A team of Cincinnati doctors caring for an American student medically evacuated from North Korea said Thursday he has a neurological injury and remains in a coma.
The hermit state freed Otto Warmbier on Tuesday after about 17 months in custody. He was then flown back to the U.S. where received urgent medical attention from a team of physicians at the University of Cincinnati Medical Center in Ohio.
The communist regime accused the 22-year-old of stealing a political banner and held a trial in March 2016 where he was convicted of "hostile acts" and sentenced to 15 years of hard labor.
North Korea claims Warmbier went into a coma after taking a sleeping pill and says he also had botulism. However, physicians in his care team in Cincinnati said during a press conference Thursday that they conducted tests and showed no signs of active botulism.
Warmbier remains in a coma, but stable since being brought back to his home state of Ohio. It was learned only this week that he's been in a coma for more than a year.
There have been reports Warmbier was mistreated in the custody of the North Koreans and possibly physically beaten.
His father Otto Warmbier spoke Thursday and expressed relief that his son was released but added the family has "anger that he was so brutally treated for so long. We went for 15 months without a word from or about Otto."
The elder Warmbier said his family doesn't believe the excuse given by North Korea that Otto's condition today was due to a sleeping pill and botulism. Regardless, he said there's "no excuse for any civilized nation to have kept his condition secret and denied him top-notch medical care for so long."
His son went to North Korea as part of a group tour arranged by a China-based company. He was in Asia during a break from his studies at the University of Virginia.
In Cincinnati, doctors said they performed a battery of tests on Warmbier, ranging from ordinary X-rays to more advanced magnetic resonance imaging (MRI) scans as well as skeletal surveys of the skull, ribs, pelvis and other areas to look for broken bones.
Dr. Daniel Kanter, medical director of the Neuroscience Intensive Care Unit at the Cincinnati hospital, told reporters "there's no fractures of the bones that we can detect."
Furthermore, he said "minor blemishes" on Warmbier's skin were found but noted they are consistent with a medical patient having intervenous lines.
"We do not see any skin indications that are strongly suggestive of mistreatment," he said. "Beyond that we cannot speculate on what might have occurred in the past."
According to Kanter, the MRI scan of Warmbier's brain "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."
Also, Kanter said the type and pattern of damage they see on the latest MRI scan is not what they normally see in patients with traumatic brain injuries.
Warmbier's scan, though, is consistent with what's usually seen after cardio-pulmonary arrest, where the blood supply to the brain is inadequate for a period of time. The doctor said this type of condition is what can lead to the destruction of brain tissue.
"His neurological condition can best be described as a unresponsive wakefulness," said Kanter.
Kanter said Warmbier "has spontaneous eye opening and blinking. However, he shows no signs of understanding language, responding to verbal commands or awareness of his surroundings."
Speaking in general terms, doctors said one cause of cardio-pulmonary arrest in a young person could be respiratory arrest, including possible airway obstruction. They also said there could many causes for respiratory arrest in the young, including trauma or intoxication.
Kanter said his medical team has had no direct contact with North Korean authorities although he did say they sent along medical records, including medical imaging scans on a disk and blood lab results with dates. Some of the information was dated from April but doctors at the Cincinnati hospital said they have no way to verify those dates.
And Kanter said medical records sent by the North Koreans do not "shed light on the circumstances of his injury or the exact cause."
At the request of the family, Kanter said the hospital won't provide any information on his prognosis, prospects for care or future treatment. Reporters asked questions about his prognosis but the hospital declined to comment on that due to the privacy considerations.