” THE TOXIC LADY ” – Gloria Ramirez

sources :    wikipedia.com            web.archive.org

                                                     Gloria   Ramirez

Gloria Ramirez (January 11, 1963 – February 19, 1994) was a Riverside, California, woman dubbed “the toxic lady” by the media when several Riverside General Hospital workers became ill after exposure to her body and blood.

*        About 8:15 in the evening on February 19, 1994, Ramirez was brought into the emergency room of Riverside General Hospital by paramedics, suffering from the effects of advanced cervical cancer. She was extremely confused, and suffering from bradycardia and Cheyne-Stokes respiration.

*        The medical staff injected her with Valium, Versed, and Ativan to sedate her, and agents such as lidocaine to stimulate her heartbeat. When it became clear that Ramirez was responding poorly to treatment, the staff tried to defibrillate her heart; at that point several people saw an oily sheen covering Ramirez’s body, and some noticed a fruity, garlic-like odor that they thought was coming from her mouth. A registered nurse named Susan Kane attempted to draw blood from Ramirez’s arm, and noticed an ammonia like smell coming from the tube.
She passed the syringe to Julie Gorchynski, a medical resident who noticed manila-colored particles floating in the blood. At this point, Kane fainted and was removed from the room. Shortly thereafter, Dr. Gorchynski began to feel nauseated. Complaining that she was light-headed, she left the trauma room and sat at a nurse’s desk. A staff member asked her if she was okay, but before she could respond she also fainted. Maureen Welch, a respiratory therapist who was assisting in the trauma room was the third to pass out. The staff was then ordered to evacuate all emergency room patients to the parking lot outside the hospital. A skeleton crew stayed behind to stabilize Ramirez. At 8:50pm, after 45 minutes of CPR and defibrillation, Ramirez was pronounced dead from kidney failure related to her cancer.

*        The county health department called in California’s Department of Health and Human Services, which put two scientists on the case, Doctors Ana Maria Osorio and Kirsten Waller. They interviewed 34 hospital staff who had been working in the emergency room on February 19. Using a standardized questionnaire, Osorio and Waller found that the people who had developed severe symptoms such as loss of consciousness, shortness of breath, and muscle spasms tended to have certain things in common. People who had worked within two feet of Ramirez and had handled her intravenous lines had been at high risk. But other factors that correlated with severe symptoms didn’t seem to match a scenario in which fumes had been released: the survey found that those afflicted tended to be women rather than men, and they all had normal blood tests after the exposure.

*       Dr. Gorchynski denied that she had been affected by mass hysteria, and pointed to her own medical history as evidence. After the exposure, she spent two weeks in the intensive care unit with breathing problems, she developed hepatitis and avascular necrosis in her knees. Eager to clear her name and win her lawsuit against General Hospital in Riverside, she and RN Susan Kane contacted Livermore Laboratories for a second opinion.
Livermore Labs postulated that Ramirez had been using dimethyl sulfoxide (DMSO), a solvent, as a home remedy for pain. Users of this substance report that it has a garlic-like taste. The Livermore scientists theorized that the DMSO in Ramirez’s system might have built up, due to urinary blockage. Oxygen administered by the paramedics would have combined with the DMSO to form dimethyl sulfone (DMSO2). DMSO2 is known to crystallize at room temperature, and crystals were observed in some of Ramirez’s drawn blood. Electric shocks administered during emergency defibrillation could have then converted the DMSO2 into dimethyl sulfate (DMSO4), a powerful poisonous gas, exposure to which could have caused the reported symptoms of the emergency room staff.

*        Two months after Ramirez died, her badly decomposed body was released for an independent autopsy and burial. The Riverside Coroner’s Office hailed Livermore’s DMSO conclusion as the probable cause of the hospital workers’ symptoms, while her family disagreed. The Ramirez family’s pathologist was unable to determine a cause of death because her heart was missing, her other organs were cross-contaminated with fecal matter, and her body was too badly decomposed. Ten weeks after she died, Ramirez was buried in an unmarked grave at Olivewood Memorial Park in Riverside.
The possible chemical explanation for this incident by Dr. Patrick M. Grant of the Livermore Forensic Science Center is beginning to appear in basic forensic science textbooks. In Houck and Siegel’s textbook, the authors opine that, although some weaknesses exist, the postulated scenario is “the most scientific explanation to date” and that “beyond this theory, no credible explanation has ever been offered for the strange case of Gloria Ramirez.”

*         Everything that Grant ever speculated or concluded about this incident was evaluated by professional forensic scientists, chemists, and toxicologists, passed peer-review in an accredited, refereed journal, and was published by Forensic Science International. The first paper was very technically detailed and did, in fact, give two potential chemical reaction mechanisms that may possibly have formed dimethyl sulfate from dimethyl sulfoxide and dimethyl sulfone precursors. The second communication gave supplemental support for the postulated chemical scenario, as well as insight into some of the sociology and vested interests inherent in the case.

*       One of the letters proposed the production of toxic chloramine gas due to urine mixing with bleach in a nearby sink. This hypothesis, previously proposed to the investigators and to the medical personnel involved in the incident, was apparently never considered by all involved. The noxious effects of this gas are documented in the New England Journal of Medicine, Vol.341:848–849, Sept. 9, 1999, “Severe Lung Injury after Exposure to Chloramine Gas from Household Cleaners”. In reality, Grant addressed this chloramine scenario in Ref. 8, and it did not come close to fitting the ER incident.

 

ANATOMY  OF  THE  ” FUMING WOMAN “

New Times Los Angeles Published: 05/15/97

The Riverside coroner’s office treated Gloria Ramirez’s body like a toxic-waste dump after mysterious vapors felled a hospital er team. But the fumes probably came from a hidden drug lab.

 

”    On a winter afternoon in downtown Riverside three years ago, preparations were under way for one of the most elaborate autopsies ever conducted in U.S. history. No one was sure what pathologists would find when they opened up Gloria Ramirez’s body, but they were ready for the worst.
Six days earlier, as Ramirez was being treated at Riverside General Hospital for nausea and difficulty breathing, six emergency-room workers attending to her smelled ammonialike fumes and became ill. A nurse who had been drawing Ramirez’s blood passed out. An ER doctor was wheeled out of the room unconscious and with severe breathing problems. A respiratory therapist also passed out; another nurse threw up. Other workers near Ramirez complained of headache and nausea. An evacuation of the ER was ordered.
Ramirez, a young mother with advanced cervical cancer, died in the emergency room that night–February 19, 1994. Inspectors from California’s worker-safety agency deemed her corpse a public health hazard; it was wrapped in two layers of heavy plastic and stored in an airtight aluminum casket.
The story of the “fuming woman” of Riverside–about 50 miles east of downtown L.A.–grabbed headlines around the world. Astonished hospital officials had no explanation for the fumes. Intrigued newspaper and TV reporters poured in from around the country, drawn by what they dubbed “the medical mystery of the century.”
Health officials weren’t taking any chances when it came time to autopsy Ramirez’s body. With the help of experts from Cal/OSHA, the state worker-protection agency, elaborate steps were taken to shield the pathologist and his crew from whatever strange chemicals might be lurking in the corpse.

Inside the ivy-covered Riverside County Coroner’s Office, a special chamber was constructed so the four men dealing with the body would be sealed off from the rest of the world. They would wear Level A protective suits–spacesuitlike gear normally used by specialists cleaning up toxic spills. Oxygen would be pumped to the autopsy workers through umbilical cords. In the event the main oxygen supply failed, they had emergency air canisters tucked inside their suits.
Outside the chamber, four members of Riverside County’s hazardous-materials team watched the autopsy via video monitor. They too wore protective suits and were assigned to rescue those inside if problems arose. Three fire trucks were nearby, their crews ready to leap into action.
The scene was like something out of a science-fiction movie, and the mood was tense. More than 50 reporters had gathered for the spectacle. During a media briefing in the basement of the coroner’s office, a reporter shouted to county officials, “What are you afraid of?” Chief Deputy Coroner Dan Cupido yelled back, “The unknown.” As darkness fell, reporters and camera crews were herded behind a cordon of yellow police tape across the street from the coroner’s office. They waited anxiously, notebooks in hand, for the autopsy to begin.
Inside the office, Charles Cox, a Cal/OSHA district manager, and Tom Kranjcevich, a Cal/OSHA inspector, looked over the autopsy chamber and emergency standby equipment, checking that everything was in order. They had helped design the autopsy plan and had carefully gone over it with coroner’s officials a few days earlier. It was their job to ensure that the people who entered the chamber were protected as well as possible, and by law, the autopsy couldn’t start until they gave the go-ahead.
But shortly before it was supposed to begin, Riverside County Coroner Scotty Hill ordered the Cal/OSHA men to leave. Cox and Kranjcevich protested, saying they were there in compliance with state law and the autopsy couldn’t move forward without their OK.
Their protests made no difference. At Hill’s request, a Riverside police sergeant escorted Cox and Kranjcevich off the property.
It was at that moment, recalls Cox–a 12-year Cal/OSHA veteran–that everything about the Ramirez case seemed to change. “I had never encountered such hostility in all my years with Cal/OSHA,” he says. “As we were being led off the property by the police sergeant, I had the feeling that something very serious had occurred at that hospital, and the coroner knew what it was. They wanted us out of there because they were afraid we might find out what really happened at the hospital that night.”

Just  what  did  happen  at  Riverside  General

Government officials insist the mystery fumes came from Ramirez’s body and apparently were released into the air when her blood was drawn. But a three-month New Times investigation has concluded that the fumes probably came instead from chemicals used to make the drug methamphetamine, and that someone in the hospital may have been illegally manufacturing it or a component of it near the time of Ramirez’s death. The probe found that meth chemicals may have been smuggled out of the hospital in IV bags and that one such bag may have been accidentally injected into Ramirez. The investigation–which included more than 30 interviews and a review of thousands of pages of government documents and legal papers–also shows that crucial evidence disappeared in the wake of a medical fiasco that could cost the county millions of dollars in damages.
Paramedics barged through the doors at Riverside General and wheeled Ramirez to a trauma bay in the emergency room about 8:15 p.m. on February 19, 1994. Earlier that evening, the 31-year-old mother of two had been vomiting and having trouble breathing. In the ambulance on the way to the hospital, paramedics had inserted an intravenous line in Ramirez, spilling some of her blood in the process, according to testimony they gave in a lawsuit the Ramirez family has filed against the county and others. But the paramedics said they hadn’t noticed any strange odors coming from Ramirez. When they arrived at the hospital, she was alert and talking.

Emergency-room doctors and nurses quickly gave Ramirez drugs to sedate her and smooth out her irregular heartbeat. But when nurse Susan Kane started a second IV line in the patient, strange things began happening in the ER.
Standard protocol when administering IV medications is to squeeze some fluid out of the IV tubing to clear it of air bubbles, which could prove fatal to a patient. Kane inserted an IV needle into Ramirez’s right arm. Then, using a separate needle, she drew a blood sample from near the IV site. As she did so, she began to smell something odd.

“Who popped the ammonia?” Kane asked, according to a deposition she gave in the Ramirez lawsuit. Prior to starting the IV, Kane said, she had not noticed any unusual odors, even though Ramirez’s veins had already been punctured in the ambulance.
Kane handed the syringe with Ramirez’s blood to Julie Gorchynski, an ER resident, and bent down to smell the IV site. Kane then stood up and fainted. Someone yelled, “Catch her!” Humberto Ochoa, the doctor in charge of the emergency room, lunged forward and eased Kane to the floor.
Gorchynski then sniffed the syringe and began feeling queasy. She started to leave the trauma bay but passed out on the way. She was having difficulty breathing, and her body was shaking. She was the second ER staffer to be wheeled away on a gurney.
Meanwhile, respiratory therapist Maureen Welch, who also smelled the syringe and noted an ammonialike odor, began to feel faint. She passed out too. When she regained consciousness, her arms and legs were jerking uncontrollably. Another nurse, Sally Balderas, began vomiting and complaining of a burning sensation. She also was placed on a gurney and rolled out into the parking lot.

Several others in the ER complained of feeling ill and smelling ammonia like odors. With the ER near chaos, Ochoa ordered an evacuation, and someone dialed 911.
Patients were taken to the parking lot while a skeleton crew stayed inside, trying to save Ramirez’s life. A short while later, the Riverside Fire Department responded and ordered those remaining in the ER to get out. About 8:50 p.m., Ochoa pronounced Ramirez dead. It is unclear from medical records whether she died before or after the full ER evacuation.
At least 15 people later told investigators they detected a strange smell in the ER that night. Of the 12 sickened by the odor, most complained of dizziness, nausea, headache, and difficulty breathing. Most ER staffers said the fumes had an ammonia odor, while others described it as “gaslike” or having a chemical smell.
Six ER workers were later admitted to nearby hospitals. Gorchynski, the sickest, lay in an intensive care unit for two weeks, breathing with the aid of a respirator. Ochoa had no symptoms.

Although officials never pursued the theory that the fumes came from an illicit methamphetamine lab in the hospital, the smells and symptoms experienced by the ER staff uncannily match those associated with exposure to meth fumes.

“Those smells and symptoms are classic to meth-fume exposure,” says Tom Netwal, a forensic chemist who analyzes drug-lab materials for the Colorado Bureau of Investigation. “All that would be consistent with a drug laboratory.”
Almost immediately after Ramirez’s death, crucial evidence began disappearing.
The syringe used to draw her blood couldn’t be found. After dodging questions over its whereabouts for several weeks, Riverside County spokesman Tom DeSantis finally confirmed it was missing. He told reporters it did not occur to the Fire Department to retrieve it the night of February 19.
But nurse Sally Jo McCorkle, the last person to handle the syringe that night, said in sworn testimony in the Ramirez lawsuit that the Fire Department’s hazardous-materials specialists did inquire about the needle. McCorkle said she was asked by both the HAZMAT crew and her supervisor where, exactly, she had disposed of the syringe and how they could find it.

The blood taken from Ramirez at the hospital before she died also disappeared, according to notes obtained by New Times that were written by Tom Hanley, Southern California regional manager for Cal/OSHA.
Meanwhile, Ramirez’s IV bag, another possible source of the fumes, was sent to the U.S. Food and Drug Administration for testing, according to Riverside Chief Deputy Coroner Cupido. But Cupido recently acknowledged in a deposition that he never bothered to follow up with the FDA, failing to call and find out whether the bag had indeed been tested. (An FDA spokeswoman refused to confirm whether her agency received or tested the bag.)

Other materials–IV tubing, towels, bedding, and clothing worn by the ER staff–were packed into barrels and sent to a desert waste facility, where they baked in the sun for the next several months, according to a deposition by Kent Livingston, the county’s risk manager. No tests were performed on the materials.
Livingston said that when he went to the desert dump to look over the evidence four months after Ramirez died, he discovered that none of it had been tagged and that nearly all of it was spoiled.
“There were no labels on any of the items in there,” he said. “It was as though they had collected up bags, red bags filled with items, thrown them in a barrel, sealed the barrel and shipped it….I can honestly say that everything I saw out there is useless except for a couple of items.”
Despite the high-profile nature of the Ramirez case, the county did not have a chain of custody indicating who was in charge of what evidence and when, Livingston said. He also admitted that no one made any effort to figure out how the evidence should be preserved.

The Ramirez episode left Riverside County facing some hair-raising liability problems. A young mother–who, doctors say, was likely to live at least another year despite her cancer–was dead. A young doctor wound up in intensive care. Five other Riverside General staffers had been hospitalized.
Sure enough, the county was later hit with two lawsuits: one by Ramirez’s family, the other by Dr. Gorchynski. The physician, who subsequently spent three months in a wheelchair and experienced debilitating knee injuries and bleeding in her brain, is seeking $6 million in damages; the Ramirez family has not yet specified an amount.

Both suits, expected to go to trial this fall, charge that county and state officials deliberately destroyed evidence and covered up the release of some kind of toxic or dangerous substance in the ER. The Ramirez suit specifically names Cal/OSHA; Ken Cohen, the head of Riverside County’s Health Services Agency; Coroner Hill; and other high-ranking county and hospital officials.

“The way they handled the evidence is consistent with a total cover-up,” says Ronald Schwartz, a Newport Beach attorney representing the Ramirez family.
Peter Osinoff, a Los Angeles lawyer representing Cohen and the county health agency, denies there was a meth lab in the hospital or that county officials covered it up. “There’ve never been so many [government] agencies looking into the same thing,” he says. “You had the county, OSHA, the state. There’s not a shred of evidence as to a cover-up.” A Cal/OSHA spokesman also denied a cover-up.
The Ramirez family’s suit was fueled in part by anger at how the county handled her corpse.

For a month after she died, bereaved relatives regularly called the coroner’s office asking when her body would be released. The family wanted an independent autopsy done on the body and, after that, they wanted to bury it.
The response by county officials? They sued the family.
The county wanted a judge to order the family to follow the sameextraordinary autopsy protocol the coroner’s office had as a condition of releasing the body. But it came out during court hearings on the lawsuit that the coroner’s office had secretlyperformed a second autopsy several weeks after Ramirez died–withoutbothering to follow many of the original protective measures they later demanded of the family.
Under pressure to explain their actions, coroner’s officials said they simply were finishing what they hadn’t the first time around. But Cal/OSHA’s Cox believes they had another motive. “When they did the second autopsy they wanted to make sure the chemicals Ramirez had been injected with or exposed to had sufficiently dissipated,” says Cox. “There are many chemicals that have a half-life and disappear over time.”

Even though county officials acted as if it were normal to conduct anautopsy in two acts, others who cut up bodies for a living say it is not standard procedure. “Normally we do autopsies all at one time,” says Scott Carrier, a spokesman for the L.A. County Coroner’s Office. “A veteran pathologist should be able to do an autopsy all in one setting.”
During one hearing on the county’s suit, Riverside Superior Court Judge Victor Miceli criticized coroner’s officials for conducting the second autopsy and not informing the Ramirez family so their pathologist could attend. The county’s actions, said Miceli, gave “the appearance to the public that the county is trying to hide something.” The judge then ordered county officials to answer questions under oath about the Ramirez investigation. Only hours before they were to begin doing so, the county abruptly withdrew its suit.

Two months after Ramirez died, her body was finally released. Despite county promises of cooperation, the corpse was delivered in poor condition to an Orange County pathologist hired by her family to conduct an independent autopsy. For one thing, it was badly decomposed. And all of Ramirez’s internal organs–removed during the Riverside autopsies–had been slopped together in a plastic bag as if they were turkey giblets. Strangely, her heart was missing.
Even today, three years later, Ramirez’s heart has not been released by the county. Asked during a deposition if there was any medical reason to keep it, Coroner Hill replied, “I don’t know of any.”
Hill ruled that Ramirez died from heart and kidney failure stemming from her cervical cancer. But the Ramirez family’s pathologist said he wasn’t able to determine a cause of death because her heart was missing, her other organs were cross-contaminated with fecal matter, and her body was so badly decomposed.

“Gloria was held hostage so long so that our autopsy would have no meaningful results,” Gloria’s brother-in-law, David Garcia, said at the time. “I think the county has already found out how she died and wanted to make sure we did not find out.”
Meanwhile, Cal/OSHA’s inquiry into the hospital fumes had ground to a mysterious halt. Two weeks after Ramirez died, Cox and Kranjcevich–the Cal/OSHA officials who had been kicked out of the first autopsy–were taken off the fumes investigation. Cox was told he wasn’t sensitive to the highly political nature of the case. Kranjcevich–one of Cal/OSHA’s most aggressive enforcement officers–was told he was being removed because he’d been disruptive and uncooperative with Riverside General officials. Hill also complained that the two Cal/OSHA men had used threats and intimidation to try to delay the autopsy proceedings. The Ramirez file was then transferred to Cal/OSHA’s regional office in Anaheim, and a new investigator didn’t set foot in the hospital for another six weeks–even though some Cal/OSHA officials believed the fumes were some kind of toxic agent possibly as potent as poison gas.

Not long before Cox and Kranjcevich were pulled off the case, Cohen, head of the county’s Health Services Agency, sent a cryptic E-mail to his staff. In the message, obtained by New Times, Cohen, who oversees Riverside General, ordered subordinates to keep their mouths shut about the fumes incident because of “a very sensitive agreement with Cal/OSHA that could be disrupted with adverse press reporting.”
Asked about any such agreement, Hanley, Cal/OSHA’s Southern California chief, said, “I’m not sure what Ken is talking about….I would not have entered into any kind of sensitive agreement.”

But attorney Osinoff, who represents Cohen and the county health agency, acknowledges that there was a behind-the-scenes deal between the county and Cal/OSHA. He says Cal/OSHA agreed to yank Kranjcevich off the investigation. The state agency also promised, Osinoff says, to shift its hospital probe from Cox’s supervision to Hanley’s. Cox was subsequently demoted.

Ramirez lived a quiet, unremarkable life. She volunteered at her children’s schools, cooked, and decorated hair barrettes in her spare time. Quick with a smile and a good talker, she made friends easily. She grew up in Riverside, one of three children in a tight-knit Mexican-American family. Her father was a car mechanic, her mother a homemaker.
A high school dropout, Ramirez was unmarried and on welfare at the time of her death. She had held various jobs over the years, occasionally working in fast-food restaurants. She’d met the father of her children, a maintenance worker named Angel Arciniega, at a Riverside park in 1978. He saw her swimming and fell madly in love. The couple was together for the next eight years.

After breaking up with Arciniega, Ramirez moved into a converted garage apartment at her parents’ house with her kids–Evelyn, now 15, and Angel “Buddy” Jr., now 12. Eventually, she met another man, Johnnie Estrada, and again fell in love. They were engaged to be married when Ramirez died.
A month before her death, Ramirez was diagnosed with advanced cervical cancer. She had been losing weight and feeling ill for two months. In 1991, she’d been treated at Riverside General after being raped and had been given a Pap smear that came back abnormal. (Her family’s attorneys say Ramirez wasn’t informed of the abnormality; Osinoff says medical records show she was told to return to the hospital for the test results.) Doctors consulted by the Ramirez family said that with prompt notification and proper care, Ramirez would probably have fully recovered from her cancer.

Although her life was low-key, her death became a widely publicized, politically charged circus. The coroner’s investigation of her death in the spring of 1994 coincided with a hard-fought campaign by Hill to hold on to his job. Hill, who called himself the “Quiet Coroner,” was being challenged for re-election by a subordinate, Deputy Coroner Rick Diaz.
Hill, a slow-talking man who had spent 18 years in the mortuary business and 20 years in the coroner’s office, found himself in an enviable position during the campaign: the spotlight. He was besieged by reporters hungry for quotes in the mystery-fumes case. His name was in the papers and his face on TV day after day after day–a priceless advantage to any politician in the heat of a close campaign.
But just a month into the investigation, something happened that could have spelled political disaster for Hill. The high-ranking coroner’s deputy in charge of the Ramirez case, Stephanie Albright, committed suicide.
Albright shot herself while talking to her estranged husband on the phone. Hill’s chief deputy, Cupido, says she “may have been under pressure” from the case. Hill, in campaign mode, quickly announced that Albright’s startling death would not impede the progress of the investigation.
With the June election just a few weeks away, Hill finally released his conclusions about the cause of Ramirez’s death: heart and kidney failure related to cervical cancer. The fumes that sickened ER workers, he speculated to the press, were simply the “smell of death.”
At first, the intensive news coverage had made Hill look good: a real-life Quincy trying to solve a puzzling and difficult case. Before long, though, Hill found himself under attack. He was criticized for careless handling of Ramirez’s body and for conducting the secret autopsy.

In June, voters forced him into a November runoff election with Diaz. With the pressure on, Hill abandoned his smell-of-death theory five days before the runoff and instead released a report blaming thefumes on a bladder medication. The report had been prepared byscientists at the Lawrence Livermore National Laboratory in the Bay Area, long known for its work on nuclear weapons. Lawrence Livermore scientists speculated that the fumes were most likely the result of a bizarre chemical chain reaction in Ramirez’s blood prompted by use of dimethyl sulfoxide, or DMSO. Because scientists found a breakdown product in Ramirez’s body that could have been produced by DMSO, they began looking into what chemicals could be created when other compounds were added to the medicine.
They found that DMSO could react with oxygen, which Ramirez was given in the ambulance, to create dimethyl sulfate–a compound used as a poison gas. The scientists said some symptoms of dimethyl sulfate exposure–fainting and convulsions–matched those reported by the ER staff.

Despite Hill’s enthusiasm for the DMSO theory and its easy acceptance by the press (the Los Angeles Times, for instance, ran a wholly uncritical story on its front page), the Lawrence Livermore study was widely ridiculed in the scientific community. “There isn’t a knowledgeable chemist anywhere who would call this theory plausible,” says Stanley Jacob, professor of surgery at Oregon Health Sciences University and one of the world’s leading DMSO experts. “Even a college chemist would know this couldn’t happen.” Jacob, who did the clinical trials on DMSO in the 1960s, describes the Lawrence Livermore study as so “goofy” that its authors haven’t been able to get it published.
The other significant problem with the DMSO theory: There’s no evidence Ramirez was using the medication at the time, according to her family’s attorneys.
Lawrence Livermore scientists refused to speak with New Times. But in a 1995 article in Discover magazine, they said they had advanced DMSO only as a theory, not as the definitive explanation of what happened. They also criticized Hill for releasing to the press what they intended to be a confiden-tial report.
Along with Hill’s smell-of-death theory and Lawrence Livermore’s poison-gas scenario, a third questionable explanation emerged. The state Department of Health Services released a report blaming the ER uproar on mass hysteria, triggered by a strange smell. Injecting a note of sexism into the debate, state researchers said mass hysteria was the most convincing theory in part because more women in the ER became ill than men.
The hospital workers who had been made sick denounced the findings, as did physicians who had treated them. Christopher Jobe, a Loma Linda University orthopedist who cared for Gorchynski, angrily dismisses the state study, saying she had too many serious physical problems to be written off as hysterical. “The mass hysteria diagnosis is very insulting,” says Jobe. “It was obvious there was a certain bureaucratic pressure to come up with the theory. But these ER workers had real physical problems, and Dr. Gorchynski was the most severely affected. ER people are not likely to succumb to mass hysteria. These are people who suck out chest wounds all day and drill holes in people’s heads.”

Others in the medical community are equally unimpressed with the mass hysteria explanation. “I’ve never heard of mass hysteria causing someone to have respiratory failure,” says Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons, referring to Gorchynski. “It sounds to me like the people in the emergency room were exposed to some sort of volatile toxin.”
Riverside County is awash in methamphetamine and people who make it. Since 1988, more than 1,000 clandestine meth laboratories have been shut down in the county, and law enforcement officials estimate that perhaps twice as many have gone undetected. Last year, the state Bureau of Narcotic Enforcement dubbed the county the “methamphetamine capital of the world.”
Meth labs have popped up in the most unlikely places in Riverside County. In 1995, three people were arrested for running one at a day-care center. In 1996, police found a lab at the home of a middle-school teacher. Three children were killed last year when a lab exploded in the mobile home they lived in; the cooker was their mother.
Still, the notion of a meth lab in a public hospital may sound ludicrous. But such an operation was uncovered at a public medical facility in Denver in 1990.
“It’s a [state] lab…where they do testing for TB, communicable diseases, urine screenings for parolees, and water pollution exams,” says Netwal, the Colorado Bureau of Investigation chemist. “An employee at the facility worked at night, and he had set up a lab within the lab and was manufacturing meth at night.” The operation was discovered after a supervisor smelled strong chemical fumes.

Netwal says meth could just as easily be made at a hospital. “In a hospital you have a legitimate lab,” he says. “You could easily order the chemicals needed without suspicion. Also, there are not a lot of locked doors in hospital labs.”
Meth can be made by just about anyone with a few beakers and some solvents. Not only is the drug simple to cook, but a $500 investment in chemicals and equipment can quickly be turned into $10,000-$12,000 worth of dope. But the process requires a variety of volatile chemicals, which can explode or release noxious fumes.
Facing law enforcement crackdowns, many meth cookers have resorted to making the drug in stages, carrying out different steps in different locations to elude detection. California and some other states have tried to suppress the meth trade by requiring permits to buy solvents and other chemicals needed to make it. Consequently, a lucrative black market has developed in chemical “precursors” that can be mixed together to make the drug.

It is one of those precursors that Cox, the Cal/OSHA district manager, thinks was being made at Riverside General.

“I believe there was an intermediate product, not full meth, that was being manufactured in the hospital and then transported out to be completed elsewhere,” Cox says. “I think very quickly into the investigation county officials figured out there were some hospital workers running their own business on the side. I don’t think anyone in the hospital knew about it at the time other than those involved. But as a result of this incident, they found out what was going on and decided to cover everything up. It is the only plausible scenario to explain what happened.”

Cox says he thinks precursor chemicals were surreptitiously packaged in IV bags to be smuggled out of the hospital. If that were the case, did one of those bags accidentally wind up in the ER? Did a nurse inadvertently inject its contents into Ramirez? If a nurse squeezed out some fluid from such a bag before starting Ramirez’s IV, it could explain how strong fumes got into the air.
While finished meth has no detectable smell (unless it has been poorly made), precursors commonly give off ammonia and sewerlike odors, says Tom Holeman, a senior narcotics investigator with the Los Angeles County Sheriff’s Department and member of the state Justice Department’s meth-lab task force.

The night Ramirez died was hardly the first time fumes that could have been released from a meth lab had wafted through Riverside General. According to hospital and Cal/OSHA records, sewerlike smells were regularly reported, but no source could ever be found. About a month before the ER evacuation, a cancer patient fled his room after he and his wife were overcome by noxious fumes. Dennis Weiss says the stench was so intense it made him vomit. Two days later, chemical fumes again filled his room, and again he was forced to flee. Hospital records show that on the morning before Ramirez arrived, staffers again reported sewerlike odors.

But such smells aren’t the only evidence that points to meth. A number of symptoms experienced by Ramirez and the sickened ER staffers match those associated with exposure to meth gases. And tests on blood drawn from Ramirez, Gorchynski, and nurse Balderas showed something both rare and puzzling: elevated levels of cyanide. To date, government researchers haven’t been able to explain where the highly toxic agent came from.
But Ed Brown, a Bay Area chemist and meth specialist who provides expert testimony in criminal trials involving drugs, says the elevated cyanide levels–plus Gorchynski’s breathing problems–could be explained by exposure to methylamine, a toxic ingredient of meth with a strong ammonia odor.
“High concentrations of methylamine can cause a volatile vapor which is very caustic and causes headaches, dizziness, burning in the eyes and throat. It also is a respiratory-tract irritant,” says Brown, president of Brown’s Chemistry Services in Lafayette. “Methylamine can be metabolized by the body and converted to cyanide.”

Another mystery state researchers failed to solve was the identity of a vapor found in the body bag that contained Ramirez’s corpse. Researchers claimed it was something not in their chemical libraries. But Alexander Shulgin, a former University of California at Berkeley professor of forensic toxicology, analyzed the formula for the gas at New Times’s request and found it matched a couple of amine compounds. One of them is a meth precursor that also has a strong ammonia scent.

“This formula is completely chemically compatible with amyl amine–a precursor chemical used to make meth,” says Shulgin, a consultant tothe U.S. Drug Enforcement Administration and the National Institute on Drug Abuse. He adds that he was able to figure out what it was soquickly that he doubted if state investigators made a serious effort.

Tests on Ramirez’s body failed to detect meth or other illegal drugs, government officials said. But toxicologists consulted by New Times say a decomposing body produces substances that could make detection of meth difficult or impossible. Moreover, drug analysts don’t screen for meth precursors when they test for finished meth, says Jim Meeker, chief toxicologist at the Institute of Forensic Sciences in Oakland, a private lab that does work for police agencies around the state.
Experts also suggest another possible explanation for the negative meth screen: that the samples of blood and tissue tested didn’t come from Ramirez. Says Meeker: “If someone died of a catastrophic meth overdose and you wanted to hide that from toxicologists, the best way to do it would be to send off phony samples to labs.”

According to Ramirez family attorney Schwartz, no DNA testing was ever done on the samples sent out by the county for analysis to confirm that they had come from Ramirez. Therefore, he says, there is no guarantee that the samples are valid.
Coroner Hill, who was in charge of the samples, refused to speak to New Times, as did his Riverside attorney, Michael Bell
.
Lawrence Heiskell, a Palm Springs ER doctor who trains federal narcotics investigators about the medical hazards of drug abuse, says that in severe cases of meth-fumes exposure, victims’ respiration can become so impaired that a breathing tube must be pushed down their windpipe to keep them alive. Gorchynski had to be intubated following the fumes incident. She also had chemical burns in her nose and throat–symptoms also linked to meth fumes, experts says.

Ochoa, the ER chief, suffered no symptoms. And experts say that reaction, too, is consistent with meth exposure. “These chemicals affect some people and don’t affect others,” says Netwal. “Some people can pass out when exposed to these fumes, while others are unaffected.”
Ramirez went to her grave with the media calling her “the toxic woman” and “the smelly body no funeral home wants.”
Her half-brother, Raul Ochoa, turned on the TV just days after she died and saw a comedian joking that Ramirez must have eaten one spicy burrito to have knocked out so many people in the hospital. Ramirez’s son Buddy was teased at school by kids who yelled, “Your mom’s a monster! Your mom’s a monster!”

Ten weeks after she died, Ramirez was finally buried in an unmarked grave at Olivewood Cemetery in her hometown. She wore a simple white dress. Her family and friends had held an extended yard sale to pay for the funeral. For days, they peddled homemade cookies and brownies and worn-out stuffed animals.
The Rev. Brian Taylor, who presided at the burial, could not contain his anger over the county’s handling of the investigation of Ramirez’s death. “Gloria,” he told mourners, “has not been treated right.”

Her body was lowered into the ground without its heart.  ”

                    Evelyn Arciniega, with a photo of her mother, Gloria   Ramirez