BOARD OF MEDICOLEGAL INVESTIGATIONS OFFICE USE ONLY OFFICE OF THE CHIEF MEDICAL EXAMINER Re Eastern Division 1115 West 17th Tulsa, Oklahoma 74107 (918) 295-3400 Fax (918) 585-1549 Central Office 901 N. Stonewall Oklahoma City, Oklahoma 73117 (405) 239-7141 Fax (405) 239-2430 Co I hereby certify that this is a true and correct copy of the original document. Valid only when copy bears imprint of the office seal. By Date REPORT OF INVESTIGATION BY MEDICAL EXAMINER DECEDENT First-Middle-Last Names (Please avoid use of initials) Age DARIUS 41 ROBINSON Birth Date 11/26/1974 Race Sex BLACK M HOME ADDRESS - No. - Street, City, State 2100 NE 19TH, OKLAHOMA CITY, OK DATE EXAMINER NOTIFIED BY - NAME - TITLE (AGENCY, INSTITUTION, OR ADDRESS) CARL LAFOON, PHYSICIANS HOSPITAL ER INJURED OR BECAME ILL AT (ADDRESS) CITY CADDO COUNTY JAIL LOCATION OF DEATH CITY PHYSICIANS HOSPITAL TYPE OF VEHICLE: DRIVER AUTOMOBILE DESCRIPTION OF BODY PASSENGER LIGHT TRUCK RIGOR 04/04/2016 TYPE OF PREMISES OKLAHOMA Unknown TIME DATE ER COUNTY 23:19 TIME 04/04/2016 TYPE OF PREMISES CADDO OKLAHOMA CITY DATE JAIL COUNTY CITY 901 N STONEWALL TYPE OF PREMISES CADDO ANADARKO BODY VIEWED BY MEDICAL EXAMINER EXTERNAL PHYSICAL EXAMINATION COUNTY ANADARKO IF MOTOR VEHICLE ACCIDENT: TIME 04/04/2016 DATE AUTOPSY LAB 22:50 TIME 04/05/2016 13:00 PEDESTRIAN HEAVY TRUCK BICYCLE MOTORCYCLE OTHER: NOSE EXTERNAL OBSERVATION LIVOR Jaw Complete Neck Arms Absent Color Lateral Beard Hair BLOOD Eyes: Color Mustache Passing Posterior OTHER Legs Passed Anterior Pupils: Decomposed Regional Body Length MOUTH EARS Opacities R L Body Weight Significant observations and injury documentations - (Please use space below) SEE AUTOPSY PROTOCOL Probable Cause of Death: ASPHYXIATION Due To: MANUAL COMPRESSION OF NECK Manner of Death: Natural Accident Suicide Homicide Unknown Pending Case disposition: Autopsy YES Authorized by CLAY NICHOLS M.D. Pathologist CLAY NICHOLS M.D. Not a medical examiner case Other Significant Medical Conditions: MEDICAL EXAMINER: Name, Address and Telephone No. CLAY NICHOLS M.D. I hereby state that, after receiving notice of the death described herein, I conducted an investigation as to the cause and manner of death, as required by law, and that the facts contained herein regarding such death are true and correct to the best of my knowledge. 06/17/2016 901 N STONEWALL AVE Date Signed OKLAHOMA CITY, OK 73117 Signature of Medical Examiner Computer generated report CME-1 (REV 7-98) CLAY NICHOLS M.D. 1601666 04/05/2016 Date Generated CERTIFICATION Board of Medicolegal Investigations Office of the Chief Medical Examiner 901 N. Stonewall Oklahoma City, Oklahoma 73117 (405) 239-7141 Voice (405) 239-2430 Fax I hereby certify that this document is a true and correct copy of the original document. Valid only when copy bears imprint of the office seal. By____________________________ Date__________________________ REPORT OF AUTOPSY Decedent Age Birth Date DARIUS ROBINSON 41 11/26/1974 BL Race Type of Death Means Sex Case No M 1601666 ID By Toe tag While in penal incarceration Authority for Autopsy CLAY NICHOLS, M.D. Present at Autopsy Mike Nelson FINDINGS I. Asphyxiation due to manual neck compression with: A. Fractured hyoid, right wing with surrounding hemorrhage B. Focal hemorrhage on bilateral strap muscles C. Possible petechial hemorrhage of the left eye II. Fracture of right rib 5, left ribs 4 and 5 and sternum due to cardiopulmonary resuscitation (CPR) III. Old bullet recovered from right upper arm IV. Two circular scars right upper arm V. Healing parallel, linear abrasions around right wrist consistent with handcuff abrasions VI. Healing abrasions/contusion on back of right hand consistent with fingernail marks VII. History of being pepper sprayed VIII. Mild cardiomegaly CAUSE OF DEATH: DUE TO: ASPHYXIATION MANUAL COMPRESSION OF NECK OSC: MANNER OF DEATH: HOMICIDE The facts stated herein are true and correct to the best of my knowledge and belief. OCME Central Division CLAY NICHOLS, M.D. Pathologist Location of Autopsy 4/5/2016 1:00 PM Date and Time of Autopsy CASE NO. 1601666 External Description: Received in a body bag is the body of a well-developed, well-nourished black male appearing compatible with the stated age. The height is 72 inches and the weight is 167 pounds. The rigor is full and generalized. Purple lividity is posterior and fixed. The body is identified by a toe tag on the left great toe. The head and face are normally formed. The head hair is dark. A moustache and goatee are present. Graying stubble is also present. The irides are brown and the pupils are equal at 0.2 inch each. A possible petechial hemorrhage is in the left eye. The ears and nose are intact without evidence of trauma. Bloody vomitus is around the mouth. The neck is free of masses. The chest, abdomen, and posterior aspects are appropriately developed. Tattoos are on the upper mid back and upper left back. The genitalia are those of a normal adult male. There is no evidence of trauma to or discharge from the genitals or anus. Venereal warts are present. The upper and lower extremities are appropriately developed. Two roughly rounded scars are present over the right biceps; these measure up to 0.7 inch each. A tattoo is on the right shoulder, right and left triceps. Clothing: The deceased is dressed in orange pants, white boxer briefs, and an orange shirt. Evidence of Medical Intervention:     A nasogastric and endotracheal tube are in place. Pacing pads are on the right upper chest and left lower chest. An intraosseous catheter is in the right shin. An intravenous catheter is in the left antecubital fossa. Evidence of Trauma: Abrasions on the wrist consistent with handcuff abrasions are present. Also, on the back of the right hand are multiple healing abrasions and a contusion consistent with fingernail marks. Upon reflecting the external skin flaps, bilateral neck hemorrhage is noted. In addition, focal areas of hemorrhage are found adjacent to right rib #5, left ribs #’s 4 and 5, and the sternum secondary to fracture by cardiopulmonary resuscitation. Upon dissecting of the neck, focal areas of hemorrhage are identified around the deeper paratracheal muscles. There is a fracture of the right wing of the thyroid. There is surrounding hemorrhage. 2 CASE NO. 1601666 Internal: The descriptions below are exclusive of the “Evidence of Trauma”, section. Body Cavities The body is opened with the usual Y-shaped incision. The skin flaps are reflected and no hemorrhage is found beneath the skin. The chest plate is removed. The pleural cavities, pericardial sac and abdominal cavity are intact. Total body Lodox x-rays located an old bullet in the right upper arm. Cardiovascular System Heart Weight: 420 grams The great vessels arise and distribute normally. The epicardium is red-brown and firm. The left anterior descending coronary artery is approximately 50% occluded by atherosclerotic plaque. The ventricles are of appropriate size and thickness without evidence of old or recent infarction. No thrombus is found within the atria, ventricles or appendages. The valves are intact and lined by the usual number of unremarkable leaflets. The aorta and vena cava are free of significant disease process. Respiratory System Right Lung Weight: 1100 grams Left Lung Weight: 810 grams The pleural surfaces are gray-tan and intact. On section, the red-brown surfaces are free of consolidation or focal lesion. A pulmonary embolism is not identified. Gastrointestinal System The gastrointestinal tract is intact throughout. The stomach contains approximately 4 to 5 ounces of green-brown partially digested food. An appendix is present. Liver Liver Weight: 1980 grams The capsule is intact. On section, the red-brown surfaces are free of cirrhosis or neoplasia. The gallbladder is intact and otherwise unremarkable. No stone is identified. Spleen Spleen Weight: 180 grams On section, the red-brown surfaces are unremarkable. 3 CASE NO. 1601666 Pancreas The pancreas is of normal size and, on section, is unremarkable. Urinary System Right Kidney Weight: 210 grams Left Kidney Weight: 220 grams The capsules strip easily from the underlying red-brown, smooth cortical surfaces. On section, the normal renal architecture is maintained throughout. The ureters are intact and drain to a bladder containing approximately 30 ml of yellow urine. The bladder is unremarkable. Reproductive Systems The prostate gland is of normal size and, on section, is unremarkable. Endocrine System The pituitary gland, thyroid gland and adrenal glands are of appropriate size and are unremarkable. Neurologic Brain Weight: 1440 grams There is no evidence of epidural, subdural or subarachnoid hemorrhage. The leptomeninges are thin and delicate. The cerebral hemispheres are symmetrical and otherwise unremarkable. The arteries at the base of the brain are intact without evidence of significant atherosclerotic occlusion or aneurysm formation. On section, no lesion is identified. Integumentary System The integumentary system is intact. Immunologic System There is no evidence of lymphadenopathy or significant residual thymus gland. Musculoskeletal System The musculoskeletal system is intact. 4 CASE NO. 1601666 Summary of Sections: 1. 2. 3. 4. 5. Left ventricle Right lung, kidney and adrenal Left lung, kidney and adrenal Liver, spleen, pancreas and thyroid Brain Microscopic: The slides were reviewed. Except for the findings noted below, the sample tissue shows varying degrees of congestion and autolysis and is otherwise noncontributory. Heart: A section of the left ventricle shows large myocardial cells with enlarged and hyperchromatic nuclei. A fine fibrosis is in the background concentrated mainly around blood vessels. A section of left anterior descending coronary artery confirms the presence of a bridging component. Sections of right coronary artery and an additional section of the left coronary artery from slide #1 confirm the presence of atherosclerotic plaque formation. Liver: A section of the liver shows moderate steatosis mainly in the form of macrovesicular fat. There is no evidence of cirrhosis or neoplasia. Summary: A complete autopsy was performed on the deceased identified as Darius Robinson on April 5, 2016. The deceased was a 41-year-old black male who presented to the local emergency room via ambulance. Prior to being transported, the deceased was incarcerated in the Caddo County Jail. There was a history given of unknown pill abuse. On April 4, 2016, the deceased began acting violently and agitated in his cell. When the jail staff opened his cell door to check on him, the decedent reportedly charged the staff. He was subdued, handcuffed, and pepper spray was reportedly used. In addition, it was reported that a neck hold was also used to restrain the deceased. While lying handcuffed and prone on the jail floor, the deceased became unresponsive. There was a report of white foam coming from his mouth. Death was declared at the emergency room. At autopsy, significant findings include the presence of a fractured hyoid bone with surrounding hemorrhage. Focal hemorrhage was identified on the deeper muscles of the neck. In addition, hemorrhage was identified beneath the skin flap forming the neck flap. Handcuff abrasions were identified. Incidental CPR fractures were also present. 5 CASE NO. 1601666 Summary (cont’d): Histologic evaluation revealed hypertensive heart disease, coronary artery disease, and a bridging coronary artery. Hepatic steatosis was also present. No blood ethanol was detected in a sample of heart blood. No significant substance was identified on a screen performed on heart blood. After review of the historic and autopsy findings contained herein, it is my opinion that the deceased, Darius Robinson, died as the result of ASPHYXIATION SECONDARY TO MANUAL COMPRESSION OF HIS NECK. Atherosclerotic cardiovascular disease and a history of recently being pepper sprayed are considered contributory. The manner of death is HOMICIDE. May 25, 2016 CAN/kg CLAY NICHOLS, M.D. 6 OFFICE USE ONLY BOARD OF MEDICOLEGAL INVESTIGATIONS Re. _____ Co. _____ OFFICE OF THE CHIEF MEDICAL EXAMINER I hereby certify that this is a true and correct copy of the original document. Valid only when copy bear im-print by the office seal. 901 N.Stonewall Oklahoma City, Oklahoma 73117 REPORT OF LABORATORY ANALYSIS By ______________________ Date ____________________ ME CASE NUMBER: 1601666 LABORATORY NUMBER: 161407 DECEDENT'S NAME: DATE RECEIVED: DARIUS ROBINSON 04/06/2016 MATERIAL SUBMITTED: BLOOD, VITREOUS, URINE, LIVER, BRAIN, GASTRIC HOLD STATUS: 1 YEAR SUBMITTED BY: MEDICAL EXAMINER: MIKE NELSON CLAY NICHOLS M.D. NOTES: ETHYL ALCOHOL: Blood: NEGATIVE (Heart) Vitreous: Other: CARBON MONOXIDE Blood: TESTS PERFORMED: ALKALINE DRUG SCREEN - (Heart Blood) EIA - (Heart Blood) - Amphetamine, Methamphetamine, Fentanyl, Cocaine, Opiates, PCP, Barbiturates, Benzodiazepines (The EIA panel does not detect Oxycodone, Methadone, Lorazepam or Clonazepam) RESULTS: NONE DETECTED 04/28/2016 DATE Byron Curtis, Ph.D., F-ABFT, Chief Forensic Toxicologist