The Terrible Case of Jahi McMath

j

Jahi McMath is a 13-year-old girl who has been declared brain dead after experiencing complications following a tonsillectomy at Children’s Hospital in Oakland.  The family did not understand what brain dead means.  They then got a lawyer who ordered the hospital to keep Jahi on a ventilator until further order from the court.

These are the cases than no one wants to be involved in.  It is a horrible situation even for the hospital to be involved with.  The family is devastated.  I am sure the doctors are devastated.  It is a no-win situation for everyone.

I am not going to debate brain death versus coma here.  I just want to bring up the point about “death panels”.  This is a  conservative lightening rod, usually propagated by Sarah Palin.   She, like a lot of things she talks about, is wrong.

Who decides when enough is enough?  Someone has to. The cost of care, especially at the end of life, is extraordinary.  There has to be limitations on the resources.  There also has to be consistency.  We just can let the media and lawyers change things for one family because they don’t understand what brain dead means.   Should a 90+ year old with severe dementia be allowed to stay alive via a ventilator?  Well, she was.  True story.

To update this story, Jahi’s case has been decided and the judge also agreed that she is brain dead.  Now the family wants her moved to another facility.   I know this sounds harsh but would they feel the same way if they had to pay?

Someone has to pay for this healthcare mess.  Actually, ALL of us should have to pay something.  Then the real ethical debate can happen and in that debate there actually has to be a discussion about appropriation of funds.  Someone has to bring it up whether Sarah Palin or the McMath family likes it or not.

 

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  16 comments for “The Terrible Case of Jahi McMath

  1. Habib
    January 1, 2014 at 9:46 pm

    This family thinks they are going to get a payday for med mal. The reality is that virtually no lawyer is going to take the case. This is because of California’s MICRA laws capping indirect (pain & suffering) damages at $250k. They will not be able to sue for financial damages because a 13 year old is deemed not to have any economic value. Lawyers’s fees are capped at 25%, so there a nothing in it for them. The health care providers – surgeon, nurses, hospital will have a very strong case for suing Jahi’s family for excessive costs associated with her care while dead. Very cruel all the way around. The hospital is positioning itself to the community must be a steward of its capital above all else.

  2. ken kayser
    January 1, 2014 at 2:28 pm

    I worked on a similar case where a young girl underwent tonsillectomy for “snoring”. She died from anesthesia overdose. She was 6 y/o and weighed over 105 lbs! As long as surgery is done (on children) instead of a proper diet, this type of tragedy will continue. Let’s hope Obamacare finds a way to ban this type of surgery. I can assure you that if it is not paid for, it won’t be done.

    The reason the parents want to prolong the life of their child is that they were totally unprepared for this death. I’ll bet they were not told that the procedure results in the death of a child XX times per year. I’ll bet that a rigorous trial of healthy diet was not tried.

    • Sir Lance-a-lot
      January 1, 2014 at 3:47 pm

      Right on, Ken.

      I personally see a girl from time to time who is now 8 years old, 45″ tall, weighs 255 (yes, TWO HUNDRED AND FIFTY-FIVE POUNDS), and has a BMI over 88.
      She can barely walk and barely breathe.

      I have personally called Child Protective Services about her (“Brought BCW down on their ass” as we used to say in NYC), waaaay back 8 months ago when she only weighed 217, they were well aware of her, and they did absolutely NOTHING.

      If this kid got a tonsillectomy for OSA (which I believe she’s already had), and died because of a poor outcome, you’d better believe the “parents” would be just as PO’d as these idiots on the news are, and all they need to do is feed her less.

      It’s pathetic, really.

  3. DrHockey
    January 1, 2014 at 10:33 am

    Certainly, this was a family tragedy. Their lawyer, for both self-aggrandizement and swaying public opinion in advance of the malpractice lawsuit, seems to be the family’s go-to person for medical and all other advice. The family does not seem to have a high level of education and their attorney is playing them for his selfish reasons.

    Jahi is dead — a brain death. Just like the 80-year-old person is dead, a cardiac arrest death. Just ask the 6 different physicians who examined Jahi, her chart, and her tests, and gave their uniform opinion that she is dead. I find it hard to understand why the judge required the hospital to keep her on medical support in the absence of donating her organs. Her attorney, if he were truly interested in doing what is best, would advise them to donate her organs so Jahi “could live on in other people.”

    This media circus would never happen in a physician’s family. We know and understand.

    Two of the things in the news media that greatly bother me:
    1. She did not have a tonsillectomy, her operation was for sleep apnea and more than just tonsils were removed.
    2. And what bothers me the most is that they report it as “routine surgery.” It may be a “common operation,” but speaking as a surgeon there is no such thing as “routine surgery.” Surprises are found, there can be technical difficulties, etc. I remind people there is even a risk of death just driving to my office.

  4. Brian Battista
    January 1, 2014 at 8:43 am

    I agree that we need to do better with such tragic cases, but it has to be at a local and not national level. This case may have unique features that don’t apply to a one size fits all policy. The local physicians, with the help of a hospital ethics committee can work with a grieving family to do the proper thing.
    Having said that, this is not a case about death panels nor an opportunity to promote more misinformation about Sarah Palin. Death panels have nothing to do with cases of brain death. They refer to system wide attempts to control cost by limiting care, denying services based on age or other factors. If Sarah Palin opposes those, then God bless her. I know that she was FAR more qualified to be President than BHO, and that, had she had the opportunity, she would have been a far better president, though that would not be a difficult task.

  5. kay peterson
    December 31, 2013 at 7:28 pm

    Sorry Dr Farrgo about not acknowleding just before that you had wised up to using media well re getting medicine accross. I had responded to your article before I’d explored your site more. That said, excluding you, the rest of the profession need to wise up media wise. If they had and did there would be less of the inane understanding and behaviors coming from this sad mess of a case.

    • Doug Farrago
      December 31, 2013 at 7:33 pm

      🙂

  6. kay peterson
    December 31, 2013 at 7:02 pm

    This miserable case has become a nightmare for all those involved. Well excluding one lawyer who is using this to get free advertising.
    Seperately it has had some positive benefits in that it has revealed how little the general public understand about the basic risks of surgery, resucitation and the mechanics of artificial life support and the various uses for it for different reasons. There is no understanding either of how uncomfortable it could be for some, nor that many who undergo that may suffer various degrees of cognitive impairments even when it’s of temporary use. Many of the general public don’t even grasp that when rescources go into life support on inapropriate cases that it deprives rescources for other needed treatments for patients who would be assisted.
    Furthermore, when much of the population are permitted to be poorly educated in basic sciences and clear logical thinking, we are left with people who when faced by crisis situations where resucitation and life support arise cannot grasp properly teven the basic medical explanations given to them , hence resorting to primitive defences and reactive responses at various levels.
    I do blame the medical profession for their insular focus of not recognising the importance to use the media to provide via accesible documentaries and talk shows to provide this important field of information so people are better informed when not under the stress of facing such.
    The fact is that many will face these dilemmas for one reason or other over their life course.
    When an interesting murder is to go to trial there are often movies hitting the screen before any trial outcome has happened.
    It would be most productive if the medical profession were to rapidly get shows out covering these topics while this girl’s case has the current interest at full force.
    It ought to provide concise accurate medical information, context and reasons for what laws and guidlines exist, plus the issues and differences from social as well as religous groups having impact. It ought to also show the reprecussions for how those those individuals feel when affected by dealing with both the experience and consequences of extended life support mechanics. That ought to be for both dubious and relatively valid cases.
    This could be done rapidly and cheaply if some of the medical profession got ambitious media students to work collaberatively with them on this. The media students gain would be the plus on their CV. Also get your doctors and nurses working in this field on talk show doing discussions on this topic pronto.
    Could it be of worth to indicate that the appaling turn of events with this girl’s case may well have broader consequences.
    Initially to avoid such a fiasco, there won’t be use of life support in seemingly poor prognosis cases where a small chance of some recovery isn’t entierly out of the question, but giving up at the point basic resucition fails, more so wherever kin seem questionable in predictable capacity to be co operative.
    The following next stage would be to maintain parity and principles free of any seeming bias when both hispitals and insurers would come up with across the board stringent criteria for exclusion for use of life support where only those with high chances of recovery access such or outright known agreed on organ donors.The latter then even impacting on less organ donations.
    I wonder if anyone would dare indicate that the extreme irrational entitled behavior of this girl’s family can be responsible for reducing access and even rescources for many those who may have lived in many ways, currently accessing ICU care and in the future.
    Would any one dare state that like this girl’s mother from not controlling first her obesity from pregnancy -predisposing the child’s obesity- then afterwards her daughters levels of obesity, shows that the consequences can be dire. Compromised quality of life and earlier death. Not in a way of blame, but as why keeping obesity down is important. Again the public are keen to look at this case right now so well handeled another useful opportunity. The mother could even be enlisted to want to warn others of what she had not understood before and use their life story to help others avoid these problems. It wouldn’t invalidate any wrongful death claim if there were practice issues.
    Medical practioners need to use the screen media, for as good as blogs are they are only read by the literate, a disappearing group.

    • Sir Lance-a-lot
      December 31, 2013 at 9:37 pm

      “.. use the media to provide via accesible documentaries and talk shows to provide this important field of information so people are better informed …”

      Ha ha ha. Good one.

      I predict that if such a presentation were ever to see the light of day, it would have an audience of about three, so long as Duck Dynasty, Mob Wives, and NCIS re-runs were still being shown

  7. Madelyn Sieraski
    December 28, 2013 at 9:52 am

    There are many patients who do not understand the difference between bad outcome and malpractice. I had something done now I am not perfect. I see it most often with post op surgery/post ICU expectations.

  8. Pat
    December 27, 2013 at 2:33 pm

    Yesterday I heard a moronic news reader say of the hospital in question how sad it was that they were being so tight-lipped about the case, and how it was clearly about the money “at a time when that shouldn’t be the issue.” Her co-moron chimed in that “of course a wrongful death suit will be filed.” Bingo, genius.

    Published reports indicate a one-in-15,000 tonsillectomy mortality rate, either from the anesthesia or bleeding five to seven days after the operation. It is awful, it is rare, and largely avoidable, but it can and does happen. Surgery is NEVER casual. I have no idea what complication, intra- or post-operative this little girl suffered – more that a few years in ER’s has taught me to be humble when considering an outcome without knowing the facts. That same experience has also taught me how things roll.

    I was involved with an adolescent death a few years back, another tragic story with what we thought was a happy ending. A dead teenager arrived nearly dead, was revived and is able to walk and speak to this very day, though sadly, brain damaged. The hospital comp’d everything, and even then the CEO immediately prepared for the worst. Sure enough, the hospital, EMS, every nurse, and every doc who even saw the chart was sued. It was a horrible plight for the family, but made no better by flinging their grief and vengeance on those who not only tried their best, but actually saved the kid’s life. The suit lasted for over a decade, and the family never got their lawyer-sought $25 million, only a small “you don’t have a case” settlement that probably paid for a nice dinner after the legal fees, and landed the rest of us on the national registry.

    So the hospital in this case is quiet? They better be, and so had anyone involved with the case. Maybe they screwed up, and maybe they didn’t. Because it won’t matter in the end. The media is already playing into the unrestrained emotion over a tragically (brain) dead girl and her grieving family as the foundation for finding fault where none may exist. Meanwhile, the hospital in question still has to keep running, still has other demented nursing homers whose families are clamoring for ICU beds, still has to cost-shift to pay for the increasing numbers without insurance…and idiot news readers say money shouldn’t be the issue? The hospital will be provably derelict in its duties if money is NOT the issue.

  9. Ken
    December 27, 2013 at 1:04 pm

    We usually hear something from the religious kooks accusing physicians of “playing god” whenever they want to do the humane thing and let patients die peacefully. The kooks never can explain why god caused the brain damage in the first place.

    • Sir Lance-a-Lot
      December 27, 2013 at 1:28 pm

      Yeah. I never got that one either.
      If a guy is down on the ground in arrest, and I come along and shock him when he’s lying there with no heartbeat, and bring him back to life, it seems to me that I’m playing God. When I let nature take its course, and stop temporarily staving off multisystem organ failure, it seems to me that I’m admitting that I’m not God, and letting Him have His patient back.

  10. Scribe
    December 27, 2013 at 11:53 am

    Sir-Lance-a-Lot stole a lot of my thunder and shortened my rant by a few paragraphs here, but I agree about the ethics committees. Those go back years – they were in existence in my physical therapist days pre-2000. They served a very useful function and actually addressed each case individually.

    What I fear with the ACA is the nebulous panel behind the scenes at the federal level that sets the rules. Not all cases are as obvious as Jahi’s, who obviously has 0% chance for recovery. The higher the edict, the more likely any case is to encounter a lot of “zero tolerance” stupidity.

    Ever tried to get an exception to some rule dished out by a federal agency? Ever try to contact someone who could even help with your situation? It’s almost impossible to even find contact numbers or addresses for VA physicians. If there’s a screw-up on one of your electronic forms due to a systems crash somewhere or a clerk grabbing stuff off the fax in a hurry, whatever your issue was has been lost in the electrons of cyberspace or the buildings full of hard copies.

    While Sarah Palin was simplistic in her definition of death panels, in a sense she was correct. I’d much prefer dealing with the hospital ethics committee than with some hospital administrator who has a list of absolutes from the feds and a sense of zero tolerance.

  11. Dave Mittman, PA, DFAAPA
    December 27, 2013 at 11:17 am

    Totally agree. Brain dead is brain dead.
    Lawyers are the ones who understand the definition the best.
    Dave

  12. Sir-Lance-a-Lot
    December 27, 2013 at 7:13 am

    We’ve all been there in the ICU with the unreasonable family demanding that “everything be done” when, in reality, there is nothing to do except say a little prayer and call the undertaker. It is maddening, and is the result of poorly educated family members and the generally low level of respect for the medical profession, which leads people to naturally assume that the doctor is wrong instead of right.

    Death panels? Sure. Every hospital has one already. It’s called an “ethics committee,” and it tries to arbitrate between irrational families and doctors who want to do what’s right.
    It looks like the committee in this hospital made its decision, which was then overruled by the family’s lawyer (naturally), but has now been re-ruled by a local judge in consultation with outside experts.

    People die. It’s sad and tragic. Years ago kids her age would have been dropping from smallpox, polio, minor skin infections, and undefined “fevers.” Today, it’s much less common, and, I think, harder to accept, but it’s nonetheless real. As the alkies say, “Let go and let God.”

Comments are closed.