CA - Parents Of Toddler Declared Brain-Dead Convinced He’s Still Alive

[K_Z]

KZ, question: I understand the physiology of the Lazarus sign as far as the nerve pathway, but don't understand how it originates. Is it just random nerve movement because the body is still functioning even if the brain isn't? If so, why does Israel respond that way every time his mom touches him? Also, are the arms the only place that nerve transmission is seen or are there other areas of the body that can move?

Thanks in advance!

I have to run, but will answer more later. There are a number of stimuli that can cause muscular movement. I'm not trying to be funny, but here is a video that might explain this more graphically. It's fresh frog legs, moving in response to the stimuli (salt-- an electrolyte). There is no question that the 3 unfortunate frogs who previously owned these legs are dead. Of course, a human mammal is not an amphibian, but these frog muscles are responding to the stimuli just like mammal muscles might.

In fact, there is a diagnostic test for a very serious condition called Malignant Hyperthermia, a genetic disease where patients have life threatening reactions to some anesthesia drugs. In that test, a muscle contracture test, a fresh sample of thigh muscle is removed surgically, and exposed to triggers to see if the patient has MH.

http://www.mhaus.org/testing/chct

Here's the frog legs with the sodium chloride stimulant:

[video=youtube;2YZJt_Bw3eo]https://www.youtube.com/watch?v=2YZJt_Bw3eo[/video]

 

[K_Z]

Well, I guess my point is that doctors can be wrong sometimes. Abigail was actually declared dead at first.

"Doctors called time of death. The Kopfs lay over their daughter, sobbing. Then Vickie Kopf felt her move."

http://wkbn.com/2016/03/14/the-recovery-of-kalamazoo-shooting-victim-abigail-kopf/

Correct, docs can be wrong. Abigail's case was massive head trauma. Israel's death is from a medical/ disease cause, not trauma. As such, he has had weeks of testing, all of it entirely consistent. There is no mistake with brain death properly diagnosed. Israel has had MRI, CT, doppler flow studies, and radionuclide testing, in addition to apnea testing, EEG, and clinical exam. They are not wrong, and no mistake in the diagnosis was made. This unfortunate child is brain dead, and has no hope of ever recovering.

Brain death is a "first world" problem, created by our advanced technology, skill, and medications. Organ transplant is a miraculous therapy to preserve and restore the lives of the very sick and dying, from the gifts of the dead. That is why it is so hard to grasp for so many. For one to live, another must die. What is particularly frustrating is that the racial/ ethnic groups who represent the lowest rates of willingness for donation (living donation, and after cardiac or neuro death), and "reject" brain death, are also the very groups of people who have the highest percentage of transplant candidates on the lists, and have no conflicts morally, religiously, or ethically with being organ recipients. I can't wrap my head around that. It's profoundly sad. These groups historically are more than willing to take, but won't consider giving.

 

[scmom]

After reading through the court documents at the link KZ posted I wondered what was was being referenced about the state possibly becoming Israel's guardian so I started looking and found this article, http://www.sacbee.com/news/local/health-and-medicine/article75472347.html.

 

[katydid23]

After reading through the court documents at the link KZ posted I wondered what was was being referenced about the state possibly becoming Israel's guardian so I started looking and found this article, http://www.sacbee.com/news/local/health-and-medicine/article75472347.html.

from article:


Multiple hospitals have been involved in Israel’s care. According to court papers filed by Kaiser’s lawyers, Israel was treated at Kaiser Vacaville’s emergency department for a severe asthma attack about four months ago. In January, the filing said, the child’s parents and county Child Protective Services were informed that Israel’s medical history and the failure to comply with medical recommendations were weakening Israel’s lung capacity to the point where he might be unable to recover from a severe bronchospasm.

In another court declaration, Dr. Paul Byrne, a non-Kaiser pediatrician who examined Israel’s medical records on behalf of Fonseca and visited Israel several times in the hospital, said the 2-year-old suffers from hypoxia (lack of oxygen supply to body tissues) and hypothyroidism, a deficiency in thyroid hormones. He was also being treated for diabetes insipidus, which causes extreme thirst and heavy urination.

In the court documents, Kaiser states that Israel had an asthma attack at home on April l. He was taken to Mercy General Hospital’s emergency room, where he was intubated and transferred to the pediatric intensive care unit at UC Davis Medical Center. The ventilator tube was removed the next day and, shortly thereafter, he had a second asthma attack and suffered cardiorespiratory arrest. He was again intubated, placed on a ventilator, and treated with a pump to circulate blood through an artificial lung back into his bloodstream.

On April 4, brain scans showed “near total absence of blood flow into the bilateral cerebral hemispheres.” Eight days later, on April 12, Kaiser Roseville admitted Israel, with his parent’s consent, for a second brain death examination.

Read more here: http://www.sacbee.com/news/local/health-and-medicine/article75472347.html#storylink=cpy

 

[K_Z]

Order denying the Preliminary Injunction from the hearing 5/12/16, and the appeal filed by Jonee Fonseca, from Professor Pope's website:

http://thaddeuspope.com/images/Fonseca_v._Kaiser_ED_Cal_05-13-16_Order.pdf (31 pages)

http://thaddeuspope.com/images/Fonseca_v._Kaiser_ED_Cal_05-13-16_Appeal.pdf (7 pages)

 

[K_Z]

After reading through the court documents at the link KZ posted I wondered what was was being referenced about the state possibly becoming Israel's guardian so I started looking and found this article, http://www.sacbee.com/news/local/health-and-medicine/article75472347.html.

This is from the link below of the state court proceeding: (Snyder is the Fonseca attorney from the Life Legal Defense group; Jones is the attorney representing UC Davis hospital)

THE COURT: ….and I see that Mr. Coffman is present on behalf of the county public guardian – as to whether or not this court should appoint the Director of the Department of the Public Guardian as a temporary guardian of the person of the minor child.
I want to hear from each of you on that.

MS. SNYDER: Your Honor, we would ask that that not be the case; that – that the parents would – would retain their – their role at this time. We do have a declaration by the parents with regard to the – the missed appointments that states – and I’ll get that to you, but that states that many of those appointments were rescheduled. There was one medication that was not refilled. It was one steroid medication, and that was because Israel became violently ill when he took that – that medication. And if you like, you can hear from Israel’s mother regarding that. But his parents have signed a declaration to that effect.

THE COURT: That’s okay. I’ll accept your representations right now. I am just looking more to – obviously, you’ve touched upon the issue – when I see what was contained in here on its face, not accepting it as true, but as something that is brought before me, not from a true evidentiary perspective, but giving me knowledge of something that needs to be inquired upon as a judge when I see that because it – it raises, obviously, red flags in my mind and an issue. Are we in a situation akin to Dority at that point? You know. And, of course, I’m referring to the Dority, D-o-r-i-t-y, case, madam reporter. And so that’s where I stand. Yes, sir, Mr. Jones.

MR. JONES: Your Honor, I don’t think – I don’t think we’re there yet. I mean, in Dority, it had already – the guardianship had already been put in place –

THE COURT: Right.

MR. JONES: -- and this type of proceeding occurred.

THE COURT: So, I think we’re a little premature. At this point in time, Israel’s parents have full decision-making authority. And to the degree that that’s going to be challenged, I think that would be a decision of the public guardian in the state. I don’t know if it would be appropriate for Kaiser to chime in other than reporting what has happened. I don’t know that we would take a position at this point that the parents – adverse to the parents regarding the consent issue.

THE COURT: So if both parties are in agreement right now to continue with the restraining order as indicated here to the date and time that I’ve indicated, then at this time I would not be appointing the public guardian.

http://thaddeuspope.com/images/Stinson_v_UC_Davis_Placer_Cty_docs_.pdf (From the April 15 hearing.)

I have a couple comments here. First, missing appointments right after a very serious hospitalization in January is very worrisome, without immediately and proactively contacting the office to discuss the matter. It's clear that at the VERY least there was not good communication about this on Jonee's part. Second, electing to simply stop giving the oral steroids, without immediately notifying the child's doctor to get more advice and instructions, is extremely serious. I understand that stomach upset was a concern, but the steroids in a situation like that are absolutely essential-- a life sustaining medication. The doc may have elected to admit Israel for IV steroids if he could not tolerate them orally, etc.

No clinic or doc notifies child protective services for a missed appointment or two, nor for a parent "simply" stopping a medication as an outpatient. I have to believe that they did try to contact and communicate with the mom, and those efforts were not successful or productive. This is, IMO, not the simple and innocuous situation that the Fonseca attorney is trying to portray it as. IMO, there were serious disagreements between Jonee and her doc/s about Israel's care after the January admission to the hospital, and Israel had very severe asthma.

What also concerns me is that Jonee is a pharmacy tech, and works around pharmacists and medications all the time. Even as a technician, she should have had a very strong understanding that these medications were essential for her son's health, and to keep him out of the hospital. IMO, that makes her behavior that much more worrisome for Israel's health at the time. I think I understand why the docs contacted CPS, and why guardianship was in progress.

What is the "Dority Case" that is referred to? It's a CA court of appeals case from 1983, concerning a brain dead infant.

In this tragic case we are called upon to decide the propriety of judicial intervention regarding the termination of life support devices sustaining the bodily functions of a brain-dead minor.

Our courts are called upon to determine the rights and fate of persons in many situations and this may be one area in which we ought not to be involved. We are mindful of the moral and religious implications inherently arising when the right to continued life is at issue. Considering the difficulty of anticipating the factual circumstances under which a decision to remove life-support devices may be made, to say courts lack the authority to make such a determination may also be unwise.

The parents and counsel for the minor child petitioned this court for a writ of prohibition against removing the life-support device.

Before this court could act on these petitions, the infant's bodily functions ceased and the life-support device was removed.

http://law.justia.com/cases/california/court-of-appeal/3d/145/273.html (much more detail at link)

 

[K_Z]

When a part of the donor is used for direct transplantation pursuant to the Uniform Anatomical Gift Act (Chapter 3.5 (commencing with Section 7150)) and the death of the donor is determined by determining that the individual has suffered an irreversible cessation of all functions of the entire brain, including the brain stem, there shall be an independent confirmation of the death by another physician. Neither the physician making the determination of death under Section 7155.5 nor the physician making the independent confirmation shall participate in the procedures for removing or transplanting a part.

http://www.oclaw.org/research/code/ca/HSC/7182./content.html#.Vzgb85ErIfI

BBM. Just for info. CA state law, Health and Safety code 7182.

 

[MelmothTheLost]

What is particularly frustrating is that the racial/ ethnic groups who represent the lowest rates of willingness for donation (living donation, and after cardiac or neuro death), and "reject" brain death, are also the very groups of people who have the highest percentage of transplant candidates on the lists, and have no conflicts morally, religiously, or ethically with being organ recipients. I can't wrap my head around that. It's profoundly sad. These groups historically are more than willing to take, but won't consider giving.

We have the same problems in the UK, especially with the Muslim population. In fact it is a global issue where Muslims are concerned, not least because there is no clear guidance, religiously speaking, on whether organ donation is permitted or not.

http://www.bbc.co.uk/news/uk-33155326

 

[MelmothTheLost]

Education about these issues is the answer to this kind of ignorance and suspicion-- and that kind of ongoing community education has to come from LEADERS inside minority communities, IMO. Most times, saying "no" to organ donation is about the only control these unfortunate families feel they have. So they use "no" as a protest, and a way to "get back" at the evil medical establishment that they perceive has "killed" their loved one. Or, in cases like this one, and the McMath case, they engage in a high level of willful denial against the diagnosis of death, and "get back at" the "authorities" with long and drawn out court filings. IMO.

BBM

Is it really about education, though? I suspect it really does come down to religion in the end - not a problem of too much faith but one of too little faith.

It seems to me that at least part of the problem is that these families, both of which cite religious objections, don't actually trust God enough to really put their children in his hands. It's as though they are afraid that God's will in the matter is not the same as their own. They claim to have faith, but in reality don't have enough to put it to the acid test (in the accounting sense) of God's will.

 

[K_Z]

I wanted to add something more about the Dority case above, but missed the window for editing.

The Dority case was involved with parents who abused their child, and caused the injuries that produced the brain death. The parents wanted the life support continued, to shield them from homicide charges. The court appointed a guardian for the child, AFTER the child was declared brain dead, and the parents stopped cooperating. That guardianship allowed for the life support to be withdrawn after organ failure. The parents were subsequently arrested and charged with felony child abuse and neglect.

That the court in Israel's case was invoking Dority as a "comparison" case, suggests strongly (IMO only, as IANAL) that the court was being put in a position to evaluate the request for child protective services by the attending doc, for actions/ behavior that occurred prior to the current admission to hospital of Israel.

In essence, that court discussion above between UC Davis attorney and Jonee's Life Legal Defense attorney was *dancing* around the issue of "how much" culpability Jonee had for causing the asthma exacerbation that lead to the current hospitalization and brain death, and whether her current actions asking for extended TRO and continued life support was to somehow avoid consequences for her previous behavior. IMO, that is a huge window into the back story of the state case, and subsequent dismissal. It also explains why Jonee was seeking to be named Israel's guardian ad litem, which was legally "moot", because she had standing as his mother that means she didn't need to be named GAL---because no state guardian had yet been named for Israel. IMO, Jonee and her attorneys were anticipating that there was a high probability that Israel's guardianship was going to be changed, and him placed as a ward of the state. And then the state guardian could give "consent" to withdraw life support. And to follow that through, then "something" might happen to Jonee, such as criminal charges.

Yikes.

IMO, this is a much more complicated case than it first appears from the superficial coverage in the human interest mainstream media articles.

 

[katydid23]

This is from the link below of the state court proceeding: (Snyder is the Fonseca attorney from the Life Legal Defense group; Jones is the attorney representing UC Davis hospital)



http://thaddeuspope.com/images/Stinson_v_UC_Davis_Placer_Cty_docs_.pdf (From the April 15 hearing.)

I have a couple comments here. First, missing appointments right after a very serious hospitalization in January is very worrisome, without immediately and proactively contacting the office to discuss the matter. It's clear that at the VERY least there was not good communication about this on Jonee's part. Second, electing to simply stop giving the oral steroids, without immediately notifying the child's doctor to get more advice and instructions, is extremely serious. I understand that stomach upset was a concern, but the steroids in a situation like that are absolutely essential-- a life sustaining medication. The doc may have elected to admit Israel for IV steroids if he could not tolerate them orally, etc.

No clinic or doc notifies child protective services for a missed appointment or two, nor for a parent "simply" stopping a medication as an outpatient. I have to believe that they did try to contact and communicate with the mom, and those efforts were not successful or productive. This is, IMO, not the simple and innocuous situation that the Fonseca attorney is trying to portray it as. IMO, there were serious disagreements between Jonee and her doc/s about Israel's care after the January admission to the hospital, and Israel had very severe asthma.

What also concerns me is that Jonee is a pharmacy tech, and works around pharmacists and medications all the time. Even as a technician, she should have had a very strong understanding that these medications were essential for her son's health, and to keep him out of the hospital. IMO, that makes her behavior that much more worrisome for Israel's health at the time. I think I understand why the docs contacted CPS, and why guardianship was in progress.

What is the "Dority Case" that is referred to? It's a CA court of appeals case from 1983, concerning a brain dead infant.





http://law.justia.com/cases/california/court-of-appeal/3d/145/273.html (much more detail at link)

Also, from the article linked above:

"...said the 2-year-old suffers from hypoxia (lack of oxygen supply to body tissues) and hypothyroidism, a deficiency in thyroid hormones. He was also being treated for diabetes insipidus, which causes extreme thirst and heavy urination."


So this poor baby has a few difficult medical situations. So missing any appointments would be very problematic.

ETA: OOPS. Looks like i made a faulty assumption.

 

[K_Z]

Also, from the article linked above:

"...said the 2-year-old suffers from hypoxia (lack of oxygen supply to body tissues) and hypothyroidism, a deficiency in thyroid hormones. He was also being treated for diabetes insipidus, which causes extreme thirst and heavy urination."


So this poor baby has a few difficult medical situations. So missing any appointments would be very problematic.

Katydid, I think those conditions mentioned occurred during the current hospitalization, and lead to (and a consequence of) the brain death diagnosis. I don't think they refer to conditions Israel had prior to the current admission. That phrase is a direct quote from Dr. Byrne's declaration.

 

[MelmothTheLost]

In essence, that court discussion above between UC Davis attorney and Jonee's Life Legal Defense attorney was *dancing* around the issue of "how much" culpability Jonee had for causing the asthma exacerbation that lead to the current hospitalization and brain death, and whether her current actions asking for extended TRO and continued life support was to somehow avoid consequences for her previous behavior. IMO, that is a huge window into the back story of the state case, and subsequent dismissal.

Thank you for expressing what I have been trying to find the words to ask, ie whether the mother's actions are at least in part self-defensive and whether she was likely to be subject to criminal charges over the child's condition.

 

[al66pine]

Well, I guess my point is that doctors can be wrong sometimes. Abigail was actually declared dead at first.
"Doctors called time of death. The Kopfs lay over their daughter, sobbing. Then Vickie Kopf felt her move."
http://wkbn.com/2016/03/14/the-recovery-of-kalamazoo-shooting-victim-abigail-kopf/

From ^ link, appears the source re events & quotes in hospital ER is the mother.*
Was she actually inside the exam/ treatment room? Did she hear and see and understand everything as it occurred?
Is it possible in saying: 'doctors called time of death' the mother misunderstood exactly what med professionals said? IDK.

At risk of being labeled cynical, 'doctors called time of death' makes:
- a better quote in interview w MSM reporter (& soc media & in person), better than saying 'doctor said it was dicey.' (or ~ med equivalent)
- a better MSM print, broadcast, or online story, better than saying doctor said 'it was dicey.'

Whether 'ToD' stmt was factual or said w a bit of motherly license, I'm glad this teen survived, is on her road to rehabilitation.
Thoughts & prayers for her continuing recovery. And her family. Back on topic to little Israel Stinson. ^ all JM2cts, could be wrong.^

ETA: Thank you, modern medicine professionals here and elsewhere. Yay.

_________________________________________________________________________
* From link, w my bolding & underscoring, sole source of this info appears to be mother.

"At the hospital, Abbie’s vitals slowed. Staff started CPR...."
[mother states what she said]
Doctors called time of death. The Kopfs lay over their daughter, sobbing. Then Vickie Kopf felt her move.
“I said ..., ‘Could you please check her and make me feel better,’” she said.
The nurse checked and found Abbie had a pulse. She was alive, but likely brain-dead, the Kopfs were told....
[mother relates asking dau for a sign; dau then squeezing hand. Then repeated.]
Abbie gave doctors a thumbs up and she was rushed into brain surgery. Her condition was still grave and doctors made no promises that she would live.
[mother states she knew dau would survive] ....
"Less than a month after the shooting, Abbie is in a rehabilitation hospital in Grand Rapids. She can talk now...."

 

[jjenny]

Since Abigail's mother clearly describes that she saw doctors doing CPR, then clearly she was there. I don't think she misunderstood anything. Abigail was pronounced dead.

 

[sonjay]

Since Abigail's mother clearly describes that she saw doctors doing CPR, then clearly she was there. I don't think she misunderstood anything. Abigail was pronounced dead.

Even if Abigail was declared dead, it was based on her vital signs during an acute emergency. It wasn't a declaration of brain death, which involves a series of tests, which are then confirmed separately by another doctor.

So, even if we take Abigail's mother's story at face value, that story has nothing to do with the declaration of brain death in little Israel.

I'm not sure I take the Abigail story at face value. The article linked to is written by a non-physician reporter, on deadline, and has a lot of missing information, and what information is included comes only from a single source, the mother. We here at WS know how often reporters get information wrong. And we know how frequently parents and other family members & friends mis-remember or mis-report things.

But, as I said, even if we take this story at face value, it has nothing to do with Israel's diagnosis of brain death.

 

[sonjay]

A little Googling tells me that she probably was actually declared dead. But dead on the basis of a stopped heart, not brain dead:


"Lane-Davies declined to go into detail about Abigail's treatment and current status, only saying she remained on a ventilator and in critical condition. While her heart stopped and hospital officials had made contact with the organ and tissue donation program Gift of Life, he said, she never was declared medically brain-dead.'

http://www.battlecreekenquirer.com/...ts-abigail-kopf-she-did-not-deserve/80779376/

 

[sonjay]

The Daily Mail, as is frequently the case, has more details on the Abigail story.

He (Lane-Davies) also clarified at the news conference that contrary to previous reports, the 14-year-old was never declared medically brain dead, which is a process that requires multiple physical exams and could take hours.

http://www.dailymail.co.uk/news/art...-Abigail-Kopf-14-declared-dead-speak-out.html

And the Telegraph:

Abigail's heart stopped and despite the frantic efforts of several doctors and medical professionals, she was declared dead at Bronson Methodist Hospital in Kalamazoo later that night.



Her parents, Vickie and Gene Kopf, were allowed into the operating room to say goodbye to their daughter.


It was a scene that "no horror movie will ever match," Mr Kopf told the Battle Creek Enquirer, while Mrs Kopf said: "It's an image no human being will ever get out of their head.


"And every night, when I close my eyes, that's the image I see. And I don't know if it will ever fade."


However, as Mrs Kopf lay her head on what she thought was her dead child's still chest, she detected a sign of life – a breath or a feint heartbeat. "I felt that she was still there, even though they kept telling me she wasn't," she explained.
...
One doctor suggested the broken skull had given Abigail's injured brain room to swell without putting fatal pressure on the brainstem.

http://www.telegraph.co.uk/news/wor...higan-Uber-murders-walks-out-of-hospital.html


Wow. It sounds like like this little girl was indeed declared dead. It sounds to me like her very-much-working brain managed to give her heart orders to start beating again. Or, it was a miracle.

But it still has nothing to do with the brain-death diagnosis of little Israel.

 

[jjenny]

A little Googling tells me that she probably was actually declared dead. But dead on the basis of a stopped heart, not brain dead:


"Lane-Davies declined to go into detail about Abigail's treatment and current status, only saying she remained on a ventilator and in critical condition. While her heart stopped and hospital officials had made contact with the organ and tissue donation program Gift of Life, he said, she never was declared medically brain-dead.'

http://www.battlecreekenquirer.com/...ts-abigail-kopf-she-did-not-deserve/80779376/

Yes, she wasn't declared brain dead. Just dead. Sounds to me like she flat-lined, they tried CPR, couldn't get her heart beat back, and declared her dead. Which obviously means they thought her brain was dead as well (since clearly one can not be dead with an alive brain). So I am curious if they would even try to do brain death tests on her before donating her organs. There seems to be no point of doing medical tests on her to find out if she was brain dead if they pronounced her dead. I don't think this has anything to do with Israel's case, but sounds to me like this girl was pretty close to being used as an organ donor without actually being dead.

 

[K_Z]

This is a link to Professor Pope's comments on the court ruling Friday. He will probably have the appeals documents shortly after they are filed by Fonseca's attorneys, I'm guessing in the next day or two.

http://medicalfutility.blogspot.com/2016/05/us-district-court-rejects-attack-on.html