By Michael E. Miller
By Allie Conti
By Keegan Hamilton and Francisco Alvarado
By Jake Rossen
By Allie Conti
By Kyle Swenson
By Chris Joseph
By Michael E. Miller
Unlike Jenna, Cristal was born in dire straits. Fourteen weeks premature, she weighed only a couple pounds at birth. Her early months, spent in an intensive care unit, were marked by numerous medical emergencies. She suffered from a lung disease and other complications of her birth but survived them. She was transferred from Miami Children's Hospital to Broward Children's Center on January 17, 1994, a few months before her second birthday.
While Jenna was the worst off of all the children at the group home, Cristal was one of the most promising kids in the main facility. According to records kept by Broward Children's Center, Cristal could sit up on her own, pull herself up to a stand, and crawl. She liked to play with toys and watch people go by her crib. When she got agitated, center staffers knew what to get her: "She loved her chocolate milk," said Broward Children's Center staffer Robin Sargent in a deposition.
According to a reputable pediatric doctor from San Diego who was hired as an expert witness by Cristal's attorney, she had a good chance at a relatively normal, happy life, free from life-support machines. By June, in fact, she was being weaned off the ventilator. She breathed on her own through a tracheostomy tube in her neck during the day but still needed a ventilator at night to ensure that she wouldn't stop breathing while sleeping in the center's nursery, where 14 other babies connected to life-support machines slept, too.
On the morning of June 19, 1994, something tragic happened in the nursery that stripped Cristal of all of her hard-won physical advancements.
According to civil court depositions, the nursery was being supervised that morning by a respiratory therapist and a licensed practical nurse. Also on duty was a "floating" respiratory therapist, Chackocan Vadakkel, who helped in the nursery as well as in other wings.
Vadakkel, an Indian immigrant with limited English and a heavy accent, in a sworn deposition told Gary Cohen, a medical malpractice attorney hired by Cristal's family, that employees were concerned that staffing levels were too low:
Cohen: Were you ever concerned that there wasn't enough help in the nursery? Fifteen babies is a lot of babies.
Vadakkel: Lot of babies.
C: For two people to handle.
V: So, that is why floating therapist -- for helping them.
C: Was there ever any talk at the center that you know of about getting more help?
V: They were asking for more help. Everybody asking for more help.
C: Everybody thought they were in need of more help?
Shortly after 5 a.m. on June 19, Cristal remained connected to the ventilator, which literally breathed for her, though she was also able to take spontaneous breaths on her own. The ventilator was set on 12 compressions -- or breaths -- a minute. The oxygen went through a ventilator tube, which connected directly to her tracheostomy tube.
Dawn Jackson, the nurse in charge of the babies, instructed Vadakkel to take Cristal off her ventilator. That was the first mistake.
To become a respiratory therapist, Vadakkel had to complete a 15-month course and pass a state test, which he did six months prior to the incident. When he was hired by the center in March 1995, however, he had had no training or experience working with children. More important, he'd never before in his life unhooked a ventilator from a patient when Jackson asked him to unhook Cristal's.
The respiratory therapist on duty in the nursery, Robbie Harris, said under oath that he didn't know Vadakkel had never performed such a basic task, which consists of snapping the ventilator tube off the tracheostomy tube and making sure the latter is still in place afterward.
Cohen questioned Vadakkel about his lack of experience:
C: Were you worried that you may not be able to [take off a ventilator] just right?
C: How did you know how?
V: Because I -- teach in the school.
C: But they didn't teach you with babies?
C: You never touched a baby before you went to Broward Children's Center?
C: How did you study it without doing it? Anyone who is giving health care has to work on patients, don't they?
V: Book saying what to do.
Vadakkel's deposition also showed that, even if he would have had experience with ventilators, he never should have been ordered to take off Cristal's in the first place. Cristal was asleep at the time, and doctor's orders forbade her sleeping without a ventilator. Nurse Jackson would later say in a deposition that she thought Cristal was awake when she told Vadakkel to take off the ventilator. Vadakkel said Cristal never woke up.
Cohen believes that when Vadakkel took off the ventilator he also inadvertently dislodged the tracheostomy tube in Cristal's neck. In depositions staffers agreed that it was likely. Since Cristal was, by Vadakkel's own admission, asleep and couldn't have knocked it out herself, there is no other sufficient explanation.
When a tracheostomy tube comes out, skin often folds over the airway, obstructing it. According to depositions and other court records, it appears that almost everyone agrees that it was the dislodging of the tracheostomy tube that led to Cristal's brain damage.