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."

Ok Lionheart lets get this in the open

Your first post:
To: veronica
No surprises after all this time . The fix was in .. ... ..
12 posted on 06/15/2005 3:40:46 PM EDT by lionheart 247365 (( I.S.L.A.M. ; ) Islam's Spiritual Leaders Advocate Murder .. .. .. ))

My reply:
To: lionheart 247365
Fix is in?...Why would a Coroner (DR) jeopardize everything to make a false report...you conspiracy theorists amaze me He would have everything to lose. Granted the Schiavo case stinks, but it's over.
18 posted on 06/15/2005 3:47:29 PM EDT by BubbaJunebug

Your follow up reply:
To: BubbaJunebug
You amaze us all . Are you in the good ole boys club down there in "chad" land . YES the fix was in !!!
31 posted on 06/15/2005 3:58:08 PM EDT by lionheart 247365 (( I.S.L.A.M. ; ) Islam's Spiritual Leaders Advocate Murder .. .. .. ))

My follow up reply
To: lionheart 247365
You apparently have a problem with Southerners..Florida or otherwise. Go back in your hole "newbie"..and put your tin foil hat back on.

As I said the Schiavo case stinks and is very sad..but it's now over.
75 posted on 06/15/2005 4:48:38 PM EDT by BubbaJunebug

Now that was what I thought would be the end of that…but no…but you decided to send me an email (no cojones to post it here in public..huh Lionheart)…but that’s ok I will.

Re: McAuliffe Raps Dean on Personal Attacks
From lionheart 247365 | 06/16/2005 7:09:10 AM EDT read
You can't insult me , Bubba blow bag , but it sure sounds like I hit a soft spot on you chad boy , it ain't over either , go back to school , maybe start back in the third grade , and this time PAY ATTENTION !!! Over 80% of the people on this page polled are in agreement that this whole thing stinks , and we won't go away . Have a nice day in school .

Now where or how you picked that title, God only knows…since I have never posted in that thread.

So here is my offer to you. If you want to take a shot at me again…let me know and I will move closer so you can hit your target.

Terri Schiavo's sister speaks out on autopsy results

Terri Schiavo's sister, Suzanne Vitadamo, spoke out about her late sister's autopsy results Thursday.

She spoke to reporters in Minnesota on behalf of her parents and brother. Vitadamo said her sister was not in a persistent vegetative state, as the medical examiners report said she was.

"Our family stands by its strong belief that Terri was not in PVS, and we appreciate the many noted neurologists, including Dr. Cheshire, who saw Terri just weeks before she died who agree with our position," Vitadamo said.

Cheshire is a board-certified physician at the Mayo Clinic.

The medical examiner, Dr. Jon Thogmartin, wrote in his report that "There's nothing here again that's inconsistent with what's published for persistent vegetative state."

Vitadamo also disputed what was perhaps the biggest surprise of the report. The examiner said Terri Schiavo was blind. That finding calls into question the family's claim that Schiavo was seeing anything on well-publicized videos that appeared to show her looking at her mother and following a balloon with her eyes.

"Our attorneys and other witnesses clearly saw Terri recognize her mother and father, and treat them differently," Vitadamo said.

Vitadamo said Thogmartin found no evidence of bulimia.

More than a decade ago, Michael Schiavo won a large civil judgment after suing his wife's doctors, saying they should have detected an eating disorder.

"Our family would encourage Michael Schiavo to do the right thing and return the funds paid by the innocent doctors who were sued for Terri's collapse," Vitadamo said.

Click here for the report from Bay News 9.

Statement of the Schindler Family re: Medical Examiner’s report

06-16-05

Minneapolis, MN and Seminole, FL – As you are aware; the Pinellas County IME has released his report regarding Terri. We would like to thank the IME for his time and effort in making this report. We are not challenging the findings in his report, but we would like to make a few comments publicly. We do not intend to take questions afterwards.

First, the IME’s report confirms Terri’s physical condition and disability. We all knew Terri was seriously brain-injured before the IME report. This is nothing new. The IME’s report also confirms that TERRI WAS NOT TERMINAL. THAT TERRI HAD NO LIVING WILL, THAT TERRI HAD A STRONG HEART, and THAT TERRI WAS BRUTUALLY DEHYDRATED TO DEATH.

Second, our family would encourage the media to remember that this case was allegedly about “Terri’s choice.” There is absolutely no evidence that Terri wanted to die of dehydration, or that she believed that that the level of one’s disability gives anyone the moral and legal right to end another’s life.

Third, the IME said clearly that dehydration, not her brain injury, was the cause of her death. Terri was dehydrated to death before our eyes The moral shame of what happened is not erased because of Terri’s level of disability. No one would say that “blind people” or “brain-injured” people should be put to death. That would be an irresponsible and heartless position to take. Tragically, that is what happened to Terri. As a society, it seems that we have lost our compassion for the disabled.

We asked our attorney, Mr. Gibbs, to meet with the IME prior to the press conference, to attend the IME’s press conference, and to speak to the media for our family afterward. In our opinion, some of the significant items from the IME’s report are as follows:

* Terri had a strong heart according to the IME. In addition to her strong heart, Terri also demonstrated a very strong will to live.

* Terri was not terminal. The IME said with proper care Terri would have lived at least another 10 years even in her disabled condition. Terri’s case was NOT an end-of-life case. Terri’s case was about ending a disabled person’s life.

* Terri was brain-injured. This does NOT mean that she was brain-dead. Many seem to not understand this absolutely critical distinction.

* The IME essentially ruled out bulimia and heart attack as causes for Terri’s condition. In one sense the IME’s report created as many questions as it may have answered. The major question for our family that now remains is what happened? A troubling 70-minute gap appears in the timeline on the day Terri collapsed in 1990:

o According to Michael Schiavo, Terri collapsed at 4:30 AM. Mr. Schiavo said this on Larry King Live and he also re-confirmed it to the IME during his investigation.

o 911 was called at 5:40 AM. Emergency services arrived at 5:52 AM.

o Both Bobby Schindler Jr. and the original police report gave similar descriptions as to Terri’s state – laying face first, on the floor, hands crossed and up high against her chest, making gurgling noises.

o Our family doesn’t understand what led to Terri’s collapse. Our family doesn’t understand why this major discrepancy in time is not fully understood. When a person is without blood and oxygen to their brain, 70 minutes is a terribly long time when each second counts.

* With the IME effectively ruling out bulimia, the underlying basis of the malpractice case appears to now be disproved. Our family would encourage Michael Schiavo to do the right thing and return the funds that were paid by the innocent doctors who were sued for Terri’s collapse. In addition to returning the funds to the doctors who were sued, we would also ask Michael to bring closure to Terri’s death for our family by allowing us to give her a proper Christian burial as required by our faith. To this day, we have no idea where Terri’s ashes are. That is particularly hard on our mother.

* The IME’s report stated that Terri’s inability to swallow was the result of muscle atrophy. Terry was denied therapy for 12 years, and muscles atrophy when they are not used. We will never know if therapy would have helped.

* The IME clearly stated that PVS is a clinical diagnosis made on a living patient. That is something an IME cannot do by looking at a corpse.

o Dr. William Cheshire, a neurologist from the Mayo Clinic, agreed with our family’s perception that Terri was awake, aware, and at least minimally cognitive.

o We knew that Terri was visually impaired, but we did not know to what extent. Our attorneys and other witnesses clearly saw Terri recognize her mother and father and treat them differently. According to the IME’s report, it appears that after her severe dehydration, Terri was blind at the moment of her death.

* The IME stated that no conclusive medical studies have been done on what a MCS brain should look like as opposed to a PVS brain in an autopsy.

* According to the IME, Terri was given morphine for pain as she died. This seems contradictory that if Terri could feel no pain, as some would say, why would these drugs be necessary? In our opinion, the treating health care officials understood that Terri felt pain.

I would like to restate a few words from our family’s statement to Terri that we issued on March 31, 2005, the date of Terri’s death:

“Our prayer at this time is that our Nation will remember the plight of persons with disabilities and commit within our hearts to defend their lives and their dignity for many generations to come.”

In closing, the love, prayers, and concern for our family from so many around the nation are deeply appreciated. God has sustained us through these most difficult days, and we do hope that no other family ever has to live though the nightmare that our family and Terri endured. No mother and father should have to watch their child that they love more than life itself, be dehydrated and starved before their eyes. Civilized societies should not tolerate such barbaric acts.

Our family stands by its strong belief that Terri was not in PVS, and we appreciate the many noted neurologists, including Dr. Cheshire who saw Terri just weeks before she died, who agree with our position. We also thank the brave men and women in public office in Florida and Washington, D.C. who nobly stood on the side of life regardless of one’s disability. While their valiant efforts were not able to ultimately save Terri, our family is forever grateful to them for their compassion and for their conviction to do the right thing.

http://www.terrisfight.org/

I think the motive is that he did not want any possibility that she would be able to speak again and expose what he possibly had done to her.

I think the motive was also the money from the malpractice lawsuit and any insurance that would come to him as a result of her death.

The malpractice money was put into a trust and her stay at the hospice was paid by Medicare/Medicaid - so on her death, he gets all remaining monies.

And, if not that, or that he is a control freak - you tell me.

This thing just never - ever - passed the smell test. His actions, his lawyer and the changing of the Florida law that conveniently allowed the case to finally progress to death of his wife just do not hold water.

And, on top of that, I understand the nature of men. Just tell me how many ex-husbands do you know of that sincerely love their ex-wives - especially with another wife and children? How many would destroy their reputations, hurt their families, and live, eat, and breathe lawsuits for 15 years in order to kill an ex-wife? No, men tend to move on and get away from a prior family.

So, one that does do all of this has something to gain serious enough that he does what he is doing and it dang sure ain't because he worried that she would have to live in that state.

Now that is years of watching life unfold around me talking. Same as my parents and elders could see through the actions of people due to having seen the nature of men over the years.

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