The University of New Mexico Health Sciences Center

6/17/2014
MSC07 4040
1 University of New Mexico
Albuquerque, NM 87131-0001
Telephone (505) 272-3053
FAX (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
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
Michelle Aurelius, MD
District Attorney San Juan County DA
Law 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 Investigator
MSC07 4040
1 University of New Mexico
Albuquerque, NM 87131-0001
CAUSE OF DEATH
Sharp force injuries of neck and gunshot wound of back
MANNER OF DEATH
Homicide
DEATH INVESTIGATION SUMMARY
Case Number: 2014-01295
MARSZALEK, JOHN ROBERT
Michelle Aurelius MD
Assistant Chief Medical Investigator and University
of New Mexico Hospital Autopsy Director
All signatures authenticated electronically
Date: 4/25/2014 3:47:56 PM
County Pronounced: San Juan
Law 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 Tool Printed: 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 Summary Printed: 6/17/2014 1:14:41 PM
Death Investigation Report page 2 of 32
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 ml
2. 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 lungs
III. Conducted electrical weapon injury
A. Four identifiable conducted electrical weapon marks on the left upper arm, two with taser barbs in skin
VI. Mild cardiomegaly, 455 grams
A. Mild left ventricular hypertrophy, 1.5 cm
B. Mild (up to 40% stenosis) atherosclerosis of left anterior descending coronary artery
VII. Minor injuries of skin
A. Superficial abrasions and contusions of skin
SUMMARY AND OPINION:
According to the field investigator report, Mr. J ohn 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, JOHN Summary Opinion Case Number:
Death Investigation Report page 3 of 32
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2014-01295 MARSZALEK, JOHN Summary Opinion Case Number:
Death Investigation Report page 4 of 32
Medical Investigator
Michelle Aurelius MD
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
178.00
107.20
Well-developed
Well-nourished
Appears to be stated age
No
No
No
Brown
Curly
Short
Both eyes present
Irides:
Irides comments:
Eyes corneae:
Eyes sclerae:
Other
Blue-green
Translucent
White
Eyes conjunctivae:
Eyes petechiae:
Palpebral petechiae:
Bulbar petechiae:
Facial petechiae:
Translucent
No
No
No
No
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 wrist
Decedent name
Right wrist
Decedent name
No
ID confirmed at time of exam: No
Development comments:
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2014-01295 MARSZALEK, JOHN External Examination Case Number:
Death Investigation Report page 5 of 32
Oral mucosal petechiae:
Nose:
Ears:
Lips:
Facial hair:
Facial hair color:
Maxillary dentition:
Mandibular dentition:
Condition of dentition:
Neck:
Trachea midline:
No
Normally formed
Normally formed
Normally formed
None
Does not apply
Natural
Natural
Good
Abnormal - See Evidence of Injury
Yes
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
Appropriate
Flat
Abnormal - See Evidence of Injury
Normal
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
None
Yes
Yes
Yes
Breast development: None
Chest development:
Left foot digits complete: Yes
Muscle group atrophy:
Senile purpura:
Pitting edema:
No
No
No
Muscle other: No
Tattoo(s)
Tattoos present:
No
Cosmetic Piercing(s)
No
Cosmetic 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
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2014-01295 MARSZALEK, JOHN External Examination Case Number:
Death Investigation Report page 6 of 32
No Scar(s) present:
Michelle Aurelius MD Reported by:
Verified by: Michelle Aurelius MD on 4/25/2014 3:45:05 PM
Reviewed 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:
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2014-01295 MARSZALEK, JOHN External Examination Case Number:
Death Investigation Report page 7 of 32
Medical Investigator
Michelle Aurelius MD
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 Intervention
Evidence 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:
Yes
Yes
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.
Page 1 Printed: 6/17/2014 1:14:42 PM Medical Intervention
2014-01295 MARSZALEK, JOHN Medical Intervention Case Number:
Death Investigation Report page 8 of 32
Michelle Aurelius MD Reported by:
Verified by: Michelle Aurelius MD on 4/25/2014 3:46:09 PM
Reviewed and approved by: Michelle Aurelius MD on 4/25/2014 3:47:56 PM
Report Tracking
Page 2 Printed: 6/17/2014 1:14:42 PM Medical Intervention
2014-01295 MARSZALEK, JOHN Medical Intervention Case Number:
Death Investigation Report page 9 of 32
Medical Investigator
Michelle Aurelius MD
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 refrigeration
Fully fixed
Purple
Fully Fixed
Posterior
Mild putrefactive decomposition
There 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
Michelle Aurelius MD Reported by:
Verified by: Michelle Aurelius MD on 3/13/2014 6:19:03 PM
Reviewed and approved by: Michelle Aurelius MD on 4/25/2014 3:47:56 PM
Report Tracking
Page 1 Printed: 6/17/2014 1:14:42 PM Postmortem Changes
2014-01295 MARSZALEK, JOHN Postmortem Changes Case Number:
Death Investigation Report page 10 of 32
Medical Investigator
Michelle Aurelius MD
Autopsy date: 3/13/2014 3:39:00 PM
Evidence 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 1.0
cm round entrance gunshot wound with a circumferential
marginal abrasion that is widest (up to 0.3 cm) at the 3 to 12
o'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.
TRAJ ECTORY: The wound track travels from the decedent's
back to front, downward, and slightly left to right.
ASSOCIATED INJ URIES: 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
multiple0.1 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
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2014-01295 MARSZALEK, JOHN Evidence of Injury Case Number:
Death Investigation Report page 11 of 32
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.
TRAJ ECTORY: The wound track travels from front to back,
slightly left to right, and slightly downward.
MULTIPLE SHARP FORCE INJ URIES 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 6.7
cm 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.
TRAJ ECTORY: 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.
TRAJ ECTORY: 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
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2014-01295 MARSZALEK, JOHN Evidence of Injury Case Number:
Death Investigation Report page 12 of 32
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.
TRAJ ECTORY: 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
a1.2 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).
TRAJ ECTORY: 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
separate0.5 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.
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2014-01295 MARSZALEK, JOHN Evidence of Injury Case Number:
Death Investigation Report page 13 of 32
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 6.1
cm 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.
Michelle Aurelius MD Reported by:
Verified by: Michelle Aurelius MD on 4/25/2014 3:46:02 PM
Reviewed and approved by: Michelle Aurelius MD on 4/25/2014 3:47:56 PM
Report Tracking
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2014-01295 MARSZALEK, JOHN Evidence of Injury Case Number:
Death Investigation Report page 14 of 32
Medical Investigator
Michelle Aurelius MD
Date of Internal Exam:
Chest cavities examined:
Abdominal cavity examined:
See evidence of injury section
Organs in normal anatomic
position
Other 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 report
See evidence of injury section:
See evidence of medical
Intervention section:
3/13/2014 10:30:00 AM
Yes
Yes
Yes
Yes
Intact
Smooth and glistening
No
Yes
No
Yes
No
No
Yes
No
No
No
See postmortem changes section:
Facial skeleton:
Calvarium:
Skull base:
No
No palpable fractures
No fractures
No fractures
Fluid accumulation pelvis: No
Dura mater:
Skull comments:
Dural venous sinsuses:
Leptomeninges:
Epidural hemorrhages /
hematomas:
Unremarkable and without masses
Patent
Thin and transparent
Absent
Date of Autopsy: 3/13/2014 3:39:00 PM
BODY CAVITIES
HEAD
Brain fresh (g):
Brain fixed (g):
1365
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2014-01295 MARSZALEK, JOHN Internal Examination Case Number:
Death Investigation Report page 15 of 32
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
Absent
Symmetrical
Unremarkable
No widening or flattening of gyri and no narrowing of sulci
Unremarkable
Unremarkable
Unremarkable
Unremarkable
Unremarkable
Unremarkable
Unremarkable
Unremarkable
Unremarkable
Unremarkable
Neck examined:
See Evidence of Injury section:
See Evidence of Medical
Intervention section
See Postmortem Changes section:
Subcutaneous soft tissues:
Strap muscles:
Jugular veins:
Carotid arteries:
Tongue:
Epiglottis:
Hyoid bone:
Larynx:
Palatine tonsils:
Yes
Yes
No
No
See Evidence of Injury
See Evidence of Injury
See Evidence of Injury
See Evidence of Injury
Unremarkable
Unremarkable
Unremarkable
See Evidence of Injury
Unremarkable
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
No
No
No
Heart examined: Yes
Heart
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2014-01295 MARSZALEK, JOHN Internal Examination Case Number:
Death Investigation Report page 16 of 32
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
Normal
Normal
Right coronary artery
40
0
0
0
0
Unremarkable
Unremarkable
Unremarkable
Unremarkable
Unremarkable
Right ventricular myocardium:
Left ventricular myocardium:
No fibrosis, erythema, pathologic infiltration of adipose tissue or areas of accentuated
softening or induration
No 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 cm
1.60 cm
The wall thicknesses are measured at the mid point between the apex and atrioventricular valves.
Other - See comments
No
No
No
No
No
Other aortic comments:
Atrial septum: Unremarkable
Aorta
Heart fixed (g):
Heart fresh (g): 455
Cardiac Chambers and Valves:
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2014-01295 MARSZALEK, JOHN Internal Examination Case Number:
Death Investigation Report page 17 of 32
Great vessels examined: Yes
Vena 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
Yes
No
No
Yes
Unobstructed, and the mucosal surfaces are smooth and yellow-tan
Light pink
Slight amounts of blood and frothy fluid
Free of saddle embolus
None
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).
Yes
No
No
No
Red-brown
Unremarkable
Unremarkable and free of thrombus
Unremarkable
None
Unremarkable
Unremarkable
Yes
No
Pulmonary artery atherosclerosis: None
HEPATOBILIARY SYSTEM
GASTROINTESINAL SYSTEM
Lung right (g):
Lung left (g):
Liver (g):
360
280
1745
Bile vol (mL):
Gallstones autopsy:
Gallstones autopsy desc:
No
Page 4 Printed: 6/17/2014 1:14:43 PM Internal Examination
2014-01295 MARSZALEK, JOHN Internal Examination Case Number:
Death Investigation Report page 18 of 32
See Evidence of Medical
Intervention section:
See Postmortem Changes section:
Course:
Mucosa:
Mucosa:
Pylorus:
Luminal contents:
No
No
Normal course without fistulae
Gray-white, smooth and without lesions
Usual rugal folds
Patent 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 stool
Unremarkable
Appropriate caliber without interruption of luminal continuity
Normal tan, lobulated appearance
Yes
No
No
No
Smooth
Normal thickness and well-delineated from the medullary pyramids
Non-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): 185
Urine volume (mL):
Urine description:
Appendix found:
10
yellow
Yes
Stomach contents description:
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2014-01295 MARSZALEK, JOHN Internal Examination Case Number:
Death Investigation Report page 19 of 32
Location:
Size:
Consistency:
Other testicle comments:
Size:
Bilaterally intrascrotal
Unremarkable
Homogenous
Unremarkable
Prostate 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:
See Evidence of Medical
Intervention section:
See Postmortem Changes section:
Size:
Position:
Size:
Parenchyma:
Size:
Yes
No
No
No
Normal
Normal
Normal
Homogenous
Normal
Parenchyma: Absent (involution by adipose tissue)
Thymus
ENDOCRINE SYSTEM
Pituitary Gland
Thyroid Gland
Adrenal Glands
Spleen parenchyma: Moderately firm
Spleen capsule: Intact
Spleen white pulp: Indiscernible
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2014-01295 MARSZALEK, JOHN Internal Examination Case Number:
Death Investigation Report page 20 of 32
Musculoskeletal system examined:
See Evidence of Injury section:
See Evidence of Medical
Intervention section:
See Postmortem Changes section:
Bony framework:
Subcutaneous soft tissues:
Yes
Yes
No
No
See 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
Michelle Aurelius MD Reported by:
Verified by: Michelle Aurelius MD on 4/25/2014 3:47:18 PM
Reviewed and approved by: Michelle Aurelius MD on 4/25/2014 3:47:56 PM
Report Tracking
Page 7 Printed: 6/17/2014 1:14:43 PM Internal Examination
2014-01295 MARSZALEK, JOHN Internal Examination Case Number:
Death Investigation Report page 21 of 32
Medical Investigator
Michelle Aurelius MD
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 MD Reported by:
Verified by: Michelle Aurelius MD on 4/25/2014 10:20:14 AM
Reviewed 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 PM Microscopy:
2014-01295 MARSZALEK, JOHN Microscopy Case Number:
Death Investigation Report page 22 of 32
Medical Investigator
Michelle Aurelius MD
Study date:
Accession number:
Exam type:
Technique:
Comparison:
Comments:
3/13/2014 7:09:00 AM
OMI2014-01295
Anterior posterior views of the head, neck, and chest
Radiographs
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 MD Reported by:
Verified by: Michelle Aurelius MD on 4/25/2014 11:20:36 AM
Reviewed 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 PM Radiography
2014-01295 MARSZALEK, JOHN Radiography Case Number:
Death Investigation Report page 23 of 32
Medical Investigator
Michelle Aurelius MD
Study date:
Accession number:
Exam type:
Technique:
Comparison:
Comments:
3/13/2014 6:13:00 AM
OMI2014-01295
Postmortem full body
Computed 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
Michelle Aurelius MD Reported by:
Verified by: Michelle Aurelius MD on 4/25/2014 3:46:17 PM
Reviewed 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 PM Computed Tomography
2014-01295 MARSZALEK, JOHN PMCT Case Number:
Death Investigation Report page 24 of 32
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:
2014-01295
3/13/2014 3:39:00 PM
Michelle Aurelius MD
none
Sam Andrews MD
Yes
Yes
Yes
No
Yes
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, J OHN
Items Reviewed
Technical Audit
Sam Andrews MD Reported by:
Verified by: Sam Andrews MD on 4/25/2014 3:24:59 PM
Reviewed 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 PM Peer Review Report
2014-01295 MARSZALEK, JOHN Peer Review Report Case Number:
Death Investigation Report page 25 of 32
Page 2 Printed: 6/17/2014 1:14:44 PM Peer Review Report
2014-01295 MARSZALEK, JOHN Peer Review Report Case Number:
Death Investigation Report page 26 of 32
Yellow Sheet Morphology Technician
Evidence Woodrow Watts
Identification Woodrow Watts
Autopsy Woodrow Watts
Evidence Woodrow Watts
Radiology Woodrow Watts
Retention Woodrow Watts
Toxicology Woodrow Watts
Toxicology 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 MD
none
Decedent Name: MARSZALEK, J OHN
Morphology technican(s) present
Morphology technican supervisor(s) present
Yellow Sheet Morphology Technician Lead
Identification 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 PM Procedural Notes Report
2014-01295 MARSZALEK, JOHN Procedural Notes Case Number:
Death Investigation Report page 27 of 32
Autopsy attendees
Specimens obtained for toxicology testing
Other morphology technicians present:
Rebbeca Romans
Mike Falkner
Desiree Mora
Law enforcement officers present:
Detective J ohn Bonnell, Farmington Police Department.
Detective George J oy, Farmington Police Department.
J amie Clemans, Crime Scene Technician, Farmington Police Department.
Use antemortem specimens for
testing:
No
Femoral blood collected: Yes
Yes Heart blood collected:
No Blood other collected:
Yes Preserved vitreous collected:
Yes Un-preserved vitreous collected:
No Bile collected:
No Gastric contents collected:
No Kidney tissue collected:
No Liver tissue collected:
No Brain tissue collected:
No Muscle tissue collected:
No Other tissue collected:
Urine collected: Yes
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2014-01295 MARSZALEK, JOHN Procedural Notes Case Number:
Death Investigation Report page 28 of 32
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):
No
No
No
No
Yes
No
No
No
No
No
No
No
No
No
No
No
Rokitansky evisceration: No
Virchow evisceration: Yes
Modified evisceration: No
Viral Cultures: No
HIV spin and store: Yes
Page 3 Printed: 6/17/2014 1:14:46 PM Procedural Notes Report
2014-01295 MARSZALEK, JOHN Procedural Notes Case Number:
Death Investigation Report page 29 of 32
Special autopsy techniques
Tissues retention
Disposition of tissues retained for extended examination
Pericranial membrane removal: No
Neck anterior dissection: Yes
Neck posterior dissection: Yes
Facial dissection: No
Vertebral artery dissection (in situ): No
Cervical spine removal: No
Layered anterior trunk dissection: Yes
Anterolateral rib arc dissection: No
Back dissection: Yes
Posterior rib arc dissection: No
Extremity soft tissue dissection: No
Eye enucleation: No
Inner middle ear evaluation: No
Maxilla or mandible resection: No
Spinal cord removal (anterior): No
Spinal cord removal (posterior): Yes
Other dissection(s):
Stock jar with standard tissue
retention:
Yes
Rib segment: Yes
Pituitary gland: Yes
Breast tissue (women only): No
Brain retention: No
Spinal cord retention: No
Cervical spine retention: No
Heart retention: No
Heart-lung block retention: No
Rib cage retention: No
Long bone retention: No
Other retention,specify:
Specimen outcome: Not applicable; no tissues were retained for extended examination.
HIV serology: No
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2014-01295 MARSZALEK, JOHN Procedural Notes Case Number:
Death Investigation Report page 30 of 32
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: No
Blood spot card: Yes
APD blood card: No
Thumbprint: Yes
Fingerprints: Yes
Palmprints: Yes
Print hold: Yes
Oral swab: No
Vaginal swab: No
Anal swab: No
Other swab: No
Fingernails: Yes
Scalp hair: Yes
Pubic hair: No
Pubic hair combing: No
Projectile(s): Yes
Retain clothing: Yes
Retain valuables: Yes
Retain trace evidence: Yes
Retain body bag: No
Retain hand bags: No
Ligature: No
Other evidence retained:
Property Type Property Description Property Detail
Valuables 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
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2014-01295 MARSZALEK, JOHN Procedural Notes Case Number:
Death Investigation Report page 31 of 32
Clothing
Property Type Property Description Property Detail
Clothing Shirt n/a
Clothing Shorts n/a
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2014-01295 MARSZALEK, JOHN Procedural Notes Case Number:
Death Investigation Report page 32 of 32