UPDATE: On June 10, The Tarrant County Medical Examiner’s office issued a press release (below) while making the complete autopsy available ahead of schedule after the Irons family chose to consent to release. Representatives of the Irons family also made a summary of their doctors’ findings available (below as well).
Conflicting reports are currently coming in concerning the cause of death in the passing of Andy Irons. According to an official autopsy report obtained by the New York Times, the primary cause of Irons' death was cardiac arrest, related to coronary artery disease. The secondary cause of death, according to the Times, was acute mixed drug ingestion. The Tarrant County Medical Examiners office prepared the autopsy, which will not be made public until June 20. A press release, prepared by the Irons family, has also circulated. In the release, a medical examiner who consulted with the family comes to a different conclusion on the matter of whether drugs contributed to Irons' death. “[Drug ingestion was] not the cause of death and did not contribute to the death,” said forensic pathologist Dr. Vincent Di Maio in the Irons family’s statement. “The Manner of Death is in fact labeled Natural."
Read the Times story, the Iron’s family press release, the release from the Tarrant County Medical Examiner’s office, and statements from the Irons family’s consulting doctors below.
FOR IMMEDIATE RELEASE
Public Information Officer: Roger Metcalf, DDS
Inquest Performed on Phillip Andrew Irons
Tarrant County Medical Examiner's Office has concluded the inquest on the body of Philip Andrew Irons, a 32-year old white male and a resident of Hawaii. The body of the decedent was discovered in a hotel room at the Grand Hyatt at Dallas-Fort Worth International Airport. A complete postmortem examination performed at the Tarrant County Medical Examiner's morgue in Fort Worth on 11-03-2010 was essentially negative for trauma and thorough investigation has ruled out foul play. Release of final autopsy report was delayed at the request of the family and in accordance with the court injunction.
Autopsy revealed presence of severe coronary artery disease and the postmortem toxicology studies indicated recent use of methadone and cocaine. Both immunochemical and molecular studies were negative for Dengue and other flavivirus (agents causing Dengue fever). Although the primary and the underlying cause of death is attributed to ischemic heart disease due to coronary artery pathology, the presence of both methadone and cocaine is a significant finding especially in a death due to a sudden cardiac event and is listed as contributing to the death but not resulting in the underlying cause. The death is ruled as "natural".
Accredited By National Association of Medical Examiners and American Society of Crime Laboratory Directors Accreditation Board
FROM J.M. DI MAIO, M.D.
CONSULTANT IN FORENSIC PATHOLOGY
Re: Phillip Andrew Irons, deceased
As requested, I have reviewed the Autopsy Report on Phillip Andrew Irons. This is a very straight forward case. Mr. Irons died of a heart attack due to focal severe coronary atherosclerosis, i.e. "hardening of the arteries". He had an atherosclerotic plaque producing 70-80% narrowing of his anterior descending coronary artery. This is very severe narrowing. A plaque of this severity, located in the anterior descending coronary artery, is commonly associated with sudden death.
The only unusual aspect of the case is Mr. Iron's age, 32 years old. Deaths due to coronary atherosclerosis usually begin to appear in the late 40's. Individuals such as Mr. Irons have a genetic predisposition to early development of the coronary artery disease. In about 25% of the population, the first symptom of severe coronary atherosclerosis is sudden death. There were no other factors contributing to the death.
Toxicological analysis of the blood revealed the presence of two medications alprazolam and methadone. Alprazolam is an anti-anxiety drug of the benzodiazepine group. Methadone is an analgesic drug used extensively in the treatment of chronic pain. Both drugs are present in therapeutic levels. Also present was benzoylecgonine, the inactive metabolite of cocaine. These drugs did not cause or contribute to the death.
VINCENT J.M. DI MAIO, M.D.
FORENSIC TOXICOLOGY CONSULTANTS, INC.
From Gary H. Wimbish Ph.D., DABFT
Diplomate American Board of Forensic Toxicology
The following substances were listed in the Tarrant County Medical Examiners Postmortem Toxicology Report: Alprazolam, Methadone, Zolpidemand Benzoylecgonine
Alprazolam (Xanax) is a short acting antidepressant and anxiolytic (helps to relax) agent. Adult doses range from 0.25-2I11g to be taken 3x/daily. Individuals taking 6 mg/day reached an average blood concentration of 49 ng/ml. The concentration found in Mr. Irons’ blood was 52 ng/ml. This concentration is consistent with a common therapeutic regimen.
Methadone is a synthetic narcotic antagonist and was prescribed for years to block the effects of heroin. However, in recent times, it is used as an effective analgesic for the treatment of chronic pain. With chronic administration of 100-200 mg daily oral doses to tolerant individuals blood concentrations range from 428-795 ng/ml. The concentration found in Mr. Irons’ blood was 160 ng/ml. EDDP is a metabolite of methadone and an expected finding.
Zolpidem (Ambien) is a hypnotic agent (sleep inducing) prescribed in doses of 5 or 10mg to be taken before bedtime. Its duration of action is about 8hours.
Benzoylecgonine is an inactive metabolite (breakdown product) of cocaine. Its presence in his blood at 50 ng/ml is consistent with·the use of cocaine at about 30 hours prior to his death.
Irons' Family Statement
June 8th, 2011
TO: MEMBERS OF THE MEDIA
FROM: THE FAMILY OF ANDY IRONS
RE: OFFICIAL IRONS FAMILY STATEMENT REGARDING ANDY IRONS AUTOPSY AND TOXICOLOGY REPORT
We have received the final autopsy and toxicology report filed in connection with Andy’s death on November 2nd, 2010, from the Tarrant County District Attorney’s Office in Forth Worth, TX.
The family apologizes for the delay in the release of this information. The injunction filed last December was to allow Andy’s widow, Lyndie, who was then eight months pregnant with Andy’s son, Andy Axel Irons, to give birth in peace. Please understand that this decision meant that the family did not learn the cause of Andy’s death until May 20th, and only after a second delay was requested by an attorney in Dallas, without the family’s knowledge or consent, to provide time for the 13-page toxicology report to be interpreted by two independent forensic experts – a process that took several weeks, but also enabled the family to fully come to terms with the unexpected root cause of Andy’s death.
The autopsy concludes that Andy died a natural death from a sudden cardiac arrest due to a severe blockage of a main artery of the heart. Dr. Vincent Di Maio, a prominent forensic pathologist in San Antonio, TX, who has consulted on many high-profile cases, was asked to review and explain the autopsy results to the family. He states: “This is a very straightforward case. Mr. Irons died of a heart attack due to focal severe coronary atherosclerosis, i.e., ‘hardening of the arteries.’ He had an atherosclerotic plaque producing 70%-80% narrowing of his anterior descending coronary artery.This is very severe narrowing. A plaque of this severity, located in the anterior descending coronary artery, is commonly associated with sudden death.”
Dr. Di Maio continues: “The only unusual aspect of the case is Mr. Irons’ age, 32 years old. Deaths due to coronary atherosclerosis usually begin to appear in the late 40’s. Individuals such as Mr. Irons have a genetic predisposition to early development of coronary artery disease. In about 25% of the population, the first symptom of severe coronary atherosclerosis is sudden death.” He concludes: “There were no other factors contributing to the death.”
Andy had a grandmother, 77, and a grand-uncle, 51, both on his father’s side, who died of congestive heart failure.Looking back, Lyndie recalls that Andy complained of chest pains and occasional intense heartburn for the first time last year, and also recalls a holistic health practitioner, whom he sought out in Australia for vitamin therapy,offhandedly mentioning he “had the heart of a 50-year-old.” In addition, Andy contracted Typhoid Fever five years ago, which can result in damage to the heart muscle.But Andy shrugged it all off and led no one to believe he was in ill health.
The official autopsy report, prepared by Tarrant County Chief Medical Examiner Nizam Peerwani, MD, lists a second cause of death as “acute mixed drug ingestion.” On this point, Dr. Peerwani and Dr. Di Maio diverge. In a letter sent to Arch McColl, a Dallas-based attorney acting on behalf of the family, Dr. Di Maio questioned Dr. Peerwani’s decision to list the finding “Acute Mixed Drug Ingestion” under “Cause of Death” because he believes “it was not the cause of death and did not contribute to the death. The Manner of Death is in fact labeled Natural.” Dr. Di Maio goes on to say that the drugs cited, Alprazolam (Xanax) and methadone (an analgesic drug commonly used in the treatment of chronic pain), are in “therapeutic levels” and notes that benzoylecgonine is an “inactive metabolite,” which Gary H. Wimbish Ph.D., DABFT, a forensic toxicologist consulted by the family, has explained is a breakdown product of cocaine. Wimbish states that the benzoylecgonine present in Andy’s blood at 50 ng/ml “is consistent with the use of cocaine at about 30 hours prior to his death.” In addition, Wimbish agrees with Dr. Di Maio that that the amount of Alprazolam present in Andy’s blood “is consistent with a common therapeutic regimen.”
Dr. Peerwani’s report also cites the presence of a trace amount of methamphetamine. Lyndie insists Andy was not a methamphetamine user, so it is likely the substance was present in the cocaine he ingested. But again, Dr. Di Maio believes that none of these drugs was the cause of, or contributed to, Andy’s death.
As we are not doctors, we have no choice but to accept that two respected pathologists have come to different conclusions about a secondary contributing cause of death. However, the family would like to address the findings of prescription and non-prescription drugs in Andy’s system. Andy was prescribed Xanax and Zolpidem (Ambien) to treat anxiety and occasional insomnia – a result of a bipolar disorder diagnosed by his family doctor at age 18. This is when Andy first began experiencing episodes of manic highs and depressive lows. The family believes Andy was in some denial about the severity of his chemical imbalance and tended to blame his mood swings on himself and his own weaknesses, choosing to self-medicate with recreational drugs. Members of his family, close friends, and an industry sponsor intervened over the years to help Andy get clean, but the effort to find balance in his life was certainly complicated by his chemical makeup.
Finally,as has been reported, Andy was suffering from severe flu-like symptoms while in Puerto Rico to compete in the Rip Curl Pro Search leg of the ASP World Tour just days prior to his death. Andy was unable to leave his bed and for the first time in his Pro career, withdrew from a contest. He was put on an intravenous drip for hydration and strongly advised to seek further medical treatment. Against doctor’s advice, Andy left for Kauai, Hawaii, to be with his wife, telling the doctor: “I just wanna go home.”
Though Andy’s illness is not addressed in the autopsy (which only tested for and ruled out suspected Dengue Fever), Andy’s weakened condition clearly contributed to the tragic circumstances of his death, adding more stress to an already gravely compromised heart.
Having defied the odds so many times before, Andy may have felt that getting on a plane while dehydrated and wracked with fever, and choosing to meet up with acquaintances during a short layover in Miami, was nothing out of the ordinary. His strong-willed personality was part of what made him such a formidable surfer and champion. Like others who face down extreme danger, Andy seemed to feel bulletproof – as if nothing could take him down.But traveling while sick and suffering from an undiagnosed heart condition, was more than even Andy could overcome.
We are hoping that people will remember Andy for his very full life, which included his intense passion for surfing and the ocean, his astonishing achievements as a world-class athlete, and his devotion to the family and friends who love him dearly and miss him every day. Receiving the disturbing news about the cause of death brings back the shock and tremendous grief we first felt upon receiving word that Andy had passed.
We would like to thank everyone for their condolences and support over the last seven months. There was so much positivity in Andy’s professional and personal life, not least of which was how hard he worked to overcome his challenges. For this we remain forever proud of him.
This continues to be a very difficult time for our family and we appreciate the media’s respect for our privacy. We are grateful for the outpouring of love and support and will not have any immediate comment beyond this statement.
For those who wish to honor Andy’s memory, we ask that they consider making a donation to the Surfrider Foundation, a charity Andy supported, at www.surfrider.org.
–The Irons Family