Bessard's baby, Paris, ultimately was delivered by C-section just past 1 a.m. -- more than three hours after the late decelerations began. By that time, the pH of Paris' umbilical cord -- an indicator of a baby's oxygen level before birth -- was 6.8.
This level is "almost incompatible with life, it is so bad," said Dr. Khalil Tabsh, chief of obstetrics at UCLA's medical school, who spoke generally and did not review Bessard's records. "Babies that are born with 6.8, they either are dead or they are in deep trouble."
In her first months, Paris required oxygen and had seizures. "She didn't do the normal things that children would do at her age," Brown said. Paris died that November, not yet 10 months old.
The county coroner attributed her death to chronic bronchitis and bronchiolitis -- respiratory diseases -- but did not address whether it was related to birth trauma.
Bessard filed an arbitration claim, which Kaiser settled for an undisclosed amount. The HMO requires arbitration in legal disputes, a mandate that keeps all legal filings and their resolution confidential and out of public view.
In a deposition reviewed by The Times, Safari testified that it was Bessard who resisted his recommendation for a C-section.
"He changed everything around," she said in an interview, "which really blew me out of the water."
A financial settlement with Kaiser, reached in October 2005, gave Bessard little solace, she said. That's why she asked her lawyer to refer her allegations to the state medical board.
Nearly two years later, when the board accused Safari of gross negligence, it cited his failure to do an "immediate Caesarean section." Instead, officials said, he waited more than two hours to call for one and then took "some 50 minutes to deliver the infant."
Another warning
About the time of the Bessard birth, tensions within the birthing center were escalating, according to memos and interviews.
In early 2004, Safari's "behavior became irrational and included threatening to starve himself, light himself on fire, and to call CNN to witness his plight," said Moran's suit, which refers to Safari as "Dr. X."
Schear, Safari's attorney, said his client never said he would burn himself, but did threaten to go on a hunger strike to protest harassment by his boss, Moran. Other physicians complained that Moran played favorites, he said.
In May 2004, medical director Altebarmakian removed Moran as ob-gyn chief, citing his arrogance and his department's dysfunction in a follow-up letter. At the time of his removal, Moran contends in his suit, he warned Altebarmakian that if something wasn't done, Safari "would again permanently harm one of Kaiser's patients."
In December of that year, Moran had his meeting with Dr. Robbie Pearl, Permanente's top physician for Northern and Central California, to discuss Moran's concerns about Altebarmakian. According to his notes made at the time, Moran said he warned Pearl about Safari, and Pearl said he was "well aware" of the situation, including Safari's threats to harm himself.
Devin, the twin boy, died in the delivery room four months later, and the case is now key to the medical board's complaint against Safari.
Tabsh, UCLA's obstetric chief, said that in his 35 years of practice he'd never heard of a full-term baby's spinal cord being severed during a vacuum procedure.
"Everybody that was involved in it was literally sick," said one nurse, who also spoke on condition of anonymity. "She was begging for a C-section."
Another nurse, the one allegedly blamed by Safari for Devin's death, questioned why no one had investigated whether Safari was threatening his colleagues. In her July 2005 letter of concern given to her union representative, she described him as repeatedly "harassing" her about the event.
"Those of us who did the right thing and came forward to speak up against Dr. Safari when he was in the wrong feel very threatened," the veteran nurse wrote.
Schear said Safari threatened no one and had safely performed about 200 vacuum deliveries.
"It stinks. It just stinks. You're looking at one minute of this guy's career and you're going to cream him. It's very dramatic-sounding, 'Oh, the poor baby broke his neck.' It's not something where you want to destroy a good and excellent perinatalogist's reputation."
Today, Valenzuela and her husband, Randy Ramirez, both 37, decline to say much about what happened. Valenzuela said she can't discuss her arbitration settlement, and that they are afraid talking about Devin will make life unbearable again.
"Words can't even describe it," Ramirez said.
Sarah's sister, Helen Valenzuela, recalled that Sarah "cried for a year" after Devin's death.
Helen still remembers a nurse emerging from the delivery room, crying. Later, she said, she confronted Safari in the hallway: "You murdered my nephew!"
"He told me to 'Calm down, or we're going to have you removed,' " she said.
