Tragic death of a child in Oakland after surgery

[AmbulanceDriver]

I have to wonder how much is the family trying to not associate the loss of their child with Christmas? Maybe not even on a conscious level.

[gunsmith]

I have to wonder how much is the family trying to not associate the loss of their child with Christmas? Maybe not even on a conscious level.

too true.
memories sometimes disturb my own happy holidays.

the terry schiavo case, it seemed to me the "husband" who was shacking up wanted her dead for some reason, if her mom/dad were willing to provide care-whats the point of starving her to death? 

the folks that disagreed with me at the time kept coming back to "she shouldn't have to live like that" if she was brain dead then she was unaware of living like that, if she had some consciousnesses, freaking starving her to death seems kind of mean.

this case is different, the hospital/doctors screwed up a standard tonsillectomy and severely injured a child.
imo if mom/dad want a miracle the  hospital/doctors need to cough up the dough. they are the ones that screwed up.
sure, its cheaper to let the kid die, but if the kid really is brain dead imo the hospital/doctors screwed up and they should pay for whatever the parents want and I bet after a few yrs the parents will decide to let her go.

[vaskidmark]

It would be cheaper, both in terms of money and resources, for the doctors and hospital to pay the parents via a civil settlement than by tying up precious resources for however long it takes, while also emotionally traumatizing not only the parents but those that have to "care" for the alleged meatstick.

I don't know how many of you have ever spent even 5 minutes in a room where someone who has lost all contact with the world as we know it lies on a bed with tubes and wires sticking into them, let alone having to care for them.  I've spent the time but thankfully have never had to do the actual hands-on caring.  For me the worst was learning that no matter how much care and attention was given there is almost no way to prevent the breakdown of an essentially inert body.  Documenting the coping mechanisms of staff in a "quintrapalegic" unit of a head trauma hospital made for a great thesis but really bummed me out.  (Their term for quadrapalegics who also had no apparent communication with the outside world - sort of like Johnny Got His Gun but not able to know if any of the brain activity was meaningful for whatever was inside.)

No, paying off the parents will not bring the kid back and the parents may even feel worse thinking about having "sold" their kid, let alone about spending any of the money.  But it does keep a whole lot of other folks from becoming emotionally wrapped up in the situation.

stay safe.

[gunsmith]

I am sure the hospital would rather pay a settlement....in my case it would be like the holy grail, me complaining I'm not dead yet & my family ogling the cash.

The parents do not want a settlement, the kid is dead or brain dead ( whatever ) but the body still functions if hooked up to machines.
The hospital did that to the kid, if the parents want their kid hooked up to machines for a few years - imo - they ( the hospital ) should pay.

The doctors/hospital messed up - they need to pay for it.

yup. its a waste of resources, but tooooo bad. the hospital ( imo ) needs to suck it up and pay and pay and pay until mommy decides different.

[vaskidmark]

gunsmith -

I have one word for you:  bedsore.

stay safe.

[gunsmith]

gunsmith -

I have one word for you:  bedsore.

stay safe.

Well, if she is "dead" then bedsores are the least of her problems.
 
if she is dead then she's dead, she cant feel pain.

Mom is the one feeling the pain, the hospital should burden the pain of paying for care of the alive/dead body until mom is ready to let go.
They're the ones that turned a routine operation into a dead girl.

[lupinus]

And all operations come with risks, routine and common or not.

It sucks. It's tragic. It's sadder than hell. But complications can happen and result in someone dieing anytime surgery is performed. It's not the hospitals fault she's the one in however many million that is going to have a serious complication after such a procedure, and until some evidence comes to light saying otherwise it doesn't mean they screwed up. So just how long should they keep her body "alive" and how many unethical procedures should they have to perform on an essentially dead body because the mother wont  accept the reality that her child is gone? We're not talking a coma here, or even serious brain damage. The girls dead, the machines she's hooked up are just artificially extending that fact for some parts of her body.

[cordex]

So just how long should they keep her body "alive" and how many unethical procedures should they have to perform on an essentially dead body because the mother wont  accept the reality that her child is gone?

What exactly makes a surgical procedure performed on a corpse at the behest of the family unethical (besides the hospital calling it that)?

[Hawkmoon]

What exactly makes a surgical procedure performed on a corpse at the behest of the family unethical (besides the hospital calling it that)?

AMA code of ethics, among others: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion820.page?

The following general guidelines are offered to serve physicians when they are called upon to decide among treatments:

(1) Treatments which have no medical indication and offer no possible benefit to the patient should not be used (Opinion 2.035, "Futile Care").

(2) Treatments which have been determined scientifically to be invalid should not be used (Opinion 3.01, "Nonscientific Practitioners").

[cordex]

AMA code of ethics, among others: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion820.page?

Opinion 2.035 seems to state that a physician is not obligated to provide care that won't help, not that futile care is in and of itself unethical.

In a case like this, if the parents are willing to pay for an unnecessary surgery on a body after being advised of its futility I see no reason why the hospital shouldn't perform it.  It's not as though they're protecting the dead girl by refusing to provide the service.

[Hawkmoon]

Opinion 2.035 seems to state that a physician is not obligated to provide care that won't help, not that futile care is in and of itself unethical.

In a case like this, if the parents are willing to pay for an unnecessary surgery on a body after being advised of its futility I see no reason why the hospital shouldn't perform it.  It's not as though they're protecting the dead girl by refusing to provide the service.

I disagree. Opinion 2.035 states:

Opinion 2.035 - Futile Care

Physicians are not ethically obligated to deliver care that, in their best professional judgment, will not have a reasonable chance of benefiting their patients. Patients should not be given treatments simply because they demand them. Denial of treatment should be justified by reliance on openly stated ethical principles and acceptable standards of care, as defined in Opinion 2.03, "Allocation of Limited Medical Resources," and Opinion 2.095, "The Provision of Adequate Health Care," not on the concept of "futility," which cannot be meaningfully defined. (I, IV)

If [viable] patients should not be given treatments simply because they demand them, it's not much of a stretch to opine that dead "patients" should not be given treatments simply because the next-of-kin demands them.

Then we need to examine opinions 2.03 and 2.095

Opinion 2.03 is long, so I'll only quote one paragraph. The rest is here: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion203.page

Decisions regarding the allocation of limited medical resources among patients should consider only ethically appropriate criteria relating to medical need. These criteria include likelihood of benefit, urgency of need, change in quality of life, duration of benefit, and, in some cases, the amount of resources required for successful treatment. In general, only very substantial differences among patients are ethically relevant; the greater the disparities, the more justified the use of these criteria becomes. In making quality of life judgments, patients should first be prioritized so that death or extremely poor outcomes are avoided; then, patients should be prioritized according to change in quality of life, but only when there are very substantial differences among patients. Non-medical criteria, such as ability to pay, age, social worth, perceived obstacles to treatment, patient contribution to illness, or past use of resources should not be considered.

Opinion 2.095 is also somewhat long so I'll only quote part. The rest is here: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2095.page

Opinion 2.095 - The Provision of Adequate Health Care

Because society has an obligation to make access to an adequate level of health care available to all of its members regardless of ability to pay, physicians should contribute their expertise at a policy-making level to help achieve this goal. In determining whether particular procedures or treatments should be included in the adequate level of health care, the following ethical principles should be considered:

(1) degree of benefit (the difference in outcome between treatment and no treatment),

(2) likelihood of benefit,

(3) duration of benefit,

(4) cost, and

(5) number of people who will benefit (referring to the fact that a treatment may benefit the patient and others who come into contact with the patient, as with a vaccination or antimicrobial drug).

[vaskidmark]

Well, if she is "dead" then bedsores are the least of her problems.
 
if she is dead then she's dead, she cant feel pain.

Mom is the one feeling the pain, the hospital should burden the pain of paying for care of the alive/dead body until mom is ready to let go.
They're the ones that turned a routine operation into a dead girl.

My concern is not for the body, but for those that will be tasked with tending the body.  When bedsores appear they will be liable, regardless of how well they have tried to do their duty in caring for the body.  There may also be an emotional toll from failing in spite of all possible precautions.  (Many folks in the nursing profession are like that, for some reason.)

But I clearly hear your desire to make the hospital pay.  A question about that, if you will permit?  How about the hospital pay for services/care/treatment to assist the mom in accepting the death of her child?  Even lower primates who carry the corpse of their dead newborns eventually give up and let go of the body.  How long are you willing to let this mom carry the corpse?  And to what end?

stay safe.

[cordex]

I think it comes down to the purpose of professional ethical standards.  In this case it sounds as though ethics are being used by the hospital as a club to beat the family with instead of as a guide to help protect patients.

If [viable] patients should not be given treatments simply because they demand them, it's not much of a stretch to opine that dead "patients" should not be given treatments simply because the next-of-kin demands them.

I agree that it can make sense to limit requested treatments in certain cases.  If the requested treatment is more likely to cause harm than good or if the wasted treatment would cause harm by exhausting a resource necessary to treat someone who is more likely to benefit - fine, those are valid reasons to deny futile care - and that seems to be the goal of the ethical standards you quoted.  In this case, I doubt putting in a feeding tube and giving the parents the girl's body to take to a long term care facility is going to either hurt the patient any more or cause harm to someone who isn't getting necessary care in a timely manner.  That being the case, going all letter of the "law" on the family seems petty and vindictive.

[gunsmith]

My concern is not for the body, but for those that will be tasked with tending the body.  When bedsores appear they will be liable, regardless of how well they have tried to do their duty in caring for the body.  There may also be an emotional toll from failing in spite of all possible precautions.  (Many folks in the nursing profession are like that, for some reason.)

But I clearly hear your desire to make the hospital pay.  A question about that, if you will permit?  How about the hospital pay for services/care/treatment to assist the mom in accepting the death of her child?  Even lower primates who carry the corpse of their dead newborns eventually give up and let go of the body.  How long are you willing to let this mom carry the corpse?  And to what end?

stay safe.

the hospital is playing gotcha games with mom, refusing to provide nutrition ( no "food" for body since Dec 8th ) and also refusing to provide tracheotomy so body can be transported.

its clear the hospital is worried that the comatose dead kid  could actually "live" quite a long time with life support and is trying its level best to kill the body.

in essence they are not letting mom carry the dead child, they are fighting her every step of the way because they do not want to pay for a few yrs of
life support or they are actually worried that the child could partially recover.

its the hospital currently refusing to let go, mom has a facility lined up - mom will let go in her own time, but the hospital wont let her.

why should she trust them? they killed her kid.

[Firethorn]

its clear the hospital is worried that the comatose dead kid  could actually "live" quite a long time with life support and is trying its level best to kill the body.

I can understand them not wanting a Schiavo equivalent on their hands.

or they are actually worried that the child could partially recover.

Given the court appointed second opinion agreed that she's brain dead, lottery levels unlikely.

On the private facility - how are the parents going to pay for it?

[Fitz]

I can understand them not wanting a Schiavo equivalent on their hands.

Given the court appointed second opinion agreed that she's brain dead, lottery levels unlikely.

On the private facility - how are the parents going to pay for it?

It's California. The taxpayers will, via Medi-cal

[roo_ster]

Beggars can't be choosers*.  If they are not paying the freight and the taxpayers of California are, pull the plug.







* Which is why the gov't seeks to beggar us.  See Obamacare for one example.

[lupinus]

the hospital is playing gotcha games with mom, refusing to provide nutrition ( no "food" for body since Dec 8th ) and also refusing to provide tracheotomy so body can be transported.

its clear the hospital is worried that the comatose dead kid  could actually "live" quite a long time with life support and is trying its level best to kill the body.

in essence they are not letting mom carry the dead child, they are fighting her every step of the way because they do not want to pay for a few yrs of
life support or they are actually worried that the child could partially recover.

its the hospital currently refusing to let go, mom has a facility lined up - mom will let go in her own time, but the hospital wont let her.

why should she trust them? they killed her kid.

So hospitals should do whatever a dead patients parents want to the body?

[Hawkmoon]

why should she trust them? they killed her kid.

Who is "they" and how -- exactly -- did "they" kill her kid?

Granted, the facts are there -- a live kid underwent surgery, a live kid came out of surgery and requested a Popsicle because her throat hurt (not uncommon after a tonsillectomy, if I recall grammar school mates' stories way back when), and then she began bleeding and went into cardiac arrest.

You don't seem to have your argument very well organized. You refer to a "comatose" (i.e. alive but in a coma) "dead kid" (i.e. NOT alive). In other posts you seem to be suggesting that the parents are correct and that the kid might wake up again, given enough time. Then you write that "they killed her" -- again implying that the kid is, indeed, dead.

If we accept that she is dead, then the question is what (not who) killed her. Certainly, nobody set out to kill her. The operation was more than a routine tonsillectomy, and I think we can assume that the parents were advised of that. But "the hospital" didn't perform the surgery. A surgeon performed the surgery. I don't recall seeing his (or her) name mentioned at any time, and I certainly don't recall seeing anything to suggest that the doctor was an employee of the hospital. Could have been, but also very well may not have been.

So ... did the surgeon botch something? Did the kid have some undetected problem that was triggered by the operation, or by the anesthesia? We don't know. Maybe the doctor goofed, maybe the doctor did everything right and the kid died anyway. It happens.

Unless and until we know who did what, and WHY the kid died, it is irresponsible in the extreme to make statements like "They killed her kid."

[roo_ster]

Hawkmoon..

Whatever the exact chain of events the hospital gave all associated docs privileges even if they were not hospital employees.  And the hospital was likely the direct employer of all support staff.

Hospital is a reasonable target and proxy for "they."

[lupinus]

Except that, thus far, there is no evidence whatsoever to support the statement that "they killed her." Or that anyone killed her. Or that anyone in any way did something that resulted in her death. So who the "they" is is a moot point. Because there's no evidence that there is a they.

Thus far you've got a kid that had one of the known risks of the procedure (bleeding), that for whatever couldn't be brought under control, and as a result she's died in all respects but that certain functions are still going only because of machines. It sucks that she's the one in however many people that will die from a complication from a fairly routine tonsillectomy, but it happens, and she's hardly the first.

[roo_ster]

Except that, thus far, there is no evidence whatsoever to support the statement that "they killed her." Or that anyone killed her. Or that anyone in any way did something that resulted in her death. So who the "they" is is a moot point. Because there's no evidence that there is a they.

Thus far you've got a kid that had one of the known risks of the procedure (bleeding), that for whatever couldn't be brought under control, and as a result she's died in all respects but that certain functions are still going only because of machines. It sucks that she's the one in however many people that will die from a complication from a fairly routine tonsillectomy, but it happens, and she's hardly the first.

The dead kid is a pretty good start.  Along with the admission that she had a medical procedure in that hospital.  A body on the premises and opportunity are more than enough for cops to give a suspect the hairy eyeball.  To think the kid did not die due to actions that took place while she was in the care of the hospital's proxies is what requires wild speculation.

[lupinus]

The dead kid is a pretty good start.  Along with the admission that she had a medical procedure in that hospital.  A body on the premises and opportunity are more than enough for cops to give a suspect the hairy eyeball.  To think the kid did not die due to actions that took place while she was in the care of the hospital's proxies is what requires wild speculation.

Seriously?

How many millions of folks die in hospitals every year? How many due to complications after a surgery? Most are due to the fault of no one.

When someone comes up with any sort of credible evidence that someone *expletive deleted*ed up and is responsible for her dieing, I'll be right there in calling for that person to be held accountable to it. Until then statements like "they killed her!" and using it as an argument for anything is sensasalistic bull. Till there's evidence someone is in any way responsible she's a victim of no more than having bad enough luck to draw the short straw and being the "1 in X" statistic for folks who die post op. The death of a child is tragic, but it happens.

And even if that does eventually happen, it's still a moot point. It means someone should be held accountable for their screw up just like any other case of malpractice. It's not justification for forcing other physicians and staff to perform unethical medical procedures on a corpse, or for the hospital to faucilitate it. Coma? Major brain damage? Sure. Flat out dead, just having certain functions chugging along by machines? Not so much.

[Sergeant Bob]

Except that, thus far, there is no evidence whatsoever to support the statement that "they killed her." Or that anyone killed her. Or that anyone in any way did something that resulted in her death. So who the "they" is is a moot point. Because there's no evidence that there is a they.

Thus far you've got a kid that had one of the known risks of the procedure (bleeding), that for whatever couldn't be brought under control, and as a result she's died in all respects but that certain functions are still going only because of machines. It sucks that she's the one in however many people that will die from a complication from a fairly routine tonsillectomy, but it happens, and she's hardly the first.

Seriously?

How many millions of folks die in hospitals every year? How many due to complications after a surgery? Most are due to the fault of no one.

When someone comes up with any sort of credible evidence that someone *expletive deleted*ed up and is responsible for her dieing, I'll be right there in calling for that person to be held accountable to it. Until then statements like "they killed her!" and using it as an argument for anything is sensasalistic bull. Till there's evidence someone is in any way responsible she's a victim of no more than having bad enough luck to draw the short straw and being the "1 in X" statistic for folks who die post op. The death of a child is tragic, but it happens.

And even if that does eventually happen, it's still a moot point. It means someone should be held accountable for their screw up just like any other case of malpractice. It's not justification for forcing other physicians and staff to perform unethical medical procedures on a corpse, or for the hospital to faucilitate it. Coma? Major brain damage? Sure. Flat out dead, just having certain functions chugging along by machines? Not so much.

Indeed. Hey, surgery is dangerous. Sometimes, unforeseen complications arise, which cannot always be corrected in time to assure a positive outcome. I've had a few surgeries, all of which have had positive results (other than an anesthesiologist who ignored my repeated warnings that I was "difficult" to intubate, and in which I remember his three) failed attempts at doing so), in which the surgeon had to take over and did it on the first attempt (which I remembered "great surgeon". I registered a formal complaint with the hospital and he is no longer practicing at that hospital. I think "most" surgeons are competent and responsible, but sometimes  things happen which are beyond their control.

[roo_ster]

Seriously?

How many millions of folks die in hospitals every year? How many due to complications after a surgery? Most are due to the fault of no one.

When someone comes up with any sort of credible evidence that someone *expletive deleted*ed up and is responsible for her dieing, I'll be right there in calling for that person to be held accountable to it. Until then statements like "they killed her!" and using it as an argument for anything is sensasalistic bull. Till there's evidence someone is in any way responsible she's a victim of no more than having bad enough luck to draw the short straw and being the "1 in X" statistic for folks who die post op. The death of a child is tragic, but it happens.

And even if that does eventually happen, it's still a moot point. It means someone should be held accountable for their screw up just like any other case of malpractice. It's not justification for forcing other physicians and staff to perform unethical medical procedures on a corpse, or for the hospital to faucilitate it. Coma? Major brain damage? Sure. Flat out dead, just having certain functions chugging along by machines? Not so much.

Yes, seriously.

Maybe you ought to have read my first post in this thread before hyperventilating at the keyboard.  Reading my subsequent posts would also have informed you that I have not determined if there is any fault to be apportioned, but that if anything fault-worthy occurred, it did occur at the hospital.  Referring to the hospital and its employees/proxies as "they" is a reasonable shorthand.

Oh, and your faith in hospitals and hospital staff is touching.  Yes, many times shinola is just going to happen or there is no way to foresee/prevent some event.  OTOH, I have some first-hand experience with some walking future lawsuits-in-scrubs, the sort that would give Millcreek an ulcer.  And my wife has prevented destitute folk from meeting their maker due to the actions of less-competent nurses & techs or marginally competent baby docs where she works.  But, like I wrote, beggars can't be choosers(1).  (Most folk where she works are not paying their way or insured, so the taxpayer foots the bill.)  Somebody has to finish last in the class (doc, nurse, tech) and they usually manage to find a job somewhere.


(1) And the cost of affirmative action is not just to passed-over job applicants.