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Watertown: When the shooting stopped (Part II)

11/15/2015 by TBMBWH Team

“Things on your chest, you need to confess.”  Marilyn Manson

How it Began: Undisputed Facts

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Roughly 45 minutes post-midnight, an exchange of gunfire erupted between two men and several of Watertown’s night patrol division on Laurel, a poorly lit suburban street in Watertown. Local residents and their damaged properties bore witness to the destruction unleashed during the confrontation. 

Beth Israel Deaconess ER physician David Schoenfeld lived in Watertown.  He heard the gunfire and explosions that night and called the hospital to warn them of events.  The ER doctor arrived 10 minutes in advance of an ambulance carrying a cuffed male with two attendant cops.

Later news reports indicated the male arrived in cardiac arrest.  In an unsuccessful attempt to revive him, hospital “codes” (resuscitation procedures) were briefly run for a period of 15 minutes.  He was “pronounced” dead at 1:36 AM.  The abbreviated duration of these procedures indicated the futility of the medical team’s efforts.

Tsarnaev Trial Testimony: Day 52

The ambulance that delivered the man was a Basic Life Support type, hastily flagged down earlier by two Advanced Life Support (ALS) ambulance qualified paramedics waiting for it at the corner of Arsenal and Dexter.  Michael Sullivan, a Boston paramedic, was one of the flaggers.  He was qualified to work in any of the 3 ALS ambulances fielded every evening by City of Boston.  Prior to an equipment breakdown, Sullivan’s ALS ambulance had been directed to the Watertown area to be ‘ready’ after reports of the Laurel street gunfire exchange went out over the police scanners.  Testifying for the defense on Trial Day 52, April 29th, Sullivan described the wounds of the unidentified injured man he found already strapped down in the BLS A14 ambulance:
“When I first got in the truck, I noticed that he had multiple trauma, and he had some -- and road rash.”

The two police, in the ambulance, corrected the paramedic with 26+ years of experience.  “No, no, no. It was a blast-type injury from an errant explosive device,” he was told.

He elaborates:  “Some looked like they were apparent gunshot wounds, and others looked like shrapnel-type-appearing wounds.”

Sullivan described the patient, handcuffed and on his back, as combative, growling, rearing up, sweaty, pale, and resisting efforts to treat him. The man was suffering from shock and would allow only very limited medical intervention. (warning: graphic image follows)

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Elaborating on his patient evaluation, the paramedic continued: “We tried -- yeah, we tried to bandage his head wound. He had an abdominal wound which was an evisceration. It's a penetrating injury to the abdomen where the intestines come out of your abdomen.”

Sullivan stayed with the patient as he was taken directly into the trauma room after a five to six minute ambulance ride from the corner of Dexter and Arsenal. The team at BID had been alerted ahead of the ALS team ambulance’s imminent arrival and had assembled and prepped in anticipation.

Identification

As Sullivan remembers, when questioned by Dzhokhar’s defense attorney Watkins about his knowledge of who they were transporting to BID:   Q. (Watkins) Later on, you came to understand that you had transported Tamerlan Tsarnaev? A. (Sullivan) Right. On the way, we received that information.

Was Tamerlan Tsarnaev the injured man in the ALS ambulance? If this witness’s memory is accurate, it suggests the possibility ‘Suspect #1’ may have been identified well before 'his corpse was fingerprinted by law enforcement at BID Hospital' sometime after the certified time-of-death of 1:35 AM Friday morning.

Beth Israel Deaconess Trauma Center Team

The trauma team immediately put a breathing tube in Tsarnaev’s throat, Dr. Schoenfeld said, then cut open his chest to see if blood or other fluid was collecting around his heart.  (The technical term for this was a thoracotomy, releasing blood from the chest cavity and possibly massaging his stopped heart.) He was also apparently given massive amounts of blood to replace what he had lost.

At a same day press conference later that Friday morning, the patient’s injuries were detailed by Dr. Richard Wolfe, Chief of Emergency Medicine at BID.

“This was a trauma arrest, multiple injuries, probably, we believe, a combination of blast, potentially gunshot wounds," Wolfe said.

When asked how many gunshot wounds, he said: “Unable to count.”

Wolfe said the injuries may have been caused by “an explosive device, possibly shrapnel, thermal injury. It was pretty much throughout the trunk. It was multiple wounds."

Wolfe said the medical examiner could say more about the injuries.

"There were signs of more than just gunshot wounds," Wolfe said.

A blast injury to the trunk? He replied, “Yes.”

The person arrived at the hospital in (cardiac) arrest, he said.”

So, this person who Paramedic Sullivan was told was Tamerlan Tsarnaev, was dead upon arrival at BID. His heart had stopped.

Had Sullivan observed Tamerlan Tsarnaev's death on the way to BID? Neither Defense nor Prosecution teams posed this question to witness paramedic Sullivan during his testimony.

Supporting Visual Evidence?

Sometime before 10:30 AM that Friday morning of April 19, an unsourced photo was circulated on social media site Reddit, later clarified by the original poster as discovered on sports news site Rivals.com’s message board.  The Reddit poster claimed it to be a post-mortem image of Tamerlan Tsarnaev.  Both news outlets TMZ and Boston.com filed same day articles of anonymous LE sources confirming the photo was genuine.

A Reddit poster identified medical procedures performed on the body in the photograph thusly: “The big wound on his chest is a crash thoracotomy. The catheter sticking out of his R clavicle looks like a failed Cordis IV in the R AC. They didn't clamshell him, so probably been down a while. Catheters by his clavicles were needle thoracostomy attempts with 14g angiocaths left in.” (warning: graphic images follow)
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In the gruesome image below of the corpse, only the upper portion of the body is visible, ending roughly at the groin area. One can observe:
  1. Round holes in left forearm and lower left chest (below heart.) The latter could be from a chest drain tube insertion.
  2. Possible abrasions: upper right hand, upper right shoulder.
The bright red patches on his face and right shoulder area indicate this man was face down and blood pooled in those areas, a post mortem development known as lividity.

Lividity begins to work through the deceased within thirty minutes of the heart stopping and can last up to twelve hours. Only up to the first six hours of death can lividity be altered by moving the body. After the six hour mark lividity is fixed as blood vessels begin to break down within the body.


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At the Friday morning press conference, reporters hearing Dr. Wolfe's 'blast injuries to the trunk', asked the physician for clarification on the nature of the wounds.  (Watertown law enforcement personnel had described the Mercedes SUV driver running over Tsarnaev as he lay in the street.) The EM Chief was clear.

"he did not see any obvious injuries that would back up [the] theory [that] Tsarnaev was run over by a vehicle driven by his fleeing brother" and that he "certainly did not see any tire marks or the usual things we see with someone run over by a car"

To the left is a patient presenting with a case of road rash.  This individual was a security guard dragged on his stomach 20’ by a car. (Tsarnaev was reportedly face down, un-cuffed, when dragged up to 30'.)

Comparing the two images, the exposed visible skin on the deceased’s body does not display any of this.  Dr. Wolfe was correct.  But was this truly Tamerlan Tsarnaev in this post-mortem image? (Presumably the image was taken by someone in LE, as Dr.Wolfe had confirmed the body was released from BID’s care after the patient’s death.  As the FBI was in charge of the investigation, it is reasonable to presume they took possession of the body.)

"Tsarnaev was declared dead at 1:35 a.m.  Medical staff ripped off their gloves and gowns and turned the room over to law enforcement, Schoenfeld said. They returned to treating other patients, including a half-dozen with chest pains, one with a wrist fracture, and two who were suicidal, Wolfe said."

In summary, the evisceration (and related "gaping wound") injury described by both the ambulance paramedic and BID staff are not seen in this Tsarnaev post-mortem photo. Also missing is visual evidence of "shrapnel" and "thermal injury" "pretty much through the trunk."

The Medical Examiner

On June 2, 2015 the long-delayed Watertown events investigation “Statement by District Attorney Marian T. Ryan…” was released by the Middlesex County DA’s office.  It quoted Chief Medical Examiner Harry Nields’ automatically withheld autopsy report describing Tamerlan Tsarnaev’s wounds.

“The cause of death was ruled “gunshot wounds of torso and extremities and blunt trauma to head and torso” and the manner of death was “homicide (shot by police and then run over and dragged by motor vehicle.)”    There were two gunshot wounds of the torso and both bullets were recovered.  There were seven gunshot wounds of the extremities and two bullets and three fragments were recovered from those injuries.

The gunshot wounds of the extremities consisted of three gunshot wounds to the right thigh, one gunshot wound to left upper arm, one to the left forearm, one to the right upper arm, and one to the right big toe.”

(And)

During the autopsy of Tamerlan Tsarnaev, bullet fragments were recovered from the right rear calf and the left forearm and spent projectiles were recovered from the left upper back, the left upper arm, the right thigh, and the right pelvic region. (Note: Rounds slow as they pass through the human tissue, so “spent” projectiles would more likely be found in tissues reflecting the end of their trajectory.)

The DA’s Statement contained no ME report description of shrapnel wounds or recovery of shrapnel from the deceased's trunk.  It also failed to mention wounds indicative of a “thermal injury/blast injury," or an abdominal "evisceration."

Autopsy Report Comparisons to Post-Mortem Photo

Since Dr. Nields did not cite in his report a bullet wound to the lower left chest, it is likely the round opening well below the nipple was the site of a chest drain tube.  There is no discernable bullet entry point in the visible right pelvic region.  There is no bullet entry point visible on the front of the body that would account for the spent bullet found in the left upper back of the deceased. 

Off camera are areas where bullet wounds could appear in the left upper arm, the right pelvic region or the left upper back.

Again, there is no visual evidence of paramedic Mike Sullivan’s claim of “evisceration”—intestines coming out of the abdomen, nor do we see shrapnel wounds throughout the trunk or signs of a blast injury as described by Dr. Wolfe of BID.

On site Law Enforcement Accounts: Inconclusive? 

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Despite three gunshot wounds to the right thigh, Sgt. Jeff Pugliese testified in court only by tackling Tsarnaev from behind could he be brought down.  MacLellan and Reynolds confirmed that prior to the hit-and-run with the Mercedes SUV, Tamerlan prevented these 3 experienced officers from effectively subduing and cuffing him.  In the many hair-raising interviews given by these Watertown officers, none mention blast/thermal (burns) or shrapnel wounds or signs of evisceration on the torso.  Even those BPD officers, who arrived on scene as the Mercury escaped, in relating how they stripped the handcuffed body of clothing to guard against a suicide vest, failed to make mention of what BID personnel described as wounds "throughout the trunk." Such severe wounds would have damaged if not destroyed any upper body clothing the suspect was wearing. 

The Middlesex D.A.'s statement also elaborated on the the 'hit-and-run' event. Tsarnaev was struck by the front driver side tire (blood residue present with speed adjudged to be 40 mph,) and tangled beneath the carriage, was dragged up to 30' along an asphalt-type surface. (This would explain the 'blunt trauma' described by ME Dr. Nields, but would have left the sort of injuries an experienced ER doctor would catch, as these are typically seen in car crash victims, the daily fare of trauma centers.)

"(Boston Police Superintendent-in-Chief Dan) Linskey saw another gang officer holding Tamerlan on the ground and he ran over, worried that the suspect might be wearing an explosive vest — worried that he might blow up the cop.The pair began to strip the suspect’s clothes. An ambulance arrived for the officer. And cops called for an ambulance for the suspect..."

Still, casings and projectiles firearms evidence would be expected to definitively identify how and by whom Tsarnaev was shot. This was done for the Ofc. Collier shooting by forensics expert Detective Lt. Cahill.  He testified at the trial ballistics matched the projectiles recovered to the jammed Ruger retrieved from Laurel street.  Unfortunately, when it came to matching the casings from a total of 19 surrendered LE guns on Laurel in Watertown, the Middlesex D.A.'s report resorts to vagaries such as known "universes" and everything "points to" and "most likely."  It is interesting that from a firing distance of 4'-5' between Sgt. Pugliese and Tsarnaev in the driveway at 53 Laurel, the ballistics cannot be conclusive.
  
"...Detective Lieutenant Cahill ... has opined that each of the copper jacketed lead spent projectiles and fragments had similar class characteristics to the Glock test fires, but due to damage to the bearing surfaces of the projectiles/fragments there was insufficient correlation of individual markings.  Therefore, they cannot be associated with a specific law enforcement Glock firearm."  This in spite of 4 'spent projectiles' recovered from Tsarnaev's body, plus 3 fragments. Yet none of them could be correlated to an individual or several specific weapons.

"The forensic investigation of bullet casings on Laurel Street could not identify conclusively which police officer or officers fired the shots that struck Tamerlan Tsarnaev.  The ballistics evidence has limited the universe of officers who could have done so to the fourteen officers, from the Watertown police, the Boston police and the Boston University police who all used Glock .40 caliber firearms.”

Therefore, this ballistics forensic failure does not preclude other possible scenarios.   At minimum, 3 law enforcement divisions carried Glocks that night.  If (a) Glock .40 caliber weapon(s) was the source of the 4 projectiles recovered from Tamerlan Tsarnaev’s body, not matching projectiles-to-weapon leaves open the possibility 'unknown' Glocks might have been discharged by other law enforcement personnel.  It therefore remains speculative only those 14 Glocks collected from officers on Laurel Street who turned in their weapons would have been the sole source of Tsarnaev's nine gunshot wounds.

Conflicting Reports

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As for time of death and identification of Tamerlan Tsarnaev, who left his wallet on the back seat of the green Honda Civic on Laurel Street, we can consult another official Boston government report.  Several area agencies had combined forces to produce and issue on April 3, 2013 the After Action Report (AAR) for the Response to the 2013 Boston Marathon Bombings. 

“At 1:06 a.m., the first suspect was pronounced dead at the hospital after unsuccessful attempts to resuscitate him were made. Using fingerprints taken at the hospital, the suspect was identified as Tamerlan Tsarnaev. His records contained a picture of his younger brother, Dzhokhar Tsarnaev.”

This discordant 1:06 AM reported timing for Tsarnaev’s death appears multiple times in the AAR document and is unlikely to be a typographical error. Such earlier timing would conceivably be barely feasible, if only for the efficiency of Boston Public Health routinely operating 18 ambulances every night, per paramedic Sullivan’s testimony. 

“By protocol, Boston EMS units respond along with BPD SWAT units whenever they are deployed. In this case, Boston EMS had sent both a basic (BLS) and advanced life support ambulance (ALS) and shift commander to the Watertown incident, and they were staged a safe distance away during the shootout.” (from the AAR report)

Both the AAR and the Middlesex D.A. report agree the Watertown shootout incident began at 12:44 AM.

The Middlesex D.A.’s investigative report states Watertown LE called for an ambulance at 45 Laurel for the suspect at 12:51:55 AM.  (Ambulances were already staged safely nearby.)

Assuming six minutes duration for the ambulance ride to BID, if Tsarnaev was collected within a few minutes by ambulance after the shooting ceased, he could have arrived at BID close to 1:00 AM.

However, both BID’s account of events and the Death Certificate states time of death at 1:35 AM, a disturbingly large thirty minute discrepancy from the AAR’s timing of 1:06 AM. Such a high-profile Law Enforcement capture would be unlikely to have sloppy paperwork by a sleepy, disorganized clerk.

And it still defies logic to find Beth Israel Deaconess staff and the Chief Medical Examiner's office so lax in this matter.

Watertown residents' eye witness accounts

Not surprisingly, there are several eye-witness Laurel Street resident accounts that appear to support the Chief ME Nield’s blunt trauma injuries as entered on Tsarnaev’s death certificate findings. Plus, forensics reports accepted into trial evidence confirm the presence of a blood trail leading from the resident’s driveway at 55 Laurel and into the street in front of 45 Laurel. This was a violent end to a life, as reported by the Boston Globe.

“The SUV ran over Tamerlan Tsarnaev with a sickening thump. Blood pooled around him. Red streaks stained the pavement where Dzhokhar had dragged his older brother under the SUV.

“He was on his belly; he was moving,” said Jean MacDonald, who was watching from her second-floor bathroom window on Laurel Street. “I saw him trying to lift up his head.”

Police said Tsarnaev dragged his brother’s body about 30 feet.

“I could see the SUV headlights go up and then down when he drove over his brother,” said Rob Mullen of Laurel Street, who watched the gunfight unfold in disbelief.”

A third eye-witness account was more chilling than these.  A video this resident witness posted online, subsequently aired by news media, identified her only as “Jess Ica.”  (Her video captured the last minute of the gunfire exchange and ended after Dzhokhar ran the police cruiser barricade.) During a phone interview with local Fox News, she told this version of events, observed from her position “5 houses away” around the corner and down the street from the Laurel gunfire exchange.

“I was watching the news about the MIT shooting.  I heard a car speed by really fast. Soon after, I heard three pops, like fireworks.  The pops continued.  There was an explosion…and gunshots.”  “There were two explosions, I did see one orange flare…” “Soon after the bullets stopped, a lot more police showed and an ambulance showed up and about 5-10 minutes after the ambulance showed up, someone was actually getting carried out on a gurney, just wrapped in a white sheet from head to toe. They were clearly deceased.”

Again, it is conceivable, given the time-line, this unnamed white-sheeted body was the one declared dead at 1:06 AM after failed resuscitation attempts.  (An excerpt from Cambridge police scanner traffic at 1:00 AM would seem to confirm the possibility of this timeline. "Control I don't know if you have it, one suspect down on Laurel Street - EMS on site- in custody - still looking for another in the yards.") 

If so, who was the very-much alive man Boston paramedic Mike Sullivan attempted to treat at 1:15 AM in the BLS A14 ambulance with the abdominal evisceration wound, intestines protruding from his body? That man, identified during the ambulance run as Tamerlan Tsarnaev (not later at the hospital) had fought off Sullivan and his partner Sean Murphy’s attempts at medical intervention to treat his non-road rash/blast injuries resulting in gunshot and shrapnel wounds.  Sullivan’s crew collected the man at the corner of Dexter and Arsenal, so he could not have personally observed the actual cross-streets in Watertown where the patient was loaded into the ambulance.

But within those same few blocks in Watertown, another “unrelated” shooting incident had occurred.   One witnessed by a different group of residents, captured on cameras, and reported by Dan Linskey, the Boston officer.  It happened in the vicinity of Adams Street.

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