HJBR Nov/Dec 2023

DIALOGUE 26 NOV / DEC 2023 I  HEALTHCARE JOURNAL OF BATON ROUGE   Q & A with William “Beau” Clark, MD East Baton Rouge Parish Coroner Dr. Clark, congratulations on winning the position of East Baton Rouge Par- ish Coroner for the fourth consecutive time. You have held this position for 12 years now; can you tell us what signif- icant changes have occurred during your tenure? The volume. Over the last 12 years, the volume of cases, whether it be death inves- tigations, mental health investigations, or sexual assault investigations, is staggering. My operation has grown, and we still have difficulty trying to accommodate the over- whelming number of unnatural deaths in our community. You have the ear of the Baton Rouge area healthcare industry right now. What are the top things you believe they should know about your office? The biggest public health crisis for our community/state/country is Fentanyl. The opioid epidemic has continued to grow and plague our community. Without implement- ing some aggressive solutions, I fear it will only get worse. Are there common misconceptions about the work your office does that you often encounter? The role of the coroner is specifically to determine if someone’s death is the result of a crime. It is within the unnatural death environment that the coroner finds him- self making the biggest impact for the community. The third jurisdiction of the coroner, sexual assault, is a duty that most of the community isn’t aware the coroner has a role in; however, being the bridge between the healthcare community and law enforcement, it only makes sense that this is a jurisdiction of the coroner. Behavioral health is a bourgeoning concern. Orders of Protective Custody (OPC) in EBR were slightly down from 2021 but remained elevated compared to 2020. Coroner Emergency Certificates (CEC), on the other hand, saw a year-over-year increase. Could you please provide insights into what your office is observing, the underlying reasons behind the rise in behavioral health issues, and any recommendations or potential solutions you envision? The 1980s de-institutionalization of the mentally ill was a gigantic disaster. The concept to reduce healthcare costs by moving this patient population from an inpatient setting to an outpatient setting is sound with any other disease process, but it just doesn’t work for the mentally ill. Individuals that need long-term care have nowhere to go, so they end up in short- term care facilities. Individuals needing short-term care have nowhere to go, so they end up in the emergency department to eventually be transferred all over the state of Louisiana. Individuals needing clinical care have limited places to go, so they end up on the street or in jail, both of which are incredibly detrimental to their health. It is a huge mess, with the patient paying the ultimate price. The solution is challenging, namely because it’s costly, but we need long-term facilities for the sickest of the sick, and we need case management to prevent the mild or moderately sick from getting worse and disparately needing hospitalization. All this costs money. As the mental health problem grows across this country, often manifested and evidenced by the massive increase in homeless populations, we also may need to look at legislation surrounding loved ones being able to access the judicial system to provide involuntary care for chronically ill mental patients. At this point, a long-term judicial commitment for the non-compliant and involuntary patient is extraordinarily complicated, difficult, and expensive to obtain. How do EBR, specifically, and Louisiana, in general, compare to the rest of the country in terms of opioid and fentanyl overdoses? Are there any emerging drugs on the horizon that we should be concerned about? If you look at my annual graphs of overdose deaths and compare them with statewide or even nationwide data, the slope of the graph is the same — the number of cases is proportionate to population size. Right now, fentanyl and its very powerful derivatives, such as carfentanyl, etc., are the predominant drugs we are encountering. The latest trend is to adulterate cocaine, methamphetamine, and marijuana with fentanyl, increasing the number of deaths due to exposure of opioid-naïve persons to illicit fentanyl. You would be very hard- pressed to find an illicit drug on the streets of East Baton Rouge Parish that doesn’t have fentanyl in it. n