I have wonders lately if Israel's parents were told in Guatemala that this was the "end of the line" and perhaps may even had been aware that pulling the plug was the outcome if they returned. Could they have done so purposefully in order to set up the hospital for a long drawn out lawsuit resulting at least in more publicity, fame and book/tour deals? I know this sounds terrible, but if the hospital cannot speak due to Hippa laws, anything is possible.
Interestingly, in the court filings on Professor Pope's site linked above, Jonee Fonseca states she was told by doctors in Guatemala that Israel was in a "persistent vegetative state." And every country defines brain death by neurologic criteria differently.
So, after reading the following research article (from 2007), I have to wonder if Guatemala was chosen by Jonee and her attorneys specifically because Guatemala does not have well-defined brain death criteria. Originally, I had thought they went to Cuba, but from this research article, Cuba has fairly well-defined brain death criteria. In Central America, Guatemala and Honduras have the least well-defined criteria, according to this research.
Brain death worldwide
Accepted fact but no global consensus in diagnostic criteria
Abstract
Objective: To survey brain death criteria throughout the world.
Background: The clinical diagnosis of brain death allows organ donation or withdrawal of support. Declaration of brain death follows a certain set of examinations. The code of practice throughout the world has not been systematically investigated. Methods: Brain death guidelines in adults in 80 countries were obtained through review of literature and legal standards and personal contacts with physicians.
Results: Legal standards on organ transplantation were present in 55 of 80 countries (69%). Practice guidelines
for brain death for adults were present in 70 of 80 countries (88%). More than one physician was required to declare
brain death in half of the practice guidelines. Countries with guidelines all specifically specified exclusion of confounders,
irreversible coma, absent motor response, and absent brainstem reflexes. Apnea testing, using a PCO2 target, was
recommended in 59% of the surveyed countries. Differences were also found in time of observation and required expertise
of examining physicians. Additional provisions existed when brain death was due to anoxia. Confirmatory laboratory
testing was mandatory in 28 of 70 practice guidelines (40%).
Conclusions: There is uniform agreement on the neurologic examination with exception of the apnea test. However, this survey found other major differences in the procedures for diagnosing brain death in adults. Standardization should be considered.
Table on page 22 of the article (page 4 of 8 in the pdf) shows that Guatemala has absent criteria across the board in law, guidelines, apnea testing, number of physicians involved with diagnosis, observational time, and confirmatory testing.
So, it makes perfect sense, legally and medically, that CHLA follows U.S. laws and the California UDDA. They HAVE to. Just because a physician in Guatemala diagnoses a patient with "persistent vegetative state", does not mean that this diagnosis is at all legal or valid in the U.S. Physicians at CHLA have the responsibility to evaluate the patient and make a diagnosis, which they did-- they had all of the previous testing and results (tons of it, according to court filings, very much exceeding the basic diagnostic process). They are not obligated in any way to repeat any or all of that when there is a legal and valid death certificate from months earlier, just because the family wants. The standard of care was NOT to do anything further.
The goal of Jonee and her attorneys, as I understand it from their filings, was to overturn California UDDA as invalid, and thereby petition to revoke the existing death certificate-- from their July 1 filings. Again, as in the McMath case, to get state or federal money to pay for his care in perpetuity. I think they somehow thought (or hoped) that a diagnosis from a doctor in a different country would be enough "force" to invalidate U.S. law, and the other court decisions from months ago. I think they may have wanted to go to New Jersey, like the McMaths-- but whereever on the east coast they wanted to go, it appears there was not a facility willing to take him.
Perhaps NJ is now more wary of becoming a destination for medical tourism for brain dead people. It's a small state-- that would be
very burdensome, financially, to the taxpayers of NJ, if they became the desired destination for anyone who rejects brain death for their loved one, because NJ will hand out medicaid money to keep organ support in place "forever."
We won't ever know for sure what happened in Guatemala, but I strongly suspect that if they diagnosed Israel with persistent vegetative state, his time in the hospital there in Guatemala was rapidly coming to an end. There was likely nothing else that could be offered to them, and I also strongly suspect bills were piling up unpaid, and a Guatemalan hospital is not going to maintain a patient (who is not a citizen, nor is the family citizens) in an ICU on a ventilator in perpetuity. They probably were told they had to make arrangements to remove/ discharge Israel somewhere, IMO. They may have been given a deadline there, because IMO, that is a possibility why the July 8 trip to the east coast was planned. I think Jonee's comments that Israel was "well enough to return to the U.S." (from the fundraising update) indicate that the Guatemala hospital was wanting him discharged somewhere. JMO.
The fact that Jonee says they faced the same issues (home care discussions) immediately on arrival at CHLA confirms that for me. I think they had no desire to live permanently in Guatemala, no residency status there, no income or other money, and were faced with trying to set up a life there, or return to the U.S. They chose to return to the U.S. They HAD a choice. No one forced them. They had a choice to take him home BEFORE they went to Guatemala, too.
And they had a choice, again, when the medevac plane landed in Los Angeles. No one forced them to go to CHLA. They CHOSE to go to a mainstream, large university hospital-- not home care, extended care, etc.
The fact remains that if Jonee had taken Israel directly to a home care situation from the flightline (even to a hotel or apartment,or inpatient hospice center), OR moved him from CHLA to home care before Aug 18, when she filed the emergency injunction petition, she could have cared for him at home as long as she wished, and NO ONE would have barged into her home and taken Israel off "life support." She CHOSE to go to CHLA PICU, and it is abundantly clear to me that whoever her mystery doctor is that was so willing to do home visits and write prescriptions, that he or she was unable or unwilling to motivate them to get set up with home care anywhere (Vacaville, their home, or LA). Or, Jonee actively avoided/ delayed setting up home care because she didn't really want that outcome, or responsibility, despite her comments.
I think they chose CHLA so that there are "deep pockets" to sue for money. They absolutely knew that this would be the outcome, IMO. Granted, home care is an monumental task to face, but not impossible-- and it leaves one with nearly complete control of the situation. And they could have had lots of help setting up and caring for Israel, from churches, sympathetic volunteers, and pro life nonprofits, at least for a few months or years. They were trying to force the legal and the medical system to do their bidding,
rather than working within the constraints of the law and the medical system. This was a predictable outcome.
What I really wish I knew, to put an end to the story, is how and why CHLA admitted Israel to their PICU. I think that would be very interesting to know.