Thursday, 24 February 2011

SIDS: Nebraska to change guidelines for death investigations

 February 14, 2011  SARAH SCHULZ

Death investigations and coroners’ exams in Nebraska are as varied by county as the deaths themselves.
County attorneys serve as coroners in Nebraska, and there aren’t training requirements established in state statute. But all that is changing because of recent statutes that call for the development of guidelines for uniform and quality death investigations statewide.
Hall County Attorney Mark Young said a subcommittee within the County Attorneys Standards Advisory Council is working on guidelines and training.
“It’s becoming more of an issue,” Young said.
His training for his work as county coroner has consisted of what he has received at seminars, including how to fill out death certificates, determining cause and manner of death and how to gather the necessary information. He believes it will be good to have established standards and he’s glad the Legislature didn’t mandate training without providing funding.
In Hall County, as with many other counties in Nebraska, law enforcement personnel are often the first emergency responders on the scene of an unattended death, homicide, suicide or accident. They are trained in collecting evidence, conducting interviews and investigating the cause of the death, he said. Young is called out to scenes where the cause of death could potentially be criminal.
The county attorneys are also allowed to deputize others to assist with coroner duties. In Hall County, that includes the deputy county attorneys working in Young’s office, he said.
The number of cases the county coroner is involved in each month varies “wildly,” Young said, but, as an example, he said his office signed 26 death certificates/cremation permits in January and ordered one autopsy. He is called out on death investigations as a coroner 15 to 20 times a year on average, but he signs a lot more death certificates that are related to natural causes or medical reasons.
The number of autopsies ordered by the Hall County attorney also varies. Young said he must balance the potential result and necessity with the $2,000 cost to the county. The county has a line item in the general fund for coroner-related expenses and he believed it was currently set at about $44,000. For homicide-related cases, Young tries to take the autopsy costs out of the law enforcement line item he has in his budget in order to “protect the other budgets.”
Autopsies are required by law when the deceased is younger than 19 unless the death was readily recognizable as disease or didn’t occur under suspicious circumstances. The cause of death can’t be certified as sudden infant death syndrome unless an autopsy, a death scene investigation and a review of the child’s medical history reveal no other possible cause, according to state statute.
Young said he orders autopsies when foul play is suspected or the cause of death can’t be determined through the investigation of other facts.
People can request a private autopsy if one has been ordered by the county coroner or law enforcement, and they may retain a pathologist to conduct one, if they choose, he said.
According to an interim study report on the standards and oversight of death investigations in Nebraska, compiled in January 2009 under LB276, the state has no oversight of the county coroner system. The control exists at a local level as county coroners develop their own course of action or policies for death investigations.
Coroners may choose to work with law enforcement to investigate a death. According to the interim study, they can perform the following coroner’s duties or have law enforcement do the same:
n Examine the body at the scene of death or the mortuary.
n Photograph, measure and diagram the scene.
n Collect and document potential evidence.
n Contact the physician of the deceased and obtain the person’s medical history.
n Interview witnesses, family, friends and others.
n Conduct tests on bullets and firearms for evidence.
Buffalo County Attorney Shawn Eatherton said that most of those tasks are left to law enforcement because county attorneys can’t be witnesses in cases that are prosecuted.
Eatherton is on the subcommittee that is working on guidelines and training for county coroners. The group hopes to establish procedures that result in consistency in duties while allowing for flexibility by count. Differences in population, demographics and geography will play into how investigations are conducted, he said.
However, there are certain things that must be looked at in every case, such as the examination of the body and the scene, and interviews with the deceased’s physician, he said.
Eatherton added that autopsies aren’t a “magic bullet” and all the facts of a case must be considered when determining the cause of death.
“Autopsies are just part of the whole picture,” he said.
The checklist being developed by the subcommittee will be an “if, then” list, meaning that if the coroner or law enforcement finds a certain fact, it should be followed by a particular course of action. For example, a fatal traffic accident requires blood draws from those involved, he said.
The state has requested that the guidelines include guidance in determining the need for autopsies, deaths of minors, deaths while in custody, suspicious deaths, entering a death scene, documenting the scene, examining the body, and establishing and recording information.
“The checklist is based on the facts,” Eatherton said. “I’ve looked at the coroners system and the medical examiners system in other states — there is no perfect system. I think we need a blended system to use all our expertise.”

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