MichaeCJA. Burson, MD ThL>
forensic TatlioCogy ConsuCtant

P.O Box 419

Monday-Friday

Loveland, CO 80539

8 am to 5 pm

E-mail:

(970) 635-4126

bursonm@mac.com

After-hours:
(970) 635-4151
Fax:

(970) 203-2509

AUTOPSY

Name of decedent:

Douglas

Carson

County Case#:

Date

and

time

Date

and time

of

REPORT

Mangines

Case#:

DA13-085

2013-0706

death:

July

27,

of autopsy: July

2013

28,

at

2013

0932

at

hrs

1000

hrs

Age:

22

YEARS

Sex:

Male

DIAGNOSES :
I. HISTORY

OF

A. ACUTE

CHRONIC
FENTANYL

B. CEREBRAL

C.

PAIN

AND

OPIATE

ABUSE

AND

SUICIDAL

IDEATIONS

TOXICITY

EDEMA

PULMONARY

EDEMA

I I. TOXICOLOGY:
A. URINE

DRUG

SCREEN:

1 .BENZODIAZEPINE

POSITIVE

2 . FENTANYL

POSITIVE

3 . POSITIVE--ANALYTE
B. FENTANYL

AND

DETECTED

METABOLITE,

CONSISTENT

WITH

BLOOD:

1 . FENTANYL

29

2 .NORFENTANYL

ng/mL

-4.2

ng/mL

1 . DIAZEPAM

360

ng/mL

2 . NORDIAZEPAM

440

ng/mL

460

ng/mL

C. BENZODIAZEPINES

D. ESCITALOPRAM,

PANEL,

BLOOD:

BLOOD:

1 . CITALOPRAM/ESCITALOPRAM-E. ETHANOL,

WHOLE

THE

BLOOD

-0.05

g/dL

EXHIBIT
s
s
-O

3

as

AUTOPSY 0001

 MANGINES,

Douglas

CARSON

County,

Autopsy No.

Colorado

DA13-085

-2-

TOXICOLOGY :

Reference

Horizon

Lab:

2000

Lab,

LLC

Boise Ave.

Loveland,

CO

80538

OPINION:

Based

on

death

is

is

the

history

complications

provided
of

and

acute

the

fentanyl

autopsy

findings,

toxicity,

The

the

manner

cause

of

of

death

accident.

Michael A.
Forensic

MB/NW AD:

07/28/2013 AT:

08/16/2013 MD:

08/30/2013 MT :

Burson,

Pathology

M.D.,

PhD

Consultant

08/31/2013

AUTOPSY 0002

 MANGINES,

Douglas

CARSON

County,

Autopsy No.

Colorado

DA13-085
The

HISTORY :

10/24/1990)

-3-

decedent

who

has

a

is

a

medical

PHI

22-year-old

history

depression,

and

drug

himself
due

to

abuse.

into

Reportedly,

the

being

Highlands

depressed.

verbally

suicidal,

decedent

was

and

placed

The

decedent

hours

July

27,

appeared

to

be

the

into

minutes.
on

On

Health

July

2013,

that

and

found

unresponsive

dead

hours

on

0932

Michael

July

Personnel

WITNESSES:

Burson,

MD

27,

had

last

to

known

staff
At

on
to

The

admitted

18,

him

be

the

was

down.

The

every

alive

that

decedent

2013

reportedly

"checks"

hours,

pain,

ideations

July

calm

reported

0915

"blue".

on

decedent

(DOB :

chronic

suicidal

Facility

worked

male

voluntarily

and placed

time,

and

the

at

0900

decedent

decedent

was

15

was

pronounced

2013.

present

PhD,

room"

for

prior

the

staff

snoring.

subsequently
at

26,

reportedly

At

sleeping

anxiety,

Behavior

"quiet

was

significant

decedent

facility

a

2013.

the

Caucasian

for

the

Pathologist

postmortem

and

Jessica

examination

include

Carlos-Ray,

Autopsy

Assistant .

IDENTIFICATION:

*

By

the

The

CLOTHING:

the

Douglas

following

County

decedent
clothing

received

A tan

•

A pair

of blue

boxer-type

•

A pair

of blue

hospital-type

MARKS

with

AND

"The

Disco

unsealed body bag

and

clad

in

Biscuits"

logo

on

the

chest

SCARS:

tattoo

of

a

*

A monochromatic

tattoo

of

the

*

A

tattoo

left

an

Colorado.

pants

A monochromatic

the

in

of

underwear

*

polychromatic

State

items:

•

IDENTIFYING

t-shirt

is

Coroner,

of

a

tree

on

word

skull

the

right

"Inspire"

and

the

torso
across

Colorado

the

flag

chest

symbol

shoulder

*

A polychromatic

tattoo

*

Multiple

well-healed

*

Multiple

*

Multiple

of

a

sun-type

image

on

the

linear

scars

on

well-healed

linear

scars

well-healed

linear

scars

back

the

left

leg

on

the

left

wrist

on

the

right

knee

AUTOPSY 0003

on

 MANGINES,

Douglas

CARSON

County,

Colorado

Autopsy No.

DA13-085

EVIDENCE

MEDICAL/SURGICAL

OF

intervention

-4-

consists

of

*

Defibrillator pads

*

Gauze

on

the

the
on

left

INTERVENTION:

Evidence

of

medical/surgical

following:

the

leg,

torso

which

is

covering

multiple

linear

possible

incised wounds
•

Electrocardiographic

•

A hospital

leads

identification

on

the

bracelet

EVIDENCE

EXTERNAL

EVIDENCE

HEAD

NECK:

•

AND

A

small

OF

extremities

OF

on

the

right

wrist

INJURY

INJURY:

puncture

vs

laceration

on

the

left

temple

TORSO:

*

An

area

are

of

red-tan

consistent

and

with

yellow-tan

resuscitation

abrasions

on

the

sternum,

which

the

leg

efforts

EXTREMITIES:

•

Multiple

partially

*

Possible

venipuncture

INTERNAL

EVIDENCE

OF

crusted
mark

linear

incised

on

left

the

wounds

on

left

arm

INJURY:

None

GENERAL

The

autopsy

Carson
CO.

This

weighs

184

At

time

groups

and

present

exposed

to

of

age

the
is

at

performed

male

of

1000

Douglas

Colorado.

Caucasian

reported

the

at

autopsy

State

nourished

is

commenced

Mangines

Coroner,

the

is

EXTERNAL EXAMINATION

The

whose

22

years.

hours,

on

County

Coroner's

at

the

body

is

28,

request
that

appearance
The

July

of

is

body

on

Office,
of

a

2013

the

the

body

Castle

Douglas

Rock,
County

well-developed,

generally

measures

well-

consistent

70-inches

of

with

long

and

pounds.

of
the

in

autopsy,
muscles

the

rigor
of

mortis

mastication.

posterior

aspects

is

developed

Fixed,

of

the

in

the

major

muscle

pink-purple

livor

mortis

body,

except

in

areas

pressure.

AUTOPSY 0004

 MANGINES,

Douglas

CARSON

County,

Autopsy No.
HEAD :
8

Head

cm

at

scleral
not

hair

long

equal

0.7

or

-5-

red-blonde,

the

cm.

crown.
The

in

The

neck

The

ORAL

repair.

are

and

are

are

slightly

NOSE:

are

no

are

and

brown;

congested

The

The

nose

oral

is

measures
the

and

cavity

there

adult

male

to
are

are

no

and does

contains

natural

petechiae.

and without palpable

normal

up

pupils

midline,

buccal mucosal

midline

nipples

distributed

irides

CAVITY:

There

structures

breasts

The

petechiae.

palpation.

good

normally

EYES:

sclerae

conjunctival
upon

dentition

CHEST:

is

over

grate

NECK:

Colorado

DA13-085

adenopathy.

without

palpable

masses .

The

ABDOMEN:

abdomen

is

mildly

protuberant

without

detectable

fluid

wave .

The

GENITALIA:

testes

external

genitalia

are

normal

circumcised

male

with

descended bilaterally.

EXTREMITIES:
UPPER

length

with

all

in

fair

The

lower

and

EXTREMITIES:
with

The

EXTREMITIES:

symmetrical

all

digits

fair

repair.

BACK

AND

The

back

The

body

is

subcutaneous

opened
fat

The

without

extremities

are

toenails

and

GENERAL

The

extremities

present.

repair

present.

SACRUM:

upper

digits

sacrum

INTERNAL

with

a

routine

measures

3

cm

in

are

evidence
well
are

are

well

fingernails
of

of

and

moderate

and

moderate

tearing.

developed
of

developed

are

LOWER

symmetrical

length

and

in

unremarkable .

EXAMINATION

thoracoabdominal
thickness

at

incision.

The

level

the

the

of

umbilicus .

BODY

in

CAVITIES:

any

of

the

There

body

are

no

abnormal

fluid

accumulations

or

adhesions

cavities.

AUTOPSY 0005

 MANGINES,

Douglas

CARSON

County,

Autopsy No.

Colorado

DA13-085

CARDIOVASCULAR

surface

is

arteries

-6-

SYSTEM:

unremarkable.

follow

a

right

significant

narrowing

thrombosis.

The

unremarkable.
The

valve

smooth

streaking
inferior
vena

RESPIRATORY

no

The

and

ostia

grams.

are

distribution.

surface

is

firm,

and

patent.

branches,

renal

AORTA:

is

are

the

reveals
no

aorta

no

acute

muscles

without

minimal

including

arteries

The

coronary

is

papillary
and

epicardial

The

Sectioning

red-brown,

There

The

There

and

pliant.

surface.

major

390

atherosclerosis,

thin

intimal

The

SYSTEM:

and

to

show

The

foreign

right

normal

purple,

consolidation.

are

dominant

weighs

are

fibrosis.

has

a

normal

atherosclerotic

celiac,

superior

widely patent.

The

and

inferior

unremarkable.

respectively,
pink-tan

coronary

by

are

mesenteric,
is

The

myocardium

leaflets

noted.

cava

heart

endocardial

The

yellow

The

or

left

lungs

septation.

There

trachea

bodies

and

are

The

no

weigh

lung

masses

and mainstem bronchi

masses.

The

860

820

grams,

parenchyma

is

or

areas

are

pulmonary

and

gross

mottled

unremarkable.

arteries

are

of

There

free

of

capsule

is

thromboemboli .

The

SPLEEN:

intact,
color

smooth,

and

present.

LIVER

AND

LIVER:

and

smooth

cysts

The

thin-walled

soft

and

glistening.

weighs

The

There

are

320

grams.

parenchyma
no

has

infarcts,

a

The
firm

nodules,

red-purple
scars,

or

SYSTEM:

liver

is

is

texture.

BILIARY

parenchyma
A

spleen

firm

weighs

and

2000

grams.

red-brown.

gallbladder

No

contains

10

The

masses
ml

of

capsule

are

is

detected.

liquid

bile.

intact.

The

GALLBLADDER:
No

stones

are

present .

GASTROINTESTINAL

ESOPHAGUS:
STOMACH:

The

foodstuff.
rugal

esophagus

stomach

The

folds.

INTESTINES:
appear

The

TRACT:

The

contains

mucosa

There

unremarkable.

a

uniform

diameter

approximately

25

ml

of

and

smooth,

glistening,

and

no

gastric

or

ulcers.

and
The

large

duodenal

intestines

vermiform

appendix

have
is

a

intact

partially

is

are

small

has

arranged
SMALL

uniform

mucosa.
digested

in
AND

normal
LARGE

dimension

present.

AUTOPSY 0006

and

 MANGINES,

Douglas

CARSON

County,

Autopsy No.

The

PANCREAS :

is

no

-7-

pancreas

evidence

ADRENAL

Colorado

DA13-085

is

tan-orange

of hemorrhage

The

GLANDS:

adrenal

or

with

lobular

architecture.

There

saponification.

glands

have

a

golden

cortex

and

gray-brown

medulla .

GENITOURINARY

KIDNEYS:

SYSTEM:

The

right

respectively.
surface
the

is

The

urinary

yellow-orange
smooth.

The

MALE

The

epiglottis
cartilage
smooth.

has

are

are

SKULL

AND

no

The

hemorrhage.

has

dura

or
is

is

no

configuration.

hemorrhage,
brainstem,

cervical

and

spinal

grams,
cortical

delineated

nondilated.
200

tan-pink,
gland

from

URINARY

ml

clear

moist,

is

and

unremarkable.

mucosa

and

The
is

glistening.

hyoid bone

and

pink-purple,

material.

The

The

thyroid

moist,

thyroid

and

gland

unremarkable.

of

the

hematoma.

The

and

The

1480

cranial

through

cerebellum.

The

lesion

scalp

nerves

are

brain

within

the

no

intact

areas

and

epidural

The

atlanto-occipital

normal

is

hemorrhage.

grams.

the

reveals

skull

without

subarachnoid

mass

has

smooth

configuration.

or

column

is

aspirated

weighs

sections

contusion,
or

or

intact

has

coronal

laryngeal

normal

edematous

Serial

is

170

external

well

are

prostate

unremarkable.

Reflection

There

are

and

approximately

surface
The

The

ureters

contains

and appears

moderately

normal

are

masses

contusion,

fracture.

and

180

ease.

cortices

musculature

The

BRAIN:

laceration,

weigh

examined.

lobes

spine

pelves

mucosal

hypopharynx

symmetrical

The

not

with

The

GENITALIA:

intact.

There

SPINE:

The

anterior

and

strip

smooth.

The

INTERNAL

are

kidneys

bladder

urine.

testicles

NECK:

and

pyramids.

The

left

capsules

red-purple

medullary

BLADDER:

and

or
The

without
subdural

brain

cerebrovascular

symmetrically
reveal

no

cortex,

white

joint

is

of

is

system

intact.

areas

of

matter,

intact.

mobility.

AUTOPSY 0007

The

 MANGINES,

Douglas

CARSON

County,

Autopsy No.

Colorado

DA13-085

-8SPECIMENS

Specimens

SPECIMENS:

fluid,

urine

and peripheral

TOXICOLOGY :

Urine

submitted

Horizon

to

and

for

at

blood

the

LLC

of

for

LUNG:

Sections

Sections

of

of

of

the

the

the

Sections

KIDNEY :

autopsy

include

vitreous

iliac vein.

blood

from

the

iliac

vein

are

heart,

lung,

liver,

kidney

and

brain

are

histology.

Sections

LIVER:

of

analysis.

MICROSCOPIC

HEART :

time

from the

peripheral

Labs,

Sections

HISTOLOGY:

submitted

retained

OBTAINED

heart

lung

are

liver

of

are

the

EXAMINATION

without

without

are

histopathologic

without

kidney

histopathologic

abnormality.

histopathologic

are

without

abnormality.

abnormality.

histopathologic

abnormality.

BRAIN:

Sections

of

the

brain

are

without

histopathologic

abnormality.

AUTOPSY 0008