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NARRATOR: An elderly man who lives
00:00:19
alone dies under suspicious circumstances
00:00:22
during a brutal winter storm.
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There's all sorts of trauma on his face, on his hands,
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on his arm.
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I see blood on the screen door, blood
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mixed with mud on his face.
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NARRATOR: Who or what led to his tragic death?
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He was a nice guy.
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Everybody's saying he was a nice guy.
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He had lots of friends.
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Why would somebody just go in there
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and beat him up and throw him in the backyard?
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NARRATOR: And then--
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[GUNSHOT]
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--a gunshot victim is paralyzed from the waist down.
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But 30 years after the shooting, he
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dies unexpectedly at a clinic.
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Just dead right there in the waiting room.
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NARRATOR: The question is, what actually killed him--
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complications from his paralysis or natural disease?
00:01:01
That's the big question.
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Because if the paralysis killed him, it's a homicide.
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There's not going to be a statute
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of limitations on murder.
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NARRATOR: Altered lives, baffling medical mysteries,
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shocking revelations--
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these are the everyday cases of "Dr. G, Medical Examiner."
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[THEME MUSIC]
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As chief medical examiner in Orlando, Florida,
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Dr. G has had a number of fatalities attributed
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to weather conditions.
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It has been very hot here in Orlando.
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I know it's, you know, considered paradise for some,
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but it's been a little bit hot.
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NARRATOR: But one of her most troubling weather
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related deaths occurred in 2003, when
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she was a medical examiner at the Bear County
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morgue in San Antonio, Texas.
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During that winter, a brutal ice storm swept into the area.
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Temperature in the 20s, which was very unusual for Texas,
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and everything was frozen over.
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It was all over. It was cold.
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It was icy.
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It was raining.
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It was sleeting.
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NARRATOR: In the storm's wake, Investigator Steve Hanson
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is dispatched to investigate the deaths of several victims.
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One of them is a 92-year-old man who
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was discovered dead in his yard the morning after the storm.
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OK, Steve, you were at the scene.
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Yeah, the--
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What's going on here?
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NARRATOR: Investigator Hanson briefs
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Dr. G on what he's learned so far about the decedent.
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His name is Richard Adler.
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He's a 92-year-old widower and decorated
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former military officer.
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Stubbornly independent, he lived alone
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with the help of part-time care, despite his advanced age
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and a diagnosis of dementia.
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Seems like an independent, dynamic guy
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with a really good life.
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He was doing OK.
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He wasn't wheelchair bound.
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He wasn't stuck with a walker.
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You know, he's an ex-military officer.
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You know, he's old school, and he was tough.
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And you know, just that whole fact
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of him wanting to live alone--
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I mean, this was a man with dementia,
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but he still wanted to live alone and try to take care
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of himself as much as he could.
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NARRATOR: Which is why the circumstances surrounding
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his death are so disturbing.
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According to Investigator Hanson, earlier that morning,
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Mr. Adler's caregiver Suzanne arrives at his residence
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at 9:00 AM as usual.
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But she finds the front door wide open
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and no sign of Mr Adler inside the cold house.
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And I thought, well, it's kind of early for him
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to be out this morning, leave that door open.
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Keep in mind, it's in the 20s.
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Not too many people should keep their front door open.
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NARRATOR: Worried, Suzanne searches outside for Mr. Adler,
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who routinely went out to check for the mail every day.
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JAN GARAVAGLIA: She's looking all around for him,
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cannot find him.
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He's not in the house.
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He's not in the front yard.
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She's very worried about him.
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NARRATOR: As she approaches the backyard,
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she notices the fence gate ajar.
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And then she sees him.
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Mr. Adler is sprawled face down on the frozen ground
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at the foot of a cement patio.
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His body is bloody, bruised, and he is clearly no longer alive.
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It scared me real, real bad.
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NARRATOR: Investigator Hanson and the police
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are dispatched to the scene.
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Here we find this guy laying in the backyard,
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and there's all sorts of trauma on his face, on his hands,
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on his arm.
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NARRATOR: In addition, the back screen door is ripped
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and there is blood in several locations.
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You see blood on the screen door, blood
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mixed with mud on his face.
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His glasses were here.
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There was a little blood on the lenses.
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NARRATOR: The death of the independent 92-year-old man
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is immediately suspect.
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Investigators' chief concern is that he may have been
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victimized in a home invasion.
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And they have good reason to be suspicious.
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While robberies have decreased overall in the US,
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at the time of Mr. Adler's death,
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home invasion robberies, which typically target the elderly,
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are on the rise.
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Well, the first thing that comes to mind
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is there's something wrong.
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Here's a guy that shouldn't be in the backyard.
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He should be-- you know, he's 90 some odd years old.
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And he's got trauma all over him.
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Well, obviously, the first thing you do is stop and think.
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Whoa, this has possibility of being a homicide.
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So let's take it from there.
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JAN GARAVAGLIA: It was definitely
00:05:41
an ominous story at that point.
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NARRATOR: But based on photos taken at the scene,
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Investigator Hanson points out that Mr. Adler may have simply
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fallen off of the cement patio, which could have easily
00:05:54
contributed to his death.
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This raised patio area right here, you can see this is icy.
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Oh.
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And you can see that his feet are--
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NARRATOR: Moreover, he finds marks
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on the ground near the victim's feet,
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which suggests that Mr. Adler was still alive after the fall.
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So you can see at the scene, it looks like he
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was moving around a little bit.
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NARRATOR: But whatever the ultimate cause of his death
00:06:20
may have been, it seems Mr. Adler met a dreadful fate.
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When authorities informed the family of his death,
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they are distraught over what he might have endured in the hours
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he was alone at his home.
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The main concern of his family is how long was he out there?
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How long did he have to suffer?
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Did he die right away?
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He was a nice guy.
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Everybody is saying he was a nice guy.
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He had lots of friends.
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Why would somebody just go in there
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and beat him up and throw him in the backyard?
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NARRATOR: Like any unexplained fatality,
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the death of Richard Adler will require a full autopsy.
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Thank you, Steve.
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Yeah, I'll let you know what I find.
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Poor guy.
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NARRATOR: Dr. G takes her first look at the elderly man's body.
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It is muddy and covered with debris.
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And as investigator Hanson noted,
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it looks as if Mr. Adler struggled while on the ground.
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His hands, too, show signs of a struggle.
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Really crawling, really grabbing
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at something in that mud.
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You can see it's just caked on there with the blood.
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NARRATOR: Dr. G collects forensic evidence
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from Mr. Adler's fingernails in the event he was attacked.
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Then to get a better look at his injuries,
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the morgue technician strips the body and washes it of debris.
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Once the body is cleaned, the trauma is evident.
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But back of his hands really bruised,
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over the knuckles bruised.
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He's got a lot of dried blood, so he's clearly bleeding.
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He also has bruising about his elbows,
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some abrasion, and even a superficial small laceration
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on that left elbow, bruise on the back of that left hand.
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NARRATOR: And on the back of his right hand,
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Dr. G finds a deep tear.
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JAN GARAVAGLIA: He tore that skin.
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It's almost eight-inch tear with a flap.
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And so it's a bad tear and exposes
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the ligaments in his hand.
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NARRATOR: The tear is so deep it would
00:08:26
have required extensive surgery to repair
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it had Mr. Adler survived.
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JAN GARAVAGLIA: You know, this would have needed a skin graft.
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We're down to his ligaments there.
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NARRATOR: The severity of the trauma
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just adds to the burning question.
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What did this man endure before he died?
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It could be that he's in, you know,
00:08:46
some kind of fight, some type of altercation.
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You know, it wouldn't take much with this older fellow.
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NARRATOR: The external exam is coming to a close.
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And Dr. G has made several key findings--
00:09:00
bruising, trauma, signs of a struggle.
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But how Mr. Adler died, how he was injured, and by whom
00:09:07
remains a mystery.
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Solving this case will now fall to the internal examination.
00:09:14
We really have to see what kind of internal injuries
00:09:18
he has.
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NARRATOR: Coming up next, Dr. G opens Mr. Adler's body
00:09:23
and discovers his injuries are not just external.
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We've got trauma.
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NARRATOR: When "Dr. G, Medical Examiner" continues.
00:09:48
Dr. G prepares to examine 92-year-old Richard
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Adler internally.
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The elderly man was found dead outside of his home
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after a brutal winter storm.
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The police are concerned about the possibility of a robbery
00:10:01
and assault. And his family fears
00:10:03
that he may have suffered through the night outside
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in freezing temperatures.
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But Dr. G still needs to perform the internal exam
00:10:10
to determine the exact cause of Mr Adler's death.
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You don't know for sure until you finish the autopsy.
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You never know.
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You can have all the hypotheses in the world.
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But what are the forensic evidence that point to it
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or not point to it?
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NARRATOR: Dr. G opens Mr. Adler's frail, thin body
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with a Y incision and examines his organs
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in situ, meaning in their natural position
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within the body.
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JAN GARAVAGLIA: The difference between a hospital autopsy,
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usually, and a forensic autopsy or medical legal autopsy
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is here with the forensic autopsy,
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we have to look at everything in situ,
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where-- how it lies in the body.
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We are looking for trauma.
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We're not looking for just medical problems.
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We're looking sometimes at the chest wall.
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We're looking at the abdominal wall.
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NARRATOR: And as she examines the body,
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what is immediately clear is Mr. Adler's poor state of health.
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His lungs show signs of emphysema, a chronic
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and sometimes fatal pulmonary disease that is caused
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by smoking in 80% of all cases.
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His lung tissue is destroyed.
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They are over inflated as if like it's
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a balloon with trapped air.
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NARRATOR: And his heart is weakened from years
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of accumulating plaque or atherosclerosis
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in the coronary arteries.
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Mr. Adler's diseased lungs and heart are troublesome.
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If the circumstances of the scene were different,
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Dr. G might conclude that Mr. Adler died from a heart attack.
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JAN GARAVAGLIA: If he was just found dead in bed,
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it would've been clearly a result of that heart
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with that lungs.
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But that's why you have to take everything in context.
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NARRATOR: In this case, the scene
00:11:50
suggests that Mr. Adler did not simply
00:11:52
die from natural disease, but that his death was due
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to trauma, perhaps from an assault,
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and that he died while lying on the ground
00:12:00
during the frigid ice storm.
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JAN GARAVAGLIA: We really have to just see what kind
00:12:04
of internal injuries he has, and is
00:12:08
it consistent or not consistent with somebody beating him?
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OK.
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NARRATOR: Next, she removes each and every organ from the body
00:12:17
so that she can inspect the inside
00:12:19
of the empty abdominal cavity for any internal injuries.
00:12:22
And there, she finds something unusual.
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Mr. Adler has six broken ribs along his back.
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I couldn't see it with the lungs in there,
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is that he had some rib fractures that he broke.
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We've got trauma.
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We've got rib fractures on the left side
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in kind of the posterior aspect of 6, 7, 8, 9, 10, and 11.
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NARRATOR: But the fractures are very unusual.
00:12:48
The six ribs are broken in a clean distinct line
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which stretches to the spine.
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And it's one after another in a line, very sharp.
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And the ribs are slightly displaced.
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And then the back is broken at T10.
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NARRATOR: There is only one way that an injury like this
00:13:07
can occur.
00:13:08
The fractures are clearly not from a blow with a fist
00:13:11
or an object, but rather from an impact against a hard edge,
00:13:17
such as the lip of a cement patio.
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You can almost see the line where he hit, really sharp,
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and then it ends at the broken back.
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So as he's going down, he hits against the side of that patio.
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It'd would be very painful.
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All of this would be very, very painful
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and caused him to just lie there right there on the ground.
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NARRATOR: In a young person, a fall like this
00:13:46
might result in minor injury.
00:13:48
But in a 92-year-old, the fall is devastating.
00:13:52
Elderly, they're more--
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falls are more dangerous for elderly
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because they have more brittle bone.
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Over time, both men and women lose
00:14:01
the strength of their bones.
00:14:03
They lose calcium out of their bone,
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and they more easily break.
00:14:13
NARRATOR: Dr. G now believes that Mr. Adler died
00:14:15
from the trauma of the impact.
00:14:17
But based on the significant natural disease discovered
00:14:20
earlier, she concludes that Mr. Adler's heart and lungs
00:14:24
were most likely a contributing factor in his death after all.
00:14:27
If he breaks a bone, there's a lot of stress.
00:14:31
There's a lot of pain.
00:14:33
And it's cold, all of which is coming down on him to the point
00:14:39
where his heart doesn't have a lot of reserve.
00:14:42
So we definitely have an answer that trauma was involved
00:14:46
in his death, most likely from what we--
00:14:48
it appears here that he's fallen.
00:14:51
OK.
00:14:52
NARRATOR: But if Mr. Adler died in a fall,
00:14:55
this explains only one part of the bizarre and troubling death
00:14:58
scene.
00:14:59
Still unknown is what he was doing in the backyard
00:15:02
in the first place, why he fell, and whether the fall
00:15:06
occurred during an assault.
00:15:08
So we're sitting here going, OK, we've got trauma.
00:15:11
But why is he out here?
00:15:12
Why's the front door open?
00:15:14
So this is when we started trying to rebuild
00:15:16
what this guy was doing.
00:15:18
NARRATOR: Though she's determined the cause of Mr.
00:15:20
Adler's death, Dr. G wonders if his body might still
00:15:23
hold the clues to understanding this complex and puzzling case.
00:15:28
Coming up next, Dr. G opens Mr. Adler's brain, searching
00:15:32
for anything that might clarify the unusual circumstances
00:15:35
of his death.
00:15:36
And she finally finds what she's looking for.
00:15:39
He's got actual loss of tissue of the portions of his brain.
00:15:43
NARRATOR: And in Dr. G's next case,
00:15:45
it's one of the worst infections this medical examiner has ever
00:15:49
seen.
00:15:51
This man's got a black leg where the flies have laid eggs
00:15:54
in the dead tissue, and the maggots have hatched,
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and they're eating it.
00:15:58
NARRATOR: When "Dr. G, Medical Examiner" continues.
00:16:18
Dr. G's morgue assistant opens the skull
00:16:21
of 92-year-old Richard Adler.
00:16:24
During the internal exam, Dr. G has concluded
00:16:27
that the elderly man died from trauma in a fall,
00:16:30
combined with a diseased heart and lungs.
00:16:33
But the cause of his death still doesn't explain
00:16:36
exactly what happened to him.
00:16:38
Why was Mr. Adler in his backyard?
00:16:41
Why was the front door ajar and the back door damaged?
00:16:45
Who or what caused his trauma?
00:16:48
Dr. G wonders if findings in Mr. Adler's brain
00:16:50
might help explain the troubling circumstances.
00:16:59
First, she inspects the top of Mr Adler's skull
00:17:02
to make sure he did not suffer any blow to the head
00:17:04
when he fell.
00:17:06
However, she finds nothing abnormal.
00:17:09
JAN GARAVAGLIA: When I reflect the scalp,
00:17:10
I don't see any contusion or bruise.
00:17:14
NARRATOR: Then she begins to examine the brain itself.
00:17:17
And here she does find an abnormality,
00:17:20
but it's not trauma.
00:17:22
It's brain atrophy.
00:17:25
Mr. Adler's brain has shrunken.
00:17:28
There are wide open abnormal gaps
00:17:30
between the gyri, the coral-like folds of the brain.
00:17:35
It appears that Mr. Adler's dementia was more significant
00:17:39
than previously thought.
00:17:40
He's got actual loss of tissue of his brain,
00:17:43
which is typical of what we would
00:17:45
see in advanced stage dementia.
00:17:48
NARRATOR: Dementia is a disorder caused
00:17:50
by the death or impairment of nerve cells in the brain.
00:17:53
There are many kinds of dementia,
00:17:55
but the most common in people aged 65 and older
00:17:58
is Alzheimer's disease, which typically
00:18:01
causes memory loss, confusion, agitation, and even depression.
00:18:13
It could be Alzheimer's.
00:18:14
I can't say by just looking, but most likely.
00:18:18
NARRATOR: For Dr. G, the forensic evidence
00:18:21
of dementia in Mr. Adler's brain is critical to the case.
00:18:25
She believes that the finding of impaired brain function,
00:18:28
along with crucial information provided by Investigator
00:18:31
Hanson, finally provides answers to many
00:18:34
of the perplexing questions that surrounded Mr. Adler's death--
00:18:38
why he was outside, why the screen was torn,
00:18:41
how he was injured.
00:18:44
And more importantly, at the end of the autopsy,
00:18:47
Dr. G can now surmise how long Mr. Adler suffered while lying
00:18:51
alone on the ground.
00:18:59
Based on Investigator Hanson's report,
00:19:01
Dr. G knows that Mr. Adler's caregiver
00:19:04
left his home at approximately 2:30 in the afternoon,
00:19:07
as she usually does.
00:19:09
Dr. G believes that sometime in the late afternoon,
00:19:12
Mr. Adler is drawn outside.
00:19:14
But it's not due to an intruder.
00:19:17
He most likely just goes to check the mail
00:19:20
and leaves the door ajar.
00:19:21
If you go and check the mail sometimes,
00:19:23
you don't bother closing the door
00:19:24
because you're just going in and out.
00:19:27
NARRATOR: Despite the cold, Mr. Adler does not wear a jacket
00:19:31
or take his cane.
00:19:32
Here we've got a gentleman who's pretty mobile.
00:19:35
He can take care of himself.
00:19:37
But his dementia is starting to catch up with him a little bit,
00:19:40
and sometimes he forgets stuff.
00:19:42
NARRATOR: But the day's mail has not arrived yet.
00:19:45
And it's perhaps at that moment that the elderly man suffering
00:19:49
from advanced dementia, as discovered in the autopsy,
00:19:52
suddenly becomes confused.
00:19:55
Rather than return inside through the wide open front
00:19:58
door, he walks around to the backdoor.
00:20:08
But it is locked, and Mr. Adler, once confused,
00:20:12
now becomes agitated.
00:20:17
He's panicking.
00:20:18
He's trying to get into the house.
00:20:19
He's trying the door and cuts himself on the back screen.
00:20:24
He's got blood in different areas.
00:20:25
He's trying the glass door, the screen doors.
00:20:28
He takes his glasses off that has a little blood on it.
00:20:32
So now he's not seeing as well.
00:20:39
NARRATOR: Confused, blinded, bleeding from the hands
00:20:43
and knuckles, and cold, Mr. Adler
00:20:45
walks across the cement patio which
00:20:48
is covered with a patch of ice.
00:20:50
With his glasses off, he probably
00:20:52
does not even notice the surface is slick until it's too late.
00:20:59
He slips on the ice on the edge of the patio.
00:21:03
As he's falling down, he very sharply
00:21:05
on the edge of that concrete breaks ribs 6, 7, 8, 9,
00:21:10
10, and 11 and breaks his back.
00:21:12
He gets on the ground.
00:21:14
He's still alive.
00:21:16
NARRATOR: Mr. Adler is not paralyzed,
00:21:18
but the pain from his injuries is debilitating.
00:21:21
He's in a tremendous amount of pain.
00:21:23
He's not going to be able to breathe as well.
00:21:25
His lungs are already diseased, and the broken ribs
00:21:28
is causing him not to expand his lungs fully.
00:21:31
The stress of that situation would
00:21:34
put even more stress on his heart,
00:21:36
causing it to pump faster and harder.
00:21:41
NARRATOR: The trauma exacts a fatal toll on the elderly man.
00:21:44
He struggles to breathe.
00:21:46
His heart, weakened by disease and the stress of the trauma
00:21:50
and cold, falls into a deadly arrhythmia
00:21:54
and then ceases to beat.
00:22:03
Evidence from the autopsy and the scene
00:22:06
support the events that Dr. G believes
00:22:08
led to Mr. Adler's death.
00:22:10
This case definitely hinged on those findings at the scene.
00:22:14
We can never do an autopsy in the vacuum.
00:22:16
Sometimes the findings of the scene
00:22:18
tell us more than what the autopsy does.
00:22:22
NARRATOR: The findings also tell Dr. G how long
00:22:25
Mr. Adler suffered in the cold, a pressing question
00:22:28
for his family.
00:22:30
JAN GARAVAGLIA: The main concern of his family is how long he
00:22:33
was out there, did he suffer.
00:22:36
NARRATOR: Based on the devastating extent
00:22:37
of his injuries and his poor health,
00:22:40
Dr. G believes that the frail, elderly man
00:22:42
likely succumbed quickly.
00:22:45
JAN GARAVAGLIA: They were very relieved
00:22:46
to know that he didn't spend the night out in the cold suffering
00:22:50
and that it was--
00:22:52
you know, I can't say that he died, you know,
00:22:55
instantaneously.
00:22:56
I have to tell the truth.
00:22:58
And he was probably in a lot of pain,
00:23:00
but the pain didn't last long.
00:23:01
It was probably just a few minutes.
00:23:05
NARRATOR: For Dr. G, the death of Richard Adler
00:23:08
is especially poignant.
00:23:10
It shows the difficult struggle that the elderly face
00:23:13
to maintain their independence as they age.
00:23:16
It's an issue that Dr. G has encountered
00:23:18
with her own mother, who, like Mr. Adler, lives alone.
00:23:22
JAN GARAVAGLIA: And I clearly worry that she's going to fall
00:23:25
and nobody's going to be there.
00:23:27
But that's her decision.
00:23:28
She doesn't want to lose her independence.
00:23:32
She likes being in her own house,
00:23:33
and she has a right to make her own decision.
00:23:36
And I would just know I have to accept that.
00:23:38
I would rather have her fall and not be able to get up
00:23:43
than put her in a place that I know she's safe
00:23:46
but she's miserable.
00:23:48
So you know, you weigh it.
00:23:50
And every family makes a different decision.
00:23:59
NARRATOR: Coming up next, a 55-year-old man
00:24:02
dies unexpectedly in an outpatient clinic.
00:24:05
He had terrible lesions on his legs.
00:24:09
NARRATOR: But the cause of his gruesome death
00:24:11
may not be as obvious as it seems.
00:24:13
He has a clearly diseased heart.
00:24:15
NARRATOR: When "Dr. G, Medical Examiner" continues.
00:24:33
For any forensic pathologist, working a murder case
00:24:36
is always a challenge, especially when the crime took
00:24:39
place nearly 30 years earlier, such as Dr.
00:24:42
G's next case, Dennis Folton.
00:24:51
The body of 55-year-old Dennis Folton
00:24:53
arrived at the morgue yesterday afternoon.
00:24:56
We got a call yesterday from the nurse from the VA clinic.
00:25:00
And this unfortunate fellow was brought in by his family
00:25:04
for mental status changes.
00:25:05
And they didn't-- the VA really didn't know
00:25:07
much about him then.
00:25:08
NARRATOR: As a first step, Dr. G reviews the investigator's
00:25:11
report to learn what information has been gathered
00:25:14
about the victim so far.
00:25:18
The report states that the decedent had been a paraplegic
00:25:21
for 30 years, the result of a gunshot wounds
00:25:25
suffered in his 20s.
00:25:27
[GUN SHOT]
00:25:29
Dennis managed his paralysis well for many years,
00:25:32
but his medical records indicate that in the past few months,
00:25:36
his health had begun to deteriorate.
00:25:39
Three weeks ago, Dennis was hospitalized due to infection,
00:25:43
chronic high blood pressure, and advanced coronary artery
00:25:46
disease.
00:25:47
He has a lot of problems with his paralysis,
00:25:51
as oftentimes they do.
00:25:52
He had recurrent urinary tract infections and very bad
00:25:57
bedsores that he was being treated for.
00:25:59
They also know he had a bad heart.
00:26:02
NARRATOR: But as she reads further into the case file,
00:26:05
Dr. G learns that Dennis left the hospital
00:26:07
only a few days after his admission,
00:26:10
before his treatment was completed.
00:26:13
JAN GARAVAGLIA: He left that hospital
00:26:15
not because he was cured, but because he wanted to leave.
00:26:18
He just kind of went out on a pass and never returned,
00:26:21
so they decided he was discharged
00:26:23
I guess against medical advice.
00:26:26
NARRATOR: Then, only 20 days after leaving the hospital,
00:26:29
Dennis is beset by illness.
00:26:32
He loses consciousness and his family cannot wake him.
00:26:35
JAN GARAVAGLIA: He wasn't acting right.
00:26:36
He was looking really sick.
00:26:38
Basically, he was unable to be aroused.
00:26:41
NARRATOR: His wife immediately rushes him to a nearby clinic
00:26:44
for care, but it is too late.
00:26:47
Dennis is already dead.
00:26:52
JAN GARAVAGLIA: Just dead right there in the waiting room.
00:26:59
NARRATOR: The case leaves Dr. G with several possibilities.
00:27:03
First, she considers Dennis' 30-year history of paralysis.
00:27:07
JAN GARAVAGLIA: They're doing wonderful things
00:27:08
with people who are paralyzed now,
00:27:10
and they have a lot more to offer them.
00:27:14
Their lifespan used to be fairly short.
00:27:17
It still is not as long as we'd like it to be.
00:27:20
There are many, many complications.
00:27:22
And even living 20 years out can sometimes be
00:27:27
a struggle, and 30 years out.
00:27:29
And if you're not taking care of yourself--
00:27:31
you have to be really motivated to take care of yourself.
00:27:35
NARRATOR: She also weighs Dennis'
00:27:37
history of heart disease.
00:27:39
During his hospitalization three weeks earlier, doctors
00:27:43
found that Dennis suffered from ischemic cardiomyopathy,
00:27:46
a critical reduction in blood supply
00:27:48
to the heart due to coronary artery disease.
00:27:51
JAN GARAVAGLIA: We know he's got ischemic cardiomyopathy,
00:27:54
meaning the heart muscles are damaged.
00:27:56
Maybe he's just going into heart failure
00:27:58
and not getting enough blood into the brain.
00:28:01
NARRATOR: Was it natural disease or a complication
00:28:04
of his paralysis that took Dennis' life so unexpectedly?
00:28:08
We have to look at what's going to cause
00:28:10
you to be slowly unarousable.
00:28:12
Could it be a lack of blood flow to the brain?
00:28:15
Could his heart be failing?
00:28:16
What is wrong with him that he can't be aroused?
00:28:21
NARRATOR: The only way to find the answers
00:28:22
is through a full autopsy, beginning
00:28:25
with the external exam.
00:28:35
When Dr. G gets her first look at Dennis Folton's body,
00:28:38
she cannot believe its poor condition.
00:28:41
Basically, when you see him, these are bedsores--
00:28:47
the worst I've ever seen.
00:28:51
They start on his hip, especially on the right.
00:28:55
And his entire leg is necrotic and dying.
00:29:00
There is exposed bone.
00:29:02
The bone joint has been somewhat eroded from it.
00:29:07
It's obviously infected.
00:29:09
There's obvious gangrene.
00:29:11
And some of it's black.
00:29:12
Some of it's green.
00:29:14
He's got just a whole infected right leg.
00:29:17
It's partly necrotic and black and areas of--
00:29:21
some of it's dry gangrene.
00:29:24
Some of it looks wet gangrene.
00:29:26
NARRATOR: From hospital records, Dr. G
00:29:28
knows that Dennis was treated for infected bedsores, also
00:29:31
known as decubitus ulcers, which are a common complication
00:29:35
of paralysis.
00:29:38
But Dennis' bedsores had clearly worsened
00:29:40
since he left the hospital.
00:29:43
His flesh has actually begun to decompose,
00:29:47
and it is infested with maggots.
00:29:49
JAN GARAVAGLIA: There's actually even maggots
00:29:51
that have gotten into it.
00:29:52
I mean, flies have laid eggs and hatched in this wound.
00:29:55
And they're feasting on this dead tissue.
00:29:59
NARRATOR: The infection is so severe,
00:30:01
it could have actually caused Dennis' death.
00:30:03
This possibility adds a new twist to the case.
00:30:07
If Dennis died as a result of his infected bedsores,
00:30:10
it would mean his death was caused by a complication
00:30:13
of his paralysis.
00:30:15
And because his paraplegia was the result
00:30:17
of a shooting decades earlier, his death could
00:30:21
ultimately be ruled a homicide.
00:30:23
JAN GARAVAGLIA: Even 30 years later,
00:30:25
what caused him to get in a wheelchair
00:30:27
is going to be his cause of death
00:30:28
if he died from the bedsores.
00:30:34
NARRATOR: But with stakes this high, hunches aren't enough.
00:30:37
Before Dr. G turns this case over to the district attorney
00:30:40
as a potential homicide, she must
00:30:42
verify whether or not it was an infection
00:30:45
that killed Dennis Folton.
00:30:47
The nut that we have to crack in each case--
00:30:49
and especially a very old one--
00:30:51
is did that criminal act cause this death,
00:30:55
even if it was much later?
00:30:57
NARRATOR: To find out, Dr. G needs to complete the autopsy.
00:31:02
Coming up next, Dr. G opens Dennis' body
00:31:05
and discovers another possible cause of death.
00:31:07
I mean, it would be heart disease
00:31:09
that would kill most people.
00:31:10
NARRATOR: But did it kill Dennis Folton?
00:31:12
When "Dr. G, Medical Examiner" continues.
00:31:33
Dr. G's morgue technician, Arden Monroe,
00:31:35
prepares the body of Dennis Folton
00:31:38
for the internal examination.
00:31:40
The 55-year-old paraplegic man died yesterday afternoon
00:31:44
in a local clinic.
00:31:46
During the external exam, Dr. G found
00:31:48
that the victim's legs were massively
00:31:50
infected from bedsores.
00:31:52
It starts at his hip.
00:31:53
It goes down the back of his leg, even into his calf
00:31:56
is all black.
00:31:58
NARRATOR: If she determines that the infected bed
00:32:00
sores from his paralysis actually killed him,
00:32:02
then the ultimate manner of Dennis Folton's death
00:32:04
could be homicide.
00:32:07
JAN GARAVAGLIA: Whatever trauma caused him to be paralyzed,
00:32:10
that was the initiating event that
00:32:13
caused him to have bedsores.
00:32:15
And then we can relate the cause of death
00:32:18
back to the initiating event.
00:32:21
But we have to prove that the bedsores are what killed him.
00:32:29
NARRATOR: Before the body of Dennis Folton is opened,
00:32:32
Arden Monroe washes the maggots off of the body.
00:32:37
Once the body is cleaned, Dr. G opens
00:32:40
Dennis' torso from the shoulder blades to the pelvis.
00:32:44
Immediately, she encounters scar tissue in his chest cavity.
00:32:48
It is undoubtedly from the gunshot wound that
00:32:50
paralyzed him 30 years earlier.
00:32:53
JAN GARAVAGLIA: When I opened him up,
00:32:54
you know, normally your lungs sit nice and loose
00:32:56
in your lung cavity.
00:32:57
Your heart sits nice and loose in your pericardial sac
00:33:00
so it can beat.
00:33:01
And your lungs sit nice and loose in the lung cavity
00:33:03
so they can move.
00:33:04
Well, in his case, he's got a lot of adhesions,
00:33:06
or fibrous tissue, between the surface of the lung
00:33:09
and the surface of the pleural cavity,
00:33:12
which is where the lung sits, and between the surface
00:33:15
of the heart and the pericardial sac,
00:33:17
which is where the heart sits.
00:33:18
Which tells me that he's had trauma in that area.
00:33:27
NARRATOR: But also evident in the victim's body
00:33:29
cavity are visible signs of a raging infection.
00:33:32
JAN GARAVAGLIA: You get an overall sense that his tissues
00:33:35
are kind of softened.
00:33:38
The tissues don't have the same nice healthy color to them.
00:33:41
A lot of it's because with the infection,
00:33:43
they have a lower and lower blood pressure.
00:33:47
And so he didn't look well on the inside,
00:33:49
just like he didn't look well on the outside.
00:33:54
NARRATOR: But is the infection that
00:33:55
ravaged Dennis both externally and internally what killed him?
00:34:00
The answer can only be found under the microscope.
00:34:04
If there is an increase in white cells in Dennis'
00:34:06
internal organs, it would be a telltale sign
00:34:10
of a deadly infection.
00:34:11
But at this point, even without microscopic evidence,
00:34:15
Dr. G believes Dennis' cause of death is obvious.
00:34:19
You know, it's looking like this
00:34:21
is going to be complications of the paralysis
00:34:24
due to that gunshot wound.
00:34:30
NARRATOR: However, when she begins
00:34:31
to examine Dennis' heart, the course of the autopsy
00:34:35
suddenly shifts.
00:34:36
He has a clearly diseased heart.
00:34:39
It was enlarged, thickened.
00:34:42
He has diseased vessels to the heart.
00:34:45
The coronary arteries or blood vessels
00:34:48
that supply blood and oxygen in the heart were narrowed.
00:34:51
NARRATOR: One coronary artery is 80% blocked
00:34:54
with atherosclerotic plaque.
00:34:56
Another, 95%, and yet another is 98% blocked.
00:35:02
See this one.
00:35:04
You can see where the blood is supposed to be.
00:35:07
And then if you go down, see where it--
00:35:11
there's not much left where the blood is supposed to be.
00:35:15
ARDEN MONROE: OK.
00:35:16
Do you see it?
00:35:17
The only hole is right down there.
00:35:19
ARDEN MONROE: It's tiny.
00:35:20
Tiny little hole left.
00:35:21
And all the blood is supposed to go through there?
00:35:23
Well, it can't.
00:35:25
NARRATOR: It's evident that the blockage
00:35:26
has chronically reduced the flow of blood to Dennis' heart.
00:35:30
Dr. G now wonders if he simply succumbed to a massive heart
00:35:34
attack and not the infection.
00:35:36
JAN GARAVAGLIA: It would be heart disease that
00:35:38
was bad enough, certainly, to have caused him to die suddenly
00:35:42
and unexpectedly at any time.
00:35:44
In a normal man in the right circumstances,
00:35:46
I'd have said he died from his heart.
00:35:49
NARRATOR: However, Dennis Folton is anything but a normal man.
00:35:53
His legs are black and gangrenous with infection.
00:35:57
So which caused his death--
00:35:59
an infection linked to his paralysis and gunshot wound,
00:36:02
which would lead to a homicide charge,
00:36:05
or did he die from unrelated heart disease, a natural death?
00:36:09
There's only one way to know for sure.
00:36:12
Dr. G must scrutinize the samples
00:36:14
taken from Dennis' organs, including
00:36:16
his heart, microscopically.
00:36:20
Coming up next, slides are back from the lab,
00:36:23
and Dr. G faces a difficult ruling.
00:36:26
On that heart, I was particularly concerned
00:36:29
that there was nothing acute.
00:36:31
NARRATOR: When "Dr. G, Medical Examiner" continues.
00:36:54
Dr. G has just received slides of tissue samples
00:36:57
she took a few days before while performing the autopsy
00:37:00
of 55-year-old Dennis Folton.
00:37:03
During the examination, Dr. G discovered
00:37:06
massively infected bedsores, a complication
00:37:09
of the victim's paraplegia from being shot 30 years earlier.
00:37:13
However, she also found significant heart disease.
00:37:17
The question is, which actually killed him?
00:37:20
And that's the big question.
00:37:22
Because if the paralysis killed him, it's a homicide.
00:37:25
It's complications of that gunshot wound.
00:37:41
NARRATOR: Dr. G examines the slides of Dennis Folton's
00:37:43
heart tissue and other organs.
00:37:47
Under magnification, she finds no necrotic or dying
00:37:51
tissue that would indicate he suffered a fatal heart attack.
00:37:57
But in his liver and spleen are the unmistakable signs of
00:38:01
a life threatening infection.
00:38:03
JAN GARAVAGLIA: He had a tremendous amount
00:38:04
of white cells throughout his body, a collection
00:38:07
of them in his spleen.
00:38:08
So he does have evidence that he had an overwhelming infection.
00:38:13
NARRATOR: The forensic evidence points
00:38:15
to a death from infection, not a heart attack,
00:38:18
and so do the circumstances of the scene.
00:38:22
Dr. G's conclusion--
00:38:24
Dennis Folton's death is directly
00:38:26
linked to the shooting that paralyzed him 30 years ago.
00:38:32
This case has become a homicide investigation.
00:38:36
Once I decide that this man died from infection, which
00:38:40
was initiated from him being paralyzed,
00:38:43
I then have to contact homicide because it is a homicide.
00:38:48
His death is the result of the actions
00:38:50
of another, although delayed.
00:38:52
We don't get a lot of 30-year-old cases,
00:38:54
but the tragedy of homicide, the tragedy of assault,
00:38:58
battery, sex assault, it's always the same.
00:39:01
In the original crime, someone was injured.
00:39:06
Society was injured.
00:39:08
And it doesn't matter that time has passed.
00:39:10
We still have our duty to do.
00:39:12
I think we should not give people
00:39:14
a pass on killing someone, just because time has passed.
00:39:19
NARRATOR: However, the investigation
00:39:21
into the shooting of Dennis Folton is short-lived.
00:39:25
Detectives soon discover that the man
00:39:27
who shot Dennis 30 years ago has since passed away.
00:39:31
JAN GARAVAGLIA: I remember the homicide detective
00:39:34
coming in and telling me that, you know, it's not going to go
00:39:37
anywhere and that the fellow that shot him
00:39:39
had actually done time and has since died.
00:39:43
NARRATOR: At the conclusion of the homicide investigation,
00:39:46
Dr. G has the information she needs to describe
00:39:49
the circumstances leading to the death of Dennis Folton, events
00:39:53
that spanned over 30 years.
00:40:05
At age 25, Dennis Folton is shot in an altercation.
00:40:10
[GUNSHOT]
00:40:13
He survives the attack, but is paralyzed from the waist down
00:40:16
and confined to a wheelchair for 30 years.
00:40:20
JAN GARAVAGLIA: You could see the damage.
00:40:21
You could see the area where the bullet went through,
00:40:24
but the bullet was no longer there.
00:40:27
NARRATOR: By age 55, the effects of his long term paralysis
00:40:31
are catching up with him.
00:40:33
Dennis suffers from numerous health
00:40:34
conditions, including heart disease and chronic infections.
00:40:39
He gets chronic urinary tract infections,
00:40:41
not an uncommon problem.
00:40:43
And he has these terrible bedsores.
00:40:46
NARRATOR: Three weeks prior to his death,
00:40:47
Dennis is hospitalized due to infected bedsores
00:40:50
and other medical disorders.
00:40:53
But before his treatment is over,
00:40:55
he leaves the hospital without doctor consent.
00:41:00
JAN GARAVAGLIA: He goes out on a pass
00:41:02
while he's hospitalized and never returns,
00:41:04
so they in absentia discharge him.
00:41:08
NARRATOR: Without proper medical care, over the next three
00:41:11
weeks, the infection festers and invades
00:41:13
the bones of Dennis' legs.
00:41:15
You could see the bone.
00:41:16
It looked he had, you know, an infection of his bone,
00:41:18
an infection of his tissues.
00:41:21
NARRATOR: Lured by the decay of rotting tissue,
00:41:24
common house flies lay eggs in his flesh.
00:41:28
Soon, the infection in Dennis' legs
00:41:30
spreads into the bloodstream, causing
00:41:32
a massive system wide infection of the blood, known as sepsis.
00:41:37
JAN GARAVAGLIA: And that sets off a cascade of events, where
00:41:40
your body can't maintain its blood pressure
00:41:42
anymore because of the effects of the bacteria
00:41:46
inside your blood.
00:41:49
NARRATOR: As his blood pressure plummets,
00:41:51
Dennis loses consciousness and falls into a coma.
00:41:55
By the time his wife takes him to the clinic for treatment,
00:41:58
his legs are teeming with fly larva,
00:42:00
and his vital organs are on the verge
00:42:02
of shutting down completely.
00:42:04
Within moments, his heart finally gives out,
00:42:07
and Dennis dies in the waiting room.
00:42:09
But by this time, the infection is so extensive,
00:42:13
it's likely nothing could have saved him.
00:42:23
Just like the death of 92-year-old Richard Adler,
00:42:26
the case of Dennis Folton demonstrates the importance
00:42:29
of both forensic findings and knowing the circumstances
00:42:32
of a death during an autopsy.
00:42:35
JAN GARAVAGLIA: When you see that he's got necrotic wounds,
00:42:39
you see that he kind of slowly slipped
00:42:41
into a coma because he wasn't--
00:42:43
and previously not feeling well, feeling sick.
00:42:47
That's not consistent with dying from your heart.
00:42:49
It's consistent with, he's dying from the infection.
00:42:53
You always have to put it all together.
00:42:55
That's why you always have to know the circumstances.
00:42:57
You always have to know how are they feeling.
00:42:59
You know, a doctor has to take a history,
00:43:01
just like I have to take the circumstances
00:43:04
surrounding the death.
00:43:05
And basically, what that is, is your medical history of what
00:43:08
happened right before you died.
00:43:11
Honestly, these kind of cases are why I exist.
00:43:14
There are so many unanswered questions at the beginning,
00:43:16
and you just pick through it.
00:43:17
You just find out the answers one by one,
00:43:20
and things fall into place.
00:43:23
OK.
00:43:31
MAN: Atlas.
