Coroner’s Inquest rules death of Birkholz accidental but possibly preventable

JACKSON HOLE, WYO – The coroner’s investigation into the death of Anthony “Tony” Birkholz reconvened Wednesday afternoon with two scheduled witnesses—Penelope Salcido, who shared dinner with the deceased, and Dr. Bruce Hayse, at whose home Birkholz died in.

Birkholz died January 17 after a night out drinking with friends. A Bonneville County, Idaho coroner listed the cause of death as “natural” after Birkholz was transferred to the Idaho Regional Medical Center the same night he passed out at Hayse’s place and never woke. About a week after Birkholz died, county coroner Dr. Brent Blue became aware of additional circumstances surrounding the death—in particular, the possible use of a powerful hallucinogen 5-MeO-DMT, a chemically-altered Schedule 1 controlled substance modelled after the naturally-occurring neurotransmitter Dimethyltryptamine (DMT).

By the time Blue looked into things, it was all but too late. Birkholz’s body had been cremated and blood sample vials taken at the Idaho hospital had been disposed of. All but one. Blue had it tested. It came back positive for a high blood-alcohol content (.182), THC (the primary constituent in marijuana), and traces of cocaine.

Toxicology did not show any evidence of 5-DMT but Blue noted, after conferring with a national expert, that the drug is fast-acting (it produces a 45- to 60-minute high) and fast-dissipating (it’s gone form the body within 90-120 minutes of ingestion). Slightly different molecular strains also may not show up on a test looking for a specific compound, Blue added.

Salcido testifies

Salcido took the stand Wednesday—her testimony crucial in that she was likely the only sober one of foursome that had cocktails at The Wort and then more drinks at dinner at the Amangani. Salcido said she was on her fourth date with Noah Evans when he invited her to dinner with Birkholz and his friend Casey Hardison.

Salcido said Hardison drove Birkholz to Hayse’s house after the doctor suggested they stay the night rather than drive the pass in their condition. “They were pretty intoxicated,” Salcido, who was following with Evans, said. “At one point they went sideways on the road.”

Once back at Hayse’s the group started talking about hallucinogens and proposed doing some. Salcido said she thought that was a bad idea and so did Hayse, who was sitting at the table with them. Hayse would later deny this. The drug 5-DMT was produced and five lines of powder were cut on the table.

When asked where the drug came from, Salcido said she had no idea. ”Either Tony or Casey had it,” she said.

The group ingested the drug while Salcido said she began cleaning. “Dr. Hayse’s house is very dirty. There were mice running around. I thought I would clean up a little,” she said.

When she checked back in with the three men they were incoherent, mumbling to themselves, and moaning. They had all vomited some. Still, Salcido wasn’t too worried. She had read on the Internet they were typical reactions to be expected in the “experience.” She had also learned that the consumption of alcohol and meat were specifically discouraged when taking 5-DMT as the they could contribute to choking and blocked airways.

“But Tony had slipped off his chair and wiggled underneath it. He wasn’t moving at all,” Salcido said.

Hayse arrived and Salcido recalls him calling 911 at some point and instructing her to do CPR. She said she think she began chest compressions. She was too much in panic or shock to remember. She and Hayse attempted to move Birkholz down the stairs to the first floor. He was too heavy. They got a roommate of Hayse’s to help but still they could only get him to the top landing. Hayse pulled Birkholz down a some stairs by his feet as hit head bounced at each step, recalled Salcido.

When Salcido went to check on Evans, she found him face down in a “lot of vomit.” She began crying at this point in panic. Hayse roommate then announced Birkholz had sat up by himself. Hayse went to check his pulse and exclaimed, “Oh my God,” and started doing CPR on him, according to Salcido. He then asked Salcido to continue and called 911.

Salcido said she has no idea how long she did chest compressions on Birkholz but she said it felt like a very long time. She didn’t quit until she felt a paramedic’s hand on her shoulder.

Blue asked about the appearance of three tomatoes or tomato juice on the table. Salcido said it was just there at some point after she went to “check the boys and put blankets on them.”

Doctors Brent Blue (coroner) and Bruce Hayse have a disagreement at the federal court house.

911 tape

The original call came in to dispatch from Hayse’s residential landline at 12:36 am. After a 911 operator asks, “What is the nature of your emergency,” the line goes dead. A second call is placed where Hayse identifies himself and says he has a “drunk guy passed out at my place.”

“Is he breathing?” dispatch asks.

“I don’t think so,” Hayse responds.

Dispatch asks Hayse to check. The line goes dead again. The 911 operator calls Hayse back but gets a recording. Hayse finally calls 911 again and the operator asks him to use his cell phone next time.

“He doesn’t seem to be breathing,” Hayse tells the operator.

“Let me walk you through CPR,” the operator says.

The 911 recording lasts some 12 minutes while the efforts of chest compressions can be heard in the background as well as a woman’s sobbing—presumably Salcido.

“How we doing?” the operator asks.

No reply. Then a voice is heard, “No shock required.”

It’s the paramedic’s defibrillator unit. They have arrived at 12:48 am.

EMS spent an hour there trying to get an airway tube into Birkholz and stabilize him. He was transported to St. John’s at 1:48 am.

Hayse’s account

Dr. Bruce Hayse (SJMC)

A bench warrant was issued for Dr. Hayse after he initially appeared but refused to testify, saying he had patients waiting on him and was not given enough notice to clear his schedule. Hayse then left and was found later to be at the office of an attorney. He eventually arrived to be sworn in at 4:21 pm.

Hayse said he had agreed to go skiing with Hardison on January 17 but Hardison cancelled and instead invited the doctor to dinner at Amangani. When Hayse arrived around 9 pm, he saw the foursome “drinking very heavily” and decided to leave but not before suggesting they sleep it off at his place. He gave them directions and then headed to his office.

Once back home, Hayse greeted the four and said he was going to make up some beds for the night. When he returned, he said he saw all the guys pretty much unconscious…out of it. He checked their eyes. Finding no “pin-point” pupils, Hayse was satisfied it wasn’t a heroin overdose.

He left again and returned after a few minutes of making up beds. This time Birkholz was laying on the floor facedown. “I didn’t like the way he looked,” Hayse remembered for the jury. “He had a pulse but was not breathing very well.”

Hayse decided to take Birkholz to the hospital himself, believing it would be quicker than calling an ambulance. He struggled to get Birkholz down the stairs even with the help of a roommate. They made it to the first landing to rest. It was then Birkholz sat up, gasped, and turned immediately blue.

“That’s when I called 911 and began CPR. It seemed ages for them to get there. I assumed he aspirated and tried putting my fingers in his mouth and to clear his airway that way but couldn’t do it.”

“Are you still claiming a physician-patient relationship with him?” Blue asked

“Yes. I did have him as a patient of mine but did not know him very well. Obviously, there was a lot more to him that I did not know about.”

“You told law enforcement you did a Heimlich maneuver on him?” Blue said.

“Tried to, yeah,” Hayse responded.

“Why did you do that?”

“There was a possibility it would help to get him start breathing again. I tried everything I could,” Hayse answered.

“Why didn’t you call 911 earlier before moving him down the stairs?” inquired Blue.

“I was trying to get him to hospital myself because it’s two minutes to the hospital. 911 means loading him up, getting the ambulance up the driveway when there was a number of vehicles in it. Even getting up that driveway is pretty tough in the wintertime,” Hayse explained. “In retrospect, if I had known he was dying then, I would have called 911. But I don’t think in the end it would have made any difference. I assume I didn’t do any damage taking him downstairs. I suppose that’s a possibility.”

Hayse was further questioned as to whether he saw any drugs, and advised the group they shouldn’t be taking them. Hayse said he never saw any drugs or heard about talk of drugs. He did give Casey a standard general “rules of conduct” for staying at his place, which included the fact that there was no drugs or alcohol in the house and no one should be doing that.

“Is there any reason why you didn’t tell EMS that there might have been drugs onboard?” Blue asked.

“I didn’t know there were drugs onboard,” Hayse responded, believing everyone was just very drunk and maybe high on weed. In fact, he told a responding police officer everyone there seemed just pleasantly goofy. “It turned out that he had four different drugs in his system but he didn’t tell me that. There would be no reason for him to tell me that.”

Blue then turned to the moving of Birkholz down the stairs by Hayse and another mam staying at Hayse’s house.

“Did his head go thud, thud, thud down the steps?” Blue asked.

“No,” Hayse answered. “When he fell over on the landing there his head hit the wall.”

Hayse also testified that he did not go to the hospital after Birkholz was transported. He stayed with the remaining three guests at his house.

“I didn’t trust them. I had no idea what was going on. I wasn’t going to let them leave after that so I couldn’t really leave the house. I stayed up all night at the kitchen table and worked and watched over them,” Hayse said.

Hayse then further fleshed out his relationship with Hardison and Birkholz for the jury, whose members are allowed to ask direct questions of witnesses. Hardison and Birkholz were patients of his but he didn’t know them very well. Birkholz, in particular, he had not seen in a couple of years and did not recognize him all night until he overheard Hardison refer to the victim by last name during police questioning. That’s when it clicked with Hayse that Birkholz was the same man as his former patient.

You didn’t know it was Tony [Birkholz] at the Amangani?” a juror asked.

“I honestly didn’t. He had gained a lot of weight. He looked very puffy and very unhealthy,” Hayse explained. “He used to be a fit and vigorous sort of guy. Tony was a really energetic and on-top-of-it kind of guy, and this guy at the Amangani was a sort of obese, puffy guy.”

“Had all three in the kitchen (Birkholz, Hardison, and Evans) taken drugs or just two of them?” asked juror Diane Hazen.

“I don’t honestly know. I assumed they had,” Hayse said.

“Couldn’t you tell by how they were acting?” Hazen followed up.

“They were all somewhat goofy but they were all very drunk, too. It is hard to separate out being drunk from being on drugs. I’m not that skilled,” Hayse said. “If I see a young person who’s a heavy drinker in this town I assume they are also smoking pot. That’s almost automatic.”

Blue had repeatedly asked each witness about the presence of tomatoes or tomato sauce or juice without explaining the significance. It was again brought up to Hayse by a juror. Hayse admitted to hearing a lot of questioning about tomato juice or paste after the fact but he wasn’t sure why and didn’t know anything about it.

“The police asked me about tomato juice and I said I’ve never bought tomato juice in my life and I don’t know what I would use it for,” he said. “I really don’t know the significance of it. Maybe it has something to do with the drugs.”

Evans did not remember seeing any tomatoes or tomato juice that night. Salcido recalled three tomatoes suddenly appearing on the kitchen table at some point after she went to check on the condition of Hardison and Evans.

Hayse’s 34-minute testimony wrapped up with questions as to where and why his testimony conflicted with other witnesses. In particular, Blue wanted to know why he thought Salcido was too drunk to help with CPR or move Birkholz, and why there were claims that Hayse provided tomatoes and saw five lines of drugs spread on the kitchen table.

“Dr. Hayse, what would you say to the other witnesses that directly contradict your account of things?”

“I don’t know. Like the tomato thing where [I was seen setting out] three tomatoes on the table,” has pondered. “I don’t know what vision or what, uh, sort of idea was going on in their mind. I don’t know anything about the ability of whatever drug they did [to impair them]”

Jury comes back

County coroner Dr. Brent Blue

Blue then gave instructions to the three-person jury he hand-picked. They were Denny Emory, Wayne Grim, and Diane Hazen. Blue reminded the jury the inquest was not a civil or criminal investigation. The process does not assign blame but can assign accountability. Blue said he was looking at the cause and manner of death, with manner consisting of five possible outcomes­­—natural, accidental, suicide, homicide, cannot be determined.

After a half-hour of deliberation, the verdict of the jury in the case of Anthony Birkholz was death due to aspiration, second to alcohol and 5-DMT as contributing factors. There was also a “failure by witness to call 911 in a timely fashion,” and a “failure to protect head and airway in the dragging of Birkholz down stairs.”

The manner of death was ruled accidental.

The results of the inquiry will be filed in Teton County District Court. The findings of a Coroner’s Inquiry rarely result in a criminal case being opened but Blue said county attorney Keith Gingery and prosecutor Clark Allen will look the proceedings record over.

Jury verdict

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