MLive reported that according to Walter Jarnot’s death certificate, he died Sept. 4, 2015 of asphyxia due to aspiration of food, but the circumstances surrounding his death remain suspiciously unclear. According to an autopsy, the World War II veteran living at Glacier Hills Adult Care Facility was eating dinner when he began to choke on his egg drop soup. The autopsy confirms Jarnot was pronounced dead at 7:25 p.m. after choking on egg drop soup at dinner in Glacier Hills Adult Care Facility in Ann Arbor. It states Jarnot began having difficulty breathing while eating, and staff members attempted the Heimlich maneuver but Jarnot became unresponsive.
The autopsy states the funeral home received the death certificate Sept. 9—five days after the incident—and the cause of death was listed as “asphyxiation due to aspiration on food bolus due to probable dementia.”
Under Michigan law, the facility should have notified the county’s medical examiner within two days if there was suspicion that the death was sudden or accidental.
Jarnot’s family members, the Ann Arbor Police Department and the Michigan Department of Licensing and Regulatory Affairs are all trying to figure out exactly what happened next.
Walter’s son, Charles Jarnot, was informed by Glacier Hills that Walter’s death was a result of “natural causes.” He said the nursing home was negligent in documenting his father’s death and a nurse at the home may have incorrectly responded to the 89-year-old’s choking.
An inspection by the state of Michigan’s Department Licensing and Regulatory Affairs (LARA) found there was no documentation of the incident at Glacier Hills, and staff gave conflicting accounts of what happened during interviews and subsequent investigations.
According to a LARA investigation, an unnamed Glacier Hills administrator said she was not made aware of the incident until Sept. 11 and started an investigation. The investigation report contains a similar narrative to the autopsy up until the point after the Heimlich maneuver was administered. Then it diverges.
“(Nurse “E”) realized that [Jarnot] was not choking, as he was breathing and had coughed in normal fashion,” the investigation report reads.
“The staff initially moved the resident from the dining room into the hallway and attempted to take [his] vital signs. They had difficulty obtaining a blood pressure. The staff then assisted the resident into his bed… Verbal and Tactile stimulation continued with limited response from [Jarnot]. Within moments, the staff stated he took a couple of big breaths and then stopped breathing.”
The nurse stated during the investigation that the whole event lasted about 10 minutes and that she would classify it as an “unusual event or incident.” She added that she did not document the occurrence because it slipped her mind.
Walter Jarnot’s son, Charles Jarnot, said the family was preparing to bury their father in Buffalo, New York when they received a call from an employee of the funeral home asking if they were aware of the cause of death.
According to Charles Jarnot, the man told the family that their father’s death was an accidental death, and it should have been followed by an autopsy performed by the medical examiner. At that point, Jarnot’s autopsy had not yet occurred because the death had not been reported by Glacier Hills to the examiner’s office.
The call prompted the Jarnot family and the funeral director to confer, and the funeral director to notify the medical examiner.
Washtenaw County medical examiner Dr. Jeffrey Jentzen said under normal circumstances of death at a long-term care facility, the facility notifies his office within a 48 hour period, with some leeway for weekends and holidays.
“We perform autopsies on cases in which the cause of death is uncertain or when there is additional information that needs to be documented,” Jentzen said. “If a patient died in a long term care facility when there’s a suspicion that the death may have been accidental or caused by an external cause, they are reported to the medical examiner and they make the decision if it’s going to be autopsied or if it won’t be necessary.”