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She never would have recovered

Massive brain damage had left her blind and unresponsive. The autopsy reveals no evidence of abuse. But what caused her heart to stop beating 15 years ago remains a mystery.

By LISA GREENE, Times Staff Writer
Published June 16, 2005

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Autopsy results
Do you think the results of Terri Schiavo's autopsy will end the controversy behind her death?
Yes, the results seemed conclusive.
No, there are still too many questions unanswered.

LARGO - In death, Terri Schiavo finally has answered some of the questions that remained locked inside her for 15 years.

After years of emotional debate that began among family and doctors and spread to courts and the highest reaches of government, a Pinellas County medical examiner on Wednesday laid out his conclusions in pointed, scientific language:

Schiavo's brain was profoundly damaged, so much so it weighed less than half that of normal, said Dr. Jon Thogmartin, the Pinellas-Pasco medical examiner who spent nearly 11 weeks preparing her autopsy report.

The damage was irreversible, he said, and no amount of therapy would have helped her improve from what most doctors called a persistent vegetative state.

She was blind. Damage to the occipital lobe of her brain destroyed the centers that would interpret what the eyes see. The finding surprised many; the idea had not been discussed in the massive attention given to Schiavo as the world debated the removal of her feeding tube. She died March 31, 13 days after the tube was removed.

Despite accusations from Schiavo's parents that Schiavo's husband harmed her, Thogmartin found no evidence that any traumatic injury, including strangulation, led her heart to stop in 1990, depriving her brain of oxygen.

But some mysteries may always linger about the woman who sparked an international debate over the sanctity of life and the right to die. Most of all, how did Schiavo get that way? What caused her heart to stop on the morning of Feb. 25, 1990?

Thogmartin threw more doubt on that question Wednesday. Although many believed an eating disorder caused Schiavo's crisis, there is little evidence to prove it, Thogmartin said at a news conference to release his autopsy report.

Schiavo's low potassium level soon after she arrived at the hospital has long been viewed as evidence of bulimia. But it could have been caused by her heart's irregular rhythm and the medical treatments that saved her life, Thogmartin said.

But Thogmartin can't point to anything else that caused her heart to stop, despite the autopsy, consultations with outside experts, exhaustive reviews of Schiavo's medical records, and interviews with friends and family members.

"I was looking for everything I could," Thogmartin said. "And it just wasn't there. I was grasping at straws."

Thogmartin labeled the official cause of Schiavo's death as complications from her brain injury. But the manner of her death - the cause of the brain injury - he listed as "undetermined."

The immediate mechanism of her death was dehydration, not starvation, Thogmartin said.

Lawyers for both sides of Schiavo's family thanked Thogmartin and praised his thoroughness. Thogmartin and his staff "poured their heart and soul into this effort," said David Gibbs III, attorney for Schiavo's parents, Bob and Mary Schindler.

Still, each side pointed to different aspects of the report. Schiavo's husband, Michael, was "very pleased" that Thogmartin's report supported many of his claims, said his attorney, George Felos.

Felos also noted the report found no evidence of abuse and determined Terri Schiavo's condition could not have responded to any treatment.

"The balance of the brain consisted of . . . scar tissue," Felos said.

Michael Schiavo has received autopsy photographs of his wife's brain and plans to make some of them public, Felos said. Under Florida law, such photos can't be obtained by the general public.

"He feels that it is extremely important for everyone to see what is so apparent from those photos: the profound atrophy," Felos said.

Gibbs pointed to Schiavo's overall health. Thogmartin commented on the strength of Schiavo's heart and said she could have lived another decade had her feeding tube not been removed.

"It demonstrated she had a strong will to live," Gibbs said.

But the report didn't end the Schindlers' questions, Gibbs said. The report couldn't rule out some traumatic injury. Gibbs also said that Michael Schiavo had said he found his wife, collapsed on the floor, at 4:30 a.m., but didn't call 911 until 5:40 a.m.

But Felos said Michael Schiavo called for help immediately and called Gibbs' remarks "a baseless claim to perpetuate controversy in this case that in fact doesn't exist."

On Capitol Hill, members of Congress who pushed through a last-minute law aimed at federal intervention said they don't have any regrets.

The goal of the law was to give the federal courts a chance to review the case, and Schiavo's poor medical condition doesn't change that, they said.

Rep. Dave Weldon, R-Palm Bay, a doctor who sponsored the bill in the House, also questioned whether Schiavo was truly blind.

"I stand by what we did," Weldon said. "You had the mother and father, brother and sister, screaming that she be kept alive, and the husband, I thought, was not credible."

Thogmartin called in a neuropathologist, Dr. Stephen J. Nelson, a medical examiner from Polk County, as a consultant to examine Schiavo's brain.

No one can say that Schiavo was in a persistent vegetative state based on the autopsy findings, Nelson said, because that's a diagnosis made on a living patient. There's no anatomical sign or proof of vegetative state, in which a person has no conscious awareness of their surroundings.

Even so, the widespread injury to Schiavo's brain was "very consistent" with vegetative state, Nelson said. Nerve cells had died throughout the brain. Schiavo's brain weighed 615 grams, or 1.35 pounds. Cerebrospinal fluid had replaced much of the area where brain cells once lived. Examiners found 678 grams of fluid in Schiavo's skull - more than the weight of her brain.

By comparison, the brain of Karen Ann Quinlan - at the center of a right-to-die fight 30 years ago - weighed 835 grams, Nelson said.

A Tampa neuropathologist who reviewed the Schiavo autopsy report Wednesday at the request of the St. Petersburg Times called Nelson's findings "carefully detailed," done by someone "clearly experienced" in neuropathology.

Those findings "at least in my mind, lay to rest any question" about Schiavo's extensive brain damage, said Dr. Amyn M. Rojiani, pathology professor at the University of South Florida College of Medicine and director of neuropathology and autopsy at H. Lee Moffitt Cancer Center & Research Institute.

Like Nelson, Rojiani said an autopsy can't prove a vegetative state. But the report shows massive damage. Nothing indicates Schiavo might have had more brain function than most doctors believed, said Rojiani, who was not involved in the Schiavo case.

"If we were to examine a brain like this, we would say it is unlikely to have any possibility of function," Rojiani said.

That severe damage is responsible for the autopsy's most startling finding: that Schiavo was blind.

The nerve cells that would process messages from Schiavo's eyes were dead, Nelson said. Her eyes could open, close and make reflexive movements, but she could not see.

It's not certain how long Schiavo was blind, but based on doctors' statements, it appears unlikely she could see anything in a 2002 videotape, often seen in news clips, in which she appeared to follow a balloon and her eyes seemed to focus on her mother.

The damage to her brain's occipital lobe appeared to have happened years ago, but there's no way to be certain exactly when, the medical examiner's office said. The damage is "consistent with" resulting from the initial lack of oxygen in 1990.

Rojiani was more definite.

"It's got to have been part of the initial event," he said, with the damage occurring, if not immediately, then in "a matter of days" afterward.

Felos said he understood that she became blind as a result of the initial injury. That finding undermines the videotape, he said.

"The public sees a picture and has an impression," he said. "But it's a hard fact . . . that Terri Schiavo was blind. She couldn't see her mother and obviously couldn't react to the sight of her mother."

Gibbs said the family "recognizes that Terri was greatly disabled." But he questioned whether she was blind and said if Schiavo couldn't see, her other senses were acute enough to know when her mother entered and left the room.

As for the biggest unanswered question, Thogmartin said he searched for reasons that Schiavo's heart could have stopped. A drug screen at the time of the crisis was negative, although it could have been diluted by medical fluids she received.

The biggest evidence that an eating disorder caused her problem was her past. Schiavo, who weighed 112 pounds when she died, had lost more than 100 pounds before she became ill. Friends and family said she wanted to maintain her weight, and was known for eating salads and drinking ice tea.

But nobody saw any evidence of an eating disorder, Thogmartin said. Nobody saw her vomiting, taking diet pills or taking laxatives. She never confessed having such a problem. She didn't have other symptoms of an eating disorder.

"She had beautiful teeth," Thogmartin said, undamaged by vomiting.

But Thogmartin couldn't rule it out. He also said he questioned whether a large amount of caffeine might have affected her. But it seemed unlikely she would have been chugging tea in the middle of the night before her collapse.

Thogmartin stressed how long Schiavo's brain went without life-giving oxygen. Her heart stopped beating for five minutes, but after paramedics arrived, it was almost an hour before she had a blood pressure high enough to measure.

"It's a miracle she came back at all," he said.

Meanwhile, the discord that existed before Schiavo died at her Pinellas Park hospice remains.

Gibbs scolded Michael Schiavo for not yet telling the Schindlers what has been done with their daughter's ashes. A court order requires him to tell the parents when the ashes are buried. Felos said he has not violated that order.

Family members on both sides are still grieving, lawyers said. The Schindlers want to protect people who are disabled, to "stand up for the rights of other Terris," Gibbs said. Felos said the release of the autopsy report was painful for Michael Schiavo.

"On an emotional level, it's hard not to go experience this today on his part and not have it bring back what has occurred before."

Times staff writers Jacob H. Fries and Wes Allison contributed to this report.

[Last modified June 16, 2005, 01:06:39]

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