Family wants to keep life support for girl brain dead after tonsil surgery #4

[Karmady]

From the KTVN site:

"He [Dolan]said there must be communication between Children’s Hospital and the receiving facility, the family must give the receiving facility paperwork of Jahi’s health care status and she must be transported in an ambulance that can switch her to a portable ventilator

Note that he didn't use the term air ambulance?

He specifically deleted multiple references to "airvac" from the settlement agreement posted yesterday and changed them to transfer team or similar.

jmo

 

[Zuri]

IIRC, Herat or KZ described there being an artery proximal to the tonsils. A branch of the carotid maybe? So, for reasons of my post, let's say that the blood loss may have been from an arterial bleed. Theoretically, A person can bleed out in 3 minutes. So the nurses and doctors would have to have been trying to stem the bleeding, treat vital signs and related symptoms all within 3 minutes or so. OMG what a nightmare for everyone. I have no idea how to stem an arterial bleed from inside the throat other than to try and visualize and throw a stitch in? No clue. Hopefully KZ and Herat could share how they do that. TIA.

BTW, I am not stating this definitively happened. But if something like this did occur, it might explain the "how" part. Once Jahi is transferred out, is CHO still bound by HIPAA not to disclose what happened?

 

[MsSeal]

IIRC, Herat or KZ described there being an artery proximal to the tonsils. A branch of the carotid maybe? So, for reasons of my post, let's say that the blood loss may have been from an arterial bleed. Theoretically, A person can bleed out in 3 minutes. So the nurses and doctors would have to have been trying to stem the bleeding, treat vital signs and related symptoms all within 3 minutes or so. OMG what a nightmare for everyone. I have no idea how to stem an arterial bleed from inside the throat other than to try and visualize and throw a stitch in? No clue. Hopefully KZ and Herat could share how they do that. TIA.

BTW, I am not stating this definitively happened. But if something like this did occur, it might explain the "how" part. Once Jahi is transferred out, is CHO still bound by HIPAA not to disclose what happened?

A physician was commenting on this on another site. It is speculation and I am paraphrasing but he said if she had a pumper it could have gone from normal bleeding to serious bleeding in a matter of minutes. I think they have to get an airway and intubate quickly and it is difficult. A swollen postop beeding throat, trying to put a tube down, I can only imagine. Or what if she aspirated part of her popsicle or the suctioning was not done correctly (the family who was suctioning)?

You would not know without having access to the records what actually happened in the PICU. I have a hard time believing they ignored her and just let her bleed. There could have been a mistake made somewhere along the line but ICU nurses are highly trained so without knowing the details I would not assume they just let her bleed out without doing everything they could to stop it. The ENT may have been on his way to PICU as it all unfolded if it happened that fast. I am not saying the hospital did not do anything wrong but unless any of us were in that room we really have no way of knowing exactly what happened.

 

[Zuri]

IIIRC, Mr. Dolan has had copies of Jahi's medical records for some time now. I have not heard anything in MSM reporting specifically addressing what happened causing Jahi's brain death. If the medical record directly implicates the action of someone other than CHO staff, is CHO still held liable? The ENT surgeon? Or could the person, someone other than CHO staff, be held liable? TIA

 

[Softail]

He specifically deleted multiple references to "airvac" from the settlement agreement posted yesterday and changed them to transfer team or similar.

jmo

This is part of the reason I believe they are just going to bring her home. IF they sign the papers at the coroner's office, that is the only "facility" I see. IMO.... :twocents:

 

[Zuri]

A physician was commenting on this on another site. It is speculation and I am paraphrasing but he said if she had a pumper it could have gone from normal bleeding to serious bleeding in a matter of minutes. I think they have to get an airway and intubate quickly and it is difficult. A swollen postop beeding throat, trying to put a tube down, I can only imagine. Or what if she aspirated part of her popsicle or the suctioning was not done correctly (the family who was suctioning)?

You would not know without having access to the records what actually happened in the PICU. I have a hard time believing they ignored her and just let her bleed. There could have been a mistake made somewhere along the line but ICU nurses are highly trained so without knowing the details I would not assume they just let her bleed out without doing everything they could to stop it. The ENT may have been on his way to PICU as it all unfolded if it happened that fast. I am not saying the hospital did not do anything wrong but unless any of us were in that room we really have no way of knowing exactly what happened.

ITA with you. Suctioning in the hands of the "wrong" person could be very detrimental. I have been trying to remember if I ever used wall suction and a yankauer on a post op UPPP in the PACU. IIRC, it was written in the orders "Do Not Suction", but my memory is old like me. We usually used gauze or a towel to wipe the face and had an emesis basin and tissues for the patient to spit into IIRC. Also, we did not encourage patients to speak or cough as we did not want the formed clot to dislodge. Patients were given ice chips by the teaspoon.

If it turns out that CHO did nothing wrong and no staff members were at fault, could CHO turn around and hold liable the person who was at fault, even though they might have been well meaning? Do modern day ICUs have security cameras in the room? Just wondering. TIA

 

[Trino]

I do not have a reference for this. My husband read somewhere that relatives of patients that go to care facilities visit regularly at first, but as time passes, visitation becomes less and less frequently. More often than not, when the patient dies, those who are present are orderlys and staff.

I can see this as being true, and if this family transfers this unfortunate child to NY, how are they going to visit her? They live in Oakland. Travel is time-consuming and expensive.

 

[Softail]

I wanted to share this story with you about the lengths required to keep a child who is vent dependent at home.

Oh Geeze Zuri. Thanks for sharing. What a sad story. I thank you for sharing. :blowkiss:

I'm trying to catch up on SOA episodes, and tearing up. :cry:

 

[Donjeta]

A physician was commenting on this on another site. It is speculation and I am paraphrasing but he said if she had a pumper it could have gone from normal bleeding to serious bleeding in a matter of minutes. I think they have to get an airway and intubate quickly and it is difficult. A swollen postop beeding throat, trying to put a tube down, I can only imagine. Or what if she aspirated part of her popsicle or the suctioning was not done correctly (the family who was suctioning)?

You would not know without having access to the records what actually happened in the PICU. I have a hard time believing they ignored her and just let her bleed. There could have been a mistake made somewhere along the line but ICU nurses are highly trained so without knowing the details I would not assume they just let her bleed out without doing everything they could to stop it. The ENT may have been on his way to PICU as it all unfolded if it happened that fast. I am not saying the hospital did not do anything wrong but unless any of us were in that room we really have no way of knowing exactly what happened.

BBM. As per the uncle, she aspirated blood.

 

[Herat]

I do not have a reference for this. My husband read somewhere that relatives of patients that go to care facilities visit regularly at first, but as time passes, visitation becomes less and less frequently. More often than not, when the patient dies, those who are present are orderlys and staff.

I can see this as being true, and if this family transfers this unfortunate child to NY, how are they going to visit her? They live in Oakland. Travel is time-consuming and expensive.

Sadly, what you describe is very true. When someone goes to an extended care or LTAC facility, they often pass away alone, without family, and without family having made contact in the last week or so. Sometimes it just seems kinder if they had passed away before the transfer.

I don't think anyone believes the facility in New York was ever a serious option, nor is it the "facility" Dolan has given the judge. I think there is a consensus that she is going to a private residence, most likely her mother's, but it could be that of a friend or relative. I don't think most here believe she is going to a healthcare facility.

 

[Marah]

http://www.nytimes.com/2014/01/04/us/a-brain-is-dead-a-heart-beats-on.html?smid=tw-share&_r=0

So she is moving around? How is that possible?

 

[Softail]

I do not have a reference for this. My husband read somewhere that relatives of patients that go to care facilities visit regularly at first, but as time passes, visitation becomes less and less frequently. More often than not, when the patient dies, those who are present are orderlys and staff.

I can see this as being true, and if this family transfers this unfortunate child to NY, how are they going to visit her? They live in Oakland. Travel is time-consuming and expensive.

I can too. Unfortunately I don't think the "facility" in New York was ever an option. Smoke and mirrors! IMO of course....

 

[Softail]

It is really sad and frustrating for me to read so many global criticisms of this world class facility characterizing the entire facility and staff as heartless and cruel. “The hospital” is not just a cold, bricks and mortar entity—but a vibrant place, filled with many, many compassionate and caring individuals. Rarely is an entire department or facility “bad” or “incompetent” or “heartless”.

I’d like to point out something to demonstrate how compassionate “the hospital” was to this family, even BEFORE Jahi was unfortunately diagnosed as brain dead. “The hospital” has gone above and beyond for this family, IMO, at pretty much every stage of Jahi’s treatment. At the time when Mrs. Winkfield was witnessing Jahi bleed, she apparently experienced a vaso vagal reaction so severe that she herself needed treatment. She “passed out”. If you think about that for a moment, in addition to the crisis that was occurring with Jahi, the ICU staff now had an additional crisis to attend to—the patient’s mother unconscious, and probably on the floor. That required an additional group of caregivers to assess Mrs. Winkfield urgently, call for assistance, and have her transported to presumably the hospital ER for more assessment and treatment. And that is EXACTLY what appears to have happened—Mrs. Winkfield received treatment AS A PATIENT. Presumably she is satisfied with the care she herself received from the staff, both in the ICU and ER. (Which is another reason I have a hard time interpreting the family statements that they called and called for help, and no one came promptly—in an ICU described as an open bay facility—no walls.)

There is a law called EMTALA (Emergency Treatment and Active Labor Act) that compels hospitals to assess and treat emergencies and patients in active labor, and not divert them, for example, to other county facilities by doing a “wallet biopsy” to see what kind of insurance the patient has.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html

Emergency Medical Treatment and Active Labor Act - Wikipedia, the free encyclopedia

CHO was legally obligated to emergently assess and treat Mrs. Winkfield when she passed out. However, once the situation was stable, Children’s would have been completely within their rights to transfer Mrs. Winkfield to an ADULT facility ER, even if she had not agreed with the plan. Children’s Hospital treats pediatric patients. Despite this, the staff recognized that their patient, Mrs. Winkfield, and their other patient, Jahi McMath, were both experiencing a terrible combined family crisis. They apparently kept Mrs. Winkfield as a patient for a number of hours, either in their ER, or somewhere else, most likely because no one wanted to separate a terrified mother from her child, who was in a terrible crisis in the PICU. They bent, and might even be characterized as “broke” the rules to keep this family, and mother and child, together during their crises. That is not just following the law, but demonstrating compassion at a high level, IMO.

I want to contrast this to what happens today in many small hospitals. When a newborn has difficulties that require transfer to a bigger NICU, in the past, we always sent the moms with the babies in the ambulance or life flight. The moms were inpatients, whether they gave birth by vaginal delivery, or C-section. The rationale was compassion—not separating newborns from their mothers during a crisis, and the moms themselves were still recovering from the birth, and needed care and support. For the past several years (maybe as many as 10 years, I can’t recall), we have been unable to do this in small facilities. The babies are transported alone with the NICU team, and the moms have to be discharged so they can go separately, if they are stable enough for discharge. Insurance will not pay simply to keep moms and babies together—there has to be a medical reason for the MOM to be transferred as an inpatient with the newborn.

So I really question the across-the-board criticisms of this world class facility being crass, heartless, and disparaging toward this family. No one wanted this situation to end happily more than “the hospital”, except Jahi’s family.

As usual K_Z, excellent post! Worth repeating.

:goodpost:

 

[Herat]

A physician was commenting on this on another site. It is speculation and I am paraphrasing but he said if she had a pumper it could have gone from normal bleeding to serious bleeding in a matter of minutes. I think they have to get an airway and intubate quickly and it is difficult. A swollen postop beeding throat, trying to put a tube down, I can only imagine.

It's difficult enough in an OR with as full an exposure and the best lighting you can get, along with anesthesia, an oral intubation, and heavy suctioning.

 

[MsSeal]

I don't know if this has been addressed but if Jani's heart stops beating in another state, facility or in the family home will an autopsy be required? Or will her family be able to refuse it?

 

[jjenny]

So she is moving around? How is that possible?

She is in bed attached to a ventillator. I am not sure what you mean by "moving around."

 

[MaybeNotToday]

A physician was commenting on this on another site. It is speculation and I am paraphrasing but he said if she had a pumper it could have gone from normal bleeding to serious bleeding in a matter of minutes. I think they have to get an airway and intubate quickly and it is difficult. A swollen postop beeding throat, trying to put a tube down, I can only imagine. Or what if she aspirated part of her popsicle or the suctioning was not done correctly (the family who was suctioning)?



You would not know without having access to the records what actually happened in the PICU. I have a hard time believing they ignored her and just let her bleed. There could have been a mistake made somewhere along the line but ICU nurses are highly trained so without knowing the details I would not assume they just let her bleed out without doing everything they could to stop it. The ENT may have been on his way to PICU as it all unfolded if it happened that fast. I am not saying the hospital did not do anything wrong but unless any of us were in that room we really have no way of knowing exactly what happened.

Ok, now everyone knows my stance on medical personnel. Dad is an MD, mom is RN - both in hospitals. Healthcare workers, particularly hospital type are nothing short of miracle workers (IMO). Living angels , but that's just me And I take that healthy respect I have everywhere I go - meaning I give the benefit of a doubt when things go astray. . . BUT, and it's a big but, I have been on the other end of a shift change and let me tell you, it was pretty dang frustrating. They are saying there was a shift change going on when Jahi started bleeding. And for a minute I'm reminded of the total chaos called "shift change" in my own stay. Mostly, it was just a constant pushing of one shifts job onto the next one. And both shifts blamed each other for the responsibility. I am confident this staff wasn't pulling that kind of stuff in a PICU- but IMO , in my case, "shift change" was the very common excuse for errors.

Just sayin'.

 

[Marah]

She is in bed attached to a ventillator. I am not sure what you mean by "moving around."

Sorry, in the quote I quoted it said she moves around when her mom talks to her. Is it possible to be brain dead and still move your body?

 

[Softail]

Ok, now everyone knows my stance on medical personnel. Dad is an MD, mom is RN - both in hospitals. Healthcare workers, particularly hospital type are nothing short of miracle workers (IMO). Living angels , but that's just me And I take that healthy respect I have everywhere I go - meaning I give the benefit of a doubt when things go astray. . . BUT, and it's a big but, I have been on the other end of a shift change and let me tell you, it was pretty dang frustrating. They are saying there was a shift change going on when Jahi started bleeding. And for a minute I'm reminded of the total chaos called "shift change" in my own stay. Mostly, it was just a constant pushing of one shifts job onto the next one. And both shifts blamed each other for the responsibility. I am confident this staff wasn't pulling that kind of stuff in a PICU- but IMO , in my case, "shift change" was the very common excuse for errors.

Just sayin'.

They say a lot of things. Doesn't make them true. Until the hospital can tell their side, I'm not going to demonize them. The mother also apparently passed out, and became a patient herself. There is no telling what REALLY happened at this point. IMO

 

[RabidBadger]

Ok, now everyone knows my stance on medical personnel. Dad is an MD, mom is RN - both in hospitals. Healthcare workers, particularly hospital type are nothing short of miracle workers (IMO). Living angels , but that's just me And I take that healthy respect I have everywhere I go - meaning I give the benefit of a doubt when things go astray. . . BUT, and it's a big but, I have been on the other end of a shift change and let me tell you, it was pretty dang frustrating. They are saying there was a shift change going on when Jahi started bleeding. And for a minute I'm reminded of the total chaos called "shift change" in my own stay. Mostly, it was just a constant pushing of one shifts job onto the next one. And both shifts blamed each other for the responsibility. I am confident this staff wasn't pulling that kind of stuff in a PICU- but IMO , in my case, "shift change" was the very common excuse for errors.

Just sayin'.

I disagree with this because in the ICUs that I have worked in shift change occurs at the bedside so the patient can be observed. Whenever there is a decompensation during shift change the outgoing nurse or both nurses will attend to the patient as the patient always takes priority. The patient is never out of eyesight. We work as a team to save the patient always. There is no blame involved.

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