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 San Diego Medical Examiner
5570 Overland Avenue, Suite#101
San Diego, CA 92123-1206
(858) 694-2895

Case Number
Investigator
Date of Death
Date Today

2017-02857
Michael Ellano
11/26/2017
12/27/2017

INVESTIGATIVE NARRATIVE
Decedent: RITTEL, Monica Lee
Antemortem Events:
On 11/28/17, the following information was obtained through UCSD Medica Center medical records. The
decedent was a 34-year-old female with a history of multi-substance abuse. On 11/24/17, the decedent and
multiple other people were using heroin and methamphetamine in an encampment. The decedent became
unresponsive and someone called 911. When paramedics arrived, the decedent was found pulseless and apneic.
Advanced cardiac life support was initiated and the decedent was transported to the hospital along with the
other people with various complaints following an overdose. During transport, they were able to regain her
pulse. She was admitted to the emergency department and was noted to be obtunded. Her Glasgow Coma
Score was 3 and her pupils were fixed and dilated. She was intubated and placed on life support. She was
hypoxic and in severe metabolic acidosis. A CT scan of the head was performed to rule out any neurological
insult or brain herniation. A chest CT showed infiltrates, most likely secondary to aspiration. She was
transferred intensive care unit with a grave prognosis. Over the course of her hospitalization, her neurological
status deteriorated. A brain flow study was performed on 11/26/17 by Dr. Brain Lemkull and brain death was
declared at 1344 hours. On 11/27/17, a second brain flow study was performed by Dr. Sweeney and brain death
was confirmed at 1330 hours. The Medical Examiner’s Office was contacted by Charles Wainanaina from
Lifesharing on 11/28/17 at 0939 hours and advised of the brain deaths. The decedent remained on life support
pending organ donations.
Past Medical, Surgical, and Social History:
According to medical records, the decedent had a history of bipolar disease and multi-substance abuse.
Scene Description:
The scene given was UCSD Medical Center Intensive Care Unit located at 200 W. Arbor Drive in San Diego.
Body Description:
The body was not viewed due to the case being handled in office.
Special Requests:
There were no special requests at the time of this report.
Identification:
The San Diego Police Department was contacted by hospital staff for assistance in identification. Fingerprints
were taken and she was identified as Monica Lee Rittel through fingerprint comparison.
Tissue Donation:
On 11/28/17, Lifesharing requested eye, skin and organ donations. I discussed the case with Dr. V. Snyder and
authorization was given for any all donations.
Antemortem Specimens:
Antemortem blood samples were to be couriered to the Medical Examiner’s Office by Lifesharing.
Public Administrator:
No referral was needed.
Page 1 of 2
2017-02857

 Other Important Factors:
I contacted the San Diego Police Department Dispatch Center and asked if they could research the call on
11/24/17 and determined where the incident occurred. After researching the electronic log, there was no report
taken. The hospital had contacted the police department on 11/25/17 and requested fingerprints be taken to
identified the decedent. An officer responded and case number E17-110039499 was assigned and she was
identified as Monica Rittel on the same date through fingerprint comparison.

Signed:

12/27/17
Michael Ellano
Medical Examiner Investigator

Approved by: ___________________________________________

Page 2 of 2
2017-02857

 County of San Diego
GLENN N. WAGNER, D.O.

STEVEN C. CAMPMAN, M.D.

CHIEF MEDICAL EXAMINER
(858) 694-2895

CHIEF DEPUTY MEDICAL EXAMINER
(858) 694-2895

MEDICAL EXAMINER’S DEPARTMENT
5570 OVERLAND AVE, STE 101, SAN DIEGO, CA 92123-1215
http://www.sdcounty.ca.gov/me/

EXTERNAL EXAMINATION REPORT

Name:

MONICA LEE RITTEL

ME#:

2017-2857

Place of death:

UCSD Medical Center
San Diego, CA 92103

Age:

34 Years

Sex:

Female

Date of death:

November 26, 2017; 1344 Hours

Date of examination:

December 2, 2017; 0930 Hours

___________________________________________________________________________
CAUSE OF DEATH:

COMPLICATIONS OF ANOXIC/ISCHEMIC ENCEPHALOPATHY

Due To:

RESUSCITATED CARDIOPULMONARY ARREST

Due To:

ACUTE FENTANYL AND METHAMPHETAMINE INTOXICATION

MANNER OF DEATH:

ACCIDENT

OPINION: According to investigative information and review of medical records from
UCSD Medical Center, this 34-year-old woman had a history of polysubstance abuse. On
November 24, 2017, she was found unresponsive after allegedly using methamphetamine
and heroin. A 911 call was placed; emergency personnel responded and found with
pulseless electrical activity. They initiated cardiopulmonary resuscitation with return of
spontaneous circulation. She was intubated and brought to the emergency room. She had
acidosis and lung infiltrates consistent with aspiration. A computed tomography (CT) scan
of her head demonstrated findings consistent with anoxic encephalopathy with no evidence
of trauma. Her urine drug screen was positive for opiates and amphetamines. She was
declared dead by neurologic criteria and underwent organ donation. Medical records
indicate she also had a history of bipolar disorder.
An external examination with toxicology was performed on December 2, 2017, in the San
Diego County Medical Examiner’s Office and documented a well-developed, obese,
woman with evidence of medical intervention and organ-tissue donation. There were
several small bruises on her extremities. There were no significant traumatic injuries.

 EXTERNAL EXAMINATION REPORT

-2-

MONICA RITTEL 2017-2857

Toxicology testing performed on blood collected at the hospital detected fentanyl (10
ng/mL), methamphetamine (0.02 mg/L), and metabolite amphetamine (less than 0.02
mg/L). No alcohol was detected.
Based on the examination and the circumstances of the death as currently understood, the
decedent died of complications of a mixed drug intoxication (overdose) due to the
combined toxic effects of fentanyl and methamphetamine. The cause of death is listed as
complications of anoxic/ischemic encephalopathy due to resuscitated
cardiopulmonary arrest due to acute fentanyl and methamphetamine intoxication,
and the manner of death is classified as accident.

BETHANN SCHABER, M.D.
Deputy Medical Examiner
Date signed:

 EXTERNAL EXAMINATION REPORT

-3-

MONICA RITTEL 2017-2857

IDENTIFICATION: The body is identified by blue and yellow Medical Examiner's
identification bands fastened around the right ankle bearing the decedent's name and case
number. In addition, the blue Medical Examiner’s identification band indicates a height of
67 inches and a weight of 214 pounds (as received). In addition, a UCSD Medical Center
identification band bearing the decedent’s name is on the left wrist and a donor
identification band with donor ID “AEK3445” is on the left ankle.
WITNESSES: There are no outside witnesses.
Specialist Stephen Hannum.

I am assisted by Forensic Autopsy

CLOTHING: The body is unclad when initially viewed. There is no clothing accompanying
the body.
EVIDENCE OF MEDICAL INTERVENTION:
1.
An endotracheal tube is in situ in the mouth secured with a plastic and adhesive
tube tamer around the face and neck.
2.
An orogastric tube is in situ in the mouth.
3.
Single lumen intravascular catheters are in the lateral right neck.
4.
Single lumen intravascular catheters are in the right antecubital fossa and ventral
right wrist.
5.
Therapeutic puncture sites are on the ventral right forearm, ventral left wrist, left
antecubital fossa, and abdomen.
6.
A Foley catheter is in situ in the tip of the urethra.
7.
EKG electrodes are on the hips.
8.
Electrocautery pads are on the anterior thighs.
9.
Pulse oximetry monitor is on the right index finger.
10.
An intraosseous catheter puncture site is in the anterior left lower leg.
ORGAN AND TISSUE DONATION: Orange antiseptic residue covers the chest, abdomen,
and pelvis. A coarsely sutured incision extends from the sternal notch to the pubis.
Paperwork accompanying the body indicates the heart, liver, portion of spleen, lymph
nodes and vessels were donated.
EXTERNAL DESCRIPTION
The body is of a well-developed, well-nourished, 67 inch, 214 pound woman with truncal
obesity and lightly pigmented skin whose overall appearance is consistent with the
reported age of 34 years.
The head is normocephalic. The scalp is atraumatic. The curly, thick, dark brown scalp
hair measures up to 6 inches in length. Portions of the temporal scalp hair are short, 3/16
inch in length. The nose and facial bones are intact by palpation. The eyes have clear

 EXTERNAL EXAMINATION REPORT

-4-

MONICA RITTEL 2017-2857

corneae and brown irides, and conjunctivae are without hemorrhage, petechiae, or icterus.
The nose is normally formed, and the nares are unobstructed. The oral cavity has natural
teeth in good condition and an atraumatic mucosa. The ears are normally formed and
without drainage. The neck is symmetrical.
The chest is symmetrical. The breasts have no palpable masses. The abdomen is obese
and soft to palpation. Orange antiseptic residue is present on the torso and a coarsely
sutured incision extends from the sternal notch to the pubis consistent with organ donation.
The back is symmetrical and unremarkable. The upper extremities have no needle track
marks or ventral wrist scars. The fingernails are short. The nailbeds are clean. There is
black fingerprint ink present on the finger pads. The lower extremities are obese. There
are no deformities or amputations. The toenails are short, painted with variable amounts of
green nail polish. The soles of the feet are callused and slightly dirty. Black ink “X” marks
are on the feet (radiology marking).
The genitalia are of an adult woman. There is no trauma to the genitalia or anus.
SCARS: Several small, irregular, scars are on the upper chest.
TATTOOS: Multiple polychromatic tattoos are on the torso and extremities.
POSTMORTEM CHANGES: Rigor mortis is full in the upper and lower extremities, neck,
and jaw. Livor mortis is posterior, purple-red and nonblanching to pressure. The body is
cool (refrigeration).
EXTERNAL INJURIES
There are minor blunt force injuries of the extremities.
Three purple-blue contusions 1 inch in diameter are on the ventral right upper arm.
Six purple-blue contusions 1/4 inch in diameter up to 1 inch in diameter are on the ventral
left upper arm. A cluster of four purple-blue contusions 1/8 – 1/4 inch in diameter are on
the dorsal left wrist.
A purple-red contusion 2 x 1/2 inch is on the lateral right thigh. Three purple-blue
contusions 3/16 inch in diameter are on the medial right knee. A purple-red contusion 3 x 1
inch is on the medial right lower leg.
A cluster of purple-blue contusions 1/8 inch in diameter up to 2 x 1/2 inch are on the medial
left thigh. A purple-blue contusion 3 x 2 inches is on the medial left lower leg. A purpleblue contusion 2 x 1 inch is medial left ankle.

 EXTERNAL EXAMINATION REPORT

-5-

MONICA RITTEL 2017-2857

SPECIMENS
TOXICOLOGY: Two gray-top peripheral blood specimens are received from Lifesharing
along with antemortem blood.
HISTOLOGY: No tissue is retained and no specimens are submitted for microscopic
examination.
PHOTOGRAPHS: Facial identification photographs are taken.
X-RAYS: None.

BS:clb
D: 12/2/17 T: 12/4/17
Rev. 12/20/17 clb

 TOXICOLOGY REPORT
Name:
Medical Examiner Number:
Date of Death:
Time of Death:
Pathologist:
Specimens Received:
Date Specimens Received:

RITTEL, Monica
2017-02857
11/26/2017
1344
Bethann Schaber, M.D.
Antemortem Blood/Serum, Peripheral Blood 1, Peripheral Blood 2
12/01/2017, 12/04/2017

Test Name (Method of Analysis)

Specimen Tested

Alcohol Analysis (GC/FID-Headspace)
Alcohol (Ethanol)
Acetone, Isopropanol, Methanol

Antemortem Blood

Drugs of Abuse Screen (ELISA)
Amphetamines
Benzodiazepines
Buprenorphine
Cannabinoids
Carisoprodol
Cocaine metabolites
Fentanyl
Methadone
Opiates
Oxycodone
Phencyclidine (PCP)
Zolpidem

Antemortem Blood

Amphetamines (LC/MS)
Amphetamine
Methamphetamine
Ephedrine
MDA
MDMA
Phentermine
Phenylephrine
Pseudoephedrine

Antemortem Blood (Serum)

Fentanyl (GC/MS)

Antemortem Blood

Result
Not Detected
Not Detected

Presumptive Positive
Not Detected
Not Detected
Not Detected
Not Detected
Not Detected
Presumptive Positive
Not Detected
Not Detected
Not Detected
Not Detected
Not Detected

Detected (<0.02 mg/L)
0.02 mg/L
Not Detected
Not Detected
Not Detected
Not Detected
Not Detected
Not Detected
10 ng/mL

Antemortem Blood/Serum was collected on 11/24/2017 at 1344 hours
Unless otherwise requested, all specimens will be destroyed six (6) months after the closure of the case by the Medical Examiner
End Results

2017-02857

An American Board of Forensic Toxicology (ABFT) Accredited Laboratory

Page1 of 2

 Approved and Signed:
12/18/2017

2017-02857

Iain M. McIntyre, Ph.D.
Forensic Toxicology Laboratory Manager

An American Board of Forensic Toxicology (ABFT) Accredited Laboratory

Page2 of 2