According to the report, "PVS is a clinical diagnosis arrived at through physical examination of living patients. In other words, no evidence whatsoever of PVS can be revealed by an autopsy, yet the ME and his colleague Dr. Nelson opine that they believe Terri was indeed in a persistent vegetative state, a conclusion unjustified by the autopsy but one gleefully accepted by an unquestioning media.

Dr. Nelson said that they found nothing inconsistent with the PVS finding but consistently stressed that PVS was a clinical finding, not a medical one. He also indicated that there are no current studies which define and differentiate between PVS and a minimally conscious state, according to the Empire Journal.

According to the Florida statute dealing with the condition: "'persistent vegetative state' means a permanent and irreversible condition of unconsciousness in which there is:

(a) The absence of voluntary action or cognitive behavior of any kind.

(b) An inability to communicate or interact purposefully with the environment."

In a January 7, 2004, Highway 2 Health Internet broadcast, notes written by Margaret Juneman showed that in a radio interview Dr. William Hammesfahr, a world renowned neurologist and board certified in neurology and pain management, who spent many hours directly with Terri Schiavo and reviewed the medical records directly, unequivocally stated that Terri was absolutely not in a persistent vegetative state and definitely responded to instructions from those around her, that she made choices and showed decision-making ability in how she responded.

Terri, he said, was not in a persistent vegetative state or coma and added that she was a living, thinking person who made choices and decisions. When he was examining her, he observed Terri chose to ignore her husband Michael and the person taking a video but when she heard her mother's voice, she smiled and tracked her. Moreover, Terri moved her arms and legs when Dr. Hammesfahr requested her to do so.

Dr. Hammesfahr said that during his ten-hour examination, Terri responded well to verbal requests to move, and even moved to the point where it caused her pain in order to comply with a request. He indicated that such movements are definitely not reflexive.

In another radio interview with Ron Panzer's January 7, 2004 notes written by interviewer Panzer showed Dr. Hammesfahr repeated his contention that Terri was not in a persistent vegetative state and that she definitely responded to instructions from those around her and that she made choices and showed decision-making ability in how she responds.

Medical Record in Sorry State

Dr. Hammesfahr stated that the medical record was in a state of shambles when it was handed over, that it was out of order by date, and that much of the medical record was never given to the Schindlers or Dr. Hammesfahr! Dr. Hammesfahr stated that there are notes in the medical record by nurses who were NOT working at the time they stated they were caring for Terri. Also, Dr. Hammesfahr stated that parts of the medical record were completely missing!

In an affidavit submitted at the request of Florida Governor Jeb Bush on March 23, 2005, Dr. William Polk Cheshire, a renowned neurologist at the Mayo Clinic in Jacksonville, Florida, stated that he had examined Terri Schiavo and that "based on my review of extensive medical records documenting Terri's care over the years and on my personal observations of Terri, and on my observations of Terri's responses in many hours of videotapes taken in 2002, she demonstrates a number of behaviors that I believe cast a reasonable doubt on the prior diagnosis of PVS. These include:

1. Her behavior is frequently context-specific. For example, her facial expression brightens and she smiles in response to the voice of familiar persons such as her parents or her nurse. Her agitation subsides and her facial demeanor softens when quiet music is played. When jubilant piano music is played her face brightens, she lifts her eyebrows smiles and even laughs. Her later gaze towards a tape player is sustained for many minutes. Several times I witnessed Terri briefly, albeit inconsistently, laugh in response to a humorous comment someone in the room had made. I did not see her laugh in the absence of someone else's laughter.

2. Although she does not seem to track or follow visual objects consistently or for long periods of time, she does fixate her gaze on colorful objects or human faces for some 15 seconds at a time and occasionally follows with her eyes at least briefly as these objects move from side to side. When I first walked into her room, she immediately [turned] her head toward me and looked directly at my face. There was a look of curiosity or expectation in her expression and she maintained eye contact for about half a minute. Later when she again looked at me, she brought her lips together as if to pronounce the letter "O," and although for a moment it appeared that she might be making an intentional efforts to speak, he face fell blank and no words came out.

3. Although I did not hear Terri utter distinct words, she demonstrates emotional expressivity by her use of single syllable vocalizations such as "ah," making cooing sounds, or by expressing gutteral sounds of annoyance or moaning appropriate to the context of the situation. The context-specific range and variability of her vocalizations suggests at least a reasonable probability of the processing of emotional thought within her brain. There have been reports of Terri rarely using actual words specific to her situational context. The July 25, 2003 affidavit of speech pathologist Sara Green Mele MS on page 6 reads "The records of Mediplex reflect the fact that she has said 'stop' in apparent response to a medical procedure done to her." The Adult Protective Services team has been unable to retrieve those original medical records in this instance."

Dr. Cheshire cites observations of Dr. Hammesfahr when Terri obeyed his instructions to raise her right leg "four times in succession each time she was asked to do so." Dr. Hammesfahr also cites an instance when Terri showed she could anticipate pain.

"There is a remarkable moment in the videotape of the September 3, 2002 examination by Dr. Hammesfahr that seemed to go unnoticed at the time," Dr. Cheshire reported. "At 2:44 p.m. Dr. Hammesfahr had just turned Terri onto her right side to examine her back with a painful sharp stimulus (a sharp piece of wood), to which Terri had responded with signs of discomfort. Well after he ceased applying the stimulus and had returned Terri to a comfortable position he says to her parents, 'So, we're going to have to roll her over.' Immediately Terri cries. She vocalizes a crying sound "Ugh, ha ha haa,' presses her eyebrows together, and sadly grimaces. It is important to note that, at that moment, no one is touching Terri or causing actual pain. Rather, she appears to comprehend the meaning of Dr. Hammesfahr's comment and signals her anticipation of pain. This response suggests some degree of processing and interpretation at the level of the cerebral cortex. It also suggests that she may be aware of pain beyond what could be explained by simple reflex withdrawal."

Pain and Suffering

Dr. Cheshire goes on the explain that according to the definition of PVS published by the American Academy of Neurology, "persistent vegetative state patients do not have the capacity to experience pain or suffering. Pain and suffering are attributes of consciousness requiring cerebral cortical functioning and patients who are permanently and completely unconscious cannot experience these symptoms."

Adds Dr, Cheshire: "And yet in my review of Terri's medical records, pain issues keep surfacing. The nurses at Woodside Hospice told us that she often has pain with menstrual cramps. Menstrual flow is associated with agitation, repeated or sustained moaning, facial grimacing, limb posturing, and facial flushing, all of which subside once she is given ibuprofen. Some of the records document moaning, crying and other painful behavior in the setting of urinary tract infections."

Dr. Cheshire summarizes: "Teri Schiavo demonstrates behaviors in a variety of cognitive domains that call into question the previous neurological diagnosis of persistent vegetative state. Specifically she has demonstrated behaviors that are context-specific, sustained, and indicative of cerebral cortical processing that, upon careful neurologic consideration, would not be expected in a persistent vegetative state.

'Minimally Conscious'

"Based on this evidence, I believe that within a reasonable degree of medical certainty that Terri is in a minimally conscious state than in a persistent vegetative state."

Keep in mind that both Doctors Cheshire and Hammesfahr personally examined Terri for many hours while she was alive. Neither Dr. Thogmartin nor Dr. Nelson had ever seen Terri when she was alive, and both admit that nothing in the autopsy could possible show that he was in PVS. Yet they both guess that she was. And the media ate it up.

Moreover, Dr. Ronald Cranford, the doctor who made the PVS diagnosis for Michael Schiavo and the expert relied on by the court, examined Terri on one occasion, for approximately 45 minutes. Another doctor for Michael Schiavo, Dr. Peter Bambikidis of the Cleveland Clinic Foundation in Ohio, examined Terri for about half an hour.

When Dr. Dr. William Bell, a professor of neurology at Wake Forest University Medical School, learned of the cursory nature of these exams, he told Reverend Robert Johansen: "You can't do this. To make a diagnosis of PVS based on one examination is fallacious."

Writing in National Review, Rev. Johanson reported that in Cranford's examination, described by one witness as "brutal," he discounted evidence under his own eyes of Terri's responsiveness. At one point, Dr. Cranford struck Terri very hard on the forehead between her eyes. Terri recoiled and moaned, seemingly in pain. In his court testimony, Cranford dismissed the reaction and moan as a "reflex."

Adds Johanson: "Dr. Cranford was the principal medical witness brought in by Schiavo and Felos to support their position that Terri was PVS. Judge Greer was obviously impressed by Cranford's résumé: Cranford travels throughout the country testifying in cases involving PVS and brain impairment. He is widely recognized by courts as an expert in these issues, and in some circles is considered "the" expert on PVS. His clinical judgment has carried the day in many cases, so it is relevant to examine the manner in which he arrived at his judgment in Terri's case. But before that, one needs to know a little about Cranford's background and perspective: Dr. Ronald Cranford is one of the most outspoken advocates of the 'right to die' movement and of physician-assisted suicide in the U.S. today.

"In published articles, including a 1997 op-ed in the Minneapolis-St. Paul Star Tribune, he has advocated the starvation of Alzheimer's patients. He has described PVS patients as indistinguishable from other forms of animal life. He has said that PVS patients and others with brain impairment lack personhood and should have no constitutional rights. Perusing the case literature and articles surrounding the 'right to die' and PVS, one will see Dr. Cranford's name surface again and again. In almost every case, he is the one claiming PVS, and advocating the cessation of nutrition and hydration.

"In the cases of Paul Brophy, Nancy Jobes, Nancy Cruzan, and Christine Busalucci, Cranford was the doctor behind the efforts to end their lives. Each of these people was brain-damaged but not dying; nonetheless, he advocated death for all, by dehydration and starvation. Nancy Cruzan did not even require a feeding tube: She could be spoon-fed. But Cranford advocated denying even that, saying that even spoon-feeding constituted "medical treatment" that could be licitly withdrawn.

"In cases where other doctors don't see it, Dr. Cranford seems to have a knack for finding PVS. Cranford also diagnosed Robert Wendland as PVS. He did so in spite of the fact that Wendland could pick up specifically colored pegs or blocks and hand them to a therapy assistant on request. He did so in spite of the fact that Wendland could operate and maneuver an ordinary wheelchair with his left hand and foot, and an electric wheelchair with a joystick, of the kind that many disabled persons (most famously Dr. Stephen Hawking) use. Dr. Cranford dismissed these abilities as meaningless. Fortunately for Wendland, the California supreme court was not persuaded by Cranford's assessment."

Waking Up

Cranford once diagnosed Minneapolis Police Sgt. David Mack as PVS, stating, "Sergeant Mack will never regain cognitive, sapient functioning," the sergeant's relatives removed him from a respirator. Mack lived and, 18 months later (two years after his head injury) woke up.

According to CNS News Service reporter, Jeff Johnson: "Cranford insisted at the time that his initial diagnosis was correct. There is no doubt in the world that he was in the persistent vegetative state," Cranford said of Mack in a 1981 interview. "He had no interaction with the environment."

In an interview with Cybercast News Service, Cranford acknowledged a "mistake," but maintained that his original assessment of Mack was accurate.

"At the time I said that, he was in a vegetative state," Cranford said. "But, I did make that misstatement about Sgt. Mack and I was wrong and I did make a mistake in that case."

Although the Schindler's lawyer David Gibbs provided 33 affidavits submitted by other medical experts questioning the PVS diagnosis, Judge Greer refused to admit them as evidence.

Noting that the report stated that Terri had suffered irreversible brain damage, Not Dead Yet, a national disability rights group said that the autopsy report's documentation of significant brain atrophy and the assessment that the damage is "irreversible" is not the same as saying she had no cognitive ability, the group pointed out.

"It's always seemed to us that PVS isn't really a diagnosis; it's a value judgment masquerading as a diagnosis," said Stephen Drake, research analyst for Not Dead Yet. "When it comes to the hard science, no qualified pathologist went on the record saying she couldn't think or couldn't experience her own death through dehydration."

All of the evidence suggests that Terri Schiavo was in a minimally conscious state, and not in a persistent vegetative one.

As stated earlier, Terri's condition was brought about when her brain was deprived of oxygen for an elongated period of time. The initial explanation for this was that she suffered from an eating disorder, Bulemia, or that she had a heart attack. The autopsy ruled both out, leaving the cause of her collapse an open question.

According to Terrisfight.org, the record shows that after the "accident," her husband Michael called Terri's brother Bobby who lived in the same apartment complex. He then called Terri's father (who said, "Call 911!!") and then called his lawyer. He did not call 911 first.

He called his lawyer?

According to the police reports, when the paramedics got there, Terri was face-planted in the carpet. Michael did not turn her over as he testified. If he'd only turned her over and tried CPR, perhaps she'd have gotten enough oxygen to be less brain damaged/impaired, Terri's fight.org wrote.

In their extensive investigation of the Schiavo case, the Empire Journal found that "it is indisputable that Terri Schindler-Schiavo sustained brain damage as the result of a suspicious incident at her Florida home, which occurred sometime during the evening of Feb. 24, 1990 or the early morning hours of Feb. 25, 1990, which resulted in the deprivation of oxygen to her brain for four to six minutes.

"The only other person present at the time she incurred the injuries was her husband, Michael Schiavo. According to family members and friends, there had been a pattern of domestic abuse in the relationship, possessiveness and anger allegedly demonstrated by Michael Schiavo."

Dr. Thogmartin said that the anoxic brain injury sustained by Terri Schiavo on Feb. 25, 1990, was caused by lack of blood flow and oxygen to her brain but that the cause of that condition could not be detected and was undetermined. He did not rule out that the injuries could have been caused by smothering.

In an article "Experts Say Schiavo Injuries Classic Signs of Strangulation," the Journal wrote: "Strangulation is defined as a form of asphyxia, lack of oxygen, characterized by closure of the blood vessels and/or air passages as a result of external pressure on the neck.

"The stated cause of Terri's injuries was said to be an alleged cardiac arrest resulting from a potassium imbalance due to an eating disorder. However, medical and forensic experts have dispelled that with medical evidence and publicly stated that a crime of strangulation, attempted murder, occurred.

"The family believes that Michael Schiavo and Terri had a violent argument earlier in the evening she collapsed and the medical evidence seems to support, that Terri Schiavo may have been a strangulation victim that evening.

"The hospital admittance records from 1990 show evidence of trauma to Terri Schiavo's neck. Her friends have testified during court proceedings that she was unhappy in her marriage to Schiavo and was allegedly contemplating a divorce from Michael Schiavo who was allegedly possessive and jealous.

"Although the police report taken Feb. 25, 1990, by the St. Petersburg Police Department indicates that the incident should be routed to the homicide division, it was not and no criminal investigation of the matter has ever been conducted. According to the police report, the two officers from the St. Petersburg Police Department responding to the call were Philip Brewer and Rodney Tower. Perhaps one of the reasons there was virtually no investigation of the entire matter (officers arrived at 6:33 a.m. and completed their "investigation" at 8:55 a.m.) was that Tower was only a probationary officer.

"There are three forms of strangulation - hanging, ligature and manual. Almost all attempted or actual homicides by strangulation involve either ligature or manual strangulation, according to a manual regarding the investigation and prosecution of strangulation cases written by Gael B. Strack, San Diego assistant city attorney; and Dr. George McClane, emergency physician. The manual was edited by David C. James, deputy city attorney for San Diego and was updated in May, 1999.

According to that manual:

Four million American woman experience a serious assault by an intimate partner during an average 12-month period. Nearly one in three adult women experience at least one physical assault by a partner during adulthood.

Yet in Thogmartin's report, he dismisses strangulation by stressing that the records he reviewed, those supplied by one of Michaels Schiavo's lawyers:

"No trauma was noted on any of the numerous physical exams or radiographs performed on Mrs. Schiavo on the day of, in the days after, or in the months after her initial collapse." He then adds that there were no external signs of strangulation," ignoring the fact that this the above study found that in 62 percent of the cases of strangulation no visible injuries were found.

He then added that "autopsy examination of her neck structures 15 years after her initial collapse did not detect the any signs of remote trauma, but with such a delay, the exam was unlikely to show any residual neck findings."

In 1999, the Clinton County (NY) District Attorney's office and the New York Prosecutors Training Institute hosted the nation's leading experts in the prosecution and investigation of strangulation cases. Strack and McClane presented their findings at the three-day conference, "Detection and Prosecution of Strangulation in Domestic Violence and Sexual Assault Cases".

The general clinical sequence of a victim who is being strangled is one of severe pain, followed by unconsciousness, followed by brain death. The victim will lose consciousness by any one or all of the following: blocking of the carotid arteries (depriving the brain of oxygen), blocking of the jugular veins (preventing deoxygenated blood from exiting the brain) and closing off the airway, causing the victim to be unable to breath. Only 11 pounds of pressure placed on both carotid arteries for 10 seconds is necessary to cause unconsciousness.* However, if pressure is released immediately, consciousness will be regained within 10 seconds. After 50 seconds of continuous oxygen deprivation, the victim rarely recovers.

To completely close off the trachea, three times as much pressure (33 lbs) is required. Brain death will occur in 4 to 5 minutes, if strangulation persists.

No Visible Injuries

Victims may have no visible injuries whatsoever,* with only transient symptoms-yet because of underlying brain damage by lack of oxygen during the strangling, victims have died up to several weeks later. Because of the unforeseen consequences of injuries from a strangulation attempt that may appear minor to the untrained, officers at the scene should radio for medics for a medical evaluation of all victims who report being strangled - if they are capable of making a report.

Consider the testimony of Dr. Hammesfahr regarding Terri's neck injury from Oct. 11, 2002:

"Anoxic and hypoxic encephalopathies are characterized by multiple small strokes. So depending upon where that stroke is, is where your deficiency is. In your average stroke, the entire side of the body is affected. But in a hypoxic or anoxic episodes, or cerebral palsy, you will see lots of different areas affected. And there may be another injury, a neck injury with her also, which compounds her examination.

Q. Compounds what, her condition?

A. Her condition, yes. There is a neck injury. There may be a spinal cord injury, also.

Q. How were you able to determine a neck injury?

A. By physical examination. On physical examination, she has several characteristics that are not typical of a stroke. First, she has very severe neck spasms. That's typical of the body's response, splinting the area to prevent injury to that area.

Q. Splinting the area?

A. Yeah. If you injure your arm, you will move it. Your muscles will contract around it to keep that area moving. Her muscles around the neck area are heavily contracted to help prevent movement around that area. Later on in the videotape, we actually show that it's almost impossible for her to bend her neck. You can pick her entire body up off the bed just by putting pressure on the back of the neck area, which is not typical in brain injury patients but in neck injury patients. In addition, her sensory examination is nothing like a typical stroke patient or typical anoxic encephalopathy.

Q. Are you experienced in treatment of patients with spinal cord injury?

A. Yes, I am.

Q. You said that you had never felt a neck like that except for one other patient, right?

A, Correct.

Q. What was the cause of injury in the other patient?

A. The person had an anoxic encephalous due to attempted strangulation.

Governor Bush has asked Bernie McCabe, Pinellas-Pasco County State Attorney to investigate why Michael Schiavo waited 40-70 minutes to call the paramedics.

*Italics added by NewsMax.com

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