DENVER OFFICE OF THE MEDICAL EXAMINER  

  

ANNUAL REPORT 2010      

DENVER OFFICE OF THE MEDICAL EXAMINER 2010 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 ordinance 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.   The Coroner makes all proper inquiry respecting the cause and manner of death of any of the following circumstances.  1.  From external violence, unexplained cause, or under suspicious circumstances;  2.  Where no physician  is  in attendance, or where, though  in attendance, the physician  is 

unable to certify the cause of death;    3.   From thermal, chemical or radiation injury;  4.  From criminal abortion, including any situation where such abortion may have been self 

induced;  5.  From a disease which may be hazardous or contagious or which may constitute a threat 

to the health of the general public;  6.  While  in  the  custody  of  law  enforcement  officials  or  while  incarcerated  in  a  public 

institution;  7.  When death was sudden and happened to a person who was in good health or from an 

industrial accident. 

Colorado Revised Statutes 30‐10‐606 

CORONER  –  INQUIRY‐GROUNDS‐POSTMORTEM‐JURY‐CERTIFICATE OF DEATH  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: From external violence, unexplained cause, or under suspicious circumstances; 

(a) Where no physician is in attendance or where, though in attendance, the physician is unable to certify the cause of death; (b) From thermal, chemical, or radiation injury; (c) From criminal abortion, including any situation where such abortion may have been self‐induced; (d) From a disease which may be hazardous or contagious or which may constitute a threat to the health of the general public; (e) While in the custody of law enforcement officials or while incarcerated in a public institution; (f) When the death was sudden and happened to a person who was in good health; or (g) 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, if he or the district attorney deems it advisable, cause a post‐mortem examination of the body of the deceased to be made by a licensed physician to determine the cause of death. 

(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.  

1. (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.  

2. (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  spiritual means alone  in accordance with  the tenets and practices of a well‐recognized church or religious denomination.  

(6) (a) Notwithstanding  the provisions of  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 

3. (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, addiction counselor, or unlicensed psychotherapist if such report, record, or information is relevant to the inquest or investigation.  

4. (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).  

5. (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).  

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. 

Mission Statement  The Denver Office of  the Medical  Examiner,  as  a  guardian of  the health, safety, and welfare of our community, constantly strives toward the goal of a safer and healthier Denver.    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   

       

2010 Budget Org Chart Office of the Medical Examiner

23 FTE

Chief Medical Examiner/Coroner 1 FTE

Amy Martin, MD

Manager 2, 1 FTE Michelle Weiss-Samaras

Forensic Pathology Fellow, 1 FTE Michael Burson, MD (June 30, 2009)

Joe White (July 1, 2010)

Forensic Pathologist, 2 FTE James Wahe, MD John Carver, MD

Medical Transcriptionist, 2 FTE Glenda Slade Jami Milsap

Administrative Support Supervisor I, 1 FTE

Roberta (Kathy) Blea Coroner Investigator Supervisor,

1 FTE Don Bell

Forensic Autopsy Technician Supervisor, 1 FTE Karen Jazowski

Admin III, 3 FTE Monica Sandoval, Cecelia Albertson, Galena Brown

Coroner Investigator, 7 FTE Ginger Jones, Tracey Balbin-

Montano, Kerrie Cady, Harris Neil, Howard Daniel, Justin Earls, TC

Whitley

CI Duties: Investigate deaths (including scene response), oversee

custody and disposition of medications and evidence, locate and notify next of kin, coordinate

identification activities

Forensic Autopsy Technician, 3 FTE

Barb Criter, Esperanza Ortega, Robert Garner

Duties: Assist performance of autopsies, take x-rays, maintain

autopsy area, evidence and effect handling

Duties: Purchasing, release bodies and effects, prepare official

documents (e.g. death certificates), case reporting (DAWN)

Duties: Oversees investigative activities, coordinates emergency preparedness planning

Duties: Oversees and supports autopsy room operations, perform

autopsy technician duties

Duties: Oversees and support front clerical

staff: supportive role in budget, purchasing, case

reporting (CVDR)

Duties: Transcribe pathology reports, send out tests and reports,

data entry

Duties: Cause and manner of death certification, postmortem exams,

expert testimony, teaching

Duties: Forensic pathology trainees

Duties: Chief Deputy Coroner, Media Liaison, Budget and Director of Administrative and

Investigative Sections. Oversees overall administration and investigative functions

Duties: Division Director, forensic pathologist duties, Program Director

for fellow, Community liaison

 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 well known  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, and many successful pathology  residents  and  forensic  fellows through  the years who continue  to practice forensic pathology throughout the country.  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    

 

   

DENVER OFFICE OF THE MEDICAL EXAMINER  STAFF 2010  

   

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 

 

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. 

 

DENVER OFFICE OF THE MEDICAL EXAMINER INVESTIGATIVE STAFF 2010 

   

    

Donald Bell, Coroner Investigator Supervisor INVESTIGATORS

Tracey Balbin‐MontanoHoward DanielJustin EarlsKerrie Cady

Genevieve JonesHarris NeilT.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 Coroner 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.   The  investigators also investigate hospital, nursing homes and other facility deaths that fall under the  Coroner  statute.    They  are  responsible  for  identification  of  the  decedent, locating and notification of the next of kin and processing some of the evidence, medication, and effects of the decedent.  

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). Again, there can be a great deal of month‐to‐month fluctuation  in the number of scenes although overall the number does not vary greatly and generally averages between  60  and  70  scenes  per month.  2009  saw  a  slight  decrease  overall  as  a trend, although 2010 saw a slight increase trend in scenes.  

   2009 vs. 2010 scene visits

0102030405060708090

100

Num

ber

2009 66 68 87 80 65 47 45 68 62 63 77 622010 71 51 56 57 69 45 51 49 66 82 63 60

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

  

DENVER OFFICE OF THE MEDICAL EXAMINER  FORENSIC AUTOPSY TECHNICIAN STAFF 2010 

  

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 Assistant Medical Examiners and the Chief Medical Examiner.  Staff duties include but are not limited to, preparation of the bodies for autopsy, assisting the medical examiners 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.     

DENVER OFFICE OF THE MEDICAL EXAMINER  ADMINISTRATIVE STAFF 2010 

 

  

Roberta (Kathy) Blea, Administrative Support Supervisor I ADMINISTRATIVE STAFF 

Galena Brown Monica Sandoval 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.  

 

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 College and  the University of Colorado, Denver Campus.   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) accreditation after hire in a coroner or medical examiner’s office.    

FORENSIC AUTOPSY TECHNICIAN INTERNSHIP PROGRAM  OME offers numerous Autopsy Technician internships with the following schools:  University of Colorado Experiential Learning Center, Metropolitan State College at  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.      

DENVER OFFICE OF THE MEDICAL EXAMINER  INTERN STAFF 2010 

 Forensic Autopsy Internship Program – 3 month internship

Kim Johnson  Colorado University BoulderGraduate Anthropology, History, & Russian Studies 

Josh Kniss  Regis University Neuroscience and Psychology minor exercise science 

Elizabeth Empey  University of Colorado Denver Biology Chemistry Pre‐med 

Connie McCormack  Metropolitan State CollegeBiology Major 

Tori Perry  Metropolitan State College Biology Major 

     

 Coroner Investigative Internship Program – One Year Internship

Lara Ward  2009‐2010  University of Colorado at Denver Bachelors Criminal Justice and Sociology  

Alex Raxumovski  2009‐2010  University of Colorado at Denver  Bachelors Criminal Justice minor Sociology  

Justin Stiebel  2009‐2011  University of DenverGraduate School Forensic Psychology 

Ashley Anne Peightal 

2010‐2011  University of DenverGraduate School Forensic Psychology 

Katie Nilsson  2009‐2010  University of Colorado at Denver Graduate School Masters Criminal Justice 

Kate Makkai  2009‐2010  University of Colorado at Denver  Bachelors Forensic Anthropology 

Melanie Gutteau  2010‐2011  Metropolitan State College Bachelors Criminal Justice  

Kayla Wallace  2010‐2011  University of Denver Graduate School Forensic Psychology 

Andrea Raffaut  2010‐2011  University of Denver Graduate School Forensic Psychology 

Stacy Salmon  2009‐2011  University of Colorado at Denver Graduate School Masters Criminal Justice 

Amanda Sapir  2009‐2010  University of Colorado at Denver Bachelors Anthropology 

       

Wesleyan Nebraska ‐ Two Week Site Visit Antoni Stewart  Masters program Forensic Science Michael O’Brien  Masters program Forensic ScienceJonna Grooman  Masters program Forensic ScienceKristin Wiesneski  Masters program Forensic Science

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 

 Two  of  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  and  participate  in clinicopathologic  laboratories.  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 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. 

 

 

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.    

        

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. 

Cheesman Park Irrigation System Upgrade  In 2010, Cheesman Park in central Denver upgraded its irrigation system. Like the Botanic Gardens, Cheesman Park also was built on top of an historical cemetery. During excavation, several historical graves were uncovered. Many of the human bones  represented  only  partial  skeletons,  but  at  least  three  virtually  complete skeletons were uncovered along with several other fairly complete skeletons. OME partnered  with  Dr.  Cathy  Gaither,  Assistant  Professor  of  Anthropology  at Metropolitan State College of Denver to study and document the remains prior to re‐interment  at  Mount  Olivet  Cemetery.  This  was  a  unique  experience  for          Dr. Gaither's students as well as for OME staff.  

  

 

 

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.  

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. 

It's 

COMMUNITY SERVICE

Red Rocks Community College – Michelle Weiss‐

Samaras and Donald Bell  Regis  University  Criminal  Justice  &  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 Montano)  NCRFMC  (North  Central  Region  Fatality Management  Committee  ‐  10  county  region)  ‐ Tracey Montano and Donald Bell  Denver  International  Airport  –  Disaster preparation  –  Michelle  D.  Weiss‐Samaras  and Donald Bell  In  June 2010,  the Denver Office of  the Medical Examiner hosted the FEMA course Mass Fatality Incident  Response.  The  target  audience  of COHEART members numbered 38.   University  of  Colorado  Community  Project  for Alumni and Students – Tracey Montano  Media Liaison – Michelle Weiss‐Samaras  Tours/lectures  out  of  state  –  Nebraska  and Wyoming Colleges – Michelle D. Weiss‐Samaras & Don Bell 

 

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 Montano)  Southern  Institute  of  Forensic  Science  Lecture  – Tracy Montano  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  Notary Public Training – Galena Brown  Recycle Ink Program – Glenda Slade  Green Recycle – DOME staff  INTERDEPARTMENTAL COMMITTEES DEH Safety Committee – James Wahe M.D.  Performance  Evaluation  Review  Committee  – Karen Jazowski   Employee  Recognition  Committee  –  Cecilia Albertson 

 OFFICIAL COMMITTEE APPOINTMENTS  

Colorado Child Fatality Prevention Review  Team ‐ Dr. Amy Martin, Governor Appointee 

 Advisory Board for the Career Technological Education Program, 

 Montbello High School ‐ Michelle Weiss‐Samaras  

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

  

 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‐Montano, 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.   

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.   

     

 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  Drug Abuse Warning Network (DAWN) The Denver Office of the Medical Examiner also provides statistical data to DAWN, and is one of the six counties in Colorado participating.  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. 

 ACADEMIC PRESENTATIONS American Academy of Forensic Sciences 2010 Meeting  Seattle, Washington, Poster presentation  Dr. Michael Burson was the lead investigator in a project the studied the stability of Vitamin D in postmortem blood samples. The results were accepted as a poster presentation at the 2010 Annual Meeting  of  the  AAFS.  Postmortem  vitamin  D  levels may  be  useful  in  working  up potential child abuse deaths where one or more fractures are present.  

Objective: To measure vitamin D in postmortem blood samples using our recently developed liquid chromatography-tandemmass spectrometric (LCMSMS) method. Our current method provides for measurement of the 25-hydroxy derivatives of vitaminD, specifically 25(OH)-D2/D3, (OHD2, OHD3) in human serum. Increasingly, current clinical practice is to measure OHD2 andOHD3 to assess vitamin D nutritional status. To our knowledge, methods have not been evaluated for measuring these analytes inpostmortem samples. The most common assay platform used today is an immunobased assay, which relies on antibodies whichare known to cross-react with many vitamin D metabolites. Such immunobased assays are particularly sensitive to sampleintegrity and it is likely that a postmortem blood sample may not be appropriate due to hemolysis and other postmortem artifacts.Hypothesis: Postmortem (PM) vitamin D concentration, measured with a sensitive and specific assay such as LC-MSMS, willcorrelate well with antemortem (AM) concentrations. Such analysis will be helpful in those cases where antemortem vitamin Dlevels have not been previously measured in the primary care setting. Furthermore, with the recent interest in vitamin Ddeficiency (Rickets) and multiple bone fractures in pediatric deaths, such an assay will, without doubt be of interest.Materials and Methods: For our preliminary studies we selected three recent cases of natural disease. In each case, we sampledperipheral blood (iliac vein) within 24 hours of the time of pronouncement. Approximately 8 ml of peripheral blood was drawninto a red-top tube under gentle pressure to minimize hemolysis. Each sample was allowed to clot at room temperature for 1 hourand then centrifuged for 25 minutes. The serum was then transferred to a clean red-top tube and frozen at -20 C until assayed.Hexa-deuterated OHD2 and OHD3 (OHD2d6 and OHD3d6, Medical Isotopes, Inc.) were used as internal standards (IS).Calibrators were prepared in albumin at 5, 10, 20, 50, 100 and 150 ng/ml for each analyte (OHD2 and OHD3). Samples andcalibrators (500 ul) were spiked with 75 ng IS, extracted in 1 ml ACN and centrifuged. Thirty ul of supernatant was injected into aShimadzu HPLC (70% H2O:30% ACN) at an initial flow rate of 350 ul/min flow and increased to a maximal flow rate of 500ul/min. OHD2 and OHD3 were separated on a C18 column (100 mm x 2.1 mm x 3 um, RESTEK) and then introduced into atriple quadrupole mass spectrometer (ABI 3200 Q-trap) via an APCI source in the positive ion mode. OHD2 and OHD3 wereeluted at 100% ACN over a 9.7 minute run.Results: Preliminary studies addressed whether or not vitamin D analytes are stable in postmortem blood and if so whether theycan be measured with our LC-MSMS method. In each of the samples tested to date, we have successfully and reproduciblydetected and quantitated total vitamin D (OH-D3) in levels ranging from 6.43 ng/ml to 95.3 ng/ml. We are confident in theseresults because we have previously established the level of quantitation (LOQ) of our assay at 5 ng/ml.Summary: We have shown that postmortem blood contains measurable vitamin D and can be accurately measured on our LC-MSMS platform. Our immediate planned studies on adult and pediatric cases include: (1) a direct comparison of hospitaladmission antemortem blood with our 24 hr postmortem blood samples; (2) a direct comparison of plasma and serum samples; (3)a postmortem stability assay to characterize how the postmortem interval affects our ability to accurately measure vitamin D.

Michael A. Burson MD, PhD1,2, John Carver, MD1,2 Jim Wahe, MD1,2, Amy Martin, MD1,2 , Jennifer Puhl3, Geza S. Bodor MD1,3

1University of Colorado Denver, Department of Pathology, Aurora, CO; 2Denver Office of the Medical Examiner, Denver, CO; 3Denver VA Hospital, Denver, CO

Postmortem analysis of vitamin D using liquid chromatography tandem mass spectrometry

I. Using LC-MS/MS methodology, vitamin D (OH-D3) is accurately and reproducibly measurable in postmortem bloodsamples

II. Postmortem OH-D3 levels appear to correlate well with antemortem levels regardless of the type of collection tubewith the exception of Na-Citrate (data not shown)

III. OHD3 is extremely stable (up to 7 days) and thus it is likely that it may be accurately measured several days after theterminal event

IV. Although one outlier is observed (Case 2789), postmortem redistribution of OH-D3 does not appear be significant;thus the sample collection site may not be a limiting factor in those cases where postmortem blood may be limited(pediatric)

V. The clinical encounter must be considered when interpreting postmortem OH-D3 levels because the patient may havebeen fluid resuscitated and/or transfused with blood products.

VI. OH-D2 metabolite was not found in any of our cases therefore its postmortem behavior could not be assessed. Theabsence of OH-D2 in AM or PM samples is not unexpected as it is present in only found in only 15% of all individuals.

References:1. Holik MF (2007) Vitamin D Deficiency. N Engl J Med 357:266-2812. Suskind D (2009) Nutritional Deficiencies During Normal Growth. Ped Clin N Am 56:1035-1053.3. Gordan C et al (2004) Prevalence of vitamin D deficiency among healthy adolescents. Arch Ped Adol Med 158:531-537.

Discussion

Results

Abstract

Qa

ObjectivesOur primary objective is to determine the feasibility and utility of measuring vitamin D in postmortem blood samples. To address this question we’ve outlined four main objectives for this study:

I. To determine if vitamin D is measurable in postmortem blood samples.

II. To determine if postmortem vitamin D level accurately reflects the antemortem level

III. To characterize any postmortem redistribution of vitamin DIV. To characterize the stability of vitamin D in postmortem blood

under “uncontrolled” conditions (room temperature + UV light

Materials and MethodsSample preparation:Postmortem peripheral blood (iliac vein) was collected within 24 hours of the time of pronouncement. Approximately 8 mlof whole blood was collected into a glass, additive free red-top tube and allowed to clot at room temperature for 1 hourand then centrifuged for 25 minutes. The serum was then transferred to a clean red-top tube and frozen at -20 C untilassayed. Hexa-deuterated OHD2 and OHD3 (OHD2d6 and OHD3d6, Medical Isotopes, Inc.) were used as internalstandards (IS). Calibrators were prepared in 3% albumin at 5, 10, 20, 50, 100 and 150 ng/ml for each analyte (OHD2 andOHD3). Samples and calibrators (500 ul) were spiked with 75 ng IS, extracted in 1 ml ACN and centrifuged. Thirty ul ofsupernatant was injected into a Shimadzu HPLC (70% H2O:30% ACN) at an initial flow rate of 350 ul/min flow andincreased to a maximal flow rate of 500 ul/min. Analytes were separated on a C18 column (100 mm x 2.1 mm x 3 um,RESTEK) and then introduced into a triple quadrupole mass spectrometer (ABI 3200 Q-trap) via an APCI source in thepositive ion mode. OHD2 and OHD3 were eluted at 95% ACN over a 9.7 minute run.Data analysis:AM vs. PM study: Samples were injected as duplicates and the results were averaged and expressed as ng/ml.

Redistribution study: PM whole blood (2ml) was collected from the iliac vein (IV), iliac artery (IA; when available), rightatrium (RA) and aorta (Ao). Samples were injected in duplicate and the results were averaged and expressed as ng/ml.

Stability study: Postmortem whole blood from the IV was collected and allowed to set at room temperature and exposed toultraviolet light for up to seven days (T=0-7 days). Each sample was injected in duplicate and then averaged. The IV[OH-D3] was set at 100% and the remaining sites were normalized to this and the results were expressed at % recovery.Linear regression analysis was performed and the results are expressed with -/+ 2SD.

**Low AM level may representResuscitation related dilution

*PM aorta sample was QNS to repeat. This level is likely an artifact.

Introduction

Case Age Race COD MOD

61 49 C Peritonitis N

79 41 C Arrrythmia H

80 41 AA Hanging S

1744 58 H BFI Head A

1855 42 C Heroin A

1944 30 H Hanging S

1975 34 AA Undet. U

2765 57 W C/O EtOH N

2778 63 W GSW S

2789 34 W GSW S

2802 55 W ASCVD N

2806 28 W BFI A

2892 16 W Drug Tox A

2945 12 W Hanging S

Vitamin D is a prohormone that is essential for normal calcium homeostasis and bonedevelopment. Deficiency in vitamin D leads to hypocalcemia and hypophosphatemia, withresultant rickets in children and osteomalacia in adults (1-2). In adults, vitamin D deficiencyhas been linked to cardiovascular disease, insulin resistance, hypertension and otherconditions. With the well-documented worldwide prevalence of vitamin D deficiency in allages it is likely that the forensic community will encounter cases in which knowing vitamin Dlevels may be pertinent to determining the cause and manner of death. It has been reportedthat approximately 50% of Caucasian and non-Caucasian adolescents have vitamin D levelsless than 20ng/ml (3). Current guidelines set vitamin D deficiency at <20 ng/ml and vitaminD insufficiency at <30 ng/ml. . Unfortunately, to date there are no reported studies of vitaminD levels in postmortem blood. Herein, we report the results of our study on postmortemvitamin D analysis.

**

*

This work built on previous work done by Dr. Burson during pathology residency at the University of Colorado School of Medicine and presented at the American Association for Clinical Chemistry in Anaheim, CA. 

 

  

Objective: There is contradictory information regarding vitamin D (VitD) stability in human blood.Our lab used to require collection and transport of samples in dark tubes and storage below –20 C untiltesting. To eliminate the need for these error prone practices we evaluated VitD stability at ambient,refrigerated and frozen temperatures, using no additive (red top, RTT) and gel separator (SST)collection tubes. We also investigated the effect of hemolysis and exposure to fluorescent light on VitDconcentration during storage. Methods: Our in-house LC-MSMS VitD assay uses a Shimadzu binaryHPLC system and AB3200 Q-Trap triple-quadrupole mass spectrometer. 25-OH vitamin D2 (OHD2),25-OH vitamin D3 (OHD3), parent vitamins D2 and D3 and their respective hexa-deuterated internalstandards are separated on a C18 column following protein precipitation. MS analysis is performedusing APCI positive ionization. Run time is 9.7 minutes. Assay measuring range is 5 to 150 ng/mL foreach analyte. Total imprecision is 7% to 11% throughout the AMR range. We used left over serum, orserum from volunteers for our study. Fresh serum was kept at ambient temperature, under fluorescentlight on the bench for up to 24 hours to assess short-term stability. Aliquots were taken at 3, 6, and 24hours and frozen until assayed. Long-term stability of VitD was assessed by comparing result of fresh(T0) samples from RTT to that of the SST serum. Centrifuged samples were left in the SST tubes at 4C for up to 19 days to determine potential absorption of VitD by the gel. Frozen stability was assessedby re-assaying left over samples, kept below –20C for as long as sufficient amount of serum wasavailable for testing. We added increasing amounts of hemolyzed RBC to pooled sera to assessinterference from hemolysis. Each sample was assayed twice. Samples from the short-term stabilityand hemolysis interference studies were analyzed within the same run. Samples from the long-termstability study were extracted and assayed in separate runs, on days when VitD testing was performed.Results: OHD3 concentrations in samples of the short-term study ranged from 5 to 60 ng/mL. Allresults from T0 to T24 hours were within the 2SD range of our method. No statistical differencebetween time points and no trend could be detected within 24 hours of storage. No significantdifference between OHD3 result of RTT and SST serum could be detected at T0. All results from latertime were within assay imprecision. No difference between RTT and SST was found for up to 19 daysbut a slight upward trend in concentration could be observed. Hemolysis (up to 1.2 g/dL hemoglobin)had no effect on VitD concentration. Frozen samples were stable for at least six months. We couldascertain OHD3 stability only because none of the samples contained OHD2.

Michael A. Burson MD, PhD1,3, Jennifer Puhl2 , Geza Bodor MD1,21University of Colorado Denver, Department of Pathology, Aurora, CO; 2Denver VA Hospital, Denver, CO ; 3Denver Office of the Medical Examiner, Denver, CO

25-OH vitamin D is stable in the clinical setting under many different collection and storage conditions

Discussion

Results

Abstract

Q a

Materials and Methods

Ambient conditions stability: Serum was collected in red top tube from 24 volunteers and the tubes were allowed to set at room temperaturewhile exposed to fluorescent light for up to 24 hours. Aliquots were taken at T=0, 3, 6 and 24 hours and frozen until assayed. Each sample wasinjected in duplicate and the results averaged. The concentration at T=0 was assigned 100% and recoveries at the remaining time points werenormalized to this. Results were expressed as % recovery. Linear regression analysis was performed and the results are expressed with +/- 3SD(fig 1).

Additive affect on VitD (RTT vs SST): Whole blood was collected from two volunteers in red to (no additive) and SST collection tubes, centrifuged,and then were allowed to sit at 4 C for up to 19 days. Aliquots were taken at T=0, 2, 5, 6, 8, 12 and 19 days respectively and analyzed for [OHD3and OHD2]. Each sample was injected in duplicate and the results were averaged and expressed in ng/mL (fig. 2)

Hemolysis interference assay: Increasing amounts of RBC hemolyzates were added pooled serum to give final hemoglobin concentrations of0.0, 0.2, 1.2, 2.3, 4.6, 6.9 and 11.6 g/dL. Aliquots of each sample were then taken and analyzed. The 0.0 g/dL hgb sample was designated as100% and the remaining samples were normalized to this and the results were expressed as % recovery. Linear regression analysis wasperformed and the results are expressed with +/- 2 SD (fig. 3).

IntroductionVitamin D is a prohormone that is essential for normal calcium homeostasis and bonedevelopment. Deficiency in vitamin D leads to hypocalcemia and hypophosphatemia,with resultant rickets in children and osteomalacia in adults (1-2). In adults, vitamin Ddeficiency has been linked to cardiovascular disease, insulin resistance, hypertensionand other conditions. With the well-documented worldwide prevalence of vitamin Ddeficiency in all ages the volume of testing has increased dramatically over the recentpast. Thus, in effort to improve the efficiency of our laboratory and decrease the pre-analytic error associated with vitamin D testing we embarked on this study. Specifically,we addressed the following three objectives:

-Is 25-OH vitamin D stable under ambient (RT) conditions- Is 25-OH vitamin D stable when exposed to fluorescent light- Is 25-OH vitamin D stability affected by additives such as the gel in SSTs- Does hemolysis interfere with 25-OH vitamin analysis

Materials and Methods continued

Samples: Serum from study volunteers or from left over clinical samples were utilized forthese studies.

Internal standards (IS): Hexa-deuterated OHD2 and OHD3 (OHD2d6 and OHD3d6) wereobtained from Medical Isotopes, Inc.

Calibrators: Calibrators were prepared in 3% albumin at 5, 10, 20, 50, 100, and 150 ng/mLfor each analyte (OHD2 and OHD3).

Sample preparation: Samples and calibrators (500 ul) were spike with 75 ng IS, extractedin 1 ml of acetonitrile (ACN) and centrifuged. Thirty ul of the supernatant was theninjected into a Shimdazu HPLC at 70% H2O:30% ACN at 350 ul/min flow. Analytes wereseparated on a C18 column (50 mm x 2.1 mm x 3 micron, RESTEK) and then introducedinto a triple quadrupole mass spectrometer (ABI 3200 Q-Trap) via an APCI source inpositive ion mode. The analytes were eluted at 100% ACN over 9.7 minutes.

OH-Vit D (OH-D3) Stability RTT vs. SST. (T= 4C)

Effect of hemolysis on 25 OH Vit D recoveryVitamin D (OH-D3) recovery after storage(RTT, RT, + fluorescent light)

It is well known that vitamin D physiology and metabolism is dependent on UV light exposure. And perhaps this principle perpetuated some of the laboratory protocols regarding the collection and subsequent handling of samples for vitamin D analysis. Our laboratory used to require wrapping the collection tubes in aluminum foil and transferring serum into dark brown sample tubes. These protocols, due to excessive sample handling, may increase the risk of pre-analytic error. In this study we have addressed several parameters (temperature, storage conditions and collection tube additives) to determine whether or not vitamin D (25-OH vit D) is as unstable as once believed.

Based on this study we conclude that:-25-OH vitamin D is stable under ambient (RT) conditions-25 OH vitamin D is stable when exposed to fluorescent light-25-OH vitamin D is not affected by the gel additive in serum separator tubes (SST)-Hemolysis up to 2.3 g/dL does not affect the analysis of 25-OH vitamin D using our In-house LC-MSMS method. Considering clinical samples are typically rejected when gross hemolysis is detected (0.5 g/dL) this result indicates that any degree of hemolysis accepted by a clinical laboratory will be acceptable for our 25-OH vitamin D analysis.

Figure 1. Figure 2. Figure 3.

      

PUBLICATIONS Journal of Forensic Sciences. 2010 November; 55 (6): 1638 – 40. An unusual death involving a sensory deprivation tank. Lann MA, Martin A. 

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. 

                              

      

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.  

     

     

 

PERFORMANCE MEASURES 2010  2010  Identification 

and Notification of Next of Kin within 24 hours 

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  

Non‐Autopsy cause and manner of death certificates provided within 10 days 

Success  88%  70%  73% 92% 92%  84%

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.   

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           3‐5= 1 autopsy. NAME recognizes that physicians with additional administrative duties 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  2010,  OME  physicians  remain  in  compliance  with  NAME  workload requirements, with two physicians barely topping the ideal caseload number.                      

 

ANNUAL STATISTICAL REPORT  2010 TOTAL DEATHS REPORTED (All jurisdictions)  3291               Medical Examiner Cases (Jurisdiction Retained)  1032               Waived Cases (Jurisdiction Waived)  1579                           ( Waived Natural Deaths )   1314                           ( Waived Transferred Jurisdiction )   262               Waived – Declined/Other  3               Inquiries (No jurisdiction determined)                               (Declined – 2)                                 (Request for Assistance ‐ 39)                               (Natural – 639) 

680

Manner of death (ME Cases)  1033           Accident  297           Homicide  41           Suicide  104           Traffic Accidents  54           Undetermined  43

Request for assistance (non‐human bones, skeletal remains, reported asystolic deaths, outside agency assist requested etc.) 

7

           Natural  487Scene visits by ME or ME Investigators  736Bodies transported to office by order of DOME  879External examinations  211Complete autopsies  673Partial autopsies  0Outside autopsy for other jurisdiction  2Chart Review  153Hospital/private autopsies retained under the ME jurisdiction  2Cases where toxicology is performed  606Bodies unidentified after examination  0Organ and tissue releases  104               Percent  100%Unclaimed bodies (Coroner rotation  burials)  18Exhumations  0

 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. 

TOTAL DEATHS REPORTED TO THE DENVER OFFICE OF THE MEDICAL EXAMINER 2010 

 ACCEPTED  (ME) Medical Examiner Case; jurisdiction retained 

1033 (31%)

WAIVED  (W) Reported/Investigated and Released 

1579 (48%)

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

680 (21%)

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

2 (0%)

       

   

Total Deaths Reported to DOME

ME Cases, 1033, 31%

Waived Cases, 1579, 48%

Inquiries, 680, 21%

Outside Cases, 2, 0%

2009 vs 2010 ME cases

0

20

40

60

80

100

120

Num

ber

2009 ME 106 94 101 99 82 70 67 101 89 89 97 942010 ME 96 68 82 86 100 65 82 78 94 110 92 82

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

  The above table graphically depicts the month to month variation in jurisdictional cases handled by OME. Data  from both 2009 and 2010 are  included  to allow  for comparison over multiple years. Trend  lines have also been added  to  show  that trends are relatively stable although the trend in 2009 was for a slight decline over the year, while  in 2010  there was a slight  increase by  the end of  the year  in ME cases.  

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.                Again, although month‐to‐month variations occur, overall  the number of  I  cases over the last two years has remained fairly steady with only a slight increase from the prior year. 

2009 vs. 2010 W cases

0

20

40

60

80

100

120

140

160

Num

ber

2009 W 92 91 118 98 106 113 93 109 107 131 131 127

2010 W 126 132 136 121 131 113 113 123 145 143 142 147

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

2009 vs. 2010 I cases

0

10

20

30

40

50

60

70

80

num

ber

2009 I 66 39 52 48 46 50 60 46 55 51 50 52

2010 I 46 55 52 51 70 70 60 50 51 50 51 62

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

         

2010 DENVER OFFICE OF THE MEDICAL EXAMINER  CASE DISTRIBUTION 

 Total ME Cases by Manner of Death 

Undetermined, 43, 4%

Natural, 487, 47%

Traffic Accidents, 54, 5%

Suicide, 104, 10%

Homicide, 41, 4%

Accident (non-traffic), 297, 29%

Request for Assistance, 7, 1%

MEDICAL EXAMINER CASES ACCEPTED BY MANNER 2010  

Natural Deaths 487

Accident (non‐traffic) 297Homicides 41Suicides 104Traffic Accident 54Undetermined 43Request for Assistance 6

487 (47.18%)297 (28.77%)41 (3.97%)

104 (10.07%)

54 (5.23%)43 (4.16%)

6 (0.67%)

Natural Deaths

Accident (non-traffic)Homicides

SuicidesTraffic Accidents

UndeterminedRequest for Assistance

ME Cases Accepted By Manner

                         

 

 NATURAL DEATH ALL ME CASES, BY EXAMINATION AND RACE   

Category  White  Black  Hispanic AsianNative 

AmericanOther/

Unidentified Race TotalAutopsies  166  41  53 3 4 1  268External Examinations  125  34  23 2 2 0  186Initial External & Later Autopsy  0  1  1 0 0 0  2Chart Reviews  21  5  4 0 0 1  31Total  312  81  81 5 6 2  487  

Natural Deaths by Examination and Race

Black15%

Hispanic20%

White63%

Asian 1%

Other 0

%

Native American

1%

 NATURAL DEATHS BY AGE AND SEX  ALL MEDICAL EXAMINER CASES 2010 

 Age  Male Female TOTAL

0‐10 years  4 4 811‐20 years  2 0 221‐30 years  9 3 1231‐40 years  20 11 31

41‐50 years  40 16 5651‐60 years  87 36 12361‐70 years  73 26 99

71‐80 years  54 29 8381‐90 years  27 32 5991 + years  5 9 14TOTAL  321 166 487

Natural Deaths By Age and Sex

40

311

16

29

9

7387

52720

4 2 9

54

32

26

4 0

36

0-10years

11-20years

21-30years

31-40years

41-50years

51-60years

61-70years

71-80years

81-90years

91 +years

Male Female

NATURAL DEATH ALL ME CASES, BY CATEGORY and RACE 

Category  White  Black Hispanic AsianAmerican 

Indian  Other TOTALCardiovascular  187  50 35 3 3  1 279Complications of ETOH  35  2 15 1 1  0 54Metabolic/Diabetes  11  5 6 0 1  0 23Respiratory/COPD  34  6 9 0 0  0 49Infectious Disease  13  4 3 0 0  0 20Neoplastic  14  8 2 0 1  0 25Other  19  6 10 1 0  1 37TOTAL  313  81 80 5 6  2 487

0 50 100 150 200

Cardiovascular

Complications of ETOH

Metabolic/Diabetes

Respiratory/COPD

Infectious Disease

Neoplastic

Other

Natural Deaths by CATEGORY and RACE

White Black Hispanic Asian American Indian Other

 NATURAL DEATH ME Cases by AGE and RACE  

 Age  White  Black  Hispanic Asian American Indian  Other TOTAL0‐10 years  1  5  1 0 0  1 811‐20 years  0  1  0 0 1  0 221‐30 years  10  0  1 1 0  0 1231‐40 years  16  5  7 0 3  0 3141‐50 years  33  8  13 2 0  0 5651‐60 years  81  20  22 0 0  0 12361‐70 years  60  19  19 0 1  0 9971‐80 years  53  17  11 0 1  1 8381‐90 years  49  4  5 1 0  0 5991 + years  10  2  1 1 0  0 14TOTAL  313  81  80 5 6  2 487       

Natural Deaths By AGE and RACE

0

20

40

60

80

100

White Black Hispanic Asian AmericanIndian

Other

Age

0-10 years 11-20 years 21-30 years 31-40 years 41-50 years51-60 years 61-70 years 71-80 years 81-90 years 91 + years

  

  

  

     

Natural Deaths by CATEGORY And SEX, Autopsy Cases Only

37.1%

13.7%8.1%

2.9% 2.2% 3.3% 2.6%5.2%

12.2%

3.7% 4% 2.9%0% 1.4%

CARDIOVASCULAR

COMPLICATIONS OF ETOH

RESPIRATORY

INFECTIOUS DISEASE

NEOPLASTIC

METABOLIC/DIABETES

OTHER

MaleFemale

 NATURAL DEATHS BY CATEGORY/SEX  AUTOPSY CASES ONLY

CATEGORY  Male Female  TotalASCVD, NOS  61 17  78Myocardial Infarction/CAD  6 1  7Stroke  7 6  13HTN  10 5  15Aortic Aneurysm  5 1  6Berry Aneurysm  0 0  0Cardiomyopathy  6 3  9Myocarditis  0 0  0Other  5 0  5TOTAL CARDIOVASCULAR  100 33  133   COMPLICATIONS OF ETOH  37 10  47   COPD & Emphysema  9 2  11Interstitial Lung Disease  0 1  1Asthma  1 2  3Pulmonary Embolus  6 4  10Pneumonia/Bronchitis  5 1  6Other  1 1  2TOTAL RESPIRATORY  22 11  33   Pneumonia  6 4  10Meningitis/Encephalitis  0 0  0TB  1 0  1HIV/AIDS  0 0  0Other  1 0  1TOTAL INFECTIOUS DISEASE  0 4  4   NEOPLASTIC  6 0  6METABOLIC/DIABETES  9 4  13OTHER  7 14  21   TOTAL ALL   189 80  269

Undetermined Manner of Death 2010 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  or  the  inability  to  obtain  sufficient information for a variety of reasons. 

CAUSE OF DEATH  Toxin  Trauma Unknown/Other SUDI  TOTALAutopsy  9  7 19 5  40External Exam  0  0 1 0  1Chart Review  0  1 1 0  2TOTAL  9  8 21 5  43                   

Undetermined Manner of Death 2010

Autopsy, 40, 93%

Chart Review, 2,

5%External

Exam, 1, 2%

Undetermined Manner of Death by METHOD

9, 22%

7, 18%19, 47%

5, 13%

Toxin Trauma Unknown/Other SUDI

UNDETERMINED BY AGE and SEX Age  Male Female  TOTAL0‐10 years  5 6  1111‐20 years  1 0  121‐30 years  2 0  231‐40 years  5 1  641‐50 years  7 3  1051‐60 years  5 4  961‐70 years  1 0  171‐80 years  0 2  281‐90 years  0 0  091 + years  0 0  0Unknown age/sex    1TOTAL  26 16  43 

  Undetermined by AGE and SEX

1

5

1

5

2

7

5

1

0 0 0

6

0 0

3

4

0

2

0 0

0-10years

11-20years

21-30years

31-40years

41-50years

51-60years

61-70years

71-80years

81-90years

91 +years

Uknownage/sex

Male Female

UNDETERMINED BY AGE and METHOD  

Age  Toxin  TraumaUnknown/

Other SUDI  TOTAL TOTAL % BY AGE

0‐10 years  1  1 5 5  12  27.911‐20 years  0  1 0 0  1  2.321‐30 years  0  2 0 0  2  4.631‐40 years  1  0 5 0  6  13.941‐50 years  4  1 5 0  10  23.251‐60 years  3  2 4 0  9  20.961‐70 years  0  0 1 0  1  2.371‐80 years  0  1 1 0  2  4.681‐90 years  0  0 0 0  0  091 + years  0  0 0 0  0  0TOTAL  9  8 21 5  43 TOTAL % BY METHOD  20.9  18.6 48.8 11.6                 

00.5

11.5

22.5

33.5

44.5

5

Toxin Trauma Unknown/Other SUDI

Undetermined by AGE and METHOD

0-10 years 11-20 years 21-30 years 31-40 years 41-50 years51-60 years 61-70 years 71-80 years 81-90 years 91 + years

UNDETERMINED BY AGE and RACE  

Age  White  Black  Hispanic AsianAmerican 

Indian Other  Unknown TOTAL0‐10 years  4  4  3 0 0 0  1 1211‐20 years  1  0  0 0 0 0  0 121‐30 years  1  0  1 0 0 0  0 231‐40 years  3  2  1 0 0 0  0 641‐50 years  5  3  0 0 2 0  0 1051‐60 years  6  1  2 0 0 0  0 961‐70 years  0  1  0 0 0 0  0 171‐80 years  1  1  0 0 0 0  0 281‐90 years  0  0  0 0 0 0  0 091 + years  0  0  0 0 0 0  0 0TOTAL  21  12  7 0 2 0  1 43

  

  

          

 

0123456

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

Undetermined by AGE and RACE

White Black Hispanic Asian American Indian Other Unknown

SUDDEN UNEXPECTED DEATHS IN INFANCY (SUDI) 2010 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  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. 

SUDI by AGE and SEX

Male 0 1 1 0 0Female 1 0 0 1 1

1 month 2 months 4 months 5 months > 6 months

SUDI by RACE and SEX

Hispanic 0 1Black 1 1White 1 1

Male Female

  

             Morning (8:01 am

- 12:14 pm)Afternoon (12:15

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

Female, 3Female, 0 Female, 0

Male, 0 Male, 0 Male, 2

SUDI By SEX and TIME OF DAY

SUDI By SEX and MONTH OF DEATH

1 11 1 1

January

February

March

April

May

June Ju

ly

August

September

October

November

December

MaleFemale

 

 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  files  to help solve these crimes. 

homicides 2005-2010

0

10

20

30

40

50

60

70

homicides 60 60 56 55 48 41

2005 2006 2007 2008 2009 2010

 

  

Homicides by RACE and SEX

-5

0

5

10

15

Female 0 1 1 0 2 0Male 0 12 14 0 10 1

Race: Asian Black Hispanic American Indian White Other

10

4

1

9

2

11

0

5

0

4

010

2

0 0 10 0

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

2010 Homicides by AGE and SEXMaleFemale

Homicides by RACE and SEX

-5

0

5

10

15

Female 0 1 1 0 2 0Male 0 12 14 0 10 1

Race: Asian Black Hispanic American Indian White Other

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 detective in OME homicide deaths. More than one drug was present in almost 20% of cases. Over half or 63% had at least one drug documented. 34% had ethanol present. In all of these victims the level was over the legal limit of greater than or equal to .08% as defined in Colorado statute.  Sunday was the most likely day to die from homicide. Most victims were between 

the ages of 21 and 40 years of age. 

Homicides by SEX and RACE with DRUGS    SEX  RACE 

DRUGS  Male  Female  White Black Hispanic Asian American Indian  Other TOTAL

Negative/Not Available  13  2  5 5 4 0  0 1 15Cocaine/Metabolites  3  0  0 1 2 0  0 0 3Heroin  0  0  0 0 0 0  0 0 0Methamphetamine  1  0  1 0 0 0  0 0 1THC  11  1  4 6 2 0  0 0 12Morphine  0  0  0 0 0 0  0 0 0LSD  0  0  0 0 0 0  0 0 0Pseudoephedrine  0  0  0 0 0 0  0 0 0Other  2  0  0 0 2 0  0 0 2Multiple Drugs  7  1  2 1 5 0  0 0 8TOTAL  37  4    41 

   

Homicides by RACE with DRUGS

0

1

2

3

4

5

6

7

Whit

eBlac

k

Hispan

icAsia

n

America

n Ind

ianOthe

r

Negative/Not AvailableCocaine/MetabolitesHeroinMethamphetamineTHCMorphineLSDPseudoephedrineOtherMultiple Drugs

Homicides by SEX and RACE with ALCOHOL  

Blood Alcohol  SEX  RACE

  Male  Female  White Black Hispanic AsianAmerican 

Indian  Other TOTALNot Done/Negative  23  4  10 12 5 0 0  1 28Less than 0.050%  0  0  0 0 0 0 0  0 00.051% ‐ 0.1%  0  0  0 0 0 0 0  0 00.101% ‐ 0.150%  5  0  2 0 3 0 0  0 50.151% ‐ 0.2%  4  0  0 1 3 0 0  0 40.201% ‐ 0.25%  2  0  0 0 1 0 0  0 20.251% ‐ 0.3%  2  0  0 0 2 0 0  0 20.301% ‐ 0.350%  1  0  0 0 1 0 0  0 1> 0.351%  0  0  0 0 0 0 0  0 0TOTAL  37  4      41  

Homicides by RACE involving Alcohol

0 2 4 6 8 10 12 14

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%

White Black Hispanic Asian American Indian Other

                

Homicides by Time of Day  Female Male TOTALTime of Day 12:01 AM - 6:00 AM 1 15 166:01 AM - NOON 1 6 712:01 PM - 6:00 PM 1 6 76:01 PM - MIDNIGHT 1 10 11TOTAL 4 37 41 

Homicides by Day of the Week

02468

1012

MaleFemale

Male 10 7 7 6 0 6 1Female 0 2 0 0 1 1 0

Sunday Monday Tuesday Wednesd Thursday Friday Saturday

Male6:01 PM ‐ MIDNIGHT, 

10

12:01 PM ‐ 6:00 PM, 6

12:01 AM ‐ 6:00 AM, 15

6:01 AM ‐ NOON, 6

Female6:01 PM ‐ MIDNIGHT, 

1

12:01 AM ‐ 6:00 AM, 1

6:01 AM ‐ NOON, 1

12:01 PM ‐ 6:00 PM, 1

                      Homicides by AGE and RACE

0

2

4

6

8

10

12

Other 0 0 0 0 1 0 0 0 0 0American Indian 0 0 0 0 0 0 0 0 0 0Asian 0 0 0 0 0 0 0 0 0 0Hispanic 0 2 4 6 2 0 1 0 0 0Black 0 2 5 3 0 2 0 1 0 0White 1 1 2 2 2 2 0 1 1 0

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 METHOD

0 2 4 6 8

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

Sharp Force Injury 0 1 3 1 0 0 0 0 0 0GSW 0 4 6 7 4 3 1 1 1 0Combo/Other 0 0 0 2 0 1 0 0 0 0Blunt Injury 1 0 1 1 1 0 0 1 0 0Asphyxia 0 0 1 0 0 0 0 0 0 0

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

                   

Asph

yxia

Blun

t Inj

ury

Com

bo/O

ther

GSW

Shar

p Fo

rce

Inju

ry

Male, 1Female, 0

Male, 4

Female, 1

Male, 3Female, 0

Male, 24Female, 3

Male, 5Female, 0

Homicides by SEX and METHOD

0

10

20

30

40

Homicides - Examinations

Male 36 0 1

Female 4 0 0

Autopsies External Examinations Chart Review

Homicides by Setting and Sex  

  Female Male  TOTALOut of State  0 0  0Resident of Another  1 6  7Residence  2 9  11Road  0 0  0Parking Lot (work)  0 0  0Alley  0 2  2Apartment  0 0  0Car  0 4  4Nightclub  0 0  0Field  0 0  0Outside Area  0 1  1Outside Home  1 3  4Outside Restaurant  0 0  0Inside Restaurant  0 0  0Parking Lot  0 1  1Public Place  0 0  0Sidewalk  0 2  2Store  0 1  1Street  0 3  3Unknown  0 3  3Workplace Site  0 1  1Yard  0 0  0Detention Facility  0 1  1TOTAL  4 37  41

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  upwards  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.   

 

Suicides 2005-2010

0

20

40

60

80

100

120

number of suicides 97 79 102 95 99 104

2005 2006 2007 2008 2009 2010

Fem

ale

Mal

e

AutopsyExternal

Exam

ChartReview

0 001

25

78

Suicide ‐ Examinations

Autopsy 25 78

External Exam 0 1

Chart Review 0 0

Female Male

 TOTAL PERCENTAGE:    99.03%  AUTOPSIES 

              0.96%     EXTERNALS (Method – Hanging) 0%   CHART REVIEWS  

  

Suicides by AGE and RACE      SUICIDES  Year 2009   Race      Female  Male    Total      

Black      1    5    6  Hispanic    1    7    8    American Indian  0    0    0  White      19    63    82  Asian      1    2    3 

 

0

5

10

15

20

25

White 0 2 12 13 20 20 7 0 3 0Black 0 0 2 2 2 2 2 0 0 0Hispanic 0 0 6 2 5 0 2 0 0 0Asian 0 0 0 0 0 0 0 0 0 0American Indian 0 0 0 0 1 0 0 0 0 0Other 0 0 1 0 0 0 0 0 0 0

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

       

Suicide by SEX and MARITAL STATUS

7164

20

12

38

0

2

2

3

Female Male

WidowedUndeterminedSingleMarriedDivorced

Suicide by AGE and SEX

0

0

16

12

22

16

10

0

3

0

0

2

5

5

6

5

2

0

0

0

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

MaleFemale

SUICIDES BY METHOD AND AGE  

  Alcohol  Gunshot  HangingJumped 

from Height  OtherOverdose/ 

Toxic Sharp Force  TOTAL

Age                 

0‐10 years  0  0  0 0 0 0  0 0

11‐20 years  0  0  2 0 0 0  0 2

21‐30 years  0  6  8 1 3 3  0 21

31‐40 years  0  2  11 0 2 2  0 17

41‐50 years  0  4  10 2 1 11  0 28

51‐60 years  0  11  5 1 0 4  1 22

61‐70 years  0  7  3 0 0 1  0 11

71‐80 years  0  0  0 0 0 0  0 0

81‐90 years  0  2  0 1 0 0  0 3

91 + years  0  0  0 0 0 0  0 0

TOTAL  0  32  39 5 6 21  1 104

  

          

0 2 4 6 8 10 12

Alcohol

Gunshot

Hanging

Jumped from Height

Other

Overdose/Toxic

Sharp Force

Suicides by METHOD and AGE

0-10 years 11-20 years 21-30 years 31-40 years 41-50 years51-60 years 61-70 years 71-80 years 81-90 years 91 + years

SUICIDE INFORMATION /  RISK FACTORS  

Note Left  32Previous Threats/Attempts 48Prior Suicide in Family 3Loss of Loved One  11Financial  15Marital/Relationship Problems  31Illness/Self  23Legal/Disciplinary Problems 10Drug/Alcohol Problems 38Unknown/Multiple Factors 6

Suicide Information-Risk Factors

15%

21%

1%5%

7%14%

11%

5%

18%

3%

Note Left

PreviousThreats/AttemptsPrior Suicide in Family

Loss of Loved One

Financial

Marital/RelationshipProblemsIllness/Self

Legal/DisciplinaryProblemsDrug/Alcohol Problems

Unknown/MultipleFactors

  

    

   

       

05

10

15

20

Suicides by Days of the Week

Female 4 4 4 4 4 1 4Male 8 10 17 12 9 13 10

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Suicides by Time of Day

0

5

10

15

20

25

30

Female 1 6 10 8

Male 6 23 24 26

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

     

Suicide Settings  

  Female Male  TOTALAlley  1 1  2Assisted Living Facility  0 1  1Bus Station   0 1  1Car  2 2  4Cellar  0 1  1Detention Facility/Jail  1 3  4Detox Center  0 1  1Garage  1 8  9Group Home  0 1  1Highway/Roadway  1 1  2Hotel/Motel  2 6  8Other's Residence  0 2  2Outside Home/Apartment  0 3  3Outside Other's Home/Apartment  0 1  1Parking Garage  1 1  2Religious Facility (Inside or Outside)  0 1  1Residence/Home  15 42  57Residence/Apartment  1 1  2Train/Light Rail Tracks  0 2  2TOTAL  25 79  104

 

     

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.  OME would like to thank Bruce Mendelson, senior data consultant for the DODS, for his tireless work in pulling out the mortality data. 

2004 – 2010  Drugs Contributing to Cause of Death  

Including Accidents, Suicides, and Undetermined Manner   2004  2005  2006  2007  2008  2009  2010   n  %  n  %  n  %  n  %  n  %  n  %  n  % Cocaine  58  38.4  82  48.2 85 50.3 75 39.7 60 8.3  53  25.6 41 27Morphine  57  37.7  60  35.3 64 37.9 43 22.8 48 22.6  26  12.6 18 11.8Alcohol  60  39.7  44  25.9 65 38.5 66 34.9 75 35.4  72  34.8 52 34.2Codeine  25  16.6  36  21.2 36 21.3 18 9.5 19 9.0  11  5.3 3 2.0Heroin  6  4.0  18  10.6 17 10.1 18 9.5 27 12.7  49  23.7 35 23Methadone  43  8.6  17  10.0 16 9.5 14 7.4 15 7.1  15  7.2 11 7.2Oxycodone  6  4.0  12  7.1 7 4.1 38 20.1 33 15.6  48  23.2 24 15.8Methamphetamine  7  4.6  12  7.1 9 5.3 12 6.3 15 7.1  10  4.8 14 9.2Acetaminophen  9  6.0  11  6.5 2 1.2 14 7.4 13 6.1  4  1.9 8 5.3Diazepam  11  7.3  10  5.9 11 6.5 19 10.1 16 7.5  23  11.1 19 12.5Alprazolam  3  2.0  10  5.9 5 3.0 13 6.9 15 7.1  20  9.7 12 7.9Hydrocodone  4  2.6  7  4.1 10 53.9 8 4.2 22 10.4  18  8.7 10 6.6Diphenhydramine  2  1.3  7  4.1 1 0.6 11 5.8 11 5.2  3  1.4 9 5.9Clonazepam  0  0  2  1.2 0 0 1 .5 4 1.9  8  3.9 7 4.6Fentanyl  2  1.3  3  1.8 3 1.8 5 2.6 5 2.4  13  6.3 5 3.3Decedents*  151    170  169 189 212   207  152Source:  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 

2004-2010 Drugs Contributing to Cause of DeathIncluding Accidents, Suicides, and Undetermined

020406080

100

2004 2005 2006 2007 2008 2009 2010

Cocaine Morphine Alcohol CodeineHeroin Methadone Oxycodone MethamphetamineAcetaminophern Diazepam Alprazolam HydrocodoneDiphenhydramine Clonazepam Fentanyl

 

   

  

 

Accidents - Examinations

0

20

40

60

80

100

120

140

Autopsies 18 19 3 1 126 9External Examination 2 3 0 0 3 2Chart Review 4 101 0 0 3 3

Asphyxia/drowning Falls Fire Motor

VehicleOverdose

/toxic Other

Accidents by CATEGORY and AGE

0

1020

30

4050

60

Asphyxia/drowning 6 0 1 2 5 5 0 3 2 0Falls 1 1 1 1 7 7 8 21 52 24Fire 0 0 0 0 0 2 1 0 0 0Motor Vehicle 0 0 0 1 0 0 0 0 0 0Overdose/toxic 0 1 25 33 39 27 6 1 0 0Other 0 0 1 0 3 5 0 2 2 1

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

  

                 

020406080

100

Accidents by CATEGORY and SEX

Male 14 63 1 1 95 8Female 10 60 2 0 37 6

Asphyxia/drowning Falls Fire Motor

VehicleOverdose/

toxic Other

Accidents by SEX and MARITAL STATUS

Common Law

Divorced

Married

Single

Unknown

Widowed

Female 0 23 27 20 5 40Male 1 33 48 69 9 22

Common Law Divorced Married Single Unknown Widowed

           

Accidents by SEX and AGE  

  Male Female  TOTAL0‐10 years  4 3  711‐20 years  1 1  221‐30 years  21 7  2831‐40 years  27 10  3741‐50 years  40 14  5451‐60 years  31 15  4661‐70 years  9 6  1571‐80 years  15 12  2781‐90 years  27 29  5691 + years  7 18  25TOTAL  182 115  297  

43

11

21

7

27

10

40

14

31

15

96

15

1227

29

7

18

0-10years

11-20years

21-30years

31-40years

41-50years

51-60years

61-70years

71-80years

81-90years

91 +years

Accident by SEX and AGE

FemaleMale

Accidents by AGE and RACE 

  Asian  Black  Hispanic American Indian White   Other TOTAL0‐10 years  0  4  2 0 1  0 711‐20 years  0  0  0 0 2  0 221‐30 years  0  2  5 1 20  0 2831‐40 years  0  4  3 1 29  0 3741‐50 years  0  3  14 1 36  0 5451‐60 years  0  7  7 0 32  0 4661‐70 years  0  2  2 1 10  0 1571‐80 years  0  2  6 0 19  0 2781‐90 years  2  3  2 0 48  1 5691 + years  1  1  1 0 22  0 25TOTAL  3  28  42 4 219  1 297     

Accidents by RACE and AGE

0102030405060

0-10years

11-20years

21-30years

31-40years

41-50years

51-60years

61-70years

71-80years

81-90years

91 +years

Asian Black Hispanic American Indian White Other

Accidents by Setting and Sex  

  Male Female TOTALAlley  4 0 4Assisted Living/Nursing Home  14 22 36Auditorium  1 0 1Baseball Park  0 1 1Bus/Bus Stop  1 1 2Business/Store/Restaurant  4 1 5Car  2 1 3Daycare   1 0 1Garage  1 0 1Halfway House  1 0 1

Health Care Facility/Hospital  5 2 7Highway/Roadway  2 0 2Hospice  0 1 1Hotel/Motel  9 2 11Other's Residence  4 3 7Outside Area/Park  5 1 6Outside Business  1 1 2Outside Home/Apartment  5 2 7Parking Lot  5 1 6Playground  1 0 1Pool  1 0 1Rehabilitation Facility  1 0 1Residence/Home  83 66 149Residence/Apartment  3 1 4River/Lake  4 0 4Sidewalk  1 1 2Ski Resort  1 1 2Social Club  1 0 1Street  2 0 2Train/Light Rail Tracks  1 0 1Unknown  16 7 23Vacant Building/Resident  2 0 2TOTAL  182 115 297

ta 

3612

1230

Traffic Accidents - Examinations

Autopsy 30 12External Examination 2 1

Chart Review 6 3

Male Female

 TOTAL PERCENTAGE: 

73.91%  AUTOPSIES 8.7%   EXTERNALS  17.39%   CHART REVIEWS               

 

0 10 20 30 40

Male

Female

Chart Review 6 3

External Examination 2 1

Autopsy 30 12

Male Female

1

5

16

19

1

0

0

0

3

0

2

7

0

0

0Asian

Black

Hispanic

White

Other

Autopsy 1516191

External Examination 00030

Chart Review 00270

AsianBlackHispanicWhiteOther

 

TRAFFIC FATALITIES by SEX and AGE  

  Male Female  TOTAL0‐10 years  3 0  311‐20 years  6 1  721‐30 years  6 4  1031‐40 years  1 2  341‐50 years  5 2  751‐60 years  5 1  661‐70 years  1 3  471‐80 years  7 1  881‐90 years  4 2  691 + years  0 0  0TOTAL  38 16  54                

Male

3

6

6

15

5

1

7

4 00-10 years11-20 years21-30 years31-40 years41-50 years51-60 years61-70 years71-80 years81-90 years91 + years

Female

0 1

4

22

1

3

1

2 00-10 years11-20 years21-30 years31-40 years41-50 years51-60 years61-70 years71-80 years81-90 years91 + years

Traffic Accidents by Time of Day  

  Male Female  TOTAL12:01AM to 6:00 AM  9 5  1412:01 PM to 6:00 PM  5 11  166:01 AM to Noon  3 6  96:01 PM to Midnight  3 12  15TOTAL  20 34  54       

Traffic Accidents by Days of the Week

0

5

10

15

Female 2 2 1 3 0 4 4

Male 11 3 3 3 6 5 7

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Male Female

12:01AM to 6:00 AM12:01 PM to 6:00 PM6:01 AM to Noon6:01 PM to Midnight

Vehicle Position – All Traffics  

  Male Female  TOTALDriver  10 6  16Passenger  3 6  9Bicycle  2 0  2Pedestrian  10 1  11Unknown  0 2  2Moped  2 0  2Motorcycle  5 1  6Skate Board  1 0  1Struck by Lightning in vehicle  1 0  1Vehicle/Fixed object  4 0  4TOTAL  38 16  54 

Toxicology Done:    Total  28  tested  for  both  drugs  and  alcohol. One  drug  screen only.  

0

5

10

15

20

25

30

35

40

Male Female

Driver PassengerBicycle PedestrianUnknown MopedMotorcycle Skate BoardStruck by Lightning in vehicle Vehicle/Fixed object

 AT FAULT DRIVERS  Blood alcohol/drugs  Totals  No toxicology ordered  4  Negative  3  BAC Range 0 ‐ .204%  1  THC & Benzodiazepines  1  Opiates  1  Methamphetamine/Amphetamine 1Total At‐Fault Drivers  11  PEDESTRIANS  Blood alcohol/drugs  Totals  No toxicology ordered  4  Negative  3  BAC Range 0 ‐ .357%  2  Alcohol & THC  1  Benzodiazepines & Opiates 1Total Pedestrian – Traffic Accidents 7  BICYCLISTS Blood alcohol/drugs  Totals  Negative  1  Alcohol & THC  1Total  Bicyclist – Traffic Accidents 2  

MOTORCYCLE  Blood alcohol/drugs  Totals  No toxicology ordered  4  Negative (Drugs Only)  2  Negative (ETOH)  2  BAC Range 0 ‐ .220%  2  THC  1Total Motorcycle Accidents  11

      

0

2

4

6

8

10

12

14

Blood Alcohol by RACE

Not done/Not available 1 0 1 11 14 0Negative 0 0 4 3 10 0Less than 0.050% 0 0 0 0 2 00.051 - 0.100% 0 0 0 0 0 00.151 - 0.200% 0 0 0 2 3 00.201 - 0.250% 0 0 0 1 0 10.251 - 0.300% 0 0 0 0 0 00.301 - 0.350% 0 0 0 0 0 0> 0.351% 0 0 0 1 0 0

Asian American Indian Black Hispanic White Other

Blood Alcohol by SEX

0

2

4

6

8

10

12

14

16

18

Male 16 14 1 2 2 2 0 0 1Female 10 4 1 0 1 0 0 0 0

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%

Traffic Accidents, Detected Drugs by SEX and RACE  

DRUGS  SEX  RACE TOTAL

  Male   Female  White Black Hispanic AsianAmerican 

Indian  OtherNot Done/Available  15  10  14 1 9 1 0  0 25

Not Significant/Negative  14  4  9 4 4 0 0  1 18Methamphetamine 

/Amphetamine  0  1  0 0 1 0 0  0 1THC  4  1  3 0 2 0 0  0 5

Morphine  1  0  1 0 0 0 0  0 1Multiple Drugs  4  0  2 0 2 0 0  0 4

TOTAL  38  16  29 5 18 1 0  1 54  

Male

Female

4

01

0

4

10

1

14

4

15

10

Detected Drugs by SEX

Not Done/AvailableNot Significant/NegativeMethamphetamine/AmphetamineTHCMorphineMultiple Drugs

Detected Drugs by RACE

14

1

9

1

9

4 4

11

32

12 2

0

White Black Hispanic Asian AmericanIndian

Other

Not Done/Available

Not Significant/Negative

Methamphetamine/Amphetamine

THC

Morphine

Multiple Drugs

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.              

 

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.