Jahi’s family wants her declared 'alive again’

[Donjeta]

Where did Prestigiacomo refer to a sleep apnea test? Not in his signed declaration that can be found here:
http://www.thaddeuspope.com/images/McMath_Linked_File.pdf

 

[TJL]

<modsnip>
He used very specific statements and wording which very professionally tell someone they don't know what they're talking about and are clueless. This is an art form of professional writing, and takes as much experience to perfect as it does to identify it.

 

[Donjeta]

I think the point these experts have made is that there is some brain function remaining. As minimal is that function may be it means that Jahi does not meet the California statutory requirement that ALL brain function must be absent. It is the legal quandary a court needs to address, not a medical one.

JMO

Well, first it is a medical quandary imo, in that the court needs to verify that the existence of brain function or lack thereof was assessed according to the established proper guidelines. Dr. Fisher seems to think it wasn't.

7180. (a) An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.
http://www.braindeath.org/law/california.htm

 

[TJL]

I think the point these experts have made is that there is some brain function remaining. As minimal is that function may be it means that Jahi does not meet the California statutory requirement that ALL brain function must be absent. It is the legal quandary a court needs to address, not a medical one.

JMO

I'll agree with you here, only so far as they're challenging the legal meaning of the word, "ALL." Much like the famous man, Dred Scott, did when he asked SCOTUS, "What is 'colored'?" In the McMath case, they're trying to get the courts to identify where, exactly, the brain starts and ends physically, while excluding the medical and philosophical understanding that physicality of brain matter doesn't cover function of brain that self-supports life and the Soul.

 

[nrdsb4]

<modsnip>

I think you are projecting that on him. I re-read it and to me it sounds very dry and lacking in any subjective tone whatsoever.

I guess this is your cue to say "I guess we will have to agree to disagree."

 

[MyBelle]

Correction. NONE of the people on Dolan's expert list of witnesses who performed or commented on the tests, are physicians. Not a single one. Not DeFina (he has a PhD from a diploma mill, so even that is shady, and a PhD is NOT an MD, but rather, receives the academic courtesy title of "Doctor"). Not the psychologist who did the EEG. And not Machado. To be counted as an expert witness in the country of courts you are testifying, you must actually meet that country's standards for the position you are testifying as. If he wants to be counted as a physician in a court of law in the U.S., or California for that matter, then he better get either an MD here, or licensed here.

Fischer (the only MD - physician - involved here), takes about as much issue with their findings as a rocket scientist would with a cub scout launching a paper airplane.

I imagine he was as bruised by their findings as Machado's CV in Comic Sans. In other words, it was probably akin to opening the National Enquirer and seeing his face photoshopped onto an alien's body: it was comedic to him, and he merely responded enough to let the world know he's not really half-alien.

JMO

Gosh, does Rutgers University know that Dr. Charles J. Prestigiacomo, chair of the neurological surgery department at Rutgers isn't a physician?

Brain anatomy “has been preserved that we don’t expect to see nine months after what we consider brain death,” he said, and in cases of brain death “we would not see any electrical activity in any part of the brain.”

http://www.latimes.com/local/lanow/la-me-ln-medical-experts-jahi-mcmath-20141002-story.html

 

[Hiandmighty]

I also didn't see Dr. Fisher's letter as anything but explanatory about the wrong tests....

 

[TJL]

Gosh, does Rutgers University know that Dr. Charles J. Prestigiacomo, chair of the neurological surgery department at Rutgers isn't a physician?

You know, this has already been covered, so I'll just let you take a few minutes to retract your...position...here. If my bicycle tires are flat, I accept it and move on.

 

[southernmimi]

Without medical equipment and machines operated by electricity, Jahi would quit "breathing" and die. If the machines are unplugged, she's gone. To me, she's already passed away, and should be allowed the dignity of burial.

 

[TJL]

Without medical equipment and machines operated by electricity, Jahi would quit "breathing" and die. If the machines are unplugged, she's gone. To me, she's already passed away, and should be allowed the dignity of burial.

I think the reason why no qualified professional has used this as ammunition in this case is because it's widely known that a person with c2-c5 completely severed requires a ventilator to stay alive because there's no voluntary or involuntary signals from the brain, through the brain stem and spinal cord capable of reaching the diaphragm to cause inhalation or exhalation. The difference is those types of PT's are typically consciously aware, and, removing the vent would induce great suffering on them as they "suffocate" in their own mind, with no ability to stop it. (P.S. this is why it's impossible for people to kill themselves by choosing to not breath. You'd pass out first from lack of oxygen and then the autonomous signals kick in which you simply cannot prevent while unconscious.)

Were a qualified professional decide to chime in with the "remove the vent and see what happens" paradigm, it would only open the door for the anecdote about spinal cord injured PT's. And I agree that it would do more damage than not, it's why you'll likely never catch me making such a silly assertion, but I'll still laugh with it

 

[Hiandmighty]

Google "Jahi Mcmath fingers" to see the photos of her apparently decaying body.

If you can stomach it, scroll down to see the photo of her finger with the hole in it and the other finger with the black blister on it.

(I'm married to a M.D. All my friends are M.D. We hang out with M.D.s If you will believe me, I will say they are cautiously waiting for "proof" of her not brain dead, but based on what they have seen thus far, believe she needs to be buried.)

They were all waiting for the "big reveal" and when that didn't happen, they were all like.. Ok. Back to brain dead....when they saw the finger photos, they were all like "ew. That's concerning"

 

[MyBelle]

Without medical equipment and machines operated by electricity, Jahi would quit "breathing" and die. If the machines are unplugged, she's gone. To me, she's already passed away, and should be allowed the dignity of burial.

My dad was in a car accident and in the CCU for four months on a ventilator. No doctor ever considered pulling the plug nor did we. The decision wasn't up to strangers on opinion forums, thankfully.

JMO

 

[TJL]

My dad was in a car accident and in the CCU for four months on a ventilator. No doctor ever considered pulling the plug nor did we. The decision wasn't up to strangers on opinion forums, thankfully.

JMO

That's too bad, sorry about your dad. Was he diagnosed brain dead by the doctors, or some sort of vegatative or coma state? I don't think Dr's ethically suggest to "pull the plug" ever on a patient that has even a slight prognosis of improvement. Unfortunately, brain death has no prognosis of improvement.

My mother died of grade 4 glioblastoma brain cancer when she was only 49. Fortunately, she made her wishes known to all of us that when she went to sleep, to let her go. But she wasn't brain dead, so no doctor or medical professional would have ever suggested to turn anything off anyways. What does any of this have to do with a brain dead 13-year old girl? Absolutely nothing, so what exactly was your point? We've all had someone close to us die, so your reaching for sympathy as confirmation of refusing to be wrong is really unnecessary here.

P.S. I notice you forgot to agree to disagree, as you call it, in our last correspondence. Why is that?

 

[Hiandmighty]

My dad was in a car accident and in the CCU for four months on a ventilator. No doctor ever considered pulling the plug nor did we. The decision wasn't up to strangers on opinion forums, thankfully.

JMO

With all due respect, as I'm sure that was a frightening situation for your family, but your dad has nothing to do with Jahi McMath. :hug: My dad died in his 60s after a long illness. He has nothing to do with Jahi either.

 

[katydid23]

Oh well the point some of them are making is that Jahi McMath is not brain dead because the MRI shows there is brain tissue left in her cranium and it hasn't all turned into liquid. I don't think that a radiologist would disagree with the part that there is brain tissue left. The fundamental problem (imo) is that there is not a lot of frame of reference and no one's quoted any studies about how fast everything disintegrates and turns into liquid and how long tissue may remain if brain dead people are maintained on life support indefinitely. It's not a requirement in any guidelines that everything inside the cranium must have disintegrated.

I wonder if some of them may have been pretty careful in not conducting any tests themselves because if you just state that i've been told that Jahi Mcmath responds to commands and that is inconsistent with brain death it's hard to argue with. None of them state that Jahi was ever able to respond to any of their commands or requests.

BBM

Which is odd, because at one point, Dolan claims that Jahi responded to commands by her mother AND BY A PHYSICIAN. I have been waiting to hear about that from a physician. So far, *crickets.*

 

[SwampMama]

I wanted to bring Dr Fisher's response here. I hope it is ok to have it here to the forum for those who do not want to wade thru the 163 page court filing. Fisher's response was not a document that we are able to easily copy and paste from (it was like a phototcopy that cannot be highlighted and words copied from, you would have to take screencaps) so I wanted to be able to have his words here for everyone to be able to copy and comment on.

Anything I omitted is indicated by ".............". ( I had enough to transcribe without long passages about accreditation agencies and their long convoluted names.). I am not a professional transcriptionist nor do I claim to have created an error free document. There may be a few typos which I will correct if needed, especially if they are crucial to understanding what it being said.

"Dear Judge Grillo,

I have reviewed the five(5) declarations provided to me by your court offices on October 3, 2014, specifically declarations of D. Ala Shewmon, MD; Philip De Fina, PhD; Charles J. Prestigiacomo, M.D; Calixto Machado, M..D.; and Elena B Labkovsky, PhD.

In order for you to review and interpret those declarations, I provide below and number of facts and thoughts raised by these documents.

1.Criteria for brain death in a child are those posited in Pediatrics 2011;128e720-740 (attached),...................................... &#8220;The American Academy of neurology;s Practice Parameters for Determining Brain Death in Adults&#8221; as referenced by Dr. Shewmon and &#8220;AMA (American Medical Association) guidelines&#8221; as referenced by Dr Prestigiacomo are not the relevant guidelines in the instance of Jahi.

2.The diagnosis and determination of brain death requires serial neurological examinations performed in person by different attending physicians. No record of any on-site or in-person serial neurological examination of Jahi McMath, performed by a physical, have been presented to me via these declarations.

3.Videos of hand and foot movements, coincident with verbal commands heard on audio, cannot affirm or refute brain death, and are not substitutes for in-person serial neurological examinations by a physician.

4.No apnea test has been performed or reported in the declarations, as required for a determination of brain death.

5.A repeat apnea test would not cause harm to Jahi McMath

6.Dr. Prestigiacomo has referred to a&#8221; sleep apnea test&#8221;, and that is not the correct examination in the determination of brain death.

7.A &#8220;flat&#8221; EEG, or electro-cerebral silence is not required for the determination of brain death(see Pediatrics 2011;128e720-740) . The EEG performed on 9/1/14 was not performed in standard conditions, but rather at an apartment and Dr. Machado does note artifacts, which he attributes to movement. Electrical artifacts cannot be excluded as the cause of reported electrical activity, but again, electro-cerebral is not requisite to the determination of brain death.

8.No cerebral blood flow radionuclide brain scan has been performed or reported in the declarations, and that is the test used to determine cerebral blood flow in order to assist in the determination of brain death, not magnetic resonance angiography (MRA) (see Pediatrics 2011;128e720-740)

9.MRA is not a technique used to determine blood flow.

10.MRA, as performed on 9/26/14, provides a structural picture of the brain and is not part of the determination of brain death. A picture of persistent brain tissue inside a skull does not negate the determination of brain death. Liquefaction of of the brain is not requisite to the determination of brain death. There are no specific anatomic or pathologic changes noted in brain death.

11.Heart rate analysis, as presented from 9/1/14, is not part of and not relevant to the determination of brain death.

12.Menarche and menstrual cycles are not relevant to the determination of brain death.

13.A Bispectral Index (BIS) monitor has no role in and is not relevant to the determination of brain death.

14.I cannot determine form the declarations whether Ms. Labkovsky has completed EEG technician certifcation in the United States, such as that required by the American Association of Electrodiagnostic Technologists (AAET) or American Board of Registrations of Electroncephalographic and Evoked Potential Technologists (ABRET). EEG Neurofeedback Certification is not considered the appropriate certification to conduct diagnostic EEGs, such as EEGs in the determination of brain death.

Overall, none of the current materials presented in the declarations refute my 12/23/14 examination and consultation finding (attached), or those of several prior attending physicians who completed the same exams, that Jahi McMath met all criteria for brain death. None of the declarations provide any evidence that Jahi McMath is not brain dead.

I want to note on record that I have not and will not accept and compensation for my services providing expertise in the matter of Jahi McMath, and I have no affiliations with the McMath family, UCSF Benioff Children's Hospital Oakland, or their legal counsels. I continue to extend my sympathies to the family and friends of Jahi McMath,

I hereby grant permission to the court to share this document privately or public, at your discretion. My CV is attached...............................
Paul Graham Fisher MD

 

[MyBelle]

You know, this has already been covered, so I'll just let you take a few minutes to retract your...position...here. If my bicycle tires are flat, I accept it and move on.

I merely responded to your false claim none of Dolan's experts in this case were physicians. I'm pretty sure Dr. Prestigiacomo is a real physician. And I'm pretty sure the American Academy of Neurology knows Dr. Machado is also a real physician and would be considered an expert in any American court.

Dr. Machado is a very credentialed neurologist, medical professor, and recipient of the American Academy of Neurology Lawrence McHenry Award in 2005 because of his research in the field. In short, he is a very respected expert in the field of brain death.

http://www.nationalreview.com/human...est-proves-jahi-not-brain-dead-wesley-j-smith

 

[Donjeta]

Here's the gist of the guidelines in determining brain death in children:

http://pediatrics.aappublications.org/content/128/3/e720.full

CONCLUSIONS AND RECOMMENDATIONS: (1) Determination of brain death in term newborns, infants and children is a clinical diagnosis based on the absence of neurologic function with a known irreversible cause of coma. Because of insufficient data in the literature, recommendations for preterm infants less than 37 weeks gestational age are not included in this guideline.

(2) Hypotension, hypothermia, and metabolic disturbances should be treated and corrected and medications that can interfere with the neurologic examination and apnea testing should be discontinued allowing for adequate clearance before proceeding with these evaluations.

(3) Two examinations including apnea testing with each examination separated by an observation period are required. Examinations should be performed by different attending physicians. Apnea testing may be performed by the same physician. An observation period of 24 hours for term newborns (37 weeks gestational age) to 30 days of age, and 12 hours for infants and chi (> 30 days to 18 years) is recommended. The first examination determines the child has met the accepted neurologic examination criteria for brain death. The second examination confirms brain death based on an unchanged and irreversible condition. Assessment of neurologic function following cardiopulmonary resuscitation or other severe acute brain injuries should be deferred for 24 hours or longer if there are concerns or inconsistencies in the examination.

(4) Apnea testing to support the diagnosis of brain death must be performed safely and requires documentation of an arterial PaCO2 20 mm Hg above the baseline and &#8805; 60 mm Hg with no respiratory effort during the testing period. If the apnea test cannot be safely completed, an ancillary study should be performed.

(5) Ancillary studies (electroencephalogram and radionuclide cerebral blood flow) are not required to establish brain death and are not a substitute for the neurologic examination. Ancillary studies may be us d to assist the clinician in making the diagnosis of brain death (i) when components of the examination or apnea testing cannot be completed safely due to the underlying medical condition of the patient; (ii) if there is uncertainty about the results of the neurologic examination; (iii) if a medication effect may be present; or (iv) to reduce the inter-examination observation period. When ancillary studies are used, a second clinical examination and apnea test should be performed and components that can be completed must remain consistent with brain death. In this instance the observation interval may be shortened and the second neurologic examination and apnea test (or all components that are able to be completed safely) can be performed at any time thereafter.

(6) Death is declared when the above criteria are fulfilled.

Pretty sure this article is in there somewhere in the previous court records, filed by Children's. So Dolan was aware of what the guidelines say, and if any of his experts are really experts on brain death they would also have known. Briefly, they require two clinical examinations including a neurological status and an apnea test. EEG and radionuclide blood flow tests are ancillary and not substitutes for the clinical examination.

However, none of Dolan's experts say they have conducted a clinical or neurological examination or an apnea test.

 

[Zuri]

Dolan is doing what he feels he needs to do as an attorney in case this reaches an appellate court. Dolan is right to place in the court record that Dr. Fisher is no longer an independent physician because he's already rendered an opinion to the court on which the court based a decision. The Judge may or may not agree with him but his objection is still in the record.

JMO

I apologize. I am not following this logic. Would you mind breaking this down for me?

 

[Hiandmighty]

I personally believe that was part of the design... The other tests would prove brain dead as noted by accepted criteria. So Dolan chose to try something new... And it didn't work.

Did anyone google photo of her fingers??? I really want someone else to see it!