Thursday, July 13, 2017

Jahi McMath

Jahi McMath suffered catastrophic complications from throat surgery in December of 2013 — 3 1/2 years ago.

She was soon declared to be brain dead, and Oakland Children’s Hospital informed her mother, Nailah Winkfield, that life support would be terminated.

Winkfield sued, but after an independent medical examination, the judge ruled that Jahi was deceased and allowed a death certificate to be issued. He also played Solomon, and worked out a settlement whereby Children’s Hospital transferred Jahi to her relatives while still on life support. We now know she was moved to New Jersey, where she remains today.

At the time, I believed Jahi was dead, and so wrote.

But I also wrote that if she did not deteriorate as almost all people with properly determined brain death do, my eyebrows would raise. Since then, Jahi has not deteriorated, but apparently, her body’s condition has improved. My eyebrows are above my hairline.

A judge has permitted Winkfield to demonstrate that the death declaration was erroneous. Important evidence in that process was just filed in the penalty of perjury declaration of an internationally respected neurologist, who states that Jahi’s condition is no longer consistent with a brain death determination.

First, he notes that one of the bases for declaring Jahi dead was the-then apparent ongoing deterioration of her body. From the Declaration of D. Alan Shewmon, starting at page 21 (my emphasis):

Jahi’s deterioration in late December 2013 and early January 2014 was held up [by diagnosing doctors] as proof that she was most certainly a corpse being artificially maintained with the appearance of life….

Upon transfer to St. Peter’s Hospital in New Jersey, she received the tracheostomy and gastronomy feeding tube that were refused in Oakland. She received the enteral feedings that her gut was supposedly unable to handle and that would only be deleterious.

With proper nutrition and other treatments for a patient requiring intensive care, her intestines healed, her skin torgor and pulmonary status recovered to normal, and she regained spontaneous maintenance of blood pressure without pressor medications.

She still requires blankets to maintain temperature, but for the past 3+ years she has remained remarkably healthy, apart from being severely neurologically disabled. 

And here’s something I didn’t know:

Most of that time she has not even been in the hospital, but an apartment with the assistance of nothing more than a ventilator, excellent nursing care, hormone supplementation, and nutrition.
Such recovery from impending multisystem failure and such improvement in overall health, as Jahi exhibited in the early months of 2014, is not possible on a ventilated corpse.

 After describing other matters related to Jahi’s condition — such as her entering puberty — Shewmon reaches a stunning conclusion, given the history of this case and the failed adamancy of Children’s Hospital that the courts refuse permission to prove Jahi is alive:

What the above evidence and reasoning show is…that Jahi  McMath was never truly dead, even though she fulfilled the accepted medical criteria for death in December 2013. She exhibited to brain function at the time, but the cessation of at least two functions — consciousness and hypothalamic regulation of menstruation and sexual development — has proved not to be irreversible. (Shewmon’s emphasis).

This is important because irreversibility is an essential element of death, whether caused by total brain or cardio/pulmonary failure.

Shewmon’s conclusion:

Jahi McMath is a living, severely disabled young lady, who currently fulfills neither the standard diagnostic Guidelines for brain death nor California’s statutory definition of death. At the very least, in the matter of life versus death, the compelling evidence [in videos] of responsiveness to commands and of puberty warrants giving life the benefit of the doubt.

I think more is needed  here than dueling court declarations. This case is a matter of tremendous importance — to Jahi and her family, to science (it may be the first known case of recovery from brain death), and to our faith in the integrity of the medical system.

Thus, I urge the court to appoint several prominent medical experts to examine Jahi, and not just for a day or two, but over an extended time to determine whether she is sporadically responsive and to test her brain and body functions to best determine whether she still meets all the criteria of brain death.

If she does not, the death certificate should be rescinded, regardless of the impact on or consequences to the hospital’s finances in the malpractice suit — which would still require proof of negligence causing Jahi’s injury — upon the public’s perception of brain death or any potential implications for organ donation.

Read more at:


  1. Dr. Shewmon's declaration: (36 pages)

    See paragraph 25-

  2. Also on Monday, the story of Jahi McMath took a much different turn: a noted California neurologist said that he’d decided after studying 49 videos of the brain-dead girl that she was actually alive and getting better.That finding, submitted in a legal filing, could bolster the family’s case to keep Jahi hooked up to a ventilator while they purse legal action against Children’s Hospital in Oakland where the girl underwent a failed surgery in 2014.

    The recent developments in these two high-profiles cases that have captured the world’s attention promise to fuel the rousing debate around end-of-life issues such as when to remove a loved one from life support.

    Bioethicist Alta Charo, a law professor at the University of Wisconsn, says the two cases, while involving different circumstances, share a common theme: balancing the wishes of a patient’s family with the needs and mandates of the medical establishment and, in turn, society as a whole.

    “One of the hardest problems in modern medicine,’’ says Charo, “is deciding the moment when further treatment is futile.’’

    On one side, the question for doctors is how confident the medical diagnosis is, and “brain death criteria,’’ she says, “have been hard to pin down.”

    The other question is the level of hope help by the patient’s family: “A one-in-a-million chance to one person might seem like hope but to another may seem futile,” she says. “So it’s a subjective thing.’’

    “Ultimately,’’ says Charo, “it’s appropriate for society to overrule parents when the child is determined to be suffering without any benefit to be gained by the proposed treatment or when there’s a demand for the public to cover the costs of futile care. But knowing whether something is futile is a very tricky business.’’...

    On this side of the Atlantic, relatives of McMath in 2015 quietly moved their daughter from the hospital in Oakland to an undisclosed location in New Jersey where she remains hooked up to a ventilator. The recent finding by UCLA neurologist Dr. Alan Shewmon now threatens to further complicate the case while giving McMath’s family hope that she’ll somehow survive her ordeal.

    As both the McMath and Gard stories continue to unfold, their cases are stirring widespread and at times angry debate over how such dilemmas should be resolved. Dr. Paul Byrne, a pediatrician who like Shewmon and others has questioned the definition of brain death, said in court documents that he visited McMath and saw her respond to her grandmother’s voice and touch with a squirming movement.

    “In my opinion this signifies she is not dead,” Byrne said at the time. “She should receive treatment as she is alive just like everyone else with severe head injury. … If she gets treatment, she will have a chance to recover brain function.”

    But even among medical professionals, there are sharp differences of opinion on what “death” really means sometimes.

    “Sadly and tragically,” said Dr. David Magnus, a pediatrics professor and Chair of the Stanford Center for Biomedical Ehtics, “Jahi McMath has already died.”