Drug-related autopsies skyrocket for coroners
JOHNSTOWN, PA. >> Cambria County Coroner Jeffrey Lees has requested $40,000 in additional funds for operating his department and says drug overdoses are “a big part of it.”
“Our case volume is way up,” he said.
Autopsies and toxicology reports are squeezing the Cambria coroner’s department budget this year, with Lees saying he is running $10,000 in the red in this category alone.
Across the region, those who perform autopsies — both for government agencies and as private businesses — reported a spike in the number of deaths they investigate that are tied to drug abuse.
Due to the ongoing increase in drug-related fatalities, Cambria County allotted $180,000 for post-mortem examinations in the county’s 2016 budget after the office spent $195,000 in 2015 on the same line item.
That money was transferred from the county’s contingency fund, created to cover unexpected expenses and budget overages, bringing Lees’ budget for autopsies and toxicology reports to $220,000 of his department’s total $448,762 budget.
Lees said dealing with the increase is something out of his control as he works to accomplish his job to determine the cause and manner of each death.
“I cannot sacrifice a death investigation over a budget situation,” he said. “When I say that this drug epidemic is affecting everyone, it’s affecting everyone.”
‘The numbers speak ...’
To date in 2016, Lees has responded to 60 deaths that have been confirmed as drug overdoses, with 20 pending toxicology results.
In 2015, Lees reported 58 total drug overdose deaths, 20 of which were linked to heroin.
Although he doesn’t yet have a number for heroin-related fatalities for 2016, Lees predicts it will be double the amount of last year.
Since January, Lees’ office has been able to save about $103,000
in cases where it’s clear the death occurred from a drug overdose by running only toxicology reports from bodily fluid samples.
Lees said if he hadn’t implemented this plan, his budget for autopsies and toxicology reports would have been emptied around April or May, with each autopsy costing $1,750 and toxicology reports ranging from $550 to $900.
Lees only has two other full-time deputy coroners and limited funding for per-diem deputies, which is nearly depleted for the year.
“The office in general has gotten much busier,” he said. “The cases have become much more complicated. I think the numbers speak for themselves.”
Forensic Dx of Windber performs autopsies from surrounding counties, and said more than half of those completed over the past two years have been for drug overdoses: 131 overdoses out of 244 total autopsies in 2015, and 142 of 233 total autopsies to date in 2016.
Dr. Curtis Goldblatt, pathology department chairman at Chan Soon-Shiong Medical Center and president/CEO of Forensic Dx, has been performing autopsies for more than 20 years and said there are noticeably more drug-related cases than he’s ever seen before.
“We’ve seen an explosive increase in drug deaths,” he said.
The region is also experiencing an increase in cases where fentanyl, a potent painkilling opiate 50 times stronger than morphine, is present in heroin overdoses.
Goldblatt said the substance doesn’t appear in typical blood or urine samples because a small amount is sufficient to cause death.
Data compiled by Molecular Dx found that fentanyl was identified in 10 cases logged from Oct. 1 to 13. Of the 42 times in 2016 that Molecular Dx identified fentanyl in a postmortem blood sample, 57 percent have occurred since Sept. 2.
“The past five years have just been horrific as far as drug overdoses are concerned,” agreed Rick Campitell, forensic pathologist assistant at Forensic Dx and deputy coroner for Somerset County, who has 20 years of experience in the field.
If historic trends hold true, over the next two months — sure to be full of family and holiday gatherings — Forensic Dx will see an increase in overall death cases, including overdoses from those who may seek a high during their first holiday after losing a loved one, or while confronted with domestic issues or loneliness.
“It’s really a snowball effect that’s happening,” Campitell said. Drug fatalities have remained consistent in Somerset County.
Coroner Wally Miller said of 15 drug overdose deaths in 2014, 11 were linked to heroin; in 2015, six out of 16 overdose fatalities were related to heroin. So far in 2016, Miller has recorded 15
drug overdose deaths, seven of which are related to heroin.
Ronna Yablonski, executive director of the Cambria County Drug Coalition, said one of the populations at greatest risk of becoming overdose cases is people who are incarcerated or are discharged from long-term treatment who “think that they can use as much as they did before, and that’s simply not the case.”
“They don’t realize their body can’t handle what it did before,” Campitell said.
Through autopsies, Goldblatt has also been able to link multiple cases to a particular batch of the same drug using matching cutting agents to help law enforcement track and identify the sources.
“That’s an important feature of what we’re doing here,” he said.
When Cambria County 911 dispatchers handle three or four overdose-related calls within the span of a few hours, they begin to assume the cases are connected.
But for years, 911 supervisors struggled to accurately track overdose-related calls because they’re often received as reports of an unconscious person or possible cardiac arrest, according to Robbin Melnyk, deputy director and 911 coordinator for the Cambria County Department of Emergency Services.
“We didn’t really have a way to capture that,” she said.
On Oct. 4, Cambria County 911 started using a new tool in its computeraided dispatch (CAD) software that alerts the county’s drug task force, police officers and district attorney when crews are responding to an emergency involving a drug overdose.
This will allow dispatchers to alert the proper authorities based on further information provided by the person calling in the emergency and from details given by first responders.
Not only will this notification system help the 911 department track the number of overdose-related calls, it will make the county’s drug task force more aware of the overdose call volume and help officers connect the dots across ongoing investigations.
Tom Owens, chief county detective and field supervisor for the drug task force, said the alerts will help investigators see the geographical hot spots and frequency of overdose calls. So far, Owens and Cambria County District Attorney Kelly Callihan have received multiple alerts each day.
“It’s impossible for the task force to follow up on every single one of those,” Owens said, but officers will be able to track and respond to more serious calls where a stronger batch of a certain drug is under investigation or a large number of overdoses are occurring in one area.
“It’s not just the deaths,” Callihan said. “More live through it, probably, than die. It’s a missed opportunity not to investigate an overdose. We need to know how bad it is if we’re going to try to fight it.”
Pennsylvania’s Act 139 of 2014, also called the “Good Samaritan law,” also prevents charges against those who report overdoses, cooperate with first responders and stay with the overdosed individual until crews arrive.
Callihan pointed out that people can be charged with possession of drugs or drug paraphernalia only if they have items on them at the scene, but they can’t be charged for drugs that are in their systems.
Owens said overdose patients are often more willing to provide police with information about the source of drugs and the overall investigation if they know they won’t face charges.
“It’s a vulnerable time it’s a time where they almost die,” he said.
In addition to the new overdose call alerts, Melnyk said dispatchers are now trained to guide callers through the process of administering Narcan, the generic version of naloxone, a drug used to revive an individual experiencing an overdose of heroin and other opioids.
“The operators in the 911 centers have had to adjust to the increase in overdose calls,” Melnyk said, “to this plague that’s taken over our county.”
Forensic Pathology Assistant Rick Campitell operates a low-dosage digital X-ray machine at ForensicDx in Windber, Pa. In Cambria County, Pa., autopsies and toxicology reports are squeezing the coroner’s office budget this year due to a continuing increase in drugrelated fatalities, while across the region, those who perform autopsies in government agencies and private businesses report a spike in deaths they investigate tied to drug abuse.