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Investigating Your Client’s Defense. Investigating causation of medication induced suicide. Toxicology Labeling and medication guides FDA Adverse Events data base Psychological autopsy Crime Scene Reconstruction. The Vaughn Family. Chris, Kim, Cassandra, Blake and Abigayle.
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Investigating causation of medication induced suicide • Toxicology • Labeling and medication guides • FDA Adverse Events data base • Psychological autopsy • Crime Scene Reconstruction
The Vaughn Family Chris, Kim, Cassandra, Blake and Abigayle
Chris Vaughn’s first statement at scene: he believed his wife shot him • No memory when interviewed by ISP • “She couldn’t have done it”
Dissociative Amnesia • A form of memory loss • Caused when a person witnesses trauma producing event • E.g. watching entire family die in automobile crash and being sole survivor. Source: DSM-IV • Memory may come back days later or not at all
Next day: ISP investigators press him “try to remember” • “I looked over and thought I saw a gun but, I knew that was impossible – why does Kim have a gun?” • “it was like my mind shut off” • “I froze and I looked down and my leg was bleeding”
Bullet Trajectory • Proves that the shot that killed Cassandra Vaughn was fired from the front passenger seat
ISP assumed blood on passenger seat belt was Kimberly Vaughn’s blood.
Large stain retracted within door “With the seat belt extended and the latch fastened around a body, the area of the soaked through stain was directly at the hip area where the seatbelt clasp engaged the seatbelt latch.”
7/25/07 Sgt. Gary Lawson Q:And when Kimberly Vaughn was found by the paramedics . . . she was not wearing a seat belt? A: That’s correct. Q:And that is significant because she was wearing that seat belt when she was shot? A: That’s correct.
DNA INVALIDATES PROBABLE CAUSE • Defense motion to re-test front passenger seat belt filed in 2009 • Feb. 19, 2010 ISP report • All of the blood on passenger seat belt and buckle belonged to Christopher Vaughn
Bloodstain pattern analysis • Kim Vaughn unbuckled her seat belt after Chris Vaughn was shot
Transfer stain on right inner thumb Consistent with thumb coming into contact with bloody object.
A patterned transfer stain with evidence of a blood wipe pattern; consistent with the blood transfer stain on Kim’s right thumb depressing seatbelt. BLOOD SWIPE
ISP CSI: crime scene evidence supports murder suicide “. . . every time I would come up with something that the evidence would suggest or support or you would be able to at least follow the evidence to come to a logical conclusion, basically I was just given some other crazy way that this could have occurred or they would change their theory of what happened to try to match the evidence rather than letting the evidence dictate to you the events that occurred”. Deposition of Robert Deel Jan. 27, 2011.
Another crazy theory State’s Attorney James Glasgow was convinced that the barrel of the gun had been forcefully jammed underneath Kimberly Vaughn’s chin, based on their interpretation of what they called a “snowman” like soot impression on the bottom of Kimberly’s chin. Deposition of Nicole FundellJan. 26, 2011.
What the State’s Pathologist said Deposition of Dr. Larry Blum: • The “snowman” soot stain was loose contact • Not indicative of force. • Consistent with suicide
Governor’s Commissionon Capital Punishment • Tunnel vision or ‘confirmatory bias’ was “found in a number of the cases involving the 13 men who were ultimately released from death row in Illinois. . .”
Tunnel Vision “rather than keeping an open objective mind during the investigatory phase, one may leap to a conclusion that a person who is a suspect is in fact the guilty party. Once that conclusion is made, investigative efforts often center on marshaling facts and assembling evidence which will convict that suspect, rather than continuing with the objective investigation of other possible suspects”.
Forensic Science says • “A contact wound favors suicide . . .” • “Chin entry wounds tend to be self-inflicted.” Source: Forensic Pathology of Trauma: Common Problems for the Pathologist, Michael J. Shkrum, David A. Ramsey, 2007, Chapter. 6 Penetrating Truama: Close Range Firearm Wounds, pp. 306-07
Blood spatter is mostly expected on the back of the thumb that is used for pulling the trigger . . . first, blood stains occur not only during the bullet impact or exit (back spatter or forward spatter) but also following blood seepage or dripping from the wounds. . . Blood-Spatter Patterns: Hands Hold Clues for the Forensic Reconstruction of the Sequence of Events, American Journal of Forensic Medicine and Pathology June 2003
Blood stain evidence on Kim’s left thumb is consistent with self-inflicted suicide
Location of gun: another fact consistent with suicide. “I think the gun was dropped from above and that’s where it went.” CSI Bob Deel
Toxicology Autopsy report of Dr. Mitchell: "Toxicology shows Topiramate within the therapeutic range. Nortriptyline is present in the blood."
ISP Subpoenas Medical Records • Search warrant : • Requests Kim’s medical records • That may indicate “suicidal or homicidal thoughts or impulses, or relating to Kimberly Vaughn’s prescriptions for and utilization of the drugs referred to as Topamax, Avapro, and Nortriptyline.”
FDA Alert Dec. 16, 2008 • Warning: about increased risk of suicidal thoughts and behavior for patients taking the drug Topamax • FDA found a statistically significant risk of suicide associated with a class of eleven (11) medications known as antiepileptic drugs.
Topamax posed the greatest risk of suicidal behavior Of the 11 antiepileptic drugs evaluated by the FDA, Topamax (generically known as Topiramate) had the highest odds ratio (OR) of 2.57. The mean average odds ratio for all eleven of these antiepileptic drugs was 1.80. (Source: FDA Statistical Review And Evaluation Antiepileptic Drugs and Suicidality, pp. 23, 43)
May 24, 2007 Kimberly Vaughn went to see a doctor of osteopathic medicine. Her chief complaint was for “evaluation of onset of anxiety”.
FDA Medication Guide: Topamax Call a healthcare provider right away if you have any of these symptoms • new or worse anxiety • feeling agitated or restless • panic attacks • new or worse irritability • other unusual changes in behavior or mood
Email to husband • Her doctor told her: “stopping the migraine medication... will also help stop my anxiety” • “I told him that you had notice and I had notice a big personality change and anxiety change and that I was lethargic (tired all the time).”
Other side-effects “Effects on Thinking . . . TOPAMAX may cause depression or mood problems, tiredness, and sleepiness”. Source: FDA approved label warning May 9, 2009 • acting aggressive, being angry, or violent • acting on dangerous impulses Source: Medication Guide for Topamax
FDA label warning: Topamax May 9, 2009 “How can I watch for early symptoms of suicidal thoughts and actions?” • “Pay attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings”.
Deposition of Dr. Bhatia A big personality change would be an unusual change in behavior or mood: • A: Compared with what I knew about Kimberly, yes, that would be a big change. . . • Q. But with a big personality changes that she self-described, that would— • A. That would be significant. (Bhatia Dep. Tr. pp. 76-77)
Synergistic risks Dr. Bhatia was asked what the significance would be taking both medications together: “Well, it would increase the risk of suicidal thoughts.”
IDOC #M-33173 Parent Institution: MENARD CORRECTIONAL CENTER Offender status: IN-CUSTODY
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