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Deaths coded as heat stroke or sudden heat deaths are uncommon in forensic practice, particularly in areas where heat waves are rare [1,2]. Where sporadic cases occur, additional risk factors are likely to be present. These include the use of certain drugs, particularly phenothiazines, anticholinergic agents, and amphetamines [3]. Heat stroke often pursues an extremely rapid clinical course, and investigation of fatalities may consequently become the responsibility of the medical examiner [2]. The phenomenon of the acute impairment of thermoregulation as a result of phenothiazine therapy is not generally mentioned in general medical reviews of heat stroke [4,5]. However, many psychiatrists are aware of the association, and most of the documented fatalities have been in the psychiatric literature [69]. The purpose of this paper is to report another case, with the classic findings of sudden death by heat stroke in a man with chronic schizophrenia who was on long-acting fluphenazine decanoate (Prolixin®) therapy. Environmental temperatures and relative humidity were only moderately high, demonstrating the importance of documenting the drug history and other potential risk factors in cases of this kind.