Overwhelmed: Hammered by heat wave, opioid and COVID deaths, B.C. coroners struggle to keep up

B.C.’s Coroner’s Service is adding staff, hoping to end backlog of report filing and trying to stay prevention focused

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There were no early warning signs that the week of June 25 to July 1 would end with the deaths of more than 800 British Columbians. The tally, four times the average number of fatalities, would overwhelm coroners already overburdened by the toxic drug crisis.

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Calls to the B.C. Coroners Service increased gradually during the first few days of province’s unprecedented heat dome, perhaps not fast enough to predict that “a massive loss of life” was impending. But a worrisome pattern began to emerge from what the coroners were seeing in the field.

“The coroners were saying, ‘This is heat-related. This is heat-related. This person is in a home where there is no ventilation, the windows are closed, temperature in the home is 40-plus,’” Chief Coroner Lisa Lapointe recalled this week.

Often the heat victims, nearly all senior citizens , were home alone. Sometimes out-of-town family members had phoned police to say they could not reach elderly loved ones.

“The police would be able to get in and find the person deceased, often times very peacefully sitting in a chair or sitting on a couch or lying on the bed, just the impacts of that severe heat,” Lapointe said.

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The calls quickly ramped up. By July 1, 445 people in B.C. had succumbed to intense heat, representing a large portion of the 569 heat-related deaths between June 25 and July 29, when temperatures hit as high as 48C in the Interior.

This heat wave came as the coroner was already dealing with the record number of overdose deaths, which have risen at an alarming pace since COVID-related restrictions led to a more toxic drug supply and caused many people to use drugs alone, with no one nearby to reverse an overdose.

From 2017 to 2019, there was an average of 900 deaths a month reported to the coroner. That increased in 2020, and has continued to steadily climb in 2021. From January to September this year, there was an average of 1,144 fatalities reported each month, according to the coroners service.

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In June, income assistance payments were issued on the 23rd, and that typically leads to a spike in overdoses for several days. Then the heat wave started on June 25. The combined overdose and heat emergencies contributed to the 815 deaths in the final week of the month — an incomprehensible figure when the average number of deaths between June 25 and July 1 in recent years has been less than 200.

“It was a very intense week. … Police were tapped out in terms of responding to calls, ambulances were delayed significantly responding to calls, we were delayed significantly responding ,” said Lapointe, who has been chief coroner for 10 years.

In many cases, people did wait a number of hours for loved ones to be transferred to a morgue, and we hate to do that to families because we realize that sudden loss of a family member is a devastating event. We just couldn’t respond as quickly as we would like given the number of people who died.

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“The implications of that massive, significant increase in deaths in that one week are still reverberating in our agency.”

Backlog delays death reports

Lapointe, who agreed to speak with Postmedia about the last two challenging years for her service, said one example of those reverberations was a delay in completing written reports for relatives on why and how their loved ones died.

“We feel very badly for families, because families often feel they need the coroner’s report for closure. And so those are delayed and that’s very unfortunate,” she said.

Not all deaths result in written reports, which are mainly completed for fatalities deemed to be unnatural, unexpected or unexplained.

In 2020, 5,674 deaths were investigated, an increase of more than 20 per cent over 2019, and four out of 10 of those (or 2,377) are still incomplete. While Lapointe acknowledges the wait is difficult for families, she said some cases are complex and can’t be closed quickly and that the agency was “on track” to get those cases finished.

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This year proved to be even more difficult, though, with 5,508 cases deemed to be in need of investigation in just the first nine months. Coroners have had to give priority to going to death scenes and gathering information, such as medical records, autopsy reports, toxicology reports, and police evidence. Therefore, completion of reports has been further delayed, Lapointe said.

B.C.’s other major health threat for the last two years, of course, was COVID-19, which has killed more than 2,000 British Columbians, but deaths due to a viral illness are not usually investigated by a coroner. Lapointe said her staff has concluded about 20 investigations related to COVID, when there may have been questions around diagnosis or treatment or whether something could have been done sooner.

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Lapointe plans to address her report-writing backlog by hiring new staff, who she hopes will help finish the outstanding documents by sometime next year. She intends to have a dozen more full-time coroners by the end of 2021, and has just hired 14 new part-time coroners.

“We recognize the information that we provide to families is critical, so it is difficult to not be able to do it as quickly as we’d like. But we are certainly focused on getting back to a much more timely conclusion of investigations,” she said.

The new hires are also important to boost morale among coroners, who have faced rising workloads and rising frustration over the escalating number of overdose calls, with no immediate end in sight, Lapointe said.

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“We are experiencing stress among the coroners, probably more than we’ve ever seen,” she said.

“It is extremely frustrating to continue to go year after year to the same situations of death and not see any meaningful change. That has been difficult because you feel a certain futility in doing the same thing over and over, and a bit of a sense of: ‘Why isn’t anybody paying attention? Why isn’t anybody listening?’ And there are changes, but they are certainly not happening fast enough.”

B.C. chief coroner Lisa Lapointe near her office in Victoria.
B.C. chief coroner Lisa Lapointe near her office in Victoria. Photo by Chad Hipolito /PNG

In 2016, B.C.’s provincial health officer declared the overdose crisis a public health emergency, and Lapointe had hoped that would bring about immediate change. In the years since, she has joined other voices persistently lobbying for easy access to a safe drug supply, decriminalization of possession of drugs, and better and broader treatment options.

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In July, B.C. promised to become the first province to provide a permanent access to safe drug supply , which is an important step, but the NDP government continues to be criticized for taking a long time and not going far enough.

Just a month later, in August, Lapointe announced that overdoses had now become the leading cause of death for young people age 19 to 39 in B.C.

On average in 2021, six British Columbians were fatally poisoned by toxic drugs every day, a preventable death toll that has reached every community and society in the province.

“Those who are using substances, they’re not bad people. They’re you and me, they’re our friends, our neighbours, our family members. And responding with support and treatment and trying to help people to wellness — as opposed to punishing and stigmatizing, which just has not worked — that shift is happening, but it’s agonizingly slow,” Lapointe said.

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“Six years into this public health emergency, it is frustrating. You can only wish that more had been done sooner, but hopefully things will change for the future.”

Stopping future heat deaths

Lapointe has committed to finding out before next summer everything she can about the victims of this summer’s heat wave, in an effort to prevent that many fatalities from happening again.

“We recognize that this was an unprecedented event in the province. And we want to learn as much as we can about the variables and the factors involved,” she said.

For each of the 569 deaths, coroners will determine factors such as their gender, age, and if they had medical conditions. They will look at whether the victims lived in a single-family house or multi-unit building, and if they had windows that opened or air conditioning. The investigations will examine whether they had phoned for emergency assistance, and if that help had arrived or was delayed.

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“The hope is that by the time all of the investigations are concluded, we’ll have a really good analysis of who is most at risk, and where we see an opportunity to prevent similar deaths in the future,” Lapointe said.

The plan is to have these investigations done in the next three months, and then to hold a death review panel in the spring, so a final report will be finished before next summer.

She did not want to predict what recommendations could be made in such a report, but said there has already been public discussions about the role of building designs, air conditioning, ventilation and tree cover in heat-dome deaths.

Next week, Lapointe said she will release some early findings about the basic demographics of the 569 heat dome victims. The coroners service has already released some preliminary data that showed 90 per cent of the victims were 60 years or older ; half of them lived in the Fraser Health Authority, with the next largest group coming from Vancouver Coastal Health; and that the most deadly days were June 29 (301 victims), June 28 (147), and June 30 (130).

Making recommendations to avoid similar deaths in the future provides optimism for coroners, who spend their days responding to scenes of trauma and tragedy, Lapointe said.

“We communicate every day with people who have experienced profound loss, but there is that ability to say, ‘What could have been done differently to prevent this death?’ And to make recommendations to people in positions of influence, ministries and agencies, to say, ‘If this changes, then future deaths could be prevented.’ And that is a very hopeful part of the work that we do.”

lculbert@postmedia.com

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