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RePLY TO ATTENTION OF

DEPARTMENT OF DEFENSE ARMED FORCES INSTITUTE OF PATHOLOGY

WASHINGTON DC 2030lHiOOO

October 12, 2010

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Office of the Armed Forces Medical Examiner

Mr. Jerry G. Bachus 3211 Faycrest Road Columbus, OH 43232

Dear Mr. Bachus:

As requested, enclosed within this sealed envelope is a complete copy of the Amended Autopsy Report Protocol and Psychological Autopsy Report in the case of your late son, GYSGT Christopher S. Bachus, SSN 281

I must emphasize that the information contained within this report is graphically described to ensure complete accuracy of the physical details of your son's remains. I strongly recommend that you read this report in the presence of people that can provide you with emotional support during this time such as your minister, family friend, or a counselor.

I realize that there is a possibility that some of the terminology used therein may be unfamiliar to you. If you have questions regarding any portion of the report provided, please do not hesitate to call me at (301) _ or fax at (301) _ _ . You also contact me via e-mail at the following address:

If you need any further assistance, please do not hesitate to contact me.

Sincerely,

~ C.T. Mallak Captain, Medical Corps United States Navy Armed Forces Medical Examiner

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ARMED FORCES INSTITUTE OF PATHOLOGY Office of the Armed Forces Medical Examiner

1413 Research Blvd., Bldg. 102 Rockville. MD 20850

301-319-0000

AMENDED'" AUTOPSY EXAMINATION REPORT

Name: Bach .• uis., Cih.ristoPher Scott SSAN: 281. Date of Birth: 5 OCT 1969 Date of Death: 10 MAR 2008 Date and time of Autopsy: II MAR 200811 000

Date of amended Report: 06 OCT 20 I 0

Autopsy No.: ME 08-0173 AflP No.: 3087690 Rank: GYSGT Place of Death: Jacksonville, NC, Place of Autopsy: Camp Lejeune, NC

CIrcumstances of Death: Gunnery Sergeant Bachus was found dead in his quarters at Camp Geiger. Multiple medication containers were found on his dresser by investigators. There was no evidence of foul play.

Authorb:ation for Autopsy: Office ofth. Armed Forces Medical Examiner, lAW louse 1471

Identification: positive identification is established by dental comparison

CAUSE OF DEATH: MULTI-DRUG TOXICITY

MANNER OF DEATH: ACCIDENT

"'Reason for the amendment: Based on additional information from the Naval Criminal Investigative Service (NCIS) and the opinion rendered in a psychological autopsy by CDR Rosemary Malone, the manner of death is reclassified as accident.

FOR OFFICIAL USE ONLY nnd mny be ex(mpt rrom mandatory di$4;:losure under FOIA. DoD S40!).7R. "DoD Frecdcm of In(onnJUioll Aet Propm .... DoD Directive 5230.9. ·'ClearlW«." of DoD InfclrmaliQn ror Public R.cl~", and DoD InsuuCllon 5230,29. "Sc=curhy and Policy Review orOtlD Infonnation for lJublic:: R.ch:qsc" apply.

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AMENDED AUTOPSY REPORT ME08-0173 BACHUS, Christopher Scott

EXTERNAL EXAMINATION

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The body, clothed in black boxer shorts, is that of a well-developed, adequately nourished 72 inch tall, 180 pounds male whose appearance is consistent with the reported age of 38 years. Lividity is anterior except over areas of compression, rigor has resolved, and the body temperature has equilibrated to that of the refrigeration unit.

The scalp is covered with brown hair distributed in the usual male pattern. The corneas are opacified, the underlying irides are blue, and the pupils are round and equal in diameter. The sclerae are injected. The external auditory canals, external nares and oral cavity are free of foreign material and abnormal secretions. The nasal skeleton and maxilla are palpably intact. There is mild asymmetry of the nares. The lips and frenula arc without evidence of injury. The teeth are natural and in good condition. The neck is straight, and the trachea is midline and mobile. There is no evidence of injury.

The chest is unremarkable. No evidence of injury of the ribs Or the sternum is evident externally. The nbdomen is slightly protuberant. The external genitalia are those of a normal circumcised adult male. A tattoo is present on the left upper chest. The posterior torso and anus are unremarkable.

The nail beds of the hands are cyanotic. The fingernails are intact. There are tattoos over both arms and both forearms. There is a tattoo at the base of the left thumb. There is a tattoo encircling the base of the left 41h finger.

EVIDENCE OF IN.I!IRV

There is no evidence of recent trauma.

CLOTHING AND PERSONAL EFFECTS

The following clothing items and personal effects are present on the body at the time of autopsy:

• black boxer type shorts

RADIOGRAPHS

A complete set of postmortem radiographs is obtained: • no radio-opaque foreign bodies, projectiles or projectile fragments • no fractures • no other radiographically identifiable evidence of trauma or natural disease

MEDICAL INTERVENTION

Signs of medical intervention are not evident at the time of post-mortem examination.

INTERNAL EXAMINATION HEAD There is no evidence of significant recent injury: the galeal and subgaleal soft tissues of the scalp are free of injury. There are no skull fractures. The dura mater and falx cerebri are intact. There is no epidural or subdural hemorrhage present. The cerebral hemispheres are symmetric.

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INTERNAL EXAMINATION HEAD (oont.) Clear cerebrospinal fluid surrounds the brain which has unremarkable gyri and sulci. The cranial nerves spinal cord and atlanto-occipital joint are unremarkable. The brain weighs 1210 grams prior to fixation. The brain has unremarkable gyri and sulci. Coronal sections through the cerebral hemispheres reveal no lesions. Transverse sections through the brain stem and cerebellum are unremarkable. The atlanto-occipital joint is stable.

NECK The anterior strap muscles of the neck arc homogenous and red-brown, without hemorrhage. The thyroid cartilage and hyoid bone are intact. The larynx is lined by intact white mucosa; there is no evidence of foreign body. The thyroid is symmetric and red-brown, without cystic or nodular change. The tongue is intact, without bite marks. The subcutaneous tissue, muscles, ligaments and cervical spine elements of the posterior neck are without hemorrhage or other evidence of trauma.

BODY CAVITIES The ribs sternum and vertebral bodies are visibly and palpably intact. No adhesions or abnormal collections of fluid are present in any of the body cavities. All organs are present in the usual anatomic location.

RESPIRATORY SYSTEM The tracheo-bronchial tree is unremarkable, without obstruction, focal lesion or evidence ofinjury. The lungs are markedly edematous: the right lung weighs 900 grams; the left lung weighs 800 grams. The pleural surfaces are deep red purple. The cut parenchymal surfaces of the lungs are deep purple, and exude blood and frothy fluid. There are no focal lesions. The pulmonary arteries are normally developed, patent and without thrombus or embolus.

CARDIOVASCULAR SYSTEM The pericardial sac is intact. The heart weighs 5 I 0 grams prior to fixation. The epicardial surface is smooth with a generous investment of adipose tissue. The coronary arteries are present in a normal distribution. Cross section of the vessels discl9ses a stenosing atheromatous lesion of the left anterior descending coronary artery (resulting in approximately 35% reduction of the native luminal diameter) at a point 2 em from bifurcation from the left main coronary artery. The myocardium is homogenous, redbrown, and firm without evidence of focal lesion or injury. The left ventricular thickness is 1.4 cm; the interventricular septum thickness is 1.6 cm and the right ventricular thickness is 0.4 em. The valve leaflets are thin and mohile. The endocardium is redbrown and without evidence of focal lesion or injury. The aorta arises and is distributed in the usual pattern. The aorta is unremarkable. and gives rise to three intact and patent arch vessels. The renal and mesenteric vessels are unremarkable.


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LIVER & BILIARY SYSTEM

INTERNAL EXAMINATION (cont.)

The 1800 gram liver has an intact smooth capsule covering dark red-brown, moderately congested brown to tan parenchyma. No mass lesions or other abnormalities are seen. The gallbladder contains a small amount of green-black bile; there are no stones. The mucosal surface is green and velvcty. The extra hepatic biliary tree is patent.

SPLEEN The 170 gram spleen has a smooth, intact capsule covering red-purple, moderately firm parenchyma; the lymphoid follicles nrc unremarkable.

PANCREAS The pancreas is firm and yellow-tan, with the usual lobular architecture. There is no focal lesion or evidence of injury.

ADRENALS The adrenals Ihemselves nrc intact and symmetric, with bright yellow cortices and grey medullae.

GENITOURINARY SYSTEM The kidneys weigh 210 grams each (combined weight: 420 grams). The renal capsules are smooth and thin. semi-transparent and stripped with ease from the underlying smooth, red-brown cortical surface. The cortex is sharply delineated from the medullary pyramids, which are red-purple and unremarkable. The calyces, pelves and ureters are unremarkable. White bladder mucosa overlies an intact bladder wall. The bladder contains approximately 30 cc of yellow urine. The testes, prostate gland and seminal vesicle are unremarkable.

GASTROINTESTINAL TRACT The esophagus is intact and lined by smooth, grey-white mucosa. The stomach contains approximately 50 cc orthin, gray fluid. Distinct pill fragments are not identified. The gastric wall is intact. The duodenum. small bowel and proximal colon are intact and unremarkable. The appendix is present.

MUSCULOSKELETAL SYSTEM Muscle development is normal. There is no evidence of trauma. There is no evidence of acquired or congenital bone or joint abnormalities.


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AMENDED AUTOPSY REPORT MEOS-0!73 BACHUS, Christopher Scott

ADDITIONAL PROCEDURES/REMARKS

• Documentary photographs are taken by the NHCL staff medical photographer • Specimens retained for special studies including DNA identification are: vitreous

fluid, blood, bile, urine, gastric contents, and tissue from heart, brain, lung, liver, spleen, adipose tissue and skeletal muscle (psoas)

• Full body radiographs are obtained with the findings described above • Heart and brain are retained for examination after fixation • Minute portions of selected organs are retained in formalin should additional

special studies prove necessary; the remaining dissected organs except as noted are forwarded with body at the conclusion of the post-mortem examination

• Personal effects are released to the appropriate mortuary operations representatives.

AUTOPSY DIAGNOSES I. Findings A. Cardiovascular system

I. cardiomegaly 510 grams (maximum expected: 500 grams) 2. atherosclerotic coronary arterial disease of the left anterior descending

coronary artery (approximately 35 % stenosis) B. Respiratory system

I. pulmonary edema (right lung weight: 900 grams: left lung weight: 800 grams

2. no focal Or mass lesion identified C. Toxicology (see section VI below)

II. Clinical History of panic attacks and chemical dependence

Ill. Medical Intervention as noted

IV. Po.t-mortem Changes A. Resolved rigor B. Fixed posterior !ivor

V. Identifying marks A. Irregularly shaped, well healed scars (2), scalp B. Right upper chest C Tattoo, right arm D. Tattoo, right forearm E. Tattoo, left arm F. Tattoo, left forearm G. Tattoo, base of the left thumb H. Tattoo, base of the left 4111 finger


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VI. Toxicology Results A. Volatiles (blood and urine); no ethanol detected

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B. The urine was screened for acetaminophen, amphetamine, antidepressants, antihistamines, barbiturates, benzodiazepines, cannabinoids, chloroquine, cocaine. de)Ctromethorphan, lidocaine, narcotic analgesics, opiates, phencyclidine, phenothiazines, salicylates, sympathomimetic amines and verapamil by gas chromatography, color test or immunoassay. The following drugs were detected: I. Positive acetaminophen: acetaminophen was detected in the urine by

immunoassay and confirmed by color test. The blood contained 18 mg/L of acetaminophen as quantitated by immunoassay

2. Positive benzodiazepine; lorazepam was detected in the urine by immunoassay and confirmed by gas chromatography/mass spectrometry. The blood contained 0.032 mg/L of lorazepam as quantitated by gas chromatography/mass spectrometry.

3. Positive opiate; oxycodone was detected in the urine by gas chromatography and confirmed by gas chromatography/mass spectrometry. The blood contained 0.22 mg/L of oxycodone as quantitated by gas chromatography/mass spectrometry.

4. Positive opiate; oxymorphonc was detected in the urine by immunoassay and confirmed by gas chromatography/mass spectrometry. No oxymorphone was detected in the blood at a limit of quantitation of 0.05 mg/1. using gas chromatography/mass spectroscopy

5. Positive antidepressant; nortriptyline was detected in the urine by gas chromatography and confirmed by gas chromatography/mass spectrometry. The blood contained 0.51 mg/L of nortriptyline as quantitated by gas chromatography/mass spectrometry.

6. Positive antidepressant: citalopram was detected in the urine by gas chromatography and confirmed by gas chromatography/mass spectrometry. The blood contained 0.43 mg/L of citalopram as quantitated by gas chromatography/mass spectroscopy.

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OPINION

An nutopsy performed on Gunnery Sergeant Bachus found no evidence of recent trauma. There were no findings acutely attributable to an infectious agent. Radiologic studies were non-contributory.

Acute changes consisted of facial suffusion and scleral injection (most likely due to positioning ofthe body in the prone position peri- and post-mortem) and edema of the lungs.

Chronic processes include cardiomegaly

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Review of available medical records indicates that Gunnery Sergeant Bachus was admitted on two occasions for chemical dependettce. but that he had responded well to treatment.

Toxicologic analysis determined that acetaminophen was present in the blood at a concentration of 18 mg/L; lorazepam was present in the blood at level of 0.032 mg/l; oxycodone was present in the blood at level of 0.22 mg/I; nortriptyline was present in the blood at a level of O.S I mg/L and citaloprnm was present in the blood at a level of 0.43 mg/L. Oxymorphone was detected in the urine by immunoassay and confirmed by gas chromatography/mass spectrometry, but was not detected in the blood.

The cause of death is multi-drug toxicity in the setting of cardiomegaly with atherosclerotic coronary arterial disease.

Based on the additional information provided by NCIS and the forensic psychiatrist, the amended manner of death is now best classified as Accident.

T. Mallak ,MC, USN

A cd Forces Medical Examiner

tep n . Robinson CA ,MC, USN Chief Deputy Medical Examiner


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TO;

REft.YTO ,A.TTINTION OF

AFIP-CME-T

DEPARTMENT OF DEFENSE ARMO;:O FORCES INSTITUTE OF PATHOLOGY

WASHINGTON. DC 2030 .... 000

PATIENT IDENTIFICATION AFIP Acee.ssions Number Sequence

3087690 00

Name OFFICE OF THE ARMED FORCES MEDICAL EXAMINER

BACHUS. CHRISTOPHER SCOTT

ARMED FORCES INSTITUTE OF PATHOLOGY WASHINGTON. DC 20306-6000

SSAN: 281 Autopsy: ME08-0173 ToxlooloeY AC<e55ioD #: 081553 Date Report Generated: March 24, 2008

CONSULTATION REPORT ON CONTRIBUTOR MATERIAL

AFIP DIAGNOSIS REPORT OF TOXICOLOGICAL EXAMINATION

Condition of Specimens: GOOD Date of Incident: 3/10/2008 Date Received: 3/19/2008

VOLATILES; The BLOOD AND URINE were examined for the presence of ethanol at a cutoff of20 mgldL. No ethanol was detected.

DRUGS: The URINE was screened for acetaminophen, amphetamine, antidepressants, antihistamines, barbiturates, benzodiazepines, cannabinoids, chloroquine, cocaine, dextromethorphan, lidocaine, narcotic analgesics, opiates, phencyclidine, phenothiazines, salicylates, sympathomimetic amines and verapamil by gas chromatography, color test or immunoassay. The foJlowing drugs were detected:

Positive Acetaminophen: Acetaminophen was detected in the urine by immunoassay and confirmed by color test. The blood contained 18 mgIL of acetaminophen as quantitated by immunoassay.

Positive Benzodiazepine: Lorazepam was detected in the urine by immunoassay and confinned by gas chromatography/mass spectrometry. The blood contained 0.032 mglL of lorazepam as quantitated by gas chromatography/mass spectrometry.

Positive Opiate: Oxycodone was detected in the urine by gas chromatography and confirmed by gas chromatography/mass spectrometry. The blood contained 0.22 mg,tL of oxycodone as quantitated by gas chromatography/mass spectrometry.

This document contains in/ormation EXEMPT FROM MANDATORY DISCLOSURE under the FREEDOM OF INFORMATION ACT Exemption No. 6c.dApplies


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RIr.PLYTt) ATl'tN'fION Of

DEPARTMENT OF DEFENSE ARMED FORCES INSTITUTE OF PATHOLOGY

WASHINGTON, DC 20306-6000

REPORT OF TOXICOLOGICAL EXAMINATION (CONT - 081553. BACHUS. CHRISTOPHER scorn:

Positive Opiate: Oxymorphone was detected in the urine by gas chromatography/mass spectrometry. No oxymorphone was detected in the blood at a limit of quantitation of 0.05 mgIL using gas chromatography/mass spectrometry.

Positive Antidepressant: Nortriptyline was detected in the urine by gas chromatography and confinned by gas chromatography/mass spectrometry. The blood contained 0.51 mglL of nortriptyline as quantitated by gas chromatography/mass spectrometry.

Positive Antidepressant: Citalopram was detected in the urine by gas chromatography and confinned by gas chromatography/mass spectrometry. The blood contained 0.43 mgIL of citalopram as quantitated by gas chromatography/mass spectrometry.

~ yo_-'BARR~,P~ Director, Forensic Toxicology Laboratory Office of the Anced Forces Medical Examiner

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ARMED FORCES INS'ITI'VTE OF l'ATIIOLOGY Office of the Armed Forces iVledkalExlimillcr

1413. R~s~archB()ulevard, Building 102 Rockville. MD 20850

1-301·3.1 9-0()()()

Psychological Autopsy

Nmnc: Bachus, Christopher Scott Ibtc ol'Hirth: 05 ()Cr 1969 nale of DC:I!h: 10 MAR 2008 SSAN: 281 __ Rank: E-? GYSGT USMC lllltcuf Autopsy: 11 MAR 2008 I'becof Alltopsy: Camp Lejellne, NC D;ltc of Rl'florl: 30 APR 20JO

Sex: Male Ra'cc:' Caucasian M.lrihIIStatus: M,UTkd AElI' Numhel':. 3087690 i\U(O[ISy NlImber: ME 08-0173 I'[,.ce of DeMit:. JacbL1I1viile,. NC l)ate"rAu(opsy Report: 02 JUN 2008

1. SOURCE OF AND REASON.FORREQUEST:

This rcvjcWwas(C(lllcstedby Timothy D.l'vjonaglmn, tv'll), CDR, Me (FS), t!SN, Deputy Medical Examiner, Ofl1cc ofthc . .'\fmcd Forces l.,lcdical E:«lnlillcr (ClAFME), Armed Forces Institute OfPmholo£y (1\ 1"11'). to:\ssistin lhcdelerminmion of manner ,,(death ilnhe case of GYSGr Christopher Scott Ilaehus, after the Unit¢d Slate" haval Cl'im;'1(11 Investigative Service (NelS) discovered evidence suggestive nfsuidde. The deceased W,IS a 39 year-old, married white, .Iualc. active duty Marine "'ho was as,igned to the 5'hBn, 10"' Mar; 2dMar Div. Camp Lejeune. Nonh.Carolina.

2.IJISCLAIMlm:

Thisreporl represents the opinion of the .psychiatric cyaluutorsbased Oil their prol.cssiOlJal ,,"pcl·iell<.:c <1mlthc informatiOn source" enumerated belO\\'. The conclusion,; arc subject to change if ,,,liliti(\nnlitlf(mnmionbecomcs (lvailablc.

The individu,'1 intt:rvi.cwcd WaS inforHled of the purpo~e andnon-cnnf1dential nature of the evnilmlinn. She was .udviscd that her porticipation WaS .entirely v6luntmy, and that a written report would hcprcparcd for thc/\.rmcdForccs Medical E"aminer and NCIS. She agreedto participate.

FOI(OFFICIA L USE ON!. Y "",IIll!l)' bcoxempl.li'(,m ii1olldatory disclosure u"dc" FOIA. D"D 5,I()O.7R. "DoD Free-don.' ('.If 11l1.(,mn:ni.tIJl Act progralil. ", DoD'Directlv,e· 5:n,O:·9, -'Clcaram;,.; u(D()D Itlf~wlnilti(jn fi'.ll" Public Release;" ilnd"J.)~)r.llnstnlction ':5230:29. ··SecurilY and Po.Jicy ,R~vic\\' of DuD 11IJ(:)nJlation fbr Public. ,({clcm;'c," "PpJ),.

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Psychological Autopsy: BACHUS, Christopher Scott

3. SOURCES OF INFORMATION:

a. Final Autopsy Report dated 02 JUN 2008 and signed by Timothy D. Monaghan CDR, MC, USN;

b. AFIP OAFME Toxicology Report Examination dated 24 MAR 2008 and signed by Barry Levine, PhD, DABFT, Director, Forensic Toxicology Laboratory;

c. North Carolina Department of Health and Human Services, Medical Examiner's Certificate of Death, dated 10 MARCH 2008, signed by Timothy D. Monaghan, MD, CDR, MC, USN;

d. Military Medical Records: Written medical record notes from 18 MA Y 1991 and AHLTA notes from 25 OCT 2005 - 04 MAR 2008;

e. Admission note from inpatient admission to the Behavioral Health Services at CarsonTahoe Hospital, dated 04 NOV 2003;

f. Interviews with Mrs. Angela Bachus, deceased's second wife, 40 minutes, dated 30 OCT 2009, and 40 minutes dated 23 NOV 2009;

g. United States Naval Criminal Investigative Service, results ofinterview with Angela Bachus dated 17 JUN 2008;

h. Casualty Status Report for Christopher Scott Bachus, dated 13 JUL 2009; i. Supplemental Report of Cause of Death, North Carolina Department of Health and Human

Services State Center for Health Statistics - N.C. Vital Records, ICO Christopher Scott Bachus, dated 05 FEB 2009, signed by Timothy Monaghan, MD;

j. Report of Toxicological Examination, Armed Forces Institute of Pathology, Dated 24 MAR 2008;

k. DCIPS Biographical, Military, Incident, and Next of Kin Data fOr Christopher Scott Bachus;

I. Armed Forces Institute of Pathology, Report of Laboratory Examination, DNA analysis, AFDIL case number 200SM0269, ME case number ME08-0173, dated 23 JAN 2009

m. NCIS Report of query with local Jacksonville, North Carolina Pharmacies, dated 15 MAY 2009;

n. List of prescriptions that NCIS retrieved from Christopher Scott Bachus's death scene and vehicle, not dated or signed.

o. NCIS Investigative report and associated documents.

SOURCES OF INFORMATION NOT AVAILABLE:

LCDR Weis contacted SGT Bachus's Psychotherapist, Mr. Ed Ball, LCSW, and Psychiatrist, Ashraf Mikhail, MD, multiple times to obtain their provider notes. This information was not provided prior to the completion of this report due to Cited confidentiality concerns by these providers as well as their request for a court order to release the information.

Occupational information was also unavailable for review prior to the completion of the report.

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PsychOlogical Autopsy: BACHUS, Christopher Seott

4. DETAILS OF DEATH:

Date and Time 10 MAR 2008, Time unknown.

Location: Base quarters at Camp Geiger, Jacksonville, North Carolina.

Synopsis GYSGT Scott Bachus was a seventeen-year veteran of the United States Marine Corps, who struggled with mental illness since his first deployment to Iraq in 2003. Upon his return from Iraq, he began to experience anxiety symptoms consistent with Posttraumatic Stress Disorder (PTSD), along with survivor's guilt, which was documented in his admission note from the Behavioral Health Services at Carson-Tahoe Hospital in Carson City, Nevada. This is where he was first hospitalized in 2003 due to worsening anxiety symptoms and concomitant abuse of alcohol. Subsequent to this hospitalization, he received ongoing mental health care but ultimately required two additional inpatient psychiatric hospitalizations and two inpatient hospitalizations for substance abuse, which all occurred in 2005. Per Mrs. Angela Bachus's account, GYSGT Bachus's personality changed from being carefree to being constantly irritable and on edge. Additionally, she reported that he had difficulty sleeping, experienced frequent panic attacks, was hypervigilant, and experienced some flashbacks, one of which ultimately led to a second hospitalization in 2005.

Per review of GYSGT Bachus's medical and psychiatric clinic notes, he appeared to have had a period of relative stability from late 2005 until early 2007 when taking the following psychotropic medications: c10nazepam (Klonopin®), citalopram (Celexa®), and risperidone (Risperdal®). In January 2006, GYSGT Bachus, consulted with the General Medical Officer (GMO) of his unit, L T Zachary Brown, who decided to discontinue his medications. However, he was able to remain off his medications for only 6 months (January 2006 until July 2006), at which time he returned to the GMO requesting to be placed on medications again. He was prescribed citalopram, trazodone (Desyrel®), and quetiapine (Seroquel®) due to continued anxiety symptoms. In November 2006, GYSGT Bachus's condition got worse and his new QMO, LT Bradley Deafenbaugh, referred him to Division Psychiatry for "worsening depression and anxiety." The following day, the Division Psychiatrist, L T Evan Altman, discontinued GYSGT Bachus's quetiapine and added c10nazepam for treatment of his anxiety symptoms. LT Altman also opined that GYSGT Bachus was "fit for duty." Shortly afterward, the Division Psychologist, Dr. B. M. Hershey, also opined that GYSGT Bachus was "fit for Duty." GYSGT Bachus had reported to his GMO in December of 2006 that, on occasion, he had doubled his prescribed dose of c1onazepam. No other notes reviewed suggested that he continued to misuse his medications.

However, GYSGT Bachus was seen by Division Psychiatrist, LCDR David Moulton, on 12 JAN 2007, who documented in his medical notes concerns regarding GYSGT Bachus's ability to function on deployment as the NCOIC due to his psychiatric problems and his current anxiety symptoms requiring clonazepam for treatment. Dr. Moulton voiced his concerns to GYSGT Bachus's GMO and tapered him off of c10nazepam and replaced it with risperidone (Risperdal®). It was also noted in the chart by LCDR Moulton that GYSGT Bachus was

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Psyobologloal Autopsy: BACHUS, Chrislophor Soott

4. DETAILS OF DEATH (cont.):

"disheartened" after hearing Dr. Moulton's recommendations of not deploying. There were no further entries into GYSGT Bachus's chart noting any mention of LCDR Moulton's concerns.

GYSGT Bachus was ultimately allowed to deploy with his unit to Iraq in 2007. However, after seeking a refill on his medications while deployed, it was discovered that he was on multiple psychotropic medications including cIonazepam, which made him ineligible to be deployed in the first place. A decision was made to return him back to Camp Lejeune where he could receive further care and disposition. Mrs. Bachus had learned that his early redeployment from Iraq was not only because of his medications but also as a result of his behavior while in Iraq. However, she was not able to elaborate on any specific behaviors that he may have been exhibiting. Per review of the available records, GYSGT Bachus made it known that he was not in agreement with the decision for him to redeploy back to Camp Lejeune and that he was upset by the decision.

Immediately upon GYSGT Bachus's return to Camp Lejeune, he strove hard to regain deployable status. Per review of his records, he deeply believed he needed to be back with his unit and had become increasingly more depressed upon his return. He reported frustration with not being with his unit and exhibited depressive symptoms consisting of depressed mood, loss of interest, feelings of guilt, decreased appetite, reduced energy, and poor concentration. Additionally, he continued to experience anxiety symptoms, requiring continued treatment with citalopram, clonazepam and lorazepam (Ativan®).

In September 2007, LCDR Jeffery Litzinger, Division Psychiatrist, had taken him offoflimited duty status and placed him back in a deployable status after making numerous medication adjustments and observing him for a period of monitoring. However, it was later decided by LCDR Chad Bradford, the new Division Psychiatrist, that GYSGT Bachus was not well enough to deploy and instead discussed with GYSGT Bachus the option of working in an administrative position until his retirement in four years or undergoing a Medical Evaluation Board (MEB). GYSGT Bachus responded "I know myself, and I cannot see myself sitting behind a desk for the next four years until retirement." He noted to Michael Cooney, PhD, Clinical Psychologist at the Naval Hospital, that he had little tolerance for "Marines who were whiners and complainers," and that he would "go crazy" if he had to do administrative work in the future. Therefore, GYSGT Bachus decided he would go forward with the MEB after consulting with LCDR Bradford.

Over the next five months, until his death in March of2008, GYSGT Bachus became increasingly more anxious and depressed as he awaited the MEB, which was placed on hold pending a full Traumatic Brain Injury (TBI) work-up secondary to his reported exposure to lED blasts in 2003. GYSGT Bachus's continued distress and frustration were evident because he required continued modifications to his medication regimen and frequently reported to his providers and case manager about his frustration with all the appointments required for the MES. GYSGT Bachus expressed embarrassment and shame over his need for an MEB secondary to PTSD and his inability to function as a Marine at his previous performance level. This

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is supported by statements made on 20 Feb 2008 to his case manager Mrs. Shirley Ackermann when he informed her that he recently received a phone call from a friend's wife inviting him to his friend's retirement ceremony. GYSGT Bachus stated that he decided not to attend the ceremony, since he could not "face" his friend at this time due to his pending MEB.

Additionally, he noted that over the weekend since receiving the call that he became more distraught and had a "bad weekend." He noted that he debated as to whether he should have gone to the ER, but ultimately decided not to and cited that his "faith had gotten him through the weekend."

Per review of the NCIS investigation report and its associated documents, GYSGT Bachus become interested in religion and faith during the months preceding his death. Included in the NCIS report were photocopied pages from OYSOT Bachus's personal journal and Bible study notes as well as numerous pages of faith based propaganda printed from the internet. The content of the Bible study notes and propaganda appeared to center on using faith to strengthen his life. Mrs. Bachus noted on interview that her husband had been attending Bible study in the months prior to his death and did not suspect anything out of the ordinary.

In addition, OYSOT Bachus's journal entries dated from early January 2008 until the end of January 2008, suggest he was increasingly suspicious of his wife. Her concerns were centered on his increased use of lorazepam (Ativan®) and his increased attention to his faith, which led her to believe he was "addicted" to Bible Studies. Additionally, the tone oflhe entries has a guilt theme throughout.

OYSOT Bachus's distress continued to increase and peaked during the weeks leading up to his death on 07 MAR 2008. Multiple events occurred including the return of his unit from one-year deployment to Iraq, which he stated upset him since he could not face them. OYSGT Bachus also received results from psychological tests done as part of his treatment and evaluation for TBI. According to Mrs. Bachus, the results upset him greatly since it was noted he had achieved a "low IQ score." Additionally, on the Monday prior to his death, Dr. Mikhail adjusted his medications and initiated opiate therapy for his back pain.

During the week preceding his death, OYSGT Bachus was seen on 03 MAR 2008 at the Naval Hospital Mental Health Clinic for two appointments, one with Sue Graves, PhD, Clinical Psychologist, and the other with LCOR Jacob Friesen, Psychiatrist, along with Mrs. Ackermann. He told them that he felt like people were "jerking him around" and that no one was taking him seriously or giving him respect. Additionally, he noted his biggest issues were that he "didn't feel he was who he used to be and could no longer do what he used to." He stated that he did not feel comfortable around members of his unit because of his shame and embarrassment over having to return early from deployment. However, per review of the clinical notes, GYSGT Bachus was not at risk of hanning himself or others and appeared to have calmed down enough to be allowed to leave and follow up the next morning.

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4. DETAILS OF DEATH (cant.);

On 04MAR08, GYSGT Bachus followed up with Dr. Friesen and Mrs. Ackerman and noted he had gone to the ER the previous night for pain management issues for his back, but according to Dr. Friesen's notes, left the ER because he felt "challenged in trusting a new provider." He informed Mrs. Ackerman that he was "very down and tearful," and was on the "verge of breaking." He noted that he felt there was too much on his plate with the MEB and the TBl work-up, as well as his unit returning and his feelings of embarrassment and reluctance to see them. The medical records did note that he was looking into taking convalescence leave so he could return to be with his wife who was living in Ohio awaiting his return once discharged from the Marine Corps. Per Dr. Friesen's note on 04MAR08, GYSGT Bachus appeared to reconstitute himself during their intemction and they had agreed to meet the following week, at which time Dr. Friesen would dictate his MEB.

Per NClS documentation of Mrs. Bachus's interview, which was corroborated on personal interview, she reported that her husband had a "very rough" week prior to his death. She noted that he was "short tempered" and "very moody." GYSGT Bachus told her repeatedly that his "back was killing him," but the physicians could nol find anything wrong. He told her that he "was falling apart. She said that GYSGT Bachus had seen his treating psychiatrist, Dr. Mikhail, on the Monday prior to his death and he "changed all of his medications." He also prescribed some pain medication to help with his conslant back pain. GYSGT Bachus told his wife that he was also not able to sleep and that his "zolpidem (Ambien®) was no longer working for him, but he didn't want to "mess with his medications since they had just changed everything." GYSGT said, "I don't want to not wake up in the morning."

Mrs. Bachus said that on the morning of the last day lhat the two spoke, GYSGT Bachus had called her asking her to fly down from Ohio. She staled that unfortunately she was not able to fly down as a result ofa blizzard that closed the local airports. GYSGT Bachus told Mrs. Bachus that he did not fecI righl and that he was having a hard time distinguishing between what was real and what was not, also adding that he felt paranoid and thought he was imagining things. She said that he contemplated checking himself into the Camp Lejeune Psychiatric Ward because he knew something was wrong, and he felt like no one would listen to him. However, he was concerned that they would take away his Copenhagen and cigarettes, which kept him from self-referring for admission.

She stated that they spoke later during the day and that he was still considering going to the Naval Hospital to check into the inpatient unit sometime during the weekend because he was feeling more anxious and depressed. She added they talked for a while and that he was tired and wanted to go to bed. She further added that she suggested to him that he could call her ifhe could not fall asleep. He responded "You know babe, I am really tired and I don't think 1'1\ have any problems falling asleep tonight." She said he had wished her luck in battling the snow and he intended to call her the following morning.


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Ml"S. Bachus became somewhat concerned the following day after not hearing from him. She assumed he had gone to the hospital and was not able to contact her but would call as soon as he could

GYSGT Bachus was discovered unresponsive at his assigned on-base quarters by a command representative after he failed to report to work the following Monday. He was last known to be alive on 07MAR08. There was no evidence of foul play. He was found lying prone on his bed in a pair of black boxer shorts. There was no suicide note found at the scene. GYSSGT Bachus was sutTering from numerous medical and psychiatric conditions including chronic back pain, PTSD, depressive symptoms, and Alcohol Dependence at the time of his death. The cause of death was determined to be multi-drug toxicity per the autopsy conducted on II MAROS.

Notes. Videos. Other Recordings: None were found.

5. PHYSICAL AUTOPSY REPORT:

Autopsy Results

Evidence of Injuryffrauma There was no evidence of injury or recent trauma.

Diagnoses Cardiomegaly (510 grams (g), maximum expected 500 g); Atherosclerotic coronary arterial disease of the left anterior descending coronary

artery (approximately 35 % stenosis); Pulmonary edema (right lung weight: 900 grams; left lung weight: 800 grams);

No focal or mass lesion identified.

Cause of Death Multi-Drug Toxicity

Manner of Death Undetermined

Toxicology Results

GYGST Bachus had numerous substances detected in his urine, including lorazepam; two different opiates, oxycodone and oxymorphone; one non- steroidal pain medication acetaminophen (f ylenol®); and two antidepressants, nortriptyline (Pamelor @) and citalopram. Oxymorphone was not found in his blood. According to both blood and urine analyses, there was no ethanol detected.


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6. PHYSICAL EVIDENCE: The following prescription bottles were found at the scene:

I. Topiramate (Topramax@), 25 mg, original fiIl20FEBOS, 97/120 tablets; 2. lnderal LA (Propranolol ER@) 60 mg, original fill 07MAR08, 27/30 capsules; 3. lnderal LA 60mg, original fill OSMAR08, 30/30 capsules; 4. Oxycodonel APAP (Vicodin®), 5-32Smg, original fill 05MAROS, 56/90 tablets; 5. Mctaxalone (Skelaxin®), 800 mg, original fill 05MAROS, 89/90 tablets; 6. Ziprasidone (Geodon®),40 mg, original fill 20 FEB08, 60/60 capsules; 7. Ziprasidone 40 milligrams (mg), original fiIl20FEBOS, 35/60 capsules: S. Naproxen 500 mg, original fill 03DEC07, 13/60 tablets; 9. Zolpidem, 10 mg, original fill 05MAR08, 55/60 tablets; 10. Propranolol ER® 60 mg, original fill 03FEB08, 3/30 capsules; II. EscitaIopram (Lexapro®) 20 mg, original fill 07MAR08, 61/60 tablets; 12. Naproxen (Naprosyn®) 500 mg, original fill 030EC07, 66160 tables; 13. CarbidopalLevodopa (Sinemet@) 10-100 mg, original fill 28FEBOS, 53/90 tablets; 14. Zolpidem 10 mg, original fill 03FEBOS, 0/60 tablets; IS. Exzopiclone (Lunesta®) 2 mg, original fill 0 I FEBOS, 30/30 tablets; 16. Nortriptyline 25 mg, original fill OIFEB09, 5/60 tablets; 17. Escitalprarn 20 mg, original fill 03FEBOS, 0/60 tablets; 18. Divalproex sodium (Oepakote ER@) 500 mg, original fill OSOEC07, 11120 tablets; 19. Divalproex sodium 250 mg, original fi11l2DEC07, 152/150 tablets; 20. Divalproex sodium 250 mg, refill 0 I FEBOS, 154/150 tabltes; 21. Divalproex sodium 500 mg, original fill 05MAR08, 120/120 tablets; 22. Lorazepam 1 mg, original fill 120EC07, 01120 tablets; 23. Lorazepam 2 mg, original fill 03FEBOS, 0/120 tablets; 24. Lorazepam I mg, original fill 29FEBOS, 1001l20 tablets; 25. Lorazepam 2 mg, original fill 03JAN08, 0/90 tablets; 26. One blue pill container with marked sections for:

a. Risperidone, 94 pills; b. Citalopram,60 pills; c. Trazodone, 10 pills; d. Benztropine (Cogentin@), 1.5 pills; e. Citalopram, 4 pills;

27. Lorazepam I mg, refill 01FEB08, 87/120 tablets (found in center console of vehicle).

7. RECENT STRESSORS:

GYSGT Bachus had numerous stressors, both chronic and acute, at the time of his death. He had a long history of mental illness, dating back to 2003 following his first combat tour to Iraq, when he subsequently developed PTSD. He was ultimately able to deploy with his unit in 2007. However, only a few months into his deployment, he was MEDEV AC' d back home after it was discovered that he was prescribed clonazepam, which was deployment disqualifying. This left him feeling demoralized and embarrassed.


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7. RECENT STRESSORS (cont):

In the months and weeks prior to his death, OYSGT Bachus experienced multiple additional stressors to include his perceived loss of his identity as a fully functional Marine due to his PTSD. As a result of his impairment, an MEB was initiated, which confirmed to him the end of his Marine Corps Career and had its added stressors of mUltiple medical and psychiatric appointments.

In the weeks prior to GYSOT Bachus's death, he experienced increased stress stemming from the return of his unit. This left him feeling ashamed and embarrassed for his perceived shortcomings due to redeploying ahead of his unit. Additionally, during the week of his death, he received the results of psychological testing that indicated he had "low IQ," which, according to his wife, upset him greatly and added to his feelings of worthlessness.

8. SIGNIFICANT RELATIONSHIPS:

Mrs. Angel Bachus, GYSGT Bachus's wife at the time of his death, was his primary source of support.

9. DEVELOPMENTAL AND SOCIAL HISTORY:

GYSGT Bachus was one of four siblings born and raised in an intact union in Ohio. Per Service record review, GYSGT Bachus had no developmental delays or academic difficulties. He graduated on time and socialized well. GYSGT Bachus joined the military at the age of21. He married twice, divorcing his first wife in 2003 and remarrying shortly afterwards to his now widow, Mrs. Angela Bachus.

10. EDUCATIONAL HISTORY:

GYSGT Bachus never attended any special education classes and was never held back for remediation. He graduated from high school on time with a GPA of2.9.-3.5.

11. OCCUPATIONAL HISTORY:

Data was not available for review prior to the completion of this report.

12. MILITARY mSTORYIREViEW OF SERVICE RECORD:

At the time of death, GYSGT Bachus had approximately 17 years of active duty service. He rated above average on all performance evaluations

13. FINANCIAL HISTORY:

GYSOT Bachus had no known financial difficulties or debt.


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14. LEGAL HISTORY:

GYSGT Bachus never received any negative counseling statements. There were no known military or civilian legal issues at the time of his death.

15. MEDICAL HISTORY:

GYSGT Bachus had no known drug allergies. At the time of his death, he was being treated for migraine headaches (since 2005) and was being evaluated for a TBI suspected from lED blasts in 2003. Per review of GYSGT Bachus's medical and mental health records, there was no mention ofany lED blasts until March 2007, when he was evaluated by a mental health provider at his intermediate stop at the Landstuhl Regional Medical Center, Germany, on his transit back to Camp Lejeune from Iraq. His medical records indicated that both a head CT (01 MAY 2007) and brain MRI (22 DEC 2007) were unremarkable.

GYSGT Bachus was also being treated for a recent right foot talar bone spur and a ganglion cyst requiring surgery on his ankle in September 2007. He was being treated for back pain (starting in December 2007) secondary to degenerative disc disease, and was receiving physical therapy in the community. The week prior to his death, he had been prescribed opiates by his psychiatrist, Dr. Mikhail, for back pain.

16. PSYCHIATRIC HISTORY:

See Paragraph 4, "DETAILS OF DEATH," for additional history. Synopsis of Care as follows:

·First psychiatric hospitalization in November of 2003, diagnosed with PTSD and Substance Abuse;

-Symptoms intensified over the next few years resulting in additional diagnoses of Anxiety Disorder Not Otherwise Specified and Panic Disorder;

-Second psychiatric hospitalization in February 2005 wbile on deployment to Japan; -First inpatient admission for substance treatment at Point Loma, California, in February and March of 2005, diagnosed with PTSD and Alcohol Dependence; -Second inpatient admission for substance treatment in April of2005; -Third psychiatric hospitalization in May 2005 at the Naval Hospital at Camp Lejeune, diagnosed with PTSD and Alcohol Dependence; -Third inpatient admission for substance treatment from May to June 2005 at the Wilmington Drug and Alcohol Treatment Center, located in Wilmington, North Carolina; -Requested to come off medications in early 2006; -Resumed medications in July 2006; -Multiple medication adjustments resulting in one recommendation that GYSGT Bachus

not deploy due to psychiatric illness and deployment disqualifying medication; -Cleared to deploy with his unit in 2007; -Redeployed and MEDEVAC'd back from Iraq to Camp Lejeune in April 2007, two

months into his deployment;


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16. PSYCHIATRIC HISTORY cont.):

-Seen four times at Camp Lejeune between May 2007 and September 2007, resulting in multiple medication adjustments;

-Cleared for deployment September 2007; -Shortly afterward, decision made that GYSGT Bachus required an MEB as a result of

his continued psychiatric impairment; and -Continued to receive treatment from Dr. Cooney and LCDR Friesen at the Camp

Lejeune Naval Hospital, and two civilian providers in the community, Mr. Ball and Dr. Mikhail.

17. SUBSTANCE USE mSTORY:

Please see above for full description of substance use. In summary, GYSGT Bachus was diagnosed with Alcohol Dependence in 2005. There is no other known substance use disorder.

18. FAMILY OF ORIGIN MEDICAL AND PSYCHIATRIC HISTORY:

GYSGT Bachus had a family history of cardiovascular disease and hypertension. Additionally, he reported in one psychiatric intake that his mother suffered from anxiety disorder

19. REACTIONS TO THE DEATH:

Mrs. Bachus noted that she was surprised to hear that her husband was dead. In fact, she believed he had checked into the inpatient psychiatric unit at the Naval Hospital Camp Lejeune as they had discussed the day prior to his death.

20. ANALYSIS OF MANNER OF DEATH

Homicide

There were no indications offorced entry or signs of a struggle present within the room.

Suicide versus Accident

Lethality; GYSGT Bachus had access to many prescription medications that alone or in combination could prove to be lethal. This included narcotics that he had recently been prescribed for back pain as well as lorazepam that he took regularly for anxiety. When taken alone at prescribed doses, these medications are not lethal. However, when taken with other sedating medications, they could have the additive effect of causing respiratory depression, coma, and death. Additionally, GYSGT Bachus had reported to his GMO that he on occasion doubled his prescribed dose of c!onazepam. No other notes reviewed suggested that he continued to misuse his medications, but it is conceivable with increase stressors he might have done it. Respiratory depression and death could have resulted if he self-medicated with his lorazepam by taking more tablets than prescribed while taking his opiate pain medication.

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20. ANALYSIS OF MANNER OF DEATH (cont.)

Rescuability: GYSGT Bachus was living alone in his quarters on base and had little interactions with others, making it difficult to resuscitate him or intervene.

Intent: GYSGT Bachus did not give any indirect or direct suggestions that he had planned to end his life. However, he had made statements to the effect that he was close to "breaking," and that he felt that he was not the Marine that he used to be. The last time that he spoke with his wife, he mentioned that he was thinking of checking himself into the inpatient ward, but had not suggested that he was suicidal. Additionally he told his wife he was tired and wanted to go to sleep, but would contact her the next morning.

Motive: Motives for suicide include wanting to escape from mental or physical pain; anger, rage, revenge; guilt, shame, atonement; a fantasy of eternal rest or life with a loved one; wishing to be rescued, reborn, or start over; andlor a wish to make an important statement or communication.

A possible motive for suicide in this case was escape from both the psychological pain he experienced from his PTSD and depressive symptoms, as well as his shame and embarrassment stemming from his diagnosis of PTSD and his MEB. Another motive for suicide was GYSGT Bachus's perceived loss of his identity as a Marine as an unintended consequence of the MEB process.

Changes in Personality, Habits, or Appearance: GYSGT Bachus was under a great deal of stress related to his underlying feelings of shame and embarrassment. Although GYSGT Bachus had been struggling with his issues related to PTSD since his first deployment to Iraq in 2003, he continued to require ongoing treatment that inclnded both pharmacologic and psychotherapeutic interventions. As a result of his needs, it was decided that the best alternative for him was to get an MEB with the intent for him to be medically retired from the Marine Corps. This decision was made in consultation with his treating psychiatrist. However, it was evident that GYSGT Bachus had mixed feelings regarding this decision, and according to Mrs. Bachus, G YSGT Bachus had tried to get reassigned to a different MOS, hoping that would allow him to remain in the service.

It is fair to assume that GYSGT Bachus derived a great deal of his identity and self-worth from being a Marine. For GYSGT Bachus, returning early from deployment as a result of his psychiatric treatment needs was likely a significant narcissistic injury that continued to fester as he tried to regain his deployable status. This is often seen in Service Members who return early from deployment without other members of their units. This often leads to "survivor's guilt." It is also a common state of mind in individuals who develop chronic PTSD, much like what GYSGT Bachus had been experiencing.

After it was decided to go forward with the MEB, GYSGT Bachus felt defeated and his shame and embarrassment increased greatly. This was evident not only in his verbal comments made to his providers over the last six to eight months before his death, but also as evidenced by his increased physical complaints and increased emotional and psychiatric needs. This is supported

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by the dramatic increase in the use of prescription medications for both psychiatric and physical aliments, as well as the frequent changes to his medications and their dosages, as his providers attempted to treat his anguish.

Matters for GYSGT Bachus deteriorated greatly weeks preceding his death. Most notable of his stressors and providing a motive for suicide were the upcoming dictation of his MEB, the return of his unit and his inability to face his fonner unit members and the results of psychological testing stating that he had a low IQ score. In summary, GYSGT Bachus had multiple possible motives for suicide including shame and embarrassment, ongoing psychological and physical pain, guilt regarding his perceived weakness (chronic PTSD), and a loss of his identity as a Marine.

Risk Factors: GYSGT Bachus had no recent psychiatric hospitalizations. However in the months preceding his death. he had experienced an increase in his psychological distress as previously described. Additionally in the few weeks preceding his death, he sought emcrgency treatment at the ER for "pain management." that was likely closely related to his overall emotional distress. Shortly before his death, he considered getting admitted to the inpatient psychiatric ward at the Naval Hospital.

GYSGT Bachus had a prior history of several psychiatric hospitalizations, which significantly increased his risk for suicide. He reported that he was sober for years preceding his death. However, he had been prescribed lorazepam, a substance similar to alcohol in both its physical and psychological effects, and reported on occasion taking more c1onazepam, another benzodiazapine, than had been prescribed.

Other risk factors for suicide included OYSGT Bachus's mental health history of chronic PTSD, Alcohol Dependence, Major Depressive Disorder, and one past suicide attempt that was reported by Mrs. Bachus. Mrs. Bachus noted that GYSGT Bachus had talked about suicide in the past, but only when intoxicated. Additionally, she noted that she only knew of one prior suicide attempt, which occurred when he was intoxicated and when he took extra pills. No hospitalization resulted from this attempt. She added, however, that he had not led her to think that he was suicidal prior to his death, and she "knew" him not to be secretive.

Additional risk factors for suicide include OYSGT Bachus's current geographic separation from his primary support/family due to his wife relocating to Ohio pending the results of the MEB. Although he did utilize mental health assets in the area it appeared that he had become less trusting of them, based on comments noted in Dr. Friesen's note dated 04 MAR 2008. This may have been due to side effects from his medications as well. He had no history of being neglected or abused as a child.

GYSOT Bachus also had numerous protective factors guarding against suicide, including being married, being under the age of 40 years, and using faith as a source of support, which he had noted to his providers that he had used in the past. Additionally, GYSGT Bachus had indicated


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in his writings that faith was source ofstrength for him. Additionally, he had access to emergency psychiatric care and long-term supportive psychiatric care.

Conclusion: At the time of his death, OYSOT Bachus was at high risk of suicide based on an analysis oflethality, rescuability, intent, motive, and his risk factors for suicide. However, his final statements to his wife noting an intent to call her the following morning and his lack of giving any other indication, direct or indirect, of suicidal intentions suggest that OYSOT Bachus's death was accidental in nature. He told his providers and his wife the week prior to his death that he was having difficulty sleeping. He also told his wife that his "zolpidem (Ambien!!!» was no longer working for him," but he didn't want to "mess with his medications since they had just changed everything." OYSOT Bachus added, "I don't want to not wake up in the morning." Most compelling is his description in the days prior to his death of not feeling right, having a hard time distinguishing between what was real and what was not, and feeling paranoid and thinking that he was imagining things (consistent with visual hallucinations). It appeared that he was delirious, most likely due to the interactions of his medications.

OYSOT Bachus's delirium may have either resulted from taking the medications as prescribed or taking additional clonazepam. In either case, his death is most consistent with an accident. Based on the totality of the circumstances and evidence present in this case, OYSOT Bachus's manner of death is most consistent with being an accident.

21. FORENSIC OPINION: It is our opinion to a reasonable degree of medical certainty that GYSGY Bachus's manner of death was the result of an accidental overdose.

LCDR David A. Weis, MC, USN Forensic Psychiatry Fellow

CDR Rosemary Carr Malone, MC, USN Chief Deputy Medical Examiner Psychological Investigations Division AFIP,OAFME


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in his writings that faith was source of strength for him. Additionally, he had access to emergency psychiatric care and long·term supportive psychiatric care.

Conclusion: At the time of his death, GYSGT Bachus was at high risk of suicide based on an analysis of lethnlity, rescuability, intent, motive, nnd his risk faclors for suicide. However, his fmal statements to his wife noting nn intent to call her the following morning and his lack of giving any other indication, direct or indirect, of suicidal intentions suggest thai GYSGT Bachus's death wa, accidental in nmure. He told his providers and his wife the week prior to his death thai he was having difficulty sleeping. He also lold his wife Lhat his "zolpidem (Ambien®) was no longer working for him." but he didn't want to "mess with his medications since they had just changed everything." GYSGT Bachus added, "I don't want to IlOt wake up in the morning." Most compelling is his description in the days prior to his death of nOI feeling right. having n hard lime distinguishing between what was real and what was not, and feeling paranoid and thinking that he wa, imagining things (consistent with visual hallucinations). It appeared that he was delirious, most likely due to the interaetions or his medications.

GYSGT Bachus's delirium may have either resulted from taking the medications as prescribed or laking additional c1onazepam. In either case, his death is most consistent with an accident. Based on the totality oCthe circumstances and evidence present in this case, GYSGT Bachus's manner of death is most consistent with being an accident.

21. FORENSIC OPINION: It is our opinion to a reasonable degree of medical certainty that G . GY Bachus's manner of death wa.. the result of an accidental overdose. :::

LCD_ "";dt.WUC.:SN CD(jd.::;l2dl~ ~ ;f Forensic Psychiatry Fellow Chief Deputy Medical Examiner

Psychological Investigations Division AFlP,OAFME

,.

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