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The little girl could barely breathe. She lay on the hospital bed, her chest rising with each forced inhalation. Irma Nicanor held her only child's hand. The six-year-old's eyes were closed, but Irma felt her tiny fingers squeezing.
"Stay strong, Claudialee," she told her in Spanish.
Irma was dazed by how everything had gone so bad so quickly. It was early on a January evening in 2010. They'd checked into New York Hospital in Flushing that afternoon. Claudialee was nauseated and had a tummy ache. Irma figured she'd caught a stomach virus from a boy in their apartment building. She now knew that it was more than that.
Two days before, Cladialee was running around the house, climbing over couches and crawling under tables. She seemed as healthy as she'd ever been. Yes, she was overweight, and her blood sugar was slightly high, but Irma was seeing to it that her daughter would get fit.
A bubbly girl with a loud laugh, full cheeks, and a thick mop of dark brown hair, Claudialee had plenty of energy for that mission. The girl took ballet and karate lessons. She ran around the park with her dad and rode bikes with her cousin. During snack time at P.S. 32, she pulled out sandwich bags filled with celery and carrots and sliced fruit. Her first-grade teacher would eat with Claudialee so that she wouldn't feel bad about not having sweets like the other kids.
Irma was always conscious about her daughter's health. Over the past three months alone, she'd taken Claudialee to six medical appointments: three times to her pediatrician, Dr. Thelma Cabatic, for flu shots and checkups; and three times to her endocrinologist, Dr. Arlene Mercado, to deal with her blood sugar. At each visit, Mercado would tell Irma that her girl was fine, in need of nothing more than diet and exercise.
Yet two weeks after her last checkup, here was Claudialee struggling for air, half-conscious in an emergency room. "Patient has slight movement of all four extremities spontaneously but not on command," the hospital notes read. "Mumbles occasionally."
The scene was overwhelming for a mother. Nurses scurrying around. Chemicals with smells much stronger than the cleaning supplies Irma used in her job as a housekeeper. Intravenous tubes attached to Claudialee's arms, alternately streaming potassium salts, water, and glucose. The girl's blood sugar had risen to 525 milligrams per deciliter—more than five times the normal level.
How could this happen? Irma kept asking herself.
Claudialee's lungs struggled as the night wore on. Nurses strapped an oxygen mask to her face. It wasn't enough. They decided to push a tube down the child's throat so a ventilator could help her breathe. But Claudialee wasn't having it. Even half-conscious, she was still a flare of vigor. Her arms flailed and her legs kicked. The nurses didn't expect such strength. They retreated and injected her with a sedative. Then they inserted the tube. Claudialee was now unconscious and dependent on a machine to supply her with oxygen.
Irma sat in the waiting room, praying. She called her sister Marta. It was about 4 a.m., but Marta rushed to the hospital. She got lost in the hallways, missed the waiting room, and ended up at Claudialee's bedside. The two were alone, the only sounds coming from the robotic hums and beeps of intensive care.
"It hurts," Marta thought she heard the girl whisper.
"Where does it hurt?"
There came no reply.
St. James Avenue was quiet and still on October 31, 2009. Irma and Claudialee passed the modest wood-frame homes with yards fronted by low chain-link or wrought-iron fences. American flags fluttered beside satellite dishes. Not a single person was in sight. Just the kind of tranquility a family hopes for when they move to Elmhurst.
Mother and daughter stopped in front of a cream-colored three-story house, then walked up the driveway to a concrete backyard. Irma might as well have been taking Claudialee to a classmate's birthday party.
Court documents, medical records, and interviews would detail what followed.
The pair descended a stairwell to a minimalist setup: a desk and several chairs. Curtains forming two makeshift rooms. Dr. Arlene Mercado's office was in the basement of her sister Myra Mercado Capistrano's house.
Mercado opened the clinic in 2007. Thirteen different insurance companies listed her practice in their network. She had a second practice at the SUNY Downstate Medical Center in Brooklyn. And she accepted Medicaid, the government health program for low-income people. She was a pediatric endocrinologist, specializing in children and the hormones and chemicals that could stunt growth or bring on early puberty. The most common issue she dealt with was diabetes.
She was well versed in practice, if not theory. Mercado was not board-certified in her specialty, American Board of Pediatrics records show. She failed the certification exam more than five times. Without passing that, she couldn't attempt the next step, the pediatric endocrinology test. But these setbacks didn't stop her. Board certification isn't mandatory. In fact, though she couldn't pass the test herself, Mercado taught a certification-exam review course in Children's Hospital at SUNY Downstate.