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Jahi McMath has a bed waiting for her at a long-term care facility, and the Oakland hospital where she remains a patient said Friday it is willing to transfer her.

However, the brain-dead 13-year-old girl may not get the chance to go because doctors refuse to perform a tracheotomy for breathing and insert a gastric tube for feeding -- procedures all such care facilities require for new patients who can't breathe or eat on their own.

Doctors won't perform these common procedures on Jahi because they do not treat dead people, and in California and just about everywhere else, brain death means the end of life, doctors and ethicists said Friday.

Nailah Winkfield, mother of Jahi McMath, 13, as she speaks to reporters Dec. 18, 2013, after the family held a prayer vigil for her daughter at Paradise
Nailah Winkfield, mother of Jahi McMath, 13, as she speaks to reporters Dec. 18, 2013, after the family held a prayer vigil for her daughter at Paradise Baptist Church in Oakland. (Ray Chavez/Staff file)

In a letter to Jahi's family attorney Friday, Children's Hospital Oakland said it would send the girl to a long-term care facility once the family provides information on where she will go and how she will get there, and with consent from the coroner. Jahi's family does not accept that she is dead.

Facing a court-ordered 5 p.m. Monday deadline to pull Jahi off her ventilator at Children's Hospital, Jahi's family is scrambling to find a way to move her to another facility. Already, family attorney Christopher Dolan said Friday that an East Bay home gave up a bed saved for Jahi because Children's Hospital wouldn't install a trachea or gastric feeding tube. Dolan said the family may have secured a bed in North Hollywood.

At a heated news conference Friday outside Children's Hospital Oakland, Dolan said that if Jahi cannot be transferred, he would appeal the court order and may file a federal injunction to keep her ventilator going.

On Thursday night, during another tense news conference, the family said there had been a "miracle" as it announced that an unnamed facility had agreed to take over McMath's long-term care. At that same gathering, the Oakland hospital responded by saying it will not perform the needed surgeries because the hospital will not treat the "body of a deceased person."

Jahi on Dec. 9 underwent tonsil surgery and two other procedures to remove tissue from her nose and throat, to treat her sleep apnea. Complications following the operation resulted in loss of all brain function, according to six doctors who evaluated her. Jahi has been on a ventilator at the hospital since.

Dr. Jessica Zitter, a Bay Area-based physician practicing critical and palliative care, said the family might not find a physician anywhere to do the procedures it seeks.

"Most hospitals would not treat a brain-dead patient; most private doctors would not treat a brain-dead patient," Zitter said.

A health care ethics expert said the hospital is following state law, which equates brain death with end of life.

"It's a pretty rare situation," said Ryan Holmes, a bioethicist with the Markkula Center for Applied Ethics at Santa Clara University. He said he has never heard of a patient declared brain-dead transferred to a long-term care facility.

"In most cases, while it's a devastating diagnosis, people understand there's not anything that can be done when they determine the patient's brain is not functioning. But I understand why this family is hesitant to do that; they certainly have been put through a lot."

In a letter to Dolan, a lawyer for the hospital reiterated the facility's belief that Jahi suffered a "complete death," but "will allow a lawful transfer of Jahi's body in its current state to another location if the family can arrange such a transfer and Children's can legally do so."

Hospital attorney Douglas Straus listed three requirements:

  • Naming the facility to which Jahi would be moved, and providing that facility's terms and conditions.

  • Naming who will physically transfer Jahi and identifying the transportation plan.

  • Getting consent from the Alameda County Coroner's Office.

    A call to the Coroner's Office on Friday was not immediately returned, but Dolan said that office had greenlighted a transfer if a facility would accept her.

    Tracheotomies and the insertion of gastric tubes are procedures done largely to ease the task of providers, Holmes said, and are common for patients discharged to long-term facilities. However, a patient could be moved without those procedures being done, he said.

    "We're going to do everything we can to move her," Jahi's uncle Omari Sealey said Friday. "We're going to see what we can do to get around the procedure."

    The position of Children's Hospital Oakland is what would be expected from any other facility, Zitter and Holmes said.

    "Generally, when someone is determined to be dead, all remaining interventions are halted," Holmes said, adding Jahi's case is unique in that a judge intervened extending her time hooked to life support machines until Monday evening.

    "I think the whole case is dangerous in terms of precedent. I think that's probably a concern for the hospital," Holmes said. "We're able to do so much in medicine, and there are times when maybe we shouldn't do as much."

    As many patients wind up brain-dead, Jahi's case could create future problems, he said."If you don't set hard lines, it's hard to reestablish those hard lines later," Holmes said. "The hospital is in the unfortunate position that any time they set those standards, it can be perceived as cold and unsympathetic, and it's a very hard place to be put in."

    Contact Matthias Gafni at 925-952-5026 or mgafni@bayareanewsgroup.com. Follow him at Twitter.com/mgafni.