The Baltimore City prosecutor announced today he will not seek homicide charges against a former Johns Hopkins Hospital doctor quoted as saying he allowed a critically ill 81-year-old patient to die because he was "better off dead than alive."
State's Attorney Kurt Schmoke said a four-month investigation by his office into the death of retired steelworker Raymond Strickler turned up no evidence of criminal conduct by anyone at Hopkins, including Warren Summer, then director of the hospital's medical intensive care unit where Strickler died.
Summer was a major figure in a series of Washington Post articles last April on life-and-death dilemmas faced by doctors. He was quoted as saying that Strickler, who was suffering from a variety of respiratory and heart ailments, had not responded to attempts to wean him from a respirator over several months. "I made a decision that there was nowhere for this guy to go and that he was better off dead than alive," he told The Post. Subsequently, Summer said, he turned off the respirator, and Strickler died in the next 12 to 15 hours. Summer said he had not sought the consent of Strickler, who was conscious and could have voiced his opinion, or members of Strickler's family before turning off the machine.
Summer's statements triggered a rash of inquiries to Schmoke's office into whether Summer could be charged with homicide, that is, intentional killing. Schmoke assigned two senior prosecutors and a Baltimore City police investigator to the matter.
After reviewing Strickler's medical records and interviewing dozens of hospital staff members including Summer, Schmoke said today that his office concluded that "no violations of Maryland law were indicated." He said the care given Strickler and other Hopkins' patients mentioned in the Post series was "excellent and highly professional."
Schmoke said his investigators determined that Summer did not intend to remove the respirator from Strickler permanently, and that Strickler did not die as a direct result of the removal. "There were things that happened to him," he said, "not all of which were related to his being attached to the respirator or his failure to be attached to the respirator."
Marvin Ellin, an attorney for Summer, said the respirator had caused Strickler, who suffered from emphysema, also to have arrhythmia, a potentially fatal irregular heartbeat. Keeping Strickler on the respirator thus could kill him by cardiac arrest, Ellin said, while keeping him off it could kill him by lack of air. It was during the process of balancing these two risks, he said, that Strickler died. The exact cause of death, he said, was "chronic and progressive emphysema."
"This was not a death sentence by Warren Summer," Ellin said.
In tape recorded interviews with The Post, Summer said he abandoned efforts to prolong Strickler's life because its quality had fallen below what Summer considered an acceptable level. "I think if I would have asked him, he wouldn't have let me quit," Summer said. "I think he would not have . . . . I decided I knew what his quality of life is." Summer said he later viewed this attitude as a mistake.
Ellin said today these and other statements by Summer, while accurate, were out of context. "They were not intended to apply to Strickler at all," he said, "but more generally to patients very near death, specifically those in extreme pain, where going to extraordinary lengths by artificial support systems is not in the best interests of the patient."
After the stories were published, Summer was pressured to resign as head of the medical intensive care unit at Hopkins for allegedly violating the hospital's policy on patient privacy. Summer, who left Hopkins and now teaches at Louisiana State University, declined to comment.