Jahi’s family wants her declared 'alive again’

[Hiandmighty]

The fact that he used sandbagged shows he is acting. He already knows what the State of Cali uses to determine BD, and he did not attempt to refute those findings. Hence, he did not put forth evidences disputing BD. Dr. Fisher's response was just stating the obvious. No surprise or sandbagging.

If Dolan was serious about this case, he would have had ALL the tests that Cali uses to determine BD, and have them done by qualified persons and submitted the results as evidence. As an experienced lawyer, he knows who is qualified to be an expert witness and who isn't. He knows his 'team' doesn't met the qualifications.

This is exactly right. Dolan didn't try to refute what Dr. Fischer said. Dolan tried to come in a different way and throw out MOO :cow: a bunch of poo to see if anything stuck.

Somebody needs to stop these people-- stop Dolan, stop the parents, excuse me but.... Pull the plug and bury that poor girl's body.

At some point, her body is going to become a biohazard! (Probably when that black blister on her finger pops... The finger next to the finger with the hole in it)...

 

[TJL]

According to their CV's Shewmon, Mihalenko and Prestigiacomo are physicians.

There are four names of people who submitted to be accepted as expert witnesses (as per the Alameda county public records search)
DeFina, Machado, Labkovsky, and Prestigiacomo. These are the only ones I'm concerned with, or anyone else should be for that matter. They formally submitted their names to the court for scrutiny (expert witness). (And of course, Fischer...but he's not the kind of expert witness Dolan likes: one who's actually qualified to talk about what he's talking about).

You got me on Prestigiacomo. He's the only one with an apparent MD and license as such in the U.S.

What did he report, exactly, on this case to the court in writing?

 

[Donjeta]

There are four names of people who submitted to be accepted as expert witnesses (as per the Alameda county public records search)
DeFina, Machado, Labkovsky, and Prestigiacomo.

You got me on Prestigiacomo. He's the only one with an apparent MD and license as such in the U.S.

What did he report, exactly, on this case to the court in writing?

http://www.thaddeuspope.com/images/McMath_Linked_File.pdf

 

[ajaylee]

Long thread, forgive me if this has been posted before.

I heard on the radio (no link, unfortunately), that this new effort to get Jahi declared alive has something to do with potential payouts in the inevitable medical malpractice lawsuit. Apparently if she's technically still alive, the potential payouts are much greater.

 

[Herat]

yes, they would be "lifelong" benefits.

 

[Quester]

yes, they would be "lifelong" benefits.

Yes - "lifelong" benefits for this coroner certified dead, brain-dead body and, if Attny CD has his way, voted for by the majority CA idiots and ultimately paid for by all Californians (brain-live and brain-dead combined).

:notgood:

 

[TJL]

http://www.thaddeuspope.com/images/McMath_Linked_File.pdf

I'll bite again:

Prestigiacomo's statement (Page 140 of your link)

5. I have reviewed the following material: (1) The MRI of Jahi McMath's brain, (2) the MRA of Jahi McMath's brain both conducted at University Hospital.

(bbm: okay, he looked at images shown to him by Dolan. We already know this is NOT the procedure for establishing or examining a patient to determine or exclude BD. A physician must personally observe and/or conduct the tests in-person to validate or invalidate such a diagnosis.)

6. I have the following opinions to a reasonable degree of medical certainty and probability:

(bbm: ahhh, he's giving an opinion. Clever. Being careful not to use the word diagnosis, because he knows he's not qualified to do so based on merely looking at images of tests not performed in his presence, with established standards and controls in place. Have you ever had a doctor order a CT or MRI on your body for something? Who interprets the images from your MRI and provides expert opinions? The doctor who ordered the MRI, or the radiologist who performed the scan? Look at that imaging report, and you'll see the radiologist's name at the bottom. This same principle applies to virtually any sort of test, examination, etc. Doctors don't give diagnosis for things they are not personally witness to. - which raises an interesting question from me: I would like to see the radiologist's report from the new MRI and MRA.)
...I don't need to quote him any further.

 

[Donjeta]

To be fair, it's not that unusual for doctors to review images and make diagnoses based on scans and data from other tests that were not conducted in their presence.
I don't think Fisher was present in all the tests and scans that he used to make his diagnosis back in December either.

But of course they need to be the correct and relevant tests conducted by reliable methods and equipment and Fisher has legitimate concerns here (IMO).

I wish there was a proper radiologist's statement about the MRI scans. What all has been destroyed, what structures are there, what does the remaining tissue look like etc.
It seems to me that the destruction that is obvious to the untrained eye would render it pretty much impossible that she has any kind of voluntary movement in response to commands even if everything else is perfectly functional.

 

[nrdsb4]

There are four names of people who submitted to be accepted as expert witnesses (as per the Alameda county public records search)
DeFina, Machado, Labkovsky, and Prestigiacomo. These are the only ones I'm concerned with, or anyone else should be for that matter. They formally submitted their names to the court for scrutiny (expert witness). (And of course, Fischer...but he's not the kind of expert witness Dolan likes: one who's actually qualified to talk about what he's talking about).

You got me on Prestigiacomo. He's the only one with an apparent MD and license as such in the U.S.

What did he report, exactly, on this case to the court in writing?

From Dr. Fisher's letter:

6. Dr. Prestigiacomo has referred to a "sleep apnea test," and that is not the correct examination in the determination of brain death.

This "EXPERT" doesn't know the difference between a sleep apnea test and an apnea test which is one of the standard tests used to determine brain death? Yep, I bet Dr. Fisher got his feelings real hurt by having to respond to that...(rolls eyes).

 

[Herat]

Most physicians who review imaging studies are very careful to specify the date, time, and number of slices/ files/ etc to specifiy how complete their examination was.

His statement is so incomplete it shows how little experience he has at this.

 

[Herat]

6. Dr. Prestigiacomo has referred to a "sleep apnea test," and that is not the correct examination in the determination of brain death.

Oh, that is a HUGE mistake. Like an amateur playing doctor mistake.

Dolan can't claim this to be a typo. Prestigiacomo and several others would have reviewed this before submission.

 

[nrdsb4]

But of course they need to be the correct and relevant tests conducted by reliable methods and equipment and Fisher has legitimate concerns here (IMO).

I wish there was a proper radiologist's statement about the MRI scans. What all has been destroyed, what structures are there, what does the remaining tissue look like etc.
It seems to me that the destruction that is obvious to the untrained eye would render it pretty much impossible that she has any kind of voluntary movement in response to commands even if everything else is perfectly functional.

Please correct me if I'm wrong, but didn't Dolan put forth the MRI as proof of "blood flow to the brain"? And Dr. Fisher states that neither MRIs nor MRAs are tests which are used to determine whether or not there is blood flow to the brain (that would be a cerebral blood flow scan, correct?).

 

[TJL]

To be fair, it's not that unusual for doctors to review images and make diagnoses based on scans and data from other tests that were not conducted in their presence.
I don't think Fisher was present in all the tests and scans that he used to make his diagnosis back in December either.

But of course they need to be the correct and relevant tests conducted by reliable methods and equipment and Fisher has legitimate concerns here (IMO).

I wish there was a proper radiologist's statement about the MRI scans. What all has been destroyed, what structures are there, what does the remaining tissue look like etc.
It seems to me that the destruction that is obvious to the untrained eye would render it pretty much impossible that she has any kind of voluntary movement in response to commands even if everything else is perfectly functional.

Sure, to be fair it's not unusual for doctors to review images and make diagnoses based on scans and data from other tests that were not conducted in their presence.

HOWEVER, they don't make up their own diagnosis in conflict to what the radiologist reports. In other words, they say, "The imaging and radiologist report states a full-thickness tear of the rotator cuff...diagnosis: full-thickness tear of the rotator cuff." Of course, this is also done after personal examination of the patient, including hands-on testing themselves (in the rotator cuff example, my own, they yank my arm around, shove their thumb deep into the tissue and joint, etc), and then give their diagnosis with the MRI as supporting evidence.

What we're seeing here, and the point I was trying to drive home but I guess did not make happen, is an apparent physician (who knows better) giving a far-fetched opinion based merely on what he's being told by other people, with no established standards or controls in place, and no certifiable evidence presented.

 

[TJL]

6. Dr. Prestigiacomo has referred to a "sleep apnea test," and that is not the correct examination in the determination of brain death.

Oh, that is a HUGE mistake. Like an amateur playing doctor mistake.

Dolan can't claim this to be a typo. Prestigiacomo and several others would have reviewed this before submission.

Right! Hence my "rocket scientist" vs. "cub scout paper airplane" reference. Dr. Fischer knew he was arguing with people who were clearly playing with less than a full deck of information and experience. He wasn't offended or ego-bruised; I'm sure he found humor in his own writing.

 

[Donjeta]

Please correct me if I'm wrong, but didn't Dolan put forth the MRI as proof of "blood flow to the brain"? And Dr. Fisher states that neither MRIs nor MRAs are tests which are used to determine whether or not there is blood flow to the brain (that would be a cerebral blood flow scan, correct?).

MRA means magnetic resonance angiography and it's a technique to visualize blood vessels but the pediatric guidelines state that MRA has not been properly validated in children's brain death examinations
http://pediatrics.aappublications.org/content/128/3/e720.full

Other ancillary studies such as the Transcranial Doppler study and newer tests such as CT angiography, CT perfusion using arterial spin labeling, nasopharyngeal somatosensory evoked potential studies, MRI-MR angiography, and perfusion MRI imaging have not been studied sufficiently nor validated in infants and children and cannot be recommended as ancillary studies to assist with the determination of brain death in children at this time.

 

[Donjeta]

Sure, to be fair it's not unusual for doctors to review images and make diagnoses based on scans and data from other tests that were not conducted in their presence.

HOWEVER, they don't make up their own diagnosis in conflict to what the radiologist reports. In other words, they say, "The imaging and radiologist report states a full-thickness tear of the rotator cuff...diagnosis: full-thickness tear of the rotator cuff." Of course, this is also done after personal examination of the patient, including hands-on testing themselves (in the rotator cuff example, my own, they yank my arm around, shove their thumb deep into the tissue and joint, etc), and then give their diagnosis with the MRI as supporting evidence.

What we're seeing here, and the point I was trying to drive home but I guess did not make happen, is an apparent physician (who knows better) giving a far-fetched opinion based merely on what he's being told by other people, with no established standards or controls in place, and no certifiable evidence presented.

Oh well the point some of them are making is that Jahi McMath is not brain dead because the MRI shows there is brain tissue left in her cranium and it hasn't all turned into liquid. I don't think that a radiologist would disagree with the part that there is brain tissue left. The fundamental problem (imo) is that there is not a lot of frame of reference and no one's quoted any studies about how fast everything disintegrates and turns into liquid and how long tissue may remain if brain dead people are maintained on life support indefinitely. It's not a requirement in any guidelines that everything inside the cranium must have disintegrated.

I wonder if some of them may have been pretty careful in not conducting any tests themselves because if you just state that i've been told that Jahi Mcmath responds to commands and that is inconsistent with brain death it's hard to argue with. None of them state that Jahi was ever able to respond to any of their commands or requests.

 

[TJL]

Oh well the point some of them are making is that Jahi McMath is not brain dead because the MRI shows there is brain tissue left in her cranium and it hasn't all turned into liquid. I don't think that a radiologist would disagree with the part that there is brain tissue left. The fundamental problem (imo) is that there is not a lot of frame of reference and no one's quoted any studies about how fast everything disintegrates and turns into liquid and how long tissue may remain if brain dead people are maintained on life support indefinitely.

I wonder if some of them may have been pretty careful in not conducting any tests themselves because if you just state that i've been told that Jahi Mcmath responds to commands and that is inconsistent with brain death it's hard to argue with.

And the point that the real, certifiable experts are making is that absence or presence of any particular portion of brain matter does not indicate or contraindicate brain death. That is NOT the established standard for determining brain death, and plays absolutely no role in making such a diagnosis. But one cannot argue with the fact that completely missing structures such as the pons after anoxic brain injury would render a patient (body) incapable of giving indications of life that that particular structure is responsible for. Any test or "opinion" contrary to that would require established controls and standards to verify, not merely a cell phone video of a mother capturing lazarus movements after speaking to the body.

Such things would be "interesting of note" to any reviewing physician, but only so far as to want to see it for themselves if their interest is piqued enough. Giving a professional opinion suggesting the brain is still alive is not only irresponsible, but academically absurd.

edit: sorry, having internet browser problems and had to keep opening/closing to finish what I was saying.

 

[Donjeta]

And the point that the real, certifiable experts are making is that absence or presence of any particular portion of brain matter does not indicate or contraindicate brain death. That is NOT the established standard for determining brain death, and plays absolutely no role in making such a diagnosis. But one cannot argue with the fact that completely missing structures such as the pons after anoxic brain injury would render a patient (body) incapable of giving indications of life that that particular structure is responsible for. Any test or "opinion" contrary to that would require established controls and standards to verify, not merely a cell phone video of a mother capturing lazarus movements after speaking to the body.

It seems to me that you're arguing with me and trying to prove some point to me but I don't think we actually disagree.

 

[TJL]

It seems to me that you're arguing with me and trying to prove some point to me but I don't think we actually disagree.

LOL sorry Not trying to argue or believe we arguing, I just felt it's important to keep the dialogue going so we're all exploring the issue objectively.

 

[MyBelle]

Oh well the point some of them are making is that Jahi McMath is not brain dead because the MRI shows there is brain tissue left in her cranium and it hasn't all turned into liquid. I don't think that a radiologist would disagree with the part that there is brain tissue left. The fundamental problem (imo) is that there is not a lot of frame of reference and no one's quoted any studies about how fast everything disintegrates and turns into liquid and how long tissue may remain if brain dead people are maintained on life support indefinitely. It's not a requirement in any guidelines that everything inside the cranium must have disintegrated.

I wonder if some of them may have been pretty careful in not conducting any tests themselves because if you just state that i've been told that Jahi Mcmath responds to commands and that is inconsistent with brain death it's hard to argue with. None of them state that Jahi was ever able to respond to any of their commands or requests.

I think the point these experts have made is that there is some brain function remaining. As minimal is that function may be it means that Jahi does not meet the California statutory requirement that ALL brain function must be absent. It is the legal quandary a court needs to address, not a medical one.

JMO