Like Terri Schiavo, Maria is still fed with a gastric tube.
Unlike Terri, Maria has been allowed to receive rehabilitation therapy, and today she talks, laughs, keeps a journal and goes to school:
11/03/03 - Posted 12:21:28 AM from the Daily Record newsroom
 Maria Tetto who emerged from a coma after an accident six years ago, shares a laugh with her father, Frank. Tyson Trish / Daily Record |
Decisions of a lifetime
By Abbott Koloff, Daily Record
They talked to their daughter constantly, promising that if she came out of a coma they would allow her to get her ears pierced. They had argued about that before the accident. Now, they just wanted to make their daughter laugh.
Then, one day, three months after the accident, Frank Tetto playfully hit his wife, Alycea, over the head with a pillow.
Their daughter Maria, now 18, smiled.
Frank Tetto said doctors didn't believe at first that his daughter really smiled. The Tettos held their daughter's hand and she squeezed back. Doctors said that was a reflex rather than a sign of conscious behavior, said the Tettos, who live in Mount Olive.
"It wasn't just a personal goal to get her to smile," Frank Tetto said this past week. "It was to get her to smile and to have people witness it."
Eventually, Tetto said, they did, and doctors acknowledged their daughter had made some progress. Then hospital officials said that progress wasn't enough to keep her in the hospital, according to Tetto, and there was not much more they could do. He said an insurance company refused to pay for rehabilitative therapy, saying his daughter needed custodial care instead.
In one way, the Tettos' case is similar to one now going on in Florida, where a family has been divided over what to do about a woman, Terri Schiavo, who has been in a coma for 13 years. The Tettos said they had to convince doctors and insurance companies that their daughter would benefit from various kinds of therapy and come all the way out of a coma, and one day talk to them.
In Florida, a husband fought to have his wife's feeding tube removed against her parents' wishes. The courts ruled in his favor because the woman once said she'd rather die than be kept alive this way.
The Florida Legislature passed a law that allowed Gov. Jeb Bush to sign an executive order putting back the feeding tube. The parents have been saying that their daughter responds to them. Doctors appointed by the court say the woman is making reflexive responses.
The Tettos did not have to make a life or death decision about their daughter, who had run into a truck while in-line skating across Route 46 in 1998. Soon afterward, doctors performed a test to determine whether Maria Tetto was brain dead, and her father thought about what he would do if they came back with bad news.
"I would have wanted to give it six more months, at least," Frank Tetto said.
"I just would have needed the time. I would have thought that removing her respirator at that point was premature."
But doctors found brain activity, so the Tettos said there was no decision to make.
Maria Tetto now gets around in a motorized wheelchair. She speaks well enough to be understood. She tells jokes and laughs. She attends special-education classes at Mount Olive Middle School. She writes a daily journal in a computer so she will remember what happened to her the day before. She doesn't remember the accident, but she does know that it happened on March 2, 1998. She also knows she was in a coma.
"I was absent," she said.
[snip} Making a choice
Frank Tetto says he understands why Schiavo's parents have fought to keep her alive. He says he knows what it's like to hope for miracles. He describes a constant battle with Prudential, an insurance company since bought out by Aetna, to provide treatment for his daughter. Prudential, he said, responded that his daughter was beyond rehabilitation.
"Their argument was that her care was custodial," Frank Tetto said.
Prudential, in a 1999 statement issued to the media, said it paid all claims covered by the Tettos' policy. But in 1998, the debate was not about what was covered. It was about what kind of treatment Maria Tetto should receive.
The insurance company told the Tettos in an April 1998 letter, five weeks after the accident, that their daughter did not need rehabilitative therapy. It said her treatment would be custodial, and that wasn't covered. Doctors at Specialized Children's Hospital in Mountainside, where Maria Tetto was taken after a month at Morristown Memorial, responded in a June 24 letter to Prudential that she should get therapy.
"To determine after five weeks that a child's needs are custodial contraindicates all research and experience," K. Yalamanchi, the attending physician, said in the letter.
The doctor went on to say that patients with similar injuries continue to improve for a year.
Appeal after appeal
Maria Tetto was described in medical records as being in a coma in April 1998, when she made only nonspecific responses to various kinds of stimulation. Two months later, the Tettos say she smiled for the first time. Doctors eventually agreed that Maria Tetto had made some progress, Frank Tetto said, but at some point hospital officials told him that she was not going to get much more benefit from therapy. They told the Tettos, in a letter, that their daughter was going to be discharged Aug. 21, 1998.
"I went ballistic," Tetto said.
He filed one appeal, and then another, delaying the discharge for months. He said some doctors and nurses at the hospital encouraged him to keep fighting.
Meanwhile, according to letters from the insurance company, Prudential agreed to pay for a portion of Maria Tetto's hospital stay, which it previously said would not be covered. A spokeswoman for Children's Specialized Hospital said last week that the case records were not available, and officials could not comment on it.
When Maria Tetto was released in December 1998, she still could not talk, according to her father, but she was able to follow directions. She could turn her head when asked. She was sent to a residential school and hospital, coming home on weekends. She gradually became more responsive and now lives at home. She says that her first words were similar to what she might have said as a baby: "Mama and papa."
The Tettos say they have no more problems with insurance. They say perhaps it's because they spent so much time fighting, threatening to go to the media, filing appeal after appeal, until they eventually were given much of what they say they needed.
"I think they red-flagged our file," Alycea Tetto said.
Therapy and drugs
So the Tettos say they have been able to try various types of therapy. They have been able to try drugs that they say have helped unclench their daughter's right hand, so that she can use it for writing. They have tried a special mechanism that blows air into their daughter's mouth that they say helps her to speak more clearly.
They said insurance paid for Maria Tetto's $25,000 motorized wheelchair, which can extend to put her in a standing position. Her leg muscles are fine, her parents said, and she has feeling in her legs, but is unable to stay balanced. She has trouble swallowing fluids, so she still has a feeding tube attached to her stomach. She has no short-term memory.
"She will forget you were here by tomorrow," Frank Tetto said to a visitor.
That's why Maria Tetto writes in her journal. She said that she wants to remember little things that happen to her during the day. She writes about things any teenager might be concerned about -- how people loved her new hairstyle, an orthodontist's appointment, hitting a gym teacher accidentally with a basketball. She had been in the school choir before the accident and still loves to sing. One day, not long ago, she said she sang "Silent Night" in front of her classmates.
"Want to hear?" she asked.
She sang it without missing a word. Then she turned her head to show off her earrings.
Abbott Koloff can be reached at akoloff@gannett.com or (973) 989-0652.
published in The Daily Record (Parsippany, NJ)