This is the original piece written in Fall 2013 about Elvis’s death, the closing section of which is included in the post titled, “Review: The Post-Mortem Documents.”

Understanding the Death of Elvis

As the 36th anniversary of Elvis Presley’s death has passed, and his seventy-ninth birthday approaches, I am reminded once again, as I am every year, that the body of research dedicated to Elvis’s life and, particularly, his death, is rife with misinformation and inconsistencies.  This has resulted in much confusion as to what actually killed the king of rock and roll. 

Since July 1994, I have been researching and reading about Elvis Presley nearly every day, with much of that research providing the basis for my book, “Elvis Decoded:  A Fan’s Guide to Deciphering the Myths and Misinformation.”  My exhaustive efforts over the years have brought me to two very clear conclusions:  Elvis Presley is one of the most misunderstood artists in all of popular culture, largely due to so much conflicting information about him, and his death is one of the most misunderstood events (can I call it an event?) of the modern era.  How did the information become so convoluted and difficult to piece together?  Why are the facts so easily disregarded, with the salacious details taking the place of reliable, trustworthy reporting and analysis?

I was nine years old on August 16, 1977, the day that Elvis Presley died.  Though I was certainly aware of his name and (more vaguely) his importance, to me he was just, “that guy from the fifties, who went to Hollywood.”  That was my only frame of reference for him, and thus anything I heard about Elvis on this hot August evening might form the basis of my knowledge or opinion of him going forward.  So what did I hear that day?  “Elvis died this afternoon in Memphis, too many donuts.”  Yes, that’s what I heard from a guy at a friend’s pool when he came out from the house with this up-to-the-minute news brief.  It was all about the donuts.  That’s the take-away:  Elvis was a big eater — nothing to see here, folks, move along.

Over the next few years, what I learned about Elvis came primarily from celebrity magazines and tabloids, long before the Internet and social media sites such as Twitter and Facebook became the de facto sources for all that is newsworthy (and not so newsworthy).  I heard he may have faked his death, and that he may have had a drug problem.  But what I saw once I delved into the world of Elvis is that the information passed around the fan clubs and the message boards is often incorrect, misleading, or downright false.

Fast-forward to late-June 1994, and I was on my back porch having a drink with a friend named Eric, who was a big Elvis fan.  I mentioned to him that my fiancé and I were going to Wrightsville Beach, North Carolina, over the Fourth of July holiday, and that I was looking forward to the trip, as my family used to vacation there back in the seventies.  Eric off-handedly suggested Memphis instead, saying the drive to Graceland is only eight hours or so, and we’d get a true sense of “The King” there.  So we nixed the North Carolina trip, mapped out our route to Memphis (no GPS’s in 1994), and days later left Virginia for The Promised Land.  I wasn’t really an Elvis fan then, but I was interested.  That was all.

At the tail end of the thirteen-hour drive to Memphis (it wasn’t anywhere near eight), we were headed south on Elvis Presley Boulevard at two in the morning, just passing the Lisa Marie airplane on the right, and something clicked.  What was that “something”?  I don’t know, but whatever it was, it led me on this perpetual research project, and I have been researching and reading about Elvis Presley nearly every day.  As part of that never-ending effort to understand everything about Elvis, I have focused much of my work on his death, due to the conflicting and incorrect information that permeates this area of study.  I’d like to take a look at several keys pieces of the story, and see if I can clear up some of the confusion.

There are three main theories as to the cause of Elvis’s death that have been discussed and debated over the past 36 years:  he died of a heart attack, he died of “cardiac arrhythmia,” or he died of a drug overdose.  All are incorrect, going by the autopsy report, and even in public statements there has never been a professional opinion offered by anyone involved that Elvis simply died of an overdose or a heart attack.  (“Cardiac arrhythmia” is a catch-all term that offers nothing, as an irregular heartbeat cannot be detected in a patient who is no longer living.)  The accurate statements would be that Elvis died of polypharmacy, or he died due to cardiovascular disease.  The former is not an overdose, and the latter is not, necessarily, a heart attack.

On October 21, 1977, Dr. Jerry Francisco, the Shelby County Medical Examiner, announced that the “probable cause” of Elvis’s death was,“HCVD associated with ASHD,” which stands for, “hypertensive heart disease associated with atherosclerotic heart disease.”  Loosely, this means that high blood pressure and hardened/narrowed arteries led to his death.  Now, it is certainly reasonable at this point to conclude that these cardiac conditions led to death via a heart attack (the actual mechanism of death), but the glitch here is that the data and conclusions found in the autopsy report don’t support Francisco’s conclusion.  To wit, on the list of “Final Pathological Diagnoses,” we find the following:  “Coronary atherosclerosis, mild to moderate.”  The pathologists discovered that no coronary arteries were more than 50% blocked, and at autopsy, an examination of the heart yielded no surprising finds, nor evidence of a heart attack.

On the drug overdose cause of death theory, the correct term would be “polypharmacy,” a conclusion reached by the team of pathologists that conducted the autopsy.  This cause of death was reached after the toxicology reports had been submitted to Baptist Memorial Hospital (where Elvis was pronounced dead and the autopsy took place), and after a careful review of all the data.  “Polypharmacy,” as the term applies to a death, is the lethal interaction of two or more drugs, typically causing an exponentially stronger reaction to normal or therapeutic levels of drugs.  With polypharmacy, the interaction might be considered not as 2 + 2 = 4, but 2 + 2 = 7.  The interaction itself (between presumably contraindicating medications) causes the death, not an overdose of one specific medication.  In his October 21, 1977, press statement, Dr. Francisco dismissed the notion of polypharmacy, though this is the conclusion reached by the team of pathologists that conducted the autopsy.  It should be noted that Bio-Science Labs in California, where the toxicology tests were conducted, discovered at least ten drugs in Elvis’s system at the time of death, and this number has been confirmed by sources familiar with the autopsy.

Another admittedly confusing part of the story of Elvis’s death is the question of the autopsy report and why it is not available to the public.  This matter is addressed in the book, “The Death of Elvis,” by James Cole and Charles Thompson, which is a must-read for anyone interested in this story.  The confusion stems from the fact that Elvis’s death was, to paraphrase Tennessee statute, “unexpected and unattended,” and thus would fall squarely under the purview of the Shelby County Medical Examiner.  However, just because the case falls under the Medical Examiner’s office does not mean it is automatically part of the public record.  There are some nuances here that require consideration.

First, the Shelby County District Attorney General did not request that an autopsy be performed, so right out of the gate, one critical requirement of a publicly-available autopsy report is lacking.  Why the D.A.G. did not make this request is another matter for discussion, but for now, let’s just say he did not ask for the autopsy.

Second, Dr. Francisco concluded that the cause of death was due to naturally-occurring factors, meaning there was no drug overdose, nor foul play, and that the death was simply as stated — natural.  Had he found the death to be caused by something not natural, the autopsy report and the case would have been part of the Medical Examiner’s file, and thus available to the public. 

Third — this part of the story is often misunderstood — is that even though Vernon Presley, Elvis’s father, signed a “Permission for Autopsy” form, and requested that an autopsy be performed, this request is not the reason that the autopsy report is not a public document.  Had Dr. Francisco reached a different conclusion (for example, drug overdose), then the report would have been public.  But since he concluded that Elvis’s death was natural, the autopsy report thus became a private medical record belonging to the Presley family.  In my research on this matter I have found that an argument could be made that the autopsy report, regardless of the way things played out in 1977, should be available to the public (“The Death of Elvis” covers this possibility in great detail).  However, if all the information is considered, the only reasonable conclusion is that the document is, legally, a private document, and should remain that way.  Still, though, it’s a fine line.

Finally, there is a misunderstanding among fans and the media regarding the various documents that pertain to Elvis’s death, typically the Medical Examiner’s report being referred to as the autopsy report.  Below is a list of the four main documents, their meaning and context:

The Autopsy Report: This report (Postmortem #A77-160) was put together by the Baptist Memorial Hospital pathologists who performed the autopsy. The autopsy report is not a public document; it was prepared for the Presley family and is the property of the Presley family. It is not “under seal,” nor is it, as a private medical record, subject to judicial seal. Because the autopsy report is a private medical record, it will not be released at any time.

The Medical Examiner’s Report: This is the two-page report signed and submitted by the Shelby County Medical Examiner, Dr. Jerry Francisco. This document is officially titled, “Report of Investigation by County Medical Examiner,” and is designated Case #77-1944. This report is not the autopsy report.  It is a report required by the state, and the content is left to the discretion of the Medical Examiner.  In Elvis’s case, Dr. Francisco included cause of death in this report.  The Medical Examiner’s report is a public record.

The Death Certificate: This is the death certificate completed and signed by Dr. Francisco and filed with the state of Tennessee. Per Tennessee statute, death certificates become public documents at the end of a 50-year period, which means this document will be released in 2027. The death certificate, while not available to the public, is not “under seal,” but is simply not a public document based on Tennessee law.

The Permission for Autopsy Form: This is the form (BMH #29-51) signed by Vernon Presley to grant permission for the autopsy. The signing of the form was witnessed by Dr. George C. Nichopoulos and Richard H. Grob.  As noted above, this request did not create the basis for the autopsy report being deemed a private document.

Over the years since August 16, 1977, the controversy regarding Elvis’s death has been based on the question of whether Elvis died due to drugs or heart disease, regardless of which terminology is used.  Looking at the facts, it is very possible that both may have contributed to his death, since the condition of Elvis’s heart, according to the pathologists, was not critical enough to warrant serious concern, and there is no clear explanation on what role drugs may have played, if any.  It is possible that a reduction in blood flow to the heart could have exacerbated the effect of the drugs.

As the 36th anniversary of Elvis’s death has passed, and we move further and further away from August 1977, it might be a good time to re-think the way we view Elvis’s life and his death, and to keep in mind that when this man passed away at his beloved Graceland mansion, he was a father, a son, a friend, and a loving and generous member of a large, extended family.  It is only fair to him that we learn the facts about his life, and about his death, and perhaps re-assess the way he is often portrayed in popular culture.  Given that Elvis’s death is such a misunderstood part of the broader story, I think this is a good place to start.