Blog B-Day

It was pointed out to me today that I have been blogging for a year now (220 posts), wishing me “Happy Blog B-Day” (somewhat belatedly, 1st post Jan.6, 2006).

Also today, I was starting to organize a list of my accomplishments since being elected to office 2 years ago. It does sound a bit egoist to be doing that but I am also preparing to ramp up and “reapply” for this job all too soon (the Primary is a 1 year away).

These 2 things do intersect. I think one of my greatest accomplishments over the last 2 years has been making my office more open, the information it gathers in death investigations more accessible, and on a whole the experience dealing with “our office” a bit less “scary”. We have an “office tour” repeatedly showing on the local County cable access channel. Our “tours” for high school students and other groups have increased in number. I answer questions of the media as much as feasible, keeping the public informed about causes of death and contributing factors, as appropriate.

But I am most proud of this blog (thanks Steve for helping me get started). It is good for my psyche and, hopefully, interesting and useful for others.

I am able to share information we pick up locally, as well as stuff I run across that seems pertinent. I have been able to answer questions and make that information available to other folks with similar questions. I am able to discuss my thoughts about a wide range of issues. Laying it all out in the open for anyone to read, think upon, and who knows, act on and share with others.

Thanks for sharing this with me and I look forward to continuing this on into the future.

Probe post-surgical deaths

There is a proposal in South Carolina to mandate reporting of “patient deaths that happen within 24 hours of surgery to the coroner’s office”. The feeling is that an independent investigation (with the possibility of autopsy) outside the hospital would be better to track and differentiate deaths due to medical “misadventure”, those due to “error” vs. an unavoidable “accident” vs. a system problem in need of remedy. Corrective measures might be more likely to occur at the behest of an agency outside the hospital.

I like the idea.

Here in Illinois hospital deaths are reportable to the Coroner if they occur within 24 hours of admission (which include ER deaths) and if they are the result of a diagnostic or therapeutic procedure. The later categories allow for some interpretation by the hospital in reference to “as the result of”. I am not saying that hospitals “hide” things or that they are less than truthful and open in their reporting, but the perception could exist without a mandate as proposed in South Carolina.

Is it possible some cases shown not to warrant litigation could be kept out of the courts? It certainly is quite possible. Could some cases be pushed to early admission of culpability and settlement? Again, quite possibly. Could we possibly positively affect the healthcare system by pointing out errors and system problem areas, allowing for correction before others suffer a similar fate? I think this is the most important reason to consider this proposal.

MySpace, off-line community replication

I came across an article referencing MySpace that I agree with. It is an interview with a social researcher who has taken a real look at social network sites and activity. My bias: I support teens’ access to and use of social network sites.

The researcher divides the users of those sites into 2 groups. 1) (by far the larger group) those individuals who use the social network sites as an extension of their off-line lives, and 2) marginalized kids who substitute their online lives for community off-line.

Teens for the most part use the sites to talk to others they already know, building relationships not meeting “others”. These sites are just a part of their “new” social repertoire that includes cell phones, texting and the Internet. Realizing this, adults should not fear their use of these sites, as long as their child is in group 1. If their child is in group 2, they (the teen) need “help” for a variety of reasons, the least of which is their Internet usage.

We also need to keep in mind (as she states in the interview) that there has never been an abduction linked to these Internet sites. There have been “runaway situations”, but likely they would likely have occurred in some other “form” without the use of the Internet involved.

Social disapproval as a tool

The other “thing” that came up at the CeaseFire meeting yesterday was the usefulness and effectiveness of “social disapproval”. CeaseFire works to instill and reinforce social disapproval as a deterrent to violence.

Thinking about it, social disapproval used to be an important impediment to a number of behaviors when communities were communities. It is an attribute that we as a society need to recapture.

Society should disapprove of violence vocally and demonstratively. Society should be obvious in their disapproval of underage drinking. Society could use their disapproval to impact bullying in schools (“violence” in itself and a possible precursor to violent action/behavior). So many societal ills deserve disapproval. Publicly avowing that disapproval and breeding action based on that disapproval could go a long way toward solutions to many of our problems, many of those “problems” resulting in unnecessary death.

We can not continue to “accept” these things as inevitable or as unpreventable consequences of our society and/or life. These “problems” are not something we can’t do anything about. We need to disapprove and act or help others to act so that that disapproval is put into action.

I have been accused of “preaching to the choir” on these things, but it is time for the choir to sing and proclaim that it should no longer be so.

Public Health CeaseFire

I was at our local CeaseFire Advisory Board meeting this morning and was impressed by the number of interventions they had done over the last month. They really seem to be making a difference in the community, lessening the risk of violence. CeaseFire, as I think I’ve mentioned before, is a violence intervention/prevention program that originated in Chicago. It is based on what can be described as a “public health model” of violence prevention. They react to violent deaths and other incidents and work to “prevent transmission” of that violence. They also do some “primary prevention” to prevent violent behavior from manifesting itself in the first place.

What came up this morning, in addition to the successes that they are having, is the rather unexpected amount of suicidal ideation and suicide potential that they are “uncovering” among the individuals they contact (in the streets, in their homes, and in schools). It is becoming very apparent that individuals at risk of violent actions (by themselves or by others against them) are also at risk of suicide.

This suicidality will need to be addressed. The outreach workers and “interveners” are unprepared to deal with this actuality. These folks can’t continue to go out without the wherewithal to deal with this suicidality. We will be bringing a program into the county through our Suicide Prevention Task Force that should work very well with these folks (QPR, Question Persuade Refer) and most definitely we will include them in trainings.

It is amazing how problems/issues overlap and interrelate. There are no single issue, stand alone problems; therefore “real” solutions must be multifaceted as well to really address problems/issues. Realizing that to deal with violence job training, job placement, housing, healthcare and mental health care, after school programs, etc also are there and must be dealt with; it isn’t a simple as “just say no”. The “public health model” (or community health model) fits well with this, allowing for expanding thought so that whatever “treatment” is needed can and will be brought to bear on the “patient”.

Through the ice

Sadly, it has happened again, a snowmobiler into the lake through thin ice. Every year, at least one person goes through the ice on a snowmobile. This time it was a 16 year old youth with his life and potential fully ahead of him.

Lake ice should be at least 5 inches thick for snowmobile riding,, an inch thicker than for safe ice fishing. The weather locally has been so mild this season that the ice fishing derbies have been canceled.

One website sagely states that a snowmobiler shouldn’t trust other riders’ judgment regarding the safety of the ice; you should check it out yourself. This teen does not appear to have been doing anything really foolish (that can’t be said for all snowmobile into the lake deaths, like “jumping” open water). It was a terrible, unfortunate accident.

You lose consciousness in 40 degree water in approximately 1 hour, much quicker in colder water (lake water around here is 35 or less). Unfortunately, confusion precedes unconsciousness in hypothermia. Struggling actually accelerates body heat loss in cold water, so attempts at saving yourself must be methodical, yet rapidly effective.

It appears this young man did all he could to save himself, but rescue came too late.

Snowmobilers should carry with them, tethered to themselves and easy to get to: a cell phone in a water-tight bag or case, ice picks (with retractable covers) or a knife to help pull themselves out of the water over the ice, a flashlight with a beacon flasher and “alarm”. Movements to get out must be conservative with minimal body movement (foot/leg “flipper” action), stretching out over the ice or breaking repeatedly through the thin ice toward shore.

Unfortunately, as the body rapidly loses body heat, time is severely limited. Drowning can ensue in the most conditioned of individuals. Nature, as in many cases, can certainly be exceedingly cruel in these situations.

(as you suggested cheryl1054)

Snoring Can Portend Death

Snoring is NOT a good thing. It came up again this morning while we were discussing cases in conference.

Time and again the story is that the individual is heard to be snoring shortly before their death. People lying on the floor snoring. People lying on the couch snoring. People lying on their bed snoring. People snoring really loudly. Most often the snoring is unusual for that individual or seems inordinately loud, it is “remarkable” snoring.

These snoring preceding death in these cases almost invariably involve individuals impaired by alcohol and drugs. The snoring is due to the fact that their airway is way too relaxed and they are not getting enough air (oxygen). Do not allow them to continue to lie there and snore. They are going to die. Chances are that they are not “going to sleep it off”.

Yes, some people snore every night, but if they are snoring loudly after drinking or using drugs (licit or illicit) the snoring is a sign of impending death. Get them medical help (911).

Consider this yet another of Coroner Keller’s Axioms, like no cocaine after 50 and get a doctor’s clearance if over 45 and participating in certain “extra-curricular” activities.

Domestic Violence is not a joke, it can kill

K-mart sells a T-shirt that shows “a male stick figure pushing a female stick figure out of a box to a steep fall”. “The disputed ‘Problem Solved’ t-shirts are manufactured by Route 66 Attitude.”

It’s a kids’ T-shirt. I have seen some T-shirts that I consider “wrong” and/or obnoxious, but this is just incredible. According to the report K-mart took them out of their stores briefly after a complaint, but then resumed selling them.

I find it particularly repugnant today, because we had 2 recent deaths possibly due to domestic violence (one is still under investigation). Domestic violence is one of the leading contributors/causes of homicide. To make light of domestic violence, to make it a “joke”, goes way beyond “wrong”.

For information on how to speak out against Kmart’s t-shirts, visit, www.hardygirlshealthywomen.org/newsandevents.php#kmarts. To protest to Kmart, visit www.kmart.com/custserv/contact_us.jsp

Post Procrastination

See there is a psychosociocultural reason I haven't posted for a few days:

"The heart of procrastination is an adaptive natural tendency to value today much more than tomorrow," says Piers Steel, an associate professor of industrial psychology at the University of Calgary's Haskayne School of Business.

Posting more soon.

Former Inmates High Risk of Death

“Inmates from Washington state prisons are 13 times more likely to die within the first two weeks of their release… The most likely cause of death at this vulnerable period…is drug overdose, followed by suicide, heart disease, and homicide.” Let’s think of why this might be the case. The individual is released without rehabilitation programs in prison to the “old neighborhood” without drug addiction treatment or support, without mental health services, with very limited options for housing or ability to find a job; some of those may contribute.

The article goes on to quote Dr. Ingrid Binswanger who led the study as saying “…this may well point to a need for boosting support for former inmates…” May? What else does it point to? Perhaps to Mr. Scrooge’s comment about ‘decreasing the surplus population”? This is a medical (and societal) crisis. A known risk factor that increases one’s risk of death by a factor of 13 ought to stir up a “push for the cure”.

We have some local programs, but no doubt could do more, could do better. We definitely see a group of overdose victims “fresh” out of prison (they jump back to there pre-incarceration drug dose and die) through our office, but I would never have pegged the health risk at this level. Ought to look into it locally and, certainly, I will continue to support local efforts with this ‘at risk” group.

Something a bit different

I stopped at my local post office this morning (“my”? like I own it). I needed some stamps and needed to get a letter in the mail for my wife. I asked the guy at the counter for 10 stamps. His reply was that he wasn’t sure if he had 10, his supervisor forgot to order stamps. Whoa, a post office without stamps, or to quote Carlos Mencia “Dee Dee Dee”. He did find some, super-hero stamps. I hope my wife doesn’t mind that I sent her job application materials with a “Wonder Woman” stamp on them.

Or on a more lyrical note: a post office without stamps is like a day without sunshine.

Teen crash deaths

The Chicago Tribune last Sunday had a special section on teen driving deaths. They have run a series of articles highlighting this problem over the last year. The section (and the front page of the paper) had pictures of 59 teens that have died in car crashes since last January. I knew from of the faces and names from work.

There was an article with comments from parents saying that they will never “get the loss” and their working to prevent similar tragedies in other families. There was an article about new legislation that will be proposed in the state legislature (with comments that some of it may be hard to pass because it may make life a bit tougher for some people, although the deaths are even tougher). I do wish the “task force” success in getting the measure passed.

Some facts I’d like to highlight (also by putting them in my blog I can find them again more easily):

Teen crashes kill over 8000 people (over 5000 teens) and injure over 7000,000 others annually in this country
The ongoing brain construction in teens contributes to their increased risk of crashes with impulsive behavior and risk taking
Speeding is the most common contributor (over 40% of crashes) with alcohol contributing just less than 25% of the time
Only 47% of teen passengers wear seatbelts in cars with a teen driver, over 60% of teens killed were not where seatbelts

How to save these lives?

Comprehensive laws/programs restricting teen drivers, graduated licensing programs
Parents “preaching” and teaching
Teen peer pressure and information (peer pressure can do good things)
Commitment to work toward a remedy and working toward that remedy (maybe first and foremost)

Teens know online safety

Over half of all teens have a presence on MySpace or similar site. As I have discussed before these sites are often demonized unjustly. Now there is a study out from the Pew Foundation backing me up:

Teens who use social networking sites seem to be very aware of the security concerns involved as well as the measures available to them to prevent unintended usage. Only 1% of those teens surveyed were unsure whether their current profile was listed publicly or privately, which indicates that teens are making decisions about who can and cannot see their profiles.

The message in the media seemed to be one of "Oh no, predators will hunt down our children!" But the work put in here by the Pew study group indicates that teens are pretty savvy about their net usage, and perhaps savvier than the media or their parents have given them credit for.

However I guess you have to wonder about Xbox Live:

What I think is creepy is some of the people that my kids have played XBox Live with. They are talking to them online with a microphone and I can hear what they are saying. Some of them are just bizarre characters although most of them are just regular gamers.

Got to stay aware, some of it is bad, but some of it just the new Rock and Roll.

Less Young, Less Crime

One other thing I wanted to highlight from the Tribune editorial I talked about yesterday was one of the reasons they listed for the decrease in crime rates. It is one of the reasons I gave to a Pioneer Press reporter last week for a story they will be doing in their paper this Thursday.

When the number of individuals in a community who are in their later teens and early adulthood decreases the amount of crime (particularly violent crime) goes down. This is the demographic most involved in violent crime and, really, when you think about it it just makes sense. So as our population ages and we have fewer “at risk” individuals the stats are going to look better.

Violent crime still happens and is just as violent (if not, perhaps, just a bit more violent), but the totals are less. This does not mean we can quit trying to improve that number and its impact on people, but perhaps it allows us to react with more thought and base our “actions” on evidenced interventions, instead of just having to “do something” because the fabric of society is unraveling.

Effective "Justice"

An editorial in yesterday’s Chicago Tribune begins by asking why Illinois’ (and the country’s, as has my county’s) crime rate has gone down and listing several possible contributors. It then asks why has the state's corrections expenses have quadrupled when corrections has been a small part, if any, of the contributions to the fall in crime (which includes the homicides of interest to my office).

I particularly like their last point that a “culture change” (I’ve used social norm change in prior posts) will be required to move “to a more affordable, more effective prison (I would say “justice”) system”.

In their editorial they point out several examples of system “corrections” already being “piloted” in Illinois. There is an “intensive-treatment program for non-violent offenders at Sheridan Correctional Center”, rehabilitation to reduce recidivism, that has been remarkably effective. The article also mentions mental health courts providing mental health treatment instead of incarceration for appropriate non-violent offenders. In the same vein, drug courts diverting appropriate individuals to needed treatment. They close with some points about the need for a “makeover” of the parole system to increase its effectiveness.

We do need improvements in our “justice” system to make it more effective at reducing violent crimes and more effective at rehabilitating offending individuals back into society. That improved system would be more cost effective and more effective for the people that the system impacts. We do need a culture change, and a change in mindset, to realize that rehabilitation and treatment is the most effective way to deal with this problem and help these individuals and our society as a whole. We must demand improvement and change (the current system costs "$7 billion a year”, to say nothing of the human cost, “and doesn’t work”).

Licit drug abuse and death

I haven’t seen our year-end numbers yet, but I would agree with some of the points made in a post at Anxiety, Addiction and Depression Treatments.

We do have a significant number of young people die of drug overdose here in Lake County and a significant number who die from illicit drugs. Cocaine continues to ride high (so to speak) and, particularly in the last few months, we have had a spike (small but real) in fentanyl related deaths (knowing abuse and those that thought they were getting heroin).

We seem to be seeing an increasing number of deaths related to licit drugs. Most of those deaths appear to be accidental over-use or related to a bad synergistic combination of drugs, but we have seen some recreational use of prescription drugs. Most deaths related to licit drugs are in folks who are “older”, which seems to be true elsewhere (median age 45). (Even a judge on the Supreme Court can fall victim to overuse, here and here) But we need to keep in mind that while it appears we have made inroads nationwide in cutting the use of illicit drugs in young and old, the abuse and over-use of licit drugs seems to be on the increase.

That really must become a target of information/warning and education about the dangers and possible lethal outcomes of over-use and abuse.

ACE "surveys" lead to misdemeanor charges

A recent “survey” (from police press release) of Lake County (IL) “establishments” that sell alcohol yielded a 32 out of 85 sell to minor rate. The Alcohol Countermeasure Enforcement (got to have a cool acronym) “surveys” took place last month. 32 sellers were arrested and charged with misdemeanor “Unlawful Delivery of Alcoholic Liquor to a Minor”. Granted as it closes: “all defendants are presumed innocent unless proven guilty”, but I’m pretty sure they got them righteously.

While it certainly was a good effort to impact underage drinking (and the ACE “surveys” should continue), I would recommend efforts elsewhere. It is my guess, and I have seen some numbers to back me up, that buying it themselves constitutes but a small percentage of how underage drinkers get their alcohol. We will have some more local information along these lines soon, as the result of some in-school focus group work.

That is where we need to focus efforts. If they are “stealing it” from home or someone else’s home we need to intervene to stop that. If someone else is buying it for them we need to impact that. These efforts are much tougher than “surveys”, but if indeed those are the larger sources we won’t impact underage drinking without stoppering those sources.

We need to alter the social norms that say it is OK for kids to get and drink alcohol. We need to alter the social norm that says it is OK for kids to drink if “it is a controlled environment (at home, etc)” (kids are learning machines and we always generalize from specific lessons). We need to reinforce the social norms among kids that let them know it is OK not to drink until 21. We need to reinforce the social norms that let you know that you can have fun sober. We need to reinforce the social norm that drinking and driving (or riding with someone who has been drinking and is driving) is not OK, that it can and does have deadly consequences.

Every effort to address this problem and keep kids alive is great, but don’t grasp at the easy “solution” and think you are done. We must do all we can to keep kids alive for as long as we can. I don’t need them on a table in my office, I’d much rather have them for a tour.

"May" (not shall) do inquest

January 1, 2007 has brought about a change in how our office operates. On that day a change in state statute made inquests an option available to the Coroner’s Office instead of a mandate. Inquests are jury trials with the Coroner as “judge” to determine the cause and manner of death for the final death certificate in cases of “non-natural” death (accidents, homicide, suicide, and the like). The cause of death is laid out very plainly by the report of the investigating deputy coroner regarding our office investigation. The main function of the jury is to deliberate and determine the manner of death.

Most cases brought to inquest are quite obvious as to the manner of death (accidents, homicide, or suicide). In those sorts of cases the inquest unfortunately adds a step that is not really needed and delays the final death certificate on which many families depend for settling the estate and insurance.

By eliminating the inquest in those obvious cases, we will be able to generate the final death certificate in much shorter order, without a diminution in the quality of the decision making in arriving at the manner of death.

While this eliminates one of the main distinctions between coroners and medical examiners, I don’t see it as an attempt to become medical examiners. It is clearly an attempt to improve our service to the survivors (family and friends) of decedents whose deaths we investigate every day. Inquest is still an available option.

We, my office, look forward to this improvement in doing our job to the best of our ability.