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Doctors Update Situation of Comatose American; President Trump Reportedly Now Under Investigation. Aired 3-3:30p ET

Aired June 15, 2017 - 15:00   ET



BROOKE BALDWIN, CNN ANCHOR: You are watching CNN's special live coverage here from our nation's capital. I'm Brooke Baldwin. Thank you for being with me.

Just a couple hours from now, Republicans and Democrats will come together to play baseball, despite the vicious attack on so many Republicans here just yesterday morning, including the number three Republican in the House, Congressman Steve Scalise, who actually just underwent his third surgery.

But we're going to pull away from that story.

In just a moment, we're about to be briefed by doctors in Cincinnati, Ohio, taking care of American man Otto Warmbier, who had been in a coma in North Korea for months and months.

Let's listen in.


UNIDENTIFIED FEMALE: ... and rehabilitation medicine.

Dr. Jordan Bonomo, neurointensivist with the U.C. Gardner Neuroscience Institute, associate professor and director of the U.C. Department of Emergency Medicines Division of Critical Care, and Dr. Brandon Foreman, neuro-intensive care specialist with the U.C. Gardner Neuroscience Institute and U.C. professor of neurology and rehabilitation medicine.

Before we begin, we want to make clear that our physicians' comments will focus on what we know today regarding Otto's medical condition.

We will begin with Dr. Kanter, who will provide a summary. We will then accept questions regarding fact -- we will then accept questions and will conclude this gathering in approximately 20 minutes.

At that time, we will then accept questions regarding fact-checking. And you can talk with Kelly Martin, who is down in front here, regarding any facts or information contained in the press materials you have received.

Please note, our physicians will not be granting individual interviews and a copy of Dr. Kanter's remarks will be provided to you as you exit today.

Dr. Kanter?


Our purpose today is to describe the medical and neurological condition of Mr. Otto Warmbier, who arrived at our medical center approximately 40 hours ago.

The Warmbier family has given us permission and has asked us to disclose his medical condition. Mr. Warmbier arrived in Cincinnati at approximately 10:00 p.m. on June 13. Dr. Jordan Bonomo and the transport team met the aircraft and assumed care of the patient at the airport.

He was transported to the Neuroscience Intensive Care Unit at the University of Cincinnati Medical Center, where Dr. Brandon Foreman and his team were waiting.

An extensive series of imaging and diagnostic tests began immediately upon his arrival at our hospital. Throughout this process, the Warmbier family has been at their son's bedside, and information has been continuously shared with them.

His vital signs were stable upon arrival, and have remained so. He requires no supplemental oxygen or respiratory assistance. He has no signs of infection or dysfunction of the major non-neurological organs. His neurological condition can be best described as a state of unresponsive wakefulness.

He has spontaneous eye-opening and blinking. However, he shows no signs of understanding language, responding to verbal commands or awareness of his surroundings. He has not spoken. He has not engaged in any purposeful movements or behaviors.


His exam shows a spastic quadriparesis, which means he has profound weakness and contraction of the muscles of his arms and legs. The most important diagnostic test thus far was a magnetic resonance imaging scan of the brain.

This study showed extensive loss of brain tissue in all regions of the brain. We have no certain or verifiable knowledge of the cause or circumstances of his neurological injury.

This pattern of brain injury, however, is usually seen as a result of cardiopulmonary arrest, where the blood supply to the brain is inadequate for a period of time, resulting in the death of brain tissue. We received copies of brain MRI images from the medical personnel in North Korea.

The earliest images are dated April 2016. Based upon our analysis of those images, the brain injury likely occurred in the preceding weeks. At the request of the family, information regarding his prognosis, prospects for improvement and future care and treatment will remain confidential.

Throughout this ordeal, the Warmbier family has shown remarkable courage, strength and compassion. On behalf of the medical staff, nurses and associates of the University of Cincinnati Medical Center, I can say that it is our privilege to care for their son and brother.

Thank you.

UNIDENTIFIED FEMALE: At this time, we will accept questions.

Please raise your hand. And Kelly Martin to my left, your right, will acknowledge you and bring a microphone to you, so that everyone may hear your question.

QUESTION: Hi there. Josh Glancy from "The Sunday Times of London."

You spoke about cardiopulmonary arrest. What kind of things might cause cardiopulmonary arrest? I mean, because it sounds to me like, you know, physical abuse might be something that could bring that on. Could you say a little more about that?

DR. JORDAN BONOMO, UNIVERSITY OF CINCINNATI HEALTH: We have no certain or verifiable information about what happened to Otto prior to his departure from North Korea, but, in general, one of the more likely causes of a cardiopulmonary arrest in a young person would have been a respiratory arrest.


On your MRI scans that you did of Mr. Warmbier, did there -- was there any indication of a trauma to any part? Were there any fractures, anything in the head or parts, other parts of the body? And would you know, if he were in a coma for quite some time, if he had suffered a heart attack or something that would cut off blood supplies to the brain?

Would you be able to tell at this point that he suffered botulism, took a sleeping pill, had some other cause, some allergic reaction or some sort of reaction to something he took there?

KANTER: Well, there are several questions put together there.

Dr. Foreman will answer -- address the botulism question. Let me address the question of injuries.

Among the battery of tests we performed, we examined all the long bones of the body, a skeletal survey. We have looked at the bony structures of the ribs, the pelvis, the skull, and he has had C.T. scans of the chest, abdomen and pelvis.

In those scans, we see no evidence of an acute or healing fracture, including the skull. The botulism question...

DR. BRANDON FOREMAN,UNIVERSITY OF CINCINNATI HEALTH: Yes, as it relates to botulism, so, botulism, as you know, it's a toxin that causes nerve injury. And so, as part of his evaluation with us, we performed electromyography, nerve conduction studies. Those tests did not provide any evidence of active or chronic denervation, nor any repetitive stimulation that would suggest active botulism at this time.



FOREMAN: It tends not to, and so the chronic denervation was really what we were looking for, and we didn't find any evidence of that.

QUESTION: Sheryl Stolberg of "The New York Times."

Can you talk about how long a patient in this kind of condition might be expected to go on?

KANTER: At the request of the family, issues regarding his future, his prognosis are subject to ongoing discussion.

They wish us to keep those discussions private and confidential, so we will refrain from speculating about what might happen in the future to him.

It would overlap with our private discussions with the family too much.

QUESTION: Ron Mott, NBC News.

I'm wondering. You spoke a little bit about botulism. In your professional opinions, what's the likelihood or the plausibility of the story put forward by the North Koreans that botulism, plus a sleeping pill, led to this result? Have there been cases similar to this where that particular combination -- it seems very rare and sort of random.

I just wanted to get your professional opinion about the plausibility of that explanation from the North Koreans.

FOREMAN: It would be really hard to speculate on anything related to his condition or treatment prior to his departure from North Korea at this time. It would be very difficult for us to say. We have limited information about that time period.

QUESTION: Cristina Corbin, FOX News.

I just wanted to clarify, Dr. Foreman. You say you didn't find any evidence whatsoever of botulism at all?

FOREMAN: That's correct. Yes.

QUESTION: Linzie Janis, ABC News.

You said something about -- about a respiratory arrest. What would trigger that? BONOMO: There are many causes of respiratory arrest. They can extend

from intoxication to trauma. There can be other causes in a young person, but, in general, respiratory arrest in a young, otherwise healthy people, it's a rare event, generally caused by something caused by something like an intoxication or traumatic injury.

QUESTION: John Bedell with WHIO TV in Dayton.

For any three of you, the -- what Otto has suffered in this brain, is this -- are we talking irreversible damage? Can he recover from this? But what is his brain going through or will it go through long-term?

KANTER: As I delineated, there is severe injury to all regions of the brain, but because of the family's sensitivity, we're going to refrain from discussing what that holds -- what the future holds for him.

QUESTION: Anne Saker from "The Cincinnati Enquirer."

Given his condition, can you tell if he has been given good care for the last year-plus since he has been in this condition?

KANTER: We still, of course, don't know for sure what transpired before he arrived.

We can describe his condition upon arrival. His skin was in good condition. And he was well-nourished when he arrived at our facility.

QUESTION: Amanda Kelley at WLWT.

I was wondering how difficult it is for all of you to treat a patient that has such a gap in his medical history. I know that that's very important when anyone goes to the doctor's. What has it been like for you?

FOREMAN: Yes, that has been -- certainly, that has been a challenge. I think one of the things that we did as well as part of his care team is, we really performed a very comprehensive set of evaluations and diagnostics up front within the first 24 hours.

We had a great deal of information. And that allowed us to make a lot of inferences about his condition. And so by working with such a great team, I think we had a lot of great information that we weren't able to get with the missing records and missing information that you point out.


KANTER: We have no ongoing relationship. These scans were present on a disk, just the material, and they came with him with the air transport service.

There are two scans on the disk. They are dated April and July 2016. That's the notation. Of course, we can't verify that.

[15:15:01] His current scan is consistent with evolution of changes that were

visible on those scans. The word extensive in his case refers to severe loss of tissue. So...



So -- so, the final common pathway is the lack of blood flow to the brain for long enough to destroy brain cells. This can occur from a cardiac arrest alone, where the heart stops pumping blood, or from a respiratory arrest where there is inadequate oxygen supplied to the body, at which point then the heart will stop functioning correctly.

It's difficult to determine which of those occurred, of course.

MARQUEZ: And how does it work? Sorry, Miguel from CNN.

How does it work? So if one suffers that sort of event, where the blood stops flowing to the brain, is the damage done all at once, or what was that evolution of change that you saw from March -- I'm sorry -- March to July, and then presently, what we have? Did it get progressively worse, or was this -- all the damage done in one go?

KANTER: The evolving changes on the MRI are consistent with tissue -- tissue evolution, not new damage. So as the tissue is initially damaged, the body tries to remove the damaged tissue.

So, those are the kinds of changes we're seeing is the removal of the damaged tissue by the body's own internal housekeeping mechanisms.

But the damage to the brain from a cardiopulmonary arrest occurs within minutes of inadequate blood flow. And...


BONOMO: We do see respiratory arrest from overdose, for medication overdose, intentional and otherwise.

It would be inappropriate for me to speculate about the intent or whether this was a misadministration of medication. Again, we have very limited information about what happened to Otto prior to his departure from North Korea.

QUESTION: Two quick questions here.

One, Mr. Warmbier in his press conference today criticized the North Korean regime about withholding top-notch medical care from their son. I just wanted to get your opinions about whether, in this ordeal, you think he has had access to top-notch medical care.

And then the second question, the term you mentioned, unresponsive wakefulness, and that he does have some eye movement from time to time, can you tell if there is any recognition on his part about his surroundings?

FOREMAN: I will take both of those.

So, in terms of his medical care and North Korea, we have absolutely no information about the care that he received there. So, there's no way I can speculate on his care there.

What I can tell you is, here, we have really taken a lot of effort to make sure we have addressed any problems that he may be having, including his comfort, including symptoms related to the extensiveness of his brain injury.

With regard to the state of unresponsive wakefulness that he is currently in, the way that we evaluate him to be able to determine that is based on a lack of consistent and persistent responses to stimulation within his environment.

So, as we attempt to interact with him, give him verbal direction or verbal cues, he has no consistent responses to those. In our evaluation, based on standard coma recovery scale scores and those sorts of things, in addition to our imaging and electrodiagnostics, we don't feel at this time that he has any conscious awareness, that he is in this persistent -- excuse me -- in this unresponsive wakefulness state.

QUESTION: Sorry. I just wanted to follow up. Were the scans that you got from the North Koreans the entirety of everything you got from them? Were there any other files?

And are there any other signs of choking or drowning or anything else to the soft tissue that you might be able to tell from the scans you have done?

KANTER: I can take this.

So, there was a C.T. scan of the soft tissues of the neck performed as part of our extensive series of tests. At the present time, the study looks normal. We did receive a few pages of laboratory value reports from North Korea, which are numerical values of various blood tests with dates.

They did not, however, shed light on the circumstances of light on the circumstances of his injury or the exact cause.


QUESTION: Ann Thompson, WVXU here in Cincinnati.

So, of course, the speculation was that he was badly beaten, so what, if any, evidence did you see on the MRI of any injuries or trauma like that?

KANTER: The MRI -- as I said previously, the type and pattern of damage we see on the MRI is normal -- is not the type we normally see with traumatic brain injury. It's the type we normally see with cardiopulmonary arrest.

QUESTION: Thanks. Dake Kang from the Associated Press. Just wanted to ask -- I mean, it sounds like there's various kinds of

information, I know it's patchy, but from the North Koreans, including these blood tests, these disks with the scans.

I wanted to know if there was anything -- like everything and anything that they might have told you, any kind of information, any kind of -- all kinds of files. What did they tell you? What is the totality of what they told you, what kind of information you have received from them?

KANTER: We have had no direct contact with the North Korean medical authorities.

UNIDENTIFIED FEMALE: We're going to take two more questions.

BALDWIN: All right. So you have been listening to this massive press conference. This is all about Otto Warmbier.

He was that University of Virginia student who had gone over to do the study abroad over in Hong Kong, wanted to just pop in to and see North Korea. He apparently tried to steal some sort of political poster, banner at his hotel, and ultimately the North Koreans found him guilty of committing a hostile act.

And so he has been over there for -- I think it was since March of 2016 or January of 2016. He's now back. So his family has him back here stateside. The big question is, how is he doing?

I have got our chief medical correspondent, Dr. Sanjay Gupta, our real-life brain surgeon, to sort of translate some of what we are hearing from those doctors.

And so I can't even imagine, because they have no idea what happened to him in North Korea, how to put the pieces together almost backwards.


They are dealing with very limited information. You -- they obviously really described how he's doing now. And they use this term unresponsive wakefulness. That's how they describe it. It's a syndrome where someone, you know, their eyes may be open, they may be blinking, they may be even looking around, but they have no awareness of their surroundings. They just have no recognition.

They don't speak. There's nothing that is sort of voluntary in terms of movements, even though their eyes are open. In the past, this sort of state, some refer to it as a persistent vegetative state. That's sort of what they are describing.

They also pointed out, Brooke, as you heard, that the North Koreans did provide a scan dating back to April of 2016, at which point they said that the MRI findings of the brain at that point indicated that the injury to the brain, which occurred -- had already occurred by that time, and they said -- they speculated that it was some time within the previous few weeks at that point.

As you pointed out, they did not say, you know, exactly what caused this. When asked about that, they said this seems to have been some sort of respiratory arrest, meaning that, for some period of time, he wasn't getting enough air into his body, not getting enough oxygen to his brain, and that caused the injury to the brain.

Why he had that respiratory arrest, they don't know. There's nothing else within the testing that can answer that question definitively, Brooke.

BALDWIN: So many questions for these doctors and for, of course, his parents, his family. At least we know he's back here stateside and in excellent care there in Cincinnati.

Dr. Gupta, thank you so much.

GUPTA: Thank you.

BALDWIN: Coming up next here, we are live here on Capitol Hill in Washington. We're going to talk politics. Legendary journalist Carl Bernstein weighs in on this new "Washington Post" report out today that the president himself is under investigation for obstruction of justice.

Plus, we will talk about how the president has reacted to that via Twitter.

Also ahead, new details of the condition of the number three Republican in the House of Representatives, Congressman Steve Scalise. President Trump visited him last night, says he is in some trouble. That's a direct quote, this as the gates get ready to open for tonight's big congressional baseball game. It will go on, despite the bloodshed on the field yesterday morning.



BALDWIN: Welcome back. I'm Brooke Baldwin.

We're live here in Washington, D.C., talking about the president of the United States today, how he's lashing out on Twitter after a stunning report from "The Washington Post" saying that he himself is now the focus of this obstruction of justice investigation led by the special counsel, Bob Mueller, the president tweeting -- quote -- "They made up a phony collusion with the Russian story. Found zero proof. So now they go for obstruction of justice on the phony story. Nice."

And then this one: "You are witnessing the single greatest witch-hunt in American political history led by some very bad and conflicted people."

To be clear, this is the reporting from five sources to "The Washington Post." CNN can't independently confirm this, but developing now on Capitol Hill, CNN is learning that the Senate Intelligence Committee will not look into the matter regarding the president, instead, leaving the criminal inquiry to Robert Mueller himself.

So, I have got Carl Bernstein standing by, you know, CNN political analyst and Pulitzer Prize-winning journalist who broke that Watergate story wide open for "The Washington Post."

And so it is your former employer, sir, who is breaking this story today, basing this on these five sources. We were talking to Adam Entous last hour on this story.

To you, big picture, Carl, how significant is this, that the president of the United States is now under investigation?


And, at the same time, there is an inevitability about it, that the FBI investigation was inching its way to investigating the president. There has been a cover-up in the White House about all things Russians --