The case of a brain-dead Florida teen-ager has renewed the debates over the ethics of life support and who pays for extraordinary healthcare measures.
Physicians contend Teresa Hamilton of Sarasota, Fla., is clinically dead. But her parents believe their 15-year-old daughter is alive and will recover if allowed to stay on her life-support system.
After 56 days in Sarasota Memorial Hospital's intensive-care unit, Ms. Hamilton went home in early March under an unusual agreement with the 988-bed public hospital. She is being kept alive through a ventilator and feeding tubes.
Because the Hamiltons' medical insurance had run out after Teresa's bills reached $30,000, Sarasota Memorial agreed to pay the estimated $1,500 a day in home-care costs. Her daily ICU hospital charge was $3,000.
The agreement calls for the hospital to place those home-care charges on Teresa's current hospital bill of $135,000, a hospital spokesman said. That bill doesn't include physicians fees, which total $50,000.
In a similar case, a federal appellate court in Falls Church, Va., ruled in February that 656-bed Fairfax Hospital couldn't withdraw life-support systems from a baby who was born without a brain stem. The court cited the federal Emergency Medical Treatment and Active Labor Act, which requires hospitals to treat patients in emergencies.
In the Sarasota case, physicians declared Ms. Hamilton clinically dead on Jan. 8, the day after she was admitted to Sarasota Memorial with flu-like symptoms and lapsed into a diabetic coma. She had been sick since an all-night skating party on New Year's Eve.
Ms. Hamilton's physicians said three brain scans have revealed no activity, a hospital spokesman said. In addition, blood has stopped flowing to her brain.
Although Sarasota Memorial's bioethics committee voted three times to withdraw life support, hospital executives and Ms. Hamilton's physicians agreed not to make the decision because of her parents' objections, said Michael Vizvary, a hospital spokesman.
"The parents are hoping for a miracle," Mr. Vizvary said. "All along we have been trying to do the right thing, the compassionate thing. We are working with the family on medical care and finances."
Under Florida law, hospitals may remove life-support systems without family consent if two physicians agree that the patient is clinically dead, Mr. Vizvary said.
Based on a Florida Supreme Court ruling last year in the Dubreuil case, Sarasota Memorial was required to consult the state attorney's office to determine if the state wished to intervene on Ms. Hamilton's behalf before they took action to withdraw support. The state declined.
But Michael Covert, Sarasota Memorial's president and chief executive officer, requested a meeting with the Hamiltons and their lawyer and offered two options. One, remove Teresa from life support, or two, allow her to go home.
The Hamiltons chose to take their daughter home.
"Like any patient, we will set up a payment plan and look for other payers," Mr. Vizvary said. "The family has applied for Medicaid and may become eligible."
The Hamiltons were quoted in the Sarasota Herald-Tribune as saying that they would consider removing life support only if the condition of Teresa's organs began to deteriorate.
"If she starts falling apart, I'll be the one to pull the plug," said Sharon Hamilton.