On the night of March 4, 1984, Libby Zion, an 18-year-old college student suffering from a high fever and an earache, was brought to New York Hospital by her parents. After eight hours, she was dead.
Ten years of bitter litigation later, there is still no clear explanation for what killed the apparently healthy teen-ager. It does seem clear that, like many patients who enter a hospital in the middle of the night, Libby was treated by a series of busy doctors, none of whom had much time to focus on her condition.
One thing seems even more certain: Of all the patients who have come through its doors, the hospital could not have picked a worse one to lose inexplicably than Libby Zion.
Her death touched off a decade-long battle that has produced sweeping changes in the working conditions of doctors in New York City hospitals. The civil suit brought by her family against New York Hospital is only now reaching a conclusion in a Manhattan courtroom.
Leading the charge is Libby's father, Sidney, now a New York Daily News columnist. He has pursued the case with the zeal of a grieving father and the skills of a veteran journalist with a lifetime of experience in spinning the media.
Zion accuses the hospital and the physicians who treated his daughter of what amounts to medical murder. He refers to Libby's death as an execution and was outraged when a Manhattan grand jury that probed her death failed to return criminal indictments.
The defense has been equally ferocious. Lawyers for the hospital contend that cocaine killed Libby, and that she concealed her use of the drug from the physicians who treated her. Private details of her emotional problems have been read into the record of a trial beamed across the nation on Court TV.
Libby, a bright and creative young woman who hoped to grow up and make a name for herself, is famous indeed these days. An entire generation of New York journalists has heard the story of her death from her father, who, friends say, still breaks into tears when he thinks about his daughter.
Hospital administrators must now schedule their interns and residents under the "Zion" rules. And every member of the New York health community knows her as a physician's nightmare--the patient who suddenly goes "sour" for no clear reason, sending her care-givers into an eternity of career-threatening litigation.
At the center of this medical and legal storm is Sidney Zion, a pink-skinned, balding, bespectacled father of three. This mild-looking man in a conservative gray suit from J. Press can be seen nervously crossing and uncrossing his legs while sipping mineral water from a plastic bottle in the courtroom where Zion vs. New York Hospital is being tried.
But appearances can be deceiving, as the powers-that-be at New York Hospital have discovered. Zion, 61, is a hard-drinking, cigar-smoking novelist, lawyer, journalist, former prosecutor, confidant of the late Roy Cohn, and friend to those in high and low places.
Zion was born in Passaic, N.J., the son of a dentist. His harsh New Jersey accent withstood an Ivy League education at the University of Pennsylvania and the Yale Law School.
After a stint as a federal prosecutor in New Jersey, he turned to journalism. In the years before Libby's death, he worked for the New York Post, the New York Times and New York Magazine; now, for the Daily News. He is the author of an autobiographical novel called "Markers" and "The Autobiography of Roy Cohn," the memoirs of the notorious aide to Sen. Joe McCarthy.
He is a man driven by passions large and small that include a deep love of Israel ("Sidney has never gotten around to worrying about Gentiles," says a longtime friend) and unflagging devotion to the New York Giants. He rails against "Smoke Nazis" (those who would restrict smoking in public places) and Israel's "sellout" to the PLO.
But the crusade of Zion's life began with a phone call from his son on the night of March 4, 1984.
Libby, a student at Bennington College in Vermont, was in bed at the family's apartment on the Upper West Side. She was sick with a high fever. Zion's son said Libby was looking terrible.
Zion and his wife, Elsa, left a dinner party and rushed back to the apartment, where they discovered their son had not been exaggerating. Libby was "burning up" with a fever. She was also extremely agitated, a condition the hospital would later argue was consistent with a cocaine reaction.
While Elsa frantically searched for a thermometer, Sidney phoned the family physician, Dr. Raymond Sherman, who advised him to take Libby to New York Hospital.
They arrived about 11:30 p.m. Libby was admitted by a young intern named Dr. Maurice Leonard. She had a temperature of 103.5 and a rapid pulse and respiration. According to Leonard, Libby said she was using a drug called Nardil, an anti-depressant. (The hospital says Libby failed to tell doctors about other drugs she was using.)
About an hour later, Libby was examined by Dr. Gregg Stone, a resident. According to Stone, Libby denied using any illegal drugs and said she had not taken any Nardil for several days. Libby was thrashing about in bed, and Stone prescribed a small dose of Demerol to calm her.
While Stone was examining Libby, Dr. Luise Weinstein arrived on the scene. She would have the principal responsibility for Libby's care. She said she looked up Nardil in a standard reference book, but failed to see a warning against giving Demerol to a patient who was using Nardil. (The two drugs together can cause a fatal reaction in some cases.)
Both physicians were puzzled by the cause of Libby's illness, and ordered a battery of tests. Both doctors had also been on duty for about 17 hours when they began treating Libby, a fact that was to become a major issue in the case.
While Libby was being treated, her parents watched and waited. About 3 a.m., according to Sidney and Elsa Zion, Stone told them it would be better if they went home because their presence might be contributing to Libby's agitation.
"They want us to go now, and you will be OK. You sleep well, and we will see you and pick you up in the morning," Sidney testified he told his daughter. "So she said, in Jewish, 'Sleep well,' shloft gezunt, and that is the last word I ever heard from my girl."
In his testimony, Stone denied asking the Zions to leave. In any case, Sidney and Elsa returned home reasonably confident that their daughter would be well.
But that is not what happened. The Demerol was administered at 3:37 a.m. About 45 minutes later, Libby showed increased signs of agitation. A nurse found her trying to climb over the railing of her bed.
Libby was placed in a straitjacket, and later her wrists and ankles were tied to the bed. Weinstein ordered a sedative but did not come to see her patient. Libby's condition appeared to stabilize for several hours, but when her temperature was taken at 6:30 a.m., it had shot up to 108. Emergency measures failed to reverse the situation. Libby Zion died about 7:45 a.m.
In her testimony, Elsa Zion recalled receiving an early morning telephone call from Weinstein.
"She said, 'I'm sorry, but we tried everything. We gave her everything, we gave her (an) ice bath,' and her voice sort of trailed off. And I said, 'Are you trying to tell me that Libby's dead?' And she said, 'Yes.' And I said, 'I don't believe you,' and I hung up."
An autopsy report concluded that Libby died of pneumonia, a finding that shed little light on how she so swiftly lost her life. In the weeks, months and years that followed, Sidney Zion went to war with New York Hospital and the physicians who treated his daughter.
He took his case to the press in a way that only a very determined and well-connected journalist can do. He pressed for a criminal probe of his daughter's death and was rewarded when Manhattan Dist. Atty. Robert Morgenthau took the unusual step of conducting a grand jury investigation.
In January, 1987, the grand jury issued a report that cited a number of errors in the care of the patient, including the fact that she was given Demerol, was not placed in intensive care, and was not seen by a physician for a four-hour period. The report also implied that Weinstein and Stone were exhausted by the time they began treating Libby. The grand jury, however, returned no criminal indictments.
The hospital responded to the grand jury report by issuing a press release that claimed cocaine "in whole, or in part" was responsible for Libby's death. The hospital's assertion was based on a cotton swab of her nose, which revealed a trace of cocaine. There was no evidence of cocaine in her blood, according to the autopsy. And whatever cloud the Zion grand jury left on New York Hospital's stellar reputation was expanded a month later when another patient, artist Andy Warhol, died suddenly after routine gallbladder surgery.
Weinstein and Stone, whose hitherto promising careers had been overshadowed by the Zion case, were charged with negligence and incompetence by the New York State Health Department. The lengthy hearings left Weinstein in particular "looking tortured by the shame of even being there," according to a published report at the time. But in the end, a three-member panel recommended that the charges be dropped.
Sidney Zion, who wanted to see the people connected with his daughter's death behind bars, was bitterly disappointed but far from through.
The family had filed a civil suit, naming the hospital and four physicians, and asking for punitive damages. The suit has followed a tortured path through the court system, further delayed because Zion's lawyer was disbarred for reasons unrelated to the case.
Progress proved much swifter, however, in the one area in which Libby's death had a positive effect. Thanks to Zion's long and well-publicized howl of grief, the state reformed the way young hospital doctors are scheduled to work.
Pre-Zion, the interns and residents who provide much of the patient care frequently were on duty 100 to 120 hours per week in 36-hour shifts, with only a few hours of sleep between shifts. In some cases, they worked for weeks at a time without a full day off.
"Many physicians regard their residency as a little like being in combat. They love to swap old war stories," said a doctor who runs a New York emergency room. "But the fact of the matter is, you don't make good decisions after 26 or 27 straight hours on the job."
The Zion case changed all that. New regulations require that resident physicians work no more than 80 hours a week and no more than 24 hours at a time. The doctors must also receive at least eight hours off between shifts and at least one full day off per week.
Consumer advocates claim that many city hospitals are still skirting or violating these regulations. Nevertheless, there is widespread agreement that the new regulations have improved the lot of young doctors and the patients they treat.
In Southern California, interns and residents routinely work 80 to 90 hours a week, including a 36-hour shift every fourth night or so, said Dr. Michael Wilkes, professor of medicine at UCLA.
"New York programs became so attractive that other places had to change to be competitive" at retaining the top medical students, he said. "But the Zion case was not so much about the hours worked as the fact that interns need to be supervised. Unfortunately, that idea hasn't swept the country."
Zion vs. New York Hospital is now nearing an end in state Supreme Court. The charges and countercharges have changed little over the past 10 years.
The Zion family contends that the combination of Nardil and Demerol killed Libby. The defense claims that Libby received proper care and died because she never informed doctors that she was a cocaine user. The defense also has denied that the doctors who treated her were exhausted, and that the long hours they worked diminished the care Libby received.
Both sides have rolled out experts to support their arguments. Nothing has been held back. Lawyers for the hospital read into the record portions of a deposition from Dr. Kenneth Greenspan, a psychiatrist who saw Libby a few months before her death. According to the deposition, Libby suffered from depression and a depersonalization syndrome in which she felt as if her body were floating freely in space. The deposition also says she thought seriously about suicide, frequently smoked marijuana and was tormented by nightmares.
Sidney Zion, who has been banned from talking to the press about the case, could respond with his vision of Libby's life only when called to testify.
"I was crazy about her--what can I tell you--the way I suppose you are about daughters," he told the jurors. "She had red hair and she had great-looking red hair. And she was--well, I can't say much more to you without rhapsodizing a little too much."
* Times health writer Shari Roan contributed to this story.