Misdiagnosing PVS - Cranford and Terri Schiavo

CNSNews reporter, Jeff Johnson, has written an excellent article about one of the expert witnesses who testified that Terri Schiavo was in a persistent vegetative state (PVS). Dr. Ronald Cranford gave the same confident opinion ("105 percent sure") of his diagnosis of a patient he examined in 1980 who later regained consciousness and the ability to communicate.

In addition to his testimony in court, you may remember that Cranford went public three days before Terri�s death to counter public opinion that was being swayed by advocates of Terri Schiavo. He is also the doctor that supports the starvation of those afflicted by Alzheimer�s disease.

Johnson writes that Cranford called neurologists who disagreed with his diagnosis of Terri Schiavo "stupid" and accused one of being a "charlatan."

One problem with Cranford�s assertions is that he apparently did not consult a radiologist when he attempted to interpret Terri�s CT scans. Had he done so, he would have been told that the scan cannot be used to diagnose PVS and resembled that of an elderly person suffering senility but completely conscious [more].

Another problem is that Cranford lacks credibility. After he 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.

At first, he was able to respond to commands by changing his breathing pattern and following hand movements with his eyes.

"Cranford insisted at the time that his initial diagnosis was correct," writes Johnson.

"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 last week 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."

According to the CNS article, Cranford 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.

Johnson obtained a response to Cranford by Dr. David Stevens, a physician and medical ethicist who serves as executive director of the Christian Medical Association.

"Unfortunately, oftentimes, medical opinions can be 'flavored' with the individual's own worldview and preconceptions," Stevens said. "And, in Dr. Cranford's situation, I think, though he accuses others of that, he is guilty of the same thing.

"He is a 'right-to-die' proponent. He believes there are people who have lives not worthy to be lived, and those lives should be ended," Stevens continued, "and that colors him and his medical opinions. And examples of that are overstating the case to assure that people's feeding tubes are removed."

The CNS article is definitely worth reading and taking to heart. It contains a significant section on the misdiagnosis of PVS. CNS 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." In addition, 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. A 1993 study of 49 patients found that 18 of them, or 37 percent, "were diagnosed inaccurately.

Rev. Robert Johansen also wrote about Cranford in his National Review online article titled, Starving for a Fair Diagnosis. He writes,

[Cranford] 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.

Lastly, I note that numerous individuals have written to me with their testimony of loved ones who have been diagnosed as PVS or have been rehabilited after being in PVS. I�ve published a few: