376 lines
16 KiB
Plaintext
376 lines
16 KiB
Plaintext
FAQ on 'the Toxic Lady'.
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By Camilla Cracchiolo RN
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copyrighted 1995, may be freely reproduced for non-profit purposes.
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I. Who Was The Toxic Lady?
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The 'toxic lady' (as the Internet has perhaps unfairly dubbed her)
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was a 31 year old woman in Riverside, California named Gloria Ramirez.
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Her body may or may not have emitted toxic fumes which made several
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doctors and nurses in the emergency room of Riverside General Hospital
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very ill. She was the mother of two children and had been diagnosed with
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metastatic cervical cancer 6 weeks before the famous event leading
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to her name.
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II. What happened?
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On the evening of Feb. 19, 1994, Ms. Ramirez was brought by paramedics to
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the emergency room at Riverside General Hospital. She was admitted in
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respiratory and cardiac distress, and went into full cardiac arrest about 15
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minutes after arrival. A nurse named Susan Kane drew blood, probably
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for an arterial blood gas determination, as part of the routine 'code
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blue' procedure of the hospital. Nurse Kane noted a 'foul odor' and
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immediately passed out cold. A doctor (Julie Gorchynski, the senior
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medical resident) went to Nurse Kane's aid. After seeing to her
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needs (probably by making sure she did not get a head injury from
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falling), Dr. Gorchynski noted a strange odor, 'took a deep whiff' of
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the syringe and passed out. 4 other staff then passed out, all standing
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right next to each other. The paramedics who rode in the ambulance to
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the hospital with Ms Ramirez and who remained in the room, as well as one
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nurse and Dr. Humberto Ochoa, the director of the ER (who came as soon as
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he heard staff were keeling over in the middle of a code) all were
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unaffected.
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Since other cases have occured where ER staff became ill from fumes
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emitted by a patient (usually from people who have ingested pesticides,
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although this can also be a risk to staff working in hyperbaric oxygen
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chambers with people with carbon monoxide poisioning) the hospital
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assumed that this was a case of toxic contamination, sealed the ER and
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evacuated all patients and affected staff (who by now numbered somewhere
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between 8 and 11, including clerks) and brought in the County
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decontamination unit.
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III. What happened to Gloria Ramirez during all this?
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Ms. Ramirez died in the ER, after the staff tried to rescusitate her for
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about 35 -45 minutes. The official cause of death was kidney
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failure due to metasticized cancer. Her body was placed in a sealed
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body bag and sent to the county coroner for autopsy in a special
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sealed unit.
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IV. Why is this case so unusual?
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Because despite the apparently genuine and severe illnesses of the ER
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staff, no satisfactory toxin that could have caused their illnesses has
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been found. This has led to speculation as to whether mass hysteria
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could have caused the symptoms experienced by the ER staff. Opinions
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are still divided as to the cause of the incident.
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V. Well, if a toxin from Gloria Ramirez didn't cause these
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problems, what else could have?
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The main alternative explanation is that there was some toxin in the
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ER and that possibly the hospital covered this up. The hospital has
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been cited before for improper waste disposal down drains. However,
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they were inspected by nine different city, state and federal agencies
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after this incident. While cited for some violations in other
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parts of the hospital, no violations were found that affected the
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ER.
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The 'it's the hospital's fault' scenario is favored by Gloria Ramirez's
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family, who have filed a lawsuit against Riverside General saying that
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the fumes came from the hospital and also caused Ms. Ramirez's death.
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The hospital, I'm afraid, did not handle matters well with the
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Ramirez family. First, the hospital suggested that Ms. Ramirez
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tried to kill herself by ingesting pesticides. This was not an
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unreasonable initial theory given the situation (which looked very
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much like pesticide poisoning.) However, it was ill thought out to
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say this before preliminary lab results were back, since the Ramirez
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family, like most people of Mexican descent in the area, are devout
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Catholics. To allege suicide is to allege a very serious sin to
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these folks.
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To top this off, the County then hung on to Ms. Ramirez's body for
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several months and at one point improperly stored it, resulting in
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gross decomposition. The Ramirez family had to sue to get the body
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back for burial, but by then it was unfit for showing. They had
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wanted an open casket ceremony so her children could see her face
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and properly say goodbye. I'd be mad too, if I were them.
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VI. What are the official conclusions ?
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There has never been a satisfactory resolution to the case. While
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eventually 32 people reported what seem clearly to be hysteric symptoms,
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the people originally felled have lab and physical findings that
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seem to exclude hysteria. (Hysteria can only be diagnosed in the
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absence of observable lab or physical abnormalities)
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The official opinion of Cal-OSHA is that, while some of the staff
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may have been affected by hysteria, at least three people had a genuine
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reaction to some kind of toxin or agent.
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The State Dept. of Health Services report said that most people (eventually
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over 30) who reported feeling ill were suffering from mass hysteria, but
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that the original six staff who were felled may have been affected by
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either hysteria or a toxic agent.
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The Riverside Dept. of Health says that they now believe that
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Dr. Gorchynski, Ms. Welch and Ms. Balderas are not suffering from
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hysteria.
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Lawrence Livermore Lab released a preliminary report suggesting that
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dimethyl sulfate, metabolized from hypothesized consumption of DMSO, was
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the cause of their symptoms However, according to chemists here on the
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Internet, it's highly improbable that dimethyl sulfate could cause this.
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The final report was awaiting peer review and to my knowledge has not
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been released.
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VII. What is the status of the case now?
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The family's lawsuit has not come to court yet.
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Julie Gorchynski filed a lawsuit against Riverside County saying
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that they withheld key information she needed in doing her own
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investigation of the case. She is asking for six million dollars.
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This may get settled out of court since Riverside Co. has stated
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that they now believe Dr. Gorchynski's illness to be organic.
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The Lawrence Livermore final report has not yet been released.
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More Details:
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VIII. Who were the affected staff and what happened to them?
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The affected staff were:
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Susan Kane, the nurse who initially drew the blood and who fainted
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first.
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Dr. Julie Gorchynski, the senior medical resident in the ER and who
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fainted seconds after sniffing the syringe used to draw Ms. Ramirez's
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blood, and who was also the most seriously ill of all the staff.
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Dr. Mark Thomas, the attending physician in the ER, and who was
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affected third (unclear if he actually fainted, but had dizziness
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and muscle spasms).
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Maureen Welch, a respiratory therapist who was using a special
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device (called an ambu bag) to deliver breaths to Ms. Ramirez and
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who was affected fourth (fainted).
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Bettina Berry, a nurse in the ER (I don't know when she felt ill,
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and I'm not sure if she fainted or not).
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Sally Balderas, the nurse who moved the affected staff and Ms.
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Ramirez's body into a holding area, who was one of the last people
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to report feeling ill, but also the second most severely affected
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staff person.
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Debbie Carrier, a medical clerk in the ER.
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A recent Los Angeles Times article stated that the official tally of
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affected staff is 32, but no information is available on the others.
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Most affected staff suffered no permanent effects. However, Dr.
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Gorchynski, Maureen Welch and Sally Balderas continue disabled although
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partially recovered. Their symptoms included immediate change in heart
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rhythm, followed by 'spasms'. Two days after the incident, Dr. Gorchynski
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had to be placed on a ventilator because these strange muscle spasms were
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interfering with her ability to breathe to the point where her arterial
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oxygen levels were 'markedly reduced'. She also had elevated liver and
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pancreatic enzymes and subsequent to all this developed a rare necrotising
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bone disorder due to the cutoff of circulation to the bone.
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Dr. Gorchynski's case is particularly interesting. She is a very
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amazing lady. Some people have suggested that the affected staff
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must have had some kind of pre-existing medical condition, but all
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evidence is to the contrary for Gorchynski. According to the
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spokesman for Loma Linda University Medical Center (where Dr.
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Gorchynski wound up after evacuation), she is either a national or
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world surfing champion, holding the #2 title in the women's
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division. She was, according to all accounts, in glowing health
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prior to this. Certainly hospital residents must be in good health
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or they cannot withstand the grueling, often 100+ hour weeks
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demanded of them during residency. She had a masters in
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microbiology and had been published prior to attending medical
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school. She graduated at the top of her class and according to the
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most recent newspaper article I've seen on her, was preparing
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from her bed at home (she was in a wheelchair at the time) to fly
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to London to accept some kind of award for a paper she had written.
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IX. C'mon! Give us ALL the details! We're information junkies!
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Ok, here is the official chronology from Riverside General Hospital:
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(All capitalizations and spellings are in the original)
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Summary of Events on February 19 and 20, 1994
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Riverside General Hospital - University Medical Center
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Riverside, California
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Regarding Patient: Gloria Ramirez
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7:46 p.m.: Ambulance and Riverside Fire Department dispatched
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to home of 31-year old Gloria Ramirez; difficulty
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breathing.
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7:50 p.m.: Fire Personnel on scene
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8:07 p.m.: Radio call received at Hospital from Ambulance.
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Pre-hospital personnel reported patient to be in
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severe cardiac distress. Patient was placed on
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monitor, administered oxygen and an IV was started.
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8:14 p.m.: Patient arrived at Hospital semi-conscious in a
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life-threatening condition (placed in resuscitation
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room) with rapid heart beat.
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During the 36 minutes (8:14 p.m. - 8:50 p.m.) the following events
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took place:
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* Medical Team began care immediately. Dr. Mark Thomas,
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Attending Physician, leading resuscitation - Dr. Julie
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Gorchynski, Senior Resident, Emergency Department, assisted
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with Nurses and Respiratory Therapy also at bedside.
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* A full code 'resuscitation' was in progress. Emergency
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procedures: defibrillation, administered IV fluids and blood was
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drawn.
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* As Susan Kane, the Nurse, drew the blood, she noted an
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ammonia-like smell. Several other health care workers noted the
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same odor.
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* With seconds, Susan Kane fainted. She was placed on a
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guerney.
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* Dr. Julie Gorchynski assumed Kane's role in caring the the
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patient and subsequently passed out. Another physician attended
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to the fallen staff.
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* Dr. Mark Thomas continued care of the patient.
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* Susan Kane and Dr. Julie Gorchynski were moved into the
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holding area.
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* Susan Kane's condition worsened. She experienced difficulty
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breathing.
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* Evacuation of the Emergency Room was ordered by Dr. Humberto
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Ochoa, Chairman of the Emergency Medicine Department.
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* Maureen Welch, the Respiratory Therapist, while ventilating
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the patient, became ill.
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* Dr. Mark Thomas, the attending physician then became ill.
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* Medical Care of Gloria Ramirez continued uninterrupted by Dr.
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Ochoa who was assisted by a Respiratory Therapist, Resident
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Physician, a Paramedic and two Nurses.
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* Gloria Ramirez was intubated, adminstered addtional
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emergency medications and defibrillated multiple times.
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8:41 p.m.: 911 was called by Hospital.
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Fire Department Dispatched.
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8:47 p.m.: Fire Department arrived.
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* Nurse Bettina Berry, who was caring for Gloria Ramirez,
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became ill.
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* Gloria Ramirez failed to respond to resuscitation measures
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and at 8:50 p.m., Dr. Ochoa pronounced the patient dead.
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8:52 p.m.: City of Riverside HAZ MAT notified by the Fire
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Department
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9:10 p.m.: City of Riverside HAZ MAT arrived on scene.
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9:15 p.m.: Hospital Administrator On-Call and Hospital Safety
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Officer arrived on scene.
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9:29 p.m.: City of Riverside Environmental Health Resource Team
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notified.
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* Evacuation of all patients and staff from the Emrgency Room
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was completed. Kaiser Hospital, Riverside, was notified
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that RGH was on Emergency Diversion - redirecting all
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ambulance services to other community hospitals. Kaiser
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communicated this information to other base stations.
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9:30 p.m.: Hospital Administrator arrived.
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9:30 p.m.: Coroner notified and arrived shortly after.
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9:30 p.m.: The Fire Department cordoned off the area outside
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the Emergency Room.
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* Emergency Room patients were transferred, admitted, treated
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and discharged.
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No patients demonstrated any signs of exposure.
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In the parking lot, Sally Balderas, RN, exhibited symptoms.
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Six staff were transferred to local hospitals.
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11:00 p.m.: HAZ MAT entered the Emergency Room and performed
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air-test sampling for common hazardous gases.
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Results proved negative. (No contaminants
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detected).
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APPROXIMATELY MIDNIGHT:
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* Planning Meeting was held with: HAZ MAT, Environmental
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Health, Hospital Administration and Coroner to determine
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course of decontamination.
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APPROXIMATELY 12:30 A.M.:
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* Decontamination of Remaining staff took place.
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2/20/94
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2:15 a.m.: HAZ MAT, after consultation with the Coroner,
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reentered the Emergency Room, placed Gloria Ramirez
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in a double-sealed bag, which was placed in an
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airtight container and moved to the Hospital Morgue.
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HAZ MAT decontaminated the Emergency Room area.
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3:07 a.m.: HAZ MAT released the area to the Hospital staff.
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3:10 a.m.: Hospital Environmental Services Unit conducted
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extensive cleaning of all equipment and furnishings.
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7:00 a.m.: The Emergency Room was reopened.
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9:55 a.m.: Body was released to Coroner.
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HERE IS WHERE EVERYONE WAS STANDING:
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Maureen Welch, RT
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(affected fourth)
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____________________________
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paramedic intern | |
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(not mentioned as | head |
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affected, gender| |
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unknown) | | unnamed nurse,
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| | unknown if and
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| | how affected
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unnamed nurse | EXAM TABLE |
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| | Dr. Mark Thomas
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Thomas
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| | (affected third)
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| foot |
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Susan Kane RN |___________________________| Dr. Gorchynski
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(drew blood, passed out first) (took over drawing
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blood, passed out
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second)
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Dr. Humberto Ochoa (came in later)
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