North Carolina Department of Health and Human Services Office of the Chief Medical Examiner

Transcription

1 North Carolina Department of Health and Human Services Office of the Chief Medical Examiner 3025 Mail Service Center Raleigh, NC Telephone Fax REPORT OF AUTOPSY EXAMINATION DECEDENT Document Identifier B Autopsy Type ME Autopsy Name John Livingston Age 33 yrs Race White Sex M AUTHORIZATION Authorized By Melissa Dell Phillips RN Received From Harnett ENVIRONMENT 11/16/ :40 Date of Exam Time of Exam Autopsy Facility Office of the Chief Medical Examiner Persons Present Ms. Judith Page CERTIFICATION Cause of Death Multiple gunshot wounds of chest and arms. The facts stated herein are correct to the best of my knowledge and belief. Digitally signed by Nabila Haikal MD DIAGNOSES Penetrating gunshot wound of right arm; indeterminate/distant range: Entrance wound: anterior proximal right arm; without evidence of contact or close-range firing on the skin (accompanying overlying garments retained as evidence). Perforation of soft tissue of proximal right arm, lateral proximal right humerus, and posterior right clavicular region with subsequent penetration of soft tissue of right upper back. Recovery of deformed jacketed projectile from soft tissue of right upper back. Direction of fire: from decedent's front to back and right to left. Penetrating gunshot wound of left chest following perforating gunshot wound of left arm; indeterminate/ distant range: Entrance wound: anterior distal left arm; without evidence of contact or close-range firing on the skin (accompanying overlying garments retained as evidence). Perforation of soft tissue of left arm. Exit wound: antero-medial proximal left arm. Re-entrance wound: left pectoralis region; without evidence of contact or close-range firing on the skin. Perforation of left pectoralis soft tissue and muscle, left 1st intercostal muscle, apical region of upper lobe of left lung (tangentially), posterior trachea, upper lobe of right lung, and posterior right 4th intercostal muscle - with subsequent penetration of posterior right extrathoracic soft tissue. Associated bilateral hemothoraces. Recovery of deformed projectile core from right back soft tissue; and projectile jacket material from tracheal region. Direction of fire: from decedent's left to right, slightly front to back and slightly downward within upper torso. Penetrating gunshot wound of left arm; indeterminate/distant range: Page 1 of 7

2 Entrance wound: proximal left arm; without evidence of contact or close range firing on the skin (accompanying overlying garments retained as evidence). Perforation of soft tissue of proximal left arm/anterior shoulder, inferior rim of left clavicle, and left supraclavicular soft tissue. Recovery of deformed jacketed projectile from left supraclavicular soft tissue. Direction of fire: from decedent's left to right, slightly front to back and slightly upward. No contributory injury unrelated to firearm injury. Minor soft tissue abrasions and contusions of the face and upper extremities. No significant natural disease identified. Toxicologic findings: Blood ethanol concentration: 140 mg/dl. Cocaine and metabolites detected in postmortem blood. Investigation: fatal firearm injuries during reported confrontation with law enforcement. IDENTIFICATION Body Identified By Papers/ID Tag EXTERNAL DESCRIPTION Length 69 inches Weight 110 pounds Body Condition Intact Rigor 2+ Livor Posterior; purple; fixed. Hair Blonde scalp hair (up to 22") with bifrontal recession and a single braid along the back secured distally with a black elastic hair tie; mustache (up to 3"); beard (up to 11"). Eyes Blue irides. Teeth Natural dentition - in poor condition. Received within a labeled body bag are the remains of a well-developed, well-nourished adult male appearing compatible with the stated age of 33 years. Attesting to decedent identification is an ID tag secured to the right ankle. The body is received clad in the following articles of clothing: a white sock with overlying black sneaker - worn on the left foot (the matching sock and sneaker are present loose within the body bag); blue plaid boxer-style underpants; black athletic pants; blue denim slacks with black belt (unfastened). Additional garments submitted loose within the body bag include: a white undershirt; a white t-shirt; a black t-shirt; a black hoodie; and a white sweater. Handcuffs are secured around the right wrist. A few pine needles are noted within the body bag. The head, neck and thorax are well developed and symmetric with evidence of injury involving the torso, to be detailed below. The abdomen is flat. The back and anus are remarkable for minor abrasions involving the upper back, to be described below. The extremities are well-developed and symmetric without absence of digits; the fingernails appear chronically bitten. Firearm injury involving the extremities will be detailed below. External genitalia are those of an adult circumcised male without evidence of injury or other abnormality aside from a 1 cm apparent condyloma involving the penile shaft. No distinctive scars are identified. Tattoos are observed along the right shoulder (rams head), the right arm (Eye of Horus), the left shoulder (serpent), the left arm (flames; round symbol with the inscriptions "AB" and "America"), the mid upper chest (death head with wings), the left abdomen (day of the dead face), the abdominal wall (two dragons), the upper back (LIVINGSTON), the right upper back (angel Page 2 of 7

3 with wings), and the left upper back (Grim Reaper/skull). Ill-defined faint green discoloration is seen along the dorso-radial aspect of the left hand and index finger as well as the palmar/ulnar aspect of the right hand. Evidence of resuscitative intervention includes cardiac monitor leads adherent to the abdominal wall, the anterior left wrist and the proximal right arm. INJURIES [Firearm Injury] I. Penetrating gunshot wound of right arm; indeterminate/distant range: Entrance wound: Involving the anterior proximal right arm, centered 6 inch from the shoulder, is a 3/4 inch elliptical gunshot entrance wound featuring largely distal marginal abrasion (up to 1/2 inch) and proximal ill-defined discontinuous contusion (2 X 1 1/2 inch) - with no associated evidence of marginal searing, soot deposition, or surrounding gunpowder stippling. Path of wound: Extending from this entrance wound is a hemorrhagic projectile track which perforates the soft tissue of the right arm, the lateral proximal right humerus, the posterior right clavicle, and the soft tissue of the right upper back. Projectile recovery: A deformed, jacketed projectile is recovered from the soft tissue of the right upper back. Direction of fire: The projectile track is from the decedent's front to back and right to left. II. Perforating gunshot wound of left arm with re-entrance/penetrating gunshot wound of left pectoralis region; indeterminate/distant range: Entrance wound: Involving the medial distal left arm, centered 8 inch from the shoulder, is an ovoid 1/2 inch gunshot entrance wound exhibiting marginal abrasion (up to 1/4 inch distally) - with no associated evidence of marginal searing, soot deposition or surrounding gunpowder stippling. Path of wound: Extending from this entrance wound is a hemorrhagic projectile track which perforates the soft tissue of the left arm. Exit wound: Along the antero-medial proximal left arm, centered 4 1/2 inch from the shoulder, is an irregular 1 X 3/4 inch gunshot exit wound - free of notable marginal abrasion, searing, soot deposition and gunpowder stippling. Re-entrance wound: Involving the left pectoralis region, centered 14 inch from the top of the head and 6 inch to the left of the anterior midline, is a 3/4 X 1/2 inch irregular gunshot entrance wound featuring irregular marginal abrasion (up to 1/8 inch), more notable infero-laterally - with ill-defined 1/4 inch medial contusion. No marginal searing, soot deposition or surrounding gunpowder stippling is observed in association with this entrance wound. Path of wound within torso: The projectile track perforates the soft tissue of the left pectoralis region, the left 1st intercostal muscle, the apical portion of the upper lobe of the left lung (tangentially), the posterior trachea (~1" above the level of the carina), the upper lobe of the right lung, and the posterior right 4th intercostal muscle with subsequent penetration of the adjacent extrathoracic soft tissue. Associated findings: The right pleural cavity contains ~ 800 cc of partially clotted blood; and the left pleural cavity contains minimal unorganized blood. Page 3 of 7

4 Projectile recovery: A deformed projectile core is recovered from the soft tissue of the right back; with corresponding projectile jacket material retrieved from the vicinity of the posterior tracheal perforation. Direction of fire: The projectile track is from distal to proximal along the left arm (toward the shoulder) with subsequent left to right, slightly front to back and slightly downward track through upper torso. III. Penetrating gunshot wound of left arm; indeterminate/distant range: Entrance wound: Involving the proximal left arm, centered 4 inch from the shoulder, is an ovoid 1/2 inch gunshot entrance wound exhibiting nearly circumferential marginal abrasion (up to 1/8 inch) without evidence of marginal searing, soot deposition, or surrounding gunpowder stippling. Path of wound: Extending from this entrance wound is a hemorrhagic projectile track which perforates the soft tissue of the proximal left arm and anterior shoulder, the inferior rim of the left clavicle, and the left supraclavicular soft tissue. Projectile recovery: A deformed jacketed projectile is recovered from the left supraclavicular region. Direction of fire: The projectile track is from the decedent's left to right, slightly front to back and slightly upward. [Other Injury] A 1 x 1/2" area of contusion/abrasion involves the right forehead. Along the left paramedian hairline region is a 3/4" abrasion. Several abrasions and contusions (up to 1") involve the lateral left upper eyelid and cheek region as well as the left earlobe. Ill-defined 1 x 1" contusion is seen along the left supraclavicular region overlying the site of recovery of a retained projectile. Present along the posterior aspect of the left shoulder region is a 3/4 x 1/16" abrasion. Along the right upper back is a 3/4 x 1/8" abrasion. Involving the left upper back is a 3/4" abrasion. A discontinuous transversely aligned linear abrasion (up to 3/4") is seen along the lateral left mid chest. A 1/4" abrasion is seen along the dorsal distal right 3rd metacarpal region. Transversely aligned discontinuous band-like pressure marks (up to 1/4" in width) involve the right wrist region; and several abrasions (up to 1/2") as well as a 1/2" contusion are noted along the dorsal distal right forearm - altogether consistent with handcuff application. DISPOSITION OF CLOTHING AND PERSONAL EFFECTS The following items are released with the body None. The following items are preserved as evidence Clothing/personal effects - detailed above. PROCEDURES Radiographs Total body AP/lateral radiography performed. Special Evidence Collection Blood card; pulled scalp hair; handcuffs; and three recovered projectiles. INTERNAL EXAMINATION Body Cavities Page 4 of 7

5 All body organs are present in normal anatomic position. Extensive left pleural fibrous adhesions are observed. The right pleural cavity contains approximately 800 cc of partially clotted blood. The left pleural cavity contains minimal unorganized blood. Cardiovascular System Heart Weight 300 grams The epicardial surface is smooth and glistening. The coronary arteries arise normally, follow a left dominant distribution and are widely patent without significant atherosclerosis or thrombosis. The chambers and valves bear the usual size-position relationships and are grossly unremarkable. The myocardium exhibits no notable diffuse or focal abnormality; with left and right ventricular wall thickness of 0.8 cm and 0.3 cm, respectively. The aorta and its major branches are intact and without significant atherosclerosis. Respiratory System Right Lung Weight 400 grams Left Lung Weight 690 grams Examination of the soft tissues of the neck including the strap muscles and large vessels reveals no focal lesions. The hyoid bone and laryngeal cartilages are intact. The larynx is clear. The lingual mucosa is intact with unremarkable underlying musculature. The upper and lower airways are free of debris and foreign material. The lungs are normally formed; remarkable for firearm injuries, detailed above. No consolidation or other focal lesions are apparent. The pulmonary vasculature is free of thrombi/emboli. Gastrointestinal System The esophagus, GI tract and content are unremarkable. The stomach contains approximately 150 cc of dark brown/red fluid. The appendix is identified. Liver Liver Weight 1520 grams The hepatic capsule and parenchyma are unremarkable aside from mild diffuse pallor. The gallbladder contains viscid bile. The extrahepatic biliary tree is patent. Spleen Spleen Weight 100 grams The spleen is normally formed and unremarkable aside from mild diffuse pallor. Pancreas The pancreas exhibits normal appearance and consistency without focal lesions. Urinary Right Kidney Weight 130 grams Left Kidney Weight 100 grams The kidneys display normal size and shape with some persistent fetal lobulation and smooth cortical surfaces with essentially unremarkable underlying architecture without focal lesions. The ureters are not dilated. The bladder contains approximately 300 cc of straw-colored urine. Reproductive Internal genitalia are grossly unremarkable. Endocrine The thyroid and adrenal glands are grossly unremarkable. Neurologic Brain Weight 1500 grams Reflection of the scalp reveals no detectable injury. No skull fractures are apparent. The dura mater is unremarkable. The leptomeninges are thin and delicate. The cerebral hemispheres are symmetrical and externally unremarkable. The vasculature at the base of the brain is intact; free of significant atherosclerosis and apparent anomalies. Coronal sections of the cerebrum and transverse sections of the cerebellum and brainstem reveal symmetrical architecture without apparent abnormality. Page 5 of 7

6 Skin No remarkable findings, except as previously noted. Immunologic System No thymic tissue or remarkable lymphadenopathy is identified. Musculoskeletal System Essentially unremarkable, except as previously noted. MICROSCOPIC EXAMINATION Microscopic Comment Representative tissue sections are processed to the level of paraffin blocks - including sections of the heart, lungs, liver, spleen, kidneys, thyroid gland, pancreas, and brain. SUMMARY AND INTERPRETATION The cause of death of John Livingston, a 33-year-old man, is attributed to three gunshot wounds involving the chest and upper limbs resulting in internal injuries involving both lungs with associated internal bleeding. Three bullets associated with the three firearm discharges involving the body are recovered at the time of autopsy. Postmortem examination additionally revealed superficial, non-contributory blunt force soft tissue injuries (minor scrapes and bruises) of the face, upper limbs and upper back. No significant natural disease was identified; and toxicologic analysis of the blood revealed evidence of cocaine and excessive alcohol consumption. In view of the overall death investigation and postmortem examination findings - indicating demise in the setting of firearm injuries reportedly received during confrontation with law enforcement, the manner of death is classified as Homicide. DIAGRAMS 1. Body Diagram: Adult (Front/Back) Page 6 of 7

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