. MEDICAL EXAMINER DEPARTMENT - DISTRICT l9 (9 (O) 

St. Lucie, Mam'n, Indian River, and Okeechobee Counties

 

   
   

Namm September 29, ..

CAUSE or DEATH:
ACUTE OXYCODONE TOXICITY 3
MANNER OF DEATH: 
ACCIDENT

 

g9

 

I I 
Charms A. Dim, M.D. 
Associate Medical Examiner 

Date g; 

Mmmedizol

 
  
  

MEDICAL EXAMINER DEPARTMENT - DISTRICT 19
St. Lucie, Marlin, Indian River, and Okeechobee Counties

Name..--.September Z9, 


EXTERNAL EXAMINATION

The body is that ofa 5 foot 7 inch, 152 pound Caucasian male teenager, who appears his
stated age of i 7 years. The hair is brown and is normally distributed. Both eyes have brown
irides, which surround widely dilated pupils. The coniunctivae show no hemorrhages nor
congestion. The nasal cavities are free of obstructions and the septum has no perforations.
The mouth has natural dentition. The tongue and oral mucosa are free of lacerations and
hemorrhages. A foamy discharge is seen in the oral cavity. The neck has a midline trachea.
The chest is symmetrical and the abdomen is free of masses. The external genitalia are those
ofa normal male teenager. The rectum is unremarkable. Both right and left upper and lower
extremities are symmetrical and free of congenital abnormalities. The back is normal.

TH ERAPY

An endotracheal tube is properly situated in the mouth and pharynx. An intravenous line
is inserted into the right antecubital fossa.

INTERNAL EXAMINATION

HEAD: The brain weighs 1580 grams. Both cerebral hemispheres are symmetrical and free
of contusions and lacerations. The surfaces of the cerebrum, cerebellum, and
medulla show no masses, hemorrhages, nor scars. The corpus callosum is intact and the

cerebrospinal fluid is clear. The cerebrovascuiar system shows no ruptures, nor
occlusions. No subarachnoid, subdural, nor epidural hemorrhages are noted. No lacerations

of the dura mater nor leptomeninges are present. The skull is free of fractures. The
subcutaneous tissue of the scalp shows no contusions.

NECK: The cervical spine has no fractures nor dislocations. The cervical spinal cord is free
of contusions and hemorrhages. The thyroid cartilage and hyoid bone are midline and free
of fractures. The epiglottis and vocal cords are free of inflammatory changes and edema.
The strap muscles and soft tissues of the neck show no hemorrhages nor contusions.

BODY CAVITIES: The right and left thoracic cavities are symmetrical and are separated by
a midline mediastinum. No hemothorax nor pneumothorax is present in the thoracic cavities.
No hemorrhages nor masses are present in the mediastinum.

The diaphragm has no lacerations nor hemorrhages.

The abdominal organs are arranged in their proper locations and show no congenital
deformities. The abdominal cavity is lined by glistening and shiny peritoneum. No
hemoperitoneum is present. No retroperitoneal masses nor hemorrhages are noted.

 

 

   
 
 
 

MEDIQL EXAMINER DEPARTMENT - DISTRICT I9
St. lucie, Martin, Indian River, and Okeechobee Countis

29, 

CARDIOVASCULAR SYSTEM: The heart weighs 380 grams. It lies in a normal pericardial
sac which is free of fluid and hemorrhage. The epicardium is glistening, smooth, and shiny.
The myocardium is dark red/brown and shows no scars nor hemorrhages. The endocardial
surfaces are smooth and glistening. The valves are competent and the leaflets are free of
vegetations. The chordae tendineae show no shortening nor fusions. No atrial nor
ventricular septal defects are noted. The right and left coronary arteries, circumflex, and
diagonal branches are widely patent. The coronary ostia are free of occlusions. The great
vessels, including the aona, superior and inferior vena cava, along with the pulmonary anery,
arise from their usual positions and are free of congenital deformities.

LUNGS: The right lung weighs 990 grams. The left lung weighs 870 grams. Edema and
congestion are present throughout the surfaces of both right and left lungs. No
masses, scars, nor hemorrhages are present. The pulmonary arteries and branches are free
of thrombi and emboli. No obstructions are present in the bronchi, trachea, and larynx.

LIVER AND GALLBLADDER: The liver weighs 1850 grams. The capsule is smooth and
glistening. No lacerations are present. The surfaces are free of masses,
hemorrhages, and scars. The gallbladder lies in its normal bed and contains 18 ml of green
bile.

HEMIC AND The spleen weighs 270 grams. The capsule is gray and free
of lacerations. The surfaces are free of masses, hemorrhages, and scars. No
enlarged nodes are noted. The bone marrow has no metastatic tumors.

GENITOURINARY SYSTEM: The right kidney weighs 360 grams. The left kidney is a
rudimentary mass of tissue, measuring 3 4 cm in its broadest diameter. The capsule of the
right kidney is stripped with ease from the underlying red/brown conical surface. The
conical and medullary surface is unremarkable. The renal pelvis is normal.
Both ureters are free of stones. The bladder is filled with urine.

ENDOCRINE SYSTEM: The thyroid gland has its normal bilobed appearance and is free of
masses, hemorrhages, and The pancreas has its usual elongated shape and normal
tan/brown appearance. The right and left adrenal gands are free of masses, hemorrhages,
and 

DIGESTIVE SYSTEM: The esophagus and stomach have normal mucosal surfaces, which are
free of ulcerations and hemorrhages. The stomach contains 80 ml of dark gray liquid. The
small and large intestines are free of obstructions, hemorrhages, masses, and ulcerations. The
omentum and mesentery have no lacerations nor hemorrhages.

 

 

 

 

 

 

MEDICAL EXAMINER DEPARTMENT - DISTRICT 19
St. Lucie, Marlin, Indian River, and Okeechobee Counties

Name..-September 29, No. 

MUSCULOSKELETAL SYSTEM: The muscles of the torso and extremities are normally

The right and left upper and lower extremities are
No fractures of the pelvis, sternum, rib
and sacral vertebral bodies and

formed and free of atrophi: changes.
symmetrical and free of fractures and dislocations.
cage, clavicles, nor scapulae are noted. The thoracic, lumbar,

bones are free of fractures and dislocations.

   

Charles A. im, MD.
Associate Medical Examiner

CAD:medi:01

 

 

 

 

MEDICAL EXAMINER DEPARTMENT l9
St. Lucie, Martin, Indian River, and Okeechobee Counties

Nam-September 29, mum 

MICROSCOPIC EXAMINATION
LUNGS

Generalized congestion and edema.

 

HEART
No significant histopathology.

LIVER
No significant histopathology,

KIDNEI 
No significant histopathologyI i

October 16, 2002
CAD:medi:01

 

 

 

 

E: 12/09)02
ME: 1644

WUESTHOFF REFERENCE LABORATORY
6800 Court
Melbourne,Fl 32940

PAGE 1

 

ACCT 000511544 LOC: MEDX 0000968356
STATUS: REG REF REG: 09/30/02

MEDICAL 19 DISCHARGE DATE:

 

 

 

 

 

QUAL DRUG 

 

 

 

SPECIMEN TYPE BLOOD
Gc/Ms CAFFEINE
IMMUNOASSAY SCR
CANNABINOIDS NEGATIVE 0.050
COCAINE METAB NEGATIVE 0.100
OPIATES 0.100'
Screening result suggests the need for further testing.
BENZO NEGATIVE 0.100
BARBITURATE NEGATIVE 0.100
TRICYCLICS NEGATIVE 0.050
FENTANYL NEGATIVE 0.001
SALICYLATE NEGATIVE 10.0
VOLATILES
SPECIMEN TYPE BLOOD
ETHANOL 0.059 - 
QUAD DRUG 
SPECIMEN TYPE URINE
TLC OXYCODONE, NICOTINE
HPLC
OXYCODONE, OXYCODONE METABOLITES, OXYMORPHONE
OXYCODONE, CAFFEINE
IMMUNOASSAY SCR
CANNABINOIDS POSITIVE 0.050
COCAINE METAB NEGATIVE 0.300
OPIATES NEGATIVE 0.300
BENZO POSITIVE 0.200
PROPOXYPHENE NEGATIVE 0.300
METEADONE NEGATIVE 0.300
PCP NEGATIVE 0.025
METHAQUAL NEGATIVE 0.300
BARBITURATE NEGATIVE 0.200
NEGATIVE 000 
SALICYLATES NEGATIVE 10.0 
FREE OPIATES
SPECIMEN TYPE BLOOD .
CODEINE NONE DETECTED mg/L
MORPHINE NONE DETECTED mg/L
HYDROCODONE NONE DETECTED mg/L
NONE DETECTED mg/L
HYDROMORPHONE . NONE DETECTED mg/L .
OXYCODONE 0.196 mg/L.=

 

 

 

 

Specimens were intact upon receipt. Chain of custody, specimen security and integrity has
been maintained. Testing has been performed as requested by Medical Examiner under their
direction. All in?house analyses have been conducted by Wuesthoff Reference Laboratory
employees who have received special training and education in the procedures performed and
are Florida licensed as Medical Technologists.

 

Reviewed by: Date: in:

 

 

 

 

 

      
   

 

12/09/02 WUESTHOFF REFERENCE LABORATORY
E: 1544 5500 Court 
Melbourne,Fl 3294a 


ient: MEonz-19-593-- 31000511544 SSN u: (Continued) 3

 

FINAL REPORT 7 THIS REPORTING oN THIS CASE. 1
OTHER
SPECIMEN TYPE BLOOD 1
OTHER TEST

 

PANEL 

 

 

NONE DETECTED
NONE DETECTED 
NONE DETECTED 
NONE DETECTED
NONE DETECTED 
NONE DETECTED 
NONE DETECTED 
NONE DETECTED 
NONE DETECTED
NONE DETECTED
NONE DETECTED
NONE DETECTED 
NONE DETECTED 1
ESTAZOLAM NONE DETECTED

yam-own BY NATIONAL MEDICAL SERVICES, INC, 
WILLOW GROVE, PA

FINAL REPORT 7 THIS COMPLETES REPORTING ON THIS CASE.

 

 

Specimens were intact upon receipt. Chain of custody, specimen security and integr1cy has
been mainteuned. Tesung has been perxomed as [Equested by Medxcal Examiner under their
directions All ineheuse analyses have been conducted by Wuesthoff Reference Laboramry
employees who have received special and eduCaLion in the procedures performed and
are Fluxida licensed as Medical Technolcgnats,

Renewed by: 5b 53:55 3 3 Date: 1?\\cb

  
 
 
 

    

OFFICE OF THE NEEDICAL EXAMINER
DISTRICT NINETEEN- FLORIDA
2500 South 3511: sum
Fan Hex-cc, FL 34931
Phone: (561) 464-7378 -- Fax (551) 464-2409

   
 
 
  
  
  
   

 

OKEECHOBEE
SAINT LUCIE
OWL.

 

 

 

  

 

  

 

 

 

 

 

 

  
  

Womed By: /9 5. Dame/"7 Time:

vesdgawr:

 

 

 

Retude Call To: 0Y7-- Agency: MS fl
Date: 9 4 ~02 Time: 6 7? 4/7
Phone: 33--0718" Cum 0? 01" 57 2

DECEDEN

 
    
 

 

Name: ss#: 
DOB: Age: 7
Race: Sex: 

 

Means of ID:

 

 

 

 

 

 

Temporary Address'
Next 0f Kin:

    

Relationship: Wfi--i

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone Number/ Nodfieszes 240-2}
PLACE OF DEATH:

Inpatient mR/ . DOA Nursing Home A mine: 0mm
Spocify 15 0mg: l7/7 I7 6: 7V0
Lasi Verified Alive: '2124 2 5/21 m/D Injmed At Work: Yes No
FoundBy: mZiwz/wfm' 9mm"? Mv 17? Time: 1mm

 

Pmnounced By: WEN Date: '1 0 3 Time: 1; fi/J

PLACE OF IN IQBY:
Place: Location:

(Home, Fm Sneak. Funury, 5w.) (Adding. City, Sula, by)

 

 

 

 

 

 

 

 

 

 

 

Date: Tim: am.- pm.
Physician: Phone: Sign Death Cam: Yes No Unk.
Funeral Home: Phone:

COMMENTS:

 

 

 

 

 

 

 

 

 

L.E. Agency Case 

 

 

Medical Examiner or Investigmnr at Scene: Yes No 

 

 



Personal Information (rnwos, Sum. AMPs, Fractures, Dental, Eu.) 3

 

of Body Rigox Livar Alger

Comments

 

MEDICAL HISTORY: 

 

 

 

 

MEDICATION:

 

 

 

 

 

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NO 

 

MEDICAL EXANUNER,