Gambling with Children

Kaiser says its new hospital in Oakland offers first-rate services, but critics say the healthcare giant's decision to close pediatric care facilities in the East Bay has had grave consequences.

When Andrea Olguin lifted her six-month-old daughter from her cradle, she immediately knew something was wrong. It was just after midnight on April 4, and Olguin, who had just finished her shift at the Hayward FoodMaxx, did not expect to find Jenevieve completely stiff and staring at her with wide, blank eyes.

Olguin woke her mother and they immediately took Jenevieve’s temperature. It was 104 degrees. The combination of the stiffness, blank stare, and high temperature convinced Olguin and Jenevieve’s father, Ferdinand Dagatan, that the little girl was having a seizure.

The family rushed Jenevieve to the emergency room at the Kaiser Hayward Medical Center. Medical staff stabilized Jenevieve’s seizure, but the baby’s other symptoms — fever, loose stools, and vomiting — persisted. Olguin and Dagatan watched as some of the nurses struggled to insert an IV into the baby’s body. The medical staff on duty ordered a blood culture and X-ray, but the tests would take time.

Olguin repeatedly asked Kaiser staffers why her daughter had suffered a seizure, but she said they didn’t give her any answers. Both Olguin and Dagatan said in a recent interview that they felt “brushed off” by the Kaiser medical staff. The couple said that during the three hours they were in the emergency room they only saw a doctor twice, and did not see a physician before the hospital discharged Jenevieve. Their baby also was never examined by a pediatrician. Just after 4:30 a.m., the hospital sent Olguin, Dagatan, and Jenevieve home with a small package of over-the-counter Tylenol, some ibuprofen, and Pedialyte.

At roughly 7 a.m., Olguin and Dagatan were startled awake by what they said was “a high pitched grunting sound” coming from Jenevieve’s cradle. They checked on the baby and discovered that her lips had turned blue. They rushed her back to Kaiser Hayward Medical Center, and according to Olguin and Dagatan, the care their daughter received “was a mess.”

A purple rash was forming rapidly on Jenevieve’s body, and her screaming had intensified. As with their first visit, Olguin and Dagatan watched medical staffers struggle to insert an IV line in their daughter. “It got really chaotic,” Dagatan recalled. “They didn’t know what they were up against.”

Olguin and Dagatan watched nervously as doctors in the emergency room tried to figure out what was happening to Jenevieve. Olguin continued to ask them why Jenevieve’s neck was jerking and why she was scratching her face, but failed to get satisfactory answers, hearing only that the little girl was “just scared.”

From the time Jenevieve was admitted to the hospital at around 8:30 a.m. to the time the transport team arrived at 12:40 p.m. to take Jenevieve to Kaiser’s pediatric unit in Oakland, the little girl’s rash had become so severe that she was nearly unrecognizable. “She was having a purple rash right in front of them and they couldn’t help me,” Olguin recalled. “I literally felt like I was holding my baby and wasting time.”

The ambulance that would take Jenevieve to Oakland arrived with a Kaiser pediatrician and a pediatric nurse who immediately examined the little girl — four hours after she was admitted to the Hayward hospital for the second time, and about twelve hours after she had first arrived at Kaiser. The pediatric medical staffers told Olguin and Dagatan that Jenevieve was suffering from Meningiccocal Neissiea, commonly known as bacterial meningitis, a dangerous disease that can quickly turn fatal if not treated with antibiotics.

By the time Jenevieve had reached the Kaiser Oakland Medical Center’s pediatric intensive care unit, her organs were failing. Shortly thereafter, she slipped into a coma.

Eight days later, Jenevieve was dead.

Last November, roughly five months before Jenevieve died, Kaiser Permanente closed its pediatric inpatient care unit in Hayward, leaving the little girl’s parents and an estimated 100,000 other families in southern and central Alameda County without a pediatrics hospital near their homes. The healthcare giant decided to consolidate its pediatric care services at its new Oakland facility — a move that means parents must now get their children to Oakland to receive proper care.

Kaiser’s decision to eliminate pediatric services in central and southern Alameda County has drawn widespread criticism from nurses, politicians, and East Bay residents who contend that the healthcare giant has prioritized cost savings over the needs of young patients and is gambling with kids’ lives.

For their part, Kaiser officials maintain that their new state-of-the-art facility in Oakland provides better pediatric care overall than what the nonprofit had offered before. Kaiser officials also contend that some of the criticism they have received is part of a nurse’s union campaign for a better contract and increased staffing.

However, for parents like Olguin and Dagatan, Kaiser’s decision to shutter pediatric units in the East Bay has had grave consequences. The healthcare giant’s decision requires physicians in hospitals outside of Oakland who are inexperienced in pediatric care to now make life-or-death decisions about how to properly treat seriously ill children who show up in the ER.

Indeed, nurses and officials from the California Nurses Association say that Jenevieve’s death was directly related to this absence of pediatric expertise in Hayward. “I’m not an I-told-you-so type of person; I don’t want to be right about these types of things,” said Kristine Richter, a nurse who worked in the Kaiser Hayward pediatrics unit before it closed. “But this is exactly what we were worried about — these types of things happening.”

Kristine Richter had worked in the Kaiser Hayward pediatrics acute care unit for most of her nursing career before she transferred to Kaiser’s new San Leandro Medical Center. She explained that when the Hayward pediatrics unit was still open, a pediatrician was present at all times. “That’s not how it would have been when we were there,” Richter said, after hearing the account of what happened to Jenevieve and having received permission from the girl’s parents to inspect the medical records from the night of the incident.

When the Kaiser Hayward pediatrics unit was open, the ER staff would have summoned the on-duty pediatrician to advise and assist in a severe case such as Jenevieve’s, Richter said. “They are trained to see things that you don’t often see in adults,” she said of pediatricians.

But Jenevieve wasn’t seen by a pediatrician until about twelve hours after she first arrived at Kaiser Hayward. Considering Jenevieve’s young age and her severe symptoms, Richter said that, in her experience, the little girl would have been put in the pediatrics unit for observation after her first visit. “Not every patient that has a seizure gets admitted,” she said. “But this was a six-month-old.”

Bacterial meningitis works quickly. Once in the bloodstream, bacteria called Neisseria meningitides infects the lining of the brain and spinal cord, causing initial, “prodrome” symptoms, such as fever and nausea. In more developed stages, symptoms include seizures, severe rash, high-pitched cries, and neck stiffness. The Centers for Disease Control (CDC) website states — in bold type — that if meningococcal disease is suspected “It is important that treatment is started as soon as possible.” Typically, a child receives antibiotics.

But the CDC also states that antibiotic treatment shouldn’t begin until meningitis is highly suspected. Pediatric doctors and nurses usually make this determination with a “workup,” which consists of a blood culture, a urine test, and a spinal tap. A spinal tap (or lumbar puncture) is a procedure during which a large needle punctures the spine and extracts spinal fluid. By testing spinal fluid for the appearance of the bacteria, a spinal tap generally provides quicker and more accurate results. But the procedure can be dangerous on infants, whose bodies are smaller and more fragile. While Jenevieve received both blood and urine tests, she did not get a spinal tap.

“There are risks with a spinal tap,” Richter explained. “Pediatricians are more comfortable with the physical acts of doing it on smaller bodies.” Before Kaiser Hayward’s pediatrics unit closed, its pediatricians performed child spinal taps, Richter said. “I think pediatricians who are more used to giving babies spinal taps are more comfortable doing it,” she said, “whereas adult doctors are less inclined to do a spinal tap.”

Nurses suspect that Jenevieve did not receive a full workup because a pediatrician wasn’t present to give one. “I don’t have a crystal ball,” Richter said, explaining further that it’s impossible for anyone to know exactly what could have affected the outcome. “But I would hope — given her age, the febrile seizure, and past practices at our department — that when she came in the first time with the seizure, she would have at least been admitted for observation, had her workup finished, and given some antibiotics.”

For their part, Kaiser officials say that the Hayward pediatrics unit, when it was still open, would not have admitted a child with Jenevieve’s symptoms for observation. “The Hayward Medical Center inpatient pediatric unit … never cared for, and would not have cared for, acutely ill patients such as an infant with bacterial meningitis,” Barbara Crawford, Kaiser’s Northern California vice president for Quality and Regulatory Services, wrote in an email to me.

Crawford added that Kaiser investigated Jenevieve’s case and concluded that the girl’s care was “appropriate and sound.” She said that early symptoms of bacterial meningitis “mimic that of other, less serious illnesses” and are not easily detected at first. “This was the case with Jenevieve, who had no clinical signs of meningococcemia during her first visit to the emergency department,” she wrote. “… As more symptoms emerged later in the day, Jenevieve was promptly transported to the Oakland Medical Center, where she could receive the higher level of care required for critically ill children.”

But according to medical records, Jenevieve’s treatment and subsequent transfer to Kaiser Oakland was not prompt. Within thirty minutes of her second arrival at the Kaiser Hayward emergency room, her vital signs indicated a serious problem. Her heart rate was 210 beats per minute and her temperature was 102 degrees — which are both indications of sepsis, a bodily inflammation that results from bacterial meningitis. According to her medical records, Jenevieve also had arrived at the Hayward emergency room with a dark rash, stiff neck, and high pitched screaming, which are also clear symptoms of bacterial meningitis.

At the Hayward facility, medical staffers consulted with the Oakland pediatric unit by phone on Jenevieve’s case, and later sent photographs of her. But nurses say that even though it might have been too late to save the little girl during her second visit to the ER, Jenevieve’s diagnosis was not made quickly enough, and that she should have been transported to Oakland much sooner. Hayward medical staffers waited two hours after Jenevieve arrived the second time before they called to transport the girl to Oakland, and then it took another two hours for the ambulance to arrive. “I felt like they were just patching her up while they were waiting for the transport to arrive,” Dagatan said.

In 2010, to the surprise of Kaiser’s East Bay pediatric medical staff, officials from the healthcare giant announced that, in addition to the closure of the Hayward pediatrics unit, a pediatrics unit would not be included in the new Kaiser San Leandro Medical Center. Consequently, central and southern Alameda County — San Leandro, Hayward, Castro Valley, San Lorenzo, Union City, Newark, and Fremont — no longer has an inpatient hospital for children. San Leandro has a pediatric clinic, which nurses contend doesn’t provide sufficient services for young patients suffering from serious illnesses.

“Clinics are not designed to take care of patients in need of hospitalization,” said Richter, who now works in the clinic. She said clinics don’t have the staff and resources for patients in need of immediate care, and do not have pediatric staff available at all times. The only other Kaiser hospitals besides Oakland that offer inpatient pediatric care in Northern California are in Santa Clara and Roseville.

Kaiser officials said that, before it closed, the Hayward pediatric unit was underused, and that, on average, it served fewer than four patients per day. Kaiser officials used this same reasoning for not including a pediatric care unit at the new San Leandro facility. Instead, the nonprofit decided that its new hospital in Oakland would be the central hub for pediatrics for the entire region.

Since the announcement in 2010, southern Alameda County community members and union nurses and officials have been locked in an on-going battle with Kaiser to keep a pediatrics unit open in central and southern Alameda County. They argue that consolidating pediatrics services in Oakland is about cutting costs. “[Kaiser’s] decision to cut pediatric services is mainly motivated by money,” argued Karen Chan, director of the Kaiser division at the California Nurses Association (CNA). She asserted that, in recent years, Kaiser has been consolidating “specialty” services — not necessarily to improve quality, but rather to reduce the costs of operating more facilities. “Kaiser is an insurance company that collects all of its premiums upfront and owns all of its hospitals and clinics,” Chan continued. “So every time they have to deliver care it’s considered an expense for them, and ultimately they’re incentivized to provide less care.”

But Kaiser officials contend that consolidating pediatrics services in Oakland is strictly about improving quality. “The level of care that was once available in the low-volume inpatient pediatric unit in Hayward did not and could not equal the level of care now available in the Oakland Medical Center’s specialized pediatric inpatient unit,” wrote Tom Hanenburg, a Kaiser Permanente senior vice president and area manager, in an email to me.  

But critics say the newer and larger facility in Oakland does not necessarily mean an overall improvement in quality. Leaving an entire community without immediate access to expert pediatric care can not only be inconvenient, but even hazardous for families, critics say, especially if a child needs immediate, specialized care for conditions such as asthma or, in the case of little Jenevieve Dagatan, bacterial meningitis.

“It’s a big deal,” said Kathy Donohue, a nurse who works in the Kaiser Oakland Medical Center’s neonatal intensive care unit. “If you’re in traffic — you have a baby with respiratory distress or a lethal condition — there are chances the baby can die before it reaches a facility that can help them.”

Interstate 880, which connects southern Alameda County to Oakland, is one of the most congested freeways in the East Bay. “If you’re trying to go from Hayward to Oakland on 880 — in rush hour traffic — it’s going to take you an extra 45 minutes to an hour to get there, and that’s assuming you have a car,” said Hayward parent and former Castro Valley High School teacher John Green.

In 2008, the Kaiser Hayward pediatrics inpatient care unit was still available for Green and his family. That year, he and his wife took their daughter Chloe to Kaiser Hayward for a checkup, two days after she was born. Doctors noticed that Chloe had jaundice and told Green that the condition could result in permanent brain damage. The hospital admitted Chloe to the pediatrics unit overnight, during which time pediatricians treated her illness.

“The experience of her being sick was very stressful, but the care was amazing — and the fact that they were able to resolve her situation in short order and get her right in and right to the care was impressive,” Green said. “The nurses were supportive, and the doctors were excellent.”

Years later, however, Green was stunned when he learned that a pediatrics unit would no longer be available in central or southern Alameda County to Kaiser patients. He spoke with neighbors, parents of his daughter’s friends, and with moms’ groups. “It’s scary and people feel powerless,” Green said. “They feel like, ‘What’s the alternative?’ Kaiser is the low-cost provider in the county. People aren’t going to leave Kaiser and go to Blue Cross where the rates are double. Kaiser knows they have us in a corner.”

He added that newer parents, like him and Olguin and Dagatan, might not be aware of the consequences of having no pediatric care in Hayward until their child gets seriously ill. “I think a lot of families aren’t aware that there are services being taken away from their children — particularly if you’re not using the services on a regular basis, you won’t know until you’re being asked to drive up to Oakland or down to Santa Clara during rush hour.”

In fact, Green said that he received little notice from Kaiser about the closure of the pediatric unit in Hayward and didn’t know about the healthcare giant’s decision not to include a pediatric unit its new San Leandro Medical Center until he saw a CNA protest on television. “All we received were messages saying, ‘We’re here to stay in the community and we care about kids,'” he said. “That’s what I would want my healthcare provider to say and believe, but the fine print is that they’re going to provide less services for children — and we’re talking about sick children.”

As someone who worked with youth on a daily basis, Green saw the “effects of healthcare on kids who have access and those who don’t,” he said. “It affects their entire lives … their readiness for school … [and] their ability to be successful. So thinking about the high-schoolers I would teach, it breaks my heart to imagine that people like them would be denied quality healthcare in their most formative stages.

“I’m not in the medical field,” he continued. “I’m not saying that there needs to be five nurses on staff at all times. I’m just saying … there should be a wing in the community for children — it doesn’t need to be some big development.”

In January, the Express reported that there had been a spike in cost-cutting measures at the Kaiser Oakland Medical Center, including nurse layoffs and early discharges of patients, resulting in substandard care for patients there. In addition, the Express reported last week in part one of this series that Kaiser has come under increasing criticism for failing to provide adequate care to patients with severe mental health problems, and for delays in treatment, in violation of the law.

CNA officials say Kaiser’s unwillingness to include a pediatric inpatient care unit in San Leandro is yet another example of the healthcare giant cutting costs and shortchanging patients. “Over the last few years there’s been a steady program of patients who used to be monitored for various symptoms but are now being sent home with medication and more in-home monitoring,” Chan said. “Kaiser has been trying to say patients don’t need to be admitted to the hospital, and that these patients should just be discharged.”

This is exactly what happened with Jenevieve, Chan asserted. “She should have been hospitalized for observation, so that she could have been monitored to see if anything else would have happened — that way they could have caught the meningitis a lot sooner.”

When asked about the nurses’ assertion that consolidation of services is a cost-cutting measure, Kaiser’s Tom Hanenburg wrote in an email to me, “This is not about money, as the nurses’ union leadership would like everyone to believe — it is about quality. Specifically, how to offer the best, most highly specialized inpatient care to the children we care for.”

Hanenburg also said that that the nurses’ union’s claims about Kaiser’s quality, staffing, and cost-cutting measures “are not only unfounded, they are a deliberate and irresponsible strategy by the union to apply pressure before and during contract bargaining.” (Kaiser officials made similar assertions about the National Union of Healthcare Workers concerning that union’s criticisms of Kaiser’s mental health services.)

The CNA isn’t alone in denouncing Kaiser’s decision to provide no pediatric inpatient services in central and southern Alameda County or in contending that it was part of a cost-cutting move. State Assemblymember Robert Wieckowski of Fremont has urged Kaiser multiple times to keep a pediatric inpatient unit open in south county. “There’s someone in corporate saying we can cut costs by consolidating these efforts and make the patients drive … saying you come to us instead of us being there for you,” he said.

Wieckowski introduced legislation this year aimed at providing extra financial incentives to nonprofit hospitals that offer an adequate “community benefit.” But Kaiser officials have been uninterested in his plan. “They had made a decision that this is how they’re going to deliver healthcare — and I still disagree,” he said. “Hell, open a pediatrics center in Fremont. You have 32,000 [patients] there. Put something in south county and at least you have coverage for everyone, instead of just one hospital.”

Wieckowski’s sentiments are shared by California state Senate Majority Leader Ellen Corbett, who, along with Wieckowski and other local politicians, has participated in nurses’ union rallies about the pediatrics issue. “I have been very concerned ever since I first heard that Kaiser Permanente inpatient pediatric services were being consolidated in Oakland,” Corbett wrote in an email to me. “Families that have to travel longer distances to receive care and visit a very sick child in the hospital face many challenges. In addition to having to travel farther distances to the hospital, they still have to commute to work, take children to school and have many other family responsibilities. I am confident that Kaiser Permanente will continue to provide high quality care to our local children and families and I sincerely hope that — in the near future — an arrangement can be made to reestablish pediatric inpatient care services closer to Hayward and San Leandro.”

The consolidation of hospital services is an industry-wide trend that has been gaining momentum in the last three decades, according to a 2013 study published by the American Medical Association. In the United States, most hospital consolidation occurs when larger health systems acquire smaller hospitals and integrate them into a “hub and spoke” health system, in which one central hospital serves as the hub for specialized services, offering resources to surrounding, less comprehensive hospitals. Sixty percent of US hospitals are now part of consolidated health systems, according to the study.

Many healthcare providers and health policy experts believe that centralizing specialty services not only results in cost-savings, but also addresses quality deficiencies in independent hospital care. Consolidating inpatient hospital services, experts say, allows a health system to provide for more uniform and coordinated care, all while cutting duplicative services — such as pediatrics — at the other outlets in the system.

But a healthcare provider must factor a number of ethical considerations when making decisions about which services to consolidate and how to do it, said Dr. Clarence Braddock, a bioethical healthcare consultant and vice dean of education at UCLA’s David Geffen School of Medicine. The question of access, he said, is one of the main considerations for a healthcare provider when planning to consolidate services. As long as consolidating a service in one location isn’t burdensome financially or geographically on persons seeking medical care, consolidation is ethically justifiable, he said.

Kaiser’s decision to consolidate pediatric services is, in theory, also ethically justifiable, so long as Kaiser provides basic, primary care to the community. Although Braddock explained that, within the field of biomedical ethics, there is an intense debate over what “basic” service means, California state law only requires acute care hospitals to provide eight basic services — medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary — according to the California Department of Public Health, which issues hospital operation licenses based, in part, on these criteria.

Pediatrics is not included.

Kaiser’s new Oakland Medical Center is a twelve-story, $1.3 billion facility, complete with large interactive touch screens that tell visitors and patients exactly where they need to go to receive services and obtain educational resources. Some screens are positioned low enough for young guests (and patients), and other screens display art created by children from the pediatric ward.

A day before young patients from the old Kaiser facility in Oakland moved into the new building on July 1, Kaiser officials gave me a tour of the new pediatrics unit. Guiding the tour was Dr. Jorge Gutierrez, assistant physician in chief of pediatrics of the Kaiser Oakland Medical Center. He said the unit offers a full range of pediatric specialties, including pediatric neurosurgery and pediatric cardiology.

Gutierrez also said the unit offers “family -centered rounds,” during which parents are given information about their children in layperson’s terms. This is intended to improve openness and communication with parents, and ultimately to reduce their anxiety about their children’s care.

The unit’s spacious, single rooms are each equipped with a pullout bed for families who need to stay overnight, as well as what Gutierrez called a “Care Board,” a keyboard that allows patients to interact with an LCD screen that has a menu offering newly released health and safety information — and even room service.

Most rooms have sweeping views of the Oakland hills or the city below, because the unit is located on the eleventh and twelfth floors — but it wasn’t always that way. When the hospital was being designed, the pediatrics unit was originally divided between the sixth and eleventh floors. According to Gutierrez, this left a large, five-story gap in the unit. “It would have been too unsafe,” he said. “I felt it would take too long to respond to kids who were decompensating.”

Decompensation is a medical term for organ failure — like what happened to little Jenevieve. Gutierrez may have only been referring to the arrangement of the new Oakland hospital, but in doing so he inadvertently revealed the apparent misaligned intentions of Kaiser’s decision to close its Hayward pediatric unit and require families from central and southern Alameda County to transport their seriously ill children to Oakland: Children decompensate very quickly, and when pediatric resources are separated by distance — whether it’s five hospital floors or twenty miles on a congested freeway — it can be dangerous.

Kaiser was able to close the gap in Oakland by simply moving two units to adjacent floors. But a wide gap remains for the rest of the East Bay.

After Jenevieve slipped into a coma, doctors at Kaiser Oakland sat down with Olguin and Dagatan and explained their options: Jenevieve would likely eat from a tube for the rest of her life, some of her limbs would be amputated due to blood infection, and she would likely suffer from mental retardation. Olguin said a doctor pulled her aside and told her to think about her three-year-old son, who was healthy and would need her attention.

It took eight days for Olguin and Dagatan to make a decision. During that period, Kaiser medical staffers gave Jenevieve a battery of tests — including CAT scans and ultrasounds. An MRI confirmed that the meningitis had inflicted severe damage on the little girl’s frontal lobe. “When I held my daughter, they had to rotate her body because one side of her body was so swollen you could see fluid moving around,” Olguin recalled. “That’s when I knew.

“It’s really disgusting to know I had control,” Olguin continued. “That’s a really disturbing feeling [for] any parent. That’s why I don’t want other parents to go through that.”

After Olguin and Dagatan decided to remove Jenevieve from life support, Kaiser staffers transferred her to an adult bed so that Olguin and Dagatan could spend one last night with her. Jenevieve died on April 12. Ever since, the little girl’s family has been wracked with overwhelming grief and helplessness. “I’m really bitter toward other moms and babies,” Olguin admitted.  

Olguin and Dagatan have few options. They could sue Kaiser, but even if they won, they wouldn’t receive much. California state law caps medical malpractice damages at $250,000 (a revision will appear on the November ballot so that plaintiffs could receive up to $1.1 million). However, that’s only if a malpractice lawyer decides to take their case. In California, malpractice attorneys tend to be selective because of the high risk of expense and the likelihood of a low payout. But money, whatever the amount, isn’t on Olguin and Dagatan’s minds. “If I could sue for a pediatrics unit, I would,” Olguin said.

For Olguin, the best way to give true meaning to her daughter’s death is through activism. After Jenevieve died, Olguin started participating in rallies and protests with the CNA. Kaiser’s Barbara Crawford asserted in an email to me that Olguin and Dagatan’s grief is being “misused by the nurses’ union for a futile and irresponsible campaign to ‘restore’ services that never existed at Kaiser Permanente Hayward — and to draw attention to the union’s own political agenda.” But Olguin is steadfast in her desire for a pediatrics unit in her community to prevent other families, especially mothers, from feeling the pain she now endures.

In a recent meeting, Olguin sat down with high-level regional administrators at Kaiser. She said they urged her to file a complaint against the doctors who treated Jenevieve during both of her visits to Kaiser Hayward. Olguin said she told them she didn’t want to have doctors fired. Instead, she wanted them to restore the pediatrics unit, explaining that she believed the absence of the unit was largely responsible for her loss. According to Olguin, administrators told her that a pediatrician was in the Kaiser Hayward Medical Center during Jenevieve’s first visit, and that it was the ER doctor’s decision not to call the pediatrician for consultation. “They’re throwing the doctors under the bus,” Olguin said to me.

When asked about Olguin’s assertions, Hanenburg stated in an email that the firing of physicians was never discussed with Olguin, and that the administrators had merely explained to her that “it is up to the treating physician to decide on indications for an invasive test based on their expert evaluation and the information at hand.”

But why she was told a pediatrician was in at Kaiser Hayward Medical Center during Jenevieve’s first visit is unclear. Kaiser was not able to provide a record of a pediatrician’s presence at the hospital that night. Hanenburg stated that such a record was “confirmed for Ms. Olguin,” but she told me she has no recollection of seeing such evidence.

These days, Olguin is exhausted. In addition to mourning the loss of her daughter, suffering a string of disappointments associated with dealing with Kaiser administrators, navigating the state’s medical complaint process, and launching her efforts at activism, she still works nights at the Hayward FoodMaxx, which sits right across the street from Kaiser Hayward. She spends much of her free time caring for her young son.

“I feel like I’m suffering for something that Kaiser did wrong,” she said, “and they’re just getting away with it.

“They gambled my baby’s life away,” she continued. “Why take the gamble?”


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