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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
THE EL PASO COUNTY CORONER’S OFFICE
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
THE EL PASO COUNTY CORONER’S OFFICE
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
THE EL PASO COUNTY CORONER’S OFFICE
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:
THE EL PASO COUNTY CORONER’S OFFICE 05
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
†
THE EL PASO COUNTY CORONER’S OFFICE
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
THE EL PASO COUNTY CORONER’S OFFICE
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
THE EL PASO COUNTY CORONER’S OFFICE 08
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
THE EL PASO COUNTY CORONER’S OFFICE 09
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
THE EL PASO COUNTY CORONER’S OFFICE 10
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%
THE EL PASO COUNTY CORONER’S OFFICE 11
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
THE EL PASO COUNTY CORONER’S OFFICE
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
THE EL PASO COUNTY CORONER’S OFFICE
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
THE EL PASO COUNTY CORONER’S OFFICE 14
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
THE EL PASO COUNTY CORONER’S OFFICE
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
THE EL PASO COUNTY CORONER’S OFFICE 16
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%
THE EL PASO COUNTY CORONER’S OFFICE 17
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
THE EL PASO COUNTY CORONER’S OFFICE 18
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