SACRAMENTO COUNTY CORON ER CLASSIFICATION 2 Case No- 1 T403351 1 Final Classi?cation Suicide 3 Deputy Assigned Zhanna Khabetyuk 43 Date of Death 5? 9.51017 41:: Found? DECEDENT PERSONAL DATA 5 Name First: Hector 6 Name Middle: Name Last: Martinez Ba Time of Death 14:35 En Fndr'EstiUnk: 9 Sex 10 Raoe Male Filipino, Puerto Rican 11 Date of E'irth 312311982 12 Age 35 Years 1 3 Marital Status Never Married RESIDENCE 14 Usual Address 555 Rook?port Drive 15 City Los Bands 1 6 County Meroed 1 6 a State CA 1? Zip Code 93635 IDENTIFICATION 13 Remains Identi?ed by or how identi?ed VARGAS. Maria Fingerprints RELATIVES MARTINEZ, Hector SALDIVAR, Martha Father Mother PLACE OF DEATH 21 Place of Deelh Prison 22 Street Address 300 Prison Road 23 City Represe 24 County Sacramento 25 Zip REMAINS 26 Death Reported By CLEVELAND 2? Removed To Coroner Yes 28 Type of Medical Examination Full Autopsy CAUSE OF DEATH 29 Cause Hanging due to: due to: due to: OTHER SIGNIFICANT CONDITIONS 30 History of suicidal attempts. 31 Manner of Death 32 Place of Injury Suicide Prison 33 At Work? 34a Date oflnjurg.l No on 91281? 34b FndIEst?Jnk 35 Address or Looelion 300 Prison Road Eda Time of Iniury 36o FndiEsULlnk Unk. INFORMATION 3? City Represe 38 Geo nty Sacramento 39 Zip Code 956711 40 Describe how The decedent hanged himself injury occurred CASE SUMMARY See Page 2 Date Signed 81'191?201? Zhenne yfbatyuk p-g-mn?Fn-v-u-n-u. - . SACRAMENTO COUNTY CORONER Final Case Summary On 06H 9201?, the Sacramento County Coroner's Of?ce received a report of the decedent?s death from Folsom Prison. As required by Government Code, Section 21491, an inquiry was made into the death. The decedent was removed to this of?ce where an examination was performed by Kenny Su, MD. The cause of death was determined to be: Hanging Other Signi?cant Conditions: History of suicidal attempts. The decedent was found hanging in his secured prison cell by prison personnel during a scheduled body count. A scene investigation was conducted and noted no evidence of suspicious circumstances. No suicide note was found inside the cell. The decedent had history of suicidal attempts and recent suicidal ideations. Based on the circumstances and cause of death. the manner will be listed as Suicide. County of Sacramento Department of Coroner 4300 Broadway, Suite 100 Sacramento, CA 95320-153? Kimberly 1). Girl Coroner IE Autopsy El External Examination NAME: MARTINEZ, HECTOR CASE NO. 17?03 351 POSTMORTEM DATE: 06f21?7 TIME: 10:35 INVESTIGATOR: Zhanna Khabatyuk AUTOPSY FINDINGS: l. Injury and ligature marks: A. Ligature marks partially encircling the neck II. No evidence of obvious trauma or blunt force injury besides ligature marks lli. Toxicology is positive for antidepressants including sertraline and mirtazapine. CAUSE OF DEATH: Hanging OTHER CONDITIONS CONTRIBUTING BUT NOT RELATED TO THE IMMEDIATE CAUSE OF DEATH: History of suicidal attempts Keng-Chih Eu, MD. Forensic Pathologistmeuropethologist August 11, 201? MARTINEZ, HECTOR 17-03351 2 WITNESSES: None. IDENTIFICATION: The body is identified by a Sacramento County Coroner?s ID tag attached to the left great toe. labeled with the decedent?s listed name and case number. EVIDENCE OF MEDICAL INTERVENTION: The following are present, and are in proper position: De?brillator pads on the chest. There has not been organ procurement. CLOTHING: None. EVIDENCE OF EXTERNAL TRAUMATIC INJURY AND ASSOCIATED INTERNAL TRAUMATIC INJURY: All wound measurements are taken with the body in anatomic position unless otherwise stated. Injum and ligature marks: A. Ligature marks partially encircling the neck, 1M to SIB inch in width. B. No evidence of obvious trauma or blunt force injury besides ligature marks. EXTERNAL injuries are described previously. The body is identified by toe tags and is that of an unembalmed refrigerated, adult male who appears about the reported age of 35 years. The body weighs 154 pounds, measures 65 inches, and is extremely obese (Body Mass 25.6, Obesity: BMI of 30 or greater). Wrist scars are absent. Tattoo is present including: Symbol of dog at the left neck. figure of a scorpion at the left hand, letters of at the back, and claw marks at the right lateral tower leg. Rigor mortis is present. Livor mortis is present and ?xed at the posterior. The head is normocephalic and covered by brown hair. There is no balding and the hair can be described as 5 inches in length and wavy. Mustache is present. Beard is present. Examination of the eyes reveals irides that appear to be brown in color and sclerae that are unremarkable. There are petechial hemorrhages of the lids. The oronasal passages are unobstructed. Upper and lower teeth are present. Dentures are absent. The neck is unremarkable. 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 circumcised. The external genitalia are without trauma or lesions. The extremities show no edema, joint deformity, abnormal mobility, non?therapeutic punctures or needle tracks. INTERNAL The following observations are limited to findings other than injuries, it described above. INITIAL The body cavities are entered through the standard coronal incision and the standard Y-shaped incision. NECK: Injuries are described previously. 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. MARTINEZ, HECTOR 17-03351 3 CAVITY: Both pleural cavities contain scanty clear fluid and have no adhesions. The lungs are well- expanded. Soft tissues of the thoracic and abdominal walls are well preserved. The subcutaneous fat of the abdominal wall measures 1 inch. The organs of the abdominal cavity have a normal arrangement and none is absent. There is no ?uid collection. The peritoneal cavity is without evidence of peritonitis. There are no adhesions. SYSTEMIC AND ORGAN REEIEW MUSCULOSKELETAL SYSTEM: No abnormalities of the bony framework or muscles are present other than those noted above. CARDIOVASCULAR SYSTEM: The aorta is fairly elastic and of even caliber throughout with vessels distributed normally from it. The thoracic and abdominal aorta has no atherosclerosis, calci?cation or The meter branches of the aorta show no abnormality. Within the pericardial sac. there is a minimal amount of serous fluid. The heart weighs 360 grams. it has a normal configuration. The right ventricle is 0.4 cm thick, the left ventn'cle is 1.6 cm thick, and the septum is 1.6 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: Tricuspid valve 14 cm, pulmonic valve 6.5 cm, aortic valve 6 cm. and mitral valve 11 cm. There is no endocardiai discoloration. There is no abnormality of the apices of the papillary musculature. There are no defects of the septum. The great vessels enter and leave in a normal fashion. The ductus arteriosus is obliterated. The coronary calls are widely patent. There is a normal pattern of coronary artery distribution. There is no coronary atherosclerosis and no narrowing of the major coronary arteries. The blood within the heart and large blood vessels is liquid. RESPIRATORY SYSTEM: Scent secretions are found in the upper and lower bronchial passages. The mucosa is intact and pale. The lungs are unremarkable and there is dependent congestion. The left lung weighs 600 grams. The right lung weighs 910 grams. The visceral pleura are smooth and intact. The is moderately congested. The pulmonary vasculature is without thromboembolism. GASTROINTESTINAL SYSTEM: The esophagus is intact throughout. The stomach is not distended. It contains about 20 cc of pink 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 soft greenibrown stool. The pancreas occupies a normal position. There is no trauma. The is lobular and firm. The pancreatic ducts are not ectatic and there is no calci?cation. HEPATOBILIARY SYSTEM: The liver weighs 1766 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 40 cc of bile and no calculi. There is no obstruction or dilation of the extrahepatic ducts. The periportai nodes are not enlarged. URINARY SYSTEM: The left kidney weighs 160 grams. The right kidney weighs 120 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- MARTINEZ, HECTOR 17?03 3 51 4 pelvic fat is not increased. The ureters are without dilation or obstruction and pursue their normal course. The urinary bladder is distended. it contains about 325 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 220 grams and is of average size. The capsule is intact. 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. ENDOCRINE SYSTEM: The thyroid is unremarkable. The parathyroid glands are not identified. 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 1390 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: Femoral blood, heart blood. liver tissue, bile. stomach 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: Two diagrams were used during the performance of the autopsy. The diagrams are not intended to be a facsimile and are not drawn to scale. MARTINEZ, HECTOR 17-03351 RADIOLOGY: None. EVIDENCE: One white rope consisted of pieces of bed-sheets is coliected from a bag beside body. NMS Labs CONFIDENTIAL 3701 Welsh Road, PO Box 433A, Willow Grove, PA 19090-0437 Phone: (2153 EST-4900 Fax: {215} ssr-zsrz go LA ii 5 e-mail: (31? Robert A. Middleberg, F-ABFT, DABCC-TC, Laboratory Director Toxicology Report Patient Name MARTINEZ, HECTOR . Patient ID 1 7-03 351 Report Issued 07(11l201? 16.04 Chain 17198119 Age 35 DOB 03f28l'1982 Gender Male To: 1176 Sacramento i'Joontyr Coroner Workorder 17198119 Alin: Kim Gianathology 4300 Broadway, Suite 100 Sacramento, CA 95320 1 0f 4 Positive Findings: Mam Besu_t new Positive 001 - Femoral Blood Sertraline 140 UB1 - Femoral Blood 12ml not - Femoral Blood Mirtazapine 16 DB1 - Femoral Blood See Detailed Findings section for additional information Testing Requested: Analysis Code Description BUBZB Postmortem, Expert, Blood (Forensic) Specimens Received: ID TubelContainer Volume! Collection Matrix Source Miscellaneous Mass DatelTime Information 001 Gray Top Tube 10.3 mL 10:35 Femoral Blood All sample volumesiweights are approximations. Specimens received on 06l2?l2i]1?. NMS RECEIVED 14:03 FRDM- 8777039515 TOE CONFIDENTIAL Workorder 17198119 MS Chain ?198119 Patient lD 17-03351 H. Page 2 of 4 Detailed Findings: . Rpt. Analysis and Comments Result Units Limit Specimen Source Analysis Ely Positive {101 - Femoral Blood GCIMS Sertraline 140 ngr?mL 10 ?101 - Femoral Blood 1200 ngr'mL 20 {int - Femoral Blood LC-MSIMS Miriazapine 1E ngr'mL till 001 . Femoral Blood GE Other than the above ?ndings, examination of the specimenls} submitted did not reveal any positive findings of toxicological signi?cance by procedures outlined in the accompanying Analysis Summary. Reference Comments: 1. - Femoral Blood: The reported qualitative result for this substance was based upon a single analysis only. It con?rmation testing is required please contact the laboratory. 2. Desmeihylsertraline {Norsertraline; Sertraline Metabolite} - Femoral Blood: is the principal metabolite of sertraline and has about it] to 20% of the pharmacologic activity of the parent compound. Fifteen adults taking 20!) mg daily sertraline had mean trough serum concentrations of [range 40 189 In a report of seven postmortem cases in which sertraline was not related to the cause of death, deemethyisertr?aline concentrations were BB - 990 ngl?mL in heart blood. A patient survived an acute overdose with a semm concentration of 1700 Her included confusion, agitation, lever and seizures. 3. Mirtazapine lRemeronE} - Femoral Blood: Mirtazapine has been used clinically as an antidepressant since 1994. It is available as tablets containing 15, 30 and 45 mg. Daily doses for adults are usually in the range of 15 to 45 mg. The oral bioavailability of the drug is approximately 513%. It is well distributed and metabolized to several weekly active products, including Steady-state plasma levels following a daily regimen: 15 mgl'day: 27 - 51 (peak); 4.3 - 12 ngme (trough} 30 mglday: 55 - 104 ngr?mL (peak); 11 - 25 (trough) 45 mglday: 34 - 142 (peak); 1? - 39 ngirnl. [trough] 60 mgl'day: 11? 199 (peak); 25 - 52 ngimL (trough) 7?5 mgrday: 13? - 225 (peak); 25 - 64 ngimL {trough} in one case involving an apparent overdose with mirtazapine, a postmortem blood concentration of 2700 was reported. 4. Seriraline {ZolofttE} - Femoral Blood: Sertraline is a selective serotonin reuptaire inhibitor used in the treatment of depression. The initial adult dosage is 50 mg daily and can be increased to a maximum of 200 mg daily. Sartraline is subject to signi?cant ?rst pass metabolism with as the principal metabolite. Overdose with sertraline may cause sleepiness, nausea, tachycardia, and mydriasis. Fifteen adults taking 200 mg daily sertraline had mean trough serum concentrations of 29 ngr?mL (range 9 82 sertraline. The blood to plasma ratio for sertraline is approximately 1.2. In a report of seven postmortem cases in which sertraline was not related to the cause of death, sertraline concentrations were 233 - dill] in heart blood- Postmortem blood sertraline concentrations greater than 1,500 ngimL were considered to be contributory to death in a review of 75 cases. Apatient survived an acute overdose with a serum concentration of 2,900 sertraline. Her included confusion, agitation. fever and seizures. NMS RECEIVED 17 14:08 FROM- 87Ti'?39515 CONFIDENTIAL Workorder 1Y198119 Chain 1T1 981 1 9 Patient ID 1?-03351 Page 3 of 4 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 years from the date the analyses were performed. Workorder 17?198119 was electronically signed on 07l1'll201? 15:24 by: militant?. .. William H. Anderson, F-AEFT Forensic Toxicologist 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. lithe 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 521168 - Sertraline and Con?rmation, Blood (Forensicl- Femoral Blood -Analysis by High Perlon'nance Liquid Tandeml?utass Spectrometry for: Manama Baum; Slamming ?pt_.Ltn1it 20 ngi?mL Ser?tratine 10 Acode 523038 - Mirtazapine Con?rmation, Blood {Forensic} . Femoral Blood Analysis by Gas Chromatography for: em om 391ml: Midazapine 1U Acode 5092B .. Postmortem, Expert, Blood (Forensic) - Femoral Blood -Analysis by EnzymevLinlted Immunosorbent Assay (ELISA) for: EDLLi?lit Manned Elenzodiazepines mo Opiates 2D Metabolite 0.50 ngimL Oxycodone l?xymorphone 1t] Cannabinoids 1 Cl Salicylates 12D Cocaine Metabolites 20 ngr'rnL -Analysis by Gas Spectrometry (GCIMSJ for: Anesthetics, Anticoagulant Agents. Antifungal Agents, Antihypertensiye Agents, Anxiolytics {Benzodiazepina and others}, Hypnosedatiyes {Barbituratea Non?Benzodiazepine Hypnotics, and others) and Non-Steroidal Anti-In?ammatory Agents (excluding Salicylate). -Analysis by Gas Spectrometry for: The following is a general list of compound classes included in the Gas Chromatographic screen. The detection of any particular compound is concentration-dependent. Please note that not all known compounds included in each speci?ed class or heading are included. Some speci?c compounds outside these classea are also included. For a detailed list of all compounds and reporting limits included in this screen, please contact HMS Labs. Amphetamines, Analgesics (opioid and non-opioid), Anorectics, Anticholinergic Agents, Anticonyulsant Agents, Antidepressants, Antiemetic Agents, Antihistamines, Antiparkinsonian Agents, Agents, Antitusslye Agents, Antiviral Agents, Calcium Channel Blocking Agents, Cardiovascular Agents {non-digitalis), Local Anesthetics Agents, Muscle Relaxants and Stimulants (Amphetamine-like and others). NMS 1it?l?? RECEIVED i? 14:08 FROM- 877??39515 T05 CONFIDENTIAL Workorder 1??!93119 Chain 1T193119 Patient ID 17-03351 Page 4 of 4 Analysis Summary and Reporting Limits: -Analysis by Headspace Gas Chromatography for: Eamnumod ?oumound BuLJhn? Acetone 5.0 mgde Isopwpanol 5.0 mgde Ethanol 1O mgi'dL Methanol 5.0 mgde NMS [18.0 RECEIVED 14:08 3??7039515