Family wants to keep life support for girl brain dead after tonsil surgery #7

[K_Z]

I have been pondering the possibility that no autopsy may be performed . As I understand it, the coroner has the final say.

The coroner initiated a preliminary death certificate, and left cause of death (COD) as pending, which many supposed meant that autopsy at a later time, and completion of COD.

However, is it possible that the coroner already has enough information from the chart, the hospital, and the doctors to complete COD, but is awaiting cardiac arrest?

For example:

- Hemorrhage of [insert anatomical site]
- Secondary to [insert probable cause]
- Resulting in cardiac arrest, with subsequent global hypoxic encephalopathy and brain death Dec 12, 2014
- Concluding with prolonged ventilator support, and cardiac arrest [insert date]

Obviously, there is potentially much to be learned if an autopsy is conducted, both for morbidity/ mortality review, as well as what many feel are inevitable negligence and wrongful death civil lawsuits. Even if the surgical sites are altered, due to the prolonged interval.

However, the coroner does have the authority to conduct a further inquiry, including autopsy, or conclude the case. If the coroner does not do an autopsy, and the family wants more information, my understanding is that they can pursue this independently of the coroner. But my understanding is also that they cannot refuse or decline an autopsy, if the coroner decides to proceed. (And really, it is completely understandable that someone may not want to contemplate an autopsy for their child.)

As I see it, there are benefits and drawbacks to either doing, or not doing a further investigation, including autopsy. Litigation can proceed without it, and it is debatable whether either side has a potential advantage if an autopsy is not done.
Does anyone have any insights into this process? [Joypath, are you around?]

I just think that this could be another upcoming conflict that arises out of this sad case—if the coroner wants to proceed and the family does not, or vice versa. (I hope I’m wrong—the conflict have gone on long enough, IMO.)

 

[newmrsc]

I've been bothered by something since Christopher Dolan announced in the presser earlier this week that "a Catholic facility" had agreed to care for Jahi. While I'm not a practicing Catholic, I spent 12 years in Catholic school so I'm familiar with Church doctrine. Desecration of a human body is against Catholic teaching. For the living, "sins" of drunkenness and gluttony are examples of how the Church values the body as the "temple of the Holy Spirit". The same respect is due the deceased, and there is specific doctrine regarding the proper disposition of human remains.

Ethical and legal arguments have been presented with regard to the medical procedures that were performed on Jahi after she had been declared brain-dead. If Dolan was truthful when he said that a Catholic facility is caring for Jahi, it baffles me no end that a Church-affiliated institution would participate in what is obviously desecration of the teen's body. :moo:

And the Catholic Church believes brain death is death as well, so it seems these operations and continuing to give medical care to someone who has suffered brain death goes against the teachings of the Catholic Church. JMO

I wish we had information on the facility. I'm truly surprised it hasn't leaked out yet. It's pretty hard to keep things from the media!

 

[nrdsb4]

My experience with organ procurement employees was that they can be absolutely heartless. When one of my parents died at 1am we were told that we had to wait in a room to sign some paperwork before we could leave. My parent had been in hospice care at the hospital. After an hour a bumbling guy came in and after some stupid pleasantries "How ar eyou doing?" "Well, my husband just died so not too well", he started asking about organ donation. My father had been dead for an hour and there was nothing that could have been of use (heart bypass, stroke, kidney failure, cornea surgery).

BBM

That's actually not true, as skin and bone can be donated after death even when vital organs cannot. Also, the nurses could not have approached you as that is prohibited.

My condolences on the loss of your dear father.

 

[BetteDavisEyes]

Respect for the dead

2299 The dying should be given attention and care to help them live their last moments in dignity and peace. They will be helped by the prayer of their relatives, who must see to it that the sick receive at the proper time the sacraments that prepare them to meet the living God.

2300 The bodies of the dead must be treated with respect and charity, in faith and hope of the Resurrection. The burial of the dead is a corporal work of mercy;92 it honors the children of God, who are temples of the Holy Spirit.

2301 Autopsies can be morally permitted for legal inquests or scientific research. The free gift of organs after death is legitimate and can be meritorious.

The Church permits cremation, provided that it does not demonstrate a denial of faith in the resurrection of the body.93

http://www.vatican.va/archive/ccc_css/archive/catechism/p3s2c2a5.htm#2300

 

[threecrazykids]

A good question.

Some cases have been falsely diagnosed.

Some of these brain dead people who woke up were probably never diagnosed as brain dead IMO. The articles that only quote information from the family may be misleading, and if you'd dig deeper you'd find that the person was in a coma or considered PVS and the family were told that the prognosis was bad and the person would probably never wake up and maybe asked about organ donation, and took that to mean that it was brain death although it wasn't. Some might honestly not understand the difference. Some sources may be intentionally misleading because it serves their agenda (eg. anti-organ donation).

Some cases might have been miracles. But I suppose if there was a real world actual miracle and God resurrected a brain dead person the medical community would generally tend to think it was a false diagnosis. Brain death is by definition irreversible and if someone's condition gets reversed it couldn't have been brain death according to the diagnostic manuals (which don't take divine intervention into account). Individual practitioners might think it was a miracle, depending on their religious views. But ICD-10 would say it was something else.

I guess my main issue with it, is that the hospital themselves admitted fault. They said "we made a mistake" (referring to the brain dead diagnosis). If that is the case, I can certainly see where people hold on to hope that it's simply a mis-diagnosis.

Again, I am not saying I have changed my mind or that I believe Jahi is going to survive this. But I will say this, after reading even a couple articles of what could easily be misconstrued as a misdiagnosis I do understand where some (who have a horrible time accepting the facts) would err on the side of caution and opt for their loved ones to remain on support until their body completely gives out.

 

[newmrsc]

I have been pondering the possibility that no autopsy may be performed . As I understand it, the coroner has the final say.

The coroner initiated a preliminary death certificate, and left cause of death (COD) as pending, which many supposed meant that autopsy at a later time, and completion of COD.

However, is it possible that the coroner already has enough information from the chart, the hospital, and the doctors to complete COD, but is awaiting cardiac arrest?

For example:

- Hemorrhage of [insert anatomical site]
- Secondary to [insert probable cause]
- Resulting in cardiac arrest, with subsequent global hypoxic encephalopathy and brain death Dec 12, 2014
- Concluding with prolonged ventilator support, and cardiac arrest [insert date]

Obviously, there is potentially much to be learned if an autopsy is conducted, both for morbidity/ mortality review, as well as what many feel are inevitable negligence and wrongful death civil lawsuits. Even if the surgical sites are altered, due to the prolonged interval.

However, the coroner does have the authority to conduct a further inquiry, including autopsy, or conclude the case. If the coroner does not do an autopsy, and the family wants more information, my understanding is that they can pursue this independently of the coroner. But my understanding is also that they cannot refuse or decline an autopsy, if the coroner decides to proceed. (And really, it is completely understandable that someone may not want to contemplate an autopsy for their child.)

As I see it, there are benefits and drawbacks to either doing, or not doing a further investigation, including autopsy. Litigation can proceed without it, and it is debatable whether either side has a potential advantage if an autopsy is not done.
Does anyone have any insights into this process? [Joypath, are you around?]

I just think that this could be another upcoming conflict that arises out of this sad case—if the coroner wants to proceed and the family does not, or vice versa. (I hope I’m wrong—the conflict have gone on long enough, IMO.)

BBM.

I could definitely see that happening here, but I think that would be pretty cut and dry that it can't happen! Can you imagine if families could refuse autopsies where they've been ordered by the coroner? That would be a massive loophole in cases where a family might be suspected of foul play. In this case, though, I think all bets are off.

 

[threecrazykids]

Dolan is attempting damage control. See this video:

http://www.nbcbayarea.com/news/loca...Jahi-McMath-Case-Death-Threats-239538201.html

Wait - I thought the family said that Dolan contacted them?

In the article it says that the family contacted him. :facepalm:

 

[Karmady]

Wait - I thought the family said that Dolan contacted them?

In the article it says that the family contacted him. :facepalm:

Here's the bar rule. I think that explains the difference in versions of the event.

(C) A solicitation shall not be made by or on behalf of a member or law firm to a prospective client with whom the member or law firm has no family or prior professional relationship, unless the solicitation is protected from abridgment by the Constitution of the United States or by the Constitution of the State of California. A solicitation to a former or present client in the discharge of a member's or law firm's professional duties is not prohibited.

http://rules.calbar.ca.gov/Rules/RulesofProfessionalConduct/CurrentRules/Rule1400.aspx

 

[MaybeNotToday]

A good question.

Some cases have been falsely diagnosed.

Some of these brain dead people who woke up were probably never diagnosed as brain dead IMO. The articles that only quote information from the family may be misleading, and if you'd dig deeper you'd find that the person was in a coma or considered PVS and the family were told that the prognosis was bad and the person would probably never wake up and maybe asked about organ donation, and took that to mean that it was brain death although it wasn't. Some might honestly not understand the difference. Some sources may be intentionally misleading because it serves their agenda (eg. anti-organ donation).

Some cases might have been miracles. But I suppose if there was a real world actual miracle and God resurrected a brain dead person the medical community would generally tend to think it was a false diagnosis. Brain death is by definition irreversible and if someone's condition gets reversed it couldn't have been brain death according to the diagnostic manuals (which don't take divine intervention into account). Individual practitioners might think it was a miracle, depending on their religious views. But ICD-10 would say it was something else.

This is kind of OT, but if I had a nickel for every time I heard someone say:
"Doctors" gave me/him/her two/three/four days/weeks to live and here I am 20 years later. Or

"Doctors" said I'd never walk, hear,talk,see, eat again. Or

"Doctors" said I wasn't supposed to have survived and they've never seen anything like it in all their years of practice. . . . "

Well, it just makes me wonder if:
(1) doctors are really making all these misdiagnoses (while making such pessimistic and absolute predictions)

(2) we really live in a world full of miracles every day

(3) people like to exaggerate for a good story.

Honestly, I think it's a little bit of all three.

 

[nursenelms]

Just a quick answer:

Every death at EVERY hospital (at least in Texas) is required to call the OPO. From there, the answering service has a list of questions to run down about if this person would even be a potential donor. If they are ruled out, the family is never approached about organ donation. If the person fits all the criteria, then an organ recovery coordinator is notified and they physically go and look at the patient's chart to see if they are a candidate. After all of this is completed and official brain death occurs, then the family is approached (by the transplant team).

My organization always required more than one doctor with more than one study to confirm brain death. One was usually the apnea test, and the other is a cerebral blood flow scan which shows NO blood flow to the brain.

I hope this helps someone!

 

[mck16]

Wait - I thought the family said that Dolan contacted them?

In the article it says that the family contacted him. :facepalm:

In the uncle's article a few days back, the uncle says he called Dolan in the middle of the night. Correct me if I am wrong. tia

 

[Curiosum]

I saw this touching story and it made me think about all the devotion in the medical community.

A doctor entered the hospital in hurry after being called in for an urgent surgery. He answered the call asap, changed his clothes & went directly to the surgery block. He found the boy’s father pacing in the hall waiting for the doctor. On seeing him, the dad yelled: “Why did you take all this time to come? Don’t you know that my son’s life is in danger? Don’t you have any sense of responsibility?” The doctor smiled & said: “I am sorry, I wasn’t in the hospital & I came as fast as I could after receiving the call…… And now, I wish you’d calm down so that I can do my work” “Calm down?! What if your son was in this room right now, would you calm down? If your own son dies now what will you do??” said the father angrily The doctor smiled again & replied: “I will say what Job said in the Holy Book “From dust we came & to dust we return, blessed be the name of God”. Doctors cannot prolong lives. Go & intercede for your son, we will do our best by God’s grace” “Giving advises when we’re not concerned is so easy” Murmured the father. The surgery took some hours after which the doctor went out happy, “Thank goodness!, your son is saved!” And without waiting for the father’s reply he carried on his way running. “If you have any questions, ask the nurse!!” “Why is he so arrogant? He couldn’t wait some minutes so that I ask about my son’s state” Commented the father when seeing the nurse minutes after the doctor left. The nurse answered, tears coming down her face: “His son died yesterday in a road accident, he was at the burial when we called him for your son’s surgery. And now that he saved your son’s life, he left running to finish his son’s burial.”

We all have our moments, even physicians.

Seriously, I try to remind myself every day that I am often dealing with patients and families who are in difficult situations and may not be capable of being kind, or even fair, while trying to navigate through their struggles. When I was a resident, and attending I admired seemed to almost transcend past all the petty superficial stuff and just tunnel in on doing what was right for the patient (once even when security was restraining a family member who had just assaulted her). When I shared this with her she admitted that she was still doing a lot of "faking it until she could make it". Now as an attending I understand that even more.

 

[Karmady]

In the uncle's article a few days back, the uncle says he called Dolan in the middle of the night. Correct me if I am wrong. tia

Here's the original story as told by Dolan - snipped from the link:

It was the night of Dec. 16 at about 10. I had just finished a trial in a civil-rights case in federal court. I had been up all night the night before preparing my closing argument. I was tired and told my wife I needed a break. Then I got a text.

A friend from Los Angeles said there was a man in the Bay Area claiming his niece was on life support and the hospital was going to pull the plug the next morning. Could I give him a call? The account seemed unbelievable, but I made the call. That's when I met Omari, Jahi's uncle. He was desperate. He told me a bit about Jahi and asked me if I had been watching the news. I said no, since I had been working round the clock. I listened to him, turned on the news and saw that he was a real person with a real crisis.

http://www.sfexaminer.com/sanfranci...-representing-jahi-mcmath/Content?oid=2658052

eta: btw, the author of the story IS Dolan. So those are his words, presumably.

 

[K_Z]

I saw this touching story and it made me think about all the devotion in the medical community.

A doctor entered the hospital in hurry after being called in for an urgent surgery. He answered the call asap, changed his clothes & went directly to the surgery block. He found the boy’s father pacing in the hall waiting for the doctor. On seeing him, the dad yelled: “Why did you take all this time to come? Don’t you know that my son’s life is in danger? Don’t you have any sense of responsibility?” The doctor smiled & said: “I am sorry, I wasn’t in the hospital & I came as fast as I could after receiving the call…… And now, I wish you’d calm down so that I can do my work” “Calm down?! What if your son was in this room right now, would you calm down? If your own son dies now what will you do??” said the father angrily The doctor smiled again & replied: “I will say what Job said in the Holy Book “From dust we came & to dust we return, blessed be the name of God”. Doctors cannot prolong lives. Go & intercede for your son, we will do our best by God’s grace” “Giving advises when we’re not concerned is so easy” Murmured the father. The surgery took some hours after which the doctor went out happy, “Thank goodness!, your son is saved!” And without waiting for the father’s reply he carried on his way running. “If you have any questions, ask the nurse!!” “Why is he so arrogant? He couldn’t wait some minutes so that I ask about my son’s state” Commented the father when seeing the nurse minutes after the doctor left. The nurse answered, tears coming down her face: “His son died yesterday in a road accident, he was at the burial when we called him for your son’s surgery. And now that he saved your son’s life, he left running to finish his son’s burial.”

That is a beautiful story, Beginner's Luck.

I can't count the number of times I have arrived to OB units to do a labor epidural, and had a (scared) angry family member yell "Where have you been??!! What took you so long?? My wife/ daughter/ GF is in LABOR, and is in EXTREME PAIN!"

Almost every time that has happened (even if it has only been a few minutes since OB called for the epidural), I have been in ER doing a code or emergency intubation, or finishing an emergency case in the OR, on my way up to OB. (All of the small hospitals I work in have only one CRNA on call.)

But I always take a deep breath, and try to remember that for this spouse or family, it is just as much of a crisis to see their loved one in pain with labor, as it is heartbreaking for the family of the ER or OR patient. A lot of times, it seems like no matter where we are in the hospital, or what we're doing, lots of people think we should be somewhere ELSE!

I actually teach strategies to handle this OB scenario to students in one of my courses.

 

[kaki]

I got a flashback of Jose Baez watching that...no one understands...Im the victim...etc etc. :scared:
(Eh...referring to Dolans latest attempt at damage control)

 

[MaybeNotToday]

Here's the original story as told by Dolan - snipped from the link:

It was the night of Dec. 16 at about 10. I had just finished a trial in a civil-rights case in federal court. I had been up all night the night before preparing my closing argument. I was tired and told my wife I needed a break. Then I got a text.

A friend from Los Angeles said there was a man in the Bay Area claiming his niece was on life support and the hospital was going to pull the plug the next morning. Could I give him a call? The account seemed unbelievable, but I made the call. That's when I met Omari, Jahi's uncle. He was desperate. He told me a bit about Jahi and asked me if I had been watching the news. I said no, since I had been working round the clock. I listened to him, turned on the news and saw that he was a real person with a real crisis.

http://www.sfexaminer.com/sanfranci...-representing-jahi-mcmath/Content?oid=2658052

eta: btw, the author of the story IS Dolan. So those are his words, presumably.

Oh, yeah. We had a feeling that was going to come back and bite him.

 

[momrids6]

In the uncle's article a few days back, the uncle says he called Dolan in the middle of the night. Correct me if I am wrong. tia

A friend from Los Angeles said there was a man in the Bay Area claiming his niece was on life support and the hospital was going to pull the plug the next morning. Could I give him a call? The account seemed unbelievable, but I made the call. That's when I met Omari, Jahi's uncle. He was desperate. He told me a bit about Jahi and asked me if I had been watching the news. I said no, since I had been working round the clock. I listened to him, turned on the news and saw that he was a real person with a real crisis.

BBM: http://www.sfexaminer.com/sanfranci...-representing-jahi-mcmath/Content?oid=2658052

eta; see karmady already found it- these reporters don't seem to fact check much, imo

 

[ItsJustaName]

no
person who in good faith, and not for compensation, renders emergency
medical or nonmedical care or assistance at the scene of an
emergency shall be liable for civil damages resulting from any act or
omission other than an act or omission constituting gross negligence
or willful or wanton misconduct. The scene of an emergency shall not
include emergency departments and other places where medical care is
usually offered.

But if you continue it specifies:
The scene of an emergency shall not
include emergency departments and other places where medical care is
usually offered. This subdivision applies only to the medical, law
enforcement, and emergency personnel specified in this chapter.

 

[Curiosum]

Forgive me if this has been addressed in an earlier thread, but someone directed my attention to this article this morning, about a brain-dead person who miraculously 'came back to life' 3 days after being declared brain-dead following a heart attack.

http://chinadailymail.com/2013/04/0...d-brain-dead-awakes-after-calls-to-pull-plug/

The difference I see in this situation is, that while she did have at least 2 neurologists agree on brain stem death, she also had a heart valve tear that miraculously healed. Her recovery happened within 3 days of the medical event, too.

I do believe God can do miracles, and because I do not believe the Bible to be the 'fairytale' so many others call it, I do believe that God can resurrect the dead (eg. Lazarus, and most importantly, Christ). The only question I'd have about comparing this story to Jahi's is that

1) there seems to be no medical info published 'backing' up this story (no scans, etc.) that would give it added substance, and

2) this woman was 'raised back to life' within 3 days. Since brain autolysis occurs 3-5 days after true brain death, this would seem to fit.

Any comments, especially from the medical professionals in here? (Heading out for a short bit, but will return asap to check on your thoughts).

With the caveat that this occurred outside of the US so I'm not completely clear on their medical system, policies, protocols, and laws:
-It doesn't appear that she was ever truly declared brain dead. At least in the US absence of brain stem reflexes is only part of the criteria. It doesn't appear that the doctors actually went through the full criteria and made the determination. Instead they explained to the family (including a physician brother of some sort) that the prognosis was grim and recommended that they withdraw support. I get the impression that their feeling was that brain death was the likely outcome but that the ultimate outcome hadn't been reached.
-The patient in question began showing signs of improvement within less than 48 hours after her arrest.


There is the other issue (which unfortunately I think will be worse after this case) that there is a lot of misunderstanding of what brain death is. Brain death=death. Brain death is not the same as a coma, or as a persistent vegetative state (i.e.. Terry Schiavo etc). In many cases there are patients who are profoundly neurologically devastated but have some residual brain function. Their prognosis may be very grim but the important distinction is that they are not dead.

 

[Donjeta]

Oh so that's why the uncle tweeted that he called CD and he's doing it for free:

Omari ‏@_iamOMARI 28m
I will be forever grateful for this man. He took my call in the middle of the night and listened to everything I had to say and decided to help me for FREE!!! There are not many lawyers in the world that would take a case where there is no money involved, but this man has a huge heart and I will always love him for what he has done for my family. I hear people questioning his ethics and it is ridiculous. This man did what no other lawyer would and I can't thank him enough. Christopher B. Dolan you are my brother & my friend. Welcome to the family, but you were already family when agreed to help me that night @cbdlaw… http://instagram.com/p/i9d1kUopsg/