The miasma that surrounded Winnipeg Child and Family Services in 2001 when yet another social worker was assigned to watch out for Phoenix Sinclair was exceeded, it seemed, only by the unimaginable chaos enveloping the families it was serving.
In August 2001, Kathy Peterson Epps was handed the Sinclair family file. She had the express message to close it.
The remarkable thing -- if there can be a singular notable fact to this story of incredible breakdown in duty of care that ended with Phoenix's murder in 2005 -- is that at that very time, her mom and dad were themselves breaking down. And CFS knew about it.
This was just five months after they had a second baby, Echo. The social worker in charge of the file at the time had no idea Samantha Kematch, 19, and just a year "aged out" of the CFS system herself, was pregnant.
Peterson Epps on Monday told the inquiry looking into the system's handling of Phoenix Sinclair's case that at an informal meeting in July, Phoenix's dad, Steve Sinclair, told her Kematch was gone. She was back with the father of her first child, a son who was a permanent ward of CFS.
Sinclair wanted custody of his kids, whom Kematch also wanted because she needed the welfare and the child tax credit. Sinclair, Peterson Epps noted, said Kematch was no mother -- she was abusive to Phoenix, was drinking and couldn't look after the kids.
This is a tiny glimpse into the hopeless lives Phoenix and her sister were living in the Magnus Avenue apartment. Yet CFS wanted that file closed.
"At the time that I was involved, Steven Sinclair's case was considered low-risk," Peterson Epps testified. That meant the parents had met all the requirements of the agency, the child was in a stable home and there were no protection issues.
Peterson Epps had been Steven's own social worker from the time he came into CFS care himself at 13; that's why she met him in July 2001. Peterson Epps formally took on the Sinclair file in August when she joined the CFS unit in the North End.
How could CFS possibly consider this family was "stable?"
Indeed, Sinclair and Kematch had met all the recommendations of the agency. After the CFS took Phoenix at birth in April 2000, they went to parenting classes at a Boys and Girls Club and worked with a "teaching support worker" who went into their home that August.
But, despite the fact there was supposed to be regular visits with a social worker, it all broke down quickly after they got Phoenix in their home that September, documents show.
Between October 2000 and February 2001, no social worker visited. In February, one visit. Then nothing, almost no contact, even after the birth in April of Phoenix's sister, Echo, who would die of pneumonia in July, shortly after Peterson Epps' visit. CFS made contact by phone after the death. Then nothing until 2003, an internal CFS report noted.
Oblivion reigned. To underscore the fact, the inquiry heard of a short meeting between a psychiatrist and Kematch in September 2000. Just days after Phoenix was returned to the couple, Dr. Gary Altman was asked by CFS to assess Kematch for depression -- perhaps that could explain her "ambivalence" at Phoenix's birth. In fact, files show Kematch was angry throughout her pregancy; she didn't want a baby. And she and Sinclair were "ambivalent" to the degree they told CFS they didn't feel prepared emotionally or financially to parent.
Phoenix was temporarily seized at birth and a psychiatric assessment was conditional to getting her back. The assessment happened a week after Phoenix went home. Altman said Kematch wasn't depressed. Yes, she was a "closed book," refusing to reveal information about herself, but maybe her "flat affect" was simply her manner.
Altman's notes said Kematch and Sinclair had issues regarding "sex (relations)/marriage/parenting." Yet he agreed with the social worker's conclusion they were committed to each other and to parenting.
He had been given almost no background: Sinclair, two years previously, was labelled a risk to any child he would be left alone with. She was seen as hostile, promiscuous and suffering depression as a teenager.
An investigator with the medical examiner's office in 2006 summed up the stunning breakdown in professional duty to protect Phoenix.
"The quality of this (psychiatric) assessment -- and the lack of insight it provided into Ms. Kematch's capacity to parent adequately -- was not challenged by the agency."
This is how cases slip into "low risk" and are left, as Peterson Epps said, at the bottom of a growing pile. We are left to ask: What does CFS consider high-risk?