Posted on 01/05/2014 6:46:51 PM PST by Morgana
After a protracted legal battle, Children’s Hospital Oakland reached an agreement with Jahi Mcmath’s family to allow a medical team to enter the hospital to perform the procedures necessary to move her to a medical facility that will continue her care and treatment.
Her mother and family say she is alive following a tonsillectomy gone awry that has left her in an incapacitated state since early December. The family in the case says the hospital has been starving Jahi for three weeks.
The San Francisco Chronicle has more details:
The agreement, described in the courtroom of Alameda County Superior Court Judge Evelio Grillo, is the latest development in an unusual battle between the hospital and the girl’s family, who is rejecting the declaration that Jahi is dead after doctors determined that she was brain dead.
On Friday, the Alameda County Coroner issued a death certificate stating that Jahi died on Dec. 12.
The family insists that Jahi is alive and that there is hope for recovery because her heart continues to beat and she remains on a ventilator, which will be kept on as she is moved.
Under the agreement, Jahi’s mother, Nailah Winkfield, is “wholly and exclusively responsible for Jahi McMath the moment custody is transferred in the hospital’s pediatric intensive care unit and acknowledge(s) that she understands that the transfer and subsequent transport could pact the condition of the body, including causing cardiac arrest.”
Grillo refused the family’s request to require doctors from the hospital or an outside physician to insert a feeding tube and a tracheostomy tube on Jahi. Christopher Dolan, attorney for Jahi’s family, said the agreement removes the barriers the family had faced in taking the girl out of the hospital. The hospital had been saying it would allow the girl to be transferred to another facility but had not heard from any such facility. Now, under the agreement, the hospital will simply allow workers to enter and remove Jahi.
Dolan said he would not discuss details about where or when Jahi will be moved.
“Right now, arrangements are being made, and what we needed to know was that when all the balls were in line, that we could move quickly, and not to have impediments, so that we all understood what the protocol was,” Dolan said outside court. “So this is a victory in terms of getting us one step closer.”
This week, a nationally-respected pediatrician said that Jahi McMath, who is at the center of a national debate about whether she should remain on life support, is not “brain dead” and can recover with proper care and nutrition.
Dr. Paul A. Byrne, a Neonatologist who is the Director of Neonatology and Director of Pediatrics at St. Charles Mercy Hospital in Oregon, Ohio, has given a new interview to a local NBC television station. Byrne is also a Clinical Professor of Pediatrics University of Toledo College of Medicine and the past president of the Catholic Medical Association.
Byrne told the station he does not believe that brain death is “true death” and said, with “proper nutrition and care,” McMath can have meaningful recovery to the degree that she would not meet the “brain death” criteria. He also said as much in court findings that Christopher Dolan, the attorney for McMath’s family.
Late Monday afternoon, the judge in the case granted an extension for life support after a legal request from Dolan.
The article states that her heart is beating, She is only on a ventilator which helps with breathing - not the heart. I don’t understand how the heart is still beating, is she is dead.
Jahi has been released to her family and moved out of Oakland Children’s Hospital.
http://www.mercurynews.com/nation-world/ci_24850098/jahi-mcmath-attorney-tells-tv-station-child-will
http://www.latimes.com/la-me-oakland-girl-20140105,0,5779486.story#axzz2pbDCalEb
The decision to keep this dead child on a ventilator is based strictly on race and it wouldn't even have been a news story if the child was Asian, white or Hispanic.
The judge has also created a malpractice crisis. The plaintiff attorney now will ask for lifetime medical support for a corpse. Figuring about 2000 dollars / day for 50 years would come to 36. 5 million not adjusted for inflation. They will get that amount if it goes to trial in Alameda county. I guess malpractice premiums just went up in California for pediactric surgeons.
I wonder how this will play out politically? Which party will jump on the bandwagon first?
The heart has its own internal pacemaker (think of it like a battery pack for a laptop). With artificial respiration the heart continues to receive oxygen so the heart can continue beating after brain death, but without input from the brain, it will eventually stop even with artificial respiration, typically the heart can be kept beating in a brain dead person on a ventilator, but for not much longer than a month, although most people who have been verified to be brain dead are taken off life support by or before then so it is unclear how long the heart can be kept beating in a brain dead person while on vent.
Given a supply of oxygen the human heart can even be kept beating outside of the human body for a time. This is what makes heart transplants possible. During some open heart surgeries, the older techniques, the heart is stopped and partially removed from the body and the patient is put on heart-lung bypass machine to do the work of the heart during surgery. The patient is not however brain dead and not dead even though their heart has stopped beating.
Without any input from the brain however, the body will cease secreting hormones vital for maintaining organ and other biological functions including gastric (stomach and bowels), kidney and immune functions and regulation of blood pressure and temperature. Sometimes a person who has been pronounced brain dead and consented or their family has consented to organ donation, will not only be kept on a ventilator but also given hormones and kept under heated blankets to keep their organs viable and give the family a bit more time to day their goodbyes, but that typically is only for a few days.
Life After Brain Death: Is the Body Still 'Alive'?
This (complete brain death, including that of the brain stem) is very different from traumatic brain injury or a PVS or coma in that in those patients; parts of the brain and more precisely the brain stem is still functioning, regulating and maintaining biologic functions. In the case of Terri Shiavo (and Karen Ann Quinlan for that matter), she had loss of some but not all brain function. She was able to breath and move on her own, had eye movement and because her brain was still regulating other biologic functions, this is why she was able to be fed through a feeding tube, why she was still able to digest and utilize nutrition, regulate her core body temperature and fight off infection.
It is unclear in Jahi’s case if her internal organs, other than her heart, are still functioning at this point and why a feeding tube is very likely futile and may even hasten her bodily deterioration as insertion and maintenance of a feeding tube has a high risk of infection and pumping nutrition directly into the stomach of a person who’s gastric system is likely no longer functioning, is probably why Children’s Hospital, and no doctor the family contacted, wanted to perform the procedure.
I don't agree with medical and surgical solutions for self-imposed ailments. Heal thyself.
Well, you never know--maybe proper nutrition will cause a new brain to grow. < /sarc >
They can go months and not have cardiac issues...as long as the body is fed and hydrated. The girl probably has brain stem autonomic function though...else the body would go hay wire.
Dr. Paul Byrne by his own statements has said he’s not medically “examined” Jahi because he’s not licensed to practice medicine in CA. He is a Neonatologist; Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially ill and very premature newborn infants.
He is not however a neurologist and his opinions on brain death not being death are quite controversial and unsubstantiated by all that we know regarding brain death. Dr. Byrne is deeply religious and pro-life, a commendable position especially for a doctor working with premature infants, but he’s also against organ transplants and perhaps his religious beliefs and experience with treating premature newborns, who not so long ago would have died, has colored his judgment as a scientist.
As far as the Lazarus reflex:
Like the knee jerk reflex, the Lazarus sign is an example of a reflex mediated by a reflex arc – a neural pathway which passes via the spinal column but not through the brain. As a consequence the movement is possible in brain-dead patients whose organs have been kept functioning by life-support machines, precluding the use of complex involuntary motions as a test for brain activity.[3] It has been suggested by neurologists studying the phenomenon that increased awareness of this and similar reflexes "may prevent delays in brain-dead diagnosis and misinterpretations."[2] The reflex is often preceded by slight shivering motions of the patient's arms, or the appearance of goose bumps on the arms and torso. The arms then begin to flex at the elbows before lifting to be held above the sternum. They are often brought from here towards the neck or chin and touch or cross over. Short exhalations have also been observed coinciding with the action.[3]
http://en.wikipedia.org/wiki/Lazarus_sign
Here is a video that explains this phenomenon, which may be disturbing to some, so watch with caution:
This one is even more disturbing and the narration is in Portuguese, but it demonstrates the types of movements that can be observed in a brain dead patient on a vent and perhaps the types of movements that Jahi’s family and Dr. Byrne may have observed but are which are not signs of life but of involuntary arch reflect movements stemming from the spinal cord. Notice that pressing on this patient’s sternum does not elicit any response but moving his head, i.e. his spinal cord does. Again, watch with caution if you are sensitive:
http://www.youtube.com/watch?v=BTnApcbDkmM
Ironically such involuntary arch reflects along with seemingly breath sounds, even what seems to be moaning sounds emanating from a dead person but are which are typically a buildup of post mortem gasses, and the false appearance of hair and finger nails continuing to “grow” after death, gave rise to stories of vampirism and zombies before such post mortem processes were fully understood by the advancement of medicine and science.
I’m not sure if the link will work, but I will put it here anyway.
http://link.springer.com/article/10.1007%2FBF01400587#page-1
Looking at the figures in the article, it appears that the longest they have kept a corpse somewhat functional after death is about 52 days.
This group, led by T. Yoshioka of Osaka University Medical School, Japan, apparently has done a number of studies in brain dead people.
In any case, I doubt that the heart will continue to beat in this corpse for much longer. Almost certainly, whatever facility they moved her to will not have advanced life-support equipment. The length of time this corpse has been kept ventilated is already beyond the average seen in Yoshioka’s studies (23.1 +/- 19.1 days) (http://www.ncbi.nlm.nih.gov/pubmed/3714004).
The judge who has allowed this travesty to continue long past the girl’s death is reprehensible. I have no words to describe the lawyer Dolan, who must be aware of the facts yet continues to lead the family on.
I think there will be severe legal ramifications in this case. Hospitals do not usually release corpses except for transport to medical examiners or funeral homes.
Actually, the second video was less disturbing than the first (to me). I’ve seen chickens being decapitated, and know what happens—but I could not watch that part of the video. Good thing youtube recommended a kitten video to watch following that one.
Never mind party, where’s Jeesssee Jaaaaaasoon and Al sharpton?
From your first linked article:
“...autopsy revealed the fact that the brain tissue including the hypothalamus became extensively necrotic after the sixth day of brain death...”
For those of you from Rio Linda, “necrotic” means dead tissue. Necrotic brain tissue is essentially absorbed by the body if that body is kept artificially “alive”. In brain death, the ENTIRE brain (including the brain stem) becomes necrotic and is subsequently absorbed.
This “living” corpse is NOT EVER coming back to life. She’s been dead since December 12 despite the fact that her bodily “shell” has been kept viable. It will become more and more expensive to keep this shell “alive” as time goes on and the shell will eventually (several months?) no longer sustain “life” no matter how much intervention is performed. I wouldn’t let this treatment be performed on a rabid dog that bit one of my children—it’s inhumane.
This is may the death panel preview.
Actually some entities have raised >$50,000 in behalf of the family. Money is not the issue. Too many cases in the foreign lands patients were declared dead just to be discovered alive in the morgue were still alive. Miracle still happens.
this isn’t a foreign land and she’s dead. the docor that intervened has a book out on death. He’s a nutcase.
Young poor girl whether she's in Uganda or in Oakland doesn't make any difference. She may have been declared clinically dead per the doctors who want to save their careers but not biologically dead nor in eternity yet. Get real! She's still on ventilator. What if she'll ended up recuperating? Will the doctors who attended her and the coroner keep their jobs, they're probably all too nervous.
She is dead. This condition is irreversible.
Here is a video of a physician explaining brain death. https://www.youtube.com/watch?v=Ffqz-vKZO5Q
I like his statement starting at 5:06. He explains that the body appears lifelike because there are two kinds of death involved. “It’s important to recognize the difference between an organism and an organ. The human being, the organism, is dead, but the organs, such as the heart, are being kept alive for a few more days, giving the appearance of a sleeping person. A brain-stem dead patient is not a person suffering from brain-stem death—he is dead.”
As a scientist, I have worked with cell lines removed, in some cases, from dead humans or animals. The cell lines will live indefinitely as long as they are kept warm, fed, and sterile, and provided with sufficient carbon dioxide. The Hela cell line was taken from a woman who died in the early 1950s. The cells are alive, but she is not.
This little girl, Jahi, died on Dec. 12. What is going on now is more fitting to a Steven King novel than real life. The judge who has allowed the family to keep her corpse ventilated is irresponsible.
They said she’s legally dead. What does not mean? How can a person declared dead with certificate of death if she’s still on ventilator? Youtube? Yeah? But still on ventilator!
Did you watch the video I linked? The physician in that video explains very well what brain death is, and why the heart continues to beat when the dead person is kept on the respirator. If you remove the heart from the body and supply it with nutrients and oxygen (and possibly carbon dioxide, but it probably makes enough on its own), it can survive and continue to beat for a long time. That does not mean that the person it was removed from is alive.
Everything that makes you who you are is in your brain. You are aware that you are alive because of your brain. When the brain goes, you are gone--regardless of whether the rest of your body dies along with the brain or later. Jahi's heart has been kept beating for an unusually long time after her death, but that does not change the fact that she is dead.
I do not know what the family is doing with the corpse now, but this is gruesome horror-movie type stuff. The family's state of denial should have never been allowed to go this far.
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