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."
I didn't see you referring to anything. You posted an article and that's what I was making a comment on.
Note my reply goes to post #1, not to any other commentary you or others might have made that I haven't even read yet.
He did find that she died from dehydration (but not starvation).
Why do you say he didn't?
What he could not deduce conclusively was what caused her collapse years ago.
I heard that Mark Furman is doing a book on this case.
He may be able to answer some of the questions most of us have about the circumstances surrounding the collapse and eventual death of this young woman.
I hope he sticks to the projects and comes out with a lucid discussion of the issues and events that have caused this confusion about what the facts actually are.
If he publishes it, I'll buy it.
There is a common thread here "Schiavo-ites"...notice that most, actually almost all are new to FR with in the last 5 months, about the time this all came to a head.
Tell ya' what...lets get back to demonizing democrats and Dickweed Dean.
From a thread I was on, I think he said cause of death could not be determined during the news conference. I didn't get to watch it. Is that true Antceecee?
"Look. For the last time. IT DOESN"T MATTER what the ME says."
Thanks. This speaks volumes.
Re-read my post you're replying to. I am accurately reporting that he found she died from dehydration, not starvation. He could not, however, determine what caused her to collapse years ago.
"I have personally witnessed the deaths of several people in the last few years. There was nothing peaceful about it. It's strange to sugar coat it, but what do you expect from Felos the deathman, the ghoul."
What would you prefer he say?
It took me a while, but I have now waded through the whole of the report. The Pinellas County ME left no possible stone unturned, and was assisted in his efforts my various MDs and labs. So there, in my mind at least, is no way there is a 'fix' in this at all. The ME did what the state paid him to do, examine the body of Terri Schiavo dispassionately and objectively, and present his findings. He has done so.
The problem is despite his and others best efforts, no cause for her initial collapse where discovered. The low potassium results where possibly/probably explained on pages 29 and 30 of the report (low due to treatment of the cardiac arrest suffered that night). No sign of trauma or adverse medication were found either, so we have a big fat question mark. It will hang in the air in perpetuity, interpreted in any manner the beholder wants. Insert vile four letter expletive here.
Dr Nelson, the MD who examined the brain of Terri, stated in his conclusion that he could not make a definitive diagnoses of PVS, as that is not possible on a deceased patient. But she had lost an alarming amount of brain matter, far more than could be accounted for by dehydration alone. Some areas of the brain had ceased to exist almost entirely, with scant traces of neurons found. The chances of her not being in a PVS... pretty slim, though not entirely ruled out.
The conclusion: None. We didn't know then, we don't know now. Something caused her to collapse that night, but lack of evidence leaves all manner of speculation open. Was she in a PVS? Probably. I'll even go so far to say likely, but we will never truly know. So the debate over her death will rage on, without any conclusion possible.
Insert another vile four letter expletive here.
"He did find that she died from dehydration (but not starvation).
Why do you say he didn't?"
You cheated and read the actual report! LOL
Pesky facts, doncha know.
;)
WOnder how many times you will have to repeat that fact........... :)
Of course the answer is he did address this charge. From the article this thread is based on:
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."
~snip~
Trying to find the link to the report, but I was under the impression from my reading that cause of death was left "undetermined".
Does someone have a link?
I think the dehydration was noted/observed in the report, but do not recall it being listed as manner of death or cause of death.
I know. I was just wondering if the news conference was the source of confusion on the cause of death issue.
"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."
Could be, but nobody has said he wanted to "almost" kill her so she'd be PVS for 15 years, and THEN kill her, which is what you suggested.
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