JOSE HERNANDEZ ML 15-02828 AUTOPSY REPORT PIMA COUNTY, ARIZONA PIMA COUNTY SHERIFF'S OFFICE CASE # 151124005 NOVEMBER 25, 2015 Page 1MLI5-( 02828 Re: JOSE HERNANDEZ, Page 2 PATHOLOGIC DIAGNOSES: 1 Acute intoxication due to the combined effects of methamphetamine, cocaine, and methadone. Congenital bicuspid aortic valve. 2, Hypertrophy of heart (628 grams). b. Left ventricular hypertrophy (1.6 em). c. Arterionephrosclerosis. Abrasions of head, torso, and extremities without underlying vital injury. Contusions of torso and extremities without underlying vital injury. Undiagnosed skin disease, blistering, OPINION: In consideration of the known circumstances surrounding this death, the available medical history, and the examination of the remains, the cause of death is ascribed to an acute intoxication due to the combined effects of methamphetamine, cocaine, and methadone. ‘The manner of death is accident. Brie D. oo Peters, M.D. Forensic PathologistML15-02828 Re: JOSE HERNANDEZ Page 3 DATE OF DEATH: DATE OF AUTOPSY: PLACE OF AUTOPSY: PERFORMED BY: WITNESSED BY: HISTORY: November 24,2015 TIME OF DEATH: 01:08 Hours November 25,2015 TIME OF AUTOPSY: 10:30 Hours Pima County Office of the Medical Examiner 2825 E District Street Tucson, Arizona 85714 Eric D. Peters, M.D. Forensic Pathologist Gabriel Costell and Louie Goad Pathology Assistants Daniel Gottlinger, Pima County Sheriff's Department Intern; Detective Flores #1388, Pima County Sheriffs Department; Detective O'Connor #6322, Pima County Sheriff's Department; and Crime Scene Technician, Brian McGraw #3541, Pima County Sheriff's Department. This 34-year-old was reportedly acting bizarrely at a self-service car wash. He was noticed by law enforcement, and after a period of time he ran towards the adjacent road and traffic. He was tackled by law enforcement, handeuffed, and then was led back to a squad car when he was noticed to lose color, went limp, and suffered cardiae arrest. His past medical history is significant for bicuspid aortic valve (diagnosed in 2014 after he had collapsed unexpectedly), illicit drug use, asthma, hearing loss, and an unspecified skin disease PHOTOGRAPH! Photographs are taken during the autopsy by Eric D. Peters, M.D. Forensic Pathologist and Crime Scene Technician, Brian McGraw #3541, Pima County Sheriff's Department. IDENTIFICATION: ‘The body is identified by Pima County Sheriff's Department personnel, CLOTHING AND BELONGINGS: Catalogued in electronic database. EVIDENCE OF MEDICAL INTE NTION: 1) EKG leads are at the anterior torso. Defibrillator pads are in place.ML 15-02828 Re: JOSE HERNANDEZ Page 4 2) An intraosseous catheter exits the right shin, 3) A pullse oximeter electrode is at the left thumb. 4) A cervical collar is at the neck. 5) A vascular catheter exits the left antecubital fossa. 6) An endotracheal tube is in place. EXTERNAL EXAMINATION The body is received in the supine position within a white bag without numbered. seal (Comment: sealed with gray duct tape). The body is that of a well-developed, well-nourished, adult, light brown-skinned male who weighs 219 pounds, is 75 inches in length, and appears compatible with the reported age of 34 years. The body is cool. Rigor mortis is strong throughout. Livor mortis is nonfixed, pink and posterior. ‘The head is normocephalic. The scalp hair is brown with slight wave and with frontal balding. The irides are brown. The comeas are translucent. The sclerae and the conjunctivae are clear. No petechial hemorrhages are identified on the sclerae or conjunctivae. The nose is normally formed and the septum is in the midline. The anterior teeth are natural and in good condition No petechial hemorrhages are on the oral mucosa. The ears are unremarkable. There is stubble at the mustache and beard. ‘The neck organs are in the normal midline position and appear unrematkable, The thorax is well-developed and symmetrical. The abdomen is protuberant. The external genitalia are those of a normal adult male. The anus is free of lesions. ‘The upper extremities are well-developed and symmetrical without absence of digits, The fingernails are unremarkable, The lower extremities are well-developed and symmetrical without absence of digits. There are few hyperpigmented well healed scars at the inner aspect of the left shin up to 1-1/2 inch. The spine is normally formed and the surface of the back is free of lesions. ‘The decedent has multiple healed and healing circular to oval lesions up to 1/2 inch at the face, chest, and lower extremities. A few of these have a blistered appearance with some of these blisters scraped off. IDENTIFYING MARKS, SCARS AND TATTOOS: 1) There is a tattoo of an Asian character at the right shoulder region. EVIDENCE OF INJUR 1. BLUNT IMPACT TO HEAD: ‘There are approximately two dozen up to 3/4 inch irregular red abrasions at the forehead,ML 15-02828 Re: JOSE HERNANDEZ Page 5 cheeks, and chin with the largest at the right temple (Comment: Unclear if these are new injuries or lesions from known but unspecified skin disease). There are no palpable facial fractures. There are no underlying subscalp hemorrhages or skull fractures The brain weighs 1640 grams and is without injury. II, BLUNT IMPACT TO TORSO: There are few small red contusions up to 1 inch at the chest and upper abdomen, There are few punctate red abrasions at the upper right back up to 1/16 inch, There is no underlying soft tissue hemorrhage to the torso. ‘There is no underlying injury to the spine or axial skeleton or thoracic or abdominal viscera, 11. BLUNT IMPACT TO EXTREMITIE: There is a 1 inch linear red abrasion at the right triceps region. ‘There is an irregular 1- 1/2-inch red abrasion at the right elbow region. ‘There is an irregular 1 inch red contusion at the dorsal right forearm, There is an irregular 1-1/2 inch red contusion at the dorsal right forearm near the wrist. There are several linear red abrasions at the dorsal right hand, 1/2 inch-1-1/2 inch. There is a cluster of red abrasions up to 1 inch at the left elbow. There is a small linear red abrasion at the base of the left thumb. There is a linear red abrasion, 1/4 inch at the left ulnar wrist. There are two paired small red abrasions at the dorsal left hand, 1/2 inch, There is a linear red abrasion at the dorsal left hand at the base of the second and third fingers, 5/8 inch. ‘There is a 1 inch purple contusion at the outer right thigh. There is a 1/2 inch purple contusion at the lower right thigh. There is a cluster of regular red abrasions at the right knee up to 4 inches. There is a 1-1/2 inch linear red abrasion at the upper right shin. ‘There is @ 1-1/2 inch red contusion at the mid right shin, There is a 3/8 inch area of scab versus abrasion at the mid left thigh. There is a 1-1/2-inch laceration at the lateral left knee, There is an irregular 2 x 2 inch area of red abrasion at the left knee. Over a6 x3 inch area at the lateral aspect of the left lower leg is irregular red abrasion. There is a 1/8 inch red abrasion at the medial right and distal second toe. There is a 1/4- inch laceration to the outer aspect of the left fifth toe. There is a 1 inch red abrasion at the posterior left thigh near the knee. There is a 1/16 inch red abrasion at the lower rightML 15-02828 Re: JOSE HERNANDEZ Page 6 shin. There is no underlying palpable injury to the long bones. These injuries, having been described, will not be repeated. INTERNAL EXAMINATION ‘The body is opened with a routine thoracoabdominal incision. ‘The skeletal muscle has a dark red-brown color and a normal smooth texture. BODY CAVITIES: No adhesions or abnormal fluid collections are in the body cavities. The organs are in a normal and anatomic position. CARDIOVASCULAR SYSTEM: ‘The heart weighs 628 grams. The coronary arteries arise normally and have a right dominant distribution with no significant atherosclerosis. No thrombosis, plaque hemorthage, or dissection is within the atherosclerotic segments. ‘The chambers are not dilated. The valves are normally formed, thin and pliable and free of vegetations and degenerative changes except for the aortic valve which is bicuspid, focally thickened, and focally calcified. The myocardium is dark red- brown, firm, and free of fibrosis, erythema, pallor, and softening. The atrial and ventricular septa are intact and the septum and free walls are free of muscular bulges. The left ventricle measures 1.6 cm and the right ventricle measures 0.4 cm in thickness as measured 1 cm below the respective atrioventricular valve annulus. The interventricular septum measures 1.6 cm in thickness. The aorta and its major branches arise normally and follow the usual course with no significant aortic atherosclerosis. The orifices of the major aortic vascular branches are patent. The vena cava and its major tributaries are patent and return to the heart in the usual distribution and are unremarkable. RESPIRATORY SYSTEM: The right and left lungs weigh 760 and 690 grams, respectively. The upper and lower airways are unobstructed and the mucosal surfaces are smooth and yellow-tan. The pleural surfaces are smooth, glistening, and unremarkable. The pulmonary parenchyma is red-purple and free of consolidation and masses. ‘The cut surfaces of the lungs exude mild amounts of blood and frothy fluid. The pulmonary arteries are normally developed and unremarkable, There is no saddle embolus on in situ examination of the pulmonary trunk. HEPATOBILIARY SYSTEM AND PANCREAS: The liver weighs 2350 grams. The hepatic capsule is smooth, glistening, and intact, covering a red-brown congested parenchyma. A thin-walled gallbladder contains green watery bile withoutML 15-02828 Re: JOSE HERNANDEZ Page 7 calculi. The pancreas has a normal size, shape, position, and tan lobulated appearance. GASTROINTESTINAL SYSTEM: The esophagus is lined by a gray-white smooth mucosa. The gastroesophageal junction is unremarkable. The gastric mucosa is arranged in the usual rugal folds and the lumen contains 200 mi of partially digested food without pill or tablet fragments. The small bowel has a uniform dimension and appears unremarkable. The vermiform appendix is unremarkable, The colon has a uniform dimension and appears unremarkable. ‘There are no diverticula or externally obvious masses. GENITOURINARY SYSTEM: The right and left kidneys weigh 120 and 160 grams, respectively. The renal capsules are smooth, thin, semitransparent, and strip with ease from the underlying granular, red-brown, firm, cortical surfaces. The cortices are of normal thickness and delineated from the medullary pyramids. ‘The calyces, pelves, and ureters are non-dilated and free of calculi. The urinary bladder contains approximately 400 ml of clear, yellow urine. The bladder mucosa is gray-tan and smooth, The prostate has a tan cut surface and is not enlarged. The testicles are of normal size, shape and position with tan homogenous cut surfaces. RETICULOENDOTHELIAL SYSTEM: The spleen weighs 460 grams and has a smooth intact capsule covering a red-purple moderately firm parenchyma. Regional lymph nodes are grossly unremarkable. The thymus is involuted. ENDOCRINE SYSTI The thyroid gland is of normal position, size and texture. The adrenal glands have normal cut surfaces with yellow cortex and brown medulla. The pituitary gland is grossly unremarkable. NECK The soft tissues of the neck, including strap muscles and large vessels are unremarkable. ‘The hyoid and thyroid cartilage are intact. The laryngeal mucosa is unremarkable. The tongue is normal. HEAD: Reflection of the scalp reveals no abnormalities. ‘The skull is of normal thickness and without fracture. The brain weighs 1640 grams. The dura mater and falx cerebri are intact, and not adherent to the brain. ‘The leptomeninges are thin and transparent. There is no epidural, subdural or subarachnoid hemorthage. The cerebral hemispheres are symmetrical with @ normal gyral pattern, The structures at the base of the brain, including cranial nerves and blood vessels, are free of abnormality. Sections through the brain reveal noML 15-02828 Re: JOSE HERNANDEZ, Page 8 contusions, hemorrhage or mass lesions within the cerebral hemispheres, brainstem or cerebellum. The cerebral ventricles are of normal caliber. |USCULOSKELETAL SYSTEM The bony framework, supporting musculature, and soft tissues are unremarkable. The cervical spinal column is stable on internal palpation. SPECIMENS: Vitreous, peripheral blood, urine, and a DNA blood card are retained. EVIDENCE: The decedent was received with hands bagged (handbags discarded). HISTOLOGY SLIDE INDEX: Slide #1 Heart Slide#2 Liver, Kidneys, lung Heart: Moderate myocyte nuclear hypertrophy with increased perivascular fibrosis, Lung: No significant pathologie change. No foreign material upon polarization. Single microscopic focus with a marrow embolus within a small blood vessel Liver: Congestion. Kidney: Slight thickening of arterioles. TOXICOLOG See separate toxicology report.2265 Executive Drive, Indianapolis, IN 46241 ‘Telephone: (800)875-3894 / Fax: (317)243-2789, Laboratory Case Number: 3026829 Subject’s Name: HERNANDEZ, JOSE Client Account: 13399 / FSCO1-PETERS Forensic Science Center ATTN: Dr, Eric Peters 2825 E. District Street Tucson, AZ 85710 Fx: 620-243-8810 Laboratory Specimen No: 40537347 Container(s): 01;GRT Blood, PERIPHERAL Agency Case #: ML 15-2828 Date of Death: 11/24/2015 Test Reason: Other Investigator: KS Date Received: 12/01/2015 Date Reported: 12/23/2015 Date Collected: 11/25/2015 Testis): 70670 FSC Comprehensive Panel, Blood Analyte Name. Result Concentration __Units ‘Therapeutic Range Loc AMPHETAMINES, POSITIVE ‘Methamphetamine POSITIVE Methamphetamine, Quant 1065 ngiml. Amphetamine POSITIVE Amphetamine, Quant 116 gil 10-100 BARBITURATES Negative BENZODIAZEPINES Negative CANNABINOIDS Unsuitable THC-COOH Unsuitable Testing cancelled due to interference COCAINE/METABOLITES POSITIVE Cocaine POSITIVE Cocaine, Quant 767 agimt Benzoylecgonine POSITIVE Benzoylecgonine, Quant 3120 git FENTANYL Negative METHADONE/METABOLITE POSITIVE Methadone POSITIVE Methadone, Quant 176 ngimL. 50-1000 EDDP POSITIVE EDDP, Quant 30.9 ngimL Not Established OPIATES Negative (OXYCODONE/METABOLITE Negative HERNANDEZ, JOSE Laboratory Case #: 3026829 Printed Date/Time: 12/23/2015, 16:14 Page: 1 of 62265 Executive Drive, Indianapolis, IN 46241 Telephone: (800)875-3894 / Fax: (317)243-2789 Laboratory Specimen No: 40537347 Continued... Analyte Name Result Concentration __ Units The nge Loc PHENCYCLIDINE Negative PROPOXYPHENE/METABOLITE Negative ALCOHOL Negative. Methanol Negative Ethanol Negative Acetone Negative Isopropanol Negative ANALGESICS Negative ANESTHETICS Negative ANTICONVULSANTS POSITIVE Gabapentin POSITIVE Gabapentin, Quant 248 — megimL 2-20 ANTIDEPRESSANTS POSITIVE Duloxetine POSITIVE Duloxetine, Quant 145 ngimL Not Established Fluoxetine POSITIVE Fluoxetine, Quant 278 nail. 50-480 Norfluoxetine POSITIVE Not Established Norfluoxetine, Quant 150 gil. ANTIHISTAMINES Negative ANTIPSYCHOTICS Negative CARDIOVASCULAR AGENTS Negative ENDOCRINE AGENTS Negative GASTROENTEROLOGY AGENTS Negative NARCOTICS POSITIVE Dextromethorphan POSITIVE Dextromethorphan, Quant 224 ngimb NEUROLOGY AGENTS Negative SEDATIVES/HYPNOTICS Negative ‘STIMULANTS POSITIVE eattoine vosrazve Analyte is qualitatively POSITIVE, but has not been confirmed by an alternate analytical = HERNANDEZ, JOSE Laboratory Case #: 3026829 Printed Date/Tim Specimens will be kept for at least one year from the date of initial report 12/23/2015, 16:14 Page: 2 of 6AIT 2265 Executive Drive, Indianapolis, IN 46241 Telephone: (800)875-3894 / Fax: (317)243-2789 Laboratory Specimen No: 40537350 Container(s): 01:YTB Urine, Random Date Collected: 11/25/2015 Test(s): 70080 Drugs of Abuse Panel Analyte Name Result Concentration Units ‘Therapeutic Range Loc ‘ALCOHOL, Negative AMPHETAMINES. POSITIVE Amphetamine POSITIVE ‘Amphetamine, Quant 1360 ngimL Methamphetamine POSITIVE Methamphetamine, Quant 5000 ngimL. BARBITURATES Negative BENZODIAZEPINES Negative BUPRENORPHINE/METABOLITE Negative CANNABINOIDS Negative CARISOPRODOUMETABOLITE Negative COCAINE/METABOLITES POSITIVE Benzoylecgonine POSITIVE Benzoylecgonine, Quant 60000 ng/mL. FENTANYL, Negative METHADONE/METABOLITE POSITIVE ‘Methadone POSITIVE Methadone, Quant 536 ngimL OPIATES POSITIVE Morphine POSITIVE Morphine, Quant 451 ngimt PHENCYCLIDINE Negative PROPOXYPHENE/METABOLITE Negative ‘TRAMADOLIMETABOLITE Negative HERNANDEZ, JOSE Laboratory Case #: 3026829 Printed Date/Time: 12/23/2018, 16:14 Page: 3 of 6AIT 2265 Executive Drive, Indianapolis, IN 46241 Telephone: (800)875-3894 / Fax: (317)243-2789 Laboratory Specimen No: 40537351 Date Collected: 11/25/2015 Container(s): 01:VIT_CON Vitreous,EYE Test(s): 49901 Volatiles Not Performed Analyte Name Result Concentration __Units. Thera, Range < Volatile Testing Not Performed => bue to negative blood, tissue, and/or urine volatile (Acetone, Ethanol, Isopropanci, and Methanol) re: te, volatile testing wae act performed on the vitreous epecinen, HERNANDEZ, JOSE c Laboratory Case #: 3026829 Printed Date/Time: 12/23/2015, 16:14AIT 2265 Executive Drive, Indianapolis, IN 46241 ‘Telephone: (800)875-3894 / Fax: (317)243-2789 Laboratory Specimen No: 40537362 Date Collected: 11/25/2015 Container(s): 01:;GRT Blood, PERIPHERAL Test(s): 49900 Not Tested Analyte Name Result Concentration __Units ‘Therapeutic Range _Loc < No Testing Performed > HERNANDEZ, JOSE 46 Laboratory Case #: 3026829 Printed Date/Time: 12/23/2015, 16:14 Page: 5 of 6AIT 2265 Executive Drive, Indianapolis, IN 46241 ee Telephone: (800)875-3894 / Fax: (317)243-2789 Laboratory Specimen No: 4067363 Date Collected: 1172572015 Containers): OYGRT Blood. PERIPHERAL Tes{s), 49900 Not Tested Analyte Name Result Concentration Unis Therapeutic Range Loe < No Testing Pevionmed > A The Specimen denied ty the Laboratory Specimen Number has been handed and analyze in accordance wih a creamer Laboratory Director HERNANDEZ, JOSE Case Reviewer Laboratory Case #:3026829 i cs Anes Terral, PhD,DABCC pa atornmetan0¥8, 1:4 KB guap sb bostvick Page: 6 of 6 Alay