San Francisco Public Defender Jeff Adachi’s sudden death last month was accidental, caused by a mixture of cocaine and alcohol complicated by existing heart problems, according to autopsy results released by the San Francisco Medical Examiner on Friday.
Adachi was found unresponsive on the floor of a bedroom inside a North Beach apartment building on Feb. 22. Preliminary reports indicated that he had suffered shortness of breath after having dinner with a woman in North Beach and later suffered a medical episode inside of a residence at 46 Telegraph Place.
According to the autopsy report, paramedics and fire officials who responded to the 5:43 p.m. 911 call found Adachi inside of the residence and initiated cardiopulmonary resuscitation. After two unsuccessful intubation attempts, a King tube was placed down his throat to aid with breathing.
Paramedics reported “good chest rise and lung sounds” according to the report, which also states that Adachi was “shocked multiple times” and injected with epinephrine and Narcan. Adachi sustained a “slow carotid pulse,” which was lost a few seconds thereafter.
Adachi was transported to California Pacific Medical Center at 6:21 p.m., where he was transferred to the care of hospital staff eight minutes later. The hospital’s staff continued resuscitative treatment until Adachi was pronounced dead at 6:54 p.m.
Other substances found in Adachi’s system included marijuana, Zantac, Ibuprofen and benzodiazepines at levels “too small to quantify.” The blood levels of these substances indicate that they had been consumed at some point during the day, according to the report.
The report does not indicate that cocaine was found at the scene.
According to police interviews with his female companion, who placed a series of 911 calls, Adachi consumed “a small amount of alcohol” with dinner before reporting “severe mid upper gastric pain” and becoming “sweaty.”
According to the report, the woman told emergency personnel at the scene that Adachi “had been acting strange and unlike himself,” and was grinding his teeth before he collapsed.
Police interviews show that the woman and Adachi started the day together with breakfast at approximately 11 a.m., at which time Adachi appeared to be in a good physical state and “ate well.” The pair later reportedly consumed edibles, and around 4 p.m. went to a North Beach restaurant for dinner.
It was then that Adachi complained of upper abdominal pain and was too uncomfortable to walk back to the apartment, prompting the pair to order a rideshare.
The report indicates that the woman inquired several times after dinner and at the apartment whether Adachi needed medical attention, but that Adachi refused because “this had happened a few times before and resolved on its own.”
Adachi, who was 59, was reported to be in generally good health, with hyperlipidemia listed as the only significant condition in his medical history. According to the report, Adachi did complain of a cough in the recent past, but an evaluation found no pulmonary issues.
A coronary evaluation revealed blocked arteries and fibrosis.
“At some point, most likely during the dinner, his already compromised heart could no longer sustain the amount of cardiac stress caused by these stimulant substances and became ischemic with death resulting a few hours later,” concluded the report.
Adachi is remembered as a talented defense attorney who fought vigilantly for San Francisco’s disenfranchised and as an outspoken critic of police misconduct who spent years advocating for reform. A public vigil held for Adachi a week after his death drew hundreds of people into the streets for a march from the Public Defenders’ Office to City Hall.
A spokesperson for the Public Defender’s Office declined to comment “out of respect for the family” on “what we believe is a private medical matter.”
The mayor’s office also declined to comment on the autopsy report.