Editor's note: One week ago, The Mining Journal reported Michigan State Police concluded a worker at the Tilden Mine died from a heart attack and not his fall in December. This week, the county medical examiner explained the context for that conclusion.
MARQUETTE - Marquette County Medical Examiner John Weiss said Thursday he would never be able to say with absolute certainty what caused a worker at the Tilden Mine to fall from a railroad car to his death in December.
Gary Hytinen, 61, of Ishpeming was pronounced dead at 2:18 p.m. Dec. 6 in the emergency room at Bell Memorial Hospital. Hytinen, a 39-year veteran with Cliffs, was working as a reagent handler in the unloading area at the mine when he fell roughly 12 feet from a railroad tanker car to the cement below.
In his autopsy report and a county death certificate, Weiss ruled the manner of Hytinen's death was natural and that the cause of death was likely related to a heart attack Hytinen had suffered a month or two prior to the accident.
Weiss said Hytinen died from a skull fracture he suffered, but what caused him to fall and suffer that fracture is where Weiss said he sided in favor of a probable arrhythmia (irregular heartbeat) derived from the recent heart attack, based on the evidence.
"You have to work back until you stop, until you get to the thing that actually caused it," Weiss said. "We worked back and then came to a probabilistic cause of death, not a certainty."
This week, family members sought Weiss out in hopes of gaining a better sense of closure and understanding in Hytinen's death by learning more about the reports the medical examiner filed. The family made those reports available to The Mining Journal.
"I spoke with the family yesterday and went through the details of my thought pattern and how that I can't prove 100 percent that he didn't slip on some ice or something like that," Weiss said. "But the fact that he has an organic problem that would predispose him to having this sort of event and falling, makes me lean toward that being a probability, how high the probability? That's guesswork."
An investigator with the Mine Safety and Health Administration in Duluth, Minn., said the agency's investigation into the fall is continuing. Michigan State Police closed their investigation into the incident based on Weiss' autopsy finding of natural, rather than accidental, manner of death.
Hytinen's job involved climbing up ladders onto the top of railway cars and working the valves. On Dec. 6, he was assisting a semi-truck driver in backing his vehicle into the reagent barn.
"He then told the driver that he had to finish with another tank rail car at the other end of the barn," the autopsy report said, based on information from state police and ambulance reports. "The driver saw Mr. Hytinen climb up on the tanker with his hard hat and other safety gear on. He then returned to his semi-truck and was working in the back of the truck with the engine running."
A few minutes later, he walked around his truck and saw Hytinen lying on the cement floor next to the tanker car. He checked for vital signs and thought there might have been a pulse. He called for help on the radio and CPR was started by Cliffs' first responders.
"Snow on top of the tanker car was disturbed to one side of the platform," the autopsy report said. "The investigating officer felt that there was no evidence indicating he had tried to break his fall by grabbing for something on the tank."
The report indicated further investigation would come from the MSHA.
Weiss said he can say with certainty Hytinen suffered a heart attack in the weeks before his death.
"It is no question that he did. All of the findings are there," Weiss said. "...Not a very recent one, that is not within the last week or two, but a month or two out? Yeah."
Weiss said what's "amazing" is that about 50 percent of heart attacks are "silent," the patient doesn't know they've had them.
"We see this all the time, we see people with scarring in their hearts, lots of cardiovascular disease, narrowed coronary arteries, unequivocal previous infarctions and they have no history at all and didn't know they had had it," Weiss said.
Weiss said the recent heart attack would have greatly predisposed Hytinen to having arrhythmia or low blood pressure coming from it intermittently.
"That's a high-probability, though not a certainty that that was the sequence of events," Weiss said. "Have a heart attack the last couple of months, you're pretty much repaired, but you're predisposed to other events occurring from it like an arrhythmia or a fatal arrhythmia or one that shuts down your blood pressure a bit and you faint and then you fall. Of course, when nobody is there and nobody can see it, the proof isn't 100 percent. And that's a trap we always fall into, you never know what percentage to put on those probabilities."
Weiss said another potential factor was Hytinen's taking of Gabepentin, an anti-seizure medication.
"His Gabepentin levels were low. So that's another issue. How can I rule that out? Well I can't. Did he have a seizure because his medication wasn't at the right level?" Weiss asked. "All of these possibilities are there anywhere from a slip on ice to a seizure from low Gabepentin levels to an arrhythmia from the heart attack. Which one is most likely? No one knows. So you have to make a semi-educated guess, seeing the level of myocardial damage and the probabilities associated with that. Most likely, it's the most probable, but that doesn't mean that that probability is 100 percent, and it's not."
Weiss said he would have listed "accident" as the manner of death if there was no evidence of the previous heart attack as the proximate cause.
"That's why it becomes natural," Weiss said. "If that weren't there at all and I had nothing to point to in his body, nothing under the microscope or nothing grossly, nothing in the drug history, then I would have defaulted to accident."
Weiss said he encounters one case every two or three years, where the cause of death needs to be changed weeks or months after it's been determined.
"We try to maintain our flexibility on that because sometimes new information does come up," Weiss said. "I doubt that that's going to be the case in this case, but you never know."