Tuesday, April 29, 2008

Heroin Deaths Can Touch Us All

The Coroner gets letters:

Dear Dr Keller:

I came across your name while dong a “net” search in trying to find out how many deaths were contributed to heroin overdose in 2008 in Illinois. NBC 5 had an article dated 3/13/08 that indicated you determined the deaths of two men found in Fox Lake, IL, were from heroin overdose.

On 4/23/08, I attended a wake in (village name removed), IL for a young woman who died from a heroin overdose.

Last night, 4/26/08, my son who lives in Texas called me. He was sobbing terribly…his best friend/childhood friend died from a heroin overdose! I don’t know the details but it happened in (village name removed), IL.

I am very well aware of the law enforcement’s and public’s attitude concerning such details, but we must have some kind of empathy for these unfortunate souls. I know it would be a difficult task to find out who was their supplier, but I hope someone is looking into these deaths.

I agree with your sentiments about the “unfortunate souls”. We must do all we can to ensure people have adequate access to counseling and treatment in all its forms. We must be certain that people can feel “comfortable” with seeking that help.

Equally important is law enforcement seeking out the dealers and suppliers. That is certainly done in our area and we do what we can to encourage and help in those investigations.

Friday, April 25, 2008

Coroner Shipping Violation, again

Don’t tell the national package shipping company we use, but we have violated their rules again. We sent more human remains to the Center for Human Identification in Texas.

This case began for this office in December of 1991. Most of a human skull was found in an wooded ravine area of a “Nature Preserve” in the Lake Forest area of our County. No other bones were found in a search of the surrounding area. Some other stuff was found in the area, but the feeling at the time was that those things did not seem to have much, if anything, to do with the skull. Certainly nothing found seemed to shed any light on who this skull had belonged to, how that individual had died, or how their skull ended up in the area it was found. The partial skull was examined by forensic dentists and ultimately 2 anthropologists (who came up with very different opinions on the skull’s owner). Nothing was resolved.

Most likely, based on the opinions at the time, the skull belonged to a female, Black (most likely) or Native American or a mix, 40-60 years of age at death (although the range was considerable). It was felt that the skull had lain outdoors “10 or so” years after death. The results of her dental exam were entered into the NCIC database to aid in hoped for identification; there were no “hits”. Missing persons reports were searched without match.

We began looking at the case recently, as we have several other past unresolved cases. In this case that relook has taken 2 tracts. First, we had a psychic do a reading on the partial skull (why not, he has been successful in several other cases). We came up with the following impressions: Black female in her early 40s, employed as a domestic or cleaning lady (likely with an agency, since no missing persons report was filed), she abused alcohol or had a mental illness and was likely in an abusive relationship in her home life, her death seemed to have occurred near 1975 or 1976, death seemed to have been the result of strangulation or hanging and was most probably suicide, and, lastly, there seemed to be a “J” connected, likely her name.

Now she is off to Texas to see what they can come up with to help with identification. They will have their anthropologists look at her, more skilled and capable that the previous examiners, among other experts. She does have a tooth remaining; will they be able to extract DNA? If they can extract DNA will there be a match in one of the databases? We will see if they can give us any new information to go with for identification.

We will see.

Tuesday, April 22, 2008

Is this homicide?

Hypothetically speaking or I heard this someplace:

A 21 year-old is not feeling well for a couple of days, fever, cough, shortness of breath. Because he is in a boot camp-like situation, he is run (as in really running with his own 2 feet) to the clinic for medical attention. Once there he stands in line awaiting his turn to be seen. He is observed by the clinic staff to not look well when he arrived. After some time in line he passes out, falls to the hard floor, and strikes his head. Unconscious he is taken by rescue squad to a local hospital from the clinic. There he is diagnosed with bleeding in his head, a direct result of passing out and hitting his head on the floor. He dies as a result of his head injury. He is also found to have a pneumonia involving his entire right lung, all 3 lobes, the reason he had been un-well.

Is his death a homicide (death at the hands of another) because of neglect to what would be considered appropriate medical attention (or lack of appropriate medical attention) by the medical providers at the clinic? (Remember for a Coroner Homicide does not necessarily mean murder)

Thursday, April 17, 2008

Coroner Rules "That’s Drug-induced Homicide"

We had a case recently, with case conference this week, in which two individuals died of heroin overdose. It is very unusual that you get two individuals dead at a scene at the same time (prompting a broad investigation into possible causes).

The law in Illinois allows anyone who gives or sells drugs (illicit or licit) to another that results in that person’s death can be charged with drug-induced homicide (always with review of the circumstances around the incident for criminality). However this case, in the minds of myself and my deputies, rises above this simplistic definition and is without a doubt homicide.

These 2 men were found dead in a house after a 911 call occurred. The caller reported 2 men down and strongly suggested that rescue personnel bring Narcan. Narcan is a drug given to reverse the effects of opiate (e.g. heroin) overdose. The 2 men were found down, dead and beyond the ability of Narcan to rescue them.

The men were found to have bags of frozen vegetables in their pants, which seemed strange to at least some of the personnel at the scene and to my deputy. It immediately made sense to me. There is a fallacious belief among drug users’ (and others) lore that ice can be used to revive a user crashing unto death.

How much time was wasted by the third person (there was at least one other person there at the time of death and they called 911) before the 911 call was made with the very proper request for Rescue and Narcan? Narcan administered soon enough could very likely have been life saving. It is obvious that the other person or persons there with these guys knew they were in trouble and likely headed for death (the icing). In our opinion the deaths of these men were homicides for this reason, in addition to the simple fact that they were delivered high grade heroin that killed them.

Thursday, April 10, 2008

Suspended doctor charged

As I wrote last June when this doctor’s license was suspended, he was over-prescribing and that activity in our opinion contributed to the death of several individuals.

Dr. Kane has now been charged in those drug-related deaths (there are more than those listed in the article linked): prescription writing “outside the scope of normal practice”.

Update: The Chicago Tribune ran this with a bit more info

Wednesday, April 09, 2008

It ain't "Leave It To Beaver"

We came across an old Chicago Sun-Times (October 6, 1961) while going through some old files tidying up the basement. I am not sure why it was saved, but 2 articles struck me and got me thinking that many things that we think are unique to our time are not.

The first was the headline and lead article: Boy, 13, Admits Killing Girl, 7, ‘For The Thrill’. I turned 7 just weeks after that and while relatively protected (?) in Omaha, NE at the time, I can’t imagine that sort of thing happening in my world at the time. But quite obviously stuff like that was happening then and continues to happen now. We haven’t learned to stop it. I bring this up not because I am overcome with fatalism, but because I am sure we can figure out a way to impact these issues now. There has to be a way and knowing it is not only the result of current times and our cultural realities seems to me to speak to the possibility.

The other article that caught my eye was on page 2: A rumor began that some kids had seen a woman in a glass casket in a home while peeking through the window. The house was checked out by local law enforcement and no casket was found, but the rumor would not die. People gathered daily and nightly at the home, peeking in and generally being a nuisance for 8 days. The home owner apparently was overwhelmed by this and used a shotgun to end his own life. As the article concludes: “Apparent suicide, yes…But the underlying cause of death? It had to be the rumor—he did want so much to be left alone…”

So it doesn’t seem I only read the death-related articles, I’ll also mention that they had an article informing readers that that Sunday they would have “a comprehensive report on the problems Chicago area residents would face in case of a nuclear attack” (I do remember that sort of stuff). One other thing (or is it 2) just to put this in “time” context there was an ad for a men’s suit with 2 pair of pants for $60 on one page with their apparent competitor on another with that sort of suit for $38. Maybe simpler times in some ways, but not as ideal as we might imagine.

Tuesday, April 08, 2008

Photo blogging

I was looking through some old archive photos that I plan to use to “decorate” the office and I came across this one. I really like the poster in the background. Report them commies...

Friday, April 04, 2008

Teen health and welfare a priority?

This out of Florida:
A recent survey that found some Florida teens believe drinking a cap of bleach will prevent HIV and a shot of Mountain Dew will stop pregnancy has prompted lawmakers to push for an overhaul of sex education in the state.
The survey showed that Florida teens also believe that smoking marijuana will prevent a person from getting pregnant.

This from an update of the 1996 U.S. Preventive Services Task Force (USPSTF) recommendations about motor vehicle injuries:
There is evidence that screening for misuse of alcohol and targeted counseling of those persons who screen positive reduce alcohol consumption and alcohol-related (Motor Vehicle Occupant Injuries) MVOI. However, there is a critical gap in the evidence of the efficacy of behavioral counseling interventions directed to all patients in the primary care setting to reduce driving while under the influence of alcohol or riding with drivers who are alcohol-impaired.

What I take home from these 2 reports is that it seems that the lives of teens are not a high priority at least in some parts of our society right now. Each is just a reflection or a facet of that greater problem.

Teens, in many ways, aren’t getting the information they need to function (in this instance to make intelligent decisions about sex and the possible consequences about sex). That lack of real information, scientifically grounded information, has allowed them to (made them?) conflate drug use with a possible benefit of contraception. Unprotected sex is a high risk behavior that needs to be addressed proactively.

The second, a report from the U.S. Preventive Services Task Force, points out that their isn’t much, if any, research to look at whether counseling by a doctor in their office can impact drinking and driving behavior (or the risky behavior of riding with someone intoxicated) among teens. This is basic research that ought to be high priority. How do we best prevent underage drinking and driving, the high risk behaviors surrounding underage drinking, and impact the morbidity and mortality that results from that behavior? If doctor office behavioral counseling proves to not be effective, are other venues more effective and if so, what are they?

Wednesday, April 02, 2008

Coroner gets letters

I have gotten 2 letters (actually emails) from the American Society of Addiction Medicine over the last couple of days. They had information that I thought I’d pass along through my blog.

The first was a sample letter to send to members of Congress (I have sent it to those representing my area) calling for parity in health insurance coverage for mental health and addictions treatment with medical care coverage. This is incredibly important; I have seen too many folks not getting the care they need because of lack of coverage, including those otherwise covered by health insurance. This, as you might suspect, contributes to worsening of illnesses and even to death.

On March 5, 2008, the House of Representatives took a historic step in passing the “Paul Wellstone Mental Health and Addiction Equity Act” (H.R. 1424). Like the “Mental Health Parity Act” (S. 558), passed by the Senate in September, this bill seeks to end the discrimination against millions of Americans suffering with mental illness and addiction.
These bills offer hope and healing to those with addiction and mental illness by offering treatment services in the same manner as all medical diseases currently covered under private health plans. While there are differences between these two pieces of legislation, I believe a bipartisan agreement can be reached and the strongest possible bill sent to the President before the end of the 110th Congress.
Now that the House and Senate have passed their bills, millions of Americans with mental illness and addiction and their families are counting on the 110th Congress to put aside its differences and come to a bipartisan agreement. This critical legislation has languished in Congress for over a decade and, with your help, this can be the year this groundbreaking civil rights legislation passes.

The second is a notice intended to get the attention of practicing physicians, as well as the consumers of medications as a reminder of the dangers of prescription meds and the “mixtures” that occur in real life. As I have written before (here for example) these combinations can lead to death, as can the individual drugs if over-used and/or abused.

The mixture of alcoholic beverages or opioid analgesics such as oxycodone or hydrocodone, with sedative hypnotics such as diazepam, temazepam, alprazolam, is well known to physicians as a potentially fatal mixture when excessive doses are taken, either under a physician’s prescription, or with medications obtained from friends, family, or illegal sources. The general public needs to appreciate these dangers, and physicians can help educate their patients about such risks. Persons who seek intoxication via prescription drugs can accidentally put themselves into a lethal situation. Substance abuse and dependence are serious illnesses. Persons concerned about their misuse of prescription drugs, or a family member’s possible addiction, should discuss their concerns with their personal physician.

ASAM reminds physicians that no potentially addictive substance should be prescribed without obtaining a full history, including a substance use history; without clear objectives for prescribing such substances; and without clear end-points in mind for their treatment plans. ASAM encourages physician consultations for expert guidance in these patient care matters.