T O X I C O L O G Y   R E P O R T 

Office of the Chief Medical Examiner        Toxicology Folder: T200902397 Chapel Hill, NC   27599­7580                      Case Folder: F200903016 

Date of Report: 01­apr­2009 Page:  1 

DECEDENT:  Lillian Eugenia Dunn 

Status of Report: Approved Report Electronically Approved By:  Ruth Winecker,  Ph.D. 

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** Comments Concerning This Report ** No analyses requested, specimen(s) held. 

** End of Comments Concerning This Report ** 

=============================================================================== SPECIMENS received from Samuel Simmons on 30­mar­2009 

S090007595:   1.0 ml  Blood                 CONDITION: Postmortem SOURCE: Aorta                            OBTAINED: 30­mar­2009 

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S090007596:   3.0 ml  Blood                 CONDITION: Postmortem SOURCE: Vena Cava  OBTAINED: 30­mar­2009 

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S090007597:           Liver                 CONDITION: Postmortem SOURCE: Liver                            OBTAINED: 30­mar­2009 

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072009 11:00        * * *  E N D   O F   R E P O R T  * * * B200901667

Office of the Chief Medical ExaminerCB # 7580 Chapel Hill, NC 27599-7580

Telephone 9199662253

REPORT OF AUTOPSY EXAMINATION

DECEDENTDocument Identifier B200901667Autopsy Type ME AutopsyName Lillian Eugenia DunnAge 89 yrsRace WhiteSex F

AUTHORIZATIONAuthorized By Max H. Muse RN Received From Moore

ENVIRONMENTDate of Exam 03/30/2009 Time of Exam 12:30Autopsy Facility Office of the Chief Medical Examiner Persons Present Ms. Tracy Gurnsey, Dr. Clark, andOfficer B.T, Whitaker of the Moore County Sheriffs Dept. (in observation room)

CERTIFICATIONCause of DeathMultiple shotgun wounds

The facts stated herein are correct to the best of my knowledge and belief.Digitally signed bySamuel Simmons MD 10 July 2009 10:16Thomas B. Clark, III MD 16 July 2009 15:29

DIAGNOSESPenetrating shotgun wound of right lower chest with injury to ribs, liver, and right lung

Associated right hemothoraxPenetrating shotgun wound of right upper abdomen with injury to liver, large bowel, inferior vena cava, and rightkidney

Associated hemoperitoneum and peripancreatic hemorrhageAtherosclerotic cardiovascular disease, severe

Remote myocardial infarction

IDENTIFICATIONBody Identified ByPapers/ID Tag

EXTERNAL DESCRIPTIONLength 62 inchesWeight 134 poundsBody Condition IntactRigor Minimal, easily brokenLivor Posterior, red, slightly blanchingHair Black/gray, approximately 10" in lengthEyes Brown with arcus senilisTeeth NaturalReceived in a zippered disaster pouch is the body of a well developed, well nourished adult white female appearingcompatible with the reported age. The body is identified by an ID tag around the left ankle. The body is clad in a darkgreen sweater over a red dress with gray socks, blue slippers and a disposable diaper. Personal effects consist of a yellowmetal ring with multicolored stones on the left 4th finger and a pair of eyeglasses. Identifying marks and scars consist of

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a remote horizontal scar on the central lower abdomen and remote vertical scars on the anterior aspects of the bilateralknees. There is a bandaid present on the right anterior shin covering an area of skin breakdown.

INJURIESSHOTGUN WOUND #1:

Located on the right lower chest and centered at a point 19" below the top of the head and 2 1/2" to the right of anteriormidline is an entrance shotgun wound consisting of a 1 1/2" x 1 1/2" round skin perforation with slight scalloping on thesuperior margin. No gunpowder residue or plastic packing material is identified on the skin around the entrancewound. Superior to the primary entrance wound is an area of scalloping with intact subcutaneous shotgun pellets on theunderside of the right breast. There are two associated linear abrasions above and below this area of scalloping. Thewound track subsequently perforates the musculature and soft tissue of the right lower chest, anterior portion of rightribs #8 to 10 (with fracture), right lobe of liver, right hemidiaphragm, right lower lobe of lung, posterior portions of ribs#10 through 12 (with fracture) and penetrates into the soft tissue of the posterior chest cavity. Multiple small (less than1/8" diameter) gray metal shotgun pellets are located throughout the wound track. Due to the proximity of shotgunwounds #1 and 2 it is difficult to discern which shotgun pellets correspond with which wound. Four plastic fragmentsfrom a shot shell cup are also retrieved from this overlapping area of shotgun wounds #1 and 2. Associated injuries ofshotgun wound #1 include a right hemothorax (approximately 200 ml), ecchymosis of the right posterolateral back, anda graze wound on the right medial wrist which consists of a 3/4" x 1/2" oval superficial abrasion. In the anatomicalposition, the wound track for shotgun wound #1 travels from the decedents front to back and slightly downward.

SHOTGUN WOUND #2:

Located on the right upper abdomen and centered at a point 21" below the top of the head and 1 1/2" to the right ofanterior midline is an entrance shotgun wound consisting of a 1 3/4" x 1 1/2" oval skin perforation with slight scallopingat the inferior edge. No gunpowder residue or plastic packing material is present on the skin around the entrancewound. The wound track subsequently perforates the musculature and soft tissue of the right upper abdomen, rightlobe of liver, hepatic flexure of the large bowel, inferior vena cava, right kidney and adrenal, and penetrates into theparaspinous muscle and soft tissue. Recovered throughout the wound track are multiple small, less than 1/8" diametergray metal shotgun pellets. Associated injuries with shotgun wound #2 include hemoperitoneum (approximately 200ml), retroperitoneal and peripancreatic hemorrhage, and a graze wound on the dorsal aspect of the left hand whichconsists of an irregular 1 1/2" x 1 3/4" deep abrasion/laceration with fracture of the 1st phalange of the left 2nd finger.In the anatomical position, the wound track for shotgun wound #2 travels from the decedent's front to back and slightlydownward.

Examination of the decedent's clothing shows corresponding defects in the areas overlying the two entrance shotgunwounds.

The numbers assigned to these shotgun wounds are for descriptive purposes only, and do not necessarily indicate theorder in which they were inflicted.

No other significant internal or external injuries are present.

DISPOSITION OF CLOTHING AND PERSONAL EFFECTSThe following items are released with the bodyPersonal effects are released with the body.

The following items are preserved as evidenceClothing, blood spot card, and recovered shotgun pellets and plastic shot cup fragments are received by OfficerWhitaker on 03-30-09.

PROCEDURESRadiographsTwo postmortem digital radiographs of the chest, abdomen, and left hand show fracture of the left 2nd finger andmultiple small radiopacities consistent with shotgun pellets in the abdomen and chest.

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INTERNAL EXAMINATIONBody CavitiesThe bilateral pleural and peritoneal cavities contain no significant adhesions. The left pleural cavity contains nosignificant fluid. All body organs are present in their normal anatomic relationship with the exception of the surgicallyabsent appendix.

Cardiovascular SystemHeart Weight 430 gramsThe pericardial sac is free of significant fluid and adhesions. The coronary arteries arise normally and follow the usualdistribution. There is severe (75%) calcific atherosclerotic stenosis of the left anterior descending artery, and moderate(50%) calcific atherosclerotic stenosis of the right coronary artery and left circumflex arteries. No acute thromboses areidentified. There is moderate calcification of the aortic valve cusps. Otherwise, the chambers and valves bear the usualsize-position relationships and are unremarkable. There is a white-tan fibrous area within the left ventricular free wall.No other areas of infarction or focal lesions are identified within the myocardium. The aorta and its major branches areintact with severe atherosclerotic changes throughout.

Respiratory SystemRight Lung Weight 400 gramsLeft Lung Weight 290 gramsThe larynx is clear. The upper and lower airways are free of debris and foreign material. The lungs are normally formed.The parenchyma of both lungs shows slight congestion without obvious consolidation. Except as noted, no other focallesions are identified. The pulmonary arteries are free of thrombi or emboli.

Gastrointestinal SystemExcept as previously noted, the GI tract is intact throughout its length and is unremarkable. The appendix is notidentified. The stomach contains approximately 50 ml of yellow-white fluid and food material.

LiverLiver Weight 500 gramsAs previously noted, the liver is fragmented. No residual gallbladder is identified.

SpleenSpleen Weight 100 gramsThe spleen is normally formed and no focal lesions are identified.

PancreasExcept as previously noted, no other focal lesions are identified.

UrinaryRight Kidney Weight 25 gramsLeft Kidney Weight 100 gramsThe left kidney is of normal size and shape. The capsule strips with ease from the underlying granular cortical surfacewhich also contains a 1 1/4" in diameter simple cortical cyst. The renal architecture of the left kidney is intact withoutother focal lesions. The left ureter is intact without dilation. The bladder contains no residual urine. The right kidney isfragmented as previously noted and the right ureter is not identified.

ReproductiveThe bilateral ovaries are atrophic. The uterus and bilateral fallopian tubes are unremarkable.

EndocrineThe thyroid gland is of normal size, shape and consistency.The left adrenal gland is grossly unremarkable. As previously noted, the right adrenal gland is not identified.

NeurologicBrain Weight 970 gramsThe leptomeninges are thin, delicate and congested. The cerebral hemispheres show generalized atrophy but areotherwise unremarkable. The vasculature at the base of the brain shows moderate atherosclerotic changes within thecircle of Willis. Coronal sections reveal normal architecture without other focal lesions.

Skin

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Except as noted, no focal lesions are identified.

Immunologic SystemNo residual thymus gland is identified. There is no evidence of lymphadenopathy.

Musculoskeletal SystemExcept as noted, grossly unremarkable. There are no other fractures identified within the skull or of the axial andappendicular skeletons. Examination of the soft tissues of the neck including the strap muscles and large vessels revealsno abnormalities. The hyoid bone and laryngeal cartilages are intact. The lingual mucosa is intact and the underlyingmusculature is devoid of hemorrhage.

MICROSCOPIC EXAMINATIONCardiovascularSections of heart show a large fibrous scar within the left ventricle, consistent with a remote myocardial infarction.

RespiratorySections of lungs show emphysematous changes, scattered macrophages, and focal areas of intra-alveolar hemorrhage.Postmortem bacterial growth is noted within medium-sized blood vessels.

LiverA section of liver shows early autolytic changes, moderate periportal fibrosis, and postmortem bacterial growth withinmedium-sized blood vessels.

GenitourinaryA section of kidney shows mild arterionephrosclerosis, focally dilated tubules, and scattered chronic inflammation.

NeurologicSections of brain show no significant pathologic abnormality.

SUMMARY AND INTERPRETATIONThe decedent was an 89 year old woman who was one of several people shot inside a nursing home in Moore County.

Significant findings at autopsy include a penetrating shotgun wound of the right lower chest which injures the ribs,liver, and right lung with an associated right hemothorax, and a penetrating shotgun wound of the right upper abdomenwhich injures the liver, large bowel, inferior vena cava, and right kidney with associated hemoperitoneum andperipancreatic hemorrhage.

Evidence of natural disease includes atherosclerotic cardiovascular disease with evidence of a remote myocardialinfarction.

Postmortem toxicological analysis is not performed.

Given the autopsy and investigative findings, it is our opinion that the cause of death in this case is multiple shotgunwounds.

DIAGRAMS1. 1. Adult (front/back)

2. 2. Adult (front/back) - Injuries

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