Forensic Pathology Case Study PDF

My name is Dr. William/Willa J. Hunter. I am a board-certified Forensic Pathologist practicing at the 2 Wheatville Health Sciences Center in Wheatville, Winchester. I live at 2201 Wilderness Crest. I am 3 currently single, as this line of work requires that I devote a fair amount of time… I did find...

My name is Dr. William/Willa J. Hunter. I am a board-certified Forensic Pathologist practicing at the 2 Wheatville Health Sciences Center in Wheatville, Winchester. I live at 2201 Wilderness Crest. I am 3 currently single, as this line of work requires that I devote a fair amount of time… I did find an injured 4 baby red fox or kit abandoned in my yard and have since raised it by hand. I had to apply for a 5 special Captive Wildlife Permit in order for Antonio to live with me. Antonio is named for the founding 6 father of forensic pathology – Antonio Benivieni. 7 I’m an avid foodie and spent several weeks at the Florence Culinary School in Florence, Italy, several weeks 8 ago. It was a once in a lifetime opportunity and I learned how to make a pasta fresca (homemade pasta) 9 with a meat sauce, mushroom crostini and gelato….squisito!! Plus, I’m quite the music aficionado with regard 10 to jazz music. A favorite of mine is Trombone Shorty – Troy Andrews, of course Louis Armstrong, Billie 11 Holiday, Dizzy Gillespie, John Coltrane, Ella Fitzgerald, Nat King Cole, and Jelly Roll Morton. Well, enough 12 about that. 13 I earned a Bachelor of Arts degree in biology with a minor in chemistry as well as a Master of Science 14 degree in zoology from Southern Illinois University in 1996 and 1998, respectively. I earned my osteopathic 15 medical degree from the Texas College of Osteopathic Medicine in Fort Worth, Texas in 2002. Afterward, I 16 completed residency training in Anatomic Pathology at Ball Memorial Hospital in Muncie, Indiana in 2004, 17 fellowship training in Neuropathology at Indiana University School of Medicine in Indianapolis in 2006, and 18 fellowship training in Forensic Pathology at the Cuyahoga County Medical Examiner’s Office in Cleveland, 19 Ohio in 2008. 20 In 2009, I joined the staff at the Office of Chief Medical Examiner in Lincoln, Nebraska, where my primary 21 duties were as medical examiner for the state of Nebraska. In 2019, I moved to Wheatville, Winchester, 22 and became a consultant forensic pathologist with the State of Winchester’s Office of the Chief Medical 23 Examiner and serve as a coroner’s physician and forensic pathologist for Travis County, Winchester. 24 Over the course of my tenure, I have been called as a witness by the State to testify on 26 separate 25 occasions. I have never been called as a witness by the defense in my career. 26 Pathology is a study that focuses on the cause and resulting changes brought about by diseases or injuries. 27 The pathology field is a scientific area of study, as results found in the discipline are determined by 28 examining various tissue, fluid, and/or organ samples. These tests, which require forensic laboratories, may 29 have several applications in preventing, diagnosing, and treating a wide variety of diseases. Any type of 30 disease or field of medicine may be relevant to pathology, including cancer, oncology, molecular biology, urology, tumors, gynecology, pediatrics, hematology, birth injuries, liver disease, hepatitis, lymphoma, 32 Hodgkin’s disease, language disorders, infectious diseases, and other areas of focus. My field, Forensic 33 Pathology, is a sub-specialty of pathology that investigates and certifies death, depending on the jurisdiction. 34 Cause of Death 35 Simply stated, the cause of death is why a person has died. An example would be: Acute Myocardial 36 infarction, and yet another example would be a stab wound to the chest. Unfortunately, such a simple 37 concept is not well understood by a large proportion of certifiers (primary care physicians, emergency room 38 physicians). Hence it is not uncommon to encounter death certificate signed as: cardiac arrest or respiratory 39 arrest. These examples are not causes of death, but mechanistic terminal events that at the end of our days 40 all of us are going to have. Some of the consequences of certifying deaths in this manner is that stakeholders 41 trying to interpret the death certificate may get confused and come to the conclusion that the patient died of 42 a “heart attack”. When the actual chain of medical events that led to death have little or nothing to do with 43 a cardiac death. 44 With respect to Ms. Chapelle’s death, I concluded, to a reasonable degree of medical certainty that the 45 most likely cause of death was asphyxiation. This conclusion is based on my review of the case history 46 obtained from Ms. Chappell’s available medical records, the information reported to me by local law 47 enforcement, on-scene paramedics and attending physicians, as well as my forensic examination of Ms. 48 Chapelle’s corpse at my office. 49 Mechanism of Death 50 The mechanism of death is the physiological derangement due to the cause that results in the death. For 51 example, hemorrhage in the case of a stab wound. Another example would be bleeding in the abdominal 52 cavity that arose from ruptured esophageal varices. In both cases, the bleeding is the mechanism of death. In 53 the latter instance, the chain of medical events started with liver cirrhosis induced by hepatitis C. That in turn 54 induced increased pressure in the vessels of the liver, which caused the veins of the esophagus to dilate, 55 rupture and bleed. 56 The importance of the mechanism and the underlying cause or causes of death cannot be overstated. It is 57 often a concept that tends to confuse a lot of the stakeholders in a case. 58 In this case, I concluded that the most likely mechanism of death was lung inflammation induced by the 59 inhalation of Vitamin E Acetate, a controlled substance under Winchester law. Vitamin E Acetate caused rapid 60 inflammation in Ms. Chapelle’s lungs, which reduced and eliminated her ability to capture necessary oxygen, 61 and was ultimately mortally suffocated. This phenomenon is known medically as lipoid pneumonia. Lipoid 62 pneumonia is a rare form of pneumonia which was initially described to be caused by inhalation or 63 aspiration of fatty substances. 64 Chain of Events 65 There are several issues that come into play when one looks for an explanation of death. Most importantly, 66 forensic pathology focuses on the initial event that created the resulting cascade of medical issues and 67 unpackages their consequences. Such an inquiry accounts for patient comorbidities and other environmental 68 factors that could have contributed to the death at issue. The chain of events findings are generally aimed at 69 putting the pieces of the puzzle together after review of the case file, historical medical records and accounts 70 from people involved.An example would be a patient dying of sepsis (systemic infection). Some of the questions that need to be 72 elucidated are, among others, where did the infection originate from? What organs are involved? Is there an 73 underlying condition that contributed to the development of such an event? 74 In Ms. Chapelle’s case, Paramedics on scene report finding Ms. Chapelle sitting tripod in a hallway between 75 a dining room and basement stairs at the local residence. At that time, Ms. Chapelle presented CAOx4. Ms. 76 Chapelle reported that she was at a party at her home and engaged in recreational vaping. Ms. Chapelle 77 reported a history of asthma, mild persistent, but could not produce an inhaler because she had not renewed 78 her prescription. Ms. Chapelle also reported that her last asthma event was more than one year ago. 79 Initial vitals read as follows: 133/72, HR: 96, RR: 24, SpO2: 95%. Paramedics undertook transporting Ms. 80 Chapelle to the nearest treatment facility. No obvious trauma was noted, Ms. Chapelle denied fever, chills, 81 fatigue, vision changes, dental or throat pain. No rashes or bruising was noted and Ms. Chapelle denied any 82 cough, dyspnea, hemoptysis, chest pain, palpitation, edema or wheezing. No other abnormalities were 83 initially observed or reported. 84 The circumstances escalated quickly while Ms. Chapelle was in the care of paramedics and enroute to a 85 treatment facility. During transport, Ms. Chapelle reported increased anxiety, grabbed a paramedic’s arm 86 to make a statement about her sibling not providing her the vape device and that the sibling knew about 87 her asthma. Ms. Chapelle began coughing with wet secretions, ultimately became unresponsive with a 88 slowing pulse registering 47 bpm. 89 According to paramedic reports, Ms. Chapelle was placed on BVM at 16RR on 100% Oxygen at 9:18 p.m. 90 At that time, Ms. Chapelle was no longer breathing but a pulse was present. Ms. Chapelle was intubated via 91 a manual laryngoscope and placed on ETCO2 monitor