BOISE — Idaho’s Department of Health and Welfare recorded 266 drug-induced deaths and 241 drug-overdose deaths in 2017.
But Idaho almost certainly had more drug-related deaths than that.
That’s because poorly funded and understaffed coroners’ offices throughout the state mean coroners aren’t always able to be as thorough as they want to be.
While the Idaho Department of Health and Welfare tracks drug-induced and drug-overdose deaths, the thoroughness of the investigations into those deaths varies.
Some death certificates list the combination of drugs in a person’s system when they overdosed, but some don’t, said Niki Forbing-Orr, Health and Welfare spokeswoman.
It means that while more than 47,000 people died of opioid overdoses in the United States in 2017, it’s difficult to say how many Idahoans that number includes.
Ada County Coroner Dotti Owens counts herself lucky because she has the money to do her job well. She doesn’t have to hold a second job, she can conduct as many autopsy and toxicology reports as she needs to, and she has the modern technology her job requires.
In Idaho, she’s an anomaly.
Death certificates from counties such as Ada will include the drugs in a person’s system when they died, but in smaller, poorer parts of the state, coroners might not even have the money available to conduct an autopsy or a toxicology report in many cases.
“I have coroners who have told me, ‘I’m only allowed one autopsy and one toxicology report a year,’” Owens said.
Often, coroners can declare a cause and manner of death without an autopsy or toxicology report. They can examine a person’s medical history, inspect the scene of the death, and talk to police. In those cases, they might not ask for further reports, which can cost $100 each or more. That doesn’t mean they don’t want to — many coroners are limited by the budget their boards of commissioners give them.
“How do you say to a coroner you only get x number of toxicology (reports) or autopsies a year?” Owens said. “How do you do that?”
Beyond determining if opioids were in a person’s system in an overdose case, toxicology reports can tell a coroner if opioids might have influenced a person’s death in other ways — for instance in the case of a car crash, suicide or accidental death. The cause and manner of death may be evident in those cases, but a look at a person’s history with opioids could reveal more about the reach of the drug in Idaho. That analysis isn’t completed when coroners have small budgets.
Cassia County Coroner Craig Reinhart said he runs toxicology tests on 45 to 50 percent of his cases. If he had a bigger budget, though, he said he’d ask for toxicology reports in closer to 90 percent of cases. His entire budget is $65,000, he said, and that includes everything from wages to office supplies. Of that money, he said, $25,000 is dedicated to autopsies and toxicology reports.
But it’s not just a lack of funding for those reports in particular. Idaho has fewer than five full-time coroners — the rest are technically part time, with part-time salaries, but are on call. Owens listed some of them, ranging from $4,900 to almost $13,000. It means they have to have another job on the side to pay the bills.
“I’m an electrical contractor and I make 75 bucks an hour,” Lemhi County Coroner Mike Ernest said.
That job provides his primary source of income. He loses that money when he handles coroner work, which can absorb unplanned hours of his time.
“The opioid reporting is just as important as any of (the other tests),” Ernest said. “The funding’s just not there to take the time.”
And some coroners aren’t properly equipped for it either. Owens remembers one coroner who told her she doesn’t even have her own computer for work — she has to write reports on public computers at the courthouse, during regular business hours, carving time out of her day job to do so. Coroners in similar positions don’t have time to dig deeper into the smaller roles opioids may have played in a person’s death.
But even Owens, in a county with a well-funded office, said she doesn’t always know for sure when a person overdoses on opioids. Staff at hospitals draw blood samples from overdose patients, and test for the presence — but not the amount — of certain substances. The hospital keeps that sample for 72 hours, and then destroys it, she said. That means if the person dies more than 72 hours after being admitted to the hospital, she and her staff will never have access to the sample to see which substance may have killed the person.
Still, she said, the number of reported opioid overdose deaths is probably more accurate now than it was even five years ago. She’s networking with other coroners, encouraging them to come to training meetings to learn about the importance of specifying what exact substances were present in a person’s body when they died, instead of simply writing “multidrug overdose” on a death certificate. Attitudes are changing, but that isn’t helpful if coroners don’t have the resources to do the job
“(Toxicology reports) are expensive,” Owens said. “But when you have jurisdictions that are limited to so many (toxicology reports) or so many autopsies a year, how do you expect the numbers to be accurate?”
— Idaho Press Canyon County public safety reporter Emily Lowe contributed to this story.