ANNUAL REPORT 2016 TABLE OF CONTENTS INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 ORGANIZATIONAL CHART . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 TOTAL CASES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 MEDICAL EXAMINER (ME) CASES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 ME Cases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 ME Cases by Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 ME Cases by Manner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Pima County ME Cases by Manner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 HOMICIDE DEATHS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Homicide 2009-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Homicide by Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Homicide by Sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Homicide by Cause. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 ACCIDENT DEATHS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Accident by Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Accident by Sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Accident by Cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Accident by Cause 2013-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 SUICIDE DEATHS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Suicide by Age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Suicide by Sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Suicide by Cause. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Suicide by Cause 2013-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 NATURAL DEATHS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Natural by Age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Natural by Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Natural by Cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Natural by Cause 2014-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 UNDETERMINED MANNER OF DEATH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Undetermined Manner by Age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Undetermined Manner by Sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Undetermined Manner by Cause. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 OVERDOSE DEATHS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Overdose Deaths 2010-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Overdose Deaths by Age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Overdose Deaths by Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 3 Overdose Deaths by Manner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Select Drugs by Year 2013-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fentanyl Related Deaths 2010-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overdose Deaths by Drug. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 23 23 24 MOTOR VEHICLE RELATED FATALITIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Motor Vehicle Fatalities 2011-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Motor Vehicle Fatalities by Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Motor Vehicle Fatalities by Sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Motor Vehicle Fatalities by Type. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 25 25 26 26 W.H. BIRKBY FORENSIC ANTHROPOLOGY LABORATORY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . FA Exams by Number 2007-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FA Exams by Condition of Remains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FA Exams by Type. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 27 28 28 UNDOCUMENTED BORDER CROSSER (UBC) REMAINS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Recoveries by CY2001–2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Recoveries by FedFY2002–2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Recoveries by Month CY2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Recoveries by Month CY2001-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Recoveries by Age CY2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Recoveries by Age CY2001-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Condition of Remains CY2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Condition of Remains CY2001-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Recoveries by Sex CY2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Recoveries by Sex CY2001-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Recoveries by Cause CY2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Recoveries by Cause CY2001-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Recoveries by Nationality CY2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Recoveries by Nationality CY2001-2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Identified v Unidentified UBC Recoveries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 DNA Identifications 2001-2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 PIMA COUNTY DEATHS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 DEATHS BY COUNTY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Apache County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Cochise County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Gila County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Graham County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Greenlee County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 La Paz County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Navajo County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Pinal County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Santa Cruz County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Yuma County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 4 Pima County Office of the Medical Examiner ANNUAL REPORT 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 2016 there were 9,376 deaths in Pima County; of these 2,657 (28%) 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 was effective from October 24, 2011 through October 24, 2016 and requires annual accreditation verification. The office was re-inspected in January 2017 and received continued full accreditation valid through October 25, 2021. NAME accredited offices represent the highest quality of death investigation systems. There are 75 fully accredited Medical Examiner’s Offices across the United States. The PCOME has the distinction of being the sole fully accredited office in Arizona. ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 5 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. Unexpected or unexplained death. 4. Death of a person in a custodial agency as defined in section 13-4401. 5. Unexpected or unexplained death of an infant or child. 6. Death occurring in a suspicious, unusual or non-natural manner, including death from an accident believed to be related to the deceased’s occupation or employment. 7. Death occurring as a result of anesthetic or surgical procedures. 8. Death suspected to be caused by a previously unreported or undiagnosed disease that constitutes a threat to public safety. 9. Death involving unidentifiable bodies. Investigations Our 11 medical investigators processed 2,657 reports of deaths from Pima County and 725 reports from 10 additional Arizona counties in 2016. Jurisdiction was declined in 993 of these cases. A total of 2,064 decedents were transported to the PCOME for examination or storage in 2016. Examinations Pima County forensic pathologists and anthropologists performed 1,476 autopsies, 409 external examinations, 359 death certifications, 143 anthropologic examinations, and reviewed 6,280 death certificates for cremations in 2016. 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. Nine MDIs, our MDI Supervisor, and Administrative 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 reviewed by a pathologist 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 150 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 6 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 and medical student teaching. Five pathology residents, four medical students and three pathology post-sophomore fellows rotated through the PCOME for month-long rotations in 2016. Funded by the Department of Pathology, the PCOME began a Forensic Pathology training program in 2016; the only such training program offered in Arizona. Our Forensic Anthropologists hold academic appointments at the University of Arizona and five anthropology interns trained at our facility in 2016. 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 2016, the office’s six forensic pathologists and two anthropologists participated in a number of pretrial interviews, depositions and jury trials both in Pima and outof-county cases. 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 2016 Heart Lungs Liver Kidneys Pancreas Sm. Intestine Total 14 8 28 66 7 2 125 The total lives saved through organ donation involving deaths investigated by the PCOME in 2016 were 107 with 125 organs being transplanted. The authorization for the procurement of organs was granted in 100% of cases. Cornea Donations with PCOME Involvement 2016 Corneas Recovered Corneas Transplanted 296 123 There were 296 corneas recovered and 123 transplanted in 2016 with PCOME involvement. The release of corneas was granted 98% of the time. Tissue Donation with PCOME Involvement 2016 Bone Skin Vascular Heart Aortoiliac 116 65 37 48 13 The PCOME was involved in approximately 20% of all DNA tissue recoveries in 2016. The average release of tissue for procurement was granted 85% of the time across the state of Arizona in 2016. The release of tissues was granted 94% of the time by the PCOME, significantly above the state average. ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 7 ORGANIZATIONAL CHART Office of the Medical Examiner organizational chart as of December 31, 2016 Chief Medical Examiner Gregory Hess MD Forensic Anthropologists Bruce Anderson PhD Jennifer Vollner PhD Administrative Services Manager Medicolegal Death Investigator Supervisor Deputy Chief Medical Examiner Christopher Smith D-ABMDI Gene Hernandez D-ABMDI Eric Peters MD Medicolegal Death Investigators Forensic Pathologists Thomas Buck D-ABMDI Eric Slocum D-ABMDI Raelene Ruiz D-ABMDI Selina Herrera D-ABMDI Jeff Huesgen D-ABMDI Marcy Yates D-ABMDI Trevis Hairston D-ABMDI Jorge Romero D-ABMDI Kelsey Scott D-ABMDI Erica Guenther Kristopher Kaae Cynthia Porterfield DO David Winston MD PhD Jennifer Chen MD Kevin Lougee DO Administrative Specialist Morgue Supervisor Charlotte Rupel Lindsay Hershberger Administrative Pathology Assistants Linda Hernandez Amber Bates Gabriel Costell Louie Goad Jeremy Cox Kayla Hare Vacant Kristine Clor 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. Total Cases 2007 - 2016 8 Pima County Office of the Medical Examiner ANNUAL REPORT 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 2016, for Pima and all other counties listed above, 1476 autopsies, 409 external examinations and 359 DC cases were performed at the PCOME. Pima County alone accounted for 975 autopsies, 347 external examinations and 342 DC cases. 2016 Medical Examiner Cases Medical Examiner Cases by Age - 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 9 ME Cases (all counties) by Manner of Death - 2016 ME Cases (Pima only) by Manner of Death - 2016 10 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 HOMICIDE DEATHS The PCOME certified 114 deaths as homicide in 2016, 65 from Pima County and 49 from other counties. Homicide totals from 2009 – 2016 are compared below. Homicide victims were most frequently male (82%), between 20-29 years of age (30%) and died as the result of firearms (63%). Homicide 2009 - 2016 Homicide by Age 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 11 Homicide by Sex 2016 Homicide by Cause 2016 12 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 ACCIDENT DEATHS Deaths due to accidents accounted for 44% of the ME deaths investigated by the PCOME in 2016. Accident victims were most frequently males (67%), between 20-29 years of age (15%) and died as the result of a drug or medication overdose (32%). Accident by Age 2016 Accident by Sex 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 13 Accident by Cause 2016 Accident by Cause (Top 3) 2013 - 2016 14 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 SUICIDE DEATHS Suicide deaths accounted for 11% of the ME deaths investigated by the PCOME in 2016. Suicide victims were most frequently males (73%), between 60-69 years of age (18%) and died as the result of firearms (60%). Suicide by Age 2016 Suicide by Sex 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 15 Suicide by Cause 2016 Suicide by Cause (Top 3) 2013 - 2016 16 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 NATURAL DEATHS Natural deaths accounted for 30% of the ME deaths investigated by the PCOME in 2016. Individuals who died from natural causes were most frequently males (69%), between 50-59 years of age (25%) and died as the result of cardiovascular disease (60%). Natural Deaths by Age 2016 Natural Deaths by Sex 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 17 Natural Deaths by Cause 2016 Natural Death by Cause 2014 - 2016 18 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 UNDETERMINED MANNER OF DEATH Deaths in which the manner of death was undetermined accounted for 10% of the ME deaths investigated by the PCOME in 2016. Individuals who died with an undetermined manner were most frequently males (77%), of unknown age (45%) 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. Undetermined Manner of Death by Age 2016 Undetermined Manner of Death by Sex 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 19 Undetermined Manner of Death by Cause 2016 20 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 OVERDOSE DEATHS There were 356 deaths attributed to an overdose of either a single drug (189 deaths, 53%) or a combination of drugs (167 deaths, 47%) in 2016. Overdose deaths commonly involved males (66%) between the ages of 30-39 (24%). The majority of these deaths were classified as accidents (89%). 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. Methamphetamine was the most commonly abused illicit drug contributing to death in 2016 followed by heroin. Deaths due to methamphetamine were also on the rise in 2016 with a near doubling of the number of deaths from 2014 (57 to 111 deaths). 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 (ethanol) intoxication alone, not as component of a poly-drug overdose, accounted for 15 overdose (4%) deaths in 2016. Fentanyl related deaths continued to increase from 7 deaths in 2014 to 17 deaths in 2015 to 23 deaths in 2016, including 1 death in 2016 due to furanylfentanyl. Overdose Deaths 2010 - 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 21 Overdose Deaths by Age 2016 Overdose Deaths by Sex 2016 Overdose Deaths by Manner 2016 22 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Select Drugs by Year 2013 - 2016 Fentanyl Related Deaths 2010 - 2016 *Including one fentanyl analog ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 23 Overdose Deaths by Drug 2016 24 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 MOTOR VEHICLE RELATED FATALITIES Motor vehicle related fatalities accounted for 239 total deaths in 2016. The majority, 150 deaths, were occupants of a motor vehicle involved in an accident (MVA). Of the remaining, 33 were motorcycle accidents (MCA), 51 were pedestrians or bicyclists struck by vehicles and 5 were operating an all-terrain vehicle (ATV). Individuals who died from motor vehicle related fatalities were most frequently males (72%) and between 20-29 years of age (21%). Motor Vehicle Fatalities by Year 2011 - 2016 Motor Vehicle Fatalities by Age 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 25 Motor Vehicle Fatalities by Sex 2016 Motor Vehicle Fatalities by Type 2016 26 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 W. H. BIRKBY FORENSIC ANTHROPOLOGY LABORATORY Forensic Anthropologists at the W.H. Birkby Forensic Anthropology Laboratory within the PCOME performed 143 examinations (biological profiles, trauma evaluations, dental examinations and examinations for identification) in 2016 on human remains of forensic significance. An additional 27 examinations were performed on remains ultimately deemed non-human, prehistoric or otherwise not forensically significant and these remains were classified as jurisdiction declined (JD) 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 2016, skeletal remains comprised 70% 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 (86%) FA exams include a biological profile with dental examination (90%) when applicable. Less common are examinations for identification (15%) or trauma (6%) with or without biological profiles and dental examinations. Number of FA Exams 2007 - 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 27 FA Exam by Condition of Remains 2016 FA Examination by Type 2016 28 Pima County Office of the Medical Examiner ANNUAL REPORT 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 (222) recorded at the PCOME as compared to the annual average (169 recoveries per year on average from 2002 - 2016). The PCOME has received 2,615 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 154 UBC recoveries in calendar year 2016. As is the historic norm, UBC recoveries peaked during the warmer months (June – July) with 48 recoveries (31% of total for year) in 2016. Many remains are not identifiable due to postmortem changes and efforts by some UBCs to obscure their identities. Of the decedents who were identified, 32% (50 decedents) were between 20-39 years of age. Additionally, 90% (139) of the recovered remains, identified or unidentified, were males, 7% (11) were females and in 3% (4) the sex was unable to be determined. 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 2016, 25 remains (condition 1) were found within less than a day of death (16%), 42 remains (conditions 2-4) were found with a few days up to a few weeks from death (27%), and skeletal remains (body conditions 5-7) accounted for 87 (56%) of the recovered remains. The cause of death was undetermined in 71% (110) 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 26% (40) of deaths. Other, less frequent, causes of death included blunt force injuries from falls or motor vehicle accidents (2) and gunshot wound injuries (1 case). In 2016, 38 (63%) of identified UBCs were of Mexican nationality, followed by Guatemalans (15 or 25%), Hondurans (4 or 7%), Salvadorans (2 or 3%), and Ecuadorian (1 or 2%). Since 2001, identified UBCs of Mexican nationality have been the most numerous (1,403, 84%), followed by Guatemalans (154, 9%) and Salvadorans (45, 3%). Of the 2,615 decedents since 2001, 1,676 (64%) have been identified, 340 (20%) by DNA comparison to a family or law enforcement reference sample. As of December 31, 2016, 939 decedents remain unidentified. ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 29 UBC Recoveries CY2001 - 2016 UBC Recoveries FedFY2002 - 2016 30 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 UBC Recoveries by Month CY2016 UBC Recoveries by Month CY2001 - 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 31 UBC Recoveries by Age CY2016 UBC Recoveries by Age CY2001 - 2016 32 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Condition of Recovered UBC Remains CY2016 Condition of Recovered UBC Remains CY2001 - 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 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 33 UBC Recoveries by Sex CY2016 UBC Recoveries by Sex CY2001-2016 34 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 UBC Recoveries by Cause CY2016 UBC Recoveries by Cause CY2001 - 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 35 Identified UBC Recoveries by Nationality CY2016 Identified UBC Recoveries by Nationality CY2001 - 2016 36 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Identified vs Unidentified UBC Recoveries DNA Identifications CY2001 - 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 37 PIMA COUNTY DEATHS 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 2016 there were 9,376 deaths in Pima County; of these 2,657 (28%) were reported to the PCOME for investigation. Pima County Mortality by Year 2007 - 2016* * Arizona Department of Vital Statistics as of 05/22/17 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). Total Cases from Pima County 2007 - 2016 38 Pima County Office of the Medical Examiner ANNUAL REPORT 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 2016, 975 autopsies, 347 external examinations and 342 DC cases were performed on deaths from Pima County. 2016 Pima County Medical Examiner Cases Pima County Medical Examiner Cases by Age 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 39 Pima County ME Cases by Manner of Death 2016 Pima County Deaths by Law Enforcement Agency 2016 40 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Homicide Deaths The PCOME examined 65 homicides from Pima County in 2016; 4% of total Pima County deaths certified. Homicide totals from 2009 – 2016 are compared below. Homicide victims were most frequently male (88%), between 20-39 years of age (43%) and died as the result of firearms (63%). Pima County Homicide 2009 - 2016 Pima County Homicide by Age 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 41 Pima County Homicide by Sex 2016 Pima County Homicide by Cause 2016 42 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Accident Deaths Deaths due to accidents accounted for 45% of the deaths investigated by the PCOME in 2016. Accident victims were most frequently males (66%), between 80-89 years of age (15%) and died as the result of blunt force injuries (37%) often as the result of such conditions as complications of a hip fracture or intracranial hemorrhage from a fall. Pima County Accident by Age 2016 Pima County Accident by Sex 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 43 Pima County Accident by Cause 2016 Pima County Accident by Cause (Top 3) 2013 - 2016 44 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Suicide Deaths Deaths due to suicide accounted for 11% of the deaths investigated by the PCOME in 2016. Suicide victims were most frequently males (73%), between 50-59 years of age (19%) and died as the result of firearms (59%). Pima County Suicide by Age 2016 Pima County Suicide by Sex 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 45 Pima County Suicide by Cause 2016 Pima County Suicide by Cause (Top 3) 2013 - 2016 46 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Natural Deaths Deaths due to natural causes accounted for 30% of the deaths investigated by the PCOME in 2016. Individuals who died from natural causes were most frequently males (71%), between 6069 years of age (25%) and died as the result of cardiovascular disease (61%). Pima County Natural Deaths by Age 2016 Pima County Natural Deaths by Sex 2016 Pima County Natural Deaths by Cause 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 47 Undetermined Manner of Death Deaths of undetermined manner accounted for 10% of the deaths investigated by the PCOME in 2016. 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. Pima County Undetermined Manner of Death by Age 2016 Pima County Undetermined Manner of Death by Sex 2016 Pima County Undetermined Manner of Death by Cause 2016 48 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Overdose Deaths There were 263 deaths attributed to an overdose of either a single drug (133 deaths, 51%) or a combination of drugs (130 deaths, 49%) in 2016. Overdose deaths commonly involved males (66%) between the ages of 20-29 (22%). The majority of these deaths were classified as accidents (89%). 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. Methamphetamine was the most commonly abused illicit drug contributing to death in 2016 followed by heroin. Deaths due to methamphetamine were also on the rise in 2016 with a doubling of the number of deaths from 2014 (38 to 79 deaths). 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 (ethanol) intoxication alone, not as component of a poly-drug overdose, accounted for 8 overdose (3%) deaths in 2016. Pima County Overdose Deaths 2010 - 2016 Pima County Overdose Deaths by Age 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 49 Pima County Overdose Deaths by Sex 2016 Pima County Overdose Deaths by Manner 2016 50 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Select Pima County Drugs by Year 2014 - 2016 Fentanyl Overdoses 2014 - 2016 * Including one fentanyl analog ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 51 Pima County Overdose Deaths by Drug 2016 52 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Motor Vehicle Related Fatalities Motor vehicle related fatalities accounted for 146 total deaths in Pima County in 2016. The majority, 84 deaths, were occupants of a motor vehicle involved in an accident (MVA). Of the remaining, 24 were motorcycle accidents (MCA), 37 were pedestrians or bicyclists struck by vehicles, and 1 was an all-terrain vehicle (ATV) accident. Individuals who died from motor vehicle related fatalities were most frequently males (74%) and between 20-29 years of age (18%). Pima County Motor Vehicle Fatalities by Year 2011 - 2016 Pima County Motor Vehicle Fatalities by Age 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 53 Pima County Motor Vehicle Fatalities by Sex 2016 Pima County Motor Vehicle Fatalities by Type 2016 54 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 DEATHS BY COUNTY APACHE COUNTY Apache County contracts with an appointed non-Forensic Pathologist physician(s), termed an Alternate Medical Examiner(s) (AME) (A.R.S. §11591); 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). Nineteen deaths from Apache County were reported to the PCOME in 2016, 15 of which required autopsy examinations. Some pertinent statistics regarding these deaths are detailed in the tables and graphs below. Apache County Mortality by Year 2007 - 2016* *Arizona Department of Vital Statistics as of 05/22/17 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 55 Apache County Deaths Reported to the PCOME 2010 - 2016 Apache County Deaths by Type of Exam 2016 Apache County Deaths by Manner of Death 2016 56 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Apache County Deaths by Type of Death 2016 Apache County Deaths by Law Enforcement Agency 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 57 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. 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 2016 there were 1,332 deaths in Cochise County; of these 276 (21%) were reported to the PCOME for investigation. Cochise County Mortality by Year 2007 - 2016* *Arizona Department of Vital Statistics as of 05/22/2017 58 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Total Reported Deaths The total cases investigated by the PCOME from Cochise County in a given year are the sum of the ME cases (autopsies, external examinations, and death certificate cases) and cases in which jurisdiction was declined. Cochise County Deaths Reported to the PCOME 2012 - 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 2016, 116 autopsies, 29 external examinations and 15 DC cases were performed on deaths from Cochise County. 2016 Cochise County Medical Examiner Cases ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 59 Cochise County Medical Examiner Cases by Age 2016 Cochise County ME Cases by Manner of Death 2016 60 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Cochise County Deaths by Law Enforcement Agency 2016 Homicide Deaths The PCOME examined 6 homicides from Cochise County in 2016; 4% of total Cochise County deaths certified. Homicide totals from 2012 – 2016 are compared below. Homicide victims were most frequently male (83%), between 20-39 years of age (67%) and died as the result of firearms (83%). Cochise County Homicide 2012 - 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 61 Cochise County Homicide by Age 2016 Cochise County Homicide by Sex 2016 Cochise County Homicide by Cause 2016 62 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Accident Deaths The PCOME examined 63 accident deaths from Cochise County in 2016; 39% of total Cochise County deaths certified. Accident victims were most frequently males (60%), between 20-29 years of age (17%) and died as the result of motor vehicle trauma (38%). Cochise County Accident by Age 2016 Cochise County Accident by Sex 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 63 Cochise County Accident by Cause 2016 Cochise County Accident by Cause (Top 3) 2014 - 2016 Suicide Deaths The PCOME examined 29 suicide deaths from Cochise County in 2016; 18% of total Cochise County deaths certified. Suicide victims were most frequently males (79%), between 70-79 years of age (34%) and died as the result of firearms (79%). Cochise County Suicide by Age 2016 64 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Cochise County Suicide by Sex 2016 Cochise County Suicide by Cause 2016 Cochise County Suicide by Cause (Top 3) 2014 - 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 65 Natural Deaths The PCOME examined 53 natural deaths from Cochise County in 2016; 33% of total Cochise County deaths certified. Individuals who died from natural causes were most frequently males (77%), between 50-59 years of age (38%) and died as the result of cardiovascular disease (62%). Cochise County Natural Deaths by Age 2016 Cochise County Natural Deaths by Sex 2016 Cochise County Natural Deaths by Cause 2016 66 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Undetermined Manner of Death The PCOME examined 9 undetermined deaths from Cochise County in 2016; 6% of total Cochise County deaths certified. Individuals who died with an undetermined manner were most frequently males (89%), of unknown age (55%) and died from undetermined causes (89%). Many of these deaths represent skeletal remains of UBCs who died in the deserts of southern Arizona. Cochise County Undetermined Manner of Death by Age 2016 Cochise County Undetermined Manner of Death by Sex 2016 Cochise County Undetermined Manner of Death by Cause 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 67 Overdose Deaths There were 22 deaths attributed to an overdose of either a single drug (10 deaths, 45%) or a combination of drugs (12 deaths, 55%) in 2016. Overdose deaths commonly involved males (64%) between the ages of 50-59 (32%). The majority of these deaths were classified as accidents (86%). Cochise County Overdose Deaths 2014 - 2016 Cochise County Overdose Deaths by Age 2016 68 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Cochise County Overdose Deaths by Sex 2016 Cochise County Overdose Deaths by Manner 2016 Select Cochise County Drugs by Year 2014 - 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 69 Cochise County Overdose Deaths by Drug 2016 Motor Vehicle Related fatalities Motor vehicle related fatalities accounted for 24 total deaths in Cochise County in 2016. The majority, 17 deaths, were occupants of a motor vehicle involved in an accident (MVA). Of the remaining, 3 were motorcycle accidents (MCA), 2 were pedestrians struck by vehicles, and 2 involved all-terrain vehicles (ATV). Individuals who died from motor vehicle related fatalities were most frequently males (71%) and between 20-29 years of age (25%). Cochise County Motor Vehicle Fatalities 2014 - 2016 70 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Cochise County Motor Vehicle Fatalities by Age 2016 Cochise County Motor Vehicle Fatalities by Sex 2016 Cochise County Motor Vehicle Fatalities by Type 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 71 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). Twenty nine deaths from Gila County were reported to the PCOME in 2016, 28 of which required autopsy examinations. Some pertinent statistics regarding these deaths are detailed in the tables and graphs below. Gila County Mortality by Year 2007 - 2016* * Arizona Department of Vital Statistics as of 05/22/2017 72 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Gila County Deaths Reported to the PCOME 2010 - 2016 Gila County Deaths by Type of Exam 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 73 Gila County Deaths by Manner of Death 2016 Gila County Accidents by Type 2016 Gila County Naturals by Type 2016 74 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Gila County Homicides by Type 2016 Gila County Deaths by Law Enforcement Agency 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 75 GRAHAM COUNTY Graham County contracts with an appointed non-Forensic Pathologist physician(s), termed an Alternate Medical Examiner(s) (AME) (A.R.S. §11591), who triages, investigates and certifies deaths that fall under the jurisdiction of the medical examiner in 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 decedent may be referred to the PCOME for an examination and death certification. 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 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). Nine deaths from Graham County were reported to the PCOME in 2016, all of which required autopsy examinations. Some pertinent statistics regarding these deaths are detailed in the tables and graphs below. Graham County Mortality by Year 2007 - 2016* * Arizona Department of Vital Statistics as of 05/22/2017 76 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Graham County Deaths Reported to the PCOME 2010 - 2016 Graham County Deaths by Type of Exam 2016 Graham County Deaths by Manner of Death 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 77 Graham County Deaths by Type of Death 2016 Graham County Deaths by Law Enforcement Agency 2016 78 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 GREENLEE COUNTY Greenlee County contracts with an appointed non-Forensic Pathologist physician(s), termed an Alternate Medical Examiner(s) (AME) (A.R.S. §11591), who triages, investigates and certifies deaths that fall under the jurisdiction of the medical examiner in 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). Eight deaths from Greenlee County were reported to the PCOME in 2016, five of which required autopsy examinations. Some pertinent statistics regarding these deaths are detailed in the tables and graphs below. Greenlee County Mortality by Year 2007 - 2016* * Arizona Department of Vital Statistics as of 05/22/2017 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 79 Greenlee County Deaths Reported to the PCOME 2010 - 2016 Greenlee County Deaths by Type of Exam 2016 Greenlee County Deaths by Manner of Death 2016 80 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Greenlee County Deaths by Type of Death 2016 Greenlee County Deaths by Law Enforcement Agency 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 81 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 decedent may be referred to the PCOME for an examination and death certification. 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 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). Twenty nine deaths from La Paz County were reported to the PCOME in 2016, 28 of which required autopsy examinations. Some pertinent statistics regarding these deaths are detailed in the tables and graphs below. La Paz County Mortality by Year 2007 - 2016* * Arizona Department of Vital Statistics as of 05/22/2017 82 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 La Paz County Deaths Reported to the PCOME 2010 - 2016 La Paz County Deaths by Type of Exam 2016 La Paz County Deaths by Manner of Death 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 83 La Paz County Accidents by Type 2016 La Paz County Homicides by Type 2016 La Paz County Naturals by Type 2016 84 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 La Paz County Suicides by Type 2016 La Paz County Deaths by Law Enforcement Agency 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 85 NAVAJO COUNTY Navajo County contracts with an appointed non-Forensic Pathologist physician(s), termed an Alternate Medical Examiner(s) (AME) (A.R.S. §11591), who triages, investigates and certifies deaths that fall under the jurisdiction of the medical examiner in 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 decedent may be referred to the PCOME for an examination and death certification. 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 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). Fifty deaths from Navajo County were reported to the PCOME in 2016, 47 of which required autopsy examinations. Some pertinent statistics regarding these deaths are detailed in the tables and graphs below. Navajo County Mortality by Year 2007 - 2016* * Arizona Department of Vital Statistics as of 05/22/2017 86 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Navajo County Deaths Reported to the PCOME 2010 - 2016 Navajo County Deaths by Type of Exam 2016 Navajo County Deaths by Manner of Death 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 87 Navajo County Accidents by Type 2016 Navajo County Homicides by Type 2016 Navajo County Naturals by Type 2016 88 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Navajo County Suicides by Type 2016 Navajo County Deaths by Law Enforcement Agency 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 89 PINAL COUNTY Pinal County contracted with the PCOME to provide examination or other support services beyond what Pinal County provides internally for the majority of 2016. 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 were 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 historically 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 2016 there were 2934 deaths in Pinal County; of these 236 (8%) were reported to the PCOME for examination. Some pertinent statistics regarding these deaths are detailed in the tables and graphs below. Pinal County Mortality by Year 2007 - 2016* * Arizona Department of Vital Statistics as of 05/22/2017 90 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Pinal County Deaths Reported to the PCOME 2010 - 2016 Pinal County Deaths by Type of Exam 2016 Pinal County Deaths by Manner of Death 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 91 Pinal County Accidents by Type 2016 Pinal County Homicides by Type 2016 Pinal County Naturals by Type 2016 92 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Pinal County Suicides by Type 2016 Pinal County Deaths by Law Enforcement Agency 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 93 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 2016 there were 298 deaths in Santa Cruz County; of these 51 (17%) were reported to the PCOME for investigation and/or examination. Some pertinent statistics regarding these deaths are detailed in the tables below. Santa Cruz County Mortality by Year 2007 - 2016* * Arizona Department of Vital Statistics as of 05/22/2017 Santa Cruz County Deaths Reported to the PCOME 2010 - 2016 94 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Santa Cruz County Deaths by Type of Exam 2016 Santa Cruz County Deaths by Manner of Death 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 95 Santa Cruz County Accidents by Type 2016 Santa Cruz County Naturals by Type 2016 96 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Santa Cruz County Suicides by Type 2016 Santa Cruz County Deaths by Law Enforcement Agency 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 97 YUMA COUNTY Yuma County contracts with, and appoints the pathology group at Yuma Regional Medical Center, as Medical Examiner for 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. Sixteen deaths from Yuma County were reported to the PCOME in 2016, all 16 of which required autopsy examinations. Some pertinent statistics regarding these deaths are detailed in the tables below. Yuma County Mortality by Year 2007 - 2016* * Arizona Department of Vital Statistics as of 05/22/2017 Yuma County Deaths Reported to the PCOME 2010 - 2016 98 Pima County Office of the Medical Examiner ANNUAL REPORT 2016 Yuma County Deaths by Type of Exam 2016 Yuma County Deaths by Manner of Death 2016 ANNUAL REPORT 2016 Pima County Office of the Medical Examiner 99 Yuma County Deaths by Type of Death 2016 Yuma County Deaths by Law Enforcement Agency 2016 100 Pima County Office of the Medical Examiner ANNUAL REPORT 2016