Pennsylvania - Roused in the middle of the night by a nurse's phone call, the parents headed quickly for the hospital where they'd left their newborn son in the neonatal intensive care unit. The calls kept coming as they hurried over, each update more alarming than the last.
Staff would try to keep 5-days-old Abel Cepeda alive until they got there, a lawsuit says they were told. They heard he was being resuscitated.
They arrived minutes too late.
Cepeda's parents didn't know it yet, but their son was the eighth baby since summer to get sick from the same bacteria in the same Pennsylvania hospital's NICU. Two had died by the time Cepeda's mother was admitted on September 18, according to the family's lawsuit. Geisinger staff have admitted noticing "unusual" illness weeks before the hospital went public with its problem.
On Friday, Geisinger announced that its own equipment contaminated the donor breast milk that exposed premature infants to a bacteria called pseudomonas. The medical centre in Danville, Pennsylvania, says it changed its equipment on September 30, switching to single-use materials - the same day Abel Cepeda died while his parents remained in the dark about the ongoing bacteria problem, the family's lawsuit alleges.
"I've been doing this for 20 years, and I've seen a lot, and I have not seen conduct like this from a medical provider," said Matt Casey, a lawyer representing Cepeda's parents as well as another family who lost one of their twins.
Casey says findings that Geisinger's breast milk measurement materials led to the infections have reinforced his belief that Geisinger - which runs sites around Pennsylvania - was negligent both in cleaning its equipment and in taking steps to save lives once red flags surfaced.
"This isn't high-level science," he said. "This is basic stuff of any neonatal intensive care unit."
Matthew Van Stone, a spokesman for Geisinger, said the Danville facility's breast milk measurement equipment has long been "thoroughly washed by hand" before re-use. But the hospital took "several proactive measures" in September, including moving to single-use, sterilized measurement materials. That was before staff knew the infections' source, he said.
Some rate of infection is standard, but a second incident will raise questions about a "trend," a Geisinger doctor told reporters in October.
"I think for certain in early August, we had an infection that we said, gosh, this seemed unusual," the same doctor said.
Van Stone maintained there was no indication of a pattern around the time of the first death, in August, but said the hospital did notify the state health department about that death.
More cases followed in September, including two deaths, according to Van Stone. He says the hospital disclosed to the Pennsylvania Department of Health that month that another baby had been exposed to pseudomonas - but not sickened by it - back in July.
Geisinger is not commenting on ongoing litigation, Van Stone said.
Geisinger vice president and chief medical officer Edward Hartle said in a statement Friday that donor breast milk - which health experts recommend for NICU babies when the mother's milk isn't available - is safe to use at the company's facilities. Geisinger also says it's made changes across its campuses in how donor breast milk is measured and administered.
No more pseudomonas infections have emerged in NICU babies since the Danville facility adopted these new practices on September 30, staff say.
"We would like to extend our sincere apologies to the families who have been affected by this incident," Hartle said, adding that the company is "committed to doing all that we can to support [them]."
Casey contends Geisinger's actions have been anything but supportive. The Philadelphia-based lawyer says that if Geisinger were looking out for its patients, it would not have led families like Abel Cepeda's to believe its Danville NICU was safe.
Staff gave Cepeda antibiotics before his death because "they knew that they had placed [him] at a constant, heightened risk of contracting a Pseudomonas infection every day that he remained" in the NICU, the family's lawsuit states.
It wasn't until October 6 that a doctor mentioned Pseudomonas and the other two infant deaths, the lawsuit says.
On Oct. 7, Geisinger says, it started diverting some patients to other facilities - mothers and their babies who were born less than 32 weeks to term.
Pseudonomas, as waterborne bacteria, can cause symptoms including pneumonia, diarrhea, urinary tract issues, fever, rashes, and other body pain, depending on the area of infection. Pseudomonas is common in the natural environment and poses only a minor threat to healthy people, medical sites say. But an infection can be deadly to those with compromised immune systems, such as hospital patients.
"Pseudomonas can easily grow in humidifiers and types of medical equipment - catheters, for instance - that aren't properly cleaned," WebMD states. "If health care workers don't wash their hands well, they can also transfer the bacteria from an infected patient to you."
Geisinger worked with the state health department as well as the Centers for Disease Control and Prevention to determine the source of the infections, according to Van Stone. He said the medical center's old cleaning practices for donor breast milk measurement equipment "had been in place for many years without incident and [are] used by other facilities across the country."
Pennsylvania Department of Health spokeswoman April Hutcheson said in a statement that officials worked with Geisinger "to resolve any public health concerns, and to ensure that appropriate follow-up measures occurred." She said the department could not give further details.
"We also want to emphasize that breast milk is the best food for infants, including premature infants, if possible," Hutcheson added, saying that donor milk is "considered safe and is essential for infants that need it."
It's also crucial that breast milk is handled and stored properly, she said - especially when it's being fed to babies born early.
According to Geisinger, the health department visited the Danville medical center on Oct. 18 for a review and cited the facility for its lack of a written policy outlining its new cleaning procedures for donor breast milk equipment. Staff say they quickly drafted a new policy.
Of the five infants sickened but still alive, Geisinger said, one is discharged and four remain hospitalized. Two are still receiving treatment for pseudomonas.
One child of another family that plans to file a wrongful-death suit remains under medical care with brain bleeding either caused or exacerbated by infection, Casey said. The baby's twin died.
Casey has requested a slew of documents from Geisinger to shed light on what exactly hospital staff knew and when. But he thinks his clients already have a strong case as they seek damages - and mourn their children.
"It is difficult to imagine a more damning set of facts," the lawsuit says.