Dozens of cases of Massachusetts children who may have died of abuse and neglect remain unresolved for years because investigators have been hamstrung by delays in obtaining death reports and difficulty determining whether deaths were accidental, natural, or the results of a crime, the New England Center for Investigative Reporting has found.

The state medical examiner’s office, long under fire for delays in performing adult autopsies, is even slower when children die, taking an average of 242 days to find an official cause of death in child abuse and neglect cases.

Official death reports based on those findings sometimes take more than three years to complete, the New England Center found in its review of 102 cases, including the case of a 1-month-old boy who died in 2012 and whose death determination is still pending.

The unresolved cases include three open homicide investigations, but also many others in which the medical examiner was unable to determine whether the child was deliberately killed.  In more than 40 percent of the cases reviewed, the medical examiner’s report listed the cause of death as “undetermined.”

As a series of high-profile child abuse deaths in Massachusetts make headlines — including the September arraignment of the alleged killer of 2-year-old Bella Bond, whose body was found in a trash bag on Deer Island — family members of children whose abuse drew far less public notice question if justice will ever be served in their cases.

“We have been trying so hard to find out what happened.  This has been going on for two years,’’ said Sharon Crawford of the Whitinsville section of Northbridge, who says her daughter called the medical examiner repeatedly, sometimes several times a day, for news about the 2013 case of her 10-year-old son, Isaiah Buckner, whose death had been linked by social workers to abuse and neglect.

But when the medical examiner’s report finally came Oct. 21, the cause of death was listed as “undetermined,” leaving criminal prosecutors little to go on.

“I just want justice for my grandson,” said Crawford.

Trying to hire examiners

State officials acknowledge that the medical examiner’s office has been plagued by delays, and is currently facing a backlog of 1,922 pending autopsy reports from 2011 to 2014. Daniel Bennett, secretary of the Executive Office of Public Safety and Security, said the office is trying to hire more examiners and other staff to reduce the backlog.

“There are failures within the system,’’ he said. The state, for example, did not have access to a doctor who could examine infant hearts for almost a year, an issue that was resolved in May.  “The medical examiner’s office has been climbing out of a hole for the last two years,” he said.

Still, even with sufficient resources, the process is necessarily painstaking and slow in some cases, Bennett said.  Infant deaths, for instance, sometimes require multiple scientific tests and the review of reports from law enforcement, the state Department of Children and Families, and hospitals.

And not all cases can be resolved.  Worcester District Attorney Joseph D. Early Jr. said that investigating and prosecuting child maltreatment deaths can be particularly challenging for law enforcement.

When young children die, there are often few clues about the cause.

Unlike adults or older children, they generally leave no trail of evidence such as text messages, nor a wide circle of adults who might have noticed or suspected signs of abuse, and little verbal capacity to tell anyone about their plight before death.  Children also are often in the care of more than one person in the period leading up to their deaths, making it harder to identify a suspect.

“It tears your heart out in some of these cases,” Early said.  “We can only go where the facts and the evidence take us.”

Beyond the heartbreak for families, the delays and uncertainty in these cases may also be putting other children at risk, say child advocates.  Stephen C. Boos, medical director for the Family Advocacy Center at Baystate Children’s Hospital in Springfield, said long delays can hurt investigations, potentially allowing killers to escape responsibility.

“It is scary to have potential child murderers running around with other children,” said Boos.

That very thought has haunted Shelly Medeiros for years.

Pressing for answers

After 8-month-old Jay Hudson Bassett was rushed to a Worcester hospital on Thanksgiving, 2012, Medeiros, his maternal grandmother, quickly fixated on the bruise above his left eye.  As the once-playful boy lay unconscious, Medeiros began a mantra of grief that hasn’t stopped to this day:  “Something isn’t right.”

Police records show that UMass Memorial Medical Center hospital initially linked Jay’s death to Sudden Infant Death Syndrome — but Medeiros hounded authorities to look more closely.  Eighteen months later, in May 2014, her worst fear was confirmed: The Office of the Chief Medical Examiner ruled Jay’s death a homicide caused by “blunt trauma” to the head and neck, inflicted by others.

Now, three years after Jay’s death, no one has been charged, and the investigation remains open.  Jay’s parents, Hailey Corrente and Marben Santiago, were with the baby when he stopped breathing, police records show.

They cut ties with Medeiros shortly after the child’s death and moved out-of-state.  The couple, who have a new baby boy, declined to answer questions about Jay when a reporter visited last spring and left several phone calls and text messages over the last six months.

While there is no evidence that Corrente and Santiago are suspects in the open police investigation, Medeiros believes that, at the very least, Jay’s parents know what happened.  And she believes the long delay in making a death ruling seriously undermined the investigation.

“In 18 months, everything changed,” said Medeiros, 51, of North Attleboro, who says her obsession with her grandson’s death keeps her awake at night.  “Evidence wasn’t sealed off.  My daughter and her boyfriend were allowed to leave town.”

The languishing child death investigations and cold cases are symptomatic of a state government that has often given low priority to abused and neglected youths, many specialists say.

Recent highly publicized child abuse cases have spurred Governor Charlie Baker to propose reforms to help keep at-risk children safe.

But much less has been said about what happens after children die.

The New England Center analyzed all child maltreatment deaths reported by DCF from 2009 to 2013 for which a death certificate was available and found a discouraging pattern:

• The medical examiner’s office determined the cause and manner of death in only about one-third of child maltreatment deaths within 90 days, a performance dramatically below the minimum standards set by the National Association of Medical Examiners, which expects 90 percent of autopsy reports to be done in that time.  A top official at the National District Attorneys Association called the Massachusetts delays “unacceptable.”
• Some of the open criminal investigations into children who died of abuse and neglect between 2009 and 2013 are more than five years old, raising concerns among child advocates that they may have fallen through the cracks.  In all, law enforcement agencies have open investigations into the deaths of at least 14 children on DCF’s list of abuse and neglect victims between 2009 and 2013.
• In 45 of the 102 child maltreatment fatalities reviewed by the New England Center for Investigative Reporting, medical examiners could not determine the manner of death – meaning they couldn’t decide among two or more causes, including whether a child died of an accident, homicide, suicide, or natural events.  The majority involve what DCF calls “unsafe sleep” deaths linked to parents who shared a bed or put babies to sleep on their bellies, actions said to put children at higher safety risk. Other deaths involve children who ingested sleeping pills, were drowned, or were injured.

William Fitzpatrick, president of the National District Attorneys Association, based in Alexandria, Va., said there is no national database to examine what happens to children whose homicides go unprosecuted.

However, he is certain that more children are victims of homicide than data suggests.  With a sudden infant death, for example, a child could have accidentally suffocated, he said, but there are often not enough clues to confirm that.  Even when there’s evidence of wrongdoing, he said, prosecutors don’t always know who did it — particularly if two parents were present.

“The underreported story is the child victims that go unprosecuted,’’ he said.  “It’s sadly extremely easy to kill a child.”

When Massachusetts’ child deaths are ruled homicides, police do a pretty good job of closing cases, records show.  According to criminologist James Alan Fox of Northeastern University, Massachusetts police solve 90 percent of homicides involving children under 11 years old, a much higher clearance rate than for murder cases involving older children and adults, according to an analysis of 2000 to 2013 data he carried out for the New England Center.

But there is no data in Massachusetts or nationwide to show how many of those homicide investigations led to charges and convictions, said Ryan Backmann, executive director of the Florida-based nonprofit Project: Cold Case Inc. Languishing death investigations mean long delays in identifying and prosecuting perpetrators, Backmann said.

“In the meantime these people are going to have other children,” Backmann said