Thursday, March 02, 2006

Manner of Death

As I tell the Coroner's Jury at Inquest in their instructions, the verdict of manner of death is a multiple-choice question. There are 5 choices, although since natural deaths do not go to inquest they have 4 choices. For the most part the choices are self-explanatory, do not over-lap, and should be evident in the testimony given during the inquest. The choices are accidental, homicide, suicide, and undetermined.

Undetermined is chosen as the verdict when, based on the evidence presented, the manner can not be categorized into one of the other “manners”.

Suicide is an intentional act to cause one’s own death.

Accidental death is death due to an unexpected or unplanned event.

Homicide is death due to an intentional or reckless act of another. This is not to be confused with criminal “homicide”, which is a charge brought through the legal system assigning blame to an individual. The Coroner’s Inquest (jury) does not assess or assign blame to any individual.

Some of the toughest decision making that the jury has to deal with is deciding whether an individual’s action resulting in another’s death was negligent (therefore an accidental death) or reckless (therefore homicide). The jury must consider what an individual, or a “reasonable individual in that person’s place”, thought or should have thought at the time of the incident. A negligent act occurs when an individual, or a “reasonable individual in that person’s place”, is unaware or does not consider that their action may cause the death of another individual. An example would be reaching down to pick up your cell phone off the floor of the car as you are driving, resulting in you taking your eyes off the road and crashing your car into someone else with their death as a result. A reckless act is one in which an individual, or a “reasonable individual in that person’s place”, consciously disregards that their action will result in another individual’s death. An example of that would be firing a handgun into a crowd of people resulting in someone’s death.

The jury’s deliberation likely dwells most on the decision of manner of death, because their other decision, the cause of death, is even more evident in the testimony by those involved in the death investigation. The manner of death is the most important decision that they make and while it is most often obvious, it is at times emotion charged and difficult to characterize. Their decision is then memorialized on the final death certificate.


Anonymous said...

I really enjoy reading your blog. Keep up the good work. Being Coroner has got to be a difficult job but it's nice that you take the time to talk with kids and give tours and write about your day to day life. Best of luck to you in your career.

Anonymous said...

My son died in car accident and his tox repory stayed that cocaine metabolites were detected but unconfirmed for clinical use only. What does that mran

Dr. Richard Keller said...

It would appear that cocaine metabolites were found (most likely in his urine), but were not considered as contributing to his death.

sharry said...

my sister died a few weeks ago .an autopsy was perform what does acute methamphetamine poisoning mean does that mean an overdose? her levels were methamphetamine 0.94mg/L and amphetamine was 0.31mg/L

Dr. Richard Keller said...

Depending on the time between ingestion and her death and the blood being drawn, these could indeed represent toxic levels and could result in death.

The term "methamphetamine poisoning" does refers to overdose. Most of the time this is related to over-use rather than suicidal intent.

My condolences for your sister's death.

Anonymous said...

My son's death was ruled, "Acute Heroin Intoxication" but the people who were there have indicated that he died more than 24 hours after using. He was not an "addicted" daily, heavy user. A friend of his told me that he had previously seen him turn blue after using when he did not have an albuterol inhaler on hand or if the inhaler did not help him. I have not been able to find anything on line about such a delayed death caused by heroin, so I'd like to know if it is possible.

This is what the toxicology report states:

Femoral Blood:
Alprazolam: 28 ng/mL
Codeine: 19 ng/mL
6 MAM: 35 ng/mL
Morphine: 24 ng/mL
Diphenhydramine: 518 ng/mL

Positive for everything indicated in the blood test and for Hydrocodone, though none was detected in the blood. Blood and urine tests were negative for everything else.

I do know that he used Black Tar heroin and that he mixed it with diphenhydramine and snorted it.

Do these results suggest that it's possible that it was over 24 from the time he used until the time that he died?

Thanks for any information that you can provide.

Dr. Richard Keller said...

My condolences.

In addition to evidence of heroin use with diphenhydramine, your son's blood also demonstrated that he used Xanax (alprazolam) which would potentiate the breathing and heart effects of the other 2 drugs. That mixture would be consistent with death due to poly-substance use. Together they would lead to respiratory depression and heart effects leading to death.

The 6-mam in his blood sample says that his use of heroin was within a short time of his death, not 24 hours prior. His friends are wrong about the last time he used. 6-mam is cleared from the blood very quickly, therefore his last use of heroin was likely less than an hour or so before his death.