Ronald Cranford Speaks Out


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Ronald Cranford Speaks Out

June 2005, Volume 88

Published monthly by the Minnesota Medical Association


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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