The Coroner relaxes

What does a coroner do to unwind/relax? In addition to enjoying my family, I do several things regularly.

I read a wide variety of stuff, it occupies my mind, some allows an “escape”, and sometimes I learn a bit. I have always enjoyed reading. So much to read, so little time.

I have begun a regular exercise program at a local gym. It is a great stress reliever and that is the reason I first dove in. Also, I was seeing quite a few folks about my age in the office (horizontal, if you know what I mean). I am sure that the exercise makes me healthier, in addition to making me feel better now it should help me live longer. I look forward to growing old in my job (although I am part way there now at 52). My other thought is that I want to look good in life and when it comes time for me (in a long time) I want to look good in death.

The other thing I have been doing is continued learning. First and foremost, keeping up on coroner stuff and keeping up on doctor stuff (there is a fair overlap). But, in addition, I am learning stuff because it is enjoyable to learn that stuff. For example, a week ago I attended a day of learning involving a mixture of neurolinguistic programming and Hawaiian traditional healing/energy work (ehoomanamaiola). It was fascinating to meet Hawaiian elders/teachers with email addresses and a website (and even better, because I didn’t have to travel to Hawaii to do it). Prior to this class I would never have thought such a thing likely. They are doing a lot with their Hakalau in the Hawaiian school system. I have also been attending classes at the Infinity Foundation. Does this make me weird? (As Willy Wonka said: “A little nonsense now and then is prized by the wisest men.”)

Work, play, exercise your body and exercise your mind (stretch it and have fun with it); live long and prosper (to steal a line).

CeaseFire makes a difference

Eric Zorn has a great post on his “Change of Subject” blog today: “Road to ending violence starts in the streets”

Quoting a Chicago Ceasefire “violence interrupter”:

"People have been preaching to these guys for years," Hardiman said. "But they don't want to hear about God. Their god is money, violence, sex, drugs or whatever else sounds good to them at the time. They're not hearing that God message right now. They're committed to their lifestyle."
What works, Hardiman said, is "straight up, face-to-face meetings with them. Building trust. Finding out what's happening, putting a stop to conflict before it gets out of hand."
You don't do this by grandstanding or picketing. "You have to go right to the belly of the beast," Hardiman said. "You've got to be out on those streets, walking every block, showing these young people that you're with them, that peace is better for everybody."

I wrote a comment:

I am a firm believer in the effectiveness of what CeaseFire does. It is effective at interrupting violence and stopping the escalation of the violence. Its community basis and community relations (not in the advertising sense but relations developed with people in the community) are the reasons for its effectiveness.

CeaseFire and similar models are spreading outside of Chicago and re-proving that violence can be impacted and “stopped”, at least until we get the political will and wherewithal to tackle the more root causes that you mention. We have seen positive effects with our program in Waukegan and North Chicago and I look forward to continuing to work with the program. We also have a strong primary prevention component to our program, former offenders talking to young kids to head this behavior off before it starts.

I look forward to CeaseFire’s continued success to keep the victims of violence out of my office (Lake County Coroner) and offices like mine, let them live out their potential.

I do applaud CeaseFire’s efforts. It can make a difference.

Preventing "accidents"

Case conferences today. I like this new system for determining manner of death, it allows for more discussion and consideration among the staff of all the cases and I think good quality decision making occurs based on that.

I am meeting with some other coroners and IDPH representatives tomorrow about the project to formalize reporting of nursing home deaths. It will be piloted in several counties (including Lake) and then go statewide.

It is interesting that one of the deaths that we discussed today was a nursing home resident (confluence) who died after a fall in the hall of his nursing home. The case presentation brought up the fact that he or his walker likely caught on a lift device that was parked in the hallway. It should not have been there for a number of reasons, so as part of our deliberations we felt strongly that the incident needed to be reported to the IDPH department that oversees nursing homes for corrective/preventative action (we don’t want to see another needless “accident”).

There were other cases today in which we discussed ensuring that proper agencies get reported to about certain deaths and the circumstances surrounding them. I think we really do all we can to prevent deaths in this manner and I look forward to this continued effort.

Coroner’s Office investigation leads to medical license suspension

A case I alluded to in my last post came to a head yesterday. To paraphrase the press release from the Illinois Department of Professional Regulation: Information supplied by the Lake County Coroner’s Office has resulted in the suspension of the medical license of a local physician.

Based on evidence developed during our death investigation of 2 individuals, we reported the physician to the DEA and the IL Department of Professional Regulation. It was obvious, based on our investigation the he was over-prescribing and most concerning was over-prescribing meds with high lethality. One of the individuals had a bottle from a prescription that had contained 270 Oxycontin tablets. This is a medication usually taken twice a day. This is the same individual who had over 100 tablets still in his stomach on autopsy.

We, as an office, feel it is our responsibility to prevent death as well as doing our best to ensure justice is done by those who die what might be considered an unjust death. We “serve those who can no longer serve themselves”. I am absolutely certain that by this action we have prevented the future death of others. It really isn’t all that often I can say that with conviction, but in this case I am convinced.

We don’t only work to catalog death, but to forestall it.

CSI-like Coroner's biz

Sure I wrote last about the mundane aspects of my job/office, but it should not be construed that that is the end-all/be-all of our Coroner’s biz.

Things like providing our investigative information to the DEA and state licensing agencies to help get doctors out of practice who have turned their offices into Rx mills resulting in significant community problems and death. Or finding unexpected results on toxicology testing and sorting out why the results came back that way (e.g. an individual with kidney failure not getting dose reductions commensurate with their reduced drug clearance).

Or “mapping out” the scatter of body parts and stuff the individual was carrying to come to the conclusion that they were likely hit by a train, as opposed to blunt trauma from another cause. Tracking down eye-witness input that the individual used the tracks as their walking path to get places. Tracking down folks who knew the individual who could provide identifying information and/or refer us to others with that information so we knew who the individual was. Finding that the individual was a resident alien and tracking down family with consular help and getting the body back “home” for burial.

The stuff I mentioned in my last post is more filler than “what we do” day in and day out (our “raison d’etre”), but it does not lessen the frustration associated with it. The “meat” of what we do would be good TV script material, but the other stuff isn’t. The adrenaline stuff makes the job interesting and fulfilling, but the mundane allows for a pause and a breath. The service for those that can no longer serve themselves brings us to work everyday. Got to have a balance of both, but, don’t get me wrong, we do do CSI stuff (albeit with a smaller budget), nonetheless folks need to realize that it’s not all like TV all the time.

Coroner--mundane and TV-like

Just to mention some of the stuff that would never get onto CSI, but stuff that is part of the Coroner biz just as much as the stuff that makes the shows and the news. It’s all glamour, don’t you know.

I got into a discussion with the Purchasing Department about whether we needed a color copier or would be “better served” by a color scanner and color printer. Of course the “better served” really boiled down to money. It is cheaper to buy a scanner and printer with a black and white copier than a color copier, so ‘if you could maybe get by with the scanner and printer we (the County) would be grateful’. I caved quickly, figuring they would want some analysis as to why it was necessary, more than just a convenience. How about that for a CSI episode suggestion, justifying a copier purchase?

How about the “case of the missing gas ‘key’”? We need a vehicle specific chip-key to get gas at the county pumps. This weekend the key for our van went missing. Nobody knew where it was. There was a bit of “it isn’t my fault” and “I didn’t lose/take it”. Then suddenly, as if by magic, it reappeared on the counter on Monday. The whole episode struck me more like an episode with my kids than trained professionals. How about that for a CSI episode suggestion, the missing gas key?

How about my asking the County Administrator if when we bring our new transport vehicle “on-line” if we could keep the old one as a spare vehicle. With reduced use its useful life could be extended. This is supported by our Department of Transportation. But it is vacation time, so we have to wait for a decision until after vacation (not mine mind you, but therein lies the rub). On the other hand the Transportation folks want a decision ASAP or it may be marked for auction. How about that for a CSI episode suggestion, vehicle decision making to be continued?

How about the recent battle in/with a committee of the County Board to get a much deserved raise for one of my employees because I have increased her work responsibilities. That might make for “must watch TV”. How about that for a CSI episode suggestion, exciting politics and business management?

Parts of my life may be like a TV show, but mostly it is mundane and likely not fit to print. I do, however, look forward to long service to the folks in my county and assure them I will be the best Coroner I can be (even with the run-of-the-mill actions, it makes the action actions even sweeter).

"System" failure kills

Whoa, the emergency medical/healthcare system needs to be fixed, everywhere.

"Woman dies in ER lobby as 911 refuses to help"

Accident?

Tissue donation oversight

“FDA Steps Up Oversight of Body Parts Companies”

Although I wouldn’t call them “body parts companies” I think improved FDA oversight of agencies that procure tissue for transplantation and research should have considerable oversight. I want to know personally and professionally that these agencies adhere to strict guidelines and ethics (particularly considering the near-bodysnatching that was going on in the New Jersey area not long ago).

I was recently on a 3-way phone call with a family member of a deceased individual and someone with our local procurement agency. I felt comfortable vouching for the agency, because of our working relationship with them, but at the same time I understood the reticence of the family.

Tissue donation after death does a lot of good, skin for burn victims, bone for fracture healing, corneas, heart valves and the like. I certainly support the practice of tissue donation, but until we have a good oversight program, nationwide, there will always be just enough doubt out there to make the process more difficult than it needs to be. The families of these deceased individuals, by necessity, are approached at an incredibly difficult time, it would be good to have some of the doubts out of the way before discussions start about the good these donations can do.

advocate for justice, too

I was doing a case review for our next regional Child Death Review Team meeting and I was struck by several aspects. These reviews are “secret” so I can not discuss names or details, but I did want (need) to vent on one point.

This was a small, young child who died. It was the opinion of the medical staff who participated in the child’s care, as well as the physician who did the autopsy and others who reviewed the case at the time that this death occurred at the hands of another, i.e. it was a homicide, as defined in our state coronial system.

The line that got me in the voluminous record that I reviewed was: “police and the State’s Attorney (Office) declined to file criminal charges”.

WHY?

I (as do all of my deputies) do every thing we can to advocate for those that can no longer advocate for themselves. All those that have died can no longer advocate for themselves, but especially those children who die and were unable to advocate for themselves before their death are particularly vulnerable. It is yet another role of the coroner to advocate for justice.

Association of Black Cardiologists' sponsored talk

I was one of 3 speakers at a meeting sponsored by the Association of Black Cardiologists in Boston last Friday. I spoke about how the system we have for access to healthcare, and particularly access to emergency medical care, needs to be changed/improved to prevent needless cardiovascular deaths. I based my talk on the Beatrice Vance case that I have talked about here before, several posts including this one. I hope that I will have other opportunities to speak on that topic and bring this issue to the attention of as many folks as I can.

One of the other speakers spoke about the critical need and impact of disease prevention in preventing morbidity and mortality from cardiovascular disease, particularly in minority populations. She discussed the “7 Steps to a Health Heart” endorsed by the Association of Black Cardiologists. I really liked them and so I thought I’d pass them along, they are a bit different than you might see elsewhere.

Be Spiritually Active
Take Charge of Your Blood Pressure
Control Your Cholesterol
Track Your Blood Sugar (if you’re Diabetic)
Eat Smart & Enjoy Regular Exercise
Don’t Smoke
Access Better Healthcare and Take Medication as Prescribed

We can all use a bit of a reminder about working, and enjoying the work, of being healthier.

Get health, stay health, and stay out of my office as long as you can.

Suicide not in the media

While I remain doubtful that suicide “contagion” exists or is a significant problem (and there are studies to back up that belief), I have pulled some of this information from the American Foundation for Suicide Prevention’s report: Reporting on Suicide: Recommendations for the Media and they strongly caution regarding the contagion. I recommend giving it a read, particularly for media folks, or pass it on to your media friends. Although, I wish it was more supportive regarding reporting about suicide.

I think reporting on an individual’s death who has died by suicide and not reporting that fact is wrong. People ought to know that individuals are dying by suicide in their community and that it is a significant problem. It doesn’t have to be a big thing in the article, seeming to “glorify” suicide, but a mention seems appropriate to me. In this case, as I am certain is often the case, the “community” knew that the manner of death was suicide, so it was not a secret.

A brief mention of suicide near the end of the article along with the facts about suicide seems like it could be useful for others. Letting the community know that suicide happens, and that it happens more frequently than they may realize, is very important in my eyes. Letting the community know that suicide most often goes hand-in-hand with mental illness (which is often undiagnosed, untreated or both) is important. And letting the community know that help is available for those that may be considering suicide or those with mental illness in need of treatment, and just as importantly where/how to get it, would be a public service.

If we refrain from talking honestly about suicide and/or mental illness the stigma will remain and some folks who need help will not get it. Some of those folks will end up in my office and I would rather that they not.

Murder-suicide a choice?

Murder-Suicide of an elderly couple, is that such a bad way to go? Should it be a choice that folks can make?

I’m not talking about a “choice” that is forced upon one of the pair in the murder-suicide, but if it is agreed upon by both of the individuals, should it be a choice that they can make? It is difficult to grow old and particularly growing old into worsening health. It is incredibly difficult to watch a loved one deteriorate into worsening health. It is difficult to watch a loved one decline mentally (from a medical or a neurologic condition) to a point that they are no longer who they used to be.

Should it be a choice?

Smoke inhalation

I was trying to explain the different varieties of smoke inhalation to a reporter the other day, actually to a few reporters in separate phone conversations over the last few days. Not all deaths from smoke inhalation have the same etiology.

Breathing in the products of combustion (smoke) can kill in several ways. Carbon monoxide is produced from burning stuff and is the most common poison in smoke that kills and the most common cause of smoke inhalation death. It is a cellular respiration toxin, for those of you inclined to detail, although it is often spoken of as a more general toxin. There can be other toxins in the smoke that are equally fatal, such as cyanide from burning plastics. Particulates in the smoke can cause airway irritation, airway swelling, airway “compromise” and death. One smoke inhalation insult that is unusual, but did cause a death in our county the other day, is breathing in the super-heated air of the fire with resultant airway damage and death from asphyxia. An even more unusual cause of smoke inhalation death is lack of oxygen in the immediate environment around the fire causing asphyxia, so I guess it really isn’t exactly a smoke inhalation death, but certainly belongs in the “same family”.

The whole mix is then complicated by underlying disease states, concomitant other substance exposure, and all the other stuff that can complicate stuff.

Not all smoke inhalation is the same and it isn’t always what it may seem at first blush. Death is seldom simple.

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