Forestalling elder abuse deaths

I am one of about a dozen county Coroners in Illinois participating in a nursing home death reporting task force and project. The purpose of the project is to investigate and ultimately prevent death due to abuse and neglect at long-term care facilities. This will likely translate into prevention of abuse and neglect of individuals residing in long-term care facilities, even those not causing death.

The Coroner in each county is uniquely placed to discover and report instances of abuse and neglect and the Illinois Department of Public Health has decided to seek out/enlist that help. The project will not change our office procedures, for the most part, since we already ask the nursing homes to report deaths to us and we look into any that raise any suspicion. The change for our office is that we will now have deaths reported of facility residents who die up to 10 days after hospitalization.

Elder abuse is a real problem and we look forward to participating in efforts to prevent it in long-term care facilities and, in particular, proving its value so that it becomes standard at least across the state (and maybe a model for elsewhere). We even discussed going after regulatory changes to ensure the reporting and investigation on a mandated basis, if need be. All, again, in the name of forestalling death.

Drug Induced Homicide?

Is a death from the use of illicit drugs (or the “misuse” of licit drugs) an accident or “drug-induced homicide”?

We discussed that question this morning during case conferences (our replacement for inquests). If an adult chooses to obtain drugs from another and voluntarily uses, ingests or injects them, is their death “at the hands of another”?

The State of Illinois has a dug-induced homicide statute that holds that if an individual sells to or gives to an individual drugs (illicit or licit) that result in their death the individual who “delivers” the drugs can be found guilty of homicide. I realize that this was passed into law to give law enforcement another tool to get the “bad guys” (purveyors in drugs), but does it really make sense. It certainly does make sense in cases where an individual cannot make an informed decision about participating (too young or too impaired for any of a variety of reasons) or if the offending individual actually administers the drug to the other, but does it make sense in all cases?

An individual makes a series of choices that result in their use of drugs: the decision to seek the drugs, the decision to obtain the drugs (knowing that the quality cannot be vouched for), and the decision to use the drugs, by this don’t they accept culpability?

It is certainly “wrong” to use illicit drugs and misuse licit drugs, but is it homicide at the hands of another?

Most overdoses are an accident (as opposed to intentional): using too much, using stuff that is purer than what you are used to, using after a period of abstinence, mixing what should not be mixed (the problem of synergy), using what you think is one thing and it is another, using when your health isn’t up to the use, and sometimes things just happen.

I don’t know the answers, we just take it case by case, individual by individual.

Teeth as unique as fingerprints

Ah, doing the “fun” stuff today, working on the office reorganization, budget for next year and related stuff. (I am also finding out that much that I had relied a subordinate to get done had not gotten done, so some in my staff and I are playing catch-up)

But I did have an interesting conversation (actually among several about cases in progress, it just seems I am only working on the stuff I mentioned above) with a forensic odontologist whose services we use. He was dropping off his report identifying a recent “Jane Doe” case, the skeletonized remains I discussed before. He had prepared his report identifying her (with a reasonable degree of medical certainty) based on comparing teeth present in (on?) the skeletal remains with photographs of the suspected female that included a view of some of her teeth. His opinion was that it is “a match”.

He told me that an authoritative Forensic Science Journal had just published a study on the excellent validity of such identification techniques which came out after he had completed his report. In our case the points of comparison were striking even without full dental comparison.

Your teeth are indeed as unique as your fingerprints.

[We do have DNA comparison with her mother pending as well.]

Then late in the afternoon we got a call from a dentist who had treated this young woman in the past and had seen the report of her skeletal remains being found. We will now be able to do a full dental comparison, but I (as is our forensic dentist) am confident that our “match” will only be further confirmed.

Self-restraint

I came across a quote that Walter Mosley included in an article he wrote recently that I thought was an important bit to keep in mind: “Self-restraint is what makes it possible for society to exist.”

I certainly see the opposite all too frequently in my line of work. I frequently see loss or lack of self-restraint in homicides (reckless or intentional), in crashes, with folks making bad choices and/or taking chances, in cases of abuse, on and on.

Self-restraint is a critically important “skill” to acquire, but some never do, some lose it temporarily, and some set it aside never to “bother” with it again. Self-restraint doesn’t mean you don’t have the thoughts that a few others act on, but that you are able to separate the thought from the action and not partake in the action.

I hope to impart the ability for self-restraint to my children. I’m not all together clear on exactly how to do that other than repetitive talks and modeling behavior, but so far it does seem to be working. I plan on continuing with my self-restraint, at least as is socially relevant and acceptable. I hope that others who could impact my life also maintain their self-restraint, so that their loss or lack of self-restraint doesn’t affect me or “mine”, as I have seen it affect others.

Pre-prom events

I’ve done 3 pre-prom presentations during the last 2 days. It really is fun talking to all those teens (hundreds of juniors and seniors), although I still have reservations about the effectiveness of the faked crash re-enactments.

I do take pride that I seem to have rapt attention from the teens as I speak. As I said during a brief talk I gave for a video being shot at yesterday mornings event, I think that the verbal parts of the events can have some impact. I told them many things, all factual and none of it an attempt to scare them straight. I told them that alcohol and drugs can and will affect their brains under construction. Those effects are both short-term and long-term, making it more difficult to “second guess” or reconsider their actions before they take them. I told them to stay out of my office/morgue; that I had enough business without their deaths. I told them, should they be in an accident and survive, that they will be saying “I’m sorry” for the rest of their lives.

I over-heard a couple of the teens talking yesterday afternoon about an event I had participated in 2 years ago, it is interesting that their recollection of the “crash” itself was imperfect (actually wrong), but their overall impression was more “on the money”. They understood what it was all about. Did it change or impact their behavior? I don’t know, they didn’t discuss that within my earshot.

This year I added to my presentation the statement that I get goose-bumps at these events this year. I attribute that to the fact (which I discussed in my talks) that my 16 year old went to her 1st prom this year. These crashes are just the mental pictures I had while she was out. They put a face on my fear. I hope they got that. Maybe that will make it a bit more personal for them, so that they don’t take chances and make good choices. I hope we don’t have any prom related deaths and, maybe, no more teen drunk (intoxicated/impaired) driving related deaths.

More on IDs for skeletal remains

An interesting opportunity has come to my attention. In addition to an extensive database of missing persons and “ties” to other related databases, the National Center for Missing and Exploited Children has an extensive database for DNA profiling. In addition to their own database they also have ties to the criminal justice DNA profile bank.

We plan on submitting DNA from our former skeletal remains case (the adult male found on a local golf course) for their help in profiling and comparison. DNA from our more recent skeletal remains case is being submitted to the Illinois State Crime Lab for similar profiling and comparison, but I would consider submitting it to the National Center for Missing and Exploited Children as well.

I really appreciate that someone with the National Center for Missing and Exploited Children saw one of the recent articles about our “Jane Doe” and dropped me a note about their services. They are so much more than what I thought they were, that is a clearinghouse regarding missing children (you know the people that came up with the great new use for the milk carton). I look forward to working with them on these cases and, rather unfortunately because they will happen, on cases in the future.

Not that I advertise for folks, but the availability of these and their other services sure make the National Center for Missing and Exploited Children seem like they are deserving of support, if you are looking for a national organization to support.

Ruminating on skeletal remains

We (I and some of the deputies) were talking at lunch in the office today about skeletal remains. By their recollection we have had more than our fair share of late. Granted some were partially skeletal, such as the gentleman who died and burned in his pickup on a back road here in our county. Skeletal remains they are none the less. Two cases of strictly skeletal remains within 2 months, that just doesn’t happen very often, not in the recollection of the folks in my office.

The first was a male found on a golf course shortly before it opened for the season and the second is a female found in a relatively unfrequented spot by a passer-by. The first is possibly an individual who had been living/camping in the vicinity of where he was found, the second likely brought there by a person or persons unknown. The first likely dead in the area he was found several weeks, the second more a matter of months.

Nature, with all her little helpers, has done her natural work with both of them after their deaths. Skeletalized remains. But it is important to remember they were once alive, walking around, talking, interacting, real people. I hope that they will be identified soon.

We are working on identification. The former with distinctive teeth in a front bridge-work and we are working with someone to come up with a sketch of what he looked like in life. With the latter, the Sherriff’s Department is working on “leads”, working the investigation, we are working on dental examination prepping for the possibility of comparable dental records, as well as the possible submission of DNA (bone marrow or dental pulp) if someone turns up to allow for comparison.

Skeletal remains

Statutory power of the coroner

“May you live in interesting times” ancient Chinese blessing/curse

A number of “interesting” things going on in the office, but I can’t write about most of it.

If you don’t mind I need to organize a few things (statute stuff) in my head for an upcoming meeting, so I am going to lay some of them out here to familiarize myself with them (you may be interested as well).

“Each coroner shall be conservator of the peace in his county, and, in the performance of his duties as such, shall have the same powers as the sheriff.” (interesting “power”)

“No dead body…or the personal property of such a deceased person, shall be handled, moved, disturbed, embalmed, or removed from the place of death by any person, except with the permission of the coroner unless the same shall be necessary to protect such body or property from damage or destruction, or unless necessary to protect life, safety or health. Any person knowingly violating the provisions of this Section is guilty of a Class A misdemeanor.” (pretty straight forward)

“Every law enforcement official, funeral director or administrator or person having custody of the body of a deceased person, where the death is one subject to investigation under Section 3-3013…shall notify the coroner promptly. Any such person, failing to notify the coroner promptly shall be guilty of a Class A misdemeanor…”

“Circumstances under which (an) autopsy (is) to be performed (a) Where a death has occurred and the circumstances concerning the death are suspicious, obscure, mysterious, or otherwise unexplained and in the opinion of the examining physician or the coroner the cause of death cannot be established definitely except by autopsy…”

This stuff may not make much sense to you, the reader, out of context, but it lays out the authority of my Office in cases of death and does not allow latitude for others to rule or over-rule the Coroner. I do want to work cooperatively with others, but they need to understand my position of authority in these matters and should not make demands. They need to ask for and work towards cooperation. I look forward to developments.

Spykes ™

“Girlie Drinks” or alcopops sure look like they are targeted at young girls. An introduction to alcohol perhaps more tempting that a beer in a can.

Now along come Spykes ™. They are cute little 2 ounce bottles of brightly colored (except the chocolate one) malt beverage with 12 percent alcohol content. The bottles themselves look like over-fed nail-polish bottles. They are enticing, sweet with the flavors of chocolate, mango, watermelon and lime. The manufacturers website says that they are designed to add to a beer to add flavor and, I suppose in another time, pizzazz.

But my concern is that they fit easily into a tux jacket pocket or relatively unobtrusively into a purse for prom night “fun”. I want parents to be aware of these attractive “treats”. Teens should have fun on prom night, but to have fun they don’t need to drink.

Check your teen on prom night. Help them live out their full potential, their full lives. Underage drinking is not OK. Please do all that you can to keep them out of my office.

Antidepressants benefit children and teens

Dueling articles, what a difference a few weeks can make.

First from an article on nytimes.com today:

The Food and Drug Administration ordered drug makers yesterday to add warnings to antidepressant medications, saying the drugs increase the risk of suicidal thinking or behavior in some young adults.

Then an article on nytimes.com 2 weeks ago (or a non-"walled" USAToday link):

The authors of a comprehensive new analysis say the benefits of antidepressants in children and teenagers trump a small risk that they will experience increased suicidal thoughts and behavior.

The latter is based on the “more powerful” data, i.e. a meta-analysis of more studies than the data used by the FDA, with a greater number of subjects, so I would have to support it on that basis alone. In addition, the latter information resonates more with my experience.

I certainly hope that there aren’t any children or teens that are prevented from getting needed antidepressants because of the black-box warnings or news of the black-box warnings placed by the FDA. Lack of access to needed medication and its attendant treatment causes needless suffering, self-medication with licit and illicit drugs, and death by suicide. Let’s not gamble with the minds, psyches and lives of these kids (there were no deaths by suicide in the meta-analysis study). As one of the doctors quoted in the latter article says “you can’t say, take these and call me in six weeks”, but the meds are an important part of the therapy that must be available to all in need of it.

2007 WomenHeart Wenger Award

A Press Release I sent out today:

On April 30, 2007, in Washington, DC, The National Coalition for Women with Heart Disease (WomenHeart) presented Richard Keller, MD, Coroner of Lake County, IL with their 2007 Wenger Award for Excellence in Public Policy.

“The Wenger Awards were inaugurated in 2000 to honor Dr. Nanette Kass Wenger, a world-renown cardiologist who has long championed the need for improved research and treatment of heart disease in women”. (http://www.womenheart.org/)

The award was granted based on the events surrounding the death of Beatrice Vance on July 29, 2006. Her death investigation results were taken to Inquest and the jury, based on the facts of the case, found “homicide” to be the manner of her death from an acute myocardial infarction.. Their verdict was based on their opinion that the death resulted from “a gross deviation from (the) standard of care which a reasonable person would exercise in the situation”.

The case at the time of verdict engendered considerable national media attention, including medical media outlets for the American Medical Association and American College of Emergency Physicians. Since that time, the case has been used in teaching women to advocate for themselves, in teaching at medical schools and to hospital medical staffs around the country. It continues to bring about personal change and is serving as a catalyst for system change, so that her death is not repeated elsewhere.

During his acceptance speech, Dr Keller admonished those present to “push for changes in emergency care, nationwide, so that it becomes impossible for a 49 year old woman to die of a treatable disease process 20 feet from diagnosis and treatment. The problem here is bigger than a problem at a single hospital, it is a system problem. No one should be prosecuted for her death, but it should not be disregarded, either. We must do everything we can to forestall death, to keep folks out of the Coroner’s office for as long as possible”.

Dr. Keller accepted the award “on behalf of my Office and the deputy primarily involved in the investigation of the death, the jury who found for “homicide”, and Ms Vance, that her death may contribute to system change and the prevention of future deaths under similar situations”.

So there I was getting ready to go up in front of 100 or so folks and I decided to take one more bite of the sorbet they served for dessert. The humidity in the room caused the glass that the sorbet was in to sweat. The sweat dripped onto my leg fairly high up, if you know what I mean. Thank goodness, I had on slacks that dried quickly and I was able to go up front, accept the award, and give a short talk that got a standing ovation. It was all good and I know good will come of this tragic event.