Fixed Lividity/Livor Mortis: A Medical Examiner Weighs in

This is my sixth in a series of post about livor mortis/fixed lividity (first post; second post; third post; fourth post; fifth post). I've made two claims: (1) it is unlikely that a body could be on its side for about five hours after death (e.g., in the trunk of a Sentra) and exhibit solely anterior (frontal) lividity with no lateral (side) lividity; and (2) it is unlikely that a body could be buried on its side about five hours after death (e.g., a right side burial in Leakin Park) and exhibit solely anterior (frontal) lividity with no lateral (side) lividity.

These claims have particular relevance for 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 by Adnan Syed, 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 trunk of the Sentra was probably about 52 inches wide. When Lee's body was discovered in Leakin Park weeks later, it was on its right side, which was consistent with the key witness's testimony on at least one occasion that Lee was buried on her right side but inconsistent with the body's fixed frontal lividity.

In my last post, I shared information that I received from (1) pathology residents who have completed extensive rotations in forensics; and (2) a former forensic medical investigator. In this post, I will share information I received from an assistant medical examiner. This information is largely consistent with the information I've already posted. On Monday, I will do a follow-up post that might even more fundamentally change the way that everyone is looking at this case.

Let's start with the usual caveat. I haven't Lee's autopsy photos, but Susan Simpson has, and she says that 

The only visible lividity is on the chest and neck. It is a bit irregular in shape, but symmetrical in coverage area and prominence on the left and right sides. No visible lividity in the limbs; there are no differences in appearance between the right arm and left arm, or right upper leg and left upper leg. No photos of lower legs to compare.

This is entirely consistent with the description of lividity in the autopsy report for Hae Min Lee. Obviously, it would be better for the experts to have these photos, but I'm leery of creating any chance that they get posted on the internet. 

Now, let's get to the details. The assistant medical examiner confirmed that lividity typically becomes fully fixed about 8-10 or 12 hours after death. That said, the weather was relatively cold in Baltimore on January 13th, 1999, especially as day turned into night and eventually the early morning hours of January 14th as an ice storm approached. According to the medical examiner, if Lee's body was indeed solely in the trunk and Leakin Park, her body processes would have slowed down, meaning that lividity easily could have taken more than 24-26 hours to become fully fixed. This is very much consistent with what I have found regarding the temperature dependence of lividity. For example, check out this answer by Dr. Daniel Spitz, in People v. Kukla, 2007 WL 7239973 (Mich.Cir.Ct. 2007):

Lividity is the pooling of blood after death. When the heart stops beating, the blood no longer circulates and it will begin to settle out within the body, and it settles to the dependent portions of the body. So if somebody is laying on their back, the blood will slowly pool to the back and it will discolor the skin and it will begin to give the skin reddish blueish, sometimes even a purplish discoloration. This is livormortis, and in a certain time period, the lividity will be blanching meaning that if you put pressure, if you touch the area of lividity, it will blanch, it will push that blood away and it will be a pale area, and then you let go of the skin and it then becomes the discoloration that was there previously.

After a certain amount time if you put digital press or finger pressure against that area of lividity, you don't get a blanching and in general terms you get a blanching, lividity up to maybe ten or 12 hours after death, and that is assuming a fairly comfortable room-type temperature. It is the temperature dependence of extremes of temperature, cold or hot, will change that time period. But in a general room-type temperature 10, 12 hours is the approximation of when you get, up to that point you get blanching lividity. Greater than that point the lividity becomes fixed.

According to the medical examiner, Lee's anterior (frontal) lividity is definitely inconsistent with being in the trunk for hours and is much more consistent with being dumped in the woods and not buried until days later. If Lee were dumped in the woods on her right side, it's possible that her torso fell over, causing her to be face down and producing the anterior lividity.

Speaking of the burial, let's assume that Lee were indeed buried in a six inch grave. According to the medical examiner, that's not even a grave; it is dumping the body and covering the body to hide it from detection. The medical examiner was very interested to know the depth of the grave in which Lee was found, but, unfortunately, I don't think that information (publicly) exists.

Understandably, the medical examiner was unwilling to state anything too definitive and thought that more information about the specifics of the burial would be important, even though such information would be unlikely to change anything fundamental about how to understand the lividity evidence.

-CM