201"" 1315 350556295 Z127fi2534 A '3 Mow Kat 6mg" Sci/yer, 71 ATTN Tc Marsha" flue/J mdcfifih Medical Comflrehefleme flu'fia/quy Sent/(325' Ld'er $5397 lea/00W '3 1:33 +IC'ocer pg [Ems P2113 2127852634 8509562129 b3:- 2014-09-16 13:48 Had?515: was?: m. 2.0. ?3?an man $59.03 mminmm manna? Mm. Haaw ER. 553:5 wcma?. 3mm 2. 633nm" 549? 351.? 5.35. Manama. Hangman mm :5 aria?.34 $634 ?339 9.35% 5 9m gun 3. USE. Fan :5qu9 33% was. 3mm. FEE. 9m Qua: we: 33? Ewan mum: 35am: :amu?mimnan. Emumm mam mix" 3 was?a3 5m mug: 5?33.de Em?.an Mu:? 5m: ma Eu. "~an 3 3.3.3? anumazugm. BE spawn?a? 83.3? @5335 ?rmnw gm?imoaw ?b WEN: m. gamma": . Eb. .- hi 2014703715 ms iowsimirximsam: ismszizn 2i2752634 3m AUTOPSY REPORT NAME: Georg: Bogner, Jr. DATE OF AUTOPSY: 7/3/2009 SPECIAL RESTRICTIONS: None DATE OF BIRTH: 9/12/1965 SPECIAL EXAMINATIONS: Neck, Ervicai Spimx DATE OF DEATH: 6/11/2009 PERMISSION BY: Diane Bogner (Spouse) Age: 43 Race: White PATHOLOGIST: Brian McCarthy, MD. FINAL ANATOMIC CLINICAL DIAGNOSIS 1. Status Degmermive Dist: Dist-s: 8L Ccrvical Simon's. 2. Status Pun Cervical Laminecromy (C4, C5 3. Sims Post Surgical Incision, Right Antcrior Neck (mu/1009). 4. Larynx: mist Operative Carvicsl with Trachnl 5. Lungs: Pulmonary Histiocylasis (Smuker's Lung with Macrophages). 6. Lungs: Interstitial Fibrosis (Chronic Smukcr's Lung Diana): 7. Lungs: Emphyumn (Non Specific). 8t Hun: Hypertensive 9. Hun: Comllary Artery Dina>> (Mild to Focaliy Modern"). 10. Esophagus: GERD (Castro Esophageal Reflux Diane). ll. Liver: Hflpatumegnly Diffuse Stentosis (Fatty infiltration). il. Kidneys: Na Pniilokigicni Diagnosis. i3. Brain: Nu Palhulagicfll Diignasis, l4. Legs: Negmve fur (Deep Vennus Thrumbosis). 15. Status Pull Tonsifleclomy 2014?09-16 13:48 P4113 8509562129 2127852634 ?16. Status Post Umbilical Hernia Repair. 17. Status Post Tissue Harvest of Leg Bones, Spinal Column Left Lateral Abdominal Wall Skin. 18. Status Post Vasectomy. 19. Pancreas: Post Mortem Decomposition. CAUSE OF DEATH: TRACHEAL COMPRESSION BY POST OPERATIVE CERVICAL HEMATOMA. MANNER OF DEATH: NATURAL. MECHANISM OF DEATH: CLINICAL SUMMARY George Bogner was a 43 year old white male Truck Driver who lived in River Florida. Mr. Bogner?s medical history was signi?cant for Degenerative Cervical Disc Disease, Cervical Osteoarthritis, Hypertension, GERD (Gastro Esophageal Re?ux Disease) and Lumbar Spine Dysfunction (Backachc and Pain). His surgical history included a Vasectomy, Tonsillectomy Adenoidectomy, Umbilical Hernia Repair Cervical Fusion following C4, C5 C6 Laminectomy. On June 11, 2009 he was admitted to Citrus Memorial Hospital, Inverness, Florida for Anterior Surgical Repair of Advanced Cervical Disc Disease 8: Osteoarthritis. Approximately 3 hours post operativer he developed complications that included cervical edema, and bleeding from the operative site. He developed progressive dif?culty in breathing which led to multiple consultations and was ?nalized by a Code Blue that commenced at approximately 2200 Hours. Multiple attempts at rc-intuhation by the hospital stall were unsuccessful. Ultimately an emergent tracheostomy was performed allegedly through the Crlcoid Cartilage by a staff surgeon. A Hematoma that had displaced and compressed the Trachea was identi?ed and evacuated. When the intuhatlon tube was ?nally placed Mr. Bogner had developed asystole. He was pronounced dead at approximately 2325 hours. 2014-09-16 13:48 P5I13 8509562129 >33 2127852534 After reviewing the circumstance of Mr. Bogner?s Death, the District 5 Medical Examiner declined jurisdiction in the ease. The patient?s wife Diane Bogner requested a Private Autopsy to determine the Cause, Manner and Mechanism of her husband?s sudden and unexpected death. Autopsy was performed at the Strickland Funeral Home, River, Florida on July 3, 2009 by Brian S. McCarthy, MD. The Clinical Summary of this report is not a literal or detailed reeapitulation of the medical record but is generalized overview of case events abstracted from medical records and family related medical information for Reader Orientation to the events that led to the Patient?s Demise. MACROSCOPIC (GROSS TISSUE) DESCRIPTION EXTERNAL EXAMINATION The remains were positively identi?ed by a name tag on the right wrist and right ankle. The remains are Embaimed. Hair: Black. Distribution: Bald Head (Shaved). Eyes: Fixed and Dilated. 5 mm Diameter. Conjunctival Membranes: Mild Edema. Pallor: Mild. Petechiae: Negative. ictnrus: Negative for Jaundiee. Orbital Trauma: None. Orbital Edema: Negative. Oral Cavity: Bleeding: Negative. Trauma: Negative. Tongue: Edematous. Mild Traumatic Mueosal Damage, Tongue Surface. Dentition: Natural. Fair State of Repair. Neck: Status Post Surgery (Anterior Diseotomy Fusion). Right Lateral Neck Skin: 11 cm Surgical incision Embalming Site, Closed with Mortieian?s Sutures. Negative. Frenulae: Unremarkahle. Nasopharynx: Unremarkabie. Chest: Symmetrical, Large Bulky Museulature. Skin: Multiple Tattoos. Intereostal Spaces: Normal Width. Breasts: Normal Male. Trauma: Negative. Abdomen: Increase in Subcutaneous Fat. Fat Measured at 5.2 cm Thickness. Genitals: Normal Male: Unremarkable. 2014-09-16 13:49 8509562129 2127852634 Extremities: Arms: Large Bulky Musculature. Legs: Large Bulky Musculature. INTERNAL EXAMINATION The Remains are Surgically Examined employing Standard Autopsy Protocol. CARDIOVASCULAR SYSTEM Pericardium: Adhesions to Heart Surface: Negative. Contains 10 cc Serous Pericardial Fluid. Surface Fibrin Exudate: Negative. Heart: Coronary Artery Distribution: Left Dominant. Left Ventricle Dilation: Negative. Right Ventricle Dilation: Negative. Left Ventricle Thickness: 2.3 cm. Right Ventricle Thickness: 0.3 cm. Atherosclerosis of Coronary Arteries: Mild. Blood Clot in Coronary Artery: Negative. Cardiac Muscle: Red/Brown, Firm. Acute Area of Infarct: Negative. Fibrous Sear issue (Old Infarct): Negative. Cardiac Valves: Atherosclerosis Vegetations 'I?ricuspid: 1+ None Pulmonary: None None Mitral: 2+ None Aortic 1+ None Aorta: Moderate Atherosclerosis most Prominent in the Abdominal Segment. Abdominal Aortic Aneurysm: Negative. Pulmonary Arteries: Micro-Thrombo-Emboli: Negative. Carotid Arteries: Mild Focal Atherosclerosis. NECK Neck Muscle Trauma: Moderate (Post Surgery). Hematoma: Approximately 1.2 Liter of Blood Clot. Larynx: Vocal Cords: Edema: Advanced, Laryngeal Cavity: Foreign Material: Positive (Blood). Thyroid Gland: Unremarkable. Red/Brown, Firm. Parathyroid Glands: Unremarkable. 2 Glands Con?rmed. Aortic Dissection: Negative. 6/13 2014-09-16 13:49 7/13 8509562129 >5 2127852634 PULMONARY SYSTEM Pleural Cavities: Dense, Gray/White Fibrous Adhesions: Negative. Right: Serous Effusion: Negative. Left: Serous Effusion: Negative. Tracheal-Bronchial Tree: Negative for Mucus Plugging. Lungs: Heavy, Wet, Gray/Purple with Gray/White Blotehy Pareneyhma. Congested, with Edema, and Focal Consolidation. Infarcts: Lower Lubes Negative. Small Thrombosed Arteries: Negative. Edema Fluid Expressed from Cut Lung Surface: Mild. Lung: Adhesiona to Diaphragm: Negative. Anthraeotic Deposits: Advanced. Peri Hilar Nodes: Non-Reactive. KIDNEYS: URINARY TRACT Cortical Surfaces are Mildly Rough and Granular. Cortical Sears: Negative. Cortex: Atrophy: Negative. Cortico-Medullary Junction: Well De?ned. Renal Papillae: Normally Formed, not Blunted. Negative for Dilation of the Renal Calyees, Pelvis or Ureters. Renal Arteries are in normal position: Unremarkable. Urinary Bladder: Contains 15 cc of Thin Amber Fluid. Smooth Mucosa. Mueosal Erosion: Negative. Mucosal Hemorrhage: Negative. Negative for Bladder Mueosal Polyps, odules, Masses. Prostate Gland: Dense White, Fibrous Nodules (Mild Concentration). The Genitalia are Normal Adult Male. 2014-09-16 13:49 8509562129 a} 2127852634 8! 13 CASTROINTESTINAL SYSTEM The Peritoneal Cavity is smooth, glistening, ?uid free, without evidence of in?ammation, ?brous adhesions, or serosal exudate. Esophagus: Smooth Mucosal Surface. Mild Erosion Distal Margin. Candidiasis: Negative. Ulceration: Negative. Barrett?s Inflammation: Negative. Stomach: Unremarkable. Small Bowel: Negative for lsehemic Damage. Colon: Negative for Diverticula. Polyps: Negative. Tumor: Negative. Vermiform Appendix: Unremarkable. Liver: Smooth Dull Yellow/Brown Surface. Centrilobuiar Areas are Not Prominent. Negative for Bile Stasis. Negative for Noduies or Fibrous Change. Formation: Negative. Tumor Mass: Negative. Gallbladder: Disteuded with Black Bile and Negative for Caiculi (Gallstones). Biliary Ductal System is Patent, and Negative for Biliary Sludge. HEMATOPOIETIC SYSTEM Spleen: The Spleen has a Purple/Gray Smooth Surface 3.: a Soft, Red/Purple and is Negative for Tumor, or Infarct. Nodes: Pale Gray/Tan Nodes, Negative for Enlargement in the Mediastinum, Neck, Peri-Aortic and Inguinal Areas. Bone Marrow: Red/Brown, Firm. Unremarkable. ERVOUS SYSTEM The BRAIN (1315 grams): The Epidural, Subdural and Subarachnoid spaces are negative for hemorrhage. The Meningeal Surfaces are clear, glistening evidence of in?ammatory change. The Brain has been fixed in Formalin rior to Autopsy Exam and is well preserved. The Cerebral Hemispheres are firm, negative for edema, bilaterally symmetrical, without shift in the midline structures. Prominence of the Cingulate and Uncal Gyri is not seen. Cerebral Gyri are normally formed without signi?cant widening of the sulci. 011 serial section the gray and white matter are negative for hemorrhage, inflammation or gross degenerative change. 2014-09?16 13:49 9/13 8509562129 2127852634 The Basal Ganglia is anatomically unremarkable without necrosis or degenerative change. The Lateral Ventricles are symmetrical. The Cerebellar Hemispheres are symmetrical without prominence of the Cerebellar Tensile. The Brainstem contains no evidence of hemorrhage, in?ammation nor softening. The Ccrebrum, Cerebellnm and Brainstem are negative for mass lesion. Mild Atherosclerosis is present in the vessels of the Circle of Willis and larger penetrating vessels. Neither aneurysm nor occlusion of the major vessels is noted. MACROSCOPIC MICROSCOPIC FINDINGS SCALE 0F INVOLVEMENTHIGH NERVOUS SYSTEM Brain (1315 grams). Normal Adult Brain. Negative for Tumor or Infarct. No Pathological Diagnosis. SYSTEM Cervical Spine: Osteoarthritis Cervical Spine: Status Post Placement of an Alphatec Cervical Plate Screws. Status Post Cervical Disc Lamincctomy (C4, C5, C6). Status Post Cervical Spine Fusion (C4-C7). Neck: Post Surgical Hematoma (1.2 Liter Blood Clot). Trachea: Status Post Emergent Tracheostomy. Legs: Status Post Mortem Tissue Harvest: Bilateral Femurs, Tibia, Fibula and Spine. Status Post Umbilical Hernia Repair. 201409-16 13:50 8509562129 2127852634 10I13 ENDOCRINE SYSTEM Thyroid Gland (22.5 grams). Unremarkable. No Pathological Diagnosis. Parathyroid Glands: 2 Identi?ed. Unremarkable. No Pathological Diagnosis. Adrenal Glands (12.4 grams in aggregate): No Pathological Diagnosis. Endocrine Pancreas: Unremarkable. No Pathological Diagnosis. CARDIOVASCULAR SYSTEM Heart (494 grams): Hypertensive Cardiomegaly. (Enlarged Heart Due to Hypertension). Valves: Moderate Atherosclerosis. Trieuspld 9.5 cm. Atherosclerosis with Valve Thickening Pulmonary 9.0 em. Unremarkable. Mitral 8.5 cm. Atherosclerosis with Valve Thickening Aortic 8.9 cm. Atherosclerosis Coronary Arteries: Mild Atherosclerosis. Right: Atherosclerosis, Mild with 50% Focal Lumen Stenosis. Left: Atherosclerosis, Mild with 45% Focal Lumen Stenosis. Circum?ex: Mild Focal Atherosclerosis. Heart Ventrieles: Negative for Past or Recent Ischemie Damage. Left: 2.3 cm. average muscle wall thickness. No Evidence of lsehemie Damage. Negative for Interstitial Fibrosis Re?ective of Past Isehemie Damage Negative for Acute Myocardial lschemie Damage (Infarct). Right: 0.3 cm. No Evidence of lschemic Damage. Septum: 1.5 cm. Negative for Interstitial Fibrosis of Post Myocardial lsehemie Damage. Perieardium: (Sheath Around Heart) Unremarkable. Epieardium: (Heart Surface) Endoeardium: (Heart Lining) Unremarkable. Aorta: Moderate Diffuse Atherosclerosis Carotid Arteries: Mild Focal Atherosclerosis 2014-09-16 13:50 8509562129 ID 2127852634 PULMONARY SYSTEM Lungs Combined (1319 grams): (Left 607 grams) (Right 712 grams). Non Speci?c Type (Smoker?s Long). Pulmonary Histiocytosis (Diffuse Alveolar Macrophages) Interstitial Fibrosis Diffuse. Pulmonary Edema Interstitial In?ammation Atelectasis Pleural Cavities: Negative for Fibrous Adhesions. Right: Pleural Serous Effusion: Negative. Left: Pleural Serous Effuslon: Negative. Diaphragm: Negative for Adhesions with Lung Base. Larynx: Advanced Edema GASTROINTESTINAL SYSTEM Oral Cavity/Pharynx: Edema Tongue: Edema Esophagus: GERD (Castro Esophageal Re?ux Disease) Mild Stomach: Unremarkablo. No Pathological Diagnosis. Small Bowel: Unremarkable. No Pathological Diagnosis. Vermiform Appendix: Unremarkoble. No Pathological Diagnosis. lleo?Cecol Valve: Unremarkable. Patent. Colon: Negative for Sigmoid Colon Diverticulosis. Liver (2300 grams): Hopatomognly (Enlarged Liver). Congestion Diffuse Steatosis (Fatty in?ltration). Gallbladder: Unremarkable. Negative for Calculi or Biliary Sludge Pancreas (117 grams): Post Mortom Decomposition Interstitial Fibrosis Steatosis P11I13 2014?09-16 13:50 A 12/ 13 8509562129 h) 2127852634 DISCUSSION George Bogner?s Death was caused by post operative complications that developed after he underwent an Anterior Cervical Laminectomy and Spinal Fusion (C3-C7), performed on June 11, 2009. Autopsy Examination identi?ed a 1.2 Liter Cervical Hematoma that had laterally diaplaced and compressed the Teaches causing obstruction of normal air passage through the Trachea into the Lungs. A Tracheostomy SiteI through the Right Side of the Tracheal Cartilage, was identi?ed at Autopsy however the Endotracheal Tube was not present at the time of Autopsy Examination. In addition the Tongue was markedly swollen to twice normal size and the Vocal Cords were Markedly Edematous with Moderate Surface Erosion. An Alphatec Cervical Plate installed by the Neurosurgeon for Cervical Spine Stabilization, was firmly in proper position without evidence of spinal bone damage. The Lungs contained interstitial Fibrosis, Moderate Damage and markedly elevated concentrations of Pulmonary Macrophages (Illstiocytosis), re?ective of the patients history of cigarette smoking. In addition Pulmonary Edema was prominent. The Heart was enlarged (Cardiomegaly) with a markedly thickened Left Ventricle re?ecting underlying Hypertensive Disease. No evidence of Acute or Past Ischetnic Damage such as Myocardial infarct was present in the Heart. The Liver contained Diffuse Steatosis, which is fat in?ltration, reflective of dietary inadequacy, of multiple possible etiologies. The Pancreas contained Mild interstitial Fibrosis and Steatosis without evidence of Pancreatitis. The Spleen, Kidneys, GI System, Genital System and Nervous System (Brain) were essentially unremarkable. In Review, the Cause of Death was Acute Tracheal Obstruction by a large Post Operative Cervical liematoma. The Mechanism of Death defined as the ?failed physiology? was (also known as Suffocation), secondary to the Tracheal Obstruction. The Manner of Death was Natural meaning there was no evidence of Foul Play associated with Mr. Bogner's Death. JMS.WG ma Brian S. McCarth 2014-0916 13:50 8509562129 2127852634 SYSTEM Kidneys: Left (205 grams) Right (207 grams). Post Mortem Tubular Decomposition Nephroselerosls Glomemlosclerosis Interstitial Edema Arterioloselerosis Interstitial In?ammation Ureters: Patent. (Functional). Urinary Bladder: Mucosal Edema Prostate Gland (22 grams): No Pathological Diagnosis. Testes: Status Post Vasectomy. HEMATOPOIETIC SYSTEM: (Blood, Bone Marrow, Spleen, System) Bone Marrow: ormocollular Marrow. Negative for Abnormal Cellular Lolittrate. Iron Stores: Adequate. Spleen (170 grams): Unremarkable. No Pathological Diagnosis. Systemic Nodes: Negative for Reactive Changes Peripheral Blood: No Pathological Diagnosis. SKIN Multiple tattoos of Arms, Chest, Abdomen and Bock. Status Post Tissue Harvest, Left Abdominal Wall. 13113