Pa. coroners, health department at odds over how to handle suspected coronavirus cases, potentially affecting death count

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HARRISBURG — Until late last week, Dr. Christina VandePol, the coroner in Chester County, said, she had to turn to local hospitals if she wanted to test a deceased person for the coronavirus.

Since then, she said, she’s received 20 tests from the state’s lab, in two batches. For a county with over 400 cases and seven deaths reported as of Thursday, 20 doesn’t seem like a lot, but it’s more than other coroners have received.

“We are very fortunate, as I understand,” she said.

Coroners — elected public servants in most of the state’s 67 counties — say a lack of tests is just one problem they’re facing as they take on the coronavirus. Some say there’s also been a weeks-long breakdown in how hospitals are informing them about deaths, and a fundamental dispute with the state over what their role is in the crisis.

By not acknowledging what coroners see as their legal obligation, they say, the state is risking a miscount of deaths, potentially misunderstanding how the virus is spreading and overburdening hospital staff with administrative tasks.

The head of the group that represents the state’s coroners says he can’t seem to get the department to hear their concerns.

“We have to agree to disagree,” said Charles E. Kiessling Jr., coroner in Lycoming County and president of the Pennsylvania Coroners Association.

Some coroners, like VandePol, have started to acquire diagnostic kits — which they say they need to test people who died in their homes or outside of a hospital — but the Department of Health is recommending that they use them sparingly. In interim guidance released Tuesday, the department said coroners should “use their judgment” to determine whether to test a body based on a combination of factors, including if a person had symptoms or lived in an area with “known community transmission.”

To determine which bodies to test, VandePol has been using information she learns from a family, like whether they knew of a fever, shortness of breath, or a cough. She has access to medical records, too, she said, so she can understand a person’s underlying health condition.

According to the Centers for Disease Control and Prevention, testing “ideally” should be conducted, “but it is acceptable to report COVID–19 on a death certificate without this confirmation if the circumstances are compelling within a reasonable degree of certainty.”

Those cases, marked as “probable” COVID-19 deaths, are included in the state’s count.

VandePol said she hasn’t marked any coronavirus deaths as “probable.” So far, she’s had enough tests to handle suspected cases. But she said she would feel comfortable if she had to do so. For coroners, she said, listing a probable cause of death isn’t uncommon.

What’s different about the COVID-19 crisis, though, is the severity of the risk in not catching all positive cases. “The ideal would be that we would test everyone,” she said.

VandePol added that her office has had two positive test results come back from deaths that occurred “at home or in the community.” She said she communicated with the families about the results — a standard practice — and has been in touch with the funeral homes.

Giving funeral homes adequate information so they can take the right precautions is “another reason for tests to happen,” she said.

But as of Tuesday, most coroners in the state didn’t have access to tests, Kiessling, of the coroners association, said.

“We don’t know what we don’t know,” he said. “If we’re not testing the people who die at home, we might be missing … their family. That’s a concern.”

Providing answers to a community about its deaths is precisely what Pennsylvania’s coroners are elected to do, Kiessling said. But because of a dispute with the state Health Department, he said, coroners are hindered in that obligation.

County coroners typically don’t get involved when someone dies of natural causes at a hospital or nursing home. Instead, they’re tasked with investigating unexpected or suspicious deaths, like homicides or suicides.

They also say they’re obligated under state law to investigate deaths that are “known or suspected to be due to contagious disease and constituting a public hazard.”

Coroners are particularly well suited to handle these investigations because they have “boots on the ground” already, said Kiessling. They’ve built relationships with physicians, county officials, and first responders, and can properly communicate with families, track community spread, and build an accurate death count.

“The coroners have the connections in our community more accurately to track these cases,” Kiessling said. “Any time there’s a question about a death in a community, who do they call? They don’t call the Department of Health.”

But the Department of Health sees things differently, saying COVID-19 deaths — confirmed and suspected — should be considered “natural” and in most cases do not need to be investigated by coroners.

Coroners say they don’t need to handle every case, but do need hospitals to submit COVID-19 death information, as they’re required to do, through the state’s online reporting system. Kiessling said he’s spent much of the last month in conversations with the Health Department about whether that’s been happening.

According to Nate Wardle, a department spokesperson, it has been “ongoing protocol” for physicians who certify death certificates to enter COVID-19 deaths into the system.

On Wednesday, following questions from Spotlight PA, the department released additional guidance that “clarified” this requirement, Wardle said. On the same day, the department reported that over 2,000 new users had begun using the technology over the last two weeks.

But if the Department of Health wants “fast, accurate reporting,” said VandePol, the coroner in Chester County, it shouldn’t rely on busy hospital staff.

“These are physicians on the front lines, in ICUs,” VandePol said. “To me, it’s a public service” for the coroners to be involved.

Kiessling said he’s been checking in with coroners across the state every few days. And he said he is working with funeral homes, crematories, and the Pennsylvania Emergency Management Agency to plan for a possible surge.

At the moment, coroners have enough personal protective equipment, Kiessling said, because he stocked up a few years ago, when the Department of Health was emptying an old warehouse in Harrisburg.

“I took a trailer and an ambulance.… I stockpiled boxes and boxes,” Kiessling said. “Lo and behold, here we are today.”

If an area of Pennsylvania sees a spike in deaths, he’s ready to deploy the association’s four refrigerated trailers, which can each hold dozens of bodies.

Pamela Gay, who spent three decades as a registered nurse before becoming coroner in York County, said she’s been told she can’t count on receiving one of the trailers, so she’s been looking into temporary storage facilities on her own.

Though Gay’s jurisdiction isn’t seeing high numbers of COVID-19 deaths, York County has a population of nearly 450,000 and doesn’t have a morgue. Her staff shares space with a hospital in town. The joint morgue fits barely 10 bodies.

For years, long before the COVID-19 crisis hit, Gay was vocal about the morgue’s capacity issues. In a 2018 report, her office warned that it was their “most urgent need.” Concerns were reaching “critical levels.”

Finally, last summer, York County commissioners approved a plan. Gay and her staff could expect a new office in 2020, and following that, a new morgue — triple the size they were used to.

Contracts were signed. Construction began. Then the coronavirus hit.

With the statewide shutdown of non-“life-sustaining” businesses, construction on the York County coroner’s office has halted.

“It could really negatively affect our community in the next few weeks,” Gay said. “It’s just not a good situation.”

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