The long medical saga of brain-dead toddler Israel Stinson is over.
On Thursday afternoon, following a surprise ruling by a Los Angeles Superior Court judge, the 2-year-old Vacaville boy was removed from life support, ending a months-long legal battle that took Israel and his parents into courtrooms and hospitals from Sacramento to Guatemala.
“He’s gone,” a tearful Jonee Fonseca said Thursday by phone from his bedside at Children’s Hospital in Los Angeles.
Her son, first declared brain-dead in April in Sacramento, was taken off his ventilator around 3 p.m. and stopped breathing almost immediately afterward, according to the family’s attorneys.
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The ruling that abruptly ended the emotional legal proceedings was unexpected.
“It was a complete shock … a complete turnaround from last week,” said Alexandra Snyder, one of several attorneys representing Israel’s mother.
Last week, Snyder filed a temporary restraining order preventing the hospital from removing the ventilator, which had kept Stinson artificially breathing since he suffered brain injury following an asthma-related cardiac arrest at UC Davis Medical Center last April. The court granted the temporary order and gave the family until Sept. 8 to bring in another neurologist for a separate evaluation.
That process was underway, according to Snyder, but the hospital filed an appeal, which was heard Thursday morning. The judge ruled that, since the case had already been adjudicated in state and federal court, the lower court in Los Angeles was dissolving the temporary order and allowing Children’s Hospital to immediately remove the ventilator.
A hospital spokesman, Lorenzo Benet, said, “Due to health privacy regulations to which we are bound, we are unable to comment.”
Israel had already been declared brain-dead by three doctors – at UC Davis in Sacramento and at Kaiser Permanente in Roseville. In recent months, Fonseca had sued in state and federal courts, seeking to keep her son on a ventilator with the hope that she could eventually care for him at home.
Last May, facing a 9th U.S. Circuit Court of Appeals deadline in their efforts to block Kaiser from removing life support, Fonseca and Israel’s father, Nate Stinson, left the country with their son to seek other treatment in Guatemala. There, doctors at an undisclosed hospital inserted a feeding tube into his stomach and a breathing tube, connected to a ventilator, into his throat.
In Guatemala, a pediatric neurologist said Israel was not brain-dead based on an electroencephalogram that showed some brain activity, according to Fonseca and Snyder.
In the U.S., brain death is a commonly accepted diagnosis based on a series of tests of cognitive function. It involves the permanent, irreversible loss of brain function, including in the brainstem.
About two weeks ago, the family returned to the United States after Israel was accepted as a patient at Children’s Hospital. After doctors there evaluated the boy, they sought to remove his life support.
Until Thursday’s ruling, Snyder said she and Fonseca were lining up an appointment for an outside neurologist to evaluate Israel, who never opened his eyes or communicated after his initial hospitalization.
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. Transferred to UC Davis Medical Center, he suffered cardiac arrest and underwent about 40 minutes of CPR before a doctor declared him brain-dead.
During the protracted legal proceedings, Israel’s parents were represented by two pro bono legal firms, Snyder’s Life Legal Defense Foundation in Napa and the Pacific Justice Institute in Sacramento. They argued in their legal claim that parents have constitutional rights to make health decisions for their children.
“They killed him … he’s stopped breathing,” Kevin Snider, chief attorney with the institute, said in a statement. His group sued Kaiser last spring in state and federal court, seeking to block efforts to remove Israel from his ventilator. That lawsuit was left in limbo after Fonseca and Nate Stinson took the child to Guatemala.
Snider said Children’s Hospital had “rushed to court” to get the restraining order dissolved before another physician could evaluate Israel. “They knew that attorneys were frantically trying to get a window of reprieve … but they charged forward despite that.”
It’s unclear why Children’s Hospital took Israel as a patient given that a California death certificate was pending. It had been issued by Kaiser but not signed off by the parents.
Professor Arthur Caplan, a medical ethicist at New York University School of Medicine who has written extensively on brain-death diagnoses, speculated that the hospital’s decision to accept Israel may have been simply an effort to “reconfirm the diagnosis that death had come.”
“I suspect they were trying to do the right thing and see if maybe a change in environment might get the family to accept what was true,” Caplan said.
Despite the contentious legal battles, Caplan said he hoped the hospital is providing counseling to the grieving parents. “No one wants to accept the death of a child.”
Dr. Wade Smith, a University of California, San Francisco, neurologist who has been involved in more than 30 brain-death diagnoses, said he hopes Israel’s parents will gain closure.
“This is a very sad story that draws strong emotions on all sides,” Smith said. “I do think that it helps support the practice of brain-death declaration, a practice that is important for physicians, patients and medical practice in general. Perhaps his parents can find peace now.”