It's a coroner's job to decide when a death bears closer examination

It's a coroner's job to decide when a death bears closer examination

It was a fairly ordinary call for someone in Duane Northrup's line of work.

Local police checked on a 56-year-old woman whom relatives hadn't heard from in nearly a month. When they arrived, she was found dead, her body "severely decomposed."

As Champaign County's coroner, it's Northrup's responsibility to determine the cause and manner of death. In this case, given the condition of the body and little known prior medical history, he decided that performing an autopsy was the best course of action.

"I must make difficult decisions every day whether to conduct an autopsy or not," said Northrup, whose office averages about 1,900 death investigations a year, only 8 percent to 10 percent of which result in autopsies.

Since he works in a county with a Level 1 Trauma Center — Carle Foundation Hospital in Urbana — deaths in neighboring counties also fall under the jurisdiction of Northrup's office.

And with $123,000 budgeted each year for autopsies, which cost between $1,050 to $2,500 each, performing one after every death isn't financially feasible.

Nor is it physically possible, given that the one pathologist in the Urbana office serves Champaign and surrounding counties.

Northrup ordered an autopsy in the case of the 56-year-old woman not only to determine the cause and manner of death but also to positively identify her and rule out any possible trauma that wasn't apparent due to the condition of the body.

Other types of cases — including homicides — almost always result in autopsies, though not in the manner you're used to seeing on TV shows like "CSI" and "NCIS."

Rare is the real-life autopsy that ends with officials pinning down the exact time a person died or everything they ate in their last hours, coroners say.

In fact, Northrup said, "there are times when we still don't have answers — even after a full autopsy and other testing — and we must investigate further."

Preliminary autopsy reports are prompt, usually turned around in 24 hours. But the final report and testing results, such as toxicology, can take weeks, even months, particularly in those cases that happen on local roads and require vehicle accident reconstruction by Illinois State Police.

"We can't solve all of these things in 60 minutes like on TV," said Piatt County Coroner Troy Dunn. "And we have to be able to explain to families why not, or why, we need to do an autopsy."

 

'A judgment decision'

In Illinois, the decision of whether to conduct an autopsy rests solely with the county coroner — except in some situations mandated by state law. Those include suspicious, obscure, mysterious or unexplained deaths, particularly those of children, as well as people who die while being pursued or apprehended by law enforcement or while in custody.

"A lot of times, it's a judgment decision," said Dunn, recalling an autopsy two years ago that revealed an unknown condition a man had — a hereditary clotting disorder.

That finding allowed his children to be tested for the disorder, a possible life-saver, Dunn said.

Vermilion County Coroner Jane McFadden makes decisions on when to perform autopsies on a case-by-case basis, although some are automatics for her — homicides, a person who dies in custody and some accidents.

To help make that decision, the Illinois Coroners and Medical Examiners Association publishes a protocol that the majority of coroners follow.

It calls for autopsies and toxicology testing to be done in these scenarios:

— Violent deaths, including self-inflicted ones.

— Workplace or work injury deaths.

— Deaths caused by fire, smoke inhalation or electrocution.

— Deaths suspected to be associated with intoxication by alcohol, drugs or poison.

— Deaths from suspected drowning or a body found in or near water.

— Bodies that are unidentified, skeletonized or charred beyond recognition.

— Deaths that occur in motor vehicle collisions.

 

'Not always accidental'

Traffic deaths can be especially tricky, local coroners say.

"Persons not involved in death investigation seldom realize that traffic crashes are not always accidental deaths," Northrup said, adding that they are frequently determined natural, occasionally suicide, and once in a while, as homicides staged to appear accidental.

The last two autopsies Dunn ordered in Piatt County both came after traffic accidents.

"You have to try to piece together 'Why didn't they stop or slow down?'" he said. "You have to figure out if there was any impairment."

Take the case he encountered a few years ago, after a driver crashed into a restaurant in Monticello. Eventually, after an autopsy, investigation by police and reconstruction of the accident scene, it was determined that the man had a major medical event, Dunn said.

"He was pretty much deceased before he hit the building," he said.

Suspected cases of suicide also involve further investigation, Northrup said, given that they can be staged to appear natural, such as a residential fire death that turns out to be arson to cover up a homicide.

 

The Sheryl Houser case

And then there are those mysteries that take years to solve — if they are solved at all.

Dunn won't soon forget the case of Sheryl Houser, whose 1990 death was originally ruled "undetermined."

On Oct. 5 of that year, Mrs. Houser's body was found on the floor of the garage of the family home between Mahomet and Mansfield. Her upper torso was held up by yellow boating rope, which had been looped over a metal bar placed on an opening that led to the attic of the garage.

A ladder was found in an upright position near her body.

Twenty-two years later, state police asked a forensic pathologist to review the autopsy report. Dr. Scott Denton determined that hemorrhaging on Mrs. Houser’s face, a possible thumb mark on her neck, and the fact that neck bruises did not line up with the position of the tightly wound rope around her neck pointed to homicide.

A grand jury was convened for a coroner’s inquest in 2016 and changed the ruling to a homicide. Mrs. Houser’s husband was arrested, charged and convicted of strangling her and staging the scene to look like a suicide by hanging.

He was sentenced last year to 55 years in prison.

“Some cases are pretty straightforward,” Dunn said, “but you do have those that are like a puzzle. You know what you have based on the scene, but now you have a jumble of puzzle pieces and you have to slowly piece them together, whether a timeline or medical history.

“Did they go to a doctor? Did the doctor miss something?”
 

Private autopsy option

It’s not just high-profile or mysterious deaths that lead to tough calls.

Joe Victor, Douglas County’s 26-year coroner, said honoring religious beliefs can be difficult when determining whether to conduct an autopsy in search of the exact cause of death.

Victor handles deaths involving the Amish, whose families often don’t want the body of a loved one affected in the way they are during autopsies.

“Sometimes, there’s just no way we can go without it,” said Victor, emphasizing that a coroner has the right to order an autopsy in any case in which they have jurisdiction. That includes deaths where the decedent wasn’t attended by a licensed physician.

Northrup said the authority to overrule the next of kin in whether to perform an autopsy is important. Without it, he said, “many domestic violence deaths, homicides and questionable deaths might go undetected.”

In other instances, a family member will request an autopsy when the coroner hasn’t ordered one.

That’s allowed, if done at the family’s expense.

Northrup said there have been seven private autopsies paid for by families this year in Champaign County deaths, which were mostly a result of natural causes.

Sometimes, relatives want to know a specific cause of death — for instance, stroke versus renal failure. Or, they just want to know out of curiosity.

Another reason families request private autopsies: They’re considering filing suit, sometimes for medical malpractice.

“We look at cases like that, but if there’s no credible evidence, we will refuse an autopsy,” Northrup said.
 

‘The hardest decisions’

Even organ donation — a wonderful thing, coroners agree — complicates autopsy decisions.

A basic autopsy, Northrup explained, involves both an external examination of the body and removal of organs to examine them by dissection.

In Ford County, Coroner Rick Flessner said he tries to look at a decedent’s driver’s license as soon as possible after pronouncement to determine if they’re a donor, given the urgency involved in recovery.

Northrup said organs cannot be donated after an autopsy and tissue must be procured within 24 hours after death.

“This creates difficult situations ... when having to determine if donation could, or will, interfere with my ability to determine cause and manner of death and collect necessary evidence needed for our investigation,” Northrup said.

“The coroner has the final say whether organs and tissue can be released prior to any autopsy or not, and these are some of the hardest decisions I have to make frequently.”
 

Budgetary implications

So far this year, Flessner has ordered 13 autopsies, which cost about $1,300 apiece.

“In a small county, that can cost,” he said. “So you can’t make that judgment on a cavalier basis.”
It’s costly in larger counties, as well, though Northrup said that’s never a factor in his decision.

“I will never not do an autopsy because of cost,” said Northrup, who has come close to exceeding his budget at year’s end. “I’m still going to do an autopsy if it’s necessary. That’s what my responsibility is.”

In recent years, the rise of deaths caused by opioid overdoses has “drained” Champaign County’s autopsy and toxicology budgets, Northrup said.

He must come up with an estimated budget no later than July or August of the prior year, with “absolutely no way to know how many autopsy and toxicology cases” he will have or how much testing will be required. Toxicology costs range from $200 to $1,000, depending on what’s required, Northrup said.

Of the $123,200 Champaign County budgeted for autopsies in 2018, $82,553 has been spent. Of the $45,000 for toxicology, Northrup has used $25,200.

“It is definitely a continual balancing act,” he said.

 

Around the area
Not all coroner-investigated deaths require autopsies, which can range in cost locally from $1,050 to $2,500. Here’s an areawide overview of deaths and autopsies so far in 2018:

Place (Coroner) → Coroner-involved deaths → Autopsies → Cost per autopsy → Where conducted
Champaign County (Duane Northrup) → 1,296 → 95 → $1,050-$2,500 → Urbana
Douglas County (Joe Victor )→ 109 → 13 → $1,200-$1,400 → Urbana
Ford County (Rick Flessner) → 140 → 13 → $1,300 → Urbana
Piatt County (Troy Dunn) → 82 → 10 → $2,000-$2,500 → Bloomington
Vermilion County (Jane McFadden) → 462 → 28 → $2,000 → Urbana, Bloomington

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