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Fumes case follows county

10 YEARS AGO: The night Gloria Ramirez died lives on - for her family, and for Riverside.

11:46 PM PST on Sunday, February 22, 2004

By DOUGLAS E. BEEMAN / The Press-Enterprise


Ten years ago, an ailing young mother was wheeled into the emergency room at the old Riverside General Hospital and quickly made international headlines.

As doctors and nurses labored to save the life of Gloria Ramirez, fumes overwhelmed them. Some got sick. Others passed out. Ramirez died that night, her body left behind as the emergency room emptied its patients and staff into the wintry night air.

"It was very, very chaotic," recalled Joan Breeding Letbetter, a Riverside fire department spokeswoman who was there. No one knew what caused the fumes. Doctors and nurses who normally treat victims were themselves victims, Letbetter said. "It made it a very unreal experience."

Silvia Flores / The Press-Enterprise
Evelyn Arciniega, 22, with a photo of her mother, Gloria Ramirez. This week is the 10-year anniversary of Ramirez's mysterious death in the emergency room at Riverside General Hospital.

And to this day, the source of the fumes remains a mystery. But the case has not faded from memory.

Ramirez's children plan to put a headstone, with her picture, at her grave in Riverside's Olivewood Cemetery.

Her emergency room physician now works at UC Irvine Medical Center. The physician, Julie Gorchynski, hobbled by knee pain, embittered by 20 knee surgeries in the past decade, remains determined that her experience should benefit the emergency room doctors she trains.

Ramirez, 31, suffered from ovarian cancer when an ambulance crew brought her to the hospital with chest pains. She died that night of kidney failure brought on by the cancer, the coroner's office later concluded.

Her death has had an impact beyond the death of one woman, the emotional drain on her family and the lasting medical problems of the health workers who tried to save her life.

The case prompted Riverside fire officials to rethink how they handle hazardous materials cases. And it underscored the need for a new coroner's facility, where autopsies could be performed without jeopardizing the health of those performing the work.

The coroner's office has since abandoned its old Riverside quarters, where her autopsy was performed amid yards of plastic sheeting and space-age protective suits. The coroner's department, much criticized for the handling of the Ramirez case, is now under the wing of the Riverside County Sheriff's Department and works from new quarters in Perris.

The hospital where Ramirez was treated is now gone, bulldozed to make way for a shopping complex. A new county hospital with a new name, Riverside County Regional Medical Center, opened in Moreno Valley four years after her death.

Dr. Tim Nesper, the hospital's emergency department director, said many things have changed since the Ramirez case. The hospital has a large decontamination center outside its emergency department, and it now has trained its staff in how to better handle patients contaminated with chemicals.

Still, the emergency room will never be completely risk-free for those who work there, Nesper said. In the months following her death, several theories emerged to explain the source of the fumes, including that Ramirez drank a pesticide in a suicide attempt; that she used a solvent as a home cancer remedy; and that the hospital's plumbing emitted a noxious gas. A Los Angeles alternative weekly even suggested that a secret methamphetamine lab operated in the hospital and that Ramirez was inadvertently given the drug in a bag of intravenous fluids. County officials vehemently denied the theory.

Maggie R. Garcia still firmly believes her sister was not the source of the mysterious ammonia-like fumes that sickened so many. No one in the ambulance that brought Ramirez to the hospital fell ill, she said.

"I've always believed the source of fumes was within the hospital," Garcia said.

"The situation was a fluke and it was unexplainable," said Mary Dilley, the county's risk manager. "That is the mystery and it probably will remain a mystery forever and ever."

The family sued the county for medical malpractice and for general damages stemming from the coroner's autopsy. The cases eventually were settled for $800,000, without the county admitting any wrongdoing.

Much of that money went to buy annuities for Ramirez' two children, Evelyn Arciniega, now 22, and Buddy Angel Arciniega, now 19. Evelyn is now a student at Riverside Community College. Buddy is serving a 12-year sentence for voluntary manslaughter.

But Dr. Gorchynski, who treated Ramirez, ended up with little more than long hospital stays, 20 knee surgeries and debilitating pain that prevents her from working more than three days at a time. Whatever the source, the fumes apparently triggered a bone-killing disease in her knees. Gorchynski expects some day to need and get prosthetic knees.

Gorchynski sued the county, but lost. The county sought legal expenses from her. Gorchynski said she had to pay the county $40,000 in costs. County spokesman Raymond Smith said the figure was $15,000.

"Surfing was my only stress reliever. Now I can't surf because of my bone disease," she said by phone.

Gorchynski now is an emergency room physician at UC Irvine Medical Center, treating patients and training new physicians. She believes her experience as a patient - she spent a month in intensive care - has made her more sensitive to the fears and needs of patients. Gorchynski now makes time to talk first with her patients to explain what's happening. She insists that her residents do the same.

Her nightmares have faded, but Gorchynski worries that another case could occur. Gorchynski is still unsure whether the fumes came from Gloria Ramirez or the hospital.

Whatever the source of the fumes, Gorchynski believes emergency room workers remain at risk.

"It'll happen again. It's just a matter of time," she said.


After Airtight Autopsy, Mystery Lingers in Case of Hospital Fumes

Published: Saturday, February 26, 1994

Clad in airtight safety suits and working inside a specially sealed room, a team of Riverside County pathologists conducted an autopsy early today on a woman whose body apparently discharged a potent toxic chemical as she died on a hospital gurney.

The pathologists completed the procedure without mishap, emerging from the sealed chamber into a cleansing spray of solutions.

County officials said the team found nothing that provided an immediate clue to the bizarre mystery cloaking the incident, which began Saturday night when six emergency room workers were felled, apparently by fumes from the woman's body. A doctor and a nurse were hospitalized.

The chief county coroner, Scotty Hill, said that tissue and fluid samples taken in the 90-minute autopsy on the woman, Gloria Ramirez, would be analyzed and the results made public "as quickly as they can be obtained."

Other county officials said the analysis might take a week or more. And they warned that even then there might be no definitive answer to the mystery.

Tom DeSantis, the Riverside County spokesman, said that investigators were looking into the possibility, considered remote, that whatever affected the medical staff came from some other source within the emergency room at the hospital, Riverside General.

Ms. Ramirez, a 31-year-old Riverside resident, suffered from cervical cancer and died in the emergency room last Saturday after complaining of stomach and chest pains. Doctors said she went into cardiac arrest shortly before her death. But they have not ruled out the possibility that a major contributing cause of death may have been something she ingested at home.

Some emergency room personnel reported that her body gave off an ammonia-like smell and took on an oily sheen. Advanced Case of Cancer

Near the moment Ms. Ramirez died, six emergency room workers collapsed, including the two who were hospitalized, Dr. Julie Gorchynski and Sally Balderas, a nurse. Ms. Balderas has improved, but Dr. Gorchynski periodically has difficulty breathing.

Ms. Ramirez, a divorced mother with a 9-year-old son and a 12-year-old daughter, had an advanced case of cervical cancer. Medical officials said she was not taking any anti-cancer drugs and had not undergone chemotherapy. A search of her home turned up no poisons, toxic chemicals or other suspect substances.

Today's autopsy was conducted in pre-dawn darkness because of repeated delays in preparing the special examining room. The room was sealed with sheets of clear plastic, and an exhaust fan constantly sucked out air, filtering it through layers of charcoal before venting it into the chilly desert night.

While pathologists worked in pairs, breathing oxygen pumped through hoses, rescue personnel in safety suits monitored their progress on closed-circuit television, ready to rush to their aid if necessary. The job was completed without incident at 2:35 A.M.

The pathologists were checked by doctors and put under observation for half a day. All the pathologists were fine, the doctors reported.

Ms. Ramirez's body, sealed at the end of the autopsy in a body bag and an airtight coffin, was returned to the coroner's cold-storage room. County officials said it would remain there pending the outcome of the autopsy.



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