Many of you know exactly what I mean, but for those of you shaking your head and wondering exactly what the hell I'm talking about, you obviously missed the title. Yes, I'm talking about the article about Jahi McMath in The New Yorker magazine titled "What Does it Mean to Die". In case you haven't read it, click the link, read it, and then come back.
No seriously, go read it. Yeah yeah yeah, I know it's long! JUST READ IT.
If you're anything like me, the first thing you noticed was the pictures. There aren't many, but there is one very-obviously-posed picture of Jahi looking quite bloated though peaceful in her bed covered by an "I believe in Miracles" blanket, her mother leaning in talking to her, her step-father looking on and smiling, and her little sister peering in through the doorway.
Give me a break.
Much more striking than how Jahi looks is the overriding racial overtones that are pervasive throughout. The article starts with this little tidbit from Jahi's mother Nailah in the fourth paragraph:
Is any of this true? I wasn't there, so I can neither prove nor disprove these allegations. However, the procedure was performed at a world-class children's hospital (in a city that has a larger black population than white), not a run-of-the-mill facility or some rural clinic. I obviously can't disprove it, but I find it all but impossible to believe. And of course the doctors and hospital in question cannot defend themselves due to privacy laws.
The article goes on to explain how Nailah failed to understand how Jahi could be pronounced dead even though "her skin was still warm and soft and she occasionally moved her arms, ankles, and hips". This was doubtless explained to the family dozens of times both in the immediate aftermath and in the ensuing four years. I've written about it here multiple times, though I have a strong suspicion they haven't read it. Maybe they should.
Anyway, the article then delves back into thinly veiled racism with this passage:
Probably not surprisingly, Dr. Williams remembers the conversation differently (though her contradiction is not further explained in the article). Unfortunately it gets even worse in the very next paragraph:
Sigh. I nearly put the article down and stopped reading at this point, because the slant was plainly obvious. However, Jahi's story was not about race, it was about a little girl who suffered a horrible post-operative complication and died. It was never about race until they made it about race.
The next portion of the article is a retelling of the legal struggles Nailah went through and how she eventually got Jahi out of California to New Jersey, where she remains to this day. It isn't until over 3000 words later that we finally get into the heart of the issue - what it means to die (you know, the title of the damned article). The author goes into the history of how brain death criteria came into being, and she unfortunately delves into the seemingly true (yet demonstrably false) assumption that brain death was somehow invented in order to facilitate organ transplantation.
It would have taken the author 0.211 seconds (I timed it) to find an article from the Journal of Medical Ethics written by Dr. Calixto Machado (a name that should sound strikingly familiar to anyone who knows Jahi's case and who is mentioned later in the article) in 2007 that directly refutes this point. The title is rather unambiguous: "The concept of brain death did not evolve to benefit organ transplants", and the main point is summarised quite concisely in the introduction:
It is commonly believed that the concept of brain death (BD) evolved to benefit organ transplantation. Nonetheless, a historical approach to this issue will demonstrate that both had an entirely separate origin. Organ transplantation was developed thanks to technical advances in surgery and immunosuppressive treatment. Meanwhile, the BD concept was developed thanks to the development of intensive care techniques.Later the article explains how Jahi has supposedly developed the ability to move her hand and foot in response to verbal commands. This claim is based on a series of videos that have been corroborated by exactly no one, yet they somehow have convinced neurologist Alan Shewmon to declare that she no longer meets brain death criteria. What the article fails to mention is that Jahi had brainstem auditory evoked potentials performed back in September of 2014, which revealed that there was no auditory pathway, making it therefore an anatomic impossibility for her to hear anything. She simply has no neural pathways that can allow her to hear the commands to which she is supposedly responding. This hearkens back to the Terry Shiavo case, where her parents insisted that she could see them and respond to them, but an autopsy later revealed that her visual cortex had been destroyed, rendering her completely blind.
Just like with Jahi, Terri's parents had "video evidence". Just like with Jahi, Terri's parents believed that Terri was interacting with them. And just like with Jahi, Terri's parents were wrong. What you can't see in Jahi's video clips (but can with Terri's) is the presumably hours and hours of footage it took for Nailah to get these cherry-picked video clips. I have no doubt that Nailah saw Jahi twitching her hand and foot and recorded as much footage as she needed to get exactly what she wanted. There is an excellent explanation here about why we have no reason to believe these videos.
However, the part of the article that caused me to groan the most was this:
Of all the things that have never ever happened, this never happened the most.
This article is so ridiculous. I read it yesterday and I kept thinking, Oh, I hope Dr. B writes about this. It was just.....so disjoined and crazy.ReplyDelete
Completely agree, and I'm so glad Dr. B posted -- it helped get my BP down so I was able to finish the article. I can usually keep my emotions in check when reading, but The New Yorker article was a bridge too far for me. In addition to everything else, I found it inexplicable & disingenuous that the author presented as fact that Jahi had a simple/routine tonsillectomy when we all know the surgery she had was far more complex. SMH. I've tried to retain compassion for the family because losing a child is tragic, but I'm quite sad the family is just as . . . out of touch with reality as ever.Delete
So glad I fouund DocB. That article just angered and saddened me. The family is now too invested to let her go.Delete
the most dangerous thing about riding a tiger is getting off.Delete
There is something that is troubling me: DocBastard says he has been "unable to find a single article in a reputable medical journal anywhere in the world that documents an actual brain-dead patient waking up. " in his earlier blog on this. A Google scholar search reveals at least three reputable journals where brain death was shown to be reversible:Delete
Maybe, just maybe, there is room for error in determining brain death
third one (that opened first) by Defina, Calixo Machado, and ex-doctor Jonathan Fellus. not reputable.Delete
second one: if I read it right, it kind of sounds like the patient ultimately died; and never actually woke up. it also sounds like there wasn't as long a wait to retest as recommended, but Doc will know more on that.
first one, testing was NOT done in accordance with UDDA, because the infant had phenobarbitol on board.
so yes, there is room for error - but it is on the diagnosis side, not the recovery side.
The first article is concerning an infant who drowned. You cannot generalise that to this situation or to older children and adults.Delete
The second patient underwent therapeutic hypothermia, lost his cranial nerve reflexes, and regained them transiently before he lost them again. Several confounding factors.
The third is the expected article by the International Brain Injury Foundation Foundation, which includes Calixto Machado (yet again), and ex-doctor Jonathan Fellus, who lost his medical licence for engaging in a sexual relationship with one of his brain injury patients. This does not negate the case report. However, while the report mentions several things the patient was able to do after their miracle protocol, none of these are recognized aspects of brain death determination. What they very notably do NOT mention is regaining of any spontaneous respirations or cranial nerve reflexes.
I will say that the brain is a funny organ, and I am not 100% certain when it comes to the brain. What I am certain about is that central nervous tissue cannot heal or regenerate.
I read that article the other day and was hoping to get your response. I totally agree with you. However, from a patient perspective, it is very hard to know whom to trust. I have had international experts disagree with one another on my own health issues -- with a dismissive tone about the other. That left me feeling unable to trust anyone. The point I am making is that being a doctor or nurse puts you "on the other side." It is a shame that that divide exists, but it does and hurts both sides.ReplyDelete
Dr. B-what are your thoughts about Shewmon's papers & research cited in the article?ReplyDelete
I think Shewmon has gone completely off the rails. He’s demonstrated that quite convincingly by declaring his belief that Jahi is alive based on the uncorroborated videos.Delete
I find it interesting that the article is written to make you think Jahi's grandmother is an RN, when she is actually an LPN.ReplyDelete
The family has been misleading the public from the very beginning.Delete
When I first started reading this article I couldn't believe the New Yorker was actually publishing it. Is this PCness run mad? I know the racism in this country has been and is absolutely foul, but do the McMaths really think that medical people would just let Jahi die? Because she's black? Are they crazy? Is this whole country crazy? Or have people lost faith in health care so drastically? God help us. Doctors and nurses can at times be abrupt or cold, but that is not the norm in my experience, especially when a patient is dying or has died. But the idea that this situation is due to racism just boggles my mind. Maybe because I'm white, but I don't honestly think so.ReplyDelete
I agree with you, Mary. That whole aspect of the article was just mind-boggling to me as well.Delete
I think when people feel like their backs are against the wall or they are grieving, they will accuse anyone of anything in order to get the reaction or outcome they desire.Delete
It’s mind-boggling for sure to me too! I have only had experiences with kind and compassionate doctors... everyone was amazing when my three grandparents died, when I had MRSA and saw many specialists and when I got psoriasis and subsequently psoriatic arthritis.
Maybe everything is all about perception? Like I always look for the good in people and treat people kindly. I don’t go out LOOKING for arguments or to make accusations to satisfy my agenda... and maybe the mother made these accusations to keep the funding coming... she is attracting all sorts of crazy nuts with these comments I am sure.
and of course, the New Yorker doesn't accept comments so we can't point out they eve OPENED with a lie - that it was a routine tonsillectomy.Delete
If all else fails, play the race, gender, religion.sexual preference card or any combination of.Delete
While I don't necessarily think that race played a role in Jahi's case (at least not intentionally; studies have shown, however, that many medical personnel do have unconscious biases, including against people of their own particular group), there is an unfortunate history of Black people being mistreated by the medical profession in the (not-so-) past; the Tuskegee Experiment alone is responsible for a *lot* of the Black community's suspicion re: doctors and medical bureaucracy, and I wish they'd gone into more of this, rather than just nattering away for umpteen pages--that would have given the story more context, at the least.Delete
Even when race/ethnicity is taken out of the equation, there are, unfortunately, too many medical professionals who range from clueless and thoughtless, to incompetent, to sexually harassing, to hostile and potentially life-threatening--people I know personally have dealt with these situations, and I myself have had unpleasant encounters with doctors whose bedside manners, shall we say, were rather lacking. (Doc, of course, is NOT one of these doctors, and I know that the vast majority are good, hard-working people who do their damndest to save lives every day; unfortunately, the Peter Principle applies to every profession, including medicine.)
This isn't at all to say that the doctors in this case behaved that way; I'm mainly trying to explain the background from which some of the Black community's suspicion of doctors, et al. comes from. Did the doctors, nurses, etc. behave in a condescending way, or give the appearance that they were in a hurry to turn out the lights and call it a day, as it were? They themselves aay no, and doubtless honestly believe that; Jahi's family says yes, and doubtless they honestly believe *that*; unfortunately, none of the rest of us were there as impartial witnesses to see what went down, and how. Personally, I doubt that any condescension was intended, but to parents who are convinced that their child isn't actually dead until their heart stops beating, what seems sad but reasonable to the rest of us is going to come across as callous and uncaring; the doctors then think the family just "doesn't get it", or is too ignorant to get it, and around and around and around it goes, with the end result being two slides sniping at each other and a brain-dead teenager slowly degenerating in a New Jersey bedroom...and that last part is the real tragedy here.
on the other side, look at sites which made screen captures of the social media posts mama nails was posting during the whole thing - and you will get an idea of why the staff at the hospital might have been "biased" against them. among other things, bragging about stinking up the waiting room with "stanky crawfish"Delete
Oh, yeah...I'm wondering if a parallel version of "just because you're paranoid doesn't mean they aren't out to get you" is "just because other people think you're an asshole doesn't mean you aren't one." One would think that, if one had even the remotest suspicion that hospital staff were in any way prejudiced against one, the best approach would be to use one's best manners and be firm but exceedingly polite...but one doesn't always think that way, and trust me, this is *universal* behavior, not limited to any one group. If Jahi's family did indeed behave that way, and weren't just blowing smoke on social media, well... *sigh*Delete
reminds me of a car crash I responded on years and years ago. patient was under the delusion the paramedics were trying to kill him.Delete
found out after the fact the car he had totalled belonged to an off duty paramedic who had stopped in another place because he was lying on the roadway - at which point he stole the paramedic's car.
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There's a case management conference this Friday. I will try my best to attend. See Dr. Pope's bog post: http://medicalfutility.blogspot.com/2018/03/jahi-mcmath-major-case-management.htmlReplyDelete
After reading the lies by the Grandmother, she decided to suction herself, she took over where in fact she "could" be blamed for this child's demise. Just listen to Grandma. 1:39 mark. https://www.youtube.com/watch?v=2ZhhTWhlW9cReplyDelete
The article assumes that there is evidence of Jahi's awareness. Well, if there is, we have yet to see it. Hopefully the court will demand to review it, and in the very high likelihood that it does not exist, I hope they put an end to this circus.ReplyDelete
Yes. This,is,ridicoulus just let the poor girl go...peacefully..even if they are able to reverse the ruling it w ont change the outcome...they will let her go when they get their millionsDelete
they will always want a little bit more.Delete
This article is pure rubbish and insulting to its readers. Do they really think that reasonable people will actually believe this? I'm tired of the drain the family continues to place on the court system and public resources.ReplyDelete
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for the record, there was a little white girl in oregon who became brain dead at about the same time Jahi did. she lives on in four donated organ recipients, and her mother has closure.ReplyDelete
Thank you, Ken-Delete
For reaffirming my belief that pockets of sanity still exist in this Country.
But that the child was 'white' is a non-issue, and while "closure" sounds great in theory-in practicality it's relatively rare.
on the contrary - Nailah played the race card, we can only respond.Delete
and yes, the closure is figurative, but knowing she saved four lives is a lot closer to closure than pretending she is still alive.
"We" fail to grasp your point(s).
Nailah's racially divisive accusations against CHO are repulsive-which begets the question, why stoop to her level?
As for "closer to closure?"
I deeply and sincerely hope so-but that's an affirmation only the "white parents" of "the little white girl" can give.
If anybody wants to comment on the The New Yorker article, they can do so on the Facebook page.ReplyDelete
I just can’t believe that the family is going to continue this. They have to know, even subconsciously, that she is gone. She has been gone since the operation.ReplyDelete
It’s just sick and twisted to keep her heart beating and let her body deteriorate further for attention or whatever they’re doing it for.
I just hope someone manages to say no. Let this poor baby rest.
The family is continuing this because they want a big pay day. California law is such that if a patient dies and malpractice is found, there is a $250,000 cap on penalties. If the patient lives, the sky is the limit for payout. There can be payments for care and loss of future income, that kind of thing. It can be millions. Jahi's uncle stated that the $250,000 is "chump change."Delete
I don't for a moment imagine that the conversation took place but if I said to my 12-year-old that a machine kept you alive, I don't think she would imagine I meant the state that Jahi is in - not moving or talking, not thinking or dreaming or even sleeping. Just there in body without any semblance of the person she once was. No child's imagination of "alive" includes that. In fact, neither does mine.ReplyDelete
When this article first came out it included a statement saying that Jahi's mother had a DNR order on her chart. Later, the author had to issue a retraction because that wasn't the case. Nailah said from the beginning that she would only accept Jahi's death if her heart stopped. Apparently even that isn't enough if she wants them to perform a full code. The new benchmark must be only if the code fails to restart her heart.Delete
I’m a little puzzled by that too. No mention of grandma using suction machine on this poor girl; grandma acknowledged that she did so and also comes across almost as a hero in Ms. Aviv’s version of events. So why no mention at all of a fact which may have led to excessive bleeding after a complicated surgery?ReplyDelete
There were supposedly other families in the PIU that saw her mother feeding her a hamburger. If it goes to trial we should find out.Delete
Acute hamburger airway obstruction of course. Happens all the time. Sigh.Delete
G-suc DID talk about taking ut upon herself to suction Jahi instead of using the basin as instructed. there is no confirmation of the haburger rumor, although there were social media posts talking about having Jahi talking and laughing at a time she was not supposed to be vocalizing at all.Delete
There is nothing traumatic about orally suctioning the mouth by using a yankauer suction. Hospitals actually encourage patients to orally suction themselves or with help from their families. As long as you’re not forcefully shoving the yankauer suction down someone’s throat you’re fine.Delete
but not immediately after oral surgery, on a patient who is not supposed to be talking because it will stress the sutures. not to deal with a bleed that you don't want to dislodge any clotting that is starting to happen.Delete
Oral suctioning is not contraindicated even after oral surgery. You wouldn’t want them aspirating their own blood.Delete
apparently you didn't read the link I provided.Delete
let me cite you the relevant parts:
Avoid oral suctioning on patients with recent head and neck surgeries.
Use clean technique for oral suctioning.
Know which patients are at risk for aspiration and are unable to clear secretions because of an impaired cough reflex. Keep supplies readily available at the bedside and ensure suction is functioning in the event oral suctioning is required immediately.
Know appropriate suctioning limits and the risks of applying excessive pressure or inadequate pressure.
Avoid mouth sutures, sensitive tissues, and any tubes located in the mouth or nares.
Avoid stimulating the gag reflex.
Always perform a pre- and post-respiratory assessment to monitor patient for improvement.
Consider other possible causes of respiratory distress, such as pneumothorax, pulmonary edema, or equipment malfunction.
If an abnormal side effect occurs (e.g., increased difficulty in breathing, hypoxia, discomfort, worsening vital signs, or bloody sputum), notify appropriate health care provider.
and again, they did not tell G-suc to suctuion her instead of using the basin they told her to use. they told her to use a basin. abnd G-suc does NOT have the proper certifications to make the decision on her own.Delete
this is why the family is trying very hard to avoid mentioning that they took it upon themselves to suction the surgical site.
Oh, sorry, I apologize. I didn’t know that T&A with UPPP is now considered head and neck surgery. From a textbook written by a couple of RNs.Delete
where do YOU keep YOUR upper airway?Delete
This procedure, and other types of soft palate surgery, targets the back of the roof of your mouth. It involves removing and repositioning excess tissue in the throat to make the airway wider. The surgeon can trim down your soft palate and uvula, remove your tonsils, and reposition some of the muscles of the soft palate. UPPP and other soft palate procedures are the most common type of surgery for sleep apnea. But UPPP alone is unlikely to cure moderate to severe sleep apnea. It may be combined with surgeries that target other sites in the upper airway. "
anon, you there? did you suddenly realize that you were dealing with people who know how to check things?Delete
Today a lot of people have their upper airway up their asses.. I laughed out loud at work a little too hard at your comment..Delete
How can Nailah and her family trust Dr. Rosen when he didn’t even show up to re-assess Jahi’s post-op bleeding prior to her going into cardiac arrest? Rosen never returned to the hospital based on the declarations of both parties. He never returned to the hospital despite getting a call and being informed that Jahi’s condition was deteriorating. Rosen simply delegated his duties and responsibility as a surgeon to the pediatric intensivist in the unit. Where is the trust there? And what kind of surgeon would do such a thing?ReplyDelete
I don’t think anyone is asking them to trust Rosen. He operated on Jahi, and then she died. Whether his care (intra- and post-operative) was adequate or not will never change that, so I would never expect them to trust Rosen. But they also don’t trust any of the other doctors who declared her dead, including the court-appointed independent expert. The only people they seem to trust are the ones telling them what they want to hear - Dolan, Paul Byrne, Bobby Shiavo, etc.Delete
don't forget shewmon, the one who says there is no such thing as brain death.Delete
Rosen stated in his court filings that he wasn't made aware of Jahi's post-op bleeding which didn't start until he had left the hospital.Delete
Plaintiffs made a big deal over Rosen's notation that Jahi's carotid artery was located more toward the center of her throat but didn't tell the nurses who were responsible for her post-op care. They said it meant she had a higher risk of hemorrhaging. Is it possible for an intact artery to spontaneously hemorrhage hours after surgery or would it have to be nicked first during the procedure?
That allegation never made sense to me because if Rosen had nicked an artery during surgery wouldn't it spurt blood?
Jahi’s post-op bleeding started in PACU at 1900 and continued in PICU throughout the night. Her family were able to visit her at 1930. She later coded at 0035. I’m not sure how long it took them to establish an airway but according to the complaint the code lasted 2 hours and 33 minutes. I find it hard to believe that no one called Rosen’s exchange to inform him that Jahi has been bleeding for more than 5 hours postoperatively in PICU.Delete
you mean the family barged in without permission at 1930.Delete
and I find it hard to believe that if her carotid artery blew out then it would have taken her 5 hours to bleed out sufficiently to code.
Ken, if the carotid artery blew out, Jahi would be dead in approximately 2-20 minutes. That would have stopped her heart from pumping on that night.Delete
well, that kind of eliminates that as a significant factor, doesn't it?Delete
On a totally different subject, and one of your other not-so-favorite topics, Doc: Apparently there are actually doctors, nurses, and the like who are rabid anti-vaxxers who not only don't want to get the vaccines they're required to have as a condition of their jobs (such as the flu vaccine), but now have established online communities where they swap suggestions on how best to lie, cheat, and forge their way into being able to claim that they *did* get their shots, when in actuality they *didn't*. Personally, I'm of the opinion that anyone working in medicine with THAT opinion who gets busted deserves to be not only booted out of their jobs, but should be stripped of their medical license as well. If you don't want to actually, you know, *PRACTICE MEDICINE*, why the hell did you go to med school/nursing school, etc.???ReplyDelete
It’s called awareness.Delete
Awareness of what? Do tell.Delete
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Oh I see, Anon. Because of the tragic death of one girl, vaccines are evil despite the millions of deaths they have prevented. Got it. Thanks.Delete
For anyone who didn’t see the comment before I nuked it, it was a google search result, which is Antivaxxer Language for “research”.
DocBastard, do you know when this will end? Is it possible that she could be on the ventilator until her body dies of old age? Or will her body deteriorate and expire eventually from her condition?ReplyDelete
I hope it's over soon, for the sake of her family. For my sake too. Finding out that her family is still hanging on to false hope depresses me. I don't want to imagine the parents caring for her and hoping until the end of their lives.
eventually, something will go wrong and things will come to an end, but I believe the current record for undeath is over a decade.Delete
Here's the kicker, Doc:ReplyDelete
In their filings for the upcoming case management hearing on 16 March, the plaintiffs cite this obviously slanted New Yorker article as evidence that the current guidelines for determination of death may not be appropriate. Their filing says the article "documents the Jahi matter."
They also cite as evidence a Harvard Medical School bioethics conference that won't take place until next month.
The article was extremely biased. No one wins in this situation. The biggest losers are Jahi's siblings. All the attention on the corpse and very, very little on the living.Who is paying Jahi's medical bills? Most likely the taxpayers, again big losers in a very sad situation. We have lived through a loss of a child. It is the most miserable time you can imagine. Not accepting the inevitable doesn't make it any better or easier. When did lawyers and judges start practicing medicine? I thought you had to go to med school and have a lic. to practice. Doing it through the court system is aberrant.ReplyDelete
Jahi's care is being paid for by NJ taxpayers via the state's Medicaid system. This is the epitome of futile care, but NJ has a religious exemption for those who don't believe in the concept of brain death. I'm quite sure the majority of NJ taxpayers aren't aware that this is going on. You're correct that the courts need to stay out of this. Since Jahi's situation came to light in the media, there have been several other brain death cases where families have asked the courts to intervene (see Mirranda Lawson and Israel Stinson, for instance), even filing cases to have death certificates reversed.It's utter madness.Delete
and mama's praise the lawd hallelooyah religious devotion didn't start until after Dolan told her about the religious exemption in Jersey, and all her avid bible reading doesn't seem to interfere with her partying. and she doesn't seem to have come across the "thou shalt not bear false witness" part of her bible, yet.Delete
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No not yetDelete
The article suffers from a severe case of narrativium.ReplyDelete
It is all about a story not the facts of the case. The truth gets barely a passing glance. No mention is made of the fact the doctors chosen by the parents to prove Jahi is still alive also said she was brain dead. If i recall 6 different doctors all said Jahi is brain dead.
No mention made of the grandmother suctioning, or the non compliance of post surgery orders.
This is a sob story about the poor black family being subjucated by the white man.
The words attributed to Jahi did not happen, they were not said.
She would not have understood about ventilators or what they did , she was a child and children do not understand such concepts (unless they are terminally ill or so seriously ill and have been for long enough that they understand what death is and what the various medical procedures are)
The mom is saying these words as if to say my daughter vocalized a living will.
There is also the minimization of what the operation actually was in the media and by mom.
Claiming it to be a simple tonsillectomy when it was anything but thus implying the surgeon botched a simple op.
For the parents to admit the truth would be to ruin their chance of riches galore after all, didn't one of them deride the $250,000 max for a death as pocket change?
This alone shows their intent.
Do not be surprised that should they lose, Jahi would suddenly 'dies' again.
Then there will be book and movie deals.
personally i would remove their other children as it is child abuse to keep them in a home with a dead child being kept 'alive' on 'life support'.
How damaging will it be when the child later learns that she slept in a bed with a corpse?
The first sign of bleeding the doctor/surgeon should have been at bedside and Jahi should have been sent back to OR. That has always been the golden rule in any Post-Tonsillectomy, Adenoidectomy, and UPPP procedures for OSA. The MD only showed up 5 hours later when Jahi went into cardiac arrest. To give you an idea on the management of post-tonsillectomy hemorrhage: http://www.emdocs.net/post-tonsillectomy-hemorrhage/Delete
Yes he should have, assuming he had been notified. If you have information that he was notified of the bleeding but didn’t show up, please share it.Delete
funny how they disappear when presented with evidence or asked for evidence, no?Delete
Of course this is a very sad case, regardless of your view of Jahi's current condition. If she is "alive" she is certainly in a condition which no one would envy. I would personally prefer death.ReplyDelete
Moreover she does not seem to be improving at such a rate that anyone could hope for much more than her current situation.
Like many people, I originally suspected that the mother was "in it for the money." She has been through such an ordeal since 2013 that I am doubting that now. At any rate, any financial award would go first to reimburse Medicaid (the law is very clear about this, and the Medicaid people are energetic about collection) and then to cover other and continuing expenses. Children's Hospital has been very energetic in pursuing their financial interest here (which in their case would be limiting liability) and no one criticizes them for that.
I find Jahi's family personally distasteful, but I am not particularly proud of that reaction. People don't have to appeal to me personally to be admirable anyway. I do not think for an instant that Children's Hospital or its staff, a world-class institution situated in a black majority city, were motivated in any way by racism.
I can only wish, in the interest of all concerned, that the legal process were faster in resolving the legal questions that remain outstanding. I am somewhat surprised that more neurologists are not interested in studying this case. Jahi's long survival seems to present a number of interesting questions, but I suppose the family would oppose anything of that sort. I realize that Dr. Shewmon "declare[s] that Jahi no longer meets brain death criteria," but since he has never examined her I don't take that seriously.
I continue to hope for some prompt resolution.
Shewmon did examine her. He found her to be completely unresponsive, which he explains away as being a normal part of an intermittently minimally conscious state. Or some such nonsense.Delete
That’s why I said “doctor/surgeon.” If you can’t contact ENT then get someone trained in emergency management and ask for help. A pediatric intensivist. House MD. For Pete’s sake, get the ER doc from the emergency room!Delete
So according to Shewmon, responding means you're responsive so you're not dead, not responding means you're still ok, just having a bad day. You're still not dead. I wonder what it would take to get him to decide that someone really is dead.Delete
his official position is if you can get their heart to beat they are not dead.Delete
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Ken - I’ve asked for everyone to remain respectful towards this family, and I’ve asked for that name not to be used. Please respect that.Delete
very well. my point being that they are thinking emotionally, and nuances such as medicaid rules are probably not being pointed out to them.Delete
" I wonder what it would take to get him to decide that someone really is dead."Delete
I think only decapitation would convince him and I'm not saying that in jest. I truly think the man just doesn't believe in it as long as something is circulating and the heart is pumping. Even if it's done by machines.
I wonder if they had a heart, and only a heart connected up to a machine and beating away happily if they would claim the heart is alive and thus so is the previous owner by default?Delete
I feel a lot of sympathy for the family (although I find it difficult/impossible to like them).Delete
Predators and outsiders like this Shewmon, not so much. Most of the outside "experts" who have attached themselves to this narrative have another agenda, usually self-promotion. (I'm looking at you, Bobby Schindler!) Ironically, the same thing happened in the Schiavo case. All sorts of political figures, including then-President Bush, piled on and made various sorts of hay, in that case mostly political, out of a private tragedy. They didn't care about the life of a young woman which had been cut short by a horrible event, leaving only a broken remnant behind, nor about her family. Thank God good sense finally prevailed in that case.
Jahi's mother clearly believes her daughter is still alive. She truly thinks Jahi is "in there" and is trying to get out, to communicate. It is the stuff of nightmares, really.
I am not so convinced.Delete
Nothing much happened at yesterday's case management conference. The judge ordered the parties to meet and confer on a discovery schedule - depositions, exchange of documents, etc. The bifurcation motion hearing next month will be more interesting.ReplyDelete
any mention of allowing a practicing doctor to examine her?Delete
They have already made it clear to defendants that they will not allow an apnea test which rules out a standard brain death exam. Shewmon has already stated that since she would fail any further brain death testing we should just take the family's word for everything. Discovery should be very interesting.Delete
@anonymous at 17:59Delete
What the hell? If they aren't going to permit additional standard examinations, then what are they going to permit? Fortune tellers? Psychics?
Discovery may be interesting but I'm beginning to regard this as an even greater travesty. The judge has no spine, apparently.
It's almost like uneducated people are allowed to practice medicine. Everybody is a doctor these days.Delete
"One of Jahi’s most loyal nurses taped a note to the wall of her bedroom: 'During your shift, interact with her,' she had written. 'She does hear you! Speak clearly, softly, slowly.' She added, 'No one knows if she understands, but just your comforting voice or touch should help.'"ReplyDelete
Of course the self-selection bias is at work here, since a willingness to care for Jahi in the first place implies a lack of knowledge/caring about what brain death means. But this person is a nurse...
If she would fail any brain death death then ipso facto she is brain dead, end of discussion.ReplyDelete
All I can think whenever I read about this case is that if there is anything of this teenager in there, she's trapped in the worst kind of hell. I think what the parents are doing is the worst kind of cruelty. The entire situation is just disgusting and inhumane.ReplyDelete
I honestly doubt i will ever read that magazine again! Back in the early days, uncle Omari said "we won't settle for chump change", when informed of the cap when aReplyDelete
child dies. Why would anyone think for a second that this is about anything but money? Susan, you say you no longer think that the mom would endure her ordeal if it was for money, really? What ordeal? She was a minimum wage (or close to it) uneducated woman raising 4 kids on a shoe-string in a tiny house in a horrible part of town when Jahi died. Don't misunderstand, I know she would rather have never lost her kid...but she turned the loss to financial advantage. Her relatives in Cali and baby daddy takes care of the kids so she can care for Jahi...which she does not do. She has round the clock care. She doesn't have to work, she gets donations we don't even know about, her friend's Facebook shows drunken long party weekends back home, and other places several times a year. Sure she has to live in Nj, but what ordeal? From everything published, she's doing better fnancially, she is globally famous (in a very sick way). The bleeding hearts rainbow and unicorn people keep giving her awards, and if that's not enough....She is still thinking of a multi-million dollar pot of gold at the end. How then is this about anything but money?!? I only hope the judge sees it for what it is and stops it! Jahi is dead, this isn't hurting her, but the siblings suffer, the medical professionals who (IMHO) did all they could but keep getting bashed, the taxpayers, and others who have had family flock to court hoping for the same outcome are suffering. This needs to be over.
“the medical professionals who (IMHO) did all they could.” LOL. Have you ever taken care of a postop bleeding patient in an acute care setting? If not then you are not in a position to formulate any honest opinion.ReplyDelete
have you ever been trying to do something and somebody kept getting in your way? if not, then you cannot judge the medical professionals, because you have not experienced what they were going through in trying to take care of Jahi.Delete
That’s the reason why medical chronology is very important since it leads to the discovery of injury caused by negligence. Look, They’ve already won their malpractice case against Rosen and CHO. The only question left in this case is how much are they willing to compensate Jahi’s family. They will settle. And part of that settlement agreement is that Jahi will continue to be declared “dead” with a death certificate in California. Now, I don’t know about NJ but one thing is for sure, Jahi cannot come back to California, not unless they plan on burying her here.Delete
They’ve won the malpractice case? Really? I must have missed those hearings, as has every other person on this planet. Perhaps you can fill us in on details.Delete
If you mean that the hospital will settle out of court, I have no doubt you are correct. But malpractice has not been proven. Not yet.
how did they win when they've never actually gone to trial?Delete
There will be NO trial. I’m pretty sure that Dolan and Brusavich have done their homework and have done their case analysis. You can talk to any lawyer specializing in medical malpractice and they will tell you that the proving medical negligence in this case would be the easiest part. However, NO lawyer would ever take this case for 250 K. Brusavich knows this so they added a challenge to the UDDA along with the medical malpractice complaint against them. Do the math. If the defendants lose the UDDA challenge, they’ll end up paying in millions anyway, so it makes sense to settle early before trial without the challenge to the UDDA.Delete
The UDDA has to be upheld by law! It was strictly followed and hasn't been proven wrong. 250 will be the cap. The family's lawyers just keep throwing stuff against the wall to see what sticks...and not much has. Remember all the chatter about 'she grew breasts'? Until someone sent family photos taken from facebook at different gatherings showing the breasts were there before she died to Rosen's lawyer. They need to stop!Delete
Not according to Judge Stephen Pulido. It’s now up to a jury to determine whether Jahi is alive.Delete
do the math? there will be no trial = they have not won the case. Dolan has been repeatedly scolded by even the spineless judges who haven't do anything BUT scold him for not doing any homework.Delete
thing is, once this actually becomes a trial, CHO will no longer be under the HIPAA gag order the family has them under, and they will be able to tell their side of the story to the jury. and you can bet they have documentation of everything that went on instead of just hyperbole and innuendo.
I think the public and the media would love to hear their side of the story too. After all, 90% of all medical malpractice cases never goes to trial and are usually settled out of court. Going to trial is like opening a can of worms in public vs bad publicity in proving their negligence, which resulted in the death or injury, of a child. Would they be willing to take that risk? The other issue is the UDDA challenge. Keep in mind it’s now up to a jury to determine whether Jahi is alive. If the jury finds that Jahi no longer fits the criteria for brain death then that’s it. They’ve just opened the floodgate for future brain death lawsuits. I don’t think the medical community would like that. Defendants will settle out of court.Delete
which will open he floodgate for future brain death lawsuits.Delete
keep in mind that if the trial is over whether Jahi is brain dead or not, the defense can reject any juror who is not certified to administer the testing for cause. as to the bleed, they only have to prove that the family interfered with best practices. and as I already explained to another anon, above, suctioning the surgery site is NOT a best practice.
I’m sure that you are board certified in suctioning. But good luck with the trial.Delete
at least I have the experience to understand that the upper airway is in the mouth and throat, so suctioning the mouth and throat is not recommended after upper airway surgery.Delete
How have they won their malpractice suit?ReplyDelete
This comment has been removed by the author.ReplyDelete
Of course the family has not "won" a malpractice lawsuit (or any other lawsuit) because nothing has yet gone to trial, nor has it been settled out of court. I don't know where "Anonymous" is getting his/her information. Anonymous seems to think that he/she is infallible not only on medical issues but on legal issues, including the alleged strategies of all parties, including the final outcome of all settlement negotiations (which have not even taken place yet!). Also he/she can read the future. How enviable!ReplyDelete
Well, reading those comments is certainly entertaining, but I am still faced with the fact that we don't know most of this stuff. My speculations about the mother's motivations are no more (and no less) reliable than anyone else's.
The family will not allow an apnea test because they believe that it has the potential to do Jahi further damage. I know all the Omniscient Medical Authorities assure all of us that this is not true, but I'm not convinced, and I'm sure Jahi's mom, who is a profoundly ignorant person, is also not convinced. Look, I'll stop you from breathing for an extended period of time just to see if you end up fighting desperately for a breath. But it won't do you any harm, right? So no worries!
And anyone who thinks that losing a child in this gruesome, drawn-out way can be compensated by enough money to buy designer shoes and go to parties needs their own head examined. Ask yourself if you'd make that bargain.
These are trashy people who offend me on esthetic grounds. That isn't quite the same as being wrong.
It’s called case analysis. Why do you think Brusavich added the UDDA challenge on top of the lawsuit? To increase the lawsuit’s value from 250k to millions. They are not worried about proving negligence in this case. They already know that. It would be a piece of cake for them to prove that the surgeon was negligent based on the medical chronology alone. Their main strategy now is to try to convince the jury that Jahi no longer meets the criteria for brain death. That’s where all their energies are focused.Delete
Susan - I’ve explained the apnoea test before, but I’ll try again. The patient is pre-oxygenated to increase the amount of oxygen in the blood. The ventilator is then disconnected and oxygen is blown directly into the airway. Carbon dioxide and oxygen levels are monitored. The test is aborted if oxygen saturation drops below normal.Delete
There are potential risks, but they are small. There is a full review by (who else) Calixto Machado here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824942/
Anon: don't forget that if it goes to trial CHO gets to tell their side of the story, which we have not yet hears, because the family is keeping them gagged. all we have been told is the family's own testimony, and THAT doesn't even make a good case for negligence.Delete
They better settle before the jury decides on whether Jahi is alive. The uncertainty is too big and too risky. You don’t want a jury verdict ever.Delete
From day one - this has all been about setting up for a sympathetic jury....Delete
and hopefully the CHO will be aggressive in dismissing jurors who believe parents automatically know about medicine.Delete
I hope so...Delete
The info about the apnea test is reassuring. To me anyway. I don't think this kind of information can reach the parents though. They are invincibly ignorant.Delete
mind like a steel trap: once it is closed on something, you can't get it open again.Delete
Doc, I'm going to disagree with your pronouncement that it "wasn't about race until they made it about race." There have been many studies showing disparity in medical treatment and outcomes based on race. (This is just one meta study https://www.ncbi.nlm.nih.gov/books/NBK220337/ ) Were there racial biases at play that could have contributed to her death? There are certainly studies suggesting it is a possibility. While that could support their malpractice claim, it still doesn't make her any less dead. It also doesn't mean the New Yorker article wasn't rubbish.ReplyDelete
anything is possible, of course, but CHO didn't become the predominant children's hospital in a region where dark skin is not the minority by shortchanging kids with black skin.Delete
I live in the bay area and previously lived in Atlanta. I have seen differences in the way I'm treated medically (and certainly by TSA). Racial diversity doesn't negate the possibility of disparate treatment. We don't know whether conscious or subconscious bias was at play here and likely never will. I suppose the jury will decide. She's still dead though :)Delete
Given that I have heard so much about this family's non-compliance with post op instructions, maybe they shouldn't be playing the race card. After all, patient compliance /adherance is something that is also the basis of studies. Do they want their behavior pointed out as evidence of ethnicity based behavior? There are many factors that contribute to compliance / non-compliance, including race, ethnicity, education, etc. and if they want to bring it up against their providers it's fair game for them to be slapped in the face with that.Delete
Can you explain the family’s non-compliance with post op instructions?Delete
I know I've posted it at least once in this thread.Delete
The one that you poorly misunderstood regarding suctioning which is contraindicated in head injuries or s/p brain surgery due to the elevated ICP. Oh, OK.Delete
no, the one where you apparently keep your upper airway somewhere other than in your mouth and throat.Delete
I will quote the relevant parts. AGAIN.
"Avoid mouth sutures, sensitive tissues, and any tubes located in the mouth or nares."
This procedure, and other types of soft palate surgery, targets the back of the roof of your mouth. It involves removing and repositioning excess tissue in the throat to make the airway wider."
Why would you want to suction the mouth sutures and other sensitive tissue? And can you be more specific on the mode of suctioning that you’re doing?Delete
I wouldn't, but Jahi's grandmother did, instead of using the basin the nurse provided them to catch the blood and gauge the amount of bleeding that was happening.Delete
and then the bleeding got rapidly worse.
Sounds speculative to me. Just because grandma orally suctioned Jahi, it doesn’t mean that grandma was responsible for her cardiac arrest. Speculative evidence is not actually considered evidence. You’ll need more than that.Delete
That's why autopsies are performed. The family didn't want an autopsy. Hmmmmmm. I wonder why.Delete
No need for autopsy. She went into cardiac arrest, suffered cerebral hypoxia, and brain death.Delete
well, they've made sure that any evidence has long since degraded. but if grandma wasn't lying when she bragged about it, then she took it upon herself to deliver medical care she wasn't authorized to deliver against directions from people who were authorized to determine care; and when the hospital is allowed to deliver their evidence, then it will cease being speculative.Delete
and anon 19:45 they'd have to admit she was dead to have an autopsy.
and it is not normal for teenagers to go into cardiac arrest, hence the desire for an autopsy.Delete
You’re right. I agree. It’s not normal for teenagers to go into cardiac arrest after T and A and UPPP. What do you think happened? Why did she go into cardiac arrest more than 5 hours later in PICU after surgery? And why was Jahi in PICU post-operatively, instead of the regular ward? Is it because of the highly trained pediatric intensive care nurses in the unit? What were they expecting? We’re they expecting something to go wrong in PICU that would require immediate life saving intervention? Why did she crash? She looked very healthy to me aside from being obese which means that she probably have more blood volume compared to you and I. And since every additional kilogram (2 pounds) of weight, blood volume goes up by a little over 1% (60 ml, or 2 fluid ounces), we may be able to rule out that Jahi did not go into cardiac arrest due to blood loss. That’s just my opinion. I suspect acute upper airway obstruction.Delete
I suspect her parents barged int PICU without permission, before the observation period was over and she was determined to be ready to be moved to recovery. then, despite being told she was to be silent and calm and communicate only by whiteboard, they had her talking and laughing, and then when that tore sutures out, they took it upon themselves to play with the suction machine instead of using the basin the RN told them to use; which dislodged clots and increased the bleeding. from that point it was a simple cascade failure.Delete
a quick search says a class 4 hemorrage is 40% of the body's blood supply. another quick search says a 150-180 pound person will have 4.7-5.5 liters of blood. JAhi was a bit on the short side compared to the average adult, so I'd estimate her to be around 125 pounds at most. so maybe 4 liters. that means she could only afford to lose about a liter and a half.
At 125 she’d be a model.Delete
average is 85-137. so the question is whether she was short for her age.Delete
Fat not weight!!!Delete
actually, there IS a link between fat and weight. there's also a link between height and weight and muscle mass and weight.Delete
and if Jahi is below average in height, she can still have above average body fat and still be within the average weight range
Don’t quit your day job.Delete
you mean to run a "guess your weight" booth? no worries. the game is rigged. even you could make money at it.Delete
The race thing is a tough call. It has become customary to call every bad result a manifestation of racism if the facts can be made to fit that narrative. That does not make it so.Delete
It is possible of course that Jahi was disadvantaged at Childrens because she is black, but given the whole situation it isn't very likely. It's the kind of charge that is very easy to make and impossible to disprove. I'd like to hear more facts to establish "racism" than simply that Jahi and her family are black (which is all they have so far as I can tell). I don't find that terribly convincing all by itself.
General statistical variances do not translate into certainty in an individual case.
Maybe they realized that they caused her problems by suctioning, and their other interference, so this entire "she's alive" thing is a way to avoid autopsy and criminal charges against Granny.Delete
more to avoid personal guilt, I think.Delete
To: Anonymous24 March 2018 at 20:55ReplyDelete
The family did not heed post-op instructions regarding letting Jahi rest and not use her voice. Several members of the family were disruptive by whooping it up and making her laugh. That surely did not do her any good.
They aren't the first or only parents to wallow in the attention of social media in the wake of a tragedy. Look up Jaxon Buell aka Jaxon Strong. Or Chance Rollan. Parents can be delusional, even if it is a defensive mechanism. In the past, it was understood that parents were emotional, but reality still exists. Now, every person who disagrees with the medical facts has an audience to support and encourage them.ReplyDelete
Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes, and apnoea. ... A patient determined to be brain dead is legally and clinically dead.ReplyDelete
This very definition in itself is faulty in its wording especially the word "irreversible" as it implies knowledge of the future.
Brain death is a legal fiction and refers to patients in an apneic coma whose brain stems have been severely damaged or destroyed. The standard brain death tests are merely assessing the brain stem reflexes.
The professionals who disagree with the diagnosis and definition, which is decades old,often do NOt disagree with allowing these patients to be removed from ventilators and allowed to donate viable organs, only that it should be a pre determined informed choice.
Faulty? No. Central nervous system tissue death is, and always has been, irreversible.Delete
“Apneic coma” does not exist. THAT is fiction. I would ask if you were named Alan Shewmon, but your literary voice doesn’t match his.
it doesn't take a fortuneteller to know that brains don't grow back.Delete
or to know the difference between irreversible cessation of function and temporary cessation of function.
We have a case here of a baby named Alfie Evans who is currently on invasive ventilation life support.ReplyDelete
At birth he appeared healthy but over the first few months he was missing his milestones and was admitted to hospital. Over the months he went into a semi vegetative state, leading to almost constant fitting from light and touch,coma,loss of movement and the degeneration of brain matter, currently a minimum of 70% and climbing.Two key parts of his brain, the Thalamus and Basal Ganglia, had also reduced in size to the point that they had almost gone
The hospital wanted to withdraw life support as it was clear Alfie would never recover and his parents wanted them to continue life support.
It worked its way through the court with the claims he would get better, he wasn't dying, he could live to 20 or 40 , he could go swimming in the pool from his parents, mainly the father and the hospital counter claiming.
The parents went as far as sneaking in a German doctor to examine him and then involving a German hospital and Italian one who would treat him.
They lost their case in the original court case, the appeal court, the supreme court and finally the European court of human rights.
There is currently no diagnosis for what is causing his brain to degenerate and the spaces being filled with fluids, the courts have said it could be named Alfie's disease.
The parents wanted him to fly to Italy where they would intubate him and seek a diagnosis and/or treatment and if that didn't work, flown to Germany for the same thing and if there was no change after 6 months they would let him die.
The father claimed his son would be a hero if he died on the journey!
the courts rightly denied this since he could/would probably die in transit, messily and painfully in a corridor or in the ambulance.
The parents currently want him to be allowed to go home withe basically a full ICU unit and staff etc and let him allowed to die in his own time, even though the parents claim he isn't dying as he is growing and putting on weight, this despite the fact that Alfie remains alive only due to the ventilator.
What the parents want is Alfie being kept alive at home until whenever rather than life support being turned off and Alfie allowed to die peacefully and with dignity.
I wonder, at what point would the parents decide to turn off Alfie's life support?
Would it be when almost all his brain has degenerated?
Would it be when there was almost no brain at all but life support is still keeping him going?
Would it be never as his heart was still beating and he was growing and gaining weight?
Parental instinct, especially maternal instinct is extremely powerful and can and does override common sense and humanity. AS long as the heart beats there could be a miracle.
Including this case we have had 3 cases where the hospitals have asked to turn off life support and the parents objected, Charlie Gard, Isaiah Haastrup and Alfie Evans.
The first two have since died and The death of Alfie is to be decided by the hospital and parents allowing the family to say goodbye
I am missing your words of wisdom and keen insights. Hope all is well with you!ReplyDelete
either he's busy, which means more stories down the road, or he's not busy which means an epidemic of good sense.Delete
Michal Kors, Don Perignon, Cabernet Screaming Eagle, Red Carpet Manicure...ReplyDelete
No way to lose baby! GFM is always there.Delete
We don’t give a flying banana about MICRA!Delete
I'm late, really late, but by God I hope y'all are really watching mama nails and really spreading truth about this family.ReplyDelete
Not sure if anyone else has posted this yet, but on her personal IG page, she put the name and number of the docs that tx Jahi, the number for the PICU, and the number for the ICU for CHO. She instructed her followers to harass them all the time, call them murderers, blow up (figuratively) the whole department. They dutifully obliged and pledged to continue to do so. I'm sickened.
I'm Christian and a republican! I'm pro-choice, pro-euthanasia, and anti-idiocy. This isn't Christian in the least! Her zealots wishing harm on detractors isn't Christian, either!
I can't link it, but I read an interview with mama nails where she stated she "wasn't very religious prior to this." How convenient, right? You weren't religious until it suited you. Then, when you find out about NJ's obscure law, you're Mother Teresa!
I REALLY need a new house! I'd love to set down roots in Houston, or back home in Las Vegas, for my family and I. (No, that's not my husband/kid in the photo. That's my daddy and I circa 1979.) Maybe I should start a GFM? What's my angle?
Also, not a Kors fan, but am a Marc Jacobs fan. I, too, would like freebies from idiots!
This has nothing to do with Jahi, but every time I hear about a BAER test being done (same as the hearing test mentioned hear but replace the potential with response, just an alternative name) I think about how a friend of mine did it with his Dalmatian puppies to make sure they weren't deaf before he sent them off to new homes. I always wonder what a BAER test would look like on me given that I am Deaf.ReplyDelete
so what did that look like? I test pets for deafness by dropping a piece of meat on the floor.Delete
Ok Ken that made me LOLDelete
New court filings posted on the Medical Futility Blog. They are mistakenly marked as being filed on March 6 but the actual documents say April 6. They include Nailah's answers to a list of interrogatories wherein she was asked to admit or deny several questions of fact.ReplyDelete
There were several exhibits, including Jahi's current treating physician Alieta Eck's reason for objecting to an apnea test in which she displays her astounding lack of knowledge regarding the human respiratory system.
It’s not there. Link please.Delete
Look under Medical Malpractice Case (by mother)Top 3 links:DEF Opposition to Bifurcation; Still Declaration in Support Opposition to Bifurcation and DEF Opposition to Shewmon as Expert Witness
They all have the date March 6 but were actually just filed April 6 as per documents
I wonder what would happen if someone filed suits to strip these people's credentials based on lack of comprehension of medical practices.Delete
I let Dr. Pope know that the dates were incorrect. He said he would fix that.Delete
Professor Pope's summary:ReplyDelete
I have pretty much remained out of the latest Jahifest; there are a number of comments I'm not sure are germane. But it's a blog and everyone is entitled to their opinion.ReplyDelete
However, I have just looked at the latest court documents and one thing stands out. If the defendants are to be believed, Jahi's family refuses another brain death examination because she would probably fail. In addition, they are worried about the danger of the apnea test.
1. It would seem they could win the case in a minute if they could demonstrate any purposeful response as they have implied on the videos. Nothing more would be needed. No more testing. The fact that they seem unwilling to do that, speaks volumes.
2. The apnea test is, on rare occasion, dangerous, but this can usually be circumvented and whenever I had a case where the patient was too unstable to continue an apnea test, we would simply place the patient back on the ventilator and use the information as an indication that there was no brain stem activity. in other words if the test was that dangerous, the patient failed the test - indicating insufficient brain stem response. I'm not sure everyone handles it this way but it made sense.
It appears that the plaintiffs are adopting the strategy of challenging the legitimacy of the brain death criteria. It looks like a plan to play for time. I don't understand why they would want to do that - unless they could demonstrate that Jahi does not fulfill the current criteria. Given that they seem unwilling to retest, their strategy doesn't make much sense except as a challenge to the court. Again if she responded, they have proven their case - brain death criteria are insufficient. If they can not present any proof, then there is no gold standard for the court to refer to and I don't see how they can undermine the current criteria.
That's not to say there are not unusual aspects to this case - the prolonged survival, the likely neuroendocrine function - but without something more I think their case is not promising.
I do hope the medical community addresses the complex nature of the case - even the defendants noted in their motion how difficult this case is.
Cory Franklin, M.D.
It’s simple. Brusavich wants to get rid of the apnea test and at the same time try to convince the judge to perform ancillary tests on Jahi in evaluating brain death. SPECT, 4 vessel angiography, or 18 FDG PET scan, they all have limitations. And that is something trial lawyers would love to exploit. If plaintiffs are worried about disconnecting Jahi from the ventilator when performing the apnea test, defendants should counter with a modified apnea test along with a continuous EtCo2 monitoring.Delete
This comment has been removed by the author.Delete
Dr. Franklin: The Israel Stinson case is now before the 9th Circuit. Quoting the brief, "Appellants Jonee Fonseca, Israel’s mother, and Life Legal Defense Foundation (LLDF) are challenging theDelete
constitutional validity of the statutory scheme that they allege led to his death.That scheme, known as the California Uniform Determination of Death Act (CUDDA) offered woefully inadequate safeguards that facilitated the forcible termination of his life support. You can read the entire document here:
Sorry for the weird spacing. That happens when something is pasted into the comments.
I read the case.Delete
Not sure I understand the decision or agree with what I think is the decision is.
It seems that, according to this case, brain death does not automatically mandate termination of mechanical ventilation.
Calling brain death "a scheme" and "a legal fiction" don't seem to make a whole lot of sense practically.
There didn't seem to be an issue about the diagnosis, only what the diagnosis means.
It is not a good sign that the courts are making the issue more, rather than less, confusing.
Is the 9th Circuit creating more problems than it is solving?
Maybe I'm reading it wrong and I would appreciate clarification if that is the case.
I don't think the 9th Circuit has rendered any decision yet. The citation is to the appellant's (the mother's) brief, which of course states the case most favorable to that position.Delete
See Dr Frankin, you are not playing fair by using common sense :)Delete
I read both the appellant's brief and the citation on legal fiction.Delete
The appellant's brief has some unbelievable facts in it -including the fact that when Israel was in Guatemala he was responding. Throws a negative light on the entire document.
The citation on legal fiction, while written in legalese, should give pause to doctors. It may be the avenue these cases take.
Essentially brain death as death is a legal fiction, something the law accepts as true for convenience that is not really true. The author says brain death should require new rules, including continuing ventilation, in certain cases. (It also contradicts Machado on the relationship between the development of brain death and organ transplantation).
If courts adopt that view, as in both the Stinson case and the McMath case, there will be more than a little chaos in the medical community.
Dr. Franklin, have you seen this recent JAMA Viewpoint by Robert Truog regarding Jahi McMath:ReplyDelete
He does an excellent job explaining the tension between biology and the law when it comes to defining what constitutes legal death and why this tension causes confusion in cases of neurological death.
Then the JAMA editorial staff goes and muddles things up by describing the focus of his piece, Making Sense of the Case of Jahi McMath, by describing her as a "physically healthy adolescent in a vegetative state".
After reading Dr. Truog's essay I was dumbfounded by JAMA's confusing description regarding the difference between vegetative state and brain death. You would think they'd know better.
I had not read this piece by Dr. Truog before you mentioned it.ReplyDelete
A long time ago, when I was an active MICU Director, I corresponded with Dr. Truog on "do not resuscitate orders in surgical patients." He is one of the most thoughtful, intelligent physicians in the business.
His article is spot-on. The law and medicine are at a cross roads with cases like Jahi McMath. if I had one quibble with his article I would say that he did not consider the concept of neuroplasticity in patients like Jahi - could the brain form new neural connections over time? I don't know if that's possible in cases like Jahi's but it's an interesting thing to think about.
But I don't want to cavil over a fine commentary.
Medicine is primarily proactive- it must deal with new situations all the time. The law is primarily reactive - it reacts to what has occurred.This case is going to require medicine to ask new questions of brain death and as Dr. Truog states put the onus on the law to deal with the issues this unusual case presents.
I did not look at the description by JAMA about vegetative state versus brain death (paywall), but if it is as you said, it's not a good sign. Yes, you would think they would know better.
Cory Franklin, M.D.
JAMA's description of the piece is viewable when you click on Dr. Truog's name:ReplyDelete
This Viewpoint uses the case of Jahi McGrath, a physically healthy adolescent in a vegetative state since a catastrophic surgical complication in 2013, to discuss the differences between neurologic and legal definitions of brain death and to explain conflicts between families' and physicians’ understandings of prognosis that arise as a result.
By describing Jahi as being in a vegetative state they perpetuate the misconceptions that lie at the heart of the conflicts that arise between families and clinicians.
I agree that it's certainly interesting to think about what might be possible regarding neuroplasticity. I have a thought experiment for you. If it were indeed possible to form new neural connections in a brain that was functionally silent after an anoxic injury such as Jahi suffered, to the extent that consciousness were restored, would the person that emerged be the same as before with the same memories and personality?
We already know that people who have suffered strokes may have to relearn certain functions such as speaking or how to walk depending on which area of the brain was affected. But imagine if brain function was restored sometime after a global ischemic injury. Would that be more akin to rebooting a computer or starting anew like a newborn baby?
Yes, that JAMA comment about vegetative state is depressing. It's hard enough to have the lay press get the distinction right, let alone one of the top medical journals.ReplyDelete
That is a really interesting thought experiment. And it goes to the heart of what is left in the brain when brain death occurs. Science fiction authors, take note.
(I wrote a little bit about Jahi McMath in my just released book
I hope Dr. B doesn't mind the shameless plug)
Superior Court of California County of Alameda
Title: Spears v.Rosen
Case Number: RG15760730
This Tentative Ruling is made by Judge Stephen Pulido.
Counsel for Plaintiffs and Defendants are ORDERED TO APPEAR in Department 517, on April
19, 2018, at 3:00 p.m., on the Motion of Plaintiffs for a Bifurcated Bench Trial to Determine whether the American Association of Neurology and American Academy of Pediatrics Guidelines should be applied to the facts of this case to determine whether Plaintiff Jahi McMath, appearing through her Guardian Ad Litem, Latasha Nailah Spears, meets the definition of "brain death" under H&S Code Â§ 7180 (Uniform Determination of Death Act). See CCP Â§ 1048(b) (court has discretionary authority to order separate trials if to do so will further the interests of convenience,
expedition and/or to avoid prejudice).
Based on the Court's review of the papers filed by Plaintiffs and Defendants and its familiarity with the procedural history of this matter, the Court is not inclined to make the bifurcation order requested by Plaintiffs' counsel. Instead, the Court intends to issue a Trial Setting Order that sets a separate trial on the issue of whether Plaintiff Jahi McMath is a person with the capacity and/or standing to prosecute the First Cause of Action of the First Amended Complaint for Professional
Negligence. See CCP Â§ 367; and Gantman v. United Pacific Ins. Co. (1991) 232 Cal.App.3d 1560, 1566 (real party in interest is the person who has the legally conferred right to pursue the claim); and Blumhorst v. Jewish Family Services of Los Angeles (2005) 126 Cal.App.4th 993, 1001 (real party in
interest is the person with a real interest in the outcome of the adjudication). "Person," as used in the Code of Civil Procedure, is defined by the Legislature in CCP Â§ 17(b)(6). In 1992, the Legislature enacted a provision to add unborn fetuses to the definition of a "person" under the law.
In the contemplated trial, the Court will determine whether Plaintiff Jahi McMath meets the legal definition of "brain death" pursuant to the criteria set forth by the Legislature in H&S Code Â§ 7180. If the Court determines that Plaintiff meets that definition, she will not be entitled to pursue the First Cause of Action for Professional Negligence. Although the issue of whether Plaintiff has the capacity or standing to pursue her claim is ordinarily a legal issue, the Court may not make the required determination as a matter of law if the parties present conflicting evidence regarding Plaintiff's condition. The Court's determination regarding Plaintiff's legal capacity or standing to pursue her medical malpractice claim against Defendants will be based on findings of fact underlying
the issue of law. See People v. Superior Court (2002) 103 Cal.App.4th 409, 433 (jury makes
credibility determinations and resolves underlying disputed factual issues regarding standing).
Can any one with legal experience please decipher this ruling? Correct me if I'm wrong but it sure seems like the judge is willing to let a jury decide whose evidence is more credible without the benefit of an independent medical opinion.
The tragedy continues. What is it, 4 1/2 years now? Nailah and crew have had a lot of time to think up news stories like Jahi wanted to be kept on a ventilator and how the staff at the hospital were racists. As doc pointed out, it's a world class hospital in a city with a lot of black people. I have no doubt that a lot of the staff is black. So they're racists and ignored Jahi because she was black? Dear sweet Jesus, these people need to have their asses kicked. And by "these people" I mean the whole damn crazy family.ReplyDelete
As to the brain death thing - even if a person has a tiny portion of the brain that might still be sorta functioning, is it really a good idea, and in the best interest of the dead or mostly dead patient, to keep him/her on a ventilator and feeding tube? Really? Why? Just because you're warm and metabolizing nutrients doesn't mean you have any idea what the hell is going on around you. Sometimes you just have to make the decision to switch off the machines and say goodbye with dignity.
It might easier for the family to let go, if instead of this issue playing out in the press, the hospital apologized, and offered a large settlement ( the amount of which would have to remain undisclosed) -- right now, imho, it looks like this family has latched onto this as a way of creating meaning for themselves (and perhaps, in their view, for Jahi). The struggle has now become part of their identity, martyrs with a cause -- I witnessed this with clients in personal injury cases.ReplyDelete
They are in the middle of a battle, and as long as they are fighting, they can't see the bigger picture. What do you think will happen once the case is over and the spotlight is gone? It may take a long time, but eventually they'll be left with the realization that Jahi's life has lost meaning.
Jahi's family has never shown any true insight into her situation. I don't believe they are looking for, or creating, meaning. Having been a close observer of this case since the very beginning, I'm don't believe that their motives for keeping her on somatic support are altruistic in the least. Nailah seems to be enjoying her victimhood and the publicity this case has engendered. They will never let go until the bitter end. They are not honoring Jahi's existence or personhood by keeping up this ridiculous charade. Any reasonable parent would have ended this long ago, but Nailah has been spurred on by Dr. Paul Byrne and Bobby Schindler, as well as several others in the so-called pro-life movement (who are mostly anti organ donation, as well), who believe that the concept of brain death is fiction. This case has opened up a huge can of worms and the consequences have included other similar cases being filed, which are wending their way through the courts. I predict this issue will end up before SCOTUS in a few years.Delete
I see the judge has ordered a jury trial for February 2019 to decide whether to believe the family or actual medical experts. He's going to let a lay jury decide whose evidence is more compelling because he lacks the political will to order an independent medical exam which should be the final arbiter when it comes to a dispute of facts.Delete
Where did you see that?Delete
Alameda Superior Court Website. Also tweeted by Professor Pope.Delete
According to the Pray for Jahi McMath Facebook page she had to be hospitalized last night. The administrator just asked for prayers but gave no information regarding why. It would be interesting to know what hospital accepted her and how they handle this after finding out her condition.ReplyDelete
Professor Pope said that Dr. Shewmon stated at the recent Brain Death symposium that Jahi had been hospitalized several times since she's been in New Jersey.ReplyDelete
Stomach infection apparently.ReplyDelete
Are you a member of the Prayers for Jahi page? I was until I got removed yesterday. I had never left a comment until people were speculating on why Jahi was hospitalized. I left a response regarding what Shewmon said at the Harvard brain death conference about Jahi being hospitalized several times and that maybe it was just a routine thing. Someone replied that he couldn't possibly be Jahi's doctor because she wasn't brain dead. I said that he was in fact one of the family's expert witnesses and his presentation at the conference wasn't in support of brain death but just the opposite. For saying that I was removed. Anyway after all that they finally said why she was in the hospital and mentioned the stomach infection.Delete
Anonymous - they're pretty touchy over there. I was one of the ones asking, politely, for an update, as others were, and I was personally slammed for being rude and demanding. I haven't been removed though. You're not missing much. I joined up so I could see gems from granny about Jahi playing the piano and drawing with Sharpies.Delete
I joined just to learn of any updates since the administrator seems to have a connection to the family. No one has posted anything new on the other Facebook page since last November. They're pretty stingy with information and it seems they don't take too kindly to others providing info either. It makes you wonder what's really going on with Jahi. Hopefully the defendants will be able to serve discovery soon. I certainly hope the judge doesn't send this to a jury without requiring a new independent exam to find out her current condition. There's got to be a reason why the family is fighting tooth and nail to prevent that.ReplyDelete
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Heyo all. Has anyone here seen the 1997 film Firelight (written/directed by William Nicholson)?ReplyDelete
Errr ... Yes this *is* vaguely on-topic, I promise.
Just curious what others felt (if the movie moved them at all, that is) when ... well ... when watching the scenes with Charles' wife, Amy.
I just watched the film again and ...just curious.