County of San Diego Department of the Medical Examiner 2016 Annual Report Dr. Glenn Wagner Chief Medical Examiner 2016 ANNUAL REPORT SAN DIEGO COUNTY MEDICAL EXAMINER TABLE OF CONTENTS TABLE OF CONTENTS EXECUTIVE SUMMARY ......................................................................... 1 OVERVIEW AND INTRODUCTION ........................................................... 5 DEDICATION, MISSION, AND VISION .......................................................................... 7 POPULATION AND GEOGRAPHY OF SAN DIEGO COUNTY ............................................ 9 DEATHS WE INVESTIGATE ....................................................................................... 11 HISTORY ................................................................................................................. 13 ORGANIZATIONAL CHART ........................................................................................ 15 MEDICAL EXAMINER FACILITY ................................................................................. 17 HOURS AND LOCATION ........................................................................................... 19 ACTIVITIES OF THE MEDICAL EXAMINER .............................................. 21 INVESTIGATIONS ..................................................................................................... 23 AUTOPSIES ............................................................................................................. 25 EXAMINATION ROOM ............................................................................................. 27 PATHOLOGY ............................................................................................................ 29 TOXICOLOGY LABORATORY REVIEW ........................................................................ 31 Major Achievements ............................................................................................................. 31 Workload Data for 2016 in Comparison to Previous Years .................................................. 32 Publications ........................................................................................................................... 32 DEATH CERTIFICATION ............................................................................................ 35 BEREAVEMENT CENTER ........................................................................................... 37 CASE REPORT REQUESTS AND DATA SHARING ......................................................... 39 DEATH REVIEW TEAMS............................................................................................ 41 FORENSIC PATHOLOGY FELLOWSHIP ....................................................................... 45 TEACHING AND RESEARCH ...................................................................................... 47 JOHN/JANE DOE CENTER ......................................................................................... 49 ABANDONED BODIES .............................................................................................. 51 LEGAL TESTIMONY .................................................................................................. 53 ORGAN AND TISSUE DONATION .............................................................................. 55 PREPAREDNESS AT THE MEDICAL EXAMINER’S OFFICE ............................................. 57 2016 DATA SECTION .......................................................................... 59 OVERVIEW OF ALL CASES ........................................................................................ 61 All Deaths Reported to M.E, 2016 ........................................................................................ 61 i 2016 ANNUAL REPORT TABLE OF CONTENTS SAN DIEGO COUNTY MEDICAL EXAMINER Manners of Death, 2016 ....................................................................................................... 62 Manner of Death by Year, 2000 – 2016 ................................................................................ 62 Manner of Death by Month: 2016 ........................................................................................ 63 Age Distribution of Decedents, 2016 .................................................................................... 63 Number of Decedents by Age and Sex, 2016 ....................................................................... 64 Rate per 100,000 of Investigations by Age and Sex, 2016 .................................................... 64 Number and Rate of Deaths by Race/Ethnicity, 2016 .......................................................... 65 Rates of Manner by Race/Ethnicity, 2016 ............................................................................ 65 HOMICIDE .............................................................................................................. 67 Homicide Methods: 2016 ...................................................................................................... 67 Number and Rate of Homicide Victims by Age and Gender, 2016 ....................................... 67 Homicide Method by Year: 1988 - 2016 ............................................................................... 68 Toxicology Results - Percent of Homicide: 2016 ................................................................... 68 Homicide Count and Rate by Year, 1988 - 2016 ................................................................... 69 Homicide Rate per 100,000 Compared to National And State Rates ................................... 70 Homicide Rate per 100,000 by Subregional Area, 2007 - 2016 ............................................ 71 MOTOR VEHICLE FATALITIES ................................................................................... 73 Motor Vehicle Related Fatalities: 1988 - 2016 ..................................................................... 73 Motor Vehicle Related Fatalities by Victim Type: 2016 ........................................................ 73 Traffic-Related Fatalities by Year, 1988 - 2016 ..................................................................... 74 Traffic-Related Fatality Rate by Year, 1988 - 2016 ............................................................... 75 Alcohol Toxicology by Motor Vehicle Victim Type: 2016 ..................................................... 75 Motor vehicle Related Death Rates by Subregional Area, 2007 – 2016............................... 76 Motor vehicle Occupant Death Rates by Subregional Area, 2006 – 2016 ........................... 77 Number of Motor Vehicle Occupants Deaths by Age and Gender, 2016 ............................. 78 Rate of Motor Vehicle Occupants Deaths by Age and Gender, 2016 ................................... 78 Seat Belt Use by Age Group: Motor Vehicle Occupants, 2016 ............................................. 79 Unintentional Motorcyclist Deaths by Age and Gender, 2016 ............................................. 79 Helmet Use: Unintentional Motorcyclist Fatalities, 2016 .................................................... 79 Motorcycle Deaths by Subregional Area, 2007 – 2016 ........................................................ 80 Pedalcyclist Deaths by Age and Gender, 2016 ..................................................................... 81 Unintentional Pedestrian Deaths by Age and Gender, 2016 ................................................ 81 Pedestrian Deaths per 100,000 by Subregional Area, 2007 – 2016 ..................................... 82 UNINTENTIONAL DEATHS DUE TO MEDICATIONS, ALCOHOL, AND ILLICIT DRUGS ..... 83 Number of Unintentional Drug/Alcohol Related Deaths, 2000 – 2016 ................................ 85 Number of Deaths Due To Selected Substances, 2000 – 2016 ............................................ 85 Number of Drug/Med/Alcohol Deaths by Age and Gender, 2016 ....................................... 86 Rates of Drug/Med/Alcohol Deaths by Age and Gender, 2016 ............................................ 86 Unintentional Illicit Drug Deaths, 2000 – 2016 ..................................................................... 87 ii 2016 ANNUAL REPORT SAN DIEGO COUNTY MEDICAL EXAMINER TABLE OF CONTENTS Unintentional Deaths due to Drug/Medication Type, 2000 – 2016 ..................................... 87 Unintentional Deaths - Selected Drugs & Medications, 2000 – 2016 .................................. 88 Unintentional Deaths, Top 25 Drugs/Medications by Age, 2016 ......................................... 88 Novel Psychoactive Substance-Related Deaths, 2011 - 2016 ............................................... 89 2016 Unintentional Drug/Med/Alcohol Deaths by Combination ......................................... 89 Unintentional Deaths Due to Opiates and Benzodiazepines, 2000 - 2016 .......................... 90 Relative Frequency of Substances in Cause of Death by age, 2016 ..................................... 91 Relative Frequency of Substances in C.O.D. by age, 5 year Cumulative, 2012-2016 ........... 91 Drug/Medication Related Death Rates by Subregional Area: 2007 – 2016 ......................... 92 UNINTENTIONAL DEATHS, OTHERS .......................................................................... 93 Other Accidental Manners of Death, 2016 ........................................................................... 93 Other Mechanisms of Accidental Death: Mechanism by Age Group, 2016 ........................ 93 SUICIDES ...............................................................................................................