Court orders coma patient remain on life support

By Ken Ritter and Scott Sonner, Associated Press

Friday, Nov. 20, 2015 | 9:22 a.m.

RENO — The Nevada Supreme Court ruled that a Reno hospital must keep a 20-year-old comatose college student on life-support, pending a review of the legality of a medical standard used to determine she was brain dead.

The unanimous ruling granting an appeal by Aden Hailu's father returned the case to Washoe County District Court for hearings about whether American Association of Neurology brain death guidelines cited by Saint Mary's Regional Medical Center doctors conform to Nevada's Determination of Death Act.

Justice Kristina Pickering acknowledged "important implications" for the medical community, families and patients as a result of the order.

"Brain death presents a mixed legal and medical question," she wrote, adding that, "Courts have deferred to the medical community to determine the applicable criteria for deciding whether brain death is present."

Attorney David O'Mara, representing Hailu's father, Fanuel Gebreyes of Las Vegas, didn't immediately comment on Thursday's decision.

Saint Mary's acknowledged the ruling in a statement from CEO Helen Lidholm that referred to "the difficult nature of the situation."

"We remain committed to providing high quality and compassionate care to all of our patients," the statement said. "Our thoughts and prayers are with the family and we are hopeful that an amicable resolution will be forthcoming."

Hailu suffered severe low blood pressure and a lack of oxygen to the brain during surgery April 1 to remove her appendix and explore the cause of abdominal pain, and never awoke from anesthesia, according to court documents.

Electroencephalogram, or EEG, tests conducted in early April showed brain function. But hospital doctors concluded May 28 that Hailu couldn't breathe on her own without a ventilator, and declared her brain dead, the documents said.

Pickering noted that Saint Mary's failed to conduct additional EEG tests to confirm the determination.

Gebreyes lost a bid for an injunction to prevent the hospital from ceasing life-support, but appealed to the state high court.

The seven justices said they weren't convinced the American Association of Neurology guidelines are considered the accepted medical standard and can be applied in a way to conform to Nevada law.

The Nevada Legislature in 1985 included a broad reference to using "accepted medical standards" under the Uniform Determination of Death Act used nationally, and said they must be applied in a manner "uniform among the states which enact it."

The high court ruling acknowledged the Nevada law set an "extraordinarily broad standard" by requiring that before brain death is declared, a finding must be made of "irreversible cessation" of all brain functions — including a determination that there is no function the brain stem.

The brain stem regulates autonomic and involuntary body functions including heartbeat, breathing, sleeping and eating.

The court noted that another medical standard, known as the Harvard criteria, looks for three factors — responsiveness to pain stimuli, lack of spontaneous movements or respiration, and cessation of reflexes such as eye movement, blinking or swallowing — followed by flat electroencephalograph measurements.

Ritter reported from Las Vegas.