Doctors on Schiavo's Condition
OK.....I lied. I said no blog notes today on the Schiavo situation....
However, both Capt. Ed and I had said that and then we get drawn into the topic because of some really wild stuff floating around out there.....
Ed at Captain's Quarters had
this post this afternoon.....
The reference to Dr. William Hammesfahr reminded me of an email response I received from the Dr. who testified at the Schiavo hearings, Dr. Ronald Cranford. I got the missive from him last night in response to an inquiry. What struck me was Dr. Cranford referred to Dr. Hammesfahr in the email....with quite uncomplimentary terms!
Here is his email:
I'm so tired right now, I can hardly think, but .....
the truth of Terri's condition will come out when cooler heads prevail, and articles begin to appear in the professional literature in medicine, ethics, and law in order to carefully weigh the credibility and accuracy of the medical diagnoses and the medical experts in Terri's case (charlatans like Hammesfahr and Maxfield will never publish a sentence, not a word, in a peer reviewed journal). My background memo (see attached) has just been accepted in a peer-reviewed journal and hopefully will be published in the early summer.
The withdrawal of feeding tubes in PVS is a common occurrence. Death is due to dehydration, not "starvation." Starvation is a completely, misleading, and inflammatory term for this process. Most patients die within 10-14 days after stopping a feeding tube.
If withdrawing a feeding tube from a PVS patient is "murder," then there are thousands of doctors who are guilty of murder throughout the nation, and I and some other doctors are serial murderers. The US Supreme Court and over 20 state supreme court decisions have agreed that the feeding tube is a medical treatment and that the withdrawal of the feeding tube under appropriate circumstances is consistent with the highest standards of medical and ethical practice in the medical profession.
The autopsy of Terri will show exactly what I and the other credible neurologists have said for the last fifteen years, and the macroscopic and microscopic examination of the brain will show changes characteristic of extremely severe hypoxic-ischemic encephalopathy. I have previously published on this blog Dr. Cranford's 17 page item of historical reference following the Terri Schiavo case......
here.
My belief then as now was that the Dr.(Cranford) has an excellent following of the situation, and the fact of his being published on it indicates some credence as well.
Duke
Terri has Passed
Terri Schiavo passed away here in the Tampa Bay area about 10am this morning.
With respect for her husband, family, and others I will post no more on this topic today.
I am sure there will be future discussions.
Duke
The UN...The worst idea for Iraq?
How very illuminating that one of the foremost communicators from Iraq finds the UN to be very, very wrong......
Check out
The ideas of Mohammad at his site......
I find this totally fascinating, and an object of why "We", meaning the United States of America, are in this country in the first place.
The good news continues to "Rock" from the Iraqi front!
Duke
Life Springs Eternal!
My Plants for Spring!There are things dark and ugly we each must deal with daily.....Too much of our lives of recent times are centered upon items of political/social importance. Things in which we have NO say!
I post this picture, my Spring planting of tomatoes, to reaffirm that life goes on... that what we do matters, and that enjoyment and growth are part of "the" plan by whatever Gods you enjoy and believe in!
These are my spring plants for a spring/summer of fresh delicious fruit.....
In Florida we plant early and also again in the fall....(My September tomatoes are still producing fruit!)
Enjoy the picture of growth and renewal.....
Duke
p.s. In a totally unrelated aside......notice the marigolds planted at the corners of the tomato plants.....they drive away about 90% of the bugs which inhabit tomato areas.....& They are the primary plant of my hometown, Pekin, Illinois....home of the annual "Marigold Festival"!
Let her die with dignity!
Terri is long gone, by my opinion....not so by others.
However, the results of the courts; legislative; executive actions have all led to the current situation where Terri is still in state of dying.....
Regardless of your interests/prejudices/opinions, etc. the fact is she is dying, and will expire soon.
Then the facts do not matter about who is right/wrong/etc.
I hate this because the loss of a person who by ALL medical/psychological exams has not existed for 15 years, is such a media case.
Terri deserved better than this. The person who was Terri deserved to die a legitimate death....a death by natural processes. How long must we perpetuate the myth of life simply because we can induce continuation of heart/lung responses?
The idea of life is NOT one who can breath.....LIFE, by its very nature, involves THINKING!
It involves making decisions........
These options were not, nor ever could be, part of Terri on the feeding tube. Thus Michael's decision......
I am sorry it is over....SOON....I am sorry for her and her family, and the LOSS of 15 years of their collective lives to this lost cause!
How very, very sad!
Duke
I could just gag!
Just when you thought the Terri Schiavo saga could deteriorate no further....it gets even more ugly.
Are you one of the many who emailed the Schindlers (Terri's parents) in support? If so your name, along with about 30,000 others on the list
ARE FOR SALE!Check it out in the NYT
HERE!
Then go to MSNBC and Read Olbermann's interview with Jay Wolfson, a PhD here in Florida....on Terri's condition....
HERE! Wolfson was the man chosen by Gov. Jeb Bush to review entire Schiavo files for State of Florida....His information is pretty solid!
This thing gets more creepy each day....
Duke
A Jackson Too Far!
I suppose I should not be so incensed! But, I am!
The Schiavo case has drawn what I thought was every nut case, extremist, etc. to our Tampa Bay area. I have been upset with stories of people arrested trying to carry water to Terri; about wheelchair bound folks laying down across the road by the hospice where Terri is located.....
Now the topper.....Jesse Jackson comes to town! Yep, this self-appreciating, media-chasing, cause-challenged alledged "Minister" is in town and according to local morning TV news shows will show up at the hospice this morning to try to gain entry to pray over Terri!
Perhaps a better description would be to PREY ON TERRI!
I guess that is not much different than the others who gathered from around the country to be near the hospice, except....You know Jackson can sense a media exposure from three states away.
How sad as the circus continues.
Let the woman's life end in peace....
Duke
I don't Sound "Warm & Fuzzy!"
You all read my rants, and my other items (are they a nice mix, I hope so).
My lovely Dutchess & I share a wonderful story of love. Love from the middle of our lives, that is!
I have often wondered if our story is unique, or much more normal than one might believe?
Thus, I ask you to email, or "comment" on this post to give me some idea of "Your" story......
Now, I shall tell you ours......
My lovely Dutchess & I have known one another for probably about 25 or more years. She was married to a fellow who became my best friend. He was a true genius of the PCs....I was an amateur. We shared a love of life, and love of women, and a love of the things we enjoyed....good food, good booze/wine, and much more.
He died suddenly at age 50 (he was a few years older than I) of a massive heart attack.
I helped his widow, already my friend, thru the tough times. We ended up together. We married several years later. How really COOL to be friends for years first, and then much more!
Our happiness knows no bounds to this day! Now we are married 10 years plus.
We are SO very together!
Duke
Now folks, tell me your story in comments, or by email, and I'll choose and forward same to the readers!
Thanks, and I hope you are having half as much life-fun as my bride and I! If so, you are HAPPY!
A Country In Distress???
Iraq, by most all MSM accounts remains a country of death and terrorists (er... insurgents!); a land daily besieged by the war and its toll on all the citizens thereof.
If you want to see a picture that rings much more true go to
Iraq The MOdel where this entry describes the recent vacation Omar took to the North of Iraq. How normal....FOR THE USA! How telling that it occurs in Iraq!
I could not help but compare the recent tour of Stephen Green,
Vodkapundit, reported by his own pictures placed across several days of his entries.
How normal!
Maybe more people need to catch the fact of a normal life returning to Iraq. Maybe WE have to tell them....
Duke
UPDATE: Thanks Instapundit, for a quite nice "Instalanche"
Our "Failed Diplomacy" er.....Succeeds?
Kerry & Company spent most of last Spring, Summer and Fall touting the Bush Administration's so-called failed diplomacy. While that may remain a battle cry for them, (largely because of the backwards, out-of-touch and/or cowardly hiding of the involvement in Oil-For-Food by European former-powers France and Germany) Worldwide the scene seems to be developing where the USA takes center stage as the reason for moves toward Democracy in many places.
How lacking in success can the US be when we have: Afghanistan voting and organizing into a country.....Not overnight, as
Glenn Reynolds regularly reminds us! However the march is onward.....Iraq votes and now their people are shooting back at terrorists and demonstrating against them as well....while the Zarqawi block is apparently now looking for a safe road home. Lebanon is asking our help (its people are by signs and in their now large voice) as they move from under Syria and seek their identity, not under Hezbollah! The Ukraine leans to the EU and the US as they also move from despot status to fledgling Democracy. Bahrain has demonstrations underway, and they seem to be developing from Egypt East and North to cover almost every Islamic state that has repressed its people!
Hindrocket at Powerline has a quite extensive look at Albania and how it turned from a near-N. Korea in attitude to one of strong USA support.
It is a good picture.....with lots more parts than I can insert in this post....and, it is a picture you will NEVER see displayed by the MSM, and strongly derided by the Democrats (read Left).
Duke
Hatman goes Formal
Duke's Formal Look
I just have to have a hat for each occassion!My picture enroute to Elks Installation last evening. I joined the Trustees of our Tampa Lodge.
Duke
p.s. It was a great evening and I even managed to sneak out during dinner to watch the Illini come back from 15 down and beat Arizona in OT! Marvelous!
Me, A Trustee????
Yep,
Tonight the Dutchess & I will get all spiffy, and head for the Elks Lodge where yourstruly is being installed as a Trustee.
I'll post a picture tomorrow as I will be in formal dress....AND, as your favorite "Hatman" will complete the outfit with a formal felt hat!
Actually, my fellows int he Lodge have been after me for several years to take a chair, and move up the offices. Took too much time for me. Besides I have been editor of their newsletter two different stretches (In my 3rd year we won best newsletter in the nation for our size Lodge).
Anyway.....will be posting a picture tomorrow!
Gotta get ready........only one real negative.....
My Illini play at 7:05.....on the Lodge BIG Screen.....I'll be inside the meeting room in a 2 hour installation. You folks root for them for me.....
Duke
p.s. Does my heart good to see the Big 10 gnawing up the ACC which always seems to get the major press! Three of eight left are Big 10!
Bush's Groningen Protocol?
Oh hypocrisy, thy middle name is deceit!
Now comes the story of a different Bush.....a Governor who signed a law in Texas to allow medical people to trump family feelings regarding continuation of life.
FoxNews online covers it nicely
HERE!
Are the cases the same....no, however there are enough crossover threads to find that it appears more and more to me that the Presidential/Congressional action in the Schiavo case was completely "politics for public perception", without the aid of consideration of the impact upon the legal/legislative/executive balance and adherence to form.
I truly hope this goes away soon.....NO, not Terri....but rather the hundreds who have made this a cause! Most often without regard for the people involved, but rather as a stage for demonstrating their own agenda!
Nuff said!
Duke
Schiavo - Ouch! A fact is exposed!!!!
Check this out
Tech Central Station is on top of the Schiavo problem.....BOY are they!
This supports most of my posts!
Duke
President Bush, YOU are losing your constituency!
I am an unabashed GWB Fan.....I blogged the hell out of the facts/conjecture/exchanges all last Summer and Fall.
However,
I am absolutely angered/disgusted, etc. Over GWB's recent actions. The man is losing my respect and, I believe, about to disassemble an apparent GOP party perpetuation of leadership for the next 10-15 years!
Let me cite the causes:
1. The absolutely stark-raving lunatic actions in the Terri Schiavo case. Emotion overrules the facts of 15 years of judicial action. How bad is this.....Government of the individual case for ONE person????? see my blog (in satire) of this topic
HERE. Cost to the taxpayers....estimated at $4 Million!!! PLUS, How much ia this going to cost GWB in terms of the balance of votes for his judicial nominees???
2. Border politics????? What the hell is wrong with GWB? He is off in space on the issue of illegal immigrants/TERRORISTS entering this country! 1st, he said during the campaign of 2000 that he would reinforce and enlarge the number of border agents...
He lied, he never even tried! 2nd, he now feels we should welcome the illegals with open arms, and make the plan simple so all the rest of Mexico will want to come here! (Along with any terrorist group planning to explode really BAD things in our country.....) Bush seems COMPLETELY disconnected from the potential for evil herein laid! Also, he seems disconnected from the
$ problems of many millions flowing back to Mexico to support their people.....BUT President Fox of Mexico is not unaware.....he welcomes it all with open arms. GWB, WHAT the hell are you thinking????
3. This man is a powerful, and exacting leader of the program to attack terrorism. He is also clueless about the regular items of defense of our own country. Whose fault will it be when a dirty bomb goes off in Cleveland, Chicago, Detroit, etc.????
Whose fault will it be when thousands die in a program of dirty drugs/water-tainting, et al?????
George, you have lost my support!
Duke
UPDATE: I am not alone in my opinion about Bush; see
Michelle Malkin's opinion .
The End is Seemingly Near!
I have offered my feelings on the Terri Schiavo situation before. Nothing new here. Just a SAD comment that the end seems near. Why sad? Well, folks, even though I believe the decisions made by judicial levels have been correct, I still will morn the loss of a life.
NO, I will not morn the loss of Terri.....she is not lost. The person who was Terri Schiavo died many years ago.
What followed, in the courts, in the appeals, in the media, in the hearts and minds of folk involved....was tragedy! Many folks spent thousands of hours trying to influence a judicial system which decided time and time again that Terri was "Gone".
Not the emotional appeal of a parent who seeks to find again their lost daughter; not the emotionally-driven decisions of our Congress spending millions to enact a law that played to the folks who wanted Terri to be alive; not the drive by "right to life" groups who saw this as a beacon PR case; not the editorial cases spouted by folks who knew only a small fraction of the issues; BUT, the fact of a case which toured the courts for 15 years!!!!!!!!
Not once in that time did the courts (charged by law with determining the outcome of such a case) find for the parents and their view! NOT ONCE!
This is not a NEW case. This is an OLD case, now being cast in a new light by those seeking to make advancement to their particular cause/issue vis-a-vis this poor woman.
I HATE it!
Give some measure of peace to the woman involved. STOP making your causes about her. Make your thinking OF her, and of her possibilities. They are almost completely limited by FACT!
Let Terri go!
I would never want to live in her state.
I would be loath to allow my bride to do so either.
Check your feelings of how you'd address the issue with the facts you know FOR CERTAIN; not the drivel of a media campaign, nor that of an emotional appeal based upon "right-to-life".
Terri has a right to DIE!
nuff said
Duke
Syria Apparently Sees the Light - On Our Aircraft Carriers!
The Syrian Ambassador to the US, Ambassador Imad Moustapha, appearing at Georgetown University, has stated they will be completely out of Lebanon "Sooner than you think". According to Fox News he seemed to be saying before two months were out.
I believe it is amazing how when you say the right things to Assad; oh, and send three US Aircraft Carrier Groups toward Syria, his mind changes so quickly!
Bush, to me is still in charge of this thing, and winning everywhere. The stories from Iraq are more positive
IN THE MSM! How very cool is that.
Now to deal with Iran. Korea on deck!
Duke
A Voice of Reason....even if we disagree somewhat!
Thanks to Powerline's Deacon for the post on Terri Schiavo. Check it
Here. The facts of this case, as for so many cases of people versus "idealistic" attitudes, have been lost to a furor of knowledge-challenged folk.
I work, as I have mentioned, in a major healthcare facility. Today I took and unofficial poll....quietly....of those with whom I work.....care-givers, techs, office people, etc. I did not "lead" people, I gave comments and got instant replies...
BOY did I get them! At least 90% voiced instantly a support for the method used for Terri.....withdrawing the tube. We in such facilities, see this daily! The usual is a quiet family discussion, and decision. Then the patient slips away because THERE IS NO HOPE OF this person EVER being the same person again!
Life IS absolutely valued by healthcare workers.....else why would they be healthcare people (in my estimation some of the most dedicated people to life on the face of this Earth) in the first place? My Dutchess, a 40 year surgical nurse, STILL cries when a surgical patient dies in the OR!
EMOTION is ruling the Schiavo case....not fact.....
I heard today an estimated $4 million dollars were expended by a Congress/President in extraordinary actions, flying back to the nation's capitol, and holding all-night sessions, for this one person.....how SAD! These voting people knew NOTHING of the case. It has been given voice, replayed, and replayed for nearing 15 years....and EVERY decision to date by judges with FULL exposure and knowledge has been the same....The woman is brain dead! YES MRI has been performed and found her brain lobe atrophied and replaced by spinal fluid....THIS IS NOT regenerative!
We need to deal with more serious problems.....
Such as: WHY are the Legislative and Executive branches joining in this attack on the Judicial branch which has invested thousands of hours of consideration on this very case?
Does this, in any way, shadow the SCOTUS ruling told by Kennedy as a measure of the "World View"???? If so, then this country is dead....it just needs to disoplay its' own symptoms for people to see.
The Constitutional balance is being disrupted, and that scares the HELL out of me!
Duke
BULLETIN - New Landmark on Right to Life Laws
WASHINGTON DC; March 21, 2010
The U.S. Congress, Senate and House, have passed the 8,450th individual law to protect and extend the life of an incapacitated person. The bill will now go to President Condi Rice for a "stamp of approval" (One may recall she ran out of pens to do hand signing on the bill for patient number 6,443).
Senate Minority Leader Obama commented, "We, as the minority party, have joined once again with the Majority GOP to pass this bill. It has become obvious that the Congressional process will continue to be mired in individual laws as a replacement for the long-denied authority of area, and state courts and judges."
An interesting side note; While the Terri Schiavo case followed more than 12 years of court decisions, legal hearings, etc., the current patient had only eight years of legal actions (all going against the continuation of life in the described PVS). Thus the time span before the Congress steps in and substitues its will for the judicial branch's action has fallen by 1/3rd.
Obama and Senate Majority Leader Jeb Bush, in a joint statement indicated that there appears to be a break in the current batch of "PVS/Life" cases, and they are now ready to begin consideration of the budget for FY 2006....Said Bush, "It is time to move on and try to stop this operation of government under emergency funding bills included in "PVS/Life" individual laws." He explained, "We have this current break before moving on toward the enactment of some 20,000 additional individual laws as our staff cannot keep up with the publishing of required documents."
/break snarky-asm
Sorry if the above offends anyone's feelings.....however, I find it a direct slap at our entire system that the Congress of the United States takes the time and effort to undermine a judicial system which has explored this issue far beyond any need for continuation. While emotions run very high, and the media and public have been played in this case like a violin, the fact is we have a system. If it is not working, then change it. If it is, then leave it alone!
Working in the healthcare field, I am aware of how many times EACH DAY this decision is made about some unfortunate person.
As a personal aside, I found it nauseating to hear Senator Martinez of my state off in a fantasy world of caring and sensitivity. Is this the same man who absolutely tarred and feathered in an unfair blitz of misinformation, his fellow GOP primary opponent for Senator, and then later said...in effect...."Oh, never mind!"
Rant ends::::::
Duke
The "Other" Duke
1st there was me. Then, of course, son Little Duke (he is only marginally taller than am I!)
Today I met a new Duke......and also received a lesson in blogging popularity & recognition.
The Dutchess & I took our annual sojourn to the Winter Park Sidewalk Art Show. Held each March in this suburb of Orlando, and adjacent to Rollins College, it is one of the BIGGIES in art show circles.
We try to go each year, and this year we were shopping for some nice new jewelry for the Dutchess whose birthday approaches!!!!
We found a lovely combination sterling and 14K gold necklace and earrings at a display and, while completing our transaction, conversed about the vendor's badge showing his name as "Duke".
While talking about the common nicknames the subject of internet led to blogs, and his naming several including, of course, Instapundit......He reads them often, but apparently has yet to obtain his own voice on the blogs. It was fun talking, and hearing the ideas that come forth from one who reads the blogs versus the almost "canned" ideas of non-bloggers whom I now feel are among the underprivledged in knowledge of what is really going on.
Thanks for the conversation
"Nother Duke"...... Your jewelry is already much appreciated by the Dutchess. Your reading blogs helped make my day!
I am sure he'll be reading this as he took down my URL.....
Ain't bloggin fun?
I am sure this event, and accidental collision of blogging minds in the most unlikely of places will be repeated more and more often as we pass the
8 million mark in blogs.
Makes me wonder how many millions more read, experience the ideas passed around, but don't show in anything except perhaps the number of visits!
Hope your day was as sunny and nice as ours here in Florida!
Duke
Dr. Cranford's Complete Terri Schiavo Report
It is Lengthy, but full of details on the long case, and in my estimation further explaining that the case has been fairly handled....and should be ended.....
Read on: (If you don't have the time, just slide down to the section titled "Concluding Comments" where you'll find a summary.
"Facts, Lies, and Videotapes: The Permanent Vegetative State and The Sad Case of Terri Schiavo
Introduction
Right to die legal cases in the United States have evolved over the last 25 years, beginning with Quinlan in 1975. Different substantive and procedural issues have been raised in these cases, and society’s thinking has changed, with far more complex legal issues appearing today rather than the simplistic views raised in the landmark early cases. Many of the early cases involved patients in a vegetative state, but more recently patients who were in a minimally conscious state have been the center of attention. Early cases involved the withdrawal of respirators and other sophisticated technology, but later cases centered on the withdrawal of artificial nutrition and hydration, and even whether it was permissible for competent patients to stop eating and drinking in a normal manner. Early cases pitted families who argued for withdrawal of treatment usually against the attending physicians and hospitals, and/or the state or federal government, who argued for continuation of treatment. In a few more recent cases, strong disagreement among members of the immediate family has arisen, with spouses advocating non-treatment and other family members, usually parents, opposed to stopping treatment. (1-4)
The Terri Schiavo case in Florida is similar in many major respects to other major landmark legal cases as it involves the withdrawal of artificial nutrition and hydration from a patient in a permanent vegetative state. (5-7) Also, similar to more recent cases (Martin in Michigan and Wendland in California) the spouse requests cessation of treatment, while other family members of the patient are strongly opposed, resulting in extensive litigation over protracted period of time. (8-9) However, Schiavo has a few characteristics distinguishing it from all other previous cases: 1: the extreme animosity between the husband, Michael Schiavo, and the patient’s family, the Schindlers, with prolonged legal battles (and a war waged in the media and over the internet) resulting in a never ending series of motions, decisions, appeals, and trials over a eight year period; 2: the extensive and heated debate over the neurological condition of the patient, including flagrantly unbelievable testimony by two physicians at the evidentiary hearing (as well as numerous sets of affidavits submitted to the Florida courts) on the neurological condition and the proposed use of controversial medical treatments of no proven value; and 3: use of videotaping by the neurological experts at the evidentiary hearing to demonstrate and explain the patient’s neurological condition to the court; 4: the extensive use of videotapes by the Schindler family to falsely demonstrate to the media and the public the patient’s “cognitive” functions; and 5: recent actions by the governor of Florida and the legislature unprecedented in American law. For this article and background memo, I will primarily focus on the medical and neurological facts of the case.
In almost every vegetative case before the courts, there almost always has been medical testimony attempting to refute the diagnosis of the vegetative state, with doctors and others arguing that the patients had some features outside of the vegetative state (e.g., Nancy Cruzan “eating bananas,” and Joelle Rosebush covering her private parts with a gown when she was not only in a permanent vegetative state but also quadriplegic). This kind of conflicting testimony first appeared in a major right to die dispute in the case of Paul Brophy, a Massachusetts fireman in a permanent vegetative state (1985), long before the minimally conscious state was established in the medical literature. (10) These medical opinions have ranged from the plausibly persuasive to the absurd, but ultimately none of them has been successful in confusing the courts. Usually trial court judges have easily recognized the deficiencies of these highly questionable medical opinions and have had little difficulty in determining the correct neurological diagnosis.
One of the notable examples of a trial court judge favoring one set of experts in neurology over another experts occurred in the Nancy Jobes case in the state of New Jersey, the second major vegetative state case in the nation (after Brophy in Massachusetts) dealing specifically with the withdrawal of artificial nutrition and hydration (the Karen Quinlan case centered on the withdrawal of the respirator, not the feeding tube). Four nationally prominent neurologists testified, two saying Ms. Jobes was in a vegetative state with no hope of recovery, while the other two testified she was not in a vegetative state. Without involving himself in the exact neurological nuances and disagreements of her clinical condition among these creditable experts, the trial court judge simply discounted the medical opinions of the latter neurologists by expressing the following opinion: “It must be noted that all of the witnesses who claimed to elicit command responses from Ms. Jobes-certain nursing home staff members as well as Dr. Ropper and Dr. Victor- believe that it is a violation of professional ethics and personal morality to withhold or withdraw nutrition and hydration from any patient, whatever that patient’s state of health and regardless of that patient’s previously expressed wishes. … I conclude that she has no cognitive function and remains permanently fixed in a vegetative state. … These witnesses who stated that Ms. Jobes was able to respond to requests or commands were not giving false testimony under oath. Their sincere opposition to the withholding of nutrition in any patient … have (sic) caused them to see signs of intelligence where no such intelligence exists. (Emphasis added; unless specifically noted otherwise, all emphases in this document will be assumed to be emphasis added by the author and not in the original) (11) In the Matter of Nancy Ellen Jobes,
Superior Court of New Jersey Chancery Division-Morris County Docket No. C-4971-85E, Judge A. Stein, April 23, 1986, pp. 8-9.
No trial court judge before and since has ever been this forthright in his or her judicial opinion on the correlation between the credibility of the experts’ medical opinions and their own personal morality, and almost every trial court judge has bent over backwards to be as fair as possible to a variety of neurological opinions on the condition of the patient.
Chronology of events
Terri Schiavo, 25, was found unconscious and gasping for air at home by husband on the early morning of February 25, 1990. She had suffered a full cardiac arrest. Defibrillation was performed seven times during initial resuscitative efforts with eventual restoration of a normal cardiac rhythm. The initial serum potassium level was 2.0, undoubtedly the cause of her cardiac arrest. Terri had a history of erratic eating habits, including probable bulimia, with a major weight loss several years before this event. In high school it has been reported that Terri went from over 200 pounds down to 110. In November 1992 Michael Schiavo won a malpractice suit against Terri’s physicians for failing to diagnose her health problems leading up to the cardiac arrest resulting directly from her eating disorder. (12-13)
Terri was in a coma for approximately one month, and then evolved into a vegetative state. Four board-certified neurologists in Florida consulting on her care (James H. Barnhill, Garcia J. Desousa, Thomas H. Harrison, and Jeffrey M. Karp) had repeatedly made a diagnosis of PVS over the years. The initial CT scan on the day of admission, February 25, 1990, was normal but further CT scans documented a progression of widespread cerebral hemisphere atrophy, eventually resulting in CT scans of 1996 and 2002 showing extreme atrophy (CT scans-1996, 2002: “diffuse encephalomalacia and infarction consistent with anoxia, hydrocephalus ex vacuo, neural stimulator present); prior to these most recent two CT scans, CT scans had been performed on February 25, 1990, February 27, 1990, and March 30, 1990, with an MRI scan on July 24, 1990.The two most recent EEG’s have demonstrated no electrical activity-on July 8, 2002: “no evidence of cerebral activity;” and October 4, 2002-“does not have any definite brain activity. However, most of the tracing is obscured by artifact from muscle and eye movement.” The clinical exams over the years were entirely consistent with diagnosis of permanent vegetative state secondary to hypoxic-ischemic encephalopathy. From the initial hospitalization in February, 1990, until the present time, there have been no significant changes in Terri’s neurological findings, and nothing in the medical records to suggest any disagreement whatsoever among Terri’s attending and consulting physicians about the underlying diagnosis and prognosis for recovery. A deep brain stimulator was placed in Terri’s brain on December 12, 1990 at request of the husband who flew with his wife to San Francisco for the procedure. This highly experimental form of medical treatment did not result in any clinical improvement in Terri’s condition. (14)
History of disagreement between Michael Schiavo and Schindler family
With respect of the history and evolution of the major disagreements between Michael Schiavo, Terri’s husband, and the Schindlers, her parents as well as her siblings, it may be worthwhile to quote from a presumptively disinterested source, Judge George Greer. In an order he filed on February 11, 2000 (In re: The Guardianship of Theresa Marie Schiavo, In the Circuit Court for Pinellas County, Florida, Probate Division File No. 90-2908GD-003), Judge Greer states: “During the period of time following the incident of February 25, 1990, the parties worked together in an attempt to provide the best care available for Terri Schiavo. On February 14, 1993, this amicable relationship between the parties was severed. … The parties have not spoken since that date.” (p. 2). The judge further noted that, “By all accounts, Mr. Schiavo has been was [sic] very motivated in pursuing the best medical care for his wife…It is undisputed that he was very aggressive with nursing home personnel to make certain she received the finest of care.” (15)
On Valentine’s day, 1993, three years after Terri had been in a permanent vegetative state, both the Schindlers and Michael Schiavo agree that Michael and his father-in-law had an ugly fight over what kind of treatment the money received from the malpractice suit would go toward, with the Schindlers advocating rigorous therapy and Michael wanting only basic care in view of her hopeless prognosis for neurological recovery, the medical opinion that Michael had received from Terri’s doctors in the first few years of her hospitalization. (16) (“With His Wife in Limbo, Husband Can’t Move On,” New York Times, p. 14, November 2, 2003, by Abby Goodnough)
Judge Greer further noted that, in 1994, when Mr. Schiavo attempted to refuse medical treatment for an infection being experienced by his wife, the Schindlers filed an action to have him removed as guardian based upon numerous allegations, including abuse. Apparently this was the first legal action filed in this case by either side, so the Schindlers and Michael Schiavo have been involved in a legal battle over the appropriate treatment for Terri for over 10 years, far longer than any other right to die case in American law. Even the Nancy Cruzan case, from the initial legal proceedings in October 1987, to the U.S. Supreme Court decision on June 25, 1990, and her subsequent death on December 26, 1990, lasted only slightly longer than 3 years (17-18) (see Long Goodbye, The Deaths of Nancy Cruzan, by William H. Colby, Hay House Inc., Carlsbad, California, 2002).
When Michael Schiavo went to court in 1998 for permission to have his wife’s feeding tube removed, the Schindlers immediately challenged him.
In Judge Greer’s order of February, 2000, he ruled that Terri Schiavo’s previous oral declarations, including “I don’t want to be kept alive on a machine,” were “reliable,” “credible,” and rose to “the level of clear and convincing evidence,” consistent with the substituted judgment standard adopted by the Florida supreme court in two separate decisions, John F Kennedy Memorial Hospital v Bludworth in 1984 and Browning in 1990. (19)
Additionally, Judge Greer found that, “beyond all doubt,” based on “overwhelming credible evidence” from the testimony of Dr. Vincent Gambone, Terri’s treating physician, and Dr. James Barnhill, a consulting neurologist, Terri was in a persistent vegetative state as defined by Florida statues Section 765.101. (20)
Evidentiary trial, October 2002
After Judge Greer made this ruling stating unequivocally that Terri was in a persistent vegetative state and found clear and convincing evidence of Terri’s wishes in this situation, the Schindlers appealed to the Florida court of appeals. As part of their appeal, the Schindler family submitted a 113-second videotape, accompanied by multiple affidavits from various health care professionals saying patient was not in a vegetative state. Because of these videotapes, and notwithstanding the previous definitive ruling by the trial court judge on Terri’s neurological condition and chances for recovery, the court of appeals ordered the trial court to conduct an extremely thorough evidentiary hearing, the most complex evidentiary process in over three decades of landmark right to die court cases. Many of these affidavits contain the completely erroneous assertion that Terri’s ability to handle her own secretions was incompatible with the vegetative state. None of these medical professionals (including internists, rehabilitationists, speech pathologists, and others) who submitted these multiple sets of affidavits over the years at the behest of the Schindlers, had ever personally examined the patient, reviewed the medical records in any detail, considered the medical opinions of the consulting neurologists, nor looked at the CT scans or EEG’s. They instead relied on the brief videotapes showing Terri apparently interacting with her parents and noting that Terri could handle her own secretions. A few of these medical professionals did go to the bedside with the Schindler family to make observations about Terri’s apparent interactions with her family but none performed a complete neurological examination. All the videotapes released by the Schindlers to the media that I have seen are not only entirely consistent with the vegetative state but also, to the trained eye of any doctor experienced in the diagnosis of the vegetative state and related conditions, are completely compatible with the fact that Terri is in a vegetative state. For example, if one looks at Terri’s eyes closely during these videotapes, it is reasonably evident that she does not sustained visual pursuit, nor visual fixation, even when the mother is directly in front of the patient and Terri apparently “smiling” at her mother. Sustained visual pursuit (visual tracking) is almost always the cardinal feature distinguishing patients in a vegetative state from those with any degree of cognitive functioning. And the first sign of evolving from the vegetative state to a higher level of cognitive functioning, e.g. the minimally conscious state, is almost invariably the presence of sustained visual pursuit on a consistent, sustained, and reproducible basis, a physical finding that Terri Schiavo has never demonstrated.
In this evidentiary hearing that took place over six days in October, 2002, six physicians testified about the neurological condition of Terri Schiavo: Victor Gambone, the primary attending physician caring for Terri Schiavo for many years; William Maxfield, a radiologist, and William M. Hammesfahr, a Florida neurologist, representing the Schindler family; Melvin Greer and Ronald Cranford, neurologists, representing Michael Schiavo, and the expert appointed by the court, Peter Bambakidis, from Cleveland, Ohio.
It is important to fully understand and appreciate two separate and distinguishable medical facts- 1) the current diagnosis (vegetative state, minimally conscious, locked-in, brain dead), and 2) the potential for neurological recovery and potential response to treatment or rehabilitation. In previous cases medical professionals have disagreed as to whether the patient was vegetative, or minimally conscious, or locked in, depending on their interpretations of the clinical findings on examination. However, in none of these other landmark cases, until Schiavo, has any medical expert seriously argued that these patients had any meaningful chance for recovery or had a reasonable chance of responding to various treatments.
At this evidentiary hearing, the trial court heard testimony from the radiologist and neurologist testifying at the behest of the parents that, not only was Terri Schiavo not in a vegetative state, but also that she had a good chance of further recovery with treatments (hyperbaric oxygen and vasodilator therapy) recommended by these physicians. The following is a sample of the completely fallacious opinions rendered about Terri’s medical condition by Drs. Maxfield and Hammesfahr. Twelve years after an hypoxic-ischemic insult, and serial CT scans showing extremely severe atrophy of the cerebral hemispheres, both doctors said there was a “chance for recovery,” with the potential for response to treatment. Dr. Maxfield testified that “abnormal brain dissolves, so what’s left [as seen in the CT scans] is “normal, functioning brain.” He further stated that the most recent CT scan shows “improvement.” They gave no published data to support their opinions on their proposed treatments of HBO and vasodilator therapy but instead presented an infomercial style approach of anecdotal cases of dramatic responses to their therapies. There are no credible articles in the peer-reviewed medical literature on HBO or vasodilator therapies as effective treatment for patients with chronic brain damage. The articles on the internet on vasodilator therapy, including those by Dr. Hammesfahr, are extremely poorly written, and only a cursory examination of these articles would tell any medical professional that they could not have possibly been peer-reviewed. (21)
At this evidentiary hearing, the doctors were not allowed to comment on the testimony of the other five physicians, However, at one point, the attorney representing the parents of Terri Schiavo, Patricia Anderson, asked for my opinion after hearing some of Dr. Hammesfahr’s views. My reply was, “It makes me ashamed of the medical profession.” After Ms. Anderson strenuously objected to my answer as “non-responsive,” the judge replied, “Well, it seems, Ms. Anderson, you asked Dr. Cranford a question, and he answered it.” (22)
Judge George Greer’s decision from evidentiary hearing in October 2002
After these six days of testimony at this evidentiary hearing, allowing one day for each of the five experts and Terri’s attending physician, Judge Greer rendered his findings of fact on the neurological condition of Terri Schiavo, the possible beneficial effects of specific medical treatments for the patient, and the potential for rehabilitation Of the 8 neurologists either consulting directly on the care of Terri Schiavo (4), or testifying at this hearing in October 2002 (4), only one, Dr. William Hammesfahr, is not a member of the American Academy of Neurology according to 2003-2004 membership directory.
Here are some representative quotes from the trial court judge (George W. Greer, Circuit Court, Pinellas County, Florida, File No. 90-2908-GD-003) “The court also received into evidence numerous exhibits including copies of published medical articles, copies of summaries of published medical articles, CT scans and videos of medical examinations” (p. 2)… “The court also had the opportunity to observe the witnesses when they testified, to note body language, pauses, inflections and other non-verbal factors utilized in determining credibility which would not appear in a transcript of these proceedings.” (p. 2) (all emphases added) (23)
“These two sets of opinion had little in common.” (p. 4) “Those who felt that she was in a persistent vegetative state felt that her actions were neither consistent nor reproducible but rather random reflexes in response to stimuli.” (a central point and quoting directly from Multi-society PVS Task Force report, a very encouraging indication, and a rejection of the blown-up picture of Terri smiling, but not looking, at her mother-characterized by myself in court as “cheap sensationalism) (p. 4)
With respect to the judge’s opinion of the credibility of the medical experts designated by the Schindler family, he said: “Dr. Hammesfahr testified … he gave 105 commands … Mrs. Schindler gave an additional 6 commands … he asked her 61 questions and Mrs. Schindler, at his direction, asked her an additional 11 questions. [total 183]. The court saw few actions that could be considered responsive to either these commands or those questions. While Dr. Hammesfahr testified that she squeezed his finger on command, the video would not appear to support that and his reaction on the video likewise would not appear to support that testimony.” (p. 5) (24)
“…It is clear that this therapy (vasodilatation therapy) is not recognized in the medical community. …What undermines his [Hammesfahr] credibility is that he does not present to this court any evidence… he offered no names, no case studies, no videos, and no tests (sic) results to support his claim that he had success in all but one of them. If his therapy is as effective as he would lead this court to believe, it is inconceivable that he would not produce clinical results of these patients that he has treated. And surely the medical literature would be replete with this new, now patented, procedure. Yet, he has only published one article and that was in 1995 involving some 63 patients, 60% of whom were suffering from whiplash (p. 7). (For a review of Dr. Hammesfahr’s use of transcranial Doppler testing and vasodilator therapy, see the comments by Dr. Steven Novella on www.quackwatch.com, most recent revision February 14, 2000). (25-26)
“It is clear from the evidence that these therapies [hyperbaric oxygen and vasodilatation] are experimental insofar as the medical community is concerned with regard to patients like Terry (sic) Schiavo which is borne out by the total absence of supporting case studies or medical literature. … The other doctors, by contrast, all testified there was no treatment available to improve her quality of life. They were also able to credibly testify that neither hyperbaric therapy nor vasodilatation therapy was an effective treatment for this sort of injury.” (p. 8) (27)
…The court finds that the credible evidence overwhelmingly supports the view that Terry (sic) Schiavo remains in a vegetative state.” (p. 6). (28)
In my own personal experience in fifteen landmark right to die courtroom cases in the United States over a span of three decades, there has never been such unbelievably false and misleading medical testimony as in Schiavo, including the retired radiologist, Dr. Maxfield, whose specialty is the use of hyperbaric oxygen treatment, and the Florida neurologist, Dr. Hammesfahr, whose specialty is the use of vasodilator therapy in a wide variety of neurological diseases. Fortunately, the videotapes of these examinations shown at trial completely undermined these two experts’ opinions.
The Schindler family, Pat Anderson, the Schindler lawyer, various vitalist groups, and the two physicians testifying at trial on behalf of the Schindlers, as well as numerous health care professionals signing affidavits who never examined Terri but instead relied on the short videotapes, have consistently maintained the following facts-Terri Schiavo is aware, responsive, follows commands, smiles in response to the family, and has emotions; the videotapes are important because they show that “Terri is a person,” and that she can respond, follow commands, smile in response to her mother, and visually track objects placed in front of her; she will improve with appropriate treatment and rehabilitation; she has the ability to swallow; the reason she can’t swallow well now is because she has been denied appropriate medical treatment for years. However, the trial court judge and the appeals court justices have stated that Terri Schiavo is in a permanent vegetative state and that no treatment is available to restore her neurological functioning, consistent with the opinions of four neurologists directly involved in the care of Terri Schiavo over 15 years, and the three neurologists testifying at trial (two selected by Michael Schiavo, and the other selected by the trial court judge when Michael Schiavo and the Schindlers were unable to agree on a neutral court-appointed medical expert).
These presumed neurological facts and assertions by the Schindler family, their lawyer, Pat Anderson, and others about Terri’s neurological condition are all completely and categorically false, with one exception. Patients in a vegetative state usually retain an intact swallowing reflex and thus can swallow to some degree in an involuntary, reflex fashion. Swallowing tests performed on Terri Schiavo in 1990, 1991, and 1992 all showed severe oropharyngeal dysphagia, compatible with the vegetative state. No further swallowing tests were ever performed again in her subsequent clinical course, since Terri Schiavo never improved, and there was no valid reason for believing these swallowing tests would be any different today than they were over 10 years ago. Thus, Terri Schiavo does have the ability to swallow, like most other patients in a vegetative state, but only in a reflex fashion. The majority of adult patients in a permanent vegetative state, like Terri Schiavo, are given nutrition and hydration by a PEG tube placed in the stomach through the abdominal wall. This form of medical treatment is the safest and most effective way of supplying long term nutrition and hydration to an unconscious patient. (29)
It is possible (but highly unlikely) that, with a great deal of attention and care, and an understanding of how to optimize swallowing by using the involuntary swallowing reflex, Terri’s nutritional and hydration needs could be maintained by the oral route (as is the case in many children in a permanent vegetative state, where parents and health care professionals spend many hours at the bedside feeding these children by mouth by utilizing the involuntary swallowing reflex). But such an undertaking is medically inadvisable, as it would greatly increase the risk of aspiration pneumonia and death.
The overwhelming fact is that, whether Terri is fed via a PEG tube or fed orally, she is still in a permanent vegetative state, and the manner of feeding her will not result in any change in her clinical condition, except she would probably die much sooner were attempts made to feed her orally. So further swallowing tests would be totally meaningless in terms of the ultimate outcome of Terri’s neurological condition and state of consciousness.
Florida court of appeals decision
In its ruling in June 6, 2003, the Florida court of appeals concluded (in Schiavo IV, because this court had already addressed this case on three previous occasions) that the trial court had complied with the instructions of the higher court in terms of the elaborate evidentiary process to be followed.
Part of the reason why the court of appeals ordered a detailed evidentiary hearing on the medical facts of the case was the affidavits presented to the higher court by the Schindler family of doctors and other health care professionals stating under oath that new treatments could possibly improve Terri’s level of functioning. As the appeals court noted, “…Although we have expressed some lay skepticism about the new affidavits, the Schindlers now have presented some evidence, in the form of the affidavit of Dr. [Fred] Webber, of such a potential new treatment.” Later, the court “anticipated but did not require that Dr. Webber, who had claimed in his affidavit that he might be able to restore Mrs. Schiavo’s speech and some of her cognitive functioning, would testify for the parents and provide scientific support for his claim. However, Dr. Webber, who was so critical in this court’s decision to remand the case, made no further appearance in these proceedings.” (30)
This type of unprofessional affidavits and court testimony by the physicians and medical professionals is typical of the vast majority of medical experts and their opinions retained by the Schindler family, e.g. the opinions expressed by Judge Greer on the credibility of Dr. Maxfield and especially Dr. Hammesfahr. (See affidavits from Dr. Fred Webber, June 1, 2001; Dr. Jacob Green, May 30, 2001; Dr. William Scott Russell, May 30, 2002; and psychologist Alexander T. Gimon, May 29, 2001, as well as numerous other affidavits signed by doctors and other health care professionals in Florida and around the United States). Reflecting back on Judge George Greer’s original ruling in February 2000 that Terri was in a persistent vegetative state “beyond all doubt,” it seems readily apparent that the Florida court of appeals was substantially, but fortunately only temporarily, misled by these affidavits based on the videotapes.
Even though the court of appeals could have affirmed the trial court opinion on procedural grounds (ensuring that the guidelines for the evidentiary hearing were properly executed) and gone no further, the court did go further and ruled on the factual issues as well. “Despite our decision that the appropriate standard of review is abuse of discretion [by Judge Greer], this court has closely examined all of the evidence in this record. We have repeatedly examined the videotapes, not merely watching short segments but carefully observing the tapes in their entirety. We have examined the brain scans with the eyes of educated laypersons and considered the explanations provided by the doctors in transcripts. We have concluded that, if we were called upon to review the guardianship’s decision de novo, we would still affirm it.” (31)
Why have the three judges on the court of appeals bent over backwards to listen carefully to the concerns of the Schindlers over these many years, including ordering a full scale evidentiary hearing on Terri’s medical condition after all the other legal issues had been fully litigated, and the trial court judge had ruled in February 2000 that Terri Schiavo was in a persistent vegetative state “beyond all doubt”? Besides the obvious and to some extent understandable motivations of judges being afraid of making mistakes (especially on the medical diagnosis), their natural tendency to err on the side of life (rather than erring on the side of privacy), and their appropriate concern about due process in cases of a highly controversial nature, a partial answer to this question has been supplied very directly by the judges themselves. By revealing a human side of their decision making process (something that many judges are not usually willing to admit), they explicitly reflect their great sympathy and empathy toward the parents of Terri Schiavo, “The judges on this panel are called upon to make a collective, objective decision concerning a question of law. Each of us, however, has our own family, our own loved ones, our own children. From our review of the videotapes of Mrs. Schiavo, despite the irrefutable evidence that her cerebral cortex has sustained the most severe of irreparable injuries, we understand why a parent who has raised and nurtured a child since conception would hold out hope that some level of cognitive function remained. If Mrs. Schiavo were our own daughter, we could not but hold to such faith.” (p. 10). In other words, the judges, while clearly sympathetic to the feelings and concerns of the Schindlers, nevertheless based their decisions on the facts and the law. (32)
The irony of this case is that videotapes have been used for entirely two purposes, and both have been highly successful. The first use, by the medical experts examining Terri, showing the trial court (and even the court of appeals) the validity of their observations and conclusions about Terri’s condition, worked extremely well. The videotapes, when properly explained to the trial court and used by these experts as a highly effective means of educating the judge on the complexities of the diagnosis of the vegetative state, strongly confirmed the validity of the observations and conclusions of the experts testifying the Terri was indeed in a permanent vegetative state with no meaningful interactions with others or the environment. At the same time, the tapes made by Dr. Maxfield and Hammesfahr led to Judge Greer’s completely discrediting the observations of these experts opining that Terri was demonstrating cognitive functioning to some extent, e.g. Judge Greer, by his own count, disagreeing explicitly with the observations of Dr. Hammesfahr on 183 occasions.
The second use of the videotapes (released by the Schindler family and the vitalists) was to mislead much of the media and public into believing that Terri could meaningfully and cognitively interact with her parents and thus was not in a vegetative state. For those members of the unsophisticated and uneducated public and media who have never seen a patient like this and thus had no way of recognizing the typical features of someone in a vegetative state, this strategy of misinformation has also apparently been highly successful.
Further proceedings and current state of case
In late August, 2003, the family had brought forward evidence after yet another review of the medical records indicating that patient may have been strangled by the husband, thus requesting appointment of a guardian ad litem to represent patient during further judicial proceedings. The court denied this motion. The governor of Florida, Jeb Bush, after receiving 27,000 e-mails (characterized by some observers as a “high tech lynch mob”), wrote a letter to Judge George Greer requesting further judicial proceedings to safeguard the rights of Terri Schiavo. The Schindler family brought forward yet another set of affidavits from various health care professionals expressing their views that Terri Schiavo should be administered a new round of swallowing studies to determine if she has the ability to take fluids and nutrition by mouth.
Six days after Terri’s feeding tube was removed, the Florida legislature passed a law and immediately signed by the governor all in one day, which had 4 components-for a person in a persistent vegetative state who has no living will, whose feeding tube has already been removed, and where a family member objects, the feeding tube will be restarted (note: this is not the exact wording of the law but my interpretation of the essence of the law). (33) On that same evening, Terri Schiavo was removed from her current facility and transferred under police escort to a Clearwater hospital where a feeding tube was reinserted, and artificial means of nutrition and hydration restarted.
In late October 2003 Michael Schiavo through his attorney challenged the actions of the governor and legislature on the constitutionality of the new law. The new law essentially overrules all the decisions of the Florida courts where every major legal source of dispute had been fully litigated, and the courts had previously rendered definitive decisions in favor of Michael Schiavo in terms of the appropriate surrogate decision maker, the wishes of Terri Schiavo according to a clear and convincing evidence standard, and the medical condition of the patient. In 2004 the Florida Supreme Court unanimously ruled that the Florida law enacted by the legislature and governor was unconstitutional. (34)
Concluding comments
In any case of a severely brain damaged patient involving extensive, prolonged, and heated litigation, especially when the major disputants are the immediate family, the question always arises, who really suffers the most? Not the patient in the vegetative state, who is unconscious and thus incapable of any suffering. Perhaps the husband whose wishes are being seriously undermined and who almost certainly does know what his wife would want, or what most of us would want for ourselves, in this situation. But, even though I disagree with their views, a strong case can be made that the ones suffering the most are Terri’s parents and other family members. Outside doctors and medical advisors have cruelly deceived them into believing that Terri will improve, or has a chance for improvement with various treatments advocated by these individual doctors. So this family, cruelly misled by blatant distortions of fact and thoroughly unprofessional advice, believes that letting Terri die now takes away any opportunity, any slim chance, that she will receive “appropriate” treatment in order to recover. They feel like they are the last chance that Terri will ever have, and they are acting according to these strong (but unfortunately terribly mistaken and ill informed) beliefs.
The Schiavo case provides powerful and compelling evidence of the importance of videotaping of the neurological examination. In future landmark right to die cases, especially when there is a serious dispute about the actual neurological condition, videotaped neurological examinations should be considered an essential element of expert medical testimony at trial. The judge’s assessment of the conflict between the trial testimony of medical experts retained by the Schindlers, and the actions seen on the tape itself, should serve as a compelling example of the value of videotaping. Also the probative weight of the brief video of Terri “interacting” with her parents, the accompanying affidavits of numerous physicians, and the still photos of the daughter apparently “smiling” at her mother, should stand in contrast to the videos of the examinations performed by the neurological experts which were shown at trial. The neurological examinations performed by Drs. Bambakidis, Greer (Dr. Greer did not have his examination videotaped), and Cranford each lasted between 25 minutes and 1 hour. The neurological examination by Dr. Hammesfahr lasted over 3 hours, but, when Judge Greer compared the videotape of his neurological examination with his testimony and explanations in court, the judge found no credibility in Dr. Hammesfahr’s neurological assessment of Terri Schiavo’s condition. A “neurological examination” by Dr. Maxfield, the radiologist, essentially never occurred.
What are the lessons to be learned from the Schiavo case? 1) When there is extreme disagreement and bitter acrimony between family and husband, it is extremely difficult to resolve disputes in a highly adversarial atmosphere, rather than consensual attempts to resolve disputes advocated by hospital ethics committees. Every possible effort should be made to resolve disputes among immediate family outside of a courtroom setting. 2) Prolonged legal maneuvers and unusual, desperate legal strategies by the Schindlers and their supporters, have caused the Florida court system to deteriorate into a state of inaction and impotence; 3) This case illustrates the crucial significance of the correct medical diagnosis and also exemplifies the critical importance of differentiating between diagnosis of the neurological condition (vegetative state) versus the prognosis for recovery and potential response to new treatments; 4) This case demonstrates convincingly the value of videotaping to accurately explain to the court the neurological condition, as well as the unfortunate success of misleading the media and public on the same condition; 5) The credibility of experts and their testimony can usually be determined by a trial court judge; credibility is not usually based on testimony of experts who insult the intelligence of the court, e.g. judge appreciated sincerity of the court appointed expert who “agonized” over his diagnosis. Despite strong views of medical experts testifying for the Schindler family, the trial court judge simply did not see what these experts said was there; 6) The hastily passed and blatantly unconstitutional law approved by the governor and state legislature completely usurped the role of the judicial system in Florida, an action unprecedented in the history of American law and a complete disregard for the principle of separation of powers of the three branches of government".
Duke
Schiavo - Dr. Cranford Offers a Reply
My opinion, expressed in my original post
here, complete with an update referring to both Hugh Hewitt's and Captain Ed's posts on the NRO article, indicated an aversion to political/media involvement in this long-disputed case.
Following a review of the NRO article, I emailed Dr. Ronald Cranford, the expert for Terri's husband in the original trial, and asked his response to the NRO story allegations.
Here is his complete email response which he offered quite promptly, and which seems to answer the NRO charges.......
"----- Original Message -----
From: Ronald Cranford MD
To: Paul Duke Deland
Sent: Friday, March 18, 2005 12:37 AM
Subject: Re: Information Please
For your information and background on the facts of the Schiavo case, I've attached a background memo prepared by myself and a letter on the issue of a medical panel suggested by Art Caplan. I believe this material will address many of your questions, but here are a more comments.
An MRI was never recommended because, in this case and other patients in a permanent vegetative state, the CT scans were more than adequate to demonstrate the extremely severe atrophy of the cerebral hemispheres, and an MRI would add nothing of significance to what we see on the CT scans. Plus the MRI is contraindicated because of the intrathalamic stimulators implanted in Terri's brain. A PET scan was never done in this case because it was never needed. The classic clinical signs on examination, the CT scans, and the flat EEG's were more than adequate to diagnose PVS to the highest degree of medical certainty, along with the credible testimony of the three neurologists at the longest evidentiary hearing in American law, whose opinions were strongly affirmed by the trial court judge and three appeal court judges. Please see Judge Greer's opinions on the credibility of the experts testifying on behalf of the Schindler family.
In addition, the only PET scan center in the country I would trust right now for doing the PET scan for the determination of PVS is New York-Cornell Medical Center with Niko Schiff. There are other PET scan centers in the US (such as in Miami and Atlanta which I contacted in 2002 as to the feasibility of doing a PET scan at these centers), but the only one doing top quality work with the precision necessary for PVS is the one in New York.
I do not believe there are "a number of other prominent members of your field" who feel these other tests should be done, because these "other prominent members" are physicians with strong conservative credentials who obviously don't know the facts of the case, and some of these physicians have "credentials" similar to Dr. Maxfield and Dr. Hammesfahr (the "HBO and vasodilator experts"). Where were these physicians earlier in the case when they could have examined Terri and testified at trial on behalf of the Schindler family, instead of the two doctors whom Judge Greer found not very credible?
The calls for new tests on Terri are nothing more than one of several last minute desperation moves by the Schindlers and their supporters to delay the withdrawal of the feeding tube from Terri. There has never been a more extensively litigated case in the history of right to die cases in terms of the length of the entire litigation itself, and the extensive medical testimony during the elaborate evidentiary hearing of 2002, and the thorough review of this medical tesimony by the appeals court.
As for the National Review Online article, I stand by my record. The record is very clear that I did not testify that Robert Wendland was in a PVS, and the same applies for the case of Michael Martin in Michigan. Both these patients were clearly not PVS (see Broder AJ, Cranford RE. Mary, Mary, Quite Contrary, How Was I to Know? - Michael Martin, Absolute Prescience, and the Right to Die in Michigan. University of Detroit Mercy Law Review, 1995; 72:787-832. and Nelson LJ, Cranford RE. Michael Martin and Robert Wendland: Beyond the Vegetative State. Journal of Contemporary Health Law and Policy, 1999;15:427-453). In all the major right to die cases on a national level in which I have testified or been heavily involved with (including Brophy, Rosebush, Torres, Cruzan, Busalacchi, Ellison, Butcher, Martin, Wendland, and now Schiavo), my neurological diagnosis and the final opinions of the courts were identical (except for some legitimate differences of opinion on the degree of cognitive functions in Wendland). So my record stands for itself.
I feel that I am well-qualified as a national expert in this field of the neurological diagnosis of severely neurologically impaired patients, and the opinions I, and other qualified neurologists, expressed in Schiavo were strongly endorsed by the trial court and appeals court judges.
Thanks. Any further questions?
Dr. C"While the email is a bit long, Dr. Cranford's reply includes two additional items which shed some light on the subject, but are quite lengthy.
I will be following, in my next post, with one of his additional pieces...an extensive timeline, and summation of the entire case.
My opinion, following review of both the NRO story and Dr. Cranford's materials, remains the same. I believe the media circus, legislative intrusion into judicial areas, etc. is wrong. The conclusion of the case, albeit hard and against the grain for those among us who feel there might be a chance for some cognitive recovery by Terri, should be in accordance with more than ten years of complete legal exploration of the case; not by a media-driven, emotion-charged legislative intrusion! I am quite sure any legislative effort to compound laws based on one case will ultimately come back to bite us....with quite possibly disasterous long-term results.
As my original Schiavo post stated; I am sorry for all involved....however, it is time to let this go.
More to follow.....
Duke of DeLand
UPDATE: Here is link to the complete 17 page report by Dr. Cranford. It is a LONG read, but I also give you a short cut to the Summation, if you wish to cut it short.......
GO HERE for the report!UPDATE 2: Thanks to
Respectful of Otters for the link and traffic.
Duke
Let's see.....can we view the entire picture?
This is going to be a stretch.....You have to work with me here, and see what all this means as I am viewing the process....
Bush invades Iraq.....is opposed, derided, abused, etc.
Iraq, in January 2005, votes 8 million strong for freedom and the right to have their own country!
Now the dominoes fall.......
Lebanon citizens are reaching out, taking control, and are NOT afraid any longer of the Syrian idiots who have ruled them....they in fact are cowing the Hezbollah minions into silence, and eventually into surrender as they find themselves in the minority position.
Now Bush speaks with a sharp rapier tongue.....
Condi to Secretary of State
Bolton to UN
Hughes to Asst Sec. of State
Wolfowitz to World Bank.....
Do you hear the sounds of: "slap, slap, slap, slap"??????
The world, vis-a-vis the French, Germans, and Russians, as well as the other so-called "Euro-weenies" as Boortz terms them, are being told.....Get a grip folks, we are "THE MAN"...and we are running the show.....
Fade to the pic of Chirac with a loser expression.....and Putin knowing he is next!
Yes Sir, Yes Sir.....
Ya gotta love it!
Duke
Prattles Makes Carnival of The Vanities
The weekly multi-post
Carnival of The Vanities is up, and our story on Terri Schiavo is one of those named in the Carnival.
Be sure to stop by and read a lot of interesting and varied stories/posts....
Thanks to "Bird" for the inclusion!
Duke
The Terri Schiavo story mentioned on Carnival is located
Here!!!
Minutemen ride again!
One thing I cannot, for the life of me understand, is President Bush's REALLY bad decisions re: illegal immigrants, and the completely OPEN Mexican border.
He is a Texan, but the facts speak of some major problems with the borders....WAY beyond the simple fact of millions of illegals in the country working for defense contractors, naval bases, nuclear stations, etc.......
The LARGEST problem is the fact of EASY entry of WMD, "Dirty Bombs", etc. because we have NO border control to speak of.
I cannot justify any Bush arguement on this point. We NEED protection, vis-a-vis 9/11. It is fact.....what IS his problem with this.
In my humble opinion this could be the lynchpin of what will unravel an otherwise fine GOP control of the elections for years to come.
MOST voters are dismayed by the illegals, the potential for terrorist invasion via Mexico.
Bush seems not to hear!
There are many who are trying
Like the Minutemen!
Someone tell me what Bush is for in this area, cause limited response is NO response to my mind!
Duke
Social Security Reactions Reversed?
My local discussions with folks of varied ages, re: the SS changes/need for changes, to provide the opposite from each age group that I would expect.
The Dutchess and I work in an area where many younger folks are employed. Their reaction in discussions seems to support the need for change...but an attitude that nothing will change, therefore they need to prepare for their incomes on retirement separately from any SS "help".
In my local involvement with folks our age (early 60s), they seem opposed to any change, despite assurances that they, age 55 and up, will NOT be impacted.
I understand the liberal leaning of the AARP, and am a member despite my complete feeling that the organization does not listen to its members at all, but rather makes every effort to tell the members how they should be thinking, and to scare them into doing just that.
I cannot believe the Dems have done such a 180 on the need for SS change....and could never explain it as well as
Michael Tanner of Cato's Project on Social Security Choice does in his article on Foxnews.com.
Somehow the media, plus a liberal AARP, and including Democrats who seem clueless about how to address this issue are creating an atmosphere of fear and uncertainty which will doom us to let the next generation deal with the problem....by then it will be much too late to salvage the system and still provide a decent income for the recipients who follow my age group.
Duke
Unions - A Democratic Role Model!
Just when you thought nothing could get worse for the Democrats.....er UNIONS!
The UAW trips on its own tangles, and falls into a deeper pit of obsolescence!
Check out
Blackfive for the program.....
The UAW has descended much, much further into irrelevance!
What a joke......the unions, composed of Marines, former Army, former Navy, etc. have tried to "editorialize" against any Marine with a "Bush Bumper Sticker", and driving a "foreign car" (what the hell.....most "foreign" brands are built HERE in the USA today, you village idiots!)
Unions should set a schedule for self-destruction....to avoid being more embarassed...er, wait, they already are doing that!
Duke
Memories....
I have begun a second blog, one in which I will be relating some memories of my youth in Pekin, IL.....a small farmtown located along the Illinois River, and about ten miles downstream from Peoria.
Today I offer a look back at a memory of cookies in a kinder, gentler time.... Check it out at:
The Pekin We Remember.
Duke
Go Bolton Go! - Right to the UN!
No less than Ollie North has weighed in to support our new nomination to the UN... Read his excellent piece, a letter to Mr. Bolton,
right here!AMEN!
I can't wait to watch Bolton create a little terror of his own in this liberal American-Hating body.......Maybe he'll also recommend we reduce our $ dump into the UN coffers to match the responses against us!
Ya Gotta Love It!
Duke
Schiavo Becomes an Icon...for no reason!
I am sorry......
I am sorry for the parents of this "brain-dead" woman.
I am sorry for the husband who has lived with this for more than 10 years.
I am sorry for the public who is drawn into the debate by the efforts of many who are seemingly "good" people....
Teri died many years ago.Her body lives on......
EVERY court decision for the many long years has been that she is in a vegatative state.
EVERY ONE of them!
There have been specialists, doctors, etc. ALL have agreed that she is brain dead. Her body gives some responses based upon basic response mechanisms which SEEM to be live.....the docs say they are NOT!
The compelling arguement is that she "needs" treatment.....
The fact is, she will NOT respond to treatment....it has been tried!!!!!
It is SAD!
When do we say ENOUGH?
This woman, a beautiful young thing, died a death of the mind by deprivation of oxygen, basically.....
WE are perpetuating a myth that she lives.....her parents WISH, HOPE, PRAY, for this.....but their efforts are misguided.
GOD!
Do not let these folks decide I want to live, if I have the same or similar problems.
The smiling person that is presented on TV of this young woman, is a LIE!!!!!
She does not really respond, she does not have the capability to live, to eat, to be a person.
DON'T LET ME LIVE LIKE THIS!!!!!!
EVER!!!!!!
Duke
UPDATE: You may put on hold my above article as new information you can read on Hugh Hewitt & Captain's Quarters indicate a new side to treatment of Terri, or LACK thereof, by her husband could invalidate all action to date on this case...See
Hugh's and
Captain's articles for details while I explore the issue some more.
Fatwa against Osama???? WOW!!!!
This has to grate with the Islamofascists.......
The Spain branch of their order has issued a FATWA......against
HIM!Check it
Here at FOX! I am, to say the least, surprised!
This must be something to shake the Islamic terrorists.....not because it invades their perview, but because it attacks one of the stalwart members of the group!
This could be really BIG!
Duke
The "Reformer" is About to be Reformed!
Senator McCain, "Mr. Campaign Reform", is in deep doo doo!
1st, before he became a reformer, Senator McCain was censured for his part in the infamous "Keating 5" fiasco.....noted
here by Captain Ed.....
Now it appears the same may be happening with a bit of a stretch on his rules through the good senator's own Reform Institute. Check this out also with Captain Ed who, as usual, is right on top of it
here.
I have a feeling a new "blogfest of the week" has been initiated.
Could this all be the plug-pulling action for the Senator's possible 2008 Presidential run?
I believe it could.....
One mistake can be forgotten....with the right PR, but two? No-No!
Duke
It's a RATHER Big Sendoff!
Michelle (My Gal) Malkin has a list of
REALLY big celebrations for the "DAN" of C-BS....as he leaves his post Wednesday!
It is worth the read, and then some......Go you gal!
Duke
p.s. Michelle, great new pic....but I loved the old one too....why not just set up a gallery for we Malkin Monkeys?
N. Korea - without the guilt!
I am amazed, and frankly for a person of my age; one versed in the traditions of journalism (albeit the lesser well thought of radio/TV versions); that fact in and of itself is astounding.
On PAGE 1 of the L.A.Times......Barbara Demick offers a story of such ignorant proportions regarding the N. Koreans as to be almost absurd.....
Check out her article
here.....then come back and check my response, which I am saving below.....
Back?
OK!
1st, as a newsman who took his craft very seriously, and his standards to be the complete guidelines of news.....I find her story enough to make grown men PUKE!
A single source, suspect at best, provides her attempted warm and fuzzy portrayal of N. Korean people as happy, settled, and family-oriented. BS!
What news did she miss?????
Millions have died, families are ripped asunder constantly, and as a matter of regular course......The entire country is in starving, deprived existance!
If this gal has a shred of decency she would walk away before she hurts herself with the sharp pen she obviously does not know how to handle!
Nuff Said!
Duke
Blogdom offers options.....
The amazing thing about blogdom is what it has added to our options. Instapundit offers, albeit not on purpose, the examples....
HERE.
I am amazed, and yet not....we often find ourselves behind the curve in realization of the blog-world's impact......
Go Blogs!
Duke
McCain-Feingold Fiasco! Bloggers, Rally Round!
The FEC, at least one of the three Dem members, is indicating an expansion of the McCain Feingold Bill to make illegal or at least VERY costly some blogging referring to or linking with Politicians sites.......Captain Ed has a quite nice letter to the senators and has also asked blogger help in getting the message to all 100 Senators....
Read it here and then send your own email/letter to your senators and advise Capt. Ed you did so. Then we can track how many of our senators are covered, and insure multiple letters to each....
Blogger Power.......USE IT NOW!
It may well impact you and your future blogging efforts....
I have sent to our Florida Senators......My own version of the letter.
Duke
UPDATE: Now a release from the McCain camp attempting (unsuccessfully) to refute the potential problem.....it's at
Democracy Project(HT to Instapundit!) Seems to me to muddy the area, rather than clear it, and certainly DOES NOT relieve my concerns!
Duke
UPDATE2: More and more and more.....at
Little Green Footballs which seems to say there is more to this than meets the eye from Mr. Smith......Let's watch as this unfolds.....
Duke
Everett McKinley Dirksen of Illinois
The late Senator Everett M. Dirksen, from my hometown of Pekin, IL, was quite an orator. In fact, in Illinois he was referred to as "the last of the great orators".
His voice and stories were even recorded in an album which was sold in Illinois.
As a young radio newsman in Pekin (WSIV), in the late 60s, I had the rare opportunity to interview "Ev", as he liked to be called, each weekday morning as he would call me at the station and allow open questioning. I sold a lot of his comments to AP & UPI, bolstering my income. We got along quite well, but Ev did not like ill-informed nor obnoxious newsmen.
In addition to having a huge, warm voice, he loved to tell stories. I actually participated in creation of one of those stories.
Sen. Dirksen, for many years, pushed the marigold as the national flower. To this day Pekin has an annual Marigold Festival each summer, and the town's medians are planted in the many colors of marigold available. His efforts, of course, never were successful.
After I had left Pekin, and moved on to News Director of a station in Joliet, IL, part of the Chicago market, I got a call from his press person inviting me to a Dirksen press conference in Lombard, IL. It seems Ev was keynote speaker at the banquet for the annual Lombard Lilac Festival.
I showed for the press conference the afternoon of the banquet, and during the conference a young newsman for a major Chicago station boldly tried to pin Dirksen for talking out of both sides of his face. "Sen.", he smiled, "Since you are the proponent of the marigold as the national flower, how can you justify being the keynote speaker at the Lilac Festival?"
Ev, missing not a beat, explained in his deep rumbling voice; "My young friend, you obviously do not understand that the marigold is a flower and the lilac a bush!"
Duke
We'll be gone in a FEW months!
Thus spoke Assad!
I am massively distrustful of the folk who want to impliment accords of more than 10 years ago....
The facts are displayed in
Post by Capt. Ed.
The Syrians are less-than-truthful in most of their offerings; however.....the new "Southwest Asia" as Capt. Ed appoints it, is aware, and following....
Duke
Bin Laden passes the buck!
MSM & bloggers both are hitting on the call by Osama to Zarqawi to hit the US in the US! See
Fox Net News take on it.....
One thing I have not seen addressed....
Why is Osama doing this? Does this possibly indicate Zarqawi is the only remaining viable/operational arm capable of this feat? Why have not Osama and his minions done so? No fire power left? No ability to enter the US with enough "stuff" to create the mess he obviously wants?
I hope I am not stepping too far into the field of optimism....but that seems to me a realistic assessment.
Duke
