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But several minutes had passed before this crucial problem was recognized. Exactly how long will never be known, because everyone there has a different memory of the time frame. (The incident, in fact, prompted the center to install clocks in the nursery.) What is known is that by the time it was discovered, Cristal was already in cardiac arrest.
When a child stops breathing at the center, alarms are supposed to sound. An oxygen-saturation monitor to which Cristal was connected should have gone off when the oxygen level in her blood dropped to dangerous levels. Some employees said the monitor's alarm went off, others said it didn't. Vadakkel said it went off, prompting him to check Cristal, but he also said she was already in cardiac arrest -- her lips pale, her skin purple -- by the time he was alerted.
"These kids move in the night and the alarms go off and the nurses get annoyed by that. We believe the alarm was shut off," says Cohen. "That's the only way to explain it. The alarm should have gone off immediately. We know the alarm couldn't have gone off; the child was unresuscitable."
Upon discovering the problem, Vadakkel said he didn't know what was wrong. Center staffers later said in depositions that this was inexcusable: A respiratory therapist should immediately recognize when a tracheostomy tube is out of place.
Vadakkel called the other respiratory therapist, Harris, over to the crib. Harris quickly recognized the problem and put the tiny tracheostomy tube -- about five millimeters in diameter and an inch and a half long -- back in.
Harris estimated that up to eight minutes passed from the time he began CPR to the time 911 was called. Vadakkel guessed it was more like ten. In any case it was, according to depositions, way too long. Cristal was transported to Broward General Medical Center. At some point her heart started beating, but it was too late. She was already permanently brain-damaged. Today she is constantly on a ventilator, must be fed from a tube, and doesn't respond to the world. She remains in a vegetative state, says Cohen.
When it began an investigation into Cristal's death, the Florida Department of Health and Rehabilitative Services (now the Department of Children and Families), forbade Vadakkel from dealing directly with patients, Broward Children's Center chief executive officer Marjorie Evans said in a deposition. Vadakkel's boss at the time, Robin Sargent, said in a deposition that it was the center's decision to bar Vadakkel from looking after patients.
The center also took other action: Robbie Harris was demoted, and a new procedure was instituted to deal with cardiac arrests. The results of the state investigation are confidential, said Lynnette Beal, the spokesperson for the Department of Children and Families.
After learning that her daughter was suddenly brain-damaged and in critical condition, Tanganicka Edwards, Cristal's mother, drove from her Miramar home to the center, where she met with Evans. The meeting was a volatile one, with a mother furious about her daughter's sudden and unexpected turn for the worse and an administrator who didn't have a good explanation for it:
Cohen: That is not an inappropriate response is it, [for the mother] to be angry under these circumstances?
Evans: I think what was done for Cristal was appropriate.
C: Was she given an answer as to what happened?
E: Yes... by me she was. I explained what happened as I understood it.... I told her that Cristal was on a ventilator, and that her trache came out, and CPR was initiated. And I also said to her that, "You do understand that Cristal is a very sick child?" and she became absolutely outraged.... She wouldn't hear anything. We were getting nowhere. I said to her, "I told you everything I know, what do you want?"
Evans went on to say that Edwards was so furious that she refused to leave until Pompano Beach police came to the center and took a report.
Evans, who testified that she has no medical training, seemed unable to accept the fact that Cristal had been well on her way to a near-normal life. For instance, she insisted that Cristal was "respirator-dependent" rather than "respirator-assisted," apparently unaware that her own nurse, Jackson, had already testified to the fact that Cristal was technically "respirator-assisted."
Cohen, who sued for Tanganicka Edwards on the grounds of negligence by center staff, also questioned Evans about things the center's own social worker had noted in reports about Cristal -- before June 19.
Back to her deposition:
Evans: Everything Cristal was doing she was doing with assistance. She was not, you know, doing anything without physical assistance.
Cohen: OK. Were you aware that she was able to pull herself up?
C: ... able to hold objects in her hand?
C: ... able to play with toys?
C: Were you aware that she was able to sit up?
E: I know she was not --
E: -- able to sit up.
The day after the incident, the Miami Herald ran a news brief -- which didn't include Cristal's name and was marred by factual errors -- about the incident. The last line reads: "Center administrator Marjorie Evans said her staff was not to blame." The brief was the only article ever published about the case.