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

[MissJ]

I don't think we have the " official version" of when or why Jahi went to ICU post- surgery but I would like to explain how an ICU nurse or a SICU ( surgical ICU) nurse receives a patient from surgery:

The Surgical Nurse or nurses ( usually 2) transport the patient to ICU. Upon arrival, they go to the bedside and a visual and oral report is given to the receiving ICU nurse with the CHART in hand. Specifically, the OPERATIVE REPORT NOTES which are usually hand- written by the doctor, anesthesiologist and surgical nurses are referenced and any abnormality during the peri-operative or immediate post- operative period is reported.

All tubes, lines, fluids, AND THE POST OP ORDERS are read by both the surgical nurses and the ICU nurses. IF the surgical nurses have heard the surgeon say something he wants for the patient but did not write down, they CALL the surgeon and ask for clarification. ( this is fairly uncommon as the surgeon writes the orders last thing out).

I have NEVER received a patient from surgery, INCLUDING BRAIN SURGERY, in a situation where I did not know exactly what was done, what the findings were known to be at that time, and the care that was to be rendered to the patient.

Once the patient's chart was signed by the OR nurses there, which was after initial ICU vital signs were taken and recorded on the OR or PACU sheet, they left.
The patient was then my responsibility and the responsibility of my co-workers.

I have never not known the diagnosis, or the procedures performed except in ONE CASE many years ago.
A surgeon nicked a person's spleen during an abdominal surgery, did NOT record it, and only told the patient verbally, not in writing. It was a surgical error, and was treated as one. It did not affect the care given, though, as there was already an abdominal incision, etc.

Unless you have reason to KNOW that the ICU nurses goofed or were negligent, I think it's best to refrain from casting such a wide net of blame. There may have been a problem evident during the transfer report... If so, the proper procedure would have been to get the surgeon right in the ICU immediately. The nurse or nurses should have informed the proper supervisor who would have paged/ called/ gone to OR and found him.
Their attention was to be on Jahi. Not phones or paging the surgeon, but taking care of their patient, especially if bleeding had already started. The head nurse or nursing supervisor was responsible for getting the surgeon to the bedside, or receiving communication that she was to return to the O.R. with support- resp. therapy, for example.

Thank you so much for your very excellent post! You explained much better than I. I do want to add that this is a very public case and that the nurses names are known to the family who could possibly read here. It is considered libel to imply incompetence in medical personnel who earn their living by a license and anyone can and may be sued for such. Including WS and the person who wrote such a thing.:twocents:

 

[Minette]

Excellent insight, Sonya610, and a great post.

I am also disturbed about the word "injustice" being used. I am even more disturbed about the saber-rattling threats of the family attorney, Dolan, that he intends to file civil rights injunctions.

This case, IMO, is not now, and never has been about civil rights. To imply that this child's or this family's rights have been abused is to say that this child and family is not receiving "something" that OTHER non, disadvantaged people WOULD be receiving. I just don't see it that way at all. This is about the determination of death, and the proper, timely, and legal withdrawal of mechanical ventilation/ life support measures. I don't see any other families being offered prolonged life support after 6-7 determinations of brain death.

I don't see where there is any imposed "injustice" for this child or family. In fact, I see this family as receiving far more support and consideration by the hospital and the courts than many, if not most families in similar circumstances receive.

As far as the mother feeling intense guilt, I can understand that. Guilt is an emotion that is not always logical or rational. Love is also not always logical or rational, and love and guilt and grief all balled up into one excruciating mass of emotions can compel people to do all sorts of things.

What I really don't understand is why the family's religious, and other supporters feel that the only way they can express compassion and support is by buying into the family's very altered view of what is going on, and how to best proceed. I said it before-- it's a voluntary "folie a deux" for all of them.

BBM. I can help but feel that the family would have been so much better served (in several senses of the word) by retaining an attorney with experience in medical litigation rather than a civil rights attorney.

 

[Sonya610]

Of course not. The Hospital has drawn a line in the sand and is insisting it must speak directly with the specialized facility before they will release her. That hard line has resulted in facilities backing out. The coroner must also agree to the transfer. There is simply no way at this point the hospital is going to allow the child to go home, imo.

Based on what? As far as I know the family has NOT asked to take her home!

And yes, I think if the mother went to the media and said she wanted to take her baby home the hospital would let her. Would be much easier to let her do it than to fight it and deal with the bad publicity.

Taking her home would seem a whole lot more reasonable of a request than the other things they are asking for.

 

[atthelake]

K_Z and others....it's been a journey reading the posts on this thread and digging through facts vs. VERY emotional opinions. This is a subject as to end of life that perhaps we should all take a moment to reflect upon what shall we do?

For myself....I live in a state which has CODIFIED health care directives online which I filled out in 2007, and EACH YEAR I send to my entire family as to End Of Life wishes and also have given to my primary physician. If anything can come out of this it perhaps is something that we can take from it to help our families if this tragic situation arises.

As an aside, the person that has my "pull the plug" legal authorization...it is not a family member but a good friend who my family knows well. This person is accepting of having that responsibility, knowing that EACH AND EVERY BIRTHDAY I send out to everyone my wishes on such. Yeah, kinda weird to do such, but I do with a lot of items which are legal restating my wishes and letting folks know that might be impacted if the worst happens. It DOES HELP that my entire family is ok with what I have denoted on those papers as to when to "pull the plug" and there are NO disagreements/push backs of a religious nature--- all are on the same page.

FWIW...google healthcare directives for your state and see if there are documents to download for free. Again, my state has CODIFIED THEM GeorgiaLinkForHealthCareDirective and are online so perhaps yours are too? If not, perhaps this link can give you situations to discuss/ponder with loved ones?


:grouphug:

 

[Karmady]

BBM. I can help but feel that the family would have been so much better served (in several senses of the word) by retaining an attorney with experience in medical litigation rather than a civil rights attorney.

Depending on which sense we're talking about, I think this path is the "best" path. I'm guessing this will settle in the $5M-$10M dollar range eventually. jmo

 

[Softail]

BBM. I can help but feel that the family would have been so much better served (in several senses of the word) by retaining an attorney with experience in medical litigation rather than a civil rights attorney.

He is a personal injury attorney/employment law, not a civil rights attorney.


http://www.cbdlaw.com/Attorneys/Christopher-B-Dolan.shtml

 

[Minette]

Of course not. The Hospital has drawn a line in the sand and is insisting it must speak directly with the specialized facility before they will release her. That hard line has resulted in facilities backing out. The coroner must also agree to the transfer. There is simply no way at this point the hospital is going to allow the child to go home, imo.

Consider for a moment that perhaps the hospital in fact does have Jahi's best interests in mind. Would a responsible hospital release her to an unknown facility without even speaking to them? She would theoretically be going across the country far from her family--what if this new facility is not reputable or accredited? How would that be in Jahi's best interests? And they can't just decide to buck the law and defy the coroner--the coroner does have to sign off on moving someone who is clinically dead. I don't know that Jahi's family has ever asked for her to go home, do you have a link for this?

 

[Minette]

He is a personal injury attorney, not a civil rights attorney.


http://www.cbdlaw.com/Attorneys/Christopher-B-Dolan.shtml

Thanks for the correction, Softail. I guess I was misled by all his talk of civil rights and injustice and I believe the 4th amendment was cited at some point. Well, I'm baffled, then.

ETA:

Depending on which sense we're talking about, I think this path is the "best" path. I'm guessing this will settle in the $5M-$10M dollar range eventually. jmo

Aaaaand, there goes some of my bafflement I guess, though a financial settlement would be the last thing on my mind, personally. Although, at this point what does the hospital have to lose by fighting tooth and nail for a lower settlement? Assuming they didn't make any egregious errors how much worse could the publicity actually get???

 

[MyBelle]

Agree. There's definitely at least some of that going on. I read a statement from a pastor (I think the family member) who used a word like "value" or "worth" referring to Jahi's life -- the implication being that the hospital is treating Jahi's situation as "less than." I think at least some of the clergy involved are of the same mindset. jmo

If you read the declaration by the mother, she details how the family has been treated specifically by the Hospital administrator, Dr. Durand. He has repeatedly refused their request for Jahi's medical records. He's yelled at them and was so disrespectful to her mother, a nurse, that the mother left the room.

I must say from my own experience working for a medical school/teaching hospital for five years, her description would fit some of the doctors I worked with, especially if the doctor was in an administrative position. Some doctors are better administrators than they are clinicians providing direct patient care. Some doctors do act like they are on the same plane as God.

There really is no excuse for this kind of antagonistic behavior toward a grief-stricken family.

 

[MyBelle]

He is a personal injury attorney, not a civil rights attorney.


http://www.cbdlaw.com/Attorneys/Christopher-B-Dolan.shtml

He has won some civil rights cases. He's got excellent credentials.

 

[Softail]

Thanks for the correction, Softail. I guess I was misled by all his talk of civil rights and injustice and I believe the 4th amendment was cited at some point. Well, I'm baffled, then.

Don't be. I think he has said a lot of misleading things. :twocents:

 

[Karmady]

Thanks for the correction, Softail. I guess I was misled by all his talk of civil rights and injustice and I believe the 4th amendment was cited at some point. Well, I'm baffled, then.

I think he also said that he was finishing up a civil rights trial when the call came in for Jahi's case. I've read several articles about him and he definitely sees himself as a champion of the underdog. Iirc, there was a civil rights case with employment discrimination in the mix. It involved employees of a parcel delivery company-- maybe fedex.

jmo

 

[MyBelle]

Consider for a moment that perhaps the hospital in fact does have Jahi's best interests in mind. Would a responsible hospital release her to an unknown facility without even speaking to them? She would theoretically be going across the country far from her family--what if this new facility is not reputable or accredited? How would that be in Jahi's best interests? And they can't just decide to buck the law and defy the coroner--the coroner does have to sign off on moving someone who is clinically dead. I don't know that Jahi's family has ever asked for her to go home, do you have a link for this?

Please read the thread. My response is to posters suggesting Jahi's family should take the child home.

 

[Softail]

I don't think it is all about guilt. The word "injustice" has been used by the family and their lawyer MANY times. I think there is also the attitude that they are owed as much as they ask for with regard to procedures and pointless treatments. To deny them is to victimize them etc... If I thought a doctor or hospital screwed up and caused the death of a loved one I would be using the word INCOMPETENCE not injustice! Huge difference between the two and the difference is significant.

If you read any of the studies on groups that historically resist having machines turned off the belief that others are "not willing to spend money and will screw over their loved ones" is a frequently mentioned concern. They want the machines to stay on in part to prove their loved one has value and that they themselves (the family) have value.

It is bigger than just accepting the death of a loved one, there are all sorts of other belief systems that come into play.

I agree! The only "injustice" I see at this point is not letting this girl rest in peace. Making this the circus it has become is an injustice. :twocents:

 

[Karmady]

If you read the declaration by the mother, she details how the family has been treated specifically by the Hospital administrator, Dr. Durand. He has repeatedly refused their request for Jahi's medical records. He's yelled at them and was so disrespectful to her mother, a nurse, that the mother left the room.

I must say from my own experience working for a medical school/teaching hospital for five years, her description would fit some of the doctors I worked with, especially if the doctor was in an administrative position. Some doctors are better administrators than they are clinicians providing direct patient care. Some doctors do act like they are on the same plane as God.

There really is no excuse for this kind of antagonistic behavior toward a grief-stricken family.

docs like that are typically equal opportunity jacka**ses except when other docs or similar are involved. jmo

 

[SwampMama]

I know some Orthodox Jews and a few other religions have fought against brain death diagnosis as dead, but I'd like to know what Jahi's pastor says about this.

Here is a video from before the judges ruling which has various faith leaders speaking.

http://www.nbcsandiego.com/news/nat...-to-Examine-Jahi-McMath-Monday-236982021.html


I can say this. I do not appreciate them holding their press conference (with a crowd) in front of the hospital like that. I find that to be rather inconsiderate of other families who may be dealing with situations just as tragic as Jahi's family is.

Here is the most recent statement from a pastor who is described as "Jahi's Godfather". His name is Derrick Mann. He is the one who called off the fundraiser at the church off because of the lawyers advice. ""I was informed, you know, via the attorney to not have the fundraiser because we're still trying to solidify a facility for Jahi and we definitely don't want to raise funds, you know, for something that is not iron clad,"

So the actual event of a fundraiser was cancelled but the online funding campaign, asking for donations to be sent to the P.O.Box and such continues, even though they met their "goal" at the online site. Originally it was to have Jahi airlifted but now it just says that the money will be used to fight to keep her on life support.

 

[MissJ]

It also doesn't say if the family or even the ICU nurses were aware all three procedures had been performed. But then, I wouldn't expect a legal document prepared by the hospital to reflect ALL of the facts.

ONCE again the nurses were well aware of what they are doing. To imply otherwise is LIBEL. The nurses have no need or responsibility to explain to anyone that they know and do their jobs.

 

[K_Z]

Of course not. The Hospital has drawn a line in the sand and is insisting it must speak directly with the specialized facility before they will release her. That hard line has resulted in facilities backing out. The coroner must also agree to the transfer. There is simply no way at this point the hospital is going to allow the child to go home, imo.

Of COURSE the hospital is insisting they must speak with whoever accepts this child's body! They MUST. To push her body out the door WITHOUT speaking with a receiving facility, AND the physician who would be accepting her body as a patient, would be illegal, immoral, unethical, and patently ridiculous. That is not a "line in the sand".

And the coroner HAS to agree with the transfer, if there is any. She is legally dead, and her case is a coroner's case!

IMO, the hospital outlined VERY reasonable conditions in which they would facilitate the transfer of her body to another facility.

 

[Donjeta]

Of course not. The Hospital has drawn a line in the sand and is insisting it must speak directly with the specialized facility before they will release her. That hard line has resulted in facilities backing out. The coroner must also agree to the transfer. There is simply no way at this point the hospital is going to allow the child to go home, imo.

Have the family asked to take her home? They've been saying that their only hope is a facility in NY so it implies to me that they don't think taking her home is an option. But the hospital statement said that they would agree to anything that was legally and ethically possible. People have taken care of their brain dead at home before.

The requirement that the receiving facility communicates with the hospital doesn't sound unreasonable to me at all. It happens all the time when people are transferred from one place to another. I can't see why the receiving facility wouldn't want to talk with the hospital, to make sure they have all the information that the family might not be able to communicate and to coordinate the practicalities of the transfer.

The reasons the family or the lawyer have cited for the facilities backing out included no beds left available, fear of alienating their own doctors and Jahi not having had the surgery for a feeding tube and a trach. No doubt unwillingness to be involved with the media frenzy also figures into it.

 

[MyBelle]

docs like that are typically equal opportunity jacka**ses except when other docs or similar are involved. jmo

I agree but it all boils down to the perception of the family. It is very bizarre to me that a hospital administrator would be confronting the family at all. And apparently the child's surgeon wasn't present.