The Case of Terry Shivo: A Chronological and Concise Account

On the morning of Feb. 25, 1990, at approximately 4:30  a.m. EST, Terri Shivo collapsed in a hallway of her St. Petersburg, Florida  apartment. Firefighters arriving in response to Michael’s 9-1-1. She was not breathing and had no pulse. They attempted to resuscitate  her and she was transported to the Humana Northside Hospital. There she was intubated, ventilated, and eventually given a tracheotomy. The long period without oxygen led to profound brain injury termed “anoxic-ischemic encephalopathy” at autopsy.

Terri remained comatose for two and a half months and she then emerged into a vegetative state. She was eventually switched from being fed by a nasogastric feeding tube to a percutaneous endoscopic gastrostomy (PEG) feeding tube.

Dr. Garcia J. DeSousa, a board-certified neurologist in St. Petersburg, Florida, cared for Terri during her initial admission to Humana; both he and Dr. Victor Gambone, an internist and Schiavo family physician, independently made the diagnosis of persistent vegetative state (PVS) within approximately one year after Terri’s cardiac arrest.

1990-1993 Efforts to Rehabilitate Terri proved ineffective.
Terri came home to her family in September 1990 but was sent back to the College Park facility due to her needs. In November, Michael took her to the University of California, San Francisco . The treatment took several months but was unsuccessful. Michael returned to Florida with her in January 1991 and admitted her as an inpatient to the Mediplex Rehabilitation Center in Bradenton, Florida. While there, he later said that he often took “her to parks and public places in hopes of sparking some recovery”. On July 19, 1991, Terri was transferred to the Sabal Palms Skilled Care Facility, where she received neurological testing and regular speech and occupational therapy until 1994. In mid 1993, Michael requested a do not resuscitate order for Terri after she contracted a urinary tract infection, but the staff advised him to withdraw it. Jay Wolfson later wrote a report stating that Michael’s decision was “predicated on his reasoned belief that there was no longer any hope for Terri’s recovery.”

Petition to remove the tube—-Legal Cases 1998-2020
In May 1998, Terri’s husband, Michael, filed a petition to remove Terri’s feeding tube, which her parents opposed. Richard Pearse was appointed by the court as a second guardian ad litem (GAL) , and on December 29, 1998, reported “Dr. Jeffrey Karp’s opinion of the ward’s condition and prognosis is substantially shared among those physicians who have recently been involved in her treatment”. Pearse concluded from Karp’s and Dr. Vincent Gambone’s diagnosis of PVS that Schiavo was legally in a persistent vegetative state as defined by Florida Statutes, This includes the “absence of voluntary action” and an “inability to communicate or interact purposefully.”

Pearse found that there was no possibility of improvement but that Michael’s decisions might have been influenced by the potential to inherit what remained of Terri Schiavo’s estate. Due to a lack of a living will and questions regarding Michael’s credibility, Pearse recommended denying his petition to remove her feeding tube. The issue of conflict of interest raised by guardian ad litem Pearse attached to the Schindlers as well, he reported, since, had they prevailed in the various litigation over guardianship, they as the presumed heirs-at-law would have inherited the remainder of Mrs. Schiavo’s estate upon her death.

SHIVO I
Schiavo’s end-of life wishes—(everybody jump in).
Given the lack of a living will, a trial was held during the week of January 24, 2000, to determine what Terri’s wishes would have been regarding life-prolonging procedures. Testimony from eighteen witnesses regarding her medical condition and her end-of-life wishes was heard. Michael claimed that Terri would not want to be kept on a machine where her chance for recovery was minuscule. According to Abstract Appeal Trial Order, her parents “claimed that Terri was a devout Roman Catholic who would not wish to violate the Church’s teachings on euthanasia  by refusing nutrition and hydration.” Judge George Greer issued his order granting Michael’s petition for authorization to discontinue artificial life support for his wife in February 2000. In this decision, the court found that Terri was in a persistent vegetative state and that she had made reliable oral declarations that she would have wanted the feeding tube removed. This decision was upheld by the Florida Second District Court of Appeal (2nd DCA) and came to be known by the court as Schiavo I in its later rulings.

It’s not over—The case for Oral Feeding and the Second Guardianship Challenge
In March 2000, the Schindlers filed a motion to permit oral feeding of Terri, which is not considered a life-prolonging procedure under Florida law. Since clinical records indicated that Terri was not responsive to swallowing tests and required a feeding tube, Judge Greer ruled that Terri was not capable of orally ingesting sufficient nutrition and hydration to sustain life, and denied the request. The Medical Examiner in his postmortem report was more definitive and reaffirmed that Schiavo could not have swallowed.

In 2000, the Schindlers again challenged Michael’s guardianship. The Schindlers suggested that he was wasting the assets within the guardianship account by transferring Terri to Pinellas Park, Florida hospice “after it was clear that she was not ‘terminal’ within Medicare guidelines” for hospices. By this time, while still legally married to Terri Schiavo, Michael was in a relationship with Jodi Centonze, and had fathered their first child. Michael said he chose not to divorce his wife and relinquish guardianship because he wanted to ensure her final wishes (not to be kept alive in a PVS) were carried out. The court denied the motion to remove the guardian, allowing that the evidence was not sufficient and in some instances, not relevant. It set April 24, 2001 as the date on which the tube was to be removed.

Not over yet……
SHIVO II  The Legal Battle Continues
In April 2001, the Schindlers filed a motion for relief from judgment citing new evidence of Terri’s wishes. Judge Greer denied the motion as untimely under Rule 1.540(b)(5) of the Florida Rules of Civil Procedure. The Second District Court of Appeal upheld Greer’s decision but remanded the issue in order to give the Schindlers an opportunity to file a new motion. On April 24, Terri’s feeding tube was removed for the first time. The Schindlers filed a civil suit against Michael alleging perjury, which was assigned to another court. The judge, Frank Quesada, issued an injunction against removal of feeding tube until this was settled. The feeding tube was reinserted on April 26. On appeal by Michael, the Second District Court of Appeal reversed Judge Quesada’s order. In the same time frame, Michael filed a motion to enforce mandate of the guardianship court (that the feeding tube be removed). The Second District Court of Appeal denied the motion. (These three decisions, all published in a single order by Florida’s Second District Court of Appeal, came to be known by the court as Schiavo II in its later rulings.)

SHIVO III and IV  Attempt at medical diagnosis argument
On August 10, 2001, on remand from the Florida Second District Court of Appeal, Judge Greer heard a motion from the Schindlers claiming that new medical treatment could restore sufficient cognitive ability such that Terri herself would be able to decide to continue life-prolonging measures. The court also heard motions from the Schindlers to remove the guardian (Michael) and to require Judge Greer to recuse himself. Judge Greer denied the motions and the Schindlers appealed to the Second District Court of Appeals. On October 17, the Court of Appeal affirmed the denials of the motions to remove and recuse. The Court of Appeals acknowledged that their opinion misled the trial court, and they remanded the question of Terri’s wishes back to the trial court and required an evidentiary hearing to be held. The court specified that five board certified neurologists were to testify. The Schindlers were allowed to choose two doctors to present findings at an evidentiary hearing while Michael could introduce two rebuttal experts. Finally, the trial court itself would appoint a new independent physician to examine and evaluate Terri’s condition. (These decisions, all published in a single order by the Florida Second District Court of Appeal, came to be known by the court as Schiavo III in its later rulings.) In October 2002, on remand by the Second District Court of Appeal, an evidentiary hearing was held in Judge Greer’s court to determine whether new therapy treatments could help Terri restore any cognitive function. In preparation for the trial, a new computed axial tomography scan (CAT scan) was performed, which showed severe cerebral atrophy. An EEG showed no measurable brain activity. The five physicians chosen were Dr. William Maxfield, a radiologist , and four neurologists : Dr. William Hammesfahr, Dr. Ronald Cranford , Dr. Melvin Greer and Dr. Peter Bambakidis.

The five doctors examined Terri’s medical records, brain scans, the videos, and Terri herself. Drs. Cranford, Greer, and Bambakidis testified that Terri was in a persistent vegetative state. Drs. Maxfield and Hammesfahr testified that she was in a minimally conscious state. As part of the court-ordered medical exam, six hours of video of Terri were taped and filed at the Pinellas County courthouse. The tape included Terri with her mother and neurologist William Hammesfahr. The entire tape was viewed by Judge Greer, who wrote, Terri “clearly does not consistently respond to her mother”. From that six hours of video, the Schindlers and their supporters produced six clips totaling almost six minutes and released those clips to public websites. Judge Greer ruled that Terri was in a PVS, and was beyond hope of significant improvement. The trial court order was particularly critical of Hammesfahr’s testimony, which claimed positive results in similar cases by use of vasodilation therapy, the success of which is unsupported in the medical literature. This ruling was later affirmed by Florida’s Second District Court of Appeal, which stated that “this court has closely examined all of the evidence in the record,” and “we have… carefully observed the video tapes in their entirety.” The court concluded that “…if we were called upon to review the guardianship court’s decision de novo , we would still affirm it.” (This decision by the Second District Court of Appeals came to be known as Schiavo IV in later rulings.)

A MEDIA CIRCUS –it’s getting personal
Around the start of 2003, the Schindlers began to create more publicity by lobbying for their case to keep their daughter alive. They selected pro-life activist Randall Terry as their spokesman but continued to pursue their available legal options. On September 11, 2003, the Schindlers petitioned the court to forestall removal of the feeding tube to provide for “eight weeks’ therapy”. Accompanying the petition were four affidavits from members of the Schindler family and one from Dr. Alexander T. Gimon. At the hearing, the Schindlers’ counsel read into the record additional affidavits from three speech professionals and two nurses. Nurse lyer asserted that she was able to feed Terri Schiavo orally but that Michael characterized any such interaction as “therapy” and ordered her not to do so. She asserted that Michael’s attitude was one of preferring to see Terri die in the near future. Two other nurses, Heidi Law and Trudy Capone also spoke out in TV interviews that they were put off by Michael’s attitude. On September 17, Judge  denied the petition, and wrote that “the Petition is an attempt by Mr. and Mrs. Schindler to re-litigate the entire case. It is not even a veiled or disguised attempt. The exhibits relied upon by them clearly demonstrate this to be true.” Regarding (Nurse) Iyer’s Greer wrote that they were “incredible to say the least” and that “Ms. Iyer details what amounts to a 15-month cover-up April 1995 through July 1996 which include the staff of Palm Garden of Largo Convalescent Center, the Guardian of the Person, the guardian ad litem, the medical professionals, the police and, believe it or not, Mr. and Mrs. Schindler… It is impossible to believe that Mr. and Mrs. Schindler would not have subpoenaed Ms. Iyer for the January 2000 evidentiary hearing had Iyer contacted them in 1996 as her affidavit alleges”.

On October 15, 2003, Schiavo’s feeding tube was removed. Within a week, when the Schindlers’ final appeal was exhausted, State Rep. Frank Attkisson hastily passed “Terri’s Law,” giving Governor Jeb Bush the authority to intervene in the case. Bush immediately ordered the feeding tube reinserted. Bush sent the Florida Department of Law Enforcement to remove Schiavo from the hospice. She was taken to Morton Plant Rehabilitation Hospital in Clearwater, where her feeding tube was surgically reinserted. She was then returned to the hospice. Part of the legislation required the appointment of a guardian ad litem (GAL), Dr. Jay Wolfson, to “deduce and represent the best wishes and best interests” of Schiavo, and report them to Governor Bush. Wolfson’s report did not change Michael’s role as her legal guardian and did not otherwise obstruct him legally.

Michael Schiavo opposed the Governor’s intervention in Schiavo’s case, and was represented, in part, by the American Civil Liberties Union (ACLU). At the same time, Robert and Mary Schindler, her parents, attempted to intervene and participate in the “Terri’s Law” case but were denied by Judge W. Douglas Baird, a Circuit Judge in the Florida Sixth Circuit, the same circuit as for Judge George W. Greer. They appealed, and, on February 13, the Florida Second District Court of Appeal  reversed Baird’s ruling, allowing them to participate. On March 17, Baird denied the Schindlers the right to intervene a 2nd time, and the Schindlers, represented by the conservative American Center for Law and Justice /American_Center_for_Law_and_Justice>  (ACLJ), appealed the right to participate in the “Terri’s Law” case, with the court scheduling an oral argument date for June 14. The Schindlers’ other attorney, Pat Anderson, was concurrently challenging Michael Schiavo’s right to be her guardian, and, on June 16, she made a petition for writ of Quo Warranto a pleading that asks “by what right” someone acts in an official capacity.

On May 5, 2004, Baird found “Terri’s Law” unconstitutional and struck it down. Bush appealed this order to the Second District Court of Appeals, but, on May 12, they issued an “Order Relinquishing Case for Entry of Final Judgment and Order to Show Cause Why this Proceeding Should Not be Certified to the Supreme Court As Requiring Immediate Resolution.” The Second District Court of Appeals, in sending it directly to the Florida’s Supreme Court, invoked “pass through” jurisdiction.  The Florida Supreme Court then overturned the law as unconstitutional.

ENTER THE MEDIA BANDWAGON—a fly strip for politicians

EARLY MOTIONS in 2005 in next post>>>>>>