Wednesday, March 23


This is an amazing read, 38-pages-long, but I've tried to summarize it for you here. It's the report of the Guardian Ad Litem assigned to the Terri Schiavo case in Florida and charged with reviewing the case and getting back to Florida Gov. Jeb Bush:

"Theresa spent two and a half months as an inpatient at Humana Northside Hospital, eventually emerging from her coma state, but not recovering consciousness. On 12 May 1990, following extensive testing, therapy and observation, she was discharged to the College Park skilled care and rehabilitation facility. Forty-nine days later, she was transferred again to Bayfront Hospital for additional, aggressive rehabilitation efforts. In September of 1990, she was brought home, but following only three weeks, she was returned to the College Park facility because the “family was overwhelmed by Terry’s care needs.”

On 18 June 1990, Michael was formally appointed by the court to serve as Theresa’s legal guardian, because she was adjudicated to be incompetent by law. Michael’s appointment was undisputed by the parties.

The clinical records within the massive case file indicate that Theresa was not responsive to neurological and swallowing tests. She received regular and intense physical, occupational and speech therapies.

The report then goes on to document the extraordinary efforts by Michael to get Terri the latest therapies, though to no avail. "Despite aggressive therapies, physician and other clinical assessments consistently revealed no functional abilities, only reflexive, rather than cognitive movements, random eye opening, no communication system and little change cognitively or functionally." In 1993 Michael wins a medical malpractice award against the fertility doctor he and Terri had been consulting. " The court established a trust fund for Theresa’s financial award, with SouthTrust Bank as the Guardian and an independent trustee. This fund was meticulously managed and accounted for and Michael Schiavo had no control over its use. There is no evidence in the record of the trust administration documents of any mismanagement of Theresa’s estate, and the records on this matter are excellently maintained." After the malpractice award, the Schindlers begin to show diasaffection with Michael. They petition the court to remove Michael as guardian.

"Proceedings concluded that there was no basis for the removal of Michael as Guardian Further, it was determined that he had been very aggressive and attentive in his care of Theresa...By 1994, Michael’s attitude and perspective about Theresa’s condition changed. During the previous four years, he had insistently held to the premise that Theresa could recover and the evidence is incontrovertible that he gave his heart and soul to her treatment and care. This was in the face of consistent medical reports indicating that there was little or no likelihood for her improvement."

Terri gets a urinary tract infection and Michael, in agreement with Terri's doctor, asks for a "do not resuscitate" order. The nursing facility objects and Michael withdraws his request. Terri is transferred to another facility. Michael no longer believes Terri can get better, though he's fought this battle in his own heart for several years.

Michael is encouraged by the Schindler family to "get on with his life." His guardianship is challenged, but the court-appointed Guardian At Litem concludes that Michael has been unusually attentive to his wife's care. The Schindlers' challenge is dismissed.

"In 1997, six years after Theresa’s tragic collapse, Michael elected to initiate an action to withdraw artificial life support from Theresa. More than a year later, in May of 1998, the first petition to discontinue life support was entered. The court appointed Richard Pearse, Esq., to serve as Guardian Ad Litem to review the request for withdrawal, a standard procedure."

Pearse concludes that Michael has a conflict of interest (the money), but Michael shows the court that he had offered to disinherit himself so that his motives would be unchallenged. Pearse is discharged but no new Guardian Ad Litem is named. The Schinders get "frenetic" in their attempts to remove Michael as guardian.

"On 11 February 2000, consequent to hearings and the presentation of competent evidence, Judge Greer ordered the removal of Theresa’s artificial life support."

Hearings continue. Michael's brother and sister-in-law offer hearsay testimony that Terri told them (in context of funerals) that she would not want to be maintained in a vegestative state.

The Schindlers criticize Michael for his romantic interests in other women. (Remember, they earlier encouraged such.) The Schindler family members offer graphic testimony as to the lengths they would go to keep Terri alive, including multiple amputations, etc. They insist that even if they knew Terri felt differently, they would violate her wishes and keep her alive at any cost. Throughout, they acknowledge that Terri is in a persistent vegetative state.

"The court denied the Schindler’s motions to remove the guardian, allowing that the evidence was not sufficient and in some instances, not relevant. It set a date for the artificial life support to be discontinued, as of 24 April 2001."

The court refuses to remove Michael as guardian, and in April 2001 Terri's feeding tube is clamped. The Schindlers subsequently get an injunction against the clamp, but in October the District Court of Appeals rules against them ("[they] have presented no credible evidence suggesting new treatment can restore Mrs. Schiavo”, and the removal of the feeding tube is ordered.

More hearings. Five physicians are appointed to review Terri's case. Three come down squarely on the side of Terri not having the potential to improve. Two, the Schindler appointees, give only anecdotal evidence that the reverse could be true. The court sides with the three. The decision is appealed. "The June 2003 appeal to the 2 nd DCA was Schiavo IV. The 2nd DCA panel of judges engaged in what approximated a de novo review of all of the facts, testimony and video tapes presented at trial. The appellate court affirmed the trial court’s ruling and its conclusions, and in addition, ordered the trial court to set a hearing date for removal of the artificial life support."

The Schindlers continue unsuccessful attempts to try to have Michael removed as Guardian.

Mid 2003: the national press gets onto the story: " National media coverage, active involvement by groups advocating right to life, and the attention of the Governor’s office and the Florida Legislature, catapulted Theresa’s case into a different dimension."

Jeb Bush predicates his championship of Terri's continued survival on whether or not she can take oral nutrition and hydration. In October 2003 Terri's feeding tube is directed to be disconnected. Bush and the Florida legislature pass "Terri's Law," which requires a new Guardian Ad Litem. The feeding tube is reinserted per Bush's orders. The GAL conducted a vigorous review of the case, meeting continually with all parties (including the Governor), many medical experts, evaluating 30,000 pages of documents, etc.

The GAL states, "Early in Theresa’s care, neurological examinations were performed to assess her cognitive capacity. Competent medical practitioners determined that Theresa was in what has been consistently defined as a persistent vegetative state – a finding that throughout the litigation was not disputed by either side. Quite recently, the Schindlers have disputed that Theresa is in a persistent vegetative state, and in the alternative, they have argued that even if she is, she deserves to live and be maintained via artificial nutrition and hydration.
"Terri is a living, breathing human being. When awake, she sometimes groans, makes noises that emulate laughter or crying, and may appear to track movement. But the scientific medical literature and the reports this GAL obtained from highly respected neuro-science researchers indicate that these activities are common and characteristic of persons in a persistent vegetative state.
"This having been said, Theresa has a distinct presence about her. Being with Theresa, holding her hand, looking into her eyes and watching how she is lovingly treated by Michael, her parents and family and the clinical staff at hospice is an emotional experience. It would be easy to detach from her if she were comatose, asleep with her eyes closed and made no noises. This is the confusing thing for the lay person about persistent vegetative states."

The GAL concludes: "The GAL concludes from the medical records and consultations with medical experts that the scope and weight of the medical information within the file concerning Theresa Schiavo consists of competent, well documented information that she is in a persistent vegetative state with no likelihood of improvement, and that the neurological and speech pathology evidence in the file support the contention that she cannot take oral nutrition or hydration and cannot consciously interact with her environment."

But a GAL footnote says much: "But that is not enough. This evidence is compromised by the circumstances and the enmity between the parties. Until recently, while both Michael Schiavo and the Schindlers agreed that Theresa was in a persistent vegetative state, they could not agree as to the matter of discontinuation of life support. Recently, the Shindlers have adopted what appears to be a position that Theresa is not in a persistent vegetative state, and/or that they do not support the fact that such a medical state exists at all. Yet throughout the nearly ten years of litigation, it is the issue of her ability to swallow, ingest food and hydration, and the findings regarding any residual cognitive ability that have marked the medical substance of this dispute.

"Of the Schindlers, there has evolved the unfortunate and inaccurate perception that they will “keep Theresa alive at any and all costs” even if that were to result in her limbs being amputated and additional, complex surgical and medical interventions being performed, and even if Theresa had expressly indicated her intention not to be so maintained. During the course of the GAL’s investigation, the Schindlers allow that this is not accurate, and that they never intended to imply a gruesome maintenance of Theresa at all costs.

"Of Michael Schiavo, there is the incorrect perception that he has refused to relinquish his guardianship because of financial interests, and more recently, because of allegations that he actually abused Theresa and seeks to hide this. There is no evidence in the record to substantiate any of these perceptions or allegations.

"Until and unless there is objective, fresh, mutually agreed upon closure regarding measurable and well accepted scientific bases for deducing Theresa’s clinical state, Theresa will not be done justice. There must be at least a degree of trust with respect to a process that the factions competing for Theresa’s best interest can agree. To benefit Theresa, and in the overall interests of justice, good science, and public policy, there needs to be a fresh, clean-hands start.

"The Schindlers and the Schiavos are normal, decent people who have found themselves within the construct of an exceptional circumstance which none of them, indeed, few reasonable and normal people could have imagined. As a consequence of this circumstance, extensive urban mythology has created toxic clouds, causing the parties and others to behave in ways that may not, in the order of things, serve the best interests of the ward."


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