Originally Posted - September 10, 2006

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A new British study suggests that Terri Schindler Schiavo, said to be in a persistent vegetative state, may have been aware of everything going on around her.

The results of the testing done by using MRIs (Magnetic Resonance Imaging) which can detect different types of mental activity by measuring blood flow to various parts of the brain suggest PVS patients can hear, understand and have a cognitive awareness.

Under Florida law, PVS is defined as a permanent irreversible condition of unconsciousness in which there is the absence of voluntary action or cognitive behavior of ANY kind and an inability to communicate or interact purposefully with the environment.

Michael Schiavo (left) and lowly Pinellas County probate court Judge George Greer (right), who had no medical training, said Terri was PVS. Her parents and scores of medical professionals said she wasn't.

Michael Schiavo maintained that Terri would have wanted to die and wouldn't have opted for any testing, anything to prolong her life. She left no living will and couldn't clearly articulate her wishes were. In the minutes before her feeding tube was removed for the last time on March 18, 2005, Attorney Barbara Weller of the Gibbs Firm, attorneys for Terri's family told Terri if only she could relate what her wishes were, it would all be over.
http://www.northcountrygazette.org/articles/031806OneYearLater.html

"I stood up and leaned over Terri. I took her arms in both of my hands. I said to her, "Terri if you could only say 'I want to live' this whole thing could be over today." I begged her to try very hard to say, "I want to live", Weller relates.

"To my enormous shock and surprise, Terri's eyes opened wide, she looked me square in the face, and with a look of great concentration, she said, "Ahhhhhhh." Then, seeming to summon up all the strength she had, she virtually screamed, "Waaaaaaaa." She yelled so loudly that Michael Vitadamo, Suzanne's husband, and the female police officer who were then standing together outside Terri's door, clearly heard her. At that point, Terri had a look of anguish on her face that I had never seen before and she seemed to be struggling hard, but was unable to complete the sentence. She became very frustrated and began to cry. I was horrified that I was obviously causing Terri so much anguish. Suzanne and I began to stroke Terri's face and hair to comfort her. I told Terri I was very sorry. It had not been my intention to upset her so much. Suzanne and I assured Terri that her efforts were much appreciated and that she did not need to try to say anything more. I promised Terri I would tell the world that she had tried to say, "I want to live." Felos, Schiavo, Greer and others claim it was impossible.

The new British studies and others which have been completed in the last 18 months demonstrate it was not.

Terri Schiavo Schiavo died prematurely.

And there simply was no credible evidence that that was her wish.

No harm would have been incurred by Greer allowing Terri to undergo new medical testing. The harm was caused by Greer's adamant denial of all testing and Michael Schiavo's refusal to allow it.

Mary and Bob Schindler Sr., Terri's siblings, Suzanne Vitadamo and Bobby Schindler and others that Michael allowed to see Terri say that Terri interacted with them and the videos of Terri, the few that exist because Michael Schiavo refused to allow the world to see how aware and cognitive Terri really was, indicate that Terri was demonstrating more than just a reflex.

After six doctors, Russell, Webber, Green, Gimon, Neubauer and William Hammesfahr, submitted affidavits to the court as part of a motion in June 2001 by the Schindlers for an independent medical examination, Greer issued an order on Aug. 10, 2001, denying the motion and indicating that he hadn't even read the affidavits, saying that "these doctors simply disagree with the medical evidence adduced at trial (January, 2000) when it was determined by Greer that Terri was PVS. August 2001 Order

In February, 2005, Greer continued to deny a request for new testing and examination of Terri by independent and qualified specialists, almost as if he didn't want to know lest it would overturn his death order of Feb. 11, 2000 and find that his diagnosis and ruling was incorrect. David Gibbs III, attorney for the Schindlers, submitted nearly 40 affidavits from doctors and medical professionals contending that Terri's condition should be reevaluated. About 15 of these affidavits were from board-certified neurologists.

Many recommended that the same testing performed on the 23-year-old British woman in the recent study highlighted in Science magazine be conducted on Terri. Greer denied all requests.
http://www.terrisfight.org/mainlinks.php?tabl...

Michael Schiavo maintained he was carrying out Terri's wish. However, it's likely that had Terri been able to definitively communicate, she would have told Michael and the world that she wanted the testing, wanted the therapy and rehabilitation her husband in name only had denied her and that she wanted to live and go home to be cared for by her family.

For over 10 years, Michael Schiavo, estranged husband of Terri Schiavo and guardian, had been locked in a contentious court battle-Michael doggedly seeking to end his wife's life by court order. He claimed she was in a persistent vegetative state, a diagnosis which Greer concurred with although he is legally blind, couldn't see the videos shown in court of Terri and never personally visited Terri although acting in the conflicted role of guardian ad litem and judge.

Her family, supported by numerous medical professionals, said that Terri was in a minimally conscious state, should be revaluated and given new testing and that there could have been a chance for recovery had Michael Schiavo not denied her all therapy and any rehabilitation since 1993, instead locking her away in a hospice room, drawing the blinds on her windows, restricting her visitors and essentially removing her from society.

In February, 2005, Gibbs submitted 17 new affidavits to the court from medical experts who had studied videos and other medical evidence regarding the disabled woman. Each opined that the woman was not PVS as Greer had ruled but rather exhibited cognitive behavior and was aware of and stimulated by her environment.

Virtually every neurologist consulted by Schindler representatives, nearly 50 of them, said the same thing, that Terri should be reevaluated, reexamined and given new testing, the same testing which was performed on the British woman.

A team in Cambridge has discovered that a patient in a vegetative state can communicate through her thoughts. Researchers at the Medical Research Council's Cognition and Brain Sciences Unit and in Academic Neurosurgery in Cambridge, in collaboration with colleagues in Liege have for the first time discovered a way to show preserved conscious awareness in a patient who has been diagnosed as vegetative. The research is published in Science.
http://www.sciencemag.org/

A year ago, the woman, who is 23, sustained a severe traumatic brain injury in a road traffic accident. She is physically unresponsive and fulfils all the criteria for a diagnosis of vegetative state according to international guidelines.

Using a functional magnetic resonance imaging (fMRI) scanner at the Wolfson Brain Imaging Centre, Cambridge, her brain activity was mapped while the patient was asked to imagine playing tennis or moving around her home. The scientists found she was able to do this, activating different areas of her brain in the same way as healthy volunteers.

The research team studied the woman's brain for five months.

"These are startling results. They confirm that, despite the diagnosis of vegetative state, this patient retained the ability to understand spoken commands and to respond to them through her brain activity, rather than through speech or movement. Her decision to work with us by imagining particular tasks when asked represents a clear act of intent which confirmed beyond any doubt that she was consciously aware of herself and her surroundings," said Dr. Adrian Owen who led the research.

Dr. Owen has conducted research in the areas of functional neuroimaging (PET and fMRI) of frontal-lobe function, neuropsychology of planning, working memory and related 'executive' functions, and cognitive deficits in Parkinson's disease and related frontostriatal disorders.

The scientists first used fMRI to measure the patient's neural responses during the presentation of spoken sentences (e.g. "there was milk and sugar in his coffee"). These tests showed she recognized speech. Furthermore, more complex sentences that contained ambiguous words (e.g. "the creak came from a beam in the ceiling") produced an additional significant response. This indicated that the brain understood the meaning of the sentences.

Although, an appropriate neural response to the meaning of spoken sentences suggests someone is consciously aware, it does not confirm that they are. So to work out whether or not the patient was able to understand and respond, she was asked to imagine certain activities like playing tennis or walking around her home. The brain activity of the patient was indistinguishable from that of healthy volunteers.

"These are very exciting findings. This technique may allow us to identify which patients have some level of awareness" Dr Owen said. "But it is important to emphasize that if we don't see responses in a patient it does not necessarily mean that they are not aware. Future work will investigate whether the technique can be used more widely in these patients and whether this discovery could lead to a way of communicating with some patients who may be aware, but unable to move or speak."

Researchers asked the brain damaged British woman 20 times to imagine that she was playing tennis and walking around her house. They compared her responses with those of 12 healthy people and found that the brain regions involved in language, movement and navigation, had activity that was "indistinguishable" from the control group.

According to the report in Science, the woman "retained the ability to understand spoken commands and to respond to them through her brain activity rather than through speech or movement. "Her decision to cooperate….by imagining particular tasks when asked to do so represents a clear act of intention which confirmed beyond any doubt that she was consciously aware of herself and her surroundings.

Owen did caution that "this is just one patient. The result in one patient does not tell us whether any other patient will show similar results, or whether this result will have any bearing on her".

There may also be significant differences between patients who have incurred their brain injuries as a result of accidents and head trauma or those who suffer heart attacks and strokes or their brain is deprived of oxygen.

Terri Schindler Schiavo deserved to have had the opportunity for the testing.

In a Washington Post article about the findings, it was stated that Owen and other researchers had specifically stated that in the Schiavo case, awareness or recovery would have been impossible.

That appears to have been editorializing by the Post as a review of the research report issued contains no such reference to the Schiavo case nor does the interview conducted with Owen.
http://news.bbc.co.uk

Numerous medical professionals expressed doubts about the accuracy of the PVS diagnosis in the Schiavo case because the conclusion was reached without the benefit of the MRI testing that most neurologists consider standard for PVS diagnosis.

However, Terri Schindler Schiavo was never given an MRI or PET (Positron Emission Tomography) scans because Michael Schaivo repeatedly refused to consent to one, a fact that many neurologists consider neglect and should have by itself constituted grounds for removal of him as guardian.

With Schiavo's attorney George Felos and Judge George Greer likewise blocking all efforts for MRI and PET testing, it seemed clear that they didn't want to learn the truth about Terri's cognitiveness and if she was PVS as they claimed or aware and able to communicate, in a minimally conscious state, as the Schindlers and numerous medical professionals believed.

Many medical professionals have stated that before they could make such a diagnosis of PVS, particularly in a situation such as Terri Schiavo, a life or death decision, that they would have felt ethically obligated to perform MRI and/or PET scans. In Terri's case, only CT scans were done, (Computer-Aided Tomography). CT scans are less expensive and do not provide such comprehensive data as an MRI. According to neurologists, a CT scan is often the test used in an emergency room setting to initially determine the extent of brain damage but if the damage has been caused by lack of oxygen to the brain, such as in Terri's case, a MRI and PET scan are necessitated.

Without the benefit of MRI and PET scans and simply on the basis of an antiquated CT scan of Terri, Felos, Schiavo and Greer along with Dr. Ronald Cranford, Dr. Peter Bambikidis and Dr. Melvin Greer maintained that Terri's cerebral cortex had "liquefied" and that parts of her cerebral cortex had been replaced by fluid. However, medical professionals say that a CT scan can't produce the kind of detail needed to make such a determination.

Felos and Schiavo had argued that an MRI couldn't be performed on Terri because of the platinum electrodes which had been implanted in her brain in late 1990 by Dr. Yoschio Hosobuchi of the University of California at San Francisco.

Those electrodes were never removed and had remained in Terri's brain for 15 years but Mary Schindler, Terri's mother, says that after Hosobuchi's assistant, CD Yingling made the determination that the electrodes weren't working and failed to send Terri to Shands Health Care Center in Gainsville, Fla., for additional testing, the electrodes should have been removed. She says that Yingling had stated that the electrodes should not have been left in Terri's brain for more than a year.

Medical experts have said that leaving the electrodes in her brain could have caused infection and medical complications. However, as guardian Michael failed to have the electrodes removed which the Schindlers maintain is further evidence of his abuse and neglect of their daughter.

According to the medical observations of Terri recorded after the experimental surgery, she was showing improvement. But less than four months after the surgery which neurologists consulted by the Schindlers say was inadequate time, Yingling, who had no medical license and whose field of expertise was allegedly interpreting EEGs or brain scans, traveled to Florida.

Thereafter, the sensory stimuli treatment was ceased and her therapy was reduced to once a week although he admitted probably six months or more would be needed to see improvement and he failed to obtain a machine needed for testing of Terri.

In a November, 1993, in a deposition, Michael Schiavo said under oath that Yingling failed to obtain equipment that he needed to conduct testing of Terri, had "loads of wine" at dinner and spilled it all over the couch at Schiavo's home.

"Terri was at Mediplex-he came out and did some testing, and he needed a CP-900 machine or something from Shands, and it wasn't available, and he said it wasn't no big deal. He told me he had---he didn't see any evident sign that the stimulator was working", Schiavo testified in a proceeding brought by the Schindlers to remove him as guardian.

Thereafter, despite the medical reports of marked cognitive awareness by Terri Schiavo, George Felos, Michael Schiavo's attorney, reported misled both the public and the court by stating that "tests show that she is in a vegetative condition and has no consciousness". He claimed that "there has been nothing new brought up in this case for years now" and that her condition has been "essentially the same as it has been the past 13 years". Although CT brain scans were later introduced and said to be Terri's, they failed to show the platinum electrodes which were still implanted in her brain, raising question if the scans produced were those of Terri Schiavo or some other individual.

Felos had claimed that "Terri's cerebral cortex has atrophied. It's gone. She had no consciousness", Felos told the public on Fox TV.

But the medical reports contradicted Felos and raised serious questions as to the level of awareness that Terri Schiavo may have reached had her therapy not been discontinued for over 10 years following a determination by non-physician Yingling, a refusal by Michael Schiavo to allow Terri to be given therapy and rehabilitation and failure to remove the electrodes even after Yingling and Hosobuchi instructed Michael Schiavo to have the electrodes removed.

The determinations of Cranford and Bambikidis that Terri was PVS was done without any medical testing with Cranford examining Terri on one occasion, for about 45 minutes, and Bambikidis' exam lasting about a half hour, cursory examinations.

In his blog, Secondhand Smoke, award winning author Wesley Smith comments on the British study as it applies to the Schiavo case. Smith is a senior fellow at Discovery Institute, a special consultant for the Center for Bioethics and Culture and an attorney for the International Task Force on Euthanasia and Assisted Suicide.
http://www.wesleyjsmith.com/blog/

He says that the British findings, based on MRI testing, reminded many people of the Schindlers' request for Terri to receive a test that would measure brain function rather than mere structure which was adamantly refused by Judge Greer.

"I have been checking to see if the test used on the British woman would have been usable with Terri" Smith writes. "The answer is no. The test in the British case was a form of MRI. Terri couldn't have an MRI because the strong magnetic field generated by the test would not have been safe due to the fact she had electrodes implanted in her brain from an experimental procedure she received early in her disability.

"However, she could have had a PET scan, which uses radiation to measure function. This was the test the Schindlers requested. Which raises the question of whether a PET scan could have provided the same kind of details about Terri that were revealed about the British patient from the MRI. So, I have been asking doctors I know to find out.

"One doctor, a neurologist, told me the PET would indeed have been able to measure the extent of Terri's brain function. But a different doctor, a brilliant man with five board certified specialties, but not in neurology, told me that while the PET could have measured function, it couldn't have delivered the kind of sophisticated results that were described in the UK case. Based on what both these physicians have told me, it seems that some measure of function could have been measured, but not the kind of quick snapshots of specific brain centers firing when the UK patient was asked, for example, to imagine herself playing a game of tennis.

"Still, the bottom line is that while Terri was lying in the bed waiting for the appeals courts to deliver her death warrant, it would have done no harm to give her a PET scan to see what could be seen. Nor would it have harmed anyone for Judge Greer to have permitted very respected rehabilitation therapists, who believed they could have helped Terri relearn how to swallow on her own, to give it a try. Judge Greer's adamant refusal to permit a PET scan and therapy is inexplicable--if, that is, he wanted the fullest record possible before the helpless woman he was duty-bound to protect was dehydrated to death", Smith says.

Prior to Terri's death on March 31, 2005, another study involving findings about brain injured patients was published in the medical journal Neurology. The study had been conducted by a team of neuroscientists from New York, New Jersey and Washington, used imaging technology (MRIs) to compare the brain activity of several disabled people with conditions similar to that of Terri with the level of activity of healthy individuals.

In an article appearing in The New York Times, Dr. Joseph Fins, chief of the medical ethics division of the New York Presbyterian Hospital was quoted as saying "This study gave me goose bumps because it shows the possibility of this profound isolation that these people are there, that they've been there all along even though we've been treating them as if they're not".

That study seriously impacted cases such as Terri's and established the fact that brain imaging technology could help determine mental awareness. Doctors say that mental states can change over time and some patients have almost completely recovered function after being thought vegetative.

Dr. Joy Hirsch of the Columbia University Medical Center said that in the study, brain scans showed that areas of the brain that control language lit up when the patients heard recordings made by family members.

"We were not able to distinguish them from normal patients when we asked them to listen to narratives of their family members speaking to them", Hirsch said.

The brain scans showed the brain damaged patients to be in a minimally conscious state (MCS) rather than PVS in which they maintain some degree of cognitive function even though they can't follow simple instructions or communicate.

"Perhaps functional imaging can give us clues into discriminating patients that have the capability for emerging or recovering from those who do not and also to guide us in the therapeutic techniques and strategies that would promote a more accelerated emergency from the minimal conscious state" Hirsch said.

One of the doctors who worked on the study, Dr. Nicholas Schiff of the Weill Medical College at Cornell University, said a year ago that most brain injured can move to commands. "Some of then even make attempts to communicate, can mouth a word. Maybe occasionally on a rare occasion they establish communication".

Hirsch said that the most consequential thing about the study is that "we have opened a door. "The patients are more human than we imagined in the past and it is unconscionable not to aggressively pursue research efforts and evaluate them to develop therapeutic techniques".

Jay Wolfson, the last guardian ad litem in the Schiavo case, (except for self-appointed George Greer) a professor at the College of Public Health at the University of South Florida, was discharged on Dec. 17, 2003 after recommending to Greer that swallowing tests be performed on Terri Schiavo but Greer refused to so order.

Gov. Jeb Bush had then petitioned the court for the reinstatement of a guardian ad litem to report to him on 11 specific matters relating to the Schiavo case. David Demers, chief judge of the Sixth Judicial Circuit issued an order on Jan. 8, 2004 refusing to reappoint Wolfson or any guardian ad litem.

This past May, South African researchers, writing in the journal NeuroRehabilitation, reported that the insomnia drug Zolpidem can temporarily revive people in PVS to the point where they are able to speak.
http://www.northcountrygazette.org/articles/052306PVSReverse.html

As a result of those findings, the Terri Schindler Schiavo Foundation for Health Care Ethics called for a moratorium of all potential ordinary care removal for persons diagnosed in a PVS condition.

Zolpidem is usually used to treat insomnia. However, South African researchers, writing in the NeuroRehabilitation, looked at the effects on three patients of using the drug for up to six years.

They reported that "All patients were aroused transiently every morning after Zolpidem."

Their conclusion was that Zolpidem appeared to be effective in restoring some brain function to patients previously determined to be in a persistent vegetative state.

In December 2000, Patricia White Bull, after given the drug Amantadine (used to stimulate people with Parkinson's disease and brain damage) awoke after 16 years of being in what doctors were calling a persistent vegetative state. "Sadly, we will never know if any of any of these drugs or treatments that were available would have improved Terri's condition", Terri's brother said.

This findings of the British study, the South African study and the other studies which have been completed in the last 18 months demonstrate the dangers of the subjective and often incorrect PVS diagnosis. A report released by the British Medical Journal in 1996, found that 43% of the diagnosed cases of PVS they studied were, in fact, misdiagnosed.

It appears that Terri Schindler Schiavo was also misdiagnosed.

The overriding question that remains is why George Greer steadfastly refused to allow any non-invasive testing of the woman for whom he was supposedly the guardian ad litem, whose best interests he was supposed to be protecting. 9-10-06

© 2006 North Country Gazette