TORONTO — A five-year-old boy who starved to death in his grandparents’ Toronto home didn’t just slip through one crack, but through a whole institutional safety net, lawyers at a coroner’s inquest suggested Tuesday.
The jury at the inquest into the death of five-year-old Jeffrey Baldwin heard dozens of proposed recommendations aimed at various ministries and agencies during closing submissions.
The suggestions, which the jury can choose whether to adopt as part of its verdict, pointed to more than just one reason that Jeffrey died severely malnourished, unable to lift his own head, locked in a cold, putrid bedroom. Rather, they indicate a constellation of institutional and personal failures.
“Jeffrey Baldwin received far more attention after his death than he ever did in his life,” said coroner’s counsel Jill Witkin as she presented 74 recommendations jointly suggested by various groups with standing at the inquest.
“Tragically, as you know, he was not given the freedom and opportunities that children in our society deserve. He died as a child neglected by his caregivers and shielded from the organizations out there that could protect him.”
The recommendations — which included using Jeffrey’s story as a case study for training children’s aid workers, implementing better information sharing across agencies involved with child protection and starting a public awareness campaign about people’s duty to report suspected child abuse or neglect — can help prevent deaths like Jeffrey’s in the future, Witkin said.