It's been two years since the city of Phoenix's chief financial officer jumped to his death from atop his moving Mercedes on East Camelback Road.
To this day, mention of 55-year-old Kevin Keogh's highly publicized leap on the afternoon of December 8, 2004, raises the question, "What could that poor guy have been thinking?"
Now, with access to Keogh's medical records, plus interviews with medical experts and with those who knew him best, much more can finally be said about the man and about his awful death.
But a definitive answer about why Keogh jumped is as elusive now as it was after a Maricopa County medical examiner ruled initially that he had committed suicide.
"Like some real mysteries, Mr. Keogh's case has elements destined to remain unanswerable," says the county's former chief medical examiner Dr. Philip Keen.
That became evident last August 12 when Keen changed Keogh's death certificate to read "undetermined" instead of suicide.
"We did call it a suicide at first," Dr. Keen tells New Times, "because the overt action of putting your vehicle into cruise-control, getting up on a car roof and jumping off is kind of compelling. But after we collected more information, it became clear that much more was going on here than we'd originally thought."
Suicide, by definition, has to be intentional, and that's the rub.
Keen and others who have looked hard at the case, including famed New York pathologist Michael Baden, now agree that Kevin Keogh probably didn't know what he was doing literally when he jumped.
One new piece of information to which Dr. Keen was referring was a long-delayed test result proving that Keogh's brain had been damaged before he died.
Unfortunately, Dr. Diane Karluk of the Medical Examiner's Office couldn't pinpoint the cause of Keogh's brain injury, or say exactly how it had affected him.
But she wrote in a November 2005 report that her findings were "consistent with his symptoms being due to an underlying disease process."
Dr. Baden, host of HBO's Autopsy series and chief forensic pathologist for the New York State Police, tells New Times that "calling this an undetermined manner of death is definitely more reasonable under the known circumstances than calling it suicide. But one thing does seem certain: If this man really wanted to have committed suicide, he wouldn't have chosen this bizarre way to do it."
That resonates with those closest to Keogh, who insist how improbable it was that this most private man knowingly killed himself in such a grotesquely public way, and at the same time put others in harm's way by abandoning his moving car on a busy street.
"The Kevin I knew was not the guy who jumped off that Mercedes," says Phoenix city treasurer and deputy finance director Barbara Lang, a longtime colleague and dear friend of Keogh's. "He was not a man who ever, ever would have called attention to himself."
Another point: Though leaping from a car traveling at about 40 miles per hour isn't advisable, Keogh couldn't have known that he would careen headfirst into an orange tree across a sidewalk on the side of Camelback Road and die instantly.
The lay of the land there suggests he should have had much better odds of at least escaping with his life.
With Dr. Keen's recent change to the death certificate, Keogh's widow may yet become eligible for more than $300,000 in CIGNA life-insurance benefits previously denied her.
But Karlene Keogh who owns her own thriving insurance firm, is president of the Phoenix Rotary 100 club and lives comfortably in east Phoenix says she didn't contest the original suicide ruling with an eye on possible financial gain.
"I didn't know what had happened to Kevin," she says, "but it wasn't suicide. That's just inconceivable, impossible. Kevin was all about appearances, setting examples, doing the right thing. The way he died is never the way he would have wanted to die so public and so crazy. That's why I decided to fight for his name."
It was just after 2 p.m. on December 8, 2004, a sunny day in the Valley with the temperature about 70 degrees.
Scottsdale resident Karl Schumacher was driving westbound on Camelback Road, just west of 68th Street.
To his astonishment, he saw a man hoist himself out of the driver's window of a black Mercedes eastbound on the other side of the intersection.
Schumacher thought for a moment it was a prank.
He saw the man steady himself on top of the car by extending his arms outward.
When Schumacher was about even with the Mercedes, the man jumped off toward the passenger side. Through his rearview mirror, Schumacher watched him tumble over the curb into an orange tree.
Schumacher called 911 as he made a U-turn, parked, and ran over to the man, who lay motionless next to the tree, surrounded by fallen oranges.
The man was bleeding from a deep wound to his forehead, and it was obvious to everyone gathering around him that he was dead.
Another Scottsdale resident, Robert Cuevas, had been driving behind the Mercedes, at a speed he later estimated at 35 to 40 mph.
After also observing the man jump, Cuevas had seen the vacated Mercedes ram into the rear of a Dodge Neon stopped at the light at 68th Street and Camelback.
Cuevas told police that the Mercedes continued to move after it struck the Dodge, but soon had come to rest against a curb on the southeast corner of the intersection.
Kevin Randolph, the driver of the Dodge, said the collision had taken him totally by surprise. He said his attention had been on a bicycle rider in the crosswalk when he got rear-ended.
Not seriously injured, Randolph ran up to the Mercedes, opened the passenger door and looked in. It was empty, though the gearshift still was in drive.
Scottsdale police arrived within a few minutes.
The man on the ground was dead.
He was wearing blue jeans, a sweatshirt, and a pair of socks. Brown loafers on the sidewalk nearby presumably had come off after the man jumped.
Inside the car was a prescription for Valium issued to a Kevin Keogh, and a car registration in the same name.
Within the hour, Scottsdale detectives delivered the bad news to Karlene Keogh at the couple's home in the Arcadia neighborhood, a few minutes from the scene.
Mrs. Keogh told them her husband of four years had been depressed recently because of unusually hard times at work.
She said he'd stopped exercising, and had been complaining of exhaustion and other troubles, ostensibly because of the intense pressures at City Hall.
Keogh had worked for the city since the late 1970s, and had been its top financial official for years.
Most recently, he had been Phoenix's point man in some of the largest and most complex deals in city history funding for the light-rail system, the Civic Plaza makeover and the proposed downtown convention center hotel.
Karlene Keogh told the detectives that she and her husband had been planning to go on a vacation to Italy, to get away from it all.
She said she had called in sick for him at City Hall that morning, though he had seemed in decent spirits when she left for work herself.
Mrs. Keogh also said her husband had been scheduled that night to see a therapist for the first time about his work troubles.
The couple last had spoken about 1:20 p.m., and Karlene said she had told her husband she would be home by 3. He had said he might go out and grab something to eat.
As the detectives looked on, she searched her home for clues that her husband may have been thinking suicide, a note or something. Nothing turned up.
What she didn't say at the time was that Kevin Keogh had become truly paranoid mostly about work and had been slipping downhill mentally for weeks.
The morning after Kevin Keogh died, Frank Fairbanks sent an e-mail to all City of Phoenix employees:
"I write this with a very heavy heart. Last night, we learned that Kevin Keogh, the city's finance director, was killed in a car accident."
After lauding Keogh, the veteran city manager said, "Kevin contracted a tropical disease a few years ago. His wife shared with me that the disease had come back in the last two months and was affecting many parts of his life."
That stopped almost everyone short, as very few people at City Hall knew about Keogh's health problems.
The front-page headline in the Arizona Republic on December 10 also suggested that the mysterious disease had led to Kevin Keogh's strange death:
"Phoenix Official Killed in Leap Off Speeding Car; Family Fears Infection From a Parasite Led to Finance Officer's Death."
Though details then were scant, the Keoghs had taken a weeklong vacation in August 2001 to southern Mexico, into a rural area rarely frequented by tourists.
Both had become ill on the trip, not unusual under the circumstances.
Karlene Keogh soon had recovered, but her husband had not, and continued to complain of muscle weakness, stomach problems, headaches and an inability to concentrate.
In the spring of 2002, several months after Keogh first got sick, a test for antibodies had produced a borderline reading for a frightening disease called cysticercosis.
Though little-known in the United States, the infection is common in Latin America, where it's known as having "worms in the brain."
It's caused by pork tapeworms or larvae that find their way into a person's body. People who eat bad pork are at risk, as are those who eat vegetables and fruit contaminated by pig feces.
Once the parasites enter the brain, they often wreak havoc with the frontal lobe, which regulates emotions and inhibitions, among other functions.
The tiny worms cause seizures and other physical problems, and may incite manic or even psychotic behavior. They can be killed with medication, but then calcify inside tiny, shell-like cysts and still may cause more damage.
But preliminary postmortem testing didn't turn up any worms, or the cysts, the latter of which apparently do not dissipate with time. Indeed, the county Medical Examiner's Office never did uncover proof that parasites ever had lived inside of Kevin Keogh.
But even then, Dr. Rebecca Hsu, the assistant medical examiner who had performed Keogh's autopsy, listed cysticercosis as a possible "significant condition contributing to death, but not the underlying cause."
She seemed to be saying that the worms if they ever had been in Keogh's brain might have been driving him crazy, but hadn't necessarily caused him to jump.
On December 21, 2004, Dr. Hsu officially concluded that the manner of Kevin Keogh's death was suicide.
Her other choices had been homicide, accidental, or undetermined.
After that report became public, stories now suggested that the stress-laden environment at Phoenix City Hall, not parasites, had pushed Keogh over the edge.
Still, the creepy worms-in-the-brain theory continued to interest national media.
In early 2005, USA Today published a piece titled "Exotic Travel, Deadly Mementos."
The writer said of Kevin Keogh's death, "A leading suspect is a parasite he caught on a trip to Mexico several years earlier."
But Dr. Hsu didn't change her mind that it had been suicide, even after the belatedly analyzed neuropathological tests showed the degeneration in Keogh's brain late last year.
That's where things stood until last summer, when Dr. Keen turned the case on its head by changing the manner of Kevin Keogh's death to "undetermined."
Three women are meeting with New Times at Durant's, the wonderful steak joint on Central Avenue in downtown Phoenix.
"Kevin was not a warm and fuzzy guy," Karlene Keogh says. "He didn't stand for any BSer doing a song-and-dance with the city, and he was very serious about getting the best deal possible for taxpayers. And until the very end, when he got sick again, he truly loved his job."
Both of Mrs. Keogh's pals at the restaurant are high-ranking City of Phoenix officials who worked with and deeply admired her late husband.
"Kevin was definitely cutthroat at getting the best deal for the city, and he wasn't out for the glory," says Susan Perkins, an assistant city manager. "He was the most moral person I've ever met. Kevin was a man of many, many contrasts, many facets."
That description raises a smile from Mrs. Keogh, a gregarious woman with a quick laugh and sharp wit. The Phoenix native has one child from a previous marriage, a daughter who is a medical doctor in Pennsylvania. Her grandson was born a few months before her husband died.
As a couple, the Keoghs were community-minded, and not just in a lip-service way. In 2003, they started the Keogh Foundation to assist Arizonans, especially low-income women with children, with health insurance.
(The Keogh Foundation continues to thrive, and according to its Web site, helped more than 4,000 people in 2005 alone, financially and otherwise.)
"Kevin was very businesslike, but there was a lot to him that most people never saw," says Barbara Lang, one of Keogh's best friends at work for more than 20 years. "He was a very good guy who honestly thought of other people first."
Kevin Keogh was the oldest of four boys born into a middle-class Irish-Catholic family in Yonkers, New York, near Manhattan, and he always retained a touch of his East Coast accent.
Keogh worked in a bowling alley as a teen, and later took a job in Manhattan parking cars. Early on, he started a love affair with jazz music that endured.
Keogh earned his undergraduate degree in Philosophy and Political Science from Iona College, in nearby New Rochelle, and then a master's degree in Public Administration from Syracuse University.
After graduate school, Keogh found work in 1976 as a management intern with the City of Phoenix. His diligence to detail and brilliance with numbers revealed themselves as he worked his way up the City Hall ladder.
Not outgoing by nature, he won over supervisors and colleagues by dint of dogged work habits and a good attitude.
Starting in 1979, Keogh worked closely with Barbara Lang (then Alvarez), managing the city's growing bond program and handling other fiduciary duties. Lang reported directly to Keogh for two decades, and the bond between them was always strong.
"He was great to work with and for, and he never let me down," she says. "I think that's saying a lot."
After hours, Keogh often enjoyed a glass of red wine, listened to his jazz, and studied contemporary and Mexican art. Until he started dating Karlene Arnold in the late 1990s, Keogh seemed destined to remain a bachelor.
"We were very good friends for 15 years before we ever dated," Karlene Keogh recalls. "He'd never been married before. I had been. I asked myself, 'Do I really want to fall in love with my friend?' Well, I did. He loved me for who I am. Kevin was the love of my life, and vice versa."
The couple got married in 2000 at Mrs. Keogh's home in Arcadia, and enjoyed their honeymoon in beautiful and remote Monument Valley, on the Arizona-Utah border.
Back in Phoenix, Kevin Keogh took up cactus gardening, and over time tended to more than 200 desert plants at his new residence.
Keogh seemed to be on top of the world, personally and professionally, when he and Karlene vacationed in rural Mexico in late August 2001.
Kevin and Karlene Keogh traveled together whenever their cramped schedules would allow it.
They didn't mind going off the beaten path, and the trip to San Cristobal, in the rugged Mexican state of Chiapas, was one of those times.
Mrs. Keogh later described how her husband had eaten everything on that trip, even pork she'd passed on.
Though they'd had a great time, the Keoghs took ill after their adventure.
Mrs. Keogh recovered quickly, but her husband did not.
Antibiotics didn't help. Distressed by the nagging illness and unable to get a timely appointment with a neurologist, Keogh checked into the emergency room at the Mayo Clinic on October 10, 2001.
"Clinically, he appears well," Dr. Marcella Torres wrote of that visit. "I do not think he has evidence of a parasitic infection."
Dr. Torres noted the possibility of an undiagnosed infection, perhaps hepatitis or a number of other illnesses.
But another Mayo doctor pointed out that Keogh's test results had been "completely normal . . . I spent considerable time trying to reassure the patient that there does not appear to be any serious illness that is being overlooked."
That doctor wrote that if further testing also came up negative, "We may need to seek psychiatric consultation to help with the patient's rather profound anxiety."
Months passed without appreciable improvement.
On February 21, 2002, Keogh met for the first time with Dr. Robert J. Clark, an infectious-disease specialist at St. Joseph's Hospital and Medical Center.
During the session, according to Keogh's medical records, he stood up from the exam table and shuffled over to a chair. Ashen-faced, he became progressively more confused, flexing his arms, clenching his fists and remaining unresponsive for minutes.
Keogh urinated on himself during this episode, which Dr. Clark referred to as a grand mal seizure.
The doctor immediately had Keogh admitted into the hospital for observation and testing, including a test for cysticercosis. The latter was a good possibility because of the Keoghs' trip to rural Mexico.
Symptoms of the infection include seizures and general mental confusion which was just what Keogh had been complaining about.
Two MRI studies of Keogh's brain taken at the time turned up nothing unusual, and doctors say the worms surely would have showed up on the slides.
But, for some reason, doctors apparently didn't immediately analyze the results of the antibody test for the parasites. (Dr. Clark did not return a call from New Times, nor did he contact Mrs. Keogh for permission to speak about the case.)
Keogh was at the hospital for three days. He claimed not to remember his seizures and asked continually to go home, though the nurses in his wing wrote glowingly of him as a friendly gentleman.
An intern wrote on the day of Keogh's discharge that a possible diagnosis "includes cysticercosis (trip to Mexico and pork ingestion) versus brain tumor versus brain abscess versus encephalitis versus chronic meningitis."
In other words, no one knew what was ailing the patient.
One month later, in March 2002, Karlene Keogh called 911 when her husband had two seizures at their home similar to the one he had been stricken with at St. Joe's.
Kevin Keogh was readmitted to the hospital on March 11, 2002, in an "extremely agitated and confused" state. Doctors immediately ordered another test to see if Keogh had the worms in him.
This time, they had the results within hours.
According to Dr. Clark, an "equivocal, but very suspicious" finding for cysticercosis had arisen in the test.
What "equivocal" meant was that the results were just short of being able to say for sure that Keogh was carrying the worms.
Clark put Keogh on Albendazole, a drug used to kill the pork tapeworm, and Dilantin, a powerful medication used to control seizures.
The patient returned to St. Joe's a month later for a follow-up visit.
Afterward, Dr. Clark wrote that Keogh "still has symptoms, but minimized them. He states they are resolved. His wife, in the room, does take issue with a lot of his comments. . . . Major denial about his symptoms. Probable seizure disorder, temporal lobe. Possible [cysticercosis]."
All the while, Keogh continued to keep his medical troubles from everyone at City Hall, except for a few trusted colleagues.
Around that time, it was reported that two financial services had awarded Phoenix Sky Harbor Airport its highest credit rating a great victory for the city in the aftermath of the 9/11 attacks.
"I am elated and believe we deserve this rating," Keogh told a reporter.
Later that summer, Keogh was examined by Dr. David Treiman, a seizure specialist at Barrow Neurological Institute.
Treiman concluded, "My impression is that this patient has epilepsy, manifested as two complex partial seizures, probably secondary to cysticercosis, even though his MRI scans have been normal."
According to a medical journal, such seizures "cause impaired consciousness and arise from a single brain region. . . . During a complex partial seizure, the patient may not communicate, respond to commands, or remember events that occurred. [But] some patients may continue to perform complex motor behaviors such as operating a car."
Writes Dr. Orrin Devinsky, an editor of the Web site epilepsy.com, "Even though the person's eyes are open and they may make movements that seem to have a purpose, in reality nobody's home. Some people do things during these seizures that can be dangerous or embarrassing, such as walking into traffic or taking their clothes off."
Karlene Keogh says symptoms of her husband's mystery illness would subside for stretches after he completed the drug regimen for cysticercosis and continued on the Dilantin.
The couple even vacationed in Europe in 2003.
As 2004 began, the City of Phoenix was in the middle of several huge money deals in which Keogh's abilities were being put to the test.
His many tasks included coordinating the sale of $500 million in revenue bonds to pay for the light-rail system.
The city also was sorting out how to finance the proposed $350 million downtown hotel. Also pending was a $180 million sale of wastewater revenue bonds.
No one at City Hall seemed to have the slightest doubt that Keogh and his staff would put it all together, just as they always had.
Karlene Keogh says her husband's "symptoms," by which she meant what he had been complaining about on and off since the Mexico trip, reappeared in early 2004.
Keogh's appetite vanished, his stomach and head ached, and he constantly was getting sinus infections and sore throats. Never the best sleeper, he was more restless at night than ever.
Mrs. Keogh says he complained of not being able to concentrate at work nearly as well as he always had.
That June, Keogh was too ill to take his wife out for her birthday. He made an appointment with Dr. Barry Hendin, co-director of Banner Good Samaritan's department of neurophysiology.
During that visit, according to Dr. Hendin's notes, Keogh asked him "to review my situation relative to prior problems with cysticercosis."
The doctor noted that Keogh's symptoms were "suggestive of cysticercosis, [but] without any definitive positive diagnostic studies" to back it up.
Hendin ordered another MRI, as well as an EEG test, the latter to look for irregularities in the brain's electrical activity that may produce seizures. Surprisingly, the doctor did not request an updated test for parasites.
The EEG came up normal.
In October, Keogh received a 7 percent salary increase, to just under $165,000 a year.
His supervisor, Sheryl Sculley (now the city manager in San Antonio, Texas), was glowing in her praise, writing that "you are creative and always willing to figure out a financing strategy. [You are] analytical, creative and outstanding on financial matters."
But Barbara Lang says she had started to see cracks in her friend's normally even-keeled demeanor.
"We'd usually speak every day even before Kevin got into the office," she says, "and he always was a self-critic, even though he was the smartest man I've ever known. But he'd become really unsure of himself, shaky."
Lang recalls that "Kevin did a presentation for a ratings agency, and afterward he told me that he'd slipped, made a mistake. That really bothered him. Then around November, he started becoming paranoid, increasingly so."
As for the MRI, Keogh's earlier experiences with the high-tech machine had left him feeling claustrophobic, and he awaited his appointment with trepidation.
A doctor wrote a prescription for Valium, the bottle of which police found in Keogh's Mercedes after he died. But the anti-anxiety pill didn't help, and Keogh asked the MRI operator to stop the test soon after it started.
A medical dictionary says a psychotic person may suffer from agitation, anxiety, panic attacks, delusions, paranoia, difficulty concentrating and altered sleep patterns.
All that defined Kevin Keogh's state of mind in late 2004.
"He was constantly telling me that he was going to lose his job," Karlene Keogh says, "and that there was a conspiracy to get rid of him. He wasn't eating much, and he wasn't sleeping much, either. But he was very, very convincing about what he said was going on down at City Hall."
That Thanksgiving, Keogh and his wife went to a party hosted by friends. He seemed distracted and distant during the entire evening.
Some of the guests asked Mrs. Keogh if the couple had been fighting.
She explained that he just wasn't feeling well.
Kevin Keogh drove home on the afternoon of Friday, December 3, 2004, utterly spent from his workweek.
Mrs. Keogh says he continued to obsess over that weekend about his job status, apparently convinced he was going to get fired that Monday.
The couple spoke of trying a fresh start in California, with new jobs and a new life. In the short term, they were looking forward to that needed vacation together in Italy.
Mrs. Keogh says she persuaded her husband to make an appointment with local psychologist Dr. Dawn Noggle.
In a letter to Mrs. Keogh, Dr. Noggle later described the hourlong phone conversation she'd had with Keogh that Saturday:
"He related a number of concerns about his [job] regarding performance, others' perceptions of his performance, pressure he was under given the nature of some of the projects he was working on and, most importantly, his concern and belief that he was going to be fired."
But Dr. Noggle noted that "at no time did he indicate that he was hopeless or even helpless. He did not appear to have chaotic thoughts, but did seem somewhat [persevering] in his thinking and speech. There was nothing in his presentation to me to indicate he was severely depressed nor that he was suicidal."
The two planned to meet in person that Wednesday, December 8.
Keogh didn't go to work on Monday, December 6. That day, he phoned city manager Frank Fairbanks to say he was quitting. Keogh told his wife that Fairbanks had asked him to just take the day off and relax.
She says she tried to reach Dr. Robert Clark, who had treated her husband in 2002.
"I called him because it was as if the worms were back inside Kevin," Karlene Keogh says, though she never did get to speak with the doctor until after her husband died.
She is adamant that Keogh had continued to take his anti-seizure meds to the end.
But the county's postmortem toxicology test results said otherwise, and didn't detect any Dilantin in his blood or urine, just a therapeutic dose of allergy medicine.
The importance of that is that experts say it can be dangerous to quit Dilantin improperly, especially when combined with an increased stress load and lack of sleep and food.
"[That] can lead to the onset of an episode in someone with a latent seizure disorder," writes Washington, D.C., neurologist and psychiatrist Dr. Richard Restak, sounding as if he's describing Kevin Keogh.
Keogh returned to City Hall for half a day December 7. He phoned his wife from there several times, she says, unable to cope.
"Everyone just thought he was tired because of all the work," Mrs. Keogh says. "But he was hallucinating, paranoid, very, very ill."
Keogh agreed that night with his wife to take an extensive leave from work effective immediately, as they considered options.
But part of him stayed on the job. At home that afternoon, Keogh scribbled down some work-related financial numbers on a piece of paper. His wife found them weeks later while sorting through his papers.
Other than writing a few checks for household bills, no one knows what Kevin Keogh did on the last morning of his life after his wife left for work.
One thing he didn't do became a telltale sign for his wife, though after the fact.
"I didn't know until later that he'd quit watering his cactus," she says. "That was a big deal. He really loved those plants."
About 1,000 people attended Kevin Keogh's funeral at St. Theresa's Catholic Church on East Thomas Road.
He was cremated, and Mrs. Keogh scattered his ashes last August 26 in his native New York.
Early in 2005, city manager Fairbanks announced that an independent audit of Kevin Keogh's financial dealings on behalf of the city had found nothing amiss, not a penny unaccounted for.
So (and this never had been even a fleeting concern for anyone who knew Keogh) it wasn't as if he'd been stealing from the city or, more benignly, had become slipshod with taxpayer funds.
In early 2005, Mrs. Keogh asked CIGNA for life-insurance benefits from her late husband's policy with the City of Phoenix.
City executives are covered under a policy that calls for a one-time payout of 175 percent of the deceased's annual salary, or more than $300,000 in Keogh's case.
If CIGNA deems a death accidental, it's supposed to kick in another 175 percent, though that wasn't relevant in Keogh's case.
But exclusions written into the policy include no payouts in instances of suicide, which was the official manner of Keogh's death at the time.
In her March 2005 letter to CIGNA, Karlene Keogh explained why she felt Maricopa County's suicide ruling had been off-base.
She mentioned that Dr. Hsu who'd performed the Keogh autopsy and signed the death certificate recently had phoned her.
Mrs. Keogh said Dr. Hsu had expressed disappointment over having had to call it a suicide.
"She said she never calls anyone," Mrs. Keogh wrote, "but in this case she felt compelled to because she felt badly about what happened to Kevin and me and all the press.
"She said that seizures cannot be detected in an autopsy. She could not change the report and had to leave suicide on [it]. . . . However, she did tell me several times that she was absolutely certain that something horrible happened to Kevin. She said, 'It's likely he was hallucinating.'"
Dr. Hsu no longer works at the Medical Examiner's Office, and could not be reached for comment. But she never did amend the death certificate.
A few days before last Christmas, Karlene Keogh opened a discouraging letter from Sheri Leister, an accident claim specialist for CIGNA. Leister said CIGNA was rejecting Mrs. Keogh's application for life-insurance benefits for two reasons:
The first was the exclusion of benefits to survivors whose loved ones have committed suicide.
The second was another clause that seemed to say, even if worms in Keogh's brain actually had compelled him to kill himself, too bad.
Interestingly, CIGNA agreed with Mrs. Keogh that the worms had led to his death and that was another reason, Leister wrote, it wasn't going to pay up.
Leister explained that, because Keogh had become infected more than a year before he died, too much time had passed.
"As the findings indicate that Kevin Keogh's actions, caused by disease, directly resulted in his death," Leister wrote, "we have concluded that he did not suffer a covered loss."
Karlene Keogh immediately decided to appeal CIGNA's findings.
Dr. Philip Keen long has been known as a straight talker, which may have cost him his job last summer as Chief Medical Examiner (he's still working as an assistant examiner).
Keen calls it like he sees it, even when his opinion runs counter to what prosecutors, police and the county Board of Supervisors would like to hear from him.
The doctor says it's not unusual for families to question the manner of a loved one's death, especially a suicide. But it is quite unusual, he says, for anyone at the county's Forensic Science Center to amend a death certificate.
"We have to be convinced that the new information out there really is compelling," he says. "But I always will check into whatever anyone presents."
In the case of Kevin Keogh, "anyone" meant some of the best and well-respected forensic minds in the nation.
First, Karlene Keogh hired an attorney with the firm of Squire Sanders and Dempsey.
The lawyer first had to find reputable experts to examine Keogh's life and death. If that played out favorably, those experts would have to try to persuade Phil Keen to change the certificate from suicide to undetermined.
Only then could Mrs. Keogh even have a shot at getting CIGNA to reconsider its position.
The attorney asked respected Phoenix neurologist J. Michael Powers, and Steven Pitt, a nationally known Scottsdale forensic psychiatrist, to analyze the case.
For his part, Pitt studied the Keogh medical files, interviewed Mrs. Keogh, and then rendered his opinion last June 26.
"No disease process was ever established to explain Keogh's behavior," Pitt wrote to Mrs. Keogh. "Any attempt to diagnose Keogh with a specific condition would be speculative."
Still, Dr. Pitt concluded that "the known facts do not support and directly contradict a view that Mr. Keogh intentionally took his life."
Those facts, according to Pitt, included Keogh's lack of an impulsive nature, seeming stability at home and work (despite having become convinced his bosses had it in for him), no known prior suicide attempts, his Catholic faith, and the apparent absence of substance-abuse problems.
During his investigation, Pitt recommended that heavy-hitter Dr. Michael Baden also be brought into the fold. Though he's exceptionally busy, Baden tells New Times that the details of Kevin Keogh's demise lured him.
"Very sad, very interesting case," Baden says. "A medical mystery."
Baden's impressive résumé includes a stint as chairman of the Forensic Pathology Panel for the congressional committees that investigated the assassinations of President John F. Kennedy and Dr. Martin Luther King Jr.
He has testified or advised counsel in too many high-profile cases to mention the murder trials of O.J. Simpson and Claus von Bulow come to mind.
Like Pitt, Baden studied Kevin Keogh's medical records and anecdotal data before drawing his conclusions.
"Lots of things could have caused this to have happened," Dr. Baden says. "All you need is disorientation and confusion, and things can happen. This man's personal background, the location and time of his death broad daylight, a busy street the fact that there was no guarantee he would die, all of it indicates to me that he didn't intentionally hurt himself."
Baden recounts another recent case of his in which, like Kevin Keogh, a New York man was convinced he had worms in his brain.
He says the tormented man decided to try to kill the worms by attaching a wire of some sort to his scalp.
Needless to say, he electrocuted himself.
"I'm not saying Mr. Keogh jumped out of his car to get rid of the worms," Dr. Baden says. "I'm saying people who think they have worms in their head can act bizarrely."
Another take on Kevin Keogh comes from Kiran Amin, a psychology professor at Argosy University in Phoenix, who was briefed by New Times about the case.
"Here's a man at the top of his profession who was showing serious signs of paranoia, though he continued to be competent at his difficult job," says Dr. Amin, an expert in neuropsychology. "We've got various possibilities here, which include a truly organic mental disorder that affected his brain and caused him to just fall apart in terms of delusions and paranoia.
"Almost everyone only saw this brilliant, strait-laced man. But you can have folks who have a little island of paranoia in their mindset. Perhaps that paranoia was well-controlled and hidden for a long time and just burst out under the circumstances, where the anxiety and stress he was feeling exacerbated the situation inside his head."
Dr. Keen says he read everything that Karlene Keogh's attorney sent him (which included the experts' opinions), discussed the case with colleagues, and then made up his mind.
"If we had a hypothetical," Keen says, "in which we did not know anything about this man's neurological history, if we didn't know that he had had seizures and these post-seizure states, if we didn't know that he'd had episodes in which his behavior was becoming more atypical, we'd look at this and say, 'Well, he must have pretty much gone off the deep end,' as in a suicide.
"But then you start looking at these neurological things that are not just anecdotal, are not just told by the family. And there's a variety of physicians looking at him, and they're having difficulty deciding exactly what's going on with him, too. You have some docs saying, maybe it's worms in the brain because we have a borderline [reading], maybe it's epilepsy, maybe it's something else.
"In reality, that's kind of where we wind up. Which ballpark do we wind up placing this in? The word 'undetermined' is the right ballpark in this case."
That said, as of last week, CIGNA had yet to change its corporate mind about paying Karlene Keogh the life-insurance benefits.
On the morning of October 25, dozens of Kevin Keogh's friends and onetime colleagues gathered at the old Phoenix City Hall, formally known as the Calvin C. Goode building.
Former councilman Goode who knew and respected Keogh was in attendance, as well as Mayor Phil Gordon.
The occasion was the dedication of a lovely plaque in Keogh's name.
City manager Fairbanks spoke first, saying "all of us looked up to Kevin, what he did for this city, all of the personal sacrifices he made. I know he was proud of the wonderful things he had accomplished."
Keogh's buddy Barbara Lang fought to maintain her composure as she related her feelings of admiration and warmth toward him.
Mayor Gordon spoke directly to Karlene Keogh, who was standing to his side.
"Karlene, this is Kevin's family," the mayor said, gesturing to the crowded room, "and I think that's a legacy beyond the plaque and the city he built."
Gordon recalled seeing Keogh sometimes at the AJ's store at Central Avenue and Camelback Road, buying a bottle of wine to take home with him:
"He'd smile at me and say 'hi'; just a good guy. Karlene, you go home tonight and have a glass of wine for Kevin, okay?"
Finally, Karlene Keogh stepped to the podium. Practiced at public speaking, it seemed as if she was in her own living room.
"Kevin would have left halfway through this," she said. "He was a team guy, and he didn't like people focusing on him for one second."
She referred to her husband as "a very complex individual, a renaissance man who didn't do well with the simple and obvious."
Then, she addressed the pink elephant in the room, her husband's terrible and still-mysterious death.
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"We do know the truth now and he did not commit suicide," Mrs. Keogh said.
"Kevin's death was not intentional. That is official now. He would not have intentionally harmed himself or others. I thought it was very important for all of you to know this."
She closed with these words:
"The Kevin Keogh I loved the most was Kevin the husband and Kevin the friend. His job did not come first. I came first. Kevin, thank you. I'm so glad you took a chance with me. I miss you, and I will always love you."