REGIONAL FORENSIC SCIENCE CENTER Timothy P. Rohrig. Director Timothy S. Gorrill, MD, District Coroner - Chief Medical Examiner AUTOPSY REPORT CASE: 18?18-0749 A E: Lama. Adrian DATE: 3/15/2018 ADDRESS: 4925 Ii. Shadybrook, #222. Wichita. Kansas 67208 TIME: 0900 Hours 37 - year old male PERSONS PRESENT AT AUTOPSY: Forensic Assistants: Paul Schauner Morgan Snead PATHOLOGIC DIAGNOSES I. No gross anatomic cause ot?dealh II. Postmortem decompositional changes Vitreous chemistry abnormalities (see ?Other Laboratory Tests") CAUSE OF DEATH: Undetermined MANNISR: Undetermined Scott Kipper, MD. Deputy Coroner?Medical Examiner 6/57/5/ Date signed 1 109 N. Minneapolis . Wichita. Kansas 672i4-3l29 . Telephone (316) 660?4800 . Fax (316) 383-4535 NAME: Lamo. Adrian CASE: 18-18-0749 CIRCUMSTANCES OF DEATH According to reports, Mr. Lamo had a past medical history significant for an unspecified seizure disorder, Asperger's generalized anxiety disorder, major depressive disorder, and drug and ethanol abuse. He had reportedly attempted to overdose on prescription amphetamines in 2001. He was last known to be alive around 3/7/2018. On 3/14/2018, he was found unresponsive in his apartment in a state ofearly postmortem decomposition. Emergency Medical Services was dispatched and he was pronounced dead at the scene. POSTMORTEM EXAMINATION An autopsy is performed on the body ofAdrian Lamo at the Sedgwick County Regional Forensic Science Center. Wichita. Kansas on the 151" day ofMarch. 2018. CLOTHING The body is received clad accompanied by: See Chain Qf'Cusmc/y Document. EXTERNAL EXAMINATION The body is received in a body bag. Body identification includes an identification band around the right ankle. The body is lingerprinted and photographed. Body identification is con?rmed as that ol'Adrian Lamo by ?ngerprint comparison conducted by the Wichita Police Department. The body is that ofa well-developed. well-nourished, adult male who weighs 160 pounds, is 69 inches in height and appears compatible with the stated age of 37 years. There are postmortem decompositional changes as evidenced by drying ofthe lingers, toes, lips and feet: skin slippage of the lower extremities and face; blistering ofthe lower extremities, neck and abdomen; focal green discoloration ofthe abdomen; and vascular marbling of the chest and arms. The Lincmbalmed body is cool to touch. Rigor mortis is absent. Fixed purple livor mortis extends over the anterior surfaces ofthe body and right side ofthe face, except in areas exposed to pressure. The scalp hair is brown and measures 1 inch in length over the crown. The decedent wears a beard and moustache. The irides are brown/hazel. The corneas are translucent. sclerae and conjunctivae are unremarkable. The nose and ears are not unusual. The natural teeth are in poor to fair repair. The neck is unremarkable. The thorax is well?developed and symmetrical. The abdomen is flat. The anus and back are unremarkable. The genitalia are those ofa normal adult male. The upper and lower extremities bilaterally are well?developed and symmetrical, without absence ofdigits. Attached to the skin ofthe lateral proximal left thigh. underneath the clothes. is a sticker reading ?Adrian Lamo Project Vigilant Assistant Director 'l'hreat Analysist'lmiestigation 70 Rates Street Northwest. Washington DC 20001 NAME: Lamo. Adrian CASE: 18-18-0749 IDENTIFYING MARKS AND SCARS Identifying marks and scars include a 51m Silt? inch scar on the posterior proximal right hand; a It'8 inch faint scar ofthe posterolateral distal left forearm; and a 3% inch scar ofthe anterior mid right forearm. MEDICAL INTERVENTION There is no evidence of medical intervention. EVIDENCE OF INJURY DESCRIPTION OF BLUNT FORCE INJURY OF THE TORSO: On the right lower back is a 3/4 inch dry red abraded contusion. DESCRIPTION OF BLUNT FORCE INJURIES OF THE UPPER EXTREMITIES: On the posterior mid left arm is a HR ?8 inch red abrasion. There is a 71's 5/8 inch dry yellow- red abrasion ofthe posterior distal left arm. On the posterolateral distal left arm is a 3m) 3m) inch red abrasion. On the posterolateral aspect ofthe right elbow is a I 3r?8 1 inch abraded contusion. DESCRIPTION OF BLUNT FORCE INJURIES OF THE LOWER EXTREMITIES: On the anteromedial aspect of the right knee is a inch dry yellow-red superficial abrasion. On the dorsolateral proximal right foot is a inch dry dark red abrasion. with a 3 Li: 7?8 inch red contusion extending from the distal margin onto the dorsal mid foot. There is a 5-14 1/2 inch discontinuous abraded contusion of the dorsal left foot, proximal to the great toe. Overlying the left knee is a 3A: 3/1 inch dry dark red abrasion. INTERNAL EXAMINATION BODY CAVITIES No adhesions or abnormal collections of ?uid are in any ofthe body cavities. All body organs are present in normal anatomic position. The subcutaneous fat layer of the abdominal wall is 3.5 cm thick. NAME: Lamo. Adrian CASE: 18?18-0749 HEAD (CENTRAL NERVOUS SYSTEM) The brain weighs l690 grams. There is pronounced postmortem softening ofthe brain. The dura mater and Talk cerebri are intact. The leptomcninges are thin and delicate. The cerebral hemispheres are symmetrical. The structures at the base ofthe brain. including cranial nerves and blood vessels. are intact and free ofabnormality. Sections through the cerebral hemispheres reveal no lesions within the cortex, subcortical white matter, or deep parenehyma of either hemisphere. The cerebral ventricles are normal caliber. Sections through the brainstem and cerebellum are unremarkable. The spinal cord is not examined. NECK l-ixamination of the soft tissues ofthe neck. including strap muscles and large vessels, reveals no abnormalities. The hyoid bone and larynx are intact. The tongue is normal. CARDIOVASCULAR SYSTEM The heart weighs 390 grams. The pericardial surfaces are smooth. glistening, and unremarkable. The pericardial sac is free ofsignil?icant fluid or adhesions. The coronary arteries arise normally, follow the usual distribution with a right dominant system. and are widely patent and Show minimal atherosclerosis. The chambers and valves bear the usual size/position relationship and are unremarkable. The myocardium is dark red?brown, firm. and unremarkable. The atrial and ventricular septa are intact. The aorta and its major branches arise normally, follow the usual course. and show no evidence of atherosclerosis. The vena cava and its major tributaries return to the heart in the usual distribution and are unremarkable. RESPIRATORY SYSTEM The right and left lungs weigh 470 and 460 grams, respectively. The upper and lower airways are clear ofdebris and foreign material. The mucosal surfaces are smooth, yellow-tan and unremarkable. The pleural surfaces are smooth. glistening, and unremarkable. The pulmonary is dark red?purple. exuding slight to moderate amounts ofblood and frothy ?uid with no focal lesions noted. The pulmonary arteries are normally developed and patent. LIVER AND BILIARY SYSTEM The liver weighs 1090 grams. The hepatic capsule is smooth. glistening. and intact. It covers red?brown with no focal lesions noted. The gallbladder contains a large amount of Ireen-yellow viscid bile. The extrahepatic biliary tree is patent without evidence of calculi. ALIMENTARY TRACT The esophagus is lined by gray?white smooth mucosa. The gastric mucosa is arranged in the usual rugal folds. and the lumen is empty. The small and large bowel are unremarkable. The appendix is present. The pancreas has a normal gray-white, lobulated appearance, and the ducts are clear. LamoAdrian CASE: l8-18-0749 GENITOURINARY TRACT The right and left kidneys weigh 140 grams each. The renal capsules are smooth. thin, scmitransparent. and strip with case from the underlying. smooth. red-brown. lirm cortical surfaces. The cortex is sharply delineated from the medullary pyramids. The calyces. pelves, and ureters are unremarkable. The urinary bladder contains 60 ml. ofclear yellow urine. The mucosa is gray-'-tan and smooth. The prostate and seminal vesicles are unremarkable. RETICULOENDOTHELIAL SYSTEM The spleen weighs 160 grams and has a smooth, intact capsule covering red-purple, moderately firm The splenic follicles are unremarkable. The regional nodes appear normal. The bone marrow is red-purple and homogenous without evidence of focal abnormality. ENDOCRINE SYSTEM The pituitary. thyroid. and adrenal glands are unremarkable. MUSCULOSKELETAL SYSTEM The bony framework. supporting musculature. and soft tissues are not unusual. EVIDENCE The following items are collected and preserved: A fabric swatch that contains a sample ofthe decedent?s blood. MICROSCOPIC DESCRIPTION SHDE KEY I. Left \-?entricle. right ventricle. left lung 2. Right lung. liver 3 Right kidney. right hippocampus Left kidney. left hippocampus Left ventricle (anteriori lateral and posterior) 6. lnterventricular septum. right ventricle (anterior, lateral and posterior) 9?93. U1 NAME: Lamo. Adrian CASE: 18-18-0749 Brain: No signi?cant histopathologic diagnosis Heart: No signi?cant histopathologic diagnosis Lungs: Postmortem autolytie changes. changes with small patchy foci of mild librotic alveolar thickening. mild perivascular fibrosis. and mild peribronehiolar ?brosis. Liver: Postmortem autolytic changes. There are scattered vacuolar changes. likely representing mild stcatosis. though postmortem vacuolar decompositional changes cannot be ruled out. Kidneys: Postmortem autolytic changes. Granular material is seen within the lumens of some of the tubules. No polarizable material is seen. TOXICOLOGY "l?oxicological analysis showed: Blood (Heart): Ethanol Negative Acetone Negative 7-Aminoelonaxepz-im 4 ng/m (iabapentin - Positive 0.08 mg/L Chlorpheniramine 0.02 mg/L Citalopram 0.13 mg/L - Positive 0.50 mg/L) litizolam 4.8 ng/ml. Hubromazepain 270 ng/mL Negative for Acetaminophen. Alprazolam. Amitriptyline. Amphetamine, (farisoprodol. Chlordiazepoxide. Clonazepam. Cocaine. Codeine. Cyanide. CycIobenzaprino Desipraminc. Diazepam. Doxepin. Fcntanyl. Flubromazolam. lmipramine. Lorazepam, Meperidine. Methadone, Methamphetamine, Meprobamate. Methylenedioxymethamphetamine Midazolam, Nordiazepam, Nortriptyline. Oxazepam. Oxyeodone, Phenazepam, Phentermine, Propoxyphene. Seitraline. Temazepam, Tramadol, Trazodone, Verapamil. and Zolpidem. Blood (l?emoral): Gabapentin 9! .0 meg/mL* Citalopram 0.19 mg/L Positive 0.50 mg/L) lilizolam 5.0 ngr?ml. l?lubromazepam 222 ng/mL NAME: Lame. Adrian CASE: 18?18?0749 Negative for and Phenazepam. Urine: Ethanol Negative Acetone Negative Ir?lubromazepam Positive litizolam Positive Negative for Amphetamine. Barbiturates, Benzoylecgonine. Cannabinoids, Codeine. Flubromazolam. Hydrocodone, Methadone. Methamphetamine. Morphine. Phenazepam. Phencyelidine and Salicylates. Brain: Etizolam Not Detected Iilubromazepam Positive Negative i?or Flubromamlam and Phenazepam. Kidney: Negative for Arsenic and Bismuth. Physical Evidence Item ?2 (rectangular green tablet): Alprazolam Positive *Analysis performed by AXIS Forensic Toxicology. Inc. Indianapolis. IN. Not accredited for the testts) by or any other ILAC MRA signatory. OTHER LABORATORY TESTS Vitreous chemistry showed a sodium ol? I mEq/L, potassium 56.3 chloride 93 mEq/L. BUN Q7 creatinine 5.5 and glucose 32 mg/dL. OPINION In my opinion Adrian Lamo died as a result ot'undetermined causes. At autopsy. postmortem decompositional changes were present. No gross anatomic cause of death was identi?ed. Microscopic analysis showed the presence ot?postmortem auto]ytic/deeompositional changes present in multiple sections ot?tissue. changes were noted in the lungs. Possible hepatic steatosis was noted, however, postmortem autolytic/decompositional changes preclude definitive diagnosis. Granular material was noted in some ot?the tubules otthe kidneys. NAME: CASE: 18?18-0749 Vitreous chemistry showed a creatinine ol?5.5 mg/dL, consistent with renal failure. The cause of this renal failure is undetermined. The vitreous potassium of 56.3 mEq/L is spuriously high. Insuf?cient remaining quantity ot?vitreous ?uid precluded the ability to run the test again to verify results. As noted. this concentration seems spuriously high, and the mechanism by which the vitreous potassium could reach this level is unknown. Multiple studies have shown that exogenous administration of potassium (such as injudicial execution/lethal injection) does not result in signi?cantly higher vitreous potassium levels. While it is normal to have elevated postmortem vitreous potassium levels (particularly in cases ot?decomposition), such concentrations do not generally approach 56.3 mEq/L. Mr. Lamo had a reported history ofa seizure disorder. including grand mal and petite mal seizures. and a seizure causing or contributing to death cannot be ruled out. Toxicologic analysis showed the presence ofmultiple drugs, including esoteric drugs such as tlubromazepam. Review of? literature. as well as discussion with the Chief'lbxieologist olthe Sedgwick County Regional Forensic Science Center. indicated that the concentrations ot?these drugs likely did not cause or contribute to death, however, the fatal ranges of some ofthese more esoteric drugs is not well studied/described. It should also be noted that the esoteric nature of some ot?these drugs suggest the possibility that other rare drugs not tested for may have been used/abused. Despite a complete autopsy and supplemental testing, no de?nitive cause oi?dcath was identi?ed. Some causes ot'death can have minimal or absent ?ndings at autopsy. including, but not limited to. seizure. terminal cardiac (irregular heartbeat leading to death), and exposure to a drug/toxin not tested for. As the cause of death cannot be de?nitely determined, the manner ol?death is best classified as undetermined. REGIONAL FORENSIC SCIENCE CENTER Timothy P. Rohrig, Director Timothy S. Gorrill, MD, PhD?Chief Medical Examiner FORENSIC LABORATORY DIVISION TOXICOLOGY LABORATORY REPORT NAME: LAMO, Adrian TOXICOLOGY CASE NO: 18-0225 Agency Case No: 18-18?0749 Submitted by: S. Kipper, MD Date Received: 16 Mar 18 SPECIMENS SUBMITTED Blood, Urine. Liver, Bruin, Kidney, Physical Evidence (Deeomposed) RESULTS Blood (Heart): Ethanol Negative Acetone Negative 7?Aminoelonazepam 41 ng/mL Gabapentin Positive 0.08 mg/L Chlorpheniramine 0.02 tng/L Citaloprnm 0.13 mg/L N-Desmethyieilalopram Positive 0.50 mg/L) Etizolam 4.8 ng/mL Flubromazepam 270 ng/mL Negative for Acetaminophen, Alprtizolam, Amitriptyline, Amphetamine, Cnrisoprodol, Chlordiazepoxide, Clonazepam, Cocaine, Codeine, Cyanide, Cyelobenzaprine, Desipramine, Diazepam, Doxepin, Fenttinyl, Flubromazolam, Hydroeodone, lmipramine, Lorazepam, Meperidine, Methadone, Methamphetamine, Meprohztmate, Methylenedioxymelhamphetamine Midazolam, Nordiazepam, Norlriptyline, Oxazepam, Oxyeodone, Phenazepam, Pheneyelidine Phentermine, Propoxyphene, Sertraline, Stryehnine, Temazepam, Tramadol, Trazodone, Verapamil, and Zolpidem. An Accredited Laboratory 1 N. Minneapolis . Wichita. Konsos 67214-3129 . Telephone (3T6) 660-4800 . Fox (316] 383-4535 Page I of 2 All Speeimenn will be retained according, to RFSC Specimen retention policy. This report ttot be erupt in full, the iv't'ittett approval" oftt?tc laboratotzv. FORENSIC LABORATORY DIVISION TOXICOLOGY LABORATORY REPORT NAME: LAMO, Adrian TOXICOLOGY CASE NO: 18-0225 Agency Case No: 18?18?0749 Submitted by: S. Kipper, MD Date Received: 16 Mar 18 RESULTS, cont. Blood (Femoral): Gabapentin 91.0 meg/mi} Citalopram 0.19 mg/L Positive 0.50 mg/L) Etizolam 5.0 ng/mL Flubromazepam 222 ng/mL Negative for Flubromazolam and Phenazepam. Urine: Ethanol Negative Acetone Negative Flubromazepam Positive Etizolam Positive Negative for Amphetamine, Barhiturates, Benzoylecgonine, Cannabinoids, Codeine, Flubromazolam, Hydroeodone, Methadone, Methamphetamine, Morphine, Phenazepam, Pheneyelidine and Salicylates. Brain: Etizolam Not Detected Flubromazepam Positive Negative for Flubromazolam and Phenazepam. Kidney: Negative for Arsenic and Bismuth. Physical Evidence Item H2 (rectangular green tablet): Alprazolam Positive *Analysis performed by AXIS Forensic Toxicology, Inc. Indianapolis, IN. Not accredited for the test(s) by ASCLD/LAB-lnternational or any other ILAC MRA signatory. ResultsCertitied by: ?4 Date' 22 Timothy P. Rolirig, F- ABFT Director and Chiel Toxicologist All specimens. will be retained according to RFSC specimen retention policy. This report shalt not be reproduced except in ftth?. without the written approval of the laboratory. An ASC LD/LAB-fntemationat Accredited Laboratory 1109 N. Minneapolis . Wichita, Kansas 67214-3129 . Telephone (316] 660?4800 . Fox {316] 383-4535 Page 2 of 2