Increase in deaths from overdoses and heatwave detailed in 2021 medical examiner report, as office expands

A massive increase in overdose deaths, continued COVID-19 fatalities, a heatwave that left 20 dead and new contracts from outlying counties all contributed to a growing caseload for the Spokane County Medical Examiner, according to the office’s recently released 2021 year-end report.

There were 6,695 deaths in Spokane County last year, or about 1.2% of the population. Of those deaths, about 42% were reported to the medical examiner’s office, which took jurisdiction over 14.2% of the total deaths in the county. The medical examiner’s office is responsible and assumes jurisdiction to investigate and certify cause and manner of death for all sudden, unexpected, violent, suspicious or unnatural deaths in the county, the report explains.

The number of cases falling under the medical examiner’s jurisdiction has increased annually for the past three years.

More than 47% of the 952 deaths under the medical examiner’s jurisdiction were accidental, the office determined. Suicides made up 11% of the deaths, natural causes accounted for 26%, and homicides were 3%. Homicides dropped in 2021 by six cases from 2020. Deaths in all other categories increased year over year.

Overdose deaths and the fentanyl crisis

In her first year as medical examiner, Veena Singh thought the 46% increase in overdose deaths from 2019 to 2020 was startling. Then last year fentanyl continued to flood the Spokane market.

In 2021, there was a 285% increase in fatal drug overdoses compared to the year prior. Of the 203 overdose deaths, 108 involved fentanyl. Of all accidental deaths in Spokane County, 76.7% were due to fatal drug overdoses.

“We’re seeing kind of two distinct populations, one is the people who think they’re getting something else,” Singh said, when presenting the report to the Spokane County Commissioners. “And then also chronic pain patients.”

Due to increasingly strict control of opiate pain medication, people who were previously getting those drugs from their doctors are buying them online or from friends, Singh said.

“A lot of those drugs, that supply, is contaminated with fentanyl,” Singh said.

For drug users, fentanyl is easier to get than their usual drug of choice, she said. The problem is that fentanyl is being mixed into illicit pills by hand and is often distributed unevenly, making some pills deadly while others provide a typical high, Singh said.

Fatal overdoses are also common among people recently released from incarceration who assume the drug supply is the same as when they went into custody, Singh said.

“It’s a whole different landscape now,” she said.

Because of the increase in overdoses, Singh’s office hopes to purchase a machine that analyses a deceased person’s blood in the lab and identifies which drugs are present and the concentration of the drug in their system.

The office uses a mixture of private and state labs to run toxicology reports, and that wouldn’t change with this new technology. Results from a state lab can take months, leaving families in limbo waiting for the final determination on their loved one’s death, and private labs are expensive, depleting the medical examiner’s budget.

“That’s a really long time for the family to wait for an answer,” Singh said in an interview. “To have a machine like this that would enable us to let the family know.”

The new machine would allow the office to close cases quickly, based on the in-office results, with the caveat that they could be revisited once the lab analysis is returned, Singh said.

Heatwave

Last summer, 20 people died during a record-breaking heatwave.

“That is more than the last eight previous years put together,” Singh said.

The majority of those deaths were elderly people with mobility issues who died in their homes, Singh said. That’s contrary to the common belief that homeless people are the most at risk during a heatwave, Singh said.

Deaths of unhoused people

The medical examiner received 271 reports of deaths of homeless people, according to the report. The office accepted jurisdiction in 195 of those cases.

The most common manner of death was accidental at 86, followed by natural at 52, suicide at 22 and homicide at 11.

The vast majority of accidental deaths in homeless people were due to drug overdoses, at 66, followed by hypothermia at 10, according to the report. All of the people who died of hypothermia in 2021 were unhoused, Singh said.

That’s up from six hypothermia deaths in 2020 but lower than the 14 recorded in 2019.

Office expansion

Following the opening of the new medical examiner’s building in 2020, the office has taken a larger role regionally in pathology services.

Singh has the goal of her office becoming a “regional center of excellence,” both providing autopsy and death investigation services but also training the next generation of medical examiners.

The medical examiner’s office added referral contracts with Benton, Franklin, Walla Walla, Whitman and Grant counties in 2021, along with taking some cases from Adams County, when needed.

This means the medical examiner’s office completes autopsies for coroners or medical examiners in other counties who are unable to or don’t have the resources to do the procedure themselves.

The new contracts are in addition to existing contracts with Eastern Washington and North Idaho counties.

The office completed 50 autopsies for previously contracted counties, 22 from new contract counties, and 200 for Spokane County, Singh said. That means about 25% of the office’s workload is from referral counties.

The office signed a contract with SightLife to retrieve tissue for donation and is in the final stages of negotiating contracts with two other tissue collection agencies, Singh said.

The office hired three summer interns this year and is offering a medical student rotation. The office also hired another deputy medical examiner, bringing the total to three, and hired a sixth deputy medical investigator. Both new employees are set to start on Aug. 1.