*** Government of the District of Columbia Office of the Chief Medical Examiner AUTOPSY REPORT CASE NUMBER: 13-02470 NAME OF DECEDENT: MIRIAM IRIS CAREY AGE: 34 YEARS RACE/ETH: OTHER DATE OF DEATH: OCTOBER 3, 2013 GENDER: FEMALE AUTOPSY DATE: OCTOBER 4, 2013 PERFORMED BY: NIKKI MOURTZINOS, D.O. FINAL DIAGNOSES I. Multiple Gunshot Wounds II. Scattered abrasions, neck, torso, and upper extremities Ill. Scattered contusions, neck, torso, lett hand, and lower extremities IV. Lacerations, right arm and left hand V. Negative post-mortem toxicological examination: See OCME Toxicology Report. CAUSE OF DEATH: MULTIPLE GUNSHOT VVOUNDS MANNER OF DEATH: HOMICIDE Page 2 of 8 13-02470 MIRIAM IRIS CAREY PRESENT AT AUTOPSY Officer Tina Ramadan and Agent James King of the Metropolitan Police Department were present at the autopsy. Also present at autopsy was Inspector Alfonso M. Dyson of the United States Secret Service and Sergeant Mark Shutters, an Investigator for the Office of Professional Responsibility of the United States Capitol Police. EVIDENCE RELEASED Combed hair: - - Clothing: _ __ Projectiles: ___;X;_;,__ Pulled Hair: - - Fingernail clippings: _ __ Blood Patch: Bags from Hands: _ _ __ X Other: _ _ Sex Kit: - - Ligature: LABORATORY PROCEDURES Toxicology: ____X""--- Photo: X-ray: _ _;.X.-____ Bacteriology: _ __ ------- Dental: X DNA Cards: ------""'---X --- Microscopy: _ __ Fingerprints: ---'-X.....___ Virology: _ _ _ __ EXTERNAL EXAMINATION The body is that of a well-developed, well-nourished, adult female, measuring 65~ inches tall and weighing 138 lbs. She appears compatible with the stated age of 34 years. Injuries to the body are noted and will be described below. Debris, including glass fragments and grass, are present on the body. Dried blood is present on the face, torso and the upper extremities. Rigor mortis is fully developed in the extremities, jaw, and neck. Livor mortis is found on the posterior surfaces of the body except in areas exposed to pressure. The deceased has long, black and wavy scalp hair averaging 17" in length. The irides are brown. The corneae are clear. The conjunctivae are pale and show no petechial hemorrhages. The sclerae are white. Dried blood is present within the nares and the external auditory canals. The mouth contains natural teeth that are in good condition. The neck and chest are symmetrical. The abdomen is flat. The external genitalia are those of a normal adult female. A sanitary napkin overlies the external genitalia. There 13-02470 MIRIAM IRIS CAREY Page 3 of8 is asymmetry of the left arm due to injuries that will be described below. The remaining extremities are symmetrical and without obvious deformities. An identification band issued by the District of Columbia Office of the Chief Medical Examiner (DC OCME) bearing the name "(UNIDENTIFIED),(FEMALE)" and the Case #13-02470 is around the decedent's left ankle and left great toe. Hospital identification bands encircle the right ankle and left great toe. CLOTHING The body is received unclad. No clothing accompanies the body. SCARS/TATTOOS/MARKINGS Tattoos are not visualized. A 5/8" scar is on the posterior aspect of the right ankle. A 1%" x 3/8" hyperpigmented patch of skin is on the posterior aspect of the left thigh. MEDICAL THERAPY An endotracheal tube emerges from the mouth. An intraosseous catheter is inserted into the left shin. Intravascular access catheters are in the right subclavian region, the left inguinal region, and the right antecubital fossa. Electrocardiograph pads are on the chest, the left side of the abdomen, the arms, and the legs. A silastic sheet dressing is on the right chest. A 9%" thoracotomy incision is on the left side of the chest, displaying sutures and staples, and located at the level of the left 5th intercostal space. A chest tube with associated thoracotomy incision is inserted into the right chest at the level of the th intercostal space. Internal examination also reveals a previously incised pericardia! sac due to medical intervention. DESCRIPTION OF INJURY The gunshot wounds are numbered for the purpose of description only and do not imply a wound sequence. Projectiles recovered are left in the custody of the Metropolitan Police Department. GUNSHOT WOUND OF THE HEAD (GSW# 1) There is an entrance gunshot wound of the left side of the head, located 4%" below the top of the head and 4" left of the posterior midline (along the convexity of the head). The entrance gunshot wound measures 3/8" x %" and displays an eccentric ring of 13-02470 Page 4 of 8 MIRIAM IRIS CAREY abrasion measuring up to 1/8" at the 6 o'clock position. There is no soot or gunpowder stippling on the surrounding skin. The hemorrhagic wound path injures the left temporal scalp, the left temporal bone of the skull (internal beveling), the dura, the left temporal lobe of the brain, the left cerebellar hemisphere, the pontomedutlary junction of the brain stem, the right cerebellar hemisphere, the right temporal lobe of the brain, the dura, and the right temporal bone at the base of the skull from where a deformed bullet and bullet fragments are recovered. Bullet fragments are also recovered along the wound path (cerebellum). Associated injuries include a 5" x 3" hemorrhage of the parietal scalp, a 3%" x 1~" hemorrhage of the left temporal scalp, a 1%" x %" hemorrhage of the right temporal scalp, a 2%" x 1" hemorrhage of the posterior parietal/occipital scalp, subgaleal hemorrhage of the occipital and bilateral temporoparietal regions, mild subarachnoid hemorrhage of the right cerebral convexity, hemorrhage of the right temporalis muscle, extensive comminuted fractures of the calvarium and base of the skull, including bilateral orbital plates, and marked fragmentation of the cerebellum and medulla oblongata. There is a %" x %" contusion of the outer canthus of the left eye and a %" x %" contusion of the inner canthus of the left eye. There is a 2" x 1" contusion of the right upper eyelid. The gunshot wound is directed from left to right and back to front with minimal upward/downward deviation. GUNSHOT WOUND OF THE BACK (GSW # 2) There is an entrance gunshot wound of the left upper back located 8~" below the top of the head and 2%" left of the posterior midline (along the contours of the body). The entrance gunshot wound measures 5/8" x %" and displays an eccentric ring of abrasion measuring up to 1/8" at the 7 o'clock position. A 5/8" curvilinear abrasion extends outward from the entrance gunshot wound at the 11 o'clock position. There is no soot or gunpowder stippling on the surrounding skin. The hemorrhagic wound path sequentially injures the skin, soft tissue, and musculature of the left upper back, the soft tissue and. musculature of the posterior neck, the right transverse process of C5 (with fracture), and the musculature, soft tissue, and skin from the right lower cheek where a %" x 3/8" lacerated exit gunshot wound is located 7" below the top of the head and 3 5/8" right of the anterior midline (along the convexity of the head). A 2~" x 1" faint contusion encircles the exit gunshot wound. No bullets or bullet fragments are recovered along the wound path. Associated injuries include a 1" x %" contusion of the upper back that overlies the wound path of the bullet. There is no underlying injury to the spinal cord or the major vessels of the neck. The gunshot wound is directed from back to front, left to right, and upward. 13-02470 MIRIAM IRIS CAREY Page 5 of8 GUNSHOT WOUND OF THE BACK (GSW # 3) There is an entrance gunshot wound of the right upper back, located 9 3/16" below the top of the head and 4%" right of the posterior midline (along the contours of the body). The entrance gunshot wound measures 5/8" x 3/8" and displays an eccentric ring of abrasion measuring up to 1/8" at the 8 o'clock position. Several abrasions, ranging in measurement from less than 1/16" to 3/16", surround the entrance gunshot wound (pseudostippling). There is no soot or gunpowder stippling on the surrounding skin. The hemorrhagic wound path sequentially injures the skin, soft tissue and musculature of the right upper back, the right scapula (with fracture), the right proximal humerus bone (with fracture), and the musculature, soft tissue, and skin of the right shoulder where a lacerated exit gunshot wound is located %" below the top of the right shoulder. The exit gunshot wound measures %" x %". There is a 2%" x 1%" contusion encircling the exit gunshot wound. Numerous bullet fragments are recovered along the wound path (right scapula). Associated injuries include comminuted fractures of the right scapula and right humerus bone. The gunshot wound is directed from back to front, left to right with minimal upward/downward deviation. GUNSHOT WOUND OF THE BACK (GSW # 4) There is an entrance gunshot wound of the right upper back {just above the right axilla), located 11" below the top of the head and 9" right of the posterior midline (along the contours of the body). The entrance gunshot wound measures %" x %" and displays an eccentric ring of abrasion measuring up to 1116" at the 1 o'clock position. A 1" x 5/8" contusion encircles the entrance gunshot wound. There is no soot or gunpowder stippling on the surrounding skin. The hemorrhagic wound path sequentially injures the skin, soft tissue, and musculature of the right upper back, and the musculature, soft tissue, and skin of the right upper chest from where an exit gunshot wound is located 11%" below the top of the head and 3 3/8" right of the anterior midline (along the contours of the body). The exit gunshot wound measures%" x %". A 3" x 2" contusion encircles the exit gunshot wound. No bullets or bullet fragments are recovered along the wound path. The gunshot wound is directed from back to front, right to left, and slightly downward. GUNSHOT WOUND OF THE LEFT ARM (GSW #5) There is an entrance gunshot wound of the upper outer left arm, located 5" below the top of the left shoulder. The gaping entrance gunshot wound measures 1%" x %". 13-02470 MIRIAM IRIS CAREY Page 6 of 8 The left arm and forearm display an extensive 8%" x 4%" area of contusion with numerous abrasions ranging in measurement from less than 1/16" to%" (pseudostippling). There is no soot or gunpowder stippling on the surrounding skin. The hemorrhagic wound path sequentially injures the skin, soft tissue, and musculature of the upper outer left arm, the left humerus bone (with fracture), and the musculature and soft tissue of the upper inner left arm from where a deformed bullet is located. Bullet fragments are also recovered along the wound path. Associated injuries include two contusions of the upper inner left arm (3" x 2%" and 1%" x 1%"). The gunshot wound is directed from left to right with slight upward deviation. ADDITIONAL INJURIES A %" x 3/16" abrasion is on the back of the neck. A 5/8" x 3/8" contusion is on the back of the neck. Two abrasions (3/16" x 1/8" each) are on the left upper chest. A 2" x 1%" contusion encircles a%" x 1/16" abrasion of the left upper chest. A 5/16" x 3/8" abrasion is on the middle of the chest. A %" x Y2" abrasion is on the anterior chest, between the breasts. A 3/8" x 1/16" abrasion is on the left breast. A%" x 3/16" laceration is on the upper right arm. A 1%" x 3%" area of punctate abrasions is on the right forearm. A 2%" x 2" abraded area is on the dorsal aspect of the left hand, displaying several lacerations measuring up to%". A 1" x 1Y2" contusion is on the dorsal aspect of the left hand. A%" x 1/8" contusion is on the right thigh. A Y2" x %"contusion is on the left thigh. A%" x %"contusion is on the right shin. INTERNAL EXAMINATION Injuries described above will not be repeated. BODY: The body is opened with a Y -shaped incision. The organs occupy their usual positions and relationships. There is no increased fluid in the pericardia!, peritoneal, or pleural cavities. The abdominal fat has a thickness of 1%". CARDIOVASCULAR SYSTEM: The heart weighs 240 grams. The epicardial and endocardial surfaces are smooth and glistening. The great vessels and coronary arteries arise normally and follow normal courses. The myocardium where sectioned, is uniformly firm and has a homogeneous, tan-red appearance. The left ventricle has a thickness of 1.1 em, the interventricular septum 1.3 em, and the right ventricle 0.2 em. The left ventricular cavity measures 3.1 x 2.2 em and the right ventricular cavity measures 2.5 x 1.6 em. The cardiac valves are thin and delicate. The coronary arteries 13-02470 MIRIAM IRIS CAREY Page 7 of 8 on cross-section are widely patent and free of significant atherosclerotic plaque formation. The aorta displays scattered atherosclerotic plaques. RESPIRATORY SYSTEM: The trachea, mainstem bronchi and primary bronchial branches are unobstructed. The right lung weighs 240 grams and the left lung weighs 180 grams. The pleural surfaces are smooth and glistening and have a pink-red appearance. On cross-section, the parenchyma is unremarkable. There are no pulmonary emboli. HEPATOBILIARY SYSTEM: The liver weighs 1180 grams. The capsule is smooth and glistening. On cross-section, the parenchyma is unremarkable. The gallbladder is unremarkable and contains approximately 15 ml of bile. GASTROINTESTINAL SYSTEM: The esophagus, stomach, small and large bowel, and appendix are unremarkable. The stomach contains approximately 15 ml of dark-brown material; no tablets or capsules are identified. After washing, the esophageal, gastric, and duodenal mucosa present neither ulcers nor tumors. PANCREAS: The pancreas is grossly unremarkable with the usual lobular, firm parenchyma. HEMOLYMPHATIC SYSTEM: The spleen weighs 80 grams. An accessory spleen is noted. The capsule is intact. The parenchyma has a normal follicular pattern on sections. No enlarged or abnormal lymph nodes are found. GENITOURINARY SYSTEM: The right and left kidney each weigh 100 grams. The capsules strip with ease revealing smooth cortical surfaces. On cross-section, the cortices are unremarkable. The collecting systems, ureters, and bladder are unremarkable. The bladder contains 150 ml of clear yellow urine. The uterus, tubes, and ovaries are unremarkable. An intrauterine device is appropriately placed. ENDOCRINE SYSTEM: The pituitary, thyroid and adrenal glands are unremarkable. MUSCULOSKELETAL SYSTEM: (See Description of Injuries.) The uninjured skeleton is intact and without fractures or deformity. The uninjured red-brown musculature is unremarkable. NECK: Sections through the tongue reveal no contusions or hemorrhages. The neck is dissected in a layer-by-layer fashion. There are no focal hemorrhages of the strap muscles of the neck or of the intrinsic muscles of the larynx. The hyoid bone, the thyroid, the cricoid cartilages, and the cervical spine are intact. The larynx is opened 13-02470 MIRIAM IRIS CAREY Page 8 of8 posteriorly. The vocal cords are thin and pliable. There is no evidence of infection, neoplasm, or trauma. The airway is patent. HEAD AND CENTRAL NERVOUS SYSTEM: (See Description of Injuries). The scalp is incised and retracted. The cranial vault is opened. The scalp and skull display the injuries described above. The epidural space is free of hemorrhage. The uninjured dura is thin, tough, and pliable. The uninjured leptomeninges are glistening and translucent. The brain weighs 1160 grams and the cerebral hemispheres, midbrain, and pons display the injuries described above. The uninjured structures at the base of the brain, including cranial nerves and blood vessets, appear intact. On cross-section of the brain parenchyma, there is no evidence of natural disease. SPECIMENS Submitted for toxicological analyses are samples of blood, bile, urine, vitreous humor, gastric contents, liver, and brain. Representative sections are retained in formalin. TOXICOLOGIC EXAMINATION See toxicology report. •\ I ,f J~ .'0 () NIKK!. ~OURTZINOS, D.O. Deputy Medical Examiner NM/ksh/lmt Date Signed *** GOVEhNMENT OF THE DISTRICT OF CuLUMBIA OFFICE OF THE CHIEF MEDICAL EXAMINER 401 E Street SW Washington, D.C. 20024 Telephone: 202-698-9059 Fax: 202-698-9104 TOXICOLOGY REPORT SPECIMEN(S} RECEIVED CASE IDENTIFICATION Item Toxicology Number Name: Report Date: Agency Name: Agency Number: Medical Examiner: Sample Date Received TX13-1130 1 Femoral - Blood UNIDENTIFIED, Female 2 Heart - Blood 10/10/2013 3 Heart- Blood 10/10/2013 11/18/2013 4 Urine 10/10/2013 OCME 5 Bile 10/10/2013 6 7 8 9 Vitreous Humor 10/10/2013 Liver 10/10/2013 Brain 10/10/2013 Gastric Contents 10/10/2013 13-02470 Nikki Mourtzinos, D.O. 10 IVC- Blood 10/10/2013 10/10/2013 RESULTS : Item Sample Compound Method 1 Method 2 Comment None were detected ANALYSIS DESCRIPTION Volatiles- HS/GC Specimen(s) were analyzed by headspace gas chromatography (HS/GC) for ethanol, acetone, methanol, and isopropanol. EIA- ELISA Specimen(s) were screened by enzyme-linked immunosorbent assay (ELISA) for amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine metabolites, methadone, methamphetamines, opiates, phencyclidine, oxycodone, buprenorphine and zolpidem. Basic Screen- GC/MS/NPD Specimen(s) were screened by gas chromatography-mass spectrometry-nitrogen phosphorus (GC/MS/NPD) for the presence of general basic compounds. The detection of any compound is concentration dependent. Screen - LC/MS/MS Specimen(s) were screened by liquid chromatography-mass spectrometry-mass spectrometry (LC/MS/MS) for the presence of general compounds. The detection of any compound is concentration dependent. 1s~, MFS, FTS-ABFT tt;oxicologist, OCME I certify that I am the Chief Toxicologist at the Office of the Chief Medical Examiner (OCM£) for the District of Columbia or their designee. · The laboratory results summarized above vvere correctly determined by proper laboratory procedure, are accurately set forth in this official report, and are certified by me to be accurate. In addition, I certify that the above analyses were conducted while safeguarding the chain of custody of the specimens being analyzed. TX13-1130 Page 1 of 1