2020 as counties struggle with ‘unfunded mandate’


Many Pennsylvania counties are failing to review the death of every child in their area, despite a 2008 state law that requires them to do so.

The problem, advocates and program participants say, is a lack of both state assistance in collecting data and time for volunteers to run the local panels.

Gov. Josh Shapiro wants the legislature to approve $2.5 million to improve this work, but it’s unclear if the request will be considered a priority this year.

The effort to study the deaths of Pennsylvania children dates back about two decades, when the state passed a law mandating counties host a local board of healthcare professionals, law enforcement officials, child protective service providers, and a coroner or medical examiner to review the deaths of every resident under the age of 21. The law was one of several initiatives spurred by the murder of Berks County toddler Maxwell Fisher in 1996.

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Based on the information county boards gather, members are charged with creating strategies for local and state policymakers to prevent similar deaths.

But reports shared with Spotlight PA by the Pennsylvania Department of Health show that since 2020, roughly half of childhood deaths statewide have not been reviewed. Those lapses are especially prominent in rural counties, where local teams are more likely to falter or not exist.

Policymakers have known about the program’s issues for years.

A multiyear East Stroudsburg University evaluation of the program commissioned by the state Department of Health concluded in 2024 that the Child Death Review program is “an unfunded mandate.” It issued a long list of recommendations to rectify the program’s shortcomings, including creating regional teams for rural areas.

“Staffing turnovers and pandemic disruptions were detrimental to maintaining complete teams in many regions of Pennsylvania,” researchers wrote. “Some have since begun to rebuild while other teams have yet to meaningfully reengage in (Child Death Review).”

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Still, lawmakers have failed to adopt legislation — or even introduce any, according to a search of the state General Assembly’s website — to address the issues facing the 2008 law.

The status quo could change this year.

Steven Shapiro, a pediatrician and longtime member of the Montgomery County review team, told Spotlight PA that he and fellow pediatrician Erich Batra, of Lebanon County’s review board, have been urging state officials to improve the “flawed” Child Death Review system. They want a coordinated effort to improve data collection and remove some burdens from counties’ responsibilities.

“If you just unpack how the child succumbed, then you begin to learn about how you can protect other children from enduring the same fate and parents enduring the same fate,” Shapiro said.

Shapiro’s son, Gov. Josh Shapiro, happens to be in a position to help get the program some state funding. Though the elder Shapiro said he does not “try to influence” policy when speaking with his son, some topics come up “over table talk at dinner sometimes.”

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Earlier this year, for the first time, the governor proposed using a new $2.5 million from the state’s general fund to support the program. The Department of Health said in an emailed April statement that the money would be used to adopt some of the report’s recommendations. Those include adding health department staff to assist county teams with data collection and prevention strategies, creating a grant that counties could use to “enhance local CDR operations,” and expanding public education campaigns geared toward preventing child deaths.

The Department of Health’s statement did not specify how many positions would be added to improve the program’s organization.

Steven Shapiro said he and Batra are also working on a “cogent, complete and cost-effective” proposal to “redo” how the state is involved in Child Death Review data collection that would not require new legislation. He wouldn’t share details on how that new system might work, but said some funding from the state is essential.

Batra told Spotlight PA the $2.5 million in state funding the governor is proposing would be a good starting point. He envisions it helping counties with data collection and funding local prevention efforts, which can include things like adding signs at dangerous intersections, leading a smoke detector campaign in neighborhoods experiencing fires, or holding fundraisers for a local Cribs for Kids branch.

“A lot of the way Child Death Review works is what I call the intangibles,” Batra said. “It’s the community coming together and working together in a way that they might not always do on a day-to-day basis.”

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But Cathleen Palm, founder of the Center for Children’s Justice and a longtime advocate for improving Child Death Review, told Spotlight PA she’s not convinced Gov. Shapiro’s funding pitch alone is a game-changer.

She said that if improving Child Death Review were truly a priority for policymakers, there would be more fanfare around the funding proposal from the Shapiro administration.

Palm also criticized lawmakers for their inaction on addressing issues within the program that have been known for years.

“Why do we create a law if we don’t want to follow it?” Palm said.

In a year where so many competing interests are fighting over a limited amount of state funds, Palm worries Shapiro’s proposal may go overlooked by lawmakers.

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“Investing in improvements to the CDR process will further allow the Administration to expand public education and outreach, with a focus on preventable causes of child death,” Rosie Lapowsky, Gov. Shapiro’s spokesperson, said in a statement. “The Governor is hopeful the General Assembly shares that mission of protecting children and ensuring their safety.”

The annual proportion of reviewed child deaths plummeted during COVID-19 and has not fully rebounded, even though there has also been a reduction in the total number of deaths, according to annual reports from the Department of Health.

In the history of the review requirement, county boards have never succeeded in studying every death. The closest they got was in 2013 — statewide, about three-quarters of the 1,931 child deaths that happened that year were reviewed.

That rate dropped to an all-time low in 2019, when 43% of that year’s 1,907 child deaths were reviewed. The drop is often associated with the COVID-19 pandemic, because deaths tend to get reviewed many months after the fact.

The review rate climbed back to nearly 60% in 2023 (of 1,551 deaths), the most recent year for which data are available.

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However, local teams across the state left more than 600 deaths unreviewed in 2023.

Unreviewed deaths stem directly from members being “stretched thin with resources” and being “pulled in so many different directions,” according to Christina Phillips, who organized the Child Death Review program from 2018 until her retirement earlier this year.

Phillips said she worked as a “one-person project” at the state level to coordinate with counties about which deaths to review. Part of the reason the Department of Health commissioned East Stroudsburg University to do its 2022-24 study of the program is because Phillips raised concerns, she told Spotlight PA.

Most of the people who serve on local review teams are volunteers who do this work alongside their regular paid positions. Phillips said many rural counties meet as little as once or twice a year.

What they need, she said, is help from state staff to request medical records, synthesize findings into data entry, and translate any patterns they find into prevention strategies.

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Phillips said she was unsure why lawmakers have not tried to address advocates’ concerns, given they have received an annual report that highlights those problems for multiple years.

“Preventing kids from dying is never a partisan issue,” Phillips said. “Preventing kids from dying is possible if there are more resources for Child Death Review.”

East Stroudsburg University researchers sorted counties into categories: ones that already have strong review programs; ones that could improve in various ways; and ones that need to be redeveloped.

They identified 20 rural counties that should at least consider organizing under regional offices to maximize their resources, and 22 counties — 6 urban and 16 rural — that must regroup because although they experienced “sufficient deaths to justify a local team,” they saw inconsistent participation from members.

The 15 “strong” counties were a mix of urban and rural, from Philadelphia to a regional operation between Susquehanna and Wyoming Counties, according to researchers. They suggested that 10 other counties, including Allegheny, build on their current processes.

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Many of the program’s issues stem from data collection. Researchers at East Stroudsburg found that facilitating data collection falls onto volunteer team chairs. In other states, like Maryland and Delaware, there are paid staff at the state level who coordinate data collection efforts prior to meetings, according to researchers.

Roy Hoffman, medical director of Philadelphia’s Fatality Review Program, told Spotlight PA that even for his team of roughly 15 city employees working on death review, data collection is “a pain” and “time-consuming.”

Philadelphia has operated its own death review group since the 1990s, Hoffman said, and saw few differences following the 2008 law.

“I can imagine for some of these smaller counties with coroners, with not having done this, this must be a big pull and hard to do,” Hoffman said.

The most recent state Child Death Review annual report, analyzing 2023 data, found that Black or African American children died at twice the rate of white children — a statistic in line with national trends.

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Roughly 47% of the reviewed deaths in 2023 were caused by medical conditions, including prematurity. “External causes,” including bodily force or a weapon, accounted for about 45% of deaths that year.

Palm pointed to the Department of Health’s finding that roughly one-third of child deaths in 2023 were flagged by local teams as “preventable.”

“All of us as a society want to keep our kids alive and healthy and well,” Palm said. “In order to do that, we have to study the kids who died to figure out how we prevent the next child from dying.”

Palm wants the state to foster the same level of research toward preventing gun safety, motor vehicle crashes, drowning, accidental overdoses, and abuse or violence against kids as it and other institutions direct toward studying youth cancer rates.

Researchers at East Stroudsburg recommended that lawmakers amend current law to require a minimum number of quarterly meetings for each local team, boost training for local and state team members, mandate a specific timeframe for a death review to be completed, and require local teams to include representatives from school districts and “underrepresented community groups.”

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They also urged lawmakers to reduce the age cap to trigger a mandated review, from 21 to 18, and to include an “enforcement provision” to encourage counties to participate in the program.

None of the researchers’ suggested changes to Child Death Review have been proposed in the General Assembly, according to a review of introduced bills on the legislature’s website.

The original bill establishing the program was sponsored by Republican state Sen. Lisa Baker. She told Spotlight PA in response to emailed questions that it’s likely time to reevaluate the system with input from state and local stakeholders to “address evolving needs.”

“Given children are potentially falling through the cracks, a closer examination and review of the program is certainly warranted,” Baker said.

Beth Rementer, a spokesperson for Democratic state House Majority Leader Matt Bradford, noted that the chamber passed Shapiro’s budget proposal in April, which included the $2.5 million for Child Death Review.

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“We are open to discussions with the administration and stakeholders about improving the program to ensure all children are safe,” she said.

A spokesperson for Republican state Senate Majority Leader Joe Pittman did not respond to questions regarding potential changes this year to Child Death Review.

___

This story was originally published by Spotlight PA and distributed through a partnership with The Associated Press.

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Here’s what’s in — and not in — Pennsylvania’s $50.8 billion state budget

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Here’s what’s in — and not in — Pennsylvania’s .8 billion state budget


HARRISBURG — Pennsylvania’s new $50.8 billion state budget was sprawled across more than 600 pages of legislation and signed into law on Sunday. New data center regulations, new education funding, and more were approved in the wide-ranging spending package.

But some of the most pressing issues facing the General Assembly were noticeably absent from the final deal, as Gov. Josh Shapiro and lawmakers in the split legislature were unable to reach a compromise — or didn’t want to touch the contentious issues until after they are up for election in November, sidelining some of Shapiro’s top budget priorities.

Here’s a look at what’s in — and what was left out — of the 2026-27 Pennsylvania state budget.

» READ MORE: Pa. lawmakers and Gov. Josh Shapiro have approved a $50.8 billion state budget, delaying action on key issues

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Pennsylvania took another jump toward filling a multibillion-dollar funding gap between wealthy and poor school districts, after a court found that the state’s old system of funding education was unconstitutional. Since 2024, when the state first implemented new adequacy and tax equity formulas in efforts to fill the state’s $4.5 billion “adequacy gap,” lawmakers have put nearly $1.9 billion toward funding lower-income districts, with plans to fill it by 2032.

“It keeps our promise to our school districts,” said State Rep. Jordan Harris (D., Philadelphia), who serves on the powerful appropriations committee responsible for allocating state dollars, in remarks on the House floor Sunday.

The latest installment of adequacy and tax equity payments — $565 million — will largely go to low-income districts that already have high property taxes. The School District of Philadelphia, Pennsylvania’s largest school district and the only one in the state that is unable to raise its own revenue, will get $136 million of that funding increase.

Shapiro proposed generating new revenue streams to help the state fix its multibillion-dollar structural deficit in his last four budget addresses. But the ways he wants to raise that cash have been met with resistance by Senate Republicans, who argue they aren’t policies that will improve the state’s economic standing — or can’t reach agreement within their caucus on how to address the issues.

Shapiro this year didn’t get the hefty minimum wage increase he asked for, raising the hourly minimum from $7.25 to $15 — and counting on the higher wage for $80 million in higher income tax revenues. Nor was he able to get the split General Assembly, where Democrats control the House and Republicans lead the Senate, to approve adult-use cannabis, which his office estimated would bring in $729.4 million in its first year, largely through licensing. (House Democrats have approved plans for a minimum wage increase and recreational marijuana legalization, but the Senate has not voted on the bills.)

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» READ MORE: Could recreational marijuana really bring $1.3 billion in revenue to Pa. over five years? Here’s how other states are faring.

Screen shows skill games and cannabis regulation and reform as Gov. Josh Shapiro makes his annual budget proposal in the state House chamber in Harrisburg Tuesday, Feb. 3, 2026.Read moreTom Gralish / Staff Photographer

Shapiro, in his February budget proposal, also called on the General Assembly to regulate and tax skill games at the same rate as casinos, a move which he has estimated could generate nearly $800 million in revenue in its first year. But any regulation of skill games — slot-machine lookalikes that the state Supreme Court ruled last month are a form of gambling — was left out of the budget.

Lawmakers still have until October to decide whether skill games will be taxed and regulated, part of a grace period in the high court’s ruling. Otherwise, they will become illegal gambling machines found in many corner stores, gas stations, and bars. The issue has been the target of more than $8 million in lobbying and $9 million in campaign spending in Harrisburg, mostly funded by one company.

» READ MORE: How ‘skill games’ exploded across Pennsylvania — and sparked a multimillion-dollar political fight

State Senate Majority Leader Joe Pittman (R., Indiana) during a press conference at the Capitol in Harrisburg Feb. 3, 2026.
State Senate Majority Leader Joe Pittman (R., Indiana) during a press conference at the Capitol in Harrisburg Feb. 3, 2026.Read moreTom Gralish / Staff Photographer

“We can act within the 120 days, we can act after the 120 days,” Senate Majority Leader Joe Pittman (R., Indiana) said on Sunday. “But the choice is now quite simple. These machines are illegal, and in less than 120 days, they will be leaving the marketplace.”

Data centers — which are seeing a boom in Pennsylvania as artificial intelligence usage increases and communities are pushing back on where they are being built — will be required to submit information about their energy and water usage.

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Beginning next summer, data centers in the state with a peak energy demand greater than 10 megawatts will be required to submit information annually to the Department of Environmental Protection.

Outlined as part of this year’s fiscal code, those reports will be publicly-accessible. Data centers that do not submit information about their resource usage will be fined $10,000 a day.

A yard sign protests the proposed data center on New Elm Street near the Closed Cleveland-Cliffs steel mill photographed on Thursday, June 4, 2026 in Conshohocken, Pa.
A yard sign protests the proposed data center on New Elm Street near the Closed Cleveland-Cliffs steel mill photographed on Thursday, June 4, 2026 in Conshohocken, Pa.Read moreMonica Herndon / Staff Photographer

A data center regulation bill, which would have limited state benefits for data center developers and was championed by Shapiro, was not included in the final budget deal. The governor called for limiting a sales and use tax exemption and expediting permitting to projects that comply with a set of transparency and environmental standards.

And several other data center regulation efforts that have received bipartisan support in recent weeks were also absent from the final spending package.

That included efforts to repeal the existing sales tax exemption afforded to data center developers and attempts to enact a local or statewide moratorium on new data center development.

Both chambers passed language repealing the tax exemption and advanced differing bills to freeze development. One Democratic-sponsored bill would have given municipalities the option to implement a 180-day moratorium on new centers. The other, a Republican-sponsored measure, would allow for local moratoriums up to 18 months.

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“Compromise” was the word of the day around the Pennsylvania Capitol on Sunday, when the legislature swiftly passed the more than 600-page budget deal hashed out behind closed doors between Shapiro, Pittman, and House Majority Leader Matt Bradford (D., Montgomery) and passed with bipartisan support in both chambers.

The legislative leaders and Shapiro emphasized that they didn’t get exactly what they wanted in the budget, as a symptom of dealing with divided government. And leaders were proud to have reached the deal less than two weeks after their July 1 deadline, rather than the nearly five months that it took to hash out an agreement last year.

House Majority Leader Matt Bradford (D., Montgomery) speaks on Tuesday, Jan. 7, 2025.
House Majority Leader Matt Bradford (D., Montgomery) speaks on Tuesday, Jan. 7, 2025.Read moreTom Gralish / Staff Photographer

Lawmakers also agreed to work over the weekend to hurriedly approve the budget deal, with members of the Senate coming in on Saturday night to begin advancing parts of the budget deal and the House joining them Sunday afternoon. By 6:15 p.m. on Sunday, Shapiro had signed it.

Among the inspirations for the weekend of productivity: Making it to the MLB All-Star Game in Philadelphia, Bradford said, for which he has tickets.

Leaders returned to some old accounting maneuvers to address the state’s multibillion-dollar structural deficit and avoid pulling from the state’s emergency savings account.

They spent down unused and underused dedicated funds, and rolled some of the state’s Medicaid payments totaling $1.3 billion to the next fiscal year, a move lawmakers typically resorted to before the state saw an influx of federal dollars during the COVID pandemic.

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Without those delayed payments, the state budget would total closer to $52.1 billion, and several GOP members criticized the total as being disingenuous.

More than 80,000 retired public-sector employees will receive a cost-of-living adjustment to their pensions, something advocates have sought for years.

» READ MORE: More than 80,000 Pa. retired teachers, police officers, and firefighters will get a pension bump — some for the first time in decades

Public school teachers and other state employees who retired before July 1, 2002 will receive a tiered monthly payment based on the date of their retirement. Similarly, police officers and firefighters who retired more than five years ago will receive monthly payments ranging from $50 to $300 dollars, depending on how long they have been retired.

Lawmakers from both parties had called for the cost-of-living increase.

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Legislators also agreed to close a loophole that allowed online sellers to avoid paying Philadelphia’s local 2% sales tax on purchases made in the city.

Mayor Cherelle L. Parker had asked the General Assembly to close it as part of her own city budget pitch in a move estimated to bring an additional $1.5 million to Philadelphia.

Philadelphia Mayor Cherelle L. Parker is cheered by members of Philadelphia City Council at conclusion of her budget address, Thursday, March 12, 2026.
Philadelphia Mayor Cherelle L. Parker is cheered by members of Philadelphia City Council at conclusion of her budget address, Thursday, March 12, 2026.Read moreAlejandro A. Alvarez / Staff Photographer

Twenty-nine states have bell-to-bell cell phone bans. This year, Pennsylvania will not join them, despite the passage of two separate phone ban bills — one in each chamber of the legislature.

In: Mandatory recess for students K-5

Recess is now law in Pennsylvania.

Another education policy change championed by Shapiro, a mandatory, 30-minute recess for students in grades kindergarten through fifth was established in this year’s budget as a way to improve learning outcomes.

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Several Pennsylvania funding issues that have gone years without being addressed were left out of the latest budget, some with more pressing deadlines than others.

Lawmakers did not address a need for mass transit funding — which led to last year’s bitter budget stalemate among legislators — but are expected to identify a long-term funding stream for the transit agencies next year when a two-year fail-safe runs out.

» READ MORE: Public transit is in trouble all across Pennsylvania, including in GOP districts

Senator Nikil Saval, speaks at a press conference calling for more SEPTA funding from the state at Independence Hall in Philadelphia, Pa., on Friday, June 26, 2026.
Senator Nikil Saval, speaks at a press conference calling for more SEPTA funding from the state at Independence Hall in Philadelphia, Pa., on Friday, June 26, 2026.Read moreTyger Williams / Staff Photographer

Other local governments and service providers said their needs are more urgent.

The County Commissioners Association of Pennsylvania released an urgent plea after the state budget was signed that counties still have not received the critical mental health funding they need, or a surcharge increase used to fund 911 call systems. Home-health service providers also continued their calls for increased state funding they say is needed, as the industry faces serious staffing issues due to low state reimbursement rates.

» READ MORE: Pennsylvania’s home care industry is in crisis, with low pay and unfilled shifts driving it toward collapse

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Rape crisis centers got a much-needed funding increase, doubling how much the centers receive from $12 million to just over $24 million.

Philadelphia’s only rape crisis center had to lay off its employees and rely on volunteer work during last year’s monthslong state budget impasse.

Republican and Democratic lawmakers championed the organizations in this budget, making the largest single-year increase for the critical services in state history, according to the Pennsylvania Coalition to Advance Respect.

“Today marks a turning point for survivors and rape crisis centers across Pennsylvania,” said Joyce Lukima, the organization’s coalition director, in a news release.

Ethan Young is an intern with the Pennsylvania Legislative Correspondents’ Association.

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Governor Josh Shapiro signs overdue Pennsylvania state budget with bipartisan support

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Governor Josh Shapiro signs overdue Pennsylvania state budget with bipartisan support


HARRISBURG, Pa. (WPVI) — Pennsylvania Governor Josh Shapiro signed the state’s overdue 2026-2027 budget on Sunday.

The $50.8 billion spending plan was passed by state lawmakers with bipartisan support.

It is smaller than Shapiro’s initial $53 billion plan proposed back in February.

“We managed, as the math indicates, to find compromise without compromising our core values,” said Shapiro. “If you go back and look at the goals we all set together way back in 2023 – funding our schools, making our communities safer, growing our economy….four years later, this budget reflects those continued priorities.”

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Lawmakers say this spending plan expands workforce development initiatives, devotes significant new funding for basic education, and increases funding for special education and early intervention services.

Copyright © 2026 WPVI-TV. All Rights Reserved.



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Gov. Shapiro signs $50.8B Pa. budget with focus on education, public safety

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Gov. Shapiro signs .8B Pa. budget with focus on education, public safety


PENNSYLVANIA (WFMZ-TV) — Governor Josh Shapiro signed Pennsylvania’s $50.8 billion budget into law Sunday.

The largest part– $11.8 billion funding education. It also funds four more State Police classes. The budget comes with an additional $10 million for career and technical education.

“If you go back and look at the goals we all set together way back in 2023– funding our schools, making our communities safer, growing our economy, and four years later this budget reflects those continued priorities,” said Governor Shapiro.

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Republican State Senator Jarrett Coleman said he voted against the budget.

“The issue with the budget is that this wasn’t a really honest budget. This was pretty deceptive,” said Senator Coleman.

One thing in particular he said he is against– delays in $2.6 billion in Medicaid payments to managed care providers to the next fiscal year.

“So, that’s disappointing and I don’t really care to play that game. I think Pennsylvanians deserve to have an honest conversation and make no mistake; tax payers will ultimately pay the price for this charade,” said Senator Coleman.

Democratic State Rep. Mike Schlossberg said he is happy with this budget.

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“I think by and large it was an extremely solid product,” said Representative Schlossberg.

This marks the fifth year in a row the budget was not passed by the June 30th deadline. The signing of this one comes months ahead of when last year’s budget was approved.

“I think some lessons were learned. I think everybody realized we cannot do last year, we cannot do again what we did last year and also candidly election coming up in a few months, nobody wants to leave it hanging out there,” said Representative Schlossberg.



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