Dr. Autumn Klein – Medical Mystery?

In April 2013, Dr. Autumn Klein, a brilliant neurologist, suddenly collapsed after returning home from her shift at a Pittsburgh hospital. What was causing her system to shut down?  Was it something that she encountered at work or something more sinister? Listen to the medical mystery that doctor’s raced to resolve while trying to save one of their own.  Was it an accident, suicide, or murder?

Potassium Sodium Cyanide R. de Salis.Rodolph 22:24, 9 June 2007 (UTC) / CC BY-SA

Autumn Collapses

On April 17, 2013, Robert Ferrante called 911 and said his wife was “conscious and breathing, but not alert” inside their Pittsburgh home. “Please, please, please,” he said. “… I think my wife is having a stroke.”

When paramedics, Steve Mason and Jared Albaugh, arrived her husband said that she collapsed suddenly while complaining of a headache. Immediately, the two paramedics began their assessment. At least she was breathing and had a pulse. Steve got a quick summary from her husband Robert Ferrante. Autumn was a neurologist at the University of Pittsburgh-Medical Center. She had returned home at about 11:30 p.m. after work and tumbled to the floor just a few minutes later. 

Next to Autumn was a bag of white powder which Ferrante explained was creatine which his wife was taking to help her get pregnant. Autumn began crashing. Her blood pressure and pulse were dropping fast. They rushed her to the ambulance, called ahead to the hospital, and raced the half-mile there.

At the Hospital

They pulled up to the emergency entrance at 12:21 a.m., just over an hour after she had left work there.

Emergency department resident Dr. Andrew Farkas met the stretcher in the hallway. Klein’s eyes were open and glassy, and her breathing was shallow. There was a vacant look on her face. Her heart rate was measured in the low 40s, and her blood pressure was only 48 over 36. 

A team of nurses put in another IV to push fluids and boost Dr. Autumn Klein’s blood pressure. Her respirations were starting to slow — as low as four per minute. She was put on a ventilator immediately to help her breathe. Dr. Farkas inserted the breathing tube in place, then ran to get his attending physician Dr. Thomas Martin.

A broad panel of blood tests, gases, and chemistries was sent out to check Dr. Autumn Klein’s organ function. The problem was that because she was so slim, the staff was having trouble getting a blood draw from her arm. Using a larger needle, they moved to the femoral artery in her leg, but still couldn’t successfully take her blood.

Ferrantes Arrives

Robert Ferrante arrived and explained what happened. He said Dr. Autumn Klein had been complaining of headaches in recent weeks, and when she arrived home from work that night she complained of not feeling well. He said she grasped her head in her hands and then dropped to the floor.

This led physicians to believe that it was related to a brain hemorrhage and they dropped the blood work to focus on scans. The began with a CT scan of her head, but everything was clear. So they continued scanning her chest, abdomen, and pelvis but that came back clear as well.

At 1:20 am the attending physician paged Dr. Lori Shutter who was the on-call intensivist asking for assistance. Little did Dr. Martin know that she was also Dr. Autumn Klein’s colleague, neighbor, and friend. 

They had been trying to draw blood since her arrival at the ER, but due to Dr. Autumn Klein’s slim figure, it was impossible. They finally did an ultrasound to locate the jugular vein and were able to draw blood. It was then that they noticed that the blood was much brighter than it should be coming from a vein.

Trying to Stabilize Her

At 2:17 am, as the physicians continued to try to stabilize her, Dr. Autumn Klein went into cardiac arrest. They began taking turns doing CPR for 22 minutes. The attending Dr. Martin went to speak with Ferrante and explained that they were at the point where they had to call it. As they stopped compressions Dr. Shutter was able to feel a faint pulse. They shocked her heart and were able to steady her slow heart rate.

At 5:30 a.m., it was agreed that Dr. Autumn Klein could be moved from the emergency department to the cardiothoracic intensive-care unit (CTICU). Still unsure of what caused this condition the team consulted Dr. Clifton Callaway, an emergency physician, who was traveling. Based on very high levels of acid, even with improved blood flow and increased levels of oxygen, Callaway suggested running a test for cyanide toxicity. 

The blood was drawn that afternoon and sent to Quest Diagnostics to be tested.

It Becomes Clear She Will Not Recover

Over the next two days, Dr. Autumn Klein’s family members spent their time shuttling back and forth from the couple’s home to the hospital.

Over those two days, it became clear that she was not going to recover. Discussions began about her being an organ donor and an autopsy being done. Depending on the condition that she had it could be genetic and passed down to their 6-year-old daughter. Her mother wanted the autopsy to be performed to better understand what had happened to her daughter.

But Ferrante said no. He was so insistent against the procedure that several physicians noted his rejections in Dr. Autumn Klein’s chart. He didn’t even want a limited one — an external examination and toxicology screening — that would have allowed for genetic testing.

In Pennsylvania, with an unnatural death, the law requires an autopsy. Whether Ferrante wanted it or not, the Allegheny County Medical Examiner’s Office was going to do one.

Autumn Passes Away

At 12:10 pm on April 20th, she was declared brain dead. A second physician completed the same exam and came to the same conclusion. She was taken off the ventilator and held on for 5 mins before passing on. 

Early Life

Autumn grew up in a Baltimore suburb and knew from 7 years old that she wanted to be a doctor. She graduated from St. Paul’s School for Girls, in Baltimore, MD, Magna Cum Laude from Amherst College, and got her M.D/Ph.D from Boston University School of Medicine. It was in Boston where she met Bob Ferrante who worked in Neurology as well. He focused on Huntington’s disease and ALS. They married in 2001 and in 2007 had their first child Cianna.

She was recruited in 2011 to the University of Pittsburgh Medical Center as Chief, Division of Women’s Neurology and Assistant Professor of Neurology, Obstetrics & Gynecology, UPMC Presbyterian/Magee Women’s Hospital. She specialized in women’s neurology to help women with epilepsy have children.

Autopsy

When the autopsy was performed there was nothing remarkable that could determine COD. The COD was ruled undetermined and her body was released to the funeral home.

Cyanide?

After her death, one of the doctors that had been on the team trying to save her was still trying to understand what had happened and went back to her chart. He found the results of the original blood test that had been done. What that blood test revealed was…Cyanide.

Cyanide is a fast-acting poison that prevents the body’s ability to use oxygen, so it’s like suffocating. The typical symptoms are:

• Unconsciousness 
• Shallow breathing 
• Low blood pressure
• Low heart rate 
• Red discoloration of the body

Anyone can have cyanide in their system. It can come from some fruits and smoking, but the levels will stay low. Investigators began breaking down her day using footage of her from the hospital to see if she could have come in contact with cyanide accidentally. But what they came to understand is that it acts so fast that if she had come in contact at the hospital, she wouldn’t have made it out.

The next thing was to rule out is suicide. Did she purposefully poison herself? But this is quickly ruled out. They’re left with 1 last option, someone killed her. They went to question Ferrante and the first thing he says is, “Why would she do this to herself?” Then “Who would do this to her?”

Police Look Into Ferrante

Police dug deeper reviewing the texts between the husband and wife on the day she collapsed. She reminded him that she was ovulating and he insisted that she take créatine to help her get pregnant saying that it would make a huge difference.

Whatever Ferrante’s rationale, there’s no scientific consensus that creatine supplements — which some use to build muscle mass and may have medical value – help with female fertility. In fact, the National Institutes of Health says pregnant women should not use creatine. They also found that a few days before she collapsed, Ferrante ordered cyanide through his lab. Police searched his office. They found the bottle that he ordered with his fingerprint on the bottle.

He claimed it was for one of the experiments he was doing in the lab. They thought that Bob had put the cyanide in the creatine drink that she had right before she collapsed, but upon searching the home found no trace of cyanide.

In digging further they discover that while Autumn was pushing to have a 2nd child and going through IVF treatments, Bob was not as thrilled with the prospect. 

The physician immediately contacted the medical examiner’s office and the funeral home immediately trying to get the body back to take hair and nail samples. It was too late, her body had been cremated. Four weeks into the investigation the police complete a 2nd search of the home emptying the shredding bin and the DAs office used interns to piece together all of the shreds. The documents had letters, written by Ferrante to his family saying that he couldn’t go on, that he was a pariah in the community, but that he did not cause his wife’s death.

Ferrante’s Arrest

On July 24th Ferrante is arrested. Fast forward to May 2014, as the trial is quickly approaching. The defense files a huge motion and within that motion, they request the return of a safe that was confiscated. Within that safe is a laptop. This led investigators to inspect the laptop for the first time.

• 4 months before his wife’s death he googled “cyanide poisoning”
• 2 months before he googled “divorce Pittsburgh pa”
• 2 weeks before he googled “does increased vaginal size suggest wife is having sex with another?”

Days after her death searches were found for 

• potassium cyanide 
• Detecting cyanide 
• Cyanide creatine 

Leading to searches such as – “how would a coroner detect if someone is poisoned by cyanide?” These searches were done the same day investigators questioned Ferrante.

In the fall of 2014 the trial began, the defense was able to bring Cyril Wecht to the stand to testify that he could not definitively say that she died from cyanide. His findings were based on the quantitative test the NMS performed showing that Autumn had a normal level of cyanide in her system. The scientific argument here is that cyanide leaves blood quickly and that the test done by NMS was done 18 days after being collected which would be plenty of time for the cyanide to no longer show.

Verdict

On November 7, 2014, after a day and a half of deliberation, the jury came back with a verdict of guilty of first-degree murder with a sentence of life without parole.

Resources

• Something’s killing me – Season 2 Episode 2
• Robert Ferrante, convicted of killing wife with cyanide, blames old lawyers, seeks new trial
• Judge denies most of Ferrante appeal in wife’s murder, but question about jury still open
• Medical researcher convicted for fatally poisoning wife denied appeal
• Man convicted of poisoning wife: Her liver proves otherwise

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