I didn't realize there was a link in Tugela's post. But yes, for things such as advanced cardiac life support protocols, both age and weight are considered for resuscitation meds. An adolescent with no significant medical history, who is receiving general anesthesia, will receive induction meds based on their weight, as well as taking into consideration how sstable they are, and why they are having surgery. (Ex- a traumatic motor vehicle accident with a fracture, vs an elective tonsillectomy, etc.)
The whole picture of an adolescent's care has to be evaluated when determining who the best care team is for them. For example, a 16 year old with no medical history, and a broken arm, would likely be treated by adult orthopedists. A 16 year old with a congenital or chronic neuromuscular or orthopedic condition would likely be treated by pedes ortho. A pregnant 13 year old would be cared for by "adult" obstetricians or family doctors, and admitted to an "adult" labor and delivery unit.
Generally, when chronically ill adolescents reach young adulthood, there is a transition plan discussed for moving them over to adult specialists. They often overlap some visits as they establish a relationship with new docs, and it's necessary to make sure all of their records are shared and copied over to the new docs, which can be a lengthy process. It doesn't happen suddenly, and they are never "kicked out" of a pediatric hospital, or refused admission. Sometimes their insurance situation changes, and it's an appropriate time to plan the transition. Sometimes they are moving to another geographic area, and need to establish a new care team. Every situation is different. The optimal situation is that families are prepared for transitions to new care teams well in advance. Everyone understands that it is a stressful, and sometimes emotionally traumatic experience, to leave long established care relationships with trusted docs and providers.
As I see it, the Pelletiers are very resistant to establishing any kind of trusting or ongoing relationship with any caregivers. The minute they hear something they don't like, they turn aggressive, and doctor and hospital shop for a new situation with new caregivers to begin again. It's a pattern for them, IMO. It's clear Justina has some medical health problems, but equally clear that the parental psychological manipulation she is subjected to is a
far more serious situation for her than any of her medical problems, IMO.
It's my opinion that when custody was taken from the parents, the docs and hospitals were evaluating Justina for
physical medical child abuse. MCA has only been successfully prosecuted for actual physical harm on a child. To my knowledge, there have been no prosecutions of emotional/ psychological manipulation abuse, although most health care professionals acknowledge that psychological manipulation that reinforces the sick role in children (especially vulnerable and developmentally disabled children)
is abuse. It's just not the kind of abuse that rises to the level of being able to be successfully prosecuted, so when it's identified, it's handled thru family courts and medical providers such as psychologists.
I think it's unlikely Justina has been the victim of physical medical child abuse. But I think it's absolutely certain she is a victim of severe and ongoing psychological manipulation (and that's abuse, even if no one is yelling at her) by her parents, who, IMO, strive to keep her in the "sick and deteriorating" role, with lots of drama as they systematically sabotage every hospital and care provider they take her to.
The parents get a tremendous amount of secondary gain from Justina's care and care decisions. The parents, in their "folie a deux" believe that Justina is "so sick" that there are *no* health care professionals that can effectively treat her. They have built their entire lives around this meme. They are entirely co-dependent in their delusions, IMO. Folie a deux. Munchausen by proxy. Medical child abuse. It's all the same for the child victim-- who is never allowed to get better.
Sadly, I think the parents will seek guardianship for her as soon as she turns 18, and then Justina will have an almost impossible situation to either break away from, or try to improve. Unless something drastic changes in the next 2 years, I see a pretty bleak future for her. JMO.
http://en.wikipedia.org/wiki/Folie_à_deux
