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Carbon Monoxide (CO) Poisoning: A Cause of Death or A tale of Tales
By
Rockefeller F. Cooper II, MD; MSc, MSP(FS), Cert.-FDI

Dear Readers,
This paper is written so as to address not only the questionable doubts surrounding the death of Mr. Lawrence Gross and Mrs. Shelly Gross but to also evaluate the “preliminary” cause of death from a forensic standpoint which on the contrary was derived rather hastily. Before moving any further, let me begin by extending my sympathy and outmost condolence to the bereaved families of the deceased couple.

Let us begin by understanding the gaseous relationship between carbon monoxide and the human body bearing in mind that oxygen is the gaseous element needed for respiration or in layman’s term, the air needed for us to breathe. When we take in oxygen, it binds to components of the red blood cells known as hemoglobin which serves as the vehicle for transporting oxygen to tissues and vital organs (heart, lungs, brain, etc.) to ensure their viability. In the event where a person inhales carbon monoxide (CO), a “competition” in then set into place between oxygen (O) and carbon monoxide (CO) since they both have an affinity for binding to hemoglobin. However, carbon monoxide (CO) has a higher affinity (250-300 times) for hemoglobin than oxygen. This means, carbon monoxide at a certain level of concentration can easily inhibit the respiratory process and be deemed poisonous since it prevents the availability of oxygen for tissue consumption and eventually, organ supply.

With the above mentioned information, I would now like to proceed in conjunction with reports published by the Daily Observer via allafrica.com (http://allafrica.com/stories/201701030369.html , http://www.liberianobserver.com/news/amid-tension-families-gross-couple-plan-burial ) and Front Page Africa (http://www.frontpageafricaonline.com/index.php/news/2946-liberia-s-minn-couple-saga-report-sources-point-to-death-by-asphyxiation-carbon-monoxide).

Beginning with the Daily Observer’s report, an excerpt from the publication indicated that an unknown family member stated that there were eight (8) people who slept in the house on the unfaithful night of December 24, 2016. However, on the next day; the Gross’s were discovered dead whiles the host (Rev. and Mrs. Charles Larkamah) were found unconscious and transferred for medical attention.

When cross-referencing with the report from Front Page Africa, it is also mentioned that a police source had indicated that a 1.5 KVA Ruina gasoline generator was placed in the garage of the Larkamah’s residence to provide electricity for an air condition that was being installed in the guest room where the couple would have stayed. Contrary to this, as reported by the Daily Observer; Lawrence and Shelly Gross were given the master bedroom that belonging to their host, the Larkamah’s which is also located further down the corridor from the front of the house, where the garage, which houses the generator, is located. This does not coincide with further reports from Front Page Africa’s police source who stated that “the poisonous gas was concentrated in the deceased room which faced directly across the hallway where the inner door to the garage is located and that the windows in the home were air tight which lead to ventilation being very poor”.

In addition to all of the this, the Daily Observer also mentioned that a day (December 24, 2016) after the couple arrived (December 23, 2016), they were invited to dinner at the home of Lawrence’s brother (Lewis) for dinner and upon the couple’s arrival there a little after 8pm until a few minutes past 11pm when the couple were driven back to the Larkamah’s residence where they resided since their arrival in Liberia. On Christmas morning, they were found lifeless on the floor of their room.

Via the Daily Observer’s report, it was mentioned by Mrs. Kemah Larkamah that “upon the arrival of the autopsy team at the residence and prior to their investigation, they had alluded the CAUSE of DEATH to generator smoke, an indication of a premeditated finding". In conjunction to this, the Front Page Africa also reported a family member to have said that “they were informed by Dr. Christopher Chinedu Obiorah, an Anatomical Pathologist from Nigeria, who conducted the autopsies on the remains of Lawrence and Shelly Gross; that he discovered brain swelling in both decedents which is consistent with carbon monoxide inhalation”.

Critical Analysis:

  1. When considering the mechanism of how carbon monoxide (CO) would impact the normal breathing with regards to the information provided above, we can clearly see why the Larkamah’s were found unconscious. Looking at the apparent misinformation presented by the police to Front Page Africa, it was Rev. and Mrs. Larkamah who should have been affected by the exposure to carbon monoxide (CO) since they were in the guest room and closer to the garage and NOT Lawrence and Shelly Gross who were in the master bedroom and further away from the garage.

  2. Was the air condition ever installed in the guest room and if so, was it in use that night? This would have manipulated the concentration of carbon monoxide in the room since there would have been a mixture of carbon monoxide and oxygen being delivered by the air condition.

  3. If the Larkamah’s who were closer to the exposure of carbon monoxide were found unconscious, how is it that:
  • Lawrence and Shelly Gross were not alive and perhaps complaining of headache, dizziness, nausea, vomiting or even losing their consciousness; all of which by the way are symptoms due to carbon monoxide exposure as the concentration starts to increase but not yet sufficient to cause DEATH?

  • The other four (4) occupants did not die?

  1. When was the first time that the 1.5 KVA Ruina gasoline generator in question ever used at the Larkamah’s residence?
  • If it is always in use at the home, has it always been in the garage and if so, has there even been a past incident of carbon monoxide poisoning?

  • Was it perhaps a new generator that was brought in to support the generator that was being installed?

  1. With nothing personal against Dr. Christopher Chinedu Obiorah, this case should have been handled by an individual with a forensic pathology background and not just anatomic pathology.
  • What toxicological testing were done on these decedents?

  •  If any testing were done, which facility was involved and what specimens were used to have derived such a hasty finding of CARBON MONOXIDE POISONING?

  • What supporting facts did the pathologist use to derive a preliminary finding of carbon monoxide poisoning, taking into consideration the time difference between the "time of death" and the "time of the autopsy"?

  • Did Dr. Obiorah analyze the crime scene forensically to support a potential cause of death?

  • Why did Dr. Obiorah focused on carbon dioxide poisoning and not just do a full panel testing considering all the suspicions that were surrounding the case?

  • Does “brain swelling”, normally refer to as cerebral edema defines carbon monoxide poisoning?

  • Death Scene Evaluation:

CREATOR: gd-jpeg v1.0 (using IJG JPEG v62), quality = 75 B.

         Above are pictures showing a frontal view of the Larkamah’s residence where the Lawrence and Shelly Gross met their untimely demise. Looking at the garage gate, it can be clearly see that the garage gate does have an opening through which fumes from the 1.5 KVA Ruina gasoline generator could have escaped. These photographs contradict another portion of the Front Page Africa report from a Police source which stated that “The garage in which the generator was placed did not have an opening for the smoke to exit; thus causing smoke to have circulated in the house and that the poisonous gas was concentrated in the deceased room which faced directly across the hallway where the inner door to the garage is located”.

This interpretation of this photograph should also call to question the concentration of carbon monoxide (CO) that was in the home. Therefore, considering the fact that there is an opening on the garage gate and the fact that the decedents (Lawrence and Shelly) were in the master bedroom, which was probably air-conditioned and not in close proximity to the garage, is it still possible for death due to carbon monoxide poisoning from a mere 1.5 kVA generator to have been related to their demise? If so, why was such poisoning very selective in its action?

  • Looking at other event options in terms of deriving a cause of death, let us look at a critical time line:

  • Lawrence and Shelly arrived in the country December 23, 2016 and had apparently spent the night at the Larkamah’s residence as planned during this particular visit to Liberia.

  • What was the setup of their sleeping arrangement as far the availability of a generator was concerned so as to service an air condition for their use?

  • On December 24, 2016; they went to Lewis’s home for dinner around 8:00 pm and left just an hour to midnight.

  • What did they eat?

  •  What were their physical state from the time they departed Lewis’s home enroute to their place of residence?

  • On the 25th of December, 2016; the couples were discovered dead on the floor of their room.

 

  • If they were actually found dead on their room floor, what may have caused that? Were they trying to get help and then succumbed to their untimely demise?

  • Who facilitated the alteration and staging of the said “death scene” by transferring the bodies from the floor to the bed as seen in the picture above?

  • What were the appearances of those bodies prior to translocation?

  • Which part of the room floor were they positioned?

Conclusion:

As we await a final and comprehensive autopsy report as opposed to the preliminary report which indicated the cause of death as carbon monoxide poisoning, I hope that a full scale forensic analysis would be considered so as to avoid any form of biasness based on the fact that the preliminary finding mentioned is not definitive for carbon monoxide poisoning, especially when there are other clues to consider in this matter.

“Facts are to the mind what food is to the body”.
-Edmund Burke

****Disclaimer:
          This paper expresses the personal and professional views of Dr. Rockefeller F. Cooper II; based on his knowledge and experience in death investigation as it relates to both forensic science and forensic pathology as a whole. These views are also intended to ensure that the family members of the decedents are treated fairly, not left to decipher a game of mystery and to dismiss any potential stigma that may rise against any of the key players in this tragic saga.