Family wants to keep life support for girl brain dead after tonsil surgery #2

[mck16]

I wasn't who you asked, but this is what I found.

http://news.msn.com/in-depth/twin-tonsillectomy-tragedies-raise-questions

Sad story no matter what happens.

Oh yes, you are right. Very sad. jmo

 

[shana]

The media have quoted the Coroner's office:

"A spokesman with the Alameda County Coroner's Office on Monday said the office had agreed to allow her body to be moved to another facility.

"If they can find a facility I will not be opposed to that," said Lt. Rick Bowers, who oversees the office.

http://www.contracostatimes.com/news/ci_24815775/jahi-mcmath-oakland-brain-dead-girl-could-be

CHO has been ordered by a court to keep her connected to the vent until there is another court hearing. I don't believe CHO is still calling the shots in this case, I believe the Courts have taken over but that's just my opinion.

Thanks.

My bold above: Big IF.

The ruling does not remove from CHO its right to declare death: it simply delays it.

After an eleventh-hour court order was issued that will keep 13-year-old Jahi McMath on a ventilator until Jan. 7, a hospital spokesman said the facility will work with the family to help transfer the girl to nursing care — if three conditions are met.

See article for more:

http://www.latimes.com/local/lanow/la-me-ln-jahi-mcmath-20131230,0,3497539.story#ixzz2p1M22H3A

~jmo~

 

[MyBelle]

Her heart DOES not beat on it's own. LinasK.

Her heart beats because oxygenated air is pumped into her lungs.

One of the tests of brainstem function it to shut off the ventilator and see if there are spontaneous respirations. When the 6 board certified Neurologist did this, she did not have spontaneous respirations. 1-2 minutes without respirations and her heart stops beating.

I don't think you are qualified to apportion "blame". Have you seen the medical records? Have your read the operative report, the ICU care sheets? Have you talked to any of the physicians or nurses who cared for her? Have you read the autopsy report? Please show us the objective data.

Considering the medical condition of apnea is what brought her to the hospital in the first place, I questions the diagnostic usefulness of briefly shutting off the vent.

JMO

 

[otto]

the court filing mentioned a pediatrician's examination and that she is reacting to touch. I can't remember what else. Link was posted up thread a couple of hours ago.

There is nothing in the report about a reaction to touch.

http://media.nbcbayarea.com/documents/Fisher+-+Redacted+Rpt_1.pdf

 

[otto]

I thought about that, but if it is pushed at all I have a feeling the hospital would then be accused of wanting to shut off the machine to harvest her organs.

What organs would anyone want? She died on Dec 12.

 

[Karmady]

Well said. What are the medical-legal implications and ramifications?

IMO, coming from a medical POV, I see a loving mom who is unable to let go. There appears to be a disconnect between them understanding that she is clinically brain dead and vent dependent. If the vent is removed, since she does not breathe on her own as her brain stem is gone, her heart stops and she is declared deceased. From my medical POV, primal reflexes are perhaps being interpreted as cognitive responses. There is a standard for clinical death which Jahi meets. JMO, IMO, IMPO, et al.

So what happens now? TIA

Having asked for an independent opinion and gotten one from someone whom I believe to be an unassailable source, the only clear path is to overturn the cali statute providing that total brain death is death-death, imo. I think that's the path. I don't think it will possibly go to the highest court unless the family can turn up their nose on principle at a 7 or 8 figure settlement. I'm continuing to bet on settlement at this point. Especially if Jahi doesn't last on life support beyond the legal wranglings, which would undoubtedly take years. jmo

 

[Leilei]

Considering the medical condition of apnea is what brought her to the hospital in the first place, I questions the diagnostic usefulness of briefly shutting off the vent.

JMO

Linking this article from the National Institutes of Health, regarding brain death criteria and diagnosis:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772257/

After determining that the patient meets the above prerequisites, the physician should conduct the apnoea test as follows:

Connect a pulse oximeter and disconnect the ventilator.
Deliver 100% O2, 6 l/min, into the trachea. Option: place a cannula at the level of the carina.
Look closely for any respiratory movements (abdominal or chest excursions that produce adequate tidal volumes).
Measure arterial PO2, PCO2, and pH after approximately 8 minutes and reconnect the ventilator.
If respiratory movements are absent and arterial PCO2 is ≥ 60 mm Hg (option: 20 mm Hg increase in PCO2 over a baseline normal PCO2), the apnoea test result is positive (i.e. it supports the diagnosis of brain death).
If respiratory movements are observed, the apnoea test result is negative (i.e. it does not support the clinical diagnosis of brain death).
Connect the ventilator, if during testing
the systolic blood pressure becomes < 90 mm Hg (or below age appropriate thresholds in children less than 18 years of age)
or the pulse oximeter indicates significant oxygen desaturation,
or cardiac arrhythmias develop;

 

[mck16]

Having asked for an independent opinion and gotten one from someone whom I believe to be an unassailable source, the only clear path is to overturn the cali statute providing that total brain death is death-death, imo. I think that's the path. I don't think it will possibly go to the highest court unless the family can turn up their nose on principle at a 7 or 8 figure settlement. I'm continuing to bet on settlement at this point. Especially if Jahi doesn't last on life support beyond the legal wranglings, which would undoubtedly take years. jmo

I don't see her lasting more than a few months. jmo

 

[Zuri]

Having asked for an independent opinion and gotten one from someone whom I believe to be an unassailable source, the only clear path is to overturn the cali statute providing that total brain death is death-death, imo. I think that's the path. I don't think it will possibly go to the highest court unless the family can turn up their nose on principle at a 7 or 8 figure settlement. I'm continuing to bet on settlement at this point. Especially if Jahi doesn't last on life support beyond the legal wranglings, which would undoubtedly take years. jmo

Thank you so much for answering this for me/us.

 

[MyBelle]

Thanks.

My bold above: Big IF.

The ruling does not remove from CHO its right to declare death: it simply delays it.

After an eleventh-hour court order was issued that will keep 13-year-old Jahi McMath on a ventilator until Jan. 7, a hospital spokesman said the facility will work with the family to help transfer the girl to nursing care — if three conditions are met.

See article for more:

http://www.latimes.com/local/lanow/la-me-ln-jahi-mcmath-20131230,0,3497539.story#ixzz2p1M22H3A

~jmo~

The hospital spokesman can spin, make demands and say whatever he wants. Doesn't make it binding. It's all hot air and has been for days, imo.

In the legal filing today that has been posted upthread, it notes that Judge Grillo already ruled the Hospital does not have to assist with the transfer.

I believe legally, that means the family doesn't have to meet any of the Hospital demands at this point. It's up to them to get her out of there and I have no doubt they will do just that. The Coroner has jurisdiction over the "corpse" once it is out the door, not the Hospital imo.

 

[vlpate]

Can her parents say no to organ donations? I am sure they have a choice, which is why I really don't understand this position.

Also, are her organs even okay for donation? I can't imagine the poor stress on Jahi's body at this point. It's almost been 3-weeks (for some reason I have to keep saying it's been 3-weeks!).

I'm sure they were asked, that's why I stated "pushed" the issue. I have no idea if they would still be viable at this stage...especially major organs...but there is much that can be donated to give quality of life, or even life, to a living person in need.

 

[fruity]

http://blogs.kqed.org/newsfix/2013/12/30/jahi-mcmath-oakland-brain-dead-girl/



http://www.foxnews.com/health/2013/12/30/family-california-teen-declared-brain-dead-says-ny-facility-is-last-last-hope/

I just want to clarify that these are not 'their' conditions, ie these are not conditions that CHO has devised themselves and are using to make things difficult for the family. These are legally required conditions placed upon THEM. They need to fulfil these conditions otherwise they are breaking the law and will leave themselves open to (even more) litigation. I don't blame them for wanting to fulfil all legal conditions required of them.

 

[shana]

I wasn't who you asked, but this is what I found.

http://news.msn.com/in-depth/twin-tonsillectomy-tragedies-raise-questions

Sad story no matter what happens.

Thank you for the article URL! It states, as I had recalled, the following (bolding mine):

Rebecca and her parents sued the hospital, its anesthesiology unit, the surgeon and anesthesiologist Dec. 9, 2011, for medical negligence and settled with the latter three for $4.4 million, according to court documents. They reached their final settlement, with the hospital, on Nov. 26, but the amount has not been announced.

~jmo~

 

[Zuri]

Considering the medical condition of apnea is what brought her to the hospital in the first place, I questions the diagnostic usefulness of briefly shutting off the vent.

JMO

There is a difference between sleep apnea and being apneic, which is what the neurologist determined. This means the vent is set to give Jahi a certain number of breaths per minute. When they briefly take the vent off, she does not have respiratory function. I.e. she cannot and does not spontaneously breathe on her own. The brain stem regulates respiratory drive. This test is part of determining brain function, very basic brain function. The fact that there were no spontaneous breaths drawn is part of the neurologists concluding brain death. I hope this helps. It was a good thought. IMO, IMPO, JMO

 

[LinasK]

Link please. ty

Here you go again: http://www.contracostatimes.com/new...contracostatimes.com-www.contracostatimes.com
I provided it several pages ago.

 

[Karmady]

Thank you so much for answering this for me/us.

and thank you for all of your input and Dr. zuri's and the rest of the medical professionals on this thread. I'm interested in this case for a lot of reasons including my familiarity with the Karen Ann Quinlan case. I actually saw her in the hospital when I was a kid and followed the legal developments as it was local to me and relevant to my area of study. I can't imagine anyone wanting to keep their child on life support under those/these circumstances, honestly. I'm not religious, but if I were, I think I'd rather just wait to meet them in heaven. jmo

 

[LinasK]

They didn't sue for wrongful death. I recall they won 4 million, but I do not recall what the cause of her brain damage was. In a wrongful death there is usually an autopsy..which, obviously, can't be performed at this stage.

I mean, what will they say are her long term injuries? Death?

I have zero problem with the hospital being sued if they are at fault here, none...I'm just curious how this will work, legally, moving forward.

I did NOT say "wrongful death", I said malpractice.

 

[Linda7NJ]

Is this living, really? She *was* thirteen. She was ruled brain-dead, legally dead, by several doctors and a judge. She is not on life support, she is on mechanical support. No blood flowing to the brain for how long? How is that living??? She is gone, and has been gone, for almost three weeks now.

As far as Jahi not wanting the surgery, who does? Who wants to go through three complicated surgeries at one time? But the decision was made, the risks are *always* laid out to the patient or the guardian beforehand. And then, they are signed in acknowledgement of those risks.

Please know, I am not placing blame for Jahi's death on ANYONE. I believe that it was a complication that happens in some surgeries, and it is sad and terrible that this young girl lost her life. But to keep her breathing, to keep her heart beating, by a machine, and only a machine, while her organs break down so much that they can't even be donated to someone who may desperately need them, is just wrong, in my opinion. This is not living. It's some sort of horrible, awful limbo that nobody should be subjected to.

In my opinion.

I agree IMO what this child is doing is NOT living. But, trust me... You wouldn't want me walking through a nursing home or ICU making that decision for others. I would expand it to include a slew of other issues chronic and terminal issues.
My definition of "living" is different than other peoples.
This family also has a different definition. I respect theirs for their family and I would want my families definition respected as well.
Life can not always be broken down to black and white. There are shades of grey.


Sent from my iPhone using Tapatalk 2

 

[vlpate]

The hospital spokesman can spin, make demands and say whatever he wants. Doesn't make it binding. It's all hot air and has been for days, imo.

In the legal filing today that has been posted upthread, it notes that Judge Grillo already ruled the Hospital does not have to assist with the transfer.

I believe legally, that means the family doesn't have to meet any of the Hospital demands at this point. It's up to them to get her out of there and I have no doubt they will do just that. The Coroner has jurisdiction over the "corpse" once it is out the door, not the Hospital imo.

No, I think it just means the hospital doesn't have to assist with the transfer...in other words, once the hospital removes their equipment, the family and whomever they've chosen to transfer her will be liable to attach their own equipment, feeding tubes, etc..the hospital will not be performing procedures on a, basically, dead person leaving the hospital at that point. I could be wrong, but that's how I see it.

Someone from the medical profession can help me here...but the hospital, usually, has to make sure you make it safely out of the hospital once released..."you're good to go"...released. Without this order from the Judge, the hospital would be hard pressed to say "good to go" in Jahi's case. Totally JMO

 

[MyBelle]

There is nothing in the report about a reaction to touch.

http://media.nbcbayarea.com/documents/Fisher+-+Redacted+Rpt_1.pdf

You're right the legal filing just mentions "new facts" the reaction to touch appears in the news story.

http://www.contracostatimes.com/news/ci_24815775/jahi-mcmath-oakland-brain-dead-girl-could-be