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April 16, 2014

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Court-appointed doctor says Calif. teen brain dead

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Courtesy of McMath Family and Omari Sealey / AP

This undated photo provided by the McMath family and Omari Sealey shows Jahi McMath.

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In this Dec. 20, 2013, file photo, Nailah Winkfield, mother of 13-year-old Jahi McMath, cries before a courtroom hearing regarding McMath, in Oakland, Calif.

OAKLAND, Calif. — A court appointed doctor testified on Tuesday that a 13-year-old Northern California girl is brain dead after suffering complications following a tonsillectomy.

Dr. Paul Graham Fisher said Jahi McMath "meets all the criteria" of brain death. Fisher's evaluation was the second to reach that conclusion.

Children's Hospital of Oakland filed court papers Tuesday morning asking that the girl be taken off life support after doctors there also concluded she was brain dead. Her family wants to keep the 13-year-old connected to a breathing machine and has asked for another opinion. The family argues that the hospital can't remove the teen from life support without their permission.

Hospital lawyers disagree.

"Because Ms. McMath is dead, practically and legally, there is no course of medical treatment to continue or discontinue; there is nothing to which the family's consent is applicable," the hospital's Tuesday court filing stated.

Fisher first provided his opinion to Alameda County Judge Evelio Grillo behind closed doors Tuesday morning. Fisher briefly provided his conclusions in open court that Jahi has no brain activity. Fisher left court without taking questions.

Dr. Robin Shanahan, a Children's Hospital doctor, was next called to testify in the judge's chambers.

Alameda County Judge Evelio Grillo has previously ordered Jahi to remain on life support until Dec. 30, or until further order from the court. He is considering Tuesday the hospital's request to immediately remove the teen from life support, as well as the family's demand for a third opinion and that Jahi remain on a machine to keep her breathing.

Jahi was declared brain dead after experiencing complications following a tonsillectomy at Children's Hospital in Oakland.

The judge on Monday had called for Jahi to be independently examined by Fisher, the chief of child neurology at Stanford University School of Medicine.

On Dec. 12, doctors concluded the girl was brain dead and since then have wanted to remove her from life support. Jahi's family wants to keep her hooked up to a respirator and eventually have her moved to another facility.

The family said it believes she is still alive and that the hospital should not remove her from the ventilator without its permission.

"They failed her," said Sandra Chatman, Jahi's grandmother and a registered nurse, who sat in Grillo's courtroom for more than three hours Tuesday during the closed door testimony. "Jahi could have been saved."

"Miracles happen," Chatman added.

The family's attorney Dolan said he would file an emergency appeal to keep Jahi on life support if the trial judge orders her removal from the ventilator.

Dolan also wants the third evaluation done by Dr. Paul Byrne, a pediatric professor at the University of Toledo. The hospital's attorney objected to Byrne, saying he is not a pediatric neurologist.

Byrne is the co-editor of the 2001 book "Beyond Brain Death," which presents a variety of arguments against using brain-based criteria for declaring a person dead.

In a phone interview, Byrne said he could not comment in detail because he had not seen any of Jahi's medical records. But the fact that her ventilator is still functioning properly is a sign that she is alive, he said.

"The ventilator won't work on a corpse," he said. "In a corpse, the ventilator pushes the air in, but it won't come out. Just the living person pushes the air out."

Jahi's family says the girl bled profusely after a tonsillectomy and then went into cardiac arrest before being declared brain dead.

Outside the courtroom on Monday, Dr. David Durand, chief of pediatrics at Children's, said staff have the "deepest sympathy" for the family, but that Jahi is brain dead.

"The ventilator cannot reverse the brain death that has occurred and it would be wrong to give false hope that Jahi will ever come back to life," he said.

Durand said Jahi's surgery was "very complex," not simply a tonsillectomy.

"It was much more complicated than a tonsillectomy," Durand said. He refused to elaborate, citing health care privacy laws.

Arthur L. Caplan, who leads the Division of Medical Ethics at NYU Langone Medical Center and is not involved in Jahi's case, told The Associated Press that once brain death has been declared, a hospital is under no obligation to keep a patient on a ventilator.

"Brain death is death," he said, adding, "They don't need permission from the family to take her off, but because the little girl died unexpectedly and so tragically, they're trying to soften the blow and let the family adjust to the reality."

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