Standard of Care

When a childbirth went terribly wrong, the blame game began. Dodging responsibility was everybody's first order of business.

The taqueria on Collinsville Road at the outskirts of Fairmont City, Illinois, would have trouble accommodating more than a dozen diners. Potholes pock the parking lot, but that's beside the point. The food is straight out of Mexico, and it's available seven days a week.

Mario Hernandez opened El Gallos Jiros in 1997 after working at a Chicago restaurant for seven years. Before that, he was employed at an aluminum-fabrication plant in California, where he also did a little yard work -- not the best of jobs, but better than selling eggs and produce in his native Mexico, which he left in 1984.

The Hernandez family lives across the street from the small but spotless restaurant. Expect to pay $5 or less for a meal -- taco fillers include asada, pollo, goat and beef tongue, with little more than cilantro, onion and lime wedges for garnish. There's not much English spoken here, and the jukebox is loaded with Mexican tunes that lend a festive touch.

El Gallos Jiros is clearly a family place, but something's missing.

Ask about Isabel, and Teresa Hernandez, Mario's wife, smiles sadly and points to an eight-by-ten photograph of the couple's eldest child that sits beside the cash register. Isabel used to help out here almost every day.

Not anymore.

What happened to Isabel, who died nearly four years ago after a difficult childbirth, has spurred accusations and suspicions that have turned into lawsuits. On the advice of their lawyer, the Hernandez family isn't talking. Nor are officials at Touchette Regional Hospital in Centreville.

But court documents -- including affidavits, depositions and hospital records filed in lawsuits -- show what goes on behind the scenes at Touchette when things go horribly wrong. Allegations include poor quality of care, alteration of medical records and scapegoating between physicians and medical administrators.

Court files also show a hospital willing to cut a deal with a doctor whose skills have been called into question. And files show how much patients aren't allowed to know about the physicians whom they trust with their lives.

One thing is clear: No one wants to take responsibility for Isabel's death.


Isabel Hernandez was four months past her fifteenth birthday when her mother and a family friend drove her to Touchette. They'd never see her alive outside a hospital again.

Isabel was a typical patient for Touchette, a nonprofit hospital where many patients are poor and pregnant. Isabel was pregnant by the first boyfriend she'd ever had, according to her parents. She had visited Dr. Emeka O. Ekwulugo several times for prenatal care.

Now it was time for her to give birth.

Isabel was small, not quite five feet tall and less than 100 pounds. She went into labor at 8:30 p.m. on February 24, 1999. Twenty-six hours later, the baby still had not entered the world. He was too big for the birth canal.

With Isabel in her second day of labor, Ekwulugo took her to the operating room for a cesarean section. At 11:14 p.m. on February 25, 1999, Miguel Angel Hernandez was finally born. He weighed eight pounds, six-and-a-half ounces.

Most cesarean sections take less than an hour. That wasn't the case with Isabel's. After the C-section, her uterus wouldn't contract. Ekwulugo administered three different drugs over at least 40 minutes before her womb began to shrink. After childbirth, the uterus bleeds until it contracts, forcing blood vessels to close. Isabel lost a considerable amount of blood -- an estimated 1,200 milliliters, according to medical records.

Women who undergo C-sections are considered to be suffering postpartum hemorrhage, or excessive blood loss, after losing 1,000 milliliters, about one quart. But the 1,000-milliliter standard is conservative. And so Ekwulugo wasn't alarmed. Not yet.

An hour after Miguel was born, Ekwulugo ordered blood tests on Isabel. At that point, the doctor was still trying to make her uterus contract. A half-hour later, Ekwulugo ended the operation and called for the test results. They weren't good.

Isabel was anemic, with low blood counts showing reduced oxygen-carrying capacity in her blood. Before she gave birth, tests showed that her blood counts had dropped further. Ekwulugo says he ordered a blood transfusion, then sent Isabel to the recovery room at 1 a.m.

Isabel's condition crashed almost as soon as the girl arrived in the recovery room. She was gasping for air. Additional test results showed her blood counts were still dropping. Ekwulugo later said he'd never had such trouble with a patient. The stakes were clear: Isabel was fighting for her life.

The doctor called for a ventilator and asked for an anesthesiologist so he could return Isabel to surgery to make sure there was no internal bleeding. At 1:15 a.m., Isabel's blood pressure dropped to zero.

At 1:30 a.m., Isabel was given the first of three units of blood. Ekwulugo continued transfusions until 4:10 a.m., but she didn't improve. Though she had a pulse, there was still little or no blood pressure. And the anesthesiologist was nowhere in sight.

Ekwulugo had performed the cesarean section without an anesthesiologist. In an interview, he says that's customary at Touchette. A nurse anesthetist had assisted, switching from a local to a general anesthetic midway through the surgery when the uterus wouldn't contract, the doctor says. But Isabel's condition had become too grave for a second operation without an anesthesiologist.

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