Monday, February 16, 2015

Wrong Answer

APD on scene town center Wednesday 7:30 AM

If two murders occurred in Amherst last week not only would you have been instantly made aware, but you would probably still be whispering about it now.  Yet when death is self inflicted, the silence is as stunning as the desperate act itself.

Early Wednesday morning Amherst police responded to a rooming house in town center for a drug overdose victim who obviously changed his mind.  Because he used a cell phone to call 911, that cry for help went to a Northampton call center first and was then was transferred to Amherst Dispatch.

By the time a patrol officer arrived on scene it was an "unattended death."

According to the Mass Department of Public Health there were 624 "completed suicides" in 2012 and 6,729 Emergency Room visits for "self inflicted" wounds that did not result in death.

In 2011 suicides accounted for 588 deaths while Massachusetts had a total of 202 murders -- almost three times fewer than suicides -- many of which you probably saw reported by the mainstream media. 

Late Friday night, about an hour before the official start of Valentine's Day, police were called to a Mill Street apartment by a frightened Reporting Party stating she just discovered her roommate hanging.  Yet another "unattended death."

That makes two unfortunate incidents in less than 72 hours.

The national average for suicide in 2012 was 12.5/100,000 population, while Massachusetts's came in lower than average at 8.6 per 100,000.  Thus with Amherst's population of 38,000 we should see roughly three suicides per year.

If you know someone with all of the above, get them help.  Now.

The police department always refers questions to the District Attorney's office since the DA has jurisdiction over all "unattended deaths."  But when I asked about these two regrettable incidents I was told by Northwestern District Attorney Dave Sullivan's Communications Director Mary Carey, "We don't release information or comment on suicides."

If pushed I'm sure they would issue a vague official statement saying there is no cause for public alarm over the two deaths as they are not considered "suspicious."

But the preferred method seems to be for everybody to just keep completely silent so the public is never even aware these deaths happened in the first place, and therefor could not become alarmed.

Last year I was the first to publish Eric Sinacori's cause of death being "acute heroin intoxication," and caught a lot of grief for doing so:  Invasion of privacy, increasing trauma to the family,  and for raining on  UMass parade by publishing it on graduation day -- the same day I first acquired the death certificate from the Amherst Town Clerk.

Now of course that sad incident has led to a change in policy at UMass Amherst concerning the use of student informants by UMPD to investigate drug dealers higher up the ladder (a policy change  I do not agree with).

Over the past few years at least two UMass students used chemical car bombs to end their life, a method that endangers first responders or anyone who accidently comes into contact with the death vehicle.

The more people know about the warning signs of suicide the better.   And knowing that it can and does happen here in our bucolic little college town, may just make EVERYONE pay closer attention.


Dr. Ed said...

I vehemently disagree Larry -- and we can start with the statistic that 1:3 (actually more) of those who commit suicide are already receiving so-called "help."

I can't mention the details but I have absolutely no doubt that I saved lives because it was known that I wouldn't report people. "And what if you were wrong, Ed?" -- the fact is that I wasn't.

Our current approach to mental health isn't that far from 17th Century Salem, except they called it "Witchcraft."

The Heroin death is a different story -- I am wondering if one could notice that the current dose of Heroin is having a quicker and stronger effect than normal and hence realize that one has overdosed prior to the full dose taking effect.

Absent a "I wanted to die but now don't" recording on the 911 line, how on earth do you know this was a suicide? Drugs kill...

And this is how the mindless concept of 911 is a step backwards. 30 years ago, you could call the fire department DIRECTLY, from any phone, anywhere. Now you have to get relayed three times to get them...

Dr. Ed said...

BTW -- In saying "we don't comment on suicides" the DA's office was confirming that it WAS a suicide.

Interesting followup question: Is there any evidence that a particularly lethal mix of Heroin was involved in the OD, and hence currently is in the Amherst area, or anything else of public concern about this death? That'd be an interesting hook to see them twisting on, if this truly *was* a suicide...

Anonymous said...

ED...You can still call the fire department or police department directly from any phone, anywhere. You just need the local number which is readily available. Just like in the past.

Larry Kelley said...

Based on the heroin deaths I'm familiar with it, seems to be the kind of thing you don't realize is an overdose.

Anonymous said...

What was the time between call received and declaring it an unattending death? Not more then a few minutes I would think. Was CPR started? If it was heroin did anyone try Narcan. Was EMS involved? Was the victim transported to CDH? The protocol for declaring someone dead out of a hospital setting is very stringent. Cold, fixed and dilated pupils, pooling of blood, injuries not compatible with life...

Larry Kelley said...

Don't know the answer to most of those questions. I do know the medical examiner showed up about a half hour or so after the first cop responded, so pretty safe bet he was not transported to CDH be AFD.

Anonymous said...

Don't you find it interesting that if it was 4-5 minutes between Granny calling and being found in cardiac arrest, she would have been coded and transported, but if it's a junky they are an unattended death??

Larry Kelley said...

I did not get that impression.

B.B. N.A. said...

Suicide seems like it has so much potential as a public policy issue.

Too bad it doesn't.

Once we address most of the people dieing that did not want to, we can can walk up the down escalator on this one.

There is simply no action item for this issue in the public forum and I am not sure the public benefits when keep someone that depressed around.

We all decided long ago that the mentally ill are on their own, that govt was there to help middle class people better themselves, not help the desperate in society.

Larry Kelley said...

Just what I need, another Jonathan Swift.

Dr. Ed said...

ED... You just need the local number which is readily available. Just like in the past.

No, at least elsewhere, there were two numbers in the past --
and EMERGENCY number and a BUSINESS number.

FMost colleges are telling students to call the BUSINESS number and tell the dispatcher it is an emergency -- UM now has managed to have a 7 digit emergency number again but I wrote two newspaper stories on the use of the 2121 line.

But this is not true everywhere and you don't screw around with things you don't know when a life is on the line. Lots of departments now have voicemail answering their business numbers -- and all numbers are business ones.

What's worse is not only does cell 911 hand you off at least twice and usually three times -- and you have to try to summarize the situation three times while under stress -- but signal quality declines each time they transfer you. I have trouble hearing what the actual cop dispatcher is saying when I finally get to him/her/it -- I fear the same is true on the other end.

I so wish that in situations where the initial call center operator judges it to be an emergency, they would stay on the line (like the old New England Telephone operators would back when you could dial (literally dial) O in an emergency if you didn't know the local number.

Maybe even tell the folks they are connecting you to what kind of an emergency this is (e.g. MVA, woman being attacked, etc)
And maybe even where -- they know this from the GPS and well may be more accurate than the (stressed./scared calle.

But 911 on a cell phone ===- sucks. For a great mental status exam, watch an injured person attempt to call her own ambulance -- I once had to do that, and it wasn't fun...

Larry Kelley said...

Chief Livingstone told the Finance Committee last week that the state has figured out a way (using GPS) to connect 911 calls made from a cell phone in our town to our Dispatch.

So that will be happening soon.

Until then everybody should just program into their smart phone the Amherst police business number, as that is picked up 24/7 by Dispatch.

Bai Hailian said...

I agree with Mr. Ed. I recently called 911 because I was being harassed by an individual at Not Bread Alone which is housed in the First Congregational Church right next to the Amherst Police Station. That call was bounced to Northampton. In the meantime, the person harassing me took off, but I did go to the Amherst Police Station later that afternoon and got the web address from the dispatcher regarding a 'Stand Away Order". Unfortunately, there were no packets of this info available there.

As for suicides, I have several thoughts about that issue. First, a suicide is NEVER one person acting alone; it's actually a person who perceives himself to be a burden to the people around him. That could be family or in the case of individuals (ie. people without family who have even less resources at their disposal, for instance, something as material as a car or something as immaterial as love), the community around a 'suicide' should ALWAYS bear some responsibility for the death, because in some way that person was shunned to the point of extinction. It is probably the reality that people around a so-called suicide DO bear some responsibility that contributes to the taboo and the silence or lack of reporting. As for heroin deaths: anyone who reads the paper knows that there have been some particularly lethal drugs on the market. May I say, IMO, it is reprehensible for the police to USE an addict as an informer. DO NO HARM is the Hippocratic Oath; it should also be up there with 'Serve, Honor, Protect'. In addition, let's not forget that some people in society are treated like garbage and that includes returning veterans: the number of homeless vets and suicides among vets and the rate of turnover among health care professionals in the armed forces exceeding 50 per cent is truly astounding. BTW, I myself was TAZED by someone in uniform (fatigues) at a forum at Smith College a couple of years ago for asking a question about the 16 per cent suicide rate. People in fatigues in the audience objected to my question because it was "too depressing". We also want to look at the way the Town of Amherst treats people without homes: to wit, the Alan Root exhibit of "Townies vs 'Homeless'" which was approved for display by Librarian Sharon Sharry at The Jones Library.

Bai Hailian said...

Thirdly, there are cases where people are "suicided" because people don't like their politics. This happens in a lot of countries. One good example of it happening here was the case of chess Champion Bobby Fischer who decided to ignore an embargo on the former Yugoslavia and play a $3M chess game which he won. Then he decided to seek emigrate (seek asylum) in Iceland only to die of a reported 'heart attack'. We also have a local case of Professor Lynn Margulis, who attained international theory with her Gaia Theory, dying after a 'heart attack' after she made some comments to the Daily Collegian to the effect that 9/11 was the "greatest advertisement" that was ever shown (apparently for going to war). Did she die a natural death? I seriously doubt it.

Let me just add that there are a lot of pharmaceutical drugs on the market like Prozac that actually report contraindications like suicidal ideation.

The reality is, unfortunately, that we are all caught up in an Alvin Toffler 'Future Shock' type of world where the rate of change is mind-numbing and the cultural programming is completely consumer oriented, focused on planned obsolesence and limiting access because our hapless government officials have offshored all manufacturing and service jobs to people in countries who will work much cheaper, since our elected representatives are all in the pay of the elite and Wall Street. Virtually the only jobs left are in health care, though you may be lucky enough to secure one if you know the right people. Fifty million people on foodstamps says there is a DEPRESSION going on now.

Finally, let me repeat the old adage: It is not a sign of sanity to be well-adjusted to a sick society.

As John Prine said: Turn off your TV...

Anonymous said...

Larry. You don't make a call while alive a few blocks from the police and fire HQ on a sleepy weekday morning and by "the time a patrol officer arrived on scene it was an "unattended death.".... it doesn't work that way. 30 years in emergency medicine tells me that might be the way it should be, but it isn't. If you are really unbiased, you will look into this.

Anonymous said...

Exceptions to Initiation of Resuscitation
Other than in overriding circumstances such as a large mass-casualty incident or a hazardous
scene, the following are the only exceptions to initiating and maintaining resuscitative measures in
the field:
1. Current, valid DNR, verified per the Medical Orders for Life Sustaing Treatment (MOLST)/
Comfort Care Protocol. 2. Trauma inconsistent with survival
a. Decapitation: severing of the vital structures of the head from the remainder of the
patient’s body
b. Transection of the torso: body is completely cut across below the shoulders and
above the hips
c. Evident complete destruction of brain or heart
d. Incineration of the body
e. Cardiac arrest (i.e. pulselessness) documented at first EMS evaluation when such
condition is the result of significant blunt or penetrating trauma and the arrest is
obviously and unequivocally due to such trauma, EXCEPT in the specific case of
arrest due to penetrating chest trauma and short transport time to definitive care (in
which circumstance, resuscitate and transport)
3. Body condition clearly indicating biological death. a. Complete decomposition or putrefaction: the skin surface (not only in isolated
areas) is bloated or ruptured, with sloughing of soft tissue, and the odor of decaying
flesh. b. Dependent lividity and/or rigor: when the patient’s body is appropriately examined, there is a clear demarcation of pooled blood within the body, and/or major joints
(jaw, shoulders, elbows, hips, or knees) are immovable. Procedure for lividity and/or rigor: All of the criteria below must be established and
documented in addition to lividity and/or rigor in order to withhold resuscitation:

i. Respirations are absent for at least 30 seconds; and
ii. Carotid pulse is absent for at least 30 seconds; and
iii. Lung sounds auscultated by stethoscope bilaterally are absent for at
least 30 seconds; and
iv. Both pupils, if assessable, are non-reactive to light.

atriumecho said...
This comment has been removed by the author.
Dr. Ed said...

"Larry. You don't make a call while alive a few blocks from the police and fire HQ on a sleepy weekday morning and by "the time a patrol officer arrived on scene it was an "unattended death."..


That's what was bothering me about this, although I think it gos even deeper than this.

Why roll a police officer instead of an ambulance on a call reporting a medical emergency?

Or if both rolled -- with Heroin involved, that may not be unjustified -- and the cop just got there first, why didn't he wait 30-90 seconds for AFD (that he/she/it would be able to hear coming) and let them do the medical stuff?

I was taught that brain damages starts after four minutes without oxygenated blood and that death occurred some time after even that.

Cause of death in an opiate overdose is suppression of heartbeat & respiration, right? And while it can occur quickly, it isn't instantaneous like an electrocution -- instead it just gradually slows down & stops which means that there is some time involved. A couple minutes maybe?

So you have someone alive enough to talk to you on the telephone and you can be there inside of five minutes. You have four minutes after cardiac arrest before you really are worrying about brain damage, cardiac arrest didn't start immediately with the phone call but some time after that, and you have trained professionals who not only can start CPR quicker but (I presume) have O2 and an AmboBag which means that you can do a much better job.

And you instead just have a cop declare the person dead? Maybe not even roll an ambulance at all?

Whiskey Tango Foxtort?!!?!!?

Dr. Ed said...

Now there is one other possibility-- that this was a suicide and NOT an overdose. Opiates may be involved, but the cause of death was something else, such as a self-inflicted gunshot wound.

That would explain the police instead of ambulance response, that would explain how this could go so quickly to an unattended death.

Isn't this also an awfully short response time for the ME? Is this being expedited for some reason?

Is there a need to rule out the possibility that this could be a murder? Not on a pro-forma basis like in most unattended deaths, but along the lines of "really need to know..."?

There is something else here...

RSF said...

I appreciate that after days of searching, I now know what happened to the man found dead on Mill Street last Friday. Nothing in the paper or on the news that we saw or heard. No death notice, either. The police were there until the wee hours of the morning after having arrived after 11pm. Sad. So sad. It's frightening to me. My family and I didn't know if he was murdered or not and the media had done another hush hush.

Anonymous said...

Well said.

Anonymous said...

Regarding the Amity St death, i was listening to my scanner and I heard police and an ambulance respond at the same time to the location. Once APD got there someone said he wasn't breathing, paramedics got there shortly after, and after a few minutes the ambulance cleared not transporting. Im quite sure there is more to this story than someone just deciding not to revive another. All details aren't released. If your curious as to the specifics, request a police log. Im sure something is mentioned.
We have a top notch emergency services here in Amherst, and I find it hard to believe that they would just turn away at the chance of reviving someone.
Anonymous, but accurate.

Larry Kelley said...

Yes AFD has confirmed for me that an ambulance was dispatched and did not transport.

I have no concerns whatsoever that anybody connected with Amherst public safety made a bad call.

My concern is the person really did not want to die and only did it to get attention assuming his 911 call would result in being saved.

And that initial call went to Northampton ...

Anonymous said...

Based only on the facts in your story and your reporting that AFD was there and did not transport, something is missing from the picture. It might be easily explained, but its missing. The OEMS protocols for nonresusitation could not have been met by a someone overdosing on opiates a few minutes prior to arrival of EMS. It would be interesting to look at the EMS run report for the call and see how the death was documented.

Larry Kelley said...

I had a reliable source contact me earlier today and I am now satisfied that it was not a case of delayed response by anyone.

In order to protect said source I cannot go into any detail at all.