Doctors spar over
Schiavo's condition

Last examination in 2002
The diagnosis has been a court matter, both in 2000 and in 2002. In the latter year, a Florida judge agreed with four neurologists that Schiavo was in a persistent vegetative state. Brain scans and examinations were conducted in 2002, but no new neurological evaluation has been ordered since, and the medical record has been closed.

Testimony in those cases included statements from Schiavo’s treating physician, Dr. Victor Gambone, who said in 2000 that he agreed with the diagnosis. Schiavo’s daily caregivers told him they could not get any response showing an appreciation of her surroudings, he said.

In 2002, Dr. Ronald Cranford, an expert on persistent vegetative states who was brought into the case by Schiavo’s husband, testified that key centers of Schiavo’s brain probably had no viable neurons left. She was not actually fixing her gaze on her mother, as had been suggested, but rather showing a reflex action seen in patients in a vegetative state.

(Cranford said Thursday he still has no doubt the diagnosis is correct and that Cheshire is “flat-out wrong.”)

Two other neurologists also agreed with the diagnosis, including one appointed by the court to examine and evaluate Schiavo.

Testimony of parents' experts
But doctors representing Schiavo’s parents at the 2002 hearing had a different conclusion. Dr. William Hammesfahr, a Florida neurologist, said his examination of Schiavo found she is “definitely aware of her mother” and communicating through following instructions and in looking at people. And a radiologist said a brain scan in 2002 showed more normal appearance than one in 1996 and said there was a “significant probability that she would improve” with certain treatments.

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But the court was not given any objective data to support that latter assertion, said Dr. Timothy Quill, director of the Center for Palliative Care and Clinical Ethics of the University of Rochester Medical Center, writing in Thursday’s issue of the New England Journal of Medicine.

Hammesfahr has been a figure of controversy. In 2001, the Florida Department of Health accused him of falsely advertising a neurological treatment and exploiting a patient for financial gain. The treatment is “contrary to current neurological knowledge,” the department said. Hammesfahr denied the accusations, and in an interview Thursday he said the probation and fine against him were overturned on appeal.

On Thursday, Dr. Lawrence J. Schneiderman of the University of California, San Diego, a specialist in bioethics of medical futility and end-of-life care, said in an interview, “He’s a quack, to put it the politest way I can.”

Hammesfahr said he believes Schiavo can be helped by treatment and that numerous other neurologists, some of whom actually examined Schiavo, agreed.

“I’m not the only person who has said she can be rehabilitated,” he said. “Are we all quacks?

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