Nailah Winkfield, mother of Jahi McMath, cries before a courtroom hearing in Oakland, Calif., in 2013. (Ben Margot/AP)

Shortly after waking up from her tonsil-removal surgery, Jahi McMath started coughing up blood. This was normal, the nurses in Children’s Hospital Oakland told the 13-year-old girl’s worried mother, showing her how to suction blood from her daughter’s mouth.

Three hours later, at about 10 p.m., the blood filled a bucket. It covered Jahi’s clothes and bedsheets, her family recounted in a lawsuit. Despite repeated calls from her family for a doctor, a physician did not arrive until 12:30 a.m., when Jahi’s grandmother — a nurse — noticed her oxygen-saturation levels drop. At her bedside, Jahi’s family heard the doctor curse. “Her heart stopped.”

Two days later, on Dec. 12, 2013, two hospital tests showed that Jahi was brain dead. Doctors urged her family to take her off life support and donate her organs. A coroner in California issued her death certificate the following month. Legally and medically, Jahi was dead.

But connected to a ventilator, Jahi’s lungs continued breathing, and her heart continued beating. To her Christian family, Jahi was still very much alive.

Their case became the center of a national debate over the boundary between life and death that pitted the medical world against the religious. It also thrust the family into a lengthy battle to keep Jahi breathing, one that would force them to move Jahi to a state that could accommodate her, New Jersey.

More than four years later, Jahi has now died, her family’s lawyer announced Thursday in a statement to The Washington Post.

She died on June 22 in the New Jersey hospital alongside her mother, Nailah Winkfield, and her stepfather, Marvin. On a death certificate, a doctor in the New Jersey hospital listed Jahi’s preliminary cause of death as bleeding as a result of liver failure, the family’s lawyer, Chris Dolan, said.

After years of unsuccessfully fighting to bring Jahi back to her home state, the family plans to return her to California to be buried near her relatives, Dolan said.

Nailah Winkfield said in a statement she is “devastated by the loss of her daughter who had showed tremendous strength and courage.”

“Jahi has forced the world to rethink the issue of brain death,” Winkfield said. “My every day was focused and revolved around Jahi. I loved seeing her every morning and kissing her goodnight every night. The hole in my heart left by her passing is huge.”

A judge last year refused to throw out a medical malpractice lawsuit against the hospital, ruling that a jury must determine whether the girl was still alive. Now that Jahi has died, Dolan said the family plans to move forward with a wrongful-death suit against the hospital, along with a federal civil rights case to reverse her initial death certificate.

For the past four years, Jahi suffered an “anoxic brain injury” resulting from the severe blood loss after her surgery, in which doctors removed her tonsils, adenoids and soft palate to address the girl’s sleep apnea, Dolan said.

In the medical malpractice lawsuit filed against Jahi’s Oakland hospital and surgeon, the family said doctors failed to note an “anatomical anomaly” in Jahi that posed an increased risk of hemorrhaging. Jahi’s mother accused the hospital’s staff of failing to summon a doctor when her daughter, who was African American, desperately needed medical attention.

“No one was listening to us,” Winkfield recounted to the New Yorker in an article published earlier this year. “I can’t prove it, but I really feel in my heart: if Jahi was a little white girl, I feel we would have gotten a little more help and attention.”

In the days after the surgery, Jahi’s uncle slept in a chair at his niece’s bedside, to ensure no one at the hospital could “kill her off,” he told the New Yorker. In their lawsuit, Jahi’s family accused the Oakland hospital’s senior vice president and chief medical officer of, at one point, slamming his fist on a table saying, “What is it you don’t understand? She is dead, dead, dead.” (He partially disputed this account to the New Yorker.)

Oakland church leaders rallied support for the family. When the county called an outside expert to review the doctors’ conclusion, more than 200 people marched outside the hospital calling for justice for Jahi, the New Yorker recounted. The independent neurologist upheld the finding that Jahi was brain dead.

The family’s original lawsuit against the hospital said their religious beliefs called for “providing all treatment, care and nutrition to a body that is living, treating it with respect and seeking to encourage its healing.”

The Oakland hospital hired a spokesman, Sam Singer, to address the media amid national news coverage of the ordeal. Singer accused the family’s lawyer of creating a “hoax” that Jahi was “in some way alive. She’s not,” the New Yorker reported.

In her statement to the media on Thursday, Jahi’s mother pushed back against the spokesman’s claims that the lawyer was taking advantage of the situation.

“Saying I have been exploited is saying I didn’t understand what was happening with my daughter and I can’t make decisions for myself,” Winkfield said. “This is a racist narrative that he started and continues. I’m not stupid, I was right.”

Eventually, the family and Children’s Hospital Oakland reached a settlement that released Jahi, still connected to her ventilator. With the help of donation money, Jahi’s mother airlifted her to New Jersey, which allows families to reject brain death based on their religious beliefs. Winkfield has lived with her daughter in New Jersey ever since, quitting her job with Home Depot and selling her house in Oakland to pay for her daughter’s care, she told the Associated Press.

On Thursday, Singer told the San Francisco Chronicle that he was relieved to see Jahi “finally” rest in peace.

“Her case created a national debate over something that unfortunately people don’t understand,” Singer said. “And it’s very simple: Dead is dead. You don’t come back from it.”

Doctors have discussed Jahi’s case at length in symposiums and medical journals, with many neurologists agreeing with the hospital’s original conclusions that Jahi was brain dead. But one neurologist, Alan Shewmon of UCLA, decided otherwise, as the San Jose Mercury News reported. He reviewed dozens of videos recorded by Jahi’s relatives of the girl moving in response to commands, and concluded that she was not in fact brain dead.

Jahi’s case “defied all predictions of what must happen to dead bodies maintained indefinitely on ventilators,” Shewmon said in his report in court documents. “Jahi McMath is a living, severely disabled young lady, who currently fulfills neither the standard diagnostic guidelines for brain death nor California’s statutory definition of death.”

Over the last four years, her mother wrote on Thursday, “Jahi hasn’t struggled.”

“She could hear me and respond to my voice using her fingers to signal yes or no,” she said. “I knew when she had good days, bad days, if she was feeling pain, everything.”

But after Jahi recently “got sick,” her family brought her into the hospital for an exploratory surgery, her mother said. “She had some bleeding that they could not locate. So, another surgery was planned. . . . It was only at that time that I ever felt Jahi slipping away.”

“My daughter died on June 22nd, 2018, not December 12, 2013,” her mother said in the statement. “Jahi McMath was not brain dead or any other kind of dead. She was a little girl who deserved to be cared for and protected not called a dead body.”

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