John Marszalek II death investigation

The University of New Mexico Health Sciences Center

6/17/2014

MSC07 40401 University of New MexicoAlbuquerque, NM 87131-0001Telephone (505) 272-3053FAX (505) 925-0546

OFFICE OF THE MEDICAL INVESTIGATOR

Report of Findings

Decedent

OMI #

Date Report Issued

Place Pronounced

County Pronounced

Cause of Death

Manner of Death

Date of Injury

MARSZALEK, JOHN ROBERT

2014-01295

San Juan Regional Medical Center/ER

San Juan

Sharp force injuries of neck and gunshot wound of back

Homicide

3/12/2014

Date of Birth

Date Death Pronounced

Time Death Pronounced

4/7/1987

3/12/2014

3:02 PM

Autopsy performed by

Death Certificate Signed by

Deputy Medical Investigator

Michelle Aurelius, MD


Harold Larkins Rhonda Moya

Place of Injury

Location of Injury

How Injury Occurred

Intersection 20th and Butler

Farmington, San Juan NM 87401

Cut own throat and shot by on duty law enforcement officer


District Attorney San Juan County DALaw Enforcement Farmington Police Department/Devan Badoni

For details concerning this death, contact the law enforcement agency listed, records section.

For copies of the Death Certificate, contact the Bureau of Vital Statistics, 1190 St. Francis Dr., PO Box 26110, Santa Fe, NM 87502.

Appropriate investigative reports are available from the Medical Investigator, as required by law. Fees are assessed where required. A review of the reports in the Albuquerque office of the Office of the Medical Investigator is available upon request.

All requests for reports are to be directed to:

Office of the Medical InvestigatorMSC07 40401 University of New MexicoAlbuquerque, NM 87131-0001

CAUSE OF DEATH

Sharp force injuries of neck and gunshot wound of back

MANNER OF DEATH

Homicide

DEATH INVESTIGATION SUMMARYCase Number: 2014-01295

MARSZALEK, JOHN ROBERT

Michelle Aurelius MD Assistant Chief Medical Investigator and University of New Mexico Hospital Autopsy Director

All signatures authenticated electronicallyDate: 4/25/2014 3:47:56 PM

County Pronounced: San JuanLaw Enforcement: Farmington Police Department

Agent: Devan Badoni Date of Birth: 4/7/1987

Central Office Investigator: Rhonda Moya Deputy Field Investigator: Larkins, Harold

Pronounced Date/Time: 3/12/2014 3:02:00 PM

Report Name: Death Investigation Reporting ToolPrinted: 6/17/2014 1:14:40 PM

Death Investigation Report page 1 of 32

DECLARATION

The death of MARSZALEK, JOHN ROBERT was investigated by the Office of the Medical Investigator under the statutory authority of the Office of the Medical Investigator.

I, Michelle Aurelius MD, a board certified anatomic, clinical, and forensic pathologist licensed to practice pathology in the State of New Mexico, do declare that I personally performed or supervised the tasks described within this Death Investigation Summary document. It is only after careful consideration of all data available to me at the time that this report was finalized that I attest to the diagnoses and opinions stated herein.

Numerous photographs were obtained along the course of the examination. I have personally reviewed those photographs and attest that they are representative of findings reported in this document.

This document is divided into 10 sections with a final Procedural Notes section:

1. Summary and Opinion

2. External Examination

3. Medical Intervention

4. Postmortem Changes

5. Evidence of Injuries

6. Internal Examination

7. Microscopy

8. Radiography

9. Postmortem Computed Tomography

10. Peer Review

Should you have questions after review of this material, please feel free to contact me at the Office of the Medical Investigator (Albuquerque, New Mexico) - 505-272-3053.

Report Name: Death Investigation SummaryPrinted: 6/17/2014 1:14:41 PM


Medical Investigator

Michelle Aurelius MD

PATHOLOGIC DIAGNOSES:

I. Gunshot wound of back, indeterminate range of fire A. Entrance: left back B. Path: perforates the skin, subcutaneous tissue, left posterior medial first and second ribs, mediastinum (injury to left subclavian and left common carotid arteries); penetrates the sternum at the midline with fracture C. Recovery: internal surface of the sternum, 178.8 grain copper colored jacketed missile D. Trajectory: back to front, downward, and slightly left to right E. Associated injuries:

1. Left hemothorax, 950 ml2. Left lung contusion with hilar hemorrhage

II. Sharp force injuries of neck, multiple, with injuries to: A. Right and left carotid arteries B. Trachea and glottis C. Anterior thyroid cartilage D. Right internal jugular vein E. Thyroid gland F. Strap muscles of neck G. Hemoaspiration of lungsIII. Conducted electrical weapon injury A. Four identifiable conducted electrical weapon marks on the left upper arm, two with taser barbs in skinVI. Mild cardiomegaly, 455 grams A. Mild left ventricular hypertrophy, 1.5 cm B. Mild (up to 40% stenosis) atherosclerosis of left anterior descending coronary arteryVII. Minor injuries of skin A. Superficial abrasions and contusions of skin

SUMMARY AND OPINION:

According to the field investigator report, Mr. John Marszalek was pursued in his vehicle by law enforcement. He sustained self inflicted sharp force injuries of the neck and was shot by law enforcement. A conducted electrical weapon was discharged on Mr. Marszalek.

Significant findings at autopsy include a gunshot wound that entered the back, traveled through two ribs, injured two vessels the emerge from the aortic arch, and entered the sternum (breast bone). A bullet was recovered from the sternum. Associated injuries included 950 ml of blood in the left chest cavity (heomthorax) and contusion (bruise) of the left lung. The range of fire is indeterminate due to the presence of an object (decedent's t-shirt) and the possibility of other object(s) that may interfere with the deposition of indicators of range of fire.

There were also multiple sharp force injuries of the neck that entered the trachea and glottis (windpipe) and injured three vessels in the neck including the right carotid artery, left carotid artery, and right internal jugular vein. There was also hemoaspiration (inhaling blood).

There were also minor injuries to the skin and four identifiable injuries of the left upper arm from a conducted electrical weapon barbs. Two conducted electrical weapon barbs were recovered. The heart was enlarged with mild left ventricular hypertrophy (often due to high blood pressure) and mild coronary artery atherosclerosis (hardening and narrowing of a heart vessel) that did not cause or contribute to death.

Mr. Marszalek died of exanguination (blood loss) from his self inflicted sharp force injury of the neck as well as the gunshot wound of the back. Although the injury to the neck is self inflicted, the gunshot wound resulted from the actions of someone else, thus the manner of death is homicide.

SUMMARY AND OPINION

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2014-01295 MARSZALEK, JOHNSummary OpinionCase Number:




Authority for examination:

Body length (cm):Body weight (kgs):

Development:

Stature:

Age:Anasarca:Edema localized:

Dehydration:

Scalp hair color:Scalp hair color comments:

Scalp hair length:Eyes:

OMI

178.00107.20

Well-developed

Well-nourishedAppears to be stated age

NoNo

No

Brown

CurlyShortBoth eyes present

Irides:Irides comments:Eyes corneae:Eyes sclerae:

OtherBlue-greenTranslucentWhite

Eyes conjunctivae:Eyes petechiae:Palpebral petechiae:Bulbar petechiae:Facial petechiae:

TranslucentNoNoNoNo

External exam date time: 3/13/2014 9:00:00 AM

Means used to confirm identity:

Other verification means:Location of orange bracelet:

Name on orange bracelet:Other name on orange bracelet:Location of green bracelet:Name on green bracelet:Other name on green bracelet:Hospital ID tags or bracelets?

If yes specify stated name and location:

Fingerprints

Right wristDecedent name

Right wristDecedent name

No

ID confirmed at time of exam: No

Development comments:

Page 1 Printed: 6/17/2014 1:14:41 PMExternal Examination

2014-01295 MARSZALEK, JOHNExternal ExaminationCase Number:


Oral mucosal petechiae:Nose:Ears:Lips:Facial hair:Facial hair color:Maxillary dentition:Mandibular dentition:Condition of dentition:Neck:Trachea midline:

NoNormally formedNormally formedNormally formedNoneDoes not applyNaturalNaturalGoodAbnormal - See Evidence of InjuryYes

Chest symmetrical:

Chest diameter:Abdomen:

Back:Spine:Back and spine comment:

External genitalia:

Breast masses:Right hand digits complete:

Left hand digits complete:

Right foot digits complete:

Yes

AppropriateFlat

Abnormal - See Evidence of InjuryNormal

A linear white area on the upper natal cleft at the midline may represent a scar but is likely the normal juncture of the natal cleft.

Male

NoneYesYesYes

Breast development: None

Chest development:

Left foot digits complete: Yes

Muscle group atrophy:

Senile purpura:

Pitting edema:

NoNoNo

Muscle other: NoTattoo(s)

Tattoos present: No

Cosmetic Piercing(s)NoCosmetic piercing present:

Scar(s)

Extremities:Extremities comment:

Well-developed and symmetrical

The palmer right hand and fingers (index, middle, and ring) have black possible ink on them that does not wipe off easily.

Normal

Anus: Unremarkable




NoScar(s) present:

Michelle Aurelius MDReported by:Verified by: Michelle Aurelius MD on 4/25/2014 3:45:05 PMReviewed and approved by: Michelle Aurelius MD on 4/25/2014 3:47:56 PM

Reporting Tracking

The decedent is unclad. Oval tan granular material is in the hair, on the clothing, and on the skin, White athletic shorts are cut off the body for resuscitation and accompany the body. A black T-shirt is cut off the body for resuscitation and accompanies the body. A white metal necklace is around the neck.

External exam comment:






Evidence of medical intervention:

If nasogastric tube present, specify course and position:

If endotracheal tube present, specify course and position:Tracheostomy site/tube:If tracheostomy site/tube present, specify configuration:

Chest tube(s):

If Foley catheter present, specify course and position:

Vascular catheter(s):

Yes

No

No

Yes

A tracheostomy tube enters the anterior neck and terminates in the trachea.

No

No

Yes

Mediastinal tube(s): No

Right antecubital fossa:

Vascular catheter(s) comments:

Recent Surgical InterventionEvidence of recent surgical intervention:

Yes

The right antecubital fossa vascular catheter has attached tubing and saline bag. There is an adjacent needle puncture mark of the right antecubital fossa. There is a tan bandage on but not around the right hand.

No

Indwelling Tubes

ECG Monitoring Pads Present?:

ECG Chest Pads:

Other pads comments:

Defibrillator pads present?:

Other pads comments:

YesYes

There are eight total electrocardiogram pads on the skin. There are two electrocardiogram pads on the left abdomen, one of which has a clipped ECG lead. There are three electrocardiogram pads on the left upper chest, one of which has a clipped ECG lead. The right upper chest has three electrocardiogram pads.

Yes

There are two defibrillator pads on the skin. One is on the left chest and the other is on the left lateral abdomen/chest.

ECG abdomen pads: Yes

Vascular Catheter(s):

ECG Monitoring Pads

Defibrillator Pads

Medical intervention other:A pulse oximeter is on the left ring finger. Around the left upper arm is a blood pressure cuff. Tape is on the right lateral neck over sharp force injuries.

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Report Tracking

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2014-01295 MARSZALEK, JOHNMedical InterventionCase Number:




Body temperature:

Rigor mortis:Livor mortis - color:Livor mortis - fixation (if applicable):Livor mortis - position (if applicable):State of preservation:

Other external features of putrefactive decomposition:

Cool subsequent to refrigerationFully fixedPurpleFully Fixed

Posterior

Mild putrefactive decompositionThere is an area of orange subcutaneous bullae on the right anterior lateral neck from postmortem changes.

External exam date: 3/13/2014 9:00:00 AM


Report Tracking

Page 1 Printed: 6/17/2014 1:14:42 PMPostmortem Changes

2014-01295 MARSZALEK, JOHNPostmortem ChangesCase Number:




Autopsy date: 3/13/2014 3:39:00 PMEvidence of Injury:

# Injury Location Injury Description

1 Firearm injury Back ENTRANCE: On the left upper back 36.5 cm below the top of the head and 2.8 cm to the left of midline of the back is a 1.0cm round entrance gunshot wound with a circumferential marginal abrasion that is widest (up to 0.3 cm) at the 3 to 12o'clock axis. No soot, stippling, searing, or unburned gunpowder is seen on the skin around the entrance wound.

PATH: The hemorrhage wound track sequential perforates the skin, subcutaneous tissue, left posterior medial first and second ribs with adjacent fracture of the lateral left first thoracic vertebra, and mediastinum (partial transection of the left subclavian artery just distal to the branch off the aorta and injury to the left common carotid artery just distal to the branch off the aorta). It penetrates the sternum at the midline with fracture.

RECOVERY: Recovered from the internal surface of the sternum is a 178.8 grain copper colored jacketed missile.

TRAJECTORY: The wound track travels from the decedent's back to front, downward, and slightly left to right.

ASSOCIATED INJURIES: There are 950 ml of blood in the left pleural cavity. There is hemorrhage of the mediastinum and surrounding the injuries to the left common carotid and left subclavian arteries. The is contusion of the left upper lobe of the lung and hemorrhage around the hilus. The pericardial sac is intact and examination of a portion of the cervical and thoracic spinal cord show no injury.

2 Other Other There is blood on the body, shorts, and shirt. There are multiple 0.1 cm oval tan granular material most concentrated on the shirt (inside and outside surfaces), in the hair, and on the posterior upper back.

The black shirt has two defects in the upper back portion that are both 1.0 cm, round, and one on top of the other separated by a 3.4 cm area of shirt cloth. No soot, searing, or unburned gunpowder is visible around the defects however, the shirt is black and blood soaked.

3 Sharp injury Neck On the anterior and lateral neck are multiple sharp force injuries. Some of these injuries are assigned a letter for correlation with photographs and diagrams. They do not imply severity or sequence of occurrence.

STAB WOUND OF LEFT SUPERIOR LATERAL NECK (A):

Are there any injuries: Yes

Page 1 Printed: 6/17/2014 1:14:42 PMEvidence of Injury

2014-01295 MARSZALEK, JOHNEvidence of Injury Case Number:


ENTRANCE (A): On the left superior lateral neck 24.5 cm below the top of the head and 4.5 cm to the left of the anterior midline of the neck is a 2.0 cm long oblique stab wound with two sharp edges.

PATH: The 3.8 cm deep hemorrhagic wound tract perforates the skin and penetrates the underlying soft tissue.

TRAJECTORY: The wound track travels from front to back, slightly left to right, and slightly downward.

MULTIPLE SHARP FORCE INJURIES OF ANTERIOR NECK (B): Includes stab wounds, incised wounds, and superficial incised wounds.

ENTRANCE (B): On the anterior neck centered on the midline starting 26 cm below the top of the head in a 16 x 6.7cm area are multiple (at least eight separate wounds) horizontal to oblique sharp force injuries including two parallel linear superficial incised wounds of the left anterior neck that do not perforate the skin. Some of the edges are drying and the remainder appear to have sharp edges.

PATH: The up to approximately 5.8 cm deep multiple wound tracks have paths that intersect and also intersect with the path of stab wound E. The thyroid gland has four sharp force wounds. The trachea/glottis is entered four times with an area of superficial incision of the posterior trachea (trachea not perforated). There is also sharp force injury to the right sternohyoid muscle, right sternothyroid muscle, right carotid artery, left carotid artery, right jugular vein, anterior thyroid cartilage with multiple incisions, and both (right and left) thyrohyoid muscles.

TRAJECTORY: The wound tracks travel predominantly from front to back.

STAB WOUND OF LEFT LATERAL NECK (C):

ENTRANCE (C): On the left anterior lateral neck, 29 cm below the top of the head and 6.2 cm to the left of anterior midline and superior to stab wound D is a 1.0 cm long oblique stab wound with one sharp end (medial) and one 0.2 cm blunt edge (lateral).

PATH: The 2.9 cm deep hemorrhagic wound track sequentially perforates the skin and subcutaneous tissue. It penetrates the left sternocleidomastoid muscle.

TRAJECTORY: The wound track travels from the decedent's front to back, slightly left to right, and slightly downward.

STAB WOUND OF LEFT MID NECK (D):

ENTRANCE (D): On the left lateral mid neck 30.1 cm below the top of the head and 3.9 cm to the left of anterior midline and inferior to stab wound C and superior to stab wound E, is a 1.2 cm long oblique stab wound with two sharp edges and a Page 2 Printed: 6/17/2014 1:14:42 PMEvidence of Injury



superficial linear incised wound extending 0.2 cm from the lateral edge.

PATH: The 4.5 cm deep hemorrhagic wound tract sequentially perforates the skin, subcutaneous tissue, and left sternocleidomastoid muscle. It penetrates the left medial belly of the omohyoid muscle.

TRAJECTORY: The wound tract travels from the decedent's front to back, slightly left to right, and slightly downward.

STAB WOUND OF LEFT LOWER NECK (E):

ENTRANCE (E): On the left anterior neck 32 cm below the top of the head and 3.0 cm to the left of the anterior midline is a 1.2 cm long oblique stab wound with dried edges (sharp versus blunt cannot be determined) and a superficial linear incised wound extending 1.1 cm from the lateral edge.

PATH: The hemorrhagic wound tract sequentially perforates the skin and subcutaneous tissue. Its path merges with the injury from wound B and cannot be further separated (see wound B for additional injuries).

TRAJECTORY: The wound tract travels from the decedent's front to back, slightly left to right, and slightly downward.

SUPERFICIAL INCISED WOUND OF RIGHT ANTERIOR LATERAL NECK (F):

ENTRANCE (F): On the right anterior lateral neck below sharp force injuries B is a 1.0 cm orange drying oblique superficial incised wound that is 35.5 cm below the top of the head and 3.4 cm to the right of anterior midline. It penetrates the skin. It does not penetrate the subcutaneous tissue.

4 Other Extremity On the left posterior lateral upper arm is a 0.6 cm round abrasion with a puncture mark that contains a white metal conducted electrical weapon (CEW) barb (a portion of this CEW barb can be seen partially under the edge of the blood pressure cuff). Also on the left posterior upper arm is a separate 0.5 cm round abrasion with a puncture mark. On the posterior lateral left shoulder is a 0.8 cm oval superficial abrasion with an eccentric puncture mark.

The left anterior lateral upper arm has a 0.8 cm oval abrasion with a puncture mark that contains a white metal conducted electrical weapon barb.

The conducted electrical weapon barbs perforate the skin and penetrate the underlying subcutaneous tissue.

5 Blunt injury Head The left forehead has a 0.3 cm orange red superficial abrasion.The left chin and right face above the upper lip has scattered orange red superficial abrasions that are 0.2 cm in greatest dimension.




6 Blunt injury Back On the left upper back are two orange red punctate superficial abrasions that are 0.2 cm each. On the left back with extension to the right paramidline back in a 49.9 cm area of scattered orange red superficial abrasions that are 0.8 cm in greatest dimension.

The right upper back has two orange red superficial abrasions that are 0.3 and 0.2 cm from superior to inferior.

7 Blunt injury Extremity The posterior right hand with extension to the posterior little finger has a 3.2 cm area of pink purple contusion with an orange red superficial abrasion. The posterior right distal upper arm/elbow has a 1.5 cm area of orange red superficial abrasions. The right posterior lateral shoulder has a 0.1 cm orange red superficial abrasion.

The posterior left hand at the base of the thumb has a 0.9 cm pink-brown contusion. The posterior left elbow has a 0.3 cm orange red superficial abrasion. On the posterior lateral left forearm is a 0.1 cm orange red punctate superficial abrasion.The left medial upper arm has two purple contusions in a 6.1cm area.

On the right anterior thigh is a 4.5 cm blue contusion. The right lateral distal thigh has a 2.5 cm tan contusion. A 2.0 cm tan contusion is on the right anterior lateral proximal lower leg. On the right anterior lower leg is a 0.3 cm orange red superficial abrasion.

The left anterior thigh has a 1.0 cm faint grey contusion. On the left anterior lower leg is a 17 cm area with four tan contusions. A 0.2 cm orange red superficial abrasion is on the left lateral distal lower leg.


Report Tracking






Date of Internal Exam:

Chest cavities examined:Abdominal cavity examined:

See evidence of injury sectionOrgans in normal anatomic positionOther organ position comments

Diaphragm:Serosal surfaces:Body cavity adhesions present:

Fluid accumulation present:

Fluid accumulation right chest cavity:Fluid accumulation left chest cavity

Fluid accumulation pericardial sac:Fluid accumulation abdominal cavity:

Fluid accumulation comments:

Brain examined:

See separate forensic neuropathology consultation reportSee evidence of injury section:

See evidence of medical Intervention section:

3/13/2014 10:30:00 AM

YesYesYesYes

IntactSmooth and glisteningNo

YesNo

YesNoNo

YesNo

NoNo

See postmortem changes section:

Facial skeleton:Calvarium:

Skull base:

No

No palpable fracturesNo fracturesNo fractures

Fluid accumulation pelvis: No

Dura mater:

Skull comments:

Dural venous sinsuses:

Leptomeninges:Epidural hemorrhages / hematomas:

Unremarkable and without massesPatentThin and transparentAbsent

Date of Autopsy: 3/13/2014 3:39:00 PM

BODY CAVITIES

HEAD

Brain fresh (g):

Brain fixed (g):1365

Page 1 Printed: 6/17/2014 1:14:43 PMInternal Examination

2014-01295 MARSZALEK, JOHNInternal ExaminationCase Number:


Spinal cord examined:

Middle ears examined:

No

No

Subdural hemorrhages / hematomas:Subarachnoid hemorrhages:

Cerebral hemispheres:Gyral and sulcal patterns:

Gyral convolutions and sulci:Uncal processes:

Cerebellar tonsils:Cranial nerves:

Basilar arterial vasculature:Cerebral cortex:

White matter:Corpus callosum:

Deep gray matter structures:Brainstem:

Cerebellum:

Absent

AbsentSymmetricalUnremarkableNo widening or flattening of gyri and no narrowing of sulciUnremarkableUnremarkableUnremarkableUnremarkableUnremarkableUnremarkableUnremarkableUnremarkableUnremarkableUnremarkable

Neck examined:See Evidence of Injury section: See Evidence of Medical Intervention sectionSee Postmortem Changes section:Subcutaneous soft tissues:

Strap muscles:Jugular veins:

Carotid arteries:Tongue:Epiglottis:

Hyoid bone:

Larynx:Palatine tonsils:

YesYesNo

NoSee Evidence of InjurySee Evidence of InjurySee Evidence of InjurySee Evidence of InjuryUnremarkableUnremarkableUnremarkableSee Evidence of InjuryUnremarkable

Spinal Cord

Middle Ears

Neck

CARDIOVASCULAR SYSTEM

See separate Cardiovascular Pathology report:See Evidence of Injury section:See Evidence of Medical Intervention section:See Postmortem Changes section:

No

NoNo

No

Heart examined: Yes

Heart




Aorta examined:

Right coronary ostium position:

Left coronary ostium position:Supply of the posterior myocardium:

Proximal third left anterior descending coronary artery:Middle third left anterior descending coronary artery:Distal third left anterior descending coronary artery:Proximal third left circumflex coronary artery:

Distal third left circumflex coronary artery:

Cardiac chambers:

Tricuspid valve:Pulmonic valve:

Mitral valve:Aortic valve:

Yes

NormalNormalRight coronary artery

40

0

0

0

0

UnremarkableUnremarkableUnremarkableUnremarkableUnremarkable

Right ventricular myocardium:

Left ventricular myocardium:

No fibrosis, erythema, pathologic infiltration of adipose tissue or areas of accentuated softening or indurationNo fibrosis, erythema, or areas of accentuated softening or induration

Middle third left circumflex coronary artery:

0

Coronary artery stenosis by atherosclerosis (in percent):

Ventricular septum:

Right ventricular free wall thickness:Left ventricular free wall thickness:Interventricular septum thickness:

Other heart comments:

Orifices of the major vascular branches:Coarctation:Vascular dissection:

Aneurysm formation:Complex atherosclerosis:

Other aortic pathology:

Unremarkable

0.40 cm

1.50 cm1.60 cm

The wall thicknesses are measured at the mid point between the apex and atrioventricular valves.

Other - See comments

NoNoNoNoNo

Other aortic comments:

Atrial septum: Unremarkable

Aorta

Heart fixed (g):

Heart fresh (g): 455

Cardiac Chambers and Valves:




Great vessels examined: YesVena cava and major tributaries:

Lungs examined:

See separate Cardiovascular Pathology report:

See Evidence of Medical Intervention section:

See Evidence of Injury section:

Upper and lower airways:

Pulmonary parenchyma color:Pulmonary parenchyma congestion and edema:Pulmonary trunk:Pulmonary artery thrombi:

Patent

YesNo

NoYes

Unobstructed, and the mucosal surfaces are smooth and yellow-tanLight pinkSlight amounts of blood and frothy fluid

Free of saddle embolusNone

See evidence of injury.

See Postmortem Changes section: No

Vena Cava

RESPIRATORY SYSTEM

Other airway and lung comments:

Liver examined:See Evidence of Injury section:

See Evidence of Medical Intervention section:See Postmortem Changes section:

Hepatic parenchyma (color):Hepatic parenchyma (texture):Hepatic vasculature:Gallbladder:

Gallstones:Intrahepatic biliary tree:

Extrahepatic biliary tree:

Alimentary tract examined:See Evidence of Injury section:

There is geographic patchy blood on the cut surface of both lungs from hemoaspiration (see evidence of injury).

YesNoNo

No

Red-brownUnremarkableUnremarkable and free of thrombusUnremarkableNoneUnremarkableUnremarkable

YesNo

Pulmonary artery atherosclerosis: None

HEPATOBILIARY SYSTEM

GASTROINTESINAL SYSTEM

Lung right (g):

Lung left (g):

Liver (g):

360280

1745Bile vol (mL):Gallstones autopsy:Gallstones autopsy desc:

No





Course:Mucosa:

Mucosa:

Pylorus:

Luminal contents:

No

No

Normal course without fistulaeGray-white, smooth and without lesions

Usual rugal foldsPatent and without muscular hypertrophy

Partially digested food

Esophagus

Stomach

Colon

Pancreas

Small Intestine

Caliber and continuity:

Luminal contents:

Mucosa:Caliber and continuity:

Form:

Genitourinary system examined:

See Evidence of Injury section:See Evidence of Medical Intervention section:See Postmortem Changes section:

Cortical surfaces:Cortices:

Calyces, pelves and ureters:

Urinary bladder mucosa:

Appropriate caliber without interruption of luminal continuity

Formed stoolUnremarkableAppropriate caliber without interruption of luminal continuity

Normal tan, lobulated appearance

YesNoNo

No

SmoothNormal thickness and well-delineated from the medullary pyramidsNon-dilated and free of stones and masses

Gray-tan and smooth

Kidneys capsules: Thin, semitransparent

Male: Yes

Mucosa: Unremarkable

GENITOURINARY SYSTEM

Kidneys

Urinary Bladder

Male

Testicles

Kidney right (g):

Stomach contents vol (mL):

175

Kidney left (g): 185Urine volume (mL):Urine description:

Appendix found:

10

yellow

YesStomach contents description:




Location:

Size:Consistency:

Other testicle comments:

Size:

Bilaterally intrascrotalUnremarkableHomogenous

UnremarkableProstate Gland

Other prostate gland comments:

Spleen (g):

Adrenal right (g):Adrenal left (g):

Thymus (g):

170

Consistency: Homogenous

Reticuloendothelial system examined:See Evidence of Injury section:

See Postmortem Changes section:

Color:

Regional adenopathy:

Yes

No

No

Red-brown, homogeous and ample

No adenopathy

See Evidence of Medical Intervention section:

No

RETICULOENDOTHELIAL SYSTEM

Spleen

Bone Marrow

Lymph Nodes

Endocrine system examined:See Evidence of Injury section:


Size:

Position:Size:

Parenchyma:

Size:

YesNoNo

No

Normal

NormalNormalHomogenous

Normal

Parenchyma: Absent (involution by adipose tissue)

Thymus

ENDOCRINE SYSTEM

Pituitary Gland

Thyroid Gland

Adrenal Glands

Spleen parenchyma: Moderately firmSpleen capsule: IntactSpleen white pulp: Indiscernible




Musculoskeletal system examined:See Evidence of Injury section:See Evidence of Medical Intervention section:See Postmortem Changes section:

Bony framework:

Subcutaneous soft tissues:

YesYesNo

NoSee Evidence of Injury

See Evidence of Injury

Parenchyma: Yellow cortices and gray medullae with with the expected corticomedullary ratio

Musculature: See Evidence of Injury

MUSCULOSKELETAL SYSTEM

ADDITIONAL COMMENTS


Report Tracking






Microscopic description:HEART: Intersitital edema. Some myocyte nuclei are enlarged and irregular.

LUNGS: Intra-alveolar blood, congestion, a bronchiole with luminal acellular muscle and no inflammatory response from agonal aspiration. Red blood cells within some bronchioles.

LIVER, KIDNEY, BRAIN: No significant histopathologic diagnosis.

Medical lnvestigator Trainee

unassigned

Block Tissue Location Description Stain

A1 bilateral lungs, all lobes

A2 left kidney, liver

A3 heart (right ventricle, left ventricle, inter ventricular septum)

A4 brain (cerebellum)

*Unless otherwise indicated sections are stained only with hematoxylin and eosin (H&E).

Michelle Aurelius MDReported by:Verified by: Michelle Aurelius MD on 4/25/2014 10:20:14 AMReviewed and approved by: Michelle Aurelius MD on 4/25/2014 3:47:56 PM

Report Tracking

Page 1 Printed: 6/17/2014 1:14:43 PMMicroscopy:

2014-01295 MARSZALEK, JOHNMicroscopyCase Number:




Study date:

Accession number:Exam type:

Technique:Comparison:Comments:

3/13/2014 7:09:00 AMOMI2014-01295Anterior posterior views of the head, neck, and chestRadiographs

Anterior/posterior radiographs (two total) of the head, neck, and chest show a retained radiopaque missile in the chest.

Date of examination: 3/13/2014 3:39:00 PM

Michelle Aurelius MDReported by:Verified by: Michelle Aurelius MD on 4/25/2014 11:20:36 AMReviewed and approved by: Michelle Aurelius MD on 4/25/2014 3:47:56 PM

Report Tracking

Page 1 Printed: 6/17/2014 1:14:43 PMRadiography

2014-01295 MARSZALEK, JOHNRadiographyCase Number:




Study date:

Accession number:Exam type:

Technique:Comparison:Comments:

3/13/2014 6:13:00 AMOMI2014-01295Postmortem full bodyComputed tomography scan

A postmortem full body computed tomography scan shows a retained retrievable missile in the anterior chest. There is fluid in the left chest. There is air in the right heart. A radiopaque is in the sternum with adjacent fractures. There are fractures of the left posterior first and second ribs with a fracture of the left lateral 1st thoracic cervical vertebra.

Date of examination: 3/13/2014 3:39:00 PM


Report Tracking

Page 1 Printed: 6/17/2014 1:14:44 PMComputed Tomography

2014-01295 MARSZALEK, JOHNPMCTCase Number:


Case Number:

Date of Examination:Pathologist:

Fellow/Resident:Reviewer:

Death investigation report:Photographs:Microscopic slides:Toxicology report:

Other Items (specify):Other Items Comments:

Is the report independently reviewable?:

Is the external description (without injuries) appropriately case specific?:

Are the descriptions of injury, if present, appropriate for the complexity of the case, and consistent with diagrams and photographs?:

Are the descriptions of injury, if present, organized in a logical and understandable sequence?:

Are the descriptions of natural disease, if present, appropriate for the complexity of the case?:

Is the text clear and understandable without significant typographical and/or grammatical errors?:

Is the opinion readily understandable by the nonmedical reader?:

Are all significant issues addressed in the opinion?:

Was appropriate ancillary testing performed?:

Are the opinions reasonable?:

Is the cause of death reasonable?:

Is the manner of death reasonable?:

Report completed in a timely fashion?:

Comments:

2014-012953/13/2014 3:39:00 PMMichelle Aurelius MDnoneSam Andrews MD

YesYesYesNoYes

Case notes; postmortem radiographs; postmortem computed tomography scan

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Are the descriptions of clothing and identifying marks and scars appropriate for the complexity of the case?: Yes

Is the opinion logical and complete?: Yes

Decedent Name: MARSZALEK, JOHN

Items Reviewed

Technical Audit

Sam Andrews MDReported by:Verified by: Sam Andrews MD on 4/25/2014 3:24:59 PMReviewed and approved by: Michelle Aurelius MD on 4/25/2014 3:47:56 PM

Report Tracking

Page 1 Printed: 6/17/2014 1:14:44 PMPeer Review Report

2014-01295 MARSZALEK, JOHNPeer Review ReportCase Number:


Printed: 6/17/2014 1:14:44 PMPeer Review Report

2014-01295 MARSZALEK, JOHNPeer Review ReportCase Number:


Yellow Sheet Morphology TechnicianEvidence Woodrow Watts

Identification Woodrow Watts

Autopsy Woodrow Watts

Evidence Woodrow Watts

Radiology Woodrow Watts

Retention Woodrow Watts

Toxicology Woodrow Watts



LabOther Woodrow Watts

Attendees Woodrow Watts

Case Number:

Date of Examination:

Pathologist:

Fellow/Resident:

2014-01295

3/13/2014 3:39:00 PM

Michelle Aurelius MDnone

Decedent Name: MARSZALEK, JOHN

Morphology technican(s) present

Morphology technican supervisor(s) present

Yellow Sheet Morphology Technician LeadIdentification Monica Mondragon

Autopsy Stephen Adams

Evidence Monica Mondragon

Radiology Monica Mondragon

Retention Monica Mondragon

Toxicology Erika Cavalier

LabOther Monica Mondragon

Attendees Monica Mondragon

Page 1 Printed: 6/17/2014 1:14:46 PMProcedural Notes Report

2014-01295 MARSZALEK, JOHNProcedural Notes Case Number:


Autopsy attendees

Specimens obtained for toxicology testing

Other morphology technicians present:Rebbeca RomansMike FalknerDesiree Mora

Law enforcement officers present:Detective John Bonnell, Farmington Police Department.Detective George Joy, Farmington Police Department.Jamie Clemans, Crime Scene Technician, Farmington Police Department.

Use antemortem specimens for testing:

No

Femoral blood collected: YesYesHeart blood collected:

NoBlood other collected:

YesPreserved vitreous collected:

YesUn-preserved vitreous collected:

NoBile collected:NoGastric contents collected:

NoKidney tissue collected:

NoLiver tissue collected:

NoBrain tissue collected:

NoMuscle tissue collected:

NoOther tissue collected:

Urine collected: Yes




Specimens obtained for laboratory testing

Approach to autopsy dissection

HIV serology: No

HCV/HBV serology :

Influenza serology:

Other serology:

Freezer protocol:

DNA card:

Metabolic screen:

Cytogenetics:

Med-X protocol:

Urine dipstick:

Blood cultures (bacterial):Lung cultures (bacterial):

CSF culture (bacterial):

Spleen culture (bacterial):

Stool culture (bacterial):

Other bacterial culture (specify):

Mycobacterial culture (lung):Mycobacterial culture (other):

NoNoNo

NoYesNoNoNoNoNoNoNo

NoNo

NoNo

Rokitansky evisceration: NoVirchow evisceration: YesModified evisceration: No

Viral Cultures: No

HIV spin and store: Yes




Special autopsy techniques

Tissues retention

Disposition of tissues retained for extended examination

Pericranial membrane removal: NoNeck anterior dissection: YesNeck posterior dissection: YesFacial dissection: NoVertebral artery dissection (in situ): NoCervical spine removal: NoLayered anterior trunk dissection: YesAnterolateral rib arc dissection: NoBack dissection: YesPosterior rib arc dissection: NoExtremity soft tissue dissection: NoEye enucleation: NoInner middle ear evaluation: NoMaxilla or mandible resection: NoSpinal cord removal (anterior): NoSpinal cord removal (posterior): Yes

Other dissection(s):

Stock jar with standard tissue retention:

Yes

Rib segment: YesPituitary gland: YesBreast tissue (women only): NoBrain retention: NoSpinal cord retention: NoCervical spine retention: NoHeart retention: NoHeart-lung block retention: NoRib cage retention: NoLong bone retention: No

Other retention,specify:

Specimen outcome: Not applicable; no tissues were retained for extended examination.

HIV serology: No




Number of scene photos produced by the OMI

Number of autopsy photos produced by the OMI

Evidence collected

Personal effects

Scene Photos: 21

Autopsy Photos: 122

FBI blood tube: NoBlood spot card: YesAPD blood card: NoThumbprint: YesFingerprints: YesPalmprints: YesPrint hold: YesOral swab: NoVaginal swab: NoAnal swab: NoOther swab: NoFingernails: YesScalp hair: YesPubic hair: NoPubic hair combing: NoProjectile(s): YesRetain clothing: YesRetain valuables: YesRetain trace evidence: YesRetain body bag: NoRetain hand bags: NoLigature: NoOther evidence retained:

Property Type Property Description Property DetailValuables Necklace wm

Blood FTA Blood Card blood spot

Hair Scalp n/a

Missile Describe 178.8 GN from sternum

Trace Location from hair

Fingernail Clipping Left Hand w/ clippers

Fingernail Clipping Right Hand w/ clippers

Other Other taser barb from anterior (L) upper arm

Other Other taser barb from posterior (L) upper arm

Fingerprints Describe 10 PRINTS




Clothing

Property Type Property Description Property DetailClothing Shirt n/a

Clothing Shorts n/a




John Marszalek II death investigation

Documents

Transcript of John Marszalek II death investigation