Second Lividity/Dual Lividity & Moving a Body During Partially Fixed Lividity

This is the third in a series of posts about livor mortis/fixed lividity (first post; second post). Livor mortis is the settling of blood in the lower (dependent) portion of the body, and fixed lividity is the point at which the blood becomes permanently settled. In my second post, I made two claims: (1) it is unlikely that a body could be buried on its side about five hours after death and exhibit solely anterior (frontal) lividity with no lateral (side) lividity; and (2) it is unlikely that a body could be on its side for about five hours after death and exhibit solely anterior (frontal) lividity with no lateral (side) lividity.

After receiving some correspondence from experts, I now feel even better about my first claim. I noted in my prior posts that it usually takes a minimum of six to eight hours for lividity to become fixed and that it sometimes takes up to twelve hours or more. Factors that could lead to lividity becoming fixed earlier would be hotter temperatures and/or victims with certain pre-existing medical conditions. Absent either of those conditions, it would be extremely rare for lividity to become completely fixed in under six hours. In colder temperatures, fixed lividity in under six hours would be even less likely.

I haven't, however, been able to get anything in the way of corroboration (or contradiction) with regard to my second claim. I'm clear on one thing: If a body were on its side for about five hours after death before being put face down, there absolutely could be some lateral (side) lividity in addition to anterior (frontal) lividity. This is known as a few things: a "mixed" pattern of lividity, second lividity, or dual lividity. 

This post will serve two purposes. First, it's a call for information from any readers with expertise in forensic pathology or related fields. If you have such expertise, I would love to know how likely it is that there would be a "mixed" pattern of lividity in such a case, assuming that this can be quantified to some extent (e.g., very likely, likely, possible, not very likely, etc.). Second, it contains various pieces of information that I've found about moving a body when lividity has become partially fixed.

As noted, lividity usually becomes fully fixed between 6-12 (or more) hours after death. Before lividity becomes fully fixed, however, it starts becoming partially fixed within a couple hours after death. At this point, the blood starts settling into the tissues and clotting. Unlike with fully fixed lividity, the blood can still move a decent amount, but it won't move as much as it would have moved soon after death. Therefore, if a victim's body is on its side for a few hours after death before being moved to a face down position, there can be a "mixed" pattern of lividity because some lividity remains in the side (first lividity) while some shifts to the front (second lividity). This is sometimes called dual lividity because there are two separate patterns of lividity. Here are some pull quotes from a number of sources on the issue:

From In the Still of the Night, (about the real life death of Ronda Reynolds):

The second witness explained lividity carefully to the jury. "The blood settles in and clots in the 'first lividity.' Then, in this case, there was a second lividity pattern when her body was moved hours after her death. So you had 'dual pattern lividity.'"

"Ron Reynolds has said he saw his wife alive at four-thirty to five A.M., and he called 911 ay six-twenty A.M.," Ferguson began. "Could she have fixed lividity in one hour and twenty minutes?"

"She had to have been dead for at least three hours for that first lividity to become fixed."

From the autopsy of Marilyn Monroe:

"[I]f a body lies for 3 hours dead and then is moved to another position, a second lividity will take place."

From Forensic Science:

"Dual lividity could occur if the body was kept in one position two hours after death and then moved to a second position before the lividity became permanent. This is not uncommon if a murder victim is killed in one place and then transported somewhere else."

From the Affidavit of Lee Anne Grossberg, M.D., in Kiniun v. Minnesota Life Insurance Company, No. 3:10CV00399 (N.D.Fla. 2011):

"If the livor mortis is only partially fixed, moving the body to a different position will yield a second lividity pattern."

From the Deposition of Bryan Mitchell, M.D., in Gayton v. McCoy, 2005 WL 5680034 (C.D.Ill. 2005):

"Based on the presence of rigor mortis of 50 percent and the presence of lividity, which is partially fixed, a five- to, you know, six-hour window is not an unreasonable time for time of death."

From the Affidavit of Cyril H. Wecht, M.D., J.D., in Schilling v. Baldwin, 2002 WL 33004188 (E.D.Wis. 2002):

Livor is usually evident within ½ to 2 hours after death, and it becomes fixed by 8 to 12 hours, under normal temperatures. When a body is cooled, fixation may be delayed up to 24 to 36 hours. Prior to fixation, if the body is moved to a new position, some of this blood will redistribute to the new dependent areas. The sooner the body is moved after death, the more blood will redistribute. However, if movement is delayed until almost the time of fixation, then little will redistribute.

From the Oral Deposition of Linda E. Norton, M.D., in Nicholas v. Boyd, 2006 WL 4076887 (D. Colo. 2006):

A....If he had been lying in a facedown position for just a few minutes, 20 minutes, maybe even 30 minutes, and then moved to his back, you wouldn't have any livor mortis remaining in the front of his body after the length of time that he was lying on his back.

But in this case we do. We have an incredible amount of livor mortis still present on the entire front of his body, which means that he was lying in a facedown position for an extended period of time before he was moved into this shower.

Q. How much time do you think?

A. Hours.

Q. Like 10 hours?

A. No.

Q. How many hours?

A. Two, three, four possibly. But we're not talking about a few minutes of lying on the front of your body. 

From the Affirmation of Cyril H. Wecht, M.D., J.D., in People v. Rivas, 1999 WL 35136325 (N.D.N.Y. 1999):

Prior to fixation, if the body is moved to a new position, some of the blood will redistribute, causing liver to be seen on more than one side of the body, depending on how soon after death the position is changed. For the most part, livor is not a good measurement in determining the time of death, but rather, it is better for determining if a body had been moved after death.

Based on all of the above, I feel like it's pretty likely to very likely that a body placed on its side for about five hours after death would still show signs of lateral (side) lividity even if it were subsequently placed face down and remained in that position when lividity became fully fixed. That said, I would love some corroboration (or contradiction) of my claim.

I think these issues of livor mortis and fixed lividity are interesting in any number of cases, including the case discussed in the Serial Podcast: the death of Hae Min Lee. The State's contention was that the 5'8" Lee was strangled, placed in the trunk of her 1998 Nissan Sentra for about five hours, and then buried in Leakin Park. The State's key witness said on at least one occasion that Lee was "pretzeled up" in the trunk (ostensibly on her side), which would seem to have to be the case because the rear passenger compartment of a 1998 Sentra was 48 inches wide. When Lee's body was discovered in Leakin Park weeks later, it was on its right side and had fixed frontal lividity.

As I said at the start of this post, I feel pretty strong in my claim that Lee could not have been buried about five hours after her death and experience fixed frontal lividity...unless she were buried face down and later repositioned on her side. This post also challenges the theory that Lee could have been on her side for at least about five hours in the trunk of her Sentra before being taken out. My claim is that she would likely have a "mixed" pattern of lividity under such circumstances, especially given that she was eventually found buried on her side. But I would definitely welcome any additional insight into this claim.

-CM