EvidenceProf Blog

Editor: Colin Miller
Univ. of South Carolina School of Law

Tuesday, February 24, 2015

The Autopsy Posts: Vascular Strangulation, Unconsciousness & the Unlikelihood that Hae Min Lee Spoke

Um [Adnan] told me he thought [Hae] was trying to say something while he was strangling her. Um he told me that she kicked like ah knocked off the ah windshield wiper thing in the car and that was it. Jay's first recorded interview 

While we're at the cliff, we're standing over looking a whole bunch of stuff at this cliff, you know. [Adnan] starts ah, telling me about how it was when he killed [Hae]. How ah, he said he ah, wrapped his hands around her and her throat and she ah, started kicking him, and he said he looked up to make sure nobody was looking in the car at him.  And ah, he said she, he was worried about her scratching him, getting her, his skin underneath her fingernails. And that ah, she was trying to say something. He said that he thinks that she was trying to say that she was sorry, but that's what she deserved and ah, that she had broken his heart. Jay's second recorded interview

This is my sixth post about autopsies following my firstsecondthirdfourth, and fifth post posts. Once again I will be looking at the autopsy report for Hae Min Lee. As I've previously noted, "based upon information I have now received from an assistant medical examiner and a pathology resident who has completed extensive rotations in forensics," the conclusion can be drawn that

2. It is highly unlikely that Lee spoke or even came close to speech if she were being fatally strangled.

So, how can this conclusion be drawn?

If you followed the Eric Garner case, you might have questions about this conclusion.

The Eric Garner case spurred a national debate after there was no indictment.

In that case, Garner died after New York City police officer Daniel Pantaleo "grabbed him by the neck and, with other officers, threw him to the ground and pinned him there." The cause of Garner's death was "the compression of [Garner’s] chest and prone positioning during physical restraint by police." You might recall that there was a big debate about whether Pantaleo had technically used a chokehold on Garner. Moreover, you might recall that there was an even bigger debate about whether a person who can't breathe can speak given that Garner repeatedly said, "I can't breathe" while being pinned to the ground. By the end of the debate, most seemed to agree that a person can speak even if he can't breathe. I won't go into the full details, but this basic explanation suffices:

When you take a normal breath you breathe in and out you are breathing about 500ml of air. After breathing out, you are left with ~2400ml of air inside your lungs, this is the Functional Reserve Capacity. If you try to force out as much air as possible, you can still force out ~1200ml more air. This is the Expiratory Reserve Volume. This is air you are able to speak with even if you cannot take a normal breath. Important Note: Notice that the Expiratory Reserve Volume is more than twice the size of a normal breath. That is a lot of air you are able to force out, and a lot of speaking you can do even if you can't breathe.


So, why am I saying that it was unlikely that Lee was unable to speak or come close to speech while being fatally strangled? The simple answer is that Garner's case wasn't your typical strangulation case. According to the Affidavit of James Claude Upshaw Downs, M.D., in Rodriguez v. Maryland, 2008 WL 8083398 (D.Md. 2008),

As is well known, asphyxiation by strangulation is almost always a vascular phenomenon with negligible direct involvement of the airway. The presence of the prominent mucosal and conjunctival hemorrhages is indicative of vascular compression with arterial flow (blood in) relatively preserved compared to venous return (blood out) resulting in ruptures of the small intervening vessels (capillaries) which manifests as such petechial hemorrhages. (emphases added),

How do we know that Lee's asphyxiation by strangulation was a vascular phenomenon? There are a few reasons, including the fact that Lee had a "[p]etechial hemorrhage of the lower left palpebral conjunctiva." 

A petechial hemorrhage of the left conjuctiva.

In a prior post, I went into detail on petechial hemorrhaging, noting that it is the result of "sustained pressure causing blood vessels in the face and eyes to burst" and is present in approximately 70-91% of strangulation victims.

At this point, you might be wondering how I can conclude that Lee likely didn't speak or even come close to speech if her strangulation was a vascular phenomenon. After all, Eric Garner did have an airway obstruction and was still able to say, "I can't breathe" for a minute or so while pinned to the ground. Paradoxically, however, that's the point. From the testimony of Dr. Daniel Spitz in People v. Grant, 2007 WL 5099802 (Mich.Cir.Ct. 2007):

Q. Now how long does it take for unconsciousness to occur?

A. Well, unconsciousness is a little variable depending on whether the primary component is a vascular compromise because of occlusion of the carotid arteries which run up the right and left sides of the neck or whether it's strictly related to an airway compromise because of a compressive force to the upper airway. If it's purely a vascular strangulation or a vascular component unconsciousness can result in as short as ten to fifteen seconds. If it's purely a airway compromise, unconsciousness may take a minute to a minute and a half. Many times in strangulation, because of the nature of the interaction, violent interaction between two people, it's often a combination of both mechanisms. Regardless of how long it takes for unconsciousness, death ensues over a many minute period with the average being about four minutes.

Q. Whether it be by vascular or by restricting the airway, once someone is unconsciousness and being strangled you would not expect any movement from that person, is that correct?

A. No, once unconsciousness occurs then that person would not be engaging in purposeful activity or being engaged in that altercation. (emphasis added).

In other words, because Garner had purely an airway compromise, he was still able speak using the air remaining in his lungs until he lost consciousness a minute or so later. Conversely, Lee was likely only conscious for a mere 10-15 seconds or so before being rendered unconscious. In addition to the above testimony, we can also look at:

1. Deposition Testimony of Melody Arangelovich, M.D., in Beemsterboer v. Joseph J. Duffy, Co., 2009 WL 6841619 (Ill.Cir.Ct. 2009):

In strangulation cases I can tell you if somebody holds the neck for about 10 or 15 seconds, you lose consciousness, and if they continue over 45 seconds, you're probably never going to recover....

2. Testimony of Noel Palma, M.D., from State v. Berube, 2006 WL 6435568 (Fla.Cir.Ct. 2006):

Now, normally or, in general, when somebody is strangled for about ten, fifteen seconds, you will lose consciousness, and, basically, you may live. 

3. Affidavit of Kirk V. Dahl, M.D., in Breslin v. Wisconsin Health Care Liability Insurance, 2014 WL 2435982 (W.D.Wis. 2014):

If there is an interruption of adequate perfusion of the brain tissue by blood, such as one might experience with strangulation, a very rapid loss of consciousness occurs, generally within a few seconds.

That said, there's no reason to go beyond Adnan's own trial to find this conclusion. Here's the testimony of Dr. Margarita Korell, the Assistant Medical Examiner who performed Lee's autopsy, from the first trial:

Screen Shot 2015-02-23 at 9.18.20 PM
Screen Shot 2015-02-23 at 9.20.33 PM 

Dr. Korell's testimony also explains the cause of unconsciousness/death in cases of vascular strangulation: pressure to the jugular veins and/or the carotid arteries prevents blood flow to the brain.

Compression of the carotid arteries is a leading cause of strangulation deaths.

So, where does that leave us? As I noted in my prior post, the blunt force injuries to Lee's head reflect blows that likely rendered her unconscious or at least stunned. These blows likely occurred just before Lee was strangled or while she was being strangled. Obviously, if these blows rendered Lee unconscious, she couldn't say or even try to say anything. If Lee were merely stunned from the blows, she probably had at most 10-15 seconds in which she could say or try to say something while in a stunned state and being strangled with enough force to cause petechial hemorrhaging. If you believe that Lee's blunt force injuries were caused while she was being strangled, her head was likely being banged against some object/surface during those 10-15 seconds.

Jay's statements from the introduction to this post reflect the Hollywood version of strangulation: a victim who has spurned her ex-boyfriend fighting against being strangled for quite some time before finally resigning and trying to offer up an "I'm sorry." The reality is that a vascular strangulation usually knocks the victim out in 15 seconds or less, and those precious seconds are usually filled with a violent struggle, rather than anything resembling the victim speaking. The way it was told to me, in the seconds before unconsciousness, the victim's only goal is to try to prevent her strangulation, which can result in injuries to the assailant but which also often results in the victim scratching or injuring her own throat, chin, or lower face. From the affidavit of Terri L. Haddix, M.D., in United States v. $1,026,781.61 in Funds From Florida Capital, 2012 WL 5363148 (C.D.Cal. 2012):

[I]njuries of the chin or lower face are common in manual strangulation as the victim attempts to protect his/her neck from the hands of the assailant by flexing his/her chin forward.

The lack of such scratches/injuries to Lee's throat, chin, or lower face suggests that Lee was already unconscious or stunned when her strangulation started or soon thereafter.

It's not the lack of air in Lee's lungs that leads me to conclude that Lee was unable to speak during her vascular strangulation; it's the lack of time.

[Update: Jay gave very similar testimony at trial, with some added embellishments. Here's the relevant portion of Jay's testimony from the second trial (2/4/00, page 142):

Screen Shot 2015-02-24 at 7.13.18 PM



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I've lost track now -- were these statements just in one interview, or did this come up in either trial?

Posted by: fn0000rd | Feb 24, 2015 2:35:32 PM

You've spent multiple paragraphs discussing something a guy thought he saw someone trying to say. Jay doesn't say that Hae said I'm Sorry. He doesn't even say Adnan said it happened. He said Adnan THOUGHT she was TRYING to say I'm Sorry. Adnan was infuriated that his girlfriend had dumped him. I'm sure the one thing he wanted to hear most was "I'm Sorry" and his brain probably convinced him it happened.

Posted by: SD Jones | Feb 24, 2015 2:42:43 PM

fn0000rd: The quotes that open this post are from Jay's 1st and 2nd recorded statements. He gave similar testimony at trial. I will update my post to include it.

SD Jones: This post isn't really about guilt or innocence. You could believe that Jay is lying or that Jay is accurately reporting what Adnan falsely claimed. The main point of this post is simply that the type of strangulation in this case -- vascular strangulation -- is quite different than one might expect.

Posted by: Colin Miller | Feb 24, 2015 4:11:24 PM

Thank you for your always thoughtful work. Could you correct the typo in your first paragraph after the Jay's interview excerpts where you say "perviously"? It sounds like you're calling yourself a perv.

Posted by: spaceboy | Feb 25, 2015 3:24:17 AM

In Jay's second recorded interview I thought he said "wrapped his hand around her throat" not "hands". It stood out, as it seemed inconsisent with that turn of phrase, and an odd detail if he were recounting a "hollywood" style scene.
I re-listened to that section a few times and I still don't hear that "s". Is this just me experiencing confirmation bias, (or others assuming he said the phrase correctly) as all the transcripts say "hands"? Grab would seem more appropriate when describing one hand but I guess that is subjective. But this could be him giving a truthful detail by accident when trying to repeat a phrase he had heard someone else using. There is some evidence of him doing this in his statements, making odd errors and using words he does not understand and which do not fit his usual speach patterns.
I thought it was another instance of Jay slipping, like when he slips to saying "I", or describing his perspective when relaying Adnan's reasoning etc. I thought it made sense, as strangulation with one hand could be more consistent with vascular strangulation (although the autopsy report is hardly detailed enough to know - convenient). But is doesn't really fit with Miss Lee kicking or trying to speak (which could have been suggested in that pre-interview to explain the broken turn signal lever, as it is very specific, and to link the murder to Mr Syed's supposed motive with the "deserved it" which seem odd for genuine last words).
I have training in interviewing and transcription (psychotherapy context) and these interviews by the police are clearly leading. But these small slips in Jay's tellings, and presumably his underlying thoughts (possible self-incrimniation in some cases) are most interesting to me in trying to descern what has been coached by police and what if anything (I have that much doubt in this investigation) approaches the truth.
I wish the police had asked him to clarify some of these things, but I guess this is the last thing they wanted to do.
Regardles of this minor detail of the potential missing hand here, it would be interesting to see if a more coherent accounting of events could be constructed from Jay's unconscious/unintended slips.
If it wasn't for some of these "I" slips and Jenn pointing the police towards Jay, I'd suspect the police made the whole thing up, and threatened Jay into telling a completely untrue story.
Also, the addition of the Allah mention for trial seems decidedly racist (assuming worst of Pakistani culture) and anti-muslim, along with so much else in this trial. Disgusting. This whole stinks to high-heaven.
I feel so sorry for the Lee famiy having this all dragged up again like this, but how did this case ever get to trial, especially when Jay should have been much easier to pin it on? I think the police wanted to close it quickly, as links to that very similar case eight months earlier were already being drawn in the press, but on every level this "case" seems dodgy. Maybe they thought that fear/hatred of muslims would fly better in that area than the go-to pin it on the black guy attitude and they really have no idea who did it.

Posted by: Becki | Apr 16, 2015 11:50:46 AM

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