While the cause of death is clear - a stab wound to the chest - the top medical examiner in the state could not determine whether Keo Gail Pittman died as the result of suicide or at the hand of her husband, George Pittman, Jr.
"The findings of the autopsy are consistent with either a homicide or a suicide and I can't make that determination," said Iowa State Medical Examiner Dr. Julia Goodin. "The information I have is not enough to say one way or another."
Goodin testified yesterday in the first-degree murder trial of George Pittman, Jr. He is accused of stabbing to death his wife at their home on Sept. 23, 2001, in Storm Lake.
The prosecution rested its case yesterday. The defense is set to continue this morning.
There was a deep wound to the left side of Keo Pittman's chest which pierced her lung and her heart. Another stab wound was on her right forearm, Goodin said, along with bruises on the inside of her upper right arm and four abrasions on the top of her head.
In an autopsy, Goodin said there are five classifications for manner of death, including homicide, suicide, accidental, natural and undetermined. She answered questions from both the prosecution and the defense, telling attorneys on each side she could not determine the manner of death.
"You leave it undetermined if the information is inconclusive," Goodin said.
The state claims George Pittman killed his wife, while the defense says Keo Pittman committed suicide. Autopsy evidence shows Keo Pittman's death to be either a homicide or a suicide, Goodin said.
When questioned by Assistant Attorney General Chuck Thoman, Goodin said the knife that was used to stab Keo Pittman had to have passed through one of her ribs.
"It certainly takes more force to go through a rib than soft tissues of the body," she said.
The cause of death is the stab wound to the chest, Goodin said, which entered on the left side of her chest and moved toward the right, damaging the left lung, the left ventricle on the heart and part of the liver. That wound caused death by either internal bleeding or by causing Keo Pittman's heart to stop pumping properly, the medical examiner said.
While explaining the nature of Keo Pittman's wounds was easy, the hard part was to explain where they came from.
Goodin said she could not explain where the abrasions on Keo Pittman's head came from. However, she told Thoman they are not consistent with suicide.
"It's an unusual pattern in a suicide," she said, noting it would have been difficult for Keo Pittman to have inflicted those herself.
The head abrasions are listed as blunt force injury on the autopsy, she said. They could have been made with an item, a fist or by falling, she noted.
Thoman asked Goodin if George Pittman could have caused the head wounds with his fist or by grabbing Keo Pittman and throwing her into a wall. "Is he big enough, strong enough to inflict this kind of injury in that manner?" Thoman asked.
"Yes," Goodin said.
She added it was unusual for the knife not to still be in the chest if that wound was self-inflicted. Last September, Keo Pittman was found by Storm Lake Police Officers lying on her back with a knife resting in her right hand.
Also inconsistent with suicide is a lack of "hesitation marks" on Keo Pittman's wrists, Goodin said.
During cross examination by defense attorney Paul Miller, Goodin said the smaller stab wound on Keo Pittman's right forearm is not a "classic defense wound." Typically a person would hold their arms up, blocking a blow with the underside of the forearms. The wound on Keo Pittman's arm, though, is on the opposite side.
Goodin also told Miller that there was no underlying skull fracture or damage to Keo Pittman's brain associated with the abrasions on her head. She said she could not determine if the abrasions or bruising on the arm came at the time of death or earlier in the day. Goodin said those injuries could have happened four to six hours prior to Keo Pittman's death.
In determining a manner of death, Goodin said she does consider information provided to her from law enforcement officials. In this case, she knew a 911 call had been made by George Pittman saying his wife stabbed herself, and Goodin said she was aware of threats George Pittman allegedly made against his wife.
"What I'm saying is it's possible that wound could have been self-inflicted," she said. "The only thing leaving the possibility of suicide was the fact the defendant claimed he didn't do it."
A fingerprint analyst with the State of Iowa testified that no fingerprints were recovered from the knife that created Keo Pittman's wounds.
Other witnesses for the state included two of Keo Pittman's co-workers at Central Bank who said Keo Pittman did not appear depressed, and two former jail inmates who knew George Pittman at the Fort Dodge Correctional Facility. They said at times they would avoid George Pittman because of how angry he could become.
As the defense began to present its evidence, an agent with the Iowa Division of Criminal Investigation read from reports he wrote after interviewing three of the children who were at the Vestal Street house where Keo Pittman died on the evening of Sept. 23, 2001. Miller had the DCI agent point out parts of those interviews that conflicted with testimony the children gave on Wednesday.
Also, the defense questioned another DCI agent about a photograph the crime scene team took of a cigarette butt near the front steps of the Pittman house. George Pittman claimed he was outside smoking a cigarette at which time his wife stabbed herself. He claims that when he came back inside the house he found her on the floor in the bedroom.
Thoman said that cigarette could have been discarded there at any time. The DCI agent said the only reason they took a picture of the butt was because they were briefed at the Storm Lake Police Department on George Pittman's story before they went to 803 Vestal St.
A portion of the 911 call George Pittman made that night was also played. It begins with Pittman yelling for the dispatcher to "send someone over."
"My wife and I had an argument and she did something to herself," he said during the call.