What happened
At about 8:15 p.m. on February 19, 1994, paramedics brought Gloria Ramirez, 31, into the emergency room of Riverside General Hospital in Riverside, California. She had advanced cervical cancer and was confused, breathing erratically, with a racing heart and falling blood pressure. The trauma team sedated her with Valium, Versed and Ativan, gave lidocaine and Bretylium for her heart rhythm, and ventilated her by hand. When she failed to respond they prepared to defibrillate her, and as her shirt came off several staff noticed an oily film on her skin and a fruity, garlic-like smell they took to be her breath.
A nurse, Susan Kane, drew blood from her arm and noticed that the syringe smelled of ammonia. She passed it to a medical resident, Julie Gorchynski, who saw pale particles floating in the sample. Kane then fainted. Gorchynski felt sick, went to sit at the nurses’ station and collapsed. Maureen Welch, the respiratory therapist who had been bagging the patient, went down third. The department was evacuated to the parking lot, with a skeleton crew staying with Ramirez. She was pronounced dead at 8:50 p.m. By the end of the night 23 of the people who had been in the department reported symptoms, from headache and nausea to fainting and breathing trouble, and five were admitted. Gorchynski spent two weeks in intensive care and went on to develop hepatitis, pancreatitis and avascular necrosis in her knees.
The investigation
The Riverside County coroner, the county and state health departments and the hospital all investigated, and the press named Ramirez the Toxic Lady. Two scientists from the California Department of Health Services, Ana Maria Osorio and Kirsten Waller, interviewed 34 staff who had been in the department. Their report, released in September 1994, found that those who fell ill had been close to Ramirez and had handled her intravenous lines, that they were mostly women, that their later blood tests were normal, and that neither paramedic who had ridden with her in the ambulance was affected. The department concluded that the most likely explanation was mass sociogenic illness, perhaps set off by an unpleasant smell. The staff who had been hospitalized rejected that reading, and Gorchynski sued.
The coroner’s autopsy, released two months after the death, found no toxin or unusual drug in Ramirez’s body and gave the cause of death as cardiac arrhythmia brought on by kidney failure from her cancer. The body had been kept sealed for weeks, and by the time the family’s own pathologist examined it, it was too decomposed to tell them anything.
The explanations
The coroner’s office asked the Forensic Science Center at Lawrence Livermore National Laboratory to look at the chemistry. Brian Andresen and Patrick Grant found sulfate levels in her blood far above normal and sulfur compounds they traced to dimethyl sulfoxide, or DMSO, an industrial solvent that is also sold as a rub-on home remedy for pain and leaves a garlic taste. Their proposal, published in Forensic Science International in 1997, ran as follows. Ramirez, in pain and with failing kidneys, had been using DMSO, which built up in her body. The oxygen the paramedics gave her converted some of it to dimethyl sulfone, which crystallizes at room temperature and would account for the particles in the syringe. The electric shock of defibrillation, or some other step in her treatment, then converted sulfone to dimethyl sulfate, a volatile gas that attacks the lungs, eyes and skin and whose effects match what the staff described.
The authors conceded that dimethyl sulfate itself was never detected. Critics in the same journal called the paper a fishing expedition: the step from sulfone to sulfate has not been reproduced in a laboratory, the idea of a defibrillator driving it is doubtful, and the Ramirez family said she never used DMSO. Other proposals, including chloramine fumes from bleach and urine in a nearby sink and a mix-up involving a methamphetamine precursor, fit the facts worse.
Where it stands
The Riverside coroner accepted the Livermore scenario as the probable explanation, and it appears in forensic textbooks as the best available account. The California health department never withdrew its mass-hysteria finding. Neither theory has been proved. What is certain is that a dying woman was brought into a hospital, that a room full of trained staff became ill around her, and that nobody has found the poison. The verdict is unproven.