Pesticide May Be Link to Fumes in Blood : Hospitals: Autopsy may reveal why emergency room workers collapsed while treating a cancer patient.

Toxic pesticide fumes from the blood of a cancer patient they were trying to save may have caused the bizarre emergency room collapse of a physician and a nurse in Riverside on Saturday night.

But blood tests performed on the doctor and nurse left many troubling questions unanswered Tuesday, including how the patient, who died of a heart attack, could have come in contact with a pesticide and why relatives and paramedics who transported her to Riverside General Hospital were unaffected.

Investigators hope some of the questions may be answered by an autopsy, scheduled for today on the victim, 31-year-old Gloria Ramirez. Her body is being stored in a sealed aluminum box to prevent further injuries.

The two stricken emergency room workers, Dr. Julie Gorchinski and nurse Sally Balderas, remained hospitalized late Tuesday, with Gorchinski’s condition being downgraded from good to fair. Four other emergency workers were treated at hospitals and released after the Saturday incident.

Gorchinski’s blood showed evidence of exposure to organophosphates or similar chemicals, said spokesman Dick Schaefer of Loma Linda University Medical Center, where Gorchinski is being treated. Organophosphates are highly reactive chemicals that are the principal ingredients of the nerve gas used in chemical warfare, as well as in pesticides used in the home and on farms. Some household pesticides contain 1% to 2% organophosphates, while those used by farmers and exterminators contain as much as 50%.

Tests of the emergency room showed no contamination in the room or adjoining ventilator shafts, no hazardous gases in the area and no toxic spills, investigator Paul Mitchell told Associated Press. “Whatever it was, it was very localized,” and probably related to Ramirez’s body, he said.

Ramirez had been undergoing chemotherapy for ovarian cancer and had started a new course of therapy earlier in the week. Relatives reported that she had been ill since beginning the new drug and became worse Saturday night, vomiting, suffering chest pains and having difficulty breathing. Her fiance, Johnnie Estrada, called an ambulance, but was not allowed to accompany her to the hospital.

Ramirez was alert and vomiting when she arrived, Balderas told the Riverside Press-Enterprise, but shortly thereafter went into full cardiac arrest. “She had this film on her body, like you see on the ground at a gas station,” Balderas said.

When one of the nurses began withdrawing a blood sample from Ramirez, the workers reported an ammonia-like smell. The blood sample also seemed to be contaminated with white crystals.

Almost immediately after they began drawing blood, “the nurses just started fainting,” Balderas said. “I was putting them on gurneys, starting IVs, and moving them to the parking lot. I also moved the victim from the trauma room to the isolation room.” Balderas collapsed 15 minutes later.

Although the workers’ symptoms suggested poisoning by cyanide or strychnine, tests on their blood showed no traces of such chemicals, Schaefer said.

Experts said it is highly unlikely that the cancer chemotherapy was to blame for the incident, although Dr. Nir Kossovsky of UCLA conceded that “there is always the possibility of something being wrong” with one of the medications. But he noted that he had never heard of a chemotherapy patient’s blood giving off noxious fumes.

A remarkably similar case occurred three years ago in Perth, Australia, when a man who had attempted suicide by swallowing four tablets of Phostoxin--an organophosphate used to kill weevils in silos--was brought into a hospital emergency room. Fumes from his body felled emergency room workers and forced the evacuation not only of that emergency room, but of a second where some victims were taken.

Unlike the Riverside case, paramedics who transported the patients were also affected by the fumes.

Kossovsky ruled out the possibility that malathion spraying in Riverside County last week was linked to the incident, noting that other organophosphates “are far more reactive.” Support for that hypothesis comes from an incident two years ago in which a Bakersfield man who attempted suicide by swallowing malathion and chlordane vomited the pesticides in a hospital emergency room without harm to any workers.