Coup Contrecoup Contusion

Mystery Deepens in Small-Town Death: Drunken Fall or Homicide?

In a case that shook a small Illinois town to its core, a death initially ruled as an accidental fall may have been a calculated act of violence. The victim, a man locals affectionately knew as “Charlie,” was found lifeless in a concrete culvert just blocks from his favorite bar. What appeared to be a tragic misstep quickly escalated into a suspected homicide, thanks to forensic expertise and the meticulous work of Dr. Roland Kohr, a well-known forensic pathologist.

The Initial Discovery

Charlie, a habitual bar patron, was discovered early one morning, his body crumpled in a culvert behind the bar where he spent most evenings. To onlookers, the scene suggested a straightforward conclusion: Charlie, intoxicated as usual, had fallen and struck his head. Local authorities, familiar with Charlie’s history of heavy drinking, were quick to chalk it up to misfortune.

The county coroner, while not a physician, was seasoned in his role and decided to proceed with an autopsy out of caution. The task fell to the hospital pathologist, who identified brain hemorrhaging and bruising consistent with head trauma. However, something about the injuries raised enough questions for her to seek a second opinion.

Transcript

Welcome to another episode of the coroner Chronicles with Dr. Roland core forensic pathologist.

Over the years, I've worked with a lot of different counties starting off course with my home base County of Vigo County is the electric coroner But as I uh, start to establish myself in a town that had two local TV, stations word got out pretty quickly among the surrounding communities.

That there was a local forensic pathologist now who can do cases and was interested in doing so. And over the course of the next. Several years, I expanded by Word of Mouth. Among other corners, uh, police officers State Police, you name it to where I eventually. Served off and on for 19 different counties, both in Indiana and Illinois.

Now, for the most part kept at about 13 because other people would move into town over the years closer to certain locations, it'd be more convenient for him. But uh there's one particular case that kind of established myself uh in one of the Illinois counties nearby. Uh, just kind of fell into it, but it was an interesting story.

How this happened?

There had been a gentleman, we're just going to call him Charlie for the sake of a generic name. Who is known to be a heavy alcoholic. And if not exaggerating too much, you probably calling the town drunk. And Charlie hung out in the uh, the county seat of this particular County and would go to the same bar almost every night.

Usually, get intoxicated, then stumble away. Well, one day, uh, he didn't come back home. And his body was found the next morning. Laying a small concrete culvert. Just a couple blocks from the downtown area. Uh, this is right behind the bar and the question was, okay, what happened to Old Charlie Well, the initial impression was Charlie got drunk, like he usually does this time, he fell and hit his head when he struck the concrete, it was enough to cause head trauma and that's what killed him.

On top of everything else. We know that many alcoholics because of their Advanced liver disease, stop making the necessary clotting factors and Small bleeds that people could normally handle tend to become out of control and that may have been what killed him. Less that particular County coroner who was a non-position.

But very competent is job decide that North Helpsy was necessary, because this was an unwitness death. So he called his usual autopsy position. Now, in this particular County, there was a County Hospital. That had a hospital-based pathologist that did. Uh, the usual sort of things but I'll just do manage the laboratory.

Examined biopsies, examined tissues, removed surgery, and so forth. And did the occasional autopsy as well. Working with this particular corner for many years. And you know, not a great number of cases came their way, but they had a mutual level of trust. Well, uh, She received the body performed an autopsy and Anyway, with the completion of the autopsy, she's taking the brain out to notice.

There's some Hemorrhage there and some bruising Uh, but instead of cutting the brain in the Fresh State, which was something I was trying to do, uh, I'll just let them sit in formaldehyde for Week to 10 days sometimes because it gives them a little more solid consistency. They're easier to slice thinly at that stage.

So she'd set the brain behind in a bucket is formaldehyde to Become more formally fixed and preserved and started stewing over, just what this meant. Well, as she was trying to decide over the next couple days what to do with this case. I may have been on TV for one of the level quarter cases.

We were handling out of Terre Haute, she'd seen that and say well maybe Dr, core can be of assistance. So I get a phone call from her and we've never been properly introduced or even met, but she explained who she was, and said that, she'd seen that I was doing corner work and forensic sort of things and wondered if she could ask me a question or two.

And I said, certainly be happy to help you and she described the case pretty much as I've told you already, you know, Charlie the Tron drunks found in a concrete culvert right behind the bar that he frequented and looked for all the world, like, he'd fall and struck his head, and that's why he was dead.

Brain bruising and Hemorrhage inside his skull. So it seemed to be fairly straightforward. But for some reason, something just wasn't sitting right with me and so she asked if there's anything I could suggest to help her Well, at that point, I introduced her to the concept of coup versus Contra coup contusions.

Now coup is c o u p. It's a French word. As is contra coup. And what they describe are different head, injury patterns, that will help us differentiate between A moving head, hitting a stationary object such as happens with a fall, versus a moving object, hitting a stationary head, which is when you're struck with something.

So I took about five minutes to explain the mechanisms and how you looked for this and what we're looking for, in all this Uh, and when our conversation ended, after about 15 minutes total, uh, she seemed to be pretty confident. Thank me, sincerely for my assistance and And a conversation.

Now, I figured that was the last. I was going to hear from her. But the next day I got another phone call. She was calling back said, you know, just I've been thinking about what you told me and I don't want to mess this case up. Is there any way that you would examine the brain with me?

I should certainly not be a problem, said it. Yeah I'd have to ask you to come over here, bring the brain rather than have me go all the way to your town but she said, oh not a problem until we made arrangements for the next day to her to show up and she brought the brain bucket with her.

The back part of the lab we handle dissections and we examined the brain as well, as the scene, photographs, which she'd had they've taken Polaroids back then, And one of the things you need to do to differentiate a coup, from a contracuse, you've got to look at the scalp surface to see where the injuries are and then compare those to where the brain injuries are on the inside of the skull.

In this case again, I can't remember right versus left particularly, but just for the sake of illustration, let's say that Charlie had a scalp wound on the right side of his skull. Now if you'd fallen and hit the right side of his head that could do it but if somebody would hit him with something two by four crowbar baseball bat Whatever then that could also leave A scalp injury.

Now, when we're talking scalp injuries of this type, we're talking blunt force trauma, which can be either a Uh, contusion also known as a bruise, it can be an abrasion or a scrape or it could be a laceration. Now lacerations are unfortunately a term that's very often misused. Only by lay persons.

But also, by people in the medical profession, a laceration is not caused by a sharp object, like a knife or piece of broken glass. A laceration is a blunt injury caused that results in the skin actually splitting or tearing apart because the impact it has to be between two solid surfaces.

So we, commonly will see lacerations on the head because you've got the rigid skull and then whatever strikes on the outside, it basically pinches the skin between and causes it to tear.

Those places like that. So, Always got to look carefully. The other thing that will distinguish a laceration. Uh from a medical standpoint and specifically from a forensic standpoint is that Unlike a sharp object such as a knife or broken glass, a laceration will also have Contused, or upgraded edges, which is something we normally do not see in Sharp Force injuries.

Yeah, so it's very important to make that distinction, especially if you're in forensics because If you see something that's a laceration and say, oh, that was caused by a knife, you can search for days. If nots decades looking for the object, you'll never find it because it was not a sharp object.

So anyway, as I looked at the Polaroid, she brought with her, I could see. Okay, we had an injury that was uh, Contusion. And some abrasion on the right side of the scalp. Uh we then proceeded to take the brain out of the bucket as we looked at the brain.

Lo and behold, we found out that the brain contusions were also on the right side. Okay. Now, this is sometimes difficult to explain, but basically, if an impact hits, the scalp, the force from that impact, will not only injure the skin. It will be transmitted through the bone of the skull.

To the underlying brain tissue in a linear fashion. And so in this case, since we had scalp infusion on the right, Uh, no skull fracture but then a brain condition on the right. That is what we would call a coup contusion pattern. And to me, that indicates there was a moving object that struck a stationary head.

What happens with a fall is? So he had fallen and struck the right side of his head. Well, In cases like that, where the head is moving, the brain is also moving, but it is slightly lagging period compared to the rest of the head because there is some space in the head between the skull and the surface.

The brain is a couple millimeters but it's there. Is that when the impact occurs, the brain will actually rebound against the opposite side. So, if the head strikes, a hard surface on the right side, the brain's first major impact will be on the left side. Uh, one way I've tried to explain this to people over the years.

It's kind of like when you ring a bell, When you shake the Bell, the bell clapper hits the opposite side away, your bell's moving. Moving the Bell up. Clapper's going to hit the bottom if you're moving the belt down. The bell Clapper is going to hit the top of the bell.

Uh, and that would be a contrary to contusion pattern when the Contusion on the brain. Surface is opposite where the injury is on the scalp. As we looked at that on the brain surface, it was classic Um, we went ahead and made some slices into the brain to show that the bruising was not just discoloration and you can actually see Confusions in the brain that extend several millimeters.

They almost look like little tiny Splinter hemorrhages but they're very distinctive in appearance. We did that. Photographs, save some slices. And when we've done all that just because I can still see, she was a tiny bit skeptical, we went back to my office and I picked a book off my shelf of forensics and opened it to the place that describes the difference between coup and Country contusions, and was able to show her just right there in Am what the differences were and how they are reliable and reproducible.

Well. By the time, I finished explaining this to her showing all the pictures and all I had her convinced, you know, she was personal science, she is a pathologist and she could understand the medical reasoning. Uh, new enough physics to understand how that would work and she was satisfied.

So, she left, uh, After an hour or so with me and went back to the hometown and contacted the local corner and says. I just got back from meeting with Dr. Core and He didn't fall and get this injury. Somebody struck him.

Now the corner of course, was taken by surprise by this because he had pretty much reconciled himself like everybody else had, you know, Charlie got drunk fell and hit his head. And she explained it to him as best she could. And he seemed to be kind of following, but he, he could tell he was still skeptic.

And uh when he then in turn called the chief of police in the town and the prosecutor to say, we've got a homicide, not an accident suddenly, there was an uproar, I mean, you know prosecutor, well, there's no way this is Charlie. Was even worse with the chief of police.

You know, I myself have arrested Charlie numerous times and there's, there's no way. Charlie got drunk fell down. He said nobody, nobody had it in for Charlie. Nobody killed Charlie. I refuse to believe that. Yeah. Whoever the stock decor is doesn't know what the heck he's talking about. Well.

Got back to mythology. She said, no, absolutely. He knows what he's talking about and the next phone call, I had was from the corner of the county again. Someone I'd never met before never spoken with. And you know he basically introduces himself says and I've just gotten off the phone with uh my pathologist who's been doing my ontologies for years and Really having a hard time wrapping my mind around.

The fact that this could be a homicide on Charlie, he's a town drunk but at the same time I respect my pathologist and she says she respects you and if that's the case, We need to work this out because I don't want to let this go. Well, we Converse for a while I said okay tell you what I'll be more than happy to sit down with you and the prosecutor and the chief of police.

If we want to set up a time and he was agreeable. So, again, next day, they showed up at my office and we sat down and I started explaining it. Now, as I started explaining the rationale, the findings and even with the textbook, Pretty quick to grasp. What I was talking about when you can see the diagrams from a forensic textbook he said, okay I guess that makes all the sense the world to me.

Prosecutor was pretty much the same way. Not quite as rapid because he didn't have the scientific background that the coroner had down from Of. You know, in that office. But he was, uh, he kind of said, okay, I can see where you're coming from. Yeah, it's worthy to look into Chief police though.

Was, I don't see. He was a good old boy but he's small town, police chief and he said, I said this is ridiculous. He said I'm gonna waste time and manpower of chasing down something that didn't happen. Uh he was you could tell not buying in but when the coroner prosecutor both said, no, this is a homicide till you prove.

Otherwise he finally had to agree to pursue it. Well I can't remember if it was a matter of weeks or months later but they followed up with their investigation and sure enough, they found a suspect And when it went to trial, I was actually asked to come over and be one of the witnesses for the prosecution.

Uh, turned out that the case was indeed a homicide and the weapon that had been used was a wine bottle. We've been struck over the head by a wine bottle, following some argument probably because Him and another got into it. But uh, Kind of con missed him. And I think we finally made a Believer out of the chief of police now, I know I made a Believer out of the corner because thereafter the coroners started.

Sending me any case that was not straightforward natural. He still kept his Hospital pathologist to do the unattended probable natural deaths where somebody hasn't seen a doctor for months or years. And it's likely to be a heart attack or a stroke, but anything that was perceived as being possibly accident suicide or homicide started coming to Terre Haute County extended up to the time that I retired.

So we had a You know, kind of the proofs in the pudding and we were able to convince them. So, Satisfying case now. Again, this is something that uh I don't know. I've ever seen on one of these TV shows, certainly not the csi, sort of things but it is legitimate.

Forensic finding that is well, documented in the forensic literature. Now, it doesn't happen every single time. There are cases where we've had blows to the Head that will not show enough bruising. To make it a classic case, but when you do find it, it's kind of a slam dunk.

And for that reason, it's uh, one of those things you keep in back of your mind and I utilize that as an argument in cases, maybe once every three or four years because we don't see that many scenarios where we have to differentiate. But when you have it and you got the evidence behind you, it's a very compelling argument and makes it crystal clear.

What happened as it did in this case. It's a problem. You don't see probably as much in large cities where you have established medical examiner systems. But in States, such as Indiana, where you don't always have trained medical professionals serving this corner because in Indiana, the only requirement to be Corners.

You have to be 18 years old. Can have people that in a case like this would say well it's straightforward enough from the scene I'm not even going to order an autopsy. Uh, other situations are you will have autopsy sometimes done and not so much now as you would have had 20 30 40 years ago, but they'd get the hospital pathologist to do the autopsy.

Who lacks the forensic training. Again. I've done Hospital pathology, I've continued to do that up to the time of my, you know, retiring from full-time practice. But there are certain skill sets that are unique to forensics that other pathologists don't necessarily know, right, mythology has sub-specialties with that, there's neuropathology dermatopathology that looks at skin diseases hematopathology, looks of things like lymphoma leukemia, neural, pathology looks at brain injuries, and everyone has specialized training to recognize areas.

And one of the things I've learned throughout my career, not just in pathology. But in medicine in general, is you need to learn to stay in your own lane.

Limited license to practice medicine and surgery in the state of Indiana. Because that certainly doesn't make me a well-qualified obstetrician. Or a dermatologist or a heart surgeon. Uh, or a psychiatrist. Now, I've been exposed to each and all of those disciplines at least in rudimentary fashion, during medical school.

But in four years of medical school, you cannot become an expert in every single specialty. This is not the 1500s or the 1800s, you've got to make use of the advances. And again, some of these Specialties get very, very narrowed. Able to sometimes step back and says this is outside of my expertise.

I'm going to call somebody else in Now in case of this type again in in many situations, it might not even have an autopsy order because the A person Corner who could say, oh, gee Get slammed up, no need to waste County money on an autopsy. That's going to tell something we already know.

Stuff like that, which flip through the cracks. Um, That's always a danger. Now the other problem is there are still practicing in Indiana Pathologists that are not Uh, forensic trained or necessarily board certified forensic. Pathology And they may get right things, you know, 90 95 of the time, but then you really want to let that five percent or so slip by because you didn't have the expertise and didn't have the Integrity to say, I'm not sure I need help on this one.

I mean, throughout my career, if I had difficult cases, there's times that Yeah, you see things that you've not seen before. And so if I'd have a difficult case, you know, I would pick up the phone and call one of my mentors in Indianapolis Dr. John plus was a very well nationally respected forensic pathologist that.

I'd known since I was 14 years old. And whenever I had a weird case, I'd call John said, John, what do you think about this? And more often than not, he'd agree with me so you're on the right track. But sometimes you say, hey, You might want to reconsider or, I don't know if you can prove that I agree with your gut feeling, but it may be a hard sell to a jury.

But then their daughter's trying to say, well, get somebody else involved. One of those examples of things in forensics. I've got to know the rudiments of ballistics now. Am I a ballistics expert? No, but like I know the fundamentals of ballistics. Apply those to what I do know which is the effects of bullets on human tissue and how the patterns are created.

And that way I can integrate with what I find with, what a ballistic desperate will tell me. And there's other areas like that there's certain toxicologic findings where I say, you know, I can't be sure if this was enough to be fatal in and of itself. You know, a misconception is you all you got to do is look at a number on a blood test and say, oh they overdosed or didn't.

But everybody's tolerance to drugs and or alcohol is different. And a level of alcohol that might kill me because I'm, you know, I very limited, social Drinker is entirely different from level alcohol. It would take to kill somebody like Charlie, we were just talking about, you know, you know, Charlie could probably have a blood alcohol of, you know, 0.3, you know, almost four times the legal limit and still be functioning.

If I was 0.3, I'd be passed out in a coma and might not survive. Fentanyl or methamphetamine or a lot of other depressive type drugs, you got to put it in context, rule out everything else. It could be responsible and then when nothing else fits and the lug levels are within a range that has been reported in certain people to be fatal.

Then you can say okay it's consistent with a drug overdose or certainly intoxication. Any attorney worth of assault is going to have to you know challenge it as a defense attorney and you've done a you know half-assed job then they're going to have all kind of grounds for challenging, what you said challenging, your conclusions and just you know ripping you a new one when you're on the witness stand.

I think we're at this point now, if nothing else, that was a byproduct of the, uh, the CSI generation is that now people have a certain level of expectation that you've got to have certain evidence presented. Now, a lot of this is unreasonable. There have been cases. You know, things are just slam dunks.

Yeah, I can't think of, you know, my chief Deputy once telling me from police officer standpoint. A person suspected a burglary. Uh, they arrested them. Questioned them found the stolen goods in their possession. So it's kind of obvious, that's the only way they could have gotten them. But when I went to trial a juror said, well, where's the DNA?

And this was even after the person had confessed to police questioning that. Yeah, I broke in and stole the stuff. Yeah, you don't always need DNA on every single case. In fact, DNA Types of evidence. Ah, well, I doubt I've used it in one or two percent of the cases that I looked at in my career.

Dna is great if it's helpful. But the absence of DNA doesn't mean that somebody is innocent, Never will. You gotta take the sum and substance of the circumstances. Evidence is collected, autopsy findings, and other peripheral things, and integrated all together. And that's kind of ultimately what my job is as a forensic pathologist I got to kind of pull all the Loose Ends together and say, okay, this person is dead because of this sequence of events and there's no other logical explanation and that's how I reached my conclusion.

But if I'm wishy-washy on a witness stand, then jury's going to say, yeah, I don't think we got enough to conduct and it might let somebody get away from doing something. They shouldn't get away from