Report Following a Public Interest Investigation into a Chair-Initiated Complaint Respecting the Death in RCMP Custody of Mr. Robert Dziekanski
Appendix T – Medical Assessments
An autopsy was performed by Dr. Charles Lee on Mr. Dziekanski on October 16, 2007. Dr. Lee stated in his autopsy report that the cause of death cannot be conclusively determined and that a pre-existing heart condition of Mr. Dziekanski combined with chronic alcoholism and being pinned in the prone position as he was being subdued, may have led to a fatal arrhythmia.204 Dr. Lee indicated as well that although Mr. Dziekanski was agitated, he likely did not suffer from delirium. The autopsy of Mr. Dziekanski found no trace of alcohol or drugs in Mr. Dziekanski's body. Dr. Lee ruled that the death of Mr. Dziekanski was best characterized as sudden death following restraint.
Subsequent to Dr. Lee's autopsy, Dr. Michael Pollanen, the Chief Forensic Pathologist for Ontario, was asked by IHIT investigators to review the autopsy findings of Dr. Lee and provide a second opinion on the findings. After reviewing the autopsy report and supporting medical documentation and evidence collected by Dr. Lee, as well as viewing video and photos, Dr. Pollanen concluded that:
- Robert Dziekanski did not die of the effects of a physical injury, the toxic effects of a drug, or an acutely fatal natural disease or condition. There are at least four variables that could be co-factors in death: an agitated state, restraint in the prone-position, the effects of a taser discharge and chronic alcoholism.
- Robert Dziekanski did not die of a taser-induced cardiac arrhythmia.
- There is competing scientific evidence on the putative adverse non-cardiac effects of a taser discharge in animals and man. If Robert Dziekanski's death was caused, in part, by the adverse effects of an agitated state, then we need to keep an open mind about the putative role that the taser discharge may have played in indirectly contributing to death, since Mr. Dziekanski appears more (dis)stressed and agitated after the deployment of the taser.
Dr. Pollanen encapsulated his conclusions as follows:
PUTATIVE CAUSAL
FACTOR OR CO-FACTOR |
SUPPORTIVE EVIDENCE |
DETRACTING EVIDENCE |
AGITATED STATE |
Video showing agitated and distressed state.
There is an association between sudden death and an agitated state (mostly in full-blown "excited delirium"). |
Unclear if the agitated state qualifies for full-blown "excited delirium".
No non-behavioural indicators of excited delirium (e.g. hyperthermia or rhabdomyolysis). |
RESTRAINT IN THE PRONE POSITION |
Video showing struggle and restraint in the face-down position.
There is an association between sudden death and prone position restraint during excited delirium. |
Short time interval of restraint mitigates against death from chest compression. |
TASER®
|
The video evidence shows that the agitation was enhanced after taser discharge. |
The video evidence excludes a fatal taser-induced arrhythmia. |
CHRONIC ALCOHOLISM |
Fatty liver and lack of ethanol in blood. The latter may be related to alcohol withdrawal.
Alcohol withdrawal may have contributed to the development of the agitated state. |
No evidence of acetonemia.
Beta-hydroxybutyrate level not measured.
No vitreous electrolyte studies performed. |
DILATED CARDIOMYOPATHY |
Dr. Lee has found evidence for this condition |
Not confirmed on this review. |
In addition to the autopsy reports, IHIT investigators also sought an expert opinion from Dr. Christian M. Sloan of Del Mar, California with respect to the potential effects of alcohol withdrawal, on Mr. Dziekanski. Dr. Sloan is a practicing emergency physician, certified by the American Board of Emergency Physicians. He is employed as an academic attending and assistant clinical professor at the University of California at the San Diego Medical Center. Dr. Sloan indicated in his report that he has taken care of numerous patients in various states related to alcohol, including alcohol intoxication, as well as the complete range of alcohol withdrawal; from mild tremors to fully developed major alcohol withdrawal as well as delirium tremens.
I did not find Dr. Sloan's opinion helpful in analyzing alcohol withdrawal as a contributing factor in Mr. Dziekanski's death.
Dr. Sloan concluded:
From what I have available to me, in my opinion, Mr. Dziekanski's condition on that evening could certainly be consistent with some degree of alcohol withdrawal. I believe that the time frames we are looking at would allow the development of alcohol withdrawal if he was habitually using in at least the week prior to his travel. By adding the condition of alcohol withdrawal to the milieu of agitated delirium that is witnessed on the video and described by those involved, or if it is solely due to alcohol withdrawal, is difficult to definitively determine, but placed him at risk for sudden death.
I note that found in Mr. Dziekanski's effects was an unopened 750-millilitre bottle of Vodka which Mr. Dziekanski could have opened and consumed at any point. He did not do so. As a result, I must question the assumption that alcohol withdrawal was an important contributing factor in Mr. Dziekanski's death.
204 See Heart and Stroke Foundation: Arrythmia is an abnormal heartbeat.