A 37-year-old woman found dead in a Jacuzzi: A case report

Introduction

The autopsy diagnosis of drowning presents one of the major problems in forensic medicine, especially when there is delay in recovering the victim. Bodies retrieved from water may belong to persons who have died from natural disease before falling into the water, died from natural disease while already in the water, died from injury before being thrown into the water, died from injury while in the water, died from the effects of immersion other than drowning and died from drowning. ¹

The causes of drowning can be categorised into unintended cases, which occur in accidents at a pool, bathtub, river or ocean, and intended cases, in which one drowns oneself for the purpose of committing suicide. In addition, drowning after consuming alcohol or drugs tends to increase the death rate from drowning. ²

Even homicide may be committed in bathrooms, by almost any means. ¹

Drowning may be a primary event or may be secondary to events such as the following: seizures, head or spine trauma, cardiac arrhythmias, hypothermia, alcohol and drug ingestion, syncope, apnoea, hyperventilation, suicide and hypoglycemia. ³

Faced with a drowned body, one should think about why and how that person drowned to understand the manner of the death (natural, accidental, suicide and homicide).

Case presentation

The body of a 37-year-old woman, wearing a bathing suit, weighing about 60 kg and measuring 155 cm was delivered to Kahrizak autopsy centre for post mortem examination. Physical examination showed the right upper limb was swollen and cyanotic. A broad brush abrasion was observed from the right arm to the fingers. The right clavicular bone was broken. No defence injuries or electrical marks showing an electric shock were seen on the palms or upper and lower limbs. At first glance, it seemed that the physical trauma and drowning occurred simultaneously, or there was a quarrel and then drowning. The question is whether it could be a murder or whether while she was drowning she had struggled to save herself, so her right upper limb was injured (Figures 1 and 2). OPEN IN VIEWER

OPEN IN VIEWER

Figure 2.

Drowned body with right upper limb injured.

Once a history was taken from the witnesses, the death scene was evaluated, and findings of the autopsy and toxicology were obtained. It turned out that she was drowned in a public Jacuzzi and did not suffer any underlying diseases and did not abuse drugs. The findings of the autopsy showed that the brain, heart, liver, kidneys and other organs were normal, and no abnormality was found except the changes caused by drowning (foam in the airways and swelling of the lungs). According to the witnesses, the temperature of the water in Jacuzzi was suitable. The witnesses explained that the drainage valve of the Jacuzzi did not work properly, and when the woman bent down to pick up her hairpin from the bottom of the Jacuzzi, her right arm got stuck in the drainage pipe and was sucked in. Unfortunately, the suction was so strong that she could not release herself, and lifeguards and others who could not help her called the manager of the pool. The pump was unfortunately stopped too late, and she drowned. The lifeguard also neglected to attempt resuscitation after bringing her out of the Jacuzzi. The ambulance arrived too late, and by the time she reached the hospital, she had already died. Her family brought a lawsuit against the managers and personnel of the pool for their failure to develop suitable security conditions and to resuscitate her.

Discussion

A death certificate is not issued for bodies found in water, which is one of the indications for a forensic autopsy. Forensic examination is needed to determine the manner of death. Although most deaths due to drowning are accidental, the possibility of suicide and homicide should be ruled out. A drowned body mandates simultaneous consideration of all dimensions (history, death scene investigation, physical examination, autopsy and toxicology), and the death certificate should be issued on the basis of these dimensions.

Drowning is a diagnosis of exclusion. In order to prove murder or suicide, surrounding facts have to be taken into account, such as other wounds, signs of struggle (overturned furniture, etc) or the presence of a suicide note. Most of the time that is all the proof that police have. Investigation of bodies recovered from water comprises a significant proportion of medico-legal requests, however, the key question as to whether the victim died due to a “true” drowning is frequently difficult to answer. In addition, the diagnosis of hydrocution is even more difficult to prove.⁴

When a loved one dies in a drowning accident caused by the negligence or recklessness of someone else, the victim’s family may sue, alleging wrongful death. This can be because someone else physically caused the drowning or because whoever was responsible for the pool or waterway was negligent or reckless in the operation of the pool, and their behaviour (or lack of action) caused the drowning in question. ⁵

The U.S. Consumer Product Safety Commission recommends these safety precautions when using a hot tub, spa or whirlpool:

Always use a locked safety cover when the spa is not in use and keep young children away from spas or hot tubs unless there is constant adult supervision.

In most of these cases, the family of the deceased will bring a lawsuit or make a formal complaint, so autopsy examinations should be performed to respect the rights of the dead person. In this case, her family successfully claimed she had died as a result of gross negligence by the pool management and lifeguard and was awarded monetary compensation. Moreover, the delay of the ambulance was considered negligent by the relevant hospital.