Dr. G: Medical Examiner - Season 5, Episode 2 - Deadly Encounter - Full Episode | Forensic Files

[OMINOUS MUSIC PLAYING] [DRAMATIC MUSIC PLAYING] NARRATOR: A man is found bludgeoned
in a motel parking lot. He's covered with blood. A lot of broken bones. NARRATOR: And as police begin a full-scale murder
investigation, they're asking Dr. G for the impossible. They want me to figure out what the murder weapon is.
This is going to be trouble. I knew this was going to be trouble. NARRATOR: And then a man with a history of chronic pain
is found unresponsive in bed. JAN GARAVAGLIA: (VOICEOVER) The wife calls 911. They work on him for about 20 minutes,
but they realize he's dead. NARRATOR: But in this case, forensics alone do not give Dr. G all the answers.
Now the question is, how did this happen? This is the million-dollar question. How did this happen?
[EXCITING MUSIC PLAYING] NARRATOR: Altered lives, baffling medical mysteries, shocking revelations.
These are the everyday cases of Dr. G, medical examiner. It's early on a Wednesday morning
when chief medical examiner Dr. Jan Garavaglia arrives at the District 9 Morgue in downtown Orlando.
Today will not be an easy one. I was not looking forward to coming to work today.
I knew this fellow was coming in. And I knew that it was going to be difficult. I knew this was going to be trouble.
[INTENSE MUSIC PLAYING] [MACHINE WHIRRING] NARRATOR: The case that awaits Dr. G this morning is that
of 62-year-old James Duncan. Okey-dokey. Oh, boy, we've got a tough one today. We've got a 62-year-old white male who's been in the hospital
for a month due to a-- they say an assault and battery. He was beaten about the face.
And he spent the last month in the hospital trying to recover from his wounds, is what they're telling me.
NARRATOR: According to the police, James Duncan was a motel desk clerk working in a crime-ridden neighborhood of Orlando.
He's kind of a gruff old guy. He's always having trouble with people. He's not well-liked, to put it that way.
NARRATOR: Several weeks ago, he was working the night shift when he had a verbal altercation with one of the guests, whom
James accused of trespassing. He was very difficult to deal with. He would stop anything and everything that moved
or that would trespass on the property. NARRATOR: Police are uncertain what transpired next,
but 20 minutes after the run-in, they find James bludgeoned and bleeding in the motel parking lot.
He had severe-- what appeared to be severe facial injuries. A lot of facial trauma.
Broken bones, cheekbones. He's got a large chunk of tissue probably missing from the back of his head and multiple lacerations
of the face. Dispatch to Unit 91. Come in. And they asked him what happened. And he said, I don't know.
I don't know what happened. He was fully conscious, not disoriented, but he didn't know what happened.
NARRATOR: James is rushed to the hospital. His facial wounds are serious, though not
thought to be life-threatening. But by the time he arrives at the ER, his condition has rapidly deteriorated.
His blood pressure is unstable. His breathing is labored. And his heartbeat, irregular.
Doctors wonder if the stress of the assault could be triggering other more serious problems.
The emergency department doctor is pretty smart and figures, well, you know, maybe he's
had some type of heart attack. NARRATOR: Doctors check James's blood for a protein
called troponin. This could indicate whether or not he's suffering from a heart attack.
But his troponin level is normal. And further tests reveal no signs of any other life-threatening conditions.
They do a CAT scan. They do x-rays. No brain trauma, and no other trauma anywhere else.
NARRATOR: Doctors surgically repaired James's facial injuries. And yet, in the coming weeks, even though his wounds
begin to heal, his condition continues to worsen without explanation. JAN GARAVAGLIA: (VOICEOVER) They had problems
again with his blood pressure. He started getting a lot of fluid in his lungs. NARRATOR: Then, four weeks after entering the hospital,
James contracts an aggressive blood-borne bacterial infection known as sepsis. The infection is too much for his weakened body to handle,
and he dies in the intensive care unit. His body has now been transferred to the District 9
Morgue in hopes that Dr. G can pinpoint why he was unable to recover from facial injuries, which
initially didn't seem to be at all life-threatening. But already, doubts are looming.
This case is not simple. After a month in the hospital with this stormy course, that he comes to me for an autopsy.
And I don't have hopes that I'm going to be able to tell them much. NARRATOR: Since James Duncan's death followed what
police believe was an assault, the case is now considered a homicide. To help with the murder investigation,
police have asked Dr. G to undertake a nearly impossible task. Please take morgue photos to confirm the weapon.
He spent a month in the hospital. They say he's assaulted. He's already had surgery.
He's got one medical complication after another. And they want me to figure out what the murder weapon is.
Well, when they asked me what kind of weapon, it's a little easier if you have a fresh victim,
they haven't had surgery, and they haven't had their wounds heal. So I really didn't have high expectations that I
would be able to say much. [DRAMATIC MUSIC PLAYING] The external examination-- we have
a man that clearly looks like he's been in the hospital for a month. He's diffusely edematous.
Just swollen with all the fluids they'd given him. He looked very ill. And he looked every bit of having
sepsis and pneumonia and problems maintaining his blood pressure. NARRATOR: First, in an effort to identify what kind of weapon
inflicted James's injuries, Dr. G must record all trauma on the body and differentiate
wounds from surgical incisions. I had to take everything I found on his face and see what was surgery, what was done to him,
and what he came in with. I'm just like, OK. What they do, what he come in with,
let's see if we can match what he actually has now and subtract what they did to him in the hospital.
NARRATOR: As she charts the wounds, it's clear that the injuries were substantial.
He suffered extensive fractures to his jaw bone, cheek bones, eye orbit, nose, and maxillary.
JAN GARAVAGLIA: (VOICEOVER) There is some asymmetry to his face. His left side was still kind of flattened.
His nose was still kind of flattened. He looked a mess, honestly. NARRATOR: But the only wounds Dr. G finds are on his face.
This is the best wound. JAN GARAVAGLIA: Oh. NARRATOR: There were no defensive wounds
on his arms or hands to suggest that he fought back against his attacker. One of the things I'm looking at at the external
is to look for other-- maybe some minor injuries that the hospital wouldn't have
reported to me, that maybe indicate something else was going on. Or help me kind of figure out what the mechanism
of the injuries were. He didn't have a scratch on him. NARRATOR: By the end of the external exam,
Dr. G has pieced together a full diagram of the victim's injuries. Okey-dokey. I think that's it.
NARRATOR: But the exam has still not revealed what police need most-- the weapon.
It was very inconclusive at that time. JAN GARAVAGLIA: (VOICEOVER) At the end of the external
I thought, oh, brother. I don't know if I'm going to be able to tell anything. [OMINOUS MUSIC PLAYING]
NARRATOR: On the streets of Orlando, police are on the hunt for a suspect in an alleged assault that resulted in the death
of 62-year-old James Duncan. As the investigation began, we tried to contact any witnesses
or anybody that may have been at the business at the time, anyone that may have witnessed what had happened.
We put out flyers for the area to try and locate any and all witnesses in the beginning,
was where we started. NARRATOR: As police try to close in on the killer, Dr. G is ready to open the body of the victim,
looking for any internal trauma that may have been missed by the hospital. [INTENSE MUSIC PLAYING]
JAN GARAVAGLIA: I'll get those out [INAUDIBLE].. NARRATOR: Dr. G opens the body with a standard y-incision.
She is assisted by her morgue technician, Brian Mikulski. You want me to start working on this side, Dr. G?
As long as you can't hit my hand, you can work on it. Yeah, that wouldn't be good.
No, it wouldn't. I'm still on probation. Oh, I see. So when I do my y-incision, it's very wet.
Edema fluid is just pouring out. I see a tremendous amount of fluid that has accumulated
in his abdominal cavity. I see a tremendous amount of fluid that accumulated in his pleural cavities.
Yeah, he's got a lot. NARRATOR: Edema is a swelling caused by the buildup of abnormal levels of fluid in the body.
We knew we had problems with his blood pressure. They were giving them a lot of fluids to try
to maintain his blood pressure. And as he got sicker and sicker, he couldn't maintain the fluids, actually, inside his vessels.
And it would be leaking into his tissues. And a lot of it. NARRATOR: Once toxicology samples are taken,
Dr. G begins searching for any internal trauma that might have been overlooked. I'm looking very carefully for any kind of trauma.
I'm looking for broken ribs that they may have missed. I'm looking for evidence of bleeding under the skin.
And he doesn't have any at all. All righty. Why don't we just take a overall before I--
NARRATOR: The hospital was right. James did not suffer any additional trauma in his abdominal cavity.
Dr. G documents the findings for the investigative team. All righty. The picture's always worth a thousand words.
Thank you. NARRATOR: As a next step, she opens James's chest cavity to begin examining his internal organs,
one by one. [BEEPING SOUND] First organ I look at is his heart. And in the examination of the heart,
I always start with just looking at the external aspect, looking at the shape. NARRATOR: And what she finds is troubling.
Whoa. Something here. We got a big heart. JAN GARAVAGLIA: (VOICEOVER) His heart looked very dilated.
Both right ventricle and left ventricle were dilated. And I look at the coronary arteries.
NARRATOR: Here, too, all is not well. His left main coronary artery was 50% narrowed.
But his left anterior descending was about 95% narrowed. His circumflex, going to the side, had about an 80% to 85%
narrowing. The right coronary artery had over an 80% narrowing. Thanks, Brian. NARRATOR: Her conclusion?
He had extremely bad atherosclerotic coronary heart disease-- extremely bad. NARRATOR: But as she slices into the heart muscle,
Dr. G discovers that severe coronary artery disease wasn't James Duncan's only problem.
I went ahead, then, and I bread loafed the heart muscle to see if there was any damage to the heart.
And lo and behold, he's got a large myocardial infarction or heart attack that's about a month old.
NARRATOR: The timeline is shocking. The heart attack appears to have occurred near the time of James's assault,
perhaps as a result of the trauma. And yet the hospital failed to diagnose or treat it.
For some reason, the hospital just didn't pick up on it. NARRATOR: Now the question is, what
else could they have missed? [OMINOUS MUSIC PLAYING] [ROCK MUSIC PLAYING] Dr. G's morgue technician, Brian Mikulski,
opens the cranium of James Duncan. Considering the hospital's failure to diagnose James's heart attack,
Dr. G is concerned that the doctors may have also overlooked an injury to his brain.
Examining his head trauma, I would hope that maybe it would add something that they didn't
pick up on in the hospital. NARRATOR: Dr. G extracts James's brain for examination.
In the hospital, CAT scans, or computed axial tomography, of James's brain detected no internal trauma to the organ.
But it's possible that the images may have given doctors a false reading. CAT scans are wonderful, but they can miss some injuries.
They can particularly miss some subarachnoid hemorrhage. They can miss some fractures to the base of the skull.
And so I was hoping maybe we'll find some more injuries that would shed some light on something.
[INTENSE MUSIC PLAYING] NARRATOR: But her hopes are quickly dashed. No fractures to the calvarium.
No fractures to the base of his skull. I didn't find anything in his brain that was out of the ordinary.
There is no trauma. There is no natural disease. NARRATOR: Despite his severe facial wounds,
it appears as if James's brain remained unharmed. This means that head trauma likely played
no part in his downward spiral. [WATER HISSING] The autopsy is now complete. And yet for Dr. G, the case is far from over.
The findings, or lack of findings, are simply not adding up. JAN GARAVAGLIA: (VOICEOVER) Well, the end of autopsy,
I had more questions than I had answers. I knew that he'd had a heart attack. And this looked like it dated at or about
the time that he suffered these facial injuries. I knew that they missed this heart attack in the hospital.
And the injuries are so well healed that I can't really say much about a murder weapon.
NARRATOR: What's more, police have found no witnesses to the alleged assault. Nobody saw anything.
Nobody saw an altercation. Nobody saw anybody with a weapon. Nobody saw anything.
[DRAMATIC MUSIC PLAYING] NARRATOR: After thoroughly reviewing the autopsy findings
and re-evaluating information provided by the police investigation, Dr. G begins
to formulate a new hypothesis. What if James's trip to the hospital had nothing to do with an assault?
I really don't have any evidence that there was an assault. But I have another theory.
And I'm wondering if this theory was thought of at all in the hospital. But I don't--
I'm not so sure it was. NARRATOR: Dr. G compiles her findings and prepares to record them in the report of autopsy.
But instead of describing a death brought about by injuries from an assault, she will articulate her new and radical
theory on how she believes James Duncan died in the motel parking lot and why doctors failed to fully understand
his condition in the hospital. [EERIE MUSIC PLAYING] According to the police report, 62-year-old James Duncan
was working the night shift at the motel when he got into a verbal dispute with one of the patrons.
But Dr. G now believes that's where the altercation ended. Well, the new theory is that perhaps none of this
is from an assault. Perhaps he suffered a heart attack. He fell on his face, unconscious.
And people just jumped to conclusions that his facial fractures were from an assault.
NARRATOR: Based on her forensic findings, including microscopic reviews of heart tissue,
Dr. G is confident that after the argument, James suffered a severe heart attack when a small clot formed
in one of his severely narrowed coronary arteries, obstructing blood flow to the heart muscle and causing
him to lose consciousness and fall face forward. He doesn't brace himself. That would have softened the blow.
I mean, your reaction is to brace yourself and not let your face hit. NARRATOR: The impact fractures the bones of James's face.
It's a scenario Dr. G has seen before. I've had several cases where people get terrible facial lacerations and facial fractures
after suffering a heart attack. NARRATOR: Doctors successfully patch up his injuries.
But tragically, they failed to diagnose his other significant condition, a severely damaged heart.
Dr. G discovers that while the doctors do test for the protein troponin, which is released into the blood
during a cardiac event, they do so too early and only once. The problem with troponin is, just because you have
heart muscle damage or a heart attack, it's not elevated right away. It takes about four hours.
So you're not going to see it, even if you've suffered a heart attack, for about four hours.
So that's why you always order a series of troponin. NARRATOR: Given that the test is run so soon
after the heart attack, James's initial troponin levels come back normal. No further tests are performed.
And surgeons incorrectly conclude that his heart is fine. It kind of fell through the cracks in the hospital.
NARRATOR: Over the next few weeks, James's facial wounds heal, but his damaged heart is weakening
and beginning to fail. Had doctors recognized James's heart attack, they might have been able to stabilize him.
But without treatment, his condition only worsens. He has a very rocky course with his blood
pressure, which is probably because his heart is dying. NARRATOR: Then, four weeks later,
in a final blow to James's battered body, he contracts a fatal blood-borne bacterial infection
called sepsis. And in his weakened condition, the aggressive infection is just too much.
As you get the bacteria in your blood, your body reacts to that bacteria. You start releasing chemicals that start
your blood vessels to dilate. Once your blood vessels start to dilate, your heart has to beat harder and it has to beat more
to keep the blood pressure up. He's already having a hard time maintaining his blood
pressure with his heart, and he's already starting to go into failure. So this just makes it even worse.
And ultimately, he eventually dies. [DRAMATIC MUSIC PLAYING] NARRATOR: Because of the complex nature of James Duncan's death,
involving both disease and a fall, Dr. G ultimately rules that the manner of his death
was not simply natural, but accidental. Pinpointing the exact cause is more difficult.
So what killed him? Well, clearly, what started it all is the heart attack. But if not for him falling with that,
would he have ultimately died? And I'm not so sure. So it's not only just the heart attack,
it's probably a combination of the heart attack, now, with the injuries that he suffered from the fall
with the heart attack. And with all the problems he suffered in the hospital for being there so long.
NARRATOR: When Dr. G presents her new theory to the detectives investigating the case,
they agreed that they no longer have a homicide on their hands. Dr. G mentioned that she had run into one or two cases
similar to his, where she actually had worked on individuals that had had a heart attack and fall
straight down onto their face and cause the same type of injuries. Her findings were very conclusive in the sense
that there was no other injury to him. There was no defense wound on him, no indication that he was fighting
or struggling with someone. All we have is facial injuries. And we all determined that what happened to the victim
was basically an accidental death. [MUSIC - THE HIGHWAY BEAUTIFUL, "DREAM OUT LOUD"]
JASON JUREWICZ: (SINGING) And so you cut yourself to bleed, hoping they will see, asking them in not so many words.
NARRATOR: As Dr. G expected, the case was difficult, but not for the reasons she anticipated.
You know, my favorite cases are when I find something that nobody else suspects.
In this case, it wasn't the injury nobody suspected. They worked that up quite nicely.
And they were able to repair that quite nicely. But the whole heart attack was not suspected.
And when I find things on a case that aren't suspected and then just kind of turn the way the investigation goes,
those are the best cases. Those are actually a lot of fun to work with. [GUITAR MUSIC PLAYING]
NARRATOR: Unfortunately, some of Dr. G's cases leave her with more questions than answers,
and her next case is no exception. The family is on pins and needles that he committed suicide.
They really were worried. [OMINOUS MUSIC PLAYING] [UPBEAT MUSIC PLAYING] The county has a Service Award that's given every five years.
And this time, it's for our chief medical examiner, Dr. Garavaglia. So we're about to surprise her and give her her award.
I was told that a employee of this office has successfully completed five years of service.
So on behalf of Orange County, we'd like to present your five-year Service Award.
Here is your certificate. Thank you, Sheri. SHERI BLANTON: Thank you. Thank you, Orange County.
She works long and hard hours. She works a lot longer than they pay her for. It's nice. It's nice.
OK. Thank you. SHERI BLANTON: She's got work to do. [LAUGHS] NARRATOR: In fact, there's still one more body Dr. G must
autopsy before she can go home. The man's name is Michael Reardon, and he was found lifeless in bed by his wife late last night.
According to the investigators' report, the decedent was only 42 years old, married,
with two young children. And from the case file, Dr. G can see right away that he's had more than his share
of medical problems. He's got a really sad, long history. He ran into a basketball pole playing a pickup game
of basketball at least a decade ago and has had chronic pain since then. Numerous surgeries.
Hasn't really gotten over the pain. Is on some pretty high-dose medication for it.
NARRATOR: In fact, on the night of his death, Michael's wife Alyssa administered a fresh dose
of pain medication. In this case, a dermal, or skin patch, that releases painkiller in a constant flow
over several days. She's been controlling his medication for years. And she changed his patch in the late evening.
And then he went to watch TV. NARRATOR: Not long afterwards, Michael dozes off. JAN GARAVAGLIA: (VOICEOVER) She hears
him snoring very, very loudly. [SNORING] NARRATOR: At around 1:00 AM, Alyssa decides to turn in herself.
But as she approaches the bed, she makes a frightening discovery. Michael is not breathing.
His face is purple and he's cool to the touch. The wife calls 9-1-1. Yeah, I need someone here now, please.
JAN GARAVAGLIA: (VOICEOVER) They work on him for about 20 minutes, but they realize he's dead.
Oh, my sweet Jesus! NARRATOR: The unexpected loss has devastated Michael's wife and children.
Now, their only hope is that Dr. G will be able to determine what exactly brought
about his untimely death. After reading through the case file, she has her suspicions about what may have killed
Michael Reardon as he slept. We take things on face value. And we come up with the most probable explanation.
NARRATOR: In addition to suffering from chronic, severe pain, Michael was overweight and diagnosed with high blood
pressure-- both risk factors for a myriad of medical problems. But it's what his wife Alyssa noted in her statement
to the investigator that draws Dr. G's attention-- Michael's snoring. He's got a history of some snoring in the past, where
the wife has to shake him. There's a question of whether he has sleep apnea. That could be a possibility.
NARRATOR: Obstructive sleep apnea is a common problem in which the airway becomes blocked
during sleep due to the relaxation of soft tissue structures in the throat. It can lead to a temporary cessation in breathing.
And in some cases, trigger a deadly heart arrhythmia. Well, a heart arrhythmia is an irritation
in the electrical system of the heart, where it causes it to quiver. And you can't beat.
You can't send blood to any parts of your body. You pass out and you die. NARRATOR: If Michael died due to a fatal arrhythmia,
his premature death could be attributed to natural disease. But there's another notation in the investigative report
that suggests the death may have been anything but natural. The family is on pins and needles
that he committed suicide. They really were worried. NARRATOR: Twice already, Michael has tried to take his own life.
Since his basketball accident damaged his facial nerves 10 years earlier, he has suffered from
chronic and unbearable pain. Doctor G wonders if he just couldn't take it anymore.
It's a tough row to hoe. To have recurrent chronic facial pain, you know, you start getting into a frame of mind
that you're hopeless. That things can't change, and there's no other solution. And after years of trying to control that pain,
maybe that's how he's feeling. It's well-known that chronic pain patients and depression
often go together. And we know that depression often can lead to suicide. So you can't say that all patients with chronic pain
lead to suicide. But those that have chronic pain, that are profoundly depressed, certainly
can have an increased risk for suicide. NARRATOR: Did Michael finally succeed at ending his life,
as his family fears? Or was his death due to a disorder such as sleep apnea? For answers to these questions, there's
only one place to turn-- Michael's body. [DRAMATIC MUSIC PLAYING] On the external examination, the general state in the body
is a little bit overweight. You know, the weight's kind of in his belly area. NARRATOR: Dr. G begins the exam in the place
that gave Michael so much trouble-- his face. He clearly has had a lot of surgeries in the face area.
You can see the scars from that, you know, pretty much going all the way from his jaw down to his neck.
A little-- another scar on the other side. NARRATOR: Next, she searches the body for the pain patch
that Michael's wife administered the previous night. The patch, called a transdermal, administers
a constant flow of pain medication to the patient. In this case, the narcotic fentanyl.
Fentanyl is about 80 or 100 times more potent than morphine. Very small amounts are needed for pain relief.
You can take fentanyl orally. You can inject fentanyl. Fentanyl can be put in a patch and absorbed through the skin.
And it's a small enough molecule, and you'll need a small amount for it to work.
A fentanyl patch is basically a gel reservoir of fentanyl in an adhesive skin patch.
So the fentanyl trickles through the layers of the skin in a controlled manner and is picked up by the blood vessels
underneath the skin and distributed to the rest of the body for pain management.
I'm looking all over to see if they left any patches on. NARRATOR: But she doesn't find one.
From what I can tell, as soon as he got to the hospital, they removed it. I would have liked to have seen it.
That would have been important evidence for me, but it got thrown away. NARRATOR: Dr. G then combs the body for any signs
of past suicide attempts. I do look on the inner aspects of the wrist to see if there's any scars.
A lot of times, people will attempt it that way. But I don't see any. But that's not how he attempted suicide.
He attempted suicide by medication, which is worrisome. That's because that's what I'm suspecting.
NARRATOR: But she wanted to know if Michael actually overdosed until she completes the autopsy and gets
the toxicology results. At the end of the the external, we don't have a lot, as often is the case.
And we're going to have to see what's on the internal. I don't know what bad thing happened to this guy.
[OMINOUS MUSIC PLAYING] NARRATOR: Dr. G suspects that 42-year-old Michael Reardon may
have taken his own life, but his family is praying she's wrong. I think they were really on pins and needles
waiting for that answer. [DRAMATIC MUSIC PLAYING] NARRATOR: She starts the internal examination
by opening Michael's chest with a standard y-incision. Well, when I open the y-incision, I look around.
Nothing unusual. Always keeping my eyes open, seeing what's there. Now, let's see what we have, here.
I take off his chest plate. No fluid, no abnormalities. And I do my toxicology. NARRATOR: Dr. G draws fluid, urine, and blood samples
from the eyes, bladder, and large blood vessels. These will be sent to the lab and tested for drugs.
The results will be critical in determining if Michael committed suicide. We take the blood from his iliac veins,
as peripheral as we can get from the rest of his body. Just as they're going into the femorals.
And that's where we draw our blood. We put it in our tubes and get that ready for toxicology.
Well, look at that. NARRATOR: With the samples in hand, she begins her examination of Michael's chest cavity.
And almost immediately, she discovers something unusual-- something that raises doubts about a drug overdose.
Oh, wow. NARRATOR: Michael's lungs seem normal, which in drug overdoses is very odd.
So when I do the autopsy, his lungs are not very edematous. His lungs are a little over normal weight,
but not that bad. NARRATOR: Typically, a drug overdose would cause the lungs to fill with fluid, or edema.
Nobody knows exactly why we get this bad edema with the drug overdoses. But we see it trickle in these kind of slow deaths,
which is what I suggest he had. So I don't know. I'm surprised his lungs aren't a little more edematous.
NARRATOR: But there's one more organ to check for signs of an overdose, and that's the stomach.
JAN GARAVAGLIA: (VOICEOVER) The stomach on a case like this may be important because people who want to kill themselves
will take a lot of pills at once. So are taking 15, 20, 30 pills at once. And some of those may still be in the stomach.
NARRATOR: But after a careful inspection, Dr. G comes up empty-handed again. I certainly don't see any pills or pill fragments.
NARRATOR: Normal lungs, an empty stomach. One by one, Dr. G's findings are calling for her
to rethink the entire case. It's making me kind of question my whole overdose theory.
NARRATOR: Now, she wonders if Michael Reardon's killer was natural disease after all.
And one of the places that natural disease is most likely to strike is the heart, so that's her next stop.
With the lungs removed from the chest cavity, Dr. G gets her first look at the muscle.
I get to his heart. His heart is big and somewhat dilated. Definitely a big heart for his size.
Boy, that is a big heart. NARRATOR: An enlarged heart, or cardiomegaly, is a form of cardiovascular disease, the number-one killer
of adults in the United States. Certainly, an enlarged heart would be a risk factor
for the arrhythmia because as the muscle gets thicker, it would be more prone to have problems
with a decrease in oxygenation. And so when you combine a decrease in oxygenation--
let's say, from the sleep apnea-- with a thickened heart, you're more apt to have an arrhythmia.
NARRATOR: In other words, Michael's enlarged heart and his sleep apnea may have been a fatal combination.
JAN GARAVAGLIA: (VOICEOVER) So he could have died suddenly from an arrhythmia from that heart, no problem.
NARRATOR: But Dr. G can't be certain because arrhythmias leave no physical traces behind.
It's going to be a diagnosis of exclusion. We've got to rule everything else out.
NARRATOR: Although she has a likely suspect, she can't make her ruling just yet.
So at the end of the internal, we've got an enlarged heart. And we have not much else.
We're just going to pend the cause and manner of death until I get that toxicology.
[OMINOUS MUSIC PLAYING] NARRATOR: Soon after his autopsy, the body of 42-year-old Michael Reardon is laid to rest.
But questions surrounding his untimely death remain open, leaving his family searching for an explanation.
It's always a trying time for the families waiting for the answers. We always get a lot of anxious phone calls.
Is it done yet? Is it done yet? NARRATOR: But Dr. G cannot close the case until the toxicology
results are back from the lab. And three weeks later, they arrive at District 9 Morgue.
So I'm looking through these pages of tox. He had a therapeutic level of his anti-hypertensive medicine.
He had a therapeutic level of his antidepressant medication. He had kind of a high therapeutic level
of oxycodone, a very potent narcotic that we see a lot of deaths with. But his was high therapeutic.
It certainly wasn't in the lethal range. NARRATOR: But then suddenly, something in the report
catches her attention. And I turn the page on the toxicology, and there it is. His fentanyl level-- lethal.
There is the rub, right here. Without a doubt, he's got a lethal fentanyl level.
NARRATOR: Fentanyl is the powerful pain medication that Michael had been taking through a skin patch.
At first glance, the lethal level seems to confirm the family's worst nightmare--
suicide. The question is, how did this happen? To overdose on a fentanyl patch is really quite rare and unusual.
Assuming, of course, the patch is used in accordance with a doctor's prescription, is not tampered with,
and there is no uncontrolled release of the drug onto the skin, which could then absorb into the blood and cause
problems. So how do people get into trouble? Well, first of all, they put on too many patches.
Instead of one patch, I've seen some people with four patches. I've seen it come through my office, where
heat applied to the patch can cause too much medication to be given. NARRATOR: But for Dr. G, something
still isn't adding up. She knows from her research that the fentanyl patch has been
linked to accidental overdoses. Suddenly, it seems at least possible that Michael's death
was not intentional. In Florida alone, we've got a lot of accidental deaths from fentanyl a year.
Not necessarily in my office, but in the state. NARRATOR: Dr. G wonders if Michael
Reardon might have been the unfortunate victim of a defective patch. The FDA has recalled some of these patches.
And that was one of my worries, is that maybe he had a bad patch. NARRATOR: As recently as 2008, the FDA
has issued a recall on defective patches that resulted in the deaths of patients.
The FDA put out a recall warning for these patches because they found that there were some patients being harmed
by them due to uncontrolled leakage out of the side of the patch due to a tear. There have been FDA warnings.
There was one right before this fella died. And I was initially worried about that.
But it was the 25 micrograms. And he had the 75. Since that time, there's been other warnings about the 25,
the 75, and the 100. What happens with these bad patches is that the reservoir is broken.
And that gel gets on the skin directly, with the medication in it. A lot of these defective patches,
you're going to have the gel ooze out in the packet. NARRATOR: With a defective patch,
the medication is absorbed into the skin all at once, rather than being gradually
released over a period of time. So did he have a defective patch? I'll never know because the evidence was destroyed.
NARRATOR: Unfortunately, emergency workers removed the patch and threw it away before Dr. G could examine it.
And as she prepares to close the case, she's left with a number of troubling questions.
What really happened? Did he put heat on it? Does he know this? This is a guy with long-term pain problems.
Did he do it intentionally, or did he do it to try to relieve his pain? Did he have a defective patch?
I don't know what bad thing happened to this guy. All I know is he died of a fentanyl overdose.
NARRATOR: Based on the circumstances of Michael's death and the autopsy findings, Dr. G
arrives at her conclusion. I have nothing to indicate that it was a suicide. And I'm going to give him the benefit of the doubt
because it happens with these. NARRATOR: Michael Reardon's official cause of death
will be listed as accidental overdose. Now, Dr. G can record her findings in the report of autopsy.
[EERIE MUSIC PLAYING] It's a sunny afternoon, and 42-year-old Michael Reardon is busy enjoying the company
of his wife and two kids. At 3 PM, as he does every day, he makes sure to take his full regimen
of prescription medications. He takes oxycodone, which is a potent narcotic. He takes an antidepressant.
He takes a high blood pressure medication. He takes a medication for nausea. NARRATOR: Based on forensics and the testimony of his wife
Alyssa, Michael's fentanyl patch is administered around 8:00 PM that same evening,
five hours prior to his death. Unfortunately, what happens after he went to bed remains a mystery.
You know, the wife really wasn't seeing what was going on. What was he doing there?
NARRATOR: From the extremely high level of fentanyl in his blood, Dr. G knows that the medication entered
his system very quickly, which is not the way a patch is supposed to work. Maybe it's an accident with a defect in the reservoir.
Maybe he perforated the reservoir accidentally in getting it out and applying it.
Maybe he did it on purpose, just to give himself more medication. But what really happened?
I don't know. All we know is that the fentanyl level got higher and higher and higher.
NARRATOR: As the fentanyl level escalates, it circulates through his bloodstream,
ultimately reaching all of his vital organs, including his brain. It's going into his opiate receptors on his brain stem,
saturating those, causing more and more central nervous system depression. Slowly going deeper and deeper into a coma.
NARRATOR: As Michael slips into the coma, he begins to snore. But soon, his breathing becomes more labored.
Eventually, the fentanyl suppresses his central nervous system so much that his heart ceases
to beat, and Michael dies. Dr. G immediately contacts Michael's wife to inform her that she's ruled his death
an accident, not a suicide. I think she just wanted to make sure it wasn't suicide.
At least, that's the sense I got. NARRATOR: At the District 9 Morgue, the vast majority of cases are closed
with confidence in the forensic evidence and the conclusions drawn from it. But for Dr. G, the case of Michael Reardon
is not one of them. She continues to be troubled by his death and the lingering question she'll never be able to answer.
Am I comfortable with my conclusion that he didn't commit suicide? No. You know, we've investigated as much as we can.
And we're going to have to go with the preponderance of evidence that this was an accident.
Because we have nothing to suggest otherwise. You know, I wish they hadn't thrown the patch away.
I wish I really knew what was going on those five hours, that nobody saw him between the time his patch was changed
and he died. I wish I knew all that. It's so frustrating that I can't get all the exact answers I want.
And I can only use the information I have. So it's a very frustrating case, but you've got to move on.

A hotel clerk calls 9-1-1 complaining of severe facial trauma, but he has no recollection of what happened and dies soon after. Police are counting on Dr. G to aid them in this investigation.

A Florida medical examiner takes viewers through puzzling cases while explaining procedures and conclusions.

Brief Summary

Dr. G investigates the complex deaths of James Duncan and Michael Reardon, revealing heart issues and a lethal fentanyl overdose.

Key points

A Man Found Bludgeoned. A man is discovered severely injured in a motel parking lot, prompting a murder investigation.
The Million-Dollar Question. Dr. G faces a perplexing case where the cause of death remains unclear.
A Shocking Discovery. Dr. G uncovers a heart attack that went undiagnosed in the hospital.
Accidental Death Determined. Dr. G concludes that James Duncan's death was accidental, not homicide.
Dr. G's Investigation. Dr. G investigates the mysterious death of Michael Reardon, raising questions about suicide and accidental overdose.
Toxicology Results. The toxicology report reveals a lethal level of fentanyl, complicating the case further.

Episode highlights

Episode quotes

I knew this was going to be trouble.

Dr. G reflects on the case's difficulty.

0:35WatchJun 15, 2021

Tension

75/ 100High tension

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