The mother of a highly ranked U.S. gymnast said her daughter is in a coma not because of a spinal injury suffered at a meet in Japan, but because of irresponsibility on the part of a Tokyo hospital, which she said caused an accidental asphyxiation.
Otilia Gomez said her daughter, Julissa, the country's 13th-ranked gymnast, went into a coma 15 days after first entering Tokyo University Hospital to be treated for a broken neck. Julissa, 15, suffered the neck injury while performing a routine practice vault at the World Sports Fair gymnastics meet. Doctors in Japan, Mrs. Gomez said, had diagnosed Julissa as being paralyzed from the neck down.
Mrs. Gomez said that her daughter, awaiting transport to the United States, went into a coma after suffering asphyxiation when an oxygen hose slipped off the tracheotomy tube lodged in Julissa's neck. An alarm did not sound to alert the nursing staff.
Mrs. Gomez said she has taken no legal action.
"She did not exactly go into a coma because of the accident (vaulting injury)," Mrs. Gomez said from Methodist Hospital in Houston, where Julissa was transferred by U.S. military transport two days after becoming comatose last month.
"She was hospitalized for 13 days, then had a tracheotomy. The day after the tracheotomy, the oxygen tube from the respirator accidentally snapped off, and the machine's alarm was not on, and so the nurse was unaware that it had happened."
Mrs. Gomez said Julissa suffered asphyxiation, went into cardiac arrest, then fell into a coma from which she has not regained consciousness.
Julissa had been given oxygen since the vaulting accident because she could not breathe on her own. Before the tracheotomy, an oxygen tube was placed down her throat. She could move her lips but could not talk.
"We (Otilia Gomez and Julissa's father, Ramiro) were horrified and we asked the doctor (Dr. Koji Mii) why the alarm was not set," Gomez said. "He said, (through an interpreter), because, 'We feel,' although I do not remember if he said we or I or they, 'that if the alarm is set, the nurses will rely on the alarms and not check the patients.' He said they check the patients every 30 minutes.
"I have since learned it is not uncommon to have the oxygen hose snap, but it is irresponsibility on the part of the hospital. It is an accident that could and should have been prevented."
Gomez said she does not know how long Julissa was without oxygen.
Reached in Tokyo, Dr. Mii, an assistant professor at Tokyo University Hospital who treated Julissa, said he has a second explanation for Julissa's comatose condition, an explanation the Gomezes said they had not heard before Saturday night.
"The disconnection of the oxygen tube, it did happen, but when it happened, and why and how it happened, is not sure," said Mii, who speaks English.
"Julissa's pulse rate became low and decreased on the heart scope monitor, to about 8 or 9 beats per minute. At the time, she was asleep and the lamp was turned back, (the room was) not completely dark, (but) the connected part of oxygen tube was not real seen. . . . At the time, it was very dark and her room is not separated--there are other patients in the same room."
Dr. Mii said that a nurse checking Julissa found her pulse to be normal at 10:30 p.m. and 10:35 p.m. He said he checked Gomez at 10:45, and her condition was unchanged.
"About 10:50, this time is not exact, I again found her normal," he said. "Then, I returned to my room (at the hospital) . . . I was called to Julissa's bedside at two or three minutes after 11 p.m. Within 10 minutes, she was revived.
"When the nurse found extreme decreased pulse rate, she cried out in a big voice, and someone turned the lamp on and she found the disconnection of the tube."
Mii said he does not know what happened first, the oxygen disconnection or the decrease in pulse rate, but that Julissa's pulse rate had fluctuated from 38 beats per minute to 70 b.p.m. during her hospitalization.
Her normal pulse rate would be 70 b.p.m., but when Mii arrived at her bedside at the time of the accident her pulse was only 8 or 9 b.p.m. He said when he checked her at 10:50 p.m., her pulse was 58 or 59 b.p.m.
"It is a fact that the disconnection happened," Dr. Mii said. "So, we thought the decrease of pulse rate was due to oxygen disconnection--we thought it was the main cause.
"But now, I am not absolutely sure if disconnection is the main cause of the decrease of heart rate, because mild decrease of pulse rate happened many times to Julissa (during her hospitalization).
"Another possible cause is an (oblong) medulla dysfunction . . . caused by a decrease in pulse rate." (The oblong medulla contains nerve centers that control breathing and circulation.)
Dr. Mii, who used an interpreter to discuss Julissa's case with the Gomezes, said it is the hospital's usual procedure to set the alarm, and that he believes his original explanation was not properly explained by the interpreter.
"The nurses said to me perhaps they didn't set the alarm (Julissa's respirator alarm), but that fact is not sure," Mii said. "Now, I think, if they didn't set the alarm, their choice, instead of the alarm, (is) close observation. But I thought the alarm was always set."
Said Mrs. Gomez Sunday upon learning of Dr. Mii's explanation: "The cardiac monitor alarm should have gone off before her pulse rate dropped as low as 8 or 9 (b.p.m.)."
Mrs. Gomez's frustration with obtaining information underscores the reason the family decided to discuss their daughter's case. From May 5, the day of the vaulting accident, until Friday night, Julissa's parents had not talked to reporters and had ordered the hospital and doctors not to disseminate information on their daughter's condition.
"A lot of people have questioned why Julissa would go into a coma," she said. "Most people know her, and they know she is strong, but they think she gave up. The coma was a second accident. She was strong and ready to fight."
Mrs. Gomez said Julissa was paralyzed after the accident but was alert. They would write out questions, and she would blink once for yes and two times for no. Then, they made up an alphabet chart, and Julissa would spell out sentences by blinking to the letters.
"She never asked about the accident," Mrs. Gomez said. "But we knew she was hopeful because she would tell us if the nurses had not exercised her legs and arms--she was keeping track. We knew that she was fighting. And every day she would ask when she could go home."
The Gomezes said they hope that they can help others be more prepared by discussing Julissa's case.
"Our kids start traveling internationally when they are 13," Mrs. Gomez said. "And I think we as parents need to be more educated on the cultural differences and medical facilities available where our children are going."
For example, she said, had they known the procedure for transporting Julissa to the United States, she believes she could have been sent home sooner. The confusion resulted in a delay--and they missed the first plane available. Julissa went into a coma the next day.
Mrs. Gomez said there were many things she never thought about--such as insurance, dealing with foreign doctors and rules. At the Tokyo hospital, she could only visit Julissa twice a day, for 15 minutes each. And when Julissa went into a coma, the Gomezes were not informed until they arrived at the hospital the next day at 2 p.m., for their regular visit.
Mrs. Gomez said Dr. Mii told them they were not called because he didn't think it was necessary. But Dr. Mii said Saturday that he didn't call the Gomezes because he was with Julissa all night. Then, when he was going to phone them the next day, he thought they would already be on their way to the hospital, which, he said, was a couple of hours' drive from their hotel.
"Things are just different there (in Japan), and we need to be prepared ahead of time and take an active role in dealing with these situations," Mrs. Gomez said. "The U.S. Gymnastics Federation was great, but I hope we have all learned from this experience."
Julissa opens her eyes more now, but that is the only change in her condition. Her parents are at her bedside continually, talking to her, even though she can't talk back.
They play music for her: Julissa is an avid Beatles' fan, and while in the Tokyo hospital, she had asked for the sound track from the movie, "Top Gun" and George Michael's "Faith" album.
Teammates and friends have sent Julissa tapes of everyday conversations--they talk to Julissa while they are getting ready for school; and some of the tapes say, "Wake up, Julissa."
Julissa is known for her determination and optimism. She would not let family members say, " ' If Julissa makes the Olympic team . . . ' With Julissa, it was always when , not if," Mrs. Gomez said.
She remembers when Julissa first started in gymnastics. Mrs. Gomez said when she heard her telephone ring she would jump: "You're always a little fearful, but you know the risks--you just never really think it's going to happen to your child," she said.
Julissa suffered the spinal injury performing a vault she has been executing for three years--a round-off onto a springboard, a back handspring onto the vaulting horse. It is a routine maneuver for a world-class gymnast.
But she missed. Her foot slipped on the springboard and she didn't get the necessary lift, said her coach, Al Fong. She hit the vaulting horse with her head.
She lost consciousness and stopped breathing momentarily. When she regained consciousness, she couldn't move. She was taken to Tokyo University Hospital, where Dr. Mii treated her.
"Dr. Mii is a highly respected and dedicated doctor in Japan, and he saved Julissa's life after her gymnastics accident," Mrs. Gomez said.
That injury is the worst accident to happen to a U.S. gymnast in international competition, according to a United States Gymnastics Federation spokesperson.
"We have become very angry over this because after the first accident, we knew things were going to be difficult and a hard struggle for all of us, but somehow, we knew we would get through," Gomez said.
"Of course we were devastated when she was paralyzed, but the fact that she cannot be a gymnast anymore, well, that is not who she is.
"But when this happened (asphyxiation), that's when they took Julissa from us. Because who Julissa is, is in her brain and in her mind--that is our child."