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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: antceecee

I think that there is confusion over the "cause of death" and the "manner of death". Cause of death is just that - what caused it - heart attack, gunshot wound, multiple organ failure, head trauma, whatever. "Manner of Death" is natural, accidental, suicide, homicide, or in this case, undetermined.


141 posted on 06/15/2005 3:13:12 PM PDT by .38sw
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To: Smartaleck
What would you prefer he say?

How about "she died." Why the need to make death peaceful and pretty? He also noted she was surrounded her stuffed animals. Her parents and siblings were kept away, but thankfully, they let her have her teddy bear nearby...

142 posted on 06/15/2005 3:14:49 PM PDT by veronica (Mimes and clowns are weird...)
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To: antceecee

"Trying to find the link to the report, but I was under the impression from my reading that cause of death was left "undetermined"."

That was a reporters wording who probably hadn't read the report to be found here:
http://abstractappeal.com/schiavo/autopsyreport.pdf


143 posted on 06/15/2005 3:21:08 PM PDT by Smartaleck
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To: antceecee

allegedly the report can be found here -

http://abstractappeal.com/schiavo/autopsyreport.pdf

- but you know it's the Most Sought Site In Cyberspace right now and i haven't gotten through to be able to see it yet.


144 posted on 06/15/2005 3:21:25 PM PDT by DCDOGG
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To: .38sw

Thank you.
Trying to find the link to the report. I am sorry but I have been trying to keep up with these threads while trying to get some work done.
I recall (I hope correctly) that the 'report' did not list dehydration as cause of death. My earlier statement is questioning why they would not just say she died of dehydration? Seems simple enough to come to that conclusion. Prior to the removal of her feeding tube she was alive, after removal she died. Feeding tube gave her hydration and nutrition. Cause of death: Lack of hydration/nutrition. Simple.
Whatever happened to Terri years ago to disable her did not cause her death.


145 posted on 06/15/2005 3:21:46 PM PDT by antceecee
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To: blueblazes
Personally I would have liked to see several people at the autopsy - the ME, the Schindler's expert, and another disinterested party who could have been objective. That would have been the best and most logical (and kindest to the Schindlers) approach.

I notice you left out wanting to have a Michael Shiavo expert at the autopsy. So much for balance.
146 posted on 06/15/2005 3:23:07 PM PDT by drjimmy
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To: bjs1779; cyncooper

"I was just wondering if the news conference was the source of confusion on the cause of death issue."

Most likely by this reporter and article posted on FR.

Terri Schiavo Autopsy: Manner of Death 'Undetermined'
By Jeff Johnson
CNSNews.com Senior Staff Writer
June 15, 2005
http://www.cnsnews.com//ViewNation.asp?Page=/Nation/archive/200506/NAT20050615d.html


147 posted on 06/15/2005 3:24:14 PM PDT by Smartaleck
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To: Sioux-san
Michael is a huge guy -- all he needed to do was put his forearm across her throat and push until she couldn't breathe any more. No finger prints, no bruises.

If you are going to publicly accuse someone of murder, you should publicly do so, and not make your accusations anonymously.

148 posted on 06/15/2005 3:28:35 PM PDT by Mark was here (My tag line was about to be censored.)
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To: veronica

"How about "she died.""

Sounds rather cold, stark and ghoulish devoid of any feelings. That wouldn't only invite a different form of criticism.


149 posted on 06/15/2005 3:31:03 PM PDT by Smartaleck
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To: DCDOGG; .38sw

Thanks.
Cause of death: Complications of Anoxic Encephalopathy
Manner of death: Undetermined

Why couldn't they state manner of death: Court ordered removal of feeding tube?
Is that or is it not the manner of death????

Just find it a bit disingenuous to implement an act of euthanasia and not list it on the death certificate as being a manner of death.


150 posted on 06/15/2005 3:31:32 PM PDT by antceecee
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To: All
I posted this question twice on another thread, and no one has replied. I'll try again here.

Who picked the doctor? Was it a court appointed doctor?

151 posted on 06/15/2005 3:32:20 PM PDT by incindiary
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To: fooman

Until we see x-rays on the internet?


152 posted on 06/15/2005 3:33:31 PM PDT by lugsoul
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To: veronica

Not unless she had surgery first to remove the brain implant.


153 posted on 06/15/2005 3:35:37 PM PDT by lugsoul
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To: incindiary
Who picked the doctor? Was it a court appointed doctor?

You mean the doctor who did the autopsy?

Thogmartin is the Pinellas County Medical Examiner. He does all autopsies in that county.

154 posted on 06/15/2005 3:36:44 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: Smartaleck; bjs1779

I had not seen that and I'm sure you're right about it being the source of confusion. Thanks for the link and explanation.


155 posted on 06/15/2005 3:40:22 PM PDT by cyncooper
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To: blueblazes
"What matters is that the precedent for corruption and incompetence exists in Pinellas County right there in the ME's office... "

And there is a precedence for the President to boff the interns in the Oval Office, are you saying this is still going on?

Of course, now it all makes since, this is why Bush had the Twin Towers blown up, he was trying to distract people from finding out what he was doing with his Cuban cigars. /Major Sarcasm
156 posted on 06/15/2005 3:41:41 PM PDT by sammycook
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To: mware
By the way has the judge held Michael in contempt for failing to tell the parents where she is buried yet???

Has there been a court filing or are we now expecting the judge to rule based on media reports?

Perhaps her parents would complain to the court if they feel this needs addressing.

157 posted on 06/15/2005 3:48:45 PM PDT by cyncooper
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To: An American In Dairyland
Smothering is one possibility. Poisoning by plants called cardiac glycosides is another. Included are oleander, foxglove, and lily of the valley. When ingested they cause potassium levels to drop and "Various dysrhythmias may alternate or progress rapidly into life-threatening rhythms, such as ventricular tachycardia." For more info, see here. The ME hasn't been able to say what caused the collapse of an otherwise healthy young woman, but I wonder if he has any hunches he can't include in an official report.
158 posted on 06/15/2005 3:53:07 PM PDT by Sabatier
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To: antceecee

"Manner of death: Undetermined
Why couldn't they state manner of death: Court ordered removal of feeding tube?
Is that or is it not the manner of death????"

pg 35 of the autopsy report.

7. By what mechanism did Theresa Schiavo die?/
Postmortum findings...testing show that she died of maked dehydration.

Not sure what you seem to be missing?


159 posted on 06/15/2005 3:54:40 PM PDT by Smartaleck
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To: Smartaleck
Thanks Smartaleck.
160 posted on 06/15/2005 4:20:37 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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