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The family already know the facts. They have chosen not to reveal them in favor of releasing only the information they want to support their efforts.
It is one thing to do all that is possible to save the life of someone, quite another to do all that is possible with the exception of revealing all the information available, those are two very different things.
There is a reason why the family isn't telling the whole story and some people can't accept that fact. Medical care is a finite resource. While this story is tragic there are also many other people who need advanced medical care.
The family has a choice, if the hospital doesn't want or won't provide the treatments demanded by the family, the family can choose to move the girl to another facility. The fact that they choose to fight the hospital says quite a bit. Now think for yourself, if you truly believed that there was hope, do you fight the hospital and waste that valuable time or move the child to another facility? Suddenly what is right and what is not becomes a little clearer.
In all choices, it is the responsibility of the injured to mitigate damage to themselves if options to do so are available.
How many people would side with the family if it were known that the time wasted fighting the hospital instead of moving the child cost whatever hope remained, if there is any? Who could live with themselves knowing that moving their child was the best choice with the most chance of a good outcome instead of trying to make a point with a hospital that can't defend itself in the public forum and has already make it's policy clear?
If your child was in that hospital in the same condition and you truly believed there was hope, how long would you allow the child to remain there instead of moving her at the first opportunity? I doubt anyone would. So that means there is another agenda. While that agenda could be grief and needing time to realize the condition, is that an excuse for not moving the child?
If the family really believes that there is hope, move the child, that had nothing to do with any legal battles they take to the hospital. Instead, the family has become embroiled in a public media event and legal maneuvers and to what end?
There is a lot wrong with this situation and all of the wrong isn't on the part of the hospital.
You really sum the key points up well, IMHO, Mack Knife. I watched the first tv coverage of this case today. I see a lot of things from afar. The news reports they have a transport team, including a physician will to transport via air ambulance. Apparently, there have been donations - - - around $20 K.
I find it unusual the family won't name the facility or transport team. I wonder what number has been quoted to them as the cost.
I really don't like courts interfering. Supposedly, the family has a video of her "breathing" while on a vent. And the family is stating a pediatrician saw movement. Let's get all the details..would. that be a PW - I (AKA intern), currently practicing or physician even licensed in CA? I don't think this family makes their claims worse with restricting medical records and leaking one liners to the media.
It is not that unusual for a child to be declared brain dead in an ICU following an serious accident (like a car accident with a head injury and multiple organ damage) that results in prolonged resuscitation. I don't have data to back this up, but my feeling is that it might be more common with children in these settings than adults because kids typically have healthy organs and bodies up to the point of the accident and resuscitative efforts are often extreme for injured children so they make it from the scene of the accident into a PICU. Typically, the family is made aware of the gravity of the situation, the testing is done and if brain death is confirmed, support is withdrawn and the family makes funeral arrangements for their child.
What makes this case different is that given the circumstances surrounding the cause of her neurological devastation (massive blood loss post-operatively). It seems like the hospital paused to give the family an opportunity to come to terms with what had occured and then this media and legal storm blew open.
In my experience, most families do not have anywhere near this much involvement in this process as they are usually not permitted to be the "decision maker" regarding brain death. I don't think the way this has been handled has done this family any favors. No one has benefited from these two long weeks.
I couldn't rep you again pinetreelover. Your post is spot on.
The PICU where we had such a similar case is the Pediatric Trauma I Hospital for five states. At that facility a designated person to keep the family as much up to date as possible, if a Trauma I, Near Drowning and other critically I'll infants/children/teens are initially brought to the E. R. or transferred for the highest level of care possible. That staff member works on getting the right support system in place for the parents/family from the first time the family/parents meet him/her.
Because we cover patients from five states so travel time and distance can be a factor for parents. What I mean is parents might arrive 3-6 hrs. after their child, given the distance they have travel. An Attending, fellow and more meet them upon arrival to form a personal connection, even if it's 3:00 a.m. The parents have been updated during their travel. They are told how severe the brain insult id. We tend to try to give them a day or so before vents are removed so they can have others present, if they wish.
We also work very hard to coach parents how THEY can tell their other children. Of course we're there for support and back up, but siblings tend to do better if mom and dad can tell them about their brother/sister. Then we prepare the children for what they will see when they are allowed in the PICU.
It is up to the parents, of course, but we strongly encourage siblings to see the patient and say their own good-byes. What kids imagine is far worse than what they will see.
There might be slight differences given how many states vs. a few cities for which that PICU is the designated center based on when parents arrive given the distance or if there has been an MVA and family members were admitted to various hospitals. However, I believe the procedures are quite similar among all pediatric hospitals.
IMHO, Oakland Children's has been very patient with these parents.
I honestly hope there is a different hospital and transfer soon as the staff can't spend the time with this family and do all the extras as they've tried to do. I'm sure the staff is professional but they don't need to explain the same details for the 27th time since 12/12.
In my experience where the parents are going to get a "chilly reception" is from other parents who have critically ill or injured children in the same PICU. Other parents don't have to be professional. I fully anticipate if they are there another week some other parents will be saying things they don't want to hear. I've seen it happen with much shorter and "no media circus" atmosphere.
And I hope other parents don't think they can demand all the extra care as it is simply not possible. There are a finite number of physicians, nurses and other staff as well as equipment. That may sound harsh but it is factual.
As I wrote earlier, besides Governing Leaders of a country, I don't know what other patient has had three separate brain death determination exams.
Those of you who have been around brain dead patients know there are some less than pleasant events that start to happen with the dead neurons about this week. I opt not to be that graphic here.
I hope this transfer occurs ASAP, if it happens.
MSR
Last edited by Mtn. States Resident; 12-31-2013 at 12:35 AM..
Insurance will not cover it at all. She has been declared dead, and insurance is for the living.
Exactly what I've been thinking but couldn't quite find the right words. However, sine the court ordered the opinion of the Stanford Pediatric Neurologist, I wonder if a third party payor is somehow required to continue paying when the Court has ordered Oakland ' s Children's to not stop support?
I'm not a lawyer so I have no idea if rules change when a court orders the same level of care be continued. Hopefully, someone can offer some insight.
[quote=germaine2626;32807256][quote=pinetreelover;32775386]This young girl is brain dead. She is not in a chronic vegatative state or a coma or neurologically devastated. Brain dead children are not discharged from the hospital to home care. The patients that you care for have some brain function even if it is minimal. That is not the same thing.
A brain dead person does not wince, gag, move spontaneously (much less purposefully). They do not pull away from pain and dont even posture.
I care for children in a Children's hospital that are much like the children you describe. And yes - parents have the right to decide if they want their neurologically devastated child maintained on a ventilator, but that is very, very different from what is going on with this girl.
Quote:
The girl is dead. I am sorry for the parents but their daughter is dead and they need to accept that fact.
What I am worried about are the other children who are ALIVE and need care in the hospital. Resources are being diverted to this girl, who is beyond needing medical assistance, and does it effect the others who do need the care?
This is exactly what I've been saying. I'm worried about staff being able to provide the level of care the other children need. This is also where I expect other parents to start telling this family things they don't want to hear.
In this mixed up situation, should another child in that PICU crash, I wonder if they could sue the teens parents. Probably not, but it let's you know the level of frustration other parents can feel in the same waiting room. Thus why I think other parents will start to tell her parents some things they don't want to hear.
You really sum the key points up well, IMHO, Mack Knife. I watched the first tv coverage of this case today. I see a lot of things from afar. The news reports theyhave a transport team, including a physician will to transport via air ambulance. Apparently, there have been donations - - - around $20 K.
I find it unusual the family won't name the facility or transport team. I wonder what number has been quoted to them as the cost.
I really don't like courts interfering. Supposedly, the family has a video of her "breathing" while on a vent. And the family is stating a pediatrician saw movement. Let's get all the details..would. that be a PW - I (AKA intern), currently practicing or physician even licensed in CA? I don't think this family makes their claims worse with restricting medical records and leaking one liners to the media.
MSR
The news coverage says that the family will need permission of the coroner to transport their daughter. It is obvious that they will need the coroner involved as they will be transporting a dead body rather a live child.
Again, I am not making light of the suffering of the family, but enough time has passed for them to accept the determinations of three different experts that their daughter has died.
You would think that a religious family would understand that what is in the bed is just an empty shell and their actual daughter is already in heaven (if that is what she believed).
It will be very interesting to see if the court orders the hospital to insert the feeding tube and tracheostomy. I would expect that even if ordered to do so they would refuse. I'm more concerned with the way the courts seem to be overriding medical professionals. Last time I checked judges went to law school not medical school.
Even the most minor surgery is not risk-free! The patient could receive too much anesthesia or have an undiagnosed medical condition that required special attention during surgical preparation. We will never know for sure what happened to Miss McMath.
One bad thing about working in health care is that you cannot admit you made a mistake because that makes you even more vulnerable to lawsuits than you already are. Miss McMath's mother will certainly receive some sort of financial settlement, but whether or not it is sufficient to pay fully for the indefinite hospitalization of her daughter is another question. Sad news all around!
It will be very interesting to see if the court orders the hospital to insert the feeding tube and tracheostomy. I would expect that even if ordered to do so they would refuse. I'm more concerned with the way the courts seem to be overriding medical professionals. Last time I checked judges went to law school not medical school.
I seriously doubt that you can court-order a surgeon to perform a surgical procedure.
This entire situation is out of control and the family, the other patients in the PICU and the health care workers are the ones suffering. I notice that no one discusses the girl's suffering because she is NOT suffering because she is dead.
I wonder what the ripple effect of the court getting this involved for this length of time will be for future cases. Will there be another family who refuses to accept that their loved one is brain dead and get an attorney to stop the hospital from removing equipment?
Even the most minor surgery is not risk-free! The patient could receive too much anesthesia or have an undiagnosed medical condition that required special attention during surgical preparation. We will never know for sure what happened to Miss McMath.
One bad thing about working in health care is that you cannot admit you made a mistake because that makes you even more vulnerable to lawsuits than you already are. Miss McMath's mother will certainly receive some sort of financial settlement, but whether or not it is sufficient to pay fully for the indefinite hospitalization of her daughter is another question. Sad news all around!
And when will it end? How long will this go on? Will her mom keep this going until the day the mom dies?
Again, I am not making light of the suffering of the family, but enough time has passed for them to accept the determinations of three different experts that their daughter has died.
You would think that a religious family would understand that what is in the bed is just an empty shell and their actual daughter is already in heaven (if that is what she believed).
A couple of weeks is enough time for YOU to accept the fact that a beloved person is gone, but you can't speak for them. If it's your child, YOU MAY NEVER ACCEPT IT but you do what you have to do.
And just because you're religious and believe in an afterlife doesn't make it any more comforting because when it comes right down to it, you are now deprived of seeing your daughter forever as long as you're in this world. The only time the mother will see her is through memories, faith, and pictures. The sheer grief that family must be feeling I can't even fathom.
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