The Importance of Autopsies in Drug Delivery Resulting in Death Cases: Assessing the Uncertainty of Fentanyl Intoxication through the Lens of Commonwealth v. Sisco

On August 17, 2021, Bernard Sisco was arrested in Philadelphia County for drug delivery, resulting in death, possession with intent to deliver narcotics, and related charges.¹ The allegations were that Mr. Sisco sold narcotics laced with Fentanyl to the decedent.² The decedent was never autopsied, yet the assigned medical examiner, Dr. Julia De La Garza,³ concluded that he died from a Fentanyl overdose, testifying at trial that the quantity of Fentanyl in the decedent was fatal in all circumstances. Under § 2506, a person commits “drug delivery resulting in death if s/he intentionally administers, dispenses, delivers, gives, prescribes, sells or distributes any controlled substance or counterfeit controlled substance … and another person dies as a result of using the substance.” There are two elements to § 2506 that must be proven beyond a reasonable doubt: 1) that the Defendant sold/provided drugs to the decedent; and 2) that the decedent died as a result of ingesting those drugs.⁴ Defendant’s forensic pathologist⁵ testified that, first, without an autopsy, there was no way to determine what caused the decedent’s death, and second, the amount of Fentanyl in his system was not necessarily lethal. Mr. Sisco’s verdict of not guilty to the homicide charge underscores the importance of autopsies in all suspicious deaths, but, more importantly, brings to light general misconceptions of Fentanyl toxicology and the disjuncture between medical examiner reports and the scientific literature that should guide their interpretations.