<p>Honestly, I don’t care what kind of nurse the grandmother is, it is very difficult after reading that brief to believe that she or anyone else at this point cannot recognize dead. Respectfully, of course.</p>
<p>If you read the rest of that brief, it gets worse. She was literally pooping her guts out.</p>
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I don’t question that; but we’re only talking about differences which impact the job functions of a critical care team which is transporting her. And while some patients with PVS can breathe without a ventilator, I’m sure her critical care team was familiar with transporting ventilated patients. Whether the instability of the cuff in that context is a significant difference or not is unclear to me. Again: that is the context of this particular discussion, as raised by another poster who asserted that the critical care team would be facing a truly novel assignment. I questioned that. </p>
<p>Apprenticeprof, thank you for your reasoned comments. I think it was Hunt, earlier, who observed that if this family was rich we wouldn’t even have heard about this case. But the financial issue is pretty straightforward, as long as the hospital did not commit malpractice. Being brain dead means the taxpayers don’t pay for further care. Period. And while the dance with Childrens took quite a while (and I’m not going to assign blame, because I wasn’t there) the ultimate settlement seems just: the family assumes all future responsibility and takes her away. The cost of care during the period of delay in reaching that settlement is regrettable but hardly a critical issue in context. The family has indicated that private insurance in fact paid for current care; other have disputed that. I could see that going either way. </p>
<p>If the family has some source of funding to pay for the future care - donations, lottery tickets, an insurance policy which somehow covers it - then they’ll pay for it. If not, whoever is operating the facility where she is currently located no doubt is aware of that potential problem. Contrary to the self-ratifying assertions that “no reputable facility” would do so, I can see where a religion-based or other doctrinally guided institution might disagree. I see no way the taxpayers get the bill. (And I suspect the issue will be self-limiting as a result of that and the fact that I don’t think her heart will continue to beat for too much longer in any event.)</p>
<p>I’ve never suggested that the family should be encouraged to proceed as they have chosen, or that brain death is no different from PVS (other than with respect to the logistics of transportation.) I’m all for “drawing that line.” But the line I draw is at the taxpayer’s pocket, not the hospital door. As long as they get her out of there in a reasonably short period of time (given the logistics, I’ve suggested 10 days to two weeks) I don’t see a compelling justification for saying they can’t take her away on a ventilator. </p>
<p>Because we’re not really talking about “social obligations.” We’re talking about legal compulsion with the endpoint being the heart of a 13 year old is stopped by the deliberate act of a person acting with the force of law behind them. That’s where I come up short. I agree with what is the wise course of action. I’m not supportive of mandating compliance with that course of action beyond what is necessary to limit damage to those outside the family. Inside the family - it’s their business.</p>
<p>As to the malpractice issue, I have no opinion as to liability. But the monetary part raises two unsavory accusations:</p>
<ol>
<li><p>“They’re just keeping her alive to increase their payday.” This I doubt, given the cap on general damages; any increase in cost of care will be returned to whoever paid for it if there’s a judgment. (This is called “subrogation” and a lot of people seem to be unaware of it.)</p></li>
<li><p>“They want to kill her to keep the malpractice cost down to $250,000.” I don’t believe that that is true. Nobody is that cold.</p></li>
</ol>
<p>I don’t want to get down in the mud over either claim. No one profits either way, as I see it. If there was malpractice, so be it. Let them figure it out in a lawsuit; that’s what courts are for. Malpractice cases are hard to bring (extra hoops to jump through before filing) hard to win, and offer limited recoveries. Valid cases are more likely to be passed on than frivolous one to be brought. I have no idea which this case might be.</p>
<p>The whole thing is unsavory Kluge. No way around it.</p>
<p>I just cannot comprehend what Jahi’s mother and family are gaining by keeping her in the state she is in. I can’t believe it is about money - who would refuse to acknowledge the death of their child for monetary gain? And acknowledging her death in no way precludes the family from bring suit against the hospital.</p>
<p>Keeping a clinically dead person in a hospital for “10 days to two weeks.” Sorry, that makes no sense. Sorry to be blunt, but a clinically dead person belongs in a morgue or at a funeral home where they can be properly prepared for burial or cremation.</p>
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<p>Yesterday I alluded to this, though not explicitly.</p>
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<p>“Sloughing” of the bowel tissue was something I tried to avoid saying outright…But it is a horrific thing which can happen.</p>
<p>I think, based on my own family situation, that what is happening is that the mother is keeping herself moving, keeping herself focused elsewhere and keeping herself angry because the second she stands still reality will sweep over her like a tidal wave and she will be stuck in it until the day she dies.</p>
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<p>Completely agree. </p>
<p>AND</p>
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<p>I’m torn between wanting them to accept this situation as it realistically is, yet knowing that if that happens, they will realize how many people have taken advantage of them in their time of despair.</p>
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<p>Of course it is, even though you declared that there was no difference as though you had any basis to make that claim. Which is why I responded that you were talking out of your…scope.</p>
<p>The lawyer also referenced something about the horrible state of her throat…this is likely the compromised tissue of the throat/esophagus/trachea which results from long term intubation vs. tracheotomy. Which is what could have made that transfer the “end” in even terms the family would have understood.</p>
<p>Havent had a chance to catch up, so apologies if this has already been posted. <a href=“http://media.nbcbayarea.com/documents/HeidiFlori.pdf[/url]”>http://media.nbcbayarea.com/documents/HeidiFlori.pdf</a> This evaluation by the medical director of the PICU was done one Jan 3. The description of Jahi’s failing, degrading organs and systems is compelling. Jahi has had no bowel sounds (ie they are not functioning) and some fecal discharge that was passed indicated that she was sloughing the lining of her gut. Her body is not able to maintain a temperature without blankets, and her BP is unstable and half of what it was at the time of her death. Her muscles are beginning to contract (the family probably thinks that is " spontaneous movement") and her sputum is becoming odiforous, thick and discolored. I need not continue. </p>
<p>Because if HIPAA, we are only able to get these medical reports when they are part of the legal proceedings. So the MSM are fed distortions and fantasies from the family and the attorney.</p>
<p>Kluge, Your statements about the physiological parallels between a functioning body, albeit with a diseased, impaired brain function, and this deteriorating body simply do not hold true.</p>
<p>It seems to me we are getting past the brain death vs. death thing, now. This girl is unfortunately every kind of dead and no-one can believably be missing that reality. There are no words.</p>
<p>The scary thing is the lawyer still insists she is alive and says a Catholic facility which he will not name , is treating her.</p>
<p>Yet, listening to their attorney during that press conference today, he speaks as though she is still very much alive. They’re going to prove everybody wrong and she’s going to be just fine once they feed her.</p>
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<p>Looking at my beautiful 20 y/o daughter right now, with her big blue eyes and deep, saucy dimples. I absolutely believe you are right.</p>
<p>Kluge, where we differ, I think, is that I don’t see the hospital taking a brain dead child off of a ventilator as “legally compelling” the parents to do anything. Legal compulsion would be, essentially, forcing the parents to euthanize their daughter by preventing naturally occurring bodily functions for taking place. But there is nothing natural about what is going on here. If any “compulsion” is going into it, it is the court order that compelled the hospital to use their ventilator and their doctors to artificially support those functions. Of course, there are plenty of situations where hospitals should indeed be compelled to provide such support, but the case of a brain-dead patient isn’t one of them, in my opinion, and I’m someone who does have religious beliefs that lead me to be very cautious about giving up hope.</p>
<p>I know you said her small intestine and bowel were likely infarcted, Nrdsb4, but not being a medical person I didn’t know what that entailed. But it means she’s pooping out her guts.</p>
<p>Also, if she weren’t wrapped in warm blankets her body would be getting cold. </p>
<p>I understand the mother’s state of denial: that’s her little girl, and her brain just can’t process the thought that her beautiful daughter is gone. But the skeezy uncle, the ambulance chasing lawyer and the publicity-seeking Schiavo nuts have no such excuse. The mother deserves better from the people around her.</p>
<p>Just in case it’s not clear:</p>
<p>People are mentioning that she is, perhaps, in a Catholic facility. And a Dr. Byrne, who is Catholic, has disputed that brain death is death. But that’s not the mainstream Catholic doctrine. Catholics accept brain death. Brain death is death in Catholic hospitals.</p>
<p>The lawyer is a well educated guy. It is unbelievable to me that he could look at the info from the PICU doctor from January 3rd and continue on with perpetuating this illusion that she is still alive. It is disgraceful.</p>
<p>Isn’t he just representing his client? The uncle. The uncle called him. Not the mom.</p>