Eighteen-month-old Anthony Mogan's pediatrician had her suspicions about the little boy's welfare, but chose not to tell authorities.
The doctor documented her concerns multiple times in the months leading up to his October 2008 death -- first when he showed up in her office covered in mosquito bites with a skull fracture and again when he wasn't using his left arm, medical records show.
But she told an investigator she "decided to watch to see if anything else happened" before reporting Anthony's injuries to the Indiana Department of Child Services.
Within a month and a half, Anthony was dead.
The little boy's grandmother said she thought his doctor and others let Anthony down.
A Times analysis of Anthony's Indiana Department of Child Services, medical, police and coroner's office records reveals a set of circumstances DCS officials say is common. Investigators say those closest to an abused or neglected child often miss opportunities to report their concerns.
Those opportunities could save the lives of other children like Anthony.
Indiana had the eighth highest rate of child deaths from abuse and neglect in the country in 2007, according to a report by Every Child Matters. The nonprofit organization's most recent report analyzed 2007 data.
Every Child Matters found 3.35 of every 100,000 children in Indiana died from abuse and neglect in 2007, a 15 percent increase from 2001, the group reported.
More than 360 children died of abuse or neglect-related injuries in Indiana between July 1, 2002, and June 30, 2008, Department of Child Services records show. About 29.5 percent of those children died despite prior contact with the child protection agency.
Anthony was one of those children.
He died Oct. 5, 2008, of blunt force trauma injuries at St. Anthony Medical Center in Crown Point after being transported from his mother's home in Lowell.
Bruises covered the toddler's body, his liver was lacerated into separate pieces and his collarbone was broken, coroner's office records state. His death was ruled a homicide.
The Lake County Child Fatality Review Team determined Anthony's death was "definitely" preventable.
The circumstances of his death serve as a grave example of the need to report suspected neglect or abuse.
An oath to protect
Anthony's medical records show his pediatrician, Dr. Reena John, questioned the toddler's safety several times in the months before he died. But John never shared those concerns with DCS.
In a recent interview, John told The Times she asked the family to keep Anthony safe. She said Anthony's mother, Alycia Szany, was a good mother.
John declined to comment further.
John first expressed concern after the boy's mother brought him in for excessive crying in July 2008. Anthony was covered in mosquito bites and had swelling on the back of his head, medical records state.
An X-ray revealed Anthony had a skull fracture -- an injury his family members could not explain.
"The child needs to be in a safe environment, and caretakers need to be questioned about what happened to this child to sustain this injury," the doctor noted.
A month and a half later, Anthony was back in the doctor's office because he wasn't using his left arm. John said DCS would need to be contacted if it was another fracture, medical records state. It wasn't a fracture.
A month and a half after that, Anthony was dead.
Dr. Antoinette Laskey, a forensic pediatrician at Riley Hospital for Children and Indiana University School of Medicine, said any doctor with concerns about a child's welfare should immediately contact DCS or a local law enforcement agency.
Laskey, who also is chairwoman of the state's Child Fatality Review Team, declined to review or comment specifically on Anthony's case.
But she pointed out that Indiana law requires any person who suspects child abuse or neglect to report it to DCS. Those who fail to relate their concerns could be charged with a misdemeanor.
Diane Poulton, spokeswoman for the Lake County prosecutor's office, declined to comment on whether prosecutors considered filing such charges in the case of Anthony's death.
Cindi Szany, Anthony's grandmother, thinks the system let Anthony down.
"I thought they had an oath to protect," she said. "I'm very disappointed with the system -- the medical field, the lawyer field and DCS. ... The system failed us and Anthony."
But Anthony's family members weren't blind to the warning signs.
Cindi Szany admitted to DCS investigators she saw bruises on her grandson at least three months before his death. She took photographs of the little boy's injuries, which she later provided to Lowell police.
But she did not report Anthony's bruises, skull fracture or his problems moving his arm to DCS, records show.
Cindi Szany said she never reported those injuries because she didn't know who was responsible, records state.
But by September 2008, Anthony's injuries were too often and too suspicious to dismiss.
One by one, family members either called or wrote DCS, Cindi Szany said.
Anthony's uncle, Nick Szany, was one of the last to contact child services, forwarding a DCS employee a letter he'd written about the suspected abuse, an e-mail dated Sept. 22, 2008, shows. The e-mail was provided to The Times by the family.
"Is today the day (Anthony) gets another fractured skull, or maybe another leg injury that makes him limp for three weeks again?" Nick Szany wrote in the e-mail. "Why do you find the need to beat your child, and ignore him when he needs you the most? ... Every day is another day I am scared for a child that will be lucky to see the age of five."
Anthony died the next month in the midst of a DCS investigation into his safety.
A DCS case worker interviewed Anthony's mother on Sept. 8, 2008, in her Lowell apartment.
The apartment was clean, neat and well-stocked with food, a DCS report states.
Anthony appeared healthy and happy during the interview, the case worker reported. His body was devoid of injuries, except for a tiny bruise on his knee.
Alycia Szany told the case worker about her son's recent skull fracture, but DCS' attempt to contact John, Anthony's pediatrician, was unsuccessful, DCS records state.
Anthony also was "extremely attached" to his mother, records state.
The DCS case worker did not watch Anthony interact with Alycia Szany's boyfriend, Jesse Gilman Jr., who also lived in the Lowell apartment.
Gilman, who was not Anthony's father, was not home at the time of the review. It is not clear from DCS records whether the case worker asked if anyone else lived in the apartment.
The allegations that were made to DCS about Anthony's safety only mentioned Anthony's mother.
Gilman, 22, of Roselawn, later was charged with murder and felony counts of battery and neglect of a dependent in Anthony's death, Lake Criminal Court records state.
He was sentenced in January to four years in prison after pleading guilty to felony neglect of a dependent for not seeking medical attention for the injured little boy, records state. Gilman admitted stepping on Anthony, who had been lying on the floor.
Ann Houseworth, spokeswoman for the Indiana Department of Child Services, said while it is best to interview all members of a household, the law does not require it.
"While it would be best practice to speak to all members of the household, if we're not seeing any indication (of abuse or neglect), I would not think that we would go back again," she said.
Houseworth said she could not comment specifically on Anthony's case.
But DCS records from that time period show the state agency did not uncover Anthony's history of possible abuse until after his death.
Unraveling the truth
DCS investigators and Lowell police interviewed Anthony's extended family and pediatrician after his death to determine what went wrong.
It was only after Anthony died that the family fully admitted seeing Anthony's bruises and other injuries. His doctor, John, said there could have been reasons other than abuse for the toddler's earlier injuries.
DCS investigators concluded both Gilman and Alycia Szany were responsible for Anthony's death.
Investigators substantiated abuse on Gilman's part for Anthony's multiple internal and external injuries and neglect for endangering Anthony's life and health, DCS records show. The toddler's death was due to physical abuse, records state.
DCS also found Alycia Szany partially responsible for her son's death. The state agency substantiated neglect by Szany for endangering Anthony's life and health. Her neglect also was part of the reason for his death, DCS records state.
But Alycia Szany has not been charged criminally for Anthony's death.
Lowell Police Chief John Shelhart previously told The Times the Lake County prosecutor's office declined to file charges against her.
"We presented all the evidence we have, and at this point they've refused to accept charges on her," he said.
Poulton, spokeswoman for the prosecutor's office, declined to comment on whether there was an investigation into Alycia Szany's involvement in Anthony's death.
Szany declined through her mother to be interviewed for this article.
There is no guarantee Anthony would have lived if his family and doctor had spoken up earlier.
But DCS officials say circumstances like those in Anthony's case hamper DCS' efforts to ensure a child's well-being.
DCS spokeswoman Ann Houseworth said the reluctance of family, friends, neighbors, school teachers and others to notify authorities is a common problem.
"I think it's just very important for neighbors and friends and family members and citizens to realize their role in child protection," Houseworth said. "And while it is our charge (to protect children) as employees of the state working for the department, it is the responsibility of all citizens."
Indiana is a universal mandatory reporting state, meaning everyone is responsible for reporting any alleged abuse or neglect.
Laskey, the doctor who consults with doctors and DCS on some child welfare cases, said the goal isn't to remove children from their homes. It is to make sure children are safe.
"The rules that protect your family and my family are the same rules that protect people who are hurting their children, if other people aren't helpful with what they know," she said.
What is abuse or neglect?
Child abuse is an action of lack of action by the parent, guardian or custodian seriously endangering a child's physical or mental health. Sexual abuse, physical abuse, illegal manufacturing of a drug or controlled substance where a child lives or allowing a child to commit a sex offense are all examples of child abuse or neglect.
Child neglect results from the inability, refusal or neglect of a parent, guardian or custodian to supply a child with the necessary food, clothing, shelter, medical care, education or supervision.
Source: Department of Child Services