Autopsy Report: Afghan Male, FOB Gereshk, Afghanistan (Homicide) (Death Certificate Included)

Autopsy No: A03-144; Afghan civilian was found unresponsive while under guard by the Afghanistan Militia Forces at FOB Gereshk, Afghanistan. Cause of Death: Multiple blunt force injuries complicated by Rhabdomyolysis; Manner of Death: Homicide. Cause of Death: Multiple Blunt Force Injuries Complicated by Rhabdomyolysis. Multiple blunt force injuries of the lower torso and legs.

Doc_type: 
Medical
Doc_date: 
Thursday, November 13, 2003
Doc_rel_date: 
Sunday, April 17, 2005
Doc_text: 

Office of the Armed Forces Regional Medical Examiner
Landstuhl Regional Medical Center
Landstuhl, GE -APO AE 09180
DSN (314) 486-678117492
Corom 00149 (0) 6371 86678117492

FINAL AUTOPSY REPORT

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Autopsy No.: A03-144
Name: RanklSVC: Afghan Civilian
SSAN:
Date ot,..B"-I!=·r~thC:-::""'N"'/n:A------1 Org: Afghanistan Local National Place of Death: Helmand Prov, Afghanistan
I
Date of Death: 6 NOV 03 Place of Autopsy: Bagram AF, Afghanistan
Date of Autopsy: 13 NOV 03 Investigative Agency: USACIDC
Date of Report: 13 NOV 03
Circumstances of Death: The decedent, an Afghan local national civilian, was found unresponsive while under guard by the Afghanistan Militia Forces at the FOB Gereshk, Afghanistan, approximately 1430 hours. An initial autopsy was performed by a FST, TF Warrior, KAF General Surgeon on orders of the
local command.
Authorization for Autopsy: Office ofthe Armed Forces Medical Examiner, lAW 10 USC 1471
Identification: Visual recognition; fmgerprints and specimens for DNA obtained
Cause of Death: Multiple Blunt Force Injuries Complicated by Rhabdomyolysis
Manner of Death: Homicide
Autopsy Diagnoses:
I. Multiple blunt force injuries
a.
Head injuries:

i. Multiple abrasions, bilateral forehead and temporal areas
ii. Bilateral scleral hemorrhages
iii. Focal subgaleal hemorrhages, bilateral fronta-parietal areas

b.
Torso and extremity injuries:

i. Crusted abrasions; anterior chest and abdomen, right upper arm and elbow, left knee and
proximal lower leg

ii. Focal contusions; left lateral shoulder, right posterior thigh and scrotum /
iii. Confluent contusions with subcutaneous and peri-muscular hemorrhages; lower back (LR),
buttocks, posterior thighs and knees, anterior thighs and both groin areas

iv.
Intramuscular hemorrhage with associated necrosis, left lower back

v.
Peri-testicular hemorrhage

2.
Moderate pulmonary congestion and edema

3.
Moderate pulmonary anthracosis

4.
Moderate pulmonary hilar anthracotic lymphadenopathy

5.
Mild cerebral edema with bilateral uncal and cerebellar tonsil herniation

6.
Moderated hepatic fatty change

7.
Moderate visceral autolysis

Toxicology: Negative
Special Studies: Urine chemistry positive for myoglobin
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Opinion: Based on these autopsy findings and the investigative and historical information available to me the cause ofdeath ofthis Afghan male believed to be fbX6 }-4 Iis multiple blunt force injuries of the lower torso and legs complicated by rbabdomyolysis (release oftoxic byproducts into the system die to destruction ofmuscle). The manner ofdeath, in my opinion, is homicide. The decedent was Dot under the pbannacologic effect ofdrugs or alcohol at the time ofdeath.
LTC(P), Me, USA Armed Forces Regional Medical Examiner
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I. POSTMORTEM EXAMINATION:
GENERAL: The postmortem examination is perfonned at Bagram Airfield,
Mghanistan, on 13 November 2003. The autopsy is perfonned by Forensic Pathologist,

!b)(6~2 ILTC(P), Me, USA, the Armed Forces Regional Medical Examiner (AFRME). Assisting in the autopsy procedures is Mr.fb)(6~2 ~ DAC GS-ll, Forensic Pathologist Assistant and CPT!b)(6~2 ~ DC USA.
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The autopsy is witnessed by SAs rd,lb)13~l I,
Bagram AF, U.S. Anny Criminal investIgation Command (USAC C), SSI #0174-03­CID369-49232-5H9B.

The autopsy is started at approximately 0430 hrs.
B. PHOTOGRAPHY: Photographs are taken by!b)(6~2 ~ DAC GS-ll, Forensic Pathologist Assistant, and are on file in the Office ofthe Anned Forces Regional Medical Examiner, Landstuhl Regional Medical Center, Landstuhl, Gennany.
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 Anned Forces Regional Medical Examiner, appointed representative.
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D. IDENTIFICATION: The remains are identified visually as Lf_ ....J
)-4____
by the Afghan Militia Forces guarding the decedent at FOB Gereshk AF. Postmortem dental examination including dental X-rays is performed by CPTfbx6)-2 L DC USA, Forensic Odontologist. Specimens are obtained and submitted for potential DNA analysis. Fingerprints are obtained.
E. MEDICAL RECORD REVIEW: Outpatient Dental and Medical Records are
not available at autopsy.

II.
GROSS AUTOPSY FINDINGS:

A.
CLOmING AND PERSONAL EFFECTS: The remains are presented for autopsy unclothed wrapped in a blanket. No clothing or personal effects accompany the remains at autopsy.

B.
EXTERNAL EXAMINATION: The remains are those of a well developed, well nourished Mghan male of average build that has been previously, partially autopsied. The prior autopsy incision is sutured. The body is moderately well preserved and shows signs ofearly decomposition as evidenced by "greening" ofthe chest and abdomen. It has not been embalmed. Injuries are described below in the Evidence ofInjury Section.

RIGOR: Passing in the jaw and extremities.
LIVIDITY: Fixed on the posterior dependent surfaces.
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TEMPERATURE: That ofthe refrigeration unit.
SKIN: Multiple irregular crusted abrasions, each averaging Yz" in greatest dimension, are scattered over the lower anterior chest and left upper abdomen. Both buttocks have focal areas ofskin slippage. Recent injuries are described below in the Evidence ofInjury Section. No non-traumatic abnormalities are identified.
HAIR: Straight black hair, up to 4", covers the head. Facial hair consists ofa red­brown beard and mustache. The remaining body hair, the color ofthe head hair, is in a normal adult male distribution.
HEAD/SCALPIFACE: Dried blood, secretions and dust cover the face. The head is normocephalic, the scalp is intact and the facial features are normally developed. Injuries are described below in the Evidence ofInjury Section. No non-traumatic abnormalities
are identified.
EARS: Unremarkable.
EYES: Brown irides surround equal pupils partially obscured by mild corneal
clouding. The sclerae are white with bilateral lateral and medial hemorrhages. The
conjunctivae are injected most prominent on the right.

", .,f'
NOSE: Unremarkable.
MOUTHILIPS: Blood is in the mouth which is otherwise unremarkable.
TEETH: Dentition is in good repair.
NECK: Unremarkable with no evidence ofinjury.
CHEST/ABDOMENIBACKIANUS: Injuries are described below in the Evidence of Injury Section. No non-traumatic abnormalities are identified. The abdomen is flat.
EXTERNAL GENITALIA: Normal adult circumcised male with bilaterally
descended testes.

ARMS/HANDSIFINGERNAILS: Unremarkable except for injuries described below in the Evidence ofInjury Section. The palmar surfaces ofthe fingers have black ink. The fingernails are short, irregular and intact.
LEGSIFEETITOENAILS: Unremarkable except for injuries described below in the Evidence ofInjury Section.
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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 glistening and the pericardium is unremarkable. There are no fibrovascular adhesions or abnormal collections of fluid. The mediastinum and retroperitoneum show no abnormalities. The leaves ofthe diaphragm are intact and the organs are normally disposed. There is moderate visceral autolysis and no evidence of injury.
HEAD/CENTRAL NERVOUS SYSTEM: Reflection ofthe scalp shows the usual scattered reflection petechiae. Focal subgaleal injury is described below in the Evidence of Injury Section. The calvarium is intact. Removal ofthe calvarium shows the epidural space to be normal. No collections of subdural blood are present. The brain is removed in the usual manner and is mildly heavy. The leptomeninges are smooth and glistening and the gyri demonstrate the usual orientation and configuration with mild flattening and sulcal narrowing. There is mild uncal and cerebellar tonsil herniation. The vessels at the base ofthe brain are normally disposed and no anomalies or significant atherosclerosis is identified. Serial sections ofthe brain show the cerebral cortical ribbon to be intact. The lateral ventricles are normal. The usual anatomical landmarks ofthe cerebrum, basal ganglia, thalamus, mid brain, pons, medulla, and cerebellum demonstrate no abnormalities. The pituitary fossa is unremarkable. The Foramen Magnum demonstrates the normal orientation and the first portion of the spinal cord viewed through the Foramen Magnum is unremarkable.
NECK: Examination ofthe soft tissues ofthe neck, including strap muscles, thyroid gland and large vessels, reveals no abnormalities. The hyoid bone and larynx are intact.
CARDIOVASCULAR SYSTEM: The heart is ofnormal 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. Cut surfaces of the myocardium show a normal color slightly darkened by autolysis. The valves are intact with the usual anatomic relationships. The aorta follows the usual course and exhibits no significant atherosclerosis. The Origins ofthe major vessels are normally disposed and unremarkable. The great vessels ofvenous return are in the usual position and unremarkable.
RESPIRATORY SYSTEM: The larynx, trachea, and bronchi show no abnormalities. The right and left lungs are mildly heavy. Marked diffuse anthracosis is scattered over the pleural surfaces. Cut surfaces show an autolytic deep red parenchyma exuding a moderate amount ofblood and frothy fluid with no identifiable evidence of natural disease or injury.
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HEPATOBILIARY SYSTEM: The liver is of nonnal weight and has a smooth, glistening capsule. Cut surfaces show the usual anatomic landmarks with a deep red­brown unremarkable parenchyma with focally interspersed small tan-yellow patches. The gallbladder contains 10 m1 ofbile. No abnormalities are present in the mucosal lining. The biliary tree is normally disposed and no abnonnalities are demonstrated.
INTESTINAL TRACT: The pharynx and esophagus are unremarkable. The stomach lies in the nonnal position and contains approximately 60 ml thick brown-gold fluid without food particles. No tablets, capsules or residues are identified. The mucosal lining is intact. The small bowel and large bowel are unremarkable. The appendix is
unremarkable.
LYMPHORETICULAR SYSTEM: The spleen is ofnormal weight and shape and has a smooth glistening capsule with an autolytic parenchyma. The thymus is not identified. Except for bilateral anthracotic pulmonary hilar lymph adenopathy, the lymph nodes show no notable pathologic change.
URINARY SYSTEM: The right and left kidneys are of normal size and weight. The cortical surfaces are smooth with moderately good preservation ofthe cortex and good cortico-medullary differentiation. The pelves and ureters are unremarkable. The bladder is unremarkable and contains 50 ml of yellow urine.
INTERNAL GENITALIA: The prostate is palpably unremarkable. On cut sections, the testes show no abnormal masses and injuries described below.
ENDOCRINE SYSTEM: The pituitary, thyroid, adrenals, and pancreas show the
usual anatomic features without evidence ofnatural disease or injury.

MUSCULOSKELETAL SYSTEM: No fractures are identified and the skeletal
muscle demonstrates the nonnal appearance. The bone marrow, where visualized, is
unremarkable.

MISCELLANEOUS: The abdominal fat measures approximately 1-2 em in thickness and is without abnormalities. No hernias are identified.
D. EVIDENCE OF MEDICAL TREATMENT: None.
E. EVIDENCE OF INJURY: Multiple Blunt Force Injuries
(1) HEAD AND NECK INJURIES: Externally, patchy irregular abrasion~ cover an area of 1 x Yi" on the left lower forehead and 1 x W' on the right lower forehead. A y,." greatest dimension irregular abrasion is on the left temporal area and on the right upper cheek, beneath the lateral eye, is a Y4 x 1/8" irregular abrasion. On internal examination, there are focal bilateral fronto-parietal subgaleal hemorrhages.
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A03-144
(2) TORSO & EXTREMITY INJURIES: Confluent dark blue-purple contusions, focally dark blue-black, cover the left lower flank, bilateral buttocks, bilateral postero­lateral thighs, bilateral posterior knees and posterior upper left lower leg with underlying subcutaneous and peri-muscular hemorrhage. Focal intra-muscular hemorrhage with associated necrosis covers areas of 12 x 8 cm on the left lower back and 6 x 2 cm on the left posterior knee. On the left antero-Iaterallower flank extending across the groin to the mid antero-Iateralleft thigh is a confluent 23 x 6" dark blue-purple contusion. A 15 x 10" confluent red-purple contusion covers the right groin and upper right anterior thigh. Blue­purple contusion covers the anterior scrotum. A 4 x 3" irregular red-purple contusion covers the left antero-Iateral shoulder. Multiple irregular abrasions from 2 x I" to % X Y2" are scattered down the postero-Iateral right upper arm and elbow. A 4 Y2 X 3" irregular red-purple contusion covers the right lateral back ofthe hand extending to the upper 1st and 2nd fingers. On the prominence ofthe left anterior knee and upper leg are mUltiple irregular crusted abrasions each averaging from I to W' in greatest dimension.
HI. MICROSCOPIC EXAMINATION: Not perfonned. Representative sections of all major organs are retained in fonnalin for storage.
IV. TOXICOLOGY: Samples ofblood, vitreous fluid, bile, urine, and tissue samples ofmuscle, liver, and kidneys are submitted for toxicologic analysis at the Anned Forces Medical Examiner's Forensic Toxicology Laboratory, Armed Forces Institute of Pathology (AFIP), Washington, DC:
;.., ,c
AFIP Accession No.: 2900827/ !Tox No. 035410, dated 15 DEC 03.
See attached report.
v. EVIDENCE COLLECTED/OTHER PROCEDURES AND SPECIAL
STUDIES: Special chemistry performed on sample ofurine is positive for myoglobin
4250 micogramslL. The test was perfonned by Quest Diagnostics Inc.:
Accn No. B15398091893A.

LTC(P), MC, USA ARMED FORCES REGIONAL MEDICAL EXAMINER
DATE: 9 FEB 04

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DOD 003298

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3282
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72