Fear Shrouds Autopsy in Fumes Case

“What are you afraid of?” a reporter shouted.

“The unknown . . . the fear of the unknown,” answered Dan Cupido, chief deputy coroner in Riverside County, where pathologists, paramedics, fire crews and hazardous-materials squads were gathered Thursday for a most unusual autopsy.

Sometime Thursday night, a team cloaked in heavy--duty safety suits--in a building sealed off by police tape--planned to open the body of Gloria Ramirez hoping to determine why the 31-year-old cancer patient apparently began emitting toxic fumes while she lay dying in a hospital emergency room.

The case of Ramirez, who died of a heart attack Saturday night, has perplexed health officials despite nearly a week of investigation. The ammonia-like fumes were so severe that six emergency room attendants at Riverside General Hospital had to be rushed to other emergency rooms after suffering breathing difficulties and muscle spasms, and two of them remained hospitalized Thursday.

Although officials were evasive about what they found during laboratory tests of Ramirez’s blood, they told reporters at a crowded pre-autopsy news conference that the investigation is still at Square 1.

“The one thing we absolutely know about this case is that very little is known,” Tom DeSantis, a Riverside County spokesman, told at least 50 reporters and photographers who filled a basement conference room.

Riverside County Supervisor Bob Buster, who called the episode “unprecedented,” added: “The hunger for a thorough (explanation) of this strange event . . . has certainly overrun our medical and scientific abilities.”

It was hoped that the autopsy, scheduled when the building would be mostly empty, would begin to unravel the mystery. But county health officials acknowledged that the incident might never be fully understood.

Dr. Humberto Ochoa, who stood next to the most seriously afflicted nurse throughout the incident, said he suffered no problems and did not notice the noxious fumes. He did, however, notice what appeared to be white crystals in blood drawn from Ramirez just before his colleagues began collapsing.

“I’d never seen anything like that,” said Ochoa, chairman of the hospital’s Emergency Medicine Department. “I have no explanation.”

Initially, authorities said it seemed likely that the fumes were caused by organophosphates, a highly reactive group of chemicals used in pesticides and nerve gas. But tests conducted at Loma Linda University Medical Center uncovered no evidence of organophosphates in the blood of Dr. Julie Gorchinski, one of the attendants who remain hospitalized.

Cupido, who said investigators were “still dealing with an unknown,” seemed reluctant to say whether anything unusual had turned up in the initial tests on Ramirez’s blood.

“Are you saying they’re normal?” one journalist called out.

Hesitating, Cupido answered, “I did not say that,” but he termed it premature to disclose exactly what the blood analysis showed. “We have reason to believe it was not a natural death,” the deputy coroner added.

Ramirez, who was in the advanced stages of cervical cancer, had been undergoing consultation at the Loma Linda Medical Center, but authorities expressed doubt that any therapy she was undergoing elsewhere could have caused the fumes.

It is even possible, investigators acknowledged, that the fumes might have come from elsewhere, including a rinse basin located inside the emergency room.

The autopsy was to be conducted in a specially built airtight room by two pathologists in protective suits used for handling cleanup of hazardous waste. They were going to be connected to oxygen tanks. wear oxygen tanks and work in 30-minute shifts to guard against exposure. Afterward, they were scheduled to be admitted to a hospital for 12 hours of precautionary observation.

“There are certain state regulation they have to follow to ensure that employees aren’t exposed to any airborne contaminants,” said Rick Rice of Cal/OSHA “Our only interest is with employee safety. we don’t think we’ve caused anyone to go to any extreme measures.”

Times medical writer Thomas Maugh II contributed to this story in Los Angeles.