Oklahoma officials release full autopsy report for Nex Benedict

Editor's note: If you or someone you know has suicidal thoughts, addictive tendencies, stress and other mental health issues, you can call or text 988, Oklahoma's Mental Health Hotline, or call 911. 

Oklahoma's chief medical examiner has released its full autopsy report in the case of Nex Benedict, the Owasso teen whose death has drawn widespread attention and outrage.

The detailed findings released Wednesday show elevated levels of diphenhydramine, an antihistamine, and fluoxetine, an antidepressant, in Benedict's bloodstream. The office had previously disclosed a summary report that said Benedict died from toxic levels of those medications and concluded the 16-year-old died by suicide.

The autopsy was performed Feb. 9, one day after Benedict died and two days after the teen was injured in a fight with other students inside an Owasso High bathroom. Benedict used the pronouns they, them, he and him, raising questions for many people about whether they were bullied because of their gender expansive identity. Their death also has generated nationwide scrutiny over safety of gay and transgender children in Oklahoma schools.

Benedict's family declined to comment Wednesday after the full autopsy report became public.

More: After Nex's death, former LGBTQ+ students say Owasso has troubling history of bullying

Dr. Ross Miller, the pathologist who performed the autopsy, noted several bruises, a cut and other injuries on Benedict's head but determined in his report that none of those injuries played a direct role in the teen's death.

Miller noted that his findings are a medical determination. "The manner of death is not a legal determination of culpability or intent, as such decisions are outside the scope of the medical examiner’s role," Miller wrote.

Dr. Constance DiAngelo, a Washington, D.C. forensic pathologist who reviewed the autopsy report at the request of The Oklahoman and the USA TODAY Network, said she agreed with Miller's findings that the injuries noted in the autopsy did not contribute to Benedict's death.

She said the levels of diphenhydramine and fluoxetine found in Benedict's blood fall within the range of known fatalities caused by those drugs. The amount of either drug would have been lethal on its own and far outside of the range of catching up on a missed dose, said DiAngelo, the former chief medical examiner of the city of Philadelphia.

The autopsy report does not say exactly how many pills Benedict ingested, and it can be challenging to calculate based on toxicology test results alone, DiAngelo said.

"It is at times difficult to go backwards," she said.

She said the best way to know is to inspect pill bottles to see how many remain.

Dr. Donald Jason, a North Carolina forensic pathologist and consultant, agreed with DiAngelo. He said it is typically the job of forensic investigators to find answers to such questions. In cases where overdoses are suspected, a forensic investigator might go to a person's home to look for pill bottles and count the missing pills, he said. But the autopsy report does not indicate that type of investigation took place after Benedict died, Jason said.

"Police are really not trained to look for pills," he said. "A forensic investigator would be."

Jason also noted the report did not explain how Benedict had access to such a large amount of medication.

Steve Kunzweiler, the Tulsa County district attorney, announced March 21 that his office would not file any charges in connection with Benedict's death or the fight that preceded it. He said the medications were "legally available within the home where Benedict resided," and described the school bathroom altercation as one of "mutual combat."

Both Kunzweiler and Miller said investigators recovered notes that appeared to have been written by Benedict. Miller said the notes were found in Benedict's bedroom and were "suggestive of self-harm." The exact contents of the notes have not been disclosed.

The U.S. Department of Education has launched a civil rights investigation into allegations that Owasso High School failed to adequately address allegations of sex-based bullying. The school has said it would cooperate with the investigation, but denied that any reports of bullying went unaddressed.

The federal investigation came about after the Human Rights Campaign lodged a formal complaint against the school. Kelley Robinson, the president of the national LGBTQ+ advocacy group, said the autopsy report leaves many questions unanswered, including what steps schools are taking to protect other gay and transgender students.

“The full report does little to fill in the gaps in information about that day or the more than a year of bullying and harassment that led up to it," Robinson said in a statement. "It does not answer the questions of so many in Oklahoma and across the country."

Robinson's group is part of a coalition of advocacy organizations seeking the removal of state schools Superintendent Ryan Walters in response to Benedict's death. Walters has described gender fluidity as “the most radical concept we’ve ever come across in K-12 education” and advocated for a policy requiring schools to get approval from the Oklahoma State Board of Education before changing a student’s gender in official records.

Walters referenced Benedict's autopsy results in his opening remarks at a state Board of Education meeting on Thursday, describing the teen's death as a tragedy. He then claimed, without citing specific examples, that the "woke mob" and "radical groups" are using Benedict's death to further their own motives.

"And you are going to hear these groups, this woke mob, continue to push an agenda and lie to further the most radical agenda this country has ever seen," Walters said.

"Staying alive?" someone in the audience loudly asked Walters in response.

This is a developing story and has been updated.

This article originally appeared on Oklahoman: Full Nex Benedict autopsy report released by medical examiner