DEPARTMENT OF THE ARMY
HEADQUARTERS, UNITED STATES ARMY MEDICAL COMMAND
2m worm: an
FORT SAM IIOUS1DN. TEXAS muster

   

mm 
or

Freedom of Information/ 28 February 2013
Privacy Act Office (13700259)

Mr. Jason Leoiold

Dear Mr. Leopold,

This is in response to your Freedom of Information Act (FOIA) request dated 3
December 2012 for a complete copy of the autopsy reports pertaining to the
Guantanamo detainees known as Adnan Farhan Abdul Latif (ISN 156), Hajji Nassim'
"lnayatullah") (ISN 10029). and Awal Gul (ISN 782)." Your request was received
on 3 December 2012 and processed in accordance with the Freedom of Information Act
(FOIA) 5 United States Code 552. I apologize for the delay in responding to
your request due to the need to coordinate with a number of agencies.

Enclosed is the Amended Final Autopsy Report of Naseem, Haji (AKA
Inayatullah) ISM-010028 and the Amended Final Autopsy Report of Gul, Awal ISM-782.
Information is being withheld pursuant to Title 5. USC, Section 552 and
Exemption permits the government to withhold information about
individuals when the disclosure would constitute a clearly unwarranted invasion into the
personal privacy ofa third person. Exemption permits the withholding of
Special Agent names when an unwarranted invasion of personal privacy could
reasonably be expected and Exemption permits the withholding of information
when the safety or life of any individual could reasonably be endangered by the release
of that information.

Adnan Farhan Abdul Latif (ISN 156) is still the subject of an active and ongoing
investigation by the Naval Criminal Investigative Service His autopsy report is being
withheld pursuant to FOIA Exemption We are therefore unable to process this
portion of your request at this time.

Because your request has been panially denied. you are advised of your right to
appeal this determination to the Secretary of the Army, If you decide to appeal at this
time. your appeal must be submitted within 60 days of the date of this letter. In your
appeal, you must state the basis for your disagreement with the partial denial and the
justification for the release of information associated with your request for this
command, Your appeal should be addressed to: CDR US Army Medical Command,
Attention: Freedom of Information/Privacy Acts Office (MCPA), 2748 Worth Road STE
21. Fort Sam Houston, Texas 78234-6021, for forwarding, as appropriate, to the Office
of the Secretary of the Army. Please enclose a copy of this letter along with your

 

Appeal.To ensureproperprocessing
of anyappeal,the letterandthe envelopeshould
bothbearthe notation,
"Freedomof Information
ActAppeal."
Shouidyou haveany questionsregarding
the processing
of the enclosed
documents
I maybe reachedat (210)221-7826
or email
1@amedd.armv.mil.
iohn.petefson

JohnP. Peterson
Chief,Freedomof lnformatiorl/
PrivacyActs Office
U.S.ArmyMedicalCommand
Enclosures

 DEPARTMENT
OFTHEARMY

ARMEDFORCESES
MEDICAI.EXAIIINER
1413RESEARCH
BLVD
ROCKVILLE,
MD208tt0

AMENDED*
FINAL AUTOPSYREPORT
Name:NASEEM,Haji (AKA Inayatullah)

rsN-010028
Dateof Birth:Unknown(197311974)
Dateof Death:18MAY 201I
Dateof Autopsy:19MAY 201l, 0100hours
Dateof Report:07JUN 201I
Dateof AmendedReport:ll FEB 2013

FTI
Autopsy1.Is.
; I bxTx
Rank:Civilian(Detainee)
Placeof Death:Guantanamo
Bay
Placeof Autopsy:US NavalHospital
Bay,Cuba
(
Guantanamo

Circumstances
of Death:
(AKA Lnayatullah),
Haji Naseem
a civiliandetainee,
wasfoundhangingwith a ligature
(bedshect)aroundhis neckin therecreation
areain his cell blockat JointTaskForce
Guantanamo
Bay,Cubaat approximately
0335hourson l8 MAY 201l. Theligature
wilscut andresuscitation
effortswerestartedimmediatelyin thecell andcontinuedat the
localmedicaltreatmentfacility. All effortsfailedto revivehim. He waspronounced
deadat 0453hours. Thecaseis underinvestigation
by theNavalCriminalInvestigative
Service(NCIS).
Authorizationfor Autopsy: Office of the An4edForcesMedicalExaminer,LAWTitle
l0 US Codel47l
Identification:
Haji Naseem(AKA Inayatullah)is identifiedby visualrecognitionandhis detainee
identifications
tags.Fingerandfoot printsareobtainedby NCISanda tissuesampleis
collected
for DNA identification,
if needed.
CAUSEOF DEATIT:
Hanging
MANNER OF DEATH:
Suicide
s NOTE: Report is amendedto correcttypographicalerror in the headerof pages28; nameis "Inayatullahttnot tlnayarullahttandpage2. No otherchanges.

 AUropsy REpoRrFtrl(r-t-l

NASEEM,Haji (AI{A Inayatullah)
NCIS PRELIMINARY ITWESTIGATION
Accordingto preliminary
NCISinvestigation,
on themorningof l8MAY20l I NCIS
SpecialAgentsof NCISRUGuantanamo
Bay,Cuba,werenotifiedof thecustodialdeath
of Naseem
Inayatullah,
aboardNavalStationGuantanamo
Bay,Cuba.Inayatullalr
was
foundhangingby a bedsheetin therecreation
areaadjacentto his cell.NCISconducted
anexamination
of thedeathscene;resultsarependinglaboratoryfindingsfrom the
UnitedStatesArmy CriminalInvestigation
laboratory.
MEDICAL RECORDSREVIEW
Reviewof Haji Naseem's
medicalrecords
reveals
at agel5 for auditory
hospitalization
hallucination
andtwopriorsuicideattempts
duringhiscurrentdetention.Thefirst
suicideattemptwason 26 MAR 2009whenhewasfoundwith cutson bothsidesof his (
neck.He wasadmittedto theBehaviorHealthUnit (BHU)for a yearandwasdischarged
fromtheuniton 25 OCT201l. Thesecond
suicideattemptwason 2l APR2009when
helacerated
botharmsandblamedit on theJinn(Demons).Sincehisdischarge
from the
BHU on 25 OCThedeniedsuicidalthoughtsor auditory/visual
andhe
hallucinations,
wasstableon his medication(Risperadal
I mg beforebed). He hadnoothersignifrcant
illnesses.
A copyof themedicalrecords
is on file.

LIGATURE
Theligature(whitebedsheet)is collected
asevidence
by NCISat thesceneand
examined
by theprosectorandtheobservingcivilianmedicalexaminerprior to the
autopsy.Photographs
areobtainedfor documentation.
Thebedsheetis submittedin two parts,cutby first responders
at thescene.The
proximalpart,labeled# 3, is notedwith a smallloop(tiedarounda horizontalpipeat the
scene)andthedistalpart,labeled# l, is notedwith a knottednoose(wasaroundthe
neck).Bothareexamined,
photographed
andretainedby NCIS. Thereis no bloodstains
notedon theligature.

POSTMORTEMEXAMINATION
-_-lof
(AKA Inayatullah)
is
Thepostmortem
examinationFXTltF)
HajiNaseem
performed
(USNHGB),
at theUSNavalHospitalGuantanamo
Cuba
on
l9
MAY
Bay
201l, startingat approximately
0100hours. Full bodyfadiolosical
studiesareobtained
(bx6)
Attending the autopsyas medicolegalobserversare

 XTXF)
AUTOPSYREPO
NASEEM,Haji (AKA Inayatullah)

EXTERNALEXAMINATION
Thebodyis thatof a welldeveloped,
well-nourished
Caucasian
uncladmalewrapped
in
whitesheets.Clothingis submitted
separately;
sce"ClothingandPersonal
Effects". The
eyelidsareclosedwith a 0rinwhitetape.ExtemalAutomaticDefibrillator@AD)andEKG
padsarenotedon thechest;see"MedicalIntervention".
Thebodyis 68" in lengthandweighsanestimated
160lb,andappcars
with the
compatible
reported
ageof latethirties.Rigoris present
to anequaldegreein all extremities.Lividity
is present
andlxed on theposteriorsurfaceof thebody,exceptin areasexposed
to pressure.
Bodytemperature
is colddueto rcfrigeration.
Thescalphairis blackwith fewgrayhairs.Thefacialhairconsists
of blackmustache
and
longbeard,bothwith grayhair. Theeyesareuffemarkable.
Theiridesarebrown.The
corneae
areslightlycloudy.Theconjunctivae
andsclerae
with no
areunremarkable
petechiae.Theexternalauditorycanals,extemalnaresandoralcavityarefreeof foreign
materialandabnormal
secretions.
Thenasalskeleton
is palpablyintact.Thetongueis
unremarkable.
Thelipsarewithoutevidentinjury. Thefrenulaeareunremarkable.
The
teetharenaturalandunremarkable.
Examination
of theneckrevealsa broadpatterned
impression
ontheanteriorandbothsidesof thencck(ligaturemarlc/funow);
see"Evidence
of Injury". A faintscaris notedon therightsideof theneckbelowtheligaturemark;see
"Opinion".
Thechestis unremarkable.
No injuryof theribsor sternumis evidentexternally.The
abdomen
is unremarkable
with noevidence
torsois
of majorsurgicalscars.Theposterior
unremarkable
with noevidence
of externaltrauma.Theanusandsurrounding
skinare
unremarkable.
Theexternalgenitaliaarethoseof a normaladultcircumcised
male.
Theextremities
areunrcmarkable
with noevidence
of recenttrauma.Multipleinegular
scarsarenotedon theantecubital
fossae
andphotographed
for documentation;
see
"Opinion". Threeinegularhealedscarsarenotedontheposteriorleft shoulder
(one)and
theleft flank(two). No tattoos,majorsurgicalscarsor identifyingmarksarenoted.
EVIDENCEOF INJURY
NeckTrauma:
examination
Exrernat
of theneckrevehls
a ligatureimpression
aroundtheneck.A broad
reddishdiscoloration
is notedon theskinof theanteriorneck,overlyingthethyroid
t/nto l" in widthandwith upwardanglestowardstheposterior
cartilage
measuring
neck.

 AUTOPSYREPORTI(bX7XF)  
NASEEM,Haji (AI(A Inayatullah)
Theligaturemarkhasa maximumwidthof l" on theanteriormidline.Thewidthof the
ligatureimpression
on therightsideof theneckis tapered
intoa %" width,I %" inferior
andVz"anteriorto theright externalauditorycanal. Thewidthof theligatureimpression
on theleft sideof theneckis tapered
intoa %" width,3" inferiorandl" anteriorto the
left externalauditorycanal.Theligatureimpression
is incomplete
andfadesand
di.sappears
on theposterior
neck;see"Opinion".
Dissection
andexamination
of the.strap
muscles
of theneckrevealslocalized
hemorrhage
in therightsterno-hyoid
muscleandleftthyro-hyoid
theabovenoted
muscleunderlying
ligatureimpression.
No othertraumais noted.Thehyoidboneandthyroidcartilage
are
intact.
SoecialProcedures:
or muscular
Theneck,backandextremitiesaredissected
to detectanysubcutaneous
mobility.No
withno excessive
injuries.Thecervicalvertebrae
areunremarkable
hemorrhage
is notedin theleft
injuries,recentor remote,arenoted.Slightsubcutaneous
antecubital
areaandis consistent
with extravasation
of bloodduringresuscitation.
CLOTIIING and PERSONALEFFECTS
Thedeceased
clothingis submittedseparately.
A khakishirtandpantsandwhite
generalissueof thedetention
and
underwear,
for documentation
centcr,arephotographed
personal
retainedby NCIS. No
effectsarenotedon thebody.
MEDICAL INTERVENTION
is notedasfollows:
Evidence
of activemedicalintervention
- EAD andEKGpadson thechest.
puncture
bandage
on the
sitesonthearms,with pressure
- Multipleintravenous
rightsideandgazeandtapeon theleftside.
INTERNAL EXAMINATION
BODY CAVITIES:
of
collections
Mhesionsarenotedin left pleuralcavity,unknownetiology.No abnormal
normal
fluid arepresentin anyof thebodycavities.All bodyorgansareprcsentin the
wall is unremarkable.
position.Thesubcutaneous
fat layerof theabdominal
anatomical
region.
of bluntor sharpforceinjuryto thethoraco-abdominal
Thereis nointernalevidence

 -]
AUTOPSY
REpoRTl&x7xt)
NASEEM,Haji (AKA Inayatuilah)
HEAD: (CENTRALNERVOUSSYSTEM)
Thegalealand.subgaleal
tissues
revealnoevidence
of trauma.Theduramaterandfalx
cerebriareintact.Thereis noepidural,suMuralor subarachnoid
hemorrhage
present.The
leptomeninges
arethinanddelicate.Thecerebral
hemispheres
aresymmefical.The
structures
at thebaseof thebrain,includingcranialnervesandbloodvessels,
areintact.
Coronalsections
throughthecerebralhemisphere.s
revealno lqsions.Transverse
sections
throughthebrainstemandcerebellum
areunremarkable.
Thebrainweighsl2B0grams.
Serialsectioning
of thebrainrevealsunremarkable
parenchyma
andnoevidence
olmauma.
NECK:
See"Evidence
of Injury".
Examination
of thesofttissues
of theneckincludingstrapmuscles,
rhyroidglandandlarge
vessels
areunremarkable
andwithoutothertraumatic
abnormalities.
Thehyoidboneand
thyroidcartilageareintact.Multiplesmallsoftpolypoidlesionsarenotedin thelarynx
(piriformrecesses).
CARDIOVASCTJLAR
SYSTEM:
Thepericardial
surfaces
aresmooth,glistening
andunremarkable;
thepericardial
sacis free
of significantfluid andadhesions.
Thecoronary
arterie.s
arisenormally,followtheusual
distributionandarewidelypatentwith mild,?Sc/o,
atherosclerotic
changas
of theleft
anteriordescending
artery(LAD). Theepicardium
is smoothandunremarkable.
The
myocardium
is darkrcd-brown,
firm andgrosslyunremarkable.
Thevalvesexhibitthe
usualsize,textureandpositionrelationship
andareunremarkable.
Theaortaandits major
branches
arisenormally,follow theusualcou$eandarewidelypatent,'free
of significant
alherosclerosis
andotherabnormality
(mildstreaking
is notedon thedistalaorta).The
venaecavaeandtheirmajortributaries
rctumto theheartin theusualdistribution
andare
freeof thrombi.Theheartweighs370grums.
RESPIRATORYSYSTEM:
See"BodyCavities".
Theupperairwayis clearof debrisandforeignmaterial;themucosalsurfaces
aresmooft,
yellow-tanandunremarkable.
Therightpleuralsurfaces
areunremarkable.
Bothlungs
revealsignificantblackanthracotic
pigmentation.
Thepulmonary
parenchyma
is red-purple
andexudesa moderate
amountof bloodyfluidandfroth. No focallesionsidentified.The
pulmonary
arteriesarenormallydeveloped,
patentandwithoutthrombus
or embolus.The
rightandleft lungweighs980gramsand7T}grams,
respectively.
LIVER & BILIARY SYSTEM:
Thehepaticcapsuleis smootlt,glisteningandintact,coveringdarkred-brown,
moderately
parenchyma
congested
with nofocallesionsngted.Thegallbladder
geen-brown,
contains
mucoidbile;themucosais velvetyandunremarkable.
Theextratrepatic
biliarytreeis
palent,
withoutevidence
of calculi.fire liverweighs1590grams.

 AUTOPSYREPORTFITXFTI
NASEEM,Haji (AKA Inayatullah)
ALIMENTARY TRACT:
in
is arranged
smoothmucosa.Thegastricmucosa
Theesophagus
is linedby gray-white,
partiallydigested
food,a
Thestomach
contains
theusualrugalfoldsandis unremarkable.
vascular
mucosal
or
of
is
no
evidence
for
There
which
is
submitted
toxicology.
sampleof
hasa normalpink+an
Thepancrcils
injury. Thesmallandlargebowelsareunremarkable.
andunremarkable.
is pre.sent
andtheductsarepatent.Theappendix
appearance
lobulated
GENITOURINARYSYSTEM:
andstripwith easefromthe
arcsmoolhandthin,semi-transparent
Therenalcapsulas
from
Thecorticesaresharplydelineated
corticalsurfaces.
underlyingsmooth,red-brown
pelves
Thecalyces,
to tanandunremarkable.
themedullarypyramids,whicharcred-purple
clear
and
contains
is
unremarkable
bladder
Theurinary
anduretersareunremarkable.
yellowurine.Therightandleft kidneyweighs140and150grams,respectively.
prostatc
adultmalewith unremarkable
arethoseof a circumcised
Theexternalgenitalia
testes.
unremarkable
glandandbilaterallydescended

(

RETICULOENDOTHELIAL SYSTEM:
ltrm parenchyma;
moderately
the spteenhasa smooth,intactcapsulecoveringred-purple,
The regionallymphnodesappearnormal.The
the lymphoidfolliclesareunremarkable.
weighs215grams.
spleen
ENDOCRINESYSTEM:
Thepituitary,thyroidandadrenalglandsiueunremarkable.
MUSCTJLOSKELPTALSYSTFM:
arenoted.
is normal.No grossboneof joint abnormalities
Muscledevelopment
EVIDENCE
by NCIS.
photographed
andretained
Theclothingandligatureareexamined,
RADIOLOGICALSTUDIES
or abnormalities.
revealno recentskeletalfractures
Radiographs
NIICROSCOPICEXAMINATION
of
withoutpreparation
of themajororgansareretained
sections
Representative
slides.
histological

 AUTOPSYREPORT(bx7xF)
 
NASEEM,Haji (AK,l tnayatullah)
TOXICOLOGY
CarbonMonoxide:
saturation
- Carboxyhemoglbin
in bloodis lessthanI Vo(expected
normallimits)
Cyanide:
- Not detected
Volatiles(BloodandViueousfluid):
- No ethanolis detected.
Screened
medication
anddrugsof abuse(Urine):
- No illicit drugsof abusearedetected.

ADDITIONALPROCEDURES
l. Documentaryphotographsare taken

(b)(6)

2. Full bodyradiographs
NavalHospital (
of Radiology,
areobtained
by Department
Bay,Cuba.
Guantanamo
retained
for toxicological
are:Blood
3. Specimens
and/orDNA identihcation
(peripheral),
vitreousfluid,bile,urine,stomach
contents,
andtissuesamples
from
liver,lung,kidney,splecn,brain,psoasandheartmuscleandadipose
tissue.
4. Representative
sectionsof organsareretainedin formalinwithoutpreparation
of
histological
slides.
5. Clothingandligaturearephotographed
for documenlation
andretained
by NCIS.
6. Posterior
dissection
of theneck,backandextremities.
FINAL AUTOPSYDHGNOSIS
I. Hanging:
A. Ligaturemarkpartiallyencirclingtheneck.
B. No evidence
of othernecktraumaor fractures.
C. No evidence
of othertraumatic
injuries.
II. NaturalDisease:
A. Lrft pleuraladhesions,
unknownetiology.
B. Multiplelaryngeal
smallpolyps.
III. Bvidence:
andretained
by NCIS.
- Ligatureandclothingareexamined
IV. Toxicologr:
A. Carbonmonoxide:
Lessthanl7o.
B. Cyanide:Notdetected.
C. Volatiles(BloodandVitreousfluid):No ethanolis found.
(Urine):No illicit drugsof abuseare
D. Screened
drugsof abuseandmedications
detected.

 AUTOPSYREPOR XTXF)
NASEEM,Haji (AKA Inayatullah)
OPINION
Haji Na.scem,
AKA Inayatullah,a civilian detaineeof late thirties,died from asphyxia
due to hanging. He was found suspended
from a horizontalpipe in the cell block's
recreationareawith a bed sheetaroundthe neck. Autopsyrevealsno evidenceof other
significanttraumaor evidenceof maltreatment.
Multiple scarsarenotedon the right sideof the neckand the antecubitalfossaearemost
probablyrelatedto his documentedtwo prior suicideattemptsin Marchand April 2009.
The threescarsof the left shoulderand left flank areof unknownetiology.
ToxicofogicalstudiesrevealCarbonmonoxidelessthan lVo,andars negativefor
cyanide,ethanol,and illicit drugsof abuse.
Reviewof the decedent'smedicalrecordsrevealshistoryof mentalillnessduring
childhoodrequiringhospitaladmissionandtwo suicideattemptsduringdetentionin
March and April2009 requiringa yearin the BHU.
Baseduponthe curently availableinfi

the mannerof deathis "Suicide"

 DEPARTMET.IT
OFTHEARMY

ARMEDFORCES
]IIEDICAL
EXAi'II.IERSYSTET'
1413RESEARCH
BLVD,BLDG1O2
FOCKV LLE,
l[D 2@!io

AMENDED*
FINAL AUTOPSYREFORT
Name:GUL, Awal
ID No: ISN-?82
Dateof Birth: 1962(48 years)
Dateof Death:0l FEB 201I (2339hours)
Dateof Autopsy:03 FEB 2011,0?00hours
DateofReport:23ruB 2011
Date of Amended Report M IIIAR 20lI

AutopsyNg; (
AFIP No.: x7)(F)
Rank:Civilian (Detainee)
Placeof Death:Guantanamo
Bay
Placeof Autopsy:US NavalHospital
GuantanamoBay,Cuba

Circunstanccs of Death:
Mr. Awal Gul, a 48 year-olddetaineen
collapsedin the showerroom aftsr223Ahours.
Earlier he wasexe:cisingon the treadmill,andcomplainedof beingtired after5 minules.
He went to showerwherehe collapsed.He wasnotedwith his backto the showerwalt
foamingaroundthe mouth. He wascarriedby otherdetaineesto the cell block gate.
CodeYellow wascalled at2238andCPR wasstartedimmediately.He wasnoted
withoutspontaneous
respirationor pulseandCodeblue wascalled. He was transported
to the US Naval HospitalGuantanamo
Bay (USNHCB) in asystole.He waspronounced
deceased
at2339hours,on 2 FEB 2011.
Mr. Gul hada medicalhistoryof obesityandpoorlycontrolledhypertension.He had
complained
of chestpainon 28 Jan201l. Laboratorytes8on the 28h rcvealedno
evidenceof myocardialischemiaorsignificantabnormalities;see"Review of Medical
Records".
Authorization for Autopsyl Office of the Armed ForcesMedical Examiner,tAW Title
l0 US Codel47l
Identification:
Mr AwalGul, ISN 782,is identifiedby visualrecognition
anddetainee'sidentification
tags. He is positivelyidentifiedby fingerprintscomparisonby the FBI, DoverAFB on
08 FEB 2011. A tissuesampleis collectedfor DNA identification.
Causeof Death:
AtheroscleroticCardiovascularDisease
Mannerof Dealh:
Natural

 REmRTI(bx7xF)
AUTOPSY

 

GUL, Awal OSN 7E2)
MEDICAL RECORDS nEVTEW
The availablemedicalhealthrecordsarescreenedby the prosectorandthe observing
civilian medicalexaminerprior to the autopsy;see"PostmortemExamination".
Reviewof the medicalrecordsrevealsthe following in the more recententries:
Mr. Gul wasin an overallgoodhealth. He hadpastmedicalhistoryof hypertensionand
andobesity(BMI over30.0). He
non+ompliancewith ireatment,hypercholesterolemia,
in l}tz}m, bilateralkneeosteoarthritis,andlatentTB
hadalsohistoryof appendectomy
(positivePPD in Oct 2002; INH treatmentwascompleted).
On 0l DEC 2009,he complainedof upperchestpain for two weeks"with no signsof
distress,
only whenhe eatingor drinking. He believedthatthis painis dueto acidreflux
andrequesteddiet recommendation.
to themedicalareacomplainingof a
On 28 JAN 201l, Mr. Gul wastransported
pain
in the centerof thechest Therewereno
chest
localized,non-radiating,squeezing
symptomsotsigns- EKG showeda normalsinusrhythm,miqil{
otherassociated
wide QRS or
criteriafor left ventriiular hypertrophyandno ST elevation/depression,
anhythmias,Laboratorytestsfor CreatineKinase(CK-MB) andCardiacTroponinl
(cTnl) werewirhin normallimis. The differentialdiagnosisof hischestpainwas
Reflux Disease(GERD). He wasto be seen
atypicalchestpain vs. Gastro+sophageal
againin a week. He died on 0l FEB 2011at 2339hours.

POSTIIORTEM BXAMINATION
The postmortemexaminationl(bX7XF) lonAwal Cul is performedat the US Naval
Bay (USNHOB), Cubaon 03 FEB 201l, surting at approxim.ately
HosiiratGuanranamo

areobtained
MJ GB.Photographs
procedure
Assistingin theautopsy

by
ls

Attendi

theautoosyas

observers
andSpecial

EXTERNAI/ EXAMINATION
whitesheets.
uncladobesemalecoveredby multi_ple
The bodyis thatof awell-developed,
Handsand feetweretied togettreiwith white ribbonswith attrchedidentificationtagswith
theremains.
his nameandISN number.No clothingorpersonaleffectsaccompanies
a@ly220lbs,with no evidenceof extemal
68" andweighsanapproxim
The bodymeasures
present
equal
degreein all extremities.Uvidity is
o
an
traumaor abnormalities.Rigor is

 AUTOPSYREFORT
GUL,Awal (ISN 782)
presenland fixed on the posteriorsurfaceof thebody,exceptin areasexposedio pressur.
is cold dueto refrigeration.
Body temperature
The scalphairis black-graywith prominentmalebaldness.Thefacialhairconsistsof black
The iridesarebrown.Thecomeae
mustache
andlong beard.Tlreeyesareunremarkable.
areslightlycloudy. The conjunctivaeappearinjectedwith no petechiae.The scleraeare
on theright side. Theexternalauditorycanals,
whitewith a smallareaof hemorrhage
externalnaresandoral cavity arefiee of foreignmaterialandabnormalsecretions The
The lips arewithoutevident
nasalskeletonis palpablyintacl The tongueis unremarkable.
Examination
The teetharenaturalandunremarkable.
injury- The frenulais unrernarkable.
mobility.
or
abnormal
of theneckrevealsno evidenceof trauma
No injuryof theribsor sternumis evidentexternally.
Thechestis hairyand unremarkabte.
with no evidenceof
protuberant,
butotherwiseunremarkable
markedly
is
The abdomen
quadrant,
consisBntwith a
lowerabdominal
tn1uma-A suryicalscaris notedon theright
with
No otherscarsarepresent.The posteriortorsois unremarkable
remoteappendectomy.
no evidenceof traumaor abnormality. Theexlemalgenitaliaarethoseof a normaladult
testes.The anusis unremarkable.
descended
circumcisedmalewith unremarkable
with no evidenceof recentttauma.
The upperandright lower exuemitiesareunrernarkable
left
leg. The handsare
disUl
on
$e
are
noted
unknown
of
etiology
Contusions
No tiattoos,
and
unremarkable.
clean
nails
are
with no trauma The finger
unremarkable
othermajorsurgicalscarsor identifyingmarksarenoted.

EVTTIBICEQI S"{JURY
trauma-A small
of externalor intracranial
of theheadrevealsnoevidence
Examination
trauma
with
no
overlying
head
the
back
of
is notedon the
hemorrhage
areaof subgaleal
is
hemonhage
skullfracture;see"Opinion".A smallareaof
underlying
of thescalp-or
notedin thetongue;ser "Opinion".
of theneckrevealsnoevideneof externaltraumaor ligaturemarks.
Examination
on fte left
smallfocalareaof hemorrhage
reveals
of thestrapmuscles
Examination
cartilageare
and
thyroid
bone
hyoid
The
muscle;
sre
"opinion".
sternocleidomastoid
or
spinaltraumamuscular
evidence
of
no
of theneckreveals
dissection
intact.Posterior
of
hemorrhage
a smallareaof superficial
of theanteriorchestwall reveals
Examination
fiactureof rib # 3, anteroanteriormuscleoverlyinga non-displaced
theleft serratus
left ribs* 3,4,6 and7
fractured
of thechestcagereveals
Iaterally.Examination
with minimal
ribsareassociated
junction.Thdfractured
anterioily,at thestrno-chondral
abdomen
chest,
of
the
intemal
examination
and
see"Opinion".Exiernal
hemorrhige;
andgenitaliarevealsnootherevidenieof trauma.

 AUTOPSYREPORT
GUt, A$nNI(ISN 782)
Examinationof the upperandright lower extremitiesrevealsno evidenceof trauma.
Examinationof the lefi leg revealstwo contusionson the anteriorandmedialdistalleg,
well abovethe ankle.
Seriallongitudinalincisionson the backandextremitiesrevealno svid€nceof recentor
for documentation.
rcmoteinjuries;photographed

Nonereceived.

M.gDIQAL INTERVENTTPN
examination
tubeanda neckguardarenoted.cT-scanandpostmortem
An endotracheal
"Opinion"'
see
esophagus;
tbe
in
tubeinserted
theendotracheal
reveals
INTENNAL EXAMINATION
BODY CAYTTIES:
600ccof fluidandclottedblood;see
sacreveals
tttei"tactpericardial
E-*ti--ti""
.Cardiovascular
"f System".No abnormal
in thechestor
of fluidis present
coltection
Mild
irrreased.
markedly
fat
is
cavities"Theamountof intra-abdominal
abdominal
remote
the
with
wall,consistent
arenotedof the€cilm to theabdominal
adhesions
pogitign'The
anatomical
normal
prwent
in
the
organs
arc
All body
appendectomy.
atthe
?'thick
measuring
is
incr6ased,
walt
layeroi thJabAominat
sukutaneousfat
thorace
the
to
injury
of bluntorsharpfiorce
umbilicus.Thereis nointernalevidencc
region.
abdominal
IIEAD: (CENTRALNERVOUSSYSTEM)
or subaachnoid
subdural
lltr dr* materandfalxerebri areintact.Thereis noepidural,
are
hemispheres
cerebral
The
delicate.
and
are
thin
present.
The
leptomeninges
hemonhage
blood
and
nerves
cranial
including
the
of
brain,
atthebase
symmeriJal.Thestro.turcs
revealno bsionsthroughthecerebralhernispheres
vlssols,areintact.Coronalsections
Thebrain
throughtlrebrainst€mandctrebellumareunremarkablesections
Transverse
andno
parenchyma
unremarkable
reveals
the
brain
of
weighs1300grams.Seriilsectioning
evideneof trauma
NECK:
of Injury''.
Seei'Evidenoe
thyroidglandandlarge
strapmuscles,
of theneckincluding
of theiofl fissues
Examination
Thehyoidboneandthyroid
abnormalities.
andwithouttraumatic
areunremarkable
vessels
cartilageareintact.

 r(b)(7xF) I
AUTOPSYR.EFORT
GUL, Awd (ISN 782)
CARDIOVASCULAR SYSTEM:
The pericardialsurfacesarcsmooth,glisteningandunremarkable;
thepericardialsacis
distendedwith 600cc of fluid andclotredbtood.
Thecoronaryarteriesarisenormally,follow theusualdistributionandarewidelypatent
witlr no atherosclerotic
changes,exceptfor tJreleft anteriordescendingartlry (LAD).
SerialsectionsthroughtheLAD revealmarkednanowingof its lumen,pin pointshortly
afterits takeoff theleft maincoronaryartery. Focalcalcifications
arc noted.
The heartweighs440gramsandis mildly enlarged.Examinationof the heartrerealsa
perforationof the anteriorleft ventricularwall, nearthebaseandtlreanteriorinterventricular
septum.The perforationmeasures
1.0crn in lengthon tlreepicardialsurfaceand I % x 0.5
cm on theendocardialsurface;photographed
for documentation.
Thesunounding
myocardiumis dark red-brown,firm andgrosslyunremarlcableThe valvesexhibitthe
usualsize,texurc andpositionrelationshipandareunremarkableThe aortaandits majorbranches
arisenormally,follow theusualcourseandarewidely
patent.The aortarevealsfany sreakswith no apparentcalcification
andno ulceration.The
majorarteriesarefreeof significantatherosclerosis
andotherabnormality.The vcnaecavae
andtheir majorributariesreturnto theheartin theusualdistributionandarefreeof
thrombiRESPIRATORY SYSTEM:
The upperainray is clearof debrisandforeignmaterial;themucosalsurfacesaresmooth,
yellow-tanandunremarkable.
The pleuralsurfaces
arcsmoothwith no adhesiorupresent.
Thepulmonaryparenchyma
is red-purpleandexudesa moderateamountof bloodyfluid
with no focallesionsidentified.The pulmonaryarteriesarenormallydeveloped,
patentand
withoutthrombusorembolus.The right andleft lungueighs580 gramsand490 gmrnq
respectively.
LIVER & DILIARY SYSTEM:
The hepaticcapsuleis smootlr,glisteningandinacL coveringdarlcred-brown,moderately
parenchyma
congested
with no focallesionsnoted.Thegallbladdercontainsgren-brown,
mucoidbile; themucosais velvetyandunremarkable.
Theextrahepatic
biliary treeis
patent,withoutevidenceof catculi. The liver weighs2300grams.
ALIMENITARY TRACT:
See"Medicalbrterven
tion",
lined
by gray-white,smoothmucosa.The stomachis distendedwith air
Tte esophagus
is
and50 cc of darkgreenpartiallydigestedfood,a sampleof whichis submittedfor
toxicologicaltesting.The stomachrevealsnoevidenceof ulceration.Thesmallandlarge
bowelsareunremarkable.
andthe
The pancreas
hasa normalpink-un lobulatedappearance
patenl
(Jp
ductsare
The appendixis absent appendectomy)-

 6

AUTOPSYREPORTl(bx7xF) I
GUL, Awal OSN782)

GENEOURINABY.SJSTEM:

andstripwitb easefromtbe
aresmoothandthin,semi-transparent
Therenalcapsules
corticesarcsharplydelineated
The
surfaces.
granular
cortical
red-brown
finely
underlying
Thecalyces,
unremarkable.
and
to
tan
red-purple
which
are
fromthemedullarypyramids,
and
Theurinarybladderis unrcmatkable contains
pelvesandureters
areunremarkable.
cloudyyellowurine.Ttrerightandleftkidneysweigh180gramsand160
clearslightly
grafns,raspectivelyadultmalewithbilaterallydescended
Theext€malgenitaliaarethoseof a circumcised
testes.
unremarkable
RETICULOENDOTHELIALSYSTEM:
fnrn parerrchyma;
coveringred-purplamoderately
intactcapsule
@,
Theregionallymphnodesappearnormal.The
thelymphoidfolliclesareunremarkable.
spleenweighs180grams.
SYSTEM.i
ETI{DOCRINE
@d r i g hta d re n a l g l a n d sa rE unr em afkable.Asm allwel 
gland.
is notedin theleft adrenal
0.5cm adenoma
circumscribed
MUSCULOSKELETALSISTEM:
of Injury".
See"Evidence
arenotedon
boneorjointabnormalities
is normal.No non-traumatic
Muscledevelopment
grossexamination.

EVIDENCE
Nonecollected.
RADIOLOGICALSTUDIES
Verbalpreliminary
or abnormalities.
revealno recentskeletalfractures
Radiographs
tube
pericardial
sacandendotracheal
revealsdistended
TheCT-Scan
oUtained.
report-is
intotheesophagus.
inserted
IdICROSCOPICE)(AMINATTO,N
of histological
with preparation
setionsof themajororgarsareretained
Representative
slides.
Slides# 1-6Heart:
hemonhage,.fibrin
sitewithsunounding
site:Evidentperforation
1. perforation
Frbroblastic
prominent
with
infarction
of
area
andsurrounding
deposirion

 AuropsyREFoRTl6xr(F----]
GUL,Awal (ISN 782)

2.
3.
4.
5.

pmliferationconsistentwith over? days. The prominenceof fibroblastic
proliferationsuggestsl'2 weeksof age;see"Opinion"'
Sectionclosetoperforationsite: Multiple foci of prominentfibroblastic
t.
proli ferationconsisten
Section2 cm distalto perforationsite:Mulriple foci of prominentfibroblastic
proliferationconsistent.Mild myocytehypertlophicchangesarenoted.
i*ft Ventricle:Mild myocytehypertrophicchangesand perivascularfibmsis
arc noted.
Septum:Mild myocytehypertrophicchangesand perivascularfibrosisare

noted.
6. RightVentricle:Fattyinfiltration,mildSlide # 7z l*iAnlerior DescendingCoronaryArtery: Atheroscleroticchangesof the
LAD coronaryarterywith over75% focalnanowingof the lumenandfocal calcification.
macrophages'
changesanddarkpigment-laden
Slide # 8: Lungs:Postmortem
pathologicalchanges.
significant
No
Postmortemchanges.
Slide # 9: Spl&n & Pancreas:
changes'
Slide# l0: Thyroidgland:No significantpathological
changes.
pathological
significant
No
Slide# ll: Liver:
Stide# 12: Kidneys:No significantpathologicalchangesSlide # 13: I-eft Adrenalgland:Benignadenoma.
slide # 14: Right Adrenalgland:No significantpathologicalchanges.
Slide # 15: Prostategland:No significantpathologicalchangesSlide # 16: Testes:No significantpathologicalchanges.
changes.
Slide# l7-20t Brain:No significantpathological

TOXICOLOGY
CarbonMonoxide:
l% (l'3Va is expectedin-non- Carbxyhemoglobinsarurarionin bloodis lessrhaur'
smokeri, 31dEois expectedin smokersand0ver l0% is consideredelevated).
Volatiles(Blood andVitreousfluid):
- No ethanolwasdetected.
Cyanide:
- Therewas no cYanidedetected.
Screcnedmedicationanddrugsof abuse(Urine):
- Nonewerefound
ADDITTONAL PROCEDURES
aretakenotFf
photographs
l. Documentary
. ., . ,
---=l
Naval HCIpiul
of Radiology,
2. Full body Ci-b"un is obtaineOby Departrnent
GuantanamoBaY,CubaBlood
3. Specimensretainedfor toxicologicalandlorDNA identificationare:
vitreousfluid, bile, urine,stomach
(peripheraland from the hembpericardium),
conten6,and tissuesamplesfrom liver, lung,kidney,spleen,brain' psoas,heart
muscleandadiPosetissue-

 TEN7NF'-=I
AUTOPSYREPORT
GUL, Awal (ISN 7t2)
4. Vitreousfluid is submittedfor electrolytestesting.
sectionsof organsareretainedin formalinwith preparationof
5. Representative

histologicalslides. The histologicalslidesof the heartandcoronaryarteriesare
submittedfor CardiovascularPathologyConsultation;see"Opinion".

6. No Evidence
7. Soecial
8. x6)
asanindependent
autopsy

the

DilAGNOSIS
rrNdL-AUTO_Hry
Atheroeclerotic Cardiovascular Disease:
A. Rupturedrecentmyocardiatinfarction(ageover 7 days):No evidenceof
myocardialraring.
600cc of fluid andclottedblood.
B. Cardiactamponade,
right ventricle
the
C. Fattyinfiltration of
narrowing,pin point,of the LAD with focal
D. Markedatherosclerotic
examination).
calcification(over75%ste$osison microscopic
of hypertension.
wifh
history
consistent
capsules
granular
renal
Finely
E.
F. Atheromatouschangesof the aorta.
II. O0rer Flndings:
A. I-eft adrenaladenoma.
III. Evidenceof Injurl:
A. Focalsubgalealhemorrhage
minimalmusclehemonhage.
B. MultipleGft ril fracturesandassociated
and left antefior
C. Superfrcialhemorrhageof the left sternocleidomastoid
serratusanterior.
D- Two contusionson the distalleft leg.
III. Toxicologyr
A. Volatiles:No ethanolwas detected.
drugsof abuseandmedications:Nonewerefound.
B. Screened
C. CarbonMonoxideandCyanide:Not detected.
D. Elecrolytesof theVireous Fluid:No findingsof clinicalsigniFtcance-

oPrNloN
disease.
cardiovascular
diedfromatherosclerotic
Mr- AwalGul,a 48 year-olddetainee
left
wall
of
the
the
anterior
infarctionof
Theheartrevealsa rupluredmyocardial
are:a
changes
Otheratherosclerotic
ventricle,resultingin 600cccardiactamponade.
with focalcalcification,
examination)
LAD (over75%onmicroscopic
stenosed
severely

 AUTOPSYREFORTI(bX7XF) I
GUL, Awal (ISN 7E2)
atheromatus
changesof theabdominalaorta,andfinely granularrenalcapsulesconsistent
poorly
changes.
with a
The heartrevealsmild hypertrophic
controlledhypertension.
Microscopicexaminationof sectionsfrom the beartrevealsmyocardialischemicchanges
consistentwith over 7 daysof age. Histologicalsectionsof the heartandcoronaryartery
for morcdefinitive
aresubmittedfor Cardiovascular
PathologyConsultation
determinationof the ageof themyocardialinfarction. After review,the ageof the
with   -2 weeksold. No evidenceof remotemyocardial
cardiaclesionsis consistent
infarctions.
andmultipleleft
hemorrhage,
hemorrhage
The subgaleal
of theleft stemocleidomastoid
with rcsuscitation
is consistent
rib fractures(with minimalsunoundinghemorrfrage)
intubationis non-contributoryto thecauseand
effortsand intubation.The esophageal
mannerof death.
with poorcompliance,
Mr. Cul wasobese(BMI over30.0),hada historyof hypertension
potential
events.He
myocardial
of
are
indicators
and
obesity;
atl
hypercholesterolemia,
pain
hadno other
The
chest
chestpainon the28 JAN.
of localizedsqueezing
complained
with eating
signsor symptoms. The chestpainwasreportedlyassociated
associated
raisingthepossibilityof CERD. CK-MB andcNtl testingwerenegative.Mr. Gul was
on a treadmillwhenhedid not feel
to havea follow up within a week. He wasexercising
well, stoppedhis exercise,andwentto showerwherehecollapsed.
Microscopicexamination
of sectionsfrom theheartrevealsmyocardialischernicchanges
with over7 daysof age.The prominentfibroblasticproliferationnotedis
consistent
with myocardialinfarctionsof l-2 weeksage. Sectionsof theLAD
usuallyassociated
revealover75%stenosis.Sectionsfmm thelungs,liver,spleenandkidneyrevealno
is notedin theleft adrenal
significantpathological
changes.A benignadrenaladenoma
gland.
Toxicologicaltestsarenegativefor carbonmonoxide,cyanide,ethanolandscreened
andillicit drugsof abuse.Testingof thevitreousfluid for electrolytes
medications
revealsno clinicallysigni
imbalance
Mannerof deathis "Natural".

r Reportis anrendedto reflect the following:
  . Dateof Deathis 0   FEBar 2339hoursandnot02 FEB201t .
onthe2ls.
2. Historyof chestpainis onthe28of JANonly. Nochestpainis reported
lesionis l-2 weeks.
Theageof themyocardial
3. Heartsections
arereviewed.

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