Quinlan, Matter of
| Decision Date | 10 November 1975 |
| Citation | 348 A.2d 801,137 N.J.Super. 227 |
| Parties | In the Matter of Karen QUINLAN, an Alleged Incompetent. |
| Court | New Jersey Superior Court |
Paul W. Armstrong, Edison, for petitioners Joseph and Julia Quinlan (James M. Crowley, Staten Island, N.Y., of the New York Bar, of counsel, Paul W. Armstrong and James M. Crowley, on the briefs).
Daniel Coburn, Morristown, guardian ad litem, for Karen Quinlan, an alleged incompetent (Daniel Coburn, Astrid Baumgardner, Leslie Obus, Drew Kastner, Bruce Shaine, legal assistants, on the brief).
William F. Hyland, Atty. Gen., and David S. Baime, Chief, Appellate Section, for defendant State of N.J. .
Donald G. Collester, Prosecutor of Morris County, Clifton, for defendant County of Morris (Donald G. Collester and Bruce Chait, Springfield, on the brief).
Ralph Porzio, Morristown, for defendants Doctor Arshad Javed and Doctor Robert J. Morse (Porzio, Bromberg & Newman, Morristown, attorneys, Ralph Porzio, on the brief).
Theodore E. B. Einhorn, Denville, for defendant St. Clare's Hospital (Theodore E. B. Einhorn, on the brief).
In his initial pleading Joseph Quinlan, father of 21-year-old Karen Ann Quinlan, seeks, on grounds of mental incompetency, to be appointed the guardian of the person and property of his daughter. He alleges her 'vital processes are artificially sustained via the extraordinary means of a mechanical MA--1 Respirator.' He imprecates the court grant 'the express power of authorizing the discontinuance of all extraordinary means of sustaining the vital processes of his daughter.'
By a pleading amendment he also seeks to restrain the Morris County Prosecutor, Karen Quinlan's attending and treating physicians and St. Clare's Hospital from interfering with the exercise of the authorization sought, and to enjoin the prosecutor from prosecuting for homicide when the authorization sought is effected.
The court, pursuant to R. 4:26--2, appointed Daniel Coburn, Esq., guardian Ad litem.
At the pretrial conference held on the return date of an order to show cause issued with the amended pleading, the State of New Jersey through the Attorney General intervened.
Plaintiff initially asserted that Karen Quinlan is legally and medically dead but altered this position prior to trial by admitting she is not dead 'according to any legal standard recognized by the State of New Jersey.'
It is stipulated by all parties that Karen Ann Quinlan is unfit and unable to manage her own affairs.
The court's findings of fact are as hereinafter set forth:
Karen Ann Quinlan, one of three children of Joseph and Julia Quinlan, was born April 24, 1954. She was baptized and raised a Roman Catholic. She attended Roman Catholic Church-affiliated elementary and secondary schools. She is a member of her parents' local Roman Catholic Church in Mount Arlington, New Jersey. The parish priest is Father Thomas A. Trapasso.
Sometime in late 1974 or early 1975 Karen Quinlan moved from her parents' home. Thereafter she had at least two subsequent residences, with the last being a lake cottage in Sussex County, New Jersey.
On the night of April 15, 1975 friends of Karen summoned the local police and emergency rescue squad, and she was taken to Newton Memorial Hospital. The precise events leading up to her admission to Newton Memorial Hospital are unclear. She apparently ceased breathing for at least two 15-minute periods. Mouth-to-mouth resuscitation was applied by her friends the first time and by a police respirator the second time. The exact amount of time she was without spontaneous respiration is unknown.
Upon her admission to Newton Memorial urine and blood tests were administered which indicated the presence of quinine, aspirin, barbiturates in normal range and traces of valium and librium. The drugs found present were indicated by Dr. Robert Morse, the neurologist in charge of her care at St. Clare's, to be in the therapeutic range, and the quinine consistent with mixing in drinks like soda water.
The cause of the unconsciousness and periodic cessations of respiration is undetermined. The interruption in respiration apparently caused anoxia--insufficient supply of oxygen in the blood--resulting in her present condition.
Hospital records at the time of admission reflected Karen's vital signs to be normal, a temperature of 100, pupils unreactive, unresponsivity to deep pain, legs rigid and curled up, with decorticate brain activity. Her blood oxygen level was low at the time. She was placed upon a respirator at Newton Hospital.
At 10 p.m. on April 16, 1975 Dr. Morse examined Karen at the request of her then attending physician. He found her in a state of coma, with evidence of decortication indicating altered level of consciousness. She required the respirator for assistance. She did not trigger the respirator, which means that she did not breathe spontaneously nor independently of it at any time during the examination. Due to her decorticate posturing, no reflexes could be elicited.
In the decorticate posturing the upper arms are drawn into the side of the body. The forearms are drawn in against the chest with the hands generally at right angles to the forearms, pointing towards the waist. The legs are drawn up against the body, knees are up, feet are in near the buttocks and extended in a ballet-type pose.
He found her oculocephalic and oculovestibular reflexes normal. The oculocephalic reflex test consists of turning the head from side to side with the eyes open. In a positive response, when the head is rotated to the right, the eyes deviate to the left. As part of this test the head is also moved front and back, the neck is flexed in the back movement, causing the eyelids to open. This phenomenon is called 'doll's--eyelid response.' (Dr. Morse found that reflex intact on April 26, according to hospital records.) The oculovestibular reflex ascertained by a caloric stimulation test consists of the slow introduction of ice water into the ear canal. The eyes drift or move toward the irrigated ear. It is a lateral eye movement test.
He also found pupillary reaction to light in both eyes.
Her weight at the time was 115 pounds.
Dr. Morse could not obtain any initial history (I.e., the circumstances and events occurring prior to Karen's becoming unconscious). There was no information available from her friends. He speculated at the outset on the possibility of an overdose of drugs, past history of lead poisoning, foul play, or head injury due to a fall. He indicated that the lack of an initial history seriously inhibits a diagnosis.
Karen was transferred to the Intensive Care Unit (I.C.U.) of St. Clare's Hospital, under the care of Dr. Morse. At the time of her transfer she was still unconscious, still on a respirator; a catheter was inserted into her bladder and a tracheostomy had been performed.
Upon entry to the St. Clare's I.C.U. she was placed on a MA--1 respirator, which provides air to her lungs on a controlled volume basis. It also has a 'sigh volume,' which is a periodic increase in the volume of air to purge the lungs of any accumulation of fluids or excretions. The machine takes over completely the breathing function when the patient does not breathe spontaneously. 1
Subsequently, the serial blood gas or arterial blood gas examinations were made. The tests indicate the degree of acidity (pH) in the blood, the level of oxygen (pO2) in the blood and the level of carbon dioxide (pCO2) in the blood. The latter is indicia of the extent carbon dioxide is discharged from the lungs. The pH reflects whether there is an excess of acid (acidosis) or an insufficiency of acid (alkalosis) in the blood. I note, parenthetically, that the blood gas tests have been conducted continuously from the time of Karen's admission to St. Clare's up to the present. There are constant references through the hospital records of pH, pO2 and pCO2 measurements. Dr. Javed, the attending pulmonary internist, indicated some 300 tests were conducted.
Dr. Javed testified the blood tests were all normal while Karen was on the respirator.
In an effort to ascertain the cause of the coma, Dr. Morse conducted a brain scan, an angiogram, an electroencephalogram (EEG), a lumbar tap and several other tests. The first three are related to the brain and are conducted, according to the testimony, with the object of finding an injury or insult to the brain, such as a subdural hematoma or the like, or for ascertaining any abnormality in the brain activity patterns. The latter is particularly true of the EEG where electrodes are placed on the skull. The measurement is made of cortical neurons. The neuron is basically a conducting cell of nervous energy. The recordings are made on awake and sleep cycles. The awake recorded data, referred to in the testimony as alpha rhythm or activity, indicates a frequency of pattern which can be compared against normal frequencies or patterns to determine whether any abnormality exists. The EEG establishes the existence or nonexistence of normal patterns. It does not precisely locate the insult or lesion causing, in this case, the unconsciousness. Dr. Morse indicated that the EEG performed at the outset established nothing abnormal for a comatose person and did not establish the offending agent to her central nervous system which caused her unconsciousness. Subsequent EEGs provided no further information. All indicated brain rhythm or activity. 2
Subsequent tests and examinations did not further the establishment of the precise location and cause of Karen's comatose condition.
Dr. Morse testified concerning the treatment of Karen at St. Clare's. He averred she receives oral feedings since intravenous...
To continue reading
Request your trial
-
Andrews v. Ballard
...... Wensel v. Washington, supra note 2, at 1159-1160 (Superior Court of the District of Columbia, Civil Division); Matter of Quinlan, 137 N.J. Super. 227, 348 A.2d 801, 821-822 (Super.Ct. 498 F. Supp. 1049 Civ.Div. 1975), modified, 70 N.J. 10, 355 A.2d 647, 662-663 ......
-
Storar, Matter of
...... Brother Fox had first expressed this view in 1976 when the Chaminade community discussed the moral implications of the celebrated Karen Ann Quinlan case, in which the parents of a 19-year-old New Jersey girl who was in a vegetative coma requested the hospital to remove the respirator (see, Matter of Quinlan, 137 N.J.Super. 227, 348 A.2d 801, revd. 70 N.J. 10, 355 A.2d 647, cert. den. sub nom. Garger v. New Jersey, 429 U.S. 922, 97 S.Ct. 319, ......
-
Eichner v. Dillon
... . Page 517 . 426 N.Y.S.2d 517 . 73 A.D.2d 431 . In the Matter of Father Philip K. EICHNER, S.M., on behalf . of Brother Joseph Charles Fox, Respondent, . v. . Denis DILLON, District Attorney, Nassau County, ... Fox's views on the use of "extraordinary" life-sustaining measures, Father Eichner testified that in 1976, during the time that "the Karen Quinlan situation" 2 was topical, the members of the Chaminade community engaged in extended discussions as to its significance, particularly in relation ......
-
Delio v. Westchester County Medical Center
... . Page 677 . 516 N.Y.S.2d 677 . 129 A.D.2d 1 . In the Matter of Julianne DELIO, etc., Appellant, . v. . WESTCHESTER COUNTY MEDICAL CENTER, et al., Respondents. . Supreme Court, Appellate Division, . Second ... to engage in a discussion on preserving the life of a comatose patient when, in the mid-1970's the highly-publicized case of Karen Ann Quinlan began to receive attention (see, Matter of Quinlan, 137 N.J.Super. 227, 348 A.2d 801, mod. 70 N.J. 10, 355 A.2d 647, cert denied sub nom. Garger v. ......