O.C. Girl’s Revival Proves Doctors Dead Wrong

The premature declaration of death of a 20-month-old Fullerton girl presumed drowned last week was a horrific and avoidable error by emergency room doctors, experts say.

“Clearly, medicine needs to get it right 100% of the time,” said Dr. Susan Tolle, director of the Center for Ethics in Health Care at the Oregon Health and Science University in Portland. “There’s no reason for this to happen. There can’t be an occasional error. There can be no errors, ever.”

Mackayala Jespersen was declared dead Friday by emergency room doctors at Anaheim Memorial Hospital after the toddler had been found in the family pool.

About 40 minutes after the girl was pronounced dead, a police officer taking photographs of the body noticed that her chest was moving and called for help. The emergency room staff revived her, and she was transferred to Children’s Hospital of Orange County. Her condition Tuesday was upgraded to serious, from critical, and she was taken off ventilation.

Brian Oxman, an attorney for the family, said tests showed Mackayala had suffered no gross abnormalities to her brain. He said it could take as long as 10 days before doctors can determine if she will suffer difficulties speaking or have trouble walking or holding objects.

The girl may have appeared lifeless Friday because of the effects of floating in 52-degree water, according to doctors familiar with hypothermia. When people, especially children, are exposed to cold, their bodies instinctively shut down for protection, as if in hibernation.

Breathing and the heartbeat slow; blood vessels constrict, limiting blood flow; and blood pressure drops. In an extreme case, the body can mimic death.

In such situations, physicians say, the patient needs to be warmed with blankets and by other means before a determination of death can be made.

“There’s an axiom in medicine,” said Dr. Marshall Morgan, chief of emergency medicine at UCLA Medical Center in Westwood. “A victim of hypothermia is not dead until they’re warm and dead.”

Cases such as Mackayala’s are rare. “The fact that there are a handful of documented survivals of people cold and lifeless and when warmed up they develop signs of life, it makes us all worried,” said Dr. Mark Langdorf, chairman of the Department of Emergency Medicine at UC Irvine Medical Center in Orange. “But these episodes of survival are very, very rare.”

Anaheim Memorial has provided few details. “We believe everything possible was done the right way,” said Susan Solomon, a hospital spokeswoman.

She said the hospital was conducting an “intensive study of the situation.” The hospital would not release the names of the doctors involved.

Dr. Tolle, at the Center for Ethics, said “root cause analysis” should be conducted, either internally or with consultants, to figure out what went wrong.

She said the hospital should develop new protocols to ensure that such an incident doesn’t happen again.

“All of medicine would probably benefit from knowing what happened,” she said. “In general, most medical errors do not occur because of incompetent doctors but because of bad protocols, systems, check and balances,” she said.

In almost all of the 2.3 million deaths a year nationwide, doctors said, the decision to pronounce someone dead is neither difficult nor controversial. Physicians make the call when their patients have stopped breathing and their hearts have stopped beating.

In only about 1% of the cases is death declared based on the cessation of brain activity, doctors said.

“Generally, death is not a close question,” said George Annas, professor of Health Law and Bioethics at the Boston University School of Public Health.

The distinction between life and death has blurred as machines take over functions of the lungs and heart.

As laws changed to accommodate medical breakthroughs, it was once possible to be considered alive in one state and dead in another, said David Magnus, co-director of the Stanford University Center of Biomedical Ethics.

Today, brain death is considered the end of life virtually everywhere in the U.S., he said, even if the heart and lungs are working with the aid of machines and drugs.

Brain death is determined by checking for pupil reaction to light, gag reflex and reaction to pain. Doctors also monitor the electrical energy of the brain and may unhook the ventilator to see if the body is getting enough oxygen on its own.

Someone in a vegetative state, like Terri Schiavo, the Florida woman in the middle of a right-to-die controversy, is considered alive. While she has the ability to perform few functions, her cerebral cortex is intact and allows her heart and lungs to function.

Different hospitals have different standards on calling brain death, Magnus said. Often a neurologist will be brought in to pronounce death, and sometimes two physicians are required. If the patient’s organs are to be harvested for transplants, none of the doctors can be involved with the operation or patients receiving the organs.

Not all cultures accept the U.S. definition of death. Among Orthodox Jews and in Japan, Magnus said, as long as the heart is beating, the person is considered alive.

Morgan learned a lesson about death calls while a medical student in Chicago. He read a story about a woman who was declared dead an seemingly snapped back to life at the mortuary hours later.

“The lesson I took was that declaring death is something that is subject to error and one needs to be pretty cautious of that,” he said.