SF Public Defender Jeff Adachi’s death caused by cocaine and alcohol use, autopsy finds

San Francisco Public Defender Jeff Adachi meets a friend as he stops into court to check on some of his staff at the Hall of Justice, Tuesday Sept. 29, 2010, in San Francisco, Calif. San Francisco Public Defender Jeff Adachi meets a friend as he stops into court to check on some of his staff at the Hall of Justice, Tuesday Sept. 29, 2010, in San Francisco, Calif. Photo: Lacy Atkins / The Chronicle Photo: Lacy Atkins / The Chronicle Image 1 of / 5 Caption Close SF Public Defender Jeff Adachi’s death caused by cocaine and alcohol use, autopsy finds 1 / 5 Back to Gallery

San Francisco Public Defender Jeff Adachi died from a mixture of cocaine and alcohol, which caused his already-damaged heart to stop, the city medical examiner has concluded.

The San Francisco Medical Examiner’s Office released the autopsy report on Adachi’s death late Friday, one month after the 59-year-old public defender collapsed in an apartment on Telegraph Hill and was later pronounced dead at a hospital.

“The cause of death is acute mixed drug toxicity with cocaine and ethanol, with hypertensive atherosclerotic cardiovascular disease as a contributing factor,” Assistant Medical Examiner Ellen Moffatt wrote in the report. “Based on the history, autopsy, microscopic and toxicology finding, the manner of death is accident.”

The public defender’s office declined to comment on the report.

“Out of respect for the family, our office is not going to comment on what we believe is a private medical matter,” said Katy St. Clair, a spokeswoman for the office.

The report sheds new light on the final moments of the public defender, who died on Feb. 22. His unexpected death shocked city officials, who had worked closely with him during his 17 years as public defender.

Many city leaders praised his work as a relentless defender of indigent clients, a police watchdog and a criminal justice reformer. Few, though, wanted to comment on Friday’s autopsy results.

Supervisor Sandra Lee Fewer, who called for a public hearing after a police report was leaked to the media after Adachi’s death, said Friday, “What people do in their personal lives and in their own personal time is private.

“As a public official, I know that it is hard to have a private life,” she said. “But the fact that you could not even have privacy after death is also very disturbing.”

Mayor London Breed, a longtime friend of Adachi’s, declined to comment.

The 25-page autopsy report details Adachi’s final moments in dispassionate detail. It includes interviews with witnesses and police, details about Adachi’s anatomy, as well as a toxicology report that found cocaine, alcohol, and benzodiazepines in his system. Benzodiazepines, such as Valium or Xanax, are widely prescribed sedatives.

It began when paramedics were called to an apartment at 46 Telegraph Place at the base of Telegraph Hill at about 5:45 p.m. on Feb. 22, where they found Adachi unconscious.

“Paramedics and Fire Department personnel reported that witnesses at the scene stated that the subject had been acting ‘strange’ and unlike himself, and grinding his teeth before collapsing,” Moffatt wrote. “Emergency services found the subject unresponsive on the floor of the bedroom.”

Paramedics began CPR and twice intubated Adachi to clear his airway, but he remained unconscious, the report states. They also tried unsuccessfully to revive him with electric shocks and administered epinephrine and Narcan, which reverses the effects of opioid-based narcotics. No opiates were found in his system.

They rushed Adachi to California Pacific Medical Center’s Pacific Campus, where he was pronounced dead at 6:54 p.m. Staff there contacted Adachi’s cousin, who called his wife, Mutsuko Adachi, who rushed to the hospital, according to the report.

Adachi’s wife told investigators she last saw him around 6 a.m. when he left home that morning to go to the gym, Moffatt said. His wife said he had no known medical problems and was not taking any medications to her knowledge. She said he never used illegal drugs.

Investigators from the medical examiner’s office and Police Department headed to the apartment to collect evidence and try to interview a woman who first called 911 from Adachi’s phone.

According to a police report on the incident previously reviewed by The Chronicle, investigators interviewed a real estate agent, Susan Kurtz, who is a longtime friend of Adachi’s. She told them she allowed Adachi to use the apartment — which is typically unoccupied — for a couple of days.

The medical examiner’s office learned Adachi had been with a different woman that night. Kurtz had told police she believed the woman’s name is Catalina. Sgt. Scott Warnke, an inspector with the homicide unit, later interviewed the woman.

She told police she had spent the day with Adachi, “starting in the morning and had breakfast about 11 a.m.,” the report states. “Mr. Adachi seemed to be in his usual state of good health and ate well. At some point they consumed some edibles (cannabis). Around 4 p.m., they went to a North Beach restaurant and had dinner.”

At dinner the two “drank a glass or two of Champagne, and Mr. Adachi ate well” but complained of upper abdominal pain and “began sweating profusely,” Moffatt wrote.

The two left the restaurant and headed to the Telegraph Hill apartment, where Adachi took an ibuprofen and “continued to have severe abdominal pain and sweating and eventually took off his clothes (with the exception of his underwear) and got into bed because he felt ill,” the report states.

Adachi’s companion asked if he would like to go to the hospital, but he refused, so the woman then went to a corner store to purchase heartburn relief medication and returned to find Adachi still in pain, investigators said.

“Adachi then became very confused and shortly after became unresponsive,” Moffatt wrote. “She called 911 and was instructed to perform CPR.”

A toxicology report later found small amounts of alcohol, cocaine, as well as benzodiazepines in his system.

“The levels of these substance in the blood are most consistent with them having been taken at some point during the day, with metabolism occurring over the subsequent hours,” Moffatt wrote. “The heart, with a significant amount of coronary artery disease and fibrosis already present, would have worked even harder with stimulant substances such as ethanol and cocaine in Mr. Adachi’s system.”

Adachi’s “already compromised heart” could no longer take the added stress and seized up around the time he was having dinner, Moffatt found. Hours later, he was pronounced dead.

Breed has since appointed Mano Raju, a former managing attorney in the public defender’s office’s felony unit, as the new public defender. Raju told The Chronicle he intends to run for the position in November.

San Francisco Chronicle staff writers Trisha Thadani and Lauren Hernández contributed to this report.

Evan Sernoffsky is a San Francisco Chronicle staff writer. Email: esernoffsky@sfchronicle.com Twitter: @EvanSernoffsky