Friday, 24 July 2015

Musings on Jahi McMath

While I can't say the Jahi McMath news is coming fastly and furiously, at least it's coming.  Before anyone mentions it, yes I realise "fastly" is not a word, but dammit it should be.  Why isn't there an adverb form of "fast" anyway?  "Slow" has "slowly" and "quick" has "quickly."  Why not "fastly?"  But I digress, as usual.

The latest in the saga is Jahi's family's response to the demurrers by the hospital and Dr. Frederick Rosen.  The demurrers, in case you missed them, were the hospital's and Dr. Rosen's challenges of the legal sufficiency of Nailah Winkfield's case against them.  On July 17th, Nailah Winkfield's lawyer Bruce Brusavich (love that name, by the way) filed his response to their response (thanks to Professor Thaddeus Pope for posting the documents).  The way the US legal system seems to work, I expect that there will be responses to the responses to the responses, then responses to those responses, and then even more responses, and eventually the whole system will collapse under the weight of 81 million tonnes of paper.

But I digress again.

I've reviewed Brusavich's response, and a few things stood out immediately.

It seems Brusavich is taking a note from Dr. Paul Byrne's notebook and is now putting "brain dead" in quotations.  Furthermore, and even more surprising, he is continuing to claim that Jahi is "very much alive".  The rationale for this opinion is elucidated a little further on:
Yes indeed, they are saying she is not dead because her hypothalamus is functional and she has "intermittent responsiveness to verbal command".  Hypothalamic function does not equal life, though responsiveness does.  It would, however, mean that her entire brain is not dead.  Whether that would change anything is up to the lawyers to argue.  I hope that they have proof other than a few vague videos released late last year that show her moving.  If she is in fact responding to verbal commands, then that does indicate consciousness.  I will reserve judgment on that until I actually see it.

Then Brusavich goes over the details of the case with a few rather comical errors. 
I would have thought Brusavich would have learned the difference between "pallet" and palate" since the last time he made this exact same mistake.

Maybe I'm the only one who finds that funny.

Brusavich then goes on to criticise Dr. Rosen for not informing anyone about his suspicion of a medialised carotid artery.  I've been criticised by a certain someone for downplaying this point as well, so if you would indulge me for a moment, please allow me to clarify my position:  A medialised carotid artery without question increases the risk for intra-operative or post-operative bleeding after this sort of surgery.  That is not at all in doubt.  However, informing anyone in the recovery room of his suspicion was unnecessary and irrelevant, because any bleeding that occurs after ENT surgery is easily diagnosable.  Jahi obviously had a massive haemorrhage after the procedure, and everyone around her obviously knew about it.  Jahi knew, the family knew, the nurses knew, hell the custodians probably knew.  So how would informing anyone of this possible anatomic anomaly have helped?  Would it have helped them diagnose bleeding?  No.  Would it have prevented the bleeding?  NO.  Would it have stopped the bleeding?  NO.  Would it have changed anything in any way?  NO.  This is a non-issue.  Full stop.

The nurse responsible for caring for Jahi that evening recorded in her chart (several days later, mind you) that she repeatedly informed the PICU doctor about Jahi's condition, but no action was taken.  Dr. Rosen stated in his demurrer that he was not aware of Jahi's haemorrhage because he was not contacted.  I find both of these points very difficult to believe, though I am not claiming either is untrue because I was not there.  I just think it highly unlikely that intensive care doctors would ignore a bleeding patient for hours, refusing to see her.  I find it just as unlikely that the surgeon who performed the procedure wasn't called during any of this to let him know that his patient was haemorrhaging.

Was a PICU doctor called?  Probably.  Was Dr. Rosen called?  He claims not.

Unfortunately Brusavich then enters a legalese Twilight Zone and starts referring to other cases, using terms such as "judicially noticeable", "prima facie evidence", "res judicata", "collateral estoppel", andsnkseio ZZZZZZZzzzzzzzz  ZZZZZZZZZZZzzzzzzzz ZZZZZZzzzzzzz

*snort*

Wha . . . what?  Oh, sorry.  I think I fell asleep there for a bit.

Anyway, Brusavich concludes (sort of) that Jahi is alive due to some MRI results, EEG results showing neuroelectrical activity, Jahi's supposed responsiveness, and the fact that she started puberty.  Is any of this true?  We'll have to wait and see.

What I will say (yet again) is that if they can actually prove that Jahi is alive, she will be the first documented patient in history to have survived and recovered from brain death.  

I'll believe it when I see it.

220 comments:

  1. Sounds like the same "proof" mama and attorney filed in October of last year. It will be interesting to see what happens.

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  2. So, in short, there seems to possibly have been a communication issue in the hospital, of which the only "evidence" are the statements by the nurse and the surgeon.

    And Jahi might or might not have recovered from brain death, which was only claimed by the family and their lawyer and which goes against all medical experience ever.

    What a mess. But at least they are working through the material and it comes out in the open. I hope this is resolved soon.

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  3. Let's not forget that another example of his "proof" that Jahi is alive comes at the grand finale of this jumbled mass of writing. He claims that Jahi's status as a living person is a matter of public record, since she is eligible for, and receiving, Medicaid in New Jersey, and attaches some letters to document this (letter from NJ Dept. of Health and Human services affirming eligibility, and other letters addressed to Jahi from the insurance providers, documenting approvals for the in-home nursing services, and durable medical equipment which is, I believe, the ventilator). Brusavitch claims that this "proves" that Jahi does not meet the criteria for brain death.

    Yes. He really says that. Really.

    Can he *really* not know that the "criteria for brain death" isn't any different in New Jersey than it is in California? What's different in New Jersey is the *law,* which allows a patient's family to reject DDNC as a legal determination of death. Jahi is only considered "alive" in NJ because her mother chose to exercise that option.

    How is this even relevant, in a California court? The court *knows* that the law in NJ is different, so that's why Nailah had Jahi moved all the way across the country. There's nothing unusual about people relocating, if the laws or policies in another jurisdiction are more advantageous to their situation. The fact that Jahi's family made this choice has no logical relationship to the matters before the court.

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  4. Years ago I had an operation to remove my adenoids, for pretty similar reasons as Jahi. (breathing problems, constant chest infections, apnea etc. Later followed by a tonsillectomy and septoplasty)

    I hemorrhaged. Badly. They knew, they definitely knew.

    Still half under the anaesthetic I rolled over and suddenly there was blood pouring from my nose and mouth and down my throat. I was about 14 ish and I panicked, I couldn't breathe and there was a *lot* of blood.

    I was staying in a shared room and another occupant apparently started frantically hitting the call button. The next thing I know there's a whole group of people around me trying to get it under control, I remember one nurse with a bag of ice on the bridge of my nose, a doctor trying to get some coagulant to the operation site, someone else suctioning my throat so i could breathe, someone holding a basin for me and i think there was one more person holding an oxygen mask near my face. There were probably more.

    I do not have a medialised carotid artery or any other anatomical anomaly (other than the deviated septum) that i'm aware of. But I still hemmoraged.

    They kept me in after the bleed, i was supposed to be an outpatient, and later that night a nurse helped me to the bathroom to clean my teeth. While she fetched me a toothbrush the bleeding began again, they apparently found me hanging over the waste bin, bleeding and clutching the call bell cord in my hand. I don't remember this, i must have passed out.

    Cue round two of the flurry of activity.

    I spent three days in hospital with packing up my nose, and an IV in my arm to keep me from passing out again.

    And now to my point, sorry, i ramble a lot. Post operative hemorrhage is a risk in any surgery, as Doc says, knowing about the artery wouldn't make a blind bit of difference as it could have happened anyway and I can only imagine patients are watched for this kind of thing.

    I didn't bleed for long because there were so many staff around and they did their job well, but even so, i've been told, i was only a couple of minutes from being rushed down to surgery to cauterize the site again to try to stop the bleeding.

    Different hospitals, different staff, even a different country, but I, personally can't see the response over in the US as being so drastically different. From panicked but efficient treatment, to refusing to see a bleeding patient? It doesn't seem that likely somehow.

    I can't believe in a communication breakdown, they happen an all walks of life, but Dr. Rosen will hardly have been the only qualified professional around who could have responded to Jahi's situation.

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    1. Apologies, that should say "I *can* believe in a communication breakdown". Rather than can't.

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  5. that's "Dr" Paul Byrne. get that out of the way right here and now.

    now, from the top:
    is that metric tonnes or US tons, or long tons?
    "intermittent response to voice commands" - by which they mean if they give the command enough times, the twitch coincides with it.
    And yes, the newest videos proving her responsiveness are THE SAME VIDEOS as last October. you know, the ones that were inadmissible.
    and given the evidence that brusavich is pursuing this case using only information that is outdated, unsupported, and already proven invalid is clear evidence to me that HE has survived brain death.


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    1. I spent a year at the bedside of a child in a persistent vegetative state (drowning). At first he didn't move at all because he was - we were told - in deep coma. One day I was there by myself. I said his name, and his head whipped around and he 'looked' right at me, his eyes were wide open (pupils fully dialated in a well lit room). I thought, it's a miracle, he's awake! Well, no, it wasn't a miracle and he wasn't awake. He was stabilizing from deep coma to PVS. He had awake/ sleep cycles. He would move around, and his body became contracted and twisted. You could however make a Terri Schiavo type video if you timed things right. Just keep saying his name, and at some point you'd catch his head turn in your direction. Ask him for an hour to move his foot or hand, and at some point he'd do it. These were random movements, and had nothing to do with commands.

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    2. Misty, thank you for sharing this first-hand information. That's why I never figured that the videos Dolan presented last fall were real "evidence" of responsiveness. We hear a voice, presumably Nailah's, telling Jahi to move her foot, but whoever is speaking isn't shown on the camera. It's not as if we actually saw Nailah sitting beside Jahi's bed, talking to her, and the movement actually *coinciding* with the voice command. We all know that videos can be edited, so it's possible that a video of the random movements had the voice added later.

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    3. If Jahi were in PVS state then she would be back from the dead. In all States and most countries PVS is alive. If that were true CHO better get the money ready.

      Brain dead does not equal PVS anywhere. No one comes back from brain stem dead. That is full brain death. If there hypothalamic response that challenges the notion of brain death. It isn't possible brain death is whole brain death.

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    4. brain dead people have exhibited spinal bases reflexive motion. I understand it is called the lazarus reaction or something like that. Doc went over it back when Dolan tried to use the videos to prove Jahi was alive the first time.

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    5. Yes, it's called the Lazarus reflex or sign. But hypothalamic/pituitary response isn't any part of it. However, it's been known for decades (since the 80s) that people who meet the neurological criteria for brain death can have persistent pituitary activity. Finding that does not invalidate the brain death diagnosis.

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    6. Try telling that to John Benton and Dr. Byrne. They seem to think all you need to be "alive" is a hypothalamic/pituitary response, consciousness be damned.

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    7. To Anonymous at 18:49 -- I fully understand that brain death and PVS are not the same thing. My point was, random movement that has nothing what-so-ever to do with hearing, processing, and obeying commands proves NOTHING. Thus, the less than one minute Jahi videos are as bogus as the ones made by the Schiavos where they dolled Terri up with makeup, and made it look like she was responding to family. On autopsy, it was revealed that Terri's brain had liguified. It's easy to make a video that makes a brain dead or PVS person look like they're still making a connection to the outside world, and responding to those around them -- but they most certainly are not.

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  6. Phoenix, in your post you said you were in a shared room and were supposed to be an outpatient. Jahi was in the PICU! In the pictures I've seem of the PICU in CHO the patient beds are positioned around a central nurse's station with only curtains between each bed. Each patient would be visible at all times to the nurses at the station. It is unimaginable that they would blithely ignore a young girl bleeding profusely after such an extensive surgery. Her mother claimed early on in this saga that she witnessed Jahi coughing up blood and clots from the minute she arrived in the PICU unit. Add to that the claim by the grandmother that her blood oxygen saturation was dropping precipitously and the grandmother herself had to call the code! This is an astounding claim since we are talking about a PICU unit where each patient is hooked up to every monitor imaginable. Alarms would've been going off and we are to believe that the nurses simply ignored them.

    Doc, in your experience, has a patient's visitor ever had to be the one to call a code in any hospital in which you've worked? These claims, if they are to be believed, paint CHO and the entire PICU staff as grossly incompetent and not only criminally negligent but blatantly so.

    It is certainly suspicious that two different nurses added notations to Jahi's chart well after she had already been declared brain dead. If the wording as stated in the complaint is accurate both nurses appeared to be trying to exonerate themselves from blame when no doctor came. The actual inclusion of wording to the effect that doctors were notified and responded that no intervention would be forthcoming is astonishing.

    If these claims pan out then CHO and its entire PICU staff are indeed guilty of gross medical malpractice. Of course none of this will bring that precious child back to life but she deserves justice. Keeping her body preserved using the dwindling resources in the Medicaid fund will not serve that purpose.

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    1. That is a very good point. I was simply in a small ward, my operation was expected to be very straightforward but I experienced a nasty complication. In somewhere like a PICU I can't see a situation similar to mine being simply ignored.

      I was responded to extremely quickly and they did great work getting my bleeding under control. This was not any kind of intensive care, just a standard post operative childrens ward.

      At one point i tried to sit up and my blood pressure dropped, making me lightheaded, an alarm went off and a nurse was there before I had time to regret the movement.

      If indeed Jahi's condition was ignored, then every single member of staff was incredibly negligent and incompetent, and I just can't see that being the case for everyone there.

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    2. I am a nurse and have worked in hospitals for a long time. Occasionally we will chart 'after the fact' because we didn't have time when something initially happened and we were asked to by administration. Having said that, the rule is that if we call a doctor and they don't come, that doesn't release us from liability. Suppose I call Doc Bastard and he can't come or doesn't answer. Maybe he is elsewhere or blowing me off. Then its my job/responsibility to call someone else. I would call a CODE if I had to just to get people at the bedside and I have in the past done just that. Some things in this case that the family is stating just don't seem 'right' and I don't believe them. I can not imagine heavy bleeding getting ignored for all those hours, leaving the family alone in the room. If that did happen, there is serious neglect on the part of the nursing staff.

      Much of what the family has presented in this case sounds like the family would like us to believe their version but thats not what happened.

      The lawyers, it seems, are hoping that people are stupid (for lack of a better word to use) and will not fact check.

      Kate Johnson

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  7. Jahi's condition NEVER fit the actual legal and medical definition of brain death. She is receiving medicare benefits in New Jersey because her "death certificate" is a sham. It was only issued after the higher courts became involved and it became obvious that Jahi was going to be removed from CHO.

    The legal definition is the IRREVERSBLE cessation of all functions of the entire brain including the brainstem. In USA it is not merely brainstem death" as in the UK but ALL functions of the brain. Irreversible presumes knowledge of a future event.
    Yes,Jahi is in a deep apneic coma,but that is what brain death used to be called.
    Most people never have any chance at recovery or improvement because it s considered medically futile and most of these severely injured patient will eventually have their hearts cease even while on life support.
    They never have any chance because brain death is usually declared very quickly.It is being proposed also that the second opinion be eliminated or as in the UK just have a second dr observe the first during the clinical bedside exam.
    I also believe the pre oxygenation in regards to the apnea test is not to benefit the patient but to protect the organs in case they are suitable for transplant.

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    1. Hmmm, almost the same exact crap JB posts.... edit - scratch the almost

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    2. How many exams following the well-established brain death declaration protocols does one need before acceptance? Eight? Ten? Harvard did not make up the criteria willy-nilly.

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    3. Hey Doc! It looks like John Benton is back, you may want to kick him to the kerb again!!

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    4. They never have any chance because brain death is usually declared very quickly.

      No, they never have a chance because brain death is irreversible.

      One observation on the response to the demurrers. Last year, a relative of Jahi's (the grandmother) did a TV interview in which she admitted a doctor had been in attendance while Jahi was bleeding and had started an IV drug the nurses supposedly had never heard of before and had sprayed some kind of "aspirin" up Jahi's nose ( did she mean Afrin?). The demurrer mentions none of these things, claiming a doctor only arrived in time to see her code. In light of this fairly contemporaneous interview with the grandmother, it's strange that they are now not mentioning these events in favor of a claim that no doctor was ever in attendance.

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    5. Now John you're saying she is in a deep apneic coma? What about all the claims that she is responsive, getting "better" and "stronger"? Which is it??? Deep apneic coma sounds a lot like a corpse hooked to a ventilator

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    6. Jahi's death certificate would have been issued much SOONER than it was, if her sorry excuse of a mother wouldn't have gone to court for the TRO. CHO gave her and the family extra time to grieve,Jahi was going to be removed from the machines, and her BODY was going to be released with a death certificate,like every other patient that dies. End of story, so miss us all with the DC is a sham John. The only way a deceased patient leaves a hospital is with a death certificate.She's receiving medical care in NJ because NJ doesn't recognize Brain Death as death, NOT because her DC is a sham, and she's not receiving Medicare. She's not 65 or disabled.

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    7. I decided to let this comment through. I'm enjoying the feedback.

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    8. To Anon. July 25 6:41 - Excellent point about Medicare vs. Medicaid. But the reason that Jahi's mother was able to file for Medicaid for her daughter isn't because the state of New Jersey "doesn't recognize brain death as death." Death determination by neurological criteria IS recognized there. If Jahi had had her surgery there, and the same tragic events followed, we have no reason to believe that she wouldn't have met the DDNC criteria, same as in California. The difference is that the NJ law allows the patient's *family* to reject that medical diagnosis, if they choose to continue futile medical support.

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    9. Regarding pre oxygenating the patient to test for apnea. Hogwash. They do it on every patient regardless of organ donation status.

      You seem to be forgetting that the test is one in which they test for any responses at all, and if it were PVS or Coma she would not have been declared brain dead.

      Why not just admit that the girl is dead and let her go? My question to you is, since she doesn't respond, has no chance of any life, meaningful or otherwise, why do Christians not want their dead to move on into Heaven and be with the Lord? What they teach and preach they seem to fear in real life. Doesn't look good for religion......

      Kate Johnson

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  8. Jahi most certainly did fit the legal and medical definition of brain death. She has been on a ventilator now for almost two years. Even in the few cases where families insisted on keeping their loved ones ventilated no one ever recovered. Her reticular activating system was destroyed along with her brain stem. She will never be conscious or take another breath on her own. She had a blood perfusion scan done late in December weeks after her surgery. At that time her brain was still without blood flow. No one has ever recovered brain function after such a long time without oxygen, ever. You say they only pre-oxygenate before the apnea test to preserve organs but that is patently false. They do it even when they know the person will not be an organ donor.

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  9. The fact that the state investigators found nothing awry on CHO's end in this case weighs heavily in favor of the defense.

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  10. Someone with a legal mind on Facebook said that it is an attorney's job to:
    1. document their client's claims
    and
    2. Prove it.

    ole Brucey managed step one quite nicely, but he will fail miserably on step two and I can't wait to see how that turns out for him!

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    1. he was pretty bad at the first one, too.

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  11. Fastly is a word -- according to the OED. Rare these days, but a word indeed. Example of usage the OED gives: The life of the child was fastly on the wane.

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    1. True, but the Oxford English Dictionary also says "doh" (yes, Homer Simpson's "doh!") is a real word too. http://abcnews.go.com/US/story?id=93098

      So take that with a rather large grain of salt.

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  12. Doc: I will be attending the demurrer/motion to quash hearing on July 30 and will report the results here.

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    1. Excellent. I look forward to it.

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    2. Should WE ignore the law on brain death?

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    3. Cleopatra, did you make it to the hearing? I saw on the court website that media were denied coverage. Were you able to find out anything?

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    4. I did attend and will post my report above. I wasn't able to put it all together until this evening.

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  13. What happened to the smoking popsicle? Grandma Chatman said they gave Jahi one, and Dolan mentioned it in one of his numerous filings. The whole story seems to have changed, including the detail that Grandma had to be called to the hospital, when she told a TV interviewer she was there with her daughter when Jahi came out of surgery. Something is really wrong with this time line. Check out this YouTube interview with grandma. Seems like a lot of inconsistencies:

    https://www.youtube.com/watch?v=2ZhhTWhlW9c

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    1. the family is nothing if not consistent in producing inconsistencies.

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    2. This is the same interview I mentioned upthread. Thanks for linking it, Misty.

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    3. Near as I can understand what happened here is that they were all there after the surgery and then Jahi was settled in for the night. The major bleeding started hours later and that is when Granny was called back. There is a time lapse here where everything was likely just fine and dandy but the family isn't discussing that because it doesn't fit in with their drama.

      Kate Johnson

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  14. There's speculation in the comments on Thaddeus Pope's blog that Jahi's family may have committed Medicaid fraud. They say if they listed her as brain damaged and forgot to mention the California death certificate, she would be approved. A case worker looking at her would only see a very damaged child, but they wouldn't know she was dead. New Jersey allows maintaining the dead on machines, but they aren't going to pay for it.

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    1. Jahi never applied for medicaid in California. So what medicaid fraud are you talking about? If you're talking about the NJ medicad program...uhm...they don't beleive in brain death. As long as you have a heart beat and blood pressure, you're alive.

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    2. In my view "Medicaid fraud" IS pure speculation. This unhinged family and ths case are infamous enough that it's HIGHLY unlikely that NJ would be clueless re: the Calif. history.

      It's far more likely that NJ allowed for a loophole between the incomplete Calif. death certificate and NJ's vague and poorly crafted brain-death exception.

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    3. Poorly crafted? California's law on brain death is clear as daylight. It can't be ignored, or shall we?

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    4. Anon 6:23, kindly reread:

      The reference was to "NJ's vague and poorly crafted brain-death exception" -- which is relevant to the Medicaid discussion here.

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    5. Remember that Jahi was admitted to St. Peter's Hospital in NJ as a live patient of Dr. Fellus, and immediately placed in the ICU. Remember also that Dr. Fellus was, at the time, a licensed MD, in addition to being affiliated with the IBRF. It's unlikely that a Medicaid case review specialist would challenge any medical reports or assessments related to a patient already in hospital care, if they were submitted by her doctor of record, who had residency privileges at the hospital where the care was being administered.

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    6. If she was considered a living patient while at St. Peter's why did she have to leave when Fellus lost his license? At the very least I wonder why she wasn't just transferred to a long term care facility if she was receiving Medicaid all this time.

      It seems odd that her family would cram everyone into a two bedroom apartment. I wonder if the Medicaid eligibility was a recent development. To qualify you have to establish residency in New Jersey but all that takes is either a new driver's license or a bill with a New Jersey return address. Apparently not actually being alive isn't an issue.

      Is Jahi's status as alive or dead even something that can be decided at the demurrer hearing? Brusavich did say in his rebuttal that it was a complicated issue and they probably wouldn't be ready to go to trial within 12 months. It looks like this isn't going to be settled anytime soon unless they work something out in mediation.

      Brusavich made another error in his filing. Not only did he repeat his misspelling of palate, he also claimed that Jahi's grandmother became so overwrought she had to be admitted but the original complaint stated it was Jahi's mother. Does anyone proofread his documents?

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    7. For Anon 15:32 - The reason that Jahi couldn't remain at St. Peter's after Dr. Fellus lost his license is because no one can just stay in the hospital and continue to receive whatever care and services that they (or their family) want without being officially under the care of a doctor who is on staff. St. Peter's *had* to discharge Jahi, when she was no longer officially a patient of any doctor on the staff.

      When Dr. Fellus lost his license, he was ordered to transfer his then-current patients to the care of another doctor within 30 days. IMHO, it's safe to assume that no other doctor at St. Peter's *wanted* to take on Jahi's case. I'm guessing that Dr. Fellus couldn't find a colleague at any other hospital, or with an affiliation at a long-term care facility, to do this either, otherwise Jahi's family surely would have transferred her to another facility, instead of setting up the home care arrangement.

      Even at a long-term-care facility, every resident is officially a patient of the doctors on staff. Someone still has to be responsible for developing the patient care plan that the nurses implement, prescribing meds, visiting the person on a regular basis for checkups, conferring with the patient's family as needed, and such. These doctors usually have residency privileges at a hospital somewhere in the general area, so that patient care can be coordinated if the resident needs to be hospitalized for any reason.

      According to the Medicaid documents that Brusavitch submitted, the doctor who ordered and approved the durable medical equipment is Dr. Alieta Eck. She and her husband founded, and operate, a free clinic for lower-income and uninsured folks in the New Brunswick area. At this point, we don't know how much she's really involved with Jahi. Maybe Nailah found her by chance through the charity clinic, maybe the social workers at St. Peter's referred her when she couldn't find a doctor. I guess that information will become known as the case moves forward.

      Regarding the case management conference scheduled for later this week, nothing will really be "decided," regarding the substantive issues of the case. It's basically a "get organized" session, at which time the judge will give a response to the various demurrers, and probably instruct Brusavitch to amend his petition so that it makes legal sense. All parties will talk about scheduling, evidence submissions, and other procedural matters. No decision regarding Jahi's status as dead or alive will be made until evidence is presented and considered.

      First order of business, as I see it, will be the judge ordering Brusavitch to make up his mind about what he wants. I wonder if this might actually require breaking it down into two separate cases.

      The original petition presents the scenario of Jahi being both dead and alive, so the court doesn't know if he's making a wrongful death claim, or a claim for continuing care expenses due to disability. Gotta fix that.

      But then the demurrer response seems to focus on proving that Jahi is alive. So, that's asking to re-litigate a matter that's already been decided by the court. Gotta decide whether the court will even entertain that argument.

      Problem is, he can't make a claim for compensation for continuing care for a disabled person, when that person is already considered legally dead under California law. So, he has to prove the "alive" argument first, if he doesn't want to go for the "wrongful death" settlement.

      Yeah, he's right about ONE thing...it's complicated!

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    8. I attached this link from Professor Pope to another post but it does include the two responses to the response filed by Rosen and CHO:

      http://medicalfutility.blogspot.com/2015/07/jahi-mcmath-court-may-allow-family-to.html

      I totally agree with your opinion regarding no other doctor at St. Peter's or LTC facility wanting to touch this case. I had family members in LTC so I know how they work regarding attending doctors. In my experience the family doctor took care of admission into LTC but we had to choose a different doctor as the attending, one on staff at the facility. They still consulted whenever an issue arose, and there were several different health emergencies when a hospital admission was warranted.

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    9. Dr. Alieta Eck is also interested in politics, she ran for office. So that makes me wonder if that may be part of the reason she agreed to be Jahi McMath's physician.

      http://ballotpedia.org/Alieta_Eck

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  15. "Last year, a relative of Jahi's (the grandmother) did a TV interview in which she admitted a doctor had been in attendance while Jahi was bleeding and had started an IV drug the nurses supposedly had never heard of before and had sprayed some kind of "aspirin" up Jahi's nose ( did she mean Afrin?)."

    I saw grandma's TV interview and there was no mention of any MD showing up to attend to Jahi when she was profusely bleeding after tonsllectomy.

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    1. You'd better double check that, because I've quoted her exact words here twice at least. Here they are once again: "And then I even asked the doctor, "What are you going to do about this? They started some drip that even the nurses hadn't, you know, knew about, and sprayed some sort of aspirin (sic) [probably means Afrin] in her nose. And she was profusely bleeding from the nose, and Jahi and I were both trying to suction out of her..."

      From this, it's clear that the grandmother is stating 1) a doctor was there, 2) a doctor started an IV medication and used a nasal spray, and 3) this was while Jahi was still alert and able to take actions of her own, like suctioning. So, it was clearly not after she'd coded.

      Delete
    2. To Anonymous 02:30 -- I posted the link to Grandma's interview above, but you may have missed it. As Anonymous 21:24 stated, you need to recheck that. Here's the link to Grandma's interview again:

      https://www.youtube.com/watch?v=2ZhhTWhlW9c

      You will see Anon 21:24 is exactly right as to what she said. There were doctors there.

      Delete
  16. To Anonymous 02:30 -- you apparently missed grandmother Sandra Chatman's 12/2013 TV interview with Jane Velez Mitchell (HLN).

    ReplyDelete
    Replies
    1. I did not miss anything. TV interviews cannot be interpreted as facts in this case so it really doesn't matter. It's inadmissible due to the fact that's it's irrelevant, which means that it is not a sworn declaration.

      Delete
    2. The video and transcripts prove you wrong, though you claim you "didn't miss anything." And now you say that anyway, your wrongness doesn't matter.
      Don't expect to be taken seriously.

      Delete
    3. he didn't miss it, he ignored it because it didn't go along with his narrative.

      Delete
    4. Mother, Grandmother and Step Father will be grilled over and over again during deposition regarding the timeline. Bruce better prepare his clients for that. If the doctor was there he will be deposed as well and we will have conflicting testimony. The jury will choose who is credible.

      Delete
    5. @anon 25 Jul 06:16 You disputed that the statement was even MADE in the interview, and it clearly WAS said. So, you are wrong on that. Now, if you want to allege the grandmother was lying when she said it, that's an entirely different claim than you originally made, and you'd need evidence to substantiate it. So far, you haven't provided any, and you were wrong with your first claim and needed to move the goalposts. Can't say I have much faith in any subsequent claims you might trot out.

      Delete
  17. " informing anyone in the recovery room of his suspicion was unnecessary and irrelevant, because any bleeding that occurs after ENT surgery is easily diagnosable. Jahi obviously had a massive haemorrhage after the procedure, and everyone around her obviously knew about it."

    Here's what WE do know. Jahi was NOT bleeding prior to being transferred to PICU. If bleeding was delayed due to vessel spasm then Rosen should have informed everyone. It's possible that Rosen could have lacerated the same artery he mentioned in his post-operative report. The fact that vessel spasm can produce delay in bleeding, it may have given him the WRONG impression that everything was fine, that there was no bleeding prior to transferring Jahi to PICU.

    ReplyDelete
    Replies
    1. Thank you for missing the point again, John. If bleeding was delayed, it was still easily diagnosed whether she was in the recovery room, PICU, at home, or at the circus. Even a circus elephant would have understood this by now.

      If he lacerated the artery, it would have bled and someone would have seen it immediately and said, "Hey she's bleeding." Oh wait, that's EXACTLY what did happen.

      So I'll give you one chance to explain how it would have made a bit of difference.

      Delete
    2. Doc, correct me if I m wrong, but you watch what you are cutting, don't you? I mean, if you were to, say, lacerate an artery (which i assume would be visible if he noticed it to put in his report) you would have seen the scalpel slice into it?

      I don't do surgery, but when I am cutting firewood, I don't just wave my axe around blindly and then be totally surprised later when I find my cherry tree has been chopped down.

      Delete
    3. Yes of course, but even still bleeding can happen. The difference between this case and mine is that if bleeding happens in the abdomen, no one can see it. With ENT surgery, and haemorrhage can be seen from across the room.

      Delete
    4. yes, but the argument that Rosen somehow managed to cut an artery without knowing it seems specious at best, based on the fact that you DON'T just hack away blindly without checking your work.

      Delete
    5. "if you were to, say, lacerate an artery (which i assume would be visible if he noticed it to put in his report) you would have seen the scalpel slice into it?" - Ken Brown

      I don't think they use scalpels to perform multi-level ENT procedures on a child. Electrocautery is actually way faster. Zing! Zing! You're fast Bovie!

      Delete
    6. so with electrocautery you hack blindly?

      Delete
    7. Zing! Zing! It's the troll!

      Delete
    8. When I bled after my surgery, i had already been taken out of theater, had the anesthetic reversed in the recovery room and been returned to the ward. I began to bleed *after* a few minutes on the ward when I rolled over to get more comfortable.

      And trust me, it was really noticeable, there was blood *everywhere*

      They may have nicked a blood vessel of some kind, or maybe I'm just a bleeder, either way, they weren't expecting any complications otherwise I wouldn't have been returned to a standard, outpatient childrens ward, i would have been placed somewhere where they could keep a closer eye on me.

      And as I said, no anatomical anomalies here other than a deviated septum.

      I can't see that knowing her artery was in an odd position would be of any use.

      Delete
    9. you mean like, say, a PICU? and kept the family out until they were sure she was stable? well, tried. you know how rules don't apply to people who win.

      Delete
  18. I don't think that if they can actually prove that Jahi is alive, this would prove that Jahi "recovered" from brain death. It would prove that she was misdiagnosed, which is very different.

    Recovery from brain death does not happen. Medical misdiagnosis happens all the time.

    ReplyDelete
    Replies
    1. however, that would mean 5 misdiagnoses in a row.

      Delete
    2. Hormones are produced by the pituitary gland. If they detected these hormones from Jahi's blood ( serum hormones) after more than a year and a half, misdiagnosis is possible. It's either that or the brain recovered:

      Adrenocorticotrophic hormone (ACTH)

      Thyroid-stimulating hormone (TSH)

      Luteinising hormone (LH)

      Follicle-stimulating hormone (FSH)

      Prolactin (PRL)

      Growth hormone (GH)

      Melanocyte-stimulating hormone (MSH)

      Anti-diuretic hormone (ADH)

      Delete
    3. Here:

      Implications of ischemic penumbra for the diagnosis of brain death.
      Coimbra CG1.
      Author information
      Abstract
      The data reviewed here suggest the possibility that a global reduction of blood supply to the whole brain or solely to the infratentorial structures down to the range of ischemic penumbra for several hours or a few days may lead to misdiagnosis of irreversible brain or brain stem damage in a subset of deeply comatose patients with cephalic areflexia. The following proposals are advanced: 1) the lack of any set of clinically detectable brain functions does not provide a safe diagnosis of brain or brain stem death; 2) apnea testing may induce irreversible brain damage and should be abandoned; 3) moderate hypothermia, antipyresis, prevention of arterial hypotension, and occasionally intra-arterial thrombolysis may contribute to good recovery of a possibly large subset of cases of brain injury currently regarded as irreversible; 4) confirmatory tests for brain death should not replace or delay the administration of potentially effective therapeutic measures; 5) in order to validate confirmatory tests, further research is needed to relate their results to specific levels of blood supply to the brain. The current criteria for the diagnosis of brain death should be revised.

      Delete
    4. Susan, I totally agree. Still, it seems that what the plaintiffs are claiming as evidence of "life" may actually just be evidence of good *preservation* of whatever remained of Jahi's body at the time of her tragic demise.

      In fairness, because this case is so untypical, and perhaps medically unprecedented, it's possible that they are truly confused about this also.

      Brusavitch claims that Jahi "must be" alive because her body has not deteriorated and decomposed, as one would expect when a body is devoid of all brain function. Of course it hasn't...it's been preserved for more than a year and a half, with the equivalent of ICU care. That's not what *usually* happens when brain death is diagnosed. Even if the family chooses to continue not to terminate vent support immediately, and to continue some level of hydration and nutrition, the heart will eventually stop beating as other bodily functions shut down.

      But...Jahis' body wasn't just getting these basic "life support" measures. Medications were administered to control blood pressure and manage infection, and hormones were administered also, to replace those no longer being produced by the pituitary gland and the hypothalamus itself. Which brings us to another of his points...

      If he is claiming that "she exhibits hypothalamic function" because the continuation of certain body functions has been observed over time (growth, metabolic function, sexual maturation, some degree of body temperature regulation, etc.), that doesn't necessarily mean that the hypothalamus is actually working. It may just be the result of the hormone replacement therapy, to take over the job of a hypothalamus and pituitary gland that are no longer functional.

      To prove that any portion of the brain is actually healed and working, he will need to produce some solid medical evidence. IMHO, if it existed, Dolan would have presented it last year. Preservation of a body doesn't automatically equal "being alive," much less "recovering" from loss of brain function.

      Delete
    5. My wish: More DocB; infinitely less Troll.

      Delete
    6. Very sensible Scarab.

      I am not a medical professional, so I'm coming from relative ignorance. When Jahi was released from CHO a year and a half ago, we laypeople were all told that her body was already seriously deteriorating, and that she wouldn't last long. (Of course no one could know for sure.)

      The body has "lasted" for quite a long time so far, though the fact that no impartial outsider has seen her recently suggests that she may not be in very good shape.

      You are correct of course. If there were any solid evidence of brain function (let alone films showing any responses at all!) we would have heard all about it long ago.

      One question though. The level of support you detail - not just the vent, but medications and hormones - sounds more sophisticated than I would have expected this family to have access to. We know now that Medicaid New Jersey is paying for this, but won't Medicaid at some point say, "Hey, this is a waste of money"?

      We are constantly hearing about how inadequate Medicaid is. Not so, seemingly, in this case.

      I imagine we must all go through one more round of medical testing in this case, though, as someone pointed out, it's already been done six times.

      Delete
    7. Susan, there was a case in which a four year old boy's brain was destroyed after he contracted meningitis. His mother had his ventilated body released to her care and he lived for another 16 years. His body continued to grow although his head stayed proportionately smaller. He went through an abbreviated puberty in that he developed some secondary characteristics such as axillary hair but his testes never descended. I guess you could say he retained some hypothalamic function even though his brain was clearly destroyed. When he finally suffered cardio/respiratory death an autopsy was performed and his brain was a small calcified mass inside his skull.

      In light of that case the fact that Jahi's body is still functioning after a year and a half doesn't seem so significant. There haven't been many cases in which a brain dead person was kept on artificial support long term because, thankfully, the vast majority of families accept the diagnosis and allow it to be discontinued.

      Brusavich said: "...Jahi's brain is clearly not "dead" in a neuropathological sense (ie., necrotic)." I wonder if he's planning to use the slides from Jahi's MRI which were part of Dolan's old "evidence" because even then there were signs of necrosis. At least there were large areas of cerebrospinal fluid where brain tissue should've been.

      Delete
    8. Anonymous 18:14 -- that boy "continued to grow" ... but certainly not normally. At death he was 104 cm (41 inches) tall and weighed 70 kg (154 lbs).

      Delete
    9. Anonymous, how awful, what is wrong with people? Maybe Jahi is on the way to such a gruesome fate ad this boy you cite. Let's hope good sense takes hold.

      Delete
    10. Susan: Yes, this 4-year-old boy's posthumous existence was beyond awful ... as was his mother's life, since she cared for him in a basement apartment for most of 16 years. (Eventually she faced bitter reality, exercised compassion for him and herself, approved a DNR, and he died of cardiac arrest.)

      Delete
    11. Anonymous 21:36, I never said his growth was normal. Jahi was probably pretty much already at her adult height and on the cusp of puberty when she died so the two cases are certainly different. I only cited that example because it shows how long a body can last without a functioning brain and demonstrates how futile it is to prolong the inevitable.

      Delete
    12. Anon 00:32, I'm not disputing that. I thought that the distorted nature of his growth also indicated body-without-brain futility.

      Delete
    13. https://hods.org/pdf/Long%20Survival%20Following%20Baterial%20Meningits-Associated%20Brain%20Destruction1.pdf

      Here's a link to the child mentioned by Anonymous @18.14

      It's terribly sad reading. So is Terri Schiavo's autopsy report. http://euthanasia.procon.org/sourcefiles/SchiavoAutopsy.pdf

      Delete
    14. I just wanted to put some perspective on this case reference.

      I read this information well over a year ago, when my interest in Jahi's case got me interested in learning more about the general concept of brain death. Information regarding the case of "Patient T.K." comes to us from Dr. D. Alan Shewmon. He continues to cite this case in his various articles and lectures, to support his argument that "the body isn't really dead just because the brain is."

      Then, in October 2014, we learned that Dr. Shewmon was one of the "experts" that Dolan recruited for his "prove that Jahi is alive" petition:

      http://www.thaddeuspope.com/images/declaration_of_D_Alan_Shewmon,_2014-10-03.pdf

      In his letter of expert opinion submitted with Dolan's filing, Dr. Shewmon identifies himself as "a pediatric neurologist with triple board certification" in Pediatrics, Neurology (with special competence in child neurology) and Electroencephalography."

      Now, we see in Brusavitch's demurrer response that he intends to reference a "recent assessment" by a "board-certified pediatric neurologist."

      Just sayin'...might be a coincidence... ;)

      Delete
    15. I don't believe they have any "new" evidence. I want to see doctor's notes from an "examination" not evaluation or assessment.

      Delete
    16. Scarab, Shewmon uses this example in an attempt to justify his weird contention that because the death of the brain does not equal biological death of the body in the presence of mechanical support, brain death as a determination is invalid. The authors of the hods.org article actually cite Shewmon's use of their article in his own research. Of course they come to different conclusions. I also read that article back in the beginning of this saga. I believe I first saw the link on an allnurses forum.

      Professor Pope put up new court documents:

      http://medicalfutility.blogspot.com/2015/07/jahi-mcmath-court-may-allow-family-to.html

      Delete
    17. "Dr" Shewmon is inconsistent in his own writings, saying in one sentence in one of his essays that a patient is alive as long as they can keep the heart beating, and that a patient whose brain has shut down will never recover because they are dead. he's a perfect match to the family.

      Delete
    18. In more ways than one...because, unlike Dr. Byrne, he still holds a current medical license in the State of California. So, if there really IS any "new evidence" to present, in terms of verifiable medical information (real examinations or tests), it's likely that he'd be the one recruited to produce it.

      Delete
  19. To Anon. 4:45 - Since hormones have been medically-administered, along with several other drugs, as part of the care routine to keep Jahi's bodily processes as functional as possible, it's not surprising that some or perhaps all of the ones you've listed might be detectable in the blood. Their presence doesn't necessarily prove that either the pituitary gland or the hypothalamus itself is OK and working properly. We'll have to see if any other, more specific tests have been done to substantiate the claim of "she exhibits hypothalamic function."

    ReplyDelete
    Replies
    1. I was wondering this too. You posted what I was pondering.

      Delete
    2. Yes, we will have to see ... because the purpose of a demurrer (whether CHO's or Rosen's) is to challenge only the facial legal bases of a complaint; and the plaintiffs have responded accordingly.
      The full range of evidence on either side therefore hasn't been addressed.

      Delete
  20. Just saw this on Professor Pope's blog:

    http://medicalfutility.blogspot.com/2015/07/more-california-brain-death-disputes.html

    I guess it all depends on what judge hears your argument. The Santa Clara judge in this case denied the TRO request.

    ReplyDelete
  21. Am I the only one who thinks of Miracle Max when I read "very much alive" and "truly dead"? Anyone? OK, I'll see myself out then...
    I know it's a terrible story, and my heart goes out to that poor girl, but they are making it a circus, IMHO.

    ReplyDelete
    Replies
    1. Only thing to do is go through (his) pockets and look for loose change!

      Delete
    2. family has LONG since done that.

      Delete
    3. Indeed they have but they just can't stop trying to fleece the public. Apparently, the public is losing its interest in funding them. $108 donated since the first of July to the GoFundMe account started by Mrs. Spears-Winkfield. If she's expecting a huge burst of donations, she's only fooling herself.

      Wednesday

      Delete
  22. Question for everyone - is there some sort of closed circuit security footage of wards within a hospital? Not just corridors (or the pharmacy)?

    ReplyDelete
    Replies
    1. Quite often, and once it goes to trial, the family will no longer be able to keep the recordings suppressed under claims of patient privacy.

      Delete
    2. Thank you, Mr. Brown. I just couldn't imagine that there wouldn't be some sort of security footage that was archived. After all, people get very emotional and volatile in situations involving their family. Heck, an in-law was SO horrible to a hospice patient, his brother and the staff that she was BANNED. She started to carry on about it but she was told that they had recordings of what she did and said in the room and the corridors. It was her second time getting banned, too. First time was from the hospital. My mother was completely blown away by what she witnessed and it wasn't even 1/10th what her other cousin (his brother) went through with the wife. Let's say she could give this family a run for their money (entitlement).

      Yuck.

      Wednesday

      Delete
    3. However we don't know whether relevant and admissible CCTV footage is available in this specific bizarre case, so I'd park this to the side.

      Delete
  23. "Hormones were administered also, to replace those no longer being produced by the pituitary gland." - Scarab

    "Since hormones have been medically-administered, along with several other drugs, as part of the care routine to keep Jahi's bodily processes as functional as possible, it's not surprising that some or perhaps all of the ones you've listed might be detectable in the blood."- Scarab

    Scarab: Nice try. Are you suggesting that 'synthetic' hormones were administered to replace those hormones no longer produced in Jahi's brain?

    Think about what you just said. Why would they replace those hormones with 'synthetic' hormones produced in the pharmaceutical lab? It would be a contra-indication in Jahi's case. Why?


    'Synthetic' hormones can produce blood clots, cancer, and irregular bleeding. The side effects would actually put Jahi more at risk for bleeding so I don't believe 'synthetic' hormones were ever administered. Too risky. Just ask any clinician.






    ReplyDelete
    Replies
    1. John, you are absolutely correct there except for the parts that you typed.

      Delete
    2. 08:05 = the troll, who is neither a clinician nor any sort of medical (or legal) professional.

      Delete
    3. ummm... because the hormones aren't being produced?

      Delete
    4. To 08:05 - The reference to hormone administration was neither a "nice try" nor a "suggestion." The information about hormones being part of the medication cocktail that was being used to keep Jahi's bodily functions stable and balanced came from Jahi's family, both through Nailah's Instagram updates, and other statements conveyed through Dolan's various media updates. Nailah also reported that she herself was administering various other vitamins and nutritional supplements to Jahi, which were supposed to promote brain health and healing.

      The hormones were reported to support the recovery process by taking care of Jahi's metabolism, growth, regulation of body temperature, fluid balance, and some other things I can't remember right now, while the body and brain "healed." Based on these statements, I thought it reasonable to conclude that Jahi's body was no longer able to produce these hormones itself, at least to the level needed to keep bodily functions stable.

      Regarding the possible side effects of hormone therapy....I am neither a doctor nor a clinician, nor do I play one on TV...or on the internet. :) The task of weighing possible known risks against the potential benefit of any given treatment is best left to doctor and patient and/or patient's family.

      Delete
  24. "Dolan would have presented it last year. Preservation of a body doesn't automatically equal "being alive," much less "recovering" from loss of brain function." - Scarab

    Sorry, but Dolan did not really try to do everything to challenge Jahi's brain death declaration. He's a good lawyer. But Jahi's case I think would be too complex for anyone without a background in medicine to handle. Shewmon's declaration was actually the only one that mentioned the 'whole brain' criteria and the UDDA.

    ReplyDelete
    Replies
    1. well, everything except present something that would be admissable.
      and "dr" shewmon rejects brain death out of hand, despite agreeing that a person whose brain has quit working is, for all intents and purposes, dead, and will never recover.

      Delete
    2. Sorry, but Troll.

      Delete
    3. Dr. Shewmon believes in brain death. I also believe in brain death. It's the current criteria for the diagnosis of brain death that is responsible for causing all the confusion. What people don't understand is the UDDA deals with the entire function of the entire brain. If one of the brain's function recovers after BD declaration, the BD declaration needs to be reversed. That's the whole point of Brusavich's argument.

      Delete
    4. Troller, this isn't a faith ("belief") issue.
      And you "believe in brain death' just as I "believe in" fairies.

      Delete
    5. I believe in warm apple strüdel.

      Delete
    6. I believe I'll have a drink.

      Delete
    7. @mutzali - Make mine a double. Wednesday

      Delete
  25. I would be persuaded by a report of a recent (within the last month) examination by an unrelated neurologist. This would be hands-on, and include appropriate test results. Don't hold your breath until you see evidence like that. Unless the court requires it.

    What's with the family filing "declarations" by doctors who have not met the patient? That carries zero persuasive weight. The family controls access, remember. They could get any of these people in there to do an actual exam any time they wanted to. Their failure to do that speaks volumes.

    Dr. Byrne didn't examine her, he just held her hand (according to the picture he posted) and noted that she was wearing lip gloss. If there had been anything more substantial to tell ("she opened her eyes and smiled at me") he would have said it. I gather that what he saw was a made-up, unresponsive corpse. How awful.

    ReplyDelete
    Replies
    1. IMHO, the court *will* require the kind of evidence you suggest...just to determine whether or not there's even a point to entertaining this motion for a *third* time. The determination of death by neurological criteria has already been challenged twice, and was not successful due to lack of compelling and medically-relevant evidence.

      Brusavitch is claiming that res judicata doesn't apply because the facts of the case have changed since the last hearing. If that's true, he *needs* to have something better than the same old stuff that didn't work last fall.

      Delete
    2. Once upon a time...Doc Bastard said,

      "The way the US legal system seems to work, I expect that there will be responses to the responses to the responses, then responses to those responses, and then even more responses, and eventually the whole system will collapse under the weight of 81 million tonnes of paper."{

      It's been less than a week since these words of wisdom were written, and already that pile of paper is growing!

      Responses to Brusavitch's objection to the demurrers...which were the defendants' objection to his original petition...have now been filed by Dr. Rosen and the hospital. So....I guess these new filings are "objections to the objections to the objections."

      Documents posted on Prof. Pope's site.

      http://thaddeuspope.com/jahimcmath.html

      Delete
    3. @Ken, Paul A. Byrne MD is a physician and allegedly a Board Certified Neonatalogist. You don't like him, I don't like him, but he is a "Doctor."

      Delete
    4. @susan: that's what I said, he's a "doctor"

      Delete
    5. A neonatologist is not exactly board certified in a field that will allow him to make a determination of brain death (or not brain dead)

      Delete
    6. Anonymous@ 3:59

      A neonatologist is most certainly qualified to make a determination of brain death in a newborn. See page 10, the fist paragraph under the header, "Additional Considerations for All Age Groups"

      http://pntb.org/wordpress/wp-content/uploads/Nakagawa-Crit-Care-Med-2011-Update-Ped-BD-Guidelines.pdf

      Wednesday

      Delete
  26. The McMath family has a new business venture. They are selling "Team Jahi F**k brain death" T shirts. It doesn't actually say f**k, but it does have a hand flipping the bird, and then says 'brain death'. Check them out here, and take note of the children's size:

    https://instagram.com/p/5qqkO3oxsR/

    What parent would let their child wear a shirt like this? A line from the "Social Network" occurs to me: "Give me a minute to let the classiness waft over me".

    ReplyDelete
    Replies
    1. What parent would....

      I'm surprised that Zaire Jahi wasn't modelling it for the photographer. He's Natasha's grandson. So, against the odds, her eldest daughter exhibited more good taste and class than her mother. May she continue to do so!

      Delete
  27. Jahi's case is actually better than Prop. 46.

    ReplyDelete
  28. Wesley J. Smith left a comment on Professor Pope's latest blog post regarding this case. After writing that the lawyer is engaging in circular reasoning, he says that two neurologists have declared that Jahi no longer meets the criteria for brain death. It is unclear to which lawyer he refers.

    I helpfully pointed out that neither of the two neurologists, Shewmon nor Machado, performed a clinical bedside exam. Shewmon's declaration consisted entirely of his review of second hand "studies, records and reports", the two brief videos and discussions with Machado and DeFina.

    Machado himself wrote in his declaration that the AAN guidelines state Brain Death is a clinical diagnosis, right before admitting that he was unable to make one because he lacked a US medical license.

    Smith actually went on to praise Thaddeus Pope for his analysis although he still appears to believe that Jahi has risen from the dead

    ReplyDelete
    Replies
    1. and I pointed out that "dr" Shewmon is not reputable as he rejects brain death entirely despite believing that a person with no brain function is dead.

      Delete
    2. The clinical brain death bedside exam is seriously flawed anyway so what's the big deal? Try thinking out of the box. Now ask yourself this. How in the world can they examine the entire function of the brain by going through a simple bedside exam?

      I'll tell you the answer, ‘Whole brain death’ cannot be conclusively identified at the bedside by using clinical criteria.

      Delete
    3. Anon - Then it sure is lucky that we have confirmatory test, such as a brain flow scan. That study was done on Jahi, and it showed absolutely no flow into her brain.

      Since you seem to be so smart, please explain how any brain cells can survive with no blood flow for several days. I'll wait.

      Delete
    4. Anon/JB thinks that one possible randomly firing neuron means her whole brain isn't dead. He should know i guess...

      Delete
    5. SPECT scan is very difficult to perform in the context of brain death especially in children. If they're going to use this as evidence of no blood flow in the brain, it will be challenged and it will not be admitted as evidence in court:

      1. SPECT has issues with long scan times and low-resolution images.

      2. SPECT's low-resolution images are prone to artifacts and attenuation.

      3. Some artifacts can easily be misidentified as perfusion defects.

      4. SPECT also does not provide a quantifiable estimate of the blood flow, whereas PET does.

      5. SPECT cannot detect residual function of the brain.

      6. "SPECT imaging of the brain stem may not be reliable to document the absence of tracer uptake. This is primarily because the transverse size of the brainstem approaches the resolution limits of SPECT systems and the technical difficulties of performing a high quality SPECT examination in the context of brain death evaluation. In such a situation, visualization of tracer presence in the brainstem can be conclusive to determine blood flow to the brainstem, but the reliability of SPECT to definitively exclude the absence of perfusion to the brainstem remains to be established on a scientific basis. Current nuclear medicine techniques to evaluate brain flow using Tc99m HMPAO or Tc99m ECD may therefore have limited applicability to confirm brain death."

      I have no doubt that some brain cells survived. Despite the now generally accepted criteria of brain death, there were some residual function when Jahi was declared dead and thus also perfusion of the hypothalamic-pituitary neuroendocrine system. This residual function was probably sufficient enough to maintain hormonal plasma levels. If that is the case then Jahi doesn't fit the criteria of brain death.

      Delete
    6. John, the only brain function that matters is consciousness. Try climbing out of your box, it's full of rocks.

      Delete
    7. John, your copy-and-paste job is, as usual, worthless. Radionuclide brain flow scans have been shown to be accurate and reliable in diagnosing brain death, moreso than physical exam. And because I believe in supporting my statements with evidence, here you go: http://www.ncbi.nlm.nih.gov/m/pubmed/15316259/

      Delete
    8. @John/anonymous 23:35 -

      DocBastard is too much of a gentleman to insult you to the extent you deserve. I have no such inhibitions.

      http://www.karger.com/Article/Pdf/79525 Six pages. Read slowly and try not to move your lips. Life is full of challenges.

      Look! There's that "hot nose", yet again. Seen much more clearly, however.

      Delete
  29. IF Jahi was truly alive, why has her mother not called all the news networks, and showed them proof? That would be big news.

    ReplyDelete
  30. Here's the first comment we've heard from the family in a LONG time. The article was just posted online today, and references an interview with Nailah that took place on Tuesday (yesterday).

    http://www.contracostatimes.com/breaking-news/ci_28557293/family-desperate-return-oakland-jahi-mcmath

    It's not clear why Dolan, not Brusavitch, is identified as the attorney who initiated the recent filings, since we haven't seen Dolan's name on any of the documents associated with the petition or demurrer responses.

    ReplyDelete
  31. Correction to the comment I submitted a few minutes ago - I re-read the article, and realize I was mistaken about the attorney affiliation. It seems that *Dolan's* recent filings related to the case were *not* related to the petition filed by Brusavitch, but were actually two separate requests to amend or revoke Jahi's death certificate itself. He'd submitted these requests to the State of California Department of Health, and both were denied. The article says that Dolan now intends to go back to the Alameda County Court to decide the matter.

    This doesn't make sense. IIRC, the reason he would have petitioned the Dept. of Health in the first place is *because* the judge in the Alameda County Court *told* him during the last round that this would be his only option. The judge stated that determination of death is a medical decision, so it wasn't appropriate for the court to consider or rule on matters related to the death certificate itself. I don't understand what he expects to accomplish by trying this again.

    If the article is correct, and the state's Dept. of Health has recently twice declined his requests, I have to think it's reasonable to assume that Dolan wasn't able to produce any convincing medical evidence to the DOH that would justify *their* reconsideration.

    As the hospital's response to Brusavitch's most recent "objection to the demurrer" filing stated, if the plaintiffs want to object to California's current laws regarding its application of the criteria set forth in the Uniform Determination of Death Act, they need to pursue that matter with those who *enacted* the law....the state legislature, and its medical experts...not in a civil case brought before the county court.

    ReplyDelete
    Replies
    1. that article is poorly written and researched, and is quite obviously a case of the reporter just blindly accepting what mama nails said.

      Delete
    2. Definitely. The article states that when Nailah was asked about how the costs of the medical care are being paid, she "declined to answer." That would prompt *most* reporters to *look* for further information.

      And, he didn't have to look too hard. It's apparent that he hasn't actually kept up with the recent filings related to the malpractice case, or he would have known about the Medicaid..

      DOH! (Now that we know it's a real word, I'm sure we'll find plenty of occasions to use it, related to *this* particular case!

      Delete
  32. Existing brain death statutes have generally withstood court challenges,
    but when a statute is confusing or poorly worded such as California's statute on brain death, the court must overrule the defendant's demurrer claiming that Jahi is dead.

    State v. Robaczynski (a case involving the Maryland brain death
    statute).

    ReplyDelete
    Replies
    1. Copy, paste, irrelevance, troll.

      Delete
    2. John, you posted this exact same thing on the Keeper page today. The only statute that is poorly worded and confusing is the one in New Jersey which allows for the state funded maintenance of the dead.

      Delete
    3. Just to provide a bit of support to NJ - their statue is not meant to support medical care to the dead - it is meant to not declare one dead based on brain death if the person or family objects based on religious belief (the brain dead then remain in the misery of being dead in reality but not yet declared dead legally because of religious belief)
      The NJ law is likely being misinterpreted to the case of Jahi since she was already legally declared dead. Once declared dead, the NJ religious exception would no longer apply. It is likely that Jahi's medicaid eligibility status in NJ has not been competently reviewed in terms of their death declaration law.
      If this is the case, Jahi's family will be facing a bill from Medicaid to repay any care that will become unauthorized based on a review of death ineligibility.
      Kharma can be a bitch.
      -Although, perhaps then, they can sue their lawyer for malpractice if he supported their medicaid fraud!

      Delete
  33. Anon 7/30 7:26. . As far as I can tell, on this site you are the only one making the statement that the statute is poorly worded and confusing. She was examined multiple times and the same conclusion was made each time according to statute. She is dead! There is no confusion. This is a horrible tragedy, but my sympathy for the family is being eroded by their continued disrespect for Jahi and their disregard for the law.

    ReplyDelete
  34. Do journalists (reporters) no longer exist? Are they all columnists now? This was an opportunity for Mr. DeBolt to demonstrate he knows the difference and ask tough questions, read the documentation carefully, ask more questions, think and then write something more than regurgitating whatever Mrs. Winkfield states.

    Drives me crazy.

    ReplyDelete
    Replies
    1. Agreed. But bear in mind that he's writing for the Bay Area newsgroup, and the article was published in the Contra Costa Times. It seems that the tone of the article was more of a human interest, "Let's Bring Jahi and Her Family Back Home Here to Oakland" piece than a factual report on *anything* that has *really* happened.

      Delete
    2. Nevertheless, in my head I'm running around in circles, screaming and pulling my hair out while kicking a door off of its hinges. I want a return to journalism!

      *collapses in sobbing heap*

      Wednesday

      Delete
  35. Pending getting the official results of today's hearing, Prof. Pope has posted Judge Freeman's "tentative ruling" regarding Dr. Rosen's demurrer, which is basically his opinion and comment after he's reviewed the demurrer and compared it with the petition. (This info is sent to all parties so they can be prepared for further discussion at the hearing. The "official ruling" isn't made until after that discussion happens. I just thought it would be interesting reading while we wait).

    http://medicalfutility.blogspot.com/2015/07/jahi-mcmath-courts-tentative-ruling.html

    Looks like the judge is inclined to sustain the demurrer's objection to the first cause (Jahi can't make a personal injury claim because she is deceased), but he's willing to give the plaintiffs a chance to speak to their claim to challenge this, though he doesn't find anything they've presented so far very relevant or convincing.

    He will sustain Dr. Rosen's objection to the second cause of action (negligent infliction of emotional distress) with leave to amend, if it can be rewritten into anything that makes factual sense.

    He will sustain Dr. Rosen's objection to the third cause of action, by dropping Marvin Winkfield as a defendant. (No real issue, since Brusavitch has already agreed to this, in his response to the demurrers).

    I guess we'll soon see how this all worked out.




    http://medicalfutility.blogspot.com/2015/07/jahi-mcmath-courts-tentative-ruling.html

    ReplyDelete
  36. Trial lawyers actually prefer this type of scenario. It leads to a clear and more powerful objection before a judge.

    ReplyDelete
    Replies
    1. "Actually" as opposed to what?
      The copy-paste troll still is hard at work, I see.

      Delete
  37. The judge took the matter under submission. Here we go around the Merry Go Round again:

    http://medicalfutility.blogspot.com/2015/07/jahi-mcmath-hearing-on-demurrer.html

    ReplyDelete
    Replies
    1. All that means (from my admittedly limited understanding of Califorbia law) is that he's thinking about it. I would have expected nothing less or more.

      Delete
    2. there are some hints he may try to sidestep, like Grillo did. hopefully he is just being sure to give brusavich & chang plenty of rope.

      Delete
    3. I just hope he doesn't punt.

      Delete
    4. "Here, while plaintiffs allege that "[r]ecent evaluations by doctors, including a board certified pediatric neurologist, confirm that Jahi does not meet the definition of brain death" (Complaint, ¶ 26), are such allegations in themselves sufficient to reopen a factual issue determined in a judicial proceeding and official death certificate? Does either side have additional analogous authority in this regard?"

      I'm not an attorney either, but that sounds to me as though he's willing to entertain the idea of overturning a death certificate based on nothing but someone believing that she's alive. Or is that the sound of someone getting read to punt?

      Delete
    5. well, that IS the key question. is a collection of anecdotes, opinions of doctors who have never seen Jahi, "doctors" who reject the possibility of brain death and general crackpots.

      Delete
    6. @Ken Brown - I think I'm having trouble processing his statement that she had been recently evaluated by anybody. To me, evaluated would include a currently licensed physician performing a complete neurological examination including the standard apnea test and 10 minute apnea test. Not the hocus-pocus nonsense that the family has insisted is the equivalent.

      So it makes me a bit concerned.

      I'm sorry that Jahi is dead and her family just can't seem to accept it. The person for whom I feel the worst at the moment is her younger sister who may be sharing a bedroom with Jahi. That poor girl deserves a better life than the one she has at the moment. Because, well, yuck!

      Delete
  38. I don't generally like rap but I agree with Prof. Pope, this video is pretty awesome. It's about being on a vent from the patient's perspective:

    http://medicalfutility.blogspot.com/2015/07/aint-way-to-die-awesome-video.html?utm_source=twitterfeed&utm_medium=twitter

    ReplyDelete
    Replies
    1. Oh my god. I don't if you know the original Eminem song this was taken from, but the original video literally brought me to my knees. Hit way too close to home. Makes this video almost impossible for me to endure. I'm not a rap fan either, but the original is powerful, as is the version Pro. Pope posted:

      https://www.youtube.com/watch?v=uelHwf8o7_U

      Delete
    2. Wasn't it Eminem and Rihanna? One of the few rap songs I liked.

      Delete
    3. With Eminem and Rihanna right? One of the very few rap songs I liked, it actually has a melody.

      Delete
    4. Yes, Eminem featuring Rihanna. I linked it above.

      Delete
  39. Despite it being published overseas, and not being a physician myself, this looks like a very useful checklist for determining brain death. If DocBastard has a moment or two and would offer his opinion, that would be nice. I know he's very busy though.

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

    ReplyDelete
    Replies
    1. This is an excellent summary, similar to pretty much every other country's on earth.

      Delete
    2. May I say something about this 'excellent' summary?

      1.This 'useful' checklist was not written in India. Everything was copied from JAMA, President's Commission Report on Brain Death, The American Academy of Neurology, New England Journal of Medicine, and other brain death citations on PubMed.

      2. The 'checklist' is for Adults Only.

      3. There is a separate guideline used for the determination of brain death for infants and children.

      4. The guidelines for determining brain death in children in compliance with the UDDA describes brain death as:

      (1) irreversible cessation of circulatory
      and respiratory functions, or (2) irreversible
      cessation of all functions of the
      entire brain, including the brainstem, is
      dead. A determination of death must be
      made in accordance with accepted medical
      standards.

      Delete
    3. @Anonymous 3.20

      "This review focuses on the clinical determination of brain death in adults and children, including the potential confounding factors, and provides an overview of valid confirmatory tests"

      "Interval Observation Period

      After the first clinical exam, the patient should be observed for a defined period of time for clinical manifestations that are inconsistent with the diagnosis of brain death. Most experts agree that a 6 hour observation period is sufficient and reasonable in adults and children over the age of 1 year. Longer intervals are advisable in young children."

      Miss McMath was most assuredly over one year of age.

      http://webcache.googleusercontent.com/search?q=cache:od5h-xX4l4gJ:pntb.org/wordpress/wp-content/uploads/Nakagawa-Crit-Care-Med-2011-Update-Ped-BD-Guidelines.pdf+&cd=4&hl=en&ct=clnk&gl=us

      She still meets the criteria for brain death. That continues to be a sad fact. I hope that the judge also realizes it is a (sad) fact. so this sideshow can be ended. Jahi's dead and gone, she doesn't care, I imagine her father cares even if her mother doesn't. Clearly Mr. McMath is a mess, but at least he's comported himself with more dignity than Mrs. Spears-Winkfield.

      Delete
    4. Oh rats, I hit send too soon. @Anonymous 3.20 - please read the appendices. Jahi is still (sadly) brain dead.

      Delete
    5. We've seen recurring mention here, during the course of our discussions, about the criteria for brain death in infants and children being "different" than those for adults. The implication is that perhaps Jahi was misdiagnosed, if, for whatever reason, her physical condition was evaluated by "adult" standards, when the "child" standard should have instead been used.

      My opinion - so take it for what it's worth, or not - I believe it's highly unlikely that a patient hospitalized in a *children's* hospital, and receiving medical attention from those whose training and experience focused on the care of *pediatric* patients, would not have been subjected to examinations and tests appropriate for that patient's age group.

      Fact - Medical literature recognizes that in many cases, the brains of infants and young children, not unlike the rest of their bodies, *do* have the ability to recover from conditions that are typically not recoverable in an adult patient. Not surprising, really, since the body of an infant or young child is still in a very active growth and development stage.

      So, that's why the guidelines are a bit "different"...but *not* in regards to the actual testing. The "difference" is the recommendation of a longer *observation* period for infants and young children, which may include *repeated* administrations of some of the standard testing, just to see if there *is* indeed any indication of recovery, even to a small degree, that might suggest it would be beneficial to continue supportive treatment.

      I admit that I haven't read *all* of the medical research and guidelines available on the subject, But in what I *have* found, the time recommendation for this extended testing and observation period ranges from less than a day, to maybe a couple days, or a bit longer, it there is any observed inconsistency in the test results or general observations over time.

      Here's an example from the American Academy of Pediatrics:

      "Recommended observation periods:

      (1) 24 hours for neonates (37 weeks gestation to term infants 30 days of age)

      (2) 12 hours for infants and children (> 30 days to 18 years).

      The first examination determines the child has met neurologic examination criteria for brain death. The second examination, performed by a different attending physician, confirms that the child has fulfilled criteria for brain death.

      Assessment of neurologic function may be unreliable immediately following cardiopulmonary resuscitation or other severe acute brain injuries and evaluation for brain death should be deferred for 24 to 48 hours or longer if there are concerns or inconsistencies in the examination. "

      Jahi's surgery was performed on December 9, 2013. The hospital staff informed the family of the determination of brain death on December 12, 2013 (three days later). This was all revisited one *more* time, when Dr. Fisher was appointed by the court to give an independent medical opinion, before Judge Grillo entered the ruling of DDNC on December 24, 2013. We need to remember that, during all this time, the hospital had *not* yet discontinued life support, pending the outcome of the court case. So, in fact, the "observation period" in Jahi's case was actually several weeks *longer* than typical, and there were additional examinations and evaluations performed during this time.

      Considering the time line here, I don't see any reason to believe that the testing and evaluation procedures used in this case were inconsistent with what *should* have been done for a patient of Jahi's age.

      Delete
  40. accepted medical standards <> Dolan's, Brusavich's, Chump Chang's, Mama Nails', or John "cornboy" benton's.

    ReplyDelete
  41. Were you at the hearing, 'John'-nonymous?

    ReplyDelete
  42. Jahi's brain was demonstrably without blood flow for over two weeks after her surgery. No one's brain can recover function after such an injury. Even if subsequent testing, performed 5 or 6 months later, showed a reduction in swelling and perhaps a tiny trickle of peripheral flow it was too little, too late to make any difference.

    ReplyDelete
    Replies
    1. "Jahi's brain was demonstrably without blood flow for over two weeks after her surgery. No one's brain can recover function after such an injury."

      I don't think any part of the body can recover function after not receiving blood for two weeks. Heck, look at what happens to one's extremities with severe frostbite!

      Delete
  43. Apparently even the Keepers have had enough of John Benton. His comments have disappeared from the site, although some fellow by the name of Phil Garber, left a question inquiring about updates on Jahi. He claimed to be the editor of a couple of New Jersey weeklies. He's barking up the wrong tree.

    ReplyDelete
  44. Apparently, there is still one reporter in the Bay area who hasn't drunk the Kool-Aid:

    http://www.insidebayarea.com/breaking-news/ci_28570580/drummond-legal-battle-continues-case-brain-dead-teen

    ReplyDelete
    Replies
    1. Well, that delivered a little kick-start of hope. Thank you!

      Wednesday

      Delete
    2. Yup! This reporter says:

      "Moving Jahi 3,000 miles away from home was a desperate decision made in the midst of grief. It was never going to be a sustainable long-term solution.

      Now her family must face up to that reality."

      As they *should.* They left California because the law there doesn't allow for the provision of futile medical care to a dead body. They found a place that not only allows it, but *pays* for it. Might as well settle in and get comfortable there, if that's what they want to continue to do.

      Delete
  45. I may have overlooked it, but did the judge indicate when he was going to render his decisions on the various demurrers? Tomorrow will be one week since he told everyone to go away and let him think in peace (but in legalese).

    Wednesday

    ReplyDelete
    Replies
    1. No, Judge Freedman did not give any indication of when he will rule. As I said, this case disturbs him and the stakes are very high. He wants to get this right.

      Delete
    2. Thank you Cleopatra. I didn't notice this reply when I asked the exact same question further down the page.

      Wednesday.

      Delete
  46. I don't know why I do this, at this hour, when the alarm will go off in less than six hours, but here I am.

    http://www.state.nj.us/humanservices/doas/documents/policy/2011_24_v1.pdf

    I would be more interested in seeing what Tasneem Mohammedshah, RN checked off and wrote on the form than I am in what she submitted to Jahi McMath's home address re: her eligibility.

    I'm not taking a swipe at the RN - just wondering why the attorneys didn't ask for and receive the notes made by the person completing the form.

    Wednesday

    ReplyDelete
  47. Conversation opened. 1 read message.

    7/30/15 McMath Hearing Results

    Judge Freedman is clearly disturbed by this case and my impression is that he's going to be sympathetic to the plaintiffs and give them a generous amount of leeway. Twice during the hearing he said, "What if I adopt Judge Grillo's ruling and Jahi comes into my courtroom after this is all over and says, 'Hello, I'm here. What will happen then?" He stated the obvious, which is that it must first be decided if Jahi is alive or dead.

    Plaintiff atty Andrew Chang (the appellate atty who was associated into the case by Bruce Brusavich, who appeared by phone but didn't say a word) presented his arguments first. He insisted that the case does not fall under the collateral estoppel principle because of changed circumstances, i.e. the changes of puberty - menses, breast development, etc. Chang said there are "teams of neurologists lined up" who will testify that Jahi has brain function because her hypothalmus is clearly active (as evidenced by puberty). Also, her body is "being maintained" on a vent. He did not name any of these experts and told Freedman that they would be revealed in due course. Freedman asked if Chang would present their findings or testimony in an evidentiary hearing or at trial. I would think that the defense would insist on an evidentiary hearing, as well as Daubert hearings if the "experts" are on a par with Dolan's.

    Ed. - How can the court decide whether this can proceed as a personal injury case or a wrongful death/successor-in-interest matter without the plaintiffs presenting their medical experts in a hearing?

    Chang also argued that the plaintiffs were not given any time to obtain their own independent neurologist to examine Jahi, or to "get her out of CHO in time" before the issuance of the death certificate, "which was forced" on Jahi's mother. As you know, Dolan stipulated to Dr. Fisher examining her as the independent neurologist. Chang also said that Grillo rushed through the legal proceedings and plaintiffs didn't have time to present their case, so they weren't granted due process.

    As to the NIED claim against Rosen, Chang said he would provide additional information for that claim, probably in a brief.

    For the defense, Dr. Rosen's atty, Thomas Still, did most of the arguing. He brought up some additional case law in support of the demurrer that weren't included in the pleading on the estoppel and res judicata issues. The primary case is Evans v. Celotex Corp. http://law.justia.com/cases/california/court-of-appeal/3d/194/741.html. Chang stuck with the Dority case as his authority.

    Still argued that the brain death criteria is well established and accepted by science and courts of law, and to rule that Jahi is not dead goes against common sense and public policy. Rosen's atty was good at shooting down Chang and really gave it to him over the "rush job" argument. He reminded Freedman that Dolan had experts last October, but dropped the pending court matter entirely without explanation.

    CHO's atty, Pat Galloway added that the legislature has embraced the validity of death certificates and that estoppel was established by Grillo's ruling, as well as Fisher's findings. He told Freedman that plaintiffs are proposing "endless litigation" and wanted to know where it would stop.

    Freedman will review the additional case law presented by the defense, as well as take the arguments under advisement.

    ReplyDelete
  48. Chang and his "teams of neurologists" can end this tomorrow. All they have to do is present the results of a new bedside exam using accepted criteria that show Jahi isn't brain dead and never was.

    I am dumbfounded as to why Freedmon didn't stipulate this requirement. Anything less is still just smoke and mirrors. Chang can line up every single brain death denying neurologist on the planet and it still wouldn't change the UDDA criteria.

    ReplyDelete
    Replies
    1. I know. It was frustrating being in the court room as an observer. I wanted to tell Freedman that very thing. The defense attys should have told Chang to put up or shut up, but that's against the rules. I doubt Brusavich has "experts" any more acceptable than Dolan's.

      Delete
    2. The plaintiffs will want to drag this out as long as possible with threats of "teams of neurologists" in the hope that defendants will settle. It's the oldest trick in the book, but it won't work in this case.

      Delete
    3. Cleopatra - Did the judge ever mention when he wanted everyone to gather again? I didn't see it anywhere but some days I wouldn't be able to find my head if it wasn't already attached to my neck.

      Thank you - Wednesday

      Delete
  49. Cleopatra, can I at least comfort myself that Freedmon doesn't have the authority, on his own, to declare Jahi alive and rescind the death certificate by judicial fiat? I just hope he's not one of those rabid right-to-lifers, like Byrne, who bases his decisions on religious conviction.

    I agree that plaintiff's want to drag this out, for obvious reasons. They know they don't have compelling evidence but don't they, at some point, have to put up or shut up?

    ReplyDelete
    Replies
    1. Yes, they do have to provide proof she's alive by CA's standards. Chang said, basically, "if we're wrong, then we're wrong."

      Delete
  50. This opinion was written by a doctor, Cory Franklin:

    http://www.sfchronicle.com/opinion/letterstoeditor/article/Jahi-McMath-s-tell-tale-heart-could-change-6420669.php?t=2570a411b300af33be&cmpid=twitter-premium

    Based on his assumptions I gather he has never heard of the boy who was maintained on a vent for 20 years. He thinks the issue in Jahi's case has nothing to do with Jahi regaining consciousness since that's not going to happen. Franklin thinks her case calls for a re-evaluation of brain death criteria because her heart still beats after 19 months.

    I don't get his point. He seems to be suggesting that we should maintain the brain dead on ventilators until their hearts stop which defeats the whole purpose of DDNC. He doesn't offer an opinion regarding who should bear the cost of this futile treatment or the ramifications on organ donation.

    ReplyDelete
    Replies
    1. @Anonymous 18:48 —the notable thing about Dr. Franklin (aside from the sheer volume of misstatements and case ignorance he crammed into that opinion piece), is his apparent inability to make up his mind. This is what he wrote about the McMath case in January, 2014:

      "...the proceedings that allowed Jahi's transfer were in error. However understandable the family's interests, in this case they should not supersede the law. Once declared legally dead, Jahi should have been removed from the ventilator."

      SOURCE: http://articles.chicagotribune.com/2014-01-10/opinion/ct-death-jahi-brain-legal-perspec-0110-20140110_1_brain-death-brain-trauma-brain-function/2

      One has to suspect that he's trying to get his name in the press any way he can because he's just published a book. If it is as poorly researched as his latest McMath opinion, I'll give it a miss.

      Delete
    2. One sentence stands out for me, "Her heart has been beating far longer than that of nearly any other brain-dead patient, a troublesome fact most experts have ignored."

      He didn't write, "all other brain-dead patients" because of course, he can't for several decades. Plus the other brain-dead child I believe to whom you're referring, kind of/sort of went through puberty but he most assuredly didn't develop normally and in the end, he was still brain-dead.

      It also frustrates me that he doesn't recognize that if the family wishes to maintain her body they are free to do so anywhere in the country - paying for it themselves. NJ and the rest of the country are bearing the costs for this family (via medicaid) to continue to neglect their living children. I also feel that they're perilously close to abusing Jordyn too. That may not be true, legally, but I think that most people agree that sleeping in the same room as your dead sister who probably doesn't smell so great just can't be good for her emotional development. I wouldn't be the least bit surprised if this child doesn't act inappropriately at school to get the attention of an adult and her mother in particular.

      Wednesday

      Delete
    3. Well since you asked me.
      Here are my points.
      When the case first came out, I assumed she was brain dead like most other people. I wrote that they should stop ventilation.
      But they didn't - for what ever reason.
      I assumed her heart would stop soon after.
      But it didn't - for what ever reason.
      So while you accuse me of not being able to make up my mind - or try ing to sell a book, I am simply looking at an updated set of facts.
      I am willing to change my opinion based on new and possibly contradictory information - what do you do in that situation?
      Ms. McMath may have and probably did meet the brain death criteria 18 months ago - but you seemed to have missed the big question.
      What if the brain death criteria are no longer valid? they are 50 years old, you know. Before MRI and PET scan which are far more sensitive markers.
      They were originally designed to document cessation of all neurologic function -we knew that was a convenient fiction - we can't possibly measure all neurologic fiction.
      But for a number of reasons, many of which were good, we maintained that fiction.
      But this case call it into question.
      I am not going to make pronouncement on whether the girl is brain dead, I don't have first hand access to the data.
      But I will say there is certainly enough data out there to question both the diagnosis in this case and the original construct.
      Yes, your heart can beat for long times after brain death - but without question she is a definite outlier .And one of the things you do with definite outliers is question the original assumption. It doesn't mean it is not true, it means you have to reask the question.
      Put that together with evidence of hypothalamic function and some reported MRI evidence of intact structures, and some movement (even if it is not on command) and you have a real unusual case. And that's enough to question whether the diagnosis is right here and more importantly whether we should go back to the table on what we are going to call brain death.
      the Stanford expert can dismiss these things but they matter.not necessarily because he was wrong- he may have been right according to the rules he was playing by- but the rules may need to be rebooked at, and in this respect he is wrong.
      there will alway be a question of how much neuralgic activity we accept before we deem somebody dead. this case just reinforces the point.
      Cory F.

      Delete
    4. Sorry, not buying it, there are way too many misspellings and grammatical errors. Dr. Franklin writes opinion pieces for several newspapers and knows better than to publish something without proofreading. Neuralgic refers to pain in the distribution of a nerve and the same error was made in one of the court documents in place of neurologic activity. Seriously, John, you have to do better. Or could this be one of Nailah's attorneys? Nah, they're too busy trying to wrangle their "teams of neurologists".

      Delete
    5. To me this doesn't sound like John's writing style, though I agree the grammar and spelling errors are suspect. However, I agree with several points he made. As I've said many times, if she no longer meets brain death criteria, then recovery from brain death IS possible and we need to rewrite the textbooks. No real evidence of that has been presented yet, so until it is, my opinion on the matter remains unchanged.

      If this is in fact Dr. Franklin, please email me. I would like to ask you a few questions.

      Delete
    6. Doc, as you said, no real evidence has been presented yet. If such evidence existed wouldn't Dolan have used it back in October? Like Cleopatra stated earlier,

      "He (Chang) did not name any of these experts and told Freedman that they would be revealed in due course. Freedman asked if Chang would present their findings or testimony in an evidentiary hearing or at trial."

      If they had ironclad proof what possible reason could there be for withholding it? I still think it's nothing more than legal stall tactics while they figure out their next move.

      I would be highly surprised if your anonymous Dr. Franklin is the real deal, but if he is, I think we all have a few questions for him. It would be great if he joined the discussion.

      Delete
  51. I love DocBastard's blog. I read every word. I have been following Jahi since this all happened. I am wondering if there has been any aspiration of the fluid feedings. Also, no matter how much care you give your bed patient loved one there is always a troublesome little (or big) decubitus ulcer popping up somewhere that defies healing. How do you suppose that is handled? I have seen both of these problems resulting in hospitalization for more intensive care.

    ReplyDelete
  52. Anonymous 20:02, thanks for the link, I hadn't seen that even though I was trying to find other stuff he wrote. He seems to have quite a presence on different newspaper sites writing opinions.

    Maybe his opinion on brain death has "evolved" now that he realizes hearts can indeed beat on indefinitely. I don't see what difference it makes in the long run. These people are still never going to wake up and at some point it just becomes a science experiment: Let's see how long the body lasts after brain death.

    ReplyDelete
  53. Dr. Franklin also wrote in his earlier opinion regarding the McMath case:

    "However, no high-tech equipment will ever answer exactly when life ends. That is fundamentally a conceptual question. To address it completely by technical measures, no matter how sophisticated, is impossible. The precise moment of death always will be a matter of medical and legal opinion — and those opinions must generate public confidence."

    He certainly does nothing to foster the public confidence he says is necessary by casting doubt now.

    He does have a penchant for referencing Edgar Allen Poe short stories. In the January, 2014 piece he mentions The Premature Burial, now he's reminded of The Tell-Tale Heart. Will the final chapter in this saga be akin to The Raven? Nailah falls into madness as a result of her never-ending remembrance and inability to let go.

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