Final Autopsy and Toxicology Report

[missdottiepetite]

Hi all!
I've been following this case for a while; just thought I'd stop by and mention one or two thoughts, as some of the comments on this thread have concerned me a bit. I think we all need to really consider EL when we post on here, and respect her in what we post. There is generally a lot of stigma and ignorance in modern society with regards to mental illnesses, and it is disrespectful not only to EL, but to other sufferers to refer to any actions of those who suffer from a mental illness as "crazy", "insane", etc, etc. Although her actions might have been unusual to many onlookers, we should respect that if this was accidental or a suicide, in her state of mind at that point those actions would have seemed necessary and entirely normal. I can say from personal experience that it is entirely possible that EL missed one or two pills - particularly if on holiday - I'm on strong anti-depressants and I miss taking them once in a while for various reasons. That she missed taking these in the lead up to the elevator video is purely speculation!

I can completely understand both scenarios here, however just wanted to make sure that we're considering the real person in our debates!

(All IMO!)

 

[existential]

I noticed that she had Dexedrine Spansule capsules with no physician mentioned as prescribing it, and no pharmacy issuing them.

This is used to treat ADHD, and also can be used for narcolepsy. Elisa talks a lot about insomnia, so was wondering if these were the cause of her insomnia and why she was still being prescribed (if she was) an amphetamine if she was so affected by insomnia.

Psychiatric Adverse Events
Pre-Existing Psychosis: Administration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder. Bipolar Illness: Particular care should be taken in using stimulants to treat ADHD in patients with comorbid bipolar disorder because of concern for possible induction of a mixed/manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.

Emergence of New Psychotic or Manic Symptoms: Treatment emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without a prior history of psychotic illness or mania can be caused by stimulants at usual doses.

http://www.dexedrine.com/

Certain side effects could be serious. If you experience any of the following symptoms, call your doctor immediately:
seizures
slow or difficult speech
changes in vision or blurred vision
fast or pounding heartbeat
shortness of breath
chest pain
excessive tiredness
dizziness or faintness
weakness or numbness of an arm or leg
mood swings
believing things that are not true
unusually suspicious feeling of others
hallucinations (hearing voices or seeing things that do not exist)
frenzied or abnormally excited mood
aggressive or hostile behavior
abnormal movements
verbal tics
hives

As the drug isn't noted as being prescribed by a physician, I'm wondering if she used recreationally especially seeing how the capsules were loose.

 

[CarriAnna]

Just my opinion after reading all the threads and autopsy report and everything else. I have to agree that when I saw she had Dexedrine in her system along with the other meds, my feeling is she was hallucinating in the elevator. I've seen people with mental illness hallucinate. I had a neighbor who was schizophrenic and he used to talk and argue with his imaginary people. And he would even do it in elevators.

I don't think this was a suicide or a homicide. I think she was hallucinating from the drugs, she somehow made her way to the tanks. Maybe some maint person left one open. She might have hallucinated it was a bathtub, which would explain any clothing that was off. She got in and drowned. And the maint person might have later come back and closed the tank without even looking in it. And that was probably that. Just my feeling on it. And I'd be one of the first to be screaming there was a real person after her. I don't get that feeling from the elevator tape at all.

 

[xue-ping]

First post, be merciful.

Yes it is seen as "Shameful" by Chinese Community. Checkout my post name. Mental Illness is not fully understood in China and before marriage family history is often examined for evidence, no matter how scant, for things that can be seen as mental illness, this might even be supposed promiscurity or "political unreliability." It is not unreasonable that her parents would continue to deny this possibilty strongly as it can affect the marriage and employment prospects of their other daughter and grandchildren.

 

[xue-ping]

They cut a hole in the side of the tank because it obviously would have made removing a limp, lifeless body easier than pulling it from the square hole on the top of the water tank.

It's my strong contention that Elisa's tank was hinged, because the one directly in front of her tank, has a hinge on the lid. Not only that, but it is also my contention that the lid on Elisa's tank would have opened the same way as the tank directly in front of it also -- because the 2 tanks on the left of the photo are the exact same, as are the 2 tanks on the right side of the photo -- but one pair (the right) differ from the other (the left). The 2 tanks on the right have flat tops; the 2 tanks on the left have somewhat "coned" shaped top surfaces. If you rotate the tank Elisa was found in to match up the hole to the tank in front, you can also find that the hinged lid on Elisa's tank would have been propped open by the one big metal pipe that is connected to both tanks. Rotate Elisa's tank counter-clockwise and you will see what I mean. http://tieryas.files.wordpress.com/2013/05/elisa03.jpg

It's my contention that Elisa disrobed herself, dropped each article of her own clothing into the square hole of the tank, before entering the tank herself. Whether it was suicide or whether it was her state of mind, we'll never know for certain.

The lid, having been able to be propped upright (due to the metal pipe), could have simply shut on it's own or been accidentally closed by Elisa herself upon her entrance into the tank (i.e. her arm accidentally flipped/elbowed it closed once she dropped in).

I agree. I am not convinced of suicide and definately not convinced of murder, I am sure that lids are hinged as no one would want risk of them falling off roof 15 stories up. Why they were not padlocked I do not understand. The roof was not a secure space more "Grand Central Station" if the former security guard was to be believed. What drove Elisa Lam up there we will never know but I am sure it was not intentional or malicious.

 

[wendybtn]

I have to agree with Montjoy and sabpascu. There is nothing that makes me think any foul play happened to this young lady based on the autopsy or toxicology. It first appeared to me that she was carrying a lot of meds, but she was on an international trip. She only had 2 of the drugs detected and I do not know if they are at therapeutic levels. I wish the reports had been more descriptive of her behavior in the elevator, rather than saying it looked strange or paranoid. Also, someone mentioned not testing for as many drugs as Whitney Houston. They did. Miss Lam had none detected. It was mentioned that they didn't have enough blood for some tests they might have wanted done. It all went in the water, hence the odor and discoloration of the water.
All in all, a very thorough exam.

 

[Jaylight]

.....Speculation had also been made previously in relation to the water temperatures atop the cecil in late winter, and from that, it did appear if someone ended up in the tank, hypothermia would have kicked in fairly quickly.

Good point. Temperature in Los Angeles February 1, 2013 btwn 12:30 AM and 9 AM was between 50F to 60F. Certainly cold enough to develop hypothermia if you are wearing light clothing and standing in water up to or above your waist. In cases of moderate hypothermia, once body temperature drops below 95F, the heart slows and blood vessels widen, which makes the affected person feel confused and hot. Because of this, people with advanced hypothermia often remove some or all of their clothing.

Sources:
LA Weather Feb 1, 2013
http://www.wunderground.com/history/airport/KLAX/2013/2/1/DailyHistory.html

Hypothermia symptoms
http://www.climbing-high.com/hypothermia.html
http://www.mayoclinic.org/diseases-conditions/hypothermia/basics/symptoms/con-20020453

 

[fizzypop]

I am so interested in this case even though I fully agree with the final decision of accidental death. I think it's absolutely possible that she was having mental issues and went up to the roof and went into the tank herself and then couldn't get out. So it wasn't an accident in the sense that she got into the tank on purpose, it was an accident that she got into the tank and then wasn't able to get herself out. I don't think anyone was following her, no one killed her and carried her up there, all the weird behavior we could see and that we don't see (her going on the roof/into the tank) can be reasonably explained by a mental health crisis where she wasn't thinking in her right mind. It's the only thing that really makes sense to me, besides suicide, which actually makes less sense to me, because that would be a horrible way to die and I think if she was really intent on dying, jumping would have been a much more obvious choice.

 

[Montjoy]

I am so interested in this case even though I fully agree with the final decision of accidental death. I think it's absolutely possible that she was having mental issues and went up to the roof and went into the tank herself and then couldn't get out. So it wasn't an accident in the sense that she got into the tank on purpose, it was an accident that she got into the tank and then wasn't able to get herself out. I don't think anyone was following her, no one killed her and carried her up there, all the weird behavior we could see and that we don't see (her going on the roof/into the tank) can be reasonably explained by a mental health crisis where she wasn't thinking in her right mind. It's the only thing that really makes sense to me, besides suicide, which actually makes less sense to me, because that would be a horrible way to die and I think if she was really intent on dying, jumping would have been a much more obvious choice.

I agree -- but I think that homicide makes even less sense than suicide to me, and there is no evidence whatsoever that indicates homicide.

 

[fizzypop]

I agree -- but I think that homicide makes even less sense than suicide to me, and there is no evidence whatsoever that indicates homicide.

I totally agree. Homicide isn't even plausible to me. Accident? Definitely. Suicide? Weird, but could be. Homicide? Makes no sense, IMO. Glad someone else thinks this way.

 

[RoiPD86]

I completely agree with @Userid.

Also I'm a little bit confused as to why some people still seem to think she was murdered/raped/drowned in a tub and then transported to the water tank (???????) even though there's so much compelling evidence that her death was accidental and not traumatic. (@Montjoy warned me about this)

Isn't there like a conspiracy theories thread where people can post their wildest thoughts?

In all seriousness, the death was ruled as being accidental, there's evidence to support that as well as evidence to support that her death was not a homicide. And it's all in the autopsy report, y u no read the autopsy report?

I have been following this case and have worked in L.E. much of my life. I agree with @Userid and Sabpascu. It does a disservice to the family to post unsubstantiated and wild theories as to Elisa's death. There is no video and no foul play suspected given the entirety of the physical evidence, that being her body and the water tank. The physical evidence (as documented in the autopsy report) does not support a murder or some elaborate plot to drown a young woman in a different spot and then transport her to the water tank. The autopsy report wholly substantiates a drowning, that is it. This is no conspiracy laden mystery.

 

[neesaki]

I want to know how anyone thinks she was able to get into the tanks on her own, and through locked doors to the rooftop. Please explain how that was even possible. TIA

 

[LaborDayRN]

I want to know how anyone thinks she was able to get into the tanks on her own, and through locked doors to the rooftop. Please explain how that was even possible. TIA

Hotel employees admitted that the door was left unlocked. I'd have to go back and dig through the beginning of the case, but I believe employees smoked up there. I also recall a "broken lock" story. Getting in the tank? There's a ladder.

 

[neesaki]

Hotel employees admitted that the door was left unlocked. I'd have to go back and dig through the beginning of the case, but I believe employees smoked up there. I also recall a "broken lock" story. Getting in the tank? There's a ladder.

Thank you, LaborDayRN. I did read about that, and of course it was the employees stating that, so who is to be believed? So it still doesn't really hold water, IMO. Don't get me wrong, I'm not entertaining a "conspiracy" theory, I'm just not buying into that it was an "accidental" death .... or necessarily even a suicide. But that's just MOO.

 

[LaborDayRN]

While I'm still not convinced I appreciate your response, LaborDayRN.

You're welcome neesaki. I followed this case from the beginning but haven't posted in forever! Being an RN and familiar with psych patients, in the elevator video she appeared to me to be experiencing psychosis. She broke my heart then and now. I pray her family finds peace.

 

[neesaki]

You're welcome neesaki. I followed this case from the beginning but haven't posted in forever! Being an RN and familiar with psych patients, in the elevator video she appeared to me to be experiencing psychosis. She broke my heart then and now. I pray her family finds peace.

I agree she appeared to be having problems, but I still have serious questions that she may have been drugged. On top of the psychotropic medications she was already on, the effects would have been even more devastating. I also find it hard to believe she made her way up there and into that tank on her own. I have a really hard time with that one. But that's just me. Thank you so much for your input.

 

[Montjoy]

I agree she appeared to be having problems, but I still have serious questions that she may have been drugged. On top of the psychotropic medications she was already on, the effects would have been even more devastating. I also find it hard to believe she made her way up there and into that tank on her own. I have a really hard time with that one. But that's just me. Thank you so much for your input.

There was an autopsy performed with a tox-screen, and there was no evidence that she was drugged. This has been documented -- and discussed, ad nauseum.

 

[LaborDayRN]

Hi there! I will be happy to answer any questions. Please keep in mind that I am still learning and my clinical experience is somewhat limited given the fact that I have only seen only a handful of autopsies of bodies which were recovered from water.

Okay, first of all, when a body is recovered from water there are some questions that have to be answered by the autopsy findings. One of them and the most important is: Did death occur prior to or after entry into the water?

If the death occurred prior to submersion then the autopsy would reveal no water in lungs, lungs would not be hyper inflated and there would be signs of some other cause of death: natural, toxicological or traumatic.

If the death occurred after submersion you would have quite a few indicatives that would suggest it. One of them is the presence of secretions and foam in the respiratory tract, they are a mix of water, mucus and surfactant from the lungs that has been whipped up by respiratory efforts. This is a vital phenomenon that indicates the victim was alive at the time of submersion. While the foam disappears after a week from the moment of submersion, the secretions linger around for quite a while. This is why the medical examiner found scant secretions in Elisa's respiratory tract. Such secretions could also be found in case of head injury, heart failure or drug overdose but there are no indicatives that Elisa could have sustained neither of these.

Another sign is the presence of water in the lungs. If the body has been found in water and there is no other cause of death (head injury, drug overdose or heart failure which could also be causes of fluid in lungs) then it is obvious that the death occurred due to drowning because the presence of fluid in lungs cannot be reproduced by passive flooding of the lungs with water.

I believe this is how the medical examiner concluded that Elisa was alive when she entered the water because I have read about both these indicatives in her autopsy report.

About the lack of injuries due to her climbing into the water tank: was there a ladder she could have climbed in order to get into the tank? I don't know, if there was a ladder then that could explain why she has no injuries from the climb. Perhaps she was a skilled climber?

Could she have been carried into the tank by someone else? Evidence from the autopsy suggest that she was still alive when she entered it. This is just my opinion but how in the world could she have been carried into the tank while still alive without any signs of struggle? Also, presuming she was dead, how could she have been carried into the tank without any injuries? She weighed maybe like 45-50 kg so it would have been difficult for the presumed attacker to just carry her into the tank.

And generally, yes, drowning is a bit problematic to prove as a cause of death because the lack of characteristic signs and is largely a diagnosis of exclusion. However, the findings from the autopsy do not suggest any other underlying condition that could have caused the presence of fluid in lungs or secretions in the airways such as heart failure, nor was she under the influence of drugs or sustained a head injury.

Edit: they did note a small abrasion on her left knee. Also, in response to your question about the SAR dogs, my knowledge is that they wouldn't have picked up her scent because she was in a metal tank. Also it could have been a few days until this search was conducted so they wouldn't have picked up her scent especially if it had rained or something after her disappearance.

Just bumping this great post forward.

 

[neesaki]

There was an autopsy performed with a tox-screen, and there was no evidence that she was drugged. This has been documented -- and discussed, ad nauseum.

No evidence doesn't necessarily prove anything though. And, FWIW I totally admit that I don't know anything, I just question, that's what I do. I question everything. And IJMO that in this poor girl's case, there really haven't been any answers. And this kind of thing doesn't happen "accidentally". IMO, LE dropped the ball.

I just posted this in the other thread:

"limited sample availability"

And,

"circumstances...do not support intent to harm oneself"

http://www.pdf-archive.com/2014/02/24/el-autopsy/preview/page/10/

 

[Userid]

I want to know how anyone thinks she was able to get into the tanks on her own, and through locked doors to the rooftop. Please explain how that was even possible. TIA

The fire escape.

Also, the alarm may not have worked. People on youtube accessed the rooftop via the "alarmed door," and the alarm wasn't working. And employees admitted to using that door for smoke breaks, as one poster just noted.

The lids on the water tanks were unlocked at the time. There was a ladder that led to the roof of the service room (i.e. the highest point of the roof) right next to the water tank that Elisa was found in. She climbed the ladder, accessed the top of the tank from the roof of the service room, and removed the unlocked hatch from the lid. Not Rocket Science.