Med­i­cal mys­ter­ies sur­round Warm­bier

Level of med­i­cal care he got was un­heard of for most N. Kore­ans

USA TODAY US Edition - - NEWS - Anne Saker Con­tribut­ing: Han­nah Spar­ling, The Cincin­nati En­quirer

An un­re­spon­sive Otto Warm­bier sur­vived months in North Korean care, re­turned June 13 and died six days later. His brief life of­fers mys­ter­ies on the mix­ture of medicine, geopol­i­tics and the will to live.

On Tues­day, the Hamil­ton County, Ohio, coro­ner re­ported no au­topsy was per­formed on the 22 year old’s body at the Warm­bier fam­ily’s re­quest. In her state­ment, coro­ner Lak­shmi Sam­marco de­ferred a rul­ing on the cause of his death.

“No con­clu­sions about the cause and man­ner of Mr. Warm­bier’s death have been drawn at this time as there are ad­di­tional med­i­cal records and imag­ing to re­view and peo­ple to in­ter­view,” her state­ment said.

Warm­bier’s fu­neral is sched­uled for Thurs­day at his alma mater, Wy­oming High School in Ohio.

Univer­sity of Cincin­nati Health doc­tors treat­ing Warm­bier de­clined Tues­day to an­swer fur­ther ques­tions. Warm­bier stayed at Univer­sity of Cincin­nati Med­i­cal Cen­ter since his ar­rival at Cincin­nati’s Lunken Air­port from his 18 months of cap­tiv­ity.

His fam­ily had not heard from him since he had been con­victed of a state crime in March 2016 and sen­tenced to 15 years. Af­ter all that si­lence, the Warm­bier fam­ily and the world learned last week that Warm­bier lived for at least 14 months in a state of un­re­spon­sive wake­ful­ness, or per­sis­tent veg­e­ta­tive state.

Un­re­spon­sive wake­ful­ness oc­curs af­ter a se­vere brain in­jury. The dam­age leaves a per­son un­able to re­spond to com­mands, move or re­spond to stim­u­lus although that per­son can yawn, sleep on cy­cle and breathe with­out me­chan­i­cal as­sis­tance.

The length of Warm­bier’s sur­vival while in un­re­spon­sive wake­ful­ness is re­mark­able be­cause of the mea­ger state of North Korean health care. The na­tion lives with the legacy of the “ar­du­ous or­deal,” a famine in the 1990s that killed as many as a mil­lion peo­ple. While the World Health Or­ga­ni­za­tion says food pro­duc­tion ap­pears to have im­proved, the health care sys­tem is dev­as­tated, and hos­pi­tals lack the ba­sics.

Upon Warm­bier’s re­lease, the of­fi­cial story from North Korea is that shortly af­ter his March 2016 con­vic­tion, Warm­bier be­came ill with bot­u­lism and was given a sleep­ing pill. Un­treated and out of con­trol in the body, bot­u­lism at­tacks the ner­vous sys­tem, breath­ing and heart func­tion. A sleep­ing pill would not coun­ter­act bot­u­lism.

Last week, Daniel Kanter, a Univer­sity of Cincin­nati Health neu­ro­sci­en­tist, de­scribed Warm­bier’s brain as se­verely dam­aged ev­ery­where. From the mag­netic res­o­nance images taken in Cincin­nati, Kanter said Warm­bier’s in­jury most likely oc­curred be­cause his heart stopped, cut­ting off oxy­gen to the brain.

It’s pos­si­ble that bot­u­lism dam­aged Warm­bier’s heart and lungs, but Kanter said no trace of bot­u­lism was found in Warm­bier. There was no in­di­ca­tion that Warm­bier was treated with the cus­tom­ary an­ti­toxin to halt the nerve dam­age.

In another hint about the level of med­i­cal care avail­able in North Korea, Kanter men­tioned a data disc of med­i­cal in­for­ma­tion about Warm­bier col­lected in North Korea, in­clud­ing test re­sults and scans of his brain dated April and July 2016 show­ing pro­gres­sive dam­age. Tests at UC Health showed no traces of trauma or phys­i­cal abuse. One con­clu­sion from the con­di­tion of Warm­bier’s body: He got a level of med­i­cal care vir­tu­ally un­heard of for most North Kore­ans. He sur­vived un­able to com­mu­ni­cate or move for 14 months, so some­one took care of him. He came home in what Kanter called a “well-nour­ished” con­di­tion, so some­one made sure he got nu­tri­tion and wa­ter. Kanter was able to re­view con­tem­po­ra­ne­ous med­i­cal records, so some­one knew the in­for­ma­tion was worth keep­ing.

BILL PUGLIANO, GETTY IMAGES

Lau­ren Wadds ties rib­bons around a tree for Otto Warm­bier’s fu­neral. He died June 19 af­ter an 18-month im­pris­on­ment in North Korea, where doc­tors say his brain was se­verely dam­aged.

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