You are correct, Nrdsb4, that we will most likely never know what happened that day. You obviously have much greater trust in the medical profession than I do.
^^@QuantMech, it’s not so much as having more trust, but I absolutely know that people who are not medically savvy cannot possibly be expected to understand all of the issues involved with such a complicated scenario. Therefore I cannot accept any version put out by uneducated family members in absence of seeing the medical record.
If a lawsuit for medical malpractice ensues, then the medical record will be made known. I know for a fact that medical errors are made every day, sometimes to horrific effect. I am not closed at all to the possibility that major errors were made here which could have cost this child her life. I am simply unwilling to assert such a thing without a shred of objective data to prove it.
On the other hand, the brain death tests were part of the court record. These tests are extensive as required by law. Tests which are not required by law were done in the interest of making clear to the family that the child was brain dead. I believe up to 6 physicians performed or evaluated the tests, rather than the 2 which are required by law. An independent expert not associated with CHO was then ordered to re-evaluate and test the child yet again. This Stanford pediatric neurology expert did extensive testing and came to the same conclusion as all the others that Jahi was brain dead. He had absolutely no incentive to declare a child with brain function brain dead. No way do I believe that grieving family members are in a better position to determine if a person meets all the criteria for brain death than multiple expert physicians who have spent decades studying and practicing this exact area of medicine. Nor do I believe the statements of physicians who have gone on record as refusing to “believe” in brain death under any circumstances as a result of their religious convictions (and who are not also experts in this field and who haven’t even performed the required tests or examined the child) should be given any weight whatsoever in legal proceedings. I could go on, but when lay people, judges, doctors using religious beliefs as adjuncts to medical diagnoses, and juries are given medical diagnostic privileges, we have completely jumped the shark. I say that in reference to a comment by the judge that he was considering just letting a jury decide if the child was actually alive.
Nrdsb4, do you know whether Jahi was on a ventilator or whether she was breathing on her own, after she was released to her mother in New Jersey?
I doubt that anyone believes in keeping someone on a ventilator when they have been declared brain dead. I certainly would not want that.
@QuantMech, one cannot both be breathing on their own and be declared brain dead. One of the brain death tests is the apnea test. Jahi failed it-she had zero respiratory drive whatsoever.
Yes, she was on a ventilator from early on when she arrested until her death.
That is greatly reassuring to me, Nrdsb4. Thank you for the information. (I guess the tracheostomy allowed the family to give the impression from photos that Jahi was able to breathe on her own.)
Would it be possible for a person to register as brain dead on the brain-scan component of the test–say fMRI and yet be breathing on his/her own? I am not sure whether the brain-scans would ever be run on a person in that circumstance, would they?. But I am aware of the fMRI results that apparently showed emotions in a piece of salmon purchased at a market. I would guess that the incidence of false positives would be overwhelmingly greater than the incidence of false negatives. At the same time, I would be reluctant to bet my life on zero false negatives.
Brain Death Pronouncement in California
https://www.onelegacy.org/docs/OLMDNewsletter_BrainDeathPronouncement_071910.pdf
These are the requirements for brain death testing. Ancillary testing, like brain scans, are not required unless the apnea test cannot be performed.
Essentially, the following happens:
-Doctors must make sure that there are no drugs on board which could interfere with brain testing. All drugs given must clear. This includes anything that causes CNS effects and any neuromuscular blocking agents.
-No severe acid base imbalances or electrolyte disturbances may be present at time of testing.
-Doctors much correct hypothermia if present and correct blood pressure to at least 90-100 systolic if possible.
-Two doctors must make separate determinations. They cannot in any way be associated with organ donation or procurement.
-They must do brain stem function evaluation tests in line with standard medical practice. They must then perform an apnea test. These are listed in the link.
-They MAY do ancillary tests if desired.
In Jahi’s case, not only were all these requirements met, the entire process was repeated at least twice. Additionally, a brain perfusion scan was done which revealed NO BLOOD FLOW TO THE BRAIN whatsoever. This test was done weeks after the initial insult if memory serves.
So people, tell me how it would be possible for the human brain to have no blood flow whatsoever weeks after this event and have any brain function whatsoever? We know that if you cut off all circulation to your finger, after a couple of weeks you’re going to be looking at a black, dead finger. Actually, we know that this would occur in a matter of hours, not weeks, but you get the picture.
Even after all these tests were done by numerous physicians, as well as a court appointed expert from Stanford, and all found the same result, Jahi’s parents and attorney rejected the findings. And the rest is history…
The act of a patient breathing on their own (or even requiring ventilation but showing attempts to take their own breaths at any time) is inconsistent with any finding whatsoever of brain death. Certainly there have been people who are not brain dead but show the absolute minimum of functions. Their quality of “life” is essentially the same, but if they pass any test on the list of required tests, they cannot be declared brain dead. Coma, persistent vegetative states, etc. are all devastating conditions, but they are not brain death by any stretch of the imagination.
Perhaps @wis75, @frugaldoctor, or any other physicians who post on CC can do a better job of describing brain death determinations. I want to make it clear that I’m “just a nurse.” 
Nrdsb4, what I was really asking is whether EEG, CBF or Cerebral Angiography are performed on patients who are breathing on their own. I got the point that such a patient could not be classified as brain dead. Are these tests how persistent vegetative state or other conditions are diagnosed?
Also, there is no such thing as “just a nurse,” whatever physicians are saying.
Of course the tests you mention are done on patients who are breathing on their own, but they are being done for other diagnostic reasons not associated with brain death determination.
You can google each of those tests and you will find information about the various reasons these tests would be done on a person who is breathing on their own or even on someone who is on a vent but does make occasional efforts to take their own breaths.
@eyeamom said:
I read today on a medical blog that not only did she have surgery, but that after multi organ failure, she was coded for over 2 hours before she was “called.” The blog is run by a physician who allegedly received information from someone present at several of Jahi’s recent hospital admissions.
Because this has not been officially corroborated, I can’t take it as factual. Even if you take the entire account as fiction, the alleged course of her decline sounds extremely plausible from a medical standpoint.
Thanks for the information, Nrdsb4, hoping I never need to look up those tests. I do appreciate your commentary.
I have a dumb question…who pays for these surgeries and hospital admissions? Can a brain dead person even have medical insurance?
."who pays for these surgeries and hospital admissions? "
You do. You and all the other taxpayers. Jahi was on Medicaid (taxpayer funded insurance) first in California where the surgery occurred and then in New Jersey where she was transferred after her brain death. In addition, Jahi’s mother got financial and legal support from some of the organizations who are dedicated to right-to-life type causes (such as the one formed by Terry Schiavo’s family).
That’s one of the many, many issues with this case that the media did not explore.
She had a trach placed when she was moved to New Jersey. You cannot stay on a ventilator long term. I also believe a feeding tube was placed as well. I am a critical care nurse and I read the articles that were posted. One thing I was reading was that the nurses documented that patient was bleeding and doctor was notified. No new orders received. I cannot tell you how many times I have called the doctor repeatedly during the night with patient concerns and nothing was done. I am sure she received good nursing care. Unfortunately, sometimes doctors do not listen to nurses. Such a shame as this probably could have been prevented if they caught the urgency of this.
Those reports don’t come from the medical record. There were all kinds of stories being reported after this sad story became public: that Jahi’s family gave her food against policy, that nurses said this or that, etc. But none of that can be taken as fact unless and until the medical record is made public.
There is a documented case of a boy who was declared brain dead who was maintained on a ventilator for almost 20 years. But that is so rare. Usually, once a patient is declared brain dead, the families are convinced to say their goodbyes. Every once in a while, they refuse, and hospitals remove the patient from the ventilator after a death certificate is filed. Even more rarely, cases like Jahi’s go on until the body shuts down on its own.
Sure you can. But you can’t stay on a ventilator with an ET tube in place long term. Is that what you meant to say?
This entire situation is heartbreaking! I just hope the family can recover after all the decisions that were made to focus solely on Jahi.
While I accept the opinions of all of the medical personnel who declared her brain dead, I can also understand why her parents were unable to accept the truth. The human body is remarkably complicated and dead does not always look like dead. The fact that her body did not deteriorate in the expected way made this all the more confusing to her parents.
And if they truly did not believe she was dead, it makes a certain kind of sense that they would not simply declare her so and have a funeral for her. Their faith obviously compelled them to treat her as if she were alive because in their mind she was.
Her faith was mentioned many times. Anyone have any idea exactly which faith that was?
Jahi’s family has always been rather vague about what religion they practice that rejects the notion of brain death.