Who Pays? Brain-Dead Girl To Be Kept On Life Support (After Her Actually Not-So-Routine Tonsillectomy)
Tragic story -- a 13-year-old girl went into hospital for a (supposedly -- see below) "routine tonsillectomy," and something went terribly wrong. The hospital called the procedure a "complicated" one. The girl is now brain dead.
Terry Collins wrote on December 21st for the AP that her family fought in court -- and won a restraining order against the hospital -- in their battle to keep her on life support:
"Ms. McMath is dead and cannot be brought back to life," the hospital said in the memo, adding: "Children's is under no legal obligation to provide medical or other intervention for a deceased person."The family filed a request Friday for a temporary restraining order prohibiting the hospital from taking Jahi off life support or any of her other current treatment.
At the hearing later, the hospital's attorney, Doug Straus, said two doctors unaffiliated with the hospital examined Jahi and concluded that she was brain dead. But he said, "We're happy to cooperate with the judge's suggestion that an independent expert be provided to confirm yet again that brain death is the outcome that has occurred here."
The family's attorney, Christopher Dolan, said the family wanted independent tests of their own because they do not believe the hospital's physicians are sufficiently independent.
The deadline has now been extended to January 7.
Brain death is "the irreversible end of brain activity (including involuntary activity necessary to sustain life) due to total necrosis of the cerebral neurons following loss of brain oxygenation. It should not be confused with a persistent vegetative state."
About that supposedly "routine tonsillectomy" theden.tv reports:
Every single report states that it is a simple tonsillectomy, but that is not the whole truth. The media knows this, but fails to report it and continues the charade. The court documents state that it was far more involved. This is not a simple tonsils-out-and-ice-cream-later procedure but a uvulopalatopharyngoplasty (UP3). The AP and Huffpo call it a simple tonsillectomy despite there being court documents that show it was a UP3. A UP3 is invasive, risky and comes with complications, per the NY Times and many sleep disorder forums. They want you to think this was just a tonsillectomy to help the eventual shakedown by the family with this lawyer's help because readers will be shocked to think someone could die from a tonsillectomy.A simple question no media member is asking is why a thirteen-year-old is getting a UP3. A UP3 is a surgery to help people suffering from sleep apnea. They never say she suffered from sleep apnea, because to mention it would distort the narrative. How is a thirteen-year-old already suffering from sleep apnea? Google Image search results show Jahi McMath as obese.
This is the world of obese America, where we see a rise in sleep apnea due to 1/3 of the US being overweight and 1/3 being obese. You probably have a family member with one of those sleep masks to keep an oxygen flow going, and they are probably overweight. This should not affect a thirteen-year-old. Kids are developing not only adult problems, but problems that only fat adults have.
The greater conversation is about obesity and the culpability of the obese themselves. There are money quotes from the mother of McMath about her child being perfectly fine before going to that hospital, but no one bothers to mention her daughter being obese to the point of needing surgery to prevent her from dying in her sleep. Obese is not fine. Maybe they did try a weight loss program, and momma didn't 'mom up' and work hard on getting her kid in shape.
All surgery comes with risk, and obesity sets up people for long term health problems.
And it increases the risks from surgery.
The only kids I've ever run across having this procedure done have deformities from birth defects and genetic disorders (very rare still) or they are morbidly obese (much more common). They cut out a bunch of tissue in your throat to keep it from relaxing and blocking off the airway during sleep. The fatter you are the more tissue relaxes and hangs into the airway. There's no reason a child should be so obese they require airway reconstruction surgery.
BunnyGirl at December 30, 2013 10:37 PM
Now this is a health-care blog post.
☑
Crid [CridComment at GmaIl] at December 30, 2013 11:40 PM
A sad situation, and a surgery gone wrong. A family that hasn't come to terms with the death of a child. The judge isn't helping, by allowing the family to continue in denial.
The obesity question is really a separate issue altogether.
a_random_guy at December 31, 2013 12:40 AM
> The obesity question is really a separate
> issue altogether.
No. I mean, only to sensible people.
In Obamacare, everything bad that happens is everyone's responsibility, no matter if the failure was in one family, or even one person.
Crid [CridComment at Gmail] at December 31, 2013 12:43 AM
Amy Alkon
http://www.advicegoddess.com/archives/2013/12/31/who_pays_brain-.html#comment-4165269">comment from Crid [CridComment at Gmail]I don't wish this even on the laziest parents, but I'm guessing the parents thought it would be easier to get the girl surgery than deal with her obesity on a behavioral level, thinking that life would magically be made okay through medical intervention.
I talk with and get papers from (on methodological flaws) an epidemiologist who regularly emphasizes the dangers from drug or medical intervention. All drugs have side effects and medical treatment has risks. Whether the tradeoff is worth it is a decision to be made -- one that needs to be made before treatment.
Amy Alkon at December 31, 2013 5:56 AM
Sleep apnea's cause is unknown. My father is NOT obese - and if he's overweight by 5 pounds I'd be shocked given that he's basically addicted to working out. Yet, he has horrible sleep apnea. He also has diabetes - which is how his sleep apnea ended up being discovered (the two correlate so highly that diabetics are screened as a matter of course).
So, my complaint with this is the ASSUMPTION that weight causes sleep apnea. It is simply not known... although it does correlate with things that also correlate with obesity, that does NOT mean it is causal. Moreover, anyone who spends any time here should know that insulin problems can lead to obesity... and diabetes has a definite genetic component. So... can we say that sleep apnea is caused by obesity? NO! We cannot. It could equally well be caused by some genetic quirk that also impacts insulin production and/or function.
Correlation does NOT imply causation. Otherwise we could say that the sun causes car accidents because sunrise correlates with an increase in traffic accidents - which I'm sure has nothing to do with the fact that we people tend to drive en mass around sunup (the morning commute).
Shannon M. Howell at December 31, 2013 6:10 AM
I hate it when people make up bullshit numbers to try to support a basically good point. Two-thirds of Americans being morbidly overweight or obese is a bullshit number. I challenge the author of that piece to provide a reference for that (and not something based on the government's "body mass index", which classifies a lot of world-class athelets as obese).
BunnyGirl, I have sleep apnea. At the moment I could stand to take off ten pounds or so (I'm working on it), but I had sleep apnea when I was 20 years old and at 6' tall I weighed 165 pounds. I've had the UP3 surgery and a number of other nasal surgeries and none of them have been long-term effective because, in my case, the tissue always grows back. Every few years I go in to have more removed (they do it under a local now, one hour in and out). It's always biopsied and it's always benigh, but it still grows back.
Plus, I had my nose broken when I was 14, and there were long-term consequences from that. I have met a few other people who had their noses broken when they were children or teenagers, and they all have sleep apnea now. And yes, I use one of those machines. It's been a godsend, despite the inconvenience of dealing with the machine and the mask and the hose.
As for the story here: It goes to show that no surgery is without risk. Other than that, I'm not sure what the point is. Obviously, if the girl is in fact brain dead, the family is having a hard time letting go. I sympathize with that, but in the end, there's no point in keeping a body alive when the person who inhabited it is gone.
Cousin Dave at December 31, 2013 6:14 AM
There are people who are not obese who have joint problems. There are people who are obese who have sleep apnea or diabetes. HOWEVER being overweight/obese is certainly putting you at risk for things you may not have encountered had you taken control of the weight situation! The article I read did say she was under going a tonsillectomy for sleep apnea. I then saw a picture of the girl. She was obese plain and simple. I agree with Amy its a tragedy that this happened because at 13 I am pretty sure she couldn't appreciate the risk of the surgery she was having but her parents probably thought it was easier to get the surgery than say get a nutritionist. I see it on my daughters soccer team (btw she is 5!) one of the girls who showed up for 1 game (her parents removed her from the team after) was at least 50lbs overweight at 5! My daughter doesnt even weigh 50lbs to give you some idea about the condition of this poor child. I think its a type of abuse its so sad.
lrj at December 31, 2013 7:21 AM
"HOWEVER being overweight/obese is certainly putting you at risk for things you may not have encountered had you taken control of the weight situation! "
True enough. I was just pointing out that the connection between weight and sleep apnea is far from certain. (As usual, it appears that little causality research has been done; the only thing that exists are correlation studies with typically ill-defined criteria.) In particular, there is one variety called "central" sleep apnea which results from a malfunction of the brain stem, and has nothing to do with weight per se.
Cousin Dave at December 31, 2013 9:02 AM
I don't wish this even on the laziest parents, but I'm guessing the parents thought it would be easier to get the girl surgery than deal with her obesity on a behavioral level, thinking that life would magically be made okay through medical intervention.
Not having read any of the background material, I have to ask you what led you to that guess. Within the context of this blog post, I'm not seeing a path that would lead there.
Old RPM Daddy (OldRPMDaddy at GMail dot com) at December 31, 2013 9:09 AM
I had mild sleep apnea when I was in high school, 6'3" 125lbs and swimming 5-8 hrs a day
Today, 10-20lbs overweight I dont
lujlp at December 31, 2013 9:28 AM
@Cousin Dave: If you want numbers, will the World Health Organization suffice? Here are the relevant statistics for the USA. Pretty damned close to 1/3 obese, 1/3 overweight - actually a bit worse than that.
Overweight (excluding obese)
Men: 42.3
Women: 33.1
Obese
Men: 30.2
Women: 33.2
Sure, some people throw useless numbers around. However, you could have spent a couple of minute checking, before assuming that these were nonsense. They're not. The USA is fat.
a_random_guy at December 31, 2013 9:42 AM
Random, they are bullshit because they are based on the bullshit prinicple of the body mass index. BMI prescribes weight ranges based solely on height, making no allowances for skelatol structure or body type. BMI also fails to take into account the difference between fat mass and muscle-bone mass, which is denser than fat. Body specific gravity is a much better measure of excessive body fat, but it's harder to measure. Here is an article that discusses some of the problems with BMI; it's not the best, but it's the only one I can get to from work.
Cousin Dave at December 31, 2013 10:23 AM
@Lujlp: I had mild sleep apnea when I was in high school, 6'3" 125lbs and swimming 5-8 hrs a day
Damn, you must have been a rail!
Old RPM Daddy (OldRPMDaddy at GMail dot com) at December 31, 2013 10:28 AM
Seriously... at 6' and 165 you could see my ribs through my chest...
Cousin Dave at December 31, 2013 11:13 AM
I knew there was more to the story other than a 'simple tonsillectomy', though I must admit I was too lazy to research it. You don't send tonsillectomies to the ICU unless you have a damn good reason. And ever the cynic, if this were just a botched procedure then we would be talking lawsuit instead of life support. Plus this was a Children's Hospital so it was definitely not amateur hour.
As for the obesity/sleep apnea thing, I have indeed seen rail-thin guys with horrible obstructive sleep apnea (OSA). However, they are the exception and not the rule--by a long shot. I agree that BMI is a much less than ideal number. In fact, when the CDC decided to define what 'obese' was by BMI back in 2000, there was a sudden jump in obesity. America did not just suddenly get fatter, they just changed the goalposts for what fat was. But it does not change the fact that this nation is waaaaay too overweight.
Why didn't they just get her a CPAP machine? There is still much of the story that is not being released.
coffee! at December 31, 2013 1:37 PM
Yesterday, I had my first experience with general anesthesia...
...And it was fucking fantastic.
Got-TAM that was some sweet candy.
(It was the Morning of the Snake for middle-age, a peek through the back porch, and you should know what I'm talking about. Turns out I'm as pure, well-formed and attractive on the inside as on the outside. Longtime readers of these comments, observant to the handsome contours of my emotional and intellectual interiors, will not be surprised.)
As she wheeled me into the Big Room, I asked the woman if it would be the Micheal Jackson drug. She said yes. I asked if I'd be able to moonwalk. She replied, mirthlessly, that that was funny. A few minutes later she hit the switch: Three seconds later, I said Good Morning, and the Universe stopped.
There was no descent or slowing... All the Cosmos' processes —chemical, ionizing, and gravitational— ceased without sound, lurch, or spillage; and the darkness hosted no features.
Fifteen minutes later she hit another switch, and I was back. I've awoken in earthquakes, during minor crises overseas and in airliners, and the beds of impatient husbands returning unexpectedly*... But I've never come so instantly to splendid, masterful consciousness. I as ready to go to work, to race at Monaco, to take the LSAT. Full powers, mood undiminished, not so much as a cellphone's where-were-we.
Incredible. As the guy in the next bed of the recovery room got up to leave, I heard him ask for a Doggy bag: "There's a holiday coming up!" (He didn't get one.)
I understand why Michael Jackson wanted that drug.
And why the man who gave it to him is in prison.
But again, it's important to note that I'm an extremely well-composed, neatly-proportioned and good-looking(!) specimen.
Whatever the cause of this girl's apnea, being overweight complicates surgery as you'd expect it to.
It's one reason loving parents help their kids eat properly. As bad as those problems can be, it's probably not their best reason for doing so.
Crid [CridComment at Gmail] at December 31, 2013 2:26 PM
☑ lrj at December 31, 2013 7:21 AM
Crid [CridComment at Gmail] at December 31, 2013 6:09 PM
No one ever said only obese people get sleep apnea, but it is far more common in obese people. In fact, a large majority that suffer from it are obese. My oldest had to have his tonsils and adenoids out at 2-1/2 due to loud snoring and sleep apnea. He's super skinny and considered very underweight for his height (26 lb at 40 inches tall). In his case, his problems were caused by adenoids blocking 95% of the cavity and moderately enlarged tonsils. A repeat sleep study showed his apnea cleared up. My stepdad had sleep apnea but was morbidly obese. The more weight he lost the better his snoring and apnea spells got. A less commonly known cause of sleep apnea is chronic alcohol use. The more people drink and over a longer a period of time, the higher the incidence goes up. There isn't a specific known link to that yet. Sure, plenty of things can lead to sleep apnea, but still by far the most common cause is obesity.
BunnyGirl at December 31, 2013 7:09 PM
I wonder if we have the obesity--->sleep apnea thing backwards. Sleep deprivation (caused by stress, scheduling, etc) has been linked to weight gain and in controlled settings, intentionally sleep-deprived research participants have been observed and shown poor self-regulation with food. So maybe for a good deal of patients, the sleep apnea is actually causing (or at least contributing to) the obesity rather than the other way around.
Jenny Had A Chance at December 31, 2013 7:41 PM
>>The obesity question is really a separate issue altogether
No. It isn't. I perform surgery every day, and obesity ups the risks of complications pretty much across the board...especially if general anesthesia is part of the process...and in every stage of the process including post-op.
FBMc at January 1, 2014 9:09 AM
Hey, Cousin - if the WHO is off by half re the USA's fatness, that's still pretty gross. Here in SC, just show up at WalMart late Friday night. You can hear the Spandex screaming, and you can't find a powered wheelchair because they are all occupied by people whose sole handicap is fat.
"Turns out I'm as pure, well-formed and attractive on the inside as on the outside."
Of course. As eloquently as you speak, I had no question they would find your vocal cords flawless.
Procto-men can tell you all about how to lose weight without real effort, since they share a tract with the other gastro-guys who know how it works.
If you eat like you had to catch it yourself, generally speaking, you'll be fine, and you cannot squeeze enough greens into your mouth to hurt yourself.
Radwaste at January 1, 2014 11:00 AM
"Hey, Cousin - if the WHO is off by half re the USA's fatness, that's still pretty gross. Here in SC, just show up at WalMart late Friday night. You can hear the Spandex screaming, and you can't find a powered wheelchair because they are all occupied by people whose sole handicap is fat.'
I want to see some scientific evidence, damn it. Nobody has anything to offer other than People of Wal-Mart anecdote and BMI-based numbers. Wal-Mart caters to fat people so no surprise there, but it's a bit like walking into a plus-size womens' boutique and concluding from that that all women are overweight. And with regards to the BMI, one if its problems is that due to a disgraceful ignorance of basic math, it over-estimates body fat on taller people, and it's pretty well documented that the average American has gotten taller since 1950. And besides, as coffee notes, the standard for what is considered fat keeps ratching down. You can create an epidemic of any disease by suitably defining the symptoms.
Cousin Dave at January 2, 2014 7:46 AM
I have got to address this literally (and rarely) true, but situationally stupid, argument:
"They are bullshit because they are based on the bullshit prinicple of the body mass index. BMI prescribes weight ranges based solely on height, making no allowances for skelatol structure or body type. BMI also fails to take into account the difference between fat mass and muscle-bone mass, which is denser than fat."
I am so tired of hearing this argument. How many Americans have a muscle mass that is in excess of what their BMI would predict? Do you honestly think our obesity numbers in the US are grossly inflated because we have tons of muscleheads walking around? I would wager if we looked at percent bodyfat instead, our obesity rate would be worse, not better.
My wife is 5'4" and 130, giving her a BMI of 22.3. But guess what? Her waist is 25", she can bench 130, and can do 10 bodyweight pullups and has a visible sixpack. So yeah, BMI isn't a great measure of her bodyfat. But do you really think this is typical? What is more typical for Americans is being "skinnyfat" - that is, having a percent bodyfat that is HIGHER, not LOWER than the BMI would predict because not only do we have too much fat, we are out of shape.
Brian at January 2, 2014 1:30 PM
"And besides, as coffee notes, the standard for what is considered fat keeps ratching down. You can create an epidemic of any disease by suitably defining the symptoms."
Exactly the opposite is true - we are defining healthy weight ever upward. Do a Google search for yearbook pictures (even in the South!) from the 1950s -1970s and see what you see? Not a single fat person in the bunch. Google pics of draft intake from WWII - can you imagine a random selection of draftees being so lean now? Think about TV shows in the 70s and before with a token fat person for comic relief (Mo on the Stooges, Loomis from Bad News Bears, the fat eating contest guy from Meatballs, Natalie from Facts of Life) - none of these people would even look that fat today. Kids watching those shows now don't even realize that is supposed to be the outlier fat person.
Brian at January 2, 2014 1:33 PM
"How many Americans have a muscle mass that is in excess of what their BMI would predict? "
I don't know... but by their own admission, neither does the CDC. I do think the CDC would have the means to study the matter, if they were interested in the answer. The fact that they haven't studied it tells me something.
"Do you honestly think our obesity numbers in the US are grossly inflated because we have tons of muscleheads walking around? "
I think it's possible. And what's with the animosity against muscular people? Do you think they like being called "muscleheads"?
"I would wager if we looked at percent bodyfat instead, our obesity rate would be worse, not better. "
Got any data to support that? Or are you just going to harp on about the one time you went to Wal-Mart?
It is a documented fact that in 1998, the CDC revised the BMI standard for "obese" downward, from 27.8 to 25. They did this for no apparent reason other than because the World Health Organization wanted them to.
And: The formula for BMI is based on a disgraceful ignorance of basic physics. The formula assumes that proper weight should scale to the square of a person's height. However, in the three-dimensional world that we actually live in, the mass of a uniform-density object scales to the third power of a linear dimension, not the second power. Thus, if you take two people of different heights but the same body fat percentage, the taller person will have a higher BMI even though both people are in the same physical shape. And since the average American adult male has gained about 4 cm in height since 1960, and Americans in general are on average taller than people in most other parts of the world, it's no wonder that BMI artificially calculates a spiral of apparent obesity.
And the reason I keep harping on about this is because this whole "epidemic" (and yes, those are scare quotes) of obesity is being used to justify a whole slew of intrusive-government measures, with many more to come. That's awfully convenient, isn't it? The people promoting these new regulations never met a problem that didn't require bigger and more authoritarian government to solve, and oddly enough, they keep finding problems that need solving.
Cousin Dave at January 2, 2014 5:41 PM
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