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ANNUAL REPORT 2011

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DENVER OFFICE OF THE MEDICAL EXAMINER

2011 Statistical Data

PREFACE The Coroner is an elected office pursuant to the Constitution of Colorado. State law defines the cases that are Coroner cases in Section 30-10-606, Colorado Revised Statutes. By the state Constitution, Denver is a combined City and County. The City and County charter states that the position of Coroner is to be an appointed position, chosen by the Manager of the Department of Environmental Health. These duties are entrusted to the Chief Medical Examiner. In 2011, the coroner statute was revised in an attempt to improve the coroner system

and to address weaknesses and inconsistencies in death investigation across the state. The main provisions:

mandate that forensic autopsies be performed by forensic pathologists;

mandates that autopsies be performed in accordance to the National Association of Medical Examiners (NAME) autopsy standards; and

mandates transfer of jurisdiction back to the County where the incident causing death occurred.

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Colorado Revised Statutes 30-10-606 and 606.5

CORONER – INQUIRY-GROUNDS-POSTMORTEM-JURY-CERTIFICATE OF DEATH (1) The coroner shall immediately notify the district attorney, proceed to view the body, and make all proper inquiry respecting the cause and manner of death of any person in his jurisdiction who has died under any of the following circumstances: (a) From external violence, unexplained cause, or under suspicious circumstances; (b) Where no physician is in attendance or where, though in attendance, the physician is unable to certify the cause of death; (c) From thermal, chemical, or radiation injury; (d) From criminal abortion, including any situation where such abortion may have been self-induced; (e) From a disease which may be hazardous or contagious or which may constitute a threat to the health of the general public; (f) While in the custody of law enforcement officials or while incarcerated in a public institution; (g) When the death was sudden and happened to a person who was in good health; or (h) From an industrial accident. (1.1) After consultation with the district attorney, the coroner may request that jurisdiction of any such death be transferred to the coroner of the county in which the event which resulted in the death of the person occurred, with the jurisdiction effective upon the acceptance by the receiving coroner. Such transfer shall be in writing, and a copy thereof shall be maintained in the offices of the transferring and receiving coroners. (1.2) When a person dies as a result of circumstances specified in subsection (1) of this section or is found dead and the cause of death is unknown, the person who discovers the death shall report it immediately to law enforcement officials or the coroner, and the coroner shall take legal custody of the body. The body of any such person shall not be removed from the place of death except upon the authority of the coroner in consultation with the district attorney or local law enforcement agency, nor shall any article on or immediately surrounding such body be disturbed until authorized by the coroner in consultation with the district attorney or local law enforcement agency. (2) The coroner shall perform a forensic autopsy or have a forensic autopsy performed as required by section 30-10-606.5 or upon the request of the district attorney. (3) When the coroner has knowledge that any person has died under any of the circumstances specified in subsection (1) of this section, he may summon forthwith six citizens of the county to appear at a place named to hold an inquest to hear testimony and to make such inquiries as he deems appropriate. (4) (a) In all cases where the coroner has held an investigation or inquest, the certificate of death shall be issued by the coroner or the coroner's deputy. (b) Any certificate of death issued by a coroner or a coroner's deputy shall be filed with the registrar and shall state their findings concerning the nature of the disease or the manner of death, and, if from external causes, the certificate shall state whether in their opinion death was accidental, suicidal, or felonious. In addition, the certificate shall include the information described in section 25-2-103 (3) (b), C.R.S., whenever the subject of the investigation or inquest is under one year of age. (c) A copy of the certificate of death or affidavit of presumed death, including any related documents and statements of fact, shall be retained in the applicable county in a secure location in an appropriate county facility accessible only to the county coroner or the coroner's designee and in a manner that is consistent with the county's record retention policy and federal law. (5) Nothing in this section shall be construed to require an investigation, autopsy, or inquest in any case where death occurred without medical attendance solely because the deceased was under treatment by prayer or

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spiritual means alone in accordance with the tenets and practices of a well-recognized church or religious denomination. (6) (a) Notwithstanding sections 12-43-218 and 13-90-107 (1) (d) or (1) (g), C.R.S., the coroner holding an inquest or investigation pursuant to this section has the authority to request and receive a copy of: (I) Any autopsy report or medical information from any pathologist, physician, dentist, hospital, or health care provider or institution if such report or information is relevant to the inquest or investigation; and (II) Any information, record, or report related to treatment, consultation, counseling, or therapy services from any licensed psychologist, professional counselor, marriage and family therapist, social worker, or addiction counselor, certified addiction counselor, or registered psychotherapist if the report, record, or information is relevant to the inquest or investigation. (b) The coroner shall, at the request of the district attorney or attorney general, release to the district attorney or attorney general any autopsy report or medical information described in subparagraph (I) of paragraph (a) of this subsection (6) that the coroner obtains pursuant to paragraph (a) of this subsection (6). (c) The coroner shall not release to any party any information, record, or report described in subparagraph (II) of paragraph (a) of this subsection (6) that the coroner obtains pursuant to paragraph (a) of this subsection (6). (d) Any person who complies with a request from a coroner pursuant to paragraph (a) of this subsection (6) shall be immune from any civil or criminal liability that might otherwise be incurred or imposed with respect to the disclosure of confidential patient or client information.

30-10-606.5. WHEN AUTOPSY PERFORMED - JURISDICTION - QUALIFICATIONS TO PERFORM – DEFINITION (1) (a) The coroner shall perform a forensic autopsy or have a forensic autopsy performed in accordance with the circumstances in the most recent version of the "forensic autopsy performance standards" adopted by the national association of medical examiners, when the death is apparently nonnatural and occurs in a facility or during services regulated by the department of human services, and when the death is the result of an automobile accident and a hospital physician has not documented the extent of the injuries. (b) If a person is involved in an incident that requires the person to be transported to a medical facility outside the county where the incident occurred and the person dies en route to or at the medical facility outside the county where the incident occurred, the coroner for the county where the incident occurred shall take possession of the body and shall comply with the provisions of this section. (2) (a) Except as provided in paragraphs (b) and (c) of this subsection (2), all forensic autopsies required to be performed pursuant to subsection (1) of this section shall be performed by a board-certified forensic pathologist. (b) A physician who has completed a forensic pathology fellowship and is practicing forensic pathology in Colorado and who is not a board-certified forensic pathologist as of May 4, 2011, may perform a forensic autopsy required pursuant to subsection (1) of this section. (c) A forensic pathologist who has completed a forensic pathology fellowship may perform forensic autopsies for four years from the date of completion of the fellowship before becoming a board-certified forensic pathologist. (d) A pathology resident or forensic pathology fellow may perform a forensic autopsy required pursuant to subsection (1) of this section under the direct supervision of a board-certified forensic pathologist. (e) For purposes of this subsection (2), "direct supervision" means supervision that is within the facility where a pathology resident or forensic pathology fellow is performing an autopsy and that requires a board-certified forensic pathologist's presence and availability for prompt consultation.

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Mission Statement

MISSION: To investigate and certify deaths in Denver using best practices, and thereby support law enforcement and the legal system in protecting the safety of Denver's citizens, and partnering with public health agencies to help ensure the well being of the public The office appreciates the support and cooperation received from the citizens of Denver and welcomes comments and suggestions. Questions, comments or suggestions may be directed to this office at our web site. Office of the Medical Examiner Comments and Suggestions 660 Bannock Street medcomments@ci.denver.co.us Denver, CO 80204

303-436-7711

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Department of Environmental Health

Office of the Medical Examiner

2011 Organization Chart

22 FTE

Chief Medical Examiner/Coroner 1

FTE

Amy Martin, MD

828-D

Manager 2, 1 FTE

Michelle Weiss-Samaras

815-A

Forensic Pathology Fellow, 1 FTE Joseph White, D.O

( June 2010- June 2011) Lindsey Harle, MD

(June 30, 2011-June 30,2012)

Forensic Pathologist, 2 FTE

James W. Wahe, M.D. John Carver, JD, MD

824-D

Medical Transcriptionist, 2 FTE

Glenda Slade Jami Milsap

612-C

Supervisor of Administrative Support

I, 1 FTE Roberta (Kathy) Blea

806-C

Investigator Supervisor,

1 FTE Don Bell

812-N

Forensic Autopsy Technician

Supervisor, 1 FTE Karen Jazowski

807-H

ASA III, 2 FTE Cecelia Albertson, Galena Brown

610-C

Coroner Investigator, 7 FTE Tracey Balbin, Kerrie Cady, Harris Neil,

Howard Daniel, Justin Earls, TC Whitley,

Ginger Jones

623-N

Forensic Autopsy Technician, 3 FTE

Barb Criter, Esperanza Ortega, Robert Garner

616-H

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On August 27, 1947, the Denver Coroner’s Office hired its first Medical Examiner. Dr. Angelo Lapi was a 34-year-old assistant Medical Examiner for Massachusetts. He was a graduate of the medical school of the University of Buffalo, a pathologist and research fellow of the Department of Legal Medicine in

Harvard. He was approved to start on October 1, 1947, at the monthly salary of $666.00. The assistant Medical Examiner at that time was Dr. George Ogura (who later retired in the late 1980’s as the Chief Forensic Pathologist). The State Constitution requires every county to have a coroner. On August 25, 1947, City Council approved the appointment of the Manager of Health and Charity to be the ex-officio coroner. At that time, the coroner inquests were stopped in the City and County of Denver. The office separated from Denver Health Medical Center (previously known as Denver General Hospital) in 1997, and joined the newly developed Department of Environmental Health for the City and County of Denver. During years past, this office had the pleasure to have many talented forensic pathologists as a part of the team. Dr. George I. Ogura, Dr. Henry Toll, Dr. Ben Miyahara, Dr. Donald Clark, Dr. Ben Galloway, Dr. James Wahe, Dr. Amy Martin, and Dr. Thomas Henry, as well as countless pathology residents and forensic fellows, many who continue to practice forensic pathology throughout the world. Dr. Amy Martin became the Chief Medical Examiner on December 14, 2007. She is appointed as the Coroner by the Manager of the Department of Environmental Health per City Ordinance § 2.12.2

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DENVER OFFICE OF THE MEDICAL EXAMINER

STAFF 2011

AMY MARTIN, M.D.

CHIEF MEDICAL EXAMINER

CORONER

MICHELLE D. WEISS-SAMARAS

CHIEF DEPUTY CORONER

JAMES W. WAHE, M.D.

ASSISTANT MEDICAL EXAMINER

JOHN D. CARVER, MD., J.D.

ASSISTANT MEDICAL EXAMINER

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FORENSIC PATHOLOGY FELLOWSHIP

In 2008, OME received Accreditation Council for Graduate Medical Education accreditation for a forensic pathology fellowship sponsored by the University Of Colorado Denver School Of Medicine. In July 2009, the program’s first forensic

pathology fellow began a one-year period of training in the area of forensic pathology. This program is designed to prepare forensic pathologists for board certification and

practice in the field of forensic pathology.

2009 – 2010 Forensic Pathology Fellow Michael Burson, M.D., Ph.D.

2010-2011 Forensic Pathology Fellow

Joseph K. White, D.O.

2011-2012 Forensic Pathology Fellow Lindsey Harle, M.D.

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DENVER OFFICE OF THE MEDICAL EXAMINER INVESTIGATIVE STAFF 2011

Donald Bell, Investigator Supervisor

INVESTIGATORS Tracey Balbin Howard Daniel

Justin Earls Kerrie Cady

Genevieve Jones Harris Neil

T.C. Whitley

INVESTIGATIONS SECTION The Investigations Section responds to the scenes of deaths throughout the City and County of Denver twenty-four hours a day, seven days a week. It is the responsibility of the Medicolegal Death Investigator to function as the eyes and ears of the Medical Examiner and insure that the State law is followed with respect to the reporting and handling of deaths in Denver City and County. In addition to scene response, investigators also investigate hospital, nursing homes and other facility deaths that fall under the Coroner statute via phone reports. When they deem it necessary, they will respond to these scenes as well. Investigators are also responsible for coordinating and facilitating identification of the decedent; locating and notifying of the next of kin; and processing some of the evidence, medication, and effects of the decedent.

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OME investigators respond to any death scene where the body has not been removed if the death occurs outside of a healthcare facility. Investigators may also respond to select hospital deaths; for example many homicides and child deaths where the individual has been transported to an emergency room. Investigators may also respond to a hospital or healthcare facility if the death appears due to non-natural circumstances (a suicidal hanging that occurs in a psychiatric unit). There can be a great deal of month-to-month fluctuation in the number of scenes although overall the yearly total does not vary greatly from year to year, and generally averages between 60 and 70 scenes per month

Jan Feb March April May June July Aug Sept Oct Nov Dec

2009 66 68 87 80 65 47 45 68 62 63 77 62

2010 71 51 56 57 69 45 51 49 66 82 63 60

2011 69 78 73 75 70 62 67 62 54 62 62 85

0

10

20

30

40

50

60

70

80

90

100

2009 - 2011 Scene Visits

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The Denver Office of the Medical Examiner responded to 645 calls to scenes in 2011 with a target response time of 90% less than 1 hour. We achieved that goal, with response less than 30 minutes 67% of the time, between 30 minutes and 60 minutes 28% of the time.

Scene response time is one performance measure that OME tracks to insure that families, law enforcement and others do not wait longer than necessary for the OME investigator to document the scene, gather necessary information and complete other investigative activities as needed. The vast majority of scenes have an investigator arrive within 30 minutes of OME notification. 95% of the time, an investigator is on scene within an hour. Things that could adversely impact response time include: staffing shortages due to holidays or illness, multiple scenes occurring at the same time, a prior complex scene (homicide) that requires extensive investigator time, or unforeseen traffic flow issues.

67% 28%

4%

1%

Investigator Response Time

< 30 mins 30 - 60 mins > 60 mins Unknown

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DENVER OFFICE OF THE MEDICAL EXAMINER FORENSIC AUTOPSY TECHNICIAN STAFF 2011

Karen Jazowski, Forensic Autopsy Technician Supervisor

Forensic Autopsy Technicians Barbara Criter Robert Garner

Esperanza Ortega

This section is responsible for providing direct support in the autopsy

room to the forensic pathologists. Staff duties include, but are not

limited to, preparation of the bodies for autopsy, assisting the

physicians in the performance of the autopsy, assisting in collection

and storage of toxicological specimens, performing post mortem x-

rays, performing some forensic photography and releasing bodies to

the mortuary. This section is also responsible for fingerprinting of the

decedent.

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DENVER OFFICE OF THE MEDICAL EXAMINER

ADMINISTRATIVE STAFF 2011

Roberta (Kathy) Blea, Administrative Support Supervisor I

ADMINISTRATIVE STAFF

Galena Brown Cecelia Albertson

MEDICAL TRANSCRIBERS

Jami Milsap Glenda Slade

These sections are responsible for providing administrative support to all members of the staff. Administrative staff duties include customer service, releasing remains, finalizing death certificates, billing and bookkeeping, and processing personal effects. Transcription duties include transcribing autopsy reports, fulfilling report requests, and sending out laboratory samples for analysis.

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INVESTIGATIVE INTERNSHIP PROGRAM OME offers a one-year medicolegal investigative internship program with the following schools: University of Denver Graduate Program – Masters of Forensic Psychology, Metropolitan State University of Denver, and the University of Colorado, Denver Campus. Select individuals may opt, if accepted, to continue on for an additional year. Undergraduate seniors and graduate students compete to participate in a program designed to train forensic death investigators. During the internship year, interns are expected to carry their own case load that includes gathering of information for the determination of the cause and manner of death, assisting in identification of the decedent, investigating cause and manner of death, assist in the identification of the decedent, assist in locating and notifying next of kin, and proper documentation of a death scene. Upon successful completion, participants are eligible for certification as a medicolegal death investigator by the Colorado Coroner’s Association. The program also prepares participants for eventual ABMDI (American Board of Medicolegal Death Investigation) certification after hire in a coroner or medical examiner’s office.

Investigative Internship Program – One Year Internship

Ashley Peightal 2010-2011 University of Denver, MA Forensic Psychology

Andrea Raffauf 2010-2011 University of Denver, MA Forensic Psychology

Caroline Moorman 2011-2011 Regis University

Zak Adami 2011-2011 Regis University

Megan Owens 2011-2012 Metropolitan State University of Denver BS Chemistry-Criminalistics

Jessica Carlos-Ray 2011-2012 University of Colorado, Denver

Investigative Internship Program – Two Year Internship

Justin Stiebel 2009-2011 University of Denver, MA Forensic Psychology

Stacey Salmon 2009-2011 University of Colorado, Denver, MA Criminal Justice

Kayla Wallace 2010-2012 University of Denver, MA Forensic Psychology

Melanie Gutteea 2010-2012 Metropolitan State University of Denver BA Criminal Justice

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FORENSIC AUTOPSY TECHNICIAN INTERNSHIP PROGRAM OME offers numerous Autopsy Technician internships with the following schools: University of Colorado Experiential Learning Center, Metropolitan State University of Denver, Regis University, Denver, and Wesleyan University in Nebraska, Masters in Forensic Science. With the exception of Wesleyan University, which offers a two-week rotation, participants are offered a one-semester internship. During this internship, participants work closely with staff pathologists and Autopsy Technicians in the autopsy room, and gain experience in clinicopathologic correlation, forensic photography, fingerprinting, and evidence collection. Many graduates from this internship go on to medical school; others continue on in an alternative field of medicine (physical therapy, pathology assistant) or other are in the forensic sciences.

Forensic Autopsy Internship Program – 3 month internship

Brenna Clay Fall 2011 University of Colorado, Denver

Jessica Trozzo Fall 2011 California University of Pennsylvania

Kathryne Reed Fall 2011 University of Colorado

Nicole Hertzberg Fall 2011 Carnegie Mellon University

Sara Velasco Fall 2011 Central New Mexico Community College

Shannon Quirk Spring 2011 Regis University

Victoria Buchanan Spring 2011 Metropolitan State College of Denver

Kellie Webber Summer 2011 Creighton University of Omaha

Richard Tannant Summer 2011 University of Wyoming

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SCHOLARLY ACTIVITIES

The Denver Office of the Medical Examiner participates in a wide variety of community education through affiliations with area universities, as well as community outreach activities throughout the Denver Metropolitan area with high schools and middle schools, medical providers, and other interested parties.

UNVERSITY OF COLORADO SCHOOL OF MEDICINE

The three forensic pathology staff has official academic appointments with the University Of Colorado School Of Medicine through the Department of Pathology. All staff pathologists participate in the education of medical students in both general pathology as well as forensic pathology. In addition, medical students have the opportunity to rotate through the Office of the Medical Examiner for credit, gaining firsthand knowledge of the area of forensic medicine. Pathology residents at the University of Colorado have a one-month rotation generally offered in the third or fourth year. During this rotation, pathology residents gain practical experience in the performance of the forensic autopsy, and also have the opportunity to respond with medicolegal death investigators and, when applicable, staff pathologists to death scenes. Whenever possible, residents are encouraged to accompany staff pathologists to observe courtroom testimony. OME pathologists have partnered with forensic pathologists in the Arapahoe County Coroner’s Office, as well as Dr. Geza Bodor, Director of the Chemistry and Molecular Laboratories at the Veterans’ Affairs Medical Center, to offer pathology residents a series of lectures, given over the course of two years, in a wide range of forensic and toxicologic topics.

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MASS FATALITY RESPONSE In March 2006, the Denver Office of the Medical Examiner Chief of Investigations spearheaded the establishment of the North Central Region Mass Fatalities Committee. This multi-county group was formally accepted as a joint Denver Urban Area Initiative/ North Central Region committee. The committee has drafted a regional mass fatalities plan and meets monthly to further prepare for a mass fatalities incident. The investigative unit remains very active with this organization.

RESERVE CORPS In September 2008 the Investigative section of the Denver Office of the Medical Examiner established a reserve corps. This pool of volunteers was established to train volunteers for duty in the event of a mass fatality incident. The corps received periodic forensic training as well as experience in death scene investigations.

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COHEART In Nov 2009 the North Central Region Mass Fatalities Committee was awarded a $57,000 grant by the Denver Urban Area Security Initiative to establish and train a Colorado Human Remains Extraction and Recovery Team (COHEART). The grant provides for equipment and training of up to 77 volunteers to conduct remains recovery in the event of a mass fatality incident, and builds on the Denver Office of the Medical Examiner Reserve Corps. Volunteers are recruited from prior interns, medical personnel, prior law enforcement and Coroner staff members. All volunteers are screened and have background checks. The volunteers must participate in training throughout the year, spend time with the investigators and observe autopsies.

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COMMUNITY OUTREACH

OME participates in a wide range of community outreach activities over and above education,

along with other public health activities. Examples include: regional mass fatality planning, both state and local child fatality review, maternal fatality review, the Governor’s Expert Emergency Response Council (GEERC), Denver Epidemiology Work Group (DEWG) through the Denver Office of Drug Strategy, and the Metro Area County Coroners and Medical Examiners (MACCME).

o The various fatality review committees, through case study and examination of collected data, try to determine trends and patterns in the factors that cause and contribute to death, and ultimately try to develop strategies to reduce or prevent future deaths.

o The MACCME is a forum whereby the Metro Area Coroners can regularly discuss

common issues and develop strategies to address these issues. Some examples

include partnering with Front Range Community College to develop a certificate program in death investigation and developing a standardized protocol for reporting child deaths to the metro-area coroners with The Children’s Hospital.

o The GEERC (Governor’s Expert Emergency Response Council)

The Denver Office of the Medical Examiner is represented by a staff member on the GEERC which consists of businessmen, physicians, public health officials, hospital administrators, pharmacists, American Medical Association, veterinarians, coroners, funeral directors, lawyers, Better Business Bureau, and vital statistics personnel. The Council serves to: 1) strategize state response to a disaster or epidemic, 2) oversee distribution of money and supplies (vaccines) statewide, and propose laws and regulations, 3) promote education and information distribution concerning epidemics and natural disasters, 4) evaluate

the effectiveness of the State’s responses to the Governor and to the organizations represented.

o The DEWG (Denver Epidemiology Work Group) was formed in 2008 through the

Denver Office Of Drug Strategy. Modeled after the National Institute on Drug Abuse’s Community Epidemiology Work Group, he DEWG provides ongoing community-level surveillance of alcohol and drug abuse in the Denver Metropolitan area through analysis of quantitative and qualitative data regarding drug and alcohol abuse trends and populations. Participates include representatives from law enforcement; prevention, intervention and treatment programs, medical facilities, toxicology, OME, and public health.

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o The Coroner Resource Committee of Donor Alliance was formed to improve communication between the organ and tissue procurement agencies and the coroners. All metro area coroners and representatives from DA and the Rocky Mountain Lions Eye Bank meet several times a year to discuss recovery statistics and issues that may have arisen.

In addition to their usual duties, the Chief Deputy, Chief Investigator and Coroner investigators frequently lecture at local high schools, hospitals, local organizations, law enforcement, as well as Denver colleges and universities. They participate in local job fairs and career day events. They are involved in the training of new victim advocates in Colorado. The pathologists also lecture to various agencies, health care providers, law enforcement, and coroners.

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COMMUNITY SERVICE

Red Rocks Community College – Michelle Weiss-Samaras and Donald Bell

Regis University Criminal Justice and fraternal forensic organization – Donald Bell

Coalition for the Homeless and Department of Health and Human Services – Michelle Weiss-Samaras

Colorado Hospice training, Victim Advocate training, and Denver Hospital In-Service Training - Michelle Weiss-

Samaras

Denver Police Department Victim Advocate Ride along program – Investigative Section (Inv. Daniels, Cady, Jones,

Neil, Whitley, Earls, and Balbin)

NCRFMC (North Central Region Fatality Management Committee - 10 county region) –Tracey Balbin and Donald Bell

Denver International Airport – Disaster preparation – Michelle D. Weiss-Samaras and Donald Bell

In June 2011, the Denver Office of the Medical Examiner hosted the FEMA course Mass Fatality Incident Response at

the Colorado Community College of Aurora. The target audience of COHEART members and emergency

management personnel.

Promoting Healthy Communities in partnership with Community Outreach and Decision Support, another division from

the Department of Environmental Health and other community agencies – Michelle D. Weiss-Samaras

Tours/lectures out of state – Nebraska and Wyoming Colleges – Michelle D. Weiss-Samaras & Don Bell

Experience – Adams County Colorado – Michelle D. Weiss-Samaras

History Cold Case US - National Geographic – Michelle D. Weiss-Samaras

S H I N E: Primrose Studios London – Liaison Michelle D. Weiss-Samaras

Disaster Mortuary Operational Response Team (DMORT) – Karen Jazowski

Denver Child Fatality Review, Colorado Maternal Fatality Review, DEWG, MACCME, Coroner Resource Committee,

National Association Medical Examiner Ad hoc Self Assessment Module Committee – Dr. Amy Martin

Denver Center for Crime Victims In-service - Investigative Section (Inv. Daniels, Cady, Jones, Neil, Whitley, Earls, and

Balbin)

Southern Institute of Forensic Science Lecture – Tracy Balbin

Upward Bound Math and Science Imitative – Casper Wyoming – Don Bell

Local Middle & High School lectures – metro area – Michelle Weiss-Samaras and Don Bell

University of Colorado Pathology Residents Liaison – Dr. James Wahe

Denver Police Victim Advocate Team – Michelle Weiss-Samaras

Notary Public Training – Galena Brown

Recycle Ink Program – Glenda Slade

Green Recycle – DOME staff

Governor’s Expert Emergency Response Council-Alternate-Dr. James Wahe

INTERDEPARTMENTAL COMMITTEES

DEH Safety Committee – James Wahe M.D.

Performance Evaluation Review Committee – Karen Jazowski

Employee Recognition Committee – Cecilia Albertson

COMMUNITY SERVICE

Red Rocks Community College – Michelle Weiss-Samaras and Donald Bell

Regis University Criminal Justice and fraternal forensic organization – Donald Bell

Coalition for the Homeless and Department of Health and Human Services – Michelle Weiss-Samaras

Colorado Hospice training, Victim Advocate training, and Denver Hospital In-Service Training - Michelle Weiss-

Samaras

Denver Police Department Victim Advocate Ride along program – Investigative Section (Inv. Daniels, Cady, Jones,

Neil, Whitley, Earls, and Balbin)

NCRFMC (North Central Region Fatality Management Committee - 10 county region) –Tracey Balbin and Donald Bell

Denver International Airport – Disaster preparation – Michelle D. Weiss-Samaras and Donald Bell

In June 2011, the Denver Office of the Medical Examiner hosted the FEMA course Mass Fatality Incident Response at

the Colorado Community College of Aurora. The target audience of COHEART members and emergency

management personnel.

Promoting Healthy Communities in partnership with Community Outreach and Decision Support, another division from

the Department of Environmental Health and other community agencies – Michelle D. Weiss-Samaras

Tours/lectures out of state – Nebraska and Wyoming Colleges – Michelle D. Weiss-Samaras & Don Bell

Experience – Adams County Colorado – Michelle D. Weiss-Samaras

History Cold Case US - National Geographic – Michelle D. Weiss-Samaras

S H I N E: Primrose Studios London – Liaison Michelle D. Weiss-Samaras

Disaster Mortuary Operational Response Team (DMORT) – Karen Jazowski

Denver Child Fatality Review, Colorado Maternal Fatality Review, DEWG, MACCME, Coroner Resource Committee,

National Association Medical Examiner Ad hoc Self Assessment Module Committee – Dr. Amy Martin

Denver Center for Crime Victims In-service - Investigative Section (Inv. Daniels, Cady, Jones, Neil, Whitley, Earls, and

Balbin)

Southern Institute of Forensic Science Lecture – Tracy Balbin

Upward Bound Math and Science Imitative – Casper Wyoming – Don Bell

Local Middle & High School lectures – metro area – Michelle Weiss-Samaras and Don Bell

University of Colorado Pathology Residents Liaison – Dr. James Wahe

Denver Police Victim Advocate Team – Michelle Weiss-Samaras

Notary Public Training – Galena Brown

Recycle Ink Program – Glenda Slade

Green Recycle – DOME staff

Governor’s Expert Emergency Response Council-Alternate-Dr. James Wahe

INTERDEPARTMENTAL COMMITTEES

DEH Safety Committee – James Wahe M.D.

Performance Evaluation Review Committee – Karen Jazowski

Employee Recognition Committee – Cecilia Albertson

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OFFICIAL COMMITTEE APPOINTMENTS

Colorado Child Fatality Prevention Review Team (term ends September 2011)- Dr. Amy Martin, Governor Appointee

Advisory Board for the Career Technological Education Program,

Montbello High School - Michelle Weiss-Samaras

PROFESSIONAL ORGANIZATIONS AND AFFILIATIONS

Colorado Coroner's Association – DOME Staff

American Academy of Forensic Sciences – Amy Martin, M.D. James Wahe M.D.

National Association of Medical

Examiners – Amy Martin M.D., John Carver M.D., JD, James Wahe M.D.

American Board of Medicolegal Death Investigators – Investigators Howard Daniel, Harris Neil, Genevieve Jones, Donald Bell, Tracey Balbin,

Justin Earls

Colorado Organization of Victim Assistance – Michelle Weiss-Samaras

American Medical Association – Amy Martin M.D.

College of American Pathologists – Amy Martin M.D.

American Society for Clinical Pathology – Amy Martin M.D. and John Carver M.D., JD

Colorado Society of Clinical Pathologists – Amy Martin M.D.

American Medical Association – Amy Martin M.D.

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VICTIM ADVOCATES AND FAMILY ASSISTANCE

While there are no Colorado state laws which require the Coroner/Medical Examiner to identify and locate next of kin, this office has historically been tasked with this job. The Medical Examiner’s Office is fortunate to have the assistance of the Denver Police Department Victim Advocates to assist when possible in the notification of the next of kin. The interaction between the two offices has proved to be invaluable.

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ORGAN/TISSUE/CORNEAL RECOVERY

OME supports organ and tissue recovery whenever possible, and works closely with local procurement agencies such as Donor Alliance and the Rocky Mountain Lions Eye Bank to facilitate recovery activities in response to the large need for both organs and tissues on a local, as well as a national level. OME follows the Colorado Organ and Tissue Donation Coroner Protocol, which is an agreement signed by the Coroners and the District Attorney for each participating county along with Donor Alliance and the Rocky Mountain Lions Eye Bank. This protocol is designed to optimize organ and tissue recovery through cooperation and communication between all signed parties. Local coroners meet with representatives from the procurement agencies on a regular basis to review the protocol and update as needed. In addition, the Coroner Resource Committee, made up, again, of representatives from the organ and tissue procurement agencies as well as the metro areas coroners, meets between two and four times a year. These meetings have proven invaluable in addressing any concerns local coroners may have with organ and tissue recovery, as well as address specific problems that may have arisen on a case-by-case basis. These meetings also allow the procurement agencies to keep coroners informed of the changing requirements and technologies that they may have as recovery techniques change and donation needs evolve.

INFORMATION SHARING

Colorado Violent Death Reporting System The Denver Office of the Medical Examiner compiles data on all violent deaths in the county which is then used by the Centers for Disease Control and Prevention (CDC). This grant funded program housed at Colorado Department of Public Health and Environment (CDPHE) has provided a better understanding of the drivers and risk factors associated with violent deaths. Thirteen states including Colorado participate in the National Violent Death Reporting System (NVDRS). The data collection began with cases from January 2004 to date. More information on the program is available at www.cdc.gov/ncipc/dvp/dvp.htm

Various community statistical reports The Denver Office of the Medical Examiner assists agencies such as the media, human services, and the Coalition for the Homeless with regularly distributed reports on homeless and homicide deaths.

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ACADEMIC PRESENTATIONS

American Academy of Forensic Sciences 2011 Meeting

Chicago Illinois, Poster presentation

Dr. Joseph White was the lead presenter for a poster given at the

AAFS meeting in Chicago in February 2011. He presented an

interesting case report revolving around the unexpected death of a

woman who died as a result of calcium deposition in her heart muscle

resulting from chronic renal failure and dialysis.

27

National Association of Medical Examiners Accreditation

In 2000, the Denver Office of the Medical Examiner received accreditation

by NAME for the facility. Every five years the office has applied for accreditation and on December 10, 2010 the office received its third

accreditation. This accreditation recognized that the Denver Office of the Medical Examiner had achieved consistent performance and competency

in medicolegal death investigation, and is in compliance with standards developed by NAME. Only a handful of ME/Coroner offices in the country

hold this accreditation.

28

2011 Audit by the Denver County Auditor

In 2011, OME was one of the agencies chosen to be audited by the Denver Office of the Auditor. The audit team, after an initial evaluation, focused on three areas for further study:

Cost recovery

Performance metrics

Customer service The final report made several recommendations, to include:

examining existing practices to identify ways to reduce expenditures and/or increased revenues, to include performing more fee for service autopsies for outside coroners and examine opportunities for other revenue streams

adopt additional performance metrics, including those that measure outcome and quality of work, and report those publically (website, Budget Book or Annual Report)

Make the entire annual report available on the website

formally track and analyze complaints

Full audit report available at http://www.denvergov.org/auditor/DenverAuditor/AuditServices/AuditReports

29

FT. LOGAN NATIONAL CEMETERY

This cemetery is located in the southwest area of Denver, Colorado

Fort Logan features a memorial pathway lined with a variety of memorials that honor

America’s veterans from various organizations. There are 17 memorials at Fort Logan National

Cemetery—most commemorating soldiers of various 20th-century wars.

30

PERFORMANCE MEASURES 2011

2011 Identification

and Notification of Next of Kin within 24 hours (Target 90%)

Autopsy Reports completed within 60 days

All Reports Completed within 60 days (NAME target 90%)

All Reports completed within 90 days (NAME target 90%)

Bodies ready for release to mortuary within 48 hours (Target 90%)

Non-Autopsy cause and manner of death certificates provided within 10 days (Target >80%)

Success 91% 67% 75% 94% 94% 83%

NAME requirements for report turnaround are above. Failure to achieve the 60 days is a Phase I deficiency (up to 15 allowed). Failure to achieve the 90 days is a Phase II deficiency (none allowed). The other metrics are internally chosen.

31

While NAME standards have performance metrics tied to 60 and 90 days to completion, it is widely accepted that there may be significant variation in the time needed to complete an individual report. Because of the complexity of some cases, reports may well take well over 90 days to complete investigative activities. NAME recognizes that. Looking at the average turnaround time and median turnaround time gives additional indication as to how quickly reports are completed. In addition, the OME audit, while encouraging the performance of fee-for-service autopsies for other counties, cautioned against prioritizing those autopsies above those performed for Denver. The numbers above indicate fairly similar average and median turnaround times for medical examiner cases and outside county cases. The main reason for the slightly better turnaround for outside county cases is likely that these cases have been skewed to include deaths that are relatively uncomplicated, with the more complicated cases performed by an alternate provider. OME has performed cases predominantly for the Jefferson County Coroner's Office, and is one of three providers for that service.

1- 194 1-194

21-133 All autopsies

ME autopsies

OC autopsies

48.4 48.4

44.5 43

43.5

39

Range in Days

Autopsy Report Turnaround

Average median

32

The National Association of Medical Examiners has developed case workload for physician workload. Physicians MUST keep workload levels less than 325 cases per physician in order to remain in compliance with NAME accreditation. Less than 250 cases is considered optimal. Caseload is defined as the sum of autopsies performed + the number of other non-autopsy examinations using a ratio of 4 non-autopsy = 1 autopsy. NAME recognizes that physicians with additional administrative duties (such as the Chief Medical examiner) need to handle a smaller caseload. In addition, training fellows are considered one half of a full-time pathologist; their cases are counted as one half credit for the fellow and one half credit for the attending pathologist. It is a phase I deficiency for each physician over 250,

and a phase II deficiency for each physician over 325; inspectors are given some discretion in interpreting caseload numbers. For 2011, OME physicians had two physicians slightly topping the ideal caseload number. .

0

50

100

150

200

250

300

Martin Wahe Carver fellow

Number of Cases 173.75 262.25 259.75 120.02

Physician Workload 2011

33

Identification

Proper identification of decedents is a crucial part of death investigation. While not specifically spelled out in Colorado statute, identification of human remains is generally considered a duty of the coroner/medical examiner. Identification can be considered circumstantial, which would include visual identification of decedents by family or friends and the presence of distinctive tattoos or other similar methods. Circumstantial identification is sometimes all that is possible in many cases. However, OME strives whenever possible to perform a more definitive scientific identification of persons under OME jurisdiction. Scientific methods include fingerprint comparison, identification through comparison of x-rays or dental records with a known person, or DNA analysis. In rare circumstances, definitive, scientific identification can also be made through tracing of an implanted medical device such as a pacemaker or orthopedic hardware with a distinct serial number. In 2011, there were no persons under OME jurisdiction that were unidentified in some way. Of the 935 bodies which physically came to OME for either autopsy or external examination, there is data on 929 individuals as to the method of identification. This is depicted in the graph below.

Of that 929, 275 individuals were identified solely via some sort of scientific identification method. 647 were identified visually at the time of initial report. Of those, 236 had a fingerprint confirmation performed. Thus, a total of 511 individuals, or 55%, were identified by scientific means.NAME has no standards set for this benchmark. However, knowledge of common accepted practices throughout the country suggests this is a higher than average percentage when compared with other jurisdictions.

5

411

236 262

11 3

Number of Decedents

Identification method

Circumstantial Only Visual Only

Visual with FP Verification Fingerprint Only

Dental/Other Xray Other Method 416

512 Non-scientific ID

Scientific ID

34

ANNUAL STATISTICAL REPORT 2011

TOTAL DEATHS REPORTED (All jurisdictions) 3988

Medical Examiner Cases (Jurisdiction Retained) 1088

Waived Cases (Jurisdiction Waived) 1646

( Waived Natural Deaths ) 1451

( Waived Transferred Jurisdiction ) 190

( Waived – Declined/Other) 5

Inquiries (No jurisdiction determined)

(Declined)

(Request for Assistance )

(Natural)

(Transferred Jurisdiction)

1241

10

21

1209

1

Manner of death (ME Cases)

Accident 321

Homicide 49

Suicide 91

Traffic Accidents 50

Undetermined 50

Request for assistance (non-human bones, skeletal

remains, reported asystolic deaths, outside agency assist

requested etc.)

6

Natural 521

Scene visits by ME or ME Investigators 647

Bodies transported to office by order of DOME 935

External examinations 194

Complete autopsies 735

Partial autopsies 0

Outside autopsy for other jurisdiction 13

Chart Review 153

Hospital/private autopsies retained under the ME jurisdiction 3

Cases where toxicology is performed 612

Bodies unidentified after examination 0

Organ and tissue releases 93

Percent 100%

Unclaimed bodies (Coroner rotation burials) 10

Exhumations 0

35

The Denver Office of the Medical Examiner has four main classifications of death investigations:

ME or Medical Examiner cases o The Office of the Medical Examiner retains primary jurisdiction as spelled

out in Colorado Revised Statutes. Such cases have an in-depth investigation and an Office of the Medical Examiner physician will certify the cause and manner of death.

W or Waived cases o After initial investigation, some cases that are reportable by law and/or

Office of the Medical Examiner reporting policies may be transferred to another county (if the event resulting in death occurred outside Denver) or released to a hospital or treating physician to certify the death. The Office of the Medical Examiner has no further activity.

I or Inquiry cases o Care facilities often report deaths which do not fall into the area of a

reportable death after evaluation of the circumstances of the death. These cases are totally released after this is documented.

OC or Outside cases o In 2010, the Denver Office of the Medical Examiner began performing

autopsies for other Colorado counties for a fee.

36

TOTAL DEATHS REPORTED TO THE

DENVER OFFICE OF THE MEDICAL EXAMINER 2011

ACCEPTED (ME) Medical Examiner Case; jurisdiction retained

1088

WAIVED (W) Reported/Investigated and Released

1646

NOT ACCEPTED (I) Reported to office, documented, and released

1241

OUTSIDE CASES (OC) Autopsy performed at the request of outside jurisdiction

13

ME Cases, 1088, 27%

Waived Cases, 1646, 41%

Inquiries, 1241, 31%

Outside Cases, 13, 1%

37

The above table graphically depicts the month to month variation in jurisdictional cases handled by OME from 2009 to 2011 to allow for comparison over multiple years. There does seem to be some seasonal variation for the last several years, with slightly fewer ME cases in the summer months.

106

94

101 99

82

70 67

101

89 89

97 94 96

68

82 86

100

65

82 78

94

110

92

82

105

96 98

81

90

81

95

88 87 86 82

99

Jan Feb March April May June July Aug Sept Oct Nov Dec

2009 - 2011 ME Case Trends

2009 ME 2010 ME 2011 ME

38

CAUSE OF DEATH refers to the disease or injury that sets into motion the chain of events that result in death. Causes could be from a medical condition such as coronary artery disease, or a traumatic event such as gunshot wound. MANNER OF DEATH refers to how people die. There are five manners of death: Homicide (death caused by the actions of another), Suicide (death caused by intentional harm to self), Accident (death caused by non-intentional injury); Natural (death due to a natural disease process), and Undetermined (could not assign other manner due to unclear of unknown circumstances). In general, if a non-natural action has a contribution to the death, it will determine the manner. OME includes an additional ―manner‖, ―request for assistance‖, that includes bones cases and other activities that do not fit neatly into the other manners. TYPES OF EXAMINATIONS The Denver Office of the Medical Examiner constantly strives to balance best practices in death investigation with cost effectiveness and efficiently utilizing shrinking resources. In cases that the Office of the Medical Examiner retains jurisdiction, one of three medical examinations will occur.

Autopsy – The examination of a deceased person to help determine the cause and manner of death, in addition to document injuries and disease processes, collect evidence, assist in identification, and preserved blood/tissue samples for future analysis. It includes an examination of written documents including medical records, examination of the body externally, and opening the head, neck, chest, and abdomen at a minimum, removing and thoroughly examining the organs. A report is compiled, which is a public record in Colorado.

External examination – This includes the first two steps as an autopsy case, but the body is not surgically opened. Blood/fluid or other samples are still preserved when possible.

Chart review – When a person dies of injuries that result in extensive medical treatment that is well documented, the body is not examined, but the cause of death is certified based upon review of medical records.

W cases have been steadily increasing over the past two years, although again there is fluctuation month-to-month. One explanation for this increase could be the increase in home hospice deaths, and the increase in the reporting of these deaths.

39

Again, although month-to-month variations occur, overall the number of I cases has increased over the past three years. Again increased reporting by hospice providers likely explains some of this.

92 91

118

98 106

113 93

109 107

131 131 127

126 132

136

121 131

113 113

123 145 143 142

147

153 151

197

160 155

124

99

105

121

126 116

139

Jan Feb March April May June July Aug Sept Oct Nov Dec

2009-2011 W Case Trends

2011 W

2010 W

2009 W

Jan Feb

March April

May June

July Aug

Sept Oct

Nov Dec

66 39

52 48

46 50 60 46

55

51 50 52

46 55 52 51

70

70

60

50 51

50 51 62

78 76 88

87

107 99

92

126

98

148

124

118

2009-2011 I Case Trends

2009 I 2010 I 2011 I

40

2011 DENVER OFFICE OF THE MEDICAL EXAMINER CASE DISTRIBUTION

321, 29.5%

49, 4.5%

91, 8.3%

50, 4.5% 50, 4.5%

521, 47.8%

6, 0.5%

Total ME Cases Accepted by Manner of Death

41

42

NATURAL DEATH ALL ME CASES, BY EXAMINATION AND RACE

Category White Black Hispanic Asian Native

American Other/

Unidentified Race Total

Autopsies 177 62 45 6 6 2 297 External Examinations 117 28 32 7 0 1 185 Chart Reviews 24 5 7 1 0 1 38 Total 318 95 84 14 6 4 521

34%

22%

5%

12%

5%

1%

8% 6%

1% 1% 1% 0.1%

1% 0 0

0.4% 0.1% 0.1% 0

20

40

60

80

100

120

140

160

180

200

Autopsies External Examinations Chart Reviews

Natural Deaths by Examination and Race

White Black Hispanic Asian Native American Other/Unidentified Race

43

NATURAL DEATHS BY AGE AND SEX

ALL MEDICAL EXAMINER CASES 2011

0 20 40 60 80 100 120

0-10 years

11-20 years

21-30 years

31-40 years

41-50 years

51-60 years

61-70 years

71-80 years

81-90 years

91 + years

0-10 years

11-20 years

21-30 years

31-40 years

41-50 years

51-60 years

61-70 years

71-80 years

81-90 years

91 + years

Female 1 0 2 9 19 36 34 30 21 10

Male 6 2 6 13 63 113 77 47 30 2

Natural Deaths by Age and Sex

44

NATURAL DEATH ME Cases by AGE and RACE

Age White Black Hispanic Asian Native American Other TOTAL

0-10 years 0 4 2 0 0 1 7 11-20 years 0 0 2 0 0 0 2 21-30 years 3 4 1 0 0 0 8 31-40 years 13 2 7 0 0 0 22 41-50 years 50 18 10 0 4 0 82 51-60 years 93 28 21 5 0 2 149 61-70 years 65 20 18 4 2 1 110 71-80 years 50 11 15 2 0 0 78 81-90 years 36 6 7 2 0 0 51 91 + years 8 2 1 1 0 0 12 TOTAL 318 95 84 14 6 4 521

0

50

100

150

200

250

300

350

White Black Hispanic Asian Native American

Other

Natural Death by Age and Race

91 + years

81-90 years

71-80 years

61-70 years

51-60 years

41-50 years

31-40 years

21-30 years

11-20 years

0-10 years

45

NATURAL DEATH ALL ME CASES, BY CATEGORY and RACE

46

NATURAL DEATHS BY CATEGORY/SEX

AUTOPSY CASES ONLY

CATEGORY Male Female Total

ASCVD, NOS 49 18 67 Myocardial Infarction/CAD 2 2 4 Stroke 4 3 7 HTN 22 6 28 Aortic Aneurysm 5 0 5 Berry Aneurysm 0 2 2 Cardiomyopathy 8 1 9 Myocarditis 0 2 2 Other 21 8 29 TOTAL CARDIOVASCULAR 111 42 153 COMPLICATIONS OF ETOH 40 13 53 COPD & Emphysema 6 3 9 Interstitial Lung Disease 0 0 0 Asthma 3 0 3 Pulmonary Embolus 2 2 4 Pneumonia/Bronchitis 0 0 0 Other 4 5 9 TOTAL RESPIRATORY 15 10 25 Pneumonia 9 4 13 Meningitis/Encephalitis 0 0 0 Myocarditis/Endocarditis/Pericarditis 0 0 0 TB 0 0 0 HIV/AIDS 1 0 1 Sepsis 2 2 4 Other 5 1 6 TOTAL INFECTIOUS DISEASE 17 7 24 NEOPLASTIC 3 3 6 METABOLIC/DIABETES 10 3 13 OTHER 16 8 24

TOTAL ALL 212 86 298

47

0

20

40

60

80

100

120

Male

Female

13%

4%

5%

3%

5%

2%

1%

1%

3%

1%

5%

2%

Natural Deaths by Category/Sex Autopsy Cases Only

CARDIOVASCULAR COMPLICATIONS OF ETOH

RESPIRATORY INFECTIOUS DISEASE

NEOPLASTIC METABOLIC/DIABETES

OTHER

48

49

Undetermined Manner of Death 2011

Undetermined manner is used to designate that a death does not fit the category of natural, suicide, homicide, or accident. This includes areas where the cause of death may have been found but the manner may not be clear. This may be due to a lack of background information, uncertainties in circumstances, or decomposition of the body related to a time delay in discovery. Decomposition can sometimes be a factor, as this can distort the body and render postmortem toxicology and other testing difficult to perform and/or interpret. There are also cases where the cause of death itself cannot be determined, again possibly related to advanced decomposition of the body, the inability to obtain sufficient information for a variety of reasons, or the death may have been due to causes which leave no anatomic foot print such as certain types of heart disease(long QT syndrome e.g.), some seizure deaths, and some asphyxial deaths.. In general, autopsies should be performed on cases where manner of death and cause of death are undetermined. However, in practice that is not always possible. Cases may come to the attention of OME after cremation has occurred, making autopsy impossible. In other instances, the cause of death is clear, but the determination of manner of death would not be aided by the performance of an autopsy due to insufficient investigative information in existence. This is especially true in instances where death occurs years or even decades after a traumatic injury. In these cases, an autopsy would not yield any information that would differentiate between manners of death.

50

UNDETERMINED BY AGE and SEX

Age Male Female TOTAL

0-10 years 6 4 10 11-20 years 2 0 2 21-30 years 2 3 5 31-40 years 1 6 7 41-50 years 7 5 12 51-60 years 5 4 9 61-70 years 3 2 5 71-80 years 0 0 0 81-90 years 0 0 0 91 + years 0 0 0

TOTAL 26 24 50

23%

8%

8%

4%

27%

19%

11%

0% 0% 0%

Undetermined by Age - Male

0-10 years

11-20 years

21-30 years

31-40 years

41-50 years

51-60 years

61-70 years

71-80 years

81-90 years

17% 0%

12%

25%

21%

17%

8%

0% 0% 0%

Undetermined by Age - Female

0-10 years

11-20 years

21-30 years

31-40 years

41-50 years

51-60 years

61-70 years

71-80 years

51

UNDETERMINED BY AGE and METHOD

Age Toxin Trauma Unknown/

Other SUDI TOTAL TOTAL %

BY AGE

0-10 years 1 0 6 3 10 20% 11-20 years 0 0 2 0 2 4% 21-30 years 3 0 2 0 5 10% 31-40 years 2 0 5 0 7 14% 41-50 years 8 3 1 0 12 24% 51-60 years 3 0 6 0 9 18% 61-70 years 1 1 3 0 5 10% 71-80 years 0 0 0 0 0 0% 81-90 years 0 0 0 0 0 0% 91 + years 0 0 0 0 0 0% TOTAL 18 4 25 3 50

TOTAL % BY METHOD 36% 8% 50% 6%

52

UNDETERMINED BY AGE and RACE

Age White Black Hispanic Asian Native American TOTAL

0-10 years 4 4 2 0 0 10 11-20 years 0 0 2 0 0 2 21-30 years 4 0 0 0 1 5 31-40 years 6 0 1 0 0 7 41-50 years 8 2 2 0 0 12 51-60 years 5 3 0 1 0 9 61-70 years 5 0 0 0 0 5 71-80 years 0 0 0 0 0 0 81-90 years 0 0 0 0 0 0 91 + years 0 0 0 0 0 0

TOTAL 32 9 7 1 1 50

0 1 2 3 4 5 6 7 8

0-10 years

11-20 years

21-30 years

31-40 years

41-50 years

51-60 years

61-70 years

Undetermined by Age and Race

Native American Asian Hispanic Black White

53

SUDDEN UNEXPECTED DEATHS IN INFANCY (SUDI) 2011 The Office of the Medical Examiner certifies sleep associated deaths in infants as undetermined in manner rather than natural, following evolving practice changes in the field of forensic medicine recognizing the uncertainties and multi-factorial issues related to these deaths. In the past, these deaths might have been called "SIDS" or Sudden Infant Death Syndrome. More recent forensic literature uses the term "Sudden Unexplained Death in Infancy" or SUDI. Recognized risk factors include external factors that could contribute to asphyxia in these children, for example bed sharing with an adult and unsafe sleep surfaces. OME feels these deaths are best certified as undetermined in manner for these reasons. For this reason, most of these deaths are also certified as undetermined in cause.

1 month 2 months 4 months 5 months > 6

months

Male 0 0 1 0 1

Female 0 0 1 0 0

SUDI by AGE and SEX

White Black Hispanic

Female 0 1 0

Male 1 0 1

SUDI by Race and Sex

54

0

0.2

0.4

0.6

0.8

1

1.2

Male Female

SUDI by Sex and Month of Death

January February March April

May June July August

September October November December

Morning (8:01 am - 12:14 pm)

Afternoon (12:15 pm - 6:00 pm)

Evening (6:01 pm - 8:00 am)

1

0

1 1

0 0

SUDI by Sex and Time of Day

Male Female

55

56

Violent crime nationwide has been decreasing and Denver is no exception. Since 2005, homicides in Denver have trended downward. According to 2010 census data, non-Hispanic whites account for 52.2% of Denver's population. Hispanics account for 31.8% and blacks account for 10.2%. However, blacks and Hispanics are disproportionately represented as victims of homicide. In addition, males make up a disproportionate number of homicide victims in Denver at a ratio of approximately 9:1.

COLD CASES In 2004, the Denver Police Department was the recipient of a federal grant to help work up unsolved violent crimes such as homicide and sexual assault. With advances in DNA testing, OME has increasingly been enlisted to assist with working up these cases. As custodian of records, Michelle Weiss-Samaras increasingly provides DPD with sources of DNA material and other investigative information to help solve these crimes.

60 60

56 55

48

41

49

2004

2005

2006

2007

2008

2009

2010

2011

2012

Homicides 2005-2011

57

2011 Homicide Examinations

58

Age Male Female TOTAL

0-10 years 1 0 1

11-20 years 1 3 4

21-30 years 14 3 17

31-40 years 6 2 8

41-50 years 2 6 8

51-60 years 6 1 7

61-70 years 1 0 1

71-80 years 2 1 3

81-90 years 0 0 0

91 + years 0 0 0

TOTAL 33 16 49

0 2 4 6 8 10 12 14 16

2011 Homicides by AGE and SEX

91 + years

81-90 years

71-80 years

61-70 years

51-60 years

41-50 years

31-40 years

21-30 years

11-20 years

0-10 years

59

OME almost universally performs autopsies and victims of homicide. Rarely, there is a significant delay between injury and the death and all investigative and legal activities have been exhausted by the time the death occurs. In these situations, the pathologist reviewing the case may opt to perform a more limited examination. Drug and ethanol testing is performed on all homicide deaths where feasible e.g. where death occurs shortly after the injury was inflicted and/or in hospitalized individuals adequate antemortem blood samples can be obtained from the hospital. In this latter instance OME makes every effort to procure the earliest blood sample drawn at the hospital for this testing. These samples however are not always available and thus there are a certain number of cases where drug and ethanol testing is not possible. Drugs detected include both illicit and legally obtained drugs, both over-the-counter and prescription medications. Marijuana (THC) was the drug most commonly detected in OME homicide deaths. More than one drug was present in 16% of cases. Over half or 77%had at least one drug documented. 51% had some amount of ethanol present. In 16 of these victims the level was over the legal limit of greater than or equal to .08% as defined in Colorado statute. Weekends were the most likely days to die from homicide. Most victims were between the ages of 21 and 40 years of age.

Asian Black Hispanic American Indian

White

0 5 7 0 4

0

12 13

1

7

Homicides by Race and Sex

Female Male

60

Homicides by SEX and RACE with DRUGS

SEX RACE

DRUGS Male Female White Black Hispanic Asian Native

American TOTAL

Negative/Not Available 6 8 5 4 4 0 1 14

Cocaine/Metabolites 0 1 0 1 0 0 0 1

Methamphetamine 1 0 0 0 1 0 0 1

THC 3 2 0 2 3 0 0 5

Morphine/Heroin 1 0 1 0 0 0 0 1

Other 8 3 1 5 5 0 0 11

Multiple Drugs 14 2 4 5 7 0 0 16

TOTAL 33 16 49

Male Female

6 8

1

1 3

2 1

8 3

14

2

Homicides by Sex with Drugs

Multiple Drugs

Other

Morphine/Heroin

THC

Methamphetamine

Cocaine/Metabolites

Negative/Not Available

0

5

10

15

20

25

White Black Hispanic Asian Native

American

Homicides by Race with Drugs

Negative/Not Available Cocaine/Metabolites

Methamphetamine THC

Morphine/Heroin Other

Multiple Drugs

61

9

1

1

0

9

2

2

3

1

7

2

2

4

5

0

1

0

Homicides by Race involving Alcohol White Black Hispanic Asian Native American

Homicides by SEX and RACE with ALCOHOL Blood Alcohol SEX RACE

Male Female White Black Hispanic Asian

Native

American TOTAL

Not Done/Negative 13 13 9 9 7 0 1 26

Less than 0.050% 4 1 1 2 2 0 0 5

0.051% - 0.1% 4 0 0 2 2 0 0 4

0.101% - 0.150% 6 1 0 3 4 0 0 7

0.151% - 0.2% 5 1 0 1 5 0 0 6

0.201% - 0.25% 0 0 0 0 0 0 0 0

0.251% - 0.3% 1 0 1 0 0 0 0 1

0.301% - 0.350% 0 0 0 0 0 0 0 0

> 0.351% 0 0 0 0 0 0 0 0

TOTAL 33 16 49

13

4

4

6

5

0

1

0

0

13

1

0

1

1

0

0

0

0

0% 50% 100%

Not Done/Negative

Less than 0.050%

0.051% - 0.1%

0.101% - 0.150%

0.151% - 0.2%

0.201% - 0.25%

0.251% - 0.3%

0.301% - 0.350%

> 0.351%

Homicides by Sex involving Alcohol

Male

Female

62

Homicides by Time of Day Female Male TOTAL Time of Day 12:01 AM - 6:00 AM 4 11 15 6:01 AM - NOON 3 5 8 12:01 PM - 6:00 PM 5 7 12 6:01 PM - MIDNIGHT 4 10 14 TOTAL 16 33 49

25%

19% 31%

25%

Female

12:01 AM - 6:00 AM 6:01 AM - NOON

12:01 PM - 6:00 PM 6:01 PM - MIDNIGHT

34%

15% 21%

30%

Male

12:01 AM - 6:00 AM 6:01 AM - NOON

12:01 PM - 6:00 PM 6:01 PM - MIDNIGHT

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Female 3 1 3 3 1 3 2

Male 7 6 2 5 1 4 8

Homicides by Day of the Week

63

Age Asphyxia Blunt Injury Combo/Other GSW Sharp Force Injury TOTAL

0-10 years 0 1 0 0 0 1

11-20 years 0 0 1 3 0 4

21-30 years 0 0 1 15 1 17

31-40 years 0 1 0 6 1 8

41-50 years 0 0 1 1 6 8

51-60 years 0 2 0 3 2 7

61-70 years 0 2 0 0 0 2

71-80 years 0 1 0 1 0 2

81-90 years 0 0 0 0 0 0

91 + years 0 0 0 0 0 0

TOTAL 0 7 3 29 10 49

Male Female

Asphyxia 0 0

Blunt Injury 5 2

Combo/Other 2 1

GSW 23 6

Sharp Force Injury 3 7

0

5

10

15

20

25

Homicides by SEX and METHOD

1 1 2 2

1 1 1 1

3

15

6

1

3

1 1 1

6

2

0

2

4

6

8

10

12

14

16

0-1

0 y

ea

rs

11

-20

ye

ars

21

-30

ye

ars

31

-40

ye

ars

41

-50

ye

ars

51

-60

ye

ars

61

-70

ye

ars

71

-80

ye

ars

81

-90

ye

ars

91

+ y

ea

rs

Homicides by Age and Method

Asphyxia Blunt Injury Combo/Other GSW Sharp Force Injury

64

Homicides by Age and Race

Age Race

White Black Hispanic Asian Native

American TOTAL 0-10 years 1 0 0 0 0 1 11-20 years 0 2 2 0 0 4 21-30 years 2 7 8 0 0 17 31-40 years 1 2 5 0 0 8 41-50 years 0 4 3 0 1 8 51-60 years 3 2 2 0 0 7 61-70 years 2 0 0 0 0 2 71-80 years 2 0 0 0 0 2 81-90 years 0 0 0 0 0 0 91 + years 0 0 0 0 0 0 TOTAL 11 17 20 0 1 49

0 2 4 6 8 10

0-10 years

11-20 years

21-30 years

31-40 years

41-50 years

51-60 years

61-70 years

71-80 years

81-90 years

91 + years

Homicides by Age and Race

Native American

Asian

Hispanic

Black

White

65

Homicides by Setting and Sex

7

11

1 1 1 1 1 2

1 2

1

10

5

1 2

1 1

Total Homicides

by Setting

25%

19%

0% 6%

6% 0%

0%

6%

0% 0%

0% 13%

13%

0%

13%

0%

0%

Female Homicides by Setting

Resident of Another Residence Alley Apartment Car Nightclub/Bar Outside of Nightclub/Bar Outside Home Parking Lot Public Place

9%

24%

3%

3% 3% 3% 3%

6% 3%

24%

9%

3% 3% 3%

Male Homicides by Setting

Resident of Another Residence Alley Apartment Car Nightclub/Bar Outside of Nightclub/Bar Outside Home Parking Lot Public Place

66

67

Colorado has one of the highest suicide rates in the country. Denver’s suicide rate is approximately equal to the overall state rate.

Compared with past years, suicide deaths are trending slightly upward in Denver County.

A person may have one or more risk factors that would put an individual at

increased risk for completing the suicide. In 2009, OME became more aggressive

in tracking these risk factors and recording them in a way that they could be

better tracks. These risk factors will be tracked over time to determine if there

are any identifiable trends in risk factors.

97

79

102 95

99 104

91

2005

2006

2007

2008

2009

2010

20

11

Suicides 2005-2011

68

TOTAL PERCENTAGE: 97.8% AUTOPSIES

0% EXTERNALS 2.1% CHART REVIEWS

Fem

ale

M

ale

20

69

0

0

2

0

Suicide Examinations

Chart Review External Exam Autopsy

69

Age Race White Black Hispanic Asian Native American Other TOTAL 0-10 years 0 0 0 0 0 0 0 11-20 years 3 1 5 0 0 0 9 21-30 years 11 3 5 1 0 1 21 31-40 years 7 2 4 1 1 0 15 41-50 years 12 1 5 0 1 0 19 51-60 years 14 0 1 0 1 0 16 61-70 years 5 0 0 0 0 0 5 71-80 years 3 0 1 0 0 0 4 81-90 years 2 0 0 0 0 0 2 91 + years 0 0 0 0 0 0 0 TOTAL 57 7 21 2 3 1 91

0

5

10

15

20

25

0-1

0 y

ea

rs

11

-20

ye

ars

21

-30

ye

ars

31

-40

ye

ars

41

-50

ye

ars

51

-60

ye

ars

61

-70

ye

ars

71

-80

ye

ars

81

-90

ye

ars

91

+ y

ea

rs

Suicides by Age and Race

White Black Hispanic Asian Native American Other

70

Alcohol Gunshot Hanging Jumped from

Height Other Overdose/

Toxic Sharp Force TOTAL

Age

0-10 years 0 0 0 0 0 0 0 0

11-20 years 0 3 6 0 0 0 0 9

21-30 years 0 9 9 1 0 2 0 21

31-40 years 0 2 7 2 0 3 1 15

41-50 years 0 6 4 5 0 3 1 19

51-60 years 0 5 5 0 0 6 0 16

61-70 years 0 3 0 0 0 2 0 5

71-80 years 0 2 1 0 0 1 0 4

81-90 years 0 1 0 0 0 1 0 2

91 + years 0 0 0 0 0 0 0 0

TOTAL 0 31 32 8 0 18 2 91

0 2 4 6 8 10

Alcohol

Gunshot

Hanging

Jumped from Height

Other

Overdose/Toxic

Sharp Force

Suicides by Method and Age

91 + years

81-90 years

71-80 years

61-70 years

51-60 years

41-50 years

31-40 years

21-30 years

11-20 years

0-10 years

71

This graph shows the risk factors noted in Denver suicides. Many people have more than one risk factor.

Note Left 29 Previous Threats/Attempts 38 Prior Suicide in Family 5 Loss of Significant Relationship 10 Family Member/Close Friend Died 6 Recent Period of Despondency 31 Recent Period of Rage 7 Financial Problems 18 Marital Problems 17 Illness of Self 10 Illness of Another 3 Loss of Loved One 6 Relationship Problems 22 Unknown/Other Reason 7 Drug Problems 14 Alcohol Abuse 19 Legal/Disciplinary Problems 8

72

73

Suicide Settings

Female Male TOTAL Business (Inside/Outside) 0 2 2 Car 0 3 3 Empty Building 1 0 1 Field 0 1 1 Garage 1 3 4 Homeless Shelter 1 0 1 Hotel/Motel 3 5 8 Other's Residence 2 6 8 Outside Home/Apartment 0 5 5 Outside Other's Home/Apartment 0 3 3 Park 0 1 1 Parking Garage 0 1 1 Parking Lot 0 1 1 Residence/Home 13 34 47 Residence/Apartment 1 4 5 TOTAL 22 69 91

0 0 1 0 1 1 3 2 0 0 0 0 0

13

1

2 3 0 1 3

0 5 6 5 3 1 1 1

34

4

Suicides by Setting

Female Male

74

75

DRUG RELATED DEATHS

2004 THROUGH 2010

DENVER OFFICE OF THE MEDICAL EXAMINER IN CONJUNCTION

WITH THE DENVER OFFICE OF DRUG STRATEGY (DODS)

In 2008, OME partnered with the Denver Office of Drug Strategy to

gather data on drug-related fatalities in Denver from 2003 to present.

The compilation of data is part of a bigger work group, which brings

representatives from law enforcement, OME, DODS, Denver Police

Crime Laboratory, Rocky Mountain Poison and Drug Center, Denver

Health and Hospitals, and several drug abuse treatment providers.

This workgroup will continue to examine drug use/abuse trends and

determine effectiveness of treatment and prevention efforts. Drug

deaths include not only accidental deaths related to recreational abuse

of drugs, but also other accidental toxic effects, suicidal overdoses,

and deaths with undetermined manner.

OME would like to thank Bruce Mendelson, senior data consultant for

the DODS, for his tireless work in pulling out the mortality data.

76

2005 – 2011 Drugs Contributing to Cause of Death

Including Accidents, Suicides, and Undetermined Manner 2005 2006 2007 2008 2009 2010 2011

n % n % n % n % n % n % n %

Cocaine 82 48.2 85 50.3 75 39.7 60 8.3 53 25.6 41 27 58 26.0

Morphine 60 35.3 64 37.9 43 22.8 48 22.6 26 12.6 18 11.8 55 24.6

Alcohol 44 25.9 65 38.5 66 34.9 75 35.4 72 34.8 52 34.2 58 26.0

Codeine 36 21.2 36 21.3 18 9.5 19 9.0 11 5.3 3 2.0 18 8.0

Heroin 18 10.6 17 10.1 18 9.5 27 12.7 49 23.7 35 23 40 17.9

Methadone 17 10.0 16 9.5 14 7.4 15 7.1 15 7.2 11 7.2 19 8.5

Oxycodone 12 7.1 7 4.1 38 20.1 33 15.6 48 23.2 24 15.8 35 15.6

Methamphetamine 12 7.1 9 5.3 12 6.3 15 7.1 10 4.8 14 9.2 24 10.7

Acetaminophen 11 6.5 2 1.2 14 7.4 13 6.1 4 1.9 8 5.3 5 2.2

Diazepam 10 5.9 11 6.5 19 10.1 16 7.5 23 11.1 19 12.5 19 8.5

Alprazolam 10 5.9 5 3.0 13 6.9 15 7.1 20 9.7 12 7.9 18 8.0

Hydrocodone 7 4.1 10 53.9 8 4.2 22 10.4 18 8.7 10 6.6 19 8.5

Diphenhydramine 7 4.1 1 0.6 11 5.8 11 5.2 3 1.4 9 5.9 5 2.2

Clonazepam 2 1.2 0 0 1 .5 4 1.9 8 3.9 7 4.6 8 3.5

Fentanyl 3 1.8 3 1.8 5 2.6 5 2.4 13 6.3 5 3.3 5 2.2

Decedents* 170 169 189 212 207 152 223

Source: Denver Medical Examiner’s Office Autopsy Reports * Drug totals won’t sum to decedents because more than one drug may be found in individual’s toxicology

0

10

20

30

40

50

60

70

80

90

2005 2006 2007 2008 2009 2010 2011

2005-2011 Drugs Contributing to Cause of Death

Including Accidents, Suicides, and Undetermined

Cocaine Morphine Alcohol Codeine Heroin Methadone Oxycodone Methamphetamine Acetaminophen Diazepam Alprazolam Hydrocodone Diphenhydramine Clonazepam Fentanyl

77

78

0 50 100 150 200 250

Autopsies

External Examination

Chart Review

Autopsies External Examination Chart Review

Asphyxia/drowning 16 0 2

Falls 21 4 90

Fire 0 0 0

Motor Vehicle 1 0 0

Overdose/toxic 159 2 2

Other 16 0 8

Non-Traffic Accident Examinations

1 1 1 2 4

10

2 3 4 2

4

10 7

18

9

4 4 4 1 2 1 2 2

24 23

33

40

15

20

39

29

0-10 years

11-20 years

21-30 years

31-40 years

41-50 years

51-60 years

61-70 years

71-80 years

81-90 years

91 + years

Accidents by Race and Age

Asian Black Hispanic Native American White Other

79

Accidents by Category and Age

Age Asphyxia/drowning Falls Fire

Motor Vehicle

Overdose/toxic Other TOTAL

0-10 years 2 1 0 0 0 0 3 11-20 years 0 1 0 0 3 0 4 21-30 years 3 3 0 0 22 0 28 31-40 years 0 0 0 1 34 0 35 41-50 years 1 2 0 0 38 3 44 51-60 years 4 10 0 0 50 5 69 61-70 years 1 6 0 0 14 5 26 71-80 years 4 21 0 0 2 3 30 81-90 years 3 41 0 0 0 4 48 91 + years 0 30 0 0 0 4 34 TOTAL 18 115 0 1 163 24 321

0 10 20 30 40 50 60

Non-Traffic Accidents by Category and Age

91 + years 81-90 years 71-80 years 61-70 years 51-60 years

41-50 years 31-40 years 21-30 years 11-20 years 0-10 years

80

0-10

years

11-20

years

21-30

years

31-40

years

41-50

years

51-60

years

61-70

years

71-80

years

81-90

years

91 +

years

2 1

24 26

35

52

20

14

21 18

1 3 4 9 9

17

6

16

27

16

Accident by SEX and AGE

Male

Female

81

Accidents by Sex and Marital Status

Common Law Divorced Married Single Unknown Widowed TOTAL

Male 0 51 49 81 7 25 213

Female 0 23 28 20 0 37 108

TOTAL 0 74 77 101 7 62 321

82

Male Female

Alley 7 0

Assisted Living/Nursing Home

18 17

Car 1 0

Halfway House 1 0

Health Care Facility/Hospital

74 33

Hospice 7 15

Hotel/Motel 7 1

Other's Residence 11 0

Outside Area/Park 4 0

Outside Business 1 0

Outside Home/Apartment

3 0

Parking Lot 1 0

Pool/Hot Tub 1 0

Residence/Home 63 36

Residence/Apartment 12 6

River/Lake 2 0

0

10

20

30

40

50

60

70

80

Accidents by Setting and Sex

83

84

0 5 10 15 20 25 30 35

Autopsy

External Examination

Chart Review

Autopsy External

Examination Chart Review

Female 8 1 0

Male 31 3 7

Traffic Accidents - Examinations

Total Percentages:

Autopsies – 78’% External Examinations – 8%

Chart Reviews – 14%

85

Traffic Accidents by Time of Day

Male Female TOTAL 12:01AM to 6:00 AM 2 2 4 12:01 PM to 6:00 PM 3 1 4 6:01 AM to Noon 3 1 4 6:01 PM to Midnight 6 1 7 Unknown 27 4 31 TOTAL 41 9 50

5% 7% 7%

15% 66%

Male

12:01AM to 6:00 AM 12:01 PM to 6:00 PM

6:01 AM to Noon 6:01 PM to Midnight

Unknown

22%

11%

11% 11%

45%

Female

12:01AM to 6:00 AM 12:01 PM to 6:00 PM

6:01 AM to Noon 6:01 PM to Midnight

Unknown

11

6 5

4

1

6

8

1 0

4

0 0

2 2

Su

nd

ay

Mo

nd

ay

Tu

esd

ay

Wed

nesd

ay

Th

urs

day

Fri

day

Satu

rday

Traffic Accidents by Day of the Week

Male

Female

86

Vehicle Position – All Traffics

Male Female TOTAL Driver 11 4 15 Passenger 3 2 5 Bicycle 2 0 2 Pedestrian 17 3 20 Unknown 1 0 1 Motorcycle 7 0 7 TOTAL 41 9 50

Toxicology Done: Total 31 tested for both drugs and alcohol.

Driver

Passenger

Bicycle

Pedestrian

Unknown

Motorcycle

11

3

2

17

1

7

4

2

0

3

0

0

Female Male

87

AT FAULT DRIVERS Blood alcohol/drugs Totals No toxicology ordered 3 Negative 1 BAC range 0 - .287% 4 THC 1 % BAC at or above 0.08% 44% Total At-Fault Drivers 9

Note: BAC ≥0.08% is the legal limit in CO for driving under the influence; almost half of at fault drivers who were killed were legally intoxicated by ethanol.

BICYCLISTS Blood alcohol/drugs Totals Negative 1 Alcohol & THC 1 Total Bicyclist – Traffic Accidents 2

MOTORCYCLE Blood alcohol/drugs Totals No toxicology ordered 4 Negative (drugs only) 0 Negative (ETOH) 0 BAC range 0 - 0.217% 2 THC 1 % BAC at or above 0.08% 14% Total Motorcycle Accidents 7

PEDESTRIANS Blood alcohol/drugs Totals No toxicology ordered 9 Negative 4 BAC range 0 - 0.351% 4 THC & Cocaine 2 THC &

Amphetamines/Methamphetamines 1 Total Pedestrian – Traffic Accidents 20

88

Male Female TOTAL Not done/Not available 17 2 19 Negative 12 3 15 Less than 0.050% 2 0 2 0.051 - 0.100% 1 0 1 0.151 - 0.200% 6 2 8 0.201 - 0.250% 1 0 1 0.251 - 0.300% 1 2 3 0.301 - 0.350% 0 0 0 > 0.351% 1 0 1 TOTAL 41 9 50

0

2

5

12

4

10

1

1

1

0

1

1

5

2 1

1

2 1

Asian

Native American

Black

Hispanic

White

Other

Blood Alcohol by RACE

Not done/Not available

Negative

Less than 0.050%

0.051 - 0.100%

0.151 - 0.200%

0.201 - 0.250%

0.251 - 0.300%

0.301 - 0.350%

> 0.351%

89

Traffic Accidents, Detected Drugs by SEX and RACE

DRUGS SEX RACE TOTAL

Male Female White Black Hispanic Asian Native

American Other

Not Done/Available 17 2 12 2 5 0 0 0 19 Not

Significant/Negative 16 4 11 3 4 0 1 1 20 Methamphetamine

/Amphetamine 1 0 1 0 0 0 0 0 1 THC 5 1 4 1 1 0 0 0 6

Morphine 0 0 0 0 0 0 0 0 0 Multiple Drugs 2 2 2 2 0 0 0 0 4

TOTAL 41 9 30 8 10 0 1 1 50

Not Done/Available

Not Significant/Negative

Methamphetamine/Amphetamine

THC

Morphine

Multiple Drugs

17

16

1

5

0

2

2

4

0

1

0

2

Detected Drugs by Sex

Female Male

White Black Hispanic Asian Native

American

Other

12

2

5

0 0 0

11

3 4

0 1 1 1

0 0 0 0 0

4

1 1 0 0 0 0 0 0 0 0 0

2 2

0 0 0 0

Drugs Detected by Race

Not Done/Available Not Significant/Negative

Methamphetamine/Amphetamine THC

Morphine Multiple Drugs

90

Denver has a diverse cultural composition, and continues to grow in population; Growth is comprised of a spectrum of racial and ethnic groups represented. The Denver Office of the Medical Examiner feels it is particularly important to be sensitive to others and respects, and appreciates all cultures and religious beliefs. If an autopsy is required, the office strives to adhere to as many cultural and religious beliefs as possible, though the office must complete its statutory duty and determine the cause and manner of death. The office continually strives to help the friends and families understand the duties of the office and the need for our involvement in the investigation of the death of their loved one. Contact with clergymen is encouraged, when appropriate and attempts are made to locate a professional that is bilingual when needed. While there are no Colorado State Laws which require the Coroner/Medical Examiner to identify and locate next of kin, this office has historically been tasked with this job. The Medical Examiner’s Office has been involved in the training of the Victim Advocates for years and is fortunate to have the assistance of the Denver Police Department Victim Advocates to assist when possible in the notification of the next of kin.

91

The City of Denver has over 200 city and mountain parks. Many events are held for the public in these parks. Many of the Parks have rivers, lakes, and trails for walking, riding bikes, and running, for the public enjoyment. Though the City of Denver owns many mountain parks outside of Denver proper, this office does not respond to deaths in these mountain areas. The local law enforcement and Coroner have the authority to handle those deaths for the Denver Office of the Medical Examiner.