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Body of evidence, again

Doctors will perform a second autopsy Monday on the teen beaten at a boot camp.

Published March 12, 2006

[Times art: Don Morris]
To learn whether Martin Lee Anderson died of natural causes, or from blows inflicted by guards, doctors will examine his body for the second time on Monday. Here is a look at how autopsies are done, what they found in the first autopsy, and what they may look for next.
Go to interactive

The body of 14-year-old Martin Lee Anderson has arrived in Tampa, encased in the coffin he was buried in, transported by workers who attempted to preserve the dignity of the dead.

On Monday, science takes over. Doctors will perform a second autopsy in hopes of answering why the teen collapsed then died a day after he was beaten by guards at a Panama City juvenile boot camp.

Hillsborough County Medical Examiner Vernard Adams will reopen the teenager's chest as a noted pathologist and author, Dr. Michael Baden, observes on behalf of the family.

Adams will inspect the organs and remove them, probably cutting them apart and examining them further, possibly down to a cellular level.

This is the second autopsy of Martin Anderson. The first, performed by Dr. Charles F. Siebert, the medical examiner for six north Florida counties, concluded he died of sickle cell trait, not the beating.

That conclusion proved so controversial that special prosecutor Mark Ober, appointed by Gov. Jeb Bush to investigate the death, ordered another autopsy.

"An autopsy is a process of inquiry," said Dr. Amyn Rojiani, a professor at the University of South Florida and director of neuropathology and autopsies at Moffitt Cancer Center & Research Institute.

This is a look at the arcane art of autopsies and how this one could answer the questions of a grieving family and determine if staff members of a state-funded juvenile boot camp killed one of the youths they were supposed to rehabilitate.

* * *

Forensic pathologists search corpses for clues. But when they describe their work, they don't sound like detectives looking for a single smoking gun. Instead they gather dozens or hundreds of tiny truths, which they assemble into a mosaic that is their conclusion about how someone died.

"It's a process of induction," said Dr. John Hunsaker, president of the National Association of Medical Examiners and Kentucky's associate chief medical examiner. "The first thing you've got to start with is data."

For this reason, medical examiners look at more than corpses. Reports from police, witnesses and ambulance personnel also are important, and often establish a working hypothesis. In this case, surveilence video at the Bay County Boot Camp is a key source of information.

The video shows guards striking and kneeing Martin Anderson. It also shows him attempting to stand and collapsing. An hour goes by before emergency personnel arrive.

But the most indispensable evidence comes from the body itself.

* * *

A first step in any autopsy is the external exam - looking over the body for injuries or other problems.

Some observations are obvious - a gunshot wound to the forehead, for example.

Others are misleading. A corpse can acquire splotches that look like bruises but aren't.

In Siebert's autopsy, the most remarkable thing about the external exam was that he found so little that was remarkable.

His report said the boy's face, neck, arms, legs and back were "free of scars or injuries," and that his chest had no scars.

The only injuries noted were "superficial" cuts and bruises inside his lips and two abrasions, one behind each ear, one of which was described as "superficial." The abrasions behind the ears were each less than one centimeter wide, which is smaller than the word "abrasions" in this sentence.

A layman would look at such minor injuries and think: That doesn't sound like someone who got beaten to death.

"A blow can be inflicted to an abdomen and not leave any mark on the skin whatsoever," said Dr. Joseph H. Davis, an eminent pathologist who was Dade County's medical examiner from 1957 to 1996.

In other words, he could have been beaten even if the exterior of his body doesn't show it. But even previously undiscovered bruises do not mean those injuries killed him.

To know more, doctors need to look deeper.

For that, they need a scalpel.

* * *

The internal exam begins with a cut, usually a Y-shaped incision in the chest. The pathologist who peers inside the body knows what to check for - the appropriate color and sponginess of the lungs, the location and size of other organs, the presence of unusual fluids or objects, even strange smells.

After looking at the anatomy of the corpse, the pathologist begins removing the organs, weighing them and observing them further.

Every detail provides another piece of the puzzle.

In an autopsy like this one, Davis said he would want to inspect the blood vessels in organs for evidence of complications of sickle cell trait, a blood disorder the youth's parents were unaware of.

People with this condition can have their normally round red blood cells flatten, harden and clog the blood, restricting its flow. In fact, Davis said he had seen people with sickle cell trait whose blood thickened so severely it formed a solid cast of the pulmonary arteries, looking like the branching pulmonary "tree" shown in medical diagrams.

Pathologists keep sets of finely sharpened knives for autopsies. They cut apart the organs to look for evidence like the clotting. They also can search for a variety of other findings, such as tumors, bleeding and internal injuries.

Siebert found that "the retroperitoneum has a marked amount of interstitial hemorrhage extending into the mesentery."

In other words, there was bleeding in an area near the small intestines. Asked about that finding, Davis said it could indicate "force was applied" to the body.

Enough to kill him?

Davis said he would need to know a lot more to answer that question.

The autopsy also noted bleeding on the tip of a muscle near the mitral valve of Martin's heart.

A microscopic exam provides more detail.

When Siebert looked under the microscope, he reported finding sickle-shaped cells in the blood of the kidneys, liver, spleen and brain. Presumably, that was a key finding in his conclusion.

But Davis, who read the first autopsy at the request of the St. Petersburg Times, said the report also notes three separate findings in the microscopic evidence that point to the possibility that Martin Anderson suffered from asthma. He said he would want to examine the lungs further and hear from people about the boy's exercise history.

* * *

Adams will perform the procedure, but Baden will be present and able to interact with Adams. Baden is a former New York City chief medical examiner, an author of popular books and scholarly articles, and has been featured on the HBO show Autopsy. He headed a forensic panel that reinvestigated the deaths of former President John Kennedy and Dr. Martin Luther King Jr. Adams has said that he would work to accommodate requests Baden might have for certain tests or observations, said Dick Bailey, Adams' manager of operations.

This second autopsy will present new challenges. The body was presumably embalmed before burial, which could change the coloration and feel of tissues during the new autopsy. It also could make tissue more difficult to cut. Certain inspections - such as cutting open a lung - are best to view the very first time, Davis said.

On the other hand, a lot of evidence remains. Rojiani, the USF professor, said bruising can remain detectable for a long time after death, and he would expect it to be so now. And preserved tissues from the first autopsy also can be examined.

Everything the doctors find will be noted. Then comes the hard part: the conclusion.

"The intellectual, interpretive process," said Hunsaker, president of the medical examiners' group, "consists of putting this all together."

[Last modified March 12, 2006, 01:17:10]

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