Poison expert allegedly poisoned wife—with a shockingly toxic gout drug

Colchicine is centuries old, but the line between toxic and nontoxic is still blurry.

A Minnesota doctor who had worked for a poison control center was charged this week in the poisoning death of his wife, who died from a lethal dose of the highly toxic gout medication, colchicine.

Connor Bowman, 30, was arrested last Friday and charged Monday with second-degree murder in the death of Betty Bowman, 32, who worked as a pharmacist at the Mayo Clinic.

In an investigation that followed her suspicious death on August 20, police learned that the two were having marital problems, including a deteriorating relationship and infidelity, and were talking about a divorce. They also learned that Connor Bowman was in debt and stood to gain $500,000 in life insurance upon his wife's demise.

Connor Bowman initially claimed Betty died of a rare hyper-inflammatory condition called hemophagocytic lymphohistiocytosis (HLH), but tests for the unusual condition were inconclusive, and a source told police that Betty was previously healthy before her rapid deterioration.

On August 21, the day after Betty's death, the medical examiner's office deemed the death suspicious and informed the Rochester, Minnesota, police. Connor Bowman told the medical examiner's office that Betty should be cremated immediately and tried to cancel the planned autopsy.

When it wasn't canceled, he questioned the toxicology testing that would be done, asking one death investigator over email for a list of everything they would test for.

The toxicology testing as part of the autopsy revealed an extremely high level of colchicine in her blood, as well as detection of the gout drug in her urine. Betty had not been diagnosed with gout, and none of her doctors had prescribed her colchicine. In retrospect, her death is a textbook case of colchicine poisoning.

A drug with a “dark side”

Colchicine is a centuries-old treatment for gout—a form of arthritis that occurs when elevated blood levels of urate form into needle-shaped crystals around joints, leading to severely painful inflammation. Colchicine, extracted from two flowering plants (Colchicum autumnale and Gloriosa superba), has weak anti-inflammatory activity, which makes it effective against gout. But it is shockingly toxic. And despite its long-standing use, the line between nontoxic and toxic doses remains unclear.

The reason is the fundamentally disruptive way colchicine works. The drug binds to the protein tubulin in cells, preventing it from forming into microtubules, which are vital structural components of cells. Microtubular networks are required for separating chromosomes during mitosis among many other functions. Thus, at sufficient doses, the drug halts all cells division, impairs protein assembly, decreases endocytotis and exocytosis, alters cell shape, and reduces cell motility.

Colchicine is rapidly absorbed in the gastrointestinal tract and equally rapidly distributed throughout all tissues in the body. Thus, with a toxic dose, the damage is systemic. And the downstream effects of demolishing microtubular function lead to multi-organ failure.

In a 2010 review published in Clinical Toxicology, an international team of researchers labeled colchicine a drug with a "dark side" and laid out the three stages of poisoning: The first is a gastrointestinal phase, the first 24 hours after the poisoning, in which damage to gastrointestinal mucosa leads to nausea, vomiting, diarrhea, abdominal discomfort. It might look like severe food poisoning or cholera. Then there's the second, multi-organ phase, from one to seven days after poisoning, in which the toxic effects spread around the body. There can be a variety of multi-organ dysfunction and metabolic derangements. Death often takes the form of faltering cardiovascular function and cardiac arrhythmia or arrest, but respiratory distress, liver failure, kidney failure, brain swelling, and secondary sepsis can also occur. For the lucky, the third phase is the recovery phase, which can last from seven to 21 days after the poisoning. In this phase, failing organs rebound, but patients might experience alopecia (hair loss) and other complications, including delirium, stupor and coma, convulsions, adrenal hemorrhage, and pancreatitis. In some rare cases, patients' skin blisters and peels off.

Betty Bowman didn't make it to the third stage. She was admitted to the hospital on August 16 with severe gastrointestinal distress and dehydration. She was treated as if she had food poisoning. The night before, she had texted a friend that she was drinking at home with Connor Bowman and, upon falling ill, thought the cause was something mixed into a large smoothie she had been given.

She did not improve with the standard treatment for food poisoning and instead rapidly deteriorated. In the four days she was hospitalized before her death on August 20, she experienced cardiac problems, fluid in her lungs, and eventually organ failure. During that time, she also had a large part of her colon removed due to the discovery of necrotic tissue.

Damning Internet history

The medical literature indicates that a lethal oral dose of colchicine is anything that exceeds 0.8 mg per kilogram. The police investigation that looked at Connor Bowman's Internet history found "on August 10, Bowman was converting [Betty's] weight to kilograms and is multiplying it by 0.8," according to the charging document. He was also shopping for liquid colchicine on August 10 and 11, visiting the GoodRX website where he searched for the drug and then Stripe, an online payment platform.

He also allegedly searched for things like "internet browsing history: can it be used in court?" and "delete amazon data police." He tried using a VPN but initially mistyped it as "bpn."

The toxicology report found 29 ng/mL of colchicine in her blood, which was drawn on August 16, the day she was admitted to the hospital and a day after drinking the suspicious smoothie. The medical examiner noted that the concentration was high given that it had been 24 hours since the dose and the drug was metabolized quickly.

Law enforcement also found a $450,000 bank deposit in Connor Bowman's home after the death.

Betty Bowman's family set up a GoFundMe page to take donations to help with, among other things, legal costs. The page notes that the family is raising funds because "As new evidence emerges, we realize Betty might have been taken from us not by natural causes."

Connor Bowman is scheduled to appear in court on November 1, and he faces up to 40 years in prison if convicted.

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