Fat Steve's Blatherings

Wednesday, April 13, 2005

Doctors Never Make Mistakes

      Remember Dr. Ronald Cranford?  He was the neurologist who testified that Terri Schiavo was in a persistent vegetative state, and would never recover.  He told a reporter he was "105%" sure of that.

      Guess what?  In 1980, Cranford made an identical diagnosis:
Cranford expressed similar certainty about another patient he declared to be in a persistent vegetative state (PVS) in 1980, former Minneapolis Police Sgt. David Mack.

"Sergeant Mack will never regain cognitive, sapient functioning," Cranford said six months after Mack was shot while serving a search warrant on Dec. 13, 1979. "He will never be aware of his condition nor resume any degree of meaningful voluntary conscious interaction with his family or friends."

Based on Cranford's unequivocal diagnosis of Mack, the officer's relatives removed him from a respirator [sic! should be "ventilator"] in August 1980 "because his family felt he should be allowed to die rather than exist in such a state," according to published reports.

But Mack did not die.

On Oct. 22, 1981, 18 months after Cranford declared Mack's case hopeless, doctors at the advanced care facility where Mack was being treated noticed that he was awake. The Associated Press described Mack's recovery.

"A policeman considered 'vegetative' after being shot in the head in 1979 has come out of his coma and, although doctors caution he may never recover fully, he is spelling out some of his desires: 'TALK. WALK. SKI. DOG,'" the news report stated, explaining that someone would point to letters displayed in alphabetical order on a board while Mack nodded "yes" or "no" until the correct letter was reached.

Asked how he felt about his recovery, Mack smiled and spelled out "SPEECHLESS!"

"Doctors say Mack has recovered about 95 percent of his intellectual capabilities," the news account continued, "and can understand everything said to him."

      Another piece of interesting information about Dr. Cranford:
Cranford said that he has "never been a member of any organization that's primary purpose was to advocate active euthanasia because I'm not that supportive of active euthanasia."

However, he joined the board of directors of the Choice in Dying Society, an organization created when the Society for the Right to Die and Concern for Dying merged in 1991. Research by Cybercast News Service shows that both of those groups had previously changed their names to remove the word "euthanasia" in response to negative publicity.

Cranford also told reporters in 1991 that he wanted to be known as "Doctor Humane Death." He has since publicly claimed to have facilitated the deaths of between 25 and 50 disabled patients by removing the feeding tubes that provided their nutrition and hydration.

      Just how certain is it that a patient in a persistent vegetative state won't recover?
The American Academy of Neurology (AAN) . . . also states that "recovery of consciousness from post-traumatic PVS after 12 months in adults and children is unlikely. Recovery from non-traumatic PVS after 3 months is exceedingly rare." AAN guidelines finally explain that the diagnosis of a "permanent vegetative state" is, "as with all clinical diagnoses in medicine, based on probabilities, not absolutes."

[Dr. David] Stevens said that last criterion is the main problem with the types of absolute statements made by doctors like Cranford when giving a PVS diagnosis.

"With persistent vegetative state, that diagnosis is based upon an observation and an opinion," Stevens said. "The diagnosis itself carries with it a prognosis -- in other words, that people are not going to recover, that this is permanent and that, therefore, you can do things like were done with Terri Schiavo, where her feeding tube was removed.

      Maybe the problem was an isolated instance?  No:
"A number of cases have shown this not to be the case," Stevens said. "The one that [Cranford] was involved in is a good example of that, but there are other cases as well, where patients thought to be in a persistent vegetative state have then recovered, some of them quite significantly." . . .

Cybercast News Service found more than two dozen cases where published news reports document patients diagnosed as being in a persistent or permanent vegetative state, or coma "waking up," . . .

A 1996 study published in the British Medical Journal found that 43 percent of patients in the United Kingdom thought to be in a PVS had been misdiagnosed. Of the 40 patients whose cases were reviewed, 17 were later found to be "alert, aware and often able to express a simple wish."

A 1993 study of 49 patients found that 18 of them, or 37 percent, "were diagnosed inaccurately.

"Errors in diagnosis may result from confusion in terminology, lack of extended observation of patients, and lack of skill or training in the assessment of neurologically devastated patients," according to the study, published in "Neurology," the journal of the American Academy of Neurology.

Stevens said this is all the evidence that should be needed to call for a higher standard when it comes to diagnosing a patient as being in a persistent or permanent vegetative state.

"Unfortunately, right now, it's a circular diagnosis," Stevens explained. "Doctors who are advocates for it are willing to state absolutely that a patient is in PVS and then, when the patient comes out of PVS, then they use circular reasoning and say, 'Well, then they weren't in it at all.'"

      But the absolute best part is this:
Cranford admitted that a positron emission tomography, or PET scan, could have been conducted to confirm or disprove the diagnosis in the Schiavo case. The test measures the metabolism of the cerebral cortex and patients in a verifiable PVS typically have less than 50 percent of the PET scan activity of a healthy brain.

"The only reliable PET scan in the country that could do this would be in New York City. And had I known this case would have gone to this point, I would have advocated that (PET scan) three years ago during the evidentiary hearing," Cranford said. "But we never knew Congress would get involved."

Cranford said he also did not recommend the test because he believed that neither Terri's husband, nor her parents would want her moved to New York City.

      Apparently, "Dr. Humane Death" is a lot more interested in killing people than he is in accurate diagnoses.

      Note to self: Cranford works in Minneapolis.  Make sure this clown never has anything to do with my or K.'s medical care!



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