ARMED FDRCES INSTITUTE 0F Of?ce of the nit-med Forces Medical Examiner :413 Research Blvd. Bldg. 192 Roekville. MD l-3Dl-3i9-?l?li FINAL REPORT Name: Al Hanashi. Muhammad Ahmad Niasm?m in Nu: . AFIF Neeib?aih Date of Birth: Unknown Rants: Civilian l[Detainee] Date of Death: {bile} Place of Death: Guantanamo Bay Dale of Autopsy: [13 JUN lli?? hours Place of Autopsy: US Naval Hospital Date of Report: 23 JUN Elli]? Guantanamo Bay. Cuba [Iireumetnnmut nf ?Hath: {hum fa detainee. was found unresponsive vi ith a ligature (elastic handi around his neelt in his eeli at the Behavior Health Unit [Bl-ill}. Joint Task Force Guantanamo Bay. Cuba at approximater zaoo hours on 2009. The ligature was cut and resuscitation efforts were started immediately in the cell and continued at the local medical treatment facility. All efforts I'aiied to revive him. He was pronounced dead at 2259 hours. Imus] medical records reveal a tong hister},r of adjustment disorder. anti-social personality disorder and stressors of con?nement. He has a history of suicide ideations gestures and multiple failed suicide attempts. He was on hunger strike since January and was enteralj.r fed. The case is under investigation by the Naval Criminai investigative Service Authorlaatien for Autopsy: of the Armed Forces Medical Examiner. MW Title ll] US Code id'i'l Identi?cation: {Dita} is identified by visual recognition and his detainee identifications lags. Fingerprints are obtained by NCIS and a tissue sample is collected for DNA identification. if needed. CAUSE DF DEATH: Asehvaia due to ligature strangulation MANNER OF DEATH: Suicide ACLU Detainee Deathll ARMY MEDCOM 1104 amoesv aeroa'rlbii?i 2 AL mash]. Muhammad Ahmad A. S. GTIDH According to preliminary HCIS investigation. while the shift guards were performing periodic checks on the detainees at the BHU. the decedent was viewed through the cell window and noted to not he breathinc. He was seen on the floor of his cell. on his right side in the fetal position. ibil?i .was reported to have been covered with a blanket with his hands and feet exposed. He was facing the right cell wall with head tilted. The guards entered the cell and secured the decedent's hands and feet prior to placing him on his back. The guards noticed a ligature consisting of an elastic band wrapped at least twice around the neck and twisted on the left side. The ligature was wrapped and had to hecut {at the most twisted part} from the decedent's neck. it was removed in two pieces. No pulse or spontaneous breathing was noted. CPR was immediately started. Passive vomiting occurred during CPR. At approximately 212i} hours the decedent retreated to speak to a nurse and asked for a sleepng aid. He was last known alive approximately ill-15 minutes later when he asked the guard to close his "been hole cover". a sign that he was ready to go to sleep. He appeared. to the guards. in "good spirit" and did not appear upset. He was discovered unresponsive a few minutes later at approximately 2155 hours. MECRE SHE The available mental health records are screened by the protector and the ovserving civilian medics] examiner prior to the autopsy: see ?Postmortem Examination". Screening of the mental health records reveals a history of adjustment disorder. antisocial personality disorder and stressors of confinement. The decedent has a history of suicide id?tions. suicide gestures and multiple suicide attempts by hanging. neck ligature. self in?icted sharp force injuries and frequent blunt force trauma to the head. Go January Edi}? he started a hunger strike and has been fed enteraly. He has been on a suicide watch at the BHU. where he is seen daily by the medical staff. He had five suicide attempts in May 20-09. mm The ligature is collected as evidence by NCIS at the scene and examined by the prosector and the observing civilian medical examiner prior to the autopsy. The ligature is almost ideatieal to the elastic band of a white brief. medium size 34-36. issued to the detainees at the detention facility. The ligature consists of two segments. with a combined aggregate length of approximately 23 is" and width of approximately The smaller of the two segments measures id" in length. The ligature fibers are MEDCDM Hes ACLU Detainee Deathll ARMY MEDCOM 1105 amoesy 3 AL HAHASHL Muhammad Ahmad A. S. elongated and distorted at the junction of the two out edges cl'w the history of cutting the ligature at the twisted part. There are no blood stains noted on the ligature. The postmortem enamirletion,mil?J of {?lial is perftumed at the US Naval Hospital lEuarttartamo Bay. Cuba onibli?l 2909. starting at approximately 13ml liners. Full body radiological studies are obtained at the USNH. Photographs are obtained by ibl'lE'l' .DAFME Photographer. Attending the autopsy as medicolegal observers areibli?l Medical Examinerihli?l ihli?l and Special Agents'lbl'l?l from the EX RNALKAMIAIN The body is that of a well?deyeloped. wellmou?shed Caucasian male clad in lthalti shirt and pants without urxiergannents: see "Clothing and Personal Effects?. The feet are held together with white plastic flexi cuffs and the hands are held together with black plastic flexi cuffs. The ?exi cuffs were cut open to facilitate the completion of the radiological studies. The hands are covered in brown paper bags. secured by adhesive tape: see "Evidence". A blue colored plastic identi?cation band encircl? the right wrist. The height and weight noted on the identi?cation wristband credit" and 121] lb. respectively. The body appears consistent with the reported height and weight. Rigor is present to an equal degree in all extremities. Liyidity is present and fixed on the posterior surface of the body. except in areas exposed to pressure. Body temperature is cold due to refrigeration. The scalp hair is black. long. covers the back of the neck and is matted. Vomit noted on the top and back of the head. The facial hair consists ofblack mustache and heard. The forehead reveals dark smell raised lesions: see ?Evidence of Injuries". The eyes are unremarkable. 'Ihe iridee ere brown. The are cloudy. The oonjunetiyae appear injected with no signi?cant petechiae. The sclerae are white with no petechiae. The external auditory canals. extemal nares and oral eerily are free of t?oreign material and abnormal secretions. The nasal skeleton is palpany intact. The tongue is unremarkable. The lips are without evident injury. The frenulae are unremarkable. The teeth are natural and unremarkable. Examination of the neck reveals a broad patterned impression on the anterior neck and dark colored impression on the poste'ior neck: see ?Evidence of Injury". The chest is unremarkable. No injury of the ribs or sternum is es ident externally. The abdomen is unremarkable with no evidence of major surgical scars. The posterior torso is unremarkable with no es idencc of trauma. A healing at to" ulcer of unknown etiology is neocou Hoe ACLU Detainee Deathll ARMY MEDCOM 1106 auropsv aeronribii?i 4 AL HANASHI. Muhammad Ahmad at. S. noted on the right lower back. immediately below the waist. The external genitalia are those of a normal adult circumcised male. The extremities are unremarkable with no evidence of recent trauma. Linear broad impressions are noted on the right wrist and ankles. comlstent with the history of use of the flexi cuff ties. Multiple welt healed scars are noted on the right anterior neck. scalp. right turn. right shoulder. left anticubital fossa. left thumb. both knees. left shin and the dome] surface of the left foot: photographed for documentation. Ho tattoos. ether major surgical scars or identifying marks are noted. annexes or Messy: External examination of the neck reveals a ligature impression around the neck. A. broad reddish discoloration is noted on the skin of the anterior neck. overlying the thyroid cartilage measuring 1 in it maximum width on the midline. The ligature mark has a maximum width of 1 it? at the anterior midiirte. is upwardly angled towards the posterior neck. The ligature impression on the right side of the neck is tapered into a triangular shape with its apex below the angle of the mandible and is associated with nonr patterned faint contusions. see "?pinion". The ligature impression is incomplete and fades and disappears below the cars. A small superficial abrasion is noted below the right can see "Opinion". A thin dark linear discoloration is noted on the posterior neck: see "?pinion". Dissection and examination of the strap muscles of the neck reveals localized hemorrhage on the right side of the stemo-hyoid muscle. underlying the above noted ligature impression and contusion on the right side of the neck. No other trauma is noted. The hyoid bone and thyroid cartilage are intact. che; lgiumt Examination of the forehead reveals a small cluster of dark raiSed lesions. on the midline. in an area measuring a to" with underlying mild subcutaneous Mmorrhage and no underlying skull fractures: see "?pinion". a fracture of the anterior right 5th rib is noted with minimal surrounding see ?Dpinion?. MEDCOM lit]? ACLU Detainee Deathll ARMY MEDCOM 1107 auroPs'r aesoar {?lial 5 AL HANASHL Muhammad Ahmad A. S. a well healed scar overlies a malun ion fracture of the right humerus is noted. ooatsistem with remote unrelated trauma {firearm injuryr in 2002 per medical records}. There is a super?cial healing abrasion on the left shin. No other signi?cant injuries are noted. Serial incisions on the back and upper and lower extremities reveal no evidence of trauma. The incisions are photographed for documentation. IN The deceased is clad in khaki shirt and pants. general issue of the detention center. No personal effects are noted on the body. The clothing is photographed and collected by NCIS present during autopsy. Evidence of active medical intervention is noted as follows: - An endotracheal tube. Central venous line - Multiple intravenous puncture sites on right arm and anticubitat fossa. - External automatic de?brillator pads on the chest. INTERNAL I Bilateral adhesions are noted in both pleura] cavities. No abnormal collections of ?uid are present in an}!r of the body cavities. All body organs are present in the normal anatomical position. The subcutaneous fat layer of the abdominal wall is unremarkable There is no internal evidence of blunt or sharp force injt?'j' to the thereon-abdominal region. (CENTRAL NERVOUS See ?Evidence of Injury" The dura mater and faltt cerebri are intact. There is no epidural or subdural Itemon?hage present. The leptomeninges are thin and delicate. The cerebral hemispheres are symmetrical. The suuctures at the base at the brain. including cranial nerves and blood vessels. are intact. Corornt sections through the cerebral hemiqsheres reveal no Iesiore. Transverse sections through the brain stem artd cerebellum are unremarkable. The brain weighs 136i] grams. Serial sectioning of the brain reveals unremarkable and no evidence of trauma neocont ttos ACLU Detainee Deathll ARMY MEDCOM 1108 aorossv aeron'r {?lial a At. HANASHI. Muhammad Ahmad A. 5. secs; See "Evidence of Injury". Examination of the soft tissues of the neat: including strap muscles. thyroid gland and large vessels are unremarkable and without traumatic abnormalitim. The hyoid bone and thyroid cartilage are intact. The pericardial surfaces are smooth. glistening and unremarkable: the pericardial sac is free of significant fluid and adhesions. The secretary arteries arise normally. follow the usual distribution and are widely patent with no adreroselerotic changes. The epicardium is smooth and unremarkable. The myocardium is dark red-brown. firm and grossly unremarkable. The val v3 eshiblt the usual size. texture and position relationship and are unremarkable. The aorta and its major breaches arise normally. follow the usual course and are widely patent. free of significant atherosclerosis and other abnonnality. The venae cavae and their major tributaries return to the heart in the usual distribution and are free of thrombi. The heart weighs 23D grams. The upper airway is clear of debris and foreign material: the mucosa! surfaces are srnooth. yellow-tan and Unrernarkable. The pleural surfaces presence of bilateral adhesions. more pronounced on the posterior and lateral swfaces. The pulmonary is red- purple and exudes a moderate amount of bloody ?uid with no local lesions identi?ed. The pulmonary arteries are normally developed. patent and without thrombus or ernbolus. The right and left lung weigh 650 grams and sat] grams. respectively. LIVER It I The hematite capsule issn'toolh. glistening and intact. covering darlt red?brown. moderately congested with no focal lesions noted. The gallbladder contains gross-thrown. rnucoid bile: the mucosa is velvety and unremarkable. The eahahepalic biliary tree is patent. without evidence ot calculi. The liver weighs 1300 grams. The esophagus is lined by gray-w hite. smooth mucosa. The gastric mucosa is an'anged in the usual rugal folds and is unremarkable. The stomach is distended with partially digested food with no evidence of mucosal or vascular injury. The small and large bowels are unremarkable. The pancreas has a normal pinkitan lobulated appearance and the ducts are patent. The appendix is present and um'emarlrahle. A The renal capsules are armada and thin. semi-trartspat'ent and strip with case from the mrderlying smooth. red-brown cortical surfaces. The cortices are sharply delineated from the modullary pyramids. which are red-purple to tan and unremarkable. The cal yoea. pelves and ureters are unremarkable. The urinary bladder is unremarkable and contains clear yellow urine. The right and left kidneys weigh 10!] grams each. MEDCOM Hoe ACLU Detainee Deathll ARMY MEDCOM 1109 xurorsv aseoa'r Ma} at. Hansen]. Muhammad Ahmad a. s. The extemsl genitalia are those of a circumcised adult male with bilaterally descended unremarkable tastes. The spleen has a smooth. intact eapsule covering red-purple. moderately fin-n pat-emhyma: the follicles are unremarkable. The regional appear nonnai. The spleen weighs 12$ grams. ND 5 The pituitary. thyroid and adrenal glands are unremarkable See "Evidence of Injury". Muscle development is normal. No other bone orjoint abnormalities are noted. NC The clothing. plastic flexi cuffs and the brown bags around the hands are collected ant?.l submitted to the NCIS agents attending the autopsy. The ligature is examined and retained by NCIS. Note: An intact white brief similar to the one issued to the decedent is provided by NCIE for examination and comparison to the ligature. The ligature is identical to the elastic band of the examined brief} Radiographs reveal no recent skeletal fractures or abnonnaiities. A remote healed [malunionl fractured right humerus is noted. Representative sections of the major organs are retained without preparation of histological slides. TD Carbon Monoxide: Garboxyhemoglbin saturation in blood is less than 1% {expected nonnal limits] ll'Jyanide: - Not detected Volatiles [Blood and Vitremts ?uid}: - No ethanol is detected. meoeom me ACLU Detainee Deathll ARMY MEDCOM 1110 AUTDPEY 8 AL HANASHI. Muhammad Ahmed A. S. Screened medication and drugs of abuse: Screened in urine and eonfinned in blood: Positive Acetaminophen 5 mg?. 110.5 mg Positive Henaodiazepine: Loraaepam 0.025 mg-?L mg Positive hnzodiasepine: T-Aminoelonasepam 0.1113 mgl'L mg ?ll Positive Sympathomimetic amine: Pseudoephedrine 0.3 mg?L 1. ?op?ttlmentarv photographs are taken by DAFME photographer._lbii_i_5} 2. Full body radiographs are obtained by Department of Radiology. Naval Hospital Guantanamo Bay. Cuba. 3. Specimens retained for toxicological andlor DNA identification are: Blood ween}. vitreous fluid. bile. urine. stomach contents. and tissue samples from liver. lung. kidney. spleen. brain. psoas and heart muscle and adipose tissue. 4. Representative sections of organs are retained in formalin preparation of histological slides. 5. Clothing and other evidence are photographed for documentation and submitted to NCIS agents attending the autopsy. I. Asphyitia by ligature strangulation: A. Ligature partially encircling. the neck with possible twist on the right side. E. No evidence of other neck trauma or ??actures. C. No evidence of signi?cant traumatic injuries. Evidence: - Collected evidence Submitl?i to NCIS. Ill. Toxicology: A. Volatiles {Blood and lIi'itreozus fluid}: No ethanol is found. B. Screened drugs of abuse and medications {Blood}: Positive for: Acetaminophen. Bensediasepine and its metabolites and Pswdoephedrine. meocom mt ACLU Detainee Deathll ARMY MEDCOM 1111 REPORT ibii?i 9 AL HANASHI. Muhammad Ahmad A. 5. {mm} a civilian detainee of unknown a ge. died from due to ligature strangulation by wrapping the elastic band of his underwear multiple times around the neck and apparently securing it with a twist on the right side of the neck and a head tilt. liltutopsyr reveals no evidence of other signi?cant trauma or evidence of maltreatment. The raised lesions noted on the forehead are consistent with rcported history of witnessed rapeated self-inflected hittiny'banging of the head on the detention facility walls. The contusions noted on the right side of the neck may he essentials-id with the ligature twist or by the guards' initial attempts to manually remove the ligature. The nondisplaced right 5? rib fracture noted during examination is oonsistent with CPR and resuscitation efforts. Toxicological studies positive for Acetaminophen. Benzodiaaepine and its metabolite and Pseudoephedrine. The positive medications are within their therapeutic level and are nonucontributory to the cause of death. Review of the decedent's medical records reveals multiple stressors. multiple suicide ideations and gestures and multiple suicide attempts by multiple nmdaiities as early as 3003. The decedent was on hunger strike since January and had five suicide attempts in May 2W9. .ibiiEi Based upon the available infotmatigrff?tgle manner of deallLis "Suicide' Willa} Medical Examiner ms ACLU Detainee Deathll ARMY MEDCOM 1112 canal:an m: DEATH ravEHsEnsj Am an dim {G'Dulra-Hlf} EIF DECEASED MEL Flint GRADE OF SERVICE 55cm ?Ecilil?' NUMBER Mum datum-bitum Durham? ?nd- .Arma Al Hanashi. Muhammad Ahmad, A. S. Civ?ian mm? DATE IUF Sui ?m mill-Hm Yemen mu?: FEM-ILE RACE Ra:- W-RITAI. Elt?ml Elm: EITHEFI EpI-u. Emmi 5mm: titular: mm? Drum EETHDLIC IECHCIIE: Hw- HIM I OTHER Edna: am WIDDWED 'u'lul' .IEIMEH Jul WEOFHEITCF Eli Pwummn?nm: ETHEEI ADDREE: I l?ui} CIW an mm DH: suns WI (Cod-Emu- mutt} ETJITEIEHT ?ew-?an Mull! INTERN-L BETWEEN ill-USE DF DEATH {Emmi-r mum Hr hull MEET mu, Cull-I mum-turns!? PM nun-nun I 1 - . DISEASE on LEADING DEATTH ?93mm Shn?u'mn wmdumr?r?m?n?l dill run-I1 iF LEADING TD Aura-cm"! F?m?l' CAUSE I?M-bu nun-mm CAUSE. IF (EM-HG- RISE midi TD CAUSE mm?: Emu-mum SEMIFIEJNT Auk-Em wanna-m I. Ef?F??l FEEFDFEHED Il'l'lduh ?u HO Hun DEATH UUE NJ HEM muses Emmanme nu!? Wu? MINI rlth'l?l httm'EH'l Had-'1? su??E . OF ?and; 3? {b31351 manna-Es: mm mu w. A mum-n i . Hamlan- 3 June 20GB DEE. nu Em: Hun L'rludld?l rtmr. m. Hid _.mumum 26D93{h]{5} Joint Task Force Guantanamu Bay; Cuba HEMMHS OF THE at:me AT THE mu? INDIDITED mi:- Fnuu THE Causal as ABDUE .ru rnlu qm?d?: at I: ma dun Engi- in.th dawn LITTLEGHIJIEFHE Tmuumm {[3115} Medical Examiner I ?56113? rME'MLL-t'rlcm on mass man than Bauer AFB. Buyer DE . 1: 15m? 31512539 - ?.m?m?mm?mm. ml 1 1 Wu n??ldl?m?l-??lu? nun-Ill Hill-ml.? 1: Ewan-am? I. mu an; amount. 2064 MEDCDM 1113 ACLU Detainee Deathll ARMY MEDCOM 1113