Terri Schiavo Case - Final Local Motions, Death and Autopsy

Final Local Motions, Death and Autopsy

On March 24, 2005, Judge Greer denied a petition for intervention by the Department of Children & Families (DCF) and signed an order forbidding the department from "taking possession of Theresa Marie Schiavo or removing her" from the hospice and directed "each and every and singular sheriff of the state of Florida" to enforce his order. The order was appealed to the Second District Court of Appeals the following day, which resulted in an automatic stay under state law. While the stay was in effect, Florida Department of Law Enforcement personnel prepared to take custody of Terri and transfer her to a local hospital for reinsertion of the feeding tube. Once Greer was made aware of the stay, he ordered it lifted and all parties stood down. Governor Bush decided to obey the court order despite enormous pressure from the political right. If Bush (or the Florida Legislature) had ignored Greer's order by attempting to remove her from the hospice, a confrontation between the Pinellas Park Police Department and the FDLE agents could have ensued. In jest, one official said local police discussed "... whether we had enough officers to hold off the National Guard."

Terri Schiavo died at a Pinellas Park hospice on March 31, 2005. Although there was concern that Schiavo would experience significant symptoms from dehydration with the removal of the feeding tube, studies have shown that patients who have their feeding tubes removed, such as the case of Schiavo, usually have a peaceful death.

After her death, Schiavo's body was taken to the Office of the District 6 Medical Examiner for Pinellas and Pasco counties, based in Largo, Fla. The autopsy occurred on April 1, 2005. It revealed extensive brain damage. The manner of death was certified as "undetermined". The autopsy was led by Chief Medical Examiner Jon R. Thogmartin, M.D. In addition to consultation with a neuropathologist (Stephen J. Nelson, M.D.), Dr. Thogmartin also arranged for specialized cardiac and genetic examinations to be made. The official autopsy report was released on June 15, 2005. In addition to studying Terri Schiavo's remains, Thogmartin scoured court, medical and other records and interviewed her family members, doctors and other relevant parties. Examination of Schiavo’s nervous system by neuropathologist Stephen J. Nelson, M.D., revealed extensive injury. The brain itself weighed only 615 g (21.7 oz), only half the weight expected for a female of her age, height, and weight, an effect caused by the loss of a massive number of neurons. Microscopic examination revealed extensive damage to nearly all brain regions, including the cerebral cortex, the thalami, the basal ganglia, the hippocampus, the cerebellum, and the midbrain. The neuropathologic changes in her brain were precisely of the type seen in patients who enter a PVS following cardiac arrest. Throughout the cerebral cortex, the large pyramidal neurons that comprise some 70% of cortical cells – critical to the functioning of the cortex – were completely lost. The pattern of damage to the cortex, with injury tending to worsen from the front of the cortex to the back, was also typical. There was marked damage to important relay circuits deep in the brain (the thalami) – another common pathologic finding in cases of PVS. The damage was, in the words of Thogmartin, "irreversible, and no amount of therapy or treatment would have regenerated the massive loss of neurons."

The cardiac pathologist who studied Schiavo's heart found it and the coronary vessels to be healthy, which excludes the possibility that her initial collapse was the result of myocardial infarction, although there was a localized area of healed inflammation (opening the possibility of myocarditis). Thogmartin found that "there was no proof that Terri Schiavo ever had an eating disorder such as bulimia." Regarding the possibility of strangulation or domestic violence as a cause of Schiavo's initial collapse, the report states: "No trauma was noted on any of the numerous physical exams or radiographs performed on Mrs. Schiavo on the day of, in the days after, or in the months after her initial collapse. Indeed, within an hour of her initial hospital admission, radiographic examination of her cervical spine was negative. Specifically, external signs of strangulation including cutaneous or deep neck injury, facial/conjunctival petechiae, and other blunt trauma were not observed or recorded during her initial hospital admission. Autopsy examination of her neck structures 15 years after her initial collapse did not detect any signs of remote trauma, but, with such a delay, the exam was unlikely to show any residual neck findings."

Regarding the cause and manner of Schiavo’s death, Thogmartin wrote, "Mrs. Schiavo suffered severe anoxic brain injury. The cause of which cannot be determined with reasonable medical certainty. The manner of death will therefore be certified as undetermined."

"We were not surprised the medical examiner said Terri's brain was damaged," said Bobby Schindler, Jr., her brother, in an interview hours after the autopsy report was released. "The fact that the medical examiner ruled out bulimia and ruled out a heart attack, without a doubt, adds more questions."