Plaintiff? 5 Exhibit 3 DOC 32-3 Filed 07/14/15 2 Of 11 Pg ID 771 MACOMB COUNTY, MICHIGAN OFFICE OF THE MEDICAL EXAMINER 43585 ELIZABETH ROAD MT. CLEMENS, MICHIGAN 48043 (586) 469?5214 Report of Diagnosis and Autopsy . on David Stojcevski File: ME 1099?14 LIE-.- I Kmy? DOC 32-3 Filed 07/14/15@g 3 Of 11 Pg ID 772 OPINION Final Diagnosix: I Acute Withdrawal from Chronic Benzodiazepine, Methadone and Opiate Medications Dehydration with hypernatremia Seizure/seizure-like activity Cause of Death Acute Withdrawal from Chronic Benzodiazepine,_ methadone and Opiate MEdications . Alaon Death: Natural WW Mary E. iettangelo, M.D., /Date Signed Deputy edical Examin Doc#32?3 Filed 07/14/15 {@Mf 11 773 - ?'Rgn? DESCRIPTION OF AUTOPSY FINDINGS EXTERNALEXAMINATION: June 30, 2014 at 0930 hours This is the body of a 68.5 inch, 151 pound, adult white male appearing the reported age of 32 years. The extremities have well?developed rigor mortis, and fixed lividity is posterior. The scalp is atraumatic and covered by black hair up to 2 inches in length. The eyes have brown irides with intermediate?sized, symmetric pupils. The left upper and lower palpebral Conjunctivae are congested; the right are pale. The ears and nose are unremarkable. The teeth are natural and in good condition. The upper right central incisor is remotely absent. There is a inch, red?purple, abraded contusion on the inside of the left lower lip. A inch diameter, faint red 'contusion is on the left zygoma, and a inch, red abrasion is below the left-eye. A small, redwbrown abrasion is on the left tragus. Facial hair consists of a black mustache and goatee. The face is without palpable fractures. The neck is without external injuries. The chest is symmetric. There is a 3/8 inch tan-orange abrasion on the left upper chest. The breasts are of normal male conformation and without masses. There are several, red?tan papules on the midline upper chest. The abdomen is flat. A 4 inch faint, linear, oblique red abrasion is on the left upper abdomen. There is a 3 1% inch, red contusion overlying the right anterior superior iliac spine. The upper and lower extremities are normally developed and without palpable fractures. A hospital identification band with the name ?Stojcevski, Confidential? and a Macomb County jail identification band with the name ?Stojcevski, David? are around the right wrist. An identification band with the name ?John Doe/David Stojcevski? is around the left ankle. A faint, red, linear, 1 inch, discontinuous abrasion is on the right anterior shoulder. There are multiple striae along the left anterior shoulder and arm. A small, red abrasion is on the right elbow. A 2 inch, red~pink abrasion is on the left elbow. A 3 I 32-3 Filed 07/14/15Peal? 4' 7' inch, red contusion is on the right knee and a 1% 5/8 inch inmi contusion is on the left knee. There is a 1 inch diameter red contusion on the right lateral proximal leg. _There is a healing, inch laceration on the right lateral hindfoot. Two small, red-brown abrasions are on the right 2M1toe dorsum. The lower extremities are without edema. The external genitalia are of normal male uncircumcised conformation and without lesions. The back is without injuries or pathologic changes. The anus is unremarkable. Scam and I dextz?i?g Maser I 1. Single piercing. left earlobe. 2. 1% inch, oblique scar overlying the right shoulder. .3. 1% inch, curvilinear scar, right elbow. 4. 1% inch, linear scar above the left knee. Ak?mdme%w%m 1. An oroendotracheal tube is in the mouth and extends into the trachea.' 2. An intravascular catheter is in the left hand dorsum. An intraosseous catheter is in the right anterior leg. 4. Two electrocardiogram pads are on the right and left thighs. INTERNALEXAMINATION: June 30, 2014 at 0947 hours ?mdekw?m-The right and left pleural cavities are without adhesions or effusions. The pericardial sac is intact and contains minimal serous fluid. The abdominal cavity is free of blood, ascites, or inflammatory exudate. The chest and abdominal organs are normally situated. The heart is 340 grams and has a smooth epicardial surface. The coronary arteries arise from the aorta in a normal fashion and follow a right dominant distribution. The coronary ostia are patent. The coronary arteries are free of atherosclerosis and are widely patent. The right and left ventricular myocardium is red-brown and firm, without areas of necrosis or scarring. There is hemorrhage in the posterior wall of the right ventricle from the mid?ventricle to the tricuspid I valve line (Comment: Consistent with being caused by cardiopulmonary resuscitation). The heart chambers are not dilated, and the myocardium is not hypertrophied. The valve cusps and leaflets are unremarkable. No calcifications, vegetations, or myxoid changes are noted. Rex" ?No masses or focal lesions are noted. Pg ID 775 Doc 32-3 Filed 07/14/15 6 of 11 W, - The aorta is intact and has a smooth intima. The inferior'vena cava, superior vena cava, and pulmonary artery are intact and patent. The right and left lungs are 520 and 500 grams, respectively. Both lungs have smooth pleural surfaces. The pulmonary is red-pink and crepitant, with areas of dependent lividity. The lung tissue is without areas of consolidation, or neOplasm. The tracheobronchial tree is unremarkable. The pulmonary arteries have a smooth intima and are free of thromboemboli. The diaphragm-is unremarkable. .H?mmh?qume-The liver is 1350 grams and has a smooth, intact capsule. The hepatic is red-brown and homogeneous. The gallbladder is intact and contains liquid green bile and no gallstones. The portal vein is patent and intact. spleen is 120 grams and has a smooth, intact capsule. The splenic is dark red and firm. No masses or focal lesions are neted. The throughout the body are not enlarged. The thymus gland is tan and lobular. Gmmemqy The right and left kidneys are 150 and 160 grams, respectively. Both kidneys have smooth cortical surfaces. The cortical and medullary structures are well defined and without pathologic changes. The pelves and calyceal systems have a smooth lining and are not dilated. The ureters follow their normal course to the urinary bladder. The urinary bladder is intact and contains 35 mL of urine. The prostate gland is unremarkable.? The adrenal glands have soft, yellow cortices and brown medullae without pathologic changes. esophagus is unremarkable. The stomach has a smooth, tan serosal surface and a tan?maroon mucosa with normal rugal folds. The stomach contains 60 mL of brown?red liquid. The gastric and duodenal mucosa is free of ulcers. The small and large intestines and appendix are unremarkable. The pancreas has soft, tan, lobulated without pathologic changes. th:The strap muscles of the neck are free of injury. The thyroid gland is of normal size and has dark brown The thyroid cartilage and the hyoid bone are intact. The upper airways are patent. The prevertebral fascia is free of blood. The epiglottis and larynx are unremarkable. The tongue is was?" .. rag? 776 -. - - .. Page. 6' without lacerations or contusions. Emmi The reflected scalp is free of trauma. The Calvarium arui the dura mater are intact. The subdural, epidural, and subarachnoid spaCes are free of blood. The brain is 1570 granm and has symmetric, normally?developed cerebral and cerebellar hemispheres. The leptomeninges are smooth, transparent, and without exudate. External and cut surface of the brain demonstrates no injuries or pathologic changes. The lateral ventricles are of normal size and contain clear cerebrospinal fluid. The midbrain, cerebellum, pens, and medulla are free of internal or external abnormalities. The cranial nerves and cerebral arteries are unremarkable. The base of the skull is without fractures. The pituitary gland is without pathologic changes. The sternum and clavicles are intact. There is a small amount of soft tissue hemorrhage in the right 4?5 intercostal space, anteriorly. The left Tm rib has a nondisplaced anterior fracture, with soft tissue hemorrhage involving the left 4?5 and 5?6 intercostal spaces (Comment: Consistent with being caused by cardiopulmonary resuscitation). The spine and pelvis are without fractures or deformities. The skeletal muscle is normally developed. MICROSCOPIC EXAMINATION: Emmt??nmmwa'Ebcal papillary muscle myocytolysis. ngr_Mild to moderate intra-alveolar pulmonary edema and red blood cell extravasation; mild interstitial chronic inflammation; rare, interstitial, polarizable debris. No histopathologic abnormality. MEP: 06/ 30/ 14 End of Autopsy Report; Toxicology Report is Appendocl Doc 32-3 Filed 07/14/777 NMS Labs LABS I Toxicology Report CONFIDENTIAL 3701 Welsh Road. PO Box 433A. Willow Grove. PA 19090-0437 Phone: (215) 657-4900 Fax: (215) 857-2972 e-mail: nms@nmslabs.com Robert A. Middieberg. DABFT. DABCC-TC, Laboratory Director Patient Name STOJCEVSKI. DAVID - I Patient ID 1099-14 Report Issued 0711612014 12.01 Chain 11778308 Age 32 DOB Not Given Gender Male . To: 10199 . Macornb County Medical Examiner Workorder 14 154 176 Attn: Daniel Spitz, MD. 43585 Elizabeth Road Fag? ?f 3 Mount Clemens, MI 48043 Positive Findings: compound I Result Units Matrix Source Naloxone Positive n?gimL 001 - Peripheral Blood Cannabinoids Presump Pos ngImL 003 - Urine See Detailed Findings section for additional information Testing Requested: Analysis Code Description - 8050U Postmortem Toxicology - Urine Screen Add-on (6-MAM Quanti?cation only) . - 80523 Postmortem Toxicology - Expanded, Blood (Forensic) Tests Not Performed: Part or all of the requested testing was unable to be performed. Refer to the Analysis Summary and Reportin Limits section for details. Specimens ReceiVed: ID TubeiContainer Volume! Collection Matrix Source Miscellaneous Mass Daterl?ime information 001 Gray Top Tube 8 mL 0613012014 Peripheral Blood 002 Gray Top Tube 5 mL 06/30l2014 Peripheral Blood 003 Red Top Tube 8.5 mL 06/30/2014 Urine All sample volumesiweights are approximations. Specimens received on 070002014. v.11 DOC 32-3 Filed 07/14/1541'13FIDENTIAL Workorder 141&?6 Chain 11778308 Patient ID 1099?14 i. A Page 2 of 3 Detailed Findings: Rpt. Anaiysis and Comments Result Units Limit Specimen Source Analysis By Naloxone Positive ngImL 1.0 001 - Peripheral Blood LCIT Cannabinoids Presump Pos 20 003 - Urine EIA This test is an uncon?rmed screen. Con?rmation by a more de?nitive technique such as GCIMS is recommended. Other than-the above findingsi examination of the specimen(s) submitted did not reveal any positive ?ndings of toxicological signi?cance by procedures outlined in the accompanying Analysis Summary. Reference Comments: 1. Cannabinoids - Urine: C'annabinoids are chemical compounds derived from the plant Cannabis sativa (marijuana), including active components,_ chemical congeners and metabolites. Deita-Q-Tetrahydrocannabinoi (THC) is the principal active component. This result derives from a presumptive test, which may be subject to cross-reactivity with non- - cannabinoid compdunds: therefore, a con?rmatory test is recommended. 2. Naloxone (Narcan?) - Peripheral Blood: Naloxone is a'narcotic antagonist used to counter the central nervous system depression effects of opioids. including respiratory depression. it is also used for the diagndsis of suspected acute opioid overdosage. Naioxone-is available as a 0.4 solution of the hydrochloride for parenteral injection. Naloxone .?is also available in combination with buprenorphine (Suboxone?) for the treatment of opioid dependence. This combination is available in tablets of 2_ mg buprenorphine with 0.5 mg naioxone or 8 mg buprenorphine with 2 mg of naloxone for s'ublingual administration. The reported qualitative result for this substance was based upon a single analysis only. if con?rmation testing is required please contact the laboratory. Unless alternate arrangements are made by you. the remainder of the submitted specimens will be discarded one (1) year from the date of this report; and generated data will be discarded ?ve (5) years from the date the analyses were performed. Workorder 14164176 was electronically signed on 0711612014 11:47 by: Susan Crookham, Certifying Scientist Analysis Summary and. Reporting Limits: Ail of the following tests were performed for this case. For each teet, the compounds listed were included in the scope. Please refer to the Positive Findings section of the report for those compounds that were identi?ed as being present. Aoode 500133 - Cannabinoids Con?rmation. Blood (Forensic) - Peripheral Blood -Analysis by Multi?dimensional Gas ChromatographyIMass Spectrometry (GO-GC-GCIMS) for: Compound Bgt. Limit Compound NIA Delta?9 THC NIA Delta-9 Carboxy THC NIA I Testing Not Performed: Test was canceled due to [Sample Matrix Problem]. Acode 8050U - Postmortem Toxicology - Urine Screen Add?on Quanti?cation only) v.11 DOC 32-3 Filed 07/14/Workorder meters Chain 11778308 Patient ID 1099-14 Page 3 of 3 Analysis Summary and Reporting Limits: -Anaiysis by Enzyme immunoassay for: (Arum Batu?unit 99mm t. Li 't Amphetamines 500 Methadone 300 ng/mL Barbiturates 0.30 mog/mL Opiates 300 Benzodiazepines 50 Oxycodone 100 ng/mL Cannabinoids 20 25 fig/inl- Cocaine Metabolites 150 ngImL Propoxyphene 300 ng/mL Acode 8052B - Postmortem Toxicology Expanded, Blood (Forensic) - Peripheral Blood Analysis by Enzyme-Linked Immunosorbent Assay (ELISA) for: Compound Ept. Limit Compound - . i it Barbiturates I 0.040 Salicylates 120 Cannabinoids 10 rig/mt. - -Analysis by Headspace Gas Chromatography (GC) for: it ?amed Acetone 5.0 isopropanoi 5.0 Ethanol 1O Methanol . 5.0 -Analysis by High Performance Liquid Chromatographyl'lime of Flight-Mass Spectrometry for: The following is a general list of compound classes included in this screen. The detection of any speci?c analyte is concentration-dependent. Note, not allknown analytes in each speci?ed compound class are included, Some speci?c analytes outside these classes are also included. For a detailed list of all analytes and reporting limits, please contact NMS Labs. Amphetamines, Anticonvulsants. Antidepressants. Antihistamines. Agents. Benzodiazepines, CN-S Stimulants, Cocaine and Metabolites, Hallucinogens. Hypnosedatives. Hypoglycemics. Muscle Relaxants, Non Steroids! Anti?in?ammatory Agents, Opiates and Opioids. v.11 37/18/14 11 Doc $5210 Dg??djbir/MMS @11 ofll Pg ID 780 359449 1000 Harrington Blvd., Mt. Clemens. Mi 48043 (586) 493-2222 . Final DAVID Admitted: 07/18l2014 Med. Record: MC4117561 Location: MCCOUR Encounter: M014728808 service: DOB/Age/Gender:03/18/1982 32Y Attending: PIETRANGELO, MARY, MD Pt Phone: (536)469?5151 - . Ordering: PIETRANGELO, MARY, MD REE ERENCE Reference Lab, Other Other .. . . ., .. . . Collected. 07/18/2014 Reference Unit . . 10:311 . . . . . .1 Accession 1419901871. Reference Lab, Other see results in cominnts? 1V1 treous for ucose. eiectro'l ytes, urea nitrogen and creat'i n?i ne (Vitreous F'l 2Na? 162 23.1 mmo'l/L' C1 131 mmo'I/L 4 mmo'l/L 26 mg/d'l 57.2 mg/d'l 1 . 38 I mg/d'i F'l U'l resu'l ts-? no no r'ma'l estab't 'i shed for th'i _?inst?i tut?i on Performed at MC Laboratory, 1000 Harrington Mount Clemens, MI, 48043 neoevec JUL it 8 2014 MACOMB MEDICAL Leaky-Id; L=Low, H=High, CH=Critical High, CL Critical Low A=Abnormal Print 07/182014 11:42 Page 1 of 1 Run ID: R1419902677 Reprint Results Outpatient