CA - Parents Of Toddler Declared Brain-Dead Convinced He’s Still Alive

[ArianeEmory]

K_Z, can you give us any insight on her claims about the neurologist's quote? I notice she doesn't name him.

 

[K_Z]

I think the hearing is at 3:30 today. Here are more court documents posted on Medical Futility. Go to Courts Grant TROs to Families and all the 2016 documents are related to Israel Stinson.

http://thaddeuspope.com/endofliferesources/braindeath.html

Pope also posts on his blog:
http://medicalfutility.blogspot.com/2016/05/israel-stinson-brain-death-case-next.html

To assure federal jurisdiction, the family has now asserted a claim under EMTALA. They also challenge the California brain death statute as unconstitutional, since it affords no procedural due process mechanism for challenging the declaration of death.

====
https://www.acep.org/News-Media-top-banner/EMTALA/

The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay, but since its enactment in 1986 has remained an unfunded mandate.

I'm quite familiar with EMTALA-- often called the anti-dumping "wallet biopsy" law. It provides for non-discrimination in treatment for emergency care and active labor.

It prohibits such things as asking about someone's health insurance during EMS transport, which used to happen a lot. An indigent patient would be funneled to the county hospital, even if a private hospital was closer. Or veterans would be sent to a VA, bypassing other facilities.

Personally, I think that using EMTALA is a real stretch in this case. Israel was stabilized initially at a hospital without a PICU, so transfer to a higher level of case IS allowed under EMTALA. From what I read on Prof. Pope's site a few days ago, the alleged EMTALA violation has to do with the transfer from UC Davis to Kaiser-- once he had been treated in PICU and was off ECMO. It also appears that the mother initiated the transfer to Kaiser, so there is that. Either way, I really don't know how this situation could be characterized as "dumping"-- the child had been treated in a very high level PICU, and the situation was no longer "emergent". EMTALA has to do with emergency care and active labor. And Kaiser was willing to transfer the child to Sacred Heart in WA, as well as the NJ hospital, before both declined admission. Neither of those hospitals are compelled to accept an out of state patient in transfer in a situation like this one, so I think they are protected well from allegations of EMTALA violation with Israel.

I don't think this federal challenge will be successful using EMTALA-- but that was probably just to get their foot in the door of the federal courts to ultimately challenge the brain death state law, IMO. It appears that they are trying to say that he was "unstable" when transferred to Kaiser (?). By then he had been evaluated several times and found to have no brain activity and no blood flow to the brain, but it's anyone's guess whether or not he had been officially diagnosed "brain dead" at time of transfer. But then, being brain dead is not clinically "unstable", if he was officially designated brain dead. And there is no duty to "treat" patients declared "dead", so EMTALA wouldn't apply.

So, I'm really unclear where they are going with the EMTALA challenge. It seems like a Hail Mary pass, or an end run, to get into federal court, IMO.

http://www.emtala.com/faq.htm

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/

Oh-- and the "due process" thing for declaring death as "unconstitutional"???? That is really a stretch, IMO. Declaring death is both a clinical diagnosis, and a legal one, based on the clinical diagnostic procedure. Under our laws, this is not a constitutional issue, IMO. I don't think that is going to go anywhere. Parents, spouses, and NOK don't have a "right" to participate in, or direct, the diagnostic process, or have to give consent for the diagnosis-- that is outlined by law.

This is so incredibly sad. But every case like this that the media publicizes makes it worse for the next family facing a similar situation, IMO, and more confusing for the general public. I hope the family is given permission to take his body home, if they want to do that. Give them 24-48 hours. Otherwise, care should be withdrawn.

If anyone comes across the Kaiser court filings, please post. Prof. Pope doesn't have them either.

 

[K_Z]

K_Z, can you give us any insight on her claims about the neurologist's quote? I notice she doesn't name him.

Well, without more information, that's not really possible. It might be that doc (from, was it, Cuba?), that was "consulting" from afar on the Jahi McMath case, without ever seeing her.

Whoever this person is, they are a real "outlier", and clearly not part of mainstream medicine.

Remember, there are literally dozens of highly qualified neurologists and neurosurgeons within a 100 mile radius of the Kaiser hospital. The court could (and should, IMO) easily order more testing by an outside expert.

 

[SophieRose]

Video
http://www.kcra.com/news/norcal-parents-fight-to-keep-roseville-toddler-on-life-support/39504938

Still pending. Judge needs more time. Death certificate was issued less than 24 hours after Israel was transferred to Kaiser and that's why they can't get him to another hospital.

 

[sonjay]

I'm quite familiar with EMTALA-- often called the anti-dumping "wallet biopsy" law. It provides for non-discrimination in treatment for emergency care and active labor.

<snipped for brevity>

K_Z, I have to say how much I appreciate your enlightening posts on these issues. It really helps in understanding many of the questions in context.

 

[K_Z]

Thanks, SophieRose for the video update. I found another interview with Jonee Fonseca and her fiancee. They seem like a very nice couple, but with a very limited understanding of what is going on with Israel.

Yes, absolutely a death certificate does impact the ability to get a person transferred to another hospital.

If Israel were transferred with all sorts of information documented in his chart that he has no blood flow to the brain, no electrical activity, meets brain death criteria, has had the evaluations several times by several different docs, and NO death determination was recorded, that would be a huge problem for the "sending" facility. In essence, then they WOULD be dumping a brain dead patient on another facility, without initiating the death certificate! And what a medico-legal mess that could be.

If the patient is dead, there is no "EMTALA" violation. Death is not an "emergency"-- it is the endpoint, physiologically and legally. Once death is diagnosed, the duty to treat is no longer there. But sustained care beyond a few hours or days in an ICU of a legally brain dead patient is a thorny issue for all of the licensed docs and nurses, and for the insurance and regulatory issues for the hospital. There are enormous staffing issues, issues of acuity-- how many patients do you assign to a nurse with a brain dead patient? What if something happens to the living patients while the nurse is tending to some aspect of care for the brain dead patient? If the brain dead patient has the breathing tube accidentally dislodged, or suffers a cardiac arrest without intervention by staff, is that negligence? Etc. etc.

http://www.sacbee.com/news/local/article77114262.html

 

[K_Z]

Some details from the hearing today. We find out Israel was first declared brain dead at UC Davis, the transfer to Kaiser was at the parents' request, Dr. Paul Byrne flew in specially for the hearing today, and the judge will make a determination by the end of the week.

According to court documents filed by Kaiser Permanente attorneys, Israel has been treated by three hospitals since April 1, when he was taken to a Mercy Hospital emergency room. Given his severe condition, he was transferred to UC Davis&#8217; pediatric intensive care unit where he suffered a respiratory attack that led to cardiac arrest. UC Davis physicians declared him brain dead, but his parents chose to have him transferred to Kaiser Hospital in Roseville for a second opinion.

Kaiser followed California&#8217;s Uniform Determination of Death Act, part of national standards that determine brain death, based on separate examinations by two physicians, at least 12 hours apart in the case of children. Kaiser&#8217;s determination of brain death was upheld by a California Superior Court ruling last month.

The parents&#8217; attorneys have gathered support from doctors and a religious professor in their case against Kaiser.

An expert witness for the family, pediatrician Dr. Paul Byrne, who flew in from Ohio for Wednesday&#8217;s hearing, said he has visited Israel several times in the hospital, including Tuesday night, and has seen him seemingly respond to his mother&#8217;s touch and voice.

Byrne represents the Life Guardian Foundation, a religious-based organization that believes life does not end when a person is still breathing. &#8220;Brain death is fake death,&#8221; he said Wednesday. &#8220;Israel is a living boy. He&#8217;s not dead.&#8221;

Byrne, who is not medically licensed in California, also consulted with the parents of Jahi McMath, the Oakland teenager who was declared brain dead in 2014 after cardiac arrest and complications from sleep apnea surgery.

After questioning attorneys on both sides for about an hour, Judge Kimberly Mueller said she would issue a ruling by the end of this week.

Read more here: http://www.sacbee.com/news/local/article77114262.html#storylink=cpy

And the story is being picked up by the national news/ CNN International:

[video=cnn;health/2016/05/11/israel-stinson-brain-dead-family-alive.life-legal-defense-foundation]http://www.cnn.com/2016/05/12/health/california-israel-stinson-case/index.html[/video]

On Wednesday, Israel's parents pushed their challenge to the constitutionality of state law. Federal law, they argued, provides an exception for the religious belief that brain death does not exist.

According to the Uniform Determination of Death Act, an individual is dead when he or she "has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem."
That essentially means the brain, an extremely complex organ, no longer enables the organs to function.

Snyder said state law -- more than 40 years old -- fails to take into account the latest neurological research.

http://www.cnn.com/2016/05/12/health/california-israel-stinson-case/index.html

 

[Donjeta]

According to the Uniform Determination of Death Act, an individual is dead when he or she "has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem."
That essentially means the brain, an extremely complex organ, no longer enables the organs to function.

Snyder said state law -- more than 40 years old -- fails to take into account the latest neurological research.

This makes no sense to me. What on earth could the latest neurological research have found to negate the law that irreversible cessation of all brain functioning means death? I mean, it's conceivable that research could find that some conditions are not irreversible after all, but then it just means that the person who is suffering from a reversible cessation of brain functioning is not dead yet, it does nothing to change the definition of death.

 

[K_Z]

Couple more articles this morning. This situation is remarkably like that of Jahi McMath-- the activists that don't believe in brain death appear to be more organized in their approach with the courts. The current focus is on "forcing" the Kaiser facility to place a tracheostomy and g-tube to facilitate transfer-- but the family does not have a transfer facility, and several have turned them down.

My thoughts are that the judge in the McMath case has now set a precedent in CA for handling similar cases, and that this judge will likely do the same thing. Meaning, allow the death certificate to "stand" (already litigated in state court that the diagnosis was in accordance with state law), and offer to the family the option to remove Israel in his current condition (with the oral endotracheal tube), and the visible nasogastric tube. I don't think the courts will force the Kaiser hospital to place a trach and g-tube. (From the pics, the nasogastric tube is full of bileous material, and not likely an option for enteral feeds). Additionally, one of the docs in an article said Israel's GI system is not functioning, which makes sense. Often these little ones can infarct their bowel from prolonged hypoxia/ischemia. (Dead bowel from lack of oxygen.) And he was on ECMO for several days. So it's entirely possible that even if a g-tube was placed, he may not be able to absorb anything enterally. And he's certainly not a candidate for hyperalimentation (IV nutrition).

This poor young mom and dad clearly love their beautiful son, and are devastated at his loss. I'm just so angry at the predatory activists filling their heads with false hope, and words like "neuroplasticity" (used by Jonee in her statement), which has nothing at all to do with Israel or his condition. I know the docs have explained over and over to them what happens to a brain when circulation is permanently interrupted, and ventilation support continues. I just feel like these very young parents, who don't have a lot of education, are exquisitely vulnerable, and being exploited by fringe activists with an agenda. It's bad enough they lost their son, but to peddle false hope for any kind of a recovery, cloaked in "religion" and pseudoscience, is just unspeakably cruel, IMO.

http://www.abc10.com/news/local/ros...o-keep-son-on-life-support-in-court/186063080

http://sacramento.cbslocal.com/2016/05/11/israel-stinson-brain-dead/

 

[MzOpinion8d]

BBM. Diabetes insipidis in a brain dead person does not cause "extreme thirst". Brain dead people do not sense "thirst", as they have no brain to process that. They do, however, lose massive amounts of fluids if their kidneys are functioning. DI in a brain dead person is vastly different than DI in a living person-- the 2 are not equivalent comparisons.

Patients with brain death all have "thyroid deficiency", as the release of thyroid hormone is signaled by the anterior pituitary in the brain, which is "dead" if the patient has brain death. Another example of the intentional framing of information to make it sound like legitimate medical conditions to be "treated". That's kind of like saying aysytole is an "abnormal heart rhythm"-- when it's actually the absence of any rhythm, and is nearly always a confirmation of death, not a rhythm to be treated.

Paul Byrne is not a "pediatrician"-- he's a neonatologist (NOT a neurologist or neurosurgeon) by training, practice, and certification. He is not qualified to be an expert in cases like this one, is not licensed in California, and was rejected by the California courts in the Jahi McMath case. He is more of a religious figure than a medical one-- he has spent many decades fighting against organ donation and brain death. Even the Catholic church, his church, has formally and officially disavowed Byrne's beliefs about brain death and organ donation.



https://www.catholicculture.org/culture/library/view.cfm?recnum=9719

The Catholic church's teachings on brain death and organ donation can be easily searched in a browser-- lots and lots of articles. Lots of writings by Paul Byrne, as well.

KZ, I thought he was saying he was treating Israel for those conditions prior to this asthma attack?


Edit: I should say, Israel was being treated for these conditions, not that HE was treating him.

 

[MzOpinion8d]

Some details from the hearing today. We find out Israel was first declared brain dead at UC Davis, the transfer to Kaiser was at the parents' request, Dr. Paul Byrne flew in specially for the hearing today, and the judge will make a determination by the end of the week.





Read more here: http://www.sacbee.com/news/local/article77114262.html#storylink=cpy

And the story is being picked up by the national news/ CNN International:

[video=cnn;health/2016/05/11/israel-stinson-brain-dead-family-alive.life-legal-defense-foundation]http://www.cnn.com/2016/05/12/health/california-israel-stinson-case/index.html[/video]



http://www.cnn.com/2016/05/12/health/california-israel-stinson-case/index.html

From that article "life does not end when a person is still breathing"...but he ISN'T breathing. A machine is breathing for him!

 

[K_Z]

KZ, I thought he was saying he was treating Israel for those conditions prior to this asthma attack?

Dr. Byrne is a "semi-retired" octogenarian who lives in Oregon, Ohio. He writes prolifically for pro-life websites, and has started several pro-life nonprofits. He hasn't practiced very much clinically for decades. He has not treated Israel, and is not licensed in California. He is not permitted to practice in any California facilities, and has been rejected as an expert by California courts in the McMath case, because he is not a neurologist (he was primarily a neonatologist when practicing). He "saw" both McMath and Israel in a "visitor observer" capacity, and was not permitted to conduct or participate in any examinations according to court filings.

I can find not a single professional mainstream opinion who respects the ideas of Dr. Byrne-- he is widely ridiculed for his ideas by BOTH the medical & scientific community, and his ideas are also rejected by his Catholic church.

If you really want to read some interesting commentary, google docbastard and Dr. Paul A. Byrne and read his Dec 31, 2013 comments! Docbastard is a trauma surgeon who writes a blog, and scientifically debunks nonsense like the "vaccines cause autism" movement. He had a lot to say about the Jahi McMath case, and Dr. Byrne's participation, in particular. Dr. Byrne, IMO, is a predator for his cause. He seeks to exploit these vulnerable families with pseudoscience blended with his religious ideas, and aggressively peddles false hope. He is a disgrace to the medical profession, IMO.

 

[SophieRose]

http://fox40.com/2016/05/12/battle-continues-over-toddler-on-life-support/

It's a point the hospital disputes, but his parents believe administrators are cloaking their real motivation.

"They talked about this from the beginning... donating his organs," said Silverlene Davis, Israel's Grandmother.

"It's all about organs. That's what they want. They even had somebody at our first court date there.. ready to take over my son and take his organs. The first...the second court date, but we fought it and we won and that's mainly what i believe it's all about," said Israel's father.

 

[threecrazykids]

http://fox40.com/2016/05/12/battle-continues-over-toddler-on-life-support/

It's a point the hospital disputes, but his parents believe administrators are cloaking their real motivation.

"They talked about this from the beginning... donating his organs," said Silverlene Davis, Israel's Grandmother.

"It's all about organs. That's what they want. They even had somebody at our first court date there.. ready to take over my son and take his organs. The first...the second court date, but we fought it and we won and that's mainly what i believe it's all about," said Israel's father.

I don't understand this at all...if you aren't a donor, then they don't get to "take" your organs. This is how organ donation works...no? They make it sound like some back alley doctor with a scalpel was at the court hearing demanding he leave with a random box of organs. I have to believe that these doctors and organ donation representatives (or whatever they are called) are HIGHLY sympathetic and well aware of the sensitivity of this process and aren't standing over his body like a pack of wolves.

It's all about perception and pulling at the heartstrings of people and making people turn on the same facilities that save countless lives each and every day...just chaps my behind.

 

[deedee21]

Very sad ):

This goes beyond sad. Holding back on nutrician and fluids will cause one to die of starvation and dehydration. This is a PAINFULL DEATH. Something the Drs and insurance companies DO NOT want you to know.

 

[SophieRose]

http://www2.dickinson.edu/endoflife/MedicineForgoing.html

What happens when one forgoes food and fluids at the end of life?
&#8226;Starvation? No: Starvation is a long, drawn out (and typically painful) process that can take anywhere from 30 to 60 days to run its course. Dying patients who stop taking in food and fluids do not starve to death.

 

[MHOrgel]

Except dead people cannot experience hunger or thirst, and are incapable of suffering.

 

[ArianeEmory]

http://fox40.com/2016/05/12/battle-continues-over-toddler-on-life-support/

It's a point the hospital disputes, but his parents believe administrators are cloaking their real motivation.

"They talked about this from the beginning... donating his organs," said Silverlene Davis, Israel's Grandmother.

"It's all about organs. That's what they want. They even had somebody at our first court date there.. ready to take over my son and take his organs. The first...the second court date, but we fought it and we won and that's mainly what i believe it's all about," said Israel's father.

This makes me question their mental well-being--borderline paranoia.

 

[K_Z]

http://fox40.com/2016/05/12/battle-continues-over-toddler-on-life-support/

It's a point the hospital disputes, but his parents believe administrators are cloaking their real motivation.

"They talked about this from the beginning... donating his organs," said Silverlene Davis, Israel's Grandmother.

"It's all about organs. That's what they want. They even had somebody at our first court date there.. ready to take over my son and take his organs. The first...the second court date, but we fought it and we won and that's mainly what i believe it's all about," said Israel's father.

I know to some people, it sounds very &#8220;ghoulish&#8221;, or even cruel, to ask grieving families about whether they are interested in organ donation. However, most hospitals are REQUIRED to do this within about an hour of death. Several hospital accrediting agencies (The Joint Commission; Centers for Medicare and Medicaid), as well as most state laws require hospitals to present organ donation as an option to all families and next of kin for patients who have died (both cardiac death, and those who meet neurological criteria). This is also considered as part of the Patient Bill of Rights, to be informed about their medical condition, the risks and benefits of treatment and appropriate alternatives. Patients (and guardians of minors) have the right to refuse.

Typically, the family is asked if they are interested, and then a procurement representative confers with the family. The doctor attending the patient NEVER does the organ procurement procedure, nor obtains consent. In nearly all cases, the entire team involved in procurement comes from outside the hospital, so there is no conflict of interest.

Here is an example of an Organ and Tissue Donation policy:

http://lifegift.org/sites/default/files/LIF-Organ Tissue Donation Resource Manual.pdf

If the family is interested in donation, procedures are put in place to support and optimize the deceased patient for whatever is appropriate for the planned procurement. Not all brain dead donors are candidates for &#8220;beating heart&#8221; procurement, and not all organs may be suitable (if there was a prolonged cardiac arrest, for example, the heart may not be suitable for donation, even if it is still beating). However, even if solid organs (lungs, kidneys, etc) are not suitable, due to the condition of the donor, often other tissues such as heart valves, bone, skin, and corneas can be donated.

There are also issues of religion, race, and culture that affect the willingness of families to choose donation. Here are a few scholarly articles discussing race and rates of willingness to make a donation. African Americans historically have had the lowest rates that choose donation. This may be due to historical social issues that lead some to have more suspicion of authority figures. To be honest, that is the undertone I&#8217;m hearing in the comments by Jonee and Nate&#8212;a suspicion of medical authorities in general. From their comments, they do not have an accurate or true understanding of organ donation and consent-- no one, NO ONE can "force" any family into donation, or "take" organs without clear and unwavering consent-- not even the courts! Sadly, predators like Paul Byrne only exploit and perpetuate these kind of fears, mistrust, and suspicions in situations like these, IMO.

http://www.ahrq.gov/news/newsletters/research-activities/13sep/0913RA25.html

http://www.ncbi.nlm.nih.gov/pubmed/21415828

http://content.time.com/time/health/article/0,8599,1993074,00.html

https://www.donatelifenc.org/content/minority-donation

Unfortunately, minority groups also suffer from disparities in deceased and living donation. African-Americans comprise 12.9% of the population and 34% of the kidney transplant waiting list but only 13.8% of deceased donors. Barriers to minority deceased donation include: decreased awareness of transplantation, religious or cultural distrust of the medical community, fear of medical abandonment and fear of racism. Furthermore, African-Americans comprise only 11.8% of living donors. Barriers to minority living donation include: unwillingness to donate, medical comorbid conditions, trust or fear of medical community, loss to follow-up, poor coping mechanisms, financial concerns, reluctance to ask family members and friends, fear of surgery, and lack of awareness about living donor kidney transplantation.

 

[SophieRose]

This makes me question their mental well-being--borderline paranoia.

Didn't Jahi's parents say something similar?