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The person who investigates suspicious deaths in your town may not even be a doctor
Kaiser Health News
When a group of physicians gathered in Washington state for an annual meeting, one made a startling revelation: If you ever want to know when, how — and where — to kill someone, I can tell you, and you'll get away with it. No problem.
That's because the expertise and availability of coroners, who determine cause of death in criminal and unexplained cases, vary widely across Washington, as they do in many other parts of the country.
"A coroner doesn't have to ever have taken a science class in their life," said Nancy Belcher, chief executive officer of the King County Medical Society, the group that met that day.
Her colleague's startling comment launched her on a four-year journey to improve the state's archaic death investigation system, she said. "These are the people that go in, look at a homicide scene or death, and say whether there needs to be an autopsy. They're the ultimate decision-maker," Belcher added.
Each state has its own laws governing the investigation of violent and unexplained deaths, and most delegate the task to cities, counties, and regional districts. The job can be held by an elected coroner as young as 18 or a highly trained physician appointed as medical examiner. Some death investigators work for elected sheriffs who try to avoid controversy or owe political favors. Others own funeral homes and direct bodies to their private businesses.
Overall, it's a disjointed and chronically underfunded system — with more than 2,000 offices across the country that determine the cause of death in about 600,000 cases a year.
"There are some really egregious conflicts of interest that can arise with coroners," said Justin Feldman, a visiting professor at Harvard University's FXB Center for Health and Human Rights.
Belcher's crusade succeeded in changing some aspects of Washington's coroner system when state lawmakers approved a new law last year, but efforts to reform death investigations in California, Georgia, and Illinois have recently failed.
Rulings on causes of death are often not cut-and-dried and can be controversial, especially in police-involved deaths such as the 2020 killing of George Floyd. In that case, Minnesota's Hennepin County medical examiner ruled Floyd's death a homicide but indicated a heart condition and the presence of fentanyl in his system may have been factors. Pathologists hired by Floyd's family said he died from lack of oxygen when a police officer kneeled on his neck and back.
In a recent California case, the Sacramento County coroner's office ruled that Lori McClintock, the wife of congressman Tom McClintock, died from dehydration and gastroenteritis in December 2021 after ingesting white mulberry leaf, a plant not considered toxic to humans. The ruling triggered questions by scientists, doctors, and pathologists about the decision to link the plant to her cause of death. When asked to explain how he made the connection, Dr. Jason Tovar, the chief forensic pathologist who reports to the coroner, said he reviewed literature about the plant online using WebMD and Verywell Health.
The various titles used by death investigators don't distinguish the discrepancies in their credentials. Some communities rely on coroners, who may be elected or appointed to their offices, and may — or may not — have medical training. Medical examiners, on the other hand, are typically doctors who have completed residencies in forensic pathology.
In 2009, the National Research Council recommended that states replace coroners with medical examiners, describing a system "in need of significant improvement."
Massachusetts was the first state to replace coroners with medical examiners statewide in 1877. As of 2019, 22 states and the District of Columbia had only medical examiners, 14 states had only coroners, and 14 had a mix, according to the Centers for Disease Control and Prevention.
The movement to convert the rest of the country's death investigators from coroners to medical examiners is waning, a casualty of coroners' political might in their communities and the additional costs needed to pay for medical examiners' expertise.
The push is now to better train coroners and give them greater independence from other government agencies.
"When you try to remove them, you run into a political wall," said Dr. Jeffrey Jentzen, a former medical examiner for the city of Milwaukee and the author of "Death Investigation in America: Coroners, Medical Examiners, and the Pursuit of Medical Certainty."
"You can't kill them, so you have to help train them," he added.
There wouldn't be enough medical examiners to meet demand anyway, in part because of the time and expense it takes to become trained after medical school, said Dr. Kathryn Pinneri, president of the National Association of Medical Examiners. She estimates there are about 750 full-time pathologists nationwide and about 80 job openings. About 40 forensic pathologists are certified in an average year, she said.
"There's a huge shortage," Pinneri said. "People talk about abolishing the coroner system, but it's really not feasible. I think we need to train coroners. That's what will improve the system."
Her association has called for coroners and medical examiners to function independently, without ties to other government or law enforcement agencies. A 2011 survey by the group found that 82% of the forensic pathologists who responded had faced pressure from politicians or the deceased person's relatives to change the reported cause or manner of death in a case.
Dr. Bennet Omalu, a former chief forensic pathologist in California, resigned five years ago over what he described as interference by the San Joaquin County sheriff to protect law enforcement officers.
"California has the most backward system in death investigation, is the most backward in forensic science and in forensic medicine," Omalu testified before the state Senate Governance and Finance Committee in 2018.
San Joaquin County has since separated its coroner duties from the sheriff's office.
The Golden State is one of three states that allow sheriffs to also serve as coroners, and all but 10 of California's 58 counties combine the offices. Legislative efforts to separate them have failed at least twice, most recently this year.
AB 1608, spearheaded by state Assembly member Mike Gipson (D-Carson), cleared that chamber but failed to get enough votes in the Senate.
"We thought we had a modest proposal. That it was a first step," said Robert Collins, who advocated for the bill and whose 30-year-old stepson, Angelo Quinto, died after being restrained by Antioch police in December 2020.
The Contra Costa County coroner's office, part of the sheriff's department, blamed Quinto's death on "excited delirium," a controversial finding sometimes used to explain deaths in police custody. The finding has been rejected by the American Medical Association and the World Health Organization.
Lawmakers "didn't want their names behind something that will get the sheriffs against them," Collins said. "Just having that opposition is enough to scare a lot of politicians."
The influential California State Sheriffs' Association and the California State Coroners Association opposed the bill, describing the "massive costs" to set up stand-alone coroner offices.
Many Illinois counties also said they would shoulder a financial burden under similar legislation introduced last year by state Rep. Maurice West, a Democrat. His more sweeping bill would have replaced coroners with medical examiners.
Rural counties, in particular, complained about their tight budgets and killed his bill before it got a committee hearing, he said.
"When something like this affects rural areas, if they push back a little bit, we just stop," West said.
Proponents of overhauling the system in Washington state — where in small, rural counties, the local prosecutor doubles as the coroner — faced similar hurdles.
The King County Medical Society, which wrote the legislation to divorce the two, said the system created a conflict of interest. But small counties worried they didn't have the money to hire a coroner.
So, lawmakers struck a deal with the counties to allow them to pool their resources and hire shared contract coroners in exchange for ending the dual role for prosecutors by 2025. The bill, HB 1326, signed last year by Democratic Gov. Jay Inslee, also requires more rigorous training for coroners and medical examiners.
"We had some hostile people that we talked to that really just felt that we were gunning for them, and we absolutely were not," Belcher said. "We were just trying to figure out a system that I think anybody would agree needed to be overhauled."
This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.Photo of the Day | December 26, 2022
In The Know | 9 stories you might have missed in the past week
A summary of our stories from December 20 through 22 readers might have missed. Subscribe to get your daily notification of The Sentinel's latest news and photos here. It's free and unsubscribe any time.
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A summary of our stories from December 18 through 19. Subscribe to get your daily notification of The Sentinel's latest news and photos here. It's free and unsubscribe any time.
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Recipe | Jalapeno Sweetpotato Chowder
1 small onion, 1/4-inch diced
2 tablespoons olive oil
1 quart chicken or vegetable stock
2 cups cooked chicken, cubed
1 1/2 cups whole corn kernels
2 teaspoons minced jalapenos
1/2 cup heavy cream
1 teaspoon salt
chopped scallions, for garnish
How to make it Peel baked sweetpotatoes; discard skin and puree. In soup pot, saute onion in butter until softened. Add pureed sweetpotato and stock, as desired. Bring to boil, reducing liquid slightly. Add chicken, corn, jalapenos, heavy cream and salt. Simmer 10 minutes. To serve, ladle into bowls and garnish with chopped scallions.
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Denied a home loan? Steps you can take to avoid it
Taking care of yourself during the holidays, steps you can take
You may be aware that the more free radicals you have in your body, the more skin damage can accumulate over time. But did you know that exposure can be particularly high during the holiday season? There are a few reasons for this. One is that cooler temperatures are linked to sugar cravings, making sweet treats especially hard to resist at a time of year when there are so many to choose from. Increased sugar intake can boost the production of advanced glycation end products, and ultimately unwanted free radicals. In general, diets high in fat, sugar, and processed foods can contribute to free radical production, as can stress. Fortunately, you can take steps to protect your skin from the inside out during the holidays and beyond. Fernblock PLE (Polypodium leucotomos extract), the natural antioxidant in the dietary supplement Heliocare Daily Use Antioxidant Formula, can help neutralize free radicals and the damage they cause. Dermatologist-recommended, Heliocare aids in eliminating free radicals to help maintain younger-looking, more resilient skin. “Along with the cheer of the season comes skin hazards,” says New York-based dermatologist, Rachel Nazarian, MD. “But the holiday season is the perfect time to gift your skin additional protection from the damaging effects of free radicals. You can do this by incorporating a supplement like Heliocare into your routine in addition to using a topical broad spectrum sunscreen.” To learn more, visit heliocare.com. (These statements have not been evaluated by the Food and Drug Administration. Heliocare is not intended to diagnose, treat, cure or prevent any disease.) Move Daily
Be sure to take time for yourself each day to receive the combined physical and mental health benefits of movement. Head outdoors for a morning or afternoon walk to get some fresh air, improved blood circulation and some mood-boosting sunlight during the short, dark days of winter. To promote agility, flexibility and relaxation, take a few minutes to unwind with some meditation or gentle yoga. Practice Healthy Habits
Holiday office parties and family gatherings often involve indulging in the kinds of food and drink that can leave you feeling more dehydrated, bloated and fatigued than you might normally. Counteract these effects by adopting healthy habits now that you can carry into the new year. Drink plenty of water each day, and incorporate decaffeinated green tea, coconut water or smoothies into your routine for added electrolytes. Likewise, get high-quality sleep each night. It’s especially important to do so if you’re burning the candle at both ends. For better shut-eye, avoid caffeine and blue light exposure before bedtime, and keep your bedroom temperature comfortable and consistent. While it can be hard to set aside time in your schedule when there’s so much to do, a bit of daily self-care is sure to have a restorative effect that helps you refresh, reset and be more focused.
New RF technology can make you look years younger in as little as 10 weeks
Some forms of regenerative medicine involve using the body’s own cells, taking cells from one part of the body and using them to promote healing and rejuvenation where it is needed. This type of regenerative medicine has become a standard option in treating sports injuries, and recent advances have allowed the field to expand to aesthetics, specifically skin tightening and facial rejuvenation.
The EmFace procedure harnesses the body’s own regenerative and healing ability for individuals who want to improve their appearance without surgery. EmFace uses radio frequency to heat up the skin and promote collagen and elastin regrowth. It also uses a patented technology called Hi-Fes which causes a supramaximal contraction of the facial muscles, allowing them to build back.
EmFace is a non-invasive procedure that promotes smoother, tighter skin without needles, fillers, or toxins. For example, EmFace can be used to create a “lateral brow lift” that raises the eyelids for a more energized appearance. The muscle- contracting technology also can improve the appearance of a sagging jawline by strengthening and toning the facial muscles that have weakened over time.
EmFace can also be used concurrently with Botox and fillers as part of a facial rejuvenation plan.
“EmFace is complementary to injectables but many people won’t need injectables or need less” says Dr. Daniel Savarino, director of the Apex Center for Regenerative Medicine in Tinton Falls, N.J., which was the first practice in New Jersey to offer the EmFace procedure.
“During your consultation, we will go over the best path forward for you,” he adds. Advantages of EmFace include:
- Short and sweet. Each EmFace treatment takes 20 minutes, so patients can fit in appointments during a lunch break.
- Simple and safe. No pre-treatment preparations are needed, and there is no post-procedure downtime.
- Speedy results. Data show improvements after four EmFace sessions, and optimal results are evident at 10-12 weeks after the final session.
- Safe and Effective. 20-minute treatments provide an average of 40% wrinkle reduction, 25% lift and 30% rebuilding of the facial muscles.
The noninvasive aspect makes EmFace especially appealing for the holiday season, when no one wants the inconvenience of post-procedure downtime. “Our motto is ‘Don’t Operate . . . Regenerate,” says Dr. Savarino.
Locally, a procedure known as FaceTite is available at Rejuvenis Facial Cosmetic Surgery & Medical Spa in Champaign. Like EmFace, it uses new RF technology to give patients a more youthful appearance.
Photo of the Day | December 24, 2022
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