Crowne Plaza suicide

County of San Diego GLENN N. WAGNER, D.O. STEVEN C. CAMPMAN, M.D. CHIEF MEDICAL EXAMINER CHIEF DEPUTY MEDICAL EXAMINER (858) 694-2895 (858) 694-2895 MEDICAL EXAMINER’S DEPARTMENT 5570 OVERLAND AVE, STE 101, SAN DIEGO, CA 92123-1215 http://www.sdcounty.ca.gov/me/ AUTOPSY REPORT Name: JOSE ANGEL GOMEZ-CAMACHO ME#: 2020-1088 Place of death: 2270 Hotel Circle North, Age: 28 Years San Diego, CA 92108 Sex: Male Date of death: Found, April 23, 2020; 2124 Hours Date of autopsy: April 24, 2020; 1230 Hours ___________________________________________________________________________ CAUSE OF DEATH: HANGING MANNER OF DEATH: SUICIDE AUTOPSY SUMMARY: I. Hanging: A. Ligature received around neck. B. Patterned ligature furrow above laryngeal prominence. C. Facial and palpebral and bulbar conjunctival petechiae. D. No internal neck injuries. II. No lethal or contributory natural disease. III. No lethal or contributory traumatic injuries. AUTOPSY REPORT -2- JOSE GOMEZ-CAMACHO 2020-1088 OPINION: According to the investigative information, this 28-year-old man had been staying in area hotel designated for people who had a known diagnosis of COVID-19 or were awaiting test results. On April 18, 2020, he informed facilitating staff that he had tested negative and it was presumed that he left the hotel. On the evening of April 23, 2020, hotel staff went to the clean the room and found him slumped over, unresponsive in the bathroom. 9-1-1 was called; when first responders arrived, they noted a ligature around his neck and death was confirmed without medical intervention. Scene investigation revealed spray paint cans nearby. No alcohol, illicit drugs, or suicide type notes were recovered at the scene. His medical history was relatively unknown; however, he was known to be homeless. An autopsy documented a continuous, circumferential patterned ligature furrow above the level of the laryngeal prominence anteriorly. On both sides of the neck, the ligature furrow sloped upwards towards the suspension point behind the head. Facial and palpebral and bulbar conjunctivae petechiae were present. No internal neck injuries were documented. There was no lethal or contributory natural disease or traumatic injuries. Toxicological testing on his liver detected alcohol (0.04% w/v). Based on the autopsy findings and the circumstances surrounding the death, as currently understood, the cause of death is hanging, and the manner of death is suicide. TIMOTHY JONG, M.D. Forensic Pathology Fellow SUPERVISING PATHOLOGIST: JAGBIR KHANGURA, M.D. Deputy Medical Examiner Date signed: AUTOPSY REPORT -3- JOSE GOMEZ-CAMACHO 2020-1088 IDENTIFICATION: The body is identified by two Medical Examiner's identification bands on the right ankle bearing the case number. The blue tag indicates a name of “Doe, John.” The yellow identification band bears the name “Gomez, Jose.” The decedent is identified via fingerprint comparison. WITNESSES: Assisting is Forensic Autopsy Specialist Ligia Ceja. There are no outside observers. CLOTHING: The body is clad in a light gray T-shirt when initially viewed. A separate bag of clothing accompanies the body and is not examined at this time. EVIDENCE OF MEDICAL THERAPY: None. EXTERNAL EXAMINATION Injuries are described in a separate section below. GENERAL: The body is that of a normally developed and morbidly obese (BMI 41.3), medium-complexioned male appearing consistent with the listed age of 28 years. The length is 70 inches, and the weight is 288 pounds as received. The body is cold and has not been embalmed. There are mild putrefactive (decompositional) changes, including skin discoloration, vascular marbling, gas artifact, skin blebbing and skin slippage. Rigidity is mild in the jaw and extremities. Lividity is pink-purple, nonblanching, and in a posterior distribution. HEAD: The scalp is covered with black hair measuring up to 5-1/2 inches on the top of the head. Facial hair is in a moustache pattern and goatee pattern measuring up to 3/4 inches. The ears are normally formed and without drainage. The left earlobe is pierced. The irides are brown, the corneas are clear, and the bulbar and palpebral conjunctivae both contain petechiae. The sclerae are white. The nose is intact, and the nares contain red-brown purge fluid but are otherwise unobstructed. The lips are normally formed, and there are faint upper inner lip petechiae. Red-brown purge fluid is in the mouth. The teeth are natural and in good condition. The tongue appears to protrude from the mouth. NECK: The neck is symmetrical and has a ligature furrow described in the injury section below. CHEST AND ABDOMEN: The chest is normally formed, symmetrical, and without palpable masses. The abdomen is protuberant and soft. No masses are palpable. AUTOPSY REPORT -4- JOSE GOMEZ-CAMACHO 2020-1088 EXTERNAL GENITALIA: The atraumatic external genitalia are those of a normal adult male with both testes palpable in the scrotum. BACK: The back is straight and symmetrical. The anus is atraumatic. ARMS: The arms are normally formed. No needle punctures, track marks, or ventral wrist scars are noted. The fingernails are cut short and clean and do not extend beyond the fingertips. LEGS: The legs are normally formed and have no edema, amputations, or deformity. The toenails are short, trim, and clean. BODY MARKINGS (SCARS AND TATTOOS): Scars: None. Tattoos: A monochromatic tattoo (“Gomez”) is on the central chest and left upper chest. INJURIES, EXTERNAL AND INTERNAL HANGING: LIGATURE: The ligature is received intact and tight around the neck. It is a white patterned shower curtain. The loop around the decedent’s neck measures 6 inches in diameter with a 22- 1/2 inch circumference and ranges from 3-1/4 – 5 inches in width. The loop terminates in a simple knot and a 76-1/2 inch in length segment of shower curtain extends beyond the knot. LIGATURE FURROW: A patterned (corresponding to the shower curtain) ligature furrow measuring 5 inches in width on the midline anterior neck is above the level of the laryngeal prominence, centered 10-1/2 inches from the top of the head. It is an area of abrasions and skin drying. The ligature furrow gently slopes up on both sides of the neck. On the right side of the neck, it is centered 8-1/2 inches from the top of the head and is 3-1/2 inches wide at the right lateral neck midline and passes beneath the lobule of the right ear. On the left side of the neck, it is centered 7-1/2 inches from the top of the head at midline and measures 4 inches in width at midline. On the posterior neck, it is centered 6 inches from the top of the head and measures 4 inches in width at midline. On the posterior neck, the ligature furrow gently slopes up from both sides of the neck towards the occipital scalp and terminates in a suspension point behind the head. OTHER INJURIES: None. AUTOPSY REPORT -5- JOSE GOMEZ-CAMACHO 2020-1088 INTERNAL EXAMINATION BODY CAVITIES: The abdominal fat layer measures up to 6.5 cm in thickness. Both pleural cavities contain minimal (<10 ml) red-brown decompositional fluid. The remaining body cavities otherwise have no hemorrhage or abnormal fluid. The serosal surfaces are smooth, glistening, and without adhesions. The organs are normally located. The diaphragm is intact. The body cavities have no internal injuries. The viscera show mild putrefactive (decompositional) changes including green-gray discoloration and softening. CARDIOVASCULAR SYSTEM: The heart weighs 390 grams and is not enlarged. It has a normal shape with a smooth, glistening epicardium. The coronary arteries have a normal origin and distribution with right dominance. They have no atherosclerotic stenosis and are widely patent. The myocardium is red-brown with gray discoloration, softened, and uniform without focal fibrosis or hyperemia. There is mild biventricular dilatation. The right ventricle, left ventricle, and interventricular septum measure 0.4 cm, 1.0 cm, and 1.0 cm, respectively. The endocardium is intact, smooth, and glistening. The cardiac valve leaflets are of normal number, pliable, intact, and free of vegetations. The atrial and ventricular septa are free of defects. The aorta follows its usual course and has no atherosclerotic changes. There are no vascular anomalies or aneurysms. The vena cavae and pulmonary arteries are without thrombus or embolus. RESPIRATORY SYSTEM: The right and left lungs weigh 410 and 330 grams, respectively, and have the usual lobation. The pleura are smooth and glistening; the lungs have small anthracotic pigment. The lungs are well expanded and crepitant. The parenchyma is dark red and exudes scant amounts of red fluid. The lungs have no consolidation, hemorrhage, infarct, tumor, gross fibrosis, or enlargement of airspaces. The bronchi contain no foreign material and have red-brown mucosa. HEPATOBILIARY SYSTEM: The liver weighs 1400 grams. The intact capsule is smooth and glistening. The parenchyma demonstrates gas artifact and is red-brown with mild patchy yellow discoloration and uniform without mass, hemorrhage, yellow discoloration, or palpable fibrosis. The gallbladder contains less than 5 ml of bile and no stones. Its mucosa is uniform, and the wall is not thickened. AUTOPSY REPORT -6- JOSE GOMEZ-CAMACHO 2020-1088 The pancreas has a normal size, shape, and lobulated structure. The parenchyma is tan, softened, and autolyzed. HEMOLYMPHATIC SYSTEM: The spleen weighs 160 grams. The capsule is smooth and intact. The parenchyma is maroon and liquefied. There is no enlargement of the lymph nodes in the neck, chest, or abdomen. ENDOCRINE SYSTEM: The thyroid gland is not enlarged, and the lobes are symmetrical. The parenchyma is uniform, softened, and red-brown. The adrenal glands have the usual size and shape. The parenchyma is autolyzed; however, there is no obvious tumor or hemorrhage. The pituitary gland is not enlarged. GASTROINTESTINAL SYSTEM: The esophagus and gastroesophageal junction are unremarkable. The stomach contains no contents. The gastric and duodenal mucosae are intact and unremarkable. The small and large intestines and appendix are unremarkable to inspection and palpation. GENITOURINARY SYSTEM: The right and left kidneys weigh 130 and 140 grams, respectively, and have a normal shape and position. The cortical surfaces are smooth. The kidneys have the usual corticomedullary structure without tumors or cysts. The pelves and ureters are not dilated or thickened. The bladder contains no urine. The mucosa is intact, and the bladder wall is not hypertrophied. The prostate gland is of average size and grossly unremarkable. The testes are not examined. NECK: The tongue, strap muscles, and other anterior neck soft tissues have no hemorrhage. The hyoid bone and the cartilaginous structures of the larynx and trachea are normally formed and without fracture. During dissection, the laryngeal cartilage is artifactually fractured bilaterally revealing no mass within the lumen of the airway. The airway is lined by smooth, pink-tan mucosa, and contains no foreign material. The cervical vertebrae have no displacement, hypermobility, or crepitus. MUSCULOSKELETAL SYSTEM: The musculoskeletal system is well developed and free of deformity. There are no fractures of the clavicles, sternum, ribs, vertebrae, or pelvis. The ribs are not brittle. The skeletal muscle is dark red and firm. HEAD: The scalp is free of hemorrhage. The calvarium and base of the skull are normally configured and have no fractures. The dura is intact, and there is no epidural or subdural hemorrhage. AUTOPSY REPORT -7- JOSE GOMEZ-CAMACHO 2020-1088 CENTRAL NERVOUS SYSTEM: The unfixed brain weighs 1250 grams. The leptomeninges are glistening and transparent without underlying hemorrhage, exudate, or cortical contusions. The hemispheres are symmetrical and have a normal gyral pattern. There is no flattening of the gyri, narrowing of the sulci, or midline shift. Upon removal from the cranial cavity, the brain fragments under its own weight. Sectioning through the diffusely softened, green-gray parenchyma does not reveal any obvious masses or hemorrhage. SPECIMENS RETAINED TOXICOLOGY: Samples of decompositional chest fluid and liver are retained for toxicology. HISTOLOGY: Representative sections of organs and tissues are retained. Sections of the heart (2), lungs (4), liver (1), and kidney (1) are submitted for histology. Cassette summary: Cassette 1: Heart Cassette 2: Lungs Cassette 3: Liver, kidney Cassette 4: Lungs PHOTOGRAPHS: Facial identification photographs, external overall photographs, photographs of the ligature and ligature furrow, and photographs of selected findings are taken. RADIOGRAPHS: None. EVIDENCE: The ligature is photographed and stored in evidence. AUTOPSY REPORT -8- JOSE GOMEZ-CAMACHO 2020-1088 MICROSCOPIC EXAMINATION HEART: Section of cardiac tissue shows mild autolysis. There is patchy mild interstitial fibrosis. No inflammation or myocyte disarray is appreciated. LUNGS: Sections of pulmonary tissue show mild autolysis with predominantly closed alveoli and gas artifact. Septal congestion is prominent. Focal areas of open alveoli have eosinophilic edema fluid, extravasated red blood cells and pigmented and non-pigmented macrophages. The airways contain sloughed respiratory epithelium, extravasated red blood cells, and amphophilic mucous. The airway walls contain scant chronic inflammatory cells but show no changes associated with chronic bronchial asthma. LIVER: Section of hepatic tissue shows autolysis with loss of architecture and gas artifact. Steatosis is present but cannot be quantitated. The portal tracts do not appear expanded by fibrosis or inflammation. KIDNEY: Section of renal tissue shows autolysis; however, there is no obvious tubulointerstitial inflammation or fibrosis. The glomeruli do not appear to contain inflammation or form crescents. TJ:JK:lcb D: 4/24/20 T: 4/27/20 Rev. 7/1/20 lcb 2020-01088 An American Board of Forensic Toxicology (ABFT) Accredited Laboratory Page 1 of 1 TOXICOLOGY REPORT Name: GOMEZ-CAMACHO, Jose Medical Examiner Number: 2020-01088 Date of Death: 04/23/2020 Time of Death: 21:24 Pathologist: Timothy Jong, M.D. / Jagbir Khangura, M.D. Specimens Received: Decomp Chest Fluid, Liver Date Specimens Received: 04/27/2020 Test Name (Method of Analysis) Specimen Tested Result Ethanol (GC/FID-Headspace) Liver 0.04 % (w/w) Drugs of Abuse Screen (ELISA) Liver Amphetamines Not Detected Benzodiazepines Not Detected Buprenorphine Not Detected Cannabinoids Not Detected Carisoprodol Not Detected Cocaine metabolites Not Detected Fentanyl Not Detected Methadone Not Detected Opiates Not Detected Oxycodone Not Detected Phencyclidine (PCP) Not Detected Zolpidem Not Detected Unless otherwise requested, all specimens will be destroyed six (6) months after the closure of the case by the Medical Examiner End Results Comment: Approved and Signed: 05/18/2020 Iain M. McIntyre, Ph.D. Forensic Toxicology Laboratory Manager