Family wants to keep life support for girl brain dead after tonsil surgery #3

[MEN3C]

My brother is an attorney that works quite regularly with this same hospital. Actually, he often works against them because he is a PI attorney in Oakland. I asked him about this hospital and he said they are highly respected and he believes they are very good overall.

I asked him about this particular tragedy. And obviously, he does not have the medical records. But it surprised me that he said that sometimes things just 'go wrong' and it is not always anyone's fault. A child can die from an operation in spite of great medical care. That surprised me cuz he is in the business of 'blaming doctors'. But he said ,off the record, that sometimes things just go bad. No one's fault in particular. Her hemorrhaging was perhaps a natural bodily reaction to the surgery. And once that happened, so suddenly, there is not always much that can be done in time to stop it. Tragic.

CHO is one of the most prestigious places in the country - their residency programs are extremely competitive. You'd be quite happy to match there. I have never been there but everyone speaks extremely highly of it.

As for surgeries - normal healthy people most times don't need surgeries, and there doesn't exist a surgery that doesn't have complications. Virtually every time when you take a patients history, you always ask if there is any family history of bleeding, and how much bleeding occurred in past surgeries, etc. That's crucial. Sometimes you can do 100% things by the book, and it's just not enough. It's like cancer - people accept that two people can get the best chemo and the best radiation for the same type of cancer and many times, one person will go into remission while the other person will unfortunately pass away. Surgeries are similar in many respects, though some are extremely safe. But extremely safe doesn't equal 100%.

 

[Steft50]

I will see if I can look up the laws in NY State regarding this - I have no idea if the pediatrician can get in trouble by the state medical board if he or she goes against the accepted standard of care and decides to treat a deceased body as a living person. I think in most cases, physicians are given a wide berth in terms of individualizing care for their patients since no two patients are alike, but in this case, the diagnosis of brain death seems very definitive.



Thank you, this seems like a great community. I've been looking at threads and it seems that people tend to be much more civil than other places, which is refreshing

This brought something else into my thinking....have way to much time to do that....anyway....if they need to get special consent from the CA coroners office to move Jahi, wouldn't they also need to get special permission from the NY coroner as if I read correctly, their bread dead laws are the same or similar to CA's.

 

[Donjeta]

I'm beginning to wonder if there is ANY kind of licensed medical professional at the facility: behavioral therapist, psychiatric therapist, dietician, CRNA, anybody at all?

If this was a real option, why hasn't any of her family actually visited there to see for themselves? Her LVN grandmother, for example?

http://www.nbli.org/services/americanveterans.asp

It says here that they have neuropsychologists and a clinical director who is a PhD, apparently in psychotherapy. IDK... it's written partly as if it's just a plan and this is how things will be in the future.
Nothing a psychotherapist can do for Jahi but perhaps they can help the family.

 

[MEN3C]

http://www.nbli.org/services/americanveterans.asp

It says here that they have neuropsychologists and a clinical director who is a PhD. IDK... it's written partly as if it's just a plan and this is how things will be in the future.

I would think they would need a physician? That could be the reason the other facilities pulled out - the physician may not have been willing to round on a deceased person indefinitely. The administrators might have thought it was a good idea, but don't these long term facilities need someone with medical training available?

Are these considered nursing homes? If so, here is the statement from NY state as concerns the responsibilities of the physician in that area:

http://www.health.ny.gov/professionals/nursing_home_administrator/docs/11-13_att_phys_role.pdf

 

[katydid23]

I continue to be astonished that the hospital is continuing to permit these press conferences and large crowds on their property. They are under no obligation to do so. IMO, the safety, access, and security issues for all the patients and staff should mandate that these large gatherings and demonstrations should be moved elsewhere, to another public space, off the hospital property. IMO.

I agree. and Imo,calling this a 'barricade' is ridiculous. These are light, portable, fences, used for crowd control. Not the same thing as a barricade.

 

[newmrsc]

Gitana1, or any attorneys, I would be interested in your take on Douglas Straus's filing in response to Dolans requests for TRO. Particularly his argument about neutral laws of general applicability, which I thought was an excellent argument.

I'd also be interested in your take on Straus's discussion about the right to hold beliefs, versus the exercise of those beliefs when the actions are opposition to well established law. (Paraphrasing.) I have considered that a lot.

For example, some middle eastern cultures strongly believe in honor killings, which are legal in some places in the middle east. However, if someone from that culture engaged in honor killings in the U.S., it would clearly be murder one. But we cannot prevent people in the U.S. from "believing" that honor killings are "right". We establish lawful guidelines for behavior, but can't regulate beliefs and values.

Personally, I found Straus's arguments to be very well grounded and supported, but I do have a bias. It seems Dolan's arguments rely on asking the court to ignore statute and profoundly redefine death, and redefine parental "rights" as they pertain to defining death. A fascinating read, BTW. (Link to actual documents is upstream-- I'm sorry I don't have it handy, but will find and bump it.)

If a judge or appellate court rules in opposition to clearly established precedence and established law, isn't that "legislating from the bench?"

I read some of both of the legal filings. Straus is spot on in his analysis of the law on free exercise of religion. The law (the statute on death) is a neutral one of general applicability, meaning it does not target a particular religion or religious practice. It is applied to EVERYONE. With a state law of this nature, the standard is a rational basis - there needs to be a rational relation between the law and a legitimate state interest. Federally there would be a higher standard because of the RFRA, but since there's no federal law (and there really couldn't be here) it's not at issue.

The rest of the filing is also accurate, as the parents can't have anymore interest in medical care because she is no longer alive according to the law. Now, I am not verified on WS so please please check all of this/form your own opinions, but reading through both as a lawyer, the arguments in plaintiff's filings are sound and based on the law as it exists.

The only recourse at this point in my opinion is challenging the statute. I don't see that working, but I would not be at all surprised if that's what happens next.

 

[popsicle]

I only see 1 of 2 outcomes to this. Jahi's heart fails while still at CHO or the court orders CHO to remove the vent. jmo

 

[Herat]

http://www.nbli.org/services/americanveterans.asp

It says here that they have neuropsychologists and a clinical director who is a PhD, apparently in psychotherapy. IDK... it's written partly as if it's just a plan and this is how things will be in the future.
Nothing a psychotherapist can do for Jahi but perhaps they can help the family.

I think it would be appropriate to send the family to this place and leave Jahi at CHO.

 

[Donjeta]

I would think they would need a physician? That could be the reason the other facilities pulled out - the physician may not have been willing to round on a deceased person indefinitely. The administrators might have thought it was a good idea, but don't these long term facilities need someone with medical training available?

Are these considered nursing homes? If so, here is the statement from NY state as concerns the responsibilities of the physician in that area:

http://www.health.ny.gov/professionals/nursing_home_administrator/docs/11-13_att_phys_role.pdf

I'm sure long term facilities do need someone with a medical training but this is not currently a long term facility. From what we could gather it's a community center that offers office space for people working with TBI survivors on an outpatient basis. They have a group home planned but it still needs donations to get the building finished.

 

[Herat]

Are these considered nursing homes?

I'm gonna guess there are about 5,000 nursing homes between Oakland and western New York.

Doesn't sound like they are realistically considering ANY transfer. It's all for show and drama.

 

[popsicle]

A federal court has just ordered a mandatory settlement conference for Friday between Children's Hospital Oakland and the family of 13-year-old Jahi McMath.

The family could announce Thursday, though, that it's moving her to another facility.

http://abclocal.go.com/kgo/story?section=news/local/east_bay&id=9379424

 

[K_Z]

Jahi may be receiving nutrition via an IV solution called TPN (total parenteral nutrition) and Lipids. Long term use will cause liver damage.

Respectfully, I think it is extremely unlikely that Jahi was started on TPN and lipids before she was declared brain dead.

Hyperalimentation (TPN) and lipids would almost certainly not have been started directly following the cardiac arrest. She was examined and pronounced brain dead on Dec 12, and no new interventions or meds have been started or permitted since then. So if she was on TPN & lipids, it would have had to happen between the arrest on Dec 9, and the brain death determination on the 12th. There was a lot going on physiologically in that 48-72 hour period, and TPN would not have been indicated during this acute phase of brain injury, due to the risks of induced hyperglycemia.

Here are a couple article about hyperglycemia and acute brain injury.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943579/

Acute brain ischemia is a dynamic process susceptible to multiple modulating factors, such as blood glucose level. During acute ischemic brain injury, hyperglycemia exacerbates multiple deleterious derangements.

http://stroke.ahajournals.org/content/34/9/2215.full

 

[kimlynn]

There may also be a huge element of guilty feelings: for subjecting her to the procedure, for potentially have triggered the bleeding or ignored or violated the instructions given to them.

We've read snippets that allege the family did not follow the instructions. I do not have facts on that, but it will certainly be a question for the court case.

For whatever reason, the family has had enough time to get over the shock, to discuss her status with physicians, to research the options, to plead for stays in court. What happens now is only legal manouevering and is avoiding accepting her death. I

I don't think the family would ignore instructions when they must have been able to comply with instructions and or tests before the surgery.
So far all I have seen in that regard has been posted here and comes from blogs.
This was important for the family in order to make Jahi better and I do believe that they complied.
I think that the real problem with acceptance came after the surgery as no one thinks that their child would have such an adverse reaction to a surgery that for their understanding was routine.
I can only imagine the horror and pain they feel to witness such an event when things had previously seemed to be going well.
When you compound that with what they viewed as lack of attention from the nurses and insulting remarks from the spokesperson.....It all adds up.
I have no problem with viewing the hospital as partly responsible for the current situation in regard to the way they communicated with the family.

IMO

 

[MEN3C]

I'm sure long term facilities do need someone with a medical training but this is not currently a long term facility. From what we could gather it's a community center that offers office space for people working with TBI survivors on an outpatient basis. They have a group home planned but it still needs donations to get the building finished.

Ah I see, thank you. But would they then have the capabilities to take care of someone on a ventilator, feeding tubes, etc? If they are going to accept her with the assumption she is alive, then legally speaking, they would need some sort of 24/7 nursing care with physician availability in case of emergencies, I would think (I don't know the specific laws re: NY state about this)? I mean there are many, many things that can go wrong when a person is on a ventilator being fed through tubes. Everything from bed sores to major infections to a host of other problems. My guess is that the vast majority of physicians I interact with daily would likely refuse to do this.

 

[al66pine]

Allyson Scerri wrote the court that they are going to hire a pediatrician to direct Jahi's care, which implies to me that they currently don't have any such physician in their staff (might explain why the hospital can't get a doctor from the facility on the phone...)

Donjeta, exactly, no dr 'on staff'!

And how will this facility locate any dr to treat someone already declared brain dead by multiple drs and in legal proceedings?

Will Scerri place Jahi in her guest bedroom on a vent and find a pediatrician to make house calls?
And get 24/7 home health care RNs, resp. techs? CNAs? LPNs? et al? Volunteers from the community?

Paid for by....New Beginnings? Private insurance carrier? Medicaid? Donations to Jahi's fam, then forwarded to NB?

Seriously, is this what it boils down to?
From K-Z's and others' posts, seems NB is not a
facility/organization licensed to provide med/nursing care to inpatients
or group-housing for residents.

JM2cts and I could be wrong. :seeya:

 

[fruity]

My brother is an attorney that works quite regularly with this same hospital. Actually, he often works against them because he is a PI attorney in Oakland. I asked him about this hospital and he said they are highly respected and he believes they are very good overall.

I asked him about this particular tragedy. And obviously, he does not have the medical records. But it surprised me that he said that sometimes things just 'go wrong' and it is not always anyone's fault. A child can die from an operation in spite of great medical care. That surprised me cuz he is in the business of 'blaming doctors'. But he said ,off the record, that sometimes things just go bad. No one's fault in particular. Her hemorrhaging was perhaps a natural bodily reaction to the surgery. And once that happened, so suddenly, there is not always much that can be done in time to stop it. Tragic.

It is very true that sometimes things just do go wrong despite the best care.

I'm not sure if people are familiar with Tough Mudder? This example pales in significance next to what has happened in Jahi's case.

Before you're allowed to start you sign all kinds of disclaimers and everything is explained, including the fact that you could die. The chance is extremely small but it is possible. There was a case last year where a man did die during a run. They check to see that you're up to date with your tetanus shots too. Anyway, as you're going around the course you see plenty of medical personnel and there are ambulances stationed around regularly. During my very first run I had to go to the medical tent to be patched up (busted my finger) in the first 1/4 of the race. I've seen people laying on the ground about to be transported with very obviously broken ankles ... it's not uncommon to see these kinds of injuries, in fact I would argue that it's expected.

Within 24 hours of completing one run I started to feel extremely unwell. I wondered if I was getting influenza - I was shaking, my body was aching, I couldn't eat. I worked out quickly that I had contracted some kind of bacterial infection, the doctor thought I inhaled some kind of pathogen. I was dreadfully ill for 10 days. I was surprised because I expect busted fingers, broken bones, etc. but I didn't expect this. You could never predict that this would happen and it sounds ridiculous. But it did happen.

Like I said, this example is insignificant compared to Jahi's death. But unfortunately sometimes the unexpected does happen despite the best care. Nobody expects to be the rare person that the statistics talk about when you sign consent forms.

I'm on my phone. Sorry for typos and autocorrects (I always see them after I post).

 

[Donjeta]

Ah I see, thank you. But would they then have the capabilities to take care of someone on a ventilator, feeding tubes, etc? If they are going to accept her with the assumption she is alive, then legally speaking, they would need some sort of 24/7 nursing care with physician availability in case of emergencies, I would think (I don't know the specific laws re: NY state about this)? I mean there are many, many things that can go wrong when a person is on a ventilator being fed through tubes. Everything from bed sores to major infections to a host of other problems. My guess is that the vast majority of physicians I interact with daily would likely refuse to do this.

Scerri also told the court that they would provide 24/7 nursing care and respiratory therapists but the letter wasn't explicit whether they already have these people on the payroll or not.

 

[MsSeal]

CHO is one of the most prestigious places in the country - their residency programs are extremely competitive. You'd be quite happy to match there. I have never been there but everyone speaks extremely highly of it.

As for surgeries - normal healthy people most times don't need surgeries, and there doesn't exist a surgery that doesn't have complications. Virtually every time when you take a patients history, you always ask if there is any family history of bleeding, and how much bleeding occurred in past surgeries, etc. That's crucial. Sometimes you can do 100% things by the book, and it's just not enough. It's like cancer - people accept that two people can get the best chemo and the best radiation for the same type of cancer and many times, one person will go into remission while the other person will unfortunately pass away. Surgeries are similar in many respects, though some are extremely safe. But extremely safe doesn't equal 100%.

Unfortunately there are odds and statistics and the staff can do everything in their power to treat a dire emergency situation and still not have the end result without any complications. I do feel they should investitate thorougly every thing that happened on that day of surgery to be sure if there was not something the staff could have done that would have made a difference in the outcome.

I feel like the agenda here with the family is to denigrate CHO as being an evil institution and not where you would want take your kids as a punishment for "letting her bleed" and not helping her went the surgery went wriong. When she says "my daughter does not deserve to die" and she is on "death row" how could you interpret that as anything but trying to snuff out the life of innocent child. A hospital no less. Those that don't understand brain death, don't care to understand it or feel that she is indeed alive and deserves all medical care including feeding and surgery it paints CHO is a hospital who "kills" their patients for whatever....greed, they need for organs, they don't respect for life, Jahi does not come from the "right" background, insert whatever believe you have here. And now refusing to perform the trache and feeding tube means they are refusing to care for an innocent child who does not deserve this and should be afforded all medical care. I am guessing that the phrase "innocent until proven guility" does not apply to hospitals or their staff.

I can understand Jani's mom being devastated and needing to blame because that is human nature. But the public is only hearing one very vocal and bitter side.

 

[fruity]

I only see 1 of 2 outcomes to this. Jahi's heart fails while still at CHO or the court orders CHO to remove the vent. jmo

And either way the family will insist that the hospital killed her

 

[momrids6]

headline links to most recent story- comprehensive coverage page


http://www.insidebayarea.com/jahi