# Was the "toxic lady" case ever resolved? **URL:** \ **Category:** Factual Questions\ **Created:** [November 18, 2006, 11:12pm UTC](https://boards.straightdope.com/t/was-the-toxic-lady-case-ever-resolved/380984 "2006-11-18T23:12:01Z")\ **Posts on this page:** 5\ **Page:** 1
**Author:** ![Subway\_Prophet](https://avatars.discourse-cdn.com/v4/letter/s/ecb155/32.png) [@Subway\_Prophet](https://boards.straightdope.com/u/Subway_Prophet)\ **Post date:** [November 18, 2006, 11:12pm UTC](https://boards.straightdope.com/t/was-the-toxic-lady-case-ever-resolved/380984/1 "2006-11-18T23:12:01Z")
In 1994, Glora Ramirez was brought into the emergency room at Riverside General Hospital in Riverside, CA, where she died soon after being admitted. There are claims that her body produced toxic fumes that overpowered the others in the ER. Was it ever determined just what happened here? The most recent information I can find online is the [Toxic Lady FAQ](http://tafkac.org/medical/toxic_lady_faq.html) from 1995, which ends rather inconclusively. Was there in fact a poisonous gas emitted from Ramirez’ body or from her blood samples, or was it mass hysteria? Was it caused by weird chemical interactions between [DMSO](http://en.wikipedia.org/wiki/Dimethyl_sulfoxide) (which Ramirez may have been using to treat pain from her cancer) and the high-oxygen environment of the ER? What became of the lawsuits from Ramirez’ family, and the lawsuits from the ER staff? ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [November 19, 2006, 12:06am UTC](https://boards.straightdope.com/t/was-the-toxic-lady-case-ever-resolved/380984/2 "2006-11-19T00:06:23Z")
> **[Card Smarts](https://www.discover.com/credit-cards/card-smarts/)** > > Learn how credit works, from credit scores to APRs to applying for a credit card. Gain knowledge that helps you choose the credit card that’s right for you. Not enough data was collected to be 100% certain, so 2 main theories remain: 1. An outbreak of mass sociogenic illness: > [@](#): > > Although the books on Ramirez’s death were now officially closed, there was no explanation for the outbreak of illness among the hospital staff. The county health department called in California’s Department of Health and Human Services, which put two of its top scientists on the case, Doctors Ana Maria Osorio and Kirsten Waller. They interviewed 34 hospital staff who had been working in the emergency room on February 19. Using a standardized questionnaire, Osorio and Waller found that the people who had developed severe symptoms such as loss of consciousness, shortness of breath, and muscle spasms tended to have certain things in common. Perhaps unsurprisingly, people who had worked within two feet of Ramirez and had handled her intravenous lines had been at high risk. But other factors that correlated with severe symptoms didn’t seem to match a scenario in which fumes had been released: the survey found that those afflicted tended to be women rather than men, as well as people who had skipped dinner that evening rather than those who had a full stomach. > > Those findings, coupled with the autopsy results, the hazmat analysis, and unremarkable blood test results from the stricken hospital staff, led to an official report that the health department released on September 2. The conclusion: The hospital staff most likely experienced an outbreak of mass sociogenic illness, perhaps triggered by an odor. In other words, they’d been felled by stress and anxiety. In support of this mass hysteria theory, Osorio and Waller cited the lack of evidence for a poison and the fact that women were more likely to suffer severe symptoms, both hallmark signs of mass hysteria. In addition, they pointed out, neither paramedic who had treated Ramirez in the ambulance became ill-- despite the close quarters and their having touched her skin and some of her blood after starting an intravenous line. However, Osorio and Waller did not rule out the possibility that some substance poisoned emergency room staff who had worked directly over Ramirez. 1. A very rare chemical reaction: > [@](#): > > When Ramirez collapsed (presumably from cancer-related kidney failure) and was put in an ambulance, the paramedics put an oxygen mask on her face. Oxygen molecules flooded her bloodstream, combining with the dmso in her system, the researchers hypothesized, to form high levels of dimethyl sulfone. The higher the concentrations of the ingredients required, the more efficiently chemical reactions will run; thus, with so much oxygen, no dmso was left untransformed. > > Now the Livermore team needed to figure out the next step: how the relatively harmless dimethyl sulfone could have been converted to the extraordinarily harmful dimethyl sulfate. This is where we were afraid we might find a showstopper that would kill the theory, says Grant. > > They conducted an experiment to see how much dimethyl sulfone could accumulate in the blood at normal body temperature. They dissolved the compound in a transparent liquid called Ringer’s solution, which is basically all the ingredients of blood minus red blood cells. We found we could load it up in the Ringer’s solution to an appreciable extent without any sweat, says Grant. (The autopsy, the researchers note, had found that Ramirez had a urinary tract blockage. That could have aggravated the buildup of dimethyl sulfone by preventing it from being flushed out of her system.) > > When they cooled a vial of this Ringer’s solution crammed with dimethyl sulfone to room temperature (about 70 degrees), they were greeted by a good sign. The solution became supersaturated, and dimethyl sulfone began to form beautiful white crystals, says Whipple, who did the experiment with Grant. In real blood those crystals might have appeared manila-colored. Thus this process could have produced the crystals that had been observed in the syringe in the hospital, particularly since emergency rooms tend to be cooler than most rooms–about 66 degrees. > > So far, so good. But how did the dimethyl sulfone convert to the nerve gas dimethyl sulfate? The Livermore chemists envision a reaction-- which hasn’t yet been observed–in which some of the molecules of dimethyl sulfone in Ramirez’s blood broke apart. What had been (CH3)2SO2 became CH3, CH3, and SO2. Sulfates (SO4) are common in the body, so the two CH3 molecules may have linked up with them to form (CH3)2SO4–dimethyl sulfate. But in her warm blood, the dimethyl sulfate was unstable and quickly fell apart into its hydrocarbon and sulfate components. There was not yet a sufficient amount of nerve gas to harm the paramedics. > > When Susan Kane drew blood at the hospital, however, the cool temperature had slowed the breakdown of the dimethyl sulfate. Appreciable amounts of it built up in the syringe, and some of it vaporized out of the blood. This was the gas that poisoned the emergency room staff. Dimethyl sulfate doesn’t vaporize easily–the Merck Index lists its boiling point as 370 degrees. Nevertheless, according to Grant and other chemists, some fraction will still vaporize at room temperature. The crystals of dimethyl sulfone turned into dimethyl sulfate as well and vanished from sight. In the end, all of the dimethyl sulfate either vaporized or broke back down in the blood into its constituents. And thus the macabre chemistry of that night hid most of its traces from investigators. > > It’s a really clever piece of detective work, says Oregon State toxicologist Frank Dost. It would seem to me that it would take a hell of a lot of dmso, but in that stage of fighting for her life, Ramirez may have really overloaded on it, he says. The Riverside Coroner’s Office apparently agrees–it released the Livermore report last November, hailing its conclusion as the probable cause of the hospital workers’ symptoms. > > But the theory has provoked a backlash from other scientists. Several organic chemists have scoffed at the step-by-step change of dmso into airborne dimethyl sulfate. I’m pretty skeptical, says Hans Reich, an organic chemist at the University of Wisconsin at Madison. Reich doubts that dimethyl sulfone would split apart in the human body’s relatively cool environment. I have used it as a solvent up to at least 300 degrees, he says. Other scientists don’t see a match between the symptoms of the hospital staff and some of the symptoms of industrial workers who have been accidentally exposed to dimethyl sulfate. The stuff is like tear gas, says Jack de la Torre, a physiologist and professor of neurosurgery at the University of New Mexico. When you’re exposed to dimethyl sulfate vapors, the first thing that happens is it makes you start to cry. None of the hospital staff reported tearing or other eye irritation. Furthermore, many other known effects of dimethyl sulfate usually take several hours to hit, and yet the fainting spells and other symptoms at the hospital began to occur minutes after the supposed exposure. IMO there was something that indeed affected the staff, but there was not enough to cause the damage. The individual chemistry of the affected staff was a factor, and then an anti placebo effect took over ([nocebo](http://en.wikipedia.org/wiki/Nocebo)). Cecil was leaning for the chemical explanation: [http://www.straightdope.com/classics/a4\_107.html](http://www.straightdope.com/classics/a4_107.html) but the fact the staff did not cry tells me that that is not the whole story. Cecil mentioned people that proposed the possibility of a clandestine meth lab in the hospital area, but I think there is less evidence for that. ---
**Author:** ![Subway\_Prophet](https://avatars.discourse-cdn.com/v4/letter/s/ecb155/32.png) [@Subway\_Prophet](https://boards.straightdope.com/u/Subway_Prophet)\ **Post date:** [November 20, 2006, 12:59pm UTC](https://boards.straightdope.com/t/was-the-toxic-lady-case-ever-resolved/380984/3 "2006-11-20T12:59:52Z")
[QUOTE=GIGObuster] [urlhttp://www.discover.com/issues/apr-95/features/analysisofatoxic493/]Discover Magazine article [/QUOTE] Thanks! I thought that article sounded familiar - turns out I read it back in 1995. It’s only about a month or two within the FAQ I posted earlier, and still ends with ambiguities and unanswered questions. I’m not only interested in the possible cause of the event, but also in the outcome of the threatened lawsuits from the family and the ER staff, and possibly any ambulance or ER policy changes stemming from the event. Has anyone heard anything about this case since then? It was extremely sensational at the time, and gave Chris Carter plenty of ooky plot materials for the start of X-Files’ second season. I figure _someone_ has to know a bit more about it by now. ---
**Author:** ![Subway\_Prophet](https://avatars.discourse-cdn.com/v4/letter/s/ecb155/32.png) [@Subway\_Prophet](https://boards.straightdope.com/u/Subway_Prophet)\ **Post date:** [November 21, 2006, 7:25pm UTC](https://boards.straightdope.com/t/was-the-toxic-lady-case-ever-resolved/380984/4 "2006-11-21T19:25:02Z")
Bump. Last bump on this thread, I promise. ---
**Author:** ![samclem](https://avatars.discourse-cdn.com/v4/letter/s/a9a28c/32.png) [@samclem](https://boards.straightdope.com/u/samclem)\ **Post date:** [November 22, 2006, 2:45am UTC](https://boards.straightdope.com/t/was-the-toxic-lady-case-ever-resolved/380984/5 "2006-11-22T02:45:07Z")
I searched my newspaper databases for some lawsuit resolutions, etc. Found very little to none.