Merced County Sheriff s Office-Coroner Division

Transcription

1 Merced County Sheriff s Office-Coroner Division Vernon H. Warnke Sheriff-Coroner

2 Table of Contents TABLE OF CONTENTS OVERVIEW AND INTRODUCTION EXCERPT FROM THE MISSION STATEMENT 1 INTRODUCTION OF DR. MARK A SUPER 2 POPULATION AND GEOGRAPHY OF MERCED COUNTY 3 DEATHS WE INVESTIGATE 4 ORGANIZATIONAL CHART 5 HOURS AND LOCATION 6 ACTIVITIES OF THE FORENSIC PATHOLOGIST AUTOPSIES 7 PATHOLOGICAL, MICROBIAL & HISTOLOGICAL STUDIES 8 ORGAN AND TISSUE DONATION 9 ACTIVITIES OF THE DEPUTY CORONERS INVESTIGATIONS 11 AUTOPSY ASSISTING 13 XRAY 15 UNIDENTIFIED REMAINS 16 COMMUNITY INVOLVEMENT DATA OVERVIEW OF ALL CASES 18 All Deaths Reported 18 Manners of Death 18 Manner of Death by Month 19 Manner of Death by Year, NATURAL DEATHS 20 SC Hospice 20 Funeral Home Referrals 20 Scene Investigations 21 ACCIDENTAL DEATHS 22 Mechanism of Accidental Deaths 22 Drug and Alcohol Overdose Deaths 22 Drug and Alcohol Overdose by Year, Drowning Deaths 23 Train Related Deaths 23 Electrocution Deaths 23 Other Accidental Deaths 23

3 Table of Contents TABLE OF CONTENTS 2014 DATA cont. MOTOR VEHICLE ACCIDENT DEATHS 24 Solo Vehicle Accidents 24 Multiple Vehicle Accidents 24 Motorcycle Deaths 24 Driver Deaths 24 Passenger Deaths 24 Vehicle vs Pedestrian 24 HOMICIDE 25 Methods 25 Number of Homicide Victims by Age & Gender 26 Jurisdictional Breakdown 26 Toxicology Results 26 Homicide Count by Year & Jurisdiction, Homicide Rate per 100,000 by Region 27 SUICIDES 28 Methods 28 Number and Rate of Suicide Victims by Age & Gender 28 Jurisdictional Breakdown 29 Toxicology Results 29 Suicide Count by Year 29 UNDETERMINED 30 Undetermined Deaths 30 CHILD DEATHS 31 Summary of Child Deaths 31

4 Overview and Introduction OVERVIEW AND INTRODUCTION Excerpt from the Mission Statement Our mission is to provide responsive, professional, and caring law enforcement services to all the people of Merced County. We will: Respond to calls for service promptly We will be diligent in our role as Coroners to protect the rights and dignity of those who can no longer speak for themselves. As Merced County Sheriff / Coroner employees, we will always conform to the high standards expected by the public, by being fair, compassionate, unbiased, and in conformance with the Law Enforcement Code of Ethics. 1

5 Merced County Sheriff-Coroner Overview and Introduction Introduction of Mark A. Super, MD Forensic Pathologist, Mark A. Super MD attended St. Mary s Central High School in Bismarck, North Dakota; and then attended the University of North Dakota at Grand Forks where he obtained a Bachelors of Science Degree in Physical Therapy and a Medical Doctorate. Dr. Super then did Pathology training with the United States Navy at San Diego Naval Hospital; serving for eight years before being honorably discharged as a Lieutenant Commander. Dr Super is licensed by the State of California, and board certified by the American Board of Pathology in Anatomic, Clinical, and Forensic Pathology. He currently is an active member of the American Academy of Forensic Sciences (AAFS) and the National Association of Medical Examiners (NAME). Dr. Super is also a Clinical Professor at the University of California Davis-School of Medicine. 2

6 Population and Geography of Merced County Overview and Introduction Merced County is the 25 th most populated county out of 58 that make up California. According to the most recent data published by US Census Bureau in 2010: Population 255, % Median Age 29.6 Males 128, % Median Male Age 28.7 Females 127, % Median Female Age 30.5 White 81, % Black 8, % Native American 1, % Asian/PI 18, % Hispanic 140, % Other % Mixed 4, % Racial Breakdwon Other, 439 Mixed, 4,700 White, 81,599 Hispanic, 140,485 Asian/PI, 18,659 Black, 8,785 Native American, 1,126 Merced County covers a total of 1,979 square miles, of which about 97.7% is land. 3

7 Deaths We Investigate Overview and Introduction Under California Law, our division is charged with and required to determine the cause and circumstance (manner) of certain deaths. Section of the Government Code and Section of the Health and Safety Code provide exact definitions. Generally speaking, a coroner investigation is conducted in deaths that occur unexpectedly or without an attending physician. Our jurisdiction also extends to cases where the death may have been expected, but has non-natural contributing factors, i.e. intoxication or injury; even when the injury occurred years prior. Each reportable death is assigned a Deputy Coroner who will either respond to the scene or request a Patrol Deputy assess the circumstances and report back. The course of a coroner investigation will usually cover: Interviewing of family and friends Determination of any medical problems and supporting records Documentation of the scene and circumstances surrounding the death About 30% of reportable deaths require a postmortem examination from the Forensic Pathologist. The Forensic Pathologist will then make a determination of the cause and manner of death. The examinations usually occur within two days. It is our goal to accommodate, within reason, the wishes of family and the decedent, but there are instances where an autopsy is absolutely necessary. 4

8 Organizational Chart Overview and Introduction Sheriff-Coroner Vernon H. Warnke Undersheriff Thomas I. Cavallero Captain Sergeant Forensic Pathologist Deputy Coroner II Deputy Coroner II Deputy Coroner II EH Deputy Coroner II EH Deputy Coroner I Intern 5

9 Hours and Location Overview and Introduction The Coroners Division is located at 455 East 13 th Street in Merced, California. Our business hours are 8:00 AM to 5:00 PM; but we have coverage after hours with an on-call Deputy Coroner. Our business telephone is , the oncall Deputy Coroner can be reached through the Merced County Sheriff Office Dispatch at

10 Activities of the Forensic Pathologist ACTIVITIES OF THE FORENSIC PATHOLOGIST Autopsies A postmortem examination is performed by a Forensic Pathologist. Forensic Pathology is a sub-specialty of Pathology, a branch of medicine. Our county is fortunate to have a full time Doctor on staff to perform all examinations. There are two types of post mortem examinations: an autopsy and an external examination. An external exam is a minimally intrusive examination of the body. Photographs will be taken of the body as we receive it, and again once all medical paraphernalia and or clothing are removed. The doctor will examine in detail each part of the body and notate any lacerations, abrasions, or contusions, scars or other defects, ensuring that there is no traumatic injury or evidence of any suspicious activity. Toxicology samples are usually obtained during this type of exam. External examinations are generally reserved for natural deaths where there is documented history, but no attending physician, or for some straight forward suicides such as hangings or self-inflicted gunshot wounds. An autopsy encompasses all aspects of an external exam, but goes further by examining all of the internal organs and body cavities to document all internal injuries. Every organ is weighed and examined by the doctor to document any abnormality. Toxicology is always retained during these exams. Some autopsies may even require microbial or histological studies. A common misconception is that an autopsy will render a body unsuitable for viewing in a funeral. This is not true. The incisions made during an autopsy are easily hidden by a mortician so the individual can be viewed by loved ones. In 2014, the Dr. Super conducted 143 autopsies and 83 external exams in Merced County. 7

11 Activities of the Forensic Pathologist Pathological, Microbial and Histological Studies In some cases a cadaver cannot be adequately examined by the naked eye. Pathology is a medical specialty that involves the study of tissue for diagnostic purposes. Often times there are changes that occur on a cellular level that require what is called a histological study. Samples of organ tissue will be sent to a pathological laboratory to cut slices, stain, and apply to a microscope slide so the doctor can determine the cellular malfunction. Other times a person might have been reported to have symptoms of a disease before expiring, or internal signs of infection. These can be tested in a microbiology lab. Swabs will be used to pick up the offending microbe and then it is grown on a culture plate. Similar to a histological study, it is then stained and applied to a microscope slide for examination (common swabs are puss filled sores, the throat, and sinuses of a suspected flu victim) 8

12 Activities of the Forensic Pathologist Organ and Tissue Donation Following the death of a loved one, many family members wish to participate in the anatomical gift donation process by authorizing the donation of their loved one s tissue s or organs. Recognizing that organ and tissue transplantation saves and improves thousands of lives each year, the Coroners Division is committed to accommodating the requests whenever possible. A collaborative working relationship with the organ and tissue procurement agency, the local law enforcement agencies and the medical community; enables the Coroner Division to carefully evaluate each case. When an individual is on life support and death is imminent, the organ and tissue procurement agencies will work closely with the family to provide information and assistance regarding the donation process of vital organs. If the death has already occurred, and not more than 24 hours has elapsed, corneas, bone and skin tissue still may be used for donation. Special attention is given to Coroner cases where homicide and suicide are known or suspected because of law enforcement involvement and the potential of subsequent litigation. In these cases, the Coroner s Office must ensure the circumstances, manner and cause of death are determined prior to release of the deceased to donor organizations for organ and tissue recovery. 9

13 Activities of the Forensic Pathologist Organs and Tissues for Donation CORNEA donation prevents blindness or restores vision. WHOLE EYES can be used in reconstruction of eye orbit or reconstruction of eye surface in contact with the eye. They are also utilized in medical training and research into the cause and cures for blindness. BONE donation promotes healing, restores mobility, and prevents amputation. It also assists research into causes and cures of orthopedic defects, disease and trauma. SKIN donation promotes, healing prevents fluid loss, and causes a decrease in infection for burn & trauma patients. It also aids in reconstructive surgery. HEART VALVES are used for replacement of defective valves. The graft does not calcify and there is no rejection of tissue. No long-term anticoagulant therapy necessary. This is best for children. SAPHENOUS VEIN can restore blood circulation and prevent amputation. SOFT TISSUES are Tendons, ligaments, fascia, or meniscus can restore mobility and enhance life. Used in neurosurgery. 10

14 ACTIVITIES OF THE DEPUTY CORONERS Investigations Activities of the Deputy Coroners Medico-legal death investigations are completed in a professional, ethical and timely manner and are geared to assist in the determination of the cause and manner of death. This is accomplished through the cooperation between law enforcement agencies, health care professionals and the public. The initial investigation starts with a report of death. Of the 1226 deaths in Merced County, Deputy Coroners processed 803 (65%) reports of death. Coroner jurisdiction was invoked in 682 (85%) of those reports. Deputy Coroners physically respond to the majority of death scenes falling into the Coroner jurisdiction. In 2014, we responded to 377 scenes. An initial body and scene assessment is completed at the place of death, which can be virtually anywhere in the 1979 square miles of Merced County. Photographs are taken and relevant evidence is collected in order to assist in the investigation. The evidence may include weapons, biological specimens, medications, drugs, and drug paraphernalia. All investigations are documented in a comprehensive investigative report. In non-suspicious cases where the circumstances of death and medical history is well documented, the primary care physician is able to provide a reasonable cause of death and the family has a funeral home designated, certification may be completed without bringing the body to the coroner facility. Deputy Coroners and Deputy Sheriff/Coroners are tasked with notifying the legal next of kin of the decedent. The process starts with the identification of the decedent. All identifications are done using scientific methods including fingerprints, dental comparisons, and DNA analysis. The process then continues with a diligent search for the decedent s legal next of kin. Decedents often die with valuables, both monetary and sentimental, in their possession. The decedent s personal property is retained and accurately tracked 11

15 Activities of the Deputy Coroners by a barcode system until the property is returned to the family. In some cases property will be released as evidence to the agency performing the criminal investigation. A copy of the chain of custody receipt is retained at the coroner facility. Deputy Coroners discuss the circumstances of the death with the decedent s family at the scene. Additional statements are obtained from witnesses, the treating physician and responding emergency personnel. Follow up investigation is required in many cases which include review of medical records, law enforcement reports and additional interviews. The information gathered by the Deputy Coroner through their investigation is discussed with the Forensic Pathologist should the investigation warrant an autopsy or external exam. 12

16 Autopsy Assisting Activities of the Deputy Coroners Autopsy assisting consists of a wide range of different duties. The most basic definition is helping the doctor during the autopsy examination or external examination of the deceased. There are two types of exams, an external exam and an autopsy exam, and the duties of the assistant are different for each exam. There are also many different types of cases such as homicides, suicides, naturals, accidents, etc. Each type is handled differently, but the general duties of assisting are the same. During an external examination the assistant will start by weighing the body, measuring the height of the body and photographing the body. Once the clothing and medical intervention is noted by the doctor, the assistant will remove clothing and medical intervention materials. Photographs will then be taken again of the entire body. While the doctor is noting lacerations, abrasions, contusions and other defects, the assistant will draw toxicology samples including femoral blood, vitreous fluid, and sometimes urine if available. They are also responsible for labeling and packaging the toxicology samples. Once the doctor has completed the exam, the body will go back into refrigeration until the funeral home comes to receive the body. During an autopsy examination there are many duties required of the assistant. Generally, the assistant starts by weighing the body and measuring the height of the body, and photographing the body and any evidence on it. At this time, if there is any evidence to be collected, it will be collected and packaged. After the doctor records them, the clothing and medical intervention materials will be removed. Sometimes, it is necessary to take additional photos before cleaning the body. The body is then cleaned and photographed again. After the doctor records any lacerations, abrasions, contusions or other defects, the body is ready for the internal examination. During the internal examination, the assistant will draw toxicology samples, help to retrieve and package evidence if necessary and perform the opening of the skull. The toxicology collected is generally the same as an external exam (femoral 13

17 Activities of the Deputy Coroners blood, vitreous fluid, and urine if available) but may consist of additional samples such as gastric contents, liver, bile and brain. The assistant is also responsible for labeling and packaging the toxicology samples as they are taken. When the doctor is ready, the assistant records the weights of each major organ, the amount of urine, gastric, bile and (if applicable) the amounts of blood in the body cavities. They will also record any fractures, trajectories of gunshot wounds and any other items the doctor would like to record, as necessary. At some point during the internal examination additional photographs may be necessary to document any injuries, evidence, abnormalities etc. There may also be evidence to collect and package. For example, during a homicide case there may be bullets to retrieve and package. At the conclusion of the autopsy, after the doctor has dissected each organ, the organs are placed back inside the body, the body is sewn up by the assistant and they are responsible for cleaning the body and all autopsy tools and surfaces used. The assistant will then place the decedent back in a body bag and into refrigeration until the funeral home comes to receive the body. 14

18 X-Ray Activities of the Deputy Coroners X-rays have been necessary in autopsy for many years. X-rays are a standard requirement in deaths involving: children, unidentified persons, suicides and homicides involving firearms and various other weapons Prior to November 2014, the Coroner s Division relied on a contract x-ray service. In 2014 the contract x-ray service conducted 39 x-ray examinations at a total cost of $7,124.60; an average of approximately $183 per case. In November 2014 the Coroner s Division acquired our own x-ray machine. The savings to the department are greater than just the x-ray cost. X-rays are now conducted and available in a more efficient timeline. X-rays are conducted by the Deputy Coroners. DEATH CERTIFICATION In Merced County, in 2014, there were 1226 total deaths recorded on the California Electronic Death Registration System (EDRS). Of the 1226, attending physicians signed 942; the Coroners Division signed 284; and 69 were cosigned by an attending and Coroners Division staff. 15

19 Unidentified Remains Activities of the Deputy Coroners The identification of a decedent must be made by official and verifiable means. When a decedent carries no identification, no family is present to provide identification information, or the condition of the body is such that a visual identification is not possible, he or she becomes a John/Jane Doe and the identification process begins. Most decedents are identified quickly through fingerprints. Other scientific methods can be utilized to confirm an identification if fingerprints are unavailable. These methods include dental comparison using a forensic odontologist, through radiographic comparison, or through surgical history and identifying anatomic features. When identification cannot be made by these means, DNA analysis and profile comparison is attempted. In rare occasions an artist s sketch will be obtained and released to local media outlets in hopes of learning an identity that can be compared and confirmed by the above methods. We also work with NCMEC (National Center for Missing and Exploited Children) and NamUs in our efforts to identify individuals. When a decedent remains unidentified and we have no leads for possible identity, several legal mandates go into effect. Those legal mandates include an entry of the decedent s information, known physical characteristics and full forensic dental examination into NCIC (National Crime Information Center) in order to perform a comparison of the decedent against reported missing persons. Often a full anthropology examination is conducted to provide information such as race/ethnicity, age, height and skeletal anomalies. 16

20 Merced County Sheriff-Coroner Activities of the Deputy Coroners Community Involvement 2014 Activities included: The Every 15 Minutes Program; aimed at educating high school students about drunk driving. Delhi High School Dos Palos High School Gustine High School Le Grand High School Hilmar High School In association with the UC Merced Police Department, a presentation was given to the UC Merced Fraternity & Sorority Life community about the dangers of driving under the influence. Deputy Coroners also gave an informational talk to the Medical Assisting Program at the Merced County Office of Education. Deputy Coroners hosted two young adults for a scared straight type program. These individuals were on the cusp of a dangerous lifestyle, our efforts were to educate them about the consequences of their current life choices. 17

21 2014 DATA Overview of All Cases All Deaths Reported 2014 Data In 2014, there were 682 deaths investigated by the Coroners Division, out of 1226 deaths registered in Merced County. Non- Reportable, 544 Reportable, 682 Manners of Death Homicide, 32 Pending, 14 Suicide, 18 Undetermined, 2 Accidental, 86 Natural,

22 Manner of Death by Month 2014 Data Axis Title Natural Scene Hospice (08/31) Funeral Home Accidental Homicide Suicide Pending Undetermined Manner of Death by Year,

23 NATURAL DEATHS SC Data Sheriff Code 218 is a Coroner Consult. A Coroner Consult number is assigned to any incident involving a non-reportable death in which the Coroners Division is contacted for assistance or advice. In 2014, the Coroners Division took 121 SC218 calls. Hospice Hospice care is authorized by a physician after an individual receives a terminal prognosis. Death is usually expected within six months. The individual must request hospice care, with an understanding that aggressive treatments will cease. There are two types of hospice care, residential based and facility based. California Health and Safety Code Section 1746 provides a definition of the role of the hospice nurse as an extension of the attending physician. From about 1985 until 2014, hospice cases were reviewed by Deputy Coroners. This role was largely scaled back in July as hospice deaths are not technically reportable under GC27491 and H&S In 2014, the Coroners Division investigated 197 hospice deaths, with 99% of those occurring before July 1 st. In 2014, the Coroners Division processed 197 hospice cases, of which twenty seven were legally reportable. Funeral Home Referrals Occasionally a decedent will go to a funeral home, by-passing the Coroners Division. It is the duty of the funeral home filing the death certificate to review significant conditions for factors that fall under GC27491 or H&S as reportable cases. When this occurs, the Deputy Coroner assigned the case will review the death certificate before it is filed with the state. In 2014, the Coroners Division investigated 108 funeral home referrals. 20

24 Scene Investigations 2014 Data Many natural deaths occur at the decedent s residence, making them reportable under GC27491 or H&S A Deputy Coroner will respond to the scene of the incident to ensure that foul play is not a contributing factor to the death. An external examination or autopsy is generally performed by the Forensic Pathologist to determine a cause of death. In 2014, 220 natural deaths required a scene investigation. 21

25 ACCIDENTAL DEATHS 2014 Data Mechanism of Accidental Deaths MVA, 30 OD, 28 Other, 16 Electrocution, 1 Train, 2 VvP, 3 Drowning, 6 Drug and Alcohol Overdose Deaths There were 28 deaths attributed to overdose. In this publication, the word drug refers to illicit substances; the word medication and Rx refers to prescriptions. In these cases, alcohol, drugs, or medications played a contributing factor to the cause of death. Poisoning, 1 Alcohol, 2 Rx+Drug, 1 Drug(s), 6 Alcohol+Rx, 8 Rx, 8 Alcohol+Drug, 2 22

26 2014 Data Drug and Alcohol Overdose by Year Drowning Deaths In Merced County, in 2014, there were six drowning deaths. One occurred in a swimming pool at a private residence, one occurred in a drainage ditch at a private club, and the other four occurred in public waterways. In four of these cases, intoxication was a factor. Train Related Deaths There were two train related accidental deaths. Both of these individuals were intoxicated. Electrocution There was one death caused by electrocution. Intoxication was not an issue in this case. Other There were fifteen deaths classified as accidental other. Eleven of these cases involved injury due to a ground level fall. The remaining cases were comprised of one occupational asbestos exposure, one positional asphyxiation, one probable spider bite, and one injury due to a vehicle versus bicycle accident. 23

27 2014 Data Motor Vehicle Accident Deaths Merced County has seven major highways that run through it; Interstate 5 and State Routes 33, 59, 99, 140, 152 and 165. In 2014, there were thirty motor vehicle accident (MVA) deaths and three, vehicle versus pedestrian deaths investigated by the Coroners Division. MVA deaths occurring at a hospital out of county are not investigated by our Office; unless requested by the investigating agency. Driver toxicology information presented below is solely based on deceased drivers involved. Solo Vehicle Accidents In 2014, there were fourteen solo vehicle accidents. Of the fourteen solo MVAs, six involved an intoxicated driver. Multiple Vehicle Accidents In 2014, sixteen MVA deaths involved more than one vehicle. Of the sixteen MVA deaths, five were intoxicated, toxicology is pending on two of the sixteen cases. Motorcycle Deaths In 2014, three of the MVA deaths involved motorcycles. One was a solo vehicle accident, included above; and two were multiple vehicle accidents, included above. Driver Deaths In 2014 twenty four of the decedents were drivers. Ten of these were intoxicated, one is pending toxicology. Passenger Deaths In 2014, six decedents were passengers in vehicles. Vehicle vs Pedestrian Deaths In 2014, three pedestrians died as a result of struck by a motor vehicle. One was intoxicated. 24

28 Merced County Sheriff-Coroner Homicide In 2014, there were thirty two homicides Data Methods Of the thirty two homicides, twenty six were a result of gunshot wounds; three were a result of an assault; two were the result of a stabbing; one was a result of child abuse. Nine cases were gang related, three related to marijuana cultivation and distribution, and two were related to both. Other, 1 3% Assault, 3 10% Stabbing, 2 7% Method GSW, 26 80% Gang/Marijuana Affiliation Gang & Marijuana, 2 6% Gang, 9 27% Unrelated, 17 58% Marijuana, 3 9% 25

29 2014 Data Number of Homicide Victims by Age & Gender Homicides by Age/Gender 17 Male Female Jurisdictional Breakdown LBPD, 1 3% MPD, 15 45% MCSO, 16 52% Toxicology Results Alcohol+ Alcohol+Rx, 3 THC, 3 9% 9% Rx, 1 3% Alcohol+ Opiate, 1 3% Meth+ THC, 1 3% Meth, 3 9% Unknown, 1 3% Negative, 10 34% Alcohol, 4 12% Alcohol+ Meth, 2 6% Alcohol+ Ketamine, 1 3% Pending, 2 6% 26

30 2014 Data Homicide Count by Year & Jurisdiction MCSO MPD APD LPD LBPD DPPD Homicide Rate per 100,000 by Region In 2014, there were thirty three homicides out of a population of 255,793 residents. That equates to homicides per 100,000 people. According to the Federal Bureau of Investigation (FBI), the national average is 4.5 per 100,000 people. According to California Department of Justice, the state average is 4.6 per 100,000 people. 27

31 2014 Data In 2014, there were eighteen suicides. Suicide Method Of the eighteen suicides, nine were by hanging, four were by gunshot wound, three were overdoses, one jumped off a structure, and one was by train. Jump, 1 5% Train, 1 6% OD, 3 17% Hanging, 9 50% GSW, 4 22% Number of Suicide Victims by Age & Gender Suicide by Age/Gender Male Female

32 Jurisdictional Breakdown 2014 Data APD, 2 11% LPD, 1 5% LBPD, 1 6% MCSO, 7 39% MPD, 7 39% Toxicology Results Rx, 7 39% Negative, 4 22% Not Tested, 3 17% Alcohol, 2 11% Suicide Count by Year Pending, 2 11%

33 Undetermined 2014 Data In 2014, there were two cases where the manner of death was undetermined. 30

34 Child Deaths Summary of Child Deaths 2014 Data In 2014, there were thirteen child deaths. A child death is defined by California to be any death occurring before the eighteenth birthday mo 13mo-12yr 13yr-17yr Male Female 31

35 ACKNOWLEDGEMENTS Acknowledgements This report was prepared for Sheriff Vernon H. Warnke at the direction of Sergeant Buck Ledford. The following individuals have contributed to this document. It could not have been done without them: Deputy Coroner Nicholas D. Nakamura, DD BS Deputy Coroner Mark L. Morton, D-ABMDI Deputy Coroner Laura Fontes, BA Mark A. Super, MD Deputy Sheriff/Coroner Keith McClain 32