Undetected Drug Intoxication in a Correctional Facility Leads to Death

This case study examines the tragic death of a young adult in a correctional facility due to acute drug toxicity, despite not showing initial signs of intoxication.

ByWendy Ketner, M.D.


Published on February 2, 2024

Lab blood test

Case Overview

This case study delves into the tragic circumstances surrounding a young adult who was arrested and subsequently placed in a correctional facility. Upon their admission, the individual disclosed to the correctional officers that they had consumed drugs but did not specify the type or quantity. Despite this disclosure, no signs of intoxication were apparent at the time. The following day, however, the individual was found unresponsive with rigor mortis setting in. Their last known conscious moment was two hours prior.

An autopsy revealed an opened bag in their large intestine and toxicology reports indicated high levels of cocaine (269 ng/mL), methamphetamine (114 ng/mL), and fentanyl (105 ng/mL) in their bloodstream. The cause of death was determined to be acute toxicity from methamphetamine, fentanyl, acetyl fentanyl, and cocaine. A forensic pathologist was sought to provide expert opinion on the events leading up to their death and correlate them with the autopsy findings.

Questions to the Forensic Pathology expert and their responses


Can you describe your experience evaluating patients who have expired under similar circumstances?

As a medical examiner, I have investigated countless drug overdoses, some of which occurred within jail settings. I have also examined non-drug related deaths in similar environments.


What signs and or symptoms would you expect the patient to exhibit if she was acutely intoxicated from the substances found in her blood?

The substances found in the patient's blood could produce a wide range of symptoms. Excited-type symptoms may include hyperactivity, hyperthermia, agitation, anxiety, delirium, and hallucinations. Depressed-type symptoms might manifest as sleepiness or stupor, euphoria, slow breathing. Seizures are also a possibility.


Have you ever reviewed a similar case? If so, please elaborate.

Yes, I have reviewed similar cases before. The circumstances often involve individuals who have consumed drugs prior to their incarceration and subsequently succumb to the effects while in custody.

About the expert

This expert is a seasoned forensic pathologist with over a decade of experience, board-certified in anatomic and clinical pathology as well as forensic pathology. Their extensive education includes a BS in Biology, an MD, a residency in Pathology, and a fellowship in Forensic Pathology from reputable institutions. Currently serving as the co-director of a forensic pathology fellowship program and the chief medical examiner for a state office, they have contributed to their field through numerous postmortem examinations, peer-reviewed publications, and active memberships in several medical societies.

Expert headshot



About the author

Wendy Ketner, M.D.

Wendy Ketner, M.D.

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

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