Propofol took center stage in the news several years ago when Michael Jackson died following an injection of it from physician Conrad Murray. Murray was later convicted of involuntary manslaughter. Nonetheless, propofol is rarely an instrument of death, let alone murder, though several cases have been brought to trial.
Anesthesia Medications Propofol is at top.
While abuse of the drug is spreading, propofol itself is not easily accessible to the general public as its primary use is with anesthesia. A respiratory depressant, it can affect both respiration and the heart. Since an overdose can cause death, it is also a weapon.
Used without intent to kill, effects last only a short time and the last evidence of it leaves deep tissue in about six days. It’s not illegal. It’s felt by users in just seconds and is somewhat easily obtainable by many in the medical community.
Here’s a scene from THE SHARK in which Dr. Kincaid, the Medical Examiner, Joshua Shield, head of Shield Security, former FBI agent Clay Bowman and Virginia state trooper Riley Tatum look for leads in a murder—and suspect propofol as the means.
He released the button and the elevator descended, the doors opening to the cool antiseptic air of the medical examiner’s offices and Joshua Shield.
Shield was dressed in his trademark dark suit with his shock of white hair combed off his angled face. He strode straight to them, his attention riveted on Riley. Dark eyes collected and inventoried details quickly. “Trooper Tatum. I’m Joshua Shield.”
“I recognize you from your press pictures.”
Bowman noticed that most people were intimidated by Shield. They dropped gazes, shuffled feet, or fidgeted in some way. Not Riley. She glared at him as if he were a rookie intern late for his first briefing.
Shield extended his hand to her. “Nice to finally meet you,” he said. “Mr. Bowman speaks well of you.”
Clasping hard, she held his gaze.
“Solving this case is a team effort,” Shield said.
Smiling, she shook her head. “We’ll see.”
Bowman gave her props for not pulling punches.
“Consider the advantages of my expertise,” Shield said. “My company resources helped you in the past.”
“You were an uninvited guest that I could have managed without.”
He grinned as if enjoying the sparring.
Before he could respond, Dr. Kincaid appeared. She wore a lab coat and glasses that covered slightly bloodshot eyes.
“Dr. Kincaid,” Bowman said. “We appreciate you meeting us. Sorry to get you out of bed so early on a Saturday morning.”
“Mr. Bowman, Mr. Shield, you gentlemen have friends in powerful places.” Calm and unruffled, she extended her hand to both.
Shield shook her hand. “We help each other out when we can.”
Dr. Kincaid glanced at Riley. “I’m assuming Agent Sharp called you.”
“No, it was Mr. Bowman. But I contacted Agent Sharp.”
“Good,” Dr. Kincaid said. “Follow me.” She led them down the long hallway and pushed through a set of double doors. “I understand you also want to see Vicky Gilbert’s body.”
“Correct,” Shield said.
“Your timing is fortuitous. The funeral home is picking up her remains in a couple of hours. Her mother opted for cremation.”
“And you’ve done a complete exam?” Shield asked.
“I have. I’ve collected enough samples so that we can run any kind of test conceivable in the future if necessary. The Gilbert family is anxious to have a memorial service.”
“Their daughter ran away from home over a month ago and they didn’t call the police or try to find her,” Riley said. “What’s the big rush now?”
A slight shift in Riley’s tone could have made her sound bitter. But she kept her voice monotone, effectively hiding any potential anger or resentment.
Bowman reached in his breast pocket and removed a slip of paper. “Dr. Kincaid, I’d like you to test for this sedative.”
“Propofol? That’s a very powerful narcotic and I don’t see it often.”
“If we’re dealing with the man we suspect is the killer, this is likely the drug he used on his first four victims. This killer is a creature of habit. The sedative is one of his signatures.”
We’ve all heard talk about CSI Effect—people watch crime shows and movies and read mystery and suspense novels and start expecting all sorts of cutting edge forensic technology is available at crime scenes and to analyze evidence. Some think that test results can happen in hours or days, instead of weeks. When a case goes to trial, it may be that some jurors are anticipating lots more forensic evidence than is possible or they’re putting less emphasis on circumstantial evidence.
Also discussed is another element of CSI Effect—criminals knowing more than ever before about police and forensic procedure and behaving accordingly.
Vernon J. Geberth is the Former Commander of Bronx Homicide, New York City Police Department and author of Practical Homicide Investigation: Tactics, Procedures, and Forensic Techniques, which is used by the FBI, homicide departments, lawyers and investigators across the country. He addresses the criminal side of C.S.I. Effect in his article for PI Magazine: Journal of Professional Investigators in which he refers to “staging” the scene of a crime.
He defines the process saying “staging a scene occurs when the perpetrator purposely alters the crime scene to mislead the authorities and/or redirect the investigation. Staging is a conscious criminal action on the part of an offender to thwart an investigation.”
He also points out the perpetrator’s side of C.S.I. Effect. “The problem is that criminals read the same books and watch the same TV shows as everybody else, so they are gaining insight into the investigative process as well as the value of trace evidence and have become more savvy. These ‘CSI Criminals’ attempt to prevent leaving evidence at crime scenes. Offenders are now ultra-careful not to leave any blood, fingerprints, body hair or anything else that may identify them in the crime scene.”
Here’s an excerpt from VULNERABLE showing just that—names and some narrative have been changed to avoid spoilers.
“He pressed his finger on the back doorbell. As bell chimes echoed in the house, he pulled a clean handkerchief from his coat pocket and wiped the doorbell button clean. Lights clicked on inside. Fast, determined footsteps approached. By the sound of it, the old man wasn’t happy about the interruption . . . the door jerked open to Jim Simmons’s frowning face. An instant passed as the old man stood and stared . . .
Ken grinned. “Mr. S. How’s it going?”
Mr. Simmons blinked. The anger that always buzzed behind his gaze softened. “Ken. What are you doing here?”
He removed a silver flask from his pocket. “I thought we could drink a toast . . .”
They moved down a carpeted hallway into the brightly lit kitchen . . . “Can I get you something to eat? . . . Let me make you a sandwich.”
“I’d like that.”
Ken took another drink from the flask, replaced the cap, and stuck it back in his pocket. He settled on a bar stool . . . Mr. Simmons carefully made the sandwich, set it on a plate, and pushed it toward him before turning back to the refrigerator to dig out a couple of beers . . .
The old man twisted the top off his beer and carefully set the top on the counter . . . “You spent time in Texas, didn’t you?”
“Sure.” Ken balled up his napkin and tossed it on his plate.
“The cops showed me a picture of a guy in Austin. I didn’t recognize him at first.”
“Really?”
Simmons looked at him, his gaze hardening as if pieces of a puzzle clicked into place.
Ken smiled and reached in his pocket for latex gloves . . . He tugged on the gloves . . . “She told me what you made her do . . . if the cops find out what you did . . . you’ll be ruined.”
“You wouldn’t do that.”
“I would.”
“I can crush you without breaking a sweat, kid. Don’t ever think you can threaten me.”
Ken shifted his grip around the neck of the beer bottle as if it were a club. Moving with swiftness he’d learned on the football field, he raised the bottle and lunged across the kitchen island, cracking the glass against the side of the old man’s skull . . .
Ken’s brain morphed from thinking to primal as he moved fast, scrambling around the island and landing hard blows with the bottle on the old man’s face. Simmons staggered and fell back to the floor. A look of panic and disbelief swept over the old man’s gray eyes.
Ken reached in his pocket and pulled out a clear plastic bag. With a snap he opened it and straddled Mr. Simmons. He pulled it over the man’s head and twisted the ends shut, cutting off his air flow. Ken settled his weight on Simmons’s chest and held the bag in place as his victim struggled for air. Several minutes passed until finally, Simmons’s eyes rolled back in his head and Ken was certain he was dead.
Ken removed the bag and checked for a pulse. There was none. Satisfied, he poured out the remaining beer in the sink. He dumped both bottles in his plastic bag as well as the remains of the sandwich. He turned on the hot water tap and when steam rose from the now hot water, he washed the plate and dried it with a paper towel, which he used to wipe down the counter.
As he backed away, his heart still thundered in his chest.
Forensic science and details of how law enforcement operates play key roles in my police procedurals, and I’ve always believed that actually experiencing much of it, as I have at Writers Police Academy and elsewhere, has enhanced my writing.
I find the same to be true of setting. It helps me tremendously to have walked around a city or to have visited the types of locales I’m planning to include in a story, even when I’m going to be making them up. Getting the setting right is very important. Whether I’m describing the inside of a courthouse, a squad car or a jail, I try to be as accurate as possible.
Which is why I went to jail the other day. The visit was courtesy of the Richmond City Justice Center, which gave Sisters in Crime Central Virginia the opportunity to tour and learn more about the facility and its people, including a rundown of the procedures prisoners go through when they first arrive.
The gang from SINC Central Virginia happy to know we can leave at any time.
Worth pointing out is that some of us confuse the terms jail and prison. Jail is a short-term incarceration—less than three years. Inmates stay in jail while awaiting their trial and sentencing and then after that, they are transferred to a prison for the term of their incarceration.
The Richmond facility is new and houses up to 1000 male and female inmates, called “residents” by the staff. These individuals have been arrested in Richmond by law enforcement authorities including the Richmond City Police, FBI, Virginia Commonwealth University Police and J. Sergeant Community College Police.
Residents at a prayer meeting. (Image taken from the Richmond City’s Sheriff Office Facebook page.)
When prisoners arrive, they’re searched, given a Breathalyzer, their money is loaded into an account and a nurse medically assesses them. If the magistrate does not set bond or if it isn’t paid, an individual’s threat level is then determined and he/she is assigned a uniform based on that threat level. They are then assigned a spot among the thirty-two housing units, a.k.a. pods, which hold from twelve to seventy-two people.
While there, we also learned about the Center’s program, REAL (Recovering from Everyday Addictive Lifestyles), created by Director of Internal Programs Sarah Scarborough. Residents admitted to the 40-hour a week program complete classes such as remedial math, anger management and creative writing, taught by volunteers and staff.
Thanks to all at the City of Richmond Justice Center, in particular, Sarah who showed us around and shared background and insights along with facts and figures.
There are two types of strangulation. One is manual, using the fingers, another body part or an object such as a baton. The other is via ligature, which means using a rope, cord, scarf, really anything that can be used for tying or binding.
Strangulation as cause of death shows itself in many ways, the obvious being bruising and ligature marks, but also manifesting as damage to the larynx, the hyoid bone (between chin and thyroid cartilage) and other neck bones.
Investigators faced with a possible murder will know not to rely solely on ligature impressions to determine strangulation as these telltale marks can be made by similar means after death. They’ll look for additional evidence of asphyxiation and other clues the body can provide as well as circumstantial and, preferably, direct evidence.
Ligature strangulation is often the case in homicides but also occurs in accidents and suicides. One way of differentiating it from death by hanging is that the mark will most likely be lower on the decedant’s neck. A ligature mark may not be present if a soft material is used, making it more difficult to determine if the death is a crime.
In this scene from VULNERABLE, Medical Examiner Dr. Miriam Heller walks Detectives Jake Bishop and Rick Morgan through her assessment of the visible marks on the body of victim Elisa Spence.
Dr. Heller moved to the body’s feet and uncovered them. Decomposition had discolored the soles and shrunk the skin around the toes’ cuticles, giving the impression that the nails had grown.
The doctor turned the ankle so that the heel was in plain view. “She has fresh blisters and abrasions. I took a look at her remaining shoe before I sent it to the lab and noted it was older, well worn. I wouldn’t think the shoes would have worn blisters unless she’d been on her feet a long time. There are also scratches on her upper arm that suggest she ran into something abrasive like a tree.”
Jake rested his hands on his belt. “Like someone was chasing her through heavy brush?”
“That would be my guess. Her shoes created the blisters and the branches scratched her face.” Dr. Heller arched a brow.
“One could assume she lost her other shoe while she running.”
“Scent dogs are combing the brush, but so far have not found it,” Rick said.
She moved to the head of the table and uncovered the girl’s face, also darkened and drawn from death. Her lips were pale, bloodless, and more scratches raked across the left side of her face. A purple ligature mark ringed the skin around her neck like a Victorian choker. “The scratches on her cheekbones are also consistent with running through the woods.” She lifted the head and turned it to the right, exposing the flesh under the left ear. “What does that look like to you?”
Jake leaned in to study the blue-purple marks. “Looks like bruises.”
“She’s got matching sets on the other side. The shape is consistent with fingers. Because they’re in slightly different positions, it appears whoever strangled her put hands on her neck several times.”
“Strangled her but didn’t kill her,” Jake said.
“That’s right. I’ve seen bodies marked like this before. They often indicate a choking game.”
Rick pointed to the narrow ribbon of bruises around her neck. “That’s a ligature mark if I’m not mistaken?”
“It is. She died from asphyxiation. The other marks might have been enough to make her pass out but not sufficient to cause death.”
Jake flexed his fingers. “So this started as a game?”
Absently, Dr. Heller laid a hand on the victim’s shoulder. “Smart girls can make stupid choices sometimes. And she might have gone into the woods thinking it was going to be fun when the killer had a different plan all along.”
“Shit,” Jake muttered, thinking about the cave and the candle that had burned through. The killer had not simply dragged her to the cave and killed her, he kept her there for hours and toyed with her. “Any older bruises that might suggest she tried this kind of thing before?”
“No, also no signs of drug abuse. This could have been her first foray into this kind of sexual play.”
“According to her roommate she was smart,” Rick said. “But she did like to party.”
Dr. Heller raised the victim’s right hand and fanned the pale fingers painted in purple chipped at the fingertips. “Debbie found dirt under her nails as if she’d been digging. Maybe she got away and tried to hide. Also embedded in the dirt under her nails, I found skin, so I did scrapings. We’ve processed and sent it off for DNA testing. Looks like she was able to scratch him perhaps a couple of times.”
“Hopefully, she marked him up good,” Rick said.
“Be interesting to know if our killer is in a DNA database.”
“Wouldn’t that be nice.” DNA in a database wasn’t a given. If this guy had never been arrested, it was very possible law enforcement possessed no record of him.
When the heart stops pumping the blood goes to the lowest points in the body and creates an unnatural coloring of the skin. This phenomenon is called lividity.
This discoloration of the skin after death can offer invaluable clues to the investigators. For instance, if a person dies sitting in a chair or hanging from a noose, the bruising will occur in the dead person’s feet and hands. Or if the person dies lying down, the patterns will appear on the underside of the victim’s legs, arms and back. If the person is lying face down when death occurs, the bruising will be found on the front of the body. If the body’s position at the crime scene does not match these discoloration patterns, investigators have forensic evidence to suggest that the body has been moved.
So if a forensic investigator finds a body face down but the discoloration is on the back, he/she knows the killer altered the original crime scene.
Here’s Georgia at work in VULNERABLE, assessing a victim.
Georgia sat cross-legged as she lifted the victim’s cold and badly swollen hand. Though the cuticles had receded, she could see that in life the victim kept them neatly filed and painted with a faint sheen of purple nail polish that still caught the light.
Carefully, Georgia inspected the fingernails, crusted with dirt, searching for any sign that the victim might have scratched her attacker. Knowing the medical examiner would do scrapings under the fingernails, she covered both hands with paper bags. Porous, the paper allowed air to circulate so that moisture didn’t form and destroy any DNA that might be present.
“Let’s hope you scratched the hell out of him. Maybe together, we can put this asshole away.”
When both hands and feet were bagged, she gently rolled the body on its side. Pushing up the shirt, she noted a purplish discoloration darkening the backside of the girl’s legs and arms.
Called lividity, the color change was caused by blood settling or pooling in the body’s lowest point when the heart stopped pumping. Forensic technicians used stippling patterns to determine if the body had been moved or repositioned.
If there’d been discoloration on the front of the body, she’d have known the girl lay face down for a time before being placed on her back. In this case, it ran the back length of the girl’s body. This suggested the girl was positioned here at the time of death.
Here’s a scene from THE SHARK in which Dr. Kincaid, the Medical Examiner, Joshua Shield, head of Shield Security, former FBI agent Clay Bowman and Virginia state trooper Riley Tatum look for leads in a murder—and suspect propofol as the means.
Vernon J. Geberth is the Former Commander of Bronx Homicide, New York City Police Department and author of 
Here’s an excerpt from 
Which is why I went to jail the other day. The visit was courtesy of the Richmond City Justice Center, which gave Sisters in Crime Central Virginia the opportunity to tour and learn more about the facility and its people, including a rundown of the procedures prisoners go through when they first arrive.
Strangulation as cause of death shows itself in many ways, the obvious being bruising and ligature marks, but also manifesting as damage to the larynx, the hyoid bone (between chin and thyroid cartilage) and other neck bones.