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On my last rotation through IM we had a geriatric patient in the ICU that wasn't coming off the vent. And my attending allowed the family to wait until after the holidays before they had to start making EOL decisions...this patient SAT in the ICU for just under 3 WEEKS before t-giving! It just seemed crazy to me to allocate the resources like that just to spare a family's thanksgiving.

This is a tragedy turned circus.
 

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On my last rotation through IM we had a geriatric patient in the ICU that wasn't coming off the vent. And my attending allowed the family to wait until after the holidays before they had to start making EOL decisions...this patient SAT in the ICU for just under 3 WEEKS before t-giving! It just seemed crazy to me to allocate the resources like that just to spare a family's thanksgiving.

This is a tragedy turned circus.
Peg, trach --> long term care. Happy holidays.
 

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Some real idiocy in this case http://www.cbsnews.com/news/teen-left-brain-dead-after-tonsillectomy-to-get-second-opinion/ :

"The family's attorney also asked Judge Evelio Grillo to allow a third evaluation by Paul Byrne, a pediatric professor at the University of Toledo. The hospital's attorney objected to Byrne, saying he is not a pediatric neurologist.

Byrne is the co-editor of the 2001 book "Beyond Brain Death," which presents a variety of arguments against using brain-based criteria for declaring a person dead.

In a phone interview, Byrne said he could not comment in detail because he had not seen any of Jahi's medical records. But the fact that her ventilator is still functioning properly is a sign that she is alive, he said.

"The ventilator won't work on a corpse," he added. "In a corpse, the ventilator pushes the air in, but it won't come out. Just the living person pushes the air out."
 
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http://www.cnn.com/2013/12/23/health/jahi-mcmath-girl-brain-dead/

I'm speechless. I can accept the fact that the mother is uneducated, or in denial, but the sensationalist monkeys who call themselves reporters should know better.

There should be clear laws about this kind of stuff.

The law IS clear - the child is dead. But hey - this is California, where judges routinely see themselves as above the law. And now they want a doctor that actually thinks brain dead isn't really dead because the ventilator pushes air in but "only the patient can push the air out which means she is still alive". WTF? Talk about tragic comedy.
 

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"Under the law, brain dead is 'dead' when it connotes death by neurological criteria. In such circumstances, if accurately determined, there is no legal right to continue life support of what is, essentially, a cadaver." Yes, Wesley, a cadaver with a beating heart, circulation, and respiration who moves when stimulated. But to avoid those in the operating room seeing responses, a paralyzing drug is given. When these paralyzed "brain dead" patients are cut into to take their organs, the heart rate and blood pressure increase, similar to what the anesthesiologist observes during surgery when the anesthetic gets too light. Yes, that means response to pain!
http://www.renewamerica.com/columns/byrne/131224

And we all know that pain is an important cortical reflex. </sarcasm>
"The ventilator won't work on a corpse," he added. "In a corpse, the ventilator pushes the air in, but it won't come out. Just the living person pushes the air out."
Elasticity = life. Must be the new E=mc2.

If this how a UToledo Professor thinks like, I am already afraid of their graduates.
 
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Not to change the subject (but I'm not really), but it appears CNN has made sensationalizing end-of-life withdrawal issues their thing this holiday season: http://www.cnn.com/2013/12/23/health/pregnant-life-support-texas/index.html?hpt=hp_t2

"Complicating an already difficult situation is that Munoz is also pregnant, about 18 weeks along, WFAA reported. Texas state law prohibits withdrawing or withholding life-sustaining treatment from a pregnant patient, regardless of her wishes." Sigh.

Ever since the story about the young girl on the lung transplant wait list, it seems like families have had tremendous success with going to CNN about these medical sympathy stories.
 

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http://www.renewamerica.com/columns/byrne/131224

And we all know that pain is an important cortical reflex. </sarcasm>

Elasticity = life. Must be the new E=mc2.

If this how a UToledo Professor thinks like, I am already afraid of their graduates.

Yeah I guess somebody with severe emphysema must be less alive then. Seriously, who is this jokester and does he need to go back to his first year physiology class?

I'd also like there to be a quote from the family about how they'll be paying for her hospital stay since the day she was declared brain dead. Oh wait...
 
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so not to argue, but if the patient is breathing on her own, she is not brain dead.
If she were breathing on her own, this would be a clear-cut case: peg, trach and long-term care facility for vegetative state. But she is ventilator-dependent, which at this point makes her brain dead.

The judge agreed today:
http://www.cnn.com/2013/12/24/health/jahi-mcmath-girl-brain-dead/
A judge has concluded that 13-year-old Jahi McMath, who suffered complications after tonsil surgery, is brain dead.

But it's unclear what will happen next to the California teen.

An attorney representing her family told reporters they haven't decided yet whether to appeal the judge's decision, which came after a court-appointed doctor testified Tuesday that Jahi was brain dead.

The judge has ruled that Jahi will remain on life support at least until December 30. Family members said they planned to spend Christmas in her hospital room, opening gifts and sipping hot chocolate.
It's unclear why he feels the populist need to waste public money by postponing any decision for after December 30th. Can we send him the bill?
 
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If she were breathing on her own, this would be a clear-cut case: peg, trach and long-term care facility for vegetative state. But she is ventilator-dependent, which at this point makes her brain dead.

The judge agreed today:
http://www.cnn.com/2013/12/24/health/jahi-mcmath-girl-brain-dead/

It's unclear why he feels the populist need to waste public money by postponing any decision for after December 30th. Can we send him the bill?

just for clarification, being ventilator dependent does not make you brain dead. if she is initiating breaths on a ventilator but still requires it for support, she is not brain dead. i imagine that this is not the case, given that she was declared and physicians are testifying to the facts, but the wording does matter
 
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if you switch from A/C to SIMV and nothing changes, brain dead.

someone probably already thought of that during her eval.

"The family's attorney also asked Judge Evelio Grillo to allow a third evaluation by Paul Byrne, a pediatric professor at the University of Toledo. The hospital's attorney objected to Byrne, saying he is not a pediatric neurologist.

"The ventilator won't work on a corpse," he added. "In a corpse, the ventilator pushes the air in, but it won't come out. Just the living person pushes the air out."

Dr. Byrne, the heart and the brain are part of different organ systems.
 

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if you switch from A/C to SIMV and nothing changes, brain dead.

That doesn't matter at all. If she isn't breathing above the vent that alone doesn't make her brain dead, there are multiple other reasons for that. However, her breathing above the vent does rule it out. If she is on CMV(Continuous Manditory Ventilation, the accepted nomenclature for AC) or IMV she can breath above the vent implying some function, the mode doesn't matter, whether she gets a preset tidal volume or what she takes is irrevelent.
 
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calvnandhobbs68

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That doesn't matter at all. If she isn't breathing above the vent that alone doesn't make her brain dead, there are multiple other reasons for that. However, her breathing above the vent does rule it out. If she is on CMV(Continuous Manditory Ventilation, the accepted nomenclature for AC) or IMV she can breath above the vent implying some function, the mode doesn't matter, whether she gets a preset tidal volume or what she takes is irrevelent.

However, I would assume none of this could be true in a case of confirmed brain death with an apnea test.
 

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However, I would assume none of this could be true in a case of confirmed brain death with an apnea test.

Right. Just wanted to clarify that switching modes is irrelevant in the context stated above. A patient has the ability to breath above the preset minute ventilation in either mode suggested.
 

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That doesn't matter at all. If she isn't breathing above the vent that alone doesn't make her brain dead, there are multiple other reasons for that. However, her breathing above the vent does rule it out. If she is on CMV(Continuous Manditory Ventilation, the accepted nomenclature for AC) or IMV she can breath above the vent implying some function, the mode doesn't matter, whether she gets a preset tidal volume or what she takes is irrevelent.

poorly worded post night shift attempt at moribund humor in reply to post #63. the spontaneous breaths by SIMV are a more recognizable waveform than supported initiated breaths on A/C. never meant to imply that breathing above the vent confirms or rules out brain death. the patient has already been extensively evaluated by neurology, it would be ridiculous if something as similar as central apnea had not been ruled out. disregard.
 

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All we need now is a non-practicing physician Senator to opine on the case from afar, based on carefully examined CNN footage.

Wonder who'll get the trach/PEG consult ...
 

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What's in it for the accepting facility? Loads of press (yes I am familiar with the mantra all press is good press), minimal reimbursement if any, and the inevitable plug pull whenever the family is finally ok with it? I feel bad for all involved, but now we are going to see court ordered surgical procedures?

I wonder if anyone in that hospital will sign up to operate/anesthetize or if all providers will rally and object? Could you be forced to or can this be like refusing to perform late abortions etc? Ugh.
 

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A trach & PEG for long term care are not emergency procedures. Only the dumbest surgeon on the face of the earth would voluntarily get entangled with this case and that family.

And it looks like the hospital isn't interested: "Children's Hospital Oakland does not believe that performing surgical procedures on the body of a deceased person is an appropriate medical practice."
 

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If they asked me to trach and peg I would tell them to f*ck off and I have zero respect for any physician who gives in and does the procedures. There is no way they can force a person to perform the procedure, but they can force the hospital to grant temporary privileges to someone who is willing to do it. It would be nice if the coroner says no to the transfer so that the hospital is then off the hook. Also, what a f*cking shyster nursing facility that is willing to keep a dead patient in their facility. Just crazy.

As far as that guy from Toledo, I would say that aside from his ideas sounding ridiculous it would be easy enough to exclude him from rendering an opinion since he is not practicing in California and is going against the legal definition of death for California by saying brain dead is not actually dead.
 
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All we need now is a non-practicing physician Senator to opine on the case from afar, based on carefully examined CNN footage.

Wonder who'll get the trach/PEG consult ...

No doubt some climber will step up.
 

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I find the insurance part incredibly hard to believe and I feel like they may have made the whole transfer thing up just to try to make the hospital look worse. As the hospital said, they still don't have the name of whatever "facility" this is.
 

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She's not going anywhere. We've all been there trying to keep brain dead people going for organ donation. They're still dreaming that she's in a coma.
I'm sure the PICU team is working to keep things going, and it's going to get a lot harder.
 

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Yes, every ASA 6 I have taken care of was pretty difficult to keep going. Nature will take care of her sooner rather than later.
 

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so what im getting from this thread is that, even if the anesthesiologist works his/her ass off and a rare, freak accident occurs, his or her life- and all of those involved- can be ruined? How?Wouldn't malpractice help them? I'm confused as to how doctors should be thankful and scared everyday that there was no accident so they won't get sued.
 

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so what im getting from this thread is that, even if the anesthesiologist works his/her ass off and a rare, freak accident occurs, his or her life- and all of those involved- can be ruined? How?Wouldn't malpractice help them? I'm confused as to how doctors should be thankful and scared everyday that there was no accident so they won't get sued.
Bad outcome does not always equal malpractice. I would bet the majority of "bad outcomes" get nothing at all. Looking at the other thread, many folks don't even pay for the teeth they broke.
 

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Bad outcome does not always equal malpractice. I would bet the majority of "bad outcomes" get nothing at all. Looking at the other thread, many folks don't even pay for the teeth they broke.
If someone has jacked up teeth that break that sounds fine, or if the anesthesiologist took all proper steps, but due to difficult airway or whatever a small chip occurred. This case will almost certainly have a suit filed for malpractice, but it isn't clear that malpractice actually occurred (I don't really believe anything the family says because they don't seem like the brightest tools in the shed)
 

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On my last rotation through IM we had a geriatric patient in the ICU that wasn't coming off the vent. And my attending allowed the family to wait until after the holidays before they had to start making EOL decisions...this patient SAT in the ICU for just under 3 WEEKS before t-giving! It just seemed crazy to me to allocate the resources like that just to spare a family's thanksgiving.

This is a tragedy turned circus.

We had a similar situation at the children's hospital with a case of congenital lobar emphysema. Oxygenating really poorly even with ventilator support. Situation continued even after getting the affected parts resected. Parents were very adamant about not taking their barely 1 year old daughter off ventilator until the head of PICU sat them down and had a long conversation. It was very sad to watch but deep down the parents knew it was going to happen.
 
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so what im getting from this thread is that, even if the anesthesiologist works his/her ass off and a rare, freak accident occurs, his or her life- and all of those involved- can be ruined? How?Wouldn't malpractice help them? I'm confused as to how doctors should be thankful and scared everyday that there was no accident so they won't get sued.

where does the responsibility to the patient end? when they leave PACU? when they leave the hospital? we havent been very good about defining this as a specialty.
 

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where does the responsibility to the patient end? when they leave PACU? when they leave the hospital? we havent been very good about defining this as a specialty.

What responsibility are you talking about?

If a patient has an uneventful anesthetic and recovers as expected in the PACU and is discharged from PACU under appropriate discharge criteria, it's tough to blame the anesthesiologist if something bad happens after that. But that's assuming the care was reasonable. If a 20 year old kid had their tonsils out and I gave them 50 mg of morphine over 60 minutes between OR and PACU and discharged them home 60 minutes later, I'll look pretty bad if they have a respiratory arrest at home.

If a patient is an inpatient, there is only so much blame the anesthesiologist can take once a patient is discharged from PACU and taken to a floor or ICU where they are under the care of an inpatient physician.
 
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What responsibility are you talking about?

If a patient has an uneventful anesthetic and recovers as expected in the PACU and is discharged from PACU under appropriate discharge criteria, it's tough to blame the anesthesiologist if something bad happens after that. But that's assuming the care was reasonable. If a 20 year old kid had their tonsils out and I gave them 50 mg of morphine over 60 minutes between OR and PACU and discharged them home 60 minutes later, I'll look pretty bad if they have a respiratory arrest at home.

If a patient is an inpatient, there is only so much blame the anesthesiologist can take once a patient is discharged from PACU and taken to a floor or ICU where they are under the care of an inpatient physician.

Based on the limited data available- failure to resuscitate, or discharging the patient from PACU while bleeding would be the only thing that I can think of that could possibly tag the anesthesiologist.
 

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Bad outcome does not always equal malpractice. I would bet the majority of "bad outcomes" get nothing at all. Looking at the other thread, many folks don't even pay for the teeth they broke.
Certain bad outcomes are almost always punished, though, despite the fact that the patient signed a truly informed consent and assumed the risk. The jury are humans, not robots, and not very smart humans to being with. The general population does not understand that one can do its best and bad things can still happen. So expect to be punished for bad outcomes despite the fact that you were not negligent (in your physician peers' eyes).

The worst thing lawyers did to this country was to not allow a grown-up citizen to waive his/her malpractice rights (at least partially).

P.S. The only reason people don't sue for broken teeth is that no malpractice lawyer would waste time for a fraction of $10-20K.
 

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so what im getting from this thread is that, even if the anesthesiologist works his/her ass off and a rare, freak accident occurs, his or her life- and all of those involved- can be ruined? How?Wouldn't malpractice help them? I'm confused as to how doctors should be thankful and scared everyday that there was no accident so they won't get sued.
That's exactly how it is. And it can happen in any specialty, although the less acute the lower the chances.

We have a bad PR image, and the general population juries likes to "punish" us, the big bad doctors. You don't hear of most cases because they get settled, but a settlement will make you look at least partially guilty for the rest of your professional life. This is probably the only profession where your list of civil harassments (read malpractice suits) is not only easily-accessible public record, but also basis to be denied a professional license or facility privileges.
 

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That's exactly how it is. And it can happen in any specialty, although the less acute the lower the chances.

We have a bad PR image, and the general population juries likes to "punish" us, the big bad doctors. You don't hear of most cases because they get settled, but a settlement will make you look at least partially guilty for the rest of your professional life. This is probably the only profession where your list of civil harassments (read malpractice suits) is not only easily-accessible public record, but also basis to be denied a professional license or facility privileges.

Dramatic injuries (even with appropriate care) in relatively routine, traditionally low risk procedures are tough to defend and often result in the biggest payouts.
 

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That's exactly how it is. And it can happen in any specialty, although the less acute the lower the chances.

We have a bad PR image, and the general population juries likes to "punish" us, the big bad doctors. You don't hear of most cases because they get settled, but a settlement will make you look at least partially guilty for the rest of your professional life. This is probably the only profession where your list of civil harassments (read malpractice suits) is not only easily-accessible public record, but also basis to be denied a professional license or facility privileges.
That's terrifying. It shouldn't be like that. Too many people think doctors are the big bad, greedy wolf. That's not fair at all. So what, a case goes south and there is an accident and it settles. You may get fired because of that???

Btw, was it always so litigious back when docs had more respect?
 

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So what, a case goes south and there is an accident and it settles. You may get fired because of that???

It's extraordinarily uncommon to "get fired" or lose hospital credentials after a bad outcome unless there was really, really gross negligence involved. And usually not even then.
 
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That's correct. However, getting privileges in a different hospital and different state might not be a piece of cake.
Dramatic injuries (even with appropriate care) in relatively routine, traditionally low risk procedures are tough to defend and often result in the biggest payouts.
That is correct. Even if a low-risk surgery has a less than 1% (but more than 0%) chance of serious complications, imagine defending the case with the patient who got her first stroke or heart attack during GA in an ambulatory setting. God forbid your patient had a MAP under 60 or a significant BP drop for even a minute, even if 99.99% of your ASA 1-3 patients will do fine with both of those. Patients (and juries) just can't accept that not everything can be prevented; in their minds, 90% of the bad outcomes are due to poor medical care. They want to blame somebody, and they will NOT blame God (or Nature, or whatever Flying Monster they believe in). For their peace of mind, they might need just one POS "expert" that will lie on stand against you.

Average IQ is 100. That is VERY LOW, actually, compared to the average truly intelligent person. Jury decisions are taken with the majority of votes, so if you have 7 people with IQ <=100 (which is highly probable statistically) you are screwed (this is why malpractice premiums tend to be higher in counties with many stupid/uneducated people - litigious patients and unpredictable jury outcomes). We live in a society where people love to blame everybody else, except themselves, and their own stupidity.

You are not being judged by YOUR peers. You are being judged by average Joe's peers, many of whom are nothing like the average physician.

P.S. Disclaimer: I have never been involved in any malpractice, but I have read about enough decent physicians who have been traumatized for life after making non-major mistakes any of us could have done (or just having sheer bad luck). One professional mistake can destroy your life like nowhere else in the entire world.
 
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and so it begins

http://www.dailynews.com/health/201...tioned-after-two-cases-of-severe-brain-damage

"Children’s anesthesia questioned after two cases of severe brain damage"

12/27/13
RODEO – Two years before a 13-year-old California girl was left brain-dead following a tonsillectomy, another Children’s Hospital Oakland patient was left with catastrophic brain damage following a common tonsil surgery to treat sleep apnea.

Rebecca Jimenez, of Rodeo, once a smart and vivacious elementary school student, can no longer walk, talk or communicate with her family following her Sept. 6, 2011, elective tonsillectomy and adenoidectomy, the most common surgery with general anesthesia for kids in America.


Rebecca and her parents sued the hospital, its anesthesiology unit, the surgeon and anesthesiologist Dec. 9, 2011, for medical negligence and settled with the latter three for $4.4 million, according to court documents. They reached their final settlement, with the hospital, on Nov. 26, but the amount has not been announced.

Part of the money has been placed into a trust to pay for 24-hour-a-day care for Rebecca, 11, who, unlike Jahi, shows some brain activity.

Different doctors were involved in each girl’s surgeries, although both girls began showing signs of distress in the hospital’s pediatric intensive care unit.


Rebecca’s attorney, Richard Schoenberger, said he has reached out to Jahi’s family to offer assistance any way possible. “It is eerily and sadly reminiscent — startlingly so — to what happened to Rebecca.”

The twin tragedies have raised further questions about the use of tonsillectomies to treat sleep apnea, as well as the level of care at the highly respected East Bay hospital. Should pediatric tonsillectomy patients have second thoughts about Children’s Hospital Oakland?

“I don’t know; that’s why it’s so terrifying to see this,” Schoenberger said.


“I do think it’s unfair to indict a whole hospital, one that is very good at what it does,” he said. “It’s more important to find out how it happened and prevent it from happening again.”

A hospital spokeswoman said the hospital could not comment on pending litigation but released a statement:

“Over the course of its 100 years, Children’s Hospital & Research Center has successfully cared for tens of thousands of children who have had great outcomes. In fact, we have saved countless lives,” Cynthia Chiarappa said. “Unfortunately, as happens in hospitals across the nation with any complicated surgery, there are risks involved, and there are rare circumstances when complications arise. We are sorry that Jahi McMath suffered catastrophic complications and hope that her family can find closure in this sad situation.”


A judge ruled the hospital can discontinue life support Monday, but Jahi’s family said Thursday it is planning to move Jahi to a long-term care facility in the Bay Area that has agreed to care for her.

The 13-year-old girl underwent what the hospital called a “complicated” surgery Dec. 9 removing her tonsils and other throat and nose tissue, according to the hospital, to treat her severe sleep apnea. She started bleeding shortly after surgery, eventually going into cardiac arrest and losing brain function, according to the results of six doctor examinations.


Her mother claims that nurses in the PICU told her the bleeding was “normal” and left it up to her and Jahi’s grandmother to control the bleeding.

Calls, emails and texts to Jahi’s family and attorney were not returned Thursday, and Schoenberger said Rebecca’s family declined to comment.

Rebecca’s court and medical records raise questions about her post-surgical care. In contrast to Jahi’s surgery, the hospital called Rebecca’s procedure “uncomplicated,” according to the medical records; it did not involve the removal of other throat and nose tissue.


The 8-year-old girl came out of surgery disoriented, with her head slumped sideways, saying over and over “me duele,” Spanish for “it hurts,” according to medical records. Her mother told nurses she looked pale, had cold fingers, and her eyes, when open, were not focused, according to the records included in court documents.

Her mother was told to give Rebecca pain medicine when she returned home, but the mom asked how she could do it if Rebecca was not opening her mouth, so the nurse gave her extra morphine through a drip. When asked by her mom whether she was ready to go home, Rebecca replied “mmm” without moving her head. The girl was loaded onto a wheelchair without the input of the anesthesiologist, according to the settlement documents.


On the drive home, her mother grew concerned when her daughter became extremely pale, with her eyes rolled back in her head, her heart racing, so she called the postoperative hotline from the car, according to the medical records. The parents were reassured and told to call back in five hours if the symptoms did not improve, records show.

Five hours later, the mother brought Rebecca to the emergency room, where doctors realized she was in critical condition. A CAT scan discovered a cerebral and brainstem edema, or severe swelling of the brain, that deprived oxygen to the brain, records show.


“We believed then and we believe now that Rebecca’s condition is such that she should never have been discharged,” Schoenberger said. “Had she not been discharged, she wouldn’t have suffered the fate she did.”

Schoenberger said there are very good doctors and nurses at the hospital but said a “constellation of mistakes” led to Rebecca’s plight.

Now 11, Rebecca is confined to her bed with no voluntary movement in her extremities, and requires a feeding tube. She laughs and smiles in response to being tickled and when listening to cartoons, and cries when the television is turned off, but that is the extent of her reactions, according to a plan prepared for court that estimates her care the rest of her life will cost between $5 million and $10 million.


“She was a delightful, wonderful, smart, beautiful little girl,” Schoenberger said. “She was her parents’ pride and joy, and now she’s a shell of a human being.”

Schoenberger said Rebecca’s family has been touched by Jahi’s story.

“At one point, they were not sure that Rebecca would make it,” he said. “That’s why the family is very sympathetic to this loving family.”
 
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jwk

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While both are bad outcomes, the details seem a lot different. Don't you love how attorneys band together?
 

dpmd

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Interesting that the anesthesiologist had to pay when it seems that the nurses discharged the patient without anesthesia input.
 

core0

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If they asked me to trach and peg I would tell them to f*ck off and I have zero respect for any physician who gives in and does the procedures. There is no way they can force a person to perform the procedure, but they can force the hospital to grant temporary privileges to someone who is willing to do it. It would be nice if the coroner says no to the transfer so that the hospital is then off the hook. Also, what a f*cking shyster nursing facility that is willing to keep a dead patient in their facility. Just crazy.

As far as that guy from Toledo, I would say that aside from his ideas sounding ridiculous it would be easy enough to exclude him from rendering an opinion since he is not practicing in California and is going against the legal definition of death for California by saying brain dead is not actually dead.
So far every one has begged off. I can easily see ending up in front of the Medical Board for abuse of a corpse. According to what I read the hospital is even refusing to place a feeding tube.

We had a similar case with a patient that was declared brain dead. A family member got a hospital in another state to accept the patient in transfer (when our lawyers pointed out that state law prohibited the transfer of a corpse across state lines without embalming or cremation the decided against the transfer (they weren't told the patient was brain dead). In our case the family got a court order prohibiting removal of life support (again family conveniently forgetting to tell the court that the patient was brain dead). The patient then arrested which led to us calling the lawyers to ask if we could disconnect the ventilator (there was also concern that people could be held for contempt of court for letting the patient die).

I saw a similar case in another state where the parents went to court and got a court order. In that case the intensivist handled this but calling the judge and asking " the MAP is now less than 40 what would you like to do" "No you took over medical care of the patient when you signed the court order" "No I need specific medical orders on how to treat the patient". This was followed a few minutes later by a fax cancelling the court order.

On the other hand:
http://journals.lww.com/ccmjournal/...ble_brain_death_after_cardiopulmonary.44.aspx
 

calvnandhobbs68

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So far every one has begged off. I can easily see ending up in front of the Medical Board for abuse of a corpse. According to what I read the hospital is even refusing to place a feeding tube.

We had a similar case with a patient that was declared brain dead. A family member got a hospital in another state to accept the patient in transfer (when our lawyers pointed out that state law prohibited the transfer of a corpse across state lines without embalming or cremation the decided against the transfer (they weren't told the patient was brain dead). In our case the family got a court order prohibiting removal of life support (again family conveniently forgetting to tell the court that the patient was brain dead). The patient then arrested which led to us calling the lawyers to ask if we could disconnect the ventilator (there was also concern that people could be held for contempt of court for letting the patient die).

I saw a similar case in another state where the parents went to court and got a court order. In that case the intensivist handled this but calling the judge and asking " the MAP is now less than 40 what would you like to do" "No you took over medical care of the patient when you signed the court order" "No I need specific medical orders on how to treat the patient". This was followed a few minutes later by a fax cancelling the court order.

On the other hand:
http://journals.lww.com/ccmjournal/...ble_brain_death_after_cardiopulmonary.44.aspx

Yeah these one off articles are the reason there's a bit of a debate over whether there should be ancillary tests involved demonstrating lack of cerebral blood flow (nuc med, trans-cranial doppler, CTA, MRA) along with the clinical exam. Some would argue that if you have a clinical exam consistent with brain death with persistent arterial flow, you should hold off declaring someone brain dead until you have a repeat study showing no brain activity or arterial flow (even though this isn't part of the AAN guidelines and isn't a requirement at all for diagnosing brain death).
 

dr doze

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So far every one has begged off. I can easily see ending up in front of the Medical Board for abuse of a corpse. According to what I read the hospital is even refusing to place a feeding tube.

We had a similar case with a patient that was declared brain dead. A family member got a hospital in another state to accept the patient in transfer (when our lawyers pointed out that state law prohibited the transfer of a corpse across state lines without embalming or cremation the decided against the transfer (they weren't told the patient was brain dead).

Actually you can transfer a corpse across state lines without embalming or cremating. Both embalming and cremation are contrary to Jewish funerary custom. However, you do have to have the body refrigerated. I have had it done for family members. It can even be done internationally. Packed in dry ice. Of course the heart would stop beating in that case.
 
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calvnandhobbs68

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Another week taking up a hospital bed. What a joke.

This case gives me another reason why I never want to work in California.
 
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