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Department of Pathology

Medical Center Blvd


Winston-Salem, NC 27157
Phone: (336) 716-4311
Fax: (336) 716-7595

MEDICOLEGAL AUTOPSY REPORT

Pathologist: ANNA GREENE MCDONALD , MD Patient Name:: AGNEW, JOHN DOUGLAS


Resident: Medical Record #:
Autopsy Assistant: Eric M. Vail DOB/Age:: 9/5/1941 (Age: 75)
Service: Race/Gender: B/M
Admitted:
Expired: 4/10/2017
Autopsied: 4/13/2017
Reported: 4/21/2018
Attending Physician: NCBH Path #: A17-702
Medical ANNA GREENE MCDONALD
Examiner:
Forsyth County Medical Examiner

FINAL AUTOPSY DIAGNOSIS

I. Sharp force injuries of the head and neck:


A. Stab wounds of neck (x3):
1. Perforation: skin and soft tissue
2. Perforation: left transverse process of vertebra C7
3. Penetration: cervical spinal cord
4. Approximate depths: 1 ¾-inch, 1 ½-inch, 2 ½-inches
5. Directions of wounding: back-to-front
B. Incised wound of the head:
1. Perforation/penetration: skin and soft tissue
II. Blunt force injuries of the head and neck:
A. Contusions of back of head (x2), right side of head, posterior neck
B. Subscapular hemorrhage, posterior
C. Temporalis muscle hemorrhage
D. No intracranial injuries
III. Sharp force injuries of the torso:
A. Stab wound of the left chest:
1. Perforation: skin and soft tissues
2. Perforation: left rib #4
3. Penetration: left lung
4. Associated injury: scant left hemothorax
5. Approximate depth: 4 ¼-inches
6. Direction of wounding: front-to-back, left-to-right, and downwards
B. Stab wound of the back:
1. Perforation: skin and soft tissues
2. Penetration: spinous process of vertebra S1
3. Approximate depth: 1 ¾-inches
4. Direction of wounding: back-to-front, left-to-right, and downwards
C. Overlapping, incised wounds of the genitalia:
1. Perforation: skin and soft tissues
2. Penetration: corpora cavernosa (superficially)
3. Approximate depth: 1-inch
IV. Blunt force injuries of the torso:
A. Abrasion over left scapula
B. Contusions over right scapula
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AGNEW, JOHN DOUGLAS Autopsy Report A17-702

V. Sharp force injuries of the right hand:


A. Superficial incised wound of back of the right hand
B. Superficial incised wound of right posterior thumb
VI. Blunt/chop force injuries of the upper extremities:
A. Right arm:
1. Contusion of upper arm
2. Contusions over anterior wrist and thenar eminence
3. Contusion of posterior hand and fingers
4. Chop injury of proximal phalanges:
a) Complete amputation of fingers #2 and #3 proximally
b) Skin avulsion of posterior finger #4 proximally
c) Partial amputation of finger #2 distally with involvement of fingernail
B. Left arm:
1. Contusion of upper arm
2. Contusion over posterior wrist and back of hand
3. Chop injury of proximal phalanges:
a) Fractures of metacarpals of fingers #3 and #5
b) Complete amputation of finger #4
VII. Sharp force injuries of the left thigh:
A. Incised wounds of anterior thigh (x2):
1. Penetration/perforation: skin and soft tissues
2. Approximate depths: 2 ½-inches and ½-inch
VIII.Blunt force injuries of the lower extremities:
A. Right leg:
1. Abrasion of anterior thigh
2. Contusions of distal thigh
3. Contusions around ankle and on top of foot
B. Left leg:
1. Contusions on top of foot
IX. Perimortem decapitation and dismemberment
X. Hypertensive cardiovascular disease:
A. Heart with increased interstitial fibrosis
B. Kidneys with arteriolonephrosclerosis
XI. Lymphocytic thyroiditis
XII. Liver with steatosis (etiology uncertain)
XIII.Renal cyst (1.2 cm), left
XIV. Duplex ureter, left

***Electronically Signed Out By: ANNA GREENE MCDONALD , MD***

ts

Summary of Findings
The cause of death is stab wounds of neck and torso.

Major findings at autopsy include stab wounds of the neck with injury to the underlying spinal cord; a stab wound of the chest with
injury of the left lung; incised wounds of the head, left thigh, genitalia and hands; and blunt/ chop injuries of the hands with
amputation of several fingers. Evidence of perimortem decapitation and dismemberment through the cervical spine, bilateral
humeri, and bilateral femurs is present, with matching apposing body segments. Postmortem toxicologic analysis on urine revealed
amlodipine and no other substances included in a routine screen.

According to investigative reports, the decedent was last known to be alive on 4/8/2017. When his residence was entered on
4/10/2017, blood was on the carpet and in the kitchen. In the bathroom was a black duffel bag containing dismembered body
parts, including his head, arms and legs. Knives and a hacksaw were in the kitchen and a hatchet was on the couch. His torso was
not at the scene. Concurrently in Randolph County, the Sheriff's Office responded to a body found by NCDOT workers near
Archdale, NC. The remains (torso matching dismembered body parts) were found in a wooded area off of Canter Road near
Woody Creek. After speaking w/ the Randolph County SO and ME (Charles Reeder) and consultation w/ NC OCME, the torso
was brought to WFBMC for autopsy along with the dismembered body parts from 308 Timberline Drive.

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AGNEW, JOHN DOUGLAS Autopsy Report A17-702

EXTERNAL EXAMINATION

Body Weight: 153 lb Representatives for Winston Salem Police Department are present
Body Length: 71 in during the autopsy.
BMI: 21.3
The body is that of an African American male received in two sealed
body bags labelled “John Doe”, one containing the torso with attached
segment of neck and proximal thighs and the other containing the head/
proximal neck, upper extremities, and distal lower extremities. Winston
Salem Police Department subsequently confirmed the decedent’s
identity by visual means.

The torso is received unclothed with a black, flat sheet containing a 9


½-inch, cut defect. Personal effects accompanying the torso include a
fitted sheet in a paper bag. The body bag containing the head and
remaining extremities is unclothed and has only paper material collected
from near the dismembered area of the neck.

The body portions are cold to touch. Rigor and livor mortis are difficult to
appreciate secondary to perimortem dismemberment.

The head and proximal neck are severed at the level of the thyroid
cartilage with complete transection through the cervical vertebra and
spinal cord posteriorly and associated fractures of the bilateral superior
horns. The scalp hair is gray and sparse and in the distribution of male
pattern baldness. The irides appear light with overlying cloudy cornea.
The sclerae are white. Inferior palpebral petechiae are present
bilaterally. The nose and ears are not unusual. The lips and gums are
pink and atraumatic. The teeth are in natural condition. Facial hair
consists of a gray beard.

The torso portion consists of the neck distal to the thyroid cartilage plane
of section; right shoulder with attached 2 ½-inch segment of humeral
head and shaft; left shoulder with attached 2 3/8-inch segment of
humeral head and shaft; and both thighs which are severed through the
distal femur. The thorax is symmetrical. The abdomen is flat. The
external genitalia are those of a normal adult male; the testes are
bilaterally descended within the scrotum. The anus is unremarkable.

The upper and lower extremities are well-developed and symmetrical


after reapproximation of all segments. A 2 ¾ x 3/8-inch, incised wound
is on the lateral thigh below the buttock with no surrounding
hemorrhage, consistent with a postmortem injury at or around the time
of dismemberment.

The appositional segments of neck, upper extremities, lower extremities,


and amputated digits all correspond in body location and cut surface
and comprise that of a single individual.

Evidence of medical therapy consists of a bandage and tape over the


right forehead.

Evidence turned over to Officer Robinson of the Winston Salem Police


Department during the autopsy includes body bag #1, body bag #2, flat
sheet from torso, fitted sheet from torso, body bag from torso, bandage
from head, bag seal from head/extremities, bag seal from torso, blood
spot card from head/extremities, blood spot card from torso, fingernail
scrapings (right/left), scalp hair and paper material from the neck
(4/12/2017 at 14:51).

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AGNEW, JOHN DOUGLAS Autopsy Report A17-702

EVIDENCE OF INJURY:

NOTE: The sharp force injuries are labeled for documentation purposes only. The lettering does not denote the severity of the
injuries nor does it denote the chronologic order in which the injuries were received.

HEAD AND NECK SHARP FORCE INJURIES:

STAB WOUNDS OF THE POSTERIOR NECK (x3)


(LABELED “B”, “C” AND “D” ON CHARTS AND DIAGRAMS):

On the back of the neck, ½-inch below the top of the neck
dismemberment site and 1 ¼-inches left of the posterior midline, is a
5/8-inch in length, horizontal stab wound (“B”). Also on the back of the
neck, ¾-inch below the top of the neck dismemberment site and 1 inch
left of the posterior midline, is a 1 3/16-inch in length, oblique stab
wound (“C”). Blunt and sharp aspects of both wounds are
indeterminate. There is no abrasion or other injury on the skin
surrounding the stab wounds.

The paths of stab wounds “B” and “C” overlap, sequentially perforating
the skin and soft tissue of the neck with hemorrhage into the
paravertebral musculature, left transverse process of vertebra C7 (2
defects), and one penetrates the cervical spinal cord (single defect).

The hemorrhagic wound tracks have an approximate depth of 1


¾-inches and 1 ½-inches and travels from the decedent’s back-to-front.

On the right side of the neck posteriorly, 7/8-inches below the top of
the neck dismemberment site and ¾-inches right of the posterior
midline, is a 9/16-inch in length, slightly oblique stab wound (“D”).
Blunt and sharp aspects are indeterminate. There is no abrasion or other
injury on the skin surrounding the stab wound. The path of the stab
wound sequentially perforates skin and soft tissues only with
surrounding hemorrhage. The hemorrhagic wound track has an
approximate depth of 2 ½-inches and travels from the decedent’s
back-to-front.

INCISED WOUND OF THE HEAD:

On the right side of the head above the ear, centered 1 ½-inches below
the top of the head and 3-inches right of the anterior midline, is a 1
7/8-inch in length, oblique, incised wound. The hemorrhagic wound
track involves skin and soft tissue only, to an approximate depth of
3/8-inch.

BLUNT FORCE INJURIES:

Two red contusions (3 x 1 ¾-inches and 1 ¼ x 3/8-inch) are over the


back of the head. A 1 ½-inch, red contusion is on the right side of the
head. A 1 x 1/8-inch, red-purple contusion is over the posterior neck, 7
½-inches below the top of the head and at the posterior midline.

Internally, a 2 ½ x 1 ½-inch, subcapsular hemorrhage is over the occiput


and hemorrhage is present within bilateral temporalis muscles. No skull
fractures or intracranial injuries are present.

CHEST AND ABDOMEN SHARP FORCE INJURIES:

STAB WOUND OF THE LEFT CHEST


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(LABELED “E” ON CHARTS AND DIAGRAMS):

On the left side of the chest, 4-inches below the top of the neck
dismemberment site and 4 ½-inches to the left of the anterior midline, is
a 7/8-inch in length, oblique stab wound. Blunt and sharp aspects are
indeterminate. There is no abrasion or other injury on the skin
surrounding the stab wound.

The path of the stab wound sequentially perforates skin, soft tissues, left
rib #4 (2 cm defect), and penetrates the upper lobe of the left lung (1.3 x
0.6 cm defect). The hemorrhagic wound track has an approximate depth
of 4 ¼-inches and travels from the decedent’s front-to-back, left-to-right,
and downwards.

Associated injuries include scant blood within the left pleural cavity.

STAB WOUND OF THE BACK


(LABELED “A” ON CHARTS AND DIAGRAMS):

On the back, 13 ¾-inches below the top of the neck dismemberment


site and ¼-inch to the right of the posterior midline, is a 1 1/16-inch in
length, oblique stab wound. Blunt and sharp aspects are indeterminate.
There is no abrasion or other injury on the skin surrounding the stab
wound.

The path of the stab wound sequentially perforates skin, soft tissues,
and penetrates the spinous process of vertebra S1 without penetration of
the underlying spinal cord. The hemorrhagic wound track has an
approximate depth of 1 ¾-inches and travels from the decedent’s
back-to-front, left-to-right, and downwards.

INCISED WOUNDS OF THE GENITALIA:

Over the mons pubis and extending into the penile shaft, 4 ½-inches
from the tip of the penis and roughly centered at the anterior midline, is
a 4 x 3 3/8-inch area of coalescing incised wounds. The region of
incised wounds involves skin and soft tissue with exposure of the
underlying corpora cavernosa of the penile shaft with surrounding soft
tissue hemorrhage. The area of incised wounds has an approximate
maximal depth of 1-inch. An adjacent, 1 ½ x 1-inch region of
hemorrhage is present within the abdominal wall near the umbilicus.

BLUNT FORCE INJURIES:

A 4 x ¾-inch, red abrasion is over the left scapula. Two red contusions
(3 ½ x 1 ¾-inches and 1 ¾-inches) is over the right scapula.

UPPER EXTREMITIES SHARP FORCE INJURIES:

A 3/4-inch, superficial incised wound is over the back of the right hand
near the ring finger. A 5/8-inch, superficial incised wound is over the
back of the right thumb.

BLUNT AND CHOP FORCE INJURIES:

RIGHT: A 3 x 2 ¾-inch, red contusion is over the lateral aspect of the


upper arm. A ½-inch, red contusion is over the anterior wrist. A 2 x
¾-inch, red contusion is over the thenar eminence. A 5 ½ x 3-inch, red
contusion involves the back of the hand with extension down the
posterior surfaces of fingers #1-3. Adjacent chop force injuries of the
proximal phalanges include complete amputation of the fingers #2 and
#3, as well as adjacent skin avulsion of finger #4 posteriorly. A 5/8 x
3/8-inch, partial amputation of the finger #2 is also present and involves

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AGNEW, JOHN DOUGLAS Autopsy Report A17-702

the fingernail.

LEFT: A 2 ½ x 2-inch, red-blue contusion is over the lateral aspect of the


left upper arm. A 6 x 3 ½-inch, red contusion involves the posterior wrist
and back of the left hand with an adjacent 2 ¾-inch, chop injury of the
proximal phalanges. Underlying injuries include metacarpal fractures of
fingers #3 and #5 as well as complete amputation of finger #4.

LOWER EXTREMITIES SHARP FORCE INJURIES:

INCISED WOUNDS OF LEFT THIGH (x2):

On the anterior left thigh at about the level of the genitalia injuries are
two incised wounds (5 ¾ x 3 ¾-inches and 2 7/8 x 1/8-inches) that are
located at 15 ½-inches and 14 ¼-inches from the distal end of the left
femur dismemberment plane and 5 ½-inches and 3 ½-inches left of the
anterior midline through the limb, respectively. The paths of the incised
wounds sequentially perforate skin, soft tissues, and penetrate
musculature with some surrounding hemorrhage and appear to nearly
connect with the incised wound on the posterior left thigh. The
hemorrhagic wound tracks have approximate depths of 2 ½-inches and
½-inches, respectively.

BLUNT FORCE INJURIES:

RIGHT LEG: A 2 ¼ x 1/8-inch, red abrasion is over the anterior right


thigh. Two red-blue contusions (1 x ¾-inch and 1 ½ x 1-inch) are over
the lateral aspect of the right thigh, distal to the site of femur
dismemberment. Three contusions (1 ½ x ¾-inch, ¾-inch, and 2 ½ x
2-inches) are around the right ankle and top of the right foot.

LEFT LEG: Two red-purple contusions (1 ¾ x 1-inch and 1 ½ x 1-inch)


are over the top of the left foot.

INTERNAL EXAMINATION
BODY CAVITIES Right pleural and abdominal cavities have no abnormal fluid collections
Panniculus adiposus: 2.5 cm or adhesions. All body organs are present in normal and anatomical
position.

CENTRAL NERVOUS SYSTEM The skull has no fractures. The dura mater and falx cerebri are intact.
Brain weight: 1430 gm The leptomeninges are thin and delicate. The cerebral hemispheres are
symmetrical. The structures at the base of the brain, including cranial
nerves and blood vessels, are intact and free of abnormality. Sections
through the cerebral hemispheres reveal no lesions within the cortex,
subcortical white matter, or deep parenchyma of either hemisphere. The
basal ganglia, thalami, and Ammon's horn are unremarkable. The
cerebral ventricles are normal caliber. Sections through the brain stem
and cerebellum are unremarkable.

NECK SEE “EVIDENCE OF INJURY” AND “EXTERNAL EXAMINATION”


SECTIONS ABOVE.

The hyoid bone is intact. The lingual mucosa is intact; the underlying
firm red-brown musculature is devoid of hemorrhage.

CARDIOVASCULAR SYSTEM The pericardial surfaces are smooth, glistening and unremarkable; the
Heart weight: 310 gm pericardial sac is free of significant fluid or adhesions. The coronary
arteries arise normally, follow the usual right dominant distribution and
are widely patent, without significant atherosclerosis or thrombi. The
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chambers and valves bear the usual size-position relationships and are
unremarkable. The circumferences of the valves are as follows:
pulmonic (7.2 cm); tricuspid (13.5 cm); aortic (7.5 cm); mitral (11 cm).
The myocardium is dark red-brown, firm, and unremarkable; the atrial
and ventricular septa are intact. The thicknesses of the ventricular walls
are: left ventricle (1.0 cm); interventricular septum (1.0 cm); right
ventricle (0.2 cm). The aorta and its major branches arise normally,
follow the usual course and are widely patent, free of significant
atherosclerosis and other abnormality. The vena cava and its major
tributaries return to the heart in the usual distribution and are free of
thrombi.

RESPIRATORY SYSTEM SEE “EVIDENCE OF INJURY” SECTION ABOVE.


Right lung weight: 350 gm
Left lung weight: 280 gm The upper airway is clear of debris and foreign material; the mucosal
surfaces are pink. The pleural surfaces of the left lung are smooth,
glistening and unremarkable. Lobar divisions are of the usual
configuration. The pulmonary parenchyma is dark red-purple, exuding
minimal mounts of blood and frothy fluid; no focal lesions are noted. The
pulmonary arteries are normally developed, patent, and without
thrombus or embolus.

LIVER AND BILIARY SYSTEM The hepatic capsule is smooth, glistening and intact, covering red-tan
Liver weight: 1110 gm parenchyma with no focal lesions. The gallbladder contains
Bile volume: 5 mL green-brown, slightly mucoid bile; the mucosa is velvety and
unremarkable. The extrahepatic biliary tree is patent, without calculi.
The portal vein and its tributaries are unremarkable.

ALIMENTARY TRACT The esophagus is lined by gray-white, smooth mucosa. The gastric
mucosa is tan-pink with postmortem loss of the usual rugal folds. The
gastric lumen contains approximately 10 mL of tan liquid. The serosa of
the small and large bowel is unremarkable. The appendix is
unremarkable. The pancreas has pink-gray, lobulated appearance and
the ducts are unobstructed.

GENITOURINARY TRACT The renal capsules are smooth and thin, semi-transparent, and strip with
Right kidney: 110 gm ease from the underlying, red-brown cortical surfaces. The cortex is
Left kidney: 120 gm sharply delineated from the medullary pyramids, which are red-purple to
Urine volume: 20 mL tan and unremarkable. A 1.2 cm simple cyst is noted in the left kidney.
The calyces, pelves, and ureters are unremarkable. The relationships at
the trigone are unremarkable. The mucosa of the urinary bladder is
gray-tan and smooth. The testes, prostate and seminal vesicles are
without hemorrhage.

RETICULOENDOTHELIAL SYSTEM
Spleen weight: 30 gm The spleen has a smooth, intact capsule covering red-purple, softened
parenchyma; the lymphoid follicles are indistinct. The regional lymph
nodes appear normal. The bone marrow is red-purple and
homogeneous, without focal abnormality.

ENDOCRINE SYSTEM The pituitary, thyroid, and adrenal glands are unremarkable.

MUSCULOSKELETAL SYSTEM Aside from the injuries and regions of dismemberment noted above, the
remaining bony framework, supporting musculature, and soft tissues are
not unusual.

BLOCK SUMMARY
1. Fibroadipose tissue
2. Paravertebral skeletal muscle, lung
3. Lung, heart
4. Heart, pituitary, thyroid
5. Kidney, liver, heart, skeletal muscle
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6. Hippocampus, basal ganglia, watershed cerebral cortex

MICROSCOPIC DESCRIPTION

HEART: The heart has scattered hypertrophic myocytes with an increase in interstitial fibrosis.

LUNGS: The lungs have emphysematous changes and regions of intra-alveolar, extravasated red blood cells. No significant
inflammation is identified.

LIVER: The liver has a moderate, macrovesicular steatosis without significant inflammation or fibrosis.

KIDNEY: The kidney has scattered sclerotic glomeruli and arterioles with an eccentric intimal proliferation.

THYROID: The thyroid is replaced with dense fibrosis and regions of chronic inflammation and scattered follicular epithelium with
oncocytic change.

BRAIN: The sections of brain have no significant inflammation, hemorrhage, or gliosis. The pituitary has an unremarkable mixture
of acidophils and basophils.

TOXICOLOGY
Toxicology Folder: T201704025
Case Folder: F201704345
Date of Report: 04-jun-2017

DECEDENT: John Douglas Agnew

Status of Report: Approved


Report Electronically Approved By: Ruth Winecker, Ph.D.

===============================================================================
SPECIMENS received from Anna Greene McDonald on 19-apr-2017

S170010821: 2.0 ml Vitreous Humor CONDITION: Postmortem


SOURCE: Eye OBTAINED: 13-apr-2017

_______________________________________________________________________________

S170010822: Brain CONDITION: Postmortem


SOURCE: Brain OBTAINED: 13-apr-2017

_______________________________________________________________________________

S170010823: Liver CONDITION: Postmortem


SOURCE: Liver OBTAINED: 13-apr-2017

_______________________________________________________________________________

S170010824: 17.0 ml Urine CONDITION: Postmortem


SOURCE: Urinary Bladder OBTAINED: 13-apr-2017

Amlodipine ------------------------ Present 06/04/2017


Benzodiazepines ------------- None Detected LCMS 06/04/2017
Cocaine metabolite ---------- None Detected LCMS 06/04/2017
Ethanol --------------------- None Detected 06/04/2017
Gabapentin/Pregabalin ------- None Detected LCMS 06/04/2017
Opiates/Opioids ------------- None Detected LCMS 06/04/2017
Other Organic Bases --------- None Detected 06/04/2017
_______________________________________________________________________________

Accredited by the American Board of Forensic Toxicology, Inc.

060517 08:01 *** END OF REPORT ***

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AGNEW, JOHN DOUGLAS Autopsy Report A17-702

COPY TO:
ANNA GREENE MCDONALD , MD

AGNEW, JOHN DOUGLAS Page 9 of 9 A17-702

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