OFFICE OF THE MEDICAL EXAMINER

COUNTY OF COOK, ILLINOIS

FOLLOW-UP REPORT

NAME MARKHAM, DONALD CASE NO. ME2015-03757

AGE 51 RACE WHITE SEX MALE DATE OF DEATH SEPTEMBER 2, 2015

DATE EXAMINED SEPTEMBER 2, 2015

The Federal Bureau of Investigation provided additional

information regarding the death of Donald Markham in November,
2017. This consisted of multiple interview statements from
friends, family, colleagues, and scene witnesses, a blood stain
pattern analysis by an outside expert, and a review by an
outside pathologist.

INTERVIEW STATEMENTS

The interview statements provided give contradictory information

about the scene; some witnesses state that the scene appeared
“odd” while others state that the scene was consistent with a
self-inflicted gunshot wound.

Neighbors, friends, colleagues and family members stated that

the subject and his wife argued frequently. Some family members
stated that, not only did the subject and his wife argue
frequently, but that during these arguments they would express
statements about killing themselves. On the night of his death,
the subject and his wife were heard arguing. Statements were
also provided by friends and colleagues that the subject did not
appear depressed or suicidal.

REPORT OF BLOOD STAIN PATTERN ANALYSIS PROVIDED BY THE FEDERAL

BUREAU OF INVESTIGATION

The report states that following the gunshot wound, the

direction of blood flow on the subject’s face indicates that
there was very little, if any, movement of the head.
MARKHAM, DONALD Page 2
ME2015-03757

REPORT BY OUTSIDE PATHOLOGIST HIRED BY THE FEDERAL BUREAU OF

INVESTIGATION

The review of the report by the outside pathologist makes the

following arguments (not verbatim):

1. The blood flow pattern on the subject’s face in the scene

photos is inconsistent with the position of the head.

The absence of a patch of blood on the right side of his

chin, and the presence of blood on the left hand, are
characterized as a blood transfer pattern, leading the
outside pathologist to conclude that the left hand or left
hand and right arm were lifted upward after death and
before the blood dried.

2. Following the gunshot wound, the subject would be

immediately unconscious and lose all muscle tone and
movement and his right arm would immediately fall to the
right side of his body along with the gun.

It is very concerning that the right hand and wrist are

below and even partially under the left forearm that
crosses over his chest. If this were a case of suicide,
the gunshot wound of the right side of the head requires
that he would use his right hand to hold the gun and pull
the trigger.

3. Only in 25% of self-inflicted gunshot wounds is the gun

still in the hand and almost always the finger is still
within the trigger guard or the hand did not move after
sustaining the gunshot wound.

4. The outside pathologist in his review of autopsy photographs

regarding the gunshot wound of entrance, describes the wound
as “a very close range or near contact range gunshot wound
of entrance”. He goes on to state that in his experience the
distance is “certainly closer than one inch”. He states he
sees a muzzle imprint “the wound still shows concentric
rings anteriorly from the entrance defect due to the muzzle
striking the skin”.
MARKHAM, DONALD Page 3
ME2015-03757

5. The subject had no history or indication that he was

depressed or ever expressed an indication that he wanted to
commit suicide. There was no history that the subject was
prescribed anti-depressant or other psychoactive
medications.

6. It is a matter of potential bias in the determination of

manner of death that the scene investigation photographer’s
placard and initial investigation reports all indicate that
the subject’s death was a suicide before a critical
evaluation of the circumstances of his death was performed.

A forensic pathologist who believes going into an autopsy

that a death is an unquestioned suicide as opposed to one
in which there is a possibility that it may be a homicide
or that there are concerns it is not a suicide will treat
each of those autopsy situations differently, and again may
be subject to continued confirmation bias.

The outside pathologist argues that the gunshot wound was not
self-inflicted based on the position of the body on the bed,
blood flow pattern on the face, the blood transfer pattern on
the chin, the left hand under the chin, and “the moved and
placed appearance of the gun in his right hand” stating these
are “consistent with his body having been moved after death from
its position lying more on his left side and the gun placed
loosely in his right hand after death”.

THE COOK COUNTY MEDICAL EXAMINER’S OFFICE DISAGREES WITH THE

OUTSIDE PATHOLOGIST’S CONCLUSIONS:

1. The report by the blood stain analysis expert disagrees

with the analysis offered by the outside pathologist. The
blood stain analysis expert hired by the FBI states (not
verbatim) that the direction of the blood flow indicates
very little, if any, movement of the head following the
gunshot wound. Blood on the left hand is due to a spatter
stain following the gunshot wound and not caused by blood
transfer from the chin to the left hand.
MARKHAM, DONALD Page 4
ME2015-03757

A review of scene photographs reveals the pattern of dried

blood on the face is consistent with the gravitational flow
of blood.

2. There are multiple reports in the literature that state

that an individual can move after sustaining a gunshot
wound to the head; but one is cited below for brevity. The
medical examiner's office has video of a self-inflicted
gunshot wound to the head at a shooting range, where the
gunshot wound goes through the midbrain and the pons, and
the subject displays convulsive movements after getting
shot. Moreover Donald Markham displays evidence of
aspirated blood in the lungs. This indicates he took some
breaths following the gunshot wound. The outside
pathologist does not dispute this.

In Vincent J. M. DiMaio’s textbook on Gunshot Wounds, third

edition, pages 225-227, "An individual may sustain a fatal
gunshot wound and yet engage in physical activity.”
“Individuals can perform tasks or even survive gunshot
wounds of the brain, especially if the injury involves only
the frontal lobes.” “The fact that one can survive at
least for a limited time with a wound of the head that
would ordinarily be thought to cause instant death is shown
in figure 9.1. This elderly male shot himself in the right
temple with a .357 magnum. In spite of the obvious
devastating nature of the wound, he lived 1 hour and 34
minutes without any life-support systems."

In Vincent J. M. DiMaio’s textbook on Gunshot Wounds, page

316, "When individuals shoot themselves with a handgun,
they do not necessarily hold the weapon the same way they
would if they were firing the weapon at a target.
Commonly, they will hold a handgun with the fingers wrapped
around the back of the butt, using the thumb to depress the
trigger and fire the weapon while steadying the barrel
against the body with the other hand (Figure 14.3)". A
handgun held in this fashion would allow for the body
position observed in the scene photos if all muscle tone
was lost at the moment of injury. Hence, it is not
concerning that the right hand and wrist are below and even
partially under the left forearm that crosses over his
chest, as stated by the outside pathologist.
MARKHAM, DONALD Page 5
ME2015-03757

The outside pathologist offers creative and descriptive

scenarios regarding hand, arm and body position of the
subject.
The proposed scenarios, are presented as fact, however, in
reality they have no basis in the standards of practice in
the field of forensic pathology. The Cook County Medical
Examiner’s Office rejects the above scenarios proposed by
the outside pathologist as groundless.

Because body movement can occur after fatal gunshot wounds

to the head, the subtleties of body position at the scene
cannot be used to prove or exclude the precise position of
the body at the moment the firearm was discharged, and are
not evidence that the firearm was discharged by another
person.

3. The statement of the outside pathologist regarding self-

inflicted gunshot wounds:

“Only in 25% of self-inflicted gunshot wounds is the gun

still in the hand and almost always the finger is still
within the trigger guard or the hand did not move after
sustaining the gunshot”.

The above statement is rendered by the outside pathologist

to support his theory that the gun was placed in the hand
following death.

The statement is erroneous and incomplete.

The referenced article is from the March 1999, American

Journal of Forensic Medicine and Pathology, page 1-5,
"Weapon Location Following Suicidal Gunshot Wounds". The
same article is also cited in Vincent J. M. DiMaio’s
textbook, Gunshot Wounds, third edition, page 324. It
states in 25.7% of self-inflicted gunshot wounds, the gun
is in the hand when the subject is in the lying down
position. The gun is considered to be in the hands if one
of the fingers is found in the trigger guard or if the
hands are loosely gripping the barrel or the grip of the
gun, the latter is seen in the scene photographs of Donald
Markham.
MARKHAM, DONALD Page 6
ME2015-03757

4. The Cook County Medical Examiners rejects the opinion of

the outside pathologist that the gunshot wound is anything
other than a contact range wound.

The outside pathologist fails to include in his

description of the muzzle imprint, that among the
“concentric rings anteriorly from the entrance defect” is a
recoil spring guide mark.

It is the opinion of the Cook County Medical Examiner that

the wound is a contact gunshot wound and not “very close
range”. Reviewing the autopsy photographs, which were
reviewed by the outside pathologist, show a muzzle imprint
and recoil spring guide imprint, leaving no doubt that this
is a contact gunshot wound.

References refuting the outside pathologist’s statements

are easily found:

a. If the gunshot wound was “very close range or near

contact range” there would be no muzzle imprint, which
the outside pathologist sees and states in his review.

-Vincent J. M. DiMaio’s textbook, Gunshot Wounds, third

edition: page 116: “A loose-contact wound is produced when
the muzzle of the weapon is held in very light contact with
the skin at the time of discharge. The skin is not indented
by the muzzle”- Accordingly, no muzzle imprint would be
produced in a very close range gunshot wound.

-Spitz and Fisher’s textbook, Medicolegal Investigation of

Death, fourth edition, page 623 Figure XII-20. “Contact
shot of the right temple. Patterned injury caused by
housing frame and recoil spring guide”.

b. “It is also difficult to understand how no one inside the

house heard the gunshot wound unless an object muffled
the sound of the gunshot”

This is contradictory and inconsistent: an object, used to

“muffle the sound” by either placing it between the muzzle
of the gun and the skin or somehow wrapping around the gun,
or employing the use of a silencer/suppressor, all would
alter the characteristics of a gunshot wound, like the
MARKHAM, DONALD Page 7
ME2015-03757

recoil spring guide mark, muzzle imprint, and soot. The

latter two are recognized by the outside pathologist who
agrees are present.

5. A history of depression is common in suicides, but may not

be evident/documented in many cases. The subject had a
blood alcohol of 123 mg/dl. At a level of 100-200 mg/dl
(0.10-0.20g/100mL), the signs/symptoms of acute alcohol
intoxication include: increasing impairment of sensory-
motor activities, reaction times, attention, visual acuity,
and judgment. Progressive increase in drowsiness,
disorientation, and emotional lability (Vincent J. DiMaio
and Dominick DiMaio textbook, Forensic Pathology, second
edition, Table 23.1 page 519).

6. The subject’s death was reported to the Medical Examiner’s

office after the body was already enroute to the office.
The Medical Examiner’s investigations unit was not able to
perform a scene investigation. Scene photographs taken by
the Chicago Police Department with the ‘Suicide’ placard
and the police reports were obtained after the autopsy; the
allegation of preconceived and continued confirmation bias
is hence in error.

The outside pathologist raises the issue of confirmation

bias at the end of his report, and implies that the
Assistant Medical Examiner who performed the autopsy on
Sergeant Donald Markham was locked into a determination of
suicide from the outset of the examination. However, that
is not the case. The examination was performed thoroughly
with the collection of all necessary evidence and the
determination of manner of death was made only after the
evaluation of the requisite investigative information.

In support of his position, the outside pathologist states

in his report that a Chicago Police Department detective
arrived at the Medical Examiner’s Office “to continue
investigating the death after the autopsy had been
completed”. The outside pathologist continues that “it is
important for the forensic pathologist to consider any
investigation information and scene investigation
photographs before beginning the autopsy.” These
statements ignore the presence of Chicago Police Department
liaison detectives and evidence technicians who are
assigned to the Medical Examiner’s Office on a daily basis
MARKHAM, DONALD Page 8
ME2015-03757

and who can relay questions, concerns, and requests for

additional evidence to be collected from the investigating
detective in the field to the Assistant Medical Examiner
performing the autopsy.

These statements also introduce a significant inconsistency

into the outside pathologist’s discussion of bias because
in the very next sentence he states that “It is also a
matter of potential bias in the determination of manner of
death that the scene investigation photographer’s placard
and initial scene investigation reports all indicate that
Sergeant Markham’s death was a suicide before [italics
added] a critical evaluation of the circumstances of his
death was performed.” If, however, as implied by the
outside pathologist, the Assistant Medical Examiner, had
completed the autopsy before the Chicago Police Detective
had arrived, how could his determination of suicide have
been prejudiced by documents and photographs that he had
not seen?

The FBI’s consultant cannot have it both ways and imply

that the Assistant Medical Examiner erred in failing to
wait for the Chicago Police Department detective, but was
led to the determination of suicide by documents and
photographs that he could not have seen because he made his
determination before the detective had arrived.
Furthermore, since the autopsy findings that Sergeant
Markham died from a gunshot wound of the head are
undisputed, implying that there was some defect in the
performance of the autopsy is both unsupported and
unwarranted.

Furthermore, the outside pathologist has neglected to

provide any disclaimer in his report identifying other
cases in which he has been retained by the Federal Bureau
of Investigation to offer opinions on matters of forensic
pathology and which may be relevant to the issue of his own
bias. Indeed, if there is confirmation bias, it appears to
be found throughout the outside pathologist’s report in his
efforts to backfill a justification for a determination of
homicide as a manner of death when the evidence is simply
not there.
MARKHAM, DONALD Page 9
ME2015-03757

THE MEDICAL EXAMINER’S OFFICE WAS ASKED BY THE FEDERAL BUREAU OF

INVESTIGATION TO ADDRESS THE LOCATION OF THE CARTRIDGE CASING AS
SHOWN IN THE SCENE PHOTOGRAPHS:

The functioning of a .380-Glock was reviewed with a firearms

specialist. The ejection port on this weapon is on the right as
with most semi-automatic handguns. When the Glock is fired at a
target, the cartridge casing ejects to the right. The trajectory
and the final resting location of the cartridge casing depend on
number of variables, including but not limited to the precise
position the weapon was held when it was fired, the grains of
powder in the cartridge, the condition of the semi-automatic
handgun - for example, the condition of the extractor and
ejector mechanism; whether or not the cartridge casing struck an
intermediate object before coming to its final resting location,
and finally, the surface on which the cartridge casing lands.
Accordingly, it is the position of the Cook County Medical
Examiner’s Office, that the location of the cartridge casing as
shown in the scene photographs is fully consistent with a self-
inflicted gunshot wound.

The certification of the cause and manner of death, by the Cook

County Medical Examiner’s Office, an independent agency, is free
of bias and influence from outside sources. In determining the
cause and manner of death all available information is
critically evaluated. The final determination of the cause and
manner of death in this case, as in all cases, is in keeping
with the standards of practice in the field of forensic
pathology.

CAUSE OF DEATH: After review of the additional submitted

reports and photographs, the original autopsy report, scene and
autopsy photographs, and a review of the pertinent literature,
the death of Donald Markham is due to a self-inflicted gunshot
wound of the head.

MANNER OF DEATH: Suicide

_______________________________________________________________________________________

Ponni Arunkumar, MD
Chief Medical Examiner

1-9-2018