HENNEPIN COUNTY MEDICAL EXAMINER'S OFFICE AUTOPSY

HENNEPIN COUNTY

MEDICAL EXAMINER’S OFFICE

AUTOPSY REPORT

ME NO.:

20-3700

CASE TITLE:

CARDIOPULMONARY ARREST COMPLICATING LAW ENFORCEMENT

SUBDUAL, RESTRAINT, AND NECK COMPRESSION

DECEASED:

George Floyd aka Floyd Perry

SEX:

AGE:

DATE AND HOUR OF DEATH:

5-25-20; 9:25 p.m.

DATE AND HOUR OF AUTOPSY:

5-26-20; 9:25 a.m.

PATHOLOGIST:

Andrew M. Baker, M.D.

FINAL DIAGNOSES:

46-year-old man who became unresponsive while being restrained by law

enforcement officers; he received emergency medical care in the field

and subsequently in the Hennepin HealthCare (HHC) Emergency

Department, but could not be resuscitated.

I. Blunt force injuries

A. Cutaneous blunt force injuries of the forehead, face, and

upper lip

B. Mucosal injuries of the lips

C. Cutaneous blunt force injuries of the shoulders, hands,

elbows, and legs

D. Patterned contusions (in some areas abraded) of the wrists,

consistent with restraints (handcuffs)

II. Natural diseases

A. Arteriosclerotic heart disease, multifocal, severe

B. Hypertensive heart disease

1. Cardiomegaly (540 g) with mild biventricular

dilatation

2. Clinical history of hypertension

C. Left pelvic tumor (incidental, see microscopic description)

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III. No life-threatening injuries identified

A. No facial, oral mucosal, or conjunctival petechiae

B. No injuries of anterior muscles of neck or laryngeal

structures

C. No scalp soft tissue, skull, or brain injuries

D. No chest wall soft tissue injuries, rib fractures (other

than a single rib fracture from CPR), vertebral column

injuries, or visceral injuries

E. Incision and subcutaneous dissection of posterior and

lateral neck, shoulders, back, flanks, and buttocks

negative for occult trauma

IV. Viral testing (Minnesota Department of Health, postmortem nasal

swab collected 5/26/2020): positive for 2019-nCoV RNA by PCR

(see ‘Comments,’ below)

V. Hemoglobin S quantitation (postmortem femoral blood, HHC

Laboratory): 38% (see ‘Comments,’ below)

VI. Toxicology (see attached report for full details; testing

performed on antemortem blood specimens collected 5/25/20 at

9:00 p.m. at HHC and on postmortem urine)

A. Blood drug and novel psychoactive substances screens:

1. Fentanyl 11 ng/mL

2. Norfentanyl 5.6 ng/mL

3. 4-ANPP 0.65 ng/mL

4. Methamphetamine 19 ng/mL

5. 11-Hydroxy Delta-9 THC 1.2 ng/mL;

Delta-9 Carboxy THC 42 ng/mL; Delta-9 THC 2.9 ng/mL

6. Cotinine positive

7. Caffeine positive

B. Blood volatiles: negative for ethanol, methanol,

isopropanol, or acetone

C. Urine drug screen: presumptive positive for cannabinoids,

amphetamines, and fentanyl/metabolite

D. Urine drug screen confirmation: morphine (free) 86 ng/mL

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Comments: The finding of sickled-appearing cells in many of the

autopsy tissue sections prompted the Hemoglobin S quantitation

reported above. This quantitative result is indicative of sickle

cell trait. Red blood cells in individuals with sickle cell trait

are known to sickle as a postmortem artifact. The decedent’s

antemortem peripheral blood smear (made from a complete blood count

collected 5/25/20 at 9:00 p.m.) was reviewed by an expert HHC

hematopathologist at the Medical Examiner’s request. This review

found no evidence of antemortem sickling.

The decedent was known to be positive for 2019-nCoV RNA on 4/3/2020.

Since PCR positivity for 2019-nCoV RNA can persist for weeks after

the onset and resolution of clinical disease, the autopsy result most

likely reflects asymptomatic but persistent PCR positivity from

previous infection.

2020

Andrew M. Baker

M.D.

Chief Medical Examiner

ned b

: Andrew M. Baker MD

In accordance with HCME policy, this report was

reviewed by another board-certified forensic

pathologist prior to release.

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IDENTIFICATION:

Positive identification is confirmed by comparison of antemortem

and postmortem fingerprints (Federal Bureau of Investigation).

EXTERNAL EXAMINATION:

When initially examined, the body is in a sealed/locked and

properly labeled body bag. Evidentiary paper bags are secured

over the hands.

The body is that of a normally developed, muscular and

adequately nourished appearing, 6 feet 4 inch long, 223 pound

male whose appearance is consistent with the reported age of 46

years. Unfixed lividity is present on the posterior dependent

surfaces of the body, except in areas exposed to pressure.

Rigor mortis is established in all of the major muscle groups,

relenting with modest pressure. The temperature is somewhat

cool following refrigeration.

The scalp is covered with closely cropped black hair in a normal

distribution, with some early vertex thinning. The irides are

brown, and the pupils are round and equal in diameter. The

conjunctivae are somewhat injected, but there are no bulbar or

palpebral conjunctival petechiae. There are no facial,

periorbital, or oral mucosal petechiae. The external auditory

canals are free of blood. The lobe of the left ear is remotely

pierced once; the ears are otherwise unremarkable. The nares

are patent. The nasal and facial bones are stable to palpation.

A faint, 2 cm maximum dimension V-shaped scar is near the

superior end of the left jawline. The teeth appear native and

in good repair. Very short black mustache and beard stubble is

in the usual distribution on the face, and a small patch of

slightly longer black beard hair is just inferior to the lower

lip.

The neck is straight, and the trachea is midline. A 0.6 cm

diameter circular gray-brown scar is over the middle of the left

clavicle. The chest is symmetric. The abdomen is flat. The

external genitalia are those of a normal adult male. The testes

are descended and free of masses. Pubic hair is present in a

normal distribution. The back, buttocks, and anus are

unremarkable.

The upper and lower extremities are symmetric and free of

clubbing, edema, or absence of digits. Six faint,

hypopigmented, haphazardly oriented linear scars ranging up to

1.2 cm long are scattered across the dorsum of the right

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forearm. Approximately eight gray-tan foci of healing injuries

(scars) ranging up to 0.8 cm maximum dimension are scattered

across the dorsum of the right hand. Two similar appearing

healing injuries (scars), each 1 cm maximum dimension, are on

the anteromedial right wrist. A similar appearing, obliquely

oriented 2 cm long linear healing injury (scar) is on the medial

right wrist. The skin of the first dorsal webspace on the right

hand has a 4.5 cm maximum dimension area of brown

hyperpigmentation and gray-tan hyperkeratosis. An 8 cm maximum

dimension area of brown hyperpigmentation and gray-tan

hyperkeratosis spans the first dorsal webspace on the left hand,

and has five superimposed healing linear skin cracks ranging up

to 1.2 cm long. Similar gray-tan, scar-like areas are on the

dorsum of the left hand (over the left 2

and 3

metacarpophalangeal joints and the webspaces between the

fingers) and wrist in areas ranging 0.2 to 2 cm maximum

dimension. A 4 cm maximum dimension flat tan scar is on the

dorsum of the left hand over the 5

metacarpal. The nails of

the hands are cut or chewed extremely short.

A 4 cm maximum dimension horizontally oriented linear brown scar

is over the anterior right hip. A 0.5 cm maximum dimension

macular brown nevus is over the anterior right hip. Two flat,

hyperpigmented patches, 1.2 and 2 cm maximum dimension, flank

the left side of the waistline. A 1.5 cm maximum dimension

hypopigmented oval scar is over the right knee. Approximately

nine haphazardly oriented linear hypopigmented scars ranging up

to 2 cm maximum dimension are scattered over and just inferior

to the right knee. Approximately nine hyper- and hypopigmented

linear and oval scars ranging up to 2 cm maximum dimension are

over the right shin. A faint, 1.5 cm maximum dimension hyper-

and hypopigmented scar is on the posterolateral left thigh.

Five hypopigmented linear scars ranging up to 5 cm maximum

dimension are over, just superior to, and just inferolateral to

the left knee. A 3 cm maximum dimension area of slight skin

darkening associated with hair follicle plugging is on the

distal left calf. The nails of the toes are somewhat elongated,

markedly thickened, and discolored yellow-brown. The soles of

the feet and the posterior heels are somewhat hyperkeratotic and

desiccated appearing, particularly on the right.

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TATTOOS:

 A 42 cm maximum dimension monochromatic blue tattoo of an

eagle holding a rifle spans the upper chest, from shoulder

to shoulder and from the inferior neck to the distal

sternum.

 An 11 cm maximum dimension monochromatic blue tattoo of a

pair of praying hands is on the epigastric abdomen.

 A 9 cm maximum dimension monochromatic blue tattoo of the

name “LAURA” is on the right upper abdomen.

 A 10 cm maximum dimension monochromatic blue tattoo of the

name “CISSY” is on the left upper abdomen.

 A 28 cm maximum dimension monochromatic blue tattoo of the

name “FLOYD” spans both sides of the abdomen just superior

to the umbilicus.

 A 10 cm maximum dimension monochromatic blue tattoo of what

appears to be a gravestone with some letters and numbers

and the letters “R.I.P.” is on the anterior right forearm.

 A 12 cm maximum dimension monochromatic blue tattoo of two

stars and what appears to be the name “Brittney” and the

letters “R.I.P.” is on the proximal anterior left forearm.

 A 20 cm maximum dimension patterned monochromatic blue

tattoo spans the anterior, lateral, and posterior aspects

of the left forearm.

CLOTHING AND PERSONAL EFFECTS:

The following clothing items are received with the body in the

body bag, in a hospital patient belongings bag, and examined

separate from the body at the start of the postmortem

examination:

 Size XXL “Nike” brand blue track pants, extensively cut

apart (presumably for medical intervention)

 A black ribbed sleeveless t-shirt (no tag), extensively cut

apart (presumably for medical intervention)

 Size 3XL “Starting 5” brand black and gray sweatpants,

extensively cut apart (presumably for medical intervention)

 A pair of black dress socks, one with a gray heel and gray

toe box

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MEDICAL INTERVENTION:

 Oral endotracheal tube, correctly positioned in the trachea

and held in place on the face with a white and tan plastic

and elastic band

 Thoracostomy incision (3.6 cm maximum dimension, somewhat

ragged and V-shaped), right lateral chest (approximately

six superficial punctures and cuts, ranging from pinpoint

to 1.5 cm long, are adjacent to the thoracostomy)

 Thoracostomy incision (3.9 cm long, somewhat ragged and

linear), left lateral chest (a pinpoint cut or puncture is

just inferior to the thoracostomy)

 Curvilinear orange abrasions centered over the sternum

(10 cm maximum dimension aggregate), consistent with

cardiopulmonary resuscitation

 Intravascular catheter with attached segment of tubing,

taped in place just proximal to the left antecubital fossa

(the tape associated with this catheter has created a

localized area of skin slippage in the left antecubital

fossa)

 Needle puncture, just distal to the left antecubital fossa

 Intraosseous catheter with attached tubing, right tibia

 Intraosseous catheter with attached tubing, left tibia

 Intravascular catheter with attached tubing, taped in place

on the right groin

 Hospital tag, right great toe

 Hospital bracelets (2), right wrist

 Needle puncture, left groin

 Minimally hemorrhagic horizontal fracture in the sternum,

consistent with cardiopulmonary resuscitation

 Non-hemorrhagic fracture of the anterior left 4

rib,

consistent with cardiopulmonary resuscitation

EVIDENCE OF INJURY:

Head and Neck

 4 cm maximum dimension abraded red-black-purple contusion,

lateral corner of left brow

 Pinpoint red abrasion, just left of the midline of the

forehead

 6.5 cm maximum dimension red-black abrasion, left cheek

 0.6 cm maximum dimension red abrasion, just inferior to

left corner of mouth

 0.8 cm maximum dimension curvilinear red avulsion, just

superior to right side of upper lip

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 Eight pinpoint to 0.2 cm maximum dimension red abrasions,

right side of nose

 Faint blue contusions on the body of the nose (3.5 cm),

right naris (1.5 cm), and left naris (1.0 cm)

 1.5 cm maximum dimension aggregate of pink-purple mucosal

abrasions and lacerations, upper lip

 2 cm maximum dimension aggregate of pink-orange mucosal

abrasions and lacerations, lower lip

Shoulders and Extremities

 8 cm maximum dimension purple contusion with 4.5 cm maximum

dimension aggregate of linear red abrasions, anterolateral

right shoulder

 2 cm maximum dimension red L-shaped scratch, superior right

shoulder

 14 cm maximum dimension pink-purple contusion with a

discontinuous 8 cm maximum dimension dried red-black

abrasion, left shoulder

 0.2 cm maximum dimension red abrasion, just medial to the

right elbow

 3 cm maximum dimension faint pink contusion, just medial to

the left elbow

 Pinpoint red abrasion, just medial and distal to the left

elbow

 1.5 cm maximum dimension purple contusion, proximal right

shin

 2.5 cm maximum dimension aggregate of red abrasions, distal

right shin

 0.3 cm maximum dimension red abrasion over the left calf

Wrists and Hands

 1.4 cm maximum dimension red and dried black abrasion,

dorsum of proximal interphalangeal joint, right index

finger

 Two 0.8 cm maximum dimension red and focally dried black

abrasions, dorsum of proximal interphalangeal joint, right

middle finger

 Circumferential, discontinuous, 3.5 cm maximum width,

roughly parallel pink-purple contusions encircling the

right wrist, with areas of superimposed abrasions up to 1.2

cm maximum dimension; a 0.9 cm long superficial red scratch

is on the lateral right wrist between the patterned

contusion and the hand

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 Circumferential, discontinuous, 2.5 cm maximum width,

roughly parallel pink-purple contusions encircling the left

wrist, with areas of superimposed abrasions up to 1.3 cm

maximum dimension

- On the anterolateral left wrist, in a 3.5 cm long

area, the injury transitions to a dried yellow-black

abraded furrow before blending into the anterior wrist

crease

 2.2 cm maximum dimension purple contusion, dorsum of left

hand

INTERNAL EXAMINATION:

HEAD: The soft tissues of the scalp are free of injury. The

calvarium is intact, as is the dura mater beneath it. Clear

cerebrospinal fluid surrounds the 1380 g brain, which has

unremarkable gyri and sulci. Coronal sections demonstrate sharp

demarcation between white and gray matter, without hemorrhage or

contusive injury. The ventricles are of normal size. The basal

ganglia, brainstem, cerebellum, and arterial systems are free of

injury or other abnormalities. There are no skull fractures.

The atlanto-occipital joint is stable.

NECK: Layer by layer dissection of the anterior strap muscles of

the neck discloses no areas of contusion or hemorrhage within

the musculature. The thyroid cartilage and hyoid bone are

intact. The larynx is lined by intact mucosa. The thyroid is

symmetric and red-brown, without cystic or nodular change. The

tongue is free of bite marks, hemorrhage, or other injuries.

The cervical spinal column is palpably stable and free of

hemorrhage.

BODY CAVITIES: Except as previously noted, the ribs, sternum, and

vertebral bodies are visibly and palpably intact. Stripping of

the parietal pleura reveals no occult rib fractures. No excess

fluid is in the pleural, pericardial, or peritoneal cavities.

The organs occupy their usual anatomic positions. Adjacent to

the left external iliac vessels and left psoas muscle (but not

apparently arising from them or attached to them) is a firm,

4 cm maximum dimension thinly encapsulated mass consisting of

red-brown and fleshy white-gray areas, admixed with centrally

scarred and calcified areas.

RESPIRATORY SYSTEM: The right and left lungs weigh 1085 and

1015 g, respectively. The external surfaces are pink only on the

most anterior aspects, and deep red-purple in all other areas.

The pulmonary parenchyma is diffusely congested and edematous.

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No mass lesions or areas of consolidation are present. The

pulmonary vascular tree is free of thromboemboli. The

tracheobronchial tree is free of blood, edema fluid, or foreign

material.

CARDIOVASCULAR SYSTEM: The 540 g heart (upper limit of normal for

body length is 510 g; upper limit of normal for body weight is

521 g)

is contained in an intact pericardial sac. The

epicardial surface is smooth, with modest fat investment. The

coronary arteries are present in a normal distribution, with a

right dominant pattern. Cross sections of the vessels show

multifocal atherosclerosis, with 75% proximal and 75% mid

narrowing of the left anterior descending coronary artery; 75%

proximal narrowing of the 1

diagonal branch of the left

anterior descending coronary artery; 25% proximal narrowing of

the circumflex coronary artery; and 90% proximal narrowing of

the right coronary artery. The myocardium is homogeneous, red-

brown, and firm. The valve leaflets are thin and mobile. The

walls of the left and right ventricles are 1.2 and 0.4 cm thick,

respectively. The endocardium is smooth and glistening. Both

ventricular cavities are mildly dilated. The minimally

atherosclerotic aorta gives rise to three intact and patent arch

vessels. The renal and mesenteric vessels are unremarkable.

LIVER AND BILIARY SYSTEM: The 2565 g liver has an intact, smooth

capsule and a sharp anterior border. The parenchyma is tan-

brown and congested, with the usual lobular architecture. No

mass lesions or other abnormalities are seen. The gallbladder

contains a moderate amount of green-black bile and no stones.

The mucosal surface is green and velvety. The extrahepatic

biliary tree is patent.

SPLEEN: The 140 g spleen has a smooth, intact, red-purple

capsule. The parenchyma is maroon and congested.

PANCREAS: The pancreas is firm and yellow-tan, with the usual

lobular architecture. No mass lesions or other abnormalities

are seen.

ADRENALS: The right and left adrenal glands are symmetric, with

bright yellow cortices and gray medullae. No masses or areas of

hemorrhage are identified.

Kitzman DW, Scholz DG, Hagen PT, et al. Age-related changes in normal human

hearts during the first 10 decades of life. Part II (maturity): a

quantitative anatomic study of 765 specimens from subjects 20 to 99 years

old. Mayo Clin Proc. 1988; 63: 137-146.

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GENITOURINARY SYSTEM: The right and left kidneys weigh 205 and

225 g, respectively. The external surfaces are intact and

smooth. The cut surfaces are red-tan and congested, with

uniformly thick cortices and sharp corticomedullary junctions.

The pelves are unremarkable and the ureters are normal in course

and caliber. White bladder mucosa overlies an intact bladder

wall. The bladder contains approximately 80 mL of yellow urine.

The prostate is normal in size, with lobular, yellow-tan

parenchyma. The seminal vesicles are unremarkable. The testes

are free of mass lesions, contusions, or other abnormalities.

GASTROINTESTINAL TRACT: The esophagus is intact and lined by

smooth, gray-white mucosa. The stomach contains approximately

450 mL of dark brown fluid with innumerable soft fragments of

gray-white food particulate matter resembling bread. The

gastric wall is intact. The duodenum, loops of small bowel,

and colon are unremarkable. The appendix is present.

SPECIAL PROCEDURES:

Incision and subcutaneous dissection of the anterior and lateral

aspects of the wrists demonstrates no foci of contusion or

hemorrhage deep to the skin on the right. In the left wrist,

there is multifocal fascial hemorrhage, with approximately 3 mL

liquid blood accumulation, in the tissue surrounding the flexor

tendons. The exposed wrist musculature itself appears free of

injury.

An incision from the back of the head to the lower back,

extending onto both buttocks, is dissected subcutaneously to the

lateral aspects of the neck, the shoulders, and flanks. No

areas of subcutaneous hemorrhage, soft tissue contusion, or

other occult injury are found in the posterior neck, right and

left lateral neck, shoulders, back, flanks, or buttocks.

ADDITIONAL PROCEDURES:

 Documentary photographs are taken.

 Postmortem specimens collected and retained: vitreous

fluid, femoral blood, urine, liver, and gastric contents.

 Representative tissue biopsies are retained in formalin for

microscopic examination.

 The dissected organs are returned to the body.

 Pulled head hairs are placed in a labeled, sealed envelope.

AB/SB: 5/27/20

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MICROSCOPIC EXAMINATION:

HEART (3-5): Cross sections of left ventricular, right

ventricular, and interventricular septal

myocardium are examined and show the expected

microscopic architecture, with readily visible

boxcar nuclear changes in the septal and left

ventricular sections. Cross sections of coronary

arteries, though not all ideally oriented,

confirm the gross impression of atherosclerotic

narrowing.

LUNGS (6): Sections of right and left lung show generally

normal overall architecture, without malignancy,

pneumonia, granulomatous inflammation, or

polarizable intravascular foreign material. Many

small vessels contain rounded clear vacuoles,

consistent with bone marrow embolism from

cardiopulmonary resuscitation.

LIVER (7): No significant pathologic abnormality (marked

congestion).

SPLEEN (7): No significant pathologic abnormality.

KIDNEY (8): No significant pathologic abnormality (marked

congestion).

PANCREAS (8): No significant pathologic abnormality.

ADRENAL (9): No significant pathologic abnormality (marked

congestion).

SPLEEN (9): No significant pathologic abnormality (marked

congestion).

BRAIN (10-12): Sections of hippocampus, cerebellum, cerebral

cortex, and midbrain show the expected

microscopic architecture, without hypoxic-

ischemic, reactive, neoplastic, or inflammatory

changes.

LEFT PELVIC

MASS (1,2):

Decalcified (1) and routinely fixed (2) sections

show a proliferation of generally bland appearing

cells with small to moderate amounts of

eosinophilic cytoplasm and generally uniform

nuclei with neuroendocrine features. Occasional

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nuclei show mild pleomorphism, but mitotic

activity is not seen. Much of the tumor is

composed of cells in sheets, cords, and nests in

a carcinoid-like pattern; other areas vary from

vascular to sclerosed and fibrotic. Taken

together, the gross and microscopic (H&E-stains)

features of the lesion are most suggestive of an

extraadrenal paraganglioma. AFB and GMS stains

are non-contributory.

NOTE:

Many of the above tissue sections, particularly

those noted to have congestion, contain sickled-

appearing red blood cells.

NMS Labs

200 Welsh Road, Horsham, PA 19044-2208

Phone: (215) 657-4900 Fax: (215) 657-2972

e-mail: [email protected]

Robert A. Middleberg, PhD, F-ABFT, DABCC-TC, Laboratory

CONFIDENTIAL

Toxicology Report

Report Issued 05/31/2020 18:44

148889

Hennepin County Medical Examiner

530 Chicago Avenue

Minneapolis, MN 55415

To:

Patient Name

Patient ID

Chain

Age

Gender

Workorder

FLOYD, GEORGE

2020-3700

NMSCP59310

46 Y

Male

20159963

DOB 10/14/1973

Positive Findings:

Compound Result Units Matrix Source

Caffeine Positive 001 - Hospital Bloodmcg/mL

Cotinine Positive 001 - Hospital Bloodng/mL

4-ANPP 0.65 003 - Hospital Bloodng/mL

11-Hydroxy Delta-9 THC 1.2 001 - Hospital Bloodng/mL

Delta-9 Carboxy THC 42 001 - Hospital Bloodng/mL

Delta-9 THC 2.9 001 - Hospital Bloodng/mL

Methamphetamine 19 001 - Hospital Bloodng/mL

Fentanyl 11 001 - Hospital Bloodng/mL

Norfentanyl 5.6 001 - Hospital Bloodng/mL

Cannabinoids Presump Pos 012 - Urineng/mL

Amphetamines Presump Pos 012 - Urineng/mL

Fentanyl / Metabolite Presump Pos 012 - Urineng/mL

Morphine - Free 86 012 - Urineng/mL

See Detailed Findings section for additional information

Testing Requested:

Analysis Code Description

8050U Postmortem, Urine Screen Add-on (6-MAM Quantification only)

9096B Alcohol Screen, Blood (Forensic)

8210B Novel Psychoactive Substances (NPS) Screen 2, Blood

8052B Postmortem, Expanded, Blood (Forensic)

8756B Novel Psychoactive Substances (NPS) Screen 1, Blood

Specimens Received:

ID Tube/Container Volume/

Mass

Collection

Date/Time

Matrix Source Miscellaneous

Information

001 Lavender Vial 2.8 mL 05/25/2020 21:00 Hospital Blood

002 Gray Vial 0.6 mL 05/25/2020 21:00 Hospital Blood

003 Lavender Vial 5.75 mL 05/25/2020 21:00 Hospital Blood

004 Light Blue Vial 2.5 mL 05/25/2020 21:00 Hospital Blood

005 Green Vial 1.3 mL 05/25/2020 21:00 Hospital Blood

006 Red Vial 0.75 mL 05/25/2020 21:00 Hospital Serum or Plasma

007 Gray Top Tube 8.8 mL 05/26/2020 12:20 Femoral Blood

008 Gray Top Tube 8.8 mL 05/26/2020 12:20 Femoral Blood

009 Gray Top Tube 8.8 mL 05/26/2020 12:20 Femoral Blood

NMS v.18.0

Page 1 of 7

ID Tube/Container Volume/

Mass

Collection

Date/Time

Matrix Source Miscellaneous

Information

010 Gray Top Tube 8.8 mL 05/26/2020 12:20 Femoral Blood

011 Gray Vial 3.3 mL 05/26/2020 12:20 Femoral Blood

012 Yellow Vial 7.75 mL 05/26/2020 12:20 Urine

013 Yellow Vial 7.75 mL 05/26/2020 12:20 Urine

All sample volumes/weights are approximations.

Specimens received on 05/28/2020.

Detailed Findings:

Analysis and Comments Result

Units

Rpt.

Limit

Specimen Source Analysis By

Caffeine Positive 0.20 001 - Hospital Blood LC/TOF-MSmcg/mL

Cotinine Positive 200 001 - Hospital Blood LC/TOF-MSng/mL

4-ANPP 0.65 0.10 003 - Hospital Blood LC-MS/MSng/mL

11-Hydroxy Delta-9 THC 1.2 1.0 001 - Hospital Blood LC-MS/MSng/mL

Delta-9 Carboxy THC 42 5.0 001 - Hospital Blood LC-MS/MSng/mL

Delta-9 THC 2.9 0.50 001 - Hospital Blood LC-MS/MSng/mL

Methamphetamine 19 5.0 001 - Hospital Blood LC-MS/MSng/mL

Fentanyl 11 0.10 001 - Hospital Blood LC-MS/MSng/mL

Norfentanyl 5.6 0.20 001 - Hospital Blood LC-MS/MSng/mL

Cannabinoids Presump Pos 50 012 - Urine EIAng/mL

This test is an unconfirmed screen. Confirmation by a more definitive technique such as GC/MS is recommended.

Amphetamines Presump Pos 500 012 - Urine EIAng/mL

This test is an unconfirmed screen. Confirmation by a more definitive technique such as GC/MS is recommended.

Fentanyl / Metabolite Presump Pos 2.0 012 - Urine EIAng/mL

This test is an unconfirmed screen. Confirmation by a more definitive technique such as GC/MS is recommended.

Morphine - Free 86 25 012 - Urine LC-MS/MSng/mL

Other than the above findings, examination of the specimen(s) submitted did not reveal any positive findings of

toxicological significance by procedures outlined in the accompanying Analysis Summary.

Reference Comments:

11-Hydroxy Delta-9 THC (Active Metabolite) - Hospital Blood:

11-Hydroxy Delta-9 THC is an active intermediate metabolite of tetrahydrocannabinol (THC) the active

component of marijuana. Usual peak levels: Less than 10% of THC levels after smoking.

4-ANPP (Despropionyl fentanyl) - Hospital Blood:

4-ANPP (despropionylfentanyl) is a precursor chemical used in the production of fentanyl and is also a fentanyl

metabolite. It may be used in the production of other related compounds such as acetyl fentanyl, butyryl

fentanyl and furanyl fentanyl and may be a metabolite of these and other fentanyl-related compounds. It is

considered to be pharmacologically weak.

Amphetamines - Urine:

Amphetamines are a class of central nervous system stimulant drugs, with some therapeutic uses, and a high

potential for abuse.

This result derives from a presumptive test, which may be subject to cross-reactivity with non-amphetamine

related compounds. A second test is necessary to confirm the presence of amphetamine related compounds.

NMS v.18.0

CONFIDENTIAL

Workorder

Chain

Patient ID

20159963

NMSCP59310

2020-3700

Page 2 of 7

Reference Comments:

Caffeine (No-Doz®) - Hospital Blood:

Caffeine is a xanthine-derived central nervous system stimulant. It also produces diuresis and cardiac and

respiratory stimulation. It can be readily found in such items as coffee, tea, soft drinks and chocolate. As a

reference, a typical cup of coffee or tea contains between 40 to 100 mg caffeine.

The reported qualitative result for this substance was based upon a single analysis only. If confirmation testing

is required please contact the laboratory.

Cannabinoids - Urine:

Cannabinoids are chemical compounds derived from the plant Cannabis sativa (marijuana), including active

components, chemical congeners and metabolites. Delta-9-Tetrahydrocannabinol (THC) is the principal active

component.

This result derives from a presumptive test, which may be subject to cross-reactivity with non-cannabinoid

related compounds. A second test is necessary to confirm the presence of cannabinoid related compounds.

Cotinine (Nicotine Metabolite) - Hospital Blood:

Cotinine is a metabolite of nicotine and may be encountered in the fluids and tissues of an individual as a result

of tobacco exposure.

Anabasine is a natural product occurring in tobacco, but not in pharmaceutical nicotine and a separate test for

anabasine in urine can be used to distinguish tobacco from pharmaceutical nicotine use.

The reported qualitative result for this substance was based upon a single analysis only. If confirmation testing

is required please contact the laboratory.

Delta-9 Carboxy THC (Inactive Metabolite) - Hospital Blood:

Delta-9-THC is the principle psychoactive ingredient of marijuana/hashish. Delta-9-carboxy-THC (THCC) is the

inactive metabolite of THC. The usual peak concentrations in serum for 1.75% or 3.55% THC marijuana

cigarettes are 10 - 101 ng/mL attained 32 to 240 minutes after beginning smoking, with a slow decline

thereafter. The ratio of whole blood concentration to plasma concentration is unknown for this analyte. THCC

may be detected for up to one day or more in blood. Both delta-9-THC and THCC may be present substantially

longer in chronic users. THCC is usually not detectable after passive inhalation.

Delta-9 THC (Active Ingredient of Marijuana) - Hospital Blood:

Marijuana is a DEA Schedule I hallucinogen. Pharmacologically, it has depressant and reality distorting effects.

Collectively, the chemical compounds that comprise marijuana are known as Cannabinoids.

Delta-9-THC is the principle psychoactive ingredient of marijuana/hashish. It rapidly leaves the blood, even

during smoking, falling to below detectable levels within several hours. Delta-9-carboxy-THC (THCC) is the

inactive metabolite of THC and may be detected for up to one day or more in blood. Both delta-9-THC and

THCC may be present substantially longer in chronic users.

THC concentrations in blood are usually about one-half of serum/plasma concentrations. Usual peak levels in

serum for 1.75% or 3.55% THC marijuana cigarettes: 50 - 270 ng/mL at 6 to 9 minutes after beginning

smoking, decreasing to less than 5 ng/mL by 2 hrs.

Fentanyl (Duragesic®; Sublimaze®) - Hospital Blood:

Fentanyl is a DEA Schedule II synthetic morphine substitute anesthetic/analgesic. It is reported to be 80 to 200

times as potent as morphine and has a rapid onset of action as well as addictive properties.

It is reported that patients lost consciousness at mean plasma levels of fentanyl of 34 ng/mL when infused with

75 mcg/Kg over a 15 min period; peak plasma levels averaged 50 ng/mL.

After application of a fentanyl transdermal preparation (patch), serum fentanyl concentrations are reported to

be in the following ranges within 24 hours:

25 mcg/hour patch: 0.3 - 1.2 ng/mL

50 mcg/hour patch: 0.6 - 1.8 ng/mL

75 mcg/hour patch: 1.1 - 2.6 ng/mL

100 mcg/hour patch: 1.9 - 3.8 ng/mL

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Reference Comments:

Following removal of the patch, serum fentanyl concentrations are reported to decrease with a mean

elimination half-life of 17 hours (range, 13 to 22 hours).

The mean peak plasma serum fentanyl concentration in adults given an 800 mcg oral transmucosal fentanyl

preparation over 15 minutes is reported at 2.1 ng/mL (range, 1.4 - 3.0 ng/mL) at approximately 0.4 hours.

Signs associated with fentanyl toxicity include severe respiratory depression, seizures, hypotension, coma and

death. In fatalities from fentanyl, blood concentrations are variable and have been reported as low as 3 ng/mL.

Substance(s) known to interfere with the identity and/or quantity of the reported result: 4-methylphenethyl

acetyl fentanyl

Fentanyl / Metabolite - Urine:

Fentanyl is a DEA Schedule II synthetic morphine substitute anesthetic/analgesic. It is reported to be 80 to 200

times as potent as morphine and has a rapid onset of action as well as addictive properties.

This result derives from a presumptive test, which may be subject to cross-reactivity with non-fentanyl related

compounds. A second test is necessary to confirm the presence of fentanyl related compounds.

10.

Methamphetamine - Hospital Blood:

d-Methamphetamine is a DEA schedule II stimulant drug capable of causing hallucinations, aggressive

behavior and irrational reactions. Chemically, there are two forms (isomers) of methamphetamine: l- and d-

methamphetamine. The l-isomer is used in non-prescription inhalers as a decongestant and has weak CNS-

stimulatory activity. The d-isomer has been used therapeutically as an anorexigenic agent in the treatment of

obesity and has potent CNS-, cardiac- and circulatory-stimulatory activity. Amphetamine and norephedrine

(phenylpropanolamine) are metabolites of methamphetamine. d-Methamphetamine is an abused substance

because of its stimulatory effects and is also addictive.

A peak blood concentration of methamphetamine of 20 ng/mL was reported at 2.5 hr after an oral dosage of

12.5 mg. Blood levels of 200 - 600 ng/mL have been reported in methamphetamine abusers who exhibited

violent and irrational behavior. High doses of methamphetamine can also elicit restlessness, confusion,

hallucinations, circulatory collapse and convulsions.

*In this case, the level of methamphetamine determined has not been differentiated according to its isomeric

forms. Differentiation of the isomers of methamphetamine is available upon request.

11.

Morphine - Free (Codeine Metabolite) - Urine:

Morphine is a DEA Schedule II narcotic analgesic. In analgesic therapy, it is usually encountered as the parent

compound, however, it is also commonly found as the metabolite of codeine and heroin. In illicit preparations

from which morphine may arise, codeine may be present as a contaminant. A large portion of the morphine is

bound to the blood proteins or is conjugated; that which is not bound or conjugated is termed 'free morphine'.

Hydromorphone is a reported metabolite of morphine.

In general, free morphine is the active biologic agent. Morphine has diverse effects that may include analgesia,

drowsiness, nausea and respiratory depression. 6-monoacetylmorphine (6-MAM) is the 6-monoacetylated form

of morphine, which is pharmacologically active. It is commonly found as the result of heroin use.

12.

Norfentanyl (Fentanyl Metabolite) - Hospital Blood:

Norfentanyl is the primary inactive metabolite of the synthetic narcotic analgesic fentanyl.

Substance(s) known to interfere with the identity and/or quantity of the reported result: Benzyl Fentanyl

13.

Sample Comments:

001 Physician/Pathologist Name: Dr. Andrew Baker

Unless alternate arrangements are made by you, the remainder of the submitted specimens will be discarded one (1) year

from the date of this report; and generated data will be discarded five (5) years from the date the analyses were

performed.

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Daniel S. Isenschmid, Ph.D., F-ABFT

Forensic Toxicologist

Workorder 20159963 was electronically

signed on 05/31/2020 18:27 by:

Analysis Summary and Reporting Limits:

All of the following tests were performed for this case. For each test, the compounds listed were included in the scope. The

Reporting Limit listed for each compound represents the lowest concentration of the compound that will be reported as being

positive. If the compound is listed as None Detected, it is not present above the Reporting Limit. Please refer to the Positive

Findings section of the report for those compounds that were identified as being present.

Acode 50016U - Opiates - Free (Unconjugated) Confirmation, Urine

-Analysis by High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) for:

Compound Rpt. Limit Rpt. LimitCompound

6-Monoacetylmorphine - Free 5.0 ng/mL

Codeine - Free 25 ng/mL

Dihydrocodeine / Hydrocodol - Free 25 ng/mL

Hydrocodone - Free 25 ng/mL

Hydromorphone - Free 5.0 ng/mL

Morphine - Free 25 ng/mL

Oxycodone - Free 25 ng/mL

Oxymorphone - Free 5.0 ng/mL

Acode 52198B - Cannabinoids Confirmation, Blood - Hospital Blood

-Analysis by High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) for:

Compound Rpt. Limit Rpt. LimitCompound

11-Hydroxy Delta-9 THC 1.0 ng/mL

Delta-9 Carboxy THC 5.0 ng/mL

Delta-9 THC 0.50 ng/mL

Acode 52483B - Amphetamines Confirmation, Blood - Hospital Blood

-Analysis by High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) for:

Compound Rpt. Limit Rpt. LimitCompound

Amphetamine 5.0 ng/mL

Ephedrine 5.0 ng/mL

MDA 5.0 ng/mL

MDEA 5.0 ng/mL

MDMA 5.0 ng/mL

Methamphetamine 5.0 ng/mL

Norpseudoephedrine 5.0 ng/mL

Phentermine 5.0 ng/mL

Phenylpropanolamine 20 ng/mL

Pseudoephedrine 5.0 ng/mL

Acode 52484B - Fentanyl and Acetyl Fentanyl Confirmation, Blood - Hospital Blood

-Analysis by High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) for:

Compound Rpt. Limit Rpt. LimitCompound

Acetyl Fentanyl 0.10 ng/mL

Fentanyl 0.10 ng/mL

Norfentanyl 0.20 ng/mL

Acode 52488B - Designer Opioids Confirmation (2019 Scope), Blood - Hospital Blood

-Analysis by High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) for:

Compound Rpt. Limit Rpt. LimitCompound

2-Furanylfentanyl 0.050 ng/mL

4-ANPP 0.10 ng/mL

Acryl Fentanyl 0.050 ng/mL

Butyrylfentanyl 0.050 ng/mL

Carfentanil 0.050 ng/mL

Cyclopropylfentanyl 0.050 ng/mL

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Analysis Summary and Reporting Limits:

Compound Rpt. Limit Rpt. LimitCompound

Isobutyrylfentanyl 0.050 ng/mL

Methoxyacetylfentanyl 0.050 ng/mL

THF-F 0.050 ng/mL

U-47700 0.050 ng/mL

U-49900 0.050 ng/mL

U-51754 0.050 ng/mL

Valeryl Fentanyl 0.050 ng/mL

cis-3-Methylfentanyl 0.050 ng/mL

meta-Methylmethoxyacetylfentanyl 0.050 ng/mL

ortho-Fluorofentanyl 0.050 ng/mL

para-Fluorobutyrylfentanyl 0.050 ng/mL

para-Fluorofentanyl 0.050 ng/mL

para-Fluoroisobutyrylfentanyl 0.050 ng/mL

para-Methylmethoxyacetylfentanyl 0.050 ng/mL

trans-3-Methylfentanyl 0.050 ng/mL

Acode 8050U - Postmortem, Urine Screen Add-on (6-MAM Quantification only)

-Analysis by Enzyme Immunoassay (EIA) for:

Compound Rpt. Limit Rpt. LimitCompound

Amphetamines 500 ng/mL

Barbiturates 0.30 mcg/mL

Benzodiazepines 50 ng/mL

Cannabinoids 50 ng/mL

Cocaine / Metabolites 150 ng/mL

Fentanyl / Metabolite 2.0 ng/mL

Methadone / Metabolite 300 ng/mL

Opiates 300 ng/mL

Oxycodone / Oxymorphone 100 ng/mL

Phencyclidine 25 ng/mL

Acode 8052B - Postmortem, Expanded, Blood (Forensic) - Hospital Blood

-Analysis by Enzyme-Linked Immunosorbent Assay (ELISA) for:

Compound Rpt. Limit Rpt. LimitCompound

Barbiturates 0.040 mcg/mL

Cannabinoids 10 ng/mL

Gabapentin 5.0 mcg/mL

Salicylates 120 mcg/mL

-Analysis by High Performance Liquid Chromatography/Time of Flight-Mass Spectrometry (LC/TOF-MS) for: The

following is a general list of compound classes included in this screen. The detection of any specific analyte is

concentration-dependent. Note, not all known analytes in each specified compound class are included. Some

specific analytes outside these classes are also included. For a detailed list of all analytes and reporting limits,

please contact NMS Labs.

Amphetamines, Anticonvulsants, Antidepressants, Antihistamines, Antipsychotic Agents, Benzodiazepines, CNS

Stimulants, Cocaine and Metabolites, Hallucinogens, Hypnosedatives, Hypoglycemics, Muscle Relaxants, Non-

Steroidal Anti-Inflammatory Agents, Opiates and Opioids.

Acode 8210B - Novel Psychoactive Substances (NPS) Screen 2, Blood - Hospital Blood

-Analysis by Gas Chromatography/Mass Spectrometry (GC/MS) for: The following is a general list of compound

classes considered to be Novel Psychoactive Substances included in the Gas Chromatographic screen. The

detection of any particular compound is concentration-dependent. Please note that not all known compounds

included in each specified class or heading are included. Some specific compounds outside these classes are

also included. For a detailed list of all compounds and reporting limits included in this screen, please contact

NMS Labs.

Substituted Phenethylamines, Opioid Analgesics, Substituted Cathinones, Pyrrolidinophenones, Piperazines,

Tryptamines, Aminoindanes, and Benzofurans.

Acode 8756B - Novel Psychoactive Substances (NPS) Screen 1, Blood - Hospital Blood

-Analysis by High Performance Liquid Chromatography/Time of Flight-Mass Spectrometry (LC/TOF-MS) for:

Compound Rpt. Limit Rpt. LimitCompound

2-Furanylfentanyl 0.10 ng/mL

25B-NBOMe 1.0 ng/mL

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Analysis Summary and Reporting Limits:

Compound Rpt. Limit Rpt. LimitCompound

25C-NBOMe 1.0 ng/mL

25H-NBOMe 1.0 ng/mL

25I-NBOMe 1.0 ng/mL

3-Fluorophenmetrazine 5.0 ng/mL

3-MeO-PCP 5.0 ng/mL

4-ANPP 0.10 ng/mL

4-MeO-PCP 5.0 ng/mL

Acetyl Fentanyl 0.50 ng/mL

Acryl Fentanyl 0.10 ng/mL

BZP 10 ng/mL

Bromazepam 10 ng/mL

Butylone 10 ng/mL

Butyrylfentanyl 0.10 ng/mL

Carfentanil 0.10 ng/mL

Clephedrone 50 ng/mL

Clonazolam 5.0 ng/mL

Cyclopropylfentanyl 0.50 ng/mL

Delorazepam 5.0 ng/mL

Deschloroetizolam 2.0 ng/mL

Dibutylone 10 ng/mL

Diclazepam 20 ng/mL

Ethylone 10 ng/mL

Etizolam 10 ng/mL

Flubromazepam 20 ng/mL

Flubromazolam 5.0 ng/mL

Isobutyrylfentanyl 0.10 ng/mL

MDPV 10 ng/mL

MPHP 10 ng/mL

Meclonazepam 5.0 ng/mL

Mephedrone 10 ng/mL

Methoxetamine 2.0 ng/mL

Methoxphenidine 5.0 ng/mL

Methoxyacetylfentanyl 0.50 ng/mL

Methylone 10 ng/mL

Mitragynine 10 ng/mL

N-Ethyl Pentylone 10 ng/mL

Pentedrone 2.0 ng/mL

Pentylone 10 ng/mL

Phenazepam 10 ng/mL

Pyrazolam 5.0 ng/mL

TFMPP 10 ng/mL

THF-F 0.20 ng/mL

U-47700 1.0 ng/mL

U-49900 1.0 ng/mL

U-51754 1.0 ng/mL

Valeryl Fentanyl 0.50 ng/mL

alpha-PVP 2.0 ng/mL

cis-3-Methylfentanyl 0.10 ng/mL

meta-Methylmethoxyacetylfentanyl 0.50 ng/mL

ortho-Fluorofentanyl 0.10 ng/mL

para-Fluorobutyrylfentanyl 0.10 ng/mL

para-Fluorofentanyl 0.10 ng/mL

para-Fluoroisobutyrylfentanyl 0.10 ng/mL

para-Methylmethoxyacetylfentanyl 0.50 ng/mL

trans-3-Methylfentanyl 0.10 ng/mL

Acode 9096B - Alcohol Screen, Blood (Forensic) - Hospital Blood

-Analysis by Headspace Gas Chromatography (GC) for:

Compound Rpt. Limit Rpt. LimitCompound

Acetone 5.0 mg/dL

Ethanol 10 mg/dL

Isopropanol 5.0 mg/dL

Methanol 5.0 mg/dL

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