Because Mercado had locked in on type 2, she did not monitor her patient's blood. She did not tell Irma to purchase a $20 blood sugar meter from the drugstore. She did not ask Irma about the frequency with which her daughter drank and urinated. And neither she nor Cabatic described to Irma the danger signs to look out for.

"Being that she has a family history of diabetes, I would be thinking that she would know the symptoms of diabetes," Cabatic later testified in court.

Even after it was clear that Claudialee suffered from type 1, Mercado stood by her diagnosis. When later questioned in court, she disagreed with the notion that type 2 diabetes is uncommon in young kids.

"How many type 2 infant diabetics have you treated?" a lawyer asked her.

"A lot," she replied. "Maybe it's geographical, because I work at Brooklyn as an assistant professor and also in wellness program where there are a lot of obese children, so we diagnose a lot of children with type 2 diabetes."

It's tempting to assume that Claudialee received substandard care because of her family's income status. Doctors don't make as much money treating Medicaid beneficiaries, explains Jim Sheehan, former New York State Medicaid inspector general. A specialist earns as little as $30 a visit. By contrast, a pediatric endocrinologist treating someone with private insurance gets nearly $100 an hour. So Medicaid providers often have trouble filling their networks with enough doctors who specialize in common issues like diabetes. Patients are sometimes left to the lesser skilled or lesser known—doctors who can't afford to turn away the business.

"Some specialties, they have a very tough time recruiting people to be Medicaid-based," says Sheehan. "And so you're not gonna say, 'We want board-certified.'"

Though she'd failed to earn certification, Arlene Mercado had established a respectable career. She graduated from the University of Santo Tomas's medical school in the Philippines in 1984 and spent much of the next decade treating poor people in rural villages. She came to the U.S. in the mid-1990s, interning at Harlem Hospital before beginning her residency at Pitt County Memorial Hospital in Greenville, North Carolina. Her transition reflected competence: Foreign doctors must complete a rigorous testing process to become licensed here.

After two years of endocrinology training at the National Institutes of Health, Mercado took a position as a senior fellow at Mt. Sinai Hospital in Manhattan. In 2006, SUNY Downstate hired her as an attending physician. Two years later, she was named associate medical director of the hospital's wellness program for obese and diabetic patients. (SUNY did not respond to interview requests for this story.)

By the time Mercado treated Claudialee, a good number of experienced doctors had vouched for her. She'd co-authored at least seven academic papers in peer-reviewed journals. Multiple private insurance companies added her to their networks. Over the course of her career in New York, she sustained a spotless record. Not once had the Office of Professional Medical Conduct, an investigatory division of the New York State Department of Health, taken disciplinary action against her.

Shortly after sunset on January 23, 2010, Irma and Napolean sat in the waiting room at New York Presbyterian Cornell Medical Center. Claudialee had been transferred there a few hours before. Family and friends surrounded the parents.

A doctor approached and explained what was happening to their daughter. Claudialee's blood sugar had been rising for months. Because she didn't have enough insulin, her body burned fatty acids as an alternative fuel source. As those acids accumulated, they poisoned her body, and its systems began to shut down. The resulting nerve damage allowed fluids to seep into her brain, causing it to swell and pushing her further from consciousness. Twice that evening, doctors had had to resuscitate Claudialee. Now only machines kept her alive.

There was almost no chance she would recover.

That reality was dawning on Irma. She'd tried to stay optimistic, to stay strong for her only child. She'd dedicated herself to building a life for her daughter. She thought she'd done everything right. Coming to America. Working the long hours that might pull them up the economic ladder. Signing the girl up for dance classes and after-school tutoring sessions. And all those doctor visits. She wondered what she should have done better.

She felt guilty and betrayed. She'd put her faith in the healthcare process and it failed her.

Irma asked about organ donation. The doctor told her that wouldn't be possible. Her daughter's organs were damaged beyond repair.

The family members entered Claudialee's room and said their goodbyes.

On a summer afternoon, the waiting room of Downstate Pediatrics Associates is filled with nearly two dozen people. There are babies in strollers, parents reading magazines, and grade-schoolers playing tag. There are giggles and stomps and adults saying things like "give that man his sunglasses back" and "take that sticker off your face."

A reporter approaches the front desk and asks to speak with Dr. Arlene Mercado. The receptionist goes to get her.

It has been a rough few weeks for Mercado. In July, a jury found her 100 percent liable for the death of Claudialee Gomez-Nicanor. (Cabatic, also a defendant, was cleared.) In her testimony, Mercado admitted to having thrown away her original notes from Claudialee's treatments after learning she had been subpoenaed. Before discarding them, she typed up copies for the court. The new version indicated that she had intended to administer a blood test at Claudialee's next appointment in January 2010, days before the girl's death.

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13 comments
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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