Annual report from the IOSME
The continuing COVID pandemic has impacted the Iowa Office of the State Medical Examiner in several ways, according to Iowa Chief State Medical Examiner Dennis Klein, MD. Dr. Klein discussed COVID and other issues faced by the IOSME in his annual report to IACME members at the IACME Fall Meeting November 6.
The pandemic has caused concerns for staff safety at IOSME, reported Dr. Klein. There have been problems getting any type of equipment containing microchips, including computers. In addition, national toxicology laboratory wait times have doubled got six to eight weeks because of staff shortages at the labs.
The average of COVID autopsies done at the IOSME in 2020 was 52 years. COVID co-morbidities include obesity (48 percent of autopsies); hypertension (23 percent of autopsies); cardiac problems (32 percent of autopsies) and diabetes (13 percent of autopsies). Fifty-two percent of those autopsied for COVID at IOSME had two or more co-morbidities.
There were 213 opioid deaths in Iowa in 2020, a new record.
“Thirty-five of these deaths were people over age 55,” commented Dr. Klein. “Age is not a good discriminator for drug use.
Iowa has seen a steady increase in people using both fentanyl and methamphetamines, while heroin use in Iowa has leveled off. Iowa is one of the states where new synthetic opioids have surfaced for the first time, said Dr. Klein. Synthetic opioids can be missed on some screening tests.
A major challenge for medical examiners today is identifying potential drug intoxication deaths so that they are properly autopsied and then confirming in a timely manner which deaths are due to drug intoxication.
“By the time you’re sure all the data is correct, it’s out of date,” he explained.
IOSME Work Load
Because some pathology groups in Iowa have discontinued providing autopsy service, there have been 18 – 20 percent annual increases in the number of cases referred to the IOSME for the past two years. In 2020, staff conducted 1,196 autopsies. There were 124 homicides reported to IOSME, and autopsies were conducted on all of those cases either at the IOSME, Polk County Medical Examiner’s Office, or the University of Iowa.
There were 516 suicides referred to IOSME in 2020, a significant increase over previous years. Autopsies were conducted on 66 percent of these cases. Dr. Klein said one goal of IOSME is to increase this percentage.
“Suicide cases can be very difficult for families,” he explained. “Understandably, families often challenge a ruling of suicide, so it’s very important to have all the facts.”
A much-needed general fund increase for the IOSME allowed for the hiring of a new forensic pathologist, Dr. Jacob Smith. IOSME anticipates conducting 1,400 autopsies this year. The National Association of Medical Examiners (NAME) recommends that offices conducting 1,400 autopsies have seven pathologists (IOSME has five) and seven to nine investigators (IOSME has four).
The need for pathologists to provide court testimony also impacts the staff work load, he added.
“There was no court testimony for nearly a year due to the COVID lockdown,” he explained. “Now courts are back in session and it strains our schedule when a pathologist must be out of the office for an entire day several times a month, and sometimes multiple days in a week.”
The IOSME anticipates awarding of full NAME accreditation this year. To gain this accreditation, one of the requirements that has been corrected, but caused the office to be demoted to provisional status last year, was that 90 percent of autopsies must be completed within 72 hours.
Finally, significant strides were made in mass fatality planning in 2020. The IOSME purchased a refrigerated truck which has been upgraded and will double the IOSME storage capacity. The truck will be made available to county medical examiner offices experiencing mass fatalities.
IACME banquet speaker change
Pottawattamie County Sheriff’s Deputies Ryan Avis and Jim Doty and Digital Forensics Administrator Anthony Kava — investigators who solved the high profile Cari Farver case — will speak at this year’s IACME Banquet Friday evening, November 4. Their presentation is Shot in the Dark: A Cold Case Homicide in the Digital Age.
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