Dr. Susan Ignacio, Medical Examiner

She is the Associate medical examiner with the District 6 Medical Examiner’s Office in Largo, FL. She previously did a fellowship in Forensic Pathology, did a year in District 5, then District 6 - it’s been 23 years. She performs autopsies or external examination to find cause and manner of death.

Background

Education: 4 years of med school, 5 years general pathology, 1 year general pathology. Med school in the Philippines, general in Jackson Memorial Hospital, 1 year at Miami Dade ME Office.
Does training annually by the NAME and FLAME. (National Association of Medical Examiners / Florida Association of Medical Examiners)
She has a license in Florida and has been licensed for 24 years.
She has been board certified in anatomic pathology and forensic pathology for 20 years.
Dr. Ignacio has performed at least 6,000 medical exams.
She has testified as an expert too many times to count, all in Florida. Miami, Pinellas and Pasco Counties, Tampa federal court, Volusia County.
This witness is qualified as an expert in this court.

Gannon’s Autopsy

In March 2020 she was helping in Santa Rosa County doing autopsies.
A body was found in a suitcase under a bridge; the body she performed an autopsy on was the same body in the crime scene photos from the bridge.
Ignacio performed an autopsy on March 18th, 2020.
Exhibits 144 - 180 are diagrams and photos from the autopsy.
Exhibit 144 is Ignacio’s body diagram from the autopsy report.
Exhibit 145 is the diagram of the head.
E146 is a diagram of the top of the head, the skull, and under the chin.
E147 is a photo from the scene; it shows Gannon’s body.
E148 is an autopsy photo.

She is pointing out signs of decomposition. The bone of the right hand is exposed. There is black discoloration on his abdomen and hip, possibly from the clothes he was wearing.

There is a sharp force injury on the left side of his chest as well as at least four other wounds on his chest and abdomen.
Sharp force injury is a wound caused by a sharp object like a knife or a blade.
Some of the injuries are deeper than other.s
E149 is a closeup of 148.
Looking at the wound, it went into the third rib and the space between the ribs you can see a sharp clean cut line.
The state of decomposition made it difficult to examine some of the wounds.
E150 is another sharp force injury.

There are jagged edges from decomposition. Inside the body it was a linear clean cut wound.

E151 is a closeup of the wound.

Inside the sharp tip was clear.

E152 is a sharp force injury in the left chest.

It did not enter the chest cavity, it only hit the pec muscle.

E153 is a close up of that wound.

It has a clean line, a straight edge.

E154 is a photo of a sharp force injury right above the clavicle on the left.

The photo is blurred for the jury, it shows Gannon’s face.

E155 is a closeup view of the wound above his left clavicle.
E156 is another sharp force injury in the left upper arm near the arp pit.
E157 is a closeup view of that injury.
E158 is a sharp force injury on the left wrist region
Some of the injuries are pulled apart due to skin slipping and stretching.
E159 is a closeup view of the wound on the left upper arms.
All of the injuries are marked in diagram E144.
E160 is a photo of the left hand.

There is a cut on his hand.

E161 is a photo of the right hand.

There are four wounds on the back of the right hand, clean cut caused by a sharp object. They are consistent with defensive wounds.

E162 is a photo of the palm of the right hand.

The is another cut on the right middle finger.

E163 is another view of the same injury.
E164 is a photo of Gannon’s back.

There is a sharp force injury on the left upper back. This is one of the deeper sharp force injuries. It fractured the left 6th rib and penetrated the left 5th intercostal space between the 5th and 6th ribs. It entered the chest cavity.

E165 is a closeup view of the back sharp force injury.
E166 is a photo of another two sharp force injuries on the back side of Gannon’s left shoulder.

One of the wounds ended in the scapula and hit the bone of the shoulder blade. The other went deeper into the shoulder joint, about 4 inches deep.

E167 is a closeup of the two injuries on the shoulder.

You can see black fiber from his jacket or T-shirt in the wound.

E168 is another view of the top of the shoulder.
E169 is a closeup of the top of the shoulder.

The injury has clean edges.

E170 is a blurred photo of a sharp force injury on the inside of the left forearm.

The groin area is blurred for the jury.

E171 is a closeup of the injury of the left forearm.

Tissue is coming out of the wound.

E172 is a photo of Gannon’s head.

You can see the left ear. There is a cut in the back of his ear, on the scalp.

E173 is a closeup of the cut on his ear.
Head wounds bleed heavily due to the amount of blood vessels.
E174 is the right side of the head.

There is a laceration caused by a blunt object, the skin and tissue was not completely split; it’s near the back side of his right head.

E175 is a closeup of the wound and the edges.

They are not straight like a knife wound.

E176 is a laceration on the top of his head.
E177 is another photo of the laceration in 176 and an additional two lacerations with jagged edges.
E178; the scalp is peeled to analyze the wounds.

The wound from E172, near his temple and the back of the head, now shows a skull fracture. This would take a lot of force to fracture this bone with blunt force injury.

Gannon suffered 18 sharp force injuries, 4 lacerations from blunt force injuries.
E179 is the left side of Gannon’s face.

You can see his ear and the left side of the lower jaw; there is a hole from a bullet in the jaw.

E180 is a closeup of the gunshot wound in his jaw.
Regarding the path the bullet took: the entrance was on the left side of the lower jaw, the mandible. It entered the oral cavity, hit the 2nd and 3rd cervical vertebrae in the back, crossed the midline, and entered the muscles in the neck. It was from left to right, front to back.
A projectile was recovered from the muscle tissue in the back of the head.
There was 1 gunshot through the chin.
Regarding the progression of injuries, Ignacio believes the sharp force injuries came first because he could still defend himself. She does not know if the gunshot wound or the blunt force injury which caused bleeding in his brain came next.
This would have taken a period of time to cause all of these injuries.
Cause of death was gunshot wound and blunt trauma of the head; contributing factors were sharp force injuries.
Manner of death is homicide.
Toxicology, which is done in all violent deaths, determines if any drugs were in the system at the time of death.
Gannon’s system had acetaminophen (Tylenol) at the time of autopsy as well as hydrocodone in the liver tissue.
Hydrocodone is a prescription-only controlled substance used for pain or in cough syrup to suppress cough. It is indicated as highly addictive, it is an opiate. Depending on dosage it can cause drowsiness, lightheadedness, dizziness, problems breathing, lethargy, coma, and eventually death.
It is unusual to find hydrocodone in an 11 year old; if it was for cough you would use a different medication for children.

Cross Examination

The wounds to the top of Gannon’s head occurred before he died, she was never unsure of this.
Injures indicate this was a violent death
It seems like a random attack because there was no pattern to it.
There were injuries on different parts of the body and different types of injuries.
The blunt force injuries would have been fatal by themselves; the gunshot was fatal as well.
The bullet did not enter into the cranial vault; the bullet severed the spinal cord.
The mechanism for death with the blunt force injuries would have been hemorrhaging in the brain.
Ignacio didn’t inquire whether the hydrocodone was prescribed to Gannon.
The skull fracture could not have been caused by the impact of the suitcase hitting the ground.
No stippling around the gunshot wound, possibly due to decomposition.
She is unsure how far away the gun was from Gannon’s body when it was discharged.
Ignacio didn’t see any injuries to the lungs which would indicate fatal sharp force injury but that could have been due to the decomposition.
Injuries to the chest cavity could have been fatal if left unattended.
She could not find a pancreas due to decomposition.

Redirect

It is common to find victims in bodies of water; common to find a victim was killed in one place and moved to another to try to conceal crime.
Ignacio believes the location the body was found in is an attempt to conceal the cause of death.
Stippling refers to powder burns on the skin due to the gun being 2 inches to 2 feet from the skin when discharged.
If a pillow was between the gun and victim, there would be no stippling on the skin.
2 bullets were removed from a pillow.
The injuries were not random, they were intentional.
They were targeted to upper body and head - an indication the intention was to cause fatal wounds.
All of the injuries occurred before Gannon’s death.

Juror questions

Can you determine how long the body has been decomposing or when the time of death was?: No
During autopsy was there any evidence of burn marks or bubbling of the skin?: No. Due to decomposition it would be impossible to tell. If there had been burns it no longer would have been detectable.
How long does Tylenol and hydrocodone stay detectable in the body?: Usually 12 hours after taken; the drug was in the body at the time of death. It was able to metabolize because it converted to hydromorphone. At the time of his death the body started metabolizing the hydrocodone but not all of it. The toxicology sample was taken from the liver tissue. They took spleen samples too but only tested liver. Spleen and liver results could potentially differ.