EL PASO COUNTY CORONER’S OFFICE · THE EL PASO COUNTY CORONER’S OFFICE 05 2018 Revenue for El...

THE EL PASO COUNTY CORONER’S OFFICE

EL PASO COUNTYCORONER’S OFFICE

2018 ANNUAL REPORT

THE EL PASO COUNTY CORONER’S OFFICE 01

The Coroner’s Office (EPCCO) serves El Paso County by investigating all sudden, unexpected, and non-natural deaths. While many natural deaths can be certified by the decedent’s physician, approximately one quarter of deaths require further investigation to determine cause and manner of death and ensure public health and safety. In addition to performing 844 autopsies on El Paso County Deaths, the office performed 354 autopsies for a fee for 19 surrounding counties

In 2018, the Coroner’s Office staff consisted of five board-certified forensic pathologists including the county’s former elected Coroner Robert Bux, M.D., Deputy Chief Medical Examiner and current Coroner Leon Kelly, M.D. and Associate Coroners Dan Lingamfelter, D.O., Emily Russell, M.D., and Travis Danielsen, M.D., as well as five administrative staff, eight death investigators, four toxicologists, one histologist, and five morgue technicians.

TOTAL DEATHS INVESTIGATED

4779AUTOPSIES

PERFORMED

1198


Why Perform an Autopsy?

Colorado Revised Statute 30.10.606 describes the roles and responsibilities of the coroner in investigating deaths. A complete forensic investigation provides the cause and manner of how an individual died. The investigation can assist in settling insurance and estate claims as well as the implementation of civil and criminal actions. Identifying cause and manner of death is a critical component of ensuring public health and safety. The surviving family and general public can have peace of mind that a thorough investigation was completed.

It is the responsibility of the Coroner’s Office to identify the decedent and notify next-of-kin. In many cases, identification and next-of-kin notification can be quickly achieved. However, in cases of burns, extensive injury, or decomposition this can prove more challenging. Our office ensures all leads have been exhausted in pursuit of identification and notification. At the time of this report, 1 body from 2018 is still awaiting positive identification. In 2018, 22 unclaimed remains were released to the Public Administrator.

02

MEANS OF IDENTIFICATION

Visual or Circumstances

Fingerprints – 50

Dental – 2

X-ray – 1

No individuals were identified using DNA during 2018

– 800


What is an Autopsy?

An “autopsy” can encompass several levels of examination:

307 cases in 2018 were “external only” examinations, in which the cause and manner

are well established by the external examination* and a

thorough medical history.

*External Examination – Every autopsy includes a thorough examination of the outside of the decedent’s body documenting changes of natural disease, identifying marks and scars, medical treatment, injuries, and an inventory of clothing and property.

307 39 85239 of the 2018 examinations were partial autopsies and

typically consisted of “head only” examinations to ensure that head trauma didn’t cause or

contribute to death.

852 Examinations included a full internal exam in which each organ and

body cavity is examined and is considered a complete autopsy.

90% of cases had toxicology testing performed. Samples are nearly always collected,

but testing may not be performed at the discretion of

the physician

90%El Paso County Coroner’s Office does not perform Hospital Autopsies.

596The El Paso County

Coroner’s Office performed a single

exhumation in 2018

03

596 autopsies required death scene investigations

1

⌧

Average number of days from autopsy report to completion during 2018 was 32 days.

82 cases (<7%) took greater than 60 days to complete due to their complexity or ongoing investigation.

Average time to completion


What Deaths are Investigated?

// Sudden, unexpected, or non-natural // No physician available to certify the death // Industrial accidents // Deaths in the custody of law enforcement or in the care

of a public institution // Deaths due to contagious diseases // All unexplained deaths

// Pronounce death // Determine cause and manner of death // Identify human remains // Notify next-of-kin // Investigate death in conjunction with but independent of

law enforcement agencies // Collect evidence on or in the body // Secure a decedent’s property for next-of-kin // Provide expert testimony // Grant tissue/organs for donation

04

Responsibilities of the Coroner:

Colorado Revised Statutes (C.R.S) 30-10-606 mandate that the following deaths are reported to and investigated by the coroner:


2018 Revenue for El Paso County Coroner’s OfficeGrant for Violent Death Reporting $3,825Out-of-County Autopsy Fees $456,120Out-of-County Toxicology Fees $108,745

Miscellaneous Fees $1,453$574,443

El Paso County Citizen Cost Breakdown

Total Revenue for 2018

2018 Population* 713,856$2,668,929Total 2018 Budget

$2,668,929 (Budget)

(Revenue)- $574,443

$2,094,486 Overall Cost to Citizens

÷ 713,856 (Population)

= $2.93 Annual cost to each El Paso County Citizen

*US Census Bureau ( July, 2018) †This represents an 8% increase in revenue over 2017

Histology Fees $4,300

†


ALAMOSABACABENTCHAFFEECONEJOSCOSTILLACROWLEYCUSTEREL PASOELBERT

3146

281012

919

84418

FREMONTHUERFANO

KIOWAMINERAL

OTEROPARK

PROWERSRIO GRANDE

SAGUACHE

6024242420111618

1,198 – TOTAL CASES

06

Overall Breakdown of Autopsies Performed by the El Paso County Coroner’s Office

TELLER38


Manner of Death

There are five manners of death that can be listed on a Colorado Death Certificate.

Natural - Deaths due solely to disease or aging

Accident - Deaths due to unintentional injury

Suicide - Deaths due to an intentional self-inflicted injury

Homicide - Deaths due to the intentional injurious action of another individual

Undetermined - Deaths in this category may or may not have a determined cause of death, or may have several different possible manners.

07

Natural (30%)

Accident (44%)

Suicide (18%)

Homicide (7%)

Undetermined (1%)

Unclassified - Death of a fetus in utero (in the uterus) does not receive a manner determination

Unclassified (0.1%)

2018 El Paso County Breakdown


Deaths Due to Natural Diseases

Cardiovascular

Chronic Alcohol

Pulmonary Embolism

Infections

Gastrointestinal

Geriatric Decline/Dementia

Cancer

Significant Contributing Causes – The diseases that are most commonly listed as significant contributing factors in death alongside those causes listed above include obesity, diabetes, pulmonary disease, cardiovascular disease, smoking, and chronic alcoholism.

Complications of Pregnancy

Morbid Obesity

Pulmonary Disease

Liver Disease

255145

27

13

12

7

5

7

6

6

8

1

Total

Diabetes

2

Epilepsy 7

Cerebrovascular 5

Other 4


Blunt Force Injury Accidents

Deaths Due to Accidents

369 Total

Motor Vehicle Accidents

Drugs

Falls

Pedestrian Injury

Firearms

Fires/Burns

Carbon Monoxide

Choking

Acute Alcohol Intoxication

Asphyxias

Train

Drowning

Bicycle Injuries

67

133

100

19

4

2

5

1

1

14

1

10

2

Falls in elderly

Passenger vehicles

Motorcycle

Pedestrian

Train

Bicycle

86

122

55

119

Hypothermia 2

Others 6

There was a slight decrease in accidents (378 in 2017) largely due to a decrease in drug related deaths (147 in 2017). This decrease was partially offset by an increase in motor vehicle deaths (60 in 2017).

Falls from climbing/hiking

Falls down stairs 53

Falls from height

Structure collapse 1

6


Motor Vehicle Crashes

Type of Vehicle InvolvedSedan

Mini Van

Motorcycle SUV

Other/Unknown

Truck

39%16%14%14%1%16%

Use of Restraint/seatbelt

Yes

Unknown No

Motorcycle

24%

37%21%18%

Type of Collision

Front

Unknown

Rear Side

Rollover

26%33%3%28%10%

*Every crash in which the decedent was ejected there was failure to use a seatbelt

Suspected Primary Cause of Crash

Operator Error

Unknown

Reckless Driving/Excessive Speed*Of the 41 fatal accidents where the decedent was the “at fault driver” 31 had drugs, alcohol, or THC in their system at autopsy

Vehicle vs. Pedestrian Drugs: 2Alcohol: 12THC: 2

Alcohol + THC: 5Drugs + Alcohol: 3Drugs + THC: 4

Drugs, Alcohol + THC: 3

8%

24%

68%

Pedestrian at fault Driver at fault Unknown

26% 21%53%


Drug Related Accidental Deaths

133Total

Methamphetamine

Heroin

Heroin + Methamphetamine

Prescription Opioids

Fentanyl

Heroin, Cocaine + Methamphetamine

Non-Opioid Prescription Drugs

Methamphetamine + Fentanyl

Ethanol

Prescription Opioids + Benzodiazepines

Methamphetamine + Prescription Opioids

Cocaine

Cocaine + Heroin

36

22

18

10

6

4

6

3

2

3

9

7

3

HeroinOxycodone HydrocodoneFentanylMorphineTramadolMethadone

Mixed RX Opioids withMethadone

Mixed RX Opioids

Cocaine, Methamphetamine + Mixed Opioids 1

There were decreases in the total number of drug-related deaths from 2017 (147) due to decreases in opioid deaths (92 in 2017) including heroin, but a slight increase in fentanyl related deaths (5 in 2017).

Cocaine + Methamphetamine 3

78 TotalOpioids resulting in death


v

12

Of medication used in the overdose was prescribed by the

decedent’s physician.

12%The average age at death (range of 17 - 91 years)

old)

2018 Drug Related Death Facts

Accidental drug deaths that were

male

74%

v Have a prior history of

substance abuse or addiction

70%

44 YEARS

Death scene investigations

revealed drugs, drug paraphernalia or

medications of abuse

52%

Percentage of the accidental opioid deaths that were

heroin

60%

Have a known history of

mental illness

23%

21%Deaths of all causes that have marijuana metabolites present

at autopsy Represents a 1% increase

from 2017

v Total number of opioid related deaths

(including accident and suicides)

102 in 2017

87


Apparent Circumstances of the Homicides

13

56Total

Firearms

Blunt Force Injuries

Sharp Force Injuries

Restraint

41

7

6

2

AltercationDrug relatedUnknownDomestic violenceOfficer involved*Reckless use of firearmSelf defense (no charges filed)Hit + run motor vehicle collision

77

3

5

128

5 5

There was a marked increase in homicides (42 in 2017) largely involving firearms (30 in 2017) under circumstances where another crime (drugs or burglary) was being committed, or there was reckless use of a firearm.

80% of homicide victims were intoxicated with drugs (48% of victims), alcohol (38% of victims), THC (38% of victims) or some combination at death

*All 5 officer-involved deaths were associated with the lawful use of force that resulted in the death of another. Therefore, the manner is medically ruled a homicide. One law enforcement officer was killed in the line of duty serving our community.

While committing another crime 5 Child Abuse 1

Deaths Due to Homicide


Deaths Due to Suicide

152 Total

Drugs Used in Suicide

Other

Benzodiazepines

Opioids

Psychiatric Medication

Mixed alcohol and non-opioids

9

3

2

1

2

44Average age

at death (Range of 13 -

90 years)

35% 59% 73% 22%Notes or social

media posts indicating suicidal

intentions

Have a reported history of prior mental illness

Autopsies contain drugs (39%), alcohol (36%), or THC (15%) at the time of death

Have a history of prior suicide

attempts

2018 Suicide Facts

of completed suicides were male74%of firearm deaths used their personal weapon96%

Four most common risk factors: recently ended relationship, personal health crisis, financial struggles, and legal issues.

Firearms

Ligature

Drugs

Carbon Monoxide

Sharp Force Injury

Asphyxia

Fall

80

37

18

9

1

4

2

Train 1


Gender

15

Child Fatalities

39 Total

Fetus

<1 Year

13-17

1-4 Years

5-12 Years

1

9

17

9

3

Age

Male: 3

Hanging

Drugs

Firearms

Female: 4

4

2

1

Teen Suicides (Ages 13-15 Years)

Breakdown

NaturalHomicides SuicidesPedestrian struck by motor vehicleInfant unsafe sleep/asphyxiaUndeterminedDrowningMotor vehicle accident

Drugs, AccidentFetal death

5371

835311

Deaths due to an unsafe sleep surface

Deaths due to bed sharing with adults

4

4

El Paso County Coroner’s Office investigated the deaths of 39 children (below the age of 18 years old). This is a marked decrease from 2017 (53 total deaths) due in large part to our decrease in teen suicides (13 in 2017) and homicides (9 in 2017). These cases are individually reviewed by the El Paso County Child Fatality Review Team to identify strategies to prevent these types of deaths in the future, which has resulted in community-wide efforts to decrease teen suicide in El Paso County. Additional areas of concern include an increase in infant deaths due to unsafe sleeping environments and two deaths due to unsecured firearms.

Firearms, Accident 2

When the Suicides Occurred

January February October

1 51

Infant Asphyxias: 8 Total


Homeless Deaths in El Paso County

61 Total

Manners of Death

As homelessness continues to be a concern for our community, it is important to examine what issues cause or contribute to death in this population. In 2018, 61 total individuals died unexpectedly and were investigated by the coroner.

Homelessness is defined as: • Sleeping on the streets

• Sleeping in a tent, vehicle, or shelter

• “Couch surfing” or “squatting”

• Transitional living program

• Temporary residence in a motel

49Average age at death

82%RACEWhite – 81% Black – 11%

Hispanic – 8%

Homeless deaths were

male

Accident

Undetermined

Homicide Natural

Suicide

56%29%10%3%2%

Natural Deaths

Heart Disease

Pulmonary Embolism

Infections Alcoholism

Chronic Substance Abuse

104211

Drug Intoxications

Methamphetamine

Methamphetamine + Cocaine

Methamphetamine + Heroin Heroin

Methamphetamine + Fentanyl

114211

Accidents

Drug intoxication

MVA

Carbon monoxidePedestrian stuck by vehicle

Hypothermia

55%27%9%6%3%


Firearms Related Deaths

125 Total In 2018, 125 total individuals died of firearms related injuries.

Firearm Related Homicide Circumstances

Suicide

Accident Homicide

64%33%3%

Altercation

Drug related

Domestic violence

Unknown

Lawful use of deadly force by law enforcement

Reckless use of a firearm

Lawful self-defense

8

8

5

5

3

5

4

Breakdown of Manners

FIREARM HOMICIDE

17 – 72 years old

61%

30%

Of males used a firearm to complete suicide

vs.

AGE RANGESFIREARM

ACCIDENTFIREARM SUICIDE

2 – 80 years old

15 – 90 years old

Of females

Commission of another crime 3


10 of the 20

El Paso County donors had organs recovered for transplantation20

There were no refusals of organ

requests and only a single tissue denial

by the El Paso County Coroner

59

Organ Donation

Were coroner jurisdiction cases and all were approved for

donation

Organs were transplanted from El Paso County donors

65

In 2018:

El Paso County tissue donor cases fell under the coroner’s jurisdiction

Cases resulted in tissue harvest

37

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