Health & Medicine

Brain-dead child’s parents fight to keep him on ventilator at Kaiser Roseville

On his mother’s Facebook page, Israel Stinson is a big-smiled, brown-eyed 2-year-old playing with his sister, lapping up ice cream and sitting for his first haircut.

That innocent toddlerhood came to an end a few weeks ago. On April 2, Israel suffered cardiac arrest following an asthma attack and lapsed into a coma. Days later, after numerous efforts by several hospitals to keep him alive, the toddler was declared brain-dead at Kaiser Permanente Medical Center in Roseville. After hospital officials moved to take him off life support, his parents launched a legal battle to keep him hooked up to a ventilator.

On Tuesday, his parents, mother Jonee Fonseca and father Nathaniel Stinson, were in federal court again to discuss their temporary restraining order blocking Kaiser from discontinuing life support for their son. The Vacaville couple declined to speak with reporters.

On a GoFundMe fundraising site, “Save Israel’s Life,” Fonseca described her son’s situation: “My little boy was taken to the (emergency room) where he was intubated and placed on a ventilator and later transferred to a children’s hospital. Shortly after, his … tube was removed leading to an increased difficulty breathing and cardiorespiratory arrest. Israel was then re-intubated and transferred to Kaiser Permanente Roseville Medical Center in Sacramento, where he was quickly diagnosed as ‘brain dead.’”

Fonseca states on the site that she is seeking $50,000 to pay for an air medical transfer to another hospital, likely in another state. She and the baby’s father also state they are Christians and removing their son’s breathing tube violates their religious beliefs.

“God is telling me not to let go,” his mother writes. Her attorneys argue she is her son’s “health care decision maker” and is objecting on religious grounds to the removal of his ventilator. To override her religious beliefs would be to trample on her constitutional right to freely practice her religion, her lawyers said.

Physicians at Kaiser contend that Israel is “brain dead,” leaving them with no alternative but to abide by California law, which mandates shutting down the cardiopulmonary equipment that allows the boy’s heart to continue beating.

“Three different physicians have administered brain death examinations and each found the results to be consistent with brain death,” read court papers filed by Kaiser’s attorneys.

His parents continue to hold out hope. “The minute he laid in my hands he took a deep breath and then that’s when I first started to notice he was doing a little bit of movement, a little head motion, a little shoulder moving,” said Fonseca in a TV interview with ABC10.

Israel’s father, Nate Stinson, told the station Kaiser Permanente shouldn’t give up on his son.

“We would hope that they would do everything they can to see our son walk again, to see our son get up, but they’re not doing that,” Stinson said. “They’re not doing that. They’re fighting us on it. And we don’t understand why.”

Doctors say that’s why declaring a patient brain dead is so emotionally difficult for families.

“Brain death is both very emotional and a definitive diagnosis,” said Dr. Wade Smith, a neurologist and director of neurologic intensive care at UC San Francisco. “It can be difficult to convey a diagnosis of brain death because the body is still warm, the heart’s still beating and it’s hard to understand that that child or adult has died.”

But even when a brain-dead patient may seemingly respond, it’s an irreversible diagnosis, said Smith, who has been involved with 30 cases of patients declared brain-dead. Parents or family need an “appropriate amount of time” to grieve and say goodbye before the body is turned over to the morgue, he said.

Dr. Chris Palkowski, chief of staff at Kaiser Roseville, said in a statement: “Our hearts go out to this family as they cope with the irreversible brain death of their son, and we continue to offer our support and compassion to them.”

One of Fonseca’s attorneys, Matthew McReynolds of the Pacific Justice Institute in Sacramento, said in an emailed statement: “Any parent in this situation who sees their child fighting for life would be fighting for him just like our clients are doing. We appreciate the careful approach being taken by the courts to prevent the cessation of life-sustaining treatment. … We’re doing everything we can to give this child the opportunity to get better.”

Fonseca’s lawyers are also asking U.S. District Judge Kimberly J. Mueller to make it possible to have Israel removed from Kaiser’s care and placed in another hospital. They want an order compelling Kaiser’s doctors to perform a tracheotomy and insert gastric feeding tubes in Israel, which will provide “proper respiratory support and nutrition and … meet the conditions required for transfer to another facility.”

Fonseca’s goal is to relocate Israel to long-term care in New Jersey, the one state with a religious exemption allowing patients to remain on ventilators even when brain-dead.

In a similar case that grabbed headlines in 2013, then-13-year-old Jahi McMath was declared brain-dead at Children’s Hospital Oakland following cardiac arrest after surgery for sleep apnea. Her parents fought to keep their daughter on life support even after several doctors declared her brain-dead and Alameda County issued a death certificate. Her parents were allowed to have her medically transported to New Jersey, where Jahi has remained on life support for more than two years.

Jahi’s parents, who post photos and videos showing her twitching fingers or reacting to their coaxing voices, have filed a lawsuit requesting Jahi’s death certificate be revoked so the family can move back to California.

Multiple hospitals have been involved in Israel’s care. According to court papers filed by Kaiser’s lawyers, Israel was treated at Kaiser Vacaville’s emergency department for a severe asthma attack about four months ago. In January, the filing said, the child’s parents and county Child Protective Services were informed that Israel’s medical history and the failure to comply with medical recommendations were weakening Israel’s lung capacity to the point where he might be unable to recover from a severe bronchospasm.

In another court declaration, Dr. Paul Byrne, a non-Kaiser pediatrician who examined Israel’s medical records on behalf of Fonseca and visited Israel several times in the hospital, said the 2-year-old suffers from hypoxia (lack of oxygen supply to body tissues) and hypothyroidism, a deficiency in thyroid hormones. He was also being treated for diabetes insipidus, which causes extreme thirst and heavy urination.

In the court documents, Kaiser states that Israel had an asthma attack at home on April l. He was taken to Mercy General Hospital’s emergency room, where he was intubated and transferred to the pediatric intensive care unit at UC Davis Medical Center. The ventilator tube was removed the next day and, shortly thereafter, he had a second asthma attack and suffered cardiorespiratory arrest. He was again intubated, placed on a ventilator, and treated with a pump to circulate blood through an artificial lung back into his bloodstream.

On April 4, brain scans showed “near total absence of blood flow into the bilateral cerebral hemispheres.” Eight days later, on April 12, Kaiser Roseville admitted Israel, with his parent’s consent, for a second brain death examination.

Fonseca and her attorneys will be back in Sacramento federal court on May 11 seeking a preliminary injunction blocking Kaiser Permanente Medical Center in Roseville from discontinuing life support for their son.

Sammy Caiola: 916-321-1636, @SammyCaiola