Particularly Dangerous Situation

I was watching CNN the other day and there were a large number of very serious storms happening across the mid-section of the US, but CNN wasn’t talking Severe Storm Warning or the like. They were issuing several PDS warnings (Particularly Dangerous Situation).

I really like PDS (Particularly Dangerous Situation). It would seem to have a very wide range of application. Storms, earthquakes and pestilence would fall into the category.

In our line of work a body in an unsafe environment (e.g. shooter still present) could warrant a PDS alert. Folks drinking (or using drugs) and driving ought to get a PDS alert. I like the idea of a broad based warning, useful until overused. I look forward to using it.

One of three pre-prom events last week

Crash simulations and presentation to head -off drinking and driving among teens. As always we hope we made an impression and that they think, don't take chances, and make good choices.

Lifted from a recent email

I just want to thank all of you for your educational emails over the past year:

Thanks to you, I no longer open a public bathroom door without using a paper towel.

I can't use the remote in a hotel room because I don't know what the last person was doing while flipping through the adult movie channels.

I can't sit down on the hotel bedspread because I can only imagine what has happened on it since it was last washed.

Eating a Little Debbie sends me on a guilt trip because I can only imagine how many gallons of trans fats I have consumed over the years.

I can't touch any woman's purse for fear she has placed it on the floor of a public bathroom.

I no longer use cancer-causing deodorants even though I smell like a water buffalo on a hot day.

Because of your concern I no longer drink Coca Cola because it can remove toilet stains.

I no longer can buy gasoline without taking someone along to watch the car so a serial killer won't crawl in my back seat when I'm pumping gas.

I no longer use plastic wrap in the microwave because it causes cancer.

And thanks for letting me know I can't boil a cup of water in the microwave anymore because it will blow up in my face...disfiguring me for life.

I no longer check the coin return on pay phones because I could be pricked with a needle infected with AIDS.

I no longer go to shopping malls because someone will drug me with a perfume sample and rob me.

I no longer answer the phone because someone will ask me to dial a number for which I will get a phone bill with calls to Jamaica, Uganda , Singapore and Uzbekistan .

And thanks to your great advice, I can't ever pick up $5.00 dropped in the parking lot because it probably was placed there by a mugger waiting underneath my car to grab my leg.

I no longer buy expensive cookies from Neiman Marcus since I now have their recipe.

Treating depression can make you healthier

Yet another reason to ensure that depression is treated appropriately:

Natural Killers (NK) cells in your body are responsible for attacking and killing virus-infected and cancerous cells. Studies have demonstrated that NK cell function is decreased in folks with depression. Now a study has demonstrated that treatment with anti-depressants improves that NK cell function.

Treat depression and increase immune function, quite probably decreasing morbidity and mortality. Further proof that medical care is a good investment and can improve health.

Emo not a cause of death

[You may notice that the quote below is a link to MySpace. Now I don’t cruise MySpace, but do from time to time come across a link to that networking site.]

Apparently recently in the U.K. a coroner blamed emo music for the death by suicide of a 13 year-old girl. Wouldn’t it be great if it was really that simple? Merely do away with one type of music and kids will stop dying by suicide. Similarly, as discussions seem to be running in the media lately, do away with guns and kids will stop dying from violence in our streets. No problem is that simplistic. All of these types of problems are “over-determined” with multi-factorial etiologies. Their solutions must similarly be multi-pronged, addressed on many fronts. That is not to say that they can be solved, but that they will require work and not magic wands or bandaids.

As someone posts in their comments in the discussion on the girl’s death:

NME.COM user Time For Something Bibical said: "My heart goes out to her family, but you don't get 'suicidal' just solely by listening to 'emo' music, there are always deeper reasons and connections

We must work on these “deeper reasons and connections” while providing an out, access to help and folks pushing/assisting those in these sorts of spirals to access that help.

One last aside, in response to a recent question posed to me I could not find any research demonstrating a causal link with emo music and suicide (including asking some folks I know for some help in the search).

Illicit Drug Prices

I was looking through a document put out by the National Drug Intelligence Center (US Dept. of Justice) titled: National Illicit Drug Prices. [It was emailed to me so I don’t have a link]

It really struck me how this report discusses this stuff similarly to other commodities. It is a commodity based business after all. It includes information on the prices of various illicit drugs at the wholesale-level, midlevel and at the retail end of the business. It talks about how some sporadic shortages and their concomitant price increases may be caused “by Columbian suppliers’ shifting cocaine from U.S. drug markets to European markets…taking advantage of the stronger euro…”

Also driving the cost of the drugs is the issue of purity at the wholesale level. Increased purity at the wholesale level in turn increases the amount of midlevel and retail drug that can be derived per kilo of wholesale-level drug. “The price of a kilogram of heroin in Chicago decreased…(related to)…heroin purity recently increased…ending a nearly 10-year decline…increasing availability of the drug.”

I am not sure that we view the drug trade as much as a commodity business as it really is, with various market pressures. This isn’t a discussion of right or wrong, Lord knows we see the heavy toll of these illicit substances, but just an observation as my thoughts were provoked by the publication.

It would be interesting to see drug-related deaths and other drug-related problems and crimes plotted against these price fluctuations.

Suicide magnet?

I agree with the author of this series of articles (I & II). Signs suggesting that folks prepared to jump from a bridge should call a suicide hotline are not going to change the death toll. You can park your ambulances down stream and pluck the dead and dying from the waters or you can do all you can to prevent them from jumping. A part of that are preventative barriers. A part of it is pushing suicide prevention (making access to mental health care readily available, hotlines, working to decrease stigma attached to seeking caring, etc) before these folks get out onto the bridge.

Awareness is key. (Thanks for the links, Randy)

Medication sharing can result in death

A recent report:

…roughly 23 percent reported loaning their prescription medications to someone else, and 27 percent reported borrowing prescription medications.

The medications most frequently shared (loaned or borrowed) were allergy drugs like Allegra (25 percent), followed by pain medications like Darvocet and OxyContin (22 percent); and antibiotics like amoxicillin (21 percent).

Seven percent of those interviewed said they shared mood-altering drugs like Paxil, Zoloft, Ritalin and Valium.

This certainly seems to agree with what we see in our cases of death due to licit drug intoxication or overdose, although certainly our death cases are more heavily weighted toward pain meds and “mood-alerting drugs”. This is a huge problem. People really don’t realize the danger in sharing, trading, and taking someone else’s meds. Just because they come from a drug store doesn’t mean they are always safe.

Lake County Coroner’s Office Investigation of a Death

Notes from a recent presentation I did to discuss how much work goes on with (and it is by no means all-inclusive):

Lake County Coroner’s Office Investigation of a Death

The Call:
The On Call Deputy receives the call of a Death
General Information about the Deceased if available (may take several calls)

The Scene:
Collection of Evidence, Photodocumentation
Collection of Personal Property and Physical Evidence (Chain of Custody)
The Body
Preliminary Drug testing (Urine draw)
Interviewing of Witnesses and Family

Types of Scenes (many are “Messy”):
Train Tracks
Highways and Byways
Homes
Burned Homes
Fields and Streams
“Scary” Homes (see above)
Hospital
Nursing Home

“Bad Scenes”:
Trains
The Decomposed
Fire
Motor Vehicle Accidents
Gun Shot Wounds
Infants

Making Identification:
Wallet Content
Live Scan, fingerprinting
Forensic Odontology, Forensic Anthropologist
DNA Sampling

Notification:
Find Next of Kin (can take quite a bit of work)
Notify of death
Discuss Office Procedures and Protocols affecting the Decedent
Get support for family if necessary (brochures and website references)

X-Rays

Autopsy:
Procedure itself, Assisting Pathologist
Photodocumentation
Collection of Evidence
Toxicology from blood urine, vitreous, bile, liver, brain (rarely maggots)

Paperwork:
Call Sheet, Data Sheet, Narrative, Call Log, Personal Notes
Temporary Death Certificate, Permanent Death Certificate
Police Report, EMS Report
Medical Records reviewed
Toxicology Report
Fingerprints
Autopsy Report
Verdict Sheet
Letters to Family

Case Conferences:
Presenting Case Investigation Details
Deciding Manner of Death
Closing Case and Final Death Certificate

Community Outreach:
Pre-Prom Demonstrations
Career Fairs
Office Tours
Driver’s Ed
Science & Health Classes at High Schools and Colleges

Parents Groups
Suicide Prevention Task Force
Child Death Review Team

Nursing Home Death Repoprting Pilot Project

Key “Partners” we work with:
Law Enforcement Agencies, Fire Departments, MEG (local Durg "Enforcement" Groups)
Major Crimes Task Force and Major Crash Accident Team
NCIS
OSHA
CPSC
DCFS
DEA
FBI
FAA, NTSB
Hospitals
AFIS, LEADS

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.

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.

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)

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.

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

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.

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...

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?

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.

Misestimating Peer Activities Contributes to Death

In support of other social norms research a study recently published in the Journal of the National Medical Association (Vol. 100, No. 3, Mar 08, sorry no link) found

“that 90% of subjects overestimated the rate of smoking among their peers. Overestimating was associated with a > 80% increase risk of smoking.”

Perceptions of use patterns and use acceptability have been shown to influence a number of behaviors, including both smoking and alcohol consumption. But the effect occurs with life activities as diverse as tax compliance, energy consumption, violence, and risky sexual behavior. This effect seems particularly prevalent and strong among adolescents. We need to learn to harness social norms “marketing” for prevention efforts.

What is the best way to convince folks that they overestimate the amount of smoking and drinking that is occurring amongst their peers? Who is the best spokesperson? How do we reinforce healthy, non-detrimental behaviors using social norms “marketing”? How do we expand social norms-based education to other behaviors that are detrimental to health and longevity?

I am sure this holds great promise with improving health and forestalling death, I’m just not sure how best to utilize this technique. But as awareness of this technique spreads, who knows?

Ten Deadliest Drugs

I was pointed to an article about a study published in the Archives of Internal Medicine rating the top 10 deadliest drugs based on deaths related to their use. The top 2 are potent pain meds, oxycodone and fentanyl. Deaths with these are most often related to misuse, either intentional (over-medicating yourself looking for release) or unintentional (over-medicating yourself looking for relief). But we have seen a very few related to over-prescribing because of lack of familiarity with their potency, pharmacokinetics, and/or synergism of side-effects with other meds (i.e. respiratory depression) and medical conditions (e.g. sleep apnea).

The 4th med on the list is morphine. I would have to wonder (without seeing the original study) if some of these might be heroin deaths in which the characteristic metabolite of heroin (and diagnostic of heroin use) was missed in the analysis. The 6th on the list is methadone which I have written about several times before.

The 5th med is acetaminophen, as alluded to in the article its ranking is likely due to its often being in combination forms of narcotic pain meds.

The one drug missing from the list is hydocodone (a frequently used and abused pain med) and I am a loss to explain that.

This study was based on voluntary reports to the FDA, so there is a possibility of some under-reporting and, pretty significantly, does not include illicit drugs. The caveat to be aware of and “respectful” of these drugs is well taken.

Is There a CSI Effect on Juries?

A recent study in the National Institute of Justice Journal casts serious doubt on at least part of what is feared as the CSI effect.

The biggest fear engendered by the perceived CSI effect is the fear that if there is not enough scientific evidence in a given case the jury (versed in the CSI way of investigating cases) will acquit on that basis alone.

This is a major concern because as many as 30 million folks watch CSI on a given night. Over 100 million folks watch CSI and similar criminal case shows in a given week. That is a lot of folks.

One interesting point that came up in the study is that the more individuals watch CSI and similar shows the more “real” they felt those shows to be. I don’t know if they watch them because they feel that they are “real” or if the watching convinces the individuals that they are “real” portrayals. Either way TV shows are TV shows, more entertainment than reality and we ought to keep reminding folks of that fact.

The study found that while CSI viewers had higher expectations of scientific evidence, at least in discussions of possible court trial scenarios, that did not result in acquittals in cases where that evidence was lacking. The biggest factor in decision making seemed to be the testimony of the victim or other witnesses, just like in the old days.

Nonetheless, while anecdotal evidence is not very good evidence, there are enough stories (and I have had a few experiences at inquest) that more research needs to be done before we can put to rest all of our fears of the CSI effect on juries. We, as a people, also need to do better at separating fact from fiction when we watch anything on TV. Just because you see it on TV, it doesn’t make it so.

Uninsured to Death

The data isn’t available yet for Illinois, but Family USA is looking at the lethal effect of lack of medical insurance on a state-by-state basis and the results are terrible a exemplified in Ohio:

Families USA researchers are doing a state by state analysis of people 25 to 64 to highlight the effects of what they see as a disjointed and broken U.S. health system.
"For this group of people, lack of health insurance is the third leading cause of death after heart disease and cancer," Ron Pollack, executive director of Families USA said…
Families USA took their lead from a 2002 Institute of Medicine study that found a link between avoidable health-related deaths and lack of health insurance, finding that uninsured adults were 25 percent more likely to die early than adults with private health insurance. They estimated that 18,000 adults nationwide died in 2000 because they did not have health insurance.
A more recent study found that uninsured people 55 to 64 are even more likely to die early.

We, as a humane society, can not continue to ignore the plight of uninsured and underinsured people in our country. We must support the frayed safety net of care provision we have now and work to a more universal and permanent solution, whether that is universal healthcare in some form or a solid amalgam of private and public efforts at providing access to healthcare.

I have talked about this before and likely will again as close to this topic as I have been for a number of years.

Heroin use spikes in Lake County

Heroin use spikes in Lake County

Lake County law enforcement officials say they're seeing a disturbing trend: an increase in heroin traffic.
The evidence county officials point to is the amount of heroin seized and several overdose deaths so far this year...
"It's something we are definitely keeping our eye on," he said. "It seems like it's becoming more popular out here."

As I am quoted in the article: “I am really concerned” (I think it is more a throw away quote so they could use my data). My intent of the longer quote I gave him was that if this is indeed a trend of increased heroin use and death it is concerning on many levels.

Beyond just the toll of the heroin itself, its use is associated with increased participation in crime and violence, certainly negatively impacting the community. To address this problem we need a multipronged approach with targeted law enforcement, and social prevention programs with treatment availability, to mention just a few parts of the attack. We must also be mindful that this is but one of the many problems that need to be addressed, but if we look for commonalities in approaches we might be able work effectively using a broadened scope and work under a rubric of community healing and wellness beyond individual wellness.

CORONER’S OFFICE SEEKS HELP TO SOLVE COLD CASE

Waukegan, Illinois – The Lake County Coroner’s Office is once again asking the public to help identify the human remains found at Countryside Golf Club last March.

The remains, believed to be those of an older male, were found March 19, 2007, when golf course workers were preparing the course for the spring opening. Also found at the scene, was an upper denture with distinct characteristics. The denture contains two gold teeth, one on each side. Additionally, one tooth near the front has a gold R and a front tooth is marked with a gold star. A picture of the denture is attached in hopes that someone will recognize the denture and notify the authorities.

If you have information about this case, please contact the Lake County Coroner’s Office at 847-377-2200.

* * *

Yes, folks are dying to get into Coroner's office

It has seemed busier at work. My phone seems to go off a bit more often at night and my staff consultations and media calls continued through my recent brief vacation. So we looked at the numbers:

Last year (December 1, 2006 through March 12, 2007) we had a total of 1086 deaths looked at through our office, with 60 classified as “inquiries” and 54 classified as “inquest” cases. Inquiries are somewhat extended investigations to make decisions whether the case is a “natural” death or should be moved to the inquest category. Inquest cases are full investigations of cases that include questionable deaths, homicides, suicides, accidents and drug intoxication/overdose cases.

This year (December1, 2007 through March 12, 2008) we have looked at a total of 1137 deaths with 56 “inquiry” and 75 “inquest” cases. For the mathophobes, that is about a 40% increase in inquest cases, our most labor intensive case category. That is a huge increase in casework and staff involvement in just a year.

We really haven’t, as yet, looked at the jump in detail as to which categories of death have contributed to this increase. It is, however, my feeling that it is related to increased drug related deaths. For example, at our last case conference (which has replaced our jury inquest) 5 of the 10 deaths we reviewed for manner of death were directly drug-related and it is possible drugs contributed in at least 2 of the others.

We work hard in the office. Thank goodness I have such great staff willing and able to step up to this work load and to perform it most professionally. They are second to none.

Punish the dead?

“The mayor of a village in southwest France has threatened residents with severe punishment if they die, because there is no room left in the overcrowded cemetery to bury them.”

Lake Barrington Homicide

This sort of stuff doesn’t happen in Lake County. You don’t think it happens anywhere. It so closely borders the surreal that it seems more TV fiction than real life, unless you were involved like I was involved in the case.

The material from my media release today:

Lake Barrington Homicide

On Saturday, February 23, 2008, a man was pronounced dead at 28031 Lakeview in Lake Barrington, Illinois. The victim was found pinned underneath a pickup truck which had burned. Based on circumstantial evidence, he was tentatively identified as Ari Squire. The burning of the body hindered positive identification.

An autopsy performed on February 23, 2008 revealed the cause of death to be a crushing injury to his chest, which ruptured his heart. The level of carbon monoxide in his blood demonstrated that the fire had occurred after his death.

DNA blood specimens were obtained during the autopsy for assistance with identification. Tattoos that should have been present did not appear to be on the body of the deceased. The severity of the burns on his hands precluded the use of fingerprints for identification purposes.

On Sunday, February 24, our forensic dentist examined the deceased and took dental x-rays to assist with ongoing attempts at scientific identification. Although we encountered difficulty in obtaining Mr. Squire’s dental records, we were able to secure them one and a half weeks after the autopsy. A review of these records by our forensic dentist consultant found that they were not consistent with the x-rays of the deceased. We then began efforts to obtain dental records of other possibilities for the victim.

On Sunday, March 2, my office was notified that the body of a male matching the description of Ari Squire was discovered dead of an apparent self-inflicted gunshot wound in a motel room in Eureka, Missouri.

As the events unfolded in Missouri, DNA samples from the victim being held in our facility since February 23rd were compared to family members of a Missing and Endangered Person. We have now positively identified the victim as Justin M. Newman, 20-year old male from Arlington Heights.

Other information revealed at the press conference today:

The decedent received his burns primarily from heat conducted from the very hot truck fire (a fire of uncertain origin) as the truck sat on his chest after his death, most were not direct burns. Was he unconscious before the truck dropped on his chest?

When Mr. Newman was found under the burned truck he had on Mr. Squire’s clothing and boots and had Mr. Squire’s wallet in his back pocket.

Mr. Squire had purchased blue contact lenses an hair dye (Mr. Newman had blue eyes and brown hair)

The events in Missouri: Eureka, Missouri police while running plates of cars in a motel parking lot (something they routinely do) had the plates come back as belonging to Justin Newman listed in LEADS as a missing and endangered individual. The front desk staff reported that the room was rented under the name of Justin Newman. Mr. Squire killed himself as police approached his motel room (single gunshot to the head).

The investigation continues into several matters, such as who else was involved, was there indeed email communications between Mr. Squire and his wife after his supposed death on February 23rd?

Is fact stranger than fiction?

Safer Sleeping for Infants

My 4th grader needed a science fair project for school. In part because I had just been at a meeting in which we discussed infant deaths in cribs with too soft bedding and from SIDS, I suggested a display pertaining to that topic. She thought it sounded good, however her teacher said no because she was supposed to do an experiment not just research and a display. I still think it would have made a good project and I always look for unique ways to get this sort of information out to the public. What a great way to get it out to parents of infants, a display by a kid at school with parents wandering through looking at it.

We recurrently have infant deaths, luckily not frequently, locally and regionally, that are due to soft bedding and “stuff” in their cribs, as well as due to co-sleeping and Sudden Unexplained Infant Death (SUIDS/SIDS). Quite often parents don’t know about safer ways to put their babies to bed in their cribs. (And I heard something on the radio today, so it is back in the news).

So as a reminder (and please pass the information on to any new and expecting moms):

Safe Bedding Practices For Infants
• Place baby on his/her back on a firm tight-fitting mattress in a crib that meets current safety standards.
• Remove pillows, quilts, comforters, sheepskins, pillow-like stuffed toys, and other soft products from the crib.
• Consider using a sleeper or other sleep clothing as an alternative to blankets, with no other covering.
• If using a blanket, put baby with feet at the foot of the crib. Tuck a thin blanket around the crib mattress, reaching only as far as the baby's chest.
• Make sure your baby's head remains uncovered during sleep.
• Do not place baby on a waterbed, sofa, soft mattress, pillow, or other soft surface to sleep.

Need for Coroner System Improvement

Some folks are demanding change in Nebraska’s coroner system. Reading this article it is apparent that such change is needed.

Nebraska's county-coroner system tacks on death investigation as a footnote to other jobs…

The Douglas County morgue, where half of Nebraska's autopsies are done, predates "Quincy M.E.," the 1970s TV show about a medical examiner. (Cool, I’d still recognize it, I went to med school and residency in Omaha in the late 70s and early 80s)

A fly strip dangles over the single autopsy table, and paint peels off the concrete-block walls in the 18-by-20-foot autopsy room in the Douglas County Health Center basement.

As the article points out we in Illinois are more professional about the coroner’s business.

In some states, such as Colorado and Illinois, elected coroners have created their own organizations to provide training, guidance and support.

Certainly backward, archaic systems still in existence in parts of this country give the coroner business a bad name. In my office we push professionalism, participation in training, leadership in medicolegal death investigation, and continuous improvement in office techniques (improving current practices and embracing new practices and equipment, as appropriate).

I hope Nebraska shapes up their “act”, I have family there.

Can homicide occur by willful and wanton neglect?

I begin by saying I can not give out details because of pending litigation and on-going investigations by a couple of organizations. (Some details may have been changed here)

A gentleman had been confined to a care facility for a while because of his inability to care for himself due to psychiatric problems. While at the facility he developed a “failure to thrive” syndrome, malnutrition with significant weight loss. A short while before his death he was admitted to a hospital for evaluation to ascertain if their was a medical reason for his failing status, that evaluation revealed no significant disease processes to explain his condition. He was returned to the care facility.

The day before his death staff at the facility became concerned (his failing seemed to be accelerating) and expressed that concern to his physician who asked that he be transported to the hospital where his recent evaluation had taken place. That hospital was apparently over-full and was not accepting ambulance traffic. Upon hearing this, the patient’s doctor told the staff to get him taken to another hospital, one that was close by. Here things get a bit fuzzy; the gentleman was not transported that day.

The next morning the gentleman was noted to be having difficulty breathing and looked worse to staff. The staff called the gentleman’s doctor who was surprised, to say the least, that the gentleman was still at the facility. The doctor again told the staff to get him sent to the closest hospital. A private ambulance company was called to transport the gentleman and they informed staff that they would pick him up in 30-45 minutes. When the ambulance called and said that they would arrive in 15 minutes the gentleman was checked in preparation for transport. At that point he was found to be dead by facility personnel. The ambulance was called and told that they were no longer needed. The patient’s doctor was notified, the facility administrator was notified and the Coroner was notified.

The finding of the Coroner’s Office: Death was due to a pulmonary embolism, contributing to this was a “blatant disregard for medical care” The manner of death was ruled a “homicide” (death at the hand of another).

Regulatory agencies are now involved in further investigation, as is State law enforcement.

Decomp fun facts to know and tell

I was steered to a fun and informative website by my Toxicology Analyst/Lab Manger. All sorts of stuff about decomposition (as they say there are some graphic photos, as a warning to some and an enticement to others).

Continuing death prevention efforts on multiple fronts

I was at a meeting this noon and we were discussing possible “events” for April and Alcohol Awareness Month. The group is a mixed group of politicians, school representatives, folks from non-profits, and (most interestingly and appropriately) middle school students. The main focus of the group right now is underage drinking prevention. The input from the kids/teens was great. They had great ideas, ranging from possible initiatives to graphic design of the flyers and the like, and they were not afraid to express them. It is great to have their help and I think we can really get some successful stuff going with their help.

My meeting earlier today was our Lake County Suicide Prevention Task Force. Great discussions and I think the group was able to help with a couple of projects started and/or supported by some of our members. We discussed the growing collection of referral sources we are posting on the Lake County Coroner website for access and the possible expansion of uses for the locally developed/adapted “Project Safety N.E.T” (a program to help recognize and refer teens at risk for suicide). Besides their usefulness to families of decedent individuals that our office works with, it seems from our discussion that these will be helpful resources for Task Force members (and others in the community) seeking information for screening and referring folks locally. Also, “Project Safety N.E.T”, available on our website for use and distribution, will likely serve as a basis for a training project for folks outside of the schools that were original the target of “Project Safety N.E.T”, for example youth groups or as a part of parenting classes.

The other discussion we had was prompted by a young lady who lost someone to suicide recently. She had sent me a link to a posting on mydeathspace (link not provided, you’ll see why in a second). The posting was about the death by suicide of a young man that both she and young man’s family want removed from the site. Despite their efforts they have been unable to get it removed. I understand that the site can serve as a memorial, but it seems that it should be responsive and responsible to those closest to the deceased individual.

It is great that our office can serve as a resource, a catalyst, a “helper”, and sometimes a leader for change and ultimately death prevention.

From my friends at the CDC Injury Center

From my friends at the CDC Injury Center (s/p NIU shooting incident):

We encourage you to link to the Web pages listed below from your organization's website and disseminate it to anyone or any professional organization that you believe may benefit from this information.

Coping with Stress

Preparing for a Mass Casualty Event

Coping With a Traumatic Event: Information for Health Professionals

Uninsured and Underinsured and Death by Cancer

A nationwide study has found that the uninsured and those covered by Medicaid are more likely than those with private insurance to receive a diagnosis of cancer in late stages, often diminishing their chances of survival.

At HealthReach (a free medical clinic for low-income, uninsured individuals that I founded and directed for several years) our patients could get some screening tests, but were often unable to get needed follow-up for positive screens. Other screening tests were out of their reach or the numbers were rationed because of our limited referral sources.

Uninsured and under-insured folks have huge problems accessing medical care and their increased death rates reflect that fact. Death due to lack of insurance exists (also see). Why does that continue?

Nicotine and opiate addiction related?

Before you light up that next cigarette ponder this:

Research in the Journal of Neuroscience has demonstrated that the mechanism of nicotine addiction appears to be physiologically similar to opiate addiction. It appears that the same area of the brain is involved with the dopamine mediation of both drugs.

This would seem to explain why it is so difficult to stop smoking when you are addicted to nicotine (as with any drug, not all smokers are physiologically addicted). It also adds credence to a point I wrote about some time ago that nicotine is THE gateway drug.

The nucleus accumbens causing blasts of dopamine that signals the brain to keep seeking rewarding sensations brought on by drugs.

Mind over matter will not work for either addiction.

Bipolar disorder is chemical disorder

According to the National Institute of Mental Health approximately 2.6% of Americans 18 years or older have bipolar disorder. Significantly, there is now further evidence that it is a brain chemistry disorder.

A study in Molecular Psychiatry reports that specific chemical abnormalities can be demonstrated, unfortunately at this point that testing seems to be confined to post-mortem. It would seem that in the future this may yield some sort of testing for diagnosis of bipolar disorder. That would be a great step forward. Those same researchers were also able to demonstrate improvement in the chemical milieu with treatment, documenting that these drugs do provide benefit. These results may also point the way for new, innovative treatments.

CDC puts out data on "Choking Game" deaths

The CDC has finally begun to look at the “Choking Game”. In this “game” an individual, usually a teenager, chokes themselves or has someone choke them to get a “high”. It is incredibly dangerous with severe anoxic brain damage or death as a possible result.

Because no traditional public health dataset collects mortality data on this practice, CDC used news media reports to estimate the incidence of deaths from the choking game. This report describes the results of that analysis, which identified 82 probable choking-game deaths among youths aged 6--19 years, during 1995--2007. Seventy-one (86.6%) of the decedents were male, and the mean age was 13.3 years.
These demographics are consistent with greater risk-taking behavior among boys than girls…
Parents, educators, and health-care providers should learn about the choking game and be able to recognize any of the following warning signs in youths: mention of the choking game (or the game by its other names); bloodshot eyes; marks on the neck; frequent, severe headaches; disorientation after spending time alone; and ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor.

I wrote about it in 2006 after it resulted in a death here. Talking with his mother and family at the time and a memorial rally shortly after, reinforced the tragedy of a life ended before the youth’s potential could be fully realized.

Be aware and get kids help before they end up in my office. As I wrote in 2006:

The “high” someone gets from this “game” is the brain screaming for oxygen, pleading, not wanting to die. The odds really are stacked against the “player”. Some brain cells will die every time you “play”. The roulette part is the very real risk of “winning” death.

Think, make good choices, don’t take chances.

Sources of licit drugs for use and abuse

Where do folks get the medications that they over-use and abuse?

Some get them from prescription “mills”, i.e. doctors who prescribe without examining the patients or only cursorily. They are more than willing to write for meds requested for a fee. Doctors like we saw in a recent case who was more than happy to write for Fentanyl, Oxycontin, morphine, and benzodiazepines for an individual. This doctor had been asked to leave his previous group practice because of this practice and had lost staff because of this practice. He was famous (infamous) locally because of the practice. [We are reporting him to the DEA and state licensing folks.]

Some get them from doctors in a hurry or want to send the patient home with “something” because “they expect it” or feel that it is the right thing to do to throw a med at everything and every symptom. I know an individual who I had seen (I do some volunteer work) and we discussed my opinion that he didn’t need meds, but needed to deal with what was going on. After our discussion the individual agreed. A short while later he saw another physician, mentioning the same symptoms he had discussed with me, who promptly wrote him 3 prescriptions and sent him on his way. (The individual filled the prescriptions, but felt 2 of them made things worse or made him feel worse. He takes the other intermittently, although I don’t think he needs it and he continues to agree with me it might be best to go without meds)

Some get them from doctors who just can’t imagine that their patients would over-use or abuse anything. Some from doctors that are not really aware of the possibility of non-medical use of prescription meds. Some from doctors that are not as familiar as they ought to be with the meds they a prescribing.

And then there are folks that “borrow” them or obtain them with various surreptitious means.

So many possibilities and quite frankly most of them are not really related to wrong doing. But it is a significant problem that not enough folks, including doctors, are aware of. We will work to get the word out.

Death by lethal mixture

"Mr. Heath Ledger died as the result of acute intoxica- tion by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine,"… The list of generic names refer to drugs more commonly known as the painkillers OxyContin and Vicodin, the antianxiety medications Valium and Xanax, and the sleeping pill Restoril, (and) Unisom…
"While no medications were taken in excess, we learned today the combination of doctor-prescribed drugs proved lethal…

The death was ruled accidental. All of these medication cause respiratory depression, so likely the result of this mix was that his breathing stopped.

Just as overuse and abuse of prescription medications is increasing, so is the increased use of potentially deadly “cocktails” such as that that caused Mr. Ledger’s death. We have seen similar deaths with the mixture of drugs being the cause without any of them really standing out in the toxic range.

We often see prescription drugs as being so “safe”, after all someone won’t prescribe unsafe stuff. That will, at times, lull us into a false sense of security and from that come these accidents. Folks take too much of medication attempting to self-medicate/self-manage, not really thinking through that you can take too much. Or, as in this case, taking a mixture of stuff, in the hopes that it will be just the mix they need, with potential lethal results.

Prescription medications are poisons too. Prescription medications should only be taken as prescribed. Medications shouldn’t be mixed, except at the direction of, and with the knowledge of, your doctor, so that they can sort out the possible interactions and synergies.

Don’t get me started on “pharm parties”.

Non-medical use of prescription opiates

I have been doing some continuing education stuff lately and came across some statistics (sorry no links) collected by SAMHSA (Substance Abuse and Mental Health Services Administration).

We always think of heroin as the real “bad guy” opiate of abuse and it is. It is associated with presentation to the ER with problems of various sorts, increased risk of various infectious diseases, suicide and death. SAMHSA estimates (and admits that it may be an underestimate) that nearly 400,000 folks used heroin in 2004 (most recently studied year), including about 120,000 first-time users.

But what is even more concerning to me, 11.2 million Americans used prescription opioids for “non-medical” purposes in 2003 (most recent SAMHSA data). They estimate that there are 4.4 million “current non-medical users” in this country. Talk about a real problem with huge numbers.

Certainly this agrees with what we see through our office. Death related to non-prescription use of prescription drugs outpaces the heroin deaths we see and we see our share of both.

One last bit of data, tracked down in conjunction to a recent case: there are 185 online pharmacies and nearly 90% of them do not require a prescription to get controlled medications, including opioids. (We continue to work with the DEA on some cases related to meds obtained through this route)

So whether folks get the prescription drugs online, from their doctors, from their friends or off the streets, the illicit use of licit medications is a huge problem that many are unaware of. People just don’t think of these drugs as a problem, or a potential problem, very often. They should be used and prescribed with the proper amount of “respect”.

Blackouts aren’t something to laugh about

Drunken “blackouts” occur without loss of consciousness, actually the individual functions quite well for being drunk out of their mind. The next day the individual doesn’t remember anything that occurred during their blackout and that is where it gets its name.

Alcohol is a poison, keep that in mind.

Alcohol has been found to suppress certain receptors in the brain (the hippocampus, for those keeping score). When those receptors are not working as they should, memory acquisition is affected and I don’t mean improved. The suppression is dose related, i.e. the more alcohol ingested the greater the effect. This effect is likely the cause of the blackouts.

Adolescents appear to be particularly susceptible to this effect of alcohol, blacking-out at lower doses and, especially with binge drinkers, a fairly common pattern of adolescent drinking, blacking-out on a frequent/repeated basis. This is of concern for many reasons, not the least of which is that this repeated receptor poisoning may have cumulative effects over time with permanent impairment of memory as a result.

So the old description of someone who has consumed too much alcohol as “stupid drunk” is closer to the truth than we used to realize.

Blackouts aren’t something to laugh about, they are brain damage.

Med errors kill more folks in U.S. than breast cancer or AIDS

There were 2 articles in the Tribune Tempo section last Tuesday that caught my eye (actually they caught my wife’s eye and she pointed them out to me). (Sorry no links)
Interestingly they were on opposed pages:

One article, titled “Doctors’ math errors can be dangerous”, reported that “Doctors make the same arithmetic mistakes the rest of us make, but the consequences can be considerably more serious.” Looking at a single drug dose calculation the Annals of International Medicine published study found drug dosage calculation errors by a “factor of 10”. Thank goodness between us and the drug being given or taken there is often a pharmacist allowing for checking and error remedy. But wait:

The other article was titled “Errors by pharmacists”. It cited an Ohio State University study that found that pharmacists “make an estimated 5.7 errors per 10,000 prescriptions processed…more than 2.2 million dispensing errors a year.”

Makes you feel safe, doesn’t it?

Coroner system on death bed?

While this bit from Minnesota Public Radio seems to have a bit of an anti-coroner bent to it, it does bring up some interesting points.

As is pointed out, “28 states still primarily use coroners to determine the cause of death.” (although I disagree with the second sentence in that paragraph) However, Medical Examiners discuss problems with the Coroner System in place around the country (as a member of the National Association of Medical examiners I get to listen in). State and local government officials and regular folks around the country have discussed problems.

Will the coroner system be replaced in this country? I doubt it, but likely it will hybridize into some sort of mixed system as exists in some states. There are not enough Forensic Pathologists to cover the entire country, “there should be 1000 medical examiners, but only half of that are practicing now”. We need to be certain that all areas of the country have access to trained forensic pathologist to lend their expertise to medicolegal death investigations and for autopsy.

But more importantly, we must ensure (and this is indeed where the coroner system comes up short in certain areas of the country) that we have trained and experienced folks in the field. Not just anyone can be a coroner or coroner’s deputy or a medicolegal death investigator. We must be sure that the medicolegal death investigation system is strengthened by any changes that are proposed or occur. We must ensure that a separate death investigation is done in every homicide or questionable death (Coroner’s case), in balance with and in parallel to law enforcement.

As stated on MPR:

“…it's important to have a trained death investigator at every death scene.
Somebody who understands the combination of the forensic issues, the medical issues, the evidentiary issues," .... "Somebody who can address things like the rigor mortis of the body, the position of the body, who can then give those clues back to the forensic pathologist in a way that would be meaningful to him or her."

That is our goal in every case and always will be. We take very seriously our duty of thorough medicolegal death investigation for determination of the cause and manner of death and pursue it professionally in every case, as should every office whether coroner or medical examiner.

Lake County Strategic Plan Community Outreach

Lake County, IL Strategic Plan Community Outreach Schedule

An open house from 6 to 7 and the meeting begins at 7 p.m.

Lake County Community Forums:

CENTRAL LAKE COUNTY
Monday, March 10 @ Division of Transportation, 600 W. Winchester Road,Libertyville

SOUTHEAST LAKE COUNTY
Tuesday, March 18 @ Highland Park Country Club, 1201 Park Avenue West, Highland Park

NORTHWEST LAKE COUNTY
Wednesday, March 19 @ Lake Villa Public Library, 1001 E. Grand Ave, Lindenhurst

SOUTHWEST LAKE COUNTY
Monday, March 31 @ Ela Area Public Library, 275 Mohawk Trail, Lake Zurich

NORTHEAST LAKE COUNTY
Tuesday, April 1 @ Warren Newport Public Library, 224 N. O’Plaine Rd., Gurnee

Is obesity killing our kids and can we ameliorate it?

I was at a meeting yesterday (I have had quite a run of meetings lately, including one in Bloomington Tuesday) of a new group/task force out to prevent death and promote healthy lifestyles. It is a group of various folks from our county coming together to “tackle the single most critical health concern facing Americans today”. I’m not so sure their target is the “most critical health concern”, but it is a serious concern and one worth tackling and that is obesity.

This effort got its start from the national YMCA “Activate America” initiative.

Another slogan from their PowerPoint presentation was “We want you to get Lake County active and fit”. That is, I think, a better (and more reasonable) target. Encouraging folks to get and stay active (and “fit”) and to see what we can do to aid folks in eating healthier stuff. This effort will include special emphasis on kids, likely their behavior is a bit easier to change/impact, but also because of some recent studies demonstrating that early obesity is shortening the life expectancy of our future generations. The first such studies came out in 2005 (see this New York Times article)

For the first time in two centuries, the current generation of children in America may have shorter life expectancies than their parents, according to a new report, which contends that the rapid rise in childhood obesity, if left unchecked, could shorten life spans by as much as five years.

and the New England Journal has again published similar studies the latter part of last year (see USAToday article).

Taken together, doctors say, the studies provide new evidence that excess weight does affect a child's long-term risk of heart disease and life expectancy.

Pushing activity (and fitness) is a great goal and would likely have a great impact on this and so many other health issues. Creative thought and attention needs to be directed at special problems experienced by folks in lower socioeconomic strata, those in neighborhoods not conducive (for many reasons) to outside, local activity, and other special populations, but it is doable for all.

I look forward to participating in this effort. Working to promote health and forestall death by many avenues is my “most critical…concern”.

Morgue: punishment community service and I work there

Punishment community service in the morgue.

I guess our court-mandated tours for certain groups of youths aren't too far out of the mainstream.

Unidentified since death in 1981

I am going to use this as a “test case”. I had conversations recently with an individual wondering if we could put together a “local” website (i.e. for Illinois specifically) to make available information about unidentified Coroner’s cases to seek help with identifying them from the local public and police jurisdictions not in the immediate area (in our case, outside Lake County). This does make sense in that unidentified folks may not travel all that far before death and local folks may recognize them. Information could/would still be submitted to data bases like NamUs and the Doe Network, but a more local listing site could be helpful. That is keeping in mind that nationwide only 20% of Coroner and Medical Examiner offices regularly report their unidentified to the FBI National Crime Information Center.

[I am going to post one here to check the Blogger format and search capabilities as a test to see if this sort of placement would work. I will be considering other website deliveries as well.]

Case in point (in reviewing our older cases, this gentleman came to our attention recently):

This individual died March 5, 1981, 8:11 a.m., after being struck by a northbound freight train at the Deerfield, IL train station. He had no ID with him.

The individual was a white male approximately 60 to 68 years old. The individual was approximately 5 foot 10 inches tall and weighed about 195 pounds. He was balding with gray hair and brown eyes. He had a 10 inch abdominal scar from his sternum to his waist, as well as 2 surgical drain-type scars laterally. He had been observed to walk with a limp or shuffling gait. He seemed to have an inability to use his left middle, ring, and little fingers. He was also described as, at least somewhat, disheveled in appearance.

His clothing consisted of a white T-shirt, brown cardigan sweater, brown polyester warm-up jacket with white stripes, orange socks, and brown dress pants with brown belt and shoes. He also wore a gold-colored Hilton wristwatch.

“John Doe” was buried April 22, 1981, he continues with that appellation to the present.

If you have any information on this individual call our office (847 377 2200) or email (coroner@co.lake.il.us).

If you are an Illinois Coroner and want to participate in such a project, let me know.

Learning more about insects

I ran across this article today, it reminds me of some of the Anthony Bourdain TV shows. (Have you seen the one where the octopus tentacles were still moving as he ate them? There has also been a show or two where he ate insects.) This article not only recommends eating insects but includes 4 receipts:

…they taste good. Plus insects are high in protein and have essential fatty acids and important vitamins.

Bon Appetite

Insects are indeed so fascinating.

There are always drug-related deaths

I received this as a comment to a previous post, but in looking at it I thought I would move it up to the level of a primary post. It seemed particularly pertinent as we worked through our case conferences last Wednesday with 5 overdose deaths (out of the 12 deaths we discussed). Those deaths were due to a variety of drugs, sometimes singly and sometimes poly-pharmacy, but drug-related deaths none the less. The individuals ranged in age from 18 to 69 and came from various places across the county and various socioeconomic strata.

Here is a mother’s heartfelt note:

My son Timothy Galvin was 18 years old and died of a methadone overdose.
Timothy is my son. He was my life. He was going to begin classes at Rogers State University in January 2008. He was a soldier in the National Guard and would have been deployed for Iraq in November 2007, but he had scored a 56 on his ASVAP test for enlistment. His Sergeant said this was one of the highest scores he had seen in 6 years. Therefore, he was eligible fro the college first program. He would not have to be deployed if he was enrolled in college. He was at a party on November 7 2007. I was told that he had been drinking liquor and Tim was not in his right mind if he was drinking anything other than a few beers. Somebody "gave him" or "let him take" a deadly dose of Methadone and by the next morning his best friend had to be the one to find him dead in his bed. This was a tragic & unfortunate accident that I pray no other family will have to go through, but I know that it will happen again. That is why, I don't know how & I don't know what it will take, but i am starting to gather more information on Methadone availability and find out what regulations the government is actually enforcing. Then I will call every Senator, State Representative, Pharmacy Boards, Clinic and mother that has lost their child to this drug and maybe we can change something. If you have lost your child from a methadone overdose and would like to e-mail me:
timarajmeeks2006@yahoo.com

God Bless,
Timara Jean Meeks

Alzheimer’s cure?

Although I am a firm believer that exercising your brain, like exercising your body, will keep it fit, it is nice to know that there is hope if Alzheimer’s ever strikes.

Reversal Of Alzheimer's Symptoms Within Minutes In Human Study

Coroner fascinated by insects

Insects will rule the world? Or have they? Do they already?

I have written before about insects being crucial to decomposition and at times I have been concerned about insects serving as a vector for a variety of diseases. As a matter of fact, I was reading recently about concerns that as global warming progresses we will see a spread in insect-vectored illnesses out of typical subtropical regions and spreading in this country. Another thing that came up recently was a discussion of cysticercosis. While I saw several cases as an ER physician and working at HealthReach, apparently more areas of the country are finally seeing cases.

With these things recently in my head, I was intrigued by this brief article. It reports a hypothesis (reasonable in my estimation) from a recent book by some folks in Oregon. They posit that the fall of the dinosaurs was due to insects. The insects spreading reptilian disease and pollinating flowers, so that they proliferated and replaced plants they were more used to eating, spelled the doom of the dinosaurs.The mighty thunder lizards brought low by lowly insects.

Bug spray or pledges of peace? You decide.

The Ada County, Idaho Coroner asked "Human or Not"?

Larger Decedents Impact Equipment Purchases

We have budgeted for a new lifting device for the office to lift and move bodies in the office, to ensure that it is robust enough for the larger folks we are seeing through the office. We have purchased body bags that will be big enough for some of the folks we are seeing these days. We are making certain that the new transport gurneys we are buying are tough enough.

I hadn’t thought about this, but we do need a new autopsy table, so I will think about this now:

The Orange-Osceola Medical Examiner's Office has a new addition: An autopsy table that can support 1,000 pounds.

Lack of access to quality healthcare kills

I was taking a look at some articles in the recent issue of the Journal of the National Medical Association regarding “Access to Care”. This is an issue that has been of interest to me for a number of years (prompting me to action doing an itinerant clinic for homeless individuals, founding HealthReach, and helping getting the HIV Primary Care Clinic going at the Lake County Health Dept., as examples). It is also of interest in my present business, the Coroner business.

Without proper and humane access to healthcare people die before they should.

Two themes revealed in a study published in the Journal that involved interviewing physicians regarding their thoughts about access to healthcare really struck me. They go beyond simply access, but more encompass how folks are often treated even when they get access, but aren’t treated up to standard (humanely).

Respecting the patient is key to quality care.
Understanding the patient is key in quality care.

The article has comments in these categories about not being judgemental, not making generalizations based on appearance, and the like. However consider a not unusual example, an individual presenting for care that is perceived as a drug addict with drug seeking behavior, so the exam and testing is cursory and treatment is thus “not all that great”. (one of my previous related posts) Now add a worsening co-factor: old tract marks on their arm. (Not true in the case referenced above, but may have been in others) The individual presents with pain. The severity of the pain is “discounted”, they are after all only “looking for pain medicine”.

I would caution healthcare providers that while some of these folks are indeed looking for drugs, even active drug users/abusers get sick and develop “real” medical problems that can end their lives, prematurely.

All people deserve access to proper, humane and quality healthcare.

quick blogging

Just some quick blogging today with fun links (Case conferences and State's Attorney talks consumed the day):

Watch this video of nature’s non-lethal(?)firearm (who would have thought it possible).

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Eco-friendly burials

Cremation was long considered more environmentally friendly than burials in graveyards, but its use of fossil fuels has raised concerns.

Biodegradable coffins are part of a larger trend toward "natural" burials, which require no formaldehyde embalming, cement vaults, chemical lawn treatments or laminated caskets. Advocates say such burials are less damaging to the environment.

Death this time of year...

A reporter asked me the other day if there were more suicides at this time of year. My answer was no. While we are often more acutely aware of them this time of year, they actually happen with greater frequency in the spring. We tend to be more acutely aware of all deaths this time of year. Folks and family are supposed to gather and celebrate this time of year, not die.

I also talked with the mother of a young person who died recently. We discussed how unfair it was that her “child” died. How unfair that he died so young, without fulfilling his potential. How unfair he was taken away, particularly at this time of year. His death was going to change things so much. The holidays would not be the same.

But death at anytime during the year is often “unfair”. Death at anytime during the year will change our holidays and our celebrations and our lives. Death is always sudden, even when it is anticipated. Death is part of life, but it is the part we want way off in the future, not here and now.

My condolences to all who have lost loved ones to death, particularly this time of year.

Death by Hanging

Here is some stuff that you are not likely to see most any place else (it came up in recent conversations; some of my conversations take strange turns):

Hanging, and most strangulation, deaths are a result of vascular compression in the neck (not airway compression as is commonly thought). Compressing the blood vessels in the neck lead to either blood pumping into the head but not being allowed to exit (venous compression) or no blood pumping into the head (arterial compression). The end result of either is that brain cells are not fed with oxygen and sugar (the latter is fuel for function). The starved brain cells die. (This also explains why someone doesn’t need to be suspended to die by hanging.)

Arterial compression is the most “efficient” for causing death and most often the case in hanging deaths. Based on published data and observational studies, unconsciousness occurs in 6-15 seconds, at 1-2 minutes heart rhythm problems occur because of the brain cell anoxia, and death in 3-6 minutes (with irreversible brain damage in 4 minutes). [Do remember that there are no absolutes in medicine, so these times do vary individual to individual.]

In homicidal strangulation, the arterial occlusion is not so absolute, so the times are often prolonged. It is not until the victim loses consciousness that the arterial occlusion can approach total.

[Just as an aside (should I say in a different vein), severe arterial bleeding, like the carotid arteries, results in death in more like 10-20 minutes.]


Yes, I do get in strange conversations, but there are those that would like to eavesdrop and pick up on a few of these facts.

Emotional shock/stress can kill

Apparently, you can die of a broken heart or be scared to death or similar events.

Today (or yesterday) in the National Association of Medical Examiner’s listserv someone pointed to an article on Medscape (originally from Nature Clinical Practice Cardiovascular Medicine) about Takotsubo Cardiomyopathy, also know as stress cardiomyopathy.

It seems that extremely stressful events (either emotionally or physically stressful) can stun the heart. The stunned heart doesn’t pump well, there may be chest pain, and because it is epinephrine (or adrenaline) mediated there is also the risk of dysrthymia. Death can result either from the pump problem of the rhythm problem.

So stay mellow out there.

The mystery of shipping for identification

Here is an imponderable: How do you get a body to the Center for Human Identification at the University of North Texas if none of the common carriers will handle/move body parts?

That came up recently because we were sending what turned out to be two sets of skeletalized remains there for examination and DNA identification testing. We contacted the usual companies that move packages around these United States and were told they do not allow the shipping of body parts (or most of a body for that matter). We contacted the folks in Texas and they reported that they get hundreds of shipments on a regular basis for their services.

How could that be? Well, as you can imagine, we solved our conundrum. We were able to send 2 sets of skelatalized remains to them for their services. One has returned and the family, after assurance of identification, was able to have services and burial of their loved one. The Center continues to work with the other set, but once the DNA matching is done those remains will also return to our office for release to his family for burial.

The cloaking of mystery, the remains go to Texas and return from Texas, but they can not be shipped. Sometimes it is best not to pull back the curtain.

NamUs growth will help Coroner's ID the unidentified

According to a 2004 Bureau of Justice survey there were over 13,000 unidentified human remains known to medical examiners and coroners in our country that year. Approximately 4000 unidentified human remains cases are handled each year and of those about 1000 remain unidentified after one year. We are working a one such case here in our office.

We need a better system to get these individuals identified and it seems it may finally be coming. It will be a dual database system developed by the Dept. of Justice’s Office of Justice Programs (with the cute name of NamUs), phased into existence over the next few years. One database will contain records of unidentified human remains and the other will contain missing persons reports centrally compiled. I think the best part will be that by sometime in 2009 there will be the capability for the system to compare the 2 databases automatically and put out possible matches without labor-intensive “hand” searches.

While all kids 18 years old and younger are currently entered into the FBI’s National Crime Information Center (NCIC), adult missing persons reporting into the system is much less consistent. Only some states require it be done and some agencies feel that adults have many reasons to “disappear” and so are sometimes less conscientious about entering their missing persons reports.

The Doe Network can be a help in these attempts at identification, but they are a page by page search system begging for improved searchability.

The new system will have information inputted by and will be searchable by coroners and medical examiners, law enforcement, and the public; but with different levels of information access. There are certainly times when we all can use all the help we can get in difficult identifications.

Currently unidentified human remains are entered into the database and it is searchable, but not easily and without as much automation as computer searches should allow.

This is going to be a great tool in helping with difficult identification cases.

Lots of ways to die

Well that was interesting.

I got a call today from someone with Spike TV. She was doing research for an upcoming show and had a question for me. Apparently they will be doing a series about strange ways people die (1000 of them). The death she had questions about was a hyperthermia death while skin diving.

Apparently an individual made their own wetsuit (nothing like an amateur hobbyist). The plastic he used (salvaged from a waterbed) was too impervious to the loss of his body heat and he died of hyperthermia.

What she wanted was a list of stages he and his body would have gone through prior to his death for a graphic they are making to show during the broadcast. She said the graphic would be like they show on CSI, which didn't help me, because I don't watch the show. I laid them out for her: profuse sweating, muscle cramps, weakness, headache, nausea, loss of sweating and flushing, rapid pulse, difficulty breathing, confusion, agitation, possible hallucination, seizure, coma, and then death. She wrote them down, read them back to me and thanked me. Goodbye.

Another day and another brush with fame (I doubt she will credit my contribution, but we will see; if I ever see the show). Fun none the less.

Update: Got called back. It seems the guy was not skin diving, but "jumping around" in this homemade plastic "suit" in relatively hot weather. That is not a good thing, as you can tell by this guy's outcome.

Electronic control devices and death

I have been following an ongoing discussion of electronic control device use associated death (aka Stun Gun, etc; yes, I am avoiding naming name brands).

There are folks that say the deaths don’t happen do to these devices (heavily weighted by manufacturer representatives and those whose speaking fees are at times covered by manufacturers). They contend that somewhere in the neighborhood of 600,000 law enforcement folks have been zapped in training demonstrations without a reported death, so how can you say that they kill?

But deaths have been reported related to the use of these electronic control devices and not just the weird one’s like the gentleman who was zapped after dousing himself with gasoline and was set afire or the gentleman zapped on the edge of a bridge, knocked off and drowned.

From reading available materials it seems that the cause of death is likely related to 2 causes with a third less supported possible cause.

First, is the possible of a heart dysrythmia causing death. These folks collapse and die quickly, in around 20 seconds. Likely for this to occur the prongs have to hit the individual in the chest over the heart and the individual must be relatively thin (the electric shock does not penetrate very deeply). Nobody knows if someone at greater risk for dysrythmia is more likely to develop them with zapping, not a doable study.

The second possible mechanism of death is increased physiologic “stress”. This stress results from muscle contraction of patterned tonic-clonic muscle effects superimposed on catecholamines released due to pain and fear, often with a contribution post-exertion effects on the body. These folks die with a terminal collapse within minutes (“few to many”) of the last shock they received.

I would also like to mention here that both of the above mechanisms are made more likely by the superimposition of adrenergic-like drugs, e.g. cocaine and methamphetamine.

The third proposed is asphyxia related to muscle tetany or excessive tonicity from the zap. This may be a contributor in cases of prolonged administered shock seen in some cases with certain equipment, but seems uncertain. As mentioned above the electrical current doesn’t penetrate far so it is generally unlikely that this would contribute in any but a few rare cases (there are no absolutes in medicine). I should mention here that it is thought that the generalized apparent muscle effects seen with the use of these devices is a secondary spinal nerve effect. However, again, no one is going to do a randomized, controlled study to define the effects of these devices, there is always that rare risk of death no matter what some folks say.

Thrill Rides Kill

I saw this article about the dangers of carnival and theme park rides today, and while there isn’t much riding going on around here at this time of year, it ought to be at least thought provoking.

These rides are not safe, no one is tracking their safety record, infrequently is someone working to ensure they are safe, and parents should be concerned.

…supermarket shopping carts feature a more standardized child-restraint system than do amusement rides, which can travel as fast as 100 mph and, according to federal estimates, cause an average of four deaths and thousands of injuries every year.

I have wondered about these rides for years, especially the traveling carnival ones, but after reading this article I am convinced that they ought to be policed or shut-down. I don’t mean to be a kill-joy, but why should we allow children to be put at risk needlessly.

Theme parks won their exemption in 1981, after a CPSC (Consumer Product Safety Commission) probe of ride accidents at Marriott theme parks alleged a coverup of safety hazards…The exemption was included in an omnibus agriculture bill that year, leaving oversight of theme parks to disparate state programs, including some lacking inspectors or enforcement powers. Family activists and state regulators say that as a result, efforts to find and correct safety problems have been inhibited, the number and extent of ride injuries remains uncertain, and families have been prevented from assessing the risks posed by roller coasters and Ferris wheels, wave pools and spinning rides.

Here is an issue that needs pushing to federal legislators. It ought to be a slam-dunk, saving kids lives and limbs. We must fight back against “big business” influence that limits action on this issue. Kids are dying and being injured. The time to act is now, before it happens to another kid.

Heroin deaths, not just for the young

I was talking with a reporter from Fox News (Chicago) last week, because they were going to do a story on a large drug bust here in Waukegan. It was a heroin centered bust and the police had said it was triggered at least in part due to heroin overdose deaths, so she was looking for information.

I discussed with her that so far in 2007 we had had 3 heroin-only overdose deaths and 12 others with heroin and other substances. The thing that really seemed to catch her attention was the ages of the overdose victims. The ages ranged from 18 to 53. She was amazed that folks that old died of overdose or that folks that old did illicit drugs. While it is true that most of these deaths were in young adults, 3 of them (20%) could have been (may have been) AARP members.

Heroin use and abuse is not restricted to the young, it is not restricted to poor n’er-do-wells, and it is not restricted to “bad neighborhoods”. Heroin, as is true with all drug abuse, can and does cut across socioeconomic strata. We, as a society, need to realize that and understand the ramifications of that. If we realize that it isn’t just “them”, we can more rationally work toward prevention and treatment. It is not someone else’s problem, it is ours.