Family wants to keep life support for girl brain dead after tonsil surgery #8

[MyBelle]

Snipped for focus.

That's not an accurate statement.

There are MANY situations where there may be an attended death in a hospital where a case must be referred to the coroner's/ medical examiner. It is up to the coroner/ ME to determine if an autopsy is required, not the physician attending the death. Hospitals have guidance in their policies regarding mandatory notifications to the ME/ coroner. I'm not aware of any states that have a blanket policy that if a death occurs in a hospital, regardless of circumstances, that an autopsy is never required.

There are also many situations where an attended death occurs in a hospital, and no notifications to the ME are required. Families are usually given the option of requesting an autopsy, in those circumstances.

It is an accurate statement for my state. While there may be situations where a hospital or physician asks for a medical examiner autopsy, in Jahi's case there has been no autopsy but I'm betting when her heart finally stops beating, there will be an autopsy.

JMO

 

[MyBelle]

This link is from another California county but I think it probably works pretty much the same way where Jahi died:

http://www.riversidesheriff.org/coroner/



Jahi fits the third condition:


I would say her death was also rather sudden and unusual:


http://usnews.nbcnews.com/_news/201...hi-mcmath-released-to-coroner-mother-hospital
Since the family went public saying the hospital tried to kill her to cover up some kind of shady stuff the suspicion of criminal act part might also apply.

Note that it's mandatory that there is always a coroner investigation if the death is unattended and there is no doctor contact prior to death. It does not mean that the reverse is true (that there is never a coroner investigation, or an autopsy, required, if the death was attended by doctors).



Jahi fits a few of these criteria as well. She's under 17, had surgery during the current hospital admission and a therapeutic procedure is involved in her death.

Moreover, the representatives of the coroner's office have clearly implied more than once that they want to do an autopsy, so I'm going to assume that it's not their rule that an autopsy is never needed if the person died attended by doctors.

If Jahi had been disconnected from life support at the hospital--as the hospital fought to make that happen--her death would be considered an "attended" death. She wasn't disconnected from life support at the hospital so the medical examiner's office certainly would want to see what could be found with an autopsy, if anything.

JMO

 

[nrdsb4]

If Jahi had been disconnected from life support at the hospital--as the hospital fought to make that happen--her death would be considered an "attended" death. She wasn't disconnected from life support at the hospital so the medical examiner's office certainly would want to see what could be found with an autopsy, if anything.

JMO

In California, there are conditions when a death must be reported to the ME, even if the death was "attended." The decision whether to perform the autopsy will be made by the Coroner.

Not all deaths are reportable to the Coroner. Those deaths that are reportable fall into 25 categories. Those categories are:

1. No physician in attendance.

2. Medical attendance less than 24 hours (hospital or residence).

3. Wherein the deceased has not been attended by a physician in the 20 days prior to death.

4. Wherein the physician is unable to state the cause of death.

5. Known or suspected homicide.

6. Known or suspected suicide.

7. Involving any criminal action or suspicion of a criminal act.

8. Related to or following a known or suspected self-induced or criminal abortion.

9. Associated with a known or alleged rape of crime against nature.

10. Following an accident or injury, old or recent, (primary or contributory, occurring immediately or at some remote time.)

11. All deaths due to drowning, fire, hanging, gunshot, stabbing, cutting, starvation, exposure, acute alcoholism, drug addiction, strangulation or aspiration.

12. Accidental poisoning, (food, chemical agent, drug or therapeutic agent).

13. Occupational disease or occupational hazards.

14. Known or suspected contagious disease constituting a public health hazard, including AIDS.

15. All deaths in operating rooms.

16. All deaths where the patient has not fully recovered from an anesthetic whether in surgery, recovery room or elsewhere.

17. All deaths wherein the patient expired within 24 hours of an operation or surgical procedure.

18. All deaths in which the patient was comatose throughout the period of the physician’s attendance, whether at home or hospital.

19. All solitary deaths.

20. All deaths of unidentified persons.

21. All deaths where the suspected cause of death is Sudden Infant Death Syndrome (Crib Death).

22. All deaths in prison, jails or of persons under the control of a law enforcement agency.

23. All deaths of patients in state mental hospitals.

24. Wherein there is no known next of kin.

25. Fetal deaths of older than 20 weeks gestational age.

Jahi's death would have had to be reported to the Coroner, and we can safely assume autopsy would have been required.

http://www.montereytrust.com/coroner.htm

Note that it's mandatory that there is always a coroner investigation if the death is unattended and there is no doctor contact prior to death. It does not mean that the reverse is true (that there is never a coroner investigation, or an autopsy, required, if the death was attended by doctors).

Important point, and I doubt any state has any such blanket allowance.

 

[Donjeta]

The date of death in her death certificate is a couple of days after the surgery when she was declared brain dead, not an undetermined date sometime in the future when/if she is disconnected from life support or her cardiorespiratory systems fail on their own.

It was an attended death, and the coroner's office wanted to do an autopsy regardless, and would have, if the family hadn't gone to the courts to prevent the hospital from disconnecting the life support systems.

I think there is a misconception because the family claimed that the hospital wanted to disconnect the life support systems to cover up malpractice or something. But if they had been allowed to get their way and disconnect life support it would just have meant that she'd ended up on the autopsy table sooner. JMO.

 

[MyBelle]

In California, there are conditions when a death must be reported to the ME, even if the death was "attended." The decision whether to perform the autopsy will be made by the Coroner.



Jahi's death would have had to be reported to the Coroner, and we can safely assume autopsy would have been required.

http://www.montereytrust.com/coroner.htm



Important point, and I doubt any state has any such blanket allowance.

So do I. I said an attended death in a hospital in my state doesn't REQUIRE an autopsy. I think all states require all deaths to be reported to the ME or coroner so that a death certificate can be issued. I didn't suggest Jahi's death was not reported to a coroner.

 

[MyBelle]

The date of death in her death certificate is a couple of days after the surgery when she was declared brain dead, not an undetermined date sometime in the future when/if she is disconnected from life support or her cardiorespiratory systems fail on their own.

It was an attended death, and the coroner's office wanted to do an autopsy regardless, and would have, if the family hadn't gone to the courts to prevent the hospital from disconnecting the life support systems.

I think there is a misconception because the family claimed that the hospital wanted to disconnect the life support systems to cover up malpractice or something. But if they had been allowed to get their way and disconnect life support it would just have meant that she'd ended up on the autopsy table sooner. JMO.

I don't believe it is a misconception on the part of the family and their attorney, I believe it is their sincere belief. I don't agree with you that the coroner would automatically do an autopsy if her organs had been donated.

JMO

 

[joypath]

I don't believe it is a misconception on the part of the family and their attorney, I believe it is their sincere belief. I don't agree with you that the coroner would automatically do an autopsy if her organs had been donated.

JMO

BBM:

As long as there is a semantics discussion underway, CORONERS do NOT perform post mortem examinations UNLESS the individuals so designated as a "coroner" has possession of a medical degree & license, post mortem EXAMINATIONS aka autopsies are regarded as medical procedures. IMVHO, most individuals who have become organ donors have post mortem examinations, the OCME is notified by the organ donor coordinator @ the primary hospital, the OCME may even send a representative to the procurement procedure and may even forgo the formal OCME "in-house" examination. Been there, done that! That being said, those cases where limited donations are made i.e. corneas, and the COD is determined as natural, it still remains the determination of the coroner or medical examiner if an autopsy is mandatory. At any time, a family may request that a post mortem examination be performed at cost but that case will not be considered an OCME case UNLESS the attending pathologist encounters an "unusual finding" that REQUIRES referral by State statute.



For edification: http://medical-dictionary.thefreedictionary.com/coroner
http://medical-dictionary.thefreedictionary.com/medical+examiner

 

[al66pine]

I don't believe it is a misconception on the part of the family and their attorney, I believe it is their sincere belief. I don't agree with you that the coroner would automatically do an autopsy if her organs had been donated.

JMO

Not trying to speak for Donjeta, but I went back & re-read several of Donjeta's most recent posts and did not see anything to the effect-

coroner (or med exam'er or OCME) wd automatically do an autopsy
if Jahi's organs had been donated.

I may have missed it.
Anyone?
TIA

 

[nrdsb4]

So do I. I said an attended death in a hospital in my state doesn't REQUIRE an autopsy. I think all states require all deaths to be reported to the ME or coroner so that a death certificate can be issued. I didn't suggest Jahi's death was not reported to a coroner.

BBM

That just doesn't make any sense. If there is foul play suspected, an autopsy wouldn't be required simply because the death was attended? If an apparently healthy child drops dead in her bed in the recovery, the ME has no power to require an autopsy simply because the death was attended? And any other number of other scenarios which usually mandate an autopsy?

 

[Frigga]

BBM:

As long as there is a semantics discussion underway, CORONERS do NOT perform post mortem examinations UNLESS the individuals so designated as a "coroner" has possession of a medical degree & license, post mortem EXAMINATIONS aka autopsies are regarded as medical procedures. IMVHO, most individuals who have become organ donors have post mortem examinations, the OCME is notified by the organ donor coordinator @ the primary hospital, the OCME may even send a representative to the procurement procedure and may even forgo the formal OCME "in-house" examination. Been there, done that! That being said, those cases where limited donations are made i.e. corneas, and the COD is determined as natural, it still remains the determination of the coroner or medical examiner if an autopsy is mandatory. At any time, a family may request that a post mortem examination be performed at cost but that case will not be considered an OCME case UNLESS the attending pathologist encounters an "unusual finding" that REQUIRES referral by State statute.



For edification: http://medical-dictionary.thefreedictionary.com/coroner
http://medical-dictionary.thefreedictionary.com/medical+examiner

Thank you Joypath- a voice of reason.

 

[MyBelle]

BBM

That just doesn't make any sense. If there is foul play suspected, an autopsy wouldn't be required simply because the death was attended? If an apparently healthy child drops dead in her bed in the recovery, the ME has no power to require an autopsy simply because the death was attended? And any other number of other scenarios which usually mandate an autopsy?

I was trying to stay on topic about Jahi and what is the statute in my state and many other states when a death occurs in a hospital with an attending physician. Jahi wasn't an apparently healthy child, she was there for a complicated surgery, according to the hospital.

 

[nrdsb4]

I was trying to stay on topic about Jahi and what is the statute in my state and many other states when a death occurs in a hospital with an attending physician. Jahi wasn't an apparently healthy child, she was there for a complicated surgery, according to the hospital.

I don't believe that in "many states," simply having an attending physician at the time of death in a hospital means that no autopsy would be required by the ME. Most states have a laundry list of conditions in which an autopsy would be mandated, attending physician notwithstanding.

 

[joypath]

Originally Posted by MyBelle
So do I. I said an attended death in a hospital in my state doesn't REQUIRE an autopsy. I think all states require all deaths to be reported to the ME or coroner so that a death certificate can be issued. I didn't suggest Jahi's death was not reported to a coroner.

BBM

That just doesn't make any sense. If there is foul play suspected, an autopsy wouldn't be required simply because the death was attended? If an apparently healthy child drops dead in her bed in the recovery, the ME has no power to require an autopsy simply because the death was attended? And any other number of other scenarios which usually mandate an autopsy?

To clarify: the first statement as bolded by nrdsb4 has the term "require"
thus making it a statement of truth for some states and the next sentence becomes a clarifier of action that can happen. NOT all States have the same guiding statutes but the usual & customary definition of "attended patient" is one who has been under the care of a healthcare professional within the last 28 days (a physician or a provider acting under a physician license). Point #2: reporting of a death to a coroner or OCME triggers the evaluation process of the probable manner of death, please remember that the cause of death is a medical opinion backed by FACTS.
Therefore, the question raised in the italics would be answered by the evaluation of the coroner/ME as he/she reviews the case FACTS.
The BBM piece in the second comment is easily answered as the ME has complete authority to demand an autopsy and even conduct it, if so qualified! Medical-legal post mortem examinations are conducted often when families would prefer not (special arrangements are made when religious objections are raised, religious practitioners are NOT in the habit of trying to block earthly justice!).
One of the key points of Jahi's case is the incomplete death certificate, it is pending autopsy results and as such remains a "coroner/OCME" case.

Please remember that jurisdictions have various specific regulations BUT legal burials can not be performed without permission of the authorities

 

[MyBelle]

I don't believe that in "many states," simply having an attending physician at the time of death in a hospital means that no autopsy would be required by the ME. Most states have a laundry list of conditions in which an autopsy would be mandated, attending physician notwithstanding.

Then we'll agree to disagree. I've yet to see any state legislature to mandate a laundry list of medical conditions when the death occurs in a licensed hospital with attending physicians.

 

[MyBelle]

Originally Posted by MyBelle
So do I. I said an attended death in a hospital in my state doesn't REQUIRE an autopsy. I think all states require all deaths to be reported to the ME or coroner so that a death certificate can be issued. I didn't suggest Jahi's death was not reported to a coroner.





To clarify: the first statement as bolded by nrdsb4 has the term "require"
thus making it a statement of truth for some states and the next sentence becomes a clarifier of action that can happen. NOT all States have the same guiding statutes but the usual & customary definition of "attended patient" is one who has been under the care of a healthcare professional within the last 28 days (a physician or a provider acting under a physician license). Point #2: reporting of a death to a coroner or OCME triggers the evaluation process of the probable manner of death, please remember that the cause of death is a medical opinion backed by FACTS.
Therefore, the question raised in the italics would be answered by the evaluation of the coroner/ME as he/she reviews the case FACTS.
The BBM piece in the second comment is easily answered as the ME has complete authority to demand an autopsy and even conduct it, if so qualified! Medical-legal post mortem examinations are conducted often when families would prefer not (special arrangements are made when religious objections are raised, religious practitioners are NOT in the habit of trying to block earthly justice!).
One of the key points of Jahi's case is the incomplete death certificate, it is pending autopsy results and as such remains a "coroner/OCME" case.

Please remember that jurisdictions have various specific regulations BUT legal burials can not be performed without permission of the authorities

In this case, Jahi is not yet buried nor has anyone suggested she is going to be buried without permission by authorities. I do believe you are confusing an autopsy with an inquest.

Jahi has a death certificate issued by the coroner but it hasn't been accepted by the State Health Department. I've seen nothing to suggest an autopsy is going to be required.

http://www.nbcbayarea.com/news/loca...licates-Cause-of-Death-Experts-238945011.html

Robert "Rocky" Shaw, San Bernandino County Coroner and president of the California State Coroners Association, agreed with Murphy in that in this case, the hospital's medical records would be ample in determining a cause of death; a body would not have to be opened up.

Some of what has already happened in Jahi's body has been documented in federal court filings written by Children's Hospital doctor Heidi Flori, a pediatric critical care physician who has overseen some of Jahi's care.

 

[Donjeta]

I don't believe it is a misconception on the part of the family and their attorney, I believe it is their sincere belief. I don't agree with you that the coroner would automatically do an autopsy if her organs had been donated.

JMO

What I meant was, I think there is a misconception that there wouldn't have been an autopsy if Jahi was disconnected from life support at Children's, because the family claimed the hospital was trying to cover something up.

This has nothing to do with whether the family believes it sincerely.

I didn't say anything about organ donation.

In this case, Jahi is not yet buried nor has anyone suggested she is going to be buried without permission by authorities. I do believe you are confusing an autopsy with an inquest.

Jahi has a death certificate issued by the coroner but it hasn't been accepted by the State Health Department. I've seen nothing to suggest an autopsy is going to be required.

http://www.nbcbayarea.com/news/loca...licates-Cause-of-Death-Experts-238945011.html


[/I]

From your own link, conveniently ignored?

The Alameda County Coroner issued a death certificate for the 13-year-old girl Friday, 23 days after Jahi was declared brain dead, but said the document is incomplete because no cause of death has been determined pending an autopsy, which has yet to take place.

"It does make it more difficult," Alameda County Sheriff's Sgt. J.D. Nelson told NBC Bay Area when asked if delaying an autopsy could affect figuring out how someone died. "It can change a lot of things when the bodily functions continue. In fact, we may not be able to determine a cause of death."

Nelson, who serves as spokesman for the medical examiner's office, shares this sentiment with a prominent bioethicist, who says the delayed autopsy could also affect any future legal proceedings in the case.

"When you don't get an exam relatively quickly, it puts everything into dispute," said Arthur Caplan, head of the Division of Bioethics at New York University Langone Medical Center in New York City and a regular NBC News contributor. "The evidence into what caused the bleeding will be harder to determine, and the ability to show what happened - and the liability - will become way more difficult. The more time you delay, the more difficult it is to establish cause of death because you've lost control of some of the evidence."

They don't know the cause of death and it seems like there might be a lawsuit coming up. Any coroner would want to have an autopsy done.

We've had this conversation before and I don't know why it's still in dispute when the coroner's office has clearly stated that they are unable to determine Jahi's cause of death without an autopsy and that her autopsy being delayed means that they might never be able to.

This means they need to do an autopsy, wanted to do it all along and are going to, eventually, when her heart stops sometime in the future.

Surely they're the people who would know?

 

[al66pine]

Appears to be link to current CA law (but not swearing to it) BBM UBM
http://www.leginfo.ca.gov/cgi-bin/displaycode?section=gov&group=27001-28000&file=27490-27512

27490. The coroner shall hold inquests pursuant to this article.

27491. It shall be the duty of the coroner to inquire into and
determine the circumstances, manner, and cause of all violent,
sudden, or unusual deaths; unattended deaths; deaths where the
deceased has not been attended by either a physician or a registered
nurse, who is a member of a hospice care interdisciplinary team, as
defined by subdivision (e) of Section 1746 of the Health and Safety
Code in the 20 days before death; deaths related to or following
known or suspected self-induced or criminal abortion; known or
suspected homicide, suicide, or accidental poisoning; deaths known or
suspected as resulting in whole or in part from or related to
accident or injury either old or recent; deaths due to drowning,
fire, hanging, gunshot, stabbing, cutting, exposure, starvation,
acute alcoholism, drug addiction, strangulation, aspiration, or where
the suspected cause of death is sudden infant death syndrome; death
in whole or in part occasioned by criminal means; deaths associated
with a known or alleged rape or crime against nature; deaths in
prison or while under sentence; deaths known or suspected as due to
contagious disease and constituting a public hazard; deaths from
occupational diseases or occupational hazards; deaths of patients in
state mental hospitals serving the mentally disabled and operated by
the State Department of State Hospitals; deaths of patients in state
hospitals serving the developmentally disabled and operated by the
State Department of Developmental Services; deaths under such
circumstances as to afford a reasonable ground to suspect that the
death was caused by the criminal act of another; and any deaths
reported by physicians or other persons having knowledge of death for
inquiry by coroner. Inquiry pursuant to this section does not
include those investigative functions usually performed by other law
enforcement agencies.
In any case in which the coroner conducts an inquiry pursuant to
this section, the coroner or a deputy shall personally sign the
certificate of death. If the death occurred in a state hospital, the
coroner shall forward a copy of his or her report to the state agency
responsible for the state hospital.
The coroner shall have discretion to determine the extent of
inquiry to be made into any death occurring under natural
circumstances and falling within the provisions of this section, and
if inquiry determines that the physician of record has sufficient
knowledge to reasonably state the cause of a death occurring under
natural circumstances, the coroner may authorize that physician to
sign the certificate of death.
For the purpose of inquiry, the coroner shall have the right to
exhume the body of a deceased person when necessary to discharge the
responsibilities set forth in this section.
Any funeral director, physician, or other person who has charge of
a deceased person's body, when death occurred as a result of any of
the causes or circumstances described in this section, shall
immediately notify the coroner. Any person who does not notify the
coroner as required by this section is guilty of a misdemeanor.

27491.1. In all cases in which a person has died under
circumstances that afford a reasonable ground to suspect that the
person's death has been occasioned by the act of another by criminal
means, the coroner, upon determining that those reasonable grounds
exist, shall immediately notify the law enforcement agency having
jurisdiction over the criminal investigation. Notification shall be
made by the most direct communication available. The report shall
state the name of the deceased person, if known, the location of the
remains, and other information received by the coroner relating to
the death, including any medical information of the decedent that is
directly related to the death. The report shall not include any
information contained in the decedent's medical records regarding any
other person unless that information is relevant and directly
related to the decedent's death.


27491.2. (a) The coroner or the coroner's appointed deputy, on
being informed of a death and finding it to fall into the
classification of deaths requiring his or her inquiry, may
immediately proceed to where the body lies, examine the body, make
identification, make inquiry into the circumstances, manner, and
means of death, and, as circumstances warrant, either order its
removal for further investigation or disposition or release the body
to the next of kin.
(b) For purposes of inquiry, the body of one who is known to be
dead from any of the causes or under any of the circumstances
described in Section 27491 shall not be disturbed or moved from the
position or place of death without permission of the coroner or the
coroner's appointed deputy. Any violation of this subdivision is a
misdemeanor.
----------------------------------------------------------------------
If this is not current CA law, maybe someone else can link us to the correct statute.
Anyone?

 

[K_Z]

I do believe you are confusing an autopsy with an inquest.

Snipped for focus.

I disagree. I don't think this discussion is complicated at all. I'm not exactly sure what the point, or source, of this dispute is, going forward.

IMO, pretty much everyone here commenting on this case understands the difference between an autopsy and an inquest. That isn't in dispute.

Sometimes, it's possible, for whatever reason, to "misunderstand" even very clear explanations. We all adjust and move the conversation onward.

 

[MyBelle]

What I meant was, I think there is a misconception that there wouldn't have been an autopsy if Jahi was disconnected from life support at Children's, because the family claimed the hospital was trying to cover something up.

This has nothing to do with whether the family believes it sincerely.

I didn't say anything about organ donation.



From your own link, conveniently ignored?



They don't know the cause of death and it seems like there might be a lawsuit coming up. Any coroner would want to have an autopsy done.

We've had this conversation before and I don't know why it's still in dispute when the coroner's office has clearly stated that they are unable to determine Jahi's cause of death without an autopsy and that her autopsy being delayed means that they might never be able to.

This means they need to do an autopsy, wanted to do it all along and are going to, eventually, when her heart stops sometime in the future.

Surely they're the people who would know?

Clearly stated where? I've yet to see where a coroner has requested an autopsy done on Jahi. All of us are certainly free to draw conclusions about the family but I have yet to see any coroner's office demanding an autopsy. Would you please post links? Thanks. I posted a link where an expert opined that medical records might preclude the need for an autopsy. I agree with that possibility.

 

[MyBelle]

What I meant was, I think there is a misconception that there wouldn't have been an autopsy if Jahi was disconnected from life support at Children's, because the family claimed the hospital was trying to cover something up.

This has nothing to do with whether the family believes it sincerely.

I didn't say anything about organ donation.



From your own link, conveniently ignored?



They don't know the cause of death and it seems like there might be a lawsuit coming up. Any coroner would want to have an autopsy done.

We've had this conversation before and I don't know why it's still in dispute when the coroner's office has clearly stated that they are unable to determine Jahi's cause of death without an autopsy and that her autopsy being delayed means that they might never be able to.

This means they need to do an autopsy, wanted to do it all along and are going to, eventually, when her heart stops sometime in the future.

Surely they're the people who would know?

I'm sorry but not only haven't I had this conversation previously, <modsnip> Reporters have issued stories consistently that indicate an autopsy may not be necessary and I haven't seen anything to support your theory that "they" wanted to do it all along. Please don't accuse me of conveniently ignoring links. Thanks. This seems to be a case where some of us believe a parent does have a right to make these decisions and other want to obliterate that ability. I will never believe a parent does not have that right.