Her business was a family affair. Mercado had two paid employees: Myra, the clinic manager, and Myra's husband, Edward Capistrano, the billing supervisor. The Capistranos' children handled the patients.

By the time Mercado treated Claudialee, a good number of experienced doctors had vouched for the endocrinologist.

Paul, a 23-year-old political science grad student with a degree in math, and Bernard, a 21-year-old graphic design major, measured heights, weights, and blood pressure. Twelve-year-old William sat at the front desk, answering phones and filling out appointment cards.

Irma handed William a referral card from Claudialee's pediatrician, Dr. Cabatic.

Dr. Arlene Mercado’s clinic was in the basement of her sister’s Elmhurst house.
Voice Media Group
Dr. Arlene Mercado’s clinic was in the basement of her sister’s Elmhurst house.

She'd taken Claudialee to see Cabatic five days earlier for the first in a series of flu vaccinations. Claudialee had the sniffles, so Cabatic ran her through a full examination. Four days later, the doctor called to say that Claudialee's urine and red blood cells showed abnormal glucose levels. Her blood sugar was above normal, suggesting the girl might become diabetic. In her notes, Cabatic wrote, "probable diabetes mellitus."

The disease stems directly from high blood sugar. In type 1 diabetes, the immune system kills off cells that produce insulin, the hormone that brings the body's glucose supply to muscle and fat. If the body doesn't get more insulin, the person will die.

In type 2, a person has a lot of insulin, but the stuff just doesn't work. Insulin resistance, doctors call it. Obesity is the usual cause. The damage is slower and can be treated through diet, exercise, and medication.

Cabatic knew Claudialee was at high risk for diabetes. The girl's maternal grandmother, paternal grandfather, and three of her uncles had it. She recommended that the girl see a specialist and gave Irma the name of a pediatric endocrinologist who spoke Spanish and would accept her Metroplus Medicaid card. (Metroplus, a nonprofit healthcare organization that provides Medicaid in New York, did not respond to interview requests for this story.)

Irma called Mercado's office to set up an appointment for the next morning.

After asking about the family history, Mercado took a blood sample from Claudialee. The doctor was a short, round woman who peered over thin spectacles and disarmed with a cheerful smile. She told Irma she would send the blood to a lab and they'd discuss the results in two weeks.

The test would duplicate Cabatic's results: Claudialee's blood sugar level was higher than normal, but not high enough to be considered diabetes. She was "prediabetic." During the next visit, Mercado explained to Irma that the results were nothing to be too concerned about. The girl just needed to lose weight. Diet and exercise. She handed Irma a sheet of paper with a food pyramid on it.

In her notes, Mercado wrote that if the patient didn't lose weight by her next checkup in mid-December, she would prescribe Metformin, a drug used to treat type 2 diabetes.

Though type 2 used to be called "adult-onset" diabetes, Mercado knew recent studies had shown that a growing number of kids were getting it. At 3-foot-9 and 67 pounds, Claudialee was clinically obese. Mercado noticed a dark spot on her neck, often a sign of insulin resistance.

By her next appointment on December 12, things were looking up. Claudialee was thinner. Mercado didn't conduct any tests or ask many questions. It was a brief but reassuring meeting, full of grins and calming words. Claudialee is fine, the doctor told Irma. She just needs to drop another pound or two. Diet and exercise.

In her notes, Mercado wrote that she'd administer another blood glucose test on the next visit. As Irma left, William handed her an appointment card telling them to come back on February 23.

Cabatic echoed Mercado's optimism when the mother and daughter returned on January 9 for the girl's final flu shot. It happened that Claudialee had come home early from school the day before. During snack time, she complained that her heart was beating faster than normal. The nurse sent Irma a note saying a doctor had to sign off before Claudialee could return to class. Cabatic assessed her vital signs. Normal heart rate and blood pressure. No cough. No chest pain. No difficulty breathing. All was stable.

Cabatic had more good news: In the 10 weeks since the October 26 checkup, Claudialee had lost five pounds and grown two inches.

As far as the doctors could tell, Claudialee was getting healthier by the week.

On January 21, Marta Nicanor, Irma's sister, picked up her six-year-old son, Gustavo, and Claudialee from school. Irma worked as a housekeeper for a family in Port Washington, Long Island. Most days she left her apartment at 8:30 a.m. and didn't get home until nearly 8 p.m, so Claudialee spent most of her evenings at her aunt's place. She'd play with Gustavo, her best friend.

Claudialee told Marta she was tired and that her stomach had been bothering her. She wanted to lie down. Marta called Irma, who called Dr. Cabatic to schedule an appointment for first thing the following morning. She left work early and arrived at her sister's apartment about 4:30 p.m.

When Claudialee heard her mother come in, she hopped out of bed, ran over to her, and threw up. Irma took her to their apartment, one floor up in the same building.

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14 comments
jamestovet
jamestovet

I feel terrible after reading this. Mishaps occur often but doctors should be more careful. This sort of misdiagnosis is not acceptable. After all the research and treatments found for diabetes, if someone dies because of misdiagnosis, it can be very enraging.


mrf948
mrf948

Like rty9, I am a diabetic. I am seen for primary care in a federally supported community clinic of a major academic medical center, Montefiore, in the Bronx, where I live.  Most of the patients, including myself, are low income, many on medicaid or uninsured. I have also been seen by a private endocrinologist. In both settings, everyone who is diabetic or pre-diabetic has a glucose finger stick test each time he/she comes in. It does not need to be done by a doctor, or sent to a lab. The whole thing takes a minute and results are available immediately. Even if this doctor was so out of it that she thought this lovely child had type II diabetes, if she had been doing this simple finger stick she would have known her glucose was through the roof.  This negligence of the basics of endocrinology amounts to homicide. Why is she still on the faculty of SUNY??? This was truly tragic, and the fact that she continues in practice with the ability to kill another child is terrifying. 

rtyr9
rtyr9

This gross negligence of Mercado and Cabatic  was the direct cause of this child's death.  There is NO EXCUSE for such a misdiagnosis.  EVERY glucose meter on the market in the US--including the store-brand ones for $10 for the meter, and including the teeny one which is the cap for the vial of testing strips--is accurate enough to catch this! There was NO need to do a venous draw and wait 2 weeks for a lab turnaround; why did nether "doctor" have a fingerstick glucose meter there in the office, and why did neither tell the mom to go to a chain drugstore and get one? Or better, write the prescription for the meter and strips which IS COVERED by Medicaid in every state.  Even Type 2 diabetes needs to be monitored daily! If the "doctor" was ordering lab tests, why did neither order  a C-peptide measurement, which is THE definitive factor for Type 1 diabetes.

  These two are not the only ignoramuses with medical licenses who endanger the lives of diabetic patients everyday. Earlier this year I was admitted to a small-city facility of the largest and oldest HMO in the country after going to the ER (I called the advice nurse first before going to the ER). The hospitalist was a DO (osteopath) who was too lazy to contact either my primary care provider (an MD) or diabetes care manager (an NP-CDE), or even look at the settings and history on my insulin pump! I had to call a family member to bring me my meter and insulin so I could take care of myself; I literally walked off the floor and out of the hospital and walked home when the hospital administration did not replace  the ignorant DO with someone competent and accountable.  I have also complained to the state boards, and to the regulating agency, but because I took my care into my own hands, and left the hospital before I was irreparably damaged, it was ruled that I had suffered no harm. Interesting that the HMO refunded my ER co-pay and did not bill me anything for the inpatient time!

  I've been diabetic for nearly 50 years, so I have knowledge about diabetes that neither  Claudialee nor her overwhelmed mother had. THEY were not the ones expected to be knowledgable about this condition. Instead, the persons who SHOULD have had at least the knowledge of adult  Type 1 patients exhibited less expertise than the writers of popular  magazine ads for  diabetes testing supplies and accessories. Irma trusted these women with her daughter's life, and their willful neglect killed her child. I am so shocked and disgusted with these murderers and with the regulatory agencies which supposedly protect the public I cannot find adequate words

Dear Irma, I am so sorry for the loss of your precious little girl. I pray that her death was not in vain, and that this reporting to the public will result in action to prevent another such tragedy from happening to another family..

newlight51
newlight51

I am glad the mom won the case and the doctor admitted fault. At least she will not be putting more people at risk. When you see a doctor's office too dirty or messy, friends and family helping out, it means they are providing sub-standard care and uneducated. You need real nurses and trained medical personnel. Its best to question our doctors and look up things to make sure they are doing at least some of the right tests. Some of you may not realize Obamacare could set in motion sub-standard care like this. Be warned. National health care is good, but this Obamacare is too large and needs to be cut back and made voluntary.

deidrem
deidrem

Oh, and I hope someone checks all those other children she says she's diagnosed with type II diabetes. Some of them may also have type I diabetes, and they may be in danger, too. This woman sounds like her medical judgement is being clouded by her assumptions about weight.

deidrem
deidrem

This is just unconscionable. I'm not a fan of the overuse of lawsuits, but in this case, I hope the mom sues the hell out of that doctor. This is so incompetent that it borders on murder. That poor little girl. She had her whole life ahead of her.

DoctorsKill
DoctorsKill

A fasting insulin test is what $20, medical boards need to be more proactive at stripping licenses.

morethancereal
morethancereal

@ScritchfieldRD horrible - I hate doctors that make assumptions instead of listening. You know my story...serious pet peeve of mine

FeedMeImCranky1
FeedMeImCranky1

@CurvyFitGirl it's terrible beyond words. brings up bigger issues of how class plays a huge role in your chances to get quality healthcare

deidrem
deidrem

@newlight51 Really? What mistaken assumptions are you basing that statement on? I've been living in Canada and the UK for the past ten years after living in the US for the first 33 years of my life, and the care is MORE, not less, professional than the care in the US. Doctors and insurance companies make less money, however.

 
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