Elijah McClain’s autopsy report changed ahead of arraignments of the officers, paramedics involved in his violent arrest

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David Zalubowski/AP Photo
A placard is displayed on a bicycle during a rally and march over the death of 23-year-old Elijah McClain, Saturday, June 27, 2020, outside the police department in Aurora, Colo. McClain died in late August 2019, after he was stopped while walking to his apartment by three Aurora Police Department officers.

New information from the grand jury investigation into the death of 23-year-old Elijah McClain prompted the Adams County coroner to amend the official autopsy report, potentially giving prosecutors a stronger case to charge the three police officers and two paramedics involved in his violent arrest with manslaughter.

In 2019, a contract pathologist for the Adams County coroner conducted McClain’s autopsy seven days after he died and found both the cause and manner of death to be “undetermined” —  rather than a homicide.

After multiple attempts of trying to obtain that amended autopsy, CPR News on Thursday night sued the Adams County coroner to get the new report. 

Coroner Monica Broncucia-Jordan confirmed to CPR News that the autopsy has been amended because of grand jury testimony.  Autopsies are subject to Colorado Open Records Act. 

That previously “undetermined” cause and manner of death for McClain made for a much higher hurdle to successfully hold those who arrested him and the paramedics who treated him accountable for his death, legal experts say. 

Causes of death can vary widely, but manners of death are limited to homicide, suicide, accidental, natural or undetermined.

Former Aurora Police officer Jason Rosenblatt and officers Nathan Woodyard, Randy Roedema and paramedics Peter Cichuniec and Jeremy Cooper collectively face 32 criminal charges, including manslaughter, criminally negligent homicide and assault charges. 

It was exactly a year ago this week that they were indicted, but their proceedings have dragged on with procedural delays and backlogged courts. They have an arraignment set for November.

McClain’s arrest and subsequent death

McClain was stopped by police on Aug. 24, 2019, after they received a call of someone walking down the street looking suspicious.

McClain wasn’t suspected of committing any crimes and wasn’t armed, but officers still restrained him with two chokeholds, and paramedics later injected him with a large dose of ketamine. He went into a coma in an ambulance and was pronounced brain dead at the hospital on Aug. 27, 2019. McClain died three days later.

In May, The Denver Gazette obtained records that were supposed to be sealed by the court and reported that the contracted pathologist, Dr. Stephen Cina, said, “Mr. McClain would most likely be alive but for the administration of ketamine.” 

Several things happened at the time of McClain’s initial autopsy that were not considered best practice, one leading industry expert told CPR News in 2020, including not seeking a second opinion when the first pathologist declared McClain’s cause and manner of death to be undetermined.

CPR News also reported in 2020 that the elected Adams County coroner, Monica Broncucia-Jordan, who is not a doctor and contracts out autopsies, met with police officers about McClain before a death determination was made.

In addition to the meeting with Broncucia-Jordan in the middle of an investigation into McClain’s death, Aurora police investigators were also present at the autopsy —  even as the conduct of some of the department’s officers was under review. 

The former Adams County district attorney declined to press charges against anyone in relation to McClain’s death, at the time. He cited the lack of evidence proving that the officers, or anyone, actually caused McClain’s death.

Amended autopsies are rare

It’s extremely rare for autopsies to be changed after a death and it only happens if the pathologist or medical examiner discovers new information they didn’t have at the time of the examination, lawyers said.

In McClain’s case, the potential change in his death determination comes after a grand jury met behind closed doors for eight months in 2021. 

Information from that investigation —  tens of thousands of investigatory documents, interviews and forensic and physical evidence —  is sealed from the public, but that information is what apparently led Broncucia-Jordan to change the death certificate.

Autopsies are open record in Colorado and when CPR News requested the second autopsy or any supplemental material from the 2019 report, Broncucia-Jordan declined, citing a judge’s order sealing materials from the grand jury.

“My office received confidential grand jury information that was reviewed and considered in preparing the Amended Autopsy Report in this case,” she wrote. “My hands are tied and I am not permitted to release the Amended Autopsy Report unless and until I am released from the attached Order and Oath.”

Coroners’ Autopsy Reports are Public Records and subject to no exemption from the disclosure requirements under CORA, according to the lawsuit. 

Heidi Miller, an attorney for Adams County, said in an email, “as I’m sure you can understand, our primary concern is to ensure that Coroner Broncucia-Jordan does not violate her oath related to the grand jury proceedings and does not jeopardize the grand jury proceedings in any way.”

Lawrence Pacheco, a spokesman for the Colorado Department of Law, which is a special prosecutor on this case, had no comment for this story.

Sheneen McClain, Elijah’s mother, had no immediate comment on the story. The city of Aurora settled a lawsuit she filed against the police department for $15 million in November 2021.

Implications for the case against officers, paramedics

While not common, prosecutors can file charges of homicide and manslaughter in cases where the manner of death is undetermined —  or if there is no body at all, experts said.

But the path to conviction is steep, said former Denver District Attorney Mitch Morrissey, who is not involved in the McClain prosecution. 

Morrissey said that all murder charges, from first degree murder to criminally negligent homicide, require that the defendants be the cause of death. He said the more specificity in an autopsy, the better for a prosecution.

“It’s problematic if you don’t have a cause of death,” said Morrissey, who served as DA from 2005 to 2017. “Any level of homicide requires that the actor you’re charging caused the death … I think that anytime you don’t have a cause of death it’s very difficult to go forward with any kind of homicide charge in Colorado.”

Denver defense attorney Iris Eytan, who represented a client who was acquitted in a murder trial after an autopsy was changed, called the coroner’s first-blush impressions of what happened, and the potential for police persuasion, problematic. 

“Rarely do they have all the information,” Eytan said. “What ends up happening is law enforcement’s versions of events are not that objective and the findings are not necessarily reliable and the police and prosecutors are extremely influential in moving the forensic pathologist in the direction they want them to go.”