Posted on 01/04/2014 7:06:47 AM PST by NYer
We don’t know what health conditions that the girl might have had other than the sleep apnea which is a serious health condition; she was in fact in failing health. The family won’t allow the hospital to disclose any details, filed a restraining order against them and the only details we know are those disclosed in court filings which are not covered under HIPAA or the restraining order.
She was quite obese and her sleep apnea was according to her own family and court documents, was causing her problems with bedwetting, the inability to concentrate and hence doing poorly in school, and irritability. Untreated sleep apnea can also cause or contribute to obesity and difficulty in losing weight and also high blood pressure, heart arrhythmias, congestive heart failure, diabetes among others. Yes the mortality rate for such a surgery, even when including a tonsillectomy (and BTW the morbidity rate associated with tonsillectomy alone is 2% to 4% due to post-operative bleeding; the mortality rate is 1 in 15,000, due to bleeding, airway obstruction, or anesthesia complication), is low as compared to some other major surgeries, but it is not without risks of complications. This was not as has been reported in many MSM outlets and in several opinion pieces and blogs, a “routine” or simple tonsillectomy.
No surgery is “supposed” to result in anyone’s death, but there is always risk to any surgery. A low morbidity rate does not equal a zero morbidity rate. And complications after surgery, even fatal ones, does not always mean that the surgeons and hospital staff did something wrong. Although I will say that at least according to what the family has said, and understanding that we don’t know the whole story yet, that if Jahi was experiencing severe and unusual post op bleeding and that complication was ignored by the ICU staff, that the mother would have a good case for suing the hospital and if that turns out to be the case, I hope she wins. But ironically since her mother won’t allow her daughter to be taken off artificial life support and refuses to accept that her daughter is dead, and hence no autopsy can be performed that might prove negligence or malpractice, and the longer this goes on the more difficult it may become to prove her case.
But the family also said that Jahi was talking and asking for a popsicle in the recovery room, very shorty after the surgery. Did the family encourage her to talk and give her that popsicle even though normal post op protocol would be for her not to try to speak or take anything by mouth so soon. When they saw what might have been at first very normal post op bleeding, did they freak out and become hysterical, causing Jahi to also become so? We don’t yet know exactly what happened. But this type of surgery is not without some controversy.
http://www.nytimes.com/health/guides/disease/sleep-apnea/surgery.html
http://www.journalotohns.com/content/42/1/15
Now the family is faced with not only the shock of what happened, but also the rudeness of the doctors and hospital staff, while, on the other hand, there are people telling them there's still hope.
I agree that the hospital spokesperson and attorney is a PR nightmare, they have come across very poorly and callously. But we can’t say that all the doctors and all the hospital staff were rude or uncaring. (A doctor or several doctors informing the family that the fact is that this child is dead, while painful, is not necessarily being “rude”.) We also don’t know anything about the behaviors and attitudes and perhaps rudeness of the family and their attorney before we got to this point. We also have to understand that since Jahi has been declared dead, that I’m pretty sure that no private insurance, Medicaid or Medi-Cal is going to reimburse the hospital for continued and very expensive care and life support for a person who has by all medical and legal standards has been declared dead. The hospital is now in very perilous legal and ethical dilemma.
So, it's understandable that Jahi's mother does not trust the "brain death" diagnosis or the hospital or any of the doctors and, instead, is clinging to that glimmer of hope.
It is perfectly understandable why a mother would want to fight for her child and I can’t blame her for holding out hope and praying for a miracle. But the brain death diagnosis was confirmed by multiple doctors, multiple tests and protocols and confirmed by an independent neurologist not affiliated with this hospital appointed by the court.
At some point, Jahi's family will have to accept what happened, but right now it should be understandable why they're not.
At some point they will have to accept that this child is sadly dead. But in the meantime, we have a protracted very public and emotional legal battle and now much added confusion regarding the difference between, brain damage, brain impairment, coma, PVS and complete brain death and the fact that the artificial life support that keeps Jahi’s heart beating and her body warm, doesn’t mean that she is not dead.
We would like to think that a patient or the patient’s family has the right to make all the calls regarding medical care and continuation of life support, and I think a lot of latitude should be given when a diagnosis is unclear, but that is not always how it works.
For instance, let’s say a person thinks, truly “believes” that one of his kidneys needs to be removed, let’s even say that the patient prayed about it and truly believes that God sent him a message in a dream that told him that needed this surgery, his pastor even prayed about it and also believes this as a sign from God. But all subsequent medical tests prove that his kidney is functioning perfectly, that he is in perfect health and that such a surgery would not only be unnecessary but unnecessary life threatening. Should this patient be able to demand that the hospital and surgeons remove his kidney? Should a person who “wants” to be a paraplegic or have a limb amputated because of some psychological fetish demand a hospital to carry this out just because they want it?
What about a person who takes a shot gun shot at close range directly to the head in a tragic hunting accident and the entire upper half of the person’s head is blown off, but let’s say that his friends and the EMT’s are somehow and against all odds able to restart his heart and administer artificial respiration while he is transported to the hospital. But once there, the doctors determine that the patient is brain dead because he has no brain left and he is declared dead. But if his family “believes” that their son is still alive because his heart is still beating, even though it is only kept beating due to artificial means, should the hospital have to continue life support and be forced to perform other medical procedure on him when all medical indications says that he’s dead?
What a mess.
2.) Popsicles are routinely given to UPPP patients after surgery. See this PDF file. What should I eat and drink? For 1 to 2 days - cool/clear liquids, tepid broth, Jell-O, popsicles, ice cream, ice sherberts, puddings, applesauce, milkshakes, flat sodas.
3.) At first, the family's lawyer was complaining that the hospital wouldn't release Jahi's records to him or the family.
4.) If this young girl had other serious health issues that would make this surgery risky for her, then either (a) the surgeon would've/should've refused to operate and advised the family about other options, such as a CPAP; or (b) the hospital would've/should've made a point to watch her much more closely.
The study I think you are citing was a very limited study among adult patients in VA hospitals who had sleep apnea who got UPPV surgery alone and not with a tonsillectomy. Tonsillectomies have a mortality rate of around 2% to 4%.
So, her death (assuming she is deceased) should not have happened.
You are conflating and confusing a low statistical incidence of morbidity with a zero chance of morbidity. Statically her, chances of developing a serious or fatal complication was low; but statistically “low” does not equate with zero or “should not have happened”.
Popsicles are routinely given to UPPP patients after surgery
Yes, but not in the recovery room just an hour or so after surgery. When I had a tonsillectomy and removal of my adenoids when I was 18 years old, I was given nothing by mouth while in the recovery room and only allowed small amounts of ice chips after I was brought to my room for my overnight stay and observation – I recall being told by the RN that “sucking on a popsicle” could dislodge blood clots so I wasn’t allowed to have popsicles or soft foods like jello until I was released the next morning and sent home and even then we were told that with popsicles, that I should not suck on them, only allow them to slowly let them dissolve in my mouth for the next 24 to 48 hours .
At first, the family's lawyer was complaining that the hospital wouldn't release Jahi's records to him or the family.
We only have the family’s lawyer’s word on this.
If this young girl had other serious health issues that would make this surgery risky for her, then either (a) the surgeon would've/should've refused to operate and advised the family about other options, such as a CPAP; or (b) the hospital would've/should've made a point to watch her much more closely.
We do not know if a CPAP was tried first. Some people do not do well on a CPAP, especially adolescents. Obstructive Sleep Apnea is a serious health condition. But certainly with her weight and perhaps other medical conditions stemming from her sleep apnea, it may have well been a more risky surgery. But untreated sleep apnea also carries very serious risks. We also don’t know if Jahi was first put on a diet and exercise regime, but keep in mind that people with severe sleep apnea often gain weight and have trouble losing weight even with a healthy diet.
From what I’ve read and understanding that we do not know all the facts, but if the ICU staff did not promptly and quickly address severe bleeding and hemorrhaging then the family would have a good case for a lawsuit against the hospital regard her post op care.
When I had mine out (1960) I begged until I cried for a few sips of water.
The doctor finally relented and told to nurse to give me a few sips.
I then proceeded to vomit blood all over myself and the crib I was in.
I believe the other parents visiting their children (I was in a dorm with about 10 other children) thought I was dying. I think my stay in the hospital was at least over a weekend.
Nevertheless, if a popsicle did cause the complications this young girl experienced, then the hospital staff shouldn't have given her one (or let her have one).
You're confusing morbidity and mortality. The morbidity rate for tonsillectomy is 2% to 4%. (That's the rate of complications or illness following the surgery.) The mortality (death) rate is far, far lower - only 1 in 15,000.
OTOH, the morbidity rate for UPPP is higher, but the mortality rate is very low, which suggests that the vast majority of patients with UPPP complications survive.
And, no, the UPPP studies I'm citing were not small. In post #19, I linked to the article. Here's the link again. Here's what the article says:
A review of 3,572 patients treated with uvulopalatopharyngoplasty revealed the incidence of serious complications to be 37.1 per 1,000 patients. The most common complications were postoperative hemorrhage and infections; there were no perioperative or postoperative deaths. A similar study of 3,130 patients found an incidence of nonfatal complications of 1.5% and a 30-day mortality rate of 0.2%.
This tragedy should not have happened.
Oops. Wrong link. Here’s the correct link to the article on the UPPP studies:
http://emedicine.medscape.com/article/1942134-overview#a30
Oops. Wrong link. Here’s the correct link to the article on the UPPP studies:
http://emedicine.medscape.com/article/1942134-overview#a30
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.