<p>We get to comment because this is a public policy issue. Is it good public policy to spend scarce medical resources on someone who is dead just because the family is delusional?</p>
<p>I don’t think so. </p>
<p>None of which makes this loss of a child any less of a tragedy.</p>
<p>So the family has my sincere sympathy for the terrible loss of their daughter, along with my hope that an autopsy provides clearer information on what happened.</p>
<p>I had excessive bleeding after my tonsil surgery many years ago, and mine wasn’t nearly as complicated as the surgery that this girl had. We don’t really expect people to die as a result of surgery, but those consent forms are very clear about the many terrible possibilities.</p>
<p>I agree with zoosermom here, when she says the family should sue the hospital and that through legal discovery process the facts of this case will come out. This is the second case of tonsillectomy/adenoidectomy at Oakland Children’s Hospital that resulted in catastrophic harm to a young girl. Rebecca Jimenez suffered severe brain damage resulting in the need for specialized care for the rest of her life. According to the article below, both girls were operated on by different doctors but were recovering in the same pediatric ICU. Two very similar cases in two years is concerning.</p>
<p>Only if that exceeds the norm for this type of procedure and if, in either or both cases, there weren’t factors contributing to a high risk. And, clearly, you do not know if that’s the case.</p>
<p>two very similar cases –> two apparently similar cases</p>
<p>But feel free to jump to conclusions based on no medical data.</p>
<p>It seems clear that the transfer to a nursing home won’t happen, the machines will be turned off shortly, and the family will bury their child and mourn. Legal action will determine the malpractice claim, an entirely separate issue that no one here has sufficient facts to opine upon. There’s really nothing to argue about, and I’m not understanding the passion this thread has produced. I will note that the girl’s presence in the ICU (prior to the hemorrhaging) confirms that this was hardly a routine tonsillectomy. It appears the surgery was also complicated by her obesity, which was likely a contributor to the apnea in the first place. It’s possible that some guilt about letting a child become so obese may be factoring into the parents’ reaction.</p>
<p>I remember reading in some of the early news stories that the hospital wanted the ventilator removed as quickly as possible so that an autopsy could provide the best possible information on what went wrong.</p>
<p>An autopsy performed today would be of much less value because of changes that may have occurred during the prolonged period between then and now. Some tissues may have healed and others may have deteriorated. It may no longer be possible to figure out what went wrong, even though it would have been possible three weeks ago.</p>
<p>I wonder whether the realization that a prompt autopsy was more important than usual in this case might have led some hospital personnel to approach the family in a way that was too abrupt.</p>
<p>Interestingly enough, we do not know the whole story. I agree with zoosermom, the family should sue, so that the facts of this case are fully disclosed to them. And I also believe the tone of Flossy is cold and callous. I wish this type of tragedy on no one. Until you walk in those shoes, opinions are just that.</p>
<p>When I worked in the ICU, we often took the tonsillectomy/adenoidectomy cases because there was a potential for bleeding and swelling which could result in a compromised airway. Fortunately none of my patients ever had any complications; in fact, we nurses would always lobby to get one of these patients because they were so much easier to take care of than the regular ICU patients. However, they were there because they absolutely had the potential to go south.</p>
<p>I don’t know if the standard of care was maintained in these cases, but one absolutely cannot assume that a bad outcome is evidence of negligence. I’m sure it will all come out in the lawsuit.</p>
<p>An ET tube cannot remain in place indefinitely. It will gradually erode the tissues of the throat/esophagus. A tracheotomy must be done and a feeding tube placed surgically. It will be difficult to find a doctor to do this procedure. It’s considered medically unethical to do procedures on a patient who has been declared brain dead (the judge also legally agreed with this diagnosis-there really is no “confusion” on the judge’s part on this matter). </p>
<p>What is unprecedented here is that the court has ruled that the child is dead, yet is paving the way for continued treatment and requiring a hospital keep a legally dead person on life support. It’s a scary precedent, quite frankly. </p>
<p>As to another comment, hospitals usually do cease life support within hours of a declaration of brain death. There was nothing rushed or sinister about the hospital’s response to a brain death diagnosis relative to the standard of care usually applied in those cases.</p>
<p>Its great when message board phonies talk about the effects on society when its not their child. And worrying about the cost of an isolated case like this on taxpayers is the equivalent of Obama staying up at night concerned about the boil on my butt.</p>
<p>From the article above. Doesn’t sound like “dead” to me.</p>
<p>I know someone whose baby suffered a traumatic brain injury during childbirth. Her child had a sucking reflex and nothing more. He does not respond to his mother’s voice, cannot move, and has no hope of a normal life. Yet he is in a permanent care facility and will likely live there for decades. </p>
<p>It’s just too hard to put ourselves in others’ shoes sometimes.</p>
<p>A traumatic brain injury is not the same thing as brain death. </p>
<p>I’ve read this whole thread and followed this case from day one and the personal attacks on posters for not caring enough when there are legitimate reasons to believe this a dreadful situation that the family and their lawyer have chosen to turn into a public spectacle are a little shocking,</p>
<p>The ethics of being a doctor. Doctors have professional ethics that they have to live up to or face censure / license-pulling.</p>
<p>This is what differentiates a licensed medical professional from, say, a painter. Because if I hire you as a painter and I want you to paint my living room bright purple, you may think it’s ugly but too bad – my wishes get to rule. Health care doesn’t work that way. Medical professionals are not “for hire” in the same way. I can’t demand that my doctor cut off my leg because I’m sick of having a right leg. I can’t demand that my doctor write me a prescription for green eggs and ham because I read on the internet that green eggs and ham will cure my cancer. I can’t demand that my doctor do a C-section on me at 30 weeks for no other reason other than I’m tired of being pregnant. He has to balance patient desires / demands with the ethical strictures of the practice.</p>
<p>Let’s play with your hypothetical. Let’s pretend this patient was of age, and prior to her tonsillectomy tragedy, had intended to get breast implant surgery. Maybe she’d even signed all the papers. Let’s say her family was in full support of this. Would it be “unethical” for the plastic surgeon previously retained to go ahead and give breast implants to her? What ethics would or should prohibit this? How should the plastic surgery board feel about the plastic surgeon who agrees to do this because after all, he had a consent form and the family is fine with it?</p>
<p>I know that’s a silly hypothetical, but it touches on … there are principles in medicine other than “patient desires trumping all.”</p>
<p>This is exactly the kind of ill-informedness that malpractice lawyers love! Every operation has a risk of something going wrong - just like every time you step into a car you have a chance of dying. There could have been something wrong with how the doctors performed the operation or the post-op care – or everything could have been done exactly by the book and, well, the 0.005% chance of death from this operation occurred here. None of us know. But there certainly are enough dumb people out there who think that bad outcome = someone did something wrong.</p>
While the frequency is low (estimates range at around 2-5%) not sure thats considered “rare”. And there is indication that perhaps 25% of children diagnosed with ADHD actually have sleep apnea, and appropriate treatment of the apnea can reduce or resolve the attentional issues.</p>
<p>I have read this thread with interest, and it is clear who the medical professionals are, who the lawyers are and who the lay people are. We who work in medicine have had to come to terms with our feelings toward death, as we experience it more frequently than most. I guess that can come across as callous to some.
Bleeding is a very real risk with tonsillectomies. We used to do them all the time and patients bled out. We do them much less often now BECAUSE of the risks involved. And the older the patient the higher the risk. Not sure there is any malpractice that occurred here. Could be just an unfortunate outcome.
As many others have said, brain dead is dead. It is not comatose. It is not a vegetative state. She is not on life support. She is on a ventilator while her body begins to decompose. It is very sad to me that a judge and lawyers are prolonging this family’s agony by pretending otherwise. A doctor, not a judge, should be the one to determine life. That’s what they train for, it’s part of their job.
I am very sorry for this family and what they are going through, but what is happening here is wrong, medically, ethically and morally. JMHO</p>
<p>Yet it seems that communication in this instance was regrettably ineffective.</p>
<p>I think that even after all these years in which the concept of brain death has been in use, there is still room for improvement in the way that health professionals communicate with families in such tragic situations.</p>
<p>The Schiavo family wanted to believe that about their daughter, even when every competent medical health professional around said that she was in a PVS. Sadly, some movements are not indicative of anything other than what the parents’ heartfelt wishes are.
I took a lot of interest in the Schiavo case because we are the same age and grew up in the same town (though I didn’t know her, as she went to private school and I was in the public school). I was sufficiently horrified by the charade to try to keep her body going that the case is explicitly referenced in my living-will, as I would absolutely want my loved ones to pull the plug. I realize this is different, as Schiavo was a PVS and this is full brain death.
Google Christine Busalacchi if you’re interested. Similar case to the Schiavo case (PVS) - this occurred to friends of friends of my family. It made the cover of Time magazine.</p>
<p>Pizzagirl, excellent post # 194. There are mentally ill people who want a doctor to amputate a limb. Thankfully, doctors won’t. I agree – ethics trump patient wishes.</p>