Autopsy Report: 52-year-old Iraqi male, Camp Whitehorse, Iraq (strangulation) (death certificate included)

Office of the Armed Forces Regional Medical Examiner
.~
Landstuhl Regional Medical Center Landstuhl, GE -APO AE 09180
DSN (314) 486-678117492 Comm 001 49 (0) 6371 86678117492

FINAL AUTOPSY REPORT (Addendum)
b)(6l-4
[ Name: SSAN:1--______----' Date of Birth: UNK Date of Death: 6 JUN 03 Date of Autopsy: 10 JUN 03 Date of Report: 22 OCT 03 Autopsy No.: A03-S1 RanklSVC: CIV Detainee Org: EPW Place of Death: Nasiriyah, Iraq Place of Autopsy: Talil, Iraq Investigative Agency: NCIS
Circumstances of Death: Decedent is a reported 52 ylo Iraqi Male, Civilian Detainee,

who was found unresponsive outside in isolation at Whitehorse detainment facility; Nasiriyah, Iraq. He was pronounced at 1230 hours.
Authorization for Autopsy: Office of the Armed Forces Medical Examiner, lAW 10 USC 1471
Identification: Visual recognition; fingerprints and specimens for DNA obtained
Cause of Death: Strangulation
Manner of Death: Homicide
Autopsy Diagnoses:
Head, neck and torso injuries:
1.
Right hyoid bone fracture with associated recent hemorrhage

2.
Rib fractures; right anterior 4-7, left anterior 4-5

3.
Contusions; mid abdomen, back and buttocks extending to the left flank

4. Abrasions, lateral buttocks Extremity injuries:
1.
Contusions, back oflegs and knees

2.
Abrasions; knees, left fingers and encircling left wrist

3.
Lacerations and superficial cuts, right 4th and 5th fmgers

Toxicology: Negative
SUBSTITUTE FOR SF 503
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Opinion: Based on these autopsy findings and the investigative and historical infonnation available to me, this believed to be 52 year old Male,E~_____._·_.~Jdied as a result of asphyxia (lack ofoxygen to the brain) due to strangulation as evidenced by the recently fractured hyoid bone in the neck with soft tissue hemorrhage extending downwards to the level ofthe right thyroid cartilage. Although the right superior hom ofthe thyroid cartilage was palpably intact prior to excision, an underlying hairline fracture cannot be entirely ruled out. Additional fmdings at autopsy include blunt force injuries, predominantly recent contusions (bruises), on the torso and lower extremities. The abrasions encircling the left wrist are consistent with the use of restraints. There is no evidence ofdefense injuries or natural disease. The alcohol detected on toxicologic analysis is most likely due to postmortem production. The manner of death in my opinion is homicide.
This is the second addendum report. The first addition has been made to reflect the presence ofa second Forensic Pathologist at autopsy who concurs with the findings and opinions listed in this report. On the second addendum report, changes are made to clarify the descriptions ofthe larynx in the Internal Examination and Evidence of Injury Sections.
Original signed, on file
LTC(P), Me, USA ARMED FORCES REGIONAL MEDICAL EXAMINER
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I. POSTMORTEM EXAMINATION:
A. GENERAL: The posbnortem examination is performed at Talil Air Base, Iraq.
The autopsy is performed by Forensic Pathologistr(6~2 -==~~--==_=~-=-~==J LTC(P}, MC, USA, the Armed Forces Regional Medical Examiner (AFRME). Assisting in the autopsy procedures is SSGTt~______JMe, USAF, Forensic Assistant.
The autopsy is witnessed by Special Agent b)(6H Naval Criminal Investigation
l and are on file in the Medical Photography Section, Landstuhl Regional Medical
Service. Additional witnesses at autopsy include COL b)(6~2 Forensic Pathologist. MC USAF,
The autopsy is started at approximately 0500 hours.
=-=B~. PHOTOGRAPHY: Photographs are taken by SSGT fbX6~2 Iand COL fb)(6~2 I

/b)(6}2 Center, Landstuhl, Germany.
C. AUTHORIZATION: The autopsy is authorized by the Armed Forces Medical Examiner under Title 10 U.S. Code, Section 1471, with an SF 523 signed by the Armed Forces Regional Medical Examiner, appointed representative.
D. IDENTIFICATION: The remains are presumptively identified visually by Naval Criminal Investigation Agents and authorities at the Whitehorse detainment facility. Specimens for DNA analysis are obtained.
E. MEDICAL RECORD REVIEW: Medical and dental records are not available for review.
II.
GROSS AUTOPSY FINDINGS:

A.
CLOTHING AND PERSONAL EFFECTS: The remains are presented for autopsy unclothed with no accompanying clothing or personal effects.

B.
EXTERNAL EXAMINATION: The remains are those ofa well developed, well nourished apparent middle eastern male ofaverage build that appears compatible with the listed age of 52 years. Length is approximately 69 inches. The body shows signs of moderate decomposition as evidenced by greening and darkening ofthe skin, bloating, marbling, skin slippage and severe visceral autolysis. Injuries are described below in the Evidence ofInjury Section.

RIGOR: Passed.
LIVIDITY: Fixed, faintly visible on the posterior dependent surfaces.
TEMPERATURE: That ofthe refrigeration unit.
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SKIN: Unremarkable except for decomposition changes and evidence ofinjury described below in the Evidence ofInjury Section.
HAIR: Straight black-gray hair, up to Y2 inches in length covers the head. Facial hair consists ofa short gray beard. The remaining body hair, the color ofthe black head hair, is in a normal adult male distribution.
HEAD/SCALPIFACE: The head is normocephalic, and except for decomposition changes including slippage, the scalp is intact and the facial features are normally developed.
EARS: Unremarkable.
EYES: Brown irides surround 4 mm pupils. The globes are dried and flattened. The comeae are mildly clouded and the sclerae are predominantly white. The conjunctivae are unremarkable. There is no evidence ofpetechiae.
NOSE: Well formed and unremarkable except for postmortem artifact.
MOUTHILIPS: Unremarkable.
TEETH: Dentition is in fair repair.
NECKlCHEST/ABDOMENIBACKIANUS: Except for injuries described below in the Evidence of Injury Section and decomposition changes, unremarkable. The abdomen is bloated and protuberant.
EXTERNAL GENITALIA: Normal adult circumcised male with bilaterally descended testes. There is prominent scrotal bloating.
ARMSIHANDSIFINGERNAILS: Unremarkable except for injuries described below in the Evidence of Injury Section and decomposition changes. The fingernails are short, irregular yet intact.
LEGS/FEETITOENAILS: Unremarkable, except for injuries described below in the Evidence of Injury Section and decomposition changes.
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C. INTERNAL EXAMINATION:
BODY CAVITIES: The body is opened by the usual Y-shaped incision. The pleural and peritoneal surfaces are smooth and dusky. The pericardium is unremarkable. There are no fibrovascular adhesions or abnonnal collections of fluid except for a moderate amount ofdecomposition fluid. The mediastinum and retroperitoneum show no antemortem abnormalities. The leaves of the diaphragm are intact and the organs are nonnally disposed.
HEAD/CENTRAL NERVOUS SYSTEM: Reflection of the scalp shows the usual scattered reflection petechiae. The calvarium is intact. Removal ofthe calvarium shows the epidural space to be normal. No collections of subdural or subarachnoid blood are evident. The brain is removed in the usual manner. Marked softening and discoloration due to decomposition precludes definitive evaluation. No abnonnalities are otherwise identified. The base ofthe skull is unremarkable.
NECK: Examination ofthe soft tissues of the neck and internal structures by a
separate. bloodless layerwise dissection reveals the hyoid bone fracture and associated
soft tissue hemorrhage described below in the Evidence ofInjury Section. No non­
traumatic abnonnalities are identified.

CARDIOVASCULAR SYSTEM: The heart is ofnonnal size and shape. The epicardium is intact and unremarkable. The chambers demonstrate the usual shape and configuration with no gross hypertrophy. The coronary arteries are normally disposed and there is no atherosclerosis. Marked autolytic changes preclude definitive evaluation. No evidence ofnatural disease or injury is identified. The aorta follows the usual course and exhibits 110 atherosclerosis. The origins of the major vessels are normally disposed and unremarkable. The great vessels of venous return are in the usual position and unremarkable.
RESPIRATORY SYSTEM: The larynx, trachea, and bronchi show no non-traumatic abnonnalities. Injuries are described below in the Evidence of Injury Section. The right and left lungs are normally shaped with no evidence ofnatural disease on cut sections. Marked autolytic changes preclude definitive evaluation.
HEPATOBILIARY SYSTEM: The liver is ofnonnal size and shape. It has a
smooth, dusky capsule. Cut surfaces show the usual anatomic landmarks with a dark
brown-green parenchyma. Marked decomposition and autolytic changes preclude
definitive evaluation. The gallbladder is empty. Except for decomposition changes no
abnonnalities are identified.

INTESTINAL TRACT: The pharynx and esophagus are unremarkable. The stomach lies in the normal position and contains approximately 20 ml ofdark brown fluid without food particles, tablets, capsules or residues. Except for decomposition changes, the small bowel and large bowel are unremarkable. The appendix is unremarkable.
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LYMPHORETICULAR SYSTEM: The spleen is ofnonnal size and weight and is unremarkable except for decomposition changes. The thymus is not identified. Lymph nodes where visualized show no notable pathologic change.
URINARY SYSTEM: The right and left kidneys are ofnormal size and weight. The cortical surfaces are smooth and dull with marked decompositional changes precluding definitive evaluation ofthe parenchyma. The pelves and ureters are unremarkable. The
bladder is empty.
INTERNAL GENITALIA: The prostate is palpably unremarkable. On cut sections,
the testes show no abnormal masses or evidence ofinjury.
ENDOCRINE SYSTEM: Except for marked autolysis the pituitary, thyroid, adrenals, and pancreas show the usual anatomic features without evidence ofnatural disease or injury.
MUSCULOSKELETAL SYSTEM: Fractures are described below in the Evidence
ofInjury section. Except for autolysis, skeletal muscle demonstrates the normal
appearance. The bone and bone marrow, where visualized, is unremarkable.

D. EVIDENCE OF MEDICAL TREATMENT: None.
E. EVIDENCE OF INJURY: Multiple blunt and sharp force injuries:
(1)
HEAD AND NECK INJURIES:

a.
On internal examination the distal right portion ofthe hyoid bone is palpably and
visibly fractured with prominent associated recent hemorrhage extending downwards to
the soft tissues ofthe right thyroid cartilage. The right superior horn ofthe thyroid
cartilage is palpably intact.

(2)
TORSO INJURIES:

a.
External examination: An 8 x 6 inch irregular red-purple contusion is
centered over the umbilicus on the mid lower abdomen. On the mid lower back is a 3 x
% inch elongated red-purple contusion. A 2 x I inch irregular abrasion is on the left
flank. On the right lateral buttock, is a 4 x 4 inch irregular abrasion with the suggestion
ofa "brush burn" pattern. A 4 Y4 x 3 inch irregular red-purple contusion is on the left
postero-Iateral buttock. On the left lower posterior-lateral buttock is a ';4 inch greatest
dimension abrasion.

b.
On internal examination the ribs are fractured with associated hemorrhage as
follows: Right anterior 4-7; left anterior 4-5.

(3)
EXTREMITY INJURIES: A 2 x 1 inch red-blue irregular contusion is on the
left anterior arm just above the elbow. On the left wrist, a discontinuous focally Yz inch
thick abrasion encircles the wrist. Small 'h inch irregular abrasions are on the
prominences ofthe distal left phalangeal joints ofthe first and second fingers.

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Superficial, predominantly linear cuts and irregular healing lacerations, Yz to 1" greatest
dimension, are on the 4th and 5th fmgers ofthe right hand. Multiple irregular abrasions in
association with red-purple contusions cover both anterior knees. The back ofthe left
knee has patchy, irregular blue-purple contusions in association with a 3" greatest
dimension irregular dark blue-purple contusion. On the back ofthe left upper thigh is a 7
x 7 inch red-purple contusion with prominent subcutaneous and perimuscular
hemorrhage. On the back ofthe mid thigh is a 3 x 1 inch irregular red-purple contusion
with associated subcutaneous hemorrhage. The right upper thigh has a 6 inch greatest
dimension irregular-putple contusion with associated subcutaneous hemorrhage
extending to the perimuscular area. Beneath this just above the back ofthe right knee is a
3 x 2 inch irregular red-purple contusion. On the back ofthe right lateral ankle is a Yl
inch irregular slightly crusted abrasion.
III. MICROSCOPIC EXAMINATION: Not perfonned due to damage reSUlting from decompositional gases and severe thennal artifact during transport.
IV. TOXICOLOGY: Samples ofblood, urine and tissue samples ofliver and kidneys are submitted for toxicologic analysis at the Armed Forces Medical Examiner's Forensic Toxicology Laboratory, Armed Forces Institute ofPathology (AFIP), Washington, DC:
AFIP Accession No.: 2889528/033579, dated 25 August 2003.
See attached report .
.. '" ~,f
V. OTHER PROCEDURES AND SPECIAL STUDIES: None perfonned.
VI. EVIDENCE: None collected.
ORIGINAL SIGNED, ON FILE
DOD 003170
LTC(P), MC, USA
15 SEP 03
ARMED FORCES REGIONAL MEDICAL EXAMINER
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DO FORM 2064, APR 1977 REPLACes OA FORM 3565, 1 JAN 1972 ANO 0/\ FORM 3566-R(PASI, 26 SEP 1975. WHICH AFIE OaSOLETE. USAPAV1.00
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