CA - Parents Of Toddler Declared Brain-Dead Convinced He’s Still Alive

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From reading the articles, it appears that the hospital accepted him based on medical records from Guatemala, but confirmed the truth when they ran their own tests. I wonder if the family really believed what they'd been told in Guatemala and thought it would be confirmed in the US, but I suspect there were other reasons they brought him back to the US when they did. Perhaps because money was going to run out and the hospital in Guatemala wouldn't let him stay.
 
Thanks for the update. I'm sad for the aching grief of the parents, but I think the decision to withdraw organ support was correct. I also think there is quite a bit more to the story than the WaPo article (and the heavily biased pro-life website article) states about how the third round of court petitions/ decisions, and physician diagnostic procedures, transfer decisions, etc occurred after the admission from Guatemala.

We are getting a very condensed version that is entirely one sided. The parents absolutely had to know that this was the most likely outcome if they chose to return from Guatemala to a hospital setting, since a death certificate had already been initiated from the second admission at Kaiser. They could have simply brought him back by airevac to a home care environment, and could have continued to care for his body as long as they desired, just as Jahi McMath's family has.

I don't believe any health care providers raced into Israel's room after the court decision, shoved the family aside, and callously switched off the ventilator. There are very well defined procedures about how that is conducted, when support is withdrawn. It is a very dignified and family centered process.

I'm very sad they lost their beautiful little boy. But absolutely everything, everything, was done to save him. Even the original ECMO course was probably a "hail mary" attempt, as he had had a very long cardiac arrest and resuscitation preceding that, IIRC. There were just too many physiological and social factors stacked up against this little boy for his tiny body to overcome.

That said, I expect in the next few weeks to months they will file many lawsuits against providers at all three of the U.S. hospitals that cared for him. The pro life legal fund will be willing to pay for those, IMO, but ultimately I doubt they will prevail. It will take a few years to sort it all out in the courts, just as in the McMath case.

The Mirranda Lawson case continues, but hers is somewhat unique in that she has not yet been "officially" diagnosed brain dead by standard neurological criteria. Her family has been trying to prevent the diagnosis of brain death, by refusing to consent to testing.

Here's the thread for Mirranda Lawson:

http://www.websleuths.com/forums/sh...ly-goes-to-court-to-prevent-brain-death-tests
 
More links, with a bit more detail:

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.
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http://www.latimes.com/local/lanow/la-me-ln-toddler-life-support-20160826-snap-story.html
“They are devastated. I think still in shock,” family attorney Alexandra Snyder said. “It’s not even my child; I am still in shock this could happen so quickly.”

Snyder is shocked by a judge’s decision because just last week the court gave her a temporary order to stop the hospital from removing the ventilator so they could get an opinion from another neurologist.

This heartbreaking ordeal began back in April in the Sacramento area. Israel was declared brain dead after a severe asthma attack that led to cardiac arrest. Since then, his parents have been fighting in court to keep Israel on life support, hoping to eventually care for him at home.
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http://www.cbsnews.com/news/israel-...ter-brain-dead-boy-removed-from-life-support/

Though there'd been dispute between doctors locally about baby Israel being brain dead, Snider says the hospitals involved had not performed the Electroenchelaogram, or EEG, that can be one of the definitive tests for brain waves.

"When those were performed by another facility, (they) found that he in fact did have brain waves. He was not brain dead," Snider said.

That facility was the one in Guatemala.

FOX40's learned there was direct consultation between doctors there and the one who agreed to admit him at Children's in L.A.

But baby Israel's lawyers claim as soon as he arrived there staff was "difficult from the get go."

The Stinsons secured a restraining order to keep him on life support until Sept. 9 to clarify his condition.

"The hospital would not provide an examination for brain death, and so we got permission from the court to bring in the parents' own doctor. The hospital of course did not want that," said Snider.
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http://fox40.com/2016/08/25/vacavil...n-dies-after-being-removed-from-life-support/

Blue areas colored by me for emphasis.

As I read between the lines here, my suspicion is that the main source of the dispute was two things: one is that he ALREADY has a death certificate from the hospitalization at Kaiser from a few months ago. That means that the LA Children's Hospital was not lawfully bound, IMO, to conduct MORE determinations of brain death. And no, there was no "dispute" about his condition. He was brain dead. The family may not understand that an isoelectric EEG tracing (flat line) is not a required part of brain death criteria, because so many environmental and other factors can cause low level interference on an EEG. The presence of some low grade oscillations is not diagnostic for functional brain tissue, which is why an isoelectric tracing is not required. (In any state.) A lemon, for example, will generate measurable electricity if connected to electrodes. AND-- multiple tests and multiple factors are used to determine brain death--not just one test.

https://en.wikipedia.org/wiki/Lemon_battery

The second issue I see is that "eventually" planning to move to home care is the same issue from the earlier hospitalization at UC Davis and Kaiser, when the family repeatedly told the court and the hospital that they had a long term care facility secured to accept him (Washington, then Pennsylvania, and NJ turned them down), or would "eventually" move to home care. I think that perhaps there was not an actual plan that was in progress at all, just perhaps a vague idea about home care that had not been pursued sufficiently to the satisfaction of the courts. I strongly suspect they were given deadlines by the court to show that they were making progress on their home care plans, just as they were in the decisions months earlier. I think they were probably warned by the judge that if they made no progress on setting up and moving to home care that the restraining order would be withdrawn. Just my best guesses, given the circumstances. The hospital cannot maintain a brain dead patient forever in an expensive ICU bed, and I doubt that there will ever be any insurance or other funding to any of the hospitals after the diagnosis of brain death was made originally.

The bigger questions I have, is why did one of the docs at the Los Angeles Children's Hospital agree to admit him from the Guatemala hospital? Or did they? Maybe they just showed up in the ER from an ambulance that met the plane? Did the hospital admin know that this doc was going to admit a brain dead patient with a death certificate? Did the doc agree to admit Israel for organ support without discussing that with his chain of command at the hospital? Did the doc know there was a death certificate from months earlier? So many questions.

Why did the family choose to return to California with his body? Why not stay there if they were comfortable with his care there?

The news articles are quite one sided, and I suspect we will never hear the "other" side of the story because the hospitals cannot say a thing publicly. Only if the hospitals respond thru court filings that are public, will we hear the other side of the story. Until then, the family and their lawyers get to control the public and msm narrative.
 
K_Z said:
More links, with a bit more detail:



http://www.latimes.com/local/lanow/la-me-ln-toddler-life-support-20160826-snap-story.html


http://www.cbsnews.com/news/israel-...ter-brain-dead-boy-removed-from-life-support/



http://fox40.com/2016/08/25/vacavil...n-dies-after-being-removed-from-life-support/

Blue areas colored by me for emphasis.

As I read between the lines here, my suspicion is that the main source of the dispute was two things: one is that he ALREADY has a death certificate from the hospitalization at Kaiser from a few months ago. That means that the LA Children's Hospital was not lawfully bound, IMO, to conduct MORE determinations of brain death. And no, there was no "dispute" about his condition. He was brain dead. The family may not understand that an isoelectric EEG tracing (flat line) is not a required part of brain death criteria, because so many environmental and other factors can cause low level interference on an EEG. The presence of some low grade oscillations is not diagnostic for functional brain tissue, which is why an isoelectric tracing is not required. (In any state.) A lemon, for example, will generate measurable electricity if connected to electrodes. AND-- multiple tests and multiple factors are used to determine brain death--not just one test.

https://en.wikipedia.org/wiki/Lemon_battery

The second issue I see is that "eventually" planning to move to home care is the same issue from the earlier hospitalization at UC Davis and Kaiser, when the family repeatedly told the court and the hospital that they had a long term care facility secured to accept him (Washington, then Pennsylvania, and NJ turned them down), or would "eventually" move to home care. I think that perhaps there was not an actual plan that was in progress at all, just perhaps a vague idea about home care that had not been pursued sufficiently to the satisfaction of the courts. I strongly suspect they were given deadlines by the court to show that they were making progress on their home care plans, just as they were in the decisions months earlier. I think they were probably warned by the judge that if they made no progress on setting up and moving to home care that the restraining order would be withdrawn. Just my best guesses, given the circumstances. The hospital cannot maintain a brain dead patient forever in an expensive ICU bed, and I doubt that there will ever be any insurance or other funding to any of the hospitals after the diagnosis of brain death was made originally.

The bigger questions I have, is why did one of the docs at the Los Angeles Children's Hospital agree to admit him from the Guatemala hospital? Or did they? Maybe they just showed up in the ER from an ambulance that met the plane? Did the hospital admin know that this doc was going to admit a brain dead patient with a death certificate? Did the doc agree to admit Israel for organ support without discussing that with his chain of command at the hospital? Did the doc know there was a death certificate from months earlier? So many questions.

Why did the family choose to return to California with his body? Why not stay there if they were comfortable with his care there?

The news articles are quite one sided, and I suspect we will never hear the "other" side of the story because the hospitals cannot say a thing publicly. Only if the hospitals respond thru court filings that are public, will we hear the other side of the story. Until then, the family and their lawyers get to control the public and msm narrative.
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Agreed. In cases like this, though, hospitals should be allowed to respond to allegations that they "killed" Israel. This kind of one sided story is what gets people all riled up.


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A bit more info as to what transpired since the emergency restraining order filed by the mother Aug 18:

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.

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.

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.

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.

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

Blue color by me.

Thaddeus Mason Pope (professor of medical ethics at Hamline Univ Law School) has more, including images of the ex parte request for the latest restraining order. I assume he will have the newest court orders later this week, since he's followed this case closely.

http://medicalfutility.blogspot.com/2016/08/israel-stinson-v-childrens-hospital-la.html

http://medicalfutility.blogspot.com/2016/08/law-of-brain-death-in-los.html

For those interested, "doc *advertiser censored*" has an incendiary post criticizing the press coverage of this sad case. The blog is "stories from the trauma bay"-- easy to search. (Not sure if I can post the link.) FWIW, I typed an entire post earlier that I ultimately deleted expressing the same outrage against the FOX article using terms like "execution", "heartless", and "crass".

And something else that has bothered me, is the legal circumstances under which Israel was transported internationally. I'm a former USAF flight nurse from years ago, and I'm well aware of the immense amount of coordination involved with moving living patients internationally, as well as the issues of moving deceased patients internationally. I have to wonder if any of the usual procedures were followed for either one of the 2 international private company airevac moves to and from Guatemala. He had no passport at time of death, and no passport agency will issue an emergency passport to someone with a death certificate-- and deceased people don't travel under passports, they travel as manifested "cargo" with specific sets of rules. It's up to Guatemala what they will accept, but coming back the the U.S. they have to follow U.S. laws. And I highly doubt that permits to move a deceased person INTO the U.S. were pursued. So, I'm guessing a lot of people are looking the other way on this case.

This whole case is a mess from beginning to end, and the court system and media are making these cases even worse. It seems so simple to me-- once someone is determined to be brain dead, the family in disbelief/ denial should be given a timeline of a few days at most to either remove their loved one to privately funded home care, or the organ support should be withdrawn. IMO, cases like this one (and others, like the McMath case) are persuading hospitals to be LESS compassionate about the timeline for withdrawing support.
 
K_Z said:
A bit more info as to what transpired since the emergency restraining order filed by the mother Aug 18:



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

Blue color by me.

Thaddeus Mason Pope (professor of medical ethics at Hamline Univ Law School) has more, including images of the ex parte request for the latest restraining order. I assume he will have the newest court orders later this week, since he's followed this case closely.

http://medicalfutility.blogspot.com/2016/08/israel-stinson-v-childrens-hospital-la.html

http://medicalfutility.blogspot.com/2016/08/law-of-brain-death-in-los.html

For those interested, "doc *advertiser censored*" has an incendiary post criticizing the press coverage of this sad case. The blog is "stories from the trauma bay"-- easy to search. (Not sure if I can post the link.) FWIW, I typed an entire post earlier that I ultimately deleted expressing the same outrage against the FOX article using terms like "execution", "heartless", and "crass".

And something else that has bothered me, is the legal circumstances under which Israel was transported internationally. I'm a former USAF flight nurse from years ago, and I'm well aware of the immense amount of coordination involved with moving living patients internationally, as well as the issues of moving deceased patients internationally. I have to wonder if any of the usual procedures were followed for either one of the 2 international private company airevac moves to and from Guatemala. He had no passport at time of death, and no passport agency will issue an emergency passport to someone with a death certificate-- and deceased people don't travel under passports, they travel as manifested "cargo" with specific sets of rules. It's up to Guatemala what they will accept, but coming back the the U.S. they have to follow U.S. laws. And I highly doubt that permits to move a deceased person INTO the U.S. were pursued. So, I'm guessing a lot of people are looking the other way on this case.

This whole case is a mess from beginning to end, and the court system and media are making these cases even worse. It seems so simple to me-- once someone is determined to be brain dead, the family in disbelief/ denial should be given a timeline of a few days at most to either remove their loved one to privately funded home care, or the organ support should be withdrawn. IMO, cases like this one (and others, like the McMath case) are persuading hospitals to be LESS compassionate about the timeline for withdrawing support.
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I could not agree more. Thanks for such a well written, informative post. [emoji122]


Sent from my iPhone using Tapatalk
 
Thanks, peeps, for the enlightening posts & analyses above. Trying to make sense of statements below in light of what has happened in past 10 days and possible discrepancies from stmts made to MSM. From page on an internet funding site, events as relayed by mother or father (maybe atty/PR rep?):

"Update 7
1 month ago
....Dear friends and supporters of our GREAT CAUSE! My little boy, Israel!...
For the last eight weeks, my little boy has been in Central America. Yes, that’s right.
Since his arrival there [May 23], Israel has done nothing but get better and better!...
We took this risk for Israel's sake. Now we have to get him back to the US for further treatment....
Israel still has a way to go, but because he was received by a wonderful hospital in Central America, his physical health is completely restored, he received his tracheostomy and gastrostomy which enable him to breath and take in real nutrition… but best of all, Israel had a new EEG done last month that shows HE IS NOT BRAIN DEAD!!!"

^bbm. Asks for $$$.

"Update 8
8 days ago
....After almost 3 months of staying in Guatemala, Israel's condition has progressed and we are so happy that he has 2 EEG's that prove his brain is not "dead" and that there is still activity.
With this new diagnosis we were accepted into a hospital that agreed to take us in and help us get facilitated with home care so that we can now take care of Israel from our own home, which is exactly what we want. We are hoping to raise enough money to begin the process of finding a small home so that we could take care of Israel ourselves with nurses around the clock. We have found a Doctor willing to treat Israel and assist with making home visits and writing prescriptions for Israel when necessary all we need now is to find a home near the Docs office so that we begin Israel's discharge from the hospital. We are just asking that you all continue to donate and share our story so that we can fulfill this plan as it would be the best thing for our family to finally have Israel home with us, it is just what we have been hoping for.....
Israel's organs are functioning just fine and he is being well fed even gaining lots of weight and now he is stable enough to take home less than 5 months after the injury occurred...."
^bbm

RIP, young Israel.
 
Yes, al66pine. Agree. There are discrepancies in the mother's statements to the press, and what is posted on the fundraising and FB sites.

It appears from some of the posts that Israel was in 2 separate facilities in Guatemala-- initially in a "more expensive" facility, then moved to a "less expensive" facility. Theories are that there may have been problems with paying bills at both facilities, which may have "encouraged" the family to return to the U.S.
 
Family returned to the US, and to the same state. In Ca, brain death is recognized as legal death.
That's why JM's family took her to NJ. I am not sure what family expected was going to happen in a state where legally he is dead?
 
There is even more to the story. This article is from July 8, and the family was planning to go to the EAST COAST.

A lot seems to have changed between July 8 and August 8 (day the family arrived back in CA and Israel was admitted to Children's Hospital LA). It seems one of the primary goals of returning was to file court documents to have the death certificate overturned. This was filed July 1-- more than a month before Israel was flown back from Guatemala.

The lawyer states this is so the family can access state and/ or federal funding for perpetual care, despite the additional prattling on about Israel not being able to "enroll in school, meet the identity requirements for employment, marry, obtain a driver license, register to vote, qualify for a credit card, or secure a home loan if he remains officially deceased." (Great googly moogly-- what planet does this lawyer live on?? That is completely delusional, and intentionally deceptive lawyerese, IMO. Outrageous, and entirely unprofessional, IMO. Even the insufferable Jahi McMath attorney Dolan didn't stoop THAT low.)

An air ambulance return trip to the U.S. was scheduled Friday morning for 2-year-old Israel Stinson, “but there were administrative hiccups with the (U.S.) hospital,” said Alexandra Snyder, an attorney with the Life Legal Justice Foundation, one of two nonprofit legal groups handling Israel’s case.

Snyder said it’s likely the boy and his parents will leave an unidentified Central America country early next week on a medical flight to an East Coast hospital, where he’ll be treated by a pediatric specialist for “technology-dependent” children, such as those on ventilators.
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His attorneys are seeking a jury trial in the U.S. Eastern District of California federal court to overturn the child’s death certificate, which was signed April 14 at Kaiser Permanente Roseville Medical Center. In court documents, the attorneys state that the death certificate was issued prematurely, given his current condition.
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According to the July 1 filing, the pending death certificate “causes actual injury,” including the loss of medical insurance coverage and government benefits for Israel and his family.

The filing adds: “In the future, he will be unable to enroll in school, meet the identity requirements for employment, marry, obtain a driver license, register to vote, qualify for a credit card, or secure a home loan if he remains officially deceased.”
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Snyder said the plan is for Israel to spend a few weeks or months back East where his parents can be trained in how to care for him at home. Eventually, they hope to return to California.
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http://www.sacbee.com/news/local/health-and-medicine/article88599767.html

So the timeline was (if I have most of this right):

March 2016- Child protective services involved with family due to physician reports of non-compliance with medications, appointments, and care for Israel's severe asthma.

March 30 - Israel has severe asthma attack. Admitted to local hospital and transferred immediately to UC Davis. Prolonged cardiac arrest of approximately one hour, with resuscitation to cardiac rhythm, and placed on ECMO for about a week. Removed from ECMO and found to be brain dead. Court petitions to prevent withdrawal of support.

April 11- Mother requests and arranges transfer to Kaiser Roseville for another opinion. Diagnosed brain dead. (Total of three physicians completed brain death testing at 2 hospitals).

April 14 - Death certificate signed. More injunctions to prevent withdrawal of support.

May 21- Parents arrange donations, airevac, and transfer acceptance, and take Israel to a hosplital in Guatemala.

July 10- Family plans to fly back to U.S. with Israel to the "east coast"-- cancelled

July 8 - Arrived Los Angeles/ admitted to Children's LA, with doc accepting Israel for admission, by report of family lawyer. Family appeals on fundraising site for money to buy a house "close to the doctor who agreed to do home visits and write prescriptions for Israel."

July 18 - Mother files emergency restraining order to prevent withdrawal of support (After ten days of treatment and consultations with the hospital and doctor of her choice)

July 23 - After another 5 days, hospital notifies family that they are filing an appeal of the restraining order

July 25 - Appeal heard in court around 10 am; restraining order lifted due to finding that 2 higher courts already adjudicated the case. Support withdrawn at approximately 3:30 pm with family present.

So, the really interesting 2 questions that remain are:

1. Why didn't the family stay in Guatemala, apply for residency there, etc? (I think I know the answers to this.)

2. If they were determined to come back to California and do "home care", why didn't they get the home care set up by their supporters in their existing home, and take Israel directly to their home from the aircraft? Why did they go to Children's Hospital LA? (And I think I know the likely answers to that one, too.)

(Bold and blue by me above.)
 
Why did the hospital accept him to begin with? Rather clearly this was not going to end well. Child is brain dead but parents aren't able to accept that. And it clearly wasn't going to change.
As for parents, why did they bring him back to Ca where he was already legally dead?
The reason JM's is still on live support is because her parents took her to New Jersey.
And if they were arranging home care, why didn't they just took him home?
 
K_Z said:
There is even more to the story. This article is from July 8, and the family was planning to go to the EAST COAST.

A lot seems to have changed between July 8 and August 8 (day the family arrived back in CA and Israel was admitted to Children's Hospital LA). It seems one of the primary goals of returning was to file court documents to have the death certificate overturned. This was filed July 1-- more than a month before Israel was flown back from Guatemala.

The lawyer states this is so the family can access state and/ or federal funding for perpetual care, despite the additional prattling on about Israel not being able to "enroll in school, meet the identity requirements for employment, marry, obtain a driver license, register to vote, qualify for a credit card, or secure a home loan if he remains officially deceased." (Great googly moogly-- what planet does this lawyer live on?? That is completely delusional, and intentionally deceptive lawyerese, IMO. Outrageous, and entirely unprofessional, IMO. Even the insufferable Jahi McMath attorney Dolan didn't stoop THAT low.)









http://www.sacbee.com/news/local/health-and-medicine/article88599767.html

So the timeline was (if I have most of this right):

March 2016- Child protective services involved with family due to physician reports of non-compliance with medications, appointments, and care for Israel's severe asthma.

March 30 - Israel has severe asthma attack. Admitted to local hospital and transferred immediately to UC Davis. Prolonged cardiac arrest of approximately one hour, with resuscitation to cardiac rhythm, and placed on ECMO for about a week. Removed from ECMO and found to be brain dead. Court petitions to prevent withdrawal of support.

April 11- Mother requests and arranges transfer to Kaiser Roseville for another opinion. Diagnosed brain dead. (Total of three physicians completed brain death testing at 2 hospitals).

April 14 - Death certificate signed. More injunctions to prevent withdrawal of support.

May 21- Parents arrange donations, airevac, and transfer acceptance, and take Israel to a hosplital in Guatemala.

July 10- Family plans to fly back to U.S. with Israel to the "east coast"-- cancelled

July 8 - Arrived Los Angeles/ admitted to Children's LA, with doc accepting Israel for admission, by report of family lawyer. Family appeals on fundraising site for money to buy a house "close to the doctor who agreed to do home visits and write prescriptions for Israel."

July 18 - Mother files emergency restraining order to prevent withdrawal of support (After ten days of treatment and consultations with the hospital and doctor of her choice)

July 23 - After another 5 days, hospital notifies family that they are filing an appeal of the restraining order

July 25 - Appeal heard in court around 10 am; restraining order lifted due to finding that 2 higher courts already adjudicated the case. Support withdrawn at approximately 3:30 pm with family present.

So, the really interesting 2 questions that remain are:

1. Why didn't the family stay in Guatemala, apply for residency there, etc? (I think I know the answers to this.)

2. If they were determined to come back to California and do "home care", why didn't they get the home care set up by their supporters in their existing home, and take Israel directly to their home from the aircraft? Why did they go to Children's Hospital LA? (And I think I know the likely answers to that one, too.)

(Bold and blue by me above.)
Click to expand...

I also wonder if all of this could have been avoided if the parents had listened to the doctors before he had a fatal asthma attack. They've consistently shown pretty selective hearing, even before he died.


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Although I'm no expert, it seems that there are two possibilities: the child is brain dead, or the child is in a coma. If the child is in a coma, has this new technique for jumpstarting the brains of coma patients been tried?

"A team at UCLA recently used ultrasound to “jump-start” the brain of a 25-year-old man after a coma.
...

“As the authors pointed out, with this type of study it is difficult to know if the patient’s improvement was due to the brain stimulation or just the patient improving on his own,” Dr. Aaron S. Lord, director of neurocritical care at NYU Langone Medical Center, told the Observer. “However, targeting the thalamus to stimulate a patient with a disorder of consciousness has been successful in the past, and this new technology has the benefit of being non-invasive, unlike the deep brain stimulation which requires neurosurgery.”

http://observer.com/2016/08/scientists-discovered-how-to-jumpstart-the-brain-of-a-coma-patient/
 
“A team at UCLA recently used ultrasound to “jump-start” the brain of a 25-year-old man after a coma.”

The guy woke up first before they applied their treatment. I am fairly certain that most doctors who work with those kinds of things can decipher the difference between brain death and a coma.
 
otto said:
Although I'm no expert, it seems that there are two possibilities: the child is brain dead, or the child is in a coma. If the child is in a coma, has this new technique for jumpstarting the brains of coma patients been tried?

"A team at UCLA recently used ultrasound to “jump-start” the brain of a 25-year-old man after a coma.
...

“As the authors pointed out, with this type of study it is difficult to know if the patient’s improvement was due to the brain stimulation or just the patient improving on his own,” Dr. Aaron S. Lord, director of neurocritical care at NYU Langone Medical Center, told the Observer. “However, targeting the thalamus to stimulate a patient with a disorder of consciousness has been successful in the past, and this new technology has the benefit of being non-invasive, unlike the deep brain stimulation which requires neurosurgery.”

http://observer.com/2016/08/scientists-discovered-how-to-jumpstart-the-brain-of-a-coma-patient/
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He wasn't in a coma. He was brain dead. A brain that is dead can not be jump started.
 
Reading between the lines, I'm not at all convinced that Children's Hospital LA "accepted" Israel in the cooperative, planned, transparent manner, that the attorney has presented to the media interviewers. IMO, there was *almost certainly* significant internal strife going on at CHLA over the admission of Israel to the PICU from Guatemala, between admin, the intensivists, and whomever the mystery doctor is. (Including issues by the nursing staff and supervisors, who would be questioning things like "does the malpractice policy cover nurses caring for a patient with a death certificate?".) The "standard of care" for a patient with a death certificate, is withdrawal of all support.

I think it is extraordinarily unlikely that the doctor Jonee has said was willing to do "home visits" and "write prescriptions" ALSO is an intensivist in the PICU at CHLA. It's possible that Jonee's doc had some kind of admitting privileges at CHLA, but not necessary, especially if the ambulance went directly to the ER from the flightline.

Nearly all major urban ICU's employ intensivists to actually care for patients once admitted. And that usually means that the original "admitting physician" often has little to no involvement with the day to day, hour to hour care of the patient in the ICU, until the patient is moved to stepdown or discharged from the hospital. Hospital policies and politics are at play-- there may be policies that the intensivists take over as attending physician during the ICU admit. Or, if they disagree with the ICU admission, they may officially decline to be the attending, and the "other" physician will have to be present a lot, write all the orders, etc. (For example, it's difficult for a hospital to bill and be reimbursed for ICU care provided by an intensivist if another doc is the attending doc, and a family doc, for example, may not have ICU privileges.) Intensivists are usually hospital employees, and they assign their billing rights to the hospital. An intensivist usually becomes the "attending physician" during the ICU admission. It's complicated to explain, but I think there was a serious turf war going on over who was responsible for the admission and ongoing care.

Anyway, it is possible that the reason Jonee and her attorney describe CHLA as being "difficult right from the get go" is that there was significant resistance and disagreement by both admin, and the intensivist team, with admitting Israel to ICU (since he was brain dead and had a death certificate). Clearly for the first 10 days CHLA cared for him, and simultaneously discussed withdrawing support, because otherwise there wouldn't have been a need for Jonee to seek a restraining order on Aug 18.

While we will likely never hear how the admission to CHLA went down, I have to assume from my knowledge of how hospitals operate that one of 2 things happened-- Israel went to the ER without prior knowledge of the hospital, and "someone" advocated to have him admitted to PICC via the ER visit. Or, "someone" arranged a direct admit from the flight line aircraft directly to the PICU. Either way, I'm virtually certain the hospital admin and/ or intensivist team was definitely not happy with how either of these scenarios unfolded.

Once he was physically inside the hospital, they had no choice but to place him in PICU until the court battles could be fought to determine exactly what the hospital's rights and responsibilities are with a patient who has a death certificate from 4 months ago.

I don't think CHLA was ever a "willing participant" in accepting Israel into their PICU. I personally think they were intentionally manipulated into getting him inside the facility. I think it was an intentional legal strategy. Maybe not outright deception, but definitely manipulation to achieve the desired admission to PICU, while the July 1 court filings were playing out. JMO. I don't think the July 1 "overturn the death certificate" could have proceeded with Israel in Guatemala, or in home care. They needed an admission so they could push (via court filings) to try to insist on "new" brain death testing. (And delay tactics to keep the vent going to allow that to unfold.)

Jonee and her attorneys never anticipated that the hospital's appeal of the restraining order (that they intended to file even before Aug 18, IMO) would actually be heard and decided so quickly. I think Jonee got bad legal advice from the pro-life lawyers about the CHLA admission. All they had to do was go home from the airport with his body, and a transport ventilator & equipment, and they could have continued to battle the courts for years (just like the McMath case). Lots of churches and pro life groups would have helped out setting up and carrying out the home care thing, which is why I think they were never serious about that in the first place. They wanted him in a facility cared for by others, and paid for by others. Their actions tell me that. JMO.
 
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