A Life That Matters (28 page)

2. I have carefully viewed the public tapes of Terri Schiavo. It is apparent that while severely disabled, she is not brain dead, she tracks objects, she smiles. I did not see any “primitive reflexes.” It appears to me that she reacts to stimuli.

3. I have been informed of the diagnostic studies upon which the decision to terminate her life have been based. It is my opinion that these studies were inadequate, and insufficient to allow a reasoned opinion by her physicians. In my opinion, further neurologic studies are needed before a declaration of Persistent Vegetative State can be made.

4. Many medical advances have been made in the area of Neurorehabilitation. One distinguished Neurologist has announced on television that he believes she can be rehabilitated. Mrs. Schiavo has not had the benefit of these new techniques. I submit that she should be given the chance.

5. I feel it a grave mistake to give full credence to a statement made in a conversation after watching a movie. (I hope I am not held to statements I made at age 20.)

6. I urge you, before it is too late, to provide basic nutrition to Mrs. Schiavo. If she is to be killed, pass a law dealing with the matter of Euthanasia and Assisted Suicide. Even convicted murderers sentenced to death are treated more humanely than this poor woman.

7. I declare under the penalty of perjury under the laws of the State of Florida that the foregoing is true and correct.

Executed this 23rd day of March 2005, in Longwood, Florida.

[signed by Rodney Dunaway, MD], Declarant

DECLARATION OF LAWRENCE HUNTOON, M.D.

I, Lawrence Huntoon, M.D., have personal knowledge of the facts stated in this declaration and, if called as a witness, I could and would testify competently thereto under oath. I declare as follows:

1. I am a medical doctor specializing in neurology in New York. I currently operate a clinical office in Derby, New York.

2. I am a Board Certified Fellow of the American Academy of Neurology. I currently serve as Editor-in-Chief of the Journal of American Physicians and Surgeons. I am also a member of the Association of American Physicians and Surgeons.

3. I have attached a copy of my curriculum vitae.

4. Although I have not physically examined Theresa Marie Schiavo, I have viewed the short video clips on Terri Schiavo’s website. Based on those short video clips there appears to be evidence that Ms. Schiavo responds to her mother and is able to distinguish her mother from other persons who interact with her. There is also evidence of sustained visual pursuit, which is the clip where she is following the balloon. These behaviors indicate awareness of the environment, and this type of behavior distinguishes minimally conscious state (MCS) from persistent vegetative state (PVS).

5. The definition and diagnostic criteria for minimally conscious state were published in
Neurology,
in February 2002. Among the purposeful behavior cited in that article, which generally supports a diagnosis of MCS, is “appropriate smiling or crying in response to the linguistic or visual content of emotional but not to neutral topics or stimuli.”

6. The video clips on Ms. Schiavo’s website show clearly that she smiles. Her face “lights up” when her mother is talking to her. That same type of reaction does not occur when a male health care worker is talking to her. That suggests that Ms. Schiavo is able to distinguish who is talking to her and she has an appropriate “happy” response to her mother talking to her. This single behavior, according to the article cited, would be sufficient to qualify Ms. Schiavo for a diagnosis of MCS, made by an examining neurologist.

7. If there is any question about clinical interpretation of behavior (i.e. is it “reflexive” or “responsive”), then other objective, supportive testing might be considered. Although this testing is still in its infancy, there is evidence that some MCS patients retain cognitive function despite inability to communicate or follow commands. A
Neurology
article in February of 2005 cited, “These findings of active cortical networks that serve language functions suggest that some MCS patients may retain widely distributed cortical systems with potential for cognitive and sensory function despite their inability to follow simple instructions or communicate reliably.”

8. Swallowing therapy, via a qualified speech therapist, should absolutely be provided in the case where artificial nutrition has been given and the artificial nutrition is being terminated. A speech therapist can provide advice on amounts and consistency of food that will minimize the risk of aspiration.

9. Food and water should be offered to patients in the ordinary way in the case where artificial nutrition and hydration are being terminated. Providing food and water in the natural way, by mouth, constitutes “ordinary care” not “treatment.” Ordinary, comfort care should always be provided irrespective of instructions regarding “limitation of treatment.”

10. I would be willing to participate in the matter concerning Terri Schiavo in any way that would be helpful.

I declare under the penalty of perjury under the laws of the State of New York that the foregoing is true and correct.

Executed this 3rd day of March 2005, in Eden, New York.

[signed by Lawrence Huntoon, M.D.], Declarant

DECLARATION OF JACOB GREEN, M.D., Ph.D.

I, Jacob Green, have personal knowledge of the facts stated in this declaration and, if called as a witness, I could and would testify competently thereto under oath. I declare as follows:

1. I am a medical doctor specializing in neurology in Jacksonville, Florida, practicing at the Southeastern Neuroscience Institute, P.A.

2. I have been in practice as a physician for 38 years and am certified by the American Board of Psychiatry and Neurology in neurology. I hold a Ph.D. as well as an M.D. degree, and I did post-graduate residencies in both neurology and neurological surgery at the University of Alabama Hospital at Birmingham, as well as a residency in neurology at the Medical University of South Carolina Medical Center. Presently, I am or have been licensed to practice medicine in Florida, Alabama, Georgia, Virginia, and Kentucky. I have published six textbooks and more than sixty papers published in various peer-reviewed journals.

3. Although I have not physically examined Theresa Marie Schiavo, I base my opinions about her condition on a review of her medical records and on scrutiny of a videotape of the patient, dated January 22, 2000.

4. Ms. Schiavo is not in a persistent vegetative state. Based on the fact that Ms. Schiavo can look around, smile, and make verbalizations, it is my opinion that she is not in a persistent vegetative state.

5. Since the time of the original court’s ruling in the Terri Schiavo matter, a new neurologic entity has, subsequently, been defined. This entity is known as “minimally conscious state” (MCS). The American Academy of Neurology’s own journal has published four articles on this condition in the last several months.

6. This new diagnostic brain-damaged category clearly indicates that Terri Schiavo should be re-evaluated for the correct diagnosis, (MCS).

7. Based upon my medical experience and review of the information available in this matter regarding Terri Schiavo, it is my professional opinion that the correct diagnosis for Terri is, in fact, minimally conscious state and not persistent vegetative state.

8. Since the court previously ruled that Terri is in a persistent vegetative state, new technology has become available to more accurately diagnose the current mental functioning of a patient. This new technology, which is called functional magnetic resonance imaging or fMRI, can measure brain activity by creating multidimensional images of blood flow to various parts of the activated brain. For the first time, doctors using the MRI may predict a patient’s capability for emerging or recovering from those who do not, and also to guide us in therapeutic techniques and strategies that would help a patient recover from a minimally conscious state.

9. Terri Schiavo deserves the opportunity to be treated for her minimally conscious state condition and she deserves to have the benefit of new technology that was not available prior to the court’s original ruling on her condition.

I declare under the penalty of perjury under the laws of the State of Florida that the foregoing is true and correct.

Executed this 22 day of February 2005 in Jacksonville, Florida.

[signed by Jacob Green, M.D., Ph.D.], Declarant

DECLARATION OF JAMES P. KELLY, M.D.

I, James P. Kelly, M.D., have personal knowledge of the facts stated in this declaration and, if called as a witness, I could and would testify competently thereto under oath. I declare as follows:

1. I am a licensed physician in Colorado and Illinois and an Attending Neurologist at the University of Colorado Hospital. I am a Diplomate in Neurology of the American Board of Psychiatry and Neurology and a Fellow of the American Academy of Neurology.

2. I am a Visiting Professor in the Department of Neurosurgery at the University of Colorado School of Medicine in Denver, Colorado.

3. I am an Examiner for the American Board of Psychiatry and Neurology.

4. I am currently Chairman of
AAN news
Subcommittee, Publications Committee of the American Academy of Neurology.

5. I serve on the Board of Governors for the International Brain Injury Association.

6. Since 2003, I have participated in Mild Traumatic Brain Injury and Mass Trauma Events for the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

7. I was Director of the Brain Injury Program at the Rehabilitation Institute of Chicago from 1993 to 2000 and a member of the International Working Party on the Vegetative State which was convened by the Royal Hospital for Neuro-Disability at the Royal College of Physicians in London, England in 1995.

8. Since 1994, I have been involved in a research project, “Assessment of the Minimally Conscious Patient,” Development of an Evaluation Instrument for the Rehabilitation Institute of Chicago.

9. I am a co-author of the research that created the term “minimally conscious state” or “MCS” and directed the Aspen Neurobehavior Conferences in the 1990s where this new term was coined. MCS is intended to describe someone who is in a higher state of neurocognitive functioning than Vegetative State (VS). The term Minimally Conscious State (MCS) was not used in this context before the late 1990s.

10. I am a co-author on research papers coming out now, that have validated the Disorders of Consciousness Scale (DOCS), which was developed to distinguish between the states of coma, PVS, and MCS. Bedside tests, such as the DOCS, can be used to determine a person’s level of consciousness.

11. A copy of my CV is attached for the reader’s review.

12. Regarding Terri Schiavo, it would be inappropriate for me to offer a diagnosis or prognosis without examining her. However, the evidence presented in lay press accounts, radio broadcasts and internet sites indicating that she smiles appropriately, opens and closes her eyes on command and attempts to speak suggests that Terri Schiavo is not in a vegetative state but is in MCS (or possibly a higher level of functioning). If this is the case, Dr. Ron Cranford and other medical expert witnesses have been wrong in their statements that she is in a “persistent vegetative state.” People in vegetative state are consistently unconscious and do not interact in a meaningful way with people or the environment around them. There is only reflexive reaction or stereotyped response to external stimulation in VS.

13. I have been asked on three occasions to present the issues of the ethical dilemmas involved in Terri Schiavo’s case to academic audiences, and I have reviewed the available information thoroughly for those occasions.

14. The issue of removing Ms. Schiavo’s feeding tube is problematic as well. The actual physical removal of the tube is unnecessary and inappropriate. Feeding tubes should be left in place even if feedings are discontinued. The tube is the best route for medicines to be offered in “comfort care” protocols at the end-of-life. Removing the feeding tube and putting it back in place, as apparently has been done in Terri Schiavo’s case, can be physically traumatic and painful. Regardless of the decision to stop or to continue feedings, there is no reason to consider removing the tube.

15. If an MRI of Terri Schiavo’s brain has not been done in the last 12 months, one should be obtained to compare with earlier images to determine if her brain anatomy has undergone any changes over the interval of time. While it is possible that functional neuroimaging such as fMRI could offer information about the pattern of activation of her brain under specific stimulation applications, such testing is not routinely done for clinical purposes. This type of testing is considered experimental at this time and should be done only in academic settings with ongoing research protocols investigating coma/VS/MCS.

16. I would agree to review all pertinent medical records and examine Terri Schiavo to determine her level of consciousness, if asked to do so by the court. Her swallowing would be best assessed by a skilled and experienced Speech Pathologist and a diagnostic Modified Barium Swallow radiological test.

I declare under the penalty of perjury under the laws of the State of Colorado that the foregoing is true and correct.

Executed this 7th day of March, 2005, in Denver, Colorado.

[signed by James P. Kelly, MD, FA AN], Declarant

DECLARATION OF PETER J. MORIN, M.D., Ph.D.

I, Peter J. Morin, have personal knowledge of the facts stated in this declaration and, if called as a witness, I could and would testify competently thereto under oath. I declare as follows:

1. I am a neurologist certified by the American Board of Psychiatry and Neurology. I practice neurology in Massachusetts and in Maine. I serve as Instructor of Neurology at the Boston University School of Medicine and Director of Outpatient Services for the New England GRECC (Geriatric Research Education and Clinical Center) at the Bedford VAMC. In that capacity, I supervise a 50-bed hospice ward for individuals in the advanced stages of dementia. I perform molecular research in neurology and neuroscience. I am also principal investigator for several neurological clinical research studies and serve as a neurologist for the Framingham Heart Study. I am providing this declaration as a neurologist, and not as a representative of Boston University or of the Department of Veterans Affairs.