Lab Suggests Mystery Fumes Answer

RIVERSIDE — The mystery fumes that felled emergency room attendants as they treated a dying cancer patient in February were most likely the result of a bizarre chain of chemical reactions in the patient’s blood that produced a potentially lethal gas, officials announced Thursday.

Dimethyl sulfate, which is cited in scientific literature as a chemical warfare agent, was created by an unusual confluence of chemical reactions that began inside the body of Gloria Ramirez, according to chemists at the Lawrence Livermore National Laboratory. Scientists surmise that the chemical is what caused six people to be hospitalized after they inhaled the fumes.

“There are some emergency room personnel who could be very lucky to be alive,” said Riverside County Coroner Scotty Hill, who released the report.

The findings, which scientists say may be amended after peer review, appear to resolve a baffling medical mystery that generated worldwide interest.

Although such an episode has not been previously documented, scientists now worry that it could occur again because it was probably prompted by the use of DMSO, a chemical sold on the black market as a home remedy for aches and pains.

If the scenario occurred, the Lawrence Livermore report stated, it “might be a condition for more widespread concern” in other hospitals.

County officials said they no longer believe that the attendants in the Riverside General Hospital emergency room succumbed to mass hysteria on the night of Feb. 19, as the state Department of Health Services previously concluded.

Dr. Julie Gorchynski, the most seriously injured of the victims, said she found the fumes explanation plausible.

“At least it puts the mass hysteria (conclusion) to rest. That wasn’t doing much for my reputation,” said Gorchynski, who sustained permanent knee damage. “I always knew it was a chemical exposure to something, and I’m happy that they’ve finally come up with it, even though it took eight months.”

But the attorney for the Ramirez family--which, along with Gorchynski and other emergency room doctors, has sued the county--said he remained skeptical.

“The coroner’s office is still saying she died of cervical cancer, but now they’re saying she created a chemical warfare agent that didn’t hurt her,” said lawyer Ron Schwartz. “That doesn’t make sense to me.”

He accused Hill of releasing the report just days before the election to bolster his chances of winning reelection as the county coroner. “He had to come up with something,” Schwartz said.

Russ Kussman, the attorney for Gorchynski, said he still had doubts about the scenario proposed by the Livermore scientists. “DMSO is commonly used, and they’re saying now that everyone who uses it emits a nerve gas? There must have been something else that happened in the hospital that converted it (into the toxin). Otherwise, we’d be seeing a lot more of these incidents in emergency rooms.”

The Lawrence Livermore scientists said the chemical reaction that may have occurred in Ramirez could have been “unique to her specific pathology.”

Respiratory therapist Maureen Welch, who said she still suffers from profound memory loss because of what she breathed that night, said she was “absolutely relieved” that a likely cause of the incident has been identified.

“I’m still concerned for my future health, but when you go into this field, you have to make the choice to be responsible for yourself,” she said. “There are certain risks in emergency room medicine, no matter how obscure they might be.”

Lawrence Livermore scientists said their hypothesis resulted from a scenario re-created in their laboratories. The scenario produced the toxic crystal dimethyl sulfate, which is listed in scientific literature as a chemical warfare agent that can lead to death.

Scientists believe that in the Ramirez case, the progenitor of the chemical reaction was the woman’s presumed use of dimethyl sulfoxide, commonly known as DMSO.

Although it is not prescribed in this country, it is sold on the black market and can be obtained in Mexico, authorities said. It is portrayed in scientific literature as “something of a wonder drug” for its analgesic and anti-inflammatory properties, according to the Lawrence Livermore report.

DMSO is used legally in veterinary applications and as an industrial solvent.

In addition, the cream, which is easily absorbed by the skin, has been used as a carrier to deliver PCP--an illicit drug which, according to Cal/OSHA’s own report on the mystery fumes incident, Ramirez had used.

Although authorities do not know if Ramirez used DMSO, it is metabolized through oxidation to become dimethyl sulfone, which was found in her system. Scientists believe that the creation of dimethyl sulfone in her body was accelerated when paramedics administered oxygen to Ramirez as she was rushed to the hospital the night of Feb. 19, nauseous and in pain.

When attendants drew blood from Ramirez in the emergency room, the relatively sudden and sharp drop in the temperature of her blood--from body temperature to the cool air of the hospital-- could have created dimethyl sulfate, the lethal compound. Her body temperature was too high to allow creation of the deadly compound internally.

Witnesses at the time said they saw crystals in the syringe containing Ramirez’s blood, and scientists now believe those crystals were the source of the mystery fumes.

The step of creating the lethal toxin from the benign dimethyl sulfone was re-created in the Lawrence Livermore lab.

The scientists noted that virtually every known side effect of dimethyl sulfate--short of death--was exhibited by those who smelled Ramirez’s blood. Likewise, virtually every symptom displayed by the attendants was consistent with exposure to the toxin.

Also, DMSO can appear oily, which is consistent with the presence of an “oily sheen” on Ramirez’s body that some witnesses said they saw.

The scientists who believe they cracked the mystery said they relied on “heavy-duty science”--and some serendipity.

“It was lucky that all three compounds that we were dealing with were all listed on the same (chemical resource) page,” said chemist Patrick Grant.

Brian Andresen, director of Lawrence Livermore’s Forensic Science Center, said: “We saw some of the compounds in the blood and we took time to think about it, wonder why they were there and what impact they could have.”

One of the hypotheses panned out. “It was somewhat by chance,” he said.

The fact that, in retrospect, the chemical reaction seemed obvious “is usually the case,” he said.