Snohomish County Medical Examiner’s Office by eot15664

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									Snohomish County Medical Examiner’s Office


           2002 Annual Report
     And Statistics from 2000 and 2001




                 -0-
April 14, 2004

Honorable Aaron Reardon
Snohomish County Executive
County Administration Building
Everett, Washington 98201

Re. Transmittal of 2000, 2001, 2002 Statistical Report of the Medical Examiner’s Office

Dear County Executive Reardon:

I am pleased to transmit the years 2000, 2001, 2002 Annual Statistical Report of the Medical
Examiner’s office of Snohomish County. This report is organized into three sections:
Information about the Office, Explanation of Terms, and Statistical Information.

The Medical Examiner’s Office serves the public health, safety, law and justice, and the family
of the deceased. Forensic pathology is the specialty field of medicine involving the application
of the principles of medicine and pathology in determining the cause and manner of sudden,
unexpected, and medically unattended deaths. Complete and timely investigations of death are
necessary so that the innocent are exonerated, murder is recognized, criminal and civil
proceedings are provided with documented, sound and impartial medical evidence, public
health and safety hazards, medical hazards and industrial hazards are recognized. Complete
and timely investigations of death also provide the family of the deceased with medical data
enabling them to receive adequate medical and genetic counseling from their private physician
and information necessary for expeditious settlement of insurance claims, estates and civil
proceedings.

It is my hope that this report will increase public understanding of the Medical Examiner’s
Office and the public services this office performs, and will provide useful and informative
statistical information. As we review the statistics within this report, however, we are
reminded that each one represents a person who has died during the past few years. They will
be remembered by a surviving relative or friend who can be assured the investigation of their
loved one’s death was done with respect and confidentiality.

Thank you for the support you have given this office. I will be happy to respond to any
questions or comments about the information contained in this report.

Sincerely,



Norman Thiersch, M.D.
Chief Medical Examiner


                                           -1-
                      INFORMATION ABOUT THE OFFICE



1. The office of the Snohomish County Medical Examiner was created in June 1987 and
   operates under the Snohomish County Executive in accordance with statutes, authority,
   and jurisdiction of the State of Washington.

2. The Medical Examiners are licensed physicians who have specialized training and
   board certification in the field of forensic pathology.

3. The staff consists of twelve full-time and one half-time employees. See organization
   chart on next page.

4. At least one medical investigator is on duty and a forensic pathologist is on-call 24
   hours a day, seven days a week.

5. The Medical Examiner’s Office is located at Paine Field at 9509 29th Avenue West in
   Everett, Washington 98204. The office phone number is (425) 438-6200.

6. Office hours are 9:00 a.m. to 5:00 p.m. Monday through Friday.

7. The Medical Examiner’s Office serves a resident population of 618,603. This includes
   all cities and all unincorporated areas of Snohomish County.

8. The geographical jurisdiction of the Medical Examiner’s Office extends over 2,090
   square miles. It includes Everett Navy base, Boeing, the Tulalip Reservation and
   casino, Monroe Fair Grounds, the Snohomish County Jail and the Washington State
   Reformatory (WSR) including the WSR Hospice center in Monroe.




                                       -2-
                                        SNOHOMISH COUNTY
                                     MEDICAL EXAMINER’S OFFICE
                                       ORGANIZATION CHART




                                                Chief Medical
                                                  Examiner



                 Associate Medical               Deputy Director            Chief Medical
                     Examiner                                                Investigator


 Sr. Pathologist Assistant        Medical Secretary          Accounting Tech II        Medical Investigator



                   Pathologist Assistant                                               Medical Investigator
                    Half time reg. empl


                                                                                       Medical Investigator



                                                                                       Medical Investigator



                                                                                       Medical Investigator



                                                      MISSION

The mission of the Medical Examiner's Office is to provide the citizens of Snohomish County
a modern medicolegal death investigation system and to assure that their interests and those of
their loved ones are safeguarded during their time of personal loss.

                                                      PURPOSE

The primary purpose of the Snohomish County Medical Examiner's Office is to determine the
cause and manner of death of persons who die suddenly, violently, or unexpectedly while in
apparent good health within the geographic boundaries of the county and who fall under the
jurisdiction of the Medical Examiner. (RCW 68.50).




                                                      -3-
                                  FUNCTION AND ROLE

The main function of the Medical Examiner (ME) is the determination of the cause and manner
of death which are of concern to the public health, safety and welfare. The investigation and
determination of cause and manner of death is performed by a highly trained technical staff of
forensic pathologists and the application of modern medicine and forensic science to the death
investigation process. There are several reasons why an accurate determination of the cause
and manner of death is essential to our society:

   1. The innocent shall be exonerated.
   2. Murder shall be recognized.
   3. Criminal and civil court proceedings will be provided with documented, sound and
      impartial medical evidence.
   4. Unrecognized hazards to public health and safety shall be revealed.
   5. Industrial hazards shall be exposed.

        SEPARATE AND INDEPENDENT AUTHORITY AND JURISDICTION

While the ME works hand-in-hand with law enforcement, the Prosecuting Attorney and
various health agencies, we have fully separate and independent authority and jurisdiction over
the medical investigation of deaths, including, but not limited to:
           • Apparent natural deaths,
           • Accidents,
           • Suicides,
           • Homicides,
           • Officer involved and in-custody deaths,
           • Deaths of children.

                               LEGISLATIVE AUTHORITY

The jurisdiction of the Medical Examiners established by Washington State Law and
Snohomish County Code:

RCW 36.16 -- County Officers
RCW 36.24 -- County Coroner
RCW 36.39 -- Disposition of Indigent Remains
RCW 68.50 -- Human Remains
RCW 73.08.070 -- County Burial of Indigent Deceased Veterans
WAC 248-40-040 -- Handling and Care of Human Remains
WAC 248-40-050 -- Transportation of Human Remains
SCO 87-042 -- Snohomish County Medical Examiner
SCO 93-107 -- Disposition of Unclaimed Remains




                                          -4-
                                 EXPLANATION OF TERMS


Death Investigations, Autopsies and Inspections
The Medical Examiner’s statutory functions include but are not limited to the investigation of
death and performance of postmortem examinations, as set forth in the statutes of the State of
Washington.

The Medical Examiner has statutory authority to perform postmortem examinations. These
include examinations of bodies at scenes, external examinations (called inspections) and
forensic autopsies (external and internal examinations) at the Medical Examiner's Office.
Dental and anthropological examinations and collection of physical material or samples having
potential evidentiary value may be a part of the examinations. The term autopsy means to "see
for one's self". The purpose of dissection of the human remains is to allow direct observation
of the body by the pathologist. The autopsy involves observing the external and internal
structures of the body to gain information about that individual and that individual's death.
Family permission is not required by the Medical Examiner, as it is in a hospital setting. This
allows the Medical Examiner to function independently to serve the public. The goals of the
forensic autopsy are to discover information that cannot be obtained in other ways, to provide
independent confirmation of what is known or suspected, and to provide a variety of means of
documenting findings. It is not required to perform autopsies in all cases. The authority to
perform autopsies is used judiciously where the examinations are needed to gather information
critical to the investigation in the interest of the general public. In cases of natural death, where
a forensic autopsy is not indicated by the Medical Examiner, arrangements for private
(hospital-type) autopsies may be sought by the family or by a physician with family
permission.

Death Certification
The Medical Examiner's office does not issue death certificates; Vital Records (Vital
Statistics/Public Health Department) issue death certificates. The vast majority of deaths in
Snohomish County are due to natural causes. Most deaths can and should be certified by one
of the deceased individual's physicians. The Medical Examiner's Office is only responsible for
completing a limited number of entries on the death certificate form in cases of sudden or
violent death. Further entries are the responsibility of the funeral director and the local Vital
Records Registrar. The completed death certificate is filed with Vital Records. Copies of
death certificates may only be obtained from Vital Records. Certification of the cause and
manner of death by the Medical Examiner follows the guidelines established by the
Washington State Department of Health and the National Center for Health Statistics of the
Centers for Disease Control and Prevention. The certification of cause and manner of death is
based on the preponderance of evidence (more probable than not, or reasonable medical
probability, not necessarily beyond everyone's doubt). No Medical Examiner case is ever
"closed". If new information concerning a past case is provided to the Medical Examiner, the
information will be reviewed and considered. If the new information changes the
preponderance of evidence, the entries on the death certificate can be amended. If the new
information does not change the preponderance of evidence, the death certificate entries remain
as is.



                                             -5-
Cause of Death
The cause of death statement is used to indicate the medical cause of death, listing the
disease(s) or injuries that caused death. Specific cause of death information is recorded on the
death certificate and is entered into the Vital Statistics System of the State of Washington.
Sudden Infant Death Syndrome (SIDS) is used as a cause of death listing for cases of sudden
death during infancy (first 12 months of life) that meet current criteria and have no competing
cause of death identified by autopsy, review of medical history, or scene investigation. Why
an accident occurred, why a person took their own life, or why someone killed another person
are not causes of death for death certification purposes.

Manner of Death: Classifications
The only death certificate options for the classification of manner of death are: Natural (the
manner section may be left blank on the death certificate), Accident, Suicide, Homicide, and
Undetermined. The determination of manner of death is made by the Medical Examiner for
death certification purposes based upon the preponderance of available evidence. The manner
of death designation represents the Medical Examiner's effort to condense the action(s) and
events that led to a person's death into one of five State determined categories. It is used for
statistical purposes and is not intended as a social or moral statement about the death, about the
deceased person, or anyone else involved in the events leading to death (not a value judgment).
It is an objective assessment of the action and events leading to death, based on knowledge of
the individual case, and the professional experience of a physician formally trained as a death
investigator.

Natural is defined as caused solely by disease. If natural death is hastened by injury (such as a
fall or drowning in a bathtub), the manner of death is not considered natural.

Accident is defined for Medical Examiner death certification purposes as an unnatural death
resulting from an inadvertent chance happening. Traffic related fatalities (involving vehicles
used for transportation on any public roadway) are classified as accidents. Deaths related to
the deliberate or purposeful use of vehicles as weapons, rather than transportation, are
classified as homicides. On-the-job injury related deaths are referred to as industrial deaths
and are classified as accidents. Illicit drug or excessive medication use-caused deaths, in the
absence of evidence specifically supporting the conclusion of the manner of death being
homicide or suicide, are classified as accident. Traffic deaths are a subset of accidental deaths,
but deaths resulting from traffic accidents are reported separate from other accidental deaths
for statistical purposes. A traffic death is defined as an unintentional death of driver,
passenger, or pedestrian involving a motor vehicle on public roadways. Accidents involving
motor vehicles on private property (such as driveways) are not included in this category and
are classified non-traffic vehicular deaths. Complication of Therapy (COT) deaths are a
subset of accidental deaths occurring during, or predominantly due to complications of
medical/surgical therapeutic or diagnostic procedures.

Suicide is defined for Medical Examiner death certification purposes as a death from self-
inflicted injury with some form of evidence of intent to die. It must be understood that a
"suicide note" is found in the minority (well less than half) of all suicide deaths. Self-inflicted
contact/close range gunshot wounds (particularly of the head, chest, or abdomen) are



                                             -6-
recognized as having very high potential for lethality, and are considered to be implicit
evidence of intent to take one’s life.

Homicide as used for the Medical Examiner's certification of manner of death is defined as the
action of one person directly causing the death of another or a death that occurs during and is
related to the commission of a felony. A violent death may stem from some kind of deliberate
or purposeful action, but intent to cause death need not be present or proven for the
classification of the manner of a death as homicide. Homicide and murder are not the same.
All murders are homicides, not all homicides are murder. "Murder" is not an acceptable
manner of death classification for death certification purposes; it is a term used under specific
conditions in criminal law.

Undetermined is listed as the manner of death classification in only a small number of cases
each year. Undetermined is an appropriate designation for cases that have very little available
information about the circumstances surrounding death (e.g., partial skeletal remains) or where
known information equally supports, or conflicts with, more than one manner of death. An
undetermined manner of death is assigned to cases of unnatural death when a clear
preponderance of evidence supporting a specific manner (homicide, accident, or suicide) is not
available.

Pending Investigation may be listed temporarily on the death certificate for cause and/or
manner when additional investigation, information and/or test results are required for
certification.




                                           -7-
                                     DEATH INVESTIGATIONS

A total of 2191 deaths were reported to the Medical Examiner's Office in 2002. This
represents 62% of the 3,548 deaths that occurred in Snohomish County in 2002. Each reported
case received basic investigative review. No jurisdiction was assumed (NJA cases) in 1,655
deaths. Jurisdiction was assumed (SCME cases) and further investigations and medical history
review were conducted in 533 deaths. Postmortem examinations by forensic pathologists
(autopsies and external inspections) were conducted in 415 cases including 306 cases for which
autopsies were performed. Toxicology examinations were obtained and completed for 384
cases.


                    CASES REPORTED TO MEDICAL EXAMINER’S OFFICE

                                                      2000        2001       2002
           SCME                                        562         508        533
           NJA                                        1585        1639       1655
           Total Reported                             2147        2147       2191
           Total Deaths in County                     3824        3967       3991
           Population                              606,024     618,603    628,003
           Percent Reported per population           0.4%        0.3%       0.3%
           Percent SCME cases per total deaths        56%         54%        55%


SCME statistics include deaths that occurred outside of Snohomish County but were examined
by SCME as follows: 7 cases in 2000, 8 cases in 2001 and 2 cases in 2002. Three (3) indigent
cases are included in 2002 “Total Reported” deaths, for which only disposition arrangements
were performed.




                                          -8-
                                      MANNER OF DEATH

Natural causes account for the vast majority of the 3,548 deaths in Snohomish County in 2002.
Natural causes accounted for 41% (216) of the deaths of the 2,191 cases investigated by the
Medical Examiner’s Office. Accidents, including Traffic and Complication of Therapy,
accounted for 41% (218).


                    2002 Deaths Investigated by Manner of Death
                            including Traffic Accidents
                                          Undetermined,
                                               3%
                          Homicides, 2%
                                                           Accident, 41%
                     Suicide, 13%




                       Natural, 41%




                                           -9-
                         CASES OF JURISDICTION ASSUMED (SCME)

Manners of Death                                 2000          2001          2002
Natural, Excluding SIDS                          253           219           208
   • SIDS                                          5             9             8
Accident, Non-Traffic                            151            131           169
   • Traffic Accidents                            38            45            46
   • Complication of Therapy                       2             1             3
Suicide                                           84            67            68
Homicide                                          13            14            13
Undetermined                                      16            22            18
Total Cases                                      562           508           533

                                    AUTOPSIES PERFORMED

Manners of Death                                 2000          2001          2002
Natural, Excluding SIDS                          130           106            98
   • SIDS                                          5             9             8
Accident, Non-Traffic                             83            54            92
   • Traffic Accidents                            38            41            38
   • Complication of Therapy                       1             1             3
Suicide                                           45            33            37
Homicide (Includes two out of county)             13            14            13
Undetermined                                      14            21            17
Total Cases                                      329           279           306

                               MANNER OF DEATH BY GENDER

Manner of Death                              2000              2001            2002
                                         Male     Female   Male   Female   Male Female
Natural                                  176        77     151       68    150       58
   • SIDS                                  3         2       4        5      7        1
Accident                                  78        73      62      69      81      88
   • Traffic                              31         7      28       17     32       14
   • Complication of Therapy               2         0       0        1      1        2
Suicide                                   64        20      51       16     54       14
Homicide                                  8         5       11       3      9        4
Undetermined                              10        6       12      10      7       11
Totals                                   372       190     319      189    341      192




                                        - 10 -
                     Snohomish County Geographical Areas 2002
                Natural   Accident   Traffic     COT   Suicide   Homicide   Undetermined   Sum
Arlington          12         9         0         0       3          0            0         24
Brier               1         0         0         0       1          0            0          2
E. County          11        11        13         0       7          1            2         45
N. County          20        18         9         0      12          3            0         62
S. County          28        14         4         0      15          1            3         65
Darrington          1         2         0         0       0          0            0          3
Edmonds            22        16         3         1       7          0            0         49
N. Everett         50        34         8         2       6          2            1        103
S. Everett         15        21         3         0       4          0            6         49
Goldbar             0         1         0         0       0          0            0          1
Granite Falls       1         2         0         0       0          0            1          4
Lake Stevens        0         1         0         0       0          0            0          1
Lynnwood            8        11         2         0       1          1            2         25
Marysville         13        10         0         0       4          2            1         30
Mill Creek          1         0         0         0       1          0            1          3
Mtlk Terrace        8         2         0         0       1          0            0         11
Monroe             13         6         1         0       2          1            1         24
Mukilteo            2         1         0         0       2          0            0          5
Snohomish           4         8         2         0       1          0            0         15
Stanwood            3         2         1         0       1          0            0          7
Sultan              3         0         0         0       0          0            0          3
Woodinville         0         0         0         0       0          0            0          0
Skagit              0         0         0         0       0          2            0          2
Total             216       169        46         3      68         13           18        533




                                        - 11 -
                     Snohomish County Geographical Areas 2001
                Natural   Accident   Traffic     COT   Suicide   Homicide   Undetermined   Sum
Arlington          12         7         1         0       1          0            0         21
Brier               1         0         1         0       1          0            0          3
E. County          11         3        10         0       5          0            3         32
N. County          27         9         8         0       6          4            2         56
S. County          28         9         3         0      10          6            0         56
Darrington          3         0         0         0       0          0            0          3
Edmonds            20        20         0         1       5          0            3         49
N. Everett         50        32         5         0       5          2            5         99
S. Everett         18        19         5         0      13          1            1         57
Goldbar             0         0         0         0       1          0            0          1
Granite Falls       2         1         1         0       2          1            2          9
Lake Stevens        2         0         0         0       0          0            0          2
Lynnwood           11         4         0         0       4          0            0         19
Marysville          8         7         4         0       5          0            2         26
Mill Creek          3         0         0         0       1          0            0          4
Mtlk Terrace        3         3         0         0       2          0            0          8
Monroe             10         2         2         0       2          0            0         16
Mukilteo            4         4         0         0       1          0            1         10
Snohomish           7         4         4         0       3          0            0         18
Stanwood            4         4         0         0       0          0            0          8
Sultan              1         0         0         0       0          0            1          2
Woodinville         0         0         1         0       0          0            0          1
San Juan            3         1         0         0       0          0            2          6
Skagit              0         2         0         0       0          0            0          2
Total             228       131        45         1      67         14           22        508




                                        - 12 -
                 Snohomish County Geographical Areas 2000
                Natural   Accident   Traffic     COT   Suicide   Homicide   Undetermined   Sum
Arlington           8         7         1         0       0          0            1         17
Brier               0         0         0         0       1          0            0          1
E. County          22        12        11         0       7          2            0         54
N. County          27        16         6         0      13          2            3         67
S. County          25        12         2         0      15          2            5         61
Darrington          0         0         0         0       0          0            0          0
Edmonds            24        27         1         0       2          1            2         57
N. Everett         54        31         3         1       7          2            2        100
S. Everett         33        13         1         0      10          4            1         62
Goldbar             1         0         0         0       1          0            0          2
Granite Falls       1         0         0         0       0          0            0          1
Lake Stevens        1         0         0         0       0          0            0          1
Lynnwood           17         6         2         0       7          0            0         32
Marysville         11         8         2         0       6          0            0         27
Mill Creek          1         0         0         0       0          0            0          1
Mtlk Terrace        6         1         0         0       2          0            0          9
Monroe             16         5         4         1       3          0            0         29
Mukilteo            4         2         0         0       2          0            0          8
Snohomish           4         5         3         0       4          0            1         17
Stanwood            1         4         0         0       1          0            1          7
Sultan              0         0         1         0       1          0            0          2
Woodinville         0         0         0         0       0          0            0          0
San Juan            2         2         1         0       2          0            0          7
Skagit              0         0         0         0       0          0            0          0
Total             258       151        38         2      84         13           16        562




                                        - 13 -
                     Manner of Death: Natural Deaths

The Medical Examiner has jurisdiction over the investigation of deaths that are
determined to be from natural causes when death occurred suddenly, when in
apparent good health, when no other physician is available to certify death, the
death occurs in jail or prison, or the body is unclaimed.

In 2002, the Medical Examiner’s Office investigated 216 natural deaths, including 8
Sudden Infant Death Syndrome (SIDS) deaths.

Natural causes account for 41% of deaths investigated by the Snohomish County
Medical Examiner’s Office. Various forms of cardiovascular disease are the
leading cause of natural deaths. Specific cause of death information is recorded on
the death certificate and is entered into the Vital Statistics System of the State of
Washington.



                  2002 Natural Deaths by Disease Category
                   Deaths Certified by Medical Examiner

                    Cardiovascular                138
                    Central Nervous System         13
                    Diabetes                        3
                    Gastro-Intestinal               4
                    Infectious Disease              5
                    Kidney                          2
                    Liver                          11
                    Malignancy                      6
                    Respiratory                    17
                    SIDS                            8
                    Unknown                         2
                    Other                           7




                               - 14 -
                            Natural Deaths by Gender

                   200

                   150

                   100

                       50

                       0
                              2000            2001      2002
               Males           179            155       157
               Females         79             73        59




                                  Natural Deaths
                                By Age and Gender

                     2000                     2001          2002
Years of Age     Male Female              Male Female   Male Female
    0-9            9      3                 4       9     8       1
   10-19           0      0                 3       0     2       2
   20-29           2      0                 3       0     1       1
   30-39          13       4               12       2     7       5
   40-49          37      16               32      13    31      10
   50-59          48      10               40      10    49      11
   60-69          30      10               31      16    31       6
   70-79          19      13               17      11    19       7
    80+           21      23               13      12     9      16
   Total         179      79              155      73   157      59




                                 - 15 -
                               Manner of Death: Accident
There were 218 accidental deaths in Snohomish County in 2002 including Traffic
Accidents. Accidental deaths account for 41% of deaths investigated. Included in this
number are 169 non-traffic deaths, 46 traffic caused deaths, and 3 deaths caused by
complications of therapy. For statistical purposes, traffic and complication of therapy
deaths and reported separately.

Non-traffic accidental deaths increased 20% in 2002 over the average of the prior two
years. Of the 169 non-traffic accidental deaths in Snohomish County in 2002, 44% (74
deaths) involved falls as a cause or contributory factor with 95% (70 deaths) involving
falls occurring in people over 60 years of age. Thirty-six percent (36% or 61 deaths)
involved drugs as a cause or contributing factor. These drug caused deaths represent an
82% increase over the average of the prior two years and account for the 20% increase
in accidental deaths. Fifty-one percent (51%) of the 2002 drug caused accidental
deaths occurred in people between the age of 40 and 49.

                   Non-Traffic Accidental Deaths by Gender

                       100



                          50



                          0
                                  2000           2001       2002
                  Males            78            62           81
                  Females          73            69           88



                                Non-traffic Accident Deaths
                                   By Age and Gender

                     2000                         2001                 2002
Years of Age     Male Female                  Male Female          Male Female
    0-9            1      2                    1       0            2       1
   10-19           2      2                    0       0            1       0
   20-29           8      2                    3       1            3       3
   30-39           4       4                    9       4           14       9
   40-49          26       8                   13       5           27      14
   50-59           4      6                    3       6            6       5
   60-69           5      1                    5       4            7       2
   70-79          12      7                    3        6            7      12
    80+           16      41                   25      43           14      42
   Total          78      73                   62      69           81      88


                                     - 16 -
2002 Non-Traffic Accidental Deaths by Age
         (Age, Number of Deaths)


                          0-19, 4
                                       20-39, 29
80+, 56




                                            40-59, 52
     60-79, 28




 Non-Traffic Accidents by Geographical Area

                     2000     2001   2002
  Arlington          7        7      9
  E. County          12       3      11
  N. County          16       9      18
  S. County          12       9      14
  Darrington         0        0      2
  Edmonds            27       20     16
  N. Everett         31       32     34
  S. Everett         13       19     21
  Goldbar            0        0      1
  Granite Falls      0        1      2
  Lake Stevens       0        0      1
  Lynnwood           6        4      11
  Marysville         8        7      10
  Mtlk Terrace       1        3      2
  Monroe             5        2      6
  Mukilteo           2        4      1
  Snohomish          5        4      8
  Stanwood           4        4      2
  San Juan           2        1      0
  Skagit             0        2      0
  Total              151      131    169




                 - 17 -
                Non-traffic Accident Deaths by Cause of Death
                          Deaths Certified by Medical Examiner

                                     2000            2001        2002
        Method of Death             Count           Count        Count
Fall (cause or contributing)          77              79           74
Drug(s)                              39              27           61
Alcohol                               4               6            5
Blunt force                           0               1            4
Fire                                  8               3            3
Choking                               2               3            5
Drowning                              6               6            5
Carbon Monoxide                       2               1            0
Airplane or Helicopter                5               0            3
Mechanical Asphyxia                   1               1            2
All Terrain Vehicle (ATV)              0               1            1
Train                                 1               1            1
Work Related                          1               1            1
Chemical Burn                         0               1            0
Other                                 5               0            4
Total                                151             131          169




                                   - 18 -
                2002 Non-traffic Accidental Deaths Caused by Drugs

Fifty-one percent (51%) of the 61 of the drug caused accidental deaths occurred in
people between the age of 40 and 49.


                         2002 Accidental Drug Deaths by Age
                                  by Age and Count




                                       60+, 1 0-19, 1
                          50-59, 7                         20-29, 6

                                                                      30-39, 15



                      40-49, 31




                         Accidental Deaths Caused by Drugs
                                By Age and Gender

                         2000                        2001                    2002
 Years of Age     Male     Female             Male     Female         Male     Female
     0-9            0         0                0          0            1          0
    10-19           0         0                0          0            0          0
    20-29           4         1                2          1            3          3
    30-39           5         2                7          3            7          8
    40-49          20          6               13          8           20         11
    50-59           2         4                1          4            3          4
    60-69           1         0                0          2            1          0
    70-79           1         0                0          0            0          0
     80+            0          0                0          1            0          0
    Total          33         13               23         19           35         26




                                     - 19 -
Drugs Identified in Non-traffic Accidental Deaths

         Drug         2000 2001 2002
    Acetaminophen       0    1    4
      Alprazolam        0    1    3
     Amitriptyline     6     6    4
    Benzodiazepine      0    0    1
       Bupropion        1    0    1
       Butalbital       1    0    2
    Carbamazepine       0    0    2
     Carisoprodol       2    1    2
   Chlordiazepoxide     3    0    1
   Chlorpheniramine     0    0    1
    Chlorpromazine      0    0    1
      Citalopram        3    3    3
     Clomipramine       0    0    1
        Cocaine        19    7   19
        Codeine         1    0    0
   Cyclobenzaprine      0    2    2
      Desipramine       0    0    1
  Dextromethorphan      0    0    4
       Diazepam         7    0    7
       Diltiazam        1    4    0
Dioxymethamphetamine    2    0    0
   Diphenhydramine      2    1    5
        Doxepin         1    1    2
      Doxylamine        1    0    1
        Ethanol        10    9   18
        Fentanyl        1    1   2
     Fluorocarbon       0    0    1
       Fluoxetine       1    1    3
      Gabapentin        0    2    1
      Hydrocone         3    3    6
    Hydromorphone       0    1    0
       Ibuprofen        1    0    0
      Lorazepam         0    1    1
      Manganese         0    0    1
        MDMA            0    0    1
     Meprobamate        1    1    0
       Methylene        1    0    0
      Methadone        11   10   19
   Methamphetamine      0    2    7
Methocarbamol       0     2    0
 Metoprolol         0     0    1
 Midazolam          0     0    1


                - 20 -
      Continuation of Drugs Identified as Non-traffic Accidental Deaths

                         Drug                 2000          2001    2002
                     Mirtazepine                0            1       2
                      Naproxen                  0            1       2
                     Nefazodone                 0             0       2
                    Nordiazepine                1            0        1
                   Norpropoxyphene              0            0        1
                     Nortriptyline              1             0       0
                     Olanzepine                 1            0        1
                        Opiates                16            8       25
                     Oxycodone                  8            6       13
                      Papaverine                1            0        0
                      Paroxetine                1            2        1
                    Phenobarbital               0             0       1
                    Promethazine               0             1       2
                    Propoxyphene                0            2        4
                     Propranolol                0            0        1
                     Quaifenesin               0             1       0
                      Salicylates               0            1        1
                       Sertraline               3            0        2
                     Temazepam                  0            2        0
                     Topiramate                 1            0        1
                       Tramadol                 0            1        0
                      Trazodone                 1            6        3
                    Valproic Acid               0            0        1
                     Venlafaxine                1            1       0
                      Verapamil                 0            1        1
                       Zolpidem                 0            0        2

Note: Most drug caused deaths involve combined drugs, therefore, the number and
variety of drugs identified does not directly correlate to the number of drug caused
deaths.

                      General Classification of Drugs
              Anti-anxiety                        14
         Anti-depressant                                      25
       Sedative Hypnotic             6
       Narcotic Analgesic                                                  45
                  Opiates                                     25
          Anti-convulsant            7
               Stimulants                                      27
           Anti-histamine                9
            Non-narcotic                     11
        Muscle Relaxants         4
                  Ethanol                              18
                    Other            7



                                     - 21 -
                         MANNER OF DEATH: TRAFFIC
                             (A subset of Accident)


The Snohomish County Medical Examiner investigated 46 fatalities involving motor
vehicles on public roadways in 2002. Traffic accidents account for 21% of all 2002
accidental deaths. Thirteen (13) driver deaths involved alcohol; twelve (12) were at or
over the legal limit of “.08” alcohol level.

                                   Traffic Accident

                      2000                      2001                2002
 Years of Age     Male Female               Male Female         Male Female
     0-9           2       0                 0       1           0       0
    10-19          6       0                 5       2           3       3
    20-29          7       2                 3       2           10      2
    30-39          4       2                 6       3           3       1
    40-49          8       0                 8       5           8       4
    50-59          2       1                 4       1           3       2
    60-69          0       0                 0       0           1       0
    70-79          1       0                 2       1           3       2
     80+            1      2                 0       2           1       0
    Total          31      7                 28      17          32      14

                              Traffic by Geographic Area

                                        2000     2001   2002
                      Arlington              1     1      0
                      Brier                  0     1      0
                      E. County             11    10     13
                      N. County              6     8      9
                      S. County              2     3      4
                      Edmonds                1     0      3
                      N. Everett             3     5      8
                      S. Everett             1     5      3
                      Granite Falls          0     1      0
                      Lynnwood               2     0      2
                      Marysville             2     4      0
                      Monroe                 4     2      1
                      Snohomish              3     4      2
                      Stanwood               0     0      1
                      Sultan                 1     0      0
                      Woodinville            0     1      0
                      San Juan               1     0      0
                      Total                 38    45     46


                                   - 22 -
                     Traffic Accidents

                      2000        2001    2002
 ATV                     0           1       1
 Bicycle                 0           0       1
 Motorcycle              3           3       1
 Driver                 25          24      32
 Pedestrian              1           3       4
 Passenger               9          12       7
 Train                   0          1       0
 Unknown                 0           1       0



             2002 Traffic Accidents

                                  Pedestrian,
                    Bicycle, 1        4
                                            ATV, 1
                                              Passenger,
                                                   7

                                             Motorcycle,
Driver, 32                                       1




     Traffic Fatalities Blood Alcohol Levels


              Driver Blood Alcohol Levels

        6

        4

        2

        0
              <.08      .08-.14 .15-.19    .20-.25   >.25
     2000       2             2       3       5       1
     2001       0             2       3       4       0
     2002       1             3       2       3       4




                     - 23 -
                                 Manner of Death: Suicide

A death is classified as suicide when it is the result of non-accidental, self-inflected
injury or injuries. Snohomish County Medical Examiner investigated 68 suicide deaths
in 2002 of which 29 or 43% of the decedents were between 20 and 39 years of age.




                                    Suicide Deaths

                        80

                        60

                        40

                        20

                        0
                                 2000               2001           2002
                Males             64                    51         54
                Females           20                    16         14




                             2000                       2001               2002
 Years of Age     Male         Female            Male     Female    Male     Female
     0-9            0             0                0         0        0         0
    10-19           2             1                3         0        6         0
    20-29          11             4                6          1      13          1
    30-39          11             5               11         4       10         5
    40-49          18              5               7          3       7          3
    50-59           8             3               14          5       5          1
    60-69           5             1                3         1        6         1
    70-79           6             1                5         1        4         2
     80+            3              0               2          1       3          1
    Total          64             20              51         16      54         14




                                        - 24 -
  2002 Suicide Methods of Death

                            Overdose, 7
     Misc., 5                              Carbon
                                          Monoxide, 4
Hanging, 23


                                       Gunshot, 29




              Suicide by Geographic Area

                       2000     2001   2002
       Arlington            0   1          3
         Brier              1   1          1
      E. County             7   5          7
      N. County            13   6         12
      S. County            15   10        15
       Edmonds              2   5          7
      N. Everett            7   5          6
      S. Everett           10   13         4
       Goldbar              1   1          0
     Granite Falls          0   2          0
      Lynnwood              7   4          1
      Marysville            6   5          4
      Mill Creek            0   1          1
     Mtlk Terrace           2    2         1
        Monroe              3   2          2
       Mukilteo             2   1          2
      Snohomish             4   3         1
      Stanwood              1    0         1
        Sultan              1   0          0
       San Juan             2    0         0
         Total             84   67        68




                  - 25 -
                            Manner of Death: Homicide

When the life of a person is taken by another through violent means, the death is
classified as Homicide. In 2002, 11 of the homicide deaths were in Snohomish County
and 2 homicide deaths occurred in Skagit County.


                               Homicide Deaths

                       15

                       10

                       5

                       0
                             2000             2001         2002
               Males           8               11           9
               Females         5                3           4




                       2000                   2001                2002
Years of Age    Male     Female        Male     Female     Male     Female
    0-9          1          0            1         0        1          0
   10-19         3          0            1         2        1          2
   20-29         1          2            5         0        2          1
   30-39         1          3            0         1        2          0
   40-49         1          0            2         0        2          0
   50-59         1          0            0         0        1          0
   60-69         0          0            1         0        0          1
   70-79         0          0            0         0        0          0
    80+          0          0            0         0        0          0
   Total         8          5           10         3        9          4

Note: One male homicide victim was unidentified in 2001. This was a Skagit County
case.




                                   - 26 -
      2002 Homicide by Method


                            Strangulation, 1
 Beating, 4


                                         Gunshot, 5

     Stabbing, 3




     Homicides by Geographic Area

                   2000       2001     2002
 E. County              2      0        1
 N. County              2      4        3
 S. County              2      6        1
 Edmonds                1      0        0
 N. Everett             2      2        2
 S. Everett             4      1        0
Granite Falls           0      1        0
 Lynnwood               0      0        1
 Marysville             0      0        2
 Mill Creek             0      0        0
  Monroe                0      0        1
   Skagit               0      0        2
    Total              13      14       13




              - 27 -
                            Manner of Death – Undetermined

Drugs caused or contributed to nine (9) of the 18 Undetermined deaths. Because of the
inherent private and secretive nature of drug use, the exact circumstances leading to fatal
drug toxicity are often not clearly defined and the manner (whether Suicide or Accident)
could not be determined.


                              Undetermined Deaths


                       15

                       10

                        5

                        0
                                  Male              Female
                    2000           10                   6
                    2001           12                  10
                    2002            7                  12




                     2000                     2001                    2002
Years of Age     Male Female             Male   Female           Male   Female
    0-9            2      0                0        0             1         2
   10-19           0      0                0        0             1         0
   20-29           2      0                2        2             0         1
   30-39           2      2                3        0             1         2
   40-49           1      2                5        7             3         5
   50-59           3      1                2        0             1         1
   60-69           0      0                0        0             0         0
   70-79           0      1                0        0             0         0
    80+            0      0                0        1             0         0
   Total          10      6               12       10             7        11




                                    - 28 -
                        2002 STATISTICS
          SNOHOMISH COUNTY MEDICAL EXAMINER’S OFFICE



            Description                       Count      Percentage
Total Population in Snohomish County         628,000
Deaths in Snohomish County                     3,991
Deaths Reported to Medical Examiner            2,191 55% of deaths in county
Cases where No Jurisdiction Assumed             1655 76% of deaths reported
(NJA)
Deaths Investigated (SCME)                      533 24% of deaths reported
Scenes Investigated                             434 82% of cases investigated
Bodies Transported to the Morgue                421 79% of cases investigated
External examinations
Cases where toxicology performed                384 72% of cases investigated
Autopsies                                       306 14% of deaths reported
Autopsies      performed       for outside        2 0.6 % of autopsies
jurisdictions
Deaths certified as natural (including 8        216 10% of deaths reported
SIDS)
Naturals autopsied                              106 49% of Naturals
Deaths certified as Accidents                   218 10% of deaths reported
(including 46 traffic& 3 condition of
therapy)
Accidents autopsied                             133   61% of Accidents
   Deaths certified as Traffic                   46   9% of deaths reported
   Traffic autopsies                             38   83% of Traffics
   Complication of Therapy COT                    3   0.1% of deaths reported
   COT autopsied                                  3   100% of COTs
Deaths certified as suicide                      68   3% of deaths reported
Suicides autopsied                               38   56% of Suicides
Deaths certified as homicide                     13   0.6% of deaths reported
Homicides autopsied                              13   100% of Homicides
Deaths certified as Undetermined                 18   0.8% of deaths reported
Undetermined autopsies                           17   94% of Undetermined
Unclaimed or Indigent bodies                      3
Organ Tissue




                               - 29 -

								
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