sf.coroner.report.2007-2008 by auweia

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									Office of the Chief Medical Examiner
 City and County of San Francisco




          Annual Report
     Fiscal Year 2007 – 2008



                                            Amy P. Hart, MD
                                     Chief Medical Examiner


                                 Stephen R. Gelman
                     Medical Examiner’s Administrator

               Report prepared by: A.M. Gordon, Forensic Laboratory Manager
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




                                    TABLE OF CONTENTS

 Introduction.             ... ............         ………………………….                         1–4

 General Information                                ………………………….                       5 – 20

                                Budget               …………………………                            5
                   Organizational Chart              …………………………                            6
                   General Information               …………………………                       7 – 21
 Deaths in San Francisco FY 2007-2008                …………………………                       7 – 8
                         Demographics                …………………………                      10 –18
   Overview and Ten Year Perspective                 …………………………                      19 – 21

 Manner of Death                                    ………………………….                      22– 98

               Manner of Death - Overview            …………………………                      22 – 23

                     Accident (Non-Vehicular)        …………………………                      24 – 37
                                Demographics         …………………………                      24 – 27
                                     Methods         …………………………                      27 – 31
                        Drug-Related Deaths          …………………………                      31 – 34
                          Fall-Related Deaths        …………………………                      34 – 36
                                        Other        …………………………                           37

                    Homicide (Non-Vehicular)         …………………………                      38 – 51
                                Demographics         …………………………                      39 – 42
                                      Methods        …………………………                      42 – 44
                              Firearm-Related        …………………………                      44 – 47
                          Sharp Injury-Related       …………………………                      47 – 49
                    Blunt-Force Injury-Related       …………………………                      49 – 51

                      Suicide (Non-Vehicular)                                        52 – 70
                               Demographics          …………………………                      52 – 56
                                     Methods         …………………………                      56 - 58
                                 Drug-Related        …………………………                      58 – 61
                                Jump-Related         …………………………                      61 – 64
                                     Hanging         …………………………                      65 – 67
                             Firearm-Related         …………………………                      67 – 70




Table of Contents                                                                      Page i
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Manner of Death (continued)                        ………………………….                      22 – 98

                            Vehicular Deaths    ………………………………                         71 – 86
                              Demographics        …………………………                         71 – 75
                                    Methods       …………………………                         75 – 76
                                      Drivers     …………………………                         76 – 80
                                 Passengers       …………………………                         80 – 83
                                 Pedestrians      …………………………                         83 – 86

            Undetermined (Non-Vehicular)        ………………………………                         87 – 91
                     General Information          …………………………                              87
                          Demographics            …………………………                         87 – 90
                                Methods           …………………………                         90 – 91

                                    Natural                                          92 – 98
                              Demographics          ………………………….                      92 – 95
                         Disease Description        ………………………….                      96 – 98

 Drugs Detected in Death                            ………………………….                    99 – 143
 Investigations

                         General Information         …………………………                          99
                         Incidence of Testing        …………………………                   100 – 101
                               Positive Rates        …………………………                   102 – 105

                          Drugs Detected             …………………………                  106   – 126
                      General Information            …………………………                  106   – 110
                Accident (Non-Vehicular)             …………………………                  110   – 115
               Homicide (Non-Vehicular)              …………………………                  116   – 117
                  Suicide (Non-Vehicular)            …………………………                  117   – 121
                                Vehicular            …………………………                  121   – 123
            Undetermined (Non-Vehicular)             …………………………                  123   – 124
                                  Natural            …………………………                  125   – 126

                    Drug Specific Information        …………………………                  127   – 143
                                      Ethanol        …………………………                  127   – 131
                                     Cocaine         …………………………                  132   – 135
                         Narcotic Analgesics         …………………………                  135   – 138

Table of Contents                                                                      Page ii
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



 Drugs Detected in Death                            ………………………….                     99 - 143
 Investigations (continued)

                        Methamphetamine              …………………………                  138 – 141
                        Drug Combinations            …………………………                  141 - 143

 Forensic Laboratory                                ………………………….                   144 – 146

                     Workload Parameters             …………………………                        144
                                  Histology          …………………………                  144 – 145
                Toxicology - Other Services          …………………………                  145 – 146

                                  Firearms          ………………………….                   147 – 154

                   General Information               …………………………                        147
            Firearm Deaths by Manner                 …………………………                  148 – 149
                        Demographics                 …………………………                  150 – 153
 Firearm Deaths & Drugs and/or Alcohol               …………………………                  151 – 153

                        Childhood Deaths            ………………………….                   155 – 159

                       General Information           …………………………                         155
                           Demographics              …………………………                   156 – 157
                                 Homicide            …………………………                         158
                                  Accident           …………………………                         158
                                   Natural           …………………………                         159
                                   Suicide           …………………………                         159
                           Undetermined              …………………………                         159
                                 Vehicular           …………………………                         159




Table of Contents                                                                    Page iii
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



____________________________________________________________

                         Introduction
____________________________________________________________


The Office of the Chief Medical Examiner (OCME) is mandated by State law to investigate and
certify all sudden, unexpected and/or violent deaths in the City and County of San Francisco. The
Chief Medical Examiner can utilize any and all medico-legal investigative techniques, including
autopsy, to establish both the cause and manner of death (natural, accident, homicide, suicide or
undetermined). Information presented herein is a compilation of the deaths for which the OCME
assumed jurisdiction during Fiscal Year 2007-2008. In addition to demographic information on
decedents, there is a review by cause and manner of deaths for Fiscal Year 2007-2008. For
purposes of comparison, a review of the data over the past ten years has been included (where
available) to reveal trends. This report includes sections which emphasize the role of alcohol,
drugs and firearm use in violent deaths and an overview of childhood deaths. Health agencies,
safety councils and lawmakers may find these statistics useful in understanding the most frequent
contributors to sudden, unexpected and violent deaths in San Francisco and may assist policy
decision makers in their efforts to improve the quality of life for the citizens of the City and County
of San Francisco.

The OCME serves the geographic area of the City and County of San Francisco. In 2007, the US
Census Bureau estimated the population of San Francisco to be 764,976. The Demographics of
that estimate are included here to add perspective to the Demographics of the decedents which
are investigated by the OCME. There were six thousand one hundred and forty-four (6216)
deaths reported to the San Francisco Public Health Department in Fiscal Year 2007-2008. Of
those, 4173 were reported to the Medical Examiner’s Office for a jurisdictional decision. The
Investigative Division of the OCME evaluates all reported cases to determine if the OCME should
accept or decline jurisdiction of the reported case. Of the 4179 cases reported to the OCME,
jurisdiction was assumed in 1279, (2 of which were later released to another jurisdiction) and
jurisdiction was released in 2805. This latter group are tracked and logged into the OCME
database as No Case (NC) cases. There were an additional 90 cases which were accepted by
the OCME as indigent deaths or for administrative purposed. These indigents are natural deaths
previously certified by non-OCME physicians. The remains of these decedents are accepted the
OCME for the sole purpose of disposition. Indigent deaths are included in the total number of
jurisdictional cases, but not in the numbers of investigated cases, because the death certificates
were previously signed by non-OCME physicians. It must be noted that this is a change from
annual reports prior to 2006-2007 fiscal year. Indigent deaths in earlier years were included in
OCME natural deaths in statistics. It is important to remember this when comparing this report to
those produced prior to Fiscal Year 2006 - 2007.




Introduction                                                                               page 1
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




The OCME is required to investigate and the following must be reported to the OCME.

          1. All known or suspected homicides
          2. All known or suspected suicides
          3. All deaths following accident or injury (whether the accident or injury is the
             primary cause or contributory, with death occurring immediately or at some
             remote time)
          4. All deaths without medical attendance of less than 20 days
          5. All deaths with no physician in attendance
          6. All deaths where a physician is unable to state the cause of death (must be
             unable, not merely unwilling)
          7. All deaths thought to be related to poisoning (food, chemical, drug and
             therapeutic agents)
          8. All occupational or industrial deaths
          9. All deaths in which the patient did not fully recover from an anesthetic, whether in
             surgery, recovery room, or elsewhere
         10. All deaths in operating rooms
         11. All solitary deaths (unattended by physicians or other person in the period
             immediately preceding death)
         12. All deaths in which the patient is comatose throughout the period of the
             physician's attendance
         13. All deaths of unidentified persons
         14. All deaths in which there are grounds to suspect that the death occurred in any
             degree due to a criminal act
         15. All deaths involving contagious disease - known or suspected - and constituting a
             possible public health hazard
         16. Deaths of all individuals who are incarcerated or under law-enforcement pursuit
         17. All deaths associated with a rape - known or alleged
         18. All deaths related to or following abortion - known or suspected
         19. All deaths involving drowning, fire, hanging, gunshot, stabbing, cutting, starvation,
             exposure, alcoholism, drug addiction, strangulation or aspiration

Additional mandated responsibilities include protecting and safekeeping of property belonging to
deceased individuals, maintaining proper public records, making reports to other agencies,
identification of deceased persons, interment of indigent dead, and many other death related
activities.

The demographics from individual cases are summarized and presented in aggregate form.
The demographic variables displayed in the tables such as race, sex, age group, etc., have been
selected as those most likely to assist use of this data to assemble a profile of death statistics for
those deaths examined by the OCME for Fiscal Year 2007-2008. For reference, the US Census
Bureau has estimated the racial distribution for San Francisco in 2007 to be 45.2% White (non-
Hispanic), 6.9% Black, 32.1% Asian/Pacific Islander, 14% Hispanic and 1.3% other. These
numbers are provided here are for general interpretation of data and cannot be specifically
related to the demographics of decedents investigated by the OCME.




Introduction                                                                               page 2
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



Age groups in these data are divided into youth and adult. The youth groups are infants (newborn
through 11 months), toddlers (1-5 years), grade school (6-12 years), junior high (13-16 years),
and high school (16-19 years). Adult age groups are in corresponding decades starting with 20-
29 and the last group including those aged 90 years old or older. For comparison, the US
Census Bureau estimated the 2007 San Francisco population to be 50.9% male, 5.2% were
under age 5, 14.3% were under 18 and 14.6% were 65 years or older.

The blood ethanol (alcohol) data and drug data included herein represents the blood levels at the
time of death. It must be understood that the ethanol (alcohol) concentration at the time of death
may not represent the ethanol concentration at the time of the incident which precipitated the
death if there was any survival period between the incident and the resulting death. Ethanol is
generally metabolized at a rate of 0.015 to 0.025 grams per 100 mL blood per hour. A significant
survival interval would result in a blood alcohol lower than it was at the time of incident which
precipitated the death. For these reasons, an unknown number of cases not tested or showing
no blood alcohol may actually have had a measurable alcohol concentration at the time of the
incident. Similar caveats must be applied to drug information with the additional understanding
that the extent of drug testing varies from case to case based upon the circumstances of the
death, the investigation and the autopsy results. Whenever possible, antemortem blood (blood
collected prior to death) is obtained and tested to provide a more accurate representation of
alcohol and drugs at the time of death. This is not always possible.

Traffic related fatalities are of special interest both at the local and national levels. The National
Highway Traffic Safety Administration (NHTSA) tracks traffic fatality statistics nationwide. Policy
recommendations and federal highway safety fund distribution rely upon these numbers. All
traffic or vehicular deaths are mannered as Accident, Homicide, Suicide or Undetermined but are
discussed together in this report in the section entitled Vehicular Deaths. This collection of traffic
fatality deaths is combined in order to draw focus to areas where public policy changes may
reduce the numbers of these types of preventable deaths. In the cumulative tabulations by
manner of death, traffic fatalities are included with the respective manner; however, in the
discussions for each manner of death they have been extracted (e.g. non-vehicular accidents)
and are discussed as a separate entity the section entitled “Vehicular Deaths”.

Data on natural deaths investigated by the OCME are included herein; however, these natural
deaths are not representative of all natural deaths in San Francisco. The only natural deaths
investigated by the OCME Examiner are those that occur suddenly and unexpectedly with no
physician in attendance or under suspicious circumstances. Such natural deaths comprised
51.6% (660/1277) of all deaths investigated by the OCME in Fiscal Year 2007-2008, but the
deaths for which jurisdiction was declined and those not reported to the OCME are presumably all
natural deaths. Presumably, all of the No Case (NC) cases, 2805 deaths and all of the cases not
reported to the OCME for jurisdictional determination (2043) were all natural deaths so the 660
natural deaths under the jurisdiction of the OCME represent only 12% of all natural deaths for
Fiscal Year 2007-2008. Conclusions from these data must be drawn conservatively.
.




Introduction                                                                               page 3
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




The "Undetermined" manner category includes deaths in which the manner could not be clearly
determined. In some cases, serious doubt existed as to whether an injury occurred due to the
actions of another person, by the actions of the decedent or as a result of an untoward event. In
others, lack of witnesses or prolonged time between death and discovery precluded the accurate
determination of the circumstances surrounding death. Moreover, it may be difficult to assess
street drug or medication overdose deaths as showing enough features to reasonably determine
the manner of death.

Those interested in obtaining more specific information and data from the OCME should contact
the office directly and ask for the Administrator.




Introduction                                                                            page 4
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




                                   DEPARTMENTAL COSTS
                                     FISCAL YEAR 2007 - 2008




Total Budget                                                                    $5,152,687


Transfers to Controller: Health and Retirement                                    $813,417


Net Budget (all other costs)                                                    $4,339,270


Total Death Cases Reported                                                           4,216


Cost Per Death Case Investigated                                                  $1029.24


Revenues (sales of records, public auctions, fee-for-service work)                $468.669


Total Costs (Ad Valorum* Taxes) Per Case Investigated                              $918.07




These include amounts for all investigative, administrative, scientific and expert witness costs to
the County.

* Ad Valorum tax means “according to value” and refers to real property tax, used to fund local
government expenditures.




General Information - Budget                                                              Page 5
         Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




                                             Office of the Chief Medical Examiner
                                                     Organizational Chart
                                                           2007 - 2008




                                                                                0965
                                                                        Chief Medical Examiner
                                                                                1 FTE



                            1452                                                 0952                                                 2598
                    Executive Secretary II                          Medical Examiner’s Administrator                      Assistant Medical Examiner
                           1 FTE                                                1 FTE                                                4 FTE



              2458                                        0931                                       1823                                       2579
  Forensic Laboratory Director                Forensic Laboratory Manager                 Senior Administrative Analyst                  Chief Investigators
             1 FTE                                       1 FTE                                      1 FTE                                      2 FTE




                      2456
         Assistant Forensic Toxicologist                                                                                              2578
                     5 FTE                                                                              1426              Medical Examiner Investigator
                                                                                                 Senior Clerk Typist                 9 FTE
                                                                                                       1 FTE


                      2403
         Forensic Laboratory Technician
                     1 FTE                                                                                                            2577
                                                                                                                             Investigative Assistant
                                                                                                                                     1 FTE




                                                                                                                                     2523
                                                                                                                          Forensic Autopsy Technician
                                                                                                                                    2 FTE




General Information – Organizational Chart                                                                                                 Page 6
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Section 1:              General Data
___________________________________________________________

This section of the Annual Report summarizes the general information for the aggregate cases.
As detailed in the Introduction Section of this report, there were 6216 deaths in San Francisco in
Fiscal Year 2007-2008 of which 4173 were reported to the OCME for jurisdictional review. Of
these, 2805 were determined to be non-jurisdictional cases (NC) and 1279 were accepted for
investigation. Two (2) were later released back to the jurisdiction of the incident and the data
from these cases are not included in the summaries in this report.
 Table 1-1:             Deaths in San Francisco FY 2007-2008

                                                    Number                   %
    Reported to Department of Public
                 Health                              6216                   100%

          Reported to SF-OCME                        4173                  67.13%

       OCME Accepted Jurisdiction                    1279                  20.58%

                 Indigents                           <90>




This data is graphically portrayed in Figure 1-1.

  Figure 1-1:                    Deaths in San Francisco
                                      FY 2007-2008


                                          Not Reported to
                                           OCME, 2043
                    OCME
                 Jurisdiction,
                     1368
                                           Reported,
                                           Juisdiction
                                         Released, 2805




General Information                                                                     Page 7
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



Table 1-2 summarizes deaths which came under the jurisdiction of the San Francisco OCME in
Fiscal Year 2007-2008. In this table, traffic related fatalities are included in the numbers of their
respective manner of death and they are also delineated separately below each appropriate
category. In later tables, the vehicular related deaths are described as a separate category. The
indigent deaths are not included in the totals but the numbers are provided for reference.


 Table 1-2:                        San Francisco OCME Investigated Deaths
                                                     FY 2007 - 2008
                                                    NUMBER OF OCME                     PERCENT OF OCME
                                                        DEATHS                             DEATHS
 Accident (All))                (A)                           378                          29.55%
     Accident (Vehicular)                                                 <42>                      <3.3%>
 Homicide (All)                (H)                            122                           9.54%
         Homicide (Vehicular)                                               <7>                     <5.5%>
 Suicide (All)                  (S)                            96                           7.51%
      Suicide (Vehicular)                                                   <2>                     <0.1%>
 Undetermined (All)            (U)                             21                           1.64%
    Undetermined (Vehicular)                                                <1>                     <0.1%>
 Natural                       (N)                            660                          51.60%
 Indigents/Cremation/Scattering                                           <90>
 Jurisdiction Released                                         2                            0.16%
             Total                                           1279                           100%




Once jurisdiction is accepted, the medical examiner determines whether an autopsy should be
performed. In 54.4% of accepted cases, an autopsy was performed at the OCME, 45.5% of
cases were investigated by external examination, scene investigation, review of medical records
and, in some cases, toxicological examination. If an autopsy was performed by an outside
physician before jurisdiction was assumed and those records were reviewed to determine the
cause and manner of death.


                      Table 1-3:          Method of Examination
                                             FY 2007-2008
                        Autopsy             696                       54.5%
                        External            580                       45.42%
                         Other               1                        0.08%
                         Total             1353*

                         •   Includes 2 cases later released to another jurisdiction




General Information                                                                                 Page 8
         Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Figure 1-2:                              Method of Examination
                                             FY 2007 - 2008

                                               Other, 0.08%




                                 External,
                                  45.42%                         Autopsy, 54.5%




Table 1-4 summarizes the percentage of autopsies and externals performed as they vary by
manner of death in Fiscal Year 2007-2008. For this table, the vehicular deaths have been
removed from the “Manner of Death” assigned by the forensic pathologist and have been
grouped into a separate category.



 Table 1-4:                 Method of Examination / Manner of Death
                                        FY 2007 - 2008
                    A           H            V            S             U            N             Total
 Autopsy           208         108          51            85           17           234             703
                 61.90%       100%        86.44%       90.43%        85.00%       35.45%         75.89%
 External          128          0            8             9            3           425             573
                 38.10%                   13.56%        9.57%        15.00%       64.39%         23.95%
 Other*             0           0            0             0            0             1              1
                                                                                   0.60%          0.16%
 Total                336      108           59           94           20           660            1277
 Legend: A = Accident, H = Homicide, V = Vehicular, S = Suicide, U = Undetermined, N = Natural

 * Other – Administrative records review which may include an autopsy by another facility or mannered at
 another facility




General Information                                                                                 Page 9
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



Demographics

The next tables and figures describe the overall demographics of the decedent population in San
Francisco Fiscal Year 2007-2008 by Manner of Death. The population of investigated deaths is
predominantly male, 71.6%. US Census Bureau estimated the general population of San
Francisco to be 50.9% male and 49.1% female for the year 2007. These data should be
remembered when evaluating the racial distributions as seen in Table 1-5 and Figure 1-3. Also, it
is noteworthy that the racial Demographics of San Francisco are markedly different than those of
the population served by this Office. The Demographics of the decedent population for Fiscal
Year 2007-2008 are 53.9% White, 21.5% Black 14.3% Asian, 9.1% Hispanic, and 1.2% other.
The US Census Bureau estimates for 2007 of 45.2%, 6.9%, 32.1%, 14% and 1.3%, for Whites,
Blacks, Asians, Hispanics and Other, respectively. These differences are significant when
reviewing Table 1-7 and Figure 1-5.


 Table 1-5:                        Manner of Death by Sex
                                      FY 2007 - 2008
                   A         H           V          S           U           N        Total
 Male             222       102         39         78          16          454        911
                66.07%    94.44%      66.10%     82.98%      80.00%      68.79%     74.07%
 Female           114         6         20         16           4          206        366
                33.93%     5.56%      33.90%     17.02%      20.00%      31.21%     25.93%
                  336       108         59         94          20          660        617


The greatest discrepancy between males and females is in deaths classified as homicides, where
males outnumber females 17:1. The smallest discrepancy occurs in deaths classified as accident
and vehicular deaths (1.95:1). Males outnumber females in natural deaths (2.2:1), deaths
classified as suicide (4.9:1) and in undetermined deaths (4:1).




General Information                                                                    Page 10
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




     Figure 1-3:                    Manner of Death by Sex
                                       FY 2007 - 2008

     500



     400              Male     Female


     300



     200



     100



        0
            Accident     Homicide   Vehicular   Suicide   Undetermined   Natural


Table 1-6 reviews each manner of death by age and sex and once again the vehicular fatalities
are examined as a group rather than with their respective Manner of Death groups.




General Information                                                                    Page 11
          Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 1-6:                 Manner of Death by Age and Sex
                                    FY 2007 - 2008
                                  Manner of Death
                           A      H    V    S    U     N       Sub-Total     Total        %
 Under 1 year              1      0     0    0    5     6                     12        0.97%
                   Male     0      0    0    0    5     3          8
                 Female     1      0    0    0    0     3          4
 Age 1 - 5                  0      0    0    0    0     3                      3        0.00%
                   Male     0      0    0    0    0     2          2
                 Female     0      0    0    0    0     1          1
 Age 6 - 12                 1      0    1    0    0     0                      2        0.32%
                   Male     1      0    0    0    0     0          1
                 Female     0      0    1    0    0     0          1
 Age 13 - 16                0      3    1    0    0     1                      5        0.65%
                   Male     0      3    0    0    0     0         3
                 Female     0      0    1    0    0     1         \2
 Age 17 - 19                2     10    0    1    0     1                      14       2.11%
                   Male     1     10    0    1    0     0         12
                 Female     1      0    0    0    0     1          2
 Age 20 - 29               21     41   10    8    0     6                      86      12.97%
                   Male    13     40    4    7    0     4         68
                 Female     8      1    6    1    0     2         18
 Age 30 - 39               38     30   16   30    4    23                     141      19.12%
                   Male    30     26   16   29    3    17        121
                 Female     8      4    0    1    1     6         20
 Age 40 - 49               68     16   10   16    5    66                     181      18.64%
                   Male    51     15    8   11    5    51        141
                 Female    17      1    2    5    0    15         40
 Age 50 - 59               86      3    9   14    4   157                     273      18.80%
                   Male    65      3    5   12    3   129        217
                 Female    21      0    4    2    1    28         56
 Age 60 - 69               27      5    3   15    1   131                     182       8.27%
                   Male    17      5    1   12    0   107        142
                 Female    10      0    2    3    1    24         40
 Age 70 - 79               27      1    6    6    0   117                     157       6.48%
                   Male    15      1    3    3    0    74         96
                 Female    12      0    3    3    0    43         61
 Age 80 - 89               40      0    2    4    0   115                     161       7.46%
                   Male    18      0    1    3    0    60         82
                 Female    22      0    1    1    0    55         79
 Age > 90                  25      0    0    0    1    34                      60       4.21%
                   Male    11      0    0    0    0    12         23
                 Female    14      0    0    0    1    22         37
 Totals                   336    109   58   94   20   660        1277        1277       100%




General Information                                                                      Page 12
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



The following Figure reviews the Manner of Death normalized by age group to evaluate the
Manner of Death for each Age Group. Deaths classified as natural represent a greater
percentage of the older age groups, (50 and above). Deaths classified as homicide are the most
common manner of death in the 13 -29 age groups. Deaths classified as suicides are more
common in the 20 -69 age groups.


  Figure 1-4:                   Manner of Death Normalized by Age Group
                                           FY 2007 - 2008
       100%                                             4     5      4       1    6       4        1
                                            1     8                 14      15
                                                              16
                                       1    1     6     30
        80%      5                                10
                               1
                                       1                      66                                  34
                                                        23
                                                                   157
                                                                                          115
        60%                                                                       117
                                                        16                 131
                       3                    10    41          10
                                                              16
        40%                                             30
                 6                                                  9
                                                                    3
                                       3
                               1                                                          2
                                                              68                  6               25
        20%                                                                 3
                                                                            5     1
                                                                    86
                                                  21    38                                40
                                            2                               27    27
                 1
          0%
                <1    1-5    6-12   13-16 17-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89        >90

           Accident         Homicide       Vehicular     Natural        Suicide        Undetermined



Race and sex Demographics by Manner of Death are detailed in Table 1-7. It is of note that they
do not correspond to the demographic racial make-up of the residents of San Francisco. The US
Census Bureau1 estimates that in 2007, San Franciscans were 50.9% male, 45.2% non-Hispanic
White, 32.1% Asian/Pacific Islander, 14% Hispanic, 6.9% Black and 1.3% other. The differences
between the OCME population Demographics and the US Census Bureau Estimates are
depicted in Figures 1-5 and 1-6. Males and Blacks are over represented in the OCME decedent
population as aggregate data. The individual Manner of Death Demographics are discussed in
later in this report.




General Information                                                                           Page 13
         Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 1-7:                    Race / Sex / Manner of Death
                                       FY 2007 - 2008
         Race / Sex            A        H     V    S         U    N       Sub-total      Total     %
 White                         205      17    24   72         9   361                    688     53.88%
                        Male   133      15    19   58         7   264       496
                      Female    72       2     5   14         2    97       192
 Black                          67      53     7    5         7   136                    275     21.53%
                        Male    49      51     5    4         6    80       195
                      Female    18       2     2    1         1    56        80
 Asian                          33      10    13   13         3   111                    183     14.33%
                        Male    19       9     5   12         2    68       115
                      Female    14       1     8    1         1    43        68
 Hispanic                       26      27    12    4         0    47                    116     9.08%
                        Male    22      26     8    4         0    38        98
                      Female     4       1     4    0         0     9        18
 Unknown/Other                  5       1      3    0         1     5                     15     1.17%
                        Male     2       1     2    0         1     4        10
                      Female     3       0     1    0         0     1         5
                               336     108    59   94        20   660       1277         1277    100%




         Figure 1-5:         2007 - 2008 Populations Demographics:
                          OCME vs US Census Bureau Estimates by Race


         60%                         SF-OCME Case Demographics
                                     US Census Bureau SF Demograhic Estimates - 2008
         50%

         40%                                            fI

         30%

         20%

         10%

          0%
                      White           Black         Asian               Hispanic      Unknown/Other




General Information                                                                              Page 14
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




   Figure 1-6:                2007 - 2008 Populations Demographics:
                            CME vs US Census Bureau Estimates - Sex

                                                         Male
                 80%                                     Female

                 60%

                 40%

                 20%

                      0%
                               SF - OCME Case             US Census Bureau SF
                                Demographics              Demograhic Estimates -
                                                                 2008

Figure 1-7 Manner of Death of death by race. This data shows that Blacks are significantly
overrepresented in deaths classified when compared to the demographic data of the City of San
Francisco and Whites are significantly overrepresented in the population of deaths classified as
Suicide. Asians are underrepresented in all categories in the decedent population of the San
Francisco OCME.


        Figure: 1-7:                   Manner of Death Normalized by Race
                                                FY 2007 - 2008

                       5               1          3               4           1           5
       100%                                                                               47
                      26
                                                                  13          3
                      33            27           12                                       111
        80%                                                       5
                      67            10
                                                 13                           7           136
        60%

                                                  7
                                    53                            72
        40%
                      205
                                                                                          361
                                                                             10
                                                 24
        20%

                                    17

         0%
                Accident        Hom icide    Vehicular      Suicide    Undeterm ined   Natural


            White              Black         Asian              Hispanic          Unknown/Other



General Information                                                                               Page 15
         Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



The next Table (1-8) and Figure (1-8) reflect the marital status of the OCME cases. It must be
noted that in approximately 43% of the cases, the marital status is unknown at time of OCME
investigation. This information may be collected by funeral directors for the final death certificate
issued by the Department of Public Health but is not always a part of the OCME business
records.




 Table 1-8:                Marital Status/ Sex / Manner of Death
                                           FY 2007-2008
                                     Manner of Death

     Status    & Gender         A    H      V    S    U     N    Sub-total    Total      %
 Unknown                       153   59     30   33   10   272                507      43.62%
                        Male   103   54     21   26    7   201     412
                      Female    50    5      9    7    3    71     145

 Single/Never Married          90    28     13   40   9    180                 360     28.19%
                        Male   58    28      6   36   9    130     267
                      Female   32     0      7    4   0     50      93

 Married/Domestic Partner      48    19     12   14   2    90                  185     14.49%
                     Male      38    18      8    9   1    68      142
                   Female      10     1      4    5   1    22       43

 Divorces/Separated            19     3      2   7    0    48                  79      6.18%
                        Male   14     3      2   7    0    31       57
                      Female    5     0      0   0    0    17       22
 Widow                         26     0      0   0    0    70                  96      7.52%
                        Male    9     0      0   0    0    24       33
                      Female   17     0      0   0    0    46       63
                                                                                        100%
 Total                         336   109    57   94   21   660                1277




General Information                                                                      Page 16
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




          Figure 1-8:                    Marital Status Normalized by Manner of Death
                                                       FY 2007 - 2008

                           9                  9                2
         100%            33                                  14                7
                                            40

          80%
                         272                                 90
                                            180                                48          70
          60%

                         32                                  12
          40%            58                 13
                                            28               19
                                                                               32
          20%            153                90               48                19          26

           0%
                      Unknown            Single           Married          Divorced     Widow

           Accident           Homicide        Vehicular          Natural      Suicide   Undetermined



In the following Table (1-9) and two Figures (1-9 and 1-10), the case data by month is depicted.
January and March are the months with the most deaths and June and September have the least
deaths. While there is a modest increase of cases in January, there are no discernable trends
with respect to the Manner of Death by month of year.

 Table 1-9:                              Manner of Death by Month
                                             FY 2007 - 2008
                         A          H         V     S       U         N        Total        %

 Jul-07                  28         14        7     7        2        50        108        8.46%
 Aug-07                  24          8        7    13        0        48        100        7.84%
 Sep-07                  25         11        4    13        0        34         87        6.82%
 Oct-07                  27          5        8     6        1        54        101        7.91%
 Nov-07                  29          7        2     7        2        49         96        7.51%
 Dec-07                  37          5        9     7        3        63        124        9.71%
 Jan-08                  31         12        2     8        1        76        130       10.18%
 Feb-08                  22          8        1    10        2        67        110        8.62%
 Mar-08                  33        14        7     8        3        65         130       10.18%
 Apr-08                  26          9        3     6        3        52         99        7.75%
 May-08                  24         8         5    8        0        64         109        8.53%
 Jun-08                  30          7        4     1        3        38         83        7.29%
 Total:                 336        108       59    94       20       660        617        100%




General Information                                                                                Page 17
          Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




      Figure 1-9:               OCME Deaths and Indigents by Month
                                         FY 2007 - 2008



       150


       120


          90


          60


          30


           0
               Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08
                          Cases                         Indigents/County Cremations


While there appears to be a higher rate of deaths in December through March, it is not
statistically significant as depicted in Figure 1-10. The monthly averages vary by a less than1.5
standard deviation.


    Figure 1-10:                  Average Number Deaths per Day
                                         FY 2007 - 2008

           4.949

           4.467
 + 1 SD    3.985

  Mean     3.503
 - 1 SD    3.020

           2.538

           2.056
                          07




                          08




                         08
                         07
                           7
                           7




                           8
                         08
                         07




                         07




                         08


                           8
                        -0
                        -0




                        -0
                        -0
                      g-




                      v-




                       r-




                      n-
                      p-




                      c-

                      n-

                      b-
                   l




                     ct




                     ay
                     ar
                Ju




                   Ap
                   Au




                   No




                   Ju
                   Se




                   De

                   Ja

                   Fe
                   O




                   M




                   M




General Information                                                                       Page 18
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



Figure 1-11 summarizes the distribution of manners of death normalized for each month. Suicide
rates are highest in August and September but this is not statically significant.


   Figure 1-11:                  Manner of Death Normalized by Month
                                           FY 2007 - 2008
         100%         2                   1       2       3      1       2      3       3            3
                      7                   6       7       7      8              8       6      8     1
                           13    13                                      10


          80%
                                                                                                    38
                      50                  54              63                    65
                                 34               49             76                     52    64
                           48
          60%                                                            67

                                                                                                     4
                      7          4
          40%                                     2       9                     7                    7
                           7     11       8                                             3
                      14                          7       5       2                            5
                                          5                      12             14      9
                           8                                             1                     8
                                                                         8
          20%                                     29      37
                                                                                                    30
                      28   24    25       27                     31             33      26
                                                                         22                   24

            0%
                 Jul-06 Aug-    Sep- Oct-06 Nov-       Dec-    Jan- Feb-07 Mar- Apr-07 May-        Jun-
                         06      06          06         06      07          07          07          07


         Accident          Homicide           Vehicular        Natural        Suicide        Undetermined

It is useful to review the data for trends by looking at the changes in the data over time. For this
purpose, some of the data presented in this report has been subjected to a ten year perspective
review. For total numbers of cases, in years prior to 2006-2007, indigent cases were included in
the total number of OCME cases. In Table 1-12, indigents have been delineated so that the ten
year perspective data can be assessed.



     Figure 1-12:               Total Number od San Francisco OCME Cases
                                        Ten Year Perspective

       1,800
       1,600
       1,400
       1,200
       1,000
         800
         600
         400
         200
            0
                ’98-‘99 ’99-‘00 ’00-‘01   ’01-‘02 ’02-‘03 ’03-‘04 ’04-‘05      ’05-‘06 ’06-'07 ’07-'08

                            Cases                         Indigent/County Cremations


General Information                                                                                 Page 19
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 1-10:                      Comparison of Manner of Death
                                      Ten Year Perspective
   Manner of           ’98-     ’99-     ’00-     ’01-     ’02-     ’03-     ’04-     ’05-     ’06-      ’07-
    Death               ‘99      ‘00      ‘01      ‘02      ‘03      ‘04      ‘05      ‘06      '07       '08
     Natural           1,075     959      914      969      993      955      897      815      717       660
       %              66.30%   63.20%   62.10%   68.40%   65.50%   65.50%   63.90%   58.90%   53.10%    51.68%
    Accident            307      281      280      214      256      244      243      287      317       336
       %              18.90%   18.50%   19.00%   15.10%   16.90%   16.70%   17.30%   20.70%   23.10%    26.31%
     Suicide            90       101      112      93       114      106      104      93       110       94
       %              5.60%    6.70%    7.60%    6.60%    7.50%    7.30%    7.40%    6.70%    8.10%     7.36%
    Vehicular            60       72       65      53        53       47       57      62        63       59
       %              3.70%    4.70%    4.40%    3.70%    3.50%    3.20%    4.10%    4.50%    4.70%     4.62%
    Homicide            59        60       66      68        80       90       79      101      112       108
       %              3.60%    4.00%    4.50%    4.80%    5.30%    6.20%    5.60%    7.30%    8.30%     8.46%
  Undetermined          30        44       36      19        20       15       23      26       32        20
        %             1.90%    2.90%    2.40%    1.30%    1.30%    1.00%    1.60%    1.90%    2.40%     1.57%

      Totals          1,622    1,518    1,474    1,417    1,517    1,458    1,404    1,385    1,351     1,277




Natural death is the most common Manner of Death in all years. However, there is a steady
decline in the number of natural deaths since its high in Fiscal Year 2001-2002 and this trend has
continued in Fiscal Year 2007-2008. In Fiscal Year 2001-2002, 68.4% of all deaths were
determined to be natural and in Fiscal Year 2007-2008 this had declined to 51.7% which
represents a decrease of 33.5% in cases determined to be natural deaths over the past six years.
The decline in percentage was greater because there was also a decline in the number of OCME
jurisdictional cases over the same period of time. Figure 1-13 shows the changes in all Manners
of Death over the past ten years and the decline in naturals was off-set mostly by a rise in deaths
mannered as Accident. There was also an increase in deaths mannered as Homicide over the
same period. Deaths mannered as Accident comprised 15.1% of all deaths in Fiscal Year 2001-
2002 and increased to 26.3% in Fiscal Year 2007-2008. This represents a 56.8% (from 214 in
2001-2002 to 336 in 2007-2008) increase over six years while at the same time the overall
caseload decreased by 10%. Deaths mannered as Homicide comprised 4.8% of all deaths in
Fiscal Year 2001-2002 and rose to 8.15% in Fiscal Year 2007-2008. This represents a 58.8%
increase over five years in percentage of cases classified as Homicides with a raw number
increase of 63.2% (from 68 to 108). The other categories have exhibited only random changes
from year to year but have not exhibited any identifiable trends.




General Information                                                                           Page 20
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




       Figure 1-13:                           Manner of Death Distribution
                                                Ten Year Perspective
    1,200



    1,000



      800



      600



      400



      200



        0
             ’98-‘99    ’99-‘00   ’00-‘01   ’01-‘02   ’02-‘03   ’03-‘04     ’04-‘05   ’05-‘06   ’06-'07   ’07-'08

                       Natural     Accident       Suicide       Vehicular        Homicide       Undetermined




The next section of this report will focus on each specific Manner of Death.




General Information                                                                                   Page 21
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




SECTION 2:                          Manner of Death



Manner of death is delineated into five categories, Natural, Accident, Homicide, Suicide and
Undetermined. For purposes of this report, motor vehicle or traffic-related deaths have been
separately identified as Vehicular deaths. While each Vehicular death is classified as Accident,
Homicide, Suicide or Undetermined, the conglomerate data has greater significance for traffic and
public safety.


Natural deaths are due solely or nearly entirely to disease and/or aging process. The category
Accident applies when an injury or intoxication (poisoning) causes death and there is little or no
evidence that the injury or intoxication occurred with intent to harm or cause death. In essence,
the fatal outcome was untoward. Suicide results from an injury or intoxication (poisoning) as a
result of an intentional, self-inflicted act committed to do self harm or cause death of ones self.
Homicide occurs when death results from a volitional act committed by another person to cause
fear, harm or death. Intent to cause death is a common element but is not required for
classification as Homicide. It is to be emphasized that the classification of Homicide for the
purposes of death certification is a “neutral” term and neither indicates nor implies criminal intent,
which remains a determination or province of legal processes. Undetermined or “Cannot Be
Determined” is a classification used when the information pointing to one manner of death is no
more compelling than one or more other competing manners of death in thorough consideration
of all available information.


The following graphic, Figure 2-1, demonstrates the distribution of Manners of Death for Fiscal
Year 2007-2008. Again, the category “Vehicular” is comprised of Accident, Homicide and Suicide
cases and the specific distribution is further detailed can be seen in Figure 2-36.




Manner of Death                                                                           Page 22
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




     Figure 2-1:                     Manner of Death
                                     FY 2007 - 2008

                                        Undetermined,
                                             21
                    Suicide, 96


                                                        Accident, 378



                      Natural, 660




                                                              Homicide, 122




Manner of Death                                                                       Page 23
         Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




___________________________________________________
Manner: ACCIDENT (Non-Vehicular)



Accident is defined as an injury or intoxication (poisoning) caused death and there is little or no
evidence that the injury or intoxication (poisoning) occurred with intent to harm or cause death.
The San Francisco OCME certified 336 deaths as Non-Vehicular Accident deaths in fiscal year
2007 -2008. Forty-two (42) additional cases were classified as manner of death Accident but
these are discussed in the Vehicular Death section. Deaths mannered as Accident represent the
most common non-natural death in Fiscal Year 2007 - 2008.



Demographics:


The following details the demographics of deaths classified as Accident in this report by race, sex
and age group. Table 2-1 details the occurrence of Accidents by race and sex.


 Table 2-1:             Manner of Death Accident by Race and Sex
                                    FY 2007 – 2008
                                 Male            Female            Sub-total
 White                           129                76                               205
                               38.39%            22.62%             61.01%
 Black                            49                18                                67
                               14.58%             5.36%             19.94%
 Asian                            19                14                                33
                                5.65%             4.17%             9.82%
 Hispanic                         22                 4                                26
                                6.55%             1.19%             7.74%
 Unknown/Other                     2                 3                                5
                                0.60%             0.89%             1.49%
 Total                           221               115                               336
                               65.77%            34.23%              100%



Deaths classified as Accident are predominantly male (65.8%). Blacks are over-represented
(19.9% of deaths classified as Accident occurred in blacks yet Blacks represent only 6.9% of the
population in San Francisco), Whites are minimally over represented (61% as compared to 45.2%
of the population) and both Asians and Hispanics are under represented. (Asian deaths classified
as Accident represent only 5.7% when Asians comprise 32.1% of the population and Hispanics
comprise only 6.6% of deaths classified as Accident when Hispanics comprise 14% of the San
Francisco population.)


Manner of Death - Accident                                                                Page 24
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Figure 2-2 details the distribution of non-vehicular deaths classified as Accident by race and sex.



            Figure 2-2:        Manner of Death Accident by Race and Sex
                                          FY 2007 - 2008


           150
           125
           100
             75
             50
             25

              0
                      White        Black          Asian         Hispanic     Unknown/Other


                                    Male                    Female



Table 2-2 and Figure 2-3 detail deaths classified as Accident by age group and sex. The greatest
concentration of deaths classified as Accident (45.8%) occurs in the 40-59 age groups (20.2% in
the 40-49 age group and 25.6% in the 50-59 age group). As with most categories, males are over
represented in the deaths classified as Accident. With the over 80 age group, there is a shift in
sex as women become more prevalent than men.




Manner of Death - Accident                                                              Page 25
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 2-2:                    Manner of Death Accident by Age and Sex
                                          FY 2007 - 2008
                              Male          Female           Sub-total              Total
        <1                     0               1                                     1
                                            0.30%              0.30%
       1-5                     0                                                     0

       6 - 12                   1              0                                     1
                             0.30%                             0.30%
      13 – 16                   0              0                                     0

      17 – 19                    1              1                                    2
                              0.30%          0.30%             0.60%
      20 – 29                   13              8                                    21
                              3.87%          2.38%             6.25%
      30 – 39                   30              8                                    38
                              8.93%          2.38%            11.31%
      40 – 49                   51             17                                    68
                             15.18%          5.06%            20.24%
      50 – 59                   65             21                                    86
                             19.35%          6.25%            25.60%
      60 – 69                   17             10                                    27
                              5.06%          2.98%             8.04%
      70 – 79                   15             12                                    27
                              4.46%          3.57%             8.04%
      80 – 89                   18             22                                    40
                              5.36%          6.55%            11.90%
       > 90                     11             14                                    25
                              3.27%          4.17%             7.44%
      Totals                   222            114                                   336
                                                               100%




Manner of Death - Accident                                                               Page 26
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




        Figure 2-3:           Manner of Death Classified as Accident by Age and Sex
                                                   FY 2007 - 2008

        100



         75



         50



         25



          0
              <1        1-5       6 - 12   13 – 16 17 – 19 20 – 29 30 – 39 40 – 49 50 – 59 60 – 69 70 – 79 80 – 89   > 90

                                                        Male                     Female



Methods of Death Classified as Accident:


Non-vehicular deaths classified as Accident are further classified into sub-groups by method.
Method describes how the death occurred. The most frequent method of deaths classified as
Accident is the category defined as drug-related. Any drug (including alcohol) given in sufficient
dose can result in a fatal ingestion. A full discussion on the drugs identified in cases can be
found in Section 4 of this report. Figure 2-4 shows the methods of deaths classified as Accident
in Fiscal Year 2007-2008.


        Figure 2-4:                    Methods of Death Classified as Accident
                                                  FY 2007 - 2008

                              8        3        3
                                           5                                                Drug-related
                   12                                                                       Fall
              7
        12                                                                                  Burn
    7
                                                                                            Blunt Trauma
                                                                                            Asphyxia
              85                                                   194                      Aspiration Food
                                                                                            Smoke/CO Inhalation
                                                                                            Drowning
                                                                                            Therapeutic Complication
                                                                                            Unk/Other




Manner of Death - Accident                                                                                       Page 27
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



The following Table (Table 2-3) shows the distribution of the common methods of death classified
as Accident by race and sex distribution. The majority of deaths classified as Accident are drug-
related (57.7%) followed by falls (25.3%). There is a more in depth discussion of all drug involved
deaths in Section 3 of this report.

 Table 2-3:                  Methods of Deaths Classified Accident by Race and Sex
                                              FY 2006-2007

                      White      Black   Asian   Hispanic   Unk/Other   Sub-total   Total       %
 Drug-related         116         56       5        15          2                   194       57.74%
            Male       86         42       4        14          2         148
         Female        30         14       1         1          0          46
 Fall                  58          5      15        6          1                     85       25.30%
            Male       30          4      8         4                      46
          Female       28          1      7         2          1           39
 Burn                   6          1      0         0          0                     7        2.08%
            Male        2          0      0         0          0           2
          Female        4          1      0         0          0           5
 Blunt Trauma           7          0      3         2          0                     12       3.57%
            Male        4          0      3         2                      9
          Female        3          0      0         0                      3
 Asphyxia               5          0      0         1          1                     7        2.08%
            Male        2          0      0         1          0           3
          Female        3          0      0         0          1           4
 Aspiration Food        4          1      5         2          0                     12       3.57%
            Male        3          1      1         1          0           6
          Female        1          0      4         1          0           6
 Smoke /      CO
 inhalation             4          2      2         0          0                     8        2.38%
            Male        2                 2         0                      4
          Female        2          2      0         0                      4
 Drowning               1          2      0         0          0                     3        0.89%
            Male        0          2                                       2
          Female        1                                                  1
 Therapeutic
 Complication           2          2      0         0          1                     5        1.49%
            Male        0          1                                       1
         Female         2          1                           1           4
 Firearm                0          0      0         0          0                     0
            Male                                                           0
         Female                                                            0
 Unk/Other              1          0      1         0          1                     3        0.89%
            Male        1                           0          0           1
         Female                           1         0          1           2
 Total                                                                    336       336        100%




Manner of Death - Accident                                                                Page 28
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



Examination of deaths classified as Accident with a ten year perspective for trends provides
additional useful information. Figure 2-5 reveals the gradual but consistent rise in the number of
deaths classified as Accident over the past six years. The majority of the increases seem to be in
the drug-related deaths classified as Accident.



 Figure 2-5:                                 Manner of Death Classified as Accident
                                                   Ten Year Perspective

        350

        300
        250

        200
        150

        100

         50
          0
               ’98-‘99   ’99-‘00   ’00-‘01    ’01-‘02   ’02-‘03   ’03-‘04   ’04-‘05   ’05-‘06   ’06-‘07   ’07-‘08




Information on the occurrence of each type of death classified as Accident will determine if one or
more methods predominate in this rise. This information may be helpful in establishing public
health and safety prevention policies. Deaths classified as Accident, by their nature, are
presumably avoidable with improved safety and health policies. A review of these deaths may
reveal areas to focus upon to address the causes of these deaths.

Examination of the specific methods of death in the ten year perspective is detailed in Table 2-4.
This shows the numbers for each method of death classified as Accident over the past 10 years.
There is a slow but consistent rise in the numbers of drug-related deaths classified as Accident,
specifically over the most recent three years and deaths classified as Accident have increased by
nearly 50% over the past five years at the same time the overall caseload decreased.

Table 2-4 summarizes the different methods of death classified as Accident over the past ten
years. Almost all of the increase in deaths classified as Accident is attributed to an increase in
drug-related deaths. All other methods exhibit only random changes in numbers from year to
year.




Manner of Death - Accident                                                                                      Page 29
         Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 2-4:                           Manner of Death Accident - Method of Death
                                                10 Year Perspective
 Accident        ’98-‘99      ’99-       ’00-     ’01-     ’02-     ’03-     ’04-     ’05-     ’06-      ’07-‘08
                               ‘00        ‘01      ‘02      ‘03      ‘04      ‘05      ‘06      ‘07
 Drug-related      204        169        151       95      152      115      136      169      190         194
                 66.40%      60.60%     54.10%   44.60%   59.80%   47.10%   56.00%   58.30%   59.90%     57.74%
 Fall              52          49         70       68       53       75       68       73       81         85
                 16.90%      17.60%     25.10%   31.90%   20.90%   30.70%   28.00%   25.20%   25.60%     25.30%
 Burns              4          7          4        10       7        11       10       8        14          7
                  1.30%      2.50%      1.40%    4.70%    2.80%    4.50%    4.10%    2.80%    4.40%       2.08%
 Blunt Trauma       2          2          *        *        4        1        3        1        3          12
                  0.70%      0.70%                        1.60%    0.40%    1.20%    0.30%    0.90%       3.57%
 Asphyxia           5          12         20       10       13       11       6        7        8           7
                  1.60%      4.30%      7.20%    4.70%    5.10%    4.50%    2.50%    2.40%    2.50%       2.08%
 Aspiration
 Food               1          7          5        6        4        2        3        7        5          12
                  0.30%      2.50%      1.80%    2.80%    1.60%    0.80%    1.20%    2.40%    1.60%       3.57%

 Smoke / CO
 inhalation         4          4          8        3        2        4        1        4        5           8
                  1.30%      1.40%      2.90%    1.40%    0.80%    1.60%    0.40%    1.40%    1.60%       2.38%
 Drowning           6          8          16       13       5        2        3        10       5           3
                  2.00%      2.90%      5.70%    6.10%    2.00%    0.80%    1.20%    3.40%    1.60%       0.89%

 Therapeutic
 Complication      22          17         5        8        7        14       8        6        4           5
                  7.20%      6.10%      1.80%    3.80%    2.80%    5.70%    3.30%    2.10%    1.30%       1.49%
 Firearms           0          0          1        1        1        0        1        1        0           0
                                        0.40%    0.50%    0.40%    0.00%    0.40%    0.30%
 Other              7          4          4        7        6        9        4        4        2           3
                  2.30%      1.40%      1.40%    3.30%    2.40%    3.70%    1.60%    1.40%    0.60%       0.89%
 Total             307        279        279      213      254      244      243      290      317         336




Manner of Death - Accident                                                                            Page 30
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Figure 2-6 depicts the normalized annual data for each method of death classified as Accident
with a ten year perspective. It is clear from this figure that drug-related deaths are increasing in
numbers.

 Figure 2-6:                  Manner Accident - Methods Normalized by Year
                                         Ten Year Perspective

   100%      7          4         4         7         6          9         4        4         2
                                                                                              4          3
                                                                                                         5
                                  5                   7                    8        6         5          3
             22        17                   8                              3        10        5
                                                                                              5          8
                                 16                   5
                                                      2         14         1
                                                                           3                            12
                        8                             4                    6        4         8
             6          4         8         13                   2
                                                                 4         3        7         3          7
             4
             1          7         5         3         13         2        10        7
                                                                                    1         14        12
             5
             2                              6         4         11                  8
             4         12        20                              1                                       7
                        2                   10        7
                        7         4                             11
    80%
             52                             10
                                                                                    73        81
                       49                             53                  68                            85
                                 70
                                                                75
    60%                                     68




    40%
            204
                      169                            152                           169       190       194
                                151                                      136
                                                               115
                                            95
    20%




     0%
          ’98-‘99   ’99-‘00   ’00-‘01    ’01-‘02   ’02-‘03   ’03-‘04   ’04-‘05   ’05-‘06   ’06-‘07   ’07-‘08


     Drug-related                       Fall                               Burns                               Blunt Trauma
     Asphyxia                           Aspiration Food                    Smoke / CO inhalation               Drowning
     Therapeutic Complication           Other




Drug-Related Deaths Classified As Accident:


This rise in drug-related deaths classified as Accident warrants a closer examination. The
demographic data are detailed in the following tables and Figures. As with all deaths classified
as Accident, Blacks are over-represented in this group with Blacks representing 28.9% of all
drug-related deaths; Whites represent 54.7% of drug-related deaths classified as Accident and
Asians are under represented with only 4.2% of drug-related deaths classified as Accident.




Manner of Death - Accident                                                                                   Page 31
         Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 2-5:         Manner Accident – Drug-Related Deaths by Race and Sex
                                     FY 2007-2008
                         Male             Female             %                  Total
 White                    86                 30                                 116
                         44%              15.46%           59.79%
 Black                    42                 14                                  56
                       21.65%              7.22%           28.87%
 Asian                     4                  1                                    5
                        2.06%                1%            2.58%
 Hispanic                 14                  1                                  15
                        7.22%              0.52%           7.73%
 Unknown/Other             2                  0                                    2
                        1.03%                              1.03%
 Total                   139                51                                  194
                       71.65%             26.29%           100%

The majority of drug-related deaths are male (72%) with white males comprising 44% of this
group.



 Figure 2-7:                 Drug-Related Accident Deaths by Race and Sex
                                          FY 2007 - 2008


         120

         100                                                       Male   Female

         80

         60

         40

         20

           0
                  White           Black            Asian      Hispanic    Unknown/Other




Manner of Death - Accident                                                                Page 32
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Looking at age groups and drug-related deaths classified as Accident, the largest group is
between the ages of 30 and 59 years of age, representing 59.2% all drug-related deaths. Nearly
half (47.5%) of these deaths are in the 40-59 age groups. Males (67.1%) predominate over
females (32.9%).

 Table 2-6:       Manner: Accident - Drug-Related Deaths by Age and Sex
                                  FY 2006-2007
                              Male           Female                %                Total
         <1                    0               0                                     0

        1-5                    0                0                                     0

       6 - 12                  0                0                                     0

       13 - 16                 0                0                                     0

       17 - 19                 0                 1                                    1
                                              0.52%              0.52%
       20 - 29                   9               5                                   14
                              4.64%           2.58%              7.22%
       30 - 39                  26               7                                   33
                             13.40%           3.61%             17.01%
       40 - 49                  42              12                                   54
                             21.65%           6.19%             27.84%
       50 - 59                  53              17                                   70
                             27.32%           8.76%             36.08%
       60 - 69                  12               4                                   16
                              6.19%           2.06%              8.25%
       70 - 79                   5               0                                    5
                              2.58%                              2.58%
       80 - 89                   1              0                                     1
                              0.52%                              0.52%
        > 90                     0              0                                     0

        UNK                    0                                                      0

       Totals                  148             46                                   194
                             67.10%          32.90%             100.00%




Manner of Death - Accident                                                                Page 33
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




  Figure 2-8:         Manner Accident: Drug Related Deaths by Age and Sex
                                        FY 2007 - 2008
       70

       60

       50                      Male     Female

       40

       30

       20

       10

        0
             <1     1-5      6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89




The incidence of these deaths is greatest in the older middle aged groups (50-59 years of age
comprise 36% of drug-related deaths and 40-49 years of age comprise 28% of drug-related
deaths). This is evidence that intervention programs may be effective in reducing this death rate,
especially where acute drug use is a component of the cause of death. Further information on
the specific drugs found among these individuals can be found in Section 3 of this report.



Fall-Related Deaths Classified As Accident


The second most frequent method of death classified as Accident is falls. Of the 336 deaths
classified as Accident, 85 (25.3%) were attributed to injuries sustained in falls. The majority of
these falls occurred in the elderly with 47.67% age 60 and above and 24.7% age 90 and above.
Of note, is that unlike other types of deaths investigated by OCME, women are more equally
represented in fall deaths and comprise 43.9% of these deaths.




Manner of Death - Accident                                                                              Page 34
         Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 2-7:              Manner Accident Due to Fall by Race and Sex
                                  Fiscal Year 2007 - 2008

                                 Male           Female              %                     Total
 White                            30               28                                      58
                               35.29%           32.94%           53.70%
 Black                             4                1                                      5
                                4.71%            1.18%            7.30%
 Asian                             8                7                                      15
                                9.41%            8.24%           28.00%
 Hispanic                          4                2                                      6
                                4.71%            2.35%            9.80%
 Unknown/Other                                      1                                      1
                                                 1.18%            1.20%
 Total                           46               39                                       85
                               54.12%           45.88%            100%




The racial breakdown of deaths due to falls closely resembles the racial Demographics of San
Francisco.



         Figure 2-9:      Manner: Accident Fall-Related Deaths by Race and Sex
                                            FY 2007 - 2008


            60                                                           Male    Female
            50

            40

            30

            20

            10

             0
                       White            Black          Asian    Hispanic        Unknown/Other




Manner of Death - Accident                                                                  Page 35
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Examining the age groups in relationship to fall-related deaths classified as Accident reveals that
the percentage of deaths due to falls increases with increasing age. Sixty-one percent (61.2%) of
the fall related deaths classified as Accident occurred in the 80 or older age groups.




        Table 2-8:           Fall-Related Deaths Classified as Accident by Age and Sex
                                               FY 2007-2008
                              Male          Female              %                 Total
            <1                                                                     0

           1-5                                                                     0

           6 - 12                                                                  0

          13 - 16                                                                  0

          17 - 19                                                                  0

          20 - 29               2              1                                   3
                             2.35%       0.011764706          3.53%
          30 - 39                              1                                   1
                                            1.18%             1.18%
          40 - 49                2                                                 2
                              2.35%                           2.35%
          50 - 59                4              1                                  5
                              4.71%          1.18%            5.88%
          60 - 69                4              4                                  8
                              4.71%          4.71%            9.41%
          70 - 79                7              7                                  14
                              8.24%          8.24%            16.47%
          80 - 89               16             15                                  31
                             18.82%         17.65%            36.47%
           > 90                 10             11                                  21
                             11.76%         12.94%            24.71%
          Totals                45             40                                  85
                             52.94%         47.06%            100.00%




Manner of Death - Accident                                                                Page 36
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Other Methods of Death Classified as Accident


Other deaths classified as Accident in San Francisco during fiscal year 2007-2008, included 12
(3.6%) burn or thermal injury deaths, 8 (2.1%), blunt trauma, 12 (3.6%), asphyxia, 8 (2.4%) food
aspiration, 12 (3.6%) fire deaths due to inhalation of smoke or carbon monoxide, 8 (2.4%)
drowning deaths, 3 (0.9%) and deaths due to therapeutic complications, 5 (1.5%). Of note, is that
there were no deaths classified as Accident due to firearms in the past two fiscal years, 2006-
2007 and 2007-2008.

     Figure 2-10: Manner: Accident Fall-Related Deaths / Age and Sex
                                  FY 2007 - 2008


           35

           30

           25                      Male         Female
           20

           15

           10

            5

            0
                0 - 12   13 - 16   17 - 19   20 - 29   30 - 39   40 - 49   50 - 59   60 - 69   70 - 79   80 - 89   > 90




Manner of Death - Accident                                                                                           Page 37
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




____________________________________________________________

Manner: HOMICIDE




Manner Homicide occurs when death results from a volitional act committed by another person to
cause fear, harm or death. Intent to cause death is a common element but is not required for
classification as Homicide. For the purposes of death certification, Homicide is a “neutral” term
and nether indicates nor implies criminal intent, which remains a determination within the
province of legal processes.


In Fiscal Year 2007-2008, there were 132 deaths classified as Homicide, of which 14 (12.5%)
were vehicle-related and for the purpose of this report are discussed in the section pertaining to
Vehicular deaths. Non-Vehicular deaths classified as Homicide in fiscal year 2007-2008
numbered 108.


The following graphic (Figure 2-11) provides a ten year perspective on Non-Vehicular Homicides
in San Francisco. This data indicates an increasing trend in numbers of homicide deaths with a
64.7% increase between Fiscal Year 2002-2003 and Fiscal year 2006-2007. In Fiscal Year 2007
– 2008 there was a decrease in homicide deaths while perhaps a trend, it is not yet statistically
significant.


      Figure 2-11:                      Manner: Homicide - San Francisco
                                             Ten Year Perspective

        120


        100


         80


         60


         40


         20


          0
              ’98-‘99   ’99-‘00   ’00-‘01   ’01-‘02   ’02-‘03   ’03-‘04   ’04-‘05   ’05-‘06   ’06-‘07      ’07-‘08




Manner of Death - Homicide                                                                              Page 38
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Demographics:


The Demographics of Homicide deaths are detailed in the next Figures 2-12 and 2-13 and Tables
2-9 and 2-10.



   Table 2-9:                Manner Homicide by Race and Sex
                                     FY 2007 - 2008
                                Male          Female             %               Total
   White                         15              2                                17
                              13.89%          1.85%           15.74%
   Black                         51              2                                53
                              47.22%          1.85%           49.07%
   Asian                          9              1                                10
                               8.33%          0.93%            9.26%
   Hispanic                      26              1                                27
                              24.07%          0.93%           25.00%
   Unknown/Other                  1              0                                1
                               0.93%                           0.93%
   Total                        102              6                               108
                              94.44%          5.56%          100.00%


Deaths classified as Homicide occur predominantly in males (94.4%) with females representing
only 5.6% of these deaths. Homicide deaths are disproportionately concentrated among Blacks
(49.1%) when compared to the percentage of Blacks in the general population (estimated at
6.9%) and in the population of Black decedents investigated by the San Francisco OCME
(20.9%). Hispanics are also overrepresented in deaths classified as Homicide as Hispanics
comprise 25% of the deaths classified as Homicide which is almost double the proportion of
Hispanics in San Francisco (14%) and Hispanics represent only 9% of the deaths investigated by
the OCME. Both Asian (9.3%) and White (15.7%) deaths classified as Homicide are under
represented in proportion to their demographic composition of San Francisco and the San
Francisco OCME, 14.3% and 53.9% respectively.




Manner of Death - Homicide                                                               Page 39
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




   Figure 2-12:                 Manner: Homicide by Race and Sex
                                        FY 2007 - 2008

          60

          50                                                       Male    Female


          40

          30

          20

          10

           0
                   White        Black           Asian          Hispanic    Unknown/Other




Table 2-10 provides information on Homicide deaths by age and sex. More than half of all
Homicides are aged 20-39 years of age (64.8%) with the 20-29 age group comprising 37% of all
Homicides and 30-39 age group comprising 27.8% of all Homicides.




Manner of Death - Homicide                                                            Page 40
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




          Table 2-10:        Manner Homicide Deaths by Age and Sex
                                       FY 2007 - 2008
              Age Group           Male           Female          Sub-total          Total
                 <1                                                                  0

                 1-5                                                                 0

                6 - 12                                                               0

                13 - 16              3                                               3
                                  2.78%                           2.78%
                17 - 19             10                                               10
                                  9.26%                           9.26%
                20 - 29             39               1                               40
                                 36.11%           0.93%           37.04%
                30 - 39             26               4                               30
                                 24.07%           3.70%           27.78%
                40 - 49             15               1                               16
                                 13.89%           0.93%           14.81%
                50 - 59              3                                               3
                                  2.78%                           2.78%
                60 - 69              5                                               5
                                  4.63%                           4.63%
                70 - 79              1                                               1
                                  0.93%                           0.93%
                80 - 89                                                              0

                 > 90                                                                0

                Totals             102               6             100%             108
                                 94.44%           5.56%


The age group distribution for deaths classified as Homicide is revealed in Figure 2-13.
Homicides most frequently occurred in males ages 20 through 39 with 27.7% (31/112) of these
deaths between 20 and 29 years of age and 25% (28/112) between 30 and 39 years of age. Six
deaths classified as Homicide occurred in the 13 and 16 age group and 12 occurred in the 17 and
19 age group. There were no deaths classified as Homicide in the age groups above 60-69.
Homicide deaths were overwhelmingly male (94.4%).




Manner of Death - Homicide                                                            Page 41
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




       Figure 2-13:                        Manner: Homicide by Age and Sex
                                                    FY 2007 - 2008
         40
                                                                            Male     Female

         30



         20



         10


          0
              0 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89   > 90




Methods and frequency of deaths classified as Homicide in Fiscal Year 2007 - 2008 are detailed
in Figure 2-14. Firearms are the most common method of Homicide representing 75% of all Non-
Vehicular Homicides. Firearm deaths are not restricted to Homicides and there is a separate
discussion of all firearm deaths in Section 4 of this report. Blunt injury (12%) and sharp injury
(11%) are the second and third most frequent common methods for death classified as Homicide.


Methods:


Figure 2-14 describers the methods for Manner of Death Homicide for Fiscal Year 2007 – 2008.


       Figure 2-14:                 Manner Homicide - Methods
                                          FY 2007 - 2008
                                       1       1

                                  12
                  13                                                                           Firearm
                                                                                               Blunt Injury
                                                       81
                                                                                               Sharp Injury
                                                                                               Asphyxia
                                                                                               Strangulation

.




Manner of Death - Homicide                                                                            Page 42
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



Table 2-11 describes the ten year perspective for deaths classified as Homicide by method of
death.


 Table 2-11:                                 Manner Homicide - Methods
                                                 Ten Year Perspective
 Homicide    ’98-‘99     ’99-‘00     ’00-‘01       ’01-‘02           ’02-‘03         ’03-‘04       ’04-‘05     ’05-‘06    ’06-‘07        ’07-
                                                                                                                                          ‘08
  Firearm       35           41            38           43              55              65           62          79         81            81
             59.32%      68.33%      57.58%        63.24%            70.51%          73.86%        78.48%      81.44%     72.32%     75.00%
   Blunt
   Injury       8              7           13             9             14              13           8           7          10            13
             13.56%      11.67%      19.70%        13.24%            17.95%          14.77%        10.13%      7.22%      8.93%      12.04%
   Sharp
   Injury       10             8           10           10               9               6           5           3          14            12
             16.95%      13.33%      15.15%        14.71%            11.54%            6.82%       6.33%       3.09%      12.50%     11.11%
 Asphyxia       3              0           3              6              0               2           2           4           3             1
              5.08%                   4.55%         8.82%                              2.27%       2.53%       4.12%      2.68%          0.93%
   Other         3           4           2             0                 0                2           2           4          4              1
              5.08%       6.67%       3.03%                                            2.27%       2.53%       4.12%      3.57%          0.93%
   Total        59          60          66              68              78               88          79          97        112            108




Figure 2-15, shows the methods of deaths classified as Homicide normalized by year for each of
the last ten years. It is important to note the total number of cases for each year. For example,
there has been a general increase in deaths classified as Homicide and a general increase in
firearm deaths and sharp injury deaths.


   Figure 2-15:           Manner: Homicide Methods Normazlized by Year
                                   Ten Year Perspective
      100%      3                      2                                         2             2          4          4        1
                                                                                                                              1
                           4           3           6                             2             2                     3
                                                                 9                                        4                  12
                3                                                                6             5          3
                           8                                                                                        14
                                      10           10                                          8          7
                10                                               14             13                                           13
       80%                                                                                                          10
                           7
                                                   9
                8                     13

       60%



       40%                                                                                   62           79
                                                                 55             65                                 81        81
                           41
                35                                 43
                                      38

       20%



        0%
             ’98-‘99    ’99-‘00    ’00-‘01      ’01-‘02       ’02-‘03        ’03-‘04     ’04-‘05     ’05-‘06    ’06-‘07   ’07-‘08

              Firearm               Blunt Injury                        Sharp Injury                     Asphyxia                Other


Manner of Death - Homicide                                                                                                   Page 43
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




There is a statistically significant rise in the numbers of firearm-related Homicide deaths since
Fiscal Year 2002-2003 with a 47.3% (from 55 firearm-related Homicides in Fiscal Year 2002-2003
to a total of 81 firearm-related Homicides in Fiscal Years 2006-2007 and 2007-2008) and an
increase of 55.6% (from 9 in Fiscal Year 2002-2003 to 14 in Fiscal Year 2006-2007) and 12 in
Fiscal year 2007-2008 in the number of Homicides due to sharp injuries. Trend analysis of these
changes is depicted in Figure 2-16. While the trend in increasing firearm-related deaths classified
as Homicide is demonstrated by this graphic it is also clear that there is no trend with respect to
sharp injury deaths classified as Homicide. Fiscal Year 2007-2008 did have a significant rise in
these sharp injury deaths classified as Homicide, but this may be only a random increase or a
beginning of a trend which cannot be explored with the current data.



    Figure 2-16:                   Trends: Firearm, Sharp Injury and
                                     Blunt Force Injury Homicides
                                        Ten Year Perspective
       100

        80

        60

        40

        20

         0
             ’98-‘99   ’99-‘00   ’00-‘01   ’01-‘02   ’02-‘03    ’03-‘04   ’04-‘05    ’05-‘06   ’06-‘07   ’07-‘08

                                             Firearm           Sharp Injury         Blunt Injury




Firearm-Related Homicides


Firearm deaths are the most significant proportion of homicide deaths. Further examination of
the Demographics of firearm-related Homicides may provide insight. The next Tables (2-12 and
2-13) and Figures (2-17 and 2-18) clearly demonstrate that these deaths are predominantly
males, aged 20-39.




Manner of Death - Homicide                                                                                   Page 44
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




            Table 2-12: Firearm-Related Homicide Deaths by Race and Sex
                                    FY 2007-2008
                                   Male     Female      Sub-total        Total
            White                    6         1                          7
                                  7.41%     1.23%        8.64%
            Black                   45         2                          47
                                 55.56%     2.47%       58.02%
            Asian                    8         0                          8
                                  9.88%                  9.88%
            Hispanic                18        0                           18
                                 22.22%                 22.22%
            Unknown/Other            1        0                           1
                                  1.23%                  1.23%
            Total                   78         3                          81
                                   96%        4%         100%




Blacks represent 58% (47/81) of all firearm-related Homicides with Hispanics representing the
second most common group at 22% (18/81). Both Whites and Asians are under represented in
these deaths at 7.4% and 9.8%, respectively.


   Figure 2-17:              Firearm-Related Homicides by Race and Sex
                                         FY 2007 - 2008

          50                                                           Male        Female


          40

          30

          20

          10

           0
                    White          Black      Asian         Hispanic          Unk/Other




Manner of Death - Homicide                                                                Page 45
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Further, the examination of the age groups (Table 2-13) of firearm-related Homicides clearly
shows that 20-39 years of age account for more than 70% of all firearm-related homicides. Next
are 17-19 year age group followed by 40-49 years age group.


 Table 2-13:             Firearm-Related Homicides by Age and Sex
                                     FY 2007-2008
    Age Group                Male       Female             Sub-total                Total
       <1                                                                            0

       1-5                                                                            0

      6 - 12                                                                          0

      13 - 16                3             0                                          3
                          3.70%                             3.70%
      17 - 19                8             0                                          8
                          9.88%                             9.88%
      20 - 29               36             0                                         36
                         44.44%                             44.44%
      30 - 39               22              3                                        25
                         27.16%          3.70%              30.86%
      40 - 49                6              0                                         6
                          7.41%                             7.41%
      50 - 59                2             0                                          2
                          2.47%                             2.47%
      60-69                  1             0                                          1
                          1.23%                             1.23%
      70 - 79                0                                                        0

      80 - 89                                                                         0

       > 90                                                                           0

      Totals               78              3                100 %                    81
                         86.40%         13.60%


The most frequent firearm-related death is between ages 20 – 39 (44.4% of the 20-29 age group
and 30.9% of the 30-39 age group). Males compromise 86.4% of these deaths.

Firearm-related deaths are further discussion of all firearm deaths in Section 5 of this report.




Manner of Death - Homicide                                                                  Page 46
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




  Figure 2-18:                       Firearm-Related Homicides by Age and Sex
                                                  FY 2007 - 2008
         40
         35
         30                                                                       Male         Female

         25
         20
         15
         10
          5
          0
              <1     1-5     6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60-69 70 - 79 80 - 89 > 90




Sharp Injury-Related Homicides


Demographic information on sharp injury-related Homicides appears in the next two tables (Table
2-14 and 2-15) and Figures (Figures 2-19 and 2-20).


          Table 2-14:           Sharp Injury-Related Homicides by Race and Sex
                                                FY 2007-2008
                              Male                Female              Sub-total                  Total
          White                 3                   0                                             3
                             25.00%                                    25.00%
          Black                 3                    0                                              3
                             25.00%                                    25.00%
          Asian                                      1                                              1
                                                  8.33%                 8.33%
          Hispanic              5                                                                   5
                             41.67%                                    41.67%
          Total                11                    1                                             12
                             91.67%               8.33%                 100%


Sharp injury-related Homicides are most frequently seen among Hispanics. Hispanics represent
41.7% of this group (almost four times their prevalence in San Francisco). Blacks are also
overrepresented at 25% of this group when they compromise 6.9% of the population and whites
are underrepresented at 25%.




Manner of Death - Homicide                                                                                   Page 47
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




        Figure 2-19:         Sharp Injury-Related Homicides by Race & Sex
                                          FY 2007 - 2008
                                          Male   Female
            5

            4

            3

            2

            1

            0
                     White             Black              Asian      Hispanic



Sharp injury-related Homicides are predominantly males (92.3%) and 61.5% occur between 30-
49 years of age.


       Table 2-15:           Sharp Injury-Related Homicides by Age and Sex
                                         FY 2007 - 2008
                Age Group               Male         Female       Sub-total     Total
                  0 - 12                                                         0

                  13 - 16                                                        0

                  17 - 19                  1                                     1
                                        7.69%                      7.69%
                  20 - 29                  2                                     2
                                       15.38%                     15.38%
                  30 - 39                  2            1                        3
                                       15.38%        7.69%        23.08%
                  40 - 49                  5                                     5
                                       38.46%                     38.46%
                  50 - 59                  1                                     1
                                        7.69%                      7.69%
                  60 - 69                  1                                     1
                                        7.69%                      7.69%
                  70 - 79                                                        0

                  80 - 89                                                        0

                   > 90                                                          0

                  Totals                 12             1                        13
                                       92.31%        7.69%         100%


Manner of Death - Homicide                                                              Page 48
         Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



There was only one sharp injury-related Homicides of a female in the 30-39 age group.


 Figure 2-20:                   Sharp Injury-Related Homicides by Age and Sex
                                                 FY 2007 - 2008
            5
                                                                                         Male        Female
            4

            3

            2

            1

            0
                <1    1-5    6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89 > 90




Blunt Injury-Related Homicides


Demographic information on blunt force injury-related Homicides appears in the next two tables
(Table 2-16 and 2-17) and Figures (Figures 2-21 and 2-22).


 Table 2-16:         Blunt Injury-Related Homicides by Race and Sex
                                      FY 2007-2008
                             Male                    Female                        Sub-total                 Total
 White                      4                            1                                                     5
                        30.77%                        7.69%                        38.46%
 Black                      3                                                                                  3
                        23.08%                                                     23.08%
 Asian                      1                                                                                  1
                        0.07692                                                     7.69%
 Hispanic                   3                            1                                                     4
                        23.08%                        7.69%                        30.77%
 Total                     11                            2                                                    13
                        84.62%                       15.38%                          100%




Blunt force injury-related homicides are fairly evenly distributed among Whites, Blacks and
Hispanics and are predominantly male.




Manner of Death - Homicide                                                                                         Page 49
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




       Figure 2:21            Blunt Injury-Related Homicides by Race & Sex
                                             FY 2007 - 2008

           5
                                                          Male    Female

           4

           3

           2

           1

           0
                    White              Black            Asian         Hispanic



          Table 2-17:        Blunt Injury- Related Homicides by Age and Sex
                                                FY 2007-2008
                 Age Group              Male         Female      Sub-total       Total
                   0 - 12                                                         0

                   13 - 16                                                        0

                   17 - 19                 1                                      1
                                        7.69%                     7.69%
                   20 - 29                 1            1                         2
                                        7.69%        0.07692     15.38%
                   30 - 39                 2                                      2
                                       15.38%                    15.38%
                   40 - 49                 3             1                        4
                                       23.08%         7.69%      30.77%
                   50 - 59                 0                                      0
                                                                  0.00%
                   60 - 69               3                                        3
                                      23.08%                     23.08%
                   70 - 79               1                                        1
                                      0.07692                     7.69%
                   80 - 89                                                        0

                    > 90                                                          0

                   Totals                11             2                         13
                                       84.62%        15.38%       100%




Manner of Death - Homicide                                                               Page 50
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008



There are no patterns with respect to age in blunt force-related homicides, except that they are
not found in the 0 – 16 age groups and the 80 and above age groups.


   Figure 2-22:          Blunt Injury- Related Homicides by Age & Sex
                                          FY 2007 - 2008
         4


         3                      Male      Female


         2


         1


         0
             <1    1-5   6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89   > 90




Manner of Death - Homicide                                                                                   Page 51
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




_________________________________________________________

Manner: SUICIDE (Non-Vehicular)



Suicide as a Manner of Death is defined as an injury or intoxication (poisoning) that is the
result of an intentional self-inflicted act committed to do self harm or cause one’s death. In
fiscal year 2007-2008, the OCME determined that there were 94 deaths classified as
Suicide, one with the ascribed method of using a vehicle. This death is discussed in the
section on Vehicular deaths.

There have been no statistically significant changes in the numbers of Suicide deaths in San
Francisco over the past then years, ranging between 90 and 110 Suicide deaths per year.


       Figure 2-23:                    Manner Suicide San Francsico
                                           Ten Year Perspective

       120

       100

        80

        60

        40

        20

         0
             ’98-‘99 ’99-‘00 ’00-‘01 ’01-‘02 ’02-‘03 ’03-‘04 ’04-‘05 ’05-‘06 ’06-‘07 ’07-‘08




Manner of Death: Suicide                                                                       Page 52
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




Demographics:


The demographics of Non–Vehicular Suicide deaths are detailed in the following Tables and
Figures. Most (76.6%) of the Suicides occur among Whites which is higher than their
incidence in the general San Francisco population and the OCME decedent population;
50.9% and 53.9% respectively. Asians are approximately 32.1% of the general San
Francisco population but only represent 14.3% of the OCME decedent population. This is
similar to the percentage of Asian Suicides. Blacks represent 6.9% of the general
population, 21.5% of the OCME decedent population but comprise only 4.3% of Suicide
deaths. Hispanics represent 14% of the general population, 9.1% of the OCME decedent
population but only 4.3% of Suicide deaths. This is evidence that Blacks and Hispanics are
less likely to die from Suicide than Whites and Asians. Suicide is more common in males
(83%) than in females.

The Demographics with respect to race and sex are detailed in Table 2-18 and Figure 2-24.


     Table 2-18:              Suicide Deaths by Race and Sex
                                    FY 2007 - 2008
                             Male           Female           Sub-total          Total
     White                    58               14                                72
                           61.70%           14.89%            76.60%
     Black                     4                1                                5
                            4.26%           0.01064           5.32%
     Asian                    12                1                                13
                           12.77%            1.06%            13.83%
     Hispanic                  4                0                                4
                            4.26%                             4.26%
     Total                    78              16                                 94
                           82.98%           17.02%            100 %


White males are the most likely to die from Suicide, and of note there were no Hispanic
female Suicide deaths in Fiscal Year 2007-2008.




Manner of Death: Suicide                                                                Page 53
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




     Figure 2-24:               Suicide Deaths by Race and Sex
                                      FY 2007 - 2008

       100

        80                          Male      Female


        60

        40


        20


          0
                 White      Black          Asian       Hispanic      Total




The demographic information with respect to age and sex are detailed in Table 2-19 and
Figure 2-25. Most Suicide deaths are White (61.8%) males (81.8%) and are most likely to be
between the ages of 30 and 59 with the peak occurring in the 40-49 age group (23.6%).




Manner of Death: Suicide                                                               Page 54
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




     Table 2-19:             Suicide Deaths by Age and Sex
                                     FY 2007 - 2008
                            Male         Female           Sub-total           Total
     <1                                                                        0

      1-5                                                                      0

      6 - 12                                                                   0

      13 - 16                                                                  0

      17 - 19                  1            0                                  1
                            1.06%                          1.06%
      20 - 29                  7             1                                 8
                            7.45%         1.06%            8.51%
      30 - 39                 29             1                                 30
                           30.85%         1.06%            31.91%
      40 - 49                 11             5                                 16
                           11.70%         5.32%            17.02%
      50 - 59                 12             2                                 14
                           12.77%         2.13%            14.89%
      60 - 69                 12             3                                 15
                           12.77%         3.19%            15.96%
      70 - 79                  3             3                                 6
                            3.19%         3.19%            6.38%
      80 - 89                  3             1                                 4
                            3.19%       0.0106383          4.26%
      > 90                     0                                               0

     Totals                  78            16              100%                94
                           82.98%        17.02%           100.00%




Middle aged adults are the most likely to die from Suicide. Suicides are most likely to occur
in the 30-39 age group (31.9%) with the 40-69 age groups making up another 47.9 % of
these deaths. Men are far more likely to die from suicide than women (83%).




Manner of Death: Suicide                                                               Page 55
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008



          Figure 2-25:                         Suicide Deaths by Age and Sex
                                                      FY 2007 - 2008
            30

            25

            20
                             Male     Female
            15

            10

             5

             0
                  <1       1-5   6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89   > 90
                 year



The most frequent method of Non-Vehicular Suicide death is drug-related (intentional
overdose) with 30 deaths attributed to this method (31.6%) followed by jumping from
buildings or bridges at 21 (22.1%) and hanging at 20 (21%). There was a significant drop in
suicides by firearm in 2007 – 2008 over the previous fiscal year from 24 to 12.


Methods:


Methods of Suicide death are detailed in Figure 2-26. The most frequent method of Non-
Vehicular Suicide death is drug-related (intentional overdose) with 30 deaths attributed to
this method (31.6%) followed by jumping from buildings or bridges at 21 (22.1%) and
hanging at 20 (21%). There was a significant drop in suicides by firearm in 2007 – 2008 over
the previous fiscal year from 24 to 12.


   Graph 2-26:                        Manner Suicide by Method
                                           FY 2007 - 2008



                                                      3       4    4
                           30                                                 12


                                                                       20

                                        21




     Drowning      Sharp Injury      Asphyxia       Firearm       Hanging     Jump      Drug-related



Manner of Death: Suicide                                                                                      Page 56
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




Further examination into the method of Suicide deaths is detailed in Table 2-20.

 Table 2-20:                                   Suicide Methods
                                             Ten Year Perspective
                ’98-‘99    ’99-‘00   ’00-‘01     ’01-‘02   ’02-‘03   ’03-‘04   ’04-‘05   ’05-‘06   ’06-‘07   ’07-‘08

 Drug-
 related          25         24        28          30        27        22        20        26        23         30
               28.40%      24.00%    25.00%     31.30%     23.70%    20.80%    18.00%    27.40%    20.90%    31.58%
 Firearm          19         26        20          19        25        18        11        17        23         12
               21.60%      26.00%    17.90%     19.80%     21.90%    17.00%    9.90%     17.90%    20.90%    12.77%
 Hanging          19         27        29          21        22        32        29        20        28         20
               21.60%      27.00%    25.90%     21.90%     19.30%    30.20%    26.10%    21.10%    25.50%    21.28%
 Jump             15         15        20          11        24        18        34        19        24         21
               17.00%      15.00%    17.90%     11.50%     21.10%    17.00%    30.60%    20.00%    21.80%    22.34%
 Asphyxia         2          3         5           6         7         6         8         3         7           4
                2.30%      3.00%     4.50%       6.30%     6.10%     5.70%     7.20%     3.20%     6.40%       4.26%
 Drowning         2          0         3           2         3         4         3         5         3           3
                2.30%                2.70%       2.10%     2.60%     3.80%     2.70%     5.30%     2.70%       3.19%
 Sharp
 Injury           4          4         3           1         2         2         3         0         2           4
                4.50%      4.00%     2.70%       1.00%     1.80%     1.90%     2.70%     0.00%     1.80%       4.26%
 Other             1         0          2           4         2         2         1         3                    0
                1.10%                1.80%       4.20%     1.80%     1.90%     0.90%     3.20%
 CO
 Poisoning        1          1         2           2         2         2         2         2         0           0
                1.10%      1.00%     1.80%       2.10%     1.80%     1.90%     1.80%     2.10%
 Total            88        100       112          96       114       106       111        95       110         94



There is also very little change in numbers of Suicide deaths over the past ten years as
depicted in Table 2-20 and Figure 2-27.




Manner of Death: Suicide                                                                             Page 57
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




       Figure 2-27:                    Manner Suicide - Methods Normalized by Year
                                               Ten Year Perspective

      100%         1
                   1          1
                              0           2        2          2         2         2
                                                                                  1         2         0
                                                                                                      2          0
                                                                                                                 4
                              4           2        4          2
                                                              2         2         3         3         3
                   4          0
                              3           3        1          3         2                   0                    3
                   2                      3        2                    4         3         5         7
                   2                      5                   7                                                  4
                                                   6                    6         8         3
                              15
       80%         15                              11                                                 24
                                         20                             18                  19                  21
                                                              24
                                                                                  34
                              27                   21
                   19
       60%
                                         29                   22                            20        28        20
                                                                        32


                   19                              19                             29
       40%                    26                                                                                12
                                                              25                            17
                                         20
                                                                                                      23
                                                                        18
                                                                                  11
       20%
                   25                              30                                                           30
                              24         28                   27                            26
                                                                        22        20                  23

        0%
             ’98-‘99       ’99-‘00    ’00-‘01   ’01-‘02    ’02-‘03   ’03-‘04   ’04-‘05   ’05-‘06   ’06-‘07   ’07-‘08
    Drug-related        Firearm      Hanging    Jump      Asphyxia    Drowning     Sharp Injury    Other     CO Poisoning


In Fiscal Year 2007-2008, the most common method of Suicide was drug ingestion, followed
by jump-related (typically from buildings or bridges) and hangings. Drug ingestion Suicide
and Suicide by firearm are further explored in Sections 3 and 4.



Drug-Related Suicides


Table 2-21 and Figure 2-28 detail the Demographics of Suicide deaths by drug ingestion with
respect to race and sex. Examination of drug-related Suicides reveals that these individuals
are predominantly White (at 82.1%).




Manner of Death: Suicide                                                                                       Page 58
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




     Table 2-21:                Drug-Related Suicide Deaths by Race and Sex
                                           FY 2007 - 2008
                                Male        Female           Sub-total              Total
     White                       22            3                                     27
                              73.33%        10.00%           82.14%
     Black                        1                                                  1
                               3.57%                          3.57%
     Asian                        3           0                                      3
                              10.71%                         10.71%
     Hispanic                     1                                                  1
                               3.57%                          3.57%
     Total                       27            3                                     30
                              90.00%        10.00%            100 %




Drug-related Suicides are predominantly male and there were no Hispanic, Asian or Black
female Suicides by this method. Females represent only 10 % of drug-related Suicide.



      Figure 2-28:          Drug-Related Suicide Deaths by Race and Sex
                                        FY 2007 - 2008



          25

          20
                                            Male       Female
          15

          10

             5

             0
                    White           Black            Asian               Hispanic



Additional demographic information with respect to age and sex are detailed in Table 2-22
and Figure 2-29. All drug-related Suicides were between the ages of 20 and 69 and there
were no cases under 20 years of age. Nearly half of the drug-related Suicide deaths
occurred among males aged 30-39 (46.4%). Males were the predominant sex in drug-
related Suicide deaths (89.3%).




Manner of Death: Suicide                                                                    Page 59
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




        Table 2-22:        Drug-Related Suicides by Age and Sex
                                     FY 2007 - 2008
                                Male          Female           Sub-total          Total
                 <1                                                                0

                1-5                                                                0

                6 - 12                                                             0

               13 - 16                                                             0

               17 - 19                                                             0

               20 - 29             2             0                                 2
                                6.67%                           6.67%
               30 - 39            14             0                                 14
                               46.67%                           46.67%
               40 - 49             3              2                                5
                               10.00%          6.67%            16.67%
               50 - 59             4              1                                5
                               13.33%          3.33%            16.67%
               60 - 69             4              0                                4
                               13.33%                           10.71%
               70 - 79             0                                               0

               80 - 89            0              0                                 0

                > 90                                                               0

               Totals            27              3                                 30
                               90.00%         10.00%             100%




Manner of Death: Suicide                                                                  Page 60
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




         Figure 2-29:              Drug-Related Suicides by Age and Sex
                                            FY 2007 - 2008

         14

         12                                                                      Male     Female

         10

          8

          6

          4

          2

          0
              <1     1-5   6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89 > 90




Jump-Related Suicide


Jump-related Suicide deaths comprised 22.3% of the Suicide deaths in Fiscal Year 2007-
2008. Whites were predominant (70%) as were males (80%). Of note, is that there were no
Hispanic, Asian or Black women in this population. Table 2-23 and Figure 2-30 detail the
demographic information of this population with respect to race and sex.




Manner of Death: Suicide                                                                                   Page 61
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




        Table 2-23:         Suicide Deaths by Jumping by Race and Sex
                                             FY 2007 - 2008
                             Male            Female            %            Total
        White                 10                4                            14
                            50.00%           20.00%       70.00%
        Black                  3                                                 3
                            15.00%                        15.00%
        Asian                  3               0                                 3
                            15.00%                        15.00%
        Hispanic               0                                                 0

        Total                 16                4                            20
                            80.00%           20.00%           100%




  Figure 2-30:             Jump-Related Suicide Deaths by Race and Sex
                                        FY 2007 - 2008



          14
                                                       Male        Female
          12
          10
           8
           6
           4
           2
           0
                   White             Black            Asian           Hispanic




Manner of Death: Suicide                                                               Page 62
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008


Table 2-24 and Figure 2-31 detail the demographic information with respect to age and sex.
Most jump-related Suicide deaths were male (81%).


     Table 2-24:           Jump-Related Suicide Deaths by Age and Sex
                                     FY 2007 - 2008
                            Male      Female           Sub-total            Total
               <1                                                            0

      1-5                                                                    0

      6 - 12                                                                 0

          13 - 16                                                            0

          17 - 19            0                                               0
                                                        0.00%
          20 - 29              3         1                                   4
                           14.29%     0.04762           19.05%
          30 - 39              6         0                                   6
                           28.57%                       28.57%
          40 - 49              2         1                                   3
                            9.52%     0.04762           14.29%
          50 - 59              0                                             0
                                                        0.00%
          60 - 69              3         2                                   5
                           14.29%     0.09524           23.81%
          70 - 79              1         0                                   1
                            4.76%                       4.76%
          80 - 89              2        0                                    2
                            9.52%                       9.52%
            > 90                                                             0

           Totals            17          4                                   21
                           80.95%     19.05%            100 %




Manner of Death: Suicide                                                               Page 63
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




            Figure 2-31:             Jump-Related Suicide Deaths by Age and Sex
                                              FY 2007 - 2008

        6

        5
                           Male   Female
        4

        3

        2

        1

        0
            <1       1-5    6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89 > 90




Jump-Related Suicide death is unique in that the location of the jump is important to public
safety. A review of these deaths in Fiscal Year 2007 - 2008 indicates that the majority
(61.9% or 13/21) jumped from buildings but no specific buildings were implicated. The
second most common sites were bridges at 28.6% of these deaths (6/21); four were from the
Golden Gate Bridge and two from the Bay Bridge. It should be noted that there was a 26.6%
decrease in jump-related suicides from Fiscal Year 2006 – 2007 to Fiscal Year 2007 – 2008.



        Figure 2-32:              Sites Invovled in Jump-Related Suicides
                                              FY 2007 - 2008

              14
              12

              10

                 8
                 6

                 4
                 2

                 0
                     Bay Bridge         Golden Gate           Overpass            Building
                                          Bridge




Manner of Death: Suicide                                                                                     Page 64
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




Suicide by Hanging


Suicide deaths by hanging are further detailed in Table 2-25 and Figure 2-33 with respect to
race and sex.

          Table 2-25:         Suicide Deaths by Hanging by Race and Sex
                                           FY 2007 - 2008
                               Male      Female         Sub-total          Total
          White                 12          2                               14
                             60.00%      10.00%          70.00%
          Black                  0                                          0
                              0.00%      0.00%           0.00%
          Asian                  4          1                               5
                             20.00%      5.00%           25.00%
          Hispanic               1                                          1
                              5.00%       0.00%          5.00%
          Total                 22           6                              20
                             85.00%      15.00%           100%



Whites (70%) and Asians (25%) comprised the majority of Suicide by hanging deaths and
there was only one (5%) Hispanic. Males comprise 85% of these deaths and females 15%.



       Figure 2-33:            Suicide Deaths by Hanging by Race and Sex
                                           FY 2007 - 2008



          14
          12                                                   Male    Female

          10
           8
           6
           4
           2
           0
                     White            Black            Asian           Hispanic




Manner of Death: Suicide                                                               Page 65
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




Table 2-26 and Figure 2-34 explore the age and sex Demographics of this group.


        Table 2-26:         Suicide Deaths by Hanging by Age and Sex
                                        FY 2007 - 2008
                            Male      Female        Sub-total          Total
              <1                                                        0

             1-5                                                        0

            6 - 12                                                      0

            13 - 16                                                     0

            17 - 19            1                                        1
                            5.00%                    5.00%
            20 - 29            2                                        2
                           10.00%                    10.00%
            30 - 39            5          1                             6
                           25.00%      5.00%         30.00%
            40 - 49            3          1                             4
                           15.00%      5.00%         20.00%
            50 - 59            5                                        5
                           25.00%                    25.00%
            60 - 69            0         1                              1
                                        0.05         5.00%
            70 - 79          0           0                              0
                                                     0.00%
            80 - 89           1          0                              1
                           5.00%                     5.00%
             > 90                                                       0

            Totals           17          3                              20
                           78.60%     21.40%          100%




The majority of Suicide by hanging deaths are male (78.6%) and are most likely to occur
within the 17 – 59 age groups.




Manner of Death: Suicide                                                               Page 66
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




     Figure 2-34:                Suicide Deaths by Hanging by Age and Sex
                                             FY 2007 - 2008

         6

         5                   Male      Female
         4

         3

         2

         1

         0
                <1   1-5   6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89   > 90




Firearm-Related Suicides


Firearm-related Suicides accounted for 12.8% of Suicide deaths in Fiscal Year 2007-2008
(12/94). This is a significant decrease from Fiscal Year 2006 – 2007 when 23/110 (20.9%)
Suicide deaths were firearm-related. Whites were the most frequently encountered group
among Suicide by firearm, representing 83.3% of these deaths. Males were three times
more likely than females to die from firearm-related suicides. There were no Black or
Hispanic firearm-related deaths classified as Suicide in Fiscal Year 2007 – 2008. The details
of race and sex are provided in Table 2-27 and Figure 2-35.




        Table 2-27:          Suicide Deaths by Firearms by Race and Sex
                                           FY 2006-2007
                             Male             Female           Sub-total                 Total
        White                  7                 3                                        10
                            58.33%            25.00%            83.33%
        Black                  0                                                           0

        Asian                  2                                                           2
                            16.67%                              16.67%
        Hispanic               0                                                           0

        Total                  9                 3                                         12
                            75.00%            25.00%             100%




Manner of Death: Suicide                                                                                       Page 67
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




 Figure 2-35:       Suicide Deaths by Firearms by Race and Sex
                                   FY 2007 - 2008


          10

           8                                                Male    Female

           6

           4

           2

           0
                    White        Black           Asian         Hispanic




Firearm-related Suicides were almost exclusively male and there was a general distribution
across all adult age groups with a slightly higher concentration in the 60-69 age groups. Age
and sex demographics of this population are detailed in Table 2-28 and Figure 2-36.




Manner of Death: Suicide                                                               Page 68
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




     Table 2-28:       Firearm-Related Suicide Deaths by Age Group and Sex
                                    FY 2007 – 2008
                            Male        Female              %             Total
             <1                                                            0

           1-5                                                             0

           6 - 12                                                          0

          13 - 16                                                          0

          17 - 19                                                          0

          20 - 29            0                                             0

          30 - 39              1                                           1
                            8.33%                       8.33%
          40 - 49              1            1                              2
                            8.33%        8.33%          16.67%
          50 - 59              2                                           2
                           16.67%                       16.67%
          60 - 69              4                                           4
                           33.33%                       33.33%
          70 - 79              1           2                               3
                            8.33%       16.67%          25.00%
          80 - 89              0           0                               0

            > 90                                                           0

           Totals             9            3                               12
                           75.00%       25.00%          100 %




Firearm-related suicide deaths tend to be older and male.




Manner of Death: Suicide                                                               Page 69
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008



      Figure 2-36:         Firearm-Related Suicide Deaths by Age Group and Sex
                                            FY 2007 - 2008

         4


         3
                            Male      Female

         2


         1


         0
             <1    1-5     6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89   > 90




Manner of Death: Suicide                                                                                           Page 70
    Office of the Chief Medical Examiner – San Francisco - Annual Report - Fiscal Year 2007-2008




_________________________________________________
VEHICULAR DEATHS



Vehicular deaths are mannered as Homicide, Accident, Suicide or Undetermined but as a
group they have more in common with each other than with the other Manner of Death
categories. The reasons are several; there has been much effort to reduce the numbers of
Vehicular deaths by federal and state government, law enforcement and the automotive
industry. Vehicular deaths can be prevented by addressing such issues as removing
impaired drivers from the roadways, enactment and enforcement of statutes pertaining to
traffic safety and enhancement of automotive safety equipment. Extraordinary efforts are
made to address and reduce these types of deaths. Some issues may be less controllable
such as unsafe roadways or conditions. It is important to review these deaths as an
aggregate to evaluate them for consideration of additional efforts at reducing them. In Fiscal
Year 2007-2008, there were 59 traffic fatalities (a 6.3% decrease from Fiscal Year 2006 –
2007), 42 (71.2%) were classified as Accident, 14 (23.7%) were classified as Homicide, 2
(3.4%) were classified as Suicide and one (1) was classified as Undetermined (1.7%).
Figure 2-37 portrays this distribution.



     Figure 2-37:                 Vehicular Deaths: Manner of Death
                                          FY 2007 - 2008

                                           2     1
                             14

                                                               42




                  Accident            Homicide       Suicide          Undetermined




Manner of Death: Vehicular                                                             Page 71
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




A reviewing of traffic fatalities over the past ten years showed that there was a general
decline with a low of 45 in Fiscal Year 2003 - 2004 with a slight increase in the subsequent
three years. It should be noted that this data was not included in the San Francisco OCME
Annual Report issued in 2001 - 2002; however, this data was retrospectively extracted for
purposes of this report.


          Figure 2-38:             Vehicular Deaths - San Francisco
                                       Ten Year Perspective

         80
         70
         60
         50
         40
         30
         20
         10
          0
              ’98-‘99 ’99-‘00 ’00-‘01 ’01-‘02 ’02-‘03 ’03-‘04 ’04-‘05 ’05-‘06 ’06-‘07 ’07-‘08




Demographics:


Table 2-29 and Figure 2-39 portray the Demographics of Vehicular deaths with respect to
race and sex. Comparing the Demographics of this population with the general population,
Whites represent 41% of these deaths (compared to 45.2% in the general population);
Asians represent 22% of these deaths (compared to 32.1% of the general population).
Hispanics are over represented with 20% of traffic fatalities occurring in Hispanics who
comprise 14% of the general population and Blacks are 12% of traffic fatalities consistent
when and Blacks comprise 6.9% of the general population.




Manner of Death: Vehicular                                                                      Page 72
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




     Table 2-29:               Vehicular Deaths by Race and Sex
                                           FY 2007 - 2008
                            Male           Female      Sub-total         Total
     White                   19               5                           24
                          32.20%           8.47%         41%
     Black                    5               2                            7
                             8%              3%          12%
     Asian                    5               8                           13
                             8%             14%          22%
     Hispanic                 8               4                           12
                          13.56%           6.78%         20%
     Other/Unk                2               1                            3
                           3.39%           1.69%         5%
     Total                   39              20                           59
                            66%             34%         100%




    FIgure 2-39:              Vehicular Deaths by Race and Sex
                                     FY 2007 - 2008


         25

         20                                           Male    Female


         15

         10

           5

           0
                  White            Black      Asian    Hispanic    Other/Unk




Manner of Death: Vehicular                                                             Page 73
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Table 2-30 and Figure 2-40 detail the Demographics of Vehicular-related deaths with respect
to age and sex.


          Table 2-30:                Vehicular Deaths by Age and Sex
                                              FY 2007 - 2008
                              Male          Female       Sub-total         Total
            < 1 year                                                        0

           1-5                                                               0

           6 - 12                               1                            1
                                             1.69%        1.69%
             13 - 16                            1                            1
                                             1.69%        1.69%
             17 - 19                                                         0

             20 - 29             5             6                            11
                              8.47%         10.17%       18.64%
             30 - 39            16             0                            16
                             27.12%                      27.12%
             40 - 49             8              2                           10
                             13.56%          3.39%       16.95%
             50 - 59             5              4                            9
                              8.47%          6.78%       15.25%
             60 - 69             1              2                            3
                              1.69%          3.39%        5.08%
             70 - 79             3              3                            6
                              5.08%          5.08%       10.17%
             80 - 89             1              1                            2
                              1.69%          1.69%        3.39%
              > 90               0                                           0

             Totals            39             20          100%              59
                             66.10%         33.90%       100.00%




Manner of Death: Vehicular                                                             Page 74
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




          Figure 2-40:                           Vehicular Deaths by Age and Sex
                                                        FY 2007 - 2008

            16
            14
            12
            10
                              Male      Female
              8
              6
              4
              2
              0
                    <1    1-5        6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89     > 90
                   year




Methods:


Vehicular deaths can be drivers, passengers, bicyclists or pedestrians. In Fiscal Year 2006
– 2007, there were no bicyclists but in Fiscal Year 2007-2008 there were eight bicyclists of
the fifty-nine vehicular deaths representing 13.6%. This is a significant portion of vehicular
related deaths and is a public health concern. Pedestrians represented nearly half of all
vehicular deaths (44% or 26/59). Drivers comprised 30.5% of the vehicular fatalities (18/59)
and 11.9% of these were passengers (7/59). Figure 2-41 show the distribution of vehicular
deaths among these three groups.


     Figure 2-41:              Vehicular Death - Drivers, Passengers,
                                       Pedestrians and Bicyclists
                                           FY 2007 - 2008

                                                                      8
                                     26
                                                                                     18
                                                             7




                  Bicyclist                 Driver                 Passenger                    Pedestrian




Manner of Death: Vehicular                                                                                            Page 75
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Of note is the significant proportion of drivers that are motorcycle or motor scooters. In Fiscal
Year 2006 – 2007, there were only 2 of 21 (9.5%) which involved motorcycles or motor
scooters and in Fiscal Year 2007 -2008, this number increased to 7 of 18 (44.4%). This is
represented in Figure 2-42.



      Figure 2-42: Vehicular Death - Drivers (Autos/Motorcycyles/
                Scooters), Passengers, Pedestrians and Bicyclists
                               FY 2007 - 2008


                                                      8

                             26                                      11


                                               7               7




     Bicyclist      Auto Driver    Motorcycle/Scooter Driver       Passenger       Pedestrian




Manner of Death: Vehicular                                                                Page 76
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Drivers


Drivers who died as a result of a vehicular collision were evenly distributed by race with
23.8% White, 30% Black, 25% Asian and 25% Hispanic. They were predominantly males
(81%). The racial and sex Demographics are portrayed in Table 2-31 and Figure 2-43.


          Table 2-31:        Vehicular Driver Deaths by Race and Sex
                                         FY 2007 - 2008
                                Male       Female          Sub-total          Total
          White                   7                                            7
                              38.89%                       38.89%
          Black                   3            1                               4
                                17%         5.56%          22.22%
          Asian                   2            0                               2
                              11.11%                       11.11%
          Hispanic                3            1                               4
                              16.67%       0.055556        22.22%
          Other                   1                                            1
                               5.56%                        5.56%
          Total                  16           2                                18
                                89%          11%            100%


       Figure 2-43:             Vehicular Driver Deaths by Race and Sex
                                              FY 2007 - 2008


            7

            6                                                          Male         Female

            5

            4

            3

            2

            1

            0
                     White         Black           Asian        Hispanic         Other




Manner of Death: Vehicular                                                                   Page 77
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Almost all drivers were between the ages of 20 and 59 (71.8%) and two drivers (one male
and one female) were between 80 and 89 years of age. The age and sex demographics are
detailed in Table 2-32 and Figure 2-44.



        Table 2-32:          Vehicular Deaths: Drivers by Age and Sex
                                        FY 2007 - 2008
                                Male        Female         Sub-total              Total
             < 1 year                                                              0

               1-5                                                                 0

               6 - 12                                                              0

              13 - 16                                                              0

              17 - 19                                                              0

              20 - 29             6            0                                   4
                               26.1%                         28.6%
              30 - 39             3            1                                   4
                               13.0%         4.3%             19%
              40 - 49             3            2                                   4
                               13.0%         87%             23.8%
              50 - 59             4            0                                   4
                               17.4%                          19%
              60 - 69             2            0                                   2
                                8.7%                         9.5%
              70 - 79             0                                                0

              80 - 89            1             1                                   2
                               4.3%          4.3%            9.5%
               > 90              0                                                 0

              Totals            19            4              100%                  23
                              82.65%        17.4%




Manner of Death: Vehicular                                                                Page 78
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




             Figure 2-44:                 Vehicular Driver Deaths by Age and Sex
                                                    FY 2007 - 2008

             9
             8
             7
             6                 Male     Female
             5
             4
             3
             2
             1
             0
                   <1    1-5    6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89   > 90
                  year




Looking at the Demographics of Motorcycle/Scooter drivers might be helpful in directing
prevention programs directed at this specific group. Table 2-33 and Figure 2-45 describe the
race and sex Demographics of this group.



          Table 2-33:        Motorcycle/Scooter Driver Deaths by Race and Sex
                                         FY 2007 - 2008
                                                                         Sub-
                                Male                Female               total               Total
          White                   4                                                           4
                               57.14%                                   57.14%
          Black                   2                     0                                       2
                                29%                                     28.57%
          Asian                   0                     0                                       0

          Hispanic                1                     0                                       1
                               14.29%                                   14.29%
          Total                   7                                                             7
                                100%                                     100%




Manner of Death: Vehicular                                                                                        Page 79
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




   Figure 2-45:              Motorcycle/Scooter Deaths by Race (All Male)
                                           FY 2007 - 2008

            4

            3

            2

            1

            0
                     White             Black        Asian           Hispanic


The age distribution for Motorcycle/Scooter is 6 males in the 30-39 age group and one male
in the 50-59 age group.



Passengers


Passengers were the least common traffic fatality and although Asians represent 43% of
these deaths, the total numbers are small and may be statistically insignificant. The majority
of passenger fatalities were female. The demographic data for race and sex is in Table 2-34
and Figure 2-46.


          Table 2-34:        Vehicular Passenger Deaths by Race and Sex
                                          FY 2007 - 2008
                                Male       Female       Sub-total          Total
          White                   0           1                             1
                               0.00%       14.30%           14%
          Black                   0           1                                1
                                 0%         14%             14%
          Asian                   2           1                                3
                                29%         14%             43%
          Hispanic                1           1                                2
                              14.30%       14.30%           29%
          Total                   3           4                                7
                                43%         57%          100%




Manner of Death: Vehicular                                                             Page 80
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




      Figure 2-46: Vehicular Passenger Deaths by Race and Sex
                           FY 2007 - 2008


          4


          3                  Male      Female


          2


          1


          0
                 White              Black       Asian   Hispanic      Other

Age and sex Demographics for passenger Vehicular deaths are found in Table 2-35 and
Figure 2-47.




Manner of Death: Vehicular                                                             Page 81
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




        Table 2-35:          Vehicular Passenger Deaths by Age and Sex
                                    Fiscal Year 2007 - 2008
                             Male     Female         Sub-total            Total
          < 1 year                                                         0

            1-5                                                             0

           6 - 12                                                           0

           13 - 16                                                          0

           17 - 19                                                          0

           20 - 29          1            3                                  4
                         14.29%       42.86%         28.60%
           30 - 39          2            0                                  2
                         28.57%                      28.60%
           40 - 49          0            0                                  0
                                                     14.30%
           50 - 59            0          0                                  0
                                                     14.30%
           60 - 69            0          0                                  0

           70 - 79            0          1                                  1
                                      14.29%
           80 - 89            0                                             0
                                                     14.30%
            > 90              0                                             0

        Totals                3          4            100%                  7
                             43%        57%




Manner of Death: Vehicular                                                             Page 82
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




      Figure 2-47:               Vehicular Passenger Deaths by Age and Sex
                                                FY 2007 - 2008

             4


             3
                                                                                  Male         Female

             2


             1


             0
                  <1    1-5    6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89   > 90
                 year




Pedestrians


Pedestrians are the most common Vehicular deaths and represented 44% of all Vehicular
deaths in San Francisco in Fiscal Year 2007-2008. Demographic information on race and
sex for pedestrians is detailed in Table 2-36 and Figure 2-48.


        Table 2-36:      Vehicular Pedestrian Deaths by Race and Sex
                                   FY 2007 - 2008
                               Male               Female                Sub-total                   Total
        White                    8                    2                                              10
                             30.77%                7.69%                 38.46%
        Black                    2                    1                                               3
                              7.69%              0.038462                11.54%
        Asian                    3                    8                                              11
                             11.54%               30.77%                 42.31%
        Hispanic                 2                    0                                               2
                              7.69%                                       7.69%
        Total                   15                  11                                               26
                             57.69%               42.31%                100.00%




Manner of Death: Vehicular                                                                                             Page 83
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Asians are over-represented in this population, accounting for 42% of all pedestrian deaths
which is statistically significant; Asians comprise 32.1% of the general San Francisco
population and only 14.3% of the OCME investigated cases. Women represent a much
more significant proportion of pedestrian deaths than other deaths investigated by the San
Francisco OCME (42.3%) which closely resembles their proportion in the San Francisco
community. Asian women are a significant proportion of these deaths.




      Figure 2-48:           Vehicular Pedestrian Deaths Race and Sex
                                        FY 2007 - 2008


          12                    Male      Female

          10

            8

            6

            4

            2

            0
                     White             Black         Asian          Hispanic




Manner of Death: Vehicular                                                             Page 84
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Age and sex demographic data for pedestrians is detailed in Table 2-37 and Figure 2-49.


          Table 2-37:        Vehicular Pedestrian Deaths by Age and Sex
                                         FY 2007 - 2008
                               Male       Female       Sub-total          Total
          < 1 year                                                         0

           1-5                                                             0

           6 - 12                                                          0

           13 - 16                            1                            1
                                           4.00%        2.90%
           17 - 19                                                         0

           20 - 29                3           1                            4
                              12.00%       4.00%        14.30%
           30 - 39                2                                        2
                               8.00%                    5.70%
           40 - 49                4           1                            5
                              16.00%       4.00%         20%
           50 - 59                2           2                            4
                               8.00%       8.00%         20%
           60 - 69                            2                            2
                                           8.00%        14.70%
           70 - 79                3           2                            5
                              12.00%       8.00%        5.90%
           80 - 89                1           1                            2
                               4.00%       4.00%        14.30%
           > 90                   0                                        0

          Totals                15          10           100%              25
                              60.00%      40.00%




Manner of Death: Vehicular                                                             Page 85
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Only one vehicular pedestrian death was a minor, (a 15 year old female struck by a Muni
bus).


       Figure 2-49:            Vehicular Pedestrian Deaths by Age and Sex
                                            FY 2007 - 2008

             5

             4
                        Male     Female
             3

             2

             1

             0
                  <1    1-5    6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89   > 90
                 year




Nine of the twenty-five pedestrian fatalities (36%) were struck by a Municipal vehicle,
including buses, street cars and trains.




Manner of Death: Vehicular                                                                                      Page 86
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Manner: UNDETERMINED (Non-Vehicular)


Manner of death “Undetermined” is used for cases when, after thorough consideration of all
available information, the information pointing to one manner of death is no more compelling
than one or more other manners of death. In Fiscal Year 2007-2008 Undetermined manners
represent 2.4% of all deaths in San Francisco.

A ten year perspective of Undetermined deaths can be seen in Figure 2-50. There is
statistically significant variation from year to year, but this has remained between 1% and
2.9% of the OCME decedent population.


     FIgure 2-50:                       Undetermined Deaths
                                        Ten Year Persepctive

        45
        40
        35
        30
        25
        20
        15
        10
         5
         0
             ’98-‘99 ’99-‘00 ’00-‘01 ’01-‘02 ’02-‘03 ’03-‘04 ’04-‘05 ’05-‘06 ’06-‘07 ’07-‘08




Demographics:

The demographics of race and sex for Undetermined deaths are found in Table 2-38 and
Figure 2-51.




Manner of Death: Undetermined                                                                  Page 87
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




       Table 2-38:               Undetermined Deaths by Race and Sex
                                           FY 2007 - 2008
                                                                    Sub-
                                 Male         Female                total        Total
       White                       7              2                               9
                                35.00%        10.00%               45.00%
       Black                       6              1                               7
                                 30%             5%                35.00%
       Asian                       2              1                               3
                                10.00%         5.00%               15.00%
       Hispanic                    0              0                               0

       Other                        1               0                             1
                                 5.00%                             5.00%
       Total                       16            4                                20
                                80.00%        20.00%               100.00%




        Figure 2-51:            Undetermined Deaths by Race and Sex
                                        FY 2007 - 2008


          9
          8
          7                                             Male   Female
          6
          5
          4
          3
          2
          1
          0
                  White          Black      Asian       Hispanic        Other




Manner of Death: Undetermined                                                            Page 88
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




The demographics of age and sex are detailed in Table 2-39 and Figure 2-52.



       Table 2-39:              Undetermined Deaths by Age and Sex
                                        FY 2007 - 2008
                         Male           Female      Sub-total         Total
       < 1 year            5                                           5
                        25.00%                       25.00%
        1-5                                                             0

        6 - 12                                                          0

        13 - 16                                                         0

        17 - 19                                                         0

        20 - 29                                                         0

        30 - 39            3               1                            4
                        15.00%          5.00%        20.00%
        40 - 49            5                                            5
                        25.00%                       25.00%
        50 - 59            3               1                            4
                        15.00%          5.00%        20.00%
        60 - 69                            1                            1
                                        5.00%        5.00%
        70 - 79                                                         0

        80 - 89                                                         0

        > 90                1                                           1
                         5.00%                       5.00%
       Totals              17              3         100%              20
                        85.00%          15.00%




Manner of Death: Undetermined                                                         Page 89
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




            Figure 2-52:              Undetermined Deaths by Age and Sex
                                               FY 2007 - 2008

           5

           4

           3
                              Male      Female

           2

           1

           0
                <1    1-5   6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89   > 90
               year




Methods:


The methods of death for manner Undetermined are identified in Table 2-40 and Figure 2-53.
Blunt force injury-related Undetermined deaths are the most common method of death (30%)
followed by drug-related Undetermined deaths (15%).




 Table 2-40:            Undetermined Deaths by Age and Sex
                                FY 2007-2008
 Fall                                                                             6
 Drug-Related                                                                     5
 Undetermined                                                                     3
 Drowning                                                                         2
 SUID                                                                             2
 Cardiac vs Assault                                                               1
 Alcohol vs Assault                                                              1
                                             Total                               20




Manner of Death: Undetermined                                                                                       Page 90
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




     Figure 2-53:            Manner Undetermined - Method of Death
                                      FY 2007 - 2008



                                                                    Fall
                         1      1
                2                           6                       Drug-Related

           2                                                        Undetermined

                                                                    Drowning
                     3                  5
                                                                    SUID

                                                                    Cardiac vs Assault

                                                                    Alcohol vs Assault




Manner of Death: Undetermined                                                         Page 91
          Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




_________________________________________________________

Manner: NATURAL


More than half of the deaths (53.9%) investigated by the OCME are classified as Natural
deaths however, most Natural deaths do not come under the jurisdiction of the San
Francisco OCME (see discussion in the introduction of this report). Therefore, the data
presented here is not reflective of all Natural deaths which occur in San Francisco.


A ten year review of Natural Deaths investigated by the San Francisco OCME is shown in
Figure 2-54.




  Figure 2-54:                            Natural Deaths - San Francisco
                                             Ten Year Perspective

          1,200

          1,000

           800

           600

           400

           200

             0
                  ’98-‘99 ’99-‘00 ’00-‘01 ’01-‘02 ’02-‘03 ’03-‘04 ’04-‘05 ’05-‘06 ’06-‘07 ’07-‘08




Natural                                                                                        Page 92
          Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Demographics:


The demographics for Natural deaths investigated by the OCME are detailed in the next
tables and Figures.


           Table 2-41:              Natural Deaths by Race and Sex
                                            FY 2007 - 2008
                                           Male            Female             %         Total
           White                           264                98                        362
                                         39.88%            14.80%          54.68%
           Black                            81                56                        137
                                           12%              8.46%          20.69%
           Asian                            68                43                        111
                                         10.27%             6.50%          16.77%
           Hispanic                         38                 9                         47
                                          5.74%             1.36%           7.10%
           Unknown/Other                     4                 1                         5
                                          0.60%             0.15%           0.76%
           Total                           455               207                        662
                                         68.73%            31.27%            100%




           Figure 2-55:             Natural Deaths by Race and Sex
                                          FY 2007 - 2008


            400
            350
            300                                           Male      Female
            250
            200
            150
            100
             50
              0
                      White      Black            Asian      Hispanic   Unknown/Other




Natural                                                                                      Page 93
          Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




     Table 2-42:                    Natural Deaths by Age and Sex
                                            FY 2007 - 2008
                                    Male           Female              %            Total
              < 1 year                3               3                              6
                                   0.45%           0.45%             0.91%
                1-5                   2               1                              3
                                   0.30%           0.15%             0.45%
               6 - 12                                                                0

               13 - 16                                 1                             1
                                                    0.15%            0.15%
               17 - 19                                 1                             1
                                                    0.15%            0.15%
               20 - 29                4                2                             6
                                   0.60%            0.30%            0.91%
               30 - 39               17                6                             23
                                   2.57%            0.91%            3.47%
               40 - 49               52               15                             67
                                   7.85%              2%             10.12%
               50 - 59              129               28                            157
                                  19.49%            4.23%            23.72%
               60 - 69              107               24                            131
                                  16.16%            3.63%            19.79%
               70 - 79               74               44                            118
                                  11.18%            6.65%            17.82%
               80 - 89               60               55                            115
                                   9.06%            8.31%            17.37%
                > 90                 12               22                             34
                                   1.81%            3.32%            5.14%
               Totals               460              202                            662
                                  69.49%           30.51%           100.00%




Natural                                                                                     Page 94
          Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




             Figure 2-56:                     Natural Deaths by Age and Sex
                                                      FY 2007 - 2008

              160
              140
              120
                                 Male      Female
              100
              80
              60
              40
              20
               0
                     <1    1-5   6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89   > 90
                    year




Methods:


Table 2-43 details the primary cause of death for the Natural deaths certified by the San
Francisco OCME in Fiscal Year 2007 - 2008.

Cardiovascular disease is the most commonly certified cause of death for Natural deaths;
cited in 61.7% of all Natural deaths, followed by respiratory disease at 7.7% and
malignancies at 5.7%. It should also be noted that in 55 cases, drugs or alcohol were
certified as the cause of death (7.7%) but these were determined to be Natural because they
were a result of chronic (with or without acute use) misuse of the drugs and or ethanol.




Natural                                                                                                                  Page 95
          Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 2-43:                 Natural Death – Disease Description
                                      FY 2007 - 2008
  DISEASE DESCRIPTION                                                 NUMBER OF DEATHS
 CARDIOVASCULAR
 Aortic Aneurysm/dissection                                                     7
 Arteriosclerotic Cardiovascular Disease (ASCVD)                               124
 Cardiac dysrhthymia                                                            7
 Cardiomyopathy                                                                 3
 Heart Failure (not specified)                                                  2
 Congestive Heart Failure                                                      32
 Hypertensive ASCVD / Hypertensive Heart Disease                               223
 Myocardial Infarct                                                             5
 Cardiomegaly                                                                   1
 Cardiac tamponade                                                              3
 Acute pericarditis                                                             1
                                       TOTAL CARDIOVASCULAR                    408

 CENTRAL NERVOUS SYSTEM
 Infarct                                                                        5
 Encephalopathy                                                                 2
 Spontaneous Intracerebral Hemorrhage                                           6
 Seizure                                                                        1

                            TOTAL CENTRAL NERVOUS SYSTEM                        14

 ENDOCRINE
 Diabetic Ketoacidosis                                                          4
 Diabetes Mellitus                                                              7
                                             TOTAL ENDOCRINE                    11

 GASTROINTESTINAL
 Bacterial Peritonitis                                                           2
 Gastrointestinal Hemorrhage                                                    17
 Ulcerative Colitis                                                              1
 Gastric Bezoar                                                                  1
 Divrticulitis                                                                   1
                                     TOTAL GASTROINTESTINAL                     22

 HEPATIC
 Cirrhosis                                                                      3
 Hepatitis with necrosis                                                        1
 Chronic Liver Disease                                                          2
                                                 TOTAL HEPATIC                  6



Natural                                                                                  Page 96
          Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 2-43 (continued):          Natural Death – Disease Description
                                        FY 2007 - 2008
 RENAL
 Renal failure                                                                8
 Polycsytic Kidney Disease                                                    1


                                             TOTAL RENAL                      9
  DISEASE DESCRIPTION                                              NUMBER OF DEATHS

 MALIGNANCY
 Breast                                                                       3
 Colon                                                                        1
 Lung                                                                         4
 Pancreas                                                                     1
 Prostate                                                                     1
 Esophageal/Laryngeal/Throat                                                  1
 Liver                                                                        2
 Leukemia                                                                     2
 Lymphoma                                                                     2
 Squamous Cell Carcinoma                                                      5

                                       TOTAL MALIGNANCY                      22

 RESPIRATORY
 Asthma                                                                       1
 Chronic Obstructive Pulmonary Disease                                       33
 Pneumonia                                                                   10
 Pulmonary Thromboembolus                                                    10
 Emphysema                                                                    1
                                    TOTAL RESPIRATORY                        55




Natural                                                                                  Page 97
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 Table 2-43 (continued):           Natural Death – Disease Description
                                         FY 2007 - 2008
 OTHER PROCESSES
 Chronic Ethanolism (Alcoholism)                                             38
 Hyponatremia                                                                6

 HIV / Acquired Immunodeficiency Syndrome (AIDS)                             9
 Infection/Sepsis                                                            21
 Chronic(and acute) cocaine abuse                                            6
 Chronic Polysubstance Abuse                                                 11
 Parkinson's                                                                 2
 Alzheimer's                                                                 3
 Sickle Cell                                                                 1
 Sudden Unexpected Infant Death                                              6
 Turner Syndrome                                                             1
 Interuterine Fetal Demise                                                   1
 Ankylosing Spondylitis                                                      1
 Disease Related Exsanguination                                              2
 Multiorgan failure                                                          1
 Schizophrenia                                                               1
 Dehydration                                                                 1
 Sarcoidosis                                                                 1
 Inaniation                                                                  1
                                TOTAL OTHER PROCESSES                       113

 TOTAL                                                                      660




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Section 3: DRUGS DETECTED IN DEATH INVESTIGATIONS



General Introduction


Drugs and alcohol are frequent findings in death investigation cases. In some cases, the
drugs and/or alcohol contribute directly to the cause of death and in other cases, the drugs
and/or alcohol finding is incidental. It is important to note that the presence of the drugs
does not mean that the drug was a cause or contributor to the death. Before one can draw
any conclusions from such data, several parameters must be detailed.

In reviewing this data, several caveats must be clarified. Every case does not receive the
same level of comprehensive testing. The reasons level of testing is dictated by the
circumstances of the death. Post-incident medications may be detected but will not reflect
the dug status of the decedent at the time of the incident. These medications are evaluated
on a case-by-case basis. However, given that, data presented here is useful for general
information on patterns of use and trends.

While not every case tested receives the same test panel, nearly all cases submitted for
testing are analyzed for the presence of alcohol. The next level of testing includes screening
for most common illicit drugs and many commonly used and abused prescription drugs
associated with mortality. Once a drug is detected, additional procedures are employed for
the purpose of confirmation and/or quantification. It is not possible to test for every possible
drug and/or poison but when the investigation reveals concerns testing is directed to detect
analyte(s) of concern.

Once analytical testing is completed, the results are forwarded to the forensic pathologist
who makes a determination as to whether the detected drugs were significant to the cause
and manner of death. These data are presented in aggregate form and demographic data
can reveal information about patterns of use and the generalized role of drugs (both licit and
illicit) in death investigations.




Drugs Detected                                                                           Page 99
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Incidence of Testing and Positive Rates


Table 3-1 provides information on the cases submitted for toxicological evaluation. Each
case is individually reviewed to ensure that the appropriate testing is performed. Virtually
every Homicide and Suicide case is submitted for toxicology, as long as there are
appropriate samples to test. The majority of Vehicular-related deaths and Undetermined
deaths are also submitted for toxicological examination.



Table 3-1:             Incidence of Toxicology Testing by Manner of Death
                                        FY 2007 - 2008
                                # Cases              # Tested               % Tested
        Accident                  336                  250                   74.4%

        Homicide                  108                  102                   94.4%

        Vehicular                 59                    51                   86.4%


         Suicide                  94                    90                   95.7%

      Undetermined                20                    17                    85%

         Natural                  660                  239                   36.2%

          Total                  1277                  749                  58.65%




There was a significant increase in the percentage of cases tested in Fiscal Year 2007 –
2008 over the previous Fiscal Year. In Fiscal Year 2006 – 2007, 539 of 1351 were tested
(39.9%) which increased to 749 of 1277 (56.7%). This reflects a 40% increase in the
number of cases tested (at the same time there was a 5.5% decrease of OCME cases). The
greatest increase in testing was in cases mannered as Accident followed by Natural deaths.
Figures 3-1 and 3-2 demonstrate that most of the increased testing was among deaths
mannered as Accident and Natural.




Drugs Detected                                                                         Page 100
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  Figure 3-1:               Percentage of Cases Tested by Manner of Death
                                  FY 2006 - 2007 and FY 2007 - 2008
      100%


       80%


       60%


       40%


       20%


        0%
                 Accident      Homicide    Vehicular     Suicide   Undetermined   Natural
                                          2006-2007           2007-2008


Figure 3-1 details the percentage of cases receiving testing by Manner of Death and Figure
3-2 details the numbers of cases tested by Manner of Death. Again, the increased testing
was predominantly in cases mannered as Accident followed by Natural.




          Figure 3-2:                  Numbers of Cases Tested
                                  FY 2006 - 2007 and FY 2007 - 2008

        250

        200

        150

        100

         50

           0
                 Accident     Homicide    Vehicular    Suicide Undetermined Natural

                                    2006-2007          2007-2008




Drugs Detected                                                                              Page 101
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There are several factors which should be examined to determine if the increased testing
was efficacious. One factor is to evaluate if the 40% increase in laboratory workload had an
adverse effect on the laboratory performance. The laboratory monitors average turn-around-
time as a quarterly performance parameter. In Figure 3-3 the Quarterly Average turn-
around-time is monitored for Fiscal Years 2006 – 2007 and 2007 – 2008.



                 Figure 3-3:       Quarterly Turn-Around-Time (Days)
                                    FY 2006 - 2007 & FY 2007 - 2008

                 100
                  90
                  80
                  70
                  60
                  50
                  40
                  30
                  20
                  10
                   0
                       Jul - Sep        Oct - Dec      Jan - Mar         Apr - Jun
                                     2006 - 2007           2007 - 2008




The increased work-load did not cause a statistically significant effect on the turn-around-
time during this time but there were some staffing differences between the two time periods.
The laboratory hired a full-time laboratory manager in FY 2007 – 2008 and also the
laboratory was able to use the assistance of two part-time temporary employees (who were
recently retired from the laboratory and skilled laboratory procedures). These two part-time
positions are not reflected on Department Organizational Chart in Section 1 of this report.



Positive Rates:


It is also important to evaluate the efficacy of the increased testing by reviewing the positive
rates. The positive toxicology rates for Fiscal Year 2007 – 2008 are detailed in Table 3-2 by
Manner of Death. .




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 Table 3-2:                   Positive Toxicology Rate by Manner of Death
                                            FY 2007-2008
                                     Tested               Positive                   Negative
       Accident                       250                   223                         27
          %                         74.40%                 89.2%                      10.8%
       Homicide                       102                    63                         39
          %                         94.44%                61.76%                     38.24%
       Vehicular                       51                    28                         23
          %                         86.44%                54.90%                     45.10%
        Suicide                        90                    72                         18
          %                         95.74%                  80%                        20%
     Undetermined                     17                     13                         4
          %                         85.00%                76.47%                     23.53%
        Natural                       239                   130                        109
          %                         36.21%                54.39%                     45.61%
         Total                        749                   530                        219
            %                       58.65%                70.76%                     29.24%




If the increased testing was not appropriate, the positive rate would be expected to fall but
this was not the case. Figure 3-4 details the positive rates in Fiscal Year 2006 – 2007 with
fiscal Year 2007 – 2008 by Manner of Death and the data clearly demonstrates that rather
than fall, the positive rates increased. The positive toxicology rate for all cases in Fiscal Year
2007 – 2008 was 70.8% which is a significant increase over the 57.3% positive toxicology
rate for Fiscal Year 2006 – 2007.



  Figure 3-4:                     Positive Rates by Manner of Death
                                  FY 2006 - 2007 and FY 2007 - 2008

     100%


      80%


      60%


      40%


      20%


       0%
                 Accident   Hom icide    Vehicular      Suicide      Undeterm ined     Natural

                                   FY 2006-2007                   FY 2007-2008


Drugs Detected                                                                                  Page 103
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The positive rate for increased or stayed the same for every Manner of Death. The positive
rates for deaths mannered as Homicide, Suicide and Undetermined as well a Vehicular
death accurately reflect the positive rate for these cases because nearly 90% of these cases
are subjected to testing. The positive rate for Natural deaths (54.4%) in Figure 3-4 may be
artificially elevated because only 36% of these deaths receive toxicology testing. Cases
where there is evidence of drug use (prescription or illicit) are more likely to have toxicology
testing ordered. When there is no evidence or suspicion of drug involvement, (for example
the death is very clearly due to a natural disease process) toxicology testing is not ordered.
This is significantly different for other Manners of Death.

In Fiscal Year 2007 2008, there is a significant increase in the positive rate among deaths
mannered as Accident, Suicide and Natural. Deaths mannered as Accident have the highest
positive toxicology rate at 89.2%. (In Fiscal Year 2006 – 2007, deaths mannered as
Accident also had the highest positive toxicology rate at 75.8%.) It is important to note that
there was also a significant increase in the number of cases tested for deaths mannered as
Accident. Deaths mannered as Accident and Suicide deaths share a commonality in that
death by ingestion is the most frequent method of death in both Manners. It is useful to
separate the drug-related deaths to further assess the efficacy of the level of testing ordered
for these two manners of death. Figure 3-5 examines the percentage of cases tested by
Manner of Death with the drug-related Suicide and Accident deaths separated out.




      Figure 3-5:                     Percent of Cases Tested by Manner of Death
                                              Drug-Related Separated
                                          FY 2006 - 2007 & FY 2007 - 2008

          100%

           80%

           60%

           40%

           20%

            0%
                 D-R Accident   Non-D-R    Hom icide   Vehicular Undeterm ined Natural   Non-D-R   D-R Suicide
                                Accident                                                 Suicide

    D-R - Drug-Related                           FY 2006-2007                      FY 2007-2008




Non-drug related accidents have one of the lowest testing rates (52.4% in Fiscal Year 2007 –
2008 and 47.6% in Fiscal Year 2006 – 2007). Figure 3-6 details the positive finding rate for
Fiscal Years 2006 – 2007 & 2007 – 2008 with the drug-related Suicide and Accident deaths
separated out.

Drugs Detected                                                                                      Page 104
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In Fiscal Year 2006 – 2007, Accidents had the highest positive toxicology rate and even the
non-drug related Accident deaths were higher than for all other Manners of Death at 83.3%
but decreased to 63.2% in Fiscal Year 2007 – 2008. This is closer to the positive rate in
other non-drug related deaths.


Detected Drugs


From the data in Table 3-1, 58.7% of all OCME death investigation cases were tested for
some toxicology. (This is up from 39.9% tested in Fiscal Year 2006 – 2007.) The increased
testing was efficacious because the positive rate also rose from 57.3% in Fiscal Year 2006 –
2007 to 62.6% in Fiscal year 2007-2008.positive rate. The drugs and frequency of detection
are detailed in Table 3-3. It is important to remember that many of the cases are
polysubstance cases (where more than one drug is detected). Additionally, some cases were
tested only for ethanol which would mean that the positive rate for drugs may be even higher
than suggested by these data.


The aggregate data for all drugs detected in death investigation toxicology at the OCME is
presented in Table 3-3 and Figure 3-7. One finding from this data is that cocaine is the most
commonly detected drug. Since ethanol is the most commonly ingested drug, finding
cocaine as the most prevalent drug is noteworthy.

 Table 3-3:                                  Frequency of Drugs Detected
                                                 FY 2007 - 2008

                 Drug            # Positive Cases    % Positive Cases               Drug Class
 No Drugs Detected                     219               29.24%
 Cocaine                               180               24.03%         Stimulant
 Ethanol                               163               21.76%         Alcohol
 Morphine                              97                12.95%         Narcotic Analgesic
 Methadone                             76                10.15%         Narcotic Analgesic
 Diphenhydramine                       41                 5.47%         Antihistamine
 Methamphetamine/Amphetamine           41                 5.47%         Stimulant
 Diazepam/Nordiazepam                  40                 5.34%         Anxiolytic/Muscle Relaxant
 Acetone/Isopropanol                   31                 4.14%         Volatile (Metabolic Product)
 Oxycodone                             33                 4.41%         Narcotic Analgesic
 Citalopram                            27                 3.60%         Antidepressant
 Hydrocodone                           22                 2.94%         Narcotic Analgesic
 Codeine                               22                 2.94%         Narcotic Analgesic
 Fentanyl                              16                 2.14%         Narcotic Analgesic
 Amitriptyline                         16                 2.14%         Antidepressant
 Sertraline                            14                 1.87%         Antidepressant
 Quetiapine                            14                 1.87%         Antipsychotic


Drugs Detected                                                                               Page 105
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 3-3:                       Frequency of Drugs Detected
                                          FY 2007 - 2008             (continued)
              Drug             # Positive Cases   % Positive Cases    Drug Class
 Mirtazepine                         14                1.87%         Antidepressant
 Zolpidem                            12                1.60%         Sedative
 Acetaminophen                       11                1.47%         Anti-inflammatory
 MDMA (Ecstacy)*                     11                1.47%         Stimulant-Hallucinogen
 Trazodone                           10                1.34%         Antidepressant
 Lidocaine                           10                1.34%         Local Anesthetic
 Alprazolam                           9                1.20%         Anxiolytic
 Hydroxyzine                          7                0.93%         Antihistamine
 Gabapentin                           7                0.93%         Antiseizure
 Promethazine                         7                0.93%         Antihisamine
 Doxylamine                           7                0.93%         Antihistamine
 Fluoxetine                           6                0.80%         Antidepressant
 Midazolam                            6                0.80%         Sedative Hypnotic
 Metoprolol                           6                0.80%         Beta-Blocker
 Venlafaxine                          6                0.80%         Antidepressant
                                                                     Metabolic Product of Carbon
 Carboxyhemoglobin                    6                0.80%         Monoxide Exposure
 Carisoprodol/Meprobamate             6                0.80%         Muscle Relaxant
 Phenytoin                            6                0.80%         Anticonvulsant
 Tetrahydrocannabinol                 6                0.80%         Marijuana
 Amphetamine (only)                   6                0.80%         Stimulant
 Carisoprodol/Meprobamate             6                0.80%         Muscle Relaxant
 Ibuprofen                            5                0.67%         Anti-inflammatory
 Lamotrigene                          5                0.67%         Anticonvulsant
 Phenobarbital                        5                0.67%         CNS Depressant
 Imipramine                           4                0.53%         Antidepressant
 Tramadol                             4                0.53%         Narcotic Analgesic
 Atropine                             4                0.53%         Anticholinergic
 Olanzapine                           4                0.53%         Antipsychotic
 Phencyclidine (PCP)                  4                0.53%         Sedative-Hallucinogen
 Temazepam                            4                0.53%         Anxiolytic
 Dextromethorphan                     3                0.40%         Antitussive
 Bupropion                            3                0.40%         Antidepressant
 6-monoacetylmorphine                 3                0.40%         Narcotic Analgesic (heroin)
 Propoxyphene                         2                0.27%         Sedative Hypnotic
 Propoxyphene                         2                0.27%         Narcotic Analgesic
 Chlorpheniramine                     2                0.27%         Antihistamine
 Thioridazine                         2                0.27%         Antipsychotic
 Paroxetine                           2                0.27%         Antidepressant
 Lorazepam                            2                0.27%         Anxiolytic
 Metoclopramide                       2                0.27%         Anti-nausea
 Pseudo/Ephedrine                     2                0.27%         Cold Medication
 Valproic Acid                        2                0.27%         Anticonvulsant
 *Methyldeoxymethamphetamine


Drugs Detected                                                                                Page 106
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 3-3:                        Frequency of Drugs Detected
                                         FY 2007 - 2008        (continued)
              Drug         # Positive Cases   % Positive Cases    Drug Class
 Carbamazepine                    2                0.27%          Anticonvulsant
 Lithium                          2                0.27%          Antidepressant
 Clonazepam                       1                0.13%          Anxiolytic
 Chlorpromazine                   1                0.13%          Antipsychotic
 Diltiazem                        1                0.13%          Calcium Channel Blocker
 Difluroethane                    1                0.13%          Inhalant
 Methylphenidate                  1                0.13%          Stimulant
 Meperidine                       1                0.13%          Narcotic Analgesic
 Fluvoxamine                      1                0.13%          Antidepressant
 Flurazepam                       1                0.13%          Anxiolytic
 Doxepin                          1                0.13%          Antidepressant
 Salicylate                       1                0.13%          Anti-inflammatory
 Clomipramine                     1                0.13%          Antidepressant
 Topiramate                       1                0.13%          Anticonvulsant
 Butalbital                       1                0.13%          CNS Depressant
 Oxazepam                         1                0.13%          Anxiolytic
 Benztropine                      1                0.13%          Parkinson's Treatment
 Amilodipine                      1                0.13%          Calcium Channel Blocker
 GHB                              1                0.13%          Sedative
 Amobarbital                      1                0.13%          CNS Depressant
 Propofol                         1                0.13%          Sedative
 Pentobarbital                    1                0.13%          CNS Depressant
 Guaifenesin                      1                0.13%          Expectorant
 Zopiclone                        1                0.13%          Sedative
 Isopranol                        1                0.13%          Alcohol




Drugs Detected                                                                            Page 107
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




            Figure 3-6:                 Most Frequently Detected Drugs
                                              FY 2007 - 2008
                                               22        16
                                 27     22
                         33

                 41                                            180

             41

                                                                     163
                                  76
             41                                     97




                 Cocaine                     Ethanol                       Morphine
                 Methadone                   Diphenhydramine               Methamphetamine
                 Diazepam/Nordiazepam        Oxycodone                     Citalopram
                 Codeine                     Hydrocodone                   Fentanyl




In Fiscal Year 2007 – 2008, cocaine was the most frequent finding (24%) in all death
investigation cases tested at the OCME. While cocaine was the most frequent finding in
Fiscal Year 2006 – 2007 the percentage of cocaine positive cases in those tested dropped
from 30.5%. The presence of cocaine and/or its metabolites does not mean that it was a
factor in the cause of death but its presence in such a large percentage of cases is
significant. There is further discussion of the presence of cocaine by Manner of Death,
below.

Ethanol is the second most commonly detected drug (21.8%) down from 27.7% even though
it is most frequent drug ingested drug but in San Francisco and it will be discussed in
additional detail later in this report. Of the next most commonly detected 11 drugs, 6 are
classified as narcotic analgesics; morphine at 12.95%, methadone 10.15%, oxycodone at
4.41%, hydrocodone 2.94%, codeine at 2.94% and fentanyl at 2.14%. Compared to Fiscal
Year 2006 – 2007, the positive rates for morphine, methadone, oxycodone, hydrocodone
and fentanyl increased and the positive rate for codeine decreased. The positive fentanyl
rate went from 0.7% to 2.14%, which may be attributed to improved laboratory methodology
for fentanyl. The heroin metabolite, 6-monoacetyl morphine, is unique to heroin use but it is
not always present because it is eliminated very rapidly after use. Tramadol, propoxyphene
and meperidine are also narcotic analgesics which were identified. Many cases are positive
for more than one narcotic analgesic. Narcotic analgesics are commonly used in the medical
management of both acute and chronic pain yet they are also commonly misused or abused.
From the data presented here, it is not possible to discern use from misuse or abuse of
prescription medications. Morphine is the most common narcotic analgesic detected and
can arise from the legitimate or illegitimate use of morphine sulphate but it is also the primary
metabolite of heroin. It also often used to treat acute pain from trauma so at least some of
the positive morphine findings can be attributed to medical administration of the drug
antemortem. In most cases of heroin use, morphine and perhaps, codeine, are the only

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detected drugs as the heroin-specific metabolite, 6-monoacetylmorphine, (6-MAM)) is very
short-lived and can be completely metabolized while a person is dying from a heroin
overdose. Without the presence of 6-MAM, the presumption of heroin use can only be
discerned from the circumstances revealed in the investigation. Due to improved techniques,
the laboratory identified 6-MAM in 9.3% of the morphine positive cases. Codeine is detected
from codeine use and is also a contaminant in heroin. The ratio of morphine to codeine can
be an indicator of potential heroin use; however, these data must be used with considerable
caution as it is certainly possible that someone has used both codeine and morphine.
Methadone is the second most common narcotic analgesic detected and more than14% of
the positive cases were positive for methadone. Methadone as multiple uses; it is used to
treat opiate dependence, chronic pain management and like all narcotic analgesics, is
subject to misuse. Oxycodone and hydrocodone are narcotic analgesics which are
frequently prescribed to treat acute and chronic pain and are commonly misused. Fentanyl
is a very potent narcotic analgesic used in hospitals and also used as a patch for dermal
absorption. It is subject to misuse. There was a significant increase in Fentanyl positive
cases from 5 positives in Fiscal Year 2006 – 2007 to 16 in Fiscal Year 2007 – 2008. This
increase may not be solely due to increased use but may also be attributed to improved
detection methodology in the laboratory.

Methamphetamine is typically an illicit drug but still has some limited but legitimate medical
uses. Forty cases (7.6%) were positive for methamphetamine. This was a significant
decrease in positive Methamphetamine cases from Fiscal Year 2006 – 2007 to Fiscal Year
2007 – 2008 from 55 to 40. Since the data has only been captured for two years, it is not
possible to discuss trends but future monitoring will enable this process. Amphetamine is a
metabolite of methamphetamine but may also be detected due to legitimate medical use of
amphetamine.       Six cases were positive for amphetamine in the absence of
methamphetamine.

Benzodiazepines are the next class of drugs detected but this probably does not reflect
increased use but rather improved detection capabilities. Benzodiazepines are some of the
most commonly prescribed medications and are used to treat anxiety, induce sleep and for
other medical treatment. Diazepam, nordiazepam, alprazolam and midazolam were all
detected in Fiscal Year 2006-2007 and Fiscal Year 2007 – 2008 but newly identified in Fiscal
Year 2007 – 2008 chlordiazepoxide, flurazepam, temazepam, lorazepam and clonazepam
were also detected. The incidence of detection still does do not reflect all of the
benzodiazepines present as there continue to be analytical challenges to detecting this class
of drugs.

Antihistamines are the next class of drugs detected (diphenhydramine, promethazine,
hydroxyzine, chlorpheniramine and doxylamine) and are used to treat sleep disorders,
allergies, and as antiemetics. They do have some interaction with narcotic analgesics and
there is some indication that misusers will combine antihistamines with prescription narcotic
analgesic to increase the desired euphoria.

Antidepressants and antipsychotic drugs are not significantly misused. The most common
antidepressant detected remains citalopram and the most common antipsychotic detected is
quetiapine.




Drugs Detected                                                                        Page 109
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Other illicit drugs detected are methylenedioxymethamphetamine (MDMA or ecstasy)
Phencyclidine (PCP) and tetrahydrocannabinol THC (marijuana). Of note, is that for the first
time the inhalant, difluroethane, was detected. This compound is most commonly associated
with “Huffing”.

Drugs Detected in Non-Vehicular Deaths Mannered as Accident


Table 3-4 and Figure 3-7 detail the drugs detected in Non-Vehicular deaths mannered as
Accident. This category has the majority of drug-related deaths. Table 3-5 lists the drugs or
drug combinations which were implicated in drug-related deaths mannered as Accident.

 Table 3-4:                        Manner of Death: Accident
                                    Frequency of Drugs Detected
                                             FY 2007 - 2008
                 Drug             # Positive Cases     % Positive Cases                Drug Class
 No Drugs Detected                      27                    10.80%
 Cocaine                                96                    38.40%      Stimulant
 Morphine                               63                    25.20%      Narcotic Analgesic
 Ethanol                                58                    23.20%      Alcohol
 Methadone                              53                    21.20%      Narcotic Analgesic
 Methamphetamine/Amphetamine            28                    11.20%      Stimulant
 Diazepam/Nordiazepam                   24                    9.60%       Anxiolytic/Muscle Relaxant
 Oxycodone                              21                    8.40%       Narcotic Analgesic
 Diphenhydramine                        15                    6.00%       Antihistamine
 Codeine                                14                    5.60%       Narcotic Analgesic
 Hydrocodone                            13                    5.20%       Narcotic Analgesic
 Fentanyl                               11                    4.40%       Narcotic Analgesic
 Acetone/Isopropanol                    10                    4.00%       Volatile (Metabolic Product)
 Citalopram                              9                    3.60%       Antidepressant
 Quetiapine                              8                    3.20%       Antipsychotic
 Amitriptyline                           6                    2.40%       Antidepressant
 Zolpidem                                6                    2.40%       Sedative
 Sertraline                              6                    2.40%       Antidepressant
 Alprazolam                              6                    2.40%       Anxiolytic
 Carboxyhemoglobin                       6                    2.40%       Carbon Monoxide Exposure
 Amphetamine (only)                      6                    2.40%       Stimulant
 Trazodone                               5                    2.00%       Antidepressant
 MDMA (Ecstacy)*                         5                    2.00%       Stimulant/Hallucinogen
 Acetaminophen                           4                    1.60%       Anti-inflammatory
 Mirtazepine                             4                    1.60%       Antidepressant

*Methyldeoxymethamphetamine


Drugs Detected                                                                                 Page 110
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 Table 3-4:                       Manner of Death: Accident
                                   Frequency of Drugs Detected
                                           FY 2007 - 2008        (continued)
               Drug             # Positive Cases       % Positive Cases             Drug Class
 Hydroxyzine                           4                    1.60%         Antihistamine
 Midazolam                             4                    1.60%         Sedative Hypnotic
 Promethazine                          4                    1.60%         Antihisamine
 Venlafaxine                           4                    1.60%         Antidepressant
 Temazepam                             4                    1.60%         Anxiolytic
 Gabapentin                            3                    1.20%         Antiseizure
 Metoprolol                            3                    1.20%         Beta-Blocker
 Carisoprodol/Meprobamate              3                    1.20%         Muscle Relaxant
 Phenytoin                             3                    1.20%         Anticonvulsant
 Ibuprofen                             3                    1.20%         Anti-inflammatory
 Phenobarbital                         3                    1.20%         CNS Depressant
 Lamotrigene                           3                    1.20%         Anticonvulsant
 Tramadol                              3                    1.20%         Narcotic Analgesic
 6-monoacetylmorphine                  3                    1.20%         Narcotic Analgesic (heroin)
 Lidocaine                             2                    0.80%         Local Anesthetic
 Tetrahydrocannabinol                  2                    0.80%         Marijuana
 Fluoxetine                            2                    0.80%         Antidepressant
 Phencyclidine (PCP)                   2                    0.80%         Sedative-Hallucinogen
 Olanzapine                            2                    0.80%         Antipsychotic
 Dextromethorphan                      2                    0.80%         Antitussive
 Chlordiazepoxide                      2                    0.80%         Sedative Hypnotic
 Chlorpheniramine                      2                    0.80%         Antihistamine
 Metoclopramide                        2                    0.80%         Anti-nausea
 Imipramine                            1                    0.40%         Antidepressant
 Atropine                              1                    0.40%         Anticholinergic
 Bupropion                             1                    0.40%         Antidepressant
 Valproic Acid                         1                    0.40%         Anticonvulsant
 Carbamazepine                         1                    0.40%         Anticonvulsant
 Lithium                               1                    0.40%         Antidepressant
 Lorazepam                             1                    0.40%         Anxiolytic
 Chlorpromazine                        1                    0.40%         Antipsychotic
 Difluroethane                         1                    0.40%         Inhalant
 Methylphenidate                       1                    0.40%         Stimulant
 Meperidine                            1                    0.40%         Narcotic Analgesic
 Fluvoxamine                           1                    0.40%         Antidepressant
 Topiramate                            1                    0.40%         Anticonvulsant
 Butalbital                            1                    0.40%         CNS Depressant
 Amobarbital                           1                    0.40%         CNS Depressant
 Propofol                              1                    0.40%         Sedative
 Zopiclone                             1                    0.40%         Sedative
 Clonazepam                            1                    0.40%         Anxiolytic




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    Figure 3-7:                      Most Frequently Detected Drugs
                                      Manner of Death: Accident
                                           FY 2007 - 2008
                                      11
                                13           10
                           14
                      15
                 21                                           96

                 24
                                                                     63
                                        53            58
                 28




    Cocaine                           Morphine                      Ethanol
    Methadone                         Methamphetamine/Amphetamine   Diazepam/Nordiazepam
    Oxycodone                         Diphenhydramine               Codeine
    Hydrocodone                       Fentanyl                      Acetone/Isopropanol




Figure 3-7 details the drugs identified in Non-Vehicular deaths classified as Accident.
Cocaine is overwhelmingly the most frequently detected drug at 38% followed by morphine
at 25.2%. While this is a significant reduction in cocaine positive non-vehicular Accident
deaths from Fiscal Year 2006 – 2007 when the cocaine positive rate was 53.8%, it is still
present in a significant percentage of deaths mannered as Accident. Some of the morphine
positive cases are, undoubtedly, rising from post accident medical intervention. The third
most frequently finding is ethanol at 22.8% (down from 32.5% in Fiscal Year 2006 - 2007).
This was followed by methadone at 21.2% (up from 16.2%). Three of the 63 positive
morphine cases had the heroin-specific metabolite (6-mono-acetyl-morpine) detected and
seven had morphine to codeine ratios which might support heroin use. This does not
exclude that some of the other morphine positive cases might also have been from heroin
use or that some of these might be from co-ingestion of morphine and codeine.

Fifty-seven percent (192/336) of deaths mannered as Non-Vehicular Accident are “drug-
related”, defining drugs detected in this sub-group is significant and should be further
examined. Table 3-6 details the drugs detected in drug-related deaths. Six (6) cases were
not tested because of significant hospitalization time would have made the testing
uninformative. One additional case was tested for drugs but no drugs were identified, again
due to an antemortem interval during which the ingested drugs were metabolized. These
drug related deaths were determined by other evidence and in all seven of these cases, the
drug(s) involved, if specified, were determined by history or hospital testing. In subsequent
Tables, the percentages of drugs reported are based upon the drugs determined to be
involved in causing the death which, for some cases, were determined by other than
postmortem toxicology testing. There were seven deaths certified with heroin or possible
heroin as the cause of death or part of the cause of death in Fiscal Year 2007-2008. This is
a significant decrease from Fiscal Year 2006 – 2007 when eighteen deaths were certified as
heroin or possible heroin related deaths.

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 Table 3-5:                      Manner of Death: Drug-Related Accident
                                    Frequency of Drugs Detected
                                           FY 2007 - 2008
                 Drug             # Positive Cases   % Positive Cases               Drug Class
 No Drugs Detected                       1                 0.54%
 Cocaine                                91                49.19%          Stimulant
 Morphine                               57                30.81%          Narcotic Analgesic
 Methadone                              52                28.11%          Narcotic Analgesic
 Ethanol                                42                22.70%          Alcohol
 Methamphetamine/Amphetamine            26                14.05%          Stimulant
 Diazepam/Nordiazepam                   22                11.89%          Anxiolytic/Muscle Relaxant
 Oxycodone                              18                 9.73%          Narcotic Analgesic
 Diphenhydramine                        14                 7.57%          Antihistamine
 Hydrocodone                            13                 7.03%          Narcotic Analgesic
 Codeine                                12                 6.49%          Narcotic Analgesic
 Fentanyl                               10                 5.41%          Narcotic Analgesic
 Citalopram                              8                 4.32%          Antidepressant
 Quetiapine                              6                 3.24%          Antipsychotic
 Alprazolam                              6                 3.24%          Anxiolytic
 Carboxyhemoglobin                      6                  3.24%          Carbon Monoxide Exposure
 Amphetamine (only)                      6                 3.24%          Stimulant
 Trazodone                               5                 2.70%          Antidepressant
 Amitriptyline                           5                 2.70%          Antidepressant
 Zolpidem                                5                 2.70%          Sedative
 Acetone/Isopropanol                     4                 2.16%          Volatile (Metabolic Product)
 Sertraline                              4                 2.16%          Antidepressant
 MDMA (Ecstasy)*                         4                 2.16%          Stimulant/Hallucinogen
 Acetaminophen                           4                 2.16%          Anti-inflammatory
 Mirtazepine                             4                 2.16%          Antidepressant
 Hydroxyzine                             4                 2.16%          Antihistamine
 Promethazine                            4                 2.16%          Antihisamine
 Carisoprodol/Meprobamate                4                 2.16%          Muscle Relaxant
 Temazepam                               3                1.62%           Anxiolytic
 6-monoacetylmorphine                    3                1.62%           Narcotic Analgesic (heroin)
 Midazolam                               2                1.08%           Sedative Hypnotic
 Venlafaxine                             2                1.08%           Antidepressant
 Gabapentin                              2                1.08%           Antiseizure
 Metoprolol                              2                1.08%           Beta-Blocker
 Phenytoin                               2                1.08%           Anticonvulsant
 Ibuprofen                               2                1.08%           Anti-inflammatory
 Phenobarbital                           2                1.08%           CNS Depressant
 Tramadol                                2                1.08%           Narcotic Analgesic
 Phencyclidine (PCP)                     2                1.08%           Sedative-Hallucinogen
 Olanzapine                              2                1.08%           Antipsychotic

*Methyldeoxymethamphetamine



Drugs Detected                                                                                Page 113
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




There were 185 Drug-Related deaths classified as Accident and Cocaine was detected in
nearly half (49.2%). (In Fiscal Year 2006 – 2007, cocaine was detected in 68% of the cases
classified as Drug-Related Accident.) Stimulants are the most frequent drug class detected
(55.7%) followed by narcotic analgesics (59.5%) in the drug-related deaths. It should be
noted that this number is not derived from Table 3-5 because some of the decedents were
positive for more than one stimulant. Ethanol is present in 22.7% (down from a Fiscal Year
2006 – 2007 level of 26.5%) although morphine levels are somewhat elevated due to post-
incident medical intervention in some cases. Atropine and lidocaine were all most likely
detected as a result of medical intervention. Many of these cases are positive for more than
one drug in a class, a better understanding of their frequency can be determined by
reviewing the drug classes present as is seen in Table 3-6 and Figure 3-8.


 Table 3-6:          Drug Classes Detected in Drug-Related Deaths
                                  Mannered as Accident
                                        FY 2007-2008
                         Drug Class(es)                              Occurrence     Frequency
 Stimulant Only                                                          59          31.89%
 CNS Depressant Only                                                     12           6.49%
                                                      Alcohol only            (6)         (3.24%)
 Narcotic Analgesic Only                                                 17           9.19%
 Stimulant + CNS Depressant                                              11           5.95%
                                               Stimulant + Alcohol           (10)         (5.41%)
 Narcotic Analgesic + CNS Depressant                                     39          21.08%
                                      Narcotic Analgesic + Alcohol           (13)         (7.03%)
 Stimulant + Narcotic Analgesic                                          27          14.59%
 Stimulant + Narcotic Analgesic + CNS Depressant                         19          10.27%
                          Stimulant + Narcotic Analgesic + Ethanol            (7)         (3.78%)
 Other                                                                    1           0.54%




Drug combinations are often more lethal and Table 3-6, describes the major drug class
combinations identified. Stimulants are identified in 62.7% of the drug related deaths
mannered as Accident. Narcotic analgesics are identified 36.1% and Central Nervous
System (CNS) Depressants are identified in 43.8% of these cases. Alcohol was present as
at least one of the CNS depressants in 19.5% of the cases. (One alcohol was isopropanol,
not ethanol.) Figure 3-9 shows that stimulants only are the most frequent finding (31.9%),
followed by the combination of narcotic analgesics with CNS depressants at 21.1%.
Stimulants with narcotic analgesics represented 14.6%.




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   Figure 3-9:      Drug Classes Detected - Drug-Related Deaths
                               Mannered as Accident
                                    FY 2007 - 2008
                                                   1

                                       19
                          27                                 59



                               40                                 12
                                              11       16




     Stimulant Only                                      CNS Depressant Only
     Narcotic Analgesic Only                             Stimulant + CNS Depressant
     Narcotic Analgesic + CNS Depressant                 Stimulant + Narcotic Analgesic
     Stimulant + Narcotic Analgesic + CNS Depressant     Other


Combinations of drugs may result in greater toxicity. The majority of the stimulant only group
are cocaine, but 10% of the positive cocaine cases also have methamphetamine and/or
amphetamine present. The most prevalent narcotic analgesic is morphine but methadone is
the most common when only one narcotic analgesic is present. Morphine was present in 57
cases (30.8%) and of those 7 had the morphine to codeine ratio that supported heroin use.
For 3 of the 7, the heroin specific metabolite, 6-monacetylmorphine) was identified. This is a
very rapidly metabolized compound and it may have been eliminated as the subject was
dying.

The most toxic combinations appear to be cocaine plus a narcotic analgesic with cocaine
plus morphine and/or cocaine plus methadone as the most common drug combinations.
Cocaine plus ethanol is a frequent finding because their co-ingestion produces a
pharmacologically active metabolite, cocaethylene, which actually extends the cocaine high.

The one case that is describes as other was an overdose of phencyclidine (PCP).




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Drugs Detected in Non-Vehicular Homicide Deaths


Table 3-7 and Figure 3-10 present the drugs detected in non-Vehicular Homicides.

 Table 3-7:                       Manner of Death: Homicide
                                 Frequency of Drugs Detected
                                       FY 2007 - 2008
                 Drug             # Positive Cases    % Positive Cases            Drug Class
 No Drugs Detected                      38                37.25%
 Ethanol                                35                34.31%         Alcohol
 Cocaine                                27                26.47%         Stimulant
 Methamphetamine/Amphetamine            7                  6.86%         Stimulant
 MDMA (Ecstacy)*                        5                  4.90%         Stimulant/Hallucinogen
 Morphine                               4                  3.92%         Narcotic Analgesic
 Diphenhydramine                        3                  2.94%         Antihistamine
 Diazepam/Nordiazepam                   2                  1.96%         Anxiolytic/Muscle Relaxant
 Citalopram                             2                  1.96%         Antidepressant
 Acetone/Isopropanol                    2                  1.96%         Volatile (Metabolic Product)
 Lidocaine                              2                  1.96%         Local Anaesthtic
 Oxycodone                              1                  0.98%         Narcotic Analgesic
 Hydrocodone                            1                  0.98%         Narcotic Analgesic
 Amphetamine (only)                     1                  0.98%         Stimulant
 Midazolam                              1                  0.98%         Sedative Hypnotic
 Phencyclidine (PCP)                    1                  0.98%         Sedative-Hallucinogen
 Gamma hydroxybutyrate (GHB)            1                  0.98%         Sedative

*Methyldeoxymethamphetamine



It is noteworthy that the most frequent finding in Non-Vehicular Homicide deaths is “No
Drugs Detected”. These cases receive a comprehensive drugs screen so this reflects the
drug status of Homicides. Of the drugs detected, ethanol is the most frequent finding at
34.3%, followed by cocaine at 26.5%. Methamphetamine is detected in 7 cases (6.7%). It is
noteworthy that MDMA (methylenedioxymethamphetamine) was detected in 5 (4.9) of the
cases, the highest incidence of this drug for any Manner of Death. Phencyclidine (PCP) and
gamma-hydrozyburyrate (GHB) are the only other illicit drugs detected in this population.
Lidocaine and some of the morphine is most likely due to post incident medical intervention.
There is a low incidence of narcotic analgesics compared to other Manners of Death.




Drugs Detected                                                                             Page 116
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    Figure 3-10:                        Most Frequently Detected Drugs
                                         Manner of Death: Homicide
                                              FY 2007 - 2008

                                        1   1      1 1 1
                                 2     2
                             2    2                     1
                         3
                     4
                                                                        38
                             5
                     7

                                  27
                                                                   35




        No Drugs Detected                   Ethanol                          Cocaine
        Methamphetamine/Amphetamine         MDMA (Ecstacy)                   Morphine
        Diphenhydramine                     Diazepam/Nordiazepam             Citalopram
        Acetone/Isopropanol                 Lidocaine                        Oxycodone
        Hydrocodone                         Amphetamine (only)               Midazolam
        Phencyclidine (PCP)                 GHB




Drugs Detected in Non-Vehicular Suicide Deaths


The drug detection data for Non-Vehicular Suicide deaths is presented in Table 3-9 and
Figure 3-10.


The majority of Suicide deaths (98.1%) undergo toxicology testing and most of these receive
comprehensive analysis, therefore, conclusions drawn from the following data are
statistically significant. Approximately one-fifth (20.1%) of Suicide deaths are drug-related
and 39.8% of the Suicides had no drugs detected. If drug-ingestion Suicides are excluded,
in 50.6% of the other Suicides, there were no drugs detected. In 20.5%, stimulants were
detected (cocaine at 13.1% and methamphetamine at 7.4%). It is not surprising that, more
than any other category, there are more psychiatric medications in this group (citalopram,
quetiapine and mirtazepine) than other Manners of Death.




Drugs Detected                                                                            Page 117
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 Table 3-8:                          Manner of Death: Suicide
                                    Frequency of Drugs Detected
                                          FY 2007 - 2008
                 Drug            # Positive Cases   % Positive Cases               Drug Class
 No Drugs Detected                     18               29.03%
 Ethanol                               20               32.26%         Alcohol
 Cocaine                               15               24.19%         Stimulant
 Diphenhydramine                       14               22.58%         Antihistamine
 Morphine                               9               14.52%         Narcotic Analgesic
 Sertraline                             7               11.29%         Antidepressant
 Diazepam/Nordiazepam                   7               11.29%         Anxiolytic/Muscle Relaxant
 Citalopram                             7               11.29%         Antidepressant
 Amitriptyline                          6                9.68%         Antidepressant
 Mirtazepine                            6                9.68%         Antidepressant
 Oxycodone                              5                8.06%         Narcotic Analgesic
 Hydrocodone                            5                8.06%         Narcotic Analgesic
 Zolpidem                               4                6.45%         Sedative
 Acetaminophen                          4                6.45%         Anti-inflammatory
 Quetiapine                             4                6.45%         Antipsychotic
 Alprazolam                            3                 4.84%         Anxiolytic
 Trazodone                              2                3.23%         Antidepressant
 Phenobarbital                         2                 3.23%         CNS Depressant
 Olanzapine                             2                3.23%         Antipsychotic
 Lamotrigene                           2                 3.23%         Anticonvulsant
 Fluoxetine                             2                3.23%         Antidepressant
 Fentanyl                               2                3.23%         Narcotic Analgesic
 Codeine                                2                3.23%         Narcotic Analgesic
 Acetone/Isopropanol                    2                3.23%         Volatile (Metabolic Product)
 Methamphetamine/Amphetamine            2                3.23%         Stimulant
 Propoxyphene                           2                3.23%         Narcotic Analgesic
 Venlafaxine                            1                1.61%         Antidepressant
 Tetrahydrocannabinol (THC)             1                1.61%         Marijuana
 Propofol                               1                1.61%         Sedateve
 Promethazine                           1                1.61%         Antihisamine
 Phenytoin                              1                1.61%         Anticonvulsant
 Methadone                              1                1.61%         Narcotic Analgesic
 MDMA (Ecstacy)                         1                1.61%         Stimulant/Hallucinogen
 Lorazepam                              1                1.61%         Anxiolytic
 Ibuprofen                              1                1.61%         Anti-inflammatory
 Clonazepam                             1                1.61%         Antidepressant
 Chlordiazepoxide                       1                1.61%         Sedative Hypnotic
 Bupropion                              1                1.61%         Antidepressant
 Benztorpine                            1                1.61%         Parkinson's Disease
 Amobarbital                            1                1.61%         CNS Depressant
 Doxylamine                             1                1.61%         Antihistamine
 Imipramine                             1                1.61%         Antidepressant
 Doxepin                                1                1.61%         Antidepressant
 Salicylate                             1                1.61%         Anti-inflammatory
*Methyldeoxymethamphetamine


Drugs Detected                                                                                Page 118
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     Figure 3-11:                  Most Frequently Detected Drugs
                                    Manner of Death: Suicide
                                         FY 2007 - 2008

                                       4   4
                               4
                       5
                 5                                       18
             6
                                                                        20
             6
                       7
                           7                                       15
                                   7                14
                                            9




   No Drugs Detected       Ethanol                Cocaine                    Diphenhydram ine
   Morphine                Sertraline             Diazepam /Nordiazepam      Citalopram
   Am itriptyline          Mirtazepine            Oxycodone                  Hydrocodone
   Zolpidem                Acetam inophen         Quetiapine




There were 30 drug-related Suicide deaths in Fiscal Year 2007-2008, two were not subjected
to testing because of delayed deaths but the ingested drugs were determined from
investigation/history. Of these, eleven subjects involved the ingestion of a single drug, four
additional subjects involved a single drug with ethanol ingestion and two more were
combination drugs consistent with an over-the counter medication with two active
ingredients. The data supports that 56.7% of these ingestion-related deaths mannered as
Suicide ingested only one preparation, with or without ethanol. Nearly one-third of the single
drug ingestions (5) involved ingestion of over-the-counter medications, another third (5)
involved the ingestion of a single narcotic analgesia and one quarter involved ingestion of
antidepressant medications.




Drugs Detected                                                                            Page 119
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 Table 3-9:                    Manner of Death: Drug-Related Suicide
                                   Frequency of Drugs Detected
                                         FY 2007 - 2008
                 Drug            # Positive Cases    % Positive Cases            Drug Class
 Morphine                               8                28.57%         Narcotic Analgesic
 Ethanol                                7                25.00%         Alcohol
 Cocaine                                6                21.43%         Stimulant
 Diphenhydramine                        6                21.43%         Antihistamine
 Diazepam/Nordiazepam                   4                14.29%         Anxiolytic/Muscle Relaxant
 Amitriptyline                          4                14.29%         Antidepressant
 Acetaminophen                          4                14.29%         Anti-inflammatory
 Quetiapine                             4                14.29%         Antipsychotic
 Mirtazepine                            4                14.29%         Antidepressant
 Oxycodone                              3                10.71%         Narcotic Analgesic
 Methadone                              3                10.71%         Narcotic Analgesic
 Sertraline                             2                 7.14%         Antidepressant
 Hydrocodone                            2                 7.14%         Narcotic Analgesic
 Zolpidem                               2                 7.14%         Sedative
 Olanzapine                             2                 7.14%         Antipsychotic
 Fluoxetine                             2                 7.14%         Antidepressant
 Citalopram                             2                 7.14%         Antidepressant
 Alprazolam                             1                 3.57%         Anxiolytic
 Doxylamine                             1                 3.57%         Antihistamine
 Fentanyl                               1                 3.57%         Narcotic Analgesic
 Acetone/Isopropanol                    1                 3.57%         Volatile (Metabolic Product)
 Venlafaxine                            1                 3.57%         Antidepressant
 Promethazine                           1                 3.57%         Antihisamine
 Lamotrigene                            1                 3.57%         Anticonvulsant
 Methamphetamine/Amphetamine            2                 7.14%         Stimulant
 Phenobarbital                          1                 3.57%         CNS Depressant
 Lorazepam                              1                 3.57%         Anxiolytic
 Ibuprofen                              1                 3.57%         Anti-inflammatory
 Clonazepam                             1                 3.57%         Antidepressant
 Chlordiazepoxide                       1                 3.57%         Sedative Hypnotic
 Bupropion                              1                 3.57%         Antidepressant
 Benztorpine                            1                 3.57%         Parkinson's Disease
 Amobarbital                            1                 3.57%         CNS Depressant
 Salicylate                             1                 3.57%         Anti-inflammatory
 Trazodone                              1                 3.57%         Antidepressant
 Propoxyphene                           1                 3.57%         Narcotic Analgesic
 Doxyalmine                             1                 3.57%         Antihisamine
 Doxepin                                1                 3.57%         Antidepressant




Drugs Detected                                                                               Page 120
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    Figure 3-12:                    Most Frequently Detected Drugs
                                 Manner of Death: Drug-Related Suicide
                                           FY 2007 - 2008
                                                  2
                                        2
                                 2
                         2                                 8
                 3
                                                                         7
           3
                     4                                                    6
                             4                                   6
                                       4
                                                  4   4



   Morphine                      Ethanol              Cocaine             Diphenhydram ine
   Diazepam /Nordiazepam         Am itriptyline       Acetam inophen      Quetiapine
   Mirtazepine                   Oxycodone            Methadone           Sertraline
   Hydrocodone                   Zolpidem             Olanzapine




Drugs Detected in Vehicular Deaths


Table 3-10 and Figure 3-13 detail the drugs detected in traffic-related (Vehicular) deaths.
There were 59 deaths as a result of motor vehicle collisions. Of these, 53 (89.8%) received
toxicology testing. The remaining six were not tested as they were remote deaths. Of the 53
tested, 24 (45.3%) had no drugs detected. Five additional cases (9.4%) were positive only
for drugs that were administered as part of medical intervention. One additional case was
positive for a drug that does not generally contribute to the impairment of the subject.




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 Table 3-10:                            Manner of Death: Vehicular
                                         Frequency of Drugs Detected
                                                FY 2007 - 2008
                    Drug                 # Positive Cases   % Positive Cases   Drug Class
 None Detected                                 24               45.28%
 Ethanol                                       16               30.19%         Alcohol
 Cocaine                                       11               20.75%         Stimulant
 Methamphetamine/Amphetamine                   2                 3.77%         Stimulant
 Phenytoin *                                   2                 3.77%         Anticonvulsant
 Methadone                                     1                 1.89%         Narcotic Analgesic
 Oxycodone                                     1                 1.89%         Narcotic Analgesic
 Mirtazepine                                   1                 1.89%         Antidepressant
 Phenobarbital *                               1                 1.89%         CNS Depressant
 Valproic Acid *                               1                1.89%          Anticonvulsant
 Tetrahydrocannibinol (THC)                    1                 1.89%         Marijuana
 Lidocaine *                                   1                1.89%          Local Anesthetic
 Metoprolol                                    1                 1.89%         Beta-blocker

* Medical Intervention Drugs



The most frequent finding in Vehicular deaths was “no drugs detected”, in 45.3% of the
cases tested. Thirty percent were positive for ethanol and 21% positive for cocaine.
Phenytoin, Phenobarbital, Valproic Acid and Lidocaine were most likely administered to the
subjects as part of the post collision medical intervention.


 Figure 3-13:                  Vehicular Deaths: Most Frequently Detected Drugs
                                               FY 2007 - 2008
                           1   1 1 1
                     1 1                                                       None Detected
              1 1                                                              Ethanol
                                                                               Cocaine
                2
          2                                                                    Methamphetamine/Amphetamine
                                                      24
                                                                               Phenytoin *
                11                                                             Methadone
                                                                               Oxycodone
                                                                               Mirtazepine
                                       16
                                                                               Phenobarbital *
                                                                               Valproic Acid *
                                                                               Tetrahydrocannibinol (THC)
                                                                               Lidocaine *
       N = 53
                                                                               Metoprolol




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Table 3-11 provides information on the distribution of drugs which may have lead to the
impairment of the decedent prior to death. This may be an important factor in vehicular
collisions, most notably for drivers but also for pedestrians and bicyclists. Even passengers
who are impaired may be more likely to get into a vehicle with an impaired driver, thus
increasing their risk of injury or death.



Table 3-11:                              Impairing Drugs in Vehicular Deaths
                                                  FY 2007 - 2008




                                                                                                                 Methamphetamine
                                                   Impairing Drugs
                                                   Subjects with




                                                                                                                                                 Mirtazepine
                                                                                            Oxycodone




                                                                                                                                    Methadone
                                                                                 Cocaine
                                                                      Ethanol
                                          Tested
                                Total




                                                                                                         THC
Drivers*                       10          8         5                 2          1          1
           % Pos of tested                         62.5%             25.0%      12.5%      12.5%
Motorcycle/Scooter Driver*      7          6                           3                                  1       1
           % Pos of tested                                           50.0%                              16.7%   16.7%
Bicylcists                      8          6         1                            1
           % Pos of tested                         16.7%
Pedestrians***                 26        25          11                7          5                                                  1            1
           % Pos of tested                         44.0%             28.0%      20.0%                                              4.0%         4.0%
Passengers****                  7          6         1                 4          2                               1
           % Pos of tested                         16.7%             66.7%      33.3%                           16.7%

* 1 Subject Positive for Cocaine & Oxycodone
** 1 Subject Positive for Cocaine and Ethanol
*** 1 Subject Positive Cocaine & Ethanol; 1 Subject Positive for Cocaine, Ethanol & Methadone
**** 2 Subjects Positive for Cocaine & Ethanol




Drugs Detected in Non-Vehicular Undetermined Deaths

The drug detection data for Manner of Death Non-Vehicular Undetermined is presented in
Table 3-12 and Figure 3-12.

The Manner of Death “Undetermined” is a classification used when the information pointing
to one manner of death is no more compelling than one or more other competing manners of
death, after thorough consideration of all available information. The majority (82.9%) of
these are subjected to a comprehensive toxicological analysis. The most positive frequent
findings are ethanol (31.3%) and cocaine (25%). In 21.8% of the cases, were there no
drugs detected, but it must be remembered that the number of these cases is fairly small (n
= 32).




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Table 3-12:                    Non-Vehicular Undetermined Deaths
                                  Frequency of Drugs Detected
                                        FY 2007 - 2008
               Drug                        # Positive Cases                % Positive Cases
No Drugs Detected                                  4                           20.00%
Ethanol                                            5                           25.00%
Cocaine                                            3                           15.00%
Methadone                                          2                           10.00%
Morphine                                           2                           10.00%
Diphenhydramine                                    2                           10.00%
Paroxetine                                         2                           10.00%
Diazepam                                           1                            5.00%
Acetaminophen                                      1                            5.00%
Midazolam                                          1                           5.00%
Fluvoxamine                                        1                            5.00%
Trazodone                                          1                           5.00%
Nortriptyline                                      1                            5.00%
Methamphetamine                                    1                           5.00%
Quetiapine                                         1                            5.00%
Atropine                                           1                            5.00%
Phencyclidine (PCP)                                1                            5.00%



Seven of the 32 (21.9%) Undetermined deaths were found to be drug-related in the cause of
death and ethanol was the predominant finding.



      Figure 3-14: Non-Vehicular Undetermined Deaths
                       Frequently Detected Drugs
                            FY 2007 - 2008



                       2                                      No Drugs Detected
                 2                     4
                                                              Ethanol
         2
                                                              Cocaine
                                            5
                 2                                            Methadone
                           3
                                                              Morphine
                                                              Diphenhydramine
                                                              Paroxetine




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Natural Deaths


The drugs detected in Natural deaths are detailed in Table 3-13 and Figure 3-13. The
selection of cases for drug analysis is not random but is based upon the circumstances of
the death or the knowledge that the decedent had a history of drug misuse. Therefore, this
data cannot be used to draw conclusions about drug rates in Natural deaths. Only 40% of
the cases certified as Natural deaths received drug or alcohol testing.

 Table 3-13:                       Manner of Death: Natural
                                    Frequency of Drugs Detected
                                          FY 2007 - 2008
                 Drug            # Positive Cases    % Positive Cases            Drug Class
 None Detected                         109               45.61%
 Cocaine                               37                15.48%         Stimulant
 Ethanol                               31                12.97%         Alcohol
 Morphine                              19                 7.95%         Narcotic Analgesic
 Acetone/Isopropanol                   16                 6.69%         Volatile (Metabolic Product)
 Methadone                             15                 6.28%         Narcotic Analgesic
 Diazepam/Nordiazepam                  10                 4.18%         Anxiolytic/Muscle Relaxant
 Citalopram                             9                 3.77%         Antidepressant
 Diphenhydramine                        8                 3.35%         Antihistamine
 Codeine                                6                 2.51%         Narcotic Analgesic
 Mirtazepine                            4                 1.67%         Antidepressant
 Oxycodone                              4                 1.67%         Narcotic Analgesic
 Amitriptyline                          3                 1.26%         Antidepressant
 Hydrocodone                            3                 1.26%         Narcotic Analgesic
 Fentanyl                               3                 1.26%         Narcotic Analgesic
 Gabapentin                             3                 1.26%         Anticonvulsant
 Methamphetamine/Amphetamine            3                 1.26%         Stimulant
 Acetaminophen                          2                 0.84%         Anti-inflammatory
 Zolpidem                               2                 0.84%         Sedative
 Fluoxetine                             2                 0.84%         Antidepressant
 Doxylamine                             2                 0.84%         Antihistamine
 Promethazine                           2                 0.84%         Antihistamine
 Atropine                               2                 0.84%         Anticholinergic
 Lidocaine                              2                 0.84%         Local anesthetic
 Hydroxyzine                            2                 0.84%         Antihistamine
 Trazodone                              2                 0.84%         Antidepressant
 Metoprolol                             2                 0.84%         Beta-blocker
 Tetrahydorcannabinol (THC)             2                 0.84%         Marijuana
 Ibuprofen                              1                 0.42%         Anti-inflammatory
 Sertraline                             1                 0.42%         Antidepressant
 Diltiazem                              1                 0.42%         Ca Channel Blocker
 Clonazepam                             1                 0.42%         Anxiolytic
 Venlafaxine                            1                 0.42%         Antidepressant
 Imipramine                             1                 0.42%         Antidepressant



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 Table 3-13:                        Manner of Death: Natural
                                     Frequency of Drugs Detected
                                           FY 2007 - 2008             (continued)
           Drug              # Positive Cases      % Positive Cases                 Drug Class
 Bupropion                          1                   0.42%            Antidepressant
 Pseudo/ephedrine                   1                   0.42%            Cold Medication
 Guaifenesin                        1                   0.42%            Expectorant
 Flurazepam                         1                   0.42%            Anxiolytic
 Propoxyphene                       1                   0.42%            Narcotic Analgesic
 Queitiapine                        1                   0.42%            Antipsychotic
 Phenytoin                          1                   0.42%            Anticonvulsant
 Thioridazine                       1                   0.42%            Antipsychotic
 Tramadol                           1                   0.42%            Narcotic Analgesic
 Chlorpheniramine                   1                   0.42%            Antihistamine



Thirty-six percent of the Natural deaths received some toxicology testing and of those, 45.6%
had no drugs detected. Cocaine was the most frequent finding as was detected in 15.5% of
the tested cases, is an increase over the 12.9% detected in Fiscal Year 2006 – 2007.
Ethanol was the second most frequent finding in Fiscal Year 2007 – 2008 at 13%. Even with
cocaine as the most frequent finding, illicit drugs, in general, were less prevalent in this
population of decedents.

Natural deaths may also be drug-related, if the drug use resulted in a disease process which
caused the death, e.g. chronic alcoholism. Table 3-14 lists the Natural deaths in fiscal year
2007-2008, for which drugs or alcohol were cited in the cause of death. These deaths
represent 9.2% (up from 6.5% in Fiscal Year 2006 – 2007) of the Natural deaths but a
discussion of drug related-deaths would be incomplete without their inclusion.


         Table 3-14:           Drug-Related Natural Deaths
                                      FY 2007-2008
                       Cause of Death                                 Number
         Chronic Alcoholism                                             37
         Acute and Chronic Alcoholism                                    3
         Chronic Polysubstance Abuse                                    12
         Acute and Chronic Cocaine Abuse                                 9
         Chronic Cocaine and Ethanol Abuse                               1
                                                       Total             62




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Drug Specific Information


In review of aggregate data by Manner of Death for specific drugs, some interesting
findings are revealed. It is important remember that many of the submitted cases are
positive for more than one substance. Below, there is a discussion of the ethanol,
cocaine, narcotic analgesics and methamphetamine prevalence by Manner of Death.


Ethanol

In this jurisdiction, ethanol positive findings are second to cocaine but ethanol is the
most widely used drug. Table 3-15 provides information on the percentage of cases for
each Manner of Death which are tested for the presence of ethanol and the positive
versus negative rates.

 Table 3-15:                        Blood Alcohol Testing by Manner of Death
                                               FY 2007 - 2008
                         Accident   Homicide   Vehicular   Natural   Suicide   Undetermined   Non-Natural      Total
 Tested                    250         102       51          239        90         17            510          749
 Test Rate               74.40%      94.44%    86.44%      36.21%    95.74%      85.00%        82.66%       58.65%
              Positive     58           35       16           37        20         10            139          176
 % Pos of Tested         23.20%      34.31%    31.37%      15.48%    22.22%      58.82%        27.25%       23.50%
             Negative      192          67       35          202        70          7            371          573
 % Neg of Tested         76.80%      65.69%    68.63%      84.52%    77.78%      41.18%        72.75%       76.50%
 Not Tested                86            6        8          421         4          3            107          528
                         25.60%       5.56%    13.56%      63.79%     4.26%      15.00%        17.34%       41.35%
 Total # Cases             336         108       59          660        94         20            617         1277



The ethanol positive rate for tested cases ranges from a low of 15.5% in Natural deaths
to a high of 58.8% in Undetermined deaths, followed by 34.3% for deaths classified as
Homicide, 31.4% for Vehicular deaths, 23.2% for Accidents and 22.2% for Suicides.

Table 3-16 and Figure 3-13 summarize the BAC (blood alcohol concentration) for those
cases which were tested for ethanol. The highest mean and median BAC is for
Vehicular deaths and the lowest is for Suicides, followed by Natural deaths. It is
important to note that for both Suicides and Natural deaths, there is a significant
difference between the mean (average) and the median which indicates that in general,
the BACs are even lower in these populations but that there were a few cases with very
high BACs.




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 Table 3-16:                 BAC (Mean & Median) by Manner of Death
                                        FY 2007-2008
                  Accident    Homicide      Vehicular    Natural    Suicide      Undetermined       Total
  # Cases           336          108           59          660        94              20            1277
  # Tested          250          102           51          239        90              17             749
 % Tested          74.4%       94.44%        86.44%      36.21%     95.74%          85.0%          58.65%
  # Tested
  Positive           58          35           16           37         20               7             173
 % Positive        31.7%       34.31%       31.37%       15.48%     22.22%          41.18%         23.10%
 Mean BAC           0.20        0.14         0.16         0.16       0.09            0.14           0.16
  Median
    BAC             0.18        0.14          0.16           0.13       0.09          0.06          0.13




Figures 3-13 and 3-14 provide detail for the Blood Alcohol Concentration (BAC) for each
Manner of Death. It is noteworthy that of those decedents with ethanol concentrations
above 0.30 gm/dL, there are 17 deaths mannered as Accident, 3 mannered as
Homicide, 1 Vehicular, 1 death mannered as Suicide. 1 mannered Undetermined and 5
mannered as Natural.




 Figure 3-13:                           BAC by Manner of Death
                                           FY 2007 - 2008

  0.80%
  0.70%
  0.60%
  0.50%
  0.40%
  0.30%
  0.20%
  0.10%
  0.00%
          0            10              20               30               40              50                60

                 Accident    Homicide       Vehicular         Suicide         Undetermined      Natural




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Table 3-17 and Figure 3-15 summarize the demographics of ethanol positive cases by
race and sex.


                  Table 3-17: Ethanol-Related Deaths by Race and Sex
                                     FY 2007-2008
                                                           Sub-
                      Male         Female                  total               Total
       White           67             19                                        86
                    41.10%         11.66%              52.76%
       Black           27              8                                        35
                    16.56%          4.91%              21.47%
       Asian            7              1                                         8
                     4.29%          0.61%              4.91%
      Hispanic         29              2                                        31
                    17.79%          1.23%              19.02%
  Unknown/Other         3              0                                         3
                     1.84%                             1.84%
       Total          133              30                                       163
                                                       100.00
                    81.60%         18.40%                %




  Figure 3-15:            Ethanol Related Deaths by Race and Sex
                                    FY 2007 - 2008
          70
          60
          50
          40
          30
          20
          10
           0
                 White         Black               Asian           Hispanic Unknown/Other

                                            Male            Female




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The demographic data on ethanol positive cases by age and sex are summarized in
Table 3-18 and Figure 3-16.


 Table 3-18:       Ethanol-Related Deaths by Age Group and Sex
                                 FY 2007-2008
                                                     Sub-
                 Male            Female              total                   Total
    <1                                                                        0

   1-5                                                                        0

  6 - 12                                                                      0

 13 - 16                                                                      0

 17 - 19         2                  1                                         3
              1.23%              0.61%              1.84%
 20 - 29        21                  4                                        25
              12.88%             2.45%              15.34%
 30 - 39        35                  3                                        38
              21.47%             1.84%              23.31%
 40 - 49        33                  6                                        39
              20.25%             3.68%              23.93%
 50 - 59        31                  9                                        40
              19.02%             5.52%              24.54%
 60 - 69         6                  3                                         9
              3.68%              1.84%              5.52%
 70 - 79         4                  2                                         6
              2.45%              1.23%              3.68%
 80 - 89         1                  2                                         3
              0.61%              1.23%              1.84%
   > 90

  Totals        133                30                                        163
              81.60%             18.40%            100.00%

The highest incidence of ethanol positive rate is found in the age groups 30-59 and they
are predominantly men.




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     Figure 3-16:                      Ethanol Related Deaths by Age and Sex
                                                FY 2007 - 2008

         35

         30

         25

         20

         15

         10

          5

          0
                 <1   1-5   6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89   > 90

                                             Male                       Female




There were 3 non-Natural deaths attributed solely to ethanol intoxication or toxicity. All
were mannered as Accident with Blood Alcohol Concentrations (BAC) at the time of
death of 0.42 g/dL, 0.58 g/dL and 0.32 g/dL. Of the 39 Natural deaths attributed to
ethanol abuse, three were cited as acute and chronic ethanol abuse and they had BAC
levels of 0.43 g/dL, 0.21 g/dL and 0.55 g/dL. Of note is the highest determined BAC in
Fiscal Year 2007 - 2008 was a death mannered as Accident attributed to positional
asphyxia due to acute ethanol intoxication with a BAC of 0.72 g/dL.




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Cocaine

Cocaine is the most frequent drug finding in the decedent population of the San
Francisco OCME and warrants further examination. The demographics by race and sex
are depicted in Table 3-19 and Figure 3-17.


 Table 3-19:                 Cocaine-Related Deaths by Race and Sex
                                      FY 2007 - 2008
                       Male            Female         Sub-total           Total
      White             66               19                                 85
                     35.48%            10.22%          45.70%
      Black             52               16                                 68
                     27.96%            8.60%           36.56%
      Asian             7                 0                                 7
                      3.76%            0.00%            3.76%
     Hispanic           20                2                                 22
                     10.75%            1.08%           11.83%
 Unknown/Other          4                 0                                 4
                      2.15%            0.00%            2.15%
      Total            149               37                                186
                     80.11%            19.89%           100%


Nearly half of these decedents are White (45.7%) and they are predominantly male
(80.1%). Blacks make up 36.6%, Hispanics account for 11.8% and Asian 3.8% of this
population.




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    Figure 3-17:            Cocaine-Related Deaths by Race and Sex
                                     FY 2007 - 2008

        70

        60

        50

        40

        30

        20

        10

          0
                 White         Black          Asian        Hispanic    Unknown/Other

                                       Male            Female


The age and sex demographics for cocaine related-deaths are detailed in Table 3-20
and Figure 3-18.

.




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 Table 3-20:               Cocaine-Related Deaths by Age and Sex
                                      FY 2007-2008
 Age Group          Male              Female          Sub-total            Total
      <1                                 1                                    1
                                      0.54%            0.54%
     1-5                                                                      0

    6 - 12                                                                    0

    13 - 16                                                                   0

    17 - 19            2                                                      2
      %             1.08%                              1.08%
    20 - 29           18                 4                                   22
      %             9.68%             2.15%            11.83%
    30 - 39           28                 4                                   32
       %           15.05%             2.15%            17.20%
    40 - 49           36                 8                                   44
       %           19.35%             4.30%            23.66%
    50 - 59           49                14                                   63
       %           26.34%             7.53%            33.87%
    60 - 69           12                 5                                   17
       %            6.45%             2.69%            9.14%
    70 - 79            3                 1                                    4
       %            1.61%             0.54%            2.15%
    80 - 89            1                                                      1
       %            0.54%                              0.54%
     > 90

    Totals           149                37                                  186
                   52.80%             14.60%          100.00%




The majority of these decedents are in the 30-59 age groups with 74.7% of the cases
falling in this age span. More than half (57.5 %), are between the ages of 40 and 59. It
is of note that six cases were over the age of seventy and 2 were attributed to acute
polysubstance abuse.




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         Figure 3-18:               Cocaine-Related Deaths by Age and Sex
                                              FY 2007 - 2008

        50
        45
        40
        35
        30
        25
        20
        15
        10
          5
          0
                 <1   1-5   6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89

                                               Male                Female




Narcotic Analgesics


It is probably more helpful to examine at narcotic analgesics as a group, rather than as
individual drugs because many of these cases are positive for more than one narcotic
analgesic.

The race and sex demographics of Narcotic Analgesic positive deaths are detailed in
Table 3-21 and Figure 3-19.


 Table 3-21:          Narcotic Analgesic-Related Deaths by Race and Sex
                                      FY 2007-2008
                       Male            Female                                          Total
     White              104              26                                             130
       %              53.61%           13.40%                 67.01%
     Black               35              11                                              46
       %              18.04%           5.67%                  23.71%
     Asian               3                2                                               5
       %              1.55%            1.03%                   2.58%
    Hispanic             8                3                                              11
       %              4.12%            1.55%                   5.67%
 Unknown/Other           2                0                                               2
       %              1.03%                                    1.03%
     Total              152              42                                             194
                      78.35%           21.65%                100.00%


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Users of narcotic analgesics are overwhelmingly Whites (67.4%). White males
represent 53.9% and White females 13.5% of narcotic analgesic users. Blacks
represent 23.3% of the narcotic analgesic users (Black males 18.1% and Black females
5.2%).



       Figure 3-19:      Narcotic Analgesic-Related Deaths by Race and Sex
                                        FY 2007 - 2008

       120

       100

         80

         60

         40

         20

          0
                 White         Black          Asian         Hispanic   Unknown/Other

                                       Male                Female



Age and sex demographics are provided in Table 3-22 and Figure 3-20.




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 Table 3-22:           Narcotic Analgesics-Related Deaths by Age and Sex
                                        FY 2007-2008
 Age                                          Sub-
 Group            Male         Female         total                      Total
     <1             1                                                      1
                 0.52%                       0.52%
     1-5                                                                    0

    6 - 12                                                                  0

   13 - 16                                                                  0

   17 - 19         0               1                                        1
                                0.52%        0.52%
   20 - 29         21              3                                       24
                 10.82%         1.55%       12.37%
   30 - 39         21              6                                       27
                 10.82%         3.09%       13.92%
   40 - 49         24              9                                       33
                 12.37%         4.64%       17.01%
   50 - 59         61             18                                       79
                 31.44%         9.28%       40.72%
   60 - 69         18              3                                       21
                 9.28%          1.55%       10.82%
   70 - 79          5              0                                        5
                 2.58%                       2.58%
   80 - 89          1              2                                        3
                 0.52%          1.03%        1.55%
     > 90                          0                                        0

    Totals         152           42                                       194
                 80.11%        19.89%       100.00%




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     Table 3-20:          Narcotic Analgesics-Related Deaths by Age and Sex
                                            FY 2007 - 2008

        70

        60

        50

        40

        30

        20

        10

         0
             <1    1-5   6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89
                                               Male    Female



These users tend to be concentrated in the 50-59 age groups with 40.7% of these
decedents falling in this age group. They are overwhelmingly male (80.1%) and
predominantly white (67%).



Methamphetamine

Methamphetamine is a stimulant similar to cocaine and misusers of these two drugs may
have a preference for one over the other, but are known to interchange when the
primary choice is not available. In a number of cases, both methamphetamine and
cocaine are present. Far fewer decedents are positive for methamphetamine than
cocaine. The demographics of methamphetamine users in the OCME population are
detailed in Tables 3-23 and 3-24 and Figures 3-21 and 3-22.




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 Table 3-23:      Methamphetamine-Related Deaths by Race and Sex
                               FY 2007-2008
                          Male            Female         Sub-total              Total
      White                22               11                                   33
                         48.89%           24.44%         73.33%
      Black                 8                0                                    8
                         17.78%           0.00%          17.78%
      Asian                 1                0                                    1
                         2.22%            0.00%           2.22%
     Hispanic               2                                                     2
                         4.44%                            4.44%
 Unknown/Other              1                                                     1
                         2.22%                            2.22%
      Total                34               11                                   45
                         75.56%           24.44%         100.00%

Methamphetamine users are predominantly White (73.3%) and male (75.6%). Less than
18% (17.8%) are Black, 2.2% are Asian and 4.4% are Hispanic.


 Figure 3-21:     Methamphetamine-Related Deaths by Race and Sex
                                   FY 2007 - 2008


        25

        20

        15

        10

          5

          0
                 White            Black          Asian      Hispanic   Unknown/Other

                                          Male           Female




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 Table 3-24:       Methamphetamine-Related Deaths by Age and Sex
                                FY 2007-2008
                  Male            Female               Sub-total
      <1                             1                                              1
                                  2.22%                  2.22%
     1-5                                                                            0
                                                         0.00%
    6 - 12                                                                          0
                                                         0.00%
   13 - 16                                                                          0
                                                         0.00%
   17 - 19                                                                          0
                 0.00%                                   0.00%
   20 - 29          2                2                                              4
                 4.44%            4.44%                  8.89%
   30 - 39          9                3                                             12
                 20.00%           6.67%                 26.67%
   40 - 49          6                2                                              8
                 13.33%           4.44%                 17.78%
   50 - 59         13                2                                             15
                 28.89%           4.44%                 33.33%
   60 - 69          3                1                                              4
                 6.67%            2.22%                  8.89%
   70 - 79          1                                                               1
                 2.22%                                   2.22%
   80 - 89                                                                          0
                                                         0.00%
     > 90                                                                           0
                                                         0.00%
   Totals          34               11                                             45
                 75.56%           24.44%               100.00%




Decedents positive for methamphetamine tend to be in the 30-59 age groups with 30-39
representing 26.7%, 40-49 representing 17.8% and 50-59 representing 33.33%. Males
represent 75.6%.




Drugs Detected                                                                          Page 140
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




    Figure 3-22:         Methamphetamine-Related Deaths by Age and Sex
                                       FY 2007 - 2008
       14

       12

       10

        8

        6

        4

        2

        0
             <1    1-5   6 - 12   13 - 16   17 - 19   20 - 29   30 - 39   40 - 49   50 - 59   60 - 69   70 - 79

                                  Male                               Female




Drug Combinations by Manner of Death

Drug combinations can contribute to adverse outcomes (impairment and death) and it is
useful to look at drug combinations by class. The drugs of interest are classified as
Ethanol which is a central nervous system depressant but is presented here, separately,
CNS depressants which includes benzodiazepines, muscle relaxants, sedatives and
over-the counter sedating antihistamines. Stimulants include cocaine and
methamphetamine and narcotic analgesics include both illicit and prescription pain
relievers. Figure 3-23 examines cases with only one of these drug classes was present
at death (although there may have been multiple drugs within the class).




Drugs Detected                                                                                             Page 141
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




       Figure 3-23:               Single Drug Class by Manner of Death
                                            FY 2007 - 2008

          120


          100


           80


           60


           40


           20


            0
                 Ethanol        CNS         Narcotic     Stimulants      MDMA
                             Depressants   Analgesics

                 Accident   Homicide   Vehicular   Natural   Suicide   Undetermined




Drugs Detected                                                                        Page 142
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Looking at those cases where drug combinations were identified it is clear that narcotic
analgesics in combination with central nervous system depressants (including ethanol)
seems to be the most frequent combination finding.

                        45

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                                    Accident           Homicide   Vehicular    Natural    Suicide    Undetermined
                 Legend:                    EtOH: ethanol; Stim: stimulant (cocaine, methamphetamine); NA: Narcotic Analgesics;
                                            CNS: Central Nervous System Depressants




Summary of Drugs Detected

This section describes the prevalence of drugs in deaths in San Francisco in Fiscal Year
2007-2008. It is important to remember that the mere presence of a drug is not always
related to the cause of death but there are many factors to consider, only some of which
have been discussed herein.




Drugs Detected                                                                                                                    Page 143
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




_________________________________________________________

Section 4: FORENSIC LABORATORY DIVISION
_________________________________________________________

Forensic Laboratory Workload Parameters

The Forensic Laboratory Division of the San Francisco Office of the Chief Medical Examiner
performs toxicological and histological services for the Office and provides toxicological
services to other agencies within the City of San Francisco. In Fiscal Year 2007-2008, the
laboratory had a Forensic Laboratory Director, five Assistant Forensic Toxicologists and one
Forensic Technician.

The Laboratory is physically located within the OCME. The Laboratory performed analytical
testing as part of the death investigation process on 539 cases in Fiscal Year 2007-2008.
This typically represents 4 or more specimen types (blood, both peripheral and central, urine
and vitreous humor). In Fiscal Year 2007 – 2008, the laboratory lacked a Laboratory
Information Management System and all data reflecting toxicology and histology services is
manually tabulated.



Histology Services

As part of the assessment of a death investigation case, the Medical Examiners select
tissues to evaluate for cellular evidence of disease processes. These tissue sections are
forwarded to the laboratory for embedding, cutting and staining and the resulting slides are
reviewed by the Medical Examiners. Table 4-1 provides information on histology requests
made to the Forensic Laboratory.




Forensic Laboratory                                                                   Page 144
         Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 4-1                        Histology Workload Parameters
                                            FY 2007 - 2008
                                                             Histo-
                                 Number of
                                                No. of    Pathological    Special       Other
                      # Cases     Organs
                                               Sections      Slides       Stains    Determinations
                                 Submitted
                                                           Prepared
          2007
 July                  112          224           586         232              15        17
 Aug.                  114          144           395         162              29         9
 Sept.                 108          164           382         148              22         4
 Oct.                   98          136           384         149              3         13
 Nov.                  114          127           350        131               33        18
 Dec.                  113          190           495         192              18        17
          2008
 Jan.                  150          186           514         196              22        18
 Feb.                   91          156           351         145              31        10
 Mar.                  107          209           637         259             97         22
 April                 110          184           446         186            216         20
 May                   111          124           273         112            399         18
 June                  123          122           282         125            24          17

     Total             1351         1825         5095        2037            909         190




Toxicology Services for other Agencies within San Francisco

The Forensic Laboratory performs toxicological analysis for other agencies. One such
service is employment-related testing. In Fiscal Year 2007-2008, this service was provided
for the San Francisco Police Department and the San Francisco Fire Department. The
numbers of cases submitted are listed in Table 4-2.



 Table 4-2:             Employment Related Drug Testing Cases
                                   FY 2007 - 2008
 Police Department      Multiple Substances in Urine                     681
 Fire Department        Multiple Substances in Urine                     157
 Adult Probation                                                         4




Forensic Laboratory                                                                     Page 145
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




The Forensic Laboratory provides human performance testing for Police Investigations. This
testing is by nature, far more comprehensive as subjects are selected with a high probability
of drug and/or alcohol positive results. The testing may require supportive testimony in legal
proceedings both as to the analytical results and the interpretation of the effects that the
drugs and/or alcohol as related to the specific circumstances of the investigation. The types
of cases submitted to the Forensic Laboratory are Driving Under the Influence Alcohol cases
where blood or urine is the submitted sample (misdemeanors and felony cases), Driving
Under the Influence of Drugs (misdemeanors or felonies), samples from alleged victims of
Drug Facilitated Sexual Assaults and public intoxication cases. In addition to these defined
groups, many arrested suspects are tested for the presence of drugs or alcohol to assist in
the prosecution of other crimes.

Table 4-3 lists the numbers of human performance toxicology cases submitted in Fiscal Year
2007-2008.

 Table 4-3:                       Human Performance Toxicology Cases
                                             FY 2007 - 2008 FY 2006 - 2007
    Misdemeanor Driving Offense (DUI);
  Single Substance (Alcohol) in Blood and
                    Urine                         555            461
   Felony Driving Offense (DUI); Multiple
            Substances in Blood                   143            165
  Drug Facilitated Sexual Assault; Multiple
            Substances in Urine                   129             96
 Public Intoxication; Multiple Substances in
                    Urine                          13             96
     General Police Suspect; Multiple
            Substances in Blood                   114            134

     Private - Alternative Matrix Testing          1                 0




Forensic Laboratory                                                                   Page 146
          Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




SECTION 5:        Firearms
_________________________________________________________

Firearm-Related Deaths:

All deaths due to firearms fall under the jurisdiction of the Office of the Chief Medical
Examiner. The data presented here is specific to firearm-related deaths. In Fiscal Year
2007-2008, the OCME investigated 93 firearm-related deaths, which represents a 8.9%
decrease over Fiscal Year 2006 - 2007.


 Table 5-1                                       Number of Firearm-Related Deaths
                                                           10 Year Perspective
               ’98-‘99      ’99-‘00       ’00-‘01      ’01-‘02       ’02-‘03       ’03-‘04      ’04-‘05     ’05-‘06   ’06-‘07    ’07-‘08

 Totals          54           67            60             63             81         73           74          97       104         93




          Figure 5-1:                      Number of Firearm-Related Deaths
                                                10 Year Perspective


      120


      100


          80


          60


          40


          20


           0
                  ’99-‘00       ’02-‘03          ’03-‘04        ’04-‘05        ’05-‘06       ’06-‘07      ’07-‘08




Firearm-Related Deaths                                                                                                Page 147
        Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Table 5-2 details the incidence of firearm-related deaths by manner over the past ten years
in raw numbers and shows the percentage of firearm-related deaths by Manner of Death.
The majority of firearm-related deaths are a result of homicidal violence. As a percentage of
firearm-related deaths, Homicides increased, however this is not due to a increase in
firearm-related Homicides but is due to a decrease in the numbers of Suicide by firearm.


 Table 5-2:                   Number of Firearm-Related Deaths by Manner of Death
                                             10 Year Perspective
                 ’98-‘99    ’99-‘00      ’00-‘01       ’01-‘02        ’02-‘03       ’03-‘04      ’04-‘05   ’05-‘06   ’06-‘07    ’07-‘08

 Homicide          35         41           39              43              55         65           62        79        81         81
    %           64.80%      61.20%     65.00%          68.30%         67.90%        89.00%       83.80%    81.40%    77.90%     87.10%
  Suicide          19         26           20              19              25         18           11        17        23         12
    %           35.20%      38.80%     33.30%          30.20%         30.90%        24.70%       14.90%    17.50%    22.10%     12.90%
 Accident          0          0            1               1                1          0           1         1         0          0
    %              na         na         1.70%         1.60%              1.20%       na         1.40%     1.00%       na         na
  Totals           54         67           60              63              81         73           74        97       104         93
    %            100%        100%        100%              100%           100%       100%         100%      100%      100%       100%


Firearm-related deaths can be classified as Homicide, Suicide or Accident. Figure 5-2 looks
at the ten year perspective as a function of manner of death.


                Figure 5-2:           Firearm-Related Deaths By Manner of Death
                                               10 Year Persepctive

        90
        80
        70
        60
        50
        40
        30
        20
        10
            0
                  ’99-‘00      ’02-‘03           ’03-‘04         ’04-‘05          ’05-‘06       ’06-‘07    ’07-‘08

                            Homicide                            Suicide                       Accident


From this data, there has been a significant increase in the numbers of firearm-related
homicides over the past ten years with stabilizing over the past three fiscal years at about 80
firearm-related Homicide deaths per year. Firearm-related Suicide deaths declined in Fiscal
Year 2007 – 2008.



Firearm-Related Deaths                                                                                               Page 148
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Looking at the Manner of Death for firearm-related deaths as a percentage of all firearm
deaths, Figure 4-3 details a ten year perspective of the firearms by Manner of Death as a
percentage of the number of firearm deaths per year. Overall, the percentage of Suicide
deaths as compared to all firearm deaths has decreased in the past four years. From Fiscal
Year 1997-1998 through Fiscal Year 2002-2003, Suicide by firearms comprised more than
30% of the firearm-related deaths. In Fiscal Year 2007 – 2008, the percentage of firearm-
related deaths that were a result of suicide reached a low of 12.9%.



    Figure 5-3:             Firearm Related Deaths by Manner of Death
                                Normalized - 10 Year Perspective


        100%


         80%


         60%


         40%


         20%


          0%
                  ’99-‘00    ’02-‘03    ’03-‘04    ’04-‘05      ’05-‘06   ’06-‘07   ’07-‘08

                                       Homicide   Suicide    Accident


Firearm-related deaths are the leading cause of Homicide deaths, representing 75% of all
deaths mannered as Homicide but comprise only 12.8% of deaths mannered as Suicide.




Firearm-Related Deaths                                                                        Page 149
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Demographics:

Black males comprised more than one-half of all firearm-related deaths (51%). The details
of the racial and sex distribution of firearm-related deaths are detailed in Table 5-4 and
Figure 5-4.


 Table 5-4:                 Firearm-Related Deaths by Race and Sex
                                      FY 2007-2008
                          Male             Female           Sub-total         Total
       White               13                 4                                17
                         13.98%            4.30%              18%
       Black               45                 2                                47
                         48.39%            2.15%              51%
       Asian               10                                                  10
                         10.75%                               11%
     Hispanic              18                                                  18
                         19.35%                               19%
       Other                1                                                   1
                         1.08%                                1%
       Total               87                6                                 93
                          94%               13%              100%




 Figure 5-4:                 Firearm-Related Deaths by Race and Sex
                                        FY 2007 - 2008


           45
           40
           35
           30
           25
           20
           15
           10
            5
            0
                    White         Black             Asian       Hispanic     Other

                                          Male                Female




Firearm-Related Deaths                                                                Page 150
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 5-5:         Firearm-Related Deaths by Race and Sex and Manner of Death
                                          FY 2007-2008
                      Male                   Female          Subtotal        Total
              Homicide     Suicide Homicide       Suicide
   White          7           6         1             3                        17
               7.53%       6.45%     1.08%         3.23%     18.28%
   Black         45           0         2                                      47
               48.39%                2.15%                   50.54%
   Asian          8           2                                                10
               8.60%       2.15%                             10.75%
 Hispanic        18           0                                                18
               19.35%                                        19.35%
   Other          1           0                                                 1
               1.08%                                          1.08%
   Total         79           8         3             3                        93
                85%          9%        3%            3%       100%




There were no Hispanic or Black firearm-related Suicides in Fiscal Year 2007 – 2008 and yet
these are the most prevalent races in firearm-related deaths.




Firearm-Related Deaths                                                               Page 151
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




        Figure 5-6:         Firearm-Related Deaths by Age, Sex and Method
                                           FY 2007 - 2008


       40
       35
       30
       25
       20
       15
       10
        5
        0
            <1     1-5   6 - 12 13 - 16 17 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89   > 90

            Homicide Male            Homicide Female                Suicide Male             Suicide Female




Examination of the age groups of firearm-related deaths is described in Table 5-6 and Figure
5-6. Approximately 12% of all firearm-related deaths were 19 years of age or younger and
all were classified as Homicides. The largest concentration of firearm-related deaths
occurred in males, ages 20-39 representing 66.7% of all firearm-related deaths.




Firearm-Related Deaths                                                                                    Page 152
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




 Table 5-6                   Firearm-Related Deaths by Age and Sex
                                       FY 2007-2008

                         Homicide         Suicide            Total                  %
 Under 1 year                                                 0
                Male
              Female
 Age 1 - 5                                                     0
                Male
              Female
 Age 6 - 12                                                    0
             Male
           Female
 Age 13 - 16                3                                  3                  3.23%
             Male           3
           Female
 Age 17 - 19                8                                  8                  8.60%
             Male           8
           Female
 Age 20 - 29               36                                 36                 38.71%
             Male          36
           Female           0
 Age 30 - 39               26                                 26                 27.96%
             Male          23
           Female           3
 Age 40 - 49                6                2                 8                  8.60%
             Male           6                1
           Female           0                1
 Age 50 - 59                2                2                 4                  4.30%
             Male           2                2
           Female
 Age 60 - 69                4                1                 5                  5.38%
             Male           4                1
           Female
 Age 70 - 79                                 3                 3                  3.23%
             Male                            1
           Female                            2
 Age 80 - 89                                                   0
             Male
           Female
 Age > 90                                                      0
             Male
           Female
             Total         85                8                93                  100%




Firearm-Related Deaths                                                               Page 153
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Fifty-eight percent of all firearm-related deaths are positive for alcohol and/or drugs. Table 5-
7 and Figure 5-7 show the incidence of alcohol, drugs and those that are both alcohol and
drug positive. It is important to note that the alcohol and drug category are also represented
in the alcohol group and in the drug group. Firearm-related Homicides were positive for
alcohol and/or drugs in 49.6% of the cases. Of those which were positive for alcohol, the
average Blood Alcohol Concentration (BAC) for Homicides was 0.11 gm/100 mL. The two
BAC results for Suicides were 0.02 gm/100 mL and 0.10 gm/100 mL.



              Figure 5-7: Firearm-Related Deaths with Alcohol and/or Drugs
                                     FY 2007 - 2008


         40
         35
         30
         25
         20
         15
         10
          5
          0
                  Alcohol          Drugs        Alcohol + Drugs        None

                               Homicide                  Suicide



     Table 5-7:      Firearm-Related Deaths - Drug and/or Alcohol Involved
                                     FY 2007-2008
                             Homicide         Suicide              Combined
            Alcohol              24              2                    26
               %              26.67%          2.22%                 28.89%
             Drugs              32               8                    40
               %              35.56%          8.89%                 44.44%
        Alcohol + Drugs          12              3                    15
               %              13.33%          3.33%                 16.67%
             None               35               3                    38
               %              38.89%          3.33%                 42.22%
             Total              103             16                    90
          Not Tested             3               0                     3




Firearm-Related Deaths                                                                   Page 154
       Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




SECTION 6:        Childhood Deaths
_________________________________________________________

There were 36 childhood deaths in the ages 0-19 in Fiscal Year 2007 - 2008. Table 6-1 and
Figure 6-1 provide information on the Manner of Death for these cases.


            Table 6-1:      Childhood Deaths - Manner of Death
                                    FY 2007-2008
            Homicide            13                    36.11%
            Accident             4                    11.11%
            Natural             11                    30.56%
            Suicide              1                     2.78%
            Vehicular            2                     5.56%
            Undetermined        5                     13.89%
            Total               36                     100%




Homicide is by far the most frequent Manner of Death accounting for 36% of all childhood
deaths. This is followed by Natural at 30.6%, Accident at 16.7%, Vehicular at 5.56% and
Suicide at 2.8%.


   Figure 6-1:                Childhood Deaths by Manner
                                    FY 2007 - 20008




                                     5
                     2
                                                          13
   1


                                      11




             Homicide       Natural        Suicide     Vehicular      Undetermined


Childhood Deaths                                                                   Page 155
    Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Demographics:


The demographics of childhood deaths by race and sex are shown in Table 6-2 and Figure
6-2. Blacks and Whites are represented almost equally and together account for 72% of all
childhood deaths.

            Table 6-2:       Childhood Deaths by Race and Sex
                                      FY 2007-2008
                            Male     Female           Total               Percentage
              White           8        4               12                  33.33%
              Black          11        3               14                  38.89%
              Asian           3                         3                   8.33%
             Hispanic         4         1               5                  13.89%
              Other           0         2               2                   5.56%
              Total          26        10              36




              Figure 6-2:          Childhood Deaths by Race and Sex
                                           FY 2007 - 2008


       12

       10

        8

        6

        4

        2

        0
               White           Black          Asian            Hispanic      Other

                                     Male                     Female




Childhood Deaths                                                                       Page 156
    Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Nearly half (44.7%) of the childhood deaths occur in the 17-19 age group and the next most
prevalent group is 13-17 (26.3%). These childhood deaths occur predominantly in males
(81.5%).




       Table 6-3:         Childhood Deaths by Age and Sex
                                   FY 2007-2008
                        Male   Female     Total              Percentage
           <1             8       4        12                 33.33%
          1-5             2       1        3                   8.33%
         6 - 12           1       1         2                  5.56%
        13 - 17           3      2         5                  26.30%
         17-19           12       2        14                 44.70%
         Total           26      10        36




       Figure 6-3:                Childhood Deaths by Age and Sex
                                         FY 2007 - 2008

       12

       10

        8

        6

        4

        2

        0
                   <1          1-5         6 - 12       13 - 17           17-19

                                 Male               Female




Childhood Deaths                                                                   Page 157
    Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Homicides

Thirteen of the 36 childhood deaths were classified as Homicides (36.1%). Eleven of these
deaths were firearm-related, one was a blunt force injury and one was a sharp injury. The
methods of childhood Homicide death are summarized in Figure 6-4.



      Figure 6-4:         Methods of Childhood Homicide Deaths
                                      FY 2007- 2008



                            1            1



                                              united    11




                       Firearm          Blunt Injury         Sharp Injury




All childhood Homicide deaths were males between the ages of 15 and 19; 7/13 (53.8%)
were Black 3/13 were White (23.1%) and 3/13 were Hispanic (23.1%). All firearm-related
deaths are further examined in Section 5 of this report.

Of these Childhood homicide deaths three had positive toxicology reports (one was positive
for cocaine only, one was positive for cocaine and ethanol and one was positive for ethanol
only).



Accident

Four of 36 childhood deaths were classified as Accident (11.1%). One was a 19 year old
male who died as a result of a mixed drug intoxication including ethanol and MDMA/ecstasy
(methyldeoxymethamphetamine). One was a result of blunt injuries from a tiger attack.
One was a drowning and one was a result of overlay from co-sleeping. Two were male and
two were female; two were White, one Black and one was classified as Other.




Childhood Deaths                                                                    Page 158
    Office of the Chief Medical Examiner – San Francisco - Annual Report - FY 2007-2008




Natural


Eleven of the 36 (30.56%) of the Childhood deaths in Fiscal Year 2007 – 2008 were
classified as Natural. Six of these deaths were female and 5 males; 9 were 5 years old or
younger. Six cases were attributed to Sudden and Unexpected Infant Death, one was an
intrauterine demise, one hyponatremia, one encephalopathy, one asphyxia from pneumonia
and one was attributed to seizures as a complication of infection.

Only one childhood Natural death had positive toxicology findings, the intrauterine demise
was positive for cocaine.


Suicide

There was one Suicide, a 19 year-old Asian male who hanged himself and he was positive
for cocaine.


Undetermined

There were five infants whose deaths were classified as Undetermined. All five were male
(one Asian, two Black and two White). Two were probable Sudden and Unexpected Infant
Death, one was a subarachnoid hemorrhage as a result of a fall. Two were either Sudden
Unexpected Infant Death or overlay from co-sleeping and two were classified as unknown.


Vehicular:

There were two Childhood Vehicular deaths, one was an 11 year old female who was riding
her bicycle and collided with a van. The other was a 15 year old Black female pedestrian
who was struck by a Muni bus.




Childhood Deaths                                                                  Page 159

								
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