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SANJAY GUPTA MD
What Does Brain Dead Mean?; Hospital Program to Re-Open Following Heart Surgery Deaths; New Test for Prostate Cancer
Aired January 26, 2014 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN HOST: There's a gut wrenching story in Dallas where a 33-year-old pregnant woman was hooked up to a breathing machine over the family's objections, even after doctors determined she was brain dead. The hospital said it was required under Texas law to do all of this to preserve the unborn child. Court documents say the fetus was not viable and late Friday, a judge sided with the family and said the woman can be removed from the breathing machine.
But many people are still confused by all this. Over what it means to be brain dead.
LYNNE MACHADO, MARLISE MUNOZ'S MOTHER: There's a lot of twinkle in her eyes, a lot of smile and laughter and not any more.
GUPTA (voice-over): It's difficult for Marlise Munoz's parents to see her now. According to court documents, she's been brain dead since November 28. But what does that mean exactly?
Many people confused it with being in a coma.
DR. STEPHAN MAYER, NEW YORK PRESBYTERIAN HOSPITAL: A coma is a severe brain injury and the brain, though, is still getting blood flow and still getting oxygen and still generating electrical activity, which is what the brain does. But most importantly in a coma, even though that person is in a state of semi-responsiveness, looks like a deep sleep, there is a potential for recovery.
GUPTA: A long-term coma can become a vegetative state. Now, in a rare number of cases, patients have come out of that condition. But if diagnosed correctly, brain death is permanent.
MAYER: There is no oxygen coming to the brain or being consumed. There is no electrical activity and most importantly for families to know, there's no potential for that brain function to ever come back.
GUPTA: To test for brain death, doctors will check to see that there's no blood flow to the brain and also that there's no electrical activity. They will perform tests such as shining a light in the eyes to see if the pupils move and constrict, or gently rub the eyeballs with cotton ball to test for reaction. Sometimes, they may put ice water into the ears and see if the eyes move in a particular direction. All of that is to check for activity in the brain stem.
Doctors will also perform an apnea test. That means they turn the ventilator off and see if the patient is breathing at all on their own.
Marlise's husband, Erick, an EMT himself, says his wife would have never wanted this.
ERICK MUNOZ, MARLISE MUNOZ'S HUSBAND: Reached a point that you wish your wife's body would stop.
GUPTA: Now on to a different hospital controversy. You know, last year we brought you the story of a hospital where several babies had died after heart surgery and they, in fact, shut down the program there. But they wouldn't offer parents any details as to what might have happened, what might have caused those deaths.
Well, now, they're reopening the program. They plan to start operating again without a public investigation or even an explanation as to what has changed.
Elizabeth Cohen has the story from Lexington, Kentucky.
ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT (voice-over): What happened to these babies, behind the walls of Kentucky children's hospital?
Jason Moore was the first to die, then Katlyn Allen, then Mason Hall, then Connor Wilson, then Ray Shaun Lewis Smith.
JOEQUETTA LEWIS, SON, RYAN SHAUN DIED: It 53 days I got to hold him. And then the next day, he was gone.
SARAH MOORE, SON JASON DIED: He was born and looked as healthy as any of my other children. Then three weeks later, I was burying him.
COHEN: Five babies, all dead after having heart surgery at Kentucky Children's Hospital -- surgeries that nationally babies usually survive.
Did you ever get answers about your son's death?
UNIDENTIFIED MALE: No. And we're still searching. We asked and asked and asked.
COHEN (on camera): It's awful to lose a baby anytime. Does it make it even harder when you're never told why?
LEWIS: Something happened. Can't nobody give me no answers.
COHEN (voice-over): The babies all died within 11 months. Shortly after the fifth baby died in 2012, the hospital decided to stop heart surgeries, and they put their only pediatric heart surgery on leave.
But now, only a little more than a year later, Kentucky Children's says it plans to start doing heart surgeries again. Shockingly, it seems no medical governing body is required to sign off on the hospital's decision to reopen the troubled unit.
DR. MICHAEL KARPF, EXECUTIVE IN CHARGE, KENTUCKY CHILDREN'S HOSPITAL: The only person, they only say permission from me.
COHEN: That's Dr. Michael Karpf, the executive in charge of Kentucky Children's Hospital. Last May, he told us he commissioned an internal report on the heart surgery program. These parents hoped that report would give them answers.
(on camera): But here it is, 102 pages long, and it doesn't explain why the babies died. In fact, it doesn't even acknowledge the babies died at all.
KEVIN ALLEN, DAUGHTER KATLYN DIED: How do you know when the problems have been fixed when they're not identified? I mean, they can say they fixed them. But is an internal review really objective?
UNIDENTIFIED FEMALE: I expect nothing more from a health care facility than honest answers and whether it's good or bad, we should know. I mean, that's not too much to ask.
COHEN (voice-over): Last May, Dr. Karpf told us, parents could rest assured.
(on camera): And parents should trust you, that you're re- opening and you're going to do a good job?
KARPF: This is America. They have a choice. They can trust us or not trust us. All I can tell them is, I'm not going to reopen until I feel good about it. It's as simple as that.
COHEN (voice-over): A spokesman for Kentucky Children's declined our request for another interview with Dr. Karpf referring us to their press release about the report. So we went to talk to Dr. Karpf ourselves as he was arriving to speak at a community center.
(on camera): Can you tell parents why their babies died after having heart surgery at your hospital? Sir, can you give these parents some answer? Sir, can you give these parents answer?
KARPF: Unfortunately, babies died at children's hospital after heart surgery at other places also.
COHEN (voice-over): That's true. But other hospitals are far more transparent. They report how many babies die. Kentucky Children's won't say.
(on camera): Dr. Karpf, can you explain why so many babies died after having heart surgery at your hospital? KARPF: We explained to you that our mortality fit the national standards.
COHEN (voice-over): But he's spinning the facts. At his hospital in 2012, after heart surgeries, children were dying at an alarming rate of 7.1 percent. That's more than double the national average of 3.2 percent.
And when it comes to how well his hospital performed specific heart surgeries on children, Dr. Karpf won't say. At other hospitals, you can find that detailed information right on their Web sites.
(on camera): These parents say they want an explanation and your report didn't give an explanation.
They're going to be taking in patients again. How does that feel?
SHANNON HALL, SON, MASON DIED: It's scary. It's scary. Just because we don't have answers.
LEWIS: It really hurts they're going to open this program back up. I'm very scared for the kids. I don't want nobody to have to go through this again.
COHEN: What are you worried could happen?
MOORE: The same thing that happened to my baby, the same thing that happened to their babies. I never brought my child home. He never left the hospital. He was three weeks old.
COHEN (voice-over): Kentucky Children's Hospital says it will do things differently this time. For starters, the original heart surgeon who was put on leave eventually left. So the hospital plans on hiring a new heart surgeon.
It also plans on creating a dedicated intensive care unit just for heart patients. And it's considering partnering with another hospital for pediatric heart surgeries. And Kentucky Children's says they plan to no longer perform the most difficult types of congenital heart surgeries.
But that doesn't satisfy these parents, who are left mourning their children, tortured for more than a year now by unanswered questions.
GUPTA: Elizabeth is going to stay down there and keep following the story and see what happens next.
Up next for us, a new test for one of the most common types of cancer. Could it replace a test that's been around for more than a quarter century? We'll explain.
(COMMERCIAL BREAK) GUPTA: One of the most confusing stories I've covered has to do with prostate cancer. Millions of men routinely undergo screening with what is known as a PSA test. It's a blood test. A high PSA number often leads to a biopsy to check for cancer, and then sometimes for surgery and radiation therapy.
But about a year and a half ago, a federal task force said the PSA test does more harm than good -- think about that -- that more men are hurt by complications from treatment than are helped from finding cancer early. That left a lot of us wondering, what now?
GUPTA (voice-over): Mark Cwern is no stranger to a biopsy. He's had three over the past 12 years as his PSA level has gone up and up.
But each painful procedure comes back with the same answer. No cancer.
You might think he'd be happy, but it's complicated.
MARK CWERN, PROSTATE CANCER PATIENT: Every time I got a negative exam, in a way I felt relieved, but in another way, I felt cheated. What if something is really there and we're not picking it up?
UNIDENTIFIED MALE: In this area, we'll target that.
GUPTA: Last spring, Cwern came to see Dr. Samir Taneja, he's a urologist at New York University, who uses a type of advanced MRI scan to get a better look at the prostate. He says it's a more systematic way to search for cancer.
DR. SAMIR TANEJA, NEW YORK UNIVERSITY: You can see here almost a dark, black hole in the prostate at this level. When we see an area like this, we're suspicious that may represent prostate cancer, and we recommend a targeted biopsy to that area.
GUPTA: With that dark spot as a target, this most recent biopsy did find cancer.
(on camera): So, he had these three biopsies and they came back negative, but he had cancer all along.
TANEJA: I suspect he did.
GUPTA (voice-over): Some would say that's part of the problem. Many prostate cancers can sit there a decade or more without causing harm. The thing is, it's very difficult to identify those that do require aggressive treatment.
(on camera): What are you going to do?
CWERN: That I still have to discuss with the Dr. Taneja.
GUPTA (voice-over): In the end, Cwern opted for surgery to remove his prostate. (on camera): What was your sort of attitude?
(voice-over): Another patient we met in Dr. Taneja's office took a different route.
TANEJA: Our goal with your biopsy today is --
Mr. Hanley was a great example of a patient who often comes to me. He's been on surveillance for a while. His initial biopsy showed a very tiny amount of cancer. So, he'd typically say he's somebody who has very little disease.
GUPTA: And yet his PSA kept going up.
Taneja used an MRI to help determine if Hanley's cancer was aggressive enough to warrant surgery. It wasn't.
TANEJA: But, you know, certainty in medicine is never 100 percent, unfortunately. But I can tell him with as much certainty I have in this disease that I don't think he has a more aggressive tumor than what our biopsy has shown.
GUPTA: Studies are under way to see if MRIs are a reliable predictor and if they really do make biopsies more accurate.
We did catch up with Mark Cwern and Paul Hanley six months later just to check in. So far, no regrets.
PAUL HANLEY, PROSTATE CANCER PATIENT: I'm fortunate that we caught this thing early and I'm fortunate that we have, I think, a good plan to deal with it and manage it going forward.
CWERN: To finally have a secure diagnosis and make a decision about what to do was very important to me as they say, so far so good.
GUPTA: And joining me now, Dr. Otis Brawley, who is chief medical officer of the American Cancer Society and a good friend of the program. Thanks for joining us.
DR. OTIS BRAWLEY, AMERICAN CANCER SOCIETY: Thanks for having me.
GUPTA: You know, part of the reason I want to do this story is I find this confusing as a physician -- this idea of who should get screened with PSA testing and then what to do about it. What do you think of this idea of using an MRI, as well?
BRAWLEY: Well, for men who have actually been diagnosed with a prostate cancer, I'm excited about the technology of using an MRI, still experimental and we still need to develop it and maybe we're going it be able to watch a group of men who have a localized prostate cancer and say this tumor is not growing over time. Therefore, this is a man who does not need to be treated.
From epidemiology, I can already tell you of men who have localized prostate cancer perhaps have, or maybe even 60 percent don't need to be treated because that tumor will never bother them. I want to be able to treat the guys who need to be treated, and the MRI may help me.
GUPTA: That's the interesting point. So, someone has an elevated PSA, this prostate specific antigen. The questions you really want to know are "A," is this cancer, "B," if it's cancer, what kind of cancer is it? Is it an aggressive cancer, something to worry about?
PSA doesn't tell you that.
BRAWLEY: That's right.
GUPTA: But that doesn't mean we should stop doing PSAs. It means we should better enhance the screening. So, if you get the PSA, it's rising, and maybe the MRI can be a good adjunct to that.
BRAWLEY: You know, there is a pendulum out there on PSA screening. There's a group of doctors who say, don't do it. And then there's a group of people who have been literally doing it in vans and super market parking lots.
I think the pendulum can go too far in either direction. There is a legitimate use of PSA and we need to drive this back into the doctor's office where a man is informed of the risks and the benefits and probably some benefits and then the man can decide to get the PSA. And, in some instances, he is going to need to get some of these other tests like the MRI that I'm excited about.
GUPTA: Is this -- is this a change in position for you? I think the last time we spoke, you -- the task force came out and said the PSA testing should not be done? I mean, that was the message that I think a lot of people heard. Was that the message that was supposed to be heard?
BRAWLEY: I don't think so.
The task force on -- unfortunately, the sixth paragraph actually said that some men are going to want to be screened, some doctors are going to want to screen and those doctors have an obligation to inform the man of the known risk and the known benefits, and make sure that the man understands before he is screened. What we all focused on was the first paragraph which said they recommended against routine PSA screening. The whole idea of what is routine is what many of us don't understand frequently.
GUPTA: All right. You're always a good voice of reason. I appreciate it. Glad you're well.
BRAWLEY: Thank you.
GUPTA: The chief medical officer for the ACS has to stay healthy himself.
BRAWLEY: Thank you. GUPTA: All right. Sir, thanks for joining us.
We're going to keep you healthy, as well. You know, it's not the fine print that is leading you astray at the grocery store, really those big words on the front of the packaging. Those could be confusing. So, we've decided to bust some of the most common buzz words. That's next.
GUPTA: I often say that fresh fruits and vegetables are some of the best medicine there is out there. But I also know, I acknowledge, it is hard to avoid all that processed food as well.
So, today, I've decided to spend just a moment teaching you what I look for on labels.
GUPTA (voice-over): You always hear, look at the fine print. But in the grocery store, it's the big print that can lead you astray.
UNIDENTIFIED FEMALE: Manufacturers are really good at picking up on those buzzwords that consumers are concerned with and they use those to catch our attention.
GUPTA (on camera): So, if you're not already a label reader, turn the package over. Let's start clearing up some things right now.
(voice-over): The first pitfall is on this bread label.
UNIDENTIFIED FEMALE: Although it might say wheat or multi-grain, it doesn't mean it's a whole grain bread.
GUPTA: You want whole grain? Look for it to say 100 percent. And trans fats. Many manufacturers have removed these bad fats from processed foods. But beware, although a label says zero --
UNIDENTIFIED FEMALE: By law, it could contain a half a gram of trans fat and still claim zero on the label per serving.
GUPTA: And that can cause trouble if you eat multiple servings. You want to look for the words in the ingredients "partially hydrogenated oil". That's a major source of trans fats and steer clear of those items.
Next, the term light, whether L-I-T-E or spelled the right way. It means the same thing. Less calorie, fat, or sodium than the original version of the brand, but --
UNIDENTIFIED FEMALE: Just because a label says light does not mean it is a license to eat more of that food.
GUPTA: And here's one I always get questions about -- organic. You know, with fruits and vegetables, it can reduce your exposure to pesticides, but just because the label says organic doesn't mean it's good for you.
Another slice of that organic chocolate cake, anyone?
GUPTA: One of the best parts of my job is being part of the Fit Nation Triathlon Challenge. We help regular viewers train for and race a triathlon.
Now, I never thought that I could do it myself. And now, I'm a triathlete. The road is tough but everyone who's ever joined us has completed this. Something they thought impossible.
GUPTA (voice-over): Hundreds of viewers sent in videos to our iReport site. But in the end, only six were chosen.
(on camera): I watched your video and I want to he officially welcome you to our 2014 Fit Nation triathlon team.
UNIDENTIFIED FEMALE: Oh, my God! Are you serious?
GUPTA: Nearly everyone on our 2014 team has been through a major health crisis.
KAREN MANNS, FIT NATION PARTICIPANT: I received my second hip replacement.
JAMIL NATHOO, FIT NATION PARTICIPANT: I was diagnosed with stage three testicular cancer.
MIKE WILBER, FIT NATION PARTICIPANT: I had a stroke. I had a hole in my heart and the clot passed through, went up to my brain.
GUPTA: For others, the pain was emotional.
CONNIE SIEVERS, FIT NATION PARTICIPANT: When my daughter when she turned 3 was diagnosed with leukemia. At age 5, she relapsed, and then at age 6 she passed away following a bone marrow transplant.
GUPTA: The tragedy sent Connie into a tailspin. She gained 60 pounds.
Ron Cothran had gastric bypass surgery but it wasn't enough.
RON COTHRAN, FIT NATION PARTICIPANT: I always wanted to live the second half of my life better than my first. I vowed that to myself.
SIA FIGIEL, FIT NATION PARTICIPANT: Sixteen months ago, I decided on a beach that enough is enough.
GUPTA: I call it hitting the reset button. Just take a look at me several years ago. I didn't look good. I weighed too much. Fit Nation changed my life. (on camera): It all starts up here. I'm going to show you how to do it. Whether you just want to get in better shape or you want to inspire a nation.
NATHOO: You can be fit again. You can be healthy again. Cancer is not the end.
GUPTA (voice-over): The last word goes to Coach Wilbs.
WILBER: I'm afraid that my weight situation right now, I'm not going to be around much longer unless I make a change.
GUPTA: And over the next several months we're going to help him make that change and share some lessons with all of you to get anyone more fit, whether you're training for a triathlon or just training for life.
Now we weren't going to say a word about this story, I got to tell you, but I did realize there is a lesson you could actually learn from the arrest of Justin Bieber. I'll have that for you next.
GUPTA: All right. Here it is. Pop star Justin Bieber was taken into custody early Thursday morning in Miami. He told the arresting officer that he had beer, pot and prescription drugs in his system. That's a quote.
Now, the type of prescription drug does matter, but if it's something like a painkiller or a sedative, it could spell a whole lot of trouble and that's why we want to talk about it. What this is is stacking. Alcohol in particular and certain prescription drugs can separately slow down your breathing, your heart rate, your blood pressure. Basically, the central nervous system reflexes.
But when taken together, these substances, they tend to amplify one another. That's why it is called stacking. The end result: the person stops breathing. A better way to describe it, they lose their drive to breathe. While awake they may be OK but when they go to sleep, they may never wake up.
What I just describe happens every 19 minutes in this country. Forget about Bieber. But remember, this is a lesson for all of you. Don't do this. It will help you chase life.
That's going to wrap things up for SGMD. But stay connected with me at CNN.com/Sanjay. Let's keep the conversation going on Twitter @DrSanjayGupta.
"NEW DAY SUNDAY" continues right now with Christi Paul and Victor Blackwell.