"The University of New Mexico Health Sciences Center OFFICE OF THE MEDICAL INVESTIGATOR SCO? 4040 1 University of New Mexico Albuquerque, NM_ 87131-0001 'elephone (505) 272-3053 FAX (505) 925.0546 Report of Findings 10/9/2014 Decedent HAN, MARY Y_ OMI # 2010-05705 Date of Birth 9/15/1957 Date Report Issued 4/7/2014 1:26:57 PM Date Death Pronounced ‘11/18/2010 Place Pronounced Residence ‘Time Death Pronounced 1:45 PM County Pronounced Bernalillo Cause of Death Carbon monoxide intoxication Manner of Death Suicide Date of Injury 11/17/2010 Place of Injury Residence Location of Injury Albuquerque, Bernalillo NM 87107 How Injury Occurred Inhaled carbon monoxide in enclosed garage Autopsy performed by R Ross Reichard, MD R. Ross Reichard, MD Death Certificate Signed by R. Ross Reichard, MD ‘Deputy Medical Investigator Terry Coker District Attorney Bernalillo County DA Law Enforcement APD/FI Mike Muniz/C# 100111888 For details concerning this death, contact the law enforcement agency listed, records section. For copies of the Death Certificate, contact the Bureau of Vital Statistics, 1190 St. Francis Dr., PO Box 26110, Santa Fe, NM 87502. “Appropriate investigative reports are available from the Medical Investigator, as required by law. Fees are assessed where required. A review of the reports in the Albuquerque office of the Office of the Medical Investigator is available upon request. ‘All requests for reports are to be directed to: Office of the Medical Investigator MSCO7 4040 1 University of New Mexico Albuquerque, NM 87131-0001AUTOPSY REPORT ‘ee ‘THE UNIVERSITY OF NEW MEXICO HEALTH SCIENCES CENTER bo10-05705 OFFICE OF THE MEDICAL INVESTIGATOR 7 ST Schoo! of Medicine Albuquerque, New Mexico 87131 091 POSTMORTEM EXAMINATION An autopsy is performed on the body of Mary Y. Han at the Office of the Medical Investigator, State of New Mexico, on the 19" day of November 2010. The examination is performed under the legal authority of the Office of the Medical Investigator of the State of New Mexico. The body is received within a sealed body bag. EXTERNAL EXAMINATION the body is that of a well developed, well-nourished, Korean female who weighs 121 pounds, is 62 inches in length, and appears compatible with the reported age of 83 years. There are orange and green OMI identizication\bands around the left wrist. The body is received clad in clothes and agcompaiited by personal effects. see inventory log. 7 ~ the body is cold (refrigerated). Rigdf moxfis\is fully fixed,” Fixed cherry red- purple livor mortis extends over the ahterior And posterior surfaces of the body. The scalp hair is brown, straight, long, and measures approximately 12 inches in length over the crown. The iyides are browns The pupils are round. The corneae are clouded. The sclerae are|white and the\conjunctivae are clear. No petechial hemorrhages are identified on\the\sclerae, bulbar conjunctivae, facial skin or oral mucosa. The nose and ears are\norally formed. the teeth are natural and in good condition. The neck/is unremakkable, } the thorax is well develgped and symmetrical/ the abdonen is flat. The spine is normally formed and the gurface-of the back is free of lesions. The breasts are symmetrical) without] palpable masses. The external genitalia are those of a normal adult ‘female: } The upper and lower extremitiés~are well developed and symmetrical, without absence of digits. Identifying marks and scars include small linear bilateral inframammary scars. Evidence of medical intervention includes an approximately 2 x 1 1/2 inch gauze “Combi” patch on the lower abdomen. In addition, approximately six 1/2 x 1 1/2 inch round, hyperpigmented areas are present across the lower abdomen. INTERNAL EXAMINATION BODY CAVITIES: No adhesions or abnormal collections of fluid are in any of the body cavities. All body organs are in normal and anatomic position. The serous surfaces are smooth and glistening. HEAD (CENTRAL NERVOUS SYSTEM): The brain weighs 1270 grams. The dura mater and falx cerebri are intact, and not adherent to the brain. The leptomeninges are thinAUTOPSY REPORT pes aa 2 BY secs tee ER wcsome | 2 OFFICE OF THE MEDICAL INVESTIGATOR 1010-05705 TE ———— School of Medicine Albuquerque, New Mexico 87131-S091 and transparent. There is no epidural, subdural or subarachnoid hemorrhage. The cerebral hemispheres are symmetrical, The structures at the base of the brain, including cranial nerves and blood vessels, are free of abnormality. Sections through the cerebral hemispheres reveal no lesions within the cortex, subcortical white matter, or deep parenchyma of either hemisphere. The cerebral ventricles are of normal caliber. Sections through the brain stem and cerebellum reveal no lesions. NECK: Examination of the soft tissues of the neck, including strap muscles and Jarge vessels, reveals no abnormalities. The hyoid bone and larynx are intact. CARDIOVASCULAR SYSTEM: ‘The heart weighs 345 grams. “tie pericardial sac is free of Significant fluid or adhesions. The pericardial suifaces are smooth and glistening. ‘| the coronary arteries arise normally and folléu the distribution of a right dominant pattern with mild (less than 25%) atherdselerotic stenosis of the left main and right coronary artery, focally.“ : fue chanbers and valves are proportioate. (Ty valves ere 'nggilly tnrved, thia and pliable and free of vegetations and degénefative changes. the myocardium is dark red-broysi; firmy~and free\of focal or regional fibrosis, erythema, pallor or softening/ The atrial and ventricular septa are intact and the septum and free walls are cree) of muscular bulges. The aorta and its major branches arise noxmally afd follow the usual course, with no significant atherosClerosis."., The-vena/cavd and its major tributaries are patent and return to the heart in the udual distribution and are unremarkable. RESPIRATORY SYSTEM: |The\ right ant\Jefrtufigs weigh 595 and 455 grams, Tespectively The upper ‘and lover Airways are unobstructed and the mucosal surfaces are smooth and yellow-tan. |The pleural surfaces are smooth, glistening, ghd unremarkable, ‘The pulmonary parenchyma is dark red-purple and the cut surfaces exude moderate amounts of “blood and’ frothy fluid. The pulmonary arteries are normally developed and patent~without thromboemboli. LIVER AND BILIARY SYSTEM: The liver weighs 1545 grams. The hepatic capsule is Smooth, glistening, and intact, covering red-brown parenchyma. The gallbladder contains a small amount of watery green bile without stones. ALIMENTARY TRACT: The esophagus is lined by gray-white smooth mucosa. The gastric jmucosa is arranged in the usual rugal folds, and the lumen contains approximately 150 ml. of tan fluid and partially digested food fragments. The serosa of the small bowel is smooth and glistening. The small bowel contains partially digested food. There are no mucosal lesions of the small and large bowel. The colon Contains semi-formed stool. The appendix is present. The pancreas has a normal tan lobulated appearance. GENITOURINARY TRACT: The right and left kidneys weigh 110 and 130 grams, Tespectively. The renal capsules are smooth, thin, semitransparent, and strip with ease from the underlying smooth, red-brown, firm, cortical surfaces. The corticesAUTOPSY REPORT fan, MARY ¥ ‘THE UNIVERSITY OF NEW MEXICO © HEALTH SCIENCES CENTER 2) OFFICE OF THE M1 i 2010-05705 DEF [EDICAL INVESTIGATOR School of Medicine Albuquerque, New Mexico 87131- 091 are of normal thickness and delineated from the medullary pyramids. The calyces, pelves, and ureters are non-dilated and free of stones. The urinary bladder contains no urine; the mucosa is gray-tan and smooth. ‘he cervix, fallopian tubes, ovaries, and vagina are unremarkable. The wall of the uterus is 3 cm thick and has a trabeculated pattern indicative of adenomyosis. In the midline of the posterior uterus is a 4 x 4 x 3 om subserosal leiomyoma. The breast tissue has the normal fibrous and adipose tissue and bilateral breast implants are present. RETICULOENDOTHELIAL SYSTEM: The spleen weighs 60 grams and has a smooth intact Gapsule covering red-purple diffluent parenchyma. ‘he ‘splenic white pulp is grossly indiscernible. The bone marrow (rib) is red-puzple. vy ENDOCRINE SYSTEM: The pituitary gland is of nofmal.siize.\ The thyroid gland is of normal position, size and texture. The adrenél glands have normal cut surfaces with yellow cortex and gray medulla SS \ ee Gare ee ry Tissues are not unusual. The cervical spinal column is stable“on internal palpation. ween ’ MICROSCOPIC EXAMINATION _ WN HEART, KIDNEYS, LIVER, BRAIN:| No/Sigigicant Whistobathology. LUNGS: Patchy intra-alyeolar eosihophilit material. SECTION KEY: / HEART AND LIVER | KIDNEYS LUNGS BRAIN PeEE ~~-PRTHOLOGIC DIAGNOSES ry Carbon monoxide poisoning A. 84.8% carbon monoxide saturation B. Found in motor vehicle within closed garage OPINION Mary Y. Han, a 53-year-old woman, died of carbon monoxide poisoning. According to reports, she was found in her motor vehicle with the windows down in a closed garage. Also present at the scene was a bathrobe with a pill bottle container in the pocket, a glass containing what appeared to be an alcoholic beverage, and a plastic bag between her legs. She was currently prescribed zolpidem and had previously been prescribed hydrocodone and phentermine.AUTOPSY REPORT fa pos “THE UNIVERSITY OF NEW MEXICO 0 HEALTH SCIENCES CENTER bo10-05705 OFFICE OF THE MEDICAL INVESTIGATOR = eel School of Medicine ‘Albuquerque, New Mexico 87131-5091 Toxicology testing revealed alcohol (46 mg/dl), caffeine, theobromine, acetaminophen, phentermine, hydrocodone, and zolpidem tartrate. The carbon monoxide saturation was 64.8%. The manner of death is suicide. R. Ross Reichard M.D. A Assistant Chief Medical Investigator All Signatures Electronically Authenticated Final Date: 02/02/2011 aa ~NMS Labs CONFIDENTIAL 83701 Welsh Road, PO Box 433A, Wilow Grove, PA 19080-0497 Phone: (215) 657-4000 Fax (215) 657-2072 ‘ema ns@amstabs.com Robert A Middleberg, PRD, DABFT, DABCC-TC, Laboratory Director Toxicology Report Patient Name HAN, MARY Y. Patient ID 2010-05705 Report Issued 12/14/2010 10:00 pas ee Age s3Y Gender Female To: 20141 New Mexico Office of Medical Investigators Workorder 10261681 ‘Attn: Amy Boule ol 1101 Camino de Salud NE- Ste B oo Albuquerque, NM 87105 Positive Findings: [Compound Result Units Matrix Source Ethanol 4s mg/dl ——_—Femoral Blood Blood Alcohol Concentration (BAC) 0.048 % wiv Femoral Blood Caffeine Positive megiml Femoral Blood Theobromine Positive megimL Femoral Blood Acetaminophen 2 megimL Femoral Blood Phentermine 640 rngimL -—_-Femoral Blood Hydrocodone - Free 100 rngimL Femoral Blood Zolpidem 6 ngimL Femoral Blood See Detaled Fincings section for atonal information Testing Requeste ‘Analysis Code Description mee Postmortem Toxcoogy - Expanded, Blood Specimens Received: 1D TubelContainer Volume! Collection Matrix Source Miscellanous Mass DateTime Information DOT Gray Top Tao TOTEmL TST Femoral Bod All sample volumesiveights are approximations ‘Specimens recelved on 12/03/2010. viCONFIDENTIAL Workorder 1026168 NMS Chain 11204046 Page 2 of 5 Detailed Findings: Rpt. Analysis and Comments Result Units Limit Specimen Source Analysis By Ethanol 46 rmgidl 40 001--Femeral Blood Headspace GC Blood Alcohol 0.086 wiv 0.010 001 - Femoral Blood Headspace GC Conceritation (BAC) Caffeine Positive mogim. 010-—=—«O01-Femoral Blood GCIMS Theobromine Positive megin. 5.0001 -Femoral Blood coms ‘Acetaminophen 2 mmogim. 0.50 «001 Femoral Blood ‘HPLC Phentermine «40 rolmt 10 001-Femoral Blood = LC-MSIMS Hydrocodone - Free 100 aim 10 001 - Femoral Blood coms Ethanol Confirmed mola 40 001-Femoral Blood = EZA Zolpidem % git 40 001-Femoral Blood GC Other than the above findings, examination of the specimen(s) submitted did not reveal any positive findings of toxicological significance by procedures outlined in the accompanying Analysis Summary. Reference Comments: 4. Acetaminophen (Tylenol®) - Femoral Blood ‘Acetaminophen is an over the counter analgesic with antipyretic properties; however, it has no anti inflammatory actions. It may be found both alone and in combinations with other substances such as codeine, hydrocodone, tramadol, butalbital, and propoxyphene. It appears to be a relatvely safe substance when used in analgesic amounts; however, It frequently produces acute hepatic necrosis after overdose. “The generally accepted therapeutic range of acetaminophen is 10- 20 mogimL of plasma; however, there are considerable individual diferences in plasma concentrations. ‘Symptoms of acetaminophen overdose usually are not seen immediately but re reflected in hepatic damage atte 1/2 to 6 days with concentrations of 120 mog/ml. and above. A reported range of blood leve's in individuals Succumbing to acetaminophen overdose ranged from 160 - 380 megimL. Caffeine (No-Doz) - Femoral Blood Caffeine is @ xanthine-derived central nervous system stimulant. It also produces diuresis ané cardiac and respiratory stimulation. It can be readily found in such tems as coffee, tea, soft drinks and chocolate. AS @ ‘eference, atypical cup of coffee or tea contains between 40 to 100 mg caffeine. Following the ora ingestion of 120 and 200 mg of caffeine, reported peak plasma concentrations of the drug Gveraged 3.0 moglm (range, 2.0 - 4.0 mogiml.) and 7.9 megiml (range, 6.0 - 9.0 mogimL), respectively. A Single oral dose of 500 mg produced a reported peak plasma concentration of 14 mogiml. ater 30 min, Reported concentrations of caffeine in caffeine-elated fatalties averaged 183 mog/ml. (range, 78-944 megiml) “The reported qualitative result for this substance is indicative of a finding commonly seen folowing typical use and is usualy not toxicologically significant Ethanol (Ethyl Alcohol) - Femoral Blood: thy alcohol (ethanol, drinking alcohol is a central nervous system depressant and has effects so-related, €.6., impaired judgment, reduced alertness and impaired muscular coordination. Ethanol is 2iso a product of postmortem decomposition. viCONFIDENTIAL Workorder 10261681 Chain 11234946 Pationt ID 2010-05705 Pa 30f5 Reference Comment: 4, Hydrocodone - Free (Dicodid®) - Femoral Blood: Hydrocodone is a DEA Schedule Il semisynthetic narcotic analgesic. Its similar to codeine in analgesic activity and is also widely used in cough syrups for its antitussive activily. This compound is reported to be highly ‘ddietive. For relief of pain, hydrocodone, as the bitartrate salt, is only available in oral form in combination with Fan-opiate drugs, eg., acetaminophen. Active metabolites of hydrocodone include hydromorphone and hhyérocoda (dinydrocodeine). Normal adult oral dosages range from 5 to 10 mg every 4 to Gr. Hydrocodone has elso been demonstrated to be @ metabolite of codeine. [After a siagle oral administration of 10 mg, mean peak serum levels of 20 ng/mL were reported at 1.5 hr; levels cropped to 7 ng/mL at 8 hr. Hydrocodone is reported to be more toxic than codeine. In overdose, it produces the same manifestations @s ther opiates including: drowsiness, sedation, respiratory depression, coma and death. In reported overdosage, post-mortem blood levels ranged from 130 - 7000 ng/mL. 5. Phentermine (Adipex-P®; lonamin®; Pro-Fast®) - Femoral Blood: Phentermine isthe alpha-methy derivative of amphetamine and is used as en anorectic agent. Following a Single oral dose of 0.375 malkg, peak blood concentrations average 80 ngimL at 4 hr. During chronic therepy of 30 mg per day, plasma phentermine concentrations average 360 ng/ml (range 180 - 510 ng/ml). ‘Adverse reactions to normal of elevated doses of phentermine include nervousness, tremor, confusion, headache, hallucinations and psychotic episodes. Phentermine may also contribute to heart valve disorders, particularly when taken in combination with fenfluramine. Blood concentrations of phentermine following fatal overdoses are reported to range from 1500 - 7600 nai. 6. Theobromine (Kantheose) - Femoral Blood: “Theobromine is a methylxanthine alkaloid found in tea and cocoa products and has been reported to pess into the breast mik of nursing mothers, Theobromine has the general properties ofthe xanthines, including diuresis land smooth muscle stimulation. 7. Zolpidem (Ambien) - Femoral Bioos: Zolpidem is a sedative hypnotic. It's used for the short-term treatment of insomnia. Plasma concentrations following single oral 5 mg and 10 mg doses range from 29 - 113 nglml. (mean, 69 nglmL) and 58 - 272 ng/mL (mean, 121 nglml), respectively, occuring at a mean time of 1.6 hrs. Adverse effects include drowsiness, laziness, amnesia, headache and nausea. In one death involving zolpidem, a blood concentration of 1120 ngimL was reported. Clozapine and Heloperidl interfere with Zolpidem in this analysis. The presence of Clazapine or Haloperiéo| ‘will adversely affect the quantitation of Zolpidem. if Clozapine or Haloperidol are potential iterferents inthis ‘case, call the laboratory for alternate quantitative procedures. ‘Sample Comments: (001 Physician/Pathologist Name: REICHARD ‘Chain of custody documentation has been maintained for the analyses performed by NMS Labs. Unless slternate arrangements are made by you, the remainder of the submitted specimens will be discarded six (6) ‘weeks from the date ofthis report; and generated data will be discarded five (5) years from the date the analyses were performed, Workorder 10261681 was electronically signed on 12/14/2010 09:45 by: Yeti ‘Susan Crookham, Certifying Scientist vaCONFIDENTIAL Workorder 10261001 NMS Chain “22404 Patient ID. 2010-08705 aoa a Page 4 of 5 Analysis Summary and Reporting Limit ‘Acode 500008 - Acetaminophen Confirmation, Blood (Forensic) - Femoral Blood Analysis by High Performance Liquid Chromatography (HPLC) for: ‘Compound Bot Limit ‘Compound ‘Acetaminophen 0.50 mog/mL. ‘Acode 500108 - Amphetamines Confirmation, Blood (Forensic) - Femoral Blood Analysis by High Performance Liquid Chromatography/Tandem Mass Spectrometry (LC-MSIMS) fr: Compound ‘Bot Limit ‘Compound ‘Amphetamine 5.0 ngjmL Norpseudoephedrine Ephedrine 5.0 ng/mL Phendimetrazine MDA 5.0 ngimk Phenmetrazine MDEA 10 ngimL Phentermine MoMA, 5.0 nami. Phenylpropanolamine Methamphetamine 5.0 ng Pseudoephedrine Methylephedrine 5.0 ng. Selegiine ‘Acode 500168 - Opiates - Free (Unconjugated) Confirmation, Blood (Forensic) - Femoral Blood Analysis by Gas ChromatographyiMass Spectrometry (GC/MS) for ‘Compound Bot Limit ‘Compound G-Monoacetyimorphine - Free 10:ngimt. Hydromorphone - Free Codeine - Free 10 ngim. Morphine - Free Dinydrocodeine /Hydrocadol -Free 10 ngimL. Oxycodone - Free Hydrocodone - Free 40 ngimt (Oxymorphone - Free ‘Acode 500308 - Ethanol Confirmation, Blood (Forensic) - Femoral Blood -Analysis by Enzymatic Assay (EZA) for: ‘Somoound Rot Limit nna. Ethanol 10 mold. ‘Acode 621398 - Zolpidem Confirmation, Blood (Forensic) - Femoral Blood -Analysis by Gas Chromatography (GC) for: Compound init Compound Zolpidem 40 ngimt ‘Acode 621478 - Antidepressants / Anthistamines Confirmation Panel 1, Blood (Forensic) - Femoral Blood Analysis by Gas Chromatography (GC) for: Compound ‘Bot Limit Compound Amitriptyline 10.ngimt, Doxepin Chlorpheniramine 10ngimL Doxylamine Desmethyldoxepin 10.ngimL Fluoxetine extra / Levo Methorphan 5.0 ngimL Hydroxyzine Diphenhydramine 50 ngiml. Mirtazapine ot. Limi Bot himit 5.0 ng/mL. 10 noi. 5.0 ngimt 10.gimL. 5.0 ngim 5.0 ngimk 5.0 ngimt Bot Limit 10.ngimt 10 noi 10 ngimt. s0ngimt. Bot Limit Rot. Limit 10 ngim. 50 gira 40ngimL. 10.ngim. 5.0 nom v7CONFIDENTIAL Workorder 10261081 N MS Chain 1234046 Patient ID 2010-08705 (as aaa al Page 5 of Analysis Summary and Reporting Limit Compound ‘Bot. Limit Compound innit Nortotne ‘Oram. Traosone 0 moat Noreyine ‘orgmt \trapra ‘Dngm Promethane Ong ‘Acode 80528 - Postmortem Toxicology - Expanded, Blood - Femoral Blood Analysis by Colorimetry(C) for ‘Compound Bot Lim ‘Compound Rot Limit Salcylates 200 meal. -Analysis by Enzyme-Linked Immunosorbent Assay (ELISA) for: ‘Compound Bot bimit ‘Gompound Rot Lit Benzodiazepines 100 ngimnt Cocaine / Metabolites 20 ngira. Cannabinoids 10ngimL Opiates 20 ngimnt. Analysis by Enzyme-Linked Immunosorbent Assay (ELISA) for: ‘Compound ‘Bot Limit ‘Sompound Bot Limit Buprenorphine / Metabolite 0.50 ngimt. Analysis by Gas ChrometographyiMass Spectrometry (GC/MS) for: The following is a generalist of compound ‘lasses included in the Gas Chromatographic screen. The detection of any particular compound is concentration- Sependent. Please note that not all knawn compounds included in each specified ciass or heading are includes ‘Some speciic compounds outside these classes are also included. Far a detailed list of all compounds and reporting limits included in this screen, please contact NMS Lets. ‘Amphetamines, Analgesics (opioid and non-opioid), Anesthetics, Anticholinergic Agents, Anticonvulsant Agents, ‘Antidepressants, Antiometic Agents, Anthistamines, Antiparkinsonian Agents, Antipsychotic Agents, Anxilytics (Benzosiazopine and others), Cardiovascular Agents (non-cigitals), Halucinogens, Hypnosedatives (Barbiturates, Non-Benzodiazepine Hypnotics and others), Muscle Relaxants, Non-Steroidal Anti-iflammatory [Agents (excluding Salicylate) and Stimulants (Amphetamine-lke and others), Analysis by Headspace Gas Chromatography (GC) for: Acetone 4.0 molal Isopropanol 4.0 mold Ethanol 10 mad Methanol 5.0 mld vr