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  Date / Time: 12/17/2008 6:38 AM UTC

  Toxic Lady Backstory
  

  http://www.totse.com/en/politics/green_planet/toxlady.html
  
  
  FAQ on the 'Toxic Lady', and the Incident at Riverside Hospital
  By Camilla Cracchiolo RN
  
  Copyrighted 1995 may be freely reproduced for non-profit purposes.
  
  I. Who Was The Toxic Lady?
  
  The 'toxic lady' (as the Internet has perhaps unfairly dubbed her) was a 31 year old woman in Riverside, California named Gloria Ramirez. 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 famous event leading to her name.
  
  II. What happened?
  
  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 (probably by making sure she did not get a head injury from falling), 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) all were unaffected.
  
  Since other cases have occurred 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 poisoning) 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.
  
  III. What happened to Gloria Ramirez during all this?
  
  Ms. Ramirez died in the ER, after the staff tried to resuscitate 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.
  
  IV. Why is this case so unusual?
  
  Because despite the apparently genuine and severe illnesses of the ER staff, no satisfactory toxin that could have caused their illnesses has been found. This has led to speculation as to whether mass hysteria could have caused the symptoms experienced by the ER staff. Opinions are still divided as to the cause of the incident.
  
  
  
  
  
  
  
  V. Well, if a toxin from Gloria Ramirez didn't cause these problems, what else could have?
  
  The main alternative explanation is that there was some toxin in the ER and that possibly the hospital covered this up. The hospital has been cited before for improper waste disposal down 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 'it's the hospital's fault' scenario is favored by Gloria Ramirez's family, who has filed a lawsuit against Riverside General saying that the fumes came from the hospital and also caused Ms. Ramirez's death.
  
  The hospital, I'm afraid, did not handle matters well 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 to these folks.
  
  To top this off, the County then hung on to Ms. Ramirez's body for several months and at one point improperly stored it, resulting in gross decomposition. The Ramirez family had to sue to get the body back for burial, but by then it was unfit for showing. They had wanted an open casket ceremony so her children could see her face and properly say goodbye. I'd be mad too, if I were them.
  
  VI. What are the official conclusions?
  
  There has never been a satisfactory resolution to the case. While eventually 32 people reported what seem clearly to be hysteric symptoms, the people originally felled have lab and physical findings that seem to exclude hysteria. (Hysteria can only be diagnosed in the absence of observable lab or physical abnormalities)
  
  The official opinion of Cal-OSHA is that, while some of the staff may have been affected by hysteria, at least three people had a genuine reaction to some kind of toxin or agent.
  
  The State Dept. of Health Services report said that most people (eventually over 30) who reported feeling ill were suffering from mass hysteria, but that the original six staff who were felled may have been affected by either hysteria or a toxic agent.
  
  The Riverside Dept. of Health says that they now believe that Dr. Gorchynski, Ms. Welch and Ms. Balderas are not suffering from hysteria.
  
  Lawrence Livermore Lab released a preliminary report suggesting that dimethyl sulfate, metabolized from hypothesized consumption of DMSO, was the cause of their symptoms.
  
  However, according to chemists here on the Internet, it's highly improbable that dimethyl sulfate could cause this.
  
  
  
  
  
  
  
  
  
  The final report was awaiting peer review and to my knowledge has not been released.
  
  VII. What is the status of the case now?
  
  The family's lawsuit has not come to court yet.
  
  Julie Gorchynski filed a lawsuit against Riverside County saying that they withheld key information she needed in doing her own investigation of the case. She is asking for six million dollars.
  
  This may get settled out of court since Riverside Co. has stated that they now believe Dr.Gorchynski's illness to be organic.
  
  The Lawrence Livermore final report has not yet been released.
  
  More Details:
  
  VIII. Who were the affected staff and what happened to them?
  
  The affected staff was:
  
  Susan Kane, the nurse who initially drew the blood and who fainted first.
  
  Dr. Julie Gorchynski, the senior medical resident in the ER and who fainted seconds after sniffing the syringe used to draw Ms. Ramirez's blood, and who was also the most seriously ill of all the staff.
  
  Dr. Mark Thomas, the attending physician in the ER, and who was affected third (unclear if he actually fainted, but had dizziness and muscle spasms).
  
  Maureen Welch, a respiratory therapist who was using a special device (called an ambu bag) to deliver breaths to Ms. Ramirez and who was affected fourth (fainted).
  
  Bettina Berry, a nurse in the ER (I don't know when she felt ill, and I'm not sure if she fainted or not).
  
  Sally Balderas, the nurse who moved the affected staff and Ms.Ramirez's body into a holding area, who was one of the last people to report feeling ill, but also the second most severely affected staff person.
  
  Debbie Carrier, a medical clerk in the ER.
  
  A recent Los Angeles Times article stated that the official tally of affected staff is 32, but no information is available on the others.
  
  Most affected staff suffered no permanent effects. However, Dr.Gorchynski, Maureen Welch and Sally Balderas continue disabled although partially recovered. Their symptoms included immediate change in heart rhythm, followed by 'spasms'.
  
  Two days after the incident, Dr. Gorchynski had to be placed on a ventilator because these strange muscle spasms were interfering with her ability to breathe to the point where her arterial oxygen levels were 'markedly reduced'. She also had elevated liver and pancreatic enzymes and subsequent to all this developed a rare necrotizing bone disorder due to the cutoff of circulation to the bone.
  
  Dr. Gorchynski's case is particularly interesting. She is a very amazing lady. Some people have suggested that the affected staff must have had some kind of pre-existing medical condition, but all evidence is to the contrary for Gorchynski.
  
  According to the spokesman for Loma Linda University Medical Center (where Dr.Gorchynski wound up after evacuation), she is either a national or world surfing champion, holding the #2 title in the women's division. She was, according to all accounts, in glowing health prior to this. Certainly hospital residents must be in good health or they cannot withstand the grueling, often 100+ hour weeks demanded of them during residency.
  
  She had a master’s degree in microbiology and had been published prior to attending medical school. She graduated at the top of her class and according to the most recent newspaper article I've seen on her, was preparing from her bed at home (she was in a wheelchair at the time) to fly to London to accept some kind of award for a paper she had written.
  
  IX. C'mon! Give us ALL the details! We're information junkies!
  
  Ok, here is the official chronology from Riverside General Hospital:
  (All capitalizations and spellings are in the original)
  
  Summary of Events on February 19 and 20, 1994
  Riverside General Hospital - University Medical Center
  Riverside, California
  
  Regarding Patient: Gloria Ramirez
  
  7:46 p.m.: Ambulance and Riverside Fire Department dispatched to home of 31-year old Gloria Ramirez; difficulty breathing.
  
  7:50 p.m.: Fire Personnel on scene
  
  8:07 p.m.: Radio call received at Hospital from Ambulance. Pre-hospital personnel reported patient to be in severe cardiac distress. Patient was placed on monitor, administered oxygen and an IV was started.
  
  8:14 p.m.: Patient arrived at Hospital semi-conscious in a life-threatening condition (placed in resuscitation room) with rapid heart beat.
  
  During the 36 minutes (8:14 p.m. - 8:50 p.m.) the following events took place:
  
  * Medical Team began care immediately. Dr. Mark Thomas, Attending Physician, leading resuscitation - Dr. Julie Gorchynski, Senior Resident, Emergency Department, assisted
  with Nurses and Respiratory Therapy also at bedside.
  
  * A full code 'resuscitation' was in progress. Emergency procedures: defibrillation, administered IV fluids and blood was drawn.
  
  * As Susan Kane, the Nurse, drew the blood, she noted an ammonia-like smell. Several other health care workers noted the same odor.
  
  * With seconds, Susan Kane fainted. She was placed on a gurney.
  
  * Dr. Julie Gorchynski assumed Kane's role in caring the patient and subsequently passed out. Another physician attended to the fallen staff.
  
  
  * Dr. Mark Thomas continued care of the patient.
  
  * Susan Kane and Dr. Julie Gorchynski were moved into the holding area.
  
  * Susan Kane's condition worsened. She experienced difficulty breathing.
  
  * Evacuation of the Emergency Room was ordered by Dr. Humberto Ochoa, Chairman of the Emergency Medicine Department.
  
  * Maureen Welch, the Respiratory Therapist, while ventilating the patient, became ill.
  
  * Dr. Mark Thomas, the attending physician then became ill.
  
  * Medical Care of Gloria Ramirez continued uninterrupted by Dr. Ochoa who was assisted by a Respiratory Therapist, Resident Physician, a Paramedic and two Nurses.
  
  * Gloria Ramirez was intubated, administered additional emergency medications and defibrillated multiple times.
  
  8:41 p.m.: 911 was called by Hospital. Fire Department Dispatched.
  
  8:47 p.m.: Fire Department arrived.
  
  * Nurse Bettina Berry, who was caring for Gloria Ramirez, became ill.
  
  * Gloria Ramirez failed to respond to resuscitation measures and at 8:50 p.m., Dr. Ochoa pronounced the patient dead.
  
  8:52 p.m.: City of Riverside HAZ MAT notified by the Fire Department
  
  9:10 p.m.: City of Riverside HAZ MAT arrived on scene.
  
  9:15 p.m.: Hospital Administrator On-Call and Hospital Safety Officer arrived on scene.
  
  9:29 p.m.: City of Riverside Environmental Health Resource Team notified.
  
  * Evacuation of all patients and staff from the Emergency Room was completed. Kaiser Hospital, Riverside, was notified that RGH was on Emergency Diversion - redirecting all ambulance services to other community hospitals. Kaiser communicated this information to other base stations.
  
  9:30 p.m.: Hospital Administrator arrived.
  
  9:30 p.m.: Coroner notified and arrived shortly after.
  
  9:30 p.m.: The Fire Department cordoned off the area outside the Emergency Room.
  
  * Emergency Room patients were transferred, admitted, treated and discharged. No patients demonstrated any signs of exposure.
  
  In the parking lot, Sally Balderas, RN, exhibited symptoms.
  
  Six staff were transferred to local hospitals.
  
  
  11:00 p.m.: HAZ MAT entered the Emergency Room and performed air-test sampling for common hazardous gases. Results proved negative. (No contaminants detected).
  
  APPROXIMATELY MIDNIGHT:
  
  * Planning Meeting was held with: HAZ MAT, Environmental Health, Hospital Administration and Coroner to determine course of decontamination.
  
  APPROXIMATELY 12:30 A.M.:
  
  * Decontamination of Remaining staff took place.
  
  2/20/94
  
  2:15 a.m.: HAZ MAT, after consultation with the Coroner, reentered the Emergency Room, placed Gloria Ramirez in a double-sealed bag, which was placed in an airtight container and moved to the Hospital Morgue. HAZ MAT decontaminated the Emergency Room area.
  
  3:07 a.m.: HAZ MAT released the area to the Hospital staff.
  
  3:10 a.m.: Hospital Environmental Services Unit conducted extensive cleaning of all equipment and furnishings.
  
  7:00 a.m.: The Emergency Room was reopened.
  
  9:55 a.m.: Body was released to Coroner.
  
  Copyrighted 1995 may be freely reproduced for non-profit purposes.
  
  
  HERE IS WHERE EVERYONE WAS STANDING:
      
                                        Maureen Welch, RT
                                             (Affected fourth)
                              ____________________________________
   Paramedic intern      |                                           |
   (Not mentioned as     |                           head                     |
     affected, gender     |                                            |
     unknown)            |                                            |   unnamed nurse,
                              |                                           | unknown if and
                            |                                           | how affected
                                    |                                           |
      Unnamed nurse      |                EXAM TABLE                |
                             |                                           |
                            |                                           | Dr. Mark Thomas                
                                                                               Thomas
                              |                                          | (affected third)
                             |                                          |
                             |                                            |
                             |                   foot                        |
               |       ___________________________      |   
  
  Susan Kane RN   (drew blood, passed out first)           
  Dr. Gorchynski (took over drawing blood, passed out second)
  Dr. Humberto Ochoa (came in later)
  
  
  
  
  
  ========================================================
  
  http://query.nytimes.com/gst/fullpage.html?res=9F02E6DF1F3BF936A15751C0A962958260&sec=health&spon=&pagewanted=all
  
  
   Elaborate Precautions Taken for Autopsy in Mystery Fumes Case
  
  By B. DRUMMOND AYRES JR.,
  Published: February 25, 1994
  
  The bizarre and puzzling circumstances of Gloria Ramirez's death in the emergency room of Riverside General Hospital last Saturday have suddenly transformed this city of 200,000 people into the scene of a techno-thriller straight from a best seller like "The Andromeda Strain."
  
  A doctor and five nurses in the hospital's emergency room were felled by a mysterious substance from Ms. Ramirez's body; two of them are still hospitalized.
  
  A four-member pathology team took extraordinary safety precautions, donning airtight, toxin-proof safety suits in preparation for an autopsy scheduled to begin late tonight.
  
  The primary aim of the autopsy, conducted in a specially sealed coroner's chamber with emergency personnel skilled in the handling of hazardous materials standing by, was to determine the nature and possible antidote of the substance that caused such a bizarre medical incident. 'Nonspecific' Substance
  
  Dan Cupido, the chief deputy coroner for Riverside County, said before the autopsy that while the autopsy team was "dealing with the unknown," it already suspected that Ms. Ramirez did not die of a "disease process."
  
  Asked to elaborate, Mr. Cupido said early tests of blood drawn from Ms. Ramirez in the emergency room found a "nonspecific" substance that merited more testing.
  
  "We have a direction that we are looking at," he added, refusing to take further questions.
  
  Some of the emergency room victims told of an ammonia-like smell rising from the woman's body, which they said also seemed to have an unusual sheen. They reported seeing white and yellow particles in blood samples. Equally puzzling, some emergency room personnel who worked on Ms. Ramirez said they suffered no ill effects.
  
  "I felt nothing," said Dr. Humberto Ochoa who, as head of the Riverside Hospital emergency medicine department, was in the emergency room throughout the incident.
  
  At a news conference here, Tom DeSantis, the Riverside County spokesman, said the results of the autopsy might take as long as a week.
  
  "This is different than anything we've ever done before," he said.
  
  For that matter, the carefully orchestrated autopsy would be a rarity anywhere -- a new safety challenge for medical personnel already burdened by the exceptional precautions required by the AIDS epidemic.
  
  The only known similar incident occurred a few years ago, in Perth, Australia, where medical personnel were felled by toxins from the body of a man who had committed suicide by swallowing a weevil poison.
  
  Ms. Ramirez, who was 31, suffered from advanced cervical cancer, but the medical authorities said she was taking no medical substance that could have caused the emergency room incident. The Riverside woman was brought to the hospital Saturday night in a semiconscious condition after complaining of stomach pains.
  
  While emergency room personnel tended her, drawing blood and instituting other medical procedures, she vomited, went into cardiac arrest and died. At about the same time, members of the emergency team began to faint.
  
  Among them were Julie Gorchynski, a doctor, and Sally Balderas, a nurse. Both were hospitalized in serious condition, with Dr. Gorchynski initially requiring a ventilator because of irregular breathing. Although they are still hospitalized, both women are expected to recover. The doctors treating them were hoping that tonight's autopsy might provide clues as to how to hasten their recovery. Pesticide Is Suspected
  
  There has been speculation among medical personnel here and elsewhere that the toxic substance that felled the emergency room workers may have been an organophosphate, a chemical used in pesticides and military nerve gas. Officials from the Riverside coroner's office, curious as to whether Ms. Ramirez may have ingested some toxic agent, possibly an organophosphate, searched her apartment here but found no toxins, most notably nothing containing an organophosphate.
  
  Her cancer medicine, the officials said, was limited to Compazine; an anti-nausea drug that they said posed no threat to emergency room workers. Ms. Ramirez was scheduled for extensive radiation treatments but had not begun them.
  
  Members of her family and her lawyer, Steve Otto, have strongly denied speculation that Ms. Ramirez, a divorced mother of two, may have swallowed some substance in a suicide attempt.
  
  "There's no way she did that, absolutely no way," Mr. Otto said shortly before the autopsy was conducted. Precautions Necessary
  
  County officials said the autopsy, carried out at the coroner's main office building here, would have been conducted much sooner had not so many safety precautions been necessary.
  
  First, air-tight safety suits with flexible gloves, self-contained oxygen and two-way radios were obtained for the autopsy team. Then the autopsy room was made air-tight and equipped with a filter system to clean exhaust air.
  
  Meanwhile, Ms. Ramirez's body was kept in an air-tight body bag that was within another such bag. Those two bags, in turn, were sealed inside an air-tight coffin that was stored in an isolated, refrigerated room.
  
  Emergency workers trained to deal with toxic substances and clad in safety suits were on hand outside the autopsy room, prepared for a rescue mission if necessary. Before the autopsy, hygienists took air samples from the body bags and skin samples from Ms. Ramirez.
  
  Shortly before 10 P.M., a pair of industrial hygienists in shiny yellow airtight suits entered the autopsy area, opened the casket, and took air samples. They were monitored via closed-circuit television by rescue experts.
  
  When the autopsy is completed, the four members of the pathology team, whose identities were not disclosed, are to be hospitalized for 12 hours for testing and observation.
  
  "We're dealing with the unknown and fear of the unknown," Mr. Cupido, the deputy coroner, said. "There's a clinical history in which two people have had to be hospitalized."
  
  
  
  http://en.wikipedia.org/wiki/Gloria_Ramirez
  
  
  Gloria Ramirez
  From Wikipedia, the free encyclopedia
  Jump to: navigation, search
  
  Gloria Ramirez (January 11, 1963-February 19, 1994) was a Riverside, California, woman dubbed "the toxic lady" by the media after exposure to her body and blood had sickened several hospital workers. Her case was the basis for a scene in one episode of the American TV series The X-Files and an episode of the American TV drama Grey's Anatomy.
  
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Comments

D.L.Contostavlos 10/17/2009 5:44 PM UTC My theory has been ignored. Gloria's urine was poured into a sink adjacent to her bed and all attendants. Urine reacts with bleach to produce toxic irritant gas chloramine. This gas, with attendant lung irritation PLUS hysterical reaction could account for everything. Fears for AIDS causes hospital staff to pour undiluted bleach into sinks, in this case flushed away after gas was formed. Evacuation of buildings and even city blocks have been caused by this noxious gas.

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