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Ronald Cranford
Speaks Out
June 2005, Volume 88
Published monthly by
the Minnesota
Medical Association
PULSE
News Digest
Expertly Stated
Minnesota’s most
famous expert
witness speaks out.
Ronald Cranford,
M.D., surveys the
crowded waiting room
shared by the
departments of
obstetrics and
neurology on the
fifth floor of
Hennepin County
Medical Center (HCMC)
in downtown
Minneapolis. In this
spare moment before
his next
appointment, the
neurologist jokes
with a nurse who has
come for his
signature that she
needs to “pretend”
to show him more
respect. After all,
he’s an expert.
This lull in
Cranford’s day is a
change from the past
several months,
during which he has
fielded media calls
nearly nonstop. As
one of a half-dozen
physicians who in
2002 examined
brain-damaged
Theresa M. Schiavo
and then testified
about her condition
in an evidentiary
hearing in a Florida
court, he’s been in
demand around the
country. The day
before this
interview, he was
talking to the New
York Times. On March
21, the day Congress
and President Bush
gave jurisdiction
over the Florida
woman’s case to the
federal courts,
Cranford did nonstop
interviews starting
at 6:30 a.m.
Why the frenzy
around Cranford?
He’s the only expert
in the Schiavo case
who has been willing
to talk to the
press. And talk he
will, to almost
anyone, fast and
furiously
explaining, and
re-explaining, why
Terri Schiavo was
clearly in a
persistent
vegetative state and
why the videotapes
released by
Schiavo’s parents to
the media were
misleading and why
the experts who
suggested treatments
such as vasodilation
therapy or
hyperbaric oxygen
therapy were not
only mistaken but,
in his words,
“charlatans” and
“frauds.”
“I don’t mind,” he
says of the press
interviews. “It goes
with the territory.”
That territory is
one he has mapped
out over the last 30
years, building a
national reputation
as an expert on
end-of-life ethics
issues.
All in a Day’s Work
Unlike many
physicians who shun
the courtroom,
Cranford sees his
work in the courts
as part of his job.
“It’s a natural for
neurology,” he says.
“It’s a natural for
me to come in to
clarify brain death,
vegetative state,
and minimally
conscious state.”
Making such fine and
tragic
determinations and
explaining them to
the court is
something he has
done in 13 major
right-to-die cases
and countless
lesser-known ones.
For the former, he
takes no pay. He
considers it his
vocation.
For the latter, most
of which are
malpractice cases
involving a patient
with a significant
brain injury, he
says he “charges
quite nicely.” In
such cases, Cranford
is hired by the
defense at the point
in a trial at which
juries are
determining damages.
He examines the
patient and states
whether he or she is
in a vegetative or
some other state and
whether the patient
is experiencing pain
and suffering. And
he makes a
prediction about
life expectancy.
Attorneys might
argue that a patient
needs to be
sustained for 50
years. Cranford
counters with
medical evidence
that shows their
likely lifespan to
be five to 10. “So
life expectancy at
five to 10 years
means I can be worth
$5 to $20 million in
these cases.”
Cranford has no
qualms about the
value of his work.
“First and foremost,
I’m doing what any
credible neurologist
would do,” he says.
“I’m explaining
neurology. Second,
I’m representing the
medical profession
by articulating the
medical-legal
standards. … Third,
I’m representing
families. … Fourth,
I’m representing
evolving social
standards. I think
I’m doing what’s
generally good for
society.”
For three decades,
Cranford has been at
the forefront of
those evolving
standards, literally
helping to write
definitions for such
conditions as brain
death and persistent
vegetative state and
formulate guidelines
for medical decision
making.
Like many people, he
first became
interested in the
ethical issues
around the end of
life in the mid
1970s, when the
Karen Quinlan case
captured national
attention. Quinlan
was an unconscious
woman whose father
petitioned the court
for guardianship of
his daughter so that
he could terminate
her artificial
respirator. Cranford
began to realize
that Quinlan and
other similar cases
hinged on the
patients’ neurologic
condition and that
he had a role to
play in the evolving
ethical discussions.
He joined HCMC’s
then-fledgling
ethics committee as
well as Minnesota
Medical Association
committees on death
and dying. He was
first asked to serve
as an expert witness
in 1977 in the brain
death case of a 4
½-year-old child
named Stacey
Ellison.
Over the years,
Cranford has served
on national
committees such as
the President’s
Commission for the
Study of Ethical
Problems in Medicine
and Biomedical and
Behavioral Research
and the ethics
committee of the
American Academy of
Neurology, which he
chaired. Clearly, he
is no lightweight
when it comes to
clinical ethics and
end-of-life
treatment issues.
The Need to Speak
Out
Yet, what sets
Cranford apart in a
field of experts is
his willingness to
speak out, not only
in court but to the
public. “I have a
responsibility to
stand out front,” he
says, adding that he
believes he’s
representing the
values of 80 percent
to 90 percent of
Americans.
So in 2001, when the
call came from James
Barnhill, M.D., a
Tampa, Florida,
neurologist, asking
if he might be
interested in
examining a young
woman for a court
hearing, Cranford
said yes. He knew
the issue at
stake—who should
make the final
decision for the
patient—was
important, but he
had no idea at the
time that the case
of young Terri
Schiavo was poised
to move from the
courtroom to the
newsroom to
Congress.
Cranford just
thought he was doing
what he had done in
other major cases
around the
country—clarifying
the patient’s
medical condition.
There was to be an
evidentiary hearing
in 2002 involving
five experts, two
hired by Schiavo’s
husband, Michael;
two hired by her
parents, the
Schindlers; and one
appointed by the
court.
Each of the experts
literally had their
day in court. Three,
including Cranford,
confirmed Barnhill’s
diagnosis of
persistent
vegetative state.
Two other witnesses,
both hired by the
Schindler family,
testified that
Schiavo could
benefit from
treatment. “They
advocated for
vasodilator therapy,
which is bogus
treatment, and
hyperbaric oxygen
therapy, which is
bogus therapy. They
said after being in
a vegetative state
for 12 years she had
a chance of
recovering, of
walking, which is
totally ludicrous,”
Cranford says.
Cranford believes
that offering a
therapy such as
hyperbaric oxygen
treatment, in which
patients are
immersed in 100
percent oxygen,
preys on desperate
families’ desire to
do anything to help
their loved one.
Cranford speculates
that because
vasodilator and
hyperbaric oxygen
treatment centers
are more common in
Florida than in
other states, the
courts were more
willing to consider
the testimony of
experts advocating
these treatments.
“You wouldn’t get
away with that in
Minnesota,” he says.
“It isn’t close to
the standard of
care.”
Cranford credits
Judge George Greer
for “bending over
backwards for due
process. He let the
Schindlers bring in
their experts. He
just discredited
their credentials
and testimony
later.” Although the
judge dismissed the
testimony of the two
Schindler witnesses,
it was clearly taken
quite seriously by
many in the public
and in Congress,
which still
irritates Cranford.
“Anybody who’s a
board-certified
neurologist or
board-certified
something can go to
court. Dr. Maxfield
[one of the
Schindlers’
witnesses] was
board-certified in
radiology. He didn’t
know squat about
neurology. He knew
as much about
neurology as Bill
Frist did, and yet
he was allowed to
testify.”
Cranford doesn’t
limit his criticism
to the experts in
the case. “In the
face of the longest
and most litigated
case in the history
of right-to-die
cases, and the
longest evidentiary
hearing on the facts
of the case, which
were unequivocal,
Congress comes along
and says the case
wasn’t litigated
properly,” he says.
“They made complete
fools of themselves,
just complete
fools.”
Such scathing
commentary has
earned Cranford more
than his share of
detractors—he
estimates having
millions of enemies.
He’s been called an
advocate of
euthanasia. He
receives hate
e-mails—he says they
never come by U.S.
mail anymore—and he
is a favorite target
of Internet
bloggers. But
Cranford shrugs this
off, seeing each
barb, each false
characterization on
the Internet, each
accusation as a
reminder that he’s
making a difference
in the world. “I’ve
argued these
positions for 25
years,” he says.
“It’s gradually
sinking in that
parents and families
have a right to make
decisions.” It’s not
likely Cranford will
pipe down any time
soon.
“The worse these
people are,” he
says, “the more I
realize I’m doing
something
worthwhile.”—Carmen
Peota
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