03x07 - Old Wounds Run Deep

[bunniefuu]

NARRATOR An elderly man who lives

alone dies under suspicious circumstances

during a brutal winter storm.

There's all sorts of trauma on his face, on his hands,

on his arm.

I see blood on the screen door, blood

mixed with mud on his face.

NARRATOR Who or what led to his tragic death?

He was a nice guy.

Everybody's saying he was a nice guy.

He had lots of friends.

Why would somebody just go in there

and b*at him up and throw him in the backyard?

NARRATOR And then--

[g*nsh*t]

--a g*nsh*t victim is paralyzed from the waist down.

But years after the sh**ting, he

dies unexpectedly at a clinic.

Just dead right there in the waiting room.

NARRATOR The question is, what actually k*lled him--

complications from his paralysis or natural disease?

That's the big question.

Because if the paralysis k*lled him, it's a homicide.

There's not going to be a statute

of limitations on m*rder.

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations--

these are the everyday cases of "Dr. G, Medical Examiner."

[theme music]

As chief medical examiner in Orlando, Florida,

Dr. G has had a number of fatalities attributed

to weather conditions.

It has been very hot here in Orlando.

I know it's, you know, considered paradise for some,

but it's been a little bit hot.

NARRATOR But one of her most troubling weather

related deaths occurred in , when

she was a medical examiner at the Bear County

morgue in San Antonio, Texas.

During that winter, a brutal ice storm swept into the area.

Temperature in the s, which was very unusual for Texas,

and everything was frozen over.

It was all over. It was cold.

It was icy.

It was raining.

It was sleeting.

NARRATOR In the storm's wake, Investigator Steve Hanson

is dispatched to investigate the deaths of several victims.

One of them is a -year-old man who

was discovered dead in his yard the morning after the storm.

OK, Steve, you were at the scene.

Yeah, the--

What's going on here?

NARRATOR Investigator Hanson briefs

Dr. G on what he's learned so far about the decedent.

His name is Richard Adler.

He's a -year-old widower and decorated

former m*llitary officer.

Stubbornly independent, he lived alone

with the help of part-time care, despite his advanced age

and a diagnosis of dementia.

Seems like an independent, dynamic guy

with a really good life.

He was doing OK.

He wasn't wheelchair bound.

He wasn't stuck with a walker.

You know, he's an ex-m*llitary officer.

You know, he's old school, and he was tough.

And you know, just that whole fact

of him wanting to live alone--

I mean, this was a man with dementia,

but he still wanted to live alone and try to take care

of himself as much as he could.

NARRATOR Which is why the circumstances surrounding

his death are so disturbing.

According to Investigator Hanson, earlier that morning,

Mr. Adler's caregiver Suzanne arrives at his residence

at AM as usual.

But she finds the front door wide open

and no sign of Mr Adler inside the cold house.

And I thought, well, it's kind of early for him

to be out this morning, leave that door open.

Keep in mind, it's in the s.

Not too many people should keep their front door open.

NARRATOR Worried, Suzanne searches outside for Mr. Adler,

who routinely went out to check for the mail every day.

JAN GARAVAGLIA She's looking all around for him,

cannot find him.

He's not in the house.

He's not in the front yard.

She's very worried about him.

NARRATOR As she approaches the backyard,

she notices the fence gate ajar.

And then she sees him.

Mr. Adler is sprawled face down on the frozen ground

at the foot of a cement patio.

His body is bloody, bruised, and he is clearly no longer alive.

It scared me real, real bad.

NARRATOR Investigator Hanson and the police

are dispatched to the scene.
[ … ]

Here we find this guy laying in the backyard,

and there's all sorts of trauma on his face, on his hands,

on his arm.

NARRATOR In addition, the back screen door is ripped

and there is blood in several locations.

You see blood on the screen door, blood

mixed with mud on his face.

His glasses were here.

There was a little blood on the lenses.

NARRATOR The death of the independent -year-old man

is immediately suspect.

Investigators' chief concern is that he may have been

victimized in a home invasion.

And they have good reason to be suspicious.

While robberies have decreased overall in the US,

at the time of Mr. Adler's death,

home invasion robberies, which typically target the elderly,

are on the rise.

Well, the first thing that comes to mind

is there's something wrong.

Here's a guy that shouldn't be in the backyard.

He should be-- you know, he's some odd years old.

And he's got trauma all over him.

Well, obviously, the first thing you do is stop and think.

Whoa, this has possibility of being a homicide.

So let's take it from there.

JAN GARAVAGLIA It was definitely

an ominous story at that point.

NARRATOR But based on photos taken at the scene,

Investigator Hanson points out that Mr. Adler may have simply

fallen off of the cement patio, which could have easily

contributed to his death.

This raised patio area right here, you can see this is icy.

Oh.

And you can see that his feet are--

NARRATOR Moreover, he finds marks

on the ground near the victim's feet,

which suggests that Mr. Adler was still alive after the fall.

So you can see at the scene, it looks like he

was moving around a little bit.

NARRATOR But whatever the ultimate cause of his death

may have been, it seems Mr. Adler met a dreadful fate.

When authorities informed the family of his death,

they are distraught over what he might have endured in the hours

he was alone at his home.

The main concern of his family is how long was he out there?

How long did he have to suffer?

Did he die right away?

He was a nice guy.

Everybody is saying he was a nice guy.

He had lots of friends.

Why would somebody just go in there

and b*at him up and throw him in the backyard?

NARRATOR Like any unexplained fatality,

the death of Richard Adler will require a full autopsy.

Thank you, Steve.

Yeah, I'll let you know what I find.

Poor guy.

NARRATOR Dr. G takes her first look at the elderly man's body.

It is muddy and covered with debris.

And as investigator Hanson noted,

it looks as if Mr. Adler struggled while on the ground.

His hands, too, show signs of a struggle.

Really crawling, really grabbing

at something in that mud.

You can see it's just caked on there with the blood.

NARRATOR Dr. G collects forensic evidence

from Mr. Adler's fingernails in the event he was att*cked.

Then to get a better look at his injuries,

the morgue technician strips the body and washes it of debris.

Once the body is cleaned, the trauma is evident.

But back of his hands really bruised,

over the knuckles bruised.

He's got a lot of dried blood, so he's clearly bleeding.

He also has bruising about his elbows,

some abrasion, and even a superficial small laceration

on that left elbow, bruise on the back of that left hand.

NARRATOR And on the back of his right hand,

Dr. G finds a deep tear.

JAN GARAVAGLIA He tore that skin.

It's almost eight-inch tear with a flap.

And so it's a bad tear and exposes

the ligaments in his hand.

NARRATOR The tear is so deep it would

have required extensive surgery to repair

it had Mr. Adler survived.

JAN GARAVAGLIA You know, this would have needed a skin graft.

We're down to his ligaments there.

NARRATOR The severity of the trauma

just adds to the burning question.

What did this man endure before he d*ed?

It could be that he's in, you know,

some kind of fight, some type of altercation.

You know, it wouldn't take much with this older fellow.

NARRATOR The external exam is coming to a close.

And Dr. G has made several key findings--

bruising, trauma, signs of a struggle.

But how Mr. Adler d*ed, how he was injured, and by whom

remains a mystery.

Solving this case will now fall to the internal examination.
[ … ]

We really have to see what kind of internal injuries

he has.

NARRATOR Coming up next, Dr. G opens Mr. Adler's body

and discovers his injuries are not just external.

We've got trauma.

NARRATOR When "Dr. G, Medical Examiner" continues.

Dr. G prepares to examine -year-old Richard

Adler internally.

The elderly man was found dead outside of his home

after a brutal winter storm.

The police are concerned about the possibility of a robbery

and as*ault. And his family fears

that he may have suffered through the night outside

in freezing temperatures.

But Dr. G still needs to perform the internal exam

to determine the exact cause of Mr Adler's death.

You don't know for sure until you finish the autopsy.

You never know.

You can have all the hypotheses in the world.

But what are the forensic evidence that point to it

or not point to it?

NARRATOR Dr. G opens Mr. Adler's frail, thin body

with a Y incision and examines his organs

in situ, meaning in their natural position

within the body.

JAN GARAVAGLIA The difference between a hospital autopsy,

usually, and a forensic autopsy or medical legal autopsy

is here with the forensic autopsy,

we have to look at everything in situ,

where-- how it lies in the body.

We are looking for trauma.

We're not looking for just medical problems.

We're looking sometimes at the chest wall.

We're looking at the abdominal wall.

NARRATOR And as she examines the body,

what is immediately clear is Mr. Adler's poor state of health.

His lungs show signs of emphysema, a chronic

and sometimes fatal pulmonary disease that is caused

by smoking in % of all cases.

His lung tissue is destroyed.

They are over inflated as if like it's

a balloon with trapped air.

NARRATOR And his heart is weakened from years

of accumulating plaque or atherosclerosis

in the coronary arteries.

Mr. Adler's diseased lungs and heart are troublesome.

If the circumstances of the scene were different,

Dr. G might conclude that Mr. Adler d*ed from a heart att*ck.

JAN GARAVAGLIA If he was just found dead in bed,

it would've been clearly a result of that heart

with that lungs.

But that's why you have to take everything in context.

NARRATOR In this case, the scene

suggests that Mr. Adler did not simply

die from natural disease, but that his death was due

to trauma, perhaps from an as*ault,

and that he d*ed while lying on the ground

during the frigid ice storm.

JAN GARAVAGLIA We really have to just see what kind

of internal injuries he has, and is

it consistent or not consistent with somebody b*ating him?

OK.

NARRATOR Next, she removes each and every organ from the body

so that she can inspect the inside

of the empty abdominal cavity for any internal injuries.

And there, she finds something unusual.

Mr. Adler has six broken ribs along his back.

I couldn't see it with the lungs in there,

is that he had some rib fractures that he broke.

We've got trauma.

We've got rib fractures on the left side

in kind of the posterior aspect of , , , , , and .

NARRATOR But the fractures are very unusual.

The six ribs are broken in a clean distinct line

which stretches to the spine.

And it's one after another in a line, very sharp.

And the ribs are slightly displaced.

And then the back is broken at T.

NARRATOR There is only one way that an injury like this

can occur.

The fractures are clearly not from a blow with a fist

or an object, but rather from an impact against a hard edge,

such as the lip of a cement patio.

You can almost see the line where he hit, really sharp,

and then it ends at the broken back.

So as he's going down, he hits against the side of that patio.

It'd would be very painful.

All of this would be very, very painful

and caused him to just lie there right there on the ground.

NARRATOR In a young person, a fall like this

might result in minor injury.

But in a -year-old, the fall is devastating.

Elderly, they're more--

falls are more dangerous for elderly

because they have more brittle bone.

Over time, both men and women lose

the strength of their bones.

They lose calcium out of their bone,

and they more easily break.

NARRATOR Dr. G now believes that Mr. Adler d*ed
[ … ]

from the trauma of the impact.

But based on the significant natural disease discovered

earlier, she concludes that Mr. Adler's heart and lungs

were most likely a contributing factor in his death after all.

If he breaks a bone, there's a lot of stress.

There's a lot of pain.

And it's cold, all of which is coming down on him to the point

where his heart doesn't have a lot of reserve.

So we definitely have an answer that trauma was involved

in his death, most likely from what we--

it appears here that he's fallen.

OK.

NARRATOR But if Mr. Adler d*ed in a fall,

this explains only one part of the bizarre and troubling death

scene.

Still unknown is what he was doing in the backyard

in the first place, why he fell, and whether the fall

occurred during an as*ault.

So we're sitting here going, OK, we've got trauma.

But why is he out here?

Why's the front door open?

So this is when we started trying to rebuild

what this guy was doing.

NARRATOR Though she's determined the cause of Mr.

Adler's death, Dr. G wonders if his body might still

hold the clues to understanding this complex and puzzling case.

Coming up next, Dr. G opens Mr. Adler's brain, searching

for anything that might clarify the unusual circumstances

of his death.

And she finally finds what she's looking for.

He's got actual loss of tissue of the portions of his brain.

NARRATOR And in Dr. G's next case,

it's one of the worst infections this medical examiner has ever

seen.

This man's got a black leg where the flies have laid eggs

in the dead tissue, and the maggots have hatched,

and they're eating it.

NARRATOR When "Dr. G, Medical Examiner" continues.

Dr. G's morgue assistant opens the skull

of -year-old Richard Adler.

During the internal exam, Dr. G has concluded

that the elderly man d*ed from trauma in a fall,

combined with a diseased heart and lungs.

But the cause of his death still doesn't explain

exactly what happened to him.

Why was Mr. Adler in his backyard?

Why was the front door ajar and the back door damaged?

Who or what caused his trauma?

Dr. G wonders if findings in Mr. Adler's brain

might help explain the troubling circumstances.

First, she inspects the top of Mr Adler's skull

to make sure he did not suffer any blow to the head

when he fell.

However, she finds nothing abnormal.

JAN GARAVAGLIA When I reflect the scalp,

I don't see any contusion or bruise.

NARRATOR Then she begins to examine the brain itself.

And here she does find an abnormality,

but it's not trauma.

It's brain atrophy.

Mr. Adler's brain has shrunken.

There are wide open abnormal gaps

between the gyri, the coral-like folds of the brain.

It appears that Mr. Adler's dementia was more significant

than previously thought.

He's got actual loss of tissue of his brain,

which is typical of what we would

see in advanced stage dementia.

NARRATOR Dementia is a disorder caused

by the death or impairment of nerve cells in the brain.

There are many kinds of dementia,

but the most common in people aged and older

is Alzheimer's disease, which typically

causes memory loss, confusion, agitation, and even depression.

It could be Alzheimer's.

I can't say by just looking, but most likely.

NARRATOR For Dr. G, the forensic evidence

of dementia in Mr. Adler's brain is critical to the case.

She believes that the finding of impaired brain function,

along with crucial information provided by Investigator

Hanson, finally provides answers to many

of the perplexing questions that surrounded Mr. Adler's death--

why he was outside, why the screen was torn,

how he was injured.

And more importantly, at the end of the autopsy,

Dr. G can now surmise how long Mr. Adler suffered while lying

alone on the ground.

Based on Investigator Hanson's report,

Dr. G knows that Mr. Adler's caregiver

left his home at approximately in the afternoon,

as she usually does.

Dr. G believes that sometime in the late afternoon,

Mr. Adler is drawn outside.

But it's not due to an intruder.

He most likely just goes to check the mail

and leaves the door ajar.

If you go and check the mail sometimes,

you don't bother closing the door

because you're just going in and out.

NARRATOR Despite the cold, Mr. Adler does not wear a jacket
[ … ]

or take his cane.

Here we've got a gentleman who's pretty mobile.

He can take care of himself.

But his dementia is starting to catch up with him a little bit,

and sometimes he forgets stuff.

NARRATOR But the day's mail has not arrived yet.

And it's perhaps at that moment that the elderly man suffering

from advanced dementia, as discovered in the autopsy,

suddenly becomes confused.

Rather than return inside through the wide open front

door, he walks around to the backdoor.

But it is locked, and Mr. Adler, once confused,

now becomes agitated.

He's panicking.

He's trying to get into the house.

He's trying the door and cuts himself on the back screen.

He's got blood in different areas.

He's trying the glass door, the screen doors.

He takes his glasses off that has a little blood on it.

So now he's not seeing as well.

NARRATOR Confused, blinded, bleeding from the hands

and knuckles, and cold, Mr. Adler

walks across the cement patio which

is covered with a patch of ice.

With his glasses off, he probably

does not even notice the surface is slick until it's too late.

He slips on the ice on the edge of the patio.

As he's falling down, he very sharply

on the edge of that concrete breaks ribs , , , ,

, and and breaks his back.

He gets on the ground.

He's still alive.

NARRATOR Mr. Adler is not paralyzed,

but the pain from his injuries is debilitating.

He's in a tremendous amount of pain.

He's not going to be able to breathe as well.

His lungs are already diseased, and the broken ribs

is causing him not to expand his lungs fully.

The stress of that situation would

put even more stress on his heart,

causing it to pump faster and harder.

NARRATOR The trauma exacts a fatal toll on the elderly man.

He struggles to breathe.

His heart, weakened by disease and the stress of the trauma

and cold, falls into a deadly arrhythmia

and then ceases to b*at.

Evidence from the autopsy and the scene

support the events that Dr. G believes

led to Mr. Adler's death.

This case definitely hinged on those findings at the scene.

We can never do an autopsy in the vacuum.

Sometimes the findings of the scene

tell us more than what the autopsy does.

NARRATOR The findings also tell Dr. G how long

Mr. Adler suffered in the cold, a pressing question

for his family.

JAN GARAVAGLIA The main concern of his family is how long he

was out there, did he suffer.

NARRATOR Based on the devastating extent

of his injuries and his poor health,

Dr. G believes that the frail, elderly man

likely succumbed quickly.

JAN GARAVAGLIA They were very relieved

to know that he didn't spend the night out in the cold suffering"], index ,…}

and that it was--

you know, I can't say that he d*ed, you know,

instantaneously.

I have to tell the truth.

And he was probably in a lot of pain,

but the pain didn't last long.

It was probably just a few minutes.

NARRATOR For Dr. G, the death of Richard Adler

is especially poignant.

It shows the difficult struggle that the elderly face

to maintain their independence as they age.

It's an issue that Dr. G has encountered

with her own mother, who, like Mr. Adler, lives alone.

JAN GARAVAGLIA And I clearly worry that she's going to fall

and nobody's going to be there.

But that's her decision.

She doesn't want to lose her independence.

She likes being in her own house,

and she has a right to make her own decision.

And I would just know I have to accept that.

I would rather have her fall and not be able to get up

than put her in a place that I know she's safe

but she's miserable.

So you know, you weigh it.

And every family makes a different decision.

NARRATOR Coming up next, a -year-old man

dies unexpectedly in an outpatient clinic.

He had terrible lesions on his legs.

NARRATOR But the cause of his gruesome death

may not be as obvious as it seems.

He has a clearly diseased heart.

NARRATOR When "Dr. G, Medical Examiner" continues.

For any forensic pathologist, working a m*rder case

is always a challenge, especially when the crime took

place nearly years earlier, such as Dr.

G's next case, Dennis Folton.
[ … ]

The body of -year-old Dennis Folton

arrived at the morgue yesterday afternoon.

We got a call yesterday from the nurse from the VA clinic.

And this unfortunate fellow was brought in by his family

for mental status changes.

And they didn't-- the VA really didn't know

much about him then.

NARRATOR As a first step, Dr. G reviews the investigator's

report to learn what information has been gathered

about the victim so far.

The report states that the decedent had been a paraplegic

for years, the result of a g*nsh*t wounds

suffered in his s.

[g*n sh*t]

Dennis managed his paralysis well for many years,

but his medical records indicate that in the past few months,

his health had begun to deteriorate.

Three weeks ago, Dennis was hospitalized due to infection,

chronic high blood pressure, and advanced coronary artery

disease.

He has a lot of problems with his paralysis,

as oftentimes they do.

He had recurrent urinary tract infections and very bad

bedsores that he was being treated for.

They also know he had a bad heart.

NARRATOR But as she reads further into the case file,

Dr. G learns that Dennis left the hospital

only a few days after his admission,

before his treatment was completed.

JAN GARAVAGLIA He left that hospital

not because he was cured, but because he wanted to leave.

He just kind of went out on a pass and never returned,

so they decided he was discharged

I guess against medical advice.

NARRATOR Then, only days after leaving the hospital,

Dennis is beset by illness.

He loses consciousness and his family cannot wake him.

JAN GARAVAGLIA He wasn't acting right.

He was looking really sick.

Basically, he was unable to be aroused.

NARRATOR His wife immediately rushes him to a nearby clinic

for care, but it is too late.

Dennis is already dead.

JAN GARAVAGLIA Just dead right there in the waiting room.

NARRATOR The case leaves Dr. G with several possibilities.

First, she considers Dennis' -year history of paralysis.

JAN GARAVAGLIA They're doing wonderful things

with people who are paralyzed now,

and they have a lot more to offer them.

Their lifespan used to be fairly short.

It still is not as long as we'd like it to be.

There are many, many complications.

And even living years out can sometimes be

a struggle, and years out.

And if you're not taking care of yourself--

you have to be really motivated to take care of yourself.

NARRATOR She also weighs Dennis'

history of heart disease.

During his hospitalization three weeks earlier, doctors

found that Dennis suffered from ischemic cardiomyopathy,

a critical reduction in blood supply

to the heart due to coronary artery disease.

JAN GARAVAGLIA We know he's got ischemic cardiomyopathy,

meaning the heart muscles are damaged.

Maybe he's just going into heart failure

and not getting enough blood into the brain.

NARRATOR Was it natural disease or a complication

of his paralysis that took Dennis' life so unexpectedly?

We have to look at what's going to cause

you to be slowly unarousable.

Could it be a lack of blood flow to the brain?

Could his heart be failing?

What is wrong with him that he can't be aroused?

NARRATOR The only way to find the answers

is through a full autopsy, beginning

with the external exam.

When Dr. G gets her first look at Dennis Folton's body,

she cannot believe its poor condition.

Basically, when you see him, these are bedsores--

the worst I've ever seen.

They start on his hip, especially on the right.

And his entire leg is necrotic and dying.

There is exposed bone.

The bone joint has been somewhat eroded from it.

It's obviously infected.

There's obvious gangrene.

And some of it's black.

Some of it's green.

He's got just a whole infected right leg.

It's partly necrotic and black and areas of--

some of it's dry gangrene.

Some of it looks wet gangrene.

NARRATOR From hospital records, Dr. G

knows that Dennis was treated for infected bedsores, also

known as decubitus ulcers, which are a common complication

of paralysis.

But Dennis' bedsores had clearly worsened

since he left the hospital.

His flesh has actually begun to decompose,

and it is infested with maggots.
[ … ]

JAN GARAVAGLIA There's actually even maggots

that have gotten into it.

I mean, flies have laid eggs and hatched in this wound.

And they're feasting on this dead tissue.

NARRATOR The infection is so severe,

it could have actually caused Dennis' death.

This possibility adds a new twist to the case.

If Dennis d*ed as a result of his infected bedsores,

it would mean his death was caused by a complication

of his paralysis.

And because his paraplegia was the result

of a sh**ting decades earlier, his death could

ultimately be ruled a homicide.

JAN GARAVAGLIA Even years later,

what caused him to get in a wheelchair

is going to be his cause of death

if he d*ed from the bedsores.

NARRATOR But with stakes this high, hunches aren't enough.

Before Dr. G turns this case over to the district attorney

as a potential homicide, she must

verify whether or not it was an infection

that k*lled Dennis Folton.

The nut that we have to cr*ck in each case--

and especially a very old one--

is did that criminal act cause this death,

even if it was much later?

NARRATOR To find out, Dr. G needs to complete the autopsy.

Coming up next, Dr. G opens Dennis' body

and discovers another possible cause of death.

I mean, it would be heart disease

that would k*ll most people.

NARRATOR But did it k*ll Dennis Folton?

When "Dr. G, Medical Examiner" continues.

Dr. G's morgue technician, Arden Monroe,

prepares the body of Dennis Folton

for the internal examination.

The -year-old paraplegic man d*ed yesterday afternoon

in a local clinic.

During the external exam, Dr. G found

that the victim's legs were massively

infected from bedsores.

It starts at his hip.

It goes down the back of his leg, even into his calf

is all black.

NARRATOR If she determines that the infected bed

sores from his paralysis actually k*lled him,

then the ultimate manner of Dennis Folton's death

could be homicide.

JAN GARAVAGLIA Whatever trauma caused him to be paralyzed,

that was the initiating event that

caused him to have bedsores.

And then we can relate the cause of death

back to the initiating event.

But we have to prove that the bedsores are what k*lled him.

NARRATOR Before the body of Dennis Folton is opened,

Arden Monroe washes the maggots off of the body.

Once the body is cleaned, Dr. G opens

Dennis' torso from the shoulder blades to the pelvis.

Immediately, she encounters scar tissue in his chest cavity.

It is undoubtedly from the g*nsh*t wound that

paralyzed him years earlier.

JAN GARAVAGLIA When I opened him up,

you know, normally your lungs sit nice and loose

in your lung cavity.

Your heart sits nice and loose in your pericardial sac

so it can b*at.

And your lungs sit nice and loose in the lung cavity

so they can move.

Well, in his case, he's got a lot of adhesions,

or fibrous tissue, between the surface of the lung

and the surface of the pleural cavity,

which is where the lung sits, and between the surface

of the heart and the pericardial sac,

which is where the heart sits.

Which tells me that he's had trauma in that area.

NARRATOR But also evident in the victim's body

cavity are visible signs of a raging infection.

JAN GARAVAGLIA You get an overall sense that his tissues

are kind of softened.

The tissues don't have the same nice healthy color to them.

A lot of it's because with the infection,

they have a lower and lower blood pressure.

And so he didn't look well on the inside,

just like he didn't look well on the outside.

NARRATOR But is the infection that

ravaged Dennis both externally and internally what k*lled him?

The answer can only be found under the microscope.

If there is an increase in white cells in Dennis'

internal organs, it would be a telltale sign

of a deadly infection.

But at this point, even without microscopic evidence,

Dr. G believes Dennis' cause of death is obvious.

You know, it's looking like this

is going to be complications of the paralysis

due to that g*nsh*t wound.

NARRATOR However, when she begins

to examine Dennis' heart, the course of the autopsy

suddenly shifts.

He has a clearly diseased heart.

It was enlarged, thickened.
[ … ]

He has diseased vessels to the heart.

The coronary arteries or blood vessels

that supply blood and oxygen in the heart were narrowed.

NARRATOR One coronary artery is % blocked

with atherosclerotic plaque.

Another, %, and yet another is % blocked.

See this one.

You can see where the blood is supposed to be.

And then if you go down, see where it--

there's not much left where the blood is supposed to be.

ARDEN MONROE OK.

Do you see it?

The only hole is right down there.

ARDEN MONROE It's tiny.

Tiny little hole left.

And all the blood is supposed to go through there?

Well, it can't.

NARRATOR It's evident that the blockage

has chronically reduced the flow of blood to Dennis' heart.

Dr. G now wonders if he simply succumbed to a massive heart

att*ck and not the infection.

JAN GARAVAGLIA It would be heart disease that

was bad enough, certainly, to have caused him to die suddenly

and unexpectedly at any time.

In a normal man in the right circumstances,

I'd have said he d*ed from his heart.

NARRATOR However, Dennis Folton is anything but a normal man.

His legs are black and gangrenous with infection.

So which caused his death--

an infection linked to his paralysis and g*nsh*t wound,

which would lead to a homicide charge,

or did he die from unrelated heart disease, a natural death?

There's only one way to know for sure.

Dr. G must scrutinize the samples

taken from Dennis' organs, including

his heart, microscopically.

Coming up next, slides are back from the lab,

and Dr. G faces a difficult ruling.

On that heart, I was particularly concerned

that there was nothing acute.

NARRATOR When "Dr. G, Medical Examiner" continues.

Dr. G has just received slides of tissue samples

she took a few days before while performing the autopsy

of -year-old Dennis Folton.

During the examination, Dr. G discovered

massively infected bedsores, a complication

of the victim's paraplegia from being sh*t years earlier.

However, she also found significant heart disease.

The question is, which actually k*lled him?

And that's the big question.

Because if the paralysis k*lled him, it's a homicide.

It's complications of that g*nsh*t wound.

NARRATOR Dr. G examines the slides of Dennis Folton's

heart tissue and other organs.

Under magnification, she finds no necrotic or dying

tissue that would indicate he suffered a fatal heart att*ck.

But in his liver and spleen are the unmistakable signs of

a life threatening infection.

JAN GARAVAGLIA He had a tremendous amount

of white cells throughout his body, a collection

of them in his spleen.

So he does have evidence that he had an overwhelming infection.

NARRATOR The forensic evidence points

to a death from infection, not a heart att*ck,

and so do the circumstances of the scene.

Dr. G's conclusion--

Dennis Folton's death is directly

linked to the sh**ting that paralyzed him years ago.

This case has become a homicide investigation.

Once I decide that this man d*ed from infection, which

was initiated from him being paralyzed,

I then have to contact homicide because it is a homicide.

His death is the result of the actions

of another, although delayed.

We don't get a lot of -year-old cases,

but the tragedy of homicide, the tragedy of as*ault,

battery, sex as*ault, it's always the same.

In the original crime, someone was injured.

Society was injured.

And it doesn't matter that time has passed.

We still have our duty to do.

I think we should not give people

a pass on k*lling someone, just because time has passed.

NARRATOR However, the investigation

into the sh**ting of Dennis Folton is short-lived.

Detectives soon discover that the man

who sh*t Dennis years ago has since passed away.

JAN GARAVAGLIA I remember the homicide detective

coming in and telling me that, you know, it's not going to go

anywhere and that the fellow that sh*t him

had actually done time and has since d*ed.

NARRATOR At the conclusion of the homicide investigation,

Dr. G has the information she needs to describe

the circumstances leading to the death of Dennis Folton, events

that spanned over years.

At age , Dennis Folton is sh*t in an altercation.

[g*nsh*t]

He survives the att*ck, but is paralyzed from the waist down

and confined to a wheelchair for years.

JAN GARAVAGLIA You could see the damage.
[ … ]

You could see the area where the b*llet went through,

but the b*llet was no longer there.

NARRATOR By age , the effects of his long term paralysis

are catching up with him.

Dennis suffers from numerous health

conditions, including heart disease and chronic infections.

He gets chronic urinary tract infections,

not an uncommon problem.

And he has these terrible bedsores.

NARRATOR Three weeks prior to his death,

Dennis is hospitalized due to infected bedsores

and other medical disorders.

But before his treatment is over,

he leaves the hospital without doctor consent.

JAN GARAVAGLIA He goes out on a pass

while he's hospitalized and never returns,

so they in absentia discharge him.

NARRATOR Without proper medical care, over the next three

weeks, the infection festers and invades

the bones of Dennis' legs.

You could see the bone.

It looked he had, you know, an infection of his bone,

an infection of his tissues.

NARRATOR Lured by the decay of rotting tissue,

common house flies lay eggs in his flesh.

Soon, the infection in Dennis' legs

spreads into the bloodstream, causing

a massive system wide infection of the blood, known as sepsis.

JAN GARAVAGLIA And that sets off a cascade of events, where

your body can't maintain its blood pressure

anymore because of the effects of the bacteria

inside your blood.

NARRATOR As his blood pressure plummets,

Dennis loses consciousness and falls into a coma.

By the time his wife takes him to the clinic for treatment,

his legs are teeming with fly larva,

and his vital organs are on the verge

of shutting down completely.

Within moments, his heart finally gives out,

and Dennis dies in the waiting room.

But by this time, the infection is so extensive,

it's likely nothing could have saved him.

Just like the death of -year-old Richard Adler,

the case of Dennis Folton demonstrates the importance

of both forensic findings and knowing the circumstances

of a death during an autopsy.

JAN GARAVAGLIA When you see that he's got necrotic wounds,

you see that he kind of slowly slipped

into a coma because he wasn't--

and previously not feeling well, feeling sick.

That's not consistent with dying from your heart.

It's consistent with, he's dying from the infection.

You always have to put it all together.

That's why you always have to know the circumstances.

You always have to know how are they feeling.

You know, a doctor has to take a history,

just like I have to take the circumstances

surrounding the death.

And basically, what that is, is your medical history of what

happened right before you d*ed.

Honestly, these kind of cases are why I exist.

There are so many unanswered questions at the beginning,

and you just pick through it.

You just find out the answers one by one,

and things fall into place.

OK.

MAN Atlas.