Jeff Adachi, 1959-2019. Photo by Joe Eskenazi

Claims of “independent” doctors released Wednesday by the Public Defender’s office mirror opinions of medical professionals reported in April by Mission Local

With all the pugnacity of its deceased former boss Jeff Adachi, the Public Defender’s office on Wednesday lambasted the city’s Medical Examiner as “dysfunctional and untrustworthy” and claimed “independent” medical analyses confirmed Adachi died of “natural” causes — not  “acute mixed drug (cocaine and ethanol) toxicity,” as the Medical Examiner’s office ruled in March.

This is not surprising. Adachi’s colleagues had privately bemoaned that the medical examiner had assigned drug use as the No. 1 cause of death, and not Adachi’s advanced heart disease and — especially for a vital 59-year-old man who outwardly appeared to be in exceptionally good health — jarringly poor physical condition.

Adachi, who died on Feb. 22 after a bout of lethal arrhythmia — an irregular heartbeat — had hyperlipidemia (high cholesterol). He had high blood pressure, revealed by the thickening of his heart muscles. His left anterior descending artery, per the autopsy, was 70 percent blocked — and subsequent analysis put that blockage at 80 percent (with 50 percent blockage on the right artery). He worked up to 20 hours a day, ate poorly and, to boot, he was purportedly not taking any prescription medications.

The claims from three doctors on Wednesday released by Adachi family lawyer Robert Chan, and blasted to the media by Adachi’s former city colleagues, in fact partially mirror those in April reported by Mission Local. We sent his autopsy to some half-dozen doctors, including current and former presidents of the American Academy of Emergency Medicine.

Toxicology reports revealed trace amounts of cocaine and benzodiazepine in Adachi’s system, as well as low levels of alcohol. But several of the doctors Mission Local spoke with were skeptical about drug use being the top cause of death.

“Based on the autopsy, he was a ticking time bomb,” Dr. David Farcy, the president of the American Academy of Emergency Medicine, told us in April.

“Even without the cocaine and the alcohol,” Farcy continued, “he could’ve had a sudden death due to a plaque rupture in an artery in his heart.”

City Hall was already starting to fill up half an hour or so before Jeff Adachi’s memorial on March 4. Photo by Joe Eskenazi.

In today’s press release, the Public Defender’s office said out loud what, previously, had largely only been implied. It claimed that bad blood between the Medical Examiner’s office and Public Defender’s office may have played a part in the embarrassing assignment of drug use as Adachi’s top cause of death, even though only trace amounts of drugs were detected in his system.

Specifically, Adachi in 2018 accused Christopher Wirowek, the Medical Examiner’s director of operations, of dishonesty, charging him with misrepresenting the office’s level of accreditation.

Those complaints stemmed from accusations leveled by former Medical Examiner chief forensic toxicologist Dr. Nikolas Lemos — who filed suit in 2017 after claiming he “begrudgingly resigned” from the office after Wirowek instructed him to keep silent about a colleague’s lack of qualifications to undertake DUI testings.

Of note, Lemos was one of the three doctors who pored over the Medical Examiner’s Adachi autopsy and came to a different conclusion regarding the cause of death.

The Medical Examiner’s office on Wednesday defended the veracity of its report, stating that, “forensic pathologists sign off on the cause and manner of death, and their reports speak for themselves.”

Public Defender Jeff Adachi, seen here defending his departmental budget to the Board of Supervisors, was fanatically devoted to his clients and his colleagues. But, exams revealed, not as much to his own wellbeing.

While Adachi’s devotion to his clients and the office he led since 2003 was legion, his devotion to his own well-being was not. In April, the doctors Mission Local contacted pointed out a series of long- and short-term missteps that worsened Adachi’s health and, in the end, likely cost him his life.

“He had high cholesterol. He had high blood pressure. He had coronary artery disease,” summed up Dr. William Durkin, a past president of the American Academy of Emergency Medicine. “He should have been on a statin.”

But Adachi, again, was not on any medications.

In the shorter term, several doctors pointed out that if Adachi had taken the advice posited to him by his Feb. 22 dining companion to seek medical attention for his chest pains, he would very likely have lived. And, furthermore, if he had sought medical attention following earlier bouts of chest pains, the extent of his heart disease would likely have been detected prior to his autopsy.

“If a male comes in at that age, or even younger, with complaints about exertional chest pain or shortness of breath, it would result in immediate investigation and intervention,” Dr. Carl Chudnofsky — the chairman of the Department of Emergency Medicine at the Keck School of Medicine at USC, and chief of emergency services at Los Angeles County USC Medical Center — told us in April. “If he’d gone in and been honest about his history, they’d have kept him on a cardiac monitor.”

Regardless of the conflicting claims of cocaine’s importance in Adachi’s death — and acknowledging that the amount of it detected within his system was minuscule — every doctor Mission Local talked to acknowledged that this drug was just about the worst one a person with a heart condition like Adachi could’ve used. What’s more, alcohol magnifies the effect of cocaine.

Cocaine, in fact, induces lethal arrhythmia of the sort that killed Adachi. “It can send the heart into an irregular heart rate,” Farcy told us. “It allows the heart to pump and no blood is going anywhere and the person dies.”

The ultimate cause of Jeff Adachi’s death may never be known. And it may always be disputed. But, if anyone was hoping to prove, beyond the shadow of a doubt, that drug use was the top culprit  Adachi’s erstwhile colleagues have, today, mounted a spirited defense.

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Managing Editor/Columnist. Joe was born in San Francisco, raised in the Bay Area, and attended U.C. Berkeley. He never left.

“Your humble narrator” was a writer and columnist for SF Weekly from 2007 to 2015, and a senior editor at San Francisco Magazine from 2015 to 2017. You may also have read his work in the Guardian (U.S. and U.K.); San Francisco Public Press; San Francisco Chronicle; San Francisco Examiner; Dallas Morning News; and elsewhere.

He resides in the Excelsior with his wife and three (!) kids, 4.3 miles from his birthplace and 5,474 from hers.

The Northern California branch of the Society of Professional Journalists named Eskenazi the 2019 Journalist of the Year.

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  1. People came out for his concern and I’m not sure what rule a ‘press pass’ has to say if stealing information from someone makes it okay. Art and Work will give you respect. Adachi was a Man. Some of you can’t see yourselves. Lets not let this happen agin.

  2. I think Adachi’s advocates should take comfort in and celebrate his record of exceptional job performance and be less concerned about his life choices. Those personally grieving his loss should know and have accepted him as a person, his personality, and temperament. No one is nominating him for sainthood and anyone nominating him for villainhood should be called out as simply mean and nasty. Tongues will wag, they always do. That doesn’t tarnish Adachi’s accomplishments one bit.

  3. I’m sorry that the Public Defender’s office is spending taxpayer money on this when they have other important things to do, like working for actual criminal defendants. So what if Jeff’s non-prescription drug use contributed or did not contribute to his death. He didn’t take care of himself and he paid the price. I’m nearing that age and listening to my body tells me I need to consume less substances and get more exercise. If my social life suffers because of that, well, at least I will still have life.

      1. Nonsense. He was a very good public defender. But he had some other issues, as we all do. It’s a very human story. You don’t have to be a saint to be recognized for your professional work. On the other hand, I wish elected officials who actually do good work for the city, like Jeff did, would take care of themselves. Misuse of drugs is a common problem in the legal community. Every lawyer has to take a continuing education class on substance abuse regularly to keep their license. Litigation is a high-pressure job. We shouldn’t gloss over the negative effects that has on people.