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

[K_Z]

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.

I agree that the issue has been made worse, nationally, not better or clearer. And I think the media has a lot to do with that.

I'm concerned that now a very high profile "example", or precedent, has been set. Meaning, other families will cite this case as an example of why they might not want to "agree to" brain death and withdrawl of ventilator support. (We know they don't have to, but I think the issue has been tremendously muddied, rather than clarified.)

 

[Herat]

Dolan is asking for attorney's fees in the Violation of Privacy/ Religious Rights filing that went to the federal court. Of course he couldn't ask the family for money........

Yeah, lots of sleight of hand going on. His interest in repealing the $250K malpractice cap is also massively self-serving. He's got enough money, this is probably about stoking a campaign chest with contributions from other PI attorneys.

Somewhere in his office there's bound to be a yellow legal pad with "The Honorable Senator Chris Dolan" doodled all over it......

JMO, of course.

 

[Karmady]

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/

Subtlety is not their strong suit, imo :facepalm:

 

[mck16]

Yesterday, 02:20 PM
popsicle
faith hope love Join Date: Mar 2009
Posts: 5,238

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/

long time no hear jmo
__________________

This is the tweet I was referring to. Bolded above. ty

 

[ItsJustaName]

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.

I'm not sure how useful 80 year old bone and skin might be - but my main point was that a group of college graduates, all pro organ donation were so incensed by the insensitivity of the process that none of us are organ donors anymore. I have told my spouse specifically that I do not want to be a donor. If the hospital had only made us wait a few minutes it might have been okay. The process was insensitive. The OPO reminded me of Dan Ackroyd pretending to be a used car salesman.

I can completely understand how a grief stricken mother, who was not expecting a dead daughter, who was still in denial, would be very upset about the process.

Organ donation is a wonderful thing for the recipients. Its a good thing for society. Some donor families get great satisfaction knowing that their loved one's death helped other. But there is often collateral damage to grieving families that are forced to wait and deal with an arm twisting salesman and a time of great emotion. (I know not all OPOs are that way but ours was).

If the McMath family's experience was anything like ours than I am not surprised that she would think that the hospital was more interested in her daughter's organs than her recovery (especially since there was no chance of recovery, she would be right).

 

[popsicle]

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.

(a) No person who in good faith, and not for
compensation, renders emergency medical or nonmedical care at the
scene of an emergency shall be liable for any civil damages resulting
from any act or omission. 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.

(2) Except for those persons specified in subdivision (a), 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. This subdivision shall not be construed to alter
existing protections from liability for licensed medical or other
personnel specified in subdivision (a) or any other law.

http://law.onecle.com/california/health/1799.102.html

 

[Donjeta]

I think it might still be considered the hospital's fault if they let non-staff members, in good faith or otherwise, cause harm to any of their patients who were their responsibility and under their supervision at the time.

 

[seattlechiquita]

Dolan is asking for attorney's fees in the Violation of Privacy/ Religious Rights filing that went to the federal court. Of course he couldn't ask the family for money........

Yeah, lots of sleight of hand going on. His interest in repealing the $250K malpractice cap is also massively self-serving. He's got enough money, this is probably about stoking a campaign chest with contributions from other PI attorneys.

Somewhere in his office there's bound to be a yellow legal pad with "The Honorable Senator Chris Dolan" doodled all over it......

JMO, of course.

:floorlaugh: you kill me, Herat :floorlaugh:

 

[Karmady]

I think it might still be considered the hospital's fault if they let non-staff members, in good faith or otherwise, cause harm to any of their patients who were their responsibility and under their supervision at the time.

I think that's why the law is drafted the way it is. Not only does it not protect medical professionals in a medical setting (A "volunteer" doc, for example, can't avoid liability for rendering medical assistance in his usual professional setting by pointing to this law), it also does not protect lay volunteers who would not be expected to intervene when there were non-volunteer medical professionals to act instead -- such as in an ER.

The law is pretty hard to read, imo, but I think the main point is you can't be a protected volunteer if you're standing in a hospital at the time you act. You need to leave it to the non-volunteer medical professionals. jmo

 

[Wolfie]

I'm not sure how useful 80 year old bone and skin might be - but my main point was that a group of college graduates, all pro organ donation were so incensed by the insensitivity of the process that none of us are organ donors anymore.

So, you would rather let people die than donate becuase of one hospital's process?

 

[Donjeta]

Subtlety is not their strong suit, imo :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/Rul.../Rule1400.aspx

D Omari's tweet says CD is his bro and a family member so he's covered on all fronts.

 

[ItsJustaName]

So, you would rather let people die than donate because of one hospital's process?

Its not my decision whether someone lives or dies. I am not the only potential donor in the world.

It is my decision that I would never want my family to be subjected to the treatment my mother and siblings received. I strongly disagree with a process where nurses and doctors treating the patient are not allowed to use discretion is which families are approached.

I think that I have every right to put my family ahead of strangers.

 

[Karmady]

D Omari's tweet says CD is his bro and a family member so he's covered on all fronts.

yes, he is a family member "nunc pro tunc" lol

Nunc pro tunc - Wikipedia, the free encyclopedia

jmo

 

[txsvicki]

I'm just glad we still have to the right to decide whether or not we want to be organ donors and free speech to say if or why we do not want to. I'm not even saying my status because it's no ones concern but my own. It's my body.

 

[Donjeta]

Hopefully the process is not handled in such an insensitive way in many other places. Some families eventually manage to find comfort in the thought that their loved one's death helped other people.

 

[joypath]

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.)

Terrific, CLEAR & Concise presentation, K_Z! Been missing you all, being whipped by cellulitis :tantrum:...beware of residents dropping sharp objects, I'm just saying!

Okay: here's the CDC link regarding standardized death certificates: http://www.cdc.gov/nchs/data/dvs/blue_form.pdf (included 'cause I'm NOT & with this new BOSS NEVER,ever going to be WS verified! & remain @ OCME!)
Please note Item 32 & scroll down to directions:THIS part of the form SHOULD HAVE BEEN COMPLETED @ CHO & before the Coroner/OCME was notified. It is the provider(s)'s BEST MEDICAL OPINION, it is the "reason d'etre" for the OCME's intervention. YES, the MSM has claimed the cause of death as pending BUT I'm betting that the pending piece(s) of the certificate is /are Items #33(BLANK or a handwritten "pending") & DEFINITELY #37 as "pending investigation".

CHANGES to the COD can be made if/when more information is available, USUALLY those changes are "contributory" or "due to" dx. ALL "bits & pieces" are coded & gathered as statistical data.

Item #37 will be completed eventually. The OCME/Coroner has final say over this factor, families DO NOT choose whether a decedent gets an autopsy. We do listen & evaluate but the Coroner/ME makes the final choice UNLESS a court order demands a post. IMHO, if YOU want your family member to be officially examined make with passion & FACTS your case to the authorities ASAP! (editorial comment, not OCME policy!)

The family may contract for a private autopsy AFTER the official one but NOT in lieu of one. If NOT designated an OCME case, the family may contract for a private autopsy also, at their cost.

Specific to this case, an autopsy IMVHO should be performed. The data discovered again IMVHO will NOT be a crystal ball regarding a future lawsuit.


Adding this link 'cause I'm wicked partial to this organization! (LOL, wonder why?) https://netforum.avectra.com/temp/ClientImages/NAME/76bc59b3-9464-4ca8-8b2a-1f0624b22f99.pdf

 

[Donjeta]

To say that there is hope is meaningless. Hope for what? For a cure? For a longer survival? For a return of some degree of brain function?

And to say that there is no hope -- a statement that I hear far too often from well-meaning colleagues -- is meaningless. Of course there is always hope, for something. This statement is harmful, too. To say that there is no hope effectively cuts off any thought for the future.
What could Jahi McMath's family have hoped for? That's the most important question, and it's one that hasn't received any attention. But there are possibilities.

They could have hoped for an assurance that Jahi wasn't suffering. They could have hoped that their entire family would have a chance to come together to say their goodbyes. They could have hoped for an understanding of the events following the tonsillectomy that led to her death.

These hopes may sound pitifully anemic in comparison to the hope of a daughter returned to health, and of course they are. That's why it's essential for health care providers to help patients and families to navigate the language of hope. Perhaps no one could have convinced Jahi McMath's family that hope for her recovery was unreasonable. Someone could have offered other goals to hope for. Goals that were more realistic, and hopes that might be realized.

http://www.huffingtonpost.com/david-casarett-md/jahi-mcmath-and-the-dange_b_4574303.html

Though a death certificate has been issued for Jahi McMath, many of the 13-year-old Oakland girl’s classmates still believe the “quiet leader” who laughed at jokes that weren't funny will one day return to school — if they just pray hard enough.

“The school told us that she’s not officially dead yet,” said *DA*, one of Jahi's friends at EC Reems Academy of Technology and Arts in East Oakland. “And we should keep her in our prayers. I still hope. And God has the last say-so.”

The academy's chief operating officer Lisa Blair said she has tried to honor Jahi's family's wishes by telling students that their classmate may still be alive, even though doctors say she is legally and clinically dead.

http://www.nbcbayarea.com/news/loca...-Academy-Friends-Believe-Alive-239629891.html

Initials by me. Her siblings and classmates are named here.
JMO I think the media should leave those kids alone... MOO



http://www.newsday.com/opinion/oped...t-care-for-those-who-are-brain-dead-1.6767446

Caplan: The case against care for those who are brain dead
Originally published: January 9, 2014 4:50 PM
Updated: January 9, 2014 6:05 PM
By ARTHUR CAPLAN

Thirteen-year-old Jahi McMath died on Dec. 12 at Children's Hospital & Research Center Oakland.
Yet about a month later, Jahi is still on a ventilator because her parents refuse to accept her death. Aided by a misguided legal decision, she has been moved to another facility to be kept on artificial life support, which makes no medical or moral sense. What's being done to her corpse is wrong, but a bigger issue is the threat her case poses to the rational and moral use of health care resources.

http://www.firstthings.com/onthesquare/2014/01/reflections-on-the-jahi-mcmath-tragedy

We should all have great empathy for Jahi’s heartbroken family. Indeed, Judge Grillo magnificently threaded the needle, correctly applying the law, but mitigating its harshness with the balm of compassion. He did not require Children’s Hospital to treat Jahi as if she were alive, for example, refusing the family’s request to force the insertion of a feeding tube. On the other hand, he delayed state coercion—and the bitter public distrust that would have sowed—by giving the family time to make private arrangements to continue their quixotic quest.

This is a horrible tragedy. But in all the outpouring of support for Jahi and her family, we see that in America human life still matters. That, at least, is worth celebrating. May God bless Jahi McMath.

 

[BeginnersLuck]

I'm not sure how useful 80 year old bone and skin might be - but my main point was that a group of college graduates, all pro organ donation were so incensed by the insensitivity of the process that none of us are organ donors anymore. I have told my spouse specifically that I do not want to be a donor. If the hospital had only made us wait a few minutes it might have been okay. The process was insensitive. The OPO reminded me of Dan Ackroyd pretending to be a used car salesman.

I can completely understand how a grief stricken mother, who was not expecting a dead daughter, who was still in denial, would be very upset about the process.

Organ donation is a wonderful thing for the recipients. Its a good thing for society. Some donor families get great satisfaction knowing that their loved one's death helped other. But there is often collateral damage to grieving families that are forced to wait and deal with an arm twisting salesman and a time of great emotion. (I know not all OPOs are that way but ours was).

If the McMath family's experience was anything like ours than I am not surprised that she would think that the hospital was more interested in her daughter's organs than her recovery (especially since there was no chance of recovery, she would be right).

I'm sorry that your experience was so bad with this person.

I can say that throughout my life I have had "bad" experiences in a personal and professional setting. I prefer to look at it from a perspective that the relationships weren't a good match. Therefore, I discontinued the association with that individual and moved forward. I didn't allow my feelings to cross over to every person of that profession or ethnicity or gender etc..etc...

I don't allow an encounter with one employee at a facility or business to form my opinion about that business as a whole. I have been known to call businesses/organizations with my concerns of employees though. I do that because I don't want others to have bad experiences and if it were my business I would want to know about a employee.

I would encourage anyone that has had any kind of bad experience, to talk to someone else that might be able to mend that wound.

On another note:

I would hate to see people stop receiving medical care just because they had one bad experience or read about a sensationalized story in the news. I think the reporting of this case has created some exaggerated fears.

 

[Herding Cats]

I have a question. I've read several places (and can't link, sorry...can't find them again) that say Jahi has had other surgeries prior to this one (three, iirc). For a 13 year old, that's a fairly high number if she was a normal, "healthy" child.

Can anyone confirm this, and/or provide any further information? I am trying to figure out if there was any indication of a co-morbidity, or a higher-than-average risk for her UPPP et al procedures, and, if so, would that account for the ICU watching and subsequent hemorrhage.

TIA!

Best
Herding Cats

 

[popsicle]

Nick Smith ‏@nicksmithnews 5m
@sevnthstar I have continued contact w/family of #JahiMcMath & @cbdlaw. As soon as they give pic to share, I will. #accuratereporting