Born less than 15 months apart, Irma and Marta were closer to one another than to any of their other six siblings. The family grew up poor in the state of Puebla, southeast of Mexico City, and they both dreamed of raising their children in the United States. When they were in their early 20s, they made their way north. Over the years, they would earn the solid, working-class life they'd aspired to.

I did my best for this patient. I know in my heart that I did everything for this patient.

For a while Irma lived in East Harlem with Claudialee's father, Napolean Gomez. They separated when Claudialee was a year old. Irma moved in with Marta and her husband in Flushing. She stayed for a year, waiting for an apartment to open up in the same building. She wanted to live near her sister, who stayed home to look after her three children. There was nobody Irma trusted more with the care of her daughter.

Irma took Claudialee's temperature. No fever. She offered food but the girl wasn't hungry. She was very thirsty, though. Irma placed Gatorade and ginger ale on the nightstand by her bed, but Claudialee only wanted water. She napped for a couple of hours, then gulped more water. She fell back to sleep at about 10 p.m., with her mother lying beside her.

Ellen Weinstein
Claudialee Gomez-Nicanor wanted to be a veterinarian when she grew up.
Courtesy Paul Hayt
Claudialee Gomez-Nicanor wanted to be a veterinarian when she grew up.

Claudialee woke up drowsy. She always dressed herself, but on this day Irma had to do it for her.

They made the 10-minute walk and got to Dr. Cabatic's clinic at 9:30 a.m. It didn't open until 10, but Irma routinely arrived at doctors' appointments early. Then 9:30 became 10:30 and 10:30 became 11. The door remained locked. Irma called Cabatic's cell phone and office line seven times. No answer.

Claudialee kept saying her stomach ached, that she felt tired and really thirsty. She'd vomited three more times that morning.

She normally didn't complain about things—she was the type of girl who fell off a scooter, scraped her knee, and got right back on without hesitation. Irma called a cab and asked the driver to take them to New York Hospital.

Claudialee began to sway and stumble as they walked toward the emergency room. Before reaching the entrance, she nearly collapsed. Irma picked her up and carried her the rest of the way.

As hospital workers ran tests, a nurse asked Irma if Claudialee had been urinating more and drinking more than usual recently. Irma said she had noticed her daughter doing both since Christmas.

This suggested that Claudialee's blood sugar had been rising.

The test results—five times the normal level—supported that hypothesis.

"When the doctors came in and told me about blood-sugar levels—that was a surprise," Irma tells the Voice. "That was the last thing I expected to hear. That's when I knew something was really wrong."

There had been other signs. Months after Claudialee checked into New York Hospital's ER, pediatric endocrinologist Craig Alter reviewed her medical records. He was shocked, unable to understand why Dr. Mercado had so quickly ruled out type 1 diabetes.

"If you tell me there is a five-year-old with diabetes, the chance that they have type 1 is probably 99.99 percent," he would later testify. "If you tell me they are obese, I would say, okay, the chance is 99.7. It's almost definitely type 1."

Alter, a physician at the Children's Hospital of Philadelphia, is one of the world's top experts on diabetes in kids. He teaches a pediatric endocrinology class at the University of Pennsylvania's medical school. He is chairman of the Educational Committee for the Endocrine Society and gives lectures across the globe. In 2001, he founded Camp Freedom, a summer program in Pennsylvania that brings together diabetic youth for a week of swimming, hiking, and sharing insulin-injection stories around the bonfire. Last year, 140 kids registered; 139 of them had type 1.

Even though rates of type 2 are rising among minors, the condition remains rare in children under 10 years old. The National Institutes of Health report that one out of every 5,000 kids in that age group has type 1 diabetes, while one out of every 250,000 gets type 2. The reason is simple: Type 1 is a condition people are born with or acquire very early in life; type 2 develops over time—enough time for the body to build a resistance to insulin.

Not only is type 1 far more common in six-year-olds, it is also far more urgent.

"Type 2, you have a little more luxury of time. Type 1, you do not have the luxury of time," Alter testified. "Type 1, if we don't give them insulin, they will die."

Blood sugar is like temperature—it rises gradually. In the months since Claudialee's last tests, the girl's blood sugar level continued to rise, right under her doctors' noses.

Even as the puzzle pieces began to emerge, each showing a symptom of the disease, neither Mercado nor Cabatic saw the whole picture. Weight loss can indicate that the body is starving as a result of its failure to absorb glucose. Sudden heart palpitations can indicate that the body is dehydrated from losing the sugar-laden fluids via urination.

"In a child where there is a possibility of diabetes, any symptoms that develop that might be linked to diabetes have to be assumed diabetes until proven otherwise," Alter said. "You look for anything to tip you over the edge. The appropriate treatment would have been more-frequent monitoring to determine if diabetes was present then, or to catch it early within a few days, had it progressed."

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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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