Family wants to keep life support for girl brain dead after tonsil surgery #3

[Zuri]

Agree that bleeding times are obsolete. I haven't seen one done, or ordered, in more than 10 years.

Believe it or not, they still did them up until 2011 in the hospital where I worked. Scary. I should have stated coags if there was a bleeding or clotting question in her history.

 

[K_Z]

Ah I see, thank you. But would they then have the capabilities to take care of someone on a ventilator, feeding tubes, etc? If they are going to accept her with the assumption she is alive, then legally speaking, they would need some sort of 24/7 nursing care with physician availability in case of emergencies, I would think (I don't know the specific laws re: NY state about this)? I mean there are many, many things that can go wrong when a person is on a ventilator being fed through tubes. Everything from bed sores to major infections to a host of other problems. My guess is that the vast majority of physicians I interact with daily would likely refuse to do this.

And when the ETT is inevitably dislodged, or the cuff develops a leak, will they call 911 to transport Jahi's body to the nearest hospital ER? Are there care givers that can bag ventilate with a mask for hours? Most long term care facilities do not have someone in house 24/7 qualified to re-intubate, and this isn't a situation where a supraglottic airway, like an LMA, or a Combitube, is a good idea. (Or maybe it is, since she is declared brain dead? IDK anymore what is the right thing to do in a situation like this.)

At this point, if the ETT is dislodged at CHO, I wonder if the hospital will replace it? It's a very confusing situation-- clearly not alive and declared brain dead for 3 weeks, but still on the vent.

When the cuff of the current ETT eventually erodes thru the tracheal mucosa, or begins leaking, then what? Will they attempt a tube exchange?

 

[Zuri]

headline links to most recent story- comprehensive coverage page


http://www.insidebayarea.com/jahi

I started doing back reading of articles on the above referenced website. After reading quotes from Dolan dated 12/26/13, I was surprised at how misleading they were. Are there sanctions a judge can put on an attorney that misleads the court or is it just accepted as normal? TIA

 

[seattlechiquita]

I only see 1 of 2 outcomes to this. Jahi's heart fails while still at CHO or the court orders CHO to remove the vent. jmo

I'm with you. I wonder if at the end, the family will regret not spending all this time by her bedside, singing to her, holding her hand, instead of going bonkers on a futile legal cause. jmho

 

[MsSeal]

Blog written by physician. What is Death?

I hope more physicians will write to help the public understand. Even if one does not accept brain death as death and believe in miracles it still helps to be educated.

http://www.carilionclinic.org/blogs/ackerman/what-death

 

[MEN3C]

And when the ETT is inevitably dislodged, or the cuff develops a leak, will they call 911 to transport Jahi's body to the nearest hospital ER? Are there care givers that can bag ventilate with a mask for hours? Most long term care facilities do not have someone in house 24/7 qualified to re-intubate, and this isn't a situation where a supraglottic airway, like an LMA, or a Combitube, is a good idea. (Or maybe it is, since she is declared brain dead? IDK anymore what is the right thing to do in a situation like this.)

At this point, if the ETT is dislodged at CHO, I wonder if the hospital will replace it? It's a very confusing situation-- clearly not alive and declared brain dead for 3 weeks, but still on the vent.

When the cuff of the current ETT eventually erodes thru the tracheal mucosa, or begins leaking, then what? Will they attempt a tube exchange?

With a combitude you'd obviously worry about aspiration pneumonitis, pneumothorax, etc. But in this case, I have no idea what would be the standard of care.

Re: ETT, the question becomes who would do it? My guess is that they'd have to find another hospital in NY State who will do procedures on a deceased person. IMO, they'd probably need an agreement with a hospital nearby who is willing.

 

[Herat]

Scerri also told the court that they would provide 24/7 nursing care and respiratory therapists but the letter wasn't explicit whether they already have these people on the payroll or not.

This facility cannot claim it does Inpatient Care.

It would have to comply with CMS (Medicare) standards, and the list of standards is probably 30 pages long. I doubt she has actually read this list of standards or even has enough understanding to begin to comply. I do not believe she has any formal medical credentials, and that fact, alone, will prevent any "Inpatient Care". One cannot "contract away" the responsibility to provide sound and appropriate patient care. There is an on-site inspection process where the state inspector actually examines the facility, reviews staff licensing and records, reviews the floorplan, the door size and frames, the construction, etc etc etc.

This may all be well-intentioned do-gooder, or an attempt at publicity and fundraising, but the state of New York can step in an serve an injunction preventing the facility from accepting any "patient" if they feel this violates the laws, perpetuates fraud, or puts any patient at risk. Just because the purported patient is "brain dead" does not mean the regulations are waived.

She may want to very careful about those claims.

 

[Herat]

With a combitude you'd obviously worry about aspiration pneumonitis, pneumothorax, etc. But in this case, I have no idea what would be the standard of care.

Re: ETT, the question becomes who would do it? My guess is that they'd have to find another hospital in NY State who will do procedures on a deceased person. IMO, they'd probably need an agreement with a hospital nearby who is willing.

Tranfer agreements / contracts are a standard part of a facility requirement. What other healthcare facility is going to contract with her unlicensed outpatient office to accept patients? No one will do that.

And once again, the absurdity of the claim that her facility can provide care.

 

[MsSeal]

Let's say the family is granted their demands and Jahi does get a feeding tube and the trache and is then transferred. What would day to day life be like for Jahi. Would her body contract. Would she have bedsores, infections. What happens to the body when maintained for extended period of time on a ventilator. I know the tube would be in her treacheostomy but wouldn't she be at risk for infections?

I remember reading that Jahi's brother was in a coma for 3 weeks and the mother had a some kind of plaque or inspirational message that she kept in his room if I read it correctly. I can't remember the details or the link (sorry, I would have to go looking). I wonder if she feels that Jahi situation is similar to her brother and that is why she wants more time thinking that Jani will come around if given time to "heal" and have "nourishment."

 

[Linda7NJ]

Let's say the family is granted their demands and Jahi does get a feeding tube and the trache and is then transferred. What would day to day life be like for Jahi. Would her body contract. Would she have bedsores, infections. What happens to the body when maintained for extended period of time on a ventilator. I know the tube would be in her treacheostomy but wouldn't she be at risk for infections?

I remember reading that Jahi's brother was in a coma for 3 weeks and the mother had a some kind of plaque or inspirational message that she kept in his room if I read it correctly. I can't remember the details or the link (sorry, I would have to go looking). I wonder if she feels that Jahi situation is similar to her brother and that is why she wants more time thinking that Jani will come around if given time to "heal" and have "nourishment."

I would think she would be susceptible to all the problems you've listed.

 

[krimekat]

So now he is trying to start a riot in Oakland? It isn't hard to do. He thinks maybe civil unrest will encourage the payout?

I totally agree!

This atty is :scared:

 

[Donjeta]

I wonder if her body would even heal surgical incisions properly at this point after being for weeks on whatever nourishment CHO considers appropriate for legally deceased patients. Thyroid deficiency wouldn't help either I think.

 

[seattlechiquita]

http://abclocal.go.com/kgo/story?section=news/local/east_bay&id=9379424

Can someone tell me what "mandatory settlement conference" means?

 

[BeginnersLuck]

Blog written by physician. What is Death?

I hope more physicians will write to help the public understand. Even if one does not accept brain death as death and believe in miracles it still helps to be educated.

http://www.carilionclinic.org/blogs/ackerman/what-death

Thank you. This is an excellently written article by a physician who has experience in these situations. I wish that everyone could read it.

The physician explains that Jahi deserves respect.

It's my understanding the number one responsibility a physician has is to the patient. Shipping her body off just anywhere, among other things, should be highly condoned by anyone in the medical community and elsewhere.

 

[mck16]

I need a lesson in how a tracheotomy works. Just because there is an opening in your throat that goes to your lungs, how does that keep you oxegenated? Do you still need some artifical means of pushing air into the lungs? tia

 

[BeginnersLuck]

I would think she would be susceptible to all the problems you've listed.

Then don't you believe that Jahi deserves respect and dignity. This is what the very large majority of the medical community believes. They do not think she is "worthless". They are protecting her rights.

 

[Steft50]

I need a lesson in how a tracheotomy works. Just because there is an opening in your throat that goes to your lungs, how does that keep you oxegenated? Do you still need some artifical means of pushing air into the lungs? tia

If I understand it correctly, the ventalator connects to the tube in the throat rather than the tube that currently come out of her mouth.

 

[Cubby]

Can someone tell me what "mandatory settlement conference" means?

It's mandatory both sides show up.

 

[krimekat]

Can someone tell me what "mandatory settlement conference" means?

2014 California Rules of Court Rule 3.1380. Mandatory settlement conferences

(c) Settlement conference statement

No later than five court days before the initial date set for the settlement conference, each party must submit to the court and serve on each party a mandatory settlement conference statement containing:

(1)A good faith settlement demand;

(2)An itemization of economic and noneconomic damages by each plaintiff;

(3)A good faith offer of settlement by each defendant; and

(4)A statement identifying and discussing in detail all facts and law pertinent to the issues of liability and damages involved in the case as to that party.

The settlement conference statement must comply with any additional requirement imposed by local rule.

 

[Donjeta]

I need a lesson in how a tracheotomy works. Just because there is an opening in your throat that goes to your lungs, how does that keep you oxegenated? Do you still need some artifical means of pushing air into the lungs? tia

It's a way to bypass the mouth and nose in the breathing. You can breathe through a tracheostomy if you have spontaneous respiration but in Jahi's case the tube would need to be connected to a machine.