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When doctors give up

Oct 27, 2009 | Andria Simmons | Cox News Simmons

Nonnie Hawkins remembers standing beside her daughter's hospital bed, steeling herself for a final goodbye.

She turned to physicians at DeKalb Medical Center in Decatur, Ga., who minutes earlier had disconnected a machine that was breathing for 18-year-old Tara Bottoms-Hawkins. Hawkins thought her daughter was in a coma, as she had been for four months. But doctors said the young woman was brain-dead.

It was March 18, 2004, two days after Tara gave birth to a premature son, bucking the predictions of some doctors who said the fetus wouldn't survive.

The Lithonia, Ga., woman said she looked at the four doctors, the hospital administrator and the respiratory therapist. She called each of them by name. She thanked them individually for everything they had done to bring her grandson, Emmanuel, into the world.

Then she told them, "Tara's blood is on your hands because you just killed my child."

Thousands of people die daily in the United States, almost all before they're declared brain-dead. That designation usually comes into play when a person suffers a traumatic injury or stroke and is attached to devices that maintain organ function.

When doctors determine the brain is not working anymore, families and hospitals usually agree that life support should then be removed, said Dr. Richard W. Cohen, longtime chairman of the ethics committee for Wellstar Health System in Atlanta.

Sometimes, however, the family disagrees with the diagnosis.

That was the case with Nonnie Hawkins. Hawkins said her daughter was alive and responding - albeit minimally - to people in the hospital room. On one occasion, a doctor had noticed Tara was breathing over the ventilator on her own.

The hospital kept Tara on the ventilator for four months - as long as her unborn baby was alive. They couldn't perform certain tests to determine the extent of Tara's brain damage without damaging the fetus, said Hawkins' attorney, John Crongeyer.

After Emmanuel was born, however, doctors evaluated Tara several times over the next two days. They determined that she was brain-dead, but Hawkins was not convinced.

About 10 minutes before her daughter was taken off the ventilator, Hawkins said people were gathered around the bed praying and saying, "Please wake up, the baby needs you," when Tara moved her hand. When Hawkins went to get the neurologist, he said it was just a reaction from the spine, she said.

"It was like their mind was already made up," Hawkins said. "There was nothing besides Tara opening her eyes and sitting up that she could've done to stop them from taking her off life support."

Hawkins sued DeKalb Medical Center, the doctor and DeKalb Neurology Associates on May 15, 2006, on behalf of her grandson. The lawsuit alleges medical malpractice, wrongful death and negligence. Hawkins said she never consented for the hospital to take her daughter off the ventilator.

At the crux of the case is whether Tara was brain-dead or just brain-damaged.

Georgia law leaves the final decision on discontinuing treatment for brain-dead patients to doctors, not family members.

DeKalb Medical Center tried to have the case dismissed, but the Georgia Court of Appeals said no, noting that for "incompetent adult patients" who may have some brain function remaining, the decision to terminate life support rests with the family.

The court has not yet ruled whether Tara's brain had ceased functioning, or whether a glimmer of life remained.

DeKalb Medical Center maintains that she was brain-dead, and that the decision to stop treating her was appropriate.

The medical center appealed to the Georgia Supreme Court.

Beyond a short statement, the hospital declined to comment for this story.

From a legal standpoint, being brain-dead is the same as being dead.

Before a patient can be declared brain-dead, two doctors must evaluate the patient on two occasions.

Dr. Michael Hartman, a neurologist at Emory Eastside Medical Center in Snellville, Ga., routinely removes patients from machines that support organ function after he declares brain death.

Hartman said the physicians have to make the tough decisions when families can't.

"If you let them take control, they will never let go," Hartman said. "I realize this lack of control families must feel when we go in, but it's part of the job."

People avoid discussing their end-of-life wishes until it's too late, said Beverly Tyler, executive director of Georgia Health Decisions. The nonprofit organization educates residents about health care options and helps people prepare advanced directives.

"They always say it's important, but getting them to take action is really difficult until something dramatic happens in their own families," Tyler said.

Disputes between families and hospitals crop up because both sides think they know what's best.

An advanced care directive clarifies the patient's wishes. It tells caregivers whether to withhold or maintain life-sustaining treatment if a person is terminally ill, in a coma or in a persistent vegetative state.