Terri Schiavo Autopsy: Manner of Death 'Undetermined'

(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.'"

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.

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."

"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."

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:

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.

"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."

Obviously the Florida courts disagreed with you.

Obviously wrong, the 2DCA stated he was conflicted which is why the order to dehydrate TS to death came from the state. There's no debate here, that is what happened. If you deny it, you slip from spin to something a bit more pejorative.

Please do me the courtesy of not imputing beliefs to me. I think I have a little better idea of what I think than you do.

I'm not imputing anything, I'm taking you at your word. You have made it more than clear that you support the State ordered dehydration of TS, a severely disabled woman. Why deny it?

Slander and libel are torts, whether it comes from you or from someone like Hannity.

And truth is an absolute defense to either. Which is why you are in no position to sue anybody who claims you support the state ordered death by dehydration of severely disabled citizens like TS.

The difference between you and Hannity is that you are tiptoeing around the edges, posting anonymously, to a small audience, and you likely have little in the way of assets to make an action against you worthwhile. Hannity is a whole different ballgame.

I don't post anonymously. I post under my real name. I say what I mean and I stand behind what I say and if you think you can intimidate me into shutting up with your libel and slander bs you better think again pal.

But that doesn't mean that explicitly calling someone else a murderer is not libel. Slander and libel are NOT protected speech, and pointing it out when someone skirts either one is not "squelching debate".

Nobody slandered or libeled anybody, you used in an effort to squelch debate because you had nothing else left. It didn't and won't wok with me. Try somebody else.

Slander and libel laws are fascist? Who knew?

This is simply a strawman false assertion you conjured up because, well, you had nowhere else to go.

I could just as easily say that your throwing around terms like "fascist" is an attempt to "squelch debate".

You could but then you'd be lying.

Who made the decision to die? Terri? There is absolutely nothing but hearsay by a few

Judge Greer explicitly concluded that he could not rule on Terri Schiavo's intentions based solely on her husband's testimony. He ruled, instead, that Michael Schiavo's testimony was corroborated by multiple other witnesses whose statements were consistent and reliable. The testimony related to statement made by Terri Schiavo to members of her family after the funeral of her husband's grandmother, who had been kept alive in her final days on artificial life support. According to several people who were present at the conversation, Terri said that she would not want to be kept alive on artificial life support. This evidence has been referred to derisively by conservative commentators as "hearsay," which is meant to make it seem unreliable and insubstantial.

Here a little legal background helps. According to the online legal dictionary at http://dictionary.law.com, "hearsay" is "second-hand evidence in which the witness is not telling what he/she knows personally, but what others have said to him/her." (http://tinyurl.com/6earu) The idea is that you are testifying, not to what you saw, but to what someone else said they saw. Direct testimony would be "I saw Smith shoot Jones"; hearsay testimony would be "I heard Davis say he saw Smith shoot Jones." This is unreliable, since Davis is not testifying directly, so there is no way to judge the credibility of his alleged statement.

But that doesn't quite apply to this case, because the Schiavo relatives who testified about Terri's statements *did* directly observe the facts to which they were testifying: they directly heard Terri state her intentions about what she wanted to happen if she became permanently incapacitated.

MS testified that Terri had expressed a desire not to live in such a condition. His testimony was corroborated by several other witnesses. The Schindlers, on the other hand, testified that they would not agree to follow Terri's wishes even if that was what she wanted.

The below article was written shortly before the autospy report was made public. The writer is on target.

Will Report Make "Outlandish" Claims?
by Rob Johansen

The long-awaited autopsy report of Terri Schiavo will be released later today, according to reports in the Washington Post and elsewhere.

Pinellas County Medical Examiner Jon R. Thogmartin will hold a press conference on the autopsy report at 11:00 AM Wednesday.

What the report will conclude is not yet known, but the Schindler family and many supporters of Terri's right to live hope the autopsy will provide clues regarding the cause of the cardiac arrest which led to her anoxic brain injury in 1990. They also hope that the autopsy will provide evidence of the abuse of which they have accused Michael Schiavo.

I am not terribly optimistic that the autopsy will provide evidence of either the cause of Terri's cardiac arrest or any abuse. I think there was simply too much time between Terri's injury(ies) and her death for any such evidence to still be detectable.

What I am most interested to see is whether or not, as Michael Schiavo and his attorney George Felos hope, the M.E. purports to draw any conclusions regarding whether Terri was in a PVS (Persistent Vegetative State).

As many readers will recall, when George Felos announced that Michael would "permit" an autopsy (the matter was later shown to be completely out of his hands), he said that Michael wanted "definitive proof showing the extent of her brain damage".

Of course, as I pointed out back then, an autopsy cannot possibly "prove" whether Terri was PVS or not. Indeed, Dr. Bernardine Healy, a former Director of the National Institutes of Health and medical columnist for U.S. News & World Report, responded to Felos' announcement, in an appearance on MSNBC, by pointing out that an autopsy can tell us nothing about Terri's neurological function. She lamented the surreal reasoning by which Michael would permit an autopsy when Terri was dead, but refused the medical tests that could assess Terri's brain function while she was still alive.

The inability of an autopsy to retrospectively diagnose PVS did not stop some "talking heads" on cable news shows from offering ill-informed speculation. One pathologist, appearing on Greta Van Sustern's "On The Record" (partial transcript here), said that though a determination that Terri was PVS could not be made with 100% certainty, nonetheless an autopsy could confirm the extent of Terri's brain damage - her "loss of neurons" - and whether she was in fact in a PVS.

Neurologists react to statements such as the above with incredulity. Dr. Mack Jones, a Florida neurologist I interviewed for my National Review Online article "Starving For a Fair Diagnosis", characterized such claims as among "the most outlandish statement[s] that I have ever heard". He continued, saying:

Autopsy findings cannot diagnose PVS. I expect evidence of severe brain damage consistent with hypoxic - ischemic injury to the cerebrum with subsequent atrophy. These findings nor any other findings have no bearing on the diagnosis of "minimal consciousness" or PVS.

In a March 31 article at MedPage Today, Dr. Michael De Georgia, head of the neurology/neurosurgery intensive care unit at the Cleveland Clinic Foundation, said that the PVS diagnosis "cannot be confirmed by autopsy." Dr. Mouhammed Kabbani, a neurologist at the University of Missouri, concurred with this evaluation, and added that an "autopsy can show the degree of brain damage and how much brain tissue survived the injury", but that "it cannot by any means tell about the patient's clinical status."

In the MedPage Today article, Harvard neuropathologist E. Tessa Hedley Whyte said that "the [pathologic examination of the] brain can't tell if there is a persistent vegetative state or not". But, unfortunately, that won't necessarily prevent excessive claims from being made. Dr. K.J. Oommen, Vice Director of Clinical Neuroscience at the Oklahoma University Medical Center, summed up the problem best, saying that "a pathologist can make such statements, because you cannot disprove them. The patient is already dead!"

While I don't know what the autopsy report will say, I'm going to go out on a limb here: I predict that the autopsy report will, in at least a tentative way, offer a conclusion that Terri was in a PVS. I say this for three reasons: Firstly (and perhaps this is just my cynicism coming out), it would fit the generally unfortunate and dishonest way that the rest of the Terri Schiavo saga has played out. Secondly, doctors with whom I have discussed the Schiavo case share my pessimistic outlook. Dr. Peter Morin, a Boston neurologist interviewed for my March 16 NRO article, said that he anticipated "gross overstatements regarding the implications of the neuropathology." Thirdly, this Philadelphia Inquirer article provides a hint of what is to come:

William A. Pellan, director of forensic investigations for the District Six Medical Examiner's Office in Largo, said the report would address whether Schiavo was in a persistent vegetative state.

There would be no point in mentioning the intent to "address" the issue of PVS if the report was not going to draw a conclusion on the matter. Furthermore, the autopsy cannot prove that Terri was not PVS. Thus it seems likely to me that the report will in some way be presented as "confirming" the diagnosis.

Such a conclusion would be in keeping with the way that various "memes" have governed the debate surrounding Terri Schiavo's fate. I discussed some of these memes in my article "The Death of Terri Schiavo", which appeared in the May 2005 issue (available online soon) of Catholic World Report. These memes, such as "9 (or 12 or 16) judges have all reviewed the case and found for Michael", and "all the doctors who examined Terri diagnosed her as PVS", were readily regurgitated by most of the MSM, as part of what Nat Hentoff described as the "disgracefully ignorant" coverage of Terri's case.

If, as I predict, the Medical Examiner's report offers anything approaching a "conclusion" that Terri was PVS, then George Felos, the "right-to-die" advocates, and their accomplices in the media elite will have the final meme, with which they can tie up the Terri Schiavo case in a nice, neat bow. The Culture of Death will advance a little further, abetted by self-assured and willing acolytes.

Rob Johansen's article can be found at his website Thrown Back

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