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DETROIT -- The official cause of death for Detroit police officer Kenneth Steil is listed as a shotgun wound to the chest, but it's more complicated than that.

A gunman shot Steil in the right side of his chest with a sawed-off shotgun during a foot pursuit on Sept. 12.

Steil was recovering from his injuries and listed in stable condition shortly after being hospitalized. He met and spoke with Detroit Police Chief James Craig within hours of being shot.

Five days after the shooting, his condition had improved dramatically. Steil was in good spirits. He'd taken dozens of visitors in his hospital room at St. John Providence, including Detroit Mayor Mike Duggan, and was preparing to go home to his wife and two sons.

Police said one of Steil's sons even hung a welcome-home sign on the family home in anticipation of his father's return.

Then, something happened. Steil died suddenly and unexpectedly of a medical complication. Police officials never revealed what the medical complication was.

MLive requested a copy of the Wayne County Medical Examiner's autopsy report on Nov. 11. The county requested a 10-day extension and eventually agreed to fulfill the request Nov. 29.

The report, conducted by Wayne County Medical Examiner Dr. Carl Schmidt, indicates Steil's body shut down due to internal bleeding that occurred after a tube was removed from his body.

He had a healing bullet wound that tracked from his right shoulder into his lung. The medical examiner found 600 milliliters, 2.5 cups, of blood in "the right chest cavity."

"Associated with the wound path was soft tissue, laceration of the right, lower lobe of the lung, and bleeding into the right chest cavity," the autopsy says. " ... A single, deformed bullet fragment was recovered from the wound path and retained.

" ... Given the findings and known circumstances, it appears the decedent suffered another bleeding episode into the right chest cavity after removal of the chest tube. The manner of death is homicide."

Steil had a chest tube, which is meant to drain fluids from the chest cavity near the lungs, heart and esophagus, inserted soon after being hospitalized.

It was removed on Sept. 16, the day before his death, and followup X-rays showed no fluid accumulation, puncture or leaking of the lung.

Doctors encouraged Steil to get up and walk around the following day. A short time later, he told staff "he wasn't feeling good," according to the autopsy report. Steil began sweating heavily. He then became unresponsive.

"Resuscitation was attempted; however, was ultimately unsuccessful," the report says.

Schmidt declined to be interviewed to further explain his findings.

Wayne County spokesman Lloyd Jackson said in an email:

Dr. Schmidt says he does not want to speak on it at this time, because the suspect in the shooting has not yet had his preliminary exam, and Dr. Schmidt may have to testify, so he does not want to speak with media before he may have to testify in the preliminary exam.

MLive attempted to speak to medical professionals at multiple area hospitals and private pathology firms to get a general understanding of why internal bleeding can be sudden and deadly, what causes it and how it can be detected and prevented.

Most declined comment after learning it was related to the Steil case, or referred back to Wayne County Medical Examiner Carl Schmidt.

"Unfortunately, we don't have anyone available to speak with you," a spokeswoman for Detroit Medical Center Detroit Receiving Hospital said.

"We're not in a position to talk about that type of thing," said Brian Taylor, a spokesman at St. John Providence, the hospital where Steil died.

Dr. Paul Tranchida of Wayne State University's Department of Pathology said the information provided in the autopsy was "way too vague" to determine what ultimately caused Steil's body to shut down.

As far as the amount of internal bleeding noted in the autopsy report, Tranchida said he doubts 600 milliliters in the chest cavity would be enough to constrict the lungs, heart or other vital organs. He said some bleeding in the chest cavity isn't abnormal following a surgery.

Regarding the discovery of a bullet fragment during the autopsy, Tranchida said doctors usually try to remove all bullets and fragments after someone is shot, unless removal is too dangerous, or the fragments are so small they're difficult to detect on X-rays.

He said it's possible Steil "exerted himself and reopened the wound in his chest.

"Once there is internal bleeding, a couple of things could lead to death," he said.

If there is enough bleeding in an internal cavity, hemoglobin levels could drop to low levels and cause heart failure.

"But the space that the lungs are in usually won't let too much blood accumulate," Tranchida said. " ... I don't think he would have bled enough that he would have had heart failure."

Other possibilities include blood filling a sac surrounding the heart and putting pressure on it, Tranchida said, or surrounding and constricting the lungs.

The only way you can tell there is internal bleeding is with a CT scan or X-ray, the pathologist said, and if there aren't symptoms or complaints from the patient, those tests aren't usually performed.

The hospital staff did perform an X-ray following the removal of Steil's chest tube, but saw nothing that concerned them.

Steil might have felt symptoms and not shared them with doctors because he was eager to get home, or thought he could endure through them, Tranchida speculated.

Another possibility is he didn't detect the early signs of internal bleeding because of pain medication masked them. Steil had oxycodone, a popular and strong pain medicine, in his system at the time of death, toxicology reports show.

Steil's family said they didn't wish to comment.