Ingrid Diaz stoops behind her daughter's wheelchair and kisses her on the cheek. She whispers something faint in Spanish. The flicker of human recognition does not animate the girl's nearly unseeing eyes. Beneath the husk of a body that has been left to Alessandra Villalobos, 4, it is difficult to determine whether she can differentiate her mother's voice from the incomprehensible drone of a world she will never fully realize.
Alessandra doesn't speak. When she cries, she doesn't make a sound—there are only tears and a pained grimace. She has a tracheotomy. The hiss and click of the mechanical ventilator sounds beneath her shirt. She is on two medications for seizures, has cerebral palsy and severe brain damage. Her kidneys continue to fail her.
A mistake at Vanderbilt University Medical Center in 2007 left her daughter this way, according to a suit filed on her behalf.
She requires around-the-clock nursing that her mother can never begin to cover with the $630-a-month Social Security stipend Alessandra receives. TennCare picks up the tab because Diaz, an illegal immigrant, could be deported for finding work. But if she can't find work, she can't provide a home for her daughter—a brutal catch-22.
Today Diaz is at Vanderbilt Children's Hospital Rehabilitation Services on Thompson Lane, where Alessandra will work her atrophied muscles. Diaz is a quiet 23-year-old with the sort of innocent, guileless face that—were it not for the hardscrabble existence that has characterized her life up to this point—might be considered naive. She and her boyfriend, with the help of a coyote, made their way to Tennessee five years ago from the southern tip of Mexico.
She slips her fingers into her daughter's limp hand. Alessandra's eyelids droop and her mouth is slack like the rest of her body, which is strapped to a wheelchair to prevent her from listing. Diaz is angry about the way the little girl's hair looks today. She'll weep for this and for a thousand other things when she returns home, once again, without her daughter.
Diaz didn't bring Alessandra to this appointment. She doesn't have custody of her anymore. A nurse named Amanda Stinnett does at the moment. Depending on who you ask, there are many reasons for this: The arrest of Diaz and the subsequent deportation of Alessandra's father, Manuel Villalobos-Sernas, for cocaine. Or Diaz's status as an illegal immigrant. Or the reportedly crowded and squalid conditions in which mother and daughter lived before arriving at this day.
But there are also accusations of scheming lawyers, of the people trusted with Alessandra's care jockeying for proximity to what may well be a multimillion dollar malpractice judgment. It's all so troubling that the Mexican government appointed an attorney to monitor the case. Because when you speak of Alessandra Villalobos, both past and future seem wedded to trouble.
Alessandra wasn't always this way. Through a translator, Diaz says the little girl used to sing and dance to children's CDs. She loved to paint. Her canvas, to her mother's chagrin, was the walls of their small town home, where she scribbled rudimentary lines like frantic webbing.
But in October 2007, Alessandra got sick. Diaz suspects contaminated crab legs from a Chinese restaurant. Alessandra began vomiting and suffering from severe diarrhea. She couldn't keep anything down. Diaz took her to an urgent care clinic on a Friday. The doctor told her to drink plenty of water and to make an appointment to see a pediatrician.
Alessandra's condition didn't improve. Diaz tried to get her to drink, but nothing stayed down. Alessandra became listless. The normally active little girl didn't speak much and didn't want to walk.
Monday rolled around and Diaz took her to the pediatrician. She says the doctor took a blood sample and wanted to keep an eye on the girl. Diaz was given Pedialyte, a solution that replaces fluids and electrolytes in dehydrated children with the flu, and was instructed to bring Alessandra into the office every day for the next three days. After a few days Diaz began to see something of the old Alessandra.
But on the fourth visit, Diaz wasn't satisfied with the flu explanation. The illness had gone on too long. Alessandra was feverish. Something was very wrong.
On Oct. 19, 2007, Diaz took her to Southern Hills Medical Center. She was transferred to Vanderbilt roughly a week later. Doctors ran a battery of tests. An IV was inserted into her arm to rehydrate her. Over the course of her illness, Alessandra, who was born with anemia, had wasted away.
The 2-year-old may have been suffering from a severe syndrome caused by E. coli poisoning. It is suspected that a toxin released by the bacteria had begun to destroy her blood platelets, vascular system and kidney functions. Doctors were forced to perform a tracheal intubation to preserve her airway. The little girl was placed into a medically induced coma.
Much of what happened that day is still unclear. But according to medical records, attending doctor Marek Grzeszczak inserted a catheter into the internal jugular vein, which runs from the ribcage to the neck, at roughly 11:45 a.m. on Oct. 29. The catheter was sewn into place for the purpose of plasmapheresis, which essentially separates the plasma from the blood so that it can be treated, cleaned and returned to the body. An agent that prevents blood clotting is also injected into the body.
But by the time the sewing was finished, some 20 minutes after the catheter was placed, Alessandra's oxygen levels had dropped by 10 percent. Five minutes later an X-ray of her chest was taken. Fourteen minutes later the results were interpreted, showing that the catheter was "projecting upon right heart border.... This is shown to lie in abnormal position," a radiologist's report said. More troubling, the technician spotted an excessive amount of fluid in the cavity surrounding her lungs.
Two-and-a-half hours later, another X-ray was taken. Alessandra's lungs were depressed, probably by the fluid on top of them. Thirty minutes later, the catheter was removed by Grzeszczak. According to the doctor's report, her blood pressure dropped sharply. The catheter had perforated a vein and she was now bleeding freely. Her tiny chest had to be surgically opened to stanch the flow.
"The proper protocol would be to pull (the catheter) out and apply pressure. The line impacted the subclavian vein. Whether it migrated out at some point or whether it nicked it when it was pulled out, we don't know," said Vanderbilt lawyer Steven Anderson. "It wasn't a result of anybody's negligence."
At around 3:30 p.m. her heart stopped. It took 37 to 38 minutes of CPR for doctors to establish a pulse—an eternity for the brain to be starved of oxygen.
The report indicates that doctors had to replace 1.5 to 2 times her total blood volume. The massive bleeding collapsed one of her lungs.
It was mid-December when Alessandra was well enough to be released from the hospital and transferred to a rehabilitation center in Atlanta. Nearly a month later she returned to Nashville with Diaz, a profoundly damaged child who would never scribble on walls again. In fact, she would require 24-hour care for the rest of whatever life was left to her.
Diaz and Alessandra's father, Manuel Villalobos-Sernas, retained Blair Durham to sue Vanderbilt for malpractice.
But in April 2008, a police informant identified only as "Zorro" arranged a cocaine buy for Metro Nashville officers, according to police reports. Zorro was to meet two men at a Phillips 66 on Wallace Road. One of them was Sernas. The informant and an undercover officer followed the men back to the Nob Hill Apartments where Sernas lived with Diaz, Alessandra and several others.
Sernas entered the stairwell of the complex. Court records say he returned with an ounce of cocaine. Zorro handed him $800, then turned the coke over to the undercover officer. Sernas and his partner were arrested.
A search of Sernas and Diaz's house yielded another 10 grams of cocaine and a crack pipe, apparently belonging to another of the apartment's residents. A Spanish-speaking officer allegedly translated this statement from Diaz before they arrested her: "She knew the cocaine was there and knew her husband was selling cocaine for the last five months."
Police were left with a conundrum—what to do with the utterly helpless Alessandra, whose parents were both about to be jailed and possibly deported? One of the girl's TennCare-funded nurses, Amanda Stinnett, volunteered to take emergency custody.
Sernas pleaded guilty to possession in exchange for dismissal of the trafficking charge. He would soon be deported back to Mexico.
Meanwhile, Stinnett, who did not respond to the Scene's interview requests, sought temporary custody of Alessandra. The nurse also refused visitation to Diaz, who'd been granted a humanitarian release from jail because of her unusual plight. It's hard to blame her for wanting to keep the fragile child away from a mother who, according to police reports, tacitly allowed coke to be dealt out of the very home in which she cared for her daughter.
But Stinnett's petition for custody raised something of a conflict. It was drawn up by attorney Robert Doll. Beneath his signature was the name of Blair Durham's firm, Durham and Dread. The same firm that was supposed to be representing Diaz in her malpractice suit was also attempting to take away her child.
Diaz's lawyer in this custody case, Laura Stewart, filed a complaint with the Board of Professional Responsibility.
In his response, Doll asserted that he wasn't a lawyer with Durham and Dread. The firm's website says otherwise, listing his name among other lawyers. Either way, Doll, who did not respond to interview requests, withdrew from the case. The bar complaint was dismissed. Stewart says she was given no reason.
A court ordered the Department of Child and Family Services to investigate Diaz's living situation. After a lengthy hearing, the judge ordered Stinnett to return the child to her mother.
Stinnett countered by petitioning the court to appoint a guardian for Alessandra. Judge Randy Kennedy appointed attorney Jeanan Stuart to oversee the child's estate, such as it was, and all litigation on her behalf. (Stuart declined multiple interview requests from the Scene.)
A new lawsuit drawn up by Blair Durham and Mark Chalos, a medical malpractice attorney enlisted by Stuart, named the newly appointed guardian as Alessandra's representative. Diaz had lost control to pursue any claims on her daughter's behalf.
Even the custody of her daughter that she now enjoyed would prove to be short-lived.
On March 25, 2009, two of the nurses staffed by On Call, a company started by Stinnett, gave affidavits attesting to the tenuous and squalid conditions in Diaz's household. There had been a warning of eviction and concern of roaches crawling over Alessandra's medical supplies, the nurses claimed.
Nurse Tammy Lipscomb, however, worked for On Call in Diaz's home and disputes their claims of infestation. "There may be one or two every now and then—she lived in a complex. This girl cleaned every day."
The affidavits also alleged that toilet paper and soap were in short supply; residents used writing paper and newspaper instead, leaving the bathroom floor and trash can littered with balled-up pieces of paper smeared with feces.
Guardian Stuart said she cut checks amounting to $300 just to keep Diaz's electricity on, which was vital for the equipment that sustained the little girl's life.
Worse yet, they claimed Diaz left Alessandra with the nurses while visiting family in New Jersey, against court orders, and provided no way to contact her should something happen to the girl. And something did happen. Alessandra's oxygen level dropped below 30 percent. She had to be transported to the hospital without a legal guardian to make critical decisions.
On April 16, Stuart entered the modest home of Ingrid Diaz with Stinnett and took Alessandra from her mother. She decided that Stinnett would care for Alessandra after all. Diaz would only be allowed to visit twice a week at Stinnett's house in Nashville or at Alessandra's rehab appointments.
While Diaz's living situation was less than ideal, so was Stinnett's legal situation. Tennessee Bureau of Investigation spokesperson Kristen Helm says the agency opened an ongoing case on Stinnett in April 2008 for fraud against the very entity that pays for Alessandra's medical needs—TennCare. It's unknown if it's related to Alessandra's case. Helm declined to offer specifics.
David Lyons, Laura Stewart's co-counsel in the custody case, says Stinnett also received an advance on the medical malpractice judgment of $15,000 to $20,000.
Durham says he provided Stinnett with the names of companies that give advances on legal settlements, but says he doesn't know what became of it. "It's all about the money," claims Kim Franklin, a former colleague of Stinnett. "She wants (Alessandra) at the house because the money comes with her, eventually."
But if anyone involved in the case believes that custody of Alessandra is a perpetual meal ticket, they're probably mistaken. Whatever a jury decides the lawsuit is worth, the court will oversee how that money is spent—namely on Alessandra.
An unanticipated bend in the road came May 13. Durham and his co-counsel, Mark Chalos, brought a motion to seal court documents they deemed too sensitive to be made public. The documents actually pertained to an agreement between Diaz, Durham, Chalos, Stuart, Stewart and Lyons in which Diaz officially relinquished any potential claims and control of Alessandra's lawsuit. By signing it, Diaz gave a legally binding thumbs-up to the lawyers handling her daughter's case. Judge Kennedy questioned Diaz for more than half an hour about the contract, to ensure she understood what she was signing.
Durham claims the move to seal those documents was made because he and Chalos didn't want to "air lawyer laundry" to the Vanderbilt lawyers.
But on May 26, an objection was submitted by Elliott Ozment, an immigration lawyer with a penchant for wading into controversy—most notably the case of an illegal immigrant who was cuffed in a Davidson County jail while pregnant and in labor. Ozment had been hired by the Consul General of Mexico, Salvador De Lara, to look after the interests of Alessandra's deported father, Manuel Villalobos-Sernas. The Mexican government was worried that, by filing papers under seal, Sernas would be denied the right to monitor his daughter's case. He may have been deported, Ozment asserted, but his parental rights weren't terminated.
Then Ozment dropped another bomb—an affidavit from Diaz saying she had no confidence in Stewart or Lyons. She believed they had taken no steps to arrange for a work visa or a humanitarian exclusion to allow her to remain in country.
"I do believe there was a miscommunication," Stewart says. "I have talked to her since and she has told me in front of witnesses that she wants me to continue as her attorney."
But Diaz's signed salvo didn't end with her own attorneys. She claimed that under Stinnett's care, Alessandra missed physical therapy appointments. Because of that, she had no confidence in Stuart in her role as guardian. According to an appointment log stretching from late February to late June, Alessandra missed 18 of 24 appointments during the time she was in Stinnett's custody. (It should be noted that the ratio wasn't much better under Diaz's custody.)
Diaz further claimed she felt "ambushed" and pressured to sign away control of Alessandra's malpractice suit, saying she didn't understand the document—which came as a surprise to all the attorneys present for the signing, including her own.
Lastly, Diaz stated she had no confidence in Blair Durham because he failed to file a claim representing the entire family, as she had retained him to do. Both Durham and Chalos petitioned to be removed from Alessandra's case.
"We didn't want to afford (Ozment) the opportunity for the media circus he was trying to create," Durham says.
Chalos declined to discuss what prompted him to step down.
David Lyons thinks the airing of "lawyer laundry" may have fatally damaged the attorneys' ability to pursue the malpractice case: "We were all disturbed by the affidavit filed by Mr. Ozment. I think it's done so much damage to the case (that Durham and Chalos) can't prosecute it."
Yet the surprising turns of events kept coming. On July 1, Stinnett was to appear for a deposition, in which she was to produce tax returns, Alessandra's hospital admissions, all judgments against her in the past five years, and all correspondence relating to the case. But instead of going through with it, Stinnett indicated she would relinquish custody of the child.
It began to seem as though Diaz might finally regain custody of Alessandra. Susie McGowan, a guardian ad litem for the court, had made a surprise visit to Diaz's new apartment. She now found the place "immaculate."
But on July 3, Stinnett suddenly moved to Maryville. Stuart placed Alessandra in an Extended Stay Motel in Brentwood under the supervision of her nurses. She was then shuttled to a Volunteers of America group home in Hermitage. Diaz's attorneys say she has a pink room all to herself.
Last week, Diaz sat on a wooden hallway bench in Davidson County Probate Court, staring vacantly out the window. Around her, the people involved in the case—Lyons, Stewart, McGowan and Stuart—discussed the fate of her daughter. Diaz doesn't speak English. The translator was on his way. The word is the attorneys think Alessandra is better off at the group home in Hermitage, where trained nurses can care for her 24 hours a day. That it's better for the health of the malpractice lawsuit this way.
"What I don't want to happen is if Alessandra gets hurt in her care, and as a result Vanderbilt says she did something wrong," Lyons tells the nurses who've come to support Diaz. "If something happens to Alessandra, it's on her."
Diaz just wants her daughter back. She doesn't want anything to do with the money. She wants to go back to Mexico, and to take her daughter with her.
Stewart and Lyons appealed to Diaz, but she didn't seem to understand. There's another agreement to sign. This one would leave Alessandra in the group home for the time being, but allows her "liberal" visitation rights. They tell her she's not giving up any of her parental rights.
In a case sprawling across multiple courts—with millions of dollars potentially at stake—this small, soft-spoken woman from Mexico seems swept up in a current she can't resist.
Diaz's nurses watched as her attorneys spelled out the agreement through the translator.
"She's gonna cave," predicted Kristin Johnson, one of Alessandra's nurses who had come to the hearing. "Anytime she gets under pressure, she'll cave."
Diaz signed the document.
In court, Judge Kennedy read the agreement into the record. He asked Diaz if she understood and agreed with its provisions.
"Si," she said, nearly inaudibly.
For now, at least, the damaged little girl who's been shuffled from home to home will remain in the group home with the pink room.
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