Jahi McMath: Hospital fights in court to remove brain-dead girl from ventilator

[YankeesPwnMets]

I've known about this story for a few weeks but I'm surprised no one has posted it yet. To add some background, On Dec 9, a girl named Jahi McMath underwent surgery to remove her tonsils and extra tissue to help with sleep problems. She suffered complications from the surgery, went into cardiac arrest and was declared brain dead. The hospital wants to take her off life support, but the family refuses because they insist she is still alive.

 

OAKLAND -- The battle over a brain-dead girl remained in legal limbo Tuesday as a state appellate court judge postponed ruling on whether she should be removed from a ventilator, giving the family a few more days to find a facility that may be able to care for her.

Judge Robert Dondero of the 1st District Court of Appeals asked attorneys to submit updates by 4 p.m. Friday on Jahi McMath's status and her family's attempts to move the 13-year-old girl from Children's Hospital Oakland to a another facility. Dondero acknowledged a Monday ruling by an Alameda County Superior Court to extend an order forcing the hospital to keep Jahi on a ventilator until 5 p.m. Jan. 7.

Children's Hospital Oakland spokesperson Sam Singer, left, speaks to media about the case of 13-year-old Jahi McMath, Monday, Dec. 30, 2013 in Oakland, Calif. (D. Ross Cameron/Bay Area News Group) ( D. ROSS CAMERON )

Attorneys for the hospital submitted a 40-page motion to Dondero late Monday, arguing the family already had ample time to find another facility to take over Jahi's care and that she should be removed from her ventilator.

"Very sadly she's deceased and there's nothing anyone can do to change that status," hospital spokesman Sam Singer said. "We're going to fight in court to see if we can get the right thing to be done, which is to finally find peace for the body."

On Tuesday, Jahi family attorney Christopher Dolan filed a second brief with the appeals court, asking the judge to reverse earlier orders forbidding the hospital from giving Jahi a tracheotomy for breathing and inserting a gastric tube for feeding. However, a judge denied that request later Tuesday.

Hospital officials have refused to perform any medical procedure on Jahi since she was declared brain dead, saying it is unethical to do so. The hospital also will not allow an outside doctor to perform the procedures at Children's Hospital, according to spokesman Sam Singer.

Other facilities have said they will not accept her without the tracheotomy and the feeding tube.

"We want Children's Hospital to help us or get out of the way," Jahi's uncle, Omari Sealey, said.

Jahi suffered complications after a Dec. 9 surgery to remove her tonsils and clear tissue from her nose and throat and was declared brain-dead on Dec. 12. Since then, her family has been battling the hospital to keep her on a ventilator; the fight has garnered national attention and a debate over the medical term "brain death" and whether such persons can recover.

The hospital's attorneys argued in the motion submitted Tuesday that Nailah Winkfield, Jahi's mother, has had enough time to find a facility that would accept her daughter. "No such facility has been identified and it's not plausible that a medical facility will be identified to care for such a person," the hospital contended.

The family's court filings said New Beginnings Community Center in Medford N.Y., is willing to take Jahi and provide 24-hour medical care. The center, founded by a former hair stylist whose father suffered traumatic brain injury after a 2007 motorcycle crash,

The family plans to keep Jahi on the ventilator long enough to have her flown to the New York facility, "an organization that believes in life," according to family attorney Christopher Dolan. The girl's uncle, Omari Sealey, said the family has contracted with an air ambulance to fly her across the country under the watch of a California doctor.

As of Tuesday morning, however, officials at Children's Hospital said they had not heard from the facility's medical staff, a requirement before any transfer could take place. Singer described paperwork submitted by the family spelling out the girl's transfer as "faulty."

Dr. Jessica Nutik Zitter, a Bay Area physician who specializes in critical and palliative care medicine, does not have personal knowledge of Jahi's case, but has practiced medicine for more than 20 years.

"Nutrition is essential to continued physiological processes,'' said Nutik Zitter. " A body can't go for much more than two to three to four weeks without nutrition. A young person may be on the longer end."

Thursday marks three weeks since Jahi was declared brain dead.

" Brain-death doesn't usually go on for several weeks. The brain is responsible for autonomic processes and if the brain is not alive, certain autonomic processes will cease and result in eventual death,'' she said.

Nutik Zitter said she has never heard of a case where a family has fought so many legal battles to keep a brain-dead person on machines in hopes that he or she would recover.

"The reality is doctors and hospitals don't usually do medical procedures on people who are dead,'' she said. "If we are doing things that we know are not medically appropriate, what does that say? I think it sets a very dangerous precedent . I think we have a lot of clear data on brain-death and we know there is a zero percent prognosis (for recovery)."

The family wants to transport Jahi 3,000 miles across the country and could be forced to do so without a feeding tube or a tracheotomy for breathing.

"Physically someone could be transported without the (breathing) and feeding tubes being surgically attached but it's definitely very risky,'' she said.

What's more, she said, if the breathing tube fell out or became disconnected, in flight, "There is the possibility, they would not be able to reinsert it."

The case has touched on medical, ethical and legal tenets.

The hospital's attorneys argue that since Jahi has already been declared brain-dead, her constitutional rights cannot be violated by taking her off the ventilator.

"There's no violation of any constitutional or statutory rights raised for the first time in this court because there is no parental, religious or privacy right to reject the scientific definition of death developed by medical professionals and enacted by the California legislature into state law with appropriate safeguards," states the motion.

The family's hopes were boosted Monday, when her grandmother said Jahi has been moving her legs and responding to her mother's voice, and her uncle said they have produced video to prove it. The family has declined to release the footage.

The hospital has dismissed such claims by Jahi's relatives, saying that any muscle activity was an involuntary muscle reflex.

 

Now for my 2 cents: I get it. Nobody wants to see their child die. Your child should be burying you, not the other way around. It is worse when you're the parent who decided to put your child under the knife, only to have her die from the same procedure. But lets think rationally: She is brain dead. A brain dead person does not respond to any external stimuli. Their eyes don't move when poked, they do not breathe when the breathing tube is removed and they do gag when something is put inside their throats. They do not have oxygen/blood flow or electrical activity in the brain. The survival chance is 0%. Before any scientifically illiterate person goes (well so and so survived after x years brain dead) no, they were in a coma, which is something that is completely different. Jahi McMath won't survive. Unfortunate, but the truth. It is better to pull the plug rather than delay the inevitable. Transferring her to another care facility won't help. The brain dead don't come back. The family should just pull the plug and let Jahi off to a better place, rather than confined to a bed like a vegetable. 

 

But if this girl somehow manages to awake from this: I'll be damned

[Turbo19]

I feel that it should ultimately be up to the family, but in my honest opinion it's a huge disservice to keep her on life support. It is truly doing the body more harm than good. It is understandable the family is in shock and obviously distressed but no one benefits from keeping her alive any longer, if you consider it alive at all.

 

Personally I'd want to be thrown in the ground rather than fester in a medical institution.

[realizm]

I'm very wary of how the poor girl fell into a cardiac arrest from a simple tonsil removal in the first place. That's my question. Nosocomial infections acquired during a hospital stay tends to be frequent. Your cardiovascular system can indeed fail as a result of infections gone rampant in a hospital setting, or due to negligence on the part of HCPs and MDs.

 

Same with mistakes on the operating table with many well documented cases. We'd be surprised at what even hospital administration may try to cover up many times where it comes to death during treatment and care in a medical care facility.

 

As for personal opinion on the very deep ethical issues here ? Its ultimately up to the patient who is terminally ill to make the determination as to whether they wish to remain on respiratory ventilator support if they are incapacitated. There are legal procedures that can be made to fulfill a patient's wishes (a health proxy) in the case the person is not able to make conscious decisions. Granted the child is only 13 years old and may or may not be fully competent in terms of maturity, due to age, to make her own decisions but thats left up to debate I guess.

[CenSin]

If there is a sliver of hope, it's that the girl is put on life support for a long time with the possibility that a medical advance can reverse her condition.

 

With that said, in retrospect, I don't think people getting surgeries for non-major problems is a good idea. Even very "minor" surgeries have complication rates in the single-digit percentage range. I'm sure most of you can list them off the top of your head starting with appendectomy.

 

Various doctors and medical professionals have recommended various "treatments" and "surgeries" to my parents over the course of me growing up. I'm quite lucky I never saw the knife unnecessarily taking various parts of my body away with all the advice my parents were getting.

 

Remember to always weigh the risks of surgery to the benefits. Don't go for bariatric surgery just because you think you're fat. Eat less.

[YankeesPwnMets]

Well she had sleep apnea, which I would call pretty serious. I believe it caused her to stop breathing in her sleep. Recent studies have shown that sleep apnea could be deadly.

 

But other than that, I would definitely agree with your advice about unnecessary surgeries

[realizm]

Well she had sleep apnea, which I would call pretty serious. I believe it caused her to stop breathing in her sleep. Recent studies have shown that sleep apnea could be deadly.

 

But other than that, I would definitely agree with your advice about unnecessary surgeries

 

CenSin knows. Because what happens many times is that in the operating room its not the actual surgeon under the knife but an inexperienced intern or resident!

 

As for sleep apnea and related breathing disorders up to the big ones like lung cancer and COPD, now that may mean either the anesthesiologist during surgery or the respiratory care practitioner observing and treating her during recovery may be in hot water for this. The RCP tackles ventilator/BiPAP assisted life support unlike RNs. 

[CenSin]

CenSin knows. Because what happens many times is that in the operating room its not the actual surgeon under the knife but an inexperienced intern or resident!

The only surgery I've ever had was for fractured bones. That was a necessary surgery and right before getting knocked out by anesthesia, I saw the faces of the entire team. Most of them were young faces. One of them was a fine young lady. I was lucky little peter didn't act up right right before the surgery. That would've been awkward as I was naked.

[realizm]

The only surgery I've ever had was for fractured bones. That was a necessary surgery and right before getting knocked out by anesthesia, I saw the faces of the entire team. Most of them were young faces. One of them was a fine young lady. I was lucky little peter didn't act up right right before the surgery. That would've been awkward as I was naked.

LOL. This reminds me of a hot female doctor who recently performed a physical for clearance so I can start my nursing internship. Fine looking professional woman, 100% ABC. Need I say more?

[mediccjh]

She is braindead. The family doesn't want to accept that.

 

Barring a miracle, she will be a turnip for the rest of her life.

Let her go. Yes, I have a daughter, and if I was in that situation, I wouldn't want her to suffer.

 

(I think after 16 years, I have just a little bit of expertise on the subject)

[QM1to6Ave]

Perhaps with some time and emotional distance the family will be able to think more rationally. At this point, given their emotional states, I'm not at all surprised that they are fighting this battle. It's easy for us to think logically given our detachment from the situation. 

[realizm]

The patient has been moved to an undisclosed facility for long term treatment. There, she is received a gastrostomy for feeding tube (after several days or weeks without nourishment) and also a tracheotomy for long term ventilator-assisted support. Her vital signs in itself may be improving perhaps by artificial means, however she has no significant neurological brain function. She most likely doesn't even have a sleep wake cycle, let alone the ability to carry on conscious thought.
 
Apparently the new medical staff at this point, in going along with the parents' wishes, are putting the patient through medical treatment in an effort to resuscitate her, which was why she was transported. In the past there were exceptional cases of patients who woke from a coma, regaining consciousness into a vegetative state or even to full recovery. In the latter case after 19 years.
 
However the chances of a person waking up from a coma increases with time. Eventually the parents may have to take this into consideration that the chances of her recovery is very slim with the fact that there is extensive permanent brain damage involved exasperated by the fact that she was not put on a feeding tube for an entire month.
 
There is a degree of criticism being received because the family's lawyer pushed for a court order, granted by judges, to reverse the initial clinical diagnosis. As to the credibility of the arguments that the lawyer took advantage of the family and the legal system by setting the stage for a lawsuit against the hospitals involved, which seems to be the main argument, I cannot say yet as I tend to be reluctant in taking things at face value.

[Turbo19]

What can I say, best of luck to the family. If they feel that this is best then it's at their discretion.

[YankeesPwnMets]

I'm going to go with the three hospital doctors and three independent doctors who examined her. I believe that she is brain dead. I have a hard time believing that any doctor would find it ethical to perform an operation on someone who was legally declared dead. I seriously hope the family is paying everything for this because if this was done at a hosptial and resources were being wasted to treat someone who has been declared legally dead, then that is simply not fair for others who were awaiting treatment.

 

But like I said, if she somehow *magically* reawakens, I'll take everything back. I just don't believe she will. It is pretty hard to say there was a mistake made when six doctors confirmed total cessation of brain activity.

[realizm]

I'm going to go with the three hospital doctors and three independent doctors who examined her. I believe that she is brain dead. I have a hard time believing that any doctor would find it ethical to perform an operation on someone who was legally declared dead. I seriously hope the family is paying everything for this because if this was done at a hosptial and resources were being wasted to treat someone who has been declared legally dead, then that is simply not fair for others who were awaiting treatment.

 

But like I said, if she somehow *magically* reawakens, I'll take everything back. I just don't believe she will. It is pretty hard to say there was a mistake made when six doctors confirmed total cessation of brain activity.

 

Meh I made a typo, in my post I meant that the chances of recovery decreases with time. Anyway yes I agree, the chances of the girl coming back to, is very slim.