Death investigations rise in 2018 in Lenawee County with fentanyl a growing factor in drug deaths – News – The Daily Telegram – Adrian, MI

ADRIAN — At the beginning of every year, Sarah Palmani, the office manager of the Lenawee County Medical Examiner’s office, collects the statistics that she has fastidiously kept over the previous year of all the unexpected deaths in the county.

In 2018, the office responded to 244 cases, which is a record for the small office of about 17 employees — all but one of whom are paid-on-call. The number is 40 more than in 2017. Palmani’s chart, which goes back to 1999 when she began working for the office, shows the number remaining steady for a number of years in the low 100s, but then starting to trend up beginning in 2012.

The medical examiner’s office investigates unexpected deaths, which are either sudden, violent or suspicious.

Deaths in Lenawee
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When emergency personnel arrive at the scene of a death, a medical examiner investigator (MEI) is called, who gathers information from evidence at the scene as well as inspecting the dead body and speaking to family members or witnesses. That information is relayed to the county’s chief medical examiner, Dr. Bader Cassin, who makes a determination if the body can be released to family members or an autopsy needs to be performed.

The MEIs attempt to contact the primary care physician of the deceased to find out the person’s medical history. If it’s determined that the death was caused from natural causes, the physician would sign the death certificate. If there is no doctor but it is still a natural death, the office also can sign the death certificate.

All homicides, accidents or suicides are forwarded to be autopsied by Cassin at the county’s morgue at ProMedica Bixby Hospital in Adrian.

Of the 244 total cases in 2018, 107 received an autopsy and toxicology tests — only one more than in 2017 — indicating that most of the rise came as a result of natural death.

Cassin suspects that much of the rise came as a result of previously unreported hospice deaths.

“We found that people who had come to hospice, at least in whole or in part because of an injury, were dying in what everybody thought in hospice was, well, it was a death they expected. It was a death that resulted from complications of something. They considered it as a medical event,” Cassin said. “But because of the investigation of some of those deaths, we discovered really that accident or an accident event may be or was involved in their deaths. And so I spoke to the people at hospice and was very generously received. … I did talk to them about how to report or when to report deaths to the medical examiner and so now we have a much higher rate of hospice deaths being reported to us.”

Another part of the increase is simply due to an aging population, health and economics. Older citizens in better health are more likely to stay in their homes at an advanced age rather than go to nursing homes, meaning there is a higher chance of a sudden, unexpected death that requires the office’s involvement. Another factor is because of economic reasons, hospital utilization is discouraged.

“Hospital utilization now has been much more restricted by virtue of limited insurances and that sort of thing. So physicians, as well as patients themselves, are all aware of the fact that patients in general don’t like being in hospitals. Doctors are told you have to get your patients out of hospitals and because hospitals are saying they can’t make any money on them after a certain short period of time,” Cassin said. “So there are a lot of people who are going on to either a rehabilitation or halfway house type of approach before going home. Or they are going directly home but not fully well. … But the most important thing is that they are not being monitored as closely or at least that is what generally is given as the reason.”

Of the total, 42 percent of the deaths the office responded to involved individuals older than 70.

Palmani divided the autopsied deaths into those who were determined to have died a natural death; accident, which includes drug deaths; suicide; homicide; and indeterminate.

Homicide

Last year, the county almost made it the entire year without recording a homicide investigation until Dec. 4, when the body of a Toledo man was dumped off Lipp Highway near Yankee Road in Riga Township.

“That’s our one homicide and it actually came from somewhere else,” Palmani said. “I was pretty pleased (until) it happened right at the tail end, in December. So it was kind of disappointing actually.”

In recent years, the county has had one or two homicides per year.

Last year also saw no deaths for those between birth and 18 years old, which Palmani was also happy about.

“So last year was a great year. We didn’t have a lot of very young children pass away. So we were fortunate in that. We’ve kind of already blown that this year,” she said.

Suicides

There were 10 suicides in the county last year, half by gunshot and half by asphyxia, which includes hanging and “exit bags,” which are plastic bags that a person puts over their head then pipe in a toxic gas. Eight suicide victims were male and two were female. This number is about average for the county, which came off of a 10-year low in 2017 of five, after two years of record highs of 18 suicides in 2015 and 2016.

Palmani noted that in Lenawee County since 2009, most of the suicides were among people in their 30s, 40s and 50s, with a few exceptions.

Cassin said that sometimes it can be hard to determine the accuracy of suicide numbers and a high standard of evidence goes into its determination.

“People in my specialty have been suspicious for many years that suicides in general are unreported,” Cassin said. “For a number of reasons, either not recognized or people in some ways had so many comorbidities, that it was easy to disguise them as natural deaths by those who lived with them or found them.”

Accidents

The most expansive field tracked by Palmani was that of accidental deaths. As the office responsible for investigating deaths that occur outside of monitored medical environments, it makes up the second largest field with 37 in 2018.

One was the result of a multiple-vehicle crash, another was a pedestrian crash, six died as the result of a fall, one from fire, one from drowning, two from asphyxia, one from hyperthermia and 24 from drugs.

In 2009, 15 accidental deaths were reported. The number started rising until 2012 when it reached 30. Theses deaths stayed in the mid-20s from 2013 to 2016 when it reached 29 and began to climb from there.

Drugs

By far the greatest contributor to the increase is the opioid crisis, specifically the emergence of the lethal synthetic drug fentanyl.

Palmani’s statistics outline the drug combinations from the toxicology reports, helping visualize the extent of the problem in the county.

In 2008, the county experience eight drug deaths. That number began to increase slowly until beginning a rapid climb from 2013 to 2015 to a peak of 25. There were 20 drug deaths in 2016, followed by 12 in 2017, before turning to climb to 25 again in 2018. One of the deaths was categorized as an indeterminate drug death and therefore not part of the accidental death statistics.

But the story reflects that of the country. The types of drugs found beginning in 2008 to 2013 were mostly prescription opiates, with one or two instances of fentanyl a year. But in 2014, the number of instances of fentanyl being found in toxicology began to increase as a percentage of overdose deaths. By last year, 64 percent of the overdoses in the county included fentanyl, often mixed with heroin, cocaine and other drugs.

“There’s a ton of fentanyl and it’s killing people quickly. Fentanyl is a serious painkiller,” Palmani said. “A lot of these people die very quickly. We’ve had a person die standing up, we’ve had a person die when their hand rigored in the plunger position because they were shooting up.”

Palmani wondered how many people who were found to have died from fentanyl knew that was what they were taking. Investigators have been consistently told from family and friends of victims that the victim was taking heroin, methamphetamine, cocaine or other drugs, when in fact fentanyl was the dominant drug.

Cassin and Palmani both found the ages of the drug deaths curious.

“A lot of people have this impression that the drug deaths are referable to teenagers or 20-somethings. And while a large number of them are, there is a growing number every year we see in the last several decades that are above the age of 30 or 40 (or 50) … ,” Cassin said. “I’m old enough to remember the 1960s and 1970s. In earlier years, drug experimentation, at least lethal drugs, was much more confined to younger ages. So people under the age of 30. Whereas the habit has grown up with people so to speak.”

Meagan Skampo, 37, of Adrian and a radiologist at ProMedica Bixby, knows the pain such deaths can cause on families and the speed with which fentanyl kills, first hand. Her sister, Joan Iott, of Deerfield, died of a drug overdose on Jan. 15 at the age of 34, leaving behind three teenage children.

Skampo described the feelings of guilt and frustration that her sister’s drug addiction and death caused the family.

Skampo said that her sister had always had addictions, from alcohol at an early age to harder drugs as time went on including heroin and methamphetamine.

“Prior to her death, I felt very angry, resentful — just felt she was very selfish,” Skampo said. “You know, ‘You have three kids you need to think about,’ and ‘You need to get it together.’

“And then when she died that’s when all this guilt set in. That she did want a better life and she just didn’t know how.”

Skampo described her sister as funny, a good cook and someone who was a good mother and loved her children despite her addiction and having them taken away from her by Child Protective Services. But even though the family tried multiple times to get Iott to rehab, she would fail to finish the program.

Skampo recalled that she once walked in on her sister and friends sitting at a table, cooking drugs in a spoon.

Another time, their father found Iott blue and unconscious in a bathtub. Skampo said that her sister had overdosed at least six times.

But prior to her death, her sister appeared to be recovering and looking better at family holiday gatherings, whereas previously, she would sleep and slur her speech.

But on the day she died, Iott was found to have taken 47.9 milligrams of fentanyl.

“From what he told me at the medical examiner’s office, … he said if she did have heroin in her system, it was so masked by how much fentanyl that it didn’t even show up,” Skampo said.

Skampo said that the dose was so high, Narcan was ineffective.

“When someone’s addicted, you anticipate them dying, … but you don’t really actually think it’ll happen. It’s totally different when it does. You can’t plan for that,” Skampo said.

Fentanyl began as a prescription painkiller in 1960s, but in recent year has started being produced for the illicit drug market by labs in Mexico and China. The power and low price, have given drug dealers incentive to mix it other drugs.

“She had $20 on her that day,” Skampo said. “So it cost her her life for $20.”

Janee Cox, president of HALO Lenawee, which works to find help for drug addicts and their families, said that the prevalence of the drug in this area is coming from a new stream of drug dealers coming from large cities such as Detroit, Jackson and Chicago.

“I think a lot of the people that use are not aware, they’re not educated as far as what’s out there, what they’re getting,” Cox said. “And a lot of them are so naive thinking my dealer would never do that to me. Well, you know what, where does your dealer get his drugs? Is he getting them from Detroit? Because that’s what happens here. A lot of people here that are dealing go to Detroit and get their drugs and those dealers there are adding the fentanyl. It’s a horrible cycle.”