Official examinations of this case have claimed the victim died by suicide after placing the muzzle of a 12 gauge shotgun in his mouth, against his soft palate and shooting himself. This conclusion could be made only if there was no consideration of several basic fundamentals of brainstem physiology that define the difference between instantaneous and sudden death. Instantaneous means occurring in an instant without any perceptible period of time - much as the passage of electricity appears to be instantaneous. When we say death is sudden, it means the death must follow the injury, but allowing a period of time that is perceptible, although the period may be quite brief. In contrast to instantaneous, the word, sudden, is more comprehensive and elastic in its meaning. The death certificate used the term "immediate" in reference to the alleged suicide. However, in view of the autopsy findings it is not clear what was meant by this term.
A few examples of sudden death are those resulting from cardiac causes, respiratory arrest (such as due to airway obstruction, which may be seen in cases of choking or asphyxiation), toxicity or poisoning, anaphylaxis, and trauma. In all these cases, there remains some body and neurological function, such as gasping, musculo-skeletal posturing, blinking, etc. These events indicate death is imminent but has not yet occurred. Furthermore, these terminal events require at least some elemental brainstem function. Conversely, when death is instantaneous, the event resulting in death causes the person to lose all brainstem function with no perceptible passage of time from the event until death. Obviously, instantaneous death is rare but from a forensic standpoint and, particularly in this case, its recognition and understanding are critical in order to arrive at a valid conclusion as to the manner of death.
The following physiological principles must be understood in differentiating sudden from instantaneous death:
Consequently, since the shotgun blast would have resulted in instantaneous death, there must be another explanation for the autopsy and crime scene evidence:
- The brainstem is the upper continuation of the spinal cord. All impulses descending from the brain cortex and upper areas of the brainstem must pass through the medulla, which is the lowest portion of the brainstem.
- All information from the periphery must pass through the medulla before it reaches higher brain centers.
- The respiratory and cardiac centers are located in the medulla.
- Deep within the brainstem, there is a nerve fiber complex known as the ascending reticular activating system (RAS). This fiber complex, among other things, is necessary to maintain consciousness. Disease or injury results in varying degrees of impairment of consciousness.
- Within and surrounding the RAS are the nerve fibers that constitute the autonomic nervous system, including the sympathetic and parasympathetic. These systems are necessary for vascular tone and cardiac regulation.
- The muscles involved with breathing are the diaphragm and the intercostals or chest muscles. They receive their nerve supply from cells originating in the spinal cord. However, these cells cannot function without input from nerve impulses descending in the spinal cord originating in the brain and brainstem. There is no respiratory center in the spinal cord.
- The abrupt transection of the spinal cord results in instant and total flaccid paralysis beneath the level of transection (spinal shock). Clinicians may observe agonal respirations after cardiac arrest but this requires neural continuity between the brainstem and spinal cord.
- The heart is regulated through the autonomic nervous system with nerve tracts originating in the medulla. The heart muscle has the ability to beat without extrinsic neural input. However, its rhythm (chronotropic effect) is aberrant and its contraction (ionotropic effect) is weak, due to the loss of sympathetic input. Hence, the cardiac muscle loses its contractile force as well as effective rhythm.
- The sympathetic nervous system is responsible for maintaining vascular tone. Sudden loss of the body’s entire sympathetic input results in vasomotor paralysis and shock.
Considering the evidence presented above and, not taking into account other compelling factors such as gunshot residue and blood stains and spatter, we concluded the first assault on the decedent was a blow to the back of his head causing a large depressed skull fracture. This caused a sudden death. After being struck, the victim was rendered unconscious and he fell to the ground on his right side. A fatal brainstem injury followed. He exhibited the classic signs and symptoms of this injury, which included decerebrate and decorticate posturing. As this took place, there were violent contractions of all extensor muscles of the body and clenching of the jaws. During these severe muscular contractions, biting and laceration of the tongue and lips took place. The injury caused central neurogenic hyperventilation and because he was lying on his right side, he aspirated one-half liter of blood into his right lung. Death soon followed. Because the victim had already expired when an assailant shot him, and was without circulation, only a small amount of blood was part of the gunshot back spatter. Essentially no blood was present on the front of the victim.
- Depressed occipital skull fracture.
- Large subcutaneous and subgaleal hemorrhage seen exclusively above the depressed skull fracture.
- Basilar skull fractures associated with both Battle’s and Raccoon Signs.
- Aspiration of approximately 500 cc of blood into the right lung.
- Lacerations of the tongue and lips corresponding with the upper and lower incisors.
- The estimated crime scene blood loss of only 50 cc.
- Positioning of victim at death scene.
In view of this evidence, the officer could not have shot himself. The death was homicide with an attempt by the assailant or assailants to make it look like suicide.
These basic facts of brainstem physiology as applied to certain death investigations will aid in establishing whether the manner of death was by suicide or homicide.
This particular death investigation represents the necessity of not jumping to conclusions when immediate appearances at a death scene suggest one thing but scientific evidence shows the opposite. It further underscores the axiom; the initial death certificate in an unwitnessed violent death should be considered as only a preliminary record. This is especially true since the crime scene evidence, such as fingerprints, crime scene photos, particulate analysis, blood spatter, interviews of neighbors and other mitigating factors are generally not available at the time of the initial death report. In this particular case none of the evidence was yet available. Furthermore, in this case, there was no indication the skull x-rays were even seen by the medical examiner, for the skull x-ray evidence was not mentioned in the autopsy report. And since the x-rays show a depressed fracture beneath a localized subgaleal hematoma, their significance was indisputable.