Saturday, October 17, 2015

Brain death 2

A teenage girl is hooked up to a respirator in New Jersey, her heart still beating, her brain the subject of a fractious dispute over what many consider long-settled medical standard: the point at which someone can be pronounced dead.

Jahi McMath was declared brain dead by doctors in California nearly two years ago after a simple tonsillectomy went horribly wrong. Her family fought with doctors over the diagnosis and went to court, where they persuaded a judge to allow them to bring her across the country to a facility that would care for her.

More recently, Mikey LaVecchia — a 13-year-old victim of a Wayne car crash that killed his father — was transferred out of St. Joseph’s Regional Medical Center in Paterson after his doctors, too, declared him brain dead and his family vehemently objected, saying they had given up on him too soon and were pressuring them to donate his organs. Mikey died weeks later when his mom agreed to take him off life support...

Mikey and Jahi’s families’ allegations that doctors misdiagnosed their deaths cut deep into that delicate fabric of trust with the doctors on the cases. In both cases, the families found solace and support from the International Brain Research Foundation. The controversial New Jersey-based group argues that the term “brain dead” has been misapplied to some patients – and that tests are being done too quickly and too early in some cases to make an accurate diagnosis...

“The knowledge of the brain is so elementary compared to what we need to know,” said Philip DeFina, chief executive officer of the Brain Research Foundation, based in Flanders. “We’re still at the early stage of understanding how complex the brain is.”

The foundation argues for more sophisticated testing, which can take days or weeks before a determination is made about whether a patient’s brain has ceased to function.

The group has been praised by some for challenging the standards on brain death and criticized by others for pushing, as one neurologist put it, “quackery.” Its claim that it has helped people wake up from prolonged comas and improve after severe brain trauma with experimental regimens has further rankled critics...

"None of these people are ever going to wake up,” said Dr. Michael E. Shapiro, surgical program director of New Jersey Medical School at Rutgers. “None of these people are ever going to breathe on their own. None of these people are ever going to open their eyes and see anything. None of these people are ever going to recover.”...

Dr. Charles Prestigiacomo, chairman of the Department of Neurological Surgery at Rutgers’ medical school, wrote an affidavit in the McMath case, noting that tests indicate Jahi does not meet the diagnostic criteria for brain death. DeFina and four other clinicians also provided sworn declarations...

 After news reports about the case, LaVecchia said the Brain Research Foundation reached out to her. Although doctors at the second hospital came to a similar grim conclusion about her son’s brain death, LaVecchia said the hospital was open to her talking to outside consultants and trying what she called “unconventional” tests and treatments — such as adding Omega 3 and other nutrients to his feeding tube — as well as performing an MRI, a CAT scan and a transcranial Doppler scan.

LaVecchia, who lives two hours away on Long Island, stayed with Mikey in his room in intensive care. Her parents and other family stayed nearby at a Ronald McDonald House. Every morning, they would gather to discuss Mikey’s test results and compare notes on their research. They raised money to pay for a plane ticket for Dr. Calixto Machado, a Cuban neurologist and a principal researcher in the foundation, to fly in to evaluate Mikey. It was the only fee she paid to the foundation, she said.

In addition to brain-death cases like Mikey’s, the foundation claims to have treated 138 patients who were in a deep and prolonged coma or a persistent vegetative state — cases where patients are not considered “brain dead” but hopes for living a meaningful life are grim. The foundation said 90 have recovered — some to the point of being able to return to past lives — after undergoing an experimental protocol.

That treatment involves electrical and sensory stimulation as well as off-label use of prescription medicines to regulate chemicals in the brain. It also includes administration of more than 30 different types of nutrients, such as Omega 3 and high-potency Vitamin D, which are believed to stimulate brain activity...

Mikey’s family clung to hope in the first three weeks after he was transferred. They continued to see movements and what they believed to be responses to pain as they massaged Mikey’s arms and legs.
Then, those movements began to wane. After Machado evaluated Mikey on Sept. 16, he and DeFina told the family they saw no sign that his brain was functioning, LaVecchia said. They convinced the family there was no hope for improvement.

The next day, Mikey was removed from his ventilator and died, his mother and grandmother by his side.

LaVecchia is grateful for the additional measures taken and the advice and help from DeFina, who spent a lot of time with the family and even attended her son’s wake.

“I needed to know 100 percent,” she said, “that there was nothing that could be done.


See:"Post-mortem" movements  8/21/15


  1. The family of a Oakland teenager who was declared brain dead after suffering complications from sleep apnea surgery has shared an update saying, “as you can see she is still alive and just as beautiful as ever.”

    But almost two years after the surgery, Jahi McMath, now age 15, is still on life support.

    In an update recently posted to Facebook, the family shared photos of the girl and stated:

    “Hello everyone. As requested here is the latest pic of Jahi. Our little sleeping beauty is doing great and progressing. She is moving more on her mothers command. As you can see she is still alive and just as beautiful as ever. Flawless skin! She will be 15 in a few days. Thank you all for the continued love, support and prayers!”

    The girl’s mother has kept her organs functioning on life support since her operation went awry at an Oakland hospital, where she was determined to be brain dead.

    McMath was declared brain dead after the 2013 operation, which gained national attention during a court fight over the removal of her life support. Her family then moved to New Jersey in a controversial decision that also made headlines.

    The family’s attorney, Chris Dolan, argued in court papers filed last year that 13-year-old Jahi McMath is no longer brain dead and shows significant signs of life.

    Dolan acknowledges that a recovery from brain death would be a medical first. But he says brain scans show electrical activity and that she responds to verbal commands from her mother.

    Lawyers for UCSF Benioff Children’s Hospital say the evidence in Jahi’s case still supports the determination that she is legally dead.

  2. A court in California has permitted Jahi McMath’s mother to present evidence that Jahi ”has standing” to bring a lawsuit.

    From the court’s order sustaining a demurrer (meaning the original pleadings were insufficient to go forward):

    CHO’s demurrer…is SUSTAINED…WITH LEAVE TO AMEND to allege facts sufficient to state a cognizable cause of action by Jahi against CHO…for negligence, including facts to the effect that Jahi has standing to bring the cause of action despite the issuance of a death certificate on January 3, 2014.

    [Ed. Note. CHO refers to Children’s Hospital Oakland.]

    What does that mean? A dead person does not have standing to sue.

    In other words, the court opened the door for the presentation of evidence that Jahi McMath is not dead, that is, her current condition does not meet the clinical criteria for a declaration of brain death.

    There is reason to think that could be done. It has been nearly two years since Jahi’s medical catastrophe, and yet, her body has apparently not deteriorated as generally occurs in a brain death situation.

    Declarations from respected physicians have concluded she exhibits neurological functions that are inconsistent with a deceased person.

    Note that the judge ruled that saying she is dead because a death certificate so declares she is dead will not be determinative if the plaintiff can offer pleadings indicating facts to the contrary.

    I agree with bioethicist and law professor, Thaddeus Mason Pope’s, take:

    This is a significant ruling…although a California court has already declared Jahi dead (in 2013), that fact can now be re-litigated. To be sure, this is a ruling only about pleading. If the First Amended Complaint (due in early November) can allege sufficient facts, then Jahi must still later offer sufficient evidence to substantiate them. Still, it seems that the amended complaint had better be pretty detailed.

  3. An Oakland, Calif., teen who was declared brain-dead by doctors in December, 2013 "is still alive and just as beautiful as ever," her mother wrote in a recent Facebook post.

    The mom, Nailah Winkfield, gave an update about her daughter, Jahi McMath, on Wednesday, saying she was moving more on her mother's command.

    "Hello everyone," Winkfield wrote in a post at Keep Jahi Mcmath on life support. "As requested here is the latest pic of Jahi. Our little sleeping beauty is doing great and progressing. She is moving more on her mothers command. As you can see she is still alive and just as beautiful as ever. Flawless skin! She will be 15 in a few days."

    In a post Friday, Winkfield listed an updated image of her daughter with braids for her 15th birthday on Saturday.

    Jahi was declared legally dead On Dec. 12, 2013, following complications from tonsillectomy. Although multiple experts confirmed that nothing more could be done for the girl, her family moved her to an undisclosed facility that agreed to continue treating her.

    Chris Dolan, the family’s attorney, filed papers last year arguing that medical experts, including world-class experts on brain death, said she is not brain-dead.


  4. “Is anyone aware of a dead person coming back to life?” That is the question Dr. Drew asked his panel just weeks after Jahi McMath was declared brain-dead. Nearly two years later, the question still stands.

    McMath, the young girl who suffered post-surgery complications on December 12, 2013, celebrated her birthday on Sunday.

    New photos of the teen were posted to her community Facebook page with the caption, “Happy Birthday Beautiful Jahi, You Are 15 today, your friends love you, your family love you, many many people worldwide love you, but most importantly God loves you.”

    The 15-year-old and her family have been at the center of a legal battle as doctors and judges declared the teen dead, but her family refuses to let her go.

    Just three days before her birthday, family members posted this photo with an update, saying she is "doing great and progressing."

    Dr. Drew was not surprised by the recent photos, saying, “She’ll have skin breakdown, aspiration pneumonia, urinary infections, but that can all be treated and that can go on indefinitely often times." But questions, "What’s the end game? Her parents think she will wake up, but that will never happen.”

    He believes it is unethical to keep her on life-support, but acknowledges the difficult situation the parents are in. “I don’t blame the parents, I blame the caretakers who gave them a distorted version of what’s really going on." Adding, “The medical professionals that sustain the body when the brain is dead do not give the parents the chance to grieve the person who is no longer there.”

  5. When last we visited the Jahi McMath case, a judge gave her mother the chance to file an amended complaint showing that Jahi is alive, with the assurance that if properly pleaded, evidence of life could be brought.

    She seems to have done just that. From Thaddeus Mason Pope’s blog Medical Futility, quoting the amended complaint:

    30. Since the Certificate of Death was issued, Jahi has been examined by a physician duly licensed to practice in the State of California who is an experienced pediatric neurologist with triple Board Certifications in Pediatrics, Neurology (with special competence in Child Neurology), and Electroencephalography. The physician has a sub-specialty in brain death and has published and lectured extensively on the topic, both nationally and internationally. This physician has personally examined Jahi and has reviewed a number of her medical records and studies performed, including an MRI/MRA done at Rutgers University Medical Center on September 26, 2014. This doctor has also examined 22 videotapes of Jahi responding to specific requests to respond and move…

    34. The female menstrual cycle involves hormonal interaction between the hypothalamus (part of the brain), the pituitary gland, and the ovaries. Other aspects of pubertal development also require hypothalamic function. Corpses do not menstruate. Neither do corpses undergo sexual maturation. There is no precedent in the medical literature of a brain dead body developing the onset of menarche and thelarche.

    35. Based upon the pediatric neurologist’s evaluation of Jahi, Jahi no longer fulfills standard brain death criteria on account of her ability to specifically respond to stimuli. The distinction between random cord-originating movements and true responses to command is extremely important for the diagnosis of brain death. Jahi is capable of intermittently responding intentionally to a verbal command.

    36. In the opinion of the pediatric neurologist who has examined Jahi, having spent hours with her and reviewed numerous videotapes of her, that time has proven that Jahi has not followed the trajectory of imminent total body deterioration and collapsed that was predicted back in December of 2013, based on the diagnosis of brain death. Her brain is alive in the neuropathological sense and it is not necrotic. At this time, Jahi does not fulfill California’s statutory definition of death, which requires the irreversible absence of all brain function, because she exhibits hypothalamic function and intermittent responsiveness to verbal commands.

    Woof. That should be enough to get the case beyond the pleadings stage and into the collection and presentation of evidentiary proof.

  6. The family of a 13-year-old Oakland girl who was declared brain dead is expected to announce the filing of a federal lawsuit on Wednesday.

    The suit apparently claims that Alameda County violated Jahi McMath’s civil rights when it issued a death certificate for the girl.

    The teen was declared brain dead more than two years ago after undergoing complications during a sleep apnea surgery at Children’s Hospital in Oakland.

    She’s now at a facility in New Jersey where machines keep her organs functioning.

    "The fact that the state refuses to recognize the mountain of evidence that Jahi McMath does not meet brain death criteria is the most grave of injustices. In essence, they proclaim that once she is determined to be brain dead they will never revisit, or reconsider, the death sentence no matter what factual evidence is presented. This is like refusing to reconsider a death sentence when evidence is presented demonstrating that the original conviction was erroneous, and the condemned is innocent," wrote Christopher Dolan, the attorney for McMath and her mother, Nailah Winkfield.

    McMath’s family continues to insist she’s alive.