Episode 5: Not Quite a Homicide

Welcome to another gripping episode of Kohroner Chronicles with Dr. Roland Kohr, where the line between science and mystery often blurs. In this episode, we delve into a fascinating case that demonstrates how initial appearances can be deceiving and how the meticulous application of forensic science can reveal the unexpected.

Dr. Kohr opens by emphasizing a fact often overlooked in the sensationalized portrayals of forensic work: homicides account for only about five percent of a forensic pathologist’s practice. Yet, it is often with other cases that initially seem to be homicides can turn out to be something entirely different that challenges the skills and expertise of forensic professionals.

One such case unfolded, involving a homeless man whose death initially appeared to be the result of foul play. The story began on a pleasant spring morning when the man, who had been residing at a local homeless shelter, volunteered to sort bricks at a nearby building demolition site to earn some pocket money. After starting to feel unwell, he decided to return to the shelter, taking an alleyway route. He was later discovered unresponsive by a teenager on a dirt bike, whose suspicious actions—failing to assist and instead alerting others before riding away—added an air of mystery.

Transcript

Welcome to another episode of the Kohroner Chronicles with Dr. Roland Kohr. All right, today, uh, the stat Roland Kohr French pathologist. I want to talk about a couple of things. Uh, but one of the big things we need part of so many podcasts and TV shows and everything else making a big deal.

And everything is a murderer, really murders, don't make up a large percentage of any pathologists practiced in the forensic world. Uh, Account for usually around five percent of my practice in a year-to-year basis. And that's after doing this for over 30 years. What? We often find even more challenging than the homicides, are the cases that are Potential homicides that then really turn out to be something entirely different and they'll sometimes take more skill and application of forensic science than you know, the Homicides again, you know?

Southern Indiana, you don't have the complicated bizarre type of homicides that you might see elsewhere. Uh you know, most what we see are the typicals that you see anywhere around the country uh love triangles uh drug related deals, things of that type, but it's the unusual cases that stand out that really make things a bit of a challenge.

Uh, one of those that really stands out in my mind, uh, was initially investigated for several days as a homicide. Uh, backstory was we had a gentleman who lived in one of the homeless shelters here in town? Uh, had some metal issues, like many people in homeless shelters, do but he was functional and on a nice spring morning, I had walked several blocks away to where there was a building demolition going on.

Residents of the nursing or of the homeless shelter had been invited to come down there to make a little pocket money if they could sort bricks during the And you just put a pile of the usable bricks that are there, apart from the ones that are, you know, crumbled or whatever.

And he'd been doing that for a short time and started feeling poorly. So he said I'm going to go back to the shelter because I just don't feel good. Guy walks back, he's taking an alley and First thing we know there's a problem, is somebody notices. There's a guy laying non-responsive in the alley.

Now to make this even a little more complicated, is the person that noticed him was uh, this teenager Well-Known to police who was riding a dirt bike and didn't stop to give any Aid but saw him zoomed up. Another couple, Lots stopped, the bike yelled at somebody that was working in their backyard.

Hey, there's a guy laying down the alley and then zoomed off without staying around to assist. Made it suspicious and of course by the time 9-1-1 was called the response was made suddenly, this was considered a suspicious and unusual. The guy was not dead in the scene, but he was transported to one of the local hospitals.

Uh in a comatose state and he survived a couple hours before finally being pronounced. During the time, he never regained Consciousness. Uh, but he had several marks about him, that looked like signs of violence blunt force trauma to his head. To use upper extremities. What even looked like burn marks from the backs of his thighs?

Well, that was enough for the Terre, Haute Police Department to respond as if this was a homicide and they threw out all stops and as was typical back in those days, they assigned, like six different homicide detectives to really hit this one hard and fast the philosophy being, let's let's get it before.

The trail goes cold, put all resources on since we don't have any other cases going out at the time and gets the bottom of it. Down. I was out of town at a meeting. In fact, it was one of the local state. Corner conferences for training and so I was not available and wouldn't be back in town for a couple of days and back then it was my routine.

If I was out of town for just a few days or rather than make the autopsy, wait. Uh, if it happened at the other Hospital, in this case, it was Union Hospital. I would contact their pathologist and see if they'd be willing to do the autopsy. So, that is what I did and they agreed to take it on Now, the pathologist working there at the time we were a couple of well-qualified individuals.

Very competent in hospital, pathology matters, but not necessarily in forensic matters. But yeah, you get what you can take, you know. It didn't seem as going to be that much of an issue. Nevertheless, when the autopsy was done the next morning, they decided this guy had died of multiple blunt, force trauma and they classified it as a homicide.

So again, the police department now is even at a higher state of alert so they start, you know, Fanning out all over talking to any contacts. This guy might have had Uh, they ran down the kid on the motorbike to see what was going on with him. If he had an alibi or something else going on.

And of course you know, robbery is not much of a motive in a case like this when you're dealing with a homeless person. Uh, but after the first 24 hours, they were coming up cold. Uh, so it went into the second day of their, you know, full court, press in terms of trying to figure things out.

And finally, that afternoon I got back in town. My mini was over and Was contacted by the police department. They told me what was going on what they had so far. And, uh, even went far to ask said, you know, we're not getting anywhere. Would you come by take a look at the body?

It's not been claimed yet and see if something jumps out at you, that might be of Aid. So I said certainly so, uh, late that afternoon, I went down and took a look at the body. Of course in the refrigeration cooler, at the More Union Hospital, we pulled him out, looked him over.

And what I could see, very readily was the fact that this guy had multiple bruises abrasions small lacerations about his face, he had black eyes Kind of a dark purple contusion all over the bridge of his nose where it looks like he's been wearing glasses and falling forward on those small laceration on his chin.

More contusions on his cheeks. Um, One of the things that really stood out was the Bachelor's thighs looked like they had second degree blistering Burns. And police were trying to speculate what could possibly explain this? And well, maybe somebody had a trash fire, a 55 gallon metal drum and it held him against that caused his legs to be burned.

So yeah, we had all kind of possibilities, but the one thing that jumped out at me as I'm looking at this body was a particular unusual finding that kind of made the case for us. This gentleman had around his left upper arm a circumferential bruise. Went all the way around the upper arm.

Was about four to five inches in height. Uh, but again all the way around you start thinking, okay, what kind of weapons or impact could cause a bruise to go around your upper arm? Uh, and of course, being a hospital pathologist as well as having done a general surgery internship earlier in my training, I'm familiar with weapons of this type.

And the weapon turned out to be a blood pressure cuff. I was like, okay, it was a perfect imprint of what you'd have from a blood pressure cuff being inflate on the arm. But as you know anybody who's ever had their blood pressure taken, you know that you know normally just getting your blood pressure taken does not leave bruising even though it feels like they're pumping it up real high.

There's no bruising. So there's got to be an explanation. Why did this one bruise? And have all these other similar injuries in terms of bruising elsewhere in the body. Is there something wrong with this guy's clotting factors? Well, fortunately, he'd been in the emergency room long enough before he expired that they had drawn blood and done, some blood testing on him.

And what we found out is when we looked at his chart in the blood testing parameters that his clotting factors were way out of line. Uh prolonged bleeding times. And so in a case like that, say okay that would explain why you've been exaggerated bruising after minor trauma. Uh, but the question becomes why?

And here's where I began to channel my inner four-year-old. Now four-year-old, if anybody's ever been around them, they like to ask, why, and you give them an answer and then they follow that out with why and they have all that up with whatever you have to with why? This point.

Okay, we've already had the first y answer, you know, why is this guy bruising on his upper arm with his plotting factors are off. But my question now is okay. Why are his clotting factors off? Now, there are certain medical conditions, one's called disseminated intravascular coagulation, which can follow severe infections.

Uh, can follow, you know, certain types of pregnancy, complications, things of that time. This guy clearly is not pregnant. If he'd been suffering from severe infection, you'd expect that he would have found signs of that. During the hospital autopsy, either his lungs would have had, you know, pus within them and indicating pneumonia.

You might have had meningitis under that type but nothing had been noticed. What's going on with this guy that he's in DIC? That he's bruising this way. So, the question now becomes We know why is bruising. But the question is, why is he in a DIC like status? Again, DIC for disseminated intravascular coagulation.

Go back to the chart again and this time I look at, we're looking for things and I find out that this guy's temperature. When they hit the emergency room, Almost 105 degrees. Now, 105° temperature is a very serious, medical emergency and most commonly. When you think of a high fever, again, you're thinking of some really severe unusual.

Infectious process Now, we'd already thought about that. In terms of maybe an infectious process, it triggered the DIC That's to be 105 degrees. We're thinking something really serious? Like, again, rip, roaring pneumonia or again, you know, meningitis with a layer of pus colored in the brain. A lot of things along those lines.

But again, when I look at the chart and look at the address report, These this Hospital pathologists have done the autopsy. Those are the sort of things they would notice. He wouldn't just you know be oblivious to it you know when you unroof the uh the skull to take the brain out for examination.

If there's meningitis, you're going to see pus covering the surface of the brain. If you take the lungs out of somebody that has advanced ammonia, the lungs are going to be extremely heavy, they're going to be very firm as opposed to the normal sponge-like consistency. When you cut across them, you're going to be exuding pus from the cut surfaces.

That had happened. So there has to be another explanation going on with this particular felon.

So again, as we scrutinize things, nothing else came to mind. There are certain conditions associated associated with very high temperatures, that the high temperature by itself, can trigger DIC Well, what else could cause a severely elevated temperature in the neighborhood of 105 degrees? Yeah, there can be, you know, abnormalities of the brain itself certain tumors can cause it on occasion Uh, but there's also certain medications.

Now, surgeons and anesthesiologists in the hospital, operating rooms are very familiar with this sort of phenomena because there's something called malignant hyperthermia. Are a very small percentage of patients in response to getting a general anesthetic, will suddenly Spike at temperature just again, 100 405 degrees, which is a true medical emergency.

And so every hospital that has an operating room will have a special crash cart with special drugs in it for addressing if you go into malignant hyperthermia and again that suddenly requires an immediate very extreme response. Just can't ignore. So, We looked in terms of that, but of course, this guy had not had general anesthetic, he'd been walking down an Alleyway on a spring morning after having done a little bit of light work.

As we look through his chart, we also found there was another drug that Sky was taking and the drug in question was something called melaril. Miller Royal, I don't know that it's used anymore, but back in the 70s 80s and even into the 90s was a front line type of drug use for psychosis.

Along with drugs like thorazine things of that type. Now they've since come out with better drugs, with fewer side effects, So it's not really used much but mellorelle can be associated with these sort of things and specifically the syndrome you have with this is called the neuroleptic malignant syndrome.

Neuroleptic malignant syndrome, basically is a unusual You know, somewhat rare complication to melaril. And it can occasionally be seen with other drugs, which will cause your temperature to suddenly Spike to these, you know? Incredibly high levels. So it finally all fit in place, this guy had been taking Milleryl long term because of his psychiatric issues.

And so, the sequence became obvious to us, He been taking melaril the melaril, in his particular case, it triggered, interleptic malignant syndrome that causes temperature to drop or jump. As his temperature. Got very high. He became confused disoriented sometimes can lead to all and out. Seizures like, you have a, feveral seizure and a child with a severe infection.

You know, basically your brain is slowly cooking for all intents and purposes, he passed out lost Consciousness and did a face plant in the alley. Because the high temperature also triggered the DIC, the coagulation abnormalities. Really not hit from that high surface just doing the face plant. Uh, he'd bruised.

Very readily and bled abundantly Uh, when they got into the emergency room and put the blood pressure cuff on his arm, and pumped that up that because of the abnormal clotting caused bruising down, his upper arm Turns out that would also explain why he had these burn-like marks on the backs of his thighs, purely a complication of the DIC and the elevated temperature, So when all this finally came together, I was able to tell the police department.

We do not have a homicide, we've got an unusual complication of a medical therapy. Uh, so stand down. Now. A lot of people think, well, gee, the cost must have been disappointed. I can assure you, they were not disappointed. As much as homicide detectives love their work and try to do the most thorough job they can from working with these guys for 30 plus years.

They would much rather not have to investigate a homicide with minimal leads. As they could put something to bed that says Not homicide, not Foul Play. Wait for the next case. And so in that case, we resolve this Very readily, but unfortunately, two days after the incident had happened, Uh, but it was a very valuable lesson and Yeah, very fascinating.

Sort of case that without understanding is some basic medicine and going back to the Chart and looking what the chart had to say. Yeah, we've still been looking for the uh, You know, the perpetrator in this homicide, whether it really never was a homicide