Family wants to keep life support for girl brain dead after tonsil surgery #1

[Zuri]

Original letter from family's family to Children's Hospital Oakland. Written so quickly they refer to son rather than daughter. Please read page 2 paragraph on MICRA's $250,000 cap on non-economic (pain and suffering) damages.

http://www.cbdlaw.com/Letter-to-CHO.PDF

I just wanted to thank you SophieRose for linking all these articles. :seeya:

 

[BeginnersLuck]

Zuri, thank you and Dr. Zuri for taking the time to give your educated analysis of the case. I really appreciate your efforts, as it helps me to learn all the different aspects that come into play in these situations. One of the reasons why I have continued to participate in this forum is due to the fact that there are experts willing to take their time to give their educated opinions.

 

[SwampMama]

This is such a sad case and I appreciate everyone's input and experiences. I can see all sides from the clinical perspective of medical experts, knowing how such cases typically end, to the family who simply do not give up on a child no matter what.

http://www.contracostatimes.com/new...-family-brain-dead-girl-seeks-injunction-keep

So already FIVE experts have assessed her and confirmed she is brain dead. Two were all that was needed but the hospital accommodated the family and so THREE more independent experts assessed her and came to the same conclusion.

I think her family is probably in shock, deep denial and holding onto faith, praying for a Christmas miracle. They obviously need more time to come to terms with the fact that she is gone and is not coming back. I hope they find a resolution that brings them peace.

"In a legal filing, the hospital's attorney says that "two separate Children's physicians determined that Ms. McMath was brain-dead. In addition, at the request of the family, three additional independent physicians -- unaffiliated with Children's and either selected by or approved by Ms. McMath's family/next of kin -- examined Ms. McMath.

"Each confirmed the diagnosis of brain death. ... Accordingly, Children's has declared Ms. McMath to be dead."

The hospital listed numerous steps officials took to support the family once the diagnosis of brain death was made,.....
The strongly religious family has said from the start of the struggle that they are hoping for divine intervention and a medical miracle. "

 

[Zuri]

Jahi died 12 days ago essentially. Postponing the inevitable is prolonging the agony. Unfortunately, a lot of us never get the chance to say goodbye while they are alive. Hopefully, Jahi knew that she was loved by many and IMO the family is doing a disservice to not only Jahi, but themselves. If there is to be a miracle, there will be once the ventilator is disconnected, where she can breathe on her own, maintain all body systems and recover. That would be a miracle. The fact that the family does not want the vent disconnected and Jahi taken off all life prolonging measures speaks volumes. IMO They know she is dead. IMO they just can't let go. This young girl deserves true peace. It is time....JMV

 

[SophieRose]

Very sad letter from Jahi's mother to the public
http://www.contracostatimes.com/new...-letter-from-jahi-mcmaths-mom-keep?source=pkg

"She is Jahi a name that means 'known by many.' If she knew about all this attention she would blush. She is very shy.

"My daughter sits on life support. I feel like she is on Death Row. The clock is ticking -- ticking down. Children's Hospital Oakland says she is dead. She was not dead when I brought her here on Dec. 9 for a routine tonsillectomy. I put her in their hands, now they want to wash their hands of her.

 

[Linda7NJ]

Very sad letter from Jahi's mother to the public
http://www.contracostatimes.com/new...-letter-from-jahi-mcmaths-mom-keep?source=pkg

So sad.
"mothers guilt" for not listening To her daughters fears is going to haunt this mom till her dying day. That poor woman. Makes me want to hug her close.


Sent from my iPhone using Tapatalk 2

 

[SophieRose]

Jahi, her mom and 13 days at Children's Hospital Oakland
http://www.contracostatimes.com/new...om-and-13-days-at-childrens?source=JBarTicker

As tears rolled down her cheek, Winkfield said her daughter mouthed the words: "Don't cry mom."

"It was like she was still worried about me even though blood was coming out of her mouth," a tearful Winkfield said in her first extensive interview since her daughter made national headlines when Children's Hospital Oakland doctors declared her brain-dead Dec. 11 after¿ tonsil surgery complications caused cardiac arrest.

 

[Roxye]

I don't know if it is Mother's guilt or not, I don't care at this point. The child is certainly brain dead, and I said earlier in this thread, we as parents make informed decisions. My son told me right before adenoid/tonsillectomy surgery he was scared too. I told him everything would be fine, he would wake up, I would be there, and we would go get some chocolate ice cream or chicken noodle soup, what every he wanted. My son is fine.

That being said, something went wrong here, it's not the Mom's fault, and it doesn't appear to be the hospital's fault either.

What is so wrong about letting this play out AFTER Christmas. Give the Family more time to deal. And like earlier in the thread, send the child home on life support, so that the family can deal with it on a personal level, with home health care coming in every few hours/days to help them.

I think they would feel better if she died at home then in a hospital they felt didn't do what they expected them to do. Even if the hospital isn't at fault at all.

 

[shana]

Jahi McMath: Medicine's ability to keep a heart beating complicates how death is perceived

Excellent and informative article, imo.

 

[SophieRose]

On the news tonight, it was reported that the judge said that the opinion of the neurologist from USF would be enough for the hospital to disconnect the ventilator. Testing would be on Monday, back to court on Tuesday.

Then from this article.
http://www.contracostatimes.com/new...om-and-13-days-at-childrens?source=JBarTicker

Her attorney, Christopher Dolan, said even if the doctor next week rules Jahi brain dead, the family will file an appeal and stay with the California Court of Appeals and will take it to the California Supreme Court, if necessary.

"I will not stop until I have done everything in my power legally to stop this injustice," he said.
Her attorney, Christopher Dolan, said even if the doctor next week rules Jahi brain dead, the family will file an appeal and stay with the California Court of Appeals and will take it to the California Supreme Court, if necessary.

"I will not stop until I have done everything in my power legally to stop this injustice," he said.

 

[K_Z]

I've been an independent practice anesthetist for 15 years, and have probably done in excess of 500 T& A's. My husband is also an anesthetist, and many of our colleagues are docs and anesthetists. We have discussed this very sad case for the last 2 days, and cannot wrap our collective heads around WTH happened. Every single one of us cannot move the conversation beyond WHY did this patient not immediately return to the OR??? Post operative T & A bleeding is a SURGICAL problem-- NOT a "medical" one. No amount of transfusions or blood products will "plug the hole" in the dyke when the bleeding is massive. There was NOTHING that could be done to stop the bleeding in the ICU. You can pour blood into the tank for only so long.

It seems clear that she was alert and oriented and breathing well in recovery. News articles say "then" she was taken to ICU, and was AGAIN alert enough to write a note to her mom, so at that point she was not sedated, paralyzed, and intubated. It seems the bleeding continues for HOURS (news articles), she was transfused, and then she arrested, with subsequent catastrophic brain damage.

WHERE THE HELL WAS THE SURGICAL TEAM???????????????

There must be at least 20 ENT residents and docs in a hospital of that size, in a major metro area. And more than a dozen general surgeons, probably. I suspect the Anesthesia dept alone has 15+ anesthesiologists and probably 30+ anesthetists. Definitely they are big enough to have a dedicated anesthesiologist or 3 in the preop area, and in PACU. News articles do not describe a single member of the surgical team involved with the care of this teen. WHAT WAS GOING ON?? WHERE IS THE SURGICAL TEAM?

Absolutely this young girl had serious pre-existing conditions that made her high risk. She was morbidly obese, sleep apnea, and other conditions as described. She was at a MAJOR pediatric hospital.

The catastrophe this family is facing is monumental-- and will go on for years as they engage in legal action. Sadly, she is brain dead, and that cannot be reversed. It is just a matter of time now-- whether her body gives out first, or legal death is declared and she is removed from support.

Patients DO bleed following tonsil removal. She may have also had a UPP (uvulopalatoplasty), which is a fancy term for removing excess tissue in the posterior pharynx. She was high risk, with comorbidities, but was in a major metro pedes hospital.

I just cannot get beyond what happened beyond the popsicle and pink cup of blood. WHY was this teen not brought back to the OR? WTH happened in that process? Where was ENT or General Surgery? Where was anesthesia? Why didn't the ICU docs insist she return to the OR? This was a SURGICAL problem-- she bled out till she arrested. That seems clear from all the news reports.

 

[fruity]

Jahi died 12 days ago essentially. Postponing the inevitable is prolonging the agony. Unfortunately, a lot of us never get the chance to say goodbye while they are alive. Hopefully, Jahi knew that she was loved by many and IMO the family is doing a disservice to not only Jahi, but themselves. If there is to be a miracle, there will be once the ventilator is disconnected, where she can breathe on her own, maintain all body systems and recover. That would be a miracle. The fact that the family does not want the vent disconnected and Jahi taken off all life prolonging measures speaks volumes. IMO They know she is dead. IMO they just can't let go. This young girl deserves true peace. It is time....JMV

I feel the same. If there's going to be a miracle it will be when the machines are turned off.

I personally don't believe it will happen because she's dead and there's only one person who has come back after a few days in that state

I can understand that it's hard for he family to believe she's dead since her heart is still beating but they don't understand the science. It's so sad that this has happened at Christmas. It is every parent's worst nightmare at any time but now each Christmas will be full of grief and sad memories of this time.

 

[momrids6]

Patients DO bleed following tonsil removal. She may have also had a UPP (uvulopalatoplasty), which is a fancy term for removing excess tissue in the posterior pharynx. She was high risk, with comorbidities, but was in a major metro pedes hospital.

bbm/rsbm:

The hospital's court filing described Jahi's operation as a "complicated surgical procedure" that included an adenotonsillectomy, a separate procedure to remove throat tissue and a third procedure to remove excess nose tissue.

 

[Roxye]

Absolutely this young girl had serious pre-existing conditions that made her high risk. She was morbidly obese, sleep apnea, and other conditions as described. She was at a MAJOR pediatric hospital.

Until you mentioned this, I didn't even remember.... Nik's doctor told us before he could go in for surgery to have A/T removal, (it was already proven he had sleep apnea, which is why we were doing the A/T) he had to lose 20 pounds and be reevaluated.

Shocking enough I didn't consider this till you mentioned it. I guess those 20 pounds Nikel lost is possibly what made his surgery, post-op and recovery go so well.

His sleep apnea is gone and he is still alive.

 

[K_Z]

Respectfully snipped. My comments in red.

I just talked to Dr. Zuri to get a better idea of what might have happened from a medical perspective. This is speculation but makes medical sense. I was wrong in what I had posted about bleeding factors not being screened.

A bleeding time is typically done to determine whether a patient's ability to clot is in a timely fashion. If the bleeding time is prolonged, a hematologist is usually consulted to figure out what blood factors may be present. If a bleeding time was not done, that could be a problem for the ENT doc.

No, not every tonsillectomy or surgical pt has a crossmatch, or even a screen done. Bleeding times are a rather crude method of determining clotting, and very likely were not done. Very few pts have these done nowadays. Any way, it would not have made a difference in her survival.

Ok. Dr. Zuri said IHO not having read anything about this case, that the morbid obesity and neck size were likely key contributors. During a tonsillectomy, the patient is intubated nasally.

I strongly disagree about nasal intubation. In the vast majority of tonsillectomies they are orally intubated and the tube is unsecured and moved side to side by the ENT doc as he works. Very seldom do we nasally intubate, and in a morbidly obese teen, probably not.

Because of neck size, the intubation may have been "traumatic" meaning very difficult sometimes causing laryngeal tissues to swell.

I agree. But there are no descriptions of stridor or shortness of breath in recovery. No one mentions a difficult intubation scenario.

Due to her size, during surgery, more air has to be forced into the lungs, which sometimes causes alveoli to burst, resulting in decreased respiratory function once extubated.

Somewhat true. A standard tonsillectomy is minutes long from the time we turn the table. She wasn't in trendellenberg, or undergoing laparoscopy, so high airway pressures in a brief (flat or head's up) procedure are unlikely.

She was extubated and seemingly alert in the recovery room. Then the perfect storm. She bled which may have been a result of surgery, blood dyscrasia, intubation, extubation. The swelling of laryngeal tissue combined with the bleeding compromised her airway, thus not allowing oxygen circulation.

Somewhat disagree, based on descriptions of recovery care. This was a bleeding issue, not a breathing issue in the recovery room, from every description.

(snipped)

The anesthesia docs are trying to get an airway either via intubation or tracheostomy while patient is being bagged. Since the airway is occluded, this is usually very difficult. Bagging the patient with airway occlusion with an ambu bag is unbelievably difficult. The chest doesn't rise like it is supposed to. While someone is trying to intubate the nose, someone else may be trying to do a trach. Mind you, having been in this scenario, everything is happening so fast, and if one person is unsuccessful, another doc moves in to try. Yes, there is a very high level of anxiety, almost panicky. Oxygenated Blood is not being circulated. The brain is not getting oxygen and upper neuron function is being lost causing the brain to die.

There is absolutely no indication in news reports that she was a difficult intubation AFTER the PACU. Family describes her as being placed back on the vent as a rather routine thing. I don't get the sense that her brain damage is a result of a botched intubation. I totally get the sense that she bled out until she arrested. I don't think botched intubation is the culprit here.


Once an airway is established and heart function restored ( through defibrillation, cardiac drugs, volume), efforts are made to stabilize the patient. However, oxygen deprivation has not just starved the brain, causing it to die, it has starved every major organ system. Dr. Zuri said it is unlikely that Jahi responds to mother's touch. The Brain Death EEGs are done to determine brain wave activity, usually a series of three. If all are the same, the patient is declared brain dead.

I asked Dr. Zuri about the feeding tube if placed and then life support is withdrawn, does the feeding tube matter. He said no because the patient is brain dead and not in any other brain state. I asked him about the coroner's request and comments. He said that the COD determination could be complicated by the intervening treatments such as massive amounts of steroids, drugs, healing of tissues. In a malpractice suit, it has to be proven that there was negligence and harm. Delaying things could work against the family IHO.

Another factor is cost. Once a patient has been declared brain dead, the insurance company will cease to pay the hospital for costs incurred. I would imagine that her care is probably between 2-4K a day. The hospital will eat that unless if a lawsuit is taken to court, and found not negligent, the family will be held liable for those costs. UGH.

Dr. Zuri felt that there would be an out of court settlement by the hospital to the family. He also thought that the one sided negative press was harmful to the hospital which is why they are asking the family for permission to speak and clarify some of the misinformation that has been disseminated by the family and their attorney.

I completely agree.

Sorry for the long post. I just wanted to share with you what a doctor thought. He may be totally off base, but he just explained things to me as I understood the facts to be. There truly are no winners here. JMO

 

[fruity]

The higher someone's BMI is, the higher their risk during surgery. That's why weight loss surgery can't be done on some of the people who need it most. They simply can't operate on some people because of their weight.

People with an extremely low BMI are at risk during surgery too.

 

[K_Z]

bbm/rsbm:

The hospital's court filing described Jahi's operation as a "complicated surgical procedure" that included an adenotonsillectomy, a separate procedure to remove throat tissue and a third procedure to remove excess nose tissue.

Just an FYI, but adenoids are typically "gone" by age 13 (shrunken and less prominent), unless the pt has chronic infection.

 

[fruity]

I'm on my phone so I won't quote (unable to snip large bits of text) but you are right, K-z. She bled out. From memory it was 3 days after the procedure. I will try to find an article.

 

[fruity]

I was wrong, it wasn't three days it was a few hours.

http://m.huffpost.com/us/entry/4485119

 

[SophieRose]

Documents here at end of article
http://www.insidebayarea.com/news/ci_24765964/oakland-family-brain-dead-girl-seeks-injunction-keep