OKLAHOMA CITY - Jerry Trivett was a tough kid to take care of.

The boy had a disease that caused tumors to grow around his spinal cord and brain. The tumors had spread into his lungs, turning the pink elastic tissue into a hard, fibrous mass.

The disease also affected his mind, making Jerry hyperactive and unable to control his anger.

His looks weren't spared either. His left eyelid drooped in a permanent wink. He had kyphoscoliosis, which made his back twist like a corkscrew. His chest popped out, like a chicken's. He wobbled when he walked.

Despite his small size, Jerry dreamed of driving a big truck, like his grandfather, said his mother, Vicky Sue Trivett, 56, in an interview. "I told him he was too little to drive a truck. 'How are you going to get up there?' "

His mother said she couldn't make the weekly two-hour trips from Johnstown, Pa., to Pittsburgh for medical treatment. At the age of 9, the courts took Jerry away, saying she neglected his medical needs.

He was bounced through a handful of foster homes before Ester Hicks, a cook at a vocational school, welcomed Jerry into her large family in Windber, Pa.

The boy was a good companion. He would hold her hand, follow her around the house talking and inventory the kitchen, calling out items for Hicks to add to a grocery list.

At night, he would not sleep until Hicks bent low and told him "Good night."

But when Jerry became frustrated, which was often, he would explode.

In the summer of 2000, the Make-a-Wish Foundation sent Jerry and his foster family to Disneyworld.

He was treated like a king. He stayed at the Disney Village in a beautiful house. But on the second day, Jerry had a meltdown.

"We just sat there on the curb," Hicks said, "while he screamed."

When the family returned, Hicks' husband fell ill and she realized that with six children, she couldn't handle Jerry anymore.

"I drove him to a respite house and I said, 'Good-bye Jerry,' and he said 'Good-bye,' like nothing was happening, and that was the last time I saw him."

All told, Jerry would bounce through 20 foster homes by age 15. Child welfare workers in Cambria County finally placed him at High Pointe in Oklahoma City, an adolescent psychiatric facility. At the time, the center also had dozens of kids from Philadelphia, placed there by the city's Department of Human Services.

Jerry arrived at High Pointe on Feb. 12, 2003, along with a 56-page medical file detailing his condition.

On his first day there, his carbon-dioxide levels were so high he should have been immediately referred to a specialist, said doctors who later reviewed the case for Oklahoma child-welfare officials.

Despite his severe medical condition, the staff never met about his case, nor was he referred to a pulmonologist or a pediatrician. Instead, his psychiatrist treated him for asthma, a condition Jerry did not have.

"We were not set up for him," said Larry J. Coffman, High Pointe's former director of nursing, in an interview.

On May 31, 2003, a Saturday, a staff member became worried that residents on Jerry's unit were "rowdy," and that the staff assigned there were "weak," according to a confidential report from an Oklahoma child-welfare agency obtained by The Inquirer.

Just a week before, the Oklahoma Commission on Children and Youth had told High Pointe it needed to better supervise the children.

As the staff member talked to nurses about his worries, a resident slammed Jerry to the ground.

It was an easy maneuver. Jerry stood just 4 feet tall and weighed 90 pounds. He landed on his sternum with a loud thump.

He said he was having trouble breathing, and asked to go to a hospital. "Not today, maybe tomorrow," was the response. The staff did call in a nurse, but he only examined Jerry's attacker.

That night, Jerry was in and out of sleep, except when he sat up to try to breathe. He vomited blood and was handed a rag and a bottle of disinfectant to clean it up. He asked repeatedly to go to the hospital, at one point enlisting friends to plead on his behalf.

On Sunday, Jerry's lips and ears turned blue. His breathing turned to a pant.

He asked two friends to hold his hands.

They screamed for a nurse. Staff put Jerry in a wheelchair and slipped his shoes on his feet.

How far away is the hospital? he asked.

Just down the street, they said.

Jerry said he didn't think he could make it.

He began to convulse. The staff called an ambulance.

At 7:43, Jerry was pronounced dead at Children's Hospital at the Oklahoma University Medical Center.

The report found that High Pointe staff incorrectly told the hospital he suffered from asthma.

A doctor who reviewed the file said the staff "administered oxygen blindly as he gradually smothered to death over the course of a day and a half."

"I find that the treatment Jerry received at High Pointe was grossly inadequate," said Jonathan Finder, chief of pulmonology at Children's Hospital in Pittsburgh.

"He had a life threatening condition, and they ignored it."

Because of Jerry's complex medical condition, the state did not hold High Pointe responsible for his death.

The Oklahoma state nursing board disciplined five nurses for failing to provide adequate care.

One was Wesley Dale Willbanks, who had spent nearly five years in an Oklahoma state prison after being convicted on 18 felony drug-dealing charges. Willbanks was still on probation when he began working at High Pointe.

Coffman, then director of nursing, was also disciplined. He said the proceeding was unfair.

"I became the fall guy," he said.

High Pointe surrendered its license to Oklahoma officials and closed nine months after Jerry died.

The center's owner, David Linden, insisted that the boy received proper medical care, and that even if he'd seen a specialist, it might not have made a difference. But he said he understands why some would wonder.