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MINNEAPOLIS-Although credible neurologists frequently dispute the accuracy of a diagnosis of persistent vegetative state, some cases are open and shut. The case of Terri Schiavo is one of those, says neurologist Ronald Cranford, MD, who has examined her.

In emphatic tones, Dr. Cranford, a professor of neurology at the University of Minnesota Medical School, said in an interview that the real take home message from the Terri Schiavo case is this: "no credible neurologist came forward to challenge that diagnosis."

Dr. Cranford is one of several neurologists who examined Ms. Schiavo during 7 years of litigation over the removal of her feeding tube. After those years of involvement, he offers these observations about the players in the Terri Schiavo drama:

• Senate Majority Leader Bill Frist, MD: "I am outraged by [his actions]. It really surprised me that Frist would be such a fool as to be relying on these videos and to rely on the opinion of [William] Hammesfahr. That is shameful." Dr. Hammesfahr, a board-certified office-based neurologist, is not a member of the American Academy of Neurology.

(The office of Sen. Frist, a cardiothoracic surgeon, said in a statement: "Before addressing the Senate concerning Terri Schiavo last Thursday, Sen. Frist carefully reviewed medical information, records, video tapes and sworn affidavits that were in the court records. He spoke with physicians involved in the case. He noted that some doctors have concluded she is not in a persistent vegetative state and could improve with therapy.

("The suggestion by some," the statement continues, "that Sen. Frist was making a 'diagnosis' in the Schiavo case is absurd. Nowhere in his comments was he substituting his opinion for others. But with medical experts split on Terri Schiavo's condition and a woman's life at stake, he suggested the court solicit additional tests and attempt to reach a medical consensus on her condition. Specifically, he recommended current and complete neurological examinations, which she has not had, using the most up-to-date medical technologies.")

• William Hammesfahr, MD, a neurologist: "He has no credibility - none whatsoever," said Dr. Cranford. "During the evidentiary hearing he testified that Terri's condition could be improved by treatment with vasodilators. There is not a single study in peer-reviewed literature to support that statement."

(Dr. Hammesfahr, in response, commented that "Dr. Cranford is ill-informed.")

• William P. Cheshire, MD, a Mayo Clinic Florida neurologist who maintains that Terri Schiavo is in a minimally conscious state based on his review of videos, medical records and time spent observing her in her hospice room. Florida Governor Jeb Bush sought state custody of Terri Schiavo citing Dr. Cheshire's diagnosis as new and compelling evidence. "In The New York Times I said he was a bogus fanatic," said Dr. Cranford. "That's not true. He is a genuine fanatic, he is a religious fanatic. But I must say that he handled himself credibly in this case, as opposed to Hammesfahr and Maxfield."

• William Maxfield, MD, a radiologist who also testified at a 2002 trial in support of Ms. Schiavo's parents' position. Dr. Maxfield testified that treatment in a hyperbaric oxygen chamber would increase oxygen in Schiavo's brain, which could - potentially - improve her condition. "He isn't even a neurologist, so he couldn't do a neurological examination," said Dr. Cranford.

(In response, Dr. Maxfield said that he considers he comported himself quite credibly, relying on a vast experience over the years with end-of-life patients. He noted that because he is not a neurologist he deferred to those specialists for a full neurological exam on Ms. Schiavo. He also pointed out that as a radiologist he possesses more expertise than Dr. Cranford does in interpreting Ms. Schiavo's brain scans. Finally, he said that other patients with severe neurologic injury, present for years, have responded positively to noninvasive hyperbaric oxygen therapy.)

• "Michael Schiavo is very genuine," said Dr. Cranford. "He is the hero in this case. One reason is that he is a real man of principle. He has no real money left. There is no financial issue here; he is just a good husband, who has moved on with his life, while staying loyal to his wife. What's wrong with that? Terri doesn't want to live like this, 81% of Americans don't want to live like this. Terri wants to die and he is loyal to her wishes."

• Mary and Bob Schindler, Terri Schiavo's parents: "I have great sympathy for the Schindlers," said Dr. Cranford, "In their hearts they really believe that she is interacting with them. They're wrong, but they are in this for the right reason because in their hearts they can't believe that that they are wrong about this. This isn't unusual for families. It is no one's fault that a family cannot accept reality."

• Melvin Greer, MD, a former president of the American Academy of Neurology who, along with Dr. Cranford, testified in support of Michael Schiavo at the 2002 trial, and Peter Bambakidis, MD, the court-appointed expert at the 2002 trial. Drs. Greer and Bambakidis testified that Terri Schiavo was in a persistent vegetative state. "All credible neurologists," said Dr. Cranford.

Dr. Cranford also offers this additional information from clinical records presented during years of litigation:

• CT scans in 1996 and 2002 revealed extreme atrophy.

• An EEG done on July 8, 2002, demonstrated "no evidence of cerebral activity" and another on Oct. 4, 2002, did not reveal any definite brain activity although most of the tracing was "obscured by artifact from muscle and eye movement."

• A deep brain stimulator was placed in Ms. Schiavo's brain on Dec. 12, 1990, but this experimental procedure did not result in any improvement in her condition. The procedure was done at the request of Michael Schiavo, who flew his wife to San Francisco for the operation.

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