The final hours of Jeremiah Clark

Kathern Clark holds her 9-year-old son, Jeremiah, on the day he died, at Children's Memorial Hospital in Chicago on May 21, 2009. (Family photo)

One student wanted to know: Why did he die?

"Unfortunately, that sometimes happens to children with multiple disabilities," she said she responded. "His body just gave out."

But she didn't believe that.

A few days after Jeremiah was buried, Moffitt called the Illinois Department of Public Health and filed a complaint against Alden.

Over the next several weeks, investigators interviewed Alden nurses, Gale staff and Jeremiah's doctors.

When investigators asked Tess Adriano, then Alden's acting nursing director, why it took so long for her staff to call a doctor, she said, "I don't know."

She then pointed fingers at Jeremiah's school, records show, asking why the teachers didn't call 911 if they thought he was in so much distress.

In an interview with the Tribune, Moffitt responded: "I'm not his guardian. I'm not Alden." She said that when a teacher sends a student home sick, the expectation is that the parent or, in this case, the facility will seek proper medical care.

"It was horrible — horrible — to know that I sent him home and nothing was done," she said.

When its inquiry was complete, the state cited Alden for several violations, including neglect. Regulators said Alden didn't recognize Jeremiah's illness, assess him before sending him to school or promptly notify a doctor of his condition.

They fined Alden $35,000 — the eighth fine against the facility in the last 10 years. As in some previous cases, Alden is contesting the citations and fine. A hearing is scheduled for February.

In July, Jeremiah's mother amended her lawsuit against Alden, changing it from a simple neglect case over his broken arm in 2007 to a wrongful-death claim.

"If he would have stayed home with his mother, none of this would have happened," said Craig Manchik, an attorney representing Jeremiah's family. His mother agreed: "I could take care of him better."

Moffitt said she worries that more children will be neglected at Alden. "How many times does this have to happen before they close it down?" she asked. "Who's responsible for doing that?"

The Illinois Department of Public Health, which oversees Alden and other facilities for people with developmental disabilities, has "grave concerns" with the facility and will shut it down if problems persist, said spokeswoman Melaney Arnold. "There is never an excuse for a death due to negligence," she said.

Moffitt has two keepsakes to remind her of Jeremiah. One is the memorial booklet from his funeral, which she keeps in her desk drawer at school.

The other is the battered red tambourine the boy loved so much. Shortly after he died, Moffitt pinned it to a bulletin board in her classroom.

It hangs there today, without note or explanation.