Archie Battersbee thread 5

[henryhihat]

New thread...

I am a lawyer not a doctor but this is my rudimentary understanding:

To diagnose brain stem death, there are a series of tests you have to undertake, one of which requires the peripheral nerves to be able to respond to a signal from the brain stem. However in Archie’s case, his peripheral nerves were not working, and the test couldn’t be done.

The reason it couldn’t be done is it would not be reliable and might produce a false negative - if the brain stem sent a signal to the peripheral nerves they wouldn’t be able to respond, so the lack of response would not necessarily be attributable to brain stem death.

Although the scans provide compelling evidence of brain stem death, there are sound reasons why doctors are not permitted to diagnose brain stem death in any way other than the prescribed tests. Therefore it has not been possible to diagnose brain stem death.

I suspect on of the major stumbling blocks in moving Archie is finding staff to accompany him. Imagine, you're a doctor accompanying a highly unstable patient for a move that you don't believe should happen, and inevitably his heart stops and he dies. The patient's relatives are already accusing the hospital of negligence and murder, so as a minimum you know that you are going to spend ages afterwards writing a minute by minute account of exactly what happened and probably being interrogated by your superiors and the hospital's lawyers. Then you may well end up with formal complaints against you to the hospital and the General Medical Council trying to get you struck off, police investigations, a hefty negligence claim and all sorts of other unforeseeable trouble.

If it were me, I'd be planning to go off sick round about now.

I would assume, too, that it is indeed noisy in PICU; even with the door closed, there will be the noise of other children's machines beeping, alarms going off, staff and visitors asking etc. I’ve spent time in an adult ICU as a patient, and actually it is an incredibly quiet place.

There is no need for beeping alarms because patients have one to one nursing care, so the nurse is always within sight of the monitors.

On all occasions I’ve been in ICU there have been patients on ventilators who have had their life support removed. And in all situations the families were given an enormous amount of privacy. The only reason I was aware of the fact was because relatives get to know one another in the relatives room and everyone there knows everyone’s story, iyswim.

On the last occasion I was in there I was actually on a ventilator, but when I came round I realised that the ward was an incredibly quiet place. And I know that one man had come in after an accident which left him brain dead, and, and I later read in the media that he’d donated his organs. But unless you knew these situations were going on, you wouldn’t have known. Iyswim.

Thank you.

By this point he had no peripheral nerve response and therefore couldn't have the tests carried out under policy and guidelines

Would you mind explaining what this means a bit further?

someone somewhere likened it to a computer.

if you have a computer connected to a printer, and the printer isn’t working, is it because the computer (brain) is dead, the wires (nerves) are broken, or the printer (muscles) doesn’t work?

to test for brain death you need to know the wires and printer are ok. Archie’s muscles weren’t responding, but because of the necrosis/possible damage in his neck they couldn’t demonstrate without doubt that it was a lack of brain response, or somehow his wires had disconnected.

I guess because she believes he's recovering so in her opinion "trying" to breathe but his body isn't strong enough to cope entirely .
So if they take away the ventilator it will "kill" him.

She stated a few days ago that a broken leg takes 8 weeks to heal and a brain will obviously take longer .

She took Archie to TRL with the plan of surgery ( transferred from Southend )
A Dr told her that "he won't last the night"
Hollie is now concerned that they're after his organs ( young , fit , adolescent , they would be very well sought after )

Without the tests they cannot say he is dead . If he's not dead they cannot take his organs.
If the tests proved he ws dead then she has lost control and the hospital has authority .
So the constant "He breathes/he grips/he focuses his eyes/he reacts when he hears my voice/he's put weight on/he's maintaining his Stats ,/he's in there , I know , I feel it"

I don't understand the medical side of it.

But in layman's terms of what I understand there are pre tests to brain stem testing. They must be passed to be able to continue.

Archie didn't pass them.

Therefore they couldn't continue with brain stem testing and went by the findings in the mri scans which the medics describe as pretty conclusive.

Can I just clarify that in England and Wales, health care professionals are legally bound to comply with a living will (advance directive/advance decision to refuse treatment) as long as it is deemed valid and applicable to the situation.

For it to be valid you need to be 18 or over at the time of writing it, you need to have capacity at the time of writing it, and it should clearly state what specific treatments you are refusing (i.e. life sustaining treatment, intravenous fluids, intravenous nutrition etc) and in what circumstances you want it to apply (eg after a stroke, cardiac arrest, living with dementia).

In addition, if your advance direction refuses life sustaining treatment it needs to be in writing, include the phrase “even if my life at risk” or similar, and be signed by you and witnessed by someone who should also sign it.

For it to be applicable you must lack capacity and be in the situation the direction refers to and the treatments you have refused are the treatments that would be given. There must also be no doubt that you could have changed your mind since writing the direction.

If you appoint a lasting power of attorney they may be able to override your advance decision but you can choose whether they are allowed to make decisions about life sustaining treatment or not. If you don’t give permission for that they cannot override it.

i have worked in a hospice. You cannot just demand to be transferred to one - you can self refer but they take the people that they can offer the best care for. There are no ventilators, life support systems in a hospice. They stabilise patients with medication, and most end of life they facilitate at home. They are not NHS. Their mantra is ‘a good death’ and he has already died.

I can’t imagine any hospice saying yes to this transfer. It is a medical decision made between professionals for the patient’s best interest. They would not want the enormous pressure or press attention, as could impact other patients care.

I hope that lessons are learned from this case and previous ones. My wish would be for a reporting ban and anonymity in court cases, say Child X rather than naming them or the "cannot be named for legal reasons" we so often see in trials involving under 18s. But then IANAL so I would not know whether that is actually feasible or not.

To a certain extend, I also see this as a social media issue. Without social media, it would have been quite a bit harder to garner support. The conspiracy theories and idiotic advice would probably still be bandied about, but not in such a public place.
The media also have their part in this, they are not reporting accurately and are giving a platform where it might be better to step back and say "We understand you are going through an incredibly difficult time, we will let you process in peace".

I think the reporting ban and/or anonymity should also be extended to protect the medical staff in these such cases.

I'm concerned that medical staff who are working under extreme circumstances be protected from being pictured or filmed doing their jobs, with the images shared on social media for example. Also publicly shared medical letters and legal documentation where names are not redacted.

Where emotions are high and potential bad actors are taking advantage of people or campaigns for their own agendas, medical staff should not be identified and potentially signposted for abuse.

I seem to remember it was too late to do the tests because there was further deterioration after having to wait for the court to order the tests because the family refused permission.

@SummerWithMyHorse Sorry for your loss

Sadly I have to agree with this... poor little Archie is not going to come back to life and I think it's terribly tragic what happened - really genuinely tragic.

But I really don't understand why they're trying to do what they're doing, trying to keep fighting for his life, because he is already gone. Anyway I won't say anymore just it's all very very upsetting and sad. I do feel the for the parents, and I guess they will do anything they can to try to save him, but it's too late.

Equally as a layman trying to understand it: it seems almost like saying that the test to legally prove a leg is not broken is to wiggle the toes.

But this person has lost their leg, therefore the toes can't wiggle, therefore legally there is no definitive proof of legal leg broken status, and despite all the other obvious evidence this person cannot definitively be said legally to have a broken leg.

The court judgement goes into detail of the scans, including mentioning necrosis of the brain stem, liquid build up, total lack of blood flow, coning, and this was the situation when those scans were taken weeks ago. There is a comment in the judgement where the judge asked one of the doctors interpreting the scans about how much worse things could get on the scans and the doctor said more or less that there wasn't much further deterioration possible.

I also wish they'd stop using that photo - show him as he is now ...

Quite apart from any such publication being deeply inappropriate, I suspect it's something which many wouldn't enjoy seeing

Doctors call them ‘heart sink’ patients. As in when you see their name on your ledger your heart sinks.

Oh, definitely. All parties in those cases should be given anonymity. I mean, this could easily be reported as "Doctors at xyz hospital or health trust" or similar.

Have you seen this (apologies for Sun link)

The CLC really are awful. I’m despairing for this family now

www.thescottishsun.co.uk/news/9258027/archie-battersbee-mum-mouth-to-mouth-oxygen/

When my mum died in the HDU there wasn’t a side room so we just cracked on with it in the main ward with curtains. It was fine, the staff were phenomenal, I’ll never ever forget them talking to her gently through everything and brushing her hair before she died. I think people lose sight of how incredibly lucky we are to have the NHS, for our relatives to be given every chance and to able to say goodbye to them with their suffering mostly alleviated where possible. Honestly, there are worst ways to go.

we all know that medical professionals make the right decisions for their patients and do not willingly make things worse for them or neglect them Are you sure? Harold Shipman, Beverley Allitt, Ian Paterson to name a few.

I'm not saying anyone is doing that in this case but it is naive to imply medical professionals always make the right decisions for their patients, most of them do just like most police officers don't kill women but Wayne Couzens did.

I believe a nurse hastened my mothers death, it was her attitude, the sudden deterioration when we left to get food and something the nurse said afterwards. She was terminally ill and maybe it was for the best but it wasn't the nurses decision to make.

Yep just seen that she's saying she will give him mouth to mouth...

Again, really not sure WHERE she thinks this is going to happen, he'd be with nurses etc to be moved to an ambulance, theres no chance she'd go in an ambulance with him so... at the hospice?

I believe the High Court hearing is happening now.

It's being said on one of the FB groups that the hearing will start at 3:30pm today. I don't know if that's accurate though.

As soon as family refused medically recommended tests after such a traumatic and shocking incident social services should have been involved, frankly, to ensure that these tests happened. No safe, rational caregiver or guardian would decline medical advice like that without an ulterior motive.

If HD wins and gets Archie moved to a hospice and he dies on the way - which, given the fragility of his current state - is highly likely. I’m fearful it will open another floodgate of accusations about insufficient care, negligence during the journey etc etc.
If Archie isn’t moved and passes away in the next few days in Bart’s, there will accusations that had he been transferred, he might have lived.

Poor staff. They are probably on a loser whatever way it goes now.