Mirranda Lawson, 2 yo- Family goes to court to prevent brain death tests

K_Z · Jun 9, 2016

Several cases of children with brain death have been in the news recently, with their families challenging the hospitals thru the courts to prevent withdrawal of life support after the diagnosis of brain death.

This case in Virginia, IMO, signals a new strategy on the part of the activists, especially Dr. Paul Byrne (who is also advising this family), as they arrive and advise families in similar situations. The particular strategy in the tragic and very sad case of Mirranda Lawson is to attempt to legally prevent the hospital physicians from conducting diagnostic tests to determine brain death. As long as those tests are not conducted, the patient, Mirranda Lawson, is not *legally* diagnosed as brain dead.

Despite that, a number of hospitals in the area have declined to accept Mirranda as a transfer patient. The family is now pursuing transfer to home care as their only alternative. Mirranda choked on a popcorn kernal May 11, experienced cardiorespiratory arrest, and has been in an ICU unresponsive and on a ventilator since that time. May 31 a court order prevented docs from conducting brain death apnea testing for 10 days.

*KZ note-- if the child is not legally declared dead, she remains legally alive, and eligible for insurance reimbursement, lawsuits for continued care, and things like state and federal coverage for home care (unlike similar cases of Jahi McMath, Aden Hailu, and Israel Stinson.) There also appears to be a change in strategy to more aggressively try to challenge the laws that allow physicians to determine brain death, and try to persuade courts to rule to make it a "group decision" between parents/ NOK, docs, and courts (versus following established laws in all 50 states).

RICHMOND, Va. (WRIC) — A family is fighting to keep their daughter on life support at VCU Medical Center.

Doctors want to perform a test that could determine if two-year-old Mirranda Grace Lawson is considered brain dead. Her parents say it’s too soon and are fighting back.

“I know my little girl is still in there,” said Mirranda’s father Patrick Lawson. “They just got to give her a chance to wake back up again.”

A few weeks ago, Mirranda choked on a popcorn kernel. While doctors tell the family Mirranda is unresponsive, they say she deserves a fighting chance to heal on her own terms.

http://wric.com/2016/05/25/local-family-fighting-to-keep-2-year-old-daughter-on-life-support/

On May 11, the 2-year-old choked on a popcorn kernel, suffered a cardiac arrest and has been on a ventilator ever since. Doctors say she has a non-functioning brain stem and medicine is keeping her alive.

The parents of Mirranda Grace are fighting against VCU Medical Center, whose doctors want to perform a brain apnea test that would determine if the two-year-old is definitively brain dead.

On Tuesday, a circuit court judge issued a ten day continuance.

In that time, the hospital is required to continue to give Mirranda Grace life sustaining car and also allows the family to find another hospital willing to treat her.

The family has already reached out to Bon Secours St. Mary’s in Richmond, Johns Hopkins Children’s Center in Baltimore and the Children’s Hospital of the King’s Daughters in Norfolk. All have denied the transfer requests saying they would provide the same treatment she’s currently receiving.

http://wric.com/2016/05/31/fight-to-keep-2-year-old-mirranda-grace-alive-continues-in-court/

When asked about the hospitals procedures in cases like these, a spokeswoman issued the following statement:

"VCU Health is governed by federal and state laws. We understand this is a very difficult time for the family and in consideration of them, we do not feel it would be appropriate for us to comment further."
But Lawson just wants to have a voice in his daughter’s future.

“The court, the doctors, the parents should decide it – but it should not just be a doctor that decides it," Mirranda's father said.

A judge has granted the emergency injunction.

That judge is now scheduled to hear the case Friday at noon, but Lawson says he hasn't been able to get an appointment with an attorney until Monday.

http://www.nbc12.com/story/32017097...corn-family-pleas-to-keep-her-on-life-support

Friday, a judge rescinded an emergency injunction, to keep 2-year-old Mirranda Grace on life support at VCU Medical Center.

And even though this court decision was made earlier in the afternoon, Mirranda's father Patrick Lawson says he refuses to have doctors perform this test on his daughter without a court order.

After a nearly 45 minute hearing, Patrick Lawson came out of the courtroom.

“They had more power than I did,” he said sadly.

This after a judge ruled to end an emergency injunction keeping doctors from removing life support for two-year-old Mirranda. The judge said there was no evidence of an inappropriate standard of care.

In essence, tests to confirm Mirranda is brain dead will move forward, which is a devastating blow to the Lawson family, who are holding out hope the toddler will somehow recover.

“The only thing I can hope is that I bought my daughter enough time to 'practice' for her test," the emotional father said. "And she's going to have to take her test now,”

But, in court, Dr. Doug Wilson, head of the pediatric critical care unit, testified Mirranda is unresponsive and has no signs of brain stem function, which controls breathing.

Wilson says, at this point, machines are keeping her alive. He said he wished that wasn't the case.

http://www.wlox.com/story/32026319/richmond-family-loses-court-battle-in-fight-for-2-year-olds-life

http://www.dailymail.co.uk/video/ne...wson-talks-keeping-daughter-life-support.html

K_Z · Jun 9, 2016

The judge continued the case for another 10 days at last Tuesday’s hearing, the family’s attorney told LifeSiteNews, during which time the hospital may not perform the apnea brain death test and must continue to provide life-sustaining treatments.

Phillip Menke said Mirranda is not currently deteriorating and her blood pressure has actually improved, and therefore the main argument in last Tuesday’s hearing was for more time to allow the child to heal, and to ask the court to order the hospital to provide thyroid and other treatments recommended by specialist Doctor Paul Byrne.

“Barring that,” Menke said, “we asked the court to follow state law and provide the family a reasonable amount of time to seek a transfer to another physician.”

Byrne, of the Life Guardian Foundation, has been brought in as a specialist in other cases of disputed brain death, including Jahi McMath and Israel Stinson.

https://www.lifesitenews.com/news/v...to-stop-hospital-from-taking-2-year-old-off-l

K_Z · Jun 9, 2016

It's quite an interesting dilemma.

There is a small, but growing movement that believes that laws should be changed so that physicians should not be able to diagnose brain death without the *consent* of the family or next of kin. And that families should have a *right* to consent, or not consent, to the process and tests to determine brain death.

It will be very interesting to see if a coordinated effort of activists coalesce to try to overturn the Uniform Determination of Death Act (UDDA). Dr. Paul Byrne is admittedly very much an outlier in his beliefs, which have been disavowed by BOTH the medical field, and the Catholic Church (which is the foundation of Byrne's religious beliefs and opposition to brain death). These pediatric cases are especially heart wrenching, and it's easy to see why some parents are in such denial about the catastrophic effects of brain death. The kids have no outward appearance of such devastating injuries-- they look to be asleep, on a ventilator, and there is such a strong compulsion to deny the brain death, and cling to "hope" for some kind of recovery.

It doesn't help that the media constantly inserts doubt in the uninformed public about what brain death is, and what it is not (coma, or persistent vegetative state). And irresponsibly prints and reprints stories of "miraculous recoveries" that were not properly diagnosed in the first place. The media furthers the confusion, IMO, and the medical professionals cannot say a thing about specific cases because of privacy laws. So whatever the family says to the media, what they believe, is all they print. Over and over. Which makes it ever harder for the medical professionals in the next case, and the next.

Donjeta · Jun 9, 2016

Very sad case.

But shouldn't every dead person be equal in the eyes of the law...why can doctors declare cardiovascular death without referring to the family's wishes.

sonjay · Jun 9, 2016

Sorry, I just don't think we should have laws designed to accommodate magical thinking.

K_Z · Jun 11, 2016

A judge has ruled VCU Medical Center doctors were allowed to perform a brain death test on two-year-old Mirranda Grace Lawson. Mirranda Grace has been on life support since mid-May after she choked on a popcorn kernel.

"The Court finds that, with medical advice, the parents are informed regarding the medical care they believe appropriate for their child. However, sufficient time has elapsed for transfer to another medical institution or home for the provision of such desired medical care, without success," courts documents indicated.

http://wtvr.com/2016/06/10/judge-rules-child-to-be-tested-for-brain-death/

News report video and image of court order at link.

al66pine · Jun 11, 2016

A timeline from Prof. Pope's site, June 11 entry re Miranda Lawson:
http://medicalfutility.blogspot.com/2016/06/court-allows-hospital-to-perform-apnea.html

"May 11: 2-year-old Miranda Grace Lawson chokes on a popcorn kernel, suffering an anoxic brain injury.May 11: She is transferred to VCU Medical Center, where clinicians determine that she is probably dead.
May 19: Patrick Lawson seeks a temporary injunction preventing VCU from conducting an apnea test to confirm that Miranda has died.
May 20: The court finds no reason to extend the May 19 TRO.
May 20: The parents physically block clinicians from performing the apnea test. They also give clinicians a handwritten note objecting to the test.
May 23: The hospital files a petition seeking permission to perform the test.
May 26: The court holds a hearing and continues the injunction for 10 days, so that the family can find a transfer facility.
June 10: The court allows the hospital to proceed with the apnea test."

http://www.wmcactionnews5.com/story...ain-death-test-can-be-performed-on-2-year-old June 10
"The Lawson family attorney tells NBC12 if they appealed the order, they would make sure it was stayed in the meantime, meaning the tests wouldn't be performed.He says hearing back from the Supreme Court could take 30 days or even longer."

wendybtn · Jun 11, 2016

We cannot afford as a society to keep people's autonomic functions supported indefinitely just to (attempt) alleviate people's guilt and sadness over a death. As an RN who has worked in nursing homes over the past 35 years, what happens to these people's bodies due to unnatural perpetual feeding through tubes, not to mention the side effects of perpetual bedrest, this is torture, not love and care. But since we cater to people's feelings, rather than science as much as we can, illogical results will win.

cianne · Jun 13, 2016

K_Z said:
There is a small, but growing movement that believes that laws should be changed so that physicians should not be able to diagnose brain death without the *consent* of the family or next of kin. And that families should have a *right* to consent, or not consent, to the process and tests to determine brain death .

This makes me absolutely crazy. Doctors should not require someone's permission to make their diagnosis. It is what it is, whether you like it or not, whether it's good or bad. This is equivalent to a grown adult standing there with their fingers in their ears screaming LALALALA I CAN'T HEAR YOU SO IT'S NOT HAPPENING. If this becomes a real possibility, I think modern medicine is going to go out the window, in a sense.

Dockins · Jun 14, 2016

wendybtn said:
We cannot afford as a society to keep people's autonomic functions supported indefinitely just to (attempt) alleviate people's guilt and sadness over a death. As an RN who has worked in nursing homes over the past 35 years, what happens to these people's bodies due to unnatural perpetual feeding through tubes, not to mention the side effects of perpetual bedrest, this is torture, not love and care. But since we cater to people's feelings, rather than science as much as we can, illogical results will win.

I too have worked in nursing homes, and the system is very strained as it is. I cannot imagine what would happen if a growing population of brain dead patients was allowed to be indefinitely cared for by insurance companies and health care facilities. My heart breaks for these families, but evidence based practice proves there are no recoveries from brain death. Those resources should be for people who are truly in need of life sustaining treatment. It sounds harsh, but treating inevitable bedsores, infections, and other medical complications is a waste as well as unnecessary, IMO.

sonjay · Jun 14, 2016

Dockins said:
I too have worked in nursing homes, and the system is very strained as it is. I cannot imagine what would happen if a growing population of brain dead patients was allowed to be indefinitely cared for by insurance companies and health care facilities. My heart breaks for these families, but evidence based practice proves there are no recoveries from brain death. Those resources should be for people who are truly in need of life sustaining treatment. It sounds harsh, but treating inevitable bedsores, infections, and other medical complications is a waste as well as unnecessary, IMO.

Not to mention the toll it would take on healthcare workers. Imagine having to spend your days taking care of dead bodies all day long. If they wanted to do that, they would have gone into the undertaking business, not healthcare.

Doghairrules · Jun 15, 2016

I do not mean this as any criticism of the family, because it seems a lot of people don't know this. 2 year olds should not be eating popcorn. They do not have the oral motor skills to handle a food like that.

Also, I would love it if birthing classes included cpr and first aid for infants and children.

Sent from my iPhone using Tapatalk

K_Z · Jun 16, 2016

http://wtvr.com/2016/06/15/mirranda-lawson-legal-battle-continues/

Paperwork filed in court Wednesday shows the hospital cannot perform an apnea test on Mirranda Grace Lawson to determine brain death if the parents post an appeal bond. Their attorney, Phillip Menke, explained the judge agreed that if the family posts a $30,000 appeal bond by Friday, then the hospital cannot perform the apnea test.

If they do not post bond, then the VCU Health System can perform the test on Mirranda.

Lawson's attorney told us they posted the appeal bond today. Now they have three months to file a petition to try to get the case before the Virginia Supreme Court.

BBM. Three months?! Three months??? In that ICU? Good heavens.

Last Friday, Richmond Circuit Judge Melvin Hughes Jr. ordered that the hospital could go ahead with the test. But on Tuesday, he suspended his own order to give the Lawsons time to file an appeal to the Virginia Supreme Court. Patrick Lawson posted a $30,000 bond on Wednesday appealing the order. That gives the Lawsons three months to file an appeal with the high court.

The Lawsons could not be reached for comment; neither could their attorney, Phillip Menke of Manassas.

Patrick and Alison Lawson have contacted experts and other hospitals for recommendations. According to an affidavit filed by Dr. Paul Byrne, a physician in Ohio, the test will result in a buildup of carbon dioxide gas and put pressure on the brain. He also suggested that Mirranda be treated for low thyroid levels, “a lethal disorder if left untreated,” he said.

“This apnea brain death test, we believe, of itself is harmful to her,” Menke said. “It doesn’t do anything to help her. It’s a diagnostic tool, but it does nothing to help her and, in fact, it will cause some harm.”

Byrne’s affidavit was not heard during the May 31 hearing, on which Judge Hughes based last Friday’s decision. Hughes threw it out because the doctor was not there to testify.

The court did hear from Dr. Jesse Bain, a pediatric critical care interventionist at the Children’s Hospital of Richmond at VCU. Bain said the test takes eight to 15 minutes, during which time the ventilator is turned off. He agreed that it could cause brain damage.

“If we felt that there was an opportunity for recovery here, one, we wouldn’t be doing apnea death testing, and two, it would be consequential,” Bain testified. “In our estimation and opinion, the side effects that you’re speaking of won’t change Mirranda’s outcome in that we don’t believe she has functioning brain left to damage.”

Although Mirranda’s lungs are exhaling and her heart is beating, they are doing so only with the help of medicine and machines, Bain said. He said thyroid treatment is not necessary and only used in cases like this to prepare the organs for donation.

Four other hospitals, including Johns Hopkins University Medical Center in Baltimore and Children’s Hospital of the King’s Daughters in Norfolk, agreed with how VCU is caring for the child and would not agree to take her on as a patient.

http://www.richmond.com/news/local/...cle_efb59855-0bff-5d5a-853f-d324426cb3a2.html

watcher9 · Jun 20, 2016

K_Z said:
http://wtvr.com/2016/06/15/mirranda-lawson-legal-battle-continues/

BBM. Three months?! Three months??? In that ICU? Good heavens.

http://www.richmond.com/news/local/...cle_efb59855-0bff-5d5a-853f-d324426cb3a2.html

I can't believe the Judge would agree to make the hospital keep Mirranda on machines in ICU for three months. Would that mean feeding, medicating, etc also? Is this three months the time it takes for the lawyer to write up and submit his appeal or for the Virginia Supreme Court to schedule a hearing? In the Israel Stinson case, they cut strings right and left to get the case heard because of the time restraints.

K_Z,
If you have time, could you please help us understand more about how the thyroid functions with and without a brain and how medicine can alter its functions?

Dr Paul Byrne in his affidavit He also suggested that Mirranda be treated for low thyroid levels, “a lethal disorder if left untreated,” he said.

Dr Jesse Bain basically said that treatment for the thyroid was unnecessary unless the organs were being prepared for donation.

Donjeta · Jun 20, 2016

The pituitary gland in the brain produces a hormone that stimulates the thyroid glands to produce thyroid hormone. If the pituitary is not functioning properly thyroid supplements can be prescribed.

I think if Mirranda is really brain dead then any kind of treatment would be unnecessary, since dead persons do not benefit.

watcher9 · Jun 20, 2016

Donjeta said:
The pituitary gland in the brain produces a hormone that stimulates the thyroid glands to produce thyroid hormone. If the pituitary is not functioning properly thyroid supplements can be prescribed.

I think if Mirranda is really brain dead then any kind of treatment would be unnecessary, since dead persons do not benefit.

That is what I was thinking. If a brain is dead, I would think the thyroid would quit working too. But what would be the need for a thyroid supplement? Can the body organs below the neck continue to work as long as the machines are going? How could they benefit from a supplement? Can body cells continue to grow and reproduce?

Donjeta · Jun 20, 2016

Yes cells can keep growing and organs can keep functioning (to a degree) as long as the machines provide ventilation and nutrition is provided for.

Whether one sees the need for a thyroid supplement or not probably largely depends on whether one believes that Miranda can recover from her condition or not. Medically there is no need for any further treatments if she's brain dead and not considered for an organ donation

al66pine · Jun 23, 2016

Prof. Pope's blog references Public Education & Misinformation on Brain Death in MSM
http://medicalfutility.blogspot.com/...mation-on.html June 22, 2016

"We sought to evaluate the caliber of education mainstream media provides the public about brain death...."
"The subject was referred to as being “alive” or on “life support” in 72% (149) of the articles, 97% (144) of which also described the subject as being brain dead. A definition of brain death was provided in 4% (9) of the articles. Only 7% (14) of the articles noted that organ support should be discontinued after brain death declaration unless a family has agreed to organ donation. Reference was made to well-known cases of patients in persistent vegetative states in 16% (34) of articles and 47% (16) of these implied both patients were in the same clinical state." bbm

"Mainstream media provides poor education to the public on brain death. Because public understanding of brain death impacts organ and tissue donation, it is important for physicians, organ procurement organizations, and transplant coordinators to improve public education on this topic."

http://onlinelibrary.wiley.com/doi/1...12791/abstract

al66pine · Jul 30, 2016

Arguing that parental consent is not necessary for hosp to conduct apnea BD test, "... VCU makes these three points. First, the apena test is not "health care" requiring consent. Second, the interventions VCU is providing cost $10,000 per day which probably will not be covered by insurance. Third, VCU children's ICU is sometimes full, meaning that treatment must be denied to others." bbm

^ From http://medicalfutility.blogspot.com/2016/07/do-clinicians-need-consent-for-apnea.html. blog of Prof. Thaddeus Pope, July 30
Virginia Supreme Court in VCU Health System v. Lawson.

"On June 17 and June 27, because the appeals process will take months, VCU then asked the Supreme Court to either expedite the appeal or lift the stay pending appeal. On July 1 and July 8, the Supreme Court denied both petitions."

"The case will now proceed to briefing and argument on the merits. Still, the procedural
briefing and orders from June and July give some light into the issues that will be argued before the court...."

For a list of ct-filed doc's, starting May 19, 2016 thru, July 8, 2016, and pdf's of the briefs themselves, see http://thaddeuspope.com/braindeath/courtcases.html.

al66pine · Aug 4, 2016

Staggering the imagination (mine anyway), from Dr. Pope's July 31 blog,http://medicalfutility.blogspot.com/#!/2016/07/why-does-it-cost-10000-day-to-sustain.html:

"... [argument] VCU Health System made for why the court should decide the appeal quickly is the cost: $10,000 per day. Interestingly, among the petition papers, CEO John Duval, breaks down this figure."

Info from def's ct. filings:
- physician charge..............................$ 900.00 /day.
- hospital charge for PICU room .............. 5,916.00
- hospital pharmacy charges ................. 1,533.26
- hospital chemistry test charges ............ 190.57
- hematology testing charges ................ 16.28
- hospital respiratory services ............... 724.00
- hospital drug charges ....................... 490.40

................................... ave. total ~ $ 9,770.00 /day

More from def's ct filings; links to def's ct filings at Dr Pope's blog:
"To date, no reimbursement has been received from any health insurer for the services provided by VCUHS/MCV Hospitals or by the attending physicians of MCV Associated Physicians..."

Mirranda Lawson, 2 yo- Family goes to court to prevent brain death tests

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