Medical examiner outlines how his office handles autopsies of the famous and everyone else

LOS ANGELES (AP) 鈥� The Los Angeles County Medical Examiner’s Office has performed autopsies in many high-profile cases, including that of 14-year-old , who singer is charged with killing, and the death of 鈥淔riends鈥� star .

Chief Medical Examiner Dr. Odey Ukpo about how his office handles its work and reaches its headline-making conclusions.

Why the cause of death is not always the most obvious option

Perry was found unresponsive in the hot tub at his Los Angeles home in October 2023 and initial reports speculated that he had drowned.

Two months after his death, Ukpo’s office determined the main cause of his death was acute toxicity of the and that drowning was a secondary cause.

Some advocates for ketamine, which is increasingly used to treat depression and chronic pain, said drowning should have been deemed the primary cause.

Ukpo said his staffers considered how anyone could drown in a hot tub and concluded Perry would have been able to climb out safely if he hadn’t been incapacitated by the drug.

鈥淏ut for the ketamine, would he have been out of it and unable to rescue himself?鈥� Ukpo said. 鈥淭hat鈥檚 why ketamine is the cause of death primarily, and then the drowning contributed.鈥�

Why 鈥榦verdose鈥� never appears in an autopsy report

鈥淎 medical examiner never certifies a death as an overdose. If you look at death certificates, you鈥檒l never see 鈥榤ethamphetamine overdose.鈥欌€� Ukpo said.

鈥淚t鈥檚 just part of the culture and understanding about how drugs kill people. People can understand 鈥榦verdose,鈥� but any level of methamphetamine can kill somebody. When you say overdose, it suggests that there鈥檚 an appropriate amount that someone can take. This one overdid it,鈥� he said.

鈥淭hat鈥檚 never the message that we give.鈥�

Why toxicology reports take so long

Autopsies are generally performed and initial conclusions reached soon after a body is found, but a report revealing cause of death can take months if a toxicology test is required.

鈥淲e want to make sure that we get it right,鈥� Ukpo said. 鈥淲hen someone dies, the blood specimens are different than when you鈥檙e at the hospital, so they鈥檙e harder to handle. And we also have to have certainty. In the hospital if you do a urine drug test, they tell you within a few hours. And that鈥檚 because they鈥檙e OK if it鈥檚 wrong. They鈥檒l treat you because the treatment for cocaine, it doesn鈥檛 hurt. We鈥檒l just assume it鈥檚 cocaine and that鈥檚 fine. But for us, it鈥檚 cause of death and has implications. And so it does take months to come back.鈥�

In some cases, toxicology tests are needed to understand what substance may have killed the person. In others, they’re more of a check to assure conclusions are correct.

When the autopsy , who had been dead for months when her body was found, it was fairly clear she had been stabbed.

鈥淲e knew very early on what was going on, particularly defects in the clothing and on the body itself,鈥� Ukpo said. 鈥淚t鈥檚 then we have to do toxicology as due diligence to make sure drugs didn鈥檛 also play a role in the death.鈥�

Alcohol was found in her system, but it was produced postmortem.

鈥淲hen someone dies, the bacteria can then change the glucose into alcohol. And so therefore you have a presence of alcohol, which would appear that it was real, but it was actually produced by a bacteria,鈥� he said. 鈥淭here are also other interference things that can make things look like they鈥檙e positive at the beginning, but then at the later stage are negative. We do confirmation testing.鈥�