Judge Says She Cannot Pull the Plug : Medicine: A 75-year-old patient has been in a near-fetal position for seven years.

Correan Salter presents a dilemma for her doctors, lawyers, relatives, nursing home and the courts: When should she die? A state judge in Alabama ruled not now.

The 75-year-old woman--bedridden in a near-fetal position for seven years since she suffered a massive stroke--cannot speak or move. In court, kinfolks, doctors and lawyers have spoken for her.

But they didn’t offer Baldwin County Circuit Judge Pamela Baschab enough evidence to remove the feeding tube that’s kept Salter alive in a nursing home.

“It’s a good thing we can put people on feeding tubes. It’s a bad thing people make such a big deal about taking people off one,” said Gregory E. Pence, a professor of medical ethics at the University of Alabama at Birmingham.

Pence worked as an unpaid consultant on Salter’s case. “It’s absolutely atrocious that she’s been in this state for seven years,” Pence said the day after the ruling.

Pence said a state law that doesn’t give decision-making power to someone else when a patient is rendered incompetent has contributed to the dilemma facing Salter’s family.

Salter’s sister and guardian, Hortense Thompson of Ft. Worth, Tex., made a tearful appeal to the court for removal of the feeding tube. In testimony in December, Thompson said her sister “has a right to be with God.”

Doctors testified that, with her present care, Salter could live to be 100.

In a three-page ruling, the judge said she was very sympathetic toward the family who had made a “heartfelt” request. But she said she had to base her decision strictly on Alabama’s Natural Death Act and existing public policy that supports the preservation of life.

The New England Journal of Medicine estimates that between 10,000 and 25,000 adults and between 4,000 and 10,000 children nationwide last year were in a similar condition as Salter.

The cost of care was never an issue before the court. The estimated cost for a feeding-tube patient is $24,000 to $120,000 a year, according to experts.

An attorney for Salter’s relatives, Beatty Pearson, said he will appeal Baschab’s ruling, putting the case on track for a higher court ruling that could establish clear legal guidelines in such right-to-die cases in Alabama.

Richard Brockman, an attorney for the Alabama Nursing Home Assn., which had intervened in the Salter case, said the ruling--if upheld on appeal--could leave physicians “in a quandary.”

“It was our position that the Alabama Natural Death Act was sufficient to allow her (the judge) to rule that the feeding tube could be removed under certain circumstances,” Brockman said.

Brockman said a Jefferson County judge in 1991 ruled that a feeding tube could be removed from a woman in a nursing home near Birmingham, but she died before the ruling could be implemented.

Removal of Salter’s tube would cause starvation in a matter of weeks, according to testimony.

“The evidence was inconclusive as to whether this type death would be painful for her either physically, emotionally or mentally,” the judge said.

Ronald E. Cranford, a Minnesota neurologist and expert witness in such cases who testified at the Salter hearing, said refusal to order the tube removed could make doctors reluctant to order one inserted. He called Baschab’s order “frightening.”

If it’s upheld, Cranford said, “It means people in Alabama, before they become incompetent, will have to tell you what kind of treatment they want.”

Cranford and several other doctors testified that Salter’s condition is irreversible, saying she will remain in her cramped position until death.

According to testimony, Salter’s eyes are open when she’s awake and she seems to watch people moving around in her room. But doctors said they had no way of knowing how aware she is, since she’s unable to communicate in any way.

To attorneys’ arguments that Salter’s “quality of life” was destroyed by the stroke, the judge said quality-of-life arguments “can never be conclusive.”

Baschab said such arguments may raise federal issues of equal protection under the U.S. Constitution and may even raise concerns under the Americans With Disabilities Act.

Alabama law includes a living will statute giving a person the right to withhold life-support equipment. Although there was testimony that Salter had made a living will, no such document could be found.