After nearly six months of investigation into the sudden death of a teenage girl at Saint Joseph Regional Medical Center, the St. Joseph County coroner said he intends to rule her death "natural."
For the parents of 18-year-old Amanda Abbiehl, the coroner's expected ruling is unacceptable.
"It doesn't make any sense to me," said the girl's mother, Cindy Abbiehl. "There is no way you can call her death natural. I will never accept that. It's a cop out."
An initial autopsy on Amanda was inconclusive, and a second examination by Johns Hopkins Hospital in Baltimore, completed in October, offered only a suggestion as to why she may have died.
But the Abbiehls believe there is more to the story of her death, even if they will never know precisely why she stopped breathing in her hospital room.
The Penn High School graduate died July 17, two days after being admitted to Saint Joseph hospital for strep throat, high fever and severe mouth pain. Medical staff planned to hydrate the teen and relieve her discomfort with pain medication, according to the Abbiehls.
Amanda had been communicating with nurses at 6 a.m. the day of her death. She was found unresponsive at 6:20 a.m., according to medical records. Efforts to revive her failed.
Johns Hopkins concluded that the aggressive viral infection the girl contracted may have caused her heart or lungs to malfunction, leading to a fatal cardiac or respiratory arrest, according to its report.
But it is only a theory.
"There is nothing in (Hopkins') autopsy that suggests this is the definitive thing that did this," St. Joseph County Coroner Dr. Michael O'Connell said.
"I'm not too sure what else our pathologist could have done or John Hopkins could have done to say this is the definitive cause of death," he said.
O'Connell said he will likely rule the manner of Amanda's death "natural" rather than "undetermined" based on the findings of the first autopsy and further investigation by Johns Hopkins.
But the Abbiehls still have questions for Saint Joseph Regional Medical Center.
"We elected to put her in the hospital because that's the place where they get the best possible care," Brian Abbiehl said.
"She was dehydrated," Cindy Abbiehl added. "She needed to be watched carefully. Instead she was in a room, by herself, with no monitors."
According to Amanda's hospital records, she was not connected to a heart monitor or a monitor to check her oxygen levels.
Amanda was given pain medication called "dilaudid" that was self-administered by a pump, which can slow the heart rate. The parents also reported Amanda had a constricted airway from swelling in her throat when she was admitted to the hospital.
But O'Connell said neither autopsy found evidence that the girl's airway ever became fatally constricted or that there were dangerously high levels of the pain medications in her body.
In a statement, the hospital said it fully cooperated with O'Connell's death investigation.
"Saint Joseph values both the clinical and compassionate sides of health care as part of our commitment to healing body, mind and spirit," the statement said. "Saint Joseph expresses sympathy to the Abbiehl family at the loss of their loved one and understands the grief they are experiencing."
The hospital has not reached out to the family, the parents said. The Abbiehls said their only interaction with the hospital has been receiving their daughter's medical bills.
"On a personal level, I think the hospital should have done something, shown some type of sympathy at a minimum," said the family's attorney, Pete Agostino.
Agostino added, however, that the hospital has been forthcoming with medical record requests.
Agostino said he intends to request a meeting with hospital administrators and the staff who cared for Amanda to discuss the events leading up to her death.
"No one intended for this to happen," Agostino said. "But the law is, did you exercise reasonable care? Did the hospital or doctor treating her do something they should not have, or fail to do something they should have?"
If the hospital refuses, Brian Abbiehl said, the couple might file a wrongful death lawsuit.
"We're hoping we don't need to go to that level," Brian Abbiehl said.
Amanda would have turned 19 on Oct. 7.
Her body was recently cremated and a monument has been built for her at Fairview Cemetery on Jefferson Boulevard in Mishawaka.
The Abbiehls donated Amanda's memorial money to the Make A Wish Foundation, and money she received for her graduation was used to purchase a bench to be placed beside her monument at the cemetery.
"If it takes every ounce of energy and money that we have," Cindy Abbiehl said, "we are going to find out what happened to our daughter."
Staff writer Mary Kate Malone: firstname.lastname@example.org 574-235-6337