The next day, Eliza Jane vomited several times and her mother noticed she was pale. While Maggiore was on the phone with Incao, the little girl stopped breathing and "crumpled like a paper doll," the mother told the coroner. She died early the next morning, at a Van Nuys hospital.
Fleiss, Gordon and Incao all are known for their unconventional approaches to medicine. Gordon and Incao are staunch opponents of mandatory vaccination of children; Fleiss is a vocal critic of male circumcision. Incao did not return repeated phone calls this week.
Alerted to the case by The Times, several medical experts said that doctors who knew Maggiore's circumstances -- that she was HIV-positive, hadn't been treated during pregnancy and had breast-fed her children -- should have pushed for the child to be tested.
If she refused, they should have referred the matter to authorities.
According to interviews and records, Gordon and Fleiss have long known Maggiore's HIV status and that she breast-fed her children.
Experts also said that when the girl became ill, any doctor who saw her should have treated her as if she were HIV-positive. That would have meant giving her a stronger antibiotic, such as Bactrim, instead of the relatively low-powered amoxicillin.
"If you look away from something you're supposed to be looking for, that's called willful blindness," said Michael Shapiro, an ethicist and law professor at USC, "and willful blindness is one aspect of determining the negligence."
In an interview this week, Fleiss said it would have been wrong to force Maggiore to test her daughter. "This is a democracy," said Fleiss, who has treated the daughter of pop star Madonna.
Gordon said he wishes he had tested Eliza Jane when she was ill in early May, but he doesn't believe he had sufficient reason to test her earlier.
"When it comes to HIV testing, I think that it's still legally a gray area," he said, depending on whether one believes the child's life is in danger. In Eliza Jane's case, he said, he did not.
David Thornton, executive director of the Medical Board of California, said his agency probably would investigate to determine whether the doctors erred, for example, in failing to report potential child neglect.
"If I would punish anybody," said Nancy Dubler, bioethics director at Montefiore Medical Center in New York, who learned of the case from The Times, "I would punish the pediatricians."
The Focus Turns
