Drug-re­lated au­top­sies sky­rocket for coroners

Daily Local News (West Chester, PA) - - FRONT PAGE - By Jo­ce­lyn Brum­baugh

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.”

‘Ex­plo­sive in­crease’

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.

‘Snow­ball ef­fect’

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.

Cap­tur­ing calls

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.

‘Vul­ner­a­ble time’

“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.

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