Parents Fight a Texas Hospital Over Their Daughter's Life Support

A judge has granted Payton Summons' parents a restraining order against the hospital.

Sudok1/Dreamstime.com

Texas parents are fighting the Cook Children's Medical Center in Fort Worth over the right to keep a nine-year-old girl on life support.

Payton Summons has cancer. A tumor, which was discovered near her heart, cut off her circulation, and on September 25 she went into cardiac arrest. She was given CPR for an hour at home before her parents took her to the hospital. Staffers there were able to revive her heartbeat, but they had to put her on a ventilator because she was unable to breathe on her own. On Thursday, the hospital declared her brain dead.

The hospital planned to take her off life support on Monday, despite her parents' wishes. Instead, a Tarrant County judge granted Summons' parents a 40-day temporary restraining order against the hospital.

The parents hope the restraining order will give them enough time find a facility that will help their daughter. They are in talks with a hospital in West Texas, and they're open to options outside the state.

Justin Moore, the couple's attorney, argues that the Texas Advance Directives Act gives the parents a right to find an alternative facility. The hospital claims that the law doesn't apply in this case, since Summons has already been declared brain dead. Hospital attorney Laura Copeland has told a judge that it's "traumatic for the staff to have to do things for a patient they know is dead."

State District Judge Melody Wilkinson will reconsider the restraining order at a hearing scheduled for Friday morning.

The legal battle over Summons has some similarities with the death of British toddler Alfie Evans in April. Alder Hey Children's Hospital told Evans' parents that it would be "futile" and "unkind and inhumane" to keep treating the 23-month-old toddler, who suffered from a degenerative brain condition. Evans' parents spent months contesting the decision, which they eventually appealed to the European Court of Human Rights. Evans was granted Italian citizenship, and a Vatican hospital announced that it was willing to receive the boy for treatment. Despite this, the hospital removed Evans from life support and he passed away a week later.

Comments

[OverWandersTelcon-tarian]

Hospital attorney Laura Copeland has told a judge that it's "traumatic for the staff to have to do things for a patient they know is dead"

Ain't no violin small enough...

[Michael S. Langston]

Ain't no violin small enough...

This can only be written by someone who's never had to deal with these issues first hand and seemingly hasn't informed themselves on the mental issues surrounding medical staff especially those involved with traumas such as those working in areas where 24/7 life support would be used.

How many life support machines you think they have in every hospital and how many staff members are trained well enough to run them 24/7? How deep is that bench?

Let's hope deep enough to help the next trauma victim.

[OverWandersTelcon-tarian]

Oh, so it's traumatic because the hospital employees are overworked operating the complicated life support machines?

Odd that Ms. Copeland didn't say that, then.

Or is it a problem because resources are being used that might otherwise have helped "the next trauma victim"?

Strange that Ms. Copeland didn't say that, then, either.

If you're going to criticize a criticism, it might behoove you to consider interpretations of the statement initially being criticized aside from your own.

[Michael S. Langston]

The hurricane force winds you just experienced is the point going by your head.

And note, you're not quoting what Ms. Copeland said in full, only a portion captured by an article, but somehow it's Ms. Copelands fault you have chosen to not go further?

As while I haven't read the legal brief, I'm sure it touches on these issues. Especially the fact that only so many 24/7 trauma life support operations can be operated at any given time as resources as finite and this kind of medical help is costly and resource intensive.

Or should Ms. Copeland also have to explain to you that resources are finite?

Or maybe the author should have stated that clearly?

Or maybe your lack of understanding doesn't make everyone else stupid?

[OverWandersTelcon-tarian]

Or maybe your first comment was an enormous and arrogant overreaction to a casual, 5-word initial comment by a commenter who, apparently unlike you, wasn't actually planning to spend a significant amount of time pondering an issue his opinion has no immediate bearing on.

When I first read Ms. Copeland's statement, I assumed she was implying that simply "having to be in the presence of a legally dead person" was causing the employees "emotional distress". Perhaps I assumed wrongly. You will note I have not actually disagreed with any of your alternative interpretations. And why?

Because it isn't actually the validity of your alternative interpretations that anger me. It is your apparent expectation that I should have taken several moments to mull over all possible alternative explanations of Ms. Copeland's statement, and come to your preferred analysis, before making a casual 5-word comment about them.

Now compounded by several minutes of my life having been taken up by having to respond to your escalatory diatribes.

This isn't a Supreme Court nomination hearing and I'm not Brett Kavanaugh. My possible error in judgment did not justify a multiple-paragraph condemnation. Your multiple-paragraph condemnations, however, do.

[Michael S. Langston]

Please don't read my comments using voices in your head as they aren't diatribes, but simply statements that your comment indicated and lack of undersatnding.

If you did a fly-by and you didn't really mean it, then so be it. But I couldn't have known that based upon your comments here, so not sure I can apologize exactly...

But I am (sincerely) sorry if you feel these are condemnations or diatribes, but i can assure you they are not. I thought them only as a normal back and forth on a site which has a lot of people commenting who like to debate and when used openly, is a tool for leaning on all sides.

My mistake that I mistook you for someone willing to engage others.

[OverWandersTelcon-tarian]

I am willing to engage others. And I'll go one further: I think your arguments about wasting hospital resources are perfectly valid, and possibly enough to justify allowing the hospital to take the child/body off life support, now that I've heard them.

My problem is that this:

This can only be written by someone who's never had to deal with these issues first hand and seemingly hasn't informed themselves on the mental issues surrounding medical staff especially those involved with traumas such as those working in areas where 24/7 life support would be used

...is not a statement that invites cordiality. It implies that the person it is addressed to is willfully ignorant and naive. Which may even be true! But is not a way to start a productive conversation, if that was your goal.

I took your first comment as a personal insult, and reacted defensively. You can hardly be blamed for being defensive of yourself as well. I'm willing to call it even if you are.

[Michael S. Langston]

Sorry, my fault if I pushed too hard at the beginning, but it did seem to me to be a very callous statement borne from lack of understanding.

Analogous is when Patton slapped a soldier with PTSD and told him to man up.

But maybe I took it too personally.

Apologies (sincerely)

[OverWandersTelcon-tarian]

Apologies accepted, and offered in return.

[Michael S. Langston]

Though I will add other of your replies stated something about my multi-paragraph reaponses.

Please note that while my very first reply may have not been nice, it was very short and contained all the information provided to you in subsequent followup, multi-paragraph rsponses.

Namely that trauma teams are costly and finite - resources with real and specific mental health issues consistent with those jobs and forcing them to behave otherwise is problematic for these reasons (scarcity and team stability).

Just sayin' 🙂

[OverWandersTelcon-tarian]

I appreciate that. It was never your arguments about the issue itself that set me off, just the tone. As you are probably now well aware, I can be a little... defensive.

Compare it to a rattlesnake striking when stepped on, if you're feeling charitable; compare it to a gerbil or hamster biting the hand that tries to pull it out of its cage, if you're not feeling charitable; either way, it's my nature.

[Echospinner]

The child is not alive if she has met all criteria for brain death.

The parents need to accept that and may need some time and understanding but this cannot go on indefinitely.

I have no doubt that what Ms. Copeland did say in court is true.

The parents are forcing hospital workers to do something they know is wrong, it is no doubt traumatic.

What they are doing amounts to abuse of a dead body to put it bluntly.

[BYODB]

Well, assuming that they don't mind huge incurred costs for treating a brain dead child I see no real problem for the hospital. They get paid reguardless, although I know many practioners that wouldn't want to profit off false hope.

In my experience, this kind of thing usually happens when there's a question of if the hospital can get paid for treating a patient that they know insurance is going to deny payment on.

Keeping a dead kid technically alive isn't easy, and also not cheap.

[Echospinner]

Cost is not at all the issue.

At the point where they took the patient they simply did everything they could. The bean counters in the back office might be adding up numbers but they do not make decisions and do not enter the ICU. Ask the docs and nurses there about cost and you will get a blank stare. They have no idea and do not care.

[Michael S. Langston]

True that to trauma related medical staff cost is not an issue, to the continuing operations of the hospital costs are huge issues.

To say they're not...just wow. How do you think any hospital can stay afloat providing services costing hundreds of thousands of dollars a day which are not actually helping their clients at all?

[Echospinner]

They are not an issue in the care of this individual patient and what is happening with her.

Cook Children's is one of the largest pediatric institutions in the country. They see over a million patients a year. It is a 430 bed hospital. One more patient is not going to break their budget.

In a lot of these cases since there are bad feelings and courts involved the hospital will just take any insurance and write off the rest if for no other reason than PR and avoiding any legal issue.

[Echospinner]

What the admin is very worried about is PR and possible legal issues not the cost of her care.

[OverWandersTelcon-tarian]

Langston's points about wasting scarce resources and overworking hospital staff are legitimate complaints, if rudely relayed. "Emotional trauma" from having to carry out a policy the workers disagree with is not.

[Michael S. Langston]

OverWandersTelcon-tarian -

It's possible I mistook your original intent, but it's also possible that your first reply was callous...

But live and let live....

So let me try again - note that trauma teams are not like other teams and many hospitals, even in major cities have only one or two teams (most hospitals have none - ie most hospitals could not possibly do this).

Those teams deal with death and near death situations all the time. And with that comes things like feeling guilty over deaths that happened when you weren't even working (true of combat trauma units too). People feeling, I could've gone another 6 hours without sleep.

Now you take those type of people and force them to continue life support on someone they know they cannot help, can cause mental strain not typical in other hospital/medical staff. Strain such as feeling guilty for not being able to help those in need.

[OverWandersTelcon-tarian]

When you put it that way, I can see why you object to the "ain't no violin small enough" bit. I'm sure the staff are genuinely frustrated by what they consider to be a waste of their abilities.

The "violin" comment was, however, meant as comic exaggeration. Comic exaggeration, specifically, in aid of a point I will stand by: that the frustration of the staff is much less important the frustration and stress of parents who, however futilely, still believe their precious child can be saved. It's the staff's time and moral sentiment, but it's their kid.

Your points about resource allocation above are a separate issue from the one I was initially criticizing.

[Michael S. Langston]

OverWandersTelcon-tarian -

Agreed with you that too many in society like to play the "anguish" card. Especially LEOs with "putting ourselves in danger"... as if they didn't take those jobs willingly.

But this just isn't one of those cases.

[Echospinner]

Sure because the hospital workers are your slaves.

You can force them to do any immoral act and violate their own ethics just because you want it right?

Actually the resources are not an issue. If there was a chance of recovery she would get everything that could be done.

She died. She deserves that dignity. Her parents are in psychological denial and shock. They need to move past that.

[OverWandersTelcon-tarian]

@ Echospinner

If she's dead, then by definition she can deserve nothing. Treating corpses with dignity is a gesture of respect to the living loved ones- who rather obviously disagree with your definition of "dignity" in this case.

Meanwhile, the resources are the only relevant issue. The staff's emotional health, as important as it may be (nods to Mr. Langston), must come second to that of the parents- the question is whether material resources are being wasted, which could be better used to treat those whose status as "alive" is not in dispute. Which is why A, I would expect the hospital to remove the child/corpse from life/vegetable support if the machinery were needed for another patient, B, the parents should pay the full costs of the exercise regardless, and C, the child/corpse should be transferred to a willing facility ASAP. None of which necessarily means that the hospital has the right to unilaterally silence the heartbeat of what is, if nothing else, the parents' legal property.

[Echospinner]

Children are legal property?

Not even going there. That is a difficult subject especially for libertarians. But I do not think that children are mere property.

If they want to transfer her I don't think anyone would stop them. If they can find somewhere.

The judge gave them 40 days.

[OverWandersTelcon-tarian]

I thought your point here was that you were objecting to the judge's ruling. If you think it is appropriate for the hospital staff to be "enslaved" (your word) for as long as it takes to find an alternative facility (or find that there isn't one to be found), what is your objection to how the state is handling this?

And I never said that "children are mere property". I said that if nothing else they are their parents' property... because if they aren't their parents' property, they must still be alive. And if they're still alive, the hospital definitely doesn't have the right to pull the plug on them at will: because that would be, not mere "property damage", but murder.

Assuming the child is legally dead, then, the corpse, with a heartbeat or without one, must still be the property of someone: all objects must be. And since the only readily obvious alternative owner for the corpse-with-a-heartbeat is the state, a libertarian must surely assume that the rightful inheritor would be their legal guardian(s) in life: in this case, the parents.

Personal views on the ethicality of the parents' decision making aside, they have a right to protect their de facto property from being damaged. According to their own testimony, they consider taking their child/corpse-thingy off life/vegetable-support to be damage. It certainly seems to be rather important to them.

[Echospinner]

No I am not. I think I said earlier that the parents need some time and understanding. The ruling seems reasonable. I also understand the hospitals point of view.

It seemed that some of the comments indicated that the thoughts and feelings of the hospital staff did not matter. That is why I used the term slave. They are professionals and human beings. Perhaps that position has changed.

Her parents do not believe that their daughter is dead. Either way I am uncomfortable with referring to people dead or alive as property or 'vegetables'. Death comes to all of us. When we use terms like that it dehumanizes even after death. Dignity and respect for the dead is universal in all cultures and there reasons for that.

[OverWandersTelcon-tarian]

I actually thought you were the one dismissing the dead-ish girl's rights/status in this situation; that's why I went to the trouble of arguing my position from the perspective of assuming she is, in fact, really-really-dead (and thus property). Sorry if my flippancy offended you, but I actually thought I was speaking on your terms.

On a related note, I realize now that my "tiny violin" comment was too dismissive of the staff's position, and I will once again apologize for that. Though I will also note that black comedy and absurdist exaggeration are kind of to be expected around here. And that the gist of my remark was simply that the staff's emotional distress cannot be compared to that of the parents, which I stand by.

Using the word "slave" does have a certain connotation, though. Dismissing a hospital worker's feelings is mean, even unacceptably so, but enslavement is a physical act of trespass. Using that word implied that the hospital staff were actually being trespassed upon by the government; and while that's not an unreasonable position (which is why I took the time to explain why I disagreed with it), you should know that is what your comment implied.

[Echospinner]

You are a reasonable person.

Nobody wants this to happen.

One hour of CPR.

The common number is six minutes. The brain can survive without oxygenated blood flow for about six minutes. CPR might prolong that but not for long. The heart can start but she is gone.

Her parents. She does not look dead. The skin is pink and warm. Her breath is moving by the tube, her heart beats. Fluids move in and out. This is very difficult to accept. They love their daughter. There is no drug for this, no cure for what has happened to their world.

What is really a shame is that it got to the news and on a political forum. This is not politics. Mea culpa.

[OverWandersTelcon-tarian]

Technically, anything that concerns property rights (in this case, the child's/parents' vs. the hospital's) is a political issue. It seems, however, that you and I don't disagree on any important point regarding this one. Thank you for being civil.

[Fancylad]

Life support isn't just a ventilator. It's also fucking food and water.

Found this out the hard way when my grandfather had a stroke, and had told his doctor a few years before that he didn't want extraordinary measures. They didn't even change his bladder bag and he died after six days of an infection and dehydration thirst.
He was conscious the second and third days but couldn't speak and was distraught and weak. My sister snuck him water but he kept choking on it and then she got turfed.

After hearing how he died from my family, I've added a clause to my will that I want all measures possible taken, and that my family is to sue on my behalf if it's denied.

[Michael S. Langston]

This is tough and tragic no matter what, but if the patient truly is brain dead, forcing the use of numerous, costly, precious hospital resources to maintaining life support for this single patient is immoral.

[Square = Circle]

The legal battle over Summons has some similarities with the death of British toddler Alfie Evans in April.

In one case, a state-run medical system refused to treat the boy's condition (degenerative brain disease), and refused to grant the parents permission to remove the child from the system and take the child elsewhere where a facility was voluntarily willing to continue treating him.

In the other, a privately operated hospital is telling parents that it is time to stop trying to revive their daughter because she is dead (of brain damage due to her heart having stopped for over an hour), and the government is forcing them to continue caring for the daughter's body anyway while we pretend that the condition is reversible.

These two cases aren't that similar.

[Alcibiades]

Correct, in the Alfie Evan's case the state essentially muscled the parents aside and said what you wish for your son is irrelevant.

[Diane Reynolds (Paul.)]

State healthcare is a human right.

[Echospinner]

A bit more complicated.

Alfie Evans had an untreatable neurodegenerative disease. The parents wanted him transported to the Italian hospital where they would continue long term life support. He had severe seizures. While he was assessed for possible transfer it was found that any movement or stimulation induced more intractable seizures which would have worsened his condition. He was not stable enough to be transported.

There were other issues as well. I do not think it was relevant that it was a state supported hospital. This could have happened anywhere.

I agree the two cases are not at all similar.

[BYODB]

Right on the money square, saved me from writing the exact same thing. It's only similar to people who have no clue.

[EscherEnigma]

Wrong comparison case.

This is more like the Jahi McMath case. Kid is dead, parents refuse to accept it. And if it goes the same way as Jahi, the kid will get transferred to a private facility, the family will stop posting pictures as the corpse deteriorates, and four years later they'll claim the kid finally died. Funeral will be closed casket.

Some people are in denial about what "brain dead" means.

[Square = Circle]

Some people are in denial about what "brain dead" means.

Yeah - as a parent, I 100% understand not wanting to admit that your child is dead. I couldn't imagine giving up if there was even the vaguest shadow of an outside possibility that they could be brought back. And if they can find some way to continue to fund the treatment, I don't suppose there's anything wrong with that (other than the issues pointed out above that other people could probably benefit from those resources that are not actually benefiting this girl).

But I think in the end the hospital and its workers should have the right to say, as gently as they can, "this treatment is no longer serving any purpose, and we are going to have to stop so that we can treat someone else who can actually be treated."

[Michael S. Langston]

Agreed - This sucks for everyone involved.

[EscherEnigma]

Can't imagine it? You should. And talk about it with family so they know about your end-of-life wishes, and you know theirs. Get a living will if you don't think they'd respect your wishes.

That aside, the big problem with the "if they can find some way to continue treatment" bit is that in every one of these cases, the lawyers do their best to ensure that *other people* pay for it. There's a reason why the McMath's lawyer is still contesting Jahi's death certificate: if she had been "alive", the cap on damages in the malpractice case goes away

So yes. Horrible situation. And the leaches are defrauding the parents and making it worse.

[Uncle Jay]

Isn't that what we have bureaucrats for?
To contradict the wishes of parents and all the other little people?
Isn't that government paternalism really all about?

[Moridin]

If the person is brain dead, what are the life support machines doing? Moving dead parts? Or is the body alive but the brain is dead? How does that work? At what point is it not a life (the opposite end of the abortion question)?

[Square = Circle]

At what point is it not a life (the opposite end of the abortion question)?

Not answerable, really, but traditionally "brain death" is what counts. We've gotten to the point where we can do amazing things as far as forcing a body to continue functioning as a living organism long after the brain is essentially not functioning at all. Pumps working the lungs and heart, tubes bringing in food and water.

I think the "philosophical" standard behind it is "no longer sentient, and never will be again."

[Moridin]

Interesting. Makes me think of the Metallica song "One."

[Echospinner]

By definition if you are brain dead you cannot breathe. The ventilator does that. The heart however can function without the brain. It has its own electrical system. So oxygenated blood still circulates.

Also by definition there is no circulation to the brain or brain stem. The brain has zero activity. It undergoes necrosis which happens fairly quickly. The person is essentially decapitated. This has been near universally accepted as death.

Eventually things will break down even with life support.

[Atlas Slugged]

Judge issued a FOURTEEN day restraining order, not forty days.

[Atlas Slugged]

I feel terrible for the parents, a real tragedy, but this is a corpse with oxygenated blood circulating thanks to machines. Since the family thinks she will recover, they can take her home.

[OEPYZ]

Its sounds correct to unplug a "brain dead" individual. But I know some one who was declared "brain dead" and is alive today living a normal life. Recovery is rare not impossible.

[Oscarson44.]

There has never been a patient reported, who has met the brain death criteria adopted in 1996, that has subsequently regained any brain function. If there was one it would make national headlines.
http://n.neurology.org/content.....1.full.pdf