Alvarado v. New York City Health & Hospitals Corp.

145 Misc. 2d 687, 547 N.Y.S.2d 190, 1989 N.Y. Misc. LEXIS 911
CourtNew York Supreme Court
DecidedOctober 18, 1989
StatusPublished
Cited by2 cases

This text of 145 Misc. 2d 687 (Alvarado v. New York City Health & Hospitals Corp.) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Alvarado v. New York City Health & Hospitals Corp., 145 Misc. 2d 687, 547 N.Y.S.2d 190, 1989 N.Y. Misc. LEXIS 911 (N.Y. Super. Ct. 1989).

Opinion

[688]*688OPINION OF THE COURT

Helen E. Freedman, J.

In this tragic case, the court is asked to prevent Elmhurst Hospital from removing a newborn infant from a respirator. The infant’s brain ceased to function within hours of birth, although sophisticated mechanical devices have maintained heart and lung function.1

The hospital claims that life support equipment should be withdrawn because the infant, Luis Alvarado, is dead. The hospital relies upon the New York State Department of Health (DOH) regulation entitled "Determination of death” (10 NYCRR 400.16) (the Regulation). The child’s parents challenge both the application of the Regulation to this case and its validity.

The issues before this court are: (1) whether the infant is "dead” within the meaning of the Regulation, (2) whether the Regulation is consistent with current medical knowledge, and (3) whether the Regulation is otherwise consistent with law. If the answer to all three questions is yes, the law does not permit this court to interfere with hospital’s decision to remove the respirator.

I APPLICATION OF THE REGULATION TO THIS CASE

The Regulation provides:

"(a) An individual who has sustained either:
"(1) irreversible cessation of circulatory and respiratory functions; or
"(2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.”2

[689]*689Luis Alvarado was born September 6, 1989, at Elmhurst Hospital. He was transferred to Mount Sinai Hospital where on September 8, he was diagnosed as clinically brain dead. He was then returned to Elmhurst.

The hospital chart progress record discloses the following information.. On September 15, 1989, the staff at Elmhurst met with Mr. and Mrs. Alvarado to explain in Spanish that the infant was clinically and irreversibly brain dead and that his heart and lungs functioned only with the aid of the respirator and medication. The parents expressed a desire to continue life support systems.

On September 19, 1989, a Dr. Lescano, the attending neonatologist at Elmhurst, suggested to Mrs. Alvarado that she obtain an independent neurological evaluation and offered to meet with the parents and members of their church (Jehovah’s Witnesses) to explain the baby’s condition to them. She again indicated that she wished to have the life support systems maintained.

On September 21, 1989, Mrs. Alvarado met with a hospital social worker, and on September 22, 1989, Dr. Lescano again explained to Mrs. Alvarado that the infant’s condition was irreversible and that the hospital would be obliged to remove the respirator unless she obtained a court order.

The Alvarados then commenced this action. On September 28, 1989, the City of New York petitioned the court to appoint an independent pediatric neurologist to determine whether Luis Alvarado had suffered an irreversible cessation of all functions of the entire brain, including the brain stem. After a number of experts sought by the court proved unavailable or unacceptable to petitioners’ counsel, the court accepted a recommendation of petitioners’ counsel and appointed Dr. Lydia Eviatar, the Chief of Pediatric Neurology at Long Island Jewish Medical Center.

Dr. Eviatar performed two independent neurological examinations, including two electroencephalograms, on October 3 [690]*690and on October 5, 1989, in accordance with the protocols established pursuant to the Regulation (10 NYCRR 400.16 [e] [1]). The parents, the hospital administrator, the intensive care unit personnel, and on the second occasion the family’s lawyer, were present.

On October 10, 1989, Dr. Eviatar testified that the infant had sustained irreversible cessation of all functions of the brain, including the brain stem, that there was no possibility of recovery and that all of the tests she performed confirmed these facts. Her tests demonstrated that the baby was comatose with no spontaneous activity or motion of the extremities in reaction to painful stimuli and at all times the baby’s pupils remained in midposition, dilated and unresponsive to light or sound. The baby exhibited no response to irrigation of both ear canals with 20 cc’s of ice cold water and there was no ocular response to the oculocephalic maneuver. There were no rooting, sucking, coughing or corneal reflexes present. An apnea (breathing) test was performed with the baby given 100% oxygen via catheter directly into the endotracheal tube. After removal of the respirator, no spontaneous respirations were recorded, and both electroencephalograms showed complete and total electrocerebral silence. The level of phenobarbital in the blood had been reduced below five for each set of tests so that there were no substances altering the level of consciousness.

Testing by the pediatric neurologists at Elmhurst Hospital and at Mount Sinai Hospital, and by Dr. Eviatar, conclusively demonstrated that there was no function in any part of the brain. Respiration and control of blood pressure normally performed by the lowest part of the brain stem are maintained solely by machinery and medication.

Petitioners have submitted no evidence contradicting the findings of the doctors here.3

Under the Regulation the hospital’s determination of death is therefore correct. Accordingly, the court must address the validity of the Regulation.

[691]*691II THE DEFINITION OF DEATH UNDER THE REGULATION IS CONSISTENT WITH CURRENT MEDICAL KNOWLEDGE

The traditional legal and medical standard for determining death was based upon cessation of cardiopulmonary function. Since breathing and circulation may now be maintained artificially by sophisticated medical technology in cases where the brain has ceased to function entirely and irreversibly and where the ability to breathe depends completely upon artificial support, the traditional standard has had to be modified.

A definition of death which provides that death has occurred when there is irreversible cessation of all brain function has been accepted by the legal and medical professions and has been unanimously adopted by the Court of Appeals of the State of New York.

In 1968 a Harvard Medical School Committee developed criteria for determining brain death.4 Further refinements were published in 1972 and 1977.5 During the 1970’s, the American Bar Association and American Medical Association both considered and adopted model bills.6

In 1978 Congress established the President’s Commission of the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research and charged it, inter alla, with studying "the advisability of developing a uniform definition of death”.7 The Commission, chaired by Morris B. Abram, a New York lawyer, found that current technology permits physicians to "generate breathing and heart beat where the capacity to breath spontaneously has been irretrievably lost;” and thus, the formerly accepted standard for determining death of " 'cessation of cardiopulmonary function’ ” was too limited. (1980 Report of President’s Commn for Study of Ethical Problems in Med and Biomedical and Behavioral Research.)

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Bluebook (online)
145 Misc. 2d 687, 547 N.Y.S.2d 190, 1989 N.Y. Misc. LEXIS 911, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alvarado-v-new-york-city-health-hospitals-corp-nysupct-1989.