Girl Dies After Unlicensed Clinic Visit

By H.G. REZA, PETER M. WARREN and ROBERT OURLIAN

Feb. 25, 1999 12 AM PT

TIMES STAFF WRITERS

An 18-month-old Anaheim girl died after she was given an injection of allegedly illegal imported drugs at an unlicensed back-room clinic in Tustin, police said Wednesday.

“This was a black-market medical practice,” said Tustin Police Lt. Mike Shanahan. Police arrested the store’s 23-year-old manager and confiscated boxes of pharmaceuticals labeled in Spanish after the Monday death of Selene Segura Rios.

The baby’s parents, who had no medical insurance, were charged $37 for the treatment, the baby’s father said Wednesday.

“The woman told my wife she was going to give Selene an injection of penicillin that would get her well,” said Alberto Ramirez Segura as his wife sobbed nearby. “If she didn’t get better in a day or two, we were supposed to bring her back.”

Customers who arrived Wednesday at the closed Los Hermanos Gift Shop said workers there dispensed medicine, injections and other treatments in a room behind the aisles stacked high with toys, purses and knickknacks.

Selene, an almond-eyed toddler who had recently started saying “Mami” and “Papi” and loved to watch the “Teletubbies” show on television, had been mildly ill with a low-grade fever for two days before the family sought medical care, said her father, a 27-year-old construction worker.

“But when she began vomiting, we got concerned,” he said. The family had a regular physician for Selene and her 4-year-old brother, but at that point it was 6 p.m. Monday and the doctor’s office was closed.

The illness didn’t seem serious enough for an emergency-room visit, Segura said, and the parents knew a trip to the hospital would be costly. So they took the baby to Los Hermanos, which was recommended by a friend as offering inexpensive medical services. There, the woman behind the cash register took the baby to the back, felt her face for fever and then gave the injection, Segura said.

Afterward, though, the baby seemed lethargic, and later that evening the couple noticed that she was not moving and that her eyes were open but not blinking. So Segura and the mother, Maria Lucia Rios, 27, took her to Anaheim Memorial Medical Center, just two minutes from their house, where she was pronounced dead Monday night.

“They came out and told us our daughter was dead,” Segura said. “I thought they had made a mistake or that I wasn’t understanding what they were telling us.”

The family spent much of Wednesday at the Tustin police station in extensive interviews with detectives investigating Selene’s death.

Authorities are awaiting the results of toxicology tests before they can give a cause of death.

“Whatever the cause, this is a tragic death,” Shanahan said.

Tustin Police Recently Got Tip About Clinic

Ironically, Tustin police recently were alerted to the allegedly illicit medical business and “were just in the process of beginning an investigation,” Shanahan said. The tip came in an anonymous letter from a community member and was given to narcotics investigators to follow up at the narrow store wedged into a small, aging shopping strip with a hair salon, a dentist’s office, a Mexican restaurant and several military recruiting offices.

The tragedy appears hauntingly similar to a case last year in neighboring Santa Ana, in which 13-month-old Christopher Martinez died while being treated for the flu at a storefront clinic by a man not licensed to practice medicine. The man fled the country and has never been caught.

Coincidentally, the Martinez family filed a wrongful-death lawsuit in Orange County Superior Court on Wednesday against the Consultorio Medico Santa Ana, several of its employees and a doctor associated with the clinic in the death of Christopher.

Police and public health experts said such cases highlight the dangers posed by unregulated clinics being operated by unlicensed personnel to treat newly arriving immigrants and the uninsured poor, who may be intimidated by large, modern hospitals and emergency rooms.

“These are hard-working people who are paying through the nose for substandard services when they could get appropriate services for free,” said Dr. Mary Watson, director of Free Health Plan, which operates two free clinics in Santa Ana.

After last year’s tragedy in Santa Ana, health workers and public officials launched a publicity campaign to encourage residents to beware of illicit medical operations.

“People take advantage of people who don’t have as much education or are afraid to seek help,” said Dr. Jesus Hernandez, the obstetrician who attended Selene’s birth in August 1997. “I do hope they can expose those clinics and shut them down.”

The baby’s death, he said, is “devastating, especially to know it’s a baby we delivered.”

Police arrested Los Hermanos’ manager, Monica Bernabe, on suspicion of dispensing medicine without a license, though investigators do not know whether Bernabe administered the injection.

Bernabe, also described as the night manager of the store, was being held in County Jail in lieu of $150,000 bail. She has not been charged.

On Wednesday, police at the Tustin station displayed a wide variety of drugs--cough medicine to Viagra--that were allegedly being dispensed from a back room of Los Hermanos. All of the medicines had Spanish labels; under U.S. law, medications intended for shipment to this country must have English-language labels.

Also on display were two small filing cabinets filled with syringes and packaged medicines. One of the cabinets contained a small trash can filled with opened drug packets and a used syringe, crammed next to an open glass jar filled with cotton balls.

Despite the large number of medications seized at Los Hermanos, Shanahan said, “at this point there’s nothing to show that anyone there was licensed as a doctor or [had] a medical background.”

Clinic Ownership Under Investigation

Shanahan said police have just begun investigating the ownership of Los Hermanos, listed in county and city records as owned by Oscar Eduardo King of Chula Vista. King on Wednesday denied knowledge of the clinic operation and said he had transferred the business to his sister a year ago, although he is still listed as the owner.

“My name should have been taken off a year ago,” he said. “It was a gift shop then. I haven’t talked to [my sister] in a year.”

The sister, Laura Escalante, could not be reached for comment. She is listed in state records as the president of King Brothers Stores Inc., at 17292 McFadden Ave., Suite K, in Tustin, the same address where Los Hermanos is located. Los Hermanos means “The Brothers.”

Customers continued to arrive at the shop Wednesday, some with visibly ill children and relatives, surprised to find the doors locked.

“A lot of people come here to buy medicine,” said Griselda Garza of Tustin, who said she went to the store herself for some cough medicine last week. “The last time I was here, a lady said she would inject me for the cough.”

Garza said she declined the offer.

“She’s not feeling well, and I brought her here to see what they can do for her,” said Liliana Delgadillo, who brought her 8-month-old daughter, Karina, who had a cold.

A woman who asked to remain anonymous arrived with her 1-year-old son. She said the boy suffered from a heart condition but had not received medical treatment at the store. Instead, the woman said, she purchased “prescriptions” at the store for her migraine headaches.

“A lot of people around here know this store is also a pharmacy,” said Agustin Estrada of Tustin. “People come here because they think it’s cheaper, but it’s expensive.”

Police issued a plea to others who have been treated at the store.

“We need people who sought medical treatment at this location to talk to us,” said Shanahan. “Our primary concern is to determine if this child’s death is a criminal matter. We are not interested in locating or identifying members of the community who are here illegally. [Immigration] status is of no concern to us.”

Visit Lasted Less Than 10 Minutes, Father Says

The Seguras spent most of Wednesday morning at the Tustin police station, meeting with detectives. Later in the day, Alberto Segura reminisced about “mija” [“my daughter”] and recounted the events leading up to her death. Several times during the interview, he excused himself to control his emotions.

Selene “was teething and had been ill for two days,” Segura said. “The baby had a cough and occasional fevers that we were treating with Tylenol.”

When she grew sicker Monday evening, and the doctor’s office was closed, the couple felt they could not afford to take the baby to the emergency room at nearby Anaheim Memorial Medical Center, located just blocks from their home.

Instead, the couple drove to the Tustin gift shop, where friends had told them “we could find a doctor.”

When they arrived at Los Hermanos, his wife, Maria Rios, asked “the woman at the cash register if there was a doctora working there,” said Segura. The unidentified woman took the mother and baby into a back room, while he remained in the store, looking at the stuffed toys and trinkets, he said.

Rios said the woman, who also doubled as a cashier, put the back of her hand behind the baby’s neck and on her forehead and proclaimed that the child had a fever. The mother said that was the extent of the baby’s examination. Her temperature was never taken with a thermometer, she said.

The couple were in and out of the back-room “medical clinic” in less than 10 minutes, Segura said.

Still, they felt buoyed immediately afterward, certain that Selene would be feeling better soon. Though she seemed lethargic, they figured at first that she was sleepy from the medication. They rushed her to the hospital when they noticed that she was unresponsive, though her eyes were open.

Selene had always been a responsive, lively baby.

“She was starting to talk. My wife stays home with the children, so every day she’d tell me something new about Selene,” Segura said. “She was a playful, happy baby, always smiling or giggling. When she wasn’t playing with her brother, she was sitting in front of the television, watching the Teletubbies. They were her favorites.”

The family, who moved here from Mexico about five years ago, plans to hold the funeral and burial in Orange County. “If we buried her in Mexico, she would only be alone,” Segura said.

The investigation into Selene’s death underscores the need for more publicity about the availability of inexpensive medical care for immigrants, especially children, community activists and others said.

Medical and county health care professionals formed a community group last year to discourage immigrants from seeking unlicensed health care. The group, called the Santa Ana Safe Medicine Coalition, conducted a community survey, distributed fliers and did outreach at some community events, said Sara Murrieta of the county Health Care Agency.

Members also prepared some advertising materials for a variety of media but could not afford to buy space in newspapers, on television or at movie showings.

Selene’s distraught father on Wednesday issued his own plea to the Latino community: “Please be careful of these clinics and people who sell illegal medicines.”

“Are you going to warn people about the danger when they go to a clinic like Los Hermanos?” Segura asked a reporter. “Latinos have to know that the people there aren’t doctors. We learned this through our own tragedy. Nobody else’s baby should ever have to die because of people like them.”

Staff writers Lisa Richardson, Janet Wilson and David Reyes, Times correspondent Crystal Carreon and researchers Sheila A. Kern and Lois Hooker contributed to this report.

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Where to Go for Help

Here is a list of community clinics that provide low-cost or free medical treatment:

Anaheim

* UCI Family Health Center

300 W. Carl Karcher Way

(714) 774-9795

Costa Mesa

* Share Our Selves Free Clinic

1550 Superior Ave.

(949) 650-0640

Fullerton