In a last-minute scramble involving passports, an air ambulance and hundreds of dollars in donated funds, tiny Israel Stinson was airlifted over the weekend to an undisclosed hospital in a foreign country.
The 2-year-old, declared brain-dead by three Sacramento-area physicians, has spent the last month on a ventilator at Kaiser Permanente Medical Center in Roseville, as his parents battled in court to dispute his terminal diagnosis and buy time to obtain care elsewhere.
It’s the latest chapter in a case that has drawn national attention and highlighted the debate around diagnoses of brain death.
“We were out of options,” said attorney Alexandra Snyder of the Life Legal Defense Foundation, one of two nonprofit legal firms representing Israel’s family. “The physicians working with the parents felt he had to be transferred soon. ... They were concerned that his condition would become grave if they waited too long.”
She said that Israel’s parents, Jonee Fonseca and Nathaniel Stinson of Vacaville, did not want to disclose the country or hospital where their son was being treated for “privacy and security” reasons. The Vacaville couple, who also have a 1-year-old daughter, were unable to be reached Monday.
On their GoFundMe page, Fonseca posted a message Sunday that read: “After weeks and weeks of searching, no hospital facility in the United States would accept our son. And because of you all and your generous donations, Israel was able to beat the odds and is now being cared for as a live human being.”
The post states that Israel, declared brain-dead in mid-April by two doctors at Kaiser and one at UC Davis, has been examined at the foreign hospital by a neurologist and a pediatric specialist, both of whom concluded that “our son is not dead.” As a result, Israel is now “receiving nutrients (besides Dextrose) and a treatment protocol for the first time in 6 weeks.”
Snyder confirmed the post. “At this new hospital, a pediatric specialist and a neurologist both looked at him and said he’s not brain-dead. I heard that directly from the pediatric specialist via email,” she said.
“It tells me there’s at least a question about his diagnosis,” she added. “I’m just grateful there is somebody who’s willing to not give up on him.”
Because Israel had been declared brain-dead – meaning there is no brain function – Kaiser doctors deemed it medically risky and ethically inappropriate to install a feeding or a breathing tube. Instead, during the prolonged court fight, he was sustained with an intravenous combination of medications, glucose, hormones, water and electrolytes to keep his heart, lungs and other systems functioning mechanically.
At the foreign facility, Israel is receiving “protein, fats, vitamins and a treatment protocol that includes thyroid hormones,” which help with metabolism and other functions, Snyder said. Temporarily, he’s being fed through a nasal tube to his stomach, but eventually a regular feeding tube will be installed.
Israel’s treatment is considered a temporary move, lasting a few weeks or up to a month until he is stabilized. Ideally, Snyder said, his parents hope to bring him back to California where he can be cared for in-home or at a long-term care facility, depending on insurance coverage and his diagnosis.
The flurry of activity that led to his abrupt departure happened quickly, according to Snyder, who said funding for the flight was assembled from undisclosed donors, some of whom are outside the U.S. She declined to provide more details. The total raised on Israel’s online GoFundMe page, started last month by his father, passed $20,000 on Monday.
In documents filed Monday with the 9th U.S. Circuit Court of Appeals, Snyder said a Kaiser medical team and attorneys for both sides met at Israel’s bedside around 5:30 a.m. Saturday to begin the process of transferring him by ambulance to McClellan Airfield. An air transport team, including a registered nurse and a respiratory therapist, helped with preparations, which included keeping him on a temporary ventilator. Israel and his parents then departed Sacramento around 7:30 a.m. on an air ambulance and were flown to the undisclosed location, arriving sometime Saturday afternoon.
The documents also stated that Israel’s parents signed an agreement releasing Kaiser and its staff from all liability involving Israel’s transfer once he left the Roseville hospital.
Kaiser Roseville officials confirmed that Israel was no longer under their care and wished the family “peace” in their continued quest to find medical treatment elsewhere.
“At the request of his parents, Israel has been transferred to another facility,” said Dr. Chris Palkowski, Kaiser Roseville’s chief of staff, in an emailed statement. “Our primary goals have always been to offer our support to Israel’s family and follow the courts’ direction. I would like to thank our physicians and care teams for their extraordinary skill and the professionalism they have demonstrated during this difficult time. We hope this transfer brings peace for Israel’s family.”
Israel’s medical odyssey began April 1, when he was brought to a Mercy Hospital emergency room with a severe respiratory attack related to asthma. Due to the severity of his condition, he was transferred to the pediatric unit of UC Davis Medical Center in Sacramento, where he suffered cardiac arrest and underwent about 40 minutes of CPR. Ultimately, a UC Davis doctor declared him brain-dead, under a set of protocols known as the Uniform Determination of Death Act, which requires a set of tests performed by two different physicians at least 12 hours apart, in the case of children.
His parents had him transferred to Kaiser Roseville for a second opinion; two doctors there confirmed that Israel was brain-dead. Instead of allowing their son to be taken off life support, his parents went to court to block that move, starting in Placer County and ultimately winding up before the 9th Circuit.
Since then, his parents and the two nonprofit legal groups have waged a weeks-long court battle to keep him hooked up to a ventilator while they sought another facility.
On Friday, Israel’s father, Stinson, said the couple were trying to obtain passports, in case an out-of-country option became available. “I’d go to the end of the world for my son,” he said. “Who wouldn’t?”
Because of Israel’s diagnosis of brain death, they had been unable to secure a U.S. facility that would accept him as a patient. Although the parents previously said they had contacted care facilities in Canada, Nicaragua and elsewhere, their efforts were primarily focused on New Jersey, which allows a religious exemption for care of patients declared brain-dead.
The underlying issue in Israel’s court case, which had been scheduled for another round Monday in the 9th Circuit, is likely not over.
“While an important goal of this case has been achieved, it has also raised serious questions about the constitutionality of the California Uniform Determination of Death Act,” said Matt McReynolds, of the Pacific Justice Institute, in an email. “It has become clear that declarations of brain death do not always reflect medical consensus and do not comport with basic notions of due process. These legal claims have not been mooted, and we will be evaluating how best to pursue these important constitutional questions.”
In suing Kaiser to block their son being taken off a ventilator, Fonseca’s attorneys maintained that the hospital’s declaration of brain death violated his mother’s constitutional rights of due process to determine his care.
“The crisis part of this case is over,” said Kevin Snider, the Pacific Justice Institute’s lead attorney on the case. “We have an institutional interest in challenging this (brain death determination) law. This case would provide that opportunity, but ultimately (Israel’s parents) have to decide if they want the trigger pulled” on continuing the legal battle.