I read they are going to DC her feeding tube again. This is such a sad story. I was wondering what nurses are thinking about this?
I know as far as quality of life some may say she would be better off, but seeing the family's emotional response to this makes it kind of hard to know what would be the best in this situation.
How do we know someone would be "better off"? Maybe they would be by our standards, but I have seen people who didn't have much quality to life cling to their last breath. How can we know what is going on in Terri's mind?
Specializes in LTC,Hospice/palliative care,acute care.
THe so called evidence is open to interpretation.Could it be that the husband is doing what Terri wanted? This is precisely why My husband holds my DPOA,POA and copies of both of our advance directives (copies are at out PCP's offices also) I would NEVER trust either of my parents to follow through with my wishes. There is no solid evidence that implicates the husband in any way.From what I read she dieted herself into a severe electrolyte imbalance....The husband is also NOT after the money-there is very little left....Many believe that artificial feeding is life support just as "artificial respiration" is....Taking someone off of the ventilator or tube feeding is not KILLING them-but rather letting them succumb to the illness or injuries they incurred that caused them to be placed on the artificial life support to begin with....And don't kid yourself-what you and many call euthanasia with drugs is practiced all across this country.. I have seen patients removed from life support and given whopping doses of morphine.....This case is PRECISELY why advance directives are important.The more detailed they are the better they are....
I would like to add that unless someone has cared for a person like that for years and years someone would have no clue about how it feels. That is why I have in my living will/ DPOA-no feeding tubes/no hyperal.
Specializes in Nurse Leader specializing in Labor & Delivery.
On the other side of the "he's a creep" coin - there IS no insurance money left, so he does not stand to gain a penny upon her death. Furthermore, if she truly told him that she would NOT want to be kept in a vegetative state, as he insists she did, then I imagine his motivation is trying to carry out her wishes, and knowing that she would not want to be in the state she is in.
so sad. Who knows what she would have wanted without a living will. I am just about as young as a BSN prepared RN could be and i have a living will, DPOA, and funeral plans filed in three places. You just never know. I pitched it to my parents this way: now you would never have to wonder what i would have wanted.
This is the first time I have heard the theory of the husband being involved in her condition. How could he have caused a severe electrolyte imbalance without her knowledge? If I remember correctly she was a nurse. We just had a legal lesson on our floor when we had a similar case and what we learned is that if the patient is married the spouse is the power of attorney. She told him she would not want to be kept alive artificially, he is saying to stop the feedings...why is there a problem? People have issues with him having a girlfriend and a child, is he suppose to stop living? If he divorces Teri then everyone will persecute him, he can't win no matter what he does. The state needs to stay out of it and let the husband follow through with his wife's wishes.
My dad has very specific instructions in his Living Will. And we took a day and discussed this ahead of time. His bottom line: "This is what I'M wanting, please make sure this is what i get."
I also have my own Living Will. And it was all thanks to this case.
Here is one of the stories where noted pathologist Dr. Michael Baden is quoted as saying that a bone scan showed evidence of head trauma. Something that was never addressed at the time of her initial injury.
Your right I can't prove it, but my gut smells a rat. All I'm saying is that there should be further investigation and most importently an autopsy if she dies. Remember there is not a statute of limitations on murder.
Doctor Says Schiavo Likely Victim of 'Some Kind of Trauma'
By Jeff Johnson
CNSNews.com Congressional Bureau Chief
October 28, 2003
(CNSNews.com) - One of the most important battles in the fight over the life or death of Terri Schindler Schiavo has been the professional opinions of dueling medical experts. But the Schindler family has found a new ally in that battle - one it did not seek out - in the person of a famed New York forensic pathologist, Dr. Michael Baden.
Michael Schiavo, Terri's husband, and his doctors won a $1.2 million medical malpractice lawsuit based on the claim that Terri's brain injury was caused by a three-stage progression of a potassium imbalance that caused a heart attack, depriving Terri's brain of oxygen. The Schindler family has long believed otherwise.
"It's extremely rare for a 20-year-old to have a cardiac arrest from low potassium who has no other diseases," Baden said Friday on Fox News Channel's On the Record with Greta Van Susteren, restating that such an occurrence would be "extremely unusual unless she had certain kind of diseases, which she doesn't have.
"She was in her 20s. The reason that she's in the state she's in is because there was a period of time, maybe five minutes or eight minutes, when not enough oxygen was going to her brain," Baden explained. "That can happen because the heart stops for five or eight minutes, but she had a healthy heart from what we can see."
Baden has a different theory about what caused Terri's brain injury, based on a 1991 bone-scan report that only became available to the Schindlers in 1998.
"That bone scan describes her as having a head injury. That's why she's there. That's why she's getting a bone scan," Baden explained, "and a head injury can cause, lead to the 'vegetative state' that Ms. Schiavo is [allegedly] in now."
Dr. W. Campbell Walker completed the March 7, 1991, bone scan, which was requested to "evaluate for trauma" as the result of a suspected "closed head injury."
"This patient has a history of trauma," Walker wrote. "The presumption is that the other multiple areas of abnormal activity also relate to previous trauma."
Walker listed apparent injuries to the ribs, thoracic vertebrae, both sacroiliac joints, both ankles and both knees.
"It does show evidence that there are other injuries, other bone fractures that are in a healing stage," Baden explained, adding that those apparent injuries were likely the result of "some kind of trauma. The trauma could be from an auto accident, the trauma could be from a fall, or the trauma could be from some kind of beating that she obtained from somebody somewhere. It's something that should have been investigated in 1991."
Baden, author of three books on forensic pathology, has served as chief pathologist for the City of New York and as director of the Forensic Sciences Unit of the New York State Police.
Pamela Hennessy, spokeswoman for the Schindler family, expressed their hope that "something positive will come out of this.
"This is what that family and their doctors have been saying for a number of years," Hennessy told CNSNews.com Monday. "Finally, they have an independent and unsolicited expert coming forward to concur with their suspicions. Dr. Baden has said that 'this matter simply must be investigated,' and that is what the family has been asking for since 1998."
Investigation launched by advocacy group for the disabled
The Advocacy Center for Persons with Disabilities (ACPD) describes itself as "Florida's protection and advocacy program for persons with disabilities" on its website.
The agency receives federal funding to administer the "Protection and Advocacy System for Persons with Developmental Disabilities (PADD)" program. The law that created the program also gives the agency wide latitude in investigating alleged abuse or neglect of the disabled.
"PADD...has the authority to pursue legal, administrative and other appropriate remedies or approaches to protect and advocate the rights of individuals with developmental disabilities who are or who may be eligible for treatment, services or habilitation, or who are being considered for a change in living arrangements," the ACPD website explains, "[and] has the authority to investigate incidents of abuse and neglect when reported if there is probable cause to believe the incidents occurred."
Richard LaBelle, an attorney and ACPD board member involved in the investigation, said he does not know how long the inquiry will take.
"I think to the extent that Terri is still alive and will be receiving food and water," LaBelle told the Chicago Tribune, "we think that's a positive development."
How quickly the ACPD makes a determination will depend on how difficult it is for the agency to gain access to Terri's medical records and to the people it needs to interview on both sides of the legal battle.
The ACPD is to be granted "access at reasonable times and locations to any resident who is an individual with a developmental disability in a facility that is providing services, supports and other assistance to such a resident," according to relevant statutes. The agency also "may bring suit on behalf of individuals with developmental disabilities against a state or agencies or instrumentalities of a state."
That authority to bring lawsuits potentially includes actions against a disabled person's legal guardian, as guardianship is considered an "instrumentality" of the state government. Michael Schiavo's decisions regarding his wife's health care, or the alleged lack thereof, have all presumably been made in his official capacity as her guardian.
"They are conducting a pretty comprehensive investigation into past and current allegations of abuse, allegations that Terri is being abused, neglected and exploited," Hennessy said. "They're going to be looking over the current condition that she is in, the fact that therapy has been withheld, the fact that she's kept in isolation. All these things are abuses."
Schiavo's attorney and so-called "right-to-die" advocate George Felos has denied allegations that Schiavo assaulted his wife in the past or is presently "abusing" her by allegedly denying medical care and therapy. Felos has refused to talk to CNSNews.com, however, since mid-September.
Schiavo is believed to be challenging the constitutionality of "Terri's Law," legislation passed by the Florida legislature last week giving Gov. Jeb Bush authority to order Terri's feeding tube re-inserted and her nutrition and hydration resumed. Felos filed a challenge before the bill was signed into law but was told to resubmit the filing later.
Terri's Law also requires the chief judge of the circuit court in Pinellas County, Fla., where Terri lives, to appoint an independent guardian to replace Schiavo. University of South Florida public health Professor Jay Wolfson is expected to be named at a scheduled Nov. 5 hearing. Hennessy said the family is not pleased about that prospect.
"The family and the attorneys are not comfortable with Dr. Wolfson," Hennessy said. "He has stated on local television that he is opposed to Terri's Law, that he is uncomfortable with it, so we feel that creates an instant bias."
Hennessy believes attorneys for the Schindler family will submit an objection to Wolfson's appointment.
While doctors hired by Schiavo, and one court-appointed doctor, say Terri is in a "persistent vegetative state" - defined by Florida law as "a permanent and irreversible state of unconsciousness in which there is an absence of voluntary or cognitive behavior and an inability to interact purposefully with one's environment" - numerous other medical professionals have noted that Terri responds to the sound of her mother's voice by smiling, tracks moving objects with her eyes and responds to tickling or jokes with laughter. None of those responses, they argue, could come from a person in a persistent
vegetative state.
Here is another story on the same issue:
Suspicious Circumstances: The Strange Case of Terri Schiavo
By Jennifer King
November 24, 2003
As the case of Terri Schiavo slips away from the front pages, it is worth revisiting the odd twists and tangles of this bizarre case. There are mysterious connections and odd characters which, so far, have failed to elicit the curiosity of the mainstream media. To recap the case, Terri Schiavo collapsed at home in 1990, under suspicious circumstances. Her lapse into a vigorously debated "vegetative" state is usually blamed on a potassium deficiency, but hospital admittance records also show evidence of trauma to her neck.
Further questions arise from testimony of one of her friends, who allege that Terri was unhappy and contemplating a divorce from her husband, Michael. Michael is alleged to have been possessive and jealous, at one point falling into a rage when Terri spent $80 on a haircut.
After the accident, Michael became Terri's guardian, and he used that position to seek a hefty malpractice award. A sympathetic jury took the seemingly distraught Michael at his word, awarding him 1.2 million, earmarked for Terri's rehabilitation, with an additional $300,000 going directly to him for "loss of consortium". After receiving the award, however, Michael seemingly lost all interest in Terri's rehabilitation. Several nurses who worked with Terri in the early 1990s filed affidavits which detail some very troubling events. Nurse Carolyn Johnson alleges that Michael Schiavo was adamant about not providing any rehabilitation at all for Terri - including common therapies such as placing a towel in her hands to keep them from seizing up. Nurse Heidi Law testified that she would feed Terri with a wet washcloth. Terri was able to swallow these without trouble. Nurse Law also testified that Michael refused to allow any therapy whatsoever, including the usual range of motion exercises. Nurse Carla Saver Iyer had the most damning testimony. Iyer alleged that Michael would enter Terri's room, saying, "Has the ***** died yet?" Iyer says that Michael was "elated" each time Terri's condition worsened, telling her that when Terri died he was "going to be rich" and that he planned on buying a car, a boat, and traveling to Europe. Law and Iyer both allege that they heard Terri speak, saying, "help me" and "momma".
Michael Schiavo clearly has some explaining to do. A supposedly "loving" husband only carrying out his disabled wife's orders, surely wouldn't behave this way. The Schindlers, Terri's parents, further allege that Michael withheld antibiotics when Terri developed an infection, refused to clean her teeth for seven years and has kept her family and friends from visiting her. Most outrageously, when the feeding tube was disconnected and Terri lay dying, Michael also denied her last Communion - on the basis that the Host could be considered food.
Another oddity enters the case in the personage of Schiavo's lawyer, George Felos. Felos is a noted "right to die" lawyer, who has written a book on how he "communicates" with the souls of disabled people. Felos asserts that he can "hear their screams" and that they "want to be released." Felos was infuriated when Terri's feeding tube was replaced. He angrily denounced the move, saying bizarrely that Terri's "deathbed experience was unlawfully stopped." Felos, a past member of the Hemlock Society, clearly hopes to advance along the Crusade of Death, with maybe a book and/or movie deal thrown in for good measure. Felos was Chairman of the Board of the Hospice of the Florida Suncoast, when Terri was secretly whisked out of the hospital and taken there to die.
What does Michael Schiavo gain from killing his wife? Both he and Felos have said that there is only about $60,000 left from the malpractice award monies, but they refuse to make bank account information available to either the Schindlers or the public. Michael's professed reasons for ending Terri's life ring particularly hollow in light of the fact that he has been living with his girlfriend since 1995. They have one child, and another is on the way. The Schindlers allegedly offered to let him keep the malpractice money if he would just divorce Terri and move on. So why won't he?
Several possible incentives exist. One is the insurance money. None was used as mandated on Terri's rehabilitation, and it could have been invested. By now the sum could be substantially higher, even with his legal fees. Fr. Robert Johansen has also theorized that, by divorcing Terri in a community property state, Michael stands to lose half of his possessions and other monies. Better just to kill her off and keep what's left of the insurance money and all of his worldly goods.
Terri's family believes that Michael is intent upon killing her for the same reason he denied her rehabilitation - he's got something to hide and he doesn't want Terri waking up and talking about it. Several medical documents in their possession lend credence to this theory.
Michael must be made to answer some very serious questions. If he isn't trying to end Terri's life for nefarious reasons there must be another answer. At the very least, he should be called to account on why he spent money earmarked for Terri's recovery instead on lawyers who are trying mightily to have her killed.
Specializes in LTC,Hospice/palliative care,acute care.
here is one of the stories where noted pathologist dr. michael baden is quoted as saying that a bone scan showed evidence of head trauma. something that was never addressed at the time of her initial injury.
your right i can't prove it, but my gut smells a rat. all i'm saying is that there should be further investigation and most importently an autopsy if she dies. remember there is not a statute of limitations on murder.
>>>>>>>>>>>>>>>"it's extremely rare for a 20-year-old to have a cardiac arrest from low potassium who has no other diseases," baden said friday on fox news channel's on the record with greta van susteren, restating that such an occurrence would be "extremely unusual unless she had certain kind of diseases, which she doesn't have.
"she was in her 20s. the reason that she's in the state she's in is because there was a period of time, maybe five minutes or eight minutes, when not enough oxygen was going to her brain," baden explained. "that can happen because the heart stops for five or eight minutes, but she had a healthy heart from what we can see."
baden has a different theory about what caused terri's brain injury, based on a 1991 bone-scan report that only became available to the schindlers in 1998.
"that bone scan describes her as having a head injury. that's why she's there. that's why she's getting a bone scan," baden explained, "and a head injury can cause, lead to the 'vegetative state' that ms. schiavo is [allegedly] in now."
dr. w. campbell walker completed the march 7, 1991, bone scan, which was requested to "evaluate for trauma" as the result of a suspected "closed head injury."
"
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>the bone scan was obtained 53 weeks after her intial collapse because there was no physical evidence to lead anyone to believe intially that it was necessary and the findings can be interpreted as resulting from the prolonged pvs and her bedrest-she was already contracted then...it also found "compression fractures" not "broken bones" .....different injuries with very different causes....it is well known that michael baden has made his share of blunders in his career.his statements regarding the scan are a great example of how one can put a spin on anything.he did not say that the "bone scan showed she had head trauma" he said "the bone scan describes her as having a head injury. that's why she's there. that's why she's getting a bone scan," baden explained, "and a head injury can cause, lead to the 'vegetative state' that ms. schiavo is [allegedly] in now." the bone scan was ordered to rule out head trauma-they had to have a reason for ordering it.....
the ems and police that answered her husband's call when she collapsed reported no sign of a struggle,no bleeding or bruising was noted (then or later)...baden states that a cardiac event like hers is rare in one so young especially in an otherwise healthy person---yet we know that bulemics collapse and die and there is evidence that she had an eating disorder.... "talking heads" like baden sell themselves to the highest bidder..read the report on the bone scan and draw your own conclusion....instead of believing every inflammatory sound bite you hear why not reasearch the case fully on your own? here is the report----- indication: evaluate for trauma
procedure and findings. multiple gama camera images of the axial [trunk] and proximal appendicular [limbs] skeleton in the anterior [front] and posterior [back] projections were obtained following 2.1 millicuries of technetium 99m hdp.
there are an extensive number of focal abnormal areas of nuclide accumulation of intense type. these include multiple bilateral ribs, the costovertebral [where ribs and vertebra come together] aspects of several of the thoracic [upper] vertebral bodies, the l1 [lower] vertebral body, both sacroliac joints, the distal right femoral diaphysis, both knees and both ankles, the right greater than the left.
correlative radiographs are obtained of the lumbar spine and of the right femur [leg bone] which reveal compression fracture; minor, superior and plate of l1, and shaggy, irregular periosteal ossification along the distal femoral diaphysis, and metaphysis primarily ventrally. [calcification showing where bones were broken and have healed].
the patient has a history of trauma. most likely the femoral periosteal reaction reflects a response to a subperiosteal hemorrhage and the activity in l1 correlates perfectly with the compression fracture which is presumably traumatic.
the presumptions is that the other multiple areas of abnormal activity also relate to previous trauma. additional possibilities would be neoplastic bone disease, widespread disseminated infectious bone disease or multiple bone infarcts from abnormal hemoglobin.
conclusion: multiple areas of abnormal scintigraphic [actinographic?] accumulation, some of which are radiograph for differential as discussed above.
This is the first time I have heard the theory of the husband being involved in her condition. How could he have caused a severe electrolyte imbalance without her knowledge? If I remember correctly she was a nurse. We just had a legal lesson on our floor when we had a similar case and what we learned is that if the patient is married the spouse is the power of attorney. She told him she would not want to be kept alive artificially, he is saying to stop the feedings...why is there a problem? People have issues with him having a girlfriend and a child, is he suppose to stop living? If he divorces Teri then everyone will persecute him, he can't win no matter what he does. The state needs to stay out of it and let the husband follow through with his wife's wishes.
If he divorces Terri, NO ONE will persecute him. He can just go his merry way and her parents have said he can keep all the money. Why doesn't he just do the right thing and end this mess now and let Terri's parents take care of her.
If the reports from the nurses about how he treated Terri are right, he is scum, like that Peterson guy. Not even allowing her the slightest rehab, not having her teeth cleaned, not letting her be put on an antibiotic for a UTI, not letting her take communion. What a creep.
As I said when we talked about this last year, this case is a great example of why you need to make legal arrangements with all your wishes known before something like this happens.
I don't know about this whole case. If I were in that condition and my husband didn't fight to let me die, he would be a jerk. If all her husband is interested in is the money, why didn't he take the parents up on their offer and just go on about his life?
My whole family and most of my friends know my wishes in this matter, and I am probably on the extreme end of plug pulling advocates. Still I know my mom couldn't take me off any kind of life support. That's why she isn't my decision maker! I've even stipulated that I don't want to be intubated if it's only to give them enough time to reach my city and say goodbye to me.
I don't know about this whole case. If I were in that condition and my husband didn't fight to let me die, he would be a jerk. If all her husband is interested in is the money, why didn't he take the parents up on their offer and just go on about his life?
My whole family and most of my friends know my wishes in this matter, and I am probably on the extreme end of plug pulling advocates. Still I know my mom couldn't take me off any kind of life support. That's why she isn't my decision maker! I've even stipulated that I don't want to be intubated if it's only to give them enough time to reach my city and say goodbye to me.
Hard hard end of life decisions. Most folks NOT in healthcare never give it a thought.
Honestly, I would not want to live in the state that Terri is in but I also would not want a feeding tube pulled after it was placed. She is just too "awake" and aware.
I'm not sure that "advance directives" would have solved this case. Even if my wife would make such directives would they apply if I managed to beat her into a coma, and then blaimed it on a stroke induced by electrolyte imbalance (IF that is what occured here)? Also, Fergus raised the point of "if he didn't love her he would just divorce her and go on with his life." Those who accuse him of nefarious behavior assert that his motivations for not divorcing her involve monetary considerations. They assert that there may still be money in the trust fund ( this fund supposedly has not been made public). Furthermore, they assert that since Florida is a community property state that her family might be entitled to some of Terri's assets. Most of all they assert that he is concerned about the outside chance that she might actually regain enough cognitive ability to implicate him in her injury. No matter how you feel about the right to die everyone should want an autopsy after she dies (as this might show evidence of previous bone trauma, and or other injuries). I would wager my last dime, that HE will order a cremation ASAP after her death.
ktwlpn, LPN
3,844 Posts
THe so called evidence is open to interpretation.Could it be that the husband is doing what Terri wanted? This is precisely why My husband holds my DPOA,POA and copies of both of our advance directives (copies are at out PCP's offices also) I would NEVER trust either of my parents to follow through with my wishes. There is no solid evidence that implicates the husband in any way.From what I read she dieted herself into a severe electrolyte imbalance....The husband is also NOT after the money-there is very little left....Many believe that artificial feeding is life support just as "artificial respiration" is....Taking someone off of the ventilator or tube feeding is not KILLING them-but rather letting them succumb to the illness or injuries they incurred that caused them to be placed on the artificial life support to begin with....And don't kid yourself-what you and many call euthanasia with drugs is practiced all across this country.. I have seen patients removed from life support and given whopping doses of morphine.....This case is PRECISELY why advance directives are important.The more detailed they are the better they are....