Scalia suffered from many health problems; obesity, artery disease, diabetes

DALLAS (AP) -- Antonin Scalia suffered from coronary artery disease, obesity and diabetes, among other ailments that probably contributed to the justice's sudden death, according to a letter from the Supreme Court's doctor.

Presidio County District Attorney Rod Ponton cited the letter Tuesday when he told The Associated Press there was nothing suspicious about the Feb. 13 death of the 79-year-old jurist. He said the long list of health problems made an autopsy unnecessary.

Ponton had a copy of the letter from Rear Adm. Brian P. Monahan, the attending physician for members of Congress and the Supreme Court. The letter was to Presidio County Judge Cinderela Guevara, who conducted a death inquiry by phone and certified Scalia's death.

The letter dated Feb. 16 said Scalia's many "significant medical conditions led to his death," Ponton said.

In the letter, Monahan listed more than a half-dozen ailments, including sleep apnea, degenerative joint disease, chronic obstructive pulmonary disease and high blood pressure. Scalia also was a smoker, the letter said.

Ponton declined to provide a copy of the letter, saying an open-records request must be made to Guevara, who did not respond to a phone message Tuesday.

The AP filed a records request with the judge last week, but she did not provide the letter or respond to a reporter's phone message Tuesday. The Texas Department of State Health Services has declined to release a copy of the death certificate.

Scalia was found dead in his bed at the Cibolo Creek Ranch, not far from the Mexico border, where he had gone on a hunting trip.

Dr. Mark Hlatky, professor of cardiovascular medicine at Stanford University, said a 79-year-old man with those conditions, especially coronary artery disease and sleep apnea, would be at risk for a potentially fatal heart arrhythmia.

"A lot of people do die in their sleep, and they're found the next day."

The conditions are also associated with pulmonary embolism and stroke, which could also "kill somebody very suddenly."

Scalia's death, he said, was unexpected, "but it sounds like it wasn't suspicious."

The justice's many ailments, taken together, were "quite dangerous," said Dr. David Zich, a physician of internal and emergency medicine at Northwestern Memorial Hospital.

Zich said he would advise a patient with those conditions who was still smoking to stop smoking, first and then lose weight.

"Those are the main two things someone in his position can do himself," Zich said. "The rest falls on the physician to medically manage blood pressure and make sure their blood sugar levels are controlled well."

Zich said he would also want such a patient to use a continuous positive airway pressure machine, or CPAP, at night for sleep apnea "to make sure the heart and body aren't stressed while sleeping."

Guevara, who as county judge is the top administrator in the area, previously said she conferred by phone with Sheriff Danny Dominguez and a U.S. marshal before certifying the death. On the day Scalia died, she also conferred with Monahan by phone before determining the cause of death.

Scalia's death "was handled in a similar fashion as the cases of other elderly people who have died in Presidio County," Ponton said.

In rural Texas, justices of the peace investigate deaths, among other duties, but the two justices in the region were out of town and unavailable. Guevara was also out of town, more than 60 miles away, but agreed to conduct the death inquiry by phone.

The Supreme Court does not provide regular reports about the justices' health. It is left to each court member to decide how much to make public about medical conditions.

Some justices, including Ruth Bader Ginsburg, have released detailed reports of hospital stays and surgeries. The Supreme Court's press office could find just one release in 29 years pertaining to Scalia's health, a report of surgery in 2003 to repair a torn rotator cuff in his right shoulder.