Originally Posted - July 5, 2006

return home

Was Terri Schindler Schiavo in a persistent vegetative state or a minimally conscious state?

A former forensic lab analyst with the forensic science division of the toxicology department of the Office of the Medical Examiner in New York says that the evidence strongly suggests that Terri Schiavo was never properly diagnosed and very likely was misdiagnosed.

Gerald Tedesco, now a resident of Florida's East coast and a chief medical officer for an electronics company, says that the Schiavo autopsy has been "sadly misrepresented and half that blame falls on the medical examiners, Jon Thogmartin and Stephen Nelson, who appeared to mislead the public by omission of facts from the autopsy findings during their public press conference last June 15.

Tedesco, educated as a medical laboratory technician, trained and certified as a emergency medical technician and dialysis technician, says he has carefully reviewed the extensive medical-legal records available to the public in the Schiavo case including videos which clearly demonstrate Terri's interactions with family and clinicians, court and medical documents and the autopsy report.

In his position with the New York ME's office, Tedesco completed training in forensic toxicology and coursework in pharmacology and forensic science.

"The autopsy report does not support Terri's husband's or his attorney's claims as reported by much of the news media", Tedesco says. "It raises more questions than it answers. It discredited the heart attack and bulimia theory (which was the Michael Schiavo and George Felos explanation of Terri Schiavo's collapse) and supports findings that the low potassium level was caused by resuscitation efforts to stabilize her by EMS and the hospital emergency department, not by bulimia or any eating disorder. This deepens the mystery of why an apparently healthy 26 year old woman with a strong heart collapsed in the first place.

Tedesco suggests that Terri's family, the Schindlers, obtain a second opinion of the autopsy findings, requesting an outside medical and/or forensics expert to examine the medical examiner's autopsy evidence (tissues, body fluid samples, microscopic slides, x-rays, photographs) "For instance, the microscopic slides can be looked at to determine what areas of the brain were sampled and confirm the majority of damage was in Terri's visual centers of her brain (the occipital lobes at the back of the brain), and not her cognitive/awareness centers (the frontal lobes at the front of the brain, Tedesco says. It could also be determined that her brain's central wiring and 12 cranial nerves were intact as was all indicated on the autopsy report, which would mean she would have had voluntary control over swallowing, facial expressions, etc. enabling her to have awareness and interactions with the outside world.

He says if available, the brain itself could be reevaluated and re-sampled to determine the above mentioned details, as well as determine whether untreated Hydrocephalus played any role in her condition. Other tissues could be looked at as well for anything unusual, he says.

"A much more thorough toxicologic panel could be done by testing (using methods with higher accuracy) any available tissue and fluid samples, such as heart blood, urine, vitreous fluid of the eyes, stomach contents, liver, kidneys, lungs and brain to be more certain that her death was not expedited faster, through the use of any variety of substances.

"The x-rays and photographs could be examined by a forensic anthropologist, as well as a pathologist, radiologist, or forensic dentist, to determine the history of skeletal, dental and bodily injuries that may be due to trauma or neglect", the forensic scientist says.

"Terri's husband Michael Schiavo was presumably the only person with her the night of her collapse on Feb. 25, 1990. Many important details in his recollections of that night are inconsistent and contradictory. For example: Michael claimed he heard Terri collapse, found her face down, gasping for air, and unresponsive. He claims he made phone calls to 911 and then Terri's family But, he actually called Terri's parents first and they told him to call 911. Why didn't he call Bobby Schindler first, who lived in the same apartment complex?). He then claims to turn Terri over, cradle and rock her until the ambulance arrived. Yet the ambulance crew and Bobby Schindler (who arrived seconds before the ambulance) found her face down with her hands underneath, near her neck. Michael's story is obviously inconsistent with the paramedics and Bobby Schindler's version. Terri did not appear to have been moved from this position.

"Why didn't Michael attempt CPR? Allegedly he had training. Michael Schiavo has told two to three different versions of the events of that night. For example, in one story, Michael claimed he was awakened by Terri falling. Then, in another story, he claimed he was awake for some reason, then heard Terri fall. At least 40 minutes appears to elapse before Schiavo called an ambulance. The paramedics who responded, found the scene and circumstances unusual and notified the police. A thorough investigation was never followed up. These facts are based on interviews with Mr. Schiavo, court records, ambulance and police reports. Michael Schiavo was never challenged on the details of that night.

" According to some of Terri's closest friends and family, This appeared to be a troubled marriage, with a pathologically controlling husband. An argument was alleged to have occurred before the night of her collapse. While this is not proof a crime was committed, it does raise suspicions, that Michael has not been truthful, and may be hiding something.

"As for the autopsy report itself, I do not believe anyone has ever suggested Terri did not have significant brain damage. But, there is no substantial evidence from the autopsy that Terri Schiavo was in a persistent vegetative state. Here is the problem. Drs. Jon Thogmartin and Stephen Nelson stated at the press conference that Terri's brain damage was "consistent with PVS" and no form of therapy would have helped. That is their opinion. It is also the limit to their area of medical expertise. "Consistent with" is diagnostically meaningless in medical terms. It is the weakest connect you can make. Most of what these two pathologists offered in that press conference was opinion, not fact. They are not clinicians who treat living patients. They over-stepped their areas of expertise.

"PVS is a clinical diagnosis. No autopsy on earth can determine a person's level of awareness or determine with certainty the extent of her deficits. This is also clearly stated in the autopsy report by Dr. Nelson. "Neuropathologic examination alone of the decedent's brain, or any brain for that matter, cannot prove or disprove a diagnosis of persistent vegetative state or minimally conscious state".

"The report also states that there is no reliable neuropathology study data to make a determination on a "Minimally Conscious State" which appears to be the condition Terri was in. Most of the brain damage indicated on the autopsy's neuropathology report was found in the occipital lobes (the part of the brain in the back of the head--the visual centers. The higher mental functions, such as cognition, awareness, personality and emotional traits are located in the frontal lobes of the brain which were found relatively intact. The temporal lobes were also relatively intact.. The functions associated with these areas are: memory, hearing, differentiating sounds and smells, language, and expressive behavior.

"The neuropathways to and from these regions were also intact. Including the 12 cranial nerves that control all facial expressions, swallowing, etc. This encompasses all sensory and motor functions of the head and shoulders. Dr. Thogmartin's opinion that Terri was completely cortically blind is not accurate. It was well known to Dr. William Hammesfahr, neurologist who thoroughly examined Terri for 10 hours, and found her aware and not PVS, that although Terri's vision was severely compromised, she was able to visually perceive objects 8 to 12 inches from her face. In fact, most of the autopsy findings of Terri's state of health are "very consistent" with Dr. Hammesfahr's earlier findings during his clinical examinations. The media never mentioned him or his findings in any report.

"The fact that Dr. Thogmartin found no evidence of strangulation or abuse, means absolutely nothing. It would be virtually impossible to find any evidence 15 years after the event. This is also stated at the conclusion of the autopsy report by Dr. Thogmartin: "Autopsy examination of her neck structures 15 years after her initial collapse did not detect signs of remote trauma, but, with such a delay, the exam was unlikely to show any residual neck findings. Even bony anomalies would have likely resolved.."

"In fact, if a forearm chokehold, headlock or compression asphyxia from a larger person's body weight, was applied during a struggle, which is a realistic scenario, you may not find bruising, a typical hyoid bone fracture or other telltale injuries to the anterior neck. Petechial hemorrhages if present, could also go unnoticed and eventually fade away.

"In fact, Dr. Hammesfahr described Terri as having an abnormally rigid neck during the 2002 evidentiary hearing. Dr. Hammesfahr said, 'The patient's exam from a spinal perspective is abnormal. The degree of limitation of range of motion and of spasms in her neck is consistent with a neck injury. The abnormal sensory exam shows evidence of her hypoxic encephalopathic stroke. She has two sensory levels. The first is right side sensory responses, different from left. The second is a major increase in pain approximately C4 and cephalic to the head, also suggests a spinal cord injury at around the level of C4. Her physical exam and videotapes also suggest a spinal cord injury is present. She has much better control over her face, heard and neck than over her arms and legs. Interestingly, I have seen this pattern of mixed brain (cerebral) and spinal cord findings in a patient once before who was asphyxiated due to a strangulation attempt'. Terri's rigid neck was also mentioned by nursing staff and physicians during her hospitalizations. Interestingly, Dr. Thogmartin never mentioned Dr. Hammesfahr's findings anywhere in the autopsy report".

"Strangulation and Asphyxiation Injuries: There is a great deal of ignorance regarding what actually happens to a human body when suffocation (interference of oxygen supply) or strangulation (interference of oxygen and/or blood supply) occurs, and it bares some discussion here. A process leading to brain damage, Heart irregularities, cardiac arrest, and death can occur rapidly. There are also documented cases in which an individual appeared to fully recover from an incomplete strangulation, but died several hours later.

"Mechanisms of injury: These can occur by intention or accidentally during a struggle to restrain another person by applying chokeholds, headlocks, Traumatic compression (when a larger individual uses his body weight to restrain a smaller person on the floor for example - restricting chest expansion and respiration. Remember, there was evidence Terri did sustain posterior rib fractures, and sexual edge play (erotic asphyxia).

"1- Damage to structures in the neck - rupture of the windpipe, fractures of the Hyoid bone and larynx (produces swelling and airway obstruction), damage to the blood vessels in the neck, dislodging a fatty plaque in a neck artery which then travels to the brain and causes a stroke, damage to the cervical spine (including injury to soft tissues of neck, such as nerves and muscles, which could alter respiration and circulation to head), airway obstruction by the tongue and mucus, and aspiration of vomitus.

"2 - Carotid sinus syndrome - pressure on the carotid arteries within the neck, (even if compression of the windpipe is avoided) compresses baroreceptors within these arteries, known as the carotid sinus bodies. These bodies can cause vasodilation in the brain, thus reducing blood flow to the brain and the victim loses consciousness. A signal is also sent to the main electrical pacemaker of the heart, via the vagus nerve, to decrease the rate and force of the heartbeat. Most of the time, under strong vagal influence, the rate and force of the heartbeat decreases by one third. However, every now and then, the rate and force decreases to zero, and cardiac arrest occurs.

"3 - Asphyxia (oxygen deprivation or hypoxia) - When breathing is restricted, oxygen levels fall, and carbon dioxide levels rise, because the body cannot eliminate carbon dioxide, or take in adequate oxygen. This causes the pH of the blood to fall to life threatening levels in a few minutes, making the blood acidic, and producing metabolic (lactic) acidosis. When the heart gets low on oxygen, it starts to fire off "extra" electrical pacemaker sites. These usually appear in the ventricles and are called premature ventricular contractions -- PVC's for short. This can lead to ventricular fibrillation - a form of cardiac arrest. The lower the heart gets on oxygen, the more PVC's it generates, and the more vulnerable to their effect it becomes. Once PVC's begin, they could stop almost at once, or they could continue for hours. A cardiac arrest can occur in as little time as a minute or less. It is unpredictable.

Based on my review of extensive medical records documenting Terri's care over the years, on my personal observation of Terri (for 1 and 1/2 hours), on my observations of Terri's responses in the many hours of videotapes taken in 2002, she demonstrates a number of behaviors I believe cast a reasonable doubt on the prior diagnosis of PVS.


1. Her behavior is frequently context-specific .Although she does not seem to track or follow visual objects consistently or for long periods of time, she does fixate her gaze on colorful objects or human faces for some 15 seconds at a time and occasionally follows with her eyes at least briefly as these objects move from side to side. When I first walked into her room, she immediately turned her head toward me and looked directly at my face. There was a lot of curiosity or expectation in her expression, and she maintained eye contact for about half a minute. Later, when she again looked at me, she brought her lips together as if to pronounce the letter "O,"

2. There have been reports of Terri rarely using actual words specific to her situational context. The July 25, 2003 affidavit of the speech pathologist Sarah Green Mole, MS, on page 6, reads, "The records of Mediplex reflect the fact that she has said 'stop' in apparent response to a medical procedure being done to her."

3. In the taped examination by Dr. Hammesfahr from 2002, when asked to close her eyes she began to blink repeatedly. Although it was unclear whether she squeezed her grip when asked, she did appear to raise her right leg four times in succession each time she was asked to do so. Rehabilitation notes from 1991 indicated that she tracked inconsistently, and although she did not develop a yes/no communication system, did follow some commands inconsistently and demonstrated good eye contact to family members.


There is a remarkable moment in the videotape of the September 3, 2002 examination by Dr. Hammesfahr that seemed to go unnoticed at the time. At 2:44 p.m., Dr. Hammesfahr had just turned Terri onto her right side to examine her back with a painful sharp stimulus (a sharp piece of wood), to which Terri had responded with signs of discomfort. Well after he ceased applying the stimulus and had returned Terri to a comfortable position, he says to her parents, "So, we're going to have to roll her over...." Immediately Terri cries. She vocalizes a crying sound, "Ugh, ha, ha, ha," presses her eyebrows together, and sadly grimaces.

It is important to note that, at that moment, no one is touching Terri or causing actual pain. Rather, she appears to comprehend the meaning of Dr. Hammesfahr's comment and she signals her _anticipation_ of pain. This response suggests some degree of language processing and interpretation at the level of the cerebral cortex. It also suggests that she may be aware of pain beyond what could be explained by simple reflex withdrawal. "Persistent vegetative state" patients do not have the capacity to experience pain or suffering.

Pain and suffering are attributes of consciousness requiring cerebral cortical functioning, and patients who are permanently and completely unconscious cannot experience these symptoms. And yet, in my review of Terri's medical records, pain issues keep surfacing. The nurses at Woodside Hospice told us that she often has pain with menstrual cramps. Menstrual flow is associated with agitation, repeated or sustained moaning, facial grimacing, limb posturing, and facial flushing, all of which subside once she is given ibuprofen.

Some of the records document moaning, crying, and other painful behavior in the setting of urinary tract infections. . To enter the room of Terri Schiavo is nothing like entering the room of a patient who is comatose or brain-dead or in some neurological sense no longer there. Terri [Schindler] Schiavo demonstrates behaviors in a variety of cognitive domains that call into question the previous neurologic diagnosis of persistent vegetative state.

Specifically, she has demonstrated behaviors that are context-specific, sustained, and indicative of a cerebral cortical processing that, upon careful neurologic consideration, would not be expected in a persistent vegetative state.

Based on this evidence, I believe that, within a reasonable degree of medical certainty, there is a greater likelihood that Terri is in a minimally conscious state, than a persistent vegetative state. When serious doubts exist as to whether a cognitively impaired person is or is not consciously aware, even if these doubts cannot be conclusively resolved, it is better to err on the side of protecting vulnerable life."

Respectfully submitted,
William Polk Cheshire, Jr., M.D., M.A., F.A.A.N.

© 2006 North Country Gazette