10-L-0126 ACLU DO III (CID ROI) 2634 - Torture Database

{ ••... } .::; fo

FOR OFFICIAL USE ONLY - LAW ENFORCEMENT SENSITIVE

DEPARTMENT OF THE ARMY UNITED STATES ARMY CRIMINAL INVESTIGATION COMMAND

48TH MILITARY POLICE DETACHMENT (FWD)(-)

CIRFR-PIT

11TH MILITARY POLICE BATTALION (CID)(FWD) BAGHDAD CENTRAL CONFINEMENT FACILITY

ABU GHRAIB, IRAQ APO AE 09342

MEMORANDUM FOR SEE DISTRIBUTION

15 MAY 05

SUBJECT: CID REPORT OF INVESTIGATION - FINAL (C)/SSI - 0017-05-CID789 -39254 -5H9B/5HIP

l. DATESITIMES/LOCATIONS OF OCCURRENCES: 1. 30 JAN 05/1500-30 HDAD CENTRAL CONFINEMENT ~ ~. •• L!.

(b)(6), (b)(7)(C) . FACILITY (BCCF); GRID: BU GHRAIB, IZ

2. DATE/TIME REPORTED: 30 JAN 05, 2024

4. SUBJECT: 1. NONE (NFL); COMBAT DEATH

5. VICTIM' 1 FAWZZI ABDULLAH (DECEASED); INTERNMENT SERIAL NUMBER (ISN) UNKNOWN, IZ; M; WHITE; DETAINEE; BCF, ABU GHRAIB, IZ; ZZ; (NFL); COMBAT DEATH

6, INVESTIGATIVE SUMMARY:

THIS IS AN "OPERATION IRAQI FREEDOM" INVESTIGATION.

(b)( 6), (b )(7)( C)

This investigation was initiated when SPC Patient Administration Department (PAD), Task Force Medical 115TH, BCCF, notified this office of a detainee death.

Investigation disclosed that Mr. FA WZZI died as result of complications of gunshot wound he received to his left leg. On 25 Jan 05, Mr. FA WZZI was admitted to the 86th Combat Support Hospital (CSBH) (Ibn Sina Hospital), Baghdad, IZ, suffering from high velocity gunshot wounds to his thighs. His left leg had to be amputated and his right leg had trauma to the lower extremity. His injuries were received during an altercation in which he was firing at US Forces, which resulted in FA WZZI' s subsequent capture and incarceration at the BCCF.


10-L-0126 ACLU DO III (CID ROI) 2634 1

ACLU-RDI 5870 p.1

FOR OFFICIAL USE ONLY - LAW ENFORCEMENT SENSITIVE 0017-05-CID789 -39254

STATUTES:

N/A

EXHIBITS/SUBSTANTIATION:

ATTACHED:

(b)(6), (b)(7)(C)

1. Agent's Investigation Report (AIR) of SA 1 May OS, detailing the initial notification, medical and law enforcement coordinations and information report.

2. Photographic Packet comprised of 15 photographs.

3. Compact Disk 050017.789.

4. Medical records pertaining to Mr. FA WZZI.

5. Detainee Personnel Report pertaining to Mr. FA WZZI.

6. AIR of SA Feb OS, detailing other and medical coordinations.

7. DD Form 2708 (Receipt for Inmate or Detained Person) pertaining to Mr. FAWZZ1D.

8. Discharge Summary/Aeronautical Evacuation Summary pertaining to Mr. FAWZZI.

9. AIR of Feb OS, detailing medical coordinations.

10. Medical records pertaining to Mr. FA WZZI.

11. Fingerprints of Mr. FA WZZI.

12. Compact Disk 050027.259.

13. Final Autopsy Report #ME 05-126, 15 Apr OS, pertaining to Mr. FA WZZI.

NOT ATTACHED:

None

The originals of Exhibits 1,2,3,6,9, 11 and 12 were forwarded with the USACRC copy of this report. The original of Exhibits 4, 7, 8, and 10 are retained in the files of the 86th Combat Support Hospital, Ibn Sina, Hospital, Baghdad, 1Z. The original of Exhibit 5 is retained in the files ofthe Interment Holding Area, BCCF, lZ. The original of Exhibit 13 is retained in the files of AFIP, Rockville, MD 20850.

2



ACLU-RDI 5870 p.2


0017-05-CID789 -39254

STATUS: This is a Final Report. Commander's Report of Action Taken (DA Form 4833) is not required.

Report Prepared By: Report Approved By:

(b)(6), (b)(7)(C)

Special Agent in Charge

DISTRIBUTION:

1 - Director, USACRC, (ATrn: CICR-CR), 6010 6th Street, Fort Belvoir, VA 22060-5506 (original)

1 - Thru: CDR, 11th MP BN (CID) (FWD) (email only) Thru: CDR, 3rd MP Group (CID) (email only) To: CDR, HQUSACIDC (email only)

1 - AFIP, Attn: OAFME, Rockville, MD (email only) 1 - CDR, BCCF (email only) 1 - File

3


10-L-0126 ACLU DO III (CID ROI) 2636 3 ACLU-RDI 5870 p.3

FOR OFFICIAL USE ONLY Law Enforcement Sensitive

ROI NUMBER

AGENT'S INVESTIGATIVE REPORT

eID Regulation 195-1

DETAILS:

0017-05-CID789

(b)(6), (b)(7)(C) About 2024, 30 Jan OS, SPC Administration Division, Task Force ~ed the death of detainee

Patient Medical (TF Med) 11Sth , BCCF, Abdullah FAWZZI, (ISN) (b)(6), (b)(7)(C)

_DOB (b)(6), (b)(7)(C)

About 2030, 30 Jan OS, the undersigned res onded to the leU 11sth , BCCF, AGI and coordinated with 1LT

taff Nurse, ICU. 1LT was attending the body pending CID arrival. The undersigned exposed photographs of the body. (See Photo Packet)

About 2045 the undersigned coordinated with Dr (CPT) (b)(6), (b)(7)(C)

(b)(6), (b)(7)(C) Trauma OIC, TF Med 11Sth Field Hospital, BCCF, (b)(6), (b)(7)(C) AGI. According to Dr Mr. FAWZZI was admitted to the 86 th

Combat Support Hospital, Ibn Sina Hospital, Baghdad, Iraq. Dr (b)(6), (b)(7)(C) related Mr. FAWZZI was suffering from high velocity gunshot wounds to the thighs. Mr. FAWZZI was transferred to the Task Force Med 115th at BCCF on 25 Jan 05. He arrived at BCCF with Right pneumothorax, Left leg trauma near amputation and Right Lower extremity trauma. Upon arrival Mr. FAWZZI was treated for these conditions. About 1500 30 Jan OS, Mr. FAWZZI was experiencing multiple organ failure and cardiac arrest. The attendin doctors recommended no further escalation of care. Dr related he pronounced Mr. FAWZZI dead at 2020, 30 Jan 05. isted Mr. FAWZZI's preliminary cause of death as Cardiac arrest; Hepatorenal syndrome; Shock, with Iatrogenic Pneumothorax listed as a contributing condition.

About 2100, 30 Jan OS, the undersigned coordinated with SPC (b)(6), (b)(7)(C) PAD, TF Med 11Sth, BCCF, who provided a copy of Mr. FAWZZI's medical record. (See Medical Record)

About 2210, 30 Jan 05 this office, coordinated with SSG 306th Military Police Battalion (306th MP Bn), BCC 0 provided a copy of Mr. FAWZZI's in-processing packet. SSG elated when Mr. FAWZZI was transported to BCCF, AGI, he was not shipped with a Coalition Provisional Authority Apprehension Form or Sworn Statements detailing his (See Detainee Personnel Report, DA Form 2669-R-E, DA

CID FORM 94-E (Automated)

I

MP Det (CID)(FWD)(-), BCCF, AGI, APO AE 09342

DATE

1 May 05


PROTECTIVE MARKING IS EXCLUDED FROM AUTOMATIC TERMINATION (Para 13, AR 34-16)

EXHIBIT

/


ACLU-RDI 5870 p.4


ROI NUMBER

AGENT'S INVESTIGATIVE REPORT

CID Regulation 195-1

DETAILS:

0017-05-CID789

es

Form 3894, DO Form 2064, and BCCF Marks, Sc~rs and Tattoos Report)

, SA oordinated with SSG (b)(6), (b)(7)(C)

Internment Housing Authority (IHA) Property litary Police Battalion (306th MP Bn), BCCF, AGI,

who related no property was transported with Mr. FAWZZI to BCCF, AGI.

(b)(6), (b)(7)(C) About 1226, 31 Jan 05 SA oordinated with SSG

(b)(6), (b)(7)(C)

(b)(6), (b)(7)(C) C Co, 151st Field Artillery Re iment t FA Reg), NCOIC of Hospital Security, Baghdad, Iraq, NFl, who related Mr. FAWZZI was dropped off at the hosp tal at 1620, 25 Jan OS, by "Eagle Dust-off" and there was no capture paperwork dropped off with him. SSG related he was not working when Mr. FAWZZI was dropped off, but the doctors worked on Mr. FAWZZI and then notified the security personnel that they believed Mr. FAWZZI was an insurgent.

(b)(6), (b)(7)(C) About 1020, 25 Feb OS, SA this office, received an information report from the 48th MP DET (CID) (FWD), Camp Vic Ira ert ining to medical coordinations. (See AIRs of SA nd SA

About 1840, 1 May OS, SA tained a copy of Mr. FAWZZI's autopsy report, which listed the manner of death as homicide and the cause of death as complications of gunshot wound to the leg. (See Autopsy Report) IIILAST ENTRyll1

II.: • n - ~ • ,.. (b)(6),(b)(7)(C),(b)(7)(F)

(Automated)

IZATION

MP Det (CID)(FWD)(-), BCCF, AGI, APO AE 09342

DATE

1 May 05

Law Enforcement Sensitive PROTECTIVE MARKING IS EXCLUDED FROM

EXHIBIT

10_L~0126TA~ALtfrJtrI1l6)(CID ROI) 2638 5

ACLU-RDI 5870 p.5

NUMBER 1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

".", \

FOR OFFICIA..L USE ONLY - LAW ENFORCEME&) SENSITIVE

0017-05-CID789-39254

PHOTOGRAPH PACKET

DESCRIPTION OF PHOTOGRAPHS Photograph depicting victim overview

Photograph depicting Front torso with med equipment

Photograph depicting Front midsection with med equipment

Photograph depicting leg with med equipment

Photograph depicting lower leg with med equipment

Photograph depicting Front head with med Equipment

Photograph depicting front head wlo med equipment

Photograph depicting front torso wlo med equipment

Photograph depicting front lower torso wlo med equipment

Photograph depicting Rleg/Lamputated wlo med equipment

Photograph depicting mid leg wlo equipment

Photograph depicting right foot wlo med equipment

Photograph depicting upper torso/head back wlo med equipment

Photograph depicting mid torso back wlo med equipment

Photograph depicting lower leg wlo med equipment

EXHIBIT ----


1 O-L-0126 ACLU DD III (CID ROI) 2639 6

ACLU-RDI 5870 p.6

Exhibit(s)-±

Page(s) 24 thru 114 referred to:

CDR USAMEDCOM ATTN: FOIA Office, STOP 76

1216 Stanley RD 2D FL FT. Sam Houston, TX 78234-5049

10-L-0126 ACLU DD III (CID ROI) 2659 ACLU-RDI 5870 p.7

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10-L-0126 ACLU' DO II (elD ROI) 2661 ACLU-RDI 5870 p.9

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1 -0126 ACLU DO III (dl:> R~ 2665 ACLU-RDI 5870 p.13

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ACLU-RDI 5870 p.14

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10 126 ACLU DD II ( R 2667 ACLU-RDI 5870 p.15

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10 126 ACLU DD II (A> R )2668 ACLU-RDI 5870 p.16

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126A t.U DD II ,(C RO 2669 ACLU-RDI 5870 p.17

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ACLU-RDI 5870 p.19

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10-L-0126 ACLU DO II (CID ROI) 2672 ACLU-RDI 5870 p.20

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10 -0126 ACLU' DO II ( DR ) 2673 ACLU-RDI 5870 p.21

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o 10-L-0126 AeaLU DO I(C 2674 ACLU-RDI 5870 p.22

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ACLU-RDI 5870 p.23

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10-L-0126 ACLU DO II (C 0 ROI) 2676 ACLU-RDI 5870 p.24

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F.,. CUI SRP . AdLb a.. J.iq. , ReguIIIr

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~ 'RocIphit! ",' x ?eN' x GIniamyan X~' X ___ _

' ..... '

',', 11 NG T~ SuctiOn: X None X GIaviIy

!

-

,12, Foley,:· X None

13, Chest Title: X None 14 02 X None 15 Veer.uIa:1On x None

A~ ~:"

T tmperalure =ulse Respilation . , Date.Time ..

~.~ '.

I iT , ! ! , .I

~ ! ,

j , , ,

I

I :

P I

; ! i

L i ! l i I

I i"-:t

X _cmH20: XNC~ XTI' __ _

x Wliers.i t.task...;Jm "

~"fIOx:--', x RR:~.;...;..;__ x PEEP: ~

,

R

I t I

I , I i I

i

NURSES NOTES

Wl

I I

I

I -, I Stool I

I I !

I

I I

"

I

I

'.

"

Mlcicalions InCI Nuose'sNOIes

~, .'

~. ~

" "'" !

. ' , :

,

"

1 j I

--------,~,--~~------~~~----~--~----------------------~----------------

43

10-L-0126 AClU DD III {CID ROI) 2677 ACLU-RDI 5870 p.25

6th Comb t upport Hosp' lbn ina H i I

8a hdad, Jraq

Di eharge nmroary/ el"omedical oatJon uOImary

od ilTul wbl for '('r Mfcr

ACLU-RDI 5870 p.26

r l'ln/ Reconamllndatioo

b) 6)

86tft Comtnt up port Ho pitat Ibn ina Ho p tal

Bagbdad rr q

1) 'mnsfer lO prisorl h ml t o. wound clO~UK and rehabilitatiOD. J) - PI CI) ,t Dr, {b (6 with any fLtnhe. questions.

l{b)(S)

Lbe inn H 'pit.'l.l 6f~ Comha~ u pen Hospital

Bgbdad, Jrnq

I

J

ACLU-RDI 5870 p.27

(b) 6)

tAR : 27 1 uary, 1005

6"" Combat uprt Hospital Ibn Sina lospital

Ba,ghdad, Iraq

Oischarg umm ry/A rorneclicnl Evacuatiun ummar

waiting tmn fer to pri a

tension p11aUlDOlno [QIlQ\vill& tine p!acetncnt which \~ . h d OUt n 7.7 Jan 2005 •

. OJ'1'( ~ j4(1d aDd ' ,.1;11 ' for 'fran 'reT

ACLU-RDI 5870 p.28

l(bI(6) , "Plan/Recommendatfons:

I) _ ' " fer to piis n ~$DilBl f r wound clo$U1'e aodrct !lujl tion .. ... ) 1>1 C (tOots lOr. (b (6) 'lh any furth~ oue.~dtlrU( l!rf

(b){6)

Ibn Sin.a HospltoRl 86ib Combat SUpp(ln Hospitnl

'\ghtl O. Ui\q

,

ACLU-RDI 5870 p.29

Time 07 08 09 10 11 12 13 14 Total 15 16 17 18- 19 20 2l 22 Tolal

IV 't:'SLIt Hc>L.t> .::::; ~sD :2~ .;ol> 1~tGt> rtf!ldt- 1000 I~C \?5" w; 12.:4 'U (

lVPB \0() 50 {50 Ci!.... '. -_ ... _--- ---_._- . ----

KJ34883!~ ~ 'leO ] fvt.;o4---.-~ [4·' 4- 4- 4 4 4 4- - ·~e 4 'Lf- .ltSii Lt '+

- W0216 04 007946 I 400 ~o - --f"F P" ",'i-- ~'1B ~~

PO Other TOTAL ~~.

... . TIME 07 08 . 09

" 10 11 12 13 14 Total 15 16 17 1.8 19 20 21 22 Tu!al

Urine output ~I '/ IV / / V / 1/ ? ~ / ~ L ~ V V '/ '/ Hour/Total VI NGoutput Emesis ~ :

Stool .Chest tube 1/ V V V V V V V '/ ~ V L 1/ 1/ / V '/ V #1/#2 1 ackson Pratt 1/ 1/ L 1/ 1/ / 1/ / / / V i/ V / V 1/ '/ IV #11#2

!

TOTAL

ASPECT TTh1EIfNITIALS Safety 0 E N ~_f::...B~,at~bL~lSki~·:::::n..C~a)~.:p.=··· ====:t===~I"z=~=t---co---~~l-qigI=!-F-i-&I~fG-l.:.....faJls--C"-----jI-'tl (..~\HO·}Nd_I-¥-N~-Y-:-N:-r-

Oral Care ~. / Call bell in reach ¥-M Y N YN Foley Care . .•... /.,SF / Bed position/Locked I ({)N Y N' Y N Trach Care .,("It)'. / Protective device l.ru N Y N Y N Range ofM9tion. V / Cardiac Monitor l(C?)N Y N Y N

48

. 10-L-0126 A.CLU DD III (CID ROI) 2682 ACLU-RDI 5870 p.30

- ----.

. - .

-

, .-..I

MEDrCALDt~4

----.~-----~--.--~-~~.------~~~~~---

- '-"- . . . . . . • . . }>_~'rIENT $Dj.[CATlONIFSBCYOSOCIAL

TIME ~. SUBJECT ~

. . . -- ~ -

I . ' I START DATB

. DEYICPlSrre . ;lc, @~t. 18"~A~r .

1m ~jJ. "Hln!! '2,~'S~"",,

I . -- -. , ' , -~' ._ I . .

- '.. . -~'"!' ,

I,: ,

:---~~------

OA fOPJ-A4700, MAY78

RBS'poBSBl~PORTIRBFBR'RALS . ,

VASCULAR ACCESS ,

.

P8GCHANGB DAYS I EVENINGS NIGHTS

Q',~ ~./'j '

.

-

~~+-x3 . I~

-,

;eJ. ~~ , .~ ~> - .

E:?ARTII'fENiJSCRVlCEJCU ~IC

:Z-C~/

I

-

r

-.

DATE

D HJSTQRVlPHYSlcAL DRaw CHA.~T

o OTHER EXAMlL~AriON 0 O'fJ'tER (~J

. -

I

\

,

UN~------------------__ o DIAGNOSTIC STIJOtI5!ji

o TREAThIENT

10-L-0126 ACLUr DO II (CID RO j 2683 49

ACLU-RDI 5870 p.31

50

10-L-0126 ACLU DO II (C 0 ROI) 2684 ACLU-RDI 5870 p.32

I 1? ai,n Bcale

PiPositl~n

TV , . rvB.p

Other • TOTAJ,.

23 ~ 01 t)one output Hqur/Tonu .

:' NGO~ut _

TOTAL

Init=futtials J\/D;"Jugul rV~ous D;e;~ti Jl v;LeJt ' .

- , N ( -Nonl" asiv~ Btood I \lie I Nt- 0

Y"",Yes

,J .

- , .'

02 . 03

, ~en

P=Proqc PJ&b.1

04 05 06

. -

o aturafiOD of Arterial ~cn . S=Supin¢ AB~ .~l!J Blooo r~S\l~ PS=PhMmat4 0 --callY'S d3ted

.r '

,

ame (b)(6)

51

1 O-L-0126 ACLU 100 II (CID RO,I) 2685 L....~_ ACLU-RDI 5870 p.33

Time 07 08 09 10 I, tl I 12 13 14 T(l1lI1 l5 16 l7 18' 19 20 11 . 2':) TIMa!

IV I (~ IJ-2 \;)..S j¥ t , 1;{5 I~~ 15() 125'" J. 2~ f2S" 42?" .~ ~ 1/,),5 /d5 l.:llQ I I

, TVPB :,ro 5b :>0 tSf) Q!£l1v/~ I ~ ~-5"C ,

Mc0l'Chtne, t.Jo ~Q <?o ~ ,o ' 4 () ~e ~o q.:> It} (/ l'j . l.\ .~ I

. , -,

•

PO Other "

~

TOTAL '1i..S'tn j RS~ '~itts ~ - ~--

'TIME 07 08 09 to II 12 13 14 Tom! 15 16 17 1.8 19 20 2.1 22 1\1/,1

Urine OUtput l( ~ V ~ IV ~ lV ~ ~ V L ~ ~ V V V ~ Y Hourrrotal ~~b NOou~ut -----Emesis I -Stool Chest tube / 1/ V' V IV / lZ lL V V V fV / / V ~ ~ l{ #11#2 J ackso 1 Pr:-tltt / V ~I l/ y/ / / V V / V V / / / 1/ 1/ 1/ #tI#2

~ I

TOTAL I /I"Il1B tJ1IL . '---/

Protective device Cardiac o· tor

52

10-L-0126 ACLU DO II (C 0 RO) 2686 ACLU-RDI 5870 p.34

----• -'UPPLEMENT AL MEDtCAL UA ( /0\ '. .............. ... ,,1 ~'n,"" I", Cho om~ 1'ba

. START DATE NIGHTS'

10-L-0126 AClU, DO III (CID ROI) 2687 ACLU-RDI 5870 p.35

i

- 10-L-0126 ACLUI DO II {CI.D ROI) 2688 ACLU-RDI 5870 p.36

J acksOIL Pratt #lI #2

In "niiials J VIP; gulat Venous Dist~rtHon L~Left . NIBP-N 'I1vasivd 8 o' d res ~ N- No

A=> Yes o

rone R""Right Sa02> tab Q. of ~ O)tjo'geA S=Supine AB~ Attoial Looo E'n!!SSt){C.

ps.. rlnrmlloolol!i~1 0 Std!lted

, rIME I TIME PlacelMode. .

OUT IN . IlnU'nti; . . 0

--

". • . -

lfIIliJilll 1;~Jts lJ;;1 ., - . ~ - -

~.~(~nln.'1 .... • .tiIL"

INPUT . I 'Si '2.J \:"' ' '-I~ss :.,. OUTPOT. '2-oW 2,Q"5 DJFFBRENCE !~ \O~- + (Slid WEIC~HT

..

Naine I SiMaillre TInlt-= _ (bl(6)

- = . -

. .

10-L-0126 ACLUI1DD III (CrO ROI) 2689

,

ACLU-RDI 5870 p.37

Time 07 08 Og· < 1~. 13 14 15 16 T1'~19 20 21 22 N1BP! . ttfZ 11<101" l~y - - .......-_A~U: - -~ ~--=- =- ,<,!!),- -- --- - /-cUi.:

~' - - = Pulse I '\ci} \&'1 11.t:'

Respirnti~ms i I ~S I 1JQ 7J, Temperature I ... ;' , " -J 'ltl7> I L ' IleDv' /tJ1.7

, - -. I

-Sa02 q~i: ~. 117 %02 I lbL~ /b .. 9tJ

I 1-{..

CVP , r~fU1 , ;~ ~ :Lllc

I

- - 'I ;

,t -

Pain Stale -P'ainMed J Pt Fosition 1 I

Time 07 08 09 10 n 12 13 lit TalJ I 15 l6 17 18- t9 20 21 22 ~ IV I ! r,~' 1'5 1 \V1~ '1S l1£. ~l?J. J:l5 lIt? 1/1.11 j1..-/ i '11- q&a TVPB • .

I"---'

1

r - ~

, r

I PO

--Other 'I ~ TOTAL L -'I'~ ~'ij) r~ \~ ~q').J D l:ue

• -~ -~

-TIME 07 as 09 lO 11 12 13 14 Totnl 15 16 1 17 18 19 20 2t 22 ~~

Urine output V V !/ V 1/ V ~ V 1?fI> ~ ~ ~-1/ ~'(i~ ~ ~ [1t Howffotal I~ NO output ~

Emesis ., r~ ~' - '

Stool ~ .... I

chest tube / 1/ !/V V V V ~ ~ ~ L L L 7 / // '/ #1/ #2 Jackson Pratt v: ,/ 7V / V / V V iV L L 1/ 7 7 Vt/ V ff 11 #2

i

/'

TOTAL J ,-

56


~:"~. ' .

I ·

,-

--.

.llME s.u.arncr • t

ror~

.

-"

.

.

STARTDATB . ~.

r ::.

-

'.'

-

(. .~~(

I rv-'l"'KU fED(DEteJ

~~ ~;{ ,

.. 1

. -. .

-.

.

. ,

I -

~

--= ... .

. . .

-.

-

RESPONSBISUPPORT/REFERRALS

;

V ASCTIT.A 'R. A. I ·C .H.:o.o:o.o

08G CHANGE DA YS EVENINGS NIGHTS ,

• . .

o HISTORYIPIiYSICAL o FLOW CH.IL;rr

--~----=-=------_____ -I 0 OTHER e)(AMINAriO OOn{ER(~""Y) ~(O~~n' ~~Dm~u~IUN~-~~ --------__ _

o DIAGNOSTtC Srub lES

o 1REA TMEl'tr

OA FORM 4700. MAY 78

,

10-L-0126 ACLU, DO II (C,ID RQI) 2691

,

ACLU-RDI 5870 p.39

-

Signature

58

10-L-0126 ACLUi DO III (CID ROI) 2692 ACLU-RDI 5870 p.40

Itrr

PO Other TOT.AL

, .

TIME 23 24- 01 :anne output \~ H,qurlTotal , ,

' Emesis Stool

TOTAL

{r( ini~a}s

JVO=JltgUla Yen LIS DiS1:.etItion L=!l~fi . ' NI'BP=NonEi1Vasi~ BlooQ I~ N"")\Jo =Y~

~ , .,

. ' , -,

;8 -02 03 04 05. 00 . Total .

\Ifi'

P=Prnne :::Rigbt

I'

S,aO~r.:Jio of Me at Ox-ygatI Sup Q

A.8P · ~ BIOOIl !~ ~urc p~;>.cOl gbJl SQ7J~ cd

~J~ Mode Y102 Rate

n... ... ~,._~n. ... £ !~w._,"kHJPpon

pH pC02

1'T/..I:'T1

allle , b) 6)

,

-- -

L---~--~------~~5g

10-L-0126 ACLUI',DD II (CID ROI) 2693

F

ACLU-RDI 5870 p.41

ADMISSION AND CODING INFORMATION

30. AGE AT DISP 31. AUTOPSY 32. UNDERLYING CAUSE 33. RESIDUAL DISABIlITY 34. DO NOT USE· DATA FILLER #1 YIN I---- OF DEATH I SEP

123 124 125 126 127 128 129 130 131 132 133 134 f------

36. FIRST DIAGNOSIS (Principal Diagnosisl 31. SECOND DIAGNOSIS

143 144 145 146 147 148 149 150 151 '152 153 154 155 156 157 158

iii --.FOURTH DIAGNOSIS 40. FIFTH DIAGNOSIS

168 169 170 171 172 173 174 175 176 177 178 179 180 181 182

~ I';::::@::::):::, I:::::::):::::':

SEVENTH DIAGNOSIS 43. EIGHTH DIAGNOSIS

191 192 193 194 19511i; 197 198 199 200 201 202 203 204 205 206 . I:' .. :::' I':',

'" 44. FIRST PROCEDURE (Principal Diagnosis) 45. SECOND PROCEDURE

207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222

n lUi: 47. FOURTH PROCEDURE 48. FIfTH PROCEDURE

231 232 233 134 .IIi! 136 237 238 239 240 241 242 243 244 245 246

PI', - !I ,

SEVENTH PROCEDURE 51. EIGHTH PROCEDURE

255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 - I

I

52. NUMBER OF DIAGNOSTIC FIELDS 53. NUMBER OF PROCEDURAL FielDS CONTAINING CODES CONTAINING CODES

271 272 273 274

0 0 0 0

PAGE 2, DA FORM 2985, MAR 2000

35. CAUSE OF INJURY

135 136 I 137 138 139 , 140 141 142

I 3B. THIRD DIAGNOSIS

159 160 161 162 163 1648

[,::::', 41. SIXTH DIAGNOSIS

183 184 185 186 187 188

I':::

46. THIRD PROCEDURE

223 224 225 226 227 228

!i 49. SIXTH PROCEDURE

247 248 249 250 251 252

ti'

54. PRIMARY PRDVIDER 55. BLOOD USAGE SPECIAL TV CODE J---- YIN

275 276 277 278 J----

l lC

165 166

189 190

229 230

253 254

USAPA VLOO

oqen <.0 N .-. -o ~ C -U "'-'" ---c C ::J ...J U <C U) N "t""" o

I

...J I

o "t"""

ACLU-RDI 5870 p.42

~ .

;

I , urOR liNG' MTJ ADMIS~ION "NO CODING INFORMATlON'

Cb):6) f 2 1 ! 4 -1 5 6 1 B rSmuf'

QJJ.'Ib, faJ eia al Ws bl"., 114ft 4U-4UIt ~rJ)p I ~ gtr.tY Is Pf~ ! ~l ~

) , IIE'I$TEIl-lIu • .,. NAME ",F01i, .t..r./J I , PA"GB~OE SE.X l"-

e 10 11 il t:J ',. JG 10 17 18 t------

<)t 0 0

6, ,DAnOFfllllfIt (1'Yft'NMObJ 7. .(GUT ADMISSID~ RACE 9. OJIlitt 1IE\.lI1lAlIll r-- I-

IS 2~ 21 22 23 14 25 2.fi 27 28 2'9 30 11 , Iltl(· F-- f-- ~OiJ'D

I

Ie.. Ln/li1Jj 'Of ,ttR"V'« tTl n, FMI' t2. :SOtt.lSEClURf1'Y II""Bat

U 33 34 :'lEi 36' 3B 39 ..0 , , 42: 43 4$

OIlGAJlJIATl!lIll Iiti "Ovlr (}Ii/y1 130 MAltlTAl STAlUs HOtlf! !SF ... ar rCoJ\'s r- AIINISSION

46 f--

H . nvrNGSl.l1tJS IS, 'l~:OM:" CAnGUIi' 'It. al! ~OIlUfll(SIOllJle

4.1 48 50 !\1 SZ 53 54 5'5 66 51 .58 59 I 81J il

11. UNIT ($UII6I Ie. MIlS II, TRAU''''' ,.lY. AIlMiSSIOIl

&J 83 c.nrIYi:4

,64 65 11 fEAit 65 61 sa 69 70 0 I II

SCII1ACt 0 All ISSlD AImIO" ~ FOA WARD NMlElRf.l..i..-flI Of E.t.tEilIifHCY 'IlO/t£$Si! r- AtlMJSSlON

l- I AIJ1!II!SS OH "'EROftjeY AOO~(SSEE 1ltJdIr1J,Z11'c-J

I

NA AICIIIOCAT1l1tj(I~MEDJC~t'TREAT~~ fACILITY I 11 ~TH Fr 'LD HOSPITAL (UNITED STATES ARMY).

m£Piletit Itffi OF fM96J).'t1l(10AISSEE

ll. d 1l1SP>1l~1:tIO 1'12. TF lAIJI Stt]~Rtll TO ,

i Zl. IOUE D~ OLspOsmo r/rO MMODl

7" 76 t: 7~ 79 , 81 $Z 83 .~ !IS 86 a7 H!!

,

• ruNIC SVC · ADl,1ImilNO 25, M.lf TRAlISff'IlRUl J~tIM ZIi. OATfiltts A'OMISS Ot rt n I' AI M DOl

aD eo 92 II 93 , 114 55 95 57 98 99 tOO 101 102 1113 , 106

H, lOCATIII). 0 IOCCUIll\En~ ZI . Ml'f Of (IImALADM lisiON, t 9. QUE HiITlAL AoMISS1O /Yl'H4f",IJUI

108 I'llinti C ..... JJI ONrJ

10!l 110 Tl2 11'3 II. I 115 116 117 III 120 121 112

fUR LOCAL USc IF rNJUR TOAD OLDnR -

HO~ :

- V

W1 ERE.;

40 ~ I Ii Offlctll 1.'~. 1l ~

SIGNA TlJR Of AD ITTI Q CL£IIX

.£11-UA FORM,298!i, MAR 2000 EOIliOlol lilf lilA!! ~91li OSS Hi

1 O-L-0126 ACLU DO II (.GID RQ ) 2695 W " 100

ACLU-RDI 5870 p.43

c

- INPA T1ENT TREATMENT RECORD COVER SHEET For use of this form. see AR 40-400; the proponent agency is OTSG

I. REGISTER NUMBER 2. NAME IL.st. firs" Mil 3. GRADE ADMISSION REMARKS

000 4. SEX r' AGE s. RACE 7. RELIGION 8. LENGTH Of SVC 9. ETS 10. PREVIOUS

ADMISSION

II. fMP 12. SSN 13. ORGANIZATION 14. WARD

15. fLYING 16. RATING/ 17. DEPT./ 18. BRANCH/CORPS 19. UIC/ZIP 20. TYPE CASE STATUS DSG BEN

21. SOURCE Of ADMI~SION/AUTHORITY fOR ADMISSION 22. HOURS Of 23. ClINIC SERVICE ADMISSION

24. NAME/RELATIONSHIP Of EMERGENCY ADDRESSEE 25. TYPE DISPOSITION 26. DATE Of DISPOSITION

27 •. AODRESS Of EMERGENCY ADDRESSEE lincl"de ZIP Codel 27b. TElEPHONE NO. 28. DATE Of THIS ADMITTING OffiCER ADMISSION

29. NAME AND LOCATION Of MEDICAL TREATMENT fACllTY 30. DATE Of INTIAL 32. UNITS Of WHOLE BLOOD/ ADMISSION COMPONENT TRANSfUSED

1 15TH FIELD HOSPITAL (US ARMY), 31. SELECTED ADMINISTRATIVE DATA

o Check if Continued on Reverse

33. • CAUSE Of INJURY

34. DIAGNOSESIOPERATIONS ANO SPECIAL PROCEDURES

'-a IF INJURY TO AD SOLDIER-

HOW:

. -

WHEN:

WHERE:

35. Total Days This Facility

.. ABSENT SICK DAYS

\b

OTHER DAYS

\'. CDNV. LV/COOP d. SUPPLEMENTAL

I' BED DAYS

I' TOTAL SICK DAYS

CARE DAYS CARE DAYS

36. Total Days All Fa'cilites

•. ABSENT SICK DAYS

\b

OTHER DAYS Ie.

CONV.LV/CDDP d . SUPPLEMENTAL

r' BED DAYS

I' TOTAL SICK DAYS

CARE DAYS CARE DAYS

SIGNATURE Of ATTENDING MEDICAL OfFICER SIGNATURE OF PAD DR MEDICAL RECORDS OFfiCER

DA FORM 3647, MAY 79 EDITION OF I AUG 76 IS OBSOLETE USAPPC VI.l0

ACLU-RDI 5870 p.44

.'

POst'

~ ;~ 'l -t~ f _WI- ' 7 b

i'ROCEDORE 1 e:¥ t;.~ ~ j - 0 b)(6

P aYSlCIAl'f'-..

:iY.i$CJF AM:S UiESlA: oaf 0 /" ~IOURAL,-,,_,--! .... LO~ . .,.. .. __ ~ ~ATION - BWCK,--_~_~---.-PRE O~ \'trAis: :t ~?:~ f : P ~ I "";l.)" - EBL IVl I ' N IV FLUIDS 7 <::{) TIlUNE OUl"PUL ..so"""

- .. 0- , . Il?t~ TEMP~ I, PULS,E me.. 1 81' S10l SAn l OBlGYN PRE~IlNl'R,A} lMMJi:D~ POSl:~p lI1ED AdaUt 101. I f A f I~ g2,1 4~19' , . J~t I ,Ve:rsi!Jf IDg @f , ,

I , - - _ t o. ,

~J ~ .?:.~ .

-;f6 f~l ~ -q 4 tf~n 'F~~ c: OO . - , 15

• - ,0", c" ,

I ~o I I I I ZlJOuu 0 rlmg® . . , . -- I ! - . . . 1 , 0 ' 0

: ,\ " I

_.

.. J :fS ! '0 ; , T o.naw ~~® . - - -..,-. - , .. - r , . J- " . .-

j ,i 60 , ~joffu . - ' .. 9fl I .. -. p.. , - I ~ .

0 4.4 0 -. io '$ .. " r

. Ibn -. , I I • I t , Y~~Ct.. ~IJ I \J M -_ lO~ .. l5:A~ .. ,

-

150 oJ I . ,I qct;) -r Pi:.+Mt tJ o ~ Cf Ur.(. . Jos:{~

-

_ ID~~110N fFGc~eiJ or~ ~mri gf. e: Nerne -we .I'm'. middT!f:; gr.:de; rirli1; iIc$pi c • -t:2I ~Tr.yJ

.-,.. ( '

QT("i~~NA.TlO OR EVALUATlON

o 0 1 .GNOSTIC STUDIES

o Tru:ATMEN I

1-51:, FIr ~' 1 , IeG3'c- MlO

7 l!-Om AGL~ Db II (CID ROI) 2697 ACLU-RDI 5870 p.45

l'~<:"';::,!:~~J}Jk~~: ~}i~!i !$;~~??t~;~~.~;it ~~, . ~. ',' -: .;.: .

ADMISS]ON ASSESShIEJ'iT I EVALUATION

INEFFECff\IE BREATHING PATTERN LUNG SOUNDS: Equal Ycs__ No __

CI= Ycs_. _. _ No __

02 Tlr--rapyKL--way-~-EFF----=--Onll

ALTERED TBOUGHT PROCESSES __ Uim:sponsiv:: _. __ . Sedat<:dIRespO~jy:: to verbal stimuli

.. ' __ S edar::diResponsive to 8~::P srimulllS __ ._,-\y!'llkdUnserl=d . '. Oriented to u,"Il:::-' place, p6:so~ situation

POTENTI.<\..L FOR DECREASED C4JillL-iC 01JI1>UT ~ ___ . '~. Cardia!: Morutor Normal SinllS RbYUlIIl without eCICiPY

Sldll ctindiii6~: __ ,_W2rm_. _PIY __ Cool __ Moisr. ,NSi~wi1h~JUt·~S ofiI?£ltrafi6Ii·m:.~ra1ion __ Yes N~ C~pillaIY reml -< 3 SCdinds . ",btlrer ..'

ALTEREDPATrER~S,OF.URlNARY ELIMIl'\ATION . . :"Folei :"C', ~."" Drl~:to');b~d'l T=ebilasfYbiJ '. ~,"

ALTERED GIFUNc:rIONS ' , ~Actiye Bo";ei Sd~~ "'F'~ 4 .quad.--=ts _ .. _. BJ-pciacfuoe Bowel Sound;;

, Abdomen'l;lon illstended' .9fuer •

DISCH.4.RGE ASsEssi'-iE1't'T 1. EV ALUATIOK

INEFFECTIVE l3REATIIING :rATIER.~ LUNG.Sot)1IDS: EoU:ll Yes. No __

. Ckar Yes " No __

Respirations even &. pnl~orui ,-.SA02...YlNL on Room Air Yes. No

ALTERED T.HOUGJp' PROCESSES __ Oriented to time, plc,c::, P-'"I30Il, s1=D.On llJld ba.sciJ= mentaIion has rel1UTIeU.

p,OTENl1AL FORDECREA.SED CARDL-\C OlJTPL-:f Vual Signs Stable .

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ALTERED GI FUNCTIONS . , ; ',,".'>l. , . _ •• _ ~. .. II I 'V~.:.ll • i" ~ • • ..... =-....

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ACLU-RDI 5870 p.46

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DATE:

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MEDICAL RECORD-SUPPLEMENTAL MEDICAL DATA . . .,. For UN of this tom, see AR ~: the proPonent a"ency Is the Office cif The SUI'C)8OO_' _Genera"'---r',-;:"~' ::-':-~:.....:.: __ :.....:.:~_.

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TIME: TIME;

_~~~ ____ IN_J_TIAL ___ AS __ S_E_S_S ... M ... E_NT_·_'_· _. _--::: __ ...;.-....;~ , TETANIJS:'/(

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SURG: _____________ -"-__ ~~ __ ~ ____ ___

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PAllEHT"S JDENT1ACAllOH (For typed or writtmmtriD ,il'e: Nam~last. Jim. middJe; vrzdt!; dille; hospitlll or mediallfllcility) , .

DA 1 ~"'n 4700

o HISTORYfPHYSICAL'

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·US.~PMI'nq()!f ... 1990·, ?8'~'?'226

66

ACLU-RDI 5870 p.48

DA TE (YYYYMMDD)

2. CHIEF COMPLAINT; PERTINENT HISTORY, AND PERTINENT.5YSTEMREVIEW

c. TITLE

9. PATIENT IDENTIFICA TION. (For typed or written entries: Name (last, first, middle), grade, SSN, date of birth, hospitalor medical facility, ward number,and register number) .

d. SIGNATURE

10.0UTPA IHEALTH RECORD MAINTAINED AT:

11. COPY PLACED IN OUTPATIENT RECORD (X when done)

DD FORM 2770, APR 1998 (EG). .., .. .,... •.. ..... . •.

.. . ·10-L-0126·ACLUD~Dlll {etD ROI) 270t USAPA V1.00

ACLU-RDI 5870 p.49

MEDICAL RECORD CHRONOLO:GlCAtRECORD OF MElllCAtCARE

HOSPITAL OR MEDICAL FACILITY' . ". . . . STATUS OEPART./SERVI.CE

115TH FIELD HOSPITAL, FT. POLK, LA 71459

SSNIID NO ...

'CHRONOLOGICAL RECORD OF MEDICAL CARE '. . ... ,. '. Medical Record .. ST ANDARD FORM 600 (REV. 6·97)

Prescribed by GSA/lCMR FIRMR (41 CFR) 201·9.202·1 . USAPA V2.00

68

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DATE Of ORO~R TIM£ oi= o.ROeFl

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115th Fierd ~

10-L-0126 ACLU DO III (CID 'ROI) 2719 ACLU-RDI 5870 p.67

ACLU-RDI 5870 p.68

FESUL TS FORM---Qf1

.10-L-0126 ACLU DO III (CID ROI) 2721 ACLU-RDI 5870 p.69

I

115th Held h ... ~plraJ;

ad Central Datentfon Facil

ACLU-RDI 5870 p.70

I ----- , 15th Field ~ hdad Central' Dete

ACLU-RDI 5870 p.71

,. .

10-L-0126 AC Ul-DD IlllCID ROI) 2724 ACLU-RDI 5870 p.72

ACLU-RDI 5870 p.73

115th Reid" r>tta Centraf Oe'fenUon ...... _._" .... .

Np Ot.al F'amsfu;

ACLU-RDI 5870 p.74

_ _ ta;.;;-= ~ . (

-~ '" 115th Field H~p~-----"r---I'D

~~- 3

10-L-0126 ACLU DO II (C .O ROI) 2727 ACLU-RDI 5870 p.75

------~~~.~~ ----==--"" ' (: - 1151h FlaM Hosjrn.al

9

10 L-0126 ACLU DO III (CID ROI) 2728 ACLU-RDI 5870 p.76

10~L-0126 ACLUI DO III (CID ROI) 2729 ACLU-RDI 5870 p.77

ACLU-RDI 5870 p.78

ACLU-RDI 5870 p.79

115th FJeld Hospital ........ "",., 0e.n'tt31 Oe'te.nfion

ACLU-RDI 5870 p.80

' g1 flES~ , AOZfl\I P sMA

.0 P ,.: ~~lS(~OO'U( __ (j" I()

o CRVOPAfC,r, 'A I; (II",olltl( _ .. ,lib)

, 0 Ah .IMMUNE 'GLOBULI N

____________ ~~~ ________ ML

R A~KS:

Tb (6) I PATtEHTNO. '. I Itb)(6)

, I ~

R RECIP.Ie.NT

ABO 13 ABO f3 Rh fn Rh 'f bf

SLOOD OR BLOOD CO~PONENT TRANSFUSION

0 1 TV~E AND SCREEN

0 1 GRQSsMATCH

'tHa PHYSICIAN - l)

.1 l ov col) ad blood ~l!Cime" ~ U" billow named Pi'! 'en \lfll'iil d the nema arid 10 No. a t i . patien ond "",if1 " spec L5l 1U'bo label a be c orTVllt. -

KNO N ANTI BOOV F'ORMATtON(TRANSFU· S I GNATURE OF ~R'F I ER SION ~EAcnOl'l (Sp~t:If:lJ

• ,S T H E RE H ISTORV OAT~ V~~IP'ED

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II1E Ol YTIC·OISEA'SE QF NEWBOAN1

CK:

,CROSSM ~ T-cH ,I " , O 'NORECO 0 ,

Nf~ r A!,+ I . '

. «;AOSSMATCH NOT REOUIRED ' OR HE COMPONENT flEQUES11EO IDATE REMARKS, t?Y.:f ~.fLu - - I AJo O'I11·b 'f'..scJitt e..r} f ~l ~

~~ ~fP'T. ~ _____________ _

----------------~--------~~-~------~----------------------------~ , b 15

seCTION III - RECORD OF TRANSFUSION

~~~~~~~~~~~~~~~~==~--------------~~~~~~F.o.--~~~~~~~~~~~~--7nTER~uPfe1)

NO

II I'!IGCltion 15, .U$P8ct d: - IMMEDIATEL Y : 1. Di$&:0Il 1nw U'Bo$fuJil1ln. Ql!atShocit: "r pnr5\jnt . !lOp In Y9n.ous line n. 2.. Nolf",. Ph vsl~i~n al\d Tra .. ~tU$tUll SorV.ce.. 3, Follow Trcmsfusi"" A' edoo Procedurt.l$. 4, 00 NOT dl$Cllfd unit Ae1).lm Blood B:I!.l . IlterSe, and l,v , !!DIu, ons to

tJ\8 lJIQoc:l, Ban\(. ~~~~~~~==~~~~==~~~~~====~~------_10ESQ IPTIO~

"'J'IE IF! R (SibAtIO I 1(016)

o URTICARIA 0 CHILI!. o FEVER 0 , PAIN

----------------------~' [J9THER ________________________ ~-----

BLOOD 'OR 8LooD COMPONENT TRANSFUSION -STANDARD FORM 618 (R:~V. a·86l oer\61.! liltvlQet Aa,"ln~ftllon Intera;clDcy CO'1'1mltt.' on Mltdk .... j{ o' CI~ F IRMR (UCF ~I 20 l "'~.s05 ' 5 18·122

MEpl.CAl RECORD COPY

10-L-0126 ACLU DD III (CID ROI) 2733 9

ACLU-RDI 5870 p.81

MED ICAL ~E~ORD

COMPONEN T REQUESTED (Ch,clr en1lll

o FlIiO B 000 Cf! U.s

C81. F"RESJ-I FROZEN PLASMA

:0 PLATELETS (Pooj of __ llrtlU'

0 : CAVOPAECLPI'TA E (Pi n' 0' _ _ N"{UJ

o Ril IMMUNE GLOBULIN

o OT~EFi (8P#;if¥i

VOLUM REQUESTED rU4PP(Jcallr )

)~ .

DON OR REel!' E'NT

ABO A1\.lO !3 Rh

BLOOD OR BLOOD COMPONEN'T TRANSFUSION

SECTIION I - REOUISITION

, 0 TYPE AND SCREEN

I 0 CRDSSMATCIo-t

N(U!HY:; J ~IA 1P.m.,)

DIAG~OSJ$ ott OP£~ATJV£ PROCEDURE.

I -I,ivu io.iltl~ J Sip <5StJ

NOWN ANTIBODY Fa'UI'IATIONfTIilANSFU. SIGNATVRE: OF VER,P I E-R SION .R,EACTlON (SpulIYJ

DAT£VER It!:

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EMOL YTIC OISEASE OF NEWBORN'?

TeST INTERPRETA nON IANTIBODY SCREEN CROSSMATCIH

NIh- I f'Jf~ S,IGNATURE Of' PERSON PE RFORMING TES'T

_ ~c ~bIl4..~ ScJre.Lr1fY~lWd Th~d FfP

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----------~~--~---------------~--------------------------------~' SECTION 111- ~EC~flC OFTRANSFUSICN

o SUSPEC'TiE,D

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(0) 6)

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2. N(Jtify Pt-t~alc:Jafl arid Tran, tiS on ,SIlN1C£, 3, Pot/ow TransfwlOl1 Actio! p(~cJ.u~ s. 4, Do NOT discard \](\ Rfl illm Blood Ba • AI , Sa al'id t, V. f,ll' U lon 0

\,he BlDed e f\k , OEscfl I.PT,ON

I 0 URTICARIA 0 CI-t::J l L o FEVER 0 PAIN o OTIiEA ~ ___ _ _____ ___ _ ____ _

sf: x I ARC

I t~ U,"OQO OR BLOOD COMPONENT ~A"SFUSI,?N STANDARD fORM 518 ,~EV, . '861 Pl!nenl 'Serv'~' AamlntrtratlOn Inletapl\C)' OU""1'I1 tn on Mea l. I Rkc,c1s flRM R" (~lCFR) 201.--45.5005' 516-1"2

MEDICAl RECORD COpy 100

10-L-0126 ACLUI DO II (CID RO ) 2734 ACLU-RDI 5870 p.82

H$N -

SP

AAelOLDSf'C REPORT

,:PR£GNANT

DvES -ONO

CATEjEQU.,5T Eo. :,_- \ >"IUS-

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,

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l[lNl t I-ocp.liiON OF ME OJCAL ~CORO_S

I..OCA ' ON OF RAOIQL.OmC FAC. TY

RADIO LOGIC CONSUlT~l'iON

10-l-0126 A~t1~/.~ II (C 0 STANOARD FORM 51 01:8.&3) , ~1~..i~ CMi1 R V ' II Rz.-r:.l':J_1-1

1.806- 6 ACLU-RDI 5870 p.83

~\o 6, \A \ \CA.. . b

REC\JEST

C\r\.w\- t-u~ / v-€Y\t' DATE O F ntAN5c~'PT ION (Monfh. day, ~.

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ACLU-RDI 5870 p.84

t.i _

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ABO .8 ptJ7

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rf ULL IIH ( IN t

MEDtCAL R,ECORD COpy 0'

10-l-0126 AClU DO II (CID ROI) 2737 ACLU-RDI 5870 p.85

MEDICAL RECORD

coMPONENT REQil.JESl"EO {C1t~elt 0iIiIt}

[2( REO aLOOO Ct;l.lS

b 1 RESH FROZ N P'l..ASMA.

o PLATELETS 'I'_r ,0( _ lUIib)

BLOOD OR BLOOD COMPONENT TRANSFUSION

SECT,ON' REQUESTING PHVSICfAI'I (PT nJl (blt6)

CROSSMATCH

o CRYOPH6CIPITATE';'001 0' __ u Itt' , I' t hllv~ colJl;!C(ed tI blood specimen on the baJow o Flh I~MUNE GLOBULIN ,,!>. n3lTJ8d pe tlant; verlfi t"'e narne Ind 10 No. of

~~*,~.....,-,:"':":'''-!:'-~~=:-------j' {he patient lid verjf!l:Id the wec:imon tube IlIbet t!;,l o Orn1ER ($p';lhl ____ ~~~..:::;,.._ be correct.

VOl.,U..,£. f(j0ESTeD fI /ipptJCoCfb;~J ________ ~U~h~~~· _________ ML

If' PAT £NT IS f"EMALE, 15 THERE HISTOR'f' OF; ' .

. ' ,AhIG.TREA1'MENTIOATE GiVeN: ___ ~~~~~fr-~-=-~~-----

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I ,HEMOLYTIC:: D ISE~e OF NEWBORN?

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-TRANSFUSION DATA

N (Date) If re clion Is u poet d - I MEDIATEL :

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nd /ilU nfortnaUolI !dOOtlfyiflg (he Cllr1talner with lI\ended ree p~nl 3, fa'oW Trar"lu$ron RlllIcdon Prooedu",s, nlIlu:hes ili!!ltJ bY lillOfT'. The ~ipjent '.S 11'18 wme pll/'Gon :nllmed on th is Blood 4. Do NOT dl8C8d \.Inl1. Retmn Bloud aa . Flitoer Sa' • end ~,V sOlutiO/'l~ 0 COr1IponenrTr.IlISfusion Form IKld on ,t>e P&l~,..t idontlflcntiOf' I 9· the SlcJoOd 9811k ,

VGR F'IE.R lSi"'-"'''') DESCRl~'nON (b)(6)

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[JO~ER ______________ ----------------

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I , ,03. Gel1l,.r 511r1l10" Admlnlllt,atlcm 'l'nter~91,"~V Commlt,to on Mecl1 I, Ra.;Of1)s FIRMR (41CFR, 201-4 .sO! 51&·122.

MEDICAL RECQ,RD COpy It)

J 10-L-0126 ACLU DO III (C 0 RO ) 2738 ACLU-RDI 5870 p.86

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ACLU-RDI 5870 p.87

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10-L-0126 ACLU DO III (CID ROI) 2752 ACLU-RDI 5870 p.97

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I

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I

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'l'b.e Above List 0 I tam a :Is Co~ect

S,i'gnature Of Detainee

Br;i8fD -l~ O'E Daa th/Buria.1 8y Per"scn Who Cared For /fh@ Deceas.edDurl.ng !.l~nl;tlis ~r: DurlAg- La;-IMoment.:; CPoct:.o~ Nu.rse. . biu: 0' Ralig-ion. FeUo'f ;th~ee) . Death/Cremation Deta.

C DIED D TO CAADIAC ARREST. ANTZce02N'1' Cl\,USES REPATORENAL snIDRQ.'-m 1<ND SRoCK. OTHER

S~~CAN~ CONDIT ONS aONTRIBUTING ~o D~ BUT ~D TO DISEASE OR CONDITION CAUS NG D~a

- D\'l'ROGENYC PN2UNMOIl"BORAX. PRONOUNCElD DEAD By l(bHtn p~ CARE EtHYSICI::AN ,

'I!F' MaO ~ 15

DA FOruf 2669-R-E, May 1 '

62 Pa e 2 EDITION OF 1 Ju1 63 IS ..... ~JOLETi

O-L-0126 ACLU DD II (CID ROil) 2754 ACLU-RDI 5870 p.99

(Marksl oars, and t.£GOS- BeeF ann 1, .. .

~

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.. SOAR I 1.MARE. 1~~ ____________ _

119

0- -0126 AC U DO III (CIO ROI) 2755

. -• J

ACLU-RDI 5870 p.100

AGENT'S INVESTIGATION REPORT ROI NUMBER

C/O Regulation 195-1 0027-05-CI0Q.29 S-'I!}

PAGE 1 OF PAGES

INVESTIGATION: This office received an RFA (00I7-0S-CID789-392S4) from S • (b)(6), (b)(7)(C) ,

.... o.>""'uv. Interrogation Team 48th MP .. ), 11 th MP BN, Abu Ghraib, IZ APO AE 09342, to coordinate with SSG Co, lS1~t Field Artillery Regiment,

Combat Support Hosp! and obtain copies of Mr. Abdulla FA WZZI' s (ISN) Coalition Provisional Authority Apprehension Ponn (P AAF)and Sworn Statements

detailing his capture. Furthetmore, it is requested to coordinate with 86th CSIt Patient Admmistration Department (PAD) and obtain any copies of his medical records and any treatment received.

144S, 3 Feb OS, SA A and case number.

an electronic message to S~egarding receipt of the

this office traveled to the International Zone, )(6),(b)(7)(C)

I.LJ .. F,L .......... IZ, and stated the individual described as . FAWZZI, was delivered on a medical evacuation helicopter on 2S Jan OS, without a Sworn Statement and

(b)(6), (b)(7)(C) PAAF. SSG stated' Mr. FAWZZI, was listed as a "John Doe" and

S that upon his medical treatmen~ the I),' mtervlew however, at the time ofthe interview~ollld not

scribed_as missing a left leg due to a medical amputation procedure. SSG considered "stable" and because of the possible casualty rate due to the

elections, he was subseguentIy released to 11Sth Field Artillery Hospital (F AH), Abu Ghraib, IZ, on 28 Jan . SSG provided a . For Inmate or Detained Person, which

he was received by SPC Military Police, 11Sth F AH, on the same date ee DD Fm 2708 for details).

0634, S Feb OS, S " with SSG PAD, NCOIC, 86th CSH, who a copy of the medical file on Patient.see medical documents for details).

(b)(6 , (b)(7)(C)

GENT'S COMMENT: It is still undetermined if Mr. FA WZZI is Patien~owever, from t~~. on''' ... ·~ ,,.,' provided and the coordination's conducted of the hospital staff, it appears that Patient_meets

description of Mr. FA WZZI.

coordinated with briefed him on this no further investigative efforts were needed at this time.

FOR OFFICIAL USE ONLY 120 1 FEB 77


....110 o I

r-I o

....110

N en » o rc: o

,,0 ---

RECEIPT FOR INMATE OR DETAINED. PERSON .. ~

9. OFFENSE r·

10. PERSONAL PROPERTY

11. REMARKS

'f

ACLU-RDI 5870 p.102

E ·bit)~

Page(s) 122 tllfU 129 referred to:


1216 Stanley RD 2D FL FT. Sam HOllston TX 78234-5049


b 6)

(b)(6J

: _7 J n 1 I)'. ~OOS

o pitaI O-spital Iraq

mDla I el'om dkal u a . 'n . \Ullma

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o III (CID ·

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01) 2159 1 "*

ACLU-RDI 5870 p.104

(h (6

PllloJReclUiimeod. ttoos: I) Transfer 10 ~O!l __ WilaJ for und do.stm~ lUI rdl<o- ,1I ~t ,u-... #/1 ~ Plea&o Ci)lltac b (6) \ ' I.h flfl)l furtb tJu ,If't~ I( l ce),

(b (6

- Ibn S'ina (. <0 11 861t! Ccrmbatuppon..k s.p i 131 Baghd t Iraq

CLU .D 11 (C 0 RO ) ACLU-RDI 5870 p.105

MEDICAL RECORD

o CALM

COM fS· .AJ.l.ERGIES:

V-

ASSfGNED 5CR Ie

ASSIGNED eiRe /.J\TOR

o ous

bl6)

~b)

7. POSITION AND FOSI1l0f'{A,L \0 (SpadfjJ

o 1JTf-iOTOMY 0 PRONE

o YES '0 a, s

HAIR Re OVAL DOIIIESl('

ETHOD; o OR o NURSING NIT o OEPILA OR o RA...7QR o cup

OOM aNTs. 9, LOCATION OFEXTER LDEYlc.eS

~ ~

I

'--

P.El. IEF

REUIiIF CIRCULATOR

LATERAL..

N PREPARATION

LeFT SIDE UP 0 RIGHT SI D,E UP

_ ECTROSURGER OEVleE(S. rcsu, ~ U

&esu NO! ~ ___ a.=..;;;D~O=-~4-f-...........,~~ _ _ -t

r GROLJt D PAD: BRAI [) ~~~~~-• ..c;;oe:.-...-_ ... _~I lOTNO! ~~~~~~~~~~~1

[J esu t rn ---------------------------------1 GROUID ? AU; BRAIIO ___________ ~

LOT o: _______ _______ ~__;

U 81PO /lR U:

RE:j>LAl;ES 0 FORM S'f19-1 511 DEC e , \1'H ICH IS OBSOt..ETE.

-:0126 ACLU DO III (eiD RO ) 2761 ------""----ACLU-RDI 5870 p.106

AS P Ml:STllESlA; (0)19)

GROUN Pil rtE: PRE- P ~1.£ l.:\,.q"

20. OPCAA 100~{S) PERFORMeD

2.1.

lFir1;S NAME: '- I ~:

rFYES,S E

3.

r 10-L-O 26 ACL'U DO II (CIO ROI) 2762

1 ACLU-RDI 5870 p.107

MEDICAL ~ECORO

DCAL).

CoM 4ENTS'. lLERGIl?S.

c ERSONNEL

OO~UMENT ~o'Ibot "'liS If

o WI"1iORAWN

PROCEDURE:

-------r--~--------------------------

ASSIGN!:£) SCR B

AS IG CIRCULAiOR

7 POSITION AND POSInO~!Al AIDS (Spoci )

SUPI~tE o l iTHOTOMY 0 PRO~E o KRASXE

CO MSlJTS:

HAI~REMDV l OO/llEBY; 0 A~OO: 0

o

. 0 ~l1d Pad t----~(b)

iO. COUNTS Spong!!'

o o UR81 GlI IT

TOR 0 RAZOR

Re::UEF .sCRUB

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o LE.FT sIDe UP

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o Ell OlAR NO: ------------~-----------_t

REPLAOES OA f'ORM &\79-1 {TEST). OEC 82, V!l)jjCfi lS OBSOLETE.",""=j;i~~~

10 .. L-0126 ACL DO II (C 0 ACLU-RDI 5870 p.108

• '71:;!..:: 91W7d:W:;94?;•:•.wW

..N.X■rsy.r.x.ggfy,;-;•4 MEDICATIONS/ORDER

DOSAGE

1RRIGATIOMAEDICATIONS GIVEN IN OPERATING ROOM {NOT BY ANESThIESINT --f•-,.. NO

• iitREPALREDiti.

I

9:

OLIN° IRRIGATION

. - •

THER ORDERS

HYSICIANS SIGNATURE

15. X-RAY IN OPERATING

YES Q NO

...u.t.r., ....711: • :VIES NAME•±10.1_. --1:14:1%1\52,-- -j 1E - _,T1b-4tt-.3q2

+,.1. r-r.t.r4 I no01, im:9-LAN I b -.., i 1 . -S. ' ..."% t13.440.. 7.. =.... ...14:::....._= ._ .

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. .... . .

GIVEN BY

TIT#ai 21. PATIENT TRANSFERRED TO

NAME SPECIMEN IS)

YES 0 NO a FROZEN SECTION (FS)

YES El NO ►

NAME NAME

NAME NAME

97

16.

17. TUBES. DRAINS/PACKIN Ga

TYPE/SIZE 2.

SITE

NAME

NAME

NAME

111111EMENI 0 NO, TYPE(S): -

MEM= Ilinill=11

YES

• - -

4-*

JF YES, SITE

LABORATORY SPECIMENS

NAME

CARRIED OUT

13 DRESSING/IMMOSILIZATION (Specify)

c.),orvl -6a—e fN—j

gINFLMENNERMr EDICAT)oNsisoLunoN •

19. ADDM0 SURGEON

(NO) ASSIST

(IDX6) ANESTHE

TOURNIQUET

(131I6)

ACLU-RDI 5870 p.109

a OS P a

GU rat Pelvis stable:

B Distended-- YES-- 0 NO 0 Obese ❑ Non-tender Hemorrhage: E Tender 171 YES ZINO O Rigid ❑ Guarding Blood at

; N

• Alert Responds to verbal Responds to pain Ultras

GCS: Eyes Motor

Sphincter T. e: 0 WNL OWeak ❑Nona

Time logrotiet1 7 2

11.1` ATEGOR Y"`

- JOINT THEATER TRAUMA REG rSTRY RECORD

7.•

AMA/ •.S. TUSTP. Date: 3 Time of anivai: Time of Injury: Transit time: C-spine irnrnob-, YES Intubated: YES/NO 7: BP: f HR: RR: Oasat:

PAIN: 0 1 2 3 4 5 6 7 8 9 10 Last Tetanuir - GCS:

RNIOUET CPR IN P 0 ESS 1111'Aik r

i me on:

Time oft PROTECTION

0 Struck

Wom 0 Struck

0 Worn CI Struck

D Worn ❑ Struck ❑ Wom 0 Struck

0 Worn 0 Struck

•re

WOUNDED ,13

MOOETFAR RIVAL" PATIENT CATEGORY Nation:

US Host nation

• Coalition: O Enemy: Service: 0 USA E) USN • USMC O USAF

)59

L120 ■

mrnediste Delayed Minimal Expectant

■

•

❑ He]rnel kevlar or ACH (circle one)

Ei Flak vest ❑ Ceramic plate 0 Eye protection

Groirul

Unknown • 0 Worn

Unknown Enemy Friendly Civ [Host nation)

1 Training Self accident • Serf non-accident Sports recreation Other: NDER

• asked anted

USMC CASEVAC ❑ Non-reed ground • round Ambulance

(Ambulance O Ship EVAC O Other

OSURE I

11' a

0 Penetrated

❑ Penetrated E] Penetrated O Penetrated • Penetrated 0 Penetrated

■

U U

Cooling blanket Bear hugger Radiant warmer IV bag warmer Other:

Combatants O Contractor • Non-gov't org ID Other

ern @ e Time ended:

PRIMARY SURVEY Breath Sounds CIRCULATE0N DEFICIT

MINIPM64,

BR ING nlabored Rig .- Left

Labored Clear 0 Absent tn Roles El 0 Retraction 0 Flail 0

Flaring ❑ WheezeEl Absent 0

Trachea: 171Midline 0 Deviated Chest symmetry: (circle one)

Left> Equal Right

HEART . Rhythm:

D Sinus tachycardia ❑ Sinus bradycardla O Asystole O Other

Pulses: S = Strong D =• Doppler P = Palpable A = sent Carotid 131gita Lars Femoral Right Lett Brachial Imo, Left Radial MO/ Lett Pedal Right Lett

.tVD Distension: ' Right • 0 Left

kin: fl Warm ool 0 Hot ❑ - .• LI Palo Eleyanotic

Dry 0 Moist DO iaph Heart Sounds:

OClear ElVturtled Capillary Q 42 seconds (normal) In >2 seconds (delayed)

• • • •

0 Rebound tenderness.

▪ Unable to assess

Rowel sounds: ❑ '11 S 0 NO

Last Meal

AIRWAY LI Patent O Stridor O Drooling • Obstructed CI OrabiNasal Airway O AVM O Chest tube{s} O Inlubaled ED Other:

HEAD/NECK EENT Draina g er- Nose (color):-........ CSF: Halo sign _

Glucose Eyes: Equal R / L

Fixed R f L Reactive R t L Dilated R 1 L

'Other C-Spine lender:

Yes 0 No Dental injury:

0 Yea 0No TirmPanEc Membrane:.

Clear R L —0 • BlOod R L

. ' 74' • 7 j:

EXTR AYES CI NO

Fracture/dislocation: - 0 RUE

RLE LUE LE -'cj

Motor Sen Sensation

EADyNtr

meatus/vagina: YES DNO RUE

LUE Prostate:: RIE

G likeNL LLE Ab nouna I Back Exam:

O WNL

CURRENT MEDICATIONS ■ ALLERGIES Unknown

E NKDA ❑ PCN

IWasaillbeDiaa O Morphine O Codeine

nknown IM None El Respiratory, hx

0 Cardiac hx ❑ HTN

ID Other:

PATIEWIDENTWICATION Najne/Rank:7-7,.:: 1;(b)(6) ESN/Patient Id AI: .

*2 ' • ••••• . .

Deployed unit: -

- 1 KNOWN .

a NONE . • - - El OTHER -

LAST MED GIVEN Morphine r rip Ir. I

r

Other. MEDCOM Test Form 1391. DEC 2004 sut...lerti.. ti PlivacyAck or t974 Page -I of 3

- • - cSH/Bagnaad, hag

ID-L-0126 ACLU DD III (CID R01)2765 -- -- •

. . •

ACLU-RDI 5870 p.110

, .

, (JOt · -~ -t.:ol.-b t~l -S1 ').'> ..,

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ITIMe INOTES

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86 CS ACLU-RDI 5870 p.111

ExhOhit(s) 11

Page(s) 131 thru 137 referred to:

CDR USAMEDCOM ATTN: FOrA Office, STOP 76


10-L-0126 ACLU DO III (CIO ROI) 2768 ACLU-RDI 5870 p.112

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---+I~--------------------MU CULOSKELE lYE TEBRAL COLUMN:

10- -0126 ACLU DO III (elD RO ) 2769 _~)_. {-'---ACLU-RDI 5870 p.113

\

OfFICE OF DIE ARMED FORCES MmICAL EXAMINER

l

ACLU-RDI 5870 p.114

~ ____________________________________________ ~O~O~~~~ I

S. WMD

~ ") 11-6_" ____ ~~--__ ~--~ , 7. PLACS WHERE DEATH OCCURRED -

HOUR YEAR (:b (6)

O-L-0126 ACLU DO II (C D RO) 277 ACLU-RDI 5870 p.115

RECORD OF IDENTIFICA TlON PROCESSING ~;let1ls 8nd PIl vs1clIJ Dlu~)

lASr NAME ~ FrRST NAME - MIDDLE INrTfAL {Or un- GRIWE 'S!=:RvrCE NO. S-SAN CllCASE NUMBER" (If '1''' iCslJJeJ K,", wn 1111mb , aTB!Fa~. bdulln

0.'11 , en MC!d.icul Jdcu j IcatiOD Brat:cl (liS) Nolhin~ Fot! ~

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Me 1m

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£VIDE CE OF .~EALm FMCl'1JRES AN

N/D

WOU DS OR l"{JUffIES

M~dicnl suches on upper} (t leg Sur -c:ally amputated, I t.t left leg willi m.ed' a.I tr:lp

I

PLOT

N/A

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ACLU-RDI 5870 p.116

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Date Of 13uxial..

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ACLU-RDI 5870 p.117

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--------------------------------------------------------~------------------------ -----FORM 2669-R-El Hay 4O-L-O 26 Arert=U DD I1t:tCIO 0JtQNJt; OBSOLETE ACLU-RDI 5870 p.118

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10 L-0126 ACLU DO III (CID ROI) 2775 ACLU-RDI 5870 p.119

Exhibit 12:

Page 138 referred to:


1216 Stanley RD 2D FL FT. Sam HOllston, TX 78234,-5049

10-L-0126 AClU DO III (CID RO ) 2776 ACLU-RDI 5870 p.120

-----, .

\

138

10-L-0126 ACLU DD III (CID ROI) 271# it ACLU-RDI 5870 p.121

Exhibit(s) 1J

Page( s) 139 thru 144 referred to:




ARMED FORC ES INSTITUTE O F PATHOLOGY Office of the Armed Forces Medical Enminer

14 13 Research Blvd., Bldg. 102 Rockville. MD 20850

1-800-944-7912

FINAL AUTOPSY EXAMINATIO N RE PORT

Date of Autopsy: Date of Report : 15 April 2005

"'I"""'" --~' Autopsy ~'~.~' ~=_--:j AFIP No!(b)(6) Rank: Civil ian PlaceofOeath: Iraq Place of Autopsy: Army Mort uary Camp Victory, Iraq

Circums( . ne~ of Death: This 54-year-old male was a civilian detainee who died while hospitalized.

Note: In some documents the first name is spelled Abdullah

Authorization for Autopsy: O ffice of the Armed Forees Medical Euminer. lAW 10 USC 147 1.

Iden t ification: Identification is e.tablished by means of the altacllcd identification tags.

CAUSE OF DEATH: Complications of gunshot wound of the ldt leg.

MANNER OF DEATH: Homicide.

FI NAL AUTOPSY Dl AGNQSES

I. Evidence of injury: A. Gunshot wound of the left leg (per report).

I. Status poSt aoovc_the_knee amputat ion of the left leg. B. Laceration of the righl knee compatible with I grating type gunshot

wound. C. Contusion of the right fOre3rm .

II. Additional find ings: A. Acute bronchitis with early bronchopneumonia. B. Bilateral pulmonary oongestion (right 1179 sm, left 997 gm). C. RighHided pleural effusion (approx imately 100 ml) and adhesions. D. Jaundice. E. Pining edema (1 +) of hands and feel. F. Right renal calculus. G. Focal hemorrhagic cystitis.

10-L-0126 ACLU DD III (CID ROI) 2779 1 139 , ACLU-RDI 5870 p.123

)

AUTOPSY REPORliL!<b_"_' ___ --' FA WZZI, Abdulla

H. Soft tissue mass of upper cllest consistent with lipoma.

Ill. Toxicology: Morphine blood level of 0.27 mglL.

140


AUTOPSY REPO RT lbKS) f A WZZI, Abdulla

EXTERNAl. EXAMINATION

30f6

~ body is Ihat ofa well«velope<l male that weighs approximately 130 pounds, is 67 inches in length and appcan compatible with tho reponed age o r 54 yean. Li\'idiry is fixed on the posterior surface of the body except in areas exposed to pressure. Rigor is complete. The scalp hair is W-y·bl.,k. f ":lal hair cOJl$ists ofa sray·black beard and mwuclle. The irides an: dark. The corneae arc cloudy. TIle eonjun~tivllC are unremarkable. The sclerae are iClerie. The cxternal auditory canals, external nares and oral cavity are free of foreign material and aboormal secretioos. The teeth are nalural aud in poor condition. The nasal skeleton is palpably intact. The lips are wilhout evident injury. The neck is straight and the trachea is midline and mobile. A I % inch circular so il tissue mass is pre:settt on the upper mid cms!. The abdomen is flat. A 10 ineh scar is present on the right lower abdomen 100 right flank. The C};tremities show ev~ of injury to be further described below. lllert: is 1+ pitting edema of the hands and feet. The fingernails an: intact. A plastie wristband is Pre$eflt on the right wrist with ~ (tiJ(S) FawW, AbduJlahM

• A tag IS present on the left wri$1 wi!h " 8TB Fawni. AbdullahM

• A I Yo x I % friction blister is ptnerlt on the posterior surfllCe (heel) of the right foot. The genitalia are those of. oormaladul t male. The buttocks and anus Ire W1remarkable.

EVmF,NCE Of MEDICAL THERAPY

I. Therapeutic necdle pWl~ture site$ in thc right subclavicular region. rigllt inguinal region and left antecubital fosSIl.

2. A horizontal sutured I incb surgica l incision in the right Lateral ellcS!. J. A venical I inch surgical incision in the right lateral chest. 4. A vertical 5~ inch stapled incision in the mid abdomen. 5. A "crueal 3% inch supled sUrslnl incision on the anterior surflce of lhe left

!high. 6. left above-Ihc-lmee ImpuUlion, the skin nap is sutured closed and covered with

I bandage 7. A bandage on tile rightlmce.

t: V!l)E~C[ QJ- INJURY

"The ordering ofthc fonowing injurics is for descriptive purposes only. and is nOi intended to imply order ofinniction or relalive severity. An wound pathways arc given relative to standard anatomic position.

Llc~rltion or the right teg cOI"patible with a grlzing type gunshot " 'ound:

A bandage COVer$ a gaping JaeeTlltion ,ituated on the medial surface ofthc right knee located )3 inches above the bottom of the fIXM. The wound measures 2 \Ii x I Yo inches. No evidence of SOOl. or sunpowder 5tipplinS is prt:SCIIt on the skin around the "'"OW1d. "The injury invoh'es the skin and subcutallCOUS ti,sue of the medial surface or Ute right knee.


ACLU-RDI 5870 p.125

AIlTOPSY REPORTilbK8) fA WZZI, Abdulla

Additional injury:

Then: is 5 Y, x ] Y, ineh contusion on the ~lIterior surface oftlK: right forearm.

INTf-R.NAL EXAM INATION

4of6

The scalp is reflected. The calvanwn orthe skull is removed. The leptomeninges are thin 8I1d delicate. Coronal $«lions demonstnlte lharp demarcation between the uninjured .... hite and grey matter. The ventrides are ofnonnal size. The brIIin weighs 1501 gm. The atlantO)-()CCipiUlI joint is stable.

The anterior iItrap muscles oftbe necl< are homotIenow; and red-brown, .... ithout hemooTha~. The Lhyroid cartilage and hyoid are intact. The larynx is lined by intact while mucosa. The thyroid is symmetric and red-brown. The tongue is free orbite marks. hemormage, or other injuries.

BODY co. VITIES:

The body is opened by the usuallhoraoo-abdominal incision and the chest plate is removed. The $temu.m is visibly and palpably intact. Fibrinous pleural adllesions and approximately 100 ml of$CrOS.lnguinous fluid are praent in the right chest cavity. No cxcus fluid is present in the pericardial or pt'ritooeal ca,·;ties. The orgart$ occupy their usual anatomic positions.

RESPIRATORY SYSTEM:

The right and left lungs .... ..,igh 1179 gm and 997 gm, respectively. The external surfaces are smooth and deep rcd-purple. The pulmonary parenchyma ;5 diffu!iely congcsted. No mass lesions or areas of consolidation are present.

C6&DIOVASCUIJ.R SYSTEM:

The 454 gm heart is contained in an intact pericurdial sac. The epicardial surface is smooth, with minimal rat investment. The coronary arteries ari"" normally, follow Ihe U5UII distribution Ind an: ..... idely patent ,,·ithout evidence ofsignilic.ant atherosdcros i$ or thrombosis. lbe myocardium is homo~nous, red-broYoTI •• nd rlnn. The val\"c leaflets.~ thin and mobi!e. The endocardium is smooth and glistening. The ascending aorta sive5 ri"" 10 lhree intaci and patent arch vessels. The renal and mesenteric vessels are unl'C1Tll(b.ble.

10-L-0126 ACLU DD III (CID ROI) 2782 ' 42

ACLU-RDI 5870 p.126

AlfTOP'SY REPORT(bMS)

FAWZZJ,AbduU. S 0(6

LIVER & BILIARY SYSTEM:

The 22 16 grn H\'e:r has an intact, smooth capsule. The p;uenehyma is tan-btown and congested, ... ·ith the usual lobular arthite<:tute. No mass lesions are seen. The pllbladder contains approximately 30 ml of green-black bile. The mucosal surface is grttn and velvety. The extrahepatic biliary ~e is patent without evidence of caleu li.

SPLEEN:

The 260 gm spleen has a smooth, intact, red-purple capsulc. The parenchyma is maroon and congesled, with distinct Malpii/l ian corpuscles.

PANCREAS:

The pancreas is soft and ~lIow-tan, with the usuallobuJar m:hiu~eturc . No mass les ions or «her abnormalities are $Oen.

ADRENAL GLANDS:

The right and left adrenalslands are symmcuic, with bright yellow cort~el .nd srcy medullae. No masses or areas orhemormage are identified.

GENITOURINARY SYSTEM:

The right kidney weighs 188 gm; the left 212 gm. The external surfaces arc intact and smooth. The cut SurfilCeS of the right kidney reveal a I.S cm tan-brown calculuJ in the inferior pole. l be pelves arc unremarkable and the uretct"S are normal in course Ind caliba". The urinary bl.dckr OOflllins approximately 10 ml of blood tinged urine; the mucosa is focally hemorrhagic. Thc lumen is empty. The prostate is normal in size, w ith lobular. yellow-tan parenchyml. The seminal vesicles are unremarkable. The te$les a", f,,:c of mass lesions, OOfltusions. or Ofhe:r abnonnal illes.

GASTROINTESTINAL TRACT:

The esophagus is lined by smooth. srey-whitc mucosa . The stomach contains ~pproximalely SO ml of tan liquid. The gastric "" .. 11 is intact Th<: duodenum, loops of small bo .... el . colon. and appendix al"l! unremarkable.

M IC ROSCOPIC EXAMINATION

I. Heart (slide I): No sign ificant microscopic abnormalities. 2. LuuS$ (slides I-left, 3-right): Acute bronchitis with e3l"Iy acute bronchial

pneumonia (3): pulmonary alveollr conscstion. 3. Liver (slide 2): ConGestion: patchy cholcstasis. 4. Spleen (slide 2): Congestion. 5. Kidneys (slide 4): No sisnificant microscopic abnormalities.


ACLU-RDI 5870 p.127

AlffOPSY REPOR~(b.i"',---,

FA WZZI, Abdulla 6 of'

6. Brain (pons, slide 5): No significant microscopic abnormalities. 1. Anterior upper chest wall mass (slide 3): Mature adipose: tisSlie consistent with

lipoma.

AnplTIONAL PROCEDUR[..';;!REI\IABKS

• Q9cumen~ ptJ.otosraplls are taken by OAf ME sta(fphotographer (bMI ) ~IiX6)

• ~"JlC"Clmens retained for toxicologic testing and/or DNA idcnt ification Ife: blood, vitreous, bile, urine, gasuic contenlS, spleen IUld liver.

• The diSSoeC!ed organs an: fON"IU"ded witll!he body. • Personal e(fcclS are n: lcased to the appropriate mortuary operations

rcpresentatiVH.

OPINION

ACCQl'ding to available reports, the de«dent wa$ admitted to !he 86'" CSH for treatment of gunshot WOWlds to [be 10000~r extrcmiti<:s. Approximately S days laler, he ~edly experienced multi-system organ failure and cardiac arrest. Ht wu pronounced dead later !hat same day. No me4icat rccor<h W~ available for review.

Autopsy examinalion showed ajaundiec<l male witll a laceration orthe right kg compatiblt with a srazing cype gunshot wound. AdditioMI findings included a right pleu ... 1 effusion, bilateral pulmonary congestion IUld evidcn<::e of surgical intervtncion chat included a left above-lhe-Irnce amputation. No gross cvidc-n«= of in fecI ion "'"3$

identified al any wOWld silt. Micf(lSCOpic examination of!he lunss n:vealcd In acUtt bronchitis and early acute broochopncumonia. Posunoncm anal)·,is of the body nuid, showed I blood morphine level of 0.27 mglL.

After review orUle available information, the cause of this individual's demise: is most likely due to medical complications arising as Ille rC$ult a gunshot wound of the left leg. The morphine level "'U COI1$iMent willl medie.1 therapy and was not felt to be contributory to this individual's demise. The manner of death. in my opinion, is

_ homieide. (b)l$)

(bMII) ~edical EXlminer(b)(tl) L ]


ACLU-RDI 5870 p.128

10-L-0126 ACLU DO III (CID ROI) 2634 - Torture Database

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