A coroner's report on Otto Warmbier cannot determine what caused his brain damage
Warmbier's parents declined a full autopsy, which may have offered additional details
Details surrounding Otto Warmbier, the 22-year-old American student who died in June after being detained in North Korea for 17 months, were released this week by the Hamilton County Coroner’s office in Ohio.
The report – an external examination, not an autopsy – describes a 4.3-by-1.6-inch scar on Warmbier’s right foot. Parents Fred and Cindy Warmbier mentioned this scar during an interview with CNN’s Brooke Baldwin on Tuesday, when they broke their three-month silence.
“How do you get a scar that covers the entire top of your foot?” Cindy Warmbier asked. “(The coroner) said it had to be an open wound for months and months and months.”
The coroner’s report did not include this last detail. It describes a number of smaller scars, but does not contain details as to what caused them or how long they had been there.
The report also offers information that seemingly conflicts with his parents’ account.
“His bottom teeth look like they had taken a pair of pliers and rearranged them,” Fred Warmbier said. However, the coroner’s report says, “the teeth are natural and in good repair.”
Hamilton County Coroner Dr. Lakshmi Kode Sammarco addressed the discrepancy, speaking at a news conference Wednesday. She said her team, which included a forensic dentist, evaluated Warmbier’s body as well as various scans of his body.
“I felt very comfortable that there wasn’t any evidence of trauma” to the teeth or jawbone, Sammarco said. “We were surprised at (the parents’) statement.”
Fred Warmbier told CNN on Wednesday the family will not be commenting further.
A North Korean Foreign Ministry spokesman on Thursday denied that Warmbier was tortured while in North Korean custody, according to a report by the country’s state-run news agency KCNA.
On Tuesday, Warmbier’s parents described what they saw when they approached the plane that returned their son in June.
“We weren’t prepared for this at all,” said Cindy Warmbier. “No one had any idea, going in there, what we were going to see.”
“Halfway up the stairs, we hear this loud, guttural, howling, inhuman sound. We don’t know what it is,” Fred Warmbier said. “He’s strapped to the stretcher, and he’s moving around and jerking violently, making these howling, inhuman sounds.”
Warmbier’s eyes were darting around, “as big as saucers,” his father said. His head was shaved, and he had a feeding tube in place.
His hands and legs were “totally deformed,” Cindy Warmbier said. The coroner’s report describes abnormal flexing of the arms and legs, which it attributes to severe brain damage from not getting enough oxygen.
In June, doctors at the University of Cincinnati Medical Center described his state as “unresponsive wakefulness,” a product of this brain damage.
For people in this condition, “their eyes may be open, they may be blinking, they may be even looking around, but they have no awareness of their surroundings,” CNN’s Chief Medical Correspondent Dr. Sanjay Gupta said in June. Gupta has not reviewed Warmbier’s medical records.
“There’s nothing that is voluntary in terms of movements, even though their eyes are open,” Gupta added. “Some refer to it as a persistent vegetative state.”
The coroner’s report lists the cause of death as an “unknown insult more than a year prior to death” and the complications of his brain injury. An MRI from April 2016 provided by North Korea showed brain damage that doctors suspected to be weeks old at that point, Gupta said.
Dr. Daniel Kanter, one of Warmbier’s doctors and director of UC Health’s Neurocritical Care Program, said brain scans in June showed “extensive loss of brain tissue in all regions of the brain” but no evidence of a skull fracture. CT scans of the body similarly showed no evidence of recent or healing bone fractures, Kanter said in June when asked if there were any signs of trauma or injuries.
Sammarco said on Wednesday that the post-mortem examination found no obvious signs of torture.
Questions continue to swirl around how this happened – and specifically, what happened to him in North Korean custody. On the coroner’s report, Warmbier’s manner of death is listed as “undetermined.”
‘Otto is at peace’
Fred Warmbier alleged on Tuesday that “Otto was systematically tortured and intentionally injured” by Kim Jong Un’s regime. “This was no accident.”
However, Warmbier’s parents declined a full autopsy.
“The family’s objection to an autopsy was honored, and only an external examination was performed,” the coroner’s office said in a statement in June.
“I think it’s a terrible mistake” not to perform an autopsy, Dr. Cyril Wecht, a prominent forensic pathologist who was not involved in Warmbier’s case, previously told CNN. “If you have something that could be anything other than a natural death, you’re obligated to do an autopsy.”
Still, Wecht said it would be difficult to determine what caused Warmbier’s brain damage, especially in someone who had been that way for such a long time.
It could have been any number of things that prevented sufficient oxygen from reaching the brain, Wecht said, including strangulation, suffocation, medication or a botched suicide attempt. Sammarco said that either blood wasn’t getting to the brain, or Warmbier wasn’t breathing, but her examination could not draw concrete conclusions.
“One of a few things likely happened here – and we may never know, especially if there’s no autopsy,” Gupta, who is also a member of the American College of Forensic Examiners and a practicing neurosurgeon, said in June.
Sammarco said that her team discussed a potential autopsy.
“We felt like nothing was going to be gained from an autopsy, and we honored the family’s wishes,” Sammarco said on Wednesday.
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Warmbier’s parents, when asked on Tuesday why they refused an autopsy, said that they wanted the ordeal to be put to rest.
“Otto and our family have been through enough. Enough,” Fred Warmbier said.
“Otto is at peace, and it’s about time.”
CNN’s Ben Tinker contributed to this report.