Justice Ginsburg briefly hospitalized again

WASHINGTON -- Supreme Court Justice Ruth Bader Ginsburg, who had cancer surgery earlier this year, was kept at a hospital overnight after she became drowsy and fell from her seat aboard an airplane. Court officials blamed a reaction to medicine.

It was the second time Ginsburg, 76, has been hospitalized in the last month. She was taken to a hospital on Sept. 24 after falling ill at her Supreme Court office.

Ginsburg was taken to Washington Hospital Center around 11:15 p.m. Wednesday by paramedics and released Thursday morning, court officials said.

Ginsburg, along with Chief Justice John Roberts and justices Stephen Breyer and Antonin Scalia, was heading to London to take part in ceremonies marking the opening of Britain's new Supreme Court.

"Prior to the plane taking off, the justice experienced extreme drowsiness causing her to fall from her seat," a court statement said. "Paramedics were called and the justice was taken to the Washington Hospital Center as a precaution."

The statement said doctors attributed her symptoms to a reaction caused by the combination of a prescription sleeping aid and an over-the-counter cold medicine.

Ginsburg's health has been watched closely since her second cancer surgery in February.

She had surgery back in 1999 for colon cancer and received radiation and chemotherapy. And on Feb. 5, doctors removed a small, malignant growth from Ginsburg's pancreas. Doctors found no spread of it elsewhere, the court said. Her spleen also was removed.

In September, Ginsburg became lightheaded in her office after receiving treatment for anemia, a common side effect of pancreatic cancer chemotherapy. Although she was found to be stable after an examination, the court said she was taken to the hospital by ambulance as a precaution and released the next day.

She returned to the court quickly and hasn't missed a day of work since. In March she said the operation had been "a complete, successful, surgical removal" of the cancer. She also said she was to undergo chemotherapy treatment.

Mixing sleeping pills and cold medicines can be doubly sedating, depending on the cold medicine's ingredients, which often induce drowsiness by themselves.

And it's possible that Ginsburg was a bit more susceptible because of her cancer treatment, said Dr. Steven Cohen, a medical oncologist who specializes in pancreatic cancer at Philadelphia's Fox Chase Cancer Center.

The typical chemotherapy for pancreatic cancer, called gemcitabine, is given weekly for six months. (Ginsburg has not specified her chemo but it began in the spring.) It can cause anemia and fatigue that can take a few months to recover from once the chemo ends, Cohen said. And paradoxically, the fatigue affects the sleep-wake cycle in a way that leaves many patients needing prescription sleep aids, he said.

Add Ginsburg's busy schedule, and her recent reactions could be "related to simply being worn down from the chemotherapy," he said. "Patients are often more susceptible to the side effects of medications and the impact of a hectic schedule or demanding job than they would be" otherwise.

Ginsburg will no longer be going to London because she would not make it in time for the ceremony, court officials said. Breyer, who was flying with Ginsburg and got off the plane, took a later flight to London. Roberts and Scalia had taken an earlier flight.

After the retirement in January 2006 of Justice Sandra Day O'Connor, Ginsburg was the only woman on the nine-member court until Sonia Sotomayor joined in August.

Nominated by President Bill Clinton, Ginsburg took her seat on the Supreme Court on Aug. 10, 1993. She had been a judge on the U.S. Court of Appeals for the District of Columbia Circuit since 1980.

Ginsburg is considered to be one of the reliably liberal votes on the closely divided court.

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AP Medical Writer Lauran Neergaard contributed to this report.

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