The Death of Elvis

Looking back at how Memphis reacted to Elvis’ death, a story written by Beth J. Tamke foreshadowed the medical legal controversy that would follow. Tamke, then age 32, covered the medical beat for The Commercial Appeal. A tough-minded, tart-tongued reporter from Senatobia, Mississippi, she had paid her dues covering the police station and the religion beat, or, as she called it, the “God squad.” In both positions she had exposed swindlers and charlatans, because Beth Tamke was as nosy as a church auxiliary. Now, as medical reporter, she had inherited a beat that had been handled with kid gloves, consisting mostly of disease-of-the-week and profiles assignments.

Tamke and her notepad were two blocks away from the mounting hubbub around Baptist HOspital when Elvis was brought in on the afternoon of August 16, 1977. Oblivious to what was happening and bored, she was covering a drawn-out meeting of the Memphis-Shelby County Hospital Authority. “The main topic on the agenda was whether cigarettes ought to be sold in a public hospital,” said Tamke, who in those days could run through a pack of Salems in an afternoon.

“I didn’t have any idea what was going on until I got back to the office and got on the elevator. The whole building was electric. Riding up the elevator, somebody told me what was happening and I said to myself, ‘Forget cigarettes, I’m doing a story on Elvis.’”

Finding the newspaper’s old Presley clipping in a shambles, Tamke managed to pick out short, spoon-fed, one-column stories about Elvis’ hospitalizations – going back to 1960 when he broke the little finger on his right hand. “It was impossible to get through by telephone to Baptist Hospital,” she said. “So I went down there and badgered the administration to release a rundown on when he was admitted and what for.”

After obtaining accounts of Elvis’ hospitalizations since 1960, Tamke found it a simple matter to check them against the news clippings.

“It didn’t add up. From that night and for the next two months my assignment was to get the autopsy,” Tamke said. “During that time I saw that in getting the autopsy, a by-product might be getting the medical examiner [Jerry Francisco, the public official who chose to keep the autopsy results a secret]. But the editors didn’t see it that way.”

Writing her story on the night of the death, Tamke reported, “The diagnosis of Presley’s ailments released Tuesday night do not correspond with those given out at the time of his hospitalization.” What had been reported as pneumonia and pleurisy in October 1973 was now hypertension. What was identified as a liver problem in January 1975 was not hypertension and an impacted colon.

Tamke had been in the business long enough to know she was on to something. Two months later she would write the first story with hard evidence to suggest that Elvis, the hometown boy, was a chronic drug abuser. A month after that, Tamke would be transferred to one of the newspaper’s Siberian gulags – handling consumer complaints for the “Action, Please” column.

On the Trail

Beth Tamke was making it her business to meet every working pathologist in Memphis to establish a network of information for what was looking like a long assignment – trying to report the real cause of Elvis’ death. But in the newsroom she was catching flak.

Angus McEachran, metro editor at The Commercial Appeal, was gruff, arbitrary, and ambitious to rise within the news executive ranks of Scripps-Howard. McEachran wanted that autopsy report and wanted it fast. Secretly he knew the chain soon would be sending him down to The Birmingham Post-Herald as editor. In retrospect, Tamke believes the Elvis assignment would have turned out differently if McEachran had stuck around longer. Beyond his ingenuous personality, McEachran understood hard news. His replacement, in contrast, was far more comfortable with a feature story to warm, not dissect, the heart.

“McEachran kept telling me I wasn’t doing enough,” Tamke said. Whether correct or not, McEachran’s criticism kept Tamke’s gray cells on overtime as she dreamed up ways to get another story in the paper and to find some leverage to use on Jerry Francisco.

“I went to [Eric] Muirhead [chief pathologist at Baptist and one of the supervisors of Elvis’ autopsy] and told him I was writing a story, not on Elvis, but on pathology. Muirhead said, ‘Fine, but you’ll need to read this.’ It was a book on the history of pathology, but he couldn’t find it at his office. So he sent his secretary to his house – right then – to get that book. She got a speeding ticket on the way back. I offered to pay for it, but Muirhead wouldn’t let me. But I want you to know, I read every word in that book. It was interesting, but told me a whole lot more about pathology than I needed to know. Anyhow, that’s how I got to know Muirhead.”

Tamke also got to know Dr. George C. Nichopoulos, Elvis’ controversial personal physician, but in a more confrontational fashion. “Dr. Nick wasn’t returning my telephone calls. So finally I just went down to his clinic one morning – made sure I was there when they opened the doors.”

Along with her purse, notebook, and tape recorder, Tamke was carrying a copy of Elvis: What Happened?, the bodyguard book that had gained so much attention since Elvis’ death. “Dr. Nick’s receptionist asked me if I had an appointment. I told her no, that I had been trying to get one and would be happy to wait until he could see me. The receptionist said I couldn’t see him without an appointment, but I wasn’t planning on leaving.”

Tamke found herself a seat, rechecked the list of questions she planned on asking Dr. Nick, then opened the bodyguard book and began reading. As the clientele for the Medical Group, Dr. Nick’s clinic, was processed through the waiting room, Tamke noticed a pattern. Young women, mostly on the seedy side in appearance, were coming in and asking to see Dr. Nick. They, too, didn’t have appointments. And Tamke was making it a point to make eye contact over the top of her book with the receptionist who was so quick to cite an office policy obviously so rarely enforced.

“It was plain enough to me as the morning wore on,” Tamke said, “that these patients were in the habit of dropping in for a refill without notice. But all the receptionist could tell them was the same thing she told me – you can’t see him without an appointment. They finally let me in right before noon. Dr. Nick told me I had ten minutes.”

Extracting information from the bodyguard book, Tamke added a question about Elvis’ shooting out television sets, particularly when Robert Goulet appeared on the screen. Elvis hated Robert Goulet. Otherwise Tamke’s questions, which she fired off rapidly to make the best use of her limited time, gave her the basis of an exclusive story that appeared across the top of page 1 on August 25, 1977.

“What sticks in my mind most about that story – other than the fact that most of what I was told wasn’t true – was when I got back to the office there wasn’t anybody there who would transcribe the tape,” she said. “I spent the rest of the afternoon transcribing it myself and barely had time to get the story finished for the first edition.”

In the lead paragraph, Tamke quoted Dr. Nick as saying Elvis didn’t have a drug problem, “at least not in the last three years of his life.”

Staring at a cold cup of coffee on his desk, Dr. Nick had said he was trying to put his life back together. He didn’t mention his worries about the forthcoming toxicology reports performed after Elvis’ autopsy or anything about his tense relationship with Vernon Presley, who had lost faith in his son’s doctor.

Nichopolous did tell Tamke that Elvis had been unhappy in recent months over problems with Ginger Alden, his current girlfriend, that “medication” was kept from Elvis because he might wake up in the night and take too many sleeping tablets, and that Elvis probably had been dead for several hours before his body was found.

Dr. Nick also told Tamke he didn’t believe Elvis was an overdose victim. “No, I don’t think he had anything there to OD on,” the doctor said. “He had taken a couple of sleeping pills or he was given a couple of sleeping pills. Whether he had taken them or not, I don’t know. And the only other medicine he had on hand was some medication he used for his colon and medication that he used for his sinus.”

As for heart problems, Dr. Nick described Elvis’ hypertension as “mild,” a condition for which there was no need for drugs. “At a time when he was getting ready for a tour or he was having emotional problems, he had very labile [unstable] hypertension. There were times [when there were] certain stresses that would run his [blood] pressure up to 170 or 200 systolic and diastolic anywhere from 90 to 110. And there were times when he was at home resting or just convalescing from a tour or whatever, he may have had a normal pressure of 130 over 80.”

Dutifully, Tamke reported that normal blood pressure ranges from 100 to 150 systolic and 60 to 100 diastolic. She had been hitting the medical books.

So what killed Elvis. Dr. Nick, who had been present during some of the autopsy’s gross phase, rambled like Casey Stengel about the medical examiner’s preliminary ruling that Elvis had died from cardiac problems. “I think that this is a presumptive ruling, a backdoor diagnosis, which everyone has to have a cause of death. And taking a given individual who has heart-risk factors like diabetes, hypertension, and plus obesity, plus some degree of hardening of the arteries, vessels to the heart, and you don’t find other causes of death like blood clots to the lung or stroke or heart attack where the muscle itself is damaged, then you are left with this presumption that playing the percentages and odds, that this [cardiac-arrhythmia] was the cause of death.”

Francisco’s Reaction

A week later, the Memphis Press-Scimitar, the city’s afternoon paper, managed a weak follow story on Dr. Nick, who disputed rumors that Elvis had lupus. “Those were the worst two months of my life, said Peggy Burch, the Press-Scimitar reporter who was assigned to knock heads with Tamke. “It seemed like every morning that Beth would have the story I’d been trying to get.”

Tamke, having beaten the opposition to Dr. Nick, continued to keep in touch with her contacts within the pathology community and to persist in her calls, either in person or by telephone, to the medical examiner’s office. She finally got through to Francisco on August 26.

The medical examiner was sticking to his guns. Very likely, Francisco told Tamke in an interview, the cause of death would be heart attack. Why? Well, Elvis’ heart was enlarged. His liver contained fatty globules. His coronary arteries were abnormally narrowed. And apparently from either talking to Dr. Nick or reading Tamke’s exclusive interview, Francisco said he had been told of Elvis’ wide swings in blood pressure.

On two key points, Francisco either deliberately misled Tamke or hadn’t bothered to find out.

First, he said Elvis’ stomach hadn’t been pumped during resuscitation efforts and that the stomach contents revealed “nothing identifiable.” In reality, the trauma team that had tried to revive Presley had thrown the stomach contents away before the autopsy.

Second, Francisco told Tamke that Elvis didn’t have an impacted colon. He said it looked normal at the autopsy. Of course, the medical examiner had been at the first news conference after the death when Baptist Hospital pathologists were examining Elvis’ jam-packed megacolon, a symptom of long-term abuse of narcotics.

At the bottom of Tamke’s story, however, was an ominous paragraph. “[Francisco] said the autopsy report will remain private unless the case becomes a medical examiner’s matter or unless Presley’s family decides to release it.” At the time, she didn’t attach much significance to this detail.

Two Conflicting Tests

Meanwhile, Harold Sexton, M.D., one of Eric Muirhead’s assistants in the pathology department at Baptist, had arranged for a set of Elvis’ tissue and fluid samples from the autopsy to be sent for independent examination to Bio-Science Laboratories, a highly respected and state-of-the-art toxicology lab in Van Nuys, California.

Sexton was concerned about conflicting results from two evaluations that had been performed already – one initiated by Baptist and performed at Duckworth Laboratory at Methodist Hospital that screened Elvis’ urine for drugs, and one initiated by Francisco done at the University of Tennessee-Memphis’ toxicology lab.

The tests at the Duckworth lab were preliminary – aimed at giving Dr.s Muirhead, Sexton, their colleagues at Baptist Hospital, and presumably Francisco a clue about what killed Elvis or a direction for focusing further medical investigation. Overnight the results came back. The tests were positive for four types of depressants – barbiturates, meprobamate, benzodiazepines, and ethchlorvynol. They were negative for a host of other types, including amphetamines, cocaine, and notably morphine and codeine.

In contrast, Francisco’s toxicology lab at UT identified ethinamate, methaqualone, codeine, meperidine, chlorpheniramine, and unspecified barbiturates as being present in either blood or urine. It reported all of those drugs as being in concentrations “less than the toxic or lethal levels,” but otherwise failed to enumerate just what those levels were. In the world of a toxicologist, therapeutic, toxic, and lethal ranges were in a perpetual state of redefinition.

The results of the UT urine screen were of particular interest to Sexton and later would loom large in Francisco’s official ruling. The UT tests showed no presence of ethchlorvynol, more commonly known under the trade name of Placidyl.

“This was a very important element in the overall toxicology analysis,” Sexton would later say. “The Duckworth lab knocked it off that very night while Francisco’s lab didn’t find it at all. Ethchlorvynol smells just like dirty socks – really noticeable. But if you start your temperatures too high in testing for it, then you'll burn it off. It was plain enough to me early on that this is what Jerry’s technicians did. They burned it off.”

Within a week’s time after Elvis’ death, therefore, Sexton and “the chief,” as he called Muirhead, knew they were up against not only a medical examiner who shot from the hip but also a public laboratory that some doctors believed to be staffed with underskilled, fumble-fingered technicians.

“We wanted to pick the best independent toxicology lab we could find to help determine how Elvis Presley died,” Harold Sexton explained in 1979. “We asked around discreetly all over the country and the name that kept cropping up was Bio-Science Laboratories in Van Nuys, California.

An Overdose Case

Never before had the toxicologists at Bio-Science seen a more alarming case than the case of “Ethel Moore” from Memphis (Sexton had disguised Elvis’ identity when he sent the samples). The analysts at Bio-Science thought Ms. Moore, whoever she was, must have been gobbling up prescription drugs like a kid in a candy store, because the first tests were showing ten types of drugs in significant concentrations.

Upon hearing those results, Sexton decided to let the hepcat out of the bag. They were talking Elvis, he confided to the California lab, and Baptist Hospital wanted nothing less than an exhaustive investigation.

Two series of independent tests later, Bio-Science called Harold Sexton, and arranged to show him the report it had prepared on the Presley case. In exchange, Sexton showed the Toxicologists Baptist Hospital’s autopsy protocol detailing the condition of Elvis’ vital organs at death. There was no cardiac or other pathology to explain death. Sure enough, they agreed, this was an overdose case.

After receiving a full briefing from Bio-Science, Sexton huddled with his colleagues at Baptist Hospital. All were convinced that the cause of death was clear and that their investigation was nearing an end. It was October 17, 1977, two months and a day after Elvis’ death.

Muirhead assembled a group on October 18 to visit Vernon Presley at Graceland mansion to explain the autopsy report. Francisco was there. So were Maurice Elliot, administrative president at Baptist Hospital; Sexton, who was prepared to go into minute detail about the report; Marian Cocke, the Baptist Hospital nurse who attended Elvis during his hospitalizations and frequently at Graceland; and Sandy miller, Vernon Presley’s fiancée. Absent and uninvited was Nichopoulos.

Before delving into the toxicology report, Muirhead noted that Elvis’ body displayed four conditions – a minor edema, or swelling of the lungs from a small buildup of fluid; conjunctivitis, a swollen and inflamed condition around the eyes; cyanosis, or blue coloration of the lower abdomen with a distinctive line of demarcation showing how Elvis was curled in a semi-flexed position; and from that abdominal line upward, hundreds of small hemorrhages or petechiae. These petechiae, Muirhead noted, indicated that Elvis had lived for a short time, allowing the blood vessels to burst, after falling to the floor. All of the conditions, he added, were consistent with death by drug overdose, which, as the toxicology report showed, was what killed Elvis.

Francisco chimed in that he was 90 percent in agreement but would need to review the autopsy report further.

As Maurice Elliott recalled the meeting two years later in a sworn deposition:

“Dr. Muirhead reviewed in some detail with Mr. Presley, Vernon Presley, how the autopsy was performed, what sort of tests were done, and basically the results of those tests and our staff’s conclusions as to the cause of death.”

“And did Dr. Francisco make any report to Mr. Presley at that time?” an attorney asked Elliott.

“No. Dr. Francisco at that time stated that he was in general agreement with our conclusions but that he wanted to take the complete report and review it with his staff before coming to an official conclusions. And he indicated at that time, after he had done that, that he felt obligated to make some statement to the press.”

Closing In

Beth Tamke was aware of the Graceland meeting, although she knew too little about what was said to write a story. She also was aware that the assignment she had lived with for two months was coming to a head. As Tamke sized it up, the worst case scenario would be to find out what the autopsy concluded while sitting in a morning news conference with the newsbreak going to the Press-Scimitar.

Tamke’s homework paid off. Francisco was reviewing the case with his associates in the medical examiner’s office and was keeping a lid on the story – except that the medical examiner had to sign a death certificate. According to the normal procedure, it would be sent to the Memphis and Shelby County Health Department and from there to the Tennessee Department of Public Health in Nashville. Under state law, death certificates are confidential documents sealed from public view for fifty years. Nonetheless, as Tamke knew, there were many pairs of eyes between Francisco’s office and Nashville.

By that time McEachran, Tamke’s boss, had moved to Birmingham. His replacement as metro editor was E.B. Blackburn, longtime editor of the newspaper’s Sunday magazine, Mid-South. Blackburn, known around the newsroom as “Blackie,” was a jovial but opinionated editor who had measured most of his news career in column inches on the copy desk. The Commercial Appeal’s news side made him uneasy. Hard news made him nervous. And hard news pertaining to Elvis Presley made him paranoid.

On October 19, the day after the Graceland meeting, Tamke patched together a story derived from the pathologist sources she had developed during the past two months. “Pathologists are like anybody else. They want to know what’s going on, particularly in their field. They all had been talking about the Elvis case,” she said.

Tamke’s story, which quickly hit the A wire on both Associated Press and United Press International, said multiple drugs might be ruled as the cause of Elvis’ death. Burrowing in on what had taken place at Graceland, Tamke reported that Vernon Presley had learned of ten drugs that had been found in Elvis’ system. While all the drugs were within prescribed levels, Tamke’s story speculated, together they could have triggered an interaction affecting the singer’s enlarged heart. Her story correctly listed Elvis’ heart weight, aorta and all, at 520 grams.

Francisco wasn’t commenting on the story, but inside the medical examiner’s office he was sounding off to his staff that Baptist Hospital was trying to dictate the final ruling in an unseemly alliance with the press.

Jim Bell, the medical examiner’s pudgy understudy, remembered Francisco calling an in-house powwow over it. “Our conference concluded that the report from Baptist Hospital, and [in] my opinion, was wrong and that the conclusions were wrong and that the newspaper article was in error,” Bell said in a deposition two years later.

Just what was going on between the SHelby County Medical Examiner’s Office and Graceland during this critical three-day period is murky. But an assistant in his office remembers Francisco talking frequently over the telephone to Vernon Presley, who had been shaken but the autopsy’s findings as detailed by Muirhead. Now Vernon Presley apparently was being given a second, and contrary, opinion that somehow made Elvis’ death seem more palatable.

Francisco told Tamke to hold up on writing any more stories until his news conference scheduled on Friday, two days away. But Tamke wasn’t waiting. She pulled all stops to nail down what Francisco was putting on the death certificate.

“The story about the death certificate was the key to everything else I did,” Tamke said. “I had a source – I’m not telling who or where – who saw that death certificate. There was no mention of drugs. Up until that point I had been able to verify unattributed information from two separate sources. My source who saw the death certificate was absolutely reliable, but I knew I wouldn’t find a second one. “Blackburn wouldn’t have run the death certificate story,” Tamke said flatly more than ten years later. “Fortunately, I got my information at home over the telephone at night. John Weed [an assistant managing editor] was in charge. I explained what I had, and also what I didn’t have. Weed told me to come back into the office and write it.”

Appearing on the morning of October 21, Tamke’s story reported that the cause of death listed on the certificate was heart ailment. Drugs weren’t mentioned, her report stated, even though tests commissioned by Baptist Hospital showed the presence of at least ten drugs in Presley’s system. Francisco had signed the certificate the day before and had it hand-delivered to the local health department.

The repercussions from the death certificate story were threefold. One, the Baptist Hospital team had a clear indication that Francisco had double-crossed them. Two, those with access to the autopsy were mindful that Beth Tamke had the wherewithal to get the hard evidence into the newspaper. And three, Jerry francisco was persuaded forevermore that these hospital pathologists had stepped over the line into the forensic realm and were trying to tell him his business.

Not surprisingly, Francisco scheduled his news conference for Friday morning, October 21, 1977, at an hour that would give Tamke’s afternoon opposition the newsbreak.

As foreshadowed in Tamke’s reports, Francisco handed out a press release ruling that the cause of Elvis Presley’s death was hypertensive heart disease with coronary artery disease as a contributing factor. Drugs, Francisco ruled, played no part in the death.

In an effort to add clout to his ruling, Francisco said the entire staff of his office – two other forensic pathologists and a toxicologist – supported the conclusions. In addition, Francisco said, “two other toxicologists in the United States,” who were to remain unidentified for two years, had been consulted in the case. All put together, two toxicologists (a Francisco employee and an unidentified outsider) believed the drugs made no significant contribution to death. THe third toxicologist, another mystery expert, said that “all medications were in the therapeutic range and individually [sic] did not represent an overdose.” Or at least that’s what Jerry Francisco’s press release said.

Then, aiming a zinger at Muirhead and the others across the street at Baptist, Francisco added to his press release,”All the toxicologists agreed that the decision whether these medications played any role in death causation should be left to the forensic pathologist.”

As for the hard evidence that might cast doubt on the medical examiner’s opinion, he continued, “The autopsy was not ordered by the district attorney general and thus is not a part of the file of the medical examiner.”

Francisco was having it both ways. As a medical examiner’s case, he could issue a ruling and talk freely about Elvis’ death. But the naysayers, all within the private sector, were stymied.

Muirhead, an internationally recognized expert in hypertensive heart disease, was livid but held his tongue. “Vernon Presley has my report. Our dealings have been entirely with the family,” he said. “He is the only one who can release it, if he wishes. That’s all I am going to say.”

But Tamke had her sources, ones he had worked hard to establish and the newspaper brass failed to appreciate. Those sources, who remain unidentified today, slipped her a key portion of Bio-Science’s toxicology report. Tamke’s story covering and expanding on Francisco’s news conference revealed drug concentrations in Elvis’ bloodstream to the public for the first time. The toxicology results were:

• Codeine at ten times greater than a therapeutic dose, with morphine (what becomes of codeine when the body metabolizes it) at a near-toxic concentration.
• Methaqualone (Quaalude) at a toxic level.
• Diazepam (Valium) at a low therapeutic level, but its metabolite on the borderline of toxic.
• Ethinamate (Valmid) high in the therapeutic range and possibly toxic. Research hadn’t established a firm toxic level for this drug.
• Ethchlorvynol (Placidyl) on the toxic borderline.
• Pentobarbital high in the therapeutic range.
• Butabarbital within the therapeutic range.
• Phenobarbital in a low therapeutic range.

In street terms, all these drugs are “downers.” Acting together, Tamke reported her sources as saying, they would result in death by polypharmacy. Tamke’s editors refused to allow her unidentified experts to go any further than that. Otherwise, she would have reported that the codeine alone in lower concentrations than Elvis’ had put people in their graves.

In response to Tamke’s questions about the Bio-Science findings, Francisco said the tests from his own lab as a forensic shop were more reliable – a remark that brought titters from forensic specialists familiar with the high caliber of Bio-Science. Francisco went further to state that Placidyl, identified by three other laboratories, wasn’t really present in Elvis’ system.

The Last Chapter

How could Francisco’s tests – the ones performed in a public lab, commissioned by the medical examiner, and made a part of the full autopsy record – be kept out of the public domain? Indeed, couldn’t it be argued that Francisco’s contribution to the autopsy, as slipshod as Muirhead and Sexton believed it be, had in fact transformed the entire autopsy into a public record?

In the aftermath of Francisco’s devastating news conference, Tamke was asking herself these same questions as she thumbed through the newspaper’s copy of The Tennessee Code Annotated in search of answers.

“I remember what happened as plain as yesterday,” Tamke said. “I was looking through the law books when Blackburn walked by my desk. ‘You’re not a goddamn barrister,’ he told me. ‘Get your nose out of those law books and write me a story.’

“So I wrote stories about Legionnaire’s disease, about cricks in the neck, about water on the knee,” she said.

In other words, Tamke knew she was off the story. Her hard-earned documentation of Elvis Presley the drug abuser went to an unobtrusive cabinet in the newspaper morgue containing what was called “the shit files.” The press in memphis lost the initiative that Tamke had established singlehandedly.

“Beth called me up after it was all over,” Peggy Burch of the Press-Scimitar recalled. “We went out to a bar to talk it over and got stinking drunk.”