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Terri Schiavo Autopsy: Manner of Death 'Undetermined'
CNSNews.com ^ | June 15, 2005 | Jeff Johnson

Posted on 06/15/2005 12:27:19 PM PDT by veronica

(1st Add: Includes comments from George Felos, Michael Schiavo's attorney.)

(CNSNews.com) - Terri Schiavo's body did not show any signs of trauma or other criminal activity that would explain her brain injury, nor was there evidence to support previous diagnoses of a heart attack or an eating disorder, the Florida medical examiner who conducted her autopsy said Wednesday. A representative of Terri's family complimented the report, but said it still leaves many questions unanswered.

"She died of dehydration," Dr. Jon Thogmartin, the Florida medical examiner for Pinellas and Pasco counties said, noting that the official cause of death would be listed as "complications of anoxic encephalopathy."

"That's the only diagnosis that I know for sure, is that her brain went without oxygen," he added. "Why? That is undetermined."

George Felos - attorney for Terri's husband, Michael Schiavo - said the report confirms what he has argued all along.

"The courts have found that there was no abuse of Terri, no evidence of abuse, and that's what the medical examiner found," Felos said.

Terri Schiavo collapsed under unknown circumstances in 1990. Michael Schiavo was awarded nearly $2 million in judgments and settlements in a medical malpractice lawsuit claiming that the collapse was caused by a heart attack triggered by a potassium imbalance, caused by an undiagnosed eating disorder, bulimia nervosa. Thogmartin challenged that determination.

"No one observed Mrs. Schiavo taking diet pills, binging and purging or consuming laxatives and she apparently never confessed to her family or friends about having an eating disorder," Thogmartin found. "Furthermore, many other signs of bulimia nervosa were not reported to be present."

Terri was "heavy" as a teenager, according to Thogmartin, and had lost more than 100 pounds after graduation. The eating disorder diagnosis was based on that fact and a low potassium level measured during a blood test about an hour after Terri was first hospitalized.

"Her low potassium level appears to be the main piece of evidence purporting to show that she had an eating disorder," Thogmartin said. But he noted that she received numerous medical treatments when she arrived at the hospital that would have lowered that measurement.

"Thus the main piece of evidence supporting the diagnosis of bulimia nervosa is suspect," he concluded.

"Once you eliminate the potassium problem, which is known in bulimics, you end up with a 26-year-old who used to be healthy, who now lost the weight, is reveling in her thinness now, enjoying her life and doesn't want to gain the weight back," Thogmartin said. "If that's a bulimic, there's a lot of bulimics out there. It's just not enough."

Thogmartin said that because he cannot, "with reasonable medical certainty," ascertain why or how the blood and oxygen to Terri's brain were interrupted, he cannot rule on what started the chain of events that led to her death.

"The manner of death is different from the cause of death. Manner of death is the circumstances of death or how the death came about," Thogmartin said. "Since I don't know the circumstances or can't tell, actually, what the underlying cause is, the manner of death has to be 'undetermined.'"

Other allegations and theories addressed

Thogmartin dismissed the theory that the oxygen depravation to Terri's brain might have been the result of a myocardial infarction, the medical term for a "heart attack," or death of heart muscle from coronary artery disease.

"Mrs. Schiavo's heart was anatomically normal without any areas of recent or remote infarction," he explained.

In response to the allegations that Terri's collapse was the result of a physical assault, Thogmartin noted that she received nearly 30 X-rays, CAT scans and ultrasound examinations during the medical examination that followed her collapse.

"Any fractures - including rib fractures, leg fractures, ankle fractures, skull fractures, spine fractures - that occurred concurrent with her initial collapse would almost certainly have been diagnosed in 1990, especially with the number of physical exams, radiographs and other evaluations she received during her initial hospitalization," Thogmartin said. "No fractures or trauma were reported or recorded."

There was also, Thogmartin said, "no evidence to support or the evidence did not support," various allegations that Terri was abused or neglected after her initial brain injury.

Was Terri in a Persistent Vegetative State?

Thogmartin brought in Dr. Stephen Nelson, an expert in pathology of the brain and central nervous system, as a consultant during the autopsy. Nelson stressed numerous times that the diagnosis of a "Persistent Vegetative State," which was used to justify the removal of the feeding tube that kept Terri alive, "is a clinical diagnosis, it's not a pathologic diagnosis that has precision associated with it." But he did not dispute the finding.

"There is nothing in her autopsy report, in her autopsy that is inconsistent with Persistent Vegetative State," Nelson said, adding that there was evidence to support the finding.

"A normal brain weight for somebody who is approximately 41 years of age ought to be somewhere in the neighborhood of 1,200 to 1,300 grams," Nelson explained. "Her brain is 615 grams and is largely reduced to what is termed granular atrophy ... associated with the loss of blood flow that happened many years prior.

"Those all are consistent with what is reported in the literature for Persistent Vegetative State," Nelson added. "We found nothing that is contrary to what has previously been reported for Persistent Vegetative State."

Nelson compared the physical condition of Terri's brain to that of Karen Ann Quinlan, the New Jersey woman who died in 1985 -- nine years after her parents won a court battle to remove her from a respirator.

"Her brain, Karen Ann Quinlan's, weighed more than Terri Schiavo's brain weighed," Nelson said. "The findings here are, perhaps, worse, even, than Karen Ann Quinlan."

Thogmartin also concluded that Terri's brain injury was irreversible.

"Her brain was profoundly atrophied," the medical examiner concluded. "This damage was irreversible and no amount of therapy or treatment would have regenerated the massive loss of neurons."

Michael Schiavo relied on the diagnosis of a Persistent Vegetative State when he sought permission from the Florida courts to remove Terri's feeding tube. He and two of his relatives testified that Terri had said she would not want to be kept alive in such a condition. Thogmartin discussed the contention by many right-to-life advocates that Terri's family should have been allowed to offer her food and water by mouth after that feeding tube was removed.

"She would not have been able to consume sustenance safely or in sufficient quantity by mouth," Thogmartin said. "Mrs. Schiavo was dependent, therefore, on nutrition and hydration by her feeding tube and removal of her feeding tube would have resulted in her death whether she was fed by mouth or not."

In layman's terms

After a technical explanation of his findings, laden with medical language, Thogmartin was asked to summarize his findings in an exchange with one unidentified reporter:

REPORTER: "In layman's terms, did Terri Schiavo starve to death?"

THOGMARTIN: "No."

REPORTER: "Did she suffer any neglect or abuse?"

THOGMARTIN: "No."

REPORTER: "Will we ever know what caused her death?"

THOGMARTIN: "I don't know."

Pamela Hennessy, spokeswoman for the Terri Schindler Schiavo Foundation and Terri's parents, Bob and Mary Schindler, complimented Thogmartin on his report.

"However, it does seem that the conclusions of his report leave as many unanswered questions as there were previously," Hennessy said. "For instance, if Terri did not suffer bulimia and she had as healthy a heart as Dr. Thogmartin proclaimed, what caused her collapse?

"It doesn't really bring much in the way of closure to [the Schindlers] as far as what happened to their daughter, why this happened in the first place and what could have been done for her," Hennessy concluded.

Thogmartin said he is open to answering those questions.

"It is the policy of this office that no case is ever closed, and that all determinations are to be reconsidered upon receipt of credible new information," he explained.

"In addition to fading memories, the 15-year survival of Mrs. Schiavo after her collapse resulted in the creation of a voluminous number of documents, many of which were lost or discarded over those years," he continued. "Receipt of additional credible information that clarifies any outstanding issues may, or shall cause an amendment to her cause and manner of death."


TOPICS: Extended News; News/Current Events
KEYWORDS: autopsy; facts; schiavo; schiavoautopsy; terrischiavo
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To: Anita1

So they were in a dentist's office at the same time? Good grief.

So then he hatched a plot to somehow deprive her brain of oxygen for some minutes, leaving her in a PVS for 15 years, and finally prevailed through the courts, just so that he could now marry her?

Delusional.


81 posted on 06/15/2005 1:57:33 PM PDT by self_evident (#47 and #60)
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To: the OlLine Rebel
Judge should have used *judgement* and erred on the caution and let the parents care for her.

Judges used their *judgement* instead of the law, in 1973. And look what that got us.
82 posted on 06/15/2005 1:59:58 PM PDT by self_evident (#47 and #60)
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To: mountaineer

Did she ever have a modern medical exam? What year?

Thank you. Nice try though!


83 posted on 06/15/2005 2:00:13 PM PDT by spycatcher
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To: veronica; 8mmMauser; floriduh voter; tutstar; Future Useless Eater; BykrBayb; Saundra Duffy; All
"A normal brain weight for somebody who is approximately 41 years of age ought to be somewhere in the neighborhood of 1,200 to 1,300 grams," Nelson explained. "Her brain is 615 grams and is largely reduced to what is termed granular atrophy ... associated with the loss of blood flow that happened many years prior.

I wish I knew a pathologist who could point to the effect of starvation and dehydration regarding brain weight. An independant pathologist who has no axe to grind, mind you. The other thread apparently is locked, and with good reason. Let's try and ignore the trolls.

84 posted on 06/15/2005 2:01:10 PM PDT by TheSpottedOwl (Free Mexico!)
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To: sinkspur

Leaving Michael Jackson aside for the moment, the problem with Pinellas County is that from my readings (which were pretty extensive when the whole Schiavo affair hit 2-3 months ago), it's a pretty corrupt place in general. Judge Greer apparently is a big real estate crook, the Sheriff's office seems extremely corrupt, the nursing home situation is corrupt - the whole county stinks. I wouldn't have any confidence in anything that came out of Pinellas County even ASIDE from the Schiavo case.

The ME's office has been corrupt in the past. My point with this is that many people might simply accept any findings BECAUSE an ME says so - well the preceding ME had to resign because of changing her findings under pressure. It's actually very relevant because if it happened once, obviously it can happen again. The only way to forestall even the appearance of impropriety was to try to include other parties in the autopsy, particularly those of the opposition side. It might not have resolved anything, but then again - neither did this.


85 posted on 06/15/2005 2:02:35 PM PDT by blueblazes
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To: mountaineer
She was examined many, many times by medical doctors while alive

The list of doctors that actually examined her is rather short. There were a few who were allowed to observe her but not truly examine.

There were 3 doctors for Schiavo, Bambadikis was one. Ronald Cranford and I can't remember the 3rd.

For the Schindlers was Maxwell and Hammesfahr.

For the State of Florida, just before her dehydration, was Dr Cheshire but he was only allowed to look, not touch her. On page 6, he calls it a 90 minute visit.

This list doesn't include the emergency room doctors etc.

86 posted on 06/15/2005 2:05:36 PM PDT by DJ MacWoW (If you think you know what's coming next....You don't know Jack.)
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To: the OlLine Rebel
You badmouth them all you want, but clearly Terri's parents and real family wanted to take care of her. And there's nothing wrong w/that.

It certainly would have been interesting if Terri's parents had taken custody and then she choked to death because they were trying to feed her. They did insist she could swallow, so it is quite possible that might have happened.

87 posted on 06/15/2005 2:05:47 PM PDT by bukkdems ("My aunt was very frugal" - Benon Savon)
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To: TheSpottedOwl

"I wish I knew a pathologist who could point to the effect of starvation and dehydration regarding brain weight. An independant pathologist who has no axe to grind, mind you."

With all due respect. The issue is not her brain's weight, per se, the issue is it's function or lack thereof.

Maybe it did weigh less due to dehydration, but I doubt HALF of what it did prior. It was not in a freeze dryer.


88 posted on 06/15/2005 2:06:15 PM PDT by Bones75
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To: mountaineer

"247 images according to the autopsy report.
I stand corrected."

More...pg 28 of the autopsy... 72 external photographs, 116 internal photographs, "A radiologic survey of her entire body...using a fluoroscopic c-arm (x-ray) with 58 pre-autopsy images captured."

I need to go back and look again, but it appears the nortorious "bone doc" made an assumption, one that turned out to be false and he relied on somebody elses "guess" and words rather than actual proof when he referred to the bone trauma. ;-)


89 posted on 06/15/2005 2:06:39 PM PDT by Smartaleck
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To: the OlLine Rebel
"What the heck was Terri doing if not eying the balloon as it crossed in front of her?"

Random auto response of the brain stem. The "seeming to see" the balloon was coincidental and not associated with a conscious action on her part and some have posited that the balloon was manipulated to follow her eyes not the other way around.
90 posted on 06/15/2005 2:10:38 PM PDT by Smartaleck
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Comment #91 Removed by Moderator

To: blueblazes

This autopsy resolved much, except in those with a conspiratorial mindset.


92 posted on 06/15/2005 2:10:55 PM PDT by sinkspur (If you want unconditional love with skin, and hair and a warm nose, get a shelter dog.)
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To: jess35
Her wishes were deemed more important than those of her parents.

Can't have that; it conflicts with the Culture of LifeTM. (rolls eyes)

93 posted on 06/15/2005 2:13:14 PM PDT by Kretek (WPPFF)
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Comment #94 Removed by Moderator

To: TheSpottedOwl

Two weeks without fluids will result in only the loss of a few grams of brain weight. No one loses half their brain mass in 2 weeks because of dehydration.


95 posted on 06/15/2005 2:17:43 PM PDT by Greenback_dollar
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To: Sioux-san

Actually it appears that the bone scan doc was confused or wreckless. Pg 28 of the autopsy report addresses this issue in some detail.

In short, the doc when with the "trauma" words used by someone else and derived from the request form not the the actual findings of the doc. Without slamming him, the coroner indicates the doc made observations without knowledge of the patient...implying he had an incomplete picture. She did indeed have the HO bone disease as suspected by her doctors and which gave rise to the bone scan.

Note too that they did a complete x-ray/bone-scan of the entire body before commencing the autopsy.



96 posted on 06/15/2005 2:18:52 PM PDT by Smartaleck
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To: sinkspur

That's simply not true, sinkspur, that's just your own bias talking. If it really had accomplished anything it would be convincing to people who sided with Terri's parents. At least some of what he's saying might have some weight if there were another independent doctor, or someone who had sided with the Schindlers, to back it up. As it is, it's simply another report from another Pinellas County official, it is an absolutely meaningless document. No one's mind has been changed, nothing has been resolved.


97 posted on 06/15/2005 2:21:02 PM PDT by blueblazes
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To: blueblazes; sinkspur
" I have no reason to believe this ME. He might be wrong on this case, he might be under pressure, maybe he has a particular bias - I don't know. "

But your reason for disbelieving him is based on the actions of another person ?

"What matters is that the precedent for corruption and incompetence exists in Pinellas County right there in the ME's office ..."

There is a precedent for incompetence in posting right here on FR, but I don't hold that against YOU.
98 posted on 06/15/2005 2:22:55 PM PDT by RS (Just because they are out to get him, it doesn't mean he's not guilty.)
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To: hondo
"She died of marked dehydration. She did not starve to death," Thogmartin said. As measured by the balance of salt and water in her body fluids, the dehydration was the most severe he had ever seen. This attested to Schiavo's robust underlying health, and in particular the strength of her heart, the pathologist said.

Dr. Gambone, Terri's former doctors who resigned in 2003, said she had an obvious will to live. I suppose that wouldn't show up in the autopsy either.

99 posted on 06/15/2005 2:26:15 PM PDT by bjs1779 ("I don’t want anyone trying to feed that GIRL" Greer thundered from the bench in 2001)
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To: hondo
THE DEHYDRATION WAS THE MOST SEVERE HE HAD EVER SEEN. MAY THOSE WHO WANTED TO SEE TERRI SCHIAVO DEAD GET ON THEIR KNEES AND THANK GOD FOR THE GIFT OF LIFE.

Didn't George Felos come from Terri's room when she was dying and tell the public how peaceful she was? Well, if the dehydration was the worst the doctor had ever seen; that tells me George Felos lied to the public. What else has he lied about?

I was impressed with the straight forwardness of Dr. Thogmartin, and I believe I understood him to say they were open to any new evidence or something akin to that. I thought he left the door open for more investigation. Ironically, I was listening to the news on the radio, and heard one of the MSM reporters say 'that the medical examiner found the husband could not have caused her condition,' I didn't hear the doctor say that....did I miss it or did they make it up?

100 posted on 06/15/2005 2:26:28 PM PDT by PeskyOne
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