Payton Summons "passed naturally" after her heart stopped beating on its own Friday around 8:30 p.m., while she was still on the ventilator that had become the crux of a legal battle between her parents and a Texas hospital, her family's attorney said.
"The family is saddened by her loss but are glad she passed naturally," Justin Moore told CNN on Saturday.
The 9-year-old girl, who had been declared brain-dead, was at the center of an ongoing court dispute between a Fort Worth hospital, which wanted to remove her from the ventilator, and her parents, who wanted to keep her on the machine.
A judge this week ruled in favor of her parents' request to have a temporary restraining order against the hospital extended.
Payton was not removed from the ventilator, Moore said.
Payton had been on mechanical ventilation at Cook Children's Medical Center since late September, following an overnight stay with her grandmother during which she suddenly awoke, "screamed for her grandmother to help her and said that she couldn't breathe ... then she collapsed," Payton's mother, Tiffany Hofstetter, told CNN affiliate KTVT that month.
Payton was taken to the hospital, where doctors established a heartbeat, then put her on a ventilator because she was no longer breathing. The hospital established that Payton had suffered cardiac arrest caused by the growth of a very large tumor in her chest that shut off her circulatory system.
A test showed Payton no longer had brain activity, leading her doctors to declare brain death.
"When Payton Summons suffered brain death on September 25, she was determined to be dead under clear Texas law and the laws of every other state," the hospital told CNN Wednesday in a statement.
"Brain death, by definition, is irreversible," CNN Chief Medical Correspondent Dr. Sanjay Gupta has said. "In the United States and most places, it is legally synonymous with death -- the same as if your heart stops. ... But brain death means a total loss of brain activity."
In Payton's case, the hospital said that "per our protocol and national pediatric medical standards, a second brain death exam was scheduled to take place by a different physician within 12 hours of the first to complete the legal process of declaring Payton deceased," according to a separate statement released in September, KTVT reported.
However, the hospital held off on the second exam when Payton's family requested a temporary restraining order against the facility. The family wanted to keep Payton on the ventilator until they could find another hospital that would take their daughter.
The order was granted, then on Monday extended through October 22.
The day after that approval, the hospital asked the court to vacate the order.
"The judge's decision has put all of us in an incredibly difficult position. As a hospital made up of women and men who made it their careers to save lives, we are truly devastated for this family," said the Wednesday statement from Cook Children's.
"There is no treatment that can be provided for her at Cook Children's or any other facility that will change that. To maintain a dead person on mechanical ventilation and insist -- in fact order -- that health care providers continue treating a deceased, deteriorating body is medically, ethically, and morally wrong. We will continue to support this family during this difficult time," the statement said.
Moore on Tuesday called the hospital's latest challenge "legal wrangling."
"The hospital is reverting to legal wrangling for an attempt at preventing Payton's parents from looking for facilities to accept their baby girl," he wrote.
A judge on Friday ruled that the extended temporary restraining order would stay in effect through Monday, Moore tweeted.