The Kevorkian Verdict

AUTOPSY REPORT FOR MARJORIE WANTZ


OFFICE OF THE MEDICAL EXAMINER
COUNTY OF OAKLAND, MICHIGAN

AUTOPSY PROTOCOL


NAME OF DECEASED: MARJORIE WANTZ

CASE NUMBER: 91-2753

AUTOPSY NUMBER: 622

AGE: 58

RACE: White

SEX: Female

LOCATION OF DEATH: Oakland Township

DATE OF DEATH: October 23, 1991

PRONOUNCED DEAD: October 23, 1991

TIME OF DEATH: Unknown P.M.

DATE OF AUTOPSY: October 24, 1991

TIME OF AUTOPSY 11:05 A.M.

CAUSE OF DEATH: POISONING BY

MULTIPLE DRUG INJECTION

MANNER OF DEATH: HOMICIDE


WANTZ, Marjorie
#91-2753

EXTERNAL EXAMINATION:
The body clad in a tri-color blue/white jogging top and light green jogging pants, white socks, white bra, and white underwear panties is that of a 5'6 1/2", 187 pounds, well-nourished white female reported to be 58 years of age. The body is received together with a white pillow and white bedspreads where a black comb and a burgandy color pen are found on the right side of the pillow. Rigor mortis is fully developed in the cold body and livor mortis is dorsally distributed and fixed. The scalp hair is gray with some brown and measuring up to 4" in length. The irides are brown with bilateral mild arcus senilis. The earlobes are creased bilaterally and pierced once bilaterally. The external ear canals are free of foreign material and abnormal secretion. The external nares are without note. The nasal skeleton is palpably intact. The lips are without evident injury. There is dried up white foamy purge present in the left corner of the mouth. Natural dentition is present in the upper and lower jaw. The neck and anterior torso are unremarkable. There are multiple Duragesic transdermal Fentanyl patches present in the front aspect of the right shoulder, right upper and lower front thigh, left front thigh, and left and right upper back areas. A transverse scar measuring 6" in length is present in the lower front abdominal wall. A small periumbilical scar is present. A 12" long scar is present in the inner aspect of the inner aspect of the front part of the right thigh. Another 3 1/2" scar is present on the outer aspect of the left knee. A 4" midline scar is present in the lower back. The external genitalia and the anal orifice are without note. Finger clubbing and peripheral edema are absent.

EVIDENCE OF INJURY:
A stabilizing arm board with yellow sponge padding is attached to the right arm by means of white gauze strips tied in a know around the right upper arm area and the board an the right wrist area and the board. Affixed to the inner aspect of the right forearm by means of white adhesive tapes is an intravenous line connected with a bottle labeled 0.9% sodium chloride. The bottle was removed by me at the scene prior to this examination. Another line is connected to this intravenous line, on its right side, connected with a bottle labeled potassium chloride and succinyl choline. Another line inserted on the left side of the intravenous line is connected with a bottle labeled methohexital sodium 1%. Both of these bottles were disconnected by myself at the scene. After removing the intravenous lines, one fresh needle puncture wound is identified in the right cubital fossa. A black string knotted around the left index finger is present with a green plastic clip at its end. A white string is knotted around the left ring finger with green plastic clip at its free end.


INTERNAL EXAMINATION:

HEAD:
The scalp is reflected after making the usual intermastoid incision and is free of subcutaneous and subgaleal hemorrhage. The calvarium is intact. The external meninges are unremarkable, without epidural or subdural hemorrhage. The 1248 grams brain is covered by glistening transparent leptomeninges and the cerebrospinal fluid is clear. The vessels at the base of the brain pursue their usual anatomic courses and are patent. Both the brain and the spinal cord with sacral ganglia are placed in formaldehyde fixative prior to the examination. The bones at the base of the skull are without evidence of fracture. The examination of the brain and the spinal cord after fixation reveals no evidence of external or internal anatomic abnormality.

NECK:
There is no evidence of injury to the soft tissues or bony structures of the neck. The laryngeal cartilages, hyoid bone and cervical spine are intact. The lumen of the larynx and trachea shows a small amount of white foamy fluid. The mucosa is without note.

BODY CAVITIES:
The body cavities are entered in the usual manner. All cavities are free of excess or abnormal fluid accumulation and adhesions. The organs are in their usual anatomic location except for the surgically absent uterus and ovaries. The lungs are expanded. There is no internal evidence of blunt force or penetrating injury to the chest cavity or abdominal cavity.

CARDIOVASCULAR SYSTEM:
The 399 grams heart has a glistening epicardial surface with mild thickening of the tan-brown ventricular myocardium which shows no evidence of focal lesion. The endocardium and heart valves without note. The coronary ostia are patent and the coronary arteries are involved by moderate focal atherosclerosis which in the right coronary artery shows up to 50% stenosis of the lumen, and in the left coronary artery, left anterior descending branch, and left circumflex branch shows up to 20-30% focal stenosis of their lumina. The aorta shows moderate atherosclerosis and its major branches are free of significant compromise. The vena cavae and pulmonary arteries are free of antemortem thrombus.

RESPIRATORY TRACT:
The right lung weighs 892 grams and the left lung weighs 644 grams. Their pleural surfaces are smooth and glistening. The parenchyma is markedly congested and edematous but without evident focal lesion. The bronchi and their major branches contain moderate amounts of foamy whitish fluid.

LIVER, BILIARY TRACT, SPLEEN AND PANCREAS: The 1688 grams liver has a glistening capsular surface. On sectioning, the tan-brown parenchyma is of the usual consistency. The gallbladder contains approximately 50 mls of bile, and is free of stones. The bile passages are patent. The 166 grams spleen has a glistening intact capsule and an unremarkable parenchyma. The pancreas is without external or sectioned abnormality.

GENITO-URINARY SYSTEM:
The left kidney weighs 124 grams and the right kidney weighs 108 grams. Their capsules strip with ease to reveal a finely granular cortical surface. On sectioning there is good cortico-medullary definition with a slight reduction of the thickness of the parenchyma and an increase in peripelvic fat. The calyces, pelves and ureters are unremarkable. The urinary bladder contains approximately 80 mls of urine. The mucosa is without gross lesion. The uterus, tubes and ovaries are surgically absent. There are thin focal fibrous bands present in the lower abdominal cavity in the area of the pelvis adherent to the bowel loops and the mesentery. The vaginal pouch is surgically reduced.

GASTRO-INTESTINAL TRACT:
The tongue is without evident recent injury. The pharynx and esophagus are unremarkable. The stomach contains approximately 10 mls of dark brown fluid. The gastric mucosa is without note. The duodenum and remainder of the small and large bowels are without evident abnormality. The appendix is present.

ENDOCRINE SYSTEM:
The thyroid, pituitary, pineal and adrenal glands are unremarkable.

MUSCULOSKELETAL SYSTEM:
The skeletal muscle is firm and without note. The long bones of the extremities, the bony thorax and vertebral column are without evidence of fracture.


MICROSCOPIC EXAMINATION:

CENTRAL NERVOUS SYSTEM: No pathological diagnosis.

SACRAL DORSAL ROOT GANGLIA: No pathological diagnosis.

HEART: No pathological diagnosis.

LUNGS: Edema and congestion

KIDNEY: Arteriolar nephrosclerosis, mild.

THYROID: No pathological diagnosis.

PINEAL GLAND: No pathological diagnosis.

PITUITARY GLAND: No pathological diagnosis.



DIAGNOSIS:

1. Poisoning by Multiple Drug Injection:

a. Needle puncture wound in right cubital fossa.


OPINION:
This 58 year old white female, Marjorie Wantz, died as a result of poisoning by multiple drug injection administered by a system of intravenous lines into the cubital vein of the immobilized right arm. In consideration of the circumstances surrounding this death, investigation of the scene, the autopsy findings and the toxicological findings, the manner of death is homicide.



L.J. DRAGOVIC, M.D.

CHIEF MEDICAL EXAMINER



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