Autopsy and Investigative Report of Matthew Perry

Page 1 - Autopsy Summary

Matthew Perry, a $54\,year$-old male, was found deceased. The autopsy ascribes the death to the acute effects of ketamine.

Anatomic Summary:

• No signs of fatal trauma or foul play.
• Focal, moderately severe left anterior descending coronary artery disease.
• Mild cardiomegaly with a $465\,gram$ heart.
• Pulmonary edema and congestion.

Page 2 - Physical Characteristics and External Findings

• Demographics: $70\,inches$ tall, $216\,pounds$, BMI of $31.0$ (mildly obese).
• Skin and External: Mild immersion wrinkling of hands and feet; early nailbed clubbing; yellowing of the right index nail.
• Scars: Multiple abdominal scars, a back scar, and bilateral forearm scars.
• Conditions: Moderately severe aortic atherosclerosis; chronic hepatic congestion; mild splenomegaly.

Page 3 - Evidence of Injury and Medical Intervention

• Intervention: No evidence of recent therapeutic intervention or recent needle punctures.
• Postmortem Changes: Ant activity causing red-brown abrasions on the face; Tardieu spots on the back.
• Injuries: No evidence of fatal injury; only scattered contusions of various ages (green, yellow, brown).
• Neck: Hyoid bone and larynx are intact without fractures.

Page 4 - Cardiovascular Findings

• Aorta: Moderately severe atherosclerosis with plaque calcification.
• Heart: Right ventricle measures $0.5\,cm$ and left ventricle measures $1.2\,cm$.
• Chambers: Left ventricular hypertrophy; valves are competent and thin.

Page 5 - Respiratory and Gastrointestinal Findings

• Lungs: Right lung $700\,grams$, left lung $690\,grams$. Findings include dark parenchyma, moderate fluid, and bullous changes in apical areas.
• Gastrointestinal: Stomach contains approximately $40\,cc$ of green fluid; pancreas shows severe fibrosis with focal calcification.
• Liver: $2020\,grams$; red-brown with a "nutmeg" appearance; consistency is soft.
• Kidneys: Right $185\,grams$, left $200\,grams$. Surface is pitted after capsule stripping.

Page 6 - Genitourinary and Neurological Systems

• Bladder: Contains $15\,cc$ of hazy, yellow urine.
• Brain: Weighs $1530\,grams$. Normal landmarks and distribution of vessels are noted; no aneurysms or significant arteriosclerosis.

Page 7 - Procedures and Toxicological Submission

• Samples: Heart blood, femoral blood, gastric contents, liver, bile, urine, and vitreous submitted for testing.
• Radiology: CT scan performed; results showed no fractures or unusual radiodensities.
• Witnesses: LAPD witnesses were present.

Page 8-9 - Final Medical Opinion and Toxicology Interpretation

Cause of Death: Acute effects of ketamine. Contributory Factors: Drowning, coronary artery disease, and buprenorphine effects. Manner of Death: Accident.

Toxicology Findings:

• Ketamine: Peripheral blood recorded at $3540\,ng/ml$ ($3.54\,mg/L$) and central blood at $3271\,ng/ml$. This is within the range of general anesthesia ($1000-6000\,ng/ml$).
• Buprenorphine: Therapeutic levels detected ($8.0\,ng/ml$) along with its metabolite norbuprenorphine ($17\,ng/ml$).
• Benzodiazepines: Lorazepam and 7-aminoclonazepam (clonazepam metabolite) detected at non-toxic levels.
• Negative Results: Alcohol, methamphetamine, cocaine, heroin, PCP, and fentanyl were not detected.

Conclusion: High ketamine levels caused cardiovascular overstimulation and respiratory depression. Drowning occurred secondary to lapsing into unconsciousness in the pool. The ketamine in his system could not be from his last infusion therapy ($1.5\,weeks$ prior) due to its half-life of $3$ to $4\,hours$.

Page 14 - Microscopic Examination

• Lungs: Diagnosis of emphysema and remote foreign body granulomas containing vegetable/plant material.
• Liver: Chronic hepatic congestion with macrovesicular steatosis.
• Kidneys: Mild to moderate nephrosclerosis.

Page 21-23 - Respiratory Viral Testing

• Results: Nasopharyngeal swab was negative for SARS-CoV-2, Adenovirus, Coronavirus types, Influenza A and B, Parainfluenza, and RSV.

Page 24-29 - Investigative Summary

• Discovery: Found unresponsive in a "stand alone hot tub" (jacuzzi) by his assistant at approximately $16:00\,hours$ on $10/28/2023$ at his residence: 18038 Blue Sail Dr, Pacific Palisades, CA 90272.
• Medical History: History of COPD/emphysema, diabetes, and depression.
• Scene Information: Prescription medications recovered included buprenorphine, tamsulosin, quetiapine, duloxetine, and trazodone. No illicit drugs or drug paraphernalia found.