The Expert: Dr. Michael Heninger, a pathologist in Atlanta, Georgia, testifies for the plaintiff as to his belief that the individual died from a seizure that led to drowning.
An Atlanta pathologist further certified in forensic pathology, Dr. Michael Heninger testified as an expert in a 2014 Georgia trial in which a home for developmentally disabled individuals was accused of negligence that led to a drowning death at a pool party. The plaintiffs contended that the home did not properly monitor the party, while the defense argued the individual suffered a seizure and heart attack that proved fatal. The expert testifies for the plaintiff that the young man at the center of the case had a seizure that ended in his drowning.
Heninger, who performed the autopsy, explains that while sometimes people with seizures can die from them, usually that does not happen, because the patient will resume breathing once the seizure is over. In this case, the patient was submerged in water for 6 minutes, so it is likely that once the seizure abated, the victim would then drown as his breathing reflexes returned.
There is no one finding that specifically defines drowning on autopsy, the expert explains. The diagnosis of drowning has to exclude all other causes and have associated findings that point to this as a cause. In this case, examination of the lungs revealed that they were “heavy,” a finding consistent with submersion in water causing death. Other findings might include water present in the stomach from swallowing, or petechiae, tiny red spots of hemorrhage present in the eye, conjunctiva, or in the mouth from ruptured blood vessels. These latter findings were not seen in this patient. Foam in the airway is another finding but again is not specific and can disappear with intubation and CPR measures.
In this case, the patient’s heart was found at autopsy to be larger than normal, being dilated as opposed to thickened. This is again a nonspecific finding, but when he performed the autopsy, the doctor felt that the condition was a contributory factor in the patient’s demise. If the victim had an enlarged or dilated heart, he would be more susceptible to arrhythmias when the oxygen supply is lacking as when one is being submerged for six minutes. An arrhythmia causes uncoordinated beating of the heart which puts one at great risk of dying from cardiac arrest. The expert testifies that the prolonged submersion led to oxygen deprivation, which likely caused a severe arrhythmia in this patient with a dilated cardiomyopathy. Dr. Heninger felt that it was a witnessed seizure that led to prolonged water submersion, which caused anoxia and subsequent arrhythmia in a susceptible heart, ultimately killing the victim.
The jury was convinced, awarding $2 million to the plaintiff.
Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.
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