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Was autopsy the final word?
Posted By Diana Lynne On 10/11/2005 @ 1:00 am In Front Page | Comments Disabled
Editor’s note: The following article is by Diana Lynne, whose powerful, comprehensive book on Terri Schiavo’s life and death, entitled “Terri’s Story: The Court-Ordered Death of an American Woman,” is now available at WorldNetDaily’s online store.
In the minds of many Americans, the results of the autopsy performed on Terri Schiavo served as the final word on the debate over whether the 41-year-old brain-damaged Florida woman should have been dehydrated to death per court order. News outlets across the board delivered the results released June 15 to their audiences as “vindication” for Michael Schiavo for having fought seven long years in court for the right to remove his wife’s feeding tube and end her life. At the same time, journalists vilified the Schindlers, Terri’s parents and siblings, for having opposed him. “End of story,” many say, while others beg to differ.
The body of Terri Schiavo was whisked to the coroner’s office on March 31 within hours of her succumbing to 13 days with neither fluids nor food after Pinellas County Circuit Court Judge George Greer ordered her feeding tube removed and barred oral nutrition and hydration.
Nearly 11 weeks later, Pinellas-Pasco County chief medical examiner Dr. Jon Thogmartin confirmed Terri Schiavo died of “marked dehydration,” even though he listed the exact cause of death as “complications of anoxic encephalopathy,” or brain damage. He declared Terri’s heart to be strong and estimated she would have lived another decade if not for the feeding-tube removal.
Thogmartin couldn’t provide an answer for the $64,000 dollar question, although the media were largely persuaded he had and variously reported the autopsy “backed Schiavo” in his longtime assertion that his wife was in a persistent vegetative state, or PVS.
Thogmartin and consulting neuropathologist Dr. Stephen Nelson stressed in the autopsy report that PVS is a clinical diagnosis made through physical examination of a living patient ? not a pathological diagnosis made postmortem. Still, Nelson reported that pathological and anatomical findings, such as her shrunken brain and dilated ventricles, were “consistent” with the PVS diagnosis reached in the court. He pointed out that Terri’s brain weighed 615 grams, which is less than half of the expected weight for an adult her age. He also pointed out Terri’s brain weighed less than her famous vegetative predecessor Karen Ann Quinlan.
Thogmartin conceded it is unknown how much the long duration of dehydration contributed to the shrinkage of Terri Schiavo’s brain.
At the press conference held to announce the autopsy findings, Nelson went further in lending support for the court’s diagnosis of PVS. He emphasized the pathological findings were “very consistent” with PVS, but admitted he could not rule out the possibility Terri Schiavo was in a minimally conscious state, or MCS, because there are no published studies on pathological correlations to the clinical diagnosis of MCS.
In a critique of the autopsy posted on her weblog, ErosColoredGlasses.blogspot.com, physician and scientist Dr. Sherry Eros called it “medically reprehensible” for Nelson to have stated to the press that the autopsy results are either “consistent with” or “not inconsistent with” a PVS diagnosis, without emphasizing “that it is illegitimate to use postmortem findings to retroactively make the clinical diagnosis of PVS.” Eros further questions the relevance of findings that are “consistent” with PVS.
“When the scientific and medical data is equally consistent with both x and non-x as in the Schiavo case, then it is utterly meaningless to suggest … that it supports or establishes one or the other as true,” she wrote. “It is only when the physician or the ME can use data to “rule out” something, by finding that the data is ‘not consistent with’ such a diagnosis, or cause of death, that something meaningful has been said.” Eros further derisively equated Nelson’s phrase “very consistent” with the nonsensical “very pregnant.”
Neurologist Dr. William Hammesfahr, who served as an expert witness for the Schindlers after examining Terri for 10 hours over repeated visits in 2002, also criticized the perceived spin of the autopsy report. He emphasized the medical examiners’ own findings detract from the PVS diagnosis. Namely, large areas of Terri’s brain were “relatively preserved,” in the words of Nelson, and the critical areas were among those “relatively preserved.”
“In fact, the relay areas from the frontal and front temporal regions of the brain, to the spinal cord and the brain stem, by way of the basal ganglia, were preserved,” said Hammesfahr, adding this explained Terri’s “evident response” to her family members and others.
The autopsy also debunked the notion of Terri Schiavo responding to the presence of her mother and others, in the minds of many.
“Of particular importance was the hypoxic damage and neuronal loss in her occipital lobes, which indicates cortical blindness,” Thogmartin wrote, summarizing Nelson’s findings. The finding was widely reported as “confirmation” that Schindler family members, caregivers and medical experts who interpreted Terri’s smiling, crying, laughing and vocalizing as responses were mistaken.
“We have been saying for years and years and years the expert testimony showed that Terri’s eye movements and apparent responses to visual stimuli was a reflexive action,” George Felos, the right-to-die attorney who represented Michael Schiavo, commented. “It was the result of a brain stem activity, which is consistent in PVS [persistent vegetative state] patients. She had no critical sight, and that was a finding by the medical examiner as well.”
David Gibbs III, a pro-life attorney who represented the Schindlers, countered that Terri’s apparent responses could have been due to her awareness of people’s presence through the use of other senses. She may have smelled her mother’s perfume or body lotion, he posed.
Thogmartin’s postmortem finding of blindness raises the question of why the physical therapists and neurologists who worked with Terri in the early years following her injury at rehabilitation facilities noted in her medical records evidence of some visual tracking.
Most recently, neurologist Dr. William Cheshire of the Mayo Clinic in Jacksonville, Fla., observed Terri Schiavo for 90 minutes and reviewed her medical records and videotaped examinations performed by Hammesfahr and other neurologists prior to an evidentiary hearing in 2002 and reported to the Florida Department of Children and Families that Terri had “fixated her gaze on colorful objects or human faces for 15 seconds.”
“There is a greater likelihood that Terri is in a minimally conscious state than a persistent vegetative state,” Cheshire wrote in a court affidavit filed March 23, six days after the feeding tube was removed. “To enter the room of Terri Schiavo is nothing like entering the room of a patient who is comatose or brain-dead or in some neurological sense no longer there,” he continued. “The visitor has the distinct sense of the presence of a living human being who seems at some level to be aware of some things around her.”
Even neurologist Dr. Ronald Cranford, the prominent right-to-die activist solicited by Michael Schiavo to provide expert testimony was duped, if Thogmartin’s postmortem findings accurately reflect Terri’s visual capacity while alive. Cranford admitted in court that Terri successfully tracked the multicolored balloon in the first of his three trials. He reached the conclusion she was in PVS, however, because he didn’t find her visual tracking to be consistent or sustained long enough.
“Obviously, the pathologist’s comments that she could not see were not borne out by reality, and thus his assessment must represent sampling error,” suggested Hammesfahr, who testified along with Dr. William Maxfield in 2002 that Terri’s vision was impaired. “Ultimately, based on the clinical evidence and the autopsy results, an aware woman was killed.”
In his report, Thogmartin waded into the “quality-of-life” quagmire stirred by bioethicists. “Her brain was profoundly atrophied. It weighed 615 grams – roughly half the expected weight of a normal human being,” he
wrote, summarizing Nelson’s findings. “This was irreversible and no amount of treatment would have regenerated the massive loss of neurons.”
Some experts criticized this as a misleading statement, pointing out the
goal of therapy in brain-injured patients isn’t to regenerate dead neurons,
but to retrain surviving neurons to function in their place. Scientists have
only recently learned the brain has this ability. It was demonstrated in a
1999 study by a team of scientists at Carnegie Mellon University, who found
“spontaneous reorganization of cognitive function immediately following brain damage caused by stroke.”
Others slammed Thogmartin’s comment for its perceived appeasement of theright-to-die movement.
“No amount of brain injury ever justifies denying a person proper humane care. That includes food and water,” Father Frank Pavone, a Catholic priest who was with Terri in the final hours and minutes of her life, stated in a press release.
The autopsy results became a political football for those seeking to score some points against the conservatives in Congress and President Bush who had intervened in the case on Terri’s behalf.
“The autopsy results released yesterday should embarrass all the opportunistic politicians and agenda-driven agitators who meddled in Terri Schiavo’s right-to-die case,” the New York Times preached in a June 16, 2005 editorial. “The medical examiners found Ms. Schiavo’s brain ‘profoundly atrophied,’ only half the normal size, and said that ‘no amount of therapy or treatment would have regenerated the massive loss of neurons.’ … She was completely blind and could not have swallowed food or water safely on her own. Those conclusions underscore how shallow and cynical were the judgments-from-afar by the Senate majority leader, Bill Frist, who is a doctor, and by other Republicans in Congress who contended that Ms. Schiavo looked responsive and that her condition might be amenable to treatment.”
Florida Gov. Jeb Bush fired off an angry letter in which he wrote the paper’s “grotesque and chilling disrespect for the sanctity of life has never been more apparent.”
“Terri Schiavo was a deeply loved daughter, wife, sister and friend. The fact that her brain was atrophied or that she was blind or could not have been rehabilitated doesn’t change that fact,” he stated.
“I think [the media] have a euthanasia agenda,” Terri’s brother, Bobby Schindler, mused. “They want to make it as easy as possible to kill these people. Look at the way they’re justifying Terri’s death? Because her brain damage was at a certain level it gives us justification for killing her, starving her to death?”
The diametrically opposed views over the death of Terri Schiavo persist well beyond her death and the autopsy report. And so do the fundamental questions.
Frustrated at his inability to pinpoint the cause of the Schiavo’s mysterious collapse in 1990 which resulted in her brain damage – after ruling out heart attack and a bulimia-induced potassium imbalance – Thogmartin emphasized the case is not closed.
“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 wrote. Pointing out that many of the pertinent documents in the case “were lost or discarded over the years,” Thogmartin added, “Receipt of additional information that clarifies outstanding issues may or shall cause an amendment of her cause and manner of death.”
WorldNetDaily has been reporting on the Terri Schiavo story since 2002 – far longer than most other national news organizations – and exposing the many troubling, scandalous, and possibly criminal, aspects of the case that rarely surfaced in news reports. Just released from WND Books, the definitive book on the Terri Schiavo saga, titled “Terri’s Story: The Court-Ordered Death of an American Woman.” Author Diana Lynne tells a powerful, insightful, and ultimately heartbreaking story. This eye-opening book provides the background and depth missing in most of the national news coverage of the pitched battle over the life of Terri Schiavo.
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