Gloria Ramirez (January 11, 1963 - February 19, 1994) was a Riverside, California, woman dubbed "the toxic lady" by the media when several Riverside General Hospital workers became ill after exposure to her body and blood. Her case was the basis for a scene in one episode of the American TV series The X-Files and an episode of the American TV drama Grey's Anatomy.

The emergency room visit

About 8:15 in the evening on February 19, 1994, Gloria Ramirez was brought into the emergency room by paramedics, suffering from the effects of advanced cervical cancer. She was extremely confused, and suffering from bradycardia and Cheyne-Stokes respiration.

The medical staff injected her with Valium, Versed, and Ativan to sedate her, and agents such as lidocaine to stimulate her heartbeat. When it became clear that Ramirez was responding poorly to treatment, the staff tried to defibrillate her heart with electricity; at that point several people saw an oily sheen covering Ramirez’s body, and some noticed a fruity, garlicky odor that they thought was coming from her mouth. A registered nurse named Susan Kane attempted to draw blood from Ramirez's arm, and noticed an ammonia like smell coming from the tube.

She passed the syringe to Julie Gorchynski, a medical resident who noticed manila-colored particles floating in the blood. At this point, Susan Kane fainted and was removed from the room. Shortly thereafter, Dr. Gorchynski began to feel nauseated. Complaining that she was light-headed, she left the trauma room and sat at a nurse’s desk. A staff member asked Gorchynski if she was okay, but before she could respond she also fainted. Maureen Welch, a respiratory therapist who was assisting in the trauma room was the third to pass out. The staff was then ordered to evacuate all emergency room patients to the parking lot outside the hospital. A skeleton crew stayed behind to stabilize Ramirez. At 8:50, after forty five minutes of CPR and defibrillation, Gloria Ramirez was pronounced dead from kidney failure related to her cancer.

Investigation

The county health department called in California's Department of Health and Human Services, which put two of its top scientists on the case, Doctors Ana Maria Osorio and Kirsten Waller. They interviewed 34 hospital staff who had been working in the emergency room on February 19. Using a standardized questionnaire, Osorio and Waller found that the people who had developed severe symptoms such as loss of consciousness, shortness of breath, and muscle spasms tended to have certain things in common. People who had worked within two feet of Ramirez and had handled her intravenous lines had been at high risk. But other factors that correlated with severe symptoms didn't seem to match a scenario in which fumes had been released: the survey found that those afflicted tended to be women rather than men, and they all had normal blood tests after the exposure.

Theories

Possible role of dimethyl sulfoxide

Dr. Gorchynski denied that she had been affected by mass hysteria, and pointed to her own medical history as evidence. After the exposure, she spent two weeks in the intensive care unit with breathing problems, she developed hepatitis and avascular necrosis in her knees. Eager to clear her name and win her lawsuit against General Hospital in Riverside, she and RN Susan Kane contacted Livermore Laboratories for a second opinion.

Livermore Labs postulated that Ramirez had been taking dimethyl sulfoxide (DMSO), a solvent, as a home remedy for pain. Users of this substance do report that it has a garlicky taste. The idea was that through some unknown reaction this turned into dimethyl sulfate, a poisonous gas. However, they were unable to put forth any possible reaction that could have transformed the one to the other, much less a reaction that could realistically take place within a human body.

Allegations of accidental drug mixup and coverup

The New Times Los Angeles conducted an investigative report on the incident and concluded based on their own findings that in all likelihood that the fumes probably came instead from chemicals used to make the drug methamphetamine, and that someone in the hospital may have been illegally manufacturing it or a component of it near the time of Ramirez's death. The article suggested that meth chemicals may have been smuggled out of the hospital in IV bags and that one such bag may have been accidentally injected into Ramirez. The investigation, which included more than 30 interviews and a review of thousands of pages of government documents and legal papers, also shows that crucial evidence disappeared that could have cost the county millions of dollars in damages.

Final conclusion and burial

Two months after Ramirez died, her badly decomposed body was released for an independent autopsy and burial. The Riverside Coroner's Office hailed Livermore's DMSO conclusion as the probable cause of the hospital workers' symptoms, while her family disagreed. The Ramirez family's pathologist was unable to determine a cause of death because her heart was missing, her other organs were cross-contaminated with fecal matter, and her body was too badly decomposed.Ten weeks after she died, Ramirez was buried in an unmarked grave at Olivewood Cemetery.

Status of technical forensic analysis

The possible chemical explanation for this incident by Dr. Patrick M. Grant of the Livermore Forensic Science Center is beginning to appear in basic forensic science textbooks. In Houck and Siegel's textbook, the authors opine that, although some weaknesses exist, the postulated scenario is “the most scientific explanation to date” and that “beyond this theory, no credible explanation has ever been offered for the strange case of Gloria Ramirez.”

Everything that Grant ever speculated or concluded about this incident was evaluated by professional forensic scientists, chemists, and toxicologists, passed peer-review in an accredited, refereed journal, and was published by Forensic Science International. The first paper was very technically detailed and did, in fact, give two potential chemical reaction mechanisms that may possibly have formed dimethyl sulfate from dimethyl sulfoxide and dimethyl sulfone precursors. The second communication gave supplemental support for the postulated chemical scenario, as well as insight into some of the sociology and vested interests inherent in the case.

One of the letters proposed the production of toxic chloramine gas due to urine mixing with bleach in a nearby sink. This hypothesis, previously proposed to the investigators and to the medical personnel involved in the incident, was apparently never considered by all involved. The noxious effects of this gas are documented in the New England Journal of Medicine, Vol.341:848-849,Sept.9,1999, "Severe Lung Injury after Exposure to Chloramine Gas from Household Cleaners". In reality, Grant addressed this chloramine scenario in Ref. 9, and it did not come close to fitting the ER incident.

References

1. Dates from SSDI; Gloria C. Ramirez, SSN 549-57-9201.
2. http://www.simonsays.com/content/book.cfm?pid=409621&tab=1&agid=2
3. For instance, Dimethyl sulfoxide instructs how to use DMSO and mentions that several volunteers in a DMSO test had to drop out because the garlic taste made them ill.
4. Fundamentals of Forensic Science, M.M. Houck and J.A. Siegel, Academic Press, 2006, p. 46.
5. Grant et al., "A Possible Chemical Explanation for the Events Associated with the Death of Gloria Ramirez at Riverside General Hospital," Forensic Science International 87: 219-237 (1997).
6. Grant, "Response to Letters to the Editor Concerning the Riverside 'Mystery Fumes' Incident Analysis," Forensic Science International 94: 223-230 (1998).