Medical Role Thrust on Frantic Mother

In the middle of the night, Juana Caracia was jolted by the crying and gasping of her 2-month-old son. Within minutes, her terror surged when two Los Angeles city paramedics drafted her in a frenzied and futile battle to keep him alive.

Jostled in a swerving ambulance, she struggled with one hand to position a mask over the infant’s mouth. With the other, she squeezed a rubber bag, pumping air into his still lungs. Alongside her, a paramedic rhythmically pushed on the infant’s chest, hoping for a heartbeat.

“All I wanted,” she said, breaking down, “was to save my son.”

Caracia, 34, was unprepared and untrained for the responsibility thrust upon her in the most frightening moments of her life. She was in the back of the ambulance because a Fire Department dispatcher did not send enough rescuers, according to records and interviews.

Only two paramedics arrived at her Van Nuys apartment in the predawn hours of Sept. 19. One had to drive to the hospital, leaving the other no choice but to turn to the mother.

“It’s unfair, I think, to ask somebody to do something on their own child or family member that they are not trained to do,” said paramedic Jason Haney of the department’s quality assurance unit.

A spokesman for Fire Chief William R. Bamattre said Haney has been assigned to investigate the incident. The inquiry was triggered by a complaint from one of the on-scene paramedics, who believed that they did not have enough backup.

A preliminary review, Haney said, has found that the dispatcher “most likely” should have sent four additional firefighters. A final determination is pending.

Although the baby was alive at the time of the emergency call, Haney said it is hard to conclude whether dispatching more people would have changed the outcome.

A coroner’s spokesman said that, although a final report has not been completed, it appears that infant Adrian Becerra died of natural causes.

The disclosure of his death comes at a time when the department’s emergency medical system is under scrutiny from Los Angeles officials, who have vowed to bolster staffing and curb dispatching mistakes. A City Council committee has scheduled a hearing Monday on the problems.

In July, a report to the chief found four “grossly inappropriate” dispatches in fatal cases. The report also estimated that during a 60-day period earlier this year, 160 people may have been sent the wrong level of medical care.

Chief Bamattre has maintained that the dispatch breakdowns recently brought to light are rare in a system that handles more than 275,000 emergency medical calls a year.

But the July report suggested that the department does not actually know how many mistakes are being made because dispatchers often fail to obtain key information from callers about the severity of their problems.

According to the report, these lapses may be partly the result of dispatchers forming “negative impressions” about callers, doubting what is reported, imposing their own “preconceived notions” about medical emergencies or coming up with their own snap assessments, called “dispatcher diagnosis.”

The chief question under review by the Fire Department in Adrian’s case is why the veteran dispatcher classified the call as being about a “sick person” rather than a full-blown emergency. This judgment was made after the father told the dispatcher that the baby was cold, pale, unresponsive, having trouble breathing and had undergone heart surgery.

The 34-year-old father, Juan Becerra, said in an interview that the dispatcher kept interrupting and challenging him about the infant’s condition. “He seemed like he wasn’t listening,” Becerra said.

Although fire officials declined to identify the dispatcher, they described him as a good employee with no previous record of problems.

At the request of The Times, three veteran Los Angeles paramedics reviewed a transcript of the family’s emergency call, with the understanding that they would not be named. All agreed that there were enough red flags for the dispatcher to send two paramedics and four backup firefighters--the maximum response.

As one concluded, the dispatcher “misread what was there.”

Baby Was Born With Heart Defect

Adrian, the youngest of three brothers, was born July 11 with a heart defect that required surgery three days later. After a week in the hospital, he was taken home with no restrictions on his activities, his medical records show.

In the following month, his weight nearly doubled to 13 pounds. “He looked fine,” said Dr. William Vincent, who saw Adrian a few days before he died. “We did not view him as a risk.”

On Sept. 19, the baby awoke about 3 a.m. He was “white, white, white,” crying and struggling for air, his mother recalled.

Adrian’s father said his first impulse was to rush the baby to a hospital. But his panicked wife urged him to call for help.

Cradling Adrian in his arms, Becerra reached a bilingual Fire Department dispatcher about 3:15 a.m., according to a tape of the call, which was conducted in Spanish. Becerra immediately volunteered key information about the kind of emergency it was.

“Hey, listen, my son doesn’t respond,” the father said, adding that the boy was only 2 months old.

After getting Becerra’s address and phone number, the dispatcher asked: “Is he conscious, your son?”

“He is moving now very slowly.”

“Is he conscious,” the dispatcher repeated. “Yes or no?”

“Yes,” the father answered.

“OK. Is he breathing then?”

“No, he’s real cold, my son. He’s just. . . .”

“Sir!” the dispatcher interrupted, raising his voice. “Answer me, yes or no. He’s conscious, yes?”

“Yes.”

“He’s breathing?” the dispatcher asked again.

“Well, it doesn’t look like. . . .”

“Yes or no?”

“No.”

“No,” the dispatcher said. “How can he be conscious but is not breathing. . . .”

“No,” Becerra said.

“That, that is impossible, sir,” said the dispatcher.

“Uh-huh,” said the father, who then imitated the gasping sounds coming from the baby.

“Then he’s breathing?”

“Um, hum.”

“OK, does he have fever?

“No, sir.”

“What happened, now?”

“I don’t know. He just got up. Cried a lot,” Becerra said, adding: “He is very pale. He changes color because he had a heart operation.”

“He had problems with the heart before?”

“Yes,” Becerra answered. “He was operated on, and he’s real strange now. He’s now getting cold.”

The dispatcher told Becerra to lie Adrian down without pillows, face up and head tilted back so he could breathe. He also instructed the father to keep an eye out for the ambulance.

“OK,” the dispatcher said. “Bye-bye.”

Becerra said he then asked, “What do I do next?”

He heard no words of advice. “No one was there,” the father recalled.

Paramedics Expected ‘Sick Person’ Only

In the opening seconds of the call, the dispatcher deployed two emergency medical technicians, who, unlike paramedics, cannot administer drugs to stimulate a patient’s heart.

As the conversation progressed, the dispatcher apparently realized that the situation was more serious than he initially thought. So he canceled the first dispatch and ordered two paramedics into the field. He did not, however, make it a full emergency with backup firefighters.

As the family waited, Adrian’s breaths grew further apart, recalled the father, who was still holding his son.

The rescue ambulance raced past rows of apartment buildings in the working-class Van Nuys neighborhood, arriving in about seven minutes. The paramedics bolted up to the second-floor apartment.

They seemed stunned by the gravity of what they found at the front door, the mother said. They were expecting to find simply a “sick person” because of the dispatch.

“They took him out of my arms,” the father recalled, whose wife added: “All they said was, ‘Let’s go! Fast!’ ”

As the paramedics ran down the stairs to the ambulance, the parents followed. One rescuer motioned for the mother to get in. He quickly showed her how to work the breathing bag while his partner jumped behind the wheel.

For several excruciating minutes, the mother said, she tried to keep the air mask from sliding off her son’s mouth as the ambulance, siren blaring, sped toward the hospital. “How am I supposed to do this?” she asked herself. The ride was a blur. The only thing Caracia said she can remember is trying to revive her baby.

The ambulance rolled up to the emergency room of Valley Presbyterian Hospital in Van Nuys at 3:35 a.m., records and interviews show. The father, who had left the couple’s other two young children with an aunt next door, arrived minutes later--in time for a doctor to tell him and his wife that their son was gone.

The official time of death was 4:14 a.m., about half an hour after the ambulance arrived at the hospital.

Caracia believes that Adrian might still be alive if the paramedics had not arrived alone.

“If they could have come with more people,” she said, “they could have done something.”