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Mother wants more tests for son on life support

September 02, 2009|By KATE S. ALEXANDER

MARTINSBURG, W.Va. -- The mother of a West Virginia man who overdosed on heroin in August said the court order she thought would give doctors more time to screen her son for signs of life is actually preventing them from performing key tests.

Angela Lanciano Moreno of Gerrardstown, W.Va., was awarded a temporary restraining order Monday by 23rd Judicial Circuit Judge Gina M. Groh that prohibits WVU Hospitals-East from removing her 22-year-old son, Christian Lanciano, from life support, according to court records.

Lanciano was put on life support at City Hospital, which is owned by WVU Hospitals-East, after doctors resuscitated him from a heroin overdose on Aug. 22, his mother said.

However, the most definitive test of brain activity, an apnea test, will require stopping life-sustaining measures for approximately 10 minutes to see if Lanciano will breathe on his own, his mother said.

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"The whole reason for the court order was to do more testing," she said. "Now, it is blocking us from doing just that."

Moreno is seeking to modify the court order to allow the apnea test.

Paul Taylor, Moreno's attorney, said the temporary restraining order was the only way for Moreno to keep her son alive and have more tests performed.

As Moreno waits for the judge to rule on the modification, the hospital is performing other tests she requested as proof that there is no hope of her son's recovery.

"Our family is not in denial. We know this is a grave situation, but we need to know beyond a shadow of a doubt that he will not recover," she said. "I could not live with myself if I did not know for 100 percent certain he had no hope of recovering."

Hospital staff successfully resuscitated Lanciano after five injections of the opiate antidote Naloxone and five shocks with a defibrillator, Moreno said.

Unfortunately, he had gone without oxygen until the final shock revived a faint heartbeat, she said.

"When they brought him in, he was blue," she said. "They took me aside to tell me he was dead, then they said they shocked him back to life."

For Moreno, it would have been easier if her son had not been resuscitated, she said.

Watching his situation worsen daily as the many tests continue to bear bad news is worse than if had he remained dead, she said.

Still, after observing her son squeezing her hand and fluttering his eyes not long before the hospital attempted to pronounce him dead, she said she wants to see solid proof that he cannot recover.

"It's like a nightmare I can't wake from," she said. "I have always been an extremely strong woman, but I feel like I am falling apart. I have never been this weak in my life. I have never had to deal with something like this."

West Virginia's 1989 Uniform Determination of Death Act very clearly defines death.

Doctors in the state have a strict set of tests that determine if a patient meets that definition, said Dr. Alvin Moss, director of the Center for Health Ethics and Law and professor of medicine at the Robert C. Byrd Health Sciences Center of West Virginia University.

According to the legislation, death can occur when either the heart or, as in Lanciano's case, the brain ceases to function.

"Brain death is a part of what we deal with every day in our facilities and there is protocol we follow, algorithms we use to make a determination that your loved one has died," Moss said.

Moss said he is aware of at least five tests that can evaluate if the brain is no longer functioning.

Exams like the apnea test, nuclear medicine studies of blood flow to the brain, blood oxygen level tests and physical reflex tests are performed daily by doctors determining if a patient is living or dead, he said.

Until the court order was issued Monday, Moreno said only one such test, an EEG which measures electrical activity in the brain, had been performed on her son.

On Wednesday, hospital staff performed two radiological exams to determine if blood was flowing to Lanciano's brain, Moreno said.

The outcome, she said, was "very bad."

While the hospital also performed another EEG test, Moreno said her son was still testing positive for mood-altering benzodiazepines in his system, likely the result of long-term use and poor kidney functioning.

She said she understood that until the heroin and other drugs are out of his system, an EEG is not definitive.

The most reliable test a doctor can perform to determine if a patient's brain still functions is an apnea test, Moss said.

Removing the patient from machines that support the lungs for a few minutes will force the brain to kick in and tell the lungs to breathe, he said. If the patient does not breathe on his own in that time, the brain is determined dead, he said.

Moreno said she hopes she does not have to wait until the restraining order expires Sept. 10 for doctors to perform that test.

In the meantime, she prays for a miracle and for her community to realize its drug problem.

"We have got to do something to control (the drugs) in our community or at least give those who choose to use access to the antidote," she said. "We have to step up and save our children. If Christian had had access to that antidote, he would be home with me right now."

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