Ohio Doctor Loses Appeal in Wife’s Poison Gas Murder Case

In Lima Ohio a physician in prison for killing his wife in 2006, has been turned down for a new trial.

Dr Mark Wangler

Dr Mark Wangler

The Ohio Third District Court of Appeals dismissed the argument by Doctor Mark Wangler’s attorneys, challenging his murder conviction. Judge Richard Warren denied the motion for a new trial, the basis of which was juror misconduct.

Wangler’s defense team argued that one of the 12 jurors had intentionally lied on the jury questionnaire about his own criminal history. In his ruling, the judge stated the juror’s background did not change the facts of the case.

Wangler, age 57, was sentenced to 25 years to life in prison, four and one-half years after the death of his wife Kathy. By that time, he had already remarried.

HERETIC COVER 1The former anesthesiologist was convicted in part, according to several jurors, because they could not believe his story of finding her having a “seizure.”  The Paramedics who initially arrived on scene recognized that she had been dead for quite some time before they arrived, and that Doctor Wangler was certainly lying when he reported to the 911 operator that she was having a seizure when he found her. Both the emergency room doctor who examined her, and the coroner who performed the autopsy, also testified that the woman probably had been dead for an hour or longer, before the doctor called 911.

Kathy Wangler (center) in happier times

Kathy Wangler (center) in happier times

The coroner’s report states that Kathy Wrangler died of carbon monoxide poisoning as she lay in her upstairs bedroom. The prosecution was able to convince the jury that Wangler had introduced running car exhaust from the garage into the house, on the night of his wife’s death.

Our Observations:

And people have the gall to ask how and why we became the Paramedic Heretic.

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80 thoughts on “Ohio Doctor Loses Appeal in Wife’s Poison Gas Murder Case

  1. Jon Miller says:

    pretty good insights. I’ll be sure to stop by and read more from you. thanks.

  2. Michael says:

    What wasn’t considered is when someone has a seizure and then undergoes a cardiac arrest, they are stiff because they are unable to re-uptake the calcium released, which requires energy or ATP, which would be unavailable, as there would be no blood flow, or ability to make ATP, since CO has displaced oxygen from the red cells. This would simulate rigor mortis, which normally occurs from calcium release that occurs upon death. This

    • Michael says:

      This inability to re-uptake calcium released from a seizure is what led to the false conclusion that Kathy had been dead for at least an hour, as claimed by the
      ED doctor and EMS. An anesthesiologist is highly trained on rendering someone dead, and it’s unlikely that he or she would utilize a hose, to introduce gas fumes into a home, making it impossible to be in the home, and then after death, with rigor mortis now set in, think of performing cpr, and make up a story about carbon monoxide poisoning.

      • Michael –
        Appreciate your observations as well as your responses. My thoughts to what you have to say are these:

        1. An inexperienced medic could certainly mistake the body stiffness that was apparently witnessed on scene. But I’d say it’s a serious stretch in plausibility to believe both an ER doc and a pathologist would make the same mistake.

        2. I’ve assessed countless hundreds of death scenes, and I can promise you that rigor mortis evolves in fairly consistent patterns, beginning with nuchal rigidity and TM joint, and working its way south over time. The body stiffening subsequent to a grand mal seizure – as was described by Wangler, MD – follows no such pattern.

        3. Stiffening post GM seizure would have no bearing whatsoever on body temperature, and the deceased woman was cold upon arriveal at the ER.

        4. Your belief that a highly-trained specialist wouldn’t resort to crude and even amatuerish tools to kill, is naive. I study physician misbehavior for a living, and doctors are as capable as anyone of being downright ignorant when it comes to murder, unless they are serial killers.

        In the end, I find those who believe in Wangler’s innocence are under much the same delusions as the O.J. Simpson supporters. In order to believe they are innocent, you have to subscribe to a jaw-dropping amount of coincidence.
        And when it comes to homicide, true coincidences are very, very, rare.

  3. Michael says:

    Rigor mortis, or the release of calcium after death will effect the smaller muscles first, such as those of the face and jaw, and gradually set in to the larger muscles, seeming to move south as you state. The fact that calcium was released in the distribution of convulsions, and not taken back up, doesn’t change that smaller muscles are still stiff first. But could speed up onset of stiffness in some limb muscles, causing one to think that death occurred sooner.

    CO poisoning causes a vasodilatory shock and periphreal vasodilation allows rapid loss of heat, causing hypothermia. Someone with alcohol poisoning would also get hypothermia.
    Vasodilation is what causes the headaches, and some comment on a cherry red color, but this is not really seen at death.

    Actually, not many coroners, or even er docs are that up to date on CO poisoning deaths, just how to treat, and even less know about calcium release and reuptake failure in seizure deaths. A good pathologist like Dr. G might know.

    Most coroners are just family docs that got elected to the office, and not pathologists. Most ER docs are not that familiar with masseter spasm with calcium overload, and their ego is such that if the patient didn’t make it, it was probably because the patient was dead a while, and they base that on how tough it was to intubate, ie stiffness, and how cold the patient was.

    As far as OJ Simpson, it just shows me that a jury can get it wrong and that our system is not perfect, OJ’s behavior, like Dr. Essa’s behavior was highly suspect and unusual. Dr. Wrangler was out of the country multiple times and had no issues returning. He hired an attorney, and really wasn’t too worried about much of a defense, as he figured, he wasn’t guilty. Very very niave on his part.

    His use of the same attorney instead of going all out with a dream team for the appeal was also very very niave.

  4. Michael said:

    “Actually, not many coroners, or even er docs are that up to date on CO poisoning deaths, just how to treat, and even less know about calcium release and reuptake failure in seizure deaths. A good pathologist like Dr. G might know.

    Most coroners are just family docs that got elected to the office, and not pathologists.”

    I agree 100%. But Diane Scala-Barnett is neither an amateur nor an elected coroner. She is instead a forensic pathologist who appears more than capable to assemble facts and come to logical conclusions. Kathy Wangler’s lividity for one. She is recognized as a professional in her field and has contributed to some pretty impressive textbooks.

    I think anyone who studies this case ought to be able to see that there was no rush to judgment whatsoever. In fact, the investigation took considerably longer than most cases, because building a Murder case against a reputable MD with no known history of crime, takes time. They interviewed plenty of outside experts and built a logical case.

    As an MD with plenty of time to think, I’d suspect your argument might have been considered by Wangler himself on appeal.

    I personally suspect all the evidence a logical trier of fact might need, can be seen clearly in Wangler’s private diary.

    I believe his diary says it all.

  5. Michael says:

    Not to take anything away from Dr. Diana Scala-Barnett, but she really didn’t establish or address the failure of calcium reuptake in seizures, and how it can simulate rigor mortis, or vasodilatory shock causing hypothermia in carbon monoxide poisoning, nor did anyone ask her if vasodilation could cloud the story.

    While I’m sure she’s more than capable, she is not a Dr. G. I believe Dr. Diana Scala-Barnett got her MD at Universidad Autonoma De Guadalajara, outside the US, and trained in pathology at UTMC, neither program is that strong, while Dr. G trained at the St Louis University School of Medicine, one of the best in the country.

    As I said, it’s not that well known, and it would seem that a lot of people including the medical people involved have just assumed that Kathy was dead a long time, based on the hypothermia and rigor mortis, and it seems Dr. Barnett just went along. I would venture to guess that the ED team also made that conclusion, based on a very short resusitation attempt.

    In any case, we’ve all had time to think thru this case, and they’ll come a day of judgment, after death, when you will find out if you caused tremendous misery on an innocent human being. I would think the One that judges you that day will forgive you for an honest mistake,

    • Michael says:

      I guess I should leave a caveat. If the er doctor, the emt, the medical people, the coroner, the judge, and the lima people had done a simple google search on rigor mortis, they would have realized an honest mistake and just might have come to a different conclusion, and perhaps maybe Dr. Wrangler may have actually been telling the truth.

      http://health.howstuffworks.com/diseases-conditions/death-dying/rigor-mortis-cause2.htm

      Here this website from a simple google search, states….

      “Physical exertion just prior to death: If someone dies while engaged in strenuous activity like exercising or struggling against drowning, rigor mortis can set in immediately. This instant onset, sometimes called cadaveric spasm, happens because the person’s muscles, at the moment of death, were depleted of oxygen energy and ATP. This is why the victim of a violent attack may still be clutching the attacker’s hair or a piece of clothing.”

    • Michael says:

      Since you seem to respect someone who writes forensic textbooks, I’ll quote from a textbook that Dr. Diane-Barnett should or would have read during her residency. It was written by Dr. Charles Catanese and Amy Rapkiewicz, chief medical examiners from NY and trained at Bellevue Hospitat, which is quite intense in comparison to UTMC.

      http://books.google.com/books?id=fe2AcOFdWCYC&pg=PA4&lpg=PA4&dq=onset+of+rigor+mortis+in+sudep&source=bl&ots=l7WOIgKH9_&sig=N9vkIyazAyCmecVL3UuDaeKwM8I&hl=en&sa=X&ei=b2L7UYvDL5G6yAGkjoGgCA&ved=0CDsQ6AEwBQ#v=onepage&q=onset%20of%20rigor%20mortis%20in%20sudep&f=false

      Color Atlas of Forensic Medicine and Pathology
      edited by Charles A. Catanese and Amy V Rapkiewicz

      Charles A. Catanese, MD Medical Examiner, New York City, New York Clinical Assistant Professor of Pathology Department of Pathology SUNY Downstate Medical Center Kings County Hospital Center Brooklyn, New York

      Sudden Natural Death in a Forensic Setting … pg 5

      There is a condition known as sudden unexpected death in epilepsy (SUDEP). The mechanism is unclear but this phenomenon occurs in up to 18% of patients with epilepsy, presumably in those with subtherapeutic levels of anticonvulsants. Autonomic dysfunction has been proposed as a mechanism. ….. Another interesting point to remember is that there is often very rapid rigor mortis formation in deaths directly following static epilepticus due to substantial adenosine triphosphate (ATP) depletion associated with prolonged muscle contractions from prolonged convulsions. Usually there are few pathological findings that explain the sudden death.

  6. Michael – Those of us who deal with thousands of death scenes have no functional need for Google, or any other generalist reference tool. That would be like suggesting an architect use a Cub Scout manual to build a tree-house.

    We use death scenes & homicides & what we already know about human behavioral tendencies, to guide us toward logical conclusions. When you manage thousands of cases, you reach the point where you can see “patterns” with phenomenal accuracy.

    The investigators in this case performed no “rush to judgement” based on any single factor, such as “rigor.”

    Rather, they spent years – think about that, YEARS – assessing dozens of aspects of this case.

    Wangler, MD does not sit in jail today because somebody forgot to check a few basic – and valid – possibilities.

    He sits in jail because the totality of his actions point to guilt.

    It is simply not logical to believe his version of events. In order to do so, you have to suspend reason and buy into a veritable litany of coincidences.

    Now, any goofy coincidence can pop up at anytime in life.

    But when you need a string of oddities to happen at just the right time, in order to prove your innocence, you’re stacking a house of bricks on some very soft sand.

    Wangler MD convicted himself. He did it by his behavior before & after the death of his wife; he did it by things that he said & didn’t say.

    And his personal journal could have convicted him all by itself.

    Thank you for your interest in this case

    • Michael says:

      With power, one can become condescending, and perhaps blind to the truth. No one will judge you, until after death, and then you will have to deal with that day of reckoning.

      I’m assuming that you were informed by medical personel that something was wrong, ie rigor mortis and hypothermia, and then made a conclusion that there was no way that Dr. Wrangler’s version of events were true. I mean how could she have just died, if rigor mortis and hypothermia an lividity had set in? He had to be lying, right?

      You then had to come up with a logical sequence of events of what truly happened, and then set up to prove those events.

      What if the medical personel never informed you that something was amiss, what then? What if what the medical personel told you that what they told you was not true, what then? Now your house of bricks just got built on soft sand, did it not?

      In this case, you concluded that he took a hose, hooked it up to the duct work in the home, and set a fan in his bedroom to push air out, and did all this knowing he had a full day of work the next day. He waited until after death, about 2 hours, then called 911, performed cpr on someone with rigor mortis, and then had her having a seizure before death.

      By your logic, Dr. Wrangler being a physician-anesthesiologist, would have known about “immediate rigor mortis post seizure, and also vasodilatory hypothermia caused by CO poisoning, so he must have lied and orchestrated a setting that would explain these events, not counting on all the medical personel missing this physiological process, and arriving at the conclusion that he just waited 2 hours before starting cpr on a dead body.

      I’m left wondering if he was in the house, pumping all this gas into the home, why he didn’t do the most logical thing as an ahesthesiologist just give himself oxygen, instead of exposing himself to all that carbon monoxide.

      This case is fraught with ilogical events, more than enough to lend reasonable doubt. You have a doctor who is an expert, performing cpr on a dead body ‘2 hours after death’, and an anesthesiologist, an expert on causing death, hooking up a garden hose, to the duct work in a home, pumping in carbon monoxide at great risk to himself, and then this journal where he’s venting and arrive at a conclusion of murder.

      You then have a jury that had a EMT conclude he’s guilty because he did cpr on an air mattress, and his cpr count was off, ie he was using the old count, and another juror that supposedly was a HVAC expert, who turns out to be a former drug addict.

      Yep, sounds like a string of oddities and goofy concidences, except I ‘m left wondering if what really happened is that Kathy really did have a seizure, and CO poisoning did occur, and this whole investigation was because someone made a wrong conclusion that Kathy was dead for 2 hours. when actually it might have been 15 minutes.

      • Michael says:

        You have a doctor who is an expert, performing cpr on a dead body ’2 hours after death’ Think about that. If everyone, even the EMT knew about lividity, rigor mortis, why would not Dr. Wrangler know about it.

        Here you have an anesthesiologist, who has a full day at work, beginning at around 5 am. Someone who knows what rigor mortis is and all about body stiffness. After this carefully thoughout plan and execution of hooking up a garden hose, and pumping CO into the duct work, now waits 2 hours after death, and then performs cpr on a dead body, which he decides has a seizure at the last minute.

        How come this doctor didn’t think about the rigor mortis, during those 2 hours. You would think that he would have factored this in, with the execution of cpr. I mean even the ED doctor and the EMT people knew Kathy had been dead a long long time, right? So what could have he been thinking, with this fake seizure and cpr. How many doctors you know perform cpr on a dead body 2 hours post death, and not consider what any doctor would know about lividity.

      • Michael –

        You are implying that educated, highly experienced professionals would – more likely than not – act and think rationally, in the commission of a crime. Or else they are innocent of that crime.

        I strongly suggest you take a peek at our book “America’s Dumbest Doctors.”

        You should then see – with startling clarity – the logical flaw in your argument: 2,400+ errant doctors are convicted every single year in this country. One of them, a heart surgeon, thought his nurses would never notice the secret blinking camera he installed in their dressing room.

        If you investigate a few wacky doctor cases, you’ll soon see they can be as off-the-chart goofy as anybody.

  7. Michael says:

    I’m going to leave you a gift. It’s a movie that I saw a while back. It’s about life and death, something it seems you deal with everyday, and how as investigators, we see things in black and white, and block ourt ability to look deeper and see the color gray, and to then really see the truth, unbiased by our human perceptions.

    The movie is called “CRASH’. You should watch it. After you watch it, then try to put yourself in the mind of this doctor, who felt so much guilt that with his own money he made habitual trips to an Africa to dig wells for people without running water, and then returned each time, so that he could get arrested. Don’t reply until you see and reflect after the movie.

    This is not a pissing contest, Only someone interested in the truth.

    • Carol Roach says:

      I come years late to this discussion. Michael, you keep changing the basis of your insistence that you are right, even to the point of discussing rigidity occurring early in epileptics with sub-therapeutic levels of medication who experienced seizure which caused death. None of this applies so why bring it up? You seem to require removal of all possible doubt rather than removal of all reasonable doubt.

      • For all his zeal to explain away what medical experts concluded in this case, Michael has found it impossible to answer a question we posed 3 years ago:

        If status post ictal rigidity happened in this case as Michael opines, why did Wangler and his attorneys not argue this possibility when they had the chance?

  8. ankit garg says:

    I, for one, feel the decision in this case was largely based on proof of Dr. Wangler’s motive for killing his wife, rather than any actual proof of the act itself. No plausible explanation for how exactly the crime happened ever surfaced. If the doctor is deemed to be have been so dumb in executing this crime, why are its details still a mystery?

    • Ankit –
      As I see this case, the jury recognized that the physician exhibited each of the 3 key factors necessary to solve any Homicide: Motive, Means, and Opportunity. His motive was no mystery at all: His writings explained it perfectly. The means was poison gas. And he had all the opportunity in the world, because he lived with her and knew her habits.

      As one who investigates physician crime for a living, I am always a bit baffled how anybody of normal mind believes doctors are “too smart” to commit these goofy crimes. It is time for the adoration of people who wear lab coats to stop. The typical doctor is not necessarily any “smarter” than the kid behind the counter at Poco Taco. Unless he or she is a serial killer, they rarely kill people often enough to be any good at it.

      The only “mystery” to me is how exactly the doctor delivered the gas.

      Fortunately, the jury – unlike in the O.J. Simpson case – did not allow absence of knowing every detail to outweigh the astounding preponderance of evidence.

      Thanks so much for writing.

  9. I noticed the Wangler supporter keeps maintaining he did CPR and that it didn’t make sense if she had been dead 2 hours, but who says he did CPR — there was no witness to this. He was the only one who claimed to have performed CPR.

    • Tom –

      You are absolutely right. Wangler’s claim that he tried to resuscitate his wife does not match the known facts in the case. And one fact we do know is that – while on the phone – he waited for the dispatcher to ask if his wife was breathing – not something an MD needs to be reminded.

      Thanks for your comment.

      • Michael says:

        Your logic is this…….

        Many doctors are bad. I have been witness to hundreds of doctors being bad. Wrangler is a doctor….. so therefore he is also bad. Dr. Wrangler murdered his wife, because I have been witness to hundreds of scenes. Nothing else matters and the facts of the case do not change that lots of doctors are bad, Therefore Dr. Wrangler is guilty.

      • Michael –

        Still having a major problem with logic, I see. Pity.

        This doctor’s conviction has nothing to do with my experience. He was found guilty as the direct result of testimony by OTHER medical professionals – people who manage death daily, as I have.

        How many death scenes have YOU managed?

        Ever heard the phrase “the devil is in the details?” Maybe not. Also a pity.

        Here’s one detail: if you plan to debate death scene specifics with someone with a medical degree, best pay serious attention to details. And here’s one:

        The man’s name is “Wangler.” Not “Wrangler.”

        That would be a cowboy.

    • Michael says:

      The CPR was recorded by the 911 operator, and I’m assuming, but probably taken over by the medics when they arrived. No doctor waits for rigor mortis to set in and then begins cpr on a dead body. If you poll the average physician that listens to that 911 call, you’ll find that 90% would not find anything amiss, on whether or not cpr was being performed by this physician.

      The point of contention has to do with a small group of medical people that erroneously concluded that she had been dead for several hours, based on her masseter stiffness, and slightly lower body temperature.

      They forgot that someone who dies while seizing has no way to reverse the muscle contractions, or reuptake calcium, something a high school biology student would have been taught in 10th grade. Reuptake of calcium requires ATP, as it is an active transport process. No ATP production from carbon monoxide blocking oxygen transport, means no mitochondrial production of ATP.

      Kathy was never intubated because of the masseter spasm, and stiffness. No intubation in someone with CO levels of 70 means she had absolutely no change, even with the best CPR in the world. Only a hyperbaric chamber might have made a difference.

      As far as Jason Paramedic, you sound more like a ‘paparazzi figure who collects sensational stories at the expense of the medical profession’ , rather than a real professional with CSI experience, which places you just above tabloid writings. I think your book amounts to about the same level.

      • Michael –

        You continue to exhibit a juvenile level of logic regarding this case. Unfortunately your bias is preventing you from thinking clearly. To wit:Your supposition:
        “The CPR was recorded by the 911 operator.”

        Reality: That’s preposterous. It simply isn’t possible to accurately determine on the phone exactly what may – or may not – be going on across town. In 911 calls from medical professionals, dispatchers have little choice but to accept what they are being told.

        Your statement: “No doctor waits for rigor mortis to set in and then begins CPR on a dead body.”

        Reality: No doctor who has nothing to hide does so. You apparently have no idea that there are at least 409 doctors in prison right now because they killed their spouses, and more than 70 faked resuscitation efforts by doing precisely what you say they wouldn’t.

        Your view: “. . . a small group of medical people erroneously concluded that she had been dead for several hours.”

        Reality: And a small group of non-medical people who were not present, think they know more than the medical folks who saw the body. That’s brainless.

        Your thought: “They forgot that someone who dies while seizing has no way to reverse the muscle contractions, or reuptake calcium.”

        Reality: Emergency people and pathologists see an almost endless string of people who die after seizures. It happens all the time. Your insistence that you know more than they do is childlike.
        “As far as Jason Paramedic . . .”

        Reality: You continue to have a problem with basic reading, which may in part explain your lack of ability to assess facts. The screen-name is Patric Paramedic.Your statement: “. . . you sound more like a ‘paparazzi’ figure who collects sensational stories at the expense of the medical profession, rather than a real professional with CSI experience.

        Reality check: My partners and I have responded to 20,000+ calls since 1979. I’ve been involved in the resuscitation efforts of 1200+ emergency patients. I’ve examined approximately 900 death scenes.
        Tell us all about YOUR experience.

        And finally: “I think your book amounts to about the same level.”

        Really? What do you think about the 44 physicians who contributed to it?

        If you honestly want to take a righteous position in the ‘good doctor – bad doctor’ routine, you’ll put a stop to the ridiculous posture of ignoring the fact that the National Practitioner Data Bank holds files on 250,000 physicians – an appalling number of whom fall under the category of “dangerous.”

        My take is, anybody who chooses to downplay the fact that errant MDs kill & main hundreds of thousands of innocent citizens, has a serious leak in his brain-pan.

      • Michael says:

        Poor Michael –

        He rambles on and on, never doing even the slightest serious research on the subjects of which he opines. To wit:
        “Someone with really not much education, and I take it that you went to some community college and learned how to be a paramedic with some basic courses that anyone with a high school diploma would have been allowed to take.”

        My education at UCSD La Jolla School of Medicine is a matter of public record. Try to keep up.

        And you continue:

        “Here is a case of someone who did die seizing, and paramedics claimed ‘dead a long time’, and this time did something stupid like attempt to blackmail with that information. Again, wrong conclusion my some uneducated medical people.”

        Fact: This case ended in a mistrial; the charges were never proven; the jury had no ultimate finding; and the Travolta’s asked that the case not be retried. So once again, you have no idea what really happened on that death scene, either.

        http://www.cnn.com/2010/SHOWBIZ/celebrity.news.gossip/09/06/travolta.extortion.case/index.html

        And if you think the Bahama EMT curricula compare to UCSD School of Medicine’s advanced field medicine programs, you have a serious leak in your brain pan.

        Time to reload your slingshot. You’re out of ammo.

  10. Hyperbaric Training says:

    Whoa! This blog is one of a kind. Keep up the great work!

  11. Michael says:

    I’m assuming by that comment, you are claiming to have attended a paramedic program at UCSD. II commend you for attaining that certification, and yes I respect that as well as the MD degree attained from mexico (guadalajara) by the forensic pathologist who was on this case. And in no way am I stating the Bahama paramedics do a better job than you, or vice versa.

    However, I am pointing out another instance of a situation where someone dies of seizures, and there is a point of contention as to when the person died. In this case, the paramedics felt that Jett Travola was already dead, and probably should have been shipped to the Morgue, and John Travolta wanted something done.

    The release of liability being signed and whether extortion occured is a moot point as it applies to the Wrangler case. But it easily could have turned into a can of worms, with another claim of it didn’t occur like they said, because he didn’t just die, and it sort of looks suspicious cause rigor mortis has set in, and all us paramedics think he had been dead a long, long time…etc, etc.

    I hope for your sake, someone doesn’t die having a seizure, because you’re going to have to explain why you waited 6 hours before you called someone, as some paramedic is going to claim that body has been dead for hours, based on some basic, and I mean basic understanding of human physiology. Most doctors don’t understand Calcium release from the sacroplasmic reticulum, and the actin-myosin interactions that prevent muscle relaxation from occuring. All they know is that upon death, calcium is released, and somehow rigor mortis sets in.

    Again, in the setting of seizures, calcium is released immediately, and a false conclusion of death hours ago may be reached.

  12. Michael says:

    And you don’t have to take it from me. As I mentioned above, quoting from a forensic textbook by Dr. Charles A Catanese MD, Medical examiner in Brooklyn, New York and Clinical Assistant Professor at SUNY Downstate Medical Center Kings County Hospital… in his book Color Atlas of Forensic Medicine and Pathology under the chapter Sudden Natural Death in a Forensic Setting….. pg 5

    There is a condition known as sudden unexpected death in epilepsy (SUDEP). The mechanism is unclear but this phenomenon occurs in up to 18% of patients with epilepsy, presumably in those with subtherapeutic levels of anticonvulsants. Autonomic dysfunction has been proposed as a mechanism. ….. Another interesting point to remember is that there is often very rapid rigor mortis formation in deaths directly following static epilepticus due to substantial adenosine triphosphate (ATP) depletion associated with prolonged muscle contractionls from prolonged convulsions. Usually there are few pathological findings that explain the sudden death

    The assumption of the ED doc in this case was that because of neck stiffness and masseter stiffness, there was no point to attempting intubation. Hence the code was called 7 minutes post arrival. Without intubation, and even with, an CO level of 70, Kathy probably had no chance of survival. Possibly, she might have made it, post successful intubation, in a hyperbaric chamber. What’s ridiculous, is due to a fundamental lack of basic understanding of calcium release and reuptake at the molecular level, the medical staff here made a wrong conclusion of time of death.

    Dr. Diane Scala Barnett stated… You don’t seize when you’re dead……..but she didn’t understand that you can seize and get immediate rigor mortis, if you do die, so it actually could have happened like Dr. Wangler said. Unfortunately, it will probably take another 10 years for mainstream medicine to catch up and figure this out. Possibly before you die, this conclusion may become an epiphany for you.

    Also for your edification, there is no such thing as a brain pan, or a leak as you claim. The spaces in the brain, the ventricles, contain CSF that is separated from the body by a blood brain barrier. I suppose that with a CSF leak, you could postulate something like that, where you would get a constant dribbling of spinal fluid out of the nose, but this is very very rare, and would predispose one to meningitis.

    • Michael says:

      Just to be fair, we all have perceptual filters that color our view of a situation, and I understand that as a paramedic you’ve seen homicide situations, and have apparently a heightened interest in aberrant physician behavior, which could color your view of this situation. But in this one instance, I believe you are on the wrong side.

      To illustrate, I’ll post this picture of a couple in jail for murder. Their adopted child died and they were found guilty of murder.

      http://shine.yahoo.com/parenting/couple-jailed-qatar-being-accused-murdering-adopted-daughter-135200735.html

      Consider, if one had written a book like the Child Catchers, they probably would have agreed that these 2 Asian-Americans were guilty of the murder of their adopted child. But as Christians living in the United States familiar with the reasons for adoption, we look a the faces of these 2 parents and immediately know they are not guilty.

      But, they are in jail today, with the government and people of Quatar convinced that

      “they ‘bought’ their children in order to harvest their organs, or perhaps to perform medical experiments on them. ”

      Why else would they adopt children genetically different. In their county, it’s unheard of to adopt, no one does it because from a genetic standpoint, it makes absolutely no sense.

      Our system is not perfect, and someone on a jury must attempt to be impartial and remove their perceptual filters in order to make a fair and impartial jury verdict happen. Depending on their intelligence and compassion level, it may or may not happen. Unfortuately, it doesn’t always work that way, especially when media frenzy colors the objectivity.

      Just look at what happened to Amanda Knox.

      Value judgments and prejudices then become hard to push aside, and innocent people then become collateral damage.

    • Lisa S says:

      Please tell me where you practice so that I may avoid you. Your lack of logic and critical thinking skills scares the hell out of me.

  13. Dr Vivienne says:

    I must say as a doctor who has a special interest in forensic science that I find it very, very strange that the defendant, an experienced anaethesiologist, had not assessed the victim’s vital signs before phoning 911 and had to be prompted to do this.

    I believe his emotional connection with the victim would have made this more likely for him to have done as he could have helped her. This is, of course, assuming he wanted to. I don’t believe this behaviour would have been impaired by CO inhalation by him as he had no problems realising he needed to dial 911. He clearly understood the gravity of the situation. In addition to this the most damning points have not yet been raised. Listen to the 911 call…she is lying on the bed and it is 90 seconds into the 911 call before he checks to see if she is breathing!!!!!!! After finding her having an epileptic fit which he says has now stopped??!! And then… he does CPR on the BED! You can’t do CPR properly on a bed. Most mattresses prevent maximally effective CPR, you put the person on the floor (and again, in the recovery position after a fit, but he didn’t do this either). Could he really have forgotten all his training? I don’t think so.

    In addition to this, why would he think CO gas would be a contributing factor on the 2nd storey if the alarm was going off in the basement and he was ok on 1st storey? He should know CO gas rises and hence he should have been affected long before his wife. Yet the first thing he says to 911 is that the CO alarm has gone off and his wife is having a fit…sounds all very staged to me. He is very calm on the call until he is asked if she is breathing, then he sounds so frantic…too many problems with this first 90 sec, I think. Just my thoughts … and that’s before all the problems with the postmortem findings!!!

    • Response to Doctor Vivienne:
      We very much appreciate your comments. We spent many hours looking into this case, because so many non-medical folks seem to believe Wangler MD was unjustly convicted. I must say I have not met a single person who is familiar with critical care, or death scene investigations, who believes Wangler could be anything but 100% guilty. And as you pointed out, his behavior only makes sense if he committed the murder. It makes no sense if he was innocent.

      Thank you and please do write again.

  14. Eve says:

    I am a non medical person, but have had absolutely no problem seeing clearly and without a doubt that Wangler is 100 % guilty.

    A thank you to Dr. Vivenne for pointing out even more common sense and facts pertaining to his guilt. That Wangler would of been the first dead victim because he was on a lower level and that almost every non medical person knows never to do cpr on anything but a flat surface. Wangler waiting for prompts to do cpr ? His pathetic attempt at acting. And what no one has mentioned here so far, his going home to take a shower where a supposed deadly water heater just killed his wife! To me, that is extreme evidence that he knew the water heater was fine.

    What most people dont know is that most cases are circumstansial. It is the totality of physical evidence and the actions of the suspect and victim. Sometimes its just the actions of the suspect before and after the crime. There is a lot of this very thing in this case.

    People like Michael commenting here get caught up on one specific and are blind to everything else. Scary indeed, as Lisa points out and also ignorant as in using Wiki or Google and beoming an instant expert. Vey laughable when he points out that cpr was done because the 911 operator heard it?

    Omg….have to pause here to make a cray cray face. This line of thinking/reasoning will go far and does when 99% of incarcerated killers say they are innocent. Well, they said it……therefore IT IS true!

    I believe Wangler is guilty beyond a reasonable doubt because he……
    went home and took a shower in a supposedly dangerous home.

    He clearly hated his wife What stood out to me in the tv interview was how he humiliated his dead wife (while claiming to love her) by pointing how more than once how fat she was. That is NOT something someone would say about a person they loved, who supposedly died accidently. That is said by a person who still hated her and still wanted to hurt and humiliate her.

    Heck, he practically confessed on tv, in addition to the fat comments, he makes sure we all see what a slob she was and all the money she spent. The money was the catalyst, the last straw. ( it is also clear to me that Kathy is clinically depressed and probably a hoarder)

    So, Wangler (as Michael does here) gets his little bible and picks out specific passages to justify killing his wife aka satan. His journal is of course glaring evidence of his feelings, his intent, his actions and the cherry on top of his religious nonsense…..saying that God gave him the green light and Wangler thanks him !

    Of course his extremely suspect actions regarding the 911 call and the physical evidence pointing to his involvement and guilt. Also, i found it very interesting in how both sons testified to how they all loved and burned candles. How the home was dirty and very sooty from the smoke for the whole time they lived there, yet Wangler all of a sudden decides to paint the home that was never cleaned and maintained before just a few months after the death.

    Although not part of the case, it was clear to me that Wangler being creepy in personality, looks and beliefs needed someone weak and feeble minded in a wife, to make him feel and think he was everything he isnt.

    Lastly, i could see in his face and also in his brain deads wife that they probably truly believe he is not guilty. It is that glazy, knowing all face that so many of these Christian types have. Translation………Wangler thinks he was religiously justfied, sanctioned by God and above the law.

    • Carol Roach says:

      I agree. So many people are unwilling to consider circumstantial evidence when it is often the strongest.

      • Carol –

        You are absolutely right.

        What those of weaker mind fail to acknowledge is an essential aspect of critical thinking. In the absence of ‘circumstantial reasoning.’ humans would be incapable of quickly navigating a stairway, crossing a street or chewing meat.

        The mentally frail tend to believe that eye-witness testimony and confessions are the only forms of evidence that can be trusted. Nothing could be further from the truth. In reality, multiple, questionable circumstances in the same case, within a narrow time-frame, are powerful indicators of guilt.

        In order to believe Wangler is innocent, one has no choice but to believe that a stunning number of coincidences happened almost simultaneously.

        In real life? The odds are mathematically, off the chart crazy, that such weirdness might account for spousal death.

        Thank you for weighing in on this fascinating case.

  15. GV says:

    PATRIC PARMEDIC’s comments are LOGICAL, sound, wise, professional . . . His life EXPERIENCE is obviously vast and I find it insulting to critique a man who is extremely CLEAR with the facts before us. . . .

    • GV –

      Thank you for the kind words. And I very much appreciate your visits to what we believe is a very important subject, and one that is basically ignored by the mainstream media.

      Have a terrific new year.

  16. Michael says:

    Do you always carry on conversations with yourself to try to support an untenable position? PatricParamedic aka GV aka Eve.
    Check out the Central Park Five – a movie about 5 black youths that were incarcerated for the rape and near murder of a white investment banker in 1985. They did 13 years for something they didn’t do. I hope for your sake, you check out what it is that drives you to try to attain some sense of significance with this behavior, perhaps a failure to gain entrance into medical school?

    If that is the case, you can rest your efforts, you didn’t miss that much, doctors are not that awesome to deserve such focused attention from you.

  17. Dr Vivienne says:

    But Michael, you are also driven to correspond extensively on this case. In addition to this, I think PatricParamedic must be particularly clever to change his manner of writing and way of thinking to that of Eve. These two correspondents write in quite different styles. It never occurred to me they would be the same person and I am not by nature of my job a naive individual. I think the extensive debate on this case really just indicates how unusual it is.

    Personally, I would like to see this site extended to non-medical forensic cases too, I saw a particularly interesting and very sad case about a 34yr old apparently happily married woman with 2 young kids (48 hour mysteries, Lina’s heart) recently. From the first few minutes I believed the husband was innocent and the injuries on the woman’s neck in my opinion where not compatible with strangulation (especially given the frothy blood documented to be coming from her mouth). No one commented on the hyoid bone at all so I conclude from this it wasn’t fractured (it would have been very important evidence if it were).

    The husband was arrested but thankfully found innocent as his mother-in-law testified on his behalf. I understand this is the sort of case Michael is concerned about but I don’t believe that this anaesthetist is in the same predicament.

    • Eve says:

      It is no surprise that Michael would subscribe to the alias theory that i am not who i say i am. He is blind to the fact that not everyone is going to agree with him, much less stray from basing his opinion on only one fact of this case. I do not say this to be mean, but anyone who has ever studied a criminal investigation knows that even the medical examiner is going to go far beyond just the medical facts before he makes a determination.

      This case is a perfect example of that. It was not only that the deceased was cold to the touch to the paramedics and the ER doctor, but all the extensive circumstantial evidence. If I had been on the jury, I would have convicted the defendant because of and his actions and words, not the medical evidence.

      On a side note, I also felt both of his sons lied on the stand with their candle and soot testimony. I will also repeat what was the most obvious to me – who on earth let alone a supposedly intelligent doctor, would go back home to shower with a faulty water heater? He did it because HE KNEW there was nothing wrong with it. The bottom line in this case is that they did not need a shred of medical evidence to convict this truly creepy person.

      So, going back and forth with Michael is not necessary.

    • Michael says:

      This back and forth does seem ridiculous, especially as I have never met this anesthesiologist. But the fact still remains that rigor mortis can set in immediately if you seize before death, and CO does cause a vasodilatory shock. It’s my belief that none of the medical personnel involved knew this little known fact. Just like the Jett Travolta case, it can cloud the issue about when and how long it was before death. Paramedics, ER doctor, and forensic pathologist concluded, death occured hours ago. But if it was possible that she died 20 minutes before, that was not considered as a possibility, and that makes it not a fair trail. The rest is circumstantial, and should stand on it’s own in resulting in a guilty or not guilty verdict. But the truth is if you release calcium into the sacroplasmic reticulum, and then die, you have no way to relax muscle fibers, and hence the instant rigor mortis does not mean it was 2 hours ago that you died. John Travolta had to deal with this problem in the Bahamas, when paramedics claimed something was fishy, with the time of death of his son, and what the point was regarding transporting him to the ED, when he should just be taken to the morgue.

      • Dr Vivienne says:

        Hi Michael, your comment re the change in rigor mortis onset after fitting is quite reasonable. I originally made the statement about the CO rising throughout the house from level 1 where the accused was to level 2 where the victim was and the reason it rises was because it was hotter than the surrounding air – if what the accused said was correct.

    • Michael says:

      I’m just curious, and I guess a doctor wouldn’t know this, but if you are one, I would assume that underneath, you would have a science back-ground, and given that background, you would understand vasodilatory shock causing hypothermia.

      You would also know about calcium release causing tetnany and how calcium reuptake needs ATP, for muscle relaxation to occur, and I assume you would know about calcium release with seizures.

      What I’m wondering about, however is your statement that the anesthesiologist should know that CO gas rises. As a scientist, you would know that the molecular weight of CO is about the same as air, 28 vs 28.3, so your comment about CO gas makes zero sense (CO does not rise when compared to air – in fact CO detectors are placed closer to the floor than the ceiling), This makes me wonder about what type of doctor you are, and I somehow doubt pHD. Perhaps an MD? but I doubt that also.

      • Michael says:

        My girlfriend’s father killed himself by starting his truck and enclosing it in the garage. I remember the smell of car exhaust throughout the house for many days!! It was so totally obvious for the next day after we could not stay in house for long without going outside for fresh air.. It was a two story house he lived in and even the whole upstairs I could smell exhaust. I am just wandering if he did it with car exhaust then the police would have smelled it like I did and would be totally obvious. I wander why there was no recreation of turning on car and recreating it in same way to see levels smells and to see if it would leave same soot on walls… Something just doesn’t seem to fit. To ask of his innocence or guilt. I don’t know. But I do know what it’s like going into a house after car exaust has been through it and it was obvious and horrible smelling. So if he did it he definitely didn’t do it with car exaust like the prosecution says!!!!!

      • You raise an interesting point regarding the odor of vehicle exhaust. My quick thoughts are these:

        1. Carbon Monoxide is odorless. It has no smell. A car idling in an enclosed garage would result in an enormous volume of this gas, of course. But anything you smelled was the byproduct of an imperfectly running engine. It is a flaw in logic to assume that all engines would generate the same amount of odor.

        2. If in the Wangler case the gas was “funneled” upstairs to the wife’s bedroom somehow, the gases would be “targeted” and not similar to a large volume of an entire houseful, filling the house when doors were opened.

        3. There is an accepted tenent of logic that appears to be lost on some folks regarding criminal cases, and it is one that was recognized several thousand years ago. It is this:

        If by the totality of the evidence, logical persons agree that someone is guilty of a crime, it is not necessary to figure out exactly how that crime was committed.

        In fact, it is not relevant.

      • Eve says:

        Exactly……it is the totality of evidence, especially in this case. The jurors interviewed in this case said so.

        They didnt care as much about how the carbon monoxide got into the house as they did about the actions and words of Mark Wangler.

        I recently read more about his journals and it seems creepy Mark broke just about all the commandments, not just the one the judge pointed out. He seems to be one of those people who is constantly talking about being Christian out of one side of his mouth while the other is doing something immoral/illegal.

        I also read where a doctor/colleague of his also testified about Mark wanting to divorce/get rid of Cathy but did not want to lose his money. He also had several affairs over the years. Just as Cathy’s mother said…….Mark is basically a very selfsh person who did whatever the F he wanted. He thought his phoney Christian zealotry act would be his alibi to hide behind. Only people dumb enough as his current wife would believe it.

        As being a non juror, the first indication i had he was guilty was his tv interview where he could barely disguise his hatred for his wife. She was dead, but he continued to humiliate and talk badly about her.

        I think the bottom line is that Mark Wangler thought that the jurors would JUST assume because he was a doctor and spouting off about being a Christian that they would vote him not guilty without thought.

        It didnt work Mark.

    • Michael says:

      Hey Patrick, whatever happened to you alter ego, Dr. Vivienne. You know I thought perhaps it was a typo, but after reading thru the posts, Dr. Vivienne is not a doctor, or at least not an anesthesiologist.

      Michael is concerned about but I don’t believe that this anaesthetist is in the same predicament.

      An anesthesiologist is someone who has gone thru medical school and then went thru another 3 to four years in a stiff residency, where by the time he or she is finished has incredible clarity regarding the pathophysiological process of the human body, so much so that they can manage a human body undergoing trauma while in a sleep state. They are the ones that made the changes regarding ALCS, along with cardiologists and critical care docs. It takes one year for an anesthesiologist to complete a fellowship and then become a critical care doc. Anesthesiogists take great pride in their level of training,

      An anesthestist is someone that went thru 2 years of school after high school, then 2 additional years to get a BSN and opposed to an RN, and then 1 year of didactic training, and then a watered down 1 year of procedural training in the OR, to become a cRNA. Often confused by the public, including a Jason Paramedic as an anesthesiologist, they are no where near the same. No real MD would confuse the two.

      • Michael says:

        I have to apologize, and I’ll be the first to admit if I’m wrong about something. Not realizing that Dr. Vivienne may be from England, she is in fact correct in the term anaesthesist in the UK being the equivalent of an anesthesiologist in this country.

  18. Diana says:

    Gosh it is all so confusing, I appreciate this site attempting to clarify the many points being brought forth.

    I can’t get these thoughts out of my head!

    1) There were jurors “familiar” with “HVAC systems and water heaters” and their opinions were used to determine if the scenario of a faulty water heater was plausible. I wonder if this is an allowable method of determining guilt or innocence, i.e.rather than using testimony of experts, they relied on laymen within their own group? Is this the usual practice of juries?

    Our answer: Jurors use their life experiences to make decisions all the time. In fact, the jury foreman is almost always the one with the highest education, or one most familiar with the law.

    2) I fear not testing the “soot” creates a situation where it should NOT be considered evidence both for or against his guilt, leaving it to be considered nothing more than conjecture.

    Note: According to the jurors, they ignored the soot as inconclusive. Sounds wise to us.

    3) Why was there no re-creation of how this crime or accident may have happened? Does that not seem prudent?

    Note: Law enforcement performed numerous re-enactments over the years. They were simply not conclusive enough to be used in court by the prosecution.

    4) If FBI labs declined to do testing on the water heater, as well as other labs, how can so much weight be given to the one lab that was willing to accept money for “testing”?

    Note: I am not aware of any lab – including the FBI – that does not bill for services. Forensic testing is very expensive.

    5) It seems that if conclusions are made (the investigator who believed Dr. Wangler was guilty, basically based on rambling journals and God forbid any of us are somehow found guilty of a crime based on private thoughts that have been put to paper!), then all investigative processes from that point forward would be skewed to fit that script.

    Hate to break it to you, but that “diary” would be considered a blueprint for murder by almost any logical trier of fact, and certainly by juries and psychiatrists. If you believe that much writing about your own wife’s death should be ignored, you are tossing out the logic in favor of emotion.

    6) If the son that testified that these markings were on the walls for years, was anyone else able to either corroborate or dispel that statement? It seems that if the markings had been there for years, there would have been at least one person able to testify to that.

    Note: See answer #2.

    7) I am curious what type of jurors were chosen, specifically their religious backgrounds. I feel this could prejudice them one way or another….I felt some prejudice when they were speaking of the case, as well as the son’s testimony.

    Note: The jurors went through what is called ‘voir dire’ which means both sides are involved in the selection. But it’s a safe bet most jurors carry their own spiritual baggage.

    8) Why had carbon monoxide alarm systems been installed in the first place? In a home that was described as “not kept up or maintained”, I am wondering at what point was this installed; had something happened to cause concern about it?

    Very good question.

    9) The rigor mortis. Seems there is adequate evidence to at the very least counter the belief that Mrs. Wangler had been dead longer than Dr. Wangler reported.

    Note: No, there is no evidence of that. There is certainly an argument that can be made. For those who believe the medics, ER doc and pathologist were all wrong in their assessment, I’d say you need something more than theory to point to. If such a theory was remotely plausible, would you not think Wangler would have used it on Appeal?

    10) The thought that he would not be able to perform CPR because she was on a bed ( or air mattress)? Not to add insult to injury but could her weight have been a factor if he HAD wanted or tried to reposition her?

    Trust me as a Paramedic, weight is always a factor. But I have been involved in more than 1200 CPR cases. I can promise you that when a bystander has performed CPR prior to our arrival, you can ALWAYS tell by looking at the chest. Wangler’s CPR story was assuredly faked.

    11) I know life IS stranger than fiction, but I see no reason why this couldn’t have been an accident. Or perhaps not. But I personally feel the investigate processes were not thorough enough to determine the difference!

    Note: But you were not there when her body was brought into the ER. These people see dead people all the time. For those of us who have done this work for a living, I don’t know any professional who thinks Wangler is innocent.

    Thank you very much for writing. It was indeed a fascinating case.

    • Michael says:

      Our answer: Jurors use their life experiences to make decisions all the time . . .

      Voir Dire is a french word meaning “To tell the truth” In the us, it’s often used to describe a process where potential jurors are interviewed for their potential biases, and suitability as being fit to be impartial regarding this case.

      That’s a politically correct way of saying, “Kick anybody out of the jury pool if they might not agree with our side.”

      In this case, the juror that was the supposed HVAC expert was a prior cocaine addict with priors, which was not mentioned in that process.

      Why wasn’t it? what’s the relevance?

      The EMT was allowed to stay, and her input surely had bias in favor of the paramedics and medical people at St. Rita’s that thought he was guilty.

      So why didn’t the Defense have her removed on Peremptory Challenge?

      Note the video, where she comments that his CPR count was all wrong, and he didn’t seem tired like she would feel after maintaining a count of 30 compressions per minute.

      Are you saying that a professional EMS opinion has no relevance?

      We all put our prior experience into evaluation of a situation. In 2010, AHA placed new guidelines into place, which affirmed data from studies done in 2002, that just fast and efficient compressions alone increase survival by 3 fold.

      No, actually, the pathetic CPR survival rate still hovers around 2%, no matter what.

      In 1979, when acls was gaining a foothold, the count was 5 compressions, and 2 breaths, after giving 2 breaths. The paramedic on the jury would never have known this as she was too young.

      Wrong. We all learn the history and changes in ACLS protocol.

      A 57 year old paramedic would remember this, and would watch Dr. Wangler doing cpr, and think nothing amiss.

      That’s called speculation. You have no idea what an older experienced medic “might” think of that scene.

      But unfortunately, it wasn’t 1980, when Mark first learned CPR, but 2010, when the faster guidelines are now in effect.

      The fact that you call this man “Mark” speaks volumes about your lack of objectivity.

      As I have said in the past, absolutely nothing about this case supports any scenario except that the doctor killed his wife. And a logical person could convict him on his diary, alone.

      • Michael says:

        You know what’s amazing to me is that you expound so much about your terrific paramedic skills, or was i mistaken, and we are talking medical degree, and yet you completely ignore something that has changed in ACLS.

        Dr. Wangler did attend Ohio State Medical School in 1978, and did first learn ACLS and BLS in his freshman year llike all other medical students at that time. Back then the count was 5 compressions to 2 breaths, and bicarb was given every 5 minutes along with calcium chloride. Verapamil was also a drug used, All these drugs are no longer used and compressions are now 30/min without breaths on onset.

        That article I sent you shows that the suvivability has increased by 3 times. Are you purposedly ignoring any facts that don’t support your position. Perhaps you missed your calling and should have attended law school, because you obviously don’t care about what happens to patients, or bother to learn anything that would make an impact..

      • Poor Michael. He tries so hard.

        “Dr. Wangler . . . did first learn ACLS and BLS in his freshman year like all other medical students at that time.”

        Wrong again. SOME med schools teach BLS early on, but most don’t, and none did then. And not one of the known 141 med schools teach ACLS early in didactic because first-year people can’t touch patients or legally push drugs anyway.

        “Back then the count was 5 compressions to 2 breaths, and bicarb was given every 5 minutes . . .”

        So let’s see if I got this straight. You are actually mindless enough to defend a doctor by saying he didn’t bother to keep up on protocols?

        . . . along with calcium chloride. Verapamil was also a drug used. All these drugs are no longer used . . .”

        Where on earth do you get the idea that we don’t use Bicarb in some cardiac arrest cases? Which EMS team do you work for?

        ” . . . and compressions are now 30/min without breaths on onset.”

        Well, the patient is by definition clinically dead, so I suppose if you want to keep them dead, as Wangler certainly did, 30 compressions a minute might do just the trick.

        What planet are you from, Michael? It’s clear you don’t treat emergency human patients for a living.

        Lord have mercy on the witless bloggers.

  19. Dr Vivienne says:

    Thank you for the apology, Michael. In Australia too an anaesthetist is someone who has obtained specialist qualifications in anaesthetics after doing a medical degree. You owe me another apology, though, as I am a real doctor with 25y clinical experience and several additional qualifications to my MBBS. I just don’t feel like corresponding any more as there is so much mud slinging and I have made any points I wish to make. I have more dignity than to continue in this argument.
    Dr Vivienne

    • Michael says:

      Yes, I do offer you and I hope you accept my deepest apology, as I have incredible respect for anyone that went thru the rigors of medical school, as it is not an easy process.

      I too have about 25 years of clinical experience, and actually in 1991, worked shifts with very er doctor that was on this case, I found her to be competent then, and feel that she is competent today. Today, I am board certified in Emergency medicine, but I am also board certified in Anesthesiology and about to begin the process to become board certified in Critical Care. I am also an oral examiner for the Emergency medicine boards.

      As I reviewed this case, I could actually see myself doing the very same thing Dr. Rina Stein did, calling this code 7 minutes post arrival in a very busy ED. I would have figured jaw’s stiff, super high CO level, rigor mortis – no chance, and put it past my ego and I would have told my nurses that this one was a lost cause and no one’s fault, and nothing could be done, because she was probably dead all night long.

      But now also trained as an anesthesiologist, I know what else can cause a jaw to become stiff, creating an intubation crisis situation. Having studied Malignant Hyperthermia, I knew that certain drugs cause flooding of the sacroplasmic reticulum with calcium, causing masseter spasm, tetnany, and tonic clonic contractions, causing rapid CO2 elevation, and a painful death from tetnanic contractions only reversed by iv dantrolene..

      What was amazing about these patients was that in the ones that died, immediate rigor mortis was observed, although no one was exactely excited about publishing about someone that they just lost to Malignant Hyperthermia.

      However, this led me to wonder if one had a seizure just before death, could it be possible that because of inablility to reuptake calcium, can immediate rigor mortis occur. No one really has done this study, but it would be relatively easy to reproduce by inducing seizures in rats with ECT to the brain, along with high CO levels, and then inducing cardiac arrest, and checking muscle tone scores, degrees of rigor mortis at death.

      Notwithstanding the science behind this case, I knew that if my theory was possible, it was possible that Dr, Wangler was then not guilty, then I was left wondering what events then caused this man to end up behind bars.

      Knowing enough about Mapleson circuits, and gas flow, I knew that Dr. Wangler had enough knowledge to end someone’s life in a multitude of ways, and just by running a fan, and creating negative airflow, and closing off certain vents, it would be ever so easy to render someone dead with whatever gas chosen.

      But this entire business of a doctor pretending to do CPR hours after death didn’t sit well with me.

      I know that I have to be up by 5 am and fully awake for a busy day in the OR, and I had visions of this doctor waiting up all night with a full load of cases the next day, and then after he was sure Kathy was dead, claiming a seizure, which would explain why he wasn’t alarmed by her unresponsiveness. Not mention all that would have been involved with hooking up hoses to the car exhaust, the vents, the water heater, the furnace. I mean If he was able to do all that, and still do well the next day, well he was a better man than me.

      So I listened to the 911 call, and asked myself if it could be real.

      As I listened to the call, I thought about the last time I had performed BLS, and when I first took ACLS as a freshman medical student in 1980,

      I recognized the BLS count as the familiar one and two and three and four and five that had been engrained in us for the past decade, and I thought about how many times as an anesthesiologist, we actually did cpr and how watered down ACLS and BLS had gotten over the years, and how really it was now just a joke of a course, that the ancillary staff really didn’t get as much out of now. I listened and I could hear Dr. Wangler whispering, come-on, Kathy, come-on, and I was left thinking, perhaps he wasn’t guilty, but what a shame that would be.

      I thank you for our short discourse, and you are right, all this mudslinging is ludicrous, and I thank you for rising above like you did. I can’t believe that I let myself waste any time arguing

  20. Dr Vivienne says:

    Thanks, Michael. And now, from a psychiatric point of view, isn’t it interesting that this case, above so many others, has stirred up correspondents emotionally in such a way to forget ourselves as we have? What is it about this case, do we think, that has got us all so passionate? Is it the controversy over the 000 call? Certainly the forensic findings. I hesitate to say that perhaps this is why jurors are not allowed to be medically trained (in Australia, anyway)!

  21. Dr Vivienne says:

    Dear Michael and others. yes, there is a whole tonne of knowledge out there from last century and prior that we completely ignore. Unfortunately there is so much to learn and so little time! My father gave me a text book of forensic science and pathology from the turn of last century 1899-1900 and it is absolutely fascinating. For example, I never learned in my obs and gynae diploma that proof on biopsy of airways and lungs for inhalation of any air, mucous or amniotic fluid was proof that the baby died in the birth canal if it was dead when it was delivered. Now, of course, we have scalp ph testing, ctg monitoring etc. Even so, this may not give us the answer (especially with aspiration then intubation and resuscitation possibly clouding the picture.) I guess it might be useful for legal reasons or for the parents’ emotional needs but right now I can’t think of any other reason (esp with 2 teenagers arguing behind me!). This was the degree of attention paid, though, to pathology and science back then.

  22. Dr Vivienne says:

    No, no, you all have it incorrect! The poor man was so traumatised finding the woman’s halved body that he pulled out the knife (hence his fingerprints on it) and carried it away to dispose of so he wouldn’t be accused of killing her, given he found her…but someone else killed her, didn’t they? Poor CO, gets blamed for everything these days! Interesting story. This excuse I have explained (on behalf of the poor man in 1926 falsely accused of murder) is still being used today…

  23. Michael says:

    Travia was long, slender, while Anna was fairly large, possibly obese. In anesthesia, we know obese patients are prone to rapid desaturation and CO2 retention, along with risks for obstructive apnea with CO2 narcosis.

    We know that when you place a slender person and obese person in an air challenged medium, the obese person may not survive, while the slender person would.

    Oxygen alone can cause a respiratory arrest and death, if one has a blunted central chemoreceptor. Dr. Wangler would have known that, and oxygen is readily available to him, if he wanted to cause Kathy’s death. If you are obese with OSA, and a blunted central chemoreceptor, too much oxygen shuts off your periphreal PO2 receptors in the aortic arch and carotid bodies, causing apnea and CO2 narcosis.

    Obesity by itself significantly compounds the inability to get rid of toxic gases like CO and CO2, especially in an air challenged environment.

    Dr. Wangler woke up in such an environment, correctly ascertained the problem, and found his wife seizing when he checked on her.

    While opening the windows and getting his bearings, he discovered that his wife had stopped seizing, but without his usual monitors, pulse oxy, end tidal co2 detector, failed to realize that post seizure, she had become apneic, and failed to immediately start cpr.

    He is guilty of poor resusitation outside the OR setting, a fish out of water, similiar to how a paramedic would perform inside the OR, not knowing what the end tidal moniter alarm meant, or vent disconnect monitor or any of the normal sounds in the OR, such as the asytole alarm, as he would be more attuned to stridor, breathing sounds, screams of pain, and actually be checking for pulse, bp, temp. etc..

    • Dr Vivienne says:

      Re the obesity and oxygen and blunted chemoreceptor abiltiy causing respiratory arrest from centrally caused hypoventilation, I do beg to differ here. You need to have chronic blunted chemoreceptor sensitivity to hypoxia, not periodic. OSA is periodic. If the OSA does cause hypoventilation it may also causes apnoes. Obesity, esp morbid, causes pressure on the chest wall and restiricts air intake. The obesity would have to be very morbid (so the person is bedbound) and I still think, from my experience, that you need additional chronic lung disease such as coad (the ‘blue bloater’) or an acute insult such as bronchitis (but that is a different causation) for someone to have a cardiorespiratory arrest from hypoxia with the administration of oxygen specifically. There are more factors at play if someone arrests from obesity, OSA and oxygen, than just central chemoreceptor sensitivity. I don’t believe ordinary obesity BMI under 35 (would arrest at all with OSA and oxygen.. Also the oxygen needs to be high dose (over 3L per min mask) to cause arrest from hypoventilation.

      • Michael says:

        I agree with most of what you said, but I think you meant chronic blunted central chemoreceptor sensitivity to hypercarbia, and not blunted chemoreceptor sensitivity to hypoxia, as intact periphreal O2 receptors maintain breathing when PO2 drops below 60 mm Hg. Central chemoreceptors are pH sensitive receptors sensitive to changes in CO2 levels.

        It’s true that for most people, this is periodic, and that there are more factors that come into play, While OSA has to do with an obstructive problem of the upper glottic structures, and collapse of the uvula, tongue, etc, pickwickian syndrome has to do with the restrictive component that you speak of in morbid obesity.

        All of these factors, then play into how someone can go into a respiratory arrest while having adequate levels of oxygen.

    • “He is guilty of poor resuscitation outside the OR setting, a fish out of water, similar to how a paramedic would perform inside the OR, not knowing what the end tidal moniter alarm meant, or vent disconnect monitor or any of the normal sounds in the OR, such as the asytole alarm . . .”

      Once again, Michael will deign to tell us what a Paramedic “wouldn’t know.” Among many things that Michael apparently does not know, is that Paramedics do clinical rotations in training – and one of those rotations is ICU. If he really thinks a typical medic wouldn’t be familiar with a respirator alarm or an EKG preset, he’s simply not qualified to weigh in on the matter.

      “He is guilty of poor resuscitation outside the OR setting, a fish out of water . . .”

      He is also guilty of predicting his wife’s death in his diary, and exalting her death to the Almighty after she died as he wanted.

      But Michael remains far too emotionally attached to Wangler to see logic. Fortunately, the jury and the medical professionals on the case were not.

      • Michael says:

        Actually, i wasn’t making a comment about what a paramedic wouldn’t know at atl, but more about what one’s senses are tuned into, as in an emergency situation.

        Anesthesiologists are highly tuned into their monitor sounds, and can tell if someone is hypoxic, and immediately react just to the sound of the pulse oxy they are tuned into. They see a pause or change in the EtCO2 graph, and immediately know if a tube is obstructed, misplaced, and make immediate adjustments.

        A paramedic is best out in the field, when they first arrive on let’s say an accident scene. They rely on what they see, hear at the scene, and are totally focused on the what the patient is doing, and immediately check basic things like airway, breathing, pulse, ongoing bleeding, etc, and make immediate adjustments.

        Rotating thru ICU doesn’t qualify you to manage someone under anaesthesia in the OR. It would be like teaching you what some of the monitors do, and asking you to fly a 747 airplane.

  24. Vivienne says:

    Yes, Michael, I agree that it is hypercarbia. Thanks for correcting me. I should have specified hypoxia is due to hypoventilation but the hypercarbia is what causes central resp depression. I should have taken my own advice and proof-read my own work!!! I always make mistakes when I don’t. (I am also a professional medical writer and editor).

  25. Kathleen Smith says:

    Very interesting reading for sure.

    As a medical professional, I believe many good points are made from all of you, particularly:

    1. My own opinion is – his very forced and staged 911 call, I personally have witnessed docs, nurses and medics caring “for their own” and believe me every remote piece of knowledge you have kicks into gear very quickly and even more effort is made. While its not a human and if you’re a dog lover you will understand…My bulldog choked on a small round bar of soap and by the time I found him and was able to remove it, he was not breathing and had no hr. Something takes over you and it all immediately kicks in, of course a dog is different requiring chest compressions on the lateral aspect of the chest and you have to close their mouths and breath through their nose, but at the time I didn’t know either. His chest was not rising with breaths and luckily my attorney husband just started pounding everywhere on his chest. I knew I had to get some air exchange so I sealed his mouth and breathed through his nose after no success. Bottom line whether he did it or not, I think he was gleeful she was dead.

    2. I believe the man is guilty through so many actions consistent with a very guilty person (and Kathy’s own words to many, that he was trying to destroy her), however with no actual proof of cause of death (i.e. carbon monoxide levels in room, home, etc. hoses showing no evidence, etc. etc. there is not proof).

    It could have just as easily been an accident and one I’m convinced he would have been pleased about. I don’t feel there should have been a guilty conviction without proof. However if the time of death is the major reason for conviction, I do agree his throwing in the seizure issue should have made the defense provide medical experts to support near immediate hypothermia, rm, etc. Did Wangler really not know this was a possible defense? Not being as familiar – what in the end was the main cause of conviction? I don’t think the diary, fake 911 call, etc should be evidence enough. He hated her that’s clear, doesn’t mean he killed her.

    3. My last point is I really felt ill with the very nasty comments made about watered down education and training of crna’s, etc, etc. While I’m not a crna, and am clearly a nurse with many years of experience and education as well as executive nursing leadership, the excellent physicians I work with would not be proud to call you one of their own. By the way, they are not “YOUR NURSES” just like they are not mine even though I have leadership responsibility to make sure they have the tools and environment to provide the best care possible and work as collaborators of care with our physicians.

    Ok last point – we love and respect our EMS guys – working in an urban area with a very high ED volume – almost 90,000 visits, they know their stuff – if it stinks of foul play, they smell it…!

    • Kathleen said: “We love and respect our EMS guys – working in an urban area with a very high ED volume – almost 90,000 visits, they know their stuff – if it stinks of foul play, they smell it…!”

      And they smelled foul play in this case, which is a very big reason Wangler didn’t get away with wife murder, as so many physicians do.

      In order to believe Wangler is innocent, you have to disregard the enormous volume of experience by the medics, cops and physicians in this case. For one thing, I have personally been on well over 1,100 death scenes, both as a medic and as an investigator. And I can promise you nothing about Wangler’s 911 call makes sense. His CPR story would not fake out even a rookie EMT; His practically predicting his wife’s death in his diary and then writing what he did after she died; that and a dozen other “coincidences” more than add up to murder.

      Never forget a Logic basic called Occum’s Razor: In any circumstance where you don’t know how something happened, the simplest answer is invariably the right answer.

      As they taught us in med school, when you hear the sound of hoof-beats outside, a wise person first thinks of horses, and maybe later thinks of cows and camels. If your first thought is of dancing chickens in wooden shoes, you’ve got a problem.

      Thank you for contributing.

    • Dr Vivienne says:

      Oh, I do hope your Dog made it! How horrible for you, you didn’t say the outcome!!! I married my husband partly because I was so impressed with him successfully resuscitating his dog who had an arrhythmia and died. ..yes, I am an animal (not just Dog!) person!!!

  26. Kathleen Smith says:

    Sorry I didn’t provide the outcome – yes he did make! We made a mad dash to the vet and he was sating in the 70’s when we arrived. Had massive pulmonary edema – no white left in his eyes, so I’m pretty sure it was a full arrest. Although locating a hr on a chubby bulldog can be challenging. I might add he also ran under the sofa for a ball and chomped down on an electrical outlet – another 4 day ICU stay – fried his lungs again and oh one more thing – ran onto a pond and fell through the ice – made it again! I know we sound like bad dog parents but he just an accident waiting to happen all the time! He will be five this August and we honestly can’t believe he’s made it this far!

    Sorry to get off topic…I honestly am very happy this man was convicted, for the less than 1% chance he is innocent (in my opinion), the 911 call is the number one smoking gun! Anyone with an oz of medical training would have assessed the abc’s before even making the call or at least at the same time.

    I just wish the investigation was more sound with documented carbon monoxide levels in home throughout and also perhaps some evidence in the hoses or exhaust fumes in the garage, etc. Unless there was evidence and I missed it.

    • Eve says:

      In this case, i would convict on not only the cause of death, but ALL the circumstantial evidence. A majority of cases are tried on circumstantial evidence. Usely, as in this case too, its the culmination of all the evidence that leads to a guilty verdict.
      For instance in this case, his very suspicious 911 call, a doctor adminstering CPR on a bed, his claim she had just died but her body was cold, his journals, his actions, his comment and a huge one….his wanting to go home after being questioned to take a shower ! He wants to take a shower in the house where he is claiming the hot water heater caused the death of his wife?
      Add in his Christian phoniness cause he broke every commandment there is.
      He just though in his limited mind that because he is a doctor and some religous freak, the jury would assume he is innocent.

    • Vivienne says:

      Oh, Good! Bull dogs are more hardy than American women, it seems…(!!) To keep on track, perhaps your Dog’s repeated survival had something to do with the effort involved in saving him!!! I gather you didn’t ring 999 before starting resus?!

  27. Kathleen Smith says:

    Actually he is an English bully – calling 911 did cross my mind but thought they probably wouldn’t come for a dog.
    I’m now in agreement the circumstantial evidence was enough to convict.

  28. Smithy says:

    There is plenty of reasonable doubt in this case NOT to have convicted Doctor Wangler. The hot water heater was absent any evidence to support the prosecution’s theory – and reading his journals into evidence? What a farce! Journals – especially journals kept as part of marital counseling – are private. They do not reflect reality and certainly they do not show intent. This is not justice. This is magical thinking.

    • “Journals – especially journals kept as part of marital counseling – are private. They do not reflect reality and certainly they do not show intent.”

      Oh, on the contrary. Wangler wasn’t writing science fiction. He was writing that he despised his wife and her death would be a relief. Only a fool would ignore this.

      What a person writes in a private journal repeatedly goes to the very essence of motive. Wangler’s “frame of mind” at the time prior to – and immediately after – the death of his wife, is absolutely critical to the case. Any competent investigator of crime knows that a key component to cases is motive. No one in a position to fairly determine guilt or innocence would – in their right mind – deliberately ignore his documented anger toward his wife. That would be incompetent. The privacy of the writings does not trump logical thought – it supports it.

      “This is not justice. This is magical thinking.”

      Wrong again. In the world of EMS, rescue and death scenes, disregarding the assessments of professionals who do this repeatedly for a living – in favor of a tweaked understanding of what you think qualifies as “reasonable doubt” – that is an excellent definition of “magical thinking.”

      Put quite simply, if you have an emergency in your future, are you going to call 911? If so, why would you call experts to help you, if you don’t trust them? The fact is, you call them because you already know they do this work for a living; they gain enormous experience because they apply logic every day; and they are invariably very good at it.

      Look up Occam’s Razor. You’ll sleep better.

      • Eve says:

        I agree the journals not only showed the hatred towards his wife, but also intent when he talks about carbon monoxide. Funny how shortly after he is alive but his wife is dead of c.m. poisoning.
        Also, contrary to the image Wangler wanted to project, especially of being so religious, he lied and cheated on his wife. He could not even play the part after she died and disrespected her by calling her overweight and a slob.
        What convinced me above all, is just one thing. After the wife died, Wangler goes back to his house and takes a shower ! Who would do that ? Stupid and guilty.

      • Eve –

        It is always refreshing to know there are folks out there who can actually apply logic to curious situations. And clearly you are one. Fortunately in this case, so were the jurors.

        It is the simple things – the small behaviors – that often prove to be undeniable. And it is the simple things that are very often glossed over by defenders of the perpetrators. And one of them – as you have pointed out – is his own testimony. If this man honestly believed his wife died as a tragic result of a faulty gas leak, why on earth would he return to the house and trust any gas appliance in the home?

        The answer is, he wouldn’t.

        Thank you for writing.

  29. Jennifer says:

    Michael- GREAT COMMENTS !!! I noticed You show your knowledge and articulate Very well W/O inciting name calling & childish behavior.
    Patrick- On the other hand Took Immediate Issue with ANYONE having a different opinion than him. Which is why HE was quick to jump to the insults on Michael,. Where THEN AND ONLY THEN Michael was defending Himself.

  30. Jennifer says:

    OBSERVATION PATRICK:;
    when you post something people have the right to THEIR OWN OPINIONS & BELIEFS. STOP taking what others post as a Personal Attack on YOU!

  31. IHG says:

    Thanks for getting Dateline interested in this story. I’ve watched two awesome programs on this very interesting case – the Ohio doctor who lost his appeal in Wife’s Murder Case. The Paramedic Heretic’s detail, in this and so many other cases, has touched me deeply. It is seriously shocking how much bad MD behavior goes on around us.

  32. Lisa Turner says:

    I have watched this murder story many times on Dateline reruns. I always think it is so odd that Dr. Wangler claimed an overflowing stinking toilet as the reason why he was holed up in his room with the door closed and a towel under the door. Why would anyone want to stay in the stinky room? Why not go sleep in another room or on the couch?

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