Laura Forrest took on Phoenix Sinclair's case in February 2003, when the toddler was brought to hospital with an infection from an object that had been lodged in her nose for three months. The hospital reported the matter as a probable case of neglect.
Forrest told the inquiry on Thursday that she went to the girl's home and was met by her father, Steve Sinclair, who said Phoenix was being cared for by a family friend. Forrest said she went back to the home a few times over the next four months, always during the daytime, but there was no answer at the door.
Under cross-examination, Forrest said she could have taken other steps such as phoning other relatives, but didn't.
"I probably could have done a few other things. I didn't at that time," Forrest said.
"I also don't know what else was going on for me with other families."
"Did you ever think of going there in the evening?" asked Jeff Gindin, the lawyer for Steve Sinclair.
"I did not, no," Forrest replied.
"I'd left cards in the door. He knew I was trying to contact him."
Forrest suggested social workers have to walk a fine line between monitoring a child and not making the family resentful and more secretive.
"It's a decision to make as to whether or not invading somebody's privacy ... will impact on my ability to work with this person."
Forrest never saw Phoenix, who was apprehended four months later when child-welfare workers received an anonymous call that suggested the girl was at risk because Sinclair was having drinking parties at his home.
Social workers went to the residence and found Sinclair drunk, along with two friends who had passed out on the floor. More social workers visited over the next 24 hours, by which time Sinclair had started smoking marijuana, the inquiry was told.
Some of the people in the home were identified as members of the Indian Posse street gang.
"You've got a little child of three with gangs, there's violence and drugs and weapons, and no one seems to be taking care of (Phoenix)," said Kim Hansen, an after-hours social worker who called police to help her take the girl into care.
Phoenix was brought to a hotel to spend the night with other social workers. Hansen was taken aback by the way the little girl called every female she saw 'mom.'
"She was calling me mom the entire time. I remember that. When I took her to the (hotel), she was calling the caregivers there mom. To me that just shows that there's no consistent care provider. It's a lack of attachment to a mother figure."
The removal from Sinclair's home was just one of many wrenching events in Phoenix's short life. She was seized by child-welfare workers several times and returned to her mother, Samantha Kematch, a final time in 2004 — the year before she was beaten to death by Kematch and her boyfriend.
Phoenix was five years old.
The inquiry has already heard evidence that social workers failed to monitor Phoenix for months at a time. The hearings are to determine how the little girl fell through the cracks of Manitoba child welfare and why her death went undetected for nine months.
Her biological parents both had histories of violence and substance abuse. Phoenix was taken by child welfare workers days after her birth in April 2000, but was given back to her parents four months later under what was supposed to be regular supervision.
A 2006 internal review of the case by Winnipeg Child and Family Services, made public only last week, found that "from October 2000 to the last contact with this family, actual service was almost non-existent."
On February 26, 2003, social workers were called by the Children's Hospital in Winnipeg. Phoenix had an object in her nose — Kematch's murder trial was told it was Styrofoam — which had been there for three months. An infection had developed.
The hospital wrote a referral to the child-welfare agency that called the infection a case of medical neglect. The internal review would later fault the agency for not immediately examining Phoenix's living environment.
Instead, the agency categorized the case as a low-level risk and resolved to contact Sinclair only to ensure he was giving Phoenix antibiotics to treat the infection.
"Maybe in hindsight it would have been a better idea that I picked the moderate medical treatment (category), but I was also considering giving the assigned worker the ability to choose how soon they could go out and investigate based on their caseload demands," Roberta Dick, the social worker who received the hospital report, testified Thursday.
Phoenix would spend the rest of her life in and out of foster care. In 2004 she was handed back to Kematch, who by then was in a new relationship with Karl McKay. In 2005, Phoenix was killed in the basement of the family home.
Kematch and McKay were convicted of first-degree murder. Evidence at their trial showed they had abused and neglected the girl, sometimes forcing her to eat her own vomit and shooting her with a BB gun.
The inquiry is still in its early stages. It has yet to delve into why child-welfare workers removed Phoenix from a foster home and gave her back to Kematch in 2004 and what, if any, monitoring followed. Kematch and McKay's murder trial heard that a social worker went to visit the family in 2005, was told Phoenix was sleeping and left without seeing her.