Family wants to keep life support for girl brain dead after tonsil surgery #2

[wendiesan]

Dr. Byrne would be considered an expert witness before a Court especially in a case that involves freedom of religion and right-to-life.
He is a board certified Neonatologist who has served on the faculties of several medical schools. He has served as President of the Catholic Medical Association.

http://www.renewamerica.com/columns/byrne

In that case he will be called to serve as an expert witness, and he can explain that he completed his board certification in Pediatrics 50 years ago in 1963, and in Neonatal Medicine 38 years ago in 1975. Then, he can list his teaching, lecturing, and writing credits for the court to consider. Right now, his expert opinion about the state of a patient's brain is that of an admired neonatologist (the care of newborn infants, especially in newborn intensive care units) who doesn't believe brain death exists. His is not the opinion of an accomplished neurologist (disorders of the brain), and, IMO, it is the informed opinion of a highly qualified neurologist that is important in the diagnosis of Jahi's state.

No one has trampled on the family's religious beliefs. No one is demanding that any of Jahi's tissues or organs be taken from her body. (There are religions which oppose transplants, and the Winkfield/Mcmath family have every right to deny such surgeries on Jahi's body.) No one has demanded that a religious holiday go unobserved by the family (according to reports, they were at the hospital playing cards on Christmas since that is one of their family's Christmas traditions). So, I'm not sure why his being an expert witness in religious freedom applies in this situation given that no one had refused treatment to Jahi because of her religious beliefs.

Many doctors have served on the faculties of various medical schools. It doesn't make them experts on the condition of someone's brain, unless they are neurologists. And having served as president of the Catholic Medical Association (or Islamic Medical Association or Jewish Medical Association) doesn't make anyone qualified as an expert in every medical speciality and sub-speciality. While Dr. Byrne has undoubtedly kept up with the rapid changes within his own sphere of expertise, I question whether his understanding of the field of neurology has kept pace with that of practicing neurologists.

That Dr. Byrne is respected, personable, and devout is not under attack nor are those attributes being denied. His qualifications as a specialist in his sub-specialty are, IMO, impressive. They are just, for this particular task, irrelevant. His qualifications need to be put in context. The halo effect just isn't good enough, IMO, to make his opinion of Jahi's state obliterate those of doctors whose specialty is neurology.

 

[SophieRose]

No, it did not. I posted a clip from the URL provided by another poster, recently upthread.

This was a SETTLEMENT for medical negligence, NOT a win for the plaintiffs; furthermore, the final amount has not been publicly disclosed.

This same info is included in the other article posted, here:

http://www.contracostatimes.com/new...contracostatimes.com-www.contracostatimes.com

Also to add (bolding mine):

Part of the money has been placed into a trust to pay for 24-hour-a-day care for Rebecca, 11, who, unlike Jahi, shows some brain activity.

~jmo~

There are three parts to a medical malpractice lawsuit - medical, economic, and noneconomic (pain and suffering.) If this had gone to court, juries are not told of the $250k max cap in California on noneconomic damages (pain and suffering), so the jury can give anything only to have it by law reduced to $250k later.

 

[SophieRose]

The information you give is not for the procedure she had. Hers was far more complex and involved at least a uvulopalatopharyngoplasty and mucosal shaving of the concha or tubinates. Please find the statistics for those procedures.

I also read that the mother was not happy with the first opinion that the child should not have had this procedure, but went shopping for a second opinion that gave her what she wanted.

There are also reports that the family did not comply with the ICU instructions to completely avoid having the child talk, and were reprimanded by nurses for persisting in encouraging the child to talk.

Last two paragraphs are all speculation from this board. If you have links to MSM please post.

 

[shana]

There are three parts to a medical malpractice lawsuit - medical, economic, and noneconomic (pain and suffering.) If this had gone to court, juries are not told of the $250k max cap in California on noneconomic damages (pain and suffering), so the jury can give anything only to have it by law reduced to $250k later.

Thanks much for the info.

The case was settled for an undisclosed amount. As well, its facts are NOT the same as in Jahi's.

~jmo~

 

[sherbetjello]

Last two paragraphs are all speculation from this board. If you have links to MSM please post.

I know the last paragraph is not speculation at all, it has been reported

Post #453 in this thread has two links, and was posted NOT too far behind these posts.

Let me see if I can drum up the other links you are requesting, because I know those exist too (has read it msm).

 

[Karmady]

I highly recommend that you guys read the court document that the mother filed. It's actually pretty interesting.

JAHI MCMATH COURT DOCS

I interpret this to mean that since the two doctors who reported that Jahi was brain dead were nullified, that only leaves the third doctor's opinion who examined Jahi and she apparently did NOT find that Jahi was brain dead.

12/20 Now, they needed to have a 2nd doctor to verify that 3rd doctor's findings to comply with the CA 7180 (find her brain dead) and 7181 (be the independent confirmation). They agreed to and asked 5 additional doctors who each declined to offer an opinion one way or another.

On 12/23 Paul Fisher, MD (Chief of Child Neurology for the Stanford University Medical Center) examined Jahi and on 12/24 Drs. Fisher and Shanahan gave testimony in a closed session and that's when they extended the Temp Restraining Order to 12/30/13.


From the filing:
“On December 11, 2013, Dr. Shanahan, a physician from CHO, declared that MCMATH was brain dead. Dr. Heidersbach, another CHO physician verified Dr. Shanahan’s findings.”

“In support of their position CHO submitted Declarations of Robert Heidersbach, MD, Sharon Williams, MD, and Robin Shanahan, MD. Of these three physicians, Dr. Hidersbach (sp?) and Dr. Shanahan were doctors who examined Jahi and testified by way of declaration that Jahi suffered irreversible cessation of all functions of her entire brain, including her brain stem.” CHO argued that the two doctors meet the requirements of Health and Safety Code section 7181.

During oral arguments on December 20, 2013, over an objection by Real Party in Interest’s counsel, the court found that Drs. Heidersbach and Shanahan did not satisfy the requirements of Health and Safety Code Section 7180 and 7181”

Health and Safety Code Section 7180 and 7181
Article 1. Uniform Determination of Death Act
Section 7180.
(a) An individual who 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, is dead. A determination of death must be made in accordance with accepted medical standards.
(b) This article shall be applied and construed to effectuate its general purpose to make uniform the law with respect to the subject of this article among states enacting it.
(c) This article may be cited as the Uniform Determination of Death Act.

Article 2. Confirmation of Death
Section 7181.
When an individual is pronounced dead by determining that the individual has sustained an irreversible cessation of all functions of the entire brain, including the brain stem, there shall be independent confirmation by another physician.

bbm

I thought it would at least say "there shall be confirmation by another [independent] physician." Reading the way it's actually worded, there's no doubt in my mind that this has previously been construed to mean confirmation by separate doctors, not confirmation by two doctors, one of whom is independent of the same institution. The family's lawyer raised the argument that there was no authority on the construction of that sentence and, imo, the Judge gave him the benefit of the doubt in the absence of such precedent and due to the gravity of the issue. Also imo, the only reasonable construction is that the confirmation needs to be done by two separate doctors independent of each other, not independent of the institution. Otherwise it would have been worded the way I expected it to be. Maybe there's some legislative history that will assist the court with that. jmo

 

[jjenny]

I am reading it the exact same way. It just says two doctors should confirm brain death. Doesn't say anything about the doctors being from a different hospital.
Seems like the court has been bending over backwards to interpret it in light most favorable to the family.

 

[momrids6]

Can someone tell me if D5 or D10 is considered a medication? Lactated Ringers? And would any of these be noted as "medications at present" on a treatment and progress record?

 

[SophieRose]

I'm sorry but you are wrong. Had nothing to do with where they practiced. Please read the court document.

Even the hospital admits that only the two doctors whose reports were nullified found her brain dead at the beginning. The 3rd doctor who examined her early on did NOT find her brain dead.

I believe the actual court documents over a msm article's headline any day of the week.

JAHI'S COURT DOCS

I'm the one who originally posted those documents. I read all documents. Where does it say in the document that the doctor did not find her brain dead? Please quote the line.

 

[jjenny]

I'm the one who originally posted those documents. I read all documents. Where does it say in the document that the doctor did not find her brain dead? Please quote the line.

I read all the documents too. And it doesn't say anything about a third doctor not finding brain death.
In fact six doctors all agreed she is brain dead. And with no blood flow to the brain, I presume the brain is decomposing if not already decomposed.

 

[SwampMama]

BBM, I had not heard of jahi coughing and yet here, right after it happened, her uncle is reporting that she was coughing. Wouldn't that be something that could dislodge a clot or rip a stictch (if she had them) and cause bleeding or catastrophically bleeding, if she was already lightly bleeding (the expected amount of blood after a surgery , ie blood mixed with saliva)


http://www.wrcbtv.com/story/24233852/california-13-year-old-brain-dead-after-tonsil-surgery (published Dec 16, 2013)


Sealey provided a rough timeline of what happened after Jahi's tonsils were removed a week ago. After she asked for a popsicle, it became immediately clear that something was wrong.

"She wasn't able to talk, and she started to write notes to her mother saying I'm swallowing too much mucus, mom – am I OK? Mom – I feel like I'm choking," Sealey recalled. "And she began to write these notes because she couldn't talk because there was so much blood – it wasn't mucus – it was blood. But my sister, the mother, was too afraid to let her know that it was blood and not mucus."

He said the scene was gruesome: "She was coughing up buckets of blood."

At the same time, Sealey said it appeared to the family as though the nursing staff had vanished during what seemed to be a shift change. In the family's mind, there didn't seem to be enough hospital staff in the room to help. The family started suctioning blood themselves;

I hadn't heard about it being around the change of shift either, not that it makes a difference , so don't attack me. I'm not trying to debate anyone. I am simply presenting inconsistencies in the story, or the reporting of the story.

 

[SophieRose]

Well the statement said the "first time" it came back negative, not "immediately". I think they allowed them more than the "ordinary" amount of time that was extended, and that is not hard to imagine...I can easily see the mother begging for them to wait...and wait.... I pray I am never in that position because I can't say I wouldn't do the same.

They gave them five days which is reasonable. Maybe the amount of time needs to be mandated by law.

 

[meanmaryjean]

Can someone tell me if D5 or D10 is considered a medication? Lactated Ringers? And would any of these be noted as "medications at present" on a treatment and progress record?

Any intravenous solution (D5W, Lactated Ringer's Solution, Saline) are considered medications and they can only be given when prescribed by a physician, nurse practitioner or medic in the field (who operates under protocols established by MDs). In fact, in order for us to flush an unused IV site with even 1 mL of saline in the PICU- we need an MD order.

 

[wendiesan]

BBM, I had not heard of jahi coughing and yet here, right after it happened, her uncle is reporting that she was coughing. Wouldn't that be something that could dislodge a clot or rip a stictch (if she had them) and cause bleeding or catastrophically bleeding, if she was already lightly bleeding (the expected amount of blood after a surgery , ie blood mixed with saliva)


http://www.wrcbtv.com/story/24233852/california-13-year-old-brain-dead-after-tonsil-surgery (published Dec 16, 2013)


Sealey provided a rough timeline of what happened after Jahi's tonsils were removed a week ago. After she asked for a popsicle, it became immediately clear that something was wrong.

"She wasn't able to talk, and she started to write notes to her mother saying I'm swallowing too much mucus, mom – am I OK? Mom – I feel like I'm choking," Sealey recalled. "And she began to write these notes because she couldn't talk because there was so much blood – it wasn't mucus – it was blood. But my sister, the mother, was too afraid to let her know that it was blood and not mucus."

He said the scene was gruesome: "She was coughing up buckets of blood."

At the same time, Sealey said it appeared to the family as though the nursing staff had vanished during what seemed to be a shift change. In the family's mind, there didn't seem to be enough hospital staff in the room to help. The family started suctioning blood themselves;

I hadn't heard about it being around the change of shift either, not that it makes a difference , so don't attack me. I'm not trying to debate anyone. I am simply presenting inconsistencies in the story, or the reporting of the story.

Also, at some point the mother faints and has to be admitted herself as a patient so that may have added to the confusion as family members try to recall the sequence of events.

 

[SophieRose]

Thanks much for the info.

The case was settled for an undisclosed amount. As well, its facts are NOT the same as in Jahi's.

~jmo~

Yes, I know it's different, I posted it originally.

Any lawyers? Does what was speculated/won for medical have to be for medical? And the lawyer gets a chunk of all of it, right?

 

[momrids6]

Any intravenous solution (D5W, Lactated Ringer's Solution, Saline) are considered medications and they can only be given when prescribed by a physician, nurse practitioner or medic in the field (who operates under protocols established by MDs). In fact, in order for us to flush an unused IV site with even 1 mL of saline in the PICU- we need an MD order.

Thank you- I asked because Fisher's report lists "medications at present" as Artificial Tears and Vasopressin , No Sedatives. I do not see any mention of any IV solution- no dextrose, no saline, no LR.

Dr Byrne states she is being given "sugar water". Trying to figure out if she has an IV, and of what.

Without antibiotics, it must be extremely difficult to be in there by now I would think.

 

[Karmady]

Yes, I know it's different, I posted it originally.

Any lawyers? Does what was speculated/won for medical have to be for medical? And the lawyer gets a chunk of all of it, right?

I have a friend whose 60ish father died of stomach cancer. For years he was diagnosed with ulcers, when it was suddenly changed to stomach cancer and he died a few months later. His family wanted to sue the doctor but couldn't find a lawyer to take the case. Why? They said he was too old. He was retired so there were no economic damages and therefore only the $250k.

jmo, and I haven't read about that case other than what's been posted here, but in the case of ongoing medical for a minor (or any settlement involving a minor, actually), the settlement normally would have to be specifically approved by the court. Also, it's common to create an annuity based on present value that will generate enough money in the future to cover ongoing medical care. That amount would be in trust. The lawyers share also would have to be approved in the case of a minor I believe. But the court would normally approve a reasonable fee. All of this is general and jmo. I have no idea exactly how things are done in Cali or in that case in particular. However, rules about settlements involving minors are pretty standard. jmo

 

[redheadedgal]

An MD on twitter says this is the location - Riverhead Patch
It is not even built yet.

hi friend... happy new year!!


found this through your link... https://www.facebook.com/brendanhouseproject

looks like windows were just installed recently and they are still asking for donations for equipment... i would imagine the interior is still weeks away from completion ??

yet the family says this is a viable option? deciding to send jahi to an unproven, not even open yet facility?

 

[Karmady]

Also, at some point the mother faints and has to be admitted herself as a patient so that may have added to the confusion as family members try to recall the sequence of events.

Well, that's new and different :facepalm:

 

[SwampMama]

From December 17. In this account Jahi's uncle, who has been serving as a spokesperson, states that Jahis' brain is 100% brain damaged and medically dead and that he knows this and accepts it. He also mentions clotting medications.

http://www.kcci.com/news/health/tee...gery/-/9356934/23523864/-/tn1o0f/-/index.html

But Jahi went into cardiac arrest. The medical staff performed chest compressions to revive her and gave her clotting medications, but nothing worked.
On Tuesday, a CT scan revealed that two-thirds of Jahi's brain was swollen.
Sealey said that Jahi's brain had been deprived of oxygen. "Now she is 100% brain damaged," he said. "Medically dead."
When told that his niece was brain dead, Sealey said the entire family went into "complete devastation."

"We pray over her daily," Sealey said. "We kiss her. I charge her iPod and make sure it is in her ears every night when I sleep next to her."

But he said he had accepted that she was legally dead.

Some have questioned why Jahi was not brought back to surgery immedicately but IF she was having a serious clotting issue, would they have brought her back to surgery, OR attempted to first counteract the bleeding with transfusions (which they were doing) and clotting meds (which uncle states they did)?

From what I have already read many times (besides this account) she was getting blood transfusions already so she was being treated for the blood loss. Perhaps she also lost a lot of blood during surgery as well.

At any rate, she was sent to the ICU so it is not like the hospital did surgery and just sent her home. They admitted her to ICU from the recovery room. From what I understand, it was in ICU that they bleeding became out of control.

Could it have just been a freak bleeding/clotting disorder like DIC?
(Not saying it IS DIC, just saying there may have been another factor that accounted for her massive bleeding, after all, she seemed fine at first.)
DIC summary: http://www.nlm.nih.gov/medlineplus/ency/article/000573.htm