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

[ArianeEmory]

Didn't Jahi's parents say something similar?

If so, I've forgotten it. I was fairly active in that thread for a while but I'm hitting the years where not everything sticks. I remember more about the uncle, the photoshopped pictures and other social media stuff, browbeating the school, etc.

I guess it makes sense, if you're already reacting irrationally, that you would invent a larger conspiracy to pretend your child was dead. And organ donation is a convenient motivation for the would-be conspirators, I guess.

 

[jjenny]

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.

Brain dead person is already dead. If a ventilator is turned off their heart will stop beating.

 

[kdblaisdell]

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

You were responding to:
"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."

Before I met my husband, I would've wondered about that, too. His family lived in poverty for at least 3 generations and often felt discarded by people wealthier. They lived in poverty, in part, because they were running a church in a rough part of town. Between religious beliefs and fear of the power and disdain of wealthy people, many of them have this same fear. Most of them aren't certifiable.😉

 

[jjenny]

Organ donation is a touchy subject. The 14 year old (who was shot in the head) -her parents were also approached for organ donation even though she wasn't brain dead or dead. Obviously she didn't die and is very much alive now. It also sounds to me that parents in that case were willing to donate, but she squeezed her mother's hand. Makes me wonder about organ donation. But parents can always decline.

 

[rob]

The hospital 'asks' if you are interested in organ donation, and if you say yes, they get the group that handles that to come speak with you (I can't remember the groups name). But if you say no, I'm not interested, that's it, it's never mentioned again.
Nobody 'takes' anyone's organs. They have to be donated.

If you are wanting to donate, they have to be ready to make it happen. You don't decide the next week, after the death, you have to plan and prepare, just in case you get there.
All MOO and experience.

 

[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.

What's strange here is that the father says the procurement organization came to the court proceedings. I doubt it because once they declined at the hospital, that would be it.

 

[K_Z]

This article from Courthouse News Service gives much more insight into what actually transpired in court on Wed, May 11, and includes several segments of comments from Judge Kimberly Mueller, Jonee's attorney (Snider), and the Kaiser hospital attorney (Curliano).

As I wrote earlier, I really don't think the EMTALA challenge will survive or proceed, and this seems to support my conclusions. And it is equally clear that the state court proceedings from a few weeks ago have settled the issue of whether Israel has been correctly and legally diagnosed brain dead, so I doubt that this will be re-hashed (or another examination ordered) in the Judge's forthcoming decision. I think the judge will give the family the option to withdraw support within a few hours or days, or take him home. I don't see an extension being ordered by this judge, but the appeal the Fonseca attorney says he will file will provide an extension. (The Judge may be happy to punt this one to the appeal court.)

http://www.courthousenews.com/2016/05/12/mom-asks-judge-to-help-keep-brain-dead-child-alive.htm

U.S. District Judge Kimberly Mueller appeared unpersuaded by Jonee Fonseca's constitutional claims that the health care giant violated a federal law requiring hospitals to stabilize and treat emergency room patients, and that its doctors wrongly declared her child brain-dead.

Throughout the hour-long argument for a preliminary injunction, Mueller acknowledged a lack of case law involving a request to force a hospital to keep a brain-dead patient on life support against its own doctors' recommendations. The judge promised a written ruling before the end of the week.

Mueller asked whether Fonseca's Emergency Medical Treatment and Labor Act (EMTALA) claims still apply, as Kaiser has provided life-saving care to 2-year-old Israel Stinson for nearly a month.

Kaiser's attorney Jason Curliano said the hospital has complied with EMTALA, and that Fonseca consented to Stinson's transfer from another local hospital. Curliano said Kaiser is not "dumping" Stinson, and that it has been treating the infant for nearly a month, despite doctors' confirming his permanent condition days after he arrived.

Mueller agreed with Curliano that California's Uniform Determination of Death Act law allows doctors some room for discretion, and that the three doctors who declared Stinson brain-dead appeared to have followed state guidelines.

Curliano reiterated that Snider was bringing up claims that were settled in state court last month, when a judge ruled that Kaiser complied with the state's brain-dead statute.

He also emphasized that the child has been seen by a non-Kaiser doctor and that the physician was actually with Stinson in the hospital Tuesday night.

(*KZ note-- they may be referring to Dr. Paul Byrne here, who articles state flew in from Ohio for the hearing.)

Fonseca has been unable to find a permanent site for Stinson since she filed the lawsuit on April 28. A temporary restraining order forcing Kaiser to keep Stinson on life support has been ordered while the challenge is heard in Federal Court.

If Fonseca's motion is declined, Snider said she would immediately petition for a stay of Mueller's decision and appeal to the Ninth Circuit.

 

[K_Z]

Regarding the family's comments about their perception that they had been pestered or bullied about organ donation, I think we have to be very honest here. This family was never, ever going to consent to organ donation, no way, no how. Every single person who cared for Israel at all 3 hospitals knew this, too. This kind of situation, and similar ones like the McMath case, never end in any kind of organ donation. Most medical professionals know that all too well.

HOWEVER-- the hospitals STILL have to ASK the question, and present the option. They HAVE to, by law and policy. And these families (often minorities) that are so mistrustful, angry and heartbroken perceive that as just another insult on top of the tragedy of losing their loved one. They perceive this as callous and cruel, as if all anyone wants is to carve up their loved one, and sell them off for parts. Sometimes they consent just so their loved one will be continued on ICU support a little longer, then abruptly "un-consent" as the time for procurement nears and the team is in the facility. In these cases, they are confused by the preparations for procurement, and misinterpret that preparation time as if the dead loved one is finally back to getting potentially "curative" medical care, as long as they consent to organ donation. They see an increase in medications given, attention paid to the machines, tubes, and numbers, and misinterpret that process of optimization of organs as curative medical care. They are confused why all that didn't happen when they were being diagnosed as brain dead, and interpret that as if medical professionals "wanted" the brain death diagnosis so they could "force" the family into organ donation.

It's the same with mandatory autopsies when the families don't want one-- they perceive this as the final "defilement" of their loved one. They often perceive that "authorities" are forcing their loved one to be cut up and dissected as disrespect or punishment.

Education about these issues is the answer to this kind of ignorance and suspicion-- and that kind of ongoing community education has to come from LEADERS inside minority communities, IMO. Most times, saying "no" to organ donation is about the only control these unfortunate families feel they have. So they use "no" as a protest, and a way to "get back" at the evil medical establishment that they perceive has "killed" their loved one. Or, in cases like this one, and the McMath case, they engage in a high level of willful denial against the diagnosis of death, and "get back at" the "authorities" with long and drawn out court filings. IMO.

 

[K_Z]

Update- portions of federal Judge Mueller's ruling in this article: (Having trouble posting link from CNN directly-- keeps reverting to the video embed.)

https://www.google.com/url?sa=t&rct...yVNuvWD--HEI3IyrA&sig2=UBJy5DdPxC6ZGB9i4lzDGQ

A U.S. District Court judge on Friday extended the order for one more week. Fonseca asked for the time so she and her attorney can take the case to the 9th Circuit U.S. Court of Appeals.

In its decision Friday, the federal district court cast doubt on Fonseca's ability to win the case.

"While Ms. Fonseca's maternal instincts and moral position are completely understandable, the concerns reviewed here suggest she is unlikely to obtain the relief she seeks," the judge wrote.

After Friday's ruling, Kaiser resent Palkowski's previous statement when asked for comment.

Here's another source:

http://abcnews.go.com/US/wireStory/california-mom-week-toddler-life-support-39108520

Mueller rejected Jonee Fonseca's request for a permanent court order requiring Kaiser Permanente Medical Center in Roseville to keep her son on life support to give her ample time to find another facility for him.

But Mueller gave Fonseca a week to appeal her decision.

Fonseca's attorney, Kevin Snider, said attorneys will go to the 9th U.S. Circuit Court of Appeals early next week.

 

[watcher9]

Update- portions of federal Judge Mueller's ruling in this article: (Having trouble posting link from CNN directly-- keeps reverting to the video embed.)

https://www.google.com/url?sa=t&rct...yVNuvWD--HEI3IyrA&sig2=UBJy5DdPxC6ZGB9i4lzDGQ





Here's another source:

http://abcnews.go.com/US/wireStory/california-mom-week-toddler-life-support-39108520

A machine such as a ventilator keeping a comatose patient alive is called life support because it supports the organs until the patient is able to do so on its own. I think even after a death, the same machines are used to keep organs viable for any transplant if needed but I may be wrong.

After a patient is determined to be brain dead, I think the use of the words "life support" by medical personnel and/or judges should be discontinued because the words can confuse the families/situation as it seems to support life. Maybe the ventilator still running to supply oxygen to the organs of the patient should be referred to simply as a ventilator or a mechanical support rather than life support?

Just did a search to make sure the terminology was correct before posting and found this article which supports my thoughts. WOW
Now I'm questioning myself - is this my thoughts or just memory resurfacing from maybe reading this back then.
I guess either way it still makes sense.

http://www.cnn.com/2013/12/28/health/life-support-ethics/

 

[jjenny]

I see the lawyer is arguing that parents believe that as long the heart is beating, the patient is alive?
I don't see how that means patient has to be on life support. Turn off the ventilator-if the heart is still beating there is no problem and the patient is alive. If the heart stops then clearly the patient isn't alive.
The reason the heart is beating in a brain dead patient is because of a ventilator.
If ventilator is turned off the heart will stop. So I don't find the argument that because Christian beliefs dictate that as long as heart is beating the patient is alive thus patient must be maintained on a ventilator to make much sense.

 

[jjenny]

What's strange here is that the father says the procurement organization came to the court proceedings. I doubt it because once they declined at the hospital, that would be it.

Maybe whoever approached the parents about organ donation was also in court. But that might have been some personnel from the hospital and not specifically somebody from procurement organization. If parents don't consent to donate there would be no reason for procurement organization to pursue organ donation. Even if life support is turned off, without parental consent, organs can not be donated.

 

[jjenny]

The hospital 'asks' if you are interested in organ donation, and if you say yes, they get the group that handles that to come speak with you (I can't remember the groups name). But if you say no, I'm not interested, that's it, it's never mentioned again.
Nobody 'takes' anyone's organs. They have to be donated.

If you are wanting to donate, they have to be ready to make it happen. You don't decide the next week, after the death, you have to plan and prepare, just in case you get there.
All MOO and experience.

But in case of 14 year old shot in the head, organ donation was brought up even though she wasn't dead and obviously she did recover. Since it appears parents were willing to consent to organ donation, that seems concerning. What if she didn't squeeze mother's hand in time?

 

[SophieRose]

But in case of 14 year old shot in the head, organ donation was brought up even though she wasn't dead and obviously she did recover. Since it appears parents were willing to consent to organ donation, that seems concerning. What if she didn't squeeze mother's hand in time?

This is where folklore starts. All over the net, people report the girl was brain dead, and then you have Israel's parents believing the same thing came happen to their son.

http://wtnh.com/2016/02/23/family-of-teen-shooting-victim-she-is-fighting/

“Due to both the nature of her injuries and the efforts required to sustain her life, our team discussed the possibility that she could become brain dead,” Lane-Davies said. “At the request and with the permission of Abigail’s parents, our team contacted Gift of Life to begin the process that ensures the dignity and safety of the injured person. The active organ donation after a tragedy like this one can only occur after a person has died. Determining brain death requires a series of physical exams, sometimes in conjunction with other testing, over the course of multiple hours. This series of exams has not begun due to Abigail’s medical condition. Abigail was not declared medically brain dead.

 

[K_Z]

A machine such as a ventilator keeping a comatose patient alive is called life support because it supports the organs until the patient is able to do so on its own. I think even after a death, the same machines are used to keep organs viable for any transplant if needed but I may be wrong.

After a patient is determined to be brain dead, I think the use of the words "life support" by medical personnel and/or judges should be discontinued because the words can confuse the families/situation as it seems to support life. Maybe the ventilator still running to supply oxygen to the organs of the patient should be referred to simply as a ventilator or a mechanical support rather than life support?

Just did a search to make sure the terminology was correct before posting and found this article which supports my thoughts. WOW
Now I'm questioning myself - is this my thoughts or just memory resurfacing from maybe reading this back then.
I guess either way it still makes sense.

http://www.cnn.com/2013/12/28/health/life-support-ethics/

The term "life support" is not a medical term, it is lay terminology. It means different things to different people. Ventilators are "breathing machines" that have far more settings than simply on and off. Ventilators can be set to help a breath that is initiated, but weak, pushing the air into the lungs. Vents can be set for "pressure support" only, which is somewhat analagous to what many people know as CPAP/ BiPAP, which is a steady stream of air under pressure that helps hold upper respiratory passages open. Vents can be set to assist/ control-- meaning the patient breathes, but if their respiratory rate or effort drops off, the machine takes over. Vents can be set to "SIMV", which synchronizes the push of air with the respiratory efforts of the patient. Vents can be set to maintain a steady stream of pressurized air at the end of a breath, to hold distant airways open ("PEEP").

Israel is on "control" settings-- he is not capable of initiating breaths at all, so the machine does all of the work. Jonee says she has "seen" Israel take 2 breaths over and above the vent, which, IMO, is not possible. Jonee doesn't understand all of the things that can influence the respiratory wave form she watches on the monitor, such as her stimulating Israel in the video under his left arm ("tickling"). Any external movement of the patient, or the bed, or the oral endotracheal tube, or the "hoses" in the ventilator circuit, turning the patient, holding them, etc., can cause a temporary change in the waveform. If, for example, a hose is impeded or kinked, an alarm will sound. If a patient (consicious or unconscious) bites down, or "tongues" the oral breathing tube, the waveform will change, and if severe enough, will cause an alarm to sound. If the resistance inside the lungs changes, such as from a bronchospasm (asthma) the machine will also alarm that the upper limits of pressure have been reached. Etc. Etc.

There is a movement within the critical care community to change the terminology from "life support" to "organ support", or even more correctly, "somatic support", to distinguish a body being optimized for organ procurement from a living person receiving critical care.

By the way, it's not just the ventilator keeping Israel's heart going. He is on very significant doses of vasopressin and levophed (norepinephrine, pronounced "leave-oh-fed", often called colloquially "leave 'em dead"). Levophed is a potent vasoconstrictor, and is a sort of last resort med. It can cause such severe vasoconstriction patients fingers and toes die and blacken, patches of skin, etc.

In the state court documents (272 pages on Prof. Pope's website) the court recorder has the extensive testimony of the head ICU intensivist at Kaiser, Dr. Myette. Israel at that point in time was so unstable that Dr. Myette or another doc was within 30 feet of him 24/7 to continuously titrate the meds to keep his BP up enough to keep his organs functioning. If the levophed or vasopressin was turned off, Israel's heart would stop, even if the vent kept pumping air. Israel's body temp is very unstable, and he arrived to Kaiser with a temp of 33 celcius (91 fahrenheit). He has to be kept on several warming devices. This is called "poikilothermia"-- tendency of a brain dead body to acclimate to room/ ambient temperature. All of these things (temp instability, diabetes insipidis, BP instability) are typical and "normal" for brain dead patients.

At some point, Jahi McMath somewhat stabilized so that she came off the norepi and vasopressin. I think they could probably keep Israel's heart pumping for quite a while as well, perhaps years, since he coded in an ICU and his heart had not stopped for long (if at all-- he had a severe bronchospasm, and it appears he was pretty promptly put on ECMO). He is very young-- his heart could go on a long time. But he is still brain dead, and that will never change or improve.

 

[K_Z]

Here's a link to all the state court documents on Prof. Pope's website. It's a good read, if you skip to the court reporter's dictation.

http://thaddeuspope.com/images/Stinson_v_UC_Davis_Placer_Cty_docs_.pdf

One of the other interesting things in there is that Jonee Fonseca tried very hard to have Israel transferred from UC Davis, to UCSF Benioff Children's-- the same hospital Jahi McMath was in. UCSF Benioff declined to take Israel once they found out Israel was brain dead. (In addition to the brain death diagnosis, I also think they don't want a repeat of what they went through with the Jahi McMath case, which was a disaster for their facility.)

Dr. Myette at Kaiser is the ICU head, and intensivist-- he agreed to accept Israel for the specific purpose of repeating the brain death evaluations. He thought (his words) that if his facility repeated the tests, the family would be more willing to accept the results, because the events that ended in the brain death diagnosis didn't happen in his facility. In essence, he thought the family was too upset with UC Davis to accept the diagnosis (his words). He was trying to be compassionate.

Another interesting thing in the state court docs is that a goal was to move Israel to NJ, so that the death certificate could be challenged and overturned (they hoped) in state NJ court. THEN they would move him to Pennsylvania to a LTC facility as a living patient. The NJ stop was necessary because Pennsylvania state law doesn't allow transfer acceptance of brain dead patients into the state.

 

[jjenny]

This is where folklore starts. All over the net, people report the girl was brain dead, and then you have Israel's parents believing the same thing came happen to their son.

http://wtnh.com/2016/02/23/family-of-teen-shooting-victim-she-is-fighting/

“Due to both the nature of her injuries and the efforts required to sustain her life, our team discussed the possibility that she could become brain dead,” Lane-Davies said. “At the request and with the permission of Abigail’s parents, our team contacted Gift of Life to begin the process that ensures the dignity and safety of the injured person. The active organ donation after a tragedy like this one can only occur after a person has died. Determining brain death requires a series of physical exams, sometimes in conjunction with other testing, over the course of multiple hours. This series of exams has not begun due to Abigail’s medical condition. Abigail was not declared medically brain dead.

I never said Abigail was declared brain dead. She wasn't brain dead or dead, in fact she was alive. But organ procurement organization was contacted anyway.

 

[MzOpinion8d]

KZ, question: I understand the physiology of the Lazarus sign as far as the nerve pathway, but don't understand how it originates. Is it just random nerve movement because the body is still functioning even if the brain isn't? If so, why does Israel respond that way every time his mom touches him? Also, are the arms the only place that nerve transmission is seen or are there other areas of the body that can move?

Thanks in advance!

 

[K_Z]

I never said Abigail was declared brain dead. She wasn't brain dead or dead, in fact she was alive. But organ procurement organization was contacted anyway.

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

IMMINENT DEATH /ORGAN REFERRALS:
 Consult LifeGift on all ventilator-dependent patients within one hour of
meeting any one of the following criteria, regardless of age, medical history,
current hospital course and hemodynamic status.
 Refer within one hour all patients who meet any one of the following: (triggers
may vary according to hospital policy):
 Ventilated with
• Severe neurological injury (i.e. CVA, GSW, MVC, Anoxia,
etc.)
• GCS of ≤ 5 or
 Plans to discuss withdrawal of life support with family.
 At the first indication that patient begins to lose neuro reflexes.
 Prior to the first formal brain death exam.
 After the initial referral, to preserve the donation opportunity and allow for
Donation after Cardiac Death (DCD) evaluation, update LifeGift if there are
plans to discuss withdrawal of care or the patient is made a DNR.

An example of a procedure manual for the Texas area organ procurement group "Life Gift". There are a number of regional groups, all of which have to be designated by UNOS as the "go to" source for organ procurement in that region.

The manual discusses contact with families of patients who are expected to die, but have not yet been diagnosed brain dead, or had cardiac death. It is very common, in my experience, that the topic of organ donation is broached in expectant situations (before death that is expected) by docs with families. The 14 year old girl had received a devastating GSW to the head, and INITIALLY docs didn't believe she would survive. It makes sense to me that the topic of donation was initiated with her parents.

I don't quite understand why that would even be controversial? I guess I've been in health care for so long that it seems quite irresponsible and unethical to me to "pretend" to families that death is not a real possibility in cases like that. To give false hope, or avoid discussing the truth in conversations with family, would be very cruel, IMO. Families often aren't in a position to "hear" the information, at least initially, so it's important that the information be given to families consistently.

This is a book I've found helpful. It's more about disasters and sudden deaths, but has a lot of good information.

https://www.amazon.com/Grave-Words-...ths&qid=1463260199&ref_=sr_1_1&s=books&sr=1-1

 

[jjenny]

Well, I guess my point is that doctors can be wrong sometimes. Abigail was actually declared dead at first.

"Doctors called time of death. The Kopfs lay over their daughter, sobbing. Then Vickie Kopf felt her move."

http://wkbn.com/2016/03/14/the-recovery-of-kalamazoo-shooting-victim-abigail-kopf/