Official Report Division of Forensic Sciences Central Regional Lab Georgia Bureau of Investigation DOFS Cases: 2016-4018825 State of Georgia Report Date: 11/25/2016 ‘George Herrin, PRD. NAME Accrodiiod= Deputy Drector Requested Service: Autopsy ‘Agency: Lowndes Co. Coroner Agency Refi: Requested by: Deputy Coroner B. Carter case individuals: ‘Vietim: Victoria, Hamitton Evidence: 2016-4018825-001 Decedent Results and Conclusions: ‘Evidence Submission: 001 in accordance with the Georgia Death Investigation Act, an autopey le performed on the body of \Vietorla Hamilton at the Georgia Bureau of Investigation, Central Regional Medical Examiner's ‘Office on 09/06/16. The autopsy is begun at 0800 and the prosector is Dr. Maryanne Gatney-Kraf. Cause of Death: Mixed carbamazepine, citalopram and ethanol toxicity Pathologic Diagnoses: ‘Carciomagaly (325 grams) Left coronary artery system hypoplasia Loft pleural adhesions. Early decomposition Presentation of Body “The body is received ina sealed body bag: seal #0175725. Body identification consists of ‘witnessing law enforcement, an identification tag attached tothe right front belt lap of the jeans and an identification tag on the 2ipper-puls ofthe body bag. The body is clothed in blue Jeans, beige underwear, a pink button-ront sweater a white pullover short-sleeved shit. and a fan bra; the pants and underwear are positioned atthe upper thighs. Askew on the face are a Pair of white metal and plastic clear stone embelished glasses. There is no evidence of ‘medical intervention External Examination: Body Conelion: Intact Length: 67 inches Weight: 125 pounds Body Heat: Room temperature Rigor: Absent vor: Red, anterior Hair: Brown with scattred gray Eyes: Brownish, comeae are cloudy, sclerae and conjunctivae are unremarkable except for dependent congestion onthe right “Teeth: Natural in fair to good condition Fingernais: Intact Report Date: 1172572016 Page tof 4 Report a: YXOOUSQ0ARYLY “Template Rev. 2015-12-11Division of Forensic Sciences, Continued Georgia Bureau of Investigation 2016-4018825: Autopsy Deanne ee nn ee cUEEEEEEEEeennnennnnI! “The body i that ofa well-developed, welLnourished adult white female appearing compatible ‘vith the reported age. Early decomposition changes are manifested by green discoloration of the right lower abdomen, variable gray-blue discoloration ofthe face, and superficial erosion of the nose. The skin shows scattered nonspecific scarring and pigmentation changes. The head ‘is normally formed and the nose and ears are not unusual. The lips, gums and oral cavity are ‘wthout obvious focal lesions. The neck is without masses and the larynx's inthe midine. The chest and back are well developed and symmetrical. The breasts are normally formed; bilateral implants without palpable masses are identified. The abdomen is ft; no obvious fuid collection is present. The extemal genitalia ae that of a normal adult female. ‘The labia and Glotal vagina aro unremarkable. The anus and perineum are without focal lesions. The upper {and lower extreities are well developed and symmetrical without absence of digits. Identifying ‘marks and scars consist of two hypopigmented linear scars ofthe right anterior wrist, an Jenthys (Greek fish) design with saying tattoo onthe right inguinal area and a flower with a ‘saying tatoo on the lower back Evidence of injury [No significant extemal or intemal injuries are identified. Acsdional Procedures: Photographs: Documentary photographs are obtained. Evidence Collected: ‘The bloodstain card is collected as evidence. Postmortem blood, urine and histology tissue samples are obtained at auiopay, the histology issue samples are held. Postmortem vitreous could not be obtained Personal fects Disposition: ‘The clothing and glasses are released with the body. The dissected organs are forwarded with the body. Internal Examination: Body Cavites: 'AY-ehapad thoraco-abdominal incision Is made and the organs are axaminad inst and, ‘eviscerated in the usual fashion. The blateral pleural and peritoneal cavities contain no significant fluid, Mid to moderate posterior left pleural adhesions are present: the right pleural and pertoneal cavities are without adhesions. All body organs are present and in their normal ‘anatomical postions, Carciovascutar system: ‘The pericardial sac is free of significant fu and adhesions. The heert weighs 325 grams; ‘expected weight based on height = 281 +/-30 grams. The epicardium 's smooth and glistening ‘wth mild to moderate amounts of epicardial adipose tissue. The coronary arteries aise ormally and follow the usual distribution. The left coronary artery system is hypoplastic wth lumens measuring up to 2 mm in greatest dimension. The coronary arteries are without ‘evidence of significant atherosclerosis or thrombosis. The heart is miy enlarged but the chambers and valves bear the usual siz-positon relationships and are unremarkable. The ‘myocardium is uniform and shows no evidence of acute infarction, scarring, or focal lesion. ‘The aorta and its major branches arise normally, follow the usual distribution and are without significant atherosclerosis Neck: ‘layered dissection ofthe anterior neck is performed. Examination of the sof issues ofthe neck including the strap muscles and large vessels reveals no abnormalities. The hyold bone ‘and laryngeal cartilages are intact. The larynx is clear. The lingual mucosa is intact: the Underlying musculature is devoid of hemorrhage. Report Date: 112872016 Page 2014 Report ia: YXOOUSQOIARYLY “Template Rev. 2018-12-11Division of Forensic Sciences Continued Georgia Bureau of Investigation 2016-4018825: Autopsy Respiratory System: “The right and left ungs weigh 450 and 430 grams respectively. The upper and lower airways are free of debris and foreign material the surface mucosa is unremarkable. The pleural surfaces are smooth and glistening; patchy anthracotic pigment deposition is present. ‘The lungs are normally frmed. The parenchyma of both lungs is without obvious consolidation or focal lesions. The pulmonary arteries are free of thrombi or embol Gastrointestinal Tract: “The Gl tract shows normal configuration and|ie intact throughout ts length. The esophageal mucosa is unremarkable without focal lesions. The stomach contains a moderate emount of unrecognizable partially digested food; the mucosa is unremarkable, The small and large bowels are unremarkable and contain progressively farmed stool. The appendix is present. Hepatobiliary System: “The liver wotghs 1275 grams. The capsule is ntact ana me parenchyma i re0-rowm and urifor without foal lesions. The galbladder contains a small amount of ie; the mucosa unremarkable. The extrahepatic bir ree is patent. Genitourinary System: ‘The right and left kidneys are of normal size and shape weighing 100 grams each. The ‘capsules strip with ease from the undertying smooth cortical surfaces. The renal architecture is Intact and is without focal lesions. The cortices are of normal thickness and the cortical-meduilary junctions are sharp. The ureters are intact and unremarkable. The bladder Contains a minimal amount of cloudy urine; the mucosa is unremarkable. The proximal vagina, Uterus and bilateral fallopian tubes and ovaries are unremarkable without focal lesions. Endocrine System: ‘The thyroid and bilateral adrenal glands are unremarkable without focal lesions. The pancreas {sof normal size, shape and consistency without focal lesions. Immunologie System: ‘The spleen weighs 100 grams. The capsule Is ntact andthe parenchyma is congested but ‘without obvious focal lesions. No significant iymphadenopathy is identified. Central Nervous System: ‘The dura mater Is intact and is unremarkable without focal lesions. The leptomeninges are thin, dalicte and congested without evidence of puntiant Ifacion The vasculature atthe base ofthe bran is normally formed and is intact without evidence of significant ‘atherosclerosis. The brain weighs 1300 grams. The cerebral hemispheres are symmetrical, ‘show a normal gyral pattem, and are unremarkable; mild generalized edema is present without ‘evidence of hemiation. Coronal sections reveal normal architecture ofthe cortical gray matter. ‘subcortical white matter, basal ganglia and thalam: no focal lesions are present. The Ventnicuar system is symmetrical and not diated. The brainstem and cerebellum are ‘unremarkable. Musculoskeletal System: “The observed bony framework, supporting musculature and soft issues are well developed ‘and without obvious focal lesions. ‘Summary and Interpretation: “The decedent is a 38-year-old white female who was found unresponsive in a leaning forward ‘kneeling postion on her bathroom floor in font of the tol; the decedent's pants/underwear ‘were pulled dow asf sho ae using the tollt and collapsed forward. The decadent’s residence was secured: she was pronounced atthe scene on 03/04/16. Per investigative reports, a note of intent and empty bottles of Lexapro, Tegretol and Geodon were present atthe scene: the medications were filed on 08/26/16, The decedent has a history of cerebral palsy “The significant ndings at autopsy are cardiomegaly, left coronary artery system hypoplasia Report Date: 1128/2016 Page 30f 4 ‘Template Rev. 2018-1241,Division of Forensie Sciences Continued Georgia Bureau of Investigation 2016-4018825: Autopsy i ‘and left pleural adhesions. Early decomposition is additionally present. No significant injuries are identified. ‘Toxicoloaical analysis of postmortem peripheral blood for ethyl alcohol is positive ata level of 10.102 (+- 0.005) grams per 100 mi. Analysis of postmortem peripheral blood for drug screen ‘esting is Indicative for certain benzodiazepines and negative for barbiturates, cannabinoids, cocaine/cocaine metabolites and common opioids. Analysis of postmortem peripheral blood {or crug confirmation testing is positive for carbamazepine at a level of 38 mg/L (+- 11 mg), Citalopram ata level of 1.1 mg/L (¥/- 0.3 mg/L), dlazepam at a level of 0.15 mg/L (¥- 0.05 ‘mg/L, dlphentyydramine ata level of 0.49 mL (+1- 0.15 mg/L) and nordlazepam at a lava of 0.14 mg. (+/-0.04 maf), Given the autopsy and investigative findings, its my opinion the cause of death inthis case is best diagnosed as med carbamazepine, citalopram and ethanol toxicity. and the manner of, death is best classified as suicide. ee Only those items discussed in the results above were ar Interpretationslopinions of the undersigned analyst. Evidence analyzed inthis report wll be returned to the ‘submitting agency. Biological evidence (body fluids and tissues) and fre debris extract will be destroyed after ‘one year. This report may not be reproduced except in Tull without written permission ofthe laboratory. lyzed for this report. The above represents the ‘Technical notes and data supporting the conclusions and findings inthis report are maintained within the laboratory case records “This case may contain avidence that must be preserved in accordance with O.C.G.A.§ 17-556. eye A ee Maryanne Gaffney-Kraft Regional Medical Examiner Related Agencies: ‘Souther Judicial Circuit (GBL-Medical Examiner Central ‘ACN: GAFFNEY-KRAFT Lowndes Co. District Attorney Valdosta Police Department End of Official Report ‘Report Date: 1125/2016 Page dot Reports: ¥xG0U4G01ARYLY ‘Template Rev. 2018-1241