Twice, No, Three Times Dead?

by Andrea Campbell

When is a nightmare real? When you die two or more times.

Earlier this year, a Caucasian woman named Pamela Harper was found lying face down and unconscious in an alley behind her brother-in-law’s house at 1322 Hunters Cove Drive in Little Rock. Despite the March night chill, she was wearing a thin gown, light underwear and socks. Her right hand clutched a pair of gray sweat pants. It was 6:30 a.m.

MEMS Arrives
According to Detective M. Nelson’s police report, the patrol officers who arrived on scene said that a Metropolitan Emergency Medical Services (MEMS) was called, and vehicle Unit #503 arrived. Two paramedics named Pat Bajorak and Keith Summerman were the first responders, arriving within twenty minutes at approximately 6:40 a.m. The medics did their work and reported that the victim was deceased. The medics remained on the premises for about an hour altogether according to police officer Ronnie Carr. Carr then notified Sgt. Helton. A couple of other detectives, Sgt. O. Jenkins and Detective Haskins, came out to the scene as well.

Interviews
Officers interviewed Jim Ducket, 71, the subject’s brother-in-law who lived at the address. Ducket said that Pamela Harper had called him a little after 1 o’clock in the morning. Ducket added that he thought she had sounded drunk, and that she said she had to get out of the house. Ducket claims he told Harper that she needed to not leave the house but that she should try to go to sleep. She said, “OK,” and ended the call. The next person police spoke to was the deceased’s husband, Tanny Harper, aged 60, who admitted that he and his wife had been drinking the night before and he thought his wife may have taken some pain pills. But Mr. Harper stated that he didn’t know if she’d left the house, and he reported last seeing her around midnight.

On Scene
Detective Nelson reports that he was urgently summoned from another crime scene to join the others at the Harper scene. Nelson reported that Lt. King said there was more going on with the dead body. Nelson arrived around 8:50 a.m.; Detective Haskins filled him in: the first MEMS unit had put a sheet over Ms. Harper before they left. Officers then went back to the body and when they pulled back the sheet, they noticed Ms. Harper had “goose bumps” on her shoulders and back! They observed that her stomach was moving up and down and that air was being exhaled from her mouth. He wrote in his report that they witnessed her taking about ten breaths over a two-minute period. Apparently, the first MEMS ambulance crew had pronounced her dead mistakenly, misdiagnosed rigor mortis. They immediately sought to cover her up and called the MEMS service again.

Second Ambulance Visit
This time MEMS Unit #408 was dispatched to 1322 Hunters Cove Drive at about 9:10 a.m. In the meantime, officers had spoken to the Pulaski County deputy coroner and described what they saw. The second ambulance crew arrived, immediately started CPR and Paramedic Brandi Johnson hooked Ms. Harper up to a heart monitor. Johnson determined that she couldn’t detect any heart rhythm, decided Harper was dead, and over the phone asked a doctor—Dr. Kennedy at Baptist Emergency—to "declare Harper officially dead.” Johnson was heard saying the victim showed signs of lividity and was cold. Harper's death was now logged in at 9:29 a.m., about three hours since she was first discovered. Before she left, Paramedic Johnson took the time to explain to the detective that what she believed he had observed was air leaving Ms. Harper’s lungs after death. The MEMS unit left the scene once again.

Notification
Officer Nelson notified his superior and called Deputy Coroner Patrick McElroy to tell him what had transpired and ask him to respond to the scene. Around 10 that morning, McElroy showed up with Pulaski County Coroner Garland Camper and another deputy coroner, Gerone Hobbs. Soon all of them observed Ms. Harper breathe again. She was covered in a blanket and MEMS Unit #133 arrived at 10:27 a.m.; and this time they were advised to take the victim to Baptist Hospital right away. They left around 10:53 a.m., according to the police report.

So let’s get this straight: about three and a half hours after she was first found in the 40-degree March temperature, she was pronounced dead several times and left to chill (literally).

Unfortunately, Ms. Harper died two days later at Little Rock’s Baptist Health Medical Center.

The Official Medical Ruling
Autopsy results determined the death was a suicide as the result of an intentional overdose of the narcotic painkiller Darvocet and alcohol. Hypothermia was a contributing factor in her demise.

The Aftermath
MEMS administrators accepted responsibility for the mistake, but Executive Director Jon Swanson, along with Medical Director Chuck Mason, said that once the two separate crews believed that 52-year-old Pamela Harper was dead, they followed the correct protocols and made decisions accordingly. They also felt that the coroner had portrayed the incident unfairly by criticizing the agency and its employees. Coroner Camper put in his report that paramedics should have followed a hypothermia protocol. Swanson disagreed, saying that paramedics should have done “Pulseless Electrical Activity” had they known Harper was alive. “I don’t know where he got his medical training,” said Mason, a physician and specialist in emergency medicine, said of Camper. “But it wasn’t medical school.”

Some other critical comments were bounced back and forth such as: the questionable age of the medic, a reluctance to share information, how likely the victim was to die, and, apparently, animosity was fully lobbied in both directions. The end result is that MEMS issued an apology for the mistakes and the Harper family did not reply to reporters' requests for comments.

“This is nothing to be proud of,” Swanson said. “We have done a thorough, honest and self-criticizing assessment of our performance. The responsibility is ours for the mistakes we made.”

Coroner Camper said he was confident in his report’s accuracy. “It is what it is,” the coroner said. “It’s as right as I could get it. I gave them the benefit of everything we address in the report.”

In Hindsight

MEMS is revising its training and protocols, in particular, Protocol 803 “Withholding/Withdrawal of Life Support.” The new policy adds four criteria for determining whether a person is “obviously dead”: No breathing through an open airway for 30 seconds, no pulse for 30 seconds, no heart sounds for 60 seconds and fixed and dilated pupils with “no neurological response to painful stimuli,” such as a pinch of the skin.

Other Cautions

There is also this: “Caution: Signs of death may be misleading.” Examples given in the manual are that a burn victim may appear dead and that poor hygiene can simulate decomposition.

And that pesky hypothermia? It “may simulate death, and resuscitation should be attempted if time of exposure to cold environment or water has been less than one hour or is unknown.”

According to news reports, Swanson said MEMS gets more than 6,000 calls a month and transports 4,000 people to hospitals. “Maybe only 1 or 2 or 3 percent of our calls are truly to render lifesaving service, to perform in life-threatening situations,” Swanson said. “We know we don’t get a second chance.”

Told that it would seem that ambulance crews got a second and then a third chance in Harper’s case, Swanson sighed deeply and thought about what to say next. "We acknowledge the duty that we have to do the best we can with each patient every time," he said after a pause. "This is an outcome that we regret. Which is why it is so important for us to learn what we can from it, to use it to better offer treatment and care to the people we will serve in the future.”

Source: MEMS criticizes coroner’s report on death Responders Erred in Overdose Case but Findings Unfair to Then, Officials Say by Jacob Quinn Sanders Arkansas Democrat Gazette, June 23, 2010.

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The Airport Evidence are Heads

by Andrea Campbell

I always hate it when Arkansas has some strange news story ongoing. The state has a not so great redneck stigma to overcome, as many states in the South often do. But this is just, well, darn weird y’all (and I say that with love because I’m not even from here originally). One news story was titled: “Coroner holds on to heads in boxes.” Another was: “Human heads go nowhere for now.” Puleese, there is no grammatically sufficient way to convey this headline (ouch).

Bad Labeling, Strange Cargo

Just recently, a Southwest Airlines employee questioned the freight shipment documents for containers that were being sent from Adams Field in Little Rock and posted for Fort Worth, Texas. Yes, there were human heads in boxes at Little Rock Airport, lots of them. The Associated Press reported: “Officials say a Southwest Airlines worker stumbled across a few boxes of human heads at the Little Rock, Ark., airport.” How on earth do you stumble upon this, you ask?

Apparently the heads were being shipped by JLS Consulting of Conway, Arkansas, and the containers were brought in by General Delivery of Little Rock. But when they reached the Southwest Airlines cargo office, the deliveryman said he didn’t know what they contained. Okay, what do airlines ask you when you check baggage? You know, the “are you traveling with …” questions, and, "... did anyone give you an unknown package” speech. 

So you know this questionable freight answer is not going to fly, literally. And the airline's employees know the drill: in 2009, Southwest Airlines moved 182 million pounds of cargo. So the airline agent did what they're supposed to do and opened the containers. The agent found red bio-hazard bags and heads wrapped in absorbent pads. According to the airline's company spokesperson, Chris Mainz, the company wisely refused to ship them airfreight because they were packaged and labeled incorrectly. And he called the police. Enter one of our state’s coroners, Pulaski County’s Garland Camper.

Over to the Morgue

Camper took possession of the heads and had them transported to the county morgue, where they’ve been since June 9. There are between 40 to 60 whole and partial heads.

The shipment was bound for a Fort Worth medical laboratory that uses them for a continuing education program for doctors, said JLS founder Janice Hepler.

And Camper replied, “I’m not just going to release a bucket of heads to go across the country without verifying that these were indeed lawfully obtained.” The specimens were in three rubber containers.

The hang-up continues because Coroner Camper says he hasn’t been able to verify the information—the company can’t accurately describe the heads and there are inconsistencies. Hepler is cooperating and understands; she says nothing is wrong, that they see the coroner’s point of view, and they'll eventually present proper documentation.

Caution for Good Reason

Camper told reporters that in his 24 years with the coroner’s office, this was the first time he knew of a shipment of bodies being stopped. "We've come to the conclusion that there is a black market out there for human body parts for research or for whatever reason," Camper told NBC. "We just want to make sure these specimens here aren't a part of that black market and underground trade."

While the heads were donated to science by an undisclosed organization—the Medtronic project—their spokesman, Brian Henry, said the company uses the specimens for physician education and training and in the development of new surgical tools. He also talked about a similar holdup a few years ago involving incorrect labeling. He probably shouldn’t have shared that.

Practice Called into Question

Okay, if you’re in the business of shipping body parts, why aren’t you getting it right? The coroner had every reason to be suspicious and was just performing his due diligence. Henry remarked, “We certainly expect our suppliers to adhere to the required processes to safely ship or transport specimens,” adding that the company would “work with our suppliers to make sure that all future orders are properly labeled.”

Ethical Lapses and Administrative Mistakes

It just makes someone reconsider donating their body to science, now doesn’t it? (That and the horrible movie “Pathology,” but let’s not go there.) Still, federal law prohibits buying or selling body parts. Companies can charge for transporting body parts, but people, you must get it right. I mean, there is a certain amount of decorum here. While I'm sure anatomical materials are shipped frequently, I don’t think the public wants to hear about snafus in this regard.

There have always been horror stories and jokes told about human remains, but no one wants their loved one to be the subject of the story, now do they? Mary Roach, author of the book Stiff: The Curious Lives of Human Cadavers, thinks that good science outweighs any taboos we may feel. She writes: “… being carved into bits and chunks and shipped to a dozen different universities and institutions seems no more distasteful than decomposing in the dark underground or being burned to a char in a crematory retort. I'm all for post-mortem adventure and travel. (I'm told that if you donate your brain to the Harvard Brain Bank, for instance, it rides up front in the cockpit on the plane to Boston.)”

The Pro Camp and Cautions 

A website called Donating Your Body to Science has an article called “The Ultimate Donation: How to Give Your Body to Science and Keep It Safe,” by the New York Times' Tara Parker-Pope, and she says that bodies donated to science have helped create crash-test dummies and safer cars, protective gear for soldiers, and a better understanding of numerous diseases.

But she also cautions that: “… potential donors should also ask what happens to a body if a university doesn't need it, and whether auditing systems are in place to track how the body is used. … potential donors and family members should ask what happens to a body when the research is complete? Many medical schools cremate the bodies. Some hold memorial services, and family members may be allowed to attend. A few universities, such as Wayne State, promise to return remains to family members.”

Mr. Henry has since told reporters he believes the heads, which he described as “four cranial samples and 40 temporal lobes,” were mislabeled by the vendor, causing the mix-up.

Notes: Southwest flies to 69 cities in 35 states.

Sources: http://www.southwest.com/about_swa/press/factsheet.html#funFacts

Donating your body to science: http://www.flatrock.org.nz/topics/older_and_under/death_wish.htm
TSA travel info: http://www.tsa.gov/311/index.shtm

Video and update on the Southwest story: http://www.wxii12.com/video/23957372/index.html

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Skeleton Tales

by Andrea Campbell

Question: If a skeleton is found walled up in a crumbling old house, what can the skeleton tell a forensic pathologist about itself? I assume sex, and if there were any injuries, like if he or she got bonked on the head before being walled up. Old broken bones, that sort of thing. But what else would we know about the deceased? Would it be mummified? Would there be any clothes left? Time of death is 20-30 years previous. How involved is the forensic pathologist going to be with the case? In your experience, are FP’s more likely to be men or women?

Answer: There’s a lot here to consider, let’s see where it goes. I’d like to define some positions before we get down to the bones. Definition: “Forensic pathology” involves the investigation of sudden, unnatural, unexplained or violent death. A medical examiner will typically be a forensic pathologist and, in his capacity within the criminal justice system, he will be called a “medical examiner” or m.e. If he has not been appointed, he will remain a forensic pathologist.

A regular pathologist (without the “forensic” designation, will be affiliated with a hospital.) By virtue of being appointed though, the forensic pathologist takes on a new title, Medical Examiner. And to define this still more, a coroner is an “elected official” who does not have to have any medical degree whatsoever. His position is based on English common law and, often, the coroner was the man who made the funeral arrangements. There are still many coroners in the United States.

Since the body in this case is so old, the m.e. may take a stab
(sorry, puns just seem to show up) at estimating time since death but, most likely, after making out a report (chain of command)—he will call in a forensic anthropologist, a specialty primarily concerned with the identification and examination of human skeletal remains.

The Forensic Goal, regardless of condition, is to identify the remains, determine the circumstances of unexplained death. (And also be able to testify in court, if need be.)


Where the forensic anthropologist is headed:

The first questions s/he will answer: • Are the bones human? • How many are present? • What is the time since death? • What is the manner of death? The main and most important job left to the anthropologist is to be able to determine major biological characteristics such as, age, sex, race or ethnicity, and stature. These are what are referred to as specific group characteristics.

“Individual” biological traits such as a pattern of dental restoration, evidence of a previous trauma or medical condition, and any unusual biological characteristics help to define the victim further, giving focus to a more specific age, sex or race group.

In the lab, investigators will examine small structures on the skeleton such as any small changes at the joint; for example, the elbow or knee might indicate a type of injury. They will look for bumps on the bone, which can indicate the site of a well-healed fracture. Perhaps they will stumble on an empty tooth socket would indicating tooth loss either shortly before death or during the recovery phase. (The way to determine the difference would be evidenced by the healing process.) And, basically, they are looking for characteristics that are either normal or abnormal because, if they are abnormal, they may have forensic significance.

Another notion, which is just as important as these biological determinations is being able to identify circumstances leading to the findings and judgment of what happened to the remains since death! By this I mean, questions concerning the state of the body: was the body moved? Time determination since death? Did trauma occur on the bones before, during or after death? I can tell you how a forensic anthropologist determines certain things, but that is for another question.

The medical examiner will be available for consultation and court testimony as long as needed for the case. (S/he works for the state.) The investigative detective assigned to the case will most likely be at an autopsy but, if not, she will still follow up with the M.E. in the lab.

Mummification of a corpse depends on the temperature and dryness of the area because heat and drying is the main ingredient. There should be clothes or artifacts if they were left behind. Their condition is another thing, meaning, moths may have eaten wool, termites may have eaten wood, worms may have ingested adipocere (body fat), and so forth, but without animals present, there is no reason why artifacts such as clothes would not be present.

Here is what a typical Forensic Anthropologist report may have on it:

Summary of Physical Characteristics on an Adult Skeleton

Case #______ Date________

• Sex:
• Age:
• Race:
• Height:
• Distinguishing dental profile:
• Handedness:
• Ante-mortem trauma:
• Peri-mortem trauma
• Post-mortem trauma:
• Disposition of body:
• Time since death:
• Pathology:
• Build:
• Comments or summary:

Suggested reading: Human and Nonhuman Bone Identification: A Color Atlas by Diane L. France (CRC Press, 2009). This is an expensive book for professionals but you may be able to order it through your library using Interlibrary Loan. Wonderful color exemplars.

The Bone Detectives: How Forensic Anthropologists Solve Crimes and Uncover Mysteries of the Dead by Donna M. Jackson (Little, Brown, 1996). This is a wonderful older book because the photography is so compelling; it is also oversized, but specifically for the children’s market. Jackson does a good job of outlining the job of a forensic anthropologist and includes a couple of well-known historical forensic cases.

Final comment: Women can do anything men can do within the criminal justice system.

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