Medical Examiner resigns after failure in N.C. hotel death investigation

frkelly@charlotteobserver.com June 14, 2013 

The N.C. medical examiner’s office learned two weeks ago that carbon monoxide might have killed an elderly woman in a Boone hotel but failed to alert local authorities about the threat until after an 11-year-old boy died in the same room.

Dr. Brent Hall, the Watauga County medical examiner who investigated the deaths, resigned his state post Friday.

A report obtained by the Observer shows the office knew that a June 1 toxicology test detected lethal levels of carbon monoxide in the blood of Shirley Mae Jenkins, 72.

She and husband Daryl Jenkins, 73, a Longview, Wash., couple, were found dead on April 16 at Best Western Plus Blue Ridge Plaza.

But seven days after the June 1 test found poisonous gas in Shirley Jenkins’ blood, Jeffrey Williams of Rock Hill was found dead in Room 225.

After the boy’s death, authorities announced that both Williams and Daryl Jenkins had died from carbon monoxide poisoning.

Experts say medical examiners should warn police and fire officials immediately after toxicology tests show someone could have died from carbon monoxide to prevent future deaths.

Ricky Diaz, a spokesman for the N.C. Department of Health and Human Services, which oversees the N.C. Office of the Chief Medical Examiner, said state officials are reviewing how the cases were handled.

Diaz said Hall failed to make the state aware that officials needed to act urgently.

Documents show that Hall requested the toxicology tests on the Jenkinses and wrote that the probable cause of death might be an overdose.

Hall did not return phone calls or respond to emails seeking comment. He is among more than 400 state-appointed medical examiners who are paid $100 per investigation.

Darrell Williams, the uncle of Jeffrey Williams, said Friday that he is angry the hotel was allowed to continue renting the room when the state knew it might be dangerous.

He said the medical examiner’s office had an obligation to warn authorities about the threat.

“It doesn’t cost any money to pick up a phone and call,” Williams said. “At the very least, that should have been done. A human of average intelligence would have called.”

Called “the silent killer,” carbon monoxide is a colorless, odorless gas that inhibits the blood’s ability to carry oxygen and can cause severe illness or death.

It is emitted by cars and other fuel-burning machinery.

The N.C. Board of Examiners of Plumbing, Heating and Fire Sprinkler Contractors found deficiencies in the hotel’s indoor pool water heater. Those may have caused the gas leak in the room where the Jenkinses and Jeffrey stayed.

Dale Dawson, executive director of the board, said Friday “there were some items that weren’t installed properly.” He declined further comment, citing an active investigation.

State building codes mandate local officials inspect hotel pool heaters when they’re installed.

Bill Bailey, director of Boone’s Planning and Inspections Department did not return phone calls seeking comment.

The Best Western in Boone is run by Appalachian Hospitality Management Inc., according to Watauga County Health Department records.

Hickory attorney Paul Culpepper, who is representing the management group, said the room was rented only once between April 16 and June 8. That took place on June 1 and no one complained of sickness at that time.

The Observer previously reported that no state medical examiner visited the hotel room after the Jenkinses died there – even though experts say inspecting the death scene is a crucial step in determining how a person died.

Boone Fire Chief Jimmy Isaacs has said the state medical examiner’s office did not ask firefighters to conduct carbon monoxide tests in the hotel after the Jenkinses died.

The Observer obtained medical examiner investigative reports and other documents related to the deaths of Jeffrey and the Jenkinses.

A toxicology report from the state medical examiner’s office dated June 1 says the saturation of carbon monoxide in Shirley Jenkins’ blood was greater than 60 percent, the documents say.

Anything over 50 percent is typically fatal, experts say.

The toxicology report for Daryl Jenkins was not completed until June 9 – the day after Jeffrey died.

It also showed carbon monoxide blood saturation greater than 60 percent, documents show.

Boone Police Sgt. Shane Robbins said that his department renewed a request for the Jenkinses toxicology reports on May 29.

But Boone police did not receive the lab results for the couple until June 10, after Williams died, Robbins said.

Asked why the delay occurred, Robbins referred a reporter to the medical examiner’s office.

State Chief Medical Examiner Dr. Deborah Radisch did not return a phone call or respond to email requests for an interview. Dr. Ruth Winecker, the agency’s chief toxicologist, referred questions to Diaz, the state spokesman.

Asked why the medical examiner’s office did not warn police and fire about the threat of carbon monoxide after receiving Shirley Jenkins toxicology test results, Diaz said “that’s a fair question for Dr. Hall.”

He said the state sent the toxicology report to Hall instead of police and fire officials.

The state had no information from Hall indicating there was an “imminent threat,” Diaz said.

Investigative reports dated April 23 that appear to be compiled by Hall do not list a probable cause of death for the couple. Those reports say the probable cause of death is “pending.”

Experts said toxicology tests for carbon monoxide in corpses take as little as 15 minutes to complete.

When asked why the state took nearly two months after Jenkins died to produce blood tests results, Diaz said Hall did not request expedited lab testing.

Clasen-Kelly: 704 358-5027

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