In Ohio, family services caseworkers reportedly dismissed a 4-year-old foster child’s fatal bowel obstruction as mere flu symptoms. According to a lawsuit, they even threatened the child’s mother with the loss of “parental rights” if she sought emergency medical attention for him.

Katie McIntosh, the mother of Alexander Howard, was adamant that her son was grappling with a condition far more severe than the flu. However, Preble County Jobs & Family Services caseworkers advised her that a trip to the emergency room was unnecessary, as detailed in a legal filing she submitted.

Alexander, who tragically passed away in February 2025, had exhibited symptoms like vomiting and diarrhea over several weeks—signs that McIntosh felt justified an emergency response. Living with foster parents, Alex was allowed “overnight visitations” with his mother, according to her legal complaint.

During these visits, McIntosh began noticing alarming conditions in her children, including their bodies being “covered with a filthy crust” and Alex showing a “coat hanger bruise,” which led her to seek medical help at Dayton Children’s Hospital in Montgomery County.

The complaint further reveals that because McIntosh sought medical care for Alex without prior approval from PCJ&FS, her overnight visitation rights were downgraded to supervised visits.

Although McIntosh regained her overnight visitation rights by November 2024, she continued to observe “ailments” in Alex that she believed needed medical intervention.

“Over the course of the evening of December 20, 2024, the health of Alex and [the sibling] deteriorated: Alex complained that his belly hurt, and he vomited,” the complaint says.

Alex’s vomiting and symptoms continued into the next day, and Katie brought him to a medical facility in Eaton. When family services found out about this, a caseworker told McIntosh that her overnight visitations were terminated once again and “further warned Katie she had placed herself in jeopardy of losing all parental rights,” the complaint alleges.

McIntosh says she “refrained” from seeking or procuring medical care for Alex “fearing that she would lose all parental rights if she did so,” per the complaint.

Alex told her during one supervised visit at the end of December 2024 that he had vomited and “complained of belly pain,” according to the complaint. He also allegedly had “bed bug bites” on his body.

In mid-January 2025, Alex once again complained of “belly pain and vomiting” and “fresh bruises” were visible on his body, according to the complaint. “Alex’s lower abdominal flesh and genital area flesh was discolored,” the complaint says. “He could not urinate comfortably. A large blood clot was found to have been discharged in Alex’s urine.”

At the end of January 2025, Alex was still suffering from the same symptoms and stated during a visit that he was “really hungry,” per the complaint. His foster parents allegedly said his sibling was taken to the children’s hospital and diagnosed with influenza, but Alex was not.

One of Alex’s caseworkers told McIntosh on Jan. 31, 2025, that her visitation scheduled for Feb. 1, 2025, was cancelled because both Alex and his sibling had been “suffering from the flu,” according to the complaint.

“Katie, based upon her personal observations and statements made by Alex, insisted that Alex was suffering from a condition which was far more serious than the flu,” the complaint reiterates. “She questioned why Alex had not been taken to Children’s Hospital simultaneously with [the sibling], and insisted that Alex be taken to an emergency room.”

Alex wound up dying at the children’s hospital on Feb. 8, 2025, “due to a blockage in his small bowel which caused necrosis of his bowel,” according to the complaint. Doctors allegedly said the necrosis had “persisted for seven or more days, resulting in diverticulitis, sepsis, and ultimately, cardiac arrest.”

“In the weeks preceding his death, Alex endured conscious pain and suffering as a consequence of the blockage in his small bowel,” the complaint concludes.

A police report included with the complaint says Alex’s foster parents notified authorities on the day he died about him suffering from “a little bit of a stomach issue.” One of the parents said, “Right now he’s looking really pale,” according to the report.

“Snot is just pouring out, or is that throw up, I don’t know? It’s clear liquid,” the parent said. “It’s coming out of his nose, I’m unsure if it’s snot or maybe throw up. … Oh my God, it’s pouring out his nose.”

EMS was called and Alex was taken to the children’s hospital, where he was pronounced dead. Police determined that Alex died of natural causes and there was no criminal liability found in the case.

McIntosh is suing Preble County Job & Family Services, as well as the caseworkers.

Attorneys for Preble County have said in court filings that the allegations being made by McIntosh are “based on facts not reasonably known until later, and are based on 20-20 hindsight for which these defendants are not liable.”