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

[Karmady]

The judge said... section 7181 requires confirmation by an independant physician but does not define or otherwise set a standard for determining independence, the court determined that, on the unique facts of this case, the independent second opinion should come from a physician who had no affiliation with CHO.

http://thaddeuspope.com/images/McMath_EXHIBITS_2_of_2.pdf page 109 (on the tope of the page listed as page 62 of 77)

~bbm

I understand why the judge did what he did. But if that's what he said, he's wrong, imhumbleo lol. The regulation requires independent confirmation by a second doc, not confirmation by an independent second doc. I think they would lose that issue on appeal. It's probably moot, though, since the "independent" third-party doc confirmed the dx. jmo

 

[momrids6]

This is incredible: the FEDERAL filing by Dolan is that the mother's and Jahi's right to privacy has been violated ... and it states she underwent " a routine tonsillectomy"...how is he getting away with this?

http://www.scribd.com/doc/195185964...ec-30-2013-McMath-Civil-Rights-Lawsuit-filing

 

[shana]

This is incredible: one of the filings by Dolan is that the mother's and Jahi's right to privacy has been violated ...

http://www.scribd.com/doc/195185964...ec-30-2013-McMath-Civil-Rights-Lawsuit-filing

I was always wondering since Dolan first mentioned last week the violation of Privacy Rights just what he meant. Thanks for the doc, will read it in the ayem.

 

[SophieRose]

Couldn't find time of death for death certificate but found this.
http://www.surgery.ucsf.edu/eastbaytrauma/Protocols/ICU protocol pages/brain death.htm

Determination & Documentation

The patient must undergo two brain death determinations, at least three hours apart, and meet all criteria listed below. The two examinations must be performed by different licensed physicians; the first exam by any (including house staff), the second exam only by an attending physician not part of the primary team (i.e. a neurosurgeon, neurologist or internist if the patient is admitted to the Trauma Surgery service).

If the patient meets all criteria for brain death on both examinations, this should be noted in the medical record at the time of the second exam. This time becomes the time of legal death declaration. Don't forget to call the coroner's office as soon as death is declared.

 

[popsicle]

Very interesting read:

http://sprocket-trials.blogspot.com/2014/01/jahis-legacy.html

That was the "Bombshell Tonight" read. imo

 

[newmrsc]

This is incredible: the FEDERAL filing by Dolan is that the mother's and Jahi's right to privacy has been violated ... and it states she underwent " a routine tonsillectomy"...how is he getting away with this?

http://www.scribd.com/doc/195185964...ec-30-2013-McMath-Civil-Rights-Lawsuit-filing

My guess is that these are all going to be non-starters. To entertain any of these arguments the court would have to decide that she is not dead under the statute or that the statute can't be used. For her to have rights in court, she has to be a living person. Same with her mother having any rights to privacy regarding her care. If she's no longer considered a living person, her mother has no more rights regarding medical decisions. The backlash from that would be enormous. I don't see a court wanting to open this can of worms. It will be interesting to see how it plays out, but it's all just so tragic and hard to watch.

 

[teedie2]

Well, keeping her "alive" is the way to establish the wrongful death lawsuit. It will sure be a lot more work to have her at home and they would have to directly confront the deterioration that will follow, as she won't have anywhere near the continuous nursing care and attention to skin care, bowel and urine hygiene, ventilator care. It's a helluva lot of work and it will be a great deal of physical work, as she literally is dead weight. Complicated and messy. You'll be too tired for media blitzes. And the media will gradually fade away.

Who will pay for the equipment? The insurance company will not be renting a ventilator and hospital bed for them. They won't be able to get equipment the quality of what the CHO ICU has.

I don't think they really want to take her home.

Is the family insurance covering Jahi's extended stay in hospital after she was declared brain dead?

I believe that I agree with your last statement. But they don't want her dead. They apparently cannot arrange things that would allow Jahi to be taken from hospital to whatever place they have in mind for her to be taken to. What DO they want? Months or years of Jahi being kept alive mechanically? They really need to let their baby go. It would be a release both for the family and for Jahi.

Also, I noticed in the Complaint, item #18, it was stated that ~ Plaintiff Winkfield has personal knowledge of other (singular?) who had been diagnosed as brain dead, decision makers refused to take off life support, and the loved one (singular) emerged from legal brain death to where they had cognitive ability .. some even fully recovering.

OK, are they talking about one person, the last part of the sentence refers to "they" (that could be singular), but when they say "some" even fully recovering ... that is not singular, and when I read this paragraph the first time (too quickly, it seems) I ended up thinking that Ms Winkfield knows of several occasions of this happening. So, is it singular or plural?

I would hate to think this is about money, about working the system.

Can a person be legally brain dead and fully recover?

I hope this post doesn't sound ugly, sure don't mean it that way, but this is all rather confusing.

IMO

 

[littlemisspriss]

I hate to keep repeating this, but I still don't understand why it hasn't been approached that they take her home, like these few other cases that have been shown in the media.

Her heart will eventually stop and I would think that the family would want her right there with them daily.

They have received a lot of donations and will continue to receive more. Plus these other organizations should be able to help get her set up at home.

It seems like a simpler answer than going this other route, but there must be reasons why they aren't considering it.

These are my questions too! Why not just allow the 2 procedures they are requesting (both I am told can be performed bedside) and let this family take her home. It is a fact that there are other people who are "technically" brain dead that are being kept alive and cared for in private facilities or private homes by family that pays for medical staff to supplement their own care for a family member aren't there? This little girl's family isn't requesting something that has never been done before or is being done now to other patients in her similar medical condition....are they?

Is it that they are afraid of setting some sort of precedent that they feel is dangerous? Or is it more nefarious and they just are determined that this girl is not only technically brain dead but her heart has stopped and she is dead in every sense of the word after being removed from a machine that is mechanically keeping her alive right now?

It is true that parents sign documents all the time that say there are risks in any medical procedure, but does that signature absolve a hospital or a physician from all responsibility if in fact they screwed up? And who decides when it is a valid case to wait and attempt to get more information and facts about the initial surgery or the aftercare of the patient when there is a question as to mistakes made? The hospital should get to be the decider? Does that sound right? Sounds more like the fox guarding the hen-house to me...

 

[littlemisspriss]

When a person is pronounced brain dead, the death certificate for the individual is issued for the time and date when brain death is declared, not when they are removed from the ventilator.

http://www.cdc.gov/nchs/data/misc/hb_me.pdf

It is my personal experience that the time of death on a death certificate is when all signs of life have stopped. This means when the heart has stopped beating. Jahi's death certificate would not indicate she died weeks ago. It would indicate the time when they removed her from the ventilator and her heart stops beating.

 

[SwampMama]

That was the "Bombshell Tonight" read. imo

Oh i wholeheartedly agree. There was so much to that one link. It had the video explaining how brain death occurs plus it had links to a video documentation of the Lazarus reflex, where a recently dead body will move it's arms.

So, yes, a bombshell it was! (But we don't have to call Momrids6 "Nancy" now, do we? lol)

 

[Donjeta]

The reason I've brought it up and discussed it is because "brain death" IMO was adopted to make organ transplantation successful and much more common. There is no doubt the topics are related and interconnected, even if it has nothing to do with this specific child. Hard to discuss one without the other.

I think another reason brain death criteria were adopted is that previously, people who became brain dead stopped breathing and died very shortly so the distinction was never an issue. With the advances of critical care medicine and artificial life support we can now save the lives of a host of people who would have been doomed in the previous generations, and that is something to be thankful for. But the downside is that it doesn't always lead to functional recovery and there suddenly was a whole new subset of patients whose brain is dead and clearly cannot recover its functions but whose heartbeat and respiration could be sustained on machines indefinitely or at least for quite some time. This leads the way to new ethical problems that the previous generations never had before. Is it really ethical and right to keep these patients with no hope of recovery breathing on the machine forevermore? Are they alive or are they dead who do not appear so because of the machines?

In the previous generations brain death and cardiac death were pretty much one and the same since the brain died shortly after the heartbeat stopped and the heartbeat stopped shortly after the brain died because the person wasn't breathing.

 

[Donjeta]

Is the family insurance covering Jahi's extended stay in hospital after she was declared brain dead?

I believe that I agree with your last statement. But they don't want her dead. They apparently cannot arrange things that would allow Jahi to be taken from hospital to whatever place they have in mind for her to be taken to. What DO they want? Months or years of Jahi being kept alive mechanically? They really need to let their baby go. It would be a release both for the family and for Jahi.

Also, I noticed in the Complaint, item #18, it was stated that ~ Plaintiff Winkfield has personal knowledge of other (singular?) who had been diagnosed as brain dead, decision makers refused to take off life support, and the loved one (singular) emerged from legal brain death to where they had cognitive ability .. some even fully recovering.

OK, are they talking about one person, the last part of the sentence refers to "they" (that could be singular), but when they say "some" even fully recovering ... that is not singular, and when I read this paragraph the first time (too quickly, it seems) I ended up thinking that Ms Winkfield knows of several occasions of this happening. So, is it singular or plural?

I would hate to think this is about money, about working the system.

Can a person be legally brain dead and fully recover?

I hope this post doesn't sound ugly, sure don't mean it that way, but this is all rather confusing.

IMO

Well, where did they treat all these legally brain dead people in her acquaintance? It seems like it would be the best place to take Jahi, not a construction site in NY.

Statement From Jahi's Attorney, Chris Dolan

Jan 1. (4:20p ET) - We continue to seek a tracheostomy procedure for Jahi McMath before she departs for or upon arrival in New York. However, many surgeons and hospital administrators are on holiday making our goal difficult to reach. If Children's Hospital Oakland would perform the procedure we could quickly move Jahi to a facility that provides innovative world-class treatments, of the type being given to Prime Minister Sharon in Israel.

Amazing research opportunities exist but Children's Hospital Oakland holds the key to Jahi's death sentence - a simple tracheostomy procedure, despite a mother's plea and the money to pay for it. Instead they starve her. Our plea is for a courageous ENT specialist physician to step forth and give this mother the choice and this child a chance. Contact the Terri Schiavo Life & Hope Network at: 484-278-4287

http://lifeandhope.com/

Is the miracle cure guy (Defina) suggesting his place for Jahi? He claimed to have treated Sharon with his cutting edge innovative techniques(although it was all top secret and Sharon did not recover).

I dunno but this does not imo look like a place where I would go to receive innovative world class treatments for anything.

http://riverhead.patch.com/groups/a...nsform-into-human-bowling-balls-at-fundraiser

 

[Donjeta]

These are my questions too! Why not just allow the 2 procedures they are requesting (both I am told can be performed bedside) and let this family take her home. It is a fact that there are other people who are "technically" brain dead that are being kept alive and cared for in private facilities or private homes by family that pays for medical staff to supplement their own care for a family member aren't there? This little girl's family isn't requesting something that has never been done before or is being done now to other patients in her similar medical condition....are they?

snipped for relevance

Other brain dead people have been taken care of in home settings or private homes but I wonder if they had surgery performed on them after they were declared brain-dead/ legally deceased. They might have had feeding tubes inserted and tracheostomies etc. procedures done before they were brain-dead.

Anyway, Chris Dolan's statement I just linked implies that they still have not even located anyone who offers to perform the procedures so the hospital allowing it or refusing it may be a moot point. The medical community as a whole doesn't seem to think that surgical procedures on a brain-dead patient does anything for their prognosis.

 

[redheadedgal]

just looked at the NB facebook page... the center is now commenting on the people leaving negative "reviews"... and they're conducting background checks on people who left them :scared:


( post from 19 hours ago @ https://www.facebook.com/www.nbli.org )



:facepalm:

 

[Donjeta]

In this particular case, I have no clue!

Originally, I supposed that a death certificate would NOT have been issued until removal of the ventilator, and the ME/ Coroner taking custody of her body.

But with all the issues in this case, I have no idea. I am confident that her medical records amply reflect that she has been examined and found to be brain dead "multiple" times, by multiple providers (around 6, IIRC).

I agree with joypath and others that the judge really defined "independent" in a way that is puzzling, and I can only wonder if something was revealed in chambers that caused him to redefine "independent". I don't think the court was questioning the findings of the 3 docs, just the definition as to whether the original #2 doc was "sufficiently" independent. That is vastly different from insinuating that the hospital recklessly did something non-standard or incompetent, or illegal, or even malicious, in the brain death determination, as has been alleged here in a few posts.

I'm wondering if one of the "independent" docs was found to have contact with Jahi, for example, while on call, and wrote orders on her before she was considered for brain death, and this was determined in chambers discussions. The judge was extra conservative, and I don't have a problem with that. Dr. Fisher's evaluation was pretty definitive, and his CV is impeccable, and there is no question he is independent. Just my speculation about why the judge would sort of redefine "independent".

But it is definitely not "standard of care" to bring in docs from outside the hospital to examine for brain death, just to be considered independent. In my experience, "independent" is defined in policy to mean that they were not substantially involved with the patient's care, as an attending. I've never heard anything that the "independent" doc could not have "any" contact with the patient. Independent also means they conduct their OWN examination, and not just review the notes of another. That does not mean that a whole new PET/ CT scan has to be done-- they can review the films themselves, just not rely on someone else's interpretation.

From an email by Fisher in the court documents (p.43) it sounds like a repeat EEG, a repeat CT scan and a repeat radionuclide cerebral blood flow scan were requested for his independent exam.

From his handwritten notes (p. 59) there was at least a repeat EEG and a blood flow scan (SPECT) that actually got done. He does not mention if there were any results from another CT but possibly he hadn't seen those yet at the time of writing the notes.

The page numbers refer to the ones you have to type to the little box in the top left corner, not those on the document itself

http://thaddeuspope.com/images/McMath_EXHIBITS_2_of_2.pdf

 

[Donjeta]

just looked at the NB facebook page... the center is now commenting on the people leaving negative "reviews"... and they're conducting background checks on people who left them :scared:


( post from 19 hours ago @ https://www.facebook.com/www.nbli.org )



:facepalm:

"Just keep deleting the negativity!!!!"

I fully contend that apples will turn out to be oranges if you delete enough Facebook posts claiming otherwise.

Why have no journalists gone to inspect the place and see where they're proposing to house and cure Jahi?

 

[Softail]

From all of the organ donation talk - I think that can be put to rest. She will not be donating any organs, per her Uncle:

Sealy said the family has made progress. He said they have secured an ambulance and a plane to transport Jahi, but would not say where the facility is located. He believes the circumstances would be different if Jahi were an organ donor.

“If she was an organ donor they would do absolutely everything to make sure she was in the best health possible,” Sealy said


http://www.ktvu.com/news/news/local/mcmaths-family-struggles-get-surgeries-teen/ncZhP/

 

[Donjeta]

From all of the organ donation talk - I think that can be put to rest. She will not be donating any organs, per her Uncle:

Sealy said the family has made progress. He said they have secured an ambulance and a plane to transport Jahi, but would not say where the facility is located. He believes the circumstances would be different if Jahi were an organ donor.

“If she was an organ donor they would do absolutely everything to make sure she was in the best health possible,” Sealy said


http://www.ktvu.com/news/news/local/mcmaths-family-struggles-get-surgeries-teen/ncZhP/

If she was an organ donor her ventilator would have been shut off the day she was declared brain dead and doctors would now be doing absolutely everything to make sure that her organs were in the best health possible, residing in some other people's bodies.

Why would a brain dead organ donor need surgery to facilitate placement in long term care?

 

[Donjeta]

This may have been posted

http://edition.cnn.com/2014/01/01/health/jahi-mcmath-girl-brain-dead/

Jahi's family said Tuesday it had found a facility in New York willing to take her. The Oakland hospital "refused to agree to allow us to proceed in that matter," Jahi's uncle Omari Sealey said.

The hospital denied the accusation.

"We have done everything to assist the family of Jahi McMath in their quest to take the deceased body of their daughter to another medical facility," hospital spokesman Sam Singer said.

"To date, they have been unwilling or unable to provide a physician to perform the procedures necessary, transportation, or a facility that would accept a dead person on a ventilator. Our hearts and thoughts go out to them in this tragic situation, but the statements being made by their attorney and some family members are misleading and untrue."

The key word may be "another medical facility". If the place isn't a licenced medical facility but a construction site or a community center renting office space for a variety of agents offering outpatient services, licenced or otherwise...

 

[Donjeta]

~bbm

I understand why the judge did what he did. But if that's what he said, he's wrong, imhumbleo lol. The regulation requires independent confirmation by a second doc, not confirmation by an independent second doc. I think they would lose that issue on appeal. It's probably moot, though, since the "independent" third-party doc confirmed the dx. jmo

From the footnote in the court papers it seems to me that the issue for the court was that both original physicians had hospital privileges in CHO and the court was not supplied with sufficient information from the medical records to verify that both of them were independent of whatever happened to Jahi during the treatment. That is, they may very well have been independent and had nothing to do with the tragic complications or other care decisions but the court could not verify it since they did not have records of who all were involved in her care or even what happened to her.

JMOO and IANAL.


page 109
http://thaddeuspope.com/images/McMath_EXHIBITS_2_of_2.pdf