ANDERSON, Ind. (AP) – A newspaper is reporting the Indiana Department of Child Services knew an Anderson 16-year-old was malnourished at least four years before she was rushed to a hospital weighing less than 40 pounds.

The Indianapolis Star reported Friday that it has obtained documents showing people expressed concern for the teen's welfare multiple times before the December hospital admission.

The Star says a DCS record dated Sept. 21, 2010, shows someone contacted the agency to report that the girl, then 11, appeared “very malnourished,” had a large bruise on her cheek and wasn't attending school. The record described the girl as “skeletal.”

DCS opened a case but later closed it.

A message seeking comment was left with a DCS spokesman.

The girl's grandparents and an aunt face neglect and other charges.