Office of the 2013 Calendar Year Annual Report

Prepared by:

Sarah LaMantia, MS Forensic Technician

Mandy Combest, MS Staff Assistant

Reviewed and Revised by: Tracey S. Corey, MD Chief Medical Examiner

Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Office of the Medical Examiner State of Kentucky Physician/Doctorate Staff

Tracey S. Corey, MD Chief Medical Examiner

John C. Hunsaker III, MD Associate Chief Medical Examiner

Office of the Chief Medical Examiner Louisville, KY Tracey S. Corey, MD Donna Stewart, MD Amy Burrows-Beckham, MD Darius Arabadjief, MD Jeffrey Springer, MD Meredith Frame, MD (Through October 2013) Victoria Graham, MD (Beginning November 2013)

Office of the Associate Medical Examiner Frankfort, KY John Hunsaker, JD, MD Cristin Rolf, MD Victoria Graham, MD (Through October 2013) Meredith Frame, MD (Beginning November 2013) Greg Davis, MD (part-time)

Western Kentucky Medical Examiner’s Office Madisonville, KY Gregory Wanger, MD

Northern Kentucky Medical Examiner’s Office Ft. Thomas, KY Charles Stephens, MD Ashton Ennis, MD

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Office of the Medical Examiner 2013 Annual Report Table of Contents

Overview ...... 6 Introduction ...... 7 Overview – Office of the Medical Examiner ...... 7 Basic Functions of the Office of the Medical Examiner ...... 7 Reportable ...... 8 Statutory Duty ...... 9 Training and Education ...... 10 Forensic Pathologist Fellowship Program ...... 10 Accreditations ...... 10 Figure 1-Organizational Chart: Office of the Medical Examiner ...... 11

Statewide Medical Examiner Data ...... 12 Table 1-Total Cases: ME Cases by Office ...... 13 Figure 2-Statewide Cases Sent for Autopsy by Locality of ...... 14 Figure 3-Statewide Cases by Year of Autopsy ...... 15 Figure 4-Statewide Cases by Month of Autopsy ...... 16 Figure 5-Statewide Cases by Age and Gender ...... 17 Figure 6-Statewide Percentages by Age and Gender ...... 18 Table 2-Statewide Cases by ...... 19 Figure 7-Statewide Cases by Manner of Death ...... 20 Figure 8-Statewide Accidents by ...... 21 Figure 9-Statewide by Cause of Death ...... 22 Figure 10-Statewide by Cause of Death ...... 23 Table 3-Statewide Medical Examiner Totals by Specific Case Type...... 24 Table 4-Statewide Medical Examiner Drug Related Deaths ...... 25 Table 5-Statewide Medical Examiner Drug Related Deaths Containing Heroin ...... 25 Figure 11-Statewide Drug Related Deaths Sent for Autopsy by Locality of Death ...... 26 Figure 12-Statewide Drug Related Deaths Containing Heroin by Locality of Death ...... 27 Figure 13-Statewide Drugs Most Frequently Detected ...... 28

Statewide Medical Examiner Data of Children (Birth-17) ...... 29 Figure 14-Statewide Child (<1) Accidents by Cause of Death...... 30 Figure 15-Statewide Child (1-5) Accidents by Cause of Death ...... 31 Figure 16-Statewide Child (6-12) Accidents by Cause of Death ...... 32 Figure 17-Statewide Child (13-17) Accidents by Cause of Death ...... 33 Figure 18-Statewide Child (<1) Homicides by Cause of Death ...... 34 Figure 19-Statewide Child (1-5) Homicides by Cause of Death ...... 34 Figure 20-Statewide Child (6-12) Homicides by Cause of Death ...... 35 Figure 21-Statewide Child (13-17) Homicides by Cause of Death ...... 35 Figure 22-Statewide Child (6-12) Suicides by Cause of Death ...... 36 Figure 23-Statewide Child (13-17) Suicides by Cause of Death ...... 36 Figure 24-Statewide Child (<1) Undetermined by Cause of Death ...... 37

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Louisville Medical Examiner Office Data...... 38 Figure 25-Louisville Cases by Manner of Death ...... 39 Figure 26-Louisville Cases by Common Causes of Death ...... 40 Table 6-Louisville Totals by Common Causes of Death ...... 41 Figure 27-Louisville Drug Related by Manner of Death ...... 42 Figure 28-Louisville Most Frequently Detected Drugs ...... 43 Table 7-Louisville Additional Drugs Detected in Drug Related Death Victims ...... 44 Figure 29-Louisville MVC by Manner of Death ...... 45 Figure 30-Louisville GSW by Manner of Death ...... 45 Figure 31-Louisville Drowning by Manner of Death ...... 46 Figure 32-Louisville Fire by Manner of Death ...... 46

Frankfort Medical Examiner Office Data ...... 47 Figure 33-Frankfort Cases by Manner of Death ...... 48 Figure 34-Frankfort Cases by Common Causes of Death ...... 49 Table 8-Frankfort Totals by Common Causes of Death ...... 50 Figure 35-Frankfort Drug Related by Manner of Death ...... 51 Figure 36-Frankfort Most Frequently Detected Drugs ...... 52 Table 9-Frankfort Additional Drugs Detected in Drug Related Death Victims ...... 53 Figure 37-Frankfort MVC by Manner of Death ...... 54 Figure 38-Frankfort GSW by Manner of Death ...... 54 Figure 39-Frankfort Drowning by Manner of Death ...... 55 Figure 40-Frankfort Fire by Manner of Death ...... 55

Western Kentucky Medical Examiner Office Data ...... 56 Figure 41-Western Kentucky Cases by Manner of Death ...... 57 Figure 42-WKY Cases by Common Causes of Death ...... 58 Table 10-WKY Totals by Common Causes of Death ...... 59 Figure 43-WKY Drug Related by Manner of Death ...... 60 Figure 44-WKY Most Frequently Detected Drugs ...... 61 Table 11-WKY Additional Drugs Detected in Drug Related Death Victims ...... 62 Figure 45-WKY MVC by Manner of Death ...... 63 Figure 46-WKY GSW by Manner of Death ...... 63 Figure 47-WKY Drowning by Manner of Death ...... 64 Figure 48-WKY Fire by Manner of Death ...... 64

Northern Kentucky Medical Examiner Office Data...... 65 Figure 49-Northern Kentucky Cases by Manner of Death ...... 66 Figure 50-NKY Cases by Common Causes of Death ...... 67 Table 12-NKY Totals by Common Causes of Death ...... 68 Figure 51-NKY Drug Related by Manner of Death ...... 69 Figure 52-NKY Most Frequently Detected Drugs...... 70 Table 13-NKY Additional Drugs Detected in Drug Related Death Victims ...... 71 Figure 53-NKY MVC by Manner of Death ...... 72 Figure 54-NKY GSW by Manner of Death ...... 72 Figure 55-NKY Drowning by Manner of Death...... 73 Figure 56-NKY Fire by Manner of Death ...... 73

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Additional Information ...... 74 Additional Data for 2013 ...... 75 Medical Examiner Districts ...... 77 Figure 57- Regional Office Coverage ...... 78 Regional Offices Contact Information ...... 79 Glossary ...... 80

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Overview

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Introduction The Office of the Medical Examiner investigates deaths occurring in the state of Kentucky, as authorized by Kentucky’s elected . The staff assists Kentucky coroners and law enforcement agencies in all aspects of death investigations by determination of the cause and manner of death, identification of the deceased, and collection and interpretation of trace evidence. The Medical Examiner Division performed services for approximately 2,384 deaths. A detailed summary of the case distribution is delineated in this report. It should be noted that this annual report does not include all deaths occurring in Kentucky, but rather those cases investigated by the Kentucky Medical Examiner Program. For total numbers of deaths occurring in the state, please contact:

Office of Vital Statistics 275 E. Main St. 1EA Frankfort, KY 40621 (502) 564-4212

The following report is presented in two sections. The first section summarizes the activity of the Medical Examiner’s Office. The second section presents data routinely collected by the Medical Examiner’s Office in regards to medicolegal death investigations performed. The graphs and figures presented are designed to be self- explanatory and provide the reader with a brief understanding of the types of cases completed within this Division.

Overview—Office of the Medical Examiner—2013

The Medical Examiners Office performs death investigations and postmortem examinations at four separate regional offices around the state:  The Office of the Chief Medical Examiner in Louisville, KY  The Office of the Associate Chief Medical Examiner in Frankfort, KY  The Western Kentucky Regional Medical Examiners Office in Madisonville, KY.  The Northern Kentucky Regional Medical Examiners Office in Ft. Thomas, KY There are six basic functions of the Office of the Medical Examiner:  determine the cause and manner of death of individual decedents in a timely fashion  identify the dead with a high degree of certainty and written documentation  prepare and maintain accurate, thorough and timely reports regarding examinations and opinions  safeguard and account for evidence and personal property  maintain confidentiality of case information  base expert opinions on logical conclusions after considering all historical and physical evidence available, in light of current scientific and medical knowledge

All medical examiner offices in Kentucky are staffed by board certified and/or board eligible forensic pathologists. These forensic pathologists are physicians who have undergone at least five years of postgraduate training to become proficient in the subspecialty of . The forensic pathologists routinely perform postmortem examinations; consult with law enforcement officials and attorneys regarding aspects of investigations including blood spatter analysis, crime scene investigation and toxicology interpretation; meet with decedents’ families; and provide expert testimony in courts throughout Kentucky.

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

OUR MISSION

The mission of the Kentucky Medical Examiners Office is to serve the public by:  providing accurate, thorough and efficient medical legal investigations of death, thereby,  insuring justice, and  providing solace, comfort and protection to the living

Reportable Deaths

KRS 72.025 Circumstances requiring post-mortem examination to be performed by . Coroners shall require a post-mortem examination to be performed in the following circumstances: (1) When the death of a human being appears to be caused by or violence; (2) When the death of a human being appears to be the result of ; (3) When the death of a human being appears to be the result of the presence of drugs or poisons in the body; (4) When the death of a human being appears to be the result of a motor vehicle accident and the operator of the motor vehicle left the scene of the accident or the body was found in or near a roadway or railroad; (5) When the death of a human being occurs while the person is in a state mental institution or mental hospital when there is no previous medical history to explain the death, or while the person is in police custody, a jail or penal institution; (6) When the death of a human being occurs in a motor vehicle accident and when an external examination of the body does not reveal a lethal traumatic injury; (7) When the death of a human being appears to be the result of a fire or explosion; (8) When the death of a child appears to indicate child abuse prior to the death; (9) When the manner of death appears to be other than natural; (10) When human skeletonized remains are found; (11) When post-mortem of a human corpse exists to the extent that external examination of the corpse cannot rule out injury or where the circumstances of death cannot rule out the commission of a crime; (12) When the death of a human being appears to be the result of drowning; (13) When the death of an infant appears to be caused by sudden infant death syndrome in that the infant has no previous medical history to explain the death; (14) When the death of a human being occurs as a result of an accident; (15) When the death of a human being occurs under the age of forty (40) and there is no past medical history to explain the death; (16) When the death of a human being occurs at the work site and there is no apparent cause of death such as an injury or when industrial toxics may have contributed to the cause of death; (17) When the body is to be cremated and there is no past medical history to explain the death; (18) When the death of a human being is sudden and unexplained; and (19) When the death of a human being occurs and the decedent is not receiving treatment by a licensed physician and there is no ascertainable medical history to indicate the cause of death. Effective: July 15, 1998

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

1. The coroner determines whether the case becomes a medical examiner case. 2. The medical examiner and the coroner may discuss whether a complete autopsy, a focused examination, or external inspection with toxicology specimen acquisition is warranted on certain cases. The Medical Examiner makes a MEDICAL DECISION regarding the type and amount of examination done to render a medicolegal opinion and thus provide assistance to the coroner. In all cases submitted by a coroner with an authorization, a report including a final opinion is generated. 3. In the rare event that the coroner declines to authorize an examination by the Medical Examiner’s office in a case in which law enforcement investigators conclude that ME involvement is crucial, then law enforcement may obtain and authorize an examination by the ME office by procuring a court order through the Commonwealth Attorney’s Office.

Statutory Duty

72.210 Purpose of Division of Kentucky State Medical Examiners Office. In enacting legislation establishing a Division of Kentucky State Medical Examiners Office for the Commonwealth of Kentucky, it is not the intention of the General Assembly to abolish or interfere with the coroner in his role as a constitutionally elected peace officer. It is the intention of the General Assembly for the office to aid, assist, and complement the coroner in the performance of his duties by providing medical assistance to him in determining causes of death. Effective: July 15, 1998 History: Amended 1998 Ky. Acts ch. 65, sec. 4, effective July 15, 1998. -- Created 1968 Ky. Acts ch. 114, sec. 1.

Summary Highlights

Aforementioned above, the four regional medical examiner offices (OCME, OACME, WKME and NKME) together performed 2,384 postmortem examinations in 2013.

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Training and Education

The Medical Examiner’s Division provides educational instruction in death investigation to coroners, law enforcement, medical, and social service agencies throughout the state. The Office of the Chief Medical Examiner plays an active role in the University of Louisville Department of Pathology educational programs and activities. Staff pathologists participate in the training of medical students, residents and fellows. Furthermore, the OACME plays an active role in the University of Kentucky, Department of Pathology.

Forensic Pathologist Fellowship Program

The University of Louisville Division of Forensic Pathology Fellowship program is a one-year extensive training program in the subspecialty of forensic pathology. The trainee works with all of the attending physicians, gaining exposure to a wide spectrum of cases with various histories, causes, manners and mechanisms of death. The trainee is always staffed by one of the attending physicians in the autopsy room. The gross findings are discussed during the , dictated at the table, and are signed out at the end of dissection. Case discussions are initiated prior to autopsy, and continued with staff and investigators through the multi-step process to the final report. The trainee is supervised throughout the process of interpretation of radiographs, microscopic slides, and toxicologic analysis. The trainees’ dictations are critiqued and modified as needed by the attending physicians. Early in training, the trainee accompanies the attending physician to death scenes as requested by coroners. As the training year progresses, the fellow may accompany coroners to death scenes without an attending physician; even when the fellow conducts a scene visit without an attending physician, an attending physician remains available to provide telephone consultation regarding scene findings, or go to the scene as circumstances indicate.

Accreditations

The Kentucky State Office of the Chief Medical Examiner in Louisville, KY is fully accredited by the National Association of Medical Examiners (NAME) through December 2017.

The University of Louisville Division of Forensic Pathology Fellowship Program at the Office of the Chief Medical Examiner in Louisville, KY is fully accredited by The Accreditation Council for Graduate Medical Education (ACGME) through April 2018.

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Office of the Medical Examiner Organizational Chart

Figure 1

Justice and Public Safety Cabinet Secretary J. Michael Brown (502)564-7554

Office of the Chief Medical Examiner Chief Medical Examiner Tracey S. Corey, MD (502)852-5587

OACME NKME WKME Frankfort Ft. Thomas Madisonville (502)564-4545 (859)572-3559 (270)824-7048

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Statewide Medical Examiner Data

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Total Cases

The remainder of this report will present data routinely collected by the Medical Examiner Offices. The graphs summarize data collected on all cases performed throughout the four regional offices.

The totals listed in this report do not represent all deaths occurring in Kentucky, but rather the total cases undergoing autopsy by the Kentucky Medical Examiner Offices.

ME CASES 2013 Table 1

Total 2,384

OCME Louisville 1,098 OACME Frankfort 638 WKME Madisonville 275

NKME Ft. Thomas 373

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Statewide Cases Sent for Autopsy by Locality of Death, 2013 Figure 2

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Statewide Cases by Year of Autopsy, 2000-2013

Figure 3

2,600 2,546 2,519 2,452 2,500 2,471 2,402 2,421 2,409 2,373 2,378 2,384 2,400 2,342 2,293 2,300 2,161

2,200 2,148

2,100

2,000

1,900

2000 2002 2004 2006 2008 2010 2012

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Statewide Cases by Month of Autopsy, 2013 Figure 4

230 221

220 210 207

210 200 200 199 197 200 197 194

187 187 190 185

180

170

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

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Cases by Age and Gender

Figure 5

Female Male Unknown Gender

350 331 315 288 300 254 250

200 173 158 150 125 109 107 92 100 85

47 54 44 50 35 31 27 23 14 13 9 8 12 10 7 5 2 2 4 0 <1 5-9 15-19 25-34 45-54 65-74 85-94 Unknown Age

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Percentages by Age and Gender

Figure 6

Female Male Unknown Gender

100% 100.0% 71.6% 66.7% 80% 64.4% 65.7% 67.6% 66.7% 48.1% 56.4% 43.8% 70.4% 60% 64.6% 66.9% 33.3% 60.0% 57.4% 56.2% 40% 43.6% 32.4% 33.3% 35.6% 51.9% 40.0% 34.3% 42.6% 20% 33.1% 28.4% 35.4% 20.6% 0% <1 5-9 15-19 25-34 45-54 65-74 85-94 Unknown Age

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

STATEWIDE MEDICAL EXAMINER CASES BY MANNER Table 2 Manner Total Percentage Accidents 1,013 42.49%

Homicides 218 9.14%

Naturals 619 25.96%

Suicides 340 14.26%

Undetermined 177 7.42%

Pending 14 0.59% Further Information Skeletal 3 0.13% Remains of No Forensic Significance

TOTAL 2,384

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Cases by Manner of Death

Figure 7 TOTAL=2,384 Accident Homicide Natural Suicide Pending Skeletal Remains

Undetermined

Homicide, 218, 9.14%

Natural, 619, 25.96% Accident, 1,013, 42.49%

Suicide, 340, 14.26% Undetermined, 177, Pending, 14, 7.42% 0.59% Skeletal Remains, 3, 0.13%

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Accidents by Major Causes

of Death Figure 8

**Drug Related, 569 600 56.17%

500

400

300 MVC, 218 21.52%

200 Fire, 65 Drowning, 49 100 6.42% 4.84% GSW, 3 0.30%

0 Drugs MVC Fire Drowning Gunshot Wound

*Only Major Categories of accidents are illustrated **Drug Related with manner of death other than “accident” are not included in above totals*

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Homicides by Cause of Death

Figure 9

160 GSW, 141 61.30% 140

120

100

80

60

Blunt Force, 33 Sharp Force, 32 40 13.91% 14.35% Children, 18 7.83% Asphyxia, 13 Starvation, 2 Thermal, 4 Undetermined, 3 Neonaticide, 1 20 5.65% 0.87% Drugs, 1 1.74% 1.30% 0.43% 0.43% 0

*Children = ages 17 and younger **Percentages may be > than 100%, as some decedents may have more than one (1) type of injury.

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Suicides by Cause of Death

Figure 10 GSW Hanging

Drugs Asphyxia (Other than Hanging)

Drowning Sharp Force Incised Injury

Jump from heights MVC

Train Environmental Exposure

Fire

GSW, 213, 61.92% Hanging, 60, 17.44%

Drugs, 39, 11.34%

Fire, 1, Drowning, 7, Asphyxia (Other than 0.29% 2.03% Hanging), 10, Environmental 2.91% Exposure, 1, 0.29% Jump, 3, Train, 2, Sharp Force Incised 0.87% 0.58% MVC, 3, Injury, 5, 0.87% 1.45%

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 STATEWIDE MEDICAL EXAMINER TOTALS BY SPECIFIC CASE TYPES

Table 3

Type Total Percentage of

Statewide

Total

Drug Related 722 30.29%

MVCs 225 9.44%

GSWs 364 15.27%

Fire-Related 75 3.15%

Drowning 63 2.64%

Infants <1yr 133 5.58% ALL Causes SUID 59 2.47%

Children >1yr 51 2.14% ≤ 12yrs, ALL Causes

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 STATEWIDE MEDICAL EXAMINER DRUG RELATED DEATHS Table 4 Manner Total Percentage Accidents 569 78.81%

Homicides 3 0.42%

Suicides 39 5.40%

Undetermined 34 4.71%

Pending 3 0.42%

Further

Information

Insufficient 4 0.55%

Information

Complications 70 9.70%

of Chronic

Use

TOTAL 722 100%

2013 STATEWIDE MEDICAL EXAMINER DRUG RELATED DEATHS CONTAINING HEROIN Table 5 Manner Total Percentage Accidents 214 93.04%

Suicides 2 0.87%

Undetermined 12 5.22%

Pending 2 0.87% Further Information TOTAL 230 100%

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Statewide Drug Related Deaths Sent for Autopsy by Locality of Death, 2013 Figure 11

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Statewide Drug Related Deaths Containing Heroin Sent for Autopsy by Locality of Death, 2013 Figure 12

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Most Frequently Detected Drugs in the Blood of Drug Related Death Victims Figure 13 Total = 722* *Includes Indiana

6-Monoacetylmorphine Alprazolam Cannabinoids

Oxycodone Codeine Hydromorphone

Hydrocodone Alcohol Morphine

7-Aminoclonazepam

6- Monoacetylmorphine 7-Aminoclonazepam 230, 32% Morphine 314, 43.49% 105, 14.54% Alprazolam 251, 34.76%

Alcohol 182, 25.21% Cannabinoids 152, 21.05%

Hydrocodone 179, 24.79% Oxycodone 144, Hydromorphone 136, 19.94% 18.84% Codeine 221, 30.61%

*Morphine represents true drug and/or metabolite of Heroin: Heroin is known in 230 statewide cases *Total Percentages >100% due to more than 1 drug being present in many decedents *Total statewide overdose cases = 722 *This figure delineates only drugs occurring ≥100.

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Statewide Medical Examiner Data of Children (Birth-17)

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Child (<1) Accidents

by Cause of Death Figure 14

Total <1 Accidental Deaths=15

7 Overlay, 6 40.00% 6

5 Positional Asphyxia, 4 26.67% 4

3 Smoke Inhalation Motor Vehicle Complications of Delivery, Residential Fire, Choking via Foreign Collision, 2 1 1 Body, 1 Wedging, 1 1 6.67% 6.67% 6.67% 6.67% 6.67% 1

0 Overlay Positional Choking via Wedging Complications MVC Fire Asphyxia Foreign Body of Delivery

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Child (1-5) Accidents by Cause of Death

Figure 15 Total 1-5 Accidental Deaths=20 Smoke Inhalation 12 Residential Fire, 11 55.00%

10

8

6

4 Drowning, 3 Motor Vehicle 15.00% Collision, 2 Positional 10.00% Ligature Asphyxia, 1 Traumatic ATV, 1 2 Strangulation, 1 5.00% Asphyxia, 1 5.00% 5.00% 5.00%

0 Fire Drowning MVC Ligature Positional Traumatic ATV Strangulation Asphyxia Asphyxia

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Child (6-12) Accidents by Cause of Death

Figure 16 Total 6-12 Accidental Deaths=12 Motor Vehicle Smoke Inhalation 4.5 Collision, 4 Residential Fire, 4 33.33% 33.33% 4

3.5

3

2.5 Drowning, 2 16.67% 2 Complications of ATV, 1 1.5 General Anesthesia, 1 8.33% 8.33% 1

0.5

0 MVC Fire Drowning Complications of ATV General Anesthesia

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Child (13-17) Accidents

by Cause of Death Figure 17

Total 13-17 Accidental Deaths=10

3.5 Motor Vehicle Collision, 3 30.00% 3

2.5 Smoke Inhalation Drowning, 2 Residential Fire, 2 20.00% 20.00% 2

1.5 Hanging, 1 Drug Overdose, 1 10.00% 10.00% Gunshot Wound, 1 10.00% 1

0.5

0 MVC Fire Drowning Hanging Drugs GSW

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Child (<1) Homicides by Cause of Death

Figure 18 Total <1 Homicide Deaths=8

6 Blunt Force, 5 62.50% 5

4

3 Smothering, 2 25.00% 2 Undetermined Means, 1 12.50% 1

0 Blunt Force Smothering Undetermined Means

2013 Statewide Child (1-5) Homicides by Cause of Death

Figure 19 Total 1-5 Homicide Deaths=2 2

Gunshot Wound, 1 Blunt Force, 1 50.00% 50.00% 1

0 GSW Blunt Force

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Child (6-12) Homicides by Cause of Death

Figure 20 Total 6-12 Homicide Deaths=3

3

Gunshot Wound, 2 66.66% 2

Blunt Force, 1 33.33% 1

0 GSW Blunt Force

2013 Statewide Child (13-17) Homicides by Cause of Death

Figure 21 Total 13-17 Homicide Deaths=5 5 Gunshot Wound, 4 80.00% 4

3

2

Manual Strangulation, 1 Ligature Strangulation, 1 20.00% 20.00% 1

0 GSW Manual Strangulation Ligature Strangulation

**Percentages may be > than 100%. Some decedents may have more than one (1) type of injury. 35

Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Child (6-12) Suicides by

Cause of Death Figure 22

Total 6-12 Suicide Deaths=1

2

Hanging, 1 100% 1

0 Hanging

2013 Statewide Child (13-17) Suicides by

Cause of Death Figure 23 Total 13-17 Suicide Deaths=10

7 Gunshot Wound, 6 60.00% 6

5

4 Hanging, 3 30.00% 3

2 Motor Vehicle Collision, 1 10.00% 1

0 GSW Hanging MVC

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Statewide Child (<1) Undetermined

Manners by Cause of Death Figure 24 Total <1 Undetermined Deaths=84 60 Consistent with SUDI, 49 58.33% 50

40

30 Undetermined, 23 27.38% 20 Attributed to SUDI, 10, 11.90% Environmental Exposure, 1 10 1.19% Consistent with Drowning, 1 Asphyxia, 1 1.19% 1.19%

0

Consistent with Attributed to Undetermined Drowning Environmental Consistent with

SUDI SUDI Exposure Asphyxia

**Percentages may be > than 100%. Some decedents may have more than one (1) type of injury.

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Louisville Medical Examiner Office Data

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Louisville Cases by Manner of Death

Figure 25

Accident Homicide Natural

Suicide Skeletal Remains Pending/Insufficient

Undetermined

Homicide, 98, 8.93% Accident, 451, 41.07%

Natural, 261, 23.77% Undetermined, 95, 8.65% Suicide, 178, 16.21% Pending/Insufficient, 12, 1.09% Skeletal Remains, 3, 0.27%

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Louisville Cases by Common Causes of Death

Figure 26

400 *Drug Related, 344 31.33% 350

300

250 GSW, 185 200 16.85%

MVC, 137 12.48% 150

100 Drowning, 31 2.82% Fire, 22 SUID, 24 50 2.00% 2.19%

0 MVC GSW Drowning Fire SUID Drug Related

*Drug Related total includes Indiana

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Louisville Totals by Common Causes And subsequent Manners of Death Table 6 Fatal Event Total Cases Percentage Drug Related - Kentucky 326 33.96% Accident 229 70.25% Homicide§ 1 0.31% Suicide 16 4.91% Natural (Complications of 47 14.42% Chronic Use) Insufficient Information 4 1.23% Pending Further Information 3 0.92% Undetermined 26 7.98% Heroin Present 124 38.04% Drug Related - Indiana 18 21.18% Accident 13 72.22% Natural (Complications of 4 22.22% Chronic Use) Suicide 1 5.56% Heroin Present 4 22.22% Motor Vehicle Accident 137 12.48% Accident 132 96.35% Suicide 2 1.46% Undetermined/Pending 3 2.19% Gunshot Wound 185 16.85% Accident 2 1.08% Homicide 69 37.30% Suicide 107 57.84% Undetermined/Pending 7 3.78% Further Information Drowning 31 2.82% Accident 22 70.97% Suicide 5 16.13% Undetermined/Pending 4 12.90% Further Information Fire Related 22 2.00% Accident 21 95.45% Undetermined/Pending 1 4.55% Further Information SUID 24 2.19% Undetermined 24 100% All other Louisville 37 3.37% Accidents *The above does not represent the total number of Louisville cases* ¤Other than Drug Related Deaths, Indiana cases are included in totals¤ §Homicide: Multiple Substance Intoxication was a contributing factor 41

Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Louisville Drug Related by Manner of Death

Figure 27 Total = 344 Includes Indiana

Accident Homicide Natural (Complications of Chronic Use) Suicide Undetermined Pending Further Information

Insufficient Information

Accident, 242 70.35%

Insufficient Information, 4 1.16%

Pending, 3, 0.87% *Homicide, 1 0.29% Undetermined, 26, Natural

7.56% Suicide, 17, 4.94% (Complications of Chronic Use) 51, 14.83%

*Homicide: Multiple Substance Intoxication was a contributing factor

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2013 Louisville Most Frequently Detected Drugs in the Blood of Drug Related Death Victims

Figure 28 Total = 344* *Includes Indiana

Alprazolam Alcohol 7-Aminoclonazepam a-oh-alprazolam Codeine Cocaine & Benzoylecgonine

Nordiazepam 6-Monoacetylmorphine

Hydrocodone Hydromorphone Oxazepam *Morphine Oxycodone Temazepam Cannabinoids Oxymorphone

Oxymorphone, 51 Temazepam, 51 14.83% Alprazolam, 111 Alcohol, 111 14.83% Cannabinoids, 76 32.27% 32.27% 22.09%

7-Aminoclonazepam, Oxycodone, 47 13.66% 57 16.57% a-oh-alprazolam 66, *Morphine, 177 19.19% 51.45%

Oxazepam, 56 Codeine, 135 16.28% 39.24%

6-Monoacetylmorphine Cocaine & 128, 37.21% Hydromorphone, 79 Benzoylecgonine 22.97% 78, 22.67% Hydrocodone, 94 Nordiazepam, 43 27.33% 12.50%

*Morphine represents true drug and/or metabolite of Heroin ^Total Percentages >100% due to more than 1 drug being present in many decedents ¤Detected drugs were found in blood, urine, and/or vitreous fluids. §This figure delineates only drugs occurring ≥30

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2013 Louisville Additional Drugs Detected in Drug Related Death Victims Table 7 *Includes Indiana 11-carboxy-tetrahydrocanabinol 16 Levetiracetam 1 2-ethylidene-1,5-3,3-diphenylpyrrolidine 4 Lidocaine 1 Acetaminophen 7 Meprobamate 6 Acetone 2 Methadone 28 Alpha-hydroxyalprazolam 5 Methamphetamine 24 Amitriptyline 6 Methanol 1 Amlodipine 2 Methylenedioxymethamphetamine 2 Ampethamine 22 Metoclopramide 1 Atenolol 1 Mirtazapine 3 Barbiturates 1 Naloxone 1 Buprenorphine 9 Naproxen 1 Butalbital 6 Norbuprenorphine 9 Cabamazepine Epoxide 1 Nordoxepin 2 Caffeine 23 Norfentanyl 11 Carasoprodol 1 Norfluoxetine 4 Carbamazepine 5 Norsertraline 3 Carboxy Tetrahydrocannabinol 17 Nortramadol 8 Carisoprodol 3 Nortriptyline 6 Chlorophenylpiperazine 1 Nuprenorphine 1 Citalopram 6 Olanzapine 1 Cloazepam 14 Orphenadrine 1 Cocaethylene 4 Oxaprozin 1 Cyclobenzaprine 6 Paroxetine 4 Dextromethorphan 1 Pentobarbital 5 Diazepam 23 Phentermine 1 Diphenhydramine 10 Phytoin 1 Doxepin 2 Pregabalin 1 Doxylamine 3 Promethazine 2 Duloxetine 3 Pseudoephedrine 2 EDDP 12 Quetiapine 6 Fentanyl 14 Salicylate 2 Fluoxetine 3 Sertaline 3 Gabapentin 16 Topiramate 3 Glucose 2 Tramadol 7 Hydrochlorothiazide 2 Trazodone 3 Hydroxyzine 2 Valproic Acid 1 Lamotrigine 1 Zolpidem 5 Laprazolam 7

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Louisville MVC by Manner of Death

Figure 29 Accident Suicide Pending Undetermined

Accident, 132, 96.35%

Undetermined, Suicide, 2, 2, 1.46% Pending, 1, 1.46% 0.73%

2013 Louisville GSW by Manner of Death Figure 30

Accident Homicide Suicide Pending Further Information

Pending Further Information, 4, Accident, 2, 1.10% 2.20% Homicide, 69, 37.91%

Suicide, 107, 58.79%

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2013 Louisville Drowning by Manner of Death Figure 31

Accident Suicide Undetermined

Undetermined, 4, 12.90%

Suicide, 5, 16.13%

Accident, 22, 70.97%

2013 Louisville Fire by Manner of Death Figure 32

Accident Pending Further Information

Pending Further Information, 1, 4.55%

Accident, 21, 95.45%

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Frankfort Medical Examiner Office Data

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2013 Frankfort Cases by Manner of Death Figure 33

Accident Homicide Natural Suicide Undetermined

Undetermined, 53, 8.31%

Accident, 271, 42.48% Suicide, 78, 12.23%

Natural, 137, 21.47% Homicide, 99, 15.52%

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2013 Frankfort Cases by Common Causes of Death

Figure 34

180 Drug Related, 159 24.92% 160

140 GSW, 117 18.34% 120

100

80

MVC, 49 60 7.68% Fire, 39 6.11% SUID, 29 Drowning, 14 40 4.55% 2.19%

20

0 MVC GSW Drowning Fire SUID Drug Related

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Frankfort Totals by Common Causes And Subsequent Manners of Death Table 8

Fatal Event Total Percentage Drug Related 159 24.92% Accident 132 83.02% Homicide* 2 1.26% Natural (Complications of 14 8.81% Chronic Use) Suicide 6 3.77% Undetermined 5 3.14% Heroin Present 23 14.47% Motor Vehicle Accident 49 7.68% Accident 49 100%

Gunshot Wound 117 16.85% Homicide 58 49.57% Suicide 59 50.43%

Drowning 14 2.19% Accident 13 92.86% Suicide 1 7.14%

Fire Related 39 6.11% Accident 31 79.49% Homicide 6 15.38% Suicide 1 2.56% Undetermined 1 2.56%

SUID 29 4.55% Undetermined 29 100%

All other FFT Accidents 50 7.84%

*The above does not represent the total number of Frankfort cases* *Homicides: 1 combined Drug Toxicity contributory cause: 1 Chronic Ethanol Abuse contributory cause

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Frankfort Drug Related by Manner of Death

Figure 35

Accident Homicide * Natural (Complications of Chronic Use) Suicide

Undetermined

Suicide 6, 3.77% Natural (Complications of Chronic Use) 14, Undetermined 5, 3.14% 8.81%

Homicide* 2, 1.26%

Accident 132, 83.02%

*Homicides:1 combined Drug Toxicity contributory cause; 1 Chronic Ethanol Abuse contributory cause

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2013 Frankfort Most Frequently Detected Drugs in

the Blood of Drug Related Death Victims Figure 36 Total = 159

Alcohol Alprazolam

Clonazepam Codeine

Cocaine & Benzoylecgonine 7-Aminoclonazepam

6-Monoacetylmorphine Hydrocodone

Hydromorphone *Morphine

Oxycodone Oxymorphone

Oxymorphone 42, 26.42% Alcohol 35, 22.01% Alprazolam 73, Oxycodone 63, 45.91% 39.62% Clonazepam 24, 15.09%

*Morphine 39, 24.53% Codeine 21, 13.21%

Hydrocodone 52,

32.70% 6-Monoacetylmorphine 23, 14.47% Cocaine & Hydromorphone 29, Benzoylecgonine 13, 18.24% 8.18% 7-Aminoclonazepam 21, 13.21%

*Morphine represents true drug and/or metabolite of Heroin ^Total Percentages >100% due to more than 1 drug being present in many decedents ¤Detected drugs were found in blood, urine, and/or vitreous fluids. §This figure delineates only drugs occurring ≥20 other than Cocaine & Benzoylecgonine.

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2013 Frankfort Additional Drugs Detected

in

Drug Related Death Victims

Table 9

Acetaminophen 1 Hydrochlorothiazide 1 Acetone 2 Ibuprofen 1

Aminoclonazepam 4 Ketamine 1 Amitriptyline 1 Levetiracetam 1 Amlodipine 1 Lorazepam 3

Ampheatime 5 Maclofen 1 a-OH-Alprazol 10 Marijuana 1 Buprenorphine 10 Meprabamate 2

Bupropion 1 Methamphetamine 7 Butalbital 6 Metoprolol 1 Caffeine 4 Norbuprenorphine 6

Carboxy 1 Nordiazepam 19 Carboxy THC 1 Norfentanyl 3 Carisoprodol 6 Nortramadol 3

Chlordiazepoxide 1 Nortriptyline 1 Cotinine 1 Oxazepam 18 Demoxepam 1 Paroxetine 1

Dextromethorphan 1 Phenobarbital 2 Diazepam 19 Pregabilin 1 Difluoroethane 1 Promethazine 1

Diphenhydramine 4 Pseudoephedrine 1 Duloxetine 1 Quitiapine 1 EDDP 2 Rocephin 1

Ephedrine 1 Temazepam 12 Fentanyl 8 Topiramate 1 Fluoxetine 1 Tramadol 6

Gabapentin 2

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2013 Frankfort MVC by Manner of Death

Figure 37

Accident

Accident, 49, 100%

2013 Frankfort GSW by Manner of

Death

Figure 38

Homicide Suicide

Homicide, 58, Suicide, 59, 49.57%

50.43%

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Frankfort Drowning by Manner of

Death

Figure 39

Accident Suicide

Suicide, 1, 7.14%

Accident, 13, 92.86%

2013 Frankfort Fire by Manner of

Death Figure 40

Accident Homicide Suicide Undetermined

Undetermined, Suicide, 1, 1, 2.56% 2.56% Homicide, 6, 15.38%

Accident, 31, 79.49%

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Western Kentucky Medical Examiner Office Data

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2013 Western Kentucky Cases by Manner of

Death Figure 41

Accident Homicide Natural Suicide Undetermined Pending

Homicide, 17, 6.18%

Natural, 95, 34.55%

Accident, 107, 38.91%

Suicide, 44, 16.00% Pending, 1, 0.36%

Undetermined, 11, 4.00%

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Western Kentucky Cases by Common Cause of Death

Figure 42

90 Drug Related, 77

80 44.00%

70

60

50 GSW, 37 40 21.14%

30 MVC, 19 10.86% 20 Drowning, 11 6.29% SUID, 4 Fire, 3 10 2.29% 1.71%

0

MVC GSW Drowning Fire SUID Drug Related

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Western Kentucky Totals by Common Causes And Subsequent Manners of Death Table 10

Fatal Event Total Percentage Drug Related 77 28.00% Accident 63 81.82% Natural (Complications of 3 3.90% Chronic Use) Suicide 11 14.29% Heroin Present 0 0%

MVC 19 6.91% Accident 18 94.74% Undetermined/Pending 1 5.26% Further Information

GSW 37 13.45% Accident 1 2.70% Homicide 10 27.03% Suicide 24 64.86% Undetermined 2 5.41%

Drowning 11 4.00% Accident 11 100%

Fire 3 1.09% Accident 3 100%

SUID 4 1.45% Undetermined 4 100%

All other WKY Accidents 16 4.32%

*The above does not represent the total number of Western Kentucky cases*

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Western Kentucky Drug Related by

Manner of Death

Figure 43 Total = 77

Accident Natural (Complications of Chronic Use) Suicide

Suicide, 11, 14.29%%

Natural

(Complications of Chronic Use) 3, 4.29%

Accident, 63, 81.82%

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2013 Western Kentucky Most Frequently Detected

Drugs in the Blood of Drug Related Death Victims Figure 44 Total = 77

Cannabinoids Alprazolam

Cocaine &Benzoylecgonine Nordiazepam

Hydromorphone Hydrocodone

Cannabinoids 22, Hydrocodone 33, 28.57% 42.86%

Alprazolam 35, 45.45%

Hydromorphone 28, 36.36% Cocaine Nordiazepam 20, &Benzoylecgonine 5, 25.97% 6.49%

*Morphine represents true drug and/or metabolite of Heroin ^Total Percentages >100% due to more than 1 drug being present in many decedents ¤Detected drugs were found in blood, urine, and/or vitreous fluids. §This figure delineates only drugs occurring ≥20 other than Cocaine & Benzoylecgonine.

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2013 Western Kentucky Additional Drugs Detected in Drug Related Death Victims Table 11 7-Aminoclonazepam 13 Hydroxyzine 1 Acetaminophen 1 Loratadine 1 Aminoclonazepam 1 Lorazepam 4 Amitriptyline 5 Meprobamate 4 Amlodipine 2 Methadone 12 Amphetamine 11 Methamphetaime 10 a-OH-alprazolam 11 Methanol 1 Atenolol 1 Morphine 9 Benzodiazepines 1 Norbuprenorphine 2 Buprenorphine 2 Nordoxepin 1 Bupropion 1 Norfentanyl 3 Buspirone 1 Norfluoxetine 1 Caffeine 3 Norsertraline 1 Carboxy THC 7 Nortramadol 4 Carisoprodol 2 Nortriptyline 4 Chlordiazepam 1 Norvenlafaxine 2 Chlorpheniramine 1 Oxazepam 17 Clonazepam 3 Oxycodone 18 Codeine 3 Oxymorphone 12 Descarboethoxyloratadine 1 Paroxetine 1 Dextromethorphan 1 Pregablin 1 Diazepam 14 Propranolol 1 Difluoroethane 1 Quetiapine 2 Diphenhydramine 2 Sertraline 1 Doxepin 2 Temazepam 16 EDDP 1 Tizanadine 1 Ethanol 18 Tramadol 4 Fentanyl 5 Venlafaxine 2 Fluoxetine 1 Zolpidem 1 Gabapentin 3

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2013 Western Kentucky MVC by Manner of Death

Figure 45

Accident Pending Further Information

Pending Further

Information, 1, 5.26%

Accident, 18, 94.74%

2013 Western Kentucky GSW by Manner of Death

Figure 46

Accident Homicide Suicide Undetermined

Undetermined, 2, Accident, 1, Homicide, 10, 5.41% 2.70% 27.03%

Suicide, 24, 64.86%

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Western Kentucky Drowning by Manner of Death

Figure 47

Accident

Accident, 11, 100%

2013 Western Kentucky Fire by Manner of Death

Figure 48

Accident

Accident, 3, 100%

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Northern Kentucky Medical Examiner Office Data

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

2013 Northern Kentucky Cases by Manner of Death

Figure 49

Accident Homicide Natural

Suicide Undetermined Pending

Homicide, 4, 1.07%

Accident, 184, 49.33% Natural, 126, 33.78%

Pending, 1, 0.27% Suicide, 40, 10.72% Undetermined, 18, 4.83%

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2013 Northern Kentucky Cases by Common Causes

Figure 50

160 Drug Related, 142 38.07%

140

120

100

80

60

40 GSW, 25 MVC, 20 5.63% 6.70% Fire, 11 Drowning, 7 2.95% SUID, 2 20 1.88% 0.54%

0 MVC GSW Drowning Fire SUID Drug Related

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NKY Totals by Common Causes And Subsequent Manners of Death Table 12

Fatal Event Total Percentage Drug Related 142 38.07% Accident 132 92.96% Natural (Complications of 2 1.41% Chronic Use) Suicide 5 3.52% Undetermined 3 2.11% Heroin Present 79 55.63%

MVC 20 5.36% Accident 19 95.00%

Suicide 1 5.00%

GSW 25 6.70% Homicide 2 8.00% Suicide 23 92.00%

Drowning 7 1.88% Accident 3 42.86% Suicide 2 28.57% Undetermined 2 28.57%

Fire 11 2.95% Accident 10 90.91% Undetermined 1 9.09%

SUID 2 0.54% Undetermined 2 100%

All other NKY Accidents 13 4.87%

*The above does not represent the total number of Northern Kentucky cases*

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2013 Northern Kentucky Drug Related by Manner of Death Figure 51

Total = 142

Accident Natural (Complications of Chronic Use) Suicide Undetermined

Undetermined, 3, 2.17%

Suicide, 5, 3.62%

Natural (Complications of Chronic Use) 2, 1.45%

Accident, 132, 92.96%

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2013 Northern Kentucky Most Frequently

Detected Drugs in the Blood of Drug Related Death Victims

Figure 36 Total = 159 Alcohol Alprazolam

Caffeine Codeine

Cocaine & Benzoylecgonine 7-Aminoclonazepam 6-Monoacetylmorphine Nordiazepam

Cannabinoids *Morphine

Oxycodone

Oxycodone 34, Alprazolam 32, *Morphine 98, 69.01% 23.94% Alcohol 36, 26.09% 22.54%

Caffeine 28, 19.72%

Codeine 65, 45.77%

Cannabinoids 54, Cocaine & 38.03% Benzoylecgonine 18, 12.68%

6- Nordiazepam 23, Monoacetylmorphine 16.20% 79, 55.63% 7-Aminoclonazepam 29, 21.01%

*Morphine represents true drug and/or metabolite of Heroin ^Total Percentages >100% due to more than 1 drug being present in many decedents ¤Detected drugs were found in blood, urine, and/or vitreous fluids. §This figure delineates only drugs occurring ≥20 other than Cocaine & Benzoylecgonine.

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2013 Northern Kentucky Additional Drugs Detected in Drug Related Death Victims Table 13

ACETAMINOPHEN 4 HYDROCODONE 12 ACETONE 1 HYDROMORPHONE 10 AMIODARONE 2 HYDROXYZINE 1 AMITRIPTYLINE 1 LORAZEPAM 4 AMLODIPINE 1 METHADONE 12 AMPHETAMINE 1 METHAMPHETAMINE 1 BISOPROLOL 1 MIRTAZAPINE 1 BUPRENORPHINE 1 NALOXONE 1 BUPROPION 1 NORDOXEPIN 3 BUSPIRONE 1 NORFLUOXETINE 3 BUTALBITAL 1 NORSERTRALINE 2 CHLORDIAZEPOXIDE 1 NORTRAMADOL 4 CHLOROPHENLYPIPERAZINE 1 NORTRIPTILINE 1 CIMETIDINE 1 NORVENLAFAXINE 2 CITALOPRAM 6 OXAZEPAM 4 CLONAZEPAM 5 OXYMORPHONE 15 COCAETHYLENE 2 PREGABALIN 3 CYCLOBENZAPRINE 2 PROMETHAZINE 4 DEXTROMETHORPHAN 2 PROPRANOLOL 1 DIAZEPAM 21 PSEUDOEPHEDRINE 1 DIPHENHYDRAMINE 4 QUETIAPINE 4 DOXEPIN 3 TEMAZEPAM 6 DULOXETINE 4 TOPIRAMATE 1 EDDP 5 TRAMADOL 4 FENTANYL 1 TRAZODONE 4 FLUOXETINE 3 VENLAFAXINE 2 GABAPANTIN 11 VERAPAMIL 1 HYDROCHLOROTHIAZIDE 3 ZOLPIDEM 3

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2013 Northern Kentucky MVC by Manner of

Death Figure 53

Accident Suicide

Suicide, 1, 5.00%

Accident, 19, 95.00%

2013 Northern Kentucky GSW by Manner of Death Figure 54

Homicide Suicide

Homicide, 2, 8.00%

Suicide, 23, 92.00%

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2013 Northern Kentucky Drowning by Manner of Death Figure 55

Accident Suicide Undetermined

Undetermined, 2, 28.57% Accident, 3, 42.86%

Suicide, 2, 28.57%

2013 Northern Kentucky Fire by Manner of Death Figure 56

Accident Undetermined

Undetermined, 1, 9.09%

Accident, 10, 90.91%

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Additional Information

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Office of the State Medical Examiner 2013 Annual Report Kentucky Justice & Public Safety Cabinet

Additional Data for 2013

Scene Visits at the request of local law enforcement and/or county coroner: The OCME attended six (6) scenes. The Frankfort Office attended zero (0) scenes. The Western Kentucky attended one (1) scene. The Northern Kentucky Office attended three (3) scenes.

Bodies Transported: Due to the combined Coroner/Medical Examiner system, no regional Medical Examiner Office transports bodies or arranges/orders the transport of bodies. This duty falls under the purview of the county coroner in which the death occurred. Therefore, zero (0) bodies were transported by any regional office.

Hospital : Due to the combined Coroner/Medical Examiner system, the Regional Medical Examiner’s Offices do not have jurisdiction over hospital deaths and autopsies. There were zero (0) hospital autopsies retained under ME jurisdiction.

Organ and Tissue Donation: KODA had 109 system wide Organ Donors and 263 Tissue Donors in 2013. Of the 1,098 cases undergoing postmortem examinations by the OCME, 11 were organ and 19 were tissue donations.

Of the 638 cases undergoing postmortem examinations by the Frankfort Office, 9 were organ and 10 were tissue donations.

Of the 275 cases undergoing postmortem examinations by the Western Kentucky Office, 0 were organ and 1 was tissue donation.

Of the 373 cases undergoing postmortem examinations by the Northern Kentucky Office, 0 were organ and tissue donations as KODA does not perform any recoveries at the Northern Kentucky Facility.

Unclaimed Bodies: Due to the combined Coroner/Medical Examiner system, the Regional Medical Examiner’s Offices does not have purview over unclaimed bodies. This is the duty of the county coroner in which the death occurred. Therefore, there were zero (0) unclaimed bodies in 2013.

Exhumations: The OCME had zero (0) postmortem examination from an exhumation in 2013. The Frankfort Office had one (1) postmortem examination from an exhumation in 2013. The Western Kentucky Office had zero (0) postmortem examinations from an exhumation in 2013. The Northern Kentucky Office had zero (0) postmortem examinations from an exhumation in 2013.

Complete Autopsies The OCME performed 918 complete autopsies in 2013. The Frankfort Office performed 527 complete autopsies in 2013. The Western Kentucky Office performed 266 complete autopsies in 2013. The Northern Kentucky Office performed 284 complete autopsies in 2013.

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Focused Examinations The OCME performed 127 focused examinations in 2013. The Frankfort Office performed 62 focused examinations in 2013. The Western Kentucky Office performed 4 focused examinations in 2013. The Northern Kentucky Office performed 10 focused examinations in 2013.

External Autopsies The OCME performed 53 external examinations in 2013. In addition, 4 were examinations of skeletal remains. The Frankfort Office performed 49 external examinations in 2013. In addition, 3 were examinations of skeletal remains. The Western Kentucky Office performed 5 external examinations in 2013. The Northern Kentucky Office performed 79 external examinations in 2013. In addition 1 was an examination of skeletal remains.

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MEDICAL EXAMINER DISTRICTS

The Office of the Chief Medical Examiner in Louisville covers the following CENTRAL counties in Kentucky and Southern IN: Adair, Allen, Barren, Breckinridge, Bullitt, Butler, Carroll, Casey, Clinton, Cumberland, Edmonson, Grayson, Green, Hancock, Hardin, Hart, Henry, Jefferson, Larue, Marion, Meade, Metcalfe, Monroe, Nelson, Oldham, Russell, Shelby, Simpson, Spencer, Taylor, Trimble, and Warren. Southern Indiana counties: Clark, Crawford, Dearborn, Dubois, Floyd, Harrison, Jackson, Jefferson, Ohio, Orange, Perry, Scott, Spencer, Switzerland, Warrick, and Washington. *Additionally, the OCME provides weekend, holiday, and vacation coverage for the Western counties delineated below.

The WKME in Madisonville office covers the following WESTERN counties: Ballard, Caldwell, Calloway, Carlisle, Christian, Crittenden, Daviess, Fulton, Graves, Henderson, Hickman, Hopkins, Livingston, Logan, Lyon, Marshall, McCracken, McLean, Muhlenberg, Ohio, Todd, Trigg, Union, and Webster.

The OACME in Frankfort office covers the following EASTERN counties: Anderson, Bath, Bell, Bourbon, Boyle, Boyd, Breathitt, Carter, Clark, Clay, Elliott, Estill, Fayette, Floyd, Franklin, Garrard, Harlan, Harrison, Jackson, Jessamine, Johnson, Knott, Knox, Laurel, Lawrence, Lee, Leslie, Letcher, Lincoln, Madison, Magoffin, Martin, McCreary, Menifee, Mercer, Montgomery, Morgan, Nicholas, Owsley, Perry, Pike, Powell, Pulaski, Rockcastle, Rowan, Scott, Washington, Wayne, Whitley, Wolf, and Woodford.

The NKME in Ft. Thomas office covers the following NORTHERN counties: Boone, Bracken, Campbell, Fleming, Gallatin, Grant, Greenup, Kenton, Lewis, Mason, Owen, Pendleton, and Robertson.

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Regional Office Coverage Figure 57

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Office of the Chief Medical Examiner (OCME) 810 Barret Avenue Louisville, KY 40204 Tel: (502)852-5587 Fax: (502)852-1767

Office of the Associate Chief Medical Examiner (OACME) Central Laboratory Facility 100 Sower Blvd, STE 202 Frankfort, KY 40601 Tel: (502)564-4545 Fax: (502)564-1699

Northern Kentucky Regional Medical Examiner’s Office (NKME) 85 North Grand Avenue Ft. Thomas, KY 41075 Tel: (859)572-3559 Fax: (859)572-3558

Western Kentucky Regional Medical Examiner’s Office (WKME) 25 Brown Badgett Loop Madisonville, KY 42464 Tel: (270) 824-7048 Fax: (270) 824-7092

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Glossary

Accident – The manner of death used when, in other than natural deaths, there is no evidence of intent. The death occurs as a result of an unforeseen event.

Autopsy – A detailed postmortem external and internal examination of a body to determine cause of death.

Homicide – The manner of death in which death results from the intentional harm of one person by another. The medical examiner does not determine whether or not a criminal act has occurred.

Manner of Death – The general category of the condition, circumstances or event, which causes the death. The categories are natural, accident, homicide, suicide and undetermined.

Natural – The manner of death used when solely a disease causes death. If death is hastened by an injury, the manner of death is not considered natural.

Office of the Medical Examiner - the Office of the Medical Examiner investigates deaths occurring in the state of Kentucky, as authorized by Kentucky’s elected coroners. The staff assists Kentucky coroners and law enforcement agencies in all aspects of death investigations by determining the cause and manner of death, identification of the deceased, and collection and interpretation of trace evidence.

Suicide – The manner of death in which death results from intentional act by one’s self.

Unclassified – Are cases in which Medical Examiner involvement was for purposes other than for determining the cause and manner of death—e.g. tissue where no products of conception were identified; exhumation for DNA sampling only.

Undetermined – The manner of death for deaths in which there is insufficient information to assign another manner.

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