OFFICE OF THE STATE CHIEF MEDICAL EXAMINER DEPARTMENT OF HEALTH, ANDREW JOHNSON TOWER, 7 th FL 710 JAMES ROBERTSON PKWY, NASHVILLE, TN 37243 FAX: 615-401-2532 EMAIL: [email protected]Case Number: __________ Report of Medicolegal Death Investigation PH – 4217 (Rev. 7/16) 1 of 2 RDA 1094 DEMOGRAPHIC INFORMATION County of Death Last Name First Name Middle Race Age Sex Residential Address City County State Zip INDICATION FOR MEDICAL EXAMINER INVESTIGATION Type of Death: Violence or Trauma Suddenly when in apparent health Prisoner or person in state custody On the job or related to employment Threat to public health Suspected abuse/neglect of extended care resident Identity is unknown or unclear Suspicious/unusual/unnatural manner Found dead Cremation request Sudden unexpected death of infants/children (USE SUIDI/SUDC) Jurisdiction Declined (Skip to Narrative Summary) IDENTIFICATION OF BODY Preliminary Viewing Need Scientific Identification Will need dental records, antemortem x-rays. Dentist: Dentist #: Positive Photograph ( ) If by viewing, viewed by: Name: Relationship: Is decedent known to have fingerprints on file? Address: Phone #: ( ) Yes No INFORMATION ABOUT DECEDENT AND DESCRIPTION OF BODY Date of Birth: Marital Status: Single Married Divorced Widowed Unknown History of Domestic Violence: Yes No Occupation: Type of Work Industry: N/A Body Temperature: Cold Warm Refrigerated Other: Decomposition Early Advanced None Rigor Mortis: 0 1 2 3 ‘0’ = Absent, ‘3’ = Full JAIL/POLICE CUSTODY Yes No Livor Mortis: Absent Blanchable Fixed Anterior Posterior Blood/Froth: Nose Mouth Ears Clothing None Color: Other: (Dirt, water etc.): Nose Mouth Ears None INFORMATION ABOUT OCCURRENCE ITEM DATE TIME LOCATION COUNTY TYPE OF PREMISES (House, Trailer, Apt, Farm, Roadway, Hospital, etc.) INJURY OR ONSET OF ILLNESS (Where: Address) (By whom: Name & Phone Number) LAST KNOWN TO BE ALIVE (Where: Address) (By whom: Name & Phone Number) FOUND DEAD (Where: Address) (By whom: Name & Phone Number) POLICE NOTIFIED POLICE AGENCY: INVESTIGATOR/PHONE NUMBER: EMS TRANSPORT TO E.R. Arrive HOSPITAL: BLOOD, URINE obtained in Emergency Room Yes No (Obtain admission blood/urine & send with the body.) DEATH (PRONOUNCED) (By Whom/Where: Name & Address) TOXICOLOGY Ordered: No Yes, specimen site: (Do not draw toxicology if sending for autopsy.) 17161 Roane Scafido Joseph Basil White 63yr Male 119 Fallberry Street Oak Ridge Roane TN 37830 Kerry Scafido Wife 119 Fallberry Street, Oak Ridge, TN 37830 865 202-8493 08/18/1953 Executive Food Industry 06/17/2017 0540 745 Gallaher Road #4, Kingston, TN 37763 Kerry Scafido Roane House 06/17/2017 0646 Roane Medical Center ER Doug Batchelor MD Roane Hospital 06/17/2017 0542 Oak Ridge Police Department Detective Moore 865-425-4399 06/17/2017 0641 Roane Medical Center 06/17/2017 0712 Douglas Batchelor MD @ RMC ER
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OFFICE OF THE STATE CHIEF MEDICAL EXAMINER DEPARTMENT OF HEALTH, ANDREW JOHNSON TOWER, 7th FL
County of Death Last Name First Name Middle Race Age Sex
Residential Address City County State Zip
INDICATION FOR MEDICAL EXAMINER INVESTIGATION
Type of Death: Violence or Trauma Suddenly when in apparent health Prisoner or person in state custody On the job or related to employment Threat to public health Suspected abuse/neglect of extended care resident Identity is unknown or unclear Suspicious/unusual/unnatural manner Found dead Cremation request Sudden unexpected death of infants/children (USE SUIDI/SUDC) Jurisdiction Declined (Skip to Narrative Summary)
IDENTIFICATION OF BODY
Preliminary Viewing Need Scientific Identification Will need dental records, antemortem
x-rays.
Dentist: Dentist #: Positive Photograph ( )
If by viewing, viewed by:
Name: Relationship: Is decedent known to have
fingerprints on file?
Address: Phone #: ( ) Yes No
INFORMATION ABOUT DECEDENT AND DESCRIPTION OF BODY
Date of Birth: Marital Status: Single Married Divorced Widowed Unknown
History of Domestic Violence: Yes No Occupation: Type of Work Industry: N/A
Body Temperature: Cold Warm Refrigerated Other: Decomposition Early Advanced None
FAMILY PHYSICIAN – DOCTOR: ADDRESS: PHONE #: MEDICATIONS (Please use attached Medication Log)
NEXT OF KIN Address and Phone #:
FUNERAL HOME Address and Phone #:
NARRATIVE SUMMARY OF CIRCUMSTANCES SURROUNDING DEATH (Add Sheet if Needed):
Body Viewed by Medical Examiner or Medicolegal Death Investigator: Yes No
CAUSE AND MANNER OF DEATH
Presumed Cause of Death: Date: NATURAL HOMICIDE ACCIDENT SUICIDE UNDETERMINED PENDING
I hereby declare that after receiving notice of death described herein, I took charge of the body and made inquiries regarding the cause of death in accordance with Section 38-7-109 Tennessee Code Annotated and that the information contained herein regarding such death is true and correct to the best of my knowledge and belief.
Medical Examiner/Investigator: Physician Responsible for Death Certificate:
The accompanying body of is the subject of an investigation by the medical examiner. In
accordance with Tennessee Code Annotated 38-7-106, I am ordering an autopsy upon the body. Order for Autopsy: Yes No
Was served to the next of kin on at
Was unable to locate the next of kin by a diligent search and inquiry.
Authorizing Signature of Medical Examiner or Delegated Investigator:
Decedent was in good health butsedentary. No family Doctor. Nomedications, NON SMOKER. He and wifelived in Asheville NC, but had a homelocally which they were in the process ofselling. They came over from NC theprevious evening to meet with a realtor.He had been experiencing cramps in hisleft leg for the past few days. He hadleg cramps maybe once or twice yearly.He planned to walk this one off.
Around 0540 he work up with a complaintof sharp, pleuritic chest pain withassociated dyspnea. Wife reports he as"gurgling," and could not catch his
Acute Pulmonary Embolus (1.5 hrs) due to DVT left 06/17/2017
Roane Medical Examiner--Thomas Boduch MD Thomas Boduch MDJoseph Scafido
Report of Medicolegal Death Investigation
CONTINUATION OF NARRATIVE SUMMARY
Joseph Scafido
breath. EMS contacted. EMS noted that he was cyanotic and extremely diaphoretic--EKG leadswould not stay on. Transported to RMC by EMS who arrived @ 0641. He became unresponsivewhile being transferred to a stretcher. CODE called. His cyanosis resolved somewhat after ET tubeplaced. ACLS efforts were not successful.
Decedent examined by me @ 0810. Left calf was 14.25 inches in circumference; right was 13.5.Palpable thrombus detected mid left calf. ET. tube had blood and some froth.