Allegheny County medical examiner: 'All options open' in UPMC doctor's cyanide death
Investigators are still trying to determine how a prominent UPMC doctor ingested an apparently lethal dose of cyanide before collapsing at her home last month.
“It's not a natural death, that's all I know,” said Dr. Karl Williams, the Allegheny County medical examiner. “At this point, all options are open.”
Dr. Autumn Marie Klein, 41, died in UPMC Presbyterian on April 20, three days after she collapsed at her Schenley Farms home. The medical examiner's office has not determined if her death was a homicide, suicide or accident.
Williams said he is awaiting results of the investigation by police, the FBI and District Attorney Stephen A. Zappala Jr.'s office before ruling.
Cyanide poisoning is one of the rarest forms of murder and suicide, experts said.
Only 107 killers used poison between 2000 and 2009, according to a study by the FBI and researchers at the University of Virginia and Indiana University. The nation recorded 142,916 homicides during that decade.
In 2011 alone, firearms were used in 8,583 of the nation's homicides. Poison was used in five murders, according to FBI statistics.
Poison was more commonly a cause of death in suicides.
There were 38,364 suicides in 2010 in the United States, according to the Centers for Disease Control and Prevention. In 19,392 of those cases, a firearm was used. Suffocation was the second-most popular method, and poisoning was third, with 6,599 cases.
Sixteen people committed suicide by poisoning themselves in Allegheny County in 2012, according to medical examiner's records. Poisoning is the most common method of suicide for women, according to 2010 statistics from the CDC.
The disparity makes some experts question whether investigators discover all of the poisonings.
“Cyanide poisoning is a great mimicker of other diseases,” said Dr. Chris Holstege, chief of the Medical Toxicology Division and an associate professor at the University of Virginia, who wrote the study. “All of us who work in this realm feel we're missing a lot of these. Many of them were just luckily caught.”
The last murder by poison in Allegheny County occurred in 2008 when a Brentwood dentist, Dr. John Hucko, 60, used an IV to kill his wife, Martha Hucko, 61, with painkillers before he committed suicide, according to medical examiner records.
John Trestrail, director of the Center for the Study of Criminal Poisoning, has tracked 1,026 cases of known homicides by poisoning. He said cyanide was used in 83 of those murders. He said it is one of the “big three” poison agents, along with arsenic and strychnine.
“Most of the common poisons people turn to are medications or garage poisons like antifreeze,” Trestrail said. “Cyanide is not that common. When you're up against cyanide, you have to look at how is it obtained. Usually, these people have to have some kind of contact with a chemical laboratory or a chemical supplier.”
A lethal dose of cyanide is less than 200 milligrams, Trestrail said. He said the weight of a nickel in the palm of a hand is equivalent to 25 lethal doses of cyanide.
“That's a lot of firepower,” Trestrail said.
Eating cyanide will cause a person to collapse within 10 minutes, Trestrail said.
“It's not something you give to somebody in the morning and they become ill in the evening. They're going down quickly,” he said. “That's why it was a suicide weapon carried by spies. It would cause instantaneous death.”
Klein was chief of women's neurology at UPMC and an assistant professor of neurology, obstetrics, gynecology and reproductive sciences at the University of Pittsburgh. She treated pregnant women with neurological problems such as headaches and seizures and was recruited to Pittsburgh by the chairman of neurological surgery in 2011. She had offices in Magee-Womens Hospital and the Kaufmann Medical Building, which are both about a mile from her home on Lytton Avenue.
According to investigators, Klein walked from work on April 17 and collapsed at the home she shared with her husband, Dr. Robert Ferrante, 64, and their daughter, Cianna, 6. Ferrante called emergency dispatchers for assistance.
Three days later, Klein died with a lethal amount of cyanide in her system, Williams said.
This month, Pittsburgh police took a computer, cellphones, vacuum cleaners and other items from the home. Detectives traveled to Boston, where Klein and Ferrante lived before University of Pittsburgh Neurological Surgery Chairman Robert Friedlander recruited the couple to Pittsburgh.
And police learned that Ferrante, co-director of the Center for ALS Research and a visiting professor of neurological surgery at Pitt, bought cyanide using a university credit card in the days before his wife's collapse.
It's unknown whether Ferrante used the substance for his research.
Pitt officials have declined to discuss the case.
Ferrante could not be reached for comment. His attorney William Difenderfer declined to comment.
Dr. Benjamin Rix Brooks, medical director of Carolinas HealthCare System's Carolinas Neuromuscular/ALS-MDA Center, said it's possible that an ALS researcher might use cyanide, especially if the person is studying the effects of upper motor neuron degeneration, which is when nerve cells in the brain no longer function properly.
“If it's related to ALS, it is probably how cyanide can produce upper motor neuron system degeneration,” Brooks said. “The cyanide replicates that effect in animal models.”
Brooks said his lab does not use cyanide, but he has been in labs that do, especially if the lab is studying the effects of vitamin B12, which is the antidote for cyanide poisoning.
Dr. Robert Bowser, former director of the Center for ALS Research at Pitt, said he had no firsthand knowledge of cyanide use in the research labs while he was there. He said cyanide is not one of the commonly used toxins in research studies.
Bowser left Pitt in 2011 to become director of the ALS Research Center at the Barrow Neurological Institute in Phoenix.
“If you're trying to find things that protect cells, in those experiments you expose cells to different toxins, then see how well your drug works to protect them,” Bowser said.
Dr. J. Douglas Bricker, dean of the Duquesne University School of Pharmacy, said cyanide was commonly used in laboratory research years ago.
“There would be a tracking of where it was ordered, who it was ordered from and whose hands it exchanged,” Bricker said. “It falls under other dangerous chemicals that are typically monitored when they are purchased.”
The FBI does not track the sale of cyanide but does work with suppliers informally, spokeswoman Kelly Kochamba said.
“We do extensive outreach to universities and labs, and the private sector in general and encourage them report any potentially suspicious purchases or attempts to purchase any hazardous chemicals and/or biological material,” she said.
Bricker said he thought a standard order would be about 100 grams, or about 3.5 ounces.
“It's a very dangerous chemical, but it does have its uses,” Bricker said.
Margaret Harding is a staff writer for Trib Total Media. She can be reached at 412-380-8519 or firstname.lastname@example.org. Staff writer Bobby Kerlik contributed to this report.