Blagojevich Co-Defendant Dies, Was Scheduled to Surrender Next Week

Christopher Kelly, a co-defendant and former top fundraiser for former Ill. Gov. Rod Blagojevich, has died of salicylate intoxication.

Kelly pleaded guilty earlier this year to tax fraud charges in a 2007 case. He was sentenced to 37 months and scheduled to surrender in November, 2009. According to documents on PACER, the judge recommended in its sentencing order that he serve his sentence at Yankton, S.D. and that he be allowed to participate in a residential drug and alcohol program.

Kelly was charged in a wire fraud/money laundering case in early 2009. He pleaded guilty last week. The plea agreement (pdf) called for a 57 month sentence to run consecutive to the 37 month sentence. The judge either sentenced him immediately or denied him bond pending sentencing, as he was ordered to surrender to the U.S. Marshals Service on Sept. 18, 2009. His bond conditions were also modified for the short period between his plea and September 18, 2009, to include a provision that he have no contact with three persons (unnamed in the order) and that he spend every night between midnight and 6:00 a.m. in his house. [More...]

(Update: From what I can gather, he was not sentenced immediately. The Court either advanced his surrender date in the 37 month case, or more likely, denied him bond pending sentencing in the case in which he just pleaded guilty, giving him until Sept. 18 to wrap up his affairs. According to PACER, the Government moved to modify the conditions of his bond in the case in which he just plead and he agreed to the modification. The court modified the terms as I wrote above, ordering him to surrender on Sept. 18. There is no recent change in the surrender date on the docket for his 37 month case.

None of his plea agreements involved cooperation with the Government. He still faced charges in the Blagojevich case. R.I.P., Mr. Kelly.

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    Found dead (5.00 / 1) (#2)
    by drobertson on Sat Sep 12, 2009 at 09:05:59 PM EST
    in a lumberyard? Late at night? Huh.

    Salicylate intoxication? (none / 0) (#1)
    by andgarden on Sat Sep 12, 2009 at 06:17:11 PM EST
    That's a new one. Did he take a whole bottle of aspirin?

    Actually, andgarden, it's an old one. (4.83 / 6) (#4)
    by Elizabeth Blackwell on Sat Sep 12, 2009 at 10:07:42 PM EST
    Salicylate poisoning is not so common these days since acetaminophen has become the most commonly recommended/prescribed non-narcotic pain reliever.  

    But back in the day - when aspirin was what every one of every age took for headaches, fever, minor aches and whatever -  intentional overdose of aspirin was a very common occurrence.  There was a time that I could write admitting orders for salicylate overdose in my sleep - and frequently did.  Nowadays it's  acetaminophen overdose orders.

    There is an interesting angle to this.  Commercial aspirin tabs (325 - 500 mg) are not the most concentrated form of salicylate readily available.  Oil of Wintergreen, used as a flavoring in baking especially around the holiday season, contains 7000 mg salicylate per teaspoon (5 cc).  Toddlers love this stuff for some reason, and if Mom has a new bottle of 15-30 cc of the essential oil  around (which amount lasts the average home baker for years)  you can see there might be problems since the potentially lethal salicylate dose is 500mg/kg and the typical toddler weighs 12-17 kg (6000-8500 mg). Plus which the oil is easily swallowed and rapidly absorbed.

    But for an adult of Mr. Kelly's (apparent) weight (80-90 kg) it's a bit more complicated.  At 80-90 kg one would need 40,000 to 45,000 mg  just to be in danger - salicylate overdose is quite treatable provided one gets at it and knows what one is doing.  Death is not guaranteed.  In fact, I've never lost a salicylate overdose that came in for treatment within 12 hours - even the toddlers who usually have the highest initial levels.

    But the adult potentially lethal dose requires 80 - 90 high dose OTC aspirin tabs, and tabs are what most adults use, taken in a short period of time. Now no one takes 80 aspirin tabs for pain; I don't care how bad the headache is.  Indeed, most people do not succeed in taking anywhere near the lethal number of aspirin tablets because by the time they get to 20 or 30 the gastric irritation of ASA kicks in, and they  start to vomit.  Even dissolving that number of tabs in an easily swallowed amount of liquid is tricky.  

    Back story of this would be interesting.


    Backstory of your sig name (5.00 / 1) (#5)
    by Cream City on Sat Sep 12, 2009 at 10:13:00 PM EST
    and knowledge of 19th-century medicine might be more interesting.

    But most interesting to me would be family gossip about your fascinating in-law.  How's Lucy Stone?


    Ah, Cream City, I hate to type, but (5.00 / 1) (#7)
    by Elizabeth Blackwell on Sat Sep 12, 2009 at 11:05:00 PM EST
    I lurk around here a fair amount and enjoy your comments...

    My knowledge of 19th century medicine is not as extensive as my knowledge of early-mid 20th century American medicine and the reforms initiated by Flexner, the changes brought about by antibiotics, surgical advances, and the advances of pharmacology.

    As for Dr. Blackwell.  Well, I grew up long enough ago that "women weren't doctors."  I found Elizabeth Blackwell reassuring:  If she could do it in the 1850's, surely I could do it a century later.  Not that it was easy, but if she could...

    As far as Lucy goes.  Medicine is a passionate and demanding mistress.  Those of us who fall in love with her have little time, and less energy,  for much else.  But I admire Lucy greatly.  Without women like her on the political front lines for equality, my work on the medical front lines for equality would have been much more difficult if not impossible.  And I passionately believe that women can bring a dimension to medicine (and to politics) that is rare, much needed, and in today's corporatized medicine often lacking.

    In addition, I'm a "Lucy Stoner."  Liked the name I was born with and kept it.  Caused a certain amount of hoo-ha at medical school at graduation.  For some reason they seemed to think that just because I had used my name all through school I would want another one on my diploma.  It's a good thing I was as exhausted  as I was - med school is not just intellectually rigorous - or I might have said things that would have prevented me from graduating at all.

    Thanks for the interest.


    Nice to hear from you (5.00 / 3) (#12)
    by gyrfalcon on Sun Sep 13, 2009 at 07:58:17 AM EST
    My grandmother, born 1886, was a physician.  Not the first woman physician, but one of the early ones.  She and my grandfather went through medical school together (Jefferson Medical and Women's Medical in PA) and came in 1 and 2 on the state exam.  Except that my grandmother, like Ginger Rogers, did it while giving birth to and caring for two children.  She still beat my grandfather on the exam.

    Doctor, if he were taking warfarin, (none / 0) (#13)
    by janisgore on Sun Sep 13, 2009 at 09:35:47 AM EST
    Would the needed dosage change?  And would the cause of death still show as salicylate intoxication?

    They work on different body systems.
    So the potentially lethal salicylate dose is not affected by the fact that a person is taking warfarin (Coumadin).

    However, if one is so unlucky as to have an aspirin tablet sit itself down on the gastric mucosa above a good sized gastric blood vessel and cause erosion through into the vessel itself (and everybody's gastric mucosa bleed a little when in direct contact with aspirin) the resultant gastric hemorrhage would be both larger and more difficult to control due to the action of warfarin in decreasing the amount of circulating clotting factors.*

    As far as the cause of death.  Salicylate levels in the blood are measurable to very low levels, and would not be affected by the clotting changes induced by warfarin.  However, it might be difficult to say that the salicylate alone was the cause of death as a level that might be fatal for one person might not be for another depending on treatment, other metabolic factors, renal clearance, general health and often just plain luck.

    Hope that helps.

    * this is one of many reasons that acetaminophen has replaced aspirin as the non-narcotic pain reliever of choice for most doctors and patients.


    Thank you, ma'am. (none / 0) (#16)
    by janisgore on Sun Sep 13, 2009 at 07:46:15 PM EST
    A very informative comment, thank you (5.00 / 3) (#6)
    by andgarden on Sat Sep 12, 2009 at 10:19:39 PM EST
    Worked the lab (5.00 / 1) (#11)
    by Fabian on Sun Sep 13, 2009 at 06:11:43 AM EST
    the one night we had an oil of wintergreen poisoning.  Serum levels were so sky high that they had to dilute the samples to get the levels low enough for the machine to read.  Otherwise it just spat out error readings.  Toddler, Amish, oil of wintergreen being used for making liniment => LifeFlight => hemodialysis.  I'm fairly sure the kid made it okay, but only due to rapid response by the family, medical professionals and knowing exactly what she swallowed.

    (Oil of wintergreen didn't come with warnings, but now it does and the bottle is twice sealed.  Pregnant women should avoid it and double check the ingredients in any rubs, creams or liniments.)


    Thanks, Elizabeth (none / 0) (#8)
    by Jeralyn on Sat Sep 12, 2009 at 11:13:51 PM EST
    That was so informative. So, do you think it was foul play or he planned and studied this and drove to the lumber yard to carry it out? If the latter, do you think he took the wintergreen oil or something else? Or maybe he knew he had an allergy to it to begin with and knew he wouldn't need as much as the average person?

    Did mention I cannot type? OK. Here goes. (5.00 / 2) (#9)
    by Elizabeth Blackwell on Sun Sep 13, 2009 at 12:50:07 AM EST
    Believe he went to the lumbar yard to be alone.  Bet he used tabs.  That oil of wintergreen stuff isn't widely known, not that it couldn't be found easily on the web (Pepto-Bismol has lots of salicylate also), but suicides are usually pretty depressed for that kind of research, and the linked story mentions that he had vomited.

    As you probably know men attempt suicide less often, but succeed, as a percentage, more frequently than women.  This is due to the fact that they usually use much more immediately lethal means than pills: gunshot, single car accidents, hanging.  That's the one reason I might suspect foul play: it's an uncommon method for a man to use.  Still forcing someone to take a bunch of aspirin is sort of a silly murder method, too.

    Working from very little info I'd say he was found in extremis at that lumbar yard and taken, unconscious, to a local hospital.  There he would have had a normal CT scan, so surely they would have done routine drug screens of urine.   The problem is that the routine screens do not include salicylate.  That's a separate blood test (as is acetaminophen).   The screens routinely done in ER are for "drugs of abuse."

    The laboratory findings of salicylate poisoning change as the absorption and cellular effects increase.  I have always been impressed by the profound Kussmaul breathing.  These people sound like jet engines as the body blows off carbon dioxide to compensate for all that unbuffered acid.  

    But if this man was near death his respiratory rate might actually have been depressed in which case someone would have had to think of salicylate poisoning and order a serum salicylate level to make the diagnosis - and as I mentioned this poisoning is rare these days.  I'd bet a lot of residents coming out of training have never even seen one.  Difficult to make a diagnosis one does not think of.  It's also possible that the original hospital was not able to do a salicylate level on site and sending one out always takes more time.

    In addition I would not be surprised if alcohol was involved.  Quite a lot of it.  Both to wash down the pills and to help the suicide along with courage and/or unconsciousness.  The alcohol smell would have masked the acid smell of the ASA, and it's just possible that the serum bicarb, which should have been low, was not so low as to cause questions.

    In any case, I suspect that the original hospital did  make the diagnosis and transferred him for hemodialysis, but since he died within 5 hours of transfer I am quite certain he was metabolically too far gone for it to make a difference.  In addition he was late into the poisoning and sometimes these very metabolically stressed/compromised patients just up and die.  Suddenly. For no immediately discernible reason.  It is also possible that his labs presented such a mixed picture that the original hospital did not really know just how acidotic he was at the cellular level and did not transfer him emergently - although even priority  transfers take more time than seems possible.

    Sure would like to see his original labs, follow ups, and salicylate levels.

    Should warn you that this is perilously close the the Bill Frist School of Medicine method of diagnosis  (although most doctors enjoy the puzzles of diagnosing from news reports) so take it with a shaker of salt.  It could be all wrong.

    Oh, and an allergy to aspirin wouldn't make a difference in the lethal amount unless it caused anaphylaxis which it does not sound like this did.


    another great post (5.00 / 1) (#10)
    by Jeralyn on Sun Sep 13, 2009 at 02:38:09 AM EST
    I'm so glad to have a doctor reading TalkLeft, and such an informed one who writes in terms the lay person can understand.

    In the movie Play It As It Lays with Anthony Perkins and Tuesday Weld (one of my all time favorites, because Joan Didion wrote the book it was based on), He drank a bottle of vodka and took sleeping pills. When she found him, he was still alert, and she just cradled him and sang to him until he was gone. (See the pyramids along the Nile...) Then the police came and everyone freaked out and they put her in a mental institution.

    I've had analphylactic shock a few times from mold, usually from moldy berries or a cookie, and you have to go to the hospital to get shot up with adrenaline because your throat closes and your whole head blows up, but if you get there soon enough, it's not that big a deal, just scary.

    I'd really like to know exactly what he took so I remember never to take it with alcohol. Really sad story. It's sounding more like a suicide to me now. I'd ask his lawyer, who is also one of my pals, but I'm sure he's very upset and don't want to bug him just yet.

    Thanks again, Eliabeth!