A Scientific Approach to the Issue of Mark’s Blood Alcohol Level

As the tenth anniversary of my brother’s suspicious death draws near, this post considers a major problem underlying the insistence by the New York State Police that my brother caused the fire that took his life, specifically because he was very intoxicated.  In spite of evidence that Mark was attacked right where he normally parked his truck in the area off his driveway (see especially posts of May 29 and September 22, 2012), the authorities have adamantly maintained that he either deliberately poured gasoline or accidentally spilled it on himself after putting a gas can in the cab of his truck and backing the vehicle well into the field across the road.  The State Police acknowledged that they based this view on the very high blood alcohol level recorded in my brother's autopsy report.  But how carefully did they actually probe this issue?

Although the State Police emphasized that my brother’s blood alcohol level (actually a serum alcohol level) recorded in the autopsy report was a very high .25, Inv. Edward Kalfas never interviewed Mark's attending physician at the burn unit during the investigation.  However, when Atty. Michael Kelly met with Inv. Kalfas and Sr. Inv. John Wolfe in September 2005, he informed them of Dr. Edward Piotrowski’s comment to me that the .25 reading in the autopsy report had to be wrong.  Even Erie County M. E. Sung-ook Baik, who performed the autopsy, acknowledged to Atty. Kelly in a phone conversation that the .25 was too high, but explained that it was what the lab people had given him.  At their meeting with Atty. Kelly, the two State Police officials agreed that the issue of Mark’s blood alcohol needed to be clarified, and Wolfe said that he would speak with the doctor himself.  Yet he made no real effort to interview Dr. Piotrowski (see post of September 22, 2010).
 
When I brought to their attention Dr. Piotrowski’s statement that Mark's blood alcohol level should have been zero because of all the fluids pumped into him while he was at the Erie County Medical Center, three different New York State Police officials continued to maintain the validity of that .25 alcohol reading.  In late 2005, Sr. Inv. Wolfe claimed that the doctor was wrong, insisting that even if a person is flushed with fluids, alcohol still remains in the blood.  In early 2006, Capt. George Brown similarly dismissed the information from Dr. Piotrowski, maintaining that the technician involved in the testing would be an experienced professional and the doctor reading the results would know how to interpret them.  In early 2007, Lt. Allen insisted that Mark’s blood alcohol level was in fact .25, asserting that this reading had been obtained by blood taken from the heart, the liver, and vitreous humor.

As will be explained, the statements by Mr. Wolfe and Mr. Brown are questionable for various reasons.  The assertion by Mr. Allen is, in fact, simply wrong; he clearly misread the autopsy report.  Blood from the heart, vitreous humor, and the liver were used to screen for certain chemicals (as it turned out, all that emerged were used in treating Mark at the hospital); however, serum only was used to test for alcohol.  That in itself is problematic.

In 2012, I consulted a forensic toxicologist with a Ph. D. in Chemistry, who worked for many years in a state police forensic lab and served for some time as head of the lab.  The information he provided raises numerous doubts about the .25 reading of the autopsy report.  What follows summarizes most of the major points raised by this forensic toxicologist. 

First, the .25 in Mark’s case represents 250 mg per deciliter (i.e., 250 mg/100 mL or .25 g/ 100mL).  It reflects a serum alcohol, not a blood alcohol, level.  Serum as the liquid portion of the blood has 60% more water than blood, and the blood alcohol would be 16% less; in Mark’s case, the blood alcohol is thus .215 rather than .25.

Second, the reading was obtained from a “headspace” test, typically used by forensic toxicologists, but the toxicology screen indicates that only one test was performed.  That makes the results questionable.  At least two tests are regularly done in order to produce accurate results by checking one against the other.  There are two primary reasons for more than one test: fluids for testing can get contaminated, and there is movement of chemicals in the body after death different from what takes place in a living person.  In Mark’s case, one expected a second test using vitreous humor in addition to the one using serum.

Third, in assessing test results for a trauma victim, a blood alcohol test is routinely performed on the person while still alive in the hospital.  That test is then normally used to check against the post-mortem blood alcohol tests.  However, as Dr. Piotrowski mentioned, no blood alcohol test was performed on Mark while he was in the burn unit.  Interpreting Mark’s alcohol reading in the autopsy report is more complicated as a result.

Fourth, to determine the validity of the .25 serum alcohol reading, it is necessary to have the graphs and chromatogram information from the lab test.  One needs to have that information to determine how reliable the test actually was.  Lab technicians are also known to make mistakes transcribing data, such as blood alcohol levels, sometimes reversing digits, for instance. 

Fifth, the blood normally metabolizes alcohol at the rate of .015 per cent per hour, which would mean having to add .210 (i.e., .015 x 14 hrs. in Mark's case) to the blood alcohol level at the time of the autopsy.  Mark’s blood alcohol level at the time of the truck fire would then be calculated at about .425.  This very important point will be expanded below.

Sixth, infusion of I.V. fluids can dilute blood alcohol, but it depends on how much fluid has been infused into the individual.  Although fluids alone do not flush out the alcohol, they would speed the process up.  As this toxicologist put it, the combination of the I.V. fluids and the continued metabolization of alcohol during the fourteen hours in which Mark survived makes the .25 reading hard to believe.

Seventh, a person with a blood alcohol level over .40 would probably be in a coma.  This forensic toxicologist in his own experience knew of only one or two cases in which someone with such a high blood alcohol level could function.  He added that the kind of person who might function in that state would likely be fat.  By contrast, Mark was lean and muscular: he was normally around 175 lbs. (though the autopsy report lists his weight as 187) at 5 ft. 11 ½ in. (though the autopsy report in an obvious error lists his height as 67 ½  in., i.e., 5 ft. 7 ½ in.).

Eighth, there is no indication in the autopsy report that M. E. Baik consulted with Dr. Piotrowski, something he should have done.  The medical examiner could not draw proper conclusions about Mark’s death without knowing about his condition when he was hospitalized.
   
On the subject of the elimination of alcohol, recent scholarship has demonstrated that serious burn victims experience a hyper-metabolic state and thus eliminate alcohol at a faster rate, up to .031 g/100mL/h (see Wigmore on Alcohol, reference number 10808).  As calculations based on this work indicate, Mark would have had an even higher blood alcohol level at the time of the truck fire than he would have had if he had not been badly burned.  If the .25 is correct, one can conservatively assume that he would have had at least a .46 blood alcohol level at the time of the truck fire.  With such an extraordinarily high BAC, how could Mark have driven his truck virtually in a perfectly straight line down his driveway and fifty feet into the field?  People who are even moderately drunk normally weave around when driving a vehicle.  Yet at least two emergency workers on the scene that night noticed the tire marks in a straight line.  As explained in an earlier post, someone else must have driven that truck into the field (see September 22, 2012).
    
The toxicologist with whom I spoke last year informed me that if I gave him a copy of the lab work with information about the calibrations, he could tell if the alcohol test had been done properly and if it was valid or not.  As I informed him, however, I would not be able to provide that information.  It is frustrating and difficult to comprehend why, given the very suspicious circumstances of Mark’s death, I am not legally permitted access to his medical records, even though I am the closest living relative from his birth family.  It is only by chance that I obtained a copy of the autopsy report: just after it came out, Mark’s son Brian in a phone call to me emphasized that it ruled my brother’s death an accident and sent it to me.

In September 2005, Atty. Michael Kelly asked Sr. Inv. Wolfe to get the medical records in hopes of learning more specific information about Mark’s condition.  Mr. Wolfe told Atty. Kelly that he would ask Mark’s wife to release the medical records.  A few weeks later, Wolfe told me that Susan had not returned his call and that he would therefore go to the Salamanca High School and ask her in person to sign off on the medical records. 

Less than two weeks afterwards, however, Wolfe informed me that he was in the process of getting those documents by subpoena.  He did not explain why.  But after obtaining the medical records in that way, Wolfe basically stated that he saw no evidence of foul play in those sixty-odd pages (see post of September 22, 2010) and added that the wound on Mark’s forehead was “positional” (e.g., possibly caused when my brother was placed in the ambulance, though it is hard to believe that the deep soft-tissue swelling noticed by Dr. Piotrowski could have been inflicted in such a way). 

Having admitted to me that he was no scientist and that he had found the doctor’s handwriting difficult to decipher, Wolfe obviously did not know how to interpret properly the information in those records.  He should certainly have discussed the medical records with Dr. Piotrowski.  But, in any case, the information contained in the autopsy report and the medical records in general required scrutiny by someone trained in medical and scientific analysis.  I managed to find a forensic toxicologist willing to clarify issues related to the alcohol reading in my brother’s report.  Why didn’t Senior Investigator Wolfe, with the resources of the New York State Police at his disposal, consult a comparably qualified forensic toxicologist in one of their forensic labs?