The sedative that paramedics gave to a gay San Francisco man who'd had a violent outburst at a Castro district bar was partly to blame for his death, the San Francisco Medical Examiner's office has determined.
Paramedics responding to Hecho Cantina, at 2200 Market Street, on March 11 gave Abel Marquez, 36, the sedative midazolam to calm him. Marquez, who'd reportedly been using methamphetamine, soon fell into a coma and died almost two weeks later, according to the medical examiner's report, which was made available last week.
The report, which calls the death an "accident," lists the cause as "complications of anoxic ischemic encephalopathy," or brain injury stemming from a lack of oxygen, "due to probable methamphetamine exposure with midazolam sedation."
The filing says that police responded to Hecho, which has since closed, at about 8:30 p.m. after someone called 911 saying that Marquez was "behaving violently and allegedly breaking windows."
Paramedics with the San Francisco Fire Department noted when they arrived that police were restraining a "combative" Marquez, the report says.
"The subject's hands had been handcuffed behind his back and he was being held prone on the floor by the officers," according to the report. "Paramedics noted the smell of alcohol on the subject," and there was also a cut on his left wrist.
Paramedics reported that Marquez's "aggressive behavior made assessment and treatment difficult."
As they secured him to a backboard, they gave him a 5-milliliter intramuscular injection of midazolam, which is also known as Versed. As they continued securing Marquez, "he suddenly went limp, pulseless," and stopped breathing, the report says. An electrocardiogram showed that he was in cardiac arrest.
Paramedics "immediately" began resuscitation, and they continued their efforts on their way to Zuckerberg San Francisco General Hospital. Marquez "was successfully resuscitated and stabilized" shortly after they got there just after 9, but he remained comatose.
Almost two weeks later, Marquez was pronounced dead at 12:11 a.m. March 24 in the Intensive Care Unit.
Max Szabo, a spokesman for the San Francisco District Attorney's office, said Marquez's case "is being investigated as an in-custody death by our independent investigations bureau."
The medical examiner's report says that Marquez, who was also known as Abel Florentino, was "obese" and had a history of meth and alcohol use.
Methamphetamine, amphetamine, and evidence of midazolam were found in urine samples taken from Marquez about two days after he arrived at the hospital.
Dr. Amy Hart, who performed the autopsy, wrote in notes included with the report that she viewed body camera recordings from officers who responded to Hecho and "blurry" surveillance footage from the bar, and the images didn't change her opinion about the cause and manner of death. She also reviewed reports from police and paramedics about the incident.
David Monroe, Marquez's stepfather, said just before Marquez died that he believed mixing the sedative with other substances in Marquez's body had endangered his life.
In an interview last week, Monroe, who'd called Marquez "one of the most loving, caring guys you'll ever meet," said the family isn't pursuing a lawsuit "at this time."
"The whole thing's a nightmare," he said. "... We lost our only son."
Monroe said that an attorney told him the family doesn't have a legal case because it takes "much longer" for midazolam "to take effect" than what the medical examiner's office indicated.
"I probably could look into it further, but I haven't, really. It's not something you want to think about all the time, to tell you the truth, and I just can't put my wife through any more of this," said Monroe, who declined to share the name of the law firm he'd consulted with.
Lieutenant Jonathan Baxter, a fire department spokesman, didn't respond to an interview request for this story.
Marquez's husband didn't respond to a message sent through Facebook.