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A Question Of Homicide?

The Diagnosis: Cancer

For decades, morphine has been a widely accepted remedy for reducing pain. Doctors call it a wonder drug, and are using it to bring relief to thousands of people, especially those suffering from cancer. But too much, if improperly administered, can kill. 60 Minutes II Correspondent Dan Rather reports on a Florida case in which morphine may have killed a cancer patient who wasn't in pain, and who may not have even had cancer.

Last year, Mary Comford went into the hospital for what seemed a common ailment, and ended up losing her life. The 78-year-old Comford, who lived in Florida, seemed to be in good health until she developed kidney stones last year. When she became faint and dizzy, doctors put her in the hospital for observation. They then told her daughter, Cindy Coolbaugh, that her mother was terminally ill with brain cancer.

Cindy's mother died at a hospice in Volusia County, Florida. Doctors at Halifax Hospital, which treated Comford and which owns the hospice, insist the cause was cancer. But Dr. Ronald Reeves, the county's medical examiner at the time, disagrees. He performed the autopsy and he believes she did not have cancer, and that she died of a morphine overdose.

The hospital says that Reeves is wrong. "I reviewed that case as I remember, and in detail. I don't think she got. . . an eye dropper full of morphine; I mean, it wasn't enough to cause any problems,"says Dr. Alvin Smith, director of Halifax's oncology center

But the hospice records were incomplete. Some orders for morphine are unsigned and undated. Others were signed in June, three months after Cindy's mother died.

"We did make some mistakes," says Deborah Harley, who runs the hospice where Cindy's mother spent her final days. "We made some mistakes in documentation. Physicians didn't sign their orders in a timely manner. We are not perfect. It is a documentation issue and it doesn't harm patients in any way."

But the poor record keeping means no one can be sure how much morphine Comford was given. To add to the confusion, Cindy says her mother did not need the morphine in the first place. Her mother, she says, was not in pain, but was simply nervous and frightened.

Nurses' notes do not indicate that Cindy's mother was in pain for most of her illness. Then at 9:30 a.m. on March 17 of last year, a notation was made that her mother experienced pain when she was moved.

"When we moved her to do her treatment, she was painful and actually it says here, tearfulness, to the point where they had to put a vest restraint on her," Says Harley.

The vest restraint was used to immobilize her. Apparently it worked: By 12:30 that same day, medical records show that she was sleeping comfortably. Nevertheless, the first dose of morphine, called Roxanol, was given at 2 p.m. that afternoon.

Two days later, Comford was dead. A toxicology report shows an extraordinarily high level of morphine--almost 3,00 nanograms--in her bloodstream. That amount is enough to kill almost a dozen people. On top of that, Dr. Reeves could not find any cancer in Comford's body.

"We autopsied her and I guarantee you I did it myself," says Reeves, "and there wasn't a part of her body that wasn't examined, closely, but we also sent the sections to a neuropathologist outside our office who concurred with us."

That second opinion, which Reeves got in writing, supported his conclusion that Comford did not have cancer. At that point, Reeves decided that she had not died of natural causes, and he ruled the death a homicide.

Says Cindy: "I thought that I was watching a bad mystery on television."

In the examination room at the morgue, Reeves determined that three other people he had autopsied had also died from overdoses of morphine. He listed those deaths as homicides too.

"Someone gave these individuals excess doses of medication which they knew or should have known would cause their death," Reeves says. "The medications were given at best recklessly, without regard to what it would do to the patient. But the levels in some of the cases suggest otherwise even to the point that they were given intentionally to cause death of the patient."

Increasingly suspicious, Reeves dug deeper. He began investigating 15 other cases. He was now questioning a total of 19 deaths, most from the same hospice.

In the middle of his investigations, Reeves was suddenly suspended. Volusia County officials told us it was because of his personality--that he couldn't get along with others running investigations, most notably the sheriff and the state's attorney.

"He was conducting an independent investigation without anyone's knowledge," says John Tanner, the state attorney. "About that time and for the preceding six or so months he had become more difficult to work with."

But that doesn't explain why county officials also suspended Reeves' associate medical examiner and tried to reassign his chief investigator. One county official told us: "We had to cut off all his tentacles."

With Reeves suspended, a panel of medical experts was appointed to review the cases. Last summer, the panel concluded that all 19 people--including Cindy Coolbaugh's mother--died from natural causes. The report said Reeves was "foolhardy" for relying on morphine levels alone to determine cause of death, a charge Reeves denies.

Says Reeves: "Our decisions weren't made in a vacuum. We look at these cases, we get all the medical records, before and after the care was provided. We read those records, we study those records, we study the toxicology, we do a complete autopsy. And everything has to be taken, again as I've said, in the totality of all the circumstances and all of the evidence."

After reviewing the evidence, the panel reported that all the patients were terminally ill, including Comford. This reprt directly contradicted the autopsy, and the second opinion, which found no cancer. The panel did say that it was "puzzled" by her death, and that she was "doing reasonably well when she entered the hospice."

Hospice administrator Harley says that Comford did not die of an overdose, and that the hospice does not use morphine to hasten the deaths of patients it believes are terminally ill.

Dr. Reeves says the panel was unfair. "I think they had an agenda when they went in; they intended to determine every case was natural." Reeves says he is sure crimes were committed. Who committed them? That's a mystery to him: "That's not my job and I don't know who did them."

The local police started investigating, and several police sources told CBS News that they were waved off by the state attorney's office, a charge the state attorney denies. Tanner says he ran his own investigation and found no evidence that any crime, even manslaughter, was committed.

But Tanner based his investigation almost entirely on the medical panel's findings, which may not be accurate. For example, the panel said that some of the patients could tolerate large doses of morphine. But Comford's medical history shows that she was not one of these patients.

The panel also said that morphine levels are high because after death, the drug leaves the organs and goes into the blood stream. But eminent toxicologist Graham Jones, who at CBS News' request reviewed Comford's file, says that this explanation is not accurate. It's been demonstrated that morphine does not redistribute that much after death," Jones says. He says that he disagrees with the panel's findings.

Dr. Jones says that it is a "certainly a possibility" that Comford died of an overdose. As to why Comford had such high levels of morphine in her body, Jones says: "I have no satisfactory explanation other than the possibility that she was given more morphine than is charted in her medical record."

Dr. Stephen Nelson, the head of the panel, refused an on-camera interview. Instead, he referred us to several medical articles to support the panel's conclusion. Two were authored by Dr. Jones, who insists that the panel misinterpreted his work. The panel's report has only further frustrated Coolbaugh.

"My parents raised me to believe that if you have nothing to hide, then why can't you talk?" she says. "All I'm doing is asking questions, and I have yet to get any answers."

Most physicians agree that deaths do occur from the use of morphine, sometimes because it is given in excessive doses to ease excruciating pain near the end of terminal illness; sometimes because it is intentionally used to hasten death; and sometimes because of an accidental overdose.

But Coolbaugh will never know what killed her mother because the death certificate which originally read "homicide" has been changed based on the medical panel's eport. It now reads "undetermined."

The state attorney just recently wrapped up his investigation and concluded that there was "no evidence that any. . . health care provider intentionally or unlawfully terminated the life of any patient under their care"


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