EPISD Superintendent Gilberto Gonzalez announces Autopsy Report of Michael Sanchez
By: Jose G. Landa, Eagle Pass Business Journal, Inc., Copyright 2015
Almost four months to the date of the tragic death of Eagle Pass Independent School District Glass Elementary School student Michael Sanchez, age 12 years old, on April 24, 2015, who collapsed during physical education class and was resuscitated by school nurses and air-lifted to a San Antonio hospital where he died three days later, Superintendent Gilberto Gonzalez held a press conference on Tuesday, August 25, 2015 to announce the formal findings of the late Michael Sanchez’s Autopsy Report at the district’s central office. Young Michael Sanchez passed away on April 24, 2015 at a San Antonio hospital after succumbing to his health injuries or conditions. The autopsy was performed on Sanchez on April 29, 2015 by the Bexar County Medical Examiners Office.
At the press conference, EPISD Superintendent Gilberto Gonzalez expressed his deepest condolences to the family of young Michael Sanchez for their sudden and tragic loss. Gonzalez did not invite nor advised young Michael Sanchez’s mother of his press conference regarding the public announcement of her son’s Autopsy Report.
Gonzalez stated “I just received yesterday some information on the autopsy of our student, Michael Sanchez, from Glass Elementary. As you recall, this was a tragic incident that happened last school year on April 24,2015 where it was very unfortunate that Mr. Sanchez had what has been determined by the autopsy, and that Texas Ranger Jose Sanchez who did the investigation, that the medical examiner’s report concluded that Michael Sanchez died as a result of complications of a probable cardiac arrhythmia (irregular heartbeat) of undetermined natural cause. No evidence of trauma which could have caused or contributed to death was identified.”
Gonzalez added that “After reviewing exhibit 14.1 the autopsy the manner of death was recorded as natural. With this last piece of information, the Texas Ranger informs me that the case is closed. It is very unfortunate for the family and again we offer our condolences. As Superintendent you never want something like this to happen in the district and it’s a tragic loss for everyone.”
Gonzalez’s announcement seemed to imply that the Eagle Pass Independent School District and its employees were not liable for any negligence resulting in the death of young Michael Sanchez, although the Autopsy Report does not address this issue except the probable medical causes of death of the young student. Gonzalez noted that Texas Ranger Sanchez had closed his investigation of any alleged wrongdoing as a result of the Autopsy Report.
Gonzalez was asked if the Eagle Pass Independent School District had implemented any policies to assure that similar situations or incidents with district students do not reoccur.
Gonzalez replied that “The cause of death by my understanding was a condition that the student already had. As far as policies and procedures, of course, we have reviewed the policies, we have reviewed procedures for whenever an incident like this happens, just to be on the safe side. We do have CPR classes for our employees and in addition what we have purchased this year is defibrillators so that all our campuses have those. But, again I have to emphasize by the information that was determined by the medical examiner, this was a pre-existing condition that the student already had.”
Gonzalez was questioned by a press member: “Do all Physical Education Instructors have CPR certification?
Gonzalez responded: “Yes they do. They’re also trained in the defibrillator, this year.”
Gonzalez noted the importance of medical exams of students be done, and if the parent knows of any possible pre-existing health problems of their children to please advise that type information to the director of their school to assure the safety of every child within the Eagle Pass Independent School District.
The Eagle Pass Business Journal was provided a courtesy copy of the Autopsy Report by the mother of young Michael Sanchez and authorized this newspaper to publish its findings.
A review of the Bexar County Medical Examiners Autopsy Report under an external examination of the body of Sanchez determined that there was no evidence of injury under Evidence of Medical Intervention and Tissue Recovery; the remainder of the external examination of the body.
Under the internal examination portion of the autopsy performed on Sanchez revealed that under an inspection of the remaining organs in-situ reveals no anatomic abnormalities.
The Cardiovascular Autopsy report states that “the 280 gram heart appears normal in shape and configuration. The coronary arteries arise normally and are free of significant atherosclerosis. A 4 cm segment of the left anterior descending artery passes intramuscularly in the anterior left ventricular and septal wall, beginning approximately 1 cm distal to the bifurcation of the left main coronary artery. Sectioning reveals smooth endocardium and dark red and firm myocardium with focal areas of hyperemia within the papillary muscles and sub endocardial left ventricular myocardium. The cardiac valves are normally formed grossly unremarkable. No ventricular septal defect is identified. The aorta is free of significant atherosclerosis.”
Grossly unremarkable in medical terms means that viewing the organ/biopsy/structure/whatever with bare eyes (and maybe hands too) didn’t reveal anything out of the ordinary.
Atherosclerosis (ath-er-o-skler-O-sis) is a disease in which plaque (plak) builds up inside your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body. Atherosclerosis disease limits the flow of oxygen-rich blood to your organs and other parts of your body.
The lung report reveals “soft parenchyma without discrete mass lesions, prominent congestion or edema. The pulmonary vessels are unobstructed.”
The Alimentary, Endocrine, Lymphoreticular, Genitourinary, Systems reports all found those areas had no significant abnormalities and unremarkable.
The Microscopic System report shows “no significant atherosclerosis of the intramuscular left anterior descending artery and is surrounded by adipose (body fat) and loose connective tissue. Extensive areas of grossly evident subendocardial and papillary muscle myocardial necrosis appear microscopically as eosinophilic myocytes with loss of nuclei, interspersed hemorrhage and dense zones of acute inflammatory cells. Within the central portions of the myocardium, there are abundant foci of acute inflammation and macrophages without clear evidence of myonecrosis. The region of the atrio- ventricular node reveals no significant histopathological alterations, aside from the subendocardial charges noted above throughout the rest of the heart. No evidence of myocyte disarray, significant myocyte hypertrophy, or vasculitis is found.”
“The brain had cortical rarefaction with shrunken and eosinophilic neurons containing pyknotic nuclei. No evidence of vasculitis or meningitis.”
Under the findings portion of the autopsy it was noted that “the subject had a clinical history of sudden collapse and resuscitation; absent clinical evidence of prolonged QT syndrome; no clinically identified structural heart abnormalities; negative hospital toxicology screening, Anoxic encephalopathy (encephalopathy is a condition where brain tissue is deprived of oxygen and there is global loss of brain function. The longer brain cells lack oxygen, the more damage occurs), Marked diffuse cerebral edema (a swelling in the brain caused by the presence of excessive fluid), Pneumonia, clinical history of prior syncopal episode (fainting), September 2014, a. Negative workup for underlying cause, Acute myocardial ischemic changes consistent with history of cardiac arrest and resuscitation.”
QT syndrome (LQTS) is a rare inherited or acquired heart condition in which delayed repolarization of the heart following a heartbeat increases the risk of episodes of torsades de pointes (TdP, a form of irregular heartbeat that originates from the ventricles).
Myocardial ischemia occurs when blood flow to your heart is reduced, preventing it from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart’s arteries.
The conclusion portion of the autopsy performed on Michael Sanchez states that “after a complete autopsy examination, including histologic examination and review of available investigative information including medical records it is the opinion of the Bexar County Medical Examiner’s office that Michael Sanchez died as a result of complications of a probable cardiac arrhythmia (irregular heartbeat) of undetermined natural cause. The decedent reportedly suddenly collapsed while at school. He was resuscitated and subsequently survived in hospitals for approximately three days. During his hospitalization, an inciting condition for the arrhythmia was not identified. At autopsy, changes related to the lack of blood flow to the heart during the decedent’s cardiac arrest were identified, and a segment of a major coronary artery was noted to be bridged by myocardial fibers (heart muscles) myocardial bridging of coronary arteries has been associated myocardial ischemia and sudden death. However, many such myocardial bridges do not produce clinical symptoms and may be discovered incidentally at autopsy, the significance of this finding is therefore uncertain. Findings of cerebral edema and pneumonia are likely related to the decedent’s anoxic brain injury and prolonged ventilator dependency. Definite exclusion of drug toxicity as contributory to death was not possible; although hospital toxicology screening did not reveal the presence of drugs, this testing is not reliable and because of the decedent’s prolonged hospitalization, toxicology analysis of postmortem blood was not performed. No evidence of trauma, which could have caused or contributed to death, was identified.”
The Autopsy report concludes by stating that the manner of death to be determined as natural.
The tragic death of young Michael Sanchez raises many questions regarding the policies and procedures which Texas public school systems such as the Eagle Pass Independent School District need to have in place concerning the health conditions of students, the training required of public school employees regarding CPR and use of Defibrillators such as in the case of Texas Senate Bill 7 passed in 2007 http://www.legis.state.tx.us/tlodocs/80R/billtext/html/SB00007F.htm , notice of pre-existing conditions, and the physical education curriculum implemented in public school districts. Let us never forget young Michael Sanchez and may his tragic death not be in vain.
