What possible scenarios could account for this patient’s death?What do you believe to be the most likely Cause and Manner of Death, and why?

Questions

1.  Police descend on an intersection well known for drug sales.  Upon the arrival of marked patrol cars, everyone congregated on the sidewalk begins to run, with officers in hot pursuit.  After a search of an abandoned apartment building close to the intersection, several individuals are taken into custody, based on outstanding warrants, drugs found in their possession, fighting with officers—or combination thereof.  One of those arrested is known to law enforcement to be the primary drug dealer on that corner.  When confronted by officers in the abandoned building, the suspect fought fiercely with the police, being Maced, and struck multiple times with the officers’ fists and batons during his apprehension.

Because of a 3” laceration of his forehead, and other contusions and abrasions of his face and chest, he was to be evaluated at the Jail Medical Clinic before being brought to his cell.  While in the Clinic, some 2-hours after his arrest, he began to vigorously complain of abdominal pain.  After doing so for a few minutes, he became very agitated, began to scream and shout incoherently, was noted to be very tremulous, appeared to be pale, and was sweating profusely.  Because of his agitation, medical personnel were hesitant to approach him, even though he was still in handcuffs.  After only 90-seconds from onset of his agitated state, he took 3 gasping, irregular breaths, and slumped, apparently unconscious.

Now assessed by jail medical staff, he was found to be non-breathing and pulseless.  CPR was immediately initiated, and the patient was transferred to the treatment room of the Jail Clinic to receive Advanced Cardiovascular Life Support.  Resuscitative efforts at the scene of collapse, in the Jail Clinic, during STAT transport by ambulance to a hospital, and in the Emergency Department, were to no avail, and the patient was pronounced dead approximately 1-hour after having been stricken.
a) What possible scenarios could account for this patient’s death?
b) How would you go about conducting the medicolegal investigation of this person’s death?
c) What do you believe to be the most likely Cause and Manner of Death, and why?

 

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