00:00:04
[OMINOUS MUSIC PLAYING]
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[DRAMATIC MUSIC PLAYING]
00:00:18
NARRATOR: A man is found bludgeoned
00:00:19
in a motel parking lot.
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He's covered with blood.
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A lot of broken bones.
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NARRATOR: And as police begin a full-scale murder
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investigation, they're asking Dr. G for the impossible.
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They want me to figure out what the murder weapon is.
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This is going to be trouble.
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I knew this was going to be trouble.
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NARRATOR: And then a man with a history of chronic pain
00:00:41
is found unresponsive in bed.
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JAN GARAVAGLIA: (VOICEOVER) The wife calls 911.
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They work on him for about 20 minutes,
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but they realize he's dead.
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NARRATOR: But in this case, forensics alone do
00:00:52
not give Dr. G all the answers.
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Now the question is, how did this happen?
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This is the million-dollar question.
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How did this happen?
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[EXCITING MUSIC PLAYING]
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NARRATOR: Altered lives, baffling medical mysteries,
00:01:08
shocking revelations.
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These are the everyday cases of Dr. G, medical examiner.
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It's early on a Wednesday morning
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when chief medical examiner Dr. Jan
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Garavaglia arrives at the District
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9 Morgue in downtown Orlando.
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Today will not be an easy one.
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I was not looking forward to coming to work today.
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I knew this fellow was coming in.
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And I knew that it was going to be difficult.
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I knew this was going to be trouble.
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[INTENSE MUSIC PLAYING]
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[MACHINE WHIRRING]
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NARRATOR: The case that awaits Dr. G this morning is that
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of 62-year-old James Duncan.
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Okey-dokey.
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Oh, boy, we've got a tough one today.
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We've got a 62-year-old white male who's been in the hospital
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for a month due to a--
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they say an assault and battery.
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He was beaten about the face.
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And he spent the last month in the hospital
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trying to recover from his wounds,
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is what they're telling me.
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NARRATOR: According to the police,
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James Duncan was a motel desk clerk
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working in a crime-ridden neighborhood of Orlando.
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He's kind of a gruff old guy.
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He's always having trouble with people.
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He's not well-liked, to put it that way.
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NARRATOR: Several weeks ago, he was working the night shift
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when he had a verbal altercation with one of the guests, whom
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James accused of trespassing.
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He was very difficult to deal with.
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He would stop anything and everything that moved
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or that would trespass on the property.
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NARRATOR: Police are uncertain what transpired next,
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but 20 minutes after the run-in, they
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find James bludgeoned and bleeding
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in the motel parking lot.
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He had severe--
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what appeared to be severe facial injuries.
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A lot of facial trauma.
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Broken bones, cheekbones.
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He's got a large chunk of tissue probably missing
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from the back of his head and multiple lacerations
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of the face.
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Dispatch to Unit 91.
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Come in.
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And they asked him what happened.
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And he said, I don't know.
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I don't know what happened.
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He was fully conscious, not disoriented,
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but he didn't know what happened.
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NARRATOR: James is rushed to the hospital.
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His facial wounds are serious, though not
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thought to be life-threatening.
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But by the time he arrives at the ER,
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his condition has rapidly deteriorated.
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His blood pressure is unstable.
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His breathing is labored.
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And his heartbeat, irregular.
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Doctors wonder if the stress of the assault
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could be triggering other more serious problems.
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The emergency department doctor is pretty smart
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and figures, well, you know, maybe he's
00:04:13
had some type of heart attack.
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NARRATOR: Doctors check James's blood for a protein
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called troponin.
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This could indicate whether or not he's
00:04:22
suffering from a heart attack.
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But his troponin level is normal.
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And further tests reveal no signs
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of any other life-threatening conditions.
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They do a CAT scan.
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They do x-rays.
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No brain trauma, and no other trauma anywhere else.
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NARRATOR: Doctors surgically repaired
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James's facial injuries.
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And yet, in the coming weeks, even though his wounds
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begin to heal, his condition continues
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to worsen without explanation.
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JAN GARAVAGLIA: (VOICEOVER) They had problems
00:04:54
again with his blood pressure.
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He started getting a lot of fluid in his lungs.
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NARRATOR: Then, four weeks after entering the hospital,
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James contracts an aggressive blood-borne bacterial infection
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known as sepsis.
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The infection is too much for his weakened body to handle,
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and he dies in the intensive care unit.
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His body has now been transferred to the District 9
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Morgue in hopes that Dr. G can pinpoint why he was
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unable to recover from facial injuries, which
00:05:30
initially didn't seem to be at all life-threatening.
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But already, doubts are looming.
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This case is not simple.
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After a month in the hospital with this stormy course,
00:05:43
that he comes to me for an autopsy.
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And I don't have hopes that I'm going
00:05:48
to be able to tell them much.
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NARRATOR: Since James Duncan's death followed what
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police believe was an assault, the case
00:05:57
is now considered a homicide.
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To help with the murder investigation,
00:06:04
police have asked Dr. G to undertake
00:06:07
a nearly impossible task.
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Please take morgue photos to confirm the weapon.
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He spent a month in the hospital.
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They say he's assaulted.
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He's already had surgery.
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He's got one medical complication after another.
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And they want me to figure out what the murder weapon is.
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Well, when they asked me what kind of weapon,
00:06:29
it's a little easier if you have a fresh victim,
00:06:33
they haven't had surgery, and they
00:06:35
haven't had their wounds heal.
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So I really didn't have high expectations that I
00:06:41
would be able to say much.
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[DRAMATIC MUSIC PLAYING]
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The external examination-- we have
00:06:56
a man that clearly looks like he's been in the hospital
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for a month.
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He's diffusely edematous.
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Just swollen with all the fluids they'd given him.
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He looked very ill.
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And he looked every bit of having
00:07:09
sepsis and pneumonia and problems
00:07:13
maintaining his blood pressure.
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NARRATOR: First, in an effort to identify what kind of weapon
00:07:19
inflicted James's injuries, Dr. G must
00:07:23
record all trauma on the body and differentiate
00:07:27
wounds from surgical incisions.
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I had to take everything I found on his face
00:07:35
and see what was surgery, what was done to him,
00:07:38
and what he came in with.
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I'm just like, OK.
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What they do, what he come in with,
00:07:43
let's see if we can match what he actually has now
00:07:48
and subtract what they did to him in the hospital.
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NARRATOR: As she charts the wounds,
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it's clear that the injuries were substantial.
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He suffered extensive fractures to his jaw bone, cheek bones,
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eye orbit, nose, and maxillary.
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JAN GARAVAGLIA: (VOICEOVER) There
00:08:10
is some asymmetry to his face.
00:08:12
His left side was still kind of flattened.
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His nose was still kind of flattened.
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He looked a mess, honestly.
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NARRATOR: But the only wounds Dr. G finds are on his face.
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This is the best wound.
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JAN GARAVAGLIA: Oh.
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NARRATOR: There were no defensive wounds
00:08:32
on his arms or hands to suggest that he fought
00:08:35
back against his attacker.
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One of the things I'm looking at at the external
00:08:40
is to look for other--
00:08:41
maybe some minor injuries that the hospital wouldn't have
00:08:44
reported to me, that maybe indicate something else
00:08:48
was going on.
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Or help me kind of figure out what the mechanism
00:08:53
of the injuries were.
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He didn't have a scratch on him.
00:09:00
NARRATOR: By the end of the external exam,
00:09:02
Dr. G has pieced together a full diagram
00:09:04
of the victim's injuries.
00:09:06
Okey-dokey.
00:09:07
I think that's it.
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NARRATOR: But the exam has still not revealed
00:09:10
what police need most--
00:09:12
the weapon.
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It was very inconclusive at that time.
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JAN GARAVAGLIA: (VOICEOVER) At the end of the external
00:09:17
I thought, oh, brother.
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I don't know if I'm going to be able to tell anything.
00:09:24
[OMINOUS MUSIC PLAYING]
00:09:38
NARRATOR: On the streets of Orlando,
00:09:39
police are on the hunt for a suspect
00:09:42
in an alleged assault that resulted in the death
00:09:44
of 62-year-old James Duncan.
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As the investigation began, we tried to contact any witnesses
00:09:50
or anybody that may have been at the business
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at the time, anyone that may have
00:09:53
witnessed what had happened.
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We put out flyers for the area to try and locate
00:09:58
any and all witnesses in the beginning,
00:10:00
was where we started.
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NARRATOR: As police try to close in on the killer,
00:10:04
Dr. G is ready to open the body of the victim,
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looking for any internal trauma that may have
00:10:10
been missed by the hospital.
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[INTENSE MUSIC PLAYING]
00:10:28
JAN GARAVAGLIA: I'll get those out [INAUDIBLE]..
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NARRATOR: Dr. G opens the body with a standard y-incision.
00:10:34
She is assisted by her morgue technician, Brian Mikulski.
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You want me to start working on this side, Dr. G?
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As long as you can't hit my hand, you can work on it.
00:10:43
Yeah, that wouldn't be good.
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No, it wouldn't.
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I'm still on probation.
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Oh, I see.
00:10:51
So when I do my y-incision, it's very wet.
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Edema fluid is just pouring out.
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I see a tremendous amount of fluid that has accumulated
00:11:01
in his abdominal cavity.
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I see a tremendous amount of fluid that accumulated
00:11:05
in his pleural cavities.
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Yeah, he's got a lot.
00:11:09
NARRATOR: Edema is a swelling caused
00:11:11
by the buildup of abnormal levels of fluid in the body.
00:11:15
We knew we had problems with his blood pressure.
00:11:17
They were giving them a lot of fluids to try
00:11:19
to maintain his blood pressure.
00:11:21
And as he got sicker and sicker, he
00:11:24
couldn't maintain the fluids, actually, inside his vessels.
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And it would be leaking into his tissues.
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And a lot of it.
00:11:34
NARRATOR: Once toxicology samples are taken,
00:11:37
Dr. G begins searching for any internal trauma that
00:11:40
might have been overlooked.
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I'm looking very carefully for any kind of trauma.
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I'm looking for broken ribs that they may have missed.
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I'm looking for evidence of bleeding under the skin.
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And he doesn't have any at all.
00:12:04
All righty.
00:12:05
Why don't we just take a overall before I--
00:12:08
NARRATOR: The hospital was right.
00:12:10
James did not suffer any additional trauma
00:12:13
in his abdominal cavity.
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Dr. G documents the findings for the investigative team.
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All righty.
00:12:20
The picture's always worth a thousand words.
00:12:22
Thank you.
00:12:26
NARRATOR: As a next step, she opens
00:12:28
James's chest cavity to begin examining his internal organs,
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one by one.
00:12:33
[BEEPING SOUND]
00:12:36
First organ I look at is his heart.
00:12:39
And in the examination of the heart,
00:12:40
I always start with just looking at the external aspect,
00:12:43
looking at the shape.
00:12:48
NARRATOR: And what she finds is troubling.
00:12:51
Whoa.
00:12:52
Something here.
00:12:53
We got a big heart.
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JAN GARAVAGLIA: (VOICEOVER) His heart looked very dilated.
00:12:58
Both right ventricle and left ventricle were dilated.
00:13:02
And I look at the coronary arteries.
00:13:05
NARRATOR: Here, too, all is not well.
00:13:08
His left main coronary artery was 50% narrowed.
00:13:11
But his left anterior descending was about 95% narrowed.
00:13:17
His circumflex, going to the side, had about an 80% to 85%
00:13:21
narrowing.
00:13:22
The right coronary artery had over an 80% narrowing.
00:13:27
Thanks, Brian.
00:13:28
NARRATOR: Her conclusion?
00:13:30
He had extremely bad atherosclerotic coronary heart
00:13:34
disease--
00:13:35
extremely bad.
00:13:38
NARRATOR: But as she slices into the heart muscle,
00:13:41
Dr. G discovers that severe coronary artery disease wasn't
00:13:45
James Duncan's only problem.
00:13:48
I went ahead, then, and I bread
00:13:51
loafed the heart muscle to see if there
00:13:53
was any damage to the heart.
00:13:56
And lo and behold, he's got a large myocardial infarction
00:14:00
or heart attack that's about a month old.
00:14:06
NARRATOR: The timeline is shocking.
00:14:08
The heart attack appears to have occurred
00:14:10
near the time of James's assault,
00:14:12
perhaps as a result of the trauma.
00:14:16
And yet the hospital failed to diagnose or treat it.
00:14:19
For some reason, the hospital just didn't pick up on it.
00:14:22
NARRATOR: Now the question is, what
00:14:25
else could they have missed?
00:14:30
[OMINOUS MUSIC PLAYING]
00:14:41
[ROCK MUSIC PLAYING]
00:14:48
Dr. G's morgue technician, Brian Mikulski,
00:14:51
opens the cranium of James Duncan.
00:14:54
Considering the hospital's failure
00:14:56
to diagnose James's heart attack,
00:14:58
Dr. G is concerned that the doctors
00:15:01
may have also overlooked an injury to his brain.
00:15:05
Examining his head trauma, I would hope that maybe it
00:15:09
would add something that they didn't
00:15:11
pick up on in the hospital.
00:15:24
NARRATOR: Dr. G extracts James's brain for examination.
00:15:30
In the hospital, CAT scans, or computed
00:15:33
axial tomography, of James's brain
00:15:35
detected no internal trauma to the organ.
00:15:41
But it's possible that the images may have
00:15:43
given doctors a false reading.
00:15:47
CAT scans are wonderful, but they can miss some injuries.
00:15:51
They can particularly miss some subarachnoid hemorrhage.
00:15:55
They can miss some fractures to the base of the skull.
00:15:58
And so I was hoping maybe we'll find
00:16:01
some more injuries that would shed some light on something.
00:16:04
[INTENSE MUSIC PLAYING]
00:16:12
NARRATOR: But her hopes are quickly dashed.
00:16:17
No fractures to the calvarium.
00:16:20
No fractures to the base of his skull.
00:16:23
I didn't find anything in his brain
00:16:25
that was out of the ordinary.
00:16:27
There is no trauma.
00:16:28
There is no natural disease.
00:16:32
NARRATOR: Despite his severe facial wounds,
00:16:35
it appears as if James's brain remained unharmed.
00:16:40
This means that head trauma likely played
00:16:42
no part in his downward spiral.
00:16:45
[WATER HISSING]
00:16:48
The autopsy is now complete.
00:16:52
And yet for Dr. G, the case is far from over.
00:16:59
The findings, or lack of findings,
00:17:01
are simply not adding up.
00:17:05
JAN GARAVAGLIA: (VOICEOVER) Well, the end of autopsy,
00:17:06
I had more questions than I had answers.
00:17:12
I knew that he'd had a heart attack.
00:17:14
And this looked like it dated at or about
00:17:16
the time that he suffered these facial injuries.
00:17:20
I knew that they missed this heart attack in the hospital.
00:17:25
And the injuries are so well healed that I can't really
00:17:30
say much about a murder weapon.
00:17:33
NARRATOR: What's more, police have found no witnesses
00:17:36
to the alleged assault.
00:17:38
Nobody saw anything.
00:17:39
Nobody saw an altercation.
00:17:41
Nobody saw anybody with a weapon.
00:17:44
Nobody saw anything.
00:17:46
[DRAMATIC MUSIC PLAYING]
00:17:52
NARRATOR: After thoroughly reviewing the autopsy findings
00:17:55
and re-evaluating information provided
00:17:58
by the police investigation, Dr. G begins
00:18:01
to formulate a new hypothesis.
00:18:05
What if James's trip to the hospital had
00:18:08
nothing to do with an assault?
00:18:11
I really don't have any evidence
00:18:12
that there was an assault. But I have another theory.
00:18:23
And I'm wondering if this theory was thought
00:18:28
of at all in the hospital.
00:18:31
But I don't--
00:18:32
I'm not so sure it was.
00:18:36
NARRATOR: Dr. G compiles her findings
00:18:38
and prepares to record them in the report of autopsy.
00:18:42
But instead of describing a death brought about by injuries
00:18:45
from an assault, she will articulate her new and radical
00:18:49
theory on how she believes James Duncan died in the motel
00:18:53
parking lot and why doctors failed to fully understand
00:18:58
his condition in the hospital.
00:19:01
[EERIE MUSIC PLAYING]
00:19:10
According to the police report, 62-year-old James Duncan
00:19:14
was working the night shift at the motel
00:19:16
when he got into a verbal dispute
00:19:18
with one of the patrons.
00:19:20
But Dr. G now believes that's where the altercation ended.
00:19:25
Well, the new theory is that perhaps none of this
00:19:30
is from an assault. Perhaps he suffered a heart attack.
00:19:36
He fell on his face, unconscious.
00:19:38
And people just jumped to conclusions
00:19:41
that his facial fractures were from an assault.
00:19:45
NARRATOR: Based on her forensic findings, including
00:19:48
microscopic reviews of heart tissue,
00:19:51
Dr. G is confident that after the argument,
00:19:54
James suffered a severe heart attack when a small clot formed
00:19:58
in one of his severely narrowed coronary arteries, obstructing
00:20:03
blood flow to the heart muscle and causing
00:20:05
him to lose consciousness and fall face forward.
00:20:10
He doesn't brace himself.
00:20:13
That would have softened the blow.
00:20:14
I mean, your reaction is to brace yourself
00:20:17
and not let your face hit.
00:20:19
NARRATOR: The impact fractures the bones of James's face.
00:20:23
It's a scenario Dr. G has seen before.
00:20:26
I've had several cases where people
00:20:28
get terrible facial lacerations and facial fractures
00:20:33
after suffering a heart attack.
00:20:35
NARRATOR: Doctors successfully patch up his injuries.
00:20:38
But tragically, they failed to diagnose
00:20:41
his other significant condition, a severely damaged heart.
00:20:46
Dr. G discovers that while the doctors do test for the protein
00:20:50
troponin, which is released into the blood
00:20:53
during a cardiac event, they do so too early and only once.
00:20:59
The problem with troponin is, just because you have
00:21:01
heart muscle damage or a heart attack,
00:21:03
it's not elevated right away.
00:21:05
It takes about four hours.
00:21:08
So you're not going to see it, even if you've suffered a heart
00:21:10
attack, for about four hours.
00:21:12
So that's why you always order a series of troponin.
00:21:16
NARRATOR: Given that the test is run so soon
00:21:18
after the heart attack, James's initial troponin levels
00:21:21
come back normal.
00:21:25
No further tests are performed.
00:21:27
And surgeons incorrectly conclude
00:21:29
that his heart is fine.
00:21:33
It kind of fell through the cracks in the hospital.
00:21:37
NARRATOR: Over the next few weeks,
00:21:39
James's facial wounds heal, but his damaged heart is weakening
00:21:43
and beginning to fail.
00:21:45
Had doctors recognized James's heart attack,
00:21:48
they might have been able to stabilize him.
00:21:51
But without treatment, his condition only worsens.
00:21:55
He has a very rocky course with his blood
00:21:58
pressure, which is probably because his heart is dying.
00:22:02
NARRATOR: Then, four weeks later,
00:22:04
in a final blow to James's battered body,
00:22:07
he contracts a fatal blood-borne bacterial infection
00:22:10
called sepsis.
00:22:12
And in his weakened condition, the aggressive infection
00:22:15
is just too much.
00:22:18
As you get the bacteria in your blood,
00:22:20
your body reacts to that bacteria.
00:22:22
You start releasing chemicals that start
00:22:24
your blood vessels to dilate.
00:22:25
Once your blood vessels start to dilate,
00:22:27
your heart has to beat harder and it has to beat more
00:22:30
to keep the blood pressure up.
00:22:32
He's already having a hard time maintaining his blood
00:22:34
pressure with his heart, and he's already
00:22:36
starting to go into failure.
00:22:37
So this just makes it even worse.
00:22:40
And ultimately, he eventually dies.
00:22:44
[DRAMATIC MUSIC PLAYING]
00:22:52
NARRATOR: Because of the complex nature of James Duncan's death,
00:22:56
involving both disease and a fall,
00:22:59
Dr. G ultimately rules that the manner of his death
00:23:02
was not simply natural, but accidental.
00:23:06
Pinpointing the exact cause is more difficult.
00:23:09
So what killed him?
00:23:10
Well, clearly, what started it all is the heart attack.
00:23:14
But if not for him falling with that,
00:23:18
would he have ultimately died?
00:23:20
And I'm not so sure.
00:23:21
So it's not only just the heart attack,
00:23:24
it's probably a combination of the heart attack, now,
00:23:27
with the injuries that he suffered from the fall
00:23:29
with the heart attack.
00:23:30
And with all the problems he suffered in the hospital
00:23:35
for being there so long.
00:23:37
NARRATOR: When Dr. G presents her new theory
00:23:39
to the detectives investigating the case,
00:23:42
they agreed that they no longer have a homicide on their hands.
00:23:46
Dr. G mentioned that she had run into one or two cases
00:23:52
similar to his, where she actually had worked
00:23:56
on individuals that had had a heart attack and fall
00:24:00
straight down onto their face and cause
00:24:03
the same type of injuries.
00:24:05
Her findings were very conclusive in the sense
00:24:08
that there was no other injury to him.
00:24:10
There was no defense wound on him,
00:24:14
no indication that he was fighting
00:24:16
or struggling with someone.
00:24:18
All we have is facial injuries.
00:24:20
And we all determined that what happened to the victim
00:24:23
was basically an accidental death.
00:24:27
[MUSIC - THE HIGHWAY BEAUTIFUL, "DREAM OUT LOUD"]
00:24:36
JASON JUREWICZ: (SINGING) And so you cut yourself to bleed,
00:24:40
hoping they will see, asking them in not so many words.
00:24:45
NARRATOR: As Dr. G expected, the case was difficult,
00:24:49
but not for the reasons she anticipated.
00:24:52
You know, my favorite cases are when I find something
00:24:55
that nobody else suspects.
00:24:59
In this case, it wasn't the injury nobody suspected.
00:25:02
They worked that up quite nicely.
00:25:03
And they were able to repair that quite nicely.
00:25:07
But the whole heart attack was not suspected.
00:25:10
And when I find things on a case that aren't suspected and then
00:25:15
just kind of turn the way the investigation goes,
00:25:18
those are the best cases.
00:25:20
Those are actually a lot of fun to work with.
00:25:24
[GUITAR MUSIC PLAYING]
00:25:27
NARRATOR: Unfortunately, some of Dr. G's cases
00:25:30
leave her with more questions than answers,
00:25:33
and her next case is no exception.
00:25:37
The family is on pins and needles
00:25:39
that he committed suicide.
00:25:41
They really were worried.
00:25:47
[OMINOUS MUSIC PLAYING]
00:25:57
[UPBEAT MUSIC PLAYING]
00:26:01
The county has a Service Award that's given every five years.
00:26:05
And this time, it's for our chief medical examiner,
00:26:08
Dr. Garavaglia.
00:26:09
So we're about to surprise her and give her her award.
00:26:13
I was told that a employee of this office
00:26:18
has successfully completed five years of service.
00:26:21
So on behalf of Orange County, we'd like to present
00:26:25
your five-year Service Award.
00:26:27
Here is your certificate.
00:26:29
Thank you, Sheri.
00:26:30
SHERI BLANTON: Thank you.
00:26:31
Thank you, Orange County.
00:26:33
She works long and hard hours.
00:26:35
She works a lot longer than they pay her for.
00:26:37
It's nice. It's nice.
00:26:39
OK. Thank you.
00:26:40
SHERI BLANTON: She's got work to do.
00:26:41
[LAUGHS]
00:26:46
NARRATOR: In fact, there's still one more body Dr. G must
00:26:49
autopsy before she can go home.
00:26:52
The man's name is Michael Reardon,
00:26:55
and he was found lifeless in bed by his wife late last night.
00:27:05
According to the investigators' report,
00:27:07
the decedent was only 42 years old, married,
00:27:10
with two young children.
00:27:12
And from the case file, Dr. G can
00:27:15
see right away that he's had more than his share
00:27:18
of medical problems.
00:27:19
He's got a really sad, long history.
00:27:21
He ran into a basketball pole playing a pickup game
00:27:25
of basketball at least a decade ago
00:27:28
and has had chronic pain since then.
00:27:31
Numerous surgeries.
00:27:32
Hasn't really gotten over the pain.
00:27:34
Is on some pretty high-dose medication for it.
00:27:39
NARRATOR: In fact, on the night of his death,
00:27:42
Michael's wife Alyssa administered a fresh dose
00:27:45
of pain medication.
00:27:46
In this case, a dermal, or skin patch,
00:27:49
that releases painkiller in a constant flow
00:27:51
over several days.
00:27:54
She's been controlling his medication for years.
00:27:57
And she changed his patch in the late evening.
00:28:01
And then he went to watch TV.
00:28:05
NARRATOR: Not long afterwards, Michael dozes off.
00:28:08
JAN GARAVAGLIA: (VOICEOVER) She hears
00:28:09
him snoring very, very loudly.
00:28:12
[SNORING]
00:28:14
NARRATOR: At around 1:00 AM, Alyssa
00:28:16
decides to turn in herself.
00:28:19
But as she approaches the bed, she
00:28:20
makes a frightening discovery.
00:28:23
Michael is not breathing.
00:28:26
His face is purple and he's cool to the touch.
00:28:29
The wife calls 9-1-1.
00:28:30
Yeah, I need someone here now, please.
00:28:32
JAN GARAVAGLIA: (VOICEOVER) They work
00:28:33
on him for about 20 minutes, but they realize he's dead.
00:28:37
Oh, my sweet Jesus!
00:28:42
NARRATOR: The unexpected loss has devastated
00:28:45
Michael's wife and children.
00:28:50
Now, their only hope is that Dr. G
00:28:53
will be able to determine what exactly brought
00:28:56
about his untimely death.
00:29:01
After reading through the case file,
00:29:04
she has her suspicions about what may have killed
00:29:06
Michael Reardon as he slept.
00:29:09
We take things on face value.
00:29:12
And we come up with the most probable explanation.
00:29:16
NARRATOR: In addition to suffering
00:29:18
from chronic, severe pain, Michael
00:29:20
was overweight and diagnosed with high blood
00:29:23
pressure-- both risk factors for a myriad of medical problems.
00:29:29
But it's what his wife Alyssa noted in her statement
00:29:32
to the investigator that draws Dr. G's attention--
00:29:36
Michael's snoring.
00:29:40
He's got a history of some snoring in the past, where
00:29:44
the wife has to shake him.
00:29:46
There's a question of whether he has sleep apnea.
00:29:50
That could be a possibility.
00:29:51
NARRATOR: Obstructive sleep apnea is a common problem
00:29:55
in which the airway becomes blocked
00:29:57
during sleep due to the relaxation of soft tissue
00:30:00
structures in the throat.
00:30:02
It can lead to a temporary cessation in breathing.
00:30:05
And in some cases, trigger a deadly heart arrhythmia.
00:30:09
Well, a heart arrhythmia is an irritation
00:30:12
in the electrical system of the heart,
00:30:14
where it causes it to quiver.
00:30:16
And you can't beat.
00:30:18
You can't send blood to any parts of your body.
00:30:20
You pass out and you die.
00:30:25
NARRATOR: If Michael died due to a fatal arrhythmia,
00:30:27
his premature death could be attributed to natural disease.
00:30:33
But there's another notation in the investigative report
00:30:36
that suggests the death may have been anything but natural.
00:30:40
The family is on pins and needles
00:30:43
that he committed suicide.
00:30:46
They really were worried.
00:30:48
NARRATOR: Twice already, Michael has tried to take his own life.
00:30:56
Since his basketball accident damaged his facial nerves
00:30:59
10 years earlier, he has suffered from
00:31:01
chronic and unbearable pain.
00:31:04
Doctor G wonders if he just couldn't take it anymore.
00:31:10
It's a tough row to hoe.
00:31:13
To have recurrent chronic facial pain,
00:31:16
you know, you start getting into a frame of mind
00:31:19
that you're hopeless.
00:31:20
That things can't change, and there's no other solution.
00:31:25
And after years of trying to control that pain,
00:31:29
maybe that's how he's feeling.
00:31:31
It's well-known that chronic pain patients and depression
00:31:35
often go together.
00:31:37
And we know that depression often can lead to suicide.
00:31:42
So you can't say that all patients with chronic pain
00:31:45
lead to suicide.
00:31:46
But those that have chronic pain, that
00:31:49
are profoundly depressed, certainly
00:31:50
can have an increased risk for suicide.
00:31:56
NARRATOR: Did Michael finally succeed at ending his life,
00:31:59
as his family fears?
00:32:01
Or was his death due to a disorder such as sleep apnea?
00:32:07
For answers to these questions, there's
00:32:09
only one place to turn--
00:32:12
Michael's body.
00:32:15
[DRAMATIC MUSIC PLAYING]
00:32:27
On the external examination, the general state in the body
00:32:31
is a little bit overweight.
00:32:33
You know, the weight's kind of in his belly area.
00:32:37
NARRATOR: Dr. G begins the exam in the place
00:32:39
that gave Michael so much trouble--
00:32:42
his face.
00:32:42
He clearly has had a lot of surgeries in the face area.
00:32:47
You can see the scars from that, you
00:32:49
know, pretty much going all the way
00:32:51
from his jaw down to his neck.
00:32:53
A little-- another scar on the other side.
00:32:56
NARRATOR: Next, she searches the body for the pain patch
00:32:59
that Michael's wife administered the previous night.
00:33:03
The patch, called a transdermal, administers
00:33:06
a constant flow of pain medication to the patient.
00:33:10
In this case, the narcotic fentanyl.
00:33:13
Fentanyl is about 80 or 100 times
00:33:15
more potent than morphine.
00:33:18
Very small amounts are needed for pain relief.
00:33:22
You can take fentanyl orally.
00:33:25
You can inject fentanyl.
00:33:26
Fentanyl can be put in a patch and absorbed through the skin.
00:33:30
And it's a small enough molecule,
00:33:32
and you'll need a small amount for it to work.
00:33:36
A fentanyl patch is basically a gel reservoir of fentanyl
00:33:40
in an adhesive skin patch.
00:33:43
So the fentanyl trickles through the layers of the skin
00:33:46
in a controlled manner and is picked up by the blood vessels
00:33:49
underneath the skin and distributed
00:33:51
to the rest of the body for pain management.
00:33:53
I'm looking all over to see if they left any patches on.
00:33:59
NARRATOR: But she doesn't find one.
00:34:01
From what I can tell, as soon as he got to the hospital,
00:34:05
they removed it.
00:34:06
I would have liked to have seen it.
00:34:08
That would have been important evidence for me,
00:34:10
but it got thrown away.
00:34:13
NARRATOR: Dr. G then combs the body for any signs
00:34:16
of past suicide attempts.
00:34:17
I do look on the inner aspects of the wrist
00:34:20
to see if there's any scars.
00:34:22
A lot of times, people will attempt it that way.
00:34:25
But I don't see any.
00:34:26
But that's not how he attempted suicide.
00:34:29
He attempted suicide by medication, which is worrisome.
00:34:33
That's because that's what I'm suspecting.
00:34:35
NARRATOR: But she wanted to know if Michael actually overdosed
00:34:38
until she completes the autopsy and gets
00:34:40
the toxicology results.
00:34:43
At the end of the the external,
00:34:45
we don't have a lot, as often is the case.
00:34:47
And we're going to have to see what's on the internal.
00:34:50
I don't know what bad thing happened to this guy.
00:34:56
[OMINOUS MUSIC PLAYING]
00:35:11
NARRATOR: Dr. G suspects that 42-year-old Michael Reardon may
00:35:14
have taken his own life, but his family is praying she's wrong.
00:35:23
I think they were really on pins and needles
00:35:25
waiting for that answer.
00:35:28
[DRAMATIC MUSIC PLAYING]
00:35:36
NARRATOR: She starts the internal examination
00:35:38
by opening Michael's chest with a standard y-incision.
00:35:42
Well, when I open the y-incision, I look around.
00:35:46
Nothing unusual.
00:35:47
Always keeping my eyes open, seeing what's there.
00:35:50
Now, let's see what we have, here.
00:35:53
I take off his chest plate.
00:35:56
No fluid, no abnormalities.
00:36:01
And I do my toxicology.
00:36:03
NARRATOR: Dr. G draws fluid, urine, and blood samples
00:36:07
from the eyes, bladder, and large blood vessels.
00:36:11
These will be sent to the lab and tested for drugs.
00:36:14
The results will be critical in determining
00:36:17
if Michael committed suicide.
00:36:19
We take the blood from his iliac veins,
00:36:24
as peripheral as we can get from the rest of his body.
00:36:28
Just as they're going into the femorals.
00:36:30
And that's where we draw our blood.
00:36:32
We put it in our tubes and get that ready for toxicology.
00:36:37
Well, look at that.
00:36:39
NARRATOR: With the samples in hand,
00:36:41
she begins her examination of Michael's chest cavity.
00:36:44
And almost immediately, she discovers something unusual--
00:36:49
something that raises doubts about a drug overdose.
00:36:53
Oh, wow.
00:36:55
NARRATOR: Michael's lungs seem normal, which in drug overdoses
00:36:58
is very odd.
00:37:00
So when I do the autopsy, his lungs are not very edematous.
00:37:07
His lungs are a little over normal weight,
00:37:10
but not that bad.
00:37:12
NARRATOR: Typically, a drug overdose would cause the lungs
00:37:14
to fill with fluid, or edema.
00:37:17
Nobody knows exactly why we get this bad edema
00:37:20
with the drug overdoses.
00:37:22
But we see it trickle in these kind of slow deaths,
00:37:26
which is what I suggest he had.
00:37:28
So I don't know.
00:37:30
I'm surprised his lungs aren't a little more edematous.
00:37:34
NARRATOR: But there's one more organ
00:37:35
to check for signs of an overdose,
00:37:38
and that's the stomach.
00:37:40
JAN GARAVAGLIA: (VOICEOVER) The stomach on a case like this
00:37:42
may be important because people who want to kill themselves
00:37:47
will take a lot of pills at once.
00:37:49
So are taking 15, 20, 30 pills at once.
00:37:53
And some of those may still be in the stomach.
00:37:56
NARRATOR: But after a careful inspection,
00:37:58
Dr. G comes up empty-handed again.
00:38:04
I certainly don't see any pills or pill fragments.
00:38:07
NARRATOR: Normal lungs, an empty stomach.
00:38:10
One by one, Dr. G's findings are calling for her
00:38:14
to rethink the entire case.
00:38:16
It's making me kind of question
00:38:18
my whole overdose theory.
00:38:21
NARRATOR: Now, she wonders if Michael Reardon's killer
00:38:23
was natural disease after all.
00:38:26
And one of the places that natural disease
00:38:28
is most likely to strike is the heart, so that's her next stop.
00:38:34
With the lungs removed from the chest cavity,
00:38:36
Dr. G gets her first look at the muscle.
00:38:40
I get to his heart.
00:38:42
His heart is big and somewhat dilated.
00:38:45
Definitely a big heart for his size.
00:38:47
Boy, that is a big heart.
00:38:51
NARRATOR: An enlarged heart, or cardiomegaly,
00:38:55
is a form of cardiovascular disease, the number-one killer
00:38:59
of adults in the United States.
00:39:03
Certainly, an enlarged heart would be a risk factor
00:39:06
for the arrhythmia because as the muscle gets thicker,
00:39:09
it would be more prone to have problems
00:39:12
with a decrease in oxygenation.
00:39:14
And so when you combine a decrease in oxygenation--
00:39:17
let's say, from the sleep apnea--
00:39:19
with a thickened heart, you're more apt to have an arrhythmia.
00:39:23
NARRATOR: In other words, Michael's
00:39:25
enlarged heart and his sleep apnea
00:39:28
may have been a fatal combination.
00:39:29
JAN GARAVAGLIA: (VOICEOVER) So he
00:39:30
could have died suddenly from an arrhythmia
00:39:33
from that heart, no problem.
00:39:35
NARRATOR: But Dr. G can't be certain
00:39:37
because arrhythmias leave no physical traces behind.
00:39:40
It's going to be a diagnosis of exclusion.
00:39:43
We've got to rule everything else out.
00:39:45
NARRATOR: Although she has a likely suspect,
00:39:47
she can't make her ruling just yet.
00:39:51
So at the end of the internal, we've got an enlarged heart.
00:39:54
And we have not much else.
00:39:56
We're just going to pend the cause and manner of death
00:39:59
until I get that toxicology.
00:40:04
[OMINOUS MUSIC PLAYING]
00:40:16
NARRATOR: Soon after his autopsy,
00:40:18
the body of 42-year-old Michael Reardon is laid to rest.
00:40:22
But questions surrounding his untimely death
00:40:25
remain open, leaving his family searching for an explanation.
00:40:31
It's always a trying time for the families
00:40:33
waiting for the answers.
00:40:34
We always get a lot of anxious phone calls.
00:40:36
Is it done yet?
00:40:37
Is it done yet?
00:40:38
NARRATOR: But Dr. G cannot close the case until the toxicology
00:40:42
results are back from the lab.
00:40:44
And three weeks later, they arrive at District 9 Morgue.
00:40:48
So I'm looking through these pages of tox.
00:40:50
He had a therapeutic level of his anti-hypertensive medicine.
00:40:55
He had a therapeutic level of his antidepressant medication.
00:41:00
He had kind of a high therapeutic level
00:41:04
of oxycodone, a very potent narcotic
00:41:07
that we see a lot of deaths with.
00:41:10
But his was high therapeutic.
00:41:11
It certainly wasn't in the lethal range.
00:41:13
NARRATOR: But then suddenly, something in the report
00:41:16
catches her attention.
00:41:18
And I turn the page on the toxicology, and there it is.
00:41:23
His fentanyl level-- lethal.
00:41:29
There is the rub, right here.
00:41:32
Without a doubt, he's got a lethal fentanyl level.
00:41:36
NARRATOR: Fentanyl is the powerful pain
00:41:38
medication that Michael had been taking through a skin patch.
00:41:43
At first glance, the lethal level seems to confirm
00:41:46
the family's worst nightmare--
00:41:49
suicide.
00:41:53
The question is, how did this happen?
00:41:57
To overdose on a fentanyl patch
00:41:58
is really quite rare and unusual.
00:42:00
Assuming, of course, the patch is used in accordance
00:42:03
with a doctor's prescription, is not tampered with,
00:42:07
and there is no uncontrolled release of the drug
00:42:09
onto the skin, which could then absorb into the blood and cause
00:42:13
problems.
00:42:14
So how do people get into trouble?
00:42:16
Well, first of all, they put on too many patches.
00:42:20
Instead of one patch, I've seen some people with four patches.
00:42:23
I've seen it come through my office, where
00:42:25
heat applied to the patch can cause too
00:42:29
much medication to be given.
00:42:32
NARRATOR: But for Dr. G, something
00:42:34
still isn't adding up.
00:42:38
She knows from her research that the fentanyl patch has been
00:42:41
linked to accidental overdoses.
00:42:45
Suddenly, it seems at least possible that Michael's death
00:42:49
was not intentional.
00:42:51
In Florida alone, we've got a lot of accidental deaths
00:42:54
from fentanyl a year.
00:42:55
Not necessarily in my office, but in the state.
00:42:58
NARRATOR: Dr. G wonders if Michael
00:43:00
Reardon might have been the unfortunate
00:43:02
victim of a defective patch.
00:43:05
The FDA has recalled some of these patches.
00:43:07
And that was one of my worries, is
00:43:09
that maybe he had a bad patch.
00:43:13
NARRATOR: As recently as 2008, the FDA
00:43:16
has issued a recall on defective patches that resulted
00:43:19
in the deaths of patients.
00:43:22
The FDA put out a recall warning for these patches
00:43:26
because they found that there were some patients being harmed
00:43:29
by them due to uncontrolled leakage out of the side
00:43:32
of the patch due to a tear.
00:43:34
There have been FDA warnings.
00:43:36
There was one right before this fella died.
00:43:39
And I was initially worried about that.
00:43:41
But it was the 25 micrograms.
00:43:44
And he had the 75.
00:43:46
Since that time, there's been other warnings about the 25,
00:43:49
the 75, and the 100.
00:43:51
What happens with these bad patches
00:43:53
is that the reservoir is broken.
00:43:55
And that gel gets on the skin directly,
00:43:59
with the medication in it.
00:44:01
A lot of these defective patches,
00:44:04
you're going to have the gel ooze out in the packet.
00:44:07
NARRATOR: With a defective patch,
00:44:09
the medication is absorbed into the skin
00:44:12
all at once, rather than being gradually
00:44:14
released over a period of time.
00:44:17
So did he have a defective patch?
00:44:20
I'll never know because the evidence was destroyed.
00:44:26
NARRATOR: Unfortunately, emergency workers
00:44:29
removed the patch and threw it away
00:44:31
before Dr. G could examine it.
00:44:35
And as she prepares to close the case,
00:44:37
she's left with a number of troubling questions.
00:44:41
What really happened?
00:44:43
Did he put heat on it?
00:44:44
Does he know this?
00:44:45
This is a guy with long-term pain problems.
00:44:50
Did he do it intentionally, or did he do
00:44:52
it to try to relieve his pain?
00:44:55
Did he have a defective patch?
00:44:58
I don't know what bad thing happened to this guy.
00:45:01
All I know is he died of a fentanyl overdose.
00:45:05
NARRATOR: Based on the circumstances of Michael's
00:45:07
death and the autopsy findings, Dr. G
00:45:10
arrives at her conclusion.
00:45:13
I have nothing to indicate that it was a suicide.
00:45:16
And I'm going to give him the benefit of the doubt
00:45:19
because it happens with these.
00:45:21
NARRATOR: Michael Reardon's official cause of death
00:45:23
will be listed as accidental overdose.
00:45:26
Now, Dr. G can record her findings
00:45:29
in the report of autopsy.
00:45:32
[EERIE MUSIC PLAYING]
00:45:38
It's a sunny afternoon, and 42-year-old Michael
00:45:41
Reardon is busy enjoying the company
00:45:43
of his wife and two kids.
00:45:46
At 3 PM, as he does every day, he
00:45:49
makes sure to take his full regimen
00:45:51
of prescription medications.
00:45:53
He takes oxycodone, which is a potent narcotic.
00:45:57
He takes an antidepressant.
00:45:59
He takes a high blood pressure medication.
00:46:03
He takes a medication for nausea.
00:46:05
NARRATOR: Based on forensics and the testimony of his wife
00:46:08
Alyssa, Michael's fentanyl patch is administered
00:46:11
around 8:00 PM that same evening,
00:46:15
five hours prior to his death.
00:46:18
Unfortunately, what happens after he went to bed
00:46:21
remains a mystery.
00:46:24
You know, the wife really wasn't
00:46:25
seeing what was going on.
00:46:26
What was he doing there?
00:46:29
NARRATOR: From the extremely high level of fentanyl
00:46:31
in his blood, Dr. G knows that the medication entered
00:46:34
his system very quickly, which is not the way
00:46:38
a patch is supposed to work.
00:46:40
Maybe it's an accident with a defect in the reservoir.
00:46:43
Maybe he perforated the reservoir
00:46:46
accidentally in getting it out and applying it.
00:46:49
Maybe he did it on purpose, just to give
00:46:52
himself more medication.
00:46:54
But what really happened?
00:46:56
I don't know.
00:46:57
All we know is that the fentanyl level got
00:46:59
higher and higher and higher.
00:47:01
NARRATOR: As the fentanyl level escalates,
00:47:03
it circulates through his bloodstream,
00:47:05
ultimately reaching all of his vital organs,
00:47:08
including his brain.
00:47:10
It's going into his opiate receptors on his brain stem,
00:47:14
saturating those, causing more and more central nervous system
00:47:18
depression.
00:47:19
Slowly going deeper and deeper into a coma.
00:47:24
NARRATOR: As Michael slips into the coma, he begins to snore.
00:47:28
But soon, his breathing becomes more labored.
00:47:32
Eventually, the fentanyl suppresses
00:47:34
his central nervous system so much that his heart ceases
00:47:37
to beat, and Michael dies.
00:47:44
Dr. G immediately contacts Michael's wife
00:47:47
to inform her that she's ruled his death
00:47:49
an accident, not a suicide.
00:47:53
I think she just wanted to make sure it wasn't suicide.
00:47:55
At least, that's the sense I got.
00:47:57
NARRATOR: At the District 9 Morgue,
00:47:59
the vast majority of cases are closed
00:48:01
with confidence in the forensic evidence
00:48:03
and the conclusions drawn from it.
00:48:06
But for Dr. G, the case of Michael Reardon
00:48:09
is not one of them.
00:48:12
She continues to be troubled by his death
00:48:14
and the lingering question she'll never be able to answer.
00:48:20
Am I comfortable with my conclusion
00:48:21
that he didn't commit suicide?
00:48:22
No.
00:48:23
You know, we've investigated as much as we can.
00:48:27
And we're going to have to go with the preponderance
00:48:29
of evidence that this was an accident.
00:48:31
Because we have nothing to suggest otherwise.
00:48:36
You know, I wish they hadn't thrown the patch away.
00:48:39
I wish I really knew what was going on those five hours,
00:48:43
that nobody saw him between the time his patch was changed
00:48:46
and he died.
00:48:47
I wish I knew all that.
00:48:48
It's so frustrating that I can't get
00:48:50
all the exact answers I want.
00:48:52
And I can only use the information I have.
00:48:56
So it's a very frustrating case, but you've got to move on.
