Outside doctor: Titus Cromer is not brain-dead. Family continues fight with Beaumont

His skin is still warm to the touch. His heart continues to beat. But 16-year-old Titus Cromer Jr. is dead, doctors at Beaumont Hospital in Royal Oak told his family. 

Beaumont contends that medical tests conducted Oct. 24 showed no brain activity, even in the brain stem, says Jim Rasor, an attorney representing the family. The hospital system had planned to remove life support last week from the Lathrup Village teen, who suffered an undisclosed brain injury Oct. 17.

But Titus' family took legal action to keep him on a ventilator, disputing the diagnosis that he is brain-dead. A hearing that initially was scheduled for Thursday in the courtroom of Oakland Circuit Judge Hala Jarbou has been postponed to Nov. 14. In the meantime, the judge ordered Beaumont to continue to provide medical care to Titus, a junior at the University of Detroit Jesuit High School. 

Dr. Richard Bonfiglio, a physical medicine and rehabilitation specialist from Murrysville, Pennsylvania, visited Titus on Wednesday at the hospital, and concluded that he is showing signs of some brain activity. 

"It is my belief that he's not brain-dead," Bonfiglio told the Free Press. "Under the statute in Michigan, in order to be declared brain-dead, you can have absolutely no brain or brain stem function. He has functioning of his hypothalamus.

"I know that because he's able to maintain his body temperature without any assistance. So in other words, if he was brain-dead, in order to stay warm you need to have a heating blanket. He has no such need. And he's also maintaining his blood pressure and pulse without medications. He's been taken off the ventilator at times for short periods of time and is able to tolerate that.

"What he needs is time. This has been about three weeks now that he has been in this situation, and I do not understand why the hospital is in such a rush."

Although Bonfiglio said he was allowed to visit Titus and his mother, LaShauna Lowry, at Beaumont, he said he was not able to examine Titus. 

"The hospital will not allow me to examine him. I have no idea why," said Bonfiglio, who is affiliated with the Terri Schiavo Life & Hope Network, an advocacy organization created by Schiavo's brother, Bobby Schindler, in the wake of his sister's highly publicized death. Schiavo was in a persistent vegetative state for years after a heart attack in 1990. Her husband, Michael Schiavo, insisted his wife wouldn't want to live that way and got a court order to disconnect her feeding tube against the wishes of her parents and brother. She died 13 days later, on March 31, 2005. 

"I don't have privileges at the hospital, but I'm licensed in the state of Michigan," Bonfiglio said. "I asked them just to allow me to examine him. I was not going to do anything intrusive, but they declined. So I was able to visit with him and with his mother for about an hour."

He drew his conclusions, he said, from medical reports Rasor obtained from Beaumont. 

"The other thing is his mother told me that at times when she holds his hand, Titus will move one of his fingers, Bonfiglio said. "In real life, it’s very different than in TV shows. In TV shows, somebody comes out of a coma, and they immediately start talking, right? That's just not the thing that happens in real life. A flicker of a movement is typical. And she's seeing that.

"People that are in this kind of situation respond much more to family members, than they do to doctors and nurses. … It makes sense that's the case."

Rasor said the family plans to move Titus to a long-term care facility in Farmington, but there's a catch. 

Titus can't be transferred until a surgeon places a tracheostomy tube in his throat and feeding tube through the wall of his abdomen and into his stomach. Beaumont won't allow its doctors to perform those procedures because Titus has already been declared dead, Rasor says.

Negotiations had begun between Rasor and Beaumont's lawyer to decide whether permission could be granted for an outside doctor to place the tracheostomy tube and feeding tube so Titus can be transferred. 

But, Rasor said, those negotiations broke down Wednesday.  

"What's important to know is that Beaumont is refusing to have any doctor come to Beaumont and perform the tracheostomy," Rasor said. "Even Beaumont doctors are prohibited from doing that. So we're urgently seeking a facility to transfer him to where physicians can perform a tracheostomy and the placement of a PEG tube, a feeding tube, so that he can then be transferred to the nursing facility."

Beaumont Health wouldn't confirm that it is refusing to allow any doctor to perform those procedures for Titus. The health system also declined to provide any details about Titus' case or comment even generally on its policies regarding brain death determination and the removal of life support in cases like these.  

More:Beaumont says Titus Cromer, 16, is brain-dead. A judge says it can't pull the plug yet.

More:Why parents don't get a say about end of life when a child is brain-dead

However, Beaumont spokesman Mark Geary issued the following statement:

"We continue to abide by the order that was entered by the court last week. We empathize deeply with families in these kinds of very difficult circumstances, but we cannot discuss the particulars of a patient’s care without the family’s explicit permission. We remain committed to supporting the family in a compassionate, ethical and legally appropriate way."

Other families fight for life 

Titus is the second Michigan teen this fall to hang in the balance as the courts, hospitals and their families fight to continue medical care following a brain death determination. 

Fourteen-year-old Bobby Reyes of Ash Township was hospitalized Sept. 22 after suffering a severe asthma attack.

Two days later, doctors at C.S. Mott Children's Hospital in Ann Arbor conducted a brain-death examination and found no evidence of electrical activity in Bobby's brain stem. A separate blood-flow test found no blood flowing to the boy's brain. A repeat examination, completed Oct. 15, confirmed no electrical activity to Bobby's brain. 

Bobby died later that day, when doctors turned off a breathing-support machine. His family had also struggled to keep Bobby on life support while they, too, sought an outside long-term care facility that could take him. 

More:Family loses hard-fought battle to stop hospital from taking son, 14, off life support

More:Boy at center of brain death case officially dies after life support is stopped

In a statement, Michigan Medicine said: "Continuing medical interventions was inappropriate after Bobby had suffered brain death and violates the professional integrity of Michigan Medicine’s clinicians." 

According to Michigan's Determination of Death Act, a hospital system may discontinue medical treatment once a doctor or registered nurse determines one of the following conditions has occurred: 

• Circulatory and respiratory functions have irreversibly stopped.  
• All functions of the entire brain, including the brain stem, have irreversibly stopped.  

However, Rasor says: "We do not believe that the hospital has the right to full life support from any patient, despite any opinion they have. Michigan law clearly says that that's the right of the parent, only."  

A study published in Neurology, the official journal of the American Academy of Neurology, detailed a strikingly similar case in California involving a 13-year-old Jahi McMath, who was declared brain-dead Dec. 12, 2013, following complications from tonsillectomy, adenoidectomy, and sinus surgery. 

Like Titus, her family said Jahi was not dead because of her beating heart and movement in response to touch. They sought a court order to keep her on life support with the hope that she might recover. 

Also like Titus, the family eventually looked for a place outside the hospital to move Jahi for long-term care, but needed a surgeon to place a tracheostomy tube and feeding tube.

Ultimately, Jahi was moved to an undisclosed outside long-term care center, and about four years after doctors initially declared her brain-dead, an attorney for the family said Jahi's liver stopped functioning. He told CNN he would seek to change her death certificate to say June 22, 2018. 

A debate about time 

Jahi's story sparked widespread discussion about how much time hospitals should give the families of patients who have been declared brain-dead before removing life support. No clinical guidelines have yet to be established for hospital systems in situations like these, the study, which was published in October 2014, noted. 

"This likely reflects the great diversity of needs that grieving families have in such circumstances, as well as differing clinical settings in which death may occur. ..." the study concluded.  "When patients die in intensive care units, it is reasonable to expect that their bodies will be removed from those bed spaces within a few hours due to the need for other patients to receive the heavily monitored care available in those units."

It suggested that in rare situations, hospitals may wait to withdraw life support so loved ones who live out of town might be able to say goodbye, or to support grieving rituals that meet a family's cultural or religious needs. 

However, continuing medical care to brain-dead patients, it said, "may compromise the professional integrity of physicians. Doing so also may foster misconceptions about the deceased patient's status as dead, detract from the care of living patients, and create significant moral distress for medical professionals."

Titus' case, Rasor says, reveals a hole in the legal system surrounding medical declarations of death. 

"There's no appeal process," Rasor said. "... There's a lack of due process in the determination of death statute because there's no pre-determination hearing and there's no opportunity for the family to contest it, and there's no appeal.

"Once two doctors in a medical facility say that the person is dead, then you have no appellate rights and the person's liberty interest in being alive is terminated without any due process whatsoever."

A GoFundMe account has been set up to support Titus and his family at https://www.gofundme.com/f/fighting-for-titus. More than $17, 280 had been collected by Wednesday evening.  

"We really hope we can find a surgeon to to step up and save this boy," Rasor said. "There's hope for him," Rasor said. "And we are going to make sure that he has that, that he has every chance possible."

Contact Kristen Jordan Shamus: 313-222-5997 or kshamus@freepress.com. Follow her on Twitter @kristenshamus.