Sunday, January 04, 2004

By Paula Reed Ward, Pittsburgh Post-Gazette

A 1994 Japanese study could hold the answer to an Indiana County mystery.

For more than a year, the coroner's office, state police and other investigators have been trying to figure out why the bodies of several people who died recently in Indiana County showed extremely high cadmium levels in their blood.

	CLOSE-UP 2003 Last of a series
	John Beale, Post-Gazette Michael Baker, Indiana County chief deputy coroner.

At first, they suspected someone had poisoned them.

But as time wore on and investigators were unable to come up with any clear links among the deaths, they shifted their focus to an unknown environmental cause. Now, they've shifted again.

It's possible none of the people had high cadmium levels prior to death at all. Instead, the high readings may have come about as a result of the death process in which the internal organs released cadmium and other heavy metals stored in them.

Now, that theory, first tested in Japan, will be the focus of a study by the Indiana County coroner's office.

Michael Baker, the chief deputy coroner, said his office would begin the study within two weeks. He plans to take blood from people who are near death and then compare the blood-cadmium levels to samples taken after death.

The people whose blood will be sampled will have to give informed consent, and Baker believes that they will want to participate.

"We need to determine if this is actual contamination or just a phenomenon of post-mortem blood," Baker said.

The Japanese study, published in "Environmental Research" in 1994, examined the problems of cadmium analysis in autopsies.

"It is known that the blood [cadmium] level in the dead body is higher than in the living body. This indicates that postmortem blood is not a suitable sample for [cadmium] analysis," the authors wrote.

In part of their study, blood was drawn before death and then several hours after death in two patients -- an 81-year-old man and an 85-year-old woman. In both cases, the cadmium level before death was very low, the study found. Ten hours after death, however, the man's blood cadmium level was 435 times what it was before he died. The woman's blood cadmium concentration 32 hours after death was 354 times her pre-death level.

"It is possible that the elevated blood [cadmium] level after death is due to leakage from the organs in which [cadmium] is highly accumulated," the study's authors wrote.

Cadmium, a naturally occurring heavy metal used in batteries, metal coatings and pigment making, has a very low absorption rate. Once it is absorbed and accumulated, though, it stays, the authors wrote.

Baker said the conclusions in the Japanese study probably would be replicated in his. Either way, he hopes to have an answer by February or March.

"I feel confident we will get to the bottom of it," Baker said.

The coroner's office stumbled on the mystery when Russell Repine, of the Homer City area, died in March 2002. He was a healthy, 61-year-old retiree, and investigators couldn't determine a cause of death.

Indiana County Coroner Thomas Streams ordered a toxicology test, wondering if Repine could have been poisoned.

"We weren't looking for cadmium, but for heavy metals," Baker said.

They found a high cadmium level -- 352 micrograms per liter when a level of 7 micrograms or lower is considered normal -- which set off an alarm that led to the exhumation of Anna Nagg, who died in November 2001. The two had a tenuous link -- a woman who knew both of them.

Within several months, though, the coroner's office found Nagg had died of natural causes and no evidence of any foul play.

But that didn't stop investigators from looking.

They still couldn't figure out why Repine died, so they started testing every body that went through the Indiana County coroner's office.

They found three more people with incredibly high levels of cadmium.

Burnell Dwyer, 72, of Conemaugh, who died Aug. 4. His blood cadmium level was almost 600 micrograms per liter.

Walter Pardee, of Plumville, died Sept. 14. His cadmium concentration was greater than 1,000 micrograms.

Violet Shuster, of Buffington, died Sept. 22 of a heart attack. But toxicology tests showed her cadmium level after death at 348 micrograms.

"No one has ever seen levels of 50, 60, 300 or 1,000," said Dr. Karl E. Williams, who is helping Indiana County officials in the investigation. "My first reaction when I saw the levels was, 'This is impossible.'"

Initially, investigators feared a criminal connection to the cadmium levels.

"Cadmium is a lousy poison," Williams said.

The director of laboratories at Ellwood City Hospital, Williams just finished his master's thesis on cadmium exposure in the workplace. There have been a number of studies done in that setting, he said, but very few examining cadmium levels after death.

"Not a lot is known in measuring cadmium in the post-mortem population," Williams said.

After months of investigation, officials were almost certain they were not dealing with a crime.

The Pennsylvania State Police, who were at one time heavily involved in the investigation, now are stepping aside, said Sgt. Bernard Petrovsky.

"We kind of opened a can of worms, but we don't know much about it," Petrovsky said. "Now we're kind of scratching our heads."

After ruling out a crime, investigators then speculated the high cadmium levels came from an environmental source.

Now, Baker said, they are fairly confident that they'll find average cadmium levels before death, with readings increasing dramatically after death.

If that theory plays out, Baker said, it's possible they'll have to list Repine's cause of death as "undetermined." While that is not unusual, it's not a frequent occurrence, he said.

In his study, Baker hopes to have a sample size of at least a dozen people to get reliable results.

Until after the study comparing pre- and post-mortem blood is completed, Baker said, his office would not pursue any other lines of investigation.

"I don't want to go in 10 different directions at once," he said.

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