Randall Lee Smith died of complications from injuries suffered when he crashed a pickup truck stolen from one of the men he was accused of shooting near the Appalachian Trail in Giles County, police said Thursday.

The 54-year-old Pearisburg man died May 10 in the New River Valley Regional Jail, a day after he was released from Carilion Roanoke Memorial Hospital.

According to the Roanoke medical examiner's office, Smith died from acute pulmonary thromboembolism as a result of blunt-force injuries. Pulmonary thromboembolism is the blockage of one of the arteries in a lung by a blood clot.

Smith's death was ruled accidental, the medical examiner's office said.

Smith was accused of shooting two fishermen just after 9 p.m. May 6 at their campsite, not far from the site where he killed two hikers 27 years earlier to the month.

Giles County investigators said he took a truck belonging to one of the men and crashed it about 9:40 p.m. on Sugar Run Road near Eggleston.

He was flown to Roanoke Memorial, where he spent about a day and a half breathing with the aid of a ventilator.

He was released from the hospital May 9. From there he was taken to the Roanoke Police Department for a bond hearing. Wearing a hospital gown and looking frail, Smith stayed in a police car during the hearing because of his condition.

Smith was ordered held without bond and taken to the Giles County Sheriff's Office for questioning. After talking to him briefly, investigators took him to the jail. He was committed there about 7:55 p.m. May 9, Superintendent Gerald McPeak said, and was held in a medical unit.

About 4:55 p.m. May 10, a corrections officer took Smith his dinner tray. Smith was lying on the bunk in his cell, unresponsive, police said.

Corrections officers and emergency medical workers administered first aid and CPR for more than 40 minutes, McPeak said, but were unable to revive Smith. He was taken to Pulaski Community Hospital and pronounced dead.

Carilion spokesman Eric Earnhart said Thursday that privacy laws prevent him from talking about a specific patient.

However, he said, "when we release a patient it's because it's medically appropriate to do so. And we don't release a patient until it is."

Patients are released, he said, when the physicians managing their care determine that they no longer need to be in an acute-care hospital and can be safely discharged to another level of care.

The level of care that patient will receive is considered, Earnhart said.

Giles County Lt. Ron Hamlin said Thursday that he was not surprised by the ruling. He said he hadn't suspected there was any foul play in Smith's death.

Smith had told him he was ready to die, Hamlin said.

He said investigators are still searching the woods for Smith's campsite.

Sean Farmer and Scott Johnston were shot May 6 with a .22-caliber pistol, the same type of gun used to kill Robert Mountford Jr. in 1981. Smith served 15 years in prison for killing Mountford and Susan Ramsay, who was beaten and stabbed to death.

In the shootings of Farmer and Johnston, Smith was charged with two counts of attempted capital murder, two counts of use of a firearm in the commission of a felony, grand larceny and possession of a firearm by a convicted felon.

Farmer and Johnston have recovered and are writing a book about the ordeal.