Questions Remain After Lowenthal Autopsy

I posted about Louis Lowenthal in Youth Swimmer Remembered, and have been waiting to find out what happened. I’m sure his family, friends and teammates want to know exactly what led to such a tragic death, but this article doesn’t clear things up:

Towson teen swimmer’s death was accidental, autopsy shows

An autopsy on the body of Louis Lowenthal, the 14-year-old swimmer from Towson who died last October after being found unconscious in a pool at North Baltimore Aquatic Club, determined his death was accidental and caused by complications of partial drowning. …

The report, completed by Associate Pathologist Erin Carney and Assistant Medical Examiner Russell Alexander, said Louis was in cardiac arrest when he was pulled from the pool.

The autopsy said he was resuscitated and taken to Sinai Hospital, where he was found to have anoxic brain injury — which is caused by prolonged lack of oxygen to the brain.

Frankly this report raises more questions than it answers. The boy was so well-liked that I assumed it was an accident, but did he pass out while underwater and partially drown, or did he have a heart attack while underwater …  and partially drown? Could he have been saved from the anoxic brain injury? How long was he underwater?

Lowenthal was reportedly doing extra lengths of underwater swimming after practice, but whether he was practicing face-down breaststroke, face-down dolphin or face-up dolphin hasn’t been reported, and may not be known. I’ve seen the extra lifeguard posted to watch underwater swimmers in the 50m lane more closely, but I have no idea what lane Louis was in.

Update 1: Concussion.net claims they have a full copy of the eight-page autopsy, but has only summarized the conclusions. SCAQblog claims they got the autopsy from Concussion, and writes a disturbing account of what they say it contains. They’ve each made a lot of unsupported claims, though, so I prefer to withhold judgment until the actual document is produced.

Update 2: In a comment, SCAQblog’s Tony Austin repeats hearsay about the events leading to Louis Lowenthal’s drowning, but it doesn’t really add up:

If you satellite view the Meadowbrook Aquatic & Fitness center at Google, look to the left of the LCM pool and you will see a building that houses the indoor pool. An opaque curtain separates the indoor on the left from the outdoor pool to the right.

Actually both the indoor and outdoor pools are 50 meters in length. Six of the eight indoor lanes are divided into 25m and 25 yard lanes. Six of the 12 outdoor lanes are divided into 25m and 25 yard lanes. In good weather, there is an opaque fabric screen between them, but there are gaps you can walk through. The outdoor pool was scheduled to be open until at least October 15th. Weather was warm enough that by October 28th, the outdoor pool was still open, still heated to 70 degrees and we fitness swimmers were still using it. It was closed on October 30th.

When workout was over; (and this is how I understood it), Louis went under the curtain to the long course pool and began swimming unsupervised. The lifeguard at the indoor pool could not see that Louis had done this for an opaque curtain obfuscated his view of the LCM pool. Believing that everyone left the indoor pool area the lifeguard left the indoor pool and went inside since his “shift” was seemingly over.

That sounds possible (but see Update 3 below). The pool was warm, but the air was cold. Only diehard fitness swimmers that like having their own 50m lane (like me) were using the outdoor pool by then, so there wouldn’t have been a lifeguard out there unless staff knew there was a swimmer or swimmers wanting to be out there. I did, in fact, walk outside to find an empty pool earlier in October. I started swimming 50m laps and within a few minutes a lifeguard came out to watch me.

Some time later in the LCM pool Louis was found near dead. I was told he was underwater for about 8-12 minutes, …

This makes no sense. If someone saw him motionless underwater, how could they have known how long he had already been underwater? If someone knew he was in trouble 8-12 minutes earlier, why didn’t they save him then? He could have been swimming until just a few minutes before he was found.

… but the autopsy report is so vicious I presume he was underwater much longer than that.

I’ve read that after only three to five minutes of drowning while conscious in warm water, one can expect irreversible brain damage. Ten minutes is long enough for death to occur. The Sun reported that the boy was partially drowned with anoxic damage and cardiac arrest, which leads me to think that he was pulled out somewhere between three and ten minutes after blacking out.

Update 3: Concussion.net has posted a partially redacted copy of the Pool Injury Report to the MD Department of Health and Mental Hygiene, which places the boy’s unconscious body in the longest lane – more than 50m – of the outdoor pool, and close to the pool entry ramp near the door to the hallway that leads to lockers and the swim shop. That is not a very deep part of the pool. The report claims that three lifeguards were present, though that may include lifeguards at the indoor pool and indoor kids pool. I have a theory about why he may not have been seen until too late.

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2 responses to “Questions Remain After Lowenthal Autopsy”

  1. SCAQTony (@SCAQTony) says :

    I am Tony Austin, the SCAQ blogger. I am very flattered you linked to me.

    Allow me to clarify the 8-12 minute statement. I was told the lifeguard went inside after the swim workout. 8-12 minutes later he walked outside and saw Louis at the bottom of the pool. He immediately extracted him and CPR was began by a second person. (I forgot his name – not a lifeguard.)

    The brain will die after approximately six minutes without oxygen but special conditions may prolong this. (Frigid water, salt water etc. etc.)

    I suspect he was under for longer than 12-minutes due to the brain Autolysis noted in the autopsy. 6-minutes without oxygen will kill a brain but for dramatic autolysis to really be witnessed; (autolysis is when cells commit suicide en masse thereby rendering the brain into “jello” like state), will take hours. I suspect he had to have been in distressed longer than 12-minutes.

    Hence, for the Sylvius Aqueduct to completely self-destruct or become obliterated to quote the autopsy report, and then compound that by the observable autolysis condition, how can a brain to be in such a dramatic condition in “just” 8-12-minutes?

    Nonetheless, one could argue that the Autolysis occurred when he was on the ventilator and the brain bleeding started at that time as well, but we still have a death here due to poor management of the pool yard and sloppy inventory of where and what the NBAC swimmers were doing.

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    • Donal says :

      Your clarification claims that the boy was found 8 to 12 minutes after practice ended, so unless he slipped out of practice early (which would have been noticed), he could only have been underwater for 7 to 11 minutes. That he was able to be partially revived seems to indicate that he spent less time than that underwater.

      And I see another commenter claims that practice was held outdoors, and that Louis never left the pool.

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