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Pathologists Conclude Homicide, Not ALS, Ended Heidi Good Swiacki’s Life

Grand jury transcripts reveal details of autopsy results pointing to combination of drugs, disconnected ventilator that led to Solvang woman’s death

Amyotrophic lateral sclerosis patient Heidi Good Swiacki out for a “roll” with her mother, Marjorie Good, left, and her caregiver, Wanda Nelson, the two women who eventually would be charged with her murder. Good and Nelson have entered not-guilty pleas and are to stand trial in November. Click to view larger
Amyotrophic lateral sclerosis patient Heidi Good Swiacki out for a “roll” with her mother, Marjorie Good, left, and her caregiver, Wanda Nelson, the two women who eventually would be charged with her murder. Good and Nelson have entered not-guilty pleas and are to stand trial in November. (Swiacki family file photo)

[Noozhawk’s note: This is the final article in a three-part Noozhawk series exploring the 2013 death of Heidi Good Swiacki, who suffered from amyotrophic lateral sclerosis, or ALS. Information for the stories was derived from statements and evidence presented during criminal grand jury hearings that resulted in the Solvang woman’s mother and her caregiver being indicted on first-degree murder and conspiracy charges. Not-guilty pleas have been entered for the defendants, who are to stand trial in November. Click here for the first article, and click here for the second article.]

Heidi Good Swiacki’s body bore no signs that death was near when she took her final breath on March 25, 2013.

An autopsy conducted by Dr. Robert Anthony, a forensic pathologist at the Santa Barbara County Coroner’s Office, revealed none of the usual problems that lead to death for people with amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease, or ALS.

Instead, the analysis determined that someone had given Heidi a toxic cocktail of medication, slowing her breathing to the point of severe sedation before disconnecting the ventilator that kept her breathing.

When asked during his testimony before a county criminal grand jury how long it would have taken to kill the 52-year-old Solvang wife and mother of two, Dr. Dean Hawley answered: “Minutes.”

“In my opinion, within a reasonable medical certainty, Heidi Good died of asphyxiation,” said Hawley, a forensic pathologist on the faculty at Indiana University School of Medicine in Indianapolis.

“It is a combination of respiratory-depressing drugs and being disconnected from the mechanical ventilator.”

Hawley was blunt in his testimony. 

“In a medical sense, I have two events, neither of which were done by the patient,” he added. “One is an installation of medications that were not prescribed for the patient, which have a particular effect on the patient, and the second is disconnecting from the ventilator.”

Prosecutors contend Heidi’s mother, then 87-year-old Marjorie Good, and her primary caretaker, Wanda Nelson, conspired to kill her and pin the blame on Swiacki’s husband, Stephen.

The two women are to stand trial in November on first-degree murder and conspiracy charges. Not-guilty pleas have been entered on their behalf.

Scroll down to see a timeline of events from those transcripts.

Hawley testified that Heidi, like most people living with ALS, most likely would have died eventually from an infection that would start with bed sores, with the bacteria eventually spreading to her lungs.

That was not observed at Heidi’s autopsy, he said in his testimony. According to the grand jury transcripts, Hawley said she did not have any skin breakdown or a critical infection, such as sepsis or pneumonia, indicating that death was near.

Marjorie Good, 89, the mother of Heidi Good Swiacki, has been charged with her murder and conspiracy. Prosecutors say Good and Heidi’s caregiver, Wanda Nelson, conspired to kill the 52-year-old Solvang woman and blame it on her husband, Stephen. Good has pleaded not guilty. Click to view larger
Marjorie Good, 89, the mother of Heidi Good Swiacki, has been charged with her murder and conspiracy. Prosecutors say Good and Heidi’s caregiver, Wanda Nelson, conspired to kill the 52-year-old Solvang woman and blame it on her husband, Stephen. Good has pleaded not guilty. (Janene Scully / Noozhawk file photo)

“This was not Heidi’s day to die,” Deputy District Attorney Cynthia Gresser said in her closing remarks to the grand jury.

“Heidi was in good health, she had a debilitating disease, but she was in exceptional health,” Gresser said. “Most who are bedridden, they have bed sores; they die from infection, from sepsis from pneumonia; that was not the case.

“Heidi was in excellent health and tragically has been trapped in her body, but she still led a full life.”

Anthony, who performed the autopsy, was not a grand jury witness.

Several factors led the forensic experts to deem Heidi’s death a homicide, according to the grand jury transcripts. 

Hawley said an analysis of Heidi’s blood and stomach contents revealed that she was getting her medications — and much more.

Samples were tested by the National Medical Services Labs in Pittsburgh, and the results revealed that Heidi was administered several drugs that suppress respiratory effort.

The tests revealed a number of drugs in Heidi’s system:

» Dihydrocodeine, an opiate narcotic with 15 nanograms per milliter in the blood

» Hydrocodone, another pain medicine, at 92 nanograms per milliliter

“That is a significant level of this opiate drug,” Hawley said of the hydrocodone.

» Zolpidem, at 71 nanogram per milliliter

“It’s a drug that going to stop her breathing when it’s added to the opiate narcotics and these other drugs that follow,” Hawley testified.

» Diphenhydramine (aka Benadryl), also found in ZzzzQuil, which is Benadryl and alcohol, making it a “very potent sedative drug,” according to Hawley.

Wanda Nelson, Heidi Good Swiacki’s caregiver, has been charged with her murder and conspiracy. Prosecutors say Nelson and Marjorie Good, Heidi’s mother, conspired to kill the 52-year-old Solvang woman and blame it on her husband, Stephen. Nelson has pleaded not guilty. Click to view larger
Wanda Nelson, Heidi Good Swiacki’s caregiver, has been charged with her murder and conspiracy. Prosecutors say Nelson and Marjorie Good, Heidi’s mother, conspired to kill the 52-year-old Solvang woman and blame it on her husband, Stephen. Nelson has pleaded not guilty. (Janene Scully / Noozhawk file photo)

“Its blood level was 1,600 ng/ml, and that’s way toxic,” he testified. “It’s not fatal. In patients dying of overdoses of Benadryl, this wouldn’t be enough Benadryl to kill a healthy person independent of other drugs.

“In other words, if the only thing you took was ZzzQuil, you’d have to take more of it to die if you were healthy and you didn’t have any other medicines. But for even a healthy person combined with these other drugs, this is really bad.”

» Dextromethorphan (aka over the counter Delsym). While Heidi had a prescription for Dex and Quinidine — prescribed for muscle spasms and cramps — the Quinidine was at a “really low level,” Hawley testified.

The level of Dex in Heidi’s system — 200 times what normally would be expected — could not have come from the combination pill, Hawley said.

It likely came from a separate source, he added.

“All I can say is it’s at least two-fold the upper limit, at least twice as much of the upper limit of the toxicity of the drug, maybe 200 times too high; that’s going to suppress respirations,” Hawley said in his testimony.

“You add that to the Benadryl, to the Zolpidem, to the Hydrocodone and Dihydrocodeine, and you have a cocktail here that’s going to make her severely sedated.”

In addition to the tracheostomy tube for breathing, she also had a G tube (or gastrostomy tube) for feeding. The feeding tube also is how she received her medications.

According to a written log cited in the grand jury transcripts, Heidi’s last feeding or prescription administration through the G tube occurred at 12:16 p.m.

But the last entry was logged at 1:23 p.m. for suctioning of her breathing tube to remove any mucus. Under the normal procedure, she would have been taken off the ventilator briefly while a caregiver completed the suctioning and reconnected the machine.

A prosecutor asked Hawley if it’s possible that two different people administered the drugs and did not record it?

“Yes,” he answered.

Wanda Nelson, Heidi Good Swiacki’s caregiver, says the Solvang woman sent her on an errand to the Rite Aid Pharmacy on the day she died. When she returned, she testified that she found the 52-year-old wife and mother of two dead in her bed with her ventilator’s alarm going off. Click to view larger
Wanda Nelson, Heidi Good Swiacki’s caregiver, says the Solvang woman sent her on an errand to the Rite Aid Pharmacy on the day she died. When she returned, she testified that she found the 52-year-old wife and mother of two dead in her bed with her ventilator’s alarm going off. (Janene Scully / Noozhawk file photo)

In addition to the medications, alcohol was found in Heidi’s stomach contents but not in her blood, which means it got there shortly before she died, since alcohol is digested very quickly, Hawley said in his testimony.

Hawley testified that examination of data pulled from the ventilator confirmed “the machine was disconnected from the patient when she died.”

The machine had been disconnected for 30 minutes, the blaring alarm unheard or ignored.

But Hawley said accidental disconnection of the machine doesn’t explain other findings revealed by the autopsy.

“A simple explanation that there was an inadvertent or accidental disconnection from the ventilator, followed by leaving the house, therefore not hearing the alarm, avoids the discussion about the installation of drugs in this patient’s stomach,” Hawley said.

According to the grand jury transcript, Nelson said Heidi had sent her to the pharmacy on an errand and Good said she was outside the house, gardening.

The alarm was going off when Nelson returned, and she testified that she found Heidi dead in her bed.

Even accepting the ventilator was accidentally disconnected doesn’t account for the unprescribed drugs administered before the breathing machine stopped, Hawley told the grand jury.

“So I can’t justify just one event here, saying one followed the other, when neither one of those events should have happened,” he added. “I would still conclude in a medical report that the death was homicide, even under the unlikely circumstance that whoever the caregiver is is simply unable to hear the alarm; that doesn’t explain the rest of the sequence here.”

Noozhawk North County editor Janene Scully can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

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