C.S.I. Grand Rapids—The Real Deal

Presented by Dr. Stephen Cohle & Tobin Buhk, Chief Medical Examiner & Forensic Pathologist/ Teacher & Freelance writer (respectively)

About the Speaker

Stephen D. Cohle, MD (Grand Rapids, MI), a nationally recognized figure in the community of forensic medicine, is the chief medical examiner for Kent County, Michigan, and a forensic pathologist for Laboratory Pathologists, PC.

Tobin T. Buhk (Grand Rapids, MI) is a high school teacher and freelance writer. In preparation for writing their co-authored books, he observed and assisted Dr. Cohle and his forensic team in more than thirty autopsies.

Together, Stephen Cohle and Tobin Buhk have authored two books – “Skeletons in the Closet: Stories from the County Morgue” and “Cause of Death: Forensic Files of a Medical Examiner”

About the Event

Summary with commentary for the #262nd meeting of CFI- Michigan, held on October 8, 2008.

The topic for this meeting was Skeletons in the Closet; C.S.I. Grand Rapids- The Real Deal. This was co-presented by Dr. Stephen Cohle, Chief Medical Examiner and Forensic Pathologist, and Tobin Buhk, Teacher and True- crime writer. Dr. Stephen D. Cohle has nearly 25 years of solving forensic mysteries in his work at the Kent County Morgue.

In this presentation we were invited to take a peek into the Kent County Morgue and its skeleton laden closets, from which emerge sordid tales of serial killers; Jekyll and Hyde drunks whose Hydes turned into homicidal killers who have done bizarre things to conceal their victims’ bodies; and murderers who have left juries to ponder the question: By reason of insanity? Dr. Cohle and Buhk discussed, in their second book collaboration: Skeletons in the Closet: Stories from the County Morgue, the medical examiner’s role in criminal investigations, and some of the area’s most fascinating cases. The book was available for sale at this meeting.

Dr. Cohle began the presentation by showing us images of bodily wounds and we in the audience were asked to provide guesses as to which type of weapon was likely to have been utilized to attack and kill the victim. We used cues of shape, size and other physical characteristics of the wounds to make our determinations. We learned that, as to fracture characteristics, a long slim one indicates a weapon such as a two- by- four type board, for instance, whereas a depression in a spider webbed pattern indicates an attack from a hammer blow or other blunt trauma- inflicting weapon. Even the degree of savagery can be detected from the characteristics of blows/injuries. For example, randomness of areas of bodily trauma can indicate an uncontrolled attack, whereas targeted strikes to one area shows that more control was involved n the attack.

Dr. Cohle is a world renowned cardiovascular pathologist and has been involved in giving expert opinion on what heart conditions were present and what influence they had, if any, on the victim’s death. One high profile case that he was involved in was the Terry Shiavo one. Near the end of the book, there is a chapter called Things Ain’t Always What They Seem that features surprises where what at first appear to be open and shut cases, upon further examination turn out to be much more complex. The real cause of death is, in these cases, quite different from the obvious one. One death that was recounted in that chapter, where an expertise in heart conditions played an important role in getting to the real cause of death, involved what was deemed to be a drug overdose, initially. But upon further scrutiny, it was discovered that the dead woman had taken doctor- prescribed antidepressants at the correct dosage, but due to the condition known as postmortem redistribution, there was an elevated level of the drug found in the sample taken from her body. The class of medication she was on is known to result in an elevation of as much as three times what it should read as. When divided by three, it was at the normal range. However, it was also found that she had a heart anomaly where her coronary arteries were arranged incorrectly, which is a lethal condition. It was this condition, not a drug overdose, that resulted in her death.

Gunshot wounds can provide a fairly detailed report to the skilled medical examiner. Changing angles of entry wounds tell a tale of movement of the attacker and the victim, and signs of defensive movements will indicate if the victim saw his or her killer before being slain. Gunpowder residue tells if a gun was fired at close range or not. A stellate shape can occur when a bullet is fired after being placed against a skull, because the gas following the firearm discharge has no place to go.

One victim was presented by the killer husband as a suicide but there had been two gunshot wounds to the head. This is not the sort of inconsistency that goes by undetected, of course. However the appearance of more than one bullet hole cannot immediately be the last word on if the death resulted from homicide or suicide. To explain: one mysterious case involved what had all the earmarks of a suicide but with what appeared to be two bullet holes in the skull. This head- scratcher was cleared up by a more thorough medical examination when it was discovered that this was the result of what investigators call the keyhole effect. The suicide, Moore, shot himself at a severe angle to his skull; the skull being composed of three layers—the outer dense one, the inner dense one, and, sandwiched between these, a spongy layer. The bullet fragmented upon contact with the inner layer, so that one piece went on through his brain, killing him, while the other piece ricocheted off the inner layer and exited out his forehead, creating what looked at first like an a second entrance wound, instead of an exit one.

When exploring the skull and its contents for clues as to how death occurred, a Stryker Saw is typically employed; this saw has an oscillating blade and is employed to cut through bone, such as removing the skull cap—calvarium—before moving onto the dura, which is the protective membrane that lines the inside of the skull. Another type of pattern of skull injury that we were introduced to was one of generalized eggshell fractures, which is often the result of the head being run over by a vehicle.

Besides gunshot wounds (whether self- inflicted or as the result of a homicide) to the head, a concussion that does not crush or shatter the skull can yet lead to death by stunning the brain stem which controls breathing, causing it to cease to function.

Drowning, surprisingly for most laypeople, leaves no conclusive, tell- tale clues that prove that the victim aspirated water. Also, there are two types of drowning: wet drowning (water sucked in when victim can no longer deny the urge to take in the water as a reflex to attempt to draw in needed air)— and dry drowning, where the influx of water into the throat causes the airway to close; called a laryngospasm… with the result of a drowning victim but without the presence of water in the lungs. Determining if a person has drowned is a process of exclusion, where the medical examiner rules out any other possible cause of death and if drowning is left, then that becomes the prime culprit. Context is everything in such a process.

Drowning, however, is a violent process for the desperate person experiencing this terrible fate. It involves a great deal of thrashing, etc., which leads to depletion of ATP (adenosine triphosphate) from the muscle tissue, which causes a more rapid onset of rigor mortis (stiffening of the muscles). The body initially sinks but the next phase, involving the formation of methane gas inside the body cavity will generally cause the body to surface and this is termed a floater. The process of resurfacing can take longer in colder waters when the formation of gas stalls. Dr. Cohle deals, with some frequency, with drowning victims who are recovered in the icy waters of Lake Michigan. One such case was detailed in the chapter of the book called The Sea Shall Give Up Her Dead. Dr. Cohle and Buhk discussed this case at length with us as well.

The nude, unidentified body was found in March of 2004 in Pigeon Lake, just north of Holland, in an advanced state of decomposition that had obliterated everything: age, height, weight- everything except for the victim’s gender, leaving a mass that was virtually unrecognizable as human. There was an absence of jewelry or other identifying features as well. Further obliteration of the personhood of the woman resulted when marine animals such as crabs and turtles had fed on the body, causing extensive damage, including chunks of her anatomy that were missing entirely. Her estimated weight at the time of her death was 170 to 180 pounds in life— but only 135 pounds on the morgue scale. She was also bald.

It was difficult to tell if she was a homicide victim or had suffered a terribly unlucky accident. She had rib fractures and it was not known initially if this had been sustained ante- or post- mortem. Through forensic sleuthing, including information provided by her still extant dentition, an identity for Jane Doe as well as a possible explanation for what preceded her demise was eventually arrived at. Teeth are like fingerprints and this is why the more savvy of killers take extra effort and care in extracting the teeth or even detonating them by concentrating an explosive fluid in the oral cavity, in order to confound investigators in their attempts at identifying their victims, should the bodies be discovered. Teeth are extremely durable, however, so they often leave medical examiners the only data on which to pursue after the body has been otherwise destroyed.

The forensic ondontologist is the specialist who deals with the dental portion of trying to determine the identification of an otherwise unknown body. Teeth are considered as unique and person- specific as fingerprints because of the extraordinary number of variables that come into play. One may multiply the number of teeth by the number of possible dental fixes and the number of possible materials used in those fixes and this produces a virtually infinite variety of results. The individual teeth themselves have several surfaces to work with, including the sides of the biting surfaces, such as the lingual (facing the roof of mouth) buccal, distal (backside, away from the midline) and mesial (toward the midline).

Dr. Cohle’s highest profile case in recent times involved the identity mix- up of two young Michigan women; Whitney Cerak and Laurie Van Ryn; one who died at the scene of the road accident, and the other who sustained a brain injury. But the two were misidentified, leaving the parents of the living daughter to believe that their girl was dead, while the family of the head injured daughter (whose face was distorted by swelling, bruising and other injury trauma, and who did share some physical similarities with the other woman) were living in the false belief that the battered person they visited in the hospital was their loved one. Dental records played a huge role in ultimately making a correct identification of the individuals.

The Pigeon Lake Jane Doe was identified as Barbara Riehn , who went missing from Racine, Wisconsin. Underwater currents had ferried her body (sunk below the surface in the chill Lake Michigan waters) from Wisconsin to Pigeon Lake, a distance of about 100 miles. During her aquatic journey, she encountered ice formations that her body had become lodged between, which created those mysterious rib fractures mentioned earlier. Surgical repair to one ankle had been done during life and the hardware contained in the surgical reconstruction provided serial numbers corresponding to B. Riehm. The dental records also matched. It was learned that she had been depressed and had had breast cancer. She had been on a round of chemotherapy which explained her bald state when her body was recovered but the powerful medicines also prevented her from taking anti- depressants and it was thought that her death may have been a suicide rather than a result of foul play.

Lividity is one aspect of the bodily condition that the medical examiner may use to determine what position the victim was in when he or she died, as long as the body had not been moved for several hours after death, since the fluids congeal toward the ground/floor on the underside portions of the body, with cessation of heart activity to move blood throughout the body.
Throttling a victim can result in damage to the delicate horseshoe- shaped hyoid bone in the neck. Damage can also be sustained to the cornua (posterior projections) of the thyroid cartilage, so these injuries may be used in determining the manner in which the victim met his or her end.

On page 323 of the book that our presenters drew their talk from, we learned that when a body lies outside in temperate weather, a procession of insects, beginning with fly larvae, invades. The presence of these insects can help forensic scientists establish the time of death. Extremely cold weather can impede or even prevent this process. Elsewhere in the book, we are told that bones bend more in life, so when medical examiners encounter what is called the green stick effect , it indicates that fractures sustained occurred while victim was still alive. Staining occurs on bones exposed to elements, therefore differential staining reveals different amounts of time that they were exposed to the elements. Another interesting note was that murderers often park victims’ cars in public places as a way to create a red herring for investigators who are trying to track the last movements of the person during life.

Buhk notes that anyone who spends any amount of time around this underworld, will realize that in forensic pathology, no fiction is stranger than the truth. He also wrote of how the LoAnn Oil (a wintergreen and disinfectant smell combination) that is typically used in morgues to mask the smell of death, has affected him after spending so much time in such settings. Now Buhk has acquired an aversion to anything wintergreen. However, the smell of death is one that has an evolutionary and universally repellant quality to humans that no other smell can match, so such masking precautions are necessary, even if they are themselves odious.

One case discussed in both the book and the oral presentation to us was that of what came to be known as Jack in the Box. A badly burned (in an attempt by the murderer to hide the identity of his victim) body had been discovered by a Michigan blueberry farmer. It was found in a steel travel trunk in the middle of a charcoal circle. The corpse was battered and contorted and there was a strong smell of gasoline. The burnt body looked to have been jammed into the box. The arms were raised slightly upward; a posture that can result from the heat of the fire that dehydrates tendons, causing them to shorten and flex. Chemical tests revealed the brand of gas used was from Amoco. Since there were no such station close by, investigators could determine that the body had been moved some distance after his horrific demise.

The killer was careless in leaving behind a Craftsman brand claw hammer, pieces of a baseball hat, a T- shirt nylon rope and a Wal- Mart shopping bag. Besides labeling information on some of the items, analysis of the shirt even determined the manufacturer. The hammer was the likely murder weapon as the blunt force trauma impressions on the John Doe’s skull matched the hammer head precisely. Lung levels of carbon monoxide indicated that the victim was not breathing when doused with gas, set on fire and then stuffed into the trunk. The examination of the internal organs disclosed that the victim died within 2 days of discovery. The Jack in the Box victim was believed to have been fairly affluent as he had had extensive and expensive dental work done. Murder investigations involve a wide variety of specialized disciplines, and clues can emerge from the environment (murder scene), from the body and from fibers, objects and other materials found.

When a probable identity has surfaced for an unidentified skull, a technique may be employed where antemortem (before death) images may be superimposed over skull remains with key points (called landmarks) checked to see if they match; the points of orientation are: the eye orbits, chin (gnathion), and subnasal (under the nose). Flesh markers may be introduced to indicate the depth of tissues that once covered the bone. Some factors that may be determined include the ethnicity, sex, and age of the individual. The robustness of bony attachment areas for sinews can indicate the girth or slenderness of the muscles that are no longer available for direct examination. Skull form and densities can also tell specialists who reconstruct faces over skulls how thick to make the flesh markers on different parts of the face.

There has always been a fascination with serial killers. Buhk wrote that there are more books written about Jack the Ripper than Abe Lincoln. One such killer that was given a lot of ink in the book and discussed with some degree of detail in the presentation by the True Crime writer, Buhk, was of a twisted individual who came to be referred to as Scorecard. In the case, Dennis Alt and Chris Shoenborn, who had come to Grand Rapids to attend a horticultural show (they were farmers) were discovered by Consumers Energy workers by a water tower near Grand Rapids. Their nude bodies showed a sexual angle in their deaths and one had an enlarged opening in the penis. The examination of the bodies revealed that a pen had been jammed deeply into the penis, up to the pelvis, of one of the victims; a pen with the Amway Grand Hotel inscription on it. Both victims had been strangled with a ligature leaving petechial hemorrhages, which gave further clues as to the manner in which they were murdered. The killer avoided physical resistance from his victims by giving them a combination of dizapam, or in other cases linked to him, other sedatives, and alcohol.

A break in the case came with the arrest of a drunk driver, Randy Kraft, in Orange County, California. In his car, a seated figure was seen in the front passenger seat who could not be roused by officers. He was dead. The covering was removed from the victim, leaving his penis exposed which was propped up with the victim’s undergarments. There was always a sexual component to Kraft’s killings. An empty pill bottle of Valium, a cooler and a leather strap were all found in the car as well. The dead passenger, Terry Gambrel, had been asphyxiated by something tightened around the neck in keeping with Kraft’s general modus operandi , as would be later discovered. Also in keeping with his procedures, he had given his victim Ativan and alcohol. Kraft turned out to be a highly prolific serial killer whose spree spanned over a decade of time. The tally of murders attributed to him was 67! The most damning evidence found during that routine traffic violation stop was a batch of photographs in his car of murder victims and a briefcase containing a list of entries – what came to be known as the scorecard-that were related to victims, including Church, Nelson and DeVaul as well as several other unsolved murders. Kraft also took souvenirs that linked his victims to him. The death list gave a time line and map of Kraft’s criminal activities.

Another case discussed at the meeting and in the book was that of Florence Unger, who se body was found in Lower Herring Lake, lying face down in 5 inches of water, but at a distance from where she was determined to have fallen from atop a deck. The first question was: did she fall from the deck, or was she pushed? The scene included a fractured wood railing and a cement slab below with a blood stain there. An oddity was that there was a pool of blood indicating that Unger’s body had lain there for some time before going into water. Too, there was no indication of tumbling or momentum of force from an outward fall, and yet no drag smears on the cement were present to indicate that Unger’s body had been dragged across the ground and deposited into the water. The possibility was raised that she was still conscious after the fall and had hauled herself into the water. But she sustained a fractured hip, rendering movement of that kind difficult and this activity would have had to have happened after lying unconscious and immobile (as indicated by the pool of blood) for some time first. Also, why would she have made that lake- ward movement in the first place?

Her death became contentious as to whether she died by a blow to the cranium (from an assailant) or from drowning. The head trauma that was evident could have come from striking the cement below after an accidental fall and if weakened or unconscious, Unger could have drowned in the shallow water. After more extensive forensic investigation, it came to be believed that she was pushed over the railing and her living, yet unconscious, body had been carried into the lake to make it look accidental. The blow to the head could have caused the portion of the brain responsible for controlling respiration—brain stem— to have swelled up at the point where it passes through the skull via the foramen magnum, resulting in it ceasing to function, resulting in her death. Fluid was found in her lungs but rather than as a result of aspirating water, it could have resulted from the brain injury that was sustained. Such an injury can cause fluid to form in the lungs if the brain stem is affected and breathing stops. Mark Unger, Florence’s husband, became the prime suspect in her death. The juicy parts of the story I shall leave for the reader to pursue if he or she purchases the book. Those parts- involving the motive for the crime- dealt with sex, drugs, marital problems, deceit, etc.

Another story- one that was quite ghastly- involved a decapitation where the murderer kept, named, and mutilated the severed head of his victim. The book notes that all autopsies start with a detailed description of the victim and the wounds sustained. The one for this victim ran some 16 pages! Quoted from page 151: The face looked less like a face than a prop from a Hollywood horror film: a crimson mass barely recognizable as a human head. The mutilations left little more than muscle over the skull with some patches of skin still clinging to it around the eyelids and a strip running across the bridge of the nose. The nose itself was gone. The lips were missing. The ears had been removed, as had been the scalp. The head had been skinned, with almost all of the skin and subcutaneous tissue of the face and head removed. The eyes, however, remained. End of quote. At the point of decapitation there were hesitation marks—indicating pauses in the process, in keeping with the use of a butcher knife. There was also an attempt to remove the heart and spinal column. Tread marks were apparent from a sneaker where the victim had been stomped by his attacker and killer. Despite all the violence and that the murderer had kept the head as a trophy or souvenir, the victim had simply been in the wrong place at the wrong time. His attacker had no personal knowledge of him (the victim) nor any animosity toward him. He just decided to kill, decapitate and mutilate the removed head on a deranged whim, it seems.
Yet another tale from the files of forensic investigation was probably the most true- crimes like of the lot, in that it was so fraught with so many titillating and engrossing details, sordid twists, and intriguing insights into the uglier side of human nature and the vices humanity is prone to. It involved sex, counterfeiting and international intrigue, for starters. Oh yes, and four hundred pounds of cement. One bag short of what was needed to fill a space in a basement. The missing material would be compensated for by the body of a murdered foreigner named Onunwa Iwuagwu, who would become filler.

A case in the book that was not discussed at the meeting, dealt with the death of a man who was the epitome of the mild- mannered, straight-laced and innocuous- seeming individual. He never took time off from work and was as reliable as an atomic clock for punctuality and dedication. One day, however, he did not show up for work and had not called in. Time went by, and this major change in routine did not go unnoticed. He was checked in on (after not returning calls and no one knowing of any plans he had made) and his corpse was discovered in his home in under circumstances that no one who knew him would have guessed. He had died after absorbing large quantities of alcohol via an enema. Though foul play could not be ruled out entirely at first, the evidence indicated that his death was accidental (not a suicide) and had not involved any other people. Under medical examination, his liver was found to contain fatty change, which indicates a consistent consumption of large amounts of alcohol. One can drink to the point of death. 400 milligrams per deciliter of ethanol is considered to be lethal. When the blood- alcohol level approaches this point, the alcohol overwhelms the brain stem’s ability to control respiration and death results. In the case recorded in the book, the individual took in, through his rectum, the equivalent of 27 drinks! The book also gave a litany of names for various conditions in which people derive pleasure in what are considered unusual ways and that have, occasionally, led to accidental deaths. One of these was klismaphilia, which is the term for sexual pleasure derived from enemas.

Munchausen by proxy syndrome was introduced into the presentation when a case involving this rare condition was discussed. The story was echoed in the book as well. The syndrome was named after a German baron. Typically what happens is that a caregiver or parent with this syndrome is involved in secretly injuring and eventually killing another- usually a child. Those with this condition derive pleasure from forming a close relationship with the hospital staff, or in cases where they, themselves, are hospital staff (nurses, etc.), they get their strokes from the bond they form with the parents of the dying child. In any event, the individual often slowly brings the victim to the brink of death, then restores them to health, often over and over again. Whether the perpetrator is the parent (often a mother) or a hospital worker (usually a nurse), she becomes the focal point of attention and is seen as brave, heroic and valiant. Non-medical staff perpetrators will often become extremely intertwined with the hospital employees and get involved in their lives, while staying at the hospital for long stretches of time, putatively to be with the dying child. All the while, she will be secretly harming the child. It eventually ends up with the death of the suffering child.

In this case, the woman killed her small boy by smothering him. He was alleged to suffer from sleep apnea and there was a monitor in place to detect times when the boy stopped breathing. It was this device that caught the mother, reported on in the book, by use of a hidden memory chip. The chip recorded that the monitor had been tampered with; it had been repeatedly turned off and on, including the final time it was left off permanently. The child had been smothered during a 36 minute period that the monitor was off. It was also later discovered that the mother had previously lost two other children to what had been concluded at the time to be SIDS. She confessed to her crimes which typically involved placing a towel over the mouths of her children. She claimed that she truly did not know why she behaved in this manner. This last death, that of her son Aaron, was accomplished by suffocation where a pillow was pressed over his face.
In the chapter: Things Ain’t Always What They Seem, mentioned earlier in this summary, there is the quote from Sir Arthur Conan Doyle’s creation, Sherlock Holmes: There is nothing more deceptive than an obvious fact. End of quote. When the answer seems apparent, it may be seized upon without further investigation, becoming a misleading red herring that ends up leading medical examiners and detectives astray.

One death that appeared to be a homicide, since the victim was discovered amid a large amount of her own blood turned out to be that she had lung cancer and a blood vessel had eroded from the disease. She exsanguinated the resulting blood and died.

Whether suicides, homicides, accidents; whether the cause of death was easily determined from conclusive straight forward evidence or as a result of a myriad of twists, complications and subterfuge, the skeletons in the closet at the Kent County Morgue that Dr. Cohle has examined have absorbing and fascinating tales to tell. A book this summary writer has about a forensic anthropologist’s exploits (Florida’s Dr. William Maples) is titled: Dead Men Do Tell Tales. Indeed, this seems to be the case, and, as Tobin Buhk notes: the true cases that occur and the mysterious circumstances surrounding the deaths that are investigated, are far more interesting and often stranger than fictional mystery yarns. In keeping with the skeletons in the closet theme of the talk and book, Dr. Maples wrote (page 280 of the aforementioned book): They [the skeletons in his laboratory, and Maples worked almost exclusively with bones, not fleshy corpses] have tales to tell us, even though they are dead. It is up to me, the forensic anthropologist, to catch their mute cries and whispers, and to interpret them for the living, as long as I am able. End of quote.

Synthesized by Charles LaRue