BY TIM BONFIELD
The Cincinnati Enquirer
For more than 20 years, they were among the hidden casualties of the Cold War - 90 people with terminal cancer, most of them black or poor.
All of them sought care from 1960 through 1971 from doctors at General Hospital (now University Hospital) and wound up in a radiation experiment sponsored by the Department of Defense.
This week, the final chapter of their saga begins.
U.S. District Judge Sandra Beckwith has scheduled a hearing Thursday to decide the fairness of a proposed $4.27 million settlement that includes:
Much like the entire history of the experiments, the legal status of the settlement remains tangled. Most of the families accept the latest offer. Some don't.
- Paying each family of irradiated patients $36,000 to $66,000.
- Getting an apology from a government official.
- Placing a memorial plaque somewhere on the University of Cincinnati campus.
If the disputes cannot be resolved, lawyers predict, the settlement offer will evaporate - resulting in another 10 years of litigation.
''The vast majority of the families want to get this over with,'' said Robert Newman, one of the plaintiffs' attorneys. ''It's been very difficult for some of them to relive the death of their ancestors.''
Even as the final details of the settlement are argued, the lawsuit already has achieved one of its objectives. For the first time since the experiments began 37 years ago, the names of all the patients involved have been made public.
Most of the names have never before been printed - research documents identified the patients only by a study number and their initials. During a 1994 investigation, the Enquirer tracked down the identities of 29 patients. Lawyers later identified several more.
The long-awaited, full patient list reveals that 90 terminal cancer patients were given doses of whole-body or partial-body radiation from a cobalt-60 machine during experiments in the basement of General Hospital.
Patients were told that the treatments were intended to ease their pain. But the purpose of the study was to determine how radiation might affect soldiers on the battlefield. Whether the radiation had therapeutic effect remains the subject of bitter debate.
Of the 90 patients who were irradiated, all but one are dead. Forty-six were men, 44 were women; 52 were black, 34 were white. Racial data was not available for four patients. Among the cases that now have names:
Investigators have long had trouble pinning down the number of patients involved in the experiments. Research papers previously listed 88 or 89 patients. Some reports speculated that as many as 120 patients were involved.
- Donna White Christy, patient 087. She was one of four children in the experiments and is the sole surviving patient. She was 10 years old in 1969, suffering from a type of bone cancer called Ewing's sarcoma, when total body radiation was used to treat her disease. She has declined to be interviewed.
- Carolyn Brown, patient 060, a 49-year-old black woman with breast cancer who died 30 days after total body radiation treatment in 1965. After 150 rad of total body radiation, her white blood cell count plummeted from 5,100 to 3,200 and then to 800 by Dec. 6, 1965 - the day she died. She is one of 41 patients for whom relatives have not been found.
- Margaret Bacon, patient 090, an 80-year-old black woman with lung cancer who got 150 rad of total body radiation in 1969 and died of a stroke six days after becoming the first patient in the group to receive a bone marrow transplant in the experiment.
Now, the lawsuit lists 116 people who were involved in the study: 90 who got radiation, including three patients who got two doses; 22 who were given study identification numbers, but did not get radiation; and four who were considered for the study but never got a number.
Those who did not get radiation are part of the settlement, but their heirs would not be eligible for as much money.
To many families involved, the class action lawsuit has been about much more than money. It has been a way to get answers from reluctant sources and a chance to make a statement about the ethics of human experimentation.
As part of the court record, 31 surviving family members wrote letters about their relatives, the experiments, and whether they think the settlement is fair.
''Losing a loved one is hard enough. No settlement will ever adequately compensate for what was done to these people,'' wrote Penny Anderson, granddaughter of Louis Romine, patient 053. ''The money to be gained is not what's important here. To finally obtain closure and have this wrong be publicly admitted and steps taken to ensure that this does not happen again. .Ç.Ç. that's what is important here.''
Robert Conyers was 14 years old when his mother, Ellen Elizabeth Conyers, patient 024, died in 1962.
''When I first started reading about the radiation experiments in the paper, I had no idea that my mother had been involved,'' Mr. Conyers wrote last month. ''After some research and more reading, the certainty of her involvement was determined. I had never before felt such hurt, rage or anger.''
Charles Davis, son of Charles Davis, patient 062, wrote: ''Not telling the victims or their families the real reason for the whole body radiation was an atrocity committed by our government and those doctors who knew the experiments were being done for the military. .Ç.Ç. It is sad and hard to believe these types of military experiments happened all over the country and were covered up for years.''
About the experiments
Here is what happened in the basement of General Hospital, according to court documents and other records obtained by the Enquirer:
During the hottest years of the Cold War, Dr. Eugene Saenger - the father of the nuclear medicine department at General Hospital and a world expert on radiation - started an 11-year study to measure the physical and psychological effects of radiation on humans. The study was supported by $651,000 from the Department of Defense. The military wanted to know what would happen to soldiers exposed to atomic attack and how to treat them.
Patients with solid tumor cancers (lung, colon, breast, etc.) were selected. Researchers wanted people with stable blood cell counts and body weight. In later years, attempts were made to add more white people to the study and to include younger, healthier cancer patients who could participate in follow-up research.
The patients were exposed to total body radiation as high as 200 rad, or partial body radiation up to 300 rad. The military interest in the different doses was to predict the effects on soldiers and civilians who may have had some cover during a nuclear attack.
After giving the radiation, researchers looked for signs of vomiting, diarrhea and loss of appetite. They tracked blood cell counts and took frequent urine samples. Some patients went through a battery of psychological tests.
Medical staff were ordered not to warn patients about side effects the researchers wanted to study, such as nausea and vomiting. Some patients even were kept in rooms away from the Tumor Ward, where most cancer patients stayed, in a deliberate attempt to prevent subjects from discussing their treatment.
In 1973, researchers reported that 56 percent of the patients reported feeling better from the treatments. Yet most patients experienced nausea and many endured loss of appetite.
For some patients, at the higher doses, the radiation caused so much blood cell damage they needed bone marrow transplants, a now familiar procedure that doctors barely knew how to do in the early 1960s.
Years ago, Dr. Saenger wrote that the radiation exposure may have contributed to at least eight deaths. But in a congressional subcommittee hearing in Cincinnati in April 1994, he recanted.
Dr. Saenger - who has cancer himself and will be 81 years old next month - contended that rapid downhill courses experienced by some patients were due to their cancer, not the radiation. Critics have claimed the experiments hastened the death of at least 20 patients.
The Cincinnati radiation experiments were reviewed by the Advisory Committee on Human Radiation Experiments, a task force formed by President Clinton in January 1994 that eventually identified 4,000 human radiation experiments sponsored by the federal government between 1944 and 1974.
In October 1995, the committee criticized several aspects of the experiments, but left the issue of compensation to the courts. After 18 months of study, the panel found only three cases, involving about 30 people, that clearly warranted compensation.
In part, the committee's recommendation reflected several gray areas inherent in the Cincinnati case. Those gray areas help explain why this case is headed for a settlement hearing instead of a full-blown trial.
Unlike some experiments awarded compensation by the government, the Cincinnati tests were not classified secrets. The tests were civilian data supplied to military agencies.
Unlike experiments that never had any chance of benefiting the patients, there is evidence that the Cincinnati experiments helped at least some patients.
Dr. Saenger and other co-researchers maintain to this day that the radiation was intended to help reduce pain. While some patients may have been severely harmed, others were clearly helped. The key evidence: a patient who survives today.
''Dr. Saenger remains convinced that the work they did was intended to help people and was valuable,'' said his attorney, R. Joseph Parker.
Was there consent?
Although families claim patients in the study did not give informed consent, the issue remains fuzzy.
The patients were told that they were participating in an experiment to treat their cancer. It would not be a cure, but might help relieve their pain.
Written consent forms were not used until 1965. Consent forms detailing the risks of bone-marrow transplants were used only in the late years of the study, and none of the forms said the patients faced potentially fatal risks.
The extent of oral communication with patients is a matter of dispute. Researchers say the treatments were explained in detail. Several patient families claim they were told little or nothing.
If such a study were to be conducted today, even defense attorneys agree that the lack of detailed consent forms would be considered highly unethical.
In defense of the researchers, their attorneys say, the concept of written informed consent was new in the 1960s and not uniformly practiced.
Yet even in the 1960s, doctors agreed that informed consent was needed to use healthy people in experiments. But for sick people, the guidelines were not so clear.
''One cannot judge the actions of the '60s by the standards of the '90s,'' Mr. Parker said.
Still, plaintiffs attorneys argue that the experiment violated basic ethical standards well understood by all doctors then and now, including the centuries-old Hippocratic oath, which requires doctors to first do no harm.
They claim doctors knew it was wrong to give patients a risky treatment with dubious chances of success, especially without clearly explaining it was part of an experiment that had nothing to do with curing cancer.
Barbara Mathis, niece of Lula Tarlton, patient 010 in the study, wrote: ''Thirty years later to find out that the U.S. government used poor and black people as radiation experiments without consent is morally wrong and a violation of human rights. To find out it was total body radiation to determine what would be the effects of a bomb doubles the grief I felt 30 years ago.''
Coming to terms
In agreeing to settle the case, none of the researchers, nor the University of Cincinnati where the team worked, nor the city - which owned General Hospital at the time - will admit any wrongdoing. Nor will they issue an apology.
The apology would come from the federal government, the original sponsor of the tests, as part of a side agreement with patient families.
Except for a handful of families that want the right to sue for more money, all sides want to avoid the cost and emotional burden of more litigation.
Many surviving family members are senior citizens. Nearly all the researchers are retired.
Doris Baker, great-granddaughter of Gertrude Newell, patient 20, who helped form the Cincinnati Families of Radiation Victims Organization, spent three years hounding the government on behalf of the families. She often paid out-of-pocket for research materials and transportation to various hearings. Now, she wants to rest.
''We had to fight many hurdles to get where we are now ... Our hearts are heavy. I for one can't take much more,'' Mrs. Baker wrote in January.
LIST OF PATIENTS