Max Shacknai EMS Report

K_Z said:

I agree. That is a really important question, jjenny.

Dr. Peterson is alive and well, from all indications. From my perspective, he is reluctant to answer these questions publicly, at this point in time. He has not moved to support Dina's claims, either with interviews or with written statements. He has not moved to disclaim her comments, either. (And I suspect that hospital attorneys may have influenced his ongoing silence there.)

So his comments, as reported by Nina and Dina, are puzzling, and far from settled.

I hope he will have public comments about these issues at some point soon. And I hope very much that Dina will choose to make Max's medical records available, in their entirety, as part of her search for truth.

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MyBelle said:

To my knowledge, federal health privacy laws prohibit a physician from publicly discussing any patient. I doubt Dr. Peterson will ever make any comments about Max outside of a courtroom.

JMO

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seattlechiquita said:

I don't follow this case much, but I am curious about something. Is Dina trying to somehow get Rebecca indicted post mortem for the death of Max? Please tell me I'm wrong.

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K_Z said:

You are correct that on his own, Dr. Peterson cannot comment. However, Dina and Jonah CAN give him permission to comment. They can ask Rady to hold a press conference. They can ask Dr. Peterson to write a letter of support outlining his comments and concerns.

I do also agree that we will not hear from Dr. Peterson unless or until he is legally compelled to speak. And I'm sure the Rady attorneys have told him to stay quiet. Clearly, we have no evidence he is attempting to help Dina with reopening Max's case. (Which I find immensely curious-- why did Dina not ask for his help? Why ONLY use Dr. Melinek?)

For the same reasons, I don't think Dina will consider releasinfg Max's medical records, or allowing an independent review of them. I believe that this is because the records do not support her interpretation of events.

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K_Z said:

I also want to point out that Max's airway at the scene was quite compromised with secretions and regurgitated stomach contents, according to the EMS report. It could be that this was a deterrent and complication for Rebecca to initiate rescue breaths before paramedics arrived. Paramedics had suction equipment, oral and nasal airways, ambu bags and oxygen, EMS emergency airways, and endotracheal tubes and laryngoscopes, and they STILL had great difficulty managing Max's airway. So whether or not Rebecca gave, or attempted to give rescue breaths is not worth debating-- paramedics had great difficulty managing his airway. Why would anyone expect a layperson to be any more skilled than paramedics?

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MyBelle said:

I think Dina and her attorney have charted the legal course they wish to take. Jonah has publicly stated he accepts the determination it was an accident. Dina has not yet publicly said WHY she didn't want her son left alone with RZ or her family, which is why I believe a lawsuit is ahead.

Why would either parent want the physician to comment anywhere other than in a courtroom? And I sure don't understand why you think Rady or Dr. Peterson would want to proactively get involved in it at this point. Their patient has been deceased for more than a year and his death still ruled an accident.

JMO

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MyBelle said:

I think Dina and her attorney have charted the legal course they wish to take. Jonah has publicly stated he accepts the determination it was an accident. Dina has not yet publicly said WHY she didn't want her son left alone with RZ or her family, which is why I believe a lawsuit is ahead.
JMO

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K_Z said:

I agree that Dina is laying groundwork for at least one civil lawsuit. However, Dina denies this, and states she only wants to find out the truth of what happened to her son. She says this is why she is petitioning to have his case reopened. She has said she will leave no stone unturned. She will not rest until she finds out what happened to Max. She clearly said that a civil lawsuit was a last resort. I take her at her word. And I think there is an awful lot that can be done at this point to get to the truth. We are not yet at "last resort" (but will be June 2013 when the SOL is up for wrongful death suits to be filed.)

Parents and patients waive confidentiality and have hospital press conferences all the time. When there is a case with public interest, such as the injury of a popular high school athlete, for example. If Dina wanted to, she could work with Rady administrators to allow Dr. Peterson to comment publicly,

So if I take Dina at her word, that her only concern is uncovering the truth, then why would Dr. Peterson not logically be a part of that quest? Why would she not want his help? Why would she not want him to publicly support and acknowledge her quest to reopen the case? His comments would surely have been more persuasive to reopen Max's case, than Dr. Melinek's comments alone, right? He was actually there, and cared for Max, and communicated with Dina.

That is, unless Dr. Peterson's comments have been misinterpreted by Dina. Or unless Dr. Peterson didn't say what Dina says he did. Or unless Dr. Peterson regrets whatever it was that he said. All reasons for keeping quiet until or unless legally compelled to speak.

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K_Z said:

The EMS run report that we have been looking at for a couple days was available to any of the doctors caring for Max. It would have been available as soon as he was admitted. The paramedics clearly state that "no CPR was performed before we arrived." That would have been communicated verbally by paramedics at the scene to the base hospital, as well as verbally reported to the receiving docs and nurses at Coronado AND Rady.

Dr. Peterson, and all of Max's caregivers surely knew that from the moment of admission. No CPR in progress is no CPR till paramedics arrived. They would note this, and move on in their decision making process of caring for Max. They would not be wasting time wringing their hands over whether or not CPR was started and abandoned. That is just not how a busy ICU works.

I fail to understand why Dina or Nina would claim that days later the docs were still ruminating and musing about whether or not CPR was "done within 2 minutes", when the paramedic run report is far more important and definitive than any verbal report from Jonah or Rebecca. It simply didn't matter to Max's care or prognosis. However, it IS a detail that I think Dina and Nina have grasped as though it would have made a difference-- and have blamed Rebecca. There is no medical evidence we currently know of from Max's records that says it would have made a difference, and a lot of evidence that Max very likely would have had the same outcome even with expert CPR.

The paramedics documented CPR was not performed before their arrival, and was not in progress until they initiated it. It would not matter one bit to Max's in-hospital treatment whether or not some rescue breaths or a few compressions were done before paramedics arrived, because clearly it was not continued. There is nothing "different" that the docs would have done for Max if he had had CPR before paramedics arrived.

There were so many very serious issues that needed to be discussed between the docs and Max's parents that I cannot imagine that ANY time was spent in the first 24 hours discussing or debating whether or not CPR was done. It wasn't, according to the paramedics who were there.

Nina's claims that the docs were ruminating and musing about whether or not CPR was done before paramedics arrived are ludicrous, in light of the documentation by paramedics. Max's docs would have been consumed with details of managing his ICU care, and communicating that to the parents, along with the very likely prognosis that he would not make it. (Reference the trauma studies posted earlier in the thread.)

I also want to point out that Max's airway at the scene was quite compromised with secretions and regurgitated stomach contents, according to the EMS report. It could be that this was a deterrent and complication for Rebecca to initiate rescue breaths before paramedics arrived. Paramedics had suction equipment, oral and nasal airways, ambu bags and oxygen, EMS emergency airways, and endotracheal tubes and laryngoscopes, and they STILL had great difficulty managing Max's airway. So whether or not Rebecca gave, or attempted to give rescue breaths is not worth debating-- paramedics had great difficulty managing his airway. Why would anyone expect a layperson to be any more skilled than paramedics?

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K_Z said:

The EMS run report that we have been looking at for a couple days was available to any of the doctors caring for Max. It would have been available as soon as he was admitted. The paramedics clearly state that "no CPR was performed before we arrived." That would have been communicated verbally by paramedics at the scene to the base hospital, as well as verbally reported to the receiving docs and nurses at Coronado AND Rady.

Dr. Peterson, and all of Max's caregivers surely knew that from the moment of admission. No CPR in progress is no CPR till paramedics arrived. They would note this, and move on in their decision making process of caring for Max. They would not be wasting time wringing their hands over whether or not CPR was started and abandoned. That is just not how a busy ICU works.

I fail to understand why Dina or Nina would claim that days later the docs were still ruminating and musing about whether or not CPR was "done within 2 minutes", when the paramedic run report is far more important and definitive than any verbal report from Jonah or Rebecca. It simply didn't matter to Max's care or prognosis. However, it IS a detail that I think Dina and Nina have grasped as though it would have made a difference-- and have blamed Rebecca. There is no medical evidence we currently know of from Max's records that says it would have made a difference, and a lot of evidence that Max very likely would have had the same outcome even with expert CPR.

The paramedics documented CPR was not performed before their arrival, and was not in progress until they initiated it. It would not matter one bit to Max's in-hospital treatment whether or not some rescue breaths or a few compressions were done before paramedics arrived, because clearly it was not continued. There is nothing "different" that the docs would have done for Max if he had had CPR before paramedics arrived.

There were so many very serious issues that needed to be discussed between the docs and Max's parents that I cannot imagine that ANY time was spent in the first 24 hours discussing or debating whether or not CPR was done. It wasn't, according to the paramedics who were there.

Nina's claims that the docs were ruminating and musing about whether or not CPR was done before paramedics arrived are ludicrous, in light of the documentation by paramedics. Max's docs would have been consumed with details of managing his ICU care, and communicating that to the parents, along with the very likely prognosis that he would not make it. (Reference the trauma studies posted earlier in the thread.)

I also want to point out that Max's airway at the scene was quite compromised with secretions and regurgitated stomach contents, according to the EMS report. It could be that this was a deterrent and complication for Rebecca to initiate rescue breaths before paramedics arrived. Paramedics had suction equipment, oral and nasal airways, ambu bags and oxygen, EMS emergency airways, and endotracheal tubes and laryngoscopes, and they STILL had great difficulty managing Max's airway. So whether or not Rebecca gave, or attempted to give rescue breaths is not worth debating-- paramedics had great difficulty managing his airway. Why would anyone expect a layperson to be any more skilled than paramedics?

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KariKae said:

But Dina (and I don't believe Jonah) was not at the hospital when Max arrived. If Rebecca told Jonah she had begun CPR ASAP, Jonah and Dina would have believed her, even though the paramedics and physicians already knew otherwise. Pehaps, when there was no denying the prognosis any longer, one of the parents asked, "How could this be? Rebecca started CPR right away." The doctor knew the truth and perhaps Rebecca was caught in a (potentially fateful) lie.

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KariKae said:

But Dina (and I don't believe Jonah) was not at the hospital when Max arrived. If Rebecca told Jonah she had begun CPR ASAP, Jonah and Dina would have believed her, even though the paramedics and physicians already knew otherwise. Pehaps, when there was no denying the prognosis any longer, one of the parents asked, "How could this be? Rebecca started CPR right away." The doctor knew the truth and perhaps Rebecca was caught in a (potentially fateful) lie.

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K_Z said:

I agree that Dina is laying groundwork for at least one civil lawsuit. However, Dina denies this, and states she only wants to find out the truth of what happened to her son. She says this is why she is petitioning to have his case reopened. She has said she will leave no stone unturned. She will not rest until she finds out what happened to Max. She clearly said that a civil lawsuit was a last resort. I take her at her word. And I think there is an awful lot that can be done at this point to get to the truth. We are not yet at "last resort" (but will be June 2013 when the SOL is up for wrongful death suits to be filed.)

Parents and patients waive confidentiality and have hospital press conferences all the time. When there is a case with public interest, such as the injury of a popular high school athlete, for example. If Dina wanted to, she could work with Rady administrators to allow Dr. Peterson to comment publicly, or write a letter of support.

So if I take Dina at her word, that her only concern is uncovering the truth, then why would Dr. Peterson not logically be a part of that quest? Why would she not want his help? Why would she not want him to publicly support and acknowledge her quest to reopen the case? His comments would surely have been more persuasive to reopen Max's case, than Dr. Melinek's comments alone, right? He was actually there, and cared for Max, and communicated with Dina.

That is, unless Dr. Peterson's comments have been misinterpreted by Dina. Or unless Dr. Peterson didn't say what Dina says he did. Or unless Dr. Peterson regrets whatever it was that he said. All reasons for keeping quiet until or unless legally compelled to speak.

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Zinn said:

I would have to listen to the entire interview again to be certain of this, but it was my impression that Nina was very general about who she meant by "we" when she stated they were operating on the assumption that CPR was started within two minutes. She may have been speaking strictly about herself and Dina. She said they believed this because this is what Jonah told them, the implication being that Rebecca lied to Jonah.

It's interesting to me that there was conflict around this detail and that there is a continued fixation on it, considering the content of the message that was painted on the door at the scene of Rebecca's death (She saved him / Can you save her?). Of course, that message could be interpreted many ways, but I personally find it quite interesting in this context.

Question for people with knowledge of EMS procedures: How do paramedics determine whether CPR has been performed at the scene? Do they ask witnesses or rely more on findings at the scene? If the former is true, I don't understand what the motive would be for Rebecca to lie to the 911 operator (via XZ) and Jonah (per Dina/Nina) but tell the paramedics she did not administer CPR.

As always, JMO.

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bourne said:

It could be that Rebecca said she "tried" to do CPR but couldn't because of airway obstructions, vomiting, etc., and Jonah did not hear the word "tried" or interpreted her statement to mean she did do CPR. He might even have left out the word "tried" in order to calm everyone down when he relayed the message to Dina.

I agree with Time it's the phone tree dilemma where one person says one thing and then as the statement is passed along from listener to listener, it gets distorted and sometimes completely changed down the line. Nothing nefarious about any of this; it's human nature.

But I see what you mean that there is a fixation on this CPR, and that someone who murdered Rebecca might have painted the words "She saved him. Can you save her" in a sarcastic manner to imply that Rebecca did not do CPR and did not save Max, so see if you can save this lying child-killer now.

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K_Z said:

The EMS run report that we have been looking at for a couple days was available to any of the doctors caring for Max. It would have been available as soon as he was admitted. The paramedics clearly state that "no CPR was performed before we arrived." That would have been communicated verbally by paramedics at the scene to the base hospital, as well as verbally reported to the receiving docs and nurses at Coronado AND Rady.

Dr. Peterson, and all of Max's caregivers surely knew that from the moment of admission. No CPR in progress is no CPR till paramedics arrived. They would note this, and move on in their decision making process of caring for Max. They would not be wasting time wringing their hands over whether or not CPR was started and abandoned. That is just not how a busy ICU works.

I fail to understand why Dina or Nina would claim that days later the docs were still ruminating and musing about whether or not CPR was "done within 2 minutes", when the paramedic run report is far more important and definitive than any verbal report from Jonah or Rebecca. It simply didn't matter to Max's care or prognosis. However, it IS a detail that I think Dina and Nina have grasped as though it would have made a difference-- and have blamed Rebecca. There is no medical evidence we currently know of from Max's records that says it would have made a difference, and a lot of evidence that Max very likely would have had the same outcome even with expert CPR.

The paramedics documented CPR was not performed before their arrival, and was not in progress until they initiated it. It would not matter one bit to Max's in-hospital treatment whether or not some rescue breaths or a few compressions were done before paramedics arrived, because clearly it was not continued. There is nothing "different" that the docs would have done for Max if he had had CPR before paramedics arrived.

There were so many very serious issues that needed to be discussed between the docs and Max's parents that I cannot imagine that ANY time was spent in the first 24 hours discussing or debating whether or not CPR was done. It wasn't, according to the paramedics who were there.

Nina's claims that the docs were ruminating and musing about whether or not CPR was done before paramedics arrived are ludicrous, in light of the documentation by paramedics. Max's docs would have been consumed with details of managing his ICU care, and communicating that to the parents, along with the very likely prognosis that he would not make it. (Reference the trauma studies posted earlier in the thread.)

I also want to point out that Max's airway at the scene was quite compromised with secretions and regurgitated stomach contents, according to the EMS report. It could be that this was a deterrent and complication for Rebecca to initiate rescue breaths before paramedics arrived. Paramedics had suction equipment, oral and nasal airways, ambu bags and oxygen, EMS emergency airways, and endotracheal tubes and laryngoscopes, and they STILL had great difficulty managing Max's airway. So whether or not Rebecca gave, or attempted to give rescue breaths is not worth debating-- paramedics had great difficulty managing his airway. Why would anyone expect a layperson to be any more skilled than paramedics?

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bourne said:

Thanks for reiterating that Max's airway was compromised and obstructed so CPR would be difficult to administer. I think Rebecca attempted to do CPR but couldn't because of these physical mechanical issues. Also agree that if the paramedics were having trouble administering CPR to Max, no reason to assume a layperson with rudimentary knowledge of CPR can do it more skillfully.

It would be so helpful if we all had Max's medical records to review.

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bourne said:

It could be that Rebecca said she "tried" to do CPR but couldn't because of airway obstructions, vomiting, etc., and Jonah did not hear the word "tried" or interpreted her statement to mean she did do CPR. He might even have left out the word "tried" in order to calm everyone down when he relayed the message to Dina.

I agree with Time it's the phone tree dilemma where one person says one thing and then as the statement is passed along from listener to listener, it gets distorted and sometimes completely changed down the line. Nothing nefarious about any of this; it's human nature.

But I see what you mean that there is a fixation on this CPR, and that someone who murdered Rebecca might have painted the words "She saved him. Can you save her" in a sarcastic manner to imply that Rebecca did not do CPR and did not save Max, so see if you can save this lying child-killer now.

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