It would be very interesting to learn what if anything has been done to ensure this miscarriage of justice is not repeated in the future.  Reassigning folks who drop the ball just moves the problem elsewhere.  What revised or new procedures have been put in place to preclude other children from suffering the same tragic harm.  Sadly the current System is broken.  The Valientes are to be commended for trying to force required changes.  Thanks to Mr. Hill's efforts to keep light shining on this dismal government of Hawaii performance.