Monday, April 04, 2005

The Terri Schiavo Evidence Analyzed

The Terri Schiavo Evidence Analyzed by RD [DRAFT]
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Liberals & Conservatives For Terri (http://liberalsforterri.blogspot.com)
Schiavogate (http://schiavogate.blogspot.com)
SchiavoHoax (http://schiavohoax.blogspot.com)


LEVELS OF HOPE FOR RECOVERY

Stage 1: Beyond hope - minimal cortex left: fetal position, no pain, no emotion, no memory, no open eyes, death is only a matter of time - "pull the plug"
Stage 2: Hope - no way to speed it along, therapy does not help, etc. - "keep alive"

PVS fits in this category, if only because 50% of PVS is reclassified as Stage 3 within the patient's lifetime (brain scans run the gamut from partially atrophied to intact - vast majority (75-90%?) are only minimally atrophied)

Stage 3: Don't need to hope, can Expect improvement, therapy helps, etc. - "rehabilitate"

It's key to understand that prior to the 1996 brain scan "revelation", Terri was classified as Stage 3.
After the 1996 brain scan, an objective evaluation of the brain scan (by the peer review) revealed that she was NOT Stage 2, but Stage *1*.

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ILLNESSES SHOWN BY EXHIBITS

1. Late-stage Acute Cortical Atrophy / Hydrocephalus ("AHC") - Stage 1. Shown in CT brain scan. Note:
- Diagnosis does not explicitly reveal Acute vs. Congenital HC
- Assumed to be Acute since Congenital is FALSIFIED by patient history.
- Without further tests we can't precisely know the level of cortical function (CBB); CT scan could be misleading
- However, the courts assumed the implications were as they appeared, so victim was "blamed" for Stage 1 disorder anyhow.

2. Persistent Vegetative State (PVS) - Stage 2. Argued by Dr. Cranford et al
3. Palsy/Partial Blindness/Aphasia - Stage 3. Not argued until a longer diagnosis was undertaken in [2002]

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EXHIBITS (aggregated)

Exhibit A: 1996 CT brain scan, EEG
Exhibit B: Dr. Cranford et al - patient exams, "balloon" video

Exhibit C (Trial): Schindler doctors - patient exams, videos
Exhibit C (Peer review): add'l doctors to examine patients, nurses' testimony

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CRITERIA for ranking validity of evidentiary claims (besides peer review)

1. Amount of time spent / # of records
2. # of people
[3. Eminence --> Credibility]
[4. Conflict of Interest --> Credibility]

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EXHIBITS - QUANTITY/QUALITY OF EVIDENTIARY SUPPORT

1. Amount of time / # of records
Exhibit A: 1 CT scan - shows clear evidence of severe cortical atrophy and hydrocephalus (w/therapy via shunting potentially indicated); 1 EEG which shows "flatline" activity
Exhibit B: 75 min. doctor's testimony - 45 min., 10 min., 20 min., ?h nurse, ?h (Michael Schiavo)
Exhibit C: 600 - 1000 min. doctor's testimony, 2000-10000h nurse, ?h (all other visitors)

2. # of people
Exhibit A: 1 CT scan, 1 EEG - one person (medical records bearer)
Exhibit B: 3 doctors' testimony Cranford et al - 45 min., 10 min., 20 min. = 75 min. total, ? nurses, ? visitors + Michael Schiavo
Exhibit C: 5-8 (?) doctors' testimony, 100 (?) nurses, ? visitors (all other visitors)

3. Eminence --> Credibility (TBD)
4. Conflict of Interest --> Credibility (TBD)

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INFERENCE (This is not a detailed inference as it does not handle items in evidence individually but could be made into one)

Court
Presented at trial we have 2 Exhibits (A & B) arguing Terri should die, and 1 Exhibit (C) arguing Terri should not die.

Exhibit A is introduced into evidence: 1996 CT Brain Scan, 1 scan, 1 EEG report, 1h lab work, 1 medical records bearer
Exhibit B is introduced into evidence: 3 doctors, 1 nurse (Michael Schiavo), 1 balloon video, witnesses (Schiavo family)
Exhibit C "lite" is introduced into evidence: 2 doctors, ? nurses, witnesses (Schindler family)

Exhibit A indicates Stage 1 (supported by peer review)
Exhibit B alleges Stage 1 or Stage 2, but must conclude PVS (a Stage 2 diagnosis) due to balloon videotape (which peer review suggests is really evidence of Stage 3)
Exhibit C alleges Stage 3 (supported by peer review)

Exhibit A ("AHC") is VERIFIED by peer review - Gupta (CNN), Austin (CBB), et al (though many neurologists debate clarity of CT scan)
Exhibit B (PVS) is CONTESTED by peer review - Cranford et al vs. soon-to-be 45 neurologists
Exhibit C (palsy/partial blindness/aphasia) is VERIFIED by peer review - Mayo clinic, Hammersfahr, Bell et al (+45 neurologists)

Exhibit A ("AHC") is VERIFIED by peer review - Gupta (CNN), Austin (CBB), et al
ergo Stage 1
ergo NOT Stage 2
ergo NOT PVS
ergo Exhibit B (PVS) is FALSIFIED by A (peer review also lacking)

Exhibit C (palsy/partial blindness/aphasia) is VERIFIED by peer review - Mayo clinic, Hammersfahr, Bell et al (+45 neurologists)
ergo NOT PVS
ergo Exhibit B (PVS) is FALSIFIED by C (peer review also contests B's classification as Stage 2)

A & C contradict even more strongly than B & C, but both are equally supported by peer review. [Paradox #1]
ergo C (being subjective) is SELECTIVELY FALSIFIED by A (which is objective) - the tie-breaker is "objectivity" not provenance.

Post facto: Because Stage 1 is indicated by Exhibit A, Cranford argues that his Stage 2 PVS diagnosis is actually Stage 1 or "borderline" Stage 1/Stage 2, retaining the label of "PVS" while supporting the Stage 1 conclusion affirmed in Exhibit A. [Paradox #2]

Court concludes Stage 1 and provides for a quick termination.


Points to note:
(1) Exhibit B - and the PVS diagnosis - is falsified by BOTH A AND C, on different grounds, even though A & C form a paradox. (!) (More on that below)
(2) Court determination (Stage 1) is a condition WORSE than the PVS/Stage 2 conclusion "warranted" by Dr. Cranford's Exhibit B.
(3) Exhibit C was eyewitness testimony who had one-on-one with patient; Exhibit A was a photograph and a document in a medical file.
(4) Reclassifying Exhibit B as "borderline" Stage 1/Stage 2 weakens both Exhibits A & B by the same token. [Paradox #2])
(5) PVS inherently does not preclude hope, as at least 40% are reclassified as Stage 3. Some may express the wish to die at Stage 2 in a living will, but Terri was not one of them.

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PARADOX #1
[Court's Dilemma or Greer's Dilemma]: Exhibits A (Stage 1) & C (Stage 3) contradict more strongly than either A & B or C & B, yet both A AND C are equally supported by peer review. This presents a paradox: both purport to be valid, yet one being true implies the other is false and vice versa. Additionally both A & C promise to provide virtually "unlimited" corroboration / overdetermination in the form of additional scans (in the case of A) and additional testimonials from other witnesses (in the case of C).

Clearly one or the other is not what it seems. The problem for the court is that it MUST introduce both into evidence in one form or another since each (A and C) form the foundation of each side of the case.

The question for the court is: on which basis can it selectively falsify either Exhibit A (CT brain scan / EEG) or Exhibit C (doctors' exams, nurse interactions, etc.) to permit a ruling to be made? They can't both be right, yet both are equally supported by peer review. And both are admitted into evidence. The only explanations are EITHER (1) at least one is phony IOW deliberately faked ("provenance"); or (2) at least one is incompetently derived from the objective evidence ("objectivity").

[Note: CodeBlueBlog is handling the case where conclusions are incompetently derived from Exhibit A. For the sake of argument we will rule out this possibility in order to consider the remaining options (as peer review strongly supports the conclusion - rightly or wrongly - that Exhibit A demonstrates a patient in critical condition).]

Exhibit C can be challenged on the basis of objectivity but not provenance; after all BOTH sides were present when Terri was examined and Exhibit C garnered. That is NOT the case in the case of Exhibit A however; only Michael was "present" during the chain of custody from the lab to the courtroom. So: though Exhibit A cannot be challenged on the basis of objectivity, its provenance can indeed be challenged.

And here's the dilemma: Challenging Exhibit A's provenance attributes outright criminality to Michael. (Thus it's not to be done lightly.) Yet challenging Exhibit C's objectivity is a weak attack because there is more than enough available evidence (i.e., overdetermination) - including those willing to provide yet more - to refute this attack. (In contrast Exhibit A rests solely on one CT brain scan and one EEG report.)

So, what to do? On the one hand Greer could order more tests in support of Exhibit A (as the Schindlers had requested), the goal being to match the level of overdetermination provided by C; on the other hand, Greer could - through his discretionary powers as a judge - fail to admit [all of] Exhibit C, thus providing Exhibit A less falsification in the court record. So how did judge Greer handle the dilemma?

We know from history that Greer chose the latter. By failing to order additional tests, by holding specific corroboration of Exhibit C out of the court record, and by allowing the doctors' analysis of Exhibit A to be entered into the court record as "proscriptive" of Terri's condition, he SELECTIVELY FALSIFIED Exhibit C on the grounds of objectivity. Exhibit A (consisting of objective patient medical data) was deemed a more objective source than the "eyewitness testimony" (including videotape - see below).

Meanwhile, the provenance of Exhibit A appears not to have been considered by the court. The two Exhibits (as entered) were left to duel each other as if they represented the very best that each side could bring to the table.

Analysis:

* Exhibits A & C created a condition of deadlock. To break the deadlock, only one ground for selective falsification - either provenance or objectivity - could be selected as the tie-breaker. As a trial judge, Greer had the discretion to exercise a form of control that promised to break the deadlock without examining the reasons for it: that of how much corroborating evidence to admit into evidence. In the case of Exhibit C, it meant excluding volumes of corroborating testimony. This is clearly an arbitrary exercise of power, not a decision made in the interests of truth-seeking.

* Besides: there is a flaw in this approach. It lies in the inherent asymmetry between proving something and falsifying it: as with the "PVS" diagnosis in the balloon video, all it takes is ONE credible example of Stage 3 to disprove 100 examples of alleged "Stage 1". (In other words, one credible report of someone reacting to pain or responding to an examiner is enough to disprove Stage 1.) We have at least two examples in court that show Stage 3 (Schindlers' doctors' testimony) and two that show Stage 1 (the CT scan and the EEG). The only attack available on Exhibit C is its objectivity; and that attack is only [barely] supportible as long its level of corroboration/overdetermination is low (such as what Greer has managed to engineer by restricting Exhibit C to the bare minimum). The flaw in even this "clever" approach is that, if ANY of those "minimal" examples are later shown to be supported by video, audio, or additional eyewitness testimony, then the "selective falsification" of Exhibit C (on grounds of "credibility") can no longer be supported. Realize that any such retractions would immediately call into question Exhibit A, the original chain of provenance that that supported it, and the presumption of innocence of those promulgating it.

* Michael had the opportunity to obtain additional brain scans and EEGs under the close supervision of the court and/or defense but declined the offer. He preferred to stand on Exhibit A as it was rather than corroborate Exhibit A through additional testing. This looks, to say the least, suspicious.

* To our knowledge no valid evidence was provided in court demonstrating the chain of custody of Exhibit A test results.

* Contrast this with Exhibit C: the doctors' ten-hour+ physical examination of Terri, which was not only witnessed by both sides, but provided compelling evidence that she felt pain, understood speech and suffered from discernible disorders not related to either PVS OR late-stage cortical atrophy. This evidence was also corroborated by every caregiver responsible for Terri's welfare over the last 7 or 8 years. Why was this evidence not entered into the court record? It would have bolstered Exhibit C and forced Michael to corroborate his Exhibit A through a new set of tests (whose results were transparently obtained).

* As to the video evidence provided in court by BOTH sides: Dr. Cranford helped recast any such video evidence as "evidence of PVS" rather than a Stage 3 affliction by his own characterization of his "balloon" video, where phenomena such as "eyes tracking balloon", "response to suggestion", and so on was deemed inconclusive and/or "PVS". This recharacterization may have allowed the court to "weaken" any claims from Terri's doctors that their video evidence demonstrated Stage 3 on the grounds that, since the two videos showed substantially similar behavior - and one was "clearly" identified as symptomatic of PVS - the others must be indicative of the same.


PARADOX #2
[Plaintiff's Dilemma or Cranford's Dilemma]: (In Exhibit B subject's eyes were open and made sounds; peer review hints at Stage 3 but if it's used there it will undermine his case.) PVS (nominally Stage 2) was assumed as the best-fit diagnosis. PVS is not a Stage 1 affliction. Yet if it remains in Stage 2, then the diagnosis contradicts Exhibit A. There can't BE "borderline" diagnoses in mutually exclusive categories (like the Stages above) anyhow; either there's hope or there's not; either there's a decision to pursue therapy or there's not. Yet if he doesn't put Exhibit B in a "borderline" category he can't keep it because it won't fit in EITHER Stage 1 OR Stage 2. (Diagnoses that are not clear-cut will always err on the side of caution and a higher Stage.) Attempting to use both pieces of evidence (Exhibit A and Exhibit B) - regardless of what stage Cranford tries to put Exhibit B in - leads to a PARADOX for Dr. Cranford.

ergo Dr. Cranford's post facto arguments are FALSIFIED,
the assertion that Exhibit B can simply be moved to fit the other available evidence is FALSIFIED,
and Exhibit B is UTTERLY FALSIFIED.

And Cranford is DISCREDITED and DISQUALIFIED to evaluate or submit evidence for peer review.

(Note: Those who are wondering what happens when A is thrown out have a good point - but remember Dr. Cranford has never argued that Exhibit A was not a picture of Terri's brain. If he chooses to do that then he is left with ONLY Exhibit B and Exhibit C. (See Peer Review below)

Analysis:

* Dr. Cranford uses testimony that can only be [Stage 2 or] Stage 3 (eyes follow balloon) to support a Stage 1 (CT brain scan) diagnosis. As soon as Stage 1 diagnosis was decided the court should have thrown out Exhibit B. Yet they held onto both Exhibits simultaneously. Therein lies a contradiction borne of BOTH Paradoxes noted above: Exhibits that argue for more than one Stage simultaneously cannot be valid since a patient cannot be in more than one Stage simultaneously, nor can either of them be moved where they are most convenient. That means, at least one of the Exhibits (Exhibit A or Exhibit B) - REGARDLESS of where it is moved or reclassified - MUST be false. It is also quite possible that they are BOTH false (but at least one of them MUST be).

* Arguing in court using evidence that points toward different Stages (Stage 1 and Stage "2") implies either incompetence or incrimination. (Using evidence supporting different diagnoses within the same Stage is bad enough; arguing for both "AHC" AND PVS is further grounds for suspicion.)

* Dr. Cranford ignored the peer review which suggested that the balloon video (which he participated in) ought to be classified Stage 3. If he had admitted this to the court it would have undermined his entire case. It would have given his evidence a spread over the entire spectrum (Stage 1 through Stage 3) with Michael's testimony possibly to fit either Stage 1 or Stage 2.

* If Dr. Cranford had instead chosen to leave out the balloon video altogether, he would have been left with subjective testimony from the husband ("oh yeah she can't move her eyes...she's unconscious") and the brain scan, which would have clearly indicated Stage 1. That would have given his "chain" of evidence a narrower spread and avoided some of the contradictions inherent in his court case; on the other hand it would have left the PVS diagnosis unsupported and made the substantial "disconnect" between Exhibits A and C [Paradox #1] much more explicit. (It is likely this could not have been resolved without calling both Exhibits A & C into question. IMHO Exhibit B provided a convenient foil and diffused this pressure to some degree.)

Q: Did Cranford HAVE to release the balloon video? Did others know about it before he tried to use it or could it have just "disappeared"? If so Michael's side might have been better served sticking to a Stage 1 story and skipping the PVS, stonewalling Schindler's two doctors with their three. Perhaps they felt the strategy would be so brazen it would never hold up on appeal. (It appears they were wrong. No appellate judge questioned Judge Greer's right to pick & choose whatever evidence he wished even though it supported blatant contradictions.)


Peer Review
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Presented we have 2 Exhibits (A & B) arguing Terri should die, and 1 Exhibit (C) arguing Terri should not die.

Exhibit A is introduced into evidence: 1996 CT Brain Scan, 1 scan, 1 EEG report, 1h lab work, 1 medical records bearer
Exhibit B is introduced into evidence: 3 doctors, 1 nurse (Michael Schiavo), 1 balloon video, witnesses (Schiavo family)
Exhibit C is reintroduced into evidence: 3-8 (#?) doctors, 10-200 nurses (#?), corroborating videos, 10-100 witnesses (Schindler family)

Exhibit A reveals Stage 1 (supported by peer review)
Exhibit B alleges Stage 1 or Stage 2 - since argued to quasi-Stage 1 (refuted by peer review, which suggests Stage 3)
Exhibit C alleges Stage 3 (supported by peer review)

Exhibit A ("AHC") is VERIFIED by peer review - Gupta, Austin et al
Exhibit C (---) is VERIFIED by peer review - Mayo clinic, Hammersfahr, Bell et al (+45 neurologists)
ergo Exhibit B (PVS) is FALSIFIED by A & C (peer review also lacking)

A & C contradict even more strongly than B & C, but both are equally supported by peer review. [Paradox #1]
ergo A (not guaranteed to be from Terri) is SELECTIVELY FALSIFIED by C (which is guaranteed to be from Terri) on the grounds that it CANNOT BE PROVED the scan is Terri's.

There is no other acceptable conclusion. Exhibit A requires confirmation of authenticity through additional brain scans whose provenance can be assured beyond all doubt.

Monday, March 28, 2005

Terri Schiavo is a Victim of Medical Records Fraud

[Cross-posted and UPDATED from the CodeBlue HC thread]

For the sake of argument I identify these levels or "stages" by which doctors judge what to do with a patient:

Stage 1 - Beyond hope ("pull the plug")
Stage 2 - Hope ("let them live but don't rehabilitate them")
Stage 3 - No need to 'hope' - can improve ("rehabilitate")

I allege Medical Records Fraud perpetrated on the Schindlers. On all counts. Not because all documents are GUARANTEED to be fraudulent, but because - when someone has already done it once - why not for "all" of them? (Remember there's only one CT scan and one EEG in question; they were unwilling to consent to "further" tests.) Consider:

We already know of the overwhelming and irrefutable evidence (from patient examinations & eyewitness testimony) that Terri is a Stage 3 patient. The peer review on the latest patient exams is clear and incontrovertible (except by those very same "medical records"). As we've already pointed out here, the CT scan is clearly of a Stage 1 patient (not even a Stage 2). Therefore, it CAN'T be Terri's brain scan.

It is my contention:

1. Whatever blood or other fluid entered Terri's brain from head trauma early on in her treatment (so-called "hydrocephalus") was well-contained and had other effects and outcomes - NOT this one. Or else we'd have known it by [not] talking to the woman.

2. The patient here in this scan is a very sick person indeed. Their cortical atrophy puts them in Stage 1, with "no hope" - and no verbal interaction either. (Terri gave one heck of a scream the other day as you recall. The only question in the judge's mind was whether it was her expressing her will to live or just a moan.)

If we get our heads out of the weeds a minute and THINK, it's obvious this can't be Terri's CT scan. And that means we might as well throw out the EEGs and Dr. Cranford's testimony as well. (!)

Recall that he's the man who used a "balloon video" (which clearly demonstrated Stage 3) and a CT scan (which clearly demonstrated Stage *1*) and "averaged" his way to the conclusion that Terri has PVS (Stage 2) rather than conclude that one of the exhibits was obviously faked. I guess he really is the man of compromise.

THEN he argued - the slimeball that he is - that because of the "irrefutable" nature of the Stage 1 diagnosis on the CT scan, plain for all to see (which isn't a lie), that Terri was a new kind of "PVS" patient - one with no hope (Stage 1).

That the CT scan wasn't even Terri's had either not been considered, or had not been admitted.

J'accuse.
RD

Get the word out to the world IMMEDIATELY!

P.S. LFT & SG are for the main threads, Hoax is for dedicated for working on this one - it's a CodeBlue spillover for my content. I'll try to keep you posted but will only have certain times of the day today to check in.

CT Scan Is An Obvious Hoax - J'Accuse

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[UPDATED - X-posted from the CodeBlue HC thread]

For the sake of argument I identify these levels or "stages" by doctors to judge what to do with a patient:

Stage 1 - Beyond hope ("pull the plug")
Stage 2 - Hope ("let them live but don't rehabilitate them")
Stage 3 - No need to 'hope' - can improve ("rehabilitate")

I allege Medical Records Fraud. On all counts. Not because all documents are GUARANTEED to be fraudulent, but because - when someone has already done it once - why not for all of them? Consider:

We already know of the OVERWHELMING and IRREFUTABLE evidence (from patient examinations & eyewitness testimony) that Terri is a Stage 3 patient. End of story. As we've already pointed out here, this CT scan is clearly of a Stage 1 patient (not even a Stage 2). Therefore, it CAN'T be Terri's brain scan.

It is my contention:

1. Whatever blood or other fluid entered Terri's brain from head trauma early on in her treatment was well-contained and had other effects and outcomes - NOT this one.

2. The patient here in this scan is a very sick person indeed. Their cortical atrophy puts them in Stage 1, with "no hope" - and no verbal interaction either. (Terri gave one heck of a scream the other day as you recall. The only question in the judge's mind was whether it was her expressing her will to live or just a moan.)

If we get our heads out of the weeds a minute and THINK, it's obvious this can't be Terri's CT scan. And that means we might as well throw out the EEGs and Dr. Cranston's testimony as well.

Recall that he's the man who used a "balloon video" (which clearly demonstrated Stage 3) and a CT scan (which clearly demonstrated Stage *1*) and "averaged" his way to the conclusion that Terri has PVS (Stage 2). I guess he really is the man of compromise.

THEN he argued - the slimeball that he is - that because of the "irrefutable" nature of the Stage 1 diagnosis on the CT scan, plain for all to see (which isn't a lie), that she was a new kind of "PVS" patient - one with no hope (Stage 1).

J'accuse.
RD

Get the word out to the world IMMEDIATELY!

P.S. LFT & SG are for the main threads, Hoax is for dedicated to this one. Am working on a follow-up PROOF for which I will all need your help (working copy will be posted shortly on SchiavoHoax - it's a bunch of unformatted text). If any of you need posting permission let me know. I'll try to keep you posted but will only have certain times of the day today to check in.

http://liberalsforterri.blogspot.com
http://schiavogate.blogspot.com
http://schiavohoax.blogspot.com


Posted by: RD | March 28, 2005 09:12 AM

CodeBlue CT Scan Thread - Excerpts

[Originally posted on CodeBlueBlogs]

For any visitors linking from mine or other Schiavo posts in defense of Terri's cognitive abilities or potential: the point is, this CT scan may not even be hers at all. (!) Dr. Martin finds at least two reasons for that conclusion. And if it is hers, CodeBlueMD finds reasons to doubt her diagnosis was accurate. I'm not a doctor ;) so I'm not voting - others will have to build a consensus - but I think it's time to consider the possibilities here...

Posted by: RD | March 24, 2005 08:48 PM

RD, I have major issues with the validity of the CT too.

Posted by: | March 24, 2005 08:55 PM

Yeah, WTF? What the heck is that thing on the CT? There's nothing in Terri's published medical record to indicate she ever had a shunt. Are we looking at falsified evidence?

Posted by: | March 24, 2005 09:22 PM
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So, here's the question:

Is the spot in the CT scan a shunt, or is it her implant? What do the doctors think? It is either one or the other. Is there a way to tell, or any identifying characteristics separating one from the other?

Also: It stands to reason that (1) if her type of implant does show up on a scan, they would attempt to find a patient with a "similar splotch" on the CT; or (2) if not, then they simply screwed up.

I'd like us to be right on this so that we aren't called "idiots" for "overlooking" her current implant.

Posted by: RD | March 25, 2005 02:34 PM

I was specifically addressing the following point from an earlier provocateur:

I hope someone here has posted that this isn't a SHUNT it's a thalamic stimulator implant. Which, incidentally, would have required surgery, which would have caused damage to Terri's skull. ... So, basically half this article is specious (and incorrect).

Is there a firm opinion on this before I go to press w/it?

Posted by: RD | March 25, 2005 02:51 PM

RD, if you look at CodeBlue's responses above, he feels it's a shunt, but cannot confirm from the one slice. If it is her implant, it's in the wrong place.

Posted by: | March 25, 2005 03:06 PM
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Look, first of all, there is no "scanning mistake" -- the scan is in radiological convention (left on right and right on left) as it is supposed to be. Second, the brain shown in this CT -- if it is, indeed, Schiavo's -- is very, very atrophied. There are almost no parietal lobes, very little frontal matter, nothing to speak of in the temporal lobes -- almost no cortex at all. Anyone looking at that scan and saying that it's "not that bad" hasn't seen a normal CT scan.

Posted by: Anna | March 25, 2005 05:41 PM

Anna, there is no confirmation that this is Schiavo's CT.
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Thanks for the thumbs-up on the shunt - I'm going w/it. Back to the subject of medical records fraud for a minute: If we assume this brain scan is not Terri's, that means either:

1. Terri had a CT scan performed, but someone else's records were substituted for hers (a switcheroo)
2. Terri never had a scan performed. The medical data just materialized on its own. (a phantom)

IMO it raises the following questions:
1. Was Terri taken out of & back to her care facility at the time the scan was allegedly performed? Or was there no 'trip'?
2. Were there any witnesses who saw Terri going to or from the lab?
3. Does the radiologist or operator remember Terri?
4. Do they remember what they saw on the scans? (long shot) Do they remember the circumstances surrounding her trip?
5. Were any copies sent to archival storage for safekeeping? Might those records be available to criminal investigators at some point?

6. Was Michael Schiavo far enough along in his nursing career by 1996 that he could manipulate the provenance (chain of evidence) of those scans?
7. Was Michael far enough along in his career that he could have had access to medical documents of other patients, or even had his pick of available substitutes?
8. Was Michael sufficiently well-connected by 1997 (the time they filed the death suit) to have others do the searching for him?
9. If there were duplicates made, were they purged or returned to Mr. Schiavo? Did Michael ask for them back? What was the argument used at the time? What was the outcome?

On incrimination: Realize that if no one was actively looking at Mr. Schiavo, it's possible he might have thought he could get away with it in the knowledge that no one would ever [be permitted by Judge Greer to] look at them.

Is there anyone in law enforcement or other relevant fields thinking along the same lines? Maybe there are ways to find independent corroborating information on the brain scan question. Either way it would clear up some questions - Thanks

Posted by: RD | March 25, 2005 07:51 PM


Posted by: | March 25, 2005 05:46 PM

Anna, we weren't discussing a "scanning mistake", we were discussing the nature of the artifact on the slice.

Posted by: | March 25, 2005 05:59 PM
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Any possibility that the scan picture isn't "Terri's"? Any reason to believe the Miami ethics site has the wrong scan? Just checking... 'cause that'll be the question from the other side. :)

Posted by: RD | March 26, 2005 06:58 AM
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I'm working on a post on that will be going on my site in the next 2-3 hours (or as soon as I can finish it). I'm going to need everyone's help to check the document and offer whatever suggestions are needed. But I think you're gonna like it. Back in a little while...

Posted by: RD | March 26, 2005 05:38 PM
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Finally done! Sorry for the delay. I have a post up on the site (LFT) arguing the thread's contention that "Exhibit A" - our scan - is a hoax. I'll need some help fixing any issues w/accuracy (or blurring the precision sufficiently ;) Also have an article on medical records fraud up on Schiavogate that also hints to why he may have picked Exhibit A instead of something less incriminating.

Next: There's a truly DEVASTATING indictment of the chain of evidence in the works. It should close all looopholes. I'd like to post it somewhere and have us be able to look at it (not a blog comment IOW). Any place on your site - or a free web host - you'd like me to put it? If not I'll find a place somewhere & post the link.

Thanks
RD

P.S. If there's something in the post that's patently absurd, let me know. It's not 100% logically consistent but that was kinda on purpose. The text file's got it whittled down to just the meat...

http://liberalsforterri.blogspot.com
http://schiavogate.blogspot.com

Posted by: RD | March 27, 2005 03:50 PM

RD, a good point of investigation would be to find out how the medical records were treated in the chain of evidence in this particular case. After the CT (did a radiologist read the CT? Is there a report available?)left the Imaging facility, how was it delivered to the court? Did the neurologists have access to the entire scan or just selected parts of it? Her medical records have been sealed by Judge Greer but (I assume) within those records there would have been a chain of events as the patient would have been moved to an Imaging facility, records as to the patients presence at the Imaging facility, who performed the scan, etc. Also, does the Imaging facility who performed the scan keep copies of such things?

Posted by: | March 27, 2005 04:41 PM

This is a crazy tin-foil thought.....but.....since Felos and Schiavo had control over at the Hospice, what would stop them from transporting a different patient to the Imaging facility but provide ID, at the facility, that it was Terri? I mean, I doubt that Terri has a recent picture ID or that a picture ID would be required for patient ID to perform the scan.

Posted by: | March 27, 2005 04:53 PM

Oh crud, more tin-foil thoughts.....maybe that's why Schiavo is adamant regarding immediate cremation with no autopsy. One look at Terri's brain could identify this CT as fraudulent.

Posted by: | March 27, 2005 04:57 PM

The portion of Dr. Cranford's report to the court dealing with CT scans, MRIs and EEGs:

Terri was in a coma for approximately one month, and then evolved into a vegetative state. Four board-certified neurologists in Florida consulting on her care (James H. Barnhill, Garcia J. Desousa, Thomas H. Harrison, and Jeffrey M. Karp) had repeatedly made a diagnosis of PVS over the years. The initial CT scan on the day of admission, February 25, 1990, was normal but further CT scans documented a progression of widespread cerebral hemisphere atrophy, eventually resulting in CT scans of 1996 and 2002 showing extreme atrophy (CT scans-1996, 2002: “diffuse encephalomalacia and infarction consistent with anoxia, hydrocephalus ex vacuo, neural stimulator present); prior to these most recent two CT scans, CT scans had been performed on February 25, 1990, February 27, 1990, and March 30, 1990, with an MRI scan on July 24, 1990.The two most recent EEG’s have demonstrated no electrical activity-on July 8, 2002: “no evidence of cerebral activity;” and October 4, 2002-“does not have any definite brain activity. However, most of the tracing is obscured by artifact from muscle and eye movement.” The clinical exams over the years were entirely consistent with diagnosis of permanent vegetative state secondary to hypoxic-ischemic encephalopathy. From the initial hospitalization in February, 1990, until the present time, there have been no significant changes in Terri’s neurological findings, and nothing in the medical records to suggest any disagreement whatsoever among Terri’s attending and consulting physicians about the underlying diagnosis and prognosis for recovery.

Posted by: neloho | March 27, 2005 09:48 PM

neloho, don't know if you figured this out but a few of us here don't put a lot of credence into what Cranford says as he is a euthanasia activist.

Posted by: | March 27, 2005 10:16 PM
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I just wanted to counter the often repeated, yet totally incorrect claim that no EEG had been done for over 10 years.

As the report from 2003 reports:

The two most recent EEG’s have demonstrated no electrical activity-on July 8, 2002: “no evidence of cerebral activity;” and October 4, 2002-“does not have any definite brain activity.

Posted by: neloho | March 27, 2005 10:42 PM

I've said all along that something is certain to be fishy about Shaivo. He seems adament alright. Too soon after the 'execution' process started by Greer and the so-called husband team, did he want to start talking about cremating poor Terri. He looks, acts, talks, and jestures like a man who had just gotten away with the murder plot of his wife. God have mercy! What would Ben Franklin say about his discovery of electricity not being put to the good use of human life sanctity? What would he and others from our history pages have to say about all this uproar? There is a final judge and He is Christ Jesus. Then what? I'd hate to see His courtroom filled with all the people in our judicial system who's fought against Terri's parents, with Terri's relatives and her two-bit husband in the same room with all these earthly judges who helped with this murderous plot. I rest my case!

Posted by: Betty J Taylor | March 27, 2005 11:01 PM

neloho, does that really matter? She should have had one done last week or last month.

Posted by: | March 27, 2005 11:05 PM

Posted by: | March 27, 2005 11:18 PM

There may have been more recent EEGs. The report I quoted is from back in 2003.

Posted by: neloho | March 28, 2005 12:24 AM

neloho,

"March 9, 2005… Judge Greer denies Schindlers' motion requesting new tests"

Why would they put in a new motion for tests if tests were being done?

Posted by: | March 28, 2005 12:34 AM

They were requesting additional tests as a delaying tactic. I suspect that had the motion been granted, they would have continued to request additional tests year after year after year.

Posted by: neloho | March 28, 2005 12:44 AM

neloho,

"They were requesting additional tests as a delaying tactic. I suspect that had the motion been granted, they would have continued to request additional tests year after year after year."

There has been no tests SUBMITTED INTO EVIDENCE since 2002 and you say that the motion is a "delaying tactic". You are a heartless, cruel, injust b*****d. I can tell that there will be no protesting when it's time to pull your plug.

Posted by: | March 28, 2005 12:54 AM

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In Cranfords diagnosis:

"diffuse encephalomalacia and infarction consistent with anoxia, hydrocephalus ex vacuo, neural stimulator present"

If you had "hydrocephalus ex vacuo" you wouldn't need a shunt because it would be NPH, right? Can you fluctuate between NPH and increased intracranial pressure? I guess these questions are for the docs because there is nothing in anyones notes about a shunt. If her "stimulator artifact" were in the wrong place, wouldn't that be noted on the neurolgist review of the scan or in the radiologists notes? If she does have a shunt doesn't she have to be tested for increased intracanial pressure? Because certainly, at one time, she had pressure or there wouldn't be a shunt. How can you tell if someone is NPH all the time unless you do testing? Otherwise, isn't it negligent?

Posted by: | March 28, 2005 03:35 AM

In Cranfords diagnosis:

"diffuse encephalomalacia and infarction consistent with anoxia, hydrocephalus ex vacuo, neural stimulator present"

Also, Cranfords diagnosis is wrong off the bat because she never was diagnosed as having a MI. Read the Humana discharge summary and Dr. Peter Bambakidis testimony.

Posted by: | March 28, 2005 03:47 AM

Dang, Cranfords diagnosis may just contain a litany of neglect to this patient. Infarct? Where's the infarct? When did this happen? How was she treated? It didn't happen at Humana, so when did it occur? How and where was the patient treated? Hydocephalus? Why no treatment? Shunt? Why? When? How? For what purpose? What was the patients after care in regards to the shunt? Is it NPH or no? He's supposed to be a neurologist but no mention that the "stimulator artifact" is floating somewhere it shouldn't be? Why not? It's an odd enough finding to put in your notes in any case.

Posted by: | March 28, 2005 04:35 AM

Sunday, March 27, 2005

What if the CT Brain Scan Isn't Terri's?

Online Medical Discussion Board Concludes 1996 CT Brain Scan Is Likely A Hoax

[This post will be updated to fix facts or update conclusions as needed with informed consensus. Assertions will be withdrawn as they are refuted.]

Analysis and discussion on the award-winning medical blog CodeBlueBlog are casting suspicion on the single 1996 CT scan that has provided the entire basis of evidence - apart from Dr. Cranford et al's since-discredited testimony - for Terri's diagnosis of PVS and the claims of massive cortical atrophy (the so-called "liquefying brain"). From Dr. Martin on CodeBlueBlog:
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I have seen many CT scans looking like ["Terri's"] as well ... The single image from this particular scan shows SEVERE loss of cortical tissue. The PATIENTS who go along with CT scans like that are for the most part in advanced demented states, nonverbal, often contracted into the fetal postition, unable to follow any instructions or engage in purposeful movements.
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The conclusion that the 1996 CT scan shows severe brain damage and almost no hope for meaningful recovery was echoed by Dr. Sanjay Gupta, CNN's medical correspondent and a trained neurosurgeon himself, who reportedly based his opinion on this scan and the (disputed) EEG report. Dr. Martin's assertion above - that this scan may not even be Terri's - is either a five-alarm scandal in the making or a fantasy driven by collective "false hope".

Yet the consensus building on the discussion thread's medical participants indicates: The 1996 CT scan is a hoax.

WHY A HOAX?

Why we reached this conclusion is an excellent question. There are several reasons to consider.

First: Like Dr. Martin, Dr. Bell at Wake Forest and other respected neurologists in the field have collectively concluded that the two different exhibits being used to justify Terri Schiavo's diagnosis of persistent vegetative state or PVS - the CT brain scan ("Exhibit A") and the 10- to 45-minute patient exams by 3 doctors ("Exhibit B") - point in two entirely different directions. To a large degree they may even contradict each other.

That does not address the question of whether or not Terri has PVS. What it means is, the two exhibits gathered to "diagnose" Terri contradict each other. It means that at least one of the exhibits - Exhibit A or Exhibit B - must be false.

Which is it (or is it both)? Competent neurologists believe it is both, for reasons that will become clear shortly.

EXHIBIT B - Testimony of Dr. Cranford et al

First: there is reason to doubt Exhibit B independently. Exhibit B consists of testimony from three doctors - two for Michael Schiavo and a tie-breaker - that all agree she has "PVS". This is ludicrous for the following reason: Every neurologist (besides Dr. Cranford et al) who has examined Terri in person has found immediate and solid evidence of her cognitive abilities. Though this evidence was swished away as "irrelevant" by Judge Greer on every occasion (for reasons known only to him), they have found Terri to be alert, conscious, able to feel pain, and trying to speak. That falsifies Exhibit B - testimony that has been discredited by the eyewitness reports and even her own medical records - on its face.

[Ed: There will be more credible and irrefutable problems and contradictions that will impeach Exhibit B in a future post.]

While they have noted some obvious disabilities in Terri - partial blindness is one of them - they all realize she continues to hear well and respond. Why this hasn't been entered into evidence in Judge Greer's court is a mystery he has yet to answer for.

EXHIBIT A - 1996 CT Brain Scan

And now to the question of the hoax. If the flimsy provenance of the Exhibit B diagnosis has not put you in doubt about the entire case, then this may not stand for much to you. But there is serious reason to doubt the origin of Exhibit A on at least three grounds:

1.  Dr. Austin's argument that a patient with this degree of hydrocephalus (fluid in the brain) and cortical atrophy (diminishing brain matter) would not correlate to the patient history seen here and here is a compelling one, and one shared by the eminent neurologists quoted by Robert Johansen.

2.  If Exhibit A is to be believed then we must also believe that the deterioration in her brain was unusually rapid from 1993 to 1996, yet so slow between 1996 and 2005 that not only did she not die, but she remained sufficiently cognitive to appear in these videos, recognize music and express her wish to live. Whether or not it is called "PVS", it is doubtful the physicians could provide a viable explanation as to how the brain managed to retain those abilities in the face of such massive brain injury.

3.  Most patients who have PVS have almost-normal CT brain scans. This CT brain scan is considered anything but normal. It is a patient with late-stage hydrocephalus (whether it shows an acute or congenital problem depends on the patient's medical history).


WHY EXHIBIT A AND EXHIBIT B CONTRADICT EACH OTHER

A word on brain scans and PVS: Their consensus opinion is that a CT brain scan of a typical PVS patient may not look much different from a scan of a healthy brain. That's one of the reasons why doctors assert a CT scan of the brain does not diagnose PVS (a point the judge failed to understand when he admitted it into evidence). They DO, however, diagnose hydrocephalus of this advanced stage quite easily. The diagnosis reached on the brain scan is late-stage acute hydrocephalus (an acronym which I'll call AHC until a doctor is disgusted with it ;) and does NOT have a normal-looking brain scan.

Exhibit A and Exhibit B contradict each other because they defend entirely different diagnoses, and those diagnoses contradict each other. Dr. Cranford succeeded in moving both diagnoses toward the middle, but for reasons I will post in a follow-up, that interpretation can't be sustained either.

People with the kind of massive brain evisceration shown on the CT Scan would look like the patient described at the top, and not like the PVS patient that they claim Terri to be. We know that Terri Schiavo is neither of those (for reasons that were never submitted into evidence): she is much healthier and more able than either of those diagnoses permit, as her medical chart clearly demonstrates. All protestations to the contrary from 3 doctors and ONE image of dubious provenance, it simply cannot be explained how EITHER exhibit can be linked to Terri Schiavo.

Realize that if:

(1) the "liquefied brain" claim is based ONLY on the scan and not the "PVS" diagnosis that used the famous "balloon" video;
(2) her "PVS" diagnosis is based ONLY on the testimony of the three doctors (which now appears to be in some doubt) and NOT the scan showing massive cortical atrophy;
(3) each diagnosis contradicts the other; and
(4) Terri is reported by witnesses not to have the classic symptoms of either one, then we can conclude only one of two things:

1. Every clinician who has reported Terri's real symptoms other than the three appointed by the Greer / Felos partnership - which includes:
are all incompetent, delusional or lying. OR:

2. Both chains of evidence are phony.

Note that to date NO clinician who has actually treated Terri - whether a nurse or a doctor - from 1993 to the present day - has believed she was in a persistent vegetative state. Nor a helpless state of the sort implied by the brain scan - an even more horrific diagnosis than the PVS.

And it's also absurd that a doctor would allow competing and contradictory evidence to form the basis of a single conclusion (that fits neither one of the diagnoses these exhibits actually represent). The responsibility for a travesty of this magnitude is shared by Dr. Cranford regardless of whether or not the obtained the fraudulent evidence himself.

[This is not a proof, it's an argument. I'm working on a proof. It's longer. Stay tuned!]

And one thing more about the alleged brain scans:

There is a shunt clearly visible on the scan, yet Terri never had one installed.

Either an unauthorized shunt was installed into Terri Schiavo's head and then removed - for no particular reason or benefit (which is highly doubtful since Michael Schiavo forbade all medical treatment from 1993 onward) - or else the brain shown on the CT scan is not Terri's.

That should raise alarm bells.


WISHFUL THINKING?

On the subject of the shunt, there are a couple of things to note:

1. There was initial disagreement on the board as to exactly what the CT scan reveals. Consensus appears to be established however.

2. There is a thalmic implant that was installed earlier in her recovery and not removed. A dissenter had this to say:

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It still seems far more likely that this is a thalamic implant.

"How could they gage serial brain degeneration without serial follow-up?"

Are you really suggesting that 1996 is the only time anyone did a CT?

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Perhaps there's never been one performed. And the rebuttals - and the consensus - are quite clear:
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That is the tip of a venticulatr shunt which we are only seeing on one scan slice (because that's all we have). It was placed there to relieve increased intraventicular pressure which can have 2 causes: overproduction of CSF or obstruction to CSF outflow (= "communicating" and "noncommunicating" hydrocephalus).
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Regarding the possible existence of a "thalamic shunt":
A shunt is a device employed to drain CSF out of the ventricles when the body's natural mechanism of doing so has failed. If somebody placed a shunt into the thalamus, he basically has bad aim. It's a no-no to put shunts into the thalamus. People get sued for putting shunts into the thalamus. Stimulators, on the other hand, have for many years been placed in the thalamus in an effort to treat movement disorders.

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There can be considerable debate about the meaning of these anomalies, but the total set of contradictions are too overwhelming to sustain. And for reasons to be clarified in a follow-up post, the brain scan was both the pivotal piece of evidence that put Terri away - and kept the media incurious - and introduced a trojan horse (more on that later) that may unravel the chain of evidence.

Now here's the entire excerpt from Dr. Martin on CodeBlueBlog:
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I have seen many CT scans looking like ["Terri's"] as well ... The single image from this particular scan shows SEVERE loss of cortical tissue. The PATIENTS who go along with CT scans like that are for the most part in advanced demented states, nonverbal, often contracted into the fetal postition, unable to follow any instructions or engage in purposeful movements. (There are exceptions to this of course, but based on reports of her condition Terry Schiavo is not one of them.)

In addition [to contributing a misleading and incorrect analysis], it is irresponsible to contribute to the debate based on a scan that is possibly and even probably not from her.

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I call "shenanigans" on the medical evidence being used to convict Terri to death.

More to follow. I will have both a more coherent point-by-point explanation, a detailed logical analysis of WHY the brain scan is a hoax (will need help from the CBB), why it may have been picked over another by the perpetrator, and what contradictions it buried into the chain of evidence. There might also be a trojan horse buried inside (that will unravel the chain) that even Judge Greer can't exclude because it's already been admitted into evidence.

Thursday, March 17, 2005

Michael Schiavo, We're On To You

[Cross-posted from Liberals For Terri]

These are some of the reasons (Alpha, Bravo, Charlie, Delta, Echo, Foxtrot, Golf, Hotel, Indigo, Jackass) that the story Michael Schiavo is sticking to has begun to collapse. [Will UPDATE SOON]