Increase in homicides, fentanyl overdoses in 2020 according to Spokane County Medical Examiner report

The Spokane County Medical Examiner’s Office is investigating more deaths in the past two years than ever before.

While the largest number of them were determined to be accidental, there has been a sharp rise in drug overdoses, homicides and people dying unattended at home, making it busy for the team of pathologists and other medical investigators who perform autopsies and determine how a person died.

In all there were 5,954 deaths in Spokane County in 2020, or about 1.1% of the population, according to a new report. Of those deaths last year, 2,183 were reported to the medical examiner’s office.

The office has already dealt with nearly 600 more cases in 2021 than at this time last year.

Dr. Veena Singh, the Spokane County medical examiner, said the higher numbers can’t be attributed to just one thing, such as the climb in fentanyl overdose deaths. Consider that in 2018 there was one death due to fentanyl. In 2019 there were 11 such deaths. And then in 2020 there were 28. So far in 2021, the medical examiner’s office reports 51 fentanyl deaths with many more likely by the end of the year.

While there hasn’t been an increase in homicides so far in 2021, Singh said she can’t rule out an increase over the 38 killings in 2020 within the next few months. Last year, homicides spiked in December, she said.

Singh has also seen an increase in people dying at home with COVID because they didn’t go to the hospital or weren’t admitted if they did.

“They went to the hospital but there wasn’t a bed for them, or they didn’t go because they didn’t want to be admitted alone with the visitor restriction or something else,” Singh said of why more people are dying at home.

The medical examiner’s office releases data each year detailing the deaths the office investigates and the manner of death. The report for 2020 was released later than normal, largely due to delays in processing lab work.

After investigation, the report noted 726 cases ultimately fell to the medical examiner to issue death certificates. The caseload was the largest in the office’s history, including about 100 more death investigations than in 2019.

Most deaths investigated involved men, with 471 cases versus 254 investigations of the deaths of women. One person’s gender was unknown.

Despite growing caseloads, staffing has remained the same at the office since 2019 with just six investigators handling the surge of cases.

Deaths are reported to the medical examiner for a variety of reasons, including if the death was suspicious, has an unknown cause, or the death was unattended.

The office also contracts with surrounding counties.

Last year medical personnel performed 167 autopsies for other counties. Most came from Kootenai County.

Manner of death

The classification of manner of death was added to the death certificate in 1910 by public health officials to clarify the circumstances of death.

For a death to fall under the medical examiner’s purview, the death must meet certain criteria for investigation or the death must be unattended, leaving the medical examiner to certify the cause and manner of death.

The manner of death is not the same as the Spokane County Prosecutor’s Office’s legal determination. An example of this is vehicle deaths, which are classified as accidental by the medical examiner’s office – that classification has no impact on the prosecutor charging a someone with vehicular homicide.

Of the 726 cases that fell under the medical examiner’s jurisdiction in 2020, about 47% were classified as accidental, 5% were homicide, 22% were natural causes, 14% were suicide, and 10% were vehicular.

A small portion of the deaths were either undetermined, not classified or pending.

The medical examiner’s office did not investigate the many COVID-19 deaths, Singh said. Only nine autopsies were done on patients whose cause of death was COVID. Those cases were referred to the medical examiner’s office for other reasons, such as if the individual died at home.

COVID being a natural disease is not something that would normally fall under the medical examiner, she said.

In the early stages of the pandemic, the Centers for Disease Control and the Occupational Safety and Health Administration issued guidance discouraging autopsies on COVID positive patients because at the time little was known about how the disease spread, Singh said.

The number of accidental deaths at 342 was higher than in recent years but in line with the overall increase in deaths under medical examiner jurisdiction.

Homicides were also at a high with 38, more than any year since 2014. The majority of homicides were committed with a firearm. Others included homicidal violence and stabbing. Just six of those victims were female.

Law enforcement killed six of the people, equating to 15.7% of the total homicides. All of those killings were deemed justified by the Spokane County Prosecutor’s office, which has not found issue with any deadly use of force by law enforcement in the past 20 years.

Suicides were up from 2019 by four deaths with a total of 99 ; however, the number fell from a 2017 high of nearly 130. Data from the Centers for Disease Control and Prevention indicates that nationwide, suicides declined in 2020 by about 5%.

The majority of suicides in Spokane County are done with a firearm, which is consistent with historic data. There were also 10 overdose deaths listed as suicide.

Most overdose deaths are listed as accidental. In 2020 there were 115 such deaths, a high for the last few years but on par with data from 2016.