Theresa Vasquez, 34, a home health aide whose insurance required her to be cared for at county facilities, said Olive View officials at first told her that Jaemy might be transferred to UCLA for the surgery, "because they don't do it at Olive View." But the next morning, hospital staff called to say plans had changed: a surgeon would operate on Jaemy at Olive View instead.
"I said 'Whatever you guys think is best for her,' " Vasquez said.
According to her death certificate, Jaemy died of asystole and nonresponsive bradycardia —meaning her heart slowed then stopped — and extreme prematurity.
Babies in that condition were required to be transferred to a better-equipped and staffed hospital by California Children's Services, a state program that funds healthcare for needy children, including many receiving Medi-Cal, according to Williams, the state health department spokesman.
Hospital officials did not stop allowing surgeries until May 17, Wilson said, a move that came after The Times documented problems at the neonatal intensive care unit.
Dr. Gail V. Anderson Jr., interim chief medical officer for the county's Department of Health Services, said pediatric surgeons operating at Olive View had the training and staff needed to perform such surgeries.
"All these surgeons are eminently qualified," Anderson said, "With adequate subspecialists and nursing support."
But neonatologists familiar with state regulations said it was risky to perform such surgeries at intermediate facilities because they do not have enough skilled staff and do not treat enough high-risk babies to be truly familiar with the required procedures.
It takes a daily census of at least 15 babies to establish the skills needed for such surgeries, experts said. Olive View's 24-bed unit had an average daily census of six babies as of August, the most recent month available, and an average daily census of about eight babies a month since January.
Dr. David Durand, director of the neonatology division at Children's Hospital & Research Center Oakland and a technical advisor to California Children's Services, said the agency's regulations were intended to ensure that hospitals have enough trained staff to care for critically ill babies.
"Most neonatologists would say you should not be doing surgery routinely at an intermediate hospital," Durand said.
Vasquez said she and her husband, who tried for 11 years to conceive, have lingering questions about whether their daughter might have fared differently had she been transferred from Olive View.
"In the other hospital they might have more equipment or more doctors and it would have been better," Vasquez said. "But they didn't give us a choice."
Times staff writer Rong-Gong Lin II contributed to this report