05x09 - Deadly Remedies

[bunniefuu]

[ominous tone playing]

[music playing]

NARRATOR A healthy -year-old boy is found

dead on his bedroom floor.

It was so sad.

Oh my goodness, how could this happen?

NARRATOR But as questions multiply,

it quickly turns into a case unlike any Dr.

G has ever faced.

DR. G It's really opened my eyes.

I just can't forget it.

NARRATOR Then, a young girl is struck by lightning,

and tragically does not survive.

And then the doctor is telling me this is it.

You know, I'm sorry Mrs. Chappelle,

Erica's no longer with us.

NARRATOR And suddenly, Dr. G must make a potentially

life saving decision.

That's one of the calls we get in the middle of the night

if you deny those organs, you know, people may die.

[music playing]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations, these are the everyday cases of Dr. G,

medical examiner.

[music playing]

-year-old, history of heart disease, let's see--

NARRATOR As chief medical examiner of the District

morgue in Orlando, Dr. Jan Garavaglia's days

are usually jam packed.

This is going to be a mess.

NARRATOR But if there's one thing she'll always make time

for, its consultations with fellow medical examiners,

like her good friend Norma Jean Farley.

And it's face down, and it's a strangulation.

Dr. Farley and I practice in different states,

but oftentimes, when either one of us

wants to bounce off ideas about a case,

we'll just both pick up the phone,

and drop what we're doing, and talk to each other.

We-- we think very much alike.

I really value her judgment, and she's an excellent pathologist.

NARRATOR They first met in the s,

at the Bexar County medical examiner's

office in San Antonio, Texas.

Back then, Dr. Farley was a pathology fellow,

working under Dr. G's guidance.

During the fellowship, Dr. G was one of my mentors.

I would often consult Dr. G about cases

that I may have had in the morgue,

any questions or anything I wasn't sure about.

NARRATOR And in the winter of ,

Dr. Farley sought Dr. G's advice on a case that

seemed impossible to cr*ck.

--at this point.

NARRATOR Little did either know,

it would soon become one of the most

confounding and emotionally charged

cases of both pathologists' careers.

I was just involved somewhat peripherally,

but I just can't forget it.

It was a child, and it was so sad and so unexpected,

that it's just never left me.

NARRATOR September, .

Danny Evans is years old and living with his parents

in San Antonio, Texas.

Like a lot of kids his age, he loves sports and video games,

but he also has a passion for music.

In fact, he spent much of the past summer teaching himself

to play electric guitar.

This is a happy, happy go lucky child with a nice family.

NARRATOR But as the school year gets underway,

parents Katie and Tom begin to notice a troubling change

in Danny's behavior.

He wasn't his normal self.

He's a little too hyper, and he was having

a hard time in school sitting still,

focusing, and concentrating.

NARRATOR Determined to get a better handle on the problem,

Danny's parents arranged for a consultation

with his pediatrician.

What they discover next changes their lives forever.

They finally got him diagnosed, and he had ADHD,

attention deficit hyperactivity disorder.

And there's certainly different variations of that,

but it's basically that these children

have a hard time focusing and concentrating,

and are very hyperactive.

NARRATOR The doctor prescribes Ritalin, a drug commonly

used to treat ADHD.

The effect on Danny is dramatic.

He was finally given the proper medication,

and, I mean, he reached his potential.

He was just a go getter, always adventurous.

And, from my understanding, he wanted to be a doctor.

And they were just so excited.

DR. G He went from a special ed kid

to a gifted and talented student.

So the family was very happy about his progress

with the medication that he was taking.

NARRATOR But their happiness is short lived.
[ … ]

Only three months after his diagnosis,

the unthinkable happens.

It's a chilly Monday morning and Danny's

running late for school, again.

His parents assume he's overslept as usual.

But stepping into his bedroom, Katie is startled to find

Danny crumpled on the floor.

He wasn't breathing, and he was cold to the touch.

They immediately called .

NARRATOR Paramedics arrive within minutes,

but they only confirm Katie and Tom's worst fear.

DR. NORMA JEAN FARLEY They did try CPR, because with children

we want to try so hard, you know,

to resuscitate them and bring them back.

But it was unsuccessful.

No, actually, I don't have an address.

I--

NARRATOR Medical investigator Steve Hansen,

who is also working in Texas at the time,

moves quickly to gather as much information as possible

about Danny.

This was a tragedy.

And I mean, everybody was upset about this.

Here's a kid that should be OK, and he d*ed basically

a sudden, unexpected death.

DR. G He's years old when he d*ed.

That's a very uncommon age to come into the morgue.

NARRATOR Danny's case promises to be tough.

But when his body arrives at the morgue,

Dr. Farley, on a one year fellowship at the time,

volunteers to do the autopsy.

As a fellow, I always try to be

in on the most difficult and interesting cases.

NARRATOR Now, as she pores over Danny's medical history,

one detail catches her eye.

Looking at the investigative report,

I saw the child was taking Ritalin, or methylphenidate,

for his ADHD.

NARRATOR Both Ritalin and its generic version,

methylphenidate, are widely used and considered very safe.

As she continues reading Danny's medical history,

she discovers an alarming piece of information.

The child had asthma.

Asthma as a chronic, lifelong lung disease.

Usually a person can live with the chronic part

of the disease, they may have some coughing,

but when they have an acute asthma att*ck,

then that's when it becomes life threatening.

The airways constrict, and they get inflamed, and you--

you have a hard time breathing.

It can k*ll you, especially if you don't have

a fast acting inhaler near you at the time

of your asthma att*ck.

NARRATOR But Dr. Farley must also

explore the ultimate tragic scenario

that Danny's untimely death involved no disease at all.

You know, we have a child that's dead.

And the sad truth of it is, child abuse is

still present in our society.

DR. NORMA JEAN FARLEY Even the happiest family

might be hiding dark secrets.

And in our field, we really know this.

NARRATOR As a mother of three children herself,

Dr. Farley understands all too well that the stakes are high,

and the answers may be grim.

But I don't let my emotions get in the way.

In the end, the family has to be held accountable

if we find something.

[music playing]

MAN [inaudible]

I think we're ready to go.

We look very closely at the outside of the body.

We look for any injuries to the body at that point,

and we also look for scars.

DR. G We're going to look for subtle marks,

because those marks might help us determine how he was hit,

and what he was hit with.

Is there anything that can give us a clue of what happened.

NARRATOR But soon, a subtle injury

catches Dr. Farley's eye.

Got a small, blue contusion here on the right chest,

right at the nipple.

OK, I got . centimeters.

I wasn't very worried about it.

This was a very small contusion, and it really wasn't

suggestive of any foul play.

That could just be from cardiopulmonary resuscitation

where they had EKG pads.

Looks like they gave him quite a bit of fluids when they

were trying to resuscitate him.

Hmm.

No other injuries neither to the abdomen or chest.

NARRATOR But after scouring Danny's

body for any hint of injury, Dr. Farley comes up empty handed.

He looked like a well developed,

well nourished -year-old, and the external really

didn't give us any hints.

NARRATOR Still, if there's one thing Dr. G and her team know,

it's that physical abuse can leave

surprisingly little evidence.
[ … ]

I will tell you that I've worked many cases where there

is not a mark on the child, and until the autopsy is done,

you don't know that the physical trauma is there.

DR. NORMA JEAN FARLEY Everybody ready?

We must rule out child abuse, we must rule out that something

happened to this child.

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[ominous tone playing]

NARRATOR At the Bexar County morgue in Texas,

forensic pathology fellow Dr. Norma Jean Farley

is determined to find out what, or who,

k*lled -year-old Danny Evans.

The police investigating this mysterious surroundings

of the death started suspecting the parents,

which were the last people to have seen him.

The parents were in a state of shock.

Couldn't even believe that they were actual suspects in this,

you know, the death of their son.

It was a nightmare for them.

NARRATOR But when it comes to the unexpected death

of a child, the forensic team has no choice but to explore

even the darkest scenarios.

The worst thing we can do is to assume things.

We ask what seem to be an awful lot of stupid, basic questions,

but--

but they turn out not to be.

Because these are the basic questions that we--

we really need to ask.

You really have to finish the internal examination

to rule out foul play.

I've been fooled before.

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So, we start with a y-shaped incision, which

comes across the chest in a v, and then a single line

down to the pelvic region.

I'm going to make a few cuts in the soft tissue, just make

sure there's no contusions that we're not seeing,

little bruises that might be hiding.

But I didn't see any soft tissue injury at all in this child.

There's no blood in any of the cavities,

there's no rib fractures that we can see.

So right now, I'm not seeing anything that

worries me that this is trauma.

NARRATOR To completely rule out foul play as a cause of death,

Dr. Farley still needs to examine

Danny's head for injuries to his skull and brain.

But for now, she continues her inspection

of his internal organs, looking for any sign

of natural disease.

DR. NORMA JEAN FARLEY I want to stay focused

on the organs of the chest.

And I was very anxious to do this,

because I wanted to take a look at the lungs,

since one of the main clinical clues

was the fact that this child had asthma.

NARRATOR Upon opening the chest plate,

Dr. Farley gets her first good look at Danny's lungs.

Really, these-- these lungs are

deep within the chest cavity.

They feel like they're a little bit heavy,

but they're not overexpanded at all.

Not what we typically would expect in a--

an acute asthma att*ck.

So maybe the fact that they were doing CPR

would push some of that air out of the lungs.

NARRATOR If that's the case, asthma

still may be the culprit.

To find out, she now extracts the lungs

to examine Danny's bronchi, the airway passages

that extend through the organ.

DR. G With asthma, you produce a overabundance of mucus.

You get a lot of mucus mixed with some eosinophils

or inflammatory cells.

And they plug up all those bronchi,

so you can see that they weren't able to exchange air.

NARRATOR She dissects the organ, inspecting every slice

for mucus plugs that could have robbed him of oxygen.

But the search is difficult.

Oh, well, the bronchi do car--

they have a little bit of a green tinge to mucus.

And that's pretty much all I found.

Hmm.

There really wasn't a lot.

There was a little mucus there, but it wasn't

like there was a plug of mucus.

Again, I had to remember though, this child had CPR.

And so could some of that mucus been moved out

of these smaller airways during the time they

were trying to resuscitate him?

So basically, we can't rule in or rule

out asthma at this point.

What I'm going to have to do is take microscopic sections

of the lungs, and multiple sections in different areas,

and see if I can prove this acute asthma

by the microscopic examination of the tissue.

Keep a little bit of this.

So maybe microscopics will give us something on this one.

NARRATOR Dr. Farley prepares the lung samples to send out

to a lab, where they'll be chemically

treated, mounted onto slides, and stained
[ … ]

for her examination.

But the process will take at least a week.

In the meantime, she still has a long way

to go on Danny's autopsy.

And next up is the heart.

Well, the heart looks normal within the sac.

Doesn't look too big.

Just to make sure, I'm going to go ahead and take the heart out

to make sure that there's no anomalies to the heart

or the great vessels.

NARRATOR Carefully, she removes Danny's

heart from his chest cavity.

And as she turns the organ over in her hand,

she makes a discovery that's completely unexpected.

DR. NORMA JEAN FARLEY Hmm.

There were some small contusions,

little tiny bruises or areas of hemorrhage,

on the surface of the heart.

Could be the cause of death of this child.

[ominous tone playing]

NARRATOR The baffling case of Danny Evans

is putting Dr. Farley to the test.

So far, she's uncovered two possible causes of death

an acute asthma att*ck and foul play.

But now, as she inspects the heart,

she finds evidence of a third possible k*ller.

Ah, now right here on the front of the heart,

there are scattered little contusions here.

See?

It's--

Some tiny ones there, like a myocarditis.

Myocarditis is an inflammation of the heart itself,

the tissue in the heart.

And it's usually caused by some type of infection, especially

a viral type infection.

And so this inflammatory process actually

injures and starts eating away at the heart,

and can result in fatal cardiac arrhythmias.

That could definitely cause death in a kid this age.

NARRATOR The symptoms of myocarditis

can resemble the flu, with fatigue,

fever, and a sore throat.

Oddly, this fits with a minor detail

in Danny's medical history.

About two weeks before his death,

he was diagnosed with a case of the flu.

But if myocarditis is the true culprit,

she can only prove it under the microscope.

So I typically put five pieces in different locations.

One more from here.

All right.

NARRATOR These samples will go to the lab, along with Danny's

lung tissue, and return as microscopic slides

in several days.

Only then can Dr. Farley determine

if the young boy d*ed of asthma, myocarditis,

or even something else.

But the autopsy is still not over.

She has one place left to look for evidence

of foul play Danny's head.

We start this, of course, by reflecting the scalp,

and looking, again, for any soft tissue

hemorrhages that may not have made it to the skin surface.

And there weren't any.

We also look at the skull itself.

All right.

And no skull fractures.

You see the suture lines, because this is a child,

and his head's still growing.

So they're all open, but no fractures at all.

Totally clean.

And there's no blood here, so there's

no signs of any kind of trauma.

I continued, and we removed the brain as well,

and I didn't see any abnormalities to the brain.

There was no evidence of any type of meningitis,

or inflammation to the membrane around the brain.

The brain is totally normal at this point.

We're not finding anything unusual.

NARRATOR With the cranial exam complete,

the entire autopsy comes to a close.

And looking back, only one thing is clear to Dr. Farley.

I have now totally ruled out foul play,

which I will relate to the investigative officer

on the case.

[music playing]

NARRATOR But for Danny's parents,

being proved innocent of child abuse

is small relief, compared to the agony of losing their only son."], index ,…}

They were just in a state of confusion.

They wanted to find out what happened.

I was hoping with a microscopic examination,

I would be able to give the family some type of answer,

some type of closure.

NARRATOR A long week after Danny's autopsy,

Dr. Farley gets the microscopic slides back from the lab.

So I do have two possibilities at this point asthma,

or it may be some type of inflammatory process

in the heart itself that caused a fatal, abnormal arrhythmia

that caused the child to die.
[ … ]

OK.

I began by looking at the heart, and looking

for the inflammation that I was hoping

would be there and prove myocarditis.

And I didn't see this.

Hmm.

And the heart looked totally healthy and normal.

NARRATOR Dr. Farley now knows that myocarditis

did not cause his death.

She immediately looks at another slide, this time

of Danny's lung tissue.

Mostly what I'm looking for is increased numbers

of white blood cells, especially eosinophils, which

is a type of white blood cell that we often

see and associate with asthma.

NARRATOR Asthma is similar to allergies

in that an att*ck triggers a flood of

inflammatory white blood cells.

If Danny d*ed from an acute asthma att*ck,

she would find a large number of inflammatory cells,

specifically eosinophils, saturating his lung tissue.

Slowly, she turns the dial, bringing

every cell into sharp focus.

And I did see some inflammation, mild to moderate

chronic inflammatory cells.

NARRATOR Danny Evans clearly had asthma,

but Dr. Farley isn't certain if her findings prove he

suffered a fatal asthma att*ck.

I then went through the other tissues, looked at the liver,

looked at the kidney, looked at the adrenal glands,

the pancreas.

I didn't see anything wrong with any of those tissues.

I then went to the brain, and looked at the brain,

thinking, you know, maybe I didn't see a subtle meningitis.

But there was nothing wrong with the sections of the brain,

either.

So after the microscopic examinations,

I'm still at a dead end.

I may never have the answers for this boy's family.

[ominous tone playing]

I just dictated this case, could you download it for me?

And let me know when it gets back, OK?

Sure.

Thanks.

NARRATOR At the Bexar County morgue in Texas,

Dr. Farley has hit a brick wall in her search for what

k*lled -year-old Danny Evans.

After the microscopic examinations,

I still don't have a cause of death in this child.

NARRATOR Weighing heavily on her mind

are Danny's parents, Katie and Tom,

whose anguish is growing each day as they wait for answers.

They just couldn't take the pressure.

It was a emotional strain on them of just

unbelievable proportions.

NARRATOR For their sake, and as a professional, giving up

is not an option.

Only twice since I've been a forensic pathologist

I've had to say this--

a death was undetermined, and I really don't like to do that.

NARRATOR She did find hints of asthma

in Danny's lung tissue, which leaves

the possibility, however slim, that asthma caused his death.

But as Dr. G's pathology fellow, she knows when it's time

to get a second expert opinion.

So at this point I decided to go up to Dr. G's office

and have her just quickly take a look at the slides,

and in particularly the lung slides,

and just make sure I wasn't missing

anything in my diagnosis.

At the time of this case, she's clearly the fellow,

I'm clearly the staff, and I have to help teach her.

But it was more than that, because we had hit it off.

I think we just had a mutual like of each other,

and whenever she had a question, she- she would--

she'd often come to me.

With Dr. G, I always felt comfortable that I

wasn't interrupting something.

She always made time to discuss the cases with me.

She was kind of on the fence whether it was enough asthma

or not, because she really wanted

to give the family the answer.

It was getting close to Christmas,

she really wanted to just put this to rest

and have some closure for the family.

NARRATOR Now Dr. G carefully scans Danny's lung tissue

for inflammatory cells and diffuse bronchial plugging,

which indicate an acute asthma att*ck.

I really wanted her to be able to find the acute asthma

I didn't see on those slides.

But when I looked at the slides, there wasn't--

there wasn't near enough acute changes.

So, unfortunately, I had to tell her that she just did not

have enough on that slide under the microscope

to say that's his cause of death.

It-- clearly, his cause of death was not asthma.

NARRATOR Doctor G's analysis is a huge blow to Dr. Farley,

and she's beginning to fear she may never find

closure for Danny's parents.

And I'm wondering where else I can go.
[ … ]

NARRATOR But then, Dr. G offers one last ray of hope.

What she told me was, Norma, wait for the toxicology,

it could have all the answers.

NARRATOR The chances are extremely small.

But there is the slight possibility

that a large overdose of Ritalin could have triggered

a fatal arrhythmia, a cause of death

that would have been impossible to detect in autopsy.

[music playing]

Unfortunately, toxicology at that time

took about three months to come back,

so it meant that the family was going

to have to wait before I'd have that result.

It was hard on the family.

They were just overwhelmed with the whole process.

I mean, the mother was in really bad shape.

But, we want the right answer, not the fast answer.

I just want to give them some type of closure.

So now I'm even more anxious to get

these toxicology results back.

NARRATOR A grueling month goes by, followed by another.

Finally, on a cloudy Friday afternoon in March,

the toxicology report on Danny Evans arrives.

Finally, I get the toxicology results

and I'm very anxious to see if there's

anything that could help me determine the cause of death.

And I'm expecting to see Ritalin,

because the child is on this for the attention

deficit hyperactive disorder.

But when the tox came back, it was a surprise to us all.

It was a shock.

[music playing]

[ominous tone playing]

NARRATOR At the Bexar County morgue in Texas,

a b*mb shell has just been dropped on the case

of -year-old Danny Evans.

This was a child with ADHD, who was on Ritalin.

And so I'm expecting to see Ritalin

in these toxicology results.

But, when we got the tox back, it

was a shock, because the toxicology

showed no Ritalin whatsoever.

DR. NORMA JEAN FARLEY Instead, I find

a drug I'm not even expecting.

I'm finding the drug methadone.

NARRATOR Methadone is a powerful central nervous system

depressant, a synthetic drug strictly monitored by the FDA.

It's almost inconceivable that the -year-old would have

access to it, because the drug's primary use

is to treat heroin addiction and chronic severe pain.

But Dr. Farley is startled to find

he not only had methadone in his system,

he'd ingested a huge amount.

The methadone level in this child

was . milligrams per liter.

That's not only lethal in a child,

but that's lethal in an adult. So at this point,

I do have a cause of death it's an acute methadone

intoxication.

NARRATOR Her discovery sends shock waves through the morgue,

and immediately sparks a barrage of questions.

How did he get the methadone?

What could possibly be the ways this child

could have gotten methadone?

Is he trading his Ritalin, which

is a stimulant, for the methadone, which is more

of a downer or a depressant?

You know, it's-- it's certainly--

methadone is certainly becoming a very common drug of abuse.

But we mostly see it in teenagers,

I've never seen it in one so young.

years old is pretty young to be using

methadone as a drug of abuse.

But maybe he didn't know what he was trading his Ritalin for.

Or is there someone in the family,

the mother or the father, maybe on the medication?

NARRATOR Dr. Farley and Dr. G call

the entire investigative team back into action,

launching an exhaustive search for the origin

of the dangerous pills that k*lled Danny.

All of a sudden, we get a call saying, we need to go back

and we need to find out why this kid had methadone.

Go back to the family and see if anybody in the family

was on methadone.

And there was no one.

Go back to the school and see, what kind of student

was this child, was he drug seeking in any ways.

DR. G But he's not the type of kid.

Everybody at school is baffled, and his family's baffled.

Nobody seems to know.

DR. NORMA JEAN FARLEY So, and then I started thinking, where

else would he get methadone?

Well, you know, one of the things we finally thought about

is, well, how about those pills that he

is supposed to be taking, has anybody checked those?

NARRATOR Danny's bottle of prescribed Ritalin

had been brought to the morgue with his body,

and left untouched ever since.

Looking at the label on the bottle,

I noticed right away that the name is correct,
[ … ]

but instead of Ritalin, which is what

I was told he was on, which is a brand name,

he was on the generic.

And that generic was methylphenidate.

NARRATOR Ritalin and methylphenidate,

both dr*gs are identical.

And it's common for doctors to allow a brand name

prescription to be filled with the cheaper

generic counterpart.

But in this case, Dr. Farley has a strong hunch

that this seemingly benign switch

triggered a deadly mix up.

If she's right, she'll be able to close

the three-month-old case for good, and replay for Danny's

parents the exact chain of events

that led to his tragic death.

It's PM on a Tuesday, time for Danny to take

his evening dose of Ritalin.

Over the past few months, the medication has transformed

his struggle with ADHD.

After being properly diagnosed and given

the proper medication, he went from being

in special ed classes to being an honor roll student.

A gifted and talented little boy.

NARRATOR His parents, Katie and Tom, couldn't be happier.

But recently, they've been dealing with an entirely

new health concern.

He was not himself.

He was always drowsy, and he would

start getting the cold sweats.

NARRATOR Alarmed by these new and perplexing symptoms,

they take Danny to the doctor.

He reassures them that it's only the flu.

But the diagnosis couldn't be more wrong.

Unbeknownst to anyone, Danny is actually feeling the effects

of a powerful narcotic--

methadone.

And Dr. Farley think she knows how it got into his system.

She immediately heads to the poison control office

with the contents of the pill bottle.

I pass the pill over to the poison control,

and within about minutes, they

were able to tell me what the medication was,

and it was methadone.

The methadone had been filled, most likely,

incorrectly at the pharmacy.

I could see how it might happen, methylphenidate,

methadone, both Ms, maybe sitting by each other

on the shelf.

And inadvertently you pick up the wrong one,

and you fill it in the prescription bottle.

When they refilled his prescription three weeks

before he d*ed, they had switched it from the brand name

to the generic of methylphenidate.

And the person who filled that prescription inadvertently

gave him methadone instead of methylphenidate.

Now, the family didn't pick up on the fact

that it was a different-appearing pill,

because they just thought, well, this is the generic,

it's a different shaped pill, a different color pill,

as it often is.

And the depressant effect of methadone

started almost immediately.

DR. NORMA JEAN FARLEY He's drowsy, they can't wake him up,

he seems always tired.

NARRATOR The symptoms grow worse

each day, because methadone has what's

known as a long half life.

And basically, a half life just means

the time it takes to get half of the drug

that you've ingested out of your system.

So the more he takes, the more methadone

he's accumulating in his system.

NARRATOR Frightened by his worsening condition,

Danny's parents rush him to the ER.

But again, an opportunity to identify this tragic mistake

falls through the cracks.

DR. NORMA JEAN FARLEY They even do a urine drug screen.

But most likely, the urine drug screen that they preformed only

looked for five or six different medications.

DR. G It's totally different in forensics.

The drug tests we do are confirmatory,

and they're the gold standard, and they're done in your blood.

The drug screen that you get in the emergency room

is very limited.

It's only designed to pick up the common dr*gs of abuse.

And methadone has to be looked at and asked for specifically.

And in this case, the drug screen panel

did not pick up methadone.

In the meantime, Katie and Tom continue

to follow the advice of Danny's doctor,

cutting the medication to half the original dose.

But, you know, he's been on methadone now

almost a month, so it's accumulating in his system

this whole time.

And on this night, it becomes too much for his small body,

and he has too high of a level of methadone.

He's breathing slower and slower,

until he stops breathing, and dies.

[ambulance siren]
[ … ]

NARRATOR Dr. Farley has put together almost

all the pieces, except one.

She calls the Texas State Board of Pharmacies

to confirm this tragic chain of events.

DR. NORMA JEAN FARLEY Methadone and methylphenidate

are both controlled substances.

So we kind of keep a good eye on them.

In fact, they do counts on this type of medication

to make sure no one's abusing the medications.

In this case, we did find out that they were short

on the methadone the exact number that they

prescribed to this child.

So it was clearly a pharmacy error.

Although they didn't do it on purpose,

they mixed up the name of methadone and methylphenidate.

Just a-- just a really bad, unfortunate circumstance.

Nobody wanted this to happen.

NARRATOR The State Board issues a fine and suspension,

and the case is settled out of court with the family.

But to the pharmacists, it isn't about the money.

Oh, it's sad.

You know, it was just a small mom and pop type of pharmacy,

they'd been in business for, you know, years.

And he was devastated that his business

caused the death of this child.

He was grieving just like the-- you know,

the family was grieving.

And he lost his business.

He-- he sold it.

NARRATOR For Danny's parents, the wounds cut even deeper.

DR. G Although the family was angry that these mistakes were

made, the pharmacy mix-up, the fact that it wasn't picked up

on the drug screen, the fact that no doctor could figure out

what was going on, ultimately they were very upset

that what caused his death was what

they were giving him to take.

It was through their hands that what

they gave him caused his death.

Each one of those pills had been cut in half, just

as the parents were told to.

They were following the directions

given to them by the doctor.

They wanted to do right.

And by continually giving those pills that they thought he

needed, they were k*lling him.

[door opens]

NARRATOR The impact of Danny's death

runs deep for both Dr. G and Dr. Farley.

This is one of those cases you walk away from

and you take with you the rest of your life.

When my children get prescriptions

now, or my husband, or myself, I actually do look at the pills.

I usually do it on every medication

that we get in the family, from-- just

because of this case.

DR. G I've been a medical examiner for over years.

I've worked on thousands of cases, well over ,.

Why this case stands out, why this case is one

that I can't forget, is that it was a surprising ending to me,

and a tragic involvement of the mother who loved him so much.

I'm a mom, and you want to do nothing

but good for your children.

[music playing]

NARRATOR The loss of a child is always tragic.

But Dr. G's next case gives her an opportunity

to turn tragedy into hope.

It's a beautiful case of a tragedy

that this family was able to turn around into something

very positive for other people.

[ominous tone playing]

[music playing]

NARRATOR In her career as a medical examiner,

Dr. G encounters astonishing stories every day.

And many of these stories stay with her forever.

This case actually very much stands

out my memory, because, you know, this shows you

how our lives turn on a dime, and how precious life is,

how fast it can be taken away from us.

[music playing]

NARRATOR It's August , , and fourth grader Erica

Chappelle is on her way home from school.

Erica Chappelle was just a healthy,

beautiful -year-old girl that was having an ordinary day.

NARRATOR Her mother Bianca still

remembers the rainy afternoon as if it were yesterday.

Erica and three other children had

gotten off of the school bus.

And my daughter Erica was taller than the rest

of the kids in her class.

And so she asked them, could she hold

the umbrella and everybody come under the umbrella with her.

They heard a cr*ck.

[thunder strikes]

She directly got struck by lightning.

NARRATOR Rescue workers arrived just

minutes later to find that Erica has no pulse

and is not breathing.

CPR is done on her for about minutes

before her heart rate returns, but unfortunately,

during that time her brain wasn't getting enough oxygen.
[ … ]

NARRATOR When Erica arrives at the hospital, she's in a coma.

Her chances of survival are slim,

but doctors refuse to give up hope.

BIANCA CHAPPELLE They were trying to regulate her vitals

and figure out how-- where we were going to go from there.

Really didn't have a lot of answers,

other than keeping her stable, monitoring

her heartbeat, and her respiratory, and all of that.

[music playing]

NARRATOR Hours pass, then a day, then two.

Still, Erica shows no sign of improvement.

To see your child in that kind of state and feel so helpless,

you know, not knowing what I was-- what the outcome.

I just didn't really know how to act, other than the fact

that I knew I needed to be strong for Erica,

and I needed to be strong for my family.

[music playing]

On the third day was when they came to us and said,

we have a test that we have to run on her.

And after that we'll be able to tell you whether or not

she's brain dead.

It was on August the th when the doctor ran the last test.

And then the doctor is telling me, this is it.

You know, I'm sorry, Mrs. Chappelle,

Erica is no longer with us.

NARRATOR Devastated at their loss, Bianca Chappelle

and her husband are now confronted

with one of the biggest decisions of their lives.

They came to us within probably

minutes of her passing, and they told

me her organs could be donated.

That part was hard.

But my husband and I, at that moment, together, looked

at each other and went, yeah.

We think that that is going to be a wonderful legacy to her,

to save someone else's life.

NARRATOR But before Erica's organs can be donated,

the organ procurement agency must get approval

from one more person Dr. G.

[music playing]

They have to call my office, because she

is an unnatural death, it's a traumatic death,

an accidental death, and I have to investigate that death.

NARRATOR She must decide if she can perform

a successful investigation without many

of Erica's vital organs.

It's an urgent situation, and every second counts.

With Erica's case, we have to make a quick decision,

so they can quickly get her into an operating room

and recover the organs before they're damaged any further.

NARRATOR She quickly runs through all the information

she has hospital records, police reports, and accounts

from her medical investigators.

There didn't seem to be any question about why she d*ed.

It was witnessed, she'd already had a CAT scan of her brain,

so there was really no questions left.

NARRATOR Dr. G is always eager to help save a life

by facilitating organ donation.

Occasionally, we have to put restrictions on it.

We may not let them open up the chest, let's say,

because that's where the injuries are.

We may not want them to open up the abdominal cavity.

A couple of times I've had to restrict them from not taking

the heart for heart valves, and restrict

them not to take the skin, because I

need to look at the bruises.

So I will occasionally have to put restrictions on them, if it

looks like there's foul play involved that I am still trying

to figure out what happened.

NARRATOR This time, the decision is easy.

Once the hospital gets the official sign off from Dr. G,

the usable organs and tissues are removed from Erica's body,

and she's transferred to the District morgue.

[music playing]

She has an incision all the way

down her chest and her abdomen, which they

made to get her organs out.

But when I see her, she's still a beautiful young girl.

Pretty, dark brown eyes.

She still has clear injuries and burns from the lightning.

.

NARRATOR And she anticipated, Dr. G is able to quickly

confirm Erica's cause of death.

It's clear she was a victim of a lightning injury.

The way people die from lightning

is usually an electrical event.

It harms the nervous system, and guess

what keeps your heart pumping?

It's that electrical component of the heart,

and so when that electricity splash comes over you,

it can stop your heart.

It was a cardiac arrest, and her brain didn't get enough oxygen."], index ,…}

DR. G [inaudible]

NARRATOR Dr. G's brief autopsy is now complete.

She records the cause of death as cardiac arrest as a result

of lightning strike.

But Erica's story is far from over.

They were able to use kid--

kidneys, liver, that the valves of her heart

were able to be used, that the corneas of her eyes
[ … ]

were able to be used.

So she saved three lives.

We got a letter from a -year-old girl who

lives in Tallahassee who said that she had received Erica's

kidney, and if she had not gotten Erica's kidney,

she would have d*ed.

And she told us that she loved us,

and that she was my daughter because she had

a part of my daughter in her.

And that just really, really--

it-- it made it all worth the while.

Erika was a person who I know all

through her life loved people.

She always had the attitude where she wanted to help.

So that's basically what keeps me going.

[water running]

NARRATOR To this day, the strength

of the Chappelle family is a continuous source

of inspiration for Dr. G.

You know, donating organs of a loved one

is a very personal decision.

And it takes a really special family, really special people,

to turn their own grief and tragedy around

to try to help somebody else.

[music playing]

(SINGING) Though you're desperate to the

believe [inaudible]

ANNOUNCER (WHISPERED) Atlas.