Monday, September 28, 2009

The Strange Case of the 'Toxic Lady'

'The Toxic Lady' was Gloria Ramirez, a 31 year old woman from Riverside, California. Her body may or may not have emitted toxic fumes which made several doctors and nurses in the emergency room of Riverside General Hospital very ill. She was the mother of two children and had been diagnosed with metastatic cervical cancer 6 weeks before the infamous event.

On the evening of Feb. 19, 1994, Ms. Ramirez was brought by paramedics to the emergency room at Riverside General Hospital. She was admitted in respiratory and cardiac distress, and went into full cardiac arrest about 15 minutes after arrival. A nurse named Susan Kane drew blood, probably for an arterial blood gas determination, as part of the routine 'code blue' procedure of the hospital. Nurse Kane noted a 'foul odor' and immediately passed out cold. A doctor (Julie Gorchynski, the senior medical resident) went to Nurse Kane's aid. After seeing to her needs, Dr. Gorchynski noted a strange odor, 'took a deep whiff' of the syringe and passed out. 4 other staff then passed out, all standing right next to each other. The paramedics who rode in the ambulance to the hospital with Ms Ramirez and who remained in the room, as well as one nurse and Dr. Humberto Ochoa, the director of the ER (who came as soon as he heard staff were keeling over in the middle of a code) were all unaffected.

Since other cases have occured where ER staff became ill from fumes emitted by a patient (usually from people who have ingested pesticides, although this can also be a risk to staff working in hyperbaric oxygen chambers with people with carbon monoxide poisioning) the hospital assumed that this was a case of toxic contamination, sealed the ER and evacuated all patients and affected staff (who by now numbered somewhere between 8 and 11, including clerks) and brought in the County decontamination unit.

Ms. Ramirez died in the ER, after the staff tried to rescusitate her for about 35 -45 minutes. The official cause of death was kidney failure due to metasticized cancer. Her body was placed in a sealed body bag and sent to the county coroner for autopsy in a special sealed unit.

Despite the apparently genuine and severe illnesses of the ER staff, no satisfactory explanation as to what toxin could have caused their illnesses was given. This has led to speculation as to whether mass hysteria could have caused the symptoms experienced by the ER staff.

The most likely alternative explanation is that there was some toxin in the ER and that possibly the hospital covered this up. The hospital had been cited for improper waste disposal in drains. However, they were inspected by nine different city, state and federal agencies after this incident. While cited for some violations in other parts of the hospital, no violations were found that affected the ER.

The hospital did not properly handle the situation with the Ramirez family. First, the hospital suggested that Ms. Ramirez tried to kill herself by ingesting pesticides. This was not an unreasonable initial theory given the situation (which looked very much like pesticide poisoning.) However, it was ill thought out to say this before preliminary lab results were back, since the Ramirez family, like most people of Mexican descent in the area, are devout Catholics. To allege suicide is to allege a very serious sin.

The county confiscated Ms. Ramirez's body for several months and at one point improperly stored it, resulting in significant decomposition. The Ramirez family had to sue to get the body back for burial, but by then it was unfit for viewing.

Many tests, hypotheses and lawsuits were to follow, but an explanation was found, by no less than the famed Lawrence Livermore National Laboratory, nearly nine months later. Naturally, the solution to the mystery, not being nearly as exciting as stating the mystery itself, was not well publicized. Dimethyl sulfate, which is cited in scientific literature as a chemical warfare agent, was created by an unusual confluence of chemical reactions.

It is believed that Ramirez used DMSO (dimethyl sulfoxide), a sort of wonder drug for relieving various arthritic aches and pains. DMSO is metabolized to become dimethyl sulfone, which was found in her system, likely produced by the administration of oxygen by paramedics.

When attendants drew blood from Ramirez in the emergency room, the relatively sudden and sharp drop in the temperature of her blood, from body temperature to the cool air of the hospital, could have created dimethyl sulfate, the lethal compound. Her body temperature was too high to allow creation of the deadly compound internally.

Witnesses at the time said they saw crystals in the syringe containing Ramirez's blood, and scientists now believe those crystals were the source of the mystery fumes.

The step of creating the lethal toxin from the benign dimethyl sulfone was performed at Lawrence Livermore.

The scientists noted that virtually every known side effect of dimethyl sulfate was exhibited by those who smelled Ramirez's blood. Likewise, virtually every symptom displayed by the attendants was consistent with exposure to the toxin.

Also, DMSO can appear oily, which is consistent with the presence of an "oily sheen" on Ramirez's body that some witnesses said they saw.

The family sued the county for medical malpractice and for general damages stemming from the coroner's autopsy. The cases eventually were settled for $800,000, without the county admitting any wrongdoing.

Most of the money went to buy annuities for Ramirez' two children: Evelyn Arciniega, now a 22-year-old student at Riverside Community College, and Buddy Angel Arciniega, 19, who is serving a 12-year prison sentence for voluntary manslaughter.

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