Fear Shrouds Autopsy in Fumes Case

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

In a basement room, not far from a gathering throng of pathologists, paramedics, fire crews and hazardous-materials specialists, Chief Deputy Coroner Dan Cupido answered without hesitation: “The unknown . . . the fear of the unknown.”

Late on Thursday night, doctors cloaked in heavy-duty safety suits--in a building sealed off by police tape--began to perform the most extraordinary autopsy ever conducted in Riverside County or perhaps anywhere else. They were to open the body of Gloria Ramirez cautiously, hoping to determine why the 31-year-old cancer patient apparently emitted 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 in laboratory tests of Ramirez’s blood, they told a crowded pre-autopsy news conference at the Riverside morgue that they remain baffled.

“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. Through the day, the number of media on hand from around the nation grew as interest in the mystery soared.

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 preliminary tests conducted on the blood sample uncovered no evidence of organophosphates.

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 consulted with doctors at Loma Linda University Medical Center, but was not being treated there.

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

“Those are the kinds of questions we are asking,” DeSantis said. “At this point, we can’t rule out anything.”

In preparation for the autopsy, authorities closed off two narrow avenues beside the quaint Spanish-style, ivy-covered coroner’s office. Safety cones and yellow police tape divided Orange Street along its center stripe.

On one side of the barrier, reporters and TV camera crews huddled outside their satellite transmission vans and clustered near the rear entrance of the building, hoping for glimpses into the mystery.

On the other side of the police line, emergency teams prepared for the moment when Ramirez’s body would be removed from its airtight, aluminum casket and double layer of plastic body bags.

“I don’t think anybody’s ever done anything like this,” said Bill Redden, a supervising industrial hygienist for the Riverside County Environmental Health Department, as he showed reporters the arrangements--including the 8-by-15-foot, plastic-lined enclosure specially created to house the examination.

Two industrial hygienists--from Riverside County and Cal/OSHA--were to begin the procedure by removing the outer body bag and poking small holes into each end of the inner bag, Redden said.

Air samplers and a remote camera were to monitor the body for about an hour with no members of the autopsy team present, he said. The forensic examination was then to begin and would involve checking the skin and organs for chemical contamination and clues to the cause of death. The autopsy was expected to conclude about midnight.

All four members of the team were to be wearing “Level B” safety suits, sealing themselves completely from gases in the room. Four members of a hazardous-materials team would be outside in oxygen masks and protective suits, ready to rescue the others if necessary.

According to a detailed report released Thursday, Ramirez arrived by ambulance at the emergency room semiconscious with a rapid heart beat. Nurse Susan Kane, who was drawing blood, was the first to faint. Dr. Julie Gorchynski, who took over, also passed out, and soon afterward Ochoa ordered an evacuation. County officials said Ramirez received uninterrupted care.

Rick Rice of Cal/OSHA said the heating and ventilation system in the emergency room had been checked and nothing was found that could explain the bizarre episode. A spokesman for the hazardous-materials team noted at the news conference, however, that no one had checked the drains in the emergency room.

Gorchynski was removed from a respirator at Loma Linda University Medical Center and was breathing normally, hospital spokeswoman Anita Rockwell said Thursday. Gorchynski’s condition is listed only as fair, however, because she continues to have mild muscle spasms.

Residents of Riverside who looked on with curiosity Thursday expressed sympathy for Ramirez’s family while puzzling over the strangeness of the case.

“God only knows, if they find something, how it might change the medical profession,” said attorney William Shapiro, who speculated that the worst-case scenario might be another “AIDS-type epidemic.”

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