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Case 2:17-cv-04565-DLR Document 382-13 Filed 11/30/21 Page 1 of 11
SA INT LOU IS 

U N IVER SITY 

Karen Stillwell 

O'Connor and Dyet 

7955 South Priest Drive 

Tempe, AZ 85284 

Dear Ms. Stillwell: 

1402 South Grand Hlvd. RS 17 

St. Louis, MO 6.'I 10~ 

Phom· .114-977-784 1 

Fax .l 14-977-7843 

www.slt1.cd11 

Division of Forensic P:itholog)' 

Dt\par1rne111 of l'atholo1w 

School of Medicine 

September 20, 2020 

At your request I reviewed records (including photographs, video and audio) 

and microscopic slides pertaining to Muhammad Muhaymin (DOB-). 

My opinions are based upon my education, training and experience. My 

opinions are stated to a reasonable degree of medical certainty unless otherwise 

specified. My general opinions regarding deaths temporally related to law 

enforcement apprehension and representative scientific literature forming the 

bases of these opinions can be found in the following scientific article, including the 

scientific literature cited in this publication (Graham MA, Investigation of Deaths 

Temporally Associated with Law Enforcement Apprehension, Acad Forensic Pathol 

2014: 4(3): 366-389). A copy of my curriculum vitae and a list of testimony I have 

given as a consultant accompany this report. My professional.time is compensated 

at $500/hour plus expenses. 

The information available for my review includes: 

• Order regarding Stipulated Protective Order 

• Confidentiality Agreement 

• Plaintiffs First Amended Complaint 

• Body Camera Video from Officer Grenier {COP 000001) 

• Body Camera Video from Officer Hobel {COP 000002) 

• Body Camera Video from Officer Hobel (COP 000003) 

• Body Camera Video from Officer Canilao (COP 000004) 

• Body Camera Video from Officer Head (COP 000005) 

• Body Camera Video from Officer Head (COP 000006) 

• Body Camera Video from Officer McGowan (COP 000007) 

• Body Camera Video from Officer Nielsen (COP 000008) 

• Body Camera Video from Officer Nielsen (COP 000009) 

• Body Camera Video from Officer Nielsen (COP 000010) 

Case 2:17-cv-04565-DLR Document 382-13 Filed 11/30/21 Page 2 of 11
Karen Stillwell 

September 20, 2020 

Re: Muhammad Muhaymin 

Page 2 

• Body Camera Video from Officer Aker (COP 000011) 

• Body Camera Video from Officer Clark (COP 000012) 

• Body Camera Video from Officer Miller (COP 000013) 

• Phoenix Police Department Incident Report (COP 000014-000238) 

• Recorded interview of Anthony Tarango (COP 000251) 

• Recorded interview of Anthony Williamson (COP 000252) 

• Recorded interview of Arizona Smith (COP 000253) 

• Recorded interview of David Head (COP 000254) 

• Recorded interview of Dennis Leroux (COP 000255) 

• Recorded interview of Dennis Leroux (COP 000256) 

• Recorded interview of Everett Baeza (COP 000257) 

• Recorded interview of Hannah Glemba (COP 000258) 

• Recorded interview of Jason Hobel (COP 000259) 

• Recorded interview of Jimmy Yee (COP 000260) 

• Recorded interview of Juan Lara (COP 000261) 

• Recorded interview of James Clark (COP 000262) 

• Recorded interview of Kevin McGowan (COP 000263) 

• Recorded interview of Mark Aker (COP 000264) 

• Recorded interview of Murray Williamson (COP 000265) 

• Recorded interview of Oswald Grenier (COP 000266) 

• Recorded interview of Ronalda Canilao (COP 000267) 

• Recorded interview of Ryan Nielsen (COP 000268) 

• Recorded interview of Steven Wong (COP 000269) 

• Recorded interview of Susan Heimbigner (COP 000270) 

• Recorded interview of Tonya Davis (COP 000271) 

• Recorded interview of Tonya Davis (COP 000272) 

• Recorded interview ofTonya Davis (COP 000273) 

• Transcript of Anthony Williamson's Recorded Interview (COP 012054-012076) 

• Transcript of Antonio Tarango's Recorded Interview (COP 012077-012156) 

• Transcript of Arizona Smith's Recorded Interview (COP 012157-012183) 

• Transcript of David Head's Recorded Interview (COP 012184-012206) 

• Transcript of Dennis Leroux' Recorded Interview (COP 012272-012278) 

• Transcript of Dennis Leroux' Recorded Interview (COP 012279-012295) 

• Transcript of Everett Baeza's Recorded Interview (COP 012335-012350) 

• Transcript of Hannah Glemba's Recorded Interview (COP 012351-012387) 

• Transcript of James Clark's Recorded Interview (COP 012388-012407) 

• Transcript of Jason Hobel's Recorded Interview (COP 012445-012481) 

• Transcript of Jimmy Yee's Recorded Interview (COP 012541-012572) 

• Transcript of Juan Lara's Recorded Interview (COP 012573-012603) 

• Transcript of Kevin McGowan's Recorded Interview (COP 012604-012622) 

• Transcript of Mark Aker's Recorded Interview (COP 012671-012695) 

• Transcript of Matt Murray's Recorded Interview (COP 012696-012709) 

• Transcript of Oswald Grenier's Recorded Interview (COP 012710-012751) 

Case 2:17-cv-04565-DLR Document 382-13 Filed 11/30/21 Page 3 of 11
Karen Stillwell 

September 20, 2020 

Re: Muhammad Muhaymin 

Page 3 

• Transcript of Ronaldo Canilao's Recorded Interview (COP 012817-012872) 

• Transcript of Ryan Nielsen's Recorded Interview (COP 012951-012967) 

• Transcript of Steven Wong's Recorded Interview (COP 013025-013065) 

• Transcript of Susan Heimbigner's Recorded Interview (COP 013115-013131) 

• Transcript of Tonya Davis' Recorded Interview (COP 013189-013219) 

• Transcript of Tonya Davis' Recorded Interview (COP 013220-013225) 

• Transcript of Tonya Davis' Recorded Interview (COP 013226-013236) 

• Medical Examiner's Autopsy Report & Toxicology Report (COP 003356-003370) 

• X-rays taken by medical examiner (COP 003377) 

• Photos taken of items received at autopsy (COP 000886-000926) 

• Photos taken of autopsy and scene (COP 000927-001274) 

• Records from Phoenix Fire Department (COP 013882-013892) 

• Records from Abrazo Community Health (COP 014724-015221) 

• Records from Terros (COP 015222-015398) 

• Records from Community Bridges Integrated Medical Group (COP 013893-013918) 

• MCC Video 1 (COP 000274) 

• MCC Video 2 (COP 000275) 

• MCC Video 3 (COP 000276) 

• MCC Video 4 (COP 000277) 

• Deposition of Defendant Antonio Tarango 

• Deposition of Defendant Officer Oswald Grenier 

• Deposition of Defendant Officer Jason Hobel 

• Deposition of Defendant Officer Ronalda Canilao 

• Deposition of Defendant Officer David Head 

• Deposition of Defendant Officer Susan Heimbigner 

• Deposition of Defendant Officer Ryan Nielsen 

• Deposition of Defendant Officer James Clark 

• Deposition of Defendant Sgt. Steven Wong 

• Deposition of Witness Andy Damiano 

• Deposition of Witness Jimmy Yee 

• Deposition of Witness Arizona Smith 

• Deposition of Mussa lina Muhaymin 

• Deposition of Muhammad Muhaymin 

• Deposition of-Muhaymin 

• Deposition of Sgt. James Ward 

• Deposition of Detective Jemima Schmidt 

• Deposition of Dr. Amanda Maskovyak 

• Recorded interview of Dennis Leroux (COP 010809) 

• Recorded interview of David Head (COP 010810) 

• Recorded interview of James Clark (COP 010811) 

• Recorded interview of Jason Hobel (COP 010812) 

• Recorded interview of Kevin McGowan (COP 010813 

• Recorded interview of Oswald Grenier (COP 010814) 

Case 2:17-cv-04565-DLR Document 382-13 Filed 11/30/21 Page 4 of 11
Karen Stillwell 

September 20, 2020 

Re: Muhammad Muhaymin 

Page 4 

• Recorded interview of Ronalda Canilao (COP 010815) 

• Recorded interview of Ryan Nielsen (COP 010816) 

• Recorded interview of Susan Heimbigner (COP 010817) 

• Recorded interview of Steven Wong (COP 010818) 

• PSB Investigation File (COP 010819-011008) 

• Use of Force Results (COP 011009 and COP 010501.1) 

• PSB COR Affidavit and Summary (COP 011010-011021) 

• Transcript of David Head's recorded interview (COP 012207-012271) 

• Transcript of Dennis Leroux' recorded interview (COP 012296-012334) 

• Transcript of James Clark's recorded interview (COP 012408-012444) 

• Transcript of Jason Hobel's recorded interview (COP 012482-012540) 

• Transcript of Kevin McGowan's recorded interview (COP 012623-012670) 

• Transcript of Oswald Grenier's recorded interview (COP 012752-012816) 

• Transcript of Ronalda Canilao's recorded interview (COP 012873-012950) 

• Transcript of Ryan Nielsen's recorded interview (COP 012968-013024) 

• Transcript of Steven Wong's recorded interview (COP 013066-013114) 

• Transcript of Susan Heimbigner's recorded interview (COP 013132-013188) 

• Letter from Maricopa County Attorney (COP 3371) 

• Plaintiff's Notice of Claim (COP 3372-3376} 

• 148 photos taken by the Medical Examiner (COP 3378-3525) 

• Incident Report prepared by Antonio Tarango (COP 11239-11246) 

• Phoenix Police Department's Operations Orders (COP 11449-11508) 

• Memo sent to Antonio Tarango (COP 11509} 

• Notice of Inquiry to Antonio Tarango January 2017 (COP 11510-11513) 

• Notice of Inquiry to Antonio Tarango February 2017 (COP 11514-11517) 

• Brochure on Disability Issues (COP 11518-11519) 

• Statement prepared by Hannah Glemba re Sept 2016 (COP 11520) 

• Statement prepared by Hannah Glemba re Jan. 2017 (COP 11521) 

• Notice of Inquiry/Interview to Hannah Glemba (COP 11522-11523) 

• Documents from Maricopa County Correctional Health Services (COP 11932-12022) 

• Phoenix Police Department's Operations Order regarding Use of Force 2019 (COP 

13919-13942) 

• Mesa Police Department Report (COP 15399-15407) 

• Phoenix Police Department's Operations Order regarding Purpose Statement (COP 

15676-15677) 

• Abrazo Maryvale Hospital Incident Report (COP 15680-15683) 

• Maricopa County Animal Care & Control Report (COP15684-15687) 

• Statements from Joshua Govan and Isabel Silvas (COP 15688-15693} 

• Statements from MCC Employees (COP 15694-15701) 

• Tox Run Sheet from Medical Examiner (COP 15702-15757) 

• Expert Report of Scott De Foe with CV, Fee Schedule, Testimony List 

• Expert Report of Dr. Bennet Omalu with CV, Fee Schedule, Testimony List 

• Expert Report of Dr. Gary Vilke with CV, Fee Schedule, Testimony List 

Case 2:17-cv-04565-DLR Document 382-13 Filed 11/30/21 Page 5 of 11
Karen Stillwell 

September 20, 2020 

Re: Muhammad Muhaymin 

Page 5 

• Expert Report of Greg Meyer with CV, Fee Schedule, Testimony List 

In addition, I reviewed microscopic slides containing tissues sampled during the 

autopsy. A set of tissue slides (7 slides) was prepared by The Maricopa County 

Office of the Medical Examiner and a set (39 slides) was prepared by Dr. Omalu. 

My Summary of Incident Based on Review of Records 

Mr. Muhaymin's medical history includes schizophrenia, PTSD and acute 

claustrophobia. On 1/4/17 he entered the Maryvale Community Center with his pet 

dog. Personnel at the community center were familiar with Mr. Muhaymin and his 

dog because of previous interactions. He was reportedly verbally confrontational on 

1/4/17 and his dog was unrestrained. Mr. Tarango, a community center employee, 

requested that Mr. Muhaymin leave the premises. Mr. Muhaymin reportedly 

became agitated and indicated he needed to use the restroom. Mr. Tarango stopped 

him from entering the restroom because the dog was not leashed. Mr. Muhaymin 

attempted to get by Mr. Tarango and bumped him in the process. The Phoenix 

Police Dept. was called to respond to an "assault" (the bumping incident). An officer 

arrived circa 5 minutes later and additional officers arrived circa 5 minutes after the 

arrival of the first officer. Mr. Muhaymin was eventually allowed to use the 

restroom. While he was in the bathroom (circa 5 minutes), one of the police officers 

was informed via radio that Mr. Muhaymin had an outstanding warrant. Mr. 

Muhaymin was escorted from the building after he had exited the restroom. After 

leaving the building he was told by officers to stop, that he was being arrested 

because of the outstanding warrant and told to let go of the dog and put his hands 

behind his back. Mr. Muhaymin refused to release the dog. A struggle ensued 

between Mr. Muhaymin and the officers. He was taken to the ground and his hands 

cuffed behind him within 1-2 minutes. The officers had difficulty securing the 

handcuffs. Mr. Muhaymin was speaking after he was handcuffed. Police officers 

were breathing hard. Within circa a minute Mr. Muhyamin got to his feet and was 

vocalizing. He was led to a police vehicle where officers intended to search him. He 

continued to offer resistance when walking to the police vehicle. While being 

searched at the police vehicle his arms were raised upward to allow search of the 

pocket area and he was able to move his hands from behind him to the front of his 

body. He continued to struggle against the officers. He was taken to the ground and 

struggled against the officers as they tried to uncuff then recuff Mr. Muhaymin. 

Within a minute he said that he "can't breathe" while he was actively vocalizing and 

struggling. He was lying on his left side. His upper extremities were being held. He 

reportedly was attempting to turn himself over by rolling his hips. Additional 

officers arrived to offer assistance. Officer Head was holding Mr. Muhaymin's legs 

and Officer Hobel was holding the waist. Another officer subsequently helped hold 

Case 2:17-cv-04565-DLR Document 382-13 Filed 11/30/21 Page 6 of 11
Karen Stillwell 

September 20, 2020 

Re: Muhammad Muhaymin 

Page 6 

the waist. An officer had a knee against Mr. Muhaymin's shoulder blade area as Mr. 

Muhaymin continued to resist. The officer's foot was on the ground at this time. 

Officers managed to get Mr. Muhaymin's hands behind him but had to cut a rope 

bracelet from his right wrist prior to securing the handcuffs. His ankles were 

secured and the two sets of restraints connected. After Mr. Muhaymin was 

restrained the officers got up from the ground and Mr. Muhaymin suddenly went 

limp and regurgitated. Officer Clark indicated that Mr. Muhaymin struggled 

throughout the encounter until his ankles were secured. Mr. Muhaymin was 

described as displaying surprising strength. After Mr. Muhaymin regurgitated the 

restraint was removed and resuscitative efforts, including CPR, were instituted. 

EMS was called and continued resuscitative efforts. The initial cardiac "rhythm" 

recorded by EMS was asystole. He was transported to a hospital where 

resuscitative efforts were noted to be unsuccessful and he was pronounced dead. A 

postmortem examination was performed by Dr. Amanda Maskovyak at the Maricopa 

County Office of the Medical Examiner. 

Summary of Dr. Maskovyak's Postmortem Examination, Results of Laboratory 

Testing and Opinions 

The postmortem examination report (17-95) indicates that Mr. Muhaymin 

was 67 inches long and weighed 164 pounds. No conjunctiva! petechiae were noted. 

There were scattered abrasions and contusions. Bilateral fractures of parasternal 

and anterolateral ribs were associated with mild hemorrhage and were attributed to 

CPR. 

The heart weighed 325 grams. A 20 mm long segment of the proximal left 

anterior descending coronary artery tunneled within the myocardium (1 mm deep). 

Atherosclerotic narrowing ( 40-50%) of the left anterior descending artery was 

present. Microscopic examination of the heart demonstrated patchy myofibers with 

enlarged nuclei, acidophilia, interstitial fibrosis and perivascular fibrosis. 

Thick small blood vessels were noted in the kidneys. 

Toxicological analysis of iliac blood demonstrated the presence of 

methamphetamine (0.81 mg/L) and amphetamine (0.24 mg/L). No other 

potentially toxic agents were identified. Chemical analysis of vitreous fluid 

indicated Sodium-164 mmol/L, Potassium-12 mmoljL, Chloride-127 mmol/L, 

Urea Nitrogen-17 mg/dl, Creatinine-0.7mg/dl and glucose-14 mg/dl. 

Dr. Maskovyak reviewed law enforcement incident reports and viewed body 

camera videos. 

Case 2:17-cv-04565-DLR Document 382-13 Filed 11/30/21 Page 7 of 11
Karen Stillwell 

September 20, 2020 

Re: Muhammad Muhaymin 

Page 7 

The cause of death was opined as being cardiac arrest in setting of coronary 

artery disease, psychiatric disease, acute methamphetamine intoxication and 

physical restraint during law enforcement subdual. The manner of death was 

certified as homicide. 

Opinions of Retained Experts 

A number of persons retained as experts have reviewed pertinent 

information and offered a variety of observations and opinions about this matter. 

Included among the reports that I have reviewed are those of physicians Dr. Vilke 

( emergency medicine) and Dr. Omalu (forensic pathology). Areas of concordance 

and disagreement between their observations/opinions and mine can be 

ascertained and more fully explored from reading my observations and opinions as 

discussed in other portions of this report. 

Dr. Vilke Report: 

Dr. Vilke opines that Mr. Muhaymin died due to toxic effects of 

methamphetamine and continued exertion and resistance causing physiologic stress 

on an abnormal heart. Cardiac abnormalities that he cites are coronary artery 

disease and the tunneled coronary artery. He indicates that death was likely 

precipitated by a cardiac event. 

He indicates that methamphetamine, agitation and physical resistance 

increase oxygen demand and acidosis. It is noted that acidosis increases myocardial 

irritability. 

He indicates that although Mr. Muhaymin stated that he "can't breathe" he 

was, in fact, able to breath as indicated by yelling loudly and moving air. Dr. Vilke 

indicates that the videos demonstrate weight intermittently placed on Mr. 

Muhaymin's upper back during the re-handcuffing and that the restraint did not 

limit ventilation and cause asphyxia. He indicated that Mr. Muhaymin was yelling, 

grunting and physically resisting until circa up to or less than a minute prior to 

vomiting. 

Dr. Omalu Report: 

Dr. Omalu supplemented the 7 microscopic tissue slides prepared by the 

medical examiner. He prepared and examined 39 additional tissue samples. He 

reports seeing scattered hypertrophic left ventricular myofibers, multifocal 

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Karen Stillwell 

September 20, 2020 

Re: Muhammad Muhaymin 

Page 8 

myocytolysis with way fibers and acidophilia and focal contraction band necrosis. 

He described hypoxic changes in the brain that he attributes to restraint. 

He further indicates that the drug concentration identified in Mr. Muhaymin's 

blood reflects chronic use ( and its accompanying tolerance) and postmortem 

redistribution. He opines that the methamphetamine in Mr. Muhaymin's blood was 

not forensically significant. 

Dr. Omalu indicates that compression of Mr. Muhaymin's trunk and body led 

to compression of vital plexuses and nerves. He further indicates that "high 

traumatic stressor" led to gastroesophageal sphincter relaxation with consequent 

vomiting and aspiration. 

It is Dr. Omalu's opinion that the underlying cause of death is mechanicalpositional asphyxiation. He opines that the "compression of his head, neck, trunk 

and extremities by multiple police officers while he laid prone on the hard ground 

for a cumulative period of 10 minutes ... precipitated relaxation of his gastroesophageal sphincter, which precipitated vomiting, which resulted in massive 

aspiration of gastric contents, which aggravated mechanical-positional asphyxiation 

by mechanic obstruction of the airways, which resulted in asphyxia brain injury and 

sudden death." 

My Forensic Observations and Opinions 

I reviewed the microscopic slides containing tissues sampled during the 

autopsy. One set of slides (7) was prepared by the Maricopa County Office of the 

Medical Examiner and the other set (39) was prepared by Dr. Omalu. Sections of the 

heart ( right ventricle, left ventricle, AV node/HIS bundle, SA node, valve) 

demonstrate a focus of subendocardial fibrosis that appears to involve a papillary 

muscle. A papillary muscle tip has focal fibrosis and calcification. Sections of lung 

demonstrate agonal orogastric aspiration. The features of the other tissues are noncontributory. 

Based on the available information it is my opinion to a reasonable degree of 

medical certainty that Mr. Muhaymin died of cardiac asystole precipitated by 

marked agitation and physical exertion on a background of methamphetamine use 

and schizophrenia. Agitation ( associated with increased catecholamines), 

methamphetamine/amphetamine and strenuous exertion (with accompanying 

acidosis) each increase myocardial irritability. Methamphetamine use and 

schizophrenia are each associated with an increased risk of sudden death. I have 

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Karen Stillwell 

September 20, 2020 

Re: Muhammad Muhaymin 

Page 9 

observed multiple decedents who died suddenly in the context of a scenario similar 

to that displayed by Mr. Muhaymin. 

It is my opinion that Mr. Muhaymin did not die of asphyxia and that the 

observed features leading up to and culminating in Mr. Muhaymin's death were not 

those of lethal asphyxia. Death due to asphyxia is associated with prolonged 

unremitting unconsciousness that eventually leads to death. Mr. Muhaymin's 

history of actively struggling with sudden cessation of activity and essentially 

instantaneous death is not a death sequence characteristic of asphyxia but is a 

common sequence of events during a death due to sudden cardiac dysfunction. 

Most cases of cardiac sudden death are related to the onset of a non-perfusing 

cardiac rhythm disturbance and do not involve myocardial infarction. Even when 

cardiac ischemia precipitates the rhythm disturbance, myocardial infarction is 

usually not present. Dr. Omalu inaccurately indicates that the medical examiner 

attributed Mr. Muhaymin's death to coronary artery disease. Actually, the medical 

examiner opined that coronary artery disease was a factor in causing death but did 

not indicate that "the cause of death" was solely coronary artery disease. 

The presence ofmethamphetamine/amphetamine in Mr. Muhaymin's blood 

indicates he used methamphetamine (the amphetamine is most likely present as a 

metabolite of the methamphetamine ). While I agree with Dr. Omalu that the 

significance of the methamphetamine cannot be determined by solely looking at the 

amount of methamphetamine in the blood, an opinion about its significance ( or lack 

thereof) may be formulated by interpreting the methamphetamine in the context of 

the case details and the current scientific literature. Methamphetamine is generally 

recognized as being a cause of agitation, erratic behavior, apparent enhanced 

strength and sudden death. Based on the available information, any statement 

about Mr. Muhaymin's methamphetamine tolerance or lack thereof is speculative. 

Regurgitation is a very common agonal or postmortem event. The coinciding 

of Mr. Muhaymin's sudden cessation of the struggling, loss of consciousness and 

regurgitation marks the onset of cardiac arrest and not some direct effect of 

compression. I am not aware of any scientific literature supporting Dr. Omalu's 

contention that the gastroesophageal sphincter relaxed due to "high traumatic 

stressor levels." 

Dr. Omalu indicates that compression of the trunk and body can cause 

compression of vital plexuses and nerves resulting in decreased respiration and 

hypotension. I am not aware of any scientific support that restraint of the type Mr. 

Muhaymin experienced is associated with such dysfunction. 

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Karen Stillwell 

September 20, 2020 

Re: Muhammad Muhaymin 

Page 10 

Lastly, Dr. Omalu reports that he observed hypoxic changes in the brain and 

that these were attributable to restraint-related asphyxia. He does not discuss how 

he distinguishes these changes from hypoxic-ischemic damage to the brain 

consequent to Mr. Muhaymin's documented cardiopulmonary arrest and the 

subsequent resuscitation effort. 

Summary 

It is my opinion to a reasonable degree of medical certainty that Mr. 

Muhaymin's death was caused by marked agitation and physical exertion coupled 

with schizophrenia and methamphetamine use. It is my opinion to a reasonable 

degree of medical certainty that Mr. Muhaymin's death was not caused or 

contributed to by asphyxia related to forcible restraint. 

Thank you for referring this matter to me. Please do not hesitate to contact 

me if I can be of further assistance. 

Michael Graham, M.D. 

Professor of Pathology 

Case 2:17-cv-04565-DLR Document 382-13 Filed 11/30/21 Page 11 of 11