North Korea

What an autopsy could reveal about Otto Warmbier's death

Family declines autopsy for US student released by North Korea

PUBLISHED : Wednesday, 21 June, 2017, 8:05pm
UPDATED : Saturday, 24 June, 2017, 11:48am

Otto Warmbier’s death and the events in North Korea that led up to it remain a mystery.

North Korean officials said that during his 17 months in detention for “hostile acts against the state,” Warmbier had contracted botulism, was given a sleeping pill and never woke up.

Last week, after nearly a year and a half in captivity, the University of Virginia student was brought home to Ohio in a coma. Doctors there said Warmbier had extensive loss of brain tissue and had suffered a severe neurological injury. Warmbier died Monday, six days after being flown back to the United States.

So what led to Warmbier’s death?

The Ohio coroner’s office said on Tuesday that it had not been able to determine the cause after carrying out an external examination. His parents have asked doctors not to conduct an autopsy.

There was no immediate word from the family about why relatives declined an autopsy, which may have shed more light on the cause of the neurological injuries that left him in a coma.

Watch: friend remembers Otto Warmbier

“No conclusions about the cause and manner of Mr Warmbier’s death have been drawn at this time as there are additional medical records and imaging to review and people to interview,” the coroner’s office said in a statement.

Experts say postmortem examinations can be illuminating, but the amount of time that has passed since Warmbier fell into a coma may limit what pathologists would be able to find.

Werner Spitz, a forensic pathologist who has worked on numerous high-profile cause-of-death investigations, said that even if there was an autopsy, he was not very hopeful it would shed light on what happened to him, given how long his body has had to erase the evidence.

“After a year of this fellow being unconscious, it is a futile effort,” said Spitz, who worked as a medical examiner in Baltimore and Detroit and is now a professor of pathology at Wayne State University School of Medicine.

“He essentially died a year ago. But being on life support maintaining him artificially there are a lot of things that will not show any longer.”

Bruises, cuts and other superficial markings on the skin would be among the first to fade, likely leaving behind no trace that they were ever there. Damage to bones or organs might show scars, but it would be almost impossible to tell how long ago they occurred. If Warmbier had been arrested or otherwise mishandled by North Korean security officials in such a way that it affected his ability to breathe, Spitz said, “it will not show at all.”

One exam that may provide a hint of what happened will give a closer look at the brain. Warmbier’s doctors could tell there had been some damage to parts of the comatose student’s brain when he arrived in the United States.

“Certain areas of the brain are more susceptible to oxygen deprivation than others. When those areas are affected, that tells you a lot about what happened in the past,” said Spitz, whose past cases included the deaths of President Kennedy and Nicole Brown Simpson.

“And since he was conscious and well when he went there, and shortly he became unconscious, that all adds up together not necessarily in their favour over there.”

Brian Peterson, president of the National Association of Medical Examiners, said that it’s clear that Warmbier suffered brain damage at some point.

“One pathway to brain damage would be anoxia - insufficient oxygen to the brain,” Peterson said.

“This could be caused by intoxication (think drug overdose), physical means (smothering, strangulation, mechanical asphyxia, etc.), or many other ways.

Bottom line - months later - there would be nothing particular to find at autopsy except for the damaged brain. Another pathway to brain damage would be direct physical trauma - an impact to the head, or an impact by the head against something.”

Peterson also said that “potentially, there could be physical findings months later in this case - a healed fracture, or macroscopic/microscopic brain changes consistent with impact.” But he warned that even if a complete autopsy with neuropathology is performed, the results may not be specific enough to provide real answers.

“It all depends on what happened to Mr Warmbier,” he said.
“That is why to forensic pathologists, history is so crucial. We need history just as much as clinicians do. Seriously, to withhold history (or fabricate it) can make our work difficult to impossible, at least in terms of producing meaningful diagnoses.”

Additional reporting by The Guardian and Reuters