Countywide Services Agency Navdeep S. Gill, County Executive Nancy Newton, Assistant County Executive Bruce Wagstaff, Interim Chief Deputy County Executive Department of Coroner Kimberly D. Gin, Coroner Jason P. Tovar, MD, Chief Forensic Pathologist County of Sacramento April 27, 2018 Sacramento Police Department 5770 Freeport Boulevard Sacramento, CA 95822 Attn: Sergeant eifrey Shiraishi Sergeant Shiraishi, The reports for the decedent, Stephen Clark, are attached to this letter. In light of the erroneous information that was released from the private autopsy and in an effort to ensure that we got the facts correct, the autopsy conducted by Dr. Su was reviewed by Sacramento County Coroner Chief Forensic Pathologist Jason Tovar and Sacramento County Coroner pathologists, Dr. Brian Nagao and Dr. Katherine Raven. All three doctors concur with Dr. Su?s ?ndings and have signed the autopsy report with Dr. Su. In addition, I sought independent review from forensic pathologist, Dr. Gregory Reiber. His independent report concurs with Dr. Su?s ?ndings and is included. He also reviewed the ?ndings of the second autopsy in his report. All ?ve doctors are board certi?ed forensic pathologists and combined have over ?fty years of experience in the ?eld of forensic pathology. I also sought con?rmation of toxicology results from the Sacramento County District Attorney?s (DA) Crime lab and the Sacramento County Coroner?s contracted lab, NMS. The DA Crime Lab sent samples to their contracted lab, Central Valley Toxicology for further testing as well. All the results are attached with the reports. Thank you for being patient as I took extra steps in this process to ensure that the facts presented by my of?ce are true facts backed by scienti?c evidence. Respectfully, Kimberly Coroner CC: State of California Department of Justice Sacramento County District Attorney?s Of?ce 4800 Broadway, Suite 100 0 Sacramento, California 95820 0 Phone (916) 874-9320 Fax (916) 874-9257 0 SACRAMENTO COUNTY CORONER 1Final Classi?cation 2 Case No. 3 Deputy Assigned 4a Date of Death 4b Found? Homicide 18-01644 Marcus Kelln 3/18/2018 CLASSIFICATION 5 Name First: 6 Name Middle: 7 Name Last: 8a Time of Death 8b Fnd/Est/Unk: DECEDENT STEPHON ALONZO CLARK 21 :42 PERSONAL DATA 9 Sex 10 Race 11 Date of Birth 12 Age 13 Marital Status Male Black 7 8/10/1995 22 Years Never Married 14 Usual Address 7572 29TH STREET . I 15 City 16 County 16a State 17 Zip Code Sacramento Sacramento CA 95822 18 Remains identi?ed by or how identi?ed FEARNE, Erica Fingerprints RESIDENCE IDENTIFICATION CLARK, Se'Quette Mother CLARK, Stephen Father RELATIVES 21 Place of Death RESIDENCE - OWN 22 Street Address PLACE OF DEATH 7572 29TH STREET 23 City 24 County 25 Zip Sacramento Sacramento I 95822 26 Death Reported By 27 Removed To Coroner 28 Type of Medical Examination REMAINS KOPPINGER, KRISTA Yes Homicide 29 Cause Multiple gunshot wounds due to: CAUSE OF DEATH due to: due to: OTHER 30 None SIGNIFICANT CONDITIONS 31 Manner of Death 32 Place of Injury 33 At Work? 34a Date of Injury 34b Fnd/Est/Unk Homicide RESIDENCE - OWN N0 3/18/2018 35 Address or Location 36a Time of Injury 36b Fnd/Est/Unk INJURY 7572 29TH STREET 21:26 INFORMATION 37 City 38 County 39 Zip Code Sacramento Sacramento 95822 DECEDENT WAS SHOT BY LAW ENFORCEMENT 40 Describe how injury occurred CASE SUMMARY See Page 2 Deputy Date Signed 4/26/2018 HeameilGrif?tth SACRAM ENTO COUNTY . CORONER Final Case Summary As required by Government Code, Section 27491, an inquiry was made into the death of the subject of this report. It was determined by an investigation that an autopsy would be necessary to establish the cause of death. An autopsy was performed and revealed the above cause of death. Based on the known circumstances and cause of death, the manner of death is Homicide. County of Sacramento Department of Coroner 4800 Broadway, Suite 100 Sacramento, CA 95 820-1530 Kimberly D. Gin Coroner NANEE: CLARK, STEPHON A. POSTMORTEM DATE: INVESTIGATOR: El External Examination CASE NO. 18-01644 TIME: 10:55 Autopsy 03/20/18 7 Marcus Kelln AUTOPSY FINDINGS: l. Gunshot wound #1 of neck: A. TWUQFU Entry: Right lateral neck 1. No soot 2. No stippling Exit: Left lateral neck Path of entry: Skin, posterior neck Projectile: None Direction: Right to left, downward and front to back. Associated injuries: 1. Perforation of the soft tissue of posterior neck ll. Gunshot wound #2 of right arm: A. Entry: Right lateral posterior arm 1. No soot 2. No stippling Exit: None Path of entry: Skin, right humerus Projectile One deformed copperjacketed metal bullet at the right arm Direction: Right to left and downward Associated injuries: 1. Penetration of the right arm 2. Comminuted fracture of the right humerus m. Gunshot wound #3 or back: A. 7??"9990 Entry: Right back/scapular area 1. No soot 2. No stippling Exit: None Path of entry: Skin, left scapula Projectile One deformed copper jacketed metal bullet at the left scapula Direction: Right to left, upward and back to front Associated injuries: 1. Penetration of the soft tissue of back 2. Perforation of the left scapula lV. Gunshot wound #4 of chest: A. B. Entry: Right lateral chest at axillary area 1. No soot 2. No stippling Exit: None County of Sacramento Department of Coroner 4800 Broadway, Suite 100 Sacramento, CA 95820-1530 Kimberly D. Gin . Coroner Vl. Vll.. C. Path of entry: Skin, right lateral 3rd rib, upper lobe of right lung, left anterior 2nd rib D. Projectile One deformed copper jacketed metal bullet at the left lateral chest wall E. Direction: Right to left, back to front and upward F. Associated injuries: 1. Fractures of the right 3rd rib and the left 2nd rib 2. Perforation of the upper lobe of right lung with right hemothorax Gunshot wound #5 of back: A. Entry: Right lateral back 1. No soot 2. No stippling B. Exit: Left lateral chest C. Path of entry: Skin, right 7th rib, lower lobe of right lung, thoracic aorta, left ventricle of heart, lower lobe of left lung, left 5th intercostal space skin D. Projectile: None E. Direction: Right to left, upward and back to front F. Associated injuries: 1. Fractures of the right 7th rib 2. Perforation of the lower lobe of right lung with right hemothorax 3. Laceration of the thoracic aorta 4. Laceration of the left ventricle of heart 5. Perforation of the lower lobe of left lung with left hemothorax Gunshot wound #6 of back: A. Entry: Right back/flank area 1. No soot 2. No stippling B. Exit: None 0. Path of entry: Skin, posterior right 10th and 11th ribs, thoracic spine at T12 D. Projectile One deformed copper jacketed metal bullet and fragments collected at the thoracic spine (T12) E- Direction: Right to left, horizontal and back to front F. Associated injuries: 1. Penetration of the soft tissue of the right paraspinal area. 2. Fractures of the posterior right 10th and 11th ribs. 3. Fracture of the right pedicle of thoracic spine (T12) with epidural hemorrhage of the lower thoracic cord. Gunshot wound #7 of left thigh: A. 9.0.0? Entry: Left anterior thigh 1. No soot 2. No stippling Exit: Left lateral buttock Path of entry: Skin, soft tissue of left thigh Projectile One deformed copper jacketed metal bullet within the underwear outside ofbody Direction: Front to back and upward Associated injuries: 1. Perforation of the soft tissue of left thigh County of Sacramento Department of Coroner 4800 Broadway, Suite 100 Sacramento, CA 95820-1530 Kimberly D. Gin Coroner Toxicology: A. From Laboratory of Forensic Services, there is positive for ethanol cocaine metabolite, cannabinoids, codeine, alprazolam and etizolam in femoral blood. And, codeine and hydrocodone are positive in urine specimen. B. From NMS Labs, there is positive for ethanol cannabinoids, codeine, alprazolam, etizolam, nicotine, hydrocodone and promethazine in femoral blood. CAUSE OF DEATH: Multiple gunshot wounds Keng-Ch?r? Su, M.D. Forensic Pathologist/Neuropathologist April 26, 2018 Case has been also reviewed by: I g. Vs? Katherine Raven, MD. Forensic Pathologist . ,3 7 W/fg/gw Kc} Brian Nagao, M.D. Forensic Pathologist Jas??rfTovar, MD. Chief Forensic Pathologist were} CLARK, STEPHON A. 1 8?01644 4 WITNESSES: SPD Det. B. Alonso CSI R. Lindner (#538) and K. Louie (#6384) witnessed. IDENTIFICATION: The body is received in a body bag that is locked with a red plastic lock bearing the inscription ?310776?. A Sacramento County Coroner?s identi?cation tag attached to the body bag zipper has the inscription ?1 8?01644 CLARK, (later identified as CLARK, STEPHON A.). EVIDENCE OF MEDICAL INTERVENTION: The following are present, and are in proper position: EKG pads at chest and abdomen. There has not been organ procurement. CLOTHING: 1. Black hoodie coat with multiple tears including: one at the right lower neck, one at the left lower neck, four at the right back, four at the left back, and one at the right lateral arm. 2. White T?shirt with multiple tears including: four at the right back, four at the left back, and one at the right lateral arm. Black pants with one tear at the left anterior thigh. Grey underwear with one tear at the right inguinal area. Pair of white sports shoes. Pair of white socks. Metal rings including: one at the right little finger, one at the left middle finger and one at the left little ?nger. EVIDENCE OF EXTERNAL TRAUMATIC INJURY AND ASSOCIATED INTERNAL TRAUMATIC INJURY: . Gunshot wounds are numbered for purposes of the autopsy and do not represent a chronological order in which wounds are received. All wound measurements are taken with the body in anatomic position unless otherwise stated. I. Gunshot wound #1 of the neck: Entry: The entrance wound is located at the right lateral neck, 8 inches below the top of the head and 1-1/2 inch inferior to the right external auditory meatus. The entrance wound is round and measures 1/4 inch in diameter. There is peripheral dark red abrasion surrounding the entrance hole measuring 1/16 inch in width. There is no soot or stippling on the skin. Exit: The exit wound is located at the left lateral neck, 9 inches below the top of the head, 2-1/2 inch inferior and 1 inch posterior to the left external auditory meatus. The exit wound is irregular and measures 1l2 3/8 inch. There is no peripheral dark red abrasion surrounding the exit hole. Path of entry: The wound track begins at the skin of right lateral neck, perforates the soft tissue of posterior neck, and exits at the left lateral neck. Projectile: None. Direction: Right to left, downward and front to back. Associated injuries: 1. Perforation of the soft tissue of posterior neck. ll. Gunshot wound #2 of the right arm: Entry: The entrance wound is located at the right lateral posterior arm, 8 inches below the top of the head and close to the top of shoulder. The entrance wound is oval and measures 3/8 1/4 inch. There is peripheral dark red abrasion surrounding the entrance hole measuring 1 I16 inch in width. There is no soot or stippling on the skin. CLARK, STEPHON A. 1 8-01644 5 Exit: None. Path of entry: The wound track begins at the skin of right arm, fractures and terminates at the right humerus. Projectile One deformed copper jacketed metal bullet is collected at the right arm. Direction: Right to left and downward. Associated injuries: 1. Penetration of the right arm. 2. Comminuted fracture of the right humerus. Gunshot wound #3 of the back: Entry: The entrance wound is located at the right back/scapular area, 14 inches below the top of the head and 5?1/2 inches to the right of the midline. The entrance wound is oval and measures 1/2 3/8 inch. There is peripheral dark red abrasion surrounding the entrance hole measuring 1/16 inch in width. There is no soot or stippling on the skin. Exit: None. Path of entry: The wound track begins at the skin of right back/scapular area, penetrates the soft tissue of back, perforates and terminates at the left scapula. Projectile One deformed copper jacketed metal bullet is collected at the left scapula. Direction: Right to left, upward and back to front. Associated injuries: 1. Penetration of the soft tissue of back. 2. Perforation of the left scapula. IV. Gunshot wound #4 of the chest: Entry: The entrance wound is located at the right lateral chest at axillary area, 15 inches below the top of the head and between the middle and posterior axillary lines. The entrance wound is oval and measures 1/2 1/4 inch. There is peripheral dark red abrasion surrounding the entrance hole measuring 1/16 inch in width. There is no soot or stippling on the skin. Exit: None. Path of entry: The wound track begins at the skin of right lateral chest at axillary area, perforates the right lateral 3rd rib, upper lobe of right lung, left anterior 2nd rib, and terminates at the left lateral chest wall. Projectile One deformed copper jacketed metal bullet is collected at the left lateral chest wall. Direction: Right to left, back to front and upward. Associated injuries: 1. Fractures of the right 3rd rib and the left 2nd rib. 2. Perforation of the upper lobe of right lung with right hemothorax (measuring 75 ml of liquid blood). CLARK, STEPHON Gunshot wound #5 of the back: Entry: The entrance wound is located at the right lateral back, 19-1/2 inches below the top of the . head and at the posterior axillary line. The entrance wound is oval and measures 1/2 3/8 inch. There is peripheral dark red abrasion surrounding the entrance hole measuring 1/16 inch in width. There is no soot or stippling on the skin. Exit: The exit wound is located at the left lateral chest, 18 inches below the top of the head and at the middle axillary line. The exit wound is irregular and measures 1/2 1/4 inch. There is no peripheral dark red abrasion surrounding the exit hole. Path of entry: The wound track begins at the skin of right lateral back, perforates the right 7th rib and lower lobe of right lung, lacerates the thoracic aorta and left ventricle of heart, perforates the lower lobe of left lung and left 5th intercostal space, and exits at the left lateral chest. Projectile: None. Direction: Right to left, upward and back to front. Associated injuries: Fractures of the right 7th rib. Perforation of the lower lobe of right lung with right hemothorax (estimated 75 ml of liquid blood). Laceration of the thoracic aorta. Laceration of the left ventricle of heart, measuring 4 2 cm. Perforation of the lower lobe of left lung with left hemothorax (estimated 750 ml of liquid blood). Nr? Vl. Gunshot wound #6 of the back: Entry: The entrance wound is located at the right back/?ank area, 20 inches below the top of the head and 4 inches to the right of the midline. The entranCe wound is oval and measures 1/2 3/8 inch. There is peripheral dark red abrasion surrounding the entrance hole measuring 1/16 inch in width. There is no soot or stippling on the skin. Exit: None. Path of entry: The wound track begins at the skin of right back/flank area, fractures the posterior right 10th and 11th ribs, and terminates at the thoracic spine at T12. Projectile One deformed copper jacketed metal bullet and fragments are collected at the thoracic spine (T12). Direction: Right to left, horizontal and back to front. Associated injuries: 1. Penetration of the soft tissue of the right paraspinal area. 2. Fractures of the posterior right 10th and 11th ribs. 3. Fracture of the right pedicle of thoracic spine (T12) with epidural hemorrhage of the lower thoracic cord. Vll. Gunshot wound #7 of the left thigh: Entry: The entrance wound is located at the left anterior thigh, 24 inches above the bottom of the left heel. The entrance wound is round and measures 5/16 inch in diameter. There is no peripheral dark red abrasion surrounding the entrance hole. There is no soot or stippling on the skin. CLARK, STEPHON A. 1 8-01644 7 Exit: The exit wound is located at the left lateral buttock, 32 inches above the bottom of the left heel. The exit wound is irregular and measures 3/4 5/16 inch. There is no peripheral dark red abrasion surrounding the exit hole. Path of entry: The wound'track begins at the skin of left anterior thigh, perforates the soft tissue of left thigh, and exits at the left lateral buttock. Projectile One deformed copper jacketed metal bullet is collected within the underwear outside of the body. Direction: Front to back and upward. Associated injuries: 1. Perforation of the soft tissue of left thigh. EXTERNAL EXAMINATION: Injuries are described previously. The body is identi?ed by toe tags and is that of an unembalmed refrigerated, adult male who appears about the reported age of 22 years. The body weighs 156 pounds, measures 68 inches, and is well-nourished (Body Mass lndex/BMI= 23.7, Obesity= BMI of 30 or greater). Wrist scars are absent. Tattoos are present including: Letters of ?Beloved? and unknown figure at the right arm. Rigor mortis is present. Livor mortis is absent. The head is normocephalic and covered by black hair. There is no balding and the hair can be described as 1/4 inches in length and curled. Mustache is present. Beard is absent: Examination of the eyes reveals irides that appear to be brown in color and sclerae that are unremarkable. There are no petechial hemorrhages of the lids and/or sclera. The oronasal passages are unobstructed. Upper and lower teeth are present. Dentures are absent. There is no chest deformity. There is no increased anterior?posterior diameter. The abdomen is not unusual. The genitalia are those of an adult male. The penis appears uncircumcised. The external genitalia are without trauma or lesions. The extremities show no edema, non?therapeutic punctures or needle tracks. INTERNAL EXAMINATION The following observations are limited to findings other than injuries, if described above. INITIAL INCISION: The body cavities are entered through the standard coronal incision and the standard Y-shaped incision. NECK: The neck organs are removed en bloc with the tongue. No lesions are present nor is trauma of the gingiva, lips or oral mucosa demonstrated. There is no edema of the larynx. Both hyoid bone and larynx are intact and without fractures. No hemorrhage is present in the adjacent throat organs, investing fascia, strap muscles, thyroid or visceral fascia. There are no prevertebral fascial hemorrhages. The tongue when sectioned shows no trauma. CAVITY: Injuries are described previously. The lungs are poorly expanded. Soft tissues of the thoracic and abdominal walls are well preserved. The subcutaneous fat of the abdominal wall measures 3/4 inches. The organs of the abdominal cavity have a normal arrangement and none is absent. The peritoneal cavity is without evidence of peritonitis. There are no adhesions. CLARK, STEPHON A. 18-01644 8 SYSTEMIC A131) ORGAN REVIEW MUSCULOSKELETAL SYSTEM: No abnormalities of the bony framework or muscles are present. CARDIOVASCULAR SYSTEM: Injuries are described previously. The thoracic aorta has no atherosclerosis. There is no tortuosity or widening of the thoracic segment. The abdominal aorta has no atherosclerosis and no calci?cations. There is no dilation of the lower abdominal segment. No aneurysm is present. The heart weighs 310 grams. It has a normal con?guration. The right ventricle is 0.3 cm thick, the left ventricle is 1.7 cm thick, and the septum is 1.8 cm thick. The chambers are normally developed and are without mural thrombosis. The valves are thin, leafy and competent. The circumference of the valve rings are: Mitral valve 9.5 cm, aortic valve 5.0 cm, tricuspid valve 10.5 cm, and pulmonic valve 7.0 cm. There is no abnormality of the apices of the papillary musculature. The great vessels enter and leave in a normal fashion. The ductus arteriosus is obliterated. The coronary ostia are widely patent. There is a normal pattern of coronary artery distribution. There is no coronary atherosclerosis. The blood within the heart and large blood vessels is liquid and scanty. RESPIRATORY SYSTEM: Injuries are described previously. Scant mucus secretions are found in the upper and lower bronchial passages. The mucosa is intact and pale. The lungs are pale. The left lung weighs 280 grams. The right lung weighs 290 grams. The is focally hemorrhagic. The pulmonary vasculature is without thromboembolism. GASTROINTESTINAL SYSTEM: The esophagus is intact throughout. The stomach is not distended. It contains about 310 cc of watery fluid. The mucosa shows unremarkable. Portions of tablets and capsules are not seen in the stomach. The small intestine and colon are opened along the anti-mesenteric border and no mucosal lesions are present with liquid green/brown stool. The pancreas occupies a normal position. There is no trauma. The is lobular and soft. The pancreatic ducts are not ectatic and there is no calcification. HEPATOBILIARY SYSTEM: The liver weighs 1040 grams, is of average size and is red-brown. The capsule is intact and the consistency of the is soft. The cut surface is smooth. There is a normal lobular arrangement. The gallbladder is present. The wall is thin and pliable. It contains about 15 cc of bile and no calculi. There is no obstruction or dilation of the extrahepatic ducts. The periportal nodes are not enlarged. URINARY SYSTEM: The left kidney weighs 100 grams. The right kidney weighs 100 grams. The kidneys are normally situated and the capsules strip easily revealing a surface that is tan-red and smooth. The corticomedullary demarcation is preserved. The pyramids are not remarkable. The peri? pelvic fat is not increased. The ureters are without dilation or obstruction and pursue their normal course. The urinary bladder is unremarkable. It contains about 75 cc of clear urine. GENITAL SYSTEM: The prostate is without enlargement or nodularity. Both testes are in the scrotum and are unremarkable and without trauma. SYSTEM: The spleen weighs 70 grams. The capsule is smooth. The is dark red. There is no increased follicular pattern. nodes throughout the body are small and inconspicuous. The bone is unremarkable. The bone marrow of the rib is unremarkable. CLARK, STEPHON A. 18?01644 a 9 ENDOCRINE SYSTEM: The thyroid is unremarkable. The parathyroid glands are not identi?ed. The adrenals are unremarkable. The thymus is not identi?ed. The pituitary gland is of normal size. SPECIAL SENSES: The eyes are not dissected. The middle and inner ear are not dissected. HEAD AND CENTRAL NERVOUS SYSTEM: There is no subcutaneous or subgaleal hemorrhage of the scalp. The external periosteum and dura mater are stripped showing no fracture of the calvarium and base of the skull. There are no tears of the dura mater: There is no epidural, subdural or subarachnoid hemorrhage. The brain weighs 1500 grams. The leptomeninges are thin and transparent. A normal convolutionary pattern is observed. Coronal sectioning demonstrates a uniformity of cortical gray thickness. The cerebral hemispheres are symmetrical. There is no softening, discoloration, or hemorrhage of the white matter. The basal ganglia are intact. Anatomic landmarks are preserved. Cerebral contusions are not present. The ventricular system has a normal appearance without dilation or distortion. The pons, medulla and cerebellum are unremarkable. There is no evidence of uncal or cerebral herniation. Vessels at the base of the brain have a normal pattern of distribution. There are no Cranial nerves are intact, symmetrical and normal in size, location and course. The cerebral arteries are without arterioslcerosis. SPINAL CORD: The superior portion of the cervical spinal cord is examined through the foramen magnum and is unremarkable. HISTOLOGIC SECTIONS: Representative sections of various organs are preserved in one storage jar in 10% formalin. No sections are submitted for slides. TOXICOLOGY: Chest blood, femoral blood, liver tissue, bile, gastric contents, urine, and vitreous humor have been obtained. SPECIAL PROCEDURES: Blood is obtained for DNA. PHOTOGRAPHY: Photographs have been taken prior to and during the course of the autopsy. DIAGRAMS: Four diagrams were used during the performance of the autopsy. The diagrams are not intended to be a facsimile and are not drawn to scale. RADIOLOGY: X-rays are obtained and reveal the radiopacity consistent with the recovered projectiles. EVIDENCE: Hair (head) and nail scrapings are collected on 3/19/2018 (one day prior to autopsy). Five metal bullets are collected during autopsy. 18?01644 Type: Homicide . 4800 Tadway, Suite 100 STEPHON A- Doom? Kenny Sacramento, California 95820-1530 R. . ., 32 Years Male Deputy: KELLN, Marcus jam/mm?? A Case Number,hza?w? 3 i 343%}; . mm m1? ?i k, ?ya?m, . . ,4 . ?701g "*fo 55ng - seas ?ha?i?zw' 5D I )1me 66?) J9 um"; v.3 433:, in YUM. {la/g?vim gym?? a? zsutdwk ?5 A m? ?dt?gpp??g? Ami? 54X: gm?w . o; A if m. 1'15 k; (viii213; 3? 7053?! #(Mia java? (BREE n\ ?33 urge}? Forensic Pathologist: q? CASE FILE SACRAMENTO COUNTY CORONER 18-01644 Type: Homicide SLARK, STEPHON A. Doctor: SU, Kenny Years Male Deputy: KELLN, Marcus if; . I . ?1 $55735 I ax 0957Forensic Pathologist: CASE FILE SACRAMENTO COUNTY CORONER '1 18?01644 Type: Homicide I STEPHON A. Doctor: so, Kenny gawk?- as? 2 Years Male Deputy: KELLN, Marcus W775i?" if; 4,147 Jill - Zf (7 ?up jaww?glk? a a? - i pen/v Magoo;ng - aw; WW Ek??i?ww . whoa; @s?wg?fv 42 'ju Via; ?rm?aL- m} mag WP. FPNEM . 49(6- mw?. ?pkg?"A ?r 0 9. .1 Ur? ryyj??may? 7? M35: . 5.3% 425? Ef?m?v Jr! 5333? d" 9 gm? gm? @Mom?zh v} wand ?fig v.59 Adi?hh Wm?w/?L 1 .- r, gull/94? Ur Dig?) Hrs/x 3W?va A 1 7445191? 9% ?yw 1 9% guwrfiv?vi. I 1 Forensic Pathologist: if CASE FILE SACRAMENTO COUNTY CORONER if 18-01544 Type: Homicide ELARK, STEPHON A. Doctor: SU, Kenny 22 Years Male Deputy: KELLN, Marcus ??kfr?g Sarina? )er [w Ajg?af ?Ma?a; Mg; Efww? MM a. 0? 7 Tara? rewa ?Wf'?Mx' gfi?xae. . 6K l. ez??agfx 03%, Mmf?wi a Hm?; WW Ems geeky MERE gabk?i Gd} 4 ?kif ?ghw? (30% mm?g (MW, . mam m; - 1 @31ng 'Iv Vim? . Teal/Forensm Pathologlst: (g :5 Tax?): L. a . a a ?7 (AWE: $41me ML gm- ((313, (J: w? Phone: (215) 657-4900 Fax: (215) 657-2972 e?mail: nms@nmslabs.com Robert A. Middleberg, F-ABFT. DABCC-TC, Laboratory Director NMS Labs CONFIDENTIAL 3701 Welsh Road, PO Box 433A, Willow Grove, PA19090-0437 Toxicology Report Patient Nam??; . Patient ID Report Issued 04/23/2018 11.03 Chain 18104157 Age 22 DOB 08l10/1995? To. 117C Gender Male Sacramento County Coroner W?rk?rder 131m?? Attn: Kim Gin/Pathology 4800 Broadway, Suite 100 Sacramento, CA 95820 Page 1 0f 6 Positive Findings: . Compound Be Units Matrix Source Ethanol 91 mg/dL 001 - Femoral Blood Blood Alcohol Concentration (BAC) 0.091 9/100 mL 001 - Femoral Blood Cotinine Positive 001 - Femoral Blood Nicotine Positive 001 - Femoral Blood Alprazolam 90 001 - Femoral Blood Alpha-Hydroxyalprazolam 33 001 - Femoral Blood Codeine - Free 200 001 Femoral Blood Hydrocodone - Free 5.9 001 - Femoral Blood Delta-9 Carboxy THC 300 001 - Femoral Blood Delta-9 THC 22 001 - Femoral Blood Promethazine 8.1 001 - Femoral Blood Etizolam 7.2 001 - Femoral Blood See Detailed Findings section for additional information Testing Requested: Analysis Code Description 80523 Postmortem, Expanded, Blood (Forensic) Tests Not Performed: Part or all of the requested testing was unable to be performed. Refer to the Analysis Summary and Reporting Limits section for details. Specimens Received: ID Tube/Container Volume] Collection? Matrix Source Miscellaneous Mass Date/Time Information 001 Gray Top Tube 6.25 mL 03/20/2018 10:55 Femoral Blood All sample volumes/weights are approximations. Specimens received on 04/10/2018. NMS V.18.0 CONFIDENTIAL Workorder 18104157 Chain 13104157 Patient ID 18-01644 A Page 2 of 6 Detailed Findings: Rpt. Analysis and Comments Result Units Limit Specimen Source Analysis By Ethanol 91 mg/dL 10 001 - Femoral Blood Headspace GC Blood Alcohol 0.091 g/100 mL 0.010 001 - Femoral Blood Headspace GC Concentration (BAC) Cotinine Positive ng/mL 200 001 - Femoral Blood Nicotine Positive ng/mL 100 001 - Femoral Blood Alprazolam 90 ng/mL 5.0 001 - Femoral Blood Alpha?Hydroxyalprazolam 33 ng/mL 5.0 001 - Femoral Blood Codeine - Free 200 ng/mL 5.0 001 - Femoral Blood Hydrocodone - Free 5.9 ng/mL 5.0 001 Femoral Blood Delta-9 Carboxy THC 300 ng/mL 5.0 001 - Femoral Blood Delta-9 THC 22 ng/mL 0.50 001 - Femoral Blood Ethanol Confirmed mg/dL 10 001 - Femoral Blood Headspace GC Promethazine 8.1 ng/mL 5.0 001 Femoral Blood Etizolam 7.2 ng/mL 4.0 001 - Femoral Blood Other than the above ?ndings, examination of the specimen(s) Submitted did not reveal any positive findings of toxicological significance by procedures outlined in the accompanying Analysis Summary. Reference Comments: 1. Alpha-Hydroxyalprazolam (Alprazolam Metabolite) Femoral Blood: Alpha?Hydroxyalprazolam is an active metabolite of alprazolam. It has approximately 66% of the potency of the parent drug. it is typically present at concentrations less than 10% of the parent. 2. Alprazolam (Xanax?) -_Femoral Blood: Alprazolam is a DEA Schedule lV second-generation benzodiazepine, which is effective at very low doses. It shares the actions of other benzodiazepines in the management of anxiety disorders and short?term relief of anxiety associated with depressive Alpha-hydroxyalprazolam is an active metabolite of alprazolam. Common CNS-depressant side effects of alprazolam include drowsiness and fatigue. For anxiety, daily doses of 0.8 to 4 mg are effective whereas for phobic and panic disorders, 6 to 9 mg daily is recommended. Reported therapeutic plasma concentrations of alprazolam are proportional to dose given: 3 mg/day produced steady?state levels of 30 6 mg/day, 60 ng/mL; and 9 mg/day, 100 in reported cases involving driving under the in?uence, alprazolam concentrations ranged from 8 - 640 Alcohol greatly enhances the activity of benzodiazepines. Reported blood concentrations of alprazolam in alprazolam?related fatalities ranged from 100 - 400 ng/mL (mean, 200 In combination with other central nervous system depressants such as ethyl alcohol, alprazolam can become toxic at low concentrations. 3. Codeine - Free - Femoral Blood: Codeine is a DEA Schedule narcotic analgesic with central nervous system depressant activity. An adult therapeutic regimen for codeine is 30 to 60 mg four to six times daily as needed. Morphine is a demethylated metabolite of codeine. Hydrocodone is also a reported metabolite of codeine. Reported peak plasma levels of codeine averaged 134 ng/mL at 1 hr. following a single 60 mg oral dose of codeine phosphate. Plasma morphine concentration reached a peak of 7 Concentrations in excess of the therapeutic level may cause drowsiness and mental clouding including impairment of coordination, judgment, alertness and response time. Signs seen with excessive use of this substance may include hypotension, convulsions, coma and respiratory failure. Reported blood concentrations of free codeine in codeine?related fatalities range from 1000 8800 NMS V.18.0 CONFIDENTIAL Workorder 18104157 5 Chain 18104157 Patient ID 18-01644 LAat Page 3 of 6 Reference Comments: 4. Cotinine (Nicotine Metabolite) - Femoral Blood: Cotinine is a metabolite of nicotine and may be encountered in the ?uids and tissues of an individual as a result of tobacco exposure. Anabasine is a natural product occurring in tobacco, but not in pharmaceutical nicotine and a separate test for anabasine in urine can be used to distinguish tobacco from pharmaceutical nicotine use. The reported qualitative result for this substance was based upon a single analysis only. If con?rmation testing is required please contact the laboratory. 5. Delta-9 Carboxy THC (Inactive Metabolite) - Femoral Blood: Delta?9?THC is the principle ingredient of marijuana/hashish. Delta-9-carboxy?THC (THCC) is the inactive metabolite of THC. The usual peak concentrations in serum for 1.75% or 3.55% THC marijuana cigarettes are 10 - 101 attained 32 to 240 minutes after beginning smoking, with a slow decline thereafter. The ratio of whole blood concentration to plasma concentration is unkn0wn for this analyte. THCC may be detected for up to one day or more in blood. Both delta-Q-THC and THCC may be present substantially longer in chronic users. THCC is usually not detectable after passive inhalation. 6. Delta-9 THC (Active ingredient of Marijuana) Femoral Blood: Marijuana is a DEA Schedule I hallucinogen. Pharmacologically, it has depressant and reality distorting effects. Collectively, the chemical compounds that comprise marijuana are known as Cannabinoids. Delta-9-THC is the principle ingredient of marijuana/hashish. It rapidly leaves the blood, even during smoking, falling to below detectable levels within several hours. Delta-Q-carboxy-THC (THCC) is the inactive metabolite of THC and may be detected for up to one day or more in blood. Both delta-9-THC and THCC may be present substantially longer in chronic users. THC concentrations in blood are usually about one-half of serum/plasma concentrations. Usual peak levels in serum for 1.75% or 3.55% THC marijuana cigarettesminutes after beginning smoking, decreasing to less than 5 by 2 hrs. 7. Ethanol (Ethyl Alcohol) Femoral Blood: Ethyl alcohol (ethanol, drinking alcohol) is a central nervous system depressant and can cause effects such as impaired judgment, reduced alertness and impaired muscular coordination. Ethanol can also be a product of decomposition or degradation of biological samples. The blood alcohol concentrations (BAC) can be expressed as a whole number with the units of mg/dL or as a decimal number with units of gl100 mL which is equivalent to w/v. For example, a BAC of 85 mg/dL equals 0.085 g/100 mL or 0.085% w/v of ethanol. 8. Etizolam - Femoral Blood: Etizolam is a benzodiazepine drug that is used as a novel substance. It is reported to have CNS depressant properties and shares anticonvulsant, muscle relaxant, hypnotic, anxiolytic and sedative effects with other benzodiazepines. It is not approved for use in the United States, but is available in some other countries. Average peak plasma concentrations following a single 0.5 mg and 1 mg dose were reported (extensive and poor metabolizers, respectively) approximately 1 hour after dosing, respectively. Chronic oral administration of 1 mg daily resulted in an average steady -state plasma concentrations of 9.3 Reported half?lives are 7 - 15hours. A post-mortem femoral blood concentration of 86 was reported along with other drugs following an apparent suicidal ingestion. In a second case of intentional overdose a post-mortem blood concentration of 260 was reported; the individual drowned in a bathtub. The blood to plasma ratio is not known. 9. Hydrocodone - Free (Vicodin?; Zohydro?) - Femoral Blood: Hydrocodone is a DEA Schedule II narcotic analgesic. It is similar to codeine in analgesic activity and is also widely used in cough syrups for its antitussive activity. This compound is reported to be highly addictive. For relief of pain, hydrocodone, as the bitartrate salt, is only available in oral form in combination with non-opiate drugs, acetaminophen. Active metabolites of hydrocodone include hydromorphone and hydrocodol (dihydrocodeine). Normal adult oral dosages range from 5 to 10 mg every 4 to 6 hr. Hydrocodone has also been demonstrated to be a metabolite of codeine. NMS v.18.0 CONFIDENTIAL . Workorder 18104157 Chain 7 18104157 Patient ID 1 8-01 644 LABS Page 4 of 6 Reference Comments: After a single oral administration of 10 mg, mean peak serum levels of 20 were reported at 1.5 hr; levels dropped to 7 at 8 hr. Hydrocodone is reported to be more toxic than codeine. ln overdose, it produces the same manifestations as other opiates including: drowsiness, sedation, respiratory depression, coma and death. in reported overdosage, post-mortem blood levels ranged from 130 - 7000 10. Nicotine - Femoral Blood: Nicotine is a potent alkaloid found in tobacco leaves at about 2 8% by weight. It is also reportedly found in various fruits, vegetables and tubers, tomatoes and potatoes, but at a smaller per weight fraction. As a natural constituent of tobacco, nicotine is found in all commonly used smoking or chewing tobacco products. it is also in smoking cessation products. Nicotine has been used as a pesticide, although not as widely since the advent of more effective agents. Nicotine is extensively metabolized; the primary reported metabolite is the oxidative product cotinine. Many factors influence the levels found in an individual, including: frequency of use; amount of nicotine exposed to; route of administration; etc. Toxic effects of nicotine overdose include nausea, vomiting, dizziness, sweating, miosis, EEG and ECG changes, tachycardia, hypertension, respiratory failure, seizures and death. Death from nicotine exposure usually results from either a block of neuromuscular transmission in respiratory muscles or from seizures. Anabasine is a natural product occurring in tobacco, but not in pharmaceutical nicotine. Aseparate test for anabasine in urine can be used to distinguish tobacco from pharmaceutical nicotine use. The reported qualitative result for this substance Was based upon a single analysis only. if con?rmation testing is required please contact the laboratory. 11. Promethazine (Phenergan?) - Femoral Blood: Promethazine is an ethylamino-derivative of phenothiazine used for its antihistaminic, antiemetic, and sedative effects. it generally produces CNS depression at the usual therapeutic range; however, promethazine also can produce CNS stimulation or it may be added to other substances and used in the treatment of allergies and management of motion sickness. Oral doses usually range from 25 to 150 mg per day. Following a single 50 mg oral administration of promethazine in 20 younger men, the average peak serum concentration of 29 (range 6-99) occurred at 3.3 hours. Promethazine has a blood plasma ratio of 0.6 - 0.7. Postmortem blood concentrations of promethazine in fatalities due to promethazine overdose were reported to be between 1800 and 12000 Promethazine may exhibit postmortem redistribution. Substance(s) known to interfere with the identity and/or quantity of the reported result: Promazine, Chlorpromazine. Unless alternate arrangements are made by you, the remainder of the submitted specimens will be discarded one (1) year from the date of this report; and generated data will be discarded ?ve (5) years from the date the analyses were performed. Workorder 18104157 was electronically signed on 04/23/2018 10:41 by: Ayako Chan-Hosokawa, M.S., Forensic Toxicologist NMS V.18.0 CONFIDENTIAL Workorder 1 8104157 Chain 18104157 Patient ID 18?01644 7f? Page 5 of 6 Analysis Summary and Reporting Limits: All of the following tests were performed for this case. For each test, the compounds listed were included in the scope. The Reporting Limit listed for each compound represents the lowest concentration of the compound that will be reported as being positive. If the compound is listed as None Detected, it is not present above the Reporting Limit. Please refer to the Positive Findings section of the report for those compounds that were identi?ed as being present. Acode 500128 - Benzodiazepines Con?rmation, Blood (Forensic) - Femoral Blood -Analysis by High Performance Liquid Chromatography/ TandemMass Spectrometry (LC-MSIMS) for: 99mm 99mm 7-Amino Clonazepam 5.0 Flurazepam Alpha-Hydroxyalprazolam 5.0 Hydroxyethyl?urazepam Alprazolam 5.0 Hydroxytriazolam Chlordiazepoxide 20 Lorazepam Clobazam 20 Midazolam Clonazepam 2.0 ng/mL Nordiazepam Desalkyl?urazepam 5.0 Oxazepam Diazepam 20 Temazepam Estazolam 5.0 ng/mL Triazolam Acode 500148 Cocaine and Metabolites Con?rmation, Blood (Forensic) - Femoral Blood -Analysis by Gas Chromatography/Mass Spectrometry for: Compound Rpt. Limit Compound Benzoylecgonine 100 Cocaine Cocaethylene 40 ng/mL Acode 500168 - Opiates Free (Unconjugated) Con?rmation, Blood (Forensic) - Femoral Blood -Analysis by High Performance Liquid Chromatography] TandemMass Spectrometry for: 9mm 3mm 9mm 6-Monoacetylmorphine - Free 1.0 Hydromorphone - Free Codeine Free 5.0 Morphine - Free Dihydrocodeine Hydrocodol - Free 5.0 ng/mL Oxycodone - Free Hydrocodone Free 5.0 Oxymorphone - Free Acode 521988 - Cannabinoids Con?rmation, Blood (Forensic) - Femoral Blood -Analysis by High Performance Liquid Chromatography! TandemMass Spectrometry for Compound Rpt. Limit Compound 11-Hydroxy Delta-9 THC Delta?9 THC Delta?9 Carboxy THC 5.0 ng/mL Not Reported: 11-Hydroxy Delta?9 THC: Test was canceled due to [Interfering Substance]. Acode 522503 - Alcohols and Acetone Con?rmation, Blood (Forensic) - Femoral Blood -Analysis by Headspace Gas Chromatography (CC) for: Compound Rpt. Limit Compound Acetone 5.0 mg/dL Isopropanol Ethanol 10 mg/dL Methanol 2.0 5.0 5.0 5.0 ng/mL 5.0 20 20 ng/mL 20 ng/mL 2.0 40 Rpt. Limit 1.0 5.0 5.0 ng/mL 1.0 ng/mL 0.50 Rpt. Limit 5.0 mg/dL 5.0 mg/dL NMS v.18.0 4 CONFIDENTIAL Workorder 18104157 5 Chain 18104157 Patient ID 18-01644 LABS Page 6 of 6 Analysis Summary and Reporting Limits: Acode 524568 - Promethazine Con?rmation, Blood (Forensic) - Femoral Blood -Analysis by High Performance Liquid Chromatography/ TandemMass Spectrometry for: Compound Rpt, Limit Compound Promethazine 5.0 Acode 524938 Designer Benzodiazepines Con?rmation, Blood (Forensic) - Femoral Blood -Analysis by High Performance Liquid Chromatography! TandemMass Spectrometry for: Compound . Bpt. Limit Compognd Clonazolam 10 Etizolam Delorazepam 10 Flubromazolam Diclazepam 10 Acode 80528 - Postmortem, Expanded, Blood (Forensic) - Femoral Blood -Analysis by Enzyme?Linked lmmunosorbent Assay (ELISA) for: Bpt. Limit Compound Barbiturates 0.040 mcg/mL Salicylates Cannabinoids 10 -Analysis by Headspace Gas Chromatography (GC) for: Compound Rpt. Limit Compound Acetone 5.0 mg/dL lsopropanol Ethanol 10 mg/dL Methanol -Analysis by High Performance Liquid Chromatography/Time of 4.0 4.0 t. i it 120 mcg/mL t. Limit 5.0 mg/dL 5.0 mg/dL Flight-Mass Spectrometry for: The following is a general list of compound classes included in this screen. The detection of any speci?c analyte is concentration-dependent. Note, not all known analytes in each speci?ed compound class are included. Some speci?c analytes outside these classes are also included. For a detailed list of all analytes and reporting limits, please contact NMS Labs. Amphetamines, Anticonvulsants, Antidepressants, Antihistamines, Agents, Benzodiazepines, CNS Stimulants, Cocaine and Metabolites, Hallucinogens, Hypnosedatives, Hypoglycemics, Muscle Relaxants, Non? Steroidal Anti-inflammatory Agents, Opiates and Opioids. NMS V.18.0 18?002357 (0001) March 23, 2018 Sacramento County Coroner 4800 Broadway, Suite 100 Sacramento, CA 95820 NAME: Clark, Stephen A Sacramento County District Attorney's Of?ce Stephen J. Grippi Chief Deputy Michael A. Neves Assistant District Attorney ANNE MARIE SCHUBERT 7 . Edward M. Pollock IsmCt Attorney Laboratory Director LAB NO: 18-002357 REQUEST NO: 0001 AGENCY NO: Blood Alcohol Report Submission: 001 Source; Stephen A 1 Sample Type: blood Km;? Hwy. Kristine Myhre, Criminalist Forensic Alcohol Analyst 3/23/2018 70.08 bee Received: 3/21/2018 Date Analyzed: 3/22/2018 femoral 7 March 22, 2018 Date 3/23/20 1 8 Technical Reviewer Date Administrative Reviewer Date Allyson Avina, Criminalist Kristel Suchland, Supervising Criminalist LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 Sacramento, CA 95820 (916) 874?9240 FAX (916) 321-2230 This report contains the results and conclusions of the signing analyst. Page 1 of 2 Supporting examination documentation is maintained in the case ?le. Sacramento County Coroner Blood Alcohol Report, 18-002357 (0001) - Continued Agency No: COR-18-001644 Compliance Statements Uncertainty of the mean concentration (Estimated Uncertainty) is expressed as an expanded uncertainty in accordance with 1702522005 at an approximate 99.7% level of con?dence using a coverage factor of k=3. Per California Code of Regulations, Title 17: - The reported result is the truncated mean of the replicate analytical results. Analysis and Measurement Uncertainty Instrumentation: Headspace Gas Chromatography Component Replicate 1 Replicate 2 Mean Concentration Estimated Uncertainty Ethanol 0.089 0.090 0.0895 i 0.003 All concentrations are expressed as (W unless otherwise noted LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 - Sacramento, CA 95820 (916) 874-9240 FAX (916) 321?2230 This report contains the results and conclusions of the signing analyst. Supporting examination documentation is maintained in the case file. Page 2 18?002357 (0002) Sacramento County District Attorney's Of?ce Stephen J. Grippi Chief Deputy Michael A. Neves Assistant District Attorney ANNE MARIE SCHUBERT Edward M. Pollock Attorney Laboratory Director March 27, 2018 LAB NO: 18?002357 REQUEST NO: 0002 AGENCY N0: COR-18-001644, Sacramento County Coroner 4800 Broadway, Suite 100 Sacramento, CA 95820 NAME: Clark, Stephon A Toxicology Report Submission: 001 Source: :Stephon A Date Received: 3/21/201 8 Sample Type: blood 5 Drug Classes Evaluated acidic drugs, basic drugs, amphetamine, benzodiazepines, benzoylecgonine (cocaine metabolite), carisoprodol, methadone, methamphetamine, opiates, oxycodone, zolpidem, tetrahydrocannabinols. Drugs Con?rmed Concentration Emmath Uncertainty Analyst (99.7% con?dence at delta-9?THC 16 ng/mL i 3 ng/mL Nakayama, Matthew 11-hydroxy?THC 2.3 ng/mL :t 0.5 ng/mL Nakayama, Matthew 11-nor?9?carboxy?THC 236 ng/mL :54 ng/mL Nakayama, Matthew benzoylecgonine (cocaine metabolite) 60 ng/mL ill ng/mL Toms, Michael codeine 120 ng/mL i16 ng/mL Triebold, Craig alprazolam 82 ng/mL :hl6 ng/mL Buckman, Karen etizolam 5.8 ng/mL i 0.5 ng/mL Buckman, Karen Testing indicates that nicotine, diphenydramine, and promethazine may be present. A portion of the sample will be sent to Central Valley Toxicology for additional testing. LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 Sacramento, CA 95820 (916) 874-9240 FAX (916) 321?2230 This report contains the results and conclusions of the signing analyst. Page 1 of 2 Supporting examination documentation is maintained in the case ?le. tie Sacramento County Coroner Toxicology Report: 18-0023 57 (0002) - Continued Agency No: WW March 27, 2018 Matthew Nakayama, Criminalist Date 3/27/2018 3/27/2018 Technical Reviewer Date Administrative Reviewer Date Craig Triebold, Criminalist Michael Toms, Supervising Criminalist LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 - Sacramento, CA 95820 (916) 874-9240 FAX (916) 321-2230 This report contains the results and conclusions of the signing analystSupporting examination documentation IS maintained 1n the case ?le. Pa?e 2 Of 18002357 (0005) Sacramento County District Attorney's Of?ce Stephen J. Grippi Chief Deputy Michael A. Neves Assistant District Attorney ANNE MARIE SCHUBERT . Edward M. Pollock District Attorney Lab oratory Director March 29, 2018 LAB N0: 18-002357 REQUEST 000.5, AGENCY No: 7 Sacramento County Coroner 4800 Broadway, Suite 100 Sacramento, CA 95820 Toxicology Report Submission: 005 Source: Clark, Stephon A Date Received: 3/23/2018 Sample Type: urine Drug Classes Evaluated amphetamine, benzodiazepines, benzoylecgonine (cocaine metabolite), carisoprodol, methadone, methamphetamine, opiates, oxycodone, zolpidem, tetrahydrocannabinols. Drugs Con?rmed Analyst codeine Toms, Michael hydrocodone Toms, Michael NOTE: Presumptive testing indicates tetrahydrocannabinols, benzodiazepines, and benzoylecgonine (cocaine metabolite) may be present. These drug classes were con?rmed in the femoral blood submission (001); therefore, no con?rmations were performed on submission 005. Michael Toms, Supervising Criminalist March 28, 2018 Date LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 - Sacramento, CA 95820 (916) 874-9240 FAX (916) 321-2230 This report contains the results and conclusions of the signing analyst. Supporting examination documentation is maintained in the case ?le. Page 1 sz w; 2%?le Sacramento County Coroner Toxicology Report: 18?002357 (0005) - Continued Agency No: 9/2018 3/29/2018 Technical Reviewer Date Administrative Reviewer Date Sara Porter, Criminalist Kristel Suchland, Supervising Criminalist LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 - Sacramento, CA 95820 (916) 874-9240 FAX (916) 321-2230 This report contains the results and conclusions of the signing analyst. Supporting examination documentation is maintained in the case ?le. Page 2 dz 18-002357 (0004) March 29, 2018 Sacramento County Coroner 4800 Broadway, Suite 100 Sacramento, CA 95 820 Stephen J. Gn'ppi Chief Deputy Sacramento County District Attorney's Of?ce Michael A. Neves Assistant District Attorney ANNE MARIE SCHUBERT District Attorney Edward M. Pollock Lab oratory Director LAB Nos] 8:902:357' REQUESTNO: 9094 AGENCY Nos coals-001644 Clara-StephpnA a Submission: 004 Source: Clark, Stephon A Sample Type: other Drug Classes Evaluated Toxicology Report 3/23/2018 Origin: Vitreous ?uid Date Received: amphetamine, benzodiazepines, benzoylecgonine (cocaine metabolite), calisoprodol, methadone, methamphetamine, opiates, oxycodone, zolpidem, tetrahydrocannabinols. Drugs Con?rmed Concentration Esmated Uncertamty Analyst (99.7% con?dence at k=3) alprazolam 32 ng/mL 6 ng/mL Triebold, Craig March 29, 2018 Craig Triebold, Criminalist Date LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 Sacramento, CA 95820 (916) 874-9240 FAX (916) 321?2230 This report contains the results and conclusions of the signing analyst. Page 1 of 2 Supporting examination documentation is maintained in the case ?le. {3?3 a ?db (?it ?4 we; ?a Sacramento County Coroner Toxicology Report: 18-002357 (0004) - Continued Agency No: 8?001644 Technical Reviewer A Date Administrative Reviewer Date Matthew Nakayama, Criminalist Michael Toms, Supervising Criminalist 3/29/2018 LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 Sacramento, CA 95820 (916) 874?9240 FAX (916) 321~2230 This report contains the results and conclusions of the signing analyst Supporting examination documentation is maintained in the case ?le. Page 2 0f2 l8~002357 (0003) Sacramento County District Attorney's Of?ce Stephen J. Grippi Chief Deputy Michael A. Neves Assistant District Attorney ANNE MARIE SCHUBERT Edward M. Pollock Attorney Laboratory Director March 29, 2018 LAB NO: 18-002357 REQUEST NO: 0003 (p . AGENCY (0911487001644 7 Sacramento County Coroner 4800 Broadway, Suite 100 Sacramento, CA 95 820 NAME 3. Clark, (StephonA . Toxicology Report Submission: 003 Source: Clark, StephonA Date Received: 3/23/2018 Sample Type: other Origin: liver Drug Classes Evaluated amphetamine, benzodiazepines, benzoylecgonine (cocaine metabolite), carisoprodol, methadone, methamphetamine, opiates, oxycodone, zolpidem, tetrahydrocannabinols. Drugs Con?rmed Concentration ES?mated Uncertainty Analyst (99.7% con?dence at k=3) alprazolam (qualitative) Triebold, Craig etizolam (qualitative) Triebold, Craig codeine (qualitative) Triebold, Craig Presumptive testing indicates that tetrahydrocannabinols may be present. Con?rmation was not performed since tetrahydrocannabinols were already reported in the femoral blood (Submission 001). March 29, 2018 Craig Triebold, Criminalist Date LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 - Sacramento, CA 95820 (916) 874-9240 FAX (916) 321-2230 This report contains the results and conclusions of the signing analyst. Page 1 of 2 Supporting examination documentation is maintained in the case ?le. i Ev a Sacramento County Coroner Toxicology Report: 18?0023 57 (0003) - Continued Agency No: 3/29/2018 0 3/29/2018 Technical Reviewer Date Administrative Reviewer Date Matthew Nakayama, Criminalist Michael Toms, Supervising Criminalist LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 - Sacramento, CA 95820 (916) 874-9240 FAX (916) 321?2230 This report contains the results and conclusions of the signing analyst. Supporting examination documentation is maintained in the case ?le. Page 2 18-002357 (0006) Sacramento County District Attorney's Of?ce Stephen J. Grippi Chief Deputy Michael A. Neves Assistant District Attorney ANNE MARIE SCHUBERT District Attorney Edward M. Pollock Laboratory Director April 6, 2018 LAB NO: 18-002357 REQUEST NO: 0006 AGENCY NO: Sacramento County Coroner 4800 Broadway, Suite 100 Sacramento, CA 95 820 NAME: ?Clark, StephohA" Toxicology Report AMENDED REPORT Submission: 006 Source: Clark, Stephon A 3/28/2018 Origin: chest blood Date Received: Sample Type: blood Drug Classes Evaluated amphetamine, benzodiazepines, benzoylecgonine (cocaine metabolite), carisoprodol, methadone, methamphetamine, opiates, oxycodone, zolpidem, tetrahydrocannabinols. Drugs Con?rmed Concentration Emmath Uncertainty Analyst (99.7% con?dence at k=3) codeine 12 ng/mL i 2 ng/mL riebold, Craig Presumptive testing indicates that tetrahydrocannabinols and benzodiazepines may be present. These drug classes were con?rmed in the femoral blood (Submission 001), so they were not con?rmed in the chest blood sample (Submission 006). NOTE: This report supersedes 18?00235 7?0006, which was released on March 29, 2018. The report has been amended to re?ect the correct sample origin (chest blood). LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 - Sacramento, CA 95820 (916) 874-9240 FAX (916) 321-2230 This report contains the results and conclusions of the signing analyst. Supporting examination documentation is maintained in the case ?le. Page 1 .c ,7 (1.6330 ?n at? ?Amati sf Sacramento County Coroner Toxicology Report: 18?002357 (0006) - Continued Agency No: April 6, 2018 Craig Triebold, Criminalist Date 4/6/2018 4/6/2018 Technical Reviewer Date Administrative Reviewer Date Karen Buckman, Criminalist Kristel Suchland, Supervising Criminalist LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 - Sacramento, CA 95820 (916) 874?9240 FAX (916) 321?2230 This report contains the results and conclusions of the signing analyst. Supportmg examination documentatlon IS maintained in the case ?le. Page 2 0f 18~002357 (0006) Sacramento County District Attorney's Of?ce Stephen J. Grippi Chief Deputy Michael A. Neves Assistant District Attorney ANNE MARIE SCHUBERT District Attorney Edward M. Pollock Laboratory Director March 29, 2018 LAB NO: 18?002357 REQUEST NO: 0006 AGENCY N0 18-001644 Sacramento County Coroner 4800 Broadway, Suite 100 Sacramento, CA 95 820 NAME: Lis-iClaerStephonA Toxicology Report Submission: 006 Source: Clark, Stephon A Date Received: 3/28/2018 Sample Type: blood Origin: heart Drug Classes Evaluated amphetamine, benzodiazepines, benzoylecgonine (cocaine metabolite), carisoprodol, methadone, methamphetamine, opiates, oxycodone, zolpidem, tetrahydrocannabinols. Drugs Con?rmed Concentration ES?mated uncertainty Analyst (99.7% con?dence at k=3) codeine 12 ng/mL 2 ng/mL Triebold, Craig Presumptive testing indicates that tetrahydrocannabinols and benzodiazepines may be present. These drug classes were con?rmed in the femoral blood (Submission 001), so they were not confirmed in the cardiac blood sample (Submission 006). March 29, 2018 Craig Triebold, Criminalist Date LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 - Sacramento, CA 95820 (916) 874?9240 FAX (916) 321?2230 This report contains the results and conclusions of the signing analyst. Page 1 of 2 Supporting examination documentation is maintained in the case ?le- 9 gar Sacramento County Coroner Toxicology Report: 18-002357 (0006) - Continued Agency No: 3/29/2018 3/29/2018 Technical Reviewer Date Administrative Reviewer Date Karen Buckman, Criminalist Kn'stel Suchland, Supervising Criminalist LABORATORY OF FORENSIC SERVICES 4800 Broadway, Suite 200 Sacramento, CA 95820 (916) 874-9240 FAX (916) 321-2230 This report contains the results and conclusions of the signing analyst. Supporting examination documentation is maintained in the case ?le. Page 2 ?f2 VALLEY TOXICOLUGY, mc. Case Name: TOXICOLOGY NUMBER: Specimen Description: 4 ml blood 1 eled "18-002357; 3/29/18" e?v ere by Federal Express Date 30-Mar-18 Received by B111 Posey Date 30-Mar-18 Request; Complete Drug Screen Agency Case 18-0023 57-001-01-A Requesting Agency Report To Sacramento Co. District Attorney Sacramento Co. District Attorney Laboratory of Forensic Services Laboratory of Forensic Services 4800 Broadway, Ste. 200 4800 Broadway, Ste. 200 Sacramento CA 95 820 Sacramento CA 95820 RESULTS Specimen: Blood Sample Complete Drug Screen: Ethyl Alcohol, Cocaine metabolite, Levamisole, and Opiate detected. No other common acidic, neutral or basic drugs detected. Blood Ethyl Alcohol 0.08 grams% Cocaine Negative Benzoylecgonine 0.05 mg/L Ecgonine Methyl Ester Negative Co caethylene Negative Levamisole Present (Free) Codeine 0.12 mg/L (Free) Morphine Negative (Free) 6MAM Negative Blood Benzoylecgonine Ranges (Free) Blood Codeine Ranges Effective Level: Non Active Effective Level: (0-01 - 0.10 mg/L) Potentially Toxic: (1 10 mg/L) Potentially Toxic: 0200 mg/L) B. L. Poe?? April 05, 2018 34.- KIMLE Direcmrs 1580 Tollhouse Road Elia; Phone (559) 323?9940 Fax (559) 3237502 as CENTRAL VALLEY TOXICOLOGY, INC. Case Name: TOXICOLOGY NUMBER: (?713185374 Clark, Steghon A. 1 ml femoral lood (gray top vial) labeled "Clark, Stephen 2018-03 ?20; 18-01644; . . . . 549873; 3-22-18; 3/22/18; 3/22/13; 3/24/18; Spec'me" Descr?pt?m 03/25/18; 3/26/18; 3/29/18; 4/9/18" Delivered by Federal Express ate 10-Apr-18 Received by Bill Posey Date 10-Apr.18 Request: Speci?c Drug Assay (Alprazolam 85 Prome?lazinggency case 18-002357-001_01 Requesting Agency Report To Sacramento Co. District Attorney Sacramento Co. District Attorney Laboratory of Forensic Services Laboratory of Forensic Services 4800 Broadway, Ste. 200 4800 Broadway, Ste. 200 Sacramento CA 95820 Sacramento CA 95 820 Specimen: Femoral Blood Sample RESULTS Speci?c Drug Screen/ Con?rmation: Promethazine by LCMS Negative Promethazine by LCMS-TOF Negative Speci?c Drug Sereen/Con?rmation/Level: Alprazolam by 2 Positive I Alprazolam 0.076 mg/L Blood Alprazolam Ranges Effective Level: (0.005 0.1 mg/L) Potentially Toxic: (0.1 0.4 mg/L) 3.1.. FOSEY KIMBLE Directors 1580Tollhouse Road 1 Clovis, California 93611 POW April 13:. 2018 Phone (559) 32a9940 Fax {559) 323-7502 11'