On November 23, Matt Canaga, the Larimer County Chief Deputy Coroner (who has been with the coroner’s office since 2009), gave us an overview of the personnel, activities, legal constraints and guidelines, and facilities of the Larimer County Coroner’s Office. He started by talking about Dr. James Wilkerson, the forensic pathologist who was the county coroner for a number of years until he retired over a year ago. Mr. Canaga pointed out that there are only some 400 forensic pathologists in the country, at least in part because the job, including conducting autopsies, can be something of a downer. The interim coroner has been Gary Darling who is not a forensic pathologist. After the recent election, the coroner-elect is Stephen Hanks, also not a forensic pathologist, who has been with the coroner’s office for seven years. To replace Dr. Wilkerson, they conducted a nationwide search that ultimately resulted in hiring of Dr. Joseph White, another forensic pathologist, who comes to us after several year’s experience in both academia and the state of Utah.
The first area of discussion was the difference between a coroner and a medical examiner. Colorado is a coroner state, so every county has an elected coroner (who is typically not a forensic pathologist). Other states use the medical examiner system where there is one state-wide medical examiner. After a 700 point inspection, the Larimer County coroner’s office has been certified by the National Academy of Medical Examiners since 2002, the smallest county in the nation to be so certified.
The coroner’s office is responsible for reporting on death scenes across the county, deciding for each death what type of response is needed. Some of these responses are various levels of medicolegal investigations to help law enforcement. They have to provide a conclusion on the manner and cause of each death (e.g., was the death natural, accidental, homicide, suicide vs. was the death by cancer, blunt-force trauma, or overdose). They have to identify the decedent (may be as simple as the widow identifying her recently deceased husband or as complex as taking finger prints, X-rays, or other scientific tests on a decedent who may have been dead for months). At some level, they must investigate any home death (when not accompanied by a medical professional), any death that may be a homicide, suicide, accident, or a natural death of a young individual, any death accompanied by suspicious circumstances, and at the request of a local law-enforcement agency. The vast majority of modes of death (MOD) are natural with much smaller proportions of accident, suicide, and, least of all, homicide (Larimer County is a very safe county). The investigators for the coroner’s office are commonly referred to as “last responders” since they typically arrive after all the other officials, but they must be prepared for a range of risks (they typically come with Narcan and full-face respirators in case of contact with, for example, fentanyl).
Mr. Canaga emphasized that, although the decedent is evidence, it is coroner-office policy that both the decedent and the living individuals associated with the decedent must be treated with respect, compassion and empathy. With the death of a child, it will likely be traumatic to have to remove the deceased child from his parents and that must be done with kindness and empathy. Dealing with a decedent who has been dead for some time will be unpleasant but that individual must still be treated with respect.
An autopsy is “seeing for oneself”. Less than 10% of decedents are autopsied. An autopsy may involve toxicology, radiology, trajectory of gunshot or stab wounds, defensive wounds, gun-shot residues, taking of finger prints, using a sex-assault kit, even taking finger-nail clippings.
He then took us on a brief tour of the Patrick Allen Regional Forensic Sciences Center. Their cold room, which is rarely full, can hold up to 70 individuals. They have a normal investigation room, where most autopsies are conducted, and a hazard room with much more rapid air turnover. They have a low-dose X-ray machine that can conduct a head-to-toe scan in 13 seconds (donated by Patrick Allen’s widow). He also proudly talked about their new electric gurneys which have significantly reduced the risk of back injuries in their investigators.
Mr. Canaga concluded by discussing the culture of the Larimer County coroner operation. Although dark humor can be a coping mechanism, they emphasize not to disrespect the deceased. They emphasize that their job is to seek the truth with dignity and respect. In a sense, death investigation is a volume business so burnout is detrimental and experience is important so they focus on trying to keep the investigators on the job as long as possible.
Questions:
Why is there such a long delay in getting toxicology results? This is post-mortem blood work on non-standard specimens that require particular skills and equipment as well as security. As a result, they have to send their samples to a lab in Pennsylvania and turnaround is at their pace.
How do they interface with organ donations? They work with organ-donation organizations as much as possible, commonly releasing the organs before an autopsy as long as there is no apparent legal or law-enforcement need to finish the autopsy first.
Do they work with hospice? They work with hospice organizations daily, having to report every death, whether in hospice or not.
Are their options for elective autopsies – and if so, who pays? What Mr. Canaga called “medical curiosity autopsies” do not meet their requirements, but they can point families to private autopsy organizations for which they will have to pay the bill.
What is their relationship to HIPPA? The coroner’s office is non-HIPPA, but they are required to protect any medical records that come into their possession as a result of a death investigation.
Do they do any limited autopsies? They may elect to do limited autopsies in certain circumstances, but more often for the young than the old.