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The Centers for Medicare and Medicaid Services concluded Children's Hospital Oakland didn't violate medical standards in the the case of Jahi McMath, although the physical status and location of of the 13-year-old brain dead girl is still unclear.
The release of the report (PDF) this week, which dinged the hospital only for an electronic database snafu, also unleashed a familiar battle between the hospital and the attorney representing the Oakland girl.
Jahi's family was "never interviewed, and myself as an officer of the court, are deeply offended and, once again, feel betrayed by the medical profession," attorney Chris Dolan sent in a Thursday email to NBC Bay Area. He said that the report is a case of the "fox guarding the henhouse."
In a tweet, Jahi's uncle, Omari Sealey, said no one from the state inverviewed his family and no one has answered why she bled so profusely.
But Children's Hospital countered on Thursday that the report was clearly in the right.
"We are very pleased with the results of ...the survey," Children's Hospital Chief Medical Officer Dr. David Durand said in a statement. "We were found to be in compliance with (the) standards in every area. No deficiencies of quality of care were identified in the survey."
Jahi went in for a series of tonsil surgeries to help her with sleep apnea on Dec. 9, suffered a cardiac arrest after surgery, bled so profusely that she choked on her own blood, and was reported brain dead on Dec. 12. Her family fought in the media and in the court to keep her on machines because they felt that she was alive because her heart was still beating.
Ultimately, the family was able to move Jahi to an undisclosed location despite several medical experts testifying that brain death is legal death.
Still, in February, Jahi's mother, Nailah Winkfield, wrote an open letter saying Jahi was "much better physically." On March 5, someone posted on the Keep Jahi McMath on Life Support Facebook page that "we pray for Jahi McMath as she heals."
At issue is a report from Jan. 7 to 10, first obtained through public records by the Contra Costa Times, who reviewed Jahi's tonsil surgery on Dec. 9, and 28 others chosen at random during the same period. State public health investigators carried out the report of behalf of the federal Centers for Medicare and Medicaid Services.
The report does not mention any patient by name. Overall, the hospital passed all the tests except for one "deficiency" in how medical records were not always entered electronically in a medical database before surgery. According to the hosptial, the information was indeed entered but a computer software glitch didn't show those entries. That problem, officials said, has since been fixed.
Durand responded: "Our newly-implemented electronic medical record system was amended and corrections were made within the week. At no time did any patient go into surgery without all required documentation.
Durand also took the time to cite that the state team "performed a detailed evaluation of our pre-operative consenting process, anesthesia and operating room processes, post-anesthesia recovery unit, and pediatric intensive care unit. We were found to be in compliance with CMS standards in every area."
Still, Dolan wanted to tell people what he thought of the report: "It's akin to an investigation, after a motor vehicle death, where they inspect the vehicle, its maintenance records and tread depth of its tires, and whether the driver was licensed. It does not examine the defendant driver's conduct before the fatal collision. It does not evaluate whether, in a specific case, there was medical negligence. It examines whether certain institutional criteria are met. It is members of the medical profession reviewing conduct of the medical profession."
Melinda Krigel, the hospital spokeswoman, added that she can't comment any more about Jahi because of federal and state patient privacy laws. But she strongly disagree that the state health investigators acted as foxes guarding the henhouse.
In an email, she said: "Mr. Dolan can voice his own opinions unchallenged, while we are precluded from addressing the issues raised since we have never received a signed authorization for us to speak to any aspect of this case. However, we can note that the CMS survey was very comprehensive. This was a federal survey that was conducted in addition to a CDPH survey. A team of six surveyors, that included nurses, physicians and state surveyors, reviewed 239 CMS Standards. While we again cannot comment on this specific case, if there was evidence of a delay in response to an emergency or treatment, this would have been a finding of a review."