MACOMB COUNTY MEDICAL EXAMINER

MACOMB COUNTY MEDICAL EXAMINER Annual Report Daniel J. Spitz, M.D. Chief Medical Examiner

Table of Contents LETTER FROM THE MANNER OF DEATH - NATURAL. MEDICAL EXAMINER Natural Cases by Age/Gender... Natural Cases by Case Reports. LAWS GOVERNING THE MEDICAL Natural by Age/Means.. EXAMINER S OFFICE. Natural Cases by Race/Gender.. MISSION STATEMENT. MANNER OF DEATH ACCIDENT 5 Accident Cases by Age/Gender. 5 ORGANIZATIONAL CHART. Accident Cases by Case Reports 5 Accident Cases by Age/Mean. 6 BUDGET... Accident Cases by Race/Gender 6 MEDICAL EXAMINER FACILITY. 5 MANNER OF DEATH SUICIDE. 7 MACOMB COUNTY DEMOGRAPHICS...6 Suicide Cases by Age/Gender 7 Suicide Cases by Case Report 7 ACTIVITIES OF THE MEDICAL Suicide Cases by Age/Mean... 8 EXAMINER.. 7 Suicide Cases by Race/Gender.. 8 Operations.. 7 Mass Disaster Preparation.. 7 Infant/Child Death Review Team 7 MANNER OF DEATH HOMICIDE... 9 Gift of Life 7 Homicide Cases by Age/Gender.9 TOTAL CASES FOR.. 8 Homicide Cases by Case Reports. 9 Homicide Cases by Age/Mean CREMATION PERMITS..9 Homicide Cases by Race/Gender.. MANNER OF DEATH. MANNER OF DEATH INDETERMINATE Manner of Death Age/ Gender. Indeterminate Cases by Age/Gender. Manner of Death Case Reports.. Indeterminate Cases by Case Reports.. Manner of Death Age/Means. Indeterminate Cases by Age/Mean Manner of Death Race/Gender Indeterminate Cases by Race/Gender..

Macomb County Medical Examiner Daniel J. Spitz, M.D. 585 Elizabeth Road, Mt. Clemens, Michigan 8 Tel: (586) 69-5 * Fax (586) 69-666 To the Macomb County Executive and the Citizens of Macomb County: The Medical Examiner s duty is to investigate deaths which occur in the county to determine the cause and manner of death. In we again surpassed the number of deaths investigated over previous years. When compared to, the workload showed a.9% increase in the number of deaths investigated. The number of cremation permits has also increased by 6%. We expect to see these numbers continually rise as they have progressively gone up over the past several years. In, the Medical Examiner s Office investigated 789 deaths, performed 65 forensic examinations and issued 78 cremation permits. Additionally, 76 home hospice deaths were reported to the Medical Examiner s Office. There was a 7.5% increase in the number of deaths related to natural disease and also a.5 % increase in the number of suicide investigations, the number of homicides decreased by.6% and the number of accidents decreased by.8%. Drug related deaths have been at an all time high for the past few years. Abused prescription medications and heroin and cocaine abuse continue to be major concerns here in Macomb County. We continue to support the efforts of the Gift of Life Organ and Tissue Procurement Agency and the Michigan Eye Bank and in we entered into a collaborative agreement. As part of the agreement the Medical Examiner staff evaluates and reports deaths that may meet donor criteria. It is hoped that this agreement will benefit the citizens of Macomb County, the Gift of Life Agency and Michigan Eye Bank. I would like to thank the Macomb County Executive for his continued support which enables the Medical Examiner staff to provide this valuable and necessary service to the citizens of Macomb County. I am pleased to present you with the Macomb County Medical Examiner s Annual Report Respectfully Submitted, Daniel J. Spitz, M.D. Chief Medical Examiner

Laws Governing the Medical Examiner s Office Act 89 of 95, MCL 5.-5.6, requires Macomb County and every Michigan county to appoint a county medical examiner who is a physician licensed by the State of Michigan to carry out the duties and functions specified in the Act, including being in charge of the office of the county medical examiner and promulgating rules relative to the conduct of his office. The primary role of a county medical examiner is to determine the cause of death and the manner of death in cases where death has occurred violently, accidentally, unexpectedly, or without medical attendance, ascertaining identity of decedent and notifying the next of kin. The county medical examiner has broad powers and specific responsibilities to act under the aforementioned section of State law to carry out that mission. Act 8 of 95, MCL Section 5. 5.6 MISSION STATEMENT The mission of the Macomb County Medical Examiner s Office is to provide medicolegal investigations into all deaths requiring a public inquiry to determine and record the cause and manner of death for all decedents families and the legal and medical communities in accordance with the highest level of professionalism, compassion and efficiency.

Organization Chart Macomb County Medical Examiner s Office The Medical Examiner is appointed by the Macomb County Executive for a year term. Chief Medical Examiner Daniel J. Spitz, M.D. Board Certified Clinical, Anatomic and Forensic Pathologist Chief Medical Examiner Investigator Deputy Medical Examiners Typist Clerk III Forensic Investigator (6 FTE s) Morgue Specialist ( FTE s) Budget Macomb County Medical Examiner s Office Revenues Expenses,,56.,,56.

Macomb County Medical Examiner s Facility The Medical Examiner facility was built in 7 and has a 6 square foot morgue with a discrete viewing area for families, a degree walk-in cooler, four autopsy stations, digital X-ray equipment and a special dissection room for decomposed/infectious cases. 5

Macomb County Demographics Macomb County is located in southeastern Michigan and comprises the northeastern portion of the Detroit metropolitan area. Macomb County is the ninth smallest of Michigan s 8 counties with 79 square miles yet it ranks third in population with 8,978 residents, an increase of population of 6.7% since (788,9). Among the County s 7 municipalities are three of the ten largest communities in Michigan; Warren ( rd ), Sterling Heights (6 th ), and Clinton Township ( th ). CENSUS SUMMARY PROFILE %change %change Numbers Percent White 7,88 75,69 -. 9.59 8.9-8.8 Black or African American,5 7,5.66.68 8.57 9.6 Hispanic or Latino,6 9,95 5.56.58.7.9 American Indian and Alaska Native,55,5.6.9.8 -.9 Asian 6,7,98 8.77..96 9. Native Hawaiian and Other Pacific Islander 57 68 7....8 Other Race 685 8 7..9. 9.86 Two or More Races,8 5,97.88.6.89 6.9 Total Population 799,9 8,978 6.7 Source: data from U.S. Census Bureau 6

Activities of the Medical Examiner s Office As part of the duties of the Medical Examiner s Office, autopsy and investigative reports are prepared and maintained on all cases. The Macomb County Medical Examiner s Office also fulfills legal obligations by testifying in criminal and civil proceeding relating to the cause and manner of death. Public health emergencies can take on many forms ranging from naturally occurring events (storms, floods, fires) to manmade events including delivery of weapons of mass destruction (bomb/blast, chemical, nuclear, or biological). In partnership with other county services, the Medical Examiner s Office developed the Macomb County Mass Fatality Plan which addresses mortuary surge capacity events and methods to respond and mitigate such issues. As part of its greater role in promoting a safe and viable community, a portion of the Medical Examiner s duties includes serving on the Macomb County Child Death Review Team (MCCDRT). The MCCDRT is composed of various county wide agencies that review and discuss comprehensive information regarding specific child death cases. The team reviews the circumstances involved in the death, and documents the investigative actions, services provided or needed, key risk factors with recommendations and/or actions taken by the MCCDRT team to improve coordination and effectiveness of child protection, investigation and legal processes. Since, over child death cases have been reviewed. Teaching has always been an integral portion of the Medical Examiner s Office duties. Such academic endeavors include forensic pathology lectures and presentations at Wayne State University. Teaching rotations at the Medical Examiner facility include Wayne State Forensic Investigation internship, Macomb Community College EMT and surgical tech students, Baker College EMT techs, Macomb County Sheriff cadets and individual autopsy observations for law enforcement personnel, nurses and medical students. The Medical Examiner s Office is also involved in community projects; drinking and driving campaigns for local high schools and lectures for community groups and health care providers involving substance abuse, forensic nursing, trauma management, etc. The Medical Examiner s Office continues to work closely with the Gift of Life Organ and Tissue Procurement Agency and the Michigan Eye Bank. In an agreement was signed between Macomb County and Gift of Life Michigan which will increase the number of potential donors. 7

TOTAL CASES FOR Macomb County Population 8,978 Number of Deaths in Macomb County 6,599 Macomb County Medical Examiners Cases,789 (Includes 8 cases of non human bones, fetus) Forensic Examinations 65 Local deaths (those that occur within the boundaries of Macomb County) that fall under the jurisdiction of the Medical Examiner are transported to the Macomb County Medical Examiner s Office (MCMEO) for examination by a contract body transport company. In many cases, a MCMEO investigator attends the scene in person and performs a preliminary examination of the scene and body. The Medical Examiner and investigative staff are on call and available hours/day, 65 days/ year. Not all bodies transported to the MCMEO for examination are autopsied. The Medical Examiner may choose to either perform an autopsy or an external examination. In most autopsies and external examinations, blood, urine and vitreous fluid specimens are collected for toxicological analysis. 7 6 5 6 67 6599 75 678 789 9 Medical Examiner Cases Total County Deaths 8

CREMATION PERMITS In Macomb County, the Medical Examiner s Office is required to sign cremation permit authorizations before a body is cremated. In order for a cremation permit to be issued, the death certificate is reviewed and in some cases a more detailed investigation is required prior to authorization. Cremation permits issued in showed a 6% increase from. $,. in revenue was generated in for cremation permit authorizations; this was a $78. increase from. The cremation permit fee was increased in January to $75.. CREMATION PERMIT AUTHORIZATIONS BY YEAR 5 5 5 5 78 8 8 9 67 68 7 8 5 6 7 8 9 9

MANNER OF DEATH Manner of Death is one of the items that must be reported on the death certificate and is a classification of death based on the circumstances, autopsy findings, toxicology results and all available information associated with the death investigation. Cases by Manner of Death Number Percent Natural 9 7.% Accident 9 6.% Suicide 7 7.% Homicide.78% Indeterminate 55.7% Unspecified (Bones/fetus) 9.5% Natural (9) Accident (9) Suicide (7) Homicide () Indeterminate (55) Unspecified (9)

MANNER OF DEATH Manner of Death Cases by Age and Gender There were a total of 789 forensic investigations in, of these (56.7%) were males; 767 (.9%) were females and 9 (.%) cases were non human bones. 5 5 5 5 67 Male () Female (767) Unspecified (9) 5 69 7 6 8 6 5 6 5 8 6 9 <9 years to9-9 -9-9 5-59 6-69 7+ Unspecified Age Group Male Female Bones/Unspecified Total 9 Years 8 Years and Older 995 75 78 Unspecified 8 8 Total 767 9 789 Randy Hanzlick, M.D., et al. A Guide for Manner of Death Classifications: Basic, General rules for classifying manner of death (National Association of Medical Examiners, 5) 5

MANNER OF DEATH Cases by Age and Means 699 69 599 59 99 9 99 9 99 9 99 9 99 9 - - 5 9 5-9 -9-9 -9 5-59 6-69 7 ++ Unsp. Natural (9) 9 9 5 8 698 Accidental (9) 7 9 57 6 9 5 Suicide (7) 6 9 6 9 Homicide () Indeterminate (55) 5 8 5 7 Unspecified (9) 9 Manner of Death Cases by Race and Gender Race Male Female Total White 9 685 588 African American 6 58 American Indian Asian Pacific 5 9 Other 5 Multiracial 8 7 55 Total Cases 767 78 (8 cases of non human bones/ unspecified fetus not included on this chart)

MANNER OF DEATH Natural Natural Cases by Age and Gender Natural deaths represented 7.% (9/789) of all medical examiner cases. Males accounted for 5.6% (68/9) of the total natural deaths cases; females accounted for 7.8% (6/9) of the natural death cases. The male 7+ age group accounted for 6.9% (/68) of all male natural cases while the female 7+ age group accounted for 6.% (85/6) of the female natural death cases. Both the combined male/female 7+ age groups represented 5.% (698/9) of all the natural death cases. 9 85 9 9 7 Male (68) Female (6) 9 5 85 9-6 5 5 5 5 <9 years to9-9 -9-9 5-59 6-69 7+ Age Group Male Female Total Percent -9 Years 7 5.9% Years and Older 67 65 78 99.6% Total Cases 68 6 9 % Randy Hanzlick, M.D., et al. A Guide for Manner of Death Classifications: Basic, General rules for classifying manner of death (National Association of Medical Examiners, 5) 5

MANNER OF DEATH Natural Natural Cases by Age and Means 7 65 6 55 5 5 5 5 5 5-5 9 5-9 -9-9 -9 5-59 6-69 7 ++ All Means (9) 9 9 5 8 698 Natural Cases by Race and Gender Race Male Female Total White 67 55 5 African American 7 89 American Indian Asian Pacific 8 Multiracial Other 5 6 Total 68 6 9

MANNER OF DEATH Accident Accident Cases by Age and Gender Accidental deaths represented 6.% (9/789) of all medical examiner cases Males accounted for 65.6% (9/9) of the total accidental death cases; females accounted for.5% (/9) of the cases. The male 5-59 age group accounted for.7% (/9) of all male accidental deaths. The highest female age grouping was the 75+ age group accounting for 9.7% (/) of all female accidental deaths. 5 5 8 5 5 Male 9 Female 5 5 5 9 8 5 <9 years to9-9 -9-9 5-59 6-69 7+ Age Group Male Female Total Percent -9 Years 8.75% Years and Older 9 9 8 95.5% Total Cases 9 9 % Randy Hanzlick, M.D., et al. A Guide for Manner of Death Classifications: Basic, General rules for classifying manner of death (National Association of Medical Examiners, 5) 5 5

MANNER OF DEATH Accident Accident Cases by Age and Means 6 8 6 8 6 8 6 8 6-5 9 5-9 -9-9 -9 5-59 6-69 7 ++ Asphyxia (8) Drowning () Fall (6) 9 5 Fire/Burn () Other (8) Poison (6) 7 7 Vehicle (5) 5 6 7 7 Accidental poisoning accounted for 5.% (6/9) of all accidental death cases with the -9 and 5-59 age groups having the highest percent of all accidental poisoning deaths. Falls accounted for the second highest accidental death cases or.% (6/9) with the majority of deaths occurring in the 7 year old and older age group. Accidental Cases by Race and Gender Race Male Female Total White 7 88 6 African American 9 9 8 American Indian Asian Pacific Multiracial Total 9 9 6

MANNER OF DEATH Suicide Suicide Cases by Age and Gender Suicide deaths represented 7.% (7/789) of all medical examiner cases. Males accounted for 8.6% (6/7) of the total suicide death cases; females accounted for 6.5% (/7) of the suicide cases. The male 5-59 age group accounted for.58% (5/6) while the -5 age group accounted for 8.86% (/6) of all male suicide cases. The -9 female age group represented 8.9% (8/) of all female suicide cases. 6 5 9 8 7 6 5 9 8 7 6 5 5 8 6 9 8 6 <9 years to9-9 -9-9 5-59 6-69 7+ Male (6) Female () Age Group Male Female Total Percent -9 Years 6 7 5.5% Years and Older 9.9% Total Cases 6 7 % Randy Hanzlick, M.D., et al. A Guide for Manner of Death Classifications: Basic, General rules for classifying manner of death (National Association of Medical Examiners, 5) 5 7

MANNER OF DEATH Suicide Suicide Cases by Age and Means 5 9 8 7 6 5-5 9 5-9 -9-9 -9 5-59 6-69 7 ++ Asphyxia (9) 7 5 8 Fall () Firearm (66) 6 8 8 7 Instrument () Other () Poison (6) 5 5 Vehicle () Firearm suicide cases represented 5.96% (66/7) of all suicides, asphyxia account for.7% (9/7) and poisoning.59% (6/7). The 5-59 age group (firearms) accounted for.7% (8/7) of cases, while the -9 age group had 7.87% (/7) for asphyxial deaths. Suicide Cases by Race and Gender Race Male Female Total White 9 5 African American 7 7 American Indian Asian Pacific Multiracial Other Unknown Total 6 7 8

MANNER OF DEATH Homicide Homicide Cases by Age and Gender Homicide deaths represented.8% (/789) of all medical examiner cases. Males accounted for 7.% (/) of the total homicide death cases; females accounted for 8.57% (/) of the homicide cases. The male 9 age group accounted for.% (/) of all male homicide victims while the 7+ female age group accounted for 5% (/) of the female homicide cases. 5 Male () Female () <9 years to9-9 -9-9 5-59 6-69 7+ Age Group Male Female Total Percent -9 Years.8% Years and Older 8 85.7% Total Cases % Randy Hanzlick, M.D., et al. A Guide for Manner of Death Classifications: Basic, General rules for classifying manner of death (National Association of Medical Examiners, 5) 5 9

MANNER OF DEATH Homicide Homicide Cases by Age and Means 5-5 9 5-9 -9-9 -9 5-59 6-69 7 ++ Asphyxia () Firearm (8) Instrument (5) Firearm homicide cases accounted for 57.% (8/) of all homicide cases with the -9 age group having the highest rate or 5% (/8) of all the firearm homicide deaths. Instrument homicides accounted for the second highest homicide cases or 5.7% (5/) with the majority of instrument deaths occurring in the 5-9 age range. Homicide Cases by Race and Gender Race Male Female Total White 5 8 African American 5 5 American Indian Asian Pacific Multiracial Total

MANNER OF DEATH Indeterminate Indeterminate Cases by Age and Gender Indeterminate deaths represented.7% (55/789) of all medical examiner cases. Males accounted for.6% (/55) of the total indeterminate death cases; females accounted for 56.6% (/55) of the indeterminate cases. The -9 age group represented the highest age group for indeterminate cases or.7% (8/55). 5 9 8 7 6 8 6 6 9 Male () Female () 5 <9 years to9-9 -9-9 5-59 6-69 7+ Age Group Male Female Total Percent -9 Years % Years and Older 55 % Total Cases 55 % Randy Hanzlick, M.D., et al. A Guide for Manner of Death Classifications: Basic, General rules for classifying manner of death (National Association of Medical Examiners, 5) 5

MANNER OF DEATH Indeterminate Indeterminate Cases by Age and Means 6 5 9 8 7 6 5-5 9 5-9 -9-9 -9 5-59 6-69 7 ++ Fall () Other () Poison (5) 9 5 5 7 Vehicle () Poisoning accounted for 9.9% (5/55) of all indeterminate death cases with the -9 age group having the highest or % (5/5) of all indeterminate poisoning deaths. Indeterminate Cases by Race and Gender Race Male Female Total White 8 5 African American American Indian Asian Pacific Multiracial Total 55