OFFICE OF THE CHIEF MEDICAL EXAMINER City and County of San Francisco, California ANNUAL REPORT

Transcription

1 OFFICE OF THE CHIEF MEDICAL EXAMINER City and County of San Francisco, California Hall of Justice 850 Bryant Street San Francisco, California Telephone: (415) FAX: (415) ANNUAL REPORT July 1, 2004 June 30, 2005 Amy P Hart, MD Chief Medical Examiner Stephen R Gelman Medical Examiner Administrator Donna J Allison, PhD Data Collection and Analysis/Statistics/Production

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5 INTRODUCTION 1 FORENSIC MEDICINE AND TOXICOLOGY 2 DEPARTMENTAL ADMINISTRATION DEPARTMENT COSTS ORGANIZATIONAL CHART 3 4 FORENSIC INQUIRY CITY AND COUNTY OF SAN FRANCISCO DEATHS IN (Figure 1) FISCAL YEAR (County Deaths) REFERRALS MEDICAL EXAMINER CASES FOR BY MANNERS OF DEATH (Figure 2) 5 MANNER OF DEATH - MONTHLY COMPARISON (Table I, Figure 3) 9 MANNER OF DEATH BY RACE (Table II) 10 MANNER OF DEATH BY AGE (Table III) 10 MANNER OF DEATH BY SEX (Table IV, Figure 4) 11 MANNER OF DEATH BY RACE (Figure 5) 12 YEARLY COMPARISON OF MEDICAL EXAMINER S CASES YEARLY COMPARISON OF MANNER OF DEATH (Table V, Figure 6) YEARLY COMPARISON, VEHICULAR DEATHS (Table VI) YEARLY COMPARISON OF NUMBER OF HOMICIDES (Table VII, Figure 7) 15 YEARLY COMPARISON OF NUMBER OF SUICIDES (Table VIII, Figure 8) 16 YEARLY COMPARISON OF NUMBER OF ACCIDENTS (Table IX, Figure 9) 17 YEARLY COMPARISON - VEHICULAR FATALITIES BY TYPE (Table X, Figure 10) VIOLENT DEATHS BY CATEGORY (Table XI, Figure 11) 19

6 NON-VEHICULAR ACCIDENTS NON-VEHICULAR ACCIDENTAL DEATHS 20 NON-VEHICULAR ACCIDENTS (Figure 12) 21 NON-VEHICULAR ACCIDENTAL DEATHS BY METHOD, DRUG/ALCOHOL INVOLVEMENT (Table 22 XII) DRUGS PRESENT IN NON-VEHICULAR ACCIDENTS (Table XIII) 23 NON-VEHICULAR ACCIDENTAL DEATH METHODS BY RACE (Figure 13, Table XIV) 24 NON-VEHICULAR ACCIDENTAL DEATH METHODS BY AGE (Figure 14) 25 (Table XV) 26 NON-VEHICULARACCIDENTAL DEATH METHODS BY SEX (Table XVI) 27

7 TABLE OF CONTENTS (Continued) VEHICULAR DEATHS 28 BY TYPE (Figure 15) 29 DRUG/ALCOHOL INVOLVEMENT (Table XVII) 30 SELECTED DRUGS PRESENT IN VEHICULAR FATALITIES (Table XVIII) 30 VEHICULAR FATALITIES BY AGE (Table XIX, Figure 16) 31 DEMOGRAPHICS OF VEHICULAR FATALITIES (Table XX) 32 RACE OF VEHICULAR FATALITIES (Figure 17) 32 NON-VEHICULAR SUICIDES 33 NON-VEHICULAR SUICIDAL DEATHS 34 BY METHOD USED (Figure 18) 35 NON-VEHICULAR SUICIDAL DEATHS, DRUG /ALCOHOL INVOLVEMENT (Table XXI) 36 SELECTED DRUGS PRESENT IN NON-VEHICULAR SUICIDAL DEATHS (Table XXII) 36 NON-VEHICULAR SUICIDAL METHODS BY RACE (Table XXIII, Figure 19) 37 NON-VEHICULAR SUICIDAL METHODS BY AGE (Table XXIII) 38 AGE DISTRIBUTION OF NON-VEHICULAR SUICIDE VICTIMS (Table XXV, Figure 20) 39 SEX DISTRIBUTION OF NON-VEHICULAR SUICIDE VICTIMS (Table XXVI) 40 NON-VEHICULAR HOMICIDES 41 NON-VEHICULAR HOMICIDE DEATHS 42 BY METHOD USED (Figure 21) 43 NON-VEHICULAR HOMICIDE DEATHS, DRUG/ALCOHOL INVOLVEMENT (Table XXVII) 44 SELECTED DRUGS PRESENT IN NON-VEHICULAR HOMICIDE DEATHS (Table XXVIII) 44 NON-VEHICULAR HOMICIDE METHODS BY RACE (Table XXIX and Figure 22) 45 AGE RANGES OF NON-VEHICULAR HOMICIDE VICTIMS (Figure 23) 46 NON-VEHICULAR HOMICIDE METHODS BY AGE (Table XXX) 47 AGE RANGES - COMPARISON BY YEAR (Table XXXI 47 SEX DISTRIBUTION OF NON-VEHICULAR HOMICIDE VICTIMS (Table XXXII) 48 MEAN AGE BY SEX OF NON-VEHICULAR HOMICIDE VICTIMS (Table XXXIII) 48 DEATHS BY FIREARMS BY MANNER (Figure 24) 49 FORENSIC LABORATORY, HISTOLOGY SECTION 50 MONTHLY FIGURES 51 FORENSIC TOXICOLOGY 52 LIST OF DRUGS/MEDICATIONS/POISONS FOUND - SF County Cases 53

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9 TABLE OF CONTENTS (Continued) SELECTED DRUGS 55 NUMBER OF DEATHS INVOLVING SELECTED DRUGS (Table XXXIV) 57 INCIDENCE BY SEX, RACE, AGE AND ALCOHOL INVOLVEMENT (Table XXXV) 58 COCAINE, HEROIN AND AMPHETAMINE DEATHS - YEARLY COMPARISON (Figure 25) 59 VIOLENT DEATHS BY MANNER - PERCENT WITH DRUG PRESENT (Figure 26) 61 DEATHS INVOLVING COCAINE COCAINE PRESENT ALONE (Table XXXVI) 60 COCAINE PRESENT IN COMBINATION WITH OTHER DRUGS (Table XXXVI) 60 DEATHS INVOLVING HEROIN HEROIN PRESENT ALONE (Table XXXVII) HEROIN PRESENT IN COMBINATION WITH OTHER DRUGS (Table XXXVII) 62 DEATHS DUE TO HEROIN BY FISCAL YEAR, ALONE OR IN COMBINATION (Figure 27) DEATHS INVOLVING AMPHETAMINES AMPHETAMINES PRESENT ALONE (Table XXXVIII) 63 AMPHETAMINES PRESENT IN COMBINATION WITH OTHER DRUGS (Table XXXVIII) 63 GLOSSARY 65

10 INTRODUCTION The Chief Medical Examiner is authorized by State law to many responsibilities, the foremost of which is the investigation and certification of a variety of sudden, unexpected and/or violent deaths The Chief Medical Examiner can utilize any and all medico-legal investigative techniques, including autopsy, to establish both the medical cause of death and manner of death (natural, accident, homicide, suicide or undetermined) The deaths that must be reported to the Medical Examiner, as required by various sections of the Government, Health and Safety and Penal codes, are as follows: 1 Homicide - known or suspected 2 Suicide - known or suspected 3 Following accident or injury (whether the accident or injury is the primary cause or contributory, with death occurring immediately or at some remote time) 4 Medical attendance of less than 20 days 5 No physician in attendance 6 Physician unable to state the cause of death (must be unable, not merely unwilling) 7 Poisoning (food, chemical, drug, therapeutic agents) 8 Occupational or industrial deaths 9 All deaths where a patient has not fully recovered from an anesthetic, whether in surgery, recovery room, or elsewhere 10 All deaths in operating rooms 11 All solitary deaths (unattended by physicians or other person in the period immediately preceding death) 12 All deaths in which the patient is comatose throughout the period of the physician's attendance 13 All deaths of unidentified persons 14 All deaths in which there are grounds to suspect that the death occurred in any degree from a criminal act 15 All deaths involving contagious disease - known or suspected - and constituting a public health hazard 16 Deaths in prison or while under sentence 17 All deaths associated with a rape - known or alleged - or crime against nature 18 All deaths related to or following abortion - known or suspected 19 All deaths involving drowning, fire, hanging, gunshot, stabbing, cutting, starvation, exposure, alcoholism, drug addiction, strangulation or aspiration Additional mandated responsibilities include protecting and safekeeping of property belonging to deceased individuals, conducting inquests when indicated, maintaining proper public records, making reports to other agencies, identification of deceased persons, interment of indigent dead, and many other death related activities 1

11 FORENSIC MEDICINE AND TOXICOLOGY Forensic medicine is the marriage of medicine and the forensic sciences oriented to medico-legal issues The field is wide-ranging and growing, becoming even broader in scope than the traditional concept as practiced in Europe Medical Examiners commonly examine living persons for medico-legal purposes, often interpreting the findings for court purposes Forensic Toxicologists commonly test specimens from living individuals for court purposes There has been continued growth and accentuation of the role of forensic medicine in the legal and medicolegal world over the past year This office has continued its role in forensic medicine for both living and dead, playing a vital role in the community We serve in a number of places in the community Some of these include: Examination and diagnosis of the living: Examination and evaluation of child abuse Examination and evaluation of sexual assault injuries Examination and evaluation of spousal abuse Evaluation of citizens' complaints against the Police Department Testimony and interpretation of hospital records and procedures Evaluation of force and patterned injuries Examination of victims and suspects for trace evidence and injuries Court testimony on force, great body injury (GBI) and other issues Alcohol and drug interaction in driving under the influence cases and impairment related issues Physiologic effects of drugs Toxicology, including environmental and industrial toxicities Teaching - hospitals, forensic, law enforcement, community Drug analysis for: recruits, random workplace drug monitoring, management control, suspects and alleged victims Examination and evaluation of the dead: Scene investigation, reconstruction and analysis Evidence collection and testing Blood spatter analysis and interpretation Patterned evidence analysis and interpretation Trace evidence collection Time and place of death information Forensic autopsy - consultation and interpretation Analysis for vitreous chemistry Forensic toxicology Consultation with District Attorney, Public Defender, City Attorney or other legal entities Reconstruction Analysis and court presentation Teaching - forensic and legal 2

12 DEPARTMENTAL COSTS FISCAL YEAR Total Budget $4,670,99200 Transfers to Controller: Health and Retirement $571,61500 Net Budget (all other costs) $4,099,37700 Total Death Cases Reported 4,089 Cost Per Death Case Investigated $1,00254 Revenues (sales of records, public auctions, fee-for-service work) $415,70900 Total Costs (Ad Valorum* Taxes) Per Case Investigated $90087 As indicated elsewhere, this includes all investigative, administrative, scientific and expert witness costs to the County * Ad Valorum tax means according to value and refers to real property tax, used to fund local government expenditures 3

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15 COUNTY DEATHS FISCAL YEAR CASES RELEASED (2,686) Figure 1 CASES NOT REPORTED (2,118) CASES ACCEPTED (1,403) MANNER OF DEATH FISCAL YEAR JURISDICTION ON 1,403 CASES Figure 2 NATURAL (897) SUICIDE (106) HOMICIDE (96) UNDETERMINED (23) ACCIDENT (281) FISCAL YEAR Total Deaths in County 6,207* 6

16 Total Deaths Reported to the Office of the Chief Medical Examiner 4,089 Cases Reported, Investigated and Cleared by the Office of the Chief Medical Examiner for physician's signature 2,686 Medical Examiner's Cases 1,403 % County Deaths Reported 659 % % County Deaths Having Medical Examiner's Jurisdiction 226 % Cases Accepted by the Office of the Chief Medical Examiner (by manner of death) ** 1 Natural (NC) 897 (639%) 2 Accidents (ACC) 281 (200%) 3 Suicides (SUI) 106 ( 76%) 4 Homicides (HOM) 96 ( 68%) 5 Undetermined (UND) 23 ( 16%) Child Deaths SIDS 2 Child Abuse 1 Autopsy Index Full Autopsy 43% Partial Autopsy/External Examination/Record Review *** 57% Dispositions Authorized by the Medical Examiner Indigents and fetus dispositions 271 Adults 266 Infants 5 Inquests Held 0 Identification Persons brought to Medical Examiner's Office with insufficient identification 133 Persons subsequently identified by fingerprints, dental X-rays or other means 130 Persons interred as unidentified 3 Fingerprints taken and forwarded to FBI, CII, or SFPD 487 * This number represents cases registered with the San Francisco Department of Public Health during fiscal year ** The abbreviations following each manner of death will be used in most tables in this report *** Includes 131 indigent cases and 5 cases determined by record review, all of which were processed by a Medical Examiner s Investigator 7

17 EXAMINATION AND REFERRALS FISCAL YEAR Specimens submitted for Toxicology testing from living individuals: Human Performance Toxicology testing Type of Case Number of Cases Alleged Misdemeanor driving offense (DUI), single substance in blood (alcohol) 555 Alleged Felony driving offense (DUI), multiple substances in blood 217 Alleged drug facilitated sexual assault, multiple substances in urine 90 Alleged public intoxication, multiple substances in urine 113 General police suspect, multiple substances in blood 59 Forensic Urine Drug testing Police department, multiple substances in urine 225 Fire department, multiple substances in urine 64 Sheriff s department, multiple substances in urine 249 8

18 OFFICE OF THE CHIEF MEDICAL EXAMINER CASES FISCAL YEAR In fiscal year , there were 6,207 deaths registered in San Francisco County Of these deaths, 4,089 were reported to the Office of the Chief Medical Examiner The Medical Examiner's Investigators examined the previous medical history, circumstances surrounding the deaths and, in many cases, the scene of the death, and determined that 1,403 of these deaths came under the jurisdiction of this office (See Figure 1, page 5) Full or partial autopsies or external examinations were performed on all cases 1 The highest total number of deaths occurred in January 2005 The highest number for the various manners of death occurred during other months (eg, highest number of homicides in February 2005, the highest numbers of accidents in July and September 2004) See Table I and Figure 3, page 9 2 The racial distribution for each manner of death was quite variable For example, the value of the ratio of Whites/Blacks was 32 overall, 34 for accidents, 253 for suicides, and 07 for homicides See Table II, page 10 and Figure 5, Page 12 3 The age range distribution for each manner of death was also variable For example, the highest number of accidental deaths occurred in the year age group, and the highest number of homicides occurred in the year age group See Table III, page 10 4 The overall distribution of deaths by sex (ratio of male/female) was 22, but this varied by manner of death from 54 in deaths due to homicides to 21 in accidental deaths See Table IV and Figure 4, page 11 9

19 MEDICAL EXAMINER CASES FOR TABLE I MANNERS OF DEATH - MONTHLY COMPARISON Manner of Death Month of Death ACC HOM SUI NC UND TOTALS July August September October November December January February March April May June TOTALS , MONTHLY COMPARISON MANNER OF DEATH 30 NUMBER OF CASES JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN MONTH Figure 3 ACC HOM SUI 10

20 TABLE II MANNERS OF DEATH BY RACE Manner of Death Race ACC HOM SUI NC UND TOTALS White 185 (66%) 34 (35%) 76 (72%) 564 (63%) 16 (70%) 875 (62%) Black 54 (19%) 46 (48%) 3 (3%) 171 (19%) 3 (13%) 277 (20%) Asian 34 (12%) 12 (12%) 23 (22%) 122 (14%) 4 (17%) 195 (14%) Other / Unknown 8 (3%) 4 (4%) 4 (4%) 40 (4%) 0 56 (4%) TOTALS ,403 TABLE III MANNERS OF DEATH BY AGE Manner of Death Age Group ACC HOM SUI NC UND TOTALS 0-11 months years years years years years years years years years years years years Unknown TOTALS ,403 TABLE IV MANNERS OF DEATH BY SEX 11

21 Manner of Death Sex ACC HOM SUI NC UND TOTALS Male Female Unknown TOTALS ,403 90% MANNERS OF DEATH BY SEX % OF CASES 80% 70% 60% 50% 40% 30% 20% 10% 0% ACC HOM SUI NC UND OVERALL MANNER OF DEATH Figure 4 MALE FEMALE 12

22 MANNERS OF DEATH BY RACE NUMBER OF CASES Figure 5 ACC HOM SUI NC UND MANNER OF DEATH WHITE BLACK ASIAN OTHER YEARLY COMPARISON OF CASES BY MANNER OF DEATH 13

23 Comparisons of manners of death as well as methods used over the last ten fiscal years, where available, are presented in this section The most significant differences that have occurred over the last ten years that can be observed in these tabulations include: 1 The number of non-vehicular homicides (79) during fiscal year was the lowest number seen since The number of cases ruled to be non-vehicular accidents (243) was the lowest seen in the last 10 fiscal years (See Table V, Table VI and Figure 6, page 14 and Table X and Figure 10, page 18) 2 With respect to methods used in homicides, deaths from firearms account for the largest percentage of non-vehicular homicides (78% in ) (See Table VII, page 15 and Figure 24, page 49) 3 With respect to methods used in suicidal deaths, the numbers of deaths due to firearms and from drugs/medications/poisons were the lowest seen for those years where data were available in the last 10 fiscal years (See Table VIII, page 16 and Figure 24, page 49) 4 Regarding deaths ruled to be accidental, deaths caused by drugs/medications are the leading cause of death However, the number of deaths caused by drugs/medications in was the second lowest in the last 10 fiscal years for which data are available (See Table IX, page 17) 14

24 TABLE V YEARLY COMPARISON OF DEATHS BY MANNER Fiscal Year Manner of Death Accident* Homicide* Suicide* Natural 1,118 1,034 1,086 1, Undetermined TOTALS 1,731 1,563 1,657 1,561 1,445 1,397 1,435 1,463 1,410 1,346 * Vehicular related deaths are not included in above tabulation except for fiscal year TABLE VI YEARLY COMPARISON OF VEHICULAR RELATED DEATHS Fiscal Year Vehicular N/A MANNER OF DEATH COMPARISON BY FISCAL YEAR NUMBER OF CASES '95-'96 '96-'97 '97-'98 '98-'99 '99-'00 '00-'01 '01-'02 '02-'03 '03-'04 '04-'05 FISCAL YEAR Figure 6 ACCIDENT HOMICIDE SUICIDE Please note: For only, vehicular deaths are included in the accident or homicide totals TABLE VII YEARLY COMPARISON OF NON-VEHICULAR HOMICIDE METHODS USED 15

25 Fiscal Year Firearm Injury n/a n/a Sharp force injury n/a n/a Blunt force injury n/a n/a Asphyxia/Strang n/a n/a Other n/a n/a TOTALS n/a n/a = information not available 120 NON-VEHICULAR HOMICIDES COMPARISON BY YEAR 100 NUMBER OF CASES Figure 7 '95-'96 '96-'97 '97-'98 '98-'99 '99-'00 '00-'01 '01-'02 '02-'03 '03-'04 '04-'05 FISCAL YEAR 16

26 TABLE VIII YEARLY COMPARISON OF NON-VEHICULAR SUICIDE METHODS USED Fiscal year Method Used Fire n/a n/a CO Poisoning n/a n/a Sharp force injury n/a n/a Drowning n/a n/a Drugs/Medications/ n/a n/a Poisons Firearm injury n/a n/a Hanging n/a n/a Jump - Bay Bridge n/a n/a Jump - Building n/a n/a Jump - GG Bridge* n/a n/a Jump Other n/a n/a Suffocation/Asphyxia n/a n/a Other n/a n/a TOTALS n/a *Starting midway in fiscal year 91-92, most Golden Gate Bridge suicides were handled by Marin County n/a = information not available 160 NON-VEHICULAR SUICIDES COMPARISON BY YEAR 140 NUMBER OF CASES '95-'96 '96-'97 '97-'98 '98-'99 '99-'00 '00-'01 '01-'02 '02-'03 '03-'04 '04-'05 Figure 8 FISCAL YEAR 17

27 TABLE IX YEARLY COMPARISON OF NON-VEHICULAR ACCIDENTAL DEATH METHODS USED Fiscal year Method Used Asphyxia n/a n/a Aspiration n/a n/a Fire-related* n/a n/a Drowning n/a n/a Drug-related** n/a n/a Drugs/medications/ Poisons*** n/a n/a Falls n/a n/a Firearms n/a n/a Hanging n/a n/a Blunt force injury n/a n/a Therap Complication n/a n/a CO Inhalation n/a n/a Other n/a n/a TOTALS * Fire-related includes deaths due to thermal injuries and/or inhalation of smoke or products of combustion ** Drug-related includes accidental deaths related to drug and/or alcohol use *** Drugs/medications/poisons includes deaths in which the death is directly related to the exposure to the drug/medication/poison Please note: The accident total for includes accidental vehicular deaths n/a = information not available 350 NON-VEHICULAR ACCIDENTS COMPARISON BY YEAR 300 NUMBER OF CASES Figure 9 0 '95-'96 '96-'97 '97-'98 '98-'99 '99-'00 '00-'01 '01-'02 '02-'03 '03-'04 '04-'05 FISCAL YEAR 18

28 Table X NUMBER OF VEHICULAR FATALITIES BY TYPE Fiscal Year Situation Pedestrian* n/a n/a Bicycle Driver n/a n/a Auto Driver n/a n/a Auto Passenger n/a n/a Motorcycle Driver n/a n/a Motorcycle Pass n/a n/a Truck Driver n/a n/a Truck Passenger n/a n/a Other/Unknown n/a n/a TOTALS n/a *Pedestrian vehicular fatalities include those struck by motor vehicles, Muni, BART or train n/a = information not available VEHICULAR FATALITIES BY TYPE NUMBER OF CASES '95-'96 '96-'97 '97-'98 '98-'99 '99-'00 '00-'01 '01-'02 '02-'03 '03-'04 '04-'05 Figure 10 '04-'05 FISCAL YEAR PEDESTRIAN BICYCLE AUTO/TRUCK MOTORCYCLE OTHER/ UNKNOWN TABLE XI VIOLENT DEATHS 19

29 Of the 1,403 deaths investigated by the Medical Examiner's Office during , 506 were determined to be the result of violence Manner Total Number % of Medical Examiner Cases % of County Deaths ACCIDENT Vehicular Non-Vehicular SUICIDES Vehicular 2 01 Non-Vehicular HOMICIDE Vehicular Non-Vehicular UNDETERMINED Vehicular 0 0 Non-Vehicular VIOLENT DEATHS FISCAL YEAR TOTAL = 506 HOMICIDES (96) ACCIDENTS (281) Figure 11 SUICIDES (106) MANNER UNDETERMINED (23) 20

30 NON-VEHICULAR ACCIDENTAL DEATHS Two hundred and eighty-one (281) deaths were ruled to have been due to accidental means during the fiscal year Of these, 243 were non-vehicular accidental deaths The numbers of individuals dying by each manner of accidental death are indicated in Figure 12, page 21 and Table XII, page 22, and the percentages of total accidental deaths represented by each method are indicated on Table XII, page 22 Of the accidental death victims tested for alcohol and drugs (ie those in the hospital for less than 24 hours), 29% had significant levels of alcohol in their blood; 65% had at least one of the selected drugs present (See Table XII, page 22) Selected Drug Involvement (Table XIII, page 23) Overall, the number of times the three most common selected drugs were found to be present in nonvehicular accidental death cases was 149 (Note that more than one of the selected drugs may have been present in a single case) Of the deaths caused by the selected drugs, cocaine was seen most frequently (54 cases) Probable heroin overdoses were seen in 34 cases This determination was based primarily on circumstances and the presence of morphine, codeine and possibly 6-MAM (6-monoacetylmorphine, a heroin metabolite) in the drug screen Amphetamines were present in deaths caused by drugs in 35 cases These selected drugs may have played a role in accidental deaths due to falls and drowning (2 cases each) Racial Distribution (Figure 13, page 24 and Table XIV, page 24) Overall, non-vehicular accidental deaths occurred most frequently in Whites Deaths due to blunt force injuries occurred more frequently in Whites (100%) than would be anticipated by the overall involvement of Whites in accidental deaths (65%) Asians are much less involved in deaths due to drugs/medications/ poisons (2%) than would be expected by the involvement of Asians in accidental deaths (11%) and are much more heavily represented in deaths due to falls (24%) and asphyxia/suffocation (50%) Blacks are less heavily represented in deaths by falls (9%) than would be expected based on the general involvement of Blacks in all types of accidental deaths (20%) Age Distribution (Figure 14, page 25 and Table XV, page 26) There was 1 non-vehicular accidental death, which was due to drugs, in the age group from years during Falls were the most common cause of accidental deaths in people over 60 years of age (74% of all deaths due to falls were in this age group) Deaths due to drug/medication overdoses are concentrated in the year age group with 61% of all deaths due to drug/medication overdoses occurring in this age group Distribution by Sex (Table XVI, page 27) Males are 2 times as likely as females to be the victims of non-vehicular accidental deaths This difference is more pronounced in deaths that are drug/alcohol abuse related and is the reverse in deaths due to drowning 21

31 NON-VEHICULAR ACCIDENTS This category includes all unintentional fatalities There were 243 accidental deaths (nonvehicular) that accounted for 173% of the Medical Examiner death investigations for the fiscal year of ACCIDENTAL DEATH (NON-VEHICULAR) FISCAL YEAR *DRUGS/MEDS/POISONS FALLS **DRUG-RELATED TYPES OF DEATHS ***FIRE-RELATED THER COMPLICATION ASPHYXIA/SUFFOCATION OTHER DROWNING ASPIRATION BLUNT FORCE INJURY Figure 12 NUMBER OF CASES * Drugs/medications/poisons = accidental deaths in which the death is directly related to the exposure to the drug/medication/poison ** Drug-Related = includes accidental deaths with the cause of death related to drug and/or alcohol use *** Fire-Related = deaths due to thermal injuries and/or inhalation of smoke/products of combustion 22

32 TABLE XII NON-VEHICULAR ACCIDENTAL DEATHS BY METHOD Drug and Alcohol Involvement Method Number % Of Total Accidents % With Alcohol * # Positive (# Tested) Ave Alc Conc (g%) % With Drugs ** # Positive (# Tested) Asphyxia/Suffocation (of 2) (of 2) Aspiration (of 1) (of 1) Fire-Related*** (of 4) (of 4) Drowning (of 2) (of 2) Drug-Related 4* (of 14) (of 19) Drug/Med/Poison 5* (of 104) (of 108) Falls (of 21) (of 19) Blunt Force Injuries (of 0) (of 1) Ther Complication (of 1) (of 1) Other (of 4) (of 4) OVERALL (of 153) (of 161) * Refers to percentage of victims (of those tested) with positive blood ethyl alcohol levels ** Refers to percentage of victims (of those tested) with positive tests for one or more of the selected drugs (heroin, cocaine, and amphetamines) ***Fire-related = includes thermal injuries and/or inhalation of smoke/products of combustion 4 * Drug-related = includes accidental deaths with the cause of death related to drug and/or alcohol use 5 * Drug/medication/poison = includes accidental deaths in which the death is directly related to exposure to the drug/medication/poison It should be noted that a blood ethyl alcohol concentration of 008% is considered to be intoxicated when driving 23

33 TABLE XIII SELECTED DRUGS PRESENT IN NON-VEHICULAR ACCIDENTS Drug Method Cocaine Heroin* Amphetamines Asphyxia/Suffocation Aspiration Fire-Related** Drowning Drug/Medication/Poison*** Drug-Related**** Falls Blunt Force Injury Therapeutic Complication Other TOTALS NOTES: There may be more than one of the selected drugs present in a case Drugs were not tested for in every case Whether drugs are tested for or not depends upon the type of case, the length of time the person was hospitalized before death, and the contribution that drug test results will make in determining the cause and manner of death In some cases, drug testing is not performed Therefore the above figures will provide only a rough idea of the relative incidence of usage of these selected drugs in accidental deaths * Determination of the presence of heroin was based on a combination of factors including case history, witness statements, presence of drugs and/or paraphernalia at the scene, and detection of morphine, codeine and a specific heroin metabolite (6-monoacetylmorphine, 6- MAM) on the drug screen ** Fire-related = includes thermal injury and/or inhalation of smoke/products of combustion *** Drug/medication/poison = includes accidental deaths in which the death is directly related to the exposure to the drug/medication/poison ****Drug-related = includes accidental deaths with the cause of death related to drug and/ or alcohol use 24

34 TABLE XIV NON-VEHICULAR ACCIDENTAL DEATH METHODS USED BY RACE Race Method White Black Asian Other Total Asphyxia/Suffocation 2 (33%) 1 (17%) 3 (50%) 0 (0%) 6 Aspiration 1 (33%) 0 (0%) 2 (67%) 0 (0%) 3 Fire-Related* 5 (50%) 3 (30%) 2 (20%) 0 (0%) 10 Drowning 2 (67%) 0 (0%) 1 (33%) 0 (0%) 3 Drug-Related** 15 (65%) 6 (26%) 1 (4%) 1 (4%) 23 Drug/Medication/Poison*** 75 (66%) 31 (27%) 2 (2%) 5 (4%) 113 Falls 44 (65%) 6 (9%) 16 (24%) 2 (3%) 68 Blunt Force Injuries 3 (100%) 0 (0%) 0 (0%) 0 (0%) 3 Therapeutic Complication 7 (88%) 1 (12%) 0 (0%) 0 (0%) 8 Other 5 (83%) 1 (17%) 0 (0%) 0 (0%) 6 TOTALS 15 9 (65%) 49 (20%) 27 (11%) 8 (3%) 243 NOTE: Row percentages refer to percentages by race for each method These can be compared to total percentages for each race to see whether a method is more or less prevalent in a racial group For instance, deaths from falls appear to occur more frequently in Asians (24%) than the general involvement of Asians in accidental deaths (11%) Deaths from falls occur less frequently in Blacks (9%) than would be anticipated, based on the overall involvement of Blacks in accidental deaths (20%) *,**,*** - see previous page for definitions RACE OF NON-VEHICULAR ACCIDENT FATALITIES FISCAL YEAR BLACK (49) WHITE (159) ASIAN (27) Figure 13 OTHER (8) 25

35 AGE OF NON-VEHICULAR ACCIDENT FATALITIES FISCAL YEAR ' AGE IN YEARS NUMBER OF CASES Figure 14 26

36 TABLE XV NON-VEHICULAR ACCIDENTAL DEATH METHODS BY AGE Age Range - Years Method Ave Age Asphyxia (33%) (67%) Aspiration (33%) (67%) Fire-Related (10%) (20%) (40%) (30%) Drowning (33%) (33%) (33%) Drug-Related (22%) 6 (26%) 3 (13%) 9 (39%) Drugs/Meds/ Poisons (09%) 0 19 (17%) 16 (14%) 38 (34%) 30 (27%) 7 (6%) 2 (2%) Falls (1%) (7%) (4%) (13%) (12%) (22%) (40%) Blunt Force Injury 1 (33%) (33%) 1 (33%) Therapeutic Complication 1 (12%) (12%) 1 (12%) 0 2 (25%) 3 (38%) Other (33%) (33%) (17%) (17%) TOTALS % Of Total (1%) (04%) (11%) (12%) (21%) (21%) (8%) (10%) (16%) NOTE: Row percents refer to percentage by age range for each method These can be compared to total percentages for each age range to see if a method is more or less prevalent in an age group For example, asphyxia occurred more frequently in the 80+ year age group (67%) than the general involvement of this age group in accidents (16%) while falls in the year age group occurred less frequently (4%) than all accidents in this age group (21%) Regarding falls, 74% occurred in the age group , while 34% of all accidents occurred in this age group 27

37 TABLE XVI NON-VEHICULAR ACCIDENTAL DEATH METHODS BY SEX Method Male Sex Female Asphyxia 4 (67%) 2 (33%) Aspiration 3 (100%) 0 Fire-Related* 8 (80%) 2 (20%) Drowning 1 (33%) 2 (67%) Drug-Related** 14 (61%) 9 (39%) Drugs/Medications/Poisons*** 82 (73%) 31 (27%) Falls 42 (62%) 26 (38%) Blunt Force Injuries 2 (67%) 1 (33%) Therapeutic Complication 4 (50%) 4 (50%) Other 4 (67%) 2 (33%) TOTALS (% of Total) 164 (67%) 79 (33%) NOTE: Row percents refer to percentages by sex for each method These can be compared to total percentages for each sex to see whether a method is more or less prevalent in one sex For example, fire-related deaths appear to occur more frequently in males (80%) than the general involvement of males in accidental deaths (67%) while deaths caused by drowning occurred more frequently in females (67%) than all accidental deaths in females (33%) * Fire-Related = includes deaths cause by thermal injuries and/or inhalation of smoke/ products of combustion ** Drug-Related = includes accidental deaths with the cause of death related to drug and/or alcohol use *** Drugs/Medications/Poisons = includes accidental deaths in which the death is directly related to exposure to the drug/medication/poison 28

38 VEHICULAR DEATHS In , there were 57 vehicular fatalities in San Francisco The number of such fatalities by type is indicated in Figure 15, page 29 and Table XVII, page 30 Percentages of all vehicular fatalities by type are shown in Table XVII, page 30 The largest number of vehicular fatalities involved pedestrians; the second largest number involved automobile drivers Of the vehicular fatalities tested for alcohol (ie, those in the hospital for less than 24 hours), motorcycle drivers had the highest average blood ethyl alcohol concentration (025%) Selected Drug Involvement (Table XVIII, page 30) Amphetamines were the selected drugs seen most frequently in vehicular fatalities (4 cases) Age Distribution (Table XIX, page 31, Table XX, page 32, and Figure 16, page 31) Deaths of motorcycle drivers in the year age group occur more frequently (40%) than the general involvement of this age group in vehicular fatalities (23%) Distribution by Sex (Table XX, page 32) Overall, males were the predominant victims of vehicular fatalities (65%) Racial Distribution (Table XX and Figure 17, page 32) Overall, vehicular fatalities occur most frequently in White non-hispanics (58%) Blacks were represented more heavily among deaths of auto passengers (38%) than would be expected by their involvement in all vehicular fatalities (11%) 29

39 VEHICULAR DEATHS In San Francisco, there were 57 vehicle-related fatalities (38 accidents, 17 homicides, and 2 suicides) accounting for 41% of the Medical Examiner death investigations for the fiscal year TYPES OF VEHICULAR DEATHS FISCAL YEAR PEDESTRIANS(30) UNKNOWN (2) MOTORCYCLE (5) BICYCLE (1) AUTO (19) Figure 15 30

40 TABLE XVII VEHICULAR FATALITIES IN Drug and Alcohol Involvement Method Number % W/ Alc* # Positive (# Tested) Ave Alc Conc (g%) % With Drugs** # Positive (# Tested) % W/ Drugs & Alcohol # Positive (# Tested) Pedestrian 30 (53%) 6% 1 (of 16) % 2 (of 17) 0% 0 (of 16) Auto Driver 11 (19%) 80% 8 (of 10) % 4 (of 10) 20% 2 (of 10) Auto Passenger 8 (14%) 40% 2 (of 5) 012 0% 0 (of 6) 0% 0 (of 5) Other/Unknown 2 (4%) 0% 0 (of 1) (of 0) - 0 (of 0) Motorcycle Driver 5 (9%) 75% 3 (of 4) 025 0% 0 (of 5) 0% 0 (of 4) Bicycle Driver 1 (2%) - 0 (of 0) (of 0) - 0 (of 0) TOTALS 57 39% 14 (of 36) % 6 (of 38) 6% 2 (of 35) * Refers to percentages of fatalities (of those tested) with positive blood ethyl alcohol levels ** Refers to percentage of fatalities (of those tested) with positive blood tests for one or more of the selected drugs (heroin, cocaine, and amphetamines) TABLE XVIII SELECTED DRUGS PRESENT IN VEHICULAR FATALITIES Drug Situation Cocaine Heroin* Amphetamines Pedestrian Auto Driver Auto Passenger Motorcycle Driver Bicycle Driver TOTALS * Determination of the presence of heroin was based on case history, witness statements, presence or evidence of drugs or paraphernalia at the scene of death, history of heroin use and detection of morphine and codeine and possibly a heroin metabolite in the blood and/or urine 31

41 TABLE XIX VEHICULAR FATALITIES BY AGE Age Range - Years Situation Pedestrian (20%) (3%) (17%) (30%) (13%) (17%) Auto Driver (9%) (36%) (27%) (27%) Auto Passenger (12%) (12%) (38%) (12%) (12%) (12%) Motorcycle Driver (40%) (20%) (20%) (20%) Bicycle Driver (100%) Other/Unknown (50%) TOTALS % Of Totals (2%) (2%) (7%) (23%) (11%) (5%) (16%) (18%) (7%) (11%) NOTE: Row percents refer to percentages by age group for each situation These can be compared to total percentages for each age group to see if a situation is more or less prevalent in an age group For example, deaths of auto drivers in the year age group occur more frequently (36%) than the general involvement of this age group in vehicular fatalities (23%) Pedestrian fatalities are more prevalent in the 60+ age group (60%) than the general involvement of this age group in all vehicular fatalities (36%) AGE 0-5 ' VEHICULAR DEATHS BY AGE FISCAL YEAR Figure 16 NUMBER OF CASES 32

42 TABLE XX DEMOGRAPHICS OF VEHICULAR FATALITIES Sex Race Age Situation M F W-NH W-H B-NH A Other Average Pedestrian (70%) (30%) (67%) (7%) (3%) (23%) Auto Driver (73%) (27%) (36%) (18%) (18%) (18%) (9%) Auto Passenger (25%) (75%) (38%) (38%) (25%) Motorcycle Driver (80%) (20%) (80%) (20%) Bicycle Driver (100%) (100%) Other/Unknown (50%) (50%) (50%) (50%) Totals % of Totals (65%) (35%) (58%) (7%) (11%) (23%) (2%) NOTE: Row percentages refer to percentage by demographic characteristics for each situation These can be compared to total percentage for each characteristic to see whether a situation is more or less prevalent in any one characteristic For example, accidental deaths of motorcycle drivers occur more frequently in males (80%) than the general involvement of males in vehicular fatalities (65%) Also, deaths of pedestrians occur less frequently in Black non-hispanics (3%), than the general involvement of Black non- Hispanics in vehicular fatalities (11%) RACE OF VEHICULAR FATALITIES FISCAL YEAR WHITE NON- HISPANIC (33) ASIAN (13) Figure 17 OTHER (1) WHITE HISPANIC (4) BLACK(6) 33

43 SUICIDES The determination of suicide as a manner of death represents the summation of scene investigation, including a review of psychological state, autopsy, pathology, toxicology and, frequently, other investigation The Office of the Chief Medical Examiner routinely performs toxicology testing on multiple organs and/or body fluids in order to evaluate the metabolic status of a drug or drugs in order to help understand the case Realizing the immense emotional impact on family, the diagnosis of suicide is never made lightly and always represents a decision made on the basis of data sufficient to defend that decision in a court of law, if necessary NON-VEHICULAR SUICIDAL DEATHS 34

44 One hundred and four (104) deaths were ruled to have been due to non-vehicular suicide during the fiscal year and are the basis for the tabulations in this section The number of individuals dying by each method of suicide are presented in Figure 18, page 35, and Table XXI, page 36, and the percentages of all suicidal deaths by type are indicated in Table XXI, page 36, along with alcohol and drug involvement for each mode Selected Drug Involvement (Table XXII, page 36) One or more of the selected drugs (heroin, amphetamines and cocaine) were present 28 times in non-vehicular suicidal deaths in The selected drugs seen most frequently in non-vehicular suicidal deaths were cocaine (7 times), amphetamines (18 times) and heroin (3 times) These selected drugs were associated more frequently with deaths caused by drug/medication/poison overdose than with any other means of suicide Racial Distribution (Table XXIII and Figure 19, page 37) Deaths from non-vehicular suicide occurred most frequently in Whites (71% of total suicides) The White racial group has been divided into Hispanic and non-hispanic in this tabulation It can be seen that the White non-hispanic group was involved in 69% of all non-vehicular suicides but in 85% of all suicides by drug/medication/poison overdose and 91% of firearm injuries Age Distribution (Table XXIV, page 38, Table XXV, page 39 and Figure 20, page 39) There were no deaths by non-vehicular suicide in the year age group during this fiscal year The year age group had the highest number of non-vehicular suicides of any age group with deaths from drug/medication/poison overdoses, firearm injuries and hanging constituting more than 80% of the total in this age group Distribution by Sex (Table XXVI, page 40) Males were more likely than females to commit suicide in (70% male, 30% female) 35

45 NON-VEHICULAR SUICIDES Suicides are self-inflicted deaths In San Francisco, the 104 suicides which are being tabulated account for 74% of the Office of the Chief Medical Examiner death investigations for the fiscal year of SUICIDE METHODS IN FISCAL YEAR HANGING DRUG/MED/POISON JUMP-BUILDING FIREARM INJURIES TYPES OF DEATHS ASPHYXIA/SUFFOCATION JUMP-OTHER JUMP-BAY BRIDGE SHARP FORCE INJURIES DROWNING CO POISONING FIRE-RELATED OTHER Figure 18 NUMBER OF CASES 36

46 TABLE XXI NON-VEHICULAR SUICIDAL DEATHS BY METHOD Selected Drug and Alcohol Involvement* Method Number % Of Total Suicides % With Alcohol* # Positive (# Tested) Ave Alc Conc (g%) % W/Selected Drugs** # Positive (# Tested) Asphyxia/Suffocation (of 7) Fire-Related (of 1) Drowning (of 3) Sharp Force Injuries (of 3) Drug/Med/Poison (of 17) Firearm Injuries (of 9) Hanging (of 20) Jump Building (of 16) Jump - Bay Bridge (of 3) Jump Other (of 6) CO Poisoning (of 2) Other (of 0) TOTALS (of 87) * Refers to percentage of fatalities (of those tested) with positive blood ethyl alcohol levels **Refers to percentage of fatalities (of those tested) with positive blood or urine tests for one or more of the selected drugs (heroin, cocaine and amphetamine) TABLE XXII SELECTED DRUGS PRESENT IN NON-VEHICULAR SUICIDAL DEATHS Drugs (of 7) (of 1) (of 3) (of 3) (of 19) (of 9) (of 21) (of 17) (of 3) (of 6) (of 2) (of 0) (of 91) Situation Cocaine Heroin Amphetamines Asphyxia/Suffocation Fire-Related Sharp Force Injuries Drowning Drug/Medication/Poison Firearm Injuries Hanging Jump Building Jump - Bay Bridge Jump Other CO Poisoning Other TOTALS

47 TABLE XXIII NON-VEHICULAR SUICIDE METHODS BY RACE Race Method W-NH W-H B-NH ASIAN OTHER TOTALS Asphyxia/Suffocation 6 (75%) (25%) 0 8 Fire-Related (100%) Sharp Force Injuries 3 (100%) Drowning 1 (33%) Drug/Medication/Poison 17 (85%) Firearm Injuries 10 (91%) Hanging 16 (55%) Jump - Building 12 (71%) Jump Bay Bridge 1 (33%) Jump - Other 4 (67%) CO Poisoning 2 (100%) (67%) 0 1 (5%) 1 (5%) (9%) 1 (3%) 1 (6%) 1 (3%) 9 (31%) 0 4 (24%) (67%) 0 1 (17%) 1 (17%) (5%) (7%) Other (100%) 0 1 TOTAL NUMBER % OF TOTALS (69%) (2%) ( 3%) (22%) (4%) NOTE: Row percentages refer to percentages by race for each method These can be compared to total percentages for each race to see whether a method is more or less prevalent in a racial group For instance, suicides by drowning appear to occur more frequently in Asians (67%) than the general involvement of Asians in suicides (22%), and deaths by firearms in White non-hispanics (91%) occur more frequently than all suicides in White non-hispanics (69%) RACE OF NON-VEHICULAR SUICIDE VICTIMS WHITE HISPANIC 2% OTHER 4% WHITE NON- HISPANIC 69% BLACK 3% Figure 19 ASIAN 22% TABLE XXIV NON-VEHICULAR SUICIDE METHODS BY AGE 38

48 Age Range - Years Method ? Asphyxia/Suffocation (12%) (38%) (12%) (12%) (12%) (12%) Fire-Related (100%) Sharp Force Injuries (33%) (33%) (33%) Drowning (33%) (33%) (33%) Drug/Med/Poison (5%) (10%) (45%) (15%) (10%) (5%) (5%) (5%) Firearm (27%) (18%) (18%) (18%) (18%) Hanging (7%) (17%) (14%) (21%) (24%) (3%) (10%) (3%) Jump Building (6%) (12%) (18%) (29%) (18%) (6%) (12%) Jump - Bay Bridge (67%) (33%) Jump Other (33%) (17%) (33%) (17%) CO Poisoning (50%) (50%) Other (100%) 0 0 TOTAL NUMBER % OF TOTAL (0%) (4%) (12%) (18%) (25%) (15%) (8%) (7%) (9%) (2%) (1%) NOTE: Row percents refer to percentage by age range for each method These can be compared to total percentages for each age range to see if a method is more or less prevalent in an age group For example, death by asphyxia appears to occur more frequently in the years of age group (38%) than the general involvement of this age group in suicides (18%), and deaths by hanging in the year age group (24%) occur more frequently than suicides by all means in this age group (15%) 39

49 NON-VEHICULAR SUICIDES TABLE XXV AGE RANGES - COMPARISON BY YEAR* Age Range Years n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Unknown n/a n/a TOTALS * Except for fiscal year , totals do not include vehicular deaths ruled to be suicide n/a = information not available NON-VEHICULAR SUICIDE VICTIMS BY AGE FISCAL YEAR AGE IN YEARS Figure 20 NUMBER OF CASES 40

50 TABLE XXVI NON-VEHICULAR SUICIDE METHODS BY SEX Method Male Sex Female Asphyxia/Suffocation 5 (62%) 3 (38%) Fire-Related 1 (100%) 0 Sharp Force Injuries 3 (100%) 0 Drowning 3 (100%) 0 Drug/Medication/Poison 10 (50%) 10 (50%) Firearm Injuries 11 (100%) 0 Hanging 20 (69%) 9 (31%) Jump Building 13 (76%) 4 (24%) Jump - Bay Bridge 1 (33%) 2 (67%) Jump Other 4 (67%) 2 (33%) CO Poisoning 1 (50%) 1 (50%) Other 1 (100%) 0 TOTALS 73 (70%) 31 (30%) NOTE: Row percents refer to percentages by sex for each method These can be compared to total percentages for each sex to see whether a method is more or less prevalent in one sex For example, deaths by firearms appear to occur more frequently in males (100%) than the general involvement of males in suicides (70%), while females die from drug/medication/poison overdoses more frequently (50%) than all suicides in females (30%) 41

51 HOMICIDE Homicide is the death of a human being due to the actions of another Murder is the unlawful killing of a human being with malice The following data do not differentiate homicide as to whether it was justifiable, accidental, or murder Such distinctions are the proper function of the judicial system and are not the responsibility or function of this office Any judicial system that deals with crimes involving death requires a well-trained staff and wellequipped Medical Examiner's Office that can and will interpret forensic findings in an unbiased, fair manner Their investigation must be intense, accurate and rapid enough so that charges may be pursued or dismissed without unfairly affecting an individual's constitutional rights That is the purpose of this office The proper evaluation and investigation of a homicide begins, naturally, at the scene In the majority of cases, a staff member of this office (either the Investigator, Medical Examiner s Administrator, or Medical Examiner), determines whether a death is potentially a homicide The Medical Examiner s Investigator responds to the scene of death and helps to determine whether the Police Homicide Detail will be called This office is responsible for the body, identification, inquiry into circumstances, cause and manner of death (Gov Code ) In addition to the scene investigation, the Medical Examiner s Investigator is responsible for recovering property, locating and notifying next of kin, and preparing a written summary of his/her investigation In about one-third to one-half of all homicides, a forensic pathologist will respond to the scene to aid in the investigation The subsequent autopsy may also use photography, fluoroscopy, X-ray, alternate light sources and other techniques to establish and define the number, nature and severity of wounds, to obtain evidence (ie, bullets) and to prepare an official report This report, including histology, chemistry and toxicology results, is used as part of the prosecution or defense of the case in the formal judicial hearing Pertaining to criminal trial, our judicial system requires identification of an individual and presentation of evidence, usually by virtue of expert testimony, relative to the cause of death or trauma associated with death The Office of the Chief Medical Examiner identifies the body, frequently relying on local police, CII, or FBI fingerprints Expert forensic testimony is provided by the Forensic Pathologist from this office In addition, the Forensic Toxicologist is frequently called upon to testify on the significance and effect of various drug levels, a matter of great importance when dealing with the concept of diminished capacity or impairment Of minor, but increasing importance, is the fact we are seeing more homicide and trauma cases transferred into the County for medical therapy because of San Francisco's excellent and advanced medical facilities If these individuals should die, the autopsy and court testimony are provided by this office NON-VEHICULAR HOMICIDE DEATHS 42