State Says ‘Mystery Fumes’ Probably a Case of Mass Hysteria : Hospitals: Report does not rule out exposure to toxic substance. Emergency room workers criticize the study.

The emergency room attendants who fell ill last February while treating a dying cancer patient in the so-called mystery fumes case probably succumbed to mass hysteria, the state Department of Health Services concluded in a report released Friday.

It is also plausible, state officials said, that a few hospital staff members were exposed to something that made them ill and that others reacted to the stressful situation. But if there was an exposure to something, its identity remains unknown, said Dr. Ana Maria Osorio, chief of the health department’s division of environmental and occupational disease control and co-author of the report.

“There doesn’t seem to be a humongous big cloud of something that overwhelmed everybody,” she said.

Dr. Julie Gorchynski, the Riverside General Hospital emergency room physician most seriously injured in the incident, bitterly contested the report. She complained that it was issued before all the facts surrounding the event have been analyzed. Gorchynski faces possible permanent bone damage to her knees that she blames on exposure to the fumes.

But epidemiology experts said that despite questions still surrounding an unidentified chemical discovered before the autopsy, they could find no culprit to explain the bizarre episode that sent six emergency room workers to hospitals after being exposed to patient Gloria Ramirez.

Friday’s report was the last, full-scale study by local and state agencies that have attempted to explain what happened Feb. 19. Each one was inconclusive.

According to the state’s 15-page report, 11 people reported smelling an unusual odor after blood was drawn from Ramirez. After five collapsed and the emergency room was evacuated, a total of 23 people complained of at least one symptom--most commonly headache, dizziness and nausea, the state report said. More serious complaints included muscle spasms and breathing disruptions.

“Despite extensive epidemiologic, toxicologic and environmental investigations, the cause of the outbreak of symptoms among (emergency room) staff members . . . remains unknown,” the report concluded.

The Department of Health Services study was based on previously released scientific investigations and interviews with hospital staff.

“The findings from our and other investigations are most compatible with an outbreak of mass sociogenic illness, perhaps triggered by an odor,” state doctors said.

The report defined mass sociogenic illness as “the occurrence in a group of people of physical symptoms suggesting an organic illnesses but resulting from anxiety or other psychological stresses.”

The report was shared by state officials with the Riverside County hospital personnel who were affected by the incident, and reaction among them was mixed.

Gorchynski said she was “frustrated and angry because the health department’s report is bull----. They’ve come up with conclusions based on only partial data.

“They didn’t refer to my medical records, or the toxicology report from the coroner’s office or wait until the final analysis” of a still-unidentified chemical was complete, Gorchynski said.

Maureen Welch, a respiratory therapist who was hospitalized nearly a week after the incident and who has filed a $3-million injury claim against the county, was more resigned.

“We’re dissatisfied and disappointed,” she said. “Something happened that night. We all know that. It absolutely was not sociogenic. But mysteries in medicine occur, and this may just be something we have to accept. Maybe there’s no one in this world who can figure this out.”

Dr. Bradley Gilbert, the Riverside County public health officer, praised the study. But “it’s frustrating to realize that we may never know what actually happened,” he said.

Echoing a report by Cal/OSHA, the Department of Health Services report said an unidentified, nitrogen-based chemical was detected later inside the coroner’s bag containing Ramirez’s body. The mystery chemical’s presence was intriguing but its significance in the outbreak of symptoms remains unknown, Osorio said.

Scientists at the Lawrence Livermore Laboratory forensic science center are still trying to identify the compound and if they succeed, she said, the state’s report will be appended.

Dr. Christopher Jobe of Loma Linda University Medical Center, who is treating Gorchynski’s knee problem, said Gorchynski was disabled by something other than mass hysteria. She has filed a $6-million claim against the county.

“She had too many things go wrong with her to make it hysterical--bone necrosis, elevated liver and pancreatic enzymes, gastritis, hepatitis and unexplained crystals in her own blood that were seen by a doctor and a nurse at a different hospital,” he said.

“I’m not sure we will know the answer, but we know that something organic happened,” he said. “Besides, these are E.R. people--adrenaline junkies who wouldn’t react hysterically. They’re the wrong personality type.”