Medical Examiner & Pathology Professor Leigh Hlavaty, M.D. on Livor Mortis, Rigor Mortis & Skin Slippage for Hae Min Lee

Last week, I forwarded the autopsy report for Hae Min Lee as well as her autopsy photos to Leigh Hlavaty, M.D., who is (1) the Deputy Chief Medical Examiner for the Wayne County Medical Examiner's Office in Detroit, Michigan; and (2) a Clinical Assistant Professor of Pathology at the University of Michigan. After she reviewed these materials, I asked for her thoughts about the evidence and arguments by the State regarding livor mortis, rigor mortis, and skin slippage at the trial of Adnan Syed for murdering Hae. In this post, I will set forth what I told and asked her, followed by her complete response.

Livor Mortis/Fixed Lividity

As I've noted in prior posts, livor mortis is the settling of blood in the lower (dependent) portions of the body after death, and fixed lividity is the point at which the blood becomes permanently settled. According to Hae's autopsy report, Hae's "body was [discovered] on her right side," and "[l]ividity was present and fixed on the anterior surface of the body, except in areas exposed to pressure." 

Given these findings, I asked Dr. Hlavaty to assess the credibility of the State's claims that (1) Hae was killed by 2:36 P.M. on January 13, 1999 and "pretzeled up" in the trunk of her Nissan Sentra for the next 4-5 hours; and (2) Hae was thereafter buried on her right side in the 7:00 P.M. hour in Leakin Park.

Rigor Mortis

As I noted in a prior post,

When a person is alive, her body produces Adenosine Triphosphate, or ATP, "the gas line that runs the movement of your muscles."  When that person dies, her body stops producing ATP, causing the muscles to start to stiffen about 8-12 hours later, with stiffening taking longer in colder climates. Then, however, about 18-24 hours after death, rigor begins to dissipate, and the decedent's limbs can thereafter easily be moved after it has completely dissipated, or "broken."

According to the Assistant Medical Examiner at Adnan's trial, when Hae's body was disinterred at about 2:00 P.M. on February 9, 1999, her body had "some rigor" that was "easily broken." Moreover, a notation made in connection with a photo of Hae's body right after it was disinterred indicated that "[r]igor appears to be fixed, probably due to temp." The autopsy on Hae was done the next day, and the autopsy report stated that that "[r]igor was broken to an equal degree in all extremities."

Given these findings, I asked Dr. Hlavaty whether it was possible that Hae's body still had "some rigor" on February 9, 1999 if she was in fact killed on January 13, 1999.

Skin Slippage

As I noted in a prior post,

skin slippage is a phenomenon which occurs when a body starts to decompose and the outer layers of the skin, outer epidermal layers separate from the underlying skin. Fluid accumulates underneath the skin surface and the skin breaks and slides off from the underneath layers of the deeper skin.

According to Hae's autopsy report, "[g]eneralized skin slippage was noted...." 

Given this finding, I asked Dr. Hlavaty about my prior post about Hae possibly having two patterns of skin slippage and what it could tell us about the hours/days after her death.

Dr. Hlavaty's Response

To me, the lividity looks fully frontal and fairly symmetrical with regards to areas of pressure.  These B&W photos are not ideal by any means. 

1. Anterior lividity means her body was in a fully anterior position for at least 8-12 hours in a temperate location (neither too hot nor too cold), so neither claim seems plausible.  If she was stored in a hotter environment the time could be less.  She was fully face down for a length of time and then placed in the grave.
 
2. If there is skin slippage the rigor should have already passed.  Given the temperature on the date she was found I think what is present is artifact from the cold and not actual rigor mortis.  
 
3. There are not two types of skin slippage and to describe such is trying to make something relatively unscientific more valid but in the end can discredit more than you want.  The skin is sloughing off the body at any point of contact.  Could be contact from being placed in the grave if she was buried at least 24 hours after death, from being buried in general, from being found and dug up, from being transported to the morgue, and from being undressed and photographed. 

The major problem as you know is the burial.  Burial delays the changes after death, the rough rule of thumb is one week exposed to air equals 8 weeks buried in dirt.  Bodies unearthed after several weeks usually look like they have been dead for only a few days.  Plus, you have freezing temperatures that must be considered and ultimately you need a lot of experience in interpreting postmortem changes in order to provide any useful information.
 
My short form is she was left face down somewhere for at least 8-12 hours and then placed in the grave after livor mortis had set because it and the grave position do not match.  The "rigor" is likely stiffening of the body due to the cold temperatures and not residual rigor, and the skin slippage is nonspecific and is completely what we see in bodies that have been buried.  She was likely buried soon after her lividity fixed as opposed to closer than when she was found, because the body is in such pretty good shape.

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-CM