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Pima County Office Of The Medical Examiner – Annual Report 2018

2 Rev: 06/27/2019

TABLE OF CONTENTS

INTRODUCTION PAGE 5

OVERVIEW PAGES 5-7

ORGANIZATIONAL CHART PAGE 8

TOTAL CASES PAGE 9

MEDICAL EXAMINER (ME) CASES PAGE 9 ME CASES (ALL COUNTIES) PAGE 10

ME CASES BY AGE (ALL COUNTIES) PAGE 10

ME CASES BY MANNER (ALL COUNTIES) PAGE 11

ME CASES BY MANNER (PIMA COUNTY) PAGE 11

HOMICIDE DEATHS (ALL COUNTIES) PAGE 12 HOMICIDE DEATHS 2009-2018 PAGE 12

HOMICIDE DEATHS BY AGE PAGE 12

HOMICIDE DEATHS BY SEX PAGE 13

HOMICIDE DEATHS BY CAUSE PAGE 13

ACCIDENT DEATHS (ALL COUNTIES) PAGE 14 ACCIDENT DEATHS BY AGE PAGE 14

ACCIDENT DEATHS BY SEX PAGE 14

ACCIDENT DEATHS BY CAUSE PAGE 15

ACCIDENT DEATHS BY CAUSE 2014-2018 PAGE 15

SUICIDE DEATHS (ALL COUNTIES) PAGE 16 SUICIDE DEATHS BY AGE PAGE 16

SUICIDE DEATHS BY SEX PAGE 16

SUICIDE DEATHS BY CAUSE PAGE 17

SUICIDE DEATHS BY CAUSE 2014-2018 PAGE 17

NATURAL DEATHS (ALL COUNTIES) PAGE 18 NATURAL DEATHS BY AGE PAGE 18

NATURAL DEATHS BY SEX PAGE 18

NATURAL DEATHS BY CAUSE PAGE 19

UNDETERMINED MANNER OF DEATH (ALL COUNTIES) PAGE 20 UNDETERMINED MANNER BY AGE PAGE 20

UNDETERMINED MANNER BY SEX PAGE 20

UNDETERMINED MANNER BY CAUSE PAGE 21


3 Rev: 06/27/2019

OVERDOSE DEATHS (ALL COUNTIES*) PAGE 22 *IF YOU WANT PIMA COUNTY ONLY GO TO PAGE 57 OVERDOSE DEATHS 2010-2018 PAGE 22

OVERDOSE DEATHS BY AGE PAGE 23

OVERDOSE DEATHS BY SEX PAGE 23

OVERDOSE DEATHS BY MANNER PAGE 24

SELECT DRUGS BY YEAR 2013-2018 PAGE 24

OVERDOSE DEATHS BY DRUG PAGE 25

MOTOR VEHICLE RELATED FATALITIES (ALL COUNTIES) PAGE 26 MOTOR VEHICLE FATALITIES 2011-2018 PAGE 26

MOTOR VEHICLE FATALITIES BY AGE PAGE 26

MOTOR VEHICLE FATALITIES BY SEX PAGE 27

MOTOR VEHICLE FATALITIES BY TYPE PAGE 27

W.H. BIRKBY FORENSIC ANTHROPOLOGY LABORATORY PAGE 28 FA EXAMS BY NUMBER 2009-2018 PAGE 28

FA EXAMS BY CONDITION OF REMAINS PAGE 29

FA EXAMS BY TYPE PAGE 29

UNDOCUMENTED BORDER CROSSER (UBC) REMAINS PAGE 30

RECOVERIES BY CY2000–2018 PAGE 31

RECOVERIES BY FEDFY2000–2018 PAGE 31

RECOVERIES BY MONTH 2018 PAGE 32

RECOVERIES BY MONTH 2000-2018 PAGE 32

RECOVERIES BY AGE 2018 PAGE 33

RECOVERIES BY AGE 2000-2018 PAGE 33

CONDITION OF REMAINS 2018 PAGE 34

CONDITION OF REMAINS 2000-2018 PAGE 34

POOLED CONDITION OF REMAINS 2000-2018 PAGE 35

RECOVERIES BY SEX 2018 PAGE 35

RECOVERIES BY SEX 2000-2018 PAGE 36

RECOVERIES BY CAUSE 2018 PAGE 36

RECOVERIES BY CAUSE 2000-2018 PAGE 37

RECOVERIES BY NATIONALITY 2018 PAGE 37

RECOVERIES BY NATIONALITY 2000-2018 PAGE 38

IDENTIFIED V UNIDENTIFIED UBC RECOVERIES PAGE 38

METHODS OF IDENTIFICATION 2000-2018 PAGE 39


4 Rev: 06/27/2019

DEATHS BY COUNTY – MEDICAL EXAMINER* PAGE 40 PIMA COUNTY PAGES 40 - 65

HOMICIDE DEATHS PAGE 44

ACCIDENT DEATHS PAGE 47

SUICIDE DEATHS PAGE 50

NATURAL DEATHS PAGE 53

UNDETERMINED DEATHS PAGE 55

OVERDOSE DEATHS PAGE 57

MOTOR VEHICLE DEATHS PAGE 62

HEAT RELATED DEATHS PAGE 64

COCHISE COUNTY PAGES 66 - 86

SANTA CRUZ COUNTY PAGES 87 - 91

*MEDICAL EXAMINER COUNTIES – PIMA COUNTY SERVES AS APPOINTED MEDICAL EXAMINER

DEATHS BY COUNTY – NON-MEDICAL EXAMINER* PAGE 92 APACHE COUNTY PAGES 92 - 94

GILA COUNTY PAGES 95 - 97

GRAHAM COUNTY PAGES 98 - 100

GREENLEE COUNTY PAGES 101 - 103

LA PAZ COUNTY PAGES 104 - 106

NAVAJO COUNTY PAGES 107 - 109

PINAL COUNTY PAGES 110 - 112

YUMA COUNTY PAGES 113 - 115

*NON-MEDICAL EXAMINER COUNTIES – PIMA COUNTY PERFORMS EXAMINATIONS ON FEE-FOR-

SERVICE BASIS BUT DOES NOT SERVE AS APPOINTED MEDICAL EXAMINER FOR THESE COUNTIES


5 Rev: 06/27/2019

INTRODUCTION

The Pima County Office of the Medical Examiner (PCOME) investigates any death in

Pima County that is sudden, violent, unexpected, or in which the cause of death is

unknown. The PCOME also serves as the Medical Examiner (ME) for Cochise and

Santa Cruz Counties and performs examinations as needed for eight additional counties.

In 2018 there were 9,816 deaths in Pima County; of these 2,774 (28%) were reported to

the PCOME for investigation. This annual report consists of four main sections. The

first is an overview of the activities and notable events of the office over the course of the

report year. The second is a statistical review of the types of all cases processed by the

office regardless of the county of death. The third is a breakdown of certain death

classifications for the three counties for which the PCOME is the appointed medical

examiner. The fourth is a breakdown of certain death classifications for deaths reported

to the PCOME from counties in which the PCOME is not the appointed medical

examiner.

OVERVIEW The PCOME was fully accredited by the National Association of Medical Examiners

(NAME) following a two-day inspection in October 2011. This accreditation was

effective from October 24, 2011 through October 24, 2016 and required annual

accreditation verifications. The office was re-inspected in January 2017 and received

continued full accreditation valid through October 25, 2021. NAME accredited offices

represent the highest quality of death investigation systems. There are 82 fully accredited

Medical Examiner’s Offices across the United States. The PCOME has the distinction of

being one of two fully accredited offices in Arizona.

Reportable Deaths

Arizona Revised Statute §11-593 delineates ten circumstances in which a death is

reportable to the PCOME.

1. Death when not under the current care of a health care provider as defined

pursuant to section 36-301.

2. Death resulting from violence.

3. Unexpected or unexplained death.

4. Death of a person in a custodial agency as defined in section 13-4401.

5. Unexpected or unexplained death of an infant or child.

6. Death occurring in a suspicious, unusual or non-natural manner, including

death from an accident believed to be related to the deceased's occupation or

employment.

7. Death occurring as a result of anesthetic or surgical procedures.

8. Death suspected to be caused by a previously unreported or undiagnosed

disease that constitutes a threat to public safety.

9. Death involving unidentifiable bodies.


6 Rev: 06/27/2019

Investigations

Our 11 medical investigators processed 2,774 reports of deaths from Pima County and

506 reports from 13 additional Arizona counties in 2018. Jurisdiction was declined in

1,108 of these cases. A total of 1,837 decedents were transported to the PCOME for

examination or storage in 2018.

Examinations

Pima County forensic pathologists and anthropologists performed 1,260 autopsies, 444

external examinations, 335 death certifications, 154 anthropologic examinations, and

reviewed 6,954 death certificates for cremations in 2018.

Education, Training and Activities

1) Medicolegal Death Investigators

Calendar year 2012 saw a transition from the term Forensic Medical Investigator

(FMI) to Medicolegal Death Investigator (MDI) for our 11 MDIs in keeping with

national norms. Seven MDIs, our MDI Supervisor, and Administrative

Supervisor are certified by the American Board of Medicolegal Death

Investigators to provide competent medicolegal death investigations. PCOME

Forensic Pathologists lecture to the MDIs on varying topics monthly. In

accordance with our MDI quality assurance and performance improvement

program, 10% of reports are reviewed by a pathologist monthly and 10% of

reports are peer reviewed quarterly.

2) Community education, presentations and media interviews

The PCOME receives numerous requests from various groups, organizations,

individuals and schools for presentations regarding a host of forensic issues

annually. Not all requests can be honored due to time and personnel constraints,

but examples of educational activities include but are not limited to: presentations

at local primary and secondary schools; lectures at various institutions and

departments at the University of Arizona; presentations and tours for

humanitarian organizations; and the teaching of a 3-credit-hour death

investigation class at Pima Community College. The Chief Medical Examiner

recorded 132 media interviews, emails and phone calls over the calendar year.

Pima County’s Forensic Anthropologists and Pathologists gave numerous

platform and poster presentations to various organizations and at national

anthropologic and forensic conferences.

3) University of Arizona College of Medicine, Department of Pathology and School

of Anthropology

PCOME Forensic Pathologists hold clinical appointments with the Department of

Pathology at the University of Arizona, College of Medicine, where they are

involved with pathology resident and medical student teaching. Four pathology

residents, four medical students and two pathology post-sophomore fellows

rotated through the PCOME for month-long rotations in 2018. Funded by the

Department of Pathology, the PCOME began a Forensic Pathology training

program in 2016; the only such training program offered in Arizona. Our

Forensic Anthropologists hold academic appointments at the University of

Arizona and four anthropology interns trained at our facility in 2018.


7 Rev: 06/27/2019

Law Enforcement and Legal System

The availability of our pathologists to assist or advise law enforcement personnel in their

investigations and the legal system in its proceedings is an important function of the

PCOME. Involvement of the PCOME in the legal system generally consists of pretrial

interviews, depositions and courtroom testimony. In 2018, the office’s six forensic

pathologists and two anthropologists participated in a number of pretrial interviews,

depositions and jury trials not only for Pima County but also for out-of-county cases.

Organ and Tissue Donation

Pursuant to A.R.S §36-861, the PCOME refers death notifications to, and partners with,

Donor Network of Arizona (DNA) and other associated tissue research agencies for the

coordination and procurement of anatomic gifts. The importance of supporting the

efforts of the organ and tissue transplant and research communities in Arizona cannot be

understated. Anatomic gifts can be life saving for organ and tissue recipients and these

donations are always in short supply. The authorization for the procurement of organs

was granted in 100% of cases. The PCOME has long been the state leader in percentage

of release on tissue and ocular cases and 2018 was no different. The release of tissues

and corneas was granted 97% of the time.

Organ Donations with PCOME Involvement 2018

Heart Lungs Liver Kidneys Pancreas Sm. Intestine Total

14 25 32 76 7 0 154

Tissue Donation with PCOME Involvement 2018

Tissue Heart Ocular

118 47 64


8 Rev: 06/27/2019

OFFICE OF THE MEDICAL EXAMINER

ORGANIZATIONAL CHART AS OF DECEMBER 31, 2018

Chief Medical Examiner

Gregory Hess MD

Administrative Services Manager

Christopher Smith D-ABMDI

Administrative Specialist

Charlotte Rupel

Administrative

Ysela Chavez

Linda Hernandez

Amber Bates

Morgue Supervisor

Lindsay Hershberger

Pathology Assistants

Gabriel Costell

Louie Goad

Jeremy Cox

Kayla Hare

Kerry Calvert

Kristine Clor

Indigent Interment

Lorenia Ton

Medicolegal Death Investigator Supervisor

Gene Hernandez D-ABMDI

Medicolegal Death Investigators

Thomas Buck D-ABMDI

Eric Slocum D-ABMDI

Raelene Ruiz D-ABMDI

Selina Herrera D-ABMDI

Jeff Huesgen D-ABMDI

JoLynne Heidt

Trevis Hairston D-ABMDI

MaryAlice Pratt

Kelsey Scott D-ABMDI

Jeffrey Honeycutt

Timothy Jessup

Deputy Chief Medical Examiner

Eric Peters MD

Forensic Pathologists

Cynthia Porterfield DO

David Winston MD PhD

Jennifer Chen MD

Kevin Lougee DO

Forensic Anthropologists

Bruce Anderson PhD

Jennifer Vollner PhD


9 Rev: 06/27/2019

TOTAL CASES

The total cases handled by the PCOME in a given year are the sum of the ME cases

(autopsies, external examinations, and death certificate cases), cases in which jurisdiction

was declined, and the number of cases stored at our facility during the calendar year

(storage cases). “All Counties” includes cases examined at the PCOME from Apache

(28), Cochise (280), Coconino (2), Gila (13), Graham (18), Greenlee (3), La Paz (30),

Maricopa (1), Navajo (40), Pinal (23), Santa Cruz (52), Yavapai (2) and Yuma (16)

counties in addition to Pima County (2,774).

MEDICAL EXAMINER CASES

The PCOME considers all cases in which the cause and manner of death are determined

by this office as “medical examiner cases.” Those cases include autopsies, external

examinations and death certificate (DC) cases. Autopsies are examinations where a

decedent is examined both externally and internally for evidence of injury or natural

disease which may have caused or contributed to the individual’s death. External

examinations consist of an external examination of the body without the internal

examination. A DC case involves review of the medical records, law enforcement

reports and any other information that may be necessary to determine the cause and

manner of death without physical examination of the decedent. In 2018, for Pima and all

other counties listed above, 1,260 autopsies, 444 external examinations and 335 DC cases

were performed or certified at the PCOME. Pima County alone accounted for 959

autopsies, 394 external examinations and 319 DC cases.

492 382 495680 739 639

734 725

475 506

2139 2195 2133

2523 2611 2520 24372657 2705 2774

2631 2577 2628

32033350

3159 31713382

3180 3280

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Total Reported Deaths 2009 - 2018

Out-of-County Pima County Office Total


10 Rev: 06/27/2019

959

394319301

50 16

Autopsy External DC

2018 Medical Examiner Cases

Pima County Other Counties

19 12 5

56

211

248

211

319332

225

193

11591

Medical Examiner Cases by Age - 2018


11 Rev: 06/27/2019

845

643

266

168114

ME Cases (all counties) by Manner of Death - 2018

Accident - 41%

Natural - 32%

Suicide - 13%

Undetermined - 8%

Homicide - 6%

716

513

221

13979

ME Cases (Pima only) by Manner of Death - 2018

Accident - 43%

Natural - 31%

Suicide - 13%

Undetermined - 8%

Homicide - 5%


12 Rev: 06/27/2019

HOMICIDE DEATHS

The PCOME certified 114 deaths as homicide in 2018, 79 from Pima County and 35

from other counties. Homicide totals from 2009 – 2018 are compared below. Homicide

victims were most frequently male (83%), between 20-29 years of age (26%) and died as

the result of firearms (71%).

121131 131 136

123

9990

114 113 114

72

93 9179

88

6256

65

84 79

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Homicide Deaths 2009 - 2018

All Counties Pima County

1 20

10

3027

17

13

75

1 0 1

Homicide Deaths by Age 2018


13 Rev: 06/27/2019

95

19

Homicide Deaths by Sex 2018

Male - 83%

Female - 17%

79

19

123

1

Homicide Deaths by Cause 2018

Firearms - 71%

Sharp Force - 12%

Blunt Force - 9%

Asphyxia - 6%

Other - 3%


14 Rev: 06/27/2019

ACCIDENT DEATHS

Deaths due to accidents accounted for 41% of the ME deaths investigated by the PCOME

in 2018. Accident victims were most frequently males (64%), between 30-39 years of

age (14%) and died as the result of an overdose (34%).

6 4 3

23

105

120

92

116

100

75

112

87

2

Accident Deaths by Age 2018

541

304

Accident Deaths by Sex 2018

Male - 64%

Female - 36%


15 Rev: 06/27/2019

289

264

194

41

23 14 9 11

Accident Deaths by Cause 2018

Overdose - 34%

Blunt Force - 31%

Motor Vehicle - 23%

Exposure - 5%

Asphyxia - 3%

Drowning - 2%

Fire Deaths - 1%

Other - 1%

268

312 318

290 289

223

270

305 300

264

190207

234

180194

2014 2015 2016 2017 2018

Accident Death by Cause (Top 3) 2014 - 2018

Overdose Blunt Force Motor Vehicle


16 Rev: 06/27/2019

SUICIDE DEATHS

Suicide deaths accounted for 13% of the ME deaths investigated by the PCOME in 2018.

Suicide victims were most frequently males (83%), between 20-29 years of age (17%)

and died as the result of firearms (58%).

0 0 1

19

4643

28

45

35

29

17

30

Suicide Deaths by Age 2018

220

46

Suicide Deaths by Sex 2018

Male - 83%

Female - 17%


17 Rev: 06/27/2019

15460

3611 5

Suicide Deaths by Cause 2018

Firearms - 58%

Hanging - 23%

Overdose - 14%

Asphyxia - 4%

Other - 2%

139

150143

161154

66

5146

57 60

37

51

27 2736

2014 2015 2016 2017 2018

Suicide Deaths by Cause (Top 3) 2014 - 2018

Firearms Hanging Overdose


18 Rev: 06/27/2019

NATURAL DEATHS

Natural deaths accounted for 32% of the ME deaths investigated by the PCOME in 2018.

Individuals who died from natural causes were most frequently males (70%), between

60-69 years of age (29%) and died as the result of cardiovascular disease (55%).

1 3 0 318

42

63

129

184

113

61

24

0

Natural Deaths by Age 2018

449

192

Natural Deaths by Sex 2018

Male - 70%

Female - 30%


19 Rev: 06/27/2019

355

50

37

37

24

38

100

Natural Deaths by Cause 2018

Cardiovascular - 55%

Chronic Alcohol - 8%

Infectious Disease - 6%

Pulmonary Disease - 6%

Diabetes Mellitus - 4%

Malignacy - 6%

Other - 16%


20 Rev: 06/27/2019

UNDETERMINED MANNER OF DEATH

Deaths in which the manner of death was undetermined accounted for 8% of the ME

deaths investigated by the PCOME in 2018. Individuals who died with an undetermined

manner were most frequently males (74%), of unknown age (52%) and died from

undetermined causes (83%). Many of these deaths represent skeletal remains of

undocumented border crossers who died in the deserts of southern Arizona.

83 1 1

1216

1116

6 3 2 1

88

Undetermined Manner of Death by Age 2018

125

33

10

Undetermined Manner of Death by Sex 2018

Male - 74%

Female - 20%

Unsure - 6%


21 Rev: 06/27/2019

140

89 4 7

Undetermined Manner of Death by Cause 2018

Undetermined - 83%

Overdose - 5%

Blunt Force - 5%

Firearms - 2%

Other - 4%


22 Rev: 06/27/2019

OVERDOSE DEATHS

There were 333 deaths attributed to an overdose of either a single drug (189 deaths, 57%)

or a combination of drugs (144 deaths, 43%) in 2018. Overdose deaths commonly

involved males (70%) between the ages of 30-39 (22%). The majority of these deaths

were classified as accidents (87%).

Opiate drugs (heroin, oxycodone, methadone, hydrocodone, morphine, oxymorphone,

hydromorphone, tramadol, opiate unspecified) and fentanyl (a synthetic opioid narcotic)

contributed to the majority of overdose deaths (203 deaths, 61%), either as a single drug

or as a component of a poly-drug overdose. Methamphetamine was the most commonly

abused illicit drug contributing to death in 2018 followed by heroin.

The number of heroin deaths is likely underreported as heroin is rapidly metabolized to

morphine by the body and if the metabolite indicative for heroin (6-monoacetylmorphine)

is not present on the toxicology report these deaths may be classified as either morphine

intoxication or opiate intoxication.

Acute alcohol (ethanol) intoxication alone, not as component of a poly-drug overdose,

accounted for 12 overdose (4%) deaths in 2018.

Fentanyl related deaths continued to increase (643% increase) from a low of 7 deaths in

2014 to 52 deaths in 2018.

273 277

314327 324

379356

328 333

2010 2011 2012 2013 2014 2015 2016 2017 2018

Overdose Deaths 2010 - 2018


23 Rev: 06/27/2019

0 0 0

8

63

74

60

72

44

8

2 2

<1 1-5 6-12 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90

Overdose Deaths by Age 2018

234

99

Overdose Deaths by Sex 2018

Male - 70%

Female - 30%


24 Rev: 06/27/2019

Select Drugs by Year 2013 - 2018

289

36 8

Overdose Deaths by Manner 2018

Accident - 87%

Suicide - 11%

Undetermined - 2%

0

20

40

60

80

100

120

140

2013 2014 2015 2016 2017 2018

Heroin Fentanyl Oxycodone Morphine

Meth Cocaine Benzo Alcohol


25 Rev: 06/27/2019

84

26

9

2

1

20

21

2

2

12

52

124

31

21

0

33

2

12

3

5

2

3

2

5

0

4

7

11

Heroin

Oxycodone

Hydrocodone

Oxymorphone

Hydromorphone

Methadone

Morphine

Codeine

Tramadol

Opiate Unspecified

Fentanyl

Methamphetamine

Cocaine

Benzodiazepines

Barbiturates

Alcohol

Antihistamines

SSRI/SNRI

Tricyclics

Atypical Antipsychotics

Muscle Relaxants

Anti-seizure Agents

Sleep Aids

Acetaminophen

Ethylene Glycol

β-Blockers

Amphetamine

Other

Overdose Deaths by Drug 2018Opiate compounds are red


26 Rev: 06/27/2019

MOTOR VEHICLE RELATED FATALITIES

Motor vehicle related fatalities accounted for 196 total deaths in 2018. The majority, 110

deaths, were occupants of a motor vehicle involved in an accident (MVA). Of the

remaining, 23 were motorcycle accidents (MCA), 57 were pedestrians or bicyclists struck

by vehicles and 6 were operating an all-terrain vehicle (ATV). Individuals who died

from motor vehicle related fatalities were most frequently males (69%) and between 20-

29 years of age (23%).

209214

199 196

209

239

184

196

2011 2012 2013 2014 2015 2016 2017 2018

Motor Vehicle Fatalities by Year 2011 - 2018

1 1 1

12

36 35

22

33 33

18

31

<1 1-5 6-12 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90

Motor Vehicle Fatalities by Age 2018


27 Rev: 06/27/2019

135

61

Motor Vehicle Fatalities by Sex 2018

Male - 69%

Female - 31%

110

47

2310 6

Motor Vehicle Fatalities by Type 2018

MVA - 56%

Pedestrian - 24%

MCA - 12%

Bicyclist - 5%

ATV - 3%


28 Rev: 06/27/2019

W.H. BIRKBY FORENSIC ANTHROPOLOGY LABORATORY

Forensic Anthropologists at the W.H. Birkby Forensic Anthropology

Laboratory within the PCOME performed 118 examinations (biological

profiles, trauma evaluations, dental examinations and examinations for identification) in

2018 on human remains of forensic significance. An additional 43 examinations were

performed on remains ultimately deemed non-human, prehistoric or otherwise not

forensically significant and these remains were classified as jurisdiction declined (JD)

cases.

The extent of postmortem decomposition of a particular set of remains is important when

performing a Forensic Anthropology (FA) examination. Remains examined by Forensic

Anthropologists were categorized as minimally decomposed, decomposing, mummified,

skeletal or burnt. In 2018, skeletal remains comprised 75% of FA examinations. Five

main types of exams are performed: biologic profiles, dental examinations, trauma

evaluations, comparisons to antemortem information and field activities.

Biological profiles refer to charting, measurements, descriptions, radiographs and

photographs taken to estimate sex, age, ancestry, stature and postmortem interval of a set

of remains. Dental examinations entail charting, descriptions, radiographs and

photographs in an effort to preserve dental information. Trauma examinations entail

charting, measurements, descriptions, radiographs and photographs to characterize the

nature of an injury, implement used to cause injury to the bone, age of injury, etc.

Comparisons are evaluation of postmortem distinctive skeletal characteristics or dental

information to antemortem information for purposes of identification. Field activities are

exhumations or other excursions from the office to assist local law enforcement with the

recovery of remains. It is common for a particular set of remains to receive more than

one type of examination.

148 149

171161 163

149 145 143 139

118

14 18 14 13

30 26 29 2735

43

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Number of FA Exams 2009 - 2018

Exams JD


29 Rev: 06/27/2019

89

11

117

FA Exam by Condition of Remains 2018

Skeletal - 75%

Mummified - 9%

Decomposing - 9%

Burnt - 6%

112

97

13

28

Biologic Profiles DentalExaminations

Comparisons Trauma Field Activities

FA Examination by Type 2018


30 Rev: 06/27/2019

UNDOCUMENTED BORDER CROSSER (UBC) REMAINS

The term ‘UBC’ refers to foreign nationals who die attempting to cross the southern

Arizona desert without permission from the United States government. Calendar year

(CY) 2010 saw the highest number of UBC recoveries (222) recorded at the PCOME as

compared to the annual average (164 recoveries per year on average from 2002 - 2018).

The PCOME has received 2,943 recovered remains of suspected UBCs since 2000. The

recoveries per year are adjusted annually to account for the association of remains found

months or years apart later discovered to be that of the same individual.

There were 127 UBC recoveries in calendar year 2018. As is the historic norm, UBC

recoveries peaked during the warmer months (May – August) with 62 recoveries (49% of

total for year) in 2018. Many remains are not identifiable due to postmortem changes and

efforts by some UBCs to obscure their identities. Of the decedents who were identified,

60% (26 decedents) were between 20-39 years of age. Additionally, 84% (107) of the

recovered remains, identified or unidentified, were males, 9% (11) were females and in

7% (9) the sex was unable to be determined.

Since the exact date and time of death of found remains are often unknown, PCOME staff

determine a ‘postmortem interval (PMI)’, which is an assessment of what period of time

elapsed from death to recovery of the remains. A 1-8 body condition scale was

developed in 2013 to provide a more objective measure of the PMI. The PMI is an

estimate and therefore subject to error. The PMIs for the body condition categories are

listed following the Condition of Recovered UBC Remains table on page 34 of this

report. In 2018, 18 remains (condition 1) were found within less than a day of death

(14%), 31 remains (conditions 2-4) were found with a few days up to a few weeks from

death (24%), and skeletal remains (body conditions 5-7) accounted for 78 (61%) of the

recovered remains.

The cause of death was undetermined in 78% (99) of cases, primarily due to limitations

of examination of decomposed and skeletal remains. Of the remainder, environmental

exposure to extremes in heat or cold combined with dehydration comprised 20% (25) of

deaths. Other, less frequent, causes of death included drowning (2 cases), and blunt force

injuries (1 case).

In 2018, 21 (49%) of identified UBCs were of Mexican nationality, followed by

Guatemalans (15 or 35%), Hondurans (4 or 9%), one Salvadoran (1 or 2%), one Peruvian

(1 or 2%) and one Indian National (1 or 2%). Since 2000, identified UBCs of Mexican

nationality have been the most numerous (1,554, 82%), followed by Guatemalans (200,

11%) and Salvadorans (52, 2%). Of the 2,943 decedents since 2000, 1,892 (64%) have

been identified. As of December 31, 2018, 1050 decedents remain unidentified.


31 Rev: 06/27/2019

74 77

147155

168

192

171

215

162

191

222

178

153167

127136

153

128 127

UBC Recoveries CY2000 - 2018

71 76

143 146

167

199

167

204

162

183

222

174 168 177

120134

143 147

123

UBC Recoveries FedFY2000 - 2018


32 Rev: 06/27/2019

5

78

12 12

22

14 14

12

9

3

9

UBC Recoveries by Month 2018

143166 161

190

279

456

517

321

240

158 157 151

UBC Recoveries by Month 2000 - 2018


33 Rev: 06/27/2019

0 0 0 2

1115

12

2 1 0 0 0

84

UBC Recoveries by Age 2018

3 2 6

210

680607

296

8414 0 0 0

1042

UBC Recoveries by Age 2000 - 2018


34 Rev: 06/27/2019

1 - Fully fleshed (PMI < 1 day)

2 - Decomposed (PMI < week)

3 - Decomposition with focal skeletonization (PMI < 3 weeks)

4 - Mummification with skeletonization (PMI < 5 weeks)

5 - Skeletonization with articulation/ligamentous attachments (PMI < 3 months)

6 - Complete skeletonization with disarticulation (PMI < 6-8 months)

7 - Complete skeletonization with bone degradation (PMI > 6-8 months)

8 – Other

18

7

10

1416

23

39

0

1 2 3 4 5 6 7 8

Condition of Recovered UBC Remains 2018

942

335

221285

240

325

592

3

1 2 3 4 5 6 7 8

Condition of Recovered UBC Remains 2000 - 2018


35 Rev: 06/27/2019

Pooled Body Conditions of Recovered UBC Remains by Year 2000 - 2018

1 – 4 represents not fully skeletal remains with a likely PMI of ≤ 3 months

5 – 7 represents fully skeletal remains with a likely PMI of ≥ 3 months

0

20

40

60

80

100

120

140

160

180

1 - 4 5 - 7

107

119

UBC Recoveries by Sex 2018

Male - 84%

Female - 9%

Unsure - 7%


36 Rev: 06/27/2019

2466

450

27

UBC Recoveries by Sex 2000 - 2018

Male - 84%

Female - 16%

Unsure - <1%

99

252

1

UBC Recoveries by Cause 2018

Undetermined - 78%

Exposure - 20%

Drowning - 1%

Blunt Injuries - <1%


37 Rev: 06/27/2019

1375

1164

210

83 45 38 15 13

UBC Recoveries by Cause 2000 - 2018

Undetermined - 47%

Exposure - 40%

Blunt Force - 7%

Firearms - 3%

Natural Causes - 2%

Drowning - 1%

Hanging - <1%

Other - <1%

21

15

4 1 1 1

Identified UBC Recoveries by Nationality 2018

Mexican - 49%

Guatemalan - 35%

Honduran - 9%

Salvadoran - 2%

Peruvian - 2%

Indian National- 2%


38 Rev: 06/27/2019

1554

200

52

43

13

8

4

2

3

4

5

Mexican - 82%

Guatemalan - 11%

Salvadoran - 3%

Honduran - 3%

Ecuadorian - 1%

Peruvian - <1%

Brazilian - <1%

Dominican - <1%

Colombian - <1%

Costa Rican - <1%

Other - <1%

Identified UBC Recoveries by Nationality 2000 - 2018

2943

127

1893

43

1050

84

2000 - 2018 2018

Identified vs Unidentified UBC Recoveries

Total Recoveries Identified Unidentified


39 Rev: 06/27/2019

UBC Methods of Identification 2000 - 2018

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Total

Visual 20 22 68 45 51 56 50 71 57 68 64 22 21 31 12 13 13 5 8 697

Circumstantial 28 30 29 36 37 34 23 31 21 15 14 18 10 8 5 9 3 0 3 354

Fingerprints 12 4 19 22 25 41 25 31 15 20 17 27 29 13 8 19 43 21 31 422

DNA 1 2 3 16 16 18 16 19 20 25 54 35 31 45 36 35 12 10 0 394

Dental 0 0 2 0 2 1 0 2 0 1 1 0 2 2 0 0 0 1 0 14

Radiography 0 0 0 1 2 0 0 3 1 0 1 0 1 1 0 1 0 0 0 11

Identified 61 58 121 120 133 150 114 157 114 129 151 102 94 100 61 77 71 37 42 1893

Unidentified 13 19 26 35 35 42 57 58 48 62 71 76 59 67 66 59 82 91 85 1050

Total UBCs 74 77 147 155 168 192 171 215 162 191 222 178 153 167 127 136 153 128 127 2943

% Identified 82% 75% 82% 76% 79% 76% 68% 73% 70% 68% 67% 57% 61% 59% 47% 54% 44% 23% 33% 64%


40 Rev: 06/27/2019

PIMA COUNTY

TOTAL MORTALITY

The number of deaths reported to the medical

examiner’s office in a given period is a

reflection of the total population that the office

serves. In 2018 there were 9,816 deaths in Pima

County; of these 2,774 (28%) were reported to

the PCOME for investigation.

*Arizona Department of Vital Statistics as of 06/06/19

8065 8163 83928713 8592 8725

92419492 9527 9816

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Pima County Mortality by Year 2009 - 2018*


41 Rev: 06/27/2019

TOTAL CASES

The total cases handled by the PCOME from Pima County in a given year are the sum of

the ME cases (autopsies, external examinations, and death certificate cases), cases in

which jurisdiction was declined, and the number of cases stored at our facility during the

calendar year (storage cases).










manner of death without physical examination of the decedent. In 2018, 959 autopsies,

394 external examinations and 319 DC cases were performed on deaths from Pima

County.

2139 2195 2133

25232611

25202437

2657 2705 2774

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Total Cases from Pima County 2009 - 2018


42 Rev: 06/27/2019

959

394319

Autopsy External DC

2018 Pima County Medical Examiner Cases

166 4

46

159

195

155

260280

182 177

110

80

Pima County Medical Examiner Cases by Age 2018


43 Rev: 06/27/2019

716

513

221

13979

Pima County ME Cases by Manner of Death 2018

Accident - 43%

Natural - 31%

Suicide - 13%

Undetermined - 8%

Homicide - 5%


44 Rev: 06/27/2019

HOMICIDE DEATHS

The PCOME examined 84 homicides from Pima County in 2018; 5% of total Pima

County deaths certified. Homicide totals from 2009 – 2018 are compared below.

Homicide victims were most frequently male (84%), between 30-39 years of age (27%)

and died as the result of firearms (68%).

72

93 91

79

88

6256

65

8479

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Pima County Homicide Deaths 2009 - 2018

12

0

8

18

21

1011

43

10 0

Pima County Homicide Deaths by Age 2018


45 Rev: 06/27/2019

66

13

Pima County Homicide Deaths by Sex 2018

Male - 84%

Female - 16%

54

12

103

Pima County Homicide Deaths by Cause 2018

Firearms - 68%

Sharp Force - 15%

Blunt Force - 13%

Asphyxia - 4%


46 Rev: 06/27/2019

Pima County Homicide Deaths by Cause (Top 3) 2014 - 2018

40 3941

5654

5 5 8

12 12

6 5

13

810

2014 2015 2016 2017 2018

Firearms Sharp Force Blunt Force


47 Rev: 06/27/2019

ACCIDENT DEATHS

Deaths due to accidents accounted for 43% of the Pima County deaths investigated by the

PCOME in 2018. Accident victims were most frequently males (62%), over 80 years of

age (27%) and died as the result of blunt force injuries (35%) often as the result of such

conditions as complications of a hip fracture or intracranial hemorrhage from a fall.

577

655

754 751716

2014 2015 2016 2017 2018

Pima County Accident Deaths 2014 - 2018

5 2 2

20

80

94

66

102

88

63

108

85

1

Pima County Accident Deaths by Age 2018


48 Rev: 06/27/2019

445

271

Pima County Accident Deaths by Sex 2018

Male - 62%

Female - 38%

246

249

146

34

8 19 17

Pima County Accident Deaths by Cause 2018

Overdose - 34%

Blunt Force - 35%

Motor Vehicle - 20%

Exposure - 5%

Drowning - 1%

Asphyxia - 3%

Other - 2%


49 Rev: 06/27/2019

Pima County Accident Deaths by Cause (Top 3) 2014 - 2018

199215

233

253 246

204

246

279 279

249

114 121

142 138146

2014 2015 2016 2017 2018

Overdose Blunt Force Motor Vehicle


50 Rev: 06/27/2019

SUICIDE DEATHS

Deaths due to suicide accounted for 13% of the Pima County deaths investigated by the

PCOME in 2018. Suicide victims were most frequently males (83%), between 20-29

years of age (17%) and died as the result of firearms (57%).

188199

177

223 221

2014 2015 2016 2017 2018

Pima County Suicide Deaths 2014 - 2018

0 0 1

15

38

32

22

34 34

26

16

31

Pima County Suicide Deaths by Age 2018


51 Rev: 06/27/2019

183

38

Pima County Suicide Deaths by Sex 2018

Male - 83%

Female - 17%

127

47

335 3 4 2

Pima County Suicide Deaths by Cause 2018

Firearms - 57%

Hanging - 21%

Overdose - 15%

Asphyxia - 2%

Jump from Height - 1%

Carbon Monoxide - 2%

Other - 1%


52 Rev: 06/27/2019

Pima County Suicide Deaths by Cause (Top 3) 2014 – 2018

101

112104

123127

4336 34

47 47

25

38

21 2433

2014 2015 2016 2017 2018



53 Rev: 06/27/2019

NATURAL DEATHS

Deaths due to natural causes accounted for 31% of the Pima County deaths investigated

by the PCOME in 2018. Individuals who died from natural causes were most frequently

males (70%), between 60-69 years of age (29%) and died as the result of cardiovascular

disease (54%).

510

440

501

471

513

2014 2015 2016 2017 2018

Pima County Natural Deaths 2014 - 2018

1 2 0 212

35

51

101

149

89

50

21

0

Pima County Natural Deaths by Age 2018


54 Rev: 06/27/2019

359

154

Pima County Natural Deaths by Sex 2018

Male - 70%

Female - 30%

276

44

31

31

22

3412

61

Pima County Natural Deaths by Cause 2018






Malignacy - 7%

Thromboemboli - 2%

Other - 12%


55 Rev: 06/27/2019


Deaths of undetermined manner accounted for 8% of the Pima County deaths

investigated by the PCOME in 2018. Individuals who died with an undetermined manner

were most frequently males (75%), of unknown age (57%) and died from undetermined

causes (86%). Many of these deaths represent skeletal remains of UBCs who died in the

deserts of southern Arizona.

152

133

168

147139

2014 2015 2016 2017 2018

Pima County Undetermined Manner 2014 - 2018

70 1 1

1113

612

5 1 2 1

79

Pima County Undetermined Manner of Death by Age 2018


56 Rev: 06/27/2019

104

26

9

Pima County Undetermined Manner of Death by Sex 2018

Male - 75%

Female - 19%

Unsure - 3%

119

78 2 3

Pima County Undetermined Manner of Death by Cause 2018

Undetermined - 86%

Overdose - 5%

Blunt Force - 3%

Firearms - 1%

Other - 2%


57 Rev: 06/27/2019

PIMA COUNTY OVERDOSE DEATHS IN 2018

There were 286 deaths attributed to an overdose of either a single drug (158 deaths, 55%)

or a combination of drugs (128 deaths, 45%) in 2018. Overdose deaths commonly

involved males (71%) between the ages of 50-59 (22%). The majority of these deaths

were classified as accidents (86%).

Opiate compounds are typically heroin, oxycodone, methadone, hydrocodone, morphine,

oxymorphone, hydromorphone, tramadol, codeine, fentanyl (a synthetic opioid narcotic)

and clandestinely manufactured fentanyl analogs. In 2018 an opiate compound

contributed to 181 (63%) of the 286 total overdose deaths. Opiate compounds, which

contributed to an overdose death in 2018, are indicated in red in the Pima County

Overdose Deaths by Drug 2018 figure.

The number of heroin deaths is likely underreported as heroin is rapidly metabolized to

morphine by the body and if the metabolite indicative for heroin (6-monoacetylmorphine)

is not present on the toxicology report these deaths may be classified as either morphine

intoxication (morphine) or opiate intoxication (opiate unspecified).

Methamphetamine was the most commonly abused illicit drug in 2018. Contributing to

35% of all 2018 overdoses, followed by heroin (26%).

Acute alcohol (ethanol) intoxication alone, not as component of a poly-drug overdose,

accounted for 7 overdose (2%) deaths in 2018 and was a contributor in 27 additional

deaths.

OVERDOSE TRENDS

Overdose deaths in Pima County increased 29% overall from 2010 (222) to 2018 (286),

punctuated by plateaus from 2013 (240) to 2014 (241), from 2015 (262) to 2016 (263)

and again from 2017 (286) to 2018 (286). The PCOME has not historically reported

overdose deaths in which an opiate compound was a component of the death separately

from the total number of overdose deaths. However, 2016 overdose deaths were re-

examined and an opiate compound contributed to 175 (67%) of the 263 total overdose

deaths in 2016 either as a single or poly-drug overdose. In 2017 an opiate or an opiate

compound contributed to 189 (66%) of the 286 total overdose deaths and decreased to

181 (63%) in 2018.

Pima County is experiencing an increase in the number of synthetic opiate deaths

(fentanyl type compounds), but not to the same magnitude that other regions of the

country. Fentanyl contributed to 5 overdose deaths in 2014 in contrast to 45 deaths in

2018, an 800% increase in the number of deaths involving fentanyl from 2014. One of

the 45 fentanyl deaths in 2018 was a fentanyl analog, acetyl fentanyl.


58 Rev: 06/27/2019

Interestingly, methamphetamine related deaths have also increased in frequency from 38

deaths in 2014 to 101 deaths in 2018, a 166% increase. The largest decrease is in

oxycodone deaths, a 41% decrease from 2014 (39 deaths) to 2018 (23 deaths).

222210

228240 241

262 263

286 286

2010 2011 2012 2013 2014 2015 2016 2017 2018

Pima County Overdose Deaths 2010 - 2018

0 0 0

8

52

63

49

64

39

8

2 1

<1 1-5 6-12 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90

Pima County Overdose Deaths by Age 2018


59 Rev: 06/27/2019

202

84

Pima County Overdose Deaths by Sex 2018

Male - 71%

Female - 29%

246

337

Pima County Overdose Deaths by Manner 2018

Accident - 86%

Suicide - 12%

Undetermined - 2%


60 Rev: 06/27/2019

74

23

9

2

1

20

20

2

2

11

45

101

31

20

0

27

1

9

2

5

2

2

2

5

2

4

7

10

Heroin

Oxycodone

Hydrocodone

Oxymorphone

Hydromorphone

Methadone

Morphine

Codeine

Tramadol

Opiate Unspecified

Fentanyl

Methamphetamine

Cocaine

Benzodiazepines

Barbiturates

Alcohol

Antihistamines

SSRI/SNRI

Tricyclics


Muscle Relaxants

Anti-seizure Agents

Sleep Aids

Acetaminophen

Promethazine

β-Blockers

Amphetamine

Other

Pima County Overdose Deaths by Drug 2018Opiate compounds are red


61 Rev: 06/27/2019

Pima County Overdoses by drug by year 2014 - 2018

0

20

40

60

80

100

120

2014 2015 2016 2017 2018




62 Rev: 06/27/2019

PIMA COUNTY MOTOR VEHICLE RELATED FATALITIES

Motor vehicle related fatalities accounted for 148 total deaths in Pima County in 2018.

The majority, 79 deaths, were occupants of a motor vehicle involved in an accident

(MVA). Of the remaining, 18 were motorcycle accidents (MCA), 47 were pedestrians or

bicyclists struck by vehicles, and 4 were all-terrain vehicle (ATV) accidents. Individuals

who died from motor vehicle related fatalities were most frequently males (68%) and

between 50-69 years of age (38%).

117

130125

118 121

146141

148

2011 2012 2013 2014 2015 2016 2017 2018

Pima County Motor Vehicle Fatalities 2011 - 2018

10

1

9

2726

12

28 28

12

3

1

<1 1-5 6-12 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90

Pima County Motor Vehicle Fatalities by Age 2018


63 Rev: 06/27/2019

100

48

Pima County Motor Vehicle Fatalities by Sex 2018

Male - 68%

Female - 32%

79

40

187 4

Pima County Motor Vehicle Fatalities by Type 2018

MVA - 52%

Pedestrian - 27%

MCA - 12%

Bicyclist - 5%

ATV - 3%


64 Rev: 06/27/2019

PIMA COUNTY HEAT RELATED FATALITIES Heat (hyperthermia) related fatalities accounted for 7 total deaths in Pima County in

2018, excluding undocumented border crosser deaths. For environmental deaths

involving UBCs, please reference the UBC section on page 30 of this report. Individuals

who died from heat related causes were most frequently males (57%) and between 80-89

years of age (57%).

12

6

5 5

3

7

10

11

7

2010 2011 2012 2013 2014 2015 2016 2017 2018

Pima County Heat Related Fatalities 2010 - 2018

0 0 0 0 0 0

1

0

2

0

4

0

<1 1-5 6-12 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90

Pima County Heat Related Fatalities by Age 2018


65 Rev: 06/27/2019

4

3

Pima County Heat Related Fatalities by Sex 2018

Male - 57%

Female - 43%


66 Rev: 06/27/2019

COCHISE COUNTY

Cochise County contracts with the PCOME to certify deaths

that fall under the jurisdiction of the medical examiner in

Cochise County. Cochise County does not maintain an in-

county Medical Examiner’s office to conduct death scene

investigations, transport remains, or triage deaths reportable to

the medical examiner. Cochise County does provide third

party transportation services, local law enforcement death

scene investigation and archival support for examinations that

occurred prior to July 1, 2012. The PCOME works closely

with Cochise County law enforcement agencies, the public

fiduciary office and funeral homes to facilitate investigations,

disposition of remains and transportation respectively. The

PCOME is also involved as needed with mass fatality

planning, child fatality review, or other medical examiner related issues in Cochise

County.

TOTAL MORTALITY

The number of deaths reported to the medical examiner’s office in a given period is a

reflection of the total population that the office serves. In 2018 there were 1,356 deaths

in Cochise County; of these 280 (21%) were reported to the PCOME for investigation.


11221218 1183 1204

12661201

1305 1342 1344 1356

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Cochise County Mortality by Year 2009 - 2018*


67 Rev: 06/27/2019

TOTAL REPORTED DEATHS

The total cases investigated by the PCOME from Cochise County in a given year are the

sum of the ME cases (autopsies, external examinations, and death certificate cases) and

cases in which jurisdiction was declined.










manner of death without physical examination of the decedent. In 2018, 112 autopsies,

41 external examinations and 16 DC cases were performed on deaths from Cochise

County.

151

268

246

270 276

253

280

2012 (halfyear)

2013 2014 2015 2016 2017 2018

Cochise County Deaths Reported to the PCOME 2012 - 2018


68 Rev: 06/27/2019

112

41

16

Autopsy External DC

Cochise County Medical Examiner Cases 2018

1 1 0

5

19

13

23

2830

28

15

42

Cochise County Medical Examiner Cases by Age 2018


69 Rev: 06/27/2019

84

58

189

Cochise County ME Cases by Manner of Death 2018

Natural - 50%

Accident - 34%

Suicide - 11%

Undetermined - 5%


70 Rev: 06/27/2019

HOMICIDE DEATHS

The PCOME did not certify any decedents pronounced in Cochise County in 2018 as

manner of death homicide. Homicide totals from 2013 – 2018 are compared below.

3

7

6 6

2

0

2013 2014 2015 2016 2017 2018

Cochise County Homicide Deaths 2013 - 2018


71 Rev: 06/27/2019

ACCIDENT DEATHS

The PCOME examined 58 accident deaths from Cochise County in 2018; 34% of total

Cochise County deaths certified. Accident victims were most frequently males (76%),

between 20-29 years of age (22%) and died as the result of an overdose (38%).

39

45

64 63

5558

2013 2014 2015 2016 2017 2018

Cochise County Accident Deaths 2013 - 2018

10 0

2

13

8

10

65

8

32

0

Cochise County Accident Deaths by Age 2018


72 Rev: 06/27/2019

44

14

Cochise County Accident Deaths by Sex 2018

Male - 76%

Female - 24%

22

18

10

35

Cochise County Accident Deaths by Cause 2018

Overdose - 38%

Motor Vehicle - 31%

Blunt Force - 17%

Asphyxia - 5%

Other - 9%


73 Rev: 06/27/2019

Cochise County Accident Deaths by Cause (Top 3) 2014 - 2018

14

24

19 19

22

10

17

24

20

18

1213

14

910

2014 2015 2016 2017 2018

Overdose Motor Vehicle Blunt Force


74 Rev: 06/27/2019

SUICIDE DEATHS

The PCOME examined 18 suicide deaths from Cochise County in 2018; 11% of total

Cochise County deaths certified. Suicide victims were most frequently males (83%),

between 50-59 years of age (33%) and died as the result of firearms (78%).

29

36

30 2931

18

2013 2014 2015 2016 2017 2018

Cochise County Suicide Deaths 2013 - 2018

0 0 0

2

4

0

2

6

1

2

1

0 0

Cochise County Suicide Deaths by Age 2018


75 Rev: 06/27/2019

15

3

Cochise County Suicide Deaths by Sex 2018

Male - 83%

Female - 17%

14

3

1

Cochise County Suicide Deaths by Cause 2018

Firearms - 78%

Hanging - 17%

Overdose - 5%


76 Rev: 06/27/2019

Cochise County Suicide Deaths by Cause (Top 3) 2014 - 2018

22

16

23

26

14

9

4 3

2

34 42

1 1

2014 2015 2016 2017 2018



77 Rev: 06/27/2019

NATURAL DEATHS

The PCOME examined 84 natural deaths from Cochise County in 2018; 50% of total

Cochise County deaths certified. Individuals who died from natural causes were most

frequently males (68%), between 60-69 years of age (29%) and died as the result of

cardiovascular disease (71%).

96

5851 53

68

84

2013 2014 2015 2016 2017 2018

Cochise County Natural Deaths 2013 - 2018

01

01

24

7

16

24

16

11

20

Cochise County Natural Deaths by Age 2018


78 Rev: 06/27/2019

57

27

Cochise County Natural Deaths by Sex 2018

Male - 68%

Female - 32%

60

4

4

33

3 2 5

Cochise County Natural Deaths by Cause 2018



Neoplasm - 5%

Stroke - 4%




Other - 6%


79 Rev: 06/27/2019


The PCOME examined 9 undetermined deaths from Cochise County in 2018; 5% of total

Cochise County deaths certified. Individuals who died with an undetermined manner

were most frequently males (66%), between 40-49 years of age (44%) and died from

undetermined causes (66%). Some of these deaths represent skeletal remains of UBCs

who died in the deserts of southern Arizona.

12

3

12

910

9

2013 2014 2015 2016 2017 2018

Cochise County Undetermined Manner 2013 - 2018

0 0 0 0 0

1

4

0 0

2

0 0

2

Cochise County Undetermined Manner of Death by Age 2018


80 Rev: 06/27/2019

6

3

Cochise County Undetermined Manner of Death by Sex 2018

Male - 66%

Female - 34%

6

2

1

Cochise County Undetermined Manner of Death by Cause 2018

Undetermined - 66%

Firearms - 22%

Overdose - 11%


81 Rev: 06/27/2019

OVERDOSE DEATHS

There were 24 deaths attributed to an overdose of either a single drug (15 deaths, 63%) or

a combination of drugs (9 deaths, 37%) in 2018. Overdose deaths commonly involved

males (71%) between the ages of 20-29 and 40-49, each 29% or 58% combined. The

majority of these deaths were classified as accidents (92%).

18

30

2221

24

2014 2015 2016 2017 2018

Cochise County Overdose Deaths 2014 - 2018

0 0 0 0

7

3

7

4

2

0 0

1

<1 1-5 6-12 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90

Cochise County Overdose Deaths by Age 2018


82 Rev: 06/27/2019

17

7

Cochise County Overdose Deaths by Sex 2018

Male - 71%

Female - 29%

22

1 1

Cochise County Overdose Deaths by Manner 2018

Accident - 92%

Suicide - 4%

Undetermined - 4%


83 Rev: 06/27/2019

5

2

0

0

0

0

1

0

0

1

3

10

0

1

0

4

2

3

0

0

0

0

0

0

0

0

3

Heroin

Oxycodone

Hydrocodone

Oxymorphone

Hydromorphone

Methadone

Morphine

Codeine

Tramadol

Opiate Unspecified

Fentanyl

Methamphetamine

Cocaine

Benzodiazepines

Barbiturates

Alcohol

Antihistamines

SSRI/SNRI

Tricyclics


Muscle Relaxants

Anti-seizure Agents

Sleep Aids

Acetaminophen

Ethylene Glycol

Amphetamine

Other

Cochise County Overdose Deaths by Drug 2018Opiate compounds are red


84 Rev: 06/27/2019

Cochise County Overdoses by drug by year 2014 - 2018

0

2

4

6

8

10

12

2014 2015 2016 2017 2018




85 Rev: 06/27/2019

MOTOR VEHICLE RELATED FATALITIES

Motor vehicle related fatalities accounted for 18 total deaths in Cochise County in 2018.

The majority, 11 deaths, were occupants of a motor vehicle involved in an accident

(MVA). Of the remaining, 4 were motorcycle accidents (MCA), 2 were bicyclists struck

by vehicles, and 1 was a pedestrian struck by a vehicle. Individuals who died from motor

vehicle related fatalities were most frequently males (83%) and between 20-29 or 70-79

years of age, each 28% or 56% combined.

10

17

24

21

18

2014 2015 2016 2017 2018

Cochise County Motor Vehicle Fatalities 2014 - 2018

0 0 0

2

5

2

1 1

2

5

0 0

<1 1-5 6-12 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90

Cochise County Motor Vehicle Fatalities by Age 2018


86 Rev: 06/27/2019

15

3

Cochise County Motor Vehicle Fatalities by Sex 2018

Male - 83%

Female - 17%

114

21

Cochise County Motor Vehicle Fatalities by Type 2018

MVA - 61%

MCA - 22%

Bicyclist - 11%

Pedestrian - 6%


87 Rev: 06/27/2019

SANTA CRUZ COUNTY

Santa Cruz County does not maintain an in-county Medical

Examiner’s office to conduct death scene investigations,

transport or examine remains, or certify deaths reportable to

the medical examiner. Nor does Santa Cruz County appoint

or contract with an Alternate Medical Examiner. The

PCOME acts as the de-facto appointed ME for Santa Cruz

County. When deaths occur in Santa Cruz County pursuant

to A.R.S. §11-593, Santa Cruz County law enforcement

agencies investigate the circumstances of the death and

notify the PCOME as necessary.

In calendar year 2018 there were 278 deaths in Santa Cruz

County; of these 52 (19%) were reported to the PCOME for

investigation and/or examination. Some pertinent statistics regarding these deaths are

detailed in the tables below.


284262

247

303286

275294

301297

278

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Santa Cruz County Mortality by Year 2009 - 2018*


88 Rev: 06/27/2019

5854

59

51

46

5551 50

52

2010 2011 2012 2013 2014 2015 2016 2017 2018

Santa Cruz County Deaths Reported to the PCOME 2010 - 2018

337

12

Santa Cruz County Deaths by Type of Exam 2018

Autopsy

External

Jurisdiction Declined


89 Rev: 06/27/2019

*All Undetermined manner of death certifications involved decomposed or skeletal remains of suspected

UBCs

15

9

6

5

4

Santa Cruz County Deaths by Manner of Death 2018

Accident

Natural

Suicide

Undetermined*

Homicide

6

3

3

21

Santa Cruz County Accident Deaths by Type 2018

Motor Vehicle

Overdose

Drowning

Exposure

Blunt Force


90 Rev: 06/27/2019

6

2

1

Santa Cruz County Natural Deaths by Type 2018

Cardiovascular

Pulmonary

Infectious

3

2

1

Santa Cruz County Suicide Deaths by Type 2018

Firearms

Hanging

Carbon Monoxide


91 Rev: 06/27/2019

22

Santa Cruz County Homicide Deaths by Type 2018

Firearms

Sharp Force


92 Rev: 06/27/2019

APACHE COUNTY

Apache County contracts with an appointed non-

Forensic Pathologist physician(s), termed an

Alternate Medical Examiner(s) (AME) (A.R.S.

§11-591); who triages, investigates and certifies

deaths that fall under the jurisdiction of the

medical examiner in Apache County. The Apache

County AME does not perform autopsy

examinations and if the AME deems an autopsy is

necessary to certify the cause and manner of death,

the decedent may be referred to the PCOME for an

examination and death certification. The PCOME

is not aware of how many deaths occurring in

Apache County are reported to the Apache County

AME, nor the total number or types of deaths

certified by the AME. The PCOME only has a

record of deaths reported to, or referred for examination to Pima County. Deaths on

Native American tribal lands do not have to be reported through the respective death

investigation system of that County and may be reported directly to the PCOME as

necessary for the needs of the appropriate agency investigating that death (Bureau of

Indian Affairs (BIA), FBI or local tribal police departments).

Twenty six deaths from Apache County were reported to the PCOME in 2018, 23 of

which required autopsy examinations. Some pertinent statistics regarding these deaths

are detailed in the tables and graphs below.


530 544

584

471

607 601646 653

689650

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Apache County Mortality by Year 2009 - 2018*


93 Rev: 06/27/2019

8

5

17

14

12

17

1918

26

2010 2011 2012 2013 2014 2015 2016 2017 2018

Apache County Deaths Reported to the PCOME 2010 - 2018

23

3

Apache County Deaths by Type of Exam 2018

Autopsy



94 Rev: 06/27/2019

11

7

3

1 1

Apache County Deaths by Manner of Death 2018

Natural

Accident

Suicide

Homicide

Undetermined

7

3

22

9

Apache County Deaths by Type of Death 2018

Cardiovascular

Motor vehicle

Firearms

Overdose

Other


95 Rev: 06/27/2019

GILA COUNTY

Gila County contracts with an appointed Forensic

Pathologist Medical Examiner, who triages,

investigates and certifies deaths that fall under the

jurisdiction of the medical examiner (ME) in Gila

County. The Gila County ME performs some

autopsy examinations in Payson if the ME deems

an autopsy is necessary to certify the cause and

manner of death. Additionally, the ME may refer

some decedents from Gila County to the PCOME

for an examination and death certification as

necessary. The PCOME is not aware of how many

deaths occurring in Gila County are reported to the

ME, nor the total number or types of deaths

certified by the ME. The PCOME only has a

record of deaths reported to, or referred for

examination to Pima County. Deaths on Native

American tribal lands do not have to be reported through the respective death

investigation system of that County and may be reported directly to the PCOME as

necessary for the needs of the appropriate agency investigating that death (BIA, FBI or

local tribal police departments).

Thirteen deaths from Gila County were reported to the PCOME in 2018, 12 of which

required autopsy examinations. Some pertinent statistics regarding these deaths are

detailed in the tables and graphs below.


646 661 682655

696747

814 832

723753

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Gila County Mortality by Year 2009 - 2018*


96 Rev: 06/27/2019

48 48

57

81

42

3229

1613

2010 2011 2012 2013 2014 2015 2016 2017 2018

Gila County Deaths Reported to the PCOME 2010 - 2018

12

1

Gila County Deaths by Type of Exam 2018

Autopsy



97 Rev: 06/27/2019

5

4

2

1

Gila County Deaths by Manner of Death 2018

Accident

Homicide

Suicide

Natural

4

2

6

Gila County Deaths by Type of Death 2018

Firearms

Motor Vehicle

Other


98 Rev: 06/27/2019

GRAHAM COUNTY

Graham County contracts with an appointed non-


Alternate Medical Examiner(s) (AME) (A.R.S. §11-

591), who triages, investigates and certifies deaths

that fall under the jurisdiction of the medical

examiner in Graham County. The Graham County

AME does not perform autopsy examinations and if

the AME deems an autopsy is necessary to certify

the cause and manner of death, the decedent may be

referred to the PCOME for an examination and

death certification. The PCOME is not aware of

how many deaths occurring in Graham County are

reported to the Graham County AME, nor the total

number or types of deaths certified by the AME.

The PCOME only has a record of deaths reported

to, or referred for examination to Pima County.

Deaths on Native American tribal lands do not have

to be reported through the respective death investigation system of that County and may

be reported directly to the PCOME as necessary for the needs of the appropriate agency

investigating that death (BIA, FBI or local tribal police departments).

Eighteen deaths from Graham County were reported to the PCOME in 2018, 17 of which




271

302

245

300275 283

251

278

305

336

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Graham County Mortality by Year 2009 - 2018*


99 Rev: 06/27/2019

1413

15

17

13

5

9

11

18

2010 2011 2012 2013 2014 2015 2016 2017 2018

Graham County Deaths Reported to the PCOME 2010 - 2018

17

1

Graham County Deaths by Type of Exam 2018

Autopsy

External


100 Rev: 06/27/2019

7

6

2

21

Graham County Deaths by Manner of Death 2018

Natural

Accident

Homicide

Undetermined

Suicide

5

43

6

Graham County Deaths by Type of Death 2018

Cardiovascular

Overdose

Firearms

Other


101 Rev: 06/27/2019

GREENLEE COUNTY

Greenlee County contracts with an appointed non-

Forensic Pathologist physician(s), termed an Alternate

Medical Examiner(s) (AME) (A.R.S. §11-591), who

triages, investigates and certifies deaths that fall under

the jurisdiction of the medical examiner in Greenlee

County. The Greenlee County AME does not perform

autopsy examinations and if the AME deems an autopsy

is necessary to certify the cause and manner of death,


examination and death certification. The PCOME is not

aware of how many deaths occurring in Greenlee

County are reported to the Greenlee County AME, nor

the total number or types of deaths certified by the

AME. The PCOME only has a record of deaths

reported to, or referred for examination to Pima County.

Deaths on Native American tribal lands do not have to

be reported through the respective death investigation system of that County and may be

reported directly to the PCOME as necessary for the needs of the appropriate agency


Three deaths from Greenlee County were reported to the PCOME in 2018, two of which




5055

71

64

43

52

69

52

6570

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Greenlee County Mortality by Year 2009 - 2018*


102 Rev: 06/27/2019

10

4

6

12

9

13

8

4

3

2010 2011 2012 2013 2014 2015 2016 2017 2018

Greenlee County Deaths Reported to the PCOME 2010 - 2018

2

1

Greenlee County Deaths by Type of Exam 2018

Autopsy



103 Rev: 06/27/2019

2

Greenlee County Deaths by Manner of Death 2018

Suicide

11

Greenlee County Deaths by Type of Death 2018

Hanging

Firearms


104 Rev: 06/27/2019

LA PAZ COUNTY

La Paz County contracts with an appointed non-



§11-591), who triages, investigates and certifies

deaths that fall under the jurisdiction of the medical

examiner in La Paz County. The La Paz County

AME does not perform autopsy examinations and if

the AME deems an autopsy is necessary to certify

the cause and manner of death, the decedent may be

referred to the PCOME for an examination and

death certification. The PCOME is not aware of

how many deaths occurring in La Paz County are

reported to the La Paz County AME, nor the total

number or types of deaths certified by the AME.

The PCOME only has a record of deaths reported

to, or referred for examination to Pima County.

Deaths on Native American tribal lands do not have to be reported through the respective

death investigation system of that County and may be reported directly to the PCOME as

necessary for the needs of the appropriate agency investigating that death (BIA, FBI or

local tribal police departments).

Thirty deaths from La Paz County were reported to the PCOME in 2018, 27 of which




227

200186

225247 253 254

270

320 316

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

La Paz County Mortality by Year 2009 - 2018*


105 Rev: 06/27/2019

29

21

13

2422

40

29 29 30

2010 2011 2012 2013 2014 2015 2016 2017 2018

La Paz County Deaths Reported to the PCOME 2010 - 2018

27

3

La Paz County Deaths by Type of Exam 2018

Autopsy



106 Rev: 06/27/2019

10

6

5

3

3

La Paz County Deaths by Manner of Death 2018

Accident

Undetermined

Natural

Suicide

Homicide

7

6

5

4

2

3

La Paz County Deaths by Type of Death 2018

Motor Vehicle

Undetermined

Firearms

Overdose

Chronic Alcohol

Other


107 Rev: 06/27/2019

NAVAJO COUNTY

Navajo County contracts with an appointed non-



§11-591), who triages, investigates and certifies

deaths that fall under the jurisdiction of the

medical examiner in Navajo County. The Navajo

County AME does not perform autopsy

examinations and if the AME deems an autopsy is

necessary to certify the cause and manner of death,


examination and death certification. The PCOME

is not aware of how many deaths occurring in

Navajo County are reported to the Navajo County

AME, nor the total number or types of deaths

certified by the AME. The PCOME only has a

record of deaths reported to, or referred for

examination to Pima County. Deaths on Native American tribal lands do not have to be

reported through the respective death investigation system of that County and may be

reported directly to the PCOME as necessary for the needs of the appropriate agency


Forty deaths from Navajo County were reported to the PCOME in 2018, 38 of which




825 819

899 897976

937 907

10101059

1124

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Navajo County Mortality by Year 2009 - 2018*


108 Rev: 06/27/2019

35

29

3633 33

30

50

4340

2010 2011 2012 2013 2014 2015 2016 2017 2018

Navajo County Deaths Reported to the PCOME 2010 - 2018

38

1 1

Navajo County Deaths by Type of Exam 2018

Autopsy

External



109 Rev: 06/27/2019

15

7

6

5

5

Navajo County Deaths by Manner of Death 2018

Accident

Natural

Suicide

Homicide

Undetermined

7

5

4

44

3

3

9

Navajo County Deaths by Type of Death 2018

Motor Vehicle

Hanging

Overdose

Undetermined

Infection

Blunt Force

Sharp Force

Other


110 Rev: 06/27/2019

PINAL COUNTY

Pinal County appointed a Medical Examiner in

December 2016 and maintains its own Medical

Examiner’s office staffed to conduct death

scene investigations, transport remains, perform

examinations and triage deaths reportable to the

ME as stated in A.R.S §11-593 above. Deaths

on Native American tribal lands do not have to

be reported through the respective death

investigation system of that County and may be

reported directly to the PCOME as necessary

for the needs of the appropriate agency

investigating that death (BIA, FBI or local tribal

police departments). The Pinal County Medical

Examiner’s Office historically issues its own

annual report. Please reference that report for

details concerning deaths occurring in Pinal

County that are not referred to the PCOME.

Twenty-four deaths from Pinal County were reported to the PCOME in 2018, 20 of

which required autopsy examinations. Some pertinent statistics regarding these deaths

are detailed in the tables and graphs below.


1994

22582380 2440 2457

2629

2968 29913110 3140

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Pinal County Mortality by Year 2009 - 2018*


111 Rev: 06/27/2019

140

304 308

223

200

264

236

29 24

2010 2011 2012 2013 2014 2015 2016 2017 2018

Pinal County Deaths Reported to the PCOME 2010 - 2018

20

31

Pinal County Deaths by Type of Exam 2018

Autopsy


External


112 Rev: 06/27/2019

11

5

3

2

Pinal County Deaths by Manner of Death 2018

Accident

Homicide

Suicide

Natural

6

54

6

Pinal County Deaths by Type of Death 2018

Firearms

Motor Vehicle

Overdose

Other


113 Rev: 06/27/2019

YUMA COUNTY

Yuma County contracts with, and appoints the

pathology group at Yuma Regional Medical

Center, as Medical Examiner for Yuma County.

Some decedents (typically suspected

homicides) are referred to the PCOME for an

examination and death certification at the

discretion of the Yuma County Medical

Examiner’s Office. The Yuma County Medical

Examiner’s Office issues its own Annual

Report. Please reference that report for details

concerning deaths occurring in Yuma County

that are not referred to the PCOME.

Sixteen deaths from Yuma County were

reported to the PCOME in 2018, all 16 of

which required autopsy examinations. Some

pertinent statistics regarding these deaths are

detailed in the tables below.


1306 12791350 1386

13201425 1427

1506 1491

1630

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Yuma County Mortality by Year 2009 - 2018*


114 Rev: 06/27/2019

20

18 18

1516

5

16

13

16

2010 2011 2012 2013 2014 2015 2016 2017 2018

Yuma County Deaths Reported to the PCOME 2010 - 2018

11

2

11 1

Yuma County Deaths by Manner of Death 2018

Homicide

Accident

Natural

Suicide

Undetermined


115 Rev: 06/27/2019

11

2

3

Yuma County Deaths by Type of Death 2018

Firearms

Blunt Force

Other

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