The "mystery fumes" said to have caused emergency room staffers at a Southern California hospital to pass out while treating a dying patient last February may actually have been the effects of shared stress, a state study has concluded.
The state Department of Health Services reviewed medical records of five hospitalized staff members, surveyed 34 staffers at Riverside (Calif.) General Hospital and went over investigative work by other agencies in an attempt to solve a medical mystery that gave rise to two lawsuits and many more questions.
On Feb. 19, Gloria Ramirez, 31, was wheeled into the hospital's emergency room near cardiac arrest. As a nurse drew blood, some of the bedside staffers noticed an ammonia smell and began to faint.
Ms. Ramirez died as other hospital staffers rushed in to save her and revive their downed colleagues.
On April 29, county authorities announced the cause of death as kidney failure brought on by cervical cancer, but they said the cause of the fainting sickness might never be known.
At any rate, local officials maintained, the illness wasn't caused by any leaks or problems at the Riverside County-run hospital.
"The findings from our and other investigations are most compatible with an outbreak of mass sociogenic illness, perhaps triggered by an odor," said a synopsis of the state report.
Such illness occurs when a group of people get physical symptoms that suggest an organic illness but actually result from "anxiety or other psychological stresses," the department said.
Ms. Ramirez's family has sued the county over its handling of the case and of her body, which was kept sealed for two months except for extensive testing to find the source of the illness.
The family maintains that something went wrong at the hospital, and that the mother of two was portrayed as a freak.
Julie Gorchynski, M.D., who passed out after sniffing a sample of Ms. Ramirez's blood, has also sued the county, saying officials botched their investigation and refused to share information (Aug. 22, p. 16).
Dr. Gorchynski was still being treated for avascular necrosis, or bone deterioration caused by lack of blood, which she believes was caused by the incident. She has said she may not be able to work again.
Her attorney didn't immediately return a phone call.
The state report weighed many risk factors, such as who stood near Ms. Ramirez, who touched her, who smelled something and who didn't.
Four people reported smelling something like ammonia, it noted, but seven others nearby described smells ranging from "chemical" to "musty" to "garlicky-fruity."
Hospitalized staff members had breathing difficulty, muscle spasms and other symptoms, but tests found no sign of toxic exposure, the state report said.
It also noted that the crew shut inside an ambulance with Ms. Ramirez during the ride to the hospital suffered no ill effects.
The report said it was also possible there may have been a toxic substance that caused symptoms in some of the staff, while the rest reacted "to the stressful situation around them." If so, the department said, it's still not clear where the toxin came from.
It did hold out the possibility of a chemical answer, however.
"The finding of small amounts of an unusual nitrogen-containing compound in air samples taken from the vicinity of (Ms. Ramirez's) body is intriguing," the health department said.
Scientists at the Lawrence Livermore Laboratory were trying to identify the compound in blood samples taken during an autopsy.