Death of an identity thief

Our electronic fingerprint submission capability, a recent addition to the office, has really proven to be a benefit. A couple of days ago we were able to submit an individual’s prints and got confirmation of his identity in about 10 minutes. Then we were able to go and inform his family, confident that he was who we thought he was. Let’s just say we were less than confident on making the identification based on visual comparison with his photograph.

Another interesting incident pertaining to our fingerprint submissions occurred recently. In reviewing the responses from the IL Bureau of Identification one day we noted that an individual was identified that we did not have in our morgue storage or case files. It was a name that was familiar to me as someone who was still alive and who worked for a local agency, certainly not someone who had been through our office. When we called the individual whose name appeared he was indeed still alive and he related that he was aware that an individual had used his identity as cover because of run-ins with the police. The identity was taken after he had helped the now deceased individual on several occasions. So not only were we able to resolve the investigation into the cause of death of one individual through our usual practices, we were able to resolve a case of identity theft as well.

Death case provoked dream?

I had a weird dream last night. As I have said I do end up taking some of the job home with me, at least in my head. I think the dream sprang from a case conference we had Monday that involved the drug-related death of an individual. In the discussion and review of the scene photos, it was revealed that the victim used a homemade aluminum foil pipe (would there be such a pipe other than a homemade?) for smoking drugs.

When I googled to check on the prevalence of using aluminum foil to make a pipe. I was surprised just how common a practice it is for crack, heroin, marijuana, the whole gamut of drugs. There was even an answer to a question posed about the safety of smoking in such a devise and the risk of the aluminum inhaled. Although it would seem to me that most folks using such a device would not be overly worried about the aluminum and most of the substances smoked would be more harmful than the aluminum.

Anyway to my dream, in it I was watching a TV show, much like Saturday Night Live in the old days, and a commercial came on for a product called “Six Pack O’ Crack” that came pre-loaded in pipes. As far as I know no such product exists and would likely be pretty lethal. I mention it to demonstrate just how strange a place the world of dreams is, particularly mine at certain times.

Killing in fiction

I cruised back to a website I visited before, one that appears to give out, shall we say, not the most accurate information pertaining to forensics mixed with some good stuff and found some more not fully accurate information and an opportunity to throw in my 2 cents worth.

The question sent in by an author:

I've got a man in his 60's who is dying (I gave him cancer, but really it could be anything convenient for the scenario I'm describing). He is being cared for at home by his wife and his niece (who is a nurse), along with help from a local hospice group. He has trouble breathing and sometimes needs a mask put over his face (oxygen, I'm guessing), to help him out. The oxygen is in a tank behind his bed.
One afternoon he needs the mask, but when they put it on him, he dies anyway. His death seems natural. It's not until autopsy that they realize he was murdered: There at the end, he wasn't breathing oxygen through the mask at all but some other substance that had been put into the tank (or that tank was switched out for another) and the substance killed him.
What deadly substance was substituted for the oxygen? Would it have a smell? How would the autopsy reveal that this is what happened?
I'd like the fatal gas to be as simple as possible, something easily attainable by any of the 5 suspects. It would also be fine if someone could've just changed the settings on the oxygen or some other gas that would be present anyway and that's what killed him. The most important part of the scene is that they have to think it was a natural death until autopsy (though a whiff of some strange odor would be fine.)

The answer posted:

There are several possibilities but three that would be very easy for your killer to employ.
1—Simply not turning on the oxygen and having him continue breathing only room air. If he were very ill with severe lung disease, and particularly if he was taking pain meds, which would suppress his respiratory drive, this alone could make him gradually slip into a coma, stop breathing, and die.
2—If he had what we call Chronic Obstructive Pulmonary Disease (COPD), which is basically emphysema and similar diseases, he would be very sensitive to high oxygen (O2) levels. The physiology here is complex but the bottom line is that people with severe COPD can slow or even stop their breathing if exposed to high levels of O2. So your killer could turn up the oxygen. Normally these tank masks combinations are set at a flow rate of 2 liters of O2 per minute. If the valve on the tank were turned up to say 10 liters/minute the victim would gradually slow his breathing and eventually stop and die from asphyxia. This could take anywhere for 15 minutes to a n hour so you have a bit of leeway here.
If the gauges were returned to normal after the victim died and before he was seen by investigators or other witnesses, then the cause of death might never be determined since there are no laboratory or autopsy findings in these situations.
3--Carbon monoxide (CO) would also work. The killer could extend a small hose—or a garden hose—from a car tail pipe in the garage or the driveway just outside the window to the mask the victim was wearing. This is a very deadly situation that comes from the unique chemistry of CO…
(the website writer goes on to actually fairly well discuss the toxicity of CO and some findings after death)

Because the questioning author listed their website I dropped her an email:

Not to be a butt-in-ski, but I ran across your question on Dr Lyle’s site and I feel there are some errors in the answer he posts.
1) Having the flow of oxygen to his mask turned off would cause him to rebreath his exhalations (and carbon dioxide) and could/would ultimately result in his death. Remember that the air hunger he would experience would get quite strong, so he would have to be pretty incapacitated to not reach for the mask.
2) Oxygen through a mask is always set at a minimum of 10 liters per minute, never at the 2 liters that a nasal cannula is set, so this one starts out wrong. High flow oxygen and the loss of hypoxic drive in severe COPD is a theoretic possibility, but is very seldom seen in real life.
3) Carbon monoxide does not normally come in tanks, but I suppose you could fill one with it. A more “natural” choice here would be nitrous oxide, used by dentists and others for anesthesia. It is lethal when used in concentrations greater than about 30% (it is normally mixed with oxygen in a “machine” for administration). Given straight it would be quite lethal and might be noticed as a sweet smell. It could be found after death when a blood gas is run found to have a very low blood oxygen content.

Maybe I should get into author consulting; I guess I have done a bit of that already. I have since corresponded with the author who sent the question above, her story has changed and I think I helped her a bit in agreeing with her new plot twist on how to kill a fictional character (kind of fun).

The Coroner biz is an amalgam...

The Coroner biz is an amalgam of many fields of the arts and sciences. It involves biology, chemistry, physics, medicine, psychology, sociology, logic, criminal and social justice, communication, writing, math, and a bit of philosophy.

Biology and chemistry gives us the ability to do toxicology testing. Physics allows us to look at the mechanics and kinetics of accidents, as well as using parts of the light spectrum and phosphorescence to look for evidence. The mercurial nature of health and illness often impact the deaths under investigation. We learn from psychology and sociology how individuals and groups of individuals act, contributing to death as well as life. Justice is our goal, not in the sense of fault finding, but ensuring the most humane conditions for society. The ability to communicate well, in all its forms, is critical to successful completion of our business. Philosophy is to help us in dealing with it all and in helping the survivors of the deceased individual.

Weekend reading with an eye to those related to death

Yesterday’s Chicago Tribune had several interesting articles:

Front page article about: “…hospital is the first in the Chicago area to disclose extensive information online about the quality of its care…” It seems to me that universal postings like this could go a long way not only in keeping patients and potential patients informed, but in pushing hospitals to ensure their quality of caring. Armed with information and with hospitals living up to quality standards, maybe we can prevent a few deaths by “medical misadventure”.

In the Q section there was a small bit on preventing hospital (medical caregiver) acquired drug-resistant bacterial infections that suggested folks:

"Politely ask hospital staff members to wash their hands before touching you if you don't see them doing so.” And
“Ask the doctor or nurse to clean the stethoscope before using it on you.”

They seem like really good points to remember and worth a mention to your healthcare provider. Although these infections cause more morbidity that mortality, they can kill and, at least some, are preventable with simple techniques.

Lastly, Mary Schmich wrote an interesting column that contained a discussion of some of the “mysteries” of death by suicide. Just because I do that sort of thing I posted a reply to her column:

You are so right when you wrote: “But another of suicide's mysteries is this: Exactly what happened is unlikely to be discovered, even if the clues add up.”

Death by suicide seldom “adds up” for those that survive individuals who choose to end their pain with suicide or choose to go on to another place where they hope that the pain is less.

Despite you column being focused on Mr. Jones, I hope that folks read your comments on death by suicide, that that reading provokes some though on their part (and maybe a little discussion), and that that awareness makes it seem a bit less of a mystery for another family member survivor of death by suicide.

Thank you for writing about death by suicide, a subject with much taboo in our society.

Life skills can prevent death

Earlier today while tidying up some stuff I came across a list that I vaguely remember copying down quite a while ago with the intent of writing about them. The list is entitled Life Skills (sorry I'm not sure who to cite, all I have is a list on a small piece of paper):

Problem solving
Conflict resolution
Understanding/Managing emotions
Empathy
Tolerance of others
Working in teams

Looking at them today I do think that they are critical life skills needed to become a mature, functioning member of our society (most societies that I know about). If we could inculcate these into all members of our communities we could go a long way to solving our problems with violence, as well as other problems that lead to preventable deaths in our community. I intentionally used the fancy word “inculcate” because it communicates the essence of how I think this “stuff” must be taught (inculcate = to impress on the mind by frequent repetition or instruction).

Problem solving without resorting to drugs, managing emotions so that they neither flare toward others or consume from within, working together to address problems and work toward solutions.

Kids need to be taught these skills at home, but they must also be taught and reinforced in the community in general by lesson and example. It must be a part of what is taught in schools, both subtly in literature selection and more obviously in things like social studies. It must be “taught” in the work place, by doing. It must be shown by example on TV, in other media, and in everyone’s day-to-day actions and interactions.

What a way to buff up society and grow community members with functional life skills. What a way to impact violence and the death and mayhem that results from it. What a great way (yes, rather grandiose, although we can start with a few) to forestall death.

Accidental Infant Asphyxial Deaths

Last Thursday and Friday I was at the 12th Annual IL Symposium for Child Death Review Teams. In addition to a couple of “business” meetings there were lectures on issues of child death.

The first lecture was about a constellation of deaths that, in the past, were often confused with SIDS. But these deaths are preventable, so it is important to look for us to look for them in investigations and based on the growing body of related information, it is incumbent on those of us involved in the investigation of these deaths to get warnings out to parents about them.

I have written some about it in the past. These tragic, accidental deaths occur while these children are in bed, most often in an “adult” bed. Broadly, they are suffocation or asphyxia deaths. They can occur with:

“Overlaying”, bed-sharing adult or child unintentionally lays upon the child either totally or partially, it only takes about 4 pounds of pressure on the neck for asphyxia to occur,

Asphyxia related a child’s face becoming trapped in soft bedding (infants are unable to move their heads out of position),

Asphyxia related to getting wedged into a space in which the chest and lungs cannot expand (often seen with trapping between mattress and wall or, as we have seen, between 2 couch cushions)

Suffocation when bedding or similar materials cover the child’s head and mouth

These deaths are way too common and are preventable. The “Back to Sleep” program to prevent SIDS has been very successful. Next we must push the information that bed-sharing is incredibly dangerous. [One point that the speaker brought up is that one of the major reasons for bed-sharing is the inability to afford a crib. A child dies because of poverty. That should not happen.] The other point that must be stressed (in part already out there, but it needs to be emphasized) is that children should only sleep on appropriate sleep surfaces, not soft surfaces, not buried in bedding, not with stuffed toys, and on a surface without the possibility that the infant might become entrapped.

We must work to prevent death and this is a great potential target for prevention.

"procured"

Hawaiian’s have a saying that “words move mana (energy)”.

This can become obvious in many ways, but most recently when a word I used was misconstrued and generated problems because of the “value” assigned to it by someone reading the report. An individual died tragically and because of the type of gentleman he was his organs were donated to save the lives of others. When asked by the media I gave what I thought was a fairly neutral and thought-out statement in response to questions regarding his organ donation, already known to at least some of the reporters, and the fact that he was pronounced dead over 24 hours after the crash. Apparently, my choice of words was not neutral. In response to their request for an apology or retraction, I have sent the following to the paper with a request that they print it soon:

My use of the phrase “organs were procured”, recently, has caused some confusion and concern and, most unfortunately, pain. The statement was used in the online version of a Daily Herald article on September 5. This is the terminology used by agencies and others involved in organ and tissue donation when organs are obtained by donation for transplantation and recipient use. This is most readily evidenced by the name of the Association of Organ Procurement Organizations, a national organization dedicated to ethical organ and tissue donation. It may be jargon, but it is the correct terminology in these instances.

I apologize that the use of this unfamiliar term created concern and pain for the family of this individual who died tragically. The word “procured” was used without any intent to denote the illegal, and unethical, action of buying or selling organs that has happened in other areas of this country and elsewhere.

I and the Lake County Coroner’s Office strongly support organ donation and celebrate the lives that organ donation is able to save.

Again my apologies to those who may have been offended.

Shielding kids with community

There was an article in last Sunday’s Chicago Tribune using the availability of bullet-proof backpacks for kids going back to school to make some good points about keeping kids safe at school.

The crux of the matter is laid out well in about the middle of the article:
So, as the new year gets under way, how do we keep our kids safe? By building caring school communities, where everyone is made to feel valued and people are vigilant about disturbing behavior.

Curriculum must push in-school community building, encouragement of diversity, and the teaching of (over and over again) the social skills necessary to value “the other” and to know what to watch for and how to report what you see so that intervention can take place earlier for individuals caught in escalating problems (violence, suicide, etc.).

We also must ensure that those kids in need of counseling and psychiatric help have access to that help. While it may make sense to some to cut the availability of these services as school budgets get tight, it is a terrible idea. There is no doubt that the need for these services in schools is growing. That is reflected in deaths by suicide, violence in our schools and outside the schools as a carry-over from school, as well as the not as obvious growing incidence of mental health issues amongst these individuals.

These are community problems that require community solutions, not “band aids” (even those as big and heavy as armored backpacks).