Autopsy Report

Author:

Joan Wood

Date:December 6, 1995
Pages:7

MEDICAL EXAMINER
District SIX
Joan E. Wood, M.D.
10850 Ulmerton Road
Largo, Florida 34648
813-XXX-XXXX (FAX XXX-XXXX)
      Edward R. Corcoran, M.D.
     Associate Medical Examiner
Marie H. Hansen, M.D.
     Associate Medical Examiner
Robert D. Davis, M.D.
     Associate Medical Examiner
Larry R. Bedore, M.S.
     Director of Operations
Ronald R. Bell, B.S.
     Chief Toxicologist
Joel Scot Cary, A.S.
     Chief Investigator



REPORT OF AUTOPSY

Name: MC PHERSON, Lisa        Case # 1951474     Age: 36 yrs     Race: White     Sex: Female
Date of Death: Dec. 5, 1995              Body Identified by: Jeff Schaffner & David Slaughter<
Date of Autopsy: Dec. 6, 1995       at: 11:00 hrs     Authorized by: Joan E. Wood M.D., D.M.E
Investigative Agency: Clearwater Police Department       Agency Case # 95-29158

Manner of Death:   Undetermined
Immediate Cause of Death: Thrombo-embolism left pulmonary artery
                               due to: Thrombosis of left popliteal vein
                               due to: Bed rest and severe dehydration

FINAL ANATOMIC DIAGNOSES

Thromboembolus-left main pulmonary artery
Thrombosis of left popliteal vein
Severe dehydration
Multiple old and recent hematomas-extremities
Abrasion of nose
JW:md

(signed)
Joan E. Wood, M.D.
District Medical Examiner
           for
Robert D. Davis, M.D. Associate Medical Examiner

OFFICE OF THE MEDICAL EXAMINER - DISTRICT SIX
REPORT OF AUTOPSY

NAME- MC PHERSON, Lisa CASE NO.-1951474 PAGE 1

PROTOCOL

EXTERNAL EXAMINATION: The autopsy is begun at 11 AM on December 6, 1995. Present at the time of the autopsy is ID technician John Grubb of the Sheriff's Office. When first viewed the deceased is clothed in one multicolored T-shirt, one pair of black pants, two white socks, two white shoes, one gray sweater. Specifically absent is cash or jewelry. The body is that of a normally developed white female who appears 32 years of age and is of average nutritional status measuring 69 inches and weighing 108 pounds. Preservation is fair on the unembalmed body. The body is cold to the touch following refrigeration. Lividity is fixed on the back. There is a moderate amount of dark brown hair with terminal frosting with a maximal length of 8 inches. A Hippocratic facies is present. The eyes are open. The irides are brown. The sclerae are clear. The pupils measure 0.4 cm. The scalp is remarkable for showing "hooded" congestion. Brown eyebrows are present. Except for evidence of injury, the nose is unremarkable. The earlobes are pierced one time on each side. Teeth are natural and in fair repair. The neck is unremarkable. The chest is unremarkable as are the breasts. The abdomen is unremarkable. There is mild greenish discoloration of the lower abdominal quadrants bilaterally. Limbs are equal and symmetrically developed and the fingernail beds are blue. The back is unremarkable. The deceased is incontinent of feces. The medical record is present. Specifically absent are medications accompanying the body. Multiple photographs are obtained and considered a part of the protocol.

EVIDENCE OF TREATMENT: An orotracheal tube is in place. Intravenous puncture sites are present in the right antecubital fossa and an intravenous line is present in the left antecubital fossa. EKG pasties are present on the right and left wrists. On the dorsal aspect of the left wrist an intravenous line is present.

EVIDENCE OF INJURY:

HEAD AND NECK: "Mirror image" 1/4 inch drying abrasions are present at the tip of the nose. The nasal bone is intact. Crusted blood is present at the nares. Crusted brown dried material is present within the mouth, on the lips; crusted (dried) material is present on the eyelids. At the point of the chin there are adjacent abrasions; one of which, measures 0.3, the other 0.4 cm. Hooded congestion is present on the left side of the face.

EXTREMITIES: The dorsal aspect of the right lower arm just above the wrist is remarkable for showing several crusted confluent dark brown lesions consistent with "insect/animal bites." A hematoma is present over the proximal portion of the right third proximal metacarpal. Mixed contusions and insect-appearing bites vary in greatest dimension from 0.2 to 0.6 cm are present over the dorsal aspect of the right hand. On the volar aspect of the right third digit (distant phalanx) there is a 0.4 cm drying abrasion. The dorsal aspect of the left arm has crusted drying areas that vary from 0.1 up to 1.4 cm. Old (blue-green/brown) areas of discoloration consistent with old hematomas are present on the medial aspect of the left thigh over a

REPORT OF AUTOPSY
NAME- MC PHERSON, Lisa CASE NO.-1951474 PAGE 2

greatest area measuring 2-1/2 inches and to a lesser extent over areas measuring 1/2 and 3/4 inch. Over the medial aspect of the right knee there is a reddish-brown area with sharp margins. On the medial aspect of the left lower leg there are confluent old (green-brown) hematoma with indefinite peripheral ages. The dorsal aspect of both feet contain multiple drying scaling lesions that vary from 0.3 to 1.2 cm. On section these lesions in common lack an underlying hemorrhagic base even centrally and the margins are peripheral and sharp. Sections are obtained from such areas of the right foot. An abrasion is present above the lateral aspect of the right lower leg adjacent to Achilles tendon. Parallel to this there are superficial abrasions medial to it numbering two and averaging 1/4 inch. On the medial aspect of the right lower leg there are scattered old (green-brown with indefinite margins) hematomas that vary in greatest dimension from 0.3 to 1.0 cm. An old (yellow-green indefinite margins) 4 inch hematoma is present over the left posterior iliac crest. On the point of the right elbow posteriorly there is a healing laceration measuring 1/8 inch. Adjacent to this there is an "old" hematoma with a greatest dimension of 2 1/2 inches. Photographs are obtained of old bruises from the right flank posteriorly and from the left lower leg. Additionally bruises of the scaling-appearing lesions are present on the dorsum of the hands and feet also are submitted

TRUNCAL: At the point of the right shoulder there is a 3/4 inch drying abrasion. In the right suprailiac area there is an 6.5 cm. green brown (old) hematoma. In the left lower flank there is a green brown (old) 9 cm.(horizontal) by 4 cm. vertical hematoma.

INTERNAL EXAMINATION:

CAVITIES: Right and left pleural cavities are free of fluid and adhesions. The pericardial cavity has 2 cc of pale clear fluid. No adhesions are present. The peritoneal cavity is free of fluid or adhesions.

CARDIOVASCULAR SYSTEM: The 230 gram heart has a dominant right coronary artery. The coronary vessels show focal mild atherosclerosis. Specifically absent are areas of discoloration with softening and fibrosis.

RESPIRATORY SYSTEM; The 210 gram left lung is remarkable for showing a partially occlusive well-established thrombus which is multifocal. This is not associated with an infarct. The visceral pleura is unremarkable. The bronchial tree contains small amounts of blood-stained fluid. The parenchyma on section is dry, pink-gray and doughy. The main branch to the left pulmonary artery is occluded by well-established thrombus. The 210 gram right lung has an unremarkable visceral pleura. The opened arterial tree is free of antemortem thrombi. The bronchial tree contains moderate amounts of faintly blood-stained mucus. The tissue on section is doughy and gray-pink. Laryngeal and tracheal cartilages are intact and their mucosae is unremarkable.

REPORT OF AUTOPSY
NAME- MC PHERSON, Lisa CASE NO.-1951474 PAGE 3

CENTRAL NERVOUS SYSTEM: The 1390 gram brain has unremarkable meninges. The vasculature of the basilar and cerebral arterial circulatory systems are unremarkable. Gyri and sulci are unremarkable. Specifically absent is opacification of the meninges at the base of the brain. Bilateral tonsilar grooving without apposition is present. The brain is fixed for sectioning at a later date. With the dura removed, the base of the skull is free of fractures. Specifically absent are subscalpular hematoma.

URINARY SYSTEM: The 120 gram left kidney and 120 gram right kidney are similar. The renal arteries are patent. The external surface is smooth. The parenchyma on section is uniform and dark brown. The cortex averages 1.0 cm. Corti comedull ary junctions are well maintained. The pelvic calyceal system and ureters are unremarkable. The bladder contains 15 cc of urine. With this removed the bladder wall is unremarkable.

GENITAL SYSTEM: Uterus, tubes and ovaries are unremarkable and specifically absent is uterine enlargement.

HEPATOBILIARY SYSTEM: The 1270 gram liver has an unremarkable capsule. The liver on section is uniform and dark brown. No masses are identified. The gallbladder contains 10 cc of thick green viscid bile. The extrahepatic biliary system is unremarkable.

GASTROINTESTINAL TRACT: The esophagus is unremarkable.The stomach contains 30 cc of thick green viscid bile. The pancreas on section is uniform, gray-pink and moderately firm. The opened duodenum has neither food, ulcers nor masses. Externally the small intestine, appendix and coloware unremarkable.

LYMPHOPROLIFERATIVE SYSTEM: The 60 gram spleen has an unremarkable capsule. The parenchyma is moderately softened and dark red-brown. Abdominal and thoracic lymph nodes are unremarkable.

MUSCULOSKELETAL SYSTEM: See also EVIDENCE OF INJURY. It is otherwise unremarkable.

MISCELLANEOUS: Dissection of the left popliteal fossa reveals a thrombus. The right popliteal fossa is also examined and is free of thrombi.
RDD:jan/dlc

BRAIN AFTER FIXATION: The now fixed brain is examined on January 26, 1996 at 1440 hours. It weighs 1380 grams. The gyri are sulci are unremarkable. The vasculature of the basilar and cerebral arterial circular systems are unremarkable. Specifically at the base of the brain there is no opacification of the meninges. Representative sections of pons, medulla and cerebellum adjacent to the upper spinal cord are submitted including their meninges. The serially sectioned pons,

REPORT OF AUTOPSY
NAME- MC PHERSON, Lisa CASE NO.-1951474 PAGE 4

medulla and cerebellum are grossly unremarkable. The serially sectioned cerebrum has unremarkable gray and white matter. The lateral ventricles are unremarkable as is the basal ganglia. Scattered prominent vascular markings resembling petechia are present within the white matter of the left parietal lobe.

The upper spinal cord is unremarkable. The brain is retained.
RDD:me

MICROSCOPIC DESCRIPTION

LUNG: Sections of major pulmonary artery are remarkable for showing loosely adherent blood to the endothelim of the underlying vessel. Focally a layer of fibrin is present at the endothelium blood interface.
RDD:dlc

LABORATORY DATA

Cerebrospinal fluid culture and sensitivity:
     Gram stain: Rare white blood cells seen
     Culture: No growth after 72 hours
Cerebrospinal fluid bacterial antigens:
     Hemophilus influenza B: Negative
     Streptococcus pneumoniae: Negative
     N. Meningitidis groups A, C, Y and W135: Negative
     Neiserria meningitidis B/E. Coli K1: Negative
WMH:md

Vitreous sodium: 180 mmol/l
Vitreous potassium: 13.9 mmol/1
WMH:md

Vitreous urea nitrogen: 300 mg/dl
Vitreous creatinine: 2.6 mg/dl
Vitreous glucose: 15 mg/dl
Vitreous chloride: 161 mmol/l
Vitreous specific gravity: 1.337
WMH:md

OFFICE OF THE MEDICAL EXAMINER DISTRICT SIX
Pinellas & Pasco
Counties
10850 Ulmerton Road
Largo, FL 34648
813-XXX-XXXX
REPORT OF AUTOPSY
Toxicology Findings


Drug Screen Results:

Urine screen {TLC-Basic} was POSITIVE* for diphenhydramine.
Urine screen {Immunoassay} was NEGATIVE.


[* Confirmed by GCMS]



Drug Quantitation Results:

Ethanol: 0 gm/dl, Blood (Heart)
Ethanol: 0 gm/dl, Vitreous

(signed)
Ronald R. Bell, B.S.
Chief Toxicologist
Dec 15,1995

OFFICE OF THE MEDICAL EXAMINER
DISTRICT SIX


Identification of Deceased Person

Case# 1951474            Name of Deceased:    Lisa   Mc Pherson
Date of Death: Dec 5, 1995                       Invest. Agency



Person to whom the deceased was identified : Robert D. Davis, M.D., Assoc. Med. Exam.
Others Present: Julia Tyndall, Investigator
Date and Time of Identification Thursday Dec 7, 1995   14:40

Identification Made By:

Name: Jeff Schaffner            Relationship:Not Related
Address:XXXXX XXXXXXXXXX XX Clearwater, FL 34630
Duration of Acquaintanceship with Deceased Fifteen Years        Phone: XXX-XXXX
Comments:

Person to whom the deceased was identified : Robert D. Davis, M.D., Assoc. Med. Exam.
Others Present: Julia Tyndall, Investigator
Date and Time of Identification Thursday Dec 7, 1995   14:40

Identification Made By:

Name: David Slaughter            Relationship:Not Related
Address: XXXXX XXXXXXXXXX XX Clearwater, FL 34630
Duration of Acquaintanceship with Deceased Ten Years        Phone: XXX-XXXX
Comments: