Hazing is a problem at many educational institutions and the causes of this phenomenon are multifactorial in nature. Sometimes it can have awful effects like severe injury. Cases of death however are extremely rare. But a death did indeed occur at one of the best HBCUs (historically black colleges or universities), Florida A&M University in Tallahassee, Florida.
Most deaths from beating of any kind whether hazing or criminal assaults most often result from severe head trauma or to damage or severing of major arteries supplying major organs. We will look at the autopsy findings that have been revealed in this case and see if indeed this youth was actually “beat to death”. Remember death is best achieved via head trauma or suffocation through choking. Without weapons, using only the hands, one can choke someone to death or make them fall and hit their heads but beating that results in death is rare. A “beat to death” is most apt to occur in a dark lonely alley not on the bus where others were available to intervene. One or two boxers in history have died from a punch to the face but underlying conditions were found to be present like arterio-venous malformations or aneurysms were found to be the ultimate culprits. Hazing, since it has no criminal intent, is really very rough horseplay. In high shchool, I myself recieved blows to my shoulder causing bruising and soreness from a friend who thought it funny. However the shoulder, back and all superficial muscles subject to blows from fists or feet are not capable of causing severe hemorrhage due to anatomical and physiological conditions inherent in human anatomy. In fact a review of the literature shows this case to be the only one where physical blows are thought to cause the death in hazing. Most cases involve ingestion of alcohol or exhaustion from excessive physical exercise.
Except for the neck, most great vessels are housed deep within the body surrounded by either muscle, bone or both. Arteries and veins are very elastic and for the most part are impossible to rupture with blunt trauma unless the artery lies on top of bone. For example the temporal artery lies over bone of the skull on the side of the head. Smaller vessels called arterioles lie under the skin and can rupture from blunt truama but clotting causes bleeding to be very minimal. Further, connective tissue in muscles and beneath skin add a tourniquet effect to contain bleeding to a local area. Fascia, or dense connective tissue, further compartmentalizes any bleeding from muscles resulting from trauma. In other words the muscle arteries and veins are too small and the area is too small to cause any severe loss of blood. Alternately, when blood is drawn for analysis the needle goes directly to a vein that clots within seconds with appropriate pressure unless there is a blood abnormality that prevents clotting. Leukemia therefore would not be a good culprit in this case due to the mechanical effects of tissue and fascia just described. Blood donations remove two pints of blood at one time without any symptoms of shock or serious hemodynamic compromise. So let’s now look at the significant reported findings leading to death in the autopsy in reference to this anatomical understanding of truama to muscles and tissues.
1)The autopsy reported hemorrhaging from muscles or tissues of the shoulder and back as causes of the blood loss causing shock and death in this unfortunate student.
2) Bruising or contusions to chest wall and back
3)abrasions or bruising below the belt line
4)temperature of 102 at time of CPR
5)Vomitus in the lungs or aspiration
1)The first finding above is stated to be the actual cause of the blood loss that led to low blood volume and shock. Essentially this was the coroner’s cause of death. As we stated above the shoulder and back are not large enough areas and most arterial or venous damage would have occurred to small superficial vessels. Additionally, the tissues are not anatomically capable of retaining large amounts of blood. Only the body cavities like in the abdomen or alternately bleeding externally can cause the amount of blood loss necessary to cause hypovolemic (low blood volume) shock. A review of the literature actually has no reports of hypovolemic shock secondary to muscle bruising or contusions. Men who lose limbs on the battlefield lose great amounts of blood from severed large arteries and veins but still survive. Muhammad Ali and his “rope a dope” tactic used against the “super man” George Foreman caused him to sustain powerful, numerous, heavy blows to his abdomen and arms but he took the blows without faltering and was able to land the decisive blows himself.
2) CPR can cause bruising to the chest wall and even the bruising found on the back of the victim.
3) abrasions here are inconsequential
4)Temperature elevation is most likely a result of heat stroke in this setting. The student was a drum major who had on heavy clothing with sweating and resultant dehydration being a common sequelae of the vigorous physical activity during the performance. The student did complain of being fatigued. Most likely this was due to dehydration and exertion or impending heat stroke. A crowded bus with no air conditioning can get pretty hot. Elevated temperature here is actually not found in shock. Abnormally low temperatures are the rule in hemorrhagic shock.
5)Vomitus in the lungs actually most likely points to a possible coronary or cardiac event.
The above mentioned findings are hardly sufficient to be a cause of death in this unfortunate student. Therefore there must have been an underlying pre-condition that was lurking and undiagnosed. There are a few possiblities here. The most frequent cause of sudden death is cardiac pathology. Hypertrophic cardiomyopathy (enlarged heart) is the most common cause of sudden death and is often mis or underdiagnosed especially in juvenile settings. Wolf Parkinson white syndrome can cause sudden death from an arrythmia. Yet considering his age, the most likely culprit is this scenario is hypertrhophic cardiomyopathy then cardiac arrythmia which was the case with Hank Gathers, the NBA player Reggie Lewis, and even the reporter, Andrew Breitbart, who died recently despite being on medication. Medication can control the condition to help prevent sudden death especcially at an early age. Hence early recognition of the disorder is imperative in this regard.
The phenotype analysis done on this young man showed similar markers to those with Wolf Parkinson White Syndrome or other arrythmia. Wolf Parkinson White Syndrome or other cardiac arrythmia, like long QT syndrome, is the likely culprit if no evidence of heart enlargenment was found. Mild cardiomegaly was the reported finding at autopsy. Foot ball players and other student athletes must undergo physical exams to be cleared for sports activity. Many are done at a bulk discount where the physician may not feel adequately compensated to do the thorough analysis for heart murmers and defects. Band members especially at HBCUs are subjected to intense physical exertion as the half time show is just as or sometimes more exciting than the game itself. The pressure to dance and blow an instrument can tax most muscles and hearts of even the strongest of us. So band members need physical clearances as well as football and basketball players for example. EKGs can detect conduction defects. We should probably be screening all students for genetic heart abnormalities since medical intervention is often remarkably preventative. Those with known conditions should probably forgo activities that involve the possibility of over exertion and heart strain especially if not adequately treated with the appropriate medication.
It should be apparent to most that one of the greatest lessons to be learned from this case is that like in a trial it generally takes a consensus or majority of the jury to decide guilt or innocense in cases of death. The current situation in the coronor’s office is therefore fraught with potential for serious human mistakes. No one person can decide the fate of another. Otherwise we would not have juries. Sure, a physician is a highly trained individual but as most evidence states, the diagnosis of cardiac pre-conditions is fraught with much difficulty in the autopsy setting. Specialists in cardiac pathology should be consulted if cardiac death is a possibility. This case is a perfect example of such. Two heads are usually better than one and even more are even better. The forensic pathalogist in this light should probably be a university professor who has rounds or conference with a panel of physicians to make a final decision with the expert being the leader in the decision making process. This helps to prevent human error from being too much of a factor in the decision to label a case a homicide with its subsequent tragic consequences. Additionally, this student died on the weekend. Statistics bear that medical decisions with errors tend to increase when doctors are wanting to be in leasure or with family; or when they are over worked. Some work 100 or more hours a week – a setting for catastrophe. Additionally, did the autopsy occur within the proper time frame? Does having a cardiac pre condition make this hazing death less traumatic? Does the fact that two persons prior to this student were hazed the same night, or that this hazing ritual has gone on for years if not decades with possibly hundreds being hazed with only one fatality on this fateful night, point directly to this students vulnerability or illness?
Just questions…..in this ongoing tragedy. Pray for justice and truth to prevail. The lone coroner as revealed by many others writing on the matter, is a situation rife with disastrous possibilites.