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Posted by Ellen on 12:33:02 2005/06/07
Diabetic's road tragedy raises thorny questions
By Kim Vo
Knight Ridder Newspapers
Published on: 06/07/05
SAN JOSE, Calif. He had been in a crash. That much he knew. Lying on the hospital bed, Robert Nebel remembered the ambulance, the Highway Patrol, the crushed sedan.
But he didn't realize the extent of the damage until a pickup truck driver he had seen on the highway stopped in the doorway of his hospital room.
ANNE-MARIE MCREYNOLDS/SAN JOSE MERCURY NEWS
(ENLARGE)
Robert Nebel and girlfriend Evelyn Santos in Nebel's home in Brisbane, Calif.
ANNE-MARIE MCREYNOLDS/SAN JOSE MERCURY NEWS
(ENLARGE)
Nebel tests his blood sugar before lunch recently. In September 2004, Nebel, semi-conscious due to low blood sugar, drove the wrong way on Highway 101 and killed an individual.
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"Do you realize you killed somebody?" the pickup driver angrily asked.
Nebel had no idea. He had no idea that he had driven his Ford Ranger the wrong way down Highway 101 along the Peninsula, somehow navigating through the four-lane highway's curves.
He didn't know that he had driven into on-coming traffic for 10 miles, in darkness, not noticing the CHP cruiser's lights and not stopping until he collided with two other vehicles.
He had no idea that the accident killed Nathan Cistone, a 27-year-old San Francisco graphics designer whose life was finally falling into place.
He does remember coming to on the side of the highway, and the California Highway Patrol officer asking what seemed like the obvious question: Have you been drinking?
"No. There's no alcohol," Nebel remembers responding. "I'm a diabetic."
Low blood sugar caused him to drive semiconscious into oncoming traffic, he would later argue. It was a fluke that had hit without warning, said Nebel, who had been driving more than 25 years without problems.
In May, after reviewing Nebel's medical history and driving record, the San Mateo County District Attorney's Office admitted a jury might find his argument persuasive and dismissed the vehicular manslaughter charge against him.
The tragedy has shaken Nebel's understanding of his disease. Like millions of diabetics nationwide, he checks his blood sugar levels and injects insulin several times a day. He thought it was enough, yet his body betrayed him.
"I was angry," said Nebel. "It's something you did everything you could to control, but you couldn't. And you cost someone their life."
Now, he's trying to regain control of his own life. His 401(K) is nearly depleted, and he may face a civil suit from Cistone's family. Then there's the question of whether the lifelong diabetic should be allowed to drive again.
Nebel was diagnosed with juvenile diabetes at age 5 or 6. Diabetes hadn't prevented him from anything, he said. He worked construction. Traveled to Italy, Malaysia, China. Generally ate what he wanted.
His blood sugar level had dipped before. As a child, he would start fighting whenever the level was low, and his sisters would have to hold his limbs while his mom sat on his chest and poured Coca-Cola into him. Switching insulin brands helped change that.
As an adult, he sometimes felt incoherent glazed eyes, unfocused, though he could still hold a conversation it happened perhaps three times, said Nebel, 43. He would drink a soda and sit back until he felt better.
When blood sugar levels get too low, the brain is basically robbed of glucose. Many diabetics go their whole lives without experiencing a severe altered mental state such as blackouts or semi-consciousness, said Dr. Martha Nolte, director of the Diabetes Teaching Center at the University of California-San Francisco.
But that possibility, coupled with other diabetes symptoms like nerve damage and poor eyesight, makes driving a sensitive topic.
The California Department of Motor Vehicles does not track how many accidents are caused by diabetic drivers. But the DMV suspended or revoked 2,755 licenses last year including Nebel's for diabetes-related problems. More people lost their license for other medical conditions such as dementia, lapses of consciousness and general physical problems, according to DMV statistics.
Generally, if the DMV is alerted that someone has developed a medical condition, officials will evaluate that person's ability to continue driving, said spokesman Steve Haskins. A driver safety officer might ask to hear from the person's doctor or make the person take another driving test.
The American Diabetes Association estimates there are more than 18 million diabetics and believes they shouldn't be prevented wholesale from driving. "No data exists to demonstrate that people with diabetes have a higher risk of traffic accidents than the general public," according to an association policy statement.
However, it's enough of an issue that the association offers a brochure on the subject and keeps tabs on driving restrictions in all 50 states. The group advises its members to monitor their glucose levels and have a sugary snack if they are low.
Nebel said he did all that on Sept. 28.
Before leaving home to pick up his girlfriend that night, Nebel checked his blood sugar level. It was 98. That's not too low for someone whose typical range is between 120 and 130, said Nolte.
Just in case, Nebel drank two cups of sugared coffee and climbed into his Ford Ranger. He glided across Brisbane's winding roads, passed a construction site. He remembers stopping at the Oyster Point Boulevard intersection and turning the corner.
It goes blank after that. Nothing until he was coming out of a daze near the freeway guardrail, realizing he was near Burlingame when he was supposed to be in South San Francisco.
Authorities say Nebel was in the fast lane when he hit Cistone's tan Saturn head-on. The Ranger then bumped another Ford pickup, said Officer Ross Wakefield. When it was over, Cistone was dead and a passenger in the other pickup was complaining of leg and back pain.
Nebel bruised his ribs and arm, and his left hand swelled. At the hospital, he learned his blood-sugar level had plummeted to 46. There were no signs of alcohol or drugs in his system, his attorney Peter Goldscheider said.
When Nebel didn't arrive at his girlfriend's home, Evelyn Santos got worried. She phoned all night. And the next morning, she went to his house 15 minutes away and found his cell phone on the bed, the television still on, as if he had just stepped out.
"I knew he was a diabetic, so I assumed he passed out or something because of his blood sugar," said Santos, 37.
By then, Nebel was in the county jail, where he stayed about three weeks before posting $50,000 bail.
He remains angry that he was in jail so long, that he lost his license which he said essentially means his livelihood, since he can no longer drive himself and his 800 pounds of tools to construction sites. He's mad because he believes his insulin, Humulin, let him down. Eli Lilly, the makers of Humulin, said the insulin isn't to blame.
He is angry that people didn't believe him.
Prosecutors were skeptical of Nebel's I-wasn't-conscious defense. They have heard it before, said Chief Deputy District Attorney Steve Wagstaffe, typically from men who claimed they were suffering from something like post-traumatic stress when they beat their girlfriends.
But after reviewing Nebel's medical history and relatively clean driving record parking tickets, a speeding ticket prosecutors thought a jury might accept the diabetes defense and dismissed the charges.
Cistone's family plans to sue Nebel. After struggling for years with family issues and his sexual identity, Cistone was the "happiest he had been in his life" once he decided to transition from woman to man, said his mother, Linda Albers, who lives in Southern California.
He had been born Angelina Marie Cistone, Albers' only daughter. She had struggled to accept her child's new identity as Nathan Travis. But she did, and the two phoned each other weekly.
"It's like there were two deaths this little girl, then a rebirth of this wonderful man, Nathan," she said. "And then, Nathan died."
The family established a music scholarship in Cistone's memory, and Albers is trying to complete some items on Cistone's list of 54 lifetime goals, which included owning an island, taking his grandparents to Italy and hugging koala bears in Australia.
While she's concentrating on Cistone's legacy, she's also haunted by his death. So many questions nag at her, questions that went unanswered because the criminal case was dropped: Did Nebel manage his diabetes well? How could he have not known?
She's horrified that he is appealing to get his license back. He has submitted his medical records to the DMV and hopes to drive again this year. DMV officials said they couldn't comment directly about Nebel's case, but more than 60 percent of diabetics who lose their licenses get them back.
"If his defense is that he was 'powerless' to prevent his diabetic state, then who is to say it couldn't happen again," Albers said.
Nebel, who once traveled the world and now must rely on others to deliver his groceries, knows there are no guarantees. He now tests his blood sugar levels six times a day instead of three and constantly second-guesses how his body is behaving. But he believes it won't happen again. He has to.
"I'm nervous," he said about sitting behind the wheel. "I'm scared because I see things differently now. But I have to live a life."
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