HJBR Sep/Oct 2021

HEALTHCARE JOURNAL OF BATON ROUGE I  SEP / OCT 2021 9 Dianne Hartley, Editor You wear a lot of hats as coroner of East Baton Rouge Parish. How would you describe the different aspects of your position? William “Beau” Clark, MD As a parish coro- ner in Louisiana, we have three jurisdictions. The one that is most notable is the investi- gation in the cause and manner of death, but more specifically, we’re there to deter- mine if somebody’s death is the result of a crime. Even though we do investigate a lot of natural deaths, we certainly are attuned and aware that really our main jurisdic- tion when it comes to death is to look for crimes, whether that be accidental deaths, suicides or homicides — those other catego- ries besides natural. The good news is that when you look at it statistically, the major- ity of the cases we do investigate are nat- ural, and from a global, 50,000-foot-view scenario, that’s what you want for a com- munity — that people should die of old age from natural disease, not young from non- natural instances. The other two jurisdictions a coroner in say, Louisiana has, one has to do with the collection of forensic evidence in sexual assaults. We’re tasked with the collection of the rape kit, and in East Baton Rouge Parish or in the state of Louisiana, we have recent legislation as of 2016/2017 that took that from a parish perspective to a regional perspective. We set up regional protocols for the collection of that evidence, and I use specially trained nurses, called sexual assault nurse examiners, in this jurisdiction to do that. The third jurisdiction has to do with the involuntary committal of the mentally ill. This, in essence is our safety net for mental health crises that occur in our state and the ability, in one instance, for me as the coroner to have an individual picked up against their will and brought to a facility for an evalua- tion; and then the second instance, admit- ting that same individual involuntarily for a prescribed amount of time, so they can have that inpatient evaluation as necessary. Those are my three jurisdictions. Statis- tically speaking, you would think that the largest jurisdiction is actually the death jurisdiction, because that’s the one we’re most noted for; however, it’s the mental health jurisdiction where we do most of our volume of work. Editor What drew you to the office of coroner? Clark I have a background in emergency medicine; I’m a board-certified emergency medicine physician. If you think about what ERs have become and are today, they are places where people with mental health cri- sis come, it’s often a place where people do die and certainly a place where someone who’s sexually assaulted shows up for help. I think ER doctors have the special niche that’s necessary to be coroners in Louisiana. During residency, though, I decided that I wanted to give back to the community through some volunteer work, and I did so by volunteering as a police officer for the Sheriff’s office. So, I had this unique qualifi- cation of being not only a physician, but also a law enforcement officer. With those two things in mind, in 2011, I was approached by the law enforcement leaders of this par- ish to see about seeking the office. I’ve been here — I guess now is my 10th year in office. Editor When does the coroner’s office get in- volved in a death? Clark We have strict criteria that makes something a coroner’s case. There are essen- tially 13 criteria that are spelled out in Loui- siana revised statute 13:5713, but it’s prob- ably easier to tell you when I’mnot involved. I am not involved in any case where a per- son dies of natural disease after they’ve been admitted to a hospital greater than 24 hours, as long as that natural disease is not the result of a virulent contagious disease or the result of a public health crisis. Those are the ones I don’t investigate. Everything else is my jurisdiction. What makes COVID my jurisdiction is that obviously that’s a public health crisis and a virulent contagious dis- ease, so regardless of the length of stay of the individual in the hospital, it becomes a coroner’s case. Editor So, you’ve had all the patients in East Baton Rouge who have passed come through your office? Clark Yes, I’m the one that tallies the COVID number in our area. Editor How have you had to adjust your pro- cedures in handling these types of cases, like COVID, where the virus is so contagious? Clark COVID has stressed the system com- pletely from one end to the other, right? So, from a pre-hospital perspective, EMS, fire, law enforcement has needed to expand their operations to deal with it, right down to our hospitals, our emergency rooms, healthcare providers and as well as here at the coro- ner’s office. It was early into COVID that we went from eight full-time death investigators to 10 pretty rapidly, because we could foresee that the total number of death investiga- tions was going to climb precipitously. In fact, when we looked backward at the num- bers, in 2019, we investigated 3,625 deaths. In 2020, which was basically the first year of COVID, we investigated 4,742 deaths. So, you’re looking at 1100 more death investi- gations. If you take that number of 1100 and back out just the COVID death investiga- tions, which in 2020, the total number of deaths due to COVID was 548, you’re still left with 600 other deaths that required investigation that were non-COVID related. The majority of those were made up from overdoses related to the opioid epidemic. We did see an increase in motor vehicle col- lisions as well as an increase in homicides. So, you can say that the year of COVID not only contributed to the COVID death num- bers increasing, but also to deaths of other manners.