Monday, April 04, 2005

The Terri Schiavo Evidence Analyzed

The Terri Schiavo Evidence Analyzed by RD [DRAFT]
=========================================
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*.

====================
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]

====================
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

====================
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]

====================
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)

========================
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.

--------------------------

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
-----------
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.

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