Post on 17-Jul-2020
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ANNUAL REPORT 2011
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DENVER OFFICE OF THE MEDICAL EXAMINER
2011 Statistical Data
PREFACE The Coroner is an elected office pursuant to the Constitution of Colorado. State law defines the cases that are Coroner cases in Section 30-10-606, Colorado Revised Statutes. By the state Constitution, Denver is a combined City and County. The City and County charter states that the position of Coroner is to be an appointed position, chosen by the Manager of the Department of Environmental Health. These duties are entrusted to the Chief Medical Examiner. In 2011, the coroner statute was revised in an attempt to improve the coroner system
and to address weaknesses and inconsistencies in death investigation across the state. The main provisions:
mandate that forensic autopsies be performed by forensic pathologists;
mandates that autopsies be performed in accordance to the National Association of Medical Examiners (NAME) autopsy standards; and
mandates transfer of jurisdiction back to the County where the incident causing death occurred.
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Colorado Revised Statutes 30-10-606 and 606.5
CORONER – INQUIRY-GROUNDS-POSTMORTEM-JURY-CERTIFICATE OF DEATH (1) The coroner shall immediately notify the district attorney, proceed to view the body, and make all proper inquiry respecting the cause and manner of death of any person in his jurisdiction who has died under any of the following circumstances: (a) From external violence, unexplained cause, or under suspicious circumstances; (b) Where no physician is in attendance or where, though in attendance, the physician is unable to certify the cause of death; (c) From thermal, chemical, or radiation injury; (d) From criminal abortion, including any situation where such abortion may have been self-induced; (e) From a disease which may be hazardous or contagious or which may constitute a threat to the health of the general public; (f) While in the custody of law enforcement officials or while incarcerated in a public institution; (g) When the death was sudden and happened to a person who was in good health; or (h) From an industrial accident. (1.1) After consultation with the district attorney, the coroner may request that jurisdiction of any such death be transferred to the coroner of the county in which the event which resulted in the death of the person occurred, with the jurisdiction effective upon the acceptance by the receiving coroner. Such transfer shall be in writing, and a copy thereof shall be maintained in the offices of the transferring and receiving coroners. (1.2) When a person dies as a result of circumstances specified in subsection (1) of this section or is found dead and the cause of death is unknown, the person who discovers the death shall report it immediately to law enforcement officials or the coroner, and the coroner shall take legal custody of the body. The body of any such person shall not be removed from the place of death except upon the authority of the coroner in consultation with the district attorney or local law enforcement agency, nor shall any article on or immediately surrounding such body be disturbed until authorized by the coroner in consultation with the district attorney or local law enforcement agency. (2) The coroner shall perform a forensic autopsy or have a forensic autopsy performed as required by section 30-10-606.5 or upon the request of the district attorney. (3) When the coroner has knowledge that any person has died under any of the circumstances specified in subsection (1) of this section, he may summon forthwith six citizens of the county to appear at a place named to hold an inquest to hear testimony and to make such inquiries as he deems appropriate. (4) (a) In all cases where the coroner has held an investigation or inquest, the certificate of death shall be issued by the coroner or the coroner's deputy. (b) Any certificate of death issued by a coroner or a coroner's deputy shall be filed with the registrar and shall state their findings concerning the nature of the disease or the manner of death, and, if from external causes, the certificate shall state whether in their opinion death was accidental, suicidal, or felonious. In addition, the certificate shall include the information described in section 25-2-103 (3) (b), C.R.S., whenever the subject of the investigation or inquest is under one year of age. (c) A copy of the certificate of death or affidavit of presumed death, including any related documents and statements of fact, shall be retained in the applicable county in a secure location in an appropriate county facility accessible only to the county coroner or the coroner's designee and in a manner that is consistent with the county's record retention policy and federal law. (5) Nothing in this section shall be construed to require an investigation, autopsy, or inquest in any case where death occurred without medical attendance solely because the deceased was under treatment by prayer or
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spiritual means alone in accordance with the tenets and practices of a well-recognized church or religious denomination. (6) (a) Notwithstanding sections 12-43-218 and 13-90-107 (1) (d) or (1) (g), C.R.S., the coroner holding an inquest or investigation pursuant to this section has the authority to request and receive a copy of: (I) Any autopsy report or medical information from any pathologist, physician, dentist, hospital, or health care provider or institution if such report or information is relevant to the inquest or investigation; and (II) Any information, record, or report related to treatment, consultation, counseling, or therapy services from any licensed psychologist, professional counselor, marriage and family therapist, social worker, or addiction counselor, certified addiction counselor, or registered psychotherapist if the report, record, or information is relevant to the inquest or investigation. (b) The coroner shall, at the request of the district attorney or attorney general, release to the district attorney or attorney general any autopsy report or medical information described in subparagraph (I) of paragraph (a) of this subsection (6) that the coroner obtains pursuant to paragraph (a) of this subsection (6). (c) The coroner shall not release to any party any information, record, or report described in subparagraph (II) of paragraph (a) of this subsection (6) that the coroner obtains pursuant to paragraph (a) of this subsection (6). (d) Any person who complies with a request from a coroner pursuant to paragraph (a) of this subsection (6) shall be immune from any civil or criminal liability that might otherwise be incurred or imposed with respect to the disclosure of confidential patient or client information.
30-10-606.5. WHEN AUTOPSY PERFORMED - JURISDICTION - QUALIFICATIONS TO PERFORM – DEFINITION (1) (a) The coroner shall perform a forensic autopsy or have a forensic autopsy performed in accordance with the circumstances in the most recent version of the "forensic autopsy performance standards" adopted by the national association of medical examiners, when the death is apparently nonnatural and occurs in a facility or during services regulated by the department of human services, and when the death is the result of an automobile accident and a hospital physician has not documented the extent of the injuries. (b) If a person is involved in an incident that requires the person to be transported to a medical facility outside the county where the incident occurred and the person dies en route to or at the medical facility outside the county where the incident occurred, the coroner for the county where the incident occurred shall take possession of the body and shall comply with the provisions of this section. (2) (a) Except as provided in paragraphs (b) and (c) of this subsection (2), all forensic autopsies required to be performed pursuant to subsection (1) of this section shall be performed by a board-certified forensic pathologist. (b) A physician who has completed a forensic pathology fellowship and is practicing forensic pathology in Colorado and who is not a board-certified forensic pathologist as of May 4, 2011, may perform a forensic autopsy required pursuant to subsection (1) of this section. (c) A forensic pathologist who has completed a forensic pathology fellowship may perform forensic autopsies for four years from the date of completion of the fellowship before becoming a board-certified forensic pathologist. (d) A pathology resident or forensic pathology fellow may perform a forensic autopsy required pursuant to subsection (1) of this section under the direct supervision of a board-certified forensic pathologist. (e) For purposes of this subsection (2), "direct supervision" means supervision that is within the facility where a pathology resident or forensic pathology fellow is performing an autopsy and that requires a board-certified forensic pathologist's presence and availability for prompt consultation.
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Mission Statement
MISSION: To investigate and certify deaths in Denver using best practices, and thereby support law enforcement and the legal system in protecting the safety of Denver's citizens, and partnering with public health agencies to help ensure the well being of the public The office appreciates the support and cooperation received from the citizens of Denver and welcomes comments and suggestions. Questions, comments or suggestions may be directed to this office at our web site. Office of the Medical Examiner Comments and Suggestions 660 Bannock Street medcomments@ci.denver.co.us Denver, CO 80204
303-436-7711
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Department of Environmental Health
Office of the Medical Examiner
2011 Organization Chart
22 FTE
Chief Medical Examiner/Coroner 1
FTE
Amy Martin, MD
828-D
Manager 2, 1 FTE
Michelle Weiss-Samaras
815-A
Forensic Pathology Fellow, 1 FTE Joseph White, D.O
( June 2010- June 2011) Lindsey Harle, MD
(June 30, 2011-June 30,2012)
Forensic Pathologist, 2 FTE
James W. Wahe, M.D. John Carver, JD, MD
824-D
Medical Transcriptionist, 2 FTE
Glenda Slade Jami Milsap
612-C
Supervisor of Administrative Support
I, 1 FTE Roberta (Kathy) Blea
806-C
Investigator Supervisor,
1 FTE Don Bell
812-N
Forensic Autopsy Technician
Supervisor, 1 FTE Karen Jazowski
807-H
ASA III, 2 FTE Cecelia Albertson, Galena Brown
610-C
Coroner Investigator, 7 FTE Tracey Balbin, Kerrie Cady, Harris Neil,
Howard Daniel, Justin Earls, TC Whitley,
Ginger Jones
623-N
Forensic Autopsy Technician, 3 FTE
Barb Criter, Esperanza Ortega, Robert Garner
616-H
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On August 27, 1947, the Denver Coroner’s Office hired its first Medical Examiner. Dr. Angelo Lapi was a 34-year-old assistant Medical Examiner for Massachusetts. He was a graduate of the medical school of the University of Buffalo, a pathologist and research fellow of the Department of Legal Medicine in
Harvard. He was approved to start on October 1, 1947, at the monthly salary of $666.00. The assistant Medical Examiner at that time was Dr. George Ogura (who later retired in the late 1980’s as the Chief Forensic Pathologist). The State Constitution requires every county to have a coroner. On August 25, 1947, City Council approved the appointment of the Manager of Health and Charity to be the ex-officio coroner. At that time, the coroner inquests were stopped in the City and County of Denver. The office separated from Denver Health Medical Center (previously known as Denver General Hospital) in 1997, and joined the newly developed Department of Environmental Health for the City and County of Denver. During years past, this office had the pleasure to have many talented forensic pathologists as a part of the team. Dr. George I. Ogura, Dr. Henry Toll, Dr. Ben Miyahara, Dr. Donald Clark, Dr. Ben Galloway, Dr. James Wahe, Dr. Amy Martin, and Dr. Thomas Henry, as well as countless pathology residents and forensic fellows, many who continue to practice forensic pathology throughout the world. Dr. Amy Martin became the Chief Medical Examiner on December 14, 2007. She is appointed as the Coroner by the Manager of the Department of Environmental Health per City Ordinance § 2.12.2
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DENVER OFFICE OF THE MEDICAL EXAMINER
STAFF 2011
AMY MARTIN, M.D.
CHIEF MEDICAL EXAMINER
CORONER
MICHELLE D. WEISS-SAMARAS
CHIEF DEPUTY CORONER
JAMES W. WAHE, M.D.
ASSISTANT MEDICAL EXAMINER
JOHN D. CARVER, MD., J.D.
ASSISTANT MEDICAL EXAMINER
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FORENSIC PATHOLOGY FELLOWSHIP
In 2008, OME received Accreditation Council for Graduate Medical Education accreditation for a forensic pathology fellowship sponsored by the University Of Colorado Denver School Of Medicine. In July 2009, the program’s first forensic
pathology fellow began a one-year period of training in the area of forensic pathology. This program is designed to prepare forensic pathologists for board certification and
practice in the field of forensic pathology.
2009 – 2010 Forensic Pathology Fellow Michael Burson, M.D., Ph.D.
2010-2011 Forensic Pathology Fellow
Joseph K. White, D.O.
2011-2012 Forensic Pathology Fellow Lindsey Harle, M.D.
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DENVER OFFICE OF THE MEDICAL EXAMINER INVESTIGATIVE STAFF 2011
Donald Bell, Investigator Supervisor
INVESTIGATORS Tracey Balbin Howard Daniel
Justin Earls Kerrie Cady
Genevieve Jones Harris Neil
T.C. Whitley
INVESTIGATIONS SECTION The Investigations Section responds to the scenes of deaths throughout the City and County of Denver twenty-four hours a day, seven days a week. It is the responsibility of the Medicolegal Death Investigator to function as the eyes and ears of the Medical Examiner and insure that the State law is followed with respect to the reporting and handling of deaths in Denver City and County. In addition to scene response, investigators also investigate hospital, nursing homes and other facility deaths that fall under the Coroner statute via phone reports. When they deem it necessary, they will respond to these scenes as well. Investigators are also responsible for coordinating and facilitating identification of the decedent; locating and notifying of the next of kin; and processing some of the evidence, medication, and effects of the decedent.
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OME investigators respond to any death scene where the body has not been removed if the death occurs outside of a healthcare facility. Investigators may also respond to select hospital deaths; for example many homicides and child deaths where the individual has been transported to an emergency room. Investigators may also respond to a hospital or healthcare facility if the death appears due to non-natural circumstances (a suicidal hanging that occurs in a psychiatric unit). There can be a great deal of month-to-month fluctuation in the number of scenes although overall the yearly total does not vary greatly from year to year, and generally averages between 60 and 70 scenes per month
Jan Feb March April May June July Aug Sept Oct Nov Dec
2009 66 68 87 80 65 47 45 68 62 63 77 62
2010 71 51 56 57 69 45 51 49 66 82 63 60
2011 69 78 73 75 70 62 67 62 54 62 62 85
0
10
20
30
40
50
60
70
80
90
100
2009 - 2011 Scene Visits
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The Denver Office of the Medical Examiner responded to 645 calls to scenes in 2011 with a target response time of 90% less than 1 hour. We achieved that goal, with response less than 30 minutes 67% of the time, between 30 minutes and 60 minutes 28% of the time.
Scene response time is one performance measure that OME tracks to insure that families, law enforcement and others do not wait longer than necessary for the OME investigator to document the scene, gather necessary information and complete other investigative activities as needed. The vast majority of scenes have an investigator arrive within 30 minutes of OME notification. 95% of the time, an investigator is on scene within an hour. Things that could adversely impact response time include: staffing shortages due to holidays or illness, multiple scenes occurring at the same time, a prior complex scene (homicide) that requires extensive investigator time, or unforeseen traffic flow issues.
67% 28%
4%
1%
Investigator Response Time
< 30 mins 30 - 60 mins > 60 mins Unknown
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DENVER OFFICE OF THE MEDICAL EXAMINER FORENSIC AUTOPSY TECHNICIAN STAFF 2011
Karen Jazowski, Forensic Autopsy Technician Supervisor
Forensic Autopsy Technicians Barbara Criter Robert Garner
Esperanza Ortega
This section is responsible for providing direct support in the autopsy
room to the forensic pathologists. Staff duties include, but are not
limited to, preparation of the bodies for autopsy, assisting the
physicians in the performance of the autopsy, assisting in collection
and storage of toxicological specimens, performing post mortem x-
rays, performing some forensic photography and releasing bodies to
the mortuary. This section is also responsible for fingerprinting of the
decedent.
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DENVER OFFICE OF THE MEDICAL EXAMINER
ADMINISTRATIVE STAFF 2011
Roberta (Kathy) Blea, Administrative Support Supervisor I
ADMINISTRATIVE STAFF
Galena Brown Cecelia Albertson
MEDICAL TRANSCRIBERS
Jami Milsap Glenda Slade
These sections are responsible for providing administrative support to all members of the staff. Administrative staff duties include customer service, releasing remains, finalizing death certificates, billing and bookkeeping, and processing personal effects. Transcription duties include transcribing autopsy reports, fulfilling report requests, and sending out laboratory samples for analysis.
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INVESTIGATIVE INTERNSHIP PROGRAM OME offers a one-year medicolegal investigative internship program with the following schools: University of Denver Graduate Program – Masters of Forensic Psychology, Metropolitan State University of Denver, and the University of Colorado, Denver Campus. Select individuals may opt, if accepted, to continue on for an additional year. Undergraduate seniors and graduate students compete to participate in a program designed to train forensic death investigators. During the internship year, interns are expected to carry their own case load that includes gathering of information for the determination of the cause and manner of death, assisting in identification of the decedent, investigating cause and manner of death, assist in the identification of the decedent, assist in locating and notifying next of kin, and proper documentation of a death scene. Upon successful completion, participants are eligible for certification as a medicolegal death investigator by the Colorado Coroner’s Association. The program also prepares participants for eventual ABMDI (American Board of Medicolegal Death Investigation) certification after hire in a coroner or medical examiner’s office.
Investigative Internship Program – One Year Internship
Ashley Peightal 2010-2011 University of Denver, MA Forensic Psychology
Andrea Raffauf 2010-2011 University of Denver, MA Forensic Psychology
Caroline Moorman 2011-2011 Regis University
Zak Adami 2011-2011 Regis University
Megan Owens 2011-2012 Metropolitan State University of Denver BS Chemistry-Criminalistics
Jessica Carlos-Ray 2011-2012 University of Colorado, Denver
Investigative Internship Program – Two Year Internship
Justin Stiebel 2009-2011 University of Denver, MA Forensic Psychology
Stacey Salmon 2009-2011 University of Colorado, Denver, MA Criminal Justice
Kayla Wallace 2010-2012 University of Denver, MA Forensic Psychology
Melanie Gutteea 2010-2012 Metropolitan State University of Denver BA Criminal Justice
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FORENSIC AUTOPSY TECHNICIAN INTERNSHIP PROGRAM OME offers numerous Autopsy Technician internships with the following schools: University of Colorado Experiential Learning Center, Metropolitan State University of Denver, Regis University, Denver, and Wesleyan University in Nebraska, Masters in Forensic Science. With the exception of Wesleyan University, which offers a two-week rotation, participants are offered a one-semester internship. During this internship, participants work closely with staff pathologists and Autopsy Technicians in the autopsy room, and gain experience in clinicopathologic correlation, forensic photography, fingerprinting, and evidence collection. Many graduates from this internship go on to medical school; others continue on in an alternative field of medicine (physical therapy, pathology assistant) or other are in the forensic sciences.
Forensic Autopsy Internship Program – 3 month internship
Brenna Clay Fall 2011 University of Colorado, Denver
Jessica Trozzo Fall 2011 California University of Pennsylvania
Kathryne Reed Fall 2011 University of Colorado
Nicole Hertzberg Fall 2011 Carnegie Mellon University
Sara Velasco Fall 2011 Central New Mexico Community College
Shannon Quirk Spring 2011 Regis University
Victoria Buchanan Spring 2011 Metropolitan State College of Denver
Kellie Webber Summer 2011 Creighton University of Omaha
Richard Tannant Summer 2011 University of Wyoming
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SCHOLARLY ACTIVITIES
The Denver Office of the Medical Examiner participates in a wide variety of community education through affiliations with area universities, as well as community outreach activities throughout the Denver Metropolitan area with high schools and middle schools, medical providers, and other interested parties.
UNVERSITY OF COLORADO SCHOOL OF MEDICINE
The three forensic pathology staff has official academic appointments with the University Of Colorado School Of Medicine through the Department of Pathology. All staff pathologists participate in the education of medical students in both general pathology as well as forensic pathology. In addition, medical students have the opportunity to rotate through the Office of the Medical Examiner for credit, gaining firsthand knowledge of the area of forensic medicine. Pathology residents at the University of Colorado have a one-month rotation generally offered in the third or fourth year. During this rotation, pathology residents gain practical experience in the performance of the forensic autopsy, and also have the opportunity to respond with medicolegal death investigators and, when applicable, staff pathologists to death scenes. Whenever possible, residents are encouraged to accompany staff pathologists to observe courtroom testimony. OME pathologists have partnered with forensic pathologists in the Arapahoe County Coroner’s Office, as well as Dr. Geza Bodor, Director of the Chemistry and Molecular Laboratories at the Veterans’ Affairs Medical Center, to offer pathology residents a series of lectures, given over the course of two years, in a wide range of forensic and toxicologic topics.
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MASS FATALITY RESPONSE In March 2006, the Denver Office of the Medical Examiner Chief of Investigations spearheaded the establishment of the North Central Region Mass Fatalities Committee. This multi-county group was formally accepted as a joint Denver Urban Area Initiative/ North Central Region committee. The committee has drafted a regional mass fatalities plan and meets monthly to further prepare for a mass fatalities incident. The investigative unit remains very active with this organization.
RESERVE CORPS In September 2008 the Investigative section of the Denver Office of the Medical Examiner established a reserve corps. This pool of volunteers was established to train volunteers for duty in the event of a mass fatality incident. The corps received periodic forensic training as well as experience in death scene investigations.
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COHEART In Nov 2009 the North Central Region Mass Fatalities Committee was awarded a $57,000 grant by the Denver Urban Area Security Initiative to establish and train a Colorado Human Remains Extraction and Recovery Team (COHEART). The grant provides for equipment and training of up to 77 volunteers to conduct remains recovery in the event of a mass fatality incident, and builds on the Denver Office of the Medical Examiner Reserve Corps. Volunteers are recruited from prior interns, medical personnel, prior law enforcement and Coroner staff members. All volunteers are screened and have background checks. The volunteers must participate in training throughout the year, spend time with the investigators and observe autopsies.
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COMMUNITY OUTREACH
OME participates in a wide range of community outreach activities over and above education,
along with other public health activities. Examples include: regional mass fatality planning, both state and local child fatality review, maternal fatality review, the Governor’s Expert Emergency Response Council (GEERC), Denver Epidemiology Work Group (DEWG) through the Denver Office of Drug Strategy, and the Metro Area County Coroners and Medical Examiners (MACCME).
o The various fatality review committees, through case study and examination of collected data, try to determine trends and patterns in the factors that cause and contribute to death, and ultimately try to develop strategies to reduce or prevent future deaths.
o The MACCME is a forum whereby the Metro Area Coroners can regularly discuss
common issues and develop strategies to address these issues. Some examples
include partnering with Front Range Community College to develop a certificate program in death investigation and developing a standardized protocol for reporting child deaths to the metro-area coroners with The Children’s Hospital.
o The GEERC (Governor’s Expert Emergency Response Council)
The Denver Office of the Medical Examiner is represented by a staff member on the GEERC which consists of businessmen, physicians, public health officials, hospital administrators, pharmacists, American Medical Association, veterinarians, coroners, funeral directors, lawyers, Better Business Bureau, and vital statistics personnel. The Council serves to: 1) strategize state response to a disaster or epidemic, 2) oversee distribution of money and supplies (vaccines) statewide, and propose laws and regulations, 3) promote education and information distribution concerning epidemics and natural disasters, 4) evaluate
the effectiveness of the State’s responses to the Governor and to the organizations represented.
o The DEWG (Denver Epidemiology Work Group) was formed in 2008 through the
Denver Office Of Drug Strategy. Modeled after the National Institute on Drug Abuse’s Community Epidemiology Work Group, he DEWG provides ongoing community-level surveillance of alcohol and drug abuse in the Denver Metropolitan area through analysis of quantitative and qualitative data regarding drug and alcohol abuse trends and populations. Participates include representatives from law enforcement; prevention, intervention and treatment programs, medical facilities, toxicology, OME, and public health.
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o The Coroner Resource Committee of Donor Alliance was formed to improve communication between the organ and tissue procurement agencies and the coroners. All metro area coroners and representatives from DA and the Rocky Mountain Lions Eye Bank meet several times a year to discuss recovery statistics and issues that may have arisen.
In addition to their usual duties, the Chief Deputy, Chief Investigator and Coroner investigators frequently lecture at local high schools, hospitals, local organizations, law enforcement, as well as Denver colleges and universities. They participate in local job fairs and career day events. They are involved in the training of new victim advocates in Colorado. The pathologists also lecture to various agencies, health care providers, law enforcement, and coroners.
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COMMUNITY SERVICE
Red Rocks Community College – Michelle Weiss-Samaras and Donald Bell
Regis University Criminal Justice and fraternal forensic organization – Donald Bell
Coalition for the Homeless and Department of Health and Human Services – Michelle Weiss-Samaras
Colorado Hospice training, Victim Advocate training, and Denver Hospital In-Service Training - Michelle Weiss-
Samaras
Denver Police Department Victim Advocate Ride along program – Investigative Section (Inv. Daniels, Cady, Jones,
Neil, Whitley, Earls, and Balbin)
NCRFMC (North Central Region Fatality Management Committee - 10 county region) –Tracey Balbin and Donald Bell
Denver International Airport – Disaster preparation – Michelle D. Weiss-Samaras and Donald Bell
In June 2011, the Denver Office of the Medical Examiner hosted the FEMA course Mass Fatality Incident Response at
the Colorado Community College of Aurora. The target audience of COHEART members and emergency
management personnel.
Promoting Healthy Communities in partnership with Community Outreach and Decision Support, another division from
the Department of Environmental Health and other community agencies – Michelle D. Weiss-Samaras
Tours/lectures out of state – Nebraska and Wyoming Colleges – Michelle D. Weiss-Samaras & Don Bell
Experience – Adams County Colorado – Michelle D. Weiss-Samaras
History Cold Case US - National Geographic – Michelle D. Weiss-Samaras
S H I N E: Primrose Studios London – Liaison Michelle D. Weiss-Samaras
Disaster Mortuary Operational Response Team (DMORT) – Karen Jazowski
Denver Child Fatality Review, Colorado Maternal Fatality Review, DEWG, MACCME, Coroner Resource Committee,
National Association Medical Examiner Ad hoc Self Assessment Module Committee – Dr. Amy Martin
Denver Center for Crime Victims In-service - Investigative Section (Inv. Daniels, Cady, Jones, Neil, Whitley, Earls, and
Balbin)
Southern Institute of Forensic Science Lecture – Tracy Balbin
Upward Bound Math and Science Imitative – Casper Wyoming – Don Bell
Local Middle & High School lectures – metro area – Michelle Weiss-Samaras and Don Bell
University of Colorado Pathology Residents Liaison – Dr. James Wahe
Denver Police Victim Advocate Team – Michelle Weiss-Samaras
Notary Public Training – Galena Brown
Recycle Ink Program – Glenda Slade
Green Recycle – DOME staff
Governor’s Expert Emergency Response Council-Alternate-Dr. James Wahe
INTERDEPARTMENTAL COMMITTEES
DEH Safety Committee – James Wahe M.D.
Performance Evaluation Review Committee – Karen Jazowski
Employee Recognition Committee – Cecilia Albertson
COMMUNITY SERVICE
Red Rocks Community College – Michelle Weiss-Samaras and Donald Bell
Regis University Criminal Justice and fraternal forensic organization – Donald Bell
Coalition for the Homeless and Department of Health and Human Services – Michelle Weiss-Samaras
Colorado Hospice training, Victim Advocate training, and Denver Hospital In-Service Training - Michelle Weiss-
Samaras
Denver Police Department Victim Advocate Ride along program – Investigative Section (Inv. Daniels, Cady, Jones,
Neil, Whitley, Earls, and Balbin)
NCRFMC (North Central Region Fatality Management Committee - 10 county region) –Tracey Balbin and Donald Bell
Denver International Airport – Disaster preparation – Michelle D. Weiss-Samaras and Donald Bell
In June 2011, the Denver Office of the Medical Examiner hosted the FEMA course Mass Fatality Incident Response at
the Colorado Community College of Aurora. The target audience of COHEART members and emergency
management personnel.
Promoting Healthy Communities in partnership with Community Outreach and Decision Support, another division from
the Department of Environmental Health and other community agencies – Michelle D. Weiss-Samaras
Tours/lectures out of state – Nebraska and Wyoming Colleges – Michelle D. Weiss-Samaras & Don Bell
Experience – Adams County Colorado – Michelle D. Weiss-Samaras
History Cold Case US - National Geographic – Michelle D. Weiss-Samaras
S H I N E: Primrose Studios London – Liaison Michelle D. Weiss-Samaras
Disaster Mortuary Operational Response Team (DMORT) – Karen Jazowski
Denver Child Fatality Review, Colorado Maternal Fatality Review, DEWG, MACCME, Coroner Resource Committee,
National Association Medical Examiner Ad hoc Self Assessment Module Committee – Dr. Amy Martin
Denver Center for Crime Victims In-service - Investigative Section (Inv. Daniels, Cady, Jones, Neil, Whitley, Earls, and
Balbin)
Southern Institute of Forensic Science Lecture – Tracy Balbin
Upward Bound Math and Science Imitative – Casper Wyoming – Don Bell
Local Middle & High School lectures – metro area – Michelle Weiss-Samaras and Don Bell
University of Colorado Pathology Residents Liaison – Dr. James Wahe
Denver Police Victim Advocate Team – Michelle Weiss-Samaras
Notary Public Training – Galena Brown
Recycle Ink Program – Glenda Slade
Green Recycle – DOME staff
Governor’s Expert Emergency Response Council-Alternate-Dr. James Wahe
INTERDEPARTMENTAL COMMITTEES
DEH Safety Committee – James Wahe M.D.
Performance Evaluation Review Committee – Karen Jazowski
Employee Recognition Committee – Cecilia Albertson
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OFFICIAL COMMITTEE APPOINTMENTS
Colorado Child Fatality Prevention Review Team (term ends September 2011)- Dr. Amy Martin, Governor Appointee
Advisory Board for the Career Technological Education Program,
Montbello High School - Michelle Weiss-Samaras
PROFESSIONAL ORGANIZATIONS AND AFFILIATIONS
Colorado Coroner's Association – DOME Staff
American Academy of Forensic Sciences – Amy Martin, M.D. James Wahe M.D.
National Association of Medical
Examiners – Amy Martin M.D., John Carver M.D., JD, James Wahe M.D.
American Board of Medicolegal Death Investigators – Investigators Howard Daniel, Harris Neil, Genevieve Jones, Donald Bell, Tracey Balbin,
Justin Earls
Colorado Organization of Victim Assistance – Michelle Weiss-Samaras
American Medical Association – Amy Martin M.D.
College of American Pathologists – Amy Martin M.D.
American Society for Clinical Pathology – Amy Martin M.D. and John Carver M.D., JD
Colorado Society of Clinical Pathologists – Amy Martin M.D.
American Medical Association – Amy Martin M.D.
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VICTIM ADVOCATES AND FAMILY ASSISTANCE
While there are no Colorado state laws which require the Coroner/Medical Examiner to identify and locate next of kin, this office has historically been tasked with this job. The Medical Examiner’s Office is fortunate to have the assistance of the Denver Police Department Victim Advocates to assist when possible in the notification of the next of kin. The interaction between the two offices has proved to be invaluable.
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ORGAN/TISSUE/CORNEAL RECOVERY
OME supports organ and tissue recovery whenever possible, and works closely with local procurement agencies such as Donor Alliance and the Rocky Mountain Lions Eye Bank to facilitate recovery activities in response to the large need for both organs and tissues on a local, as well as a national level. OME follows the Colorado Organ and Tissue Donation Coroner Protocol, which is an agreement signed by the Coroners and the District Attorney for each participating county along with Donor Alliance and the Rocky Mountain Lions Eye Bank. This protocol is designed to optimize organ and tissue recovery through cooperation and communication between all signed parties. Local coroners meet with representatives from the procurement agencies on a regular basis to review the protocol and update as needed. In addition, the Coroner Resource Committee, made up, again, of representatives from the organ and tissue procurement agencies as well as the metro areas coroners, meets between two and four times a year. These meetings have proven invaluable in addressing any concerns local coroners may have with organ and tissue recovery, as well as address specific problems that may have arisen on a case-by-case basis. These meetings also allow the procurement agencies to keep coroners informed of the changing requirements and technologies that they may have as recovery techniques change and donation needs evolve.
INFORMATION SHARING
Colorado Violent Death Reporting System The Denver Office of the Medical Examiner compiles data on all violent deaths in the county which is then used by the Centers for Disease Control and Prevention (CDC). This grant funded program housed at Colorado Department of Public Health and Environment (CDPHE) has provided a better understanding of the drivers and risk factors associated with violent deaths. Thirteen states including Colorado participate in the National Violent Death Reporting System (NVDRS). The data collection began with cases from January 2004 to date. More information on the program is available at www.cdc.gov/ncipc/dvp/dvp.htm
Various community statistical reports The Denver Office of the Medical Examiner assists agencies such as the media, human services, and the Coalition for the Homeless with regularly distributed reports on homeless and homicide deaths.
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ACADEMIC PRESENTATIONS
American Academy of Forensic Sciences 2011 Meeting
Chicago Illinois, Poster presentation
Dr. Joseph White was the lead presenter for a poster given at the
AAFS meeting in Chicago in February 2011. He presented an
interesting case report revolving around the unexpected death of a
woman who died as a result of calcium deposition in her heart muscle
resulting from chronic renal failure and dialysis.
27
National Association of Medical Examiners Accreditation
In 2000, the Denver Office of the Medical Examiner received accreditation
by NAME for the facility. Every five years the office has applied for accreditation and on December 10, 2010 the office received its third
accreditation. This accreditation recognized that the Denver Office of the Medical Examiner had achieved consistent performance and competency
in medicolegal death investigation, and is in compliance with standards developed by NAME. Only a handful of ME/Coroner offices in the country
hold this accreditation.
28
2011 Audit by the Denver County Auditor
In 2011, OME was one of the agencies chosen to be audited by the Denver Office of the Auditor. The audit team, after an initial evaluation, focused on three areas for further study:
Cost recovery
Performance metrics
Customer service The final report made several recommendations, to include:
examining existing practices to identify ways to reduce expenditures and/or increased revenues, to include performing more fee for service autopsies for outside coroners and examine opportunities for other revenue streams
adopt additional performance metrics, including those that measure outcome and quality of work, and report those publically (website, Budget Book or Annual Report)
Make the entire annual report available on the website
formally track and analyze complaints
Full audit report available at http://www.denvergov.org/auditor/DenverAuditor/AuditServices/AuditReports
29
FT. LOGAN NATIONAL CEMETERY
This cemetery is located in the southwest area of Denver, Colorado
Fort Logan features a memorial pathway lined with a variety of memorials that honor
America’s veterans from various organizations. There are 17 memorials at Fort Logan National
Cemetery—most commemorating soldiers of various 20th-century wars.
30
PERFORMANCE MEASURES 2011
2011 Identification
and Notification of Next of Kin within 24 hours (Target 90%)
Autopsy Reports completed within 60 days
All Reports Completed within 60 days (NAME target 90%)
All Reports completed within 90 days (NAME target 90%)
Bodies ready for release to mortuary within 48 hours (Target 90%)
Non-Autopsy cause and manner of death certificates provided within 10 days (Target >80%)
Success 91% 67% 75% 94% 94% 83%
NAME requirements for report turnaround are above. Failure to achieve the 60 days is a Phase I deficiency (up to 15 allowed). Failure to achieve the 90 days is a Phase II deficiency (none allowed). The other metrics are internally chosen.
31
While NAME standards have performance metrics tied to 60 and 90 days to completion, it is widely accepted that there may be significant variation in the time needed to complete an individual report. Because of the complexity of some cases, reports may well take well over 90 days to complete investigative activities. NAME recognizes that. Looking at the average turnaround time and median turnaround time gives additional indication as to how quickly reports are completed. In addition, the OME audit, while encouraging the performance of fee-for-service autopsies for other counties, cautioned against prioritizing those autopsies above those performed for Denver. The numbers above indicate fairly similar average and median turnaround times for medical examiner cases and outside county cases. The main reason for the slightly better turnaround for outside county cases is likely that these cases have been skewed to include deaths that are relatively uncomplicated, with the more complicated cases performed by an alternate provider. OME has performed cases predominantly for the Jefferson County Coroner's Office, and is one of three providers for that service.
1- 194 1-194
21-133 All autopsies
ME autopsies
OC autopsies
48.4 48.4
44.5 43
43.5
39
Range in Days
Autopsy Report Turnaround
Average median
32
The National Association of Medical Examiners has developed case workload for physician workload. Physicians MUST keep workload levels less than 325 cases per physician in order to remain in compliance with NAME accreditation. Less than 250 cases is considered optimal. Caseload is defined as the sum of autopsies performed + the number of other non-autopsy examinations using a ratio of 4 non-autopsy = 1 autopsy. NAME recognizes that physicians with additional administrative duties (such as the Chief Medical examiner) need to handle a smaller caseload. In addition, training fellows are considered one half of a full-time pathologist; their cases are counted as one half credit for the fellow and one half credit for the attending pathologist. It is a phase I deficiency for each physician over 250,
and a phase II deficiency for each physician over 325; inspectors are given some discretion in interpreting caseload numbers. For 2011, OME physicians had two physicians slightly topping the ideal caseload number. .
0
50
100
150
200
250
300
Martin Wahe Carver fellow
Number of Cases 173.75 262.25 259.75 120.02
Physician Workload 2011
33
Identification
Proper identification of decedents is a crucial part of death investigation. While not specifically spelled out in Colorado statute, identification of human remains is generally considered a duty of the coroner/medical examiner. Identification can be considered circumstantial, which would include visual identification of decedents by family or friends and the presence of distinctive tattoos or other similar methods. Circumstantial identification is sometimes all that is possible in many cases. However, OME strives whenever possible to perform a more definitive scientific identification of persons under OME jurisdiction. Scientific methods include fingerprint comparison, identification through comparison of x-rays or dental records with a known person, or DNA analysis. In rare circumstances, definitive, scientific identification can also be made through tracing of an implanted medical device such as a pacemaker or orthopedic hardware with a distinct serial number. In 2011, there were no persons under OME jurisdiction that were unidentified in some way. Of the 935 bodies which physically came to OME for either autopsy or external examination, there is data on 929 individuals as to the method of identification. This is depicted in the graph below.
Of that 929, 275 individuals were identified solely via some sort of scientific identification method. 647 were identified visually at the time of initial report. Of those, 236 had a fingerprint confirmation performed. Thus, a total of 511 individuals, or 55%, were identified by scientific means.NAME has no standards set for this benchmark. However, knowledge of common accepted practices throughout the country suggests this is a higher than average percentage when compared with other jurisdictions.
5
411
236 262
11 3
Number of Decedents
Identification method
Circumstantial Only Visual Only
Visual with FP Verification Fingerprint Only
Dental/Other Xray Other Method 416
512 Non-scientific ID
Scientific ID
34
ANNUAL STATISTICAL REPORT 2011
TOTAL DEATHS REPORTED (All jurisdictions) 3988
Medical Examiner Cases (Jurisdiction Retained) 1088
Waived Cases (Jurisdiction Waived) 1646
( Waived Natural Deaths ) 1451
( Waived Transferred Jurisdiction ) 190
( Waived – Declined/Other) 5
Inquiries (No jurisdiction determined)
(Declined)
(Request for Assistance )
(Natural)
(Transferred Jurisdiction)
1241
10
21
1209
1
Manner of death (ME Cases)
Accident 321
Homicide 49
Suicide 91
Traffic Accidents 50
Undetermined 50
Request for assistance (non-human bones, skeletal
remains, reported asystolic deaths, outside agency assist
requested etc.)
6
Natural 521
Scene visits by ME or ME Investigators 647
Bodies transported to office by order of DOME 935
External examinations 194
Complete autopsies 735
Partial autopsies 0
Outside autopsy for other jurisdiction 13
Chart Review 153
Hospital/private autopsies retained under the ME jurisdiction 3
Cases where toxicology is performed 612
Bodies unidentified after examination 0
Organ and tissue releases 93
Percent 100%
Unclaimed bodies (Coroner rotation burials) 10
Exhumations 0
35
The Denver Office of the Medical Examiner has four main classifications of death investigations:
ME or Medical Examiner cases o The Office of the Medical Examiner retains primary jurisdiction as spelled
out in Colorado Revised Statutes. Such cases have an in-depth investigation and an Office of the Medical Examiner physician will certify the cause and manner of death.
W or Waived cases o After initial investigation, some cases that are reportable by law and/or
Office of the Medical Examiner reporting policies may be transferred to another county (if the event resulting in death occurred outside Denver) or released to a hospital or treating physician to certify the death. The Office of the Medical Examiner has no further activity.
I or Inquiry cases o Care facilities often report deaths which do not fall into the area of a
reportable death after evaluation of the circumstances of the death. These cases are totally released after this is documented.
OC or Outside cases o In 2010, the Denver Office of the Medical Examiner began performing
autopsies for other Colorado counties for a fee.
36
TOTAL DEATHS REPORTED TO THE
DENVER OFFICE OF THE MEDICAL EXAMINER 2011
ACCEPTED (ME) Medical Examiner Case; jurisdiction retained
1088
WAIVED (W) Reported/Investigated and Released
1646
NOT ACCEPTED (I) Reported to office, documented, and released
1241
OUTSIDE CASES (OC) Autopsy performed at the request of outside jurisdiction
13
ME Cases, 1088, 27%
Waived Cases, 1646, 41%
Inquiries, 1241, 31%
Outside Cases, 13, 1%
37
The above table graphically depicts the month to month variation in jurisdictional cases handled by OME from 2009 to 2011 to allow for comparison over multiple years. There does seem to be some seasonal variation for the last several years, with slightly fewer ME cases in the summer months.
106
94
101 99
82
70 67
101
89 89
97 94 96
68
82 86
100
65
82 78
94
110
92
82
105
96 98
81
90
81
95
88 87 86 82
99
Jan Feb March April May June July Aug Sept Oct Nov Dec
2009 - 2011 ME Case Trends
2009 ME 2010 ME 2011 ME
38
CAUSE OF DEATH refers to the disease or injury that sets into motion the chain of events that result in death. Causes could be from a medical condition such as coronary artery disease, or a traumatic event such as gunshot wound. MANNER OF DEATH refers to how people die. There are five manners of death: Homicide (death caused by the actions of another), Suicide (death caused by intentional harm to self), Accident (death caused by non-intentional injury); Natural (death due to a natural disease process), and Undetermined (could not assign other manner due to unclear of unknown circumstances). In general, if a non-natural action has a contribution to the death, it will determine the manner. OME includes an additional ―manner‖, ―request for assistance‖, that includes bones cases and other activities that do not fit neatly into the other manners. TYPES OF EXAMINATIONS The Denver Office of the Medical Examiner constantly strives to balance best practices in death investigation with cost effectiveness and efficiently utilizing shrinking resources. In cases that the Office of the Medical Examiner retains jurisdiction, one of three medical examinations will occur.
Autopsy – The examination of a deceased person to help determine the cause and manner of death, in addition to document injuries and disease processes, collect evidence, assist in identification, and preserved blood/tissue samples for future analysis. It includes an examination of written documents including medical records, examination of the body externally, and opening the head, neck, chest, and abdomen at a minimum, removing and thoroughly examining the organs. A report is compiled, which is a public record in Colorado.
External examination – This includes the first two steps as an autopsy case, but the body is not surgically opened. Blood/fluid or other samples are still preserved when possible.
Chart review – When a person dies of injuries that result in extensive medical treatment that is well documented, the body is not examined, but the cause of death is certified based upon review of medical records.
W cases have been steadily increasing over the past two years, although again there is fluctuation month-to-month. One explanation for this increase could be the increase in home hospice deaths, and the increase in the reporting of these deaths.
39
Again, although month-to-month variations occur, overall the number of I cases has increased over the past three years. Again increased reporting by hospice providers likely explains some of this.
92 91
118
98 106
113 93
109 107
131 131 127
126 132
136
121 131
113 113
123 145 143 142
147
153 151
197
160 155
124
99
105
121
126 116
139
Jan Feb March April May June July Aug Sept Oct Nov Dec
2009-2011 W Case Trends
2011 W
2010 W
2009 W
Jan Feb
March April
May June
July Aug
Sept Oct
Nov Dec
66 39
52 48
46 50 60 46
55
51 50 52
46 55 52 51
70
70
60
50 51
50 51 62
78 76 88
87
107 99
92
126
98
148
124
118
2009-2011 I Case Trends
2009 I 2010 I 2011 I
40
2011 DENVER OFFICE OF THE MEDICAL EXAMINER CASE DISTRIBUTION
321, 29.5%
49, 4.5%
91, 8.3%
50, 4.5% 50, 4.5%
521, 47.8%
6, 0.5%
Total ME Cases Accepted by Manner of Death
41
42
NATURAL DEATH ALL ME CASES, BY EXAMINATION AND RACE
Category White Black Hispanic Asian Native
American Other/
Unidentified Race Total
Autopsies 177 62 45 6 6 2 297 External Examinations 117 28 32 7 0 1 185 Chart Reviews 24 5 7 1 0 1 38 Total 318 95 84 14 6 4 521
34%
22%
5%
12%
5%
1%
8% 6%
1% 1% 1% 0.1%
1% 0 0
0.4% 0.1% 0.1% 0
20
40
60
80
100
120
140
160
180
200
Autopsies External Examinations Chart Reviews
Natural Deaths by Examination and Race
White Black Hispanic Asian Native American Other/Unidentified Race
43
NATURAL DEATHS BY AGE AND SEX
ALL MEDICAL EXAMINER CASES 2011
0 20 40 60 80 100 120
0-10 years
11-20 years
21-30 years
31-40 years
41-50 years
51-60 years
61-70 years
71-80 years
81-90 years
91 + years
0-10 years
11-20 years
21-30 years
31-40 years
41-50 years
51-60 years
61-70 years
71-80 years
81-90 years
91 + years
Female 1 0 2 9 19 36 34 30 21 10
Male 6 2 6 13 63 113 77 47 30 2
Natural Deaths by Age and Sex
44
NATURAL DEATH ME Cases by AGE and RACE
Age White Black Hispanic Asian Native American Other TOTAL
0-10 years 0 4 2 0 0 1 7 11-20 years 0 0 2 0 0 0 2 21-30 years 3 4 1 0 0 0 8 31-40 years 13 2 7 0 0 0 22 41-50 years 50 18 10 0 4 0 82 51-60 years 93 28 21 5 0 2 149 61-70 years 65 20 18 4 2 1 110 71-80 years 50 11 15 2 0 0 78 81-90 years 36 6 7 2 0 0 51 91 + years 8 2 1 1 0 0 12 TOTAL 318 95 84 14 6 4 521
0
50
100
150
200
250
300
350
White Black Hispanic Asian Native American
Other
Natural Death by Age and Race
91 + years
81-90 years
71-80 years
61-70 years
51-60 years
41-50 years
31-40 years
21-30 years
11-20 years
0-10 years
45
NATURAL DEATH ALL ME CASES, BY CATEGORY and RACE
46
NATURAL DEATHS BY CATEGORY/SEX
AUTOPSY CASES ONLY
CATEGORY Male Female Total
ASCVD, NOS 49 18 67 Myocardial Infarction/CAD 2 2 4 Stroke 4 3 7 HTN 22 6 28 Aortic Aneurysm 5 0 5 Berry Aneurysm 0 2 2 Cardiomyopathy 8 1 9 Myocarditis 0 2 2 Other 21 8 29 TOTAL CARDIOVASCULAR 111 42 153 COMPLICATIONS OF ETOH 40 13 53 COPD & Emphysema 6 3 9 Interstitial Lung Disease 0 0 0 Asthma 3 0 3 Pulmonary Embolus 2 2 4 Pneumonia/Bronchitis 0 0 0 Other 4 5 9 TOTAL RESPIRATORY 15 10 25 Pneumonia 9 4 13 Meningitis/Encephalitis 0 0 0 Myocarditis/Endocarditis/Pericarditis 0 0 0 TB 0 0 0 HIV/AIDS 1 0 1 Sepsis 2 2 4 Other 5 1 6 TOTAL INFECTIOUS DISEASE 17 7 24 NEOPLASTIC 3 3 6 METABOLIC/DIABETES 10 3 13 OTHER 16 8 24
TOTAL ALL 212 86 298
47
0
20
40
60
80
100
120
Male
Female
13%
4%
5%
3%
5%
2%
1%
1%
3%
1%
5%
2%
Natural Deaths by Category/Sex Autopsy Cases Only
CARDIOVASCULAR COMPLICATIONS OF ETOH
RESPIRATORY INFECTIOUS DISEASE
NEOPLASTIC METABOLIC/DIABETES
OTHER
48
49
Undetermined Manner of Death 2011
Undetermined manner is used to designate that a death does not fit the category of natural, suicide, homicide, or accident. This includes areas where the cause of death may have been found but the manner may not be clear. This may be due to a lack of background information, uncertainties in circumstances, or decomposition of the body related to a time delay in discovery. Decomposition can sometimes be a factor, as this can distort the body and render postmortem toxicology and other testing difficult to perform and/or interpret. There are also cases where the cause of death itself cannot be determined, again possibly related to advanced decomposition of the body, the inability to obtain sufficient information for a variety of reasons, or the death may have been due to causes which leave no anatomic foot print such as certain types of heart disease(long QT syndrome e.g.), some seizure deaths, and some asphyxial deaths.. In general, autopsies should be performed on cases where manner of death and cause of death are undetermined. However, in practice that is not always possible. Cases may come to the attention of OME after cremation has occurred, making autopsy impossible. In other instances, the cause of death is clear, but the determination of manner of death would not be aided by the performance of an autopsy due to insufficient investigative information in existence. This is especially true in instances where death occurs years or even decades after a traumatic injury. In these cases, an autopsy would not yield any information that would differentiate between manners of death.
50
UNDETERMINED BY AGE and SEX
Age Male Female TOTAL
0-10 years 6 4 10 11-20 years 2 0 2 21-30 years 2 3 5 31-40 years 1 6 7 41-50 years 7 5 12 51-60 years 5 4 9 61-70 years 3 2 5 71-80 years 0 0 0 81-90 years 0 0 0 91 + years 0 0 0
TOTAL 26 24 50
23%
8%
8%
4%
27%
19%
11%
0% 0% 0%
Undetermined by Age - Male
0-10 years
11-20 years
21-30 years
31-40 years
41-50 years
51-60 years
61-70 years
71-80 years
81-90 years
17% 0%
12%
25%
21%
17%
8%
0% 0% 0%
Undetermined by Age - Female
0-10 years
11-20 years
21-30 years
31-40 years
41-50 years
51-60 years
61-70 years
71-80 years
51
UNDETERMINED BY AGE and METHOD
Age Toxin Trauma Unknown/
Other SUDI TOTAL TOTAL %
BY AGE
0-10 years 1 0 6 3 10 20% 11-20 years 0 0 2 0 2 4% 21-30 years 3 0 2 0 5 10% 31-40 years 2 0 5 0 7 14% 41-50 years 8 3 1 0 12 24% 51-60 years 3 0 6 0 9 18% 61-70 years 1 1 3 0 5 10% 71-80 years 0 0 0 0 0 0% 81-90 years 0 0 0 0 0 0% 91 + years 0 0 0 0 0 0% TOTAL 18 4 25 3 50
TOTAL % BY METHOD 36% 8% 50% 6%
52
UNDETERMINED BY AGE and RACE
Age White Black Hispanic Asian Native American TOTAL
0-10 years 4 4 2 0 0 10 11-20 years 0 0 2 0 0 2 21-30 years 4 0 0 0 1 5 31-40 years 6 0 1 0 0 7 41-50 years 8 2 2 0 0 12 51-60 years 5 3 0 1 0 9 61-70 years 5 0 0 0 0 5 71-80 years 0 0 0 0 0 0 81-90 years 0 0 0 0 0 0 91 + years 0 0 0 0 0 0
TOTAL 32 9 7 1 1 50
0 1 2 3 4 5 6 7 8
0-10 years
11-20 years
21-30 years
31-40 years
41-50 years
51-60 years
61-70 years
Undetermined by Age and Race
Native American Asian Hispanic Black White
53
SUDDEN UNEXPECTED DEATHS IN INFANCY (SUDI) 2011 The Office of the Medical Examiner certifies sleep associated deaths in infants as undetermined in manner rather than natural, following evolving practice changes in the field of forensic medicine recognizing the uncertainties and multi-factorial issues related to these deaths. In the past, these deaths might have been called "SIDS" or Sudden Infant Death Syndrome. More recent forensic literature uses the term "Sudden Unexplained Death in Infancy" or SUDI. Recognized risk factors include external factors that could contribute to asphyxia in these children, for example bed sharing with an adult and unsafe sleep surfaces. OME feels these deaths are best certified as undetermined in manner for these reasons. For this reason, most of these deaths are also certified as undetermined in cause.
1 month 2 months 4 months 5 months > 6
months
Male 0 0 1 0 1
Female 0 0 1 0 0
SUDI by AGE and SEX
White Black Hispanic
Female 0 1 0
Male 1 0 1
SUDI by Race and Sex
54
0
0.2
0.4
0.6
0.8
1
1.2
Male Female
SUDI by Sex and Month of Death
January February March April
May June July August
September October November December
Morning (8:01 am - 12:14 pm)
Afternoon (12:15 pm - 6:00 pm)
Evening (6:01 pm - 8:00 am)
1
0
1 1
0 0
SUDI by Sex and Time of Day
Male Female
55
56
Violent crime nationwide has been decreasing and Denver is no exception. Since 2005, homicides in Denver have trended downward. According to 2010 census data, non-Hispanic whites account for 52.2% of Denver's population. Hispanics account for 31.8% and blacks account for 10.2%. However, blacks and Hispanics are disproportionately represented as victims of homicide. In addition, males make up a disproportionate number of homicide victims in Denver at a ratio of approximately 9:1.
COLD CASES In 2004, the Denver Police Department was the recipient of a federal grant to help work up unsolved violent crimes such as homicide and sexual assault. With advances in DNA testing, OME has increasingly been enlisted to assist with working up these cases. As custodian of records, Michelle Weiss-Samaras increasingly provides DPD with sources of DNA material and other investigative information to help solve these crimes.
60 60
56 55
48
41
49
2004
2005
2006
2007
2008
2009
2010
2011
2012
Homicides 2005-2011
57
2011 Homicide Examinations
58
Age Male Female TOTAL
0-10 years 1 0 1
11-20 years 1 3 4
21-30 years 14 3 17
31-40 years 6 2 8
41-50 years 2 6 8
51-60 years 6 1 7
61-70 years 1 0 1
71-80 years 2 1 3
81-90 years 0 0 0
91 + years 0 0 0
TOTAL 33 16 49
0 2 4 6 8 10 12 14 16
2011 Homicides by AGE and SEX
91 + years
81-90 years
71-80 years
61-70 years
51-60 years
41-50 years
31-40 years
21-30 years
11-20 years
0-10 years
59
OME almost universally performs autopsies and victims of homicide. Rarely, there is a significant delay between injury and the death and all investigative and legal activities have been exhausted by the time the death occurs. In these situations, the pathologist reviewing the case may opt to perform a more limited examination. Drug and ethanol testing is performed on all homicide deaths where feasible e.g. where death occurs shortly after the injury was inflicted and/or in hospitalized individuals adequate antemortem blood samples can be obtained from the hospital. In this latter instance OME makes every effort to procure the earliest blood sample drawn at the hospital for this testing. These samples however are not always available and thus there are a certain number of cases where drug and ethanol testing is not possible. Drugs detected include both illicit and legally obtained drugs, both over-the-counter and prescription medications. Marijuana (THC) was the drug most commonly detected in OME homicide deaths. More than one drug was present in 16% of cases. Over half or 77%had at least one drug documented. 51% had some amount of ethanol present. In 16 of these victims the level was over the legal limit of greater than or equal to .08% as defined in Colorado statute. Weekends were the most likely days to die from homicide. Most victims were between the ages of 21 and 40 years of age.
Asian Black Hispanic American Indian
White
0 5 7 0 4
0
12 13
1
7
Homicides by Race and Sex
Female Male
60
Homicides by SEX and RACE with DRUGS
SEX RACE
DRUGS Male Female White Black Hispanic Asian Native
American TOTAL
Negative/Not Available 6 8 5 4 4 0 1 14
Cocaine/Metabolites 0 1 0 1 0 0 0 1
Methamphetamine 1 0 0 0 1 0 0 1
THC 3 2 0 2 3 0 0 5
Morphine/Heroin 1 0 1 0 0 0 0 1
Other 8 3 1 5 5 0 0 11
Multiple Drugs 14 2 4 5 7 0 0 16
TOTAL 33 16 49
Male Female
6 8
1
1 3
2 1
8 3
14
2
Homicides by Sex with Drugs
Multiple Drugs
Other
Morphine/Heroin
THC
Methamphetamine
Cocaine/Metabolites
Negative/Not Available
0
5
10
15
20
25
White Black Hispanic Asian Native
American
Homicides by Race with Drugs
Negative/Not Available Cocaine/Metabolites
Methamphetamine THC
Morphine/Heroin Other
Multiple Drugs
61
9
1
1
0
9
2
2
3
1
7
2
2
4
5
0
1
0
Homicides by Race involving Alcohol White Black Hispanic Asian Native American
Homicides by SEX and RACE with ALCOHOL Blood Alcohol SEX RACE
Male Female White Black Hispanic Asian
Native
American TOTAL
Not Done/Negative 13 13 9 9 7 0 1 26
Less than 0.050% 4 1 1 2 2 0 0 5
0.051% - 0.1% 4 0 0 2 2 0 0 4
0.101% - 0.150% 6 1 0 3 4 0 0 7
0.151% - 0.2% 5 1 0 1 5 0 0 6
0.201% - 0.25% 0 0 0 0 0 0 0 0
0.251% - 0.3% 1 0 1 0 0 0 0 1
0.301% - 0.350% 0 0 0 0 0 0 0 0
> 0.351% 0 0 0 0 0 0 0 0
TOTAL 33 16 49
13
4
4
6
5
0
1
0
0
13
1
0
1
1
0
0
0
0
0% 50% 100%
Not Done/Negative
Less than 0.050%
0.051% - 0.1%
0.101% - 0.150%
0.151% - 0.2%
0.201% - 0.25%
0.251% - 0.3%
0.301% - 0.350%
> 0.351%
Homicides by Sex involving Alcohol
Male
Female
62
Homicides by Time of Day Female Male TOTAL Time of Day 12:01 AM - 6:00 AM 4 11 15 6:01 AM - NOON 3 5 8 12:01 PM - 6:00 PM 5 7 12 6:01 PM - MIDNIGHT 4 10 14 TOTAL 16 33 49
25%
19% 31%
25%
Female
12:01 AM - 6:00 AM 6:01 AM - NOON
12:01 PM - 6:00 PM 6:01 PM - MIDNIGHT
34%
15% 21%
30%
Male
12:01 AM - 6:00 AM 6:01 AM - NOON
12:01 PM - 6:00 PM 6:01 PM - MIDNIGHT
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Female 3 1 3 3 1 3 2
Male 7 6 2 5 1 4 8
Homicides by Day of the Week
63
Age Asphyxia Blunt Injury Combo/Other GSW Sharp Force Injury TOTAL
0-10 years 0 1 0 0 0 1
11-20 years 0 0 1 3 0 4
21-30 years 0 0 1 15 1 17
31-40 years 0 1 0 6 1 8
41-50 years 0 0 1 1 6 8
51-60 years 0 2 0 3 2 7
61-70 years 0 2 0 0 0 2
71-80 years 0 1 0 1 0 2
81-90 years 0 0 0 0 0 0
91 + years 0 0 0 0 0 0
TOTAL 0 7 3 29 10 49
Male Female
Asphyxia 0 0
Blunt Injury 5 2
Combo/Other 2 1
GSW 23 6
Sharp Force Injury 3 7
0
5
10
15
20
25
Homicides by SEX and METHOD
1 1 2 2
1 1 1 1
3
15
6
1
3
1 1 1
6
2
0
2
4
6
8
10
12
14
16
0-1
0 y
ea
rs
11
-20
ye
ars
21
-30
ye
ars
31
-40
ye
ars
41
-50
ye
ars
51
-60
ye
ars
61
-70
ye
ars
71
-80
ye
ars
81
-90
ye
ars
91
+ y
ea
rs
Homicides by Age and Method
Asphyxia Blunt Injury Combo/Other GSW Sharp Force Injury
64
Homicides by Age and Race
Age Race
White Black Hispanic Asian Native
American TOTAL 0-10 years 1 0 0 0 0 1 11-20 years 0 2 2 0 0 4 21-30 years 2 7 8 0 0 17 31-40 years 1 2 5 0 0 8 41-50 years 0 4 3 0 1 8 51-60 years 3 2 2 0 0 7 61-70 years 2 0 0 0 0 2 71-80 years 2 0 0 0 0 2 81-90 years 0 0 0 0 0 0 91 + years 0 0 0 0 0 0 TOTAL 11 17 20 0 1 49
0 2 4 6 8 10
0-10 years
11-20 years
21-30 years
31-40 years
41-50 years
51-60 years
61-70 years
71-80 years
81-90 years
91 + years
Homicides by Age and Race
Native American
Asian
Hispanic
Black
White
65
Homicides by Setting and Sex
7
11
1 1 1 1 1 2
1 2
1
10
5
1 2
1 1
Total Homicides
by Setting
25%
19%
0% 6%
6% 0%
0%
6%
0% 0%
0% 13%
13%
0%
13%
0%
0%
Female Homicides by Setting
Resident of Another Residence Alley Apartment Car Nightclub/Bar Outside of Nightclub/Bar Outside Home Parking Lot Public Place
9%
24%
3%
3% 3% 3% 3%
6% 3%
24%
9%
3% 3% 3%
Male Homicides by Setting
Resident of Another Residence Alley Apartment Car Nightclub/Bar Outside of Nightclub/Bar Outside Home Parking Lot Public Place
66
67
Colorado has one of the highest suicide rates in the country. Denver’s suicide rate is approximately equal to the overall state rate.
Compared with past years, suicide deaths are trending slightly upward in Denver County.
A person may have one or more risk factors that would put an individual at
increased risk for completing the suicide. In 2009, OME became more aggressive
in tracking these risk factors and recording them in a way that they could be
better tracks. These risk factors will be tracked over time to determine if there
are any identifiable trends in risk factors.
97
79
102 95
99 104
91
2005
2006
2007
2008
2009
2010
20
11
Suicides 2005-2011
68
TOTAL PERCENTAGE: 97.8% AUTOPSIES
0% EXTERNALS 2.1% CHART REVIEWS
Fem
ale
M
ale
20
69
0
0
2
0
Suicide Examinations
Chart Review External Exam Autopsy
69
Age Race White Black Hispanic Asian Native American Other TOTAL 0-10 years 0 0 0 0 0 0 0 11-20 years 3 1 5 0 0 0 9 21-30 years 11 3 5 1 0 1 21 31-40 years 7 2 4 1 1 0 15 41-50 years 12 1 5 0 1 0 19 51-60 years 14 0 1 0 1 0 16 61-70 years 5 0 0 0 0 0 5 71-80 years 3 0 1 0 0 0 4 81-90 years 2 0 0 0 0 0 2 91 + years 0 0 0 0 0 0 0 TOTAL 57 7 21 2 3 1 91
0
5
10
15
20
25
0-1
0 y
ea
rs
11
-20
ye
ars
21
-30
ye
ars
31
-40
ye
ars
41
-50
ye
ars
51
-60
ye
ars
61
-70
ye
ars
71
-80
ye
ars
81
-90
ye
ars
91
+ y
ea
rs
Suicides by Age and Race
White Black Hispanic Asian Native American Other
70
Alcohol Gunshot Hanging Jumped from
Height Other Overdose/
Toxic Sharp Force TOTAL
Age
0-10 years 0 0 0 0 0 0 0 0
11-20 years 0 3 6 0 0 0 0 9
21-30 years 0 9 9 1 0 2 0 21
31-40 years 0 2 7 2 0 3 1 15
41-50 years 0 6 4 5 0 3 1 19
51-60 years 0 5 5 0 0 6 0 16
61-70 years 0 3 0 0 0 2 0 5
71-80 years 0 2 1 0 0 1 0 4
81-90 years 0 1 0 0 0 1 0 2
91 + years 0 0 0 0 0 0 0 0
TOTAL 0 31 32 8 0 18 2 91
0 2 4 6 8 10
Alcohol
Gunshot
Hanging
Jumped from Height
Other
Overdose/Toxic
Sharp Force
Suicides by Method and Age
91 + years
81-90 years
71-80 years
61-70 years
51-60 years
41-50 years
31-40 years
21-30 years
11-20 years
0-10 years
71
This graph shows the risk factors noted in Denver suicides. Many people have more than one risk factor.
Note Left 29 Previous Threats/Attempts 38 Prior Suicide in Family 5 Loss of Significant Relationship 10 Family Member/Close Friend Died 6 Recent Period of Despondency 31 Recent Period of Rage 7 Financial Problems 18 Marital Problems 17 Illness of Self 10 Illness of Another 3 Loss of Loved One 6 Relationship Problems 22 Unknown/Other Reason 7 Drug Problems 14 Alcohol Abuse 19 Legal/Disciplinary Problems 8
72
73
Suicide Settings
Female Male TOTAL Business (Inside/Outside) 0 2 2 Car 0 3 3 Empty Building 1 0 1 Field 0 1 1 Garage 1 3 4 Homeless Shelter 1 0 1 Hotel/Motel 3 5 8 Other's Residence 2 6 8 Outside Home/Apartment 0 5 5 Outside Other's Home/Apartment 0 3 3 Park 0 1 1 Parking Garage 0 1 1 Parking Lot 0 1 1 Residence/Home 13 34 47 Residence/Apartment 1 4 5 TOTAL 22 69 91
0 0 1 0 1 1 3 2 0 0 0 0 0
13
1
2 3 0 1 3
0 5 6 5 3 1 1 1
34
4
Suicides by Setting
Female Male
74
75
DRUG RELATED DEATHS
2004 THROUGH 2010
DENVER OFFICE OF THE MEDICAL EXAMINER IN CONJUNCTION
WITH THE DENVER OFFICE OF DRUG STRATEGY (DODS)
In 2008, OME partnered with the Denver Office of Drug Strategy to
gather data on drug-related fatalities in Denver from 2003 to present.
The compilation of data is part of a bigger work group, which brings
representatives from law enforcement, OME, DODS, Denver Police
Crime Laboratory, Rocky Mountain Poison and Drug Center, Denver
Health and Hospitals, and several drug abuse treatment providers.
This workgroup will continue to examine drug use/abuse trends and
determine effectiveness of treatment and prevention efforts. Drug
deaths include not only accidental deaths related to recreational abuse
of drugs, but also other accidental toxic effects, suicidal overdoses,
and deaths with undetermined manner.
OME would like to thank Bruce Mendelson, senior data consultant for
the DODS, for his tireless work in pulling out the mortality data.
76
2005 – 2011 Drugs Contributing to Cause of Death
Including Accidents, Suicides, and Undetermined Manner 2005 2006 2007 2008 2009 2010 2011
n % n % n % n % n % n % n %
Cocaine 82 48.2 85 50.3 75 39.7 60 8.3 53 25.6 41 27 58 26.0
Morphine 60 35.3 64 37.9 43 22.8 48 22.6 26 12.6 18 11.8 55 24.6
Alcohol 44 25.9 65 38.5 66 34.9 75 35.4 72 34.8 52 34.2 58 26.0
Codeine 36 21.2 36 21.3 18 9.5 19 9.0 11 5.3 3 2.0 18 8.0
Heroin 18 10.6 17 10.1 18 9.5 27 12.7 49 23.7 35 23 40 17.9
Methadone 17 10.0 16 9.5 14 7.4 15 7.1 15 7.2 11 7.2 19 8.5
Oxycodone 12 7.1 7 4.1 38 20.1 33 15.6 48 23.2 24 15.8 35 15.6
Methamphetamine 12 7.1 9 5.3 12 6.3 15 7.1 10 4.8 14 9.2 24 10.7
Acetaminophen 11 6.5 2 1.2 14 7.4 13 6.1 4 1.9 8 5.3 5 2.2
Diazepam 10 5.9 11 6.5 19 10.1 16 7.5 23 11.1 19 12.5 19 8.5
Alprazolam 10 5.9 5 3.0 13 6.9 15 7.1 20 9.7 12 7.9 18 8.0
Hydrocodone 7 4.1 10 53.9 8 4.2 22 10.4 18 8.7 10 6.6 19 8.5
Diphenhydramine 7 4.1 1 0.6 11 5.8 11 5.2 3 1.4 9 5.9 5 2.2
Clonazepam 2 1.2 0 0 1 .5 4 1.9 8 3.9 7 4.6 8 3.5
Fentanyl 3 1.8 3 1.8 5 2.6 5 2.4 13 6.3 5 3.3 5 2.2
Decedents* 170 169 189 212 207 152 223
Source: Denver Medical Examiner’s Office Autopsy Reports * Drug totals won’t sum to decedents because more than one drug may be found in individual’s toxicology
0
10
20
30
40
50
60
70
80
90
2005 2006 2007 2008 2009 2010 2011
2005-2011 Drugs Contributing to Cause of Death
Including Accidents, Suicides, and Undetermined
Cocaine Morphine Alcohol Codeine Heroin Methadone Oxycodone Methamphetamine Acetaminophen Diazepam Alprazolam Hydrocodone Diphenhydramine Clonazepam Fentanyl
77
78
0 50 100 150 200 250
Autopsies
External Examination
Chart Review
Autopsies External Examination Chart Review
Asphyxia/drowning 16 0 2
Falls 21 4 90
Fire 0 0 0
Motor Vehicle 1 0 0
Overdose/toxic 159 2 2
Other 16 0 8
Non-Traffic Accident Examinations
1 1 1 2 4
10
2 3 4 2
4
10 7
18
9
4 4 4 1 2 1 2 2
24 23
33
40
15
20
39
29
0-10 years
11-20 years
21-30 years
31-40 years
41-50 years
51-60 years
61-70 years
71-80 years
81-90 years
91 + years
Accidents by Race and Age
Asian Black Hispanic Native American White Other
79
Accidents by Category and Age
Age Asphyxia/drowning Falls Fire
Motor Vehicle
Overdose/toxic Other TOTAL
0-10 years 2 1 0 0 0 0 3 11-20 years 0 1 0 0 3 0 4 21-30 years 3 3 0 0 22 0 28 31-40 years 0 0 0 1 34 0 35 41-50 years 1 2 0 0 38 3 44 51-60 years 4 10 0 0 50 5 69 61-70 years 1 6 0 0 14 5 26 71-80 years 4 21 0 0 2 3 30 81-90 years 3 41 0 0 0 4 48 91 + years 0 30 0 0 0 4 34 TOTAL 18 115 0 1 163 24 321
0 10 20 30 40 50 60
Non-Traffic Accidents by Category and Age
91 + years 81-90 years 71-80 years 61-70 years 51-60 years
41-50 years 31-40 years 21-30 years 11-20 years 0-10 years
80
0-10
years
11-20
years
21-30
years
31-40
years
41-50
years
51-60
years
61-70
years
71-80
years
81-90
years
91 +
years
2 1
24 26
35
52
20
14
21 18
1 3 4 9 9
17
6
16
27
16
Accident by SEX and AGE
Male
Female
81
Accidents by Sex and Marital Status
Common Law Divorced Married Single Unknown Widowed TOTAL
Male 0 51 49 81 7 25 213
Female 0 23 28 20 0 37 108
TOTAL 0 74 77 101 7 62 321
82
Male Female
Alley 7 0
Assisted Living/Nursing Home
18 17
Car 1 0
Halfway House 1 0
Health Care Facility/Hospital
74 33
Hospice 7 15
Hotel/Motel 7 1
Other's Residence 11 0
Outside Area/Park 4 0
Outside Business 1 0
Outside Home/Apartment
3 0
Parking Lot 1 0
Pool/Hot Tub 1 0
Residence/Home 63 36
Residence/Apartment 12 6
River/Lake 2 0
0
10
20
30
40
50
60
70
80
Accidents by Setting and Sex
83
84
0 5 10 15 20 25 30 35
Autopsy
External Examination
Chart Review
Autopsy External
Examination Chart Review
Female 8 1 0
Male 31 3 7
Traffic Accidents - Examinations
Total Percentages:
Autopsies – 78’% External Examinations – 8%
Chart Reviews – 14%
85
Traffic Accidents by Time of Day
Male Female TOTAL 12:01AM to 6:00 AM 2 2 4 12:01 PM to 6:00 PM 3 1 4 6:01 AM to Noon 3 1 4 6:01 PM to Midnight 6 1 7 Unknown 27 4 31 TOTAL 41 9 50
5% 7% 7%
15% 66%
Male
12:01AM to 6:00 AM 12:01 PM to 6:00 PM
6:01 AM to Noon 6:01 PM to Midnight
Unknown
22%
11%
11% 11%
45%
Female
12:01AM to 6:00 AM 12:01 PM to 6:00 PM
6:01 AM to Noon 6:01 PM to Midnight
Unknown
11
6 5
4
1
6
8
1 0
4
0 0
2 2
Su
nd
ay
Mo
nd
ay
Tu
esd
ay
Wed
nesd
ay
Th
urs
day
Fri
day
Satu
rday
Traffic Accidents by Day of the Week
Male
Female
86
Vehicle Position – All Traffics
Male Female TOTAL Driver 11 4 15 Passenger 3 2 5 Bicycle 2 0 2 Pedestrian 17 3 20 Unknown 1 0 1 Motorcycle 7 0 7 TOTAL 41 9 50
Toxicology Done: Total 31 tested for both drugs and alcohol.
Driver
Passenger
Bicycle
Pedestrian
Unknown
Motorcycle
11
3
2
17
1
7
4
2
0
3
0
0
Female Male
87
AT FAULT DRIVERS Blood alcohol/drugs Totals No toxicology ordered 3 Negative 1 BAC range 0 - .287% 4 THC 1 % BAC at or above 0.08% 44% Total At-Fault Drivers 9
Note: BAC ≥0.08% is the legal limit in CO for driving under the influence; almost half of at fault drivers who were killed were legally intoxicated by ethanol.
BICYCLISTS Blood alcohol/drugs Totals Negative 1 Alcohol & THC 1 Total Bicyclist – Traffic Accidents 2
MOTORCYCLE Blood alcohol/drugs Totals No toxicology ordered 4 Negative (drugs only) 0 Negative (ETOH) 0 BAC range 0 - 0.217% 2 THC 1 % BAC at or above 0.08% 14% Total Motorcycle Accidents 7
PEDESTRIANS Blood alcohol/drugs Totals No toxicology ordered 9 Negative 4 BAC range 0 - 0.351% 4 THC & Cocaine 2 THC &
Amphetamines/Methamphetamines 1 Total Pedestrian – Traffic Accidents 20
88
Male Female TOTAL Not done/Not available 17 2 19 Negative 12 3 15 Less than 0.050% 2 0 2 0.051 - 0.100% 1 0 1 0.151 - 0.200% 6 2 8 0.201 - 0.250% 1 0 1 0.251 - 0.300% 1 2 3 0.301 - 0.350% 0 0 0 > 0.351% 1 0 1 TOTAL 41 9 50
0
2
5
12
4
10
1
1
1
0
1
1
5
2 1
1
2 1
Asian
Native American
Black
Hispanic
White
Other
Blood Alcohol by RACE
Not done/Not available
Negative
Less than 0.050%
0.051 - 0.100%
0.151 - 0.200%
0.201 - 0.250%
0.251 - 0.300%
0.301 - 0.350%
> 0.351%
89
Traffic Accidents, Detected Drugs by SEX and RACE
DRUGS SEX RACE TOTAL
Male Female White Black Hispanic Asian Native
American Other
Not Done/Available 17 2 12 2 5 0 0 0 19 Not
Significant/Negative 16 4 11 3 4 0 1 1 20 Methamphetamine
/Amphetamine 1 0 1 0 0 0 0 0 1 THC 5 1 4 1 1 0 0 0 6
Morphine 0 0 0 0 0 0 0 0 0 Multiple Drugs 2 2 2 2 0 0 0 0 4
TOTAL 41 9 30 8 10 0 1 1 50
Not Done/Available
Not Significant/Negative
Methamphetamine/Amphetamine
THC
Morphine
Multiple Drugs
17
16
1
5
0
2
2
4
0
1
0
2
Detected Drugs by Sex
Female Male
White Black Hispanic Asian Native
American
Other
12
2
5
0 0 0
11
3 4
0 1 1 1
0 0 0 0 0
4
1 1 0 0 0 0 0 0 0 0 0
2 2
0 0 0 0
Drugs Detected by Race
Not Done/Available Not Significant/Negative
Methamphetamine/Amphetamine THC
Morphine Multiple Drugs
90
Denver has a diverse cultural composition, and continues to grow in population; Growth is comprised of a spectrum of racial and ethnic groups represented. The Denver Office of the Medical Examiner feels it is particularly important to be sensitive to others and respects, and appreciates all cultures and religious beliefs. If an autopsy is required, the office strives to adhere to as many cultural and religious beliefs as possible, though the office must complete its statutory duty and determine the cause and manner of death. The office continually strives to help the friends and families understand the duties of the office and the need for our involvement in the investigation of the death of their loved one. Contact with clergymen is encouraged, when appropriate and attempts are made to locate a professional that is bilingual when needed. While there are no Colorado State Laws which require the Coroner/Medical Examiner to identify and locate next of kin, this office has historically been tasked with this job. The Medical Examiner’s Office has been involved in the training of the Victim Advocates for years and is fortunate to have the assistance of the Denver Police Department Victim Advocates to assist when possible in the notification of the next of kin.
91
The City of Denver has over 200 city and mountain parks. Many events are held for the public in these parks. Many of the Parks have rivers, lakes, and trails for walking, riding bikes, and running, for the public enjoyment. Though the City of Denver owns many mountain parks outside of Denver proper, this office does not respond to deaths in these mountain areas. The local law enforcement and Coroner have the authority to handle those deaths for the Denver Office of the Medical Examiner.