1. DEPARTMENT or rue MEDICAL EXAMINER CITY AND COUNTY OF HONOLULU835 M/ LEI ROAD 0 0NOLULU HAWAH 96617 TEi. EPMONE:(BOB) 76&EN o FAX (006) 768-30m - iN'l'ERNET:-nnrhnrlalmgoqKJRK CALDMIF:A MAYORCrR! $lCP~EF. B uh an ZHFE4Cl. .EJ. AlDRACFEL U056 ill:F5 EE3.1'V| A: |xCAL QAIIWLF nay; -some xosausrc an F (, - XVJW E: vCA-L LKMSNEIAUTOPSY REPORT Case No.15-0548-HALECK,SheldonRE:Sheldon P.HALECK DATEITIME OF PRONOUNCEMENT:03I17I2015, 7:33 AMDATE,TIME,AND PLACE OF EXAMINATION:0311812015 9:48 AM Medical Examiner's FacilityPATHOLOGIC DIAGNOSES: 1. Acute methamphetamine intoxication with delirium: A.Methamphetamine and amphetamine (methamphetamine metabolite) identied in hospital blood (see separate toxicology report for further details) and in hospital urine toxicology (see medical records). B.By report,decedent came to police attention because he was walking amongst trafc on a city street (not oriented to place,thus fullling criteria for delirium) and did not follow instructions by police to leave the roadway. 2. Physical altercation with police,with:A.Blunt force injuries of the head:1. Abrasions,contusions.and subscalp hemorrhages.B.Blunt force injuries of the torso,with:1. Abrasions,contusions.and subcutaneous hemorrhage.C.Blunt force injuries of the upper and lower extremities.with;1. Abrasions and contusions.D.History of multiple Taser deployments by police,with:1. Supercial abraded puncture mark,lower mid-chest/ upper abdomen,with:a.No evidence of Taser barb penetration of skin.2. Taser deployment ineffective according to police reports.E.History of pepper spray deployment. 3. Cardiac hypertrophy (Heart weight =510 grams),unknown etiology.
2. Case No.15-0548-HALECK,Sheldon Page 2 of 114. History of cardiopulmonary resuscitation,admission to hospital,and subsequent cerebral (brain) anoxia:A.Brain swelling,slight.B.Mixed metabolic and respiratory acidosis (by medical record):1. Marked acidosis (pH=6.60).2. Lactic acidosis (Lactate=> 20 mEq/ L).3. Increased pCO2 (73 mmHg) and decreased HCO3 (7 mmol/ L) with a marked negative base excess (BE=< -30).C.Acute renal failure (by medical record):1. Increased creatinine (4.5 mg/ dL).2. Increased blood urea nitrogen (BUN=37 mg/ dL).D.Multiple cardiac complications,with:1. Tachycardia (Heart rate =112 beats per minute upon admission to ER and peak of 125 BPM).2. Hypotension (BP =60/40 mmHg upon admission to ER).3. Probable myocardial injury (T roponin l=4.67 ng/ mL).E.Rhabdomyolysis,with:1. Markedly elevated creatine kinase (total CK=>20,000 IU/ L).2. Decreased calcium (calcium ion=0.98 mmol/ L and calcium=5.8 mgldL).3. Increased phosphorus (9.5 mg/ dL) and potassium (6.0 mEq/ L).4. Cloudy brown urine identied in Foley catheter bag. F.Hypertherrnia.1. Body temperature as high as 100.6 degrees Fahrenheit recorded in ER. CAUSE OF DEATH:Multiple metabolic and cardiac complications (following)Due to,or as a consequence of:Physical altercation with police in individual acutely intoxicated with methamphetamineCONTRIBUTING CAUSE OF DEATH:Cardiac hypertrophy;rhabdomyolysis with metabolic and respiratory acidosis;acute renal failureMANNER OF DEATH:Homicide4 Christopher Happy,M.0 Chief Medical ExaminerJune 24, 2015 Date
3. Case No.15-0548-HALECK,Sheldon Page 3 of 11OPINION: This 38 year old man,Sheldon Haleck,died of multiple metabolic and cardiac complications following a physical altercation with police while he was intoxicated withmethamphetamine. The following events are recorded in Honolulu Police Department (HPD) reports: On the evening of March 16",2015 bystanders on King Street near lolani Palace called 911 to report Mr.Haleck walking through traffic in the roadway.The rst HPD ofcer arrived at 20:18 hours and a second HPD ofcer arrived shortly thereafter.The ofcers ordered Mr.Haleck to the sidewalk and he did not comply.Pepper spray was used on Mr.Haleck to no effect and he remained in the roadway.At this time one of the ofcers used a Taser,aiming the device and deploying the electrodes at the anterior torso ofMr.Haleck.The Taser had no effect. At approximately 20:22 hours a third ofcer arrived on the scene.This ofcer also used pepper spray on Mr.Haleck,again with no effect.Meanwhile,the initial ofcer reloaded the Taser and again deployed the electrodes into Mr.Haleck's posterior torso to no effect.At this time Mr.Haleck tripped in the street and was restrained by multiple HPD ofcers who placed handcuffs and leg cuffs on him while he struggled with the ofcers.During this struggle a fourth ofcer had placed his knee on Mr.Haleck's back.At 20:24 hours he was placed under arrest and taken into custody.When Mr.Haleck was turned from prone to supine position,he was found to be unresponsive.Emergency Medical Services (EMS) were called at 20:25 hours. According to the EMS report,they arrived on scene at 20:33 hours and found Mr.Haleck with a Glasgow Coma Scale score of 3, and without a pulse.He was resuscitated,an endotracheal tube and intravenous catheters were placed,Epinephenine was given,and Mr.Haleck's pulse was regained with an unstable heart rate of 120-200 beats per minute.He was transported by ambulance to Queens MedicalCenter,where he arrived at 20:55 hours. In the Emergency Room Mr.Haleck was stabilized and admitted to the hospital,but was found to have acute kidney failure,metabolic and respiratory acidosis,cardiac arrhythmias,rhabdomyolysis,anoxic/ ischemic encephalopathy,and hyperthermia.He did not regain consciousness.A urine drug screen was positive for methamphetamine. Approximately 11 hours later Mr.Haleck was declared brain dead after undergoing brain death criteria testing.Death was pronounced at 07:33 hours on March 17",2015.Mr.Haleck had a medical history signicant for anxiety disorder,umbilical hemia,post traumatic stress disorder,depression,unspecied personality disorder,chronic back pain,obstructive sleep apnea,and substance abuse. Autopsy revealed numerous blunt force injuries of the head,torso and extremities,including abrasions,contusions,a subscalp.and subcutaneous (chest) hemorrhages.
4. Case No.15-0548-HALECK,Sheldon Page 4 of 11There was a supercial abraded puncture wound on the lower mid-chest/ upper abdomen,without penetration to the underlying subcutaneous tissue.No other wounds consistent with Taser barbs were identified. Natural disease included cardiac hypertrophy (heart enlargement).The right ventricle of the heart was dilated.Slight brain swelling was seen.Urine in the Foley catheter bag was cloudy and brown (indicating skeletal muscle breakdown). Toxicology analysis performed on blood taken at the time of hospital admission was positive for methamphetamine (180 ng/ mL) and amphetamine (66 ng/ mL,likely formed as a metabolite from methamphetamine).Caffeine and nicotine were also present (but not quantied).Postmortem vitreous fluid analysis showed sodium of 160 mmol/ L, chloride of 124 mmol/ L, potassium of 8.1 mmol/ L, vitreous urea nitrogen of 40 mg/ dL and glucose of 29 mg/ dL. Mr.Haleck displayed signs and symptoms of an acute,methamphetamine-induced delirium (not understanding where he was) when he came into contact with police.Numerous nonfatal abrasions and contusions on the head,torso and extremities are consistent with a violent physical struggle with police ofcers.Linear abrasions on theright wrist are consistent with handcuff marks.A deeper contusion seen under the scalp, just above the right eyebrow,and a hemorrhage in the right temporalis muscle of the head indicate more severe injuries,but would not be fatal in and of themselves.A subcutaneous hemorrhage into the left pectoral muscle in the left chest would also indicate an injury caused by greater force.However,this injury may have been caused by a sternal rub.which HPD incident reports indicate an ofcer performed on Mr.Haleck after he was found to be unconscious.No broken bones,intracranial hemorrhages,traumatic organ injuries or signicant intemal hemorrhaging was seen. Acute delirium,agitation,and psychosis following drug use,especially stimulant drug use,has been described in the medical and forensic pathology literature as Excited Delirium Syndrome.This entity is a conglomeration of signs and symptoms which have been said to have a high mortality.Mr.Haleck displayed many of the signs and symptoms described in this syndrome.However,there are currently no well established diagnostic criteria for this syndrome and the terminology represents a heterogeneous constellation of medical ndings. Of those ndings Mr.Haleck had:hyperthennia;acute methamphetamine intoxication;acute renal failure due to breakdown of skeletal muscle (rhabdomyolysis):cardiac arrhythmia (abnormal beating of the heart):metabolic and respiratory acidosis (too much hydrogen ion in the blood),and cerebral anoxiafrschemia (inadequate blood ow to the brain).which left him brain dead. The causes of these serious and often fatal medical conditions are multifactoral and include,in Mr.Haleck's case,the effects of methamphetamine on the heart,breakdown of muscle (rhabdomyolysisz) due to increased body temperature,methamphetamine intoxication,and the violent physical struggle with police,and the subsequent cascade
5. Case No.15-0548-HALECK,Sheldon Page 5 of 11of deleterious metabolic changes which led to irreversible damage to Mr.Halecks brain, heart and kidneys. Preexisting disease was found in the heart.which was enlarged and had a dilated right ventricular chamber.These changes could be secondary to hypertension,which was not previously diagnosed.or chronic stimulant abuse. The manner of death in this case is best classied as Homicide due to the involvement of the ofcers in Mr.Halecks death and the actions they performed which contributed to Mr.Haleck's death.The classication of Homicide is a medical classification for the purpose of Death Certication and does not imply intent by the ofcers to kill Mr.Haleck,nor does it imply that the ofcers did not