VOLUSIA GOUNTY MEDICAL EXAMINER'S OFFICE nanng,_CAR A AT, ep caseno,_2/rofot ¥ . ase pace ox pare ony_Z14 [ol grant rime_0B 30 E-0036-0509OPFICE OF THE MEDICAL EXAMINER FLORIDA, DISTRICTS 7 & 2+ VOLUSIA & ORKINOLE COMNTZES - A960 THDTAM LAME ROAD, DATSONA BEACH, Fi 33224-2061 (904) 280-4060 wot eanoy, nape pag A aay MOE 49 Dow __ BRAT 20. 3952 RACK SEX _M_ comty __yauusra __ DATE DEATH (FOUND) _ERRROARY 10, 700% GATE OF SOUH_RRDAVARY 22, 300, TIME_oDi EBS, GROSS AEATOMEC DIAGKOSES FRpnNs: 2. Blunw foree injuries. A. Read and neck. 2. Ring feactuce of base of kell. Ring includes eccipical bone, diastatic: fracture ox Daleceral Scclpitonsstoid sutures, fractures af the clivua behind the dorsum sella and through the body of che ophaneid Bone Shougn the lesser wing Gritm preservation Of che bypoprysial os: b. Aasoctaced subarachgoid and epidural heporchage €! Hild cdeae Of the postecior etelpitad Lobos and poacericz temporal lobes bilsrerally. 2. Abrapion, right side of chin. 3. Contusies sf left occipital scalp. B. Tezao. 1. Rib fractures. a. Left ribs % through 4 fractured anterierly. bl. Daft fib 9 fractured laterally. 2. Practure of 3" atornebra. 3. Supereceial abrasions. <. Extremities. 2. Fracture of eft ankle (with fracture 2) superticial abrasions T1. enolerithinets. ‘ioual fibula). FINAL DIAQROSIS CAUSE OF DEATH: Blunt Force injuries of the Mead. motor Whole Aectdent, & Rotident. SPECIAL STUDIRG: (See act page off report RE: State Attorasy’a Office Daytana Bauch Police Department DATE KESOCIATE NEDTEAL EXAMINER/Thomae A. Parsons, o.D- THIS DOCUMENT HAG MOT BEEN ROVIRWDD Ok COARECTED bY TH FHYOICEAM, AND KAY CONTAIN ERRORS AND/OR ONTSSIONS WHICH MAY Of MAY hor ANFECT THR FIVAL REPORT.OFFICE OF TIE MEDICKL XAKINER DISTRICTS 7 & 24 PAGE 2 OF ¢ wom mamernet, pate pare 0 _aoogy REPORT OF AUTOPSY EATREMAL EXAMTHATION Recoived is the wnombaleed, symmetrically developed. adequately nourished and hydrated, of an adele-waite male appearing approximately his reported age ot 42 years, Tne lengch 40 63 inches. whe weight 10 108 ~The body ie gool ta the touch and has béen previously refrigurated. Rigor martin is fully developed in the Msolee of the jav and oxtremities. Uersal livor mortia is gperod in orcan expoacd to Presdure, and blanchey ube Cin vrecgure. the cranium is symmetrically developed, with browm scalp hair moscuring up to 10 ce Sa'lengtn. “There io no palpable eropitus over the bridge of che nase. The eyebress ore intact. These is ag conguocion or petechial henozrhages within the palpabya! oz bulbar conjunctivac. The irides are blue. ‘the pupfle aré round. tqual, coneral and ceasure } mm. The pagal septum is intact and in the ayprowteste eidiine. Over cho upper lip io a well groazed, broyn haty sustacke. The remaining cheeks, chin, and nock ate clean-ohavan, Tae external sare are vnmrenarsable, with no foreign saterial in the external auditory canals, ‘There ie sbundet blood ia the external auditory canaig bilaterally. Dentition i¢ natural and tn 4 good state of ic. There age no oxal puceal mcceal njusies, ‘The neck ss symatrically developed, wichove unusual jeasse= palpable. The treches {2 palpated in the midline. rhe checc is synotricelly developed. ae abdonen i soft and without palpable mncucc or orgsneregaly. The externa) genitaliz ure thove of a circumiged adult mile with bilarera!ly desconded testec Palpable within the écrocue, The snug and perineal region are grossly Snremixkable. ‘The lower extvanitics axe symmetrically developed and are without an absence of digits. Attachad to the left great toe ia a cardboard dentification tug witch 1s dneerined with whe secedent’s identifying information. {neluding the name “Ralph Karnharde", Snedroling ‘tha right ankle ‘& hospital identification bracelet vnich is inscribed with the name “Joho Pacific boo. Attached co the right great toa by a piece of otring ia a hospital identification dick which hac the camo mana on it. Tho laft ankle haa @ dioplaced fracture with contusion, deacribed further subsequently {g¢¢ EVIDENCE Or INURY). A white plastic identification bracelet encizclea the left wrist with the nama ‘Dale Parsharde' on ie. Tha upper axtrenitien ara oymmetrionily developed and are Without an absence of digits. The gingernails are of mediuna leageh. vithoue Underlying aire, Gebris, hair, or Cigoue. There ave no absent fingerpaaia. ‘There ic no tearing of tha fingornaile on the loft hand. There io no acute tearing of the fingernaile on the right a D money op smear a mune rane ae gram ORAET 1 endotracheal tube essnates from the vight corner of the mouth. "An rencus eachater ig secured an che right side ef the neck by black ‘sycure material. Ghent cuben axe ceaured in tho chect Dilacorally by black suture material. These are inserted cucansoualy at approximately the Level of the nipploa, just anterior to the aidaxiilary line. An intwavendug Catheter i¢ decired in the left aateouhstal foana. Muncrous colf-adhaeiva Bic pads are pyeoent over the anterior shost bilaterally, over the left lateral abdonen, and left posterior shoulder. Three needle puncture arks are present over the flexor aspect of the right fowearm and antecubital feows, ‘Tiere are nunevous needle punctude marks iu the vight subclavian area and on the left ride of the neck, No other evidence of therapeutic ancervention is seen on the surface of the body. SCARS AND IDENTIFYING MARKS: A nearly vertically oriented, 11 cn goar is present over the left knee, Jateral to the patella. A nearly vortleally ordeuted, well hoaied, curvilinoar soar is preaont over the wight hice and moapures 22 cx in fengen’ 2 2 om, vareically orionted. veil healed, curvilinear cear in precast Svor tho ital nead of Che biceps on the Utero) bapcet of the left ubper axa. Thexe are ne other convincing ecsre, tattoos, ox identifyaty malin olaerved on the surface of the Body, THIS DOCUMENT HAS HOT BREN REVISHED OX CORRECTED py TAS PHYSICIAN. AND MAY CONTAIN RoDrvEOPPICE OF THE MEDICOM FEMCEEER prsomrems 7 6 24 EAGE 3 OF 6 woot ___KARNARDT. BAER DALE ae eo -ongay REPORT OF AUTOPSY SVLDBNCE OF INJURY: Over the right side of the chin jo a 2.5 x 1.0 am, euperfisial abrasion, ‘Ovex the deft clavicular head io a jh) x 0.6 oD, superficial abraoien. Over the left hip vegion 1a a nearly trancvorssly oriented, 10 x 2 om arca of superficial abradion. Over the right hip region 1 A 22 x 5 em arca of fuint superficial abrasions. Over tha mid abdomen is an area of diffuse purple-red contusion which maacuren 2.0% 4.5 em, Quat infexier to the umbilicus in the midline ig a 9.3 x 0.4 om lacexation. ror we inferior left paralla is 2 0.6 x 0-5 on, cupersieiad abravion, durrounding the palpable dislocation of the left ankle ia a porple-blue area of contusion which extends from the medial malleolus inferiorly to the ole of the foct, and from the heel antorievly to the head of the motatarcalc. ‘thia sontinacs to the agproxizate midline. There if palpable fracture of the distal jefe fibula included in this dislocatios and txractuxe of the left ankle. -Qvor the medial head of tha left gustrocnenius ia a faint purpla coneusion MeRPUTIng 4.5 x 3.5 en, Over tho posterior proximal left. forearm ic a 2.0 x 9.8 cm, pRAF Through the usual Y-chaped incision, 4.0 cm of yollow eubeutanseus adipsos tisaue and ooft, ced-hrown musculature are revealed. there Lo generalized congestion of the subcutaneous tissues and tisculature. The peritoncal cavisy is free of seers fluid, The onde of tha cheet tuhen aro prevent bilaterally within whe pleural cavities bilaterally through the 5" intereostal spacca. the onentum and vasceza are noraaliy disposed. appendix veraifurnit ig intact and grossly Unremarkable. Tho xight and lefe pleura? cavities have the aasoolated incietons- without other dafeccs of che pleurae. The reraining pieurae are smooth. glistening, and purple-gray to red-brown with aroar of dependant congestion, The Bericardial uae is intact and containa a coant amount of pols yellow, clear fluid. the pericardial sac iz othevwice unremarkable. Tha mediastinum is grossly unremarkable.” The sternum ia tranoversely fractured at the 3° sireatian, « Mage Tube 2 shvough 9 are fractured anteriorly, with sgany hewserhage surrounding the feactured and. Left rib $ io fractured laterally. approximately the mid axillary line, There are io fractures of the right ribs. there arg ao unucual oere. ¥o ether evidence of acute injury is seen externally aeeayy CARDIOVASCULLE SYSTEM: The sorta is of normal courge and caliber, hore is Eocal Sthozonatous ctveaking with miniwal caleifiention distelly. There are fo ameuryana idewtified. The great vessela have their vsukl anatomical xelatierehips. The pulmonary arteyiea appoar patent and free of chrorboenboli. The pulmonary yeino are grogsly unremarkable. the vena caya is groggay vorenarkable. ‘thu heart wedgha 429 gyama. The epicordial surface ic aseceh, glistening, and red-bram with medorate asount of yellow subepicaxdial fac. Tha sorenaty eatia aro patent and give riag toa nertatiy aLstrimuced soroneey arce system which is xighe dominant. The eoxonazy arteries are thin- elastic, and ave focal atheromatous streaking, without eignaficant stenosis Serial ceoticns through the myocardium are firm end red-brown, with RO aEcaa of softening or fibrosig. The cardiac valves and chanbere ‘have cheiy usual anatomical relationships. The valvo leaflets are thin end delicate, without wegetationa. Sections through the acca vf lhe conduction wyeten axe grossly varenazkable. “ THIS DOCOKENT HAS NOT BERN REVIEWED OR CORRECTED BY THE PMYSECIAN, ANU MAY CONTAIN means (AND/OR OMISSTONS WHTCH NAY ox MAY Kor arecroe woe oruse ueaeeeOFFICE OF THE YEDICAL EXRHTUBK Dbisteicré 7 4 oe 7 ad Page 4 oF € WAMz _.___ RARE BDY_ ALP DALE ___.. ue # _ ft etary REPORT OF AUTOPST RESPIRATORY TRACT: The tracho& conteins an appropriately placed endotracheal tube. A meall amount of Bleod is prasent over the mucosal ourfacee. Tha mucoasl surfaces of the trachea and main stem bronchi are otherwise groaily unzemarkeble. The right luag weigno 590 grame. The Jefe lung weighs 660 Srans.! The lungs are mederately collayocd, with @ pattem of henoaspiretion benesih the pisaral surfaces. The pleural surfaces are otherwise amooch, glistening, and pimk-tan to red-browm, Serial sectaene arg pink-tan to red-brown, th areas of dependant Congestion ana tila Renoaspiration. masa lesiong are noc identificd. Purulent exidates are not appacent. Emphysamacous changes are inconspicsous. CASTROINTEETINAL TRACT: The esophagus Su of posal courec and caliber. The gurfgce of the esophaqus is grosmly unremaxkable. The eoophazus in free of foreign material. nasogastric tube ic curled atove the level of the epiglortis End did nov onter inte the stomach, "he mucuoal surface of che evophagus io grossly unremarkable. Tle seresal surface of the stonach ie grossly Mnremarkable. the stomach eontaino So cc of bloody fluid, a portion of which {9 reveined. Ho food ox wadications arc identified. The mucoval ourface of the stomach i grossly unremarkable. The seragai surface of the (Amall bowel ig groubly unrémarkable. The small bovel contains a moderate amgunt of liquid. fellow-geeen anterial, Medicatiens are nol appreeiaced. ine mucosa) ourzaco of the small bowel ig greogly unremarkable. The serosal surface of the colom is rosely unremarkable. The colon contains a modorate amouht of pasty. greenish rown decal maceric?. The mucosal surface of Une colon 15 grougly untemarkebie. WBEATODIGIARY TRACT:.The liver weigho 1640 grams. Tha smooth, glistening, zed-brown eapsulex surface ie intact. sergai sections are firmi and red-brown, ith preservation of the nermal hopatic lobular architecture. Steatosie io not apparent, Fibrosis is imeonspicuous. Hage lesions are not identificd. The Seilbiedder i, intact and contains 20 cc of davk gYeun, liguid bile, a portion of which ic retained. ‘there are focal. leas than 2.0 cm. ET ga2lueonas. The Biliary tract appears tree of ebueruction. HOMATOPOIBTIC SYSTEM: The spleen weighs 219 grams. BE gray connective tiggue capsule is intact and slightly wrinkled, jerial sections are soft to gelatinous and red-brown, ‘There ave ne Mass lesions. she lywpn nodes and beue marrow ure grossly unremarkable. RMDOCRINE S¥S7EM: The xight and simflar left adranal glands are of normal size. shape and position. On cut section. the cortices ara yellow and the nadullas ava aoft and gray. Thore aré Hd hendtrhagec or waae lesions. The pancreas is of normal. efze, shape and position. ‘The etrfaca of the pancrdas is grossly Uncemakable, Soziol sections demansczace preservation of the naxwal paneroatic lolailar architecture. There are no calcifications ox henorrhages. The thyroid gleba is of normal size, ahape and position. The ceresal suxface and cut Sections are grescly unremarkable, The pituitary is ef sornai Gina, ohape and position. GENTTOURINARY TRACT: The right and Lefe kidneys weigh 260 grane each. The capaulcs: scrip with e6¢ te reveal ohooth, dark red-browa carkical surfaces punctuated by escaosenal fete) lebulationa, There are no cortical eyete, On cut section, the earticar and medullue are wali denarcatad in thelr recpective acnee. There aro no bass lesionc. ‘The renal pyzinids are groocly wnresarkable. Tha calicoal gyytuns ace grossly wurumarkeblo, Stouno A nok identified. Pie uretere are of uniform eourse and caliber, ‘The rarorai curfaco of the urinary bladdex io grossly unremarkable. The bladder contains 386 c= of palé yellow, clear urine, S pergien uf which du rotained, ghe miacosal surrace of the urinary bladder is getely unremarkable. The prevtave qiand 2 of serael gia, ohapc, and poescson fo palpation. NES DOCOMENT MAS HOT SEEN REVIEWED OR CORRECTED BY THE PHYSICIAN, AND MAY COWTAZN ERRORS (ANB/OR GMISKZONS KEICH MAY OR HAY NOT APFFOr THE Friar, REPORT.OFFICE OF ‘THs MSDTCAL EXAMINER Dierarers 7 & 26 PAGE 5 OF 6 yor RAT, BALE DAE enon RRoORT OF AUTOPSY BAD: Reflecting the scalp demonstrates an 4.0 x 5.5 cm area of contusion on Ehe Jefe side of the cecipical aceip. This Ls tocluded in tho area of ring fraccure, which extonde dt the temporal hones and occipital bane, There ie honerzhage beneath the temporalis quacles bilaterally in the area of she fracture. A feu other areas of scactersd contusion are present over tbe right sjde of the scalp and over the vortex, Reflecting the bony calvariue demonstrates epidural ond Zebasachnoid hemorrhage. ‘There 10 mo eUbdural henorrhage. Subarachnoid fenormiage is accentuated in the areal surrounding che Cracture and the bags of the brain. pidural Kenorrhige ia surrounding tho fraccure sitoe Discolorations of the bony calvarivm arg not appareat. The superior sagittal sinus end a2 venouy dural sinusas sppoar p2tent and freq of thromboemboli. ‘The brain in the fresh g¢ate weighs 1450 grams. From the vrertek, the aeebral Hemigphoren are symmetrical, withoot afgnificunt atvophy. | There ie flatcening of che gysal curfaces and narrowing or the aici in the pooterigr eecipital tenporal loban. Antevicrly, there is no evidwise of edema, Tha leptoneringes ver the urface af the brain and around tho base of the brain are thin and delicacc, with the previously described subarachnoid hesocchage. Puruleat exudates are mot appreciated. Thara is ac evidence ef hernaacien of the hippocampal viel or cerebellar tonsils. The circle of Willis mas Sts usual anstonica) relationsnipa. Tiece are ne athercnas or anqurysxr progent, gerial Sexonal ecttions af the cerebral heniepheres denonsteate no grace abnormality of che gray of white eattor. Macs lesions are not identifiet. -Serfal sagittal feecions of the cerenellam demonstrate preservation of the normal cavebellar architecture, There 36 ne gxogs alwounaiity of the dvay oF vhstd matter. Sersa2 transverse aections of the brainsten and midbrain demoatrate evecervation of the normal architecture. Tnere is no gross abnormality of tho gray or white matter. 399 lesiena are not identified. Stripping the dura Eroa tht bioo of the skull denonetrates a ring fractere which extends through the occipital bene to the venporal bode, with Qiastatic fractuve of the orcipitonasteid mutures bilaterally and with Eracture behind the deveum aaija through the avaa ef the elivua posteriorly and through the Leaser wing of the sphenoid anteriorly, to bave = Dreervation of the hypophysis) fosaa, | This ring fracture indludes wide reparation of whe ving antoriorly (through the ophonoid! bone and the eeeipicozasteid sutures) and with minimal te co zeparation of the fracture through tne posterior point ot che ocoipital bone. Although the fracture ie seen on both thé interns? and outexnel tablea of the peoterdox point of che occipital heng, thore ie ne separation of the Zractured calvarial plates ag thers ic on che Zenaining portion of the ring fracture. Examination of the supersoY eozvica: geinal canai, upon Llexion, extenaion and rokatiogeAf the head, demonat rates no fractures ox gibluxations. vice: g0 nyoid none and chyroid oa br). there are no abnormal collections of extravasated blood overMthe purface of the hyoidlbone or thyroid. cartilage. Laminar diccection of £N6 otrap nusclea of the Neck doconstrates no abnormal collactione of oxtravacated blood. succpt in association with the therapeutic devices and intravenous catheters of the right side of the neck. The Ficoid cartilage a9 intact ond gxosely unremarkable. The lacynx and hypepharynx axe freo of foroign natorial. Th: mecesal aurfaees of the Larynx are grocoly gnremarkable. the epighoctie end vocal cords are grossly unyemarkable Fosterior dissection of the neck devonstrates no injury to the vertebral arteries or to the ligamante of the posterior cexvical spina. MICeocorre AKRON waiting olides.) ‘THIS DOCUNGNT HAS NOT BURN REVIEWED OR CORRECTED RY THE PHYSICIAN. AND 2Y CONTAIM Raoxs “ANB/OR OniSéYOns wwrck MAY OR MAY MOT REPECT TUR FIMAL PororT.‘OveICE OF THY KSDIGAL EXAMINER mrorRreza 7 2 24 PAGE 6 OF ¢ Wu ___RARNHARDN, RALPH DALE 0 ye __p-guy TOXICOLOGE (Seat to Lab.) oeHALIFAX MEGICAL CENTER PERSONAL EFFECTS INVENTORY QUEL OL seep - pare: SB PSO TIME: _ M Patedes Name ‘The undersigned hereby cantfies inal ie ‘along personal stects were inventoried as the property of tha above patieat: bs biaxh =— wot ee )) "2, Opie | Blac faacy OF So / placint ond OM Page iy Eh Inventory Witnodsed By: Inventory Taken By: (Signature} . walure} . (Signature) Thereby acknewtedge receipt of wie abovs parconal steels (oxcoplthode rémbved to Safe). pare: 22 /B-Of