Florida neurologist: Terri's no vegetable
STARVATION: DAY 7
Doctor for state's adult protective services finds Schiavo has been
wrongly diagnosed
Posted: March 24, 2005
1:00 a.m. Eastern
By Joseph Farah
? 2005 WorldNetDaily.com
Dr. William Cheshire
An eminent neurologist who evaluated Terri Schiavo for the Florida
state Department of Children and Families yesterday concluded she has
been wrongly diagnosed as being in a persistent vegetative state and
urges immediate removal to another facility and the restoration of
food and water to the dying woman who has become the focal point of
the nation's attention.
In his affidavit to the court, obtained by WorldNetDaily, Dr. William
Polk Cheshire Jr. found Schiavo is aware of pain and reacts visibly to
it. She also reacts to the expectation of pain based on conversations
she overhears in her room.
"If Terri is consciously aware of pain, and therefore is capable of
suffering, then her diagnosis of PVS may be tragically mistaken," he
writes.
Florida Gov. Jeb Bush announced yesterday that Dr. Cheshire, Jr., as
part of a DCF review team, had concluded that Schiavo might not be in
a persistent vegetative state but rather in "a state of minimal
consciousness." Bush said. "This new information raises serious
concerns and warrants immediate action."
DCF Secretary Luci Hadi said that under state law the agency is
authorized to intervene and have Schiavo's sustenance restored even
without a court order.
But last night, Bush spokesman Jacob DiPietre said the administration
had no plans to defy Greer's order.
Pinellas County Judge George Greer said he expected to have a final
ruling on the case by noon today after reviewing the new evidence. He
blocked an effort by DCF to rescue Schiavo.
"It is my understanding that nearly three years have passed since
Terri has had the benefit of neurologic consultation," Dr. Cheshire
wrote in his affidavit. "How then are we to be certain about her
current neurologic status? There remain, in fact, huge uncertainties
in regard to Terri's true neurologic status."
Dr. Cheshire is the director of a laboratory at the Mayo Clinic branch
in Jacksonville that deals with unconscious reflexes like digestion.
Cheshire cited studies indicating a high rate of false initial
diagnoses of PVS.
"Furthermore, the diagnosis of minimally conscious state had not yet
become standard parlance in the field of neurology at the time of
Terri's initial diagnosis," he wrote. "The minimally conscious state
has emerged as a distinct diagnostic entity within the last few years."
Cheshire also pointed out that Schiavo has not undergone functional
imaging studies, such as positron emission tomography, or PET, or
functional magnetic resonance imagining, or fMRI.
"New facts have come to light in the last few years that should be
weighed in the neurologic assessment of Terri Schiavo," he said.
"Significant strides have been made in the scientific understanding of
PVS and minimally conscious states since Terri last underwent
neurologic evaluation. As usually happens with science, the newest
evidence is prompting the medical community to think about this field
in new ways. With new evidence comes fresh appreciation for what is
actually happening in the brains of persons with profound cognitive
impairment."
Cheshire said news studies show that when patients in a minimally
conscious state listen to narratives read by a familiar person "large
areas of the cerebral cortex normally involved in language recognition
and processing lit up." He said the presence of metabolic activity in
those brain cells was far more than expected.
He cited seven reasons to doubt the prior diagnosis of PVS in Terri
Schiavo:
# He found her facial expression brightens and she smiles in
response to the voice of familiar people such as her parents or her
nurse. Her agitation subsides and her facial demeanor softens when
quiet music is played. "When jubilant piano music is played, her face
brightens, she lifts her eyebrows, smiles, and even laughs." Cheshire
said several times he witnessed Schiavo laugh when someone in the room
made a humorous comment.
# She fixates her gaze on colorful objects and human faces for up to
15 seconds at a time and occasionally follows with her eyes as objects
move from side to side. "When I first walked into the room, she
immediately turned her head toward me and looked directly at my face.
There was a look of curiosity or expectation in her expression, and
she maintained eye contact for about half a minute." Cheshire said she
also appeared to attempt to speak to him.
# Although he did not hear her utter distinct words, the doctor said
"she demonstrates emotional expressivity by her use of single syllable
vocalizations and cooing sounds. In reviewing previous affidavits, he
noted that as late as 2003, the patient was heard to tell nurses to
"stop" during certain procedures.
# He noted that in a previous examination by a neurologist, the
patient appeared to try to follow certain commands ? such as closing
her eyes. She also raised her right leg four times when asked to do so
in 2002 under examination.
# In that same 2002 examination by a neurologist, captured on
videotape, Schiavo was turned on her side and probed with a sharp
piece of wood. She reacted with sounds of discomfort. After that
procedure, the neurologist commented to her parents that they would
have to roll her over on her other side. Schiavo vocalized a crying
sound in response. "It is important to note that, at that moment, no
one is touching Terri or causing actual pain," he writes. Rather, he
says, she appears to comprehending what was said and anticipating pain.
# According to the definition of PVS, he writes, patients do not
have the capacity to experience pain and suffering. Yet, he concludes,
after reviewing her medical records, pain issues frequently arise.
"The nurses at Woodside Hospice told us that she often has pain with
menstrual cramps." The pain and agitation subside when she is given
ibuprofen. "If Terri is consciously aware of pain, and therefore is
capable of suffering, then her diagnosis of PVS may be tragically
mistaken," he concludes.
# "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," he writes. "Although Terri did
not demonstrate during our 90-minute visit compelling evidence of
verbalization, conscious awareness, or volitional behavior, yet the
visitor has the distinct sense of the presence of a living human being
who seems at some level to be aware of some things around her."
"As I looked at Terri, and she gazed directly back at me, I asked
myself whether, if I were her attending physician, I could in good
conscience withdraw her feeding and hydration," he wrote. "No, I could
not. I could not withdraw life support if I were asked. I could not
withhold life-sustaining nutrition and hydration from this beautiful
lady whose face brightens in the presence of others."
Cheshire indicated he could see no reason to withdraw the sustenance.
"This situation differs fundamentally from end-of-life scenarios where
it is appropriate to withdraw life-sustaining medical interventions
that no longer benefit or are burdensome to patients in the terminal
stages of illness," he wrote. "Terri's feeding tube is not a burden to
her. It is not painful, is not infected, is not eroding her stomach
lining or causing any medical complications. But for the decision to
withdraw her feeding tube, Terri cannot be considered medically
terminal. But for the withdrawal of food and water, she would not die."
On the basis of all of those findings, Dr. Cheshire concluded "it
would be wrong to bring about her death by withdrawing food and water."
"At the time of this writing, Terri Schiavo, as the result of
decisions based on what I have argued to be a faulty diagnosis of
persistent vegetative state, has been without food or water for five
days," he wrote. "She is at risk of death or serious injury unless the
provision of food and water can be restored. Terri Schiavo lacks the
capacity to consent to emergency protective services and must trust
others to act on her behalf. If she were to be transferred to another
facility, it would be medically necessary to initiate hydration and
ensure that her serum electrolytes are within normal values."
Cheshire concluded: "How medicine and society choose to think about
Terri Schiavo will influence what kind of people we will be as we
evaluate and respond to the needs of the most vulnerable people among
us. 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."
Editor's note: WorldNetDaily has been reporting on the Terri Schiavo
story since 2002 ? far longer than any other national news
organization ? and exposing the many troubling, scandalous, and
possibly criminal, aspects of the case that to this day rarely surface
in news reports. Read WorldNetDaily's unparalleled, in-depth coverage
of the life-and-death fight over Terri Schiavo, including over 150
original stories and columns.
http://www.worldnetdaily.com/news/article.asp?ARTICLE_ID=43470