Friday, 29 April 2016

Another tragic brain death

Anyone who's followed this blog for any length of time knows the tragedy that was (and still is) the Jahi McMath case.  For the three of you who have never heard of Ms. McMath, she was a 13-year old girl from California who underwent a complex upper airway procedure (including a UPPP and tonsillectomy) over 2 years ago.  She bled profusely postoperatively and went into a prolonged cardiac arrest, leading to brain death.  A total of six different physicians confirmed the diagnosis, and she was declared dead.  Despite the fact that a death certificate was produced, her mother refused to accept her daughter's death and fought (successfully) to have Jahi transferred to a facility in New Jersey where brain death can be refused on religious grounds.  And there she still remains ("still" having two very distinct, but very appropriate, meanings here).

It's happening again.

This time the victim is little Israel Stinson, an adorable 2-year old boy, also (probably not coincidentally) from California.  According to his mother Jonee Fonseca, Israel had a "minor" asthma attack on April 1, so she took him to the Mercy General Hospital, where he was stabilised and transferred to University of California Davis Medical Center.  Unfortunately once he was there, he had another attack and stopped breathing.  He was without oxygen for 40 minutes while they attempted to revive him.  Once the dust settled, he was moved to yet another hospital for further treatment on April 12.

Details are rather scarce, so getting an accurate timeline is somewhat difficult.  It seems that doctors at the third hospital performed some sort of brain death study, and when the results came back as unfavourable (ie brain dead), they apparently notified Jonee of their intention of performing a confirmatory study.  His mother didn't like that idea ("I know what comes next after that, and I’m just not ready to talk about burying my baby," she said) , so she posted this note in his room:

In case you can't read it, it says,
"Dear Dr's (sic) and physicians of Kaiser and whomever else this may concern,
This letter puts you on notice that we will be filing a temporary restraining order with the courts this week.  I am in need of more time before any further tests are performed and am requesting an outside physician intervene and give a second prognosis.  If you perform any tests on my son Israel Elijah Stinson that jeopardize his well being you will be fully responsible and liable for everything and any injuries. - Jonee Fonseca" 
The doctors supposedly performed the tests anyway, which confirmed he was brain dead.  The nature of the tests and whether they were done before or after this note was written is unknown.  Regardless, Jonee was informed that because he was dead, the hospital intended to take Israel off life support within a day or two, after the family was given enough time to say their goodbyes.

Jonee did not accept this.

"How would you feel if someone said, ‘Your son is dead, we’re not doing anything for him,'" she said.  She enlisted the assistance of Alexandra Snyder and her Life Legal Defense Foundation (LLDF).  If that name sounds familiar, they are the same group that provided documents that assisted Nailah Winkfield in getting Jahi McMath out of California and transferred to New Jersey.  Jonee and her team of lawyers have successfully stopped the hospital from turning the machines off, though time seems to be running out.  Last week they were given until today to get an outside specialist's opinion, though yesterday that was extended until Monday May 2.

Alexandra Synder had this to say about brain death: "I absolutely believe this is the parent’s choice. It’s not for the state of California, it’s not for the doctors to make this declaration as long as this child’s heart is beating,"  Sound familiar?  It should.  It sounds startlingly similar to something that Jahi's lawyer Chris Dolan said: "It is our position that no doctor determination can end a life without parental consent".  

In plain English, these lawyers are claiming that doctors shouldn't be the ones to make a medical diagnosis - parents should.  Jonee said essentially the same thing:
"I don’t feel that its anybody’s right to say just because we’re not getting response from the brain right now, that we have to bury him.  That’s crazy to me."
and
"Who is a doctor to go against God?"
Out of respect for a dead toddler, I'm trying my best to avoid my usual snark and sarcasm here, so I will leave those statements alone for now.  For now.  NOTE: I will not ask commenters to do the same.

Meanwhile several videos have been released showing Israel twitching in response to being tickled.  The family seems to think this means he isn't brain dead.  It doesn't.

As expected, LLDF is trying their damndest to get Israel transferred to a facility in New Jersey, looking for a doctor and facility to accept and care for him.  As of this writing, they have found neither.  The pro-life vultures are however, continuing to demonstrate that they don't understand what brain death is.  Writing at LiveActionNews.com, self-described "evangelical pro-life attorney" Kristi Burton Brown had this to say about Israel:
"It is unthinkable that a hospital would act so quickly to pull a child off of life support without an adequate opportunity to recover. At Israel’s age, the brain still has much development and growth to work through."
I'm not sure how Ms. Burton Brown could think that a full 4 weeks is inadequate time for one to recover, ignoring the fact that recovery from brain death is physically impossible.  I have to remember though that 1) Kristi is a lawyer, not a doctor, so she most likely doesn't understand, and 2) as an evangelical pro-lifer, she has no interest in understanding.

This is the second brain death dispute case out of California just this month.  The other was a 17-year old boy who led police on a high-speed chase at 3 AM (with alcohol reportedly involved) before crashing into a pole.  He was declared brain dead, his family fought it, but he succumbed to his injuries a few days later.  Despite the circumstances surrounding the crash, his family is, predictably, talking about suing the hospital.

As I predicted waaaaaaaaaaaay back in January of 2014, Jahi's case seems to have set a precedent where family members of brain dead Californians believe they can refute the irreversible diagnosis of brain death and keep their loved ones "alive".  This belief benefits absolutely no one.  NO ONE.  

Except the lawyers.

As was (and still is) the case with Jahi, the people who will lose the most here are Israel's parents, in more ways than one.  A beautiful little boy was devastatingly lost, and just like with Jahi, various people are sadly enabling them to prolong their own agony.

278 comments:

  1. as I said elsewhere, a minor asthma attack is "he starts wheezing, the inhaler is administered and the wheezing stops."

    but on the topic of the doctor having less authority than the mom - if the doctor knows less than the mother, why was the child taken to the doctor's facility. why isn't he at home where the mother can provide the proper care?

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    1. One of my questions here is, why 40 minutes without oxygen? That must have been some asthma attack, did no one see it coming on?

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    2. More than likely a 40 minute period of resusitation was required before a return of spontaneous circulation occurred. I have been involved many times in such situations. Let me assure you that every effort was made by the medical team to save this child.

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    3. I'm guessing the media, with their usual flair for getting things wrong, should have said, 40 minutes of CPR, after he arrested.

      but I wasn't there, so I can't say for sure.

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    4. Thank you both. I have no doubt the medical team. did all they could to save the child.

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  2. As a parent of young children (living in CA!) I can sympathize with the initial impulse of "Oh god, s/he can't be dead," and that stage of utter denial. But then one would hope that basic sense and reasonable family members would intervene and help you get past that event that is undoubtedly the worst in any parent's life. I really hope this ISN'T going to become a precedent in CA, like the anti-vaxx movement.

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  3. Thank you for saying what needs to be said.

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  4. This is a horrible event for the family and my heart goes out to them. The right to lifers need to stop clogging up the court system and focus their attention on the legislature that enacted these laws. The hospital is following the law.

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    1. Not to mention taking vital resources away from the living and those who can still be helped in order to perpetuate some ghoulish farce of living death.

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    2. You are correct. Not to mention the needless time his doctor must now spend in court to testify. I presume the doctor will be in court again on Monday. Instead, the doctor could be seeing several patients and giving them good care...but no he is stuck in court. I can see the court allowing an independent neurologist to come in and do the required testing. I don't think the family wants that because then a declaration of death will be made. That was a big mistake that Jahi's family made and they are stuck with the death certificate. I read through the fed filing and I don't see anywhere that the family is. requesting an outside doctor to come in to test. (Maybe I missed it). No they simply want life support continued and the trach and feeding tube inserted. Another drain on resources and taxpayer dollars.

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    3. @ Lasacgal - That's probably how things will go. The family doesn't want a "second opinion" from another doctor because they pretty much know that they will get the same result. Independent testing won't happen until the court orders it, during its consideration of the TRO.

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    4. It looks like UC Davis declared him deceased and Kaiser. So there are the two independent diagnosis. The case should be closed and the family should prepare for his memorial. I looked at the video of the mother poking him. He is not responding to that. His movement is totally different than flinching.

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    5. @ Lasacgal - I feel obliged to point out that the Right to Life and the Pro-Life movement are about Abortion and Euthanasia. We consider these to be premeditated killings of a living being (aka first degree murder). In regards to brain death, the vast majority of us accept the what our medical professionals tell us. A person whose brain is no longer functioning at any level cannot possibly be alive

      I will not deny that there is overlap with the "brain-death deniers" (for lack of a better name to give them), but they are on the fringe, and not representative of the whole. They most certainly are wasting the court's and doctor's time in carrying out this farce.

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    6. @Lasacgal - I'm curious which "laws" you're referring to. The law clarifying that brain death is death? This is a law that's only really needed for clarity's sake, because of our technical ability to keep the body running absent brain function. A brain dead person was always dead before that law ever came to be. The rest of the body would simply stop functioning within a very short time, sparing the heartache that seeming "life" through machines inflicts. Everyone goes above and beyond in these tragic situations-sometimes, sadly, we can go beyond the body's limits.
      Your other points are well taken.

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    7. I don't know all of the legalities (thankfully - I'm not an attorney). The hospital performed the required testing and made the declaration of death, and gave the family time to gather. That is what I meant by following the law. They should not be stuck in court.

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    8. Anon 23:51. Thank you for an interesting post.

      While I don't necessarily agree with you on the "murder" thing, it is an interesting and very valid point that the issues of abortion and euthanasia are very different from that of sustaining a brain-dead body and it is reassuring to hear that most people holding pro-life views recognise that.

      I fully understand that one might consider a human life to be sacred and not to be taken under any circumstances. Of course, as you point out, there is no human life here. That life ended when there ceased to be any brain function and what remains is the driver-less vehicle, or whatever other metaphor you wish to use.

      I think there is a slightly unfortuntate linguistic shortcoming which doesn't help anyone under these circumstances: We (or at least I) don't have a word that distinguishes between "life" in the sense of biological respiration by which many of Israel's individual cells are "alive" and the type of macroscopic "life" by which a multicellular organism has an existence greater than the sum of its individual cells. The idea of "soul" is the closest I am aware of, but because that is really a religious concept it doesn't really capture the point that such a macroscopic "life" requires certain essential functions from the body which can cease to exist in cases such as these. "Personality" is also close but sets the bar too high in terms of thought and consciousness.

      If you cut out my heart and kept it beating in a jar (please don't!) then nobody would consider that to be sustaining my life (least of all me) even though the cells of my heart still "lived" and continued to beat. To be "alive" there does need to be some element of mind as well as body and for poor Israel, that mind has now gone forever. Sadly, whatever jar his body is put into, the mind part can never come back.

      Ugi

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  5. Bones isn't there anything you can do for him.

    Damn it Jim I'm a doctor not a mortician.

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  6. “This time I want you to wake up! Wake up, wake up, wake up!”
    A Vacaville mom pleads with her son to wake up.

    Jesus. How heart breaking. :(

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  7. I am not a parent but I taught for eight years and for the past two years I have been a nanny. The little boy I spend all my waking hours with is 24 months old now but I started when he was five days. I love him as if he were mine. I protect him and care for him while his sweet parents work demanding jobs. He is a sweet, funny, active, kind little wild man and I adore his antics and his infectious laugh. Those are the qualities that make him who he is... Kindhearted, loving, silly, WILD! If something happened to him that caused him to be brain dead, as Jahi and Isreal are, and he was only able to lay in a hospital bed until his heart stopped beating... That is not a life. I love him and that means I would want better for him... A better life than bedsores and tubes and a coma (or coma-like state--- whatever... I'm a teacher not a doctor). I want him to grow up and be an amazing grownup because he's a perfect and sweet little boy (biased maybe). I am so sorry for these families and I can't imagine letting P go even though he's not mine... But if he is not able to walk or talk or open his eyes or hold my hand or kiss my cheek or make a mess with his food or ask to be held... Is he really my boy anymore? Or is he just a shell whose soul is gone?

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    1. To clarify: brain death is different from a coma/vegetative state (aka an extended coma). A coma is where there was enough damage to the brain to cause extended period of unconsciousness. Brain death is where the brain itself has died and has ceased to have electric pulses in several vital areas. Someone can theoretically wake up from a coma even if it takes decades. With brain death there's nothing to wake up. There are no memories, no personality or person to wake up as they have effectively ceased to exist. Its a sad way to go.
      Connor

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    2. I guess I just meant that he would be laying there as if sleeping... I do understand the difference but thank you for explaining...

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    3. Well misunderstanding on my part then.
      Connor

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  8. I'm saddened about each aspect of this story - this toddler's tragic death most of all. But going forward, I find the family's actions since to be impulsive and emotional, and I would argue counter to the nature and character of a person who professes to believe in God, his plan for his people and eternal provision for them.

    What an awful mess.

    I agreed when you said the Jahi McMath case would bring others, but it's difficult to watch nonetheless.

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  9. Thank you Doc for saying what needs to be said. I am beginning to think these families are in it for the money or the attention. Either that, or they really are not smart enough to understand what is going on. These families seem uneducated. I say that because they are gullible and don't seem able to grasp the simplest things and are easily fooled.

    Kate Johnson

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    1. I wonder if we'll hear from the hairdresser.

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    2. I'm sure she's planning a garden party fundraiser.

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  10. This is long – sorry. If it is too much for a Friday afternoon, feel free to skip…. My deepest sympathy to all the families who have endured the loss of a child. There is no greater tragedy, and my heart goes out to these families and friends. I agree with Doc B when he predicted waaaaaaaaaaaay back in January of 2014 that the Jahi case would engender problems in the future, particularly in the medical field. However, this sort of parental “thinking” can be found everywhere. When I taught high school recently, it was normal to have parents blame the teachers for their child’s classroom problems. Of course, all their progeny are geniuses, simply not being appropriately challenged by the hapless, uniformed educators. I had a parent tell me she appreciated my realizing her son (his real gender) was a genius on par with Stephen Hawking. I have no clue how she got such a ridiculous idea, but she quickly turned on me when I expected him to perform normal classroom behaviors such as turning in his work and not shouting out when he felt like it. Another parent filed a complaint against me because I told her I could not help her son (his real gender, also) get a scholarship to a small, private, very elite college. She explained it was such an expensive college her son had to get a scholarship, and it was my job to see he did. She didn’t care that her son did not have the academic requirements to even apply to the school much less get a scholarship. The school required in-coming freshman to have at least a 3.85 GPA, SAT scores in the mid-1400 and up, or ACT scores above 29. Her son met none of these. Apparently, it was my fault he would not get a scholarship. The principal didn’t make headway with the parent either. The mother demanded her son get a scholarship and that was that. Sadly, I left the classroom rather than deal with this entitlement philosophy. This mother’s rant sounds much the same as, “My child isn’t dead; he/she can’t be.” It would be great if we could bend reality to our bidding by just making mandates and shouting the loudest. This dangerous trend will be with our society until we (no clue who “we” actually is) start saying NO to irrational demands.

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  11. At the moment from this family it seems to be hopefilly a knee jerk reaction out of grief. Now I am not sure what the average grieving period is for most people for when most of the sense of loss is still felt but the family may realize in say a month that what they are doing isnt right or that its insane and may choose to pull the plug. With Jahis family its just pure insanity and greed, in this case it may simply be due to the immediate grief.
    My heart goes out to the f a mily, its always hard to lose someone you care about, especially your child.
    I only hope they choose to make the right choice.
    Connor

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    1. I respectfully disagree. Everyone has a reaction of grief to the loss of a loved one, but this reaction is drastically out of the norm.

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    2. Doc, I agree with you. They don't appear to me to be grieving at all and they've had almost a month since April 3rd. They are going to continue on the path they are on.

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    3. Never said it was normal Doc. Just hoping that it is a temporary bout of insanity. People react to loss in very different ways after all.
      Connor

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  12. It appears as though one of the many important issues here, which is illustrative of the greater issue of ignorance/misinformation over the diagnosis of drain death, is that the testing for the determination of brain death DOES NOT in any way jeopardize the health of the patient. This was, if I recall correctly, key to the case of Ms. McMath, involving the apnea test and its "potential to cause further brain damage."

    I am not an attorney, but IMHO the doctors did not violate the mother's wishes for no testing to be performed which would "jeopardize his well-being."

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    1. Absolutely correct. I was going to point this out, but I already had in one of the various Jahi posts. When the apnoea test is performed, the patient is pre-oxygenated. The ventilator is turned off and blood oxygen saturation is carefully watched. If it ever drops below normal, the test is aborted. There is never any danger to the patient.

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    2. As Prof. Pope pointed out in one of his comments on this case, a hospital *needs* to perform testing to fulfill its obligation to meet the required level of care. I'm not a doctor, but common sense and personal experience should tell us that when we go to the hospital, or have a family member admitted, we should *expect* the staff to do whatever testing is needed to figure out what's going on...otherwise no one would ever *know* what treatment may, or may not, help.

      In this case, it seems that Israel's mother already knew of the DDNC, so anticipated that confirmatory tests would be done, and just didn't want to deal with the bad news. Understandable, when faced with the sudden loss of her beloved child. But that doesn't change the hospital's obligation to do whatever is needed to assure that the correct diagnosis is made.

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    3. Of course. But instead of just making his usual statements about the apnea test causing harm to the patient, Dr. Byrne goes a bit further this time. His declaration states:

      "His (Israel's) PCO2 increased to 82 and PH increased to 7.15. This was not bad enough, so no ventilator life support was continued for another 3 minutes. By then, the PH was down to 7.10 and the PCO2 increased to extremely high level of 95."

      The "this was not bad enough" comment suggests that he's accusing the hospital staff of *deliberately* causing harm to Israel in order to manipulate the outcome of the test.

      Really.

      Case documents, including this declaration, are on Prof. Pope's site as usual.

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    4. I would love to see news that "dr" Byrne had lost his license and was facing civil and criminal suits over that.

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    5. @ Ken - Agreed, but I'm not sure that general goofiness legally constitutes malpractice :)

      Read the full declaration for some good laughs over what he chooses to submit to the court as "evidence" to support his position. As usual, he shares his special recipe for the cocktail of medications that will support healthy recovery from brain death. But my personal favorite in this missive is the list of news articles he submits about people who have supposedly recovered after a declaration of brain death, including "Woman Wakes Up After Heart Stops, Rigor Mortis Set In." Yes. Really.

      Of course, these aren't articles from credible medical journals...they're mostly from www.lifesitenews.com. No surprise there...

      I guess we can take some comfort in the fact that Dr. Byrne has already established himself in the California court system as someone who isn't to be taken seriously.

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    6. to me a statement that something "wasn't enough and they took it farther" borders on libel.

      even if it is true that someone reached the minimum threshold for being declared brain dead, and the testers decided to have undeniable proof. not that "dr" Byrne's fans won't deny everything anyway.

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    7. Ken, that was my thought too, when I read the "this was not bad enough" comment. It's as if the hospital staff doing the testing *wanted* to prove that Israel was dead, even if it meant deliberately not following the proper protocol for maintaining adequate oxygenation throughout the procedure.

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  13. The first video the only movement is the mother shaking the child. He is dead it's tragic. It's heartbreaking. But dammit stop perpetuating false hope.

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  14. I have a living 17 year old son. If I "tickled" him like that mother is doing, he would not make a slight shrugging movement with his head. That isn't even the proper response to the stimulus. In addition, that is not tickling so much as jabbing, pinching or stabbing with fingers.

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  15. "Who is a doctor to go against God?"

    Pretty much every doctor who manages to keep their patient alive after said patient has done their utmost to be dead.

    If it wasn't for the doctors going against god, there would be a huge number of people who are currently alive, finding themselves permanently unalive.

    It seems it is perfectly acceptable for doctors to defy god's wishes when they perform, in some cases, medical miracles, but not OK when god decides he is having none of it and says:
    They're not pinin'!
    They've passed on!
    This patient is no more!
    They have ceased to be!
    They've expired and gone to meet their maker!
    They're a stiff!
    Bereft of life, They rest in peace!
    If you hadn't wired them up to the machinery, they'd be pushing up the daisies!
    Their metabolic processes are now 'istory!
    They're off the planet!
    They've kicked the bucket, They've shuffled off their mortal coil, run down the curtain and joined the bleedin' choir invisibile!!

    THIS IS AN EX-PATIENT!!

    It is OK for doctors to defy god's will when they work to keep a patient alive.
    The family announces only god can take a life.
    This amuses me in that when god calls someone to him, the family decides to deny god what he wants and expect doctors to work bloody miracles.
    When said patient still remain dead, families still claim only god can take a life yet refuse to admit this is what has happened and continue demands for said corpse to be put on support anyway.
    Can it be called life support when the patient is dead or will we have a new medical term for cases like Jahi where they are placed on death support?

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    1. Ha! Yes, docs are expected to defy Gods will but if the doc fails to produce the desired outcome then he can expect to be sued for letting God win.
      Great post, Tania.

      The alternate term you seek is "organ support" I believe...

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    2. the medical term is "somatic support"

      just so you know there is one, already. it refers to keeping the organs viable in an otherwise dead person.

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    3. The "expatient" rant is almost word for word one I heard fron "the nostalgia critic." A fellow fan perhaps?

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    4. Anon - it is a slightly altered version of The Dead Parrot sketch from Monty Python. Look it up - it's absolutely hilarious and a classic.

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    5. and should probably be linked to every single discussion of Jahi and Isaiah

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    6. I'll be damned had no idea.
      Now I think I'm going to go off and listen to some Michael Notlob music.

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  16. The Jahi story is so sad, that little girl lying forever unresponsive while a machine pumps air in and out of her lungs and she never moves, never opens her eyes, for years....If they think about it, do Israel's parents really want this? Really? I believe they have another child, they are young people...what will this craziness do to the rest of the family?

    Something went terribly wrong and the two year old died. We used to lose a lot more two year olds, now only a few, but we lost this one. Time to move on.

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    1. I think these parents are being met with a lot of pressure from the right to life groups and possibly their own church members. Removing life support is being equated with murder and lack of faith. It's a dick move.

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    2. seems to me that lack of faith is not putting the matter in God's hands and trusting him to make the best decision, probably because some rational neuron in the back of their brains is telling them that God's best decision is to claim the child for his own.

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  17. Jersey better look into changing their brain-death law before they turn into the California Graveyard.

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  18. I seriously doubt anyone is Jersey is going to admit this kid into a hospital there. The Jahi case put a microscope on that brain death law and I am sure Jersey is going to do what it can do not be the Graveyard of California.

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    1. Motel Styx.

      we'll keep the ventilator on for you.

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    2. I just spit coffee on my screen.
      You shall receive my bill shortly.

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    3. I'll forward it to my gofundme.

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  19. I am curious. Let's assume that they can get someone to do a tracheotomy where they are now, they can secure transportation and they just need to get admitted somewhere. How can a New Jersey public hospital refuse to admit someone because they are brain dead? Jahi had trouble securing her spot too even though they claimed that the NJ religious objection law allowed them to ignore the whole brain death thing ( I do not believe the law was intended to be interpreted this way, so that people could bring their dead to NJ, just no.). But they pulled it off and even got Medicaid to foot the bill. Why are these options not available to every dead person trying to get into New Jersey? So far, only Jahi has pulled it off.

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    1. the scamfam had a "doctor" (who has since lost his license) who wanted to play god.

      Hospitals are, for the most part, not required to provide medical care that will do no good.

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    2. Ken, that's correct. Jahi was admitted to St. Peter's as a live patient of Dr. Fellus.

      Betsy, I'm assuming that NJ hospitals function the way hospitals do elsewhere...you can't just check in yourself, or a family member, and demand specific care that *you* want, and expect to get it, without having a properly-accredited member of the hospital's medical team agreeing to assume responsibility for that care. You have to be "somebody's" patient of record. So, to relocate Israel to a NJ hospital or long-term-care facility, the family would have to find a doctor licensed in that state to accept him as a patient of record. A doctor is needed not only to direct and supervise the care (write the orders for procedures and medications, give the nurses instructions for the care plan, etc.) but also to sign off on this, so that insurance, whether private or Medicaid, will *pay* for the care.

      Remember that the reason Jahi *isn't* in the hospital any more is due to the fact that Dr. Fellus lost his license, and there was apparently no one on the hospital staff who was willing to take her on as a patient. But the family did find Dr. Eck to serve as Jahi's physician of record, since they still needed *someone* to sign off on the Medicaid paperwork needed to pay for the in-home care.

      That's why we're hearing that Israel's family needs to find a *doctor* willing to do this before they attempt to move him.

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    3. and when we say Fellus lost his license, we don't mean it slipped between the couch cushions. we mean it was taken away for professional misconduct.

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    4. I would assume that they would admit a body to the morgue. Barring that, then they are no more responsible for admitting a dead body than they are for admitting a plant, even though a plant is alive.

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  20. Doc B- do you have much experience with the "miracle" treatment of hypothermia protocol following cardiac arrest? I am a nurse, see it almost daily in the ICU and see only the most rare (VERY rare) of circumstance when the patient makes any kind of meaningful recovery. I have seen multiple persons declared brain dead after the protocol has ended and families decline to allow support to be withdrawn. People in their 50's to 80's are being trached and pegged and sent to nursing homes from my hospital and I am sure it is happening in every other hospital that employs this protocol. We offer false hope. Then we do not advocate for the grace and dignity of the person laying in the bed. It is morally and ethically challenging dealing with this on a constant basis as an ICU nurse. Yet dare to suggest the family is misguided in their beliefs or demands and you are thought of as heartless. Even begin to think of mentioning the financial impact this course of care treatment and care are draining from our healthcare system and government- these people will all wind up on government funded healthcare if they were not already receiving it when their illness struck- well that thought makes you evil in the eyes of Sarah Palin an so many others...

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    1. I've never seen a family refuse to withdraw support after a declaration of brain death after {redacted} years of practice. Hypothermia should theoretically work, but it has not been proved to improve outcomes in humans.

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    2. of course, in the situations it has appeared to work, hypothermia preceded the cardiac arrest.

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  21. I give you the contender for greatest comment since "Motel Styx".


    Kate Johnson

    "...Isn't science wonderful? Its taken the rigor out of mortis!!"

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  22. Grandma Skeptic30 April 2016 at 23:39

    If, indeed, the child is not dead, then turn off the machines. If it is God's Will that the child not die, the entire Earth can lose power, and the child will still live. If this family really is religious, then why would they deny this sweet child access to heaven?

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    1. But they haven't denied him access to heaven. He has died, and he is in the arms of the angels. They are denying themselves the ability to accept God's will that no miracle will be done (as their religious outlook would seem to mandate that they should), work through their grief, and to take comfort from all those around them who would (who SHOULD, anyway) give it.

      Delete
    2. they are refusing to admit that he is dead. - ergo refusing to release him to heaven.

      Delete
    3. Again, as in several other brain death cases that many of us have followed over the past few years, we hear mention of God, faith, and religious beliefs.

      Again, I don't see any kind of public statements, either from any recognized spokespersons for a particular denomination, or even from anyone who claims to be the family's personal spiritual advisor (priest, minister, pastor, rabbi, imam, etc.) speaking out in support of these families who want to continue somatic support indefinitely after the death of their loved one.

      Again, I am left wondering...what "religion" advocates the complete denial of death of the physical body, and suggests that the mortal shell left after the soul's departure be treated as a live person?

      Delete
    4. I agree, no spiritual leaders go along with this nonsense, only lawyers. Hhmmm.

      Delete
    5. Not surprising, really, when you consider that *accepting* the death of the body is actually an integral *part* of religious philosophy and practice. People of faith, regardless of the denomination, recognize the fact that there is a point in time at which the soul/spirit/essence of person transitions out of its temporary container and into another form. Particular beliefs about happens afterward vary. But all recognize the fact that the person no longer "lives in" a dead body, so we need to respectfully dispose of the remains, acknowledge the transition, and make the emotional adjustment to the lack of the loved one's *physical* presence in our lives.

      Delete
  23. In his declaration, Byrne mentions 'Joseph', a patient of his who was in a coma for 6 weeks in 1975, he had a flat EEG, which was interpreted by neurologists as being consistent with cerebral death. According to Byrne, he treated Joseph, who recovered, and went on to marry and have children.

    It's the first time I've heard of this, and I haven't been able to find anything other than a short write up on one of the anti organ donation sites, which aren't the most reliable of sources (and that's putting it mildly).

    My only guess is that the tests at the time would have not been performed correctly. There have been a lot of advances in science in the last 40 years. Either way, it would be interesting to find out more.

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    1. I note he only mentions the flat EEG, and not the stimulus response tests OR the apnea test.

      Delete
    2. Good point, Ken. Even if we assume that most hospitals were, by 1975, using the 1968 Harvard committee's criteria, we need to remember that this report stressed the importance of using *several* different kinds of tests. The committee also noted that there are a number of conditions, including hypothermia and drug intoxication, which may cause loss of brain function that is *reversible.* So, we don't know for sure that "Joseph" was ever really diagnosed as brain dead.

      Delete
  24. As a parent who has had a child die, I can attest to the extreme heart retching pain and grief you experience. No matter how much we wanted to deny the death of our daughter it was not going to change the situation. It is sad to hear of parents like these that are so deep in denial and lawyers who profit from it. How can these parents want a child who is now deaf, blind, mute, and attached to machines to continue to exist. It is not living,it's just existing.

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    1. no parent should ever have to bury a child.
      and I can say with confidence that emergency services almost invariably go way above and beyond both duty, and good sense, in trying to prevent it.

      Delete
    2. Every medical person involved with our case did everything within their power to save the life of our child. Alas, it was not to be. We experienced it one time. I don't know how medical professionals handle so frequently during the course of their careers. In fact dealing with death and suffering was the reason I killed a life long dream of becoming an MD. Right after high school, I went to work in a large trauma hospital as a collector for the lab. I saw so much death and suffering I completely changed my school major and became an accountant. I have nothing but tremendous respect for people who are able to work in the medical field.

      Delete
    3. to be entirely honest, we have a very high rate of turnover in emergency services, and those who make a career of it are a special kind of unbalanced.
      consider: Doc B's blog is a kind of therapy for him. there are other therapies that are not suitable for public consumption. partly because of patent privacy, but also because we sometimes need to let the filters wide open and let ALL of the stress out.

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    4. At the end of this month I am transferring out of a PICU as a staff nurse to a different type of setting. These type of situations have caused me to burn out. I am a very seasoned ICU nurse of 35 years. These situations are extremely hard for the staff. Seeing the note left on the bed I can only imagine how difficult the Mom is. The nurses bear the brunt of it because we are at the bedside 24/7. Dr Brynes and other enablers put up an invisible barrier between the family and staff because now we are the enemy. Instead of having nurses that could help the parents and be involved very intimately with them they now have drones coming in performing medical tasks. I can guarantee the "do not use" list has at least half the staff on it.

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  25. I am so incredibly sorry for your loss! :(

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  26. This is so sad about this little boy. I watched the video several times of the movements he makes when his mom pokes at him. Do brain dead people make movements like this? I wonder if they have done an Mri or CT scan on him?
    Mary

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  27. I have been in two of the hospitals mentioned. Mercy General is where my son was born. UCD is where I have had other medical procedures done. Mercy Gen. (and another Mercy hospital in the area) busted their tails to keep my mom alive and supported and loved me as I handled that situation alone. So, I am biased in favor of the hospitals in this case.

    My heart breaks for these parents. I would hope that they would allow little Israel to go. I'm just saddened by this. I have to wonder if there is a way for the courts to declare the parents medically negligent? But then, that would probably mean that he isn't dead.

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    1. the courts have the ability to declare the parents medically ignorant, but all evidence has indicated they are too spineless to actually do so.

      Delete
    2. This is my fear. That an excuse will be found to keep this going, another doctor's opinion, or some quack will do the procedures and he'll go home and they'll move to NJ.

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    3. and the spineless judge in this case has followed the McMath examples.

      Delete
  28. I was just looking at news sites about this little boy and of course the parents have set up a GoFundMe account to help pay for expenses to get him to NJ. I hate for any parent to lose a child, but they need to face facts and realize that he is gone.

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  29. These families do not believe a doctor has the right to declare their children deceased, believing only a parent should be allowed to do so. Does this mean when the courts rules against them, judges do not have the right to decide what should happen to their children either? Perhaps the children's teachers do not have the right to give the children a grade, that should also be the parent’s right. This could go on forever.

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  30. Okay, since no one else has, I'll say it, because I may be the only one here who can get away with saying it. I'm Black & a follower of Christ, so this isn't about me being racist or an anti-religious bigot. I don't know these people personally, but I know the type very well. Jahi's mom & Israel's mom sound like they are hyper-religious Blackfolks who attend evangelical churches that brainwash their members into believing God will answer all their prayers & that any delay is just "Satan blocking your blessing", or "the Lord testing your faith". (It always struck me as odd that the pastor could never tell you which case was which -- "Just keep praying & hold fast to your faith, sister!) Behind the scenes of these poor, broken mothers' lives, there is a pastor organizing a prayer chain for their brain dead child, so that someone somewhere, from their church or, thanks to the internet, from thousands of churches across the country, is praying for their child 24/7. And to their credit, church members are also doing tangible, useful things for these suffering mothers; dropping off meals for the family, stopping by to clean & do laundry while mom is at the hospital -- the church ladies in every Black community in America are incredibly compassionate, efficient & well-organized. If Obama had hired a bunch of them to staff his cabinet, this country would have made a LOT more progress than it has in the last 7 years.

    Because they've been taught to take everything in the Bible literally, they believe God can & will heal any illness -- cataracts, cancer, HTN, a herniated disc, ADD, schizophrenia -- as long as they pray for it long & hard enough. When you remind the pastor of all your dead/unhealed friends & relations, you get platitudes about how "their faith wasn't sufficient to bring about the miracle" or "they quit praying too soon". (If you're like me, after the reverend ran this line on you one time too many, you reached out & grabbed him by the neck, so you ended up leaving the church. But I do digress...) The lack of healing is always our fault, not God's.

    Turn on your tv anytime & you can catch lots of these pastors, of many races, doing their schtick on Daystar, TBN, the Word Network. You may even recognize some of their names, since many of them have connections to members of Congress/the Senate & the White House. Whether they're on tv in a 15,000 seat megachurch or in the basement of a bodega in the inner city, these hucksters are selling the best high of all: answered prayers. They are tricking out poor, uneducated Black women just as much as any hopper on the corner, taking their money every week & selling them hope instead of dope, convincing them that the Bible assures them God will answer their prayers, as long as they "hold fast the profession of our faith without wavering" & keep begging through prayer. They are convinced that the Lord will bring their beloved child back from the dead, like he brought Lazarus back... (cont'd)

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    1. One question. Don't black Pastors ever tell their congregations that sometimes the answer from God is "NO"? This and Jahi case are clearly cases where the answer is NO. As a white person my Pastors always taught us sometimes the answer from God was NO and we should not always expect to get the reason why it was NO. But we should accept the fact that our plans and God's plans for us are not always going to coincide resulting in a NO response for the answer to your prayers. It doesn't make it any easier, but that is the way it works.

      Delete
    2. But it seems Ms McMath only became religious after Jahi was declared dead. Or is one of those "pick-and-choose" Christians. But Black evangelicals don't monopolize "pray harder; a miracle will happen" ideology. Just look at the numerous FB pages of parents whose children have suffered severe brain injuries. Read their story and all the comments, and you'll quickly see that the refusal to accept God's will crosses all lines.

      Delete
    3. a lot of white christians reject the idea God will tell them "no," too.

      Delete
    4. Anon 17:23 -- The pastor always told us that as long as what we ask for is in line with Gods' will, He will answer our prayers, but perhaps not in the way we expected. Which was basically a meaningless CYA response.

      Evangelicals & Fundamentalists preach that sex outside of marriage is a sin, ditto for having children out of wedlock. But they also rail against abortion, even when the pregnancy resulted from rape or incest. I never subscribed to that view, even as a church member. And no pastor has ever sufficiently explained to me how an omnipotent & just God allows conception to occur after rape. That question made me realize that although God created us & this world & all living creatures & the processes that support life, He doesn't micro-manage any of it. He set the biological processes in motion & Nature does what Nature was created to do. I don't consider pregnancy & childbirth to be miracles anymore than the sun rising every day is a miracle. It's all just the natural world functioning as it was created to function.

      And sometimes, biology fails us. Sometimes children stop breathing during surgeries or asthma attacks. Sometimes babies are born with their brains outside their body. But regardless of the cause, I know that brain dead = dead, period.

      The sticky wicket is that no parent wants to believe it was God's will for their child to die. If it was God's will to give them a child in the first place, why would He turn around & snatch it away? That's beyond expecting someone to accept the fact that God's answer to their prayer to save their child was "No". It's a big reason why many people reject God. And the answer is certainly beyond my pay grade.

      As for the mothers of these 2 unfortunate children having been non-religious club rats before their kids became brain dead, churches exist to embrace sinners who are seeking redemption. If we accept Christ & repent of our sins, God forgives us, period. And nobody is more repentant than a mother with a desperately ill child. Churches welcome such women with open arms, which is what God expects of His followers.

      Delete
    5. the expression I was taught was "sowing your wild oats Friday night, and going to church Sunday to pray for crop failure."

      The fact of the matter is there are a lot of people out there who only call on God when they want something from him. This tends to create a dilemma for spiritual leaders who have to try to figure out whether a person is truly looking for help, or just looking for a bailout so they can resume their former habits.

      fact of the matter is, if you have to repent repeatedly of the same sins, God might get the idea you aren't really sorry.

      Delete
  31. Of course, it's impossible to reason with Christian fanatics. You can't explain to them that nobody comes back from brain death -- they are people of faith & "Faith is the substance of things hoped for, the evidence of things not seen." (Hebrews 11:1) Even if you are the best neurologist in the city, they will believe you are a heathen, working for the Devil, if you tell them it's time to turn off the ventilator, stop the g-tube & let their child go, so they can bury him/her & begin the long, arduous grieving process. And oddly enough, considering how few rights patients have in our for-profit medical system, despite how greedy our hospitals & insurance companies are in the US, they can't pull the plug on a brain dead child if the parents refuse because they believe a miraculous recovery is imminent.

    If the pastor is soliciting offerings to "help the family" during every Sunday service, or getting donations to the church from a GoFundMe page, the reverend can skim a nice bit off the top for himself, since churches are tax exempt organizations that don't have to open their books to the public. (On the "Save Israel's Life" GoFundMe page, his mother said "God is telling me not to let go." They've collected $9863 so far in 19 days & it does not appear to be linked to any church.)

    All this crap will continue until the hospital or insurance company is willing to take the public relations hit, send their biggest bastard lawyer into court along with 3 or 4 of the most respected doctors in the necessary specialties & decimate these ridiculous parents in court. Grind their delusions into dust in front of a judge & jury. This is the moment where lawyers as a species need to step up to the plate & be the big swinging dicks they're portrayed as in the movies, whether male or female. Let them show America that parental rights do NOT trump medical science, that faith does not trump biological facts! That brain dead means your baby is never coming back, as awful as that is. And that the ghoulish technology we've invented to keep people breathing & put nutrition into their system when they can't even swallow only provides Survival, Not Life. Their life is already over.

    When cancer patients lose the ability to swallow, everyone knows that death is near. Why can't people accept that fact when the patient is a brain dead child?

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    1. there is no evidence that either mother made a habit of darkening the doorways of churches before the loss of their child, and the evidence that they made a habit of darkening the doorways of nightclubs has recently been removed from Isaiah's mom's facebook page. Nailah hasn't really even done that - or at least can't keep it off. their religion seems entirely based on accessing the loophole in New Jersey law, and in getting more donations from the people you speak of.

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    2. I think this crap will go on until a judge grows a pair.

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    3. or they get a judge who isn't dependent on having a pair to exercise her authority.

      Delete
    4. Hi, RC. I totally agree with everything you've said about the prevailing mindset in many of our Black (and ethnic Caucasian, and Hispanic, and Asian) fundamentalist-type churches. Still, I will draw your attention to Ken's comment, and to my earlier post on this thread, about why "faith" and "religion" may not be *real* factors in these two particular brain death cases.

      We've heard no mention of any particular church involvement from either of these parents, and, just as significantly, have never heard publicly from anyone *else* who's self-identified as their pastor or fellow church member. As you've already stated, usually our "church family" will rally round us in times of need. Pastor spends time at bedside praying with family,calling upon the Holy Spirit to heal the sick one. Church ladies watch the other kids in the family so mom can be at hospital. Special collections are initiated to help with family expenses if parents can't work due to hospital vigil. And, *everyone* brings food *everywhere*!:)

      But the absence of this kind activity is telling in these two cases. IMHO, these families are using "religion" to justify their own agendas.

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  32. Some lawyer (preferably a mother who doesn't mind being portrayed as a royal bitch in the press) needs to stand up for the hospital, take this to court & force Israel's mother to admit that if she "knows" her son is alive despite all the scientific evidence to the contrary, then she should have no objection to pulling the plug on her living child. Make her admit aloud that that being disconnected from life support won't end her child's life if he's really alive. And make her see that if God intends to miraculously bring her boy back from brain death (which I really think these mom's are confusing with a coma), then God will have every opportunity to revive her child when the plug is pulled. But these parents can't have it both ways. They can't be allowed to keep claiming that they believe their child is still alive but also insist on continuing artificial life support to keep their child alive. The court has to make people recognize that religion doesn't trump biological facts.

    If one courageous lawyer is willing & qualified to take this all the way to the US Supreme Court, it will be a slam dunk. And we will finally put an end to this macabre madness of maintaining corpses with a ventilator & tube feeding.

    (And I apologize if all of that sounds vulgar or mean-spirited, esp. those who have lost a child of their own. But if we as a nation are forced by the legal system to finally have this hard conversation about brain death & Resolve The Issue, then the religious right & all the greedy vultures who hide behind the cloak of Christianity will be brought to heel once & for all. And we can finally stop being forced to pretend that death is life & wrong is right.)

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    1. Thank you for taking the time to really explain in detail how it really feels to these people. I think you are right about them needing to step up to the plate and be much more aggressive. This is a matter that needs to be settled or there will be more and more of them doing this.

      In the end, there are no winners. The children are still dead, the parents lose their homes and communities and nothing at all is gained.

      Kate Johnson

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    2. RC,
      Thank you for sharing your insights which explains their mindsets to a "T."
      I had come to the conclusion that there isn't any reasoning with those "Christian fanatics"- now armed with the inside knowledge you provided as to why they are so steadfast in their denials of brain death, reality is beyond their comprehension.
      I think you're spot on with "The court has to make people recognize that religion doesn't trump biological facts."
      As should medical science and logic. ;)
      I enjoyed reading your side of this divisive issue which does need to stop asap because of the ever growing hordes of those refusing to accept brain death= dead.

      ~Realist

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    3. It is interesting to have this type of insight. I saw an item a few years ago on "fundamentalist" type churches in the UK.

      They were, as an extreme example, telling young women with HIV that they shouldn't be taking their anti-retroviral med's because that showed a lack of faith. When the girls died as a result, it was their own fault for not having sufficient faith!

      That sort of thing should be criminally irresponsible and this is not much short. The problem is that it's difficult to distinguish well-meaning but deranged religion from deliberate exploitation.

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  33. Just popped in to say that the "Motel Styx" comment was bloody brilliant! I almost spit my tea all over my keyboard.

    As usual- love your blog Doc Bastard. Please keep it up, mate :)

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    1. thank you. I had help in formulating it, so credit to those who helped inspire it, as well.

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  34. "How would you feel if someone said, ‘Your son is dead, we’re not doing anything for him,'" she said.

    I think anyone here who is a parent will agree that you would feel utterly devastated, but not because of the "we're not doing anything for him" part. If he's dead, what are they supposed to do for him?

    Now, if you told me he was dead because you hadn't done something you should have done when he was alive then I wold be furious, but that's not what that quote says: it says that there's a problem and the doctors are refusing to fix it, as if by declaring him dead they are somehow making it so in the way that one declares a car to be an insurance write-off.

    I think in both this case and that of poor Jahi, there is the underlying idea that death of the body (say, when the heart stops and cannot be restarted) is a biological question, while brain death is a legal construct created by doctors and courts. The former is seen as reporting a fact, while the latter is making a decision to give up on someone for convenience, without any fundamental reason. I don't know how to explain to the families and campaigners that the brain is an essential organ and once it stops being able to function then you are dead whatever the doctors or lawyers say, but I do wish someone would try for everybody's sake.

    Ugi

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    1. most likely, the ACTUAL quote is, "Your son is dead, there is nothing we can do for him."

      and people try until they are blue in the face - the deniers just fall back on denial. look at some of the death denier sites, and you will see a person explain AT LENGTH how the process works, and the denier will come back with "so you have no rebuttal" or "but that's not what MY UDDA says" or some other such blather.

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  35. Thanks, folks, for your understanding. This was hard to discuss because it's semi-personal. It wasn't one of my family members but a young girl I had befriended at church years ago. The boyfriend was long gone, her family was abroad, so I became her pregnancy coach/surrogate mom/church lady. Long story short, I was with her when she delivered & her baby was born with, not anancephaly, that's when they have no brain, but part of her brain was outside her body & portions of her brain never developed. (Doc B, can you help with the med term?) Those babies never survive. A few hours later, when her daughter stopped breathing, of course the staff used all the extraordinary measures available to keep her alive. And they succeeded. And when the doctor finally asked the mother to pull the plug, she resisted. And instead of telling her to accept the facts & let her baby return to God, I encouraged her to fight for her child. I told her to hold on & pray for a miracle because I'd been drinking the Koolaid for years as a member of that church. I even called the pastor to come to the hospital & support her, which only exacerbated the shitstorm. (Our prayer group was in the hospital chapel with the pastor days later when I ended up grabbing him by the throat.) Her daughter died a few days later. But I encouraged a vulnerable, frightened girl to prolong her baby's suffering because of my delusional beliefs. Because I had let some pastor convince me to shut off my intellect & rationality & reject facts & truth. I don't want to see anyone else make those mistakes.

    I still believe in God. I even believe in miracles, but in the same way that I believe in the Lottery. It's something I know is real, but it only happens to other people. And you shouldn't encourage other people to fall for the okey-doke.

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    1. @RC - I know that I am not the "Doc" you were referring to, but I think the infant had an encephalocele. A truly devastating diagnosis. Regardless of the circumstances or outcome, it was very noble and courageous of you to support your friend. Thank you.

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  36. A link to a Sacramento Bee article with a little more information than I'd been able to find previously: http://www.sacbee.com/news/local/health-and-medicine/article75472347.html

    Hi Doc -

    I've been following your blog since sometime 2014? I got drawn in while looking for stuff about Jahi McMath, which I'd been following since it was initially reported in the papers. I was really surprised to see this same happening again so close to home, and while I really, really feel bad for all the families involved of both Israel and Jahi, I still can't comprehend the amount of self denial involved to think that the doctors really don't want what's best for their kids.

    I went through this with my mother, who was proclaimed brain dead after an aneurysm ruptured in her brain. It was hard, and no one really expects it, but I also didn't doubt that the doctors did all they could and knew that there was no coming back from that because she was already gone in all the ways that mattered.

    My heart still goes out to both these mothers, for their loss and what's keeping them from seeing what's obvious to a lot of other people. And I feel like I might be one of the few people on the internet who doesn't believe that Nailah isn't using Jahi as an excuse to get money. I think she's used some of it in ways that were stupid, but I also still think that she's doing what she thinks is in Jahi's best interest, even if it's really not.

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    1. Interesting article from the Sacramento Bee. CPS was involved in January, mother was not following medical advice with this asthmatic child. Like Jahi again, I believe the mother feels guilty.

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    2. the Bee appears to have a bit more journalistic integrity. a friend found this excerpt in one of their columns about him:

      Multiple hospitals have been involved in Israel’s care. According to
      court papers filed by Kaiser’s lawyers, Israel was treated at Kaiser
      Vacaville’s emergency department for a severe asthma attack about four
      months ago. In January, the filing said, the child’s parents and county
      Child Protective Services were informed that Israel’s medical history
      and the failure to comply with medical recommendations were weakening
      Israel’s lung capacity to the point where he might be unable to recover
      from a severe bronchospasm.

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    3. A very interesting article. Here is the passage in question:

      "Multiple hospitals have been involved in Israel’s care. According to court papers filed by Kaiser’s lawyers, Israel was treated at Kaiser Vacaville’s emergency department for a severe asthma attack about four months ago. In January, the filing said, the child’s parents and county Child Protective Services were informed that Israel’s medical history and the failure to comply with medical recommendations were weakening Israel’s lung capacity to the point where he might be unable to recover from a severe bronchospasm."

      Additionally, the article states that Paul Byrne has actually examined her, and in court documents says that Israel has hypothyroidism and diabetes insipidis, both of which are fully expected in brain dead patients. The article did not say if Byrne claims Israel responded at all.

      This bodes poorly.

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    4. This is from the same article "On April 4, brain scans showed “near total absence of blood flow into the bilateral cerebral hemispheres.” Eight days later, on April 12, Kaiser Roseville admitted Israel, with his parent’s consent, for a second brain death examination."

      So they knew they were going to do the exam on him before the transfer. These parents do not seem to me very responsible.

      They likely are also concerned that his 'death' will stop their state support payments. I hate to put things out there like that, but when you start to see lies and pointed fingers at the wrong people, it makes me pause and wonder what is their real motive here.

      I am very happy the court documents are public. It does give the medical side of things some way of pointing to the truth.

      Kate Johnson

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    5. @ Doc, re: Paul Byrne's statements - his full declaration submitted to the court is among the documents posted on Prof. Pope's site. Nothing really new here, for those of us who've read his previous declarations regarding Jahi and Aden. There's nothing truly meaningful stated (IMHO) about actual "responsiveness." He always believes that someone *can't* be truly dead if any body functions are continuing, or any reflex movements are observed.

      Again, as usual, he claims that the hospital has caused additional *harm* to Israel. Besides the usual misinformation about the apnea test, he claims that Israel isn't receiving either the correct medications to "treat" his condition, or the proper nutrition. So, he attributes the hypothyroidism, diabetes insipidus, and whatever else is wrong to medical neglect, not brain death. He even makes the claim that whatever IV solution is currently being administered, which apparently contains dextrose, as being the equivalent of 7-Up. Yes, he really said that.

      This would actually be funny except for the fact that he's apparently convinced Israel's *parents* that this is true. :( (Dad mentioned the 7-Up thing in one interview I read). Tragic enough to lose a child...worse yet when someone who puts himself out there as a "doctor" leads them to believe that the hospital is at fault, and that other things can and should be done to "save the life" of their child.

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    6. Byrne needs to lose his license for practicing outside his scope, and for malicious slander against the hospital.

      he's a pediatrician, not a neurologist.

      Delete
    7. A neonatologist, to be exact. Far as I know, neonatology is the sub-specialty of pediatrics that deals with *newborns.* Still, he's put himself out there as a medical expert in these three recent brain death cases we've followed. Jahi was 13 when she suffered irreversible anoxic brain damage. Aden was 20, actually a young adult. Israel was 2. Not a
      "newborn" in the batch.

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    8. Also, I see from the hospital's legal filing, that "dr" Byrne already has no license or certification to practice medicine in California.

      Delete
    9. Right. So, the only way he can really "help" the family get the "treatment" that they, and he, desire for Israel is by doing the same thing he did in the Aden Hailu case...trying to recruit a volunteer from his brain death denial/organ harvesting conspiracy crowd who *is* licensed to practice in the state to assume responsibility for Israel's care. (He actually never *did* find anyone in Nevada for Aden, not that it would have made a difference anyhow).

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  37. OMG. They could all be enrolled in clinical trials��
    http://www.dailymail.co.uk/sciencetech/article-3553644/Could-death-soon-REVERSIBLE-Reanimation-firm-looking-ways-bring-brain-dead-people-life.html

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    1. Do any of us need to even read the article to know the truth? Its fake/a scam/set up by brain death deniers. It won't ever work because it can't, it is physically impossible. But lets suspend disbelief for a second and say that you can restore brain cells- great except a person doesn't exist in the cells but rather Between them- out thoughts memoties etc are made up of electrical patterns sendung messages from cell to cell. If you somehow bring thr cell back, you have not recreated the electrical pattetns in the brain what so ever. It won't be the perdon whose brain died, as that person ceased to exist the moment the electrical impulses did. That is not a theory, it is Fact. This article? This "trial"? Its a load of crap from deniers or scam artists, nothing more, nothing less.
      Connor

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    2. I have to wonder if this group will try to promote the "success" of their "innovative treatments" in the same way that the IBRF does.

      IMHO, the "treatments" used by the IBRF don't really produce miraculous results, because their subjects/patients aren't *truly* brain-dead. As we've often noticed, both the media and the general public often use the term "brain dead" to describe just about any type of neurological impairment, whether temporary or permanent, that renders a person unconscious and/or apparently unresponsive to most stimuli. So, when a person who's been in a coma or persistent vegetative state for a long period of time occasionally recovers, either spontaneously or as the result of a new treatment, we hear the story as if they'd come back to life...when, in fact, they weren't really dead in the first place.

      Delete
    3. I saw that link. You'll notice I haven't commented on it - that's because I was waiting for my article on The Daily Beast to be published.

      So without further ado: http://www.thedailybeast.com/articles/2016/05/12/what-if-brain-death-could-be-reversed.html

      Delete
  38. Hey Doc. Big fan of your blog. I recently ran across this article regarding a company experimenting with reversing brain death (http://www.morningnewsusa.com/biotech-company-initiate-brain-death-reversal-project-real-2376136.html). I was curious of your take on the matter both as a scientist and as a medical professional who is expected to adhere to a set of strict ethical standards. I'm currently in veterinary school and have major interests in both surgery and ethics and again I would love your input in whatever form it may take as your opinions and stories regularly touch on my two favorite subjects. Best, DoggieDocBastard-in-training.

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    Replies
    1. Interesting link, although I find it hard to take a site seriously when the first bit of click-bait at the bottom is "Women wearing bikinis washing cars in freezing weather".

      I'm not a medic but I believe that brain-death is generally caused by oxygen starvation of the nerve cells in the brain (e.g. due to blood loss or lack of breathing). Nerve cells are very intolerant of this and die off very fast without a good oxygen supply. If that's the case then how could they be brought back? Clearly, "nerve stimulation, peptide injection and laser treatment" cannot resurrect dead cells. You would therefore be reliant on some cells surviving and the treatment provoking those into dividing and re-ordering in a way that would establish the lost brain function.

      I can't imagine those treatments achieving the above but if you could then you might get a viable organism as a result. However, you would essentially have grown a new brain so the previous person (as in personality) would most likely be gone and you would have created, at the very best, a baby in an adult body.

      It doesn't sound like the greatest of plans to me.

      Ugi

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    2. See above. And also see this: http://www.thedailybeast.com/articles/2016/05/12/what-if-brain-death-could-be-reversed.html

      Delete
    3. Great article, Doc. I totally agree with your suggestion of using this type of research towards the goal of *repairing* damaged portions of the brain, to assist *live* patients who have suffered a stroke or other brain injury that has left them with physical disabilities.

      In contrast, the Bioquark stated goal,
      "the eventual reversal of death in our lifetime," is beyond bizarre. I can't even imagine how society on earth could continue to function if no one ever died!

      Delete
  39. Prof. Pope shares an interesting observation about the information that Kaiser presented, related to the hospital's having previously informed both Israel's parents and Child Protective Services about the risks to his health posed by failure to follow medical recommendations. He states:

    "This is notable, because many brain death cases (including the leading Dority case in California) that have gone to court have involved parents who abused the child and caused the brain death. Consequently, their opposition to withdrawing physiological support is often motivated by the desire to avoid elevated criminal charges."

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    Replies
    1. or more subtly, may involve avoiding feelings of personal responsibility.

      Delete
  40. I'm finding a little time this evening to catch up on *thoroughly* reading some of the court documents I've skimmed over during the past week, and noticed something I'd missed earlier.

    One of the news articles I read last week mentioned that Israel's mother had reached out to the hospital in NJ that had accepted Jahi, but that hospital had not agreed to accept the transfer. (That would be St. Peter's in New Brunswick, though it wasn't mentioned by name).

    The opposition filing by Kaiser doesn't mention that, but does mention *another* hospital to which the family was trying to arrange transfer...Sacred Heart Medical Center in Spokane, Washington. This hospital refused to admit Israel, so that's why the family asked for another time extension on continued care at Kaiser. No mention as to why the family believed Sacred Heart would be more amenable to treating Israel. Maybe Paul Byrne was trying to "recruit" a doctor there, and the plan fell through? Far as we know, WA doesn't have the "religious objection to DDNC" policy like NJ.

    Another item of interest (but no big surprise) is the filing of a declaration by Dr. Shewmon. His statement doesn't say anything specific about the case, just that he's triple-certified, has done lots of research on brain death, so would be willing to lend his expertise and give testimony if called to do so.

    ReplyDelete
  41. Back again, and empathizing with Doc's marathon reading session of more than 100 useless antivax articles.

    A footnote in one of the plaintiff's submissions states that her team has submitted the declarations of three doctors to the court supporting their position, but the declarations aren't attached, and aren't posted separately with the other stuff on Prof. Pope's site. The other two doctors, besides Dr. Byrne (whose declaration we *did* see posted) are:

    Dr. Thomas Zabiega. The only doctor I can find online by that name is indeed a neurologist, but he is based in northwest Indiana, and is affiliated with a few hospitals there, and in the Chicago area.

    Dr. Peter Mathews. He's affiliated with Kaiser Roseville, but he's an orthopedic surgeon. Seems odd that he would be submitting a declaration on a matter that was not only outside his area of expertise, but contradicting the position of the *qualified* professional colleagues on his own hospital's staff.

    Another odd finding was the filing of a petition by Jonee Fonseca, asking that the court appoint her as guardian ad litem for Israel. Odd to me, because the law generally assumes that a minor child's parent *is* already the legal guardian and "next friend" for legal purposes...unless for whatever reason, there's some question as to that parent's legal custody rights. Guardian ad litem is generally used to appoint someone *other* than a bio parent as the child's guardian, if the court has reason to believe that the presumptive guardian can't or won't act in the child's best interests. Makes me wonder what's *really* going on with CPS being involved in the family situation. Then again, maybe it's just a pre-emptive move by the attorneys, since Kaiser has made mention of the fact that they'd included CPS in the warnings regarding failure to follow medical advice.

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  42. So Doc Bastard, (it's still so weird for me to type that & not end up getting banned from a site...), WILL YOU PLEASE HELP US OUT HERE?! In your opinion as a trauma surgeon, someone who knows death is inevitable for all of us in the end, but beats it back frequently in your work, What Is Your Solution To This Brain Death Problem?

    I don't know if you're American, but let's assume that you are. If you were appointed Surgeon General & the president granted you the power to set parameters to resolve this on a national level, What Would You Do, DB?

    At the end of the day, you are scientist with a scalpel who sees life give way to death many times. You're not a neurologist or a neurophysiologist or a fill-in-the-blank in terms of who else needs to be on "the panel" to decide who's dead. But you have written so eloquently about holding a young man's heart in your hands & repairing that heart & still having him die on your table. You know how often people come back after defibrillation in the OR vs. on television. And you know that dead means Game Over, no matter how much anyone wishes it weren't so.

    We all come here & are entertained & greatly informed by your writing, but you rarely give your opinions outside of the essays you post. So what is your solution if you had carte blanche?

    Do you think that a panel of X number of qualified medical specialists should be able to legally define, on a federal level, what brain death means vs. a persistent vegetative state vs. a coma? (And I don't pretend to know the difference between those states beyond the fact that people can & do recover from a coma.)

    We spend astronomical amounts on end-of-life care in America while not providing adequate treatment for people with all kinds of cancers, obesity issues, mental health issues, drug addictions, PTSD from military service, you name it. We spend many thousands of dollars keeping corpses alive without having a free national healthcare system like every other western nation. It's scandalous.

    But maybe, if our legislature asked the right doctors to define brain death, our government could impose a limit on useless expenditures for those who are beyond medical assistance. What say you, DB?

    ReplyDelete
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    1. RC - You've illustrated quite well the exact reason why I haven't gone into politics. If I (by some miracle) were to be named US Surgeon General (hey Mrs. Clinton/Mr. Trump - call me), it would be all I could do to avoid shouting "LOOK, IDIOTS! JUST SHUT UP AND LISTEN TO THE EXPERTS!"

      It still stuns me how people think they can doctor better than doctors. I don't know of any other profession that deals with this to this level.

      Delete
    2. @ RC and Doc - I sometimes wonder if this recent attitude on the part of lots of folks, related to insisting on what many of *us* define as futile medical care at end of life, is actually a *result* of some of the phenomenal progress made in medicine over, say, the last 25 years or so.

      Think back to the old Western movies and TV shows many of us watched as young children. The loser of the gunfight fell to the ground in the middle of the town's main street. A pal rushed to his side, while another ran off to find the town doctor. The mortally wounded gunslinger uttered his last words and took his last breath just as Doc arrived. Doc checked his pulse, got a somber look on his face, and said, "Sorry, he's gone." Next scene was the friends gathered around, placing the box they'd hastily fashioned to hold their comrade's earthly remains into the grave they'd dug. No question that once the heart had stopped beating, the man was dead.

      In real life, I can remember my grandparents having sad conversations about friends or relatives who'd been diagnosed with cancer. Invariably, it was an eventual death sentence, if it was "inoperable" and "there was nothing more that doctors could do." Sad, but accepted.

      Of course, times have changed. There are surgeries and many other types of treatments that can now change the course of illnesses and injuries that were once considered terminal. My own mother had a surgery 13 years ago and has been cancer-free since that time. Still, there are those situations where there really *isn't* "anything more" that will help...in present time.

      Could the problem be that families are wondering if maybe tomorrow, next week, or next month, some *other* new treatment will surface, that *might* offer some new hope?

      This thought was prompted by those recent articles about some new experimental treatments to "reverse brain death" that we saw a few days ago. Sure, those of us who read and comment here aren't looking for instant miracles from this, in terms of brain dead bodies transforming into living, functional, sentient human beings. But maybe some grieving families are hesitant to "give up too soon," in terms of consenting to end somatic support, in the hope that the *next* big medical breakthrough is just beyond the horizon.

      Delete
    3. Scarab -- While I appreciate the incredible advances medical science has made over the past 30 years, I think the problem with these brain death cases is not an overabundance of hope for a breakthrough. It's the fact that Americans are such dumbasses when it comes to science. We have become woefully ignorant about basic biology, the most fundamental of the sciences, during that past few decades -- but I'm not sure why.

      Remember the Hobby Lobby case from 2 years ago? I'm a SCOTUS blog junkie, so I read the transcripts they post. The ruling was shocking enough, but the straight-up negligence on the part of the justices was beyond the pale. Not once did any of the supreme court justices mention the fact that the Greens were WRONG. Medical science has proven that Plan B & IUDs are NOT abortifacients.

      The Green's lawyer argued that they believed Plan B & the IUD cause abortions, so they refused to cover those birth control methods under Hobby Lobby's health insurance plan. BUT THEY WERE WRONG! Yet the 9 people who are supposed to be the smartest, most competent judges in the nation never pointed out that the Green's belief about how a particular drug or device worked was wrong, so their claim was based on a fallacy. That's like suing someone for stealing your unicorn -- you can't, they don't exist.

      But now we've got a legal precedent that lets businesses deny their female employees coverage for Plan B, which PREVENTS unwanted pregnancy after rape, a broken condom or unsafe sex. All because nobody seems to understand basic science anymore. A woman isn't pregnant unless & until the fertilized egg implants in the uterine wall (excluding ectopic pregnancies, but that embryo can't survive anyway). And brain dead means game over, nobody can recover from that. The public should have a good enough grasp of biology to know this stuff, or at least believe the doctor when he/she tells them the bad news.

      Delete
    4. RC, I personally agree with you. But I don't know if some of these confounding (again, IMHO, others may disagree)opinions regarding "life" are due just to sheer ignorance or denial of scientific fact, or a misguided reaction to the politics and philosophy associated with the "right to life" movement. Human reproduction is a *whole* 'nother area of bioethical debate that's just as bizarre as brain death.

      In addition to the legal ruling you cited, another issue that totally confounds me is the dilemma posed by the huge stockpile of excess frozen embryos that currently remains in cryostorage indefinitely, since there's been no legal and political consensus regarding their disposal. The right-to-life advocates view them as potential children, who deserve a chance to be born, so want to see them all "adopted" instead of "murdered." IMHO, these are not "children waiting to be born," but biological material, since, as you've stated, there's not even a pregnancy, much less a "life," until and unless the embryo successfully implants in the uterine wall and begins to grow. We should all *know* this, but still the debate continues.

      Delete
  43. Teachers deal with the same thing. Schlubs who barely graduated from high school think they're qualified to "home school" their kids, even all the way through the 12th grade in some cases. Never understood how that can be legal when anyone applying for a teaching position at a public school has to have at least a BA/BS.

    ReplyDelete
    Replies
    1. most of the trades I have participated in have their people who don't get it but think they do. come to think of it, it's pretty likely the others I just didn't stay in long enough.

      Delete
  44. About 10 years ago, the Terri Schiavo case was front and center. She wasn't brain dead but had been in a permanent vegetative state for about 15 years. Her husband wanted to remove the feeding tube and let her go. Much sound and fury, and intervention by politicians, ensued. It made me realized that modern medical technology can resuscitate people who have drowned, or hit their heads and passed out with no breathing, or whatever other traumatic event. But if the victim has been without oxygen for more than a few minutes, the brain is severely damaged and just isn't coming back. I was on a forum at the time where a majority of the people believed that life, any life no matter how compromised, needed to be preserved. I patiently explained brain structure and function and what happens when oxygen is cut off for a period of time, and that brain tissue isn't going to regenerate. What you see is what you get. I was eventually banned. Meh.

    Anyway - fast forward to the brain dead cases. So many people just don't seem to understand that brain death is death. That brain isn't going to "heal." There isn't going to be a miraculous restoration of the brain and the dead loved one isn't going to arise from the death bed and throw off the ventilator.

    The bottom line for me is just because you can do a thing (resuscitate a victim who has been without O2 for more than a few minutes) doesn't mean you should do a thing. How many dead people on ventilators will New Jersey accept? How much court time will be taken up by families who can't let go? So many seem to believe that if the chest is going up and now (um, ventilator?) and the heart is beating, that person is alive. They cannot be convinced that their loved one's brain is gone and the person isn't coming back.

    I know I'm kind of all over the place here, but I'm really disturbed by these cases, especially of children, where the parents have Facebook pages and GoFundMe's for cash to take care of a dead child. Why do judges allow people with actual death certificates (Jahi) to be kept on somatic support indefinitely? Who's paying for that (look in the mirror)? That money could be used to help people who could actually benefit from help.

    It's all so tragic.

    ReplyDelete
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    1. Even Shewmon admits the person is never going to recover, even if he defines them as not-dead until the heart stops beating.

      it's only snake oil salesmen like "dr" byrne who claim they can get better.

      Delete
    2. I just can't imagine keeping a body on support until something gives out. It's just gruesome.

      In other news, I see a judge has given little Israel's family another week to find someplace to take him.

      Delete
    3. i've just come back to the site after a while off.

      I do not know all the facts in the Stinson case, the imaging studies and the apnea test, but I have to tell you I just saw the videos and that definitely does not look like brain death to me.
      The child appears to be having some response to mother's touch and possibly to her voice. That is not brain death. There must be no response to those stimuli- altho one can occasionally get a spinal reflex. I will admit it can be difficult to tell but that does not look like a spinal reflex to me. I saw someone say that his brain flow study was almost negative. Almost negative si not negative- you either live on the beach or you live near the beach.
      Every good brain death expert will tell you that there are two situations where you must be extra cautious- young children and hypoxemia injury, especially the combination of the two.

      That young boy looks severely brain damaged to me but absent some pretty convincing imaging and apnea testing, he does not look brain dead.
      Cory Franklin

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    4. Welcome back, Dr. Franklin.

      I think the key here is that we *don't* have the information. He's apparently been declared brain dead by three separate physicians who have all examined him, which you and I have not. As you know (but others here may not), a brain flow study is not necessary to declare brain death.

      I have to believe the physicians who examined him did a thorough job. I absolutely agree that young children's brains have more plasticity and that great care must be taken to confirm the diagnosis.

      Delete
  45. Doc:
    What you say is true.
    But the "three physician" fact can b taken two ways - it is either strong evidence that the facts support the diagnosis or it is the "echo chamber" effect. The first guy doesn't want to contradict the second and the third doesn't want to contradict the first two.
    And yes, while a brain flow study is not necessary to diagnose brain death, the point is it can be used as a test against brain death. Absent brain flow is compatible- evidence of brain flow is evidence against brain death. If it is true there is evidence of brain flow, even a little, I don' know that there is, but if so, that militates against brain death at the present time, especially in a child. Again overwhelming brain damage, imminent vegetative state- may progress to brain death but not brain death currently.
    Like I say those movements would bother me, unless all the other evidence was overwhelming.
    Cory F.

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    1. Agreed. I haven't seen the report of the "almost negative" brain flow study. There's obviously no such thing - it's either negative or not negative.

      So just like with Ms. McMath, we wait for evidence.

      Delete
    2. Starting on page 16 of the court reporter's transcript is the testimony of Israel Stinson's attending physician at Kaiser Roseville. He gives a very detailed account of Israel's treatment including all of the neurological tests and their outcomes. His testimony can provide a fuller understanding of the circumstances.

      http://thaddeuspope.com/images/Stinson_v_UC_Davis_Placer_Cty_docs_.pdf

      Delete
    3. Thank you for that, Anon. That answers most of my questions.

      Dr. Franklin - According to Israel's paediatric intensivist, he first failed an apnoea test at UC Davis and both a CT scan and MRI showed brain stem herniation. Once he was transferred, he failed two subsequent apnoea tests 36 hours apart (CO2 rose to 85 and 90) and a brain flow scan, which was negative (not "partially negative").

      That is pretty definitive for me. I'd appreciate your thoughts.

      Delete
    4. What would've caused the brain stem herniation? Also I read one article that said his gastrointestinal system wasn't functioning. Now in Jahi McMath her GI system must be working since she is on G-Tube feeds.
      So sad this all is.
      Mary

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    5. The brainstem herniation was caused by swelling, which was in turn caused by a lack of oxygen due to the 40-minute resuscitation.

      Delete
  46. I reviewed the document.
    With the data I saw presented in the testimony, I would consider that adequate for the diagnosis of brain death.
    Cory F.

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    1. I had not seen this document or known of the confirmation of brain stem herniation. I agree completely with your point on the plasticity of children's brains; this makes declaration and confirmation of brain death in this population significantly more difficult than for adults. A 40min resuscitation is truly not excessive, I have experienced some lasting for hours or even started after extended/unknown periods of pulselessness. A brain stem herniation is a game-changer - this is brain death. Tragic, heartbreaking, preventable brain death.

      Delete
  47. Professor Pope also posted the decision by the federal judge denying plaintiff's request for a preliminary injunction. Within that text is further clarification from Dr. Myette regarding Ms. Fonseca's perception that Israel takes breaths on his own and moves in response to her voice and touch:

    Dr. Michael Myette, M.D. is the Medical Director for the Pediatric Intensive Care Unit at Kaiser in Roseville, the doctor ultimately responsible for Israel’s care, and a defendant in this action. He explains his understanding of Israel’s condition in basic terms: “Israel’s brain is not telling his organs how to function.” Myette Decl. ¶ 5. This means doctors must meticulously monitor and support his condition by adjusting his blood pressure and hormone levels pharmaceutically, providing support with a ventilator, and keeping his body warm with blankets. Id. ¶¶ 5–7. He is receiving only dextrose—sugar—for nutrition, but has not lost weight over the three to four weeks since he was admitted. Id. ¶ 9. Dr. Myette worries that if he fed Israel internally, complications would likely arise, including infection, which would be difficult to
    detect and combat. Id. ¶ 8. Israel does not respond to any stimulus. Id. ¶¶ 10, 12. Dr. Myette
    opines that although Ms. Fonseca believes Israel has taken breaths on his own, this is a
    misreading of the ventilator, which can be artificially triggered. Id. ¶ 14. The movements Israel makes in response to his mother’s touch or voice are reflexes that originate in his spine; they also are triggered by more innocuous and lighter contact, for example, a bump on the side of his bed.
    Id. ¶¶ 10–12.

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  48. Clinically how do we distinguish movements which are spinal from those that are higher in nature.
    If these were responses to pain, say, we would not say they were spinal, so what is the distinguishing characteristic?
    Cory F.

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    1. I'd say reproducibility. That's why I find these videos so suspect, the same as I did with Jahi. We can't tell if these movements are actually in response to noxious or auditory stimuli, nor do we know if the responses are reproducible. With a negative brain flow scan and three separate failed apnoea tests and a CT scan and MRI which both show transtentorial herniation, the diagnosis is pretty clear in my mind.

      Videos can more easily be faked and/or selectively edited than any one of those tests, let alone all them.

      Delete
    2. From my non-medical perspective, I also find it significant that we've not seen any videos of either Jahi or Israel that include any "responsiveness" that involves an apparent attempt to open their eyes, move mouth, or even turn head in the direction of someone speaking. All we see are occasional movements of the extremities.

      Far as we know, neither of these children suffered trauma to the spinal cord that would have somehow caused paralysis to everything above the shoulders. If there was truly any bit of cognitive ability left that would result in "responsiveness," why don't we see any movement above the shoulders?

      Delete
  49. With all due respect, this may be oversimplifying a difficult question.

    Yes, the videos can be faked but the patients are moving.
    And movement is bothersome in the diagnosis of brain death. We write them off as spinal reflexes, and in cases like this young boy with the confirmatory evidence, that is probably what they are. I believe he is brain dead.

    But that still doesn't answer the question of how we tell spinal reflexes from higher responses. Reproducibility doesn't seem to be enough by itself. Where are the neurologists to explain this clinical question?

    And I'l tell you why it's important - because look at what's going on around us. The lay public is losing confidence in the diagnosis.
    Some readers and commentators make deride these people as stupid or religious zealots - but that doesn't absolve us as a profession from trying to secure the greatest possible confidence in the diagnosis of brain death. And that means doing a lot of things.

    I didn't have confidence in Stinson until I read the legal papers, and I'm not 100% sure in McMath. And i can pretty much guarantee you there are going to be a lot of nonmedical people who want to know why there is movement and how we know what's spinal and what's not.

    In addition, we have whole new batteries of brain imaging in the last 20 years and they haven't been applied to this diagnosis.
    You're a surgeon -think about that. Diagnostic criteria that are 20, 30, almost 50 years old- we have new imaging studies and we aren't even using them to confirm our diagnoses.
    Makes no sense.

    Stinson and McMath may be brain dead. But that is only a medical diagnosis and one that we should be updating. Death is a legal, religious and social question as well. It is a conceptual issue and if the medical community is acting responsibly, they will recognize and address these public concerns.

    Cory F.

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    1. Your statement,"And I'l tell you why it's important - because look at what's going on around us. The lay public is losing confidence in the diagnosis.
      Some readers and commentators make deride these people as stupid or religious zealots - but that doesn't absolve us as a profession from trying to secure the greatest possible confidence in the diagnosis of brain death. And that means doing a lot of things" really hit home for me.

      For whatever reason, we still see too much confusion, among both the general public and the media, about what "brain death" truly means, as opposed to coma, persistent vegetative state, or any other condition which results in a patient's apparent state of unresponsiveness. As confusing as this might be for some of us who are trying to figure this out *objectively,* I can only imagine how much tougher it must be for the families who are *personally* affected. No one wants to "give up too soon" if there's *any* chance, no matter how remote, that their loved one just *might* recover (if not completely, at least to some degree of personhood and functionality).

      When I reflect on many of the articles and comments on the subject that we've read over the past several years, as well as all of the court documents related to the cases we have followed through the legal system, it sometimes seems as if there's already a political/ethical/societal division between those who "believe" in brain death vs. those who view it as some kind of myth perpetrated by those with a selfish purpose (harvesting organs, freeing up hospital bed space, whatever). While it's important (IMHO) to support an individual's freedom to choose his or her own religion (or not), sexual preference and lifestyle, political affiliation, and such, I don't think we can function as a society if we begin to treat the concept of *death* in this way.

      Delete
    2. the big problem is that rational people are trying to cite reality to debunk fantasy - and the supporters of fantasy have already chosen to ignore reality. last year, Lawyer Dolan presented an MRI of Jahi's brain that was so far gone that it was obvious to people with no medical training that it wasn't healthy, and claimed it was healthy.

      Delete
    3. Ken, it was actually 2014 when Dolan presented that MRI. It would be interesting to see what a current MRI might show.

      I agree with Scarab regarding the lack of response above the spinal cord. Neither Jahi nor Israel has shown any facial movements such as eye opening or grimacing in response to painful stimuli. Any neurologists out there who can explain?

      Delete
  50. So Cory -- If the diagnostic criteria for brain death are out of date, isn't it up to doctors to change those criteria? They stopped using the rabbit test to confirm pregnancy, what, 50 years ago? If a simple brain scan will tell a doctor definitively whether or not there is electrical activity in the brain, why isn't that the criteria for determining brain death?

    The legal definition of death is based on a doctor's medical examination. If laws need to be changed, I've seen enough C-Span to know that when doctors testify before Congress, all the politicians pay attention. The medical profession can get the legal criteria for brain death changed, if they want to. As we speak, doctors from across the country are talking to Congress to change the laws re: prescribing narcotics & dealing with opiate addicts.

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  51. RC:
    You're right.
    Medicine is proactive, the law is reactive.

    There is no reason that we shouldn't reevaluate the brain death criteria with new imaging like the latest PET and MRI. It doesn't necessarily mean we will change clinical criteria, but we may clarify them. The cost argument is specious considering what we are seeing.

    Every diagnosis of death for centuries has been updated, there is no reason not to do that for this area of neurologic death.
    The law will not change overall - it will still be accepted medical standards, they won't demand a PET scan.

    What may change in the law is what should be done once brain death is diagnosed- the law is hesitant to change quickly in that respect though.

    Cory F.

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    1. But Cory, the law is changing as we speak in terms of narcotics -- why isn't it changing in terms of brain death? Now that lots of White kids are getting strung out on heroin because it's cheaper than Oxy & older Whites are overdosing on dope & Rx narcotics (I dunno how to create links here, so... www.nytimes.com/2015/11/03/health/death-rates-rising-for-middle-aged-white-americans-study-finds.html?_r=0 ), the script has been flipped. Which is not a new phenomenon.

      Since the Moynihan report back in the 1960s, the inner city has been the petri dish for America's social ills. Problems are seeded in the ghetto, then the feds & the sociologists study those problems to see what havoc is being wreaked (which is as immoral as using your cellphone to record someone's house burning down). Then, once the pathology starts spreading to the rest of the population, the pols declare an emergency & pass new legislation to rescue the Whitefolks who are suffering from this newly-minted, decades-old "problem".

      Thanks to compassionate doctors, narcotic abuse/addiction is no longer perceived by the Powers That Be as a character flaw the way it was when black & brown folks were the dominate groups getting hooked on opiates & heroin. Now that The Defendant usually looks like the judge's son or the ER doctor's daughter, the legal system says "It's a public health issue -- the poor darlings need rehab, not prison!".

      Yet no one's talking about changing the prison sentences for all the minorities who've been locked up for years for the same narcotics crimes that Joe College gets sent to rehab for now.

      Which is certainly not your fault. My beef is that Doctors Have The Power To Change Our Legal System! with great alacrity, when they focus on convincing the politicians that change is necessary. And it is just as necessary to change the laws regarding brain death as it is to change the laws regarding narcotic addiction. Doctors are the only ones with the clout to put a stop to the madness of the medical maintenance of corpses.

      Delete
  52. RC:
    The answer to your question lies in the nature of the problem.
    Declaring when someone is dead is a medical diagnosis that has legal and ethical implications. The law can only react to what doctors do diagnostically.
    Narcotic abuse is medical/social problem that goes far beyond diagnosis.
    The law has far more influence there than they do in a diagnostic question.
    Cory

    ReplyDelete
  53. Legal updates on Fonseca v.Kaiser are posted on Prof. Pope's site. Plaintiff's request for preliminary injunction was denied.

    Summary:

    http://medicalfutility.blogspot.com/2016/05/us-district-court-rejects-attack-on.html

    Judge Mueller's full ruling here:

    http://thaddeuspope.com/images/Fonseca_v._Kaiser_ED_Cal_05-13-16_Order.pdf

    As we would expect in any ruling, each aspect of Ms. Fonseca's claims is carefully analyzed, and given a thoughtful response. But the summary, IMHO, is in this statement:

    "Although the court agrees Ms. Fonseca has a
    fundamental liberty interest in the care, custody, and control of [her] children, it does not follow that any person, parent or not, has a right to
    demand healthcare be administered to those who
    are not alive in the eyes of the state."

    The order was stayed until Friday (May 20) to allow a week for Ms. Fonseca's appeal, which was filed on the same day as the ruling.

    ReplyDelete
  54. Scarab, her lawyers filed an emergency appeal yesterday:

    http://www.fox8live.com/story/31996878/california-mom-files-appeal-to-keep-child-on-life-support

    From the article:

    They asked the appeals court to order Kaiser to keep the toddler on life support while the judges take more time to consider the case. If they decline, the appeal asks them to at least keep him on life support while the family seeks emergency relief from the U.S. Supreme Court.

    ReplyDelete
    Replies
    1. Thanks for sharing this news. According to the briefing schedule Prof. Pope reports, the first appeal wouldn't end up being resolved before August.

      http://medicalfutility.blogspot.com/2016/05/fonseca-v-kaiser-brain-death-dispute.html

      But besides appealing to the Supreme Court, it seems that the *major* purpose of this new emergency filing is to just buy more time to allow the family to find a placement for Israel in a facility that will accept him.

      http://thaddeuspope.com/images/Fonseca_v_Kaiser_9th_Cir_emergency_motion_May_17,_2016_.pdf

      Apparently they've already arranged for air medical transport, but still haven't found a place to land. As Mom has already learned, this isn't as simple as just selecting a destination in NJ, making a reservation, then getting there. She will first need to find a *doctor* affiliated with a hospital there, who will agree to take Israel as a patient.

      Delete
    2. Scarab, have you seen this story:

      http://www.seattletimes.com/nation-world/more-families-now-challenging-doctors-brain-death-diagnoses/

      From the article:

      Dolan gives families his blueprint for filing restraining orders against hospitals, employing the same road map he used in the Jahi case.


      “I’ve created a set of pleadings that people can use to put the brakes on and go to court so they can have some decision time,” the lawyer said. “I also talk to them about (Jahi’s mother’s) experience, about how this has turned her whole life upside down, and how she’s given up everything.”

      Meanwhile, more than two years after she was declared brain-dead, Jahi remains in a New Jersey apartment, where she is under the care of a nurse and her mother, Nailah Winkfield. Dolan frequently shares Winkfield’s story with the families who call him.

      “I’m not this zealot,” he said. “I actually talk to these people. People need to know what they are getting into.”

      Delete
    3. A few months ago, I saw an ad somewhere online for a law firm (I think it was in GA, not positive) that was promoting its services to those who want to challenge a brain death determination as a "medical error." I was reminded of the many ads we we see in my area, often on late-night TV, from the law firms who encourage viewers to call for a consultation if they believe they're entitled to $ because they took a certain medicine, had a joint replacement surgery, didn't get a big enough settlement offer from their insurance company if they were in an accident, whatever. I wondered at the time if "brain death" might become the newest "specialty" for PI lawyers. Looks like what Prof. Pope calls "the Jahi Mcmath shadow effect" in this article might indeed become a trend in this direction.

      Delete
  55. A story in today's paper about another case by Chris Dolan. Young woman named Anahita Meshkin in California has been in a coma since 2007. Last year doctors at her long term care facility said she was now brain dead. The father hired Dolan. It says 2 doctors from UCSF tested her and she responded to pain so isn't brain dead. The article brings up Jahi and Israel cases. All sad. This woman is 29 years old in come since 2007.
    Mary

    ReplyDelete
    Replies
    1. If it's indeed true that two other doctors approved by the court did medically-acceptable testing that showed she *wasn't* indeed brain dead, it's possible that there *was* either a medical error, or some change in condition. Sad (IMHO) that Anahita's family insists on continuing life support after she's *already* been totally incapacitated for 9 years, but since she's still legally alive, they have that option.

      But that's been the missing piece in all the other recent cases we've followed...families *haven't* been able to find doctors who were properly qualified to present sound medical evidence that the original DDNC was indeed a "medical error."

      Delete
  56. From that Seattle Times:
    "Experts say there is a small but noticeable increase in the number of families fighting brain-death diagnoses since Jahi’s family won the legal right to remove their daughter from UCSF Benioff Children’s Hospital Oakland so she could be taken to a facility in New Jersey, where she now resides on a feeding tube and ventilator.
    “I’m getting calls from people who have a strong feeling that the doctors can’t be trusted and may be seeking to cover something up or put an end to it,”
    That is exactly the point I was trying to make earlier this week.
    The medical community can not stand still on this issue. The need better spokesmen, greater public education and updating of the brain death diagnosis with anatomic, functional, and metabolic imaging.
    Cory F.

    ReplyDelete
    Replies
    1. Agreed. And, perhaps just as important is the fact that there still seems to be a degree of subjectivity/inconsistency in the manner in which a DDNC is *done.* The Meshkin family's situation points to this problem. More info here:

      http://www.mercurynews.com/bay-area-news/ci_29904557/walnut-creek-hospital-mistakenly-diagnoses-moraga-woman-brain

      Though we don't know exactly what tests were performed by the doctors who initially determined that Anahita was brain dead, the fact that two other doctors subsequently found otherwise is a *major* point of concern. These two doctors weren't some known "non-brain-death-believers" recruited by the family and their attorneys to support their legal position. They were independent experts appointed by the court, who personally examined Anahita. After hearing this family's story, it certainly won't be surprising if even *more* families are likely to mistrust a DDNC for a loved one.

      I don't categorically agree with Dolan's statement that "doctors can't be trusted and may be "seeking to cover something up" (bury their mistakes) "or put an end to it" (declare the patient dead so that futile care can be terminated, and/or organ donation can happen). Still, the fact that two different sets of doctors can end up with two different opinions as to whether a patient is medically and legally dead or alive presents a major problem.

      Delete
    2. I respect Dr. Franklin's opinion regarding "updating of the brain death diagnosis with anatomic, functional, and metabolic imaging." but I don't think it would make any difference for the folks who are most inclined to fight the diagnosis. They will still insist that a heartbeat equals life.

      I'm interested in his opinion on what a religious exemption should entail. Should all of the states follow New Jersey's lead and codify into law that a religious exemption means all support measures plus trach & peg tube, etc. must be continued and included in insurance or Medicaid coverage until the heart stops?

      Delete
    3. Maybe some of our readers better versed in the law can jump in here, but if my understanding is correct, the NJ law for "religious objection" to the DDNC does *not* specifically require any *extra* measures besides continuing ventilator support until the heart stops beating on its own. It doesn't specifically require hospitals to perform *other* procedures which would be deemed a futile medical care to a deceased person.

      One fact that often seems to get lost in all the media coverage we've seen on the Jahi McMath case is that Jahi was never declared brain dead in NJ, so her family hasn't, as of yet, actually *utilized* that religious exemption. She was admitted to St. Peter's Hospital as a live patient. When the family needed to remove her from the hospital due to Dr. Fellus having his license revoked, Dr. Alieta Eck became the physician of record, for Medicaid purposes, and she coded Jahi's condition as "severely disabled due to anoxic brain damage" (per court documents we've seen). Because no hospital or doctor in NJ has ever officially declared Jahi dead, and made the decision to terminate somatic support there, the family hasn't actually faced this issue.

      Chris Dolan once said that Jahi remains in NJ because "that's the only place where they can't kill her." But actually, no one there has, as of yet, *tried* to make a case for terminating care.

      Delete
    4. New Jersey's statute doesn't address a situation in which a patient has a legal death certificate from another state. Regardless of whether Jahi was admitted as a "living" patient when she was first transferred to a New Jersey hospital she still had a valid death certificate and was considered legally deceased in CA. We don't really know if Fellus admitted Jahi as a living patient or if St. Peter's, being a Catholic hospital, simply considered it a compassionate transfer regardless of her status.

      Once the family established residency the section in the statute that could render the NJ Medicaid eligibility moot is this one:

      26:6A-7. Obligations of insurance providers unchanged Changes in pre-existing criteria for the declaration of death effectuated by the legal recognition of modern neurological criteria shall not in any manner affect, impair or modify the terms of, or rights or obligations created under, any existing policy of health insurance, life insurance or annuity, or governmental benefits program. No health care practitioner or other health care provider, and no health service plan, insurer, or governmental authority, shall deny coverage or exclude from the benefits of service any individual solely because of that individual's personal religious beliefs regarding the application of neurological criteria for declaring death. L.1991,c.90,s.7.

      Maybe St. Peter's had second thoughts after Jahi because they turned Israel Stinson's parents down. Surely after all of the media coverage the McMath case generated they couldn't have been unaware of Jahi's diagnosis in CA. at the time they accepted her transfer.

      If it were really that simple to bypass out of state death certificates you would think that the Right to Life organizations, with their vast connections, would be able to find a physician somewhere in New Jersey willing to admit Israel into a NJ hospital as a "living" patient.

      Delete
    5. Scarab, I was curious about the timeline of when McMath was in St. Peter's and found that the media ran the story about Fellus losing his license on June 13, 2014 which was a Friday. The story said the court ruled on Wednesday June 11th that Fellus had 30 days to transfer the care of his patients to other doctors.

      The media broke the story regarding Jahi being in a St. Peter's hospital ICU on June 18, 2014 but none of the outlets mentioned how they had acquired that information.

      Dolan, at the time, wouldn't confirm the info but he did cryptically say that Jahi was doing so well that her family might consider moving her out of intensive care.

      In February 2015 the media ran the story about the Winkfield's landlord filing suit to evict them. They reported that court documents revealed the family had moved into their apartment August 15, 2014.

      Obviously, Jahi remained in St. Peter's ICU well after the 30 days the court gave Fellus to transfer his patients. I don't recall, was it ever confirmed that Fellus actually was the doctor that got Jahi admitted into St. Peter's or did we just assume because of the timeline?

      Delete
  57. Professor Pope added new federal court documents. Appendix 1 of the opposition motion contains further testimony from Dr. Myette, Israel's attending physician. He describes that Israel makes one movement only and it is always the same. He describes it as a stereotypical spinal reflex that can be triggered by the slightest motion.

    http://thaddeuspope.com/images/Opposition_05-19-16.pdf

    ReplyDelete
  58. The Ninth Circuit granted plaintiffs their emergency stay. Kaiser must continue Israel's somatic support until the court has time to hear the family's appeal. According to Professor Pope it will be a minimum of two months before anything is decided.

    If the parents fail to find a facility in the additional two months granted they most certainly should lose their appeal which states they must demonstrate that they will likely succeed on the merits.

    Judge Mueller didn't think they would and ruled accordingly.

    The matter may become moot if Dr. Myette was correct in his assumption:

    Israel’s heart rate does not increase in response to stimulation. His heart rate and
    blood pressure increase and decrease as a result of medical intervention with drugs and hormones.
    His heart rate and blood pressure increase and decrease throughout the day. Israel’s heart rate
    dropped to 70 beats per minute on May 5, 2016. A child of Israel’s age typically has a heart rate of
    110 to 120 beats per minute. Unfortunately, we are approaching the maximum effective dosage of
    beta-stimulating medications.

    http://www.kcra.com/news/local-news/news-sacramento/court-grants-more-time-on-life-support-for-roseville-boy/39647588

    ReplyDelete
  59. here is another brain death story that will make you feel a little better. it might trigger your allergies, though.

    http://www.oregonlive.com/living/index.ssf/2016/05/a_childs_spirit_lives_on.html

    this is what Jahi's and Israel's legacy COULD have been.

    ReplyDelete
  60. What incredibly generous parents... thanks for that link, Ken. I can't believe the tiny little organs of a child less than 2 yrs. old can be successfully transplanted into a 70-odd yr-old woman & a 20-yr-old man. (I thought you couldn't get on the transplant list if you were older than 70! I think that's an extravagant waste of resources, but maybe that's just me...) I suppose even if the parents relented tomorrow, Jahi & Israel's organs are too degraded now to be of any use to anyone else.

    I really do think the crux of the issue is that the heartbeat keeps the parents hanging on. Every mother remembers hearing her child's heartbeat for the first time in the doctor's office, the definitive proof of her pregnancy. And that heartbeat is visible right there on the monitor in Israel's room. There's no imaging system there to show her his lack of brain activity.

    Perhaps the drugs will finally stop working & his heart will stop & this madness will end. But I'm curious if the judge will let Kaiser pull the plug if Israel's mom can't find another facility to take him. Nobody ever talks about the money in these cases, but at some point, even that hospital in Jersey won't be able to keep maintaining dead bodies for free. I can think of much better uses for my tax dollars.

    ReplyDelete
    Replies
    1. I've been curious about the end here, too. Since Jahi, it seems no judge wants to be the one who actually says "He's gone, turn off the vent." I can't blame them, in a way, but it's getting ridiculous. Doctors are going to be afraid to put people on a vent if it requires months in court to get them off.

      Delete
  61. RC, I totally agree with the heartbeat dynamic.
    For the many thousands of years that humankind has been in existence, up until very recent times, the the presence of a heartbeat, or lack thereof, was the conclusive factor in determining the difference between life and death.

    In case you've not already seen this, here's the link to an article by our own SFTTB reader and contributor, Dr. Cory Franklin, which addresses this.

    http://www.sfchronicle.com/opinion/letterstoeditor/article/Jahi-McMath-s-tell-tale-heart-could-change-6420669.php

    ReplyDelete
  62. Doc B and Dr. Franklin, I'd like your thoughts on this:

    Prof. Pope has reported another current case in Virginia. In his blog post about the case (Lawson v. VCU Medical Center) he says, "Virginia law is relatively unique in the United States in terms of empowering clinicians to refuse life-sustaining treatment they judge inappropriate."

    Nonetheless, the father of this child won a temporary injunction this week that prevents doctors from performing the brain death test at all. The father's argument in the press: "All I'm asking for is for time for my baby to heal.”

    See: http://www.nbc12.com/story/32017097/daughter-chokes-on-popcorn-family-pleas-to-keep-her-on-life-support

    Cory, I respect what you're saying about need for better spokesmen, greater public education and updating of the diagnostic procedures so that families are better equipped to handle brain death situations. How do you propose we address the demands of people who don't want to know?

    It's not an isolated mindset. Israel Stinson's mother posted notes in the hospital threatening legal action against the facility and doctors if they performed brain death tests. The hospital made the decision to conduct the tests despite those threats, before the case went to court. We don't know how many courts might start indulging such demands in TROs, as VA did.

    Prohibiting diagnosis is very different from questioning a diagnosis that was made. As I see it, no hospital should be forced to act as a hotel, and no physician should be forced to act as room service butler by families who bar them from determining the condition of their patient. Not everyone is educable. There has to be a cutoff point.

    ReplyDelete
    Replies
    1. "“The court, the doctors, the parents should decide it – but it should not just be a doctor that decides it," Mirranda's father said"

      This is a huge problem. A) No, the court should have -0- say in medical matters. B) Parents (and patients) should have the right to decide on their healthcare UP TO THE POINT where it prevents doctors from doing their jobs. This is beyond absurd.

      And this is only going to continue getting worse until, as Dr. Franklin said, the medical authority groups step in and say "Enough is fucking enough." They probably won't say it exactly that way, but that's why I'm not head of the WHO.

      Delete
    2. "any life and death decision should be made by a committee, no less than two thirds of them having no medical knowledge to speak of"

      no, the court recognizes the existence of experts, it should recognize the difference between a doctor and a distraught (of grifting) mother.

      Delete
    3. I totally agree that a court decision that would prohibit medical staff from conducting certain tests would be a big step in the wrong direction. When we go into the hospital (or admit a family member) the expectation is that the medical staff will do whatever is needed to diagnose the problem and treat it accordingly. If we (lay people) had all of the information, knowledge, and technology to do this ourselves, we wouldn't *be* in the hospital in the first place.

      What Mirranda's father apparently *not* considering is the fact that "testing for brain death" isn't necessarily a rush to judgment to hasten her death sentence. These tests might also help determine the actual extent of brain damage, whether or not it's permanent or there's a chance of some recovery, and lead towards the development of a realistic treatment plan. He says he "just wants to give her a chance to heal." Problem is, until testing is done to help better determine her actual condition, he's not doing *that* either.

      Delete
  63. I think it would be a big mistake to allow the courts to intervene in allowing the tests for brain death.
    Let's take as a granted that people and surrogates can refuse certain tests in certain situations.
    This is where the courts will have to come down on the side of public policy and not intervene when doctors want to perform the tests in comatose patients.
    We then come back to the issue of what to do if the tests are performed correctly. That's currently a big sticking point.
    But I think there the medical community has to revisit our diagnosis, we have to discuss with the legal and bioethics community what the diagnosis means, we have to work with the legal community in acceptable procedures once brain death is diagnosed, and we have to educate the public.
    We have been slow to do these things in the past 20 years.
    In a sense the McMath case, and the ones subsequent to it have demonstrated the growing disconnect that we are at least in part responsible for.
    Cory F.

    ReplyDelete
  64. Dr. Cory and DocB, what do you make of the independent brain death report in the Anahita Meshkin case? It is attached in the link:

    https://www.scribd.com/doc/312968084/Anahita-Meshkin-brain-death-report

    It seems as though they couldn't be sure whether the one response was spinally mediated or the result of residual brain stem or cortical function so they wanted to err on the side of caution. That just might explain the discrepancy between their exam and the one by John Muir's doctors since she failed all other aspects of the clinical exam.

    Might some ancillary brain imaging be useful here?

    ReplyDelete
    Replies
    1. That is a very curious note indeed. 1) All brainstem reflexes (corneal, gag, pupillary response) were absent. 2) They did not perform cold calorics. 3) The response to noxious stimuli, if real, is not brainstem-mediated, yet they state specifically that it may represent residual brainstem (or cortical) activity. As neurologists they should know better.

      First, they should have done an apnoea test. Second, they should have done cold calorics (though this isn't necessarily necessary). Third, response to noxious stimuli is cortically mediated, not brainstem.

      Other tests (EEG, brain flow scan, CT, MRI) are helpful though not necessary for brain death determination. In this case, at least an EEG and brain flow scan should be done if they haven't already, and redone if they have.

      Delete
    2. I wondered about that too. Reading it from a non-professional perspective, it seems to be saying, "Since we saw some response to noxious stimuli, which *might* be an indication of residual brainstem or cortical activity, she doesn't meet the criteria for brain death, so we see no need for further testing."

      If you're not sure *why* you're seeing *what* you're seeing, why wouldn't it make sense to explore further?

      Honestly, I would have expected no more from physicians that were commissioned by the *plaintiffs,* since we'd assume that they'd recruit someone to support *their* position. But it's surprising to see this (IMHO) relatively incomplete examination done by doctors recruited by the *defendants.*

      Still, I find it interesting that Anahitra moves her head in the direction of the uncomfortable stimuli. Interesting to me, anyhow, since we've not seen any videos of either Jahi or Israel actually demonstrating *this* level of possible "responsiveness."

      Delete
  65. Thank you for the evaluation! I couldn't quite make out every word so I figured another doctor would be better at deciphering doctor scribble ;)

    ReplyDelete
  66. There is clearly not evidence for brain death here.
    The deep pain response described sounds like a decortication response (a movie of the response would be useful), which indicates no higher centers but brain stem activity.
    As Dr. B says, there are no cold calorics, there is no apnea test, and thus there is no evidence of whether the brain stem is still functioning (which is suggested by the response to deep pain).
    Brain imaging might clarify here but will not prove brain death. An isoelectric EEG does not say anything about brain stem function, a non visualizing brain flow would not convince me because it is unclear how well it measures brainstem flow.
    CT is an anatomic test. I do not have enough experience with MRI in the diagnosis of brain death (and I am not conversant with the published literature). PET scan is a metabolic test, which everyone needs more experience with.
    Remember, the onus is on the doctors to prove brain death - not the other way around.
    Cory F.

    ReplyDelete
  67. Thanks for weighing in Dr. Franklin. What confuses me is the discrepancy between the diagnosis of John Muir's doctors and the report from the independent neurologists. Of course we don't have the original exam report so it's hard to compare.

    ReplyDelete
  68. According to the family's GFM page, Israel Stinson was transferred out of Kaiser to some undisclosed foreign country.

    See: https://www.gofundme.com/saveisraelstinson

    I wonder how those feedings will work out. The medical declaration submitted this week with the last Kaiser opposition said he has no GI function and hasn't had a bowel movement since he was hospitalized.

    ReplyDelete
    Replies
    1. Once again, we see misidentification of the problem.

      Mom says: "After weeks and weeks of searching, no hospital facility in the United States would accept our son." Well...yeah. You don't just reach out to hospitals to ask about the availability of accommodations, like you'd call hotels to make a reservation before finalizing the travel plans. They needed to find a *doctor* willing to take Israel as a patient, and admit him to the hospital at which s/he has residency privileges.

      Since the state of Ohio wouldn't be a "foreign country" to a California family, that eliminates Paul Byrne. Maybe Dr. Machado agreed to a placement in Cuba?

      Not sure what to think about the feeding routine. According to doctors at Children's Memorial in Oakland, Jahi's GI system had deteriorated so badly that the intestinal tissue was already beginning to slough off before she even left there. Yet nearly 2 1/2 years later, the body is still apparently utilizing both nutrients and meds to some degree. So, while we know that Dr. Byrne's special recipe doesn't have any magical properties in reversing brain death, it may have some value in somatic support of the body.

      Like Jahi's family, it looks like they won't be content with living happily ever after in a place that will give Israel the "care" that they want. The GFM posting also asks for continued support, towards the goal of bringing Israel "home." So, the legal battles will continue.

      Delete
    2. IIRC from the CHO medical reports about Jahi's post brain death condition while she was at CHO, her body had retained at least some gut motility. It sounds as if this child has none.

      The Kaiser critical care physician's updated May 10 medical declaration is on pages 27-31 of this document:

      http://thaddeuspope.com/images/Opposition_05-19-16.pdf

      Of course, if his body succumbs as a result of feedings, we'll probably never know. He'll just have been called home to god. Most likely, the US hospitals will be blamed for killing him by not feeding him sooner.

      Delete
  69. Machado was already involved so it wouldn't be surprising if he admitted Israel into a Cuban facility.

    ReplyDelete
  70. Seems like it could be a bit difficult to get a passport for someone who has been declared clinically dead.

    ReplyDelete
  71. My question (without reading all of the above) is how did he end up on life support? Why didn't the doctor's just let him go? I suppose they wanted to give him every chance at a possible recovery but it seems like 40 minutes without oxygen - why put the poor baby on life support??

    ReplyDelete

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