THE EL PASO COUNTY CORONER S OFFICE EL PASO COUNTY CORONER S OFFICE 2017 ANNUAL REPORT

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Victor Arnold
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1 EL PASO COUNTY CORONER S OFFICE 07 ANNUAL REPORT

2 0 The Coroner s Office (EPCCO) serves El Paso County by investigating all sudden, unexpected, and non-natural deaths. While many natural deaths can be certified by the decedent s physician, approximately one quarter of deaths require further investigation to determine cause and manner of death and ensure public health and safety. In addition to performing 90 autopsies on El Paso County Deaths, the office performed 33 autopsies for a fee for 9 surrounding counties TOTAL DEATHS INVESTIGATED 498 AUTOPSIES PERFORMED In 07, the Coroner s Office staff consisted of four board certified forensic pathologists including the county s elected Coroner Robert Bux, M.D., Deputy Chief Medical Examiner Leon Kelly, MD and Associate Coroners Dan Lingamfelter, D.O., and Emily Berry, M.D., as well as three full-time and two parttime administrative staff, eight full-time death investigators, four full-time toxicologists, one full-time histologist, and three full-time and two part-time morgue technicians.

0 Why Perform an Autopsy? Colorado Revised Statute 30.0.0 describes the

A complete forensic investigation provides the cause and manner of how an

The investigation can assist in settling insurance and estate claims as well

Identifying cause and manner of death is a critical component of ensuring

The surviving family and general public can have peace of mind that a

It is the responsibility of the Coroner s Office to identify the decedent

In many cases, identification and next-of-kin notification can be quickly

However, in cases of burns, extensive injury, or decomposition this can

3 0 Why Perform an Autopsy? Colorado Revised Statute describes the roles and responsibilities of the coroner in investigating deaths. A complete forensic investigation provides the cause and manner of how an individual died. The investigation can assist in settling insurance and estate claims as well as the implementation of civil and criminal actions. Identifying cause and manner of death is a critical component of ensuring public health and safety. The surviving family and general public can have peace of mind that a thorough investigation was completed. It is the responsibility of the Coroner s Office to identify the decedent and notify next-of-kin. In many cases, identification and next-of-kin notification can be quickly achieved. However, in cases of burns, extensive injury, or decomposition this can prove more challenging. Our office ensures all leads have been exhausted in pursuit of identification and notification. At the time of this report, body from 07 is still awaiting positive identification. Any identified but unclaimed bodies are released to the Public Administrator. MEANS OF IDENTIFICATION Visual 84 Dental 7 Fingerprints 40 X-ray No individuals were identified using DNA during 07

4 03 What is an Autopsy? An autopsy can encompass several levels of examination: cases in 07 were external only examinations, in which the cause and manner are well established by the external examination* and a thorough medical history. of the 07 examinations were partial autopsies and typically consisted of head only examinations to ensure that head trauma didn t cause or contribute to death. 8 Examinations included a full internal exam in which each organ and body cavity is examined and is considered a complete autopsy. 87% % of cases had toxicology testing performed. Samples are always collected, but testing is performed at the discretion of the physician. 40 autopsies required death scene investigations. El Paso County Coroner s Office does not perform Hospital Autopsies. El Paso County Coroner s Office did not perform any exhumations in 07. *External Examination Every autopsy includes a thorough examination of the outside of the decedent s body documenting changes of natural disease, identifying marks and scars, medical treatment, injuries, and an inventory of clothing and property. Average time to completion Average number of days from autopsy to report completion during 07 is days. 9 cases (<%) took greater than 0 days to complete due to their complexity or ongoing investigation.

5 04 What Deaths are Investigated? Colorado Revised Statutes (C.R.S) mandate that the following deaths are reported and investigated by the coroner: // Sudden, unexpected, or non-natural // No physician available to certify the death // Industrial accidents // Deaths in the custody of law enforcement or in the care of a public institution // Deaths due to contagious diseases // All unexplained deaths The responsibility of the Coroner: // Pronounce death // Determine cause and manner of death // Identify human remains // Notify next-of-kin // Perform an investigation into a death independent of law enforcement // Collect evidence on or in the body // Secure a decedent s property for next-of-kin // Provide expert testimony // Grant tissue/organs for donation

6 0 07 Revenue for El Paso County Coroner s Office Grant for Violent Death Reporting $3,8 Out-of-County Autopsy Fees $43,00 Out-of-County Toxicology Fees $89,730 Miscellaneous Fees $,03.7 Total Revenue for 07 $30,78.7 El Paso County Citizen Cost Breakdown 07 Population* 99,3 Total 07 Budget $,474,9 $,474,9.00 (Budget) - $30,78.7 (Revenue) $,943,900. Overall Cost to Citizens 99,3 (Population) = $.78 Annual cost to each El Paso County Citizen *US Census Bureau (July, 07)

7 0 Overall Breakdown of Autopsies Performed by the El Paso County Coroner s Office ALAMOSA 8 49 FREMONT BACA 9 HUERFANO BENT 8 KIOWA CHAFFEE 3 8 MINERAL CONEJOS 4 OTERO COSTILLA 0 PARK CROWLEY 8 PROWERS CUSTER RIO GRANDE EL PASO 90 7 SAGUACHE ELBERT 40 TELLER, TOTAL CASES

8 07 Manner of Death There are five manners of death that can be listed on a Colorado Death Certificate. Natural - Deaths due solely to disease or aging Accident - Deaths due to unintentional injury Suicide - Deaths due to an intentional self-inflicted injury Homicide - Deaths due to the intentional injurious action of another individual Undetermined - Deaths in this category may or may not have a determined cause of death, or may have several different possible manners. Unclassified - Death of a fetus in utero (in the uterus) does not receive a manner determination 07 El Paso County Breakdown Natural (34%) Unclassified (.4%) Accident (4%) Suicide (8%) Homicide (%) Undetermined (.%)

9 08 Deaths Due to Natural Diseases 308 Total Cardiovascular Chronic Alcohol Pulmonary Embolism Infections Cerebrovascular Morbid Obesity 9 Diabetes Pulmonary Disease Global Geriatric Decline Congenital 8 7 Epilepsy Cancer Complications of Pregnancy Gastrointestinal Liver Disease 4 3 Other 0 Significant Contributing Causes These are diseases that are most commonly listed as significant contributing factors in death alongside those causes listed above. Cardiovascular Obesity Diabetes Pulmonary Disease 48 3 Chronic Alcohol 8 Smoking 8

09 Deaths Due to Accidents Motor Vehicle Accidents Drugs Falls Pedestrian Injury Asphyxias Drowning Choking Fires/Burns Carbon Monoxide Wind Acute Alcohol

10 09 Deaths Due to Accidents Motor Vehicle Accidents Drugs Falls Pedestrian Injury Asphyxias Drowning Choking Fires/Burns Carbon Monoxide Wind Acute Alcohol Intoxication Train Bicycle Injuries Others 378 Total Blunt Force Injuries Breakdown Falls Wind Motorcycle Bicycle Motor Vehicle (Cars) Train Pedestrian 0 0 0

0 Motor Vehicle Crashes Type of Vehicle Sedan SUV Motorcycle Truck Mini Van Other/Unknown 0 0 7 Type of Collision Front Side Rear

was failure to use a seatbelt Suspected Primary Cause of Crash Operator Error Reckless Driving/Excessive Speed Unknown Drugs/Alcohol

11 0 Motor Vehicle Crashes Type of Vehicle Sedan SUV Motorcycle Truck Mini Van Other/Unknown Type of Collision Front Side Rear Rollover Unknown 3 9 Use of Restraint/seatbelt Yes No Unknown Motorcycle *In every crash that the decedent was ejected there was failure to use a seatbelt Suspected Primary Cause of Crash Operator Error Reckless Driving/Excessive Speed Unknown Drugs/Alcohol Asleep Natural Event Road Hazard *Of the 34 fatal crashes where the decedent was the at fault driver had drugs or alcohol in their autopsy

Drug Related Accidental Deaths Cocaine Heroin Heroin + Fentanyl Methamphetamine Heroin + Methamphetamine Cocaine + Heroin Heroin, Cocaine + Methamphetamine Cocaine + Methamphetamine Methamphetamine +

12 Drug Related Accidental Deaths Cocaine Heroin Heroin + Fentanyl Methamphetamine Heroin + Methamphetamine Cocaine + Heroin Heroin, Cocaine + Methamphetamine Cocaine + Methamphetamine Methamphetamine + Prescription Opioids Prescription Opioids Cocaine + Non-Opioid Prescription Drugs Non-Opioid Prescription Drugs MDMA Total Opioids Heroin Oxycodone Hydrocodone Fentanyl Morphine Tramadol Oxymorphine Methadone Mixed Rx Opioids Mixed Rx Opioids with Methamphetamine 9 Total

07 Drug Related Death Facts 8% % The average age Of medication used in the

Percentage of the accidental deaths that were male at death (range of 9-88

addiction Have a history of mental illness Death scene investigations

of all causes that have marijuana metabolites present at autopsy Percentage

13 07 Drug Related Death Facts 8% % The average age Of medication used in the overdose was prescribed by the decedent s physician. Percentage of the accidental deaths that were male at death (range of 9-88 years) old) 4 YEARS 7% 9% 3% v Have a prior history of substance abuse or addiction Have a history of mental illness Death scene investigations revealed drugs, drug paraphernalia or medications of abuse v 0% % 0 Deaths of all causes that have marijuana metabolites present at autopsy Percentage of the accidental opioid deaths that were heroin v Total number of opioid related deaths (suicide and accidental)

3 Deaths Due to Homicide 4 Total Firearms Sharp Force Injuries Blunt Force Injuries Neglect Physical restraint 30 Apparent Circumstances of the Homicides

14 3 Deaths Due to Homicide 4 Total Firearms Sharp Force Injuries Blunt Force Injuries Neglect Physical restraint 30 Apparent Circumstances of the Homicides Altercation Domestic Violence 8 Unknown 3 While committing another crime Officer involved 4 Abuse/Neglect Hit + run motor vehicle collision Gang Related Reckless use of firearm

15 4 Deaths Due to Suicide Firearms Ligature Sharp Force Injury Asphyxia Fall Drugs Other Total Drugs Used in Suicide Opioids 0 Other 4 Anti-convulsants Mixed alcohol and non-opioids 3 Anti-depressants Benzodiazepines 07 Suicide Facts 43 % 0% 4% 3% Average age at death (Range of - 99 years) Notes or social media posts indicating suicidal intentions Have a reported history of prior mental illness Intoxicated with drugs or alcohol at the time of death Have a history of prior suicide attempts 7% of completed suicides were male of firearm deaths used their 7% personal weapon Three most common risk factors: recently ended relationship, financial struggles, and personal health crisis

16 Child Fatalities 3 Total El Paso County Coroner s Office investigated the deaths of 3 children (below the age of 8 years old). These cases are individually reviewed by the El Paso County Child Fatality Review Team to identify strategies to prevent these types of deaths in the future. Age Fetus < Year -4 Years - Years Teen Suicides (Ages -7 Years) Gender Male: 9 Female: 4 Hanging Firearms 4 Drugs Asphyxia Breakdown Natural Homicides Suicides Pedestrian struck by motor vehicle Infant unsafe sleep/asphyxia Undetermined Drowning Motor vehicle accident Fetal death Other When the Suicides Occurred JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Infant Asphyxias Total Deaths due to an unsafe sleep surface Deaths due to bed sharing with adults 4

donation 9 Organs were transplanted from El

17 Organ Donation In 07: 0 El Paso County donors had organs recovered for transplantation 7 of the 0 Were coroner jurisdiction cases and all were approved for donation 9 Organs were transplanted from El Paso County donors El Paso County tissue donor cases fell under the coroner s jurisdiction 3 Cases resulted in tissue harvest There were no refusals of requests

TABLE OF CONTENTS INTRODUCTION 1 -SUMMARY OF CONTENTS 2 -DEATHS REPORTABLE TO THE CORONER 3 INVESTIGATIONS, CORONER CASES AND AUTOPSIES 6

TABLE OF CONTENTS INTRODUCTION 1 -SUMMARY OF CONTENTS 2 -DEATHS REPORTABLE TO THE CORONER 3 INVESTIGATIONS, CORONER CASES AND AUTOPSIES 6 -SUMMARY OF REPORTABLE DEATHS 7 -SUMMARY OF INVESTIGATIONS 5-YEARS