HENNEPIN COUNTY
MEDICAL EXAMINER’S OFFICE
AUTOPSY REPORT
ME NO.:
MEDICAL RECORDS NO.:
CASE TITLE:

GUNSHOT WOUND OF THE HEAD

DECEASED:

Jamar O'Neal Clark

SEX:

M

DATE AND HOUR OF DEATH:

11-16-15; 9:32 p.m.

DATE AND HOUR OF AUTOPSY:

11-17-15; 8:40 a.m.

PATHOLOGIST:

AGE:

15-6355
412 21 38

24

Andrew M. Baker, M.D.

FINAL DIAGNOSES:

24-year-old man who was shot by another person; taken to Hennepin
County Medical Center (HCMC), where he later died
I.

Gunshot wound of the head, penetrating, intermediate range of
fire
A.

Entrance just lateral to left eye

B.

Pathway through bony structures of left cheek/orbit (left
zygomatic bone and orbital bones), orbital contents, bones
of left anterior cranial fossa, left frontal lobe of the
brain, optic chiasm and optic nerves, midbrain, and right
occipital lobe of the brain

C.

Associated findings

D.

1.

Multiple skull fractures (with associated subgaleal
and periosteal hemorrhage)

2.

Diffuse subdural and subarachnoid hemorrhage, with
right convexity subdural hemorrhage collection
(approximately 50 mL)

3.

Cerebral edema with cerebellar tonsillar softening

4.

Proptosis and drying of collapsed left globe

Projectile recovered from right occipital lobe of brain;
additional metal fragment recovered from left temporalis
muscle

 Jamar O'Neal Clark
15-6355
Page 2
E.
II.

Direction: front to back, slightly left to right, and
slightly upward

Other significant injuries not identified

III. No natural diseases identified
IV.

AB/MR:

Toxicology
A.

Blood ethanol (performed by HCMC on specimen collected
11/15/15 at 01:18): 0.093 g/dL

B.

Blood drug and THC screen (performed on HCMC specimen
collected 11/15/15 at 01:18): THC positive by immunoassay;
immunoassay and mass spectrometry otherwise negative

C.

Blood phencyclidine (PCP) (performed on HCMC specimen
collected 11/15/15 at 01:18): none detected by GC/MS

D.

Blood LSD (lysergic acid diethylamide) trace analysis:
(performed on HCMC specimen collected 11/15/15 at 01:18,
NMS Labs): none detected

E.

Blood cannabinoids panel: (performed on HCMC specimen
collected 11/15/15 at 01:18, NMS Labs):
1.

11-Hydroxy Delta-9 THC: 1.0 ng/mL

2.

Delta-9 Carboxy THC: 43 ng/mL

3.

Delta-9 THC: 2.6 ng/mL

11/23/15

12/14/2015

12/14/2015

X

X

Andrew M. Baker, M.D.
Chief Medical Examiner
Signed by: Andrew M. Baker

Owen L. Middleton, M.D.
Reviewing Pathologist
Signed by: Owen L. Middleton

 Jamar O'Neal Clark
15-6355
Page 3
ADDITIONAL PERSONNEL PRESENT AT AUTOPSY:

•
•

Special Agent C. Michael Phill II, Minnesota Bureau of
Criminal Apprehension
Special Agent Kevin M. Cane, Federal Bureau of
Investigation

IDENTIFICATION:

Positive identification is made by comparison of antemortem and
postmortem fingerprints (Minnesota Bureau of Criminal
Apprehension).
EXTERNAL EXAMINATION:

The body is that of a normally developed, adequately nourished
appearing, 70 inch long, 168-pound male whose appearance is
consistent with the reported age of 24 years. Lividity is
posterior and dependent, and blanches with very firm pressure.
Rigor mortis is beginning to develop in all of the extremities.
The protected parts of the body are still slightly palpably
warm.
The scalp is covered with long, black hair tightly coiled into
dreadlocks. The right iris is brown, and the pupil is round.
There are no right-sided bulbar or palpebral conjunctival
petechiae. Assessment of the left eye and periorbital tissues
is limited by injury (further described below). The external
auditory canals are free of blood. The ears are unremarkable.
Abundant bloody fluid emanates from the nares. The nares are
otherwise patent. The lips are atraumatic (except for medical
intervention described below). The nose, right maxilla, and
mandible are palpably stable. The teeth appear intact, are
native, and are in good repair. A black mustache and goatee
style beard are on the face.
The neck is straight, and the trachea is midline. The chest is
symmetric. Prominent, hypopigmented stretch striae are on both
anterior axillary lines, extending onto the lateral pectoral
regions and onto the anterior aspects of each arm. A pair of
vertically oriented, 5.5 and 7 cm long co-linear scars is on the
left side of the chest extending onto the left epigastrium. The
abdomen is flat. A 3 cm long, hyperpigmented scar is on the far
right side of the abdomen. The genitalia are those of a normal
adult male. The testes are descended and free of masses. Pubic
hair is present in a normal distribution. The back, buttocks,
and anus are unremarkable.

 Jamar O'Neal Clark
15-6355
Page 4
The upper and lower extremities are symmetric and without
clubbing or edema. The nails of the hands are trimmed very
short and are focally dirty, but are otherwise unremarkable.
Approximately thirteen round and linear hyperpigmented scars,
ranging from less than 0.5 cm diameter to 3.5 cm long, are
scattered across the lateral surface of the right arm, over the
posterior right elbow, and on the posterolateral right forearm.
A faint, 0.6 cm long, linear scar is on the dorsum of the right
wrist. A 3 cm long faint, obliquely oriented scar is on the
anterior right wrist. Multiple 0.2 to 0.7 cm maximum dimension
oval and linear scars are scattered across the dorsum of the
right hand, primarily over the metacarpal-phalangeal joints.
Approximately eleven oval to linear scars, ranging from 0.2 cm
maximum dimension to 4 cm long, are scattered across the lateral
aspect of the left arm and over the left elbow. Five macular,
hyperpigmented, oval scars ranging from 0.3 cm to 1.5 cm maximum
dimension are scattered over the posterior and medial left
wrist. Patchy, nondescript scars are scattered over and around
both knees, more pronounced on the right. The nails of the toes
are unremarkable.
TATTOOS:

•
•

A 14 cm maximum dimension monochromatic blue tattoo of an
animal head-like figure with associated scroll work is on
the anterior right forearm.
A 17 cm maximum dimension monochromatic blue tattoo that
appears to be an outline of the state of Minnesota is on
the anterior left forearm.

MEDICAL INTERVENTION:

•
•
•
•
•
•
•
•
•
•
•

Hospital bracelets (2), right wrist
Intravascular catheter, anterolateral right forearm
Intravascular catheter, right antecubital fossa
Urinary bladder catheter with attached tubing and
collection bag
Hospital tag, right 2nd toe
Intravascular catheter, dorsolateral left forearm
Intra-arterial vascular catheter, left radial artery
Triple-lumen intravascular catheter, left subclavian
Gauze and medical tape covering the left eye and cheek
Electrocardiographic lead, left shoulder
Dried, curvilinear orange abrasion (2.5 cm long) over the
distal sternum, suggestive of cardiopulmonary resuscitation

 Jamar O'Neal Clark
15-6355
Page 5
•

•
•

Linear, dried brown abrasion (2.5 cm long) extending from
the left corner of the mouth and in direct continuity with
a faint, 8 cm long line along the left side of the jawline,
suggestive of a strap for an endotracheal tube
Linear, dried brown abrasion (1.5 cm long) extending from
the right corner of the mouth, suggestive of a strap for an
endotracheal tube
Healing, focally dried black and scabbed abrasion (1.5 cm
maximum dimension) on the lateral aspect (cutaneous and
mucosal surfaces) of the right side of the lower lip,
consistent with oral endotracheal intubation

RADIOGRAPHS:

Review of the decedent’s antemortem CT scan demonstrates a main
projectile in the right side of the cranial vault in the region
of the right occipital lobe; numerous minute metal fragments
project in and around a fractured left orbit.
EVIDENCE OF INJURY:
GUNSHOT WOUND OF THE HEAD:

Just lateral to the left eye, 5 inches below the top of the
head, 3¼ inches from the anterior midline (nasal bridge), and 3¼
inches from the left external auditory meatus, is an entrance
gunshot wound. The central, circular, 0.9 cm diameter defect is
circumferentially surrounded by a 0.1 cm wide pink abrasion
collar. Radiating microtears (0.2-0.3 cm long) extend from the
defect edges in the 8, 11, 12, 1, and 2 o’clock directions. The
defect is centered within an 8 x 8 cm area of powder stippling
of the skin that extends from the left cheek onto the inferior
left forehead and from the left zygomatic prominence to the
upper and lower lids of the left eye.
The left globe is collapsed and proptic due to extensive injury
of the orbital bones with injury to, and swelling of, the
orbital contents. There is dark red-black drying of the exposed
sclera and conjunctiva.
The wound pathway continues through the bony structures of the
left cheek/orbit (left zygomatic bone and orbital bones), the
left orbital contents, the bony structures of the left anterior
cranial fossa, the left frontal lobe of the brain, the optic
chiasm and optic nerves, the midbrain, and the right occipital
lobe of the brain.

 Jamar O'Neal Clark
15-6355
Page 6
The wound pathway through the brain is pulpified and
hemorrhagic, containing multiple pieces of fragmented bone. A
thin, diffuse layer of subarachnoid and subdural hemorrhage
coats the cerebral convexities and base of the brain.
Approximately 50 mL of loosely clotted subdural hemorrhage is
over the right cerebral convexity. The cerebral hemispheres are
diffusely swollen, with flattening of the gyri, narrowing of the
sulci, and compression of the lateral ventricles. The
cerebellar tonsils are swollen, softened, and tightly apposed to
the brainstem.
There is a comminuted, complex, eggshell fracture of all of the
left anterior cranial fossa and medial right anterior cranial
fossa bony structures, extending into the lesser sphenoid wing
and medial aspect of the greater sphenoid wing on the left. The
fracturing of the left anterior cranial fossa radiates into a 5
cm long linear fracture of the right side of the frontal bone, a
7 cm long linear fracture of the left parietal bone, and a 3 cm
long linear fracture of the petrous ridge of the left temporal
bone. A separate, hemorrhagic, 1 cm maximum dimension aggregate
of hairline fractures is in the orbital roof of the right
anterior cranial fossa. Four localized 0.4 to 0.7 cm maximum
dimension foci (two right and two left) of hemorrhagic hairline
fractures are in the squamous portion of each temporal bone,
just anterior to the petrous ridges. There is multifocal
hemorrhage in the frontal, superior, and right lateral scalp,
confined to the periosteum and subgaleal connective tissue and
in areas overlying or in continuity with the aforementioned bony
injuries; incisions of these areas show no subcutaneous
hemorrhage in tissue superficial to the aponeurosis of the
scalp. All layers of the scalp are widely hemorrhagic and
swollen on the left, in association with the gunshot wound and
the related left anterior cranial fossa fractures. There is
periorbital ecchymosis (5 cm maximum dimension) of the right
eye.
Recovered from the right occipital lobe of the brain, just right
of the sagittal midline, is a 2.7 cm maximum dimension copperand lead-colored projectile. A 0.5 cm maximum dimension leadcolored metal fragment is recovered from the left temporalis
muscle.
The overall wound direction, relative to standard anatomic
position, is front to back, slightly left to right, and slightly
upward.

 Jamar O'Neal Clark
15-6355
Page 7

OTHER INJURIES:

•

A pair of obliquely oriented, linear, 3 and 1 cm long dried
scratches is on the lateral aspect of the right arm.

•

A 1.5 cm long, obliquely oriented, dried linear scratch is
on the lateral aspect of the distal left forearm.

•

A discontinuous line of vertically oriented scratches, 2.5
cm maximum dimension, is just left of the midline of the
upper back.

SOFT TISSUE DISSECTIONS:

An incision is carried down the midline of the posterior
neck and back to the right and left buttocks. Subcutaneous
dissection of the neck, shoulders, back, flanks, and buttocks
demonstrates no occult contusions.
BACK:

The anterior aspect of each distal forearm and wrist is
vertically incised. Circumferential subcutaneous dissection
demonstrates no occult contusions, or other injuries suggestive
of restraint. Localized hemorrhage is encountered over the left
radial artery, consistent with documented medical intervention.
Two cutaneous macular scars on the posterior aspect of the left
wrist are also incised, confirming absence of contusions.
WRISTS:

INTERNAL EXAMINATION:

The brain weighs 1210 g. Coronal sections through
uninjured parts of the brain demonstrate sharp demarcation
between white and gray matter, without hemorrhage or contusive
injury. The atlanto-occipital joint is stable.
HEAD:

The anterior strap muscles of
red-brown, without hemorrhage. The
are intact. The larynx is lined by
thyroid is symmetric and red-brown,
change. The tongue is free of bite
injuries.
NECK:

the neck are homogeneous and
thyroid cartilage and hyoid
intact white mucosa. The
without cystic or nodular
marks, hemorrhage, or other

 Jamar O'Neal Clark
15-6355
Page 8
The ribs, sternum, and vertebral bodies are visibly
and palpably intact. A measured 150 mL straw-colored fluid is
in each pleural cavity, and a measured 100 mL straw-colored
fluid is in the peritoneal cavity. The organs occupy their
usual anatomic positions.
BODY CAVITIES:

The right and left lungs weigh 1080 and
1010 g, respectively. The external surfaces are smooth and deep
red-purple. The pulmonary parenchyma is diffusely congested,
edematous, and virtually airless. No mass lesions or areas of
consolidation are present. The pulmonary vascular tree is free
of thromboemboli. The tracheobronchial tree is free of blood,
edema fluid, or foreign material.
RESPIRATORY SYSTEM:

The 345 g 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 no atherosclerotic stenoses and no occlusions.
The myocardium is homogeneous, red-brown, and firm. The valve
leaflets are thin and mobile. The walls of the left and right
ventricles are 1.3 and 0.4 cm 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.
CARDIOVASCULAR SYSTEM:

The 1415 g liver has an intact, smooth
capsule and a sharp anterior border. The parenchyma is tanbrown and congested, with the usual lobular architecture. No
mass lesions or other abnormalities are seen. The gallbladder
contains a minute amount of green-black bile and no stones. The
mucosal surface is green and velvety. The extrahepatic biliary
tree is patent.
LIVER AND BILIARY SYSTEM:

The 160 g spleen has a smooth, intact, red-purple
capsule. The parenchyma is maroon and congested.
SPLEEN:

The pancreas is firm and yellow-tan, with the usual
lobular architecture. No mass lesions or other abnormalities
are seen.
PANCREAS:

The right and left adrenal glands are symmetric, with
bright yellow cortices and gray medullae. No masses or areas of
hemorrhage are identified.
ADRENALS:

 Jamar O'Neal Clark
15-6355
Page 9
The right and left kidneys weigh 140 and
175 g, respectively. Except for rare, minute, focally sunken
scars on the left renal cortex, the external surfaces are intact
and smooth. The cut surfaces are red-tan and congested, with
uniformly thick cortices and sharp corticomedullary junctions.
The pelves are unremarkable and the ureters are normal in course
and caliber. White and focally hemorrhagic (catheter-related)
bladder mucosa overlies an intact bladder wall. The bladder is
empty. The prostate is normal in size, with lobular, yellow-tan
parenchyma. The seminal vesicles are unremarkable. The testes
are free of mass lesions, contusions, or other abnormalities.
GENITOURINARY SYSTEM:

The esophagus is intact and lined by
smooth, gray-white mucosa. The stomach contains approximately
300 cc of watery green fluid with numerous multicolored
fragments of food-like particulate matter. The gastric wall is
intact. The duodenum, loops of small bowel, and colon are
unremarkable. The appendix is present.
GASTROINTESTINAL TRACT:

ADDITIONAL PROCEDURES:

•
•
•
•
•
•
•

Documentary photographs are taken.
Specimens retained for toxicologic testing: vitreous fluid
(right eye), femoral blood, urine (from urinary bladder
catheter collection bag), liver, and gastric contents.
Representative tissue biopsies are submitted in formalin for
microscopic examination.
The dissected organs are returned to the body.
Fingernail clippings are placed in labeled, sealed envelopes.
Pulled head hairs are placed in a labeled, sealed envelope.
The recovered projectile and metal fragment are photographed
and placed in labeled, sealed envelopes.

MICROSCOPIC EXAMINATION:
BRAIN (1-3):

Sections of midbrain, cerebral cortex, and
cerebellum are examined. Multiple areas of
parenchymal hemorrhage and disruption, consistent
with mechanical trauma, are observed; these are
particularly prevalent in the midbrain. Hypoxicischemic changes are readily observed in many of
the Purkinje cells in the cerebellum. No
neoplastic or inflammatory changes are seen.

PANCREAS (4):

No significant pathologic abnormality.

 Jamar O'Neal Clark
15-6355
Page 10
LUNG (4):

Congestion and scattered foci of anthracotic
pigment deposition; no significant pathologic
abnormality.

HEART (5):

Cross sections of right and left ventricular
myocardium show the expected microscopic
architecture, without necrosis, inflammation, or
scarring.

ADRENAL (6):

No significant pathologic abnormality.

LIVER (6):

Congestion; no significant pathologic
abnormality.

SPLEEN (6):

No significant pathologic abnormality.

THYROID (7):

No significant pathologic abnormality.

KIDNEY (7):

No significant pathologic abnormality.

AB/MR:

11/18/15