NC OCME

NC Office of the Chief Medical Examiner

Laboratory Result Report

Patient: Harman, Clark

MRN: 182222
DOB/Age: 2/9/2011 (12 yrs)
Sex: Male
CSN:

Autopsy Report (Final result) WFAM24-00167

Authorizing Provider: Giffen, Mark Anthony Jr., Ordering Provider: Giffen, Mark Anthony Jr.,
DO DO
Pathologist: Giffen, Mark Anthony Jr.,
DO
.

Staff Pathologist: Giffen, Mark Anthony Jr., DO

Autopsy Assistant: Welborn, Hailey Nichole

Expired: 2/3/2024
Autopsied: 2/6/2024
Reported: 6/19/2024

Aut ME Medical Examiner

Anthony Messer
Transylvania County

.
FINAL DIAGNOSIS
I. Smothering
A. Asphyxia
II. Contusions of the left lower extremity

Electronically signed by Giffen, Mark Anthony Jr., DO on 6/19/2024 at 1552

.

SUMMARY OF FINDINGS
The cause of death is asphyxia due to smothering. The manner of death is homicide.

No anatomic cause of death was determined at the time of autopsy. No significant natural disease was

Resulting Labs
WC Lab NC BAPTIST HOSPITALS INC PATHOL LABS, CLIA#
34D0664386, Medical Center Boulevard, Winston-Salem NC
27157

Report Printed on: 6/20/2024 8:26 AM 1 of 8

 NC OCME
NC Office of the Chief Medical Examiner

Patient: Harman, Clark

MRN: 182222
present to have caused or contributed to death. Non-specific findings included swelling of the brain. Mild
bruising was present on the left thigh and leg without significant internal injuries. Age adjusted growth charts
indicate that the decedent was between the 50th and 75th percentile for height and between the 5th and 10th
percentile for weight.

A sexual assault kit was collected at the time of autopsy and results were negative (as reported by law
enforcement). No physicial evidence of trauma was noted on examination.

Toxicologic testing of postmortem femoral blood samples detected elevated levels of cyproheptadine and
fluoxetine (and its metabolite) which were likely artificially elevated due to postmortem redistribution. Liver
tissue levels of fluoxetine (and its metabolite) were within normal range. These findings were discussed with
the Chief Toxicologist at the North Carolina Toxicology Laboratory, who is in agreement with this
determination. Testing did not detect an elevated or toxic level of clonidine.

Testing of vitreous (eye) fluid detected no dehydration, diabetes mellitus or kidney impairments.

His medications were sequestered and reviewed independently by law enforcement, and the medical
examiner. The only irregularity noted was the absence of 3 clonidine tablets. No medical administration
records were identified for the decedent at the camp and it is unclear if he took any of the missing
medication.

According to the Transylvania County Medical Examiner, investigative reports and the Transylvania County
Sheriff's Office, the decedent had a history of anxiety, attention-deficit/hyperactivity disorder (ADHD) and
migraines. He had no known seizure disorder or prior seizures. Due to ongoing behavioral issues, he was
brought from his home in New York to the Trails Carolina wilderness program at the request of his family. He
reportedly had no health complaints or abnormal behavior during travel or after arrival. He brought with him
all needed and appropriate medications for at least 30 days. He had been at the camp for less than 24 hours
when he was found unresponsive in a cabin with other adolescent attendees and adult counselors.

According to protocol, the decedent was placed to sleep in a bivy (small camping enclosure) with a sleeping
mat and sleeping bag according to program protocol. The program's protocol required the bivy to be placed
on top of a thick mil plastic sheet which was folded up the sides in the form of a 'canoe'. The opening to the
bivy was then secured with an alarm device such that if the occupant attempted to exit the bivy, it would
alarm and wake up the counselors in the cabin. According to investigative reports, the internal mesh bivy
door, which is normally used to secure the opening, was torn and the outer weather resistant door was
instead using to secure the opening with the alarm device.

Based on multiple accounts and investigation, the decedent was placed to sleep in the bivy without incident.
Sometime around 2300 he was noted to be moving around and making noise in the bivy and counselors
removed him at that time. He relaxed and fell to sleep outside the bivy a short time later. Due to protocol, he
was made to wake up and re-enter the bivy at which time he was again secured with the alarm device. A
counselor did note he was moving around again about 1-2 hours after the initial incident but stopped moving
shortly after. Routine checks were performed throughout the night, but due to the outer, opaque layer of the
bivy being closed, he could not be visualized. In the morning, the counselors attempted to wake him up but
noted he was not moving. Upon opening the bivy, he was found to be turned around 180 degrees from the
entrance, with his head at the enclosed end of the bivy and his feet near the opening. He was also noted to
not be wearing pants, which was a common practice for him at home. Resuscitation was attempted by camp
personnel while emergency medical providers were summoned. After emergency medical personnel arrived,
it was determined that he was already beyond life saving measures due to rigor mortis being present,
indicating he had likely been dead for several hours.

Resulting Labs
WC Lab NC BAPTIST HOSPITALS INC PATHOL LABS, CLIA#
34D0664386, Medical Center Boulevard, Winston-Salem NC
27157

Report Printed on: 6/20/2024 8:26 AM 2 of 8

 NC OCME
NC Office of the Chief Medical Examiner

Patient: Harman, Clark

MRN: 182222
It should be noted that a common warning on commercially available bivy products indicates that the outer,
weather resistant opening should not be fully secured as it may lead to condensation and breathing
restriction. This information was obtained on basic web search.

Asphyxia due to smothering refers to death due to the inability to breath in oxygen, in this case due to
covering the nose and mouth with a non-breathable material. It is a diagnosis of exclusion, meaning all other
reasonable causes of death must be excluded and there needs to be sufficient evidence to support the
asphyxia event occurred. Autopsy examination revealed no natural disease which could explain death.
Toxicology testing also revealed no toxic levels of his prescription medications, over the counter medications
or common drugs of abuse. Therefore, all common natural and toxic causes of death were reasonably
excluded. According to investigation, the decedent was inside the bivy but oriented opposite to the intended
use which would have allowed the waterproof material to fall onto his head and face. The outer, waterproof
opening was fully secured and closed with an audible alarm which could not be opened by the decedent and
the entire bivy was also partially surrounded by a thick plastic sheet 'canoe' under and on the sides of the
bivy. These support restriction of breathing due to these external factors. It is unclear if elevated temperature
(hyperthermia) may have also played a role in death since he was partially undressed and the way the
sleeping area was constructed could have resulted in increased environmental temperature.

He was placed into this compromised sleeping area by other(s) and did not have the ability to reasonably
remove himself from the situation with the alarm securing the opening. The standard protocol was deviated
from due to using a damaged bivy and securing the outer weather resistant door instead of the inner mesh
panel. Lastly, the counselors could not check on him as they should due to the opaque nature of the outer
panel, preventing them from potentially noting the problem and delivering aid before he died. With this
combination of factors, the death is best certified as homicide.

EXTERNAL EXAMINATION
Body Weight: 78 lb
Body Length: 60 in

Representatives of the Transylvania County Sheriff's office are present at the time of autopsy examination.

The body is that of a well developed, well nourished, White adolescent male, who appears compatible with
the stated age. Body identification includes tags on the body bag and left wrist bearing the decedent's name
and date of death. Affixed to the zippers of the body bag is a blue seal bearing "NC MedEx 0085008".

The body is received clothed in a red hooded sweatshirt and blue shirt. No personal effects accompany the
body. His medications were received, counted and taken as evidence by representatives of the Transylvania
County Sheriff's Office.

The body has been refrigerated. Rigor is fully fixed in the extremities and jaw. Diffuse, fixed, red-purple livor
extends over the right side and posterior surfaces of the body, except in areas subject to pressure.

The scalp hair is light brown and measures to 14 cm in length over the crown. The irides appear brown; the
pupils are symmetrical. The corneae are cloudy. The sclerae and conjunctivae are engorged. No petechiae
are on the palpebral or bulbar conjunctivae. The nose and ears are not unusual and the nasal septum is
intact. The lips and gums are pale. The teeth are in adequate condition. The neck is without masses, and the
larynx is in the midline.

The thorax is symmetrical. The abdomen is flat. Genitalia are those of a adolescent male in Tanner stage I;
no injuries involve the penis, scrotum or anus. The anus and back have no unusual features. The upper and
Resulting Labs
WC Lab NC BAPTIST HOSPITALS INC PATHOL LABS, CLIA#
34D0664386, Medical Center Boulevard, Winston-Salem NC
27157

Report Printed on: 6/20/2024 8:26 AM 3 of 8

 NC OCME
NC Office of the Chief Medical Examiner

Patient: Harman, Clark

MRN: 182222
lower extremities are well developed and symmetrical without absence of digits.

Identifying marks and scars consist of a 5 x 0.1 cm pale linear scar on the lateral left leg, a 0.5 cm pale round
scar on the lateral left leg; two pale round scars on the posterior right thigh up to 2.5 cm in maximal
dimension; a 1 cm pale linear scar on the posterior right thigh.

EVIDENCE OF INJURY
HEAD AND NECK:
On the interior mucosal surface of the lateral, inferior left lip is a 0.2 cm red abrasion with heaped margins.

A layered anterior neck dissection is performed to reveal no hemorrhages within the subcutaneous soft
tissues, musculature or thyroid gland and associated tissues. The hyoid bone and laryngeal cartilages are
intact without hemorrhage or fracture.

CHEST AND ABDOMEN:

None

UPPER EXTREMITIES:
None

LOWER EXTREMITIES:
On the lateral right hip is a 4.5 cm purple contusion. On the anterior left knee is a 0.5 cm abrasions with
rolled pale margins. On the left shin is a 1.5 cm purple contusion.

INTERNAL EXAMINATION
BODY CAVITIES
Panniculus adiposus: 0.5cm

The pleural and abdominal cavities contain no abnormal quantities of fluid and no fibrous adhesions. All body
organs are present in normal and anatomical position.

CENTRAL NERVOUS SYSTEM

Brain weight: 1520 gm

No subscalpular contusions or skull fracture are present. The dura mater and falx cerebri are intact without
adherent blood. The leptomeninges are thin and translucent and with no areas of extravasated blood or
exudates. The cerebral hemispheres are symmetrical with moderate global cerebral edema. No atrophy or
mass lesions are present. The structures at the base of the brain, including cranial nerves and blood vessels,
are intact and free of abnormality. The arteries of the circle of Willis are in the usual anatomical configuration
and are patent. Sections through the cerebral hemispheres reveal no lesions within the cortex, subcortical
white matter, or deep parenchyma of either hemisphere. The cortex is continuous and of uniform thickness.
The basal ganglia, thalami, and Ammon's horn have no unusual features. The cerebral ventricles are lined
by glistening ependyma and are of normal caliber. Sections through the brain stem and cerebellum reveal no
lesions. The substantia nigra and locus ceruleus have age appropriate pigmentation. The cerebral aqueduct
is patent and the fourth ventricle is not dilated.

NECK
The soft tissues of the neck, including strap muscles, and large vessels, have no abnormalities. The hyoid
bone and laryngeal structures are intact and the adjacent musculature has no areas of extravasated blood.
Resulting Labs
WC Lab NC BAPTIST HOSPITALS INC PATHOL LABS, CLIA#
34D0664386, Medical Center Boulevard, Winston-Salem NC
27157

Report Printed on: 6/20/2024 8:26 AM 4 of 8

 NC OCME
NC Office of the Chief Medical Examiner

Patient: Harman, Clark

MRN: 182222
The lingual mucosa is intact; the underlying firm red-brown musculature is devoid of hemorrhage.

CARDIOVASCULAR SYSTEM
Heart weight: 150 gm

The pericardial surfaces are smooth and glistening; the pericardial sac is free of significant fluid or
adhesions. The coronary arteries arise normally, follow the usual distribution of a right dominant pattern
without abnormality. The chambers and valves bear the usual size-position relationships. The myocardium is
dark red-brown and firm; the atrial and ventricular septa are intact. The thickness of the walls of the heart is
as follows: 0.7 cm., left ventricle; 0.5 cm., interventricular septum; 0.1 cm., right ventricle. The aorta and its
major branches arise normally, follow the usual course and are widely patent, free of significant
atherosclerosis and other abnormality. The vena cava and its major tributaries return to the heart in the usual
distribution and are free of thrombi.

RESPIRATORY SYSTEM
Right lung weight: 340 gm
Left lung weight: 280 gm

The upper airway is clear of debris and foreign material; the mucosal surfaces are smooth and yellow-tan.
Copious amounts of frothy fluid are present throughout the airways. The pleural surfaces are smooth and
glistening. Lobar divisions are of the usual configuration. The pulmonary parenchyma is dark red-purple,
exuding moderate amounts of blood and frothy fluid; no focal lesions are noted. The pulmonary arteries are
normally developed, patent, and without thrombus or embolus.

LIVER AND BILIARY SYSTEM

Liver weight: 1000 gm
Bile volume: 5 ml

The hepatic capsule is smooth, glistening and intact, covering red-brown parenchyma with no focal lesions.
The gallbladder contains green, slightly mucoid bile; the mucosa is velvety. The extrahepatic biliary tree
contains no calculi. The portal vein and its tributaries are patent.

ALIMENTARY TRACT
The esophagus is lined by gray-white, smooth mucosa. The gastric mucosa is arranged in the usual rugal
folds, and the lumen has no significant contacts. The serosa of the small and large bowel is smooth and
glistening. The appendix is present. The pancreas has a gray-tan, lobulated appearance, and the ducts are
unobstructed.

GENITOURINARY TRACT
Right kidney: 70 gm
Left kidney: 70 gm
Urine volume: 320 ml

The renal capsules are smooth and thin, semi-transparent, and strip with ease from the underlying, smooth,
red-brown, firm, cortical surface. The cortex is sharply delineated from the medullary pyramids, which are
red-purple to tan. The calyces, pelves, and ureters are not dilated. The relationships at the trigone are
arranged in the usual anatomical configuration. The mucosa of the urinary bladder is gray-tan and smooth.
The prostate and seminal vesicles have no abnormal findings.

RETICULOENDOTHELIAL SYSTEM
Spleen weight: 100 gm
Resulting Labs
WC Lab NC BAPTIST HOSPITALS INC PATHOL LABS, CLIA#
34D0664386, Medical Center Boulevard, Winston-Salem NC
27157

Report Printed on: 6/20/2024 8:26 AM 5 of 8

 NC OCME
NC Office of the Chief Medical Examiner

Patient: Harman, Clark

MRN: 182222
Thymus weight: 27 gm

The spleen has a smooth, intact capsule covering red-purple, firm parenchyma; the lymphoid follicles are
unremarkable. The regional lymph nodes appear normal. The bone marrow is red-purple and homogeneous,
without focal abnormality. The thymus has the typical lobulated grey appearance without petechiae.

ENDOCRINE SYSTEM
Combined adrenal gland weight: 12.2 gm

The pituitary, thyroid, and adrenal glands contain no lesions.

MUSCULOSKELETAL SYSTEM
The bony framework, supporting musculature, and soft tissues are not unusual.

MICROSCOPIC DESCRIPTION
Block Summary:
1. Liver; Kidney; Pancreas
2. Lungs
3. Heart
4. Brain
5. Brain
6. Brain
7. Conduction system
8. Conduction system
9. Heart
10. Cardiac apex
11. Lungs
12. Lungs
13. Kidney; Liver; Spleen
14. Cerebellum; Basal ganglia
15. Pons; Hippocampus
16. Rib

Microscopic Description:
The liver is organized into plates of hepatocytes 1-2 cell layers thick without steatosis or significant lobular
inflammation. The portal tracts contain an appropriate number of bile ducts and blood vessels without
inflammation or fibrosis. The central veins are patent without thrombosis.

The spleen has well delineated red pulp and white pulp without atypical architecture or lymphocyte
morphology.

The pancreas has moderate autolytic changes. The pancreas has well-formed acinar structures and islets
without atypia. No significant inflammation or fibrosis is present.

The kidneys have an appropriate number of glomeruli without significant sclerosis or inflammation. The
tubules have mild autolytic change without inflammation, tubule drop out or fibrosis. No polarizable material
is present.

The heart has no significant inflammation or fibrosis. The cardiac myocytes are unremarkable. The
myocardial vessels are patent without significant medial hypertrophy or thrombosis. The conduction system
Resulting Labs
WC Lab NC BAPTIST HOSPITALS INC PATHOL LABS, CLIA#
34D0664386, Medical Center Boulevard, Winston-Salem NC
27157

Report Printed on: 6/20/2024 8:26 AM 6 of 8

 NC OCME
NC Office of the Chief Medical Examiner

Patient: Harman, Clark

MRN: 182222
has no significant inflammation or fibrosis.

The lungs have normal alveolar architecture with scattered extravasated intra-alveolar erythrocytes. The
interstitium adjacent to the bronchi and bronchioles demonstrate focal scattered lymphoid aggregates. No
significant fibrosis or acute inflammation is present. No polarizable material is present.

Representative sections of the brain demonstrate no neuronal loss, inflammation, gliosis or significant
hypoxic ischemic changes.

Representative sections of bone marrow have appropriate trilineage hematopoiesis without atypia.

EVIDENCE
Evidence turned over to representatives of the Transylvania County Sheriff's Office injury a blood spot card,
pulled scalp hair, a body bag seal, finger nail scrapings from body hands, a sexual assault kit and the
decedent's clothing and medications.

Toxicology Results
Toxicology Folder: T202401828
Case Folder: F202402847

Status of Report: Approved

Report Electronically Approved By: Sandra Bishop-Freeman, PhD

======================================================================
SPECIMENS received from Mark A. Giffen on 09-feb-2024

S240005698: 20.0 ml Blood CONDITION: Postmortem

SOURCE: Aorta OBTAINED: 06-feb-2024

Amphetamines ---------------- None Detected LCMS 05/02/2024

Benzodiazepines ------------- None Detected LCMS 05/02/2024
Cocaine metabolite ---------- None Detected LCMS 05/02/2024
Ethanol --------------------- None Detected 05/02/2024
Gabapentin/Pregabalin ------- None Detected LCMS 05/02/2024
Opiates/Opioids ------------- None Detected LCMS 05/02/2024
Organic Acids/Neutrals ------ None Detected 05/02/2024
Organic Bases --------------------- Present 05/02/2024
_________________________________________________________________________

S240005699: 14.0 ml Blood CONDITION: Postmortem

SOURCE: Femoral Vessel OBTAINED: 06-feb-2024

Cyproheptadine --------------------------- 0.055 mg/L 05/02/2024

** Comments Concerning This Result **

Analysis was performed by NMS Labs.
** End of Comments Concerning This Result **

Resulting Labs
WC Lab NC BAPTIST HOSPITALS INC PATHOL LABS, CLIA#
34D0664386, Medical Center Boulevard, Winston-Salem NC
27157

Report Printed on: 6/20/2024 8:26 AM 7 of 8

 NC OCME
NC Office of the Chief Medical Examiner

Patient: Harman, Clark

MRN: 182222
Fluoxetine ------------------------------- 0.78 mg/L 05/02/2024
Norfluoxetine ---------------------------- 0.46 mg/L 05/02/2024
_________________________________________________________________________

S240005700: Liver CONDITION: Postmortem

SOURCE: Liver OBTAINED: 06-feb-2024

Fluoxetine ------------------------------- 3.6 mg/kg 05/02/2024

Norfluoxetine ---------------------------- 2.0 mg/kg 05/02/2024
_________________________________________________________________________

S240005701: 1.0 ml Vitreous Humor CONDITION: Postmortem

SOURCE: Eye OBTAINED: 06-feb-2024

Chloride --------------------------------- 116 mmol/L 05/02/2024

Creatinine---------------------- Less than 0.2 mg/dL 05/02/2024
Glucose ---------------------------------- 56 mg/dL 05/02/2024
Potassium-------------------- Greater than 9.0 mmol/L 05/02/2024
Sodium ----------------------------------- 131 mmol/L 05/02/2024
Urea nitrogen ---------------------------- 21 mg/dL 05/02/2024
__________________________________________________________________________

S240005702: 17.0 ml Urine CONDITION: Postmortem

SOURCE: Urinary Bladder OBTAINED: 06-feb-2024

__________________________________________________________________________

Accredited by the American Board of Forensic Toxicology, Inc.

050224 15:02 *** END OF REPORT ***

MEDICAL THERAPY
No evidence of emergency resuscitation and/or medical therapy is present at the time of autopsy
examination.

.
Specimens
A Autopsy

***END OF REPORT***

Resulting Labs
WC Lab NC BAPTIST HOSPITALS INC PATHOL LABS, CLIA#
34D0664386, Medical Center Boulevard, Winston-Salem NC
27157

Report Printed on: 6/20/2024 8:26 AM 8 of 8