ARMED FORCES INSTITUTE OF PATHOLOGY of the Arrned Fence Medical Examiner l4l3 Research Blvd.. l02 Rockville. MD 20850 l-301-3 9-0000 FINAL wrorsv upon Name: (8113) Abd Al-Rnhman M. Autopsy No.: W6) (W6) AFIP No.: M6) Date of Birth: (8TB) (W6) I972 Rank: Civilian Detainee Date of Death: (W5) 2007 Place of Death: Camp V, Bay. Cuba Date/Time of Autopsy: Ol JUN 2007 230 Place of Autopsy: Guantanamo Bay. Date of Report: 20 JUN 2007 Cuba Circumstances of Death: This 35-year-old male civilian detainee at Buy, Cube was found hanging by his neck in his cell with a ligature mode ofhrnided strips of bed sheet. By report. similar fabric bound his hands loosely behind him. Although ACLS protocols were followed. he could not be resuscitated. Authorization for Autopsy: Cilia of the Armed Fones Medical Examiner, IAW l0 USC I471. Identi?cation: Positive identi?cation of the ISN number is by comparison of postmortem DNA sample and antemortem DNA records. CAUSE OF DEATH: HANGING MANNER OF DEATH: SUICIDE MEDCOM 0876 FINAL Aurorsv REPORT: Page 2 of8 AL-UMARI. Abd Al-RahnranM. Evidence of Hanging A. The suspected ligature had been removed from the body prior to examination. it is available for inspection and consists of a 22-l/2-inch. three-strand braided ligature composed of white cotton material. The ligature measures on average, ?lt-inch wide and Va-inch thick. At one end of the ligature is a loop formed by tying the ligature to itself. Eight inches from the loop end is a 4. inch area of soiling with attached dark hairs. B. A brown to gray - tan. 9 "8-inch discontinuous ligature furrow is on the skin of the neck and is directed obliquely upward at approximately 45-degrees on both sides of the neck C. The ligature furrow crosses the superior third of the thyroid cartilage. 9 3/8- inches below the top of the head and then extends superiorly on both sides of the neck. ending l-inch below the lobe of the right ear and passing 2-inches below the lobe of the left ear. The highest point of the furrow is located on the back of the neck. 6 Vrinches below the top ofthe head and on the posterior midline The width of the ligature furrow ranges from %-inch to 3/8-inch. The depth ofthe furrow ranges from less than lilo-inch (posterior) to l/8?inch (left) There is a V. SIB-inch abrasion on the right side of the neck A layer-wise anterior neck dissection shows no injury to the underlying soil tissues or hemorrhage into the strap muscles. The hyoid bone and thyroid cartilage are intact Associated injuries: l. The face is suffused with scattered petechiae on the skin 2. Petechiae on the bulbar and palpebral conjunctivae, bilateral 9m rump Other Injuries A. Superficial. incised wound on the right second (fore) ?nger, l/8-inch B. Superficial. incised wound on the left second (fore) ?nger, Vo?inch C. Abrasion on the right thumb, ll8 lilo-inch D. Cluster of abrasions on the posterior right forearm. ranging in size from punctate to V4 l/looinch There is no evidence of physical abuse A. A complete skeletal survey is negative for fractures by radiology B. Radiographs of the cervical spine are negative for fractures or dislocations C. Posterior neck dissection is negative for soft tissue or bony D. Posterior incisions of the torso and extremities are negative for soil tissue E. There is no soft tissue evidence of recent binding around the wrists. MEDCOM 0877 FINAL REPORT: Page 3 0?8 AL-UMARI. Abd M. W. No significant natural diseases or pie-existing conditions are identi?ed within the limitations of this examination V. Evidence of Medical Therapy A. Endotracheal tube (properly placed) B. Cardiac pacing pads on the anterior and left chest C. Multiple electrocardiogram electrodes on the anterior torso and both arms D. Needle stick-marks in both antecubital fossae and on the dorsal surfaces of the left hand and right foot VI. Post-Morten Changes A. Rigor is passing and eqnal in all exuernities B. Lividiry is posterior and fixed except in areas exposed to pressure C. The body temperature is cold to touch. status pod refrigeration VII. Identifying Body Maria A. Puckered, circular scar on the medial right wrist. l-inch diameter B. Puckered scaron the medial le? wrist. V: i Vo-inch C. Pigmented papule on the right back, ll8-inch diameter D. Pigmented papule on the right buttock. l/l6-inch diameter E. Linear pigmentation on the le? buttock, V: l/l6-inch Toxicology A. The blood and vitreous fluid are tested for ethanol and none is found. 8. The urine is negative for screened medications (including Me?oquine) and drugs of abuse and none are found. C. The blood is tested for carbon monoxide and cyanide and none is found. AL ON The body is that of a well-devel0ped. well-nourished appearing, thin. 66-inch. I40- pounds (estimated) male whose appearance is younger than the reported age of 35-years. Lividity is posterior and violaceous except in areas exposed to pressure. Rigor is full and equal in all exuemities. The temperature of the body is that of the re?'igeration unit. The head is normocephalic altered and the scalp is covered with dark hair in a normal distribution. The skin of the face is congested and suffused with scattered petechiae. Facial hair wnsists ofa full beard and moustache. The irides are brown, the comeae are hazy and the pupils are round and equal in diameter. The conjunctivae have petechiae scattered on both the bulbar and surfaces. bilaterally. The external auditory canals are patent and free of foreign material. The cars are unremarkable. The narea are patent and the lips are atraumatic. The nose and maxillae are palpany stable. The teeth appear natural and in good condition. injuries to the neck are described below (see ?Evidence of injury"). The neck is straight. and the trachea is midline and mobile. The chest is symmetric and the abdomen is flat. MEDCOM 0878 FINAL AUTOPSY amour: (We) Page 4 on AL-umru. Abd Al-Rahman M. The posterior torso is unremarkable. The genitalia are those of a normal adult male. The penis appears to have been circumcised and the testes are descended and free of masses. Pubic hair is shaved. but present in a normal distribution. The buttocks and anus are muemarltable. There are pigmented papules on the right back (VS-inch diameter) and on the right buttock l/l6-inch diameter). There is an area of linear pigmentation on the left buttock that measures V: l/l6-inch. The upper and lower extremities are symmetric and without clubbing or edema. The ?ngernails and toenails are trimmed and intact and are otherwise unremarkable. The following minor injuries are noted on the extremities: There is a superficial. incised wound on the right second (fore) ?nger that measures l/8-inch and a super?cial. incised wound on the left second (fore) ?nger that measures Vo-inch. There is an abrasion on the right thumb (1/8 l/l6-inch) and a cluster of abrasions on the posterior right forearm. ranging in size from punctate to Va A puckered, circular scar on the medial right wrist (l-inch diameter) and a puckered scar on the medial le? wrist (l Ve- inch) are noted. 10 DP The following clothing items and personal effects are present on the body at the time of autopsy: Brown shorts An identification bracelet accompanies the remains. but is not attached to an extremity Endotracheal tube (properly located in the trachea. above the carina) 0 Cardiac pacing pads are located on the anterior right chest and the left lateral chest 0 Electrocardiogram electrodes are on the anterior torso and the extremities Needle stick-marks are located in both antecubital spaces, the dorsum of the left hand. and the dorsal right foot was A complete set of postmortem radiographs is obtained and demonstrates the following: No fractures of the skull, axial skeleton or long bones No metallic foreign bodies 0 Medical therapy (endotracheal tube) FINAL wrorsv Page on AL-UMARI. Ahd Al-Rahrnan M. Evidence of Hanging ltis available for inspection and consists of a 22 'A-inch. three-strand braided ligatue composed of white cotton maerial. The lipture measures. on average, Winch wide aid 'A-inch thick. At one end of the ligature is a loop formed by tying the ligature to itself. Eight inchesfromthe loopend A brown to gray~tan. 9 l/8-inch discontinuous ligature furrow is on the skin of the neck and is directed obliquely upward at approximately 4S-degrees on both sides of the neck. The ligature furrow crosses the superior third of the thyroid cartilage 9 below the top of the head. and extends superiorly on both sides of the neck. ending l-inch below the lobe of the right ear and passing 2-inches below the lobe of the lc? ear. The highest head and on the posterior midline. The width of the ligature furrow ranges from ?lo-inch to Ills-inch. and the depth ol?the furrow ranges from less than (posterior) to inch There is some noticeable periodicity in the furrow. which corresponds with Thereisal that is associated with the ligature furrow. There are no scratches or contusions on the neck. There is no injury to the underlying soft tissues or hemorrhage into the strap muscles by layer-wise anterior neck dissection. The hyoid bone and thyroid cartilage are intact Other injuries associated with the hangiru include: The face is suffused with scattered petechiae on the skin and there are petechiae on the bulbar and palpebral conjunctiva. bilaterally. INTERNAL W: The n'bs. sternum, and vertebral bodies are visibly and palpany intact. No excess ?uid is in the pleural. pericardial. or peritoneal cavities. The organs occupy their usual anatomic positions. The abdominal fat layer is SIB-inch thick at the umbilicus. W: Thegaleal andsubgaleal son tissuesol?thescalpare frecol'injury. Thecalvarium is intact. as is the dura mater beneath it Clear cerebrospinal ?uid surrounds the HTS-gram brain. which has uuernarkable gyri and sulci. Coronal sections demonstrate sharp demarcation between white and gray matter. without hemorrhage or contusive injury. The ventricles are of normal size. The basal walla. brainstem. cerebellum. and arterial systems are free of injury or other abnormalities. The pituitary gland is normal appearing There are no skull fraenrres. The atlanto?occipital joint is stable. The spinal cord is unremarkable. rem/u. aurorsv REPORT: (W) Page 6 of8 AL-UMARI, Abd Al-Rahman M. NECK: Injuries to the neck are described above (see ?Evidence of Injury?). The anterior strap muscles of the neck are homogenous and red-brown and without hemorrhage by layer- wise dissection. The thyroid cartilage and hyoid bone are intact. The larynx is lined by intact white mucosa. The tongue is free of bite marks. hemorrhage, or other injuries. Incision and dissection of the posterior neck demonstrates no deep paracervical muscular injury and no cervical spine fractures. The right and left lungs weigh 425 and 300-grams. respectively. The external surfaces are smooth and pink to red-purple. The pulmonary is diffusely congested and edematous. No mass lesions or areas of consolidation are present. WM: The 250-gram heart is contained in an intact pericardial sac. The epicardial surface is smooth. with minimal fat investment. The coronary arteries are present in a normal distribution, with a right-dominant pattern. Cross sections of the vessels show widely patent lurnens. The myocardium is homogenous. red-brown. and ?rm. The valve lea?ets are thin and mobile. The foramen ovale is closed. The walls of the left and right ventricles are Lo and 0.3-centimeters thick. respectively. The endocardium is smooth and glistening. The aorta gives rise to three intact and patent arch vessels. The renal and mesenteric vessels are unremarkable. W: The l.400-grarn liver has an intact, smooth capsule and a sharp anterior border. The is tan-brown and congested, with the usual lobular architecmre. No mass lesions or other abnormalities are seen. The gallbladder contains lS-milliliters of green- brown bile and no stones. The mucosal surface is green and velvety. The extrahepatic biliary tree is patent. W: The 1251mm spleen has a smooth, intact. red-purple capsule. The is maroon and congested, with distth follicles. nodes in the hilar. periaortic and iliac regions are not enlarged. WM: The thyroid gland is symmetric and red-brown. without cystic or nodular change. The pancreas is autolytic and ranges in appearance from hemorrhagic to yellow-tan. with the usual lobular architecture. No mass lesions or other abnormalities are seen. The right and le? adrenal glands are symmetric. with bright yellow cortices and gray medullae. No masses or areas of hemorrhage are identi?ed. FINAL aurorsv Page 7 are AL-UMARJ, Abd Al-Rahrnan M. The right and le? kidneys both migthO-grams each. The external surfaces are intact and smooth. The cut surfaces are red-tan and congested, with uniformly thick cortices and sharp cortico-medullary junctions. The pelves are unremarkable and the ureters are normal in course and caliber. Gray-pink bladder mucosa overlies an intact bladder wall. The bladder contains approximately 50-milliliters of yellow urine. The prostate gland is normal in size, with lobular, yellow-tan The seminal vesicles are unremarkable. The testes are free of mass lesions. contusions. or other abnormalities. W: The esophagus is intact and lined by smooth, gray-white mucosa. The stomach contains approximately 3S-milliliters ol?pink-brown ?uid. The gastric wall is intact. The duodenum. loops of small bowel and colon are unremarkable. The appendix is present. W: There is no non-traumatic bone orjoint abnormalities. Skeletal muscle development is normal. Super?cial incisions along the posterior midlines of all four extremities and the back are made and the skin re?ected to the anterior midlines to expose the underlying subcutaneous tissue and muscle. Areas of hemorrhage associated with resuscitation efforts are noted. I 1 TI Selected portions of organs are retained in formalin. without preparation of histological slides. photographs are taken by AFMES staff photographer (W6) Observed by (W6) Medical Specimens retained for toxicologic testing and/or DNA identi?cation are: heart blood, vitreous fluid. gastric contents. urine. bile, spleen. liver. lung, kidney, brain, myocardium, and skeletal muscle 0 The dissected organs are forwarded with the body and the body is sutured closed without ernbalming 0 Personal e??ects are released to the mortuary affairs representatives MEDCOM 0882 FINAL AUTOPSY REPORT: Page 3 of8 Abd Ai-Rnhnan M. This (8TB) 35-year-old civilian detainee. (8TB) (W6) died of hanging. Investigation reveals that a razor blade from a razor was used to cut strips from one or more bed sheets and a ligature was fashioned by braiding these strips together. A sliding noose was formed by tying a loop In one end of the ligature and bringing the opposite end through the loop. The free end of the ligature was secured to a ventilation opening. arrdeG) likely stood on his bedroll to place the noose over his head. It is not known if he was'l'ully or partially mspended when found. The subject?s face was congested with petechiae; it is likely that he was panially suspended (DiMaio and DiMaio. Forensic Pathology. 2" Ed, CRC Press. 20m. pp. 252-253). Some periodicity was noted in the ligature furrow at autopsy which corresponded with the suspected ligature. There was also an abrasion on the right side of the neck which corresponded with the loop at the end of the ligature. It was reported that the hands were bound loosely behind the body when found and no evidence of constrictive binding of the wrists was present at autopsy. Complete body radiographs and multiple skin incisions of the posterior back and extremities failed to reveal any evidence of physical abuse. Toxicological testing for ethanol, carbon monoxide. cyanide. medications and screened drugs of abuse was negative. The matures of death is suicide. (bits-5 Medical Examiner MEDCOM 0883 muaeu mlum nan-1m um mum 00mm? BTB N-Umd.ABDAl-Ratumn. Civilian mm mammal-1H ?x I- (we) SaudlAnbb 1972 Elm m: In. Imu?vac-too an mm Ill?0 mm Val at maximum Mucuan ?numb- Ian-mom monumentan man?n MM Mlme hum-mph!) cn-od?mw-mnw ?mutanmm ??an-ama- mu ton-mum Wuhan-numb. cannu- Mummy?, macaw mm mm mm 0- "a mot-amn- mm I nun-?- Imma- new In? Myra;- mm" (M562 ?m (We) 4sz007 unso- Ewen-n vacuum no can.? comm-dun.? mm: UM ATM mammals A m. Inasmuch-Mn.- Ital--me m?mm mammauhw mam ?9 AMIW 0? mmonm I?m-m (W6) Gmntammo Bay Naval Baa. Cuba MEDCOM 0885