<p>Thanks for the article update in #756, actingmt. It sounds like the federal court will work to hasten a resolution in this awful, no-win situation. And it appears that even if the family were to find a doctor willing to perform the trach and gastric tube insertion, the hospital will not grant temporary privileges, but will require the family to transport Jahi to another facility.
So the outcome seems pretty clear. We can only hope that the family has the comfort and support they need as they say goodbye and hopefully get closure, as best they can, on this grieving and eventual healing process. As parents we can all sympathize with their profound grief with their loss.</p>
<p>You really can’t frame it in only one way, as belief in miracles can be religious or not, depending upon the individual considering it. </p>
<p>The fact is that every once in a while, something happens in a medical environment which goes beyond “long shot.” Every once in a while a patient outcome absolutely defies rational explanation, causing every medical professional to wonder if indeed there is such a thing as a true “miracle.” </p>
<p>However, policy cannot be made on the assumption that there is a miracle out there for every situation. That’s why so many people are shaking their heads over this situation for the potential it has to set a precedent that essentially relies on a miracle in order to be justified. It’s not just this case, it is the many which will follow on its heels if doctors can be ordered by courts to perform surgery on patients which the courts have actually declared legally dead, and if facilities can be ordered by courts to keep legally dead individuals on life support indefinitely simply because their families demand it.</p>
<p>Hospitals provide post-operative care. It is unclear whether hospital personnel responded adequately when Jahi started to hemorrhage postoperatively.</p>
<p>My personal thought has always been that it might have been different if the hospital had handled this differently from the time that jahi actually died. The early statements in public were awkward and insensitive, so I wonder if the private relationship was a bit clunky, as well. As far as a relationship, it isn’t uncommon for relationships to be more personal with a primary doctor and less so with specialists. In a different field, lawyers from top firms often do very personal pro bono work with people from different backgrounds. Sometimes communication is strained and sometimes unkind judgment is passed. If the client doesn’t do the things the lawyer expects or considers appropriate, sometimes condescension and shame can occur. It is certainly possible that it happened here. Maybe the hospital, like some in the public, aren’t that sympathetic to very heavy people or people who let their kids get that way. Jahi’s mom seems strong willed to say the least. It isn’t hard to see how this could have evolved from a clash of cultures and wills.</p>
<p>But again, no one has ever seen a “miracle” happen when we have known for sure it isn’t scientifically possible (amputees limbs are never restored).</p>
<p>As an aside, has anyone been reading about the new research using MRIs to study responses of PVS patients to certain stimuli? It is very interesting. And has nothing to do with Jahi. Just interesting.</p>
<p>The public statements from the hospital can appear insensitive. I agree with that. However, the hospital is in the unthinkable position of requiring staff to provide costly and scarce intensive care for what everyone but a few fringe “experts” agree is a dead body. And it has been over 3 weeks. They are exasperated and it shows. On the other hand, the family attorney’s language is also highly-charged and frequently sadly misleading.</p>
<p>Flossy, I specifically said the early statements. Not the things said in the near of a contentious situation later. The early statements as setting the stage, as well as possibly being representative of the personal interaction.</p>
<p>I think any attorney blogging about the experience of fighting the hospital etc is out for something other than what he purports to be about.</p>
<p>This child has been pronounced brain dead by several outside agencies. On a blog in Ca, it has been RUMORED that she was given a bit of cheeseburger - not sure how accurate that is, but the point remains… the longer this child stayed on life support, the less opportunity the family would have to find out what might have gone wrong.</p>
<p>I feel horrible for this family, but they are turning this child into a martyr for which there is no point. This is an exercise to see how long you can keep a body running on a vent without being powered by a brain. It’s cruel if you ask me.</p>
<p>Of course, they had a bad relationship with the hospital. Although, as others have noted, it’s unclear how you have a relationship with a hospital in the first place. That doesn’t necessarily mean the hospital did anything wrong. You can do everything right and still get the blame when things end badly. And, whatever happens this is ending very badly.</p>
<p>Also, the hospital was exasperated on day one when the news crews were called in to the lobby. I’m not saying they are blameless. We have no idea. But, since we only have one side it’s best not to judge IMHO.</p>
<p>Just an observation . . . New Beginnings has profited quite nicely from the PR generated by their purported offer to take Jahi under their care, but they’d be out of their minds to actually follow through, as would anyone else who agreed to accept the family at this point. Think about it: a hysterical mother with an attorney who’s not hesitant to file suit. The hospital is the first in the list of defendants who’ll be served with a malpractice action, but it’s unlikely to be the last. I certainly would not want to be in the shoes of the director of the facility that’s providing Jahi’s care when artificial means eventually fail, which they inevitably will, sooner or later.</p>
<p>In the end, I think, even if the hospital were willing to approve, or even perform, the procedures necessary to facilitate Jahi’s transfer, no facility director in his or her right mind would ever agree to take her.</p>
<p>That having been said, this situation does seem to have a knack for bringing out of the woodwork all sorts of people who are clearly not in their right minds, so who knows?</p>
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<p>A physician-attorney I once knew told me that the most effective way for a surgeon to prevent a malpractice suit was to learn how to communicate with patients & families following a tragedy. And it’s extraordinarily difficult . . . not because surgeons are heartless, but because they are grieving also and dealing with their own anger and guilt over the bad outcome, which makes it that much harder for them to face the family.</p>
<p>As an side-by-side comparison, it is possible to get a dead body from the morgue and tie it into the same kind of “life support” that Jahi is getting and see if the dead body breathes and pumps blood? Maybe in the old days they should have done this with the bodies of Mao, Lenin and Stalin instead of embalming them.</p>
<p>The hospital’s handling has been poor in my opinion too. No comment would have been better than some of the things that were said. If they are in an “unthinkable” position, then someone who should have been thinking wasn’t. I represented hospitals when I practiced law and it was our job to make sure hospitals are never in “unthinkable” situations. Every time they recommended that someone be taken off life support, they should have considered what happens if the answer is “no.”</p>
<p>Cartera, that’s why I wondered up thread about the hospital’s PR because it was done badly and there has to be a lot of money and many lawyers involved. I wo der if there isn’t an issue of arrogance here running through. As I said, I’ve seen it in law firms and it has shown up here in the thread. The hospital badly handled its communication and I wouldn’t be surprised if it is because of the cultural differences between hospital personnel and the family, and the judgments brought to bear. I also wouldn’t be surprised if the personal communication was handled with a curled lip and a lifted nose.</p>
<p>Well, I agree with that, cartera. In fact, I think many people before this did not realize that if someone dies in the hospital you have the right to insist they are still alive and take the matter to court.</p>
<p>Natasha Richardson would be the celebrity example of this situation, not Christopher Reeve. On vacation, she hit her head while skiing and later suffered bleeding in the brain. Then, she was flown home and some were hopeful that she would get treatment in LA upon her return. However, before the plane landed all of the expert opinion was that she was being brought home to die peacefully.</p>
<p>What you have the right to do, flossy, is make sure that the hospital followed the letter of the law. That didnt initially happen here. Which is why the court stepped in and ruled as it did. Jahi was not declared alive. She was granted an independent evaluation. She was then declared dead and cessation of ventilation was ordered. That order still stands pending a ruling from the federal court as to whether it will step in. There don’t obviously appear to be grounds for that to happen and then the state court order will proceed.</p>
<p>Of course it’s unclear. The hospital cannot respond to any accusation of negligence or malpractice or any other issue related to Jahi’s care due to HIPAA, while the family can make any or all accusations. That’s the way the law works, and has really nothing to do with the current legal questions.</p>
<p>A lawsuit will make very clear if the current standards of practice were followed regarding the surgery and the post op care. If it actually went down the way the family claims, heads will roll, money will be paid out, licenses may be lost. And rightfully so, if gross negligence occurred.</p>
<p>This post was from the nursing forum I also follow which is discussing this event:</p>
<p>As a physician who has seen her share of unexpected bad outcomes, I have been struck by the hospitals stance/attitude: Either they’re comfortable that they don’t expect to be found liable or they completely expect to write a large check so might as well minimize costs up front. It really feels like it’s the former.</p>