Is it possible for a non staff person to completely expunge information from a patient’s chart, without there being some evidence that they’ve done so?
I am not a medical person, and don’t have a lot of experience with hospitals, but I do know how careful medical institutions are with chain of custody and such. I would think notes on a medical record would be damn tough to erase.
I don’t know the specifics of this case, so I’m just asking how easy this would be.
Polecat, XJetgirlX, and others, I’d be very leery of accepting anything posted on terrisfight as “truth”. One affidavit is not exactly convincing. In fact, as Big_Norse suggests, the parts about systematic alteration of the medical record are simply incredible.
Nor is this in any way a new story. There has been a decade-long fight over Terri Schiavo’s care. There was appropriate medical care, including earlier rehabilitation attempts through her case. The parents have fought in literally every court available to them, including four appeals to the FL Supreme Court. There have been federal decisions against the Schindlers, and the US Supreme Court refused to hear the Schindler’s appeal from the 11th Circuit. IOW, every competent court to examine the record has said there’s no conspiracy against Terri and that her husband has the right to make the decision Terri cannot.
As to the “mysterious collapse”:
From IN RE: GUARDIANSHIP OF: THERESA MARIE SCHIAVO, Incapacitated.
Potassium imbalances are not exactly mysterious. Potassium is required for nerve conduction, among other things.
As you can see in the Merck manual, there are many conditions, such as malnutrition, genetic disorders, diabetes complications, etc. that can cause potassium metabolism disorders.
The parents and the husband co-operated in a malpractice action against the initially-treating hospital. At that time, there was no suggestion that there was anything sinister about Michael’s actions.
Indeed, the settlement may be the root of the dispute between the Schindlers and Schiavo.
ibid.
Contrary to the (possibly disgruntled) nurse’s affidavit, the overwhelming majority of medical testimony has shown that Terri Schiavo is not responsive:
For all intents and purposes, as a functioning, intelligent, self-aware human being, Terri Schiavo died in 1990. Her body, directed by the remaining “reptilian” brain, has gone on unaware of this.
The morality of letting the body die, I suggest, is a different question from the one that has been presented in the OP.
Note! I am not advocating either side in this dispute. I think that what is at it’s core a wrenching family dispute has had quite enough outside “friends” interposing their own agendas on it. Look, for example, at the list of Amicus representatives in the last Fl. Supm. Ct. decision in the matter.
I am advocating that people look for sources on this story that are better than the supporters and “friends” of each side.
It is sad that the only legal alternatives in this situation come down to A) keeping the feeding tube in place and B)letting the woman die a slow, agonizing death at the hands of thirst and/or starvation. WTF? In this respect, veterinary medicine is leagues above the human equivalent. At least veterinarians put quality of life right up there with the existence of life.
Leaving this woman to waste away instead of euthanasizing her is unjustifiable. If in the year 2003, doctors can’t do a better job killing someone, then maybe they shouldn’t be doing it.
Amen.
There seem to be conflicting stories about whether or not she’s really “out of it” for good (thanks for the link, Reeder), but to let her die like this is awful.
Just to give a quick update, apparently Shrub’s brother Jeb issued a proclamation of sorts declaring that her feediung tube shouldn’t be removed. But as Judge Andrew Napolitano pointed out on FOXNews’s The Big Story w/John Gibson Jeb’s proclamation has less then no legal standing.
And the women repeatedly has said that she didn’t want any desperate measures (which would include a feeding tube) taken to prolong her life.
Pretty cut and dried to me.
What I think is awful is that she has had to suffer for more then 13 years.
I have only read enough about this to know that if I were in Terri’s state, I would not want to be kept alive. (If I had been unable to offer up my opinion on the matter for ten years, even via blinks and gestures, then I’d hope someone would recognize the end for what it is.)
If she had really made her wishes clear to her husband before any of this happened, that would be the end of it for me. My wife and I discuss these sorts of issues all the time, and if the unthinkable were to happen, I feel that I would be able to express what she would have wanted.
Then again, I’m a doctor who plans to work in hospice and palliative care, and she’s a vet tech, so this sort of thing comes up around our dinner table. Most people don’t like to talk about it. Her husband has not exactly given people every reason to trust him.
It’s a hard case. I feel like I would probably side with her husband, just based on my own views of life and death, but I don’t trust the information I’m getting from the web enough to say for sure.
From the nurse’s affidavit:
I call BS on this one. Unless this hospital was years ahead of every other hospital in the free world re: electronic medical records, this would be nearly impossible to do unnoticed. (Since her husband “took the chart in the room with him”, I’m guessing they’re not on the computer.)
Dr. J
I know that the supporters of the Schindler’s have made a lot of noise about Judge Greer. In fact, the some of them are now charging that Greer, Schiavo, the nursing home, and, who knows, maybe even the entire FL judiciary, are in a conspiracy to let Terri die. I somehow doubt it. As the FL Supreme Court said, the final determination of Terri’s mental status was made by a panel of five doctors. Two were appointed by the Schindlers, two by Schiavo, and one by a different court. The FL. Supm Ct. found that all the members of the panel were qualified experts in brain function. They all agreed that there was little to no cerebral cortex left. Again:
Dr. Hammesfahr declined to participate in the proceeding or the panel. BTW, the “Nobel Prize nominee” thing is a total red herring. Other threads have recently detailed that there is little to no trick in getting nominated.
I still say that there’s too many groups trying to hijack this tragedy for their own purposes. Let the family escape the limelight and grieve.
Amen.
Yes, Reeder, but why did the judge make that choice?
I heard on the radio this morning that Terri’s debts far outstrip any remaining insurance money, so her husband will not be receiving any money upon her death.
Convicted murderers get more mercy on Death Row. Isn’t there a more humane way of ending this woman’s misery than starving her to death? Or is giving her a lethal injection an overt act?
I would feel a whole lot better about the husband if I were sure that he wasn’t going to benefit by letting her die.
As someone who has had to help make this decision, even in the face of my grandmother being able to open her eyes, vocalize, and move, I can tell you that it is something no one should ever have to go through.
If she (the woman in this case) made any comments about not wanting any extreme measures taken to prolong her life, honor them and let her go.
I’ve had a medical directive in effect ever since we had to decide about my grandmother.
I would agree completely with you here, having seen my own grandmother spend 13 years wasting away due to alzheimer’s.
The fishy thing about this situation, though, is that during the malpractice trial the husband specifically set out for a plan of rehabilitation, and the monies received were ordered specifically to be put to use for that therapy plan. It wasn’t until after the trial and after he had the money in the bank that he decided to give up on rehabilitation and put in the DNR order. After the trial he denied any sort of rehabilitative therapy, and reportedly even denied her medication and treatment for general illnesses and infections.
I’ll second that. Even if there’s no money left from the settlement, it’s still in his best interests to have her out of the picture.
JFTR, removing the feeding tube may not result in a long protracted death, oddly.
We went through this with my grandmother three years ago - she was in a diabetic coma (which may or may not have affected this) and my parents were told that she would probably live a week or so once the hospital stopped force-feeding her.
She lived until that evening.
No, I don’t have anything other than anecdotal evidence. Sorry.
Thanks, paperbackwriter. I’m always supprised when the SDMBs have a string of “but this person who has a vested interest and no background at all said…” posts.
As for the removal of the tube, that’s another issue. At this point, for various reasons, most states have only “pull the plug options.” It helps to consider this case in terms of exercise the option or no, without looking at the option.
As I understand it, Ms Schiavo’s cerebral cortex is dead. That which was her is no more. Her body is capable of all its functions, but only on a reflex level – the conductor of her body’s orchestra is gone. It’s time (and has been time for years) for her parents to let her go.
All cites from the St Petersburg Times, my (and the Schiavos’) local paper. I used it because I am familiar with its website and the stories as they have appeared over the years.
Note here that the court-appointed doctor says she is beyond hope. In this instance, as in all the others, the only doctors who say that she may be able to recover are those hired by the Schindlers.
This particular allegation was mentioned and then quickly dropped after it was pointed out that her anti-seizure medications and prolonged immobility caused fractures in many of her bones. The judge dismissed it in court, but the specter of the abusive husband was placed in the public mind.
The article cited above also mentions the fact that the Schindlers have repeatedly attacked Mr Schiavo’s decision to go on with his life – he has a girlfriend and a baby. Further, the Schindlers’ attorney’s says that Mr Schiavo has lowered the temperature in Ms Schiavo’s room in order to ensure her contracting pneumonia.
It concludes with a good timeline of the court’s decisions in this matter as of late November 2002.
I agree with this judge completely. I think that the parents’ holding out hope is thoroughly understandable, but it flies in the face of almost every doctor who has had personal contact with Ms Schiavo. Note that the only fact in dispute is whether her cerebral cortex is completely gone or if isolated, non-functional patches remain.
This reminds me of his actions in the Orlando case involving the rape and subsequent pregnancy of a developmentally-disabled woman. In that case, he opportunistically pushed for a guardian to be appointed to an unborn child, legally extending personhood to a fetus in a bare-faced political maneuver to appeal to the right-to-life movement.
To those who fear that she would suffer unduly after having her feeding tube removed, I offer this:
9/21/03
As this column points out, it’s difficult for someone of able mind to consider this, but her body is an empty shell, devoid of sentience, of humanity.
Note also that any money remaining from the malpractice suit of 1998 is gone. It has been used to pay for housing Ms Schiavo and for the legal fees to remove her feeding tube.
The absolute, overriding medical fact in all of these, and from everybody except from doctors who stand to gain financially from the Schindlers (and as of late, Randall Terry of Operation
Rescue), is that Ms Schiavo’s brain, her personhood, her entire being is dead. It died 13 years ago from a lack of oxygen caused by a heart attack. That death was incredibly painful for all concerned, but to drag her body out for 13 years with no hope whatsoever for recovery is unconscionable. I understand that her parents need to believe that there is a chance for recovery, but a missing cerebral cortex is irreplaceable. Terri Schiavo’s mind died in an ambulance 13 years ago, and it’s time for her body to be let go as well.
Sheesh. All I can say is that this leaves me pretty determined to make sure this kind of crazyness doesn’t happen to me.
I’ve been following this case for a while. While I have no absolute opinions on the matter, I am not opposed to letting this man let his wife die. A lot of the articles cited by people supportive of the Schindlers are an appeal to emotion, which I will always find suspicious intially. I found local sources for the story, though, which might offer more insight. For instance, this is a link to a Florida (where the actual case was decided) newspaper which offers a timeline of the case, and I’ll quote at least one pertinent part:
Another Florida paper printed this article today, relevant quotes include:
The woman’s parents, who are understandably upset at the idea of losing their daughter (no matter that she may be a shell of who she really was), have resorted to some pretty underhanded techniques to save their daughter, including charges of perjury and physical abuse. The physical abuse charges were sooo pressing that they waited until November of last year to level them, 12 years after the fact.
This woman is, in the words of several doctors, severely brain damaged and there is no hope of recovery with the technology available today, or in the foreseeable future. Despite what many of the emotional cites provided said, the facial movements of this woman are not an indication that she is “aware”, they are in fact common to severly brain damaged patients, as the article I cited clearly states–and the professionals agree.
She had proper medical treatment. She apparently even had theraputic treatment for some time in an attempt at rehabilitation. Exactly how much money is this man supposed to spend on treatment for a woman who will never recover, and who most likely didn’t want to live this way?
They’re slamming the husband all over the place on another MB I belong to, saying he should have divorced her and how despicable he is because he didn’t and because he has a girlfriend. But maybe he hasn’t divorced her because he wanted to make sure her wishes were honored and didn’t want her choice usurped to assuage the grief of her parents. That is a possibility. I don’t think anyone on that (or this, for that matter) board knows what is in this man’s head. And he has a girlfriend. So what. It’s been 13 years since this happened to his wife. At what point is it acceptable for him to move on and seek some sort of happiness in this life? Thirteen years isn’t enough?
A point I hope isn’t overlooked is the folly of relying on emotional pleas to work up moral outrage. One would do well to investigate many points of view in such cases.
BTW–the tube was removed at 2 pm this afternoon. Not the first time, mind you. How cruel is that? This on again, off again dying? I was hoping Jeb Bush would stay out of this case, as he does other similar cases in Florida every year. Oh, well.
Anna
Thanks, Bambi. I didn’t know the details of how this worked and the information Dr. Walker provided and you posted if fascinating to me. Most interesting part of this, in fact. 