(CNN) — An independent autopsy could not determine why a Mississippi teenager was found dead in waters off the Mississippi coast after a Fourth of July boating trip with friends. But the keenly awaited results of a state autopsy conducted earlier this month could lend some clues.
An independent pathologist described Nolan Wells’ manner of death as undetermined pending further investigation, a preliminary autopsy report released Wednesday said.
The 18-year-old’s body was found along the shoreline of Horn Island on July 6, when local officials said it appeared to be an accidental drowning and no foul play was suspected. Attorney Ben Crump, who is representing the family, said Wells’ parents requested an independent autopsy be performed because “it is not adding up.”
Wells’ death has sparked nationwide attention and speculation over whether race played a role, as Mississippi’s fraught racial history looms over the case.
The independent autopsy, which was privately funded, is separate from the official autopsy performed by the Mississippi State Medical Examiner’s Office on July 7. Results from the state’s autopsy investigation have yet to be released, pending the outcome of standard toxicology tests.
The independent autopsy faced several limitations, wrote forensic pathologist Dr. Roger A. Mitchell Jr. in his report: some of Wells’ remains were retained by the state during the initial autopsy, which is a common practice in pathology; toxicology results weren’t yet available; and decomposition can obscure injuries and complicate toxicology.
Multiple questions about what led to the young man’s death remain unanswered, including how Wells entered the water, whether he had any neck injuries or brain bleeding and what was found in his stomach, Mitchell wrote.
There were no immediate signs of physical injury, Jackson County Coroner Bruce Lynd previously told CNN. The independent autopsy also didn’t find any apparent lacerations, fractures or deep-tissue injuries on Wells’ body.
The coroner’s office requested that the autopsy be conducted at the state medical examiner’s office because of the “condition” in which Wells’ body was found and to definitively determine whether there was any trauma or signs of foul play, Lynd said.
The Jackson County sheriff’s department has interviewed dozens of witnesses and is working with the FBI to investigate the case, Mississippi’s Sun Herald reported. CNN has reached out to the sheriff’s department for more information.
Experts told CNN the state’s autopsy – performed days before the independent examination – could help give investigators better insight into what led to the teen’s mysterious death that holiday weekend.
The state examiner should have access to witness information, retained remains and other evidence the independent examiner lacked that could help clarify cause and manner of death – though the process could take months, according to forensic pathologists who did not work on Wells’ case.
Still, the autopsy may not provide a full picture. Here’s what forensic pathologists who spoke with CNN say the state autopsy report, the toxicology results and the investigation could help determine:
How did Wells end up in the water?
Wells’ friends made it back home, but he did not. One of the friends said Wells stayed on the island to talk to a girl, but others have cast doubt on that notion.
“The biggest question that’s on the mind certainly of everyone in Jackson County, Nolan’s family, and the rest of the world is simply: ‘How did this young Black man with such a promising life ahead of him die while on a trip with a group of his peers, who could not explain why he went missing?’” said Terence Keel, a professor of human biology and society at UCLA.
One of the central questions in the case is what happened to Wells before he entered the water. For example, did he fall accidentally, enter the water voluntarily, or could he have been pushed?
Mitchell said in his report the most significant limitation in the independent autopsy “was the inability to directly observe the airway and lungs for water and directly observe the stomach for gastric contents.”
When a body is found in the water and there’s a “suspicion of drowning it is important to confirm how that person entered the water,” the pathologist wrote. “This information is especially important for those deaths of persons who can swim, as is the case with Nolan Wells.”
The currents near Horn Island can be notoriously rough. The Jackson County coroner told CNN his office has received numerous drowning victims from Mississippi’s barrier islands over the years.
And with no shelters, restrooms or communications on Horn Island, some people venture out into the water, visitors have said.
But drowning is one of the most challenging diagnoses in forensic pathology because there is no single autopsy finding that proves it, according to forensic pathologist Dr. Carl Wigren, who is not involved with the case. Examiners look for hints like wrinkling of the palms or frothy fluid in the airways, he said.
The state exam should be able to assess the lungs, airways and other thoracic organs, helping answer questions about drowning and time of death, according to Keel.
Even if Wells did drown, other questions loom. The pathologist who conducted the autopsy said he could not tell whether Wells was “conscious or unconscious, forced or unforced” before entering the water.
Whether Wells was conscious before entering the water will bear directly on whether the death was an accident or a homicide, Keel said.
But even with more access than the independent examiner had, the state could still face limitations if witness information is incomplete or the body’s condition prevents firm conclusions, experts said.
“There is no single medical finding that can reliably determine whether someone was conscious or unconscious, or whether they entered the water voluntarily or involuntarily,” Wigren said.
The investigation will help determine whether Wells was alive when entering the water, why he entered it and why he could not get out, said Missouri forensic pathologist Dr. Michael Graham, who reviewed the autopsy report and is not involved with the case. That’s where witness accounts, scene reconstruction, physical and digital evidence and other investigative findings come into play.
“An autopsy alone rarely provides every answer; the strongest forensic conclusions come from integrating the medical findings with the investigative evidence,” Wigren said.
Did he sustain a neck or brain injury?
Mitchell didn’t have access to all of Wells’ remains after the state’s autopsy, including a portion of the interior of Wells’ neck. But he noted it’s a “common forensic pathology practice” to retain “anterior neck structures during an initial autopsy.”
“Therefore, this pathologist cannot rule out injury to the neck as a contributor or cause of death,” the autopsy report states.
Dr. Priya Banerjee, a forensic pathologist based in Rhode Island who reviewed the autopsy report and is not involved with the case, said it’s not unusual for doctors to retain some remains.
“I’m guessing that they are taking a closer look at the neck structures,” she said. “Some doctors like to keep structures for further analysis or just to preserve them for posterity.”
The pathologist said he didn’t find any apparent lacerations, fractures or deep-tissue injuries on Wells’ body. But the level of decomposition “can obscure the presence or absence of bruising on the skin surface, especially during a second autopsy examination,” Mitchell wrote.
The state autopsy could assess whether there’s any damage to the larynx and other neck structures, and whether there was evidence of bleeding inside the head, according to Graham.
“The medical examiner may have examined organs or tissues that were retained during the original autopsy, have the benefit of complete toxicology and microscopic findings, and have access to the full investigative file, including scene findings, witness statements, emergency medical records, and law enforcement information,” Wigren said.
Mitchell did find “red discoloration in the soft tissue of the back of the head,” the autopsy report states, but it’s not clear what caused the discoloration or whether it had anything to do with Wells’ death.
The red discoloration “could represent decompositional changes of the musculature, or it could be from blunt force injury to the back of the head and neck,” said Dr. Kendall Von Crowns, the chief medical examiner in Tarrant County, Texas, who was not involved in the Wells case.
Or it could be lividity – blood pooling after death due to gravity, theorizes Dr. Victor Weedn, a forensic sciences professor at George Washington University. The position of the body when it was found could help determine that, he said.
Banerjee said the lack of a skull fracture finding points away from a more forceful blunt-force injury.
If there is a significant head injury, “then there’d be a pretty good chance that there would be some bleeding inside the head,” Graham said.
The state may have better insight to make a determination on what caused the red discoloration mentioned in the report because they have more of the investigational facts, Weedn said.
If the state does find trauma to the anterior neck, that could be from blunt force injuries including strangulation, Von Crowns said. Evaluating the spine for injury, which could be instantly incapacitating, is also essential, he added.
Keel says local authorities started “on the wrong foot” by publicly suggesting foul play was not involved before the investigation was complete, adding the family likely sought an independent autopsy because of a longstanding distrust of official death investigations in Black communities.
How could toxicology results help?
When a body is found in water, a major question is whether drugs, alcohol or medications played a role in the events leading up to their death, experts say.
A limitation of the independent autopsy was “the original toxicology results had not been received at the time of this report,” Mitchell noted.
The toxicology report could shed light on whether any substance may have incapacitated Wells from swimming to safety. And if it did, the question for investigators would become whether it was taken voluntarily, Weedn said.
But decomposition affects how tissues look and can complicate toxicology, especially alcohol findings, because alcohol can appear as a byproduct of decomposition, according to Banerjee.
Toxicology testing can take up to 6 to 8 weeks, according to Von Crowns.
“It may identify substances that contributed directly to the cause of death, explain altered mental status or impaired judgment, or help exclude intoxication as a contributing factor,” Wigren said. “A negative toxicology result can be just as informative as a positive one because it helps narrow the range of possible explanations.”
While the state medical examiner could have better insight on important questions because it examined Wells’ body first, experts stressed that the autopsy must be combined with a thorough investigation. Even then, some questions may remain unanswered.
“They may never have a good idea of what happened to Nolan Wells,” Weedn said.
CNN’s Holly Yan contributed to this report.
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