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MANNER OF DEATH
Homicide
Odey Ukpo MD
Forensic Pathology Fellow
DECLARATION The death of VARELA, OMAREE was investigated by the Office of the Medical Investigator under the statutory authority of the Office of the Medical Investigator. I, Sam Andrews MD, FRCPC a board certified anatomic, and forensic pathologist licensed to practice pathology in the State of New Mexico, do declare that I personally performed or supervised the tasks described within this Death Investigation Summary document. It is only after careful consideration of all data available to me at the time that this report was finalized that I attest to the diagnoses and opinions stated herein. Numerous photographs were obtained along the course of the examination. I have personally reviewed those photographs and attest that they are representative of findings reported in this document. This document is divided into 10 sections with a final Procedural Notes section:
1. Summary and Opinion 2. External Examination 3. Medical Intervention 4. Postmortem Changes 5. Evidence of Injuries 6. Internal Examination 7. Neuropathology 8. Microscopy 9. Radiography 10. Peer Review
Should you have questions after review of this material, please feel free to contact me at the Office of the Medical Investigator (Albuquerque, New Mexico) - 505-272-3053.
Case Number:
2013-06715
Summary Opinion
Medical lnvestigator Trainee Odey Ukpo MD
VARELA, OMAREE
Cause Of Death:
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Case Number:
2013-06715
External Examination
Medical Investigator Trainee Odey Ukpo MD
VARELA, OMAREE
External exam date time: Authority for examination: ID confirmed at time of exam: Means used to confirm identity: Other verification means: Location of orange bracelet: Name on orange bracelet: Other name on orange bracelet: Location of green bracelet: Name on green bracelet: Other name on green bracelet: Hospital ID tags or bracelets? If yes specify stated name and location: Body length (cm): Body weight (kgs):
12/28/2013 9:13:00 AM OMI Yes Visual Right wrist Decedent name Right wrist Decedent name Yes Left ankle Trauma-Alert, Hurdle C 128.00 27.00
Development: Development comments: Stature: Age: Anasarca: Edema localized: Dehydration: Skin comments:
Case Number: Nose: Ears: Lips: Facial hair: Facial hair color: Maxillary dentition:
2013-06715
External Examination
Normally formed Normally formed Normally formed None Does not apply Natural Natural Adequate Unremarkable Yes Normal Yes Appropriate Unremarkable Unremarkable Normal Male None None Yes Yes Yes Yes Well-developed and symmetrical No No No No
Tattoo(s)
VARELA, OMAREE
Mandibular dentition: Condition of dentition: Neck: Trachea midline: Chest development: Chest symmetrical: Chest diameter: Abdomen: Back: Spine: External genitalia: Breast development: Breast masses: Right hand digits complete: Left hand digits complete: Right foot digits complete: Left foot digits complete: Extremities: Muscle group atrophy: Senile purpura: Pitting edema: Muscle other: Tattoos present:
No
Cosmetic Piercing(s) Cosmetic piercing present: Scar(s) present: Scar face: Scar right lateral neck:
No
Scar(s)
2013-06715
External Examination
Sam Andrews MD on 3/4/2014 4:08:13 PM Sam Andrews MD on 3/7/2014 4:50:48 PM
VARELA, OMAREE
External Examination
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Case Number:
2013-06715
Medical Intervention
Medical Investigator Trainee Odey Ukpo MD
VARELA, OMAREE
Yes
Indwelling Tubes
If nasogastric tube present, specify course and position: Nasogastric tube: Nasogastric tube comment: If endotracheal tube present, specify course and position: Tracheostomy site/tube: Mediastinal tube(s): Chest tube(s): If Foley catheter present, specify course and position: Medical intervention other:
Yes Passes through the nose and nasopharynx, down the esophagus and terminates in the stomach No No No No No
Combitube within the esophagus. Recent needle puncture within the right antecubital fossa. Acute needle puncture of the left antecubital fossa. Pulse oximeter on the right hand.
ECG Monitoring Pads ECG Monitoring Pads Present?: ECG Chest Pads: ECG abdomen pads: ECG shoulders pads: ECG shins pads: Other pads comments: Defibrillator Pads Defibrillator pads present?:
No
Yes Yes
Recent Surgical Intervention
No
2013-06715
Medical Intervention
Sam Andrews MD on 3/4/2014 4:25:11 PM Sam Andrews MD on 3/7/2014 4:50:48 PM
VARELA, OMAREE
Medical Intervention
Page 2
Case Number:
2013-06715
Postmortem Changes
Medical Investigator Trainee Odey Ukpo MD
VARELA, OMAREE
External exam date: Body temperature: Rigor mortis: Livor mortis - color: Livor mortis - fixation (if applicable): Livor mortis - position (if applicable): State of preservation:
12/28/2013 9:16:00 AM Cool subsequent to refrigeration Partially fixed Purple Fully Fixed Posterior No decomposition
Report Tracking Reported by: Verified by: Reviewed and approved by: Odey Ukpo MD Sam Andrews MD on 12/28/2013 3:18:22 PM Sam Andrews MD on 3/7/2014 4:50:48 PM
Postmortem Changes
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Case Number:
2013-06715
Evidence of Injury
Medical lnvestigator Trainee Odey Ukpo MD
VARELA, OMAREE
Yes
Evidence of Injury:
Autopsy date:
12/28/2013 8:30:00 AM
Evidence of Injury
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2013-06715
Location
Evidence of Injury
Injury Description
VARELA, OMAREE
1 Blunt injury
Head
On the superior philtrum is a 0.5 x 0.5 cm red abrasion. On the lateral left supraorbital ridge is a 0.5 x 0.5 cm red/orange, dry abrasion. On the left parietal scalp is a 1.5 x 0.5 cm red laceration with granulation tissue at the base. On the anterior tongue is a 0.8 x 0.4 cm blue contusion.
2 Blunt injury
Chest
On the midline superior chest are three distinct, 0.5 x 0.5 cm, roughly square, orange, waxy abrasions. On the lateral upper left chest in a 4 x 3.5 cm area, are three distinct, circular, red contusions. There is hemorrhage within the lateral right 10th and 11th intercostal spaces. There is hemorrhage within the posterior right 11th intercostal space.
3 Blunt injury
Abdomen
There is 500 ml of liquid blood within the abdominal cavity. There is hemorrhage within the peripancreatic and left perirenal fat. There are irregular hemorrhages of the superior and inferior diaphragmatic surfaces. There is hemorrhage of the right internal oblique muscle. On the serosal surfaces of the small and large bowel are multiple patchy small contusions.
Back Extremity
On the midline lower back is a 2 x 2 cm blue contusion with associated subcutaneous hemorrhage. On the posterior distal right forearm is a 3 cm circular blue contusion. On the lateral distal left forearm are 2 cm and 1 cm circular purple contusions. On the posterior mid left forearm is a purple contusion. On the left knee is a 2 x 1 cm oval blue contusion. On the mid right shin is a 3 x 1.5 cm oval blue contusion.
Report Tracking
Odey Ukpo MD Sam Andrews MD on 3/7/2014 4:49:43 PM Sam Andrews MD on 3/7/2014 4:50:48 PM
Evidence of Injury
Page 2
Case Number:
2013-06715
Internal Examination
Medical lnvestigator Trainee Odey Ukpo MD
VARELA, OMAREE
Chest cavities examined: See evidence of injury section Organs in normal anatomic position Other organ position comments Diaphragm: Serosal surfaces: Body cavity adhesions present: Fluid accumulation present: Fluid accumulation right chest cavity: Fluid accumulation left chest cavity Fluid accumulation pericardial sac: Fluid accumulation abdominal cavity: Fluid accumulation pelvis: Fluid accumulation comments:
No
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2013-06715
No
Internal Examination
Middle Ears
VARELA, OMAREE
Middle ears examined: Neck examined: See Evidence of Injury section: See Evidence of Medical Intervention section See Postmortem Changes section: Subcutaneous soft tissues: Strap muscles: Jugular veins: Carotid arteries: Tongue: Epiglottis: Hyoid bone: Larynx: Palatine tonsils: Heart examined: See separate Cardiovascular Pathology report: See Evidence of Injury section: See Evidence of Medical Intervention section: See Postmortem Changes section: Right coronary ostium position: Left coronary ostium position: Supply of the posterior myocardium: Heart fresh (g): Heart fixed (g):
Neck
Yes No No No Unremarkable Unremarkable Unremarkable Unremarkable Unremarkable Unremarkable Unremarkable Unremarkable Unremarkable
CARDIOVASCULAR SYSTEM
Yes No No No No
Heart
Right coronary ostium: Proximal third right coronary artery: Middle third right coronary artery: Distal third right coronary artery: Left coronary ostium: Left main coronary artery: Proximal third left anterior descending coronary artery: Middle third left anterior descending coronary artery: Distal third left anterior descending coronary artery:
Internal Examination
0 0 0 0 0 0 0 0 0
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2013-06715
0 0 0
Internal Examination
VARELA, OMAREE
Proximal third left circumflex coronary artery: Middle third left circumflex coronary artery: Distal third left circumflex coronary artery: Cardiac chambers: Tricuspid valve: Pulmonic valve: Mitral valve: Aortic valve: Right ventricular myocardium: Left ventricular myocardium: Atrial septum: Ventricular septum:
Unremarkable Unremarkable Unremarkable Unremarkable Unremarkable No fibrosis, erythema, pathologic infiltration of adipose tissue or areas of accentuated softening or induration No fibrosis, erythema, or areas of accentuated softening or induration Unremarkable Unremarkable
Aorta
Aorta examined: Orifices of the major vascular branches: Coarctation: Vascular dissection: Aneurysm formation: Complex atherosclerosis: Other aortic pathology: Great vessels examined: Vena cava and major tributaries:
Yes Patent No No No No No
Vena Cava
Yes Patent
RESPIRATORY SYSTEM
Lungs examined: See separate Cardiovascular Pathology report: See Evidence of Injury section: See Evidence of Medical Intervention section: See Postmortem Changes section: Lung right (g): Lung left (g): Upper and lower airways: Pulmonary parenchyma color: Pulmonary parenchyma congestion and edema: Pulmonary trunk:
Internal Examination
Yes No No No No 130 125 Unobstructed, and the mucosal surfaces are smooth and yellow-tan Dark red-purple Slight amounts of blood and frothy fluid Free of saddle embolus
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Case Number:
2013-06715
None None
Internal Examination
VARELA, OMAREE
HEPATOBILIARY SYSTEM Liver examined: See Evidence of Injury section: See Evidence of Medical Intervention section: See Postmortem Changes section: Liver (g): Bile vol (mL): Gallstones autopsy: Gallstones autopsy desc: Hepatic parenchyma (color): Hepatic parenchyma (texture): Hepatic vasculature: Gallbladder: Gallstones: Intrahepatic biliary tree: Extrahepatic biliary tree: Alimentary tract examined: See Evidence of Injury section: See Evidence of Medical Intervention section: See Postmortem Changes section: Stomach contents vol (mL): Stomach contents description: Appendix found: Course: Mucosa: Mucosa: Pylorus:
Yes No No No 615 No Red-brown Unremarkable Unremarkable and free of thrombus Unremarkable None Unremarkable Unremarkable
GASTROINTESINAL SYSTEM
Yes Yes No No
Yes
Esophagus
Luminal contents: Mucosa: Caliber and continuity: Luminal contents: Mucosa: Caliber and continuity:
Partially digested food Unremarkable Appropriate caliber without interruption of luminal continuity
Colon
Internal Examination
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2013-06715
Internal Examination
Normal tan, lobulated appearance
GENITOURINARY SYSTEM
VARELA, OMAREE
Genitourinary system examined: See Evidence of Injury section: See Evidence of Medical Intervention section: See Postmortem Changes section: Kidneys capsules: Cortical surfaces: Cortices: Calyces, pelves and ureters: Kidney right (g): Kidney left (g): Urine volume (mL): Urine description:
Yes Yes No No
Kidneys
Thin, semitransparent Smooth Normal thickness and well-delineated from the medullary pyramids Non-dilated and free of stones and masses 45 55 0
Urinary Bladder
Urinary bladder mucosa: Male: Location: Size: Consistency: Other testicle comments:
Yes
Testicles
Unremarkable Homogenous
RETICULOENDOTHELIAL SYSTEM Reticuloendothelial system examined: See Evidence of Injury section: See Evidence of Medical Intervention section: See Postmortem Changes section: Spleen (g): Spleen parenchyma: Spleen capsule: Spleen white pulp:
Yes No No No
Spleen
Color:
Internal Examination
Case Number:
2013-06715
Internal Examination
Lymph Nodes
VARELA, OMAREE
Regional adenopathy: Thymus (g): Parenchyma: Endocrine system examined: See Evidence of Injury section: See Evidence of Medical Intervention section: See Postmortem Changes section: Size: Position: Size: Parenchyma:
No adenopathy
Thymus
Yes No No No
Pituitary Gland
Normal
Thyroid Gland
Adrenal right (g): Adrenal left (g): Size: Parenchyma: Musculoskeletal system examined: See Evidence of Injury section: See Evidence of Medical Intervention section: See Postmortem Changes section: Bony framework: Musculature: Subcutaneous soft tissues:
Normal Yellow cortices and gray medullae with with the expected corticomedullary ratio
MUSCULOSKELETAL SYSTEM
Report Tracking Reported by: Verified by: Reviewed and approved by: Odey Ukpo MD Sam Andrews MD on 3/7/2014 4:49:46 PM Sam Andrews MD on 3/7/2014 4:50:48 PM
Internal Examination
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Case Number:
2013-06715
Neuropathology Examination
VARELA, OMAREE
BLUNT HEAD TRAUMA: 1. Scalp laceration at systemic autopsy 2. Cerebral edema without frank herniation
According to reports, Omaree Varela was at home fighting with a sibling when he fell off of a rocking horse. His mother later admitted to kicking him several times, and at one point he struck his head. A formal extended examination of the brain demonstrated mild cerebral edema only. There were no significant natural diseases, and no injuries.
Brain exam date: Brain: Dura: Brain Dissection Method: Brain fresh: Brain fresh: Brain fixed:
Evidence of Injury General Description (External): Dura mater: Dural venous sinuses: Cortical briding vein: Leptomeninges: SuperficialCorticalVasculature: Gyral convolution patterns: Gyral convolutions: Uncal processes: Cerebellar ponsils: Basilar arterial vasculature: Cranial nerve roots: Cerebral cortex: Gray-white matter junctions: Internal Capsule: Ventricular system:
Neuropathology
Smooth and without massess Patent Smooth and translucent No thromboses or vascular malformations Within normal limits Slight widening and flattening Not grooved or herniated Not grooved or herniated Normal Normal
General Description (Internal):
Intact and without contusion Distinct No neoplasm, cyst, abscess or hemorrhage Appropriately configured and not compressed
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2013-06715
Neuropathology Examination No neoplasm, cyst, abscess or hemorrhage No neoplasm, cyst, abscess or hemorrhage No neoplasm, cyst, abscess or hemorrhage No neoplasm, cyst, abscess or hemorrhage No neoplasm, cyst, abscess or hemorrhage No neoplasm, cyst, abscess or hemorrhage No neoplasm, cyst, abscess or hemorrhage Normally pigmented Normally pigmented
Other Tissues Examined
VARELA, OMAREE
Other comment(s) about the deep gray nuclei: Mammillary bodies: Superior cerebellar vermis: Cerebellar parenchyma: Brainstem structures: Proximal cervical spinal cord: Substantia nigra: Locus ceruleus:
No significant histopathologic abnormalities. *Unless otherwise indicated sections are stained only with hematoxylin and eosin (H&E).
Cassette Code Tissue Location Stain
B1 B2 B3 B4 B5 B6 B7 B8 B9
Frontal lobe Hippocampus Parietal lobe Anterior basal ganglia Posterior basal ganglia Cerebellum Medulla Spinal cord Dura mater
Report Tracking
Deirdre Amaro MD Evan Matshes MD on 2/10/2014 2:26:44 PM Sam Andrews MD on 3/7/2014 4:50:48 PM
Neuropathology
Page 2
Case Number:
2013-06715
Microscopy
Medical lnvestigator Trainee Odey Ukpo MD
VARELA, OMAREE
Microscopic description:
HEART (left ventricle, interventricular septum, apex) Sections of the heart show no significant histopathologic abnormality. LUNGS Sections of the right and left lungs show no significant histopathologic abnormality. KIDNEYS A section of the right shows focal interstitial chronic inflammation. A section of the left kidney shows no significant histopathologic abnormality. LIVER A section of the liver shows no significant histopathologic abnormality. LEFT PARIETAL SCALP Sections of the left parietal scalp show a laceration cleft through the scalp to galea filled with mixed cellular debris and fibrin, and a prominent fibroblastic and granulation-like response. SKIN OF THE CHEST Sections of the skin from the chest show epithelium with smeared nuclei, karyorrhectic debris, and focal acute inflammation that does not extend to the adnexa. One focus shows epidermal detachment with coagulative necrosis and blue discoloration of the dermal-epidermal junction. BLADDER A section of the bladder shows no significant histopathologic abnormality. TONGUE A section of the tongue shows denuded and reactive epithelium with near full thickness acute inflammation with focal hemorrhage. *Unless otherwise indicated sections are stained only with hematoxylin and eosin (H&E).
Block Tissue Location Description Stain
A1 A2 A3 A4 A5 A6 A7
Heart, right kidney Right lung, left kidney Liver, left lung Left scalp Chest abrasions at sternal notch Bladder Tongue
Microscopy:
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Case Number:
2013-06715
Odey Ukpo MD
Microscopy
Report Tracking
VARELA, OMAREE
Microscopy:
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2013-06715
Radiography
Medical lnvestigator Trainee Odey Ukpo MD
VARELA, OMAREE
Date of examination: Study date: Accession number: Exam type: Technique: Comparison: Comments:
Radiography
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2013-06715
VARELA, OMAREE
Death investigation report: Photographs: Microscopic slides: Toxicology report: Other Items (specify): Other Items Comments:
Radiographs (hands not radiographed) Full body computed tomography (PMCT) scan
Technical Audit Is the report independently reviewable?: Are the descriptions of clothing and identifying marks and scars appropriate for the complexity of the case?: Is the external description (without injuries) appropriately case specific?: Are the descriptions of injury, if present, appropriate for the complexity of the case, and consistent with diagrams and photographs?: Are the descriptions of injury, if present, organized in a logical and understandable sequence?: Are the descriptions of natural disease, if present, appropriate for the complexity of the case?: Is the text clear and understandable without significant typographical and/or grammatical errors?: Is the opinion logical and complete?: Is the opinion readily understandable by the nonmedical reader?: Are all significant issues addressed in the opinion?: Was appropriate ancillary testing performed?: Are the opinions reasonable?: Is the cause of death reasonable?: Is the manner of death reasonable?: Report completed in a timely fashion?: Comments: Report Tracking Reported by: Verified by:
Peer Review Report
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Case Number:
2013-06715
VARELA, OMAREE
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Procedural Notes
VARELA, OMAREE
Morphology technican supervisor(s) present Yellow Sheet Toxicology LabOther Attendees Identification Autopsy Evidence Radiology Retention Morphology Technician Lead Erika Cavalier Erika Cavalier Monica Mondragon Monica Mondragon Stephen Adams Monica Mondragon Monica Mondragon Monica Mondragon
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Procedural Notes
Autopsy attendees Other morphology technicians present:
VARELA, OMAREE
Monica Mondragon
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Procedural Notes
Specimens obtained for laboratory testing
VARELA, OMAREE
HIV serology: HIV spin and store: HCV/HBV serology : Influenza serology: Other serology: Freezer protocol: DNA card: Metabolic screen: Cytogenetics: Med-X protocol: Urine dipstick: Blood cultures (bacterial): Lung cultures (bacterial): CSF culture (bacterial): Spleen culture (bacterial): Stool culture (bacterial): Other bacterial culture (specify): Mycobacterial culture (lung): Mycobacterial culture (other): Viral Cultures:
No Yes No
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Case Number:
2013-06715
Procedural Notes
Special autopsy techniques
VARELA, OMAREE
HIV serology: Pericranial membrane removal: Neck anterior dissection: Neck posterior dissection: Facial dissection: Vertebral artery dissection (in situ): Cervical spine removal: Layered anterior trunk dissection: Anterolateral rib arc dissection: Back dissection: Posterior rib arc dissection: Extremity soft tissue dissection: Eye enucleation: Inner middle ear evaluation: Maxilla or mandible resection: Spinal cord removal (anterior): Spinal cord removal (posterior): Other dissection(s):
Tissues retention Stock jar with standard tissue retention: Rib segment: Pituitary gland: Breast tissue (women only): Brain retention: Spinal cord retention: Cervical spine retention: Heart retention: Heart-lung block retention: Rib cage retention: Long bone retention: Other retention,specify: Disposition of tissues retained for extended examination Specimen outcome:
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Case Number:
2013-06715
Procedural Notes
Number of scene photos produced by the OMI
VARELA, OMAREE
Scene Photos:
168
Number of autopsy photos produced by the OMI
Autopsy Photos:
98
Evidence collected
FBI blood tube: Blood spot card: APD blood card: Thumbprint: Fingerprints: Palmprints: Print hold: Oral swab: Vaginal swab: Anal swab: Other swab: Fingernails: Scalp hair: Pubic hair: Pubic hair combing: Projectile(s): Retain clothing: Retain valuables: Retain trace evidence: Retain body bag: Retain hand bags: Ligature: Other evidence retained:
Property Detail Swab- bite mark wet Swab- bite mark dry eye ointment
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