Coroner’s Work Still Raises Hackles Death Certificates, Rate Of Autopsies Raise Questions Despite Amend’s Low Profile

His office is tucked in the Spokane County Courthouse mailroom, behind a nondescript door that’s usually closed.

There’s no sign, nothing identifying this as the Spokane County coroner’s office, cloistered down a narrow hallway from the rest of his staff.

Like his quarters, Spokane County Coroner Dexter Amend seems to be keeping a low profile.

But his death certificates still raise questions.

An analysis of death records filed during the first 10 months of 1996 shows that Amend continues to diagnose people as dying of alcoholic liver problems without autopsies.

And he’s ordering autopsies on only about one in 10 suicides - far below the state rate of about six in 10.

Amend, who makes $49,630 a year, says nothing’s changed over the last year. “We’re doing the same thing we did all the time,” he said in a rare interview last week.

He said he follows standard protocol in calling for autopsies and uses other information such as medical records to draw conclusions, he said. He also weighs the advantage of an autopsy against its cost.

But some families still complain that Amend’s decisions have left them with questions about how their relatives died.

“I think it was handled outrageously incompetent,” said Annette Stoddard, whose mother, Carol Ruth, died last June. “I’d like to know why he would say this is unsuspicious. Why would he think a 48-year-old woman would die in her sleep?”

Ruth’s death certificate says she died of cardiopulmonary arrest - which basically means her heart stopped beating and her lungs stopped breathing - due to a history of heart trouble.

Ruth’s daughters say she had no history of heart trouble, although she did use prescription drugs. They asked for an autopsy. They wanted to know if the methadone she started taking for pain five days earlier contributed to her death. No autopsy was performed, no drug tests made.

Before Ruth’s body was turned over to the coroner, a doctor at Deer Park Health Center and Hospital wrote that she died “due to apparent accident overdose of pain cocktail reportedly containing methadone.”

There are other questionable certificates. A year ago, a 31-year-old man’s death was written off as an overdose of cocaine combined with a history of alcoholism.

There was no autopsy. No drug tests were done at the state toxicology lab, standard practice with overdoses. The death was ruled natural, as opposed to an accident.

Amend declined to talk about specific death certificates, saying it wasn’t fair because they weren’t in front of him. He also declined to track down the certificates. He said he usually uses the state lab for toxicology tests, but sometimes relies on hospital tests and records.

Accurate death certificates are important to take the pulse of a community’s health and for a family to know its risk factors. A single word on a death certificate can mean the difference between no life insurance money for a suicide and double the policy for an accident.

The Spokane County coroner is responsible for handling questionable deaths, young people’s deaths, and most murders, accidents and suicides. The coroner only reviews about one in 10 county deaths every year.

In 1999, a medical examiner will take over death investigations in the county, after voters in November overwhelmingly opted for a new system. But until then, Amend’s decisions stand.

“The real thing here is the integrity of the death certificate,” said Dr. George Lindholm, the forensic pathologist who performs most of the autopsies ordered by the coroner. “Do we really and truly have that? If they’re signed out on the basis of circumstances and appearance, they probably don’t contain the aspects of science.”

Last year, an analysis of Amend’s death certificates showed that he routinely ruled that people died of an “alcoholic fatty liver” - without performing an autopsy.

It was a diagnosis rarely used in the rest of the state, and almost never without an autopsy.

Amend made the diagnosis eight times in 1995, and a total of 24 times in his first term, from 1984 to 1986.

Experts said it’s a difficult diagnosis to make without an autopsy. Critics worried that Amend wrote off the deaths of people who drank regularly without proper investigation.

A new look at Amend’s performance last year shows he abandoned the alcoholic fatty liver.

He has a new favorite: end stage liver disease due to alcohol abuse. Amend said 12 people died of this disease in 1996. None of them had autopsies. Almost all were male laborers. Four were found downtown, in rundown apartment buildings. The county couldn’t find relatives for two of the men.

Before last year, a Spokane County coroner hadn’t made the diagnosis without an autopsy in 16 years. Statewide, it’s a rare call to make without an autopsy.

Relatives of the people diagnosed with alcoholic livers say their loved ones were drinkers. Some say they didn’t question the coroner’s findings and found Amend professional and courteous.

Moya Smails died last year at age 33. Despite county standards calling for autopsies on people under 40, no autopsy was performed on Smails. Her death certificate said alcoholic liver. Her mother said that was fine.

“Her whole body was damaged,” said LaVonne Mohundro, adding that Amend was understanding. “It was just plain alcohol that killed her.”

But several families said they weren’t sure how their relatives died.

Ray Ballard, who died at age 59, was a drinker. But he also worked as a laborer in the masonry industry, breathing brick dust all day.

Ballard suffered from severe emphysema and coughed all the time, relatives said. A year before he died, Ballard underwent surgery, losing part of his right lung. He caught pneumonia about the same time, said his girlfriend of 14 years.

“He never did feel the same,” Violet Assing said. “He never really got better.”

Ballard’s death certificate says he died of an alcoholic liver. His sister, Clarice Brooks, said she wanted an autopsy, but none was performed. She said she didn’t like what appeared on her brother’s certificate.

“I didn’t tell the kids that’s what it said,” Brooks said. “I told them emphysema.”

Amend said there’s no reason to perform autopsies on people with a medical history of alcohol abuse and bleeding in the gastrointestinal tract. He said his research pointed to a clear diagnosis.

“There’s no use going down that road,” Amend said. “If we’re going to do an autopsy, it just becomes unprofitable since it costs about $1,500 apiece.”

Amend said he’s particularly concerned about finding community health risks.

That doesn’t include suicide. In 1994, the year before Amend took office, autopsies were performed on 87 percent of suicides under the coroner’s jurisdiction. In 1995, that number dropped to 40 percent.

In the first 10 months of 1996, autopsies were performed on only 9 percent of suicides. The state average for autopsies on suicides has hovered around 60 percent for years.

“We don’t do autopsies on suicides,” Amend said. “It’s so grossly obvious, especially if there’s a note.”

Amend does grant autopsies on critical cases, said Spokane police Lt. Jerry Oien.

Indeed, his rate of autopsies increased to 53 percent of all the deaths under his jurisdiction in 1996. That’s still below the state average, but above his 1995 rate.

Police say they’ve had no problems with Amend refusing to do autopsies they believe are necessary.

But Amend’s refusal to autopsy suicides raises questions about accidental deaths, murders or even natural deaths being called suicides.

Lindholm said most suicides are nothing more than they appear to be. But he’d still like to look at them.

“I’m particularly concerned about gunshot suicides when they’re not autopsied,” Lindholm said. “It’s an open invitation for anybody who will care to shoot someone at close range. Just drop the gun and take off. That’s not a good message to be sending out.”

, DataTimes ILLUSTRATION: 2 Graphics: 1. Alcoholic liver deaths 2. What is suicide?