Marin County (CA) pushes to prevent suicide deaths.

You know about an object that has contributed to over 1300 deaths during the past 70 years and have had a number of folks say that it is “fixable” so that most of those deaths will not occur there in the future. What do you do? Obfuscate and don’t talk about it, because it would involve saying a taboo word. Don’t talk about it because it would involve talking about suicide. It would involve admitting that death by suicide occurs there and we all know that the “law of contagion” would lead to increased numbers of deaths by suicide there.

Finally, the Medical Examiner of Marin County is pushing for something to be done:

"I'm tired of the carnage," he said. "The public needs to know these needless deaths continue at an alarming rate."
He also wants officials to erect a suicide barrier to prevent future deaths (on the Golden Gate Bridge).
"I believe a higher railing would stop a lot of the suicide attempts," Holmes said. "A lot of people go to the bridge really in the moment, rather than carrying through any well-thought-out effort to end their lives. Of course, you're not going to stop all of them. I'm not that idealistic."
Along the pedestrian walkway visited by millions of tourists each year, only a 4-foot-high railing separates visitors from the turbulent bay waters below.
"If that rail was just 6 foot tall, it would delete 75% of the suicides," he said. "Because now it is just too easy to kill yourself there. You don't even have to climb. You can just lean over the rail and go."

In office for “decades”, he has now taken a stand. He released data on the suicide deaths that have occurred off of the bridge during the last 10 years and is taking a leadership role in preventing them in the future. I applaud his speaking out about suicide and his efforts to prevent them.

Suicide should not be cloaked in taboo and stigma. Suicide happens more than most folks realize (57 deaths by suicide in our county last year). Certainly not all suicides are preventable, but we owe it to folks to try to prevent as many as we can. It is not an easy road to prevention, but we most definitely should go after those things that present an “easier” remedy and remediate them. Our Suicide Prevention Task Force keeps looking for those sorts of issues locally, as well as the tougher targets and solutions. Step one is getting folks more comfortable with talking about suicide, lessening the taboo and stigma.

Death sensor

Oscar the cat seems to have an uncanny knack for predicting when nursing home patients are going to die.

It does remind me of the old “Ripley’s Believe It or Not” articles and books, although the cat has reportedly gotten it right 25 times.

Is it natural or supernatural? I have experienced things and heard credible stories about stuff that does stretch that dynamic (or narrow it?).

Anti-smoking ads have opposite effect on teens

Study: Anti-smoking ads have opposite effect on teens

The more exposure middle school students have to anti-smoking ads, the more likely they are to smoke, according to a new University of Georgia study.
…many anti-smoking ad campaigns have the opposite effect on teenagers, backfiring because they actually encourage the rebellious nature of youth.
…the data showed middle school students are more like to be influenced by the perception of what their friends are doing, and that anti-smoking campaigns should be more focused on peer relations.

Here we have the problem defined (anti-smoking ads don’t work well), the reason spelled out (authoritarian messages invoke contrarian behavior), and the solution laid out (peer messaging), we need to pay attention to that and use it.

Obviously this also holds for so many other problems/issues and it is not the first study to “discover” this triad. Underage drinking is just that sort of issue that jumps to mind (certainly in part because it has been large in the local media lately). We need to institute “social marketing” techniques to let teens know that many of their peers don’t drink and set-up peer education as a good chunk of our campaign against underage drinking (or seatbelt use or licit and illicit drug use, etc.)

1 soda=cardiac risk, how about 42 ouncer?

I just felt I had to pull these 2 articles together for your consideration (you may need to click through the ads on the links):

Study Links…Soft Drinks with Cardiac Risks
Drinking more than one soda a day -- even if it's the sugar-free diet kind -- is associated with an increased incidence of metabolic syndrome, a cluster of risk factors linked to the development of diabetes and cardiovascular disease, a study finds.

…a new McDonald’s menu item is a bit of a stunner. Remember Supersize sodas? They’re back, except this time the chain is trying a new name. Meet the “Hugo,” a 42-ounce drink now available for as little as 89 cents in some markets. A Hugo soda contains about 410 calories.

We are considering increasing the lifting ability requirements for our Deputy Coroner job descriptions.

Distracted Driving Kills

Last Sunday the Chicago Tribune ran an article that is very concerning to read, but the data isn’t all that surprising to me.

"Americans are doing just about everything in their car except focusing on driving,"

We have seen numerous crashes caused by distracted drivers and, as you can guess if you read the article, they do outnumber alcohol-related crashes. The outcry caused by these crashes doesn’t reach the level of alcohol-related crashes, probably because of all of the multi-tasking (and distracted) drivers that are out there.

More than 80 percent of the 1,200 people who responded to its survey identified themselves as "multitaskers," drivers who do at least one other thing besides mind the helm. Motorists age 18 to 27 were the least focused on driving, with 35 percent saying they always multitask.

It is however just as critical that folks realize the real dangers of driving distracted and that it doesn’t take much in the way of distraction to crash.

The National Highway Traffic Safety Administration says that in nearly 80 percent of accidents the driver was distracted three seconds or less before the crash.

We need a campaign “Don’t do the stuff you do and drive”. Not as catchy as “Don’t Drink and Drive”, but just as important to “drive home”.

You won't see this on CSI either

Have you ever had that sickening feeling as your pushing the door shut on your car that you left your keys inside? Well that feeling struck me last Friday.

I was rushing to a meeting (regional Child Death Review Team), not speeding, but otherwise rushing. The meeting is about an hour and half drive, but the traffic is often bad enough to make it much longer. Of course, I had to stop for coffee, so I stopped at Starbucks in Buffalo Grove. As I got out of the car and shut my door, it struck me that I had dropped the ignition key into a small receptacle in the center console. Well that was going to make me late to the meeting and it was an important meeting with several cases to discuss and the election of chair and vice-chair.

While I was considering my options I went ahead and bought my coffee (venti coffee black, for those of you keeping score). I did notice that my passenger window was open about and inch, so I was thinking that maybe I could use a coat hanger to get in. I asked if the coffee folks had a hanger, but they did not. There was a Jewel in the strip mall, so maybe I could buy some. But as luck would have it there was a cleaners there as well and they were nice enough to give me a hanger.

So for 10 minutes I tried to fish my key out of the console. Quite the sight to passers-by I am sure (my vehicle is prominently marked as a Coroner’s vehicle). Nearly giving up, I dialed 411 on my cell phone to get help through the non-emergency police phone number. Amazingly as the operator answered, because I was too busy to respond to the electronic voice, I hooked the key and carefully drew it out through the window. Quickly telling the operator I no longer needed assistance, I got in my car and proceeded on to Glen Ellyn. The traffic was in my favor, too, and I made it to the meeting in time.

In addition to participating in the case discussions, I was elected to Chair the team at the meeting. Luck was with me at least through that part of the day.

Just a bit to be filed in the “day in the life…” folder.

Blog Brings Death Debate

"Blog Brings Death Debate"

Options should be at the very least be discussed.

"(But) all of the options need to be there and available," he said. "Different people would seek out different options."

It takes more than law enforcement

Report: Gang Suppression Doesn’t Work

Anti-gang legislation and police crackdowns are failing so badly that they are strengthening the criminal organizations and making U.S. cities more dangerous, according to a report being released Wednesday.
Mass arrests, stiff prison sentences often served with other gang members and other strategies that focus on law enforcement rather than intervention actually strengthen gang ties and further marginalize angry young men, according to the Justice Policy Institute, a Washington, D.C., think tank that advocates alternatives to incarceration.

I had read this article this morning before I went to a meeting (Avon Township Youth Advisory Board) at which we talked about the community problems of underage drinking and the use of other drugs by youths and a similar point was made there. None of these social/societal problems can be remedied by only using a single pronged “tool”, i.e. law enforcement, even with stiffer and stiffer penalties.

All of these problems (which would include violence and some others) must be “attacked” at multiple levels and using multiple “tools”. Parents and family must participate at the level at which they can and they probably will need help knowing what to do and how to do it. The schools will have a role, as will the community more generally. Public policy must be such that it will have a real impact, necessitating changes, embellishments and additions, based on tested and proven records. The faith community will have a role and on and on.

Just as so many are working in various locales; we will continue our work and come up with some concrete actions to accomplish our goals. I look forward to the efforts and its results.

"...and decrease the excess population."?

We had another individual die recently in our county. That really isn’t news there are approximately 10 deaths a day in our county. But it came to mind while I was doing some of my daily reading, that death (and there have been certainly been others) was related to lack of access to healthcare. No doctor because they had no health insurance and no meds because they are too expensive.

There has been a bit of a surge in media coverage on this topic, what with “Sicko” being released and some presidential campaign talk about access to healthcare. It is an issue I have been involved in for years and comments like the following that I came across today go way beyond irritating:

But Dr. Reddy … has a principled reason for his piratical practices. "Patients," the Los Angeles Times reports him saying, "may simply deserve only the amount of care they can afford." He dismisses as "an entitlement mentality" the idea that everyone should be getting the same high quality health care.

People suffer because of lack of access to healthcare, which primarily translates to lack of access to healthcare coverage, and people die because of it as well. Hopefully the political will is growing around this so something more global can be done. In the meantime, support any effort that works to address this crisis in our society.

Narcissism run amuck can kill

Young adults feel so entitled and we ought to blame it on Mr. Rogers according to some online discussions and the Wall Street Journal.

Signs of narcissism among college students have been rising for 25 years, according to a recent study led by a San Diego State University psychologist. Obviously, Mr. Rogers alone can't be blamed for this. But as Prof. Chance sees it, "he's representative of a culture of excessive doting."

This same researcher quoted elsewhere is concerned because these narcissistic kids “are more likely to have romantic relationships that are short-lived, at risk for infidelity, lack emotional warmth, and exhibit game-playing, dishonesty, and over-controlling and violent behaviors.”

We see the fallout. A young man dies by suicide, at least contributed to by his ingrained thought that he would make $80,000 right after graduation. Relationships without the thought of the work involved leads to self-medication and other problems contributing to deaths (accidents, suicides and homicides).
How do we pull this generation back? How do we prevent the next from falling into the same pit?

I like the part of the Alternet article about the need for “kung fu” (spiritual discipline and cultivation of the self). Equally important is the concept that “the self is best defined in relationship to others, a person among persons”. I know that parents must act like parents. I know that kids need to realize that they are kids and a lot of growing up requires hard work. That life is not fair sometimes. That just plain life requires hard work and a lot of stuff in it requires even harder work. Reality, what a concept. Those are the goals, but how do we get there?

Autopsy drug overdose deaths

I do go to a fair number of meetings attended by other coroner’s and the occasional representative of the Cook County Medical Examiner's Office (for a while it was Dr Denton). Lately they have been in “exotic places” like Springfield, Bloomington and Glen Ellyn. Chatting most often centers on work and it is not unusual to discuss and share about issues etc, but I digress a bit.

After discussions with folks from Cook County, we (that executive “we” again) have decided to change things a bit in the way we handle certain cases in the office. It is not a huge change, but change is the one constant. Historically (as long as anyone can remember), autopsies have been done infrequently in drug overdose deaths by the Lake County Coroner’s Office. The feeling was that having toxic levels of drugs, whether licit or illicit, in an individual “gives you” the cause of death. We will be doing autopsies now on most, if not all, drug related deaths. Information based on real experience, primarily from Cook County, informed us that possible prosecutions for dug-induced homicide proceed more smoothly with an autopsy done, despite the fact that the autopsy rarely gives any truly pertinent information as to the cause of death.

It may seem unusual that this was not encouraged through any communication from the Lake County State’s Attorney Office, but this is a newer “field” of possible prosecution and likely everyone is still “feeling their way”.

In all fairness the question was raised by a local police department and our research/information seeking in response to that brought the answers/opinions from the Cook County ME Office.

"Other" Deputy job requirements

It is easier to measure performance, e.g. case paperwork done in X hours, but employees in my office (particularly my investigators) must demonstrate certain other characteristics that are “softer” to measure.

They must have integrity and an internalized “system” of ethics that sets boundaries on their behavior. This encompasses a sense of “right” from “wrong”, but also an ability to make even more nuanced choices as decisions are made in their work and in their relations with others. My investigators are often in situations that demand this and at times may even “test” them. For example (and there are too many to list), there may be a significant amount of money found in the decedent’s home. That money must be handled properly and passed on to the legal next of kin or the proper authorities. Another example is that we are often privy to certain information about folks that must be maintained confidentially and not judged. My investigators must come to their job with this ethical outlook and basis for their actions. I can’t teach that or remediate it. Lack of these traits puts the results of their investigations in doubt.

They must accept and display personal responsibility. If something doesn’t go quite “right” they must accept and admit that part that they contributed to, take “ownership” and responsibility. It is not always someone else’s fault, you, too, contributed to that action and/or outcome. If punishment is deserved it must be accepted as the “just” thing to occur. Again, this is a part of them. It is demonstrated in many ways and many interactions. I can encourage it, but it is a part of them when they come into our office. I can not give it to them.

Lastly, they must earn trust (prove to be trustworthy), primarily by demonstrating and living the above traits. Earn my trust, because they often serve as my “eyes and ears” in our investigations. Earn their fellow co-workers trust (in and out of the office), because they work closely with others and without that trust working relationships are jeopardized and handicapped. Lack of that can make for untenable working conditions for my office and our staff, as well as damaging relationships with other organizations and outcomes of investigations.

Just some passing thoughts.

activist coroner's office

Lazy posting? I wrote this for our upcoming summer newsletter to local EMS providers:

There is a line in our office Mission Statement that has been in place since I took office that we take very seriously: “serve those who can no longer serve themselves”, also that we will “help prevent deaths of similar circumstances”. These are the underpinnings to several recent actions prompted by our office, giving us a bit of an activist role.

A recent case, picked up by some of the media, was our reporting of the prescribing pattern of a local physician and participating in his having his license suspended. We felt that this physician was over-prescribing meds (particularly OxyContin) and that that had contributed to at least 3 individual’s deaths (if not more). Medical “misadventures” (read errors) do occur and we need to ensure a system is in place to address those and learn from them and prevent reoccurrences, but some times the practice is “wrong” and it needs to be stopped before it kills again.

Another case that became prominent was a post-death inquest that resulted in WomenHeart (a Washington DC based women’s heath organization) awarding me the 2007 Wenger Award for Public Policy. Information about that case (an ER waiting room death) is now used nationwide as a teaching tool for women to advocate for themselves and for healthcare providers regarding providing care to all in need. No one should die in a waiting room 20 feet from needed (and available) treatment. I spoke recently at a meeting of the Association of Black Cardiologists in Boston and I will be participating in a national effort to effect system change so that deaths like this do not occur again here or elsewhere.

We work closely with hospital risk management staff; various departments of local, state and federal government; product safety folks; OSHA; and others, all with the goal of preventing future deaths. We also cooperate with families to ensure that any correctable contributors to an individual’s death are addressed and redressed if possible. We work on issues and advocate for solutions and changes to do our utmost to forestall death.

We do feel that we are here to “serve and protect” (a bit overused in other ways), we serve the dead and their loved ones and protect those that have not died yet so they stay out of our office for as long as possible.

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?