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Pima County Office Of The Medical Examiner – Annual Report 2015

2 Rev: 06/06/2016

TABLE OF CONTENTS

INTRODUCTION PAGE 4

OVERVIEW PAGES 4-6

ORGANIZATIONAL CHART PAGE 7

TOTAL CASES PAGE 8

MEDICAL EXAMINER (ME) CASES PAGE 8 ME CASES PAGE 9

ME CASES BY AGE PAGE 9

ME CASES BY MANNER PAGE 10

PIMA COUNTY ME CASES BY MANNER PAGE 10

HOMICIDE DEATHS PAGE 11 HOMICIDE 2009-2015 PAGE 11

HOMICIDE BY AGE PAGE 11

HOMICIDE BY SEX PAGE 12

HOMICIDE BY CAUSE PAGE 12

ACCIDENT DEATHS PAGE 13 ACCIDENT BY AGE PAGE 13

ACCIDENT BY SEX PAGE 13

ACCIDENT BY CAUSE PAGE 14

ACCIDENT BY CAUSE 2012-2015 PAGE 14

SUICIDE DEATHS PAGE 15 SUICIDE BY AGE PAGE 15

SUICIDE BY SEX PAGE 15

SUICIDE BY CAUSE PAGE 16

SUICIDE BY CAUSE 2012-2015 PAGE 16

NATURAL DEATHS PAGE 17 NATURAL BY AGE PAGE 17

NATURAL BY SEX PAGE 17

NATURAL BY CAUSE PAGE 18

NATURAL BY CAUSE 2013-2015 PAGE 18

UNDETERMINED MANNER OF DEATH PAGE 19 UNDETERMINED MANNER BY AGE PAGE 19

UNDETERMINED MANNER BY SEX PAGE 19

UNDETERMINED MANNER BY CAUSE PAGE 20


3 Rev: 06/06/2016

OVERDOSE DEATHS PAGE 21 OVERDOSE DEATHS 2010-2015 PAGE 21

OVERDOSE DEATHS BY AGE PAGE 22

OVERDOSE DEATHS BY SEX PAGE 22

OVERDOSE DEATHS BY MANNER PAGE 23

SELECT DRUGS BY YEAR 2013-2015 PAGE 23

OVERDOSE DEATHS BY DRUG PAGE 24

MOTOR VEHICLE RELATED FATALITIES PAGE 25 MOTOR VEHICLE FATALITIES 2011-2015 PAGE 25

MOTOR VEHICLE FATALITIES BY AGE PAGE 25

MOTOR VEHICLE FATALITIES BY SEX PAGE 26

MOTOR VEHICLE FATALITIES BY TYPE PAGE 26

W.H. BIRKBY FORENSIC ANTHROPOLOGY LABORATORY PAGE 27 FA EXAMS BY NUMBER 2007-2015 PAGE 27

FA EXAMS BY CONDITION OF REMAINS PAGE 28

FA EXAMS BY TYPE PAGE 28

UNDOCUMENTED BORDER CROSSER (UBC) REMAINS PAGE 29

UBC RECOVERIES CY2001–2015 PAGE 30

UBC RECOVERIES FEDFY2002–2015 PAGE 30

UBC RECOVERIES BY MONTH PAGE 31

UBC RECOVERIES BY AGE PAGE 31

CONDITION OF RECOVERED REMAINS PAGE 32

UBC RECOVERIES BY SEX PAGE 32

UBC RECOVERIES BY CAUSE PAGE 33

UBC RECOVERIES BY NATIONALITY PAGE 33

UBC RECOVERIES BY NATIONALITY, 2001-2015 PAGE 34

IDENTIFIED V. UNIDENTIFIED UBC RECOVERIES PAGE 34

DNA IDENTIFICATIONS 2001-2015 PAGE 35

DEATHS BY COUNTY PAGE 36 APACHE COUNTY PAGE 36 - 39

COCHISE COUNTY PAGE 40 - 44

GILA COUNTY PAGE 45 - 49

GRAHAM COUNTY PAGE 50 - 53

GREENLEE COUNTY PAGE 54 - 57

LA PAZ COUNTY PAGE 58 - 62

NAVAJO COUNTY PAGE 63 - 67

PIMA COUNTY PAGE 68 - 87

PINAL COUNTY PAGE 88 - 92

SANTA CRUZ COUNTY PAGE 93 - 97

YUMA COUNTY PAGE 98 - 101


4 Rev: 06/06/2016

INTRODUCTION

The Pima County Office of the Medical Examiner (PCOME) investigates any death in

Pima County that is sudden, violent, unexpected, or in which the cause of death is

unknown. The PCOME also serves as the Medical Examiner (ME) for Cochise and

Santa Cruz Counties and performs examinations as needed for eight additional counties.

In 2015 there were 9,134 deaths in Pima County; of these 2,437 (27%) were reported to

the PCOME for investigation. This annual report consists of three main sections. The

first is an overview of the activities and notable events of the office over the course of the

report year. The second is a statistical review of the types of cases processed by the

office over the same time period. The third is a by-county breakdown of certain death

classifications.

OVERVIEW The PCOME was fully accredited by the National Association of Medical Examiners

(NAME) following a two day inspection in October 2011. This accreditation is effective

from October 24, 2011 through October 24, 2016 and requires annual accreditation

verification. NAME accredited offices represent the highest quality of death

investigation systems. There are 69 fully accredited Medical Examiner’s Offices across

the United States. The PCOME has the distinction of being the sole fully accredited

office in Arizona.

Reportable Deaths

Arizona Revised Statute §11-593 delineates ten circumstances in which a death is

reportable to the PCOME.

1. Death when not under the current care of a health care provider as defined

pursuant to section 36-301.

2. Death resulting from violence.

3. Death occurring suddenly when in apparent good health.

4. Death occurring in a prison.

5. Death of a prisoner.

6. Death occurring in a suspicious, unusual or unnatural manner.

7. Death from disease or accident believed to be related to the deceased's

occupation or employment.

8. Death believed to present a public health hazard.

9. Death occurring during, in association with or as a result of anesthetic or

surgical procedures.

10. Unidentifiable bodies.

Investigations

Our 11 medical investigators processed 2,437 reports of deaths from Pima County and

734 reports from 10 additional Arizona counties in 2015. Jurisdiction was declined in

874 of these cases. A total of 2,007 decedents were transported to the PCOME for

examination or storage in 2015.


5 Rev: 06/06/2016

Examinations

Pima County forensic pathologists and anthropologists performed 1,456 autopsies, 348

external examinations, 290 death certifications, 145 anthropologic examinations, and

reviewed 6,323 death certificates for cremations in 2015.

Education, Training and Activities

1) Medicolegal Death Investigators

Calendar year 2012 saw a transition from the term Forensic Medical Investigator

(FMI) to Medicolegal Death Investigator (MDI) for our 11 MDIs in keeping with

national norms. Eight MDIs, our MDI Supervisor, and Morgue Supervisor are

certified by the American Board of Medicolegal Death Investigators to provide

competent medicolegal death investigations. PCOME Forensic Pathologists

lecture to the MDIs on varying topics monthly. In accordance with our MDI

quality assurance and performance improvement program, 10% of reports are

pathologist reviewed monthly and 10% of reports are peer reviewed quarterly.

2) Community education, presentations and media interviews

The PCOME receives numerous requests from various groups, organizations,

individuals and schools for presentations regarding a host of forensic issues

annually. Not all requests can be honored due to time and personnel constraints,

but examples of educational activities include but are not limited to: presentations

at local primary and secondary schools; lectures at various institutions and

departments at the University of Arizona; presentations and tours for

humanitarian organizations; and the teaching of a 3-credit-hour death

investigation class at Pima Community College. The Chief Medical Examiner

recorded 115 media interviews, emails and phone calls over the calendar year.

Pima County’s Forensic Anthropologist and Postdoctoral Fellow gave numerous

platform and poster presentations to various organizations and at national

anthropologic and forensic conferences.

3) University of Arizona College of Medicine, Department of Pathology and School

of Anthropology

PCOME Forensic Pathologists hold clinical appointments with the Department of

Pathology at the University of Arizona, College of Medicine, where they are

involved with pathology resident and medical student teaching. Two pathology

residents, seven medical students and two pathology post-sophomore fellows

rotated through the PCOME for month-long rotations in 2015. Our Forensic

Anthropologist also holds an academic appointment at the University of Arizona

and three anthropology interns trained at our facility in 2015.

Law Enforcement and Legal System

The availability of our pathologists to assist or advise law enforcement personnel in their

investigations and the legal system in its proceedings is an important function of the

PCOME. Involvement of the PCOME in the legal system generally consists of pretrial

interviews, depositions and courtroom testimony. In 2015, the office’s six forensic

pathologists and two anthropologists participated in a number of pretrial interviews,

depositions and jury trials both in Pima and out-of-county cases.


6 Rev: 06/06/2016

Organ and Tissue Donation

Pursuant to A.R.S §36-861, the PCOME refers death notifications to, and partners with,

Donor Network of Arizona (DNA) and other associated tissue research agencies for the

coordination and procurement of anatomic gifts. The importance of supporting the

efforts of the organ and tissue transplant and research communities in Arizona cannot be

understated. Anatomic gifts can be life saving for organ and tissue recipients and these

donations are always in short supply.

Organ Donations with PCOME Involvement 2015

Heart Lungs Liver Kidneys Pancreas Sm. Intestine Total

10 7 21 49 3 0 90

The total lives saved through organ donation involving deaths investigated by the

PCOME in 2015 were 82 with 90 organs being transplanted. The authorization for the

procurement of organs was granted in 100% of cases.

Cornea Donations with PCOME Involvement 2015

Corneas Recovered Corneas Transplanted

200 155

There were 200 corneas recovered and 155 transplanted in 2015 with PCOME

involvement. The release of corneas was granted 97% of the time.

Tissue Donation with PCOME Involvement 2015

Bone Skin Vascular Heart Aortoiliac

106 74 34 40 14

The PCOME was involved in 20% of all DNA tissue recoveries in 2015. The average

release of tissue for procurement was granted 85% of the time across the state of Arizona

in 2014. The release of tissues was granted 95% of the time by the PCOME, significantly

above the state average.


7 Rev: 06/06/2016

OFFICE OF THE MEDICAL EXAMINER

ORGANIZATIONAL CHART AS OF DECEMBER 31, 2015

Chief Medical Examiner

Gregory Hess MD

Administrative Services Manager

Vacant

Administrative Specialist

Charlotte Rupel

Administrative

Michele Gough

Linda Hernandez

Amber Bates

Morgue Supervisor

Chris Smith D-ABMDI

Pathology Assistants

Gabriel Costell

Louie Goad

Ricky Rosales

Lindsay Hershberger

Jessie Carlson

Kristine Clor

Medicolegal Death Investigator Supervisor

Gene Hernandez D-ABMDI

Medicolegal Death Investigators

Thomas Buck D-ABMDI

Eric Slocum D-ABMDI

Ron Foster D-ABMDI

Selina Herrera D-ABMDI

Jeff Huesgen D-ABMDI

Marcy Yates D-ABMDI

Trevis Hairston D-ABMDI

Christine Dougall D-ABMDI

Jorge Romero

Kelsey Scott

Raelene Ruiz

Deputy Chief Medical Examiner

Eric Peters MD

Forensic Pathologists

Cynthia Porterfield DO

David Winston MD, PhD

Jennifer Chen MD

Vacant

Forensic Anthropologists

Bruce Anderson PhD

Catherine Bird PhD


8 Rev: 06/06/2016

TOTAL CASES

The total cases handled by the PCOME in a given year are the sum of the ME cases

(autopsies, external examinations, and death certificate cases), cases in which jurisdiction

was declined, and the number of cases stored at our facility during the calendar year

(storage cases). ‘All Counties’ includes cases examined at the PCOME from Apache,

Cochise, Gila, Graham, Greenlee, La Paz, Navajo, Pinal, Santa Cruz and Yuma counties

in addition to Pima County.

MEDICAL EXAMINER CASES

The PCOME considers all cases in which the cause and manner of death are determined

by this office as “medical examiner cases.” Those cases include autopsies, external

examinations and death certificate (DC) cases. Autopsies are examinations where a

decedent is examined both externally and internally for evidence of injury or natural

disease which may have caused or contributed to the individual’s death. External

examinations consist of an external examination of the body without the internal

examination. A DC case involves review of the medical records, law enforcement

reports and any other information that may be necessary to determine the cause and

manner of death without physical examination of the decedent. In 2015, for Pima and all

other counties listed above, 1456 autopsies, 348 external examinations and 290 DC cases

were performed at the PCOME. Pima County alone accounted for 922 autopsies, 294

external examinations and 273 DC cases.

1983 1864 19702139 2195 2133

25232611 2520

24372292 2337

2505 2577 2501 2602

32033350

3159 3171

0

500

1000

1500

2000

2500

3000

3500

4000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Total Cases 2006 - 2015

Pima County

All Counties


9 Rev: 06/06/2016

922

294 273

534

5417

0

100

200

300

400

500

600

700

800

900

1000

Autopsy External DC

2015 Medical Examiner Cases

Pima County

Other Counties

27 19 7

43

222 222256

415

328

187 174

99 88

Medical Examiner Cases by Age - 2015


10 Rev: 06/06/2016

627

904

280

18590

ME Cases (all counties) by Manner of Death - 2015

Natural - 30%

Accident - 43%

Suicide - 13%

Undetermined - 9%

Homicide - 4%

440

655

199

133 56

ME Cases (Pima only) by Manner of Death - 2015

Natural - 30%

Accident - 44%

Suicide - 13%

Undetermined - 9%

Homicide - 4%


11 Rev: 06/06/2016

HOMICIDE DEATHS

The PCOME certified 90 deaths as homicide in 2015, 56 from Pima County and 34 from

other counties. Homicide totals from 2009 – 2015 are compared below. Homicide

victims were most frequently male (71%), between 20-29 years of age (29%) and died as

the result of firearms (68%).

121131 131

136

123

9990

72

93 9179

88

6256

4938 40

57

35 37 34

0

20

40

60

80

100

120

140

160

2009 2010 2011 2012 2013 2014 2015

Homicide 2009 - 2015

Total Homicide

Pima County

Out of County

04 1 2

26

19

16

12

3 4 20 1

0

5

10

15

20

25

30

Homicide by Age - 2015


12 Rev: 06/06/2016

64

26

Homicide by Sex - 2015

Male - 71%

Female - 29%

61

10

8

8 3

Homicide by Cause - 2015

Firearms - 68%

Asphyxia - 11%

Sharp Force - 9%

Blunt Force - 9%

Other - 3%


13 Rev: 06/06/2016

ACCIDENT DEATHS

Deaths due to accidents accounted for 43% of the ME deaths investigated by the PCOME

in 2015. Accident victims were most frequently males (63%), between 50-59 years of

age (18%) and died as the result of a drug or medication overdose (35%).

8 9 5

27

115 117 111

164

8571

111

78

4

0

20

40

60

80

100

120

140

160

180

Accident by Age - 2015

573

289

Accident by Sex - 2015

Male - 63%

Female - 37%


14 Rev: 06/06/2016

312

270

207

4433 17 7 14

Accident by Cause - 2015

Overdose - 35%

Blunt Force Trauma - 30%

Motor Vehicle Accident - 23%

Exposure To Elements - 5%

Asphyxia - 4%

Drowning - 2%

Fire Deaths - 1%

Other - 2%

245

283268

312

201

231 223

270

221

197 190207

0

50

100

150

200

250

300

350

2012 2013 2014 2015

Accident by Cause (Top 3) 2012 - 2015

Overdose

Blunt Force Trauma

Motor Vehicle Accident


15 Rev: 06/06/2016

SUICIDE DEATHS

Suicide deaths accounted for 13% of the ME deaths investigated by the PCOME in 2015.

Suicide victims were most frequently males (76%), between 50-59 years of age (21%)

and died as the result of firearms (54%).

0 0 013

43

32

41

58

48

2217

60

0

10

20

30

40

50

60

70

Suicide by Age - 2015

213

67

Suicide by Sex - 2015

Male - 76%

Female - 24%


16 Rev: 06/06/2016

150

51

51

12 14

Suicide by Cause - 2015

Firearms - 54%

Hanging - 18%

Overdose - 18%

Asphyxia - 4%

Other - 5%

128

144139

150

59

7266

5147

33 37

51

0

20

40

60

80

100

120

140

160

2012 2013 2014 2015

Suicide by Cause (Top 3) 2012 - 2015

Firearms

Hanging

Overdose


17 Rev: 06/06/2016

NATURAL DEATHS

Natural deaths accounted for 30% of the ME deaths investigated by the PCOME in 2015.

Individuals who died from natural causes were most frequently males (69%), between

60-69 years of age (29%) and died as the result of cardiovascular disease (62%).

4 4 1 1

2429

76

165

182

81

43

161

0

20

40

60

80

100

120

140

160

180

200

Natural Deaths by Age - 2015

430

197

Natural Deaths by Sex - 2015

Male - 69%

Female - 31%


18 Rev: 06/06/2016

39140

32

51

1826

69

Natural Deaths by Cause - 2015

Cardiovascular Disease - 62%

Sequelae of Chronic AlcoholAbuse - 6%

Pulmonary Disease - 5%

Infectious Disease - 8%

Diabetes Mellitus - 3%

Malignacy - 4%

Other - 11%

579

409 391

7354 4052

26 3247 44 5139 35 18

40 26 26

0

100

200

300

400

500

600

700

2013 2014 2015

Natural Death by Cause 2013 - 2015

Cardiovascular

Chronic Alcohol

Pulmonary

Infectious

Diabetes

Malignancy


19 Rev: 06/06/2016

UNDETERMINED MANNER OF DEATH

Deaths in which the manner of death was undetermined accounted for 9% of the ME

deaths investigated by the PCOME in 2015. Individuals who died with an undetermined

manner were most frequently males (75%), of unknown age (44%) and died from

undetermined causes (85%). Many of these deaths represent skeletal remains of

undocumented border crossers who died in the deserts of southern Arizona.

10 2 0 3 14

25

12

22

10 5 1 0

81

0

10

20

30

40

50

60

70

80

90

Undetermined Manner of Death by Age - 2015

139

37

9

Undetermined Manner of Death by Sex - 2015

Male - 75%

Female - 20%

Unknown - 5%


20 Rev: 06/06/2016

157

166 6

Undetermined Manner of Death by Cause - 2015

Undetermined - 85%

Overdose - 9%

Blunt Force Injury - 3%

Other - 3%


21 Rev: 06/06/2016

OVERDOSE DEATHS

There were 379 deaths attributed to an overdose of either a single drug (211 deaths, 56%)

or a combination of drugs (168 deaths, 44%) in 2015. Overdose deaths commonly

involved males (56%) between the ages of 50-59 (27%). The majority of these deaths

were classified as accidents (82%).

Opiate drugs (heroin, oxycodone, methadone, hydrocodone, morphine, oxymorphone,

hydromorphone, tramadol, opiate unspecified) and fentanyl (a synthetic opioid narcotic)

accounted for the majority of overdose deaths, either as a single drug or as a component

of a poly-drug overdose. Heroin was the most commonly abused illicit drug contributing

to death in 2015 followed by methamphetamine.

The number of heroin deaths is likely underreported as heroin is rapidly metabolized to

morphine by the body and if the parent compound indicative for heroin (6-

monoacetylmorphine) is not present on the toxicology report these deaths may be

classified as either morphine intoxication or opiate intoxication.

Acute alcohol intoxication alone, not as component of a poly-drug overdose, accounted

for 11 overdose (3%) deaths in 2015.

Fentanyl related deaths more than doubled from 7 deaths in 2014 to 17 deaths in 2015.

273 277

314327 324

379

0

50

100

150

200

250

300

350

400

2010 2011 2012 2013 2014 2015

Overdose Deaths 2010 - 2015


22 Rev: 06/06/2016

0 0 1 9

52

81 83

102

37

9 2 00

20

40

60

80

100

120

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

Overdose Deaths by Age - 2015

214

165

Overdose Deaths by Sex- 2015

Male - 56%

Female - 44%


23 Rev: 06/06/2016

312

5116

Overdose Deaths by Manner - 2015

Accident - 82%

Suicide - 13%

Undetermined - 4%

55

64

57

64 62

49

5954

49

78

57

90

53

77

93

34

26

34

0

10

20

30

40

50

60

70

80

90

100

2013 2014 2015

Select Drugs by Year 2013 - 2015

Oxycodone

Morphine

Alcohol

Methamphetamine

Heroin

Cocaine


24 Rev: 06/06/2016

34

90

93

57

15

8

1

25

49

2

7

3

17

47

4

49

6

25

13

18

10

3

3

2

1

5

4

3

2

2

2

5

0 10 20 30 40 50 60 70 80 90 100

Cocaine

Methamphetamine

Heroin

Oxycodone

Hydrocodone

Oxymorphone

Hydromorphone

Methadone

Morphine

Codeine

Tramadol

Opiate Unclassified

Fentanyl

Benzodiazepines

Barbiturates

Alcohol

Diphenhydramine

SSRI/SNRI

Tricyclics

Atypical Antipsychotics

Muscle Relaxants

Anti-seizure Agents

Sleep Aids

Promethazine

MDMA (ecstasy)

Acetaminophen

Amphetamine

Buproprion

Ethylene Glycol

Spice

Buprenorphine

Other

Overdose Deaths by Drug - 2015


25 Rev: 06/06/2016

MOTOR VEHICLE RELATED FATALITIES

Motor vehicle related fatalities accounted for 209 total deaths in 2015. The majority, 138

deaths, were occupants of a motor vehicle involved in an accident (MVA). Of the

remaining, 22 were motorcycle accidents (MCA), 38 were pedestrians or bicyclists struck

by vehicles and 3 were operating an all-terrain vehicle (ATV). Individuals who died

from motor vehicle related fatalities were most frequently males (66%) and between 20-

29 years of age (23%).

209214

199 196

209

100

120

140

160

180

200

220

240

260

2011 2012 2013 2014 2015

Motor Vehicle Fatalities by Year 2011 - 2015

05 3

11

48

31

23

34

2117

14

2

0

10

20

30

40

50

60

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

Motor Vehicle Fatalities by Age - 2015


26 Rev: 06/06/2016

148

61

Motor Vehicle Fatalities by Sex - 2015

Male - 66%

Female - 34%

138

35

2211 3

Motor Vehicle Fatalities by Type - 2015

MVA - 66%

Pedestrian - 17%

MCA - 11%

Bicyclist - 5%

ATV - 1%


27 Rev: 06/06/2016

W.H. BIRKBY FORENSIC ANTHROPOLOGY LABORATORY

Forensic Anthropologists at the W.H. Birkby Forensic Anthropology

Laboratory within the PCOME performed 145 examinations (biological

profiles, trauma evaluations, dental examinations and examinations for identification) in

2015 on human remains of forensic significance. An additional 29 examinations were

performed on remains ultimately deemed non-human, prehistoric or otherwise not

forensically significant and jurisdiction of the remains was declined (JD) in those cases.

The extent of postmortem decomposition of a particular set of remains is important when

performing a Forensic Anthropology (FA) examination. Remains examined by Forensic

Anthropologists were categorized as minimally decomposed, decomposing, mummified,

skeletal or burnt. In 2015, skeletal remains comprised 63% of FA examinations. Four

main types of exams are performed; biologic profiles, dental, trauma and identification

examinations.

Biological profiles refer to charting, measurements, descriptions, radiographs and

photographs taken to estimate sex, age, ancestry, stature and postmortem interval of a set

of remains. Dental and identification examinations entail charting, descriptions,

radiographs and photographs in an effort to identify an unknown individual or confirm a

suspected identity. Trauma examinations entail charting, measurements, descriptions,

radiographs and photographs to characterize the nature of an injury, implement used to

cause injury to the bone, age of injury, etc. It is common for a particular set of remains to

receive more than one type of examination. Most (92%) FA exams include a biological

profile with dental examination (88%) when applicable. Less common are examinations

for identification (12%) or trauma (14%) with or without biological profiles and dental

examinations.

97

113

148 149

171161 163

149 145

1222

14 18 14 1330 26 29

0

20

40

60

80

100

120

140

160

180

200

2007 2008 2009 2010 2011 2012 2013 2014 2015

Number of FA Exams 2007 - 2015

Exams

JD


28 Rev: 06/06/2016

9220

10

20 3

FA Exam by Condition of Remains - 2015

Skeletal - 63%

Decomposing - 14%

Burnt - 7%

Mummified - 14%

Minimal Decomposition - 2%

133128

1720

0

20

40

60

80

100

120

140

Biologic Profile Dental Identification Trauma

FA Examination by Type - 2015


29 Rev: 06/06/2016

UNDOCUMENTED BORDER CROSSER (UBC) REMAINS

The term ‘UBC’ refers to foreign nationals who die attempting to cross the southern

Arizona desert without permission from the United States government. Calendar year

(CY) 2010 saw the highest number of UBC recoveries (223) recorded at the PCOME as

compared to the annual average (171 recoveries per year on average from 2002 - 2015).

The PCOME has received 2,465 recovered remains of suspected UBCs since 2001. The

recoveries per year are adjusted annually to account for the association of remains found

months or years apart later discovered to be that of the same individual.

There were 138 UBC recoveries in calendar year 2015. As is the historic norm, UBC

recoveries peaked during the warmer months (June – Sep) with 80 recoveries (58% of

total for year) in 2015. Many remains are not identifiable due to postmortem changes and

efforts by UBCs to obscure their identities. Of the decedents who were identified, 39%

(22 decedents) were between 30-39 years of age. Additionally, 86% (119) of the

recovered remains, identified or unidentified, were males, 8% (11) were females and 6%

(8) were of unidentifiable sex.

Since the exact date and time of death of found remains are often unknown, PCOME staff

determine a ‘postmortem interval (PMI)’, which is an assessment of what period of time

elapsed from death to recovery of the remains. A 1-8 body condition scale was

developed in 2013 to provide a more objective measure of the PMI. The PMI is an

estimate and therefore subject to error. The PMIs for the body condition categories are

listed following the Condition of Recovered UBC Remains table on page 32 of this

report. In 2015, 19 remains (condition 1) were found within less than a day of death

(14%), 48 remains (conditions 2-4) were found with a few days up to a few weeks from

death (35%), and skeletal remains (body conditions 5-7) accounted for 70 (51%) of the

recovered remains.

The cause of death was undetermined in 72% (100) of cases, primarily due to limitations

of examination of decomposed and skeletal remains. Of the remainder, environmental

exposure to extremes in heat or cold combined with dehydration comprised 20% (28) of

deaths. Other, less frequent, causes of death included blunt force injuries from falls or

motor vehicle accidents (4), drowning (3), gunshot wound injuries (1 case), electrocution

(1), and envenomation (1).

In 2015, 49 (89%) of identified UBCs were of Mexican nationality, followed by

Guatemalans (2 or 4%), Hondurans (2 or 4%) and Salvadorans (2 or 4%). Since 2001,

identified UBCs of Mexican nationality have been the most numerous (1,338, 85%),

followed by Guatemalans (131, 8%) and Salvadorans (42, 3%). Of the 2,469 decedents

since 2001, 1,578 (64%) have been identified, 309 (20%) by DNA comparison to a

family or law enforcement reference sample. As of December 31, 2015, 887 decedents

remain unidentified.


30 Rev: 06/06/2016

77

148155

170

192

171

214

161

189

223

178

156168

129138

0

50

100

150

200

250

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

UBC Recoveries CY2001 - 2015

143 147

168

197

168

207

159

183

222

174168

178

120135

0

50

100

150

200

250

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

UBC Recoveries FedFY2002 - 2015


31 Rev: 06/06/2016

86 6

5 5

19

14

28

19

1011

7

0

5

10

15

20

25

30

UBC Recoveries by Month - CY2015

0 0 08

18 22

4 4 0 0 0 0

82

0

10

20

30

40

50

60

70

80

90

UBC Recoveries by Age - CY2015


32 Rev: 06/06/2016

1 - Fully fleshed (PMI < 1 day)

2 - Decomposed (PMI < week)

3 - Decomposition with focal skeletonization (PMI < 3 weeks)

4 - Mummification with skeletonization (PMI < 5 weeks)

5 - Skeletonization with articulation/ligamentous attachments (PMI < 3 months)

6 - Complete skeletonization with disarticulation (PMI < 6-8 months)

7 - Complete skeletonization with bone degradation (PMI > 6-8 months)

8 - Other

19

11

15

22

11

25

34

10

5

10

15

20

25

30

35

40

1 2 3 4 5 6 7 8

Condition of Recovered UBC Remains - CY2015

119

118

UBC Recoveries by Sex- CY2015

Male - 86%

Female - 8%

Unknown - 6%


33 Rev: 06/06/2016

100

28

4 3 1 1 1

UBC Recoveries by CYCause - 2015

Undetermined - 72%



Drowning - 2%

Firearms - <1%

Electrocution - <1%

Envenomation - <1%

49

2 2 2

Identified UBC Recoveries by CYNationality - 2015

Mexican - 89%

Guatemalan - 4%

Honduran - 4%

Salvadoran - 4%


34 Rev: 06/06/2016

1338

131

42

31

10

6

4

2

3

4

3

4

Mexican - 85%

Guatemalan - 8%

Salvadoran - 3%

Honduran - 2%

Ecuadorian - <1%

Peruvian - <1%

Brazilian - <1%

Dominican - <1%

Colombian - <1%

Uncertain - <1%

Costa Rican - <1%

Other - <1%

0 200 400 600 800 1000 1200 1400 1600

Identified UBC Recoveries by Nationality 2001 - 2015

1578

55

887

83

0

200

400

600

800

1000

1200

1400

1600

1800

2001 - 2015 2015

Identified vs Unidentified UBC Recoveries

Identified

Unidentified


35 Rev: 06/06/2016

13

16 16 16 16

19 1822

48

31

26

37

2218

0

10

20

30

40

50

60

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

DNA Identifications by Year 2001 - 2015


36 Rev: 06/06/2016

Apache County

Apache County contracts with an appointed non-Forensic Pathologist physician(s),

termed an Alternate Medical Examiner(s) (AME) (A.R.S. §11-591); who triages,

investigates and certifies deaths that fall under the jurisdiction of the medical examiner in

Apache County. The Apache County AME does not perform autopsy examinations and

if the AME deems an autopsy is necessary to certify the cause and manner of death, the

decedent may be referred to the PCOME for an examination and death certification. The

PCOME is not aware of how many deaths occurring in Apache County are reported to

the Apache County AME, nor the total number or types of deaths certified by the AME.

The PCOME only has a record of deaths reported to, or referred for examination to Pima

County. Deaths on Native American tribal lands do not have to be reported through the

respective death investigation system of that County and may be reported directly to the

PCOME as necessary for the needs of the appropriate agency investigating that death

(Bureau of Indian Affairs (BIA), FBI or local tribal police departments).

Seventeen deaths from Apache County were reported to the PCOME in 2015, sixteen of

which required autopsy examinations. Some pertinent statistics regarding these deaths

are detailed in the tables and graphs below.

*Arizona Department of Vital Statistics as of 06/02/16

454

522 510530 544

584

471

607 601

554

0

100

200

300

400

500

600

700

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Apache County Mortality by Year 2006 - 2015*


37 Rev: 06/06/2016

8

5

17

14

12

17

0

2

4

6

8

10

12

14

16

18

2010 2011 2012 2013 2014 2015

Apache County Deaths Reported to the PCOME 2010 - 2015

16

1

Apache County Deaths by Type of Exam 2015

Autopsy

Jurisdiction Declined


38 Rev: 06/06/2016

7

5

2

2

Apache County Deaths by Manner of Death 2015

Accident

Natural

Undetermined

Homicide

4

4

2

2

1

4

Apache County Deaths by Type of Death 2015

Overdose

Cardiovascular

Motor vehice accident

Firearms

Asphyxia

Other


39 Rev: 06/06/2016

9

3

3

1

1

0 1 2 3 4 5 6 7 8 9 10

Apache County Deaths by Law Enforcement Agency 2015


40 Rev: 06/06/2016

Cochise County

Cochise County contracts with the PCOME to certify deaths that fall under the

jurisdiction of the medical examiner in Cochise County. Cochise County does not

maintain an in-county Medical Examiner’s office to conduct death scene investigations,

transport remains, or triage deaths reportable to the medical examiner. Cochise County

does provide third party transportation services, local law enforcement death scene

investigation and archival support for examinations that occurred prior to July 1, 2012.

The PCOME works closely with Cochise County law enforcement agencies, the public

fiduciary office and funeral homes to facilitate investigations, disposition of remains and

transportation respectively. The PCOME is also involved as needed with mass fatality

planning, child fatality review, or other medical examiner related issues in Cochise

County.

In calendar year 2015 there were 1289 deaths in Cochise County; of these 270 (21%)

were reported to the PCOME for investigation and/or examination. Some pertinent

statistics regarding these deaths are detailed in the tables and graphs below.


1140

1093

1185

1122

12181183

1204

1266

1201

1289

950

1000

1050

1100

1150

1200

1250

1300

1350

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Cochise County Mortality by Year 2006 - 2015*


41 Rev: 06/06/2016

151

268

246

270

0

50

100

150

200

250

300

2012 (partial year) 2013 2014 2015

Cochise County Deaths Reported to the PCOME 2012 - 2015

123

2416

107

Cochise County Deaths by Type of Exam 2015

Autopsy

External

Death Certification



42 Rev: 06/06/2016

64

51

30

612

Cochise County Deaths by Manner of Death 2015

Accident

Natural

Suicide

Homicide

Undetermined

24

13

17

23

3 2

Cochise County Accidents by Type 2015

Overdose

Blunt Force Injuries

Motor Vehicle

Asphyxia

Exposure

Drowning

Other


43 Rev: 06/06/2016

4

2

Cochise County Homicides by Type 2015

Firearms

Asphyxia

322

3

5

34 2

Cochise County Naturals by Type 2015

Cardiovascular

Diabetes

Infectious

Pulmonary

Pulmonary Embolus

Chronic Alcohol Abuse

Other


44 Rev: 06/06/2016

16

4

4

42

Cochise County Suicides by Type 2015

Firearms

Hanging

Overdose

Asphyxia

Sharp Force Injury

84

65

10

15

13

25

8

6

4

3

36

0 10 20 30 40 50 60 70 80 90

Cochise County Deaths by Law Enforcement Agency 2015


45 Rev: 06/06/2016

Gila County

Gila County contracts with an appointed Forensic Pathologist Medical Examiner, who

triages, investigates and certifies deaths that fall under the jurisdiction of the medical

examiner (ME) in Gila County. The Gila County ME performs some autopsy

examinations in Payson if the ME deems an autopsy is necessary to certify the cause and

manner of death. Additionally, the ME may refer some decedents from southern Gila

County to the PCOME for an examination and death certification as necessary. The

PCOME is not aware of how many deaths occurring in Gila County are reported to the

ME, nor the total number or types of deaths certified by the ME. The PCOME only has a

record of deaths reported to, or referred for examination to Pima County. Deaths on

Native American tribal lands do not have to be reported through the respective death

investigation system of that County and may be reported directly to the PCOME as

necessary for the needs of the appropriate agency investigating that death (BIA, FBI or

local tribal police departments).

Thirty two deaths from Gila County were reported to the PCOME in 2015, 31 of which

required autopsy examinations. Some pertinent statistics regarding these deaths are

detailed in the tables and graphs below.


627

666718

646661 682 655

696747

797

0

100

200

300

400

500

600

700

800

900

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Gila County Mortality by Year 2006 - 2015*


46 Rev: 06/06/2016

48 48

57

81

42

32

0

10

20

30

40

50

60

70

80

90

2010 2011 2012 2013 2014 2015

Gila County Deaths Reported to the PCOME 2010 - 2015

31

1

Gila County Deaths by Type of Exam 2015

Autopsy

External


47 Rev: 06/06/2016

17

6

7

2

Gila County Deaths by Manner of Death 2015

Accident

Natural

Suicide

Undetermined

96

2

Gila County Accidents by Type 2015

Motor Vehicle

Overdose

Drowning


48 Rev: 06/06/2016

4

1

1

Gila County Naturals by Type 2015

Cardiovascular


Infectious

1

2

1

1

1

1

Gila County Suicides by Type 2015

Hanging

Firearms

Blunt Force Injury

Overdose

Sharp Force Injury

Motor Vehicle


49 Rev: 06/06/2016

12

1

10

5

1

2

1

0 2 4 6 8 10 12 14

Gila County Deaths by Law Enforcement Agency 2015


50 Rev: 06/06/2016

Graham County

Graham County contracts with an appointed non-Forensic Pathologist physician(s),

termed an Alternate Medical Examiner(s) (AME) (A.R.S. §11-591), who triages,


Graham County. The Graham County AME does not perform autopsy examinations and

if the AME deems an autopsy is necessary to certify the cause and manner of death, the


PCOME is not aware of how many deaths occurring in Graham County are reported to

the Graham County AME, nor the total number or types of deaths certified by the AME.

The PCOME only has a record of deaths reported to, or referred for examination to Pima




(BIA, FBI or local tribal police departments).

Five deaths from Graham County were reported to the PCOME in 2015, all of which




295 282 294271

302

245

300

275283

247

0

50

100

150

200

250

300

350

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Graham County Mortality by Year 2006 - 2015*


51 Rev: 06/06/2016

1413

15

17

13

5

0

2

4

6

8

10

12

14

16

18

2010 2011 2012 2013 2014 2015

Graham County Deaths Reported to the PCOME 2010 - 2015

5

Graham County Deaths by Type of Exam 2015

Autopsy


52 Rev: 06/06/2016

31

1

Graham County Deaths by Manner of Death 2015

Accident

Natural

Homicide

31

1

Graham County Deaths by Type of Death 2015

Overdose

Firearms

Cardiovascular


53 Rev: 06/06/2016

1

1

2

1

0 0.5 1 1.5 2 2.5

Graham County Deaths by Law Enforcement Agency 2015


54 Rev: 06/06/2016

Greenlee County

Greenlee County contracts with an appointed non-Forensic Pathologist physician(s),



Greenlee County. The Greenlee County AME does not perform autopsy examinations

and if the AME deems an autopsy is necessary to certify the cause and manner of death,

the decedent may be referred to the PCOME for an examination and death certification.

The PCOME is not aware of how many deaths occurring in Greenlee County are reported

to the Greenlee County AME, nor the total number or types of deaths certified by the

AME. The PCOME only has a record of deaths reported to, or referred for examination

to Pima County. Deaths on Native American tribal lands do not have to be reported

through the respective death investigation system of that County and may be reported

directly to the PCOME as necessary for the needs of the appropriate agency investigating

that death (BIA, FBI or local tribal police departments).

Thirteen deaths from Greenlee County were reported to the PCOME in 2015, all of which




65 63

52 5055

71

64

43

52

70

0

10

20

30

40

50

60

70

80

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Greenlee County Mortality by Year 2006 - 2015*


55 Rev: 06/06/2016

10

4

6

12

9

13

0

2

4

6

8

10

12

14

2010 2011 2012 2013 2014 2015

Greenlee County Deaths Reported to the PCOME 2010 - 2015

13

Greenlee County Deaths by Type of Exam 2015

Autopsy


56 Rev: 06/06/2016

6

6

1

Greenlee County Deaths by Manner of Death 2015

Accident

Natural

Homicide

6

3

2

11

Greenlee County Deaths by Type of Death 2015

Overdose

Cardiovascular

Pulmonary

Firearms



57 Rev: 06/06/2016

10

2

1

0 2 4 6 8 10 12

Greenlee County Deaths by Law Enforcement Agency 2015


58 Rev: 06/06/2016

La Paz County

La Paz County contracts with an appointed non-Forensic Pathologist physician(s), termed

an Alternate Medical Examiner(s) (AME) (A.R.S. §11-591), who triages, investigates

and certifies deaths that fall under the jurisdiction of the medical examiner in La Paz

County. The La Paz County AME does not perform autopsy examinations and if the

AME deems an autopsy is necessary to certify the cause and manner of death, the


PCOME is not aware of how many deaths occurring in La Paz County are reported to the

La Paz County AME, nor the total number or types of deaths certified by the AME. The

PCOME only has a record of deaths reported to, or referred for examination to Pima





Forty deaths from La Paz County were reported to the PCOME in 2015, 37 of which




200 204 200

227

200186

225

247 253244

0

50

100

150

200

250

300

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

La Paz County Mortality by Year 2006 - 2015*


59 Rev: 06/06/2016

29

21

13

2422

40

0

5

10

15

20

25

30

35

40

45

2010 2011 2012 2013 2014 2015

La Paz County Deaths Reported to the PCOME 2010 - 2015

37

1 2

La Paz County Deaths by Type of Exam 2015

Autopsy


External


60 Rev: 06/06/2016

17

11

6

32

La Paz County Deaths by Manner of Death 2015

Accident

Natural

Undetermined

Suicide

Homicide

8

6

11

1

La Paz County Accidents by Type 2015

Motor Vehicle

Overdose

Exposure

Asphyxia

Blunt Force Injury


61 Rev: 06/06/2016

2

La Paz County Homicides by Type 2015

Firearms

7

2

1

1

La Paz County Naturals by Type 2015

Cardiovascular

Malignancy

Infectious

Unknown


62 Rev: 06/06/2016

3

La Paz County Suicides by Type 2015

Firearms

3

14

12

8

3

0 2 4 6 8 10 12 14 16

La Paz County Deaths by Law Enforcement Agency 2015


63 Rev: 06/06/2016

Navajo County

Navajo County contracts with an appointed non-Forensic Pathologist physician(s),



Navajo County. The Navajo County AME does not perform autopsy examinations and if

the AME deems an autopsy is necessary to certify the cause and manner of death, the


PCOME is not aware of how many deaths occurring in Navajo County are reported to the

Navajo County AME, nor the total number or types of deaths certified by the AME. The

PCOME only has a record of deaths reported to, or referred for examination to Pima





Thirty deaths from Navajo County were reported to the PCOME in 2015, 28 of which




860 888793

825 819899 897

976 937

882

0

200

400

600

800

1000

1200

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Navajo County Mortality by Year 2006 - 2015*


64 Rev: 06/06/2016

35

29

36

33 33

30

0

5

10

15

20

25

30

35

40

2010 2011 2012 2013 2014 2015

Navajo County Deaths Reported to the PCOME 2010 - 2015

28

1 1

Navajo County Deaths by Type of Exam 2015

Autopsy


External


65 Rev: 06/06/2016

11

8

4

4

2

Navajo County Deaths by Manner of Death 2015

Natural

Accident

Suicide

Homicide

Undetermined

2

22

1

1

Navajo County Accidents by Type 2015

Motor Vehicle

Exposure

Fire

Overdose

Blunt Force Injury


66 Rev: 06/06/2016

3

1

Navajo County Homicides by Type 2015

Sharp Force Injury

Asphyxia

3

4

2

1

1

Navajo County Naturals by Type 2015

Infectious

Other

Cardiovascular


Pulmonary Embolus


67 Rev: 06/06/2016

3

1

Navajo County Suicides by Type 2015

Hanging

Asphyxia

16

2

9

1

1

1

0 2 4 6 8 10 12 14 16 18

Navajo County Deaths by Law Enforcement Agency 2015


68 Rev: 06/06/2016

Pima County TOTAL MORTALITY

The number of deaths reported to the medical examiner’s office in a given time frame is a

reflection of the total population that the office serves. In 2015 there were 9,134 deaths

in Pima County; of these 2,437 (27%) were reported to the PCOME for investigation.


TOTAL CASES

The total cases handled by the PCOME from Pima County in a given year are the sum of

the ME cases (autopsies, external examinations, and death certificate cases), cases in

which jurisdiction was declined, and the number of cases stored at our facility during the

calendar year (storage cases).

7885 7899 8075 8065 8163 83928713 8592 8725 9134

0

2000

4000

6000

8000

10000

12000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Pima County Mortality by Year 2006 - 2015*


69 Rev: 06/06/2016

MEDICAL EXAMINER CASES

The PCOME considers all cases in which the cause and manner of death are determined

by this office as “medical examiner cases.” Those cases include autopsies, external

examinations and death certificate (DC) cases. Autopsies are examinations where a

decedent is examined both externally and internally for evidence of injury or natural

disease which may have caused or contributed to the individual’s death. External

examinations consist of an external examination of the body without the internal

examination. A DC case involves review of the medical records, law enforcement

reports and any other information that may be necessary to determine the cause and

manner of death without physical examination of the decedent. In 2015, 922 autopsies,

294 external examinations and 273 DC cases were performed on deaths from Pima

County.

1983 1864 19702139 2195 2133

25232611

25202437

0

500

1000

1500

2000

2500

3000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Total Cases from Pima County 2006 - 2015


70 Rev: 06/06/2016

922

294 273

0

100

200

300

400

500

600

700

800

900

1000

Autopsy External DC

2015 Pima County Medical Examiner Cases

15 144

31

146 148166

283

234

137 143

9175

Pima County Medical Examiner Cases by Age - 2015


71 Rev: 06/06/2016

440

655

199

133 56

Pima County ME Cases by Manner of Death - 2015

Natural - 30%

Accident - 44%

Suicide - 13%

Undetermined - 9%

Homicide - 4%

1171

640

72

44

41

16

15

31

0 200 400 600 800 1000 1200 1400

Pima County Deaths by Law Enforcement Agency 2015


72 Rev: 06/06/2016

HOMICIDE DEATHS

The PCOME examined 56 homicides from Pima County in 2015; 4% of total Pima

County deaths certified. Homicide totals from 2009 – 2015 are compared below.

Homicide victims were most frequently male (73%), between 20-29 years of age (27%)

and died as the result of firearms (70%).

72

93 91

79

88

6256

0

10

20

30

40

50

60

70

80

90

100

2009 2010 2011 2012 2013 2014 2015

Pima County Homicide 2009 - 2015

0 2 1 2

15

12

10

7

23 2 0 0

0

2

4

6

8

10

12

14

16

Pima County Homicide by Age - 2015


73 Rev: 06/06/2016

41

15

Pima County Homicide by Sex - 2015

Male - 73%

Female - 27%

39

5

5

4 3

Pima County Homicide by Cause - 2015

Firearms - 70%

Sharp Force - 9%

Blunt Force - 9%

Asphyxia - 7%

Other - 5%


74 Rev: 06/06/2016

ACCIDENT DEATHS

Deaths due to accidents accounted for 44% of the deaths investigated by the PCOME in

2015. Accident victims were most frequently males (62%), between 50-59 years of age

(16%) and died as the result of blunt force injuries (38%) often as the result of such

conditions as complications of a hip fracture or intracranial hemorrhage from a fall.

48

3

17

74 76 72

107

62 60

94

74

4

0

20

40

60

80

100

120

Pima County Accident by Age - 2015

409

246

Pima County Accident by Sex- 2015

Male - 62%

Female - 38%


75 Rev: 06/06/2016

215

246

121

31 6 22 14

Pima County Accident by Cause - 2015

Overdose - 33%


Motor Vehicle Accident - 18%


Drowning - <1%

Asphyxia - 3%

Other - 2%

181

212199

215

190208 204

246

128 123114 121

0

50

100

150

200

250

300

2012 2013 2014 2015

Pima County Accident by Cause (Top 3) 2012 - 2015

Overdose

Blunt Force Injury

Motor Vehicle


76 Rev: 06/06/2016

SUICIDE DEATHS

Deaths due to suicide accounted for 13% of the deaths investigated by the PCOME in

2015. Suicide victims were most frequently males (76%), between 50-59 years of age

(28%) and died as the result of firearms (56%).

0 0 09

29

2427

44

34

15 14

30

0

5

10

15

20

25

30

35

40

45

50

Pima County Suicide by Age - 2015

151

48

Pima County Suicide by Sex - 2015

Male - 76%

Female - 24%


77 Rev: 06/06/2016

112

36

38

6 7

Pima County Suicide by Cause - 2015

Firearms - 56%

Hanging - 18%

Overdose - 19%

Asphyxia - 3%

Other - 4%

100106

101

112

4046 43

3633

22 25

38

0

20

40

60

80

100

120

2012 2013 2014 2015

Pima County Suicide by Cause (Top 3) 2012 - 2015

Firearms

Hanging

Overdose


78 Rev: 06/06/2016

NATURAL DEATHS

Deaths due to natural causes accounted for 30% of the deaths investigated by the

PCOME in 2015. Individuals who died from natural causes were most frequently males

(67%), between 60-69 years of age (30%) and died as the result of cardiovascular disease

(60%).

2 2 0 1

17 20

49

111

132

58

33

14

10

20

40

60

80

100

120

140

Pima County Natural Deaths by Age - 2015

295

145

Pima County Natural Deaths by Sex - 2015

Male - 67%

Female - 33%


79 Rev: 06/06/2016

265

30

20

38

1621

50

Pima County Natural Deaths by Cause - 2015

Cardiovascular Disease - 60%

Sequelae of Chronic AlcoholAbuse - 7%

Pulmonary Disease - 5%

Infectious Disease - 9%

Diabetes Mellitus - 4%

Malignacy - 5%

Other - 11%


80 Rev: 06/06/2016

UNDETERMINED MANNER OF DEATH

Deaths of undetermined manner accounted for 9% of the deaths investigated by the

PCOME in 2015. Individuals who died with an undetermined manner were most

frequently males (77%), of unknown age (53%) and died from undetermined causes

(88%). Many of these deaths represent skeletal remains of UBCs who died in the deserts

of southern Arizona.

5 2 0 2

1116

814

4 1 0 0

70

0

10

20

30

40

50

60

70

80

Pima County Undetermined Manner of Death by Age - 2015

103

23

7

Pima County Undetermined Manner of Death by Sex - 2015

Male - 77%

Female - 17%

Unknown - 5%


81 Rev: 06/06/2016

117

9 3 4

Pima County Undetermined Manner of Death by Cause - 2015

Undetermined - 88%

Overdose - 7%

Blunt Force Injury - 2%

Other - 3%


82 Rev: 06/06/2016

OVERDOSE DEATHS

There were 262 deaths attributed to an overdose of either a single drug (138 deaths, 53%)

or a combination of drugs (124 deaths, 47%) in 2015. Overdose deaths commonly

involved males (56%) between the ages of 50-59 (28%). The majority of these deaths

were classified as accidents (82%).

Opiate drugs (heroin, oxycodone, methadone, hydrocodone, morphine, oxymorphone,

hydromorphone, tramadol, opiate unspecified) and fentanyl (a synthetic opioid narcotic)

accounted for the majority of overdose deaths, either as a single drug or a component of a

poly-drug overdose. Heroin was the most commonly abused illicit drug contributing to

death in 2015 followed by methamphetamine.

The number of heroin deaths is likely underreported as heroin is rapidly metabolized to

morphine by the body and if the parent compound indicative for heroin (6-

monoacetylmorphine) is not present on the toxicology report these deaths may be

classified as either morphine intoxication or opiate intoxication.

Acute alcohol intoxication alone, not as component of a poly-drug overdose, accounted

for 6 overdose (2%) deaths in 2015.

222210

228240 241

262

0

50

100

150

200

250

300

2010 2011 2012 2013 2014 2015

Pima County Overdose Deaths 2010 - 2015


83 Rev: 06/06/2016

0 0 16

36

53 55

74

27

64

00

10

20

30

40

50

60

70

80

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

Pima County Overdose Deaths by Age - 2015

148

114

Pima County Overdose Deaths by Sex- 2015

Male - 56%

Female - 44%


84 Rev: 06/06/2016

215

389

Pima County Overdose Deaths by Manner - 2015

Accident - 82%

Suicide - 15%

Undetermined - 3%

3935

47

35354038

55

71 73

25

33

0

10

20

30

40

50

60

70

80

2014 2015

Select Pima County Drugs by Year 2014 - 2015

Oxycodone

Morphine

Alcohol

Methamphetamine

Heroin

Cocaine


85 Rev: 06/06/2016

33

55

73

35

9

5

1

19

35

1

3

4

14

34

4

40

3

15

12

12

6

0

2

0

1

4

2

4

0 10 20 30 40 50 60 70 80

Cocaine

Methamphetamine

Heroin

Oxycodone

Hydrocodone

Oxymorphone

Hydromorphone

Methadone

Morphine

Codeine

Tramadol

Opiate Unclassified

Fentanyl

Benzodiazepines

Barbiturates

Alcohol

Diphenhydramine

SSRI/SNRI

Tricyclics

Atypical Antipsychotics

Muscle Relaxants

Anti-seizure Agents

Sleep Aids

Promethazine

MDMA

Acetaminophen

Ethylene Glycol

Other

Pima County Overdose Deaths by Drug - 2015


86 Rev: 06/06/2016

MOTOR VEHICLE RELATED FATALITIES

Motor vehicle related fatalities accounted for 121 total deaths in in Pima County in 2015.

The majority, 70 deaths, were occupants of a motor vehicle involved in an accident

(MVA). Of the remaining, 16 were motorcycle accidents (MCA), 33 were pedestrians or

bicyclists struck by vehicles, and 2 were all-terrain vehicle (ATV) accidents. Individuals

who died from motor vehicle related fatalities were most frequently males (70%) and

between 20-29 years of age (22%).

117

130125

118 121

0

20

40

60

80

100

120

140

160

2011 2012 2013 2014 2015

Pima County Motor Vehicle Fatalities by Year 2011 - 2015

0

5

1

6

27

21

9

18

13

11

8

20

5

10

15

20

25

30

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

Pima County Motor Vehicle Fatalities by Age - 2015


87 Rev: 06/06/2016

85

36

Pima County Motor Vehicle Fatalities by Sex - 2015

Male - 70%

Female - 30%

7025

16

8 2

Pima County Motor Vehicle Fatalities by Type - 2015

MVA - 58%

Pedestrian - 21%

MCA - 13%

Bicyclist - 7%

ATV - 2%


88 Rev: 06/06/2016

Pinal County

Pinal County contracts with the PCOME to provide examination or other support services

beyond what Pinal County provides internally. Pinal County maintains its own Medical

Examiner’s office staffed to conduct death scene investigations, transport remains, assist

with the performance of some external examinations at the OME facility in Pinal County,

and triage deaths reportable to the ME as stated in A.R.S §11-593 above. Not all deaths

in Pinal County are reported to the PCOME through the Pinal County Medical

Examiner’s Office. Deaths on Native American tribal lands do not have to be reported

through the respective death investigation system of that County and may be reported

directly to the PCOME as necessary for the needs of the appropriate agency investigating

that death (BIA, FBI or local tribal police departments). The Pinal County Medical

Examiner’s Office issues its own annual report. Please reference that report for details

concerning deaths occurring in Pinal County that are not referred to the PCOME.

In calendar year 2015 there were 2911 deaths in Pinal County; of these 264 (9%) were

reported to the PCOME for examination. Some pertinent statistics regarding these deaths

are detailed in the tables and graphs below.


1948 2033 2023 19942258

23802440 2457

2629

2911

0

500

1000

1500

2000

2500

3000

3500

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Pinal County Mortality by Year 2006 - 2015*


89 Rev: 06/06/2016

140

304 308

223

200

264

0

50

100

150

200

250

300

350

2010 2011 2012 2013 2014 2015

Pinal County Deaths Reported to the PCOME 2010 - 2015

236

17 10

1

Pinal County Deaths by Type of Exam 2015

Autopsy

External


DC Case


90 Rev: 06/06/2016

76

110

32

1421

Pinal County Deaths by Manner of Death 2015

Natural

Accident

Suicide

Homicide

Undetermined

42

44

8

74

2 2 1

Pinal County Accidents by Type 2015

Overdose

Motor Vehicle

Blunt Force Injury

Asphyxia

Exposure

Aircraft

Drowning

Other


91 Rev: 06/06/2016

10

3

1

Pinal County Homicides by Type 2015

Firearms

Asphyxia

Blunt Force Injuries

55

5

4

2 22

6

Pinal County Naturals by Type 2015

Cardiovascular

Infectious

Pulmonary

Pulmonary Embolus

Chronic Alcohol

Malignancy

Other


92 Rev: 06/06/2016

13

6

8

23

Pinal County Suicides by Type 2015

Firearms

Hanging

Overdose

Blunt Force Injury

Other

91

26

30

31

15

12

11

13

10

9

0 10 20 30 40 50 60 70 80 90 100

Pinal County Deaths by Law Enforcement Agency 2015


93 Rev: 06/06/2016

Santa Cruz County

Santa Cruz County does not maintain an in-county Medical Examiner’s office to conduct

death scene investigations, transport or examine remains, or certify deaths reportable to

the medical examiner. Nor does Santa Cruz County appoint or contract with an Alternate

Medical Examiner. The PCOME acts as the de-facto appointed ME for Santa Cruz

County. When deaths occur in Santa Cruz County pursuant to A.R.S. §11-593, Santa

Cruz County law enforcement agencies investigate the circumstances of the death and

notify the PCOME as necessary.

In calendar year 2015 there were 291 deaths in Santa Cruz County; of these 55 (19%)

were reported to the PCOME for investigation and/or examination. Some pertinent

statistics regarding these deaths are detailed in the tables below.


238

263252

284

262247

303286

275291

0

50

100

150

200

250

300

350

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Santa Cruz County Mortality by Year 2006 - 2015*


94 Rev: 06/06/2016

5854

59

51

46

55

0

10

20

30

40

50

60

70

2010 2011 2012 2013 2014 2015

Santa Cruz County Deaths Reported to the PCOME 2012 - 2015

37

9

8

Santa Cruz County Deaths by Type of Exam 2015

Autopsy

External



95 Rev: 06/06/2016

19

16

4

7

Santa Cruz County Deaths by Manner of Death 2015

Natural

Accident

Suicide

Undetermined

4

44

3

1

Santa Cruz County Accidents by Type 2015

Overdose

Motor Vehicle

Drowning

Exposure

Blunt Force Injury


96 Rev: 06/06/2016

17

1 1

Santa Cruz County Naturals by Type 2015

Cardiovascular

Pulmonary

Chronic Alcohol

3

1

Santa Cruz County Suicides by Type 2015

Firearms

Hanging


97 Rev: 06/06/2016

27

22

2

4

0 5 10 15 20 25 30

Santa Cruz County Deaths by Law Enforcement Agency 2015


98 Rev: 06/06/2016

Yuma County

Yuma County contracts with the pathology group at Yuma Regional Medical Center to

perform examinations and certify deaths that fall under the jurisdiction of the medical

examiner in Yuma County. Some decedents (typically suspected homicides) are referred

to the PCOME for an examination and death certification at the discretion of the Yuma

County Medical Examiner’s Office. The Yuma County Medical Examiner’s Office

issues its own Annual Report. Please reference that report for details concerning deaths

occurring in Yuma County that are not referred to the PCOME.

Five deaths from Yuma County were reported to the PCOME in 2015, all five of which


detailed in the tables below.


1164 1180 1105

1306 12791350 1386 1320

1425 1413

0

200

400

600

800

1000

1200

1400

1600

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Yuma County Mortality by Year 2006 - 2015*


99 Rev: 06/06/2016

20

18 18

1516

5

0

5

10

15

20

25

2010 2011 2012 2013 2014 2015

Yuma County Deaths Reported to the PCOME 2010 - 2015

5

Yuma County Deaths by Type of Exam 2015

Autopsy


100 Rev: 06/06/2016

4

1

Yuma County Deaths by Manner of Death 2015

Homicide

Natural

2

2

1

Yuma County Deaths by Type of Death 2015

Firearms

Blunt Force Injury

Cardiovascular


101 Rev: 06/06/2016

1

2

1

1

0 0.5 1 1.5 2 2.5

Yuma County Deaths by Law Enforcement Agency 2015

pima county office of the medical examiner · pima county office of the medical examiner – annual...

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