* * * =============================================================================== SPECIMENS received from Samuel Simmons on 30 mar 2009

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1 T O X I C O L O G Y R E P O R T Office of the Chief Medical Examiner Toxicology Folder: T Chapel Hill, NC Case Folder: Date of Report: 01 apr 2009 Page: 1 DECEDENT: Lillian Eugenia Dunn Status of Report: Approved Report Electronically Approved By: Ruth Winecker, Ph.D. * * * ** Comments Concerning This Report ** No analyses requested, specimen(s) held. ** End of Comments Concerning This Report ** =============================================================================== SPECIMENS received from Samuel Simmons on 30 mar 2009 S : 1.0 ml Blood CONDITION: Postmortem SOURCE: Aorta OBTAINED: 30 mar 2009 S : 3.0 ml Blood CONDITION: Postmortem SOURCE: Vena Cava OBTAINED: 30 mar 2009 S : Liver CONDITION: Postmortem SOURCE: Liver OBTAINED: 30 mar :00 * * * E N D O F R E P O R T * * * B

2 Office of the Chief Medical Examiner CB # 7580 Chapel Hill, NC Telephone REPORT OF AUTOPSY EXAMINATION DECEDENT Document Identifier B Autopsy Type ME Autopsy Name Lillian Eugenia Dunn Age 89 yrs Race White Sex F AUTHORIZATION Authorized By Max H. Muse RN Received From Moore ENVIRONMENT Date of Exam 03/30/2009 Time of Exam 12:30 Autopsy Facility Office of the Chief Medical Examiner Persons Present Officer B.T, Whitaker of the Moore County Sheriffs Dept. (in observation room) Ms. Tracy Gurnsey, Dr. Clark, and CERTIFICATION Cause of Death Multiple shotgun wounds The facts stated herein are correct to the best of my knowledge and belief. Digitally signed by Samuel Simmons MD 10 July :16 Thomas B. Clark, III MD DIAGNOSES Penetrating shotgun wound of right lower chest with injury to ribs, liver, and right lung Associated right hemothorax Penetrating shotgun wound of right upper abdomen with injury to liver, large bowel, inferior vena cava, and right kidney Associated hemoperitoneum and peripancreatic hemorrhage Atherosclerotic cardiovascular disease, severe Remote myocardial infarction IDENTIFICATION Body Identified By Papers/ID Tag EXTERNAL DESCRIPTION Length 62 inches Weight 134 pounds Body Condition Intact Rigor Minimal, easily broken Livor Posterior, red, slightly blanching Hair Black/gray, approximately 10" in length Eyes Brown with arcus senilis Teeth Natural Received in a zippered disaster pouch is the body of a well developed, well nourished adult white female appearing compatible with the reported age. The body is identified by an ID tag around the left ankle. The body is clad in a dark green sweater over a red dress with gray socks, blue slippers and a disposable diaper. Personal effects consist of a yellow metal ring with multicolored stones on the left 4th finger and a pair of eyeglasses. Identifying marks and scars consist of Page 1 of 6

3 a remote horizontal scar on the central lower abdomen and remote vertical scars on the anterior aspects of the bilateral knees. There is a bandaid present on the right anterior shin covering an area of skin breakdown. INJURIES SHOTGUN WOUND #1: Located on the right lower chest and centered at a point 19" below the top of the head and 2 1/2" to the right of anterior midline is an entrance shotgun wound consisting of a 1 1/2" x 1 1/2" round skin perforation with slight scalloping on the superior margin. No gunpowder residue or plastic packing material is identified on the skin around the entrance wound. Superior to the primary entrance wound is an area of scalloping with intact subcutaneous shotgun pellets on the underside of the right breast. There are two associated linear abrasions above and below this area of scalloping. The wound track subsequently perforates the musculature and soft tissue of the right lower chest, anterior portion of right ribs #8 to 10 (with fracture), right lobe of liver, right hemidiaphragm, right lower lobe of lung, posterior portions of ribs #10 through 12 (with fracture) and penetrates into the soft tissue of the posterior chest cavity. Multiple small (less than 1/8" diameter) gray metal shotgun pellets are located throughout the wound track. Due to the proximity of shotgun wounds #1 and 2 it is difficult to discern which shotgun pellets correspond with which wound. Four plastic fragments from a shot shell cup are also retrieved from this overlapping area of shotgun wounds #1 and 2. Associated injuries of shotgun wound #1 include a right hemothorax (approximately 200 ml), ecchymosis of the right posterolateral back, and a graze wound on the right medial wrist which consists of a 3/4" x 1/2" oval superficial abrasion. In the anatomical position, the wound track for shotgun wound #1 travels from the decedents front to back and slightly downward. SHOTGUN WOUND #2: Located on the right upper abdomen and centered at a point 21" below the top of the head and 1 1/2" to the right of anterior midline is an entrance shotgun wound consisting of a 1 3/4" x 1 1/2" oval skin perforation with slight scalloping at the inferior edge. No gunpowder residue or plastic packing material is present on the skin around the entrance wound. The wound track subsequently perforates the musculature and soft tissue of the right upper abdomen, right lobe of liver, hepatic flexure of the large bowel, inferior vena cava, right kidney and adrenal, and penetrates into the paraspinous muscle and soft tissue. Recovered throughout the wound track are multiple small, less than 1/8" diameter gray metal shotgun pellets. Associated injuries with shotgun wound #2 include hemoperitoneum (approximately 200 ml), retroperitoneal and peripancreatic hemorrhage, and a graze wound on the dorsal aspect of the left hand which consists of an irregular 1 1/2" x 1 3/4" deep abrasion/laceration with fracture of the 1st phalange of the left 2nd finger. In the anatomical position, the wound track for shotgun wound #2 travels from the decedent's front to back and slightly downward. Examination of the decedent's clothing shows corresponding defects in the areas overlying the two entrance shotgun wounds. The numbers assigned to these shotgun wounds are for descriptive purposes only, and do not necessarily indicate the order in which they were inflicted. No other significant internal or external injuries are present. DISPOSITION OF CLOTHING AND PERSONAL EFFECTS The following items are released with the body Personal effects are released with the body. The following items are preserved as evidence Clothing, blood spot card, and recovered shotgun pellets and plastic shot cup fragments are received by Officer Whitaker on PROCEDURES Radiographs Two postmortem digital radiographs of the chest, abdomen, and left hand show fracture of the left 2nd finger and multiple small radiopacities consistent with shotgun pellets in the abdomen and chest. Page 2 of 6

4 INTERNAL EXAMINATION Body Cavities The bilateral pleural and peritoneal cavities contain no significant adhesions. The left pleural cavity contains no significant fluid. All body organs are present in their normal anatomic relationship with the exception of the surgically absent appendix. Cardiovascular System Heart Weight 430 grams The pericardial sac is free of significant fluid and adhesions. The coronary arteries arise normally and follow the usual distribution. There is severe (75%) calcific atherosclerotic stenosis of the left anterior descending artery, and moderate (50%) calcific atherosclerotic stenosis of the right coronary artery and left circumflex arteries. No acute thromboses are identified. There is moderate calcification of the aortic valve cusps. Otherwise, the chambers and valves bear the usual size-position relationships and are unremarkable. There is a white-tan fibrous area within the left ventricular free wall. No other areas of infarction or focal lesions are identified within the myocardium. The aorta and its major branches are intact with severe atherosclerotic changes throughout. Respiratory System Right Lung Weight 400 grams Left Lung Weight 290 grams The larynx is clear. The upper and lower airways are free of debris and foreign material. The lungs are normally formed. The parenchyma of both lungs shows slight congestion without obvious consolidation. Except as noted, no other focal lesions are identified. The pulmonary arteries are free of thrombi or emboli. Gastrointestinal System Except as previously noted, the GI tract is intact throughout its length and is unremarkable. The appendix is not identified. The stomach contains approximately 50 ml of yellow-white fluid and food material. Liver Liver Weight 500 grams As previously noted, the liver is fragmented. No residual gallbladder is identified. Spleen Spleen Weight 100 grams The spleen is normally formed and no focal lesions are identified. Pancreas Except as previously noted, no other focal lesions are identified. Urinary Right Kidney Weight 25 grams Left Kidney Weight 100 grams The left kidney is of normal size and shape. The capsule strips with ease from the underlying granular cortical surface which also contains a 1 1/4" in diameter simple cortical cyst. The renal architecture of the left kidney is intact without other focal lesions. The left ureter is intact without dilation. The bladder contains no residual urine. The right kidney is fragmented as previously noted and the right ureter is not identified. Reproductive The bilateral ovaries are atrophic. The uterus and bilateral fallopian tubes are unremarkable. Endocrine The thyroid gland is of normal size, shape and consistency. The left adrenal gland is grossly unremarkable. As previously noted, the right adrenal gland is not identified. Neurologic Brain Weight 970 grams The leptomeninges are thin, delicate and congested. The cerebral hemispheres show generalized atrophy but are otherwise unremarkable. The vasculature at the base of the brain shows moderate atherosclerotic changes within the circle of Willis. Coronal sections reveal normal architecture without other focal lesions. Skin Page 3 of 6

5 Except as noted, no focal lesions are identified. Immunologic System No residual thymus gland is identified. There is no evidence of lymphadenopathy. Musculoskeletal System Except as noted, grossly unremarkable. There are no other fractures identified within the skull or of the axial and appendicular skeletons. Examination of the soft tissues of the neck including the strap muscles and large vessels reveals no abnormalities. The hyoid bone and laryngeal cartilages are intact. The lingual mucosa is intact and the underlying musculature is devoid of hemorrhage. MICROSCOPIC EXAMINATION Cardiovascular Sections of heart show a large fibrous scar within the left ventricle, consistent with a remote myocardial infarction. Respiratory Sections of lungs show emphysematous changes, scattered macrophages, and focal areas of intra-alveolar hemorrhage. Postmortem bacterial growth is noted within medium-sized blood vessels. Liver A section of liver shows early autolytic changes, moderate periportal fibrosis, and postmortem bacterial growth within medium-sized blood vessels. Genitourinary A section of kidney shows mild arterionephrosclerosis, focally dilated tubules, and scattered chronic inflammation. Neurologic Sections of brain show no significant pathologic abnormality. SUMMARY AND INTERPRETATION The decedent was an 89 year old woman who was one of several people shot inside a nursing home in Moore County. Significant findings at autopsy include a penetrating shotgun wound of the right lower chest which injures the ribs, liver, and right lung with an associated right hemothorax, and a penetrating shotgun wound of the right upper abdomen which injures the liver, large bowel, inferior vena cava, and right kidney with associated hemoperitoneum and peripancreatic hemorrhage. Evidence of natural disease includes atherosclerotic cardiovascular disease with evidence of a remote myocardial infarction. Postmortem toxicological analysis is not performed. Given the autopsy and investigative findings, it is our opinion that the cause of death in this case is multiple shotgun wounds. DIAGRAMS Adult (front/back) Adult (front/back) - Injuries Page 4 of 6

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