Tuesday, September 6, 2016

Closure 2

September 2, 2016 (Life Legal Defense Foundation) -- Just days ago, two-year-old Israel Stinson was forcibly removed from life support at Children's Hospital of Los Angeles. I was on the phone with Jonee Fonseca, Israel's mother, when doctors disconnected his ventilator.

I could hear Jonee begging the doctors to wait just a few more hours until her family arrived to say goodbye to Israel. They refused. Then I heard her begging her son to breathe.

It was a horrific end to an ordeal that began over four months ago. Israel suffered an asthma attack and stopped breathing while being treated at a Sacramento hospital on April 2 of this year. He was resuscitated, but was placed on a ventilator.

Jonee called Life Legal for help when a second hospital declared Israel brain dead. Doctors at Kaiser Permanente Medical Center in Roseville, California said Israel's condition would soon deteriorate and that his heart would stop beating even if he were kept on life support. They refused to feed Israel for over five weeks, saying that giving him a feeding tube would be “catastrophic.”

Life Legal attorneys were able to obtain court orders in state and federal court keeping Israel alive until arrangements could be made to care for Israel at home. In order for that to happen, Israel needed two minor procedures to provide him with a breathing tube and feeding tube. Kaiser refused to perform those procedures.

A Catholic hospital in Central America agreed to accept Israel as a patient to do the procedures. In May, Israel was transported by air ambulance to Guatemala. He had to leave a hospital with state-of-the-art healthcare and travel thousands of miles to a developing nation to get the care he needed to survive.

After the procedures, Israel's condition improved markedly. Doctors did two EEGs, which showed active brain waves. Three separate doctors reported that Israel was not brain dead! Moreover, the doctors were so committed to saving Israel's life that they agreed to treat Israel without cost during the last few weeks at the Guatemalan hospital.

Jonee then began the arduous process of finding a hospital that would accept Israel temporarily while she arranged for him to be cared for at home. Children's Hospital of Los Angeles agreed to admit Israel after speaking with Israel's doctors about his condition.

However, shortly after Israel arrived at Children's Hospital, doctors threatened to end Israel's life. They refused even to look at the EEGs or examine Israel's movements in response to his mother's voice. They did not consider that Israel's condition in Guatemala had stabilized such that he needed no artificial means to maintain his heart rate, blood pressure, or body temperature. Jonee asked that a Los Angeles neurologist be permitted to examine Israel, as California’s brain death statute requires an independent exam. The hospital refused.

Ten days ago, Jonee called me saying the hospital was going to remove Israel’s ventilator the following day. I flew to Los Angeles to assist her in obtaining a court order. The judge ordered that Israel be kept on life support for three weeks to allow the neurologist to complete his exam. We also found a local attorney to work with Jonee going forward.

But the hospital immediately filed a motion asking the judge to dissolve the court order so they could terminate Israel’s life as soon as possible.

Again, Life Legal attorneys fought heroically alongside Jonee, but ultimately the fight for Israel's life was lost.

So where do we go from here?

Last January, in a unanimous decision, the Nevada Supreme Court held that the state’s brain death guidelines should be reexamined after a young woman was declared brain dead even though several EEGs showed that she had active brain waves. In that case, the woman died because the hospital refused to feed or treat her.

We have no ethical obligation to fight nature every step of the way in the dying process. However, these cases continue a very disturbing trend of medical professionals actually facilitating a person’s death. Life Legal has represented people in several recent cases where hospitals and hospice facilities have tried to end the life of a patient with a brain injury because doctors or family members believed that person had no chance for recovery. In reality, however, the decision was made in haste, before the person's brain had a chance to heal. In two cases, young women were sentenced to death who, just weeks later, were on their way to a full recovery. This should NEVER be permitted to happen!


See:  http://childnervoussystem.blogspot.com/2016/06/brain-death-5.html


  1. Israel Stinson permanently lost brain function when a heart attack severely restricted oxygen flow to his head. Three different California hospitals declared the child brain dead, but his parents insisted he could recover. Their lengthy battle in the state's courts came to a sudden end when a judge ruled that the Children's Hospital of Los Angeles could remove the toddler from his breathing ventilator.

    "I was on the phone with his mother when the doctors disconnected him," Alexander Snyder, the family's lawyer, said Friday. The Life Legal Defense Foundation is representing the couple pro-bono. "They were in such a hurry to do it, they didn't even sit down and explain what was going on."

    His parents still had hope, claiming Guatemalan doctors recorded electrical activity in Israel's brain. They took their son to Central America after the first two diagnoses, and brought him back to the United States hoping the Los Angeles hospital would continue care. But the California doctors all agreed that Israel would never recover, and the ethical decision was to remove him from life support.

    While people may differ on the definition of "brain dead" for religious reasons, the medical and legal communities understand it as the "irreversible loss of brain function." Unlike a coma or persistent vegetative state, brain death is permanent, and there's no known case of anyone recovering.

    "It's the end of life. It's not just my opinion. It's law and widely accepted among all neurologists," Dr. Wade Smith, director of neurologic intensive care at the University of California, San Francisco, told the Sacramento Bee.

    Since Fonseca and Stinson hoped to care for their son at home, his death came as a heartbreaking surprise. "They are devastated," Snyder told CBS. "I think still in shock. It's not even my child; I am still in shock this could happen so quickly."


  2. According to Israel Stinson’s parents, the family battled doctors, judges, and medical centers for months before they found a Guatemalan hospital that provided the family with the home it needed to continue their fight. Fox 40 reports that the hospital conducted an electroencephalogram, or EEG, and the results contradicted Israel’s official California diagnosis of brain death. The family of little Israel Stinson claims that the test conducted by the Guatemalan hospital showed brain activity.

    Following the diagnosis out of Guatemala, the family of Israel Stinson consulted with Children’s Hospital of Los Angeles, which reportedly agreed to admit 2-year-old Israel. The family believed they were on their way to a long-term care plan that would facilitate what they hoped would be the beginning of Israel Stinson’s recovery. Unfortunately, Israel Stinson’s mother, Jonee Fonseca, says that the family’s dream quickly became a nightmare.
    “Right when we got there they discussed home care with us, and not even two days later they, started telling us they wanted to perform their own test, but they never did their own test.”

    According to Fonesca, Children’s Hospital of Los Angeles told her that Israel Stinson’s recent Guatemalan medical records were invalid, and the hospital went to court to get an order to immediately disconnect 2-year-old Israel from the ventilator keeping his body, if not his brain, alive.

    At the time Israel Stinson was admitted to Children’s Hospital of Los Angeles, he was protected by a restraining order that prevented medical personnel from removing him from life support. However, when the hospital took the case back before a Los Angeles Superior Court judge last Thursday morning, the judge sided with the hospital’s appeal.

    According to the judge, the restraining order protecting Israel Stinson from being removed from the ventilator was null and void. It was immediately dissolved, giving the hospital the legal authority required to remove Israel’s breathing tube.

    Just hours later, and without consent from Israel Stinson’s disbelieving family, the little boy was removed from life support and died.

    “They pulled the plug about 3:10 p.m., that day. They gave me till 4 o’clock to say my goodbyes.”

    According to Israel Stinson’s mother, she doesn’t even understand why the California hospital would agree to admit the toddler if they were just going to have him removed from life support. Fonesca believes her son would still be clinging to life if she had known what the hospital had planned.

    “I could have still been in Guatemala, fighting for my son’s life, if we didn’t come back.”

    Additionally, Israel Stinson’s mother alleges that the hospital rushed to take her son off of life support knowing full well that her legal team was going to appeal the Superior Court judge’s decision to remove him. Rather than give 2-year-old Israel’s family a chance to file an appeal, the hospital removed the toddler from life support within mere hours of the judge’s decision to prevent the family from being able to do so.

    “They wanted him gone. He was just wasting money and it just, it just doesn’t make sense. It’s so corrupt they way they went about it. It was so terrible the way everything played out. They had no sympathy for us. They treated us like criminals in there. They had security around as if we’re, you know… they’re killing my child, and they’re treating me like, like I’m overreacting, like I’m doing something wrong.”

    While Israel Stinson’s mother is clearly distraught and has chosen to publicly speak out about her son’s death, the hospital is remaining silent. Citing patient privacy laws, the hospital has said it will not comment on the case of Israel Stinson.

    Read more at http://www.inquisitr.com/3470020/israel-stinson-mother-of-2-year-old-removed-from-life-support-against-familys-wishes-speaks-out-video/#QTCG7R2SFlClzK2u.99

  3. Less than two weeks ago, Children's Hospital in Los Angeles took their son in. But doctors at Children's agreed with the previous two official prognoses—Israel Stinson was brain dead.

    As doctors at Children's sought to have the boy taken off life support, his parents were given a temporary restraining order protecting their son from such action.

    In the end, Children's appealed the order, and won.

    Last Thursday, after five excruciating months of court battles, the war came to a close when a Los Angeles Superior Court judge ordered that Israel be taken off his life support.

    The boy ceased respiratory function immediately.

    Jonee told the Sacramento Bee, simply, "He's gone."

    Caring for children on life support often costs thousands of dollars per day, say many medical professionals. It can also keep other critically ill children with higher chances of survival from getting the care they need.

    But to Jonee and Nate, that's likely a cold comfort.


  4. Israel's battle over brain death declarations and contradictory reports led his family into medical centers and courtrooms around the region. Then recently to a Guatemalan hospital, where his lawyers say the definitive brain death test, an electroencephalogram or EEG, proved he was very much alive.

    Next came consultation with Children's Hospital of Los Angeles.

    Doctors there agreed to admit the Vacaville toddler.

    "Right when we got there they discussed home care with us, and not even two days later they, started telling us they wanted to perform their own test, but they never did their own test," said Fonseca.

    Instead Israel's mom, says Children's L.A. suddenly deemed her son's Guatemalan medical records invalid and rushed to court to disconnect him from life support.

    "That's something that still confuses me. I don't understand why they would even accept us," she said.

    "I could have still been in Guatemala, fighting for my son's life, if we didn't come back."

    When asked about this case, representatives for Children's L.A. would only say "due to health privacy concerns of which we are bound, we cannot comment."

    Fonseca says her child's life was taken by that hospital while lawyers there knew her legal team was appealing the decision allowing for disconnect.

    "They wanted him gone. He was just wasting money and it just, it just doesn't make sense. It's so corrupt they way they went about it," she said.

    "It was so terrible the way everything played out. They had no sympathy for us. They treated us like criminals in there. They had security around as if we're, you know... they're killing my child, and they're treating me like, like I'm overreacting, like I'm doing something wrong," Fonseca said.


  5. The long medical saga of brain-dead toddler Israel Stinson is over.

    On Thursday afternoon, following a surprise ruling by a Los Angeles Superior Court judge, the 2-year-old Vacaville boy was removed from life support, ending a months-long legal battle that took Israel and his parents into courtrooms and hospitals from Sacramento to Guatemala.

    “He’s gone,” a tearful Jonee Fonseca said Thursday by phone from his bedside at Children’s Hospital in Los Angeles.

    Her son, first declared brain-dead in April in Sacramento, was taken off his ventilator around 3 p.m. and stopped breathing almost immediately afterward, according to the family’s attorneys.

    The ruling that abruptly ended the emotional legal proceedings was unexpected.

    “It was a complete shock … a complete turnaround from last week,” said Alexandra Snyder, one of several attorneys representing Israel’s mother.

    Last week, Snyder filed a temporary restraining order preventing the hospital from removing the ventilator, which had kept Stinson artificially breathing since he suffered brain injury following an asthma-related cardiac arrest at UC Davis Medical Center last April. The court granted the temporary order and gave the family until Sept. 8 to bring in another neurologist for a separate evaluation.

    That process was underway, according to Snyder, but the hospital filed an appeal, which was heard Thursday morning. The judge ruled that, since the case had already been adjudicated in state and federal court, the lower court in Los Angeles was dissolving the temporary order and allowing Children’s Hospital to immediately remove the ventilator.

    A hospital spokesman, Lorenzo Benet, said, “Due to health privacy regulations to which we are bound, we are unable to comment.”

    Israel had already been declared brain-dead by three doctors – at UC Davis in Sacramento and at Kaiser Permanente in Roseville. In recent months, Fonseca had sued in state and federal courts, seeking to keep her son on a ventilator with the hope that she could eventually care for him at home.(continued)

  6. (continued)Last May, facing a 9th U.S. Circuit Court of Appeals deadline in their efforts to block Kaiser from removing life support, Fonseca and Israel’s father, Nate Stinson, left the country with their son to seek other treatment in Guatemala. There, doctors at an undisclosed hospital inserted a feeding tube into his stomach and a breathing tube, connected to a ventilator, into his throat.

    In Guatemala, a pediatric neurologist said Israel was not brain-dead based on an electroencephalogram that showed some brain activity, according to Fonseca and Snyder...

    About two weeks ago, the family returned to the United States after Israel was accepted as a patient at Children’s Hospital. After doctors there evaluated the boy, they sought to remove his life support.

    Until Thursday’s ruling, Snyder said she and Fonseca were lining up an appointment for an outside neurologist to evaluate Israel, who never opened his eyes or communicated after his initial hospitalization.

    Israel’s medical odyssey began April 1, when he was brought to a Mercy Hospital emergency room with a severe respiratory attack related to asthma. Transferred to UC Davis Medical Center, he suffered cardiac arrest and underwent about 40 minutes of CPR before a doctor declared him brain-dead.

    During the protracted legal proceedings, Israel’s parents were represented by two pro bono legal firms, Snyder’s Life Legal Defense Foundation in Napa and the Pacific Justice Institute in Sacramento. They argued in their legal claim that parents have constitutional rights to make health decisions for their children.

    “They killed him … he’s stopped breathing,” Kevin Snider, chief attorney with the institute, said in a statement. His group sued Kaiser last spring in state and federal court, seeking to block efforts to remove Israel from his ventilator. That lawsuit was left in limbo after Fonseca and Nate Stinson took the child to Guatemala.

    Snider said Children’s Hospital had “rushed to court” to get the restraining order dissolved before another physician could evaluate Israel. “They knew that attorneys were frantically trying to get a window of reprieve … but they charged forward despite that.”

    It’s unclear why Children’s Hospital took Israel as a patient given that a California death certificate was pending. It had been issued by Kaiser but not signed off by the parents.

    Professor Arthur Caplan, a medical ethicist at New York University School of Medicine who has written extensively on brain-death diagnoses, speculated that the hospital’s decision to accept Israel may have been simply an effort to “reconfirm the diagnosis that death had come.”

    “I suspect they were trying to do the right thing and see if maybe a change in environment might get the family to accept what was true,” Caplan said.

    Despite the contentious legal battles, Caplan said he hoped the hospital is providing counseling to the grieving parents. “No one wants to accept the death of a child.”

    Dr. Wade Smith, a University of California, San Francisco, neurologist who has been involved in more than 30 brain-death diagnoses, said he hopes Israel’s parents will gain closure.

    “This is a very sad story that draws strong emotions on all sides,” Smith said. “I do think that it helps support the practice of brain-death declaration, a practice that is important for physicians, patients and medical practice in general. Perhaps his parents can find peace now.”

    Read more here: http://www.sacbee.com/news/local/article97861097.html#storylink=cpy

  7. The parents refused. They kept the body of their son alive, going so far as to take him to Guatemala for interim treatment, then bringing him back to California. There is some question as to why the local hospital here in Los Angeles accepted Israel as a patient, but they did. But finally, recognizing his brain dead condition, the hospital petitioned the courts to allow them to pull the plug. The parents had the help of pro bono legal support and won a few days and a little false hope. Then a local judge pulled the plug judicially, and the hospital performed the physical act of turning off life support.

    The Los Angeles Times reporter Erica Evans began the account of Israel's last moments by describing him as "angelic-looking." It's true. The pictures look like a sleeping baby. It's only when you see the YouTube videos that you realize that there is almost no response to continued prodding and poking, in spite of the parents' desperate belief that they are seeing something going on.

    I am going to make a conjecture here. The parents saw Israel as injured, but somehow still with us. In photos, he looks like a sleeping baby. The parents refer to their strong religious beliefs, and felt (I think sincerely) that God was telling them to keep going. That's how they describe their beliefs on video. Perhaps they hoped that some day, this sleeping baby would awake to some level of normality. In brief, the parents were viewing their baby as comatose, and capable of recovery. It's true that some people in comas eventually wake up, sometimes years later. But they have to have intact brains for this to happen.

    These beliefs were opposed by members of the medical profession. There were several neurologists who did the standard, accepted tests, and concluded that brain death had occurred. The news story says that the doctors "declared the boy brain dead," as if it were an arbitrary ruling rather than a careful judgment based on the evidence of physical examination and lab tests.

    One YouTube discussion involved the legal definition of death. The attorney pointed out that in some states, death is defined as the cessation of heart beat rather than brain death. It was kind of irrelevant in the context, but it is part of the wider public policy question.

    Another public policy question that is of utmost importance but was avoided almost entirely, involves whether there is any obligation for any entity, public or private, to continue providing long term care. Lack of payment in a system which avoids government funded of national health care is just one element in the discussion. The other question is whether an entity, public or private, can be compelled to continue treating a person that is, in their judgment, already dead at the level of the brain. It's a legitimate question.


  8. Two year-old Israel Stinson, the curly-haired, angelic-looking toddler whose fight for life gained international attention, died Thursday after he was removed from a breathing ventilator against his parents wishes.

    Now, supporters of the family are questioning why a Los Angeles hospital moved so quickly to remove him from life support immediately after a judge upheld the decision.

    Israel’s parents, Jonee Fonseca and Nathaniel Stinson, sought an injunction Aug. 18 to prevent Children’s Hospital of Los Angeles from taking action while they rushed to make arrangements to put him in home care.

    On Tuesday, the hospital informed Israel’s mother that they would file a motion to oppose the injunction, and on Thursday the motion was filed. The family’s struggle to save Israel ended when Los Angeles County Superior Court Judge Amy D. Hogue ruled in favor of the hospital’s decision, and immediately following the ruling, Israel’s ventilator was removed...

    The family is “devastated,” Snyder said. “They lost their son yesterday after a long, long battle for him and for his life, so they are understandably heartbroken.”...

    But Israel’s parents disagreed. Doctors dismissed the boy’s small movements as involuntary muscle twitches, but the parents saw them as signs of life.

    “Israel’s medical chart at Kaiser said he was deceased. But Israel is ALIVE!” wrote Fonseca, 23, in a GoFundMe.com post. “God is telling me not to let go.

    Israel’s parents, who also have a 1-year-old daughter, sought donations from strangers to help them move their son to a different facility. Their plan was to eventually take Israel home and care for him, but first the boy needed operations to insert feeding and breathing tubes, which Kaiser hospital refused to perform.

    While they gathered donations, the parents fought the hospital in court to keep Israel on life support.

    “We believe that we should have the last say over our son’s life, not a government building or not a corporation,” Stinson, 28, said in an April 29 video he and his wife posted. “And we believe our son is still alive.”

    After a federal judge rejected the family’s lawsuit May 13, they flew Israel to a private hospital in Guatemala where doctors were willing to give him breathing and feeding tubes. Until that point, Israel had been surviving on a diet of dextrose, or sugar, according to his mother...

    Then, after about three months, Israel was accepted as a patient at Children’s Hospital in Los Angeles. The family was able to return to the United States and checked the boy into the hospital Aug. 8.

    Soon however, Fonseca and Stinson’s worst fears were realized when the Los Angeles hospital also determined that Israel should be taken off life support.

    “I’m just baffled as to why the hospital would have agreed to take him for the sole reason of putting him to death,” Snyder said. “They knew his condition when he came to the hospital.”...

    Providing intensive care for children such as Israel on life support can cost thousands of dollars a day, according to some health professionals, who argue that such care, while seeming compassionate, can jeopardize the health of other critically ill children who could use those resources.

    Snyder said lawmakers should review the circumstances under which an individual can be declared brain dead.

    “If you can declare someone brain dead who has brain activity, then we need to revisit the guidelines for what that means,” she said.

    In rare cases, Snyder said children have recovered after being diagnosed.

    “There are people who have recovered, and if that happens even once, you have to revisit it,” she said.


  9. At what cost to keep toddler alive?

    Re “Brain-dead toddler taken off life support” (Page 1A, Aug. 26): As an RN, mother and grandmother I extend my deepest sympathy to the family of Israel Stinson. As a strong proponent of quality of life over quantity, I feel immense relief that this child is no longer being tormented by tubes, needles and hopeless interventions.

    While I have profound sympathy for his parents, I have to wonder how they could afford all these months of intensive care for Israel, including moving him to a foreign country.

    I admire the Superior Court judge who ended this prolonged agony for Israel and his parents.



    Health care lesson from travesty

    This was a case of complicated grief with legal system entanglement. Thankfully Children’s Hospital Los Angeles and the judge had the compassion to end this travesty. The parents have suffered the greatest loss that can be borne and can now start the healing process.

    Each time this case came to media attention, the question should have come up: Who is paying for all this? A day in a pediatric ICU costs $20,000 to $30,000. Custodial ventilator care costs a portion of this. This has been going on for five months.

    Health care costs $3 trillion a year and one-third of that is wasted – no benefit, futile and possible harm. This case was emotionally charged because the patient was 2 years old. If there had been hope, then sure, let’s give it our all. That said, we as a society must come to grips with saying no to wasted health care.



    Read more here: http://www.sacbee.com/opinion/letters-to-the-editor/article98216267.html#storylink=cpy

  10. Can a court and a hospital take away the life of an allegedly "brain-dead" child on life-support system even if the child's parents still want to fight for their kid's life? Sadly, the answer is "yes" in Los Angeles, California.

    Although his parents fought hard to keep him alive, two-year-old Israel Stinson died last Thursday when the Children's Hospital Los Angeles decided to detach him from the hospital's life support system. The hospital reached this decision, which ran counter to the wishes of the child's parents, after a Los Angeles Superior Court judge lifted the temporary restraining order keeping him alive.

    The hospital facilitated the death of the innocent child despite the fact that Israel's parents were in the process of filing a court appeal, according to a report from Life Site News.

    Alexandra Snyder, executive director for the Life Legal Defense Foundation (LLDF) who helped fight for little Israel's life, was shocked and baffled by the hospital's decision. She maintained that the doctors were supposed to keep the child alive, not hasten his death.

    What's even worse, Snyder said, was the fact that the child died away from his parents.

    "As soon as it happened, they told the parents to leave, to get out of the hospital," Snyder told Life Site News, "which means they could not properly say goodbye to their son. It was just horrendous."

    "There's got to be a better way to do this," she added.

    Israel was transferred to the California hospital earlier this month, after spending over two months in a medical facility in Guatemala. The child has already been declared "brain dead."

    Despite this, Israel's family refused to give up on him. His parents still tried to find a long-term care elsewhere to keep him alive, maintaining that the child was still showing signs of responsiveness.

    "Why would a hospital with no obligation to take him agree to take him and give these parents hope, with the singular intention of ending his life?" Snyder said.


  11. It is hard to birth a baby; even harder to lose one. No words can describe the state of mind of parents who have lost their children. Jonee Fonseca and Nathaniel Stinson are beyond devastated after the medical staff at Children’s Hospital Los Angeles removed their 2-year-old from life support, following a court order that left their son Israel Stinson dead.

    The parents, Fonseca and Stinson had fought tooth and nail to keep their baby alive. They had taken him to Guatemala for a more precise diagnosis of his condition. Doctors there, unlike their American counterparts, believed that baby Israel was not brain dead. They conducted the electroencephalogram (EEG) tests, which showed some brain activity following which, the Children’s Hospital Los Angeles accepted him as a patient.

    However, later the doctors there decided it was time to take the baby off support. This led to a legal battle between the parents and the hospital, states a report by CBS News. Fox 40 adds that the parents then secured a restraining order that ensured Israel was on life support till September 9th, giving everyone time to understand more about his situation. However, a Los Angeles Superior Court judge dissolved the order on Thursday, resulting in him being taken off the ventilator.


  12. Nearly five months of legal battling ensued, as the California toddler's parents—who did not agree with the prognosis—fought to keep him on life support. The fight ended abruptly Thursday, after what the Sacramento Bee calls a "surprise ruling" by aLos Angeles Superior Court judge that the boy be removed from life support.

    He stopped breathing almost immediately. "He's gone," Israel's mom Jonee Fonseca tells the Bee. At the beginning of the saga, she and Israel's dad, Nate Stinson, initially had Israel transferred from Davis to Kaiser Permanente in Roseville; that hospital also determined he was brain-dead, the Washington Post reports.

    They refused to sign a California death certificate issued by Kaiser, started a GoFundMe campaign, and filed an injunction to stop Kaiser from removing him from the ventilator.

    All the while, they posted videos and updates for their supporters and got pro bono support from lawyers. A federal judge rejected the injunction in May, so Israel's parents took him to Guatemala, where, according to his parents, an electroencephalogram showed brain activity.

    Children's Hospital in Los Angeles then accepted Israel, and he was brought there about two weeks ago—but doctors at Children's agreed he was brain-dead and sought to take him off life support. Israel's parents were granted a temporary restraining order, but the hospital successfully appealed. (The family of Jahi McMath is in a similar fight.)


  13. Hospitals have always served as a lifeline to survival. Whether from pneumonia, heart attack, stroke, or trauma, they have been a community safeguard between life and death.

    Today, a cost of care has been added to the patient treatment discussion forcing medical decision-making to look closely at expense. Financial considerations have come to the forefront as preservation of resources will be important to national health care. This can be a threat to hospitalized patients teetering on the edge of life where the gray-zone of technology does not provide all answers, especially regarding brain death. There are adverse and often tragic results of uncertainty in this diagnosis.

    A two-year-old is swiftly removed from life support by a hospital before the family can appeal a court order. A son has power of attorney to make decisions for his recently stroked mother and requests a feeding tube, but is denied by the hospital. A family sees their father declared “brain dead” by two doctors, both employed by the hospital, and the ventilator is disconnected.

    Can we assure a hospital is making decisions solely on behalf of the patient they serve, as opposed to maximizing profits that personally benefit administrators in salaries, bonuses, and retirement packages?

    How do we protect the medical and legal rights of a hospitalized gravely ill patient from potential abuse?

    Declaring someone dead in the past was not complicated. No breathing or pulse equals dead. With technology, though, patients can survive on life support: ventilator for breathing; artificial pacemaker to sustain pulse; medication to maintain blood pressure; and feeding tube for nutrition.

    This might preserve the body, but here is the fundamental question: Is the brain viable and will the patient be able to return to a normal life? No one has this answer. But because the legal criteria and implementation for brain death are loose and inconsistent, some hospitals and their lawyers have exploited this ambiguity forcing termination of care.

    To be declared brain dead, certain medical criteria must be met. Some are achieved at bedside by doctor physical exam, and others defined by testing evolved through scientific technology (EEG/brain wave studies, blood flow exams, or the apnea test). Because of extreme variation of physician education and testing interpretation, application of criteria is not consistent and therefore could be subject to manipulation.

    To protect patients from potential abuse, doctors and the public must be better educated on brain death criteria. Loopholes must be shored up, and criteria standardized. With ever-changing science, new testing (like fMRI — a video of brain function) should be harnessed. And finally, utilizing the hospital ethics committee, or having available legal advice through patient advocating ombudsmen can serve as a guide.

    We must be aware of the threat profit and greed play in health care. Through education and vigilance, protecting the vulnerable against those who exploit a deficient and susceptible system might safeguard against adverse and tragic results.

    Gene Uzawa Dorio is an internal medicine physician who blogs at SCV Physician Report.


    Courtesy of Doximity

  14. A different courtroom, a different hospital, different doctors. In the end, the verdict was the same.

    Two weeks ago, the final chapter in Israel Stinson’s young life was closed when a Los Angeles Superior Court judge ruled that the child was brain-dead and could be permanently removed from a ventilator. Hours later, the 2-year-old ceased breathing at Children’s Hospital Los Angeles after being taken off mechanical support.

    As his parents, Nate Stinson and Jonee Fonseca, prepare for his funeral Monday in Fairfield, Calif., court documents provide some answers to the final treatment decisions about the toddler, whose medical and legal odyssey took him to hospitals in Sacramento, Calif.; Guatemala City; and, finally, Southern California.

    While the Vacaville, Calif., couple, who also have a 1-year-old daughter, are “a little more ready to get back to our regular routine,” Fonseca said she still has “a lot of unanswered questions.”

    One of the biggest questions was why Children’s Hospital agreed to accept a child who was declared brain-dead and had a death certificate issued by Kaiser Permanente Hospital in Roseville.
    Last April, Israel suffered cardiac arrest at UC Davis Medical Center after being admitted for a severe asthma-related respiratory attack. Based on a set of nationally established tests, he was declared brain-dead, a diagnosis later confirmed at Kaiser Permanente. But in a months-long legal fight, his parents filed lawsuits in state and federal courts to block removal of his ventilator, then flew with Israel by air ambulance to Guatemala City, where doctors inserted breathing and feeding tubes. After more than two months, the toddler, who never opened his eyes or regained consciousness, was flown back to the U.S. and admitted to Children’s Hospital on Aug. 7.

    In court documents, Dr. Barry Markovitz, medical director of the Children’s Hospital pediatric intensive care unit, said he was unaware of Israel’s complete medical history until after his admission as a patient.

    “When considering whether to accept this transfer, we understood the history of events ... that this was a 2-year-old, who suffered cardiac arrest” following an asthma episode, Markovitz stated. He said Israel was admitted as a “lateral transfer” from a Guatemala City hospital, Nuestra SeƱora del Pilar, to be evaluated for possible care at home with a ventilator.

    It was not until after Israel was admitted, he states, that Children’s Hospital became aware of his brain-death diagnosis, which was confirmed in medical records sent by Kaiser Permanente.

    During Israel’s initial two weeks at Children’s, Markovitz said he showed “no signs” of brain function, except spinal reflexes. He said a formal assessment of brain death was not conducted at Children’s “largely because the determination has already occurred” at UC Davis and Kaiser Permanente. He said Israel’s mother, in an Aug. 9 handwritten note included in the court documents, declined allowing a brain-death apnea test to be performed on her son. (continued)

  15. (continued)Seeking an ethical consultation, Markovitz brought in Dr. Cheryl Lew, chairwoman of the hospital’s ethics committee and a clinical pediatrics professor at the University of Southern California’s Keck School of Medicine.

    “It is clear ... there is no possibility that this child’s brain will recover to the extent ... that he could resume his personhood,” Lew stated in her report. Although Israel is deceased, she stated, “his corpse must be treated with respect” and not subjected to “inappropriate medical interference.”

    She recommended that the hospital give the family adequate time to find alternative care elsewhere, then proceed with removing the “un-natural medical interventions ... which are of no benefit to a dead child and serve only as unnecessary intrusions on his corpse.” She called it “morally permissible and even obligatory” for Children’s Hospital to discontinue all mechanical support “and free this child’s body from inappropriate manipulation.”

    On Aug. 13, Markovitz said he informed Israel’s parents of the decision to withdraw medical services “because of the futility of it.” He offered the family time to arrange for Israel’s transfer to a different facility but said the hospital planned to halt its medical services Aug. 18.

    That day, Fonseca filed a request for a temporary restraining order, blocking removal of her son’s ventilator, in Los Angeles Superior Court. In court documents, Fonseca said a Loma Linda facility, Totally Kids, which cares for children with traumatic brain injuries, had indicated it would have a bed open within a month.

    “If Israel cannot be transferred to home care, I would like him to go to a facility that specializes in children with special needs,” she said.

    Her request was granted until Sept. 8 and the hospital was told to allow an outside neurologist, Dr. Alan Shewmon, to perform an independent examination of Israel. That abruptly changed Aug. 25, when the hospital filed its appeal, asking for the restraining order to be dissolved, partly because Sacramento courts had already upheld Israel’s brain-death declaration by UC Davis and Kaiser Permanente physicians. In one argument, the appeal noted that Shewmon opposes brain death diagnoses and Children’s Hospital had no obligation to admit him onto its premises. The appeal said Israel’s family was free to find another location where Shewmon, a UCLA professor emeritus, could conduct his examination.

    Daniel Woodard, the Southern California attorney who handled the family’s lawsuit pro bono through the Life Legal Defense Foundation, said he’s haunted by the court’s Aug. 25 ruling. “I had my credit card at the appellate court, ready to file an appeal, when I got the call that they had removed the ventilator,” he said. “Professionally, it was the worst day of my life. I was the last person standing between Israel’s life and death.”

    More than five months after Israel’s medical saga began, Fonseca said she and Israel’s father are trying to get their lives back together. The couple both took disability or medical leaves from work. Fonseca said she plans to start classes to become a nurse or perhaps return to her job as a pharmacy technician.

    On Monday, Fonseca said, she hopes her son’s service will be “a going home” celebration.

    “At this point, I don’t feel closure,” she said. “I don’t know what the rush was. I don’t know why Children’s took us, (if) they were just going to do what they did. So many questions go through my mind.”

    Read more here: http://www.bellinghamherald.com/news/nation-world/national/article101240392.html#storylink=cpy

  16. After losing her young son recently when a hospital disconnected his life support, Jonee Fonseca spoke about the little boy she lost and said she wants people to be aware of how her child’s life ended.

    “My son was always an angel,” Fonseca said. “And the meaning of his name, ‘Apple of God’s eye,’ was more true than I had even realized.”

    “I just want people to know the truth about how everything played out,” Fonseca told LifeSiteNews. “I’d hate for it to happen to another family. I hate that it happened to my family.”

    Two-year-old Israel Stinson died August 25 when Children’s Hospital Los Angeles forcibly removed his life support after the hospital fought in court to dissolve a restraining order keeping Israel alive until an independent neurologist could examine him.

    The hospital rushed to pull Israel’s life support at the same time the family was waiting for a judge to hear their appeal, according to Alexandra Snyder, executive director for the Life Legal Defense Foundation (LLDF), making certain the test did not take place.

    “It was terrible the way everything played out,” Fonseca told LifeSiteNews. “I don’t even know how to say how it felt. We had no say.”

    The family battled Kaiser Permanente’s Sacramento-area Medical Center, where Israel was taken after the attack, all the way to federal court to keep him on life support. They decided to have him airlifted for treatment out of the country to a hospital in Guatemala — where he thrived and defied the declaration of “brain death.” But after Children’s Hospital Los Angeles accepted him and he returned to the United States, its decision to remove life support defied explanation for Fonseca’s family and their attorney.

    They were especially baffled because the LA hospital was aware of Israel’s condition while he was at the hospital in Guatemala and had showed willingness to take him knowing the family intended for him to receive treatment.

    The family had been searching for facilities back in the U.S. during his stay in Guatemala so they could come home. They had a Sacramento-area doctor familiar with his case who was willing to oversee treatment and Children’s Hospital Los Angeles had agreed to take Israel.

    Israel’s plight was no secret

    Children’s Hospital Los Angeles was supposed to be an interim stop before Israel was moved to a long-term facility for recovery, which was his parents’ plan all along. His case was well-publicized, and according to Snyder and Fonseca, there was no mistaking his situation or the family’s intent in bringing him there. (continued)

  17. (continued)While Children’s Hospital Los Angeles had initially indicated they would perform their own EEG and treat Israel, this changed within a few days of his arrival. Not only did the hospital refuse to do the test, they disregarded his two EEGs in Guatemala showing brain activity, Snyder said, refused to perform their own EEG, and insisted on deferring to Kaiser for Israel’s “brain death” declaration.

    Fonseca said the hospital expressed unwillingness to conflict with Kaiser or suggest in any way they were wrong, and asked her to sign something apparently agreeing to the hospital’s concurrence with Kaiser.

    “They told me, ‘We can’t go back in time and undo what Kaiser has done,’” Fonseca said. “They said right in front of Israel, ‘Your son is dead.’”

    One doctor insisted on telling her each time he saw her that her son was dead.

    “I got so mad, I said, ‘I don’t want you to say that to me ever again.’”

    After saying it would help the day Israel arrived, the hospital stopped feeding him the next day, and three days in to his stay they began telling Fonseca that Israel was dead. It also took three days for the hospital to tell her they would stop treating him, Fonseca said, “and all this time I’m waiting for them to tell me they’re going to work with me.”

    Instead, she was given three days to find another facility, and each time she contacted one, they would refuse to take Israel after talking with the hospital.

    Fonseca and Stinson got a court order to keep Israel’s life support in place and allow an independent doctor to perform another EEG, but were then informed in an email from the hospital of its intent to dissolve the order and remove life support.

    At the hearing, the judge took no time to make a decision, Fonseca recalled. “She didn’t give it any thought.”

    Snyder then asked for time for the rest of the family to get into town.

    Fonseca said the judge looked at the hospital’s attorney, who said, “No, she’s already had that.”

    Then there was the actual handling of removing Israel’s life support.

    Back at the hospital, Fonseca continued to implore the staff for more time while Snyder filed their appeal.

    “They told me, ‘You have to let him go, your son has been gone since April 14,’” (the date of Kaiser’s declaration of “brain death”),” she stated. “I told them, ‘You’re going against my spiritual beliefs to keep saying he’s dead.’”(continued)

  18. (continued)The couple’s family members called during this time, asking the hospital not to pull Israel’s life support.

    “The hospital questioned me, ‘Who are you calling? What are you doing?’” Fonseca said. “I explained we were appealing for another injunction and they told me, ‘We can’t have that, we have to get this done today.’”

    And despite the court order having no mention of timing, she said, the hospital insisted the judge had ruled for Israel’s life support to be disconnected immediately.

    “Why won’t you give me that time?” Fonseca asked them, to which she was told to produce something from her lawyer to stop them.

    Fonseca got Snyder on speaker phone while Snyder was awaiting a judge. Snyder asked the hospital for more time, but they refused.

    And Fonseca swears Israel was aware of what was coming, appearing restless about it.

    “Israel was grabbing at our hands. He started taking breaths off the ventilator,” she said. “I feel like he knew exactly what was going on. I feel like he knew what was about to happen.”

    Fonseca wasn’t allowed near her son when the hospital pulled him from his life support.

    “They blocked me from him,” she said.

    “They wouldn’t even let me hold his hand,” Fonseca continued, with both hospital security and a doctor physically pushing her hand away from her son as he died. “I tried to run up to Israel to hold his hand.”

    After the machines were unhooked, Fonseca said Israel took another breath.

    “I started to scream, ‘Look! He’s trying to breath!’” with Snyder still listening on the phone.

    After Israel’s life support was disconnected, she was allowed near him again. She began to perform CPR, but she then watched his body change color.

    Fonseca and Stinson were told they had a few minutes with Israel before he was to be taken to the morgue. But that was it. They wouldn’t be allowed more time with him.

    “That’s when I knew it was all so real,” she said. “That’s when I knew they took him in front of my own eyes. All in a big rush.”

    “They treated us like we were criminals,” Fonseca said, “like we had done something wrong.”

    “There was no respect for the family,” Snyder told LifeSiteNews. “And no respect for this little boy.”

    With Israel gone, questions remain for Fonseca.

    “What was so bad about keeping him on life support?” she asked. “Why were they so adamant about taking him from me? ... They said, ‘We can’t undo what Kaiser did, so why did they even take him?’”

    “They’re going to be fine,” she continued. “No one will be held accountable.”

    Having been through months of fighting for Israel’s life, leaving their home, jobs, and school to be with him in Guatemala, the family is holding up, she said, though sometimes she’s uncertain how.

    “I really don’t know. It’s hard,” Fonseca told LifeSiteNews. “I really thought he was going to wake up. I thought we were going to make it.”

    “Someone in the hospital decided he was gone. Now he’s in heaven.”