TO: Know Your Rights Camp – Autopsy Initiative

CC: Michael Harper Esq

Benjamin Crump Esq

FROM: Roger A. Mitchell, Jr. MD

Board Certified Forensic Pathologist
RAM Consulting LLC

RE: The Death of Lashawn Thompson

DATE: May 20, 2023

The Death of Lashawn Thompson Final Review Opinion:

Cause of Death: Complications due to Severe Neglect

Contributing Cause: Untreated Decompensated Schizophrenia

Significant Conditions: Dehydration, Malnutrition, Severe Body Insect Infestation

Manner of Death: Homicide

Summary Findings Outline:

I. Evidence of Severe Neglect

A. Evidence of Malnutrition/Rapid Weight Loss
1. Loose skin of the abdomen, back, buttocks, and upper thighs,
moderate to severe
2. 32 lb. weight loss in < 90 days (18% loss of body weight)
a. 180 lbs. at Fulton County Jail Intake – June 12, 2022
b. 148 lbs. at Autopsy – September 14, 2022
B. Evidence of Dehydration/Volume Depletion (Pre-renal Azotemia)
1. Vitreous Urea Nitrogen – 37 mg/dL
2. Vitreous Creatinine – 0.6 mg/dL
a. Urea Nitrogen/Creatinine ratio > 20:1
i. No evidence of congestive heart failure
ii. No evidence of urinary tract obstruction
C. Extensive and Severe Body Insect Infestation
1. Probable Pediculus humanus (Body Louse)
a. Innumerable number of insects involving head hair, face,
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 facial hair, nose, mouth, chest, pubic area, arms, and legs
2. Multiple excoriations involving the arms and legs.
D. Poor Grooming
1. Matted hair with multiple lock formation, severe
2. Dirt and filth involving the hands and bottom of the feet, severe.
3. Dirt and filth involving fingernails and toenails, severe.
E. Poor Living Conditions
1. Dirt and filth involving the jail cell, severe.
II. Untreated Decompensated Schizophrenia
A. Prescribed Haldol 5 mg bid and Benadryl 50 mg BID for psychosis and EPS
prevention.
1. Post-mortem Toxicology – Negative for treatment medications at
autopsy

Relevant Qualifications

I am board certified in Anatomic and Forensic Pathology by the American Board of

Pathology and currently serve as Professor and Chair of Pathology at Howard University
College of Medicine. I currently teach second year medical students’ basic principles of
pathology. I also serve as the Pathology Residency Program Director where I oversee the
program as well as teach autopsy pathology, forensic pathology, leadership, and quality. I
serve as the Chief Medical Officer for the Howard University Faculty Practice Plan
(Ambulatory Care Center) where I oversee physician quality and patient safety. I also
participate as a member of the Medical Executive Committee for the hospital and serve as
the Chair of the Performance Improvement Committee (Quality Committee) for Howard
University Hospital.

I am the past Chief Medical Examiner for Washington, DC where I served from 2014 to
2021. Over my tenure as Chief Medical Examiner I oversaw over 21,000 forensic
investigations. I successfully worked to achieve full accreditation by the National
Association of Medical Examiners (NAME) as well as ISO-17025 Accreditation by the
ANSI National Accreditation Board (ANAB) for the DC Office of the Chief Medical
Examiner. Just before my tenure ended as Chief Medical Examiner, I also served as Interim
Deputy Mayor for Public Safety and Justice. In that role, all public safety departments
directly reported to me including the Metropolitan Police Department, DC Fire and EMS,
the Department of Forensic Sciences, the Homeland Security Agency, the Department of
Corrections (DC Jail), and Department of Human Rights.

Prior to my role as Chief Medical Examiner for Washington DC, I served as the Assistant
State Medical Examiner In-charge for New Jersey. This role included my service as the
Chief Medical Examiner of the Northern Regional Office (Essex, Hudson, Passaic, and
Somerset Counties) and acting as the State Medical Examiner. As the highest-ranking
medical examiner in the state, during this time, I participated in the Statewide Shooting
Response Team, responsible for investigating officer involved shootings by the New Jersey

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State Police.

Before my time at the NJ Office of the State Medical Examiner, I was the Assistant Deputy
Chief Medical Examiner for Harris County, TX (Houston) and oversaw all medicolegal
death investigations. In that role I managed the 24/7 death investigation operations of
nearly 11,000 cases per year for 3 years.

I have performed approximately 2,000 forensic and hospital autopsy examinations and have
testified as an expert witness on numerous cases.

Throughout my career I served on or chaired numerous fatality review boards and

committees including Child and Infant, Domestic Violence, Maternal Mortality, Opioid
Fatality, and Elder Fatality Review. The Child and Infant Fatality and the Elder Fatality
Review Board both required evaluation of care elements provided by the primary care
givers. Both children and the elderly are at risk of negligent care. Part of the responsibilities
of these committees was to assess the level of care provided to the decedents to establish
system-wide recommendations for change.

I am published in 13 peer review journals and have performed nearly 100 lectures on a
myriad of forensic topics including Death in Custody, Gun Violence, and Mass Fatality
Management. In 2013, participated in early work surrounding elder abuse and neglect,
published in Academic Forensic Pathology entitled Forensic Markers Associated with a
History of Elder Mistreatment and Self-Neglect. In 2017, I led a national group of forensic
pathologists in the development of the paper entitled: National Association of Medical
Examiners Position Paper: Recommendations for the Definition, Investigation,
Postmortem Examination, and Reporting of Deaths in Custody. That same year I had the
opportunity to contribute on a multidisciplinary panel in a research project sponsored by
RAND Corporation entitled Caring for Those in Custody Identifying High-Priority Needs to
Reduce Mortality in Correctional Facilities. I also co-authored the paper entitled The
Violence Epidemic in the African American Community: A Call by the National Medical
Association for Comprehensive Reform. In 2022, I had the opportunity to participate as a
panelist in the research project sponsored by RAND Corporation entitled Reducing Deaths
in Law Enforcement Custody Identifying High-Priority Needs for the Criminal Justice
System.

I am currently Speaker to the House of Delegates for the National Medical Association
where we are currently working on initiatives to improve health outcomes for
disenfranchised communities across the country including improved data collection for
those who die in custody. I have lectured all over the world including Rwanda, Zambia,
Egypt, Bangladesh, India, and Belize. I currently serve as the Principal Investigator (PI) for
the project named the Medicolegal Death Investigation-International Community of
Practice where we provide education and technical support to numerous international
medical examiners and coroners.

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Method

The review occurred over approximately 20 hours including review of medical records,
autopsy report, autopsy photographs, jail incident report, toxicology report, and vitreous
chemistry report. An onsite review of the specimen in the tissue stock jar as well as
microscopic review of histology slides were also performed. A limited literature review
was also performed.

Materials Reviewed
• LT NaphCare Medical Records
• Fulton Jail Death Incident Report
• M.E. Investigative Report
• M.E. Toxicology
• Grady Labs 22-2020
• Lashawn Thompson Autopsy Photographs
• Lashawn Thompson Autopsy Report
• Recuts of Original Histology Slides
• Tissue Stock Jar
• Histology Slides from Stock Jar Review

Original Death Investigation Findings:

The original death investigation reported that the decedent was a 35-year-old male who was
found unresponsive in his cell in the psychiatric wing of the county jail in extremely poor
conditions with insect infection and other filthiness around him. The original autopsy
examination was performed by Michael M. Heninger, MD on September 14, 2022. The
cause of death was listed as Undetermined with significant conditions as schizoaffective
disorder, bipolar and acute exacerbation. The manner of death was listed as Undetermined.

Case Review Summary:

According to the Fulton County Jail Incident report, on Monday September 13, 2022, Mr.
Lashawn Thompson was found on the floor unresponsive and slumped over the toilet within
his jail cell. He was covered with feces and body lice. He was moved outside of the jail
cell where officers engaged in cardiopulmonary resuscitation (CPR) for approximately 24
minutes until Fire and Rescue Staff arrived to assist Mr. Thompson. Fire and Rescue Staff
performed CPR for another approximate 17 minutes until Mr. Thompson was pronounced
dead by Dr. Chad Huot at 0233 on September 13, 2022.

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Timeline and Medical History:

According to the LT NaphCare medical records, Mr. Thompson had a known history of
decompensated psychosis that dates back to 2016. He was recently incarcerated from
December 2018 to October 2020 at Fulton County Jail. During this incarceration he
received regular care that included mental health evaluations, ectoparasite/lice treatment,
regular laboratory work-up, and physical examination. It is important to note that although
Mr. Thompson initially refused medical attention, by mid to late May 2019 he consented to
undergo evaluations and ultimately received treatment for both his mental health and body
lice. Over the majority of that incarceration Mr. Thompson received Haloperidol and
Benztropine twice per day for his mental health diagnosis as well as Ectoparasite Protocol,
RID Shampoo, Permethrin 5% for the body lice. At that time his laboratory values revealed
normal liver and kidney function, no evidence of anemia, normal cholesterol (HDL and
LDL), normal Hemoglobin A1c and he was stable.

Lashawn Thompson was arrested 90 days prior to his death on June 12, 2022. LT NaphCare
also provided medical care during this stay at the Fulton County Jail. The intake form
reports Lashawn Thompson as a 5’11” Black male who weighed 180 lbs. The medical
records dated June 13, 2022, reads, “35-year-old male alert and oriented x 4, with
appropriate mood and affect. Patient speaks clearly, coherently and without cognitive
impairment evident by ability to follow commands without multiple prompts. Movements
are purposeful and without abnormality.” He is seen by a mental health provider and
prescribed Haldol 5 mg bid and Benadryl 50 mg BID for psychosis and EPS prevention.

On June 18, 2022, Lashawn Thompson is seen by the mental health provider after discharge
from mental health observation on June 16, 2022. He was found to be alert and oriented to
person and place. The provider reports that Mr. Thompson’s cell was clean, and he was
groomed appropriately. Mr. Thompson denied any acute psychiatric distress at that time.

On July 14, 2022, the mental health provider met with Mr. Thompson and observed him
pacing around the cell talking to himself. He was selectively mute but without distress and
psychosis. The activities of daily living were reported as normal, and his cell was clean
without trash or debris. The chart indicated that Mr. Thompson remained compliant with
prescribed medications.

On July 27, 2022, Lashawn Thompson was easily redirected by the mental health provider.
His activities of daily living were normal. His cell was clean and with no trash or other
debris present. The review of the chart indicated that Mr. Thompson remained compliant
with prescribed medications.

The LT NaphCare medical records have a significant gap in the documented health care
provision between July 27, 2022 and September 8, 2022. This represents 43 days where
there was minimal documentation found within the records that show care being delivered.
The medication administration log showed that no medication was administered from
August 11, 2022 – September 13, 2022.

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On September 8, 2022, the mental health provider documented that Lashawn Thompson
was observed lying in the fetal position on the floor and did not come to the door for the
assessment but just lifted his head in acknowledgement. His room was unkept and
malodorous. The medical record notes that the sheriff deputy reported that Mr. Thompson
appeared to be losing a significant amount of weight. The medical chart also revealed that
he was not receiving his prescribed medications. As a result, he would be placed on “psych
observation.”

On September 10, 2022, the mental health provided documented that the patient was
continuing to decompensate. According to the medical records the sheriff deputy was
informed of the housing transfer to the mental health clinic for Mr. Thompson for
stabilization. At this point transfer had not taken place.

On September 12, 2022, Mr. Thompson was seen by the mental health provider due to
severe deterioration and inability to care for himself. At this time Mr. Thompson was still
awaiting transfer to the psych observation unit.

Autopsy Review Findings:

III. Evidence of Severe Neglect

A. Evidence of Malnutrition/Rapid Weight Loss
1. Loose skin of the abdomen, back, buttocks, and upper thighs,
moderate to severe
2. 32 lb. weight loss in < 90 days (18% loss of body weight)
a. 180 lbs. at Fulton County Jail Intake – June 12, 2022
b. 148 lbs. at Autopsy – September 14, 2022
B. Evidence of Dehydration/Volume Depletion (Pre-renal Azotemia)
1. Vitreous Urea Nitrogen – 37 mg/dL
2. Vitreous Creatinine – 0.6 mg/dL
a. Urea Nitrogen/Creatinine ratio > 20:1
i. No evidence of congestive heart failure
ii. No evidence of urinary tract obstruction
C. Extensive and Severe Body Insect Infestation
1. Probable Pediculus humanus (Body Louse)
a. Innumerable number of insects involving head hair, face,
facial hair, nose, mouth, chest, pubic area, arms, and legs
2. Multiple excoriations involving the arms and legs.
D. Poor Grooming
1. Matted hair with multiple lock formation, severe
2. Dirt and filth involving the hands and bottom of the feet, severe.
3. Dirt and filth involving fingernails and toenails, severe.
E. Poor Living Conditions
1. Dirt and filth involving the jail cell, severe.
IV. Untreated Decompensated Schizophrenia
A. Prescribed Haldol 5 mg bid and Benadryl 50 mg BID for psychosis and EPS
prevention.
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 1. Post-mortem Toxicology – Negative for treatment medications at
autopsy
V. Stock Jar Examination
A. Multiple small pieces of tissue are identified in formalin solution.
1. Lung, adrenal gland, heart, kidney, liver, spleen, brain, gall stone,
appendix, testicle

Histological Evaluation:

Original Sections:
1. Insects – histology sections of insects
2. Kidney/Adrenals – No significant histological abnormality
3. Brain – No significant histological abnormality
4. Lung – Patchy interstitial thickening with increased cellularity
5. Liver/Heart – No significant histological abnormality
6. Brain – No significant histological abnormality
7. Brain – No significant histological abnormality
8. Heart/Thyroid/Testes – No significant histological abnormality
9. Heart/Pancreas – Pancreas with focal autolysis
10. Prostate/Spleen – No significant histological abnormality
Additional Sections:
11-13. Lung – Focal accumulation of debris laden macrophages and patchy
interstitial fibrosis
14. Heart/Left Ventricle – No significant histological abnormalities
15. Heart/Right Ventricle – No significant histological abnormalities
16. Liver/Adrenal – No significant histological abnormalities
17. Adrenal Gland – Focal patchy cortical vacuolization, slight
18. Liver – No significant histological abnormalities
19. Spleen – Decreased cellularity, non-specific
Opinion:

The death of Mr. Lashawn Thompson resulted from severe neglect evidenced by
untreated schizophrenia, poor living conditions, poor grooming, extensive and severe
body insect infestation, dehydration, and rapid weight loss. Mr. Thompson was
completely reliant on his caregivers to provide both day-to-day care as well as the acute
life-saving care that was needed to save him from the untreated decompensated
schizophrenia.

According to the Centers for Disease Control and Prevention (CDC) neglect is defined
as the failure to meet a person’s basic physical and emotional needs. These needs
include housing, food, clothing, education, and access to medical care (CDC, 2008). The
National Institute of Justice (NIJ) defines neglect as occurring when the caregiver does
not try to respond to the adult's needs. This may include physical, emotional, and social
needs, or withholding food, medications, or access to health care (NIJ, 2020). There are
some jurisdictions in the United States that define caregiver neglect separate from

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physical, medical, and mental health neglect (Burnett, 2013). The severe neglect
experienced by Mr. Lashawn Thompson included all forms of neglect including
caregiver, physical, medical, and mental health neglect.

Rapid weight loss and malnutrition are known markers of neglect. The autopsy findings
from Mr. Thompson show a weight loss of 32 lbs. which calculates to a loss of
approximately 18% of his body weight over a short period of time. According to
research done by University of Zurich, a substantial portion of patients with severe
mental illness are at risk of malnutrition (Risch, 2022). In fact, malnutrition can have
critical effects on the heart leading to heart failure and arrythmia (Webb, 1986).
Dehydration often occurs along with malnutrition. In the case of Mr. Thompson, post-
mortem analysis of the vitreous fluid reveals a urea nitrogen and creatine ratio > 20:1
indicating pre-renal azotemia most commonly caused by dehydration.

Another marker of neglect is the severe infestation of lice or pediculosis. Lice are
obligate blood sucking ecto-parasites. When numbers are severe, circumstances often
indicate neglect. The full life cycle of lice is 24-28 days and because they cannot live
without blood, the treatment is bathing with medicated shampoo thus interrupting the
life cycle of these insects (Lambiase, 2019). Based upon the timeline provided,
Lashawn Thompson suffered from severe body insect infestation that clearly spanned
greater 28 days. During the time it took to accumulate the severe and substantial
infestation, Mr. Thompson would not have received a bath from his caregivers. Severe
body lice infestation is known to cause iron deficiency anemia (Rudd, 2022). It is
possible that Lashawn Thompson suffered anemia from the enormous presence of body
lice. Definitive post-mortem diagnosis requires bone marrow evaluation. Samples of
bone marrow were not performed during the original autopsy. Other evidence of neglect
included the filth, dirt and grime of the fingernails and toenails of his hands and feet. His
total living conditions were also filthy. Mr. Thompson was neglected to death.

According to the timeline and medical records available, Mr. Thompson received his
last dose of medications 32 days before his death. At autopsy, post-mortem toxicology
revealed negative results for the requisite treatment medications in his blood stream. The
lack of medication in his blood stream at autopsy is objective evidence that the severe
mental illness suffered by Mr. Thompson was not being medically treated at the time of
his death. Untreated schizophrenia can lead to psychotic decompensation. In a recent
2023 article published in Psychological Medicine, authors describe the risk of poor
outcomes when proper care after initial treatment is not provided (Pelosi, 2023).

For these reasons, it is the opinion of this forensic pathologist that Mr. Lashawn
Thompson died due to severe neglect. The combination of dehydration, rapid weight
loss, and malnutrition complicated by untreated decompensated schizophrenia led to a
fatal cardiac arrythmia of Lashawn Thompson. Had Mr. Thompson received adequate
care during his incarceration at the Fulton County Jail than he would not have died at the
time that he did.

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The inactions of Mr. Thompson’s caregivers are directly related to his death; therefore
the cause of death should be listed as Complications due to Severe Neglect with the
contributing cause stated as Untreated Decompensated Schizophrenia.

Lastly, the manner of death designation of Homicide most accurately describes the
circumstances around the death of Lashawn Thompson. Mr. Thompson suffered from
schizophrenia that required medical treatment and overall care to support activities of
daily living. He did not receive the necessary medical care, nor did he receive the
adequate food, water, or shelter necessary to sustain his life.

Because care was withheld from Mr. Lashawn Thompson his condition deteriorated
(decompensated). When he was found to be suffering from his illness, acute and urgent
care was not provided to him. It is because of this severe neglect that Mr. Lashawn
Thompson died (Duncanson, 2009). Therefore, the death of Lashawn Thompson is best
classified as a Homicide.

For these reasons stated, the death is best classified as:

Cause of Death: Complications due to Severe Neglect

Contributing Cause: Untreated Decompensated Schizophrenia

Manner of Death: Homicide

The above opinions are expressed to a reasonable degree of medical certainty.

May 20, 2023

Roger A. Mitchell, Jr. MD DATE

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References:
Benson K. L. (2006). Sleep in schizophrenia: impairments, correlates, and treatment. The
Psychiatric clinics of North America, 29(4), 1033–x.
https://doi.org/10.1016/j.psc.2006.08.002

Burnett, Mitchell, R. A., Cloyd, E. A., Halphen, J. M., Diamond, P. M., Hochschild, A.
E., Booker, J., & Dyer, C. B. (2013). Forensic Markers Associated with a History of Elder
Mistreatment and Self-Neglect: A Case-Control Study. Academic Forensic Pathology,
3(4), 458–467. https://doi.org/10.23907/2013.056

Centers for Disease Control and Prevention, 2008. Child Maltreatment Surveillance
Uniform Definitions For Public Health And Recommended Data Elements.
https://www.cdc.gov/violenceprevention/pdf/CM_Surveillance-a.pdf

Duncanson, E., Richards, V., Luce, K. M., & Gill, J. R. (2009). Medical homicide and
extreme negligence. The American journal of forensic medicine and pathology, 30(1), 18–
22. https://doi.org/10.1097/PAF.0b013e3181873824

Lambiase, S., & Perotti, M. A. (2019). Using human head lice to unravel neglect and
cause of death. Parasitology, 146(5), 678–684.
https://doi.org/10.1017/S0031182018002007

National Institute of Justice, 2020. Elder Abuse. https://www.nia.nih.gov/health/elder-

abuse#types

Pelosi, A. J., & Arulnathan, V. (2023). Neglecting the care of people with schizophrenia:
here we go again. Psychological medicine, 53(4), 1–6. Advance online publication.
https://doi.org/10.1017/S0033291723000247

Risch, L., Hotzy, F., Vetter, S., Hiller, S., Wallimann, K., Seifritz, E., & Mötteli, S.
(2022). Assessment of Nutritional Status and Risk of Malnutrition Using Adapted
Standard Tools in Patients with Mental Illness and in Need of Intensive Psychiatric
Treatment. International journal of environmental research and public health, 20(1), 109.
https://doi.org/10.3390/ijerph20010109

Rudd, N., Zakaria, A., Kohn, M. A., Amerson, E. H., Fox, L. P., Linos, E., & Chang, A.
Y. (2022). Association of Body Lice Infestation With Hemoglobin Values in Hospitalized
Dermatology Patients. JAMA dermatology, 158(6), 691–693.
https://doi.org/10.1001/jamadermatol.2022.0818

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Webb, J. G., Kiess, M. C., & Chan-Yan, C. C. (1986). Malnutrition and the heart. CMAJ :
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