Family wants to keep life support for girl brain dead after tonsil surgery #9

[K_Z]

Well, I can think of a world renowned nationwide network of pediatric hospitals that provide advanced specialty care to any children, regardless of the family's ability to pay. Many of the more than 22 hospitals are affiliated with University Hospitals, and conduct important research, too.

http://en.m.wikipedia.org/wiki/Shriners_Hospitals_for_Children

There are many, many examples of charity care facilities, as well as nonprofit and private facilities that provide charity care on a case by case basis.

It's my opinion that Jahi McMath's family is not personally paying for any of the care provided by the St. Peter's hospital in NJ. I believe this admission was arranged as a charity care situation, as a manifestation of the charity missions of the Catholic Church and faith. I think the hospital board and administrators view this situation as providing a refuge and mercy to a mother and family with nowhere else to turn, and who is unwilling to accept brain death. I don't for a minute think there are any health professionals or administrators there that think Jahi can recover. They are just providing a refuge for the mother, and care for the body, IMO, until either the mother is willing to let go, or the heart finishes. JMO.

 

[nrdsb4]

Organizations like the Terri Schiavo foundation might pay for some of it.

On my part I'm confident that someone must be donating something as I doubt she would qualify for her family's regular medical insurance, having a death certificate and there's no way the family could pay out of their pockets and not be bankrupt and destitute by now.

I agree; the ******** site is helping, I'm sure, but certainly ICU care for a patient like Jahi would require more resources than what that site has raised. I'd forgotten about TSF, that may be a possibility.

 

[nrdsb4]

Well, I can think of a world renowned nationwide network of pediatric hospitals that provide advanced specialty care to any children, regardless of the family's ability to pay. Many of the more than 22 hospitals are affiliated with University Hospitals, and conduct important research, too.

http://en.m.wikipedia.org/wiki/Shriners_Hospitals_for_Children

There are many, many examples of charity care facilities, as well as nonprofit and private facilities that provide charity care on a case by case basis.

It's my opinion that Jahi McMath's family is not personally paying for any of the care provided by the St. Peter's hospital in NJ. I believe this admission was arranged as a charity care situation, as a manifestation of the charity missions of the Catholic Church and faith. I think the hospital board and administrators view this situation as providing a refuge and mercy to a mother and family with nowhere else to turn, and who is unwilling to accept brain death. I don't for a minute think there are any health professionals or administrators there that think Jahi can recover. They are just providing a refuge for the mother, and care for the body, IMO, until either the mother is willing to let go, or the heart finishes. JMO.

As always, very well said.

 

[MyBelle]

Not sure about Jahi but sometimes patients at St Peters do receive free services.

http://www.saintpetershcs.com/Patients-and-Visitors/For-Patients/Billing-and-Payment-Guide/

http://www.state.nj.us/health/charitycare/documents/charitycare_factsheet_en.pdf


Organizations like the Terri Schiavo foundation might pay for some of it.

On my part I'm confident that someone must be donating something as I doubt she would qualify for her family's regular medical insurance, having a death certificate and there's no way the family could pay out of their pockets and not be bankrupt and destitute by now.

I'm confident someone is paying for it. It would not be the State of New Jersey because she isn't a resident but I am confident some entity is paying for it.

JMO

 

[forthelost]

I'll believe she's not dead when they show the test results that show brain activity.

While most mainstream Catholics accept brain death as true death, some do not, and this hospital may have accepted her for political reasons.

 

[Donjeta]

I'm confident someone is paying for it. It would not be the State of New Jersey because she isn't a resident but I am confident some entity is paying for it.

JMO

The quote I posted says it's also available to nonresidents on certain conditions.

But I think the hospital might have waived the fees. Of course someone is paying in that case too, only not directly.

What I hope happened is that the organizations who promote the view that brain dead people should be maintained indefinitely on life support put their money where their mouth is and pay but I'm not sure they have the resources.

 

[jjenny]

^^^^The first I referenced has as its mission to treat ALL referred patients regardless of their ability to pay. The second I referenced does not do it routinely, only when special circumstances apply.

A friend died of leukemia recently. His insurance had run out, yet they treated him aggressively to the bitter end. His wife told me his bills were in excess of 6 million dollars, which she did not and never could pay. The hospital absorbed the costs. This hospital (and the second one I referenced) is a very large and renown teaching and research hospital, also in my city. I suspect these cases occur much more often than most people realize, so with regards to your certainty that this hospital would not donate all services, I wouldn't be so certain.

There was also the guy with brain dead pregnant wife in TX, who didn't want her to be kept on life support, but hospital did it anyway. I presume the hospital will have to absorb these costs of whatever is not covered by insurance.

 

[MyBelle]

The quote I posted says it's also available to nonresidents on certain conditions.

But I think the hospital might have waived the fees. Of course someone is paying in that case too, only not directly.

What I hope happened is that the organizations who promote the view that brain dead people should be maintained indefinitely on life support put their money where their mouth is and pay but I'm not sure they have the resources.

What organizations promote the view that brain dead people should be maintained indefinitely on life support? I think it will be snowing on the sun before any government or hospital waives the charges and admits a brain-dead person to an ICU bed just to appease a family. You are aware that Oakland Children's Hospital refused to do so, right?

JMO

 

[K_Z]

When we talk about what healthcare costs, it's important to remember that the COST of the care is vastly different than what is BILLED for the care, or what can be collected for the care. The cost for a unit of care is negotiated in advance with all reimbursers. A Blue Cross unit of care is billed and reimbursed differently than a Medicare unit, or a Medicaid unit, or a "no insurance" unit. Some care is billed piecemeal, some is bundled or flat rate.

Payor mix is an important part of how a price tag is affixed to a given "unit" of care. Payor mix refers to the blend of self pay, private insurance pay, Medicaid, Medicare, VA, and other payors. Medicare and Medicaid definitely do not pay for even about half of what a given service costs (and the per unit fee declines every year), so if your clinic or hospital is dominantly Medicare/ Medicaid, the facility can't bill enough to pay the staff and keep the lights on. (Facilities like Shriners are set up differently.) That is where payor mix and subsidies come into play. A big enough facility with a good payor mix can absorb more "no pay" situations. And the St Peter healthcare system is very, very large, with budget in the hundreds of millions, when I last checked. To be blunt, they can financially absorb one brain dead teenager's care without financially crumbling, IMO. This family does not have the means personally, or with their donation sites, to pay what the actual costs are, IMO. I doubt even the Schiavo organization could pay the bills. The bills since Dec 2013 probably top $2-3 million. (Jmo-- no link for that.)

That said, I'm extremely doubtful that any private insurer, or Medicaid, would pay anything for the admission for Jahi-- and NW has stated publicly she wants the death certificate "overturned" or revoked, in part, so she can apply for medical benefits for Jahi. That won't ever happen, IMO. As I've posted before, it would make for a nice splashy story for the media, but it will never happen.

I think we can all agree that the care the family has procured for Jahi is very specialty and labor intensive, as well as very expensive. The family may never pay a dime. Or they may be billed, but not able to pay, or have some other charities making some donations.

The family will never see a bill from St Peters, nor probably from CHO, IMO. What makes this situation intriguing is that a facility with a PICU apparently agreed to admit her knowing she was brain dead, with decisive court challenges, and a death certificate in a state 4000 miles away. For an undetermined period of time.

The Natasha Richardson example was a vastly different situation, and a family with substantial financial resources. Her admission was to get her back to the US, and provide a brief interval for family to gather and say goodbye.

 

[Quester]

... The coroner's office said that the death certificate -- which still needs to be accepted by the health department to become official -- has a date of death of December 12, 2013. ...
​

1/4/14: http://edition.cnn.com/2014/01/03/health/jahi-mcmath-girl-brain-dead/
​

* * *

BBM - Has/would have the death certificate since been accepted by the health department or would that not have been done (and therefore the death certificate would remain unofficial) until the autopsy is performed and those results included? TIA

What would be the ramifications, if any and in this bizarre case, if the death certificate currently remains "unofficial"? TIA

 

[lawstudent]

Just to clarify: I meant a typical private hospital. I'm aware that there are many hospitals that exist to provide charitable care or are teaching hospitals, and advertise as such. I just meant that doctors don't typically walk up to newly admitted patients and tell them they decided to donate care. Either it's an extraordinary circumstance, or the hospital is set up to target those patients. And I wasn't using Natasha Richardson as a comparison for the longterm decision to accept a patient, because they knew they would be paid and it was short-term. I was just using it as an example against people who said no hospital would admit a brain-dead patient.

I believe the Catholic position is that brain death is not death, but but brain death makes it okay to remove life support, resulting in death. Catholics don't consider the brain or mental awareness the fundamental part of a person - hence why they are so concerned with embryos and oppose abortion of fetuses with no brain etc. It gets reported that they recognize brain death as death, but I don't think so. Not in the sense that the soul has departed. They just don't believe humans are morally obligated to artificially maintain function to an extraordinary degree, so you can remove life support. Implicit in that belief though is the idea that God could work some miracle and the person could recover once life support has been removed. The Catholic Church really doesn't care about scientific 'impossibilities'. I don't think they'd view it as cruel to keep someone on life support. Talking about strict Catholic doctrine, of course, which most people who identify as Catholics do not subscribe to.

 

[Nore]

Her medical history is that she is brain dead. She was declared brain dead by multiple doctors. There is not a shred of evidence to suggest otherwise.

--------
Jahi is braindead. It hurts to say that about a thirteen year old but it is true. Her brain is incapable of functioning to keep
her alive. For proof, remove her from ventilator. If she continues to breath and have a heartbeat she is alive. If her heart
stops she is dead. The whole set of tests should be redone. Can anyone imagine the beautiful reaction if Jahi began to
move? on command? sit up in bed? No one would keep that from the public. That would be a miracle alright. People would gladly donate for her therapy, This would make every newspaper in the world. Why not show a full face picture of her right now? Sitting up with her legs crossed as though playing a game with another child? no hippa required for that.
Parents of Jahi, put that donated money where your mouth is. The poor child is dead. I am the first to say how sad. she had her whole life ahead of her, A good girl who did not deserve to die .But It Happened. as it did to the children of many on this board right now. We gave them dignity!

 

[wendiesan]

There was also the guy with brain dead pregnant wife in TX, who didn't want her to be kept on life support, but hospital did it anyway. I presume the hospital will have to absorb these costs of whatever is not covered by insurance.

There was some debate about the bills, at first the hospital said it would follow its usual billing methods. However, the John Peter Smith Hospital in Fort Worth eventually absorbed the costs of the 62 day stay that the hospital forced on Marlise Muños.
http://breakthroughs.kera.org/jps-hospital-will-not-send-a-bill-for-treatment-of-marlise-munoz/

 

[Spangle]

I doubt any hospital is going to admit a patient to an ICU just because the family of the patient has religious beliefs that the patient isn't dead. I just don't see it happening.

I'm pretty sure Saint Peter's knew her medical history prior to her being admitted but I have no proof of course because her medical records are private. And why would Oakland need to talk to a receiving hospital about a dead patient? That doesn't even make sense to me.

JMO

How can you be pretty sure? As you stated, it's private, so no, they would not have it. The original hospital wanted to 'talk' to the new one, but the family was having none of that. So if your pretty sure, explain your theory how they would have gotten the medical records before hand?

It is pretty standard procedure to do such direct talking between locations. To make sure the new place knows what they are receiving and to verify they have what they need ready to receive the patient. In this case, that would also include making sure the admitting facility understood she was declared legally dead by the state of CA because of her brain death. Based up reading some of the earlier articles, I believe the family thought they had a place lined up in CA, that pulled out of the deal when they received a better picture of the situation. Learning from this, in my THEORY it is my opinion the family wish to avoid contact and information exchange between the two location.

You say it doesn't make sense that Oakland would need to talk to the admitting hospital that it would be receiving a dead patient. It is still a body that is being maintained by the use of drugs and machines. The way around this was that they turned the body over to the corner, who turned it over to the family.

 

[Spangle]

I have no idea what they did. They may have admitted her based on their visual observations for all I know. Testing can be done as an outpatient and it can be done in an ER.

JMO

So what exactly are you trying to say? Your not making yourself clear. I see several posts of you talking about the admitting process at St. Peters and wither they would admit her. You seem all over the place on this issue and I am confused on what exactly your trying to say, or if your trying to say anything at all.

 

[nrdsb4]

I'm pretty sure Saint Peter's knew her medical history prior to her being admitted but I have no proof of course because her medical records are private. And why would Oakland need to talk to a receiving hospital about a dead patient? That doesn't even make sense to me.

When you transfer a patient from one facility to another, it ALWAYS follows that there is communication between the two facilities prior to transfer. Report from transferring nurse to receiving nurse is REQUIRED ALWAYS. Report from nursing supervisor at facility transferring to nursing supervisor at accepting facility is REQUIRED ALWAYS. These communications are essential so that the receiving facility/caregivers know the history of the patient, current medications, all relevant details of care so that the care proceeds seamlessly. Even though the brain death diagnosis no doubt complicates things, there is nothing, absolutely nothing unreasonable about a demand from the transferring facility to make contact with the receiving facility prior to them releasing the patient. You can't just load a patient onto an ambulance without that contact. If I were to transfer a patient to another facility without giving report to the receiving nurse, I could be charged with patient abandonment; my license could be in jeopardy.

You say it doesn't make sense that Oakland would need to talk to the admitting hospital that it would be receiving a dead patient. It is still a body that is being maintained by the use of drugs and machines. The way around this was that they turned the body over to the corner, who turned it over to the family.

That could well be. But if I am the transferring facility, I can't just give up the duty to report easily. You are going to worry about liability and deviating from SOP. You are going to want to cover your bases by doing what is ALWAYS required, even if someone tells you "Oh, don't worry, she's dead, the coroner is accepting responsibility." It would be very difficult to just let that go without getting major reassurance that you can deviate from SOP in that regard.

 

[Spangle]

So after the hospital checked her out, you believe they kept her as an inpatient knowing she meets not only the criteria for brain death but that she's also been declared legally dead? I don't believe that happened.

JMO

Yep. That is what I believed happened. Except the part of knowing she was declared legally dead. I believe after accepting her, they are legally required to follow the NJ law on the issue of brain death. And only found out later she was declared legally dead, hence no $$$ coming to pay her bills.

You say you don't believe it happened that way. But you didn't state what exactly YOU believe and give a logical reason for basing your beliefs just so. All those articles out there, legal records in the public, what known policies and procedures, etc. What is your well thought out theory's and how did you come up with them??

 

[Spangle]

There was some debate about the bills, at first the hospital said it would follow its usual billing methods. However, the John Peter Smith Hospital in Fort Worth eventually absorbed the costs of the 62 day stay that the hospital forced on Marlise Muños.
http://breakthroughs.kera.org/jps-hospital-will-not-send-a-bill-for-treatment-of-marlise-munoz/

View attachment 55816

Yep, I didn't see them winning that one against the insurance company

 

[lawstudent]

Was it established where she was between CA and the NJ hospital? That would seem to make a difference. I don't know how she could just show up at a NJ hospital and be admitted, unless they literally just took a chance going to the ER, in which case I assume they would have to admit her and would not know she was brain dead at first. But I can't imagine the hospital not trying to litigate this if they'd been forced into the situation. The NJ statute does not leave them as powerless as some seem to think. Plus they have to have someone providing all the medical equipment and transport, which is usually arranged between the tranferor and transferee. I would definitely lean towards the hospital willingly accepted her, but I don't know why. There's no legal bar against admitting a brain dead person - if they don't declare her legally dead, they can do it, for reasons I can't really fathom. CA's death certificate doesn't establish her status in every single situation - it can be relied on, but is not determinative.

 

[K_Z]

Medway Air Ambulance submitted a quote to transport Jahi and an attending physician to the facility for $27,950.

http://www.latimes.com/local/lanow/la-me-ln-jahi-mcmath-new-york-facility-20131231-story.html

http://www.latimes.com/local/lanow/la-me-ln-jahi-mcmath-new-york-facility-20131231-story.html

We don't know for sure if this company transported her, but back in December the family was actively seeking both ground and air transportation from Children's Hospital Oakland to an undisclosed location. Many thought the destination was the NY group run by the hairdresser, but the private home they were renovating into a group home facility was in the earliest stages of being gutted and rebuilt, and their "other" facility was an outpatient commercial building that rented office space to various therapists. They promoted this facility in advertising materials and online as a Community Center. There was definitely no inpatient capacity there.

It's possible, IMO, that she went directly from CHO to the NJ hospital. I'm pretty convinced she was a planned, direct admit, worked out in advance. There was some bad weather nationally when the family left CHO, but a combination of ground and air transport would have to have been used anyway. I've read that the uncle was tweeting about transport back then, but have no links.