REPORT OF INVESTIGATION BY MEDICAL EXAMINER

Transcription

1 Central Office 901 N. Stonewall Oklahoma City, Oklahoma (405) Fax (405) BOARD OF MEDICOLEGAL INVESTIGATIONS OFFICE OF THE CHIEF MEDICAL EXAMINER Eastern Division 1115 West 17th Tulsa, Oklahoma (918) Fax (918) REPORT OF INVESTIGATION BY MEDICAL EXAMINER Re OFFICE USE ONLY Co I hereby certify that this is a true and correct copy of the original document. Valid only when copy bears imprint of the office seal. By Date DECEDENT First-Middle-Last Names (Please avoid use of initials) Age Birth Date Race Sex JOSHUA MINTON 2 11/8/2004 WHITE M HOME ADDRESS - No. - Street, City, State P.O. BOX 15, SPERRY, OK EXAMINER NOTIFIED BY - NAME - TITLE (AGENCY, INSTITUTION, OR ADDRESS) DATE TIME ANDREA - PICU ST. FRANCIS 5/17/ :40 INJURED OR BECAME ILL AT (ADDRESS) 2648 EAST 3RD STREET CITY COUNTY TYPE OF PREMISES DAY CARE DATE 5/17/2007 TIME 14:00 LOCATION OF DEATH ST. FRANCIS HOSPITAL CITY COUNTY TYPE OF PREMISES HOSPITAL DATE 5/17/2007 TIME 22:20 BODY VIEWED BY MEDICAL EXAMINER CITY COUNTY TYPE OF PREMISES DATE TIME 1115 WEST 17TH STREET MORGUE 5/18/ :15 IF MOTOR VEHICLE ACCIDENT: DRIVER PASSENGER PEDESTRIAN TYPE OF VEHICLE: AUTOMOBILE LIGHT TRUCK HEAVY TRUCK BICYCLE MOTORCYCLE OTHER: DESCRIPTION OF BODY RIGOR LIVOR EXTERNAL OBSERVATION NOSE MOUTH EARS EXTERNAL PHYSICAL EXAMINATION Jaw Neck Arms Legs Complete Absent Passing Passed Color Lateral Posterior Anterior Beard Eyes: Color Opacities Pupils: R L Hair Mustache BLOOD OTHER Decomposed Regional Body Length Body Weight Significant observations and injury documentations - (Please use space below) ***SEE AUTOPSY PROTOCOL*** T Probable Cause of Death: ANOXIC ENCEPHALOPATHY COMPLICATIONS OF AIRWAY OBSTRUCTION Due To: Other Significant Medical Conditions: Manner of Death: Natural Accident Suicide Homicide Unknown Pending Case disposition: Autopsy Yes No Authorized by Pathologist Not a medical examiner case MEDICAL EXAMINER: Name, Address and Telephone No. I hereby state that, after receiving notice of the death described herein, I conducted an investigation as to the cause and manner of death, as required by law, and that the facts contained herein regarding such death are true and correct to the best of my knowledge W. 17th St, OK /5/2007 Signature of Medical Examiner Computer generated report Date CME-1 (REV 7-98)

2 Board of Medicolegal Investigations Office of the Chief Medical Examiner 1115 West 17 th Street Tulsa, Oklahoma Voice Fax CERTIFICATION I hereby certify that this document is a true and correct copy of the original document. Valid only when copy bears imprint of the office seal. By Date REPORT OF AUTOPSY Decedent Age Birth Date Race Sex Autopsy No Case No JOSHUA MINTON 2 11/8/2004 W M T Type of Death Means ID By Authority for Autopsy Unnatural Tape Hospital staff MA SIBLEY, MD Present at Autopsy Steve Mullins, Mike Nelson, M. A. Sibley, M.D. PATHOLOGIC DIAGNOSES 1. Anoxic encephalopathy due to complications of airway obstruction A. Cerebral edema B. Pulmonary edema C. Pleural effusions (50 cc each side) D. Interstitial pneumonitis with evolving pneumonia 2. Scattered cutaneous abrasions/contusions; no internal injuries 3. Evidence of medical intervention CAUSE OF DEATH: Anoxic encephalopathy due to complications of airway obstruction The facts stated herein are true and correct to the best of my knowledge and belief. OCME, Eastern Division 5/18/2007 2:15 PM ANDREW SIBLEY, M.D. Forensic Pathologist Location of Autopsy Date and Time of Autopsy CME-2 Page 1

3 MEDICOLEGAL INVESTIGATION CIRCUMSTANCES OF DEATH: This two year old child (DOB: November 8, 2004) was reportedly found by a daycare worker, face down and unresponsive in a bedroom. The babysitter reportedly called 911 and when emergency personnel arrived, he was pulseless and apneic with pupils fixed and dilated. There was vomitus in his airway. He was transported to St. John Hospital emergency room where he was resuscitated; he died about eight hours later, on May 17, 2007, at 2222 hours. There was some reported bruising on the child. The daycare worker reportedly confessed later that she had used masking tape to tape up the child s hands and mouth because the child was not being quiet. Police reports, witness statements, and scene photographs were reviewed. AUTHORIZATION: The postmortem examination is performed under the authorization of the Office of the Chief Medical Examiner, Eastern Division, Tulsa, Oklahoma. IDENTIFICATION: The body is identified by hospital staff. Digital photographs and full body radiographs of the deceased are taken. POSTMORTEM EXAMINATION CIRCUMSTANCES OF THE EXAMINATION: The postmortem examination of Joshua Minton is performed at the Office of the Chief Medical Examiner, Eastern Division, Tulsa, Oklahoma, on May 18, 2007, commencing at 1415 hours. Assisting in the examination are Steve Mullins and Mike Nelson. GENERAL DESCRIPTION: The unclothed, unembalmed body is received wrapped in a white sheet and a white absorbent cloth. The body is supine. CLOTHING AND PERSONAL EFFECTS: A clean white diaper is appropriately positioned. EXTERNAL EVIDENCE OF RECENT MEDICAL THERAPY: (1) Identification bracelets encircle the right ankle and right wrist. (2) An endotracheal tube protrudes from the mouth. (3) A gastric tube protrudes from the left nostril. (4) White cotton covers needle puncture sites on the back of the left hand/wrist. (5) A disposable blood pressure cuff encircles the left upper arm. (6) A pulse oximeter monitor lead is over the left index finger. (7) Vascular catheters enter the back of the right hand, and both inguinal regions. CME-2 Page 2

4 (8) An intraosseous trocar enters the anterior aspect of the right lower leg and is covered with gauze. (9) EKG conduction pads are on the chest and abdomen. (10) A catheter is in the urethra. EXTERNAL EXAMINATION The body is that of a normally developed white male appearing the recorded age measuring 36 inches and weighing 30 pounds. Rigor mortis is well established in the jaw and extremities. Livor mortis is posterior, purple and non-blanchable. The body is cool and has been refrigerated. Head: The scalp is covered by blond hair up to 8.0 cm. There is no evidence of recent cutaneous injury of the posterior scalp. The forehead is symmetrical without evidence of recent cutaneous injury. The eyebrows are blond. There are petechial hemorrhages diffusely involving the left upper and lower eyelids, and the left cheek. Red/purple petechial and larger hemorrhages up to 0.7 cm in greatest dimension are on the lateral aspect of the right upper eyelid, the right lower eyelid, and the right cheek. On the anterior aspect of the chin is a linear and obliquely oriented 3.3 x 0.2 cm red contusion. A very faint linear 0.8 x 0.1 cm red contusion is on the right side of the chin. The eyes are normally positioned with clear corneas, hazel irides, equal round pupils, and clear conjunctiva. There are no petechial hemorrhages. The nasal skeleton is midline and intact. The nares contain red fluid. The lips are pink-purple and intact. The teeth are natural. There is red fluid in the mouth. There is no evidence of injury of the oral mucosa. The frenulum is intact. The ears are normally positioned without evidence of recent cutaneous injury. Neck: The neck is symmetrical with the trachea midline. There are petechial hemorrhages on the anterior neck over a 3 x 3 cm area. Trunk: The chest and abdomen are symmetrically formed without evidence of recent cutaneous injury. The abdomen is flat and soft. External Genitalia: The external genitalia are those of a normally developed male. There is no evidence of recent cutaneous injury. Lower Extremities: The lower extremities are symmetrical without palpable fractures. Evidence of medical therapy is noted above. On the medial aspect of the left lower leg is a 1.8 x 1.5 cm blue contusion. On the anterior aspect of the left knee are two adjacent purple-brown contusions over a 1.7 x 0.9 cm area. On the medial aspect of the right lower leg are four punctate 1 mm abrasions in linear arrangement. On the lateral aspect of the right lower leg is a dried brown abrasion consisting of a linear abrasion and two punctate abrasions over a 0.9 x 0.5 cm area. On the medial aspect of CME-2 Page 3

5 the left foot are two adjacent small dried brown abrasions measuring 1-2 mm in greatest dimension. Upper Extremities: The upper extremities are symmetrical without palpable fractures. Evidence of medical therapy is described above. There are punctate to linear areas of hemorrhage on the distal aspect of the right forearm. On the back of the left wrist is a 1.7 x 1.3 cm purple contusion. On the back of the left forearm is a faint 1.5 x 1.0 cm purple contusion. On the back of the right elbow is a 0.3 x 0.2 cm area composed of two adjacent dried brown abrasions. Back: The back and buttocks are symmetrically formed without evidence of recent cutaneous injury. There is an impression of a catheter on the back in the midline. The anus shows normal anatomic features without evidence of injury. INTERNAL EXAMINATION INTERNAL EVIDENCE OF RECENT MEDICAL THERAPY: (1) An endotracheal tube terminates above the carina. (2) A gastric tube terminates within the stomach. SYSTEMS REVIEW: Body Cavities: The subcutaneous midline abdominal fat measures 0.8 cm. The organs of the thorax and abdomen have normal anatomic relations. There are 50 cc of amber fluid in each of the pleural spaces. There are no fluid accumulations in the pericardial or peritoneal spaces. Cardiovascular System: The 55 gm heart is intact and normally formed. The pericardium and epicardium are smooth and glistening. The endocardium is smooth without thrombi. There is no chamber dilatation. The ventricular walls are of normal thickness. The myocardium is firm and brown throughout without lesions. The interatrial and interventricular septa are intact. The valves and great vessels are normally formed and positioned. The coronary arteries have a normal anatomic distribution and are widely patent. There are no acute thrombi. The aorta follows a normal course and is without lesions. Respiratory System: The tracheobronchial tree contains tan-brown fluid. The left lung weighs 200 gm and the right 220 gm. The pleura is intact. The lungs are normally formed with dark purple parenchyma. No tumor, granulomas, inflammation or other discrete lesions are identifiable. There is diffuse congestion. Fluid exudes from incised portions of both lungs. The pulmonary vasculature is widely patent. The hilar lymph nodes are unremarkable. The diaphragm is intact. CME-2 Page 4

6 Liver: The 440 gm liver is normally formed with a smooth intact capsule. The parenchyma is firm and brown. No specific or focal lesions are present. The gallbladder is normal containing green viscous bile without calculi. Hematopoietic System: The 65 gm spleen is normally formed with a smooth intact capsule. The parenchyma is redpurple without specific or focal lesions. The thymus weighs 35 gm and is without focal lesions. Systemic lymph nodes and bone marrow where visualized are unremarkable. Pancreas: The pancreas is tan and lobulated without discrete lesions. Gastrointestinal Tract: The esophagus is without erosions or tumor. The stomach contains 50 cc of thick brown fluid with unidentifiable tan and brown particulate matter. The stomach lining is intact and continues into a normal appearing small bowel and colon. The small bowel and colon contains fairly thin yellow liquid. The appendix is present. Genitourinary Tract: The left kidney weighs 45 gm, and the right weighs 45 gm. The cortical surfaces are smooth and glistening. The parenchyma is brown without tumor, infarcts, or cysts. The corticomedullary junction is well delineated. The collecting system is without tumor or obstruction. The bladder contains no urine. The bladder wall and mucosa are unremarkable. The prostate and seminal vesicles are symmetrical and normal in size and appearance. Endocrine System: The pituitary is normal in size and appearance. The adrenals are normal in size without hemorrhages or masses. The thyroid is symmetrical and normal in size without lesions. Musculoskeletal System: The ribs, sternum, clavicles, vertebra, and pelvis are without fractures or other acute lesions. The general musculature appears normally developed. The subcutaneous tissue of the anterior, posterior, and lateral chest, abdomen, and neck is directly examined and reveals no contusions or other lesions. A posterior dissection of the neck musculature is also unremarkable. Neck: The neck organs have normal anatomic relations. There is no evidence of hemorrhage within the subcutaneous tissue or strap musculature of the neck. The hyoid bone and thyroid cartilage are intact. The mucosa of the larynx and trachea is without evidence of hemorrhage or erosion. The epiglottis and aryepiglottic folds are without edema. The tongue is directly visualized and shows no evidence of injury or other lesions. CME-2 Page 5

7 Head: The scalp is intact without hemorrhage. There are no skull fractures. There is no epidural, subdural, subarachnoid, or intraventricular hemorrhage. The meninges are smooth and glistening. The 1070 gm brain is symmetrical and normally formed. The surface of the brain is flattened with expanded gyri and obliterated sulci. There is medial temporal lobe notching and softening bilaterally. The circle of Willis is normally formed without lesions. Serial coronal sections reveal no internal hemorrhages, infarcts, or mass lesions. The ventricles are symmetrical and compressed. The basal ganglia, cerebellum, and brain stem parenchyma are unremarkable. The spinal cord is removed via an anterior approach and shows no evidence of hemorrhage or other lesions. The eyes are removed through the supra-orbital region and are placed in fixative for further study. Following this, sectioning reveals no definite retinal hemorrhages, optic nerve hemorrhage, or other specific pathologic changes. TOXICOLOGY See attached report. MICROSCOPIC EXAMINATION Heart: Sections of the left and right ventricular wall and interventricular septum are taken. There is no necrosis, inflammation, or other specific pathologic changes. Lungs: Sections of each lobe of each lung are taken. Alveolar septae appear normal for age. There is focal early interstitial inflammation, with some inflammatory cells extending into alveolar spaces. There are no antemortem thrombi. Liver: A section shows a normal lobular architecture without steatosis, lobulitis, or other pathologic changes. Spleen: A section shows no specific pathologic changes. Thymus: A section is unremarkable, except for erythrocyte extravasation within adjacent soft tissue. CME-2 Page 6

8 Pancreas: A section shows normal appearing endocrine and exocrine elements. Kidney: A section shows no specific pathologic changes. Adrenal: A section shows no specific pathologic changes. Gastrointestinal tract: Sections of esophagus, stomach, and large intestine show no specific pathologic changes. Thyroid: A section shows no specific pathologic changes. Central nervous system: Sections of cerebral cortex and brain stem (mid-pons) show no specific pathologic changes. OPINION Death of this infant is attributed to anoxic encephalopathy due to complications of airway obstruction. There were petechial hemorrhages on the face and neck, as well as scattered contusions and/or abrasions involving the face and extremities. There were no internal injuries. Masking tape was reportedly used to tape up the child s hands and mouth, and linear contusions on the face and right arm are consistent with marks caused by tape. In addition to the tape, the reported presence of vomitus in the airway could have caused further airway obstruction. With consideration given to the autopsy findings and the reported circumstances, the manner of death is classified as homicide. CME-2 Page 7

9 BOARD OF MEDICOLEGAL INVESTIGATIONS OFFICE OF THE CHIEF MEDICAL EXAMINER 901 N.Stonewall Oklahoma City, Oklahoma REPORT OF LABORATORY ANALYSIS OFFICE USE ONLY Re. Co. I hereby certify that this is a true and correct copy of the original document. Valid only when copy bear im-print by the office seal. By Date ME CASE NUMBER: LABORATORY NUMBER: DECEDENT'S NAME: MATERIAL SUBMITTE JOSHUA MINTON BLOOD, LIVER, BRAIN, GASTRIC, HOSPITAL SPECIMENS DATE RECEIVED: 5/22/2007 HOLD STATUS: 5 YEARS SUBMITTED BY: MEDICAL EXAMINER: NOTES: ETHYL ALCOHOL: Blood: NEGATIVE (HEART) Vitreous: Other: CARBON MONOXIDE Blood: TESTS PERFORMED: BLOOD BASES RESULTS: NONE DETECTED 06/06/2007 DATE BYRON CURTIS, Ph.D., Deputy Chief Forensic Toxicologist

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